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HomeMy WebLinkAbout008-1060-30-400Wisconsin Departrnent of Commerce Safety and Buildings Division GENERAL INFORMATION PRIVATE SEWAGE SYSTEM INSPECTION REPORT (ATTACH TO PERMIT} aunty: _. ~~~~ ~ X Sanitary Permit No.: :O State Plan ID No.: Parce Tax.No.: ~c~u -3~ _ Y~~ Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: [] City ^ Pillage (Town of: ~~~I ~~L~ ~ ~ ~_ CST BM lev.> Insp. BM Elev.: BM Description: . 3 S ~`~+ ~ w Y ut~IL Te~lk II~iFnRllAerlinnl 1 ~a c- ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic ~ Dosing NA Aeration NA Holding PUMP /SIPHON INFORMATION Manufacturer Demand Mode! Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Fi Disi. To Well CAII AR~IIRDTI~IN CYSTFM BED /TRENCH Width Length No.Of Trenches P17 No. Of Pits Inside Dia. Liquid Depth IM N TBACK S SYSTEM TO P / L BLDG WELL I LAKE / STREA LEACHING Manu adurer: E INFORMATION Type O CHAMBER. Mo a Num er: System: OR UNIT DISTRIBUTION SYSTEM STATION BS HI FS ELEV. Benchmark / c3.3S )Ia•3S ~Ja•3s Bldg. Sewer ,; f v S S ~ St/ Ht Inlet Lj }~ tJ St/ Ht Outlet ~ f -' Dt inlet Dt Bottom Header /Man. Dist. Pipe Bot. System Final Grade x Mole sae I x I Length Dia. I Length Dia. Spacing ~ I I J 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 ^ Yes ^ No COMMENTS: pndude code discrep ncies, persons present, etc.} ~ ~ ~ f ~ ((~S`~~~ ~~~ ~~ ~~ l,L~s ~ ~1 ~ i~~~ ~~~ ~~ ~ ~ C~ ~S .~ ~ u_r~ Plan revision required? ^ Yes No /„ Use other side for additional informs ion. ~ ,/~ W ~~Jl..~~ (U ~~ can~~yn na ~ro~~ Date Inspetto~ sSignatur Cert. No. County an tary Perm t App tt:a on sT. cROlx cow~rrY tMSCONSIN ~ aooord wNt 15.04 St, t:roix County Sanitary Ordirtarwe ZONINti Ot~FiCE Personal information you provide maybe used for secondary purpcees ST. CROIX COUNTY GOVERNMENT CENTER _s_ _~ " (Privacy t.aw. S. 15.04(1 xm)j 1101 Camrk~-aei Ropd ~-y.~ Hudson, WI 5401ti-7710 15 680 Fax 15 Attach to plans for the em on paper 1/2 x 1 ~ Ina,as kr size. County Sanitary Permit # ^ Check i1 revision to appl cation D//~ on Mformatioo • Please Print all Mf ~g~; Owner Name f 1/4 /4, Sec •? T N. R E or Owr>ers ~Mg Address f~ lot Number, f Block Number ~j ,~ ~ ST. CROIX COUNTY `]~ " ,State ZrP Code Sub d ivision Name or CSM Number / ~ / ype ~ Building: (check one) , jet a 2 Fam~y Dwelling - No. of bedrooms: L,! D)c b csA psi. ~~v, e ~s~y ___t____ / I 1 1i ( ~Y ovalage own of ~ ~ ~ ,,,,~.a 6~b ~~ J -~ ^ (aesrxibe use): s~ ~ ^ G ^ State~owned Nearest ~. Type of Permit: (Check only one box on Nne A. Check box on ~e B if appl'Ir~Yble) Parcel ax Numbers ~ i,^ Repair 2. i(d Recotx>edion 3.^tJort-plumbing . ^Rejuvenation sanitation ~D '~{ -' lG~d ~• Q -. pp ~ Permit Number Date Mate saracary Permit was previously Issued !' D d N. Type of POWT System: (Check ail hurt apply) --~- -/ Q Non-pressurized In-ground eta Mound ^ Sand FUtet ^ Cor>strucled Wetland ^ Prasstxized in-ground ^ H dloi 'ng Tank ^ Single Pass ^ Drip tine ^ At'9rade ^ Aerobic Treatment Unit ^ Redreutating O Other V. roatment Area lnfortnatioo: 1. Design Fk~ar (gpd) 2 Dispersal Area 3. Dispersal Area 4. Soli Application Rate 5. Pet+cdation Rate 6. System Elevation 7. Final Grade ~~ ~ 0 ~ ~ ~(j J=ay ~) (MinJmch) ~g. G~ Elevation Vt. tank Information Capaicty M Gallons T # of Manufacturer Prefab Site Con- Steel F~ Plastic New Existing Gallons Tanks Conrxete strvc:ted glass Tanks Tanks {tY ^ ^ ^ ^ V0. Res tlity statement 1, the undersi~ted, assume responsibility for repair/recbnnenctionlrejuvenation(nstaliation of net-piumt~irg for the POWTS shown on the attached plans. A ticertse is not required far telralift repair or the installation of non-plumbing sanitation system. Plumber's {Jame {print) PI s i~na no ): ItliP/t•APRS No. Business Phone Number i~ ~_ Pkrnber's Address (Street, Cdty, State, 2fp ) , val. Coon use on ' Sanitary Permit Fee Da a is ued issui gent S { o ) Approved owner 1 verse . . ~ Z 25 • a O (ai 7 0 ~] lion IY [`.nndltinne Af dnntnvsURaacnnc fnr nieannmvsi• \ ~ C ~ . 1 ~ _ /L . SYSTEM QWNER: 1. Septic tank,. effluent filter and dispersal cetl must all bgservices / mafrs as per management plan provided by pltmiDer. 2. AN setback requirerneMs must be as per applMaible code J ordittstices. 3J / • L ~ G.1 /1 /L(,. (..~1Ua,~\n~ 5 rv~V~~ ' ~+c. I ~~"""~~~Y a~ ~ ~~~ . iv J ~`i lJf.~C~,cv Seca. ~..'