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Home My WebLink About010-1070-10-100Parcel #: 010-1070-10-110 02/11/2008 04:23 PM PAGE10F1 Alt. Parcel #: 29.30.16.429A-1 010 -TOWN OF EMERALD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 05/31 /2007 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - NORDBY, RICHARD JOSEPH RICHARD JOSEPH NORDBY C - NORDBY, KATHLEEN L KATHLEEN L NORDBY 1394 230TH ST GLENWOOD CITY WI 54013 Districts: SC =School SP =Special Propert Addresses • ` =Primary Type Dist # Description ~' 1394 230TH ST SC 0231 BALDWIN-WOODVILLE AREA SP 8020 UPPER WILLOW REHAB DIST ~...___ SP 1700 WITC Legal Description: Acres: 0.000 Plat: 5417-CSM 22-5417 010-07 SEC 29 T30N R16W PT NE NE DESC AS LOT 4 Block/Condo Bldg: LOT 06 CSM 15-4202 --AND-- LOT 1 CSM 8-2369-- AND-- PT NW NW SEC 28 NKA CSM 22-5417 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) IS PART IN B L S IS 29-30N-16W NE NE T) A DWIN CHOOL D Notes: Parcel History: Date Doc # Vol/Page Type 06/28/2007 854653 22/5417 CSM 05/31 /2007 851696 QC 05/31 /2007 851695 QC 02/27/2001 639320 1592/406 W D more... 7nnA CI IMMARV Bill #: Fair Market Value: Assessed with: 0 Valuations: Description Class Acres Totals for 2008: General Property 0.000 Woodland 0.000 Land Improve 0 0 0 Last Changed: 06/08/2007 Total State Reason 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Tota I 0.00 0.00 0.00 RECEi~`E® vuL: ZZ PAGE: 5417 ~, _~ ST. CROIX COUNTY 8URVEYOR'S RECORD VIII! !III' `""'`~11 I1{II !11111!11 111111 Ill! !III * 8 6 5 3 2 854553 KATHLEEN H. WALSH REGISTER OF DEEDS ST, CROIX CO., WI RECEIVED FOR RECORD 0612$/2007 03:40PM CERTIFIED Sl~2UEY MAP CERTIFIED SURVEY MAP COPY FEE: 3.00 LOCATED IN PART OF THE NE Y4 OF THE NE Y4 OF SECTION 2s AND IN PART OF THE NW Yo OF THE NW Y c5#-TI~I 28, ALL IN T30N, R16W, TOWN OF EMERALD, ST. CROIX COUNTY, WISCONSIN BEING LOT 1 OF CERTIFIED SURVEY MAP VOLUME 8, PAGE 2369 AND LOT 4 CERTIFIED SURVEY MAP VOLUME 15, PAGE 4202 f t ('EL IN VOLUME 905, PAGE 54 LEGEND ~} - SECTION CORNER MONUMENT ( AS NOTED ) • - 1' IRON PIPE FOUND o - 1' X 18' {OUTSIDE DIAMETER) IRON PIPE WEIGHING 1.13 LBSILIN. FT SET -~.~._ - FENCE (R } - PREVIOUSLY RECORDED INFORMATION _~Nl~_ NE COBWEB, N Y CORNER, SECTION 29, SECTION 29, (1.25' IRON (P.K. NAIL FOUND) NORTFI LINE OF THE NE j~~ --~ PIPE FOUND) S87°31'43"E "- 2475.66' ~// ° 1 .~~ - ~ '= ~~~' ®~,,,. M07E_- NO NEW LOTS HAVE BEEN , CREATED. THE PURPOSE OF THIS CERTIFlEO SURVEY MAP IS TO SHOW THE RESULT OF COMBWINC' TWO PARCELS TOGETHER 70 FORM OIL AS DESCRIBED IN OOCIMENT N0.851696 IN THE ST. CROIX COUNTY REGISTER OF DEEDS. THIS 1S AN 'ADD-ON• CERTFIED SURVEY MAP. THEREFORE, STATE, TOWNSHIP OR COUNTY APPROVALS ARE NOT ~ REQUfRED PER WISCONSIN `~~~ STATUTES 236.45(2x3). ,~ ay ~~~~/ ~' i I ,el X11 b 1 ~1 ~~~1 ~ 1~ ~i ~ ~I~I~i dl ~i P ~ 1 ~; ~. ~I ~ 1 ~' ~ I JUL_ 3 ~~sc o iy W '' JOSEPH * ~ 6RANBE t ~ ~ = S-2295 ~ NEW RICHMOND ~ ,., z ~, WI i ~ g ° ~ ° ~ ~ o ~ tip V ?- suR ~ W ~~ 0 9lt~I.A BD °w ~' ~ O _ _ _ _ NW CORNER. _~~(~ SECTION 28, 1 25' IRON u°-1 ~+ o ( . i P ~F°I'"D) 14 0TH AVENUE c`3 _ / ~ ~ ll •r..e~w i'~------- - - '°3145°ET ~ .4T ` ~ ~`- ~~ / / v,~~; /. ~/ ~, ~, ~, / / I,~ 9 G ~ ~' / ~i~;' /~ / Vii' CIRiVE WiOil?10A710N ~_~_ D~II®_ T_U&fRQlls'~f k9tFaE~_ I c~~ ~~i'~~ ~°~` / Q9~.. ~, PA~fE 2 I ~~~~~'i /y l\ / `'/ Q SHEDS p a ^~ ~ LOT 6 505.65t~ SQUARE FEET (1 f _61 ACRES ) I~yIpINGR1GHT-0F-WAY- 466,996 SQUARE FEET (10.72 ACRES ) EXCLUDING RIGHT-OF-WAY @-~1(f ~ ~ff~9'BFB~ ~11~OOIs4l MAID t!®B.. 9 5.1~l6NE NE7°2Tao•W 558.37 (R N85°25'41°W ) _d®4 ffi ~~Q(~Off~ ~8D164fE4/ ~_ P _P9®lL_95 P~~C~6~ 9 - _ - _ _ - - 0' 200' 400' 600' SCALE IN FEET 1' =200' THIS INSTRUMENT DRAFTED BY: KRISTIN J. GRANBERG / 8~ / / ~i / ~i ~; ~ ~"~ _% ~ ~ ~~r I + N; 1 ~ IIz2 z I u~, = cV F m LL ~ 0 z J N ~- ._ u6J c 1 ~~ o~ °s I ~' I E Ya CORNER, SECTION 29, ( 2.25' IRON PIPE FOUND ) ®~' CURVE 1 RADIUS-1021.64' ~~ CEMRALAHGLE-16°02'10' ~~ CHORD- 285.01' ~~~ S11°3228'W ARC LENGTH• 285.94' TANGENTS IN- S19°33'33w OUr- S03°31'23'W CURVE 2 RADllS- 1064.6k CENTRAL ANGLE-16°12'18' CHORD- 29729' S11°2T24W ARC LENGTH-298.29' TANGENTS IN- S19.33'33w our- saoa-21'15w CURVE 3 RA[NlRS- 1054.64' CENTRAL ANGLE-03°3073' CHORD- sa.53' S01°3603.5w ARC LENGTH- 64.54' TANGENTS IN- S03°21'15w OUr- S00'09'OB'E OWNER RICHARD & KAT NORDBY 1394 23oTH STREET GLENW000 CITY, IM 50013 PREPARED BY: ORANSERIa SURVEYTIYG. 9100 1235 C.T.H_'E' NEW RICHMOND, WI 50017 PHONE (715) 246-7529 JOB NO. 07-036 SHEET 1 OF 2 Vol. 22 Page 5417 11 i°08' 13`W 33.1a !~/ (~ \y 1 r i Y-<:. ;~ CERTIFIED SURVEY MAP LOCATED IN PART OF THE NE Y< OF THE NE Y, OF SECTION 2s AND IN PART OF THE NW Y OF THE NW ~ OF SECTION 28, ALL IN T30N, R76W, TOWN OF EMERALD, ST. CROIX COUNTY, WISCONSIN BEING LOT 1 OF CERTIFIED SURVEY MAP VOLUME 8, PAGE 2369 AND LOT 4 CERTIFIED SURVEY MAP VOLUME 15, PAGE 420'1 AND PARCEL IN VOLUME 9014, PAGE 54 DESC/LfP7lON: A parcel of land located in pert of the NE Y of the NE Y, 01 Sector 29 and in pert of the NW Ya of the NW Ya of Section 28, ar in T3oN, R16W, Town of Emerald, SL Croix County, Wisconsin being Lot 1 of Certified Survey Map Volume 8, Page 7369 end Lot 4 Certified Surrey Map Vdume 15, Page 4202 end Parcel in Volume 905, Pegs 54 further dasa~d as tollorrs_ Commencing at the NW Comer of Section 28, thence S87°31'43'E 290.17; Branca S19'33'33W 458.40'; ttrenoe Soutllvresteriy 285.94'along the arc of a 1021.64' radius cove concave to the Southeast wtroee chcrd bears S11.32'28'W 285.01'; ihenoe S88.08'13'W 33.14': thence Southwesterly along right-af~ray line of 230th Street 64.54 abng the ar+c of a 1054.64' radius arve concave to the Southeast whose chord bears S01'36'03.5'W 64.53'; thence S00'09'08~ 233.117 along said right-al-way, thence N87'2T40'W 558.3T; thence N01'24'S1'VY 201.64'; thence N37°3G45'E 358.48; thence N01'51'4T'W 329.23'; thence N37.30'40'E 239.66' to the North 9ne of B1e NE Y of Section 29; thence S87°31'43'E 163.88' along said North tir-e to the point of beginrwlg, contairvng 505,656 square feet (11.61 saes) more a less and being subject to arnr easements, restrictions and oovenarts of record. SURVEYOR S CERTIFfCA7E I, Joseph W. Granberg, Registered Wisconsin land Surveyor, hereby certify that by the direction of Kat Ncrdby, I t-a~e surveyed the lends shown and described hereon in accordance with officio( records, Chapter 236.34 of the Wisconsin Statues, the Town of Emerald Subdivision Ordinance and the SL Croix County Subdivision Ordinance and that this map and description are a true and correct representation b scale thereof. GENERAL NOTICE STA7FAIENT Each parcel shown hereon is subject to State, County and Township laws, rules and regulations (i.e. wetlands, minimum bt size, access to parcel, etc. ). Before purchasing a developing any parcel oontacx ~ ~ Croix County Zoning Office and the appropriate Town Board for advice. This/mlap reviewed b!y SL Croix County Z/oning IexA Biadcbum Date THIS INSTRUMENT DRAFTED BY_ KRISTIN J_ GRANBERG DATED THIS 5TH DAY OF JUNE, 2007 of 2 PREPARED BY: GR.4NBERG SURVEYINq lMC 1235 C.T_H.'E' NEW RICHMOND, W1 54017 PHONE (715) 2467529 JOB NO. 07-0:16 NElN RICHMIjFUD~ WI ~ r" Q 9tio sua~~i ~~ , O~ SHEET 2 OF 2 Vol. 22 Page 5417 ~~~ yY Oro ~~7a /a P~<2~ ,~~~~ ~ti ~~ /~,~'~`~. a F~1„~0 Z I ::,; •, ~~ Q/p /D~'D /D /DD P~.Z9q VN 1 ~~gg1 ~. 1 ~~ ~z.c, Z:9 'r34 XI ~' /G Lv P.t~ ~(/L" N~ ~ J NNE1,1. 0 t ,~~,,~ / ~~~Z ~/,Z3G 9 JAM~~r of De w1 2 O ~t,Gro~Oo" .~ c CER T I E.I ED S,C:~~'R ~VE ~' M,4 P Located in the NE1/4 of the NE1/4 of Section 29, T30N, R16W, Town of Emerald, St. Croix County, Wisconsin.. Surveyed for: Robert Schlussler ~ 1374 230th St. (~, J`'1 ~~ ( I Glenwood City, W i . 54013 N 1 /4 Cor . Unplatted ands Sec . 2 9 '----- -•-_.._~ _ , _ _ _ _ I T30N,R16W J -'-S 85'29' " Imo.. 2 7 ~QL~ 163.88 0 9 N~ E~or . S 8- ~ 29' 20"E .•.•••'~: Sec . 29 North line of -'-~`~ ~' ~, the NE1/4 nj~ 9'20"W ~ " __µ___ LEGENj] ' 189.82' 2 ~ ~j <p ~ Section Corner ~ ~ 0 // ~ ~ "~ 0 1 "x24" Iron pipe ~ 2 1~0 /~,~~ weighing 1.68 lbs per lin, ft. set. / ~ East line of the NE 1 /4 o`` ~~ F 6 WETLAND Yc N O .yl. a " lf7 zl ~ W /~ O ~`~ `"v 6.k: ~ ~ ~~ ~ o O _~ Z ~~ r--- ~ OF EXISTING DRIVEWAY ~ Mobile Home ~.®-~ 217, 800 Sq. Ft. (5.00 Ac. ) .Including right -of -way 211,969 Sq. Ft. (4.87 Ac.) Excluding right-of-way Utility Pole Bearings refer:.. N 89 ~ 49' 48 ° W enced to the East. 315 , 45 ' line of the NE 1 /4 ~.s sumed ~npl~ttgc~ L~.r~ds N00°10'12"E. SCALE IN FEET I" s 100' o' za' so' loo' xoo' soo' E1/4 Cor. Sec. 29 VOLUME 8 PAGE 2369 O o O QI Q1 .~ N. (` 3 m tU .~ N , ~ O~ O 0 ~' aI W ~6 d zl ~ ~I w v g m ~, O ~ O Z ~~ ~.: y~'~ ;~ r ~a~ 3U M i 4 1991 5T. CROIX COUMY 1~+11111E PAgKS pI,ANNIN! NNWG C,OMMI'ITEE ,~u~aa~,i ~~~~aN~ti'4, ~i ~; '~'~ HARVEY. Q. ~7 ~ ~ JOHNSON 8-1899 ~ ~. HWSN ~ r '~ y'rI ENO SUR ~1 Drafted By; JW G ~n ~ , oon LEGEND • i" IRON PIPE FOUND Q i" X 24" IRON PIPE WEIGHING 1.68 LBS, / LIN. FT. SET. ~ FENCELINE IR) PREVIOUSLY RECORDED INFORMATION BEARINGS REFERENCED TO THE WEST LINE OF CERTIFIED SURVEY MAP IN VOLUME 8, PAGE 2369. PREVIOUSLY RECORDED AS ANO ASSUMED TO BEAR N00°10'!2"E. NE CORNER ~ SECTION 29 __~- -I I T30N, R16W iTV i i"f ~ R S85° 29 ' 20 "E 163.88 ' ) -__. _ -___ ~ ' ~,'2~O ~~ 0.31 - - - - ~,~ "~~~;~,~~$~ ~°' ( R 33.09 „~Z,, p (per / aP~r`~4~C",1.ti~. j.~ ~'/ ~~ `` _ Ni N ~ Q O ~ \~1 ~~' ~ I / m 3 ~ DRAINAGE AREA / WETLAND ~ ~ ~ / ~D o "`/ / rs ~' a / N ~ v ° N O ° } " / _ - Cf) N ~ In -~ CU Q p / W O ~___...