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HomeMy WebLinkAbout018-1000-50-000 n N G I c ~ ~ I ~ ~ eo ~ ~ ~ I I 3 ~ " I I n y f~D f~D N I ~ v N ~~n_ C N fn O I s O 5 <, c .. >>~ y to 3 3 o c~ I oc ~ 3 O O g ~ 3 I o z a~ w m po ~ I N S ~ °~ ° m o~ rn v a a l a w e ~ I o ~ ego c c n ~ I m ~ n co ~ O ~ N O I p I w aizD V! S', ~ o I ~ a~ I tn~D to to D _ a y N ~ m W a '' I m W a 3 ~ O rn° s _ I D ~. 0 I ~- ~ A C~ D N N I ~ N ~ ~ ~ y ~ ~ I ~ I I ~ ~ ~ ~ ~ z O O O o I ~ tan ~ N N N~ I a 3 o ~ m ~ two ~ I m ~ 1 I v ~ o o I m 3 ~ cn I ~ N I ~~ I a rt z I 0 D D o I =~ ~ a I o CD N y ~ tD CD G y c I u, I a ~ ~ ~ I ? I ~ I ~ C I ti, v, I ~, c I I ~ m I I W ~ I I a ~ I I ° o ~ I I y ~ I v I w I ~ I rn~ a 3 I ~a~ n o~ a x r ? m~ ~ a . ~• N _ N D O I = o° ~ a=i c I ~ f ~ ~ °- o=i rnm ~ I tD o a a I ~~ m o - I m I o mo_, m I rn I s f 5; rn ~ ~ I ~ I ~ ~ I ~ I m a~ O C) N Cn I j I f o x a ~ °' I I ~o ? I y I ~ ~ a I a I v + ~ , ~ I I o I I ~ N I I 3 o o I I I ~ I `~ I EA O I ts+ O o g o ~ °o ~ I °o ~ c ~ ~ ~ ~ ~ ~'~~ m ^~ N ODD 3 to C71 _ ~ c - a A a OD O J fA N N ~v v o' m _ ~ D cNO o a ~ N ~ f~D N 'C to ~ C 7 N ~ ~. c a t~D t~D a o :' 3 ~? Z F w c a 3 m o ~ ~ ~ v m ;c ~ = 0 0 ~ mmmJ ~ Q} j r `' a w ~ W o 0 °. tNp O C 3 :'! c .. o ~ D J V ~ ~ N A Z A ~ ~ ~ N 4 co z A N d ~:: m m b ~1 ~1. ~• O lti /y~ • v y 4 ~• a. x A b 3 t N O N O a 0 N dQ ti ~ N ti ~ ti Parcel #: 018-1000-50-000 12/2o/loos 02:45 PM • PAGE 1 OF 1 Alt. Parcel #: 01.29.17.36 018 -TOWN OF HAMMOND Current ',.X. ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s)' O =Current Owner, C =Current Co-Owner O - HAMMOND, PETER J PETER J HAMMOND C -MILLER, MICHELLE L MICHELLE L MILLER 1809 IRVING AVE S MINNEAPOLIS MN 55403 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 2071 117TH AVE SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 23.350 Plat: N/A-NOT AVAILABLE SEC 01 T29N R17W PT GOV LOT 2 & PT SW NE Block/Condo Bldg: BEING LOT 1 CSM 11/3177 23.35AC EZ-I-1205/378 Tract(s): (Sec-Twn-Rng 401/4 1601/4) 01-29N-17W Notes: Parcel History: Date Doc # Vol/Page Type WD 12/01 /2004 781331 2706/195 ~~JJn~ ,~ .~~yo.L--(t> ~~i2.~!~-E'er 9AAR CI IMMARV Bill #: Fair Market Value: Assessed with: -- - - - - ------- -- - - 171820 406,600 Valuations: Last Changed: 06/30/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.000 52,000 175,600 227,600 NO PRODUCTIVEFORSTLANDS G6 21.350 85,400 0 85,400 NO Totals for 2006: General Property 23.350 137,400 175,600 313,000 Woodland 0.000 0 0 Totals for 2005: General Property 23.350 137,400 175,600 313,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 09/27/2005 Batch #: 05-22 Specials: User Special Code Category Amount 010-GARBAGE SPECIAL ASSESSM ENT 60.00 Special Assessments Special Charges Delinquent Charges Total 60.00 0.00 0.00 ~':~a ~' Stock No. 26273 ~ ~ ~ ~~. t 1996 U ~5~.46 ~1 '~. ,~ ti St CROIX COUNTY ' ~' ~ 4C~ St1RVEY0R'S RECORD ;.- ~~ Y,pt CERTIFIED SURVEY MAP NO. 55146 ~ VOLUME " ,PAGE 3177; ti BE/NG A PART OF GOt/ERNMENT LOT 2 AND PART OF THE S. W.1/4 OF THE N. E.1~4 OF SECTION 1, T.29 N., R.17 W., TOWN OF HAMMOND, ST. CRO/X COUNTY, W/SCONS/N. wESr 1/4 coR FD. Z" ~P./CONC. ~ ~ ~\p ~I~ y ~~~ Q ~ 5266.47 SOO'09 34 E 2611 3J~ 2655 14' ~~ ~ e ~ O . . y ~ C = tiZO~ ~ ~ N I ~ O !tit a ibv N O ~~~ ~'{~ CVO ~~ iw~ 2o~a ~~o~ ~o`~ =;z O Aa~~ a ~ ; a c I~ I~~ I r ~Q cOp V ~ UV 0 o r 0 O v N °o m C' LOS Dm ~J: ~Oo 7~cZ ;G• Z c' :~ ~ m • `\ • O p ~ ~ ~ i i i i ~ ~~ ~ ~ Nw = O ~ ~ O ~ y ~ ~ k ~ ,y ~A~;Zo ~ ~ ~~ "~ O ~ O~ Z O 2 ~- O O ,9 9 ~ ~~ I~~ .~-ti 0 ~ i~l 7 ~ ~U ~/~ N ~~ ~~ti~ ~~ Ala ~ ,~~ ~ i~ ~'"~ ~ i~l 58~~"E99~ 115.351 1 ~Ci~o ~C~~ k ~~n c~o~z ~~,~~ ~~~~~ =o~~i ~~~~~ O~~Oy ~~~~~ ~~~~~ ~R~~m /z"~~.' • ~ w__ r FORM N0.985-A ,~ t~' , ^,1 ~~ • ~ AS BUILT SANITARY SYSTEM REPORT OWNER ~ISt/~ / e~ '~ TOWNSHIP gm rno~ SEC . j Tag N, R{ ~ W I COUNTY WISCONSIN ?.0. ADDRESS ~, ,' ST. CRS , ,tJi S SUBDIVISION LOT LOT SIZE _ ~.~ PLAN VIEW Distances & dimensions to meet requirements of H62.20 SHOW EVERYTHING WITHIN 100FEET OF SYSTEM rM ~~ ~' ~- ~~~ -- .~Id~ ~ z • 4~ ,'Q< w~ ' G~ 8a i~ ° ~c ~- C`7 , v°1 +~ r ~` c~ ~I ,me-F~ L ~~ ~I Q~ ,~ ,~ ~' .as 0 -~ 1~ °4 ~ ' c~ ~~ n ~: Z~ ~- 7 r` ~I ~: :. - , SEPTIC TANK(S). ppa MFGR. G~eG,fS CoNC2e~-~tCONCRETE~_ STEEL ~0, o£ rings on cover Depth. /a~~ DRY WELL Q D TRENCHES No. of width engt area BED no. o~ lines,~~ widt~_ ! ~ ' lengt ~ ' _ area q~ O de~t to top of pipe 3p "~ AGGREGATE / ` ~ ! ~u - o~K ~ AgFA AS BUILT ' FERK RATE /~ AREA REQUIRED ~~ DISCLAIMER: The inspection of this system by St, Cr©ix County does not imply I~ complete compliance with State Administrative Codes. There are other areas that it is not possible to inspect at this point of construction. St. Croi~s County assumes no liability for system operation. H©*rlever, if failure is noted the County will make every effort to determine cause of failure. GREASES AND OILS SHOULD NOT BE DISPOSED THROUGH TH BYSTE ~',i~~ INSPECT DATED ~ ' ~ ~J 7~ PLUMBER ON JOB _ LICENSE ~ ~ ~ ~, • REPORT OF IPISPECTIOrJ--I:dDIVIDUAL 5E[,)AGE DISPOSAL SYSTEt•i . - Srtnitary Permit ~~~ • .. ~'~ ' ~ State Septic ,~" ~j .,~, ~ , ~ TOt•TTQSHIP i~l~~.a-svo~ t. CrOl.s' COtinty s~ ~xlc Tn.*?~~ .S ~ N ``~ ~ . 3: •• Size ~~` gallons. `Dumber of Conpartments _, ° Distance From:. Tdell ~~ ~ ft, 1270 or greater slope ~" ft. .~~ ~ -' Building ~~~ ft, Wetlands f Iiighw~•~ter .ft. ~ ~ . ____r ___ DISPOSAL SYSTF,~2 7„~Tile Field or --- Seepage Pit(s) ~ . Distance From: ~~ell ft. I27a.or greater slope -'` fL Building _ ~(~ ft. Wetlands _~----° f:- FIT:Ln 'r'~i~;hwater - ft. Total length of lines ~f t, i~Tunber of lines 3 Length of each. line (Qn ft. Distance between lines ~ ft. Width of the trench ~ft. Total absor tion area =~" - . P _ ~~~,~ q . f t . Deg ttt of~rock below the in. Depth of rock over the =- in. Cover . aver ..rock ;_s ~'~,..~, .: % Depth of the below grade .~ J in. Slope of - trench __ ____in *~er 100 ft. Depth tp Bedrock `~ ft. Depth to ground water r __ ft. ______ . FITS. dumber of .pits Outsi4 d' r,ter ft. Depth below inlet ~ r,,,.. eft. Gravel around pi : ~~ds no. :Total absorption area __________s q . • f t . ~ - Square feet. of seepage trench bottom area required vquars feet of seepa . -~r=t~~ea required ~ - ~a Inspected.. b~:._ _ ~..-~-..~,d. _-V~'' .~ .. Title : .._.. Approved ~. %~ ~ ~ ~ , . Date / T 197 8 . Re3ected Date 197 - ,, ~_~f,.~~:.~- j C~ ~~ ~, ~ ~ i ` ( r ~ f ~ \~ ' ~ 1. - EH 115 • WISCONSIN DEPARTMENT OF HEALTH AND SOCIAL SERVICES DIVISION OF HEALTH, BUREAU OF ENVIRONMENTAL HEALTH P.O. BOX 309 f MADISON, WISCONSIN 53701 ,~'~' REPO~RgT. ON SOIL BORINGS AND PERCOLATION TEST,S/ / LOCATION:.L"/4,~~/4, Section ~ , Ti~~l, R ~.