` ~l~rlG QONTRACIINQ, LL,C 8PJ 160i}~ 81: 648~+t7MPRS ~ DWI X540 ~3-8526 ~~ p~,o pos .gal frjd R • fro u s v ~w• C G e4., U •t,~ ~~~~ ©~- x,~;~ ~ i~c3 ~~ ~~ _~,~ . ~~~~~ ~t4~~~~ ~~ ~~~~ arc-~G wiscons'^ Dep<artmjent of Cq~merce f PRIVATE SEWAGE SYSTEM Saferya~$ui' ;inyDivia''m .sir _ a INSPECTION REPORT t3ENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purooses [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Anderson, Jerem City Village X Township Eau Galle Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ l .Z- lot Dosing l> Aeration `7~~ ~j 1~ Holding TANK SETBACK INFORMATION 7gNK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic / 3`~ J 7 /t',~~ ~7 ~~ / ..~ Dosing ~ 34S r /6d ~~ f 7 -' Aeration Holding PUMP/SIPHON INFORMATION Manufacturer p ~~ Demand GPM Model Number ~~ ~ ~ f i ~ ~ O TDH Lift.,/ ~ D Frictiotl Los ~C System He~ ~~ i TDH Ft Forcemain Leng~~ Dia. Z i Dist. to well ~/t ~b ; I SOIL ABSORPTION SYSTEM ELEVATION DATA county: St. Croix Sanitary Permit No: 430453 0 State Plan ID No: ~. Parcel Tax No: 008-1060-30-400 Section/Town/Range/Map No: 21.28.16.306A40 ~~3~7Z STATION BS i.9 HI bi.sS FS ELEV.. Benchm k ~~ 2 be~Y ov,a Bldg. ewer SUHt Inlet 1 ~ ~~ `~ 5 ~ / SUHt Outlet -~ R . 53 ~ ~~ , ,3S Dt Inlet -7 Z q~ ?(> JJ t7 Dt Bottom l u , ~ ~ 9,, ~ Header/Man. z ~ / ~ ~ 3 g Dist. Pipe Z. g9~3Z BV Syst~ (r ~1S Ls ~ ~~ . (oS Fina Grade ~' r ~ p /~ 3 g St Cover II ~/~J T~ c.eJ~ ~'wo-` .3 Pa'' ~s ~ ~ • ~'~ ~ 3.~ ~ll~~ ('3.5 eo 5 . _5 ~°7.1~1 BED/TRENCH DI ON Width / Length ~ No. Of Trenc s PIT DIMENSIONS No. f Pits ~ Insi a Dia. ~ Liquid Depth ~ MENSI S ~ ~ Z ~` \ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ~\ INFORMATION CHAMBER OR Type~ystem: ~ ~® ` /~~ ~ /~ / /~/ UNIT Model Number: ,~`i DISTRIBUTION SYSTEM /~ Header/Manifo~d l ~ Z Z Distribution ~ , 7 / Pipe(s) '7 ~ ~ ~ x Hole Size t ~ I x Hole Spacing Vent to Air Intake ~ - Length ~ Dia ~ Z S acing Length p D "~ / ~ ~~ ~ ly 5e SOIL COVER x Pressure Svstems Onlv xx Mound Or At-Grade Svstems Only Depth Over ~ Bed/Trench Center P "7 ~ t Depth Over Bed/Trench Edges \ \ xx Depth of Topsoil ~ ~ xx Seeded/S dded , ' ;,~ Yes ~ No xx Mulched _ Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~~ /~ ~ / ~ y Inspection #2: / ` /____ Location: 2369 30th Avenue Baldwin, WI 5400``2 (NE 1/4 NW 1/4 21 T28N R16W) NA Lot 4 /~ Q Parcel No: 21.28.16.306A40 1.) Alt BM Description = ~ D~ ~ ~l\ ~ 1. 2.) Bldg sewer length = 2„ ~~ ~~ ~~'~~aJ~-S ~ ~. L ~` ~~- - amount of cover = ~ / Plan revision Required? ~ J Yes No ~ ~ Z~ ~~ ~I Use other side for additional informa Ion. i___ ____1_____ _____ __ Date SBD-6710 (R.3/97) zTT. a~ C~ ~~ ~$'3~ ~ Cert. No. 3e 04 03 09:58a FOGERTY PLUMBING ____ 17156355286 ,~: i r ~- l• Foge*lj! Phsmbia8 #221180 ~~ d/z /oY a~ w/ ~v~: ~~ S GrNI~ _ zs ~ G--~ tkie~~ 5 • ~c1° • Y /~~- Q~IM\ T1 IZ ~~ ~~ i Q S7' ~~ ~~ qI . t ~ ~ ~~ I ~ ~i 28288 MdCe~me Rd. Jr ~~ f ~ ~r~~"~ 1 l rs9__Sr ~p ~ ds/ a ~~ ~„~ sF'~eEC A4rCG ~T yls~'A~ r,t,~66EA~,A018 _ ~ ~~~ ~~. o = cG~R~/ ouT 4s-o - Q`.d ~^ 9Te-'. d 4 X B-~ + ~ ~ Safety and Buildings Division County ,~ k ~ _ . ~ 201 W. Washington Ave., P.O. Box 7162 ~ l~dtl=X jS~Q ~sn Madison, WI 53707 - 7162 Sanitary Permit Number`(to be ft7led in by Co.) r De artment of Commerce (~) ~-3151 3~ Sanitary Permit Application - State Plan 1.D. Nntttber In accoid widt Comm 83.21, Wis. Adm. Cade, petaonal information you provide 2. ~ may be used for stxondary pttrp~es Privacy Law, s15.04(lxm) (f di t ing address) I A li ti f ti Pl P i t All I I f ti . pp ca n orma on - ease r orma on n n on RECEIVED ~~ ,~y Property Owner's Na me ~ Parcel ~ O~ t Block ~ .-. ~ 0 C i 1 4 2003 _ ,~ _ s M ailing Address ST. CI?O!X COUNT`' Property lion ~~ ~ ~a ~ 7,~ ~yU ZONINu OFFICE ~ Sf (4 Section ?/ ~G J City, State Zip Code Phone Number ~ , , ~ S ,~'.... _ (circle Otte) f E T ~ N R f ~_ ~ ; II. Type of Building (check all that apply) ~ i~l or 2 Family Dwelling -Number of Bedrooms Subdivaion Name 2 CSM Number ~ ~ ~ ~ 7 ~ ^ Public/Commercial -Describe Use 1 -+ ^ State Owned -Describe Use ~ ~ J /~~ - .f 0•?I ^City ^Village ~'[`ownship of f, III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. i~New System ~-~ ^ Replacement System ^ TreamtenUHolding Tank lt~lacemettt Only ^ Other Modification to Existing System B. ^ Permit Renewal ^ Permit Revision ^ Change of ^ Permit Transfer >D New Lut Previous Permit Number atd Date Issued Before Expiration Plumber Owner • itV. of POWTS System: (Check all that a 1) - ^ Non -Pressurized L--Groutd ^ Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ l.eaciting Chamber ^ Drip Line ^ Gravel-less Pipe ^ Other (explain) V. D' rsal/Treatment Area Information: Design Flow (gpd) Design Soil A 'cation Rate(gpdsf) Dispersal Area Required (sf) Dispersal Atea posed (sf) System Elevation VI. Tank Info in Total Number Manufacturer Prefab Sire Steel Fiber Plastic otrs Gallons of Units / ~ Concrete Construard Glass New Existing I ~~~~L~Y~/ 7~'~-~ Tanks Tanks ,Oe G Septic o~ ~ ._. L ~ / / Dosing t]tamber ~ / av G t / VII. Responsibility Statement- I, the undersigned, asstmte respo ' ty for installation of We 1'OW'I'S shown on the attached plans. Plumber's Na me (Print) Plumber's Si gmture MP/MPRS Number Business Phone Number Plumber's Addre ss (Street, City. S .Zip Code), Fogerty Plumbing & Perk Testil;~ ~~~ d f/. y02 - 3/® s - - 37 C Approv. IB'c~$Qj Sanitary Permit Fee (includes Groundwater. h S F U~ Date e o ~goawre ps) A ^ Owner Given Reason for Denial urc arge ee) ~ 3 rn JV '~ Zv ~ G~ / ~ iIIi:. Conditions of ApprovaUReasons for Disapproval 3 ~ ~,~~~_ ~~~ <~0/03~ STEM OWNER: Septic tank, effluent filter and (A ~ , ~, ~ ~ yp,` ~ r /~~ dispersal cell must all be serviced / main~amed V~%l ~ as per management plan provided by plumber. . yam' /~~' ~ 6 Ail setback requirements must be maintained U ~ ~ as per applicable code/o dinances `NS ~j . 3 J r ~ Attach txanpkte pleas (to the County o~y) for the sy!<tem bu paper not llfas than 81/2 a 11 inter iu size i ~ y -- • 30th Ave. 1'~ 2 of ? Site Plan For. Je'z~emy Anderson NEl/4 NWl/4 Sec. 21 T28N R 16W Eau Galle Tnsp. - St CroA County o ~ ~ Proposedd 4 Bedroom °_°`~ ~ 600 gpd Home Grade Elev = 109.80' Proposed weeks Conc-~ete 1260 Gad Septic Tan1Ew/label A-100 Filter 360` of 4"Astor 3034 ' ~ BMel= Top ofElecbic Fence Post ~~ :r ~ ~' 3 ~~ Flagged Elev = 1011' ~,~,) ~-- o ~ (IJ~STp~~ ~~~. ~ e ~ ~~t j S~ S ~~ ') ~- BM =Top of I "PYC'Pipe ~ ~~~ ° Pro ed Weeks Concrete .~--_. 800 Dose Chamber ,~, 95.00' ~° ` 96.00' r= 1 S/ ._ y . Proposed 2" S~`40 F.M: _.______._._.__....__.._ .~---3'` 97.00' ~`'~ m .~'~ .q ~r • _~..---~ Proposed Mound w/two 4k7S' sells _ - System EleHatioa = 9818' ~ 95.00' ~.,.~ _ ~~ 40 Acne Parcel ll~atritaire well anal waterliire setbacr~s per Comm 83.43 (g)C) Y. isconsin Department of Commerce Safety and Buildings 10541N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 2648777 www.commerce.state.wi.us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary October 10, 2003 CUST ID No.224059 ATTN.• POWTS Inspector ZONING OFFICE KEITH E STONER ST CRO]X COUNTY SPIA 23220 WOOD CREEK RD 1101 CARMICHAEL RD SIREN WI 54872 HUDSON WI 54016 ~~ 30 ~ s3 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 10/10/2005 Transaction ID No. 926029 Site ID No. 666010 SITE: Please refer to both identification numbers, Jeremy Anderson above, iu all correspondence with the agency 30TH Ave Town of Eau Galle St Croix County NE1/4, NW1/4, 521, T28N, R16W FOR: ~ ~ Description: Mound 600 d. Object Type: POWT System Regulated Object ID No.: 923585 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • Deep and thorough chisel plowin shall be tion area to break up any compaction or platy c e w c may exist. The county shall verify that appropriate plowing is accomp is a prior to sand or aggregate placement. • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" Version 2.0 SBD-10691-P (N.Ol/Ol) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10706-P (N.Ol/Ol). • Comm 84.10, All materials used in this installation shall conform to the provisions of this chapter. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe made to me at the telephone number listed below, or at the address on this letterhead. ~,~" ~~~ R ~' p' ~~ ~'' ~,C 1 y ~ ^ Page 1 of 7 Index and Title Sheet Project Name: Jeremy Anderson Property Owner: Same Address: 2321 55`" Ave. Baldwin Wl 54002 Legal Description: Parcel in the NE1/4-NW1/4 Sec. 21 T28N-R16W Township: Eau Galle County: St. Croix Subdivision Name: Pending Lot Comp.#/Parcel ID: CONTENTS Page: 1 Index and Title Sheet Page: 2 Plot Plan and Sizing Calculation Page; 3 Mound Plan View and Cross Section (Cell #1 and #2) Page: 4 Lateral Layout ;~,~ y ~. % 1 ~ ~ ~y jib Page: 5 Pump Chamber Cross Section ~`._ , .3 ~, • .; ~, , l Page: 6 Pump..Curve Data y ~, ~,,,,. ~1h~ ,.n~h~ pND ~~D~NOs Fs Page: 7 Management and Contingency Plan E -' ,M- ~DE~~G ESP ~~~ R ~,OF ~~Z~ ~~~ Mound Component Manual Used =Version 2.0 SBD-10691-P (N.O1/Ol} Pressure Distribution Component Manual Used =Version 2.0 SBD-10706-P (N O1/O1) Designer: Keith E. Stoner License # Designer 157-007 Signature: ;~ Phone # (715) 653-2324 Date9/12/03 ~NS~'Nu~,,.~, %.,, .• ~ .. .• '~ ~ 1~E 6 0.157 g~ren, ••y Wis. .•' -- DESIG _.~.~~~`````. .+ r Page 2 of 7 Site Plan For. Jeremy Anderson NEl/4 NWl/4 Sec. 21 T28N R 16W Eau Ga11e Tnsp. - St. Croix County o zo +o LJ----1 c~a amp-.o a .._._1 Grade Elev. = 109.80' Proposed Weeks Concrete 1260 Gal. Septic Tmrk w/label A-100 Filter 360` of 4"Astne 3034 ~~ ~'-~~~ ~e~p b~Pro, 800 30th Ave. Proposed 4 Bedroom 600 gad Home ' ~BM#I= TopofElectricFencePost (l ~ ~ ~ ~D) Flagged Elev = 100' r i~ / #Z ~I~iSflai.,:~ w~.