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Home My WebLink About651226 042-1090-60-107Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Mike & Jean Ingalls TOWN OF WARREN CST BM Elev: Insp. BM Elev: BM Description: 1 a a� I'" Pve_ TANK INFORMATION TYPE MANUFACTI,JRER CAPACITY Septic 3 Dosing Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Fri oss System Head TDH Ft Forcemai Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: 651226 St. Croix Sanitary Permit No: 651226 State Plan ID No: Parcel Tax No: 042-1090-60-107 Section/Town/Range/Map No: 32.29.18.498A-07 STATION BS HI FS ELEV. Benchmark `t 3 7 J�bf 3 �0 .� / Alt. BM Bldg. Sewer SUHt Inlet SUHt Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe Bot. System 0 9.5- 7- a 3 9�•�� 9e.99' Final Grade , St Cover /TRENCH Width Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS '? -�D SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: /J �OW'�— i✓`%� lifl > r�l UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe( y �ZD 1 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 xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: (�/22/'2o23 Inspection #2: Location: 667 100TH ST n� � 1 � �` � L � 1.) Alt BM Description = �{� ��u�nn�-^Q( W `CSC IC2 2cu Dl�-�( (Q'r (� 2.) Bldg sewer length = \a, amount of cover Plan revision Required? ❑ Yes X No Use other side for additional information. J Date Insepctor's Signature Cent. No. rn f� rr7�3 FF—::' n n n FF= F�\ �J. _.,2 tt„1 "%"'��`'•, Indnstty Services Division —w"- County 4822 Madison Yards way u ,- r� � J U N 2023 Mom, W153705 P.O. Box 7162 Sanitary Pemnit Number (to be filled in by Co.) Madison, W153707-7162 % �f t� Application Stiie Tmmwtkm Number In accordawe with SPS 39321(2), Wim Adm. Code, submission of this fomt to the appropriate governmental unit is required prior to obtaining a sanitary pennit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional ServKm Personal information Project Address (if differnnt that mailing address) you provide may be used for secondary Purposes m accordance with the Privacy Law, s_ 15.04(1xm� Stag L Application Information -Please Print All Information Property Owner's Name A ►ko 4 �« l� �C n�, U P - ' � Patrel # 09 - I CJq a -c' p j v Property Owner's Mailing Address 572 Fy Property Locatroa D 6� Govt. Lot City, States ZCode p Number Ti 7l S r V (Phonee V -W'4 N 0- h Section] _ Z T r N R E or W 11. Type of Scalding (check all that apply) Lot Ell or 2 Family Dwelling - Number ofBedtaoms IV N Subdivision Name ublic/Commercial - Describe Use CS m Vo s� D_-' I-7 Block ft ity of aliage of State Owned -Describe Use CSM Number(2 D _ S ` : A)C_ Den % lgb�7�3 J ownof �bIL%lt'Y� 11L Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on fine B. Complete One C if appficable.) Taw System "-tt System EPther Modification to Existing System (explain) DAdditiciriai Pretreatment Unit (explain) B ❑Holding Tank ht Grorutd �4t Grade ❑Mormd hnclMdual Site Design Other Type (explain) C. ❑ Renewal Before []Revision of Plumber Transfer to New Owner ist Previous Permit Number and Date Issued Expiration 12�: -IV. IRspersaUTreatment Area and Tank Information: 2) 3 x 7D re. =j3 t4 Qaztk Design Flow (gpd) o