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006-1051-40-100
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538810 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 Kobernick, Barry I C Ion, Town of 006- 1051 -40 -100 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No J 6� �o , -t J< /��,� 23.31.16.345B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV Septic / Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom 9Z, Dosing Header /Man. 4' zc� 161, !G Aeration Dist. Pipe 10.9 91/. stjl7 Holding Bot. System PUMP /SIPHON INFORMATION Final Grade S•3g Manufacturer GPM ? Slyer /66 G` /D �• Model Number � v� ?C� � ti 7, 7. TDH Lift9 /5 Friction Loss System Hea TDH /J 5.,)+E, `7 . Forcemain Length Dia. t/ Dist. to Well �, " - Z J SOIL ABSORPTION SYSTEM BED/TRENCH Width Length i No. Of Trenches PIT DIMENSIONS No. Of Pits Inside a Liquid Depth DIMENSIONS / fi C7Z Te I-, SETBACK SYSTEM TO P/L (( BLDG WELL LAKE /STREAM LEACHING Manufacturer: nn ' INFORMATION CHAMBER OR nd"� 1 11 Type Of System: / / UNIT Mod Number: Go n ✓ r,K 1�. o `� 3 `/ �OU 4 S DISTRIBUTION SYSTEM o� J Z3 -�- 5�S Header /Manifold �� Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length �O Dia Length \ Dia ` Spacing \ 1 : 5 d J 4, , s SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Muicned Bed/Trench Center Bed /Trench Edges Topsoil w ` ' Yes No Yes No , G I COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: p / 2 (o / f Inspection #2: Location: 2058 250th Street Deer Park, WI 54007 (SE 1/4 NE 1/4 23 T31 R1 6W) NA Lot 1 Parcel No: 23.31.16.3458 1.) Alt BM Description = q �p�`; �, «iA61I`u �1 � 6 o ck loo �-L +Q,- J 2.) Bldg sewer length Q w� - amount of cover = t��` • J�'� h' �d�d1 �'b.�.e.X• Ua (`� 1- �'e„�►,c�. `Jai l� c�. ' I _ Plan revision Required? ❑ Yes No Use other side for additional information _ 1 Date Inse tor's Si ure Cert No SBD -6710 (R.3/97) county: St. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM sanitary Permit No: Safety and Building Division INSPECTION REPORT 538810 0 (ATTACH TO PERMIT) State Plan ID No GENERAL INFORMATION W7;; you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] parcel Tax No'. e: City Village X Township 006- 1051 -40 -100 ar C Ion, Town of Section /Town /Range /Map No Insp. BM Elev: BM Description: 23,31 .16.3458 TANK INFORMATION ELEVATION DATA STATION BS HI FS ELEV. TYPE MANUFACTURER CAPACITY Benchmark Septic Alt. BM Dosing Bldg. Sewer Aeration St/Ht Inlet Holding q j St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Dt Bottom Septic Header /Man. Dosing Dist. Pipe Aeration Bot. System Holding Final Grade PUMPISIPHON INFORMATION Demand St Cover Manufacturer GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth BED/TRENCH Width Length DIMENSIONS LAKE/STREAM LEACHING Manufacturer: SETBACK SYSTEM TO P/L BLDG WELL CHAMBER OR INFORMATION Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM x Hole Size x Hole Spacing Vent to Air Intake Header /Manifold Distribution Pipe(s) Length Dia Length Dia Spacing e Systems Only xx Mound Or At -Grad SOIL COVER x Pressure Systems Only 1 xx SeededlSodded xx Mulched Depth Over xx Depth of Depth Over Topsoil Yes r �I No Yes No Bed/Trench Center Bed/Trench Edges COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2: / Location: 2058 250th Street Deer Park, WI 54007 (SE 1/4 NE 1/4 23 T31 N R1 6W) NA Lot 1 Parcel No: 23.31.16.345B 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? NE Yes Rd No cert No Use other side for additional information. Date Insepctor's signature SBD -6710 (R.3/97) d Buildings Division an County �- 201 Washington Ave., P.O. Box 7162 S / 1 SC n sin t Madison, WI 53707 -7162 Sanitary Permit Number ( be filled in by Co.) 3 538/ S ° nits _ t Safety lication p StzonNumber S In accordance with s. Comm. 8 - t' 1 .2�(Z); �Wti§Y mon of this form to the appropriate unit is required prior to ob ' ' anttary permit. Note: Application forms for state -owned s (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purpos in accordance with the Privacy Law, s. 15.04(1 )(m , Stats. I. Application Informa ' n - Please Print All ration Property O is Name �' Parcel # e r V A 064PIRICIr Oo 6 -- /as Sic - m o o IN Property Owner's Mifiling Address Property Location aO ST e2 r O ' :&7 Govt_. Lot • 3Ji5 �3 Ci fate Zip Code Phone Number pc S y,, %., Section z3 �. 7 13 ' . o fD 9 S � �0 (circle one) II. Type of Building (check all that apply) 3 Lot # T 3 I N; R /(o w 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name ❑ Public/Commercial - Describe Use Block # ❑ City of ❑ State Owned - Describe Use r CSM Number Q ❑ Village of i 5l' ta-) �-� C.. �/{ f5 �� Z�S U p❑c Town of a Ib ij III. Type of Permit: (Check only o e box on line A. Complete line B if applicable) A, New System g Replacement Treatment/Holding Tank Replacement Only Other Modification to Existing System (explain) Syst F ' B. Permit Lj Permit Revision Change of Permit Transfer to List Previous Permit Number d D Issued Renewal Before Plumber New Owner 7 /07 Expiration I gZ IV. Type of POWTS System/Component/Device: Check all that appl n- Pressurized In- Ground L1 Pressurized In- Ground LJ At -Grade L1 Mound 2:24 in. of suitable soil El Mound < 24 in. of suitable soil Holding Tank Other Dispersal Component (explain) ❑ Pretreatment Device (explain) �� �` t k-m� z !Yj5 V. DispersalfIrreati6ent Area Information: le Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dis e ersal Area Ppfosed (s System Elevation VI. Tank Info Capacity in Total # of Manuf r , Gallons Gallons Units / _ Lt U P CXti D New Tanks Existing Tanks Z U 0 V 5 5 Septic or Holding Tank • r / tv-v - 6' Dosing Chamber 7 VIL Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. PI 's Name (Print) Plum afore MP/MPRS Numb Business Phone Number �/�niS `!/�c zz" &r' 9 4S 7 Plumber's Address (Street, City, State, Zip Code) VI oun /De artment Use Onl proved =� Permit Fee Date ued Issuing ent Sign e ner Giv anon for $ • 6b 1 3 `` I -1 �� — A D DL Condit'o s o rov easons for Disapproval , 1 �srrS'$�ivrr 3 ) 1.-,s !'cro.�► �, abl�, o�c�. 4, Septic tank, effluent filter and G � dispersal cell must all be serylees I maintained e as per management plan provided by plumber. n ifs ck t'equ)rements must.be maintained 6. j�J Atfach to complete plans for the system and submit to County only o per not less n 81/2 x 11 ches in size 1 SBD 6398 (R. 01/07) Valid thru 01/10 I ti __ Loh • ��_� - - � _'_ � —_ � �� 12.i7+� I I -- j Yo' I to -- _ r I -,� r � _ /v rr IV 1� � e �► --:' ley o , Asa _s �1 U4/04/2001 10:07 FAX 7155378847 BARRON CO ZONING la of SYSTEM SPECIFICATIONS In-ground Soil Absorption Component SBD - ��Q1v S C; i 1 Project Name: ✓ /' R o� �°ti r �/r Distribution Cell Type Septic Tank Aggregate ❑ Lc-aching chambcrsf�j Min. Septic Tank Vol 0 :1, : 10 g�d. Wastewater Quality Septic ' r;Lrjk V011itfjt; /006 -- - - gal. Treated ❑ Uaueated [° Manufacvurer' f. Number of Bedrooms Effluent Filter Design Loading Rate PLR) 1 5 Manufacturer Z OO (!Maximum Sod Application Rate) - - Combined wastewater: Model - Number of bedrooms `� Pump Tank gal /day /bedroom x 150 J--- Manufacturer Daily Wastewater Flow (DWF) - 'i!S�y .7S`a Volume „ , -- ga Clear and graywater only: Number of bedrooms Diverter valve Eyes Ono gal /day /bedroom( Daily Wastewater Flow (DWF) _ Manufacture Model _ Blaekwater Note : The use of a dive ur valve shall be indicated on the management plan irml ,f;ting how and when the valve Number of bedrooms shall be used. gal /day /bedroom x 60 Daily Wastewater Flow (DWF) _ Distribution Cell Sizing (Aggregate) DWF / DLR / — ftz Distribution Cell Sizing (leaching chambers) Leaching Chamber Manufacture �- Model Adjusted Design Loading Rate 01c S gpd /ft` Chamber size, bottom area yo fir System sizing = D / ADLR / ChambLr c so (Ap1,K) (sq.Ft.) # of ch t>crs Number of chambers to be used = Page of Soil Absorption System Cross. Section ft 4' Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ♦_ Tt Leaching Chamber 9 7 ft F ~ System Elevation C) ✓�- ft 1 Soil Absorption SysteW Plan View 9Zf ft ft ft Leaching Trench 1 Vent Or Observation Pipe Chambers 4' Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model EISA Rating s sq ft netr chamber Soil Applicatio Rate v� gpd/s4 jl 7 gpd Design Flow T 7 Soil Application Rate + EISA = _ Iparnbers .6 2 rows of __WXX chambers el 7.2 4-25 Page of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of INFORM T[ON SYSTEM SPECIFICATIONS - ` /Qm © -, vnar Q P P o Y� h c Septic Tank Capacity _ _ . l ❑ NA rn(t # Septic Tank