~_ W - - ~ Z ~ / 30 ,~\ ~ o ,,~~~ a ~ 0' J m / ,,~~ o O~ ~ Z LOT I 1 ~' ~ ~I _ GERTI~I~D 5UR1~Y M,~P / ~ ', - 1~OLUN1~ 8, P~6E 236x. ~'S~ ~ s~ti - '~ ~~ G B G tE* ~ NEW IGHMONO ~ N i " IRON PIPE FOUND HAS BEEN DISTURBED I I • W~ •= ti ~ ~ BUT APPEARS TO BE ~ CLOSE TO ITS' POSITION 4 •• • ~l~ I I iy~ ••..» v~ ORIGINAL sua 315.10' ~ ( R N89° 49 ' 48 " W 315.45 ' ) I PREPARED BY: GRAPHIC SCALE I i"=100' 6RANB~RG SUR~EYINC~ NEW RICHMOND, NII. 540!7 0 PHONE (715) 246-7529 100 200 300 JOB N0. 01-0i9 SUR~/EY 01= WEST LINE OE LOT 1 01= GERTIPI ED SURVEY M/~P IN VOLUME 8, P~6E 236q. Scale: i"=ioo I NE1/4 OF THE NE1/4, SECTION 29, Date: 5/6/too i ~ T30N, R 16W, TOWN OF EMERALD . Revised: Drawn By: JWG Job: 01-0 i9 Surveyor: JOSEPH W. GRANBERG N 1 O LE6END • 1" IRON PIPE FOUND Q i" X 24" IRON PIPE WEIGHING 1.68 LBS. / LIN. FT. SET. ~ FENCELINE V 0 SLY RECORDED BEARINGS REFERENCED TO THE WEST LINE OF CERTIFIED SURVEY MAP IN VOLUME B, PAGE 2369, PREVIOUSLY RECORDED AS ANO ASSUMED TO BEAR N00°10'!2"E. IR) INFORMATION NE CORNER ~ SECTION 29 _~~____--_I ~ T30N, R16W L__ _ ~~T~"f ~ R 585° 29 ' 20 "E 163.88 ' ) _ _. - _ ____ --- ---- ~' ____ - _ --- ` _'- - _ I~V~ ~~,'Z`O ~ 0.31 ' ~` ____ - - -- - -- - - n~2• o- ~~ *~. Al r o a~ ~ ' t4 * ,~^'~ ~~f°~ ~/ q 3t \OUI• 0 (V ^m CU ~ 0 ~w ~N ~~ ~o ~~ i '"'~~ o S~ti ~ ~'FG B~I~G/~~ ~ aEW ICHMOND s WI 4. Q s ua~ ~ ~ I / / / i ~ ~ / / N i - O .c-~ m 3 O / Ll.. I DRAINAGE AREA / WETLAND ~ ~ ~ / / co c;= o `-' a / ((~ / (V ~t - '_' O ~ Y ~ m ` I cD _ in ~"' ¢ o /,/ / (11 ~ W ~/ '/ \\ / xr %~ m v' ~ o ~ ,- -~~~' p Q ~ m J I ry ~ ~ I Lv_i_i yr ~ CERTIFIED 5URVEY MAP ~ VOLUME 8, PAGE 236x. I v, 0 v cu i" IRON PIPE FOUND I I HAS BEEN DISTURBED BUT APPEARS 70 BE CLOSE TO ITS' I I ORIGINAL POSITION 315.10' ( R N89° 49 ' 48 " W 315.45 ' ) I PREPARED BY: 6R~NB~RG SURVEY I NG NEw RICHMOND, WI. 54017 PHONE (7 i5) 246-7529 JOB N0. 0i-019 GRAPHIC SCALE I i"=i00' 0 100 200 300 SURVI=Y 01= YV~ST LINE O~ LOT i OI~ GERTII=IED SURVEI' MAP IN VOLUME 8, Pa6E 236q. Scale: i"=loo I NE1/4 OF THE NE1/4, SECTION 29, Date: 5/6/200 i I T30N, R 16W, TOWN OF EMERALD . Revised: ~DraWn By: JWG Job: 01-019 (Surveyor: JOSEPH W . GRANBERG ~ ~~~ ~rl %~~:~ ' , oio ~a~o io ~~ L~ z9 -r.~ou z ~G r~ t ~.~~.~ ~~ ~~~ ~~0~~2 i- N ~ti ioo 8 F~~"E`D P~,~9~ .. P,~ ti~ ti~ ~ 31lN 1 ~ 19g1 JP~E~ O GON~ELL 2 ~/z3G 9 ; ~~~~wi ~~ North line of ~` Y the NE1/4 .nj~. N 9'20"W~ . ~2 ~o°~ ~ es . s2 ' ~~ ~~ ~0 ~ 2 ~' ~ ti~ /~ ~/ ~~ ~~ F xc N o ,~ w ~~ p, ei ~~ UJ ~O ~~, , Le a O ~~i _~ Z LEGEND --„~_ -_.., ~' Section Corner CER T I F-I ED S,UR ~VE Y M,q R Located in the NE1/4 of the NE1/4 of Section 29, T30N, R16W, Town of Emerald, St. Croix County, Wisconsin.. Surveyed for: Robert Schlussler ~ 1374 230th St. ~(~Jc1 `4 ~ I Glenwood City, Wi. 54013 elc/4 for . U_ nplatted _ ands I T 30N, R 16W J44L~_ S 85 ~ 29 ' 20 "E 2475 61' 163. 88 ~ _9 N~ E~or . S 6~ 2j' 2G.,^E ~ ... ~~~ SeT ~ 9 WETLAND ~L / +~ ~J t ~ OF EXISTING DRIVEWAY a \ _1 Mobile Home lL®'il" I 217,800 Sq. Ft. (5.00 Ac.) Including right-of-way 211,969 Sq. Ft. (4.87 Ac.) Excluding right -of -way .~G~~ Oro ~0 ~o io PFtzp ZI ::, ~~ 0 1 "X24" Iron pipe weighing 1.68 lbs per lin, ft. set. ast line of the NE 1 /4 o I 0 pz ~~ N 3 ~= ~~ ~ co o~ 0 . ~ I h ss' d zl ~ ~I rl~ ~ Utility Pole Bearings refers :~. N 89 ~ 49 48'~ W enced to the East. 315.45' line of the NE 1 /4 ~ ~u 2s sumed ~.J?P~~t.~~.~. ~s'~~~. s N00°1012"E. ~ ~ ~ o SCALE IN FEET I" 100' ~ ~ O ~' o m Z 0' 2b' 30' 100' 200' 300' E1/4 Cor. Sec. 29 VOLUME 8 PAGE 2369 Drafted By: JWG / i/ ~j t ~P Y C V 3U M 14 1991 5T. CROIX COUMY il+llll~ PMKS pI,ANNIN! 20NNG C,CXMA~1'TTEE I lp~ ~''~~~v~ry`~f2~'i ~ HARVEY Q. ~ JOHNSON 5-1899 7 HUDSON • W IS , < .r' ~~i N~ SU R AA1 109A ,: ~, ~° ~ r~RIG9NAL ~~fsi~ 1217 SOIL EVALUATION REPORT Page ) of 3 Wisconsin Department of Commerce Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Certified Soil Testing ounty ---- Attach complete site plan on paper not less than 8'/: x 11 in Plan must St. Croix include, but not limited to: vertical and horizontal refe in (M I , nand q Parcel I D headrest road percent slope, scale or dimemsions, north arrow I t . . . 0 1070-10- ` P/ease print all i lion. ~ ~ ?- d~. , ~>• Dat Review y , ~ Personal information you provide may be used ndary pur~~i~l(~,v, s.15 ~4~(1) (~)). ~ ~/ 3 6 / f tC~7 ropey caner ~ v ~~ ' ro ' oca Ion )6 W 30 C~' [~[~, •~ >7 ttir) r;) ) Vieregee Constru n ovt.Lo_i N R NE 1/4 NE 1/4 S 29 Property w al mg ress ~ ~ ~,OI F Lot # Block # Subd. Name or CSM 1210. ekagon Loop ~ urt~; ~ CSM Z D Z tale Zip yetis, ho ~- City ~ Cit ~ Village Town Nearest Road Hudson ~ WI 54016`•:,; ~~"715-386-9714 Emerald 230Th St. /, New Construction Use: ®Residential /Number of bedrooms 3 Code derived design ow rate J Replacement Public or commercial -Describe: Parent material till Flood plain elevation, if applicable NA General comments and recommendations: install 1500 effective sq ft rock cell along 99.6 contour at system elevation of 96.6 for 3 br system Boring # Boring Pit Ground Surface elev. 99.1 ft. Depth to limiting factor ~ 86 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIfN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-10 7.5YR 3/2 - sl 2 m gr mvfr cs 1f/m .5 .9 2 10-22 10YR 4/4 - sl 2 m sbk mvfr cs 1f .5 .9 3 22-31 7.5YR 4/4 - sl 1 m-c sbk mfr cs 1f .4 .6 4 31-46 7.5YR 4/4 - s 0 sg ml as 1m .7 1.2 5 i 46-86 5YR 4/4 - sl 0 m mfi - - .3 .5 - occasl na s me uslons In onzon Boring # `Boring Pit Ground Surface elev. 99.6 ft. Depth to limiting factor ~ 80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ~ GP Dift' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-4 7.5YR 3/2 - sl 2 m gr mvfr cs 1f/m .5 .9 2 4-8 7.5YR 3/2 - sl 2 f sbk mvfr cs 1f .5 .9 3 8-34 10YR 4/4 - sl 2 m sbk mvfr cs 1 m .5 .9 4 34-40 7.5YR 4/4 - s 0 sg ml cs 1 m .7 ~ 1.2 5 40-80 7.5YR 4/4 - sl 0 m mfr - - .3 .5 occaslona s Inc uslons In onzon Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ` E =GODS < 30 mg/L and TS5 < 30 mg/L ame ease tint Ig a ure: um er Henry F. Grote ~ 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 5475 11/11/2000 715-233-0398 %~) t °1 ' L Property Owner Vieregee Construction Parcel ID # 010-1070-10-000 Page 2 of 3 ^ Boring # Boring Pit Ground Surface elev. 99.4 ft. Depth to limiting factor ~ 80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots = in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0-5 7.5YR 3/2 _ sl 2 m gr mvfr cs 1f/m .5 .9 2 5-12 7.5YR 3/2 _ sl 2 f sbk mvfr cs 1 m .5 .9 3 12-30 10YR 4/4 _ sl 2 m sbk mvfr cs 1 m .5 .9 4 30-ti4 7.5YR 4/4 _ sl 0 m mvfr cs 1 m .3 .5 5 64-80 5YR 4/4 _ sl 0 m mfr - - .3 .5 ~ occasiona s mc usions m onzon Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. i -_ - ---~ i ^ Boring # ~ Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots = in. Munsell pu. Sz. Cont. Color Gr. Sz. Sh. --~ i ----+-- i I --- I I i ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L "Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Certified Soil Testing 1 ~ r ., , ww`` C.IL H ~~ RaneXt _-oNiQL~' -h1L Z.A•~o'\lo~ ~ ~ .., .~ ., `: v. r~ `~ ""~ .~ 0 2 0 Ito ~4~'~~ r Zs\ ~~i4.~) 7 ~ ~40 M~~~ ' (qq.4) ,V SI J ~ r~ .3- i #~~ L c~..~ x atr~--e r ~o (~ a .v1 \ ~ ~.~. r ~. ,,., yIl ~ ...: `~ ~ c}.o `~' ~ .x per.. w J 1:..~ ~, ~e ~~ . M ~ ~~ <<~.~ ( v ~ w~' ~-ti~ ~S 2~ .~ ` ( ~~ 1~i a ~ ~ S 2 ~ b~`c J~ \ ~JI~ ' `~ L S ~.o ~l 3~1 Q'~'~~ ~ ~sJ- ~ (' 3u' z ~' a~ ~ 3 0~ 3 4 Parcel #: 010-1070-10-400 04/03/2007 02:49 PM PAGE 1 OF 1 Alt. Parcel #: 29.30.16.429D 010 -TOWN OF EMERALD Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 0 Valuations: Last Changed: 10/20/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.000 25,000 0 25,000 NO _--_ Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O - NORDBY, RICHARD J RICyB~B~ ORDBY 1394 230TH ST ~~ ~ / ~ / / ~ _ ~~~ "~ GLENWOOD CITY WI 54013 fir J ` `-~ r Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 0231 BALDWIN-WOODVILLE AREA SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 4.000 Plat: 4202-CSM 15/4202 SEC 29 T30N R16W PT NE NE & PT NW NW SEC Block/Condo Bldg: LOT 04 28 BEING CSM 15/4202 LOT 4 4 000AC . Tract(s): (Sec-Twn-Rng 401/4 1601/4) 29-30N-16W NE NE Notes: Parcel History: Date Doc # Vol/Page Type 01/30/2006 817450 EZ-U 04/08/2003 716417 2199/55 WD 03/31/2003 705305 2189/198 TI 12/21 /2000 635686 1569/233 TD more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Totals for 2007: General Property 4.000 25,000 0 25,000 Woodland 0.000 0 0 Totals for 2006: General Property 4.000 25,000 0 25,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Tota I 0.00 0.00 0.00 A,. \~\` rn rn ~. IV W ~\ ~D ~D ~`'• n w (~ O ~ ~ `•.~~ `' JS' fA ~ to ~ ~ ~ ` . ~ ~ '~~ ~ CERTIFIED SURVEY MAP LOCATED IN PART OF THE NE1/4 OF THE NE1/4 OF SECTION 29 AND IN PART OF THE NW1/4 OF THE NW1/4 OF SECTION 28, ALL IN T30N, R16W, TOWN OF EMERALD, ST. CROIX COUNTY, WISCONSIN. LEGEND ~,`\ `FF `. ~ 1" IRON PIPE FOUND -X-- EXISTING FENCELINE 0 1" X 24" IRON PIPE SET WEIGHING ® SEPTIC SITE +~ 1.13 LBS. PER LINEAR FOOT "~/~syCo °•~•~•°•°•°° 100' ROADWAY SETBACK m _ ~ cZn ~ ' ~° -~ ~~ d ~ 0 o ~ ~ ~ ~~ n o m '~ r O cn~ i~~ O 'L5 Nnl a ~ '~ O I~ g ~o o b~o b'VU m MASONRY NAIL FOUND 2" IRON PIPE FOUND SCALE IN FEET 1" = 200' EVANVIEREGGE WIN C FLANUM 1208 NAIvILKAG~ON LQOP NORTHLAND SURVEYING, INC. ~ HUDSON, WI• ~4tl18 !; ,,;'`?85.fj,A HWY "65" ~. O 200 400 ''•'~ •""°'~~RQERTS, WI 54023 -~- M_[>v1P~~4GD.. (~La~].D.~S.__.O~f~1C~D.---°_~-.04Gu]C G3~5. (715) 7as-1718 707.00' ~~ ~; ~ I' r$ 1' :.,~ WEST LINE OF THE NE1/4 OF THE NE1/4 - --oHwM- -- ORDINARY HIGH WATER MARK"',.,,, • 5~.>' ~~~~~• "r""EFERENCED TO THE (O.H•W.M.) ELEV. = 1108 '' '-,,, Eq ENE 1/4 OF SECTION •--•re'sa•--' MINIMUM FIRST FOLOOR •W.M. ~~~/U 29; ASSU1~'D}TO BEAR S00°10'12"W. ~~FFE-.ELEVATION = 1113.0' ~WNER• r! I •'~n($41RVEYOR ,., Eb ~5~"R~ ~g ~~ 0 a8 ~~ ~~o ~~ ~ N ~ g ~~~~~ ~. ~~ --- -~F . '~ ~ 2 r Z mZ OD 2 m Z m A O m ~ m A ~~'. s ~' i :~ ; ~. ..