~f~(or) W, Township or Municipality t-YA~'y- m O~~i f, C,eoi'x Lot No. ,Block No. County ~~ L t Subdivision Name Owner's Name: 1~ el~/~' Mailing Address: R~~W/n~ , C.~J, S TYPE OF OCCUPANCY: Residence X No. of Bedrooms ~~~c ~ Other EFFLUENT DISPOSAL SYSTEM: NEW X ADDITION REPLACEMENT DATES OBSERVATIONS MADE: SOIL BORINGS l ~ ` ~ ~ ~ 7 ~ PERCOLATION TESTS ~~ ~ ~`~~ 77 SOIL MAPSHEET_ ~' 7'~- SOIL TYPE ~i9rJ~/`ROc~ c~iL ~- L-ORIti! PERCOLATION TESTS TEST DEPTH CHARACTER OF SOIL HOURS HOLE WATER IN HOLE AFTER TEST TIME INTERVAL DROP IN WATER LEVEL, INCHES RATE NUM- BER INCHES THICKNESS IN INCHES SINCE 1ST WETTED SWELLING IN MINUTES PERIOD 1 PERIOD 2 PERIOD 3 MIN/IN ~ rr f P~ ~ 'I ~ ~r it ~« tc ~~ lI ~ T ~a ~O (~ ~ ~ ~ / SOIL BORING TESTS TEST TOTAL DEPTH DEPTH TO GROUNDWATER, INCHES CHARACTER OF SOIL WITH THICKNESS, INCHES NUMBER INCHES OBSERVED ESTIMATED HIGHEST (DEPTH TO BEDROCK IF OBSERVED) B- , 7 0~ SgrC, 8" Sr Lo.9M Z6 v f)N ~ Z ~ rj'2 y / r ~i i! `~ ri r~ 2 ~ r~ caZb J b 7 c!' B ~ ~f y r~ ~ ~ + rr r~ c~lr r~ ~Y f ~7 B ~~ 7y~ T~ ,, ~-" ,~- ~~ ,r ~~r, PLAN VIEW (Locate percolationtestssoil bore holes and suitable soil areas.) Indicate on the plan the location and square feet of s itable areas. Indicate number of square feet of absorption area needed for building type and occupancy. ~ ~n ~ ~ Indicate scale or distances. Give horizontal and vertical reference points. Indicate slope. t 4 ^ p ~$ ~ ~ State and County Permit Application ® for Private Domestic Sewage Systems *DENOTES STATE APPROVAL REQUIRED Date Approval Received from State if Required State Plan I.D. # State Permit # `°~ ' County Permit # ~ County .S'f. C'~2o i x A. OWNER OF PROPERTY Mailing Address: ~~ l ~e. ~~-~ ~ ~ ~i4,L~w.a ,ms's B. LOCATION: '/4 /1/ - '/4, Section T N, R ~ (or) W Lot# City _ Subdivision Name, nearest road, lake or landmark Blk# 1 Village Township Ammbn7 9~ C. TYPE OF OCCUPANCY: Commercial *Industrial *Other (specify) *Variance Single family _ ~ Duplex No. of Bedrooms ~ No. of Persons~/Z D. TYPE OF APPLIANCES: Dishwasher X YES NO Food Waste Grinder Automatic Washer YES NO Other (specify) E. SEPTIC TANK CAPACITY /d~~ Total gallons No. of tanks ON`s.. *Holding tank capacity Total gallons No. of tanks New Installation ~' Addition _ Replacement _ Prefab Concrete X *Poured in Place Steel Other (specify) F. EFFLUENT DISPOSAL SYSTEM: Percolation Rate 1) ~ 2)~3) ~~Total Absorb Area "T~p sq. ft. New Addition Replacement *Fill System Seepage Trench: No. Lin . Fee~'S'(~ Width ~~~ / Depth `r Tile Depth ~_ No. of Trenches ~~e~, Seepage Bed: Length Width Depth Tile Depth No. of Lines ~~ Seepage Pit: Inside diameter 7~ Liquid Depth ~7~-~-r~ _ Tile Size Percent slope of land ~~.~ ~ Distance from critical slope t, the undersigned, do hereby certify that the information I have reported is in accord with Section H62.20, Wisconsin Administrative Code, and that I have sized the effluent disposal system from the EH-115 prepared by the Certified Soil Tester, NAME aL C.S.T. # ~`~~ and other information obtained from ~. (owner/builder). Plumber's Signature MP/MPRSW# /17 ~-~~9 Phone # 6 ~~' ~~7~ Plumber's Address .i '_ _ I _, YES X NO # of Bath Wisconsin Department of Commerce 1 PRIVATE SEWAGE SYTEM Safety and Building Division • - ` INSPECTION REPOI GENERAL INFO~MATf,,E''1N (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 Township Hammond, Peter Hammond, Town of CST BM Elev: •v~ 1 Insp. BM Elev: BM Description: TANK INFORMATION .O~ ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic ~"~ i;~V~r ~_ ~ /OUb Dosing o ~,, , 6 50 ~4et~ttion ~ c,. `~.~ ~ ~ ~ (~ V Holding TANK SETBACK INFORMATIQN TANK TO P/L WELL BLDG. Vent to Air Intake ROAD septic 7 ~JL~ ~ 7 ~ ~ ~ 15 cS / Dosing ~ ~ ~ 7 ~ i ~~ ~ /~ Aeration Holding PUMP/SIPHON INFORMATION Manufacturer 9~,~ S ~~ Model Number 1 DH Lif~ 3` /" Forcemain Lei SOIL ABSORPT ~,3°fS IMI'r Width ~ IMENSIONS (,~. SETBACK SYSTEM TO INFORMATION Type f System: 111STRIRIITIC~N SYSTEM System Head T ~o •Sfl 2~, Dist. to Well' '~ 'EM Length / No. Of. 1 12 •Sa ~ P/L BLDG y~ ~ ~~ Cmt -f.L~...~_ 3PM ..~.kr 22 ,e H l Ft I ~f.0 County: St. CrOIX Sanitary Permit No: 479316 0 Stat Plan ID No: ~O~p = ~ ~. arcel Tax No: 018-1000-50-000 Sectionlrown/Range/Map No: 01.29.17.3B STATION BS HI FS ELL' Benchmark 3.3 /03.3 ~ ~ Alt. BM BI .Sewer 7 Olt 4~ . Z~ t/Ht Inlet l~Jy1~ q.3~p 3 . StlHt Outlet ~~ ""~ Dt Inlet q . Dt Bottom /3. ~4• z Header/Man. / i \ ` ~; ~ q~ / /~~ Dist. Pipe S',fe •6 ~ Bot. System ,d, a • , Fin•~I.G~raw;U ~ IZ ~- St Cover / J •c1-~ ~• 9 ` c f cF, , p , Z~'r C~~ s. ~9 q~.o 3 Of Pits VELL LAKE/STREAM LeACHIr CHAMBE ~~ ~- bs' UN V ~.a~ ,.. ,.~ _ Dia. r>>~,~.~ t>~1 asp- ~ Header/Man fold M Distribution ~ Pipe(s) ~ ..-. , ' /Z x Hole Size ~ ~ f'~ x le Spacing C e ~ 2 2 Vent to Air Intake Length ~~ Dia ~ ~ - Spacing Length_ S5 ia C(111 C(1VFR ., o.e~~~~.e c..~•ew.~ n.,i.. ,... Mn~~nri nr Af_f;rarla SvefPms Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center BedlTrench Edges Topsoil ~ Yes L."' No I° JI Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 /ZG / W Inspection #2: U IP V Location: 2071 117th Avenue Hammond, WI 54 15 (SE 1/4 NE 1/4 1 T29N R17W) NA Lot 1 1 1.) Alt BM Description = 2.) Bldg sewer length = Z~ ~ t~b /' ~ 4~•-1 „~ ~^.~'~ - amount of cover = C+~ ~ f • ~ ~ ~I - ~- ~-,-~1t• - - __ ..._ _ _ Plan revision Required. I :=1 Yes No WMi+~.w ~ ~~ Use other side for addltlonal informa lon. i____ ___J_____._J ~ - -~ ~' - - -- --- Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) ~' ~7Q I~; 05/15/05 THU 08:25 1r.~ 715 386 ~ t3' ST R~ (1Q.~~~~ti`~~~~ X001 JUL 1 ~ Z00 iv~~1R~;;~~ Safetyatldl3u din ~ 701 W. Washiaglto ve_, p:Z,X3LlIbBlfEd~FF]C wry wu . - ~' ir~'G1 i~ - ~~ ~a~s~~ Madison, Wl De artment of Commerce (~~ ~dB~sd6 Pettnit t+lumbrx (ta bt filled is by Co.) ~ ~/(o ~i Samitary ~"ermit Applieat~nn __, ~"" P "'~°~ ~'° '°" / !n IlCieaSd with Cornett 9S.Zi, Wis. Adm. Code, perseteaB information yor provide i / / l_Q~~ (~ ~ ! ~ '~. C~ , f tt11y re tired (oe IiC[aadary pttrpotes Peivney B.aw, r15.01(Ixm) Project Address (if different titan mailing addresr} I. Application Intormactou - Plane hint All lafocmagor .~ ~~ Property Oamer'r Nerve _~.~ Pwstl ld ~~ [,ot # /L Blac~~~ Propsrtyl'JWOar'eMoiL'ngAddres~ ~ Pt+apartyLx~stton (.38) 'Ci~~ry, Sane ` Zip Code Phone Ntttnber ^ ~ ~ ~ •, Section - t L~t~t L~) - ~- ~ ! ~~Q~~ ~ ~~- lzD - D~ 0 © ~ circoe ~ / II. Apo of Bullding (ch k aCd test atDPBY) w T Ny R 1 at 2 Faati~ Dwelling - Ttttraber of Sedeeoms .