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HomeMy WebLinkAbout014-1010-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552359 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: Flanum, Keith & Lillian LE Forest, Town of 014-1010-20-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 05.31.15.76A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~ ~ / Qua Benchmark Cn. Dosing ' Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet 7. 1 4. J/ St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover /O GPM Mode umber TDH Li Friction Loss Syste TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM rL, eader/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) n gth Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of eeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil xx S 9 Yes No F& Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 2728 Cty. Rd. Q Clear Lake, WI 54005 (SE 1/4 SW 1/4 5 T31N R15W >35 acres Lot Parcel No: 05.31.15.76A 1.) Alt BM Description Klq,D"U S 2.) Bldg sewer length = 2-A4 / - amount of cover L-+'llA dJ e-oc 3 a o~.Q_ Plan revision Required? Yes No Q f Z Use other side for additional informati n. O A34 Date Insepctor ignatur Cert. No. SBD-6710 (R.3/97) cot11t1 t Safety and Buildings Division County 201 Washington Ave., P.O. Box 7162 1 0- g-Di X sc n s i n Madison, WI 53707-71 anitary Permit Number (to be filled in by Co.) Departrrlerlt co r; 'J 5 Z 3 5 t~ anita ligation section Number In accordance with s. Comm 83.21(210Y this form to the appropriate govemmenta A)k unit is required prior to ob 'tppl6~ e: Application forms for state-owned POWTS are tAddress (ifdifferentihanmailin address) submitted to Ehe Departmen rce. Personal information you provide may be used for secondary ~ purposes in accordance with the Privacy Law, s. 15.04 I m), Slats. aJ~ FU-CIr► 1. Application Information - Please Print All Info lion ~LV! Property Owner's Name Parcel # K r 1,4 1_"7lriai l i.3 rY\ CIO U i4 - i N10 2_0 DID 40 Property Owner's Mailing Address kt it Property Location 7 Z1 ~x ~ ; K Govt Lot ` city, state Zip Code Phone Number y, Section o one) CL,Ckp-Lk l fy. C7t~Fi ~(J lc~(U~ ~Z.J£'~ I i N; R_L _(circle H. Type of Building (check all that apply) Lot # 91 or 2 Family Dwelling- Number of Bedrooms (3) Subdivision Name TOO- Block # W. 5 11 Public/Commercial -Describe Use 0, " ~ ❑ City of D State Owmed - Describe Use CSM Number ❑ Village of #614&A Tower of ~U 1 M. Type of Permit: (Check only one bo on line A. Complete line B if applicable) A. ❑ New System Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B- 0 Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS S stem/Com onentlDevice: Cheek all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized in-Ground ❑ At-Grade ❑ Mound > 24 in. ofsuitable soil ❑ Mound < 24 in of suitable soil Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaUTreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area R uired (s f) eq (f) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units c y , New Tanks Existing Tanks y Y vd n a Septic or Holding Tank 1 Dosing Chamber i~El VII. Responsibility Statement- I, the undersigned, assume res risibility for installation of the POWYS shown on the attached plans. Plumber's Name (Print) Plu b Signatu MP/MPRS Number Business Phone Number Ro is Fvu e caot,i- Plumber's Address (Street, City, State, Zip Code) VIII ount •/De artment Use Only Approved Lijais; roved Permit Fee Date zjz- Iss even Reaso r Denial $ IX. Conditions of ApprovatReasons for Disapproval / Attach to complete plans for the system and submit to the County only on paper not less than Sin x 11 inches in size SBD-6398 (R. 01/07) Valid dim 01/09 HOLDING TANK SITE PLAN Project: Flanum N Legal Description: SE SW S5 T31 N R1 5W Subdivision Name: Scale: 1" 40 ft M` Parcel ID: 0141010-20-000 Lot No.: I 9' Vi. i J. H: Ti- w I T+ t i Cs .id . J, T;\ 4-- 0 J i~ K C ice- Rt~..