HomeMy WebLinkAbout006-1043-50-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
506279 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Ellevold, Scott I C Ion, Town of 006 - 1043 -50 -100
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
16b I g o e o I 20.31.16.297B
TANK INFORMATION ff ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION Z BS / � �HI '� FS ELEV.
a /G'0
Septic ( Benchmark A I' Q � J A ' ' D /466
el��c F 't Lti
Dosing Alt. BM
l�Je� A—P 3 F: kL,,— Cwu 5,1( 9b.9�
/b
Bldg. Sewer
Holding St/Ht Inlet c( , 9L 9g
St/Ht Outlet
TANK SETBACK INFORMATION 9.3 7 2 . 75
TANK TO P/L . WELL JD ROAD Dt Inlet
Lie. to `t . 75 'i Z . 35
Septic Dt Bottom
y- Dosing / Iq i Header /Man. , - r 7
Cf `� r
Aeration Dist. Pipe q
Holding Bot. System A
Final Grade i a l IS-7
PUMP /SIPHON INFORMATION tp'
Manufacturer G 1 Demand St Cover c� 9y
Lell�- GPM rr;� G�� (
Model Number A�j (5Z It - /mod J r 7�
TDH Lift Friction Loss System Head TDH Ft
Z •'syp I /.9% 1 (p
Forcemain Len h I Dia. 2— it [ Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length f No. Of renc s PIT DIMENSIONS No. Of Pits Inside Dia. T�epth
DIMENSIONS / Z / /
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION T Of S ste yY CHAMBER OR
yp y L(C•� / ' ZZ )
DISTR IBUTION SYST UNIT Model Number: `
a LJ 7 �V k-}-
Header /Manifold Distribution Z i x Hole Size +, x Hole Spacing , Ve t o Air Intake
Pipe(s) c
Length Dia Length 5 Di a �� Spacing . o �' y Z
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of '< Seeded /Sodded U. xx ulched
Bed/Trench Center 1 , 7 7- Bed/Trench Edges i Topsoil xx � g � � Yes E] No Yes � No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: O p- 4 Q
/ / 3 Inspection #2: / /
Location: 2072 220th Street Deer Park, WI 54007 (SE 1/4 NE 1/4 20 T31N R16W) NA Lot 1 Par I No: 20.31.16.2976
1.) Alt BM Description = (1
2.) Bldg sewer length = 'S` > W' s
R ; �� 5 �\
- amount of cover = ro- j Jr -S
Plan revision Required? Yes No ' _ — _ -- __-- .____ - --
Use other side for additional information.
SBD -6710 (R.3/97) ` � Dates Insepcto Signatur Cert. No.
D C- V: re. �K�OC 3 aL t�,�. � .L - a Pre, ,,,- k1- 6 r k
Safety and Buildings Division County
` m m 201 W. Washington Ave., P.O. Box 7162 ST. CROIX
�sconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 266 -3151 50& a -?
