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HomeMy WebLinkAbout032-2076-60-020 Wisconsin Department of Commerce County: PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561077 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: Village X Township Parcel Tax No: Midbrod, Krist City Somerset, Town of 032-2076-60-020 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 0 0 0 c D _6 )y'1 14.30.20.790C20 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. t Septic j r 1066 Ben ark 121.5 Dosing d ` Alt. r , V Aeration 1 Bldg. Sewer 1 U/ S Holding /Ht I let z l r 23 el 3 utle TANK SETBACK INFORMATION H S 7F , TANK TO P /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septi Dt Bottom Dosing t a 7J Header/Man. S S 7 y 3 Aeration I o - Dist. Pipe C' C•t Holding Bot. System Final Grade AI PUMP/SIPHON INFORMATION - (14 +v X ( j U4 c 'S / o cj Z - 5 Manufacturer Demand St Cover /2_,4~_ 3 GPM Zy 3 3 Model Number r7 TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM C yL1 Ck-~/ BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS I--,- \ I / Lj~xjj i I - SETBACK SYSTEM TO P/L BLD WELL LAKE/STREAM HING ManufYaccttur ) INFORMATION Type 0 stem: AMBER I yPe qy Model Number: Sv; t . DI T-I21BUTI0 SYSTEM ' t 0 G~1 Head anifold M-,tSL~ isVi o f Ix Hole Size x Hole Spacing Vent o Air Intake Length Dia f Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over t ~~~Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ..1 /nyc Bed/Trench Edges Topsoil Yes ? No Yes No v~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 199 157th Av-er-sS,omers,?t, WI `54025/(SE 1/4 NE 1/4 14 T30N R201W)) NA Lot 2 - Parcel No: 14.30.20.790C20 1.) Alt BM Description = I " " t Y L '~J vx/A S d~_ s 2.) Bldg sewer length 7 - amount of cover = )1,4,1- Plan °~0 ` / ~ ' revision Required? ❑ Yes No (0j / - - - - - - J S~ Use other side for additional information. /0 SBD-6710 (R.3/97) Date Insepctor's Signature Cert . No. 1 /)kr s J ~ i i i \ ~ I I; I l ~5 I C~a3c•6 pest" ~ ' J /fQc~JCfiF-a G ~ P County f Safety and Buildings Division c %s 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co J p S P Pi Madison, WI 53707-7162 State Transaction Number Sanitary Permit Application N~., In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS ate submitted to Project Address (if i rent than marling address) / pp 5 g{,-GA` the Department of Safety and Professional Servies. Personal information you provide may be used for secondary u ses in accordance with the Priva Law, s. 15.04(1 m ,Stars. / / 1. A licatio Information - Please Print All InformationParcel # Property Ow s Name r e. p A 44y p _ - OZO Property Owner's Mailing Address Property Location T CRO/ 72q r Govt Lot 0 C Phone Number U V. Section -j ,LL/ - / Zi Code P / ne City, S e (circle one T ~ N; R~_ E o y) H. Type of Building {check all that appt Lot # Subdivision N 1 or 2 Family Dwelling - Number of Bedrooms Q~ Block # ❑ Public/Commercial - Describe Use ❑ City of p J9Qr M Number ❑ Village of ❑ State Owned - Describe Use d~l , - / ?5- IL :q JO Town of 2. 25 4-?4 III. Type of Permit: (Che only one box on line A. Complete line B if applicable) A' New System ❑ Replacement system ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner A It IV. T e of POWTS S stem/Com onent/Device: Check all that apply) toG .Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound? 24 in. of suitable soil ❑ Mound <24 in_ of suitable it 6L,921 ❑ Pretreatment Device (explain) ❑ Holding Tank ❑ Other Dispersal Component (explain) V. Dis ersal/Tre ent Area Information: Design Flow (gpd) Design Soil Application Ratefgpdsf) Dispersal Area Required (sf) Dispersal Area Propo (sf) System Elevation y/ 1131• VI. Tank Info Capacity in Total # of Man actumr °2 0,9 U Gallons Gallons Units 0. New Tanks Existing Tanks n / 0.0 En Septic or Holding Tank - N Dosing Chamber VII. Responsibili Statement- I, the undersigned, assume res sibility for ins Ration of the POWTS shown on the attached plans Plumber's a (Print), Plum 's Si MP/MPRS Number Business Phone Number 7 umber's Address (Street, City, State, Zip C e) VIII. un /I artment Use Only Permit Fee Date Issued Issuing nt Signature Approved =Ziiven $ u Reasor r Denial 475 / IX. Condit** easons for Disapproval / a~ t. 5ept'ic tank, effluent i8ter and /•'/uw~.t~~ dispersal calf nttlat all be ser0m I ntaintalr ad /A3A D ~ Sat ' a , as Per mane0eftut plan provided by. plumbs. All sink ltgtfY'bments mural b* WA* ainW is Pff IFF rode tordi~lioas, Attach to complete plans for the system aad submit to the County only on paper not less than 8 to x 11 inches in size CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address: Legal Description: Township: ~~.j,Etsx County: k~ Subdivision Name: Lot Number: Parcel ID Number: Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing Page 4 System Cross-Section Page 5 Filter Specs Page 6 Maintenance & Management Plan Page 7 Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Designer/Plumber: - License Number: Date: Phone Number/.5 ~_scS,L7 t Signature 44 Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 yt, i /coma l t~~ I l I I I I /~a~aSF-.n G II A ESL; ir-~! A/W i 1~ Ly f f _.I' ~ ~ ~ ~ Y~~~i=~ ` ~131,~- i ~'i5 ~ ,o Swop Soil Absorption System Cross Section .Z-ft 4' Schedule 40 Final Grade PVC Vent ripe with Vent cap q ft Leaching Chamber System Elevation / ft ft Soil Absorption System Plan View ft 1 ft Leaching Trench 1 Vent Or Observation Pipe Chambers 4' Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model 4~ :2L"A EISA Rating sq ft per chamber Soil Application Rate gpd/&q ft gpd Design Flow . Y Soil Application Rate EISA _,s Chambers 2 rows of _ chambers each. Page of INSTALLATION INSTRUCTIONS ic ft&w Zabe° &WaseeKe L- 251 P'L-625 FILTER krFioduds AdPc4dakkc INSTALLATION INSTRUCTIONS i Center'fdter t ° wfth opEaing rtR3`:YL 1 ~C-•• ty ii e r >e t tr 4.. r. s tiL -9 0.~1 T'°•- MLL 1 9T~'" j. iY i ` . ! ~Ytok Ec L nW. >x-LtN S L H' l } .C .i 1 1 r`t~~'lf~t7 '-.Y' ufz3~..Z .-JC2 FTt. Step 1: Step 2: Step 3: (A) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the (B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the is positioned so the filter can be housing, making sure the fitter removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted in the housing. MAINTENANCE INSTRUCi'IONS ~ti i~ ri S .+a7 ~yh y~,e.Y,.,+3'Y. 7 Ri y„ is yr, 3~ »R %A - t~i'~s3 ...z J} ,r ii ti•$ ~ S .,~~s ~ t{ts~$~~ Fd.'r..'' i ~y - M, .s u - •yy~'~`t"~ `1cF.i+ 'A'tY'~q~'a'9 .~'2 3` ~ ~ n --'S r1 Y-' ii*rj ts-Fry{', t` °s _ ~ °s ~•a Step 1: Step 2: Step 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filler cartridge back if necessary. into the the housing making sure • • NOT USE PLUMBING (B) Pull the filter out of the housing. the fitter is propefly alighed • ' and completely inserted. 