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HomeMy WebLinkAbout018-1083-14-000 ' ~1 f ~ ~ _ ~ ~ ~ ~ 3 ~ ~ ~ ~ ~ ~ ~ ~ M • ` 1 I _ ) r ^ O ~+y ~~ Z y owao =moo ~ • laoo,,. < ~ ~ m H ~ 7 ~ ~m 3 IV ~ 3 m~ ' ~ FBI d w c Q (D A - V ~ 4 O /~ I N a~ O/ O a~ j j .s ` ,4 ~ c o r ~ ~ ~ b I ~ c ~ v ° ~ p m m N v D ,Q ? N i ~ 8. ~ a t~ ` ' 7 ~ ~ `r D ao~ ~ I O ~ ~~ wm N I ~ C H • O O dl G C I ~ a ~ I ry~ vV I o N ~ _ I n c 3 (/! Vi y o ~' m c i v ~ ~ O ~ m •• I N ~ ~ .. N Q. ~ ~ A I z 3 .. o ~ = o =; ~, ~ ~ ~ ~' ~ ~ d ~ i O p~j d N d ~ C N ~p ~ c w v m a ~ a I n Z , ~ 3 a v ~ M o ~ ~ ~ °7 ~ Z Ny A ~ 3 N o n z I ~ ? y Q, O a ~ .. 1 ~ (p I o ~v ~ m N rn ~- o W ~ eo eo ~ Z o ~v ' a ~ p ~nm m p ;~ Z ~ O CD ~ fll Z ..a ~ y ~ i A ? I 3~ a ~ m a ~ I m ~ m c I o 3 ~ a . ~ 7 N ~ ~ I 7 7 ~ fOD i ~ 1 < °~ I V1 ~ ~ ~ I A N N p ~ ~ A ~ ~ I t~ (~D ~ I Q0 N 0 ~. f~D A ~ ; A O ~ N Oq N ~ ~ I f0 ~ ~ a v' . I wsconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT • GENERAL INFORMATION (ATTACH TO PERMIT) Parsnnal information you nrovice may He used for seoorxiary purposes [Privacy Law, s.15.04 (1)(m)l. Permit Holder's Name: ^ City ^ Village Town of: Bonte, Ron Hammond Township CST BM Elev.:• Insp. BM Elev.: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ,~~ -z,~p Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic f 2,$" NA Dosing ~~ r NA Aeration NA Holding PU P /SIPHON INFORMATION Manufa rer and Model Number GP TDH Lift Lri S stem 7L''ri Ft Forcemai Length Dia. Dist. To wen e•~u ~ n[`AnnT~fl~r t~VCTGwA / i -. ~ _ ~ t Count Sit. Croix Sanitary Permit No.: 3839990 State Ptan 10 No.: Parcel Tax No.: 018-1083-14-000 f=1 FveTInN DATA r a _ STATION / BS HI FS ELEV. Benchmark'~'Z' S . 3 ~- to ~[ • Z Alt. BM Bldg. sewer (o~~ Q~SG St / Ht Inlet ~• ~ ~' (0 9(0 St/ Ht Outlet ~-•9(,0 %(o. L Dt Inlet Dt Bottom Header /Man. 8', 2 n ~ (v• 3 (a Dist. Pipe eot. System '~ ~J ~-f ~~ Final Grade ~ s S(o0 ~'/~, ~'l L over ~~,, r 11X1, l r /o ~-~ ~. 2/e a,f7b ~,. S t2 G~ .~ i th id De Li ENCH Width f L~gth f No.Of Trenches ~ 7 PIT DIMEN I N No.Of Pits p qu Inside O a. I ~[, S SYSTEM TO a, P / L BLDG WELL LAKE / STREA EACHING , a~ ctur r: _ S SETBACK CHAMB r: N INFORMATION Type O nJ t ry t S A ~ f ~ ~ UNIT urm+~~ M e ' -`M . ., - em: y ys _. .~..~.~.......T.~u wcTru / 19l~bFuL•f' Y/c_ )tea. 1. ....~~..o v.~.^..vv^...... ... ~.. Header / Mani old .... ~ - -- - Distribution Pipe(s) -- `.~ x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing cnn rnvcQ ~ .. Orueeuro Cvc4arnc []nlV 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 ^ Yes ^ No ^ Yes ^ No ncr.nn .nn / ref Inrn rfrinn #7' +--f-~- / COMMENTS: (Include code discrepancies, persons present, et ". '- ------- -- Location: 1734 96th Street, Hammond, WI 54015 (SE 1/4 NW 1/416 T29N R17W) -162917586 Pheasant Hills -Lot 14 SYS (~,~ 1.) Alt BM Description = , 11 2.) Bldg sewer length = ~- $ ~ ' ~'O ~ ~ J1 -amount of cover = (g" ~ ~ ,~p._ 4.4 ~ C ~~ Ptan revision required? Ye ^ No ~UOsg other side or a diti_ona Informs ion. `t< ~°`r V' t~ t '~ pate ~ / Inspector's Signature Cert No. SBO-673 (R. fit) ~~ `M ~~ ~ t~/~'ac~'~-+~Fo'~v`' ~, .._. ~~ __--~ tl~ ~~ ~i -~- o ~:~ m ~ 1~..~ ~6 ~~ . a ~ yp Safety & Buildings Division ' ~ Sanitary Permit Application 201 W. W ~ ~ 73oz ~ansin ~ accord with Cornet 83.21, Wis. Adm. Code Madison, WI 53707-7302 Department et Commerce Personal information you provide may be tined f ndary purposes a `a 1 04 ~ P L (Submit t:otrtplt~ed form to cotnriy if tat ~ .,` aw, S. $. J~m) [ nYacy SLffiC OWnCd. Attach co l ate tans to the cou o 1~ on ..~" s~ntrt than 8-1 /2 x 11 inches in size. County gpievious appii~tion State , e it Number l~C}itck if t State Plan I. D. Number 5 e y O.