HomeMy WebLinkAbout032-2172-12-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
567246 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:
Lee, Bradford &Susan Somerset, Town of 032-2172-12-000
CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No:
fO6 al—. 1 c6r 18.30.19.1452
TANK INFORMATION `"'vv ELEVATION DATA
TYPE MANUFACTURER g,,,,.40 CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
(,A);eu�. 'ell-...
/z50 �� /If SS /60
Dq — Alt. BM
F;li 854- (Mk O)4— G . 5 /d3 . 2
Aeration //./0 Bldg.Sewer
7.4 /az .4'
Holding lam" St/Ht Inlet g, I /o/- IS
St/Ht Outlet
TANK SETBACK INFORMATION i • /iv
TANK TO P/L WELL BLDG. y
Vent o S t
Inl ake ROAD Dt Inlet
Septic J Dt Bottom ........-
7 /SO /1/I- /5 16o --
Dosing Header/Man. Y•S(, Ido , (0 7
Aeration ` Dist. Pipe /d. 41(4/
r O
Holding Bot. System e yr/ / Z gG, ..5S S
L
Final Grade M ,7, 6
PUMP/SIPHON INFORMATION Meat ,� /o2. . 5
Manufacturer Demand St Cover s L 6
GPM 41 5 / . a
Model ■ ember
TDH ° -• Friction Loss System Head TDH Ft
C------ _____--
Forcemain Length Dia. Dist.to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width f Length / [No.Of Trenches ((, PIT DIMENSIONS INo.Of Pz_ Inside Dia. Liquid De t _
DIMENSIONS 3 St,. 16 Z_ 'ire..,j 4V J
SETBACK SYSTEM TO P/L / BLDG /WELL LAKE/STREAM LEACHING Manufacturer
INFORMATION CHAMBER OR ' % '1 I* P—
Type Of System: w/9 A J,/L UNIT Model Numb
Cent/-� 'e tv/ �1/T� /1/r1 of✓i4/z `� 1�,✓ I�o�7,t
DISTRIBUTION SYSTEM ` 5o #4.t. Z l d- ZZ = I/3 h 4-0
Header/Manifold / If Distribution x Hole Size x Hol Spacing Ven`t,10 Air nt ke c
4 Pipe(s) �' �, "'�� J O v 7
Length /'S Dia ___III Length Dia Spacing Q..�-
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil'•■,.,......, C ,J No •••• ,X22.....1. 1 No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / /
Location: 349 153rd Ave.ipMFRSET,W 54025(NW 1/4 SE 1/4 18 T3ON R19W) St.Croix National Southern E ate Parcel No: 18.30.19.1452
1.)Alt BM Description= i/ 60% Z Go ve, A le-(ek/5
2.)Bldg sewer length= 3 Z ,i• k r e .,t e G „..„4 ,'.n.
-amount of cover= G K- off[ Lo140 An. sS
Plan Use otherls de for additional information. No l/
Required? 1Z
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<<toiX
@~ 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.)
P
P.O. Box 7162
r 3 A* i AM Madison, WI 53707-7162
/
nitary Permit Application sranctionNumber
In accordanc h S119-383.2](2), Wis. Adm. Code, submission of this form to the appropriate governmental 460 overnmental `~_~~t ' i't~k
'
is required prior to obtaining a sanitary permit. Nofe: Application forms for state-ownefOWTS are submitted o& t Qdress (if different than mailing address)
the Department of Safety and Professional Servies. Personal information you provide r~ used for secor~dary ! 9
u ses in accordance with the Privacy Law, s. 15.04([ m), Stats. fi / r m -
1. Application -Information -Please Print All Information U/~
Pro Owner' Name
-'r 7 . Patce
10 3,2 - W1 7,? 12 440
Pro Owner' Mailing Address O~ ✓t Property Location
-
00 G Govt. Lot
City, State Zip Code Phone Num
S-h t u~a ~-2 M tU 5 SDOo 2- W5~-a53-"~30 /ti SE /y Section e
circle oneL
T .30 N; R sow
11. Type of Building (check all that apply) Lot #
K1 or aI Dwelling-Number of Bedrooms I// Subdivision Name
,4&e,,
I'liQ~' / _ ✓t - Block# Sr, liroix A14ri..vsc Soe4inwa
❑ Public/Commercial - Descri se ~7/Gi/L07t ~t.v ~.C-y of
CSM Number ❑-i#ttgeof
❑ State Owned -Describe Use
Town of So.Md.6Sd r
III. Type of Permit, (Check only one box on line A. Complete line B if applicable)
A. New
Sys tem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B• ❑ Permit Renewal 11 Permit Revision El Change of Plumber ra Permit Transfer to New
Before Expiration n er
IV. Type of POWTS S stem/Com onent/Device: Check all that apply)
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 De ice (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal AreaRequired (sf) Dispersal Area Proposed (sf) System Elevation
e-00 .7 8s 7. / 8G 9. z 98.11
V1. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units a o
New Tanks Existing Tanks N at
c. U iA h v, c: C7 a
Septic or#IekWW*&nk . .
