Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
Home
My WebLink
About
651297 030-1048-70-140
Wisconsin 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 Khu & Bao Vang TOWN OF SAINT JOSEPH CST BM Elev: do.c� Insp. BM Elev' IS6.0 BM Description: scsrew� 9114141A TANK INFORMATION TYPE M NUFACTURER CAPACITY Septic V' 2 S-D Dosing — Aeration - Holding -- TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 5-0 > r / 21 Dosing Aept n Ho g PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Frictio s System Head TDH Ft Forcemain ength Dia. SOIL ABSORPTION SYSTEM ELEVATION DATA ' County: St. Croix Sanitary Permit No: 651297 State Plan ID No: Parcel Tax No: 030-1048-70-140 Section/Town/Range/Map No: 22.30.19.184B-40 STATION BS HI FS ELEV. Benchmark 3.0 I>J3•o 1 .0 Alt. BM Bldg. Sewer !D SUHt Inlet r St/Ht Outlet 6�0 ��-DOf Dt Inlet / Dt Bottom Header/Man. %.rz 93.g8 Dist. Pipe Bot. System S (o.3�_ Final Grade nn St Cover TRENCH Width Length No. Of enches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 I r q 1 D SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactimb INFORMATION CHAMBER ORType Of System: / N �� r S r �„ UNIT`Model Nur: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x acing Vent to Air Intake Length 10 Dia Pip s) Length is pacing 410 / w I V SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems 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.) Location: 615 150TH AVE 1.) Alt BM Description = / 2.) Bldg sewer length = 2$ rr amount of cover Plan revision Required? ❑ Yes X No Use other side for additional information. Inspection #1: s7141202r f Inspection #2: SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Industry Services Division 1 4R22 Madisrrst Yards Way L_ ' Madison, W l 53705 Saszitay Pwr nd Number (to be filled in by Co.) IPA (� P.U. lox 7162-- _,. Madison, W1 537077162 65`1 ZO l 3L Sanitary Permit Application state Transataion leer In acoordancc with 5PS 383.21(2k Wis. Adz- Code, submission of this form to the apprrcpnate gvvCmimental unit is required prior to obtsaring a sasritary perssit Note: Application forts for stale -owned POWTS are submitted to P.ojeet Address (if differoni that mailing edidress) the; Department of Safety and Ptnfesalonal Sety es_ Personal inrrxsrtalm you provide may be used for secondary purposes m accordance with tic Privacy Law, a- 15.04(11(rn), Suss. I. Applikad" Information - Pleats 1P'rirt All Information �_ } Property Ownces Name - - - -._ Parcel # Property Owner's Mailing Address - -- - Property Location City, State Tap Code Priors Number AI _r7 _ 111. Type of Building check all that apply) Lot # T -'Jr'N R t; 01 or 2 Family Dwelling - Number ofBedroorm Subdivisiiena Name lirJCammemial - Describe Use ity of Owned - Describe Use CSM Numberr ; f' / 77 illw of lorwn of Ill. Type of POWT S Pennit: (Check either "New" or "Rehr" and other applicable an line A. Check one box on fine IL Compkte Use C If AVPHMOLf� A. 2T=k stem, D� Sys*-�tkFrer ModificationtoExisting system (explain) dditgasal Psrareat,stertt unit (captain) B. hr-Cxotmd at—C a Mound Individual Sitc r 'type (explain) f ❑ Renewal Before PRevision of Plumber DTrartsfer in New List Previous Permit Number and Date Issued Fj*rstian FV. Dkpewr=Vrreadwcat Area and Tank Information. 2 3 x 9D %refs 'frF �S?u�ck Design Flow (gsd) Design Snit Appikation R=(gpdrsf) Ds l Area Rogoircd (st} Dispersal Area Propaaed (si) System Elevation Capacity in ToW tl of Maaufactury I� u Tank lnfamnatJcxl NenrTaint: Gal E�agT� rts Gallons Units pd .� U u v ., u rl it r, �_ -� �_ ,_I���tJa�■L V. 5tatemust- L, the tined, --+taste ra4ats>tna of the POWT'S shown as the attached pbmx. Ptmnbcx)t Now (Fmpt), Phrmbcr's SignatuxF` _ 1wIIPAlm Nurnber Business Phone Number Mdmber-s (Street, City stale, Zip Cade) r` _ r -� ) l- `✓� VI. County[Deptsrtinent Use Only C4 Approved t5appm Permit Fee Date Issued Issuing ASW Siou tare cr Ci n forl7en S �� z1S�2o2 3 Conditions of A rova 3, SYSTEM OWNER: `U n 1. Septic tank, effluent filter and dispersal cell q) Q,v`Ste-, 1, must be serviced I maintained as per S. ` l Je4� J,7Uu't� �Z,2- management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code / ordinances. Attack to complete plain for Ike slits and srbmlt to the County nary on paper not Irm tbas a to s t 1 ischn is rise SBD-6398 (R. 03/21) �j X---� 47 -�: �►?� N % COPY M/v-:, 0 � Al I 6lw 5.� 9 t2 p � i j ; ' R A 16 Mel A00108 On M U Alai YM PA E r Towalaip: $��MMoion t�iorrw: ' pupa 1 In00o sm "s P"02 flat pho 3 Pop4 pop 6pope a rt..�w.r..rMew ~irmrp""�r�.• Pap? 8t CnsAt CM[c 4A.. , Form Paps $ r.r�.rrwrr gft Dodd .�r.w..��. Pope COAorPit Aftdwwiu Sd TMl & glom Phis Dow QM�M/�uwuMtMM�M6�Myallwq�Me�Ci1��1nMrM11w1iAtPq�1:11�w��=0i�10�p p1+01A1y. Pop 1 SdIA& 40 Rid Pvcvwtpfpo WMI& vat cap f t um"V Chmiber i;;6CEkwatlon ft ft A-00 AbsornKnw93m%RJ!k--n I Vj2iomw 10\1 4* Obt Header Manufbchuw And %xkg aSA Raft Li . sq ft Per ctookbor Sol ApMkaffon Rato gpd Design Flow+ gWs4 ft Sol Appaco&m Rob aEISA 2 rown of dwnbom each. Page > -_-I_ of In: r .,Zabel` :'r•m Al>rwn.c.•. APotrlok lnC IIL-525 Effluent filter 1'l.