Loading...
HomeMy WebLinkAbout184-1000-20-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563820 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City X Village Township Parcel Tax No: Hem , Justin & Erin Village of Spring Valle 184-1000-20-200 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 9~~ 3 Q/'►'I G C 30.28.15.28 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 3 /L~~ Benchmark Alt. BM v P s•~ Dosing , 76b r at 7 Bldg. Sewer 7 1,3 Ft d ~ a IIL. Z ~ 45 Z_ Holding St/Ht Inlet /d•7 qZ. S TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. ent t Air Intake ROAD Dt Inlet Septic ;7 Z7 Dt Bottom 115.15 $ 7 Dosing Ju / ,UrT' / Header/Man. • dftp 5b AA- 1 Z7 y ZO Aeration Dist. Pipe Z Z 9 g Holding Bot. System 7• Final Grade PUMP/SIPHON INFORMATION 13.,Z6 Manufacturer Demand St Cover 5 Z// p GPM U J Model Number J~ r-z /6 J 7 9~p 0 'fi TDH Lift Friction Loss System H ad TDH v F L~ Dz• b17 5 Forcemain Leng / Dia. / Dist. to Well U6 I Z SOIL ABSORPTION SYSTEM 112- BED/TRENCH Width Length No. ;09,rench;~f PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS G6 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION ~dstem : CHAMBER OR Type / y~ -'6' 1 111 vf UNIT Model Number: DISTRIBUTION SYSTEM T pot Header/Manifold Distribution / J* x Hole Size x Hole Spacing VIntake Length f v 4 Dia /1 L ngth 67 9 Dia Spacing " Z z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded odded xx Mulch Bed/Trench Center Bed/Trench Edges Topsoil 1 A-. I Yes No Les ra-1 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: A /ZI Inspection #2: / / Location: N2000 Dugan Sprin Valley,, 'WI 54767 (SW 1/4 SE 1/4 30 T28N R1 5W) NA Lot 1 c. r0C~444 Parcel No: 30.28.15.2B 1.) Alt BM Description = A Cid✓, Lam' j 2.) Bldg sewer length = - amount of cover "t'om' S ot, Plan revision Required? ❑ Yes '41No (x ( 3 7; Use other side for additional information. 1 u ~ _ SBD-6710 (R.3/97) Date Insepctors Signature Cert. No. Plot f Ia ( 6- s [ ft- iy' d ~ so,'( rest 0 1 7, yY Dwner; T;Asf~n~w, ~0pvseIC e ~orn N--~ Ft 1A ~,$zmeK "f" r ~0ot' y '~L _ E15Tiv► ~ I~ flea , 9~PD D L745 ~ Wooc~lec~ Sat( Rn"e ~t~ .A~yM~ Sept"~pl~°S~ T`cz~ 1E'11~ 'alT~~ w t~{~ P6IY IOC ~t ~~r r i B.M. V I r' of ~Uc i~pc i. \ ~ S/op~ s \ fN.- `79. ( S 3 -gv.ts ion, 1 "PVC Pt`p~ Scv a T- SE y .5c c-, 3o r N 2 15- LL) !V ~'vril~ri County Safety and Buildings Division ST, W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 IL 11 A 1i; 6 Sanitary ermit Application State Transaction ber In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit ZZI ~ is required prior to obtaining a sanitary permit. Note: Application forms for stat OWTS are submitted to Pr 'ect Addre ss (if different than mailing address) the Department of Safety and Professional Servies. Personal information you pro Ala Vspd for secondary purposes in accordance with the Privacy Law, s. 15.0 1 m , Stats. s~ J VIZ 1. Application Information_- Please P ' All Information Ffo r^ tw Property Owner's Name J~. Parcel # Mrg-W HeNR S 6 20;3 ZO - 1t Property Owner's Mailing Address ~O/X C Property Location -i t F l7a 4✓2-. Govt. Lot City, State Zip Code Phone Number Section _0 one Alew Rxh*e- ivr- 6-407 ~lg'o~3g- $ Z clrcle E ora> a g II. Type of Building (check all that apply) Lot # T N; R ~ WI or 2 Family Dwelling -Number of Bedroo ~ Subdivision Name Block 11 Public/Commercial - Describe Use G+ aA, fk~v~. ❑ City of t^ ❑ State Owned - Describe Use, I CSM Number ~j 'R Village of .0A ~s 1 ~~Ey - 1/0 1 ! ❑ Town of A, 4L711 II. Type of Permit: (Check only one box on line A. Complete line 13 applica le) I A. N(New System ❑ Replacement System El Treatment/Holding Treatment/Holdin Tank Replacement Only El 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 IV. Type of POWTS S stem/Com onent/Device: Check all that a 1 6 k ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil 'Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) IJ V. Dis ersal/Treat ent Area Information: a Design Flow (gpd) Design Soil Application Rate f) Dispersal Area Requir sf) Dispersal Area Propos (st) System Elevation dal? 600 boo VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units a o y New Tanks Existing Tanks c U wC7 a pa 4U 'v)i y Cn Septic or Holding Tank i Dosing Chamber 7 0 70 ( wl<rf E VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number ?R24 Rr 40k ~Pg~62 71S-72r- s88 Plumbers