~a~S~ a?SG l L✓/ESE~t ~o.tl Gild 1'E ~
Dosing Chamber
VIL Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's re MP1k61tS Number Business Phone Number
a~,~ 6~EL~E P/G /J $,14 71-5' e 7a
Plumber's Address (Street, City, State, Zip Code)
G a 9~ S'r Hwy ~S . iueolJo l,J-I SY736
VIII, Jecoun /De artment Use Onl
Permit Fee Date Issued ssumg Agent 'gnatyre
IVPProved El Disapproved Te
El Owner Given Reason for Denial
$
IX. Conditions of Approval/Reasons for Disapproval
SYSTEM OVIPNER:
1. Septic tank, effluent filter and l f/yam t!`
dispersal cell must be serviced / maintained
as per management plan provided by plumber,
2. All setback requirements
y. r ark' t ...:.t r4? Irw
as per applicable4MdV1 fffft(Duns for the system and submit to the County on on paper not leas than g in x I I hes in siz
SBD-6398 R0313
4
Private Onsite Wastewater Treatment System
Index and Title Page
Project Name: -t~a-lj d Let-
Owner's Name: BVA-~ ,--A Sae- L"-
Owner's Address:
Legal Description: .-V(w, SE. 18 .?o ev /5' d
Municipality: IGNO. Vane,' eky of . So.yE,t.r~ r
county: .fir l~ix
SubdivisionName; Sr. L,toix 41.4 rio,j4i. . ~oar~.er ~'srArEs
Lot Number: ~Zp? Block Number. _
Parcel I.D. Number. D3d - d/ 7,? -
Page 1 .✓oE fir. r
Paget i"Los' i"~A~' ~✓~~i~oss- SEC3-io.✓ QA✓ tJ/E~,!
Page 3 ~Ei~ l'/G i~ ASK .S~~6GiF/G A rio.✓ S
Page /~d/✓T,f QcJ.✓ER S Zyww "e.4Z V' ~'1Aw/A6~'r~rE.rr' Pew!
Pages
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Page 7
Page 8 /9 y'rifGW/~rEirrs Spit ~yR l w y)-io w lekoo-a 1
Page 9
Name of Designer: o L KE License Number: 1*Y1- ,4?1-? y6
Signature: Date: /D •!o - W413
Designed Pursuaut to the Following POWTS Component Manual and Comm. 81-85:
In-Ground Soil. Absorption Cho ponent Manual for POWTS (Ver. 2.0) SBD-10705-P (N. 01/01)
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° SEPTIC MANUAL REV. Ili
\ Z W3716 US HWY 10 MAIDEN ROCK, N 54750 DATE: JANUARY 2010 DATE:. POST-POUR:
P REVISED JAN. 2010 800-325-8456 FILE: KM25D
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1459
"Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel's Soil Service Inc.
County
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D. 3 (g_ Y
Pleas t
I, Rev' ed B Date
Personal information you prov' r sondiy purposes (Privacy Law, s. 15.04 (1) (m)). Liz-
"-Property Owner € Property Location
44
Residential Development, Inc. 2000 0vt.Lot na NW 19 SE 19 S 18 T 30 NR 19 W
Property Owner's Mailing Address of # Block # Subd. Name or CS M#
12 na St. Croix National Southern Estates
8929 Aztec Dr. ; ,R,;
City State er City J Village 16 Town Nearest Road _ ~S3Y~
Eden Prairie MN 55347 952-9346238 Somerset 3 V7
✓i New Construction Use: / Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
~ I Replacement Public or commercial - Describe:
Parent material Knolls of pitted outwash Flood plain elevation, if applicable na
General comments
and recommendations: Conventional system, system eleva n 98.38ft. Trenches spaced and depth to code 5.42ft below grade.
