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HomeMy WebLinkAbout032-2042-60-100 STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER J1~►f~~ S S I~Z If v~~_rc 1 r y~ F•~q { ADDRESS !jt LOT # SUBDIVISION / CSM# Q SECTION IL_T_M- //ll N-R-L-1-W , Town of ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM llf 1~ rzo or,) YU 37' -i pia o~ ~ 9t~ 1 l $ _ F'' muUN~ T INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank manhole cover. f r BENCHMARK: ,4 a ALTERNATE BM: SEPTIC TANK / PUMP CHAMBER / HOLDING TANK INFORMATI ONQ t„Manufacturer:- FuM O Liquid Capacity: 800 Setback from: We1144 eR 75` Sufi , c-. 37 House (v kl' Other r a dump: Manufacturer <-oc' Model# I~ Size Float seperation Gallons/cycle: ~I~~•s D I a, Alarm Location :SOIL ABSORPTION SYSTEM Width: Q Length (OT Number of trenches Distance & Direction to nearest prop, line: a (p Setback from: well:0'1()1 100 House Other ELEVATIONS Building Sewer ST Inlet ; (D, a ~ ST outlet PC inlet 8~1 ~ PC bottom 8 Pump Off' cS . Header/Manifold 9 5, Bottom of system Existing Grade Final grade DATE OF INSTALLATION:) PLUMBER ON JOB: LICENSE NUMBER: INSPECTOR: 3/93:jt rt y. 11.30.191li`k -tE SE2IIAGE SYSTMh Stree County: Labor and Human Relations INSPECTION REPORT Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No.: GENERAL INFORMATION ❑ City ❑ Village ~ Town of: State Plan ID No.: Permit Holder's Name: ISomorset Parcel Tax No.: ST BM Elev.: Insp. BM Elev.: BM Description: TANK INFORMATION 4 ELEVATION DATA A9400074 L I ]MANUFACTURER YPE CAPACITY STATION BS HI FS ELEV. , Benchmark W. Septic_,.. E Dosing Aeration Bldg. Sewer Holding St Ht Inlet 9,g3 903/ TANK SETBACK INFORMATION St/ Ht Outlet 90'0 vent to ROAD Dt Inlet F TANK TO P / L WELL BLDG. Air Intake Septic >/Dp' 775' 37 >37, NA Dt Bottom Jy. 9 ~S Dosing > 7 5 ' 6q' y ~ (0 NA Header / Man. ji~El r7 NA Dist. Pipe 1~7 T rl~ Aeration Bot. System 9y,7 b Holding PUMP / SIPHON INFORMATION Final Grade Manufacturer AJ(),S s /3.33 94 9/ Model Number TDH Lift Fem Forcemain Lengtt Dist. SOIL ABSORPTION SYSTEM 7)( 1 No. Of Pits Inside Dia. Liquid Depth Width 0~ r k, Length ,It No. Of Tr ches p,MENSI N BED/TRENCH DIMEN I N LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE /STREAM CHAMBER Model Number: INFORMATION TypeO g8/oU ,~/r OR UNIT System: 5`{fv ro DISTRIBUTION SYSTEM f5M tributi on Pi e(s) x Hole Size x HolSpcing Vent To Air Intake Headerifold p k IN 6/ Len th Dia s Length a3 Dia. Spacing 9I SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only [xxDepth Of xx Seeded ~ e xx N}Ulched Depth Over Depth Over I Yes No Bed /Trench Edges l Yes ❑ No Bed / Trench Center COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION. Somerapt.11.30.19W, sW.,3 W, Lot 4, 70th Street . rj1-A ~ r 1.4 y"~!f c It, h:,, t Plan revision required? ❑ Yes ❑ No Use other side for additional information. 1 cert. No. Date Inspector's Signature SBD-6710 (R 05/91) ADDITIONAL COMMENT&AND SKETCH ' SANITARY PERMIT NUMBER: r al -0 SANITARY PERMIT APPLICATION LHR In accord with ILHR 83.05, Wis. Adm. Code COUNTY r STATE SANITARY PERMIT # -Attach complete plans (to the county copy only) for the system, on paper not less than El C~[.~ OR ~ 8% x 11 inches in size. Check if revision to previous application -See reverse side for instructions for completing this application. STATE PLAN I.D. NUMBER 1. APPLICANT INFORMATION - PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION C`n S A N ~ S w '/a 5 ~'/4, S I T-3 0, N, R 1~ E (or) PRrg T OWNER'S MA_II~ING AD RESS LOT # BLOCK # CITY, STATE 11V~ ^ SZIP CODE PHONE NUMBER SUBDIVISION NAME O CSM NUMBER S~~Ir< -SVo (NA 1n CITY ~ II. TYPE OF BUILDING: (Check one) ❑ State Owned 0 VILLAGE : NEAREST ROgp 5a ► RS =5 A ❑ Public ❑ 1 or 2 Fam. Dwelling-# of bedrooms A 01-1211,- ~ 2- (OO _ Ord III. BUILDING USE: (If building type is public, check all that apply) o 1 ❑ Apt/Condo ~J 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 120 Service Station/Car Wash 5 ❑ Hotel/Motel 9 ❑ Office/Factory 13 ❑ Other: Specify N. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ® New 2.0 Replacement 3. ❑ Replacement of 4.0 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 140 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 REII _D (sq. ft.) PR OSED (sq. ft.) (Gals/y/sq. ft.) (Min./i h) ELEVATION ,j S 8 rl Feet 0 Feet % VII. TANK CAPACITY Site in allons Total # of Manufacturer's Name Prefab. Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks oncret strutted glass App. Tanks Tanks Septic Tank or Holdin Tank 1060 e ' IA I Lift Pump Tank/Si hon Chamber W VIII. RESPONSIBILITY STATEMENT 1, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: S~ S e~. , . 6 3YO / 3$!~- Oaf Plumber's Address RW rest, City, Stattjip Code): R 1670 35 u rs dnJ (~))SC_ S 6 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved Sa 'tary Permit Fee (includes Groundwater ate Issued I ' g Agent Signat Stamps Approved ❑ Owner Given initial aQ' i~ Qdurcharge Fee) I Adverse Determination 4 QQ((~J ` l X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly Plb-67) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety a Buildings Division, Owner, Plumber INSTRUCTIONS r 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 rent~wal 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 TrErnsfer"Renewal Fon i (;313 6399) to be. subviilfpd to the county prior to installation. 5. Onoi1e sewage systems must be properly maintai eG. The septic tar Kc rnust be r L • .e by a licensed pumper whenever necessary, usually every 2 tc 3 years. 6. If you have questions concerning your onsite sewage system, coitact your local code ailrninistrator or the State of Wisconsin, Safety & Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax ;lumber(s) of where the system is to be installed. II. Type of building being served. Check only one and complete of tedrooms if 1 or 2 Famil•r Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if pen4"nit is for tank replacemen". reconnection, or repair. V. Type cf system. Check appropriate box depending on system type. VI. Absorpti.nn system information. Provide all information requested ii ##1-7. VII. Tanis rifc•r-mation. Fill in the capacity of every new and/or ex , !c, tank, list the total 1 : r number of tan;<, an:=- ,manufacturer's name. Indicate prefab or site construA'~ c and tank mate jal. ; 'oi plete for all septic;. c.)Lrr;p/siphon and holding tanks for this system. Check u):periniental appro,.ai c tanks received r.xperinie;)'a! product approval from DIL-HR. VIII Hesporrsioility statement. installing plumber is to till in name, !ice):;e n~uro er with approp,taie prefix (e.g. NAP, etc.), address and phone number. Plumber must sign application c;rn. IX. County/Department Use Only. X. County/Department Use Only. Corrp!ete plans and specifications not smaller than 8`/2 x 11 inche, r; ~ -Abrr 1t~d :c 1'-9 ,:ounty. The pl ns r ;.,>t include the fokowing: A) plot plan, drawn to scale or wr.f d k e T e n.,j :o:.,:tion of hoi:J r q septic: a'ar,~Js) or other treatment tanks; building vlis; water ~r .J, ~~vater service; streams ~,ncl lakes; dump or siphon tanks; Oistribution oozes; soli +r,c f3 ! ysie w z, Po -icer7!ent system areas; and the location of the building served; B) horizontal and ve-tica. lPvafi :efe ~rn ~r points; C) complete specifications for pumps and controls; dose volume; elevation differences: fr,(tion loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil at;ac ption system if required by the county; E) soil test data on a 11,5 form; and F) all sizing information.. - GROUNDWATER SURCHARGE l 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a lumber of regu!ated practices which can -ffect groundwater The moniE's collected throug`i hose surchat Sy > ?r x?!~ a i~r? ,?r;' ] 4,. 1`dVV$ter ;,v~~L. water contamination investlgai;ons and establishroman' :yr SBD-6398 (R.11/88) SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Industry, Labor and Human Relations April 14, 1994 201 East Washington Avenue P. 0. Box 7969 Madison WI 53707 BOUMEESTER & SONS EXCAVATING JIM BOUMEESTER 1070 HWY 35 HUDSON WI 54016 RE: PLAN S94-00678 FEE RECEIVED: 180.00 STANEK, JAMES / SHIRLEY SW,SW,11,30,19E TOWN OF SOMERSET COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters ILHR 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ILHR 82 or in chapters ILHR 50-64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sin e1y Peter E. Pag Plan Reviewe Section of Private Sewage (608) 266-2889 i SRD-6423 (R. 411/91) SAFETY & BUILDINGS DIVISION low • State of Wisconsin Department of Industry, Labor and Human Relations April 14, 1994 201 Ea0 Washington Avenue P 0. Box 7969 Madison WI 53707 80UMEF:STER & SONS EXCAVATING JIM BOUMEESTER fCJ~1 1070 HWY 35 `j~s'1 HUDSON WI 54016 RE: PLAN S94-00678 FEE RECEIVED: 180.00 STANEK, JAMES / SHIRLEY SW,SW,11,30,19E TOWN OF SOMERSET COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above-referenced submittal. Conditional approval i-s, hereby granted for the system plan submittal. AlI noted items must!be corrected. The review and approval of the system is based on chapter, +~l Wisconsin Statutes, and chapters IIHR 83 and 84, Wisconsin, Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter ItHR 82 or in c-hapt.ert, I1,HR 50-64, Wisconsin Administrative Cade. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made, All permits required by the city, village, township or county shall he obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sin el y, Deter' E. Page,1 Plan Reviewer Section of Private 5ewayF: (608) 266-2809 SBD-6423 (R. 01/91) a T SAFETY & BUILDINGS DIVISION e State of Wisconsin Department of Industry, Labor and Human Relations April 14„ 1994 ;?(11 East Ian;hinylorr Avorme mii'd i.:rtrl Itj I 5377) I B0(1MFF'UFR & .'IONS F?i(:AVAT ING 1TM ii06MEP;TER 1010 HWY 35 H1,10SON WT .A016 II', PF PLAN S94-006-18 FFF PM-1 VE P - 11001-00 STANF K , jAMf 1 c)I-11 ICI. FY `)W , `stei , l l , 30' 191 TOWN OF `>OMfV-')FT COUN~rY i) `5T CROEX MOUND SYSTEM The 11ep.ir"townt h~i+, rr'?vtr-wed the a.djovo (ofi-rr=r i( d ,tihm'ii(i' ti:c}rrcllt.lowil aOttr-owil is fwre,kly gr-arrir:rri for they system =Iuhmittal All r t-od it.-rtrti rr►u0 he r-rtrrert. -d the review 'Intl ~~ri1~)rr'~val 0 tho ";y';tnrrl is baspd ran ctr'jtltwt 145, W1`~t~rt7l~ In ~it.~tLratf~c rui rEr~(rth~r fl,NF -md 84, W7j ,(,ornsin Mart►ir) i ttr :if iv(,~ C.mjt=, eitid t , r~ontingi:1 t. u{to r► s' ip11.t1 {'rrr-t. u'o i h rimy st Ipt)Iat ir.n Shawn rtn the pleMs_ Th'I sy' tvrt± ha% ont Provo rr°viFrwrtiri r the rn;a0 regiilreiient.~ ;et forth it) , heipt-vr l(,Hk H';? „r ir; r ho pi cf i.i_HP 50-64, Wisconsin Admi!ilstr-,if ive tart,. Tfr'tr I~lan ~u(tiriift. l ~t1)pi-ov.i w-'j l t F-- x, 11r i-wo yeir,~. front tfw tpp rowl I rlai -e, crr If ii ~artitary perrltit l' (40,rlrtr<tl, pLin cipprov;i) will r-pltp of) the ttcty the ir<it"01 .mfliftrry Itprmli expires. The Tirplrtttrtwr ra=,l;misihlr= f(,,t this irl't'l j lit lt,rr 01;0 i kPop tsw, ',rat of pletnr5 wlt.h t-h€, t;~'Lf tr tw-W <;f.arr►tt of <)t,frrrt~':l at the t:rlnrtt►)IC#ikrrt xhla ;r).i.. llr>r ~,)+tla ~wl'-fy the dppruprAiiie iw;,por tor wherl irIS'(,ipcf low, io bw rTialde All Etr?rrrrii11 rrqu1red t/v f,hiv clt.y, 01111-rje towrlIt iti or iomly shiill ttr ohl a ifled trrirtr to itrv.'ial 'I'l11oll_ Irirlu1r"lv't ~,hintld by dIr(-dea to me at t~hf- r)ltrrther T)rt~~, ItrIow . f'1ro%e rt-terto t.hr-, plrtn nui►ther ~,howv) eibovu~. Si rr( E- I y , r J 1.A Pet:e r' dC, F?1~1 Ilan Revip'wpr,-. eff irrn of 1'rlv;it.r• `e r•`i t1 C,Tr 8) 266 '1889 SBD-6423 (R. 01/91) - - - - - - r Page of 1 Straw, Marsh Hay, Or Synthetic Covering Distribution Pipe Medium Sand G Topsoil F pfd 2 % Force Main Plowed G gregate From Pump Layer NO 0 pF1~ action Of A Mound System Using f 'r~ r A Bed For The Absorption Area G + O ~ ~ = K t GOQ`~ A Ft. H Signed- B q~7 Ft. License Number: MPR503VO Y I j_ Ft. Date: 3W 17-y J g Ft. K 10 Ft. Alternate Position L (07 Ft. of W a$ Ft. Force' Ma i n L J Observation Pipe- B K '~r. r----------- 01 a L------- I•-=--- ----------------------I o ce in W 0------- Fr P p Distribution Bed Of 2-- 2 ? Pipe Aggregate 1 Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area i . ~ i f , ; it 'ti 4~ r.-, ij ' ~ gain F~ ~ py R. A ~\ti~1~ T:~ I Page Of a Perforated Pipe Detail 0 End View Perforated End Cap i PVC Pipe o~O s J~ao~o~`6 Holes Located On Bottom, S Are Equally Spaced S Q PV Force M .7 PVC Manifold Pipe Alternate Position Of Distribution Force Main Pipe Last Hole Should Be Next To End Cop End Cop Distribution Pipe Layout P Ft. r R ~y S 3 X 30 InchPS fio Y Inches S" Signed: men- Hole Diameter y Inch y SQ Lateral Inch(es) License Number: Manifold Inches 0 Date: Force Main Inches # of holes/pipe i o ~~v Q 04~ _ ~ ~ r 4 i.', J~ ~ ;Y d i~ f. t ~~t ~ r~ wf C It ~t I '~.'l.... ~ „ w,~ f ~ . '~,a„ a 82 PRIVATE SEWAGE SYSTEMS - II PAGE OF PUMP CHAMBER CROSS SECTION ARID SPECIFICATIONS VENT CAP N"C.I. VENT PIPE WEATHER PROOF APPROVED LOCKING JUNCTION BOX MANHOLE COVER 2B' FROM DOOR. WINDOW OR FRESH 12"MIU. I AIR INTAKE I GRADE I y" MIN. r ~ IB°MIN. CONDUIT-- WAIN. \ 11, INLET y P ES - r 1 V _t~ I APPROVED JOINT A • rP I III APPROVED „DINTS W/ C.71. PIPE ,~5 \ I III W/C.I. PIPE EXTENDING 3' I II ALARM EXTENDIUC, 3' ONTO SOLID SOIL is cty ^ I II UNTO SOLID SOIL ~ p, ~~G I I oN C y Q I ELEV. FT. Q 1 O4\ O PUMP OFF Q` 17UCRETE BLOCK 5 RISER EXIT PERMITTED G y IF TANK MANUFACTURER HAS SUCH APPROVAL S SPECIFICATIOUS SEPTIC E DOSE TANKS MANUFACTURER: NUMBER OF DOSES: PER DAy TANK -.izc: GALLONS DOSE VOLUME ALARM MANUFACTURER: INCLUDING OACKFLOW: I GALLONS f(~ MODEL NUMBER: CAPACITIES: A=INCHES OR- 5GALLCUS SWITCH TYPE' 8= INCHES OR GALLONS PUMP MANUFACTURER: Z0~ le C= -.CINCHES OP.