Address (Street, City, State, Zip Code) C (Q I Z, 0 5 Cv 7-R, t3 <PA"64% V19-1e &VX 6-4 26 VIII. oun /De art ent Use Only Issuing ent Signature Approved 'approved errmt Fee D;7111 ter Given Reason for enial 1/Q Z IX. Condi ons for Disapproval tt (aJ eas / 1'. Septie tank, afflUblitflter end 3 LD .4-t o nS dispersal cell must all be serylees / M tamed G , P' as per management plan provided by'pkllo r. 2. ANN MO*ck T$q glrelA ants RKr8t bye miaintaiaid ins perapplk*l 00& / ordilla ksc Attach to complete phtns for the system and submit to the County only on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 11/11) ~tipnxT~y DIVISION OF INDUSTRY SERVICES 54'j \o~ 3824 N CREEKSIDE LA m 9~ HOLMEN WI 54636 o/ U Contact Through Relay a SP www.dsps.wi.gov/sb/ 9 c` www.wisconsin.gov Ossio* Scott Walker, Governor Dave Ross, Secretary June 21, 2013 CUST ID No. 921620 ATTN: POWTS Inspector BARRY BIGAOUETTE ZONING OFFICE PIERCE PLUMBING INC ST CROIX COUNTY SPIA N7053 CTY RD BB 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/21/2015 SITE: Identification Numbers Justin Henry Transaction ID No. 2258044 Dugan Rd Site ID No. 791758 Village of Spring Valley Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. SWIA, SETA, S30, T28N, R15W FOR: Description: Four Bedroom Mound System / 8% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1432957 Maintenance required; 600 GPD Flow rate; 15 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code CONDITI requirements. All No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, DEPT OF S stats. PROFESSION The following conditions shall be met during construction or installation and prior to occupancy or use. DIVISION OF INN) V Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with t requirements of Sec. 145.135 and 145.19, Wis. Stats. SEE ORRESpC • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. BARRY BIGAOUETTE Page 2 6/21/2013 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 ` Fee Received $ 250.00 Balance Due $ 0.00 erard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jeny.swim@wisconsin.gov cc: Edwin A Taylor, Waterwater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to x r the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered i nd addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed SPS Chapters 360-366. BARRY BIGAOUETTE Page 2 6/21/2013 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 erard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART Code: 7633 j erry. swim@wiscons in. gov cc: Edwin A Taylor, Waterwater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly ,mot Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with ' "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered TgVJ and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed SPS Chapters 360-366. ~lr~~ k RECE~V~~ JUN - 5 2013 INDEX SHEET PROPERTY OWNER: JUSTIN HENRY 915172 IDAVENUE NEW RICHMOND, WI 54017 PROJECT NAME: JUSTIN HENRY PROJECT LOCATION: SW '/a , SE 1/4 , S 30, T 28 N, R 15W MUNICIPALITY: VILLAGE OF SPRING VALLEY COUNTY: ST. CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL VERSION 2.0" SBD-106706-(N. 01 /01) MOUND COMPONENT MANUAL VERSION 2.0" :34JLLY 10691-P (N.01/01) )VED CONTENTS: SrYANo Page 1: Plot Plan % ERVrcEa iTRY SERVICES Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout L Page 4: Septic Tank and Pump Chamber Cross Section and Specification Page 5: W1250/750-MR Tank Specifications Page 6: Pump Specifications Page 7: POWTS Owner's Manual & Management Plan- Pg 1 Page 8: POWTS Owner's Manual & Management Plan- Pg 2 Page 9: Payment Voucher Name: Barry Bigaouette Signed: Address: N7053 County Rd BB Spring Valley, WI 54767 Credential Number: 92162OPM Date: 05-30-2013 plot Pla 4 !S,,,'( rest 7, vy ACPE S Prope~se-& i,~e l~ Own t r, T-u sfj n O vv~ r N I ctw~~ C ' ~a~r ra n ~P 9~/fro [5 PM ProlpoSect rr P e y BBcl as c No n..~ Nay R to sew,~Kf door ~''pv~ _ jdST/,% Elev , qy,o D t745 ~EiP~Se o~ f ~So~7so ~ac..~ 36 ep~~~~ Da,Se- Ta „ /c ~ne ( VOLtj S,U~c+~ Pb~ylOk sms- F 1 ~ B.M. Top of (j" QUc. P,pe 3 `~gv.l5 ToP t "PUc- P,P~ 9a,,s e R6 f u C&-w7'y V M aLg e- of SPr,,,' c1o ll~ y SGT y e SE y Sec 3o r.? V N R 15- LL) /V ~wh e~ks~=~ v► 1U e o 5 page Z~ Synthetic Covering ASTM C33 Distribution Pipe Medium Sand q, 7_0 Topsoti fi.„ ~rrta: s 3 cpn t0 $ °/d Siope- CEU Of 2= 2 %2 Force Main Plowed Aggregate From Pump Layer D / 75- Ft. Gross Section Of A Mound E )•~S"Ft. F . 