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014-1032-60-000
O ~ N ~ C O' = N Us (D ~_ fD d ~ ~ N ~ t4 h Q j O A N O O 'O •. O ~ G fD a ~ ~ c ~ ~ ~ ~ m ~ O m m m ~ ~ ~ . O ro ~ 'r c _. m 7 O O -~ Vi CD CD N 0 61 ~ ~ 7 p. K O N ~ (D ~ d O m N N W O O Oo v m a 7 N O O [1 Q °o ~- o ~ d ~ ~ o c ' ~ ~ ~ o 3 ~ ^. v1 ~- m ~ ~ ~ ~ . • v m m ! m m ~ 3 ! i c ~ y l~ _ ~ a~ 0 ° ~ C o cn ° ~ °.' (D n N 'A Nr V A S N ~' ~ ~ ~~,, n" ^' O N ~ t ~,,, 7 f0 ~ ~ O ¢O O '' O O ~•~. 1 7 N N < ~ '3 l~ C ~ a ~ a ~ CO N W O N ~ ~ ~ ~~~~ ~ a '.' ~ O C ~ ^~ a p _ ro ' O O O m , i ~ r ., A ~ In ~o fA v m N o x ~ C ~ ~ ~ ~ ID 61 N ~ C11 ?~ A ~ N D D o ~ ~ c ' ~+i a I lV • m +~ N d N A ~ ~ N C _ ~ Z n "~ 'A N Q p ~ O 3 CD .. N I 0o v m ~ cn a ~ ~ Z O - A ~ ~ _ Z cn N ,. Z (D A W C C 7 Q .. 'I y i 'i ~ y . ` w N O O -~, b ~ 4 A 6p + V ti V V c a i ~ Wisconsin Department of Commerce ` Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: City Village X Township Ulrich, Neil Forest, Town of CST BM Elev: Insp. BM Elev: BM Desc ' lion: /oo ~~~ ~d o~ o - ~~ l TANK INFORMATION TYPE MANUFACTURER ~ ,s CAPACITY ~ Septic y,~, 3 ~ F/ Dosing ~ ,~ ~ s ~ Aeration /~ © ~ ~~ 1 1 Holding TANK SETBACK INFORMATION TANK TO P/L 4Y~- WELL BLDG. Vent to Air Intake ROAD Septic 1t f~~ J ~OI Gb Dosing ~~ ~~ / ~ d .~.. Aeration Holding PUMP/SIPHON INFORMATION Manufacturer ' ~ Demand /t/il. 1r! riC~/`~ GPM Model Number ~ ~ g,~ 3~• ~3 TDH Lift Friction Loss System Hea ~ TDH Ft . S ~ •2- 3.~ ~ / 2 Forcemain Le gt~ / Dia. Z `~ Dist. t~Weil ~ 501E ABSORPTION SYSTEM ELEVATION DATA county:. St. Croix Sanitary Permit No: 514974 0 State Plan ID No: Parcel Tax No: 014-1032-60-000 Section/Town/Range/Map No: 15.31.15.229 STATION /Z D BS ~O HI /0%~ FS ELEV. 1613 > Benchmark Q r ~ ~OQ• ~p /OO Alt. BM s. ~~ ,. Z ,~, y Bldg. Sewer S. Q O 9',~ f SUHt Inlet 7.3 9i~3 SUHt Outlet ~ Dt Inlet ~ Dt Bottom 0 3 . i~ .~~ /~ ~ a 7,,35• Heade an. - Dist. Pipe Bot. System SGl'~ U 6`0 ~!~ 7. os- q3-~/~ Final Grade St ov r / ,~ ~ tr - •s •• ~~• S C R~ b'. 3 q 2 BED/TRENCH DIMENSIONS Width ~ r Length ~ C J No. Of Trenches PIT DIMENSI o. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO L BLDG LL KE/STREAM LEACHING Manufacturer: Type O System: r CHAMB ~ ~ s~ ~ /V~-''_' IT Model Number: UIJ I KItSU I.IVN SY51 tM ~i.n ..~,..`c ~ /J~n / ~ /l~.t __. , n ~„{ n//n _ ~ JI_ A/iw./,T,~/) _ Heade Manifold Distribution , x H e Size x Hole Spacing ~~ Venlto 'r t~kg Length 3 ~ Dia Z Length ~ 7 Dia ~ ~ ~ Spacing ~ ' ~ `~ d 0 3 ~• (o l r JVIL I:VVtK x Pressure Systems Only xx Mound Or At-Grade Systems Only ~ ri ~r~ 'TO'/GLc~:QtS Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched ~n ~" Bed/Trench Center ~~ Bed/Trench es Topsoil~~U ~ ~ ~ ~ yes ~ No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ .~[.~/ ~ Inspection #2: ~ /~ Z /~/ Location: 2937 Cty Rd O Clear Lake, WI 54005 (NE 1/4 NW 1/4 15 T31N R15W) 40 acres Lot ~ O Parcel No: 15.31.15.229 1.) Alt BM Description = ~2 ~~~-~~~ ` 2.) Bldg sewer length = ~~ ~ ~ ~ ~ ~ / ~~ S~ ~ ~- - amount of cover = ~' ~ `~~ (/-Y~L7~fWk-L /~ Plan revision Required? ~ Yes ~ No ~: I ~ ~ 'O q i ', /_ / Use other side for additional information. ~~_~~ L--- __-- __-~ ~___~_1~__L- J Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~~ ~n . 1~~' ~~ / /~ G~~ + ~~~ cl MQ,i L• na ~~ commerce.wi.gov Safety and Buildings Division County C ' ~ St Croix 5 201 W. Washington Ave., P.O. Box 7162 ~ ~ ~ ~ . i sco ns i n Madison, WI 53707-7162 umber (to be filled in by Co ) Sanitary Permit N Department of Commerce / 5~7 ~ 7 Sanitary Permit Application State Transaction Number Wis. Adm. Code, submission of this form to the appropriate gov In accordance with s. Comm. 83.21(2) ] 574588 , unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWT are ~ts~ secon ary Personal infontaation yo artment of Commerce submitted to the De Project Address (if different than mailing ddress) I . p pu oses in accordance with the Privacy Law, s. 15.04(1)(m), Stats. VV ~ ~~~ I. A lication Information -Please Print All Information Property Owner's e 0 2 2008 Parcel # ~ SEP _ is Z -c d - d0~ Neil Ulrich o Property Owner's Mailing Address 2242 Co. Rd P gT. CROIX COUNTY Property Location ~ -7 Q 2?