Manufacturer% ❑ NA ,IGN PARAMETERS Effluent Filter Manufacturer ❑ NA tuber of Bedreoms I _ -4 C1 NA Effluent Fitter Model ❑ NA nber of Public Facility Units 4�5 NA Pump Tank Capacity �S° qa1 ❑ NA n flow (avcrr_, ;e) 300 pzl /da Pump Tank tJlanufacturer ❑ NA ! icgn _aal /d flow (peak), (Estimated x 1.5) Vf'o Pump Manufacturer ❑ NA ay — —�. i) Application Rate a Sgal /da /ft2 Pump Model El NA _andard influent /Effluent Quality Monthly average` Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Dis ?nfection ❑ Othe atreated Effluent Quality Monthly average Dis Cell(s) El NA Biochemical Oxygen Demand (SOD X30 mg /L lj$ In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100ml ❑ Drip -Lino ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: 11 NA .her. ❑ NA Other: ❑ NA values typical for domestic wastewater and septic tank effluent. Other: ❑ NA AINTENANCE SCHEDULE Service Event Service Frequency ❑ month(s) (Maximum 3 years) ❑ NA ispect condition of tank(s) At least once every: -0 y ear(s) 'Limp out contents of tank(s) When combined sludge and scum equals one - thlyd (Y of tank volume ❑ NA inspect disperse! cell(s) At least once every: 3 13 months) (Maximum 3 years) O NA � earls) _. ❑ months) ❑ NA Clean effluent filter At least once every: y ear(s) ❑ morn 0 NA .respect pump, pump controls & alarm At least once every: ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) ❑ month(s) ❑ NA Other: At least once every: ❑ year(s) ❑ NA other: .1AINTENANCE 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 I must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, or pending of effluent on the ground surface. measure the volume of combined sludge and scum and to check for any back up The dispersal cell(s) shall be visually Inspected to check the effluent levels in the observation pipes and td 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 (Y 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. retreatment All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components p 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) INGROUND SOIL ABSORPTION MANAGEMENT PLAN PURSUANT TO COMM. 83.54, WIS. ADM. CODE General This sN , stem shall be operated in accordance pith Comm.82 -84 Wis Adm. Code and shall be maintained in accordance with its component manual [In- ground Absorption Component Manual for POWTS Version 2.0 SBD- 10705 -P (n.01 101) and SSWN41? publication 9.6 (01/81) anJ local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic tank 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 and 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 11te septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. 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 the triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maxium 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 Dept. of Commerce. Pump Tank The pump tank shall be inspected at once every 3 years. All switches, alarms and pumps shall be tested to verify proper operation. If on effluent filter is installed within the tank it shall be inspected and serviced as necessary. Soil Absorption System No trees or shrubs should be planted on the absorption area. Plantings may be made away from the cell's perimeter, and the area shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than foot or for vegetative maintenance) on the area is not recommended since soil compaction may hinder aeration of the infiltrative surface within the system and snow compaction in the winter will promote frost penetration. 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 incites considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency 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 shall be immediately repaired of replaced with a component of the same or equal performance. If the dispersal area fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Replacement in a suitable area nearby is also an option at which point a diversion valve will be installed between the old and new systems to allow dispersal cell rotation at a schedule to be determined at the time of cell replacement. II Illlilllllilllllllllllllll III 8023180 State Bar of Wisconsin Form 3 -2003 Tx:4016957 QUIT CLAIM DEED 93381fi [h,cmncm Number Document Name BETH PABST REGISTER OF DEEDS T IUS DEED, made between Barry A. Kobernick ST, CROIX CO., WI 03/21/2011 1:34 PM EXEMPT *: 8M ( "Grantor," whether one or more), REC FEE: 30.00 and Barry A. Kobernick and Penny M. Kobernick, husband and wife as survivorship PAGES' 1 marit to property P P Y ( "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 Recording Area County, State of Wisconsin ( "Property ") (if more space is needed, please attach addendum): Name and Return .Address Cheryl BJomstad Lot One (1) of Certified Survey Map recorded in Volume 10 of Certified Survey The RiverBank Map Page 2758, as Document No. 516991, located in art of the Southeast Q uarter 21 U.S. ighway x East t C 6 P' g P Q P.O. Box 7 of the Northeast Quarter (SE % of the NE V4), Section Twenty -three (23), Township St. Croix Fans, sconsin 54024 I hirty -one (3 1) North, Range Sixteen (16) West, Town of Cylon, St. Croix County, Wisconsin. 006- 105140 -100 Parcel Identification Number (PIN) This is homestead propc,ly. (is) (is not I Dated 311111 (SEAL) (SEAL) * Barry A. K ernick (SEAL) (SEAL) * AUTHENTICATION ACKNOWLEDGi♦1ENT Signature(s) STATE OF WISCONSIN ) ,authenticated on ) ss. POLK COUNTY ) * Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above -named Barry A. Kobernick (If not, authorized by Wis. Stat. § 706.06) to me known to be the person(s) x executed therford841Z instrument and acknowledged the sate z rt I1IIS INSTRUMENT DRAFTED BY: �� . GeC Priscilla R. Dorn Cutler " • • . Osceola, Wisconsin 54020 Notary Public, State f tsconsin My Commission (is permanent) (expires: j ) (Signatures may be authenticated or acknoNledged. Both are not necessary.) NO THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 3-2003 1 �fr� name below signatures. FROM GILLE- TRUCKING - &- EXCAVATING -_- FAX NO. : 715- 268 -7080 Aug. 10 2011 10:39AM P2 St C"!-CIA ST. CROU COUNTY ZONING OF FIC E CERTIFICATION STATEMENT F OR UTI LIZATION OF EXISTING SEP'T'IC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following reside ye QQ (Street address) 5 0. S`o S 7� 7 located %, Section , Town _ N, Range 7z W, Town of Wow -- -_ -- , St. Croix County Wisconsin, Upon inspecii on,I ccrtify that I have found the to the best of my knowledge, will conform to the requirements of Comm, 54,25, and it (they) appear(s) to be functioning properly. Most recent die of inspection or service Did flaw back occur from absorption system? "Yes No _ X (if no, skip next line,) Approximate volume or length of time: gallons rnimites Tank Capacity; – 15 1 -1- Construction: Prefab Concrete Steel Other Manufkcturex (if known): Age of Tank (if known): nu er (if known) (Licensed plumber Signature) (Fr int Name) (Title) (License Number) MPIMPIkS (Bate) Form to be completed by licensed plumber (Dept of Commerce Chapter 5 aad s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 912008 FROM GILLE- TRUCKING_ &- EXCAUATING - -- FAX NO. : 715 - 268 -7080 Aug. 10 2011 10:40AN P? x PM, St Dose Tank Cross Swdon And Pump Performanoe Speoificatiom Tack tvltmutbotwor Minimum Pump Perforuince uir� y 7 T� mfr MadsI Number p GpM� T O, / Ft 7T H Total Tank Ca aoi y - TOW DynMic Head MM - Pest Pura Mancrt uror ElovWcn KWd Pty Model Number 1 1 7 8' bfstal Pre: urc Alarm Moubzbrar <' Network Pressure Loan r Alas Modal Number Pone Math Pressure Loss . !� SvA tch Type Total U=hola Mim V Above Orede . 'SYitla LvvMrlg T3evise vent min. 12" Abovs ends '( =Cdon Box f 3uacdor. Box With cup } .. .� .w ,R - Finished Grade 3 . Aepth of Cover Ft Dieoo:snoot ►• , f. . f. a r J f i f f f f. t f l J t f f {/ i+ t f J r J 4 J + =4 i f J 4 �f I� Y f ;+ outlet mot $wltcfi Settings sad Resarve ; Tank Vol= Dimmision Thebes Volume (34. 1 A ` >: ( B 2 -. G B ' y 'aep Hole Z dasd) D to . 5 i OffEl F � Total 4 — ;. ►► D .,. ►i S Vttom of T=k BIev, pt 9 ► r ►e s f +.'e eDJ�f J i s '. f t J c c i f e << •'• a . e+ J <. f GENERAL Lt'ST.AIXA.Tl N: The dose took is bedded and back $1lad in accordance with the nzastt.ficftnnr's product appwval spaoifloati=. Maximum depth of bury as specified by the mauxfiK9rcr mey not be exceeded 'without prior approval. Menhole covers exposed to grade have an effective lacking device (Padlock) dnstaileti, Piping at the inlet sad auttot is a£' approved material, conuxted to the tank with watertIght fittbW, and laid on stabto soil to prevent nettling or nagging. The fbree trAin is sleeved, wish 4 Sch. 40 PVC to bridge the t xeavadon and i3 sealed vOtatttgllt. 