Sanitary Permit Application State Plan I.D. Num
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 1404181
may be used for secondary purposes Privacy Law, s 15.04(1)(in) Project Address (if different than mailing address)
I. Application Information - Please Print All Information e�Q/yYtrQ.�
It
Property Owner's Name REGE Parcel # Lot Block #
SCOTT ELLEVOLD J 006 -1043 -50100 1
Property Owner's Mailing Address Property Location 07 q
2072 220th ST. ' l
SE '�' NE '� <, Section 20
City, State ip Code Phone um er
DEER PARK 54007 - - 3 16circle one)
11. Type of Building (check all that apply) �� r T N; R v v r ✓
3 N Q 1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name CSM um ber N/A V. 7/1818
® Public /Commercial - Describe Use r.(it/L
❑ State Owned - Describe Use []City []village Township of CYLON
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. (3 New System E] Replacement System 0 Treatment/Holding Tank Replacement Only 0 Other Modification to Existing System
B. 11 Permit Renewal 13 Permit Revision 13 Change of [3 Permit Previous Permit Number and Date Issued Permit Transfer to New �T w. ' ��, , � /� �Gj
Before Expiration Plumber Owner U`�
hF ke
IV. Type of POWTS System: Check all that appl
0 Non - Pressurized In- Ground 0 Mound > 24 in. of suitable soil 0 Mound < 24 in. of suitable soil❑ At -Grade 0 Single Pass Sand Filter 0
Constructed Wetland 0 Pressurized In- Ground 13 Holding Tank 0 Peat Filter 0 Aerobic Treatment Unit 0 Recirculating Sand Filter 0
Recirculating Synthetic Media Filter 0 Leaching ber 0 Drip Line Grav 1 -less Pipe er (e lain) /
V. Dis ersaUTreatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area frequired (sf) Dispersal ea Proposed (so System Ele va "o
450 .4 1125 1125 �� 30 94.5 'Ti J✓p /n
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank 1000 1000 1 WEEKS X
Aerobic Treatment Unit E_Zdl_ F `O r
Dosing Chamber 800 800 1 WEEKS X
VII. Responsibility Statement- I, the undersigned, assume responsibility for inst allation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number
ROBERT HARDINA 824825 3� / 715- 986 -2508
Plumber's Address (Street, City, State, Zip Code)
477 170 AVE TURTLE LAKE WI 54889
VIII. Co /De artment Use Onl
N - A p ' proved ❑ Disapproved Sanitary Permit F (includes Groundwater Date sue ssuing Agent ign mps)
Surcharge Fee 7 3�
❑ Owner Given Reason for Denial 777777
IX. Conditions of Approval/Reasons for D
6 YSTEM �� / /�d 7 Septic tank, effluent filter and m?Z a
dispersal cell must all be serviced / maintained . 33 j �D w a � as per management plan provided by plumber. Cry4,i . � ( x
2. All setback requirements must be maintained --7-- a
as per applicable code /ordinances. �� u
N Attach complete plans (to the County only) for the system on paper not less than 81/2 x it inches in size
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commercemi.gov HAYWARD WI 54843
TDD #: (608) 264 -8777
i s c o n s i n vvww.commerce.wi.gov /sb/
www.Wsconsin.gov
Department of Commerce
Jim Doyle, Governor
Mary P. Burke, Secretary
July 24, 2007
CUST ID No. 824825 ATTN: POWTS Inspector
ROBERT J HARDINA ZONING OFFICE
HARDINA SEPTIC SYSTEMS ST CROIX COUNTY SPIA
477 170TH AVE 1101 CARMICHAEL RD
TURTLE LAKE WI 54889 -9187 HUDSON WI 54016
CONDITIONAL APPROVAL
Identification Numbers
PLAN APPROVAL EXPIRES: 07/24/2009
Transaction ID No. 1404181
SITE: Site ID No. 726395
Scott Ellevold Please refer to both identification numbers,
2072 220TH St above, in all correspondence with the agency.
Town of Cylon
St Croix County
SE1A, NE 1/4, S20, T3 IN, RI 6W
FOR:
Description: At grade, 3 bedroom residence
Object Type: POWTS Component Manual Regulated Object ID No.: 1135579
Maintenance required; Replacement system; 450 GPD Flow rate; System(s): At -grade Component Manual, SBD-
10570-P (R.6/99), SSWMP Pub. 9.6 P
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes CQnditiol
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be APPRO
constructed and located in accordance with the enclosed approved plans and with the component manual(s)
referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance Elty Of I
with all code requirements. Ol FET1f J
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.'
stats.
SEE rORRESI
The following conditions shall be met during construction or installation and prior to occupancy or us
Key Item(s)
• 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. In addition,
the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the
mound component manual are complied with. A copy of this information must be given to the owner upon
completion of the project.
