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HomeMy WebLinkAbout014-1073-30-025Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Towmship Wilson, Scot Forest, Town of CST BM Elev: Insp. BM Elev BM Description. /pp ~ ~ GS ~ TANK INFORMATION TYPE N'IANUFACTURER ~ n,q r CAPACITY Septic ' ~, ~ZSo Dosing G ~ ~~ 11J~ C 7s~ / Pt~Tr6Tn F. ~ ~ ~ ~~,c..~- t~07$ C Holding TANK SETBACK INFORMATION TANK TO ~ !~1L " WELL BLDG. Vent to Air Intake ROAD i~~e tic;-' ~"__ ' Dosing ~ ~~ ~ r Aeration _.-- _ _ - --~ ~Holdirg ~ ~___ .~__ i ----- PUMP/SIPHUN ,NFC3RiVlI~I IUN Manufacturer ) ~~ ~ Q~ vl i Model Numtrer ~ e Z TDH Lift Friction Loss System Head ~~~ ~ I I , z~ , g ~ ~ • zs remand (PM ~, Z~ ,3 SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 506246 0 State Plan ID N¢ Parcel Tax No: , 014-1073-30-02~ Section/Town/Range/Map No: .'i4.31 . i 5.544r~. STATION BS HI FS ELEV. Benchmark 3, 33 J JG3.3 /~~ Alt. B~~~ / ~. ZS ~O~j . ~j Bldg. Sewer ~ .rG 7 ~ , ~g SUHt Inlet ~o,a 9s .BSI SUHt Outlet ~ ~_ i Dtlnlet ~ t ( ~ 1 ~_ Dt Bottom ; 1,[ 77 ' $`~ ~ g Header/Man. 3.l ~~, y Z 3 Dist. Pipe 3. 1 ~ ~ ~ 3 Bot. sy°19 ~ 5~0 3. ~~ 99. s ~ Final Grade 2.l ~~al,~~ St Cover Fi ~~Pa.. v ~ 3' ZS ~~~~ ' "o ( Ld,,.~.~ i ' s . ~ ~ 9g. Z I BED/TRENCH Width ~ ILength ~ No. Of Tren ies ~ PIT DIMENSIONS \ No. Of Pits __ Inside Dia. ~ Liquid Depth DIMENSIONS 7, 5 E !_ b G~ ~3~ SETBACK SYSTEivI TO P/ I BLDG WELL LAKE/STREAM LEACHING Manufacturer: CHAMBER OR INFORMATION ~ T;~pe C~f,.~,$tem: ///~ It Ci c,. ~ 5th U ~~~ ~~ ~ 7 /) N/~11-- UNIT Model Numbr.r ~ I DiSTRiBi~TiON SYSTEM 1, ~ ,~}.,.._ UHF ~xier'IVlanlto~d r, / fD stribution ~ / / x Hole Si ~ / Ox Holt_~ S~~,aui~g ~ ~%r~ ~~~u -n<<~k~.. ~ ~ g /~s ~P,,~;(5,~ / zs 3. ~s ~,~ ~ 3 ~ ~.. Len~th ~ Dia Length Dia ~ Spacing Cnll r^n\/GR .. o_....~..... c..~«....,~ n.,r.. .... nAn.~nrl !lr et_hrarie SVStP.mS Only 1 ~..~iL^- Depth Over Depth Over ~ xx Depth of xx SeededlSodded xx Mulched Bed/Trench Center J ~ ~~ Bed/Trench Edges \ Topsoil ' ~~... ~i.. Yes No ,Yes fit: No G3` II COMMENTS; (Include code discrepencies, persons present, etc.) Inspection #1:__a /M`L`,'~ / V~~ 'Inspection #'?: ____!___/__ Location: 295 Slate Hwy 64 Glenwood City, WI 54013 (NW 1/4 NE 1/4 34 T31N R15W) NA Lot I r,~zJ~+CYI ~ f hlo: 34.31.15.544A 1.) Alt BM Description = ~ n1Q~ ,~lic~ ~ cnOc~,re~~..~, SO.~~ 2_.) Bldg sewer length = ~ L i' amount of cover = N ! a c`o S~ ~.`~- . U Plan revision Required? ;: Yes ~o i ~ 7 6~ Use other side for additional information. l~ ~ ~~._~ Date Cert. No. SBD-6710 (R.3/97) UNPLATTED LANDS North 1\4 corner STH "64" Section 34-31-IS - - Found 1.25' Iron Pipe _ _ _ 589'10'11 666.13' POB "A" ~: 0-------------------~-- -- 589'10'11"E sa.aT __ Hatched Area is a 2664.52' D.D.T. permitted access 'Ei„~ _ 666_13'_ pOB "B" __ 589'14'04 E~ ~ builtling setbock line o so' d o ; LOi 1 ~.(~ °o ; ~ CSM N5332 ~ o N 1~~ A ~ ______ ~ ~ a~ ~'' cJ m~ ~ ~ t IZ I { "ti p i~ ~ I [+] It7 ~~ ~~~ IC ~z I •v lo'~ I C+7 I CJ ~s ~ ~ ~To 0 m 666.07' ~ N89'59'31"E ~ ' o Parcel A 1,527,074 sq.ft. 1 ,583 t~ft m 35.06 acres j~~/ acre rrt~P11~! as incl. r-o-w cl. r-b-w a NW corner f SW/NE I__ Z o 40 line A N ~ rn ~ d N 00 ~ 589'59'31"W 1271.21' ~ R; 0 ~~~ ~~ o° ai97~ ~ ~" m Parcel "B" v u r,f w A 1,527,078 sq.ft. 1,522,870 sq. ft 35.06 acres 34.96 acres incl. r-o-w not incl. r-o-w A ~w corner 2658.69' sw/NE 589'09'33"W 1340.62' ~~~' 589'09'33"W West I\4 COrner ~;N UNPLATTED LANDS Section 34-31-15 ° ~ ~ --------- ----- Fd 1,25' Iron Rebar ~ ! .°~' a~w U1 I N r+i~ South 1\4 corner -t=- Section 34-31-15 ~ Found 'PK" Nail ~ ~ North Is referenced to the North line of the Northeast Quarter of Sec. 34-31-15 which bears 589°10'11"E 1St. Croix County Grid System) 1/ 1332.26' 589'10'11"E-~ ~^~ ~~-31-5 MAP OF SURVEY PART OF THE WEST HALF OF THE NORTHEAST QUARTER, OF SECTION 34, TOWNSHIP 31 NORTH, RANGE 15 WEST, TOWN OF FOREST, ST.CROIX COUNTY,WISCONSIN - 63.72 Northeus ~ cur-ner Section 34-31-15 Fd Survey Mark Nail ~g _ ~ ~ S00'06'S3"E 1 ~centerllne of 6 640.31' 6 foot wide ingress-egress easement ST.CROIX000NiY SURVEYOR'S RECORD IC ~ ~ro 'Z ' PARCEL "A" DESCRIPTION z ~~ !~°, ~ Part of the Northwest Quarter, and part of the Southwest ~o Quarter of the Northeast Quarter, of Section 34, Township v1 31 North, Range 15 West, Town of Forest, St. Croix County, o ,~ ~ Wisconsin, rn ~~ Commencing at the North Quarter corner of said Section 34, w Thence 569°10'11"E, along the north line of the Northeast m Quarter of said Section 34, a distance of 666.13 feet, to the o point of beginning of the parcel herein described: - Thence continuing 589°10'11"E, a distance of 600.12 feet; "E v0fnef SW/NE Thence 500°06'53"E, a distance of 1640.79 feet; N Thence 589°59'31"W, a distance of 1211.21 feet, to the west ~ line of said Northeast Quarter; Thence N00°03'45"E, along said west line, a distance of ^? 