6~ WHEN FILTER IS F,;, Y (C) Hose offthe fitter overt septic tank: tISE,lttaB ER.Gt31/E Make sure all solids fail back into the (B) Replace septic tank cover ~JVHEN .CLEAfVI(`I srFtLTER:'.:.. s®ptic ter* POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page /,or _ FILE INFO TION SYSTEM SPECIFICATION aI o NA Septic Tank Capacity Owner Permit # Septic Tank Manufacturer - ❑ NA Effluent Filter Manufacturer a NA DESIGN PARAMETERS Effluent Filter Model _ o NA Number of bedrooms o NA Pump Tank Capacity al ONA Number of Commercial Unit NA Pump Tank Manufacturer m NA Estimated flow (average) gal/day. Pump Manufacturer .MNA Design flow (peak), (Estimated x 1.5) gal/day Pump Model NA Soil Application Rate 1/da /ft Pretreated Unit Influent/Effluent Quality Monthly Average* o Sand/Gravel Filter o Peat Filter Fats, Oils & Grease (FOG) <30 ing/L n Mechanical Aeration o Wetland Biochemical Oxygen Demand (BODs) <220 mg/L o Disinfection ❑ Other: Total Suspended Solids (TSS) <150 mg/L Manufacturer Monthly Average" Dispersal Cell(s) Pretreated Effluent Quality ❑ NA Win-ground (gravity) o In-ground (pressurized) Biochemical Oxygen Demand (BODs) <30 mg/L ❑ At-grade ❑ Mound Total Suspended Solids (TSS) <304mg/L o Drip-line o Other: Fecal Coliform (geometric mean) <10 cfu/100mL Maximum Effluent Particle Size ''A inch diameter x Values typical for domestic (non-commercial) wastewater and septic tank effluent. Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Fre uenc Ins ect condition of tank(s) At least once eve o months ears (Maximum 3 rs) Pump out contents of tanks When combined sludge and scum _equals one third (Y3) of tank volume Inspect dispersal cells At least once eve o months,_2 pi ears (Maximum 3 rs) Clean effluent filter At least once eve o months ear(s) Inspect um um controls & alarm At least once: eve; ❑ months ❑ ear(s) NA Flush laterals and pressure test At least-once eve o months o ear(s) XNA Other: At least once eve o months n ear(s) Jf NA Other: At least once eve o months n ears O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third ('/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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other :hemicals that my impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks(s) removed by-a septage servicing operator prior to use. Page 7 or START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). It high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts, condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; most scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons, and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code- • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shat( be removed and disposed of by a Septage Servicing operator- pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with After soil, gravel or another inert solid material 'ONTiNGENCY PLAN (f the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area- Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a sail and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the b(omat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. ; <WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP 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. .DDITIONAL COMMENTS 1 IDWTS INST POWTS MAINTAINER Name 1~- Name hone Phone 1 PE EEE I EPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATOR A THORITY Name Name ' Phone Phone ils document was dra"_t =-c'°ance with chapter Comm 83.22(2)(b)(1)(d)&ff) and 83.547), (2) & (3), Wisconsin Administrative Code- ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREBMNT AND OWNERSHIP CERTIFICATION