8'z Ft. G . 5 Ft. A /0 Ft. H /.O Ft. Signed: "o B Ft. License Dumber: gaipao fm k /a Ft. Date: 57-30-13 L 91 Ft. . j -7.~ Ft. Ft. W .32. I? Ft. Observation Pipe a" puc. ---JW Y , AA, W - T-- - - - - - Distribution CL Of ZN- 2 %2n Pipe Aggregate i Observation Pipe ~a~sal ~rea' Plan View Of Mound w~► ear w~ ~ -e. r 14~ 3 a ~i Perforated Pipe Detail Cleanout Access Threaded Cleanout Eno VI Porlurolcd PVC Pip( End Manifold Holes Located on Bottom Are Equally Spaced Force Main From Pump First Hole Next to Manifold Cleanouts Distribution Pipe Lam P -7 R ya S x --;t Y Hole Diameter Inch Lateral " Inch (es) Signed: Manifold " c Inches I 0 M Force Main " Inches License Number: 5- 3D -13 Invert Elevation 109 Date: Holes Per Lateral 3 Number of Laterals 3 Total Holes / 0 D tun e-r : mow e-v,r+~ Page 4 Of~ • SEPTIC TANK 5 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS y fLX-VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF JUNCTION BOX APPROVED 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK & WARNING !ABEL [pL) . ~~.C) 4" MIN. s. a. 18" IN. ' 18 rA10. INLET I TIGHT APPROVED WATER TIGHT SEALS GAS- a SOLID SOIL JOINTS WITH ~1L7ER A SEAL ALM APPROVED PIPE APPROVED B PIPE 3' ' ON 3' ONTO ONTO SOLID C I ' SOIL PUMP OFF ELEV. g,OTT. OFF D 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE _~p TANK MANUFACTURER : ~eSGr TANK SIZES: SEPTIC (a 50 GGAL. AL. DOS g VOLUME ~ GAL. INCLUDING DOSE 7.5'0 .ALARM MANUFACTURER: SJE RhQv,,6US CAPACITIES: A = a5- INCHES = 4_ 0 3 GAL. MODEL NUMBER: 2 INCHES = ~a GAL. SWITCH TYPE: A4 -Alanica.l plod- B x . PUMP MANUFACTURER: C = _ 7 _ INCHES = l ! 8 GAL- MODEL NUMBER: D = INCHES = 029, S(GAL• TYPE: REQUIRED DISCHARGE RATE GPM PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . FEET + --bb FEET FORCEMAIN X 3.7 FT/100 FT. FRICTION FACTOR FEET TOTAL DYNAMIC HEAD = 7 rE£T INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER LIQUID 6E`PTR- et7I :SIGNED: LICENSE NUMBER: 9211P ~ DATE: 5--30-13 1/88 o o CL n Z n ^ n \ LLJ< J I~I U N rr X V U- EE3 F-- U) D ~YLo wZ CL Z w w U d- (f) O o C~ oo ao z YO W uJ ~F-fn Q \ F- o LL, ~l• Q Cap Ox ~ ~ Q ~^~I~ (14 0 r,NH m W Z Z w I \ O O C; ~Q QU JJ < I~l0 ln00 l-(n LU V o. m o j' ~o~ 00 ? C/) i 0 C14 CL ~in 00 3NO > FLrLrl (n to N < M Z it) U) \s NOtn0F-J~ ~Q m(n< N O Y J t0 ±°D?J.. F - W Z N N5 ~ Z Z ~OF-- ..3°= 0mY 0°= Q U N Q ZQOOQwZJ °L'JOV Zn < U) V) z3O Q ° 0 3 m U~ S ~ m J 3 Q Q U 0 Z LLI In J I Q a D Z Z J w~5 F- j W Z_ SIN N rilli I 1 t I I ~ II I I 1. II Lo w O W L H N I a U 1 1 s~ ~ I I „9 z i „L5 I 1 Y~ W r O .99 „OS S' I„99 M POW'Y'S OWNER'S MANUAL & MANAGEMENT PLAN Page-•Z-or FILE:INFORMATION ErPe er SYSTEMPEOIFIATIONS . tic ❑ Dose. O Holding Volume: 1250 (gal) DFSIGN•PA ERS anufacturer: Wieser it #LEfffuent anufacturer: Wieser ❑ NA Number of Bedrooms: 4 NA 0 NA tic iiz]'Dose 13 Holding Volume:. 750 (gal) Number of Public Facility Units: NA l Distance Tank Bottom(s) to Servlce'Pad: Estimated (average) Flow : (n) 400 (gaUday) tal Distance Tank(s) to Service Pad: (h) Design (peak) Flow = (estimated x 1.5 : servicing mechanics must be, provided If vertical Is >t5 feet or 600 (gal/day) ntal is >150 feet.' gpecklc instructions to bs prt)vlded on back. In Situ Soil Application Rate: . 5 (gaVday/ft') , Filter Manufacturer: Standard (Domestic) YOLYLUK L7 NA onthly average Filter Model: Yol 1ok525 Fats, Oil &-Grease (FOG) s30;mg/L Biochemical O en Demand (BODE) s220 mg/L• - 11 NA u p anu facturer: Gould 's ❑ NA 7Atal:~„- :4100aSallds,. S3 srso L:. k? i. Model:._:_ High Strength InfluentlEffluent -38 71_ Monthly average Pretreatment:llnit • (FOG) >30 mg/LManufacturer. rng/L 10 NA TSS) >220 mg/L ❑ Mechanical Aeration d"Peat-Filter . Q NA Pretreated Effluent: Monthly average Q Disinfection E] Wetland :1 (BODE) 530 mg/L Sand/Gravel Filter ❑ Other: (TSS) s3o mg/L Q NA Soil Absorption System . Fecal Conform geometric mean) s10' ' ❑ In-Ground and (pressurq). NA -Grade (gravity) 0 Mound Maximum Effluent Particle Size ;e in dia O NA ❑ At 129 - Other: Drip-Line ' 0 Other: ❑ NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) f When combined sludge and scum equals one-third'O of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every: ❑ month(s) year(s) (Maximum 3'years) Q NA Inspect dispersal' cell(s) At least once every: 2 month(s) year(s), (Maximum 3.year) ❑ NA Clean effluent filter At least once every: 13 month( s) El year(s) ❑ NA Inspect pump, pump controls & alarm At least once,every: 13 ® month(s) Q year(s) Q NA p re test . At least once every:. 