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HomeMy WebLinkAbout018-1083-16-000 ~ ~ ~ ~ ~ ~ ~ v ~ ' ~~~ ~: ~~ ~ n I ~ ~ ~ O U) T 3 d LO I Z y 0 O W W ? j S a o y ~ - n ~ 7 ~ ~ y ~ ~ N~ ~ ~O '~ Fi ~ W ry> 7~ °~ 7 v~ O A I N n 3 ~ ~ n~~ "! ( l I ~ o~ ~ O ~~ „ ~ ~ V b ~ O ~ w ~ ~ ~ ~ p ~ w ? cn v y w a s ~ ~ y D. < ~ 3 _ ~ w 00~ N~= N 1 ~ Q J t ~ ~ W A = `N N N O i Z ~ O ~. I 0 0~ (Ap O C 1 lr I a -' ~ 3 :~ c ~• n a ~ lei c~ N y N c ~ O ~ ~ y ~ •• ~ N C < ~ .. y I a ~ 7 ~ I o ~ ~' ' I 7 O ~ ~i ~ ° ~ ~p ? I O ' cc y <, ~ o 'o ~ N I N ~ fD N fyA O pl tD ' 7. ~ N ~ C ' fD I w ° ~ ~ ~ ~ ~ a I ' m c d ~ ~ ~ to ~ d o a A z _ ~ o m~ J m rn y ~ ~ Z 0 ~ ~ 0 ~ ;. 3 Z C ~ °° ~ y Z ~ 6 I ~ O W ~ ? I y ° a ~~°' ~ I 3 I ~° ~ o ~ ~? -n c I '. m o a , < ( p a (O/1 I ~ N y ~. "" I a~ m w a ~i v o ~ ,~ I ~ I A ~ O A ~ Am W O a O O N ~ O f ( ~ ~ j A i c~ ~ { I Op OOo ~ ~ , ~ ° ~ p I o n ~ ,~ /* Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and auild~ngs Division INSPECTION REPORT f , GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). Permit H Ider's Name: ^ City ^ Village Town of: Conte, ~2on Hammond Townshi CST BM Elev.: Insp. BM Elev.: BM Description: ~ n ~1 o S~ TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic O ~/ Aeration- ~ " Holding TANK SETBACK INFORMATION TANKTO P/L WELL BLDG. Vent to Air Intake ROAD Septic } ~-~ / ~ L Z ' - NA Do• _ _-_ NA Aetsaf on N Holding PUMP /SIPHON INFORMATION - anufacturer mand Model Number GP TDH Ift Friction S stem TDH L Forcemain Length Dia. D. . C'AII AQtADDT1A111 ~V~TCM Ft FveTIC1N DATA Count SYt. Croix Sanitar Permit No.: 340000 State Plan ID No.: Par<el Tax No.: 018-1083-16-000 STATION BS HI FS ELEV. Benchmark ~ ~ ~ 6 Alt. BM 2, Bldg. Sewer ~ <( o Ht Inlet ~~-. 3 ja S 1 Ht Outlet 11j -~ p Header /Man. ~-, p Q~ ~ Z Dist. Pipe / q , Bot. System L ~ ~' ~ ~ ~ ' Yd Final Grade ~ ~ Q , over k th id De li BED /TRENCH Width Length No. Of Trenches PIT No.Of Pits p qu Inside Dia. 1 ENI '3 3. ~ ~ DIMNI SYSTEM TO P / L BLDG WELL LAKE /STREAM L Manu ur r: _ SETBACK fIA ER N INFORMATION Type ~ ~'sb ~ 0 um er. Mo a c` ~ System: v f1ltTff1011T1Aw1 CVCTCwA v~.r ~ ~~.vv ..v.- r .... - ani old Header l .... (s) Distribution Pi x Hole Size x Holeing Vent To Air Intike ~ v Length ~~ Dia. ~ ~ ~ ~ Length ~ Dia. ~ Spacing _~~ ~ y' ~ SAIL OVER x Pressure Svstems Only xx Mound Or At-Grade Systems Only Depth Over Oepth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topzoil ^ Yes ^ No ^ Yes ^ No / COMMENTS: (Include code discrepancies, persons present, etc~speC IOn : ~~. 3 D/Inspection #2: / Location: 1727 97th Avenue, Hammond, WI 54015 (SE 1/4 NW 1/416 T29N R17W) - 162917588 Pheasant Hills -Lot 16 y.~~ wL~ ~- ~~ 1.) Alt BM Description =s / ~v~r 2.) Bldg sewer length = 36' -amount of cover = W ill .6~ >y//i''" , r /, /,~,~~~ w; </ ;ws~/I %Ksa ~~ `~- ~a~ ~ ~ ~~. S ia.SD~~~~ ~~h. Ystt ~) ~' I/ 5'~dx... IDGr~~ ~ (.~~t~10~-'~inLCt'f ; 3~6~se~v~~h- per/' fl ~~<< f~s-f' p SPa- '~ ~C~ L,~~C~- 7Gr G~ ~ ~ ~ Plan revlslon required? ~s ,~No Use other side for additional information. SBD-6710 (R.3/97) Date Inspedor'sSignature Cert No ~„"'~~~ ~ l~-L ~- ~ ~- i~E ""^"' ~(.