=SALONS MODEL NUMBER: I 7 D= I~ INCHES _R GALLONS SWITCH TYPE: H NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE_JSL_GPM ~INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE.. FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . Z 5 FEET + -u-FEET OF FORCE MAIN X J 3 v FYoFT.FRICTION FACTOR.. ~FEET TOTAL DYNAMIC HLAD lL" t-'aFEET ~,I II yl'' IIJTERNAL DIMENSIONS OF TANK: LENGTH ;WIDTH ;LIQUID DEPTH 5IGA.IED:Q4=`Z '362M J LICEWSE NUMB-R: nh~ DATE I M , ; t z y . x 1 ' i~ ~ c,~ ~~.~~~t ~ ~ - - 318 30-3 3Y$~ Grer9~ - - - 41 x`73 Qi ~ 6z~~ 63 , 303 a c" ' T ~ ~u I 3 ke~ - a PANn 594-006'78 S~ RECEIVED APR 13 1994 SAFELY & BUILDINGS ~ - ~ - Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY 7BY , ~ Attach comple te site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but PARCriot limited to vertical and horizontal reference point (BM), direction and % of slope, scale or dimensioned, north arrow, and location and distance to nearest road. REVIEDATE APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION PROPER OWNER: PROPERTY LOCATION 4:4 M9 S S h 1 R.Ie SNP GOVT. LOT . 1145k' ;1/4,S T 30 N,R ` Por)(O PROPERTY O N EUMAIILLI G ADDRESS LOT I BL Y # SUBD. NAME. M # CITY, STATE I COODE i HON ffE KI ER ❑CITY ❑VILLAGE [MOWN NEAREST CAD s t lo, mQX e _ WI S C I I., ~Q New Construction Usel , Residential / Number of bedrooms [ ] Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow S~ gpd Recommended design loading rate . Y bed, gpd/0~, S trench, gpd/ft2 Absorption area required bed , ft2 tren h, ft2 Maximum design loading rate-bed, gpd/ft2 , s trench, gpd/ft2 Recommended infiltration surface elevati n(s) _ e' 7 S ft (as referred to site plan benchmark) Additional design/, ite It Parent material , considerations ?-L r lai elevation, if applicable OLI NGTANK rU = E itable for system CONVENTIONAL OUND IN GRO ND PRESSURE T DE❑ U S❑YST IN FILL H❑ =suitable fors stem ❑ S U S❑ U ❑ ❑ S SOIL DESCRIPTION REPORT Boring # Depth Dominant Color Mottles Texture Structure Consistence Roots GPD/ft Horizon Bar>dary in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench / 04 J s Z -y ~OYR ~ 0/ ~s y~Y a s Ground y~ 5 7,s ye Z . / s A, /46e ✓ ~l~tt. 5Y-5 7S L S 5 {milK dh' Gi 1J / S Depth to 5 limiting fa o „ Remarks: n Boring # , 5r ~ 010 011qtd 7-V S 0Y1pe- y 2.5'YK Ground Depth to limiting factg, o Remarks: CST Name: Please Print Phone: 72 Address: i tCST Number. Signature: 2 ev PROPERTY OWNER SOIL DESCRIPTION REPORT ' Page 2 of PARCEL I.D. # I 's Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 4' 'r ,e 5; MI/P A-P 1/ Ground 24,2 b Z- ~lev. Depth to limiting fagtpr~. Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor r-F I Remarks: SBD-8330(8.05/92) P9. 3 0 3 1i Y a Gauge - - - 41S~ e 83 ~ ~G~,l ~e rzt A 0 ~0At s~`3 z SW Prop Co,r she ~ over 3~~' ~ POND ID r Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page / of --5 Labot and Nunfan Relations Division ofSafety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY~ Cro 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 % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPER OWNER: S d• SKIP-6 PNe PROPERTY LOCATION j / P GOVT. LOT 1/4 /tiJ°1/4,S T 30 N,R or PROPERTY NERIMAIL G ADDRESS LOT BLOCK # SUED. NAME R CSM # 0 t CITY, STATE 1 ZIP CODE PHON BER ❑CITY ❑VILLAGE [MOWN NEAREST OAD MqX f. U S G S 0 ( O 0 St New Construction Use Residential / Number of bedrooms [ j Addition to existing building j ] Replacement [ ] Public or commercial describe Code derived daily 'f ow .r"'l gpd Recommended design loading rate . y bed, gpd/ft2 i S trench, gpd/ft2 Absorption area required bed, ft2 trenrh,'ft2 Maximum design loading rate l _bed, gpd/ft2 - S trench, gpd/ft2 ReoDmmended Ifiltration surface elevati (s) It (as referred to site plan benchmark) Additional design considerations Parent material ZL Joo~ ai elevation, if applicable It S - SUilable for system CONV ONAL OUND IN-GRO ND PRESSURE T- DE SYSTEM IN FILL HOLDING TANK U- Unsuitable for stem ❑ S )EI U 'WS E3 U ❑ S ❑ U ❑ S EM ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 13- Z 19_y~ Vyw 50 lo" got ill- 'q 6~I S Gm,d 3 ys-S 75yc 6 2.6 i s ✓ a Y S' V-2: ft Sy`5`1 7S ,c S Y 5 ~-r A6 a w s Depth to 45~ , 5 'ye 5 v limiting Remarks: Boring # , Ground 0 YK y 2.5r y'e `r~ wt l~ /+I flyl. Depth