~ ~ ~ ~ D ~ ~ $ ~ z 17' i'~c~i-I Ah3 D ~ G!y► irk - FOI i tV, 07' MA -*10; t? IAL, 0sZ D t•e,:~~ Tc i~K. Page 3 of 4 Transaction I. D.: L 4a t A , , sus i • aid ~i t 'POP, i CONCRETE HOLDING TANK DESIGN Single Tank Option INDEX AND TITLE SHEET Project Flanum Owner Kieth Fanum Address 2728 CTH Q Clear Lake WI 54005 (715) 607-1258 Legal Description SE SW S5 T31 N R15W Township Forest County St Croix Subdivision Name Lot No. Parcel ID Number 014-1010-20-000 Plan Transaction ID Number Index and title sheet Page 1 Holding tank specifications Page 2 Site plan Page 3 Maintenance and contingency plan Page 4 Designer R Friedel r Signature Phone No. (715)637-3020 License Number 226564 Date 05/14/12 Designed pursuant to: Holding Tank Component Manual For POWTS SBD-10571-P (R.6/99) Version 5.0 (10/05) Page 1 of 4 HOLDING TANK SPECIFICATIONS 3 Number of bedrooms Non-residential estimated flow (gpd) 2000.0 Minimum holding tank volume required (gal) 2000.0 Proposed holding tank capacity (gal) Skaw Precast Co. Tank Manufacturer 2000 Tank model number Septronic Alarm manufacturer 101 Alarm model number Tank Dimensions and Data Tank Anchor Calculations X for round tank 16100 Ibs Weight of tank and cover 49.0 Liquid depth below inlet invert (in) 1.50 Safety factor 8.0 Maximum de th of soil cover (ft) 24438 Ibs Weight of anchor required 65.0 Height (in) Outside 31.9 in Soil cover req. for anchor or 152.5 Length (in) Dimensions 6.0 yd' Concrete counter weight 75.5 Width (in) Only HOLDING TANK CROSS SECTION manhole cover with locking device and finished vent cap junction warning label grade box 4" min. ~ 12" min. ~ 24 in. Manhole and vent locations T conduit may be reversed. vent pipe 18" min. building sewer service L 12.0 in. inlet blind plug alarm on Note: All tank joints, and to seal joints between tank outlet openings and piping are Electrical as per 37.0 in. sealed watertight. All pipe NEC 300 and vent materials comply and Comm 16 with Comm 84. 3 in. bedding under tank. Tank is anchored as necessary to negate buoyancy. Project: Flanum Transaction Number: Page 2 of 4 HOLDING TANK SITE PLAN Project: Flanum N Legal Description: SE SW S5 T31N R15W Subdivision Name: Scale: 1 "e= &0 ft Parcel ID: 014-1010-20-000 Lot No.: EJLJ0 ~ ' oW ~3is :24ri Fi6L.D .Y I j f C.! .i4 . t t3 r\ C~v ni r1 Mt\P-i< FL. jLG.Er C"',f 1~G14r~ i tcl c, T Y, 1,7, aUi1C}'h CiT 7~lA1f: C~i~ sN'. . ~~1~'rA Mee int., t~. ~tlk:4 L~ i u P 1 (~E cJ r' 7 P- I A L, 15 D Li 4a f'tac,n 13+c !Page 3 of 4 Transaction I.D.: pop, HOLDING TANK MANAGEMENT PLAN This Private-Onsite Wastewater Treatment System (POWTS) has been designed; and is to be-installed and maintained according to Comm 83, Wis. Admin. Code, the Holding Tank Component Manual (SBD-10571-P 6111/1999), and the St Croix County Sanitary Ordinance. 1. This POWTS is designed to accommodate an estimated domestic wastewater flow of 400.0 gpd. 2. The owner of this POWTS is responsible for system operation and maintenance, including all provisions in the attached Holding Tank Servicing Contract and Maintenance Agreements. 3. Each time the wastewater in the tank reaches 90% of the tank(s) capacity or a level of 12" below the inlet (at which time the alarm will activate), the pumper listed in the current Servicing Contract must be called to empty the tank's contents and dispose of them in accordance with NR 113, Wis. Adm. Code. 4. At each service event, the service provider should visually inspect the condition of the tank, risers and manhole cover(s) and verify that the alarm system functions and manhole locking devices are present. Discrepancies are reported to the owner in a timely manner for corrective action. All corrective actions shall comply with the county sanitary ordinance and Comm 83 and 84 Wis. Adm. Code. 5. All service events or inspections of this POWTS shall be reported to the county within 10 business days. 6. The owner may not remove any of the wastes from the holding tank(s), or cause such wastes to be removed by any person not authorized to do so under Ch.. 281, Wis. Statutes. The discharge of wastes- tank to the ground surface, including intentional discharges and discharges caused by neglect, constitutes a failing POWTS and may result in issuance of correction orders or a citation by the county or state. 