(! ;l ~~ .7 ~ ~ j I Jate[y CL iiU1KJm ,~' u~rwivu 201 W. Washington Ave. ~ Sanitary Permit Applieatioo PO Box T3o2 ~ ~~ to accord with Comm 83.21, Wis. Adm. Code Madison, VVI 33TUT-T3U2 pgpar tr-~nt of GOmn'tOrco Persa~tal iofttrmation you provide may be used for secondary purposes {Submit eotrtptetod form W county it not [Privacy l.aw, s. l 5.04{ ! xm)] stage owned. Attttdr eAe !acts to tl-e far tine not kes than 8 -[~2 x 11 inchoa in siu. Cotmty Strut . 'terry Permit Numba• O C3teolc.if'tevisioa to litatioa Slate Plan 1. I~ Number --- S T~ ~a ` u o'00 --.. I. A trios Ist*ortmtttion - Plettae Axi~t till tafot~taation .~• Location: Ptopeety C)wner tVaaoe ~` ~ ~~ ~~~ ~ • . Property t.oartion ~c ~ ... ~ ~ .r/ / t° ~ t/ c.~ 1/4 S /G T • ,N ~ ur PraQertY Ovvna>'s lvtaita~t ealddc~xr ~ t : ~ . ,-,.. _.~ ~ I.ot Wtanber I31ock N ~X City, State lap c:odn ~~ ,Phoae N Gp'F ~ ~~~ Subdwiriat lame or CSM Nutabor ,vd 5 yak ~ ~ ~ ' ~~ ~'•° i~~ ~ ! ~- Type a!'BuiWlna: ckecit ooe ~ ..:,~' `r ~ • ~'~- .._. _.--_.- o city O Viltsge 1 or 2 Family t~weltiutg - No. of Bedrooros own of C Public/Comtaerciat (describe ems): O Stateowaod IIi Type of Parneh: (Check only one box on tiro A. Check box online $ if applicable) iHmceut Road ~ O q) t. ,New Svstctn 2. D Replacemotd ~ of 4. AdditiS to 3. E Puoel T:x D b~(~ - /C 0 ~ O ~ s, o .. B) POttrlt! ~~ tote IrrueKl a 9 /7 , ~ D A Sattiwv Perrnie was issued . V. 'lope of POVVT : (Cbecic aU t~atapply) -'i~ t ~ . ~ Mound D Ssnd Fitter D Constructed Wetland Pressurized in-ground p Holding Tank D Single Pass 0 E)rip t.ina 17 At r p ©Aerobic T Unit D Racincuittin$ D Other: 2 X f 3• ~ ~ ;~ d ~'r `pt~ ur ~'',~¢,~ ~ ~ o ~* ~6 .e t~s --! !J~ v E+,d~ s V tssl~'restttee nt Ares IMormation: 1. t F7vw (gpd) 2. Dir~xsatArea 3. Diapetsat Ara 4. Soil Appliesti~ S. Percolrtioa Rate 6.3yrwot 13tevatiun 7. Fier{ C.inde • ' Ieration ~ !required Proputed Rate cc~.t:./dey/sq. e.) ~,.~ia~> 9q. ~ ~/F v ~ ~GQ ~d d r S ~ ~Q (• ~O VI Teak Capacity in Total # of Manufactwet• Pcefab Sits Steel Fibtx Plastic Inlotrmatioe Gallons Galbns Tanks Con- Caa- glass ~; F~ ~ strutxod Tards Tanks a v a ^ s"e ~ ~` ~c ~ jQOD f ,~-- p © D O C] VU Respeasibllity Statanetat the tudarsi sssttme rea 'tit fa iastatlation of the POWTS she the attached lans• Plumt+a'u tVarmt {pr~Nl Phurat>e~s 3tgOetUte Ao stamps): S Hto, Hure-eer ['berate Ntunb~K `/,'C ~°owi c~s„<`(ev ,2.~~99~ , 7iS-38`6-3lz ltltaarber's Ad~as ('Street. City, 3u+ie. 7.ip (:exie) /a~a ~~ ~ ~sa.~• w ~' '" al VDI ConatylDepsrtsent Uee Oely D Di~gp~p~~ Ssaitauy Permit Tee (Ittctudes C)rnursiwyter t7mto isswed Issuing Agent Sigrutture (IJo scamps) ~Z1.Approvod D Owner Given lttiti8! Adverse 3e F~• bD / 2.ee 1 iX. Cenditiom of st ~Keaaotss Totr trtaapptrovst: ~ $~S1R+U•~ ~~k-- ~,~- ~,.,.,~u. ~a,w.. 4,.t,..~ ~' S', oo SYS~w .e,QR~p,~,K ~ o`-- `to I v w~-: , ~ S •~ ~~'tt~.~s a.,~ ~' S a-o ~-~- : s ~~ ~ . ~- y,~~st ~at 36 a .,d~.~,t. ~-~~ .,1-tK~ ~,,~ r~ l.~'~'~ ~~~~1a~ -tf~a.S S`~,1~.Q~.ue~~-t~e+~. `-Ctµs ,~~~ uar.~Q~ S ~~-- • ,, ~- ~ `i `lS Se7 i~ 5~5~ ~ ~ ~2 " ~ c~vv t~ ~ ~ ~- o'las.r' C11~ S `~ Cam. . ,~ u ~..~~~~° ~ 97 ~ .~ .~ `,~ ~ i4 -, ~ ~ ~ ' ,' .