Design Soil Application Rate(gpd/sf) Dispersal Area Required (sf) Area Proposed (sf) System Bevatio 1 (o'i �o,114 97 0u wo oo Tank information Capacity in Gallons Total Gallons # of Units Manufacturer Metz n C PN! p o u o y NCW ram Existing ranks v fl s a �Sfpli:,._ Chamber 0 V. Responsibility Statement- k the madersignedanume r eWnsib7ih for hutafttion of the POWTS sbown on the attached platys. Plumber's Name (Print) s S MPlMPRS Number Business Phone Number M DU,N,4-A, Plumber's Address (Sheet, City, State, Zip Code) t a�; �� N VI. County/DepirtmeniUse Only Approved ❑ D pi proved Permits Fee Date issued Issuing Agent Sig<natt- n far Denial S J �i �r 2a/2p23 Conditions o Appro SYSTEM OWNER; QQ 1. Septic tank, effluent filter and dispersal cell must be serviced 1 maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per appficable code / ordinances. ,Utach to caapWe plans for the system and -aadt tf the Cody rely on papa not lea than 8 in x ll ine — is size SBD-6398 (R_ 03/21) nr_.,„., _ _ Pbt Plop me: -iN5 o I )-c - Lot 1, N �— us►�5 yS��d twK � dz�� Cc►iu�To J`Si to sags �y d SIA160 WttkS To W )t pill B* nnp�% Xul s-4(- fID4 MbMu Ojp CoVeR f5lw.16(.a� �D( >p c f�2 U-✓�-r � v� 651226 04 Nc�p Pk �p of 114 PVCV, pe a -"A►.,6s 0 3,00 �7 L�1D�"1otKr rh(,wTxoft A ) 004,)a- 51. - 651 651226 h S. mow, s t An�c`r� i/ LM Mmbar _A= _ o y ,a-, o o rW Pbm NBE3 PMW 4 z � T WamMty Deed n :a• -- j aae _ Z= m 7�.m 26 � ate. t MAP IVArrve. M, � a TepN LOCF ION �47 1 ba--' S K � Lot N�-- If 14s1�5 4"5jNyd r;f *j 6�N�1�maRk �p 4 114 pvc'�"� C c►iu��a Toy 1G with A►��l�,k �S �y 114, 4� d fix► "�j Ibbe �D��ON WttkS pill B*► S-4(- fID4MMr Ojf �J CoVeR f5lw.16(.af g� 651226 t��c-t�►PR5 aaa4o a -"A►.).s 3,00 `` LL li c-ho 'lot cr rh(,wTxoft A —, ) 004,)a- 51. - . {y?' / r.' t �'�}.' 'f'.•a.r,u.�", J r. .. .� .5' r, .• rgl •� . , r ,• , • t i iy r ,:ti,', I r r , � �', '1' r •'r.4 �y:. 1� '?r' � y ' ,rn (!r'(� IrV, d't•?% , •y ,• r f r • ' (I N''«r �J•1�%1i,'�'rr''// ''A!', y1 ''1 t .: t�, tt'•�j'r. •, ,t'r 'al�i4r,!••�1 rri4..C�r•:74i1;'i'',?I{i •4 ,•r II'!rr r,• r;, y rrr ., r •n •!f.. ri ♦' ,. 1:'.! 'I f ff"�.�,•.r. S, �,5'I r'rl .� 4�, qq.,�i�.r 1;Y.'rR�•r'l.�,d' ,"r •r,ll{.; ,'.• r4 .;�r 1t . „� .. ) u r q .rri I"5,J•�''• tr I, '". �,' ',a ' i, f •'ip{ If •Irr �y�• 'i Ml, r/' .,'rr ;S'ti. ,,r ,.1t r°jyr t.yr,JJ.,"rirSfrA,tij.y!�'1{',�'p'1�r�!,', ',1 �,', �'.�'•f'r. 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Of !,r �'�+ .'rr '.y�i.)iyt•':4;,1' ,. ,`.t.',', �, ,p..., r J:, J, ,'.71• ',5 ,'S .{,' ''i,. .•! t. �5. 1,, .r•�•: ..r. 1. r, •r 'r r,'. r, '�i •'` ri' rC'. : ':� ' 5r r., , . ''p' 'rl .i ,r •r ff 7.r. �i ,., (D N N LO (D h IA IA IA IA IA IA r 9 5 a0 Va 651226 P&3ofll 651226 IN -GROUND DOSED -GRAVITY DISPERSAL AREA Stepped Elevation Trenches with Quick4 Standard-W Chambers-' 3-ft Trench (down -sizing credit) min. 12" SOIL COVER (typical) TYPICAL TRENCH 12" CROSS SECTION VIEW min. trench depth (No Scale) (typical) f ' Highest Trench Provide minimum 3 ft 9 Lowest Trench (as applicable) separation between trenches, System Elevations = �}'% n ft 4 ft; ft; ft; ft Quick4 Standard-W w/ End Cap (Show location of Inlet / outlet pipe connection on plan