7. No one should enter a holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these- tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 8. In the event that this POWTS fails and cannot be repaired, a code compliant replacement holding tank may be installed in the same location (a new sanitary permit is required for such a replacement)_ Con- nection to municipal services would also be considered at this time if they are deemed available to the property- 9. If this POWTS is replaced, or its use discontinued, components no longer in use it shall be abandoned in accordance with Comm 83.33 Wis. Adm. Code_ 10. If there is a problem with, or question about this installation, the following persons should be contacted: a. Installer Friedell Plumbing Phone: (715 637-3020 b. Service Provider Phone: c. Co. Zoning or Health Dept. St Cxroix County Zoning Phone_ (715)3864680 11. Project: Flanum Transaction. Number: Page 4 of 4 re e w w $ ~ x54042703 4 Document Number f~ Document Title 956747 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 05/18/2012 3:24 PM EXEMPT REC FEE: 30.00 PAGES: 2 Recording Area Name and Return Address k' r 74 6 ~~u cT Rd Q C/-em e- G cc Jul ~Js c . Parcel Identification Number (PIN) THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE. This information must be completed by submitter: document title, name & return address, and PIN (if required). Other information such as the granting clause, legal description, etc., may be placed on this first page of the document or may be placed on additional pages of the document. WRDA Rev. 12/2212010 1 of 2 HOLDING TANK AGREEMENT This agreement is made between the governmental unit and holding tank owner(s) Agreement Date Governmental Unit Holding Tank Owner(s) Plan Transaction Number Ke 1-r w FL-Ats U M We acknowledge that application is being made for the installation of (a) holding tank(s) on the following described property or that continued use of the existing premises requires that a holding tank be installed on the property for the purpose of proper containment of sewage. Also, the property cannot now be served by a municipal sewer, or any other type of private onsite wastewater treatment system as permitted under Ch. Name and return address Comm 83, Wis. Adm. Code, or Ch. 145, Wis. Slats. se-4 5v03* 60G. 5 T51 W gI15L') Parcel identifier number -G C' F e c 14- i s l o ZC) - ooc) As an inducement to the county to issue a sanitary permit for the above described property, we agree to do the following: 1 . Owner agrees to conform to all applicable requirements of Ch. Comm 83, Wis. Adm. Code relating to holding tanks. If the owner fails to have the holding tank properly serviced in response to orders issued by the governmental unit or the Department of Commerce to prevent or abate a human health hazard as described in s. 254.59. Slats., the governmental unit may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s. 66.60, Slats. i 2. The owner agrees, pursuant to s. Comm 83.54 (2), and Comm 82.40(3)(e), Wis. Adm. Code, to have a water meter installed in the structure. The water meter shall be installed by a plumber authorized by the Department of Commerce to make such installations, with said Installation complying with State regulations and manufacturers specifications. The owner agrees to be financially responsible for the purchase, installation, maintenance, and repair of the water meter, and agrees to allow the governmental unit or the Department of Commerce to enter the above described property on a regular basis to read and/or inspect the water meter. 