• 517 l iItel The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class, it has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122- the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. I eaturi;: • Rated for 10,000 GPD (gallons per clay). • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" 5CHD 40 pipe. • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. PL-525 Instal l,ation, Ideal for residential and commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. C insert the PL-525 filter into its housing. 5. Replace and secure the =tic tank cover. ... 1"-- ,Ir-w, -i The PL-525 Effluent Filters wilToperate efficiently for several years under normal conditions before requinng cleating. it is recommended that the filter be cleaned every time the tank is pumped, or at least every three years, if the installed fitter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should the done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. �-3J�b�ttali!!illlg3lli1�111� 1w�• 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank, not into filter housing. 6. Insert the filter cartridge back into the housing making sum the filter is property aligned and completely uverted. 7. replace and secure septic tank cover. 1/116 " Filtration Slnt�, Alarm switch 10AW GPI] tfipriona,i . ip- Accepts 4" do 6" SCHD 40 pipe F.....___ _ -C!=- Accepts 1" PVC tension 1landle Rated for 10,000 GPID 525 Linear Ft. of 1/16" Filtration slt,ts Certifried to NSFIANS! Standard eLG Gss 17ef1ector Automatic Shutd]f[ 6a11 Polylok, Zabel & Best filters accept Easily installs the SmartFdwr® switch and alarm. into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765,9565 Fax 203.284.8514 www.lxilylok.com POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page Zlf FILE INFORMATION Owner - Permit A DESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units O NA Estimated flow (averages al/day Design flow tpeaks, (Estimated x 1.5) ailda Soil Application Rate elide /ft" Standard Influent/Effluent Quality Monthly average' Fats, Oil & Grease (FOG) 530 mg1L Biochemical Oxygen Demand (600s) 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BODs) 530 mg1L Total Suspended Solids (TSS) S30 mg1L O NA Fecal Coliform Igeometric mean) 5104 cfu/100ml Maximum Effluent Particle Size Yg in dia. ❑ NA Other: ❑ NA 'Values typical for dornestic wastewater and septic tank effluent. u A uiYcu A sinc cf'Ur_MJ 1IC SYSTEM SPECIFICATIONS Septic Tank Capacity al ❑ NA Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer ? ❑ NA Effluent filter Model � ❑ NA Pump Tank Capacity I J6 NA Pump Tank Manufacturer r&NA Pump Manufacturer NA Pump Model J9 NA Pretreatment Unit ❑ Sand/'Gravel Filter ❑ Mechanical Aeration ❑ Disinfecbon ❑ Peat Filter ❑ Wetland ❑ Other. JM NA Dispersal Cell(s) Ig In -Ground !gravity) ❑ At -Grade ❑ Drip -Line ❑ NA ❑ In -Ground (pressurized) ❑ Mound ❑ Other: Other: ❑ NA Other: ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an indivklual carrying 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 hack 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 ctxapter 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 512 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. GMW (4101j Page of START UP AND OPERATION For HOW L;OTI%truciron. prior to use of the POWTS check treatment tank(sl for the presence of painting 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 lank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Duting power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls) in one large dose, overloading the cellis) 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. Do 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; ail: painting products; pesticides; sanitary napkins; tampons;. and water softener brine.. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shalt be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: 0 All piping to tanks and pits shall he disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another insert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures 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 pioposed structure, lot lines and wells, Failure to protect the replacement area will result in ilia 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 duo to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to rr:place ilia failed POWTS. Cl The site has riot been evaluated to identify a suitable r -l.lawarment area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may he reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. c < WARNING > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER 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 --Name:.._ Phone W., POWTS MAINTAINER Name Phony. SEPTAGE SERVICING OPERATOR IPUMPER) LOCAL REGULATORY AUTHORITY Name Nance Phone Phone this dorument was drafted in compliance with chapter Comm 83.221211bll I Ifdl&fil and 83.540). (2) & (31. Wisconsin Administrative C;odr �V.urua,y Department of Safetv County' _. .