FORM OwmerBuyer Mailing Address Property Address E (Verification req=ed from Planning & Zoning Department for new cons ructiom) City/State - Parcel Identification Number LEGAL DESCRIPTION Property Location %4 , h~6' r/4 , Sec. W, 't'own of SiAbdivision , Lot j'' Certified Survey Map # l 97 3 , Volume l , Page # S6?9S~ Warranty Deed l , Volume , Page # Spec house yes Lot lines identifiable no SYSTEM MAINTENANCE AND OWNER CERTTI+'ICATION Improper use and maintenance of your septic system could result m its prune farlu re to handle wastes. Proper nainteuance consists of pumping out the septic -task every three Yeat or sooner, if seeded, by a licensed Pw3q=. What y'Ou put into s the system can affect the function of the septic tank as a treatment stage m the waste disposal system. Owner mauift nee responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St Crone County Sanitary Ordinance. The property owner agrees to submit to St Croix Commty Planning & Zoning Departmut 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 ism proper operating condition and/or (2) after inspection and pumping (ifumesmy), *e septic tank is :ens than 1/3 full of sludge. Uwe, the undersisued have read the above requireuients and agree to maintain the Private sewage disposal system with the s ~ndarus set forth, herein. as set by the Department of "Commerce and the DgxwuocW of Natural Resources, State of Wisconsin- Ce,ntrcatian stating that your septic system has been maintained must be completed and retuned to *e St Croix County Planning & Zo*ring Departnent within 30 days of the fin= year expiration date- 1/we certify that all statements on this form are true to the best of my/otr kaowiedge. Uwe amlare the owner(s) of the property- described above, by virtue of a warranty recorded in Register of Deeds Office. Number of bedroo 1 r SI A F APPLICANT(S) DATE uy information that is misrepresented may result m the sanitary permit being revoked by the Planning & Zo>risg Department _de vrith this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified sai vey map if e :e-enCe is made in the warranty deed _~T ;eC%0 8119622 State Bar of Wisconsin Form 1-2003 Tx:4095772 WARRANTY DEED 970790 BETH PABST Document Number Document Name REGISTER OF` DEEDS ST. CROIX CO., WI 01/04/2013 09:20 AM THIS DEED, made between William G. Johnston, a single person EXEMPT#: NA REC FEE: 30.00 ("Grantor," whether one or more), TRANS FEE: 189.00 and Krist Midbrod and Jenny Midbrod, as joint tenants PAGES: 1 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): FSA Title Services, LLC 5645 Memorial Avenue Stillwater, MN 55082 Lot 2 of Certified Survey Map filed May 22, 2002, in Vol. 16 of Certified Survey / Maps, page 4295, being part of Section 14, Township 30 North, Range 20 West, Northeast Quarter of Southeast Quarter, St. Croix County, Wisconsin 032.2076.60.020 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: None Dated January 2, 2013 / (SEAL) (SEAL) illiam . Johnston (SEAL) (SEAL) M AUTHENTICATION ACKNOWLEDGMENT Signature(s) 41 -;2k r► ANDREW " `dl I STATE OF MINNESOTA ) ss. authenticated o NotarvPublic Washington COUNTY Minnesota M Commission r ; n. * Personally came before me on January 2.2012 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named William G. Johnston, a single person (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrumeD~5A dged the same. owle TI-IIS INSTRUMENT DRAFTED BY: * FSA Title Services, LLC 5645 Memorial Avenue Notary I Iblic, State o1'Minnesota Stillwater, MN 55082, File #121075 My Commission (is permanent) (expires: 1 I)/rs ) (Signatures may be ;wlhenlicaled or acknowledged. Both are not necessary.) NOTE:'I'BIS I. SA STANDARD FORAM. A;NY iIIODII IC:A1'1()NS '1'O'1'111S FOR,kI SHOULD BE CL EARLY IDENTIFIED. NN'AItRAN"rl' DEED c( 2003 STATE 13AR OF WISCONSIN FOR;II NO. 1-21)(13 7 14~ui name hrlm' sienalw'c;. 