-~ 0 P 6G l ' u 8~ CSM Nueobtx .M v.i~P 3 551 `~ ~~} n a Cesigtwaeial - Daen be K /~~ ^ $tItOE I,VVpad- Desertbe Una ~~ _ ae`hry_[htlBisg9e Owr®5' strip of%~/19 !3 tQ. 'I~pe of !'erarir, (Check Orly ors box or line A, CotapletrE 1lns 8 if applicablea 'k' ^ Nntr syttltent Rcplaogttwt 3rarem ^ 7rertmwvHoiding rank ltaplekataanc Onay~.. [} tkha~ laodlfitxeiaa to Frosting 5ystatn ---- ~. ~ Psemie,Rauaant ^ Permit>ievisioo ^ Ckutgs of ~ Peewit Transfer to New ~ Pie~~z PlYtrlit l~itnnbsr and Llaea lssuod Bslbto Eapittstiaa Plumbs tOwner (t r, ~ itv. er POwBrS S ai ltrett: that a 1 ~ x /2 , So ~~ - ' _ _ _ O Non ~Pr'eiauri>'sd to-Ground Malnd ~ 2/ ie. efsuitrbk roil ~ < 2d in. of suitable soil ^ At•t3rede n 5ing:e Prar Saud Pillar [] Cooatrllelad Wetland ©Pnxrutiaed lo[3roultd ~ Heldiny 7rttk ~ Pat Titer ^ Armbic Trertment Uelit ^ Recirealarirg Sand Filix Reeiraufatima Synebede 1Nedia FiBt~ ^ i..arehing I~tamber ^ Dti line d Gtavd-teat Pope ^ ckher (osplaiu) - .-~_ --- V. ~ rgttatnt Ara IuCortaati nc S.2 Daipn Fbw (gpd) t]eeiQn Shc Applicadoa RateB,gpdat) Disperxat Aral ltequirad (sq Dispersal Asa Proposed (st) Sys:em Flav a doa ( ~ .~~ ' ~~ ~/. D So+td~ 7 ~~ ~C/ /~ ~ ~~ YI.1'artk Info Crpretry io (911110t4S Teter GallOrla ttlttber ®fUtdtr Marafrenerer 11,T'/2_ l _ /1 f}-!W Ptt:frb t: Site COnStnlCfEd Steel tber ~lasa Plastie T/] its {dngTnrtc Eodo3 ._. QQ ~ l ~,~i ~ Aaehie Tteaurteer Uoit ~ ~ ttfbar ~~~ ~' ~ ~ ~ y ! ~~J VII. Res ralbtlit Statement- I, the ulidat'rltned, arrunle rnponalhll[ry ror lprulledon of Ibe POIVTS shows oil the amchtd piss. ~p~ PButttba's Natoe (Print) , P tray's Sigaalta-e MP11~tPR5 Numder 8lasintas Phase Numlxr lJ~c~° Asti ~, ~. dc~e~ ~~a ~`5~ ~.~' -~ 3.3 Plumbe!'e Addttess (Sttoek City, Suue, Zip C e) ~.~.~. VIR. Cott. / D artment Use Orl ~~` V Approved Q p' Srairary Penmit Foe rtefteder Grouodwaler Dote Inroad lssuittg Agent Sigeet+ere (Nto Stamps) 0 Rayon for irf Sttrchuge Fa) z~. ~ ._._S , zcx~s IiX Condi4ons A rev ~FP~'~ 3~ ~t~~ S.jE- / ~ d a /I n I a-C~ Md~iQ,d! SY T S EM OWNER: _ 1 Septic tank, effluent filter and ~ ~ ~ / dispersal cell must. all be serviced! maintained `f~ ~ ____ ~ ~ as per management plan provided by plumber. ~ ~Dr~ ~~s~.~. ~o~ - 2. All setback requirements must be i t i d - ^--- -~ ma n a ne ~ as per applicable code/ordinances. <--- ----~ ANerY compttlt pNre (te tVe Cerry esy) rer ~4 ryetata a• paper sot teu tkre nYr2 x I l Itreie~ Ir fizt ~~ rl-iJ SBD-639$ (R. 08/02) 5 04:51 PM A.C.E. Boil & 8iLe E~al 71,5 a48 7764 ~~ ~`~~ ~~ ~i.,x.l~ ~,. ~ ~. i E'lisEJ~ C.rer+..fe Syedra ~v'aac. ~C,..~ .~ L~d~T ~ r'GS%141Ct ~A~Vre1[ l~~s~?rr d.~,psa. r ~.r~~ • j~sicAdt. y.7~.1~Ofi'.C' Of Sid' cFf11~.nE~i?rt. l~W,s P. 01 ^ Sa:/ e~~l~ia~6•'an N sir/~ Re fir ~+•~w~o~r d%s~~j., ~~ 13~" orsriyr-rtl ~s~-~~d ~, 4.1cbd~ ems'/ks.~~~~w! 1,To~ic~E. a~~ t"~~~ P.+,e s`ed ~e'reenWi- .' .' ~~~ 8,~. ~.~.: ,~ st1s.~. Eru ,~ r~ ~ v ~X 83 dos ~ ~,~ Arm ~~~; ~ ~, tv ~~ ;y iii ~' ~ ~i' ~i~~/ S/4r[ Sy ~~.a /4 ~~ ~OE ~twi(s > /iO ~~`rirq sr.~ ~rq 4I'L< . ~P•s~.d r+l~nd~t d,;sptrsia/ctN. Taue(.X,) ~! Ef/L/rLtE /~ ,r SSSSo~/ ~~~+p/i~i'[~S ~/alta/ 1yl a.t t.Ot ~ ~,N~- ~~ ~~~ ~~ ~t~ ~Li OQ~ ~ G q.6KJ . ~~ ' . !~~' ee.~tes...t' • ~' commerce.wi.gov i ~ ^ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary November 23, 2004 CUST ID No.220853 DALE E HUDSON BOLDT'S PLUMBING & HEATING, INC. 820 MAIN ST PO BOX 78 BALDWIN WI 54002 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/23/2006 SITE: Peter Hammond 2071 117TH Ave Town of Hammond, St Croix County SEl/4, NEI/4, SI, T29N, R17W Govt. Lot: 2, Identification Numbers Transaction ID No. 1086631 Site ID No. 692810 Please refer to both identification numbers, above, in all comes ondence with the a enc . FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 994475 Maintenance required; Replacement system; 450 GPD Flow rate; 17 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual -Version 2.0, SBD-.10691-P (N.O1/O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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, COnd stats. ~~~~ The following conditions shall be met during construction or installation and prior to occupancy or use: DER RTMEF Approval Requirements: of • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE C~RF "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1/O1) and the SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST SAS (01/81) • The existing POWTS must be properly abandoned per Comm 83.33 Wisc.Adm. Code. • The proposed tank maybe located in an area subjected to saturate conditions.. If it is determined to be subject to saturated soils at time of installation it must be anchored per Comm. 83.43(8)(g), Wis. Adm. Code to prevent floatation of the tank. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. DALE E HUDSON Page 2 11/23/2004 • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) 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. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits 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 maybe 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. Sincerely, ~.~ O ~~~ ~_ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday cbratz@commerce. state. wi.us Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 c . MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Peter Hammond 3 bedroom residential mound Owner's Name: Peter Hammond Owner's Address: 2071 117th Ave. Baldwin, WI 54002 Site Address: Same Legal Description: Gov't. Lot 2, Sec. 1, T.29N., R.17W. Township: Hammond County: St. Croix Subdivision Name: Na Lot Number: Na Block Number: Na Parcel I.D. Number: Plan Transaction No.: RECEIVED NOV 2 2 2004 SAFETY & BLDGS DIV'. Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Dale Hudson License Number: Date: 11/16/04 Phone Number: J Signat re: .~.- ~' ~~ .~~l~~Jy ~~ COh?~pERCE _QINGS '~ONOENC 220853 715-684-3378 Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) Version 3.0 (03/01/01) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83-443 in-situ soil tr~tment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150%) coliform of <= 36 inches. 450.00 Design Flow (gpd) 4.50 Site Slope (%) 95.28 Contour Line Elevation (ft) 17.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 112.50 Dispersal Cell Length Along Contour (ft) = 4.