J • This design is for a system with a 50' long force main. If the force main, upon installation, is longer than that,
the dose volume will need to be adjusted.
• The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater
particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to
the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening
used to service the filter shall terminate at or above finished grade with a watertight cover.
Reminder
• The orientation of the mound system must be such that the longest dimension is oriented along the surface
contour per COMM 83.44(6)(a)2.
ROBERT J HARDINA Page 2 7/24/2007
• Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual.
• Surface water drainage shall be diverted away from the system area per Mound Component Manual.
• Materials shall conform to the requirements of COMM 84.
• The existing POWTS must be properly abandoned per s. Comm 83.33 Wis. Adm. Code.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
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 a copy of this letter to the owner and any others who are responsible for the
installation, operation o amtenance o the POWTS.
Since Fee Required $ 175.00
Fee Received $ 175.00
—° Balance Due $ 0.00
Patricia b
POWTS Plan Reviewer, Int ated Se ice WiSMART code: 7633
(715) 634 -7810, Fax: (71 , 634-5150, M -f 7:45 am - 4:30 pm
pat.shandorf @wisconsin. v
cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M.
RESIDENTIAL AT -GRADE DESIGN
Pressurized - Sloping Site
INDEX AND TITLE SHEET
Project ELLEVOLD
Owner SCOTT ELLEVOLD
Address 2072 20th ST.
DEER PARK WI 54007
Legal Description SE, NE, S.20, T.31 N - R 16 W
Township CYLON County ST. CROIX
Subdivision Name CSM 7/1616 Lot No. 1 tal ly
Parcel ID Number 006 - 1043050100 V "
014 `
Plan Transaction Number A)
Index sheet Page 1
Calculations Page 2 >ONDE
At -grade drawings Page 3
Laterals and dose tank Page 4 , I
Specifications Page 5 ` "I
Management & contingency plan Page 6
Pump curve & specifications Page 7
Plot Plan Page 8
Soil data Page 9
Soil data Page 10
5P it bATA Nc 1)
Designer ROBERT J HARDINA License Number 824825
Signature / Phone Number 715- 986 -2508
Date 07/01 /07 e `1�
Designed pursuant to:
At -grade Component Manual for POWTS SBD- 10570 -P (R.6/99), and
SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST - SAS (01/81)
Version 4.0 (04/03) Page 1 of 16
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PRESSURIZED AT -GRADE DESIGN
At -grade Design Worksheet - Sloping Site
Flows and Site Data Entry.
(r or c) r Residential or commercial?
300.0 Estimated wastewater flow (gpd)
450.0 Design wastewater flow (gpd)
2.00 % Site slope
94.00 Contour elev. below lateral (ft)
42.00 Depth to limiting factor (in)
0.40 In -situ soil application rate (gpd /ft ^2)
Distribution Cell Information
(1 or 2) 11 Influent wastewater quality
10.00 Linear loading rate gpd/ft
10.00 Effective absorption width (ft)
10.00 Max. effective width permitted (ft)
113.00 Aggregate length (ft)
Pressure Distribution Data Entry
(c or e) c Center or end lateral connection
2 Number of laterals
0.188 Orifice diameter (in) e.g. 0.188
Not a final 1.92 Estimated orifices sp acing ft
calculation P g ( )
2.00 Forcemain diameter (in)
3.90 Forcemain flow velocity (ft/sec)
50.00 Forcemain length (ft) y or n y Does forcemain drain back?
74 87.00 Pump tank elevation (ft) y or n y Are laterals at highest point?