•~ { r T \~i ~. I. A licatioa loformation -)P lease Print all Information Location: Pmperty Ovvtter Name ~... ,. ~ ; ~ : _ Property I,ooation ~~, ~: 4 ~ Property Owner's Mailitttt Address QrF~GF ~ I.ot Number Rlock Number G Q l © /t ~ ~ City, State I.ip Code Number - . Subdivision Name ar CSM Number ,, _ ` .; ll Type of Building: (check oae) ,.a p•.^ s ~-- O t or 2 Family Dwelling - No of Btxlrooms: ~ ~~ P ~°''ts t7 city dlage . _ o Pub&c/Commercial (desrxibe use): own of O State~owned a ,~ ID Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road 70 ,t,/ A) L ~IVew System 2. [~ Replacement 3. D Replacement of 4. O Addition to Parcel Tax Number(s) Svsicm Talc Oat Exis ' S tem D /~' - !J 3 - y _ a' a" o $) Permit Number p~ Date Issued O A Sanitary Permit was viarsf isstted 0 V. Type of POWT System: (Check all that apply) -~ - ~ . Non-Pressurized !n-grottnd ^ Mound ^ Sand Fitter C] Constructed Wetlatd '~j Presstuized In-ground ^ [`folding Tank O Single Pass [~ Drip Line Q At- ~ ~ ^ Aerobic TreaWnent Unit ^ Recirculatiag ^ Other: 2 x IZS~ t.Q. ~S ~ S'.`Q e e..-'.tt~ .'~.P t- t_^-~e mb~e xs' V D~ raal/I'iwttment Area Information: 1. Design Flow (gpd} 2. DispersalArea 3. Dispersal Area d. Soil Application 5. Percolation Rate 6 em Elevation 7. Final Citade Required Proposed Rate (Gals./day/sq. R.) ~ ~) ~'!~• ~ lion ' ~~O /aao Leo • S d. J ct!._- 1'• ~" ~: 2. t VI Tank Capacity in Total # of Matwfachtrer Prefab I Fiber- astir Information Gallons Gallons Tattks Cat- Con- glass New Existing Crete strttcted Tanks Tanks ^ ^ ^ O S ~ ~`,' c a ~fl .~~ ^ f~ o a ^ Vll Responsibility Statement the tutdersi assume res sibilit for installatiatt of the POWTS sho the attached lens. Ptuml+er's Name {print) Plumber's Signature (no stamps): S No. Bustrress Phone Number .'ll' S G,u to ; Y ~ as?qQ ~~s--s -~ ~ 2 Plumber's Mdress (Street, City , S tat e. lap Code) ~ J , / ~ / VIII Couotymepartment Use Only ^ Disapproved Sanitary Permit Fce (Inciudes Grourxiwater 17ate Issued Issuing Agent Si tore (No starrtps) ~Approvod ^ Owner Given lnitial,Adverse S e Fee) Detetarination s. ~ ~ l 1X. Conditions of Approval /Reasons for Disap royal: u 5~5~(;-w~ w~ .nJe4La.u~~uC~. .l~t~q, ~ C-~~v~5 '~-o rr~~2. C~R_ ~~G l Z. .~X~ ~ U , ~ ~ `~ S s~ ~-~+~ ~ ~ ~~.. -fie. o . S" D 2 ~.~~ r~ s ~ . Sets ~- 1~]J~n ~ ~.. QA I FQ ri -F+R~iCI i aw a~ P l~nMe~ o r~lr,/.~" s~ e ~ ..,, o e ~ ., ~ wn..ADA/ ~ e0 Glee. - - ~y~O.e--~a~v.,:M4~ ~~ ~D,bc~. er" ~ ai .~e~~U c~~t.~g sr..d~tit,X S t-,r ~'...S S /~~~~v ~pe_ C~A- C.l~Y~ ~ w t'E'~,,~, ~tw.t.t/ `~ J -..~ -~~-IKS ~ v •<{ ~~'t'f~ ~ ~z . ~ ~ --_J - ~rti4~c`~a~t.~x. ova p.~, rv~e.+~. S ~' ~s . S ~,~ La~(.~ To Z Cs l -- 1,-~ s ~k.) ,~i a.~/ ,C~a,yf~ s~ %4' .1,G/~~fTiG ~ 9 U~ ~ s T / `7~ ~~i ta s~,,~ r' ~i/~ 'l/s ~~a ,~ .n e .~. ~ z. ~_ s~Cty./ iFJOA/~~ Sri ~y~W ~7~ T/C~ Q r7G~/ ~ d T l -/ Pl/ ~ Ss~.~/T~ i7'~ lllS ~~a is in s,v ~C- ~ le ~ ~~ ~ Q ,% lh 2 ~o-~r,~-, S~ ~'~•- a C` ~ Wis~!+sin Department of Commerce S~OjIpL AND SITE EVALUATION ~ Page 1 of 3 'Division of Safety and Buildings rORIGl1~~ With Comm 83.05, Wis. Adm. Code Certified Soil Testing Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and d l di th d l d di t t l i ti t St. Croix . ope, sca e or mems ons, nor arrow, an on an s ance o neares roa percertt s oca Parcel I.D.# APPLICANT INFORMATION - Please pry al~~ix-#o mation - . ~ Personal information you provide may be used for seco ry (~urposes (Priyaq Law, s. 15.04 (1) (m)). Reviewed B Y Date \ ~ Property Owner _;%` , ' Bonte, Ron ~ ~~.