31e0trioai sarVirx compliez with MC 300 and Comm 16.23 Wis. AdM. Coda 03/05 le Page of Wisconsin Department of Commerce , SOIL EVALUATION REPORT Page 1 of `1 Division of Safety and Buildings ' in accordance with Comm 85, Wis. Adm. Code County Attach complete 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 Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. r Rev ewed by Date Personal information you provide may be used for secondary purposes Priva aw, s. 15.04 (1) (m)). Q Property Owner Property Location u Govt. Lot 571;:� 114 NJ: 1/4 S3 T 2� N R `(o E (or Property Own s Mailing Address OCT 0 4 2005 Lot # Block # Subd. Name or CSM# OCU o S` 7 City Q State Zip Co e `Phg� i�p�NT1' ❑City Village Town Nearest Road a+l F I C ?X ❑ New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate GPD Replacement ❑ Publi or commercial - Describe: Parent 011* - ✓ Flood Plain elevation if applicable ft. General comments �� c f'� �jfp•S'/ and recotfimendations: F-11 Boring # I❑ Boring Q IL^J Pit Ground surface elev. #01 ft. Depth to limiting factor 7 /00 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 a- iS use mv�R aw �►� y '2 I� 3 G7.� %s Sit `MAaX Mined 5s — :6 Boring ❑ Boring g Pit Ground surface elev. �D �� d 7 ft. Depth to limiting factor � Q z- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 DI 7 R3lz_ si 1b'XrxK thV4 W . . (I. 5 ii - 's 16 D .8' ` Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSE < 30 mg /L CST Name (Please Print) ture CST Number f7 G'. �Z /S�� / Address Date Evaluation Conducted Telephone Number SBD -8330 (R07 /00) i Property Owner Parcel ID # Page Z of Fz-1 Boring # ❑Boring pit Ground surface elev. �C�Q Depth to limiting factor ID O in. Soil Application Rate . Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2 0 .10 J ,s yk+3 /Z � S it /l/<'Sb �IU�I� QW 4 �U� � y �' Z ICS , TY1s - 1Z S,L fhASe A-v1W cxA . a 3 qz• 106 OF. `m to ❑ Boring # Boring ❑ 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 /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring ❑ Boring # El pit surface elev. ft. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (x.07/00) 16 lozo -A ' S NIF RA Zzi4/7� Se Coati s I s� 3� r S1 � �o ti FLED ~ 8 �" "Y � • 1994 •► JAMES O'CONNELL L/() /09) �- Regiver of Deeds St crax ca, w, C 3 �f S6) 516991 This instrument drafted by Ed Flanum Job No. 94 -18 0 o No a'a l o N O t7' O p 70 fi S - a v � C7 .- A n F'• �- .. .•• c '+• -a v o r rt = o n c G V d •n rt " � UNPLAT T LD LAND- O N 6 A :. rt SOO "W 225,00' o � = c� s cn .o rt 0 o+ c O AP PROV ED CD z to MAY 2 4 '941 °D 4 r V 10 V V .N O m w C p ST. CROIIX COUN I > N � � a r � i TJ fD En `;and •Mater I v 00 fi m and I r 0 rt m w Fw ttN I O Q Y• p Ii ond•d I JI O Fnl s It, w m Ys of I C7 �" w = ; p data p iv H Cn of be o o_ e w I �- w Ij I� old W m 1 W O 100 Roadwa Setback Line IL 3 ......................... Y..... ............................... E O _ O `n O n - K O N0O ° 00 * 0 WE 2 � t w CA NOeOdOd�E Q W C NOO ° 00 . 00 ° E A a' 0 19 T 5 - '- NOO'00'00 E W 225.00' 2137.31' to n i East line of the NE} of Section 23 w q� 0• S T R`E o �C C t&_ It Y• a Bearings are referenced to the 0 East line of the NE} of Section rn 23, assumed to bear N00 °00' 00 "E. VOLUME 10 PAGE 2758 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 487923 0 GENERAL INFORMATION State Plan ID N!� 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: Kobernick, Barry I C Ion, Town of 006 - 1051 -40 -100 CST BM Elev: f Insp. BM Elev: BM Description: Section/Town /Range /Map No: DO (V . C) flT hnm h �n 6�tL c��.a = C S T Q ( 23.31.16.345B TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 3 ( l�'O Bernchmarr. wo� 5.5D - IBS t r Dosing U Alt. B KkL1D ter "T = 7 Aeration Bldg. Sewer Holding St1Ht Inlet T ANK S ETBACK INFORMATION SUHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > 2,S7 , > 160 t r �-- Dt Bottom V - I Dosing , r Header /Man. ZS >' Aeration Dist. Pipe Holding Bot. System r .� 9�•Sa Final Grade \ PUMP /SIPHON INFORMATION Manufacturer n^ 1 . Demand St Cover 4u•�e 1 GPM Model Number �r` r �• � �, � TDH Lift Friction Loss Syst6m Head TDH Ft Forcemain Length t Dia. rr Dist. to Well SOIL ABSORP ION SYSTEM sm RENCH idth f Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME S 3 /_� ea SETBACK SYSTEM TO � P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer `/ INFORMATION CHAMBER OR l Type Of System: ' 3 2 � �'� 7 UNIT Model Numbed L r J (SL« DISTRIBUTION SYSTEM Header /Manifold, Distribution x Hole Size x Hole Spacing Vent to Air Intake Pip s Leng Dia Length Dia Spacing SOI OVER 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 OIVN (Inclu code di cr n es, perso s prese ,etc.) —� Inspection #1 /� : OY • /I Inspection Inspection #2: ^^� S V2+4JIQO Location: 20 8 250th Street Deer Park, 1 54007 (SE 1/4 NE 1/4 23 T31N R16W) NA Lot 1 Parcel No: 23.31.16.345B Alt BM Description= 2.) Bldg sewer length = - amount of cover = 3) v«.Que toy -b �e 2�4 S�S Plan revision Required? �.� Yes No Z Use other side for additional information.��� _ I - Date Insepctor's Signature Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division County D 201 W. Washington Ave., P.O. Box 7082 ��"�e S C eO visc Madison, WI 53707 - 708 nitary Permit N (to be filled in by Co.) De artment of Commerce (608)261 $ l IZ3 Sanitary Permit .A.pplieation state Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, persona m otmyy prq) may be used for secondary purposes Privacy w, sl S �ttpp y �' 1 Project Address (if different than mailing address) 1. Application Information - Please Print All Information O C T d 4 2005 2aAMA- ( 34Sg) Property Owner's Name Parcel # Lot # / Block # Q ST CRUX COUNTY d G (o -/O-S-/ -'SAO . -/00 ZONING 0-F-F49-F. Property O er's Mailing Address Property Location 2 so S NE v,, Section Z 3 City, State Zip ode Phone Number -tit. �v 71r-- ,2(9 - s3> r T N; R�1? II. Type of Building (check all that apply) 111 or 2 Family Dwelling -- Number of Bedrooms . 3 ❑ PubliclCommercial - Describe Use — ❑ State Owned - Describe Use ❑City ❑Village KTgwnship of A III. Type of Permit: (Chec only one box on line A. Complete line B if applicable) I B. ❑ New System tot. Replacement System TreatmentfHolding Tank Replacement Only ❑ Other Modification to Existing System Permit Renewal 11 Permit Revision D Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS stem: Check all that a !� Z fQ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground Q Ho ding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand titer ❑ Recirculating Synthetic Media Filter Leaching Chamb ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf I Dispersal Area Required (sf) Dispersal Area Pr *(so evation 0 0 VI. T ank Info Capacity in Total Number Manufacturer Prefateel Fiber Plastic Gallons Gallons of Units t t �t f} -1 t>t7 oncr Glass New Existing Tanks T A Septic or Holding Tank Jam" a Am 1k Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement 1 , the undersigned, ne sume responsibility for justsillati of the POWTS shown on the attached plans. Plumber's Name (Print) Plu is Signal e M umber 7u nes Pbono Number S �: /l-e Z /4 ! /f �`8 6637 Plumber's Address (Street, City, State, Zip Code) 3 S 1 410 f S ? Am -r - G✓.T SYoe VIII. County/Department Use Onl Approved ❑ Disaartroved (anitary Permit Fee ' eludes Groundwater Date Issued suin Agent Signat re (No Stamps) urcharge Fee) 2� �M ❑ O r iven Reason f enial 3"� S GW TX. Conditions Ap rov 3) 6y SYSTEM OWNER: _ nn 1 Septic tank, effluent filter and dispersal cell must all be serviced ! maintained as per q manag ement plan provided by plumber. � +� '� S t 2. All setback ack requirements uirements must be maintained ;�,c,� as per applicable code /ordinances. Attack complete plans (te the County only) for the system on paper not less t aw 8 x IRCIIC16111 Sbt t , UK SBD -6398 (R. 08/02) `.0"` q rte{ i -{'° r . : zn " / o le i j 2 �l04 lam'- - c : i � x i _ L t 1 n \ i i 1 i o1 X 1V`,�. s,3 , r,3 i r RA Z Z/ 4 /7 / _ te ----- I S • cf r 6 , d /D iii `Wisconsin Department of Commerce SOIL EVALUATION REPORT Page l of �l Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County 0 II/ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must / o 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 roa . Please print all information. Zed by Date Personal information you provide may be used for secondary u oses Priva aw, s. 15.04 (1) (m)). Property Owner --- Property Location Govt. Lot 15-e 1/4 NF 1/4 S,23 T �i N R & E (or)(Z) Property Own s Mailing Address Q C T 0 2005 Lot # Block # Subd. Name or CSM# ,20 a S` 7" City State Zip Coe SFhe(>gj*i W9NTY ❑ City Village fKTown Nearest Road 11 ¢•� WJ; FIG ❑ New Construction Use: ❑ Residential / Number of bedrooms Code derived design flow rate 0 GPD 1�5 Replacement ❑ Publi or commercial - Describe: Parent-material �' _ Flood Plain elevation if applicable ft. General comments ��� 56'.s—/ and recoi'iimendations: k F F] Boring Boring # Q 7 OCJ 9 Pit Ground surface elev. /60, O ft. Depth to limiting factor / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 4- I S . S- R3& S' L 1119S9C 1m11W a uL , Y Z ls3G 7.