• 1 City, State Zip Code ~ Govt. Lot NE'/o, NW'/4, Section 15 Clear Lake WI 54005 715-263-3417 (circle one) II. Type of Building (check all that apply) ~~ ~ Lot # T 31 N; R 15W X 1 or 2 Family Dwelling -Number of Bedrooms 3 Subdivision Name /~ ~'/ _ ® Block # ~ ~' ~ • ^ Public/Commercial -Describe Use 7 t-'r,~ tK ^ City of ^ State Owned -Describe Use / +~ ~C 7S a~ CSM Number ^ Village of X Town of Forest III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. X New System -~ ^ Replacement System ^ Treatment/Holdin Tank Re lacement Onl g p y ^ Other Modification to Existin S stem ex lain g Y ( p ) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number Before Expiration Owner ~ IV. T e of POWTS S stem/Com orient/Device: Check all that a 1 1" ~ ^Non-Pressurized In-Ground ^ Pressurized In-Ground At-Grade 4 o u ound < 24 in. of suitable I ^ Holding Tank ^ Other Dispersal Component (explain) Pretreatment Device (explain) t /5 V. Dis ersal/Treatment Area Information: Design Flow ( d) ~ Design Soil Appli tion Rate(gpdsf) ~ Dispersal Area / wired (sf) Dispersal Area Pro sed (sf) System Elevation/ / , ~ ~ f Z J J 95 s/ 93 450 6 450 / 450 . VI. Tank Info Capacity in otal # of Manufactu rer Gallons Gallons Units ~ ;; v ~ N New Tanks Existing Tanks W ~~e~. cb t ~ ~ c a ~ ;; ~ ~ ~, Y ~ ~ ~ w~ ca a septic or Holding Tank 1000 1000 1 Skaw Pre-cast x Dosing Chamber 642 642 1 Skaw Pre-cast V[I. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu b 's Si nature MP/MPRS Number Business Phone Number 227618 Thomas D Gustum 1-715-658-1344 Plumber's Address (Street, City, State, Zip Code) N 13450 937"' Street New Aubum WI 54757 VIII. Count /De artment Use Onl Approved d Permit Fee Date I sued Issuing ent Signature $ ~~ ~ bIJ f3 ^ er Given Reason for nial ~ IX. Conditions of Approval/Reasons for Disapproval ~ / n/~ t J _ rQ , n ~~ V'41fe, .JR]G. $1>~STEM OWNER: 3, C6rl,~Jielt'~'•art. S 1. Septic tank, effluent filter and ~ ft~ ~/ S /~e~`~~ •~.~ ~ /1' _ dispersal cell must all be services /maintained as per management plan provided by plumber. Y 2. AN se'Iback relauireriments must be maintained w Mf' ~ Yb'i'1}hl~fiM"11fdi1~ the system and submit to the County only on paper not less than 8 I/z x I 1 ruches m size SBD-6398 (R. 01/07) Valid thru 01/09 ~ - - a s ~ `" ' I ~ a I I __--- ______._ u. ___ _ __ - ~ I q S N ~ IM ~I U m Q I ~_ ~- ~~ ~ LL I I~ I I O ~U ~~ ~ ~~ n „ C I x ~ ~ ' ~ -~ ~~ co ~ ~ ~ ~. ~ _~ ~ ~ ~ ~ ~ O yV ~ (/J ~ .~ .. Q n. p ^^ f 1.L. •~ ~ ~ ~~ ~ L ~ ~ ~c~o~oo mw~ U c > 0 _ ro 0 ~^v - _ m ~ ~, _ lpp l ~ N o ZCc yU 2 n v~ ~ t -~ ~ Z a ~ ~ N ~' m z W ~ o _r' I I ~ ~ ,o g ~ W ~ U ~ - ~ ~ ~1 e m W W ~.. ~ ~ ~ r ~ ` , W W U d ~i u u ~ ~ ~ M ~ ~ m m o ~ ~ a Q) ~ C Y C ----L---- N N H ~ ~ .O ~j _ ~• ~ mrn ° a~ - -- -- o --9 ~ * ~ I ~' ~ -~----0 O O - ~ ~ ~ ni ~ %9 ado~g ~ ~~ a I ~ ~ ~~ coZ ~ m rn ~ I Q" ~'~' o a ~ I ~ ; N ~ chi > ~ ~ ~ ~ ~ Ma _ ~, ~ o ~3d ~~~ ~ Q 7 ~ ~U Q i '~~/¢ ' K I I I I I I I ~ I I ~ ' ~ ~ QQ ~ ~ ~ -~ ~i m rn ~, 3 •O ~~ ``~ ~~ _~ ~--- - ~I tD ~I ~~ 00 i .~ ,~ D 7 ~ S - I ~~ N ~ I~ ~_ ~- I~ I~ ch ~ Q ~~U Q c~ I a--~ ~ ~ ~ m ---t--- I I I II I i ~I ~I ~~ U m 2 2 N f0 C6 CO c ~ T ~ ~ ~ J ~ ~ V m t _ (9 Z ~ O ~ ~ ~ ~ Z W ~ o ~ ~~ c g W m W o °D ) _ o ~, W w V d ~i u n ^ ~ ~ m ~ Q ~~ z "" 1[) O U ra o ~d L~~Q~~~~ C N V J O" - O g ~ ~ ~ ~~ ~ ZCc~U1=Z i ~ N M ~~ O 3 0 rn ~ fV ~ c ~ ~ th p~ o o ~~ ~ o m a~ _ _ _ _- rn ~ ~ -o _ _000-_ d ~'~~i °l09 ado~g ~ ~t '~ r .~ E a~ z - m * ~ ~ a ' --- rn j ~ ~' j ~i tL iv n. ~ U od CO a>_ ! ~~ ~I ~ D'v ~N NV ~ iI ~i i ~ ~O HL C 7 I I ~ (n U Q ~ ~ i u~ ~ i X N i ~~ ~ ~j i~' j i ~~ - ~ ~ oo~i aE ~; ~ ih mrn ~ 3 m > - -~~ m ~ .~ O ~~ J~ .