604.26 feet; 1~~ 5~ Thence N89°59'31"E, a distance of 666.07 feet; ° ' " E, a distance of 845.31 feet to the point of Thence N00 03 45 beginning. Said parcel contains 1,527,074 square feet (35.06 acres) and ~z I~ I•v is subject to easements of record and as shown. I Ir ,z 19 I~ iy 'a SCALE: 1" = 400' 0' 400' 800' 1340.62 , E corner ~ ,"~~ s+r/.vE 589'09'33"W i East 1\4 corner Section 34-31-15 Found RR Spike (down 1') Set Survey Mark Nail LEGEND ®........Government Corner (as noted) Set 314"x 24" Iron Rod weighing 1.5021bs./lineal ft. ...........Found 3/4" Iron Rod OWNERS/PREPARED FOR: PARCEL "B DESCRIPTION SCOT & NANCEE WILSON 2953 STATE RD 64 Part of the Northwest Quarter of the Northeast Quarter, and part of EMERALD, WI 54013 the Southwest Quarter of the Northeast Quarter, of Section 34, Township 31 North, Range 15 West, Town of Forest, St. Croix County, Wisconsin. GRAFTED BY: Commencing at the Northeast corner of said Section 34, Thence Joel A. Brandt N89°10'11"W, along the north line of the Northeast Quarter of said JB SURVEYING LLC Section 34, a distance of 1332.26 feet, to the Northeast corner of the Northwest Quarter, of the of the Northeast Quarter and east line thereof, being the point of beginning of the parcel herein described: sC,~~ Thence 500°06'53"E, a distance of 2689.82 feet to the Southeast \ s ~:.••••"•••.,:~2 corner of the Southwest Quarter of said Northeast Quarter, and south * ;~ ~~. • * line thereof; • BRAI~DT ' 8.003 Thence 589°09'33"W, along said south line, a distance of 1340.62 feet, ~ OtENM00D G!7'! ;' to the Southwest corner of said Northeast Quarter, and west line , , ~ ••, ~ • thereof; a,'9,~''• ' ~_ Thence NCO°03'45"E, along said west lire, a distance of 1069,»8 feet; ~~S Thence N89°59'31"E, a distance of 1271.21 feet; COf11t11@f't.~@.Wi.gOV Safety and Buildings n County ~~ Ci2~ J 201 W. Washington Ave., x 7 62 ' ~ Madison, WI 53 07-7 Number {to be filled in by Co.) Sanitary Permit ~ ~ 0(0 2 Sanitary Permit Application Transaction NuLmb~er D ~ In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate gove tal ~ ! / 0 unit is requited prior to obtaining a sanitary permit. Note: Application forms for state-ovmed POWTS Project Address (if different than mailing address) submitted to the Departrnent of Commerce. Personal information you rovide ses in accordance with the Priv Law s. 15. 1 m ,Stars. u ~~ ~ S .~ /-', ~ / I. A lication Information -Please Priat All Information Property Owner's Name ~uN 2 8 2007 ~ 5v~ ~fi ~~ S Parcel # p - 073- 30 02~ ~ . L~ Property Owner 's Mailing Address Property Location / ~~ j ( ~~ S ST hI v~Y y ST. CROIX COUNTY ~~~ ~ ~ d. c` /' ~~ r City, State Zip Code l ~ ~ _~ y, ~~ y,, Section l .Q ~a ~e~ t,,(,r T ~~ a i 3 Q1(p5 7~ e T ~ N; R ~ E ype of Bnikling (check all that apply) II Lot # _ ~ Subdivision Name C ~L '~ AG 1 or 2 Family Dwelling -Number of Bedrooms ~ / 3 ~~ .7 - O~~ fiU/I10 G~p.~Q~ ~ ~ Block # r ~~'1 Z D~escnbe Use ^ 1'ublic/Commercial - ~ ~'~ ~ F~I~jQ.{~ ^ City of ~~ L Q ~~i''' ~~~ i/ ^ Stag; Oi(t~Descn Ub!'~ a CSM Number ^ Village of 3y` ~ ~ Town of ~D r~5~ IiI. T ype of Permit: (Check Daly one boa on line A. Complete line B if applicable) A' ~ New System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) B• ^ Permit Renewal ^ Permit Revision ^ Change of Plumber ^ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration er ~ ~ IV. T of POWYS S stem/Com onentlDevice: Check all that a ^ 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 (expisin) ^ Pretreatment Device (explain) V. Dis rsaVTreatment Area Information: A.Q. Design Flow (gpd) Design Soil A iication Kate(gpdsf) Dispersal Area equired (sf) Dispersal Proposed (sf) System Elevation VI. Teak Info Capacity in Total # of Manufacturer Gallons Gallons Units ~~ ~ .n ~ v J New Tanks F~dstiag Taoks /QU t /' ~ ~} w c U ~ & `~ n $~ v~ $' °e} C~J fs `~ O ,,,(( p M 7~' r yr + m ( , r Septic or Holding Tank / 7 1~oi? ~ ` .Q (/ L E~E'2? C~ ~ Dosing Chamber /` 1 VII. Responsibility Statement- l; the nndtrsigned, assume responsibility for installation of the POWTS slwwa on the attached pleas. Plumber's Name (Print) Plumber's Signature MP/MPR S Number Business Phone Number ,/~ (/ I Qi~l 11,( / p/ ~ {J ~ ~ .. Plum r s Address tr e et, City, State, Zip Code) (( ry~ ` y r V ~ ~v ~ C X20 ~ ~" ~~ V oua /De artment Use On Approved ^ Disapproved Permit Fee $ ~ ~ t~ Date Issued Is ing A ent lure Gt! S~ S 2 ^ Owner Given Reason for Denia! `r 1X. Conditions of ApprovaUReasons for Disapproval 3 fir.: _ ,. ~ ` s~~ ~,Q,~ ~~ ~"~ YSTEM OWNER: 1 Septic tank, effluent filter and !