•. X71 ~ 1314.76"•: ~ ~. 1 i r `~ OHWM~ y`' ., ~ r 0 ~ ~o ~ ~~ r ~ ~ AAO ' $ m m o -~ ~a ~ p~ W ,. A ...... ~~ ..........................•......•..,..•.,.. •....• ~~ ~14,34S00°10'1 _ _ S01 °52'5'1 - --5- -~- --- --- z z ° Serra ~^'~r r33j312~~ ~ p ~ ~ • ~-- oD t F% a ~ ~ Nell ` e~E9 I ~ `o p m 201.64' I ~ r z •~ $ ~ ~ O o J ~: TO ~ -A7 -i ~ ~!'~ ~11 '`'••., ~ ~ 329.23' 300°1 O'12"W 653.02' ' 33.08' -i .~ ilk ''•~I ii ~~ i jCl ~Irn I ~~I ~ ~I -~ n? A n ~Q Z ~~ I I I I I I ~I i ~I I I I~ ~ ~I ~ I ~I N ~ ~~ I I~ 16' I~ I to ~ I" ~ '-` ,~ 3 ~ vl ,p Limo 0 g ~ l5~~~° ~ ~ z ,0£'Q4 ~n ~~]° y ~• _ ~ t0 ~ ~ 0...---------•-------------•----...----•-------~---- z _ N to m EAST LINE OFTHE NE1/4 z ~ ~ I ~ m_ I _ ~i J 611.45' S00°10'12"W 725.90' ~ m ~ ~ ~ ~~ - 233.10`- - - - - - - - - -•~ ~ ~C- ~ ~ - 547.44' c i "- zs. p ~ ~ ~' I ` I \I CURVE DATA NUMBER C1 RADIUS 1054.64' CENTRAL ANGLE 03°30'24" CHORD BEARING S03°38'03'1N CHORD LENGTH 64.54' ARC LENGTH 64.55' TANGENT IN S05°23'15'1N TANGENT OUT S01°52'51"W 6607'91 I:R~I'HLEEN H. WALSH kEGT5TEk OF DEEDS 5`f'. CkOIX CO. WI kECEIVED FOR RECaRD 11-41-@001 10:00 AM COPY FEE: 3.00 RECORDING FEE: 13.00 PAGES: 2 594.97' S00°37'08"W 627.31' yy o$ ~yv 0~~ 594.23' y~~'9D O e 5p~~N~p~~ ~ ~ t2Z ~ ~~~~ ~~g~ ~ m J O .~ v cDD ~D O CO n Ja n om ~m ~~ ~~ PQ pz ~~ ~~ IV ~. •.. `\ ` •• .V~9tf I(E \\ ~ •O ~ • ~s"~~cS ,C,9 ~., ss ~4~ `.` '••. ~r •~ .,,,~ ~, .. ~. .. 1301.97' 2~ ~~ ~• ,~•' ~ m m ~' m ~_ O ~ ~. ~ ~ ~ ~. SHEET 1 OF 2 SHEETS ~~'~.`.!~ Vo1.15 Page 4202 0 0 ~ ~ ~ c» Z Z ~ N ro ro 3 N N N O O 7 3 (p O m m :~ N ~ ~ ;~ C Z 0 ~ ~ ~ c ~ Q ~ ~ m O CD ro C CD ro N ~ O D Oro ~ d Q A O ro O O O 3 ~ °7 :: W ~ ~ °o `m o f0 N ro 'O ~ N a ~. m N ~ c~ fl. o ,' f o O ~ O C O = d N O 7 3 a ~f N ro ~ ~, N ~ ~ a O ro ~ O o g o ro o ~. n to p ' ~ f ~ m ~ ~ m ~ m 3 ~ f 3 i ° -' ~ I ~ cD ~ ~+ ~ ~ s I m a ~ ro I o ~ ~ O N a ~ ~ I O ~ ~ ~ 7 N Q d ~ ~ I t D a a ~ I ~ O m m Ni C WO I ~ rn rn s I ~ ro _ OOo OOD (D O O %. ~ ~ O O O ~ O O N N f% a _ ~ n o ~ I o. m ~ ~° ~ ! 3 m 3 ~ m - v, fD 7 ~ I a ~-n W Z Z ~ Z 0 D m' ~ I ~ ro ~ ~ s o' O y I O ~ ~ 7c N O. W ~ i d O Z a o c 7 a i .~ n m O 7 W '0 a 3 o o :-t N z ~ ro N ~ I G T I c a i I I c~ M O ', S v c o d f I c ~ o v ~ j d ~ ~ ~ ~ 3 - `.< ~! ~ o n p ° c;'n cn' m a c v 3 ~ ro can n a °~ Vo a >• ro N s 0 N ~ C) O ~ ~ CO Q o ~ y ro O D o° N .y. N ~ -~ Dt C ~, Z D ~ a ~ cc~ D N G A C O O WO r~, '" ~ rn ---n fn .. PO A s ~ N N cyo °o °o T ' ~ n r cn A A ~ ~~~.! 3 ~ a O O O o ~• ~v ~~~a!, ~ c t~/~ ~ fin (~ o ~ D y ~ ~ 0 G K '. I p ~ ~ d a ~ ~ ~ ~ m m ~ d .. ~;I ro ~ A N N ~ '. I QWj .~i W I O Z _W Z I O D ~ ~ O ~ ~ ~ 'I N N ~ ~ C C ~. ~ d ~ 7 O ~ ~ '~ p' Z typ N D °c 'I ~ .n. O jl A Z O a ~~-~ D ro 'O - Q N O y ~ O. ~ ~ > ~ w' m o _ fD 3 OZ N O oCOO ~ a ro ~ N v m x N a 0 6 d O' 'G S ro ro X N 7 co O ro ~ O o ~ o ro o ~- N N a 3 o' r; o .. 3 ro A pj fOD C ro G ~ T c Q Z W CNO m ° z j ~ Z7 z 'i m ~ I A d ~• `< C O "S A7 O .^3 ,A a A `C b N O O v A A w YC A `0 0 o o .~ ti Wisct~psin Department of Commerce PRIVATE SEWAGE SYSTEM Safety'and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Stafford, Kathleen Emerald Townshi :ST BM Elev: Insp. B Elev: BM Description: s ~ ; ~,\ ~ oW~ 'ANK INFORMATION ELEVATION D A TYPE MANUFACTURER CAPACITY Septic ~ / Z Dosing ~ S~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic ~ ~ ~ / ~ 1 ~ ~ - i ----~ Dosing ~ ~~ ~ ~ / ~~ ~ ~ / --- Aeration Holding PUMP/SIPHON INFORMATION Manufacturer / ~ Demand ~ GPM Model Nu r °'7 TDH i ~ Friction Loss Syste ead TD ~j t ~, Forcemain Leng ia. Zc ~ Dist. to we ~ Z a SOIL ABSORPTION SYSTEM 1e.25x1 county: St. Croix Sanitary Permit No: 453277 0 State Plan ID No: Parcel Tax No: 010-1070-10-100 Section/Town/Range/Map No: 29.30.16.429A STATION BS HI FS ELEV. Benchmark . ~p3.3 0 ~ Alt. B~~ Lcu ~ 'Da' i1 ~f . ~o~ d Y 9(! U Bldg. Sewer 7.~ Z gS .SCQ SUHt Inlet ~~ ,~ SUHt Outlet dd $~b q~ /~,~ Dt Inlet Dt Bottom ~ ~ ~ ~ ~~~ ~~ Header/Man. `~ 7 Dist. Pipe ~`~ (o, ~,` Bot. System ~ tp. 9 9~, ~ $ Final Grade ~ ~ ~ ~+ St Cover ,~ ~ (~~ ~- ~.05 9~ BED/TRENCH DIMENSIONS Width (~„~` Length t ~ CJ No. Of Trenches Z ~~~ 1 \ PIT DI ENSIGNS No. Of Pits Inside 'a. Liquid th SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE TREAM LEACHI CHAMBER OR Manufac r:' Type„pf System: G ~JI"t ~X2, ~ s ^~ 1 t/II ~ ~ ~ ~ UNIT Model Number DISTRIBUTIUN 5Y5TEM ' Header/Manifold (( Distributi x Hole Si x Hole acing Ve o Air Intake I Pipe(s) Length Dia Length Dia Spacing SOIL GUVER X Pressure Systems Onlv xx Mound Or At-Grade Systems Only Depth Over Bed/Trench Center ~ ~~ Depth Over Bed/Trench Edges xx D th of Topsoil xx Seed Sodded '- ' xx Mulched ~ .] Yes ~:.: j No ,,;~ No ]sue COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~1 ~ I (3~ Inspection #2: / / Location: 1394 230th S eet Glenwood City, WI 54013 (NE 1/4 NE 1/4 29 T30N R16W) NA Lot 1 ~~ Parcel No: 29.30.16.429A .~ '~i 1.) Alt BM Description = t) ~ °"'~' ~ ~J v~~ ~ C..~..a ,,.,~ ~ ~ aC~.,~ ~ d 2.) Bldg sewer length = ~~ - amount of cover = ~~ tI ~J ~ 5~ ~\ i 1D VV~ -V1 ~1~ Plan revision Required? ~ Yes No II G j ~ ~ ~ f d ~ 1 Use other side for additional information. ~_.1___--- i ~ _ _____ _ _ _ _ ~_ _ [``~ ~~~_ SBD-6710 (R.3/97) Date Ins pctors Sign ure Cert. No. . ~'~ `"~ i' ~ ~ ~~ -~ ~~ 4 i 'tea; .,~ ~ ~ i (.e,l -r _ ~ l`5'_ l `3 ff! y( ~ U /j/ 7 ~~ '~ { ...,.. -- _j_J j r~ ~~ n art ~_ CS'' _ ~- ,~ r ~ d- . „~ ~ d v ~ ~ ~ $~ ` ~. ~' ' ~ ''$ 4 ~ 1 ~ ~ ' ~ ~ ~. ~ b (~~' ~ \~O\ N .r ~ ~. ~ ~ ~~ ~ ~ f ~_ ~ ~ ~~ ~- ~:s ~y~,, rRr Uwe k ~" ~c ~e . t p ~~~;;~ -~- `~; ,_ / , ~- ~.~ i x 5 ~• ~ ~~ ~~ ~~~ ~ 4 ~ to t~ ~n~ ~" ~~ ~~ ~~ .h ~. .. .~ .. ,_ a~ fi as ~~ ~ ~~ Dm ~ ~ ~ C~ `' ~ ~ ~ • ~ ~ 33 ~., ~ h ~~ r ~~ ~ ~ 0 ~~ r `~ .~ -~ ~~ ~~ ~ W .{ (~ m 0 w t m *n QI `.y1~ `;- ~ R~ ~' ~'1 ~ y\ Q v', O` ' O nNu Y~ , o~ m C/1 t~-~ 1 0 L k'.` e'3 PY v •, ~;- C!~ ~. (~ i v,,~. 4 ~{ li i ;,~ t ~ l~ ,: i ~7`- !; 1 1'~ w fl W i • ' Safety and Buildings Division County aw ^r j ' 201 W. Washington Ave., P.O. Box 7162 M di ~VI S ~ ~~~ ~ ~~~ ~~ a son, 53707 - 7162 (6 ' Sanitary Permit Number (to be filled in by Co.j lee artment of Commerce S- 3 0~-~~ Sanitary Permit Ajpliea iori "' State Plan LD. umber In accord with Comm $3.21, Wis. Adm. Code, persona] info anon you provide may he used for seconda P i ` ry purposes r vac aw, .04(1)( ~ 7 204 Project Address (if ifferent than mailing addrzss) T. Application Information -Please Print All Informa ;; r. CROIX OOiJNTY c ~ ~~ ~ Z3~' `~ I ' ZONIN Propzrty Owu/ar/'s Name - Parcel # Lot # Block # Yropzrty Owner's Mailing Address 3 ~~ X30 ~ sT- Property cation ~ , Ciry , Statz / ') Zip Code Phone Number s=~ '~~ -~ej4, Section ~_ ~ ^ ~( / L,- /El9 G-vC7e~lI` ~.J „~. ~ zlG~ ~ 3 .~ ,., , ~(cE oe o e li. 3'ype of Building (check all that apply) ~6 ~~ T N R -~ [' _h~ (~-t-t;;r2 Family Dwelling -Number of Bzdrooms Z Subdivision Name CSM Number lJPublic/Conunercial-Describe Use ,,C~/tt. ~ Z3 ~~~(~ ~~ 7i /~~ ~ ^ State Owned -Describe Use ) S ~ • v~ (~S (,(~ ^City ^Villaga~'awnship of ~jy/ p~-~q III. Type of Permit: {Check only one box on line A. Complete line B if applicable) '~' New S stem Y rb. IGfRzplacement System ^ TreatmzndHolding Tank Replacement Only ^ Other Modification to Existing System B ~ ^ Pet7nit Rznewal ^ Pemut Revision ^ Change of ^ Permit Transfer to New List Previous Petmit Number and Date Issued Before Expiration Plumber Owner ~ l G{ ~3 ~ ~ /~ / \\ / 1V. e of POWTS S s tem: Check all that a I ~len -Pressurized In-Ground ^ Mound > 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Crrade ^ Single Pass Sand Filter ^ Constructed Wetland ^ Pressurized ht-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthede Media Filter Leaching Chamber ^ Drip Line ^ Grave]-less Pipe Other (ex}~lain) V. llis ersaUTreatment Area In ormation: 'j~ ~ s' Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dis ersal Area Propose Ss~j ystem Ele ation ? ~ ~ ~~ o g ~ ~ ~ ~ S~i~// 0 ' 97~y6. 8 9G. y ' VI. Tank Info Capacity in Total Number Manufta~eturer Prefab Site Steel Fiber Plas 'c Gallons Gallons of Units ~~~~~~~ ~ 'tS f',~c~ Concrete Constructed Glass N U ew Existing Tanks Tacks Sepiic: or Holding Taztlc ~/}- Aerobic Treatment Unit ~ _ Dosing Cltagtber ~~ ~ r~ S~~ r'~'~ C' VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. ' Pltunber s Name (Print) Plumber's S' Hato MP/MPRS Number Business Phone Number D ~ G ~~~ ~~~~t~ ' Plumber s Addr treet, City, State, Zip Co e/ VI . Conn iDe artment Use Approved ^ Disapproved Sanitary Permit Fee includes Groundwater Date Issu suing A t Si tur Stamps) 0 Owner Given Reason for Denial Surcharge Fee) ~ ~ "`ffflll"' 2~ ~ /n ~ " tt" (//J"// ` • _ ~ IY. Conditions of ApprovallReasons for Disapproval 3 Sys ~ h'l Y2ti~/~/I / ~ f b-W r OK ~S~ ~ ~~ ~!/ Gll ~{ ~ 5~202~k OWNER : SYSTEM ~ ~ /' r, 1 Septic tank, effluent filter and ~ dispersal cell must all be serviced !maintained O ~l S~'f~.~ ~~~~K--~ ~ ~~~'~"~~"~ ' d as per management plan provided by plumber. Gt~d ry ~ ~/v~,,~.s-~ ~S~--ram a 2. All setback requirements must be mairi#ained fir` Q I n _ ~~ ~ • ~i'~-~. Guue.~ G~Q',a,u4.~`~ , (~t~G~ aS ru3r anolicable code/ordinances. wfYYl~liVt ~' of , L-6 ~, 7 ~I !~'" /~ 33 i~ .. _- - - Attach complete plans (to the County only) for the system anpape ~ t le t~ 81/~ x I1 i iz ~ (,~Z vryvJ d ~ ~'D\ 581-b398 (R. 01/03) ~~~ 9.~c.cs ~~ G~i`i2~-. o ~ ~ ;~ ~ o v a 0 o ~ o a O I ~ ~ ;~ C LL 3 a~ i '' ~ ' a i U I ~ ~ N ~ y co W ~ Z ~ _ O _ ~ Z .- 'C z m ar a m N ~ o zv' ~ d z `_ ~ ° q m y F- c ~ a a~ 7 I n. c ~ m z ~ O .'