to limiting fact Remarks: CST Name:-Please Prin"A / Phone: 6 g. 3 y Address: ~yol~ r) A Sgnature:/~` te: CST Number: PROPERTYOWNER SOIL DESCRIPTION REPORT Page Z of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bound3y Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 01 Iv s tin CLJ z Ground 3 Z`~ d d 2- `Y~ `f Y S%~ j/Hrl$k Depth to limiting Remarks: Boring # 13 Ground elev. ft Depth to limiting , factor Remarks: Boring # Ground elev. . ft. Depth to limiting • factor Remarks: Boring # . . i Ground elev. ft. Depth to limiting • facto Remarks: • ,Pn_a,vAn/R 05/921 1 0 Hav. of ~ 8La ~63 o I o ~Ck l ~e Rt . Br / " fi r j~.l Ak~ 1, Ak e~ El- = /Uv .o o ; P, l a/Y 0 50 Ptop Coew s ,fie. riving Professionals What Their S r pees Demand 'EFFLUENT and DEWATERING pumps x!153". Cast Iron Series "57" Cast Iron Series 55 Bronze Sernes"59" Bronze Series" Added feature: Cast irort.& bronze base • Automatic or Non-Automatic. and impeller • .3 H.P., 1 Ph., 115V or 230V. • Non-clogging vortex impeller design.' • Passes ,h inch solids (sphere). • 11/2" NPT discharge. CAPACITY • Float operated, submersible (NEMA 6) 2 po el HEAD UNITS/MIN mechanical switch. Feet Meters Gal. Ltrs. 1 433 63 1 • Automatic reset thermal overload rote 5 1. p of~on. 10 3.05 os 34 3a 129 zs @'Stainless steel screws and switch are" 15 4.57 19 72 • Cakt iron switch case, motor an„d° Lock Valve: 19.25• ~bump housing. MW Pictured • Engineered, glass filled impgRtr with metal insert. 'Bronze motor and pump housing and • switch case. Glass fill d Pof yProPyLe° e base. "Bronze motor and pump housing, switch as~lla•s 53 Seri" SC-"25 • Models 55 arid.59 hav"(a nless steel handle & guard. case, base and impeller. ss seri.s 88 -4415 • b5 Series SC-2225 N53, non-autometic, ava' a packaged with a piggyback mercury so Series 58-1115 floe, switoh. b, UL listed Canadian standards C Assoc ssoc Approval available r Aron Series t HEAD CAPACITY UNITS/MIN Automatic or Non-Automatic. Feet Meters Gal. Ltrs. • 1/2 H. P., 1 Ph., 115V or 230V. 5 1.52 51 19 10 3.05 • Non-clogging vortex impeller design. 1s 4.57 43 163 21 6 • Passes 1h" solids (sphere). 20 6.1o 27 104 • 11/" NPT discharge. Lock Valve: gas • Float operated, submersible (NEMA 6) 2 pole mechanical switch. Series &VM • Automatic reset thermal overload protection. 'listed e7 SC-2225 -2225 • Stainless steel screws, guard, handle and arm and `4 seal assembly. / • Watertight neoprene "O" ring between motor and pump housing. Canadian 5tandaro n; SP Assoc. Approval N97, non-automatic, available packaged with a piggyback mercury available float switch. y D "137" Cast Iron Series "139" Bronze Series HEAD CAPACITY UNITS/MIN / Feet Meters Gal. Ltrs. • Automatic or Non-Automatic. 5 1.52 104 394 0 '/z H.P., 1 Ph., 115V, 200-208V or 230V. 10 3.04 79 300 15 4.57 64 242 =C 0 1/2 H.P., 3 Ph., 200-208V or 230V. 20 6.10 36 136 C Y • Non-clogging vortex impeller design. 25 7.62 a 30 _ • Passes % inch solids (sphere). Lock valve: 26• • 116" NPT discharge. Canadian Standar • Float operated, submersible (NEMA 6) 2 pole listed Assoc s 1 Assoc. Approval Approval mechanical switch. available • Automatic reset thermal overload protection. lo.r.F,r 137 Series SC-2225 C" • Stainless steel screws, bolts, guard, handle and 139 Series 38-1115 arm and seal assembly. .a...a 'Bronze motor and pump housing, switch NOTE: No UL listing for 200-208V/1 Ph. case, base and impeller. pumps. F;; Mercury float switches are available for non-automatic models. WiPbli „ 10-0015/10-0016 The alarm package features a six inch double magnetic bell with either 115V/BV or 230V/8V transformer for mounting on a standard Alarm PaC-;Kc F' utility box. The A-Pak is used in a duplex Mechanical Alternating System. When the A-Pak is utilized in a simplex system, 10-0225 - Mercury Sensor float Switch is needed to actuate the alarm. Utility 10, box is not included. UL listed components, CSA approval available. 10-0053 "A-Pak" Alarm System consists of metal panel with light, horn, sensor float and water proof cable splice kit. 120V/12V, NEMA 1, UL listed and CSA certification on entire alarm system. 10-0028 (115V/1 Ph) "A-Pak" Residential alarm system features a 217" bell with 115V/SV. NEMA 1, 10-0015/10-0016 transformer for mounting on standard utility box. Includes mercury sensor float switch to activate alarm. 10 0053 a HEAD/CAPACITY CURVE W SEWAGE and DEWATERING WARNING: Model 293 should not be subjected to less than 15 feet TOM. 24 80 i I 75 22 - MODEL I -4.. 