3. Owner agrees-to pay all charges and costs incurred by the governmental unit or county for inspection, pumping, hauling, or otherwise servicing and maintaining the holding tank in such a manner as to prevent or abate any human health hazard caused by the holding tank. The governmental unit shall notify the owner of any costs which shall be paid by the owner within thirty (30) days from the date of notice. In the event the owner does not pay the costs within thirty (30) days, the owner specifically agrees that all the costs and. charges may be placed on the tax roll as a special assessment for the abatement of a human health hazard, and the tax shall be collected as provided by law. 4. The owner, agrees to contract with a person who is licensed under Ch. NR 113, Wis. Adm. Code, to have the holding tank serviced and to file a copy of the contract with the governmental unit. The owner further agrees to file a copy of any changes to the service contract, or a copy of a new service contract, with the governmental unit within ten (10) business days from the date of change to the service contract. 5. The owner agrees to contract with a person licensed under Ch. NR 113, Wis. Adm. Code, who shall submit to the county on a semiannual basis a report detailing the servicing of the holding tank. The governmental unit or county may enter upon the property to investigate the condition of the holding lank when pumping reports and meter readings may indicate that the holding tank is not being properly maintained. 6. This agreement will remain in effect only until the county office responsible for the regulation of private onsite wastewater treatment systems certifies that the property is served by either a municipal sewer or a private onsite wastewater treatment system that . complies with Ch. Comm 83, Wis. Adm. Code. In addition, this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. . 7. This agreement shall be binding upon the owner, the heirs of the owner, and assignees of the owner. The owner shau'S~-Jt thii" agreement to the register of deeds, and the agreement shall be recorded by the register of deeds in a manner which.jvioemnwhe 0, u existence of the agreement to be determined by reference to the property where the holding tank is installed. Owner(s) Name(s) - Please Print Subscribed and sworn to before me on this date: K t-r 11 Fi o iO v w-A Notarized Owner s Si nature(s) Public e J ovemme nit Official Na e, Title - Please Prin My Commission Expires _J_u.tke..r Fv(QS_fChu%r C, Ll-2.0It_j e% k 1411 Gov ental Unit Official~ a Drafted by: _ uh3 rRl~to~l.,i,, Personal information you provide may be used for seconds purposes (Privacy Law s. 15.04 1 m 2 of 2 i Q HOLDING TANK SERVICING CONTRACT Contract Date ~j This contract is made between the Holding Tank Owner(s) Name(s) and i Pumper's Name C Ser cjie- es SAP-/, 40i I'T; I ""L.e. vs L) w~ i I We acknowledge the installation of (a) holding tank(s) on the following property: (Provide legal descriptions:) 5 it Jam, t~a SSG ~J 31 IJ R I UJ T C) 13 ©t= F[7 R.iu s- 1. The owner agrees to file a copy of this contract with the local governmental unit that has signed the pumping agreement required in Ch. ILHR 83.18(4) (b), Wis. Adm. Code and with the County of J'T C.k,O► X- 2. The owner agrees to have the holding tank(s) serviced by the pumper and guarantees to permit the pumper to have access and to enter upon the property for the purpose of servicing the holding tank(s). The owner agrees to maintain the access road or drive so that the pumper can service the holding tank(s) with the pumping equipment. The owner further agrees to pay the pumper for all charges incurred in servicing the holding tank(s) as mutually agreed upon by the owner and pumper. 