~ -~~ -~~ ' ' ao , commerce.wi.gov ~ ~ ~scons~n Department of Commerce Safety and Buildings 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary August 25, 2008 OUST ID No. 227618 THOMAS GUSTUM GUSTUM SEPTIC SERVICE N13450 937TH ST NEW AUBURN WI 54757 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/25/2010 SITE: Neil Ulrich Cty Rd Q Town of Forest St Croix County NE1/4, NW1/4, 515, T31N, R15W ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 Identification Numbers Transaction ID No. 1574588 Site ID No. 740681 Please refer to both identification numbers, above, in all comes ondence with the a enc . FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1193905 Maintenance required; 450 GPD Flow rate; 21 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, sBD-1o7o6-P (N.ol/ol) 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 the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/Ol) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD- In the event this soil absorption system or any of its component parts malfunctions cr~~ a health hazard, the properly owner must follow the contingency plan as described in the ap roved ~k~n~~~d'pn,'l~te owner must comply with the operation, maintenance and monitoring duties as describ in sect~~l~}o'f~ mound component manual. A copy of this information must be given to the owner upon compl n of th~~t. cc~•. `14 All holding/treatment tanks are to comply with Comm. 84.25(7)(a). C~~ 'py 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 Comm 84 product approval conditions. THOMAS GUSTUM Page 2 8/25/2008 A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.1.9, Wis. Stats. 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 copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. Owner Responsibilities: • Comm 83.52 Responsibilities. 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. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 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 Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. ' c rely, Julia Lewis-Osborne POWTS Reviewer 2 ,Integrated Services (262) 397-6005, Fax: (608) 283-7481 j ulia.lewis@wisconsin.gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 08/1212008 09:14 17156581344 TOM GUSTUM PAGE 02 Mound 5ystern Pressure Distribution calculations Prajeat Name: Neal 111rich 450 GPD Mound Observation Pipes Lateral Layout LaterallManifold design 94.5 ~ Lateral elevation: Lateral diameter 1'~ r In. _ ~ ~ ~ ~ Rows df Laterals: ( z Lateral spacing (S): 3 ft Manifold type: ~ ~ Lateral t4 cell edge: 1.5 ft Orifice diameter 4.188 ~ lR_ Lateral discharge rate: 15.81 gpm ,,, ~ System discharge rate: 31.83 gpm # of Laterals: Manifold diameter z ~ In. Distal Pressure: 2.5 ft Lateral Length: 7~ Manifold length: Orifice Spacing/Distribution Forcemain Fricti on Loss 6 0 Orifice spacing pq: 38.81 Inches For~cemain Length: 55 ft Orifices per Lateral- ~4 Forcemain diameter. z ~ In. Avg. ft~lC~rifice~ g.3$ ftZ Friction loss in forcemain_ 1.176 tt Lateral Side View Manifold La#eral x x x x x La#eral Length Lateral Plan View Ll~~l llalgtli _ acesostibabm l>f PVC faa~brrema~b oomply~ ia~alpspa~d s~rCr>ElIm94.J l'QlCdl~l COt11 ~ pe or cress b et ~ part Clean Out Detail Clearraut plug Grade rorbalivalve Sprinkler Box Long Sweep 90 ^riwG 45's-~ti p~aa 6 u~later tight c,~p or plug 'a ~- `s~' ~i% Nd~: Closet CoAar bE used Irt 6" hAinimu fm C~. ~ ~.~ ~ L 318" Bar 08/12/2008 09:14 17156581344 TOM GUSTUM PAGE 02 Mound System Pressure: Distribution ~alculatians project Name: Neal Ulrich 450 GF'D Mound page 9 ar 6 Lateral Layout LaterellManifold benign Lateral elevation: 94.5 ~ Lateral diameter. 1'~ ~ ln• Rows of Laterals: ~ 2~ Lateral spacing (S): 3 ft Manifold type: ~ ~ Lateral to cell edge: 1.S ft prif9ce diameter q,i$g ~ In_ Lateral discharge rate: 15.81 gpm . System discharge rate: 31.83 gpm # of L.Sterats' 2 Manifold diems#er: ~ ~ In. Distal Pressure: g,g fit Manifold length: 3 ~ Lateral Length: 74 ~ Orifice pacinglDistributinn Forcemain Friction Loss Orifice spacing (]q: 38.61 Inches ~ Forcemain length: 55 ft Orifices per lateral_ 24 Forcemain diameter. z ~ in. Avg. ftzlt7rifiCe: 9.38 Ffiz i=rietian Loss in forcemain- 1.1?6 ft Later2~i 'rde View Mar~ifald La#eral x x ~~ x x Lateral Length Lateral Plan View L>teral l~fl vat tsastiirnl>f - PVCfatardbrcema~baamply~lh it ~4o~n94.