-1.N- )0 l 1 1 r � M & Pt-ofessional Smices, Sanitary Pamut Number (to be d}]Itd is by Co- 1 I ii d nstty Sell -!'ices Division q bn2 17 rawie..A,4 state Transaction Number 1 .. _.._ TCI"l-nit application In accordance with SPS 383.21(2), Wis. Adm. Code, sul ., of this form to the appropriate gov'emmental unit Project Address (if different than mailing addreyr) is required prior to obtaining a sanitary permitVote: Ap! ,-1n forms for state-ewrmd POWTS are submitted to the DcP ••., f Safety and Professional Services. Personal information you provide may be used for secondary l+lirp s s „ ,lance, with the Prtt cv L.n,w•, s 15.04(I)(m), Stals. / I. altlrlictiitw IiiiLo nY tit ,n I lurse Pt int All Information Parccl N I'loperty ij wnta s Same r P'ropeny Cywtier's Mailing Address K Property I.-ocati m fir.: _, •' Govt. Lot ' Cav, stale Zip codc I Phone Number Sc lion T N �� l- t+ Rr 11, Type of Building (check all thin apply) Lot r. sum. iston Ironic r--• t" 1 or Family Dwelling - Numl±crofBedrnotxis— J ,f t Chock A ❑ Public,'Conmtcrclal - Dcscribc Use _ _ _ _ v-~ ❑ City of ❑ State 0wnc41 - DtCCribetISe _—._—__� ❑ �'illagrr+t — CStii tiumhcr g -( t{ l TIT. "Type of PUNTS Permit: (Check either `°?tics'" or "Replacement" and other :ipplicablc on line A. Check one box on line B. Complete Line C if a licablC. A. New System ❑ Rrplaccmrnt S}'stem i! Other Modification to Existing v i3in'Y g- S,-:t:!n,_..h, ❑ Additional PrcUeatmrn: L`nit (cxplain) R. ❑ Ifolding Tank In -Ground ❑ rat-Oradr ❑ q{oun.l � Individual Sitc Design i ❑ [7thcrTy r C cx la;n1 P P 1conventic 11) C . ❑ Renewal Before D, Revision ❑ C'hangc of Plunll+cr Ttansfcr to New Owner _ List Previous PerTivi Number and Daic Issued Expiration IV. DispersallTreatment Area and Tank Information: K0 — Lti Design Flow (gpd) Ocsign Snil Application itaic(r_T 1.111} Dispersal Area Acquired (so Dispersal Area I' vrposcd 1sf) System l:!evauoa y�o� 9 1 -m Capacity m rotal N of M.Inufacture�rr _� Tank Information Gallnns Gat!ons Ltuis Ncu Ian[Cs I:z istn:g Lnak< .U. = r ... ;1 sn a rn w G r; 1 or lio;Jmg Tsntr r' - - ,% 1'. Itt lnntsihiiily 4r.ttrnsrlti 1. rite ur 1 , 1 ,t,r+i, tisume resJpnasibility for Installation of theyo A"fS sliown on the attached plans. TIIII swhatutc f M MPRS tiumhcr i3us�:ntss i hone \umlcr ; Cs Address (Street C y, Zip Code) -71 VI. county'/l}epartment use Only Permit i=cc Dote Issurcl Issusng plecru Sigr;ahrrr Appmvcd C143 sa)1t5Tsveri S 0 J f I - �s`�n � ��r �j �1Gs'Z� EI u•trcr fox -�'f C�..,C�•fa �.y. €.'onditiansni�i�pprnv,�'�Geesons°ferDrsttrrpTTra•al �� D �'.� 2 �,L�f.�`-�:C,.�s;F,cr1 SYSTEM OWNER: 1. Septic tank, effluent fitter and dispersal cell must be serviced I maintained as per management plan provided by plumber. 2. Alf setback requirements must be maintained as per applicable code I ordinances Attach to complete plan; for the system and submit to itic t,ounry onry an paper not ,css man n ua a t s sms...a OD-6395 (R. 03i22) File #: 5-r: C RO G)I 1N-I SANITARY SYSTEM Office Use Only _. OWNERSHIP/ADDRESS FORM c-atwv2a2y Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. OWNER/BUYER INFORMATION Owner/Buyer Khu 8t Bao Wang Mailing Address 6185 54th Street City/State/Zip Oakdale, MN 55128 Phone Number (required)6551-402`3946 Email Address (required) Parcel Identification Number 030-1048-70-140 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location NW ,/. NW 1/a, Sec. 22 , T 30 N R 19 W, Town of Saint Joseph Subdivision Plat: -- Lot # Certified Survey Map # 1 g __, Volume ' Page #�C� Warranty Deed # 1E)�'�112 _(before 2006)Volume _ Page # . Number of bedrooms Spec house D yes Q no Lot lines identifiable Ryes 0 no OFFICE USE ONLY New Property Address _ � I � is � /� am J�g CSC S 1 (Verification of new address required from Community vep elopment Department for new constru(non ) C 2d Staff Initials) (Date) This farm must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is mode in the warranty deed. Community Development Department - land Use Division 715-386-4680 St. Croix County Government Center 71S-245-4250 Fax 1101 Carmichael Road, Hudson. Wl 54016 _ DOCUMENT NO- S"l ATL BAR OF WISCONSIN FORM 1-2003 8 5 1 1 5 1 6 Tx:4432872 WARRANTY DEED 1064176 THIS DEED, made between Thomas M. Schottler, a married person ISETH PABST ("Grantor" whether one or more) conveys and warrants to Khu Vang and Boo REGISTER of DEEDS Vang, husband and wife as survivorship marital property ("Grantee", whether sr. CROI]( Co., wI one or more), the following described real estate in ST CROIX County, State of 04/27/2018 02.10 PM Wisconsin: ExEktPT#: Lot 4 of Certifled Survey Map filed March 29, 2018 in Vol. 28 of C.S.M, pg. REC FEE 30.00 6473, as Doc. No. 1062808 located in the NW'/. of the IOW'/, of Section 22, TRANS FEE 154.50 Township 30 North, Range 19 West, Town of St, 3oseph, St. Croix County, PAGES: 1 Wisconsin; being part of Lot 2 of C.S.M. filed in Vol. 27 of C.S.M., pg. 6173, as Doc. No. 1022944, RETURN TO St. Croix County Abstract & Title Co. Inc. 575 N. Knowles Avenue, Suite B New Richmond, WI 54017 Tax Parcel Nn: 030-1048.70-1.0, This is NOT homestead property Exception to warranties: easements, restrictions and covenants of record; highway and street tights of way; and Municipal and zoning ordinances and agreements entered under them; and further except real estate taxes accruing in the year of this conveyance. Dated this rite day of April, 2018. Thomas M. Schottler AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of _ STATE OF WISCONSIN 20____ ss. COUNTY OF �-E-C�ir�j'}�OL TITLE MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) THIS [NSTRUMENT WAS DKAF fED BY Robert L. Lober / Loberg Law Office LLP 18354041 asc (Signatures may be authenticated or acknowledged. Both are riot necessary.) 