042 ' G ew ale) '404 ; 'sdr-; hoc 4 7 9 73LI 20 74 ~o ova Z R T I F I E D SURVEY MAPa Located in part of the Northeast Quarter of the Southeast Quarter and a. part of the Southeast Quarter of the Northeast Quarter all in Section 14, ,ID I ~e9 0q(,? Township 30 North, Range 20 West. Town of Somerset, wo!°~ C A S"f' 2. a •,#St. Croix County, Wisconsin. ~ w ° .UNPLATTED LANDS 6 Prepared for aKd~at the request of: 8C0U 1' j u~ . ANDUG W OWNER: CAMP i~pq[r,~ -1. _--NB9'47'5$"E--!r*i Wlllam and Jennifer Johnston _--313.45 193 Anderson Scout Camp Road Houlton, WI 54016 4 RIG TIVI*A '-_T 58313626 ao Drafted by. Ty R. Dodge \ -4 4 ..m.- CENWWAVE JOB # W1057SU24 MORN LINE' CF' 7N£ Z z a S£ f/4 OF 7HE N 4 a►O w to 300 0 300 / io !10 NO TH LOT 3 to GRAPHIC SCALE C.S.M. SCALE IN FEET: 1 inch =300 feet ~f .4 No BEARINGS ARE REFERENCED TO THE EAST LINE OF THE V. 8 PG. 2204 _ o SE 1 /4 OF SECTION 14, TOWNSHIP 30 N., RANGE 20 W. Haf1s£ 9" 8 ~ o WHICH IS ASSUMED TO BEAR S00.09'46'W. NOTE: NO OWNER OR RESIDENT SHALL DO ANYTHING WHICH WOULD INTERFERE WITH OR CHANGE THE ` W OPERATION OF THE APPROVED COMPREHENSIVE WATER DRAINAGE AND SOIL EROSION CONTROL PLAN ( I 9 m FOR THIS C.S.M. THIS INCLUDES BUT IS NOT LIMITED TO BUILDING UPON, OBSTUCTING, ALTERING, t~• N FILLING. OR EXCAVATING OR PLANTING IN ANY POND EASEMENTS. WATER DRAINAGE DITCHES, o (,t WATER RUNWAYS, WATER CULVERTS, BERMS OR GRASS SEEDINGS. O to M N NOTE: The parcels shown on this map are sub Je unty and r Ci C m Township laws, rules and regulations (i.e wetl o ize, access 0 f (A to parcel, etc.). Before purchasing or devel conto the St. Croix County Zoning Office and the app wn 9_gord advi NB84247~M1 I Q,(~ L pCQP rn 324.89' ~i iZ I EGENQ: 05/10/07 S;LO~ ni Section Corner Monume t o record ✓z ~ rn% • Set 1' x 24' Iron Pipe igh g C2 ~ r- " , O i \ n a 1.13 pounds per linear fo t . n C Found 1' Iron Pipe \ n d N\ O Found 2' Iron Pipe a »----.Building Setback Line(100 from ay) ; [T1 C Contiguous Buildable area \ \ i i CBA.~ 4 ;AST-W£ST 14 LIN£ N8B42'47'W g N / per Town of Somerset - uvaiuw i N7g75O8 ~.--u,' 0 F" C am- 0. _U o 7 f - 00 fo - •E ~66O O 0 NW42-47-W 333,5.C m i ICs W Z D _ z L-4N y TOWN BQAR TOWN ROAD L1 o<~ //M (n 4W 9 88'42'47'W 336.67' o \L- ^'~A/v 0 --t----- 0 r °v~ y cn C 270.66' 66.01 j ti 00 0 ©rZ 1?"~ TY EASEMENT 0 , - I-i r tip -4 M cWp Z D Co D in as Oz> rn X _n 1 .59 N O C ,-I W (n t0 Don r / 0 r- 1`0 in z C: 0) Wis. Dept of Safety and Professional Services SOIL EVALUATION REPORT Page ~ of Division of Safety and Buildings in accordance with Comm 85, V1fis. Adm. Code County Alta plets site plan on paper not less than 81/2 x 11 inches in size. Plan must 04 - nos point (BM), direction and Parcel tp. AAMt . e vertical and horizontal refere mensions, north arrow, and location and distance to nearest road. Please print all Information. Re . by Date Personal information you provide may be used for second purposes (WQw, a. 15.04 (1) (m)). Property er Property Location 41Z - k N E (or 0 r(~ 1 S Govt Lot ~ 114 114 T_ Ylr Property Owner's Mailing ness I Lot # # Subd Name CSAIHdt I _ Add -5777 c~ 7" ST CROIX COUN 3 oily State - zip Code Phone Number ❑ City ❑ Village JoTown Nearest Road T ® New Construction Use: O Residential/ Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable ft General comments -`f o / 7 and recommendations: j-1 Boring # ❑ Boring ®Pit Ground surface elev. .2~ ft. Depth to limiting factor 9e in. Sol Applic0on Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Copt Color Gr. Sz. Sh. f1 tf#2 e 6 ►1 J~X 1-~ Ad n Boring # ❑ Boring J ®pit Ground surface elev.