3 ❑ month(s) Other laterals and. ressu -year(a) At least once every: 0lnarath(s) . Other: . Q Year(s) M NA ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by ion individual carrying one. of. the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS 'Maintainer or Septage Servicing Operator {pumper). Tank inspections must include a visual Inspection of the tank(s) to identify any missing or broken hardware, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on thIdentify any crack or leak, e ground surfaces The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for an on the ground surface. The ponding of effluent on•the. ground surface may, indicate a failing condition and requires pnthe immediate notification of the local regulatory authority. When the combined accumulation of -sludge and scum in any treatment tank equals one-.third or of the tank volume, the entiro contents of the tank shall be removed by a Septage Servicing. Operator (pumper) and disposed of Inmaccordance with chapter NR 113, Wisconsin Administrative Code. All -other services, including but not. lirrtitbd.to the servicing of affluent filters, mechanical or-pressurized omponents, pretreatment units, and any servicing at Intervals of 512 months, shall be performed; by a certified POWTS Malntalner. A service report shall be provided 'to: the local regulatory authority within 30 days of completion of any service event. ' GMW-005 (02/05) Page h of ;3-- START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process 'and/or damage- the soil absorption system. If high concentrations. are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up; or restoration of power under these conditions is not recommended, as the excess wastewater will bedischarged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent. and dama'gaid the system.-.. To avoid this situation bave-the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to-restoring power to•the pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil' absorption system. 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 treatment tanks and soil absorption system: acids, antibiotics, baby wipes;' cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drsn (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons,'and water softener. brine.discharge: -.ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to'insur`e thatthe system is property and safely abandoned in compliance with s. Comm 83.33, Wisconsin Adrhiniatrao4e Codd: • All piping to tanks, pits and other soil absorption systems 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 (pumper). • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN 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 and 'site evaluation to establish a suitable replacement area. 'Replacement systems must comply with the rules in effect at the time of their permit issuance. A suitable replacement area is not available due to setback and/or soil' limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and, site evaluation must be performed to locate a suitable replacement area. If no -eplacement area is available a holding tank maybe installed.as a last resort to replace the failed POWTS. Mound and at-grade soil absorption systems rhay 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. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE, NEVER ENTER ANY TANK. UNDER ANY CIRCUMSTANCE. DEATH MAY 9SWLT. F_8dAPE-OR RESCUE FROM THEINTERiOR OF A-TANK MAY NOT BE POSSIBLE: " ADDI710NAL INSTRUCTIONS: POWTS INSTALLER POWWTS-MAINTAINER. Name Name Johnson Barr Bi aouette Sanitation Phone 715/778-5889 Phone 715/273=5811 SEPTAGE SERVICING OPERATOR PUMPER L CAL. REGULATORY AUTHORITY Name Johnson Sanitation Name St. Croix"County Zoning Phone 715/273-5811 Phone 715/366-4680 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance With sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. i Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatmentprocess'and/or damage-the soil absorption system. If high concentrations-are detected of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. have the contents • • Pump tanks may fill