'tames ofpe+ ns sr=nwj in anycapaciiy tMuld be Typed orprrAled bei)w Ctuir s18nsMm WARRANTY DEED Personally came before me this Xe day of April, 2018, the above named Thomas M. Schottler, a married person, to me known to be the person(s) who executed the foregoing instrument and acknow edge the same. Notary Public County, Wis. My Commission is permanent. If not, state expiration date: _ .. l,A N S q 0 (AR1• n p u g\,.�� c' St Croy County 1064176 Page 1 of 1 Wis. Dept. of Safety and Professional Services SOIL EVALUATION REPORT � Page e of DMsion of Safety and Buildings � �! _ in accordance with 5P5 3$5, Wis. Adm. code County �" 1 Attach complete site plan on paper not less than 8 112 x i 1 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for seonndary purposes (Privacy Law, S. 15.04 (1) (m))• `2(%2b2 Property Owner Property Location Govt. Lot 11d 114 5 l T j N R L,' E (or�llY Property Owners Mailing Address U/ Lot # Block # Subd. Name or .Cal ZZ "r 7 17,5 city State Zip Code Phone Number ❑ City ❑village ❑Town Nearest Roayd- n New Construction Use: d Residential I Number of bedrooms _ Code derived design flow rate !,_ L ( GPD ❑ Replacement Cl Public or commercial - Describe; 0 nn w a < 4- Parent material �� �s, ,4 �e K Dy�C2 � r a Flood Plain elevation if applicable ff. General ccimments / �� , C and reco • rrendations: _ � ��'a..rr� s .a, i . tic X. 1-1 t cnng Boring Fi � r [] Pit Ground surface elev. ft Depth to limiting factor in :Soil Annliratinn Rate Horizon Depth in- Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPDM r ff#1 ff#2 r Pit Ground surface elev. ftDepth to limiting factor : ;' n .^,nil Annliratinn Rate Horizon Depth in. Dominant Cola Munsell Redox Description Qu. Sz. Cant Color Texture Structure Gr. Sz, Sh. onsistence oundary Roots GPD/ft ff#1 ff#2 I",L. y' I, Iif 1 Scit r r' fi " Effluent #1 = BOO a 30 c 220 mg1L and TSS >30 c 150 mglL ` Effluent 42 = B©D < < 30 mg/L and TSS c 30 mgfL CST Na^mel,(Piease Print) Signature f CST Number a Address I Tate Cvalualfion Conducted Telephone Number MIESEInnovation, Quality and Service Si see 1965 R can F cRETE wieserconcrete.com Maiden Rock, WI (800) 325-8456 Portage, WI (800) 362-7220 Fond du Lac, WI (800) 641-5937 Spooner, WI (800) 336-3416 Property Owner ; h y: Parcel ID # `J y � ' _ if Baring Boring # EL. � Pit Ground surface elev. 1 �i���J _ ft. Depth to limiting factor_ ' /� in. Page —1. L of 5nil Annhnn inn Rala Horizon Depth in. Dominant Color Munsell Redox Description Qu, Sz. Cont. Color Texture Structure Gr. Sz. Sh. sistence Boundary Roots ' GPDIft ' "I ff#2 i j r �^ �10 1©$ �/gG Boring # Boring 1-1 p;; Ground surface elev. fr_ Depth to limiting factor in. Soil AaDlication Rate Horizon Depth in. Dominant Colof Munsell Redox Description Qu. Sz. Cont- Color Texture Structure Gr. Sz. Sh. 'onsistence Boundary Roots GPDIft ' ff#1 ' ff#2 Baring Boring # Ground surface elev. ft. Depth to limiting factor in. pit Soil Annlication Rate Horizon Depth in, Dominant Color Munsell Redox Description Qu. Sz, Cont. Color Texture Structure Gr. Sz. Sh. Consistence Roundary Roots GPDlft ' ff#1 tff#2 Effluent #1 = BDD , > 30 a 220 mg1L and TSS >30 a 150 mgfL ' Effluent #2 = BOD , a 30 mg1L and TSS c 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Delay. 4Wl.-l',- ,e.riniy 1062808 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 03/29/2018 10:33 AM CERTIFIED SURVEY MAP CERTIFIED SURVEY MAP VOLUME: 28 Located in the NW 1/4 of the NW 1/4 of Section 22, T30N, PAGE: 6473 R19W, Town of St. Joseph, St. Croix County, Wisconsin. REC FEE: 30.00 PAGES: 3 NW Corner Unptatted Land Section 22 N 1J4 Corner, Section 22 T30N, R19W (R-fast 2623L98') 1 (Aluminum Cap) 15M AN@nli e S 89.49'44' E 2623.92' 7:30N, R19W _ _ _ - -1 - (1 3/4" o.d. Iron Pipe) S 89"49'44" E 696.44' I.N I - %�, 292-84' 403_60' I - 1 �► , , 293.58' _ 265.94' 403.60' 137.68 : 1774.08' rot / t 153.40' S 89'49 44' E c .Y 697.18' ® o Lot 3 $ Lot 4 $2 North Line uJ i I o ,^„ ®si the NIV 114 (At Rood 3.541 Acres .n 3.308 Acres I^I I I M:9 Nigh Point) 154.222 S.F. c 144.086 S.F. ® r got Ind. Road RNV 5 Ind Road RNV at .4 Unpfatted Land - J t yI �3.002 Acres 3 002 Acres ~' I 6411 g ® ®gi Excl7Road R/W 93 S.F~ 130.767 S.F. Excl. Road R/W 'n OWNER 8 446.24' 1 33.01' 413.23' 403.60' SUBDIVIDER o. Tom Schottler 816.83' �� 2 G M_ eD 1491 both Street 5 89149144" t 949.84' Val. 27, P. 6173 _ 1611 Somerset, WI 54025 ' 1 Lot 5 ' boc. No f - - - - _ ao 1 ono _ 5.521 Acres 240.506 S.F. N � 0including Road R/W Observation '�' g 3 ev an House Pryes �+ °p 5.307 Acres 231.164 S F m' als I Excluding Road R/W ILA Go 3: v. j 1 S 89*49144" 1•- 849.84' 1 .a+ � O m1 "+I�rl. I' 8I6.R3' weI tl' 3Lot 6t 5.460 Acres 237,854 S.F. i r„ xpipes d eg`rincluding Road RNV �.az'Centerline!