~ " ~~ ~' - /~'(~°~ dispersal cell must all be serviced / maintained ,/~ ~ - c ~i~C~. ~ ~~'~ D~~Z~l7z,tT ~ ~'" lumber ided b r t l . y p ov p an p as per managemen .. ... _ .._ - _~ _ .__ _..:-_.Y ....a.. ..... ...a h.....nin4.~inord Y t~, - llM. 33 2- ~~y c . rnu ae wa~.~ i ey u~ ~ v ~ ~ ~ ~ eom }~. ~ ~J'a~ and submit to County only on pa net kss than 8 a 11 lnehes ig ' as per applicable co a or inn ce GSm Yo ZZ ~ , S~3 2 "1"-r~~r~ ' SBD-6398 (R. 01/07) Valid tlw 01/09 ~~~~ ~+ S ~//V G ~y ~ d ..F~.~~ a: ~,- ~ f~ t~ ~ 6. ~ t=L f ~ ~ ~ ~ ~~ ~~ ~ ~ 'i7 u f t ('b %1 F1i izt tI1 t J m r`'~r ~. t ° o ~ a ~ ~ . .__ .,. W - ~ ~ _ ~ are d ~ f _. _ o e .- ~. .. Ni .. f its ... ~ t r ~ ~'. ~ X ~ ~~ ,f - ~pptp,,,,f~ ~D ~ .. _~~~Cp~,~~ „ + G~ • *`K ti~~ _ Li`f'e !/ 1 "~ V W 0 ~ m ~ -~~+~~~_ P L~CtI~~ 1 ((~~ `VO~ o '~ ~t ~y I~Vf~4 ~ ~ _ a~ ~ ~,~i~~f ~.~j~s~~'i~ ~ N - p... a 4J <,,.P' y 4~o7.~..., I i"~ ~! t L , . ~•~; I ~ k , ,~ ~ ~ h C ~ N _ ~ rR .__..._._.__,_..__ {s3m~~ Sqp~\ S~' -a.~.n~Ss. ~~~ - rZr+a ~ ~ ~~3 ~ a ~~~~ ~ (p ~ ~~ , w -' z ~~ S t~ f .~. ~_ 1 t r , i x W~ ~~ ': ,., / -c ff l,r ~~~ w~~ 1 ~i ~ (~ ~ ~ ~Zf' ' ` 44••' d.~` `"*a v ~. d u ~I/ ~ v p i 1 1 i i I G I i ~~ i i _ ~ ~ 1~ e i e~4~ '. c 4 ~ ~~~ commerce.wi.gov isconsin Department of Commerce Safety and Buildings 10541 N RANCH ROAD HAYWARD WI 54843 TDD #: (608) 264-8777 www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary June 18, 2007 CUST ID No. 221057 DANIEL C WORRELL DANS PLUMBING & HEATING 1756 150TH AVE SAINT CROIX FALLS WI 54024-7533 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/18/2009 Identification Numbers Transaction ID No. 1405409 SITE• Site ID No. 726620 Scot Wilson Please refer to both identification numbers, Hwy 64 above, in all cones ondence with the a enc . Town of Forest St Croix County NW1/4, NE1/4, S34, T31N, R15W FOR: Object Type: POWTS Component Manual Regulated Object ID No.: 1136442 Maintenance required; 450 GPD Flow rate; 20 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-10706-P (N.O1/O1) 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: Reminders • This system is to be constructed and located in accordance with the approved plans and with the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0" SBD-10706-P (N.01 /01). • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD-10691-P(N.O1/O1). • The pressure network is to be constructed in accordance with publications SBD-10706-P(N01/O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems -Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". 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 DANIEL C WORRELL Page 2 6/18/2007 required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. 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. Sin ly, Carl J Lippe Wastewater Specialist, Integrated Services (715)634-3484, clippert@commerce. state. wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. FUND AN© PRESSURE l1t~STRtBUTi4N CEIN4PUNENT IlESiGP1 Residential Application ENQEX Ai~f TtTE.E PAGE Probed Name: Scat, V1~on ri Owner's Name: Scot Wdson mound tyamet's Address: 2953 State trwy 64 Clear Pss~jeCt ` Emerald Wi 541)13 lnformatian t_egasE Description. Nw1/4 riel/4 s34 t.31n r15e T~unship: Forest County: St. Croix Subdivision Name: dot Number: ~dc N~u~r~er: Parcel t.0. Number; Plan Tra+on No.. P.p.W.T.S. Page 1 Index anti titer Conditionally Print asslton Page 2 Qata entry ~~ ~ Page 3 Mound drawings Later ar~d dose taillC ~ , ~~ TMENT OF COMMERCE BUILDINGS 5 Syst~ril ~~ ~~~~ O SAfET A Paege 6 IlAanagement artd CGIn~ pin ~e 7 Pump cx>~ve s~~ SEE GOR PONDENCE g~q .,~o~t i~es~ __ _------ lp ~lofi !~I«h1 ~ fi C1ear t3esigrrer ln~ar[natirxi Designer. Dan Worrell E.icense Number. 22.1057 Date:. 05f15Jtf7 Phone N~nber. 715-f~fi-2634 Signature: ~~~ Mourx3 E:omportent Manual for PDWi'S Version 2U SD8-10691-P (N. 071K)lj, and SSWMP PuWica~ 9.6 Design of Pressure Dis~be~ion Ne~cxks ~' ST~SAS {01181) Version 4.0 (R 04403) Page i of 7 Found and Pressure Distribu~on Componen# Design Qesigtt Worksheet h Site Ir~ mra#~n ~r or c) Residerit"rdl ~ Canmen~al Design 31i0 Estinta~d Was~nrater Fbw {9PdI 1. Peaking Factor- (e.g.1 _~ =1506} 450_ Design Fl~r (spd} to Site Skype (°~} 96 Contour Line Elevation (itj ZQ Depot to ~9 Fau~or (~} tt. trt-situ Sod 11ppan Rate {9pdfft~} (c ore) `fib /5 Distr~uti'a-n GeN tn#ortttation 60. L~ Ceti Lent,~h Abng Contour (ft} 1. Dispet~al Celt Design Loadirts Rate (spdtt~ 1 Influent Waste ter (~ua~- (1 or 2} Pressure Disributirsn I~tforrnation Otter or Eftd Il~tifok! 