.: M C M ~ .. d E I N ~ E ~ - a R o ' iYooa` ° z ~> ~~~ ' $ '' aaa ~ a ~ •N ,o ;; ~ I' ~ ~ N ~~ (A J U ~ a~ y o O N ~ o t N 00 M CV ~ ~ ~ ~ .~ ?~ d w ~l C 0 a O L ~ yll C N f Icy) O C~ ~ ~ Q C ~ ~ O N ~ ~ +.+ N r\ y., O o v, ~ Y ~/ w G ~ ~ ~ ~ 0 0 ~ 'D ~ O FBI d (h O N ~ ~N O N W ~ M f0 fA ~ O V ~ c~ ~ m ~ ^, °j 4k o, d a `~i ~ °'~•~ dam U a O N U A ~ ~ °o O ~ a~ c 0 rn c .y .~ N L >. a a 0 a v c co Y C f0 ~ ~ w O lp ~ C ~ Z O f6 C ~ ~ N ,o~~ N N ~ = N Q 3 v w C N E .~ N O Y .n E o, a ~ 0 Z .. ~ ~~ CO c _rn Q Z fA N C O ~ N ~ Z ~ Z I I I I I I I I I I C 3 LL 3 ~ ~ Z y ~ = O a m I I I ~ I rno C I ~ N ~ ~ C o o o c Z ~ ~ I M ,,; ~ O ~ M ~y6 .. ~ d a R y V ~ o o a` ~ ~ ~ ' $~~~ a a a I ~ ~ '- w ~ ~ 00 i M N O O M ~ G1 •- d :a .e H c c W M ~ ~ ~ N ~ ~ ~ o I ~ ~ a I ~;a~ ~ :: c O vii U ~o° of m c 0 v c co Y C ~0 C O f0 m O 0 3 o ~~ c a~°i rn m `~ N ~ ~ C ~ a ~ N 07 Z L _O ~ M ~ ~ O C f6 M- 0 =o ~ c Q U N E a~ ~ ~ ~ V ~I ~ O N m a~ ~ E a cn 0 Z _ o CO c m Q Z (J) O C O y N -Op O f/1 O Z ~ Z ~~ ~n .~ 'i- ti °~ y ~~~ -~:. ~ s ~-~"-~" ,~ ~-- -~ ~. ~C~y, v X 1 1 %i ~ t~ ~il ~ ~~ fib, `~~ -r ~ -{- -~ ..L_ ~_ .Ss ~~- ~~ ~ ~ ~ ~~ a 4~ ~ S ~~ ++~ ~„ ~'~ h~ ~ y~S 1 ~~ ~Y K '~ ~ V ~' 1 a ~~.~ ~ 3 -~ y"~ ~~~ <"~° \ ~~b~ ~ ~ ~~ r ~ ~, 6m `h ~ ~ £ ~ ~' ~. ~ ~~ ~~~ ~N ~, 2 6 ~ -~ o, ~ ~.~ C ~c.~ `5~ ~/ ~ n ~~ m 0 ,~ w G r ~' '~..'""_ ~ ~ ~` ~ D P f a O~ ~ I~ N ., ~ ~ ~,J .~ ~' u $.. 1,. r ~ " ~ '~ ~ ~. o ~. ~o ~ ~ ~~ ~ ~ ~ ~, ~- ~ ~, m *:. ~*\, ~+ .' r ~• 1 , ~ ~` jS„ 1„ v\ ~%~fsY z v c~ ~i ~i ~~ ~ 0 Private Qn-Site Wastewater Treatment System (P'OWTS) • Indez and Title Sheet Project Name and System Type: r 5 ~t~,~'_~'~,-~ ~~o n ~,oeauon: _ ! ; _q ~ ~? 3 0~ ~ wee ~ Street Address ' Jll E %/ il1E %y 5 07 ~ '~' ~ G~ ti r ~C~ cv Legal Description ~.r~ ~2 r ct ~~ ~ $1 C! ro i~ x TownshiplCounty ~-~ --- Contents: Page X Page 2: -~ Page 3: ~~ Page 4: ~~ Page 5: ,®~ J' ~ ~ /1 Page6:~ S/ z ~.~y ~~~ -~ Page 7: / .~ d'l ~ ~i~~~ ss ~~~~~. Page 8: ~,~t~ ~ ~ _ ~~ Page 9: ~ r2i ./~ L It YGs ~- Attachments: Plrx~rn~er/Designer: t °~, ~C>~ C~ S Signed: -- -Credential ATumber: ~~,~ ~ ~ q y- Date: o G y~1 ~' ~~~ Chamber SAS SYSTEM ELEVATION AND SIZING CALCULATIONS Below Grade Soil Absorption Systems Kathleen Stafford Owner's Name 5/24/04 Review Date ~~Y or N Highly Pretreated Effluent 3 ft Suitable Soil Below System ~ 11 in Chamber/Unit Height2 8 ft Maximum Bury Depth s PSA Bio Diffuser Standard 11" ~ 600 gpd Estimated Daily Peak Flow 0.70 gpd/ft1 In-situ Wastewater Infiltration RCS 857.14 ft` Chamber/Unit Area bbl 31.0 EISA ft2 /Unit ~J~ 28 # of ChamberslUnits ~~~~~~~ft Proposed SAS Elevation 0 Bottom Area ft1 /Unit Soil Surface Acceptable Finished Grade EL a (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum Maximum Number Elevation (ft) Depth (in) wes Highest Elevation? 1 99.00 61 96.92 • 98.08 No Fiii required 2 98.20 •60 96.20 • 97.28 No Filf required 3 97.40 60 95.40 96.48 No Fill required 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4, based on chosen system elevation, and chamber height. Top of chamber is finished grade may be required to meet minimum or maximum code standards. Version 4.0 (04/03 Dose Tank Information Locking cover with warning label and locking device and ~1 Electrical as per NEC 300 and ----~ sealed watertight Comm 16.28 WAC -' Disconnect ~ 4 in. min. lank component is properly vented ~:: E--- Alternate outlet ~ location Wl2ser Manufacturer Forcemain diameter Ca acit 750.00 Gallons _~ 2 in. Volume 16.10 gal/inch A Dimension inches Gallons g Weep hole or anti- A 32.09 516.67 siphon device B 2.00 ~ ~ 32.20 C ~ 88 43 : ump off elevation (ft) - D 7.00 . 112.70 90.08 Total 46.58 750.00 D LDose tank elevation (ft) - ~ 89.50 Alarm Manuafacturer se tronics ^ ~ ~~ Alarm Model Number m'j1 Pump.Manufacturer zoelle~ r ~~-_~~___..__.__~~_ Pump Model Number bn151 ~ ____._ Rump Must Deliver 23.69 gpm at 12.59 ft TDH Project:, TDldealai46ns Owner's Name 5/24/04 Review Date X Gravity Dosed, or 600 gpd Design Wastewater Flow X x Pressure Dosed ft Total Combined Lateral Length Y or N y Forcemain Drainback in Lateral Diameter 50 ft 2 in 25 gpm TOTAL DYNAMIC HEAD CALCULATIONS Gravity or Pressure Dosed Systems Forcemain Length Forcemain Diameter System Flow Rate 0.00 ft Minimurrf..Design Head 9.65 ft Vertical Lift 0.69 ft Forcemain Friction Loss ~ 10.34 ft Total Dynamic Head 2.55 ft/sec Forcemain Effluent Velocity Choose Pump That Discharges At Least: 25.00 gpm at 10.34 feet TDH 120.0 gal Maximum Dose 0.0 gal 8.16 gal. Forcemain Drainback 8.16 gal 128.16 gal Maximum Dose Volume 8.2 gal Boa ~~~ '~~ i ~~ ~2 ~~ ~~~ Version 4.1 (07/03) 5x Lateral Void Volume Forcemain Drainback Minimum Dose Volume S i c~ a i- 0 0 v.-. • Timed dosing panels available. Electrical a!#ernators, for duplex systems, are available and supplied wtth an alarm. • Variable level Control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable. level long and short cycle controls. Sealed Qwik-Box available for outdoor installations. See FM1420. • Over t30°F. (54°C.} special quotation required. 'i~11~b2/'15;3 Series 151!#52!1 53 MODELS Control Selection Mudel :Volts-Ph Mode Am s Sim iex Du lex Ni51 its 1 Non 6.0 1 2or3 BIV751 115 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 2 or 3 BE15f 230 1 Auto 3.2 Included 2 or 3 N152 715 1 Non 8.5 1 2 or 3 BN152 115 1 Auto t3.5 Included _ 2 ar 3 E152 230 1 .Non 4,3 1 2 ar 3 BE152 230 1 Auto 4.3 Included 2 or 3 N753 115 1 :Non 10.5 1 2 or 3 BN153 Et53 115 1 230 1 Auto Non 10.5 5.3 Included 1 2 or 3 2or3 BEt53 230 1 Auto 5.3 Included 2 or 3 TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATERING MODEL 151 152 153 Faet Meters Gal. Li[ers Gal. Liters Gal. Liters 5 1.5 50 189 69 261 77 291 10 3.0 45 170 61 231 70 265 15 4.6 38 144 53 201 61 231 20 6.1 29 110 44 167 52 197 25 7.6 16 61 34 129 42 159 30 9.1 -- -- 23 87 33 125 35 10.7 -- -- •- -- 22 85 40 12.2 - -- -- -- 11 42 Shut-off Head: 30 ft. (9.1m) 38 ft. (11.6m) 44 ft. (13.4m) 0145088 Model 151 3 'i6 -, -.~. » ~,~a ~, ~I i _~ r ~ I I~,~\;~ I ~ 7,6 1_ 4 .---- I i ,,, L-- 7 L? Models 152 / 153 I 1z ---~ a s;'s 151 Si:.Ltti1-tistd Ci31DE ~ CAUTION .+r! +ts:atrauor or controls, arofaciion davices and wiring sktould ba done by a qualified itc ~s: d vlactri~ian. Alt electrical and safety codes should be roliavvesi irlcitiding ine toast ro; •ent tdational Electric Coca (NtC-)and the Occupational Sar'aty and Health act (OSHa)- l SI<2Gu~ 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. --_>~ ---- MAIL T0: P.0 BOX 16347 L' ~~ ~ ~1~ Lousville, KV 40256-0347 Manufacturers of. . d SHIP T0: 3649 Cane Run Road ~ ~ /~' ~ ~ ® Louisville, KY 40211-1961 ~~77 hftpJlovtvw.zoellercom PUMP /"/7 (502) 778-2731.1(800) 928-PUMP ~(Ll4UT'Y PUMPS ~iYCE ~~~~ © Copyright 2003 Zoeller Co. All rights reserved FLOW PER MINUTE ola5oan ~~ ~'(~ JJ7TY - I n --~ Wisconsin Department of Commerce SOIL EV~A-L`-U' ATION REPORT / Page ~- cf _~ Division of Safety and Buildings in accordance with Comm 85, Wis.. Adpa.•+~4de / 0 R ~~ ~~r ~~, ~~,, Attach complete site plan on Pa include, but not limited to; vertica percent slope, scale or dimensio r s n and h nt (B s, north arrow, and location and dl size. , dir f D ante t nearest r d. "'-" ' Parcel LD. Q ~~ ^ J~ ~ ~ d la~ I Y P/eas Personal inlormalion ou provide ma prln~q~l~{~ ~4 Sr/"~ei b~ use raj ~oico a p po ( Prlvar Y ( Lew, s. 15.04 1) (m)). R ~ ~ ~jj/r Dat 3 D Property Owner ~.~., ~.r".CRGlX~;~'Jlvl', ONING OFFIG't Propertyl_ocatlon . Govt. Lot ~ ~, 1/4 ~~, 1/4 S p~ T Cf7~ Jj;U N R ~ E (or w~ ~'~, Property Owner's Mailing ddress ~ I ~ Off- G Lot # Block # Subd. Name or 6dA4#-- ^~ JL ', /~ 7 2 Ciry State Zip Code Phone Number ^ City ^ Village Town Nearest Road ^ New Constntction Use: ^ Residential / Number of bedrooms _~.-__ Code derNed design flow rate _-_-~SL~-_--_-_-- GPD Replacement ^ Public or conlmercdal -Describe: _-_-~_____~ ~-_ -------------- I, Parent material ~ ~ ~S~S~_~~~~--- Flood Plain eievatlon if applicable _-_ _--_ h + /' -~~~ 1-~----- General comments /^ _/s~7' ~ /AY/rlfy ~ilrlcr!}+'oN11^1 ~10~' Jl~~~l/ ~~ ~'G~r~it ~~ /hAllr~b/1r 6{~ and recommendations: ~?~ ~f 9 a Boring r Boring # ~' pit Ground surface elev. 9.q _ tl ft. Depth to limiting factor ~- in. ~~ ration Rate th D i ant Color D Redox Description Texture Structure Consistence Boundary Roots GPD/ft' Horizon ep in. n om Muruell Qu. Sz. Cont Cobr Gr. Sz. Sh. . 'Eff#1 'Efitt2 ~~ 3 ~ ~ ~` ~ v F .b I,e ~~ 4 !,5 I rn s b rri. fv ~-5, --- r l 1. ~ i ,. Boring i i t' Boring # a ~ pit Ground surface elev. __~$,,~_ ft. Depth to limiting factor __'t_""__ in. Soil A lication Rate th D minant Color D Redox Description Texture Structure. Consistence Boundary Roots GPD/ft' I Horizon ep in. o Munsell Du. Sz. Cunt Cobr Or. Sz. Sh. 'Eff#1 'Efftl2 ~ l(~ 3 (r l/ C F ,~ l•O a - ~ u --' s l trv, 6bk m ~ . '-1 i , ~ s /~ ~ rh ~ 1 ~'~ 4rLS' --^ r rib ~~ ~.S .1 ~~ _ s u ,c'S o~ M ~ ____ , s t. o $ ~ --- m~ ~S ~ /, 6 ' Effluent #1 = GODS > 30 < 220 mg/L and TSS >30 < 150 mg/l. 'Effluent #z =Bobs < :to rng/I_ arw 155 < su rngti CST N me (Please Print) ~,~ Signature CS Number Address Date EvaluaUOn Conducted Telephone Number ~-~~8 5 ~~,~~,~a E i~~nU~a~.c. ~~ ~ - I ~ - o y "? ~ s = as z - o ~c ~, y., . ~ .. . 1rs- 3a~-a~~3 f ~ • ~ ~ ~ ~ .. e ~ of . ~_ pa , g Parcel fD # } ,. . ~ ' ' .. Property Owner ---~ ^ Boring Depth to Ilmltlng factor ~.3i~-~ In' Soil. licaoon Rage Boring # n' ' GPO/ft' y `':~ l n,~,~.. ~ w'" ~ Pit Ground --~ ;- a surface s Texture Swoture,. Consistence 8ounde'Y .,Roots,.., . Eff#1 'Eft#2 ~ Horizon Depth pominant Color ll Redox Deacrlptbn . • Gr. Sz, Sh• Du. 3z. Cont. Cobr ~ ( ~ ' In. Munse 4 ~~ [] Boring . 