=01 existingas 5.231 Acres 227,862 S.F. drivewaysExcluding Road -��' ` _ • . _... to $ �i o i 33.02' 817.09' S W571S3" W 850.11' SCALE IN FEET 1 LEGEND Unplalt©d Lond COUNTY C4 I 1 I '' FOUND (TYPE NOTED).CORNER MONUMENT, 0 90 180 360 3 I i S • 1 1/4" (o.d.) RON PIPE. FOUND. I t 1 1 1/4" (o.d.) " IRON PIPE DANEL P. KUGEL 5-2684 o O WEIGFrVG 1.8 x 18LBS./LNEAR PROFESSIONAL LAND SURVEYOR tX:OEN ENGINEERING COMPANY 0 1 - I FOOT, SET. 1234 SOUTH WASSON LANE O ,i RIVER FALLS, WI 54022 Z I 1 ; met TSOL OM BORIN STT PERFOR 14D BY JOB r 17-3413 _1 s -+E- PROPOSED DRIVEWAY LOCATION. DATE: DECEMBER 15, 2017 Ems_ OVERHEAD UTILITY POLES (AS COF 12 LINE AND-17). C:IV T TTELEPHONE ( 12 .S UNDERGROUND GAS L14E f DANIEL P. KUGEL (R-) PREVIOUSLY RECORDED INFORMATION. S-2684 RIVER FALLS, W 1/4 Corner Notes Vt11 O� Section 22 1. Soil Boring locations (as shown) were 1.30N. R19W obtained via the Sol Evaluation Report. �� SU O (Steel "Survey 2. The well Is eurrenUy shared by both Mark" Nall) houses shown on this map. T111S INSTRUMENT DRAFTED BY DANI L P. KttCRI. PAGE i OF 3 ag-bq-73 St Croix County 1062808 Page 1 of 3 nTRANSFER/RENEWAL wrl SBD-06499 (R11/20) NOG 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. :' -� 7_-7 �..- . - Department of Safety County SAN-2023-224 I �I S P I�] ! � & professional SeI-vices} '- �� Sanitary Permit Number (to be filled in by Co.) Industry Services Division - b q2 9 7 �— S=il t Application State Transaction Number In accordance with SPS 38121(2), Wis. Adm. Code, submission ofthis form to the appropriate governmental unit Project Address (ifdifferent than mailing addre ] is rcquircd prior to obtaining a sanitary permit- 'Note: Application forms for sLttc•owned POWTS are submitted to the Department of Safety an Professional Services. Personal information you provide maybe used for secondary purposes in accordance witl the Privacy Law, s. 15.040)(m), Stats. - - I: Application Informat n - Pleaw Print All Inforiaaation I'roperty Owner's Name Parcel 4 it 3 ���--- Properly Owncr's Mailing Addres Propc Lo ation _ at V Section` i 1 r. S, ;Ile Zip Code ho er N R E o 11 • Type of Building (check all that apply Lat Subdivision Name J 1 or2FamilyDwelling -- Number ofBedrooms � � Block ElPublic/Commercial- DescribeUse City of ❑State Owned --Describe Use ❑Villageof CSM Number ®oe,_ io62g6 �To,vn nf___ if ,, 1.1 L Type of POWTS Perrnit: (Check"eithek "New"•or "Re cement" and othe"r"ap cable on line A. Check one box on line B. Complete tine C if 2 cable.)_ A. New Systcm ❑ Replacement System ❑ OtherModr cation to F_xis ' System (explain) (explain) . ❑ Additional Preneatmcnc Cnir B' ❑ Holding Tank �-In-Ground ❑ At -Grade ❑ Mound ❑Individual Site Design ❑Other Type (explain) (conventional) C. ❑ Renewal Before ❑ Revision ❑ Change of P rnber ❑ Transfer to New Owner List Previous Permit Number and Date Issued Expiration IV. Dispersalfrreattnent Area and Tank Inftirm.atidn: x 16 Design Flow (gpd) Design Soil Application Rate(gpd/sf) ispersal Area Required f} Dtspersal Area Proposed (so System Elevation Vw" B 3 p `7 At ti s� is t' Capacity in Total of Manufacturer Tank Information Gallons Gallons Units r Pa SZS , c R y ~ New Tanks Exi. Ig Tanks w� p U y rR •a`, U cn,E, rn w C7 R. Septic or Holding Tank _ - Dosing Cl .• ,d J _ V. Responsibilil tiratonl n i- I, undersigned, assume res nnsibiuty for installation of the POAS shown on the attached plans. Plumbers N Plumber's S' a e MP/MPRS Number Business one Number Z, Plumbu a ;1Ci tiI It t 5tal alp Cade} VI, County/Depa. tment U] m Only (� Approved Permit Pee Date Issued I7�23 Issuing gent Si ature - $ �� I o/ y� wner on far �} Conditions pprov a ��-� D�2� .�A� SYSTEM ouvN R:7,N►r�t }z u � r P, g i s�•x 1. Septic tank, effluent filter and dispersal cell must be serviced / maintained as per - management plan provided by plumber. Z All setback requirements must be maintained as per applicable code / ordinances. Attach to complete plans for the system and submit to the t:ounty onlyon paper not Tess than ?I I z c 11 Incne5 In size � I's I :i'.? i It. 03/22) MR A 44,tWhIer<:;�) CONVENTIONAL COMPONENT DESIGN RoOdenW APPti MBW WEX MO "ME PAGE Town: &AxoWslon Now Pa" ID Woftr: F� ?�i - �i•, �1k Pape 1 Ind" W d ..,_,,._..._ Page 2 Plot Plea+ Page stemsaimp i Croce asctk d Fier" 6 Makdoneres Wmastion Pap 8 Ma»etpsrrieM P{an Page 7 S. Cmix S& =S ,c, Form Page a M inardy Dose! Pope 9 CSM or Pbt Attoohmsrf Sob Ted 6 House Phm l.icenss Ntsr�st: phww Number S�eture " ' Doom "PWW «W4oso bamom " c ow"m es sraoyvYS Voma,aosgaw7wp (m ow). pap tr 4- SdIedu PVC Vera pipes. WAh verd cap 1` ft Frrai rade f�ft ayu A6sor�fi4�. �1rs� p,�[�,r� Y� C ,) ft 5 ft SYstem Devaubn ha, der -each Gh �- -�, Manufacti er Arad FAo"w " . �� E'SA Ratingg sq ft per chamber Soil AppficaWn Rate -- / gpcilsq ft -�=-� 9Pd Design Flaw + � Sod err Rate � . � , _ EfSA =W-111 Cambers 2 roars of ---� chambers each_ Page_ of 4 yob r ��ftPiezis.,Dra�ava Zabel` !Prods:;+5 A OW.sior. of Potytok 1%. Pl., 521; Filter PL-525 Lffluerit Filler The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-12Z the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. Features- * Rated for 10,000 GPD (gallons per day). • 525 linear feet of 1/16" filtration. • Accepts 4" and 6" SCHD 40 pipe. • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. • Accepts PVC extension handle. 11L-525 Instalfationi Ideal for residential and Commercial waste flows up to 10,000 gallons per day (GPD). 