- ft Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistenoe Boundary Roots GPD/ft 2 in. Munsell Qu. Sz t Color Gr. Sz. Sh. ' e r , Effluent #1 - D > 30 220 mglL and TSS >30 < 150 nrglL t #2 = < 30 trgJL and TSS < 30 mgrL CST Name ( t) Signature CqT Number Address Zc~~ Da Evalua on ucted Telephone Number 2~ r ; 791/7 SBD-8330 (Rl Ul l) Property Owner- Parcel ID# Page --V of Boring # ❑ Boring pit Ground surface elev. ~R Depth to limiting factor > " in Sol Application Rafe Horizon Depth Dominant Color Redox Description Texture Structure Boundary Roots GPDM 2 in. Munsefl Qu. Sz. Coqt Color Gr. Sz. Sh. tT#2 _ e 62 ,2 '7- j &2 YQ - - 11 W~' s "IV ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft Depth to limiting factor in. Soil Awficaticm Rate Horizon Depth Dominant Color Redox Desm"on Texture Stricture Donsistence Boundary Roots GPDtft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. aim ff#2 i ~I I ❑ Boring ❑ Boring # Pit Ground surface elev. R _ ❑ Depth to limiting factor in. Sofl Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nos undary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. " $#1 ft#2 ' Effluent #t = BOD 5 > 30 < 220 mg1L and TSS >30 < 150 mg q- ` Effluent #2 = SOD 5 < 30 mgt and TSS < 30 mg& The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SM-asao(RI rno Property Owner Parcel ID # c 7/ - Page of Boring a Boring # Ej Pit Ground surface elev. Z ft. Depth to limiting factor in Solt Application Rabe Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD& 2 in. Munsell Qu. Sz. Coryt. Color Gr. Sz. Sh. ' ff#1 102 J L ,2 J fl ! 3 6-5 6 r ~ i ❑ Boring # ❑ Boring [-1 pit Ground surface elev. ft Depth to limiting factor in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' *02 Boring Boring # Ground surface elev. fL Depth to limiting factor in. ❑ Pit Soft Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft 1 in. Munsefl Qu. Sz. Cont Color Gr. Sz. Sh. * fff# 1 Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-9330 (RI 11 11) c7 dJr"~lc~ /~;/a yob e~c ~'b~e .tol /C~,~ n n _J Wiscahsir,Department of Commerce SOIL EVALUATION REPORT Page of 1''~vir.ion of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code S7! Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County A-O/ x CIO. direction and Parcel I.D. 03A • 2-07& include, but not limited to: vertical and horizontal reference-point i(BM)Mpnv. percent slope, scale or dimensions, north arrow, nearest road. Please print a evie `~en~d,,,, Date Personal information you provide may be use r~ nd15.04 (1) (m) . G~'l~K GC/~► / U Property Owner -_j I VW perty Loca n T N 1,) S T i o ~jf o t. Lot .5E 1/4 ~f.1/4 S T 30 N R 2-0 E (or& Property Owner's Mailing Address 3r o, 'LA # Block # Subd. Name or CSM# /93 AvP67RS' o~ z. CsM - 9r City State Zip Code hpne c, El City E] Village 5d Town Nearest Ro d avGTo.J w/, S o/(, SoA,C iPStF 7- oI}K ,?ioS,e L.