~?' S ~- _.., 7 roperty Location G vt. Lot SE 1/4 NW i/4 S 16 T 29 N,R 17 W Property Owner's Mailing Address ~ '' ~ ~ ~ to # Block # Subd. Name or CSM# - ; 1011 170th St. - __ 14 Pheasant Hills City State % ~~Code PhoneNum r ~~ ; ' ~, ,City n Village ®Town Nearest Road d 170Th St } 15 71~- 240 Hammond WI ~9~ : , Aammon . New Construction ~ si°c~ential / Number o~beElr~o s 3 ^Addition to existing building Use: Replacement ~ Pu 'c'oGCpi'ttrrteTCiOldr~s Code Derived daily flow 450 gpd'~° ~---`---Recommended design loading rate •3 bed, gpolft2 •4 trench, gpd/ft2 Absorption area required 1500 bed, ft2 1125 trench, ftz Maximum design loading rate •5 bed, gpolft2 •6 trench, gpolft2 Recommended infiltration surface elevation(s) 24" below contours ft (as referred to site plan benchmar install 2 - 5' x 112.5' shallow trenches along contours for 3 br Additional design /site considerations Parent material till Flood lain elevation, if a licable N~' ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ~ ^ U ®S ^ U ®S ^ U ®S ^ U ^ S ®U ^ S ~ U n~ c.~ : e~~ 3 i z~ ~ e H i Depth Dominant Color Mottles T t Structure Consistenc Bounda Roots GPDIft2 Boring# zon or in Munsell Qu Sz Cont Color- ex ure Sz Sh Gr ry d . . . . . . . Be ~ Trench .1 ~ 1 0-12 7.SYR 3/2 - sl 2 f-m sbk dsh cs if .5 .6 2 12-25 lOYR 4/4 - sl 2 m sbk mfr cs lm .5 .6 Ground 3 25-45 lOYR 4/4 - sl 2 m sbk dsh cs - .5 .6 elev 101.2 ft 4 - 45-87 SYR 4/4 - sl 0 m mfr - - .3 .4 depth to limiting , factor ~- gq.2o 2.' a -S ,• 5 Remarks: occasionar is poctcetsnnciustons m nonzon s wi occasional gr do con nerow l~•• 2 1 0-4 7.SYR 3/2 - sl 2 m gr mvfr cs lm .5 .6 2 4-8 7.SYR 3/2 - sl 2 f sbk mvfr cs 1 m .5 .6 3 8-18 7.SYR 4/4 - sl 2 m sbk mvfr cw lm .5 .6 4 1 24 SYR 4/4 - sl 1 f sbk mvfr cw lm .4 .5 5 2 -32 SYR 4/4 - is 0 sg dl cw lm .7 .8 6 32-64 SYR 4/4 - sl 0 m dh - - .3 .4 2`{ ~,p .~ Ground elev 101.2 ft Depth to limiting factor > 64" Remarks: occasional inclusions JYK 4/4 is m hortzon 6 SST Name (Please Print) Signature: Telephone No. Henry F. Grote 715-665-2681 Address erti ie of esting D to CST Number Ref # P.O Box 57, Knapp, WI 54749 328/2000 222774 1026 .~ PROPERTY OWNER: Bonte, Ron SOIL DESCRIPTION REPORT ~ Page 2 of. 3 PARCEL LD.# Certified Soi- esIt' img• 3 Ground elev 100.5 ft Depth to limiting factor > ~. 4 Ground elev 100.4 ft Depth to limiting factor > 64" 5 Ground elev 99.3 ft Depth to limiting factor > 60" Ground elev Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure onsistence Gr. Sz. Sh. Boundary Roots GPD/ 2 Bed ~ Trench 1 0-4 7.SYR 3/2 - sl 2 m gr mvfr cs lm .5 .6 2 4-10 7.SYR 3/2 - sl 2 f sbk mvfr cs lm .5 .6 3 10-27 7.SYR 4/4 - sl 2 m sbk mvfr cw lm .5 .6 4 27-52 7.SYR4/6 - is/lmcos 0 sg dl cw if .7 .8 S 52-64 SYR 4/4 - sl 0 m dh - - .3 .4 1 0-3 7.SYR 3/2 - sl 2 m gr mvfr cs lm .5 .6 2 3-13 7.SYR 3/2 - sl 2 f sbk mvfr cs lm .5 .6 3 13-36 7.SYR 4/4 - sl 2 m sbk mvfr cw lm .5 .6 4 36-64 7.SYR4/6 - is/lmcos Osg dl - if .7 .8 rcernar~s: ------------- a- -- ----- --- -----...,.. . Remarks: ortzon as occastona me unto s g, 1 0-4 7.SYR 3/2 - sl 2 m gr mvfr cs Im .5 .6 2 4-10 7.SYR 3/2 - sl 2 f sbk mvfr cs lm .5 .6 3 10-28 7.SYR 4/4 - sl 2 m sbk mvfr cw lm .5 .6 4 28-47 7.SYR4/6 - is/lmcos Osg dl cw If .7 .8 5 47-60 SYR 4/4 - sl 0 m dh - - .3 .4 ., Depth to limiting factor ~, o~ l 4 , ~' I~Q,..., ~.., ~ ~-~ , ~~ g Sk. 1w~Il~tw - ~ lo- 2.R- 1~ QQw 1 (7 w~ '? A~ N'- O N f7~ ~~ ~ , o ;0 4:b ' /~~.1 °te-H z-i.t"~?-~ 3~Fq ' ~~~1.2,~ ~ ~ ~`~ o ~~~e/ ~ ~C 3bb.'~`l a ~-`1 tl ~; . ~ ~ _ ~~ 13~K ~\ OO- ~ _ • Pr{1~. v- Q~ C ~ V'O ~ O 5...