- r c-~ r~~t) -BM =Topof'1"PYCPipe T~ I'~ c ~~- Flagged Elev = 95.50' ed Weeks Concrete ~- : Dose Chamber , 95.00' .r'~ ,. 96.D0' ,, sy Proposed 2" S 40 F.M. _..._..__.___...____.~__~.._.~..~.,..._ „~ro~..1~3~'' ~ 97.00' ~ ..~''.r'r,~° #1 ~~ __ - B~ 9600 ~l 0 O Proposed Mound w/two 4k7S' cells System Elevation = 9818' ', Maintain well mid waterline setbacks per Comm 83.43 (8)~) 95.00' 40 Acne Parcel ~~~{ .~'" Page 3 of ? Cross Section of a Mound System Using Two Cells for the Absorption Area w T I 1/1Q Observation Pipe O O g L ~ A 4 E " p D 25"+ G 9 „ II 3.' ' L 1 , J 9. 4 w ($ sq.} Deal Cdl Atrx Total ~ (8.~ Baeei Area Availabia -~ • '~ ~ ($} 1/10 B OR~e. Pipe Placam~t Note: C dimension = Dell separation. ~-~~Z to DG-' • Z - 3 ©00 ~- 7 Based ~ +~ ba$al ~a ro~ Mound Cross Section View for the Upslope Cell far 1/2 the deity waste watta flow. A~g~ ~ Atea Finished Grade ley tF Shading Key Topsoil Cap Subsoil Cap ASTM C33 Sand Tided Layer Aggn~ate Detail of Typical Dispersal Cell o°o°o°o°a°o°o° °o°ooooo°o°o°o 0 0 0 0 0 °o~°o°o°o °o o°o o° F ooo°o°o o°oooo °o°o°a~o°o°o o°o°o°ob~°-bo°o°o° :xtile Fabric Cover G ~b ~ &) Note: Prepare Mound Site per Component Manual Consttu~ion Procedlu+es. 3.5 % Site Slope ~ (ft) Contota Elevation -System Elev. u 1 ~: ~ ~. Y' Compacted and dense ~ ~~ ~~T I ~ 2 R I l 5~~ ~~a~ c~ . ~~ ~,~ . ~3 • Z ~ r" ~.;y, .. ~ ~ i~~ Chisel plowing, organic matter incorporation and planting to grass, as well as waiting out several freeze- thaw cycles may improve soil structure. Conduct soils verification later to show conditions have improved. Same Site Different Locations Well-structured and friable • Plowing is required to CST must recommend procedure and predict ` results on the soil re o • Doesn't apply to weak grades of platy structure Platy Structure Remediation _ r'V: i + 7(j/+ ~ w ~+ ~rrr ^wiww 0.00 gpd to 0.?? Loading '. i^~. ~':'.J :ht ~~ Page 3b of 7 Cross Section of a Mound System Using Two Cells for the Absorption Area i~ .~ 1110 GOII ~ E- B --~7~ O I O ~ - B L A 4 E " B F .S" C 9.3 ' G " D .60" 4.00 t~)~s~ N C dimensi -cell H ' I 13.38' J 9.14' K ' L 101.48' W E~) ino s ~. r;~ r ote. on - seperatta~n. Based an ~ bassi area requtremern Mound Cross Section View for the Downslope Cell for 1/2 the daily wastewater flow. ~ ~ Area Finished Grade IF Detail of Typical Dispersal Cell Shading Key Topsoil Cap °o°°°o°o°o°o°° °o°o°o°ooo°o°o ® Subsoil Cap 000000° 000000 0 0 0 o ASTM C33 Sand 000 oo ooo oo F Tilled Layer °o°o°o~o°o°o ~ Awl o000000ooooopo 0 a - A ---~ Note: Prepare Mound Site per Component Mauual Conatuction Procedrnres. ~~ x G ®La~alft) n`tile Fabric Cover [~ ($) Contour Elevation 3.5 % Site Slope ~ =System Elev. Comnti 83.44 WISCONSIN ADMII~iISTRATIVE CODE 162 'MQ,~ ~y S ~ 7Z.~~ t C~tbbD )N'~ 2. The purpose of the 6 inches of in situ soil under subd. 1. (c) The design of a treatment or dispersal component consist- shall be toassure that the influent will be assimilated into c„hs„r- ing in part of situ soil shall reflect restrictive soi rizons that j face soils without ndin on the ground surface. affect treatment or dispersal. c The infiltrative surface of unsaturated soil to whichintluent • () ~ ~.-.~.-~^ ( ) 5 .>~.ILENT D~'i'~tiN. a The distribution of effluent is ed shall be located of ne inch below the fmished~' to a treatment or dispersal component consistin of,. ' '. °' r S ~~ ~, U finer so~ material with weak platy or m assive- be tom.::;. " (4) CArASnrr~es. (a) 1. a. Except as provided under subd. 2., ~ ' _ accomplished by means of ptegstmzed ti ~ r The distribution of e~'luent to m sttu soil shall be accom- ro) 1 the dispersal capal t of a POWTS treatment or dispersal coin- poneht cdfis sfing in oftmsaturated soil shall be'lmit - d t th . Pushed by means of pressurized distribution if .the :,value for ~ p } e o at specified in Table 83.44-1 or Table 83.44-2 lfased upon the influ- BODS, TSS and f orm of the effluent is ~o ~r les§ eat quality concentrations being applied. ~ ~ ~ p~ a. A monthly average of 30mg/L$/~IAS~ := ~ j"' ~ b. Under subd. 1. a., the influent quality parameter with the highest concentration shall determine the maximum application ti ~.e ~' b. A monthly average of f 3'SS. / ~ ~- c. A monthly geometric mean of 104 fecal colif cfu per rate ~ C$fi n,~.s~ A'PP 'rte ~5 ~~~ ~6, +~ ~ .~6,n~ ...~ _ _ . c. cept as provided in par. (c), the soi ^~~ ition~_ Noce: `~[r moans oo~ony cam~ng,m;,s: r ,., u z,u untuz ~ unsatuatea sou w wmcn mrluent is to e . 1 c. shall be determined Q to es lisp the maximum`a>rolication ~ on the basis of measurements takenaaver.