above normal highwaterlevelsprior to startup or due to pump failures.. Startup or restoration of power under these conditions is not recommended, as the excess wastewater-will be-discharged to the soil absorption system in one.. large dose, causing an overload that may result in the backup or surface discharge of of rient and. damage,to the system To avoid this situation • iav. the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to -restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluant levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the Infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 fife of the treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental boss, diapers, disinfectants, fats, foundation dr* (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medicati ons, oils, painting products, pesticides, sanitary napkins, solvents, tampons, *and water softener. brine-discharge. _A&UMNMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure thafthe system is properly and safely abandoned in compliance with s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems 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 Serv Icing Operator (pumper). • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN 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 absorpti on 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 andsite evaluation to establish a suitable replacement area. -Replacement systems must comply with the rules in effect at the time of their permit issuance. , .p A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring .advances in POWTS technology, a holding tank maybe installed as a last resort. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a -soil and .site .evaluation must be performed to locate a suitable replacement area. If no -eplacement area is available a holding tank maybe 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 biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE, NEVER ENTER ANY TANK UNDER ANY. CIRCUMSTANCE. DEATH MAY I~ SULI'. ESGAPOC& i3SSCUE FROM THEIffTERIOR OF A -TANK MAY HOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POW-TS INSTALLER POWTS MAINTAINER . Name Barr Bi aouette Name Johnson Sanitation Phone 715/778-5889 Phone 715/273=5811 SEPTAGE SERVICING OPERATOR PUMPER LOCAL, REGULATORY AUTHORITY Name Johnson Sanitation Name St. Croix-County Zoning Phone 715/273-5811 Phone 715/3130'-4650 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencles In compliance with sections Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. 13 78+640 VOL 19 PAGE 4911 KATHLEEA H. WALSH REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 01/1112005 09:00AN CERTIFIED SURVEY "AP 43.90 COPY FEE. PAGES: 2 CERTIFIED SURVEY MAP LOCATED IN THE SW 114 OF THE SE 114 OF SECTION 30. T28N, R 15W, VILLAGE OF SPRING VALLEY. ST. CROIX COUNTY, WISCONSIN. NDTE: BEARINGS ARE REFERENCED PREPARED FORt TO THE WEST LINE OF SECTION 30 (ASSUMED). TOM AND JUDY GENZ p N 14~435-E UNPLATTED LANDS ,W N 78'09'0'Q'L'" it 24.39 S N 42.78 61 _ - >~t... i I IIW N 65683.9'9"E ~S'02'29'1j5"W 1 IIrNI80'45'49"W 33.35 83.0.9 X109.68 S 80'45'49 E i oZ o ~o 33.23' Z 66.00' i © ) N 32'143,3"W I CL za z LOT 1 229.47 I 0o2v ?v a = 7.94 ACRES N "W -i O 66.00' z~2 Wo mo -i 345,771 SR. FT. =b N 00'10'50'W coat hz oz i 291.36' iZ L LU r Qp to W~ W c~"n LO N 89'44'12"E 682.01' yo~~ a~ O (n O ~ I = z N ry LOT i~ 11.34 ACRES LOT 2 493,906 SO. FT. 12.61 ACRES 549,235 SO. FT. = I za i b I ti r:,w I gg 55gg 578.24' I S8323.~7'pW 663.46' SOUTH LINE OF THE SW-5E S 89'56'14 "W 1241.70' 81- 71 1' SE ZSF114 CORNER OF SECTION 2646.82' T2CORNER O SECTION 30, 8N, R CORNER ( (FOUND ST.CROIX 30, T28N, R15W. (FOUND ST.CROIX COUNTY MONUMENT). UNPLATTED LANDS COUNTY MONUMENT). CURVE DATA TABLE Curve Radius Length Delta Chord Chord Bearing 1 -2 180-00' 185.68' 59'06'08" 177.55' N 37'06'35° E 3-4 240-00' 54.81' 13'05'10" 54.70' N 60'07'04' E 5-6 490.00' 210-19' 2434'40° 208.58' N 65'51'49° E 7-8 100.00' 182.10' 104'20'08" 157.96' S 49'40'47" E Tangent Bearings at 1 = N 07'33'31 " E GOMS~iV at 2 = N 66'39'39" E 66 LEGEND of a Ni 5334 z9° E JWESER' ~t O = SET 1' O.D. X 18' IRON PIPE at 5 = N 53'34 29 E 8-10" WEIGHING 1.13LBS PER LINEAR FOOT. at 6 = N 78'09'09 E OPPRnMILLEY. at 7 = N 78'09'09" E = GOVERNMENT CDRNER AS NOTED at 8 = S 02'29'17- W ~ au V = 250' SHEET 1 OF 2 JAMES M. WEBER S-1604 O 125 250 500 LANDMARK SURVEKLUG, INC. 2003012Acsm THIS INSTRUMENT DRAFTED BY JIM WEBER DATED 1 - Vol 19 Page 4911 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer J usti n Hemry Mailing Address 915 172nd Ave. New Richmond, WI 54017 Property Address Dugan Road (Verification required from Planning & Zoning Department for new cons ction.) 