~ ° ~ ~ ~~joa ~ e~ ~ ~~~~% ~ ~ t ~; \ I~°~ s ,~rti w ~` ~! \ `' ~ ~- -,z ~~ 1 rnZ l /~ ', ~ ,• ,,~ ~ o,c. 7`~ .C ._7- .1.~ .d°~~~~Qy_ f/~l`~ l~9 /W ~ f4o 1sr rY+ C.v ._ ~ ,~/' a ~ ,,o r° ..~ ~~ ~~ ~ ',~ ~ ~4 d' ~~ ~ ~ . ~' S ~ ~ ~ . ~~ /~ c ~ ~ ~ ~~ba ~ ~/ ~ ~~~~/ ~ o~ S,`t~ f~vu~ Wd ./~ \ P~ ter. ~~~ v ~V rn2 l ~~z~-~~,~~~G ~/~ ~a ~~9~ s l~!~G~ Wisconsin Department of Commerce OR~G~~,a-N~ SITE EVALUATION Page 1 of 3 ~ Division of Safety and Buildings c with Comm 83.05, Wis. Adm. Code . ~ Certified Soil Testing Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must COUnt y include, but not limited to: vertical and horizontal reference point (BM), direction and scale or dimemsions lo e th t r ad t r d di t t St. Croix percen p , , nor arrgJb w on an o neares . s s ance o '~ -, Parcel LD.# _, APPLICANT INFORMATION - lease print all nfo >v~ation , . Personal information you provide may be, ed for seconda~pl,rposes (Phvacy~aw, s. 15.04 (1) (m)). viewed B Date ,~, < r., _ . eo Property Owner ~ Property Location Bonte, Ron Govt. Lot SE 1/4 NW 1/4 S 16 T 29 N,R 17 W Property Owner's Mailing Address ~ ~ ` ~`"''"S ~- Lot # Block # Subd. Name or CSM# 1011 170th St. ', , ~- . ~ ~• - 16 Pheasant Hills City State Zipp C e ;;>~tiogg r ~' d WI 5 H 01~'~'7~~ ~ 40 ~ City Village ®Town Nearest Road d 170Th St ~ ammon 4 - 96-52 ammon g New Construction ~ Residential / Nu~bef'of bedrooms 3 ^Addition to existing building Use: _ _ Replacement ~ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •5 bed, gpd/ftZ •6 trench, gpolftl Absorption area required 900 bed, ftZ 750 trench, ft2 Maximum design loading rate •5 bed, gpd/ftZ •6 trench, gpd/ft2 Recommended infiltration surface elevation(s) 24" below contours ft (as referred to site plan benchmar Additional design I site considerations rnstall2 - 5' x 75' shallow trenches on contours for 3 br 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 ofo..~C..,4~ :F~.1.~.:,~_5~ l.2ovo-AEI Horizon Depth Dominant Color Mottles Texture Structure Consistenc Bounda Roots GPDlft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ry Bed ~ Trench 1 0-7 7.SYR 2.5/1 - sl 2 m gr ds cs 1 f .5 .6 2 7-18 7.SYR 2.5/1 - sl 2 m sbk mvfr cs if .5 .6 3 18-43 l OYR 4/4 - sl 2 m sbk mfr cs 1 f .5 .6 4 43-76 lOYR 4/4 - s 0 sg dl cs - .7 .8 5 76-78 SYR 4/4 - sl 0 m dh cs - .3 .4 6 78-84 l OYR 5/4 - fs 0 sg sl as - .5 .6 7 84-86 SYR 4/4 - sl 0 m mfr - - .3 .4 Remarks: ~~~"' N'~ wau ,cau; „unn pn wan, 5, W S tnOrlZOn J LO 4) ~ JU-JL ; OCCaSlonal 1 V T K 4/4 SLraLIIIeQ t r/ 1 b° - U2S") IS DanUS 1 0-4 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 4-12 7.SYR 3/1 - sl 2 f sbk mvfr cw if .5 .6 3 12-34 ~- 7.SYR 4/4 - sl 2 m sbk mfr cs 1 f .5 .6 4 34-62 7.SYR 4/6 - is 0 sg dl - - .7 .8 r 9.60 --------- considers le gr co m onzon 4 Z~ 6 Remarks: "'a"""' i.~ z n yiv ~ ~v, sg, u,~ ~w 4~-4a w/ no gr or coo ~ST Name (Please Print) Signature: - Telephone No. Henry F. Grote _ 715-665-2681 Address erti re or estrng Date CST Number Ref # P.O Box 57, Knapp, WI 54749 4/16/2000 222774 1058 PROPERTY OWNER: Bonte, [ton SOIL DESCRIPTION REPORT ,. ~ page 2 of 3' ~ PARCEL LD.