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest oint in the distribution Y Pressure Disribution Information network? Enter Y or N (c ore) c Center or End Manifold 0.00 Lateral Spacing (ft) If N above, enter the elevation ft} 2 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) = 8.04 ft2/orifice 2.00 Forcemain Diameter (in) 100.00 Forcemain Length (ft} Does the forcemain drain back? ~~ 92.50 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 3.86 Vertical Lift (ft) 1.19 Friction Loss (ft) 11.56 Total Dynamic Head (ft) 16.31 Forcemain Drainback (gal) 50.97 5x Void Volume (gal) 67.28 Minimum Dose Volume (gal) 23.07 System Demand (gpm) lateral Diameter Selection in. dia. o tions choice 0.75 1.00 1.25 x 1.50 x x 2.00 x 3.00 x Manifold Diameter Selection in. dia. o tions choice 1.25 1.50 2.00 3.00 ______ Gallons/Inch Calculator (optional) Treatment Tank Information 646.00 Total Tank Capacity (gal) 2250.00 Se is Tank Capacity (gal) 38.00 Total Working Liquid Depth (in) Wieser 10001650 Co Manufacturer 17.00 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 646.00 Dose Tank Capacity (gal) Zabel Filter Manufacturer 17.00 Dose Tank Volume (gal/in) A100 Filter Model Number Wieser WLP1000~65 Manufacturer Project: Peter Hammond 3 bedroom residential mound Page 2 of 9 Mound Plan View 1 1 /j ~ Q B :. Observation Pipe K ~ T`~~e.1.-tiae,pti®ti~,.se,~.,~,a~.~..~~.•,,tie•~a.~~.®•.,R.~s~.,,~,.,~aow,'. ,'».,® . .. ti ti ~, tia4?:,e:ew~, ti • +s B _ _ _ _ _ _ • _~ i-U. T ^t J ~j TTA I 1 L Mound Component Dimensions A 4.00 ft E 21.16 in B 112.50 ft F 9.50 in D 19.00 in G 0.50 ft 450.00 (ft2) Dispersal Cell Area 4.00 (gpd/ft) Linear Loading Rate H 1.00 ft K 10.40 ft z 10.60 ft L 133.29 ft J 7.60 ft W 22.19 ft 1641.98 (fta) Basal Area Available 11.25 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area ...,.,f F 96.86 {ft) -- ' ~ ' Dispersal Cell :[~; Elevation Finished Grade 98.66 (ft) •. ff~.~ ff.. G H }... _ Dispersal CeR 97.36 (ft) Lateral Invert :D ~ ~ ... .. .• .• .• .• .• . . ...... .. ....... .. . . ..........1 ... .... • • - • • • • • . ' . . . .~ ..y i `S i ~i ~i ~ "i "5. }. i _1 a. . -L ~ i 5 Shading Key 1^ ®Topsoil Cap © }{~f~ Subsoil Cap ' • ~ : ASTM C33 Sand Tilled Layer 05 ~':r::: Aggregate 4.5 % Site Slope a 1.5 ft ~ o 0 ~ ~ 0.5 ft •~•a t.4. .y. e '~. ;? ` 3 F ~~,:' Typical Lateral ;_.::• _ I ~-- A ---* .28 (ft) Contour Elevation Geotextile Fabric Cover See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution cett's centeriine in the distribution cell (Ax6). Project: Peter Hammond 3 bedroom residential mound Page 3 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Bo1dt's Plumbin -Dale Hudson ~ Phone 715-684-3378 POWTS Regulator's Name ~ St. Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow -Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 300 gpd Maximum GODS 220 mg/L Septic Tank Capacity 2250 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Co{iform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins ect and/or service once eve 3 ears Should ins ect and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Ins ect for ponding and see a e once eve 3 ears Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished .~~~~~........ ............... Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve .. Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Peter Hammond 3 bedroom residential mound Page 5 of 9 ' ~ . ~ Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shalt be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01}and SSWMP Publication 9.6 (01/81)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in axordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shah be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater then 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet finer shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The fitter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank pertormance is generalty not required. However, if such products are used they shall tie approved for septic tank use by the Department of Commerce. Purr p Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. It an effluent fitter is installed within the tank tt shall be inspected and serviced as necessary. Mound and Pressure Distribution Svstem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Colo weather installations (October-February} dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS, 30 mg/L TSS, 10 mg/t FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and tt is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is pertormed tt should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes wtthin the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaces to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component{s) shall be immediately repaired or replaced with a component of the same or equal performance. ff the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, tt will be repaired or replaced in its' present location by increasing basal area if tce leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Peter Hammond 3 bedroom residential mound Page 6 of 9 (~p GOULDS PUMPS Submersible Effluent Pump 3871 EP04 EP05 APPLICATIONS Specifically designed for the following uses: • Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • Dewatering SPECIFICATIONS • Solids handling capability: '/a" maximum. • Capacities: up to 60 GPM. • total heads: up to 31 feet. • Discharge size: 1'/z" NPT. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous 140`F (60°Q intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor: •EP04 Single phase: 0.4 HP, 115 or 230 V, 60 Hz, 1550 RPM, built in overload with automatic reset. •EP05 Single phase: 0.5 HP, 115 V or 230V, 60 Hz, 155C RPM, built in overload with automatic reset. • Power cord: 10 foot standard length, 16/3 SJTOW with three prong grounding plug. Optional 21 foot length, 16/3 SJTW with three prong grounding plug (standard on EP05). • Fully submerged in high grade turbine oil for lubrication and efficient heat transfer. Available for automatic and manual operation. Auto- matic models include Mechanical Float Switch assembled and preset at the factory. FEATURES ^ EP04 Impeller: Thermoplas- tic Semi-open design with pump out vanes for mechanical seal protection. ^ EP05 Impeller: Thermoplas- ticenclosed design for improved performance. ^ Casing and Base: Rugged thermoplastic design provides superior strength and corrosion resistance. ^ Motor Housing: Cast iron for efficient heat transfer, strength, and durability. ^ Motor Cover: Thermoplastic cover with integral handle and float switch attachment points. ^ Power Cable: Severe duty rated oil and water resistant. ^ Bearings: Upper and lower heavy duty ball bearing construction. AGENCY LISTING SP Canadian Standards Association Goulds Pumps is ISO 9001 Registered. / ~~~, ,~~ulu~ rurrl~~ ~ 3.07~rP.rn. n2tn:mu7» -~/~ y ~; 2002 Goulds Pumps ~~~ ITT In stries Effective September, 2002 ~ ~ ~~.