•30 days, ~flE''' ~~a pclwTfi rlisti?rcal design with at least (measurements Doctoring on 6 sq~~~. ~ ~; h d. The moist soil consistence of the soil horizon in which the (c) Each dose of effluent by means of pre dtB[ibution ~ infiltrative surface of a 1'OWTS treatment or dispersal component ~ into a treatment or dispersal component ctinstin'~ gad o~'tn situ will be located may not be stronger firm or any cemented soil ma not be les than 5 times the void volume of the POWTS ~ classification. tribution s. ~ ~ i~ 2 )~~~ _> e. The .~oTl'~applicatiot~ for soil withmoderate: ~ ~ '~ t("ri re~~7 ~ stmn 1 not exceed O;is~s for ~ Zlable ~' ~ e cent concentrations of 530 mg/L BODS and TSS and sh^ al~~ Ma~mum Soil Application Rates Based Upon Percolation galsJsg. ftJday for effluent concegtragons of > 30 melt ~~ a..a Free 1~n--rS~~~ .. TT77~°.n, aae.s.,w.~r...•w~r..ws~a.e.~ _ The application rates specified under Table 83.44-1 shall only be recognized where the percolation resu ave been filed with the governmental unit before July 2, 1994. .. 2. Maximum soil application rates other than dtose specified) in Tables 83.44-1 or 83.44tr2 may be ertl~91$ e° c~esig ~f a 1'OWT9 f of dispersal component consisting in part of in situ soil if documentation is submitted iin~ approved under s. Comm' 83.22 and is based on soil oernteability and evanotran ~, BODS > 30Mg/L 5 220 mg/L ' ~1'~'~"r' «" ercolation Rate TSS > 30 mg/L ~~ BODS <_ 30 mg/L (minutes per 5150 mg/L TSS 5 30 mg/L inch) (gals/sq ft/day) (gals/sq t~/day) 0 to less than 10 0.7 1.2 1 to Tess than 30 0.6 0.9 30 to less than 45 0.5 0.7 45 to less than 60 0.3 0.5 60 to 120 0.2 ~ 0.3 (b) The treatment capability o a treatment compo- ~ greater than 120 0.0 0.0 Went consisting of unsaturated soil shall be limited to that specified ~: ~ ~,s g in Table 83.44-3, unless otherwise approved by the department. s means tess,~an o~ equ~ to ` `'' '-lhble 83A4-2 , Maximum Soil Application Rates Based Upon 1Vlorphological Soil Evaluations ti-t., Fo-~axtmum nnontmy average y ° BODS > 30 <_ 220 mg/L A~ ' BOD 5 5 30 mg/L f TSS > 30 5150 mg/L TSS _< 30 mg/L ~ ~~ ~~~~~'~ Soil Texture Soil Structure (gals/sq ft/day) (gals/sq tt/day) ' ~ Fine sand Moderate or strong 0.5 0.9 Fine sand Massive or weak 0.4 0.6 Loamy fine sand Moderate or strong c 0.5 { 0.9 Loamy fine sand Massive or weak 0.4 0.6 Very fine sand N/A 0.4 0.6 Loamy very fine sand N/A ~ _ 0.4 } 0.6 Sandy loam Moderate or strong 0.5 0.9 Sandy loam Weak, weak platy 0.4 0.6 Sandy loam Massive 0.3 0.5 Coarse sand or coarser N/A 0.7 1.6 ' Loamy coarse sand N/A 0.7 ~ 1.4 ~1,~s 5 ~:b,~,1 ~- Sand N/A 0.7 ~ 1.2 ,,, 1 b~ t . ~5 ~ Loamy sand Weak to strong ,. 0.7 1.2 ~ . Loamy sand Massive - 0.5 i 0.7 ^ p f ~D 1~" Register, April, 2000, No. 532 Wisconsin ~ of.Car>rnerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Cornet 85, Wis. Adrn. Code t---- A~'~ p~B Attach complete site plan on paper Trot less tl~rr 81/2 x 11 inches in s¢r~ Plan must ' inckrde, tart not famed b: vertical and horizontal reference paint (BM}. daediorr and Paroei ID. percent sbpe, scale ar ~mensions, north aurow, ant bcation and distance to nearest road. Please paint all information. ~ Pasorral irdorrreation you provide may be used la secandery t>u~ l~Y 4aw s. 15.04 (1) (m)} ~~'I i c Page ~ of ___L' Date ~' ~D /7 z Property toner Property location - _ ` ~ 3o b ~} -c.~ ji` (/ 1/4~I~ 1/~ 8 T~' N R E (o~ GovL Lot ~ ~ ~ C)Nmer' Ma" 3~~7 ~0 J 8 SerDd. Nams or ,~ ~l~ n_LN(1G~ Xi ~ ?. 1 Z (Sty State ~ Code Phone ~ (Town Nearest Road ®'New ConsOuction Use: ~esa>ential / Number of rpde design Ilow rate L~ GP[ n a~r,~.n+~r ~ n Public a mmnerrial - Parent macerw Y~ ~ w ~~ - Flood Plaiin elerafiorr a appi4aae Tl.¢/.¢ /~ = R neoorrrrrendations: Skl6~1' ~at/XluR of P<• / ~ /~2 O d (/~ Qi ~ ~/~'T 2 ~S C~ 6.~ ~r,ooP~ - _ _, .yl~iu i~ ~w~ # YG Plt CarOUfld SWfarei etBV. ,,,~. ~',a2,~~ $. ~ ~ ~l ~ -- n' $p~ r`Igw.w`^^• Rdt Horizon Oepth Dominant Color Redorc Description Texture Strrrc~rre Cansistenoe Baurrdary Roots ~~ ar. Murrsell (lu. Sz. Cant. Cokx Sh. 'Ef~'1 'E(fu2 -1~ - s 3 ~ 2 3 -s - S .~- a~ eons # ~~ Ground surer elev. ~~ ft. OepB- b imGng factor ~-•-. soy Raa i i R Text~ae Srnrcfrre Carrsistdtoe Borrdary Roos GP ENIt~ Horizon Depth in. Domatant Color Murrsefl ~ on edox Oaso Cu. Sz Cant. Color Sh. 'Eifi1 'Efi#2 ~ _s- r- ~ ,v ' Z "'__ • tJtluen t 81 = BOD. > ~ ~ 220 nrplL ard.TSS >30 < 1 50 nglL i2 = ~ s < 30 nglL and TSS < 30 mgfL-• - a/iR~ - -,Jat$ Cve~ooa .,u~wA.ww. . ~,.......~ -------- Fogerty Ipmbing 8r Petrit Testing pFF,rnE ?is-,L~t= Pld9 9R7RR MrKan~iw Rrf Z'~v3 _ l.F.LL IGS!-'Yo1 ~?!O~ • ~ '~ ty~,r~n, t~~.1~1~r X060 -- 3o~ma ~ ~~_~ ~~ t~arug ~ (~ ~ Grard surteoe elev. ~s.