view.) (typical) I-- — -------7jL--------f----- ----7f--------f---- ��_ B= (typical) ft INSTALL PER TRENCH: Qulck4 Std-W @ 24 ff EISA/chamber = =:YQ ft' + __.L_ Pairs of end caps @ 6 ft' EISA/pair =ft' Observation Pipe (types) Install per manufacturers / Instructions. TYPICAL TRENCH PLAN VIEW (No Scale) A = 3,0 ft (typical) `—Quick4 Standard-W Chamber (typical) (mfd by Infiltratoraysteme, Inc,) Install pursuant to manufacturers Instructions. = Proposed EISA per trench = .3 ! ft' Required infiltration Area = _ 3 ft' x _„_ trenches = Proposed Total EISA =00-Y ; ft' Distribution Method: branched manifold 651226 ST_ CR SMffARY SYSTEM Me OMERSHIPiADDRESS FORM �� Comte Development Department will utilize this information to provide the property owner with mformiaSon regarding operation and maintenance of your new or replacerner t sanitary system! This information will be proms as part of our ongoing efforts to protect pubic health, your well, groundwater, surface water. property values, and county resources. Once approved, this completed form and educational irrformatton wdl be sent to you by email. OWNIE�/BUYER INFORMAs10N IY) V,4TfAN g�liJ Mang LL7 I bb+ 5 Ij cm►Is p taLv�df Phone Nutter trecaricem GS 13S'.� CS8 7 Email Address Parcel nbficatuon Nub (intend an the wope�rty talc NO WEW SVSrEVA: LEGAL Properly t ocation, W V4 ,i�)W 'A , Sec T N R I W. Town of W bk4#0 Subdivision Plat C5 M'J y a a 7 lot �Lq Coed Surm7I MW # �a 2 : . Volume 2 0 . Page Wascs t need 5 140 3 (before 2006)Volume . Rage Numt)er of bedrooms 3 Spec house 0 yes 0 no Lot lines identifiable 0 yes O no oFMI us£ oMv New Property Address (verTkafim of rww adriress regt*W from Coo mi* Devekpmwa Deparonat for new cm shuc6m) MWkidwo This form mast be sAffmed with aft Private owe Water Treafrnent System fPownl Qppknoorm New S bxkxfe ad h dos farm a lac" warranty deed fwn the Regkow of Dm& rand o aW of the owt*d survey mrup if nefereruae Is roods IN due warfmW did Community DewelopnKst moment— land the D'nrhron 715-3864680 St Croix County Government Center 715-245-4250 FBK cddozod nrw 1101 Canrktkiel Road Hudson, Vfi 54016 State Bar of Wisconsin Form 3-2003 QUIT CLAIM DEED Document Number I Document Name THIS DEED, made between Michael E. Ingalls and Jean L. Ingalls, husband and wife ("Grantor," whether one or more), and *** ("Grantee," whether one or more). Grantor quit claims 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): Lot 4 of Certified Survey Map in Vol. 20, Page 5079, as Document No. 807923; being a part of Lot 1 of Certified Survey Map in Vol. 6, Page 1683; and also being a part of Lot 1 of Certified Survey Map in Vol. 8, Page 2217; located in part of the NW 1/4 of the NW 1/4 and part of the SW IA of the NW IA of Section 32, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin. 1051638 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 07/31/2017 11:04 AM EXEMPT#: 16 REC FEE: 30.00 PAGES: 1 Recording Area Name and Return Address Johnson Law Group, P.A. 6465 Wayzata Boulevard Suite 304 Minneapolis, MN 55426 042-1090-60-107 ***Michael E. Ingalls and Jean L. Ingalls as Trustees of the Trust Agreement of Parcel Identification Number (PIN) Michael E. Ingalls, an undivided one-half interest, and Jean L. Ingalls and Michael E. This homestead property. Ingalls as Trustees of the Trust Agreement of Jean L. Ingalls, an undivided one-half (is) (is not) interest MATHEW GRANT PASCHE Notary Public State of Wisconsin Dated �J v� _ `� , � 1 * (SEAL) !