✓ �� NA
k tq� 3.25 System head (ft) x 1.3 8.2 Forcemain drainback (gal)
6.50 Vertical lift (ft) 51.0 5x Lateral void volume (gal)
1.52 Friction loss (ft) 1 592 Minimum dose volume (gal)
11.27 Total dynamic head (ft) 38.2 System demand (gpm)
Latera Diameter Selection Gallons /inch Calculator (optional)
P
Pipe diameter _Design options Design choice 800 Total Tank Capacity (gal)
Designer 1 in 37 Total Working Liquid Depth (in)
must select 1.25 in 21.6 Gal /in (enter result in cell G46)
one lateral 1.5 in x x
diameter 2 in x Treatment Tank Information
3 in x I 1000 Se tic tank capacity (gal)
WEEKS Manufacturer
Effluent Filter I nformat ion Dose Tank Information
BEST 11 Filter manufacturer 800.0 Dose tank capacity (gal)
GF10 -8 I Filter model number 21.6 Dose tank volume (gaVin)
WEEKS IManufacturer
Project: ELLEVOLD
Transaction Number: Page 2 of 10
AT -GRADE PLAN VIEW
1/6 B Observation pipes (2 typical) A 10.00 ft
Tr + 7 D B 113.00 ft
1/6 B 18.83 ft
........................................ ............................... C 12.00 ft
W C D 5.0 0 ft
E 2.00 ft
L 123.00 ft
D B
W 22.00 ft
A X B J 1125.00 ft ^2
L
-
Typical obs. pipe.
= Total aggregate cell A x B Slotted in the lower
= Plowed area L x W s s e e and anchored
curely.
6"
AT -GRADE CROSS SECTION
Svnthetic fabric cover
95.79 ft Finished grade
Lateral elevation
invert elev. 94.50 ft `:::::..
�— Observation pipe
`....
at aggregate toe
E
Surface contour 2 % Slope
94.00 ft C A
and system ' � D —�
elevation
® = 12 in. topsoil and subsoil IC) , lore-
over aggregate and tapered to toes. CP410'' Plowed layer
0 below L x W
= 6 in. aggregate below
pipe(s), and 2 in. above pipe.
Project: ELLEVOLD
Transaction Number: Page 3 of 14
PRESSURE DISTRIBUTION AND DOSE TANK
Lateral Diagram - Center Connection
P
I<- XC 4IFx12 I x12 -)1 Laterals & force main of PVC Sch 40
Last hole drilled next to end cap (per COMM Table 84.30 -5)
Hales drilled on the bottom of the lateral,
equally spaced ! = Turn-up wfbsll valve orcleanoutplug
Lateral Specifications
0.188 Orifice diameter (in) Center Lateral connection point
X 1.94 Orifice spacing (ft) 2 Number laterals
29 Orifices /lateral P 55.29 Lateral length (ft)
19.1 Lat. discharge rate (gpm) 1.50 Lateral diameter (in)
2.00 Forcemain diameter (in)
38.21 Sys. discharge rate (gpm) 50.00 Forcemain Length (ft)
11.27 TDH (ft)
Typical Pump Chamber Layout
Approved manhole cover with
Weather -proof warning label and locking device
junction box - -�
Final grade 4 "
disconnect
T:nk onent is �► Altemate
pnted f--_ outlet
^ location 18" min.
Electrical as per NEC 300 and Ir � Approved outlet
Comm 16.28 WAC joint
Tank full
= Inches Gallons JA Provide 1/4"
.2 A 20.3 438.4 Alarm on weep hole or
c B 2.0 43.2 antisiphon
C 2.7 59.2 Pump on B device.
O D 12.0 259.2 88.00 ft C
Totalsl 37.01 800.01 -�
Pump off
D
3" Bedding under tank ♦ 87.00 ft
ZOELLER Pump manufacturer SJE- RHOMBUS Alarm manufacturer
BN 152 1 Pump model number 101 Alarm model number
Project: ELLEVOLD
Transaction Number: Page 4 of 10
At-grade System Maintenance and Operation Specifications
Service Provider's Name ROBERT J HARDINA Phone F 5- 986 -2508
POWTS Regulator's Name ST. CROIX CO. Phone 5- 386 -4680
System Flow and Load Parameters
Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L
Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L
Soil Absorption Component Size 1125.0 f: Maximum FOG 30 mg /L
Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 m
Service Frequency
Septic and Pump Tank Inspect and /or service once every 3 years
Effluent Filter Inspect and clean at least once every 3 years
Pump and Controls Test once every 3 years
Alarm Should test month)
Pressure System Laterals should be flushed and pressure tested every 1.5 years
Moundi inspect for ponding and seepage once every 3 ears
Other
Miscellaneous Construction and Materials Standards
1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap,
and are secured in as shown in the at -grade component manual.
