Loading...
HomeMy WebLinkAbout038-1116-95-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563848 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 Village X Township Parcel Tax No: Meyer, Leroy J. & Jane Star Prairie, Town of 038-1116-95-000 CST BM Elev: Insp. BM Elev: BM Description: L_5 fV Section/Town/Range/Map No: ~(Q t (a 3 SU ~ 29.31.18.488L2 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 7 Dosing (JI~U Alt. BM r 10 Aeration Bldg. Sewer f 36~Z/-i 3.s Holding S /Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 70 loll, 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom 2 Dosing Bader/~~ Z Aeration Dist. Pipe I Jp G~ Z p&b' Y. Holding System~ ~V C I ki'd ` Z U / 4 f Final Grade S s I I 2 97 ,Z, ' PUMP/SIPHON INFORMATION ' tS Manufacturer Demand St Cover 7 GPM IC _ GcL~DV~ l0 7 Model Number _77E IT TDH Lift Frictio oss Syste Bad TDH Forcemain Len4th Dia. Dist. to Well SOIL ABSORPTION SYSTEM ~rvr~ BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~j SETBACK SYSTEM TO P/L BLDG WELL LAKE/STRE ACHIN Man re . INFORMATION HAMBE R Ty a Of System: T Model Number: h V~Gt~7~7t J D IBUTION SYSTEM f[ V 'r U arnif?ld h f stributio/n~ r x Hole Size x Hole Spacing Vent to Air Intake lO e(s) 151 Length Dia ngth Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over ti Depth Over xx Depth of xx Seeded/Sodded xx Mulched ed/Trener Center l Bed/Trench Edges Topsoil ~ ® Yes No ❑ Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:-LL/ 3 Inspection #2: Location: 1959A Cty Rd C..Somerset, pWI 5440~25 (NW 1/4 NW 1/4 29 T31N R1 8W) NA Lot 4 ~ Parcel No: 29.31.18.488L2 1.) Alt BM Description ~.D0fuLx- 2.) Bldg sewer length =1 ~j /I~ n~~ G`-► W ''1- amount of cover = V ;/~C Plan revision Required? ❑ Yes No J Use other side for additional information.~ Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) - - A -1-Xk~- /a - _ ~Il V-P c a$°T County J Safety and Buildings Division 0 r 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit umber (to be filled in by Co.) S P Madison, WI 53707-7162 Sanitary Permit Application 4<~ V State TransactionONa~ . r~ rJ In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appt:1kf ate overnmentfullt is required prior to obtaining a sanitary permit. Note: Application forms for state-owned P #e jlkbmitted to Projec Ad ress (if di ere th mating ad ress) the Department of Safety and Professional Servies. Personal information you providWy be used~ondary / A 9s9 purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. / 1. Application Information - Please Print All nformation I F0 Prope Owner's Name Parcel # 7 - Property O er's ailing Address Property Location Govt. Lot \ ~ 4 City, State ode Phone Number d 1/4, 1/4, Section - circle one Lot # 11. Type of Building (check all that apply) TN; R E o> 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name O Gta ~QA-~ Block # ❑ Public/Commercial - Describe Use I ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Town of III. Type of Permit: (Check on one box on line A. Complete line B if applicable) System y ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) A. New El Replacement S System B. El Permit Renewal El Permit Revision 11 Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner -pxg;L ✓ ~e.