9 Depth to limltlng factor ~ -- In. Sop icaUon Rate ft # i ng Bor ~ Grou PN . ~~- ndsurface elev. ~~ GPOMt' Conslatence Boundary Roots ' n Depth Dominant Color i Efi#2 • Texture,:. 3trudure '~ ~Eff#1 Redox Descrfptbn Gr, 3z. 3h: , zo Hor Munsell in Qu. Sz. Cont. Cobr ~ ~ . M~ ~ c L. 1'rn !-~- , '1 , (o 2 ~ _ ~ !` m I~b n, _ 1 2 S ~ CS ~ l .sYa ~ M v ~ o ~ ;o . , ~ , ~. IFS ' 1, Y iw ~~~K~ of ~ ,~cd 's~y~ ~/8 ~] Boring Depth to Ilmltlny factor _,_,..~_:._ In, Soy badon Rate ft • ~ Boring # ^ Plt Ground surface slay, ~....~- : ~ PD/ft' Conslstance Boundary Roots Texture. Structure Inapt Color Redox DesGriptbn ' ` •Eff#i •Eff#2 ~~, , (~ Gr. Sz. Sh. br , ~~ ,, unsell (lu, Sz. Cont. Co ~ 4,. . ... -. 1. ~ ti. - i ;'' • Effluent #2 = BODr <_ 30 rrtyl. and TSS _< 30 mgti D > 220 mpR, and T33 >30 ~ t ~ ~ 30 < , • Effluent #1 = BO _ S~rvrces or rvice provider~and cmp i e t r a c y nt of Commer 1'he Departure ty se ( ~08:266 264-8777 ce is an equal opportun 608 '1'1'Y o 3151 ase contact the departmen , a l nced material in e an alternate format, p seD-~u3n ~x.mim~ t. _ , J } ~;,~,~'~ 1 ~JJ • ~ p` ~~ ~ W CP_ ;, ----- ~ ~~ ° ~_ T ~ , '~ J m y~ ~ ~.~______... - - ._..... ____ -~--- ._._. e. ~ - - - - ~ 1 -~ -- - - - - - - - - ,~ ~ ~- ~~ 0. ~~ " ~ O ~~ ~'' 1~ .- u' Q ~ _ ~~ ~. ~ - ~- ~ ~ m~ ~ a t # ~q £ ~ ~ N "~.. :~ n ~W ^^ ~- P 0 t- 41 w b t r 7 Z --~ r~ ~~~ v~ ~' a ~ ~° ~" ~ ~' ~ ~ ~ O ~ Q v z ~ ~ ~' ,. , r ~ O ~ Q ~II ~ ~~ ~~` ~ °~° ~ -~ m ~, ~' ~ ~ (J1 ~- ~ ~ o ~; , ~. ~ S ,, ~ `` ORIGINAL 0 ~- a ~~ ~~ ~1. O_ 'c ~7S `~1 w 0 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer _ ~ac-I-h1r.~ v~ S-4 a ~~o,rc1 Mailing Address _ l ~q c-1 Z ~o -tn ~ar ~.-.~r- Property Address (Verification required from Planning Department for new City/State ~ I~ n wD6c~c-.~F-~ Gu ~ Parcel Identification Number ~/~ -! U~- O - /D-- /Q~ LEGAL DESCRIPTION `~29 ~ Property Location ~ ~ %.,N ~ y,, Ste, 29 , T ~ ~ N-R 1,G ,Town of _LG Subdivision Certified Survey Map # y 7 0 ;(p,~Z~ - - Co~93z Z Warranty Deed # o r g Spec house ^ yes ~no Lot # ~_, Volume _~, . Pa e # g Volume lS4Z ,Page # L/Z Lot lines identifiable ~ yes ^ no SY~T~+ M MAily'i_'ENANCE Improper use and maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. 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. Croix Zoning Department a certification form, signed by the owner and by a masterpiumber, journeymanplumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic. tank is less than 1/3 full of sludge. Uwc, 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 da e e are p' lion date. z NATURE. o ~d `~T DATE OWNER CERTIFICATION (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 a descri bov b irtue o a warranty deed recorded in Register of Deeds Office. _~ I ATURE OF APPL 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 decd POWTS OWNER'S MANUAL MANAGEMENT PLAN Y{;a f.A'. INX+'ORT~!(ATIO { ~'4V77~3' ~ r Permit # ~- ~'sESIGN p AR A METERS Number of Bedrooms 100gpd/bedroom ^ NA Number of Commercial Units NA Estimated flow (average}* ~>gaUday Design flout! (peak), estimated x 1.S* ~>gaUday Soil Application Rate gaUday lnftuent/Effluen#Quelity (NAp) Monthly Average** Fats. Oil & Grease (FOG) ` < 30 mg/L l siochemical Oxygen Demand (BODs) Total Suspended Solids (TSS) ~ 220 mg/L 5 250 mg1L l'a-ztreated Effluent Quality ^ Monthly Average*** } #3iachemical Oxygen Demand (BODs) < 30 mg/L Total Suspended Solids (TSS) Fecal Colifonn (geometric mean) 5 30 mg/L + <10 cfu/100m1 t~laximum Effluent Particle Size 1/8 inch diameter * WastewaterFlow Verification on and calculations: (Other than bedroom based) * * Values typical for domestic (non-commercial wastewater and septic tank effluent. ***Values typical: for pretreated wastewater. SYSTEM SPECIFICATIONS Septic Tank Capacity O gal ^ NA Septic Tank Manufacturer ~. „~ ^ NA Effluent Filter Manufacturer ^ NA Effluent Filter Model _ oo ^ NA Pump Tank Capacity mc~ gal ^ NA Pump Tank Manufacturer , ~ .rte- p NA Pump Manufacturer Zee ` ,~- ^ NA Pump Model ~- ^ NA Pretreatment Unit ^ NA p Sand/Gravel Filter ^ Peat Filter ^ Mechanical Aeration ^ Wetland ^ Disinfection ^ Other: Manufacturer: Model: Dispersal Cell(s) ^ In-ground (gravity) ^ In-ground (pressurized} ^ At-grade ^ Mound ^ Drip-line Q Other: caching Ch er Manufacturer .~` Model Approval Stipulation d9 q Soil Application Rate ~ 7 ~pd/ft2Area Req. Absorption Area Credit per unit .~ /, / ftz Minimum Number of Chambers ^ Aggregate Design Flow/Loading Rate= min Materials: alt materials must comply with WI Adm. Code COMM84 and be installed per manufacturers specifications and approval letters. DESIGN CRITERIA t~ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 Q -"Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publications 9.6 Q "Design of Conventional Soil Absorption Trenches and Beds". RJ. Otis - ASAE Publications 5-77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems". EPA 625!1-80-012 October 1980 Q SBD.-10570-P (8..6/99} "At-Grade Component Manual Using Pressure Distribution" Q SBD -10567-F (R.6J99) "In Ground Absorption Component Manual" ^.SBD -1Q705-P {N.O1/01) "In Ground Soil Absorption Component Manual" Version 2.0 Gl .SBA -10628-P (N,6/99) "Recirculating Sand Filter System Component Manual" ^ SBD ~ 1:0656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" D SBD -10572-P (8.6/99) "Mound Component Manual" ^ SBD - 10691 P (N.02/Ol) "Mound Component Manual" Version 2.0 Q SBD - 10595-P (R.6/l~9) "3ingle Pass Saud Filter Component Manual" ^.:SBD -10657 P (8.6199} "Drip-llne Effluent Disposal Component Manual" © SBD - 10573 P (R 6199) "Pressure Distribution Component Manual" ^ SBD -14706-P (N.O1/Ol} "Pressure Distribution Component Manual" Version 2.0 © Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units IYIAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Tns ect condition. of tank(s) At least once every p months year s () (Maximum 3 yrs.) Pump`out contents oftank(s) When combined sludge an scum equals one-third (1/3) of tank volume lnspect dis ersal cell(s) At least once eve ^ months ~~~~ 3 yrs.) Clean effluent filter At least once every ^ months ear(s) Inspect pump, pump controls & alarm At least once every Q months ear(s) p NA Flush laterals andpressure-test At least once every ^ months ears} ^ NA Valves At least once every p months ^ yeaz{s) NA Other: At least once every ^ months ^ year(s) A Page of S`l~'iY~.T fTl" P'or x~ew canstnxction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process. and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tack(s), removed by a septage servicing operator prior to use. System startup shall not occur when soil conditions are frozen at the infiltrative surface. €i~l'Irll2ATION The property owner is zesponsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and. qualitg of the'wastewater stream will affect the performance and longevity of your POWTS. The installation ofwater-saving appliances- and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal uni#s, other cleaz water treabnent devices and foundation drains should be discharged to the ground surface whenever possible,-Note: this does not iaciude Laundry waste, showers, dishwater, etc. Tl~s system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fivit peels and seeds,. bones, and food solids such as those produced by a gazbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, .solvents, etc., should not be flushed into the system as they .can seriously damage your POWTS and contaminate your drinking water supply. ivlaintaia a reg~tladr steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction. of snow over the dispersal unit may cause it to freeze up. CI Valves ` Valves shall: be operated in the following manner: arms Alarms sltottld be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, Thete is ncuaarally a l day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected topreventback-up of sewage into the dwelling or surfacing. fNPECT]iQNS Inspection: shall be made. by an individual carrying. one of the following licenses or certifications: Master Plumber, Master I'Ir R~estt'icted Sewer, POWTS Maintainer or Septage Servicing Operator {per the attached Maintenance Schedule). eptic Tanks Component Tatzk inspections must include a visual inspection of the tonic to identify any missing or broken hazdware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any backup or ponding of effluent to the ground su~eface. Access openings used far service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be pnamptly corrected. Exposed openings greater than 8 inches in diameter shall. be secured with an effective leg device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third (1/3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications, Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. ~Puua~p Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks; backups, surfacing, missing or broken security devices. and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. -Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual. inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page of ~7 viotxrid, At-Grade, In-Graund Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals shouldbe flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. I~YOR~'5 Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned incompliance with Ch. COMM 83.33, Wisconsin Administrative Code. - All piping to tanks.. and pits shall be disconnected and the abandoned pipe openings sealed. - The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. - After pumping, all tacks and pits shall be etcavated and removed or Their covers removed. and the void space filled with .soil, gravel ar other inert solid material. CONTINGENCY PLAIN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement. system: (~-,A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need-for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that tune. suitable. replacement area is not available due to setback and/or soil l' 'tations. Barring advances in POWTS technology a l ' tank ma be installe a last resort to replace 'led PO e has n b en ev to idea ' suitable ace ent a. U n ' ure of S a it and site 'on us rf to ate a s ' replac a a. If n acement area is available a holding t c may be installed as alast to rep a the failed POWTS. C7 Mound: and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <CWARNII~TG>a SEPT1<C FUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETIIAL GASSES AND/OR INSUFFICIENT OXYGEN. DC1 NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIQNAL COlYIlVIENTS Phone SEPT. 