~ ~p,....Q,,r ~as,4~ ci ~w~~~o~ ~: ~ Zy-3' w „. Private Onsite Wastewater Treatment Systam Management Pian Septic Tank And Gravity in-Ground Soii Absorption Component Pursuant to Comm 83.54 Wis, Adm. Code each Private Onsite Wastewater Treatment System (POWYS) shah include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the ln-Ground Soii Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P {R.6199}. - Peak 150 Table 3: Maintenance Schedule Tank inspect andfor service once every 3 ears Filter ins ect once a ear and clean at least once every 3 ~ C:mm~aflP_nt Inspect once every 3 years Seats! c Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stets. The conien#s of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the se tic tank and outset filter shah be assessed at least once every 3 years by inspection. Th outlet filte aha i hP cleaned ac necessary to ensure c,~nnpratiarL The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from i#s enclosure. If the Table 2: Soil Abso ion Com onent -Limits of Reliable Operatio>~^m,~nnont .. Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shaft be serviced if the alarm is activated continuously. intermittent filter alarms may indicate surge flaws ar an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge fn the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the #ims of an 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. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used far service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. ,Exposed access openings greater than 8-inches in diameter shall be secured by an effective forking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding fank for any reason without being in full compliance w/th ~SNA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank maybe difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a P~WTS component. Solt Abaorntlon Gom on Went The soli absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly an proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic #ailure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. in general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal calf, which may lead to more intense, and earlier, organic clogging of the soil. 2 .. Management Pian for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly aver of within ten fe®t of the component should be availed since root intrusion into the component may obstruct wastewater flow. Contingency Plan In the event of system failure, a new system could be installed in an alternate area, With the installatlan of a diverter valve, the existing system could also be reused after a period of three to four years. It is the property owners responsibility to maintain the alternate area free from any planting of trees, shrubs, etc. fn case of failure of the original system, the alternate area will be needed. tf any trees, shrubs, etc, have been planted on the alternate area, they wil{ have to be removed at property owners expense. If alternate area is destroyed, there are other alternative systems that can be used, in which, could result in added expense to the property owner, Any tank abandonment abet! be done in accordance with Wisc. Code 83.33, Any questions regarding this code, please contact your local Zoning Office or contact the installing plumber. ST ~ Leo rx ~,,~ ~ ~ _ ~gD . ST CROIX COUNTY SEPTIC TANK I~~,AII~ITENANCE AGREEMBNT AND OWNERSHIP CERTIHZCATION FORM OwnerBuyer P~~ ~ i1.~~1 h~ L C Mailing Address ~~% I I Property Address ~7G~ ~ ~ ~ ~~3~i ~fh ~ ~e. ~'e~ ~-~ mar~c~. ~ l~T SUIT (Verification required from Planning Department for new construction) `~ City/State ~C`m~'~`~ ; ~~ Parcel Identification Number ~ f $-- Og~ ~ ~~ ~~ ~~, d 9 . -~: Sgt, LEGAL DESCRIPTION property Location ~ ~ '/., ~ ~ Y<, Sec• J ~ . T ~~ N R 17 W, Town of Subdivision ~ ~~~'~. ~~ ~, , I I S Lot # i Certlf-ed Survey Map # , .Volume , ,Page # Warren Deed # ~ ~ ~ ~ ~~ ,Volume ~ ,Page # ~ ~° Spec house ^ yes ~~ no Lot Iines identifiable ~ yes ^ no S'YSr'I~M MAlO!