~ 9 83871 r g• JUL-13-2005 04:51 PM A.C.E. Soil & Site E~al 715 248 7764 ~•,,~. ?: 6e r ~,rrb} ~ y' C,ri~s~lh,'J 31,~d~d6,., res;ltwcc P. 01 N setkr," Ptfir l~w-wm~Jd%~~~~y, Gw~• lif.t, Sty. / Tw. ~/' ~" ''~-~ AP/r~JC I[es~~r tFFArs.,n ~CAe, Sid: SS~ae+ed Wibded ¢~r~F.~q llsr+: s~oo.aD' '~s ~~ ~daef•+lo/rrr'cd •j~~e. ~Pro'oescd CJ;eaerC.M+e,ivf~,~/GS~-Aip eft'/ke.~~; /be~..t S,'r. e'~~f iLl~ R~,e, ,. a, ~~ F S 4ed F.-a~%I , , ~ ~ ~ ~ ' ', fp• r ~ i ~ ~i~ i~~.~J i' ~ ~~ Sfdsn~. E1~a 9~DS •~ ~~ ~rp.scJ r+t'..~ddt gas ~. ,, r` , b ~ o.t t.os.' B3 i~~ ~`~ '~ ~. y~z f~..~e..P!- ~ ~~~ S/ire sy ~~a V ~ • ~1~ Sr,Sf•.»s~ea . ~~~i ~f i~ ~' ~ , i tr,er+..fe S[~e6ra ;ogaP ~G~. ad.~c cs '~~' Wisconsin Department of Commerce Division of Safetrand Buildings SOIL EVALUATION REPORT _.a....,... ,..ati r,......, oc ~nr~ na... ~..ae 1857 Page 1 of A.C.E. Soil & Site Evaluations 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 Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . . 01 a-1000-50-000 Please print all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) Property Owner Property Location Dale Fern Govt. Lot 2 SE 1/4 NE 1/4 S 1 T 29 N R » W Property Owner's Mailing Address Lot # ~ Block # Subd. Name or CSM# 2071 117th Ave. -- City State Zip Code Phone Number --- City Village / Town Nearest Road Baldwin ~ WI 54002 I 715-684-3412 Hammond 2071 117Th Ave. New Construction Use: y! Residential /Number of bedrooms 3 Code derived design flow rate _ 450 __ GPD / Replacement _! Public or commercial -Describe: _ - _ Parent material Glacial till ___ _ Flood plain elevation, if applicable __ na General comments and recommendati ons: Install mound system at elev. 96.87' at 19" a bove 95.28' contour. Boring # _.._. Boring ' ~ 9~~ Pit Ground Surface elev. 95.45 __ ft / . Depth to - limiting factor __ in. Soil Application Rate Nonzon Depth ~ Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft i 'Eff#1 'Eff#2 in Munsell Qu. Sz. Cont. Color Gr Sz. Sh 0-4 1 ~ 10yr3/2 none sit 2fgr ' ds cs 2fm,1c j 0.6 ~'~, 0.8 _ .. - ------ - - ---- ~ -- ~ 2 J 4-8 I 10yr5/4 none sit 1thinpl ~ ds cs 2fm,1c i 0.4 0.6 3 8-13 10yr5/4 none sit lfsbk ds cw 2fm,1c ; 0.4 0.6 -- - -- --- ~ ------f - - -- 4 13-19 _ 10 r5/4 I y ~ ~ none I ------- sd ~ _ 2fsbk ~ ds ~ d h cw 1fm ' 0.6 I ~~ 0 6 ' 1f 0.8 _ _ 1 0 5 19-24 10yr5/4 f2f 7.5yr5/8 sl 2fsbk s aw . , m . 6 24-36 i 10yr5J2 m1d 7.5yr5/8 scl ~ 2msbk dvh - - 0.4 0.6 ---- - Boring # __'' Boring /' Pit Ground Surface elev. 94.56 ft. ~ 7~~ in. Soil A lication Rate Depth to limiting factor pp Horizon I Depth i Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft~ ___ in. I Munsell Qu. Sz. Cont. Color Gr. Sz. Sh 'Eff#1 'Eff#2 1 1 0_5 10yr2/2 1 none i 2fgr ~ sit i ds cs 2fm,1c I 0.6 0.8 ~ ___ - 2 5-12 ~ 10yr5/3 __ none ~ _ . 2fsbk sd ~ ~II ds cw ------ 2fm,1c ; 06 0.8 - - _ --- {--- - 3 12-17 ~! 10yr4/4 _ _ _ ?- -- ------------ J none -- - ---- _ _ __ 1 sit I 2fsbk ~-_--- ~ - - ds - i cw - ~ ~----- 1fm ~ 0.6 0.8 ---r --- -- 4 17 28 '~ 7 5 4l6 f2f 7 5/8 ~ 5 t ~ O dsh cw 0 6 1fm 0 2 ' - , . yr -I- --- -- . yr - m gr cos ! I ------- E . . , - -- -- 5 28-40 ' 10yr6/2 ___ r.__- -------- m1 p 7.5yr5/8 _ ------- sc ~ 2msbk dvh - I 1fm 0 2 0.3 f-._. --- - - Clay skins evident on fa - ces ividual sa g I -. rains in H#4. Structure is Om in place, parti ng to 0 sg w __ 1_ _. hen distrubed. ' Effluent #1 = BOD 5> 30 <_ 220 mg/L a d TSS >30 < 150 m /L ent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature: CST Number James K. Thompson 3602 ------------ ----------------- ------- - - ------- -- Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceola, 54020 10/14/2004 715-248-7767 _ _ Property owner Dale Fem Parcel ID # 018-1000-50.000 Page _ 2 of 3 ; ,Boring Boring # _. /I Pit Ground Surtace elev. 95.30 ft. Depth to limiting factor 21" in. Soil Application Rate Honzon I Depth Dominant Color Redox Description Texture Structure ~ Consistence Boundary Roots GPD/ft' _ , rn ~ Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' 'Eff#1 'Eff#2 1 ', 0-4 ~~ ' 10yr2/2 I none i sit ~ 2fgr l ds I d cs ~ 2fm,1c ~ 2fm 1c 0.6 i 0.8 0 4 ' 0 6 2 , 4-13 10yr5/4 none sit 1thinp s , cw , . I 3 ' 13-21 i - 10yr4/6 6 none sl -- lmsbk -- --- ds I ~ cw 1fm ' 0.8 0.6 -- 4 5 21-42 ', 42-50 7.5yr4/ 10yr6/2 f2f 7.5yr5/8 m 1 p 7.5yr5/8 gr cost sc Om 2msbk dsh ~ 'I dvh cw - 1fm ~ 1 fm 0.2 ~ 0.6 0.2 'Y 0.3 -~ Clay skins evident on faces of individual sand grains in H#4. Structure is Om in place, parting to 0 sg when distrubed. ^ Boring # ~ Boring ft Depth to limiting factor in f Pit Ground Surface elev. - . . Soil Application Rate Honzon Depth ~ Dominant Color Redox Description Texture Structure Consistence Boundary Roots P / ' __ in Munsell Qu. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 j i i i ~ --- +-- - - ----------- - } -- - ---_- -~-----i i -- G ~-----~--------- i --- ~-- I -- - I ---- - ~--- ~ - -- ' j ~I I I ~ ~ -- I I ^ Boring # ~. Boring _- -- Pit Ground Surface elev. _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth ~ Dominant Color in ~ Munsell Redox Description Qu. Sz Cont. Color I Texture Structure Gr. Sz. Sh. Consistence Boundary Roots CAP /ft' ___ 'Eff#1 'Eff#2 I i I i I i i L ' I ~ ~ ~ i ~ - *,--- I ~ ---- t - -- _ _ --- -- ---- -- ~ - ~ --- - _._. _.. _ _ ~ ~ i +--- ~ - ~-- --, - ~ `.- - - - i -- 1 ~ t- -~---- : ~- - ~ ~i ~ i i I i ~ j _ 'Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mglL "Effluent #2 = BODS< 30 mg/L and TSS < 30 mg/L 'the Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3] 51 or TTY 608-264-8777. ^ So, % e d41a4 ~,'o~ P' ~ ~ FX1S~ir~ eleda.~ic+-, /_ .r wI I '~ ~ i ~~ i , EX%Sffn Poncr¢'~.t $~G fa,,,c! 'Ian r('eap~c: fy ~ d °`r`~ ~rccGtilc~t/S,6a..bility t° ___-- (c dct~rmiaed~or/e~ to~ Pro/a ct~.1 erg 5 yS'~M dc5-~n. --. ~' 3 6. ~,4pproX.Iocc,Ei~ 04. 5~d;n • f{SSc,,.M~a -of 2xis-~~ n~ L~Oe~e~( e ~W: = ~OO.a~D; ~' ~i'l ~ ( 9~ Rs' .9~.0' ~' ~ ~ ~Ic ~ ~ yS.o SL~ed '~ ~z8 ~ ~~ //~i~ 95 ry~r /~~/~ / ~ y.~p' Cpnfou.r i ~i Ja ~1 \~ ~ ~ S i di r1 q . C`7Ci!