� l'rs SAY 2 ,03 , 1 Aak' NnaAi? 5 s 14 52,af1 /� ag Boring E] Boring ® g ®. Pit Ground surface elev. 0 ft. Depth to limiting factor Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 3 3 z -in c 7, 9YfV14 --� �s P m� — , s' /, a 0 .8 * Effluent #1 = BOD > 30 < 220 mg /L Gnd TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSE < 30 mg /L CST Name (Please Print) ture CST Number jo E'h/?IS (�" 22 / , V;7 / Address Date Evaluation Conducted Telephone Number 3 Z /Y0 IV s �,.�� 1' s / C�- A� o 7t �.� L fir- G 7 SBD -9330 (R07 /00) i Property Owner �" Parcel ID # Page 2— of Boring # ❑ Boring C� , ® Pit Ground surface elev. /40 7J ft. Depth to limiting factor /0 O in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz . C ' in. Munsell Qu. Sz. Cont. Gr. Sz. Sh. Eff#1 •Eff#2 0- /0 , s y ,ea /z S 11 /1444u Y Z von 2- rYa /Z S,C lhAgl( AvAe -=A 3 "12. /06 4 /6 F-1 Boring # ❑ Boring ❑ 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 ❑ Boring # ❑ Boring Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. SBD -8330 (R.07 /00) 7 f S'N' S� 3T3i UR /(,w ZZ / ma. ske0 3� O LD sl r tdt L�n� ''� SQ 10/05/2005 11:28 7152687020 GILLE TRUCKING PAGE 01 Dille T=Idng & Excavate I11C. 352 14& Street Amery, Vl 54001 Phone: (715) 268 -6637 Fax: (715) 268 -7080 FAX TRANSMMAL . Fax: D„ enn Dote: I Z 0 Pages: 3 CC: 0 urgent ❑ For Review C] Plow Comment 0 Pim" Ropy 0 Pie Pacyclo Naaes: 10/05/2005 11:28 7152687080 GILLE TRUCKING PAGE 02 Z POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page FILE INFORMATION \ tl ysnilit SPECIFICATIONS Owner Septic Tank Capacity /bB0 $I - NA Permit # �Z 3 Septic Tank Manufacturer �f r N Effluent Fiker Manufacturer E3 NA DESIGN PARAMETERS ❑ �NA Number of Bedrooms 3 ❑ NA Effluent Piker Model �p.�- P7<.2 • d Number of Public Facifity Units 1d NA Pump Tank �11 ity $'Q al NA Estimated flow (avOr'090l 00 g al/da y Pump Tank acturer ❑ NA 13 NA Design flow (peak), (Estimated x 1.5) Q gal /d Pump Manufacturer Pump Model ❑ NA Soil Application Rate al /da If ❑ NA Standard Influent/Effluent Quality Monthly aysrage• Pretreatment Unit Fats, Oil & Grease (FOG) 530 mg /L 1 ❑ Sand /Gravel f=ilter D Peat Piker Biochemical Oxygen Demand (BOP 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids ITSSI 5150 mg /L ❑ Disinfection ❑ Other: . Pretreated .Effluent.Quality..._.__ ..., ... .. Monthly-average Biochemical Oxygen pemand (I30D S30 mg /L AL In- Ground (gravity) ❑ In-Ground IDresaurizedl Total Suspended Solids (TSS) 00 mg /L 0 NA D At -Grade ❑ Mound Fecal Coliform (geometric mean) 510` efu /I00ml ❑ Drip -Line ❑ Other= Maximum Effluent Particle Size Y in die. 13 NA pti,er: 0 NA Other: 0 NA Otiaer: Q NA '*Values typical for dorneatle wastewater and septic tank effluent. Other. ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency D months) (Maximum 3 yam ,) Ell NA Inspect condition of tanks) At least once every: ,3 Aff earls) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y) of tank volume IJ NA ❑ month(s) (Maximum 3 years) d NA Inspect dispersal cell(s) At least once every: $1 year(s) ❑ month(s) ❑ NA Clean effluent filter At least once every: / MI year(s) ❑ month(a) Cl NA Inspect pump, pump controls & alarm At least once every: Q year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) other: D month(s) 13 NA At least once every: ❑ ear(s) 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 Malntainer; 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 cellW 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 regulator/ authority. When the combined accumulation of sludge and scum in any tank equals one -third IY.,) or more of the rank 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 S12 months, shall be performed by a certified POWTS Maintalner. A service report shall be provided to the local regulatory authorfty within 10 days of complexion of any service event. 10/05/2005 11:28 7152687080 GILLS TRUCKING PAGE 03 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 proceesik and /or damage the dispersal cell(sl- If high concentrations are detected have the contents of the tankls) removed by a septage servicing operator prior to use. System start up shall not occur when soli conditions are frozen at the infiltrative surface - During power outages pump tanks may fill above normal highwater levels. When power is rostored 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 perfermanc'e 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; frult and vegetable peelings; gasolene; 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 shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWTS 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 proposed structure, lot lines and wells. Failure to protect 'the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. of the POWTS a soil and site The site has not been evaluation must be performed to � ta area, locate asu'itable replacement 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> > SEPTIC. PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL. GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP Oft OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFiCULT Olt IMPOSSIBLE. ADDITIONAL. COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone S ( �( 3 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name S / , /, Phone -- phone ��`j ' 3 g�o' 7 �d This document was drafted in compliance with chapter Gomm 83.22(2)(b)( 1 )(dl &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. SYSTEM SPECIFICATIONS 'In- ground Soil Absorption Component Component Manual # 5 ,e,0 I o S r I Project Name: Distribution Cell Type Septic Tank Aggregate ❑ Non - Aggregate® Min. Septic Tank Vol. Req. 9� gal. Septic Tank Volum � /O - gal. Manufacture Type of Non - Aggregate Component r ManufacWrer Model Effluent Filter Z I Manufacturer Number of Bedrooms Model A /DD Soil Application Rate (DLR) 1 1SV gpd /ft (Designed Loading Rate) Pump Tank ` Wastewater Quality Manufacturer Treated ❑ Untreated Volume 7s0 Model Combined wastewater: Number of bedrooms Distribution Component gal /day /bedroom x 150 Distribution Box ❑ Daily Wastewater Flow (DWF) = Hydro - sputter ❑ Other Clear and graywater only: Manufacturer Number of bedrooms gal /day /bedroom x 90 Daily Wastewater Flow (DWF) = Cross section of distribution cell(s) Blackwater Number of bedrooms gal /day /bedroom x 60 Daily Wastewater Flow (DWF) _ Dispersal Area (Aggregate) f (DWF) (DLR) Dispersal Area (Non- Aggregate) EISA Rating P, / ft System sizing = DWF _ DLR _ EISA chambers (DWF) (DLR) (EISA) Diverter valve ❑yes ❑no Manufacture + Cross Sec of a Two Cell Lngt' ound Com ponent Using beaching Chambers � observation/Vent Pipes Finished Grad e-::= /°(, C Finished Grade ft. Cell Slope % = _ � Sepe rati i Original Grade = /o! ,� '`� ,� }r % , , ' �`I ;;''Original Grade ° } � � � � � � � YII � I � � O Chamber Top of Chamber — i , I;' ; / y r 'Tap Yt 1 1E �- ;-- •��, --� 1 1 } / cam, System Elev. System Elul. /(o. Trea;'ffi£nljh11d i.- .. •.•_ -. •,4 •� : b . .. + s 33 1.1fiI'ig f actor articular use. ate ials for the p + approved m ov ct adandc capped with r pipes e cans to PP Observat�onlVent pip s pP 1 w # CAS'+ daM'iY CURVE- MDDt;M_S ' 1�/�4140° �a'Etu�vr A D J]�19fA7ERWt} � e �a " FL uetei„ rU. lass. a ,ss as 344 O a 0 SASS >a !te + 4 4 0 , 1 40,4140 Wo an 7A2 95 Y� 0.14 AY 10 a0.87 313 f4+ 40 ,279 2, '�� 45 L'179 5 ?9 17 9R appap� lydi Ytl�2 4 I C, 75 O 7D O 0/UJAJ Id A 3A a0 5d so 70 80 90 ttlll 770 a lafk'R3 tilt tea 240 32O 400 s . : S O KiDW PER MVOJ7E gift" � 'fi ti i;7 Mb #.1 T FACMRY FOR SPEC MPMATUS { �.