3.7 Lateral Spsae~rtg (ft) Number of Laterals A.1 Orifice Diameter ("mj (e.g. 3. Estimated ~ Spacing 2. Fo€cerrtain Diameter (in) 6~i t=otcemain Length (~) 86. Pump Tactic Esevaiicxt (#t} 3. System Head (ft) x 1.3 11. Vet~iCai Lift {ftj U. Friction Lass (ft) 15. Total Dy~rtarrtic Head (ft) Latest Diameter SeteCtiara ~ die ~ ns choice 0.75 i x 1.25 x x 2.00 x 3.04 x Note: Sand fig (D) dons assume s Tahie 83-44-3 ~ ~ah-~t for feted co4fom~ of ~ ~ inches. e~ v {~~ Are the taterais the highest ' t in the dirt Y net+~work? Enter Y ff N at~onre, enter fire ei~ratiort ft of the highest point 025) (ft)= i1.2 ft2torif~e Does t!re forcefnair» d Y Enter Y or N 14~ Fcu!cemair- Urain5adc (gal) 37 sx void Voktme i~3 47.8 IlAinimum Dose Volume {sal) 26.21 system Derrtartd (sprrtj ~ Nta~alti laam~er Satan I ut. die otr'tians c~ce-7 Treatment Tank htft~rntation 100D. Septic Tank Capacity (gat) `eser Mactufacbttrer [)apse TaNc IMormaticnt 750_ ~ Tartlc Capacity (gat) 20_ hose Tank ~Aoiume (galfut) r NAa~tutacturer Project: Scx~t W~Ort trtvund Gattonsflitclt Ca~u(optional) 0. Total Tank Capacity (gal) fl. Total Workutg Liquid t~eptit f~+) ~ilALUE, galftn (enter resin. in cep 849) Effluent Fflter In_fa_mra~ bel titer t1+i~tufactut~ '100 Ater Model Number Page 2 of 7 c~ >Monnd Plan View trto 6 =:=:=:~_=:=:=:=:-:~:~:_:~:~:~:-: K ~~ ~~ :Lt ~ i' - - - g~ tJ- • („ 7. E 25. in 60_ F 92 ul 46. G 0. 450. ft~ Dispersal Cell Area X gpolftj Lirsear t_oariing Rate --- -_--_~: s >, ~ T A I H 4_ K 40.44 I 94_ L 80_ J 6,04 Vf- 27_ 9342. t~ Basal Area Aira~abbe s. t~> tna B c3las_ Phacernent lli~nd Cross Section V"rew Aggregate t~ispers~ Area Finished ~' 99.J0 (ftj ... F 68.43 (ft) -~- -' Dispersal Ce#! Elevation ~ t knF ~~ ~~ Ei{mot sfiae~g Kcy~ 1 ~ Topsaf Cap 2 .,....~ Subsal Cap 3 _:.::. ASTM C33 Send 4 ~,`~, -;'. Tilted t.,ayer 5 A98~~ _=-_ ~_- - G S 0) l ivJ A.. j" * . a ~ F 44.0 % site slope ~I H '-' 98.fi3 {itj f..ateral ... _ ln,~ert . .~ A A * F J -~-- _ ~ H..il t ~ ~- A Pro}ect Scut ift5lson rrxwnd (ftj Conmur Elevativr~ Geotextde Fabric Crnner see taterat deta~.s on Page 4 ~r r~rnber, size, and spacing of fat~ats_ l~erals are equa~y spaced i~rtun tfse distr~rutivn ceq's cer~tertirse in ttte dis~ut~n cel; (). Page 3 of 7 C~rtfier ~onne~ct~on Lateral layout Dai~gram Fob viatreor~rossto tliaaSQtdatae~$c'sa. P •= Tarcwpwtbs~vsEaear {~ al~eoutplug t a~~af~. i~ucnb~ of La#era~ Lateral Diameter Lateran-er~9th {P} Late[a~ SQaang {S} Lateral Fk3w Rye System Fbvv F2ate Totem E)yrramic head ELI as per WEC 3a~ Tank cornponerrt is ..laser -.._.___.... Capaci y 750.. volume 20.s ~~e~. t.~s a~ rorac maa of AS~C sd~ ~ ~err~$4.~u 3 Chiifice Diameter O~ Spacing {X} C?rifices per t.ater~ Manifold leru~Fs lUlar~btd For~main Velour Dose Tank lnfo»nation t3 Manutacturef Gaiflons galrncn La~ssg rarer w~h warm sea~a j ar. rr~ _ 1oc~ion Fnroernasf d~rr-effir ~ ill. w~ o~ ana. c a` 36.41 a~l 3" bedding under tank. Alamll~anaafacturer levelarm Alarm Model Number Pump Manufacturer oeller "~ ~~ Pump Model Plumber 152 Pump Must Deliver 2621. pm at 15_ TDH ~~ s~. oose~e~~ ~~-~. Prtyect Scat if4~ort mound Page 4 of 7 f~.OW PFR MlNU1E CONSULT FACTORY FOR SPECIAL APPLICATIONS ° 7itred dosing panels available. • Electrical aitemators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Ucuble piggyback variable level float switches are available for variable level long and short cycle conirals. • Sealed C7wik-box available for autdoar instalfafions. See Ffvt1420. • Over 134°F. (54°C.) special quotation required. 1521153 Series 1321183 MAQ[t~_LS ~ Control Selection ipndei ; Votta•Ph ~ __ Mode ~ Am~a - Simplex t)u ex - ~ N ~ ~2 : .115 1. ~ Nan _ _„ 8.6 1 r - - 2 qr 3 ~ ~< 1~ i Auto 85 ln+`luded 2a 3 - - t New 4.3 1 _ 2 or 3 _. ~ '~' = ~~ 1 _. Acto ~ _" 4 3 Inolud ed 2 or 3 I ~+ as i 1+5 ~!_ Non _ 105_ _ _ 1 ~ 2or3 5A~15S 11@ t ACi ~ 1PJS lncllMed 2or3 I +~t59 i 23G 1 ~ Non_ 5.3 _ ~ ~ F - 1 2 or 3 5F 1531 ~ r~{3 , t . .._. A1fa ~ .-- , 5 n- u " hx:lttgeci " . _-,. 2 or 3 is CAUTlON~J Ail in~tailatinn of controla, protection devices and wlNng should be done 6y a qualified ilseneed eieGtftrian. A?i elestricet and safety Bodes should ba followed irtaluding the most recant Nattanal ~k~c#ric Coda (NECj and the fkcupational Safety and Health Act (OSHA). .. n - .. _ _ ~,~~; __ _ ~ ~~ _ ~~ . ~ : ;_.~ _. ,„ ,- ,. s _._ , ,, , . .. ;~~, ...., ~ t -. . . .. .. , . '- ~.) ~ ~ ,- .__ . 1. .~ r 'f , I ~ r 4 i .. ~, ~ _ ' ~ ,_ - - ~ _ ?! _ ~}^ d ~, __ aiasos SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer fa FM0477. 2. See FM4712 for correct model of ~lectricai Alternator E-Pak. 3. Variable level control switch 10-0225 used as a cohtrai activator, specify duplex {3j or (4j final system. RESERVE PQWERED DESIGN ~~ _ ~~or unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. - R , . MAII TO: P.D. BOX 16947-__-.