� (SEAL) 44dichael E. Ingalls (SEAL) (SEAL) * *J n L. Ingalls AUTHENTICATION Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: _Kevin C. Butzen, Johnson Law Group, P.A. [EAD] 1610 Maxwell Drive, Suite 200, Hudson, Wisconsin 54016 ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. COUNTY ) Personally came before me on 'Ali V�<_ i __ P\ i Zo t "Z the above -named Michael E. Ingalls and Jean LAngalls, husband and wife to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Notary Public, State of Wisconsin My Commission (is permanent) (expires: 5VZQt' (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. QUIT CLAIM DEED C 2003 STATE BAR OF WISCONSIN FORM NO.3-2003 • Type name below signatures. St. Croix County 1051638 Page 1 of 1 D /4 Wisconsin Department of Safety and Professional Services 1 JUL 11 2023 Division du Seewes =-= �) SOIL EVALUAtT1gNiWuQR,T In accordance with SPS n = v o me St. Croix At,,-- Nate site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 042-1090-60-107 Ref #2715 Please print all information. Re iewed by� Date II Personal information you provide may be used for seconds purposes Priva Law, s. 15.04 1 m . 7/20)N23 Property Owner Property Location ❑ Mike & Jean Ingalls Trust Govt. Lot SW Y. NW '/. S 32 T 29 N R 18 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 667 10011 St. 01 1 CSM Vol. 8, P . 2217 City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Roberts I WI 154023 I (651) 353-6587 1 1 Warren 651" Ave. "3-i�-7 6512?q Page 1 0 _ ❑ New Construction Use: ® Residential/Number of bedrooms 3 Code derived design flow rate 450 GPD ® Replacement ❑ Public or commercial — Describe: Parent material Glacial Outwash Kit 4+fr- Flood Plan elevation if applicable na ft. General co.- ments and recomm ndations: Site suitable for In -ground POWTS with 0.7 gpd/sq/ft. design loading rate. Recommended system infiltrative surface elevation to be stepped down hillside at 97.00' & 96.00'. e , F Boring # ❑ Boring ® Pit Ground surface elev. 101.89 ft. Depth to limiting factor >97 in. Snil Annliratinn Rafa Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ftz `Eff#1 'Eff#2 1 0-7 1Oyr3/3 none sl 2fgr dsh gs 2fm1c 0.6 1.0 2 7-17 10yr4/4 none sl 2fsbk mfr cs 2fm 0.6 1.0 3 17-25 7.5yr4/6 none gr Is Osg ml cs 1 of 0.7 1.6 4 25-63 1 Oyr4/6 none gr s Osg ml cs - 0.7 1.6 5 63-97 1 Oyr5/4 none gr s Osg ml 0.7 1.6 5g.6g 9.6$ 27 Boring # ❑ Boring ® Pit Ground surface elev. 99.42 ft. Depth to limiting factor >93 in. Cnil Annliratinn Raft Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ftz `Eff#1 'Eff#2' 1 0-8 10yr2/1 none sl 2fgr dsh cs 2vf,fm 0.6 1.0 2 8-18 10yr3/4 none sl 2fsbk mvfr cw 2vf,fm 0.6 1.0 3 18-29 7.5yr4/6 none girls Osg ml cw 2vf1fm 0.7 1.6 4 ! 