~L ~• b ~s ~'°r--~--- "'. sd ! ~, ~, t~satp~ texwre sructi.e oarsislenoe 6oi.x~ary Roats ~,. . au. sz car. cxtor ~, '~ ... ~~ (~~ # ^ ~ ~ i I Q1 ~x Gra~ad surface elev. a Depln to Gallig taaor sat ~ Horimn Depth ~~ Redooc Desaipdian Texture Strt~una Gotrsalerrce BornrlaA- Roots GPO~E 1A, ply/ Au. Sz Car. Cdor ter. Sz. Sh. 'Etltl'1 '612 ^ t~9 ir. t~8 * ~ Pit (~ro~>ttd sur[ate elev. ~- b fining taclor tkxiaon t Oomir~nt RedQ+r Desailrion TexMae ~ Bo~Y ~0~ in. tau. Sz Carr. Cdor Gr: Sz Sh > e ' EflNaent ~2 =•80D, < 30 mgft. and TSS' 3tl mgll • Efnuent ~1 = BODS > 30 < 220 mglL and TSS 30 _ 150 mg1L The Deportment of Commerce is an equal opportunity service provider and employer. !f you need assistance to access services or need material in an alternate format, please coptact the department at 6083191 or 7'~'Y 608-264-ST77. sen~eswn<.6aoi ~. r Fogerty Plumbing #221180 28288 McKenzie Rd. Spooner, WI 54801 (715) 635-969, -~ ~f~/-' y ~o-~~r, ,~> „~8 O ~~~ ¢o ~ ~CCCL sic mar s6~ ~ " ~ Ys'_ :. d ~ r = ja~v~ T~p of ,~'YEt . p-sT Srdtcp~ r~~,D~A~B -Tr _.. /a i S'.D ~ ~"~r -- 9~ I) q~~_'. cl ~s ~ ~~ ..w~_! X - x A. yts $-2 8-~ vI e ~ ssZ x Q-3 .` ~s.~ . ~ . w ~ M, Owner/Euq~r _ Mailing Address .~ ^~ ~~I Property Addres~'~ City/State ST CROIX COUNTY SEPTIC TALK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM (Verification required from LEGAL DESCRIPTION Parcel Identification Number 00 - / 0 ~ o ~30 -~-,lc-~ Pro a Location ~ `~~ ~~ ~~ p rty ~_ %,, ivu/ '/a, Sec. ~r . T .z P N-R /6 W, Town o ~~ ~sr~ -isiest ~-s~- ~ ~:? .~~ vol lG ~a ~,/3tS'6 ,Lot #_ _ y _ _ - Certified Survey Map # ~ Volume ~ Pa`#--' - g Warranty Deed # _~~ ~ 7' Volume ~~ 5 ~' .Page # S'~`s..._. Spec house ^ yes Cy'no Lot lines identifiable CvYyes ^ no SYSTEM MAINTENANCE hriproper use. and maintenance of your septic system could iesult 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 pu~Anper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Goix Zoning Department a certification form, signed by the owner and by a ~~' P1~~.1°m'neY~Plumber, restrictedplumber or a licensedpumper verifying that (I) the on-site wastewaterdisposal system -- ._. rs in proper operating condition and%r (2) after inspection and pumping (if necessary), the septic tank is less-than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of a three year expiration date. . ''. / 3 SI A OF APPLIt:,ANi' DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the Property cribed above, by virtue of a warranty deed recorded in Register of Deeds Office. 3 SI NATURE OF APPLICANT TAI 1 ~ ~ DATE- ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. *****' ~-- ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed . .. .. Page 7of 7 -1 of 3 Private Onsite Wastewater Treatment System Mound Management Plan Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System(POWTS) Shall Include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for the system will be filed with the county zoning or health department. This management plan complies with Comm 83.54, Wis Adm. Code, and the Mound Component Manual for Private Onsite Wastewater Treatment Systems SBD-10691-P (N.O1/Ol) And the Pressure Distribution Manual SBD - 10706-P (N O 1/0l ) Table 1: System Design Specifications Sanita Permit Number CJ S 3 Number of Bedrooms 4 Desi Flow GPD 600 Soil Abso tion Corn vent Size (s . ft. } 600 1j, sT • G2 G S Se tic Tank Ca aci Gal. 1260 rated for 604 d waste water flow Purn Chamber Ca aci Gal. 805.12 T of Wastewater Domestic Table 2: Soil Absorption Component -Limits of Reliable Operation Se tic Tank Com nent Soil Abso tion Component Desi Flow-Peak GPD 604 600 Max. Influent Particle size NA 1/8 Inch Maximum BOD 5 m 1 NA 220 Maximum TSS (m 1) NA 150 Maximum FOG NA 30 Table 3: Maintenance Schedule Se tic Tank Ins ect and/or service once every 3 ears Outlet Filter Should ins ct once a ear and clean eve 3 ears Pum Chamber Ins ect once eve 3 years Soil abso tion Com nent lns ect once eve 3 ears ' ~ ~ P, ,J2025 P 59 ~ ' STATE BAROF WISCONSIN FORM 1-200( WARRANTY DEED Document Number This Deed, made between peter E. Stene, a single person Grantor, and Jeremy Anderson, a (}1~t+~ t1~+:,p(~ Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property") (if more space is needed, please attach addendum): Lot 4 of Certified Survey Map recorded in Volume 16 on page 4386 as Document No. 692666 being a part of the Northwest Quarter of the Northeast Quarter (NG1+a of NE's), Section 21, Township 28 North, Ranges 16 bleat, Town of Eau Galle Together with all appurtenant rights, title and interests. E,~E.;tZJtIJ 7 KATHLEEN H. WAi-Sti itEG35?E4 OF GEEGS REr,L'IV6i) FI]R REi:ORG i0~~b-200i 1:40 PI! SEC FEE: 11.00 THANS FEE: 17q,40 ~OFY FEE: ERT COPY FEE: PA(i£:i : 1 Area Name attd Rewm Address Title One Premier Group, Inc. 706 19th Street South Hudson, Wisconsin 54016 part of (,/~~ 008-1060-30-9g~• Parcel Identification Number (PIN) This is not homestead property. (~a) ~m uur~ Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, and Restrictions of Record. October 2002 E .