'hTF"' a~,P' ~ ~ Phone POWTS MAINTAINER ~ ~.. , • ...., . - _ r Name -- a-3 ~~ ~~ ~ ~~ Phone OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY Agency -57'y Q) ~ 6 I Phone ~ / ~- 3 ' KIWPDATAiFH11'UWTS OWNER'S MANUAL.doc Page of ,,.F.. }., _. E ;.__ e ', .:;~a. €..s.? „ 'f1 -~~ ~.. 4'^,I ~.... ~i ~~ ~~ STATE BAR OF WISCONSIN FORM 1 - 1998 639320 WARRANTY DEED ' KATHLEEN H. WRLSH ;; FEGISTER OF' DEEDS Document Number ST. CROIX CO. ~ WI RECEIVED FOR RECORD This Deed, made between CAROL AND1 SCHLUSSL~-- 02-27-2001 11:00 AN _ a si, n~Ze person - -- --- ---__- --_ idRr^.RRKTY DEED -___, Grantor, EXEMIPT p and _._ KATHLEEI3 L. STAFFORD a single person CERT COPY FEE; -- - -.---- COPY FEE: -~-- --- .-_...--_-_ TRANSFER FEE: 399.00 -.. __- , - ~ RECORDING FEE: 10.00 --•- ---- ~ PAGES: 1 - - Grantee. Grantor, for a valuable consideration, conveys to Grantee the follow[ng described real estate In - S_t . CroiX -_ County. State of Wisconsin (the "Property'): s,e.;:<•~d~n~~ nrea ::.. - , Name and Rettun Address Part of NE-1 /4 of NE-1 /4 of Section 29, Township 30 North, Range 16 ~•~ West, St. Croix County, Wisconsin described as follows: Beginning at /1 4~ F'k'~~ I ~ ~~ ~ " the Northeast corner of Section 29; thence SOO°'10'12"V1/ (bearings /'~-- assumed) 725.90 feet; thence N89°49'48"W 315.45 feet; thence N00°10'12"W 553.02 feet; thence N39°32'30"E 239.69 feet; thence ~ - -.:. _ --- ... . S85°29'20"E 163.88 feet to the point of beginning being Lot 1 of 010-1070-10-100 Certified Survey Map filed June 14, 1991 in Vol. 8, Page 2369. 010-1068-60-100 Parcel IdentitiCation Number (PIN) Part of NW-1/4 of NW-1 /4 of Section 28, Township 30 North, Range Tnis is homestead property. 16 West, St. Croix County, Wisconsin described as follows: Beginning (i5) (is not) at the Northwest corner of Section 28; thence S85°29'20"E (bearings referenced to the west line of the NW-1 /4 of Section 28, assumed S00°10'12"W) 289.99 feet; thence S21 °34'45"W 458.57 feet; thence Southwesterly 285.71 feet along the arc of a 102'1.64 foot radius curve concave to the Southeast whose chord bears S13°34'04"W 284.78 feet; thence N89 °49'48"W 55.79 feet; thence N00 ° 10' 12"E 725.90 feet i' to the point of beginning. Together with all appurtenant r(ghts, title and interests. ~! Grantor warrants that the title to the Property is good, indefeasible in fee strnple and free and clear of encumbrances except -- none. Dated this ~-}~~' '~h day of February 2001 ~~ -' - ., (SEAL) ~.~l~ti'i"--'~IJC~ ~~~ '~ (SEAL) "` w CAROL ANI3 SCHLUSSLER (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature (s) State of Wisconsin, - ~ ss. Patricia Coates-Knutson st. Croix Count JJJ authenticated th1~jD}..,... •~- _ Personally came before me this __ .a~ '~~' day of •s'`~ r February 2001 _, ~e above named State of Wisconsin _ Carol Ann Schlussler TITLE: MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person who executed the foregoing authorized by §706.06, Wis. Slats.) instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BV Attorney Barry C. Lundeen ; ~ r Notary Public. State oC Wisconsin ii-- 110 Second Street, Hudson Wisconsin 54016 My Fornmisyton is rmanent. (If not, state expiration date: (Stgnatures tnay be authenticated or acknowledged. Both are not ~~ ~.3 d._ ) necessary) -` -~~~ ~- ~-• .-.._ --. • Names a! persons signing In any capacity must be typed or printed below their signature. ' WARRANTY DEED STATE BAR OF WISCONSIN Wisconsin Lagai Blank Co., inc. FORM No. t - 1998 Milwaukee. Wis. -. LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF EMERALD COMPUTER NUMBER 010-1070-10-100 Parcel Number 29.30.16.429A OWNER NAME: First KATHLEEN L Last STAFFORD PROPERTY ADDRESS: Hse # 1/2 PD --Street Name-- Type SD Apartment 1394 230TH ST SECTION 29 TOWN 30N RANGE 16W'/4160 '/440 Line Description Line Description- PARCEL VOLUME & PAGE HISTORY TYPE VOLUME PAGE DOC# NOTES .-.WD 1592/ 406 639320 SCHLUSSER CAROL TO STAFFORD KATHLEEN ..TI 1496/ 486 619881 O CAROL ANN ..WD 905/ 53 4701 RAUSCHIVOT HERBERT T HLUSSLER ROBERT & ANN Use Arrow Keys to Select, F7-ROD, F10-Exit ~~ ~ !~ i , ci i. ~ ~ a ~ 1 1 ___ , . . ~~~ i.s r., ~I ~u rri a l ri .. :I.i i. ..~ ~ ' ~.~j~~~'oS_ -f 7'I \ 1u7 lat~(1:.}~y11'dCa :i'1ti X 8'.~ I I S:~ti _.. . .ti ~ P!? L','`. i_ _ _.. SLCGv~- / S ~~~- ~~ ~~~Y`v~~ Li Y~ /L ~~bGL/ ~~ ~~ V' ru;._ I I'5 ,: • e7. I. ~~ ~~..~ I~4. 7I'u?Iii ~~r M athy ,l, ~iv Dal M 200 [, gT s c hncnon ,~5 Denttis & ~ I Jean CREEH 8[S $p0 aIk lk John Jr J O ~•1)r ~ u~ ~ Wln Potts ° "` i/ dY& Ber~ex-sds & Ju M ar k 80 6 ~eao 80 ~ 1 r ° ii nn l) ~chh ilfe I P AB 3 9o a 160 A 80 156 az 39 ~ 153 7 149 4 Pahl 80 K 8c R ~ 160th AVE K& R Arnold Hammar- back .q ~ Norman Kenneth 8c ~ s s ~ ba~~ 110 Berg Trust 3i ~ 3 ~M~~~ Fronds & ~ o~ ~ ~ 119 160 159 80 ~ °~ ~ Klan t aNH u ~ Thom ~ ~ Maurice ~ G V ~ ~ ~ ward & w ~~ u Maloney r Mozzarella aS• ~~ `~ J ll d u ~ ~ N ,~ 240 16 0 JosePh RL : °,a°' 40 120 200 36 `.~ ~ 80 ex zo 373 a &S ~ ~z ~ 3 ~ ~ tr s G ~_ 2 ~- ~° ,~ ! ~ shams }{lldr 4 Edward 8c o Marjorie N R ~ ~ 3 MdtD E 9 Emerald ~~' 3 ~ W , ~J ~~ trranr Rid~ard ac Robert xenneay 80 ns ~.. d$ ~ di Bradley &°M an Iiohn ld8 qo A&I, p N n Derrick Lawrence ~ e N .a u,d : ; ~~ Logterman 17rieze waWean BaztOe o 19 RUN 6 Moor p ~ a°t x $ ~ ~'~ ~ ' ~ 72 A ° 110 51 ~ ~.~ ~ A dS O ~ Y ~ Earl & e o ah Harvey ~ ~ D~anie i ~ p ~ ~ ~ E ~ ~ ° t ~ ~ ~ o ~ Heins gp ~ ~ a. P+ Fiiell~emaa c~ ~ ~ B °t 8t Kaael ~ y go~ D C7 > Z S&D 3 x a -z ~ ~ ~ 06 ~ Diaaife & ~ e 3 ~ 102 ~''~~ > h3 N Dorw Schug o o ~ 4 K o 8 46 Raebel 80 t H a v " ~ e Keen & ~ 140th AVE ~ r 5U 4 278 l ~ y Omann 60 Dennis & s e Dorothy EEK ~ ~ O~ p Howard ~ BL Mari Omau r- Tnut 37 F e? ~ a~ e ~ ~ 80 ~ ~ ~ . ~ Ce Wink ~ ~~ s °o ~~ ~ 37 8[ Nancy i G0 ~ 40 40 200 ~i <n ~ s gg A C1 ~ : 63 Spoo o 00 ~ ~ ~ aymond Helen J th = . 0 D 0 (3 68 DJ 14 ~ ~ e 0 ~ c7 &S ~ Davis 120 ~ ~ A ~ N M a ~,~ ~ ~ 'y '" ~ j~anh Gary ~ Borst hammQ e~ ~ c ~ ~ a ^' g co s a _ John 8c Susan 1 y~ Daniel N N ~ • ~ j~e {Araldroff g ~ a7 v g i °.3 ~~~~ `h 3 39 ~ 04 x 8 ~ 8 38 Co ~ lace pt~ E 80 ~ a m ~ °° ~ A ~tf 5 N ~ g s.°« Loren o ,. 40 150 ~ 9O g br nk ~ ao ao ~ ~ o 0 o 0 00 0 N ~ t~ ~ " a «~ ~;, DOYa- Reuben ° a~, ` ~ u ° ° v vh>k 40 ~ , ;~ a ' Thomas S ~ ac- ~ ^ Lam es ~T s ~, ~ ~ ~ ~ s F• ~ '~ & Lots ~ ~' ^ ~ F Gene & ~ ~ ° ~ °i. a. r$ ~ a ~ & Judy Wh1k t Kevin Gar Hol le a o on 4 0 x a o Joanne °~ V s Smith 115 . F" °8 H '''~ p~ ~' ~ DOt1P,laS Anna N Smith 2S pO ~O 'u ~ ~ ° Grant Nac Ty Henderson Lundeen Scott Sao '° z ~ '" oaA ~"' carala ~ o ° v ~' . .S A pd 4 ~~ ~ tal 135 ~~ w~.. Rau '" s ~ ~ schnot 51 ~°^~° M _ na S ~` ~ anet J Holle ~ 'a ua' ~' D °~ nyovy 196 Chad & Erika m .. . ~ 20 ~ ~ oas 156 30 DD BALDWIN PAGE 40 • ~ Come visit our model home 2 miles South of New Richmond on Hwy. 65 .. _r._ - - - _ _.._ ..... .- vim. -; ~ .. tr. .. ~ .. ... rt. n~ f em. O/D ~42'D /D /DD P'S1i~99 c~e.c, z.9 ~,~oa ~~~ l,~J P-~' tit a~ Qc`I ~'~~~ ~ dli ~C Dr3i F~~,E~ ~ 3vN 1 ~~gg, J~E$ 0 CONe ds` ~ Std ~~I o`er WiC~ C ER T I F~ I ED S, C1'R ~ V E Y MA P Located in the NE1/4 of the NE1/4 of Section 29, T30N, R16W, Town of Emerald, St. Croix County, Wisconsin.. ~ Surveyed for: Robert Schlussler 1374 230th St, I Glenwood City, W i . 54013 N 1 /4 Cor . Unplatted Lands Sec. 29 ""'_- T 30N, R 16W .1~4IJt. S 85 ' 29 ' 20 "E IL____. • 163.88 ' _9 NE~or . S 812g~ 21O~~E .. ••~~~ Sec . 29 North line of ~'~ ~ '~ LEGEND the NE1/4 .nj~. 5 29'20"W M ---x-_._ . ~2 ~~ 189.52 ' Section Corner ~~rL~~~~ // 0 1 "X24" Iron pipe ~ tio~°~ //~ weighing 1.68 lbs / ~~~ ~~ ~~"~ F~'? ~ C WETLAND Yc ~ N ~~ ~/ / O ~ ~ m lC) / l17 r~,~ ' w / ~ OF EXISTING N oRrvewar I `i ~~O ~ ob le al ~ • o o e 0 Z _13 IL 217, 800 Sq. Ft. (5.00 Ac. ) Including right-o~way-~ 211,969 Sq. Ft. (4.8? Ac.) Excluding right-of-way per lin. ft. set. Ora id?o ~e P~z~ Z~~`~ ;~ ast line of the NE 1 /4 o o N o ~ r ~~ ~ / N I~ ~ m N ~ / !, N . • ~ O o ..! • / o s~i° -c/ . ~a%„ '~~ aF•e~, M~ N~ F • h ~s' Utility Pole Bearings refer::. N 89' 49' 48°W enced to the East. 315.45 ' line of the NE 1 /4 ~:ssumed ~J~P~~t~gc~L~.n~s N00°1Or12"E. SCALE IN FEET I" • 100' 0' 25' S0' 100' 200' 300' E1/4 Cor. Sec. 29 VOLUME 8 PAGE 2369 v o m ~ o ~, O ~ O Z +• 3UN1~+1991 ~ ~ ST. CROP( COUNTY ~~ COMMII7EE I~! (r ~ `~Ct~lys'f~~,ti I` r~ ~'~ HARVEY Q. '~3 JOHN80N s s-~8ag ~, $~ H W ~ N 4 ~I~ Np SUR _ i`~~ Drafted By: JW G 491-1830 ~~ ~~~ Form - S T C - 104 AS BUILT SANITARY SYSTEM REPORT ~ / .~O ` OWNER G/g,6~~~ ~i dtL/SG/y/VO7`TOWNSHIP ~G' /alai SEC. ~ T ~N-R ~b W ADDRESS ~t' ~ ST. CROIX COUNTY, WISCONSIN r SUBDIVISION °"° LOT "`- LOT SIZE '~ /~G',~~° PLAN VIEW Distances and dimensions to meet requirements of I•I,I~R 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM F~NC~, ~i^nr~ 8M /oaf ~~"~ N ~` ~~ ~ r i ~. i ~ ~~ ~ ~ ~ q 1 ~ v ~ I ~ ~ ~ V ~;- /7 ~ b ~ ~ S JoDd C~itG yet ,~" ei ~ 5`~~T°i~. 