- ~ `JB D3 ~ ,- a / f ~~ ^ ~ i GW ~ i ~ B3 ' ^ .' ~~. ~,~/ ~•' / 'y~i( tltiroKa ~ i ~ S/epe 5 y~r t i ~ ~41~ Hof /in~5 ~ ~UD~-~r~ 3y.S~~mn~ea . i~a/C Farn P/`o~.~a~~/B57 (,ova. /o~.Z, ~t c. /, 7,~. af' /fwa~mend v~E.CraiX G~~! ,~ ~. 3 0~3 ti/ Z ~ 5~ (l~.(-~ - ~ so~~c Evac~ri~ rn~~ Wisconsin Department of Commerce , J ~ Division of Safety and Buildings in acrnrrianca wif Cnmm/fist Wic Adm Code 9 `~ 6 "~ 1857 Page 1 of 3 A.C.E. Soil & Site Evaluations y ~" d " ® tt• o let ite non paper not less than 8'/ x 11 inch in sizPlan must ~ County St. Croix li o: vertical and horizontal reference po t {BM), e~n and or dimemsions, north arrow, and location st fierarest road. ' Parcel I.D. '~~ .,~ 018-1000-50-000 Please print all information. ~l'~~i~, .: e awed By Da e Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)): ` ., ~' ' Property Owner Property Location Dale Fern Govt. Lot 2 SE 1/4 NE 1!4 S 1 T 29 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2071 117th Ave. City State Zip Code Phone Number J City f Village ~/f Town Nearest Road Baldwin ~ WI 54002 715-684-3412 Hammond 2071 117Th Ave. New Construction Use: yj Residential / Number of bedrooms 3 Code derived design flow rate VJ Replacement ~ Public or commercial -Describe: Parent material Glacial till Flood plain elevation, if applicable General comments and recommendations: Install mound system at elev. 96.87' at 19" above 95.28' contour. 450 GPD na Boring # ~ Boring Pit Ground Surtace elev. 95.45 ft. Depth to limiting factor ~~- in. Soil Application Rate Horizon D~th Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr3/2 none sil 2fgr ds cs 2fm,1c 0.6 0.8 2 4-8 10yr5/4 none sil 1thin I ds cs 2fm,1c 0.4 0.6 3 8-13 10yr5/4 none sil 1fsbk ds cw 2fm,1c 0.4 0.6 4 13-19 10yr5/4 none sil 2fsbk ds cw 1fm 0.6 0.8 5 x,424 10yr5/4 f2f 7.5yr5/8 sl 2fsbk dsh aw 1 fm 0.6 1.0 6 24-36 10yr5/2 m1d 7.5yr5/8 scl 2msbk dvh - - 0.4 0.6 a Boring # Boring Pit Ground Surface elev. 94.56 ft. ~ 7" in. Soil /~f Depth to liming factor -~ Application Raie Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *E 1 0-5 10yt2/2 none sil 2fgr ds cs 2fm,1 c 0.6 0.8 2 5-12 10yr5/3 none sil 2fsbk ds cw 2fm,1 c 0.6 0.8 3 12-17 10yr4/4 none sil 2fsbk ds cw 1fm 0.6 0.8 4 1 8 7.5yr4/6 f2f 7.5yr5/8 gr cosl Om dsh cw 1fm 0.2 0.6 5 28-40 10yr6/2 m1 p 7.5yr5/8 sc 2msbk dvh - 1fm 0.2 0.3 Clay skins evident on faces wdual sa grains in H#4. Structure is Om in place, parting to 0 sg when distrubed. * Effluent #1 = BOD ~ 30 <_ 220 mg/L a d TSS >30 < 150 m L ant #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name {Please Print} Signature: CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane. Osceola. 10/142004 715-248-7767 Property owner Dale i=em Parcel 1D # 018-1000-50-000 Page 2 of 3 Boring'# ~' Boring Pk Ground Surface elev. 95.30 ft. Depth to limiting factor 21" Soil Application Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-4 10yr2/2 none sil 2fgr ds cs 2fm,1 c 0.6 0.8 2 4-13 10yr5/4 none sil 1thin~ ds cw 2fm,1c 0.4 0.6 3 13-21 10yr4/6 none sl 1 msbk ds cw 1fm ~ '9:& 4 21 2 7.5yr4/6 t2f 7.5yr5/8 gr cosl Om dsh cvv 1fm 0.2 0.6 5 42-50 10yr6/2 m1p7.5yr5l8 sc 2msbk dvh - 1fm 0.2 0.3 Clay skins evident on faces of individual sand grains in H#4. Structure is Om in place, parting to 0 sg when distrubed. ^ Boring # ~ Boring _; Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon De th Dominant Color Redox Description Texture Structure Consistence Boundary Roots p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ^ Boring # J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon th De Dominant Color Redox Description Texture Structure Consistence Boundary Roots p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 'Effluent #1 = BOD ~ 30 < 220 mg/L and TSS >30 < 150 mglL '~ Effluent #2 = BODS<30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. 4 ~.,,G ~~ ~~ -. ~. ~ ' fA.n~ ~an 1~~~Ci v4y ~r [AG~Lc2?/ S't~t..bi li t y L~'D /,c dctcr»~t%rtcd fori~~ ~ ~cp/a ccty, a+r f S yS'~~ 1 ~.~PP~~'- Iocu,Eiar Of e}CiS~~ nq La~Odtd ~~ j ~" ~ J 9G.Rs' ^ 50~ ~ e /41c~4~~o~ ~, ~ ~ ~ • Ex~s~'~ e~e,~Q~,'~,-, -~we.il Govt. /o~z, ~cc. ; 7n. af' ~iaimend ~~. Croix G~~! ,`, O 0.rrr~C Pore./dtcrt~ t,f'is~Eln '° 36ed~w, --- ~esidenee ~$ ~c.l, rity/'Jl ~ (~~fp''''' openyard 5~d ir1 ASSc~Mt~ ~~ w cad ed e ~ ev:. Oo, c~; ~"__ ,9~ o' ~- 9~or ~ le ,' shed ~ ~~ ~' yS.Z$~ ~ //~~ 9~ ry~i ~~~~ ~~ 9~0' Confou-r' ~~~ ~ A I~• /'~.M.: f3otp~o.,., of 95.28' ~ i' ,~~ Si~i+1q. ~iGi~~ /~.~3 / ' , ~ 0 ~ ~n~ ~~ ,- ~ ,. ' owr ~. ~ i r~ ' 8?~~ 9S, z3 ~' ~ g~ ~~ i . //~ / ~i ~~ C}"~I /~ V P, ~,~- ~ ~ ~ ~ S/epe s y~~.` i ' - '~/~~~ ~o~ /int5 ~ ~~~-~rar.~ Sy.S~EM-in~ea . ~ ~pn^`~~ `""^~' ~ ~ ~ ~~ 8`g~ . ~o / LDS 1 -~~ P . 3 ~'? OwnerlBuyer [i Mailing Address ST CROIX COUNTY SEPTIC TANK MAIN~4NG"~ At3REEMENT OWNERSHIP CERTIFICATION FORM ..20~/ , ~yar~ ,~ ~ -~ Property Address ~Q Y17~ ,n / (V(ccificatioa rcqu~irc)d from Planning Dcpattcacnt for acw construction) :- City/State l.~Gi (Gl t~/~t'U C,~1i~ ~ Parcel Identification Number ~/ g -/G>DD- 5Q -~(~~ LEGAL DESCRIPTION ` , 3 g~ Propefiy Location S~ '/,, ~,G '/,, Sec. ~, T•~ / N-R W, Town of , Q/l~/yJD/~~[~ . Subdivision Lot # ~. Certified Sarvey Map # _ ~J`r/~ ~'`7~ Volume Page # ~~ ~ t~ Wamdaty Deed # ~~~~3 / Volume ~~~~ .Page # ~~~ Spot ~oase ^ yes l2~ no Lot lines identifiable [H yes ^ no S'SCS"IF~1Z-~V1ASN'IC~NANCE ImpopauseaadmaiaLtaan~oeofyovrscpbicsystcmoouldrrsaltiaitspcicfailucttohaadiewast~cs.ProperaQambcaanoe ooasists of pampiag out the t'~ tangy every thrx yearx oc if neQded by a ~oensed pun>prr What you pat mto the system c~a iffoct$~e-fun~iva of tie septic taalc-u.i tnstm~tstaig~e m~e ~raste-sysr~. _ ~- Y~ oar agrccs to sabmik~ to St. taroiz Zooiag Dcpartmcnt i oatificatioa farm, signed by the ~ownet: and by a ~~P"joamcymaaphimbe~ restdctodplun~.o~ei dpamparai~g that (I) the o~a~ibo wastewaxerdisposal system is is prolxr opcratiag condition and/or (Z) after inspocxicn and p~g_(rf noa"ssary), the septic-tanlc-is Icss .than l/3 ~irll of "sludge. . I/~rr+~, Sae tmdetsignod have read the above rogaire~ nerd agrx to maiMaia tfbe private sewage disposal system with the standards ~ farQr, h'~II•-as ~ by ~ 1~patbmeat of Caam~xoe and the Depattimcat of Natural Resoarces;State of Wisconsin.. C.ertificatioa that your septic system has been maintained mast be oomplded snd rctuzmmod to the St. Qroix.Coaaty Zoaiaig Office within 30 days~of the tin+ee year prpinti-a~a~da~~,~ SIGNATUitg OF APPLICANT- DATE OWNER- CER'TI~TCATION I (wc) certify that all sLatenrcnts on this form arc true to the best of my (our) lmowicdgc. I (wc) am (arc) the owner(s) of the pmpcrty dGUxa'bod above, by virtue of a warranty dcod rccordod in Register of Deeds Office. '7 ~1 i0~ SIGNATURE OF PI;ICANT DATE "'``«• Any rnfofalatroa that u mu-entod may t+~sutt m the sanitary pecrmt bCU~g revoked by the Zoarng DcputmCIIt. ~'RSR. •• Include with this application: a starnpod warranty flood from the Register of Dads office a copy of the. certified survey map if reference is made in the warranty decd Wisconsin Department of Industry, ~ Labor and Human Relations Division of Safety & Buildings SOIL AND SITE EVALUATION REPORT ~g~ ~ of 10 Tj/ ~. --------_......._..........._, ....................., V~~~~~~L pk ~ CfyGiU~J cou c, ~ ~ Attach complete~site plan on pape not less than 8 1/2 x 11 inches in size Plan must include but Yb . , not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or P I.D. # ~ dimensioned, north arrow, and location and distance to nearest road. ~:~ APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R ED BY 'y !}/~ ""' AT NI V/l1/1 } A , . ~ V PROP R OWNER: PROPERTY LOCATION Z I G Cis=FtC ~ Fe Y n GOVT. LOT s F_ 1 /4 j{J 4/ 1/4, ,N,R r W PROP TY OWNER':S MAILING ADDRESS ~ B o~~ u~ 1a Syno~ M Wr ti LOT # BLOCK # SUBD. NAME 0 ~ ~~~ a w s fi CITY, STATE ZIP CODE PHONE NUMBER z l~ 3' V GE OWN - NEAREST ROAD (its) wr.-, bv~ ©r1 ~ Z ~~~ ~~~~ I ~, ICJ New Construction Use [~Q Residential / Number of bedrooms 3 [ ]Addition to existing building [ ]Replacement [ ] Public or commeraal desaibe t~ Code derived daily flow I S~ gpd Recommended design loading rate ~ • 2-- bed, gpd/ft2 ['~' trench, gpd/ft2 _ Absorption area required ~ bed, ft2 ~ 7 S trench, ft2 Maximum design loading rate ! ~ ~ bed, gpd/ft2 ~ ~ ~" trench, gpd/ft2 Recommended infiltration surface elevation(s) 1 0 ] r ~fD~;UD R~'Qdt'I;Fpft (as referred to site plan benchmark} Additional design /site considerations ~!v w ~entj, s(~e~ld b e_ iS~~ h~ oJ~gYPr- tr> b~«F c,o a~ a ~ Qbt1Y pT x rya T Parent material L~ mss Flood plain elevation, if applicable es{~~~k 76.D ft S =Suitable for system CONVENTIONAL MOUND IN-GROUND RESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for s stem ^ S U S^ U ^ S U ^ S U ^ S ^ S ;2~ U SOIL DESCRIPTION REPORT Boring # ~~~~ Ground elev. i o ©.'i ft. Depth to limiting factor 30 Boring # ;fir``<~:`> ti :~: ~:-" 40:hiw: n: niix ~{:~......... ~:ti Ground elev. ft. Depth to limiting factor ~_ ~. Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour>dary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trencft ~ 0-S IDYR 3 ~3 - ;~ 3 ~ ~4 ~` 2~ s D L a c o • . 2 5Iz IoYR 4/~ ~~1 2>~ d~~ b ~~ o.s a.6 Is 3o s rz ~l ~r~l -~ ~- w l D~ ~o, s X6-70 7. s r s! S ~ 2 ~ s ~d g,-~ ~ I - - -- P 1 ~- Remarks ~`~ ply'! st~uCfurP ~t, - bvea~CS 'b a~[t - rhnw,o~ o~i~,~cl7e~]~ L,~ > tS" ~, O~ $ ~~ Y~ 3 2 •--- , I 3 Fr L s 2 ~ ,s' a ~ 3 -~'~3 Io ~~ - ~ I r c s ~ f D,S d•6 3- o ,s R X16 - 2 ~ cs z~ 0. ~a.8 ~ 30, 7,~Y 5 ~6 I~F S~rRS~,; "~ t0a~ v C .~~~ -- ~- 7 ~ ~ ~o f ~~ -'-'~e t~s ~t r i' ~-o h ~ --~ ~' f ~t (nd~c wit t~ f1' v) ~. Remarks: Name:-Please Print n ~d ~. d Date: _ ~v. i996 PROPERTY OWNER ~QIr ~~'~. SOIL DESCRIPTION REPORT PARCEL I.D. # Boring # k,..3. Ground elev. ~Zs= ft. Depth to limiting factor ~~ Boring # Ground elev. ft. Depth to limiting factor Boring # Ground elev. ft. Depth to limiting factor Boring # .................. >> Ground elev. ft. Depth to limiting factor Page ~ of ~ , Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench ~ v~7 ~oYR ~/ --~ ail 3 ~a6k ~ ~a.s- 0.6 2 7-lb Ic s-! f al F 2 ~~ o,s' a~,t 3 16' 0 to "IZ `I I ~---- s% e l t a d ~t e S l V F o, y 0, ~` `r` a- 3~ 4 /4 l F 7,SrR 3 z r ~v c. S l v F --- .T 5 ~g S2 FIF ).SY123/~ 6 ,S2' 0~ 7-SYR 9 ~ F A D S ~ 8 n+r~ tin 5 ~ ~ .._' '~ ~- ^-- Remarks: Remarks: SBD-8330(8.05/92) Remarks: v L7 97.5 L i L~ ~ t,~ P~~ ~,,~ d• 96.4 ~ 4, a ~~ ~ n' n~ ,~ N a ~ 3 ~"" 03 rurrrrprpi ~~h Q ~ ~1S C ~Nsr,~ ''f ~ ~ '~' BRUCE ALLEN D - - ~ ~ WEBSTER D-1195 ELLSWORiN Bi o.4 5cnt Peet ~ ~. ~"ISCONSIN , o .~~~ .d h•• ..................-~ t ~ ~~~~r~~unum:uu;u-~ Ci (-'-~ p W ^' L.L. TaP aAra~ ~ ~~ ED P0.5T 1-1 T~' OF UARNGE ~ PAINTED POST 1t7 L<J J '~ ~ _ T'OP QF GAIRNGf v a vrur ~OL6 p~TH ~ D ~ MOUND PLANS FOR ~o~ ~~ DALE FERN X017 117TH AVE ~~x~v~~~ s~LNwI se I i T2~~~ ~i~w ~ Ir /~ ftlP G~ DARNGE PA ED PUST 96rt N o `: ~~ '~o,~ SEG[x1II BENCH -NAIL !N TREE 5 !/8 FEET aeovr: 3 M #C~Nii IN L'6 DIA MAPLE BDR ess HOUSE PROPOSED LET DEPTH 700 FEET PROPOSED LOT WIDTH 180 FEET PINE LAKE ELEVA~ICth~ 73,4 - 75~~ ~~~~~ ~'N9` ~ Q~1S~-~C'"~Nsf~% ., ~ enuc~~~~N', ~ w~sT~ ~ 0-1195 ELLSWORTN ? 1R'ISCONSIN ; ~t~'ad~+sI G1`t~'q`°~ TCP QF OARNGE ~ ~ ~J N 1) P L A N E^ R $AI~ TED POST DALE FERN X017 117TH AVE BALDWiN WIC ~~a0~ E NW see 1 T~9N R17W TOP OF ~ARNGE PAI TED POST Q is 20 ~ 40 96.4 V ~ Scnle to Feet J r~ "~~ 504' ~~ '' C~ ~ v l~~'~ SECOND BENCH - NAIL IN ~ ~~,. TREE 5 I/2 FEET•~ABOVE ~ BDRM L ~ Gf~OUND IN tsd' DIA MAPLE ~ ~' 99,4 HOUSE L ~oo~ ~-q~lah ~~we,A-P~~«st-Se~fG. ~ PREP~SED LET DEPTH 704 FEET ' PROP(JSED LOT WIDTH 1B0 FEET L FINE LAKE ELEVATIDN 73.4 - X5.4 a ~ ~ Cc,' --, ~ o s' 3 `-. ~ e ~ v Cam. t c"` ~ ~ T"" ~ mock Nartitd Scaly 40 ~~°F "5 1 ~~w,t'C ~~ ... i ~~ AIE. ~n " ,. , ~ ~,~~ ....~ y nrgc ~~~ ~ 1"~~r"~- ````av ,~~ 1 ~ 1~ i r p ry l~ na''' 6 WE~88TE ~~ ~' d-1185 ELLSWONi'N t:ISCONSIN , U 2706P 195 STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS DEED, made between Dale W. Fern and Gloria A. Fern, husband and wife, Grantor, and Peter J. Hammon and Michelle_L. Miller, husband and wife, as Survivorship Marital Property, Grantee. ~~ Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot of Certified Survey Map filed October 30, 1996 in Vol. 1l of Certified Survey Maps, ap ge 3177, as Document No. 551464, being a part of Government Lot 2 and part of the /. of t e NE %. of Section 1, T.29N., R.17W., Town of Hammond, St. Croix County, Wisconsin. 