-Stene AUTHENTICATION Signature(s) ~''id`J ~• ~d;~ Notary Public authenticated this day of '~y~'Dti'r~Q~r1 a TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Michael H. Forecki, Attorney ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. St- Croix County. ) Personally came before me this 22nd day of oetober 2002 the above named Peter E Stene to me known to be the person who executed [he for ~ g i~jst me ~ cknowledged the same. • Ka /elm Notary Public, State of Wisconsin My Commission is permanent. (lf not, state expiration date 'Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM Nn. 1-2000 [tomey Michael H Forecki 1830 Brackett Ave, Eau Claire WI 54701-4627 Phone: (715) R35-3029 Fex: (715) 835-4112 Michael H. Forecki T420411R2.ZFX Prod,ceE wtlh ZipFwm^~ by RE FormsNar, LLC 7aD25 FAteen Mie Roed. Clirton Tpwnshp, Michigan 49035, (900) 393A905 /~ =.y(v-S Monday, October 13, 2003 9;52 PM Darren Merth 7156882264 . . , ., z s f ~~ 1 11 1 I 11 I ,~.ae~arc~,~s~a~;.,~Trs, ~a ~r, ;. ~ ~~~ ~ ~ ~,, J ~4~._. _...._._._ ._._ I ~ y `~ ~ ~~ ~, .~ ~? ,~ ~ ~ 4 Y' ~~ ~..~ i €r t 1 _ 1 n iTl r Z ~ ~~ ~ JEREMY ANDERSON . , 8 .... , ~' p.04 Monday, October 13, 2003 9;52 PM Darren Merth 7156882264 a ~, x $IIJEREMY ANDERSON p.08 r „f ~- ~ `~r t}~, ~( ~ '"~ 'a ~ 692666 VOL ~ 6 PAGE 4386, KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIx CO. , MI . RECEIVED FOR RECORD ' 10-03-2002 9:00 AM REC FEE: 13.00 CERT 1 F t ~D SURVEY MAP pAGESFEE: z. 00 L OCATED ~ ! N THE NW ! /4 OF THE NE ! /4 OF SECT ! ON 2 ! , T28N, R ! 6W, , TOWN OF EAU GAL L E, ST. CROIX COUNTY, WI SCONS 1N. -PREPARED FOR: NOTE: BEARINGS ARE PETER S TENS REFERENCED TD THE NORTH L 1 NE OF THE NE 1 /4. (ST. CRO I X COUNTY COORDINATE SYSTEM). N 1 i4 CORNER OF SECTION 21. UNPL A T TED LANDS !FOUND 2" IRON PlPE). ~•••_ ••••••...... SMALL TRACT 3 O TH A ~E, 26 ! / . 60' NORTH L 1 NE of THE NE 1 i4 .ses°2s' oo"~'---- ~ s8s°2s' oo•E s2s. ~s' 3 76. 02' p 3 r- R=S88°5T' 56`E~' - 66.'x8' -'~ '--I=N86°29' 00"W W 3 76. N 5! l. 38 +I+'~E, 33_• z i 00 ~ ~ •r'i .. $ • S86 °29' 30' E o 0 33.04' 929. 86' es ! 305. 80'~ 6B. 08' ~ ~ p3 ~ • C. S. M~ 'W HWSE^ ~ 1 vE H/GHWAY ~ M • • •SETBACK • •M' ~ Z ~ OI ~ ...~.QT ..~. ap L /NE ~1 rTl ~~~_. vo~....15 ~~.~ LOT 2 ~ ss Zo ~ g' ~° ~ _ ~ s. 82 ACRES W ~ L 0 T 3 ~ z ,~ v,I .!'A. GE...41.6~ o d• ~ 296, 868 S0. FT. ~ ~ 8.52 ACRES = ~ ~0 6. 43 AC. EXC. RiW . ,~ 371, 24T S0. FT. R-N88°57' 56'W~ 279, 9T 1 S0. FT. ~ 8.26 AC. EXC. ~ ~ • 370.00' " R 1 GHT-OF-WAY ip C~: O S86 29 0p E 359, 631 S0. FT ~ rn 4: Z O ~~ 5!!.63' ~ a '~" Q: --t Z' 2 S86°29' 00`E O `c~ 8 N ~' ~ - Q~ BBT. 80' N "'~ W m o J: _ h b_ 2 p: ~.2 ~ • N ~o ~ 3 z ~, ~' ~~ ~`.: ~ O M FZ- Q: Q: ~ o o nJ, 4 ~, -': g e ~ z: ~: 9.39 ACRES p Z ~ ;`~ 844, 442 S0. FT. 8 ? ~~ ~ ~ $ 1 . 34 AC. EXC. RiW ~ -~ ~ - 42. 262 S0. FT. ~- M H ~ d' 352.33' W N ~ N86°29' 00"W " 2 aG~ /~6~ - 3v_ 400 ~~-~~ ° APPROVED N sr. cr~olx courvTY N86°32` 42'W /306. 66' _ Pl Winn Zonlnv end Parks Committee jo°IN SOUTH LINE OF THE NW-NE ~ 0CT 0 3 2002 ~~~ .~IN..P~ATTE,~, •.4A~.GS IP t re, , sued within 30 days o OO I M I app va! date approval shall b Z~ ` cFrr4nuORNER~ On,~~in .i~~401`~94~,~ ~°,~~I ~:rd vold '~~ t. i' Wisconsin DeRartmert;of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page ( of in ~rrnrfl~nro with (`nmm AC. 1A/:.. A.I.n !'~...1.. ---- Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ~ - CY~f X include, but not limited to: vertical and horizontal reference point (BM), direction and ~ Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for u ses (Privacy Law, s. 15.04 (1) (m)). Property Owner ~ ~ ~ ;~:+.~. - Location Z l.9' £ r rVl. (~. p Govt. of S T~~ N R E (or W Property Owner's Mailing Address ~"~~ ~ 3 1 S ~- ~ ~ Zoo Lot Block # Subd. Name or ~~ - Lf'~ City State Zip Code one rt~~,; ~ ~_,~~, ~, . _, ^ try ^ Village ®Town Nearest Road Y ZC; ~I;f r d w; .. I S oa z ( :~~.... J~:~=~.E- ~arJ ~-a I I -c.. 1. 30 ~ ,¢µ,~ . ® New Construction Use: ® Residential I Number of bedrooms 3 _ ~ Code derived design flow rate ~,.5?7~~ O O GPD ^ Replacement / ^ Public or commercial -Describe: Parent material ~% / ~ Flood Plain elevation if applicable - ~// /~ ft. General comments sf ~ /~ ~ ~ ~{ V ~ ~ 9. / ~ ~ vtd ~ ~~_ ~~ ~Y' ~ ~~~ and recommendations: /' T p 9 t~ Syf~rn ai4~~c.._ e~x. ~~4-c~ ~ ~t-,4t.~ ~ 'h,,2t..