~~ ~- --^^- ----- ~ p. LoursviNe, KY 40256-0347 R ~~/4/ SHIP T0: 3649 Cane Run Road Mantrfactwsrs of . hrrR:ilww4v,TOeiler.com g/rw,~~~~~rrr jjjr~~~~// ~~a, Louiswlte, ifY 40211-1961 pp _ _ !-.rJ/a-, L t5oz) n8.273i ^ r lean} s2s•PU~fP QvQ~irr FUMN.F sNCE ~v°JJ 0 t,1 tits .60 240 32Ct Service Provider's Nance ~ ~ PC3WTS i2e9utato~s Name ~ "-"D~ Wcut+~ ~ Phut 795-64fi-2&3~ r 71~-64E'r2634 SYStem Firmer and load Panan~ers Design F 4513 pd A~aximum 'l18 Estimated 3Q0 Septic 7a 4000 RAaxtir~urrs 220 Svii q~ ~ Maxirnun't 150 Type cif NV Dom Nlawrnum 30 Maxirrptm >t0E4 100 mL F Septa ar}d l andl~ SeI1/~e once 3 Efltuent Stud inspe~ and c~ti $t ie~t once. every 3 and Test once g Pressure Laterals ~ ~ ~~ should be flushed and tested 7.5 fns for arm ounce 3 Qth neoets Coil~uctinn ~ ~a 1. Obseuvation R+pes are sbtted and material confarrn to Taber Comm 64.30-1. have a watertight qp. and are secured in as sewn in fire rtuxtr~d component manual. 3. Aid 1~' ~ ~ age cOn~ td Can 84.30 {6~}r Wis.1~m. Code_ and pressure P'P~'9 ~euials cx~nforrn ~ the 4. T~lage of !~ area ~ accarri ~~ ~ Gomm 84, VY~s. Adm. Code. 5. The m~rnd structure. aid other ~ w~ a uriold tx3aM or c~ei pbmr_ and help reduce frost P,ern. areas w~ ~ seeded and rrHriched to ~ ~ erosion • ~n "~'• .iii ^i iiMi~~~ p Grade ~ ~~ "'n _ Ri^ii:^illii ii is S-$" Diameter 1-aintul _ _ _ Si?ririld4'!' Vah~e $O3C Thre~led Cleanout _ F#ug or 8aU Valve Distr~ttti~ i..aterat tom sweep 90 or Two 45 Degree Bends Same E3iarrteter as t.ateral Projects S~:ot Wilson mound Page 5 of 7 Mcua~d System ll~anage~nt Plan ~ to Con~sn tam tlt~ ~+_ coax rn~ ~ operated ~ ~ with Corrarre 8,2-e4 tnre. Adm. code, aa~ stall rra ~ ~rdance + ~~ ~ ~ -iti~#-P (I~f?~A1) and SS't+YfYiR P~ 9.6 (41181};arm Cat w state rules pesfairur~ to system mainterr~nce and maimeraance report'nag. No orre shod ewe enter a septic or pump tatadc since daxagerous gases may be present that coufd cause death. Septc and purr>F- taratc ~andoarraent swat! tae in aacadaana]e with Comm 8:1.33, Yllts_ Adm_ Code when the taroks are no bnger used as AL7>n€t•S ~xrapeatertts. Septic or pump tank matahoie risers. arxess risers Arad s slaordd ae inspec6ed tar aster tiglNrress arad sores. AoOess open~+ags used for service and ~ strdl tae sealed x+raGerGghi upon ~ oorrapatetion of servxe. Awry opening deemed vnsawad. defective, or suta~ect ~ ta>iiane mast ae replaced. Eagxased access operdngs greabar than 8-+nc~es iEa chametet s#+a~ be seaarea air an etter.~ive toc%ag de~are fe prevetrt or unmathorQed a~yr irrta a ta>aak or t~ Projecf: Srx~f 1tVifson mound Page ~ of 7 _ _ _ ~. Departmeflt of Commerce division of Safety and Buildings S©1L EVALUATION REPORT in accordance with Corms 85, Wis. Adm. Code #2194 >'a9e ___i of 3 Gusium Septic Service County At#ach cmmplete sde plan on paper not less than 8'h x 11 inches in size. Plan must ~ CrOiX inckrde, but not tinrited to: vertical and horizontal reference point ), directions and __._ percent slof-e, scale or dimensions, north snow, and bcation a distance to nearest road- .Parcel I.D_ _ __ - Please Arm a!f iafot7rla ~Tr Revrewed ~ _.,., _ Date Personar information You provide may be used for (P.,.r~acy Law, s 15.Q4 (7} (m)}. ~;,. Property Owner ~ Property Location , Wilson, Snot ~J ,~ ~ Govt Lot n/a NW1/4, NE1/4, 534, T31N, R95W ----__- --•-_________ Property Ovrners AAsiing Address Lot # ~ l3~ck # 5r~d. Name or CSN~ 2953 State i-lwy 64 n/a n/a N1A _.._ ._ _ City State Zip Code Phone Number ~N ~ y~ y~ -I-,p~ Nearest Road Emerald WI 540131 715-265-7463 Forest State 64 New Construction ~= /! Resirterrtiat 1 Number of bedrooms 3 Code derived design flow race 450 GPD __ _ ___ __' Replar~merrt -i Public tx' commaaal -Describe: _ _ Parent material glacial til Flood Plain elevation, if applicable Y ~ ~- General commerrts Part of 80 ate parcel. Recommend mound system stung 96.8' rmrstoua. and recommendations: Banng # ._ .j ~~ ._. __ Pd Ground surface elev. 97.8 8. Depth to linti6ng facts 22 in. Sal Application Rate Horizon Depth dorrsinant Coles J Redox Description Texture ~ Stnx#ure Consis Boundary Roots GP OVR~ in. Ntunsefl ~ Du. Sz. C.ont. Color ~ ~ Gr: Sz Sh. `EfEa1N 'EB#2 1 0-5 10y3/2 none i sil 2mgr mvfr as 3f, Im 0.6 0.8 2 5-9 30yr3/3 none std 2msbk mvfr cw im 0.6 0,8 3 9-13 10yr5/4 ? done s~ 2msbk mvfr cw ~m ~ 0.6 0.8 4 ~ 13-22 IOyM/4 ~ none st7 2m~k ~ mfr cw - 0.6 0.8 _ 5 22 50 ~ 7.5yr4/4 ~_ ~~7/2 gr. sc! 2msbk ~ mfi - - 0.4 0 6 E t BOnng Boring # `.__~ Pit Ground surface elev_ 94.8 ft. Depth to iicniting factor 20sn. 50~ Apion Rate Horizon Depth ~ Dominarst Color Redox DescriFstion ' Texture Stnscture ,Consist Boundary Roots . GPDIft= irs. MunseA I Qu. Sz. Cont. Comer : ~ Gr. Sz Sh. ~ "EifA~1 `Eff#2 1 0-3 10y2/2 clone sil 2mgr mvfr as 2f, im 0.6 _ ^ fl.8 2 3-9 IQyrc4/4 node sil 2msbk mvfr ~ tw 2m,ico 0.6 fl.8 3 9-20 iflyr5/4 none ~ 2msbk mvfr ~ .