~1"PRNANCE asG and nu~anaof your septic system could result in its pranat~mc failure to handle wastes. Proper maintenance oaasius of pamging orrt the septic tack every three years or sooty if needed by a ticensod 'What y~ 1~ into the system can officer the function of the septic tank as a treatment stage is the waste disposal system. "Che properly owner agcrxs to submit to St. Cboix Zoning Department a ctrtif~cation farut, signed by the owner and by a pia,~~uymaaplumt~ restrictadplumber or a lieonsodpumpex vetifyiug that (l} the as-site wastewatordispasal system is ffi proper opting condition andlor (2} aRer iosp~oa and ~mping {if -}.'~ ~p~ ~ ~ ~ than 1/3 full of sludge. ~;, ~ ignad hate toad the above t+equitern~ts and agree to maintain the private sewage disposal system with the standards set fattb, herein, as set by the ~~ of C'ommetce and the ~~ of Natural R~ State of Wisconsin. Certification that your septic system has been maintained must be completed and returned to the St. Ctnix Co~mty Zoning Office within 30 daa of the year expire "on daft. ~ / ~~ O ` ~: _ I SItJT1A'IURE OF APPLICANT DATE OWNER tGERTIRICATION I {we} rectify that all statements on this form are tout W the best of my (our} knowledge I {we) am (are} the owncr(s} of the 'bed abo by virtue of a warranty died recot~ded in Register of Deeds Office. SIt#NATURE OF APPLICANT DATE ,R4,*~* t being revoked by the Zoning Department.'`*«**'` Any information that is mis-rtptesented may result in the sanitary petmi ~' Ltdude with this apptication: a stated warranty doed taom the Register of Deeds office a dopy of the eextified survey map if reference is made in the warranty died y~1.15Q1~A~ 372 Dine M. Bonte, as Trustee and Ronald C. Eiont®, first alternative Trustee of the Karl M. Ulferts and Katherina G. Ulferts Family Trust, for a valuab{e r,~rtsideration conveys without warranty to Ronald C. 8onte and Dine M. Bonte, husband and wife, Grantee, the tollourirtg described real estate in St. Croix County. State of Wisconsin: 2000. The North Halt of the Northwest Quarter {N 74 of NW %,) of Section Sixteen {16), Township Twenty-nine (79) North, Range Seventeen (17) West. Dated this 24thday of ~~ AUTHENTlCAT10N Signatwe(s) authenticated tnis ____ day of signaure rYpe or P~ name TITLE: MEMBER STATE BAR OF WISCONSIN (Ir not. euttxnized by § 708.!)8, Wis. Slats. ) THIS INSTRUMENT WAS l?R~~ : ~' Thomas A. McCo ~ '~ Baldwin, W! 54tM~, r it ~ ~ ; `; Q' el F ''~.,N,.,w=''~ p ~ ~~ Trustee •Ronakt C. BoMa Trustee 62o9s~ KRTHCEEN N. {tRLSN REfaI$TER l3F DEEDS 5T. CRQTX CO,, tiI ItECEItiEb TOR RETARD al-tazoeo IQ:30 Rx TRIBTl~S DEED CE~RT TIADPII TEE: cacr FEE: iRAIISFER TEE: 24!).40 PpBRDIfl6 FEE: 10.44 Ttwmas A. OAcCom+aak tg2Q 10"' A~ro. Baldwin. Wi 54002 018-1034-60,-70 (Parcel Identification Number) AClCNC)Wl.EOGMENT STATE OF WISCONSIN ST. CROIX COUNTY Personauy carne Before me this 24thiay of March 2000 the above named Dore M. Bunts, Trustee end Ronald C, Bonta, as fast aitemstrve Trustee of Kari M. Ulferts and !Catharine G. Ulferts Family Trust. to rrre known to be the person(s) who executed the fa'egoin0 instrument and aolrnovrledfle fire same. _ P~ s,,,e Dale ~ Jensen Notary Pub11C St. Croix County. Wisconsin. My n ~ permanent. (If not stela expiration date o`i i .> 'Names of persons signing in any cspaciy shoub be typatl a printed bebw their nignatures. ueam~uon vmr.Nw+w caro.w ama a L.c, w+mwn a0o.85S- { ~ e r~ H ~M A ~ H~~I.... ~•~~~' T ~D t tV (~~ tYE t ~`~ QF i~t~~ tY~Y t j~. 