'ql City/State Spring Valley,Wl Parcel Identification Number 7 ~,58 LEGAL DESCRIPTION SW SE 1/4 , Sec. 30 , T 28 N R 15 W, Town of Spring Valley Property Location '/4 , Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warrantpeed # (before 2007)Volume , Page # Spec house 13yes9lo Lot lines-identifiable [3yesE]no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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 pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department 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/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services 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 Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recor d in Register of Deeds Office. Number of bedrooms 4 yL1o~ol~ SIGNATURE OF APP ANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) I y ! f ll llllllllll1111f11)111111 11111 8157971 State Bar of Wisconsin Form 1-2003 Tx:4129042 WARRANTY DEED 979455 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI 05/29/2013 2:41 PM THIS DEED, made between Lillian Martha Linder AKA Lillian M. Linder, a EXEMPT#: NA married person REC FEE: 30.00 ("Grantor," whether one or more), TRANS FEE: 144.00 and IA, C I P PAGES:2 ("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 f&4-Title Services, LLC needed, please attach addendum): 5645 M ft venue Stillwater, MN 550 avS See Attached Exhibit A L ~ ✓ t-~ -te- A.2 . ;It, , q n/ 95/J3 184-1000-20-200 Parcel Identification Number (PIN) This is NOT homestead property. (is) (is noo Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: None Dated 1" ~ f y 1 IM ~ZGL (SEAL) (SEAL) * Lillian Martha Linder AKA Lillian M. Linder (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) , ) STATE OF [ji vI authenticated on ) ss. 1 rj COUNTY ) * Personally came before me on TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Lillian Martha Linder AKA Lillian M. (If Linder, a married person not, authorized by Wis. Stat. § 706.06) to me known to be the person(s) who executed the foregoing instrument and acknowledge sam THIS INSTRUMENT DRAFTED BY: Public•Misanesota Notary MY Comhabn EVh s Jaa. 31.2011 Stillwater, ELIZABETH C. VANEYLL 411-- FSA Title Services, LLC 5645 Memorial Avenue Notary Public, Sta e (Yl p~ MN 55082, File #120861 MY Commission Cis permanent) (ex Pires:~ ) (Signatures may he authenticated or acknowledged. Moth are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD RE CLEARLY IDENTIFIED. WARRANTY DEED © 2003 SPATE BAR OF WISCONSIN FORM NO. 1-2003 * F7 f 2name below signatures. File No.: 402365 EXHIBIT A Lot One (1) of Certified Survey Map in Volume Nineteen (19) of Certified Survey Maps, page 4911, as Document (Number 784640, filed in St. Croix County Register of Deeds office on January 11, 2005, being located in the Southwest Quarter of the Southeast Quarter (SW '/4 of SE '/4) of Section Thirty (30), Township Twenty Eight (28) North, Range Fifteen (15) West, Village of Spring Valley. Together with and subject to easement for ingress and egress as shown on said Certified Survey Map Together with rights described in Easement in Volume 2577, pages 53-65, as Document Number 763287 and as shown on said Certified Survey Map. 2of2 u~wnw~ •a~ aos •A~ • e e e ~ ggg 000 R ,K .oa AFC fi,6 .a',r A•ai ti + R X rF N 9, $ x - . a QI ®I a i r i ~ V s p 7 w AI~Ai Ol•AF ~ ,rc A,a A.4 .su ,a A,u .ar,~ ,o-pc A.~a ,o-r+ 4 -0 ,a,~...,. SAWN mom Y b AVN'4NAitl ~ A• ~ N/L wuvtm OH R wCC'R tiH 1LVG ]T^.H W O a, a,. b L X y s t o.✓ z ~ r a ..c t 3 r rw Z .Wx a~ LL i 7 g 33 ~ 6 p , rr k Fp 4- § Q A-A * g r Yb -1 d- II 7 0 0 a, r t ~ tYi; z L t~i: O iri: !IH © t+~t tYt' • ~U t+1. 