~l . J New Construction Use: C6 Residential / Number of bedrooms 3 Code derived design flow rate yS 0 - &0V GPD ❑ Replacement ❑ Public or commercial - Describe: TT Parent material. A6V fE -11115 Flood Plain elevation if applicable ft. General comments and recommendations: 7E55-1'7-Z- p oPUIXi!5: • A1,0 VA-ID 3 w /'4 - /3,9SA-/ Soil- ",f,,> &O -Te- _ , 2- f U~ f Boring # ❑ Boring 3 49 Dg Pit Ground surface elev. / ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 / 0-2- AOYR z/ 2 L /f s hk .►M fib cs 1-F- y . ~ v ),-2-0 /o W %Ae S« / ,S At fib / Y , Z • 3 47 ~ • ~o s v L / of nnv~i • N N v C J -l OT-5 A'/~ i U / o Vie 4;,'12- 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 GPD1ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0-2- o YX 212- L ifshK .w, die c S 1.7f- • Y . 2 •ZS i~M 1(164 SiL /fShA ^-Cs •3 3 S- 7s ye lal~ U 5L / f sh)& /Y~e 2S _ • Y . 53 Y9&2/ 62- 7 5 o SL 2f- A /M L/ / D yj2 G/ Z 'G 5 S/(~ t Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BODs < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature ST Number A0/ G1 T Z 4 3 7$ ?l OS E T ZIM A Address Date Evaluation Conducted Telephone Number aoo/ -715• Ulbricht S Associates Private sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54018 ORIGINAL i 71t, ~ C ' , r f W ~Dti'sSTot) GoT" 2- Property Owner Parcel ID # Page Z of Boring # t❑ Boring Q S(a ~t Pit Ground surface elev. ft. Depth to limiting factor 2- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Z ~D k SiL /~Sh~~i' cs . z s4 its ,e ,rvl -?,e a. s _ . s 7.5L / ,,,A,~•, C2 1,Af i U N ~ 6 VA Z / .v S ~f ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/R2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate In. Munsell Qu. Sz. Cont. Color GPD/f Gr. Sz. Sh. "Eff#1 * Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 2 _ m9 '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-9330 (RAM) ' , i ~ S-ro !J w- SID tl- I-o T# 2 Property Owner Parcel ID # Page 2- of 3 'I a Boring # t❑~ Boring ~ %j • RSI Pit Ground surface elev. ft. Depth to limiting factor 3 2- in, Horizon Depth Dominant Color Redox Description Texture Structure Consistence ~ounda Roots Soil Application Rate In. Munsell GPD/ftt Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 10YX 2/2- - b4she *A -,,',e w a -r- , y 2 /o R SiL / ~Sh~ -Fl' cs . z Z 7. s Y? 3 sz- 17's ,e ,mot -6e CL s 7-5 L / /,*4 )CI C2 ,Ar c 5,7- 44.A ! U N s Y/4e s/& ~,v s p f Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Rate In. Munsell GPD/ft2 Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/112 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~I Effluent #1 = BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODE < 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 A/00) Gy M ~V co 5.0 0 0 W Tcor 3 Q'i o 0 3 h N N . o 4 V 11 o \C--J Q 1r4 •~~~.6g. V o V-• Pai-cbl 032-2076-60-020 03/27/2008 11:09 AM PAGE 1 OF 1 Alt. Parcel 14.30.20.790C-20 032 - TOWN OF SOMERSET • 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 - JOHNSTON, WILLIAM G & JENNIFER L WILLIAM G & JENNIFER L JOHNSTON 193 ANDERSEN SC'T CP RD HOULTON WI 54082 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description 199 157TH AVE SC 5432 SOMERSET SP 1700 WITC Legal Description: Acres: 3.560 Plat: 4295-CSM 16-4295 SEC 14 T30N R20W NE SE LOT 2 CSM 16/4295 Block/Condo Bldg: LOT 2 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-30N-20W NE SE Notes: Parcel History: Date Doc # Vol/Page Type 11/03/1999 613212 1468/170 WD 07/23/1997 972/439 2008 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/24/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.560 