3. The pumper agrees to submit to the local governmental unit which has signed the pumping agreement required by s. ILHR 83.18 (4) (b), Wis. Adm. Code, and to the County, a report for the servicing of the holding tank(s) on a semiannual basis. The pumper further agrees to include the following in the semiannual report: a. The name and address of the person responsible for servicing the holding tank; b. The name of the owner of the holding tank; C. The location of the property on which the holding tank is installed; d. The sanitary permit number issued for the holding tank; e. The dates on which the holding tank was serviced; f. The volumes in gallons of the contents pumped from the holding tank for each servicing; g. The disposal sites to which the contents from the holding tank were delivered. 4. This agreement will remain in effect until the owner or pumper terminates this contract. In the event of a change in this contract, the owner agrees to file a copy of any changes to this service contract or a copy of a new service contract with the local governmental unit and the County named above within ten (10) business days from the date of change to this service contract. Owner(s) Name(s) (Print) i Owner's Signature(s) Karrii ~tr A tJ V rn i T h;S oeC l rrle,,f w G~ Sr~~ ~1 i~.e ~~1 vs//e/ao r2-h y K~+h i , lffaAUM ry: Qr M &a 41 i ~ i i Pumpees Name (Print) i Pumper's Signature - - i Pumper's Registration Number 09 Drafted by Roo Ft -IS C P L.L' cu ti~~P,r t - - WARRANTY DEED t.:is o~:.f~t fill ~ aoDlNC=orT. STATE BAR OF VTSCUNStN `FUR31 KPIq Par It 4 G, 6`41 - RET> - Melvin R. Flanum and Lillihri M. Flalau®, loin ~ { f- , -0.~ Wl °crd <for Record as jointtsnancs, 1.'IJ i f .h E. Flay -mm Re~le)r aF Retds : ttse l:01iwvinK It ~erioeit reaI eStl l; Statc'6f Wisconsin: TAZ Parcel No: ~E !t__.I r.._a ,Tks r G - - _ ~..QUheA~_ rillai'C~1' Z2I Zt1e -_aDU►7wEatUB1-lL'F _.n T if TownsTHEREOF'~more _,.Ran_gaul5rwest,, St Croix 060nrLy, 11Isccnain; EXOEYi'"7'FIR'!'"" - - ~r P _ a oriacd in Volume 563 of ReOords on page ART 538 'as:_-document- Iio. 3'43[ in th- .Of£i.c of the PLaist.er of: Doeds in and Tor t-:` rrri7-x-1,on tv :wrsconsin 7 v _Grant ;3 _her_ev-, e_ta1t) _x life _ a A ~C -interest , in the above described proPrty. _ t Utz : _ >t 5 te cl idrtv% - - : Lx~.cption to w irrnntiP. s: Munk' 1 and zoning ordinances and easements and restrictions of record _ y Qctober 9 9 or I` tjt-yet "1/ /"~4-I.~G"✓' 1., !~l':,11.) r Z. ??"v (5 Melvin k. FlanumLillian M. Flanum rah; t,l (SET,) f _AUTHENTICATION ACKNOWLEDGMENT . Signature (5) . - cT,aT nl IVtS(-0 S11 1 St. . Barron rount~ ~ T _ t _ a S ia, of au too-ntlcaLeQ th-is -_---_.Qdl' OZ . . 1:7__.... ccFF na.C la to .cwtc - Oc bta1^, , .n,9«,.. th- _4r^YC 110Pta.1 Melvin R. r?anun .anj_Lillian.,M,_ lal?um. . _ TITLE: MEMBER STATE BAP. OF CIS(70NSI` (If not.:. t authorized by 706.06, Wig. Stat8.) 1 1 w 16~n..k:.rkttjl7, n{ortlt.?rj 1let . t ,q'm.r iI, nl nit t11 ati.l ack mow1GI:!C ~lt ito -ante. !.T T r . r, -ri iiT7.ir ufinc. ii - ~ - ` . jS - ( nt.t , SI _.;F:-0t tini, ':two I, :7. r:ltinn f.51(f11TLCT'.q may hr nu ^CtiflraLCf, i., nre not nereFts tm) to I Wisconsin Departmen f Commerc ft - T Z- OIL EVALUATION R 'PA Page of 3 Division of Sarely and ildings ,r!`1 V Comm 85, Wis. Adm. Code o t K Attach complete site p n on pa~eritO 1~~ x 11 inches in size. Plan must Coun Include, but not limited • ve cp1SA ntal reference point (BM), direction and Parcel I.D. ,tea percent slope, scale or is orth arrow, and location and distance to nearest road. O 1 - 1010 Zo -000 Please print all information. eview Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location E I TA F Govt. Lot !jC 114,5UJ 1/4 S-3- T 31 N R/ Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 27;B GT'H City _ State Zip Code Phone. Number ❑ City ❑ Village Nearest Road Wl cis (71,f) Gv7-~2 ~8 ~015-r GTH ❑ New Construction Use: -Residential / Number of bedrooms 3 Code derived design flow rate GPD 0 Replacement ❑ Public or commercial - Describe: AA Parent material 41 L.pE~>` Fi;yar} Plain elevation If applicable N . T • General comments Co~~lc HoE I> I NGIr TA~IK- and recommendations: o?F16~ ~~t Nor S w~t'1.