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J3 LdS. °£~ f e4fAR F*Jr3T aT Ati F OT*+ER LOT CCFNERS °. ` WTfi t i- fASfAfhl L TrP. J ___~__ Sf TBa~xc ~ . ,~a t ti'E RYA Y L OCA T J ah S ~ ~~ ~~ ~~ -r- ~lC~S"tE1t3 (?~FIC2i 1ta~+wdlka~ Rrcacd m~s.~---~ ~~ '~ ~..~~___.. sari ti' r \~ ,/~. tveyttar SJtf TCK se a r,ae +a r. tom.. •.: M . ram d ,...rar trot rc :crar+ UNPLATTEU r<~nv~ .. S00'44' t'3~ F '3P94, 8P' PLAT) East t ~-+° a n~ v t•• 500° 44' 15" E 2689. 05' (TO NE CO;'. • p-f,7R11i-rOUTH pt/AR7ER l1NF (THi ~ SNEETI ass se' 1939. fl3' ' 66 03' ~~ ,_ c v 330. 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U O m J ti^ a ~~" h Obi ~ N ~ ~ ~ tV ~ ti N O ~ ~ ~ ' ~ ~ r ~ , , py ,tS ~ ~ , `Y ~ .1 / 'Bbf M.lQ .Gl's8d5 , '~ _ ~ , ~ a ~ r "~ r N '~ 9 ~~~y, .,,~ ~-~,, ,a cn ~ +o ~ ,.n ~r' `.. ~ "' tt7 w N N t ~~ ~ csds a 0 f~6 N "~ ~ N .dG ; m ~ U .dC - `t V H ~~, ~ m h .ra ~ }~ h , ~ ~ Z O y~ ~ tV \ ~ ~ A ti , ~ rn tp \\ ~`` Q C p ~ 1 t ~D d .~\ ~ ~ ; _ .` Y ~ .` ' .4 .g~. tl \~ ,~b~ `~~ St9~~~2?' 9bF .Ir W ~; Vi1it. ~N~ ~ ,e~ OCS 3. .- b -~ ~~ `~ ~ ~ yJl b!y n ~~ f V ~ ~ ~ ~ r _. i ~ ~~ ~~ ~ ~ _t t-- ~ ~~~ ~ ~ ~ ~ ~l .- FR01~ Schumaker Plumbing FAX N0. 7153863121 Aug. 30 2001 06:07AM P1 Schr~r»ake- pl~rinbi~g 1070 SCO~'T RD HUDSON Wl 54016 Phone 8 Fax (715) 386-3121 aaTE : $~2 9/e/ FAX # T0: ~E /~y`~ - NO.OF PAGES: SPECIAL INSTRUCTIONS: ~OrU: FROM Schumaker Plumbinq FAX N0. 7153863121 Rug. 30 2001 O6:O9AM P5 SOIL EVALUATION R~PQRT P~~.~.~--.~ Wlscon9ln DepBrtmen# Of Commerce Oivislon of Satvty rar+d 8uidingo In eccorQance ~~ Gmm ~. Wis, Adm. Code nt C + ou y ~ Attach wttlpl~ site plan 4n p7pof not less roan 8 9/d x 11 inchos In sizB. Plan must d n°t1x°nt't r®terenc~ point(Bt1N), dlrodior+ aAr1 Pet®I i.D. l an Include, but not limltsd to; veRiex saalle rr (tI1T10nB+6nbi north grrov+, gnd location rnd distanco to near®sl roes, ~ ercent slope D i .bete , p {3ev1®wCtl ! Pfeaas print all Ihrerntssien. Par+~+al M{prmaMa~ You pravlde mar t+4 wad tot eCeOptlary purpe~s (PrireaY Lew, a 15,a4 (+) tm11 Pro~rty LOGation PropeM1Y ~e1' 14 8 ~~,~11 N R / ~ E {a'1dI.., T ~Q 114 govt. LoL C~/ _ ~' ~ Lot ~ Bbck s $utxi. Name or Properh . ~ r'e Nbrling ~ t>~ ~ e1.~ ~ ~ ~ , Phtane Number ~ ty ^ vlllape Town Gtty ~ Zip cl. Nearest Road ~~~ d i ~ t ~-.s-~ ~:o - aa~~ ~ ~ 3 - GodE derives daci~n slow mate ~J New CpnetructiVn Use: #~ F;;exidbMHel 1 Number ott+Ydroom9 ~ d GPD ^ Rapla~r'nenl Public dr cvr++tnarGal -Describe: ~ ~ Fbctl Piero elwaCbn >t applicablo ~ if. ~ Pmrenl material ~m ~'P~G- V • 9.3. a a aaneral cvmmenb e~ / end remmtnendatlons; G.I. ~t U ' ~~ GQ Boring Bvrln9 ~ Ground aurfe®e1gu.Q~(~_ft• DeA~ t0 rtrrt+~r+I; lector ~~ -- m. it IiCB n R~ Pit GP HOti~tm 17rlpth pomin»nt Color RedoX peatxiplign Texture 3truoture Conei6tQrrce Boundary 14oots •~t `~ in. Munson t1u. 9t. Cont. Ca1or' Gr. Sz. sn. 1 ~ . ~" ~ yP~ /~S.it~I/_ r ~ / r r ~ l3orlnp Boring P Pit tetognd sulT®ae elev. Z~s~ . R. Ci~+Etl to Nrtlhing f actor l Z D _ in, 1 5~ Horixo+~ Depth Den+lt~nt Doter Redox Cfeaei~lon Texture Structure Corrtstsnos Boundary r~~~o'ts Rte In Munsell Qu_ Si. Coat Color C+. SL Sh. . .r ~ ~ - L ~ J. /~// /~ `~ j/~/j Etltua7t #1 1Pl~aaa PtingPrint' y 30 S 22o ntg1L and TSS a30 •~ 150 t~>> .S' .~_.....,_ ' ~ Effluent #2 ~ k~UDL `y..p:1e ~~ialuatlon Gonductsd ~ rngrl. and ? ~S ~ 30 ntBlL l S'1' Nurntier 'I'alept+one Number W0~ bd Wd13S:66 TOOO 6~ '6~~ ~~ Xdd FROM Schumaker Plumbinq FAX N0. 