2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold board or chisel plow.
5. The at -grade structure and other disturbed areas will be seeded and mulched to prevent soil erosion
and help reduce frost penetration.
6. Areas within 15 feet of the downslope toe will be protected from compaction.
7. All other construction details are as per the at -grade component manual SBD- 10570 -P (R. 6/99).
Lateral Turn -up Detail
Finished ••.......•• ...............
Grade
6 -8" Diameter Lawn Threaded Cleanout
Sprinkler Valve Box Plug or Ball Valve
Distribution
Lateral �
Long Sweep 90 or Two
94.50 ft - ---% 45 Degree Bends Same
Diameter as Lateral
Project: ELLEVOLD
Transaction Number: Page 5 of 10
At -grade System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
Genera
This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its'
component manuals [SBD- 10570 -P (R. 06/99) and SSWMP Pub. 9.6 (01/81)] and local or state rules pertaining to system maintenance
and maintenance reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death.
Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,
defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an
effective locking device to prevent accidental or unauthorized entry into a tank or component,
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic
tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be
assessed at least once every 3 years by inspection.
The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions
are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,
the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending
continuous alarm.
The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the
tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of
when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank.
The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such
products are used they shall be approved for septic tank use by the Department of Commerce.
Pumg) Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper
operation. If an effluent fitter is installed within the tank it shall be inspected and serviced as necessary.
At -grade and Pressure Distribution System
No trees or shrubs should be planted on the at- grade. Plantings may be made around the at- grade's perimeter, and the at -grade shall
be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for
vegetative maintenance) on the at -grade is not recommended since soil compaction may hinder aeration of the infiltrative surface within the
mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the at-
grade be heavily mulched as protection from freezing.
Influent quality into the at -grade system may not exceed 220 mg/L BOD5, 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or
30 mg /L BODS 30 mg /L TSS, 10 mg /L FOG, and 10" cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design
flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be
flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test
when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution
within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any
levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
Continency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately
repaired or replaced with a component of the same or equal performance.
If the at -grade component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or
replaced in its' present location by increasing basal area if toe leakage occurs or by renovating the biologically clogged absorption and
dispersal media, installing new piping, and replacing other components as deemed necessary to bring
the system into proper operating condition.
See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider.
Project: ELLEVOLD Transaction Number: Page 6 of 1I
Page 1 of 1
e:
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PUMP PERFORMANCE CURVE
MODEL 151/152/153
50
14 45 153
12- 40
a
t0 35 152
30
0 8 25 15
d
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F-
g 20
15
4
10 5
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10 20 30 40 50 60 70 80 90 100
GALLONS
LITERS 0 40 80 120 160 200 240 280 320 360
FLOW PER MINUTE 014508A
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Wisconsin Department of commerce SOIL EVALUATION REPORT Page 1 of 2
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County ST CROIX
Attach compete site plan on paper not less than 81 /2 x 11 inch siz Ia"ust
include, but not limited to: vertical and horizontal reference point d Parcel I.D. 006 -1043 -50100
percent slope, scale or dimensions, north arrow, and location an ce to nearest road.
Please print all information. .. Reviewed by Date
Personal information you provide may be used for s s. 13 :04 (i) (m)).
in—m Film"
Property Owner Pro Location
SCOTT ELLEVOL Go . Lot SE 1/4 NE v4 S 20 T 31 N R 16 E() WW ip 11
Property Owner's Mailing Address JUL Lot Block # Subd. Name or CSM#
2072 220th ST. N/A 7/1818
City State Zip Code Phon Y ;t ®Village own Nearest Road
DEER PARK WI 54007 ( 220th ST.