76,100 0 76,100 NO Totals for 2008: General Property 3.560 76,100 0 76,100 Woodland 0.000 0 0 Totals for 2007: General Property 3.560 76,100 0 76,100 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 Total 0.00 0.00 0.00 'zg ~'"G ~4 Q!0 ~dc G 7 9 73zf 74 ~0 O.tl~ ng~ RTIFIED SURVEY MAP 191A Located In part of the Northeast Quarter of the Southeast Quarter and R r y 7yd~• -3C part of the Southeast Quarter of the Northeast Quarter all in Section 14, J i yo j # ~ ~JZ 1,0 ' (e) Township 30 North, Range 20 West, Town of Somerset, 81.0 It g ffi d /OSt. Croix County, Wisconsin. J z Prepared for 7KKd t the request of: 4 UNPLATTED LANDS u. OWNER: ANQ0"_. SCOUT WAlliam and Jennifer Johnston CAMP AOAD~~ -L- N89'47'5$E-~r*i-_ _ 193 Anderson Scout Camp Road ___313.45 - _ Houlton, WI 54016 R/00'7- I~uY- S 31.68g 7 526 Drafted by. Ty R. Dodge Z v_ CDVWftAVE JOB III WI057SU24 NOR7H 11/41NE OF 711£ N £ 4 Pg I J 300 0 300 to NO TH L0T 3 c GRAPHIC SCALE C.S.M. SCALE IN FEET: 1 inch = 300 feet . ; m 0D c V. 8_P__. 2204 BEARINGS ARE REFERENCED TO THE EAST LINE OF THE ~ F o SE 1/4 OF SECTION 14, TOWNSHIP 30 N., RANGE 20 W. - HOUSE m d WHICH IS ASSUMED TO BEAR S00'09'46"W. g"4 i g w ~.j NOTE NO OWNER OR RESIDENT SHALL DO ANYTHING WHICH WOULD INTERFERE NTH OR CHANGE THE / ~ sx OPERATION OF THE APPROVED COMPREHENSIVE WATER DRAINAGE AND SOIL EROSION CONTROL PLAN f rrI FOR THIS C.S.M. THIS INCLUDES BUT IS NOT LIMITED TO BUILDING UPON, OBSTUCTING, ALTERING, N FILLING, OR EXCAVATING OR PLANTING IN ANY POND EASEMENTS, WATER DRAINAGE DITCHES, vi N W WATER RUNWAYS, WATER CULVERTS, BERMS OR GRASS SEEDINGS. r p ^1 m O NOTE: The parcels shown on this map are sub Je unty and r" aai O G Jw W Township laws, rules and regulations (i.e. wetl 0 ize, access O C O o to parcel, etc.). Before purchasing or Bevel conto the St. Z J gand advi ,p Croix County Zoning Office and the appr i wn 8 n " o , . _ N88 4. 89. g Lam,"..e*-K-yj'' PW' 1 r~i 324.89' ~i LEGM. 0 5 o 2 s SN.y\0~ Z o ij~ Section Corner Monume t o record . cc rn% ^2i i • Set 1" x 24" Iron Pipe igh g PAC' 0 ca 1.13 pounds per linear fo t ° O 0 Found I" Iron Pipe \ n ~ ~ O Found 2 Iron Pipe X c N g ----Building Building Setback Line(100 from ay) Im c n % i Contiguous Buildable area LINE CBA ~£A5T-WEST 1 4 / per Town of Somerset - N884 Ems "T ,r vnun 33 o, a t N7975' L. Z - 270 Z f i 00 N 8-42'4T j~ D ° J 8~w.......r.. ..r. 1 V a ZM 001. r I+ O VD i 4-i i _.._.._.._.._.._N 63-_/AS,r-.!~r.11.4~1N i~ss; FO;O rS s ° , m N6i_N88*42'47'W 3~35.38-w iC m / O; ; z W O -4 W o rn' I `A TOWN gQAp a TOWN ROAD L,9 -C $ 88'42'47"W 336.67' p ~o NA C 270.66' ` 66.01 CS r 1 / ti o 0 Z 12' UAL/TY EASEMENT, ` p 1 O o m V n rno Sn TYPICAL CIA CS IN, ~!p D Co. `~S ~Dm~ W D Ln C~ ~ ~9`~SS rr1 M m ~ O O G;a O Z D ~~pp R 1 / / 01 M ;0 z (f) CA 0 C:' :'Zl I J r ~\Na~ *z -C z C= > in CA t9 ' 0 00 DETAIL rn `•i / d Prepared by. ■_150r _ 4 7-. 'o 589'4813 W n to JEO CO/ISII roue, 1;7 0 T ; 360.30 o f o . n SOUTH L/NE OF THE 13 i O ? d a -G 3 0 Phone No. (715) 246-4319 NE 114 OF THE SE 114 ' £N - 0 T C5 I ! - M 109 East Third Street, P.O. Box 325 co N `-~14 1 i t~ n x New Richmond, WI 54017 RST~CD/77 ~STATfS ! 9. 2 w " W- 0 LOT 1 LOT 2 LOT 3 LOT 4 O c TOTAL AREA: TOTAL AREA: TOTAL AREA: TOTAL AREA: ! Q 3. 275,438 SQ. FT. 155,198 SQ. FT. 159,153 SQ. FT. 260,041 SQ. FT. SOUTHEAST CORNER ~p I ° 6.32 ACRES 3.55 ACRES 3.65 ACRES 5.97 ACRES SECTk7N 14-30-20 W j (FOUND ALUM/NUM Sheet 1 of 2 COUNTY MONUMENT)__& - Vol. 16 Page 4295 j