7153863121 Aug. 30 2001 06:0BAM P3 ~, f~ pwnsr nrt I~ra Parcel 1[I ~ ~ ~ - paw _s._'~ p t ,~~ ~, y Berirtg a ~ p9onn9 Ground aurtecr elev. ~• t~oplr+ to nrniting rsetx ~'n• 5011 A Callen Ra' I"ICNiLOn Depth Dotlrilnant Colo Des«io-ion RQdoX Texture ' ~itrUGti.~ ~ Ca'+s+~n°° Brn'^d*ry r~°°ta GPO *EftC1 Ht "E1A~ In, h{un9ell Qu, Sz, Cons, CdOr .1 Gr, sz. Sh, i ~ C r * ' l ~' Sr / ~ / ~' ~ 4- r ~ I ~r ~ ' L - ~ ..S" . ~9 ,G ~ ~ ~ s G yr - ~ c ~ ~ ~J ~ / Boring tlE ^ Boring • ' ^ Pit Ground StJrhsa elev. R. Qepth ~ {irnfin9 lector ~,~._ in•. Hirkon beptfi Oominatl{ Cvlo- Rradcrx Descriplior. Te+siure Structuns 4a'va;9rCnoe Beundsry Roots I in. Mansell Qu, sr• Cunt Cola! u'r. 3s, Sh, ~~-- f'~'~ B~~ a ~ Baling Orwrad 6urtaeeBtav,.. R. CePth r411mlbna far3or_~ In. ~L ~I ^ Ph f{q•gpn t7ePth pominarU Calor Redoar pasctiPtion 'fa~sture 8tr ~ ro ConSistonCe Boundary Roots • Bmuent ~t1 = 9C»s" 88 ~ 22Q melt, and 1'39 ~3t) =1 SO -n91L ' Efiluenl *2 = 130D` s 3G mg/I„and T59 ; 30 tnylL i'he 1)epaztment of (;pp7111CSCC Is till c~ua) upquf~uttitY 9crvit:a Ury~~icicr and ampluyer. 1Fyuu nccd asslstlrnGV Ill lLGGesz sclwlcea or noel tneaetidl I~t an altCrnglc format, please aonlnrt llk. clormrtitisnt at [~()R-2fit+-3151 clr'1;'I"Y G08-~tiA-8777• 541-ILU~ Ik.a7/UUI ~~^~ ~~ ~~ : WLIi~ ~d t~s:6e zv~z ~~ FROM Schumaker Plumbing FAX N0. 7153863121 Aug. 30 2001 06:08AM P4 PAC.~~nF . ~ ~rsutt. ~~~L.._ K i r----~....... scn~.~, 1"= Y4 i f HAM 1 ET,EV,P-,T~ON_ ~ - ~ ~ ~ ]3M 1 Db.4~JFTIdN~~~-~~ _ ~~~ ~C art a ~a.~v~,~r~o~v g~ Z ~ AM 2 13z~C:~IPi'LON rte' ~ r ~ ,~, C,-d1~1,a~ o . .s.r~ i . _..... sYSTEM FJ.~VATION ~ ~ ~ .. ~q.. ..._, - ~~ _ I .~ i I • ~~ ~ I ,~~xNA'i"T3 L?.SVA 1 ION A// ; ' rOT7'~C~ZTR r~FVnTiON_~1.~.~- 1 1 ..J L_.. ~ ....... ~{pu F.yl ~~~~Z ~ .1 ~~ ~~ S'3 e ~ ~ !~ ~ ~tp.~ s y$~ch ^8-~ -.-- ~---. - ~~,,d ., .., - SIGl~A'1'IJ1tF '''~ - ''~~~" - - Wt~ Zd WdZ5:6tl 500 6Z •6nd 'Ohi mid FROM 5chumaker Plumbing FAX N0. 7153863121 Aug. 30 2001 06:07AM P2 Wiooo~,an ~opa.tms~t of ta~nn'~rce SOIL CVtiLJATION REPORT pivVaiar of Safety en4 9uild:nge to aeoardanco vnth Corttm 85, Wis. Adm. CedQ t:vunpr A;Ta[~ camplett' 5(tE plan an p~ef not 1e55 than 0 11Z z 11 IllGlvs to sire. Pan must Indu4e. Out net umitad te: veetlr~l end norlaonlell t,~rsn~ pplnt (8M1, dhterxlon atld ,, Pa~r~ .I D.I D pereentslrypa, ae~11e of tllRlanzlOnc, nolvr erro~N, aria iocallon aria tiis[ancr to nearosr tmd. I Re,-iewed please prirK tr/1 iriforr»4tian. PgreonA) Iniornwllon yeu pivvi4~ tsOY bs ~saY ter ~O^a°W pwpeaaa t'rtulloy Lnr, a. 15.M I~ I l~)1.. Gott. LGl $ i/4 Lot 4F. BIOCIc~ P'vpar:Y Page ,,,~,~ of , 6 T~ N R J ~' .E or CSM~E \' s i .. bnclruGtion flaw: ~ Residential 1 i4uenbar of b®tlroomc „~,r„ Coda partved des~tiR Aew rays ~3' 6 tiPG ^ R~leconsont ^ ~'uinlb er ~omrwewdai . Dgculbo: A. Peta~rit materiel 1. ~ f Flood Plain davati6n If q~pplieatala ~1 GYhir.~) QOn9fnanti RV~ ~ ~^ ~~ ~~b In' Sa ar / / ~;~ aria reoomrnen4aliona: ~a~~i~- J~I~~~ -~ ~~ Boring Boring iE ~.. ~ Plt Ground wrtaoa alav. ft. a-Da'i to IItNCr!9 facaor ~ M. pp li N Warvcn I Gpsh I~i-nlt`61o- RadosDescFipllen Tmxture Gr.Sz SA. alelc~e Boutlday RaotR •~1 ~ ~, N1Ut>sell t]u. S2. Cant Gobf I b-ice Z -- c5 Boriryp g ~ go ing ____..~ Plt Ground surlets elev. _~~. ~ptM to limiting }ad~ln- WOiyd tid WdZS:60 Y00a' Sz '6~ 'ON X~~ FROM 5chumaker Plumbing FASO N0. 7153863121 Aug. 30 2001 06:09AM P6 ~I,n~ a3 p~{y Owner ~~•~-----•~ B0Nt14 f` ngprh to limi((r+9 fackz .