~(2j Poll~man I~ +~ ~ or t b maCl'liold at ~ Parll Clean Out Detail ~Clean~ut plug Grade rorbalivahve Observation Pipes Sprinkler pox Long Stiveep 9~ oriwn 45's-~-.~ 6" Minimum L J~lst®r tight Cep ar plug Nnia: gost# CoAaI may bE Wsed In p1aCE of 3~" bar ~-3J8" Bar .t Mound System Cover Page Project Name: Owner's Name Owners Address Legal Description Township County Subdivision Lot# Parcel ID# pg 1 of 6 Neal Ulrich 450 GPD Mound Neal Ulrich 2242 Co. Rd P Clear Lake, WI. 54005 715-263-3417 NE ~ +/ Nw ~ +/, Sec 15 T 31 N, R 15 W _ ~ Forest Saint Croix ~ .- ` _ ;r ._ Table of Contents ~t~i' ~~ 1 Cover page ,~ ~ '~i~• `:~ 'G!; 2 Mound Sizing Calculations ~g"A : ~ 3 Pressure Distribution Layout and Dynamics 4 Dose Tank /Pump Curve 5 Management and Contingency Plan ~~~Nt'"~` 6 Plot Map ~~~-~ total # of pages: 6 Designer Name: Tom Gustum License #: D1201 Date: 7/26/2008 Ph. #: 715-658-1344 Signature: ~,~'L Mound System Design Methods Used per'TAound Component Manual For Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10691-P {N.01/01) per "Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10706-P i L ~/ .~. 3bAdvisement N12486 220th St, Boyceville, WI 54725 Ph: 715-643-6068 email: Mound System Mound Sizing Calculations Project Name: Neal Ulrich 450 GPD Mound Site Conditions PfojeCt Type: 1 or 2 Family Dwelling Slope: # of Bedrooms: Depth to limiting factor: Absorbtion rate of fill material: Absorbtion rate of in-situ soil: Effluent quality Max BOD effluent value: Max TSS effluent value: 61 1 J 21)in. 1 gal/ft2/day 0.6 gal/ft2/day Eff#1 ~ 220 mg/I 150 mgJl Design of Entire Fill Cell depth at upslope edge (D): Cell depth at downslope edge (E): Distribution cell depth (F): Cover thickness over edge (G): Cover thickness over center (H): End slope width (K): Fill length (L): Upslope width (J): Downslope width (Toe) (I): Fill Width (V11): Page 2 of 6 15.0 in. 19.4 in. 9.5 in. 6 in. 12 in. 9.7 ft. 94.4 ft. 6.5 ft. 10.7 ft. 23.2 ft. Design of the Distribution Cell Basal Area System Design Flow: 450.0 gallday Basal area required: 750 ft2 Distribution cell width (A}: 6.00 ft Basal area available: 1253 ft2 Distribution cell length (B): 75.0 ft Area of Distribution Cell: 450.0 ft2 Observation Pipes Contour Elevation of Mound: 92.70 ft Location from end of cell (Z): 12.5 ft System Elevation of Mound: 93.95 ft Final Grade of Mound: 95.74 ft Mound Plan View ~ /Observation Pipes ~ z W K ~~ / C~istriii~ution Ct311 ~ A g K- Tilled Area/Fill Material L Mound Cross Section Final Grade ~~= Synthetic Fabric Distribution Cell~• ¢ a System Elevation ~~ $ ~, Dover Material „~ ~ Lateral E Inver# Fill Material -~- Slope nervation Pipe D 3 Tilled Area ~Forcemain System Co nto u r Notes: Fill material to consist of ASTM C33 Sand Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(8) Distribution Cell to have minimum 5' aggregate below lateral and 2" above. . Mound System Pressure Distribution Calculations Project Name: Neal Ulrich 450 GPD Mound Lateral Layout Lateral elevation: 94.5 ft Rows of Laterals: 2 ~ Manifold type: End • Orifice diame r: , 88 . In. # of Laterals: Distal Pressure: Lateral Length: Orifice Spacing/ Orifice spacing (X): Orifices per lateral: Avg. ft2/Orifice: 2.5 ft\ 74 ft istribution X49.33 Inches 1 ~.84 ftz I Side Vi Page 3 of 6 Lateral/Manifold Design Lateral diameter: 1'~ ~ In. Lateral spacing (S): ~ft Latera cell edge: 1.5 ft La al discharge rate: 12.52 gpm ystem discharge rate: 25.04 gpm Manifold diameter: 2 . In. Manifold length: 3 ft Forcemain Friction Loss Forcemain length: 55 ft Forcemain diameter: z ~ In. Friction loss in forcemain: 0.763 ft ~~ Manifold Lateral x x x x x La#eral Length Lateral Plan View - lateral le~th Turo-up wlball valve or c~alrout Orifices on bottom of PVC lateral ar~forcemainto c~mplyw~h lateral~uallys~ced s~Cfiatior>SperCamm84.3a2) Forcemain conrlect~n v~ tee orcrossto ma~fo~ataay poi Clean Out Detail Clean-out plug al Grade ror ball valve Observation Pipes vVater tight cap or plug Sprinkler Box Lang Sweep 90 oriwo 45's~~ 6" Minimu~ L -Slot Note: Closet Collar may be used in place of 3~8" bar `--31$"Bar Mound System Septic, Pump and Dose Tank Project: Neal Ulrich 450 GPD Mound Tank Information Pump tank manufacturer: Skaw Precast ,_.