29938 7.5yr4/6 none Is Osg ml cs 1 vf,f 0.7 1.6 5 38-93 1Oyr5/6 none s Osg ml - 0.7 1.6 j CST Name (Please Print) Slgna CST Number James K. Thompson //L6 yL 30021 Address Date gjaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola WI 54020-5413 June 6, 2023 715 248-7767 aoLd-vaov kRV / 1a1 r*� Boring # ❑ Boring ® Pit Ground surface elev. 101.55 ft. 651226 Depth to limiting factor >96 in. Soil Annliration Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 I 'Eff#2 1 -7 10y3/3 none sl 2fgr dsh cs 2vf,fm 0.6 1.0 2 7-16 10yr4/4 none sl 2%bk mvfr cw 2vf,fm 0.6 1.0 3 16-28 10yr4/4 none gr sl 2msbk mvfr cw 1vf,fm 0.6 1.0 4 28-34 7.5yr4/4 none gr sl 1 msbk mvfr cw 2vff1 m 0.4 0.6 5 34-40 7.5yr4/6 none gr Is Osg ml cs 2vf 0.7 1.6 6 40-96 10yr5/4 none s Osg ml - 0.7 1.6 ❑ Boring # ❑ Boring . ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Annlication Rate I Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 I 'Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Snil Annliration Rate Horiz.;r Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ft2 *Eff#1 *Eff#2 * Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 s 150 mg/L * Effluent #2 = BOD, > 30 5 220 mg/L and TSS > 30 5 150 mg/L 651226 . FXi;si'n —�--EXi-Sfi {-eneC�ire`notLvt"�%q,P� Scale. - - �rlr %fit er �7"?.c�,.-►.�a /1s �. �, j f I�ob�.'trSr [ti71. .S�OI.3 p LotO/, Csrrr►lel8/� , Swy�iJ/,.�yy, set 3�,?"29dy bzt F /D. BG.2QCIYS. Kcsrcr+nC f- v Cl�r n��/f U-C i►� !,J[r,�s Gant %� • � I er% = /D¢• 8t%' r 9�TT x 141 � /� rle It Grrw: Elect = /oG.t� ' ,yscvrrc� e led: bpi i I've' 317 "t tD Lot L�nc �. 3vo 651226 Wisconsin Depertrrlent of Safety and Professional Services Page 1 of 3 Division of Industry Services SOIL EVALUATION REPORT In accordance with SPS 385, Wis. Adm. Code minty Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, St Croix but not limited to: vertical and horizontal reference point (BM), direction and percent slope, Parcel I.D. scale or dimensions, north arrow, and location and distance to nearest road. 042-1090-60-107 Ref #2715 Please print all information. Reviewed by Date Personal information you provide niay be used for Pri Law, s. 15. 1 m . Property Owner Property Location ❑ Mike & Jean Ingalls Trust GovL Lot SW 1/4 NW '/. S 32 T 29 N R 18 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 667 100"' St 01 Na I CSM Vol. 8, P . 2217 city State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road Roberts I WI 154023 I (651) 353-6587 I 1 Warren 1 65- Ave. ❑ New Consfwiction Llse: ® Residential/ Numberof bedrooms 3 Cade derived design flow rate 450 GPD ® Replacement ❑ Public or commercial — Describe: Parent material Glacial Outwash Flood Plan elevation ff applicable rLa it General comments and Site suitable for In -ground POWTS with 0.7 gpd(sgffL design loading rate. Recommended system infiltrative surface elevation to be stepped down hillside at 97.00' & 96.00'. '❑ Boring # [IBoring ® Pit Ground surface elev. 101.89 ft. Depth to limiting factor >97 in. Cnil Annlir-firm Rata Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Stricture Gr. Sz. Sh. Consistence Boundary Roots GPD/Ftz 'E1fF#1 -EN#2 1 0-7 10yr3/3 none sl 2fgr dsh gs 2fm1c 0.6 1.0 2 7-17 10yr4/4 none sl 21sbk mfr cs 2fm 0.6 1.0 3 17-25 7.5yr4/6 none gr Is Osg ml cs 1vf 0.7 1.6 4 25.63 10yr4/6 none gr s Osg ml cs - 0.7 1.6 5 63-97 10yr5/4 none gr s Osg ml - - 0.7 1.6 2 ] Boring # ❑ Boring ® Pit Ground