~-. 1 IV. Type of POWTS System/Component/Device: Check all that app ) g 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) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gp Dispersal Area Required (sf) Dispersal Area Proposed ( System Elevation VI. Tank Info Capacity in Total # of Manufacturer y Gallons Gallons Units a U New Tanks Existing Tanks Ol c y fl ca at U ~ ~ ~ w C7 s,, Septic or Holding Tank Dosing Chamber VII. Resp sibility Statement- I, the undersigned, assume responsi ' for i tallat' o the POWTS shown on the attached plans. PRS Number Business Phone Numberp Plum ame (P 'nt)~ Plumber's Si a MP/M 2 ':2 Plumber's A dress (Street, City, St e, Zip Code VIII. Count /De artment Use Only Approved Disapprove Perfm~it Fee~j Date Is ued Issuing ht Signature /3 liven Reason o 'al $ / 7 ' cc IX. Con easons for Disapproval A dim 1•: IMOi0"tank, eftluefit fifterW 166 dispersal cell must all be services"l billhallmd ! as per managetneM plan provided by'plutber. P1ood' Aas per appl oft `o w~ `ti 1,.~,,.~ c~it+ YGrrw: I-01 5Z Attach to complete plans far the system and ubruit to the County, on on paper not le s aapy/gt 1/2 x 11 inches in size SBD-6398 (R. I1/11) / I CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: a Owner's Name: %z Owner's Address: Legal Description: Abd lu) Cam, l .e / l+ Township: ~7~ County: / l J~~ Subdivision Name: sin 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. a Date: Phone Number 7 Signature designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101). Page 1 z or .A,~~ ~ ~f a "~i1ef~-,tom 00 46 f G i l -~%ji; 9s 4 Soil Absorption System Cross Section ft 4°Schedu 40 FinalFi Grade PVC Vent Pipe ~y With Vent Cap ft Chamber ♦ _ -ft System Eievation ft ft Sol] Absorption System Plan View ft ft Leaching Trench 1 Vent Or Observation Pipe Cham~rs f Dia. Trench 2 Header Leaching Chamber Spec tiicaticns Manufacturer And Model EISA Rating sq ft per chamber Soil Application Rate 7 gpd/scj ft gpd Design Flow + Soil Application Rate EISA = „;:~2_ Chambers 2 rows of chambers each. Page, Of m. INSTALLATION INSTRUCTIONS r~ mP, lA&W Z ab*P PL-525/PL-625 FILTER A011 dhWb-- INSTALLATION INSTRUCTIONS Centerfilter t +t with apening „F.~• } ..q E= zs..4.y tt.-.y-~i~•'',.ra 1 .yam,,. :t ✓'<,i j f s ~ ~i' ~ ~ ~ 6 ies -s a ~ F r.~-. - ~t~b y lC` ~ t1 .;a..4t_~ J ft -A..Sscast t {T~kxi t ~ a5~ t ,as >S ~ ~ ..J. •LS•. ~ F'lt':. } 6 ~ ,a. f~•t. , ','ri1 ~ :fir 'd.~'i~y,~ ;3~ . t ~ ava`• ~'y}r,.fa,-yr•.'~y ~a _ :~a'6•,5 ,''~~L~~7.,yr 1 ~~s. ~ ~ Z S~%, ? "Y. It sF-l.y -r./'lL1Ul'Y~~r_ _pr ~ y-_ i t4 .'i'1~ S a7~~•'. 6.... P' • ? t PalyaO"tt _ ~(Y.~ f a > ~~:fE.S~~li J1. .Kt fi - _ 11 ~ ( •r 'i Y 'f _I 33. ~St _f < 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. N 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 filter removed from the tank for cartridge is properly aligned and maintenance and service. completely Inserted in the housing. MAINTENANCE INSTRUCTIONS y r ~'t, t t 's6- s`. ;ix'.,•4y Kt~pz" k r S s~+ r F ~ +•7y .ter ~ -F4r iy~~ s > r r4. i f ~ ro \F s I 3 a ~ a-~}•~=i. ~ K Ys _t~°z' Step 1: Step 2: Stop 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back if necessary. into the the housing