~__ Pump tank size/model: 642 Pump tank gal/inch: 16.47 Tank bottom elevation (inside): 85 ft Septic tank manufacturer: ~ Skaw Precast Septic tank size/model: ~, 1000 Page 4 of 6 Dosage Volume Does forcemain drain back to tank? Lateral void volume: 15.6 gal Dosage to absorbtion Cell: 78.2 gal Forcemain volume: 9.6 gal Total dosage: 87.8 gal Pump and Filter Total Dynamic Head Pump Manufacturer: Little Giant aterals highest point? y Pump Model: 9EH if not, enter highest elevation: 0 ft Effluent Filter: 8 bio-tube System head (distal x 1.3) 3.25 ft Vertical Lift ("D" to lateral) 8.95 ft Note: Access opening of sufficient size to be provided to alto removal of filter. Opening to terminate at or above grade. FfICt10n IOSS In fofCemaln: 0.76 ft Pressure loss from filter: I~ft Total dynamic head (TDH): 12.96 ft Pump Tank Diagram WatertigMLockingcov ~ Dose Tank Levels 4 inch Wilh Warning Label finished Minimum , Grade In. Gal A eserve 25.6 422.4 ARernate J B P mp off to Alarm 2.0 32.9 Outlet Locat~n C Tot I Dosage 5.3 87.8 Elect. per Comm D Efflu nt depth for pump 6.0 98.8 16.28 and remain NEC 300 T t l it 39 0 642 0 o par y: . a . a Weep Hole orAnt~ B Siphon Device c Pump Curve: 9EH FLOW- LITERS/HOUR D 0 1000 200D 3000 3v Pump must be capable of: 25.0 GPM and head pressure of: 13.0 Feet 30 10 H W ~.5 W zo W A 5 I Q A to 2.5 0 0 0 20 40 60 BO Llftle Giant FLOW- GALLONS/MINUTE 9EH PUMP PERFURMANCE CURVE 115V 60HZ Mound System Management Plan pursuant to Comm 83.54 W. A. C. page 5 of 6 Owner's Responsibility: The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemicaUbiological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed i~ cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 113 of the usable tank volume may be occupied by sludgelscum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump/Dose Tank If an effluent filter has been installed in the pump/dose tank, it must be removed & cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches and alarms must be inspected at least every three years for proper operation. Pump/dose tank should be routinely inspected to be watertight and of good repair. Mound and Lateral System The mound system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points at each end of the component to remove scum that may clog orifices. Pertormance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the mound component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the mound and replacing said components in order to return system to proper working order as required. Y ~~~~~ Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in ac;~n~ttJ~o~ I~Wis. Adm. Code #2389 Page 1 of 3 Gustum Septic Service ~ ~'"~' County Attach complete site plan on paper not less than SY: x 11 inch2s' must St. Croix include, but not limited to: vertical and horizontal reference point (BM), directio d percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. b~ f /b ~~ Please print all information. Revi ed By Date Personal information you provide may be u ors !I~ ~~~e ~ivacy L w, s. 15.04 (1) (m)). ~,i Property Owner roperty Location Ulrich, Neil ovt. Lot n/a NE1/4 NW1/4, S15, T31N, R15W Property Owner's Mailing Address of # Block # Subd. Name or CSM# 2242 Co. Rd. P n/a n/a N/A City State Zi Cod ~gr ZONI _J City ~ Village iwI Town Nearest Road Clear Lake WI 5 - 63-3417 Forest Count Road Q _~ New Construction Use: ~/J Residential /Number of bedrooms 3 Code derived design flow rate 450 GPD i Replacement -~ Public or commercial -Describe: Parent material glacial til Flood plain elevation, if applicable n/a ft• General comments Part of 160 acres. Recommend mound system along 92.7' contour. and recommendations: Boring # -~ Boring Pit Ground surtace elev. 93.0 ft. Depth to limiting factor 25 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft2 in. MunSell Qu. Sz. Cont. Color Gr, Sz. Sh. 