� • ��' ICHt3tt8Tf��S. �t1([ �itPt6S 81' T. �:RNirBt'�'s1YA}�ia�$TK�BU�T'�T ••c f en dtarm. � � • MaeltadcW alternator's, fordtpletc iJ - Oams, are ovelabo stto i} = �. _{ i • COPW alarm SpAerns are avd able b f pt pumps used In si MW -.F'FMS .H` .J T 8fC15$ system. See rwm. • VarisbMB � C011ttDM54J��� &t's#Isb18 t$tr CDfltrOt�KJ M varfebte Meve[ 9CC•t swlEd�s $� ava>�e forvarJ�la ��Q� � � %4eombOM3. 1. Ie dcvar McMal�t el a�i.u�iBpigt akYkr.3l'Si r_, " Seded Q*-ft Mb MS fOr Ud(JOr tlf flll'dtidm Sw FW 4` 0, W soft. Rob 1t1 t 77. - Over 13WF. (WC. spwW qr *: n Mgdred. 2. Mwtm*d a lWolor WPuk 10.0072 or 1O-)D 1 5, • Rerer to M 2WP F ap39 •x iJ M & See F=12 for amed mallet of l f ik; dw yak. 4. l+ariabieleYetcontVatsadlr 10.OWusedaes c.mWadvWo; {��t�se�• 5. F�1r( �tml a .5+}�C,jraa�tarnt�c.trm'sxa�g�t am�atlotiarwira�- Gtgi�imr 140 Swim - M Q r3. 4140 Sede3- 73 fits. or 2 purtp apodU) n.104M Satect Nreild rriodml Vags PM : dYtdo . N N14Q N410 116 1 ' Pkri 16.o � ar1 &S 2ar8 &4 1 18 2orS& AN WMahm +t J dwAMW:dfld* 1*dMMY 116 1 i� S 2 S e� �iM;TI 14Q 140 231 1 inn tM 1 8 2 W 3 & d ft MCA MWt pUbw Edo Cab Pq and ft -" uw+�n .re ,�I � s�wor run► �e�awnsarsaea�x OMM $VsrN# How AdP '4 J RESEM POWERM DEM For un usuo : oan(:rjgtons a reserve sdaly i'acbr is englneeeted info ite d esign of every 2oe ner pum I t» a. KY 4tr1S uwudsnt m* 01 . 90 tw o.rcr 4W11 -10W 29w. /939" O:i9/05 THU 14:09 FAX 715 386 4686 001 STC - 104 AS BUILT SANYTAR) SYSTEM REPORT ,C," „ OWNER Ic r, ADDRESS - P i � ., SUBDIVISION / CSM# P. _ t1 SECTION T I N -R 1 W, To an of �or� ,ST, CROIX COUNTY, WISCONSIN PLAN Vl EA SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N� 5b� ��+.......� „�•� . .;.XU,�- O -ti„!.1 .L aG_t.. , �_ . -,�. �,� o, ..� r.I� �l S ��i ,( �' �..� _7.c:�.z ,P ' l k a a Fx' , - -- - &D” d✓ v LIJ IL II `Y /.._� (o' INbICAT • NORTH ARROW Provide setback and elevat n }n - ormation On reverse of this form. Provide 2 dimension to e• of septic tank manhole cover - !l'3 %2 THU 14:10 FAX 715 386 4686 0002 § 'ADM SANITARY PERMIT, %PPLICATION •• ;r;,�,.,,� _,�,, In accord with ILNR 83.05, Nis. Adm. Code COUNTY kit�lrtta�altaitttw� --Atta , h complete plans (to the county copy only) for the system, on par or not less than STATE SANITARY PERMIT 8% x 11 inches in size. 9 d ET - See reverse side for instructions for completing this application. ❑ Check If revision (0 pr wlous application I. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. STATE PLAN I.D, NUMBER at t,Tt' o1�uNi R // PROPER• Y lOCA11gN S % ti�l-` %, S _�:3 7 .3/, N, R /� (0) W i r i'!FE:F %T1wN,R;S MAILfNG A!� R @SS !OT # BLOCK # ITV, Al S TAr.E ZIP CODE PHONE NUMBER SUB01W ON NAME OR CSM NUMBER "I IMF BUILDING! (Check one) CITY NEAREST ROAD ❑ State Owned 0 v 3E }� Public 01 or2Farn. Dwellin I � r � 7 r' s�i:LG g of bedrooms - R EL 1 4 NUMBER(S) III. BUILDING USE: (If building type is public, check all that apply) 1 Q .Apt/Condo Assembly Hatt 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility amhground 7 ❑ Merchandise: Sales /Re lairs 11 ❑ Restaurant/Bar /pining I u: chlSchaol 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash LJ Hotel /Motel 9 ❑ Office /Facto :. -• --. „�.._ _,...... 1 Y 13 ❑ Other: Specify +TYPE OP PERMIT: (Check only one in line A. Check line B if • applicable) . �-� ".'4"ew Re 2. D Replacement 3 - ❑ lacementof 4. 8 .stem S ystem P ❑ Reconnection of 5. 11 Repair of an - 9 II I Y Y Tank Only Existing System Existing System B) LJ A Sanitary Permit was previously issued, Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Expt rimental Other I Se.-page Bed 21 ❑ Mound 30 [ ] Specify Type 41 [71 Holding Tank t I c epage Trench 22 Q In- Ground 42 ❑ Pit privy :3 .L. Seepage Pit Pressure 43 11 Vault Privy '14 rJ System - Fill " W0 933 RPTION SYSTEM INFORMATION; L iNS Plc`A DAY 2. ADSORP. AREA 3• ABSO RP. AREA 4. LOADIN( RATE 5. PERC. RATE 6. SYSTEM ELEV, 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /dat fsq. ft.) (Min, /inch) ELEVATION GAPACiTY S ) Feet 9_ 5 Feet Yfl. TANK in allons Total Manufacturer'! Noma Site INFORMATION a Prefab- Fib Exper. New istin Gallons Tanks oncret Fiber- s Con- Skeel Plastic _ — Tanks Tanks strutted glass App. N4 N A- ('; ii��1:3161LITY STATEMENT "he unlersig a responsibility for installation of the onsit sewage sy .tom shown on the attached plans. b , hta (Print): Plumber's Sig ure: (No St psi r ne MPS,; Business Phone Number; j. 'im , r•c, , - address (Street, City, State, Zip Cgdeja T IX. CO / r D – E � PARTIIIII T USE ONLY w J � 7� ❑ Disapproved Sanita Permit Fee pn1 ri roundwater a e ssu Issuing Agent Signature o Sta mps) / / Approved ED owner Given Initial Su rcharge Fee) / •.. .. Adv erse eterrnin on 1� OF APPROVAL /REASONS FOR DISAPPROVAL: 7 ,t: * pi.�- 7) (R. 11/88) DISTRIBUTION- Original to County, Ono Copy To: safety & Suildings Division, Owner, Plumbar %".IU ZONING �1EM0 TO: N S (i < <-LG Code Administrati FAX NUMBER: 715- 386 -4680 Landlnformati FROM: &VI AJ Planning FAx NUMBER: 715- 386 -4686 715 -386- 4 Re roperty PHONE NUMBER: 38y,, - 494 -386 -4677 Re ling NUMBER OF PAGES, INCLUDING COVER SHEET: 71 6 -4675 RE: & � ! 0- 5 ST. CRO1x COUNTY GOVERNMENT CENTER 110 1 CARM/CHAEL ROAD, HUDSON, W/ 54016 715386 FAx PZ W WW.C O.SA INT- CROIX.WI.US S T C -- `,105 'SfPTXC TANK MAINTENANCE:AGREEMENT St. Croix County OWNER /BUYER Mr. Barry Kobernick ADDRESS 2058 250th Stree• FIRE NUMBER 2058 CITY /STATE DeerPark c ZIP 54007 NE 1 4 SECTION 233 , T N -R 16 W� PROPERTY LOCATION: SE ],'4,_ _ TOWN OF Cylon , St. Croix County, SUBDIVISION N.A. LOT NUMBER N.A. . 11API Wiper use and raIn,- enance of your sept system could result in its premature failure to handle wastes. Proper maintenance consists 'Of! pumping out the septic tank every three years or-sooner, if needed a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in'the >aste disposal system. St. Croix County residents may be eligible to receive a grant for , a maximum of , 60� of the _cost of, replacement of a failing system, which wasp "in ,operation prior to- Ju ly'1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems ,'agree to keep their system properly maintained. The property owner agrees to submit'to, St. Croix Zoning a certification form, signed by the .owner and by a mater plum4er, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site, wastewater disposal system is in proper operating condition-: and ( 2) after inspection and pumpi ng (if necessary)', the septic tank is less than 1%3 full of sludge and SCUM. I/Wt, the undersigned have read the ,above requirements and agree to maintain the private sewage dispos. k system in accordance wita the standards' set, forth; - herein, as set the Wisconsin DNR. Certification stating that-your septic has been maintained must be completed and returned'to the St. Croix Co. Zoning Officer within 3o days of the three year expiration date.` SIGNED: .JeJ DATE ,3 � j � 2- - --. St. Croix co. Zoning Office 911 4th St. Hudson, WI 54016 St. Croix County Final Property Report Page 1 of 1 St. Croix Cou 2005 Property Report Print Report Generated: 10/5/2005 3:04:33 PM Data Updated: 10/5/2005 4:00:00 AM PARCEL COMPUTER NUMBER: 006 - 1051 -40 -100 PARCEL MAP NUMBER: 23.31.16.3458 2002 1 2003 1 2004 1 2005 1 < -- Click on the year to select the annual record. (* & dark red = delinquent) Property Description Billing Information Municipality: 006 - TOWN OF CYLON Name / Attn.: BARRY A KOBERNICK Document Number: Address: 2058 250TH ST Volume & Page: V1069, P364 Public Land Survey: SECTION 23 T31N R16W City, State, Zip: DEER PARK, WI 54007 Quarter: Country: USA QQ / Tract: Ownership Plat: NOT AVAILABLE Primary Owner: BARRY A KOBERNICK Description: SEC 23 T31N R16W PT SE NE BEING Address: 2058 250TH ST LOT 1 OF CSM 10/2758 2 ACRES Total Acres: 2.00 ACRES City, State, Zip: DEER PARK WI 54007 Site Address: 2058 250TH ST Country: USA Secondary Owner: Assessed Value Other Valuation Date 9/8/2004 Fair Market Value: Not Assigned Assessment Type Acres Land Improved Total Assessment Ratio: Not Assigned Value Value Value Net Assess. Val. Rate: Not Assigned G1 - RESIDENTIAL 2.00 15,000 249,500 264,500 School District: 3962 -NEW RICHMOND Totals - -> 2.00 15,000 249,500 264,500 - 2005 TAX MASTER NOT BUILT YET - http: //72.21. 230.178 /website/LRPortal /total _process. asp ?IDValue = 006 - 1051 -40- 100 &SE... 10/5/2005 CERTIFIED SURVEY MAP Located in part of the SE; of the NE; of Section 23, T31N, R16W, Town of Cylon, St. Croix County, Wisconsin. NE CORNER SECTION 23 Q /\ W OWNER N Grace Kobernick U RAT I `� LAN' g A M ; 2061 250th Street — -- "— — 8 C Deer Park, Wi. 54007 e a ; �' U - N90 00 00 W 387.20 z 354.20' 1 33.00' ,� o u o 0 I o v z c • S �iq � u t a L {' 41 4 O 0 L O W 0 uj (!II " v • " LOT I b " {sJl N N d 1 16 1( 0 4 of A 2.00 Acres Inc. AJW c 33' 33' 1 -1 m w n d et• .j v La 87,120 Sq. Ft. Inc. RJW a: (nl a L r rn w y xc. � • t_71 lu r? 3 I 1.63 Acres E AJM ,,: u W ,., T W J e { 1 I_ o o 1. 