't~Nh° `~ ~ X90 INDICATE NORTH ARROW BENCHMARK: Describe the vertical reference point used ~Q ~ ®/~ Ca/f A/~iQ /~os'J" 0 Elevation of vertical reference point: ~~ ~ Proposed slope at site: SEPTIC TANK: Manufacturer: W ~ ~ ~.~' Liquid Capacity: ~0 0 ~ Number of rings used: _~ Tank manhole cover elevation: q~,.~~ --T- Tank Inlet Elevation: ~ , Tank .Outlet Elevation: ~~~ ~~ Number of feet from .nearest- Road.: Front,~Side,o Rear, O ~ / 0 feet From nearest pr©pexty line :'..Front,®Side,O Rear, O l 9~ feet Number of feet from: well ~, building: J ~i (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE PU1~ CHAMBER ufacturer: Liquid Capacity: Pump Mode Pump/Siphon Manufacturer: Elevation of inlet: Bottom of tank evation: Pump off switch elevation: allons per cycle: Alarm Manufacturer: Alarm ch Type: Pump Size Number of feet from nea st property line: Front, (JS3~e,,~ Bed: Trench:^~~ Width: .~ Length: ~_~, Number of Lines:~_ Area Built:_~,~~j~ Fill depth to top of pipe: `~_-- Number of feet from nearest property line: Front, .Side, O Rear,O Ft.~~L Number of feet from well: y ~ Number of feet from building: ~- (Include distances on plot plan). SEEPAGE PIT umber of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Size: Liquid depth: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOLDING TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, Q Rear, OFt. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Dated: ~ %~~ ~~ Number of pits: Diameter: Bottom of seepage pit elevation: Inspector: Plumber on ob: j ~~~.~ ~ License Number : /~/~~~~~ Q Rear, ~ Ft . 3/84:mj DEPARTMENT OF INDUSTRY, LABOR & HUMAN RELATIONS P.O. BOX 7969 MADISON, 4NI 53707 TNE,NE,29,30,16W 2~~th SftEmetald INSPECTION REPORT FOR SAFETY & BUILDING DIVISION ON-SITE SEWAGE SYSTEMS OFFICE OF DIVISION CODES & APPLICATION State Plan I.D. Number: CONVENTIONAL ^ ALTERATIVE (If assigned) ^ Holding Tank ^ In-Ground Pressure ^ Mound NAME OF PERMIT HOLDER: ADDRESS OF PERMIT HOLDER: INSPECTION DATE: Herbert Rauschnot Route 2 Baldwin, WI 54002 Z• BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: CST REF. PT. LEV.: Name of Plumber: MP/MPRSW No.: County: Sanitary Permit Number: Gale Smith 5690 St. Croix 119535 SEPTIC TANK/HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.: TANK OUTLET ELEV.: WARNING LABEL LOCKING COVER PROVIDED: PROVIDED: ^ YES ^ NO ^ YES ^ NO BEDDING: VENT DIA.: VENT MATL.: HIGH WATER NUMBER OF ROAD: PROPERTY WELL: BUILDING: VENT TO FRESH ^ YES ^ NO ALARM: ^ YES ^ NO FEET FROM NEAREST -~ LINE: AIR INLET: MANUFACTURER: BEDDING: LIQUID CAPACITY: PUMP MODEL: PUMP/SIPHON MANUFACTURER: WARNING LABEL LOCKING COVER ^ YES ^ NO PROVIDED: ^ YES ^ NO PROVIDED: ^ YES ^ NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERATIONAL: NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LINE: AIR INLET: PUMP ON AND OFF ^ YES ^ NO NEAREST -~ SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing FORCE LENGTH: DIAMETER: MATERIAL AND MARKING: or excavation. (If soil can be rolled into a wire construction shall cease until , MAIN the soil is dry enough to continue.) CONVENTIONAL SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF DISTR. PIPE SPACING: COVER INSIDE DIA.: # PITS: LIQUID DIMENSIONS TRENCHES: MATERIAL: PIT DEPTH: GRAVEL DEPTH BELOW PIPES: FILL DEPTH ABOVE COVER: DISTR. PIPE ELEV INLET: DISTR. PIPE ELEV END: DISTR. PIPE MATERIAL: NO. DISTR. NUMBER OF PROPERTY WELL: BUILDING: VENT TO FRESH . . PIPES: FEET FROM LINE: AIR INLET: NEAREST ~~ MOUND SYSTEM: Mound site plowed perpendicular to Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM slope and furrows thrown unslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ^ YES ^ NO meets the criteria for medium sand. ELEVATIONS MEASURED. SOIL COVER TEXTURE: PERMANENT MARKERS: OBSERVATION WELLS; ^ YES ^ NO ^ YES ^ NO DEPTH OVER TRENCH/BED CENTER: DEPTH OVER TRENCH/BED EDGES: DEPTHS OF TOPSOIL: SODDED: SEEDED: MULCHED: ^ YES ^ NO ^ YES ^ NO ^ YES ^ NO PRESSURIZED DISTRIBU TION SYSTEM: BED/TRENCH WIDTH: LENGTH: NO. OF LATERAL SPACING: GRAVEL DEPTH BELOW PIPE: FILL DEPTH ABOVE COVER: TRENCHES: DIMENSIONS MANIFOLD ELEV : PUMP ELEV : MANIFOLD DIA DISTR. PIPE MANIFOLD MATERIAL : NO. DISTR. DISTR. PIPE DISTRIBUTION PIPE MATERIAL & MARKING: ELEVATION AND . . .: ELEV.: PIPES: DIA.: DISTRIBUTION INFORMATION HOLE SIZE: HOLE SPACING: DRILLED CORRECTLY: COVER MATERIAL: VERTICAL LIFT CORRESPONDS TO APPROVED PLANS ^ YES ^ NO ^ YES ^ NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS: NUMBER OF PROPERTY WELL: BUILDING: ^ YES ^ NO ^ YES ^ NO FEET FROM NEAREST-~ LINE: UV,IIVwu C:1'1AMtitFi: Sketch System on Reverse Side. SBD-6710 (R. O6/88) Retain in county file for audit. SIGNATURE: TITLE:LOnln~ ^,y„~lStrat~r s _e. _e son t]' 111 @Ah11TADV DCDwA1T ADDI lit'_ATIi111-1 ~~ DILHR ..~.... ~.... _....... ~.. _.-- - • ---- Cou Inaccord with ILHR 83.05, Wis. Adm. Code ~~Rs .er..,...a.,..,..,,_.,,e_ -Attach complete plans (to the county copy only) for the system, on paper not less than STATE SANITARY PERMIT ~ ~ ~~ 8'!z x 11 inches in size. ^ ch if evision o previous application -See reVer3e Side for InStrUCt10i1S for Completing thlS applicatlOn. STATE PLAN I.D. NUMBER I. APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION. PROPERTY OWNER PROPERTY LOCATION ~ ~ p /1/ '/a F'/a, S .~- T .~O , N, R /6 ~~or) W PROPERTY OWNER'S MAILING ADDRESS LOT # - BLOCK # Rt' ~- _--- _-____ CITY, STATE ZIP CODE PHONE NUMBER SUBDIVISION NAME OR CSM NUMBER .. 0 2 7 II. TYPE OF BUILDING: (Check one) ^ State Owned vi LL AGE ~ NEAREST ROAD ~`- 7` LAM ers A ~ d o ^ Public ~ 1 Or 2 Fam. Dwellings Of bedrooms ~ PA EL AX NUMBER npa 111. BUILDING USE: (If building type is public, check all that apply) I 1 ^ ApUCondo 2 ^ Assembly Hall 6 ^ Medical Facility/Nursing Home " 10 ^ Outdoor Recreational Facility 3 ^ Campground 7 ^ Merchandise: Sales/Repairs 11 ^ Restaurant/BarlDining 4 ^ Church/School 8 ^ Mobile Home Park 12 ^ Service Station/Car Wash 5 ^ Hotel/Motel 9 ^ Office/Factory 13 ^ Other: Specify IV. TYPE OF PERMIT: (Check only one in line A. Check line B if applicable) A) 1. ®New 2. ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of 5. ^ Repair of an System System Tank Only Existing System Existing System B) ^ A Sanitary Permit was previously issued. Permit # - Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ^ Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 ~ Seepage Trench 22 ^ In-Ground 42 ^ Pit Privy 13 ^ Seepage Pit Pressure 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. GALLONS PER DAY 2. ABSORP. AREA 3. ABSORP. AREA 4. LOADING RATE 5. PERC. RATE 6. SYSTEM ELEV. 7. FINAL GRADE ft.) (Min./inch) ELEVATION REQUIRED (sq. ft.) PROPOSED (sq. ft.) (Gals/day/sq. p ,~ Q O 3 ,~~ ~ p „ l ~ ~~I . /.~ Feet Feet VII. TANK CAPACITY in allons Total # of ' Name f t M Prefab. Site Con- Steel Fiber- Plastic Exper. INFORMATION New istin Gallons Tanks urer ac s anu oncret glass App Tanks Tanks strutted Se tic Tank or ~ Lift Pum Tank/Si hon Chamber VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name (Print): Plumber's Signature: (No Stamps) MP/MPRSW No.: Business Phone Number: Plumber's Address (Street, City,.State, Zip Code): tc...i ~,~ of '7` .. O / IX. COUNTY/DEPARTMEN USE ONLY ^ Disapproved San' ry Per it Fee (Includes Groundwater a e ssue Issuing Agent Signature (No Stamps) Approved ^ Owner Given Initial Surcharge Fee) /J / '"' Advers D rm'n tin !! O (~ O X. CONDITIONS OF APPROVAL/REASONS FOR DISAPPROVAL: SBD-6398 (formerly PIb~7) (R. 11/88) DISTRIBUTION: Original to County, One Copy To: Safety 8 Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/Renewal Form (SBD 6399) to be subma~tted to the county prior to installation. 5. Onsife sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed- pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety 8~ Buildings Division, 608-266-3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is Public, check all appropriate boxes that apply. IV. Type of permit. Check only one in line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information: Provide all information requested in #1-7. VII. Tank information. Fill in the capacity of every new and/or existing tank, list the total gallons, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for a// septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/Department Use Only. X. County/Department Use Only. Complete plans and specifications not smaller than Si4 x 11 inches must be submitted to the county. The - - plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if _ required by the county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE ' ° "'"""" 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater, ground- water contamination investigations and establishment of standards. SBD-6388 (R.11/88) 3TC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNER/ ~~~~~~~`" /~/j/-~.f~h'/~O7` ROUTE/~8&3f-fittlMB'Eff ~-- FIRE N0. CITY/STATE ~~La/ /,v in/ , Lv /, .~/~ O D :2- ZIP PROPERTY LOCATION: ,~1,~ l/9 X1/4, Section ~ 9 , T,~O N, R /~ W, Town of .~'/+'f er.~~,1. d , St. Croix County, Subdivision , Lot No. Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a LICENSED SEPTIC TANK PUMPER. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County Residents MAY be eligible to receive a grant for a MAXIMUM of 53000 of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of ALL NEW SYSTEMS agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. I/WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin Department of Natural Resources. Certification form must be completed and returned to the St.Croix County Zoning Office within 30 days of the three year expiration date. ff S I GNED~®,fa~ ~...1 DATE St. Croix County Zoning Office St. Croix County Courthouse 911 9th Street Hudson, WI 54016 (715) 386-9680 Sign, Date, and Return to above address .