1L. U i~ o a r ~ .1111- lie a: :o 11 tL / t I L o 7- Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ of 3 Division of Safety and Buildings n accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~y O Date Please pri a7l"7" 7 lewe Personal information you provide may be used for se b pwp~s G {P6acy La s. 15.04 (1) (m)). Property Owner Property Location M2003 Govt. Lot 5U) 1/4,5F7 1/4 S3 N R 1 $'E( W Property Owner's Mailing Address Lot Block # Subd. Name CSM# City State Zip Cod I~e ~T' ❑ City illage ❑ Town Nearest Road ~p n ~ I ~ a-~ e a~ lid rn e S 7 r r L~e ' [1?1~-ew Construction Use: Code derived design flow rate GPD ® Residential !Number of bedrooms _}L-- ❑ Replacement L ❑ Public or comineryal - Describe: Flood Plain elevation it applicable - ft. Parent material S+` ` General comments ~s ~ 11 7 s G`" a ~ou r /rF and recommendations: Ltvi de, R o w co-, Boring / p f Boring # Pit Ground surface elev. 7D ft. Depth to limiting factor in. Soil Application Rate ❑ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD •Eff#1 'Eff#Z in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. -io /C C) % s sy12 , 5- i' LI cJ ✓ S O -F rt c u loy 1 r< 7.5 a -7r s` `t 3 Boring # ❑ Boring ❑ pit Ground surface elev. DJS-ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots .E GPD EfT#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. a s" d~ s6 UUf C I~- r 8 Li . S 3 - Effluent #1 = BOD > 30:5 220 mg/L and TSS >30:5 150 mg/L ' Effluent #2 = BOD 30 mg/L and TSS 30 mg/L CST Number CST N e (Please Print) nature -LA U1 IL ~f So~ Address D valuation Conducted Telephone Number S-~ 767 Page of uv~ Z Parcel 10 # Property Owner Boring in. Soil lication Rate K Boring # El Pit Ground surface elev. l~~J ~fl Depth to limiting factor GPDIfP Horizon Depth Dominant Color Redox Description Texture structure Consistence Boundary Roots -Eff#1 *011#2 Qu. Sz. Cont. Color Gr. Sz. Sh. r t S in, Munsell 07. r i t ,J (v 3 a 70 IL - ~L c Boring ft. P factor in. soil ication Rate El Boring # ❑ ❑ Pit Ground surface elevTexture Structure Consistence Boundary Roo GPD/ff ts *Eff#1 'Eff#2 Horizon Depth Dominant Color Redox Description Gr. Sz. Sh. Qu. Sz. Cont. Color in. Munsel Boring # Boring Ground surface elev. n Depth to limiting factor in, Soil lication Rate ❑ Pit PD/ft? Roots Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary ~Eff#1 '002 Qu. Sz. Cont. Color Gr. Sz. Sh. in. Munsell • Effluent #2 =BODE 30 mg/L and TSS 30 mglL II • Effluent #1 = BOD$ > 30:S 220 mg/L and TSS >30 5150 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• SUD-8330 (RAM) i Page of Parcel ID # Property Owner q in. Soil lication Rate ❑ Boring 7 eft. Depth to limiting factor GPp . . Boring # Ground surface elev. 6 ~ -"3-~ Boundary Rood ❑ Pit Texture Structure Consistence •Eff#1 •EfW Gr. Sz. Sh. Horizon Depth Dominant Color Redox Description in. Munsell Qu. Sz. Cont. Color r Li Lo) in. ication Rate ❑ Boring Depth to limiting factor GPDIf! Boring # Ground surface elev. ❑ Pit Consistence Boundary Roots lion Texture structure •Eff#1 • Horizon Depth Dominant Color Redo. Cont. ont. p Color Gr. Sz. Sh. in. Munsell IOU. S7. C ❑ Boring ft Depth to limiting factor in. Soil Icatlon Rate El Boring # ❑ Pit Ground surface elev. P Consistence Boundary •Eff#1 gWcture Horizon Depth Dominant Color Redox Description Texture Gr. Sz. Sh. in. Munsell Qu. Sz. Cont. Color • Effluent #2 =BODE 30 mgn' and TSS = 30 rng/L • Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 150 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or ct the department at 608-266 in an alternate format, please conut-3151 or TTY 608-264-8777• need material t sao•8330 Ut-&W) 1114-OLI-VI J t► Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of -3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adfn. Code County Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must a / include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Reviewed by Date Please print all Information. Personal information you provide may be used for secondary purposes (Privacy Law. a. 15.04 (1) (m))• Property Owner Property Location c~ Govt. Lot U) 114,,,5 F 1/4 S 30 T Q~ N R 1 J E( (W Cl Property Owner's Mailing Address Lot Block # Subd• Name or CSM# C) ~ Qtn City State Zip Code Phone Number City lllage ❑ Town Nearest Road In I 02- l4ew construction Use: ® Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement y ❑ Public or com ercial - Describe: Parent material ~ i` Flood Plain elevation if applicable Alk General comments tj5 8 ~X rj 7 nn of `^d( and recommendations: tt m d e,- ~ qpo Q -e- C> CO -t A0 CA r puAo~ 5 S ftw./~0, ~3 ❑ Boring --f---' Boring # ❑ Pit Ground surface elev. & o . Depth to limiting factor In. icatim I i Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#1 QPQN 'Etfa~2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. r) V r Cd/ ~ lNl ~1r (.J r S ' l S if ` r t C.cJ U 1 '~7 o y" . S441-1 1 t :713 D tt .3 `7. ~ ~ a W1 -S L , s' c ' Boring / Boring # elev. ~~.3~ft• Depth to limiting factor 4 in. El Soil Application Rate Pit Ground surface Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'E GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ( pp j t!