'Eff#1 *Eff#2 1 0-8 10yr3/2 none sil 2msbk mvfr as 2f 0.6 0.8 2 8-14 10yr5/4 none sil 2msbk mvfr cw if 0.6 0.8 3 14-25 10yr4/6 none sil 2msbk mfr cw - 0.6 0.8 4 25-35 10yr4/6 c2 ~ 510yr7/2 sil lmsbk mfr cw - 0.4 0.6 5 35-50 7.5yr4/4 c2-3d 10yr7/2 7.5yr5/8 gr. sl lmsbk mfr - - 0.4 0.6 Boring # -~ Boring Pit Ground surface elev. 91.0 ft. Depth to limiting factor 22 in. Soil Application Rate H rizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/tt2 o in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10yr3/3 none sil 2msbk mvfr as 2f 0.6 0.8 2 9-15 10yr5/4 none sil 2msbk mvfr cw if 0.6 0.8 3 15-22 10yr4/4 none sil 2msbk mfr cw - 0.6 0.8 4 22-34 10yr4/6 c2-3p 10yr7/2 7.5yr5/8 sil imsbk mfr cw - 0.4 0.6 5 34-60 7.5yr4/6 c2- p i0y 7/2 7.5yr5/8 gr. scl 2msbk mfr - - 0.4 0.6 _.-.-- * Effluent #1 = BOD F> 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) Signatu ~ CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St. New Auburn, WI 54757 7/8/2008 715-658-1344 Property Owner Ulrich, Neil Parcel ID # Page 2 of 3 3 ] Boring Boring # ~ pit Ground surface elev. 3.0 ft. .RQepth to limiting factor 21 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture ' Structure `` Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color -- -fir: 5~. Sh. `Eff#1 'Eff#2 1 0-8. 10yr3/3 none sil 2msbk mvfr as 2f 0.6 0.8 2 8-13 10yr5/4 none sil 2msbk mvfr cw if 0.6 0.8 3 13-21 IOyr4/6 none sil 2msbk mfr cw - 0.6 0.8 4 21-34 7.Syr4/6 c2-3d 10yr7/2 ~ 5 ti gr. sl lmsbk mfr cw - 0.4 0.7 5 34-60 7.5yr4/6 c2-3d 10yr7/2 ~ 5 5 8 gr. scl 2msbk mfr - - 0.4 0.6 _] 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/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring Boring # J 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#t 'Eff#2 `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 c need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-877 i cRn.aaan ru minor Gustum Septic Service X Property Owner Ulrich, Neil Parcel ID # 3 I Boring ^ Boring # 'v' P8 r;rnnnrl enrforc eie., .rdR fl!Bt: ri'. Page 2 of 3 Depth=to limiting factor Horizoh Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color f Texture I ...- Structu~ ' " -~. `S'i. Sh. Consistence 1 0-8. 10 r3 3 Y / none sil 2msbk mvfr 2 8-13 10yr5/4 none sil 2msbk mvfr 3 13-21 10yr4/6 none sil 2msbk mfr 4 21-34 7.5yr4/6 c2-3d 10yr7/2 7.5 g gr. sl imsbk mfr 5 34-60 7.5yr4/6 c2-3d 10yr7/2 7.5 r5 8 gr. scl 2msbk mfr 21 in. Soil Application Rate Boundary Roots GPD/ft' 'Eff#1 *Eff#2 as 2f 0.6 0.8 cw if 0.6 0.8 cvv - 0.6 0.8 cw - 0.4 0.7 - - 0.4 0.6 _J Boring Boring # _f Pit Ground surtace elev, ft. Depth to limiting factor in Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil A GPD/ftYn R. in• Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 __~ Boring ^ Boring # ~ pit Ground surtace elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in• Munsell Qu. Sz. Cont. Color Gr. Sz' Sh. 'Etf#1 'EtT#Z Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 a 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 c need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-877 i snn_Razn rx mmm Custom Seaic Servke _, ~. ~ W W ~' ~ ~ m°c~ __ _ a~ ~l a ~) , ~ ". rn j ~~~ -- z w~ ~ ~ slope s~ia ~~ I ~~~ w '* __ mo ~ ~~ W ~ ^ N b' V ~° ~ ~ _ O Q C ~ ,Y C ~ W N ~ ~ • `~' N ~ ~ o 0 N~ D I-' oo r' m rn m ~ o $ _- 7 c~ I I ' O ~ Z ~ '+ ~ v N ~ ~ o ~ S ~ _ ~ m g n ~ " m Q \3 ~ N~ ~ ~ ~ nWi 1 c ~ O r(~N = ° b~ O Q ~ t ~ Sq S 0 ~ ~ ~ ~ ww 5 Q A ~ ~ ~ `G ~ T V M ° ~ ~V ~ Np (D A ~ ~ d ~ N W W ~' ~O ' ~ ~~ y ~ ~ ~ ~ I I~ w I I I I I I I I v I I I i I I I I II rn I i I I I I I N --- ~ -- - II V O wT, ^/v w ~.i ~I .I I Y I I I N z I e I I~ ~ ~ I v ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/lamer _~z'j ' ~ ~ ~~ ~ ' Mailing Addressaa y ~ ~" K ~ , _ ~ ~ ~ Property Address syoas (Verification required from planning & Zoning Department for new construction.) City/State ~, tt~. ~u.