making sure • NOT USE PLUMBING (B) Pull the filter out of the housing. the filter is prflPedy alighed WHEN FILTER IS REMOVED and completely inserted. :~;-,may:.. - ~~~~x.T .4 , (C) How off its filter over the septic tank SE-RUB ER.GC t)VE.' Make sure all solids fall back into the (B) Replace septic tank cover POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1-f FILE INFORMATION SYSTEM SPECIFICATION o NA Septic Tank Capacity ,Oep gal, Owner Permit Se tic Tank Manufacturer j ❑ NA Effluent Filter Manufacturer o NA DESIGN PARAMETERS Effluent Filter Model - ❑ NA Number of bedrooms ❑ NA Pump Tank Ca acit al o NA Number of Commercial Unit ❑ NA Pump Tank Manufacturer - ❑ NA Estimated flow (average) aUda Pump Manufacturer. _ ❑ NA Design flow (peak), (Estimated x 1.5) r"O al/da Pump Model - ❑ NA Soil Application Rate gal/day/ft' Pretreated Unit Influent/Effluent Quality Monthly Average* ❑ Sand/Gravel Filter ❑ Peat Filter Fats, Oils & Grease (FOG) <30 ing/L n Mechanical Aeration o Wetland Biochemical Oxygen Demand (BODs) <220 mg/L ❑ Disinfection ❑ Other: Total Suspended Solids (TSS) <150 mg/L Manufacturer Monthly Average" Dispersal Cell(s) Pretreated Effluent Quality ❑ NA ti In-ground (gravity) ❑ In-ground (pressurized) Biochemical Oxygen Demand (BODs) <30 mg/L ❑ At-grade ❑ Mound Total Suspended Solids (TSS) <30mg/L ❑ Drip-line ❑ Other: Fecal Coliform (geometric mean) <104 efu/IOOmL Maximum Effluent Particle Size '/s 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 ct condition of tank(s) At least once eve ❑ months :j 0 ears (MaAmum 3 rs) Pump out contents of tank(s When combined sludge and scum als one third of tank volume Inspect dispersal cells At least once eve ❑ months or ears (Mai, um 3 rs) Clean effluent filter At least once eve ❑ months M ear(s) Inspect um um controls & alarm At least once eve: ❑ months ❑ ear(s NA Flush laterals and pressure test At least -once eve ❑ months o ear(s) to NA Other: At least once eve o months ❑ ear(s) ® NA Other: At least once eve ❑ months ❑ ear(s w 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 l 13, 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 chemicals 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 y-a septage servicing operator prior to use. Page --Z 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; meat 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 shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shalt be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. "ONTiNGENCY 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 fines 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 setbabk 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 POINTS a soil 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 biomat 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. XDIT(ONAL COMMENTS ~7t?WTS INSTALLER POWTS MAINTAINER Name i l Name Phone Phone 2 2Z 2 L= SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATO Y AUTHORITY i Name Name - Phone Phone I -1 21-5 us document was drafteJ -ante with chapter Comm 83.22(2)(b)f 1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CR.OI'X COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Qwu-er/Buyer ,4 c I y r` - , Mailing Address ~7;, C Ze~ Property Address_ I c 10 (Verification required from Flaimmg & Zoning Department for new construction.) City/State ,,4,&/ Parcel Identification Number &F --,,11/` - 95--,ft LEGAL DESCRIPTION Property Location t~~L V., V., S"ec.