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover. The PL-525 Effluent several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. 1. Locate the outlet of the septic tank. 2. Remove tank cover and pump tank if necessary. 4. Pull PL-525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank, not into filter housing 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely irtserW- 7. Replace and secure septic tank cover. !%In" Fitt -ration Slot p Alarm Switch 1/�,DOQ1i (Optional) � y ��`- Accepts 1" PVC t i Extension Handle Accepts 4" 6c 6" SCI4D 40 pipe f% .s. Rated for 10,000 GPD 525 Linear Ft. of 1/16" Filtration Slots Certified to NSFIANSI Standard 46 Gas Deflector Automatic Shut-[Jff Ball O uidvo 5rtitrti' i(c? ::.St:,rnt i "10ad % I u:,"' Polylok, Zabel & Best filters accept Easily installs the SmartFdter® switch and alarrm into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, Cr 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page Zof FILE INFORMATION Owner Permit # d DESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units 9� NA Estimated flow (average) 66 al/day Design flow (peak), (Estimated x 1.5) gal/day Soil Application Rate al/day/ft' Standard influent/Effluent Quality Monthly average* Fats, Oil & Grease (FOG) <30 mg/L Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (BOD5) s30 mg/L Total Suspended Solids (TSS) <30 mg/L V! NA Fecal Coliform (geometric mean) 510° cfu/100ml Maximum Effluent Particle Size %a in dia. ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDLILE SYSTEM SPECIFICATIONS Septic Tank Capacity 4:2-5r gal ❑ NA Septic Tank Manufacturer JA)5 ❑ NA Effluent Filter Manufacturer ❑ NA Effluent Filter Model S' ❑ NA Pump Tank Capacity gal jig NA Pump Tank Manufacturer O-NA Pump Manufacturer NA Pump Model P NA Pretreatment Unit ❑ Sand/Gravel Filter ❑ Mechanical Aeration ❑ Disinfection ❑ Peat Filter ❑ Wetland ❑ Other: J9 NA Dispersal Cell(s) 0 In -Ground (gravity) ❑ At -Grade ❑ Drip -Line ❑ NA ❑ In -Ground (pressurized) ❑ Mound ❑ Other: Other: ❑ NA Other: ❑ NA Other: ❑ NA Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ears) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third %) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: Years j(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: 4 month(s) kg year(s) ❑ NA Inspect pump, um controls & alarm p p. pump At least once every: ❑ month(s) ❑ year(s) � NA Flush laterals and pressure test P every: At least once eve ❑ month(s) ❑ yeaarr((ss)) � NA Other: At least once every: ❑ month(s) ❑ year(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying 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 (%3) 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 512 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. GMW (4/01) START UP AND OPERATION Page _Z_ of __ For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting 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 infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large 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. Do 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; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83,33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shalt 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 fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area h�is been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area -h%ild be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing-,.:r.J proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new 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 soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. { WARNING 7 7 SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER 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 INSTALLS Name,i Fi1r7R3F3 ��_ v�� POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Namc Name �~ Phone _ Phone i c�I 1 fI vF This document was drafted in compliance with chapter Comm 83.22(21(h)11)Idi&(0 and 83.54(1'), (21 & (31, Wisconsin Administrative Code. MIESEInnovation, Qualif ' v and Service Since 196i R 00HURETE wieserconcrete.com V I " Maiden Rock, WI (800) 325-8456 Fond du Lac, Wl (800) 641-5937 Portage, WI (800) 362-7220 Spooner, WI (BOO) 336-3416 ST. CRO LJN-l-Y SANITARY SYSTEM File #: I Office Use Only OWNERSHIP/ADDRESS FORM Created212027 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. OWNER/BUYER INFORMATION Owner/Buyer Khu & Bao Hang Mailing Address 5185 54th Street City/State/Zip Oakdale, MN 55128 Phone Number (requi Email Address (required 651-402-3946 Parcel Identification Number 030-1048-70-140 ;found on the property tax Frill) NEW SYSTEM: LEGAL DESCRIPTION Property Location NW �/4 NW 1/4 , Sec. 22 , T 30 N R 19 W, Town of Saint Joseph Subdivision Plat: Certified Survey Map # 10629Z , Lot#� . Volume -Is , Page # (o q� Warranty Deed # D OIL (before 2006)Volume Page # Number of bedrooms ;' Spec house O yes Q no Lot lines identifiable Myes 0 no New Property Address )�k - (Staff initials) OFFICE USE ONLY Aig= /� nor (Verification of new address required from Community 6evelopment Department for new construction.) lE) y ate) This form must be submitted with off Private Onsite Water Treatment System (POWTS) oppficotiorls. New System: Include with this form 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. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdclLPsccwi.ciov 1101 Carmichael Road, Hudson, WI 54016 LEFT FEEVATIDN 1/8' = V-P - _ REAR LUVATION 119' _. c 4 ,Ng?.�,kc nMYW. f ROWUfVATIDN 114-= 1'-0Y F-p" - 91 G i'O°JKW CONC F0UHRATj0N 7'- 1 AT CfII ING @ MAIN LEVEL Fwwd.LpP JK BIDDING ONLY CON5TRUCTION s yy G v IF i I RIGHT FIPVATIDN IT _ e letc S�iHc � H' i :••::kvt�_ fi II 11 11 fOK BIDDING ONLY 13 NOT FOR CONSTRUCTION p NPt, a0 Wde Z 11 Fol; .OWtR tEV[L PLAN 114` = I'-tY - _ _._ ._ & 01 FY71jKM OW' FOUNDATION .4 leo N n N V F 09 Ks C � 4w.-`•,- � mow,.... ...yam -MA-1 NS LEVEL FLAN I!A_I' Q° D',l i/a' CEILING O MA1 INtL FOR 61DDING ONLY NOT FOR CON5TRUCTION EMGN'.MC WALL; ! [7- I 118' C}FF Cl6l((S ca f-91' 9 FOR SIDDINf1 'NLY V I NOT FOR CON:-)TRUCTION s E rr:... 1 4 z DOCUMENT NO. I STATE BAR OF WISCONSIN FORM 1-2003 WARRANTY DEED THIS DEED, made between Thomas M. Schottler, a married person ("Grantor" whether one or more) conveys and warrants to Khu Vang and Bao Vang, husband and wife as survivorship marital property ("Grantee", whether one or more), the following described real estate in ST CROIX County, State of Wisconsin: Lot 4 of Certified Survey Map filed March 29, 2018 in Vol. 28 of C.S.M., pg. 6473, as Doc. No. 1062808 located in the NW'/. of the NW'/4 of Section 22, Township 30 North, Range 19 West, Town of St. Joseph, St. Croix County, Wisconsin; being part of Lot 2 of C.S.M. filed in Vol. 27 of C.S.M., pg. 6173, as Doc. No. 1022944. NIPIIIIII411�'�IIIIIIIIEIE 1064176 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 04/27/2018 02:10 PM EXEMPT#: REC FEE 30.00 TRANS FEE 154.50 PAGES: 1 RETURN TO St. Croix County Abstract & Title Co. Inc. 575 N. Knowles Avenue, Suite B New Richmond, WI 54017 Tax Parcel No: 030-1048-70-105 This is NOT homestead property Exception to warranties: easements, restrictions and covenants of record; highway and street rights of way; and Municipal and zoning ordinances and agreements entered under them; and further except real estate taxes accruing in the year of this conveyance. Dated this (;tLe day of April, 2018. AUTHENTICATION Signatures authenticated this day of 20 TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED BY Robert L. Lobere / Lobere Law Office LLP 1835404 / asc k (Signatures may be authenticated or acknowledged. Both are not necessary.) "Names ofpetsons signing in any capacity should be typed or printed below their signatures. WARRANTY DEED Thomas M. Schottler ACKNOWLEDGMENT STATE OF WISCONSIN COUNTY OF `+C VC-7 k ss. Personally came before me this DQ day of April, 2018, the above named Thomas M. Schottler, a married person, to me known to be the person(s) who executed the foregoing instrument and acknowledge the same. g� Notary Public County, Wis. My Commission is permanent. If not, state expiration date: a _ ,,,,,,,,,, N\ON,3 '- Off'' _ O�PR s - �. Z = fi !i1d t-400 St. Croix County 1064176 Page 1 of 1 3 ECF.IUE� Ciepartmen SOIL EVALUATION REPORT #1921 3Ir Safety and i cordance wi(h Comm 85 Wis Adm. Code Page __1 of 4 = Professional 5ervic@EC �3 Schmitt Soil Testing, Inc. tJNTY County. Attach complete site plan on paper size Plan must St. Croix include. but not limited to: vanri„,�oint BM), direction and percent slope, scale or dlmensibl� , arrow, and location and distance to nearest road Parcel 1 D. " 030as O-1Yii Rev Please print all frl�rnatftn. pate ��; iewe y Personal information you provide rri ` j� - s 15 Da (1) (m)) r Property Owner ZV2x69ZE` XNQP perty Location Schottler, Thomas M. Govt Lot N 1/4, 1/4, S22, T30N, R19W Property Owner's Mailing Address Lot # 1 Block # Subd Name/rCSM# j01c2'3i:S 610 148th Ave. 4 CSM V" -(dY7j City State Zip Code Phone Number City Village Town Neatest Road Somerset WI 54025 715-781-9050 St.Joseph i 150Th Ave. New Construction Use Residential i Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Desc-ibe: Parent material Outwash Sand (Chetek-Onamia Series) Flood plain elevation, if applicable NA ft General comments Area is suitatite for a conventional system with a 0.5 gpd/s4ft rate. Possible system elevation for Area 1 is 94.5' (High trench)and and recommendations: 93,6(low trench). Slope of area is 14%h T._ . >,- Boring I 1 I L l Boring # pit Ground surface elev. 9$.2.3 ft. Depth to limiting factor 110+ in. _ Soil Application Rate Horizon [Depth Dominant Color Relax description Texture Structure 'Consistence' Boundary Roots GPDtft' in. Munsell i Qu. Sz Cont. Color Gr. Sz Sh 'Eff#1 •EW2 1 G-12 10 r3/3 y ; none sil �� 2mgr mvfr as 2vf 0.6 0.8 , t -- 2 12-24 7.5yr4/6� none sicl 2msbk mfr gw ivf 0.4 0.6 3 24-36 7.5yr5/6 none wfsl 2msbk mfr gw 1vf 0.4 0.8 4 36-65 10yr5/6 none i.. fs lcsbk mvfr ! cs ------ 0.5 1.0 5 65-1 0 10yr6/4 none s Osg ml ---- G.7 1.6 MBoiring # Boring " 'pit Ground surface elev J.23"-' fl. Depth to limiting factor llG+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots '4 GPDift' in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. •E"I 'Etf#2 1 0-9 10yr3/3 none sY 2mgr mvfr as 2vf 0.6 1.0 2 9-16 ! 7.Syr4/6 none grsl ..i 2msbk mfr gw 1vf 0.6 1.0 3 16-32 7.5yr4/4 none Grls Osg ml gw lvf 0.7 1.6 4 32-110 10yr6/4 none grs osg ml - -- ------ 0.7 1.6 Tt- --- — - - i 1 i r� Effluent #1 = BOD�> 30 a 220 mg/L and TSS >30 c 1�0 mg/L Effluent 92 = BODr_ ! 