Boring # I Boring
V Pit Ground Surface elev. 103.80 ft. Depth to limiting factor 110 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *E 1 PD/W
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 0-10 10yr3/1 none sil 2msbk mfr cs 1vf L.6 .8
2 10-34 10yr4/4 none sicl 2msbk mfr cs na .6
3 110 7.5yr4/6 none cos osg ml na na 1.6
Boring # Boring
Pit Ground Surface elev. 103.80 ft. Depth to limiting factor 110 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
1 0-36 10yr3/1 none sl 2msbk mfr cs 1f .6 1.0
2 36-57 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 7-11' 7.5yr4/4 none cos osg ml na na .7 1.6
I
Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <_30 mg/L and TSS <30 mg/L
CST Name (Please Print) ignature- CST Number
David J. Steel 248956
Address Steel's soil service In Date Evaluation Conducted Telephone Number
6S'~}
9rl 171, iL-/? eelcl o tJ / C Z 7/14/2004 715-.6W-
Property Owner Residential Development, Inc. Parcel ID # Pending Page 2 of 3
r
3 ] Boring # Boring
M Pit Ground Surface elev. 99.90 ft. Depth to limiting factor 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eft#1 PD *
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 0-10 10yr3/2 none sl 2msbk mfr cs 1f .6 1.0
2 10-27 10yr3/1 none sicl 2msbk mfr cs 1vf .6 .8
3 27-44 10yr4/4 none Sid 2msbk mfr cs na .4 .6
4 44120 7.5yr4/6 none cos osg ml na na .7 1.6
F-1 Boring # I J Pit Boring
Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QFDM
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 Stnucture Consistence Boundary Roots GPDIft!
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 S-30 mg/L and TSS <30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
~r
Page 3 of 3
STEEL'S SOIL SERVICE INC.
David J. Steel 994 200th St.
CST-POWTSM Residential Development, Inc. Baldwin, WI 54002
Lic. #248956 NWl/4,SE1/4,S18,T30N,R19W Bus.(715) 684-5680
Town of Somerset, St. Croix Co. Fax.(715) 684-3449
St. Croix National Southern Estates, Lot 12
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your
use. The location of this test may or may not be as shown, as permanent lot lines were not established at
the time the soil test was conducted. Legend
1" = 40'
A =Benchmark Ele. 100.00Ft
Top of 3/4" pvc pipe
• = Alt Benchmark Ele. 100.60Ft
Top of 3/4" pvc pipe
❑ = Borings
Boring Elevations
B 1= 103.80Ft
B2 = 103.80Ft
B3 = 99.90Ft
B4 = 00.00Ft
a2
97
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page Y of G
FILE INFORMATIO SYSTEM SPECIFICATIONS
Owner L. e-- Tank Manufacturer: 0 NA'
Permit # la Septic ❑ Dose ❑ Holding Volume: 1,7g0 (gal)
DESIGN PARAMETERS Tank Manufacturer: IN NA
Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gat)
Number of Public Facility Units: (9 NA Vertical Distance Tank Bottom(s) to Service Pad: /07 (ft)
Estimated (average) Flow : yap (gal/day) Horizontal Distance Tank(s) to Service Pad: 60 (ft)
Specific servicing mechanics must be provided if vertical is >15 feet or
Design (Peak) Flow = (estimated x 1.5): Cpl (9avdaY) if horizontal is >150 feet. Speck instructions to be provided on back.
In Situ Soil Application Rate: -.7 (gat/day/f?) Effluent Filter Manufacturer. rs r ❑ NA
Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: CaiC /p
Fats, Oil & Grease (FOG) 530 mg/L Pump Manufacturer:
Biochemical Oxygen Demand (6005) 5220 mg/L ❑ NA 5rNA
Total Suspended Solids (TSS) s150 mg/L Pump Model: .
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer:
(BOW >220 mg/L A aNA
(TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter
Pretreated Effluent Monthly average ❑ Disinfection ❑ Wetland
Y 9 ❑ Sand/Gravel Filter ❑ Other:
(BODS) s3o mg/L Soil Absorption System
(TSS) 530 mgtl \fi~NA
Fecal Coliform (geometric mean) 510° " 19 In-Ground (gravity) ❑ In-Ground (pressure) ❑ NA
Maximum Effluent Particle Size Ifi in dia. ❑ NA ❑ At-Grade ❑ Mound
❑ Drip-Line ❑ Other.
Other. ❑ NA [Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) ;9 When combined sludge and scum equals one-third (33) of tank volume
❑ When the high water alarm is activated
Inspect condition of tank(s) -At least once every: 3 00 month(s) (Maximum 3 years) ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
3 year(s)
Clean effluent filter At least once every: 1 19 month(s) ❑ NA
❑ year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) CYNA
❑ year(s)
Flush laterals and pressure test 'At least once eve El month(s) I$NA
ry' - ❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil
absorption system 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 treatment tank equals one-third (f) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113.