__ r;w im 0.6 ~_.~.. 1.0 ._ 4 5 2fl 39 39-50 7.5yr4/4 ~ c2-3d i0yr7/2 ~ i4yr5/6, ~ ~ ~ lt)yr7/2 4/6 SyrS/6 . ~ gr.sci sl : 2msbk 2msbk __. _ mfr mfr cw -- - _ 0.4 0.6 0.5 1.0 ~~ ~ _..._ .__ _ ...~.- .._ ._.~ __-___ 4 ._....._._. ..,a .... ._.. } f s '~ Effluent #1 = gpp5> 30 < 220 m9>I- and TSS >30 < 150 mglL ' Effluent #2 =GODS < 30 mg/L and TSS <_30 rrrg/L CST Name (Please Prinp Signature: CST Number Tom Gustum <~~~ _~_ _ ?27618 i Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450937th 5t. New Auburn, WI54757 5!3112006 715-658-1344 U t i ~ r~ 1 E t 1~ ~~ i ~ !~ 1~ Jm i r 1 1 ~ A N f_. _ ,__.,._ CD ~ ~_ _ - ~ i- __-. _ _ sq,g. ~ t ~ti ~~r ~ __ _ --- S~R~ i _97 $ r `k~~2~,'~, ~ ~.' ~ ti ~:, ~ ~ ~ ti , t ~~__ ,~~ r A "" f t { to s~ ---yea i 0; } (.,_~.. W { ~~ ~,~ ~~ 4 «~ E ~p ~'° p - ~~ ~ ~g3~~ iw 3 m .~ Z~n~~S 1 mo ~~~ .~ a ~~ ~ ~ ~ <'' m 1 ~ ~ ~ .A~{{ F. W ~ ; _~ ,.w~, _..___._... ~,~ .1~..._ a c7 -} d b a __ -__ 4 1 (~ w.J ~ eta i i i ~ ~ u , i ~~ ~ ~m m~u D ~~2 ~ rj ,~. mo $~ .. 4 Q j ~ Z ~ ~" ~ ~ Il ~ e o-r ~ 4 0~ ~ i ~_ ~' ~' ' ~ ~ g ~ , ~ i~ - J v ~ ~ S i ~ 2 ~ ~ , 'fl r 0 i i i i Y tl 1 1 i 1 I 1 Y i S ~T 1 Y ~ i ~ "s ~ ~ ' ~ i ~ ~ t 1 1 7 • S ~._ 1 1 i ~ .._ . t .-T- v i . X 1 V {4r y -. ~~.~ - a ~. ~-- th j,- . ~ .~, 32~r r f~ y ~~ r I '~ I ~~~~~ 4 f~ ~' ~~ ~, ~ ~ tm m ~ ~, t ~ ~m mo a t _ - p2 . , r ._. , _. ~ ~ ~ C7~ {1 ~ - - .i~"'~ ~ i ~~ a a i;~ ''a ~ W ~ ,~. 1 '~~ WG~~ ~ V O~ ~ L.~~..,~l~~~ ~ ~~ ~ ~~~~ 3~3~ ~ ~,., ~- C ~' ~ ~ rb ~ ~ '~ d ; ' ~ ;i ' ~ ~~ ]Y /' ' ~"# ~ -{ m ~~~ ~~ ~`~~ ~ ~ ~ ~~ ~ ~ ~ ~ ~ °.~ 1 1 1 -~ _~T . i. ~--_.. x ~~ ~--- s W~~ m ~ ~ n p ~~ 0 i i r r e r i t t t 1 i i i i ~, ~, ~. ~' ~~ ~. r~ a t r t i i i i, r w 4 E I 1 e i i i r E f 5 c C gyp. ~~ ~4:~~, ~~~, Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPOR in accordance with Comm 85, Wis. Adm. Cod #2194 Page 1 of 3 Gustum Septic Service Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must i l d b t t li it d t l i d h l County St. Croix nc u u no e, m e o: vert ca an orizonta reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. Review By Date Personal information you provide may be sod fortSf~riCd rivacy aw, s. 15.04 (1) (m)). 11~~LL~l1~, ~s d~ Property Owner Property Location Wilson, Scot Govt. Lot n/a NW1/4, E1/4, S34, T31N, R15W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2953 State Hwy 64 n/a n/a N/A City Stat Zip Code Pone um er City Village Town Nearest Road Emerald WI 54013 7 - - Forest State Hwy 64 New Construction Use: / Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial -Describe: Parent material glacial til Flood plain elevation, if applicable n/a ft. General comments Part of 80 acre parcel. Recommend mound system along 96.8' contour. and recommendations: ^ g Boring 1 Borin # Pit Ground surface elev. 97.8 ft. Depth to limiting factor 22 ~n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GP D/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-5 10y3/2 none sil 2mgr mvfr as 3f, im 0.6 0.8 2 5-9 10yr3/3 none sil 2msbk mvfr cw im 0.6 0.8 3 9-13 10yr5/4 none sil 2msbk mvfr cw 1m 0.6 0.8 4 13-22 10yr4/4 none sil 2msbk mfr cw - 0.6 0.8 5 22-50 7.5yr4/4 c2-3d i0yr7/2 5yr5/6 gr. scl 2msbk mfi - - 0.4 0.6 •------- * Effluent #1 = BOD 5> 30 < 220 mglL and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number ~ N13450 937th St. New Auburn, WI 54757 5/31/2006 715-658-1344 2 Boring Boring # pit Ground surface elev. 94.8 ft. Depth to limiting factor 20 ~n. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-3 10y2/2 none sil 2mgr mvfr as 2f, 1m 0.6 0.8 2 3-9 10yr4/4 none sil 2msbk mvfr cw 2m,ico 0.6 0.8 3 9-20 10yr5/4 none sl 2msbk mvfr cw 1m 0.6 1.0 4 20-39 7.5yr4/4 c2-3d i0yr7/2 5yr5/6 gr.scl 2msbk mfr cw - 0.4 0.6 5 39-50 10yr5/6,4/6 f2 5yr5%67/2 sl 2msbk mfr - - 0.6 1.0 SBD-8330 (R.07/00) Property Owner Wilson, ! ~ ~' ~~'~~_~"` Parcel ID # ~- ~ 3 Page 2 of 3 3 v x~ "Boring Boring # `"'~"T"~°~~ 97,8 ft. Depth to limitin factor /, Pit ~ce elev. 9 23 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "EtT#2 1 0-4 10y2/2 none sil 2mgr mvfr as 2f, im 0.6 0.8 2 4-10 10yr5/4 none sil 2msbk mvfr cw 1m,lco 0.6 0.8 3 10-23 10yr4/4 none gr. sil 2msbk mfr cw lm 0.6 0.8 4 23-48 7.5yr4/4 c2-3d 10yr7/2 5yr5/6 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#t `Eff#2 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 "Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L " Effluent #2 = BODS < 30 mg/Land TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) GUStum Septic Service w r ' {sP~( 01~ i i i 1 _~~ i 1 ~ ~ i8 1; 1 r ~~ ~' _~ ~~ _~ I ~_ p\ ? N .__.._____.____ __-- 07 1 I j-------- -- (~ g4.$' -..'