79 595 Sq. Ft. Exc. RJW s: o O a �L } C 3 0 o 11 w SaN1 -7 p �: oo O Ni Jl s O Z O o ?I O D �1 Q7 '� 11 0 Z w 0 Li �� , ., fA m s S90 "E 387.20' LEGEND 66 Aluminum County Section Monument Found UNIPL A I ICJ �_��i JG� , o, S-S4.7 _ w 1 W W liu!)SON, , n y 2 Iron Pipe Found b a g �S(15. �' 0 V x 24 Iron Pipe Set, weighing 1.68 W } : o °° , �qN rr z „ 8 o D Sty Ft A lbs. per linear foot. z 0 `_ E a tt NI V «� ,, 100 150 200 EI /4 CORNER �, SECTION 23 Wisconsin Department of Industry PRIVATE SEWAGE SYSTEM County: Labor and Human Relations ST. CROIX Safety and Buildings Division I NSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Pejput�ti.nldecI&e: BARRY ❑ City El Village IR Town of: State Plan ID No.: 1CC�V�i.G,,��jj��((11 CC::KK � CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 4 ,, ; r 1� y � � Benchmark 1 1, Dosing -765 Aeration Bldg. Sewer /0 �� �/5 7 Holding St/ Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet //, V3 TANK TO P/ L WELL BLDG. Ai Intake ROAD Dt Inlet tv 6 9� 17 ent Septic yaS' �</ 4 / J- NA Dt Bottom , 7 Dosing s g� NA Header /Man. 9, 3� q7S7 Aeration NA Dist. Pipe q ' s �'a X 54/ 47. Holding Bat. System q q? o3' PUMP/ SIPHON INFORMATION Final Grade y Manufacturer Demand Model Number t k � GPM (5�4 ,fi TDH Lift Friction System TDH Ft Fi ead Forcemain Length Dia. Dist. To well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �� �D I DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: SETBACK INFORMATION Type Of J �{ CHAMBER Model Number: System: _f `D',,3 f 3 r ' /I/�/* OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake 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 [I Yes ❑ No COMMENTS (Include code discrepancies, persons present, etc.) 8k,"77 LOCATION: Cylon- 23.31.16W, SE, NE, 250th Street �s✓r� ` "� "'T �F S l C � Plan revision required ? L] Yes ❑ No Use other side for additional information. y SBD -6710 (R 05/91) , + p ', I d ` Date Ins edor's Signature Cert. W Bowman Plumbing, Inc. - Master Plumber No. 5875 Page 1 of 1 2819 Knapp Street Menomonie, WI 54751 (715) 235 -4634 N FAX (715) 235 -3650 PUMP PLAN — BARRY K OMMIC K Barry Kobernick SE4NE4S23T31N /R16W Cylon township St. Croix county Part of 2 acres . 1Ya uses` �Jr�e -Jo. 'Jack A. Bowman MP 5875 - - -- X yt-i" "A =1 Vlom� LEGEND BM: 100.' base of white stake with orange ribbon System Elev. 95.5' 40 2 trenches 5' X 60' X borings X * * * ** Proposed system area meek o all required set backs of ILHR 83 X ®' X Qqk Rd 'igconsih Department of Industry SOIL AND SITE EVALUATION REPORT Page of ,bor fnd Human Rel .1Uons ivision of S;�fity & Ruildmgs in accord with ILHR 83.05, Wis. Adm. Code COUNTY ttach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but >t limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # mensioned, north arrow, and location and distance to nearest road. PPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION GOVT. LOT - 1/4 l,-' 1/4,S 3 T 3/ ,N,R 16 E (01 PROPERTY 0 ER':S MAIVNG ADDRESS L LOT # BLOCK # SUBD. NAME OR CSM # CA Y, STATE 4. ZIP CODE PHONE NUMBER [:]CITY []VILLAGE [MOWN NEAREST ROAD 2 l r Y /) d "; r✓' /tea o� 'd New Construction Use Residential /Number of bedrooms [ J Addition to existing building j Replacement [ ] Public or commercial describe ,ode derived daily Flow LSD gpd Recommended design loading rate _gy bed, gpd ft -g trench, gpd/ft Absorption area required bed, ft2 _4-;< trench, ft Maximum design loading rate ¢ gi bed, gpd /ft gpd/ft2 lecommended infiltration surface elevation s) ft (as referred to site plan benchmark) Additional design / site considerations Parent material /Ipc a. Flood plain elevation, if applicable ft a Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK J= Unsuitable for s stem S O U gs O U prs O U t�'S O U O S JZ L O S SOIL DESCRIPTION REPORT ing# Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouxlay Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trertdl I,2-, r e9�— / � f� and 14 7d ,.-_ _ z2 �?_ / nth to 5ng Dr Remarks: ing # "M and 7 1 )th to ting Remarks: 3T Name:—Please Print ✓" P one: idress: ignature: Date: CST Number: IOPERTYOWNER �Urr' /� �ci r c 4SOIL DESCRIPTION REPORT Page Of Y MEL I.D. # oring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourd3y Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trerch 3 round - ev. �epth to miting 3CtOL Remarks: oring # ��J around �h• )epth to imiting a a ' 3 Remarks: Loring # ` around Depth to imiting tV Remarks: 3oring # Ground elev. ft. Depth to limiting factor Remarks: Rh-aaanrR ncro�� Plot Plan ` Project Name rr ems- c14/- Byron Bird Jr. System Elevation �5" - S" r CST# 3479 Benchmark H. R. P. d Boring d Well 1 JJ r , > "xe -� X� s/ FILED 8 MAY `' .. 1994 a► 2 JAMES O'CONNELL �. Register of Deeds 516991 St Croix Co., W, � This instrument drafted by Ed Flanum Job No. 94 -18 0 • O N G) O Z r z 0 f° t+] 0 t . N D t-4 N N Cn K N 0) N C T X H 8 T N (D M N O = fD F 7 C z = r• = o m c y -n I- 0 o m a 0 o cn r rr rt 0 =' S00 "W 225.00' 3C 3C rr -n A� 7. O C 0 co °O = a f-h rt AP PROVED z MAY 2 4 '941 � ✓ v .N o+ co ✓ 0 0 to w No o I� Fh Si' . CROIX CO UNTY 1 r– to n n Z (� oZ� a ('iOf M 4� N f) c- 1 O `° a I rr m and r p rrrr m rt �-+ --� Fir nittee > O X O v 0 m �' :' —4 rn 1 -1 0 X p If �ordsd j �, j _ _ 1 f �� � psi ays of 10 rn w �_ w a vat date . .4 d app v a* be o o I i w e 1F�►oid I CD v I> z< 1 0 IC7 N NO 1C7 IW O 100' Roadway Setback Line I 1 r N rn � H o £ 0 rh n N �C O N00 ° 00' 0 0 "E 2 0 � w w w W w N00 0 00'00 "E C W O N00 ° 00'00 "E r � n � m 265 .00' N00 °00'00 "E w 225.00 2137.31' mm K -4 A East line of the NE} of Section 23 w 1r, 0 0 0 - o Z Z z X W rn B - 250 I I-I S l RLE` I W� n – 0 rt S . , � r.. Ct� r.. a w T;' ?3 r �. ti y ` k `" Bearings are referenced to the Z 0 � % ' 0 cr w w East line of the NE} of Section r 23, assumed to bear N00 ° 00'00 "E. N• eG " VOLUME 10 PAGE 2758 i SU CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, hereby certify that by the direction of Grace Kobernick, I have surveyed, mapped and described the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in part of the SE1 /4 of the NE1 /4 of Section 23, T31N, R16W, Town of Cylon, St. Croix County, Wisconsin; further described as follows: Commencing at the E1 /4 corner of said Section 23; thence N00O00'00 "E, along the east line of the NE1 /4 of said section, 265.00 feet to the point of beginning; thence continuing N00O00'00 "E, along said east line, 225.00 feet; thence N90 "W, 38 ".20 feet; thence S00o00'00 "W, 225.00 feet; thence S90 "E, 381.20 feet to the point of beginning. Above described parcel is subject to right -of -way for town road (250th Street) ind all easements of record. I, also certify that this Certified Survey Map is a correct representation r-o scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236..34 of the Wisconsin Statutes and the Land Subdivision Ord._nance of the County of St. Croix in surveying and ,mapping the same. Each parcel shorn on this map (plat) is subject to state and county laws, rules and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel cont;ict the St. Croix County Zoning Office and appropriate Tows Board for advice. VOLUME 10 PAGE 2758 MORTGAGE DESCRIPTION A parcel of land located in part of the SE1 /4 of the NE1 /4 of Section 23, T31N, R16W, Town of Cylon, St. Croix County, Wisconsin; further described as follows: Commencing at the E1 /4 corner of of said Section 23; thence N00 °00'00 "E, along the east line of the NE1 /4 of said section, 265.00 feet to the point of beginning thence continuing N00O00'00 "E, along said east line, 225.00 feet; thence N90 "W, 387.20 feet; thence 500 "W, 225.00 feet; thence. S90 0 00'00 "E, 387.20 feet to the point of beginning Parcel contains 2.00 Acres and is subject to right -of, -way for town road (250th Street) and all easements of record. Note: The above described parcel was created for mortgage purposes and may not be deeded as a seperate land parcel. A -E7 Waiver I, Allen C. Nyhagen, and I, Barry Kobernick agree to waive the requirements for land surveys as set forth in A -E7 of the Wisconsin Administrative Code as the corners of the land parcel described above have not been monumented. Allen C. Nyh ge Date Bart'r Kobernick Date 4 Revised March 15th, 1994. I S C - 100 This. application form is to be completed in full and signed by the owner(s) of the property. being developed. Any inadequacies will only result in I delays -of tike permit issuance. Should this development be intended for resale by- owner /contractor,(spec house), then a second form should be retained and completed when the property` is sold and submitted to this office with the appropriate deed recording. Owner of property _ Mr . Barry Kobernick Location of property 1/4 NE 1/4, Section 23 T 31 N -R 16 W Township Cylon Mailing address 2061 250th Street Deer ParY WI 54007 Address of site `a-p g o`�SO �{ '� � c rk, ��- tAc)o subdivision name N, - Lot no. t� - Othe homes on property? yes ._. No Previous owner of property Total size bf parcel c cr5 Date parcel-was created Are all corners and lot lines identifiable? Yes _.X_ Is this property being developed for (spec house)? Yes _2<_No Volume AA and Page Number ._ as recorded with the Register of Deeds. which` ncludes-a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER & Psen In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing proce3s. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I(we) certify that all statements on this form are true to the best of my ( our) knowledge that 1 (we) am ( are) the owner: (s) of the property described in this information' form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. 5 11,%y l _ , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the constrmnt'. of said system,, and the same. has been duly recordad i n th,. !+f{ R of rou - if 'GP Pr �f dPFric �c T1nn��mP_nt No. � �ay� v Signat of applicant Co- applicant Date of Signature Date of Signature S T C -- 105 SEPTIC TANK - MAINTENANCE AGREEMENT St. Croix County OWNER /BUYER Mr. Barr Kobernick ADDRESS 2058 250th Street FIRE NUMBER 2058 rITY /STATE DeerPark EG...,�., ZIP 54007 PROPERTY LOCATION: SE 1/ 4 ,NE_1 /4 , SECTION 23 T 31 N_R 16 W TOWN OF Cy1on , St. Croix County, SUBDIVISION N.A. � , LOT NUMBER N.A. . Ij). use and, - nai. -tanan e of your septic system could result in its premature failure to handle wastes. Proper maintenance consists 'of , pumping out the septic tank every three years or sooner, if needed by.a licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. ` St Croix County residentc may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was "in; operation prior to July A, 1978. St. Croix County accepted this program in August of 1980, with the requirement that. owners "`of all new systems agree to keep their system properly maintained. The property owner agrees to submit'to St. Croix Zoning a certification for signed by the .owner and by a mater plumger, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and,. (2) after inspection and pumping (if necessary)', the septic tank is less than 1/3 full of sludge and SCUM. s /WE�, the undersianed have read the above requirements and agree to maintain the private sewage disposal system in accordance wita the standards set forth,.-herein, as. set 'by the Wisconsin DNR. Certification. stating that your septic has been maintained must be completed and returned to the St. Croix Co. Zoning officer within 30 days of the three year expiration date. SIGNED: _ St. Croix co . Zoning Office 911 4th St. Hudson, WI 54016 I DOCUMENT NO. W ARRANTY DEED THIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2 —1982 51.4 !I Grace L. Kobernick,_ a single.- person_-- _._.._.. F iRE CROIXC ®.r W1.y,; ------ ..................... o'd f oe Record - - - - - -- - - - -- ----- ---------------- - - - - -- ---------------------------------- - - - - -- ----------- - - - - -- - R 1 �' 1994 -- -- - - -- - -- • -- -- -- -- - - - - -- - - -- -- -- - - -- -. - - -- - - - -- Barr A. Kobernick a sin le 9:60 A. ct conveys and warrants to --- y--- •------------- ------- • • - -• - -- •- - - - -•• . g- - - - - -- ct Person,. ----------------------- - - - - -- ------- - - - - -- rf •-- -- -- - -- . -- -- ter of De- �� Rt:�45 n °'.°'� i I ...... ........ ...---------------------------------------- ...... - ----------------------------- i i RETURN TO ... ...... ...... ..... ....... . . . . . .1 ------------- the following described real estate in ....... t. ... . . roiX County, I - - - - -_ ------ State of Wisconsin: .I Tax Parcel No: .............................. A parcel of land located in part of the SE4 of the NE4 Section 23- 31 -16, St. Croix County, Wisconsin, described as follows: Commencing at the E4 corner of said Section 23; thence NOT-00'00"E along the East line of the NV,- of said section 265.00 feet to the point of beginning; thence continuing NOOD00'00 "E along said East line, 225.00 feet; thence N90 ° 00'00 "W 387.20 feet; thence SOOD00'00 "W 225.00 feet; thence S90 °00'00 "E, 387.20 feet to the point of begin- ning. Parcel contains 2.00 acres and is subject to right -of -way for town road (250th street) and all easements of record. b i Ex MP'T This __..... iS_- no homestead property. (is) (is not) i �I Exception to warranties: Municipal and zoning ordinances of record and recorded easements, restrictions and reservations. !I it it Dated this - -- -_ . - -- .. - - - - -- day of -------- - - - - -. Ma 94 ... Ij 19 ' I --- - - - --- ------------- ---- --- ----- -- --- --- - -- - - -- ---(SEAL) ��L-z �._, - - ......(SEAL) I� ii --- •------ - - - - -- ------------------------------------------- - - - - -- --- - - Gra --- - - - - - - - e - -- L ..- Kobe- -----rni- c- - - - -- k - - - - - -- -- it - - - -- •--------- _-------- - - - - -- (SEAL) ----- ----- -------------------- - - - - -- - - - - - -. (SEAL) I AUTHENTICATION ACKNOWLEDGMENT Signature (s) ------------------------------------------------------------ STATE OF WISCONSIN ----- •----- - - - - -- - - ---- -------- --------- - - - - -• ----------- --• - -- - - -- Polk ----------------- - - - - -- County. g 15th ill authenticated this day of__.____ - - -- - - - - -- 19 _.__ Ma d o ally came before me h _..•.._..._.___ay of 4 19.. ___ the above amed Grace L: Koberi'lick, a sing.Le l person ---•----"--------------------------------------------- - - - - -- ----------- -••••• ---- - - - - -- --------- TITLE: MEMBER STATE BAR OF WISCONSIN ----------- -- - - -- ` -`t, ti�, ........------------- ---- - - - - - authorized by § 706.06, W . (If not_ .... __ __ ___ _ _ .. -- Wis. Stats.•- --- to me know � ����, � who executed the is. tatsJ�� ea Mori foregoing i e e. e THIS INSTRUMENT WAS DRAFTED BY ---- ---'-- • -- B_ex ..I?.,.__Peteg.s __ -- Attorney at__ Law `i_a� !.. C.lear__l.ake_,._ .IaI_. 54 095 Notary m b ;: -:`' c Sfl ..ot Signatu may be authenticated or acknowledged. Both , f not state expiration not necessary') date: -- -- - - - --- - - - - - -- - - - - -- ---- -- .._....-- -- ...._...... 19 ......... ) 1 persons signing in any capacity should be typed or printed below their signatures. ,ARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc. FORM No. 2— 19g2 Milwaukee. Wisconsin _ Parcel #: 006 -1051 -40 -100 01/05/2005 09:19 AM PAGE 1 OF 7 Alt. Parcel #: 23.31.16.345B 006 - TOWN OF CYLON Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * BARRY A KOBERNICK KOBERNICK, BARRY A 2058 250TH ST DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * _2058 250TH ST SC 3962 NEW RICHMOND SP 1700 W ITC Legal Description: Acres: 2.000 Plat: N/A -NOT AVAILABLE SEC 23 T31 N RI 6W PT SE NE BEING LOT 1 OF Block/Condo Bldg: CSM 10/2758 2 ACRES Tract(s): (Sec- Twn -Rng 401/4 1601/4) 23 -31 N-1 6W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 1069/364 WD 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 52787 260,000 Valuations: Last Changed: 09/08/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 15,000 249,500 264,500 NO Totals for 2004: General Property 2.000 15,000 249,500 264,500 Woodland 0.000 0 0 Totals for 2003: General Property 2.000 10,000 193,900 203,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 04117/2001 Batch #: 512 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 STC - 104 AS BUILT SANITARY SYSTEM REPOR OWNER MR. 3 Q12(1U �eb ecn��k I u L '.E. ADDRESS sr ch�,x .5400 L9 zow� � 1, SUBDIVISION / CSM# 0 , SECTION a3 T 31 N -R i W, Town of Q 41or, ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM N� 0 QV4 Y 1 PP116111 1 FuU _fi tr �I a l `All Ll �7D I I ��J�➢- v,cS�2,_ J' X �l}C� I >(aa i t - �D 8o INDICAT NORTH ARROW Provide setback and el�evat n reformation on reverse of this form. Provide 2 dimensions I to cenLer of septic tank manhole cover. ' v BENCHMARK • vY ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATION Manufacturer: Li quid Capacity: oTISO �� V Setback from: Wel House Other Pump: Manufacturer -bw r"WA8E,l Model# -P - , 4o Size �a a� ya w Float seperation Gallons /cycle: Alarm Locatio SOIL ABSORPTION SYSTEM Width: p� �o Length 0 _ Number of trenches Distance & Direction to nearest prop. line: Setback from: well: Its. House 5 3 Other ELEVATIONS ham. Building Sewer ST Inlet. ST outlet PC inlet PC bottom Pump Off Header/Manifold_ — Bottom of system Existing Grade Final grade DATE OF INSTALLATION: JI,�Qy 19 PLUMBER ON JOB: L.oR LwARRRbee. LICENSE NUMBER .A PR s 39 a3 INSPECTOR: O". 