Wisconsin Administrative Code:
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of :512 months, shall be performed by a certified POWTS Maintainer.
A service report shalt be provided to the local regulatory authority within 30 days of completion of any servic® event.
START UP AND OPERATION Page of
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process 'and/or damage- the soil absorption system. If high concentrations are
detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use.
Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these
conditions is not recommended, as the excess wastewater will be:discharged to the soil absorption system in one large dose causing an
overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to-the pump or contact a Plumber
or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. Do not drive or park over, or otherwise disturb or compact, the
area within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment
tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat
scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, 'and water softener brine discharge.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safely abandoned in compliance with s. SAr383.33, Wisconsin Administrative Code:
• All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator (pumper).
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
X A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by required
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need
for a new soil and site evaluation to establish a suitable replacement area. 'Replacement systems must comply with the rules in
effect at the time of their permit issuance.
❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS INSTALLER POWTS MAINTAINER .
Name ,/oN,✓ E4~CE /`l/~-,13y~yt Name z;'y"i 1ELKE tK~ LvrM~i~✓s
Phone ~S G 7.7 - So?GG Phone /S G 7.7 - So? 6G
SEPTAGE SERVICING OPERATOR (PUMPER 11i ,CA✓OiJn/ LOCAL REGULATORY AUTHORITY
Name Name ~f ~o/X Zo•J Off/GE
Phone Phone 71-5" 2*4 - 0 14
80
i
ST. (TOIX COUNTY
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OWNFRSI fill 0-.'RT1f,'R.,'AT1()N FORM
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979488
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
STATE BAR OF WISCONSIN FORM 2 - 2000 05/30/2013 08:00 AM
Document Number WARRANTY DEED EXEMPT # NA
REC FEE: 30.00
THIS DEED, made between Signature Bank, a Minnesota TRANS FEE: 180.00
banking corporation, Grantor, and Bradford Lee and Susan PAGES: 3
M. Lee, husband and wife, as Survivorship Marital Property,
Grantee, "The above recording information i
Grantor for a valuabie consideration, conveys and warrants to verifies that this document has
been electronically recorded +
Grantee the following described real estate in St. Croix County, & returned to the aubmitter "i
Wisconsin:
SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART
HEREOF
Recording Area _
Name and Return Address:
Edina Realty Title, inc. g9
520 Commons Drive'
Woodbury, MN 55125
1076111
Exceptions to warranties: 032-2172-12-000
Easements, restrictions and rights-of-way of record, if any. Parcel Identifleafion Number (PIN)
This Is not homestead property.
Dated this 'day of May, 2013 I;
Signature Bank, a Mine to banking corporation
BY:'
Dani otoyos '
Assistant Vice President
r
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.Ir
WARRANTY Quo STATE sAR of WISCONSIN FORM No. 2-2000
i
1 of 3
AUTHENTICATION ACKNOWLEDGMENT
i
Signature(s) STATE OF /n I n
COUNTY OF 14jn4t1J! ✓1
authenticated this day of May, 2013
Personally came before me this 201J
* the above, Daniel Motoyoshi, Asa stant Vice
TITLE: MEMBER STATE BAR OF WISCONSIN President of Signature Bank, a Minnesota banking
(If not, corporation to me known to be the person or persons
authorized by §706.06, Wis. Stats.) who executed the foregoing instrument and
acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY
h'
Martin D. Henschel '
6800 France Avenue South, Suite 410
Edina, MN 55435 Inge n re
(Signatures may be authenticated or acknowledged. Notary Publ VState of Wisconsin
Both are not necessary.) My commission is permanent. (If not, state the k,
*Names of persons signing in any capacity must be expiration date:) I - 3 I -
typed or printed below their signature.
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INGE
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~iotary y„~,2o+7 j
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WARRANTY DEED STATE BAR of WISCONSIN FORM No. 2-2000
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel's Soil Service Inc.
County
Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimemsions, north avow, and location and distance to nearest road. Parcel I.D.
Pleas r =ry Rev' BDate
s Law,
( Y lm))•
' 1 Personal iMomurtion you prov 5.04
roperty Location
Property Owner j7-
Residential Development, Inc. F.1 Lot na NW 1/4 SE 1/4 S 18 T 30 NR 19 W
# Block # Subd. Name or CSM#
Property Owners Mailing Address
8929 Aztec Dr. MCI` 2 na St. Croix National Southern Estates
4 -T
Town Nearest Road
CMWThWWNM( 6' r City J Village JiV
City State
Eden Prairie MN 55347 952-934-6238 Somerset ~Y -
New Construction Use: rr Residential 1 Number of bedrooms 4 Code derived design flow rate 600 GPD
commercial - Describe:
;~A Replacement Public or
Parent material Knolls of pitted outwash Flood plain elevation, if applicable na
General comments
and recommendations: Conventional system, system elevation 98.38ft. Trenches spaced and depth to code 5.42ft below grade.