# Certified Soil es niesT [ a Ground elev 1 /1~1 ~ 4 Depth to limiting factor > 62" Ground elev Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GP[S/ft2 ' ~-Trench 1 0-4 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 4-13 7.SYR 3/1 - sl 2fsbk mvfr cs if .5 .6 3 13-30 7.SYR 4/4 - sl 2 m sbk mfr cw if .5 I .6 4 30-46 7.SYR 4/6 - is 0 sg dl cs - .7 ~ .8 5 46-60 7.SYR 4/6 - lmcos 0 sg dl - - .7 .8 consi era a gr co I m onzons 4 Ken18n(S: 1 0-5 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 5-16 7.SYR3/1 - sl 2fsbk mvfr cs ]f .5 .6 3 16-37 7.SYR 4/4 - sl 2 m sbk mfr cw if .5 .6 4 37-60 7.SYR 4/6 - Is 0 sg dl - - .7 ~ .8 consi era a gr co rn onzon 'zl• 1. ~ re ~ ~ Sei ~ +w r~Ci i iai n~. 1 ~ 0-4 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 4-20 7.SYR 3/1 - sl 2fsbk mvfr cw if .5 .6 3 20-44 7.SYR 4/4 - sl 2 m sbk mfr cs if .5 .6 4 44 7.SYR4/4 - is Osg dl - if .7 .8 consi era a gr co m onzon r<CiiiaiR~. Depth to limiting factor .' ~ 3 ~-~'~' ~ ~ ~" G{ p ~ ; Q' i~ = ~ '.9 U ~ ~ d ~ ~ .~ ~ ~- 0 n., .. .~ S ~ O o J ~ d 0 C.. v C 0 (`n S 0 d r ~' . / , /~ lO i1/ ~ o \ 'r i ~ O G~' `f D~ V D s ~- \1; ~ ,f ~ . ~' ~ v /, Q ,i, r! I~!' M ~ ~b 5 0' 0 ~ 1 MI s o Z N ,~, ~( t °I J M 9 ~~ •• ~ ~ ~ ~ ~ `~ ~ ~ d ~~ ~ Y ~~ ~ ~ n1 s n ~~d ,~ ~ y ~ `r ~ a ~ o ~„ v 9 ~ ~ - v ~.~+ ~d' /^ ~ ~, Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite wastewater Treatment System {POUVTS) shall include information and procedures for maintaining the system within the parameters of Gomm $3 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 compi'ses with Comm 83.54, Wis. Adm. Cade, and the In-Ground Soli Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- r~~.~_ ~ . Qaaew. 1lnninn Cno~cifiC9tlAflS 1OYIC 1. ~7 arcan rrv~^ Sanita Permit Number - - ---- CTO~ Number of Bedrooms 3 Desi n Flow -Peak d ~ Estimated Ftow - Avera e ( d) 3~ Se tic Tank Ca aci al ' ~ Soil Absorption Com onent Size ft) o'eO T e of Wastewater Domestic __`._ .,_ e-_u w~........a~.... f+..r~,r.n~nen! . i_imitg of Relliabie Operation S I ~.~ 1 aL71@ 6: r7u11 naiava ~ava a vv... ....~..- -------- Se tic Tank Component Soii Absorption Com onent Desi n Flow -Peak ( d} veo s" '~ '" ws +~- Maximum Influent Particle Size (in 1/8 Maximum BOD {m L 220 150 Maximum TSS m L) Table 3: Maintenance Schedule Septic Tank lns ect and/or service once eve 3 years Outle# Filter Ins ect once a ear and clean at least once every 3 Soii Absorption Cam anent Ins ect once every 3 years Septic Tank The septic tank shat! be maintained by an individual certified to service septic tanks under s. 281.48, State. The contents 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 cond'+tion of the septic tank and outlet filter shaii be assessed at least once every 3 years by inspection. T outlet Tilt shall be ecessa to ensure ro er Aeration. The filter cartridges of b removed unless provisions are made to retain solids in the tank that may slough off the flter when removed from its enclosure. ff the / ~` ~ Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. in#ermittent fliter alarms may indicate surge flows or an impending continuous alarm. The septic