70 - - - 1-295 20 S --1 -1 C O 1 i MODEL ~il < 60 1 a W 16 294 ~ - ~ --t- - - ~ I U 55 1 t _t 115 I - - } i 34 l r- t 110 14 45 G ? MODEL j, u' ! F 12 1 - - - 105 - 40 293 30 too rrLL' , O 10 35 I - - - - --I-{- 74- 30 1_1 t I 8 25 11 - - - 28 . N I I I I I 20 MODEL i ' f 1 6 _ } _I 282 MODEL - - 28 ss - } I - } 4 1S - 292 - ' i ! 10 I MODEL 24 MODEL ~ 2 - 1 262 MODEL 7S \ 5 4 _ - MODEL 264 + - 189 ' 266, 267, 269 Q 22 \ 0 < 7o GALLONS 10 20 30 40 50 60 70 90 90 100 110 120 130 140 150 160 170 180 110 200 210 220 250 20 115 - I -f } • MODEL LITERS 0 a0 160 240 3 20 400 460 Sao 640 720 800 an U ~ t 1. Z . 165 16 60 FLOW PER MINUTE M to SS - 1 MODEL I _ O 1. ! - r• I 188 14 r - - l 112 .o. HEAD/CAPACITY CURVE u MODEL EFFLUENT and DEWATERING 10 185 ! WARNING: Model 155 should net be subjected to less than 30leet TOM. 30 MODEL 8 IJ7, 179 ' i I i 25 6 20 O EL 15 - } MODEL~~~T-~ t ~ 161 ~ ~ 4 97~ 10 MODELS 2 SJ. 55. \ f I ! ~ ~ i I S - 57, 59 1'' II'1 li 1 ti I 0 i-r GALLONS 10 20 30 40 50 60 70 80 I 90 too 110 120 1130 140 1s0 160 --1 r~i- P. LITERS 0 80 160 240 0 32 320 400 480 580 640 3280 Old ~M~lilllers Lane O. BOX I &W FLOW PER MINUTE Louisville, Kentucky 40216 (502) 778-2731 Product information presented here reflects conditions at time of publication Consult factory rpgarding discrepancies or mcor I-vn a CID FILED This instrument drafted by Fran Bleskacek Proj. No. 90-11-1 OCT 0 Q 1991 sue- 9 JAMES O'CONNELL 474396 2 s~awz~wi o CERTIFIED SURVEY MAP Located in part of the SA of the SWk of Section 11, T30N, R19W, Town of Somerset, St. Croix County, Wisconsin. W o~ CD LEGEND C N co !9 Aluminum County Section Monument Found r ~ o Iron Rod Found d 0 1" x 24" Iron Pipe Set, weighing 1.68 lbs. per linear foot t o 4-1 41 O -C Roadway Setback Line 41 ~ 7 t~~`JP P~;±T~ 40 w N NOTE: A 75 foot building setback must be maintained from the edge of pond."",; s ! ALLF~l co 41 OWNER U ? N Cn o Mark Fagerland ro -+a WI14 CORNER OF 1215 Second Street ` Vj13• f! 4s co V') SECTION 11 Hudson, WI 54016 N o U i~ bb`s r eyti4, 2 slll~9ot* 3 APPROVED N 0 ~ N r i L_ n-r-rFr` L_ n 1\1DS 0 0 ~1 LA I I v - ,~I OCT o8 1991 M ST Cj-,C))xcoupoy NORTH LINE OF THE SWI/4 OF THE SWI/4 COHN&~ Aj~ aANNM. N89°37'04°W / N89°37'04W AND COIVIR n7M 620.85' J 620.85' NO1 ° 11'35 E SOI ° 11'35"W 191•.39' 192.33 TEMPORARY. CUL-DE-SAC' (SEE DETAIL) K/ / i 4 N42041'38"W N N 66.00' m W (n! (!)I ( Z IL CSI .'o~ tip.. • LEI < I a a y orn O" b W 0 ~ iTp dp Sa ' - o y 1 u M N89 28'55"W - _ L 3I o~0 A . Off' u~ 655.79' LJ j1 U. ! 1 3 apt t 10 0opoyc. 330.21 325.58' U. 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OWNER'S CERTICATE OF DEDICATION As, owner, I hereby certify that I caused the land described on this Certified Survey Map to be surveyed, divided, mapped and dedicated as repret.-->entE.,?d on this map. I also certify that this Certified Survey Illap is required to be submitted to the Town of Somerset and the St. Croi>s County Zoning Committee for- approval or objection. w~ Witness the hand and seal of said owner this 2- ..day of Odd~CY , 19 Witness Mark Fagerland State of Wisconsin > SS County of St Croi ) Personally came before me this ~.w day of Oc:"bb2r , 19aL, the above named Mari, Fagerland, to me known to be the person who a>.eCUted the foregoing inst.rUff acknowledged the same. R. M NOTARY loot a y Public --o- My commission a>.,pi res PUBLIC OF WAS TOWN OF SOMERSET CERTICATE I hereby certify that this Certified Survey Map is ,approved by the Somerset Town Board:. i 91 C 1 er k Date aa' N~ IF'" yyy AppROVEDAL FN L F 1991 in 0S-1407 OCT HUDSON, r• ' H ( OUNTY co pt}1NN1tNG g Wis. ff ~ AND ,®~~~fd01r10 VOLUME 9 PAGE 2408 SHEET 2 OF 2 SHEETS r CI, ' }ndaa db-x~ 8 ~ pimp4! 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MAINTENANCE AGitl?IsMENT, a St Croix County. H OWNER/BUYER James D. & Shirley M. Stanek' ROUTE/BOX NUMBER Wb Fire Number CITY/STATE Somerset, WI. _ZIP 5401:7 - PROPERTY LOCATION: SW SW `4. Section 11 11• 10 It 19 W' Town of Somerset St Croix County, Subdivision NA Lot number four' Improper-use- and maintenance of your septic system could result'in its premature failure_to handle wastes.' Proper maintenance can silts of pumping.out the.,_septic tank every three,years or sooner,` if needed, by a licensed sujptic tank LLllll , wliat you put into the system can affect the function of the Sul)tic tank as a treat inent stage ill the waste disposal system. St. Croix, County residents maybe eligible to r,eceive'a grant. f sx a inaxi'mum of 60% of the cost of replaceme:it of a- failing',system, which was, in operation prior. to,.July 11978 S' C CUUnty accepted this. program in 'August"'. 