3/93:jt =jEal SANITARY PERMIT APPLICATION In accord with ILHR 83.05, Wis. Adm. Code COUNTY STATE SANITARY PERMIT # r -Attach complete plans (to the county copy only) for the system, on paper not less than (9I M ❑ 8% X 11 inches in Size. Check if revision to pr application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. ,PNPERTY OWNER v PROPERTY LOCATION /, 2 / C �� -7L Y4 AIZ- Y4, S 3 T .3/ , N, R Alo o W PROPERTY WNER' ' C AILI�IG Apo ESS LOT # BLOCK # 11 Al ✓; TY, STA, ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER _ IP P, OD 71 .265' /J/ l✓• 4 • CITY NEAREST F OAD 11. TYPE OF BUILDING: (Check one) State Owned ❑ VILLAGE: ' :C /D o7�c> .si`2GG� ❑ Public 0 1 or 2 Fam. Dwelling -# of bedrooms 111. BUILDING USE: (If building type is public, check all that apply) 00 4 _ e q,.57 .� /0D q 3 1 El Apt/Condo ✓ _/ 2 ❑ Assembly Hall 6 ❑ Medical Facility /Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant/Bar /Dining 4 ❑ Church /School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car Wash 5 ❑ Hotel /Motel 9 ❑ Office /Factory 13 ❑ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. 0 New 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Reconnection of 5. ❑ Repair of an System System Tank Only Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit # — Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 ❑ In- Ground 42 ❑ Pit Privy 13 ❑ Seepage Pit Pressure 43 ❑ Vault Privy 14 ❑ System -in -Fill VI. ABSORPTION SYSTEM INFORMATION: 1 GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals /day /sq. ft.) (Min. /inch) ELEVATION 0" AJ �5,6 Feet 9 9' 0 Feet VII. TANK CAPACITY Site in alIons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New lExisting Gallons Tanks Concrete structed glass App. Tanks I Tanks Septic Tank . r- ° E n 0 4 AL N A El F-1 I Ll E1 1 0 Vill. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's ure: (No S ps) MPpNe.: Business Phone Number: ?75 /5 ;�5 -��3f� Plumber's Addre (Street, City, State, Zip C ' , :i2p1 c iv ��iv� ) s� s IX. COUNTYIDEPAR OM ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater a e issued Issuing Agent Signature o Stamps) OApproved El Owner Given Initial lq Surcharge Fee) R Adverse Determination X. CONDITIONS OF APPROVAL /REASONS FOR DISAPPROVAL: 'BD-6398 (formerly Plb -67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years.. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation. 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you -have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety & Buildings Division, 608 - 266 - 3815 To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use: If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in linle A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type, VI. Absorption system information. Provide all information requested in #1 -7. VII. Tank information. Fill in the capacity of every new and /or existing.tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. installing plumber is to fill in name,-license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than 8'h x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump " performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD -6398 (R.11/88) Parcel #: 006 - 1051 -40 -000 01/05/2005 09:18 AM PAGE 1 OF 1 Alt. Parcel #: 23.31.16.345A 006 - TOWN OF CYLON Current OX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * KOBERNICK, BARRY A & PENNY M BARRY A & PENNY M KOBERNICK 2058 250TH ST DEER PARK WI 54007 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 3962 NEW RICHMOND SP 1700 WITC Legal Description: Acres: 37.00 )Plat: N/A -NOT AVAILABLE SEC 23 T31 N R1 6W SE NE EXC PT TO PARCEL Block/Condo Bldg: DESC 1069/364 & EXC PT TO CSM 10/2758 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 23 -31 N-1 6W Notes: Parcel History: Date Doc # Vol /Page Type 08/04/1997 1255/347 WD 07/23/1997 1069/364 WD 07/23/1997 950/409 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 52786 Use Value Assessment Valuations: Last Changed: 11/05/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 37.000 3,500 0 3,500 NO Totals for 2004: General Property 37.000 3,500 0 3,500 Woodland 0.000 0 0 Totals for 2003: General Property 38.000 29,200 0 29,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 04117/2001 Batch #: PRGRM Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 WisconaMP(partment of Industry SOIL AND SITE EVALUATION REPORT Page I of 3 Labor aFOHuman Relations division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code ' COU Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but 57/" ro not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. e /OS / APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R DATE 45� PROPERTY OWNER: PROPERTY LOCATION r GOVT. LOT 1/4 1 /4,S T ,?/ AR IC E (c W� PR R':S MALYNG ADDRESS LOT # BLOCK # I SUBD. NAME OR CSM # o� f!z S1L .�az y0� t p ia 4 s� Cl ST A ZIP CODE PHONE NUMBER ❑CITY OVILLAGE MOWN NEAREST ROAD 4 e'— rit 6CIr v� - e New Construction Use Residential/ Number of bedrooms �3 [ J Addition to existing building ] Replacement [ ] Public or commercial describe Code derived daily flow 46 gpd Recommended design loading rate .7 7 ed, gpd/ft - � trench, gpd 1ft Absorption area required j� 4 g Z bed, 111: :J trench, ft Maximum design loading rate - , - ,7 bed, gpd /ft -1 trench, gpd1ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations �o S i Parent material a, � Flood plain elevation, if applicable �,L`. ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem S❑ U S❑ U S❑ U 1�'S ❑ U ❑ S U ❑ S SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trer>ch :........._. r - 1 C Ground elev. � . ft. Depth to limiting factor �• r Remarks: Boring # 2 z a v ?ti! iii ti:: t- t A Ground elev. 7-7- ,/ Depth to limiting factor Y ` U Remarks: CST Name:-Please Print XZ r� P one: 7� r Address: Signature: a Date: CST Number: 7 PROPERTYOWNER �i�"c�rr y/Sc� ✓J��/� r c )<SOIL DESCRIPTION REPORT Page�%&of_ PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourbary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ....__ r Ground ©,h'I elev. f Depth to limiting facto Remarks: 5—foring # y� At 1 , ,G.dt;': v tiP,•X + `:i �� r '\ 11 fxg Ground el v. ��t. Depth to limiting � Remarks: Boring # ' Ground e v. (ft. Depth to limiting f t . Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) Qu. Sz. Cont Color MEMO �il3�L'�1Sl�l WA W�M� o Mv MI N ., WAW�u W, d, M. Pffl�WA WM M MWA o o Mv mm =�Mmm r Plot Plan �� � B ObnBird Jr. Project Name � E.- c// y System Elevation 5^ �� CST# 3479 Benchmark H.R.P. d Boring d Well J,3 Ik 0 le e�� . 0 r Plot Plan ��� Project Name ' rr E, - c�"/ Byron Bird Jr. System Elevation 1 5�- �� CST# 3479 Benchmark H. R. P C7 Boring Well �9 e ,l �G v 2e 2s ISO c CERTIFIED.SURVEY MAP Located in part of the SE; of the NE'h, of Section 23, T31N, R16W, Town of Cylon, St. Croix County, Wisconsin. NE CORNER 1 j SECTION 23 OWNER g ' _ N Grace Kobernick I � �1 n c $ JI JP '. T T L_D LANES o J J o 2061 250th Street -- - - - - - -- - - - -- O N N O W �g Deer Park, Ni. 54007 0 Z o N90 00 00 W 387.20 0 o 0 c 354.20' 1 33.00' o c U Z C •it V W L L Z A J q N L O L cry 0 O C_ o M N N 1— I 01 rn .� H ° N LOT I N N ''' ° LIJ) <I t i° -J a H d R M L 2.00 Acres Inc. R/W N 33' 1 -1 m W N w z c L� 87,120 Sq. Ft. Inc. R/N y: U)1 d L J L_ a 0 S� E �— 1.83 Acres Exc. R/N ,, W W ,, (T I Ld 79,695 S Ft. Exc. R N _� ° �" i — I o ° a C ., c� u o . ¢ n- p 0 _77 Q o O In I JI O '� 0 0: z o0 CJI 7i ao t Cb O 0 O Z W Z CID • .t `A4:Ei•�• 354.20 33.00' o `� ;• z �d S90 0 00'00 "E 387.20 66 1LLE LEGEND �y 1 ' "lam y, Aluminum County Section Monument Found Uip\IPLA T T G_v I - AN r u" H a "1 � &14:? f � ro tg r • 2" Iron Pipe Found } o W HUDSON, " o ���"$ ' ,� zy 0 1" x 24" Iron Pipe Set, weighing 1.68 .� F" o v e o ,,, �. ,,�' _ �% lbs. per linear foot. �, = a 8 N ap �'Vp SuRJ� aa �• V• ° ti 0 s Z �' � cv x 'fi E CL >.- � V.. V Z a 100 150 200 EI /4 CORNERµ SECTION 23 N