~,~,_ ft,~ Parcel Identification Number~~~ "' ~d,,3Z -• ~i~ -~~ LEGAL DESCRIPTION ~j Property Location ~'/4 , ~''/4 ,Sec. ~, T 3lN R ~/ W, Town of CD~G~ Subdivision Plat: Certified Survey Map # Volume ,Page # Lot # Warranty Deed # __~~(j~~ (before 2007)Volume ~b~ ,Page # J`~_ Spec house ~ yes ';' no Lot lines identifiable yes', ! 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 §Comin. 83.52(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 frill of sludge. 1/we, 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 Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms .~ ~lLrt~^ ,~.ey N ~~ SIGNATURE OF APPLICANT(S) ~' /~/ ~g 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. 08/05) OOCUM<NT fVO. oUtiT OIJ111 D'tiD ntb tttats asattRVtm roR t~CORCtRN a-T. RATS o- wtttcost~tn - rToats is 4s~oso ~R~ $~4 ~~a~t pis REGi1~T~R'b o~~~~. This indertcure, Made tens....._.__.a~.5....._......_.. day of._..?AN, i~,Q1' _,.,,,~ ~Rp ~ ~ ~. A.0. 19~.~_.., 6stwren AETNA LIFT INSURANCF._.COMPAHY _„„__._ R!C'd for ~COtd -' "'~~ Qrihec~o~cu~011 dttl, °r .nd talsdns ntlder tend fry PtiAR c? Q 1991 virtue of the laws of•tfte Sate oat atHartfor,~ Connecticut ~„~ OI 11:20 wlscortain, wrty ,~f the first !#rt. and _..~I~ W ...~I~ll..atl.~..~~~ei~.~l..'~a._ ULRICH,•_husband and wife as survivor l~ip~,>~a~,~,_._, __._....~..ro..pertYa_......._.._.._............__._...._..._.__.~...._..._.._._...._.__._._._.... RrpiWMefOaadl p,,,t,,..Wiea._. of the second pact. War ?bat the said parry of the fins part, for and in consideration of the sttm ~ Twelve_ Thqu:,and Five,_Hundred ands n~100-..~12~OO~DO)_,.Do ara to it paid hw N _ai_ -.r, ies..-.. of the second RIRURN In past, the receipt wheceof is hereby coafeaed and ~tlE~ a h,,. (.~ L .R ; (: N - acnowledgen, r. .:, granted, bargained, sold, remised, released, and quit-claimed, and by /~' T 1 f'3, x `/ ~ ~ rbese prr_-nts does give, grant, bargain, sell, rmtise, release and quit-claim unto the said C ~' ~`~ h) LN K C Iti, ,r QUO ~ part_., iPB_... of the second part, and to._.........L.11eiL..___._ heirs, and asaigos fotevet the following described real esnte, situated in the County uf....._..._...._S~_..StX.Q.d.X_..._..__.__...r._._....., State of Wt„posits, to-wit: The W-I/2 of The NW-1/4 of Section 15; S-1/2 of SE-1/4 of NE-1/4 of Section 16, all in Township 31 North, Range 15 West, St. Croix County, Wisconsin. GRANTOR HEREBY EXPRESSLY RESERVES UNTO ITSELF ALL OF THE MINERAL INTEREST IN, TO, AND UNDER THE ABOVE DESCRIBED LANDS, TOGETHER WITH TFiE RIGHT OF INGRESS AND EGRESS THERETO AND THE RIGHT TO USE AND OCCUPY SUCH PORTION OR PORTIONS OF SAID LANDS AS MAY BE NECES;iARY FOR THE PURPOSES OF THIS RESERVATION, WHICH SHALL INCLUDE THE STORING, HANDLING AND MARKETING OF SUCH MINERALS. TT IS EXPRESSLY UNDERSTOOD THAT THE GRANTOR SHALL HAVE, RECEIVE AND ENJOY ALL BONUSES, RENTS, ROYALTICS AND OTHER BENEFITS WHICH MAY ACCRUE FROM ANY VALID MINERAL LEASE COVERING THE ABOVE DESCRIBED L.~NDS. I'E2AN5 s 31- f'E'8 (iF N1RCE38ARY, CONTI\'UE DEBCRIPTIO:V ON RIDVSRHS BIDE) To Have and to Hold the same, together wish all and singular the appurtenances and ptivtleKes thereunto belonging M in uIy wise thereunto appertaining, and all the elate, cighc, tide, interest and claim a•hatscevcr of the said party of the first part, either in law or equity, either in possession or ezpectancy of, to the only proper ttse, benefit and bcha,f of the said patt ............... of the se:oad part, .-......._....__._~ heirs and assigns FOREVE1t. In Witness Whereof, the said ..... AETVA--LIFE.