1980; with ti e requlrelient that of, " owners of `"all new systellis agree to keep,thoir systems properly ma intained.~ The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a ma"suer plumber, journeyman plumber, restricted-plumber or a.Licensed puprper veri- fying. that (1) ttie on-site wastewater disposal system is`in proper operating c( nditio'n -'and (2) after inspection and. pumping. (if 'nec essary), the septic 'tank is less than,1/3; full of<sludge and scum. Certification furor will be sent.approximat'ely 30' days prior to three year expiration.' o E z I/WE, the undersignedhave read the above requirements and agree" -c„ to maintain the private sewage disposal system in accordance' With,- H the•standards set forth, herein, as set by the Wisconsin Depart- ment=of Natural'Resources. Certification form must be completed >and returned to the St.-CroixCounty Zoning Off ice'wit hin 30' days of the three year expiration date`. SICNEllM4 DATE St. Cijoix County Zoning Office P..0 I-ox 98 Hammor'•d, ;WI 54015 715-75:6-2239 " or 715-425-8363 c .ro Sign, date and return to above: address. „ - , API'MC;ATION VOR SANITARY PCRIfI'1 S '1' C - 100 This application form An to be completed in full and signed by the owner(s)'of the property being developud• Any inadequacies will only result in delays of the permit issuance. Should this duvel,ohiiiene'be Int(:ncled for resale by owner/contractc?r, ("spec,*~~ house"), then a second form whould bu rL:Lilkied: and completed when 'the property is sold and submitted Lo th'i.a OfI'.Lr_e w1LI1 t. liu'appropriate deed recording. - - - - - - - - - - - - - - - - - - - Owner of Property James D. & Shirley M. STANEK I , i Location of Property SW SW SI; Section 11 T 10 N - R 19 W Township SOMERSET i" Milling Address ~ o Al~ MN Subdivision Name _ s Lot Number FOUR. Previous Owner of Property Mark Total Size of Parcel 7.97 acres Date Parcel was Created 08 X07 X91 R - Yes Are all corners and lot lines identifiable? No Is this property being developed for resale (spec house) ? Yes X No Y't1 175 as recorded with the Register of Deeds r ` Volume 92 5' and Page Number _ . INCLUDE WITH THIS AI'PI..ICATION ONE OF THE FOLLOWING: ; 1. Warranty Deed 2, Land Contract 3, Other recordi.nge filed with the Register of Deeds Office F.j In addition, a cur. t:l f] od aurvi.ly, .I. f ii vii I I tib I o, wouldbe elpf ences u to so as to avoiSurveyys. of the reviewing ng luri.,i: olli1, I C tho dooll dr ilr LIitlon refer , 0111. Map, Ulm! thc. Cur' L:1 I ~:~r( hill,'vu1. o i. I I I I u, hu ruquir.ed. ~ _ 11!(:►I,l I i l~ t~l~tral 1' CI R CATION I (We) CuLti6y .taut IIN' a,t~t.f:enieit.f..<s art .011,,s 6otm aice tAf e tde~bed6~.ny `h.i~j (JA 5 ' IznOwQectge; That X (we) urn (tt1te) the o(oll 01 (b) 06 the p p t ~ .irt6onma,tion i6mm, bil v.0ftue oA ct uta!t~i~ui-f.il"decd &econded in tJte 016.ice 06 the . County Re,g.i.bten 06 Vv(ld,h 06 Vocimie)i.f. No. 476413 and that I (we) p~te~en,t~y curt he p~toimbc.t( e.i t.c. 6o/t .?III- (tge- c.upa -by~stem (on I (we) have obttUred an eazemen.t, .to )(,tm ttUll :tlic nl)otie demos, gibed pnopeAty, bon the comt utcti.or, o6 sa.hl ,,jjh :cam, Mid the. S(Imv licta been dIt64'c corded in the 066ice o6 the Courtly Rcgisa:eh o6 Veec16, as Vortiutieti.t No. )SIGNATURE (iF OWNER SIGNATU OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED ~r EbOCtFPJfENT NO. WARRANTY ,DEED HIS SPACE RESERVED FOR RECORDING DATA STATE BAR OF WISCONSIN FORM 2-1992 47G413, Vol y2 REGISTER'S OFFICC T ST. CROIX CO., W1 Mark A. Fagerland Recd for Record . - _ at DECO3 1991 - ----1 8:30 A. M / ~yA conveys and warrants to J-•-- --am--e- -s - D. - S----tanek and Sirley_1!I ._-Stanek-,--.husband-_an-d-. wi fe.- as--marital g9y~p;. survivorship-.-prop-ert-y..... - . RETURN TO . . _ . - 11 . the following described real estate in --.fit..-.-Croix- --.---County, i State of Wisconsin: Tax Parcel No : li Part of the SWk of SWI-4 of Section 11, Township 30 North, Range 19 West,i St. Croix County, Wisconsin described as follows: Lot 4 of Certified Survey Map filed October 8, 1991 in Vol. 1191', Page 2408, Doc. No. 474396. This AS _.nP: homestead property. (is) (is not) Exception to warranties: easements, restrictions and rights-of-way of record, if any. Dated thi# .D-.. y of November. 19.91 t. . -(SEAL) _(SEAL) Mark A. Fagerland . (SEAL) .