` T-_,14 N RZZ _W, Towns of Sulbd `JI33o11 , Lot # 6 Cert9f ed Survey Map # Z f q/ , Volume Page # --191--) Warranty Deed* Volume,8, , Page # xoo / Spec house yes no Lot lines ideati cable no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper inaintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pnnno xw. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner matnuumce responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St: Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Playa amg & Zoning Department a certification: Form, signed by the over and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site ;-astewat er disposal system is in proper operating condition andlor (2) after inspection and pumping (if may), the septic teak 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 s:a dar ds set forth, hernia as set by the Department of Commerce and the Department of Natuial Resources, State of Wisconsin. ~e v.icahoa stating that your septic system, has been maintained mast be completed and returned to the St. Croix County Plaamimg & Zo_~g Department within 30 days of the three year expiration date. Fvm certif., that ail statements on this fo true to the best of my/our knowledge. Uwe am/ate $re owner(s) of the property described above, by virtue of a warranty recorded in Register of Deeds Office. Number of bedrooms 2 x7 SI ATURE OF APPLICANT(S) DATE uy information that is misrepresented may result in the sanitary permit being revoked by the PlmniRg & Zoidag Dgmll ern - ue rith this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if :s-s ce is made in the warranty deed. I AND THE SOUTHWEST 1/4 Ur 'I'nb 11U"lr "ZZ-1 11'* , RAN SECTION 29, TOWNSHIP 3S1TNORTH CROIX COGUNTYE 18 WEST, W SCONSIN TOWN OF STAR PRAIRIE, NW 1/4 Carty LEGEND i SEC, 29. T31N. RiBW FOUND ALUMINUM MONUMENT GOVERNMENT CORNER (AS NOTED) av. 0 FOUND 1' IRON PIPE L ~ • SET, 3/4'X24' REBAR / / WEIGHING 1.502 LBS. PER LINEAL FOOT. LOT 3 139.674 SF ey / U~yp 121 ACRES 130.855 SF TO MEANDER - 100 ACRES TO MEANDER 284.3t3v~ / ..r - qe / ~ANpg LOT 4 88.905 SF 104 ACRES ! N Orf / i 6 -w 84.391 SF TO MEANDER 19• 1.94 ACRES TO MEANER LOT 1 `FH em TOP mm i~ . i < / : SM '22 E U" e61.ea AlR ~to°d► / 4 / 215.62' . ~~Access it we det•1 / Jr, iV 9` X i i ® tF} /,LSO 4' Lai & 610 N l i . 2 12 6~South_line NW 1/4 of the NW 1/4 0 0- o C;z 1 W i ® - w us z ; W 1589.16 22•E ~i t W ~ VOR i i Access Eosenmat Detail ~1/ CURVE DATA Not to scale CURVE RADIUS CENTRAL ANGLE CHORD LENGTH CHORD HEARING ARC B.T. BEARING F.T. BEARING 1-2 1382.39' 07102'53" 169.94' 52231'16"W 170.05 S1859'49'W S26'l)2'42"W 3-4 1959.86 01'11'58' 41.02' 19'40'59"W 41.02 S2016'58"MI S19VTOO W / i - i • * PETER J. SEC. CARr-4A,"+t W' 1/4 29. T31N. CORNER R18w FOUND ALUMINUM MONUMENT u 0 CEDAR CORPORATION S 1604 WILSON AVENUE i Mt719%M~Ot 54751 l• cuecr nc PER LINEAL FQOT. 10 / UNPLA ED 13t S88'310"Eb` _.,4 3.0 284.38 / Orr / / LANDS / k01y?~1 s w °`.G LOT 3 C r of ; G~'~'," e.