~~qlJ r ~ _~~ --- 1 -------- _ _ _---- - -- 1 ~w ~ 1 ---____ -~ %8'~~ r --g~8. _~ u 1 I 1 ~ w CO-~~ur 0~ _~ I 1 ~A ~~~ U~ ~ A A~ . ~~~ ~ r ~~,,,,A\ __'L ~ IA w I I -~~ I c t~ N D . N 1~ N Qn S~ 3 4j ~ 3 IN_ . S ~ ~ ~ C S. S. G. ~ S 3 1(Q _ ~ I 9 m~ ~v ~ ~ ~a ~ ~~~ w ~_ ~ ~ I ~ ~ ~ W w ~ ~ ~ ~ ~ ~ 1 -- ~ a~ g ~~ ~~ \~~~ o' ~n ~\ ~' ~/ ~'---~ ~~~ W o~ ~~ J A~ ~~ ~ "' r m° - ~ 8~ v .. 4 4 ~ ~~ '1~ O ~ O 0 AA'' `3 II 1 ~ 'a, ~ c3 ~ m m m ~ _ \~~ ~i~ i \\ ~/ ~~\,~~i. \\4 ~ l 2G~ ~ ~ I'aa.d ~~ ~, ~~"~~ I I I I i 1 1 i i i i ~~ ~~ ~~ ~~ ~~ v ' i c i c C 1 t n i ~~~~~~ ~~ it DOCUMENT NO. I - --- - -- --- ____ _ .. It von. ~~O~i ~ac~ ~~'~ STATE ^:\R CF \+.'ISCON51:•f FORM 2 - 198.'. II \'t'ARI2AiVTY DL•1:1~ ____John C. Coffer and Laurie L. Cofr.~L-_ cc•nvcys and .vamm~[s to ~cnt ~_WiI ,.~,[ an i i~~tnCe~ °i.._ __ _- LJi l san.,_hu~ancL~.nd_~:~f~,.__as~t [~ri~r_orsha.g-- - ______.. -- - -mar---ta 1 f'r~R~-Y~~ ------- -- ---.. - •---- - - [h~ following descrilxd real ^statc in --fit..-Crni x - -- -.. --- --County, Sate of Wisconsin: -r!Tl_e Mel.~nr•R srATr anR c~r• wlsco~~!gnie M. Guiiixson (lr not.. A10tary Public aathorizcd by 1;70ti.06, V.~15. Stars.) State of Wisconsin IIIIS ItJS TRIJMFMT WAS f)RhF'1F0 RY tai;tt~Cne iCilStiiea v iFiitei _.------~ ----.^- -~ -T-~--l/~f-'~t~~--rr- -~-------------- ---- (Si~,na;I:res m:+l• hr .nlthe•ntiiat:•d nr acknnwl~d};ei1 R,ah :uc n,rt nr. rscar)t) 014-1073-30 PARCEL i0EN71RICATION NUMBER ~^ 11-e ~io:_thwest Quarter of :hF~ Northeast Quarl~r, Sect_on 34, Tos,mship 31 North, Ranbe 1S tdest, To,an of ForPSt, St. Croix County, 47isconsi_n, L~CEPT part to St. Croix County for HigtlWay purposes .recorded in Volume 220, page 350 and recorded in Vo7.ume .302, pane $6. ~°~~i~:~~ER a dJOo phis 1S ~ homes[ead progeny. (is)~~ - L•xception to warranties: raSP_1 :entS, restrictions and rights-of-way of r~`eord, if any. Datccl this 6th _ day of ~t~,fnher „ A.D., 19 96_. ~> J ~ _ (sent) ~:~~-G~~ ~~'' ` `' _ _ (sr:,>,i.> John C. Coffey -_ Laurie L. Coff~ `- - AU : IiEtVTICr1TtON Signature(s) atnhentica[cd this _ day of tsr_nt_~ 19 i; ! [+ ,~ •~:r~. ,- t ~EG!S i ER"S Gi=FICE _V ST. CRGIX CO., YJI Recd Icr Flecad S~F 1 ~ 1996 at =o:oo ~;.~; hlec~istur of Deec's nus sPncr: nr-senvEn ron nr-rnnolNC unTn NAME hND RETURN ADUnESS Northwest Irami 15.t1e, Inc. Bcx 520 Nti1ltcAarl, WI 5/+$58 ACKNOWLEDGMENT (seau State of Wisconsin, lI! c fit. Cr OlX _-County 1 Personally came before me this Eith __ day of SaE YPmhPr 19__2.. the above Warned John C. Coffw and Laurie L . Coffey, ____ -- --- _htis~rld_ans~sti~e,__-__-_____ ___._ _ ---_-.._ _ to ru~ kn,+v:n to he the person __r, .-_ who csecutrd tht• frnrg~nn,; instnmlynl and tl:~kr.,twlcdgc the santc i Connie L1. Gullixson N.xar)• 1'uhli.'. _. _ .. -- _-_-- ._.._-~r._CrC1X _ County, WIs PI)• , n1111IIIGLIrlr1 Iti 11t'llllalleri[. (1( Ill,l, f(.lt.' l'X1,1raUr+il c1a1C' -- 12-14 ... , lo_ 97_ ~ ,...,., .,i L, ..,, .,ppu,;; , ,.,. ~.,p,. sl„•oLl by Igr-J , . Pr„rrd i,Arov ,t,: ,r .:I:.,. ,.,,~. r: v:x.~~ t, nrn, [.~ t t' a.tu ct[' tt~tsc<,..t ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~C,G.t ~ IvCi,i~lee~ ~ j ~ S .a-11 Mailing Address z~~s3 - ~'LPX'~ Syo 13 Property Address ~ .S.T 1-f- ~~ (Verification required from Planning & Zoning Department for new construction.) City/State ''E /~l'-X Cx,Q ~ , w~ Parcel Identification Number ~ I ~ - 1 0 '7 3 ~ 3 O - ~~ LEGAL DESCRIPTION Property Location ~ ~'/4 , ~ C '/4 ,Sec. 3 ~ , T 3 ~ N R (~ W, Town of ~~ ~~ S -F f~ /~ ~.~GGG~~''~~ y~ --~3 ~ ~` ~ Lot # 3y~ 17 Subdivision ~ . Q,~t2o Certified Survey Map # ,Volume ,Page # Warranty Deed # Je L{ ~ y ~Q 3 ,Volume `~ O p a ,Page # ~ ~~ Spec house yes no Lot lines identifiable ye 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 §Comm. 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 andlor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/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. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe 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 3 ,~ IGNATURE OF APPLICANT(S) lPl2~'~~ 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) ~~ ~ . ~-~ ~ ~ i ~ La ~~ ~t o~973~r1t Ld1`'~ - " year ~Ct ~~ ~)~~ - G~! I S 1f~2~ Per. UNPLATTED LANDS Hatched Aren is a STH _"64" 2664.52' DO. T, permitted access 589'10'11"E 66_6.13' pOB "B" ------------- 666.13' ---- _______________-POB "A" ~ 600.12' 66.01 1332.26' 589'10'11"E sa.aR' __~; ~ .----------------~'~,--0 _ _ _ _ _ 600.31' _63.79° 589'10'11 "E Z 589'14'04 E _ _ ~ 63 7 ~ N th 1~~ ~~ IC ~z ~ ~•fl ~~ iy teh is 1~~ 5~ la ~z I~;r z ~~ ~~ io ~ building setback line ~ Or ear ~ Burner o so' Section 34-31-15 ~,~ •.~ LOi 1 A 2~.