~~ in. B<x~g * spit Ground surfaq Dieu, T_-~..._ cM~uro CC1rIJiit9rl~ 801rr1d .Q goring Borin® P © Pit . , . ~,, ~. pvpttt tD limtgnp !actor _,.,_,- in. Ground atafaca elev. I I • Efflux ~ = BOns e ~ ~ ahd TS6 ~ ~ ~ • Eftlya rll *'1 F BgDs > 30 . ?A n+glL and T5S >90 W f 6d mgll I I I Ire [)wpa~~.mchl uF4~odlnrvrCe iq a~ equsil oplsoriunil7 service l+rc~viddrr titd cirPl(~Yur. I F yuU necd~;ISS+clxnCti lcs access srrVlec9 or need matet'ial in an altcrtwtc ir.nna(, pi~ata>w+ ca:lnt~ tKc deparltn(:rrl :11 608-2Gfi•3151 ur'1"1'Y lilliF~2G4-87T7, :i Nh1) H)~nIN a'IIGq PaBA ~ at • ON ,~Jd W0~ ~d Wd85:6PJ j01~ 6Z '6nd ~~ _ }I„ Denttr to limiting favor ~.~-^ In• boil Ilcedion Rate ~~~ ~ ^ Pll Grvund;tlrlpeatie~ev. Herizvn berth Dontlnant Cllr Redoec t~escrlption Texture 9lnacturra t;onsi9tenaQ 6nurdary tRoofis •~f4#li "PtiiC:2 CaY. 5z t3h. in. Muntrll Cu. 3z. Cont. GotOl' , FROM Schumaker Plumbing FAX N0. 7153863121 Aug. 30 2001 06:10AM P7 ~~~ ~ ~~ i~.,~~ r s~Ar.~; t"~ O H,M I r:1,BVATIOlti • ~ $M 1 vp,SCRtpTI01T~ a ~ t~ ~~r?t-•~~ ~' A~+t 2 L'S.BVATIUN q~`~r0 az~ ~ Drk~c,~.tPrzoN~,p a~ P~._~~. -- aYb'TBM EI.EVAT'IC)N 93, ~ d ALT~RNA1'F. ELF.VA'1 ION ~ Wi ~ ~ b - CdN'~oCJAEi.B~V'AYION .ate, .oG o I ~ i I ~ ~~~ ~~ ~ ~I 'i ~ ~ I I ._._..__.. _.._...~. ,.,, -.r.._ -.___.. WOti~ Sd Wd~S:60 'i0~ 6Z ~6nb 'ON Xb~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must ~ . include, but not limited to: vertical and horizontal reference oint (BM), direction and Parcel I.D. percent slope, scale ordimensions, north arrow, oc ti~ rn ' tance to nearest road. Please print a ~ ~ tiori: f ~~ Reviewed by Personal information you provide may be used o~econdary~tp (Privac ~ 15.04 (1) (m)). Property Own ~' / '~G.~, +~ perty Location Page ~ of Date ~~ ~ ,ti .:, ~„U©` .Lot S 1/4 ,~/1/4 S ~ TZ~ N R l ~ E (or H Property Owners Mailing Address ` ~ t1r,, ~q # Block # .Name or CSM# ICI I n (~~ ~t C;+~-~~ ~~~ „';~~~.,~c~ ~ ~ ~ ~s City State Zip Code ` Phone Numl'IA~G+"" City ^ Village ®To n Nearest Road New Construction Use: ® Residential / Number o ~ Code derived design flow rate !i CT d GPD ^ Replacement ^ Public or commercial -Describe: //~~ Parent material ~'~~ ~ I Flood Plain elevation if applicable ~/~^T' ft. General comments I n and recommendations: ~ ~ Ste, ~QY~~ 1.vy~',t. G~v q d» Co /1 tJY.~ /0/~ fi'r' Sa ~ ~~ {'~'°'`~ ~e,~.+-ter $o-Nawtu-~- syJ~~~~J .~ 8~'~'~ ,~~~~`'~1 Boring Boring # in. Pit Ground surface elev. ft. Depth to limiting factor ~ _ Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft'- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 6-t2 Z - ~ I cs • 8` 2 -29 ID ----, cg - 3 29-?'8 - r~nS s m ~ - J~ 2 ~1 ~$ I~b (D ~ 5l. ( - a Boring # ~~7I Boring lz`F Pit Ground surface elev. ft. Depth to limiting factor ~ in. Soil lication Rate 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 *Eff#2 I d-~( 2 --- Si Z ~ v . II- ~ r4 ~ -~ ' f - - I y -- Inn rr cS - `7 /. Z ~ -- L - -' S * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si CST Number a ~G ~ 30 Ad Tess / Date Evaluation Conducted Telephone Number Property Owner /~~~V Parcel ID # Page ~ of ~ u 3 Boring # ^ Boring /Q~ ~Plt Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 I -12 1 3 - S~ 1 2 r c 1 .5 ~2-~ - I ~ --- - ~-ia~ ~ ~Il~ --- m S rn I - - _ ~ - . 2. ^ Boring # ^ Boring - ^ Pit Ground surface elev. ft-. `Depth to limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * EfFluent #1 = BODS > 30 < 220 mg/Land TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services 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) PAGE 3 OF 3 NAME 60f1,~-C_ LOT# I `"l LEGAL DESCRIPTIONSL~ ~~~14,S lCo T Z9,N.R. ~ ~ E(or~VJ SCALE:l"= yC1 BM 1 ELEVATION /(~. CJ BM 1 DESCRIPTION~~.~ ~-t ~~ ~ ~ ~. Y~.y~ LQ BM 2 ELEVATION R`j. Z BM 2 DESCRIPTION ~-~.{o,,,•~ d S, ,eau o r~ 9«ro-c~. SYSTEM ELEVATION /t~/la- ALTERNATE ELEVATION N/1~- CONTOUR ELEVATION ~fl,~- 1 - t - K ~ S~c• /6 1~--0 SIGNATURE ~ z~ ~ DATE ~ ~ 12 ouo~