} U1'H C~ / C. r 8 1 0-7 1 OWL :5 t V. Z42 r J--5 U) 'K Effluent #1 = BOD > 30 1220 mg/L and TSS >30:5 150 mg/L ' Effluent #2 = BOD 30 mgn. and TSS < 30 mg1L CST (Please Print) r nature CST Number '7, e l s o c~ O (A vl l Le Address D valuation Conducted Telephone Number 7 2 a#-ej 11 - 6 '3 WD -3>.;)7k] s'l 767 ~~ol PI cty. P4J 3 0~ 3 l3 e n•e r : TA IMAL's a 6~1 C. Rc h~ 4o S e -(g 4c %L, HAy ~ic~~ / Qrox. HOLAA e ~a ca+~ o ~Ib' t Jv 1 cc. LJh•~~'2 T~f~~ ll'e..c~ ~ D IN Top w14~ orb. R 6bo,, ~)Otc-: is- Fell of Dl- \ 1 \ Lill \ \ fk, / tO~l~l~ sle I - C7 1 RM, loo. 00 6 t~~ of, JJ"PLX P~Q \ \ g?eP ~P (3.M. q9 Ov (tyory pS T° o~R,GbP()c P.pe R;hb.M 10 s at C)BU ra~_~ d-a3 j3.rt• 95.3 -ro, o-f i1''Puc pl'. 3_y \CCt.Ie I o 05~~ Fk cep 4- AS Shoe.. ~ Pp►-oX ~ Pf ~P N«.X52 Loc Q 1 pv, ~'84E~4Q~ 11AY - 9 2M VOL 19 PAGE 4911 REGIS OH. WAI:Sg- F DEEDS ST. CROIX CO., MI 8T• CROIX POW* RECEIVED FOR RECORD 01/11/2e65 09: 00A?l CERTIFIED SURVEY "AP COPY FEE: PAGES: 2 CERTIFIED SURVEY MAP LOCATED IN T"E SW 114 OF THE SE 114 OF SECTION 30, T R15W, VILLAGE OF SPRING VALLEY, ST.CROIX COUNTY 28N, , WISCONSIN- NOTE- BEARINGS ARE REFERENCED v TO THE VEST LINE OF PREPARED FDR+ SECTION 30 IASSUMED3. TOM AND JUDY GE Z C7 Jv 0 N! 44;W5 T UNPLATTED LANDS JJJ((( ~ ~ - - - - - - - N 78'09 0p"~' ; 1= s' N 53'34'9 E 24-39 p?. 42.78 N 66.399 ?~R >p 58.61 i ! S 02'29'116'W i , I N1 80-45.49 "W r_ 33.35 8.3.09 i L _ (709.68' s C a. S 80'45 49'~ - o 2 66.00' ; 33.23" I oZ o ~`o r 2 N -32'1 4 3}3 °W I yo a 2a a o "t9CRES 229.47 66.00' `i 345,771 So. FT. 2 W W b # N 00'70;50 W nNi i ego mo r- ao 297~(r✓Yl6' a rn 12 oQ- W oW jb N 89"44'12 E 682.07' toW 'H ad j!' WZ,ii z °a5 WN ^i o7 IN vlov w to a^i j~ W~ W LOT 3 c ry 11.34 ACRES N _ LOT 2 493,906 SO. FT. I- 12.61 ACRES °j n 54 9,035 SO. FT. Z I b I ,y I 663.46' 578.24' 1 5893, ~1'"W SOUTH LINE OF THE SW- E j JiJ'-' ~q S 8-9r,56,14 'W 1241.70' 81.71 S 714 CORNER OF SECTION 1323.41 " 30, T28N, R15W. (FOUND 2646.82" SE CORNER OF SEC770N 30, ST.CRO/X COUNTi MONUMENT. UNPLATTED LANDS COUNTY MON MEN) ST.CRO/X CURVE DATA TABLE Curve Radius Length Delta Chord Chord Bearing 1 -2 180.00' 185.68' 59'06'08` 177.55' N 37'06"35" E 3-4 240.00' 54.81' 13"05'W 54.70' N 60'07'04° E 5-6 490.00' 210.19' 24'34'40" 208.58' N 65'57'49° E 7-8 100.00' 182.10' 104'20'08° 157.96' S 49'40'47" E Tangent Bearint?s at 1 = N 07'3331- E ~$c0JAV ~ ~k= at 2 = N 66'3939" E at 3 = N 66'3939" E JAMES M. O = SET 1" OD. X 18" IRON PIPE at 4 = N 53'.3429" E WESER WEIGHING 1.13LBS PER LINEAR FOOT, at 5 - N 5334 29" E N 78'09'09" E ♦7~04 = GOVERNMENT CORNER AS NOTED at 8 = S 02'29 *O7" W OWN0v OQ' c 1' 250' yQ suaV a 0 125 250 500 SHEET 1 OF 2 JAMES M. WEBER S-1804 / ^ LANDAf 1 20030leAcsm THIS INSTRUMENT DRAFTED BY JIM WEBER DA ED - 1 K ! OR O ~ G, INC. VCIO ol 19 Page 4911 Parcel 184-1000-20-200 08/08/2007 08:28 AM PAGE 1 OF 1 Alt. Parcel 30.28.15.26 184 - VILLAGE OF SPRING VALLEY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 03/24/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - LINDER, LILLIAN MARTHA LILLIAN MARTHA LINDER 8255 15TH ST N LAKE ELMO MN 55042 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 5586 SPRING VALLEY SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 7.940 Plat: 4911-CSM 19-4911 SEC 30 T28N R1 5W SW SE LOT 1 CSM 19-4911 Block/Condo Bldg: LOT 01 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 30-28N-15W SW SE Notes: Parcel History: Date Doc # Vol/Page Type 01/25/2005 785721 2736/244 AGREE 01/25/2005 785720 2736/242 WD 01/11/2005 784640 20/4911 CSM 05/20/2004 763287 2577/053 EZ-1 more... 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 05/11/2007 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 7.940 36,500 0 36,500 NO Totals for 2007: General Property 7.940 36,500 0 36,500 Woodland 0.000 0 0 Totals for 2006: General Property 7.940 11,600 0 11,600 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