~00% B11 TOP REBAR rc~• V- • / / / G ~iT ~ o S89'1 1220E E~EV 861:e3'*` Seib .00 ell -Acces f obi 0 r,: /00' ~~,001 I w C%4: V- 40p - / . / 81 gin 284.15' 6•South lin-e,NW„~4, of the NW 1• i N89601"30 - ~ ~ ! t / ~ ~ ' t 5.80' •'t~ - - w'! g i ^ r I. t / dop Access Eosement Detoi Not to scote sol / CURVE DATA 1 CURVE RADIUS' CENTRAL2' ANGLE GLE CHORD LENGTH CHORD BEARING ARC B. T. 8E. 07 522'31'16"W 170.05 S18' 169.94' t-2 _ '0 1382.39 ww•/•CA•'W L~'n7 SZO 42>Q3 1 P REGISTER OF DEEDS ST. CROIX CO.. MI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD 08/84/2 805 02:30PH Document Number WARRANTY DEED WARRANTY DEED THIS DEED, made between Harold 0. Baillargeon and Ilene EXERT # Baillargeon, husband and wife, Grantor, and LeRoy J. Meyer and Jane E. REC FEE: 13.88 Meyer, husband and wife, as Marital Property, Grantee. TRANS FEE: 225.00 COPY FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee CC FEE : the following described real estate in St. Croix County, State of Wisconsin: PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return RN T0: Edina Ti 'te a ETRO.=LEGAL-gWCES; INC. Exceptions to warranties: H t 401 153Sa 330-.SOUP 2ND AVENUE, S JH 150 Easements, restrictions and rights-of-way of record, if any. 4 75 ~gtPjNEAPOLIS, MN 55401-2217 038 Metro Legal Services -1116-95-000 Parcel Identification Number (PIN) EDIRET 473757 A This is not homestead property. 483405 WD 374633 Dated this 20th day of July, 2005. - * Harold O. eon * Ilene Baillargfort AUTHENTIC ACKNOWLEDGMENT Signature(s) TIFFAN! L. AHRNDT STATE OF WISCONSIN ) O NONE- ST. CRO1X COUNTY. ) ss authenticated this 201h day of July 2 Of WjkSC011S1f1 Personally came before me this July 20, 2005 the above * named Harold O. Baillargeon and Ilene Baillargeon, husband TITLE: MEMBER STATE BAR OF WISCONSIN and wife to me known to be the person(s) who executed the instrument aad aclmowledged the same. jing (If not, authorized by § 706.06, Wis. Stats.) THLS INSTRUMENT WAS DRAFTED BY li S f Wisconsin Peterson, Fram & Bergman - Steven H. Bruns to petmanent. (If not, state expiration date: 50 East Fifth Street, St Paul, MN 55101 6/14/2009 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature 2a59P 0 0 2 EXHIBIT A Lot 4 of Certified Survey Map filed January 13, 2005 in Volume 19, Page 4912 as Document No. 784967, Located in the Northwest of the Northwest and the Southwest '/4 of the Northwest Section 29, Township 31 North, Range 18 West, Town of Star Prairie, St. Croix County, Wisconsin. File No.: 473757 ` t ^ , 1302 r Wisconsin Department of Commerce SOIL EVALUATION REPORT I'lage I or 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Cade _ Ef i I Tom Schmitt Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must C unty ,Cr©~ ) include, but not limited to: vertical and horizontal reference point (BM), direction and p rcel I D r' ' } L percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. e ' By Date L Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ' S Property Owner Property Location SaiAacgeen, Harold Govt. Lot NW 1/4 NW 19 S 29 T 31 N R 18 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# ( ` /Z 1459 C44Itd-L / J'ir* 4 CSM P"a 7 City htirC,lsor) State Zr'~C Phone Number _f City _f Village ]g Town Nearest