~lb~i- ~ ~ Se.C' ~ ~~; JQ /~ ~ ,57; cif ciX G 4 t ~N~ i~ .53 z i ~~; B , 13' ~ 8S ~'~ ' ~d ~ may,----, s~ys ~~M ,~L~~V. 9~, ~3 ~iLl T ,CAM /o d ~ ~tG1~ ~ ~ C ol~nr~,Q /~oS1`' ~~ _~ ~r'a.~ __ i r ''6 Z / d~~ ~~~i Sc'-/~j-/C 7`~lN~ y ~- er VG~N f ~~~~~ O '~,( APPLICATION FOR SANITARY PERMIT S.TC- 100 This application form is to be completed in full. and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor,("spec house"), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Owner o f Property ~~ C~-~b e~ ~ ~i4 L1, S C /i~/If D Location of Property ~~ ~'~L, Section ~, T ~© N - R ~~ W Township L-~/I,~JE~~4,L~ - Mailing Address ~f ~ / ~~La~li i/V </ / ~yoD sZ ~' Subdivision Name Lot Number Previous Owner of Property f=/~j,~-f' /f~,~7x~ ,Q~l~/~'C~O~,~i~<-dl~i/1/ ' Total Size of Parcel ~ Q /~(~ iQ G~ Date Parcel was Created / 9 ~ ~ _ _ Are all corners and lot lines identifiable? Yes !,~ No Is this property being developed for resale (spec house) ? Yes ~^ No Volume ~~_ and Page Number ~~ as recorded with the Register of Deeds INCLUDE WITH THIS APPLICATION ONE OF THE FOLLOWING: 1. Warranty Deed 2. Land Contract "''~ ~. Other recordings filed with the Register of Deeds Office In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the the Certified Survey Map shall also be required. PROP~RTy OUINFR CFRTI~ICATION I (we) cen~.i.~y ~h.cLt a.P.e b~a~ement~5 an xh.us ~anm cvice ~lcue ~a the beds ab my (auh) Fznaw.~edge; ~h.at I (we ) am ( alr.e ) the awneh (~) a ~ the pnapehty deb c~c-%bed ~.n .th,i.a ~.n~onma~i,an ~anm, by v.t~.tue a~ a wctlvcavLty deed necanded ~,n .the O~~.ice a~ ~h.e Caun~y Reg-ia~en a~ Deeds a~ ~ocumen~ Na. ~~~ and ~ha~ I (we) pne~ev~tey awn fihe pnapobed .d.cte fan the yew ge papa. -ay~s~tem (an I (we) have ab~ained an eaaement, ~a nun w.cth the abave dedc~u.bed pnaperUty, ion xhe card-t~cuct,%an a~ ba~.d b y~~em, and the game hays been du,ey necanded ~.n the 0~~~.ce a~ the County Reg-c,d~en o~ Deedd, a~5 Document No. jy~~,C ) SIG ATURE OF OWNER D SIGNATURE OF CO-OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED 21 ' 89 id6 ~ 44 w~ ' . ~ocurnE*a~s rya, NORMAN SCHUf~iACHERA WARRANTY p»i~b STATE; SAIL OI•' WISCONSIN' FOIt]'~ is - 7,a$~ _ " ! ~ PAGE. --.... -.... - - P.2r'2 ~~ ~~ ~~~ TH15 SPADE RGwGRVi:P NO{4 RECORQIi3G ~A'iA i REGISTER'S C)Fl~tCE ~.L National Ban1c of Iiald~in `~'~• CRC~1~ ~., WI --------------------------------------------------'--------..,.•,..,.,...---.•----------------------- '~~ Ret'd fctr Record __ _ ~i _. ~-------- ---------- --- -----------1---------...~...:.....:::---•-----------------~-----..:. ~~ M~Y~. X19$9 _ 4 -'._- sin le erson I H - conveys acid warrants to....,~'~~~~~.-~'--'_...........334+.'~........,.-~---...-p---•-•---- ail R! ~ OfOfD~ i ids --- ..-----. {~ .__. _....., 'f ~, ~, the Puliovrint; described real estate in S t . CrO7,x - County, ... ... State of W iseonsin : 'ti 'I'a~t Ya,rcel No :..........................••-• i', I ~~~e [~t}': 1~, of the CIE '~ of Section 29 Township 30 North Range l.6 West. ~~~ ~ ~ ~' ~ ,. ~.:',s _....,:~._;:"?-~----_...... hoxnegtead ~roporty. (i~} (is not) i ........(SEAT) ~-- ,,.,. ................(SEA~) n Ment' E~€ectattive V. Pres7,denr * .................... .....(SEAL) ...:................................................ .......... ( !;A } - --•----• -•-- -------- ., •-•-- .... S L. ~ ~ Y V. Preside~it ~, err Pederstucn Assistant ,A,VT$~r,NTYCATIQN AC3i1~0'GV'3a~I}GMENT ....Signaxure_(s) Son__M. _.:....... -._.. and ,7erx~;. ~.:...... STA.TE QP WISCONSIN Mexr.t~nl~------------~• .. _....._.. .__.. ~ Pederstuen. ~ as. -----------° .................................................................... ---.~.~.__C.~c1i~C-----------County. ,. alTtiuntieated this -, 15_day af___.Y.., ~. personall~• came before me this ._._I~:th.....d~~ rf " ., --- 19.... --------.~#'t~:•-•~---•------~ 19$x.... tha :above named ~' ---- --~Jan.~I~- +-- 3-- L'hamas R. Schumacher _--- .Padera~u~n~As~-t ~CP~..YF ----~ •----------- ~ TITT~: ~I~MPER STA~T~ $AIi. Op' WISCONSIN -------------------------•-------------•--...,.,...-•---------- --.,. authoricad by ¢ 706.06 Wis. Stats.)yy....., _s _.__._ o e utEd `ti~W~"'''' ~+ ~, •:,f to me knpwn to be the perapn _ .,~~~~r ~.•... ':s y for ~ m trument an ~e edge e s e. •• ,, TH1F INBTftUMEIVT ,_~- ~`~ ~~...' ~, y -----._ ...,. ,, ~~ ~~+ _ e a_ II & Schumach • . . e; ~ .~ .. „ ~ ~+~. R$ldraa.3x-z_-T,~I~SLrQQ2 ....... ...... ~.,;~'¢ "?,.~:,~~.,,~, ..•~Gfa y ~, ----, ...s. =•-~xQ'.~.3I._...o...__.,_Gountj~, Obis. ; `• ~ (Signatures may he authenticated ar ackrn}~ir'~~~d. Both ,-'~ !a~'~'' COYYlmis514n Is ~errnanent. (IY n t, state expiration ~; axe not neeessar ' l '" . '` • + "~ "~~ .: ' ~« r~y~ ~ f 1tt11 ~ yti~~$ate: __.RifV'~ ~ilf6 I~}~ _ -._... 1J _.._ ) .: ~i i !, ., i i ~ ~ ill t.~"``°:,•:~:. ' • yPad or s ~W' ~}(tZ~ ~iSigriBtUPC~, A1amci o! ]7BYSO[IS a~QgeayX fn $>:iy cRpacrCy ishuuld bat ~§ ~ ~ ~{~, } r _ ..... . WA1tiITY DEED STATE BAR OF WXSCOrVRI'h Wiecu~iuiri T,r~al SSlank Uo. (nr ~nnww .r.. ~- iuuA l1Sil~~'•ukUa'. 'VIA. DEPA~iTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INbUSTRY,' __~~..~- a~{~_- __ _ _ _ DIVISION LABOR AND PERCOLATION TESTS (~~J) MADISON WI 53707 HUMAN RELATIONS (ILHR 83.0911) & Chapter 145) LOCATION: SECTION: / W TOWNSHIP/NlIdA1+_/1': LOT NO.:BLK. NO.: SUBDIVISION NAME: A/x'/a ~1J~''/a ~ 9 /T 3D H/~ /C~lor) n ~/~ 10 ~// ~ /7 ._i IJSE NO. BEDRMS.: COMMERCIAL DESCRIPTION: Residence - --- ~---.+ New ^Replace RATING: S= Site suitable for system U= Site unsuitable for system DATES OBSERVATIONS MADE PROFILE DESCRIPTIONS: PER OLATION TESTS: CO __ NVENTIONAL: c~s^u MOUND: sou IN-GROUND-PRESSURE: ®s^u SYSTEM-IN-FILL as au HOLDING TANK: as^u RECOMMENDED SYSTEM:(optional) co~,>,~Nto,~,~~ If Percolation Tests are NOT required DESIGN RATE: if an y portion of the tested area is in the under s. ILHR 83.09(51(bl, indicate: ~ ~~~/Y Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS BORING TOTAL DEPTH TO GROUN DWATER-INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON BACK.) B- ~ ` 93, -6 a 7 7, a e ~ . S.~' , ~ ~ , off' . . B- ~ y o > 7 7,5 ' ,~ L , 6 ~ ' ~ . off, 6- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL-INCHES RATE MINUTES NUMBER _ INCHES AFTER SWELLING INTERVAL-MIN. PERIOD t PERIOD 2 P RIOD PER INCH ~ P_ ,~ ~o o r ~~ 3 3 P- a P- O P- P- P- 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 location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 9'/~ /'3 F~'-NC e L i N e ,J~~' QM 'ro P ©~= L'oRnreR 3~` ~ ~-~ ~ 1..99 a ~ ~ ~ ~ Pj ~. ~_ ` ~ _ ~ a _ ~ ~~ a~aPP. ~ d 3 ~,,~~3 S ~, B :,~ ' ~ - '' qy. 6.~ o ~+ M ~a~..-~-i % ~~ per- - qy.~ ~~ ~~~~h ~ did i, the undersigned, hereby certify that the soil tests reported on this form were made by me In accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: ADDRESS: J- ~' // ~~ ~ (~ wog G ~ ~`' ~ i CERTIFICATION NUMBER: ~ PHONE NUMBER(optional-: CST SIGNATU~RE~:1 / j `~~_ `~/ C~ZI/ //L~, • ~i DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR-SBD-6395 (R. 10/83) -OVER - =:T~. 7~ fit" Tip: F ~ ~ _ EiG Tn ,r ~ ac:z.crratr' sail tr t, ; ~ :.-€rr~s, ~uci ;. t~ Tri(' is t,. P. £,:ar113~i .,i,_'.' y :3(?; (`r`d1~K##. ' `,ale .I ~. Ps i C~Tlw4`cF~i Sy~ i ~ i ;~rD t`"' i~_~ i. _ .,:~{TI . ~l_ S~ rr~U i~he c, ~ „~:_ ~ u~! ~ #~ ~,',€. z~~~_ .,~lcf r;zam}~I~;==tire t~ EaIo~E plan; 7. # -"`« A L~IEt`~ ~ccu :aeiy i€~,_, t ;z~r huest Iota*iza€~ . '~)racn~irrg to scalrm~ i;~ pre~Icarre. A ,.1ert rraay ii ciesircci; . ~ ure your lae~lc}l~ ~ and vertiz:al ~:Ieifation ref`er'i lce poinr re , . <arly shourn, and are permaneratx 9. C~~rll~si~t{~ all apkrras~riatz~ l~.r~xes as tza rfat€as, names, addrzsse , ~!~ ~' I .rt~E data, perc.olatizan test exen~p_ i:ir3n, if appr~pr'iat.e; 1t~. } f the infr;rrna? ics=7 (sr~cfl as flz;~c>d ~rEair3, elauationl does r~ ~lace I.A. iii td~e ~ipfarr>pr'sate t,>nx; 7 [. Sig ~ thc. forrll and puce your cr.rrrent address arl~i your cr~rtif ~°ion nkrstlE~c~r; 1~. ~ ~ i+ "`.:~Ea c~o~aies anci c#istr~ikaute as resfuirez~l. A~.L SQI~. TEST i [V1LJS1" ~h PI~RD V~'ITt-i THE ~`v ~ f-st~1t~RITY ~~ETt-#l~ 3Q C?AYS Q1= CDIF'LRTfC~E`~. A~IIATIfl~w . ~ ~iT{fl Sfl~l. 7`EST Sail Separates T xturas Dear Syr~lb~als :,t - St~€ 1~1"1 13R -_- ~edrr~c(c cola _ ~otstrie ,~- 1Cl"j SS - S~rrdstor~e gr -- ~rssvei {_rrlc`r~r 3"} ~.S __ L~rllesto~re °$ _.. Sanz9 {'#~3~llf --- i"3~I£~#'~ Cd7YaulldLVatE=r cs - ~r>aFse Sanz~ #'erz; ~- Pereoietic~r~ Rate nle€~ y - ~~ecirum Sarld ~N -' EtZteli fs -' l*:ne SaF3c~ .cig ~ f~tatld~rtg ~s _ L.~>~rny Sark; ~ ..... Greatruxr lain y. sl -' Sandy k.~oarl~ ~ -- L~#~ss TE±C~r~ "r - L <<rn Bra -- E3ra~~en st --- ~xy -- ~ ray €;`E .~.._ L: ,arm ~ _.. ~ slluVv 54£Fs :. tl EYlat ii'.S }~: sc -- fff _.._ f3 {,, ~c _._ r cc -- r ~sllr~ ~_ : z >arse ~~ -. rae=rrt 4~l~r -- k-f~r;i= water level, sr.~I tuxt.tarey s~r~~facz~ li~a~ter c,>~ ii ..rici u~;raste disposal _._ E3er~~r;lt Mar k 1:! -- V=.~r*ical Referent,a Point TC? TINE flW~9~R. This soi# test report is the first sfiep in securing a sanitary permit. The county or the Department may request verification of this sail test in the field pricer to permit issuance. A complete set of plans far the private sewage system acid a permit app9icatian must kaa sularrrittec! to the appropriate local authority in order to obtain a permit. The sanitary permit must he o#atained and posted prior to the start o~F any construction. e