+~Fd~{Survey Mark Nail 00 ~ ~ CSM H5332 rNi' g soo•o 53"E 15ad.3t' W ; ~ ~ ---'-- ~ cen terllne of 66 foot wide A i O~ N s ingress-egress easement U~ ; rri . ~ ~ A ~~~ o o ~~' a m q^ ~ N8959'31"E ~ J ~ m o Parcel "A" o a 1,527,074 sq.ft. 1,488,583-s N m 35.06 acres 34.17 acres o° Nw e°r~er incl. r-o-w not incl. r-o-w SW/NE Z o a0 line -i•~-^(JL~ _- -- -- O > N ~ rn V ~ ' N CO ~ 589'59'31 "W 1271.21' ~ ~ 0 1~~ ~~ ~,q ~3 Parcel "B" V ~ W A 1,527,078 sq.ft 1,522,870 sq ft 35.06 acres 34.96 acres incl. r-o-w not incl. r-o-w A SW corner 2658.69' sw/NE 589'09'33"W 1340.62' O='; 589.09'33"W , West 1\4 corner ~';N UNPLATTED LANDS Section 34-31-15 °•'~ ~ --------- ------ o;o Fd 1,25° Iron Rebar w ; °' A W (.fi ; N_ m ~ South 1\4 corner -t =- Section 34-31-15 Found 'PK" Nail ~ ~ S° North is referenced to the North line of the Northeast Quarter of Sec. 34-31-15 which bears 589°10'11"E (St. Croix County Grid System) t^ ~z ~ro ~d;~ I ~ ~m Iv °o ~F, °rn ~F,~ w N = N°fi ri m 0 NE corner SW/NE N N 1~~ 5~ iC ~z I t9 it. p iy ti iH ~~ is MAP OF SURVEY PART OF THE WEST HALF OF THE NORTHEAST QUARTER, OF SECTION 34, TOWNSHIP 31 NORTH, RANGE 15 WEST, TOWN OF FOREST, ST.CROIX COUNTY,WISCONSIN ~f8 - 12001 1ST. CROIX COUPf-r MIRHEYOR'S RECORD PARCEL "A" DESCRIPTION Part of the Northwest Quarter, and part of the Southwest Quarter of the Northeast Quarter, of Section 34, Township 31 North, Range 15 West, Town of Forest, St. Croix County, Wisconsin, Commencing at the North Quarter corner of said Section 34, Thence 589°10'11"E, along the north line of the Northeast Quarter of said Section 34, a distance of 666.13 feet, to the point of beginning of the parcel herein described: Thence continuing 589°10'11"E, a distance of 600.12 feet; Thence 500°06'53"E, a distance of 1640.19 feet; Thence 589°59'31"W, a distance of 1271.21 feet, to the west line of said Northeast Quarter; Thence N00°03'45"E, along said west line, a distance of 804.26 feet; Thence N89°59'31"E, a distance of 666.07 feet; Thence N00°03'45"E, a distance of 845.31 feet to the point of beginning. Said parcel contains 1,527,074 square feet (35.06 acres) and is subject to easements of record and as shown. SCALE: 1" .400' 1340.62 SE corner ,~ 0 s,u//wr 589'09'33"Wl~ ~ East 1\4 corner Section 34-31-15 Found RR Spike (down 1') Set Survey Mark Nail 0 400 800 LEGEND 0.........Government Corner (as noted) Set 3/4'"x 24'" Iron Rod weighing 1.5021bs./lineal ft. ...........Found 3/4" Iron Rod OWNERSlPREPAREO FOR. PARCEL B D E S C R I P T I O N SCOT & NANCEE WILSON 2953 STATE RD 64 Part of the Northwest Quarter of the Northeast Quarter, and part of EMERALD, WI 54013 the Southwest Quarter of the Northeast Quarter, of Section 34, Township 31 North, Range 15 West, Town of Forest, St. Croix County, Wisconsin. DRAFTED BY: Commencing at the Northeast corner of said Section 34, Thence Joel A, Brandt N89°10'11"W, along the north line of the Northeast Quarter of said JB SURVEYING LLC Section 34, a distance of 1332.26 feet, to the Northeast corner of the Northwest Quarter, of the of the Northeast Quarter and east line thereof, being the point of beginning of the parcel herein described: SC~k Thence 500°06'53"E, a distance of 2689.82 feet to the Southeast ` ~ S1•,.•••••••••.,, ~,L corner of the Southwest Quarter of said Northeast Quarter, and south ,* :~ JOEL A. • * line thereof; • BRAMOT ' S Thence 589°09'33"W, along said south line, a distance of 1340.62 feet, ~Q3 : QlEt1YY00D CIJY r to the Southwest corner of said Northeast Quarter, and west line . , ~ thereof; ~9ti''••......••'~ Thence N00°03'45"E, along said west line, a distance of 1069.48 feet; ~;• S( Thence N89°59'31"E. a distance of 1271.21 feet: Parcel #: 014-1073-30-025 06/29/2007 09:09 AM PAGE 1 OF 1 Alt. Parcel #: 34.31.15.544A 014 -TOWN OF FOREST Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/19/2006 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -WILSON, SCOT D &NANCEE M SCOT D & NANCEE M WILSON 2953 HWY 64 EMERALD WI 54013 Districts: SC =School SP =Special Property Address(es): ' =Primary Type Dist # Description SC 2198 GLENWOOD CITY SP 8020 UPPER WILLOW REHAB DIST SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 34 T31 N R15W NW E EXC CSM 22-5332 Block/Condo Bldg: ~ Tract(s): (Sec-Twn-Rng 401/4 1601/4) GC~ -31 N-15W Notes: Parcel History: Date Doc # Vo1lPage Type 07/23/1997 2000/127 WD 07/23/1997 1094/392 WD 07/23/1997 984/188 LC ~nn7 cl IMMeRV Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 05/16/2007 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 16.500 1,500 0 1,500 NO UNDEVELOPED G5 0.500 50 0 50 NO PRODUCTIVE FORST LANDS G6 10.000 18,000 0 18,000 NO Totals for 2007: General Property 27.000 19,550 0 19,550 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