® New Construction Use Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
a Replacement Public or commercial - Describe:
Parent material GLACIAL TILL Flood Plain elevation if applicable ft.
General comments AT -GRADE
and recommendations:
a Boring # 0 Boring
D pit Ground surface elev. 92.25 ft. Depth to limiting factor 42 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f !
in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. `Eff#1 *011#2
1 0 -10 10YR3 /2 - a - SIL 1MSBK MVFR GW 2M .4 .6
2 11 -18 10YR5/4 -o- SIL 2MSBK MFR CW 2F 4 .8
3 19-41 7.5YR4/4 -o- SCL 2MSBK MFR CW IF ..4 "
4 42 -48 7.5YR4/4 C2D5YR4 /4SL SCL 2MSBK MFR N/A N/A .4 .6
F 2 ]Boring # Boring 94.75 49
pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -13 10YR3 /2 -0 - SIL 1MSBK MVFR GW 3M "4 .6
2 14 -27 10YR5 /4 -0- SIL 2MSBK MFR CW 2F .4 .8
3 2848 7.5YR4/6 -o- SCL 2MSBK MFR CW IF .4 .6
4 49 -54 7 "5YR4/6 C2D5YR4 /4SL SCL 2MSBK MFR N/A N/A .4 6
* Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L ` Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Ntxriber
ROBERT J HARDINA 824825
Address D Evaluation Conducted Telephone Number
477 170th AVE. TURTLE LAKE W1.54889 5 -5 -07 715- 986 -2508
Property Owner ELLEVOLD Parcel ID # 006 -1043 -50100 page 2 of 2
3
Boring Boring
[ 1 g E] pit Ground surface elev. 93.75 ft Depth to limiting factor 42 in.
Soil A43plication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -9 10YR3/2 -0- SIL 1MSBK MVFR GW 3M .4 .6
2 9 - 18 10YR5/4 -0- SIL 2MSBK MFR CW 2F .4 .8
3 19-41 7.5YR4/4 -0- SCL 2MSBK MFR CW N/A .4 .6
4 42-46 7.5YR4/4 F2DSYR4 /4SL SCL 2MSBK MFR N/A N/A .4 .6
F -1 Boring # Boring ri Pit Ground surface elev. ft Depth to limiting factor in.
Soil — Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eft#1 *0111
❑ Boring # Boring
Pit Ground surface elev. ft. Depth to ('uniting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2
* Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg&
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 - 2648777.
SBD- 8330Ten (11.07/00)
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Parcel #: 006 - 1043 -50 -100 07/30/2007 04:29 PM
PAGE 1 OF 1
Alt. Parcel #: 20.31.16.297B 006 - TOWN OF CYLON
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - ELLEVOLD, SCOTT B & MARY E
SCOTT B & MARY E ELLEVOLD
2072 220TH ST
DEER PARK WI 54007
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 2072 220TH ST
SC 3962 NEW RICHMOND
SP 8020 UPPER WILLOW REHAB DIST
SP 1700 WITC
Legal Description: Acres: 1.322 Plat: N/A -NOT AVAILABLE
SEC 20 T31 N R1 6W SE NE 1.322 AC LOT 1 Block/Condo Bldg:
CSM 7/1818
Tract(s): (Sec- Twn -Rng 401/4 1601/4)
20 -31 N-1 6W
vu l
b
Notes: Parcel History: 1�
Date Doc # Vol /Page , ' ype
07/23/1997 783/601 `
2007 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations Last Changed: 09/08/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.322 10,000 162,000 172,000 NO
Totals for 2007:
General Property 1.322 10,000 162,000 172,000
Woodland 0.000 0 0
Totals for 2006:
General Property 1.322 10,000 162,000 172,000
Woodland 0.000 0 0
Lottery Credit Claim Count: 1 Certification Date: 04/17/2001 Batch #: 512
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
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SEE PAGE 45
Contact Us for Any ...