surface elev. 99.42 ft. Depth to limiting factor >93 in. Snil Annliratinn Rata Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Ftz •Eff#1 -Eff#2 1 0 8 10yr2/1 none sl 21gr dsh cs 2vf,fm 0.6 1.0 2 8-18 10yr3/4 none sl 2fsbk mvfr cw 2vf,fm 0.6 1.0 3 18-29 7.5yr4/6 none gr Is Osg ml cw 2vflfm 0.7 1.6 4 29-38 7.5yr4/6 none Is 0sg ml cs 1vf,f 0.7 1.6 5 38-93 10yr5/6 none s Osg ml - - 0.7 1.6 r - ttnlwmt all = ri( A) > :ill 5 'l'/n nVVI arum 1 titi > :in < 1541 Mnrl I 1--1iM w_rN WV = Fir )1) > :in < JJn Md/1 and 1 SS > All 5 1 •fn M(V L CST Name (Please Print) Signature CST Number James K Thompson 30021 Address Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola W1540205413 June 6 2023 715 248-7767 SBD-83M (R04/15) 651226 aBoring# O Boring ® Pit Ground surface elev. 101.55 ft. Depth to imu" fact" >>6 in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az. Cont Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/Fe 'Eft#1 •Eif#2 1 0-7 10y3/3 none sl 2fgr dsh cs 2vf,fm 0.6 1.0 2 7-16 10yr4/4 none sl 2fW* mvfr cw 2vf,fm 0.6 1.0 3 16-28 10yr4/4 none gr sl 2msbk mvfr cw 1 vffm 0.6 1.0 4 28-34 7.5yr4/4 none gr sl 1 msbk mvfr cw 2vff1 m 0.4 0.6 5 34-40 7.5yr4/6 none gr is 059 ml cs 2vf 0.7 1.6 6 40-96 10yr5/4 none s dsg ml - - 0.7 1.6 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. f . Depth to smiting factor in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Az Cont. Color Texture Stnrchue Gr. Sz. Sh. Consistence Boundary Roots GPD/Fe 'Eff#1 •Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to imitnrg factor in. I CZ-d e.,.,1�.fi— a�ro I Horizon Depth In. Dominant Color Munsei Redox Description Qu. Az. Cont. Color Texture Stricture Gr. Sz. Sh. Consistence Boundary Roots GPD/Ftz 'Efl#1 'Eft#2 ' Effluent #1 = BOD, > 30 5 220 mg/L and TSS > 30 5150 mg/L ' Effluent #2 = SOD, > 30 5 220 mg/L and TSS > 30 5150 mg/L do -be 5t/-e ,tt SOr%QtIGIIJtst�iOn�J�� --�—EX.-�tivaf cneC�itt�nor✓LvtC%h.e� Scat / "-s/� " we �l oeobl,-ts, 5VaAS 0 Soto % � p Sc�J%�il�!'yS.ee 32, 729d� cvo'.� Scp c 6-.K err, /yo J r .a a 377'rb) Saa.L-L, Lot L%ne- m 651226 of 5;d rtiG 4. COY ntroU�, ildu*� /�1u.. Ae lr Grp: C3e,x �rYfu rK 7W- s 0' 3of3 651226 8Q77923 VOL 20 PAGE 5079 KATHLEM H. WWESW— REGISTER OF DEEDS ST. CROIX CO. MI RECEIVED FOR kECORD 09/29/2005 11:40AM CERTIFIED SURVEY MAP RFC FFF 1 `1 - COPY FEE: 3.00 CERTIFIED SURVEY MAP PAGES: 2 Richard J. and Karen L. Meyer Located in part of the Northwest '/4 of the Northwest %4 and part of the Southwest %44 ofthe Northwest %44 of Section 32, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin, being apart of Lot 1 of that Certified Survey Map recorded in Volume 6, Page 1683, and including Lot I of that Certified Survey Map recorded in Volume 8, Page 2217 of St. Croix County 10 Certified Survey Maps. NOR7HWESTCORNER w SECTION 32, T 29 N, R 18 W (FOUND COUNTY BERNTSEN ALUMINUM MONUMENT) '9 S N _ GENTERLINE EAST BOUND AN4' LE I.S.H. - _ - _ . _ _ _ _ 3 ---'—'-- - rq w w 2-------- --- ---_ i INTERSTATE HIGHWAY "94" h S (R= N 8T25'05' E, N 8T 13'03' E. 558. 