tank shalt have its contents removed when the volume of scum and sludge 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 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 for 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 locking device to prevent accidents! or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being In full compliance with t?SIfA 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 fhe inferior of the tank maybe d~cult or impossible. Tank abandonmen# shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. S~oil_Abso #ion Com o~ 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 on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by ali 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 feast 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 far 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 failure by freezing. This type of failure is usually temporary, but is difl'scuit 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 cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 fr Management Plan for a Septic Tank and Soi! Absarpt}an ~ompanent Plantings of deep-noted trees and shrubs directly aver of within ten feet of the component shaald be avoided since root intrusion into the component may abstract wastewater flow. Contingency Ptan In the event of system failure, a raw system could be instaiied in an alternate area. With the installation of a divert8r valve, the ~xistinp system could also be reused after a period of three to faun years. It is the property owners responsibility to maintain the alternate area free from any planting of trees, shrubs, etc, to case of fsllura of the original system, the alternate area wi}# be ne®ded. It any trees, shrubs, etc. have beer. planted an the alternate eras, they will have to b® removed at property owners expense. if sitsrnate area is destroyed, ther$ are other alternative systems that Cori be used, in which, could result In added expense to the property owner. Any tank sbartdonment she#I be done in accordance with Wlsa fade 83.33, Any questions r®garding this code, please contact your #oca} Zonin$ pffice or contact the Installing p#umber. ST CROIX COUN'T'Y SEPTIC TANK MA]INTENANGE AGREEMENT AND OWNERSHII' CERTIPTCATION FORM OwnerBuyer ~ ~ Y~O--1~ ~ - IC.X~ Y~~~ Mailing Address fo ~ ~ ~ ~~~ ~` ~~- N~--~ ~~~~ , W z S~ ~ S Property Address ~ ~7 ~ ~ ~ ~ ~1~ v (Verificati4on required from Planning Department for new coastruction) City/State ~a lr~ ~O +~O` ~ W ~ Parcel Identification Number ©~ ~ `~ ® 3 ~ ~gg~ ~-~~~ f~io~,~~,58C~ ~G ~ DESCRTPTTON ~ ~ ~ ~ Town of ~ m hn0 P'roperiy Location 5~ /., ~ /<, Sec. ~ ~ . T o~ N-R~ W, Subdivision ~ ~~~ Lot # ~~. CertQfied Survey Map # , .Volume ..Page # Warren. Deed # ~ ~°~ o~ 'S 7 ~ ,Volume ~ .Page # o ty Spec house O yes ~9 no Lot lines identifiable ~i~ yes ~ no ~ M MAINTF.