RoadRd.9s-Cf Snmemet:- WI m 715 247 6966 Star Prairie Cty { New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement _f Public or commercial - Describe: Parent material Outwash (stream terrace) Flood plain elevation, if applicable 99.0' General comments and recommendations: Area is suitable for a convetional system with a 0.7 gpd/sgft rating. Possible system elevation for Area 1 is (high trench) 100.4' (low trench) 99.4'. Slope is 10%. Boring # I Boring s f Pit Ground Surface elev. 103.44 ft. Depth to limiting factor 114+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF -Eff#1 `EfW2 1 0-6 1Oyr3/3 none grsl 2mgr mvfr 9w 3f .6 1.0 2 6-14 1Oyr4/3 none grvcos Osg ml 9w 2f .7 1.6 3 14-43 1Oyr5/4 none grcos Osg ml cs 1f .7 1.6 4 43-59 1Oyr5/6 none grms Deg ml cs .7 1.6 5 59-92 10yr5/4 none grcos Deg ml cs .7 1.6 6 92-114 10yr5/6 none grms Deg ml - .7 1.6 F2 ] 36 • }2 . `fg' Boring # J Boring Pit Ground Surface elev. 103.84 ft. " Depth to limiting factor 120+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? "Eff#1 -Eff#2 1 0-7 1Oyr3/4 none grsl 2mgr mvfr 9w 3f .6 1.0 2 7-17 7.5yr4/4 none grvcos 1 msbk mvfr 9w 2f .7 1.6 3 17-5Q 7.5yr4/6 none gds 1 msbk mvfr cw 2 1.6 4 50-102 7.5yr4/6 none grcos Deg ml cs .7 1.6 5 102-120 10yr5/6 none grms Osg ml - .7 1.6 t7D • o t ' Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS <-0 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt X 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 928/04 715-247-2941 property owner Baillargeon, Harold Parcel ID # Page 2 of 3 L 7 Boring # J Boring 01 Pit Ground Surface elev. 102.34 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 "Eff#2 1 0-9 10yr3/4 none gris 1 msbk mvfr cw 2f .7 1.6 2 9-19 10yr4/6 none ms Osg ml 9w 1f .7 1.6 3 19-37 10yr5/4 none grms Osg ml cs - .7 1.6 4 37-48 10yr5/6 none ms Osg ml 9w .7 1.6 5 48-78 10yr5/4 none grvcos Osg ml gw - .7 1.6 6 78-100 10yr5/6 none firms Osg ml - - .7 1.6 a* `M•40 Boring 3'S• 2 ')y F 4]Boring # 601 Pit Ground Surface elev. 106.24 ft. Depth to limiting factor 115+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 *Eff#2 1 0-20 1Oyr3/3 none sl 2mgr mfr ca 3f .6 1.0 2 20-36 10yr4/3 none sl 2csbk mfr 9w 1f .6 1.0 3 36-76 7.5yr4/4 none grvis 1csbk mvfr gw .7 1.6 4 76-85 7.5yr416 none grvms Osg ml cs .7 1.6 5 85-115 10yr5/6 none grms Osg ml - .7 1.6 F Boring # J Boring _I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 'Eff#2 ~i * Effluent #1 = BOD s 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD5 S_30 mg/L and TSS <30 mg& 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. Page 3 of 3 Conducted by: Conducted For: Schmitt Soil and Site Evaluations Name: Harold Baillargeon Thomas J. Schmitt, CST 227429 Address: 1959 Cty. Rd.C 1595 72nd St. City, State, Zip: Somerset, WI. 54025 New Richmond, WI. 54017 Phone: 715-247-2941 Subd.Name: CSM Pending Approval Lot No.: 4 Legal Description: NWl/4 NWl/4 S29 T31N R18W Township of- Star Prairie Bench nj'El. ' Top of 3/4" rebar at turning point on north lot line Alternanch Mar El.105.59 top of 2" pvc pipe Slope= Contour Line El. NA Scale I"= 40' i k(5o I IaY' ~ r ~J qq t 73' Ils' i P' y / r LV V111 LL 11. /ilU 1.V tai 11 It "VA 1/1 V• /llU ♦l ♦a 11~✓+ AND THE SOUTHWEST 1/4 OF THE