15') 2 w� �. N 87°24'37" E 557.26' —x x NORTH LINE LOT 1, V. 6, P. 1683 O W v� 80, g 3 ,Z v v SETBACK LNE ti loa o N,11 100, LOT 3 N (R=NORTH) N 00°03'38" W Z o z Z CONTAINS 115,562 SO. FT +N LOT 1 1 $ CERTIFIED SURVEY MAP & 80' - _ 45.42' e 50.00' a�° 51'5T E OR 2.653 A C. VOLUME 6 PAGE 1683 _ -'f N 88°54'20' E 5 �8'S1' - 8 431.3 NE coR. e LOT 1, V. 195.42' P. 2217 � lV i33' 334 100' � / ~ I n BARN 4' o A N Ilit, li JJ 2 rn�DWELUNG06 P�01 ti� LQ 00, I C„i c� 0 0 SCALE IN FEET 1 ' = 150' LLI o z / �c�� P Q v �.; 50 0 50 100 150 �• m o15j /�N i BEARINGS ARE REFERENCED o TO THE WEST LJNE OF THE W �; N I yJ SEPTIC �� p`0 ��. o NOR7HWEST 114 OF SECTION 32, ►�; 'cr' oo I . \S•(\lp VENTS • ' G' T 29 N, R 18 W, ASSUMED AS LOT 1 I LOT 2 w; I �z; / CERTIFIED LU SURVEYMAPI I / LOT 4 VOLUME.8, - PAGE_2217 �cl ,00 '-. I CONTAINS 473,141 SO- FT. OR 10.862 AC. pI /i (426,611 EXCLUDING OWNER'S ADDRESS I I TOIMV ROADRRIGNT OF 667 100TH STREET I � ROBERTS, WI 54023 I IL` CK LL{NE S ff j oo TOP IRON PIPE EL. - 984.19' E _33.3A, - W . B.M $ W TOP IRON PIPE g1'38" 8 _ --- ` 33' 331 EL. = 989.90' ��S l SOU7Ff LINE LOT', l-VeN12264 2 _ J 65TH s a�°a�'3a^ V1 12.07--wi LOT 2 I! LOT 1 _ _ CERTIFIED SURVEY_MAP f 6 6' \SGo1vS�� . �•' V )LUME 1.1, PAGE , I - 'I� I DATED; •"... •LAURF_ APRIL 28, 2005 • LEGEND I NPLA TTEQ w�� I M u P p e * INDICATES I' O.D. x 18' IRON PIPE SET (MIN. WT. - 1.13 LBIL.F.) ;� (NEST 114 CORNER 1 71 LA__N_Q$ _ P e � • SEC77ON 32, T 29 N. R 18 W e��oENviL_LE,° O V". INDICATES 1' IRON PIPE FOUND g o g (FOUND COUNTY BERNTSEN O ._ 1 A ALUMINUM MONUMENT) SOIL BORINGS (PROPOSED SEPTIC SYSTEM) � � ems`" 0 Rib •�.�Nn �yJ SECTION CORNER MONUMENT (AS NOTED) —"— THIS INSTRUMENT DRAFTED BY JERALD L. LARSON INOICATESFENCElJNE SHEET 1 OF 2 Vol 20 Page 5079 651226 ST - CROIX COUNTY ZONING OPFI CS CFRTIP1CATION STATEMRNT FOR UTTLIgATIQ,- OF AN EXISTING - SBPTIC TANK This is to certify the �it.l� �tca that I have in the septic tank present( 1 residence located at: s� T 9 _N, . � —W, Town of � JV -County, Wisconsin- �b X 1a N �II �IISPecti0i3, I certify a St _ baffles to be in goad edit -on, and it Y that 1 base found the tar Last time serviced 1 •a appears to be functioning prop line -Did flow back occur from absorption system? yes - Approximate 70 (if no, ski .Cap$i. je ox length of time P II ________ gallons `_mi-nutes o�truct3- Prefaii Concrete Manufacturer (if known) : Steel -Other Age Of TaIIk Elf know.,,) ESi } Lk -?n (Name}• Please Print (Title) J� y {License Nu�� -. (Dat,W} Form to be Meted by 11,sred I li�8ed disposer (NR P r (s- i45-a6, WiscoSne1j% Statutes) Ii3 t3�nsin Administrative code) Plumber Ea IPPlYi-ngg for sanitary permit) Certification IZ accepting the above statement certify that the t fie -"ding exist' s requirements of ink, to !; i -best of my k�owl g septic tang condition outlet �R 83, Wis' Adm_ Code �exce t f 9 will form to t baffle)- P inspection op ening O Name p L1 YVry Signature Lring and ly- or .11 ST C96 fK COUNTY NOG 651226 �51 ZZ f STATE SANIT.-RY PERMIT ICoo ST 1'i.�NSF�it/RENrl"_ J`vvAL PREVIOUS NO. jif9b% OWNER (ntUthEL t a6-AAJ 2'PGAUS PLUMBER el' 6ottw,6e 22296q_ TOWN OF W MLA EN SEC 3Z IT _ , " WATi AND/OR , BLOCK. Csm ( 20 - 571) W 8D-41 /U E 3Z 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. Zh�c. -;.AUTHORIZED DATI THIS PERMIT EXPIRES bAlc SBD-06499 (R11/20) '7lZ to) W 23