(SEAL) * R - . . . AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. County. A,~l authenticated this day of---- - - Personally came before me this .-s -2.--..... day of O~ ~?Gi V- r'~ 19-`).1--.. the above named . , a---- NQTA~tY. - TITLE: MEMBER STATE F wlsS ONSIN (If not, r,- f authorized b - - - t3 y $ 706.06, W 3ta.7 to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY ^ - Kristina 0g land Lundeen Mc-e - Attorney at Law Notar Public S~. CrC,-l County, Wis. (Signatures may be authenticated or acknowledged. Both Nty Commission is pennanent.(If not, state expiration are not necessary.) date: 1- -Names of persons siRnina in any capacity should be typed or printed below their sisenaturee. Wisconsin Legal Blank Co, Inc. - 1 State of Wisconsin County of SL Croix 1 hereby certify that of this I to full; the doaxw tan fife true and correct copy and of record in my wft and Im bon compared by m& March 7 94~ AVW James -0' James O'Connell !Register of Deed: Deputy *EPAR T'MENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, CC DIVISION LABOR BOX HUMAN REDLATIONS PERCOLATION TESTS (11J) MADISON W 53707 (ILHR 83.09(1) & Chapter 145) LOCATION: SECTION: TO N IPP URTttPALITY: LOT N ]BLK. O.: SUBDI ISION NAME: 1/4 /T2 N/R f (or)* ~S R a COUNTY: O NER'S/BUYER'S NAME: AILING ADDRESS: USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIA DESCRIPTION: PROFILE DESCRIPTIONS: PERCOLATION TESTS: Residence New ❑Replace p/ .t/Tt I f / I1L RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN-GROUND-PRESSURE: SYSTEM-IN-FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) E ]S [Zu ®S ❑u ®S ❑u ❑ s ©u a s 21U &~"er If Percolation Tests are NOT require d DESIGN RATE: If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Floodplain, indicate Floodplain elevation: 4Z PROFILE DESCRIPTIONS /'v A4 BORING TOTAL DEPTH TO GROUNDWATER-INCHES CHARACTER OF IL WITH THICKNESS, COLOR, TEXT RE, ND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) Ba o- / B- B- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL-MIN. PERIO 1 PERIOD 2 PER D PER INCH P 4 8 / % s P- Jt9 P- AJA r1F 0/0 74 P - P, .917;1 P- Pp PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their locatjpn on the plot plan. Shuw the surface elevation at all borings and the direction and percent of land slope.G , e?aZS~7~0~~ SYSTEM ELEVATION ff~t F 3 . E - E r E 40 E E _ . A N I S6 lo ~ Ia ' 41-1-11 E , E ~ E t . IS I, the undersigned, hereby certify that the soil tests reporte on this form were made by me in accord with the procedures and method fi d ne a i)c \sin Administrative Code, and that the data recorded and the loca ion of the tests are correct to the best of my knowledge and belief. C• NAME (p int): TESTS W01- ERE COMPLETED ON: AD ESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): E S 3 /S - CST SIGN T E: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) - OVER - M PLI s s N a. i THE and I O THE OWNER: T test report i equest V~ i, n s ri,,ate -u-c to c a rrn' z 'on. This instrument drafted by Fran Bleskacek Proj. No. 90-11-191 CERTIFIED SURVEY MAP Located in part of the SA of the SA of Section 11, T30N, R19W, Town of Somerset, St. Croix County, Wisconsin. W 4- CO im N N LEGEND O r o Aluminum County Section Monument Found ' • }II Iron Rod Found o b d s o 0 . 111 x 2411 Iron Pipe'Set, weighing 1.68 lbs. per linear loot v o v mar w .a~~~~''.1";.;' L 1 OWNER w. Mark Fagerland -4 0 WI/4 CORNER of 1215 Second Street co vi SECTION 11 Hudson WI 54016 i14 3 ~C~Of, rdV J: t v M UNi,LA i TED LANDS NORTH LINE OF THE SWI/4 OF THE SWI/4 N89037'04"W ! N89037'04"W 62o.e5' J 620.95' J~ NOIGII'35"E SOIoII'35"W 1,0 191..39' 192.33 TEMPORARY. CULtDE~SAC' K o (To be removed upon 612, extension 6f road.) N42041'38"W 4 ' N H (I)I 97 Acres ( % , L 66.00' X fl Ito ~•~u `p0 01 tiIb ) 10.13 Acres U. L'JI <1 to 0 -JI Coo W M 1 'V pie y, IV 0 p_ ~.j o\ ti a O N89 28'55"W bW C_-j I I.1j1, 0 3 D~ ~a1 `0 yb aOPOy4 / 655.79' 3 O Ll.{ I "I W b Q 0 1 W z 't N 0% :i <i J1 a N O POND A 0 jl 1 ,°n O P c a LLI -1 8.95 Ares 56. R/W c J z W -'I _71 0 P 8.56 Acres Exc. R/W -~i N / 2 . rp 3 I 9.84 Acres Inc. R/W1O e 9.41 Acres Exc. R/FI y iq ~ SB 09'59"E 926.42' ° C E 260.79' F 657.63' t (O~ I 6,~1 1315.45 - 0 X89020'48"E x_1315.45'-S89°20'48"E SOUTH LINE OF THE' SWI/4 SW CORNER OF . SECTION II IAVENUE SECTIONRNI OF UNPL_ATTED LANDS SCALE IN FEET 91d qoa 0 200 400 600 R ~2 C.j 1 fA ~6 tY` OD w ~n Yll t~0 GO ' z t~ o~ 1Xp o OC) \ m h o Y ~ a\O coo' v o W Qo v o -co = 8a Q d0 T oz v %Ile C7- eo PP r6 -1 1 ^ r C~p dry '1 4