Associated Milk
Bulldozing - Landclearing , ,
Roadbuilding -Earth moving Producers, Inc.
North Central Region
ILL GLEASON Manufacturers of V ti
i Pure Dairy Products
Bulldozing & Road Building Service Turtle Lake, Wisconsin
I TA Phone: 775 - 246 -5746 54889 4 -H Is Working
Box 243- New Richmond, Wisconsin Phone: 986 -4465 Together
'.CERTIFIED SURVEY MAP
FIRST NATIONAL BANK OF BALDWIN
Part of the Southeast 1/4 of the Northeast 1/4 of Section 20, Township 31 North, Range
16 West, Ton of Cylon, St. Croix County, Wisconsin.
NE COR. SEC. 20, T3 /N, ' 916w, /COUNTY
SURVEYOR'S MON.I FILED
ZIN A T TE D LA N S �" W W MAY 221 987
N W AAfY pi
N 90' 00 1 � " 240. p0' r Y O ��de to@* �
�1 /ILVY "7 20T. D 33, 00 4 C
C I W O
D W E L L 1 N 6 o N O I 2 2
oaf �! " '° Q, APPROVED
Q
W O I W h
° MAY 2 0 1987
L OT
Y1e
1
Q I g /.322 ACRES O O O b
3, 600 SO, FT, O
1 CROIX cc , u! IT V
f� O O I Q W COMPREHEN5IE PARKS PLANNINL
S O NET 1. 140 ACRES �I 2 AND ZONING COMMITTEE
S 2 49, 660 SO. fT. EOO" Wq TER C
O
N 90' 00'00 "W 240 �
UN A T TEO L Dated: 2 -2 - 87
Qo
W
SO' 200' 300'
E 1/4 COP. SEC. 20, T3 /N,R /6W, /COUNTY
W O 50' /00' /
SURVEYOR'S MON./ J
W SCALE 1 ' /00 '
O Indicates 1" x 24" iron pipe weighing 1.13 lbs. /tin. ft, set.
Description:
That certain parcel of land located in the Southeast 1/4 of the Northeast 1/4 of Section
20, Township 31 North, Range 16 West, Town of Cylon, St. Croix County, Wisconsin, more
fully described as follows; Commencing at the East 1/4 corner of said Section 20,
thence N 00 "E 971.53' to the POINT OF BEGINNING, of the parcel to be herein
described; thence N �O ° 00'00 "W 240.00'; thence N 00 11 E 240.00 thence N 90 "E
240.00 thence S 00 00 11 W 240.00' to the POI14`I` OF BEGINNING, containing 1.322 acres,
being subject to easement over the Easterly 33.00' thereof for town road purposes,
and also being subject to easements of record.
(For purposes of this description all bearings are referenced to the East line of the
Northeast 1/4 of Section 20, Township 31 North, Range 16 West, assumed N 00 "E)
,'aa Nt�ttatr
State of Wisconsin)
County of Pierce) .....
1, Laurence W. Murphy, Registered Land Surveyor, do hereby �AA
certify that by direction of the Owner, First National Bank W M Y
of Baldwin, I have surveyed and divided the lands shown hereon +► 17 3 1
in accordance with official records, Chapter 236 of the IVEF+ FA1.l8.f i
Wisconsin Statutes and the Ordinances of St. Croix County; F _W�,� / /��
and that the map and description are a true and correct � �a S
representation thereof. /' �Ot
Vol. 7 Page 1818
Certified Survey Maps Laurence W. Murphy
St. Croix County, Wisconsin Registered Land Surveyor
3
OWNER'S ADDRESS- 9 9 0 MAIN ST., BALDW/ N, W/ 54002