30 mg)L and TSS < 30 mg/L CST Name (Please Print) Signature: L ? CST Number Thomas J. Schmitt - '` `-�'�"` ti•- _ 227429 m Address Schmitt Soil Testing, Inc. Date Evaluation � aluation Conducted Telephone Number 1595 72nd St. New Richmond, WI 54017 12114/2017 715-760-1978 GRIY.1li:iiH HI Property Crooner SChottler, Thomas M. Parcel ID # Part of: 030-104$ 70-105 Page 2 of F3 Boring # Baring factor Pd Ground surface elev. 93.33 ft Depth to limiting 105+ in. Sol! Application Rat, Horizon � Depth Dominant nsColor ont `Color Texture Structure Consistence Boundary Roots GPD/N' _�, - Qu. Gr. Sz- Sh •Erf*1 'ErF#2 1 0-10 1.0yr3(3 none sl 2mgr mvfr as 2vf 0.6 1.0 2 10-16 7.5yr4j4 none grsl 2msbk mfr gw 1vf 0.6 1.0 3 16-24 7.5yr4/6 none vgrs j 0sg ml gw 1vf 0.7 1.6 4 24-36 7.5yr5/6 none grs 0s9 ml gw --- -- 0.7 1.6 10yr6j4 none grs Osg ml _-- _-___ 0.7 1.6 1 q F-1 Boring Boring # pit Ground Surface elev. _ ft• Depth to limiting factor in Soil Application Rate Horizon ' Depth Dominant Collor Redox Description 1 Texture Structure 'Consistence Boundary Roots I GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz- Sh. •UNIP1 I 'Etf#2 i Boring Boring # Pit Ground surface elev ft. Depth to Ikmiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistences BoundaryRoots GPM' in, Munsell Qu Sz, Cont. Color Gr Sz, Sh Efr#t 'Eftx2 A t ' Effluent #1 = 8005> 30 c 220 mglL. and TSS >30 c 150 mg/L ' Effluent #2 = BOO" s 30 mgll- and TSS c 30 mglL I'hc Dcpurtment is an equal upportunit% scr,, ice provider and emplo%c-r. II'.%ou n"I to a; cc• s eervice,, or need maicriul in an alternate format. PleWSc contact the dcpartmc'ni at 6118-266-+ I ;1 (rr I I 1 bilk-26-4.8777. SBim331) (k 0/0()) 5d+rntt Sod re.Onq, lnr. Page 3 of 4 Conducted by: Conducted For: Schmitt & Sons Excavating, Inc.. Name: Thomas M. Schottler Thomas J. Schmitt, CST 227429 Address: 610 148th St. 586 Valley View Trail City, State, Zip: Somerset. W 15402 5 Phone: 715--760-1978 PID: Part of: 030-1048-70-105 sV„ature ` Lot No. 4 C'SM Pending Approval Date _f i� �w 2 Legal Description: NW 1/4 NW 1/4 S22 T30N RI9W ■ Backhoe Pit Township, County: St..loseph, St. Croix County ► Bench Mark 1 El. 100.00' Top of NE Lot corner Pipe (1 1/4" steel pipe) G Bench Mark 2 El. 94.07' Top of NW Lot corner Pipe (1 1/4" steel pipe) Slope= 14% Scale 1' = 60' NOTE: For full view of Lot see Aerial Photo (Page 4 of 4) %_` W - . 1`f V& , — (SI -Z ! / .5�,�t: 1 r� a' 4 C P1 CERTIFIED SURVEY MAP LAx-Ated in the NW 114 of the NW 1/4 of Section 22, T30N, R19W, Town. of St. 3osepb, St. Croix County, W&consin_ NW Corner Unplatied Lend Section 22 r-------- T30N, R19W (R-Cast .262-198') 15M Avenue (Aluminum (up) S 89"49'44" E 267-3.92' _ S 89049'44" E 696.44' 4 'r 24a.x4' 403.60, i E `1Gti� F153.40' 233.58' 2&5.94 403.Gf7 T3 '��8' / l i r,lrrF�(R-753.3ti"J 3 89'49't4" E c ..� a, lI f Lot 3 Lot 4 Hz CS I �J �N (At Road 3.541 Acres r'nn 3.308 Acres 83 1�9 �h High Point) 164.222 S F o 144.086 S.F. `o I�f r I f Incl Road RfVV Incl. Road RJW00 Bf �� 3.002 Acres 3.002 Acres B3 MB3 130.793 S.F. o r N 130,767 S.i I9 Excl. Road RAV o Excl. Road RNV 446.24' Z. W) 33.01 ' cv 413.23' 403 k(l' { T 916.93` S 89*49'44" E f149.84' 40l ?7, P. 6173 Lot 5 17 Doc_ No 1 d229a= p o Ic 5.521 Acres 240.606 S.F. -A MAA1 33" Gil mil` �l - I �i t I plc �3D c N ; 1, -I K OI O C I rnl ah I u� I eV `r tt c —. J 1 ~ 1 � rn t S 86057'53" VV 850.11' Unplatted Land COUNTY SECTION CORNER AAONUAAENT, FOUND (TYPE NOTED). 0 1 1/4" (o.d.) RON PIPE. FOUND. 1 1,/4" (o.d.) x 18" RON PPE Q WEIGFWG 1.68 LBS./LINEAR FOOT. SET. Mal SOC BORINGS PERFORMED BY TOM SCHMITT ON 12-14-17. ---dt PROPOSED DRIVEWAY LOCATION. E OVERHEAD ELECTRIC LIW AND UTILITY PODS (AS OF 12-15-17)_ T ...... T UNDERGROUND TELEPHONE LIE (AS OF 12-15-17). UNDERGROUND GAS LINE (AS OF 12---15-17). (R- J PREVKXJSLY RECORDED INFORMATKIN. W 1/4 Corner Notes Section 22 1, Soil Boring Iocations (as shown) were "I'30N, R19W obtained via the. Soil Evoluotion Report. (Steel "Survey 2. The well is currently shared by both Hark" Nail) houses shown on this map. TINS INSTRUMENT DRAFTED BY DANIEL P. KUGEL 1062808 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI. RECEIVE❑ FOR RECORD 03/29/2018 10:33 AM CERTIFIED SURVEY MAP VOLUME:.28 PAGEc6473 REC FEE: 30.00 PAGES: 3 I N 114 Corner, Section 22 7 _'EON, R19W - (1 3/4" u.d. Iron Pipe) 17�--� Vrvrfh Line u/' the NW 114 Unplatted Land OWNER & SUBDIVIDER Tom Schottler 1491 60th Street Somerset. VVI 54025 SCALE IN FEET 0 90 180 360 DANIEL P. KUGEL S-2684 PROFESSIONAL LAND SURVEYOR OLDEN ENG0,EERNG COMPANY 1234 SOUTH WASSON LANE RIVER FALLS, WI 54022 JOB #17-3413 DATE: DECEM3ER 15. 2D 17 0 IV i DANIEL P. KUGEL S-2694 RIVER FALLS, WI C7�r i SUVCA PACE I OF 3 St, Croix County 1062808 Page 1 of 3 e�x -COUNTY ,F--]., TRAN S F E RIE ® J `' i 1 ; !. , TOWN OF ] ��r b 1 S Jsb �"Avg . L" A)--,-' NeA� so\ 1 r Yea[. 12�� f 2023 I :� Oki/ Ell ► 22 4 263 VVk�� AND/OR , BLOC-K SUBDIVISIONC!�V�A 16q:�3 :zvNE 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. M,;A PERMIT11 j�-� AUTHORIZED ISSUING OFFICER - DATE ID/q/Z023 THIS EXPIRES-• , • . . r SBD-06499 (R11/20)