Boring # Boring
Pit Ground Surface elev. 103.80 ft. Depth to limiting factor 110 in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD&
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh• "Eff#1 "Eff#2
1 0-10 10yr3/1 none sil 2msbk mfr cs 1vf .6 .8
2 10-34 10yr4/4 none Sid 2msbk mfr cs na .4 .6
3 34-110 7.5yr4/6 none cos osg ml na na .7 1.6
Boring # Boring
Pit Ground Surface elev. 103.80 ft. Depth to limiting factor 110 in. Sod Application Rate
Horizon Depth Dominant Collor Redox Description Texture Structure Consistence Boundary Roots "Eff# GPD/ft=E
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh.
1 0-36 10yr3/1 none sl 2msbk mfr cs 1f .6 1.0
2 36-57 10yr4/4 none sicl 2msbk mfr gw na .4 .6
3 57-110 7.5yr4/4 none cos osg ml na na .7 1.6
Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <30 mg/L and TSS <_30 mg/L
CST Name (Please Print) ignaturh CST Number
David J. Steel - 248956
Address Steel's Soil Service in Date Evaluation Conducted Telephone Number
f1Z1
bnZ 7/14/2004 715-; 6
Property Owner Residential Development, Inc. Parcel ID # mending Page 2 of 3
F3 Boring # Boring
✓I PS Ground Surface elev. 99.90 ft• Depth to limiting factor 120 in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-10 10yr3/2 none sl 2msbk mfr cs 1f .6 1.0
2 10-27 10yr3/1 none sicl 2msbk mfr cs 1vf .6 .8
3 2744 1Oyr4/4 none Sid 2msbk mfr cs na .4 .6
oS9 ml na na .7 1.6
4 44-120 7.5Yr4/6 none cos
❑ 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 P
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑ Boring # Boring
Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
i
* Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <30 mg/L and TSS <_30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
Page 3 of 3
STEEL'S SOIL SERVICE INC.
David J. Steel 994 2000' St.
CST-POWTSM Residential Development, Inc. Baldwin, W154002
Lic. #248956 NWl/4,sE1/4,s18,T30N,R19W Bus.(715) 684-5680
Town of Somerset, St. Croix Co. Fax.(715) 684-3449
St. Croix National Southern Estates, Lot 12
This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your
use. The location of this test may or may not be as shown, as permanent lot lines were not established at
i
the time the soil test was conducted. Legend
199 = 40
♦ =Benchmark Ele. 100.00Ft
Top of 3/4" pvc pipe
• = Alt Benchmark Ele. 100.6OFt
Top of 3/4" pvc pipe
❑ = Borings
Boring Elevations
B 1=103.80Ft
B2 = 103.8OFt
B3 = 99.9OFt
B4 = OO.OOFt
~ a2
9 9d~~
33
-74,21
3
SB-l 7• 0
r R~ \
htw
Ate, ~
op N i r
acre
rr -1 ~ 47 ~ ~ ' ~ i
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All
~ ON
Parcel 032-2172-12-000 10/29/2013 08:03 AM
PAGE 1 OF 1
Alt. Parcel M 18.30.19.1452 032 - TOWN OF SOMERSET
Current ❑ ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
09/29/2004 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
0 - LEE, BRADFORD & SUSAN M
BRADFORD & SUSAN M LEE
1109 BERGMANN DR
STILLWATER MN 55082
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description * 349 153RD AVE
SC 5432 SCH DIST OF SOMERSET
SP 1700 WITC
Legal Description: Acres: 3.627 Plat: 10-032-ST CROIX NATIONAL SOUTHERN ESTATE;
SEC 18 T30N R19W PT NW SE ST CROIX Block/Condo Bldg: LOT 12
NATIONAL SOUTHERN ESTATES LOT 12
(3.627AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4)
18-30N-19W NW SE
Notes: Parcel History:
Date Doc # Vol/Page Type
05/30/2013 979488 WD
01/13/2010 910141 QC
09/29/2004 775659 10/32 PLAT
06/23/2004 766745 2602/04 WD
more...
2013 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 10/12/2010
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 3.627 47,500 0 47,500 NO
Totals for 2013:
General Property 3.627 47,500 0 47,500
Woodland 0.000 0 0
Totals for 2012:
General Property 3.627 47,500 0 47,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00