- INSIJRANCr.F-,...G~I~.E~`.IX ..............................._....-......--•-------_.._._.._.._.._._...._..., Party of the first put, has caused these presents to be signed by ........................................_........................_......................._-•----_._..........._.-_.._._, its Presidm and countersigned by...........-°•---•--._.-•--•---._...._.....---•-- ....................................................._...........................__-•~~1~:::'t5i.{l~etary Hart~oAd, Connecticut ' at ._.._......5.~.-..._.__....._..__...._ ............................_......_...----..._......--••------_..._..., VGry~cpnsin, and its corporate seal tQ.'fle.trt6E'rtiato this ..~......:..'......._ day of......---~-A.Nk.~R_Y...-• .............. !1 •.....~ %.~ --------• -., A. D., 19....--•---• n 1^••• ~: 8I4NaD AND Btr:AI.ED PR~ss^rcE of AETNA FE IN ~ CE .t1~`1P~t5IY ^_ - v rat e ~ •~_ ........ ...... . v~%. ,,, t. M' B en be~rvta'Y STATE OF ~ CO~i.3ECTICUT Hartford ~ ss. ..........................................•----- -............_... county. ~,~ Personally carne !afore me. this ................. ~S day of...... ~. • D . y - ........... lJ~ A. t ,........... ....-~~ . V1~C[a,, rPresident..+.nd- ..~! aY.+~...Gi....5f.. - .....-... ecrer - -•~-° ...-1.,ats~. 5- ary of t:.e <!x,ve n,;med Corporation, [o e1e 1:noan ~~ Se th(al persups •'x, e•recute~l the forel;oirlg ir.sirument. .,~~d to mr ~ns,ss:~ to ce such ~. , , ,... t.f 'a~,! fo:^;;r,:ic t. nd •-{:r;;a•!e!ge•3'•tfiaY :hev rxe~'•.:ed the f-•rtrni•+~ .=incrent -,c =ugh ~ffi ers .'t thr deed ,~f <a,.! %orp, rat rn. ~ ~ - ~,~ ,t; a~rthotirv. . 7 ra , C<-_ 7 IS :NSTRUMEN W ~S DRAFTEt-• 9v A~j : r: _~ _ ELE~lt/v'~_.__-_t./~.NL_ LL/ Robert W. Mudge, Attorney 'a ,=° • Dt_fC : ~, - GILBERT,`4UDGE, PORTER & LUNDEE~1.. ~~cT~rr '~~-r..n P~ah!I_. Hart_ord- _ - _~,,,.,t~. }~ CT Hudson -WI.54Q16_____-- - ti.y f - ..i :n !t•~;.i:e„ l .l ~3~.~(~/f9.}L 1 Secti,m 59.5] (1) of the Wisconsin Shtu[e: p-,rides that a!1 wstn~ments :,• t:e raorded shall have plainly tinted nt typewnttea fhereon the ounce of the grantor, ¢ranrees, witna:e, ar,J nnurv. Sertron sq.st3 s:mduly ca1uircs that the name a~ the pawn who, or govern medal agrncy- whi.h, dra:!ed such instrument, ;h.tll be painted, tcpewrttea, camped w written thcrecr: ,a a leR~ble mamer.) STATE OF WI9CO:V9/~ ~ ~~rc:~+1n Uwe` Rlank Cwrvan- 4t'IT CLAIM OTi,Ti,D--R7 CorPoratlo^ FORIr psi. 19 `~Iettwxu ken, K'U ' 1 Parcel #: 014-1032-60-000 os/o2i2oo8 04:14 PM PAGE 1 OF 1 Alt. Parcel #: 15.31.15.229 014 -TOWN OF FOREST Current X ST. CROIX COUNTY, WISCONSIN ~~ Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 QC~ Use Value Assessment Valuations: Last Changed: 10/18/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 12,000 38,000 50,000 NO AGRICULTURAL G4 37.000 3,500 0 3,500 NO UNDEVELOPED G5 1.000 100 0 100 NO Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -ULRICH, NEIL W &WALANA M NEIL W & WALANA M ULRICH 2242 CTY RD P CLEAR LAKE WI 54005 Districts: SC =School SP =Special Property Address(es): " =Primary Type Dist # Description " 2242 CTY RD P SC 1127 CLEAR LAKE SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 15 T31N R15W NE NW Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 15-31 N-15W Notes: Parcel History: Date Doc # Vol/Page Type 07/23/1997 894/511 07/23/1997 825/236 07/23/1997 741 /632 07/23/1997 538/546 2008 SUMMARY Bill #: Fair Market Value: Assessed with: Totals for 2008: General Property 40.000 15,600 38,000 53,600 Woodland 0.000 0 0 Totals for 2007: General Property 40.000 15,600 38,000 53,600 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 12'h!5" Z'-615" 7~-615" 11~h15" CW74 CW74 ~ A O 3 m d~ b ~ 3-5 b_ A Z.b„ O N W O 3 ~ S w ° m Ol I= ® b ~ z ~~ - ~ T r 3 ~ e -6.. b A O O ~ `" z 5'-0" 5'-0" b --- 7c A m D ~ 3 _ z ,, a ~ ~ - - e 8 - II -- ~-- I I - J "~ = O1 b d D v = N \ 3 -0" 4'-bh~~ ~~-0.. 0. ~~r 3' " 3.-0.. 0• ~~~ II. ~~~ ~, 0~~ 30'-O"