~~.a~ Vie- -~ ~A~ ~- 6' .Src~ ~l ~~~e Boring # ^ Boring ~-"~ (p' ® pit Ground surface elev. ~ DU ft. Depth to limiting factor ~0 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 ~ -tZ [ Z - ~ Zmabk -~~ ~ 5 i v ~ 5 . $ Z 1 -~ [0 y ~ I Z k ~'r ~~ - 5 .8 3 IfJ 4 F ~-5yr ~-[Ir, Si I 5bk ,~'~ - - . 5 . g ^ Boring ~,~ /i Boring # tp~ Pit Ground surface elev. • D d ft. Depth to limiting factor (~ in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. 5z. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 O-lZ IZ 5,) CS IV~ _ 5 3 -~ -ZZ y F2 -z.5 y ~;I Znn k ~r - _ 5 . ~ ~~~~~~~~.+* ~ - wvs ~ vu = ccv n~y~~ ano r as ~sv _~ iav mcyL - tttluen[ #Z =BUDS < 30 mg/L and TSS < 30 mg/L CST Name (Please Printj ~,,~~ Signatur ~, CST Number .:.`..~,~M Z5 9 330 Address Date Evaluation Conducted Teleohnne Numher 2113 ~~' S~ . ~I ~ C~I~ Z~t~--y~o~ SBD-8330 lRC *1- ` . ~•~ w Property Owner ~rlole~sd ~ Parcel ID # /~ Page ~ of / 3 U Boring Boring # ~ Q .Pit Ground surface elev. 9r, . ~ ft• Depth to limiting factor ~ in• Soil Application Rate l Redox Description Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth in. or Dominant Co Munsell Qu. Sz. ConL Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I Z -ID b-11 (7'Z Ili 32 ~0 `E ~I (O 4 - -'" F 1.5 Icn it Si ~ 5i I Z 2msbk 2mSbk r rn4~r ~~ cS cs ~ (v~ - - 5 5 - 5 .8 . 8 - $ ;~ ~, [~ Boring Boring # pit Ground surface elev. ft. Depth to limiting factor in. Soil Appligtion Rate tion x Descri R d Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Color Munsell p e o 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 Rata tion scri D R d Texture Structure Consistence Boundary Roots GPD/ftz Horizon Depth in. Dominant Color Munsell p ox e e Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 • Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 =GODS < 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. + y , -> . t a • ~ PAGE 3 OF 3 ~;A_MF l~-~tc~tr5o -~ T OT# ~' T EGAL DESCRIPTION ~t/ L ~~~ t9 ,~ ~~ T a'S~ N.R. /fin E(or~cy SCALE:1"= ~~ BM 1 ELEVATION ' /QO BM 1 DESCRIPTION -{d P o-~ ~ ~ Pv [, (a~ 'Q~- BM 2 ELEVATION 9' 9 v o BM 2 DESCRIPTION 'a~ v -~ ~ ~~ ~v~ ~' p_~_ SYSTEM ELEVATION TY• ~U SYSTEM TYPE 1~1.cs~ ~.o~ Sir ~ T-C v/~ CONTOUR ELEVATION 9 ~• S~ N I i S~~ZZ ~G V ~`~ a~~ G~ ~~ 5 ~ r Q` ~~ ~ ~~e 0 6"", . ~'~~ ~, ~ _._--C~ ------ roh Tovr SIGNATURE _.,..a.,;~- ,~ _. A;~, .,.~ b' Z- ~1 -- ~ Ic ~, G.'~ ~ 9~,5-d • _~. ~_DATE Parcel #: 008-1060-30-400 03/30/2007 03:29 PM PAGE 1 OF 1 Alt. Parcel #: 21.28.16.306A-40 008 -TOWN OF EAU GALLE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -ANDERSON, JEREMY JEREMY ANDERSON 2371 30TH AVE BALDWIN WI 54002 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description ~ 30TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 19.390 Plat: 4386-CSM 16/4386 008/02 SEC 21 T28N R16W PT NW NE BEING CSM Block/Condo Bldg: LOT 04 16/4386 LOT 4 19.390AC Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-28N-16W NW NE Notes: Parcel History: Date Doc # Vol/Page Type 01/30/2006 817454 EZ-U 04/05/2004 758683 2541 /395 EZ-U 10/28/2002 696007 2025/595 WD 10/03/2002 692666 16/4386 CSM 7(1(17 CI IMMARV Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class Acres Land RESIDENTIAL G1 2.000 22,500 UNDEVELOPED G5 16.390 8,900 AGRICULTURAL FOREST G5M 1.000 300 Totals for 2007: General Property 19.390 31,700 Woodland 0.000 0 Totals for 2006: General Property 19.390 31,700 Woodland 0.000 0 Last Changed: 07/06/2006 Improve Total State Reason 48,500 71,000 NO 0 8,900 NO 0 300 NO 48,500 80,200 0 48,500 80,200 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 008-1060-30-200 03/30/2007 03:34 PM PAGE10F1 Alt. Parcel #: 21.28.16.306A-20 008 -TOWN OF EAU GALLE Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -STENE, PETER STEME PETER STEME STENE 2363 30TH AVE BALDWIN WI 54002 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description " 2363 30TH AVE SC 0231 BALDWIN-WOODVILLE AREA ! , f /r ) / SP 1700 WITC ~~ ~ ~~~ J ,v t:/ ,~( ~ ~ ~ Z P (~~ b~ ~ Legal Description: Acres: 6.820 Plat: 4386-CSM 16/4386 008/02 SEC 21 T28N R16W PT NW NE BEING CSM BlocklCondo Bldg: LOT 02 1614386 LOT 2 6 820A . C Tract(s): (Sec-Twn-Rng 401/4 1601/4) 21-28N-16W NW NE Notes: Parcel History: Date Doc # Vol/Page Type 01 /30/2006 817454 EZ-U 10/03/2002 692666 16/4386 CSM 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/12/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 22,500 50,900 73,400 NO AGRICULTURAL G4 4.820 400 0 400 NO Totals for 2007: General Property 6.820 22,900 50,900 73,800 Woodland 0.000 0 0 Totals for 2006: General Property 6.820 22,900 50,900 73,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: 12/02/2005 Batch #: 05-56 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00