NORTHWEST 1/4 • SECTION 29, TOWNSHIP 31 NORTH, RANGE 18 WEST, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN NW 1/4 CORNER LEGEND i SEC. 29, T3114, R18W FOUND ALUMINUM MONUMENT GOVERNMENT CORNER (AS NOTED) v ~ 0 FOUND 1" IRON PIPE • SET, 3/4"X24" REBAR WEIGHING 1.502 LBS. PER LINEAL FOOT. LOT 3 139,674 UNP 3.21 ACRES S88'31'30"E~` _ Q 'QED f'•-'•-' - •-~I~•-••-•• 130,855 SF TO MEANDER j 284.38'v / 3.00 ACRES TO MEANDER av / 1ANDS LOT 4 / i 88,905 SF i N i / i N~7y?. 2.04 ACRES i N O~ 41 -W 63 84,391 SF TO MEANDER L__~ 3/9' 1.94 ACRES TO MEANDER ! / `mac / c LOT 3 0). Up B4 • TOP REBAR ~FIOOD e"bpc 50~ 589'1 '22"E ELEV 861.83 ~ ! 4~ / _ _ • / 213.62. yap 15 s , • ~9•,Y ! ;t 2~~Access / ent see detoil Sys 0000 i l B• 1 LOU / / ♦6 44/~ ao % ! .126 88' / z co M _ _ R~ dM 284.15' 6• South line NW 1 4 of the NW 1/4 W Z C14' /Mi 15.80' .p3`. Cc W Z W 0: / 1 / / ~i 1 ern / y 1 L. N Q a m / / ~~CJ ~ J y i to ~ 15.80' / Z3w S8916 22"E i Cr Z j ! / ( Q w to Access Eosement Detoil 1 m - a CURVE DATA Not to stole CURVE RADIUS CENTRAL ANGLE CHORD LENGTH CHORD BEARING ARC B.T. BEARING F. T. BEARING % 1-2 1382.39' 07'02'53" 169.94' S22'31'16"W 170.05 S18'59'49"W S26'02'42"W 3-4 1959.86 01'11'58" 41.02' 19'40'59"W 41.02 S20'i6'58"W 519'05'00"W i • / i i • W 1/4 CORNER PETER J. SEC. 29. T31N. R18WA'~ FOUND ALUMINUM MONUMENT Q' 79 CEDAR CORPORATION Is ♦O 604 WILSON AVENUE , MENOMONIE. WI 54751 (715) 235-9081 c~ This Document wos drofted by Pete Gortmonn SHEET 1 OF 2 W1,S-1-11\29-31-18Wpus-11-1&d" 9/13/2" 11:0►70 AM CDT ~y • ' FORM NO. 985-A HL.1rirs:r 8 irF 9 6. 7 Stock No. 26273 VOL 19 PAGE4912 KATR = H. WALSH REGISTER OF DEEDS CT. 61i9~if SOT kECE RECEIVED FOR RECORD 01/13/2005 02:20PH CERTIFIED SURVEY HAP R£C FEE: 15.05 COPY FEE: AGES: 3 CERTIFIED SURVEY MAP NO. P VOLUME 19 , PAGE 4912 LOCATED IN THE NORTHWEST 1/4 OF THE NORTHWEST 1/4, AND THE SOUTHWEST 1/4 OF THE NORTHWEST 1/4 SECTION 29, TOWNSHIP 31 NORTH, RANGE 18 WEST, TOWN OF STAR PRAIRIE, ST. CROIX COUNTY, WISCONSIN NW 1/4 CORNER LEGEND SEC. 29. T31N. RISW FOUND ALUMINUM MONUMENT GOVERNMENT CORNER (AS NOTED) 10 o FOUND 1" IRON PIPE ~so, • SET. 3/4"X24" REBAR WEIGHING 1.502 LBS. PER LINEAL FOOT. LOT 3 139. SF 3.216ACRES S88'31'3p" _ ~~~"47I'E_D 130.855 SF TO MEANDER - -..~t._.._.. i 284.38' / ' 3.00 ACRES TO MEANDER 41VDS LOT 4 88,905 SF N~7y?. 2.04 ACRES A. i O~ / A 6 4j-W 84.391 SF TO MEANDER 1.94 ACRES TO MEANDER v / ts►' : LOT 3 i ° 0~ G rf .I ~ aM - TaP REttAR ~~.a°„ ~ ~ ' M,eat: / S89'1 22"E ELEV e6t.63 dot St p1 -Access easement see detail Low' = qiO 4P . .-26.68' ~ -South line NW 1 4 0! the NW 1/4 o i / i tam' 3 z LLA ICU / / ♦R~~ t56o' i z W 41A Access Easement Detail co % CURVE DATA Not to scale CURVE RADIUS CENTRAL ANGLE CHORD LENGTH CHORD BEARING ARC B.T. BEARING F.T. BEARING 1-2 1382.39' 07102'53" 169.94' S22'31'16 'W 170.05 S18'59'49"W S26-02'42"W /.:.T 3-4 1959.86 0111'58" 41,02' 519'40'59"W 41.02 520'16'58"W 519'OS'00"W / i / 0 4 W 1 /4 CORNER C SEC. 29. 731H. WSW FOUND ALUMINUM MONUMENT SCALE' 1"=150' ' 0• 75• 150• 300 CEDAR CORPORATION 604 WILSON AVENUE MENOMONIE. WI 54751 (715) 235-9081 This Document was drafted by Pete Gorlmonn SHEET 1 OF 3 1c~c-r_e~»_>u_uw.,w-N_~eH ui,~nao, ea .u es~ Vol 19 Page 4912