~ Du.s~ 'f}jA"'~' W+aR+c 5t runt t.st,Q. To '1"NcS6 ~ Pa~E A a Boring # ❑ Boring D ® pit Ground surface elev. 105-8 ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I o --q ~.fY~! a o- 5--1 . r n1{✓ Zf . S L G ? R- 04 M oo S i I ask Q5 - 3 -25 tor' Q 4 M yr r s 5i 04 ( aWd-- rAAr -S M4 YfiL n 5 l © P-t M-P S ~I Boring # ❑ Boring 5:1 ® Pit Ground surface elev. o[ 2 . q ft. Depth to limiting factor in. Soi! ,iw!9er. P.:.le 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 T.s'`fR A%tfA s 5-/84 Z 1-17 1 -641L 1Cr' w ► . 2- , 3 3 11-62- sty s r s D cif; - . 3 • Effluent #1 = BOD > 30 1220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) i ature CST Number C t S r4 p6p-t uz-S -71410 - Address Date Evaluation Conducted Telephone Number 4(VE d4VMAJ Wt 0 Z.- 71;r •X14 • o rz 7 J y of Property Owner. F~dIJM Parcel ID # Page Z of 3 Boring # ❑ Boring Pit Ground surface elev. 97 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 r p -10 g f r -~r a5 , S , 6 *f- It to-t t• R ( )o fix ~Al Y-- 3 14-J-1 ,t #4 1~ W's Afa s le ?c-1 44. 2 3 Q-17 y "a F J"Lj~~5 S1 /s 3 Boring # U 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr: Sz. Sh. •Eff#1 •Eff#2 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil A ication Rate Horizon Depth Dominant Color Redox Description . Texture Structure Consistence Boundary Roots GPD/fF In. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. •Efl#1 •Eff#2 Effluent #1 = BOD3 > 30 1220 mglL and TSS >30 < 150 mglL • 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.6/00) ll Property Owner Fart4K.m Parcel ID # Page Z of 3 Boring # ❑ Boring pit Ground surface elev. 9/. ft. Depth to limiting factor d in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 o -lo hlr &211- f~ ? r -iv- a5 loaf II Q + ro IN 7X ZA, WS Fa s /a ? C-1 -~4 iL 2 3 3 N-9 .t' i( 5 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. R 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. 'EM1 •Eff#2 Effluent #1 = BOD > 30:S 220 m and TSS >30 < 150 m /l. • Effluent #2 = B < OD 30 m _ t~ _ 9 s < _ gll 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. f 4 SBD-8330 (86/00) To ~ 5 i I { e { JjmNj= i (1I r l,~kI f 9t?t' i~ Y 5 w - 4 3a FoR~~~ 5~ ~ ~ ) = lob `xT. C ►X C.F~Ut~1`'~' , i { s G~ t a v, Ito YD z i i w.. E 01'10 A o ~ Zs U+~4.)A Y WCLL- AWF~ 7x,ST, . ~NEp 2 BR ►-to~t~c ~ 1 t rn Parcel 014-1010-20-000 05/17/2012P AGE E 02:33 PM 1 1 OF 1 P F 1 Alt. Parcel 05.31.15.76A 014 - TOWN OF FOREST Current LK ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - FLANUM, LILLIAN M (LE) LILLIAN M (LE) FLANUM C - FLANUM, KEITH KEITH FLANUM 2740 CTY RD Q CLEAR LAKE WI 54005 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 2740 CTY RD Q SC 1127 SCH DIST OF CLEAR LAKE SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC SP 0038 CLEAR LAKE FIRE DIST Legal Description: Acres: 38.500 Plat: N/A-NOT AVAILABLE SEC 5 T31 N R1 5W 38.37A SE SW EXC CSM Block/Condo Bldg: 2/455 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 05-31N-15W Notes: Parcel History: Date Doc # Vol/Page Type 03/07/1996 540559 1165/537 TI 10/20/1990 463621 884/563 WD 2012 SUMMARY Bill Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 04/05/2010 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.400 10,000 58,500 68,500 NO AGRICULTURAL G4 9.000 1,400 0 1,400 NO UNDEVELOPED G5 0.600 100 0 100 NO AGRICULTURAL FOREST G5M 27.500 24,800 0 24,800 NO Totals for 2012: General Property 38.500 36,300 58,500 94,800 Woodland 0.000 0 0 Totals for 2011: General Property 38.500 36,300 58,500 94,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch 131 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00