1letro Legal Ser~~ices ED1ItET 448863 A 314855 \\~'D 331159 Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Recording Area ~ai~~s ~~ KATHLEEH H. MALSH REGISTER OF DEEDS ST. CROIX CO. , M1I RECEIVED FOR RECORD 12/01/2004 12:40PM MARRAHTY DEED EXERT # REC FEE: 11.00 1'RAKS FEE: 1380.00 COPY FEE: CC FEE: PAGES: 1 to and Return Address: la ty T' e, Inc. S. 2nd -Suite 1 I S . WI 5 ~~~~ 018-1000-50-000 Parcel Identification Number (PIN) This is homestead property. Dated this 12th day of November, 2004. ~~ 4% ~~. * Dale W. Fern AUTHENTICATION ...... Signature(s) Hputen Qub11C authenticated this l 2th day of vet 9~1 l TITLE: MEMBER STATE BAR OF WISCONSIN (lf not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Peterson, Fram & Bergman -Steven H. Bruns 50 East Fifth Street, St. Paul, MN SSI01 *Gloria A. Fern ACKNOWLEDGMENT STATE OF WISCONSIN ST. CROIX COUNTY. ss. Personally came before me this November 12, 2004 the above named Dale W. Fern and Gloria A. Fern, husband and wife to me known to be the person(s) who executed the fore ing instrument and acknowledged the same. * a' a VanHouten No ry Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 7J27/2008 ) (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 WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000 ~1 ~~ FORM NO. 985-A 4~-^,.~ Stock No. 26273 .~, ~ CERTIFIED SURVEY MAP ND. 5s~4su BE/NG A PART OF ~VEL~RNMENT L!U T2 AND 3f~ART OF THE S. W. f 4 OF THE N.E. 1~4 OF SECTION 7, T.29 N., R. f 7 W., TO OF HAMMOND, ST. CRO/X COUNTY, W/SCONS/N. SURt/EYOR'S CERT/F/GATE /, Steven /. Wook, Registered Wisconsin Lond Surveyor, hereby certify that / hove surveyed, divided, and mapped o part of Government Lot 2, and port of the Southwest 1/4 of the Northeast 1/4 of Section 1, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin, and more porticular/y described os fo/%ws: Commencing of the northwest corner of the Northeast 1/4 of said Section 1; Thence SOO'09'34 E o/ong the west /ine of said Northeast 1/4, o distance of 2655. 14 feet,- Thence N89'40'58 E o%ng the south /ine of said Northeast 1/4, a distance of 1122.74 feet to the point of beginning,~ Thence N15'48 :37"'E, o distance of 457.68 feet,- Thence N31'06 ;37"E, a distance of 289.68 feet; Thence N04 34 33 "E, o distance of 447.67 feet,- Thence N89'18'12 E o distance of 386.89 feet,- Thence S09'58 00 "E, o distance of 115.14 feet,- Thence S88'16'19"'E, a distance of 509.09 feet to o point N88'16'19'13~ of, and 15 feet fron the shore of "'Pine Lake ;• Thence SO7'00 58 "E o/ong o meander /ine, o distance of 646.52 feet,- Thence S06'15 21 N/, continuing o/ong said meander /ine, a distance of 364.06 feet to o point S89'40 B8 "W of, and 24 feet from the shore of "'Pine Lake "; and the south /ine of the aforementioned Northeast >/4; Thence S89"40 58 "W a/ong said south /ine, a distance of 1265.05 feet to the point of beginning. Inc/sided in this description ore those /ands lying between the described meander /ine, and the shore of said "'Pine Lake" Said described parcel contains 1,206, 721 square feet, more or less, or 27.70 acres. That / hove made such survey, /and division, and mop at the direction of Mr: Leonard Litzner; 3200 W. Co/hours Parkway #A, Minneapo/is, Mn. 55416, for Do% Fern, owner: That such mop is a correct representation of the boundaries of the /and surveyed, and the subdivision thereof made. That /have fu//y complied with the provisions of Chapter 236.34 of the Wisconsin Statutes, Chapter AE 7 of the Wisconsin Administrative Code, and the subdivision regulations of St. Croix County, in surveying, dividing, and mapping the some. Said survey is subject to easements of record, and os shown. Doted this ~ day of ~17TEM6LR , 1996. W~ Steve Wook R.L.S. 1610 CEDAR CORPORATfON 604 WILSON AVENUE MENOMONfE, W! 54757 (715) 235-9087 STEVEN J. WAAK 5-1640 ~ ~~ MENOMONIE ~~ :-9 WIS. ~O ~~ PAG~OF ? St. Croix County Map Output Page . ~ St. Croix Countv M u Page 1 of 1 e ~ T ~ ~ ~~ 1' ~ ~ " `'I ~ ~b ~ i~ ,<<~ ~ ~ ..~ t . `` ' ' , 4~~` d '' f h . ~ ry~, ~ y~ N ~ `~ ~ '~ ~~~ l...k'. ~ ' ~ ~~ r. }~ ~ ~ ~ , ~ t -. . mow:...{~ ~ ~f J.~~;:~;'~ r- ,~ .~•y: iy .n~~ ti ~l{; F!' I :+..:".b ,.. i St. Croix County Planning Department 1101 Carmichael Road Hudson, WI 54016 Phone: (715)386-4674 DISCLAIMER :The information contained on this map is advisory. Map accuracy is limited by the quality of the public records from which it was prepared. It is not intended as a substitute for an accurate field survey. AERIAL PHOTOS :Aerial photography is date-sensitive. Features that exist presently in the County may not be present in the photos. Legend M 4rrc1P a1 6a1f11la k 3 3~bdlvlrlp+~c cer~ile d ~.rvex Yaps rmr Q13 ~~ pa~naed Orai rage 9tr+eams Darn FerreNal ~7team tikmnl Iknl3Feam .,:..15~gv Wakr http://72.21.230.178/servlet/com.esri.esrimap.Esrimap?ServiceName=StCroixOV&Client... 7/14/2005 T1 FORM NQ. 995•A 41~y1.1M. Stock No. 26273 SSg464 N~N~~ y .. _ .. :~ '' ---- - ~ So ' -- --- ~~ X848.52 ~1,-„ CERTIFIED SURVEY MAP NO. 55i46v ~ ~'~` VOLUME ii ,PAGE 3177 ,U BEING A PART OF GOVERNMENT LOT 2 AND PART OF Th/E S. W. f/4 OF THE N.E. 1~4 OF SECT!'ON 1, T.29 N., R. f7 W., TOWN OF HAMMOND, T. CRO/X COUN7Y, W/SCONS/N. WEST >/4 CDR. 1-29-17 FD. 2 ~ /. P./CONC. '~ ! ~ ~ a ^~i ~~~ ~~~~ G r ~V# b~?r~ii ~'0 2 ~ k'~M S?66 47' f SOO'09 J4 ~ /~ ~ ^f 261 f,J3 -- 265.5. 14'--_ J ~'/~~~+} g TYL f1 a i NIA ~,~° # ~ ' ap •b\ v UV~ ~~ i ~ 2~~~ 0 O ~ C x22 ~ aa~~ a s N u `\````\\~\\ \ \ \ 111111 I M I q ! J 17 ! / ~ ' O• Z C!7 •• ~ ~C: ~o y< _~: X20 7C` ~I m /y~j~,/rO^ . '/Q~//Y/hIII R ~ 1 1\\\\~ [/~~~-~ w `` ~ ~• ,k,~~ ``'mss ~ ` ~~~ IVOf .34.3.1 ~' \ ~\,_ ~~ ~~ s~• -------- ~ -.~ R_ -~ ~ ~ ~ +4z7s• •-- s~-o7. _ ~ ~ ~$S ~~~ ~~~ ~~ g~~ 1~ Y I~ i y T~ 2 b a p H 0 g o n' 0 q o 0 ~' ~ ~~~~ \` ~~../ ~~_ 1ar/~,._ . oar __sra-~s~~. ~,~6Zia~ 51~•49~~.~ ~~ ~ ~r~FlOb~l A~^. ~ ~ ~'1~.r V ~ 4 0 3~-~• ~ . ~ .:yfWjxMM. _ ~'2455'~-1~~ tZt•Q ~O ~1 O v _ ~Nj4.+g~44 .. RI( 1i2g4 l7 ~ ~ ~ y 0 'o o, q _ + ~, i ~ ~ y ~ $ ~ ~ ~ ~ 't #~~ ~ ~ti~ru ~ li m'~a N M `"~''`'1 ° 0 C''' ' ~'~ ~~ ~$ ~~ w~ 1' ?32.66' S06'1TM..c- -~~ V m > 11.40 7N/S INSTRUMENT ORAF7E0 BY S7EYLrN J IUI.4/! CEDAR CORPORATION BP4 WILSON AVENVE MENOMONlE, Wf 54751 (715) 235-9081 t ~ O i c~A I O ~ T C I ~~ A N W r+ ° 2~ O ~ k _ a 77 V ^~^ ~ ~ Y) r ~ r b ro l '1 1 x v ~D .a 9 ` I ~ I I~~ -~ - y I~ `$g ~ I r~ lu / ~ N I~ ~ ~h Is 'D.~• q ~~ ~~ ~ ~•~•9 9 1 ~1D 1~11y ~I~ M Mlu I~ ~~~~ ~~~ 8 °~~ ~$~~~ ~~~~ ~~~~ ~~~~~ ~~~ ~~~ v FYNE =~ 9/24/96 ~_ 1121.E .ms• PAGE ! OF? ~- ~~ ~' ~~ ~~ c o ~ .' ~ ~ ~ 1 ~ v ~ II Z Z~ Z ~ ~ ~ O O N O ~ N Oo I m m ~_ N -' 3 ~ •tO j N 7 I a a w ~ J I W a a o '. ~ ~ ° ~ I N N ~' ~ o ' o o I (n Z D ID ~ co D N a I a _W ` c ? I O " AI ~ < I ' O °om ' no c i ~ y a M w 3 ~ I 0003' °: o I w~ y N~ o D ~ovo- I N ~' I ~ ~ o ~ a m 3 m v, j V I D D I o ~ a I I m m A N I C D C ~ 7 I (D ? _ _~ ~ (/! I _ N c ~ A Z n ~ - ~_ .. I Q ~ ~ ~ y .. I ~ ~ I ao~ m~ a ~ 0 3 ~ Z ~ I O :~ ~ z I ~ m ~ ~ fD ~ I - O w m I ~ ', I a ~ I ~ ~ +. I o m ~ I o ~ a I I I I I m N I I • 7 N I o ~ °o ~. d K (~ ~ ^ ~' \ 1 a Q • FBI o~ O ''y ~• 0 ~• fi y A A O O~ N O O~ W 60 O A ti ti ~ ti