~tANCF Impmper use and maintcnanceof your septic system could result is its premature failure to handle wastes.Proper maintenance cons~ss csf pucngiug ou# ~ septic tank every three years ~ sooner. if needed by s lixnsed pampa'. mat y~ F~ mto ~ ~m cm agcct fire futtctiarn of the septic tank as a trcatmeat stage ~ the waste disposal sYstem- The pzopaty owner agrees to submit to St. Croix Zoning Degartm~ a catifieation foam, signed by the owner and by a ~xplwubeG j~neymaaplumber, restrictcdptumber or a licxnsedpumpar verifying that {1) the on-site wastcavaterdisposat system ~ ~ l ~ carrditicm aad(ar {2} aftrx in~pa~iou and pamping {if ~eessary), ~ ~pt-c teak ~ kss than 1/3 full of sludge. „ the iguod have read the above requirements and agree to maintain the private sewage disposal system with the standards set f~, h~in, as set by the Department of C and the Departmurt of Natrual R.esouroes, State of Wisconsin. Certification g that ymnr septic system has bcea maintained must be completed and rr~urned do the St. Croix County Zoning Office within 30 days of the year expiration date. ~ ! ~ / ~ ~- SIt3NATURE OF APPLICANT DATE OWNER t'~ERTTFTCATION I (we} certify that all statements an this foam are true to the best of my (our} knowledge. I (we} am (are) the owner(s) of tl~ property 'bed above,.by~virt-u-e of a warranty tined recorded in Register of Deeds Office. ~~ , `~ p 1 SIts~NAT(RtE OF APPLICANT DATE ««««*« ««««~ s Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning pepartttrent. '`°~` Iacluda Frith tWs application: a stamped warranty deed from flue Register of Deeds office a cApy of the certified survey map if referenRx is made in the warranty deed ~r,t.1501~E 372 Dine M. Borate, as Trustee and Ronald C. Borate, first alternative Trustee of the Karl M. Ulferts and Katherina G. Ulferts Family Trust, for a valuable consideration conveys without warranty to Ronald C. Borate and Dine M. Borate, husband and wife, Grantee, the fotlovlrir-g described real estate in St. Croix County. State of Wisconsin: tEa209t63 KATHLEEN H. NALSH REBISTER OF DEEDS sr. e~olx ca., aI RECEIVED FOR RECORD o4-io-zooo io:~o at TAIBTEES DEED TCOPrII FEE: capr FEE: TRANSFER FEE: 20.00 RECOR4Itl0 FEE: 10.04 W16ES: t Ttwrtees A, t,ACCotmadc to2o to" Ave. Baldwin. wt 54002 018-1034-60, -70 (Parcel Identification Number) The North Half of the Northwest Quarter (N h of NW %.) of Section Sixteen (16), Tovvrtship Twenty-nine (29) North, Range Seventeen (17) West. Dated this 24thday of [4~'d1 , 2000. AUTtiENT1CATWN ~~~ ~ ~~~~ 'Dine M. Borate TN~Ba `tfi~S ~~ "Ronald C. 8onte Trustee Signature(s) autlten4icated this ~ day of signaturo type or a~ nerve TITLE: MEMBER STATE BAR OF WISCONSIN (If not. authorized by § ;•oe.os. wie. state.) • THIS WSTRUMENT WAS ~ Thomas A. McCo ~ •a Baldwin. Wt 5408. 0 s ~ ' : ~; .~ o j; . .~ ~`~` spy _s~t' ACKNOWI.EDGIMENT STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this 24tlbay of ~'~ 2000 the above named Dine M. Borate, Trustee and Ronak! C. Borate. as brat alterrtafne Trustee of KeA M- UlfeAs and Katherina G. UlfeAS Family Trust. to rtte known to be the person(s) who execttterl the foregtang instrument and acknowledge tI1B same. _ agjnaturo Idle ,r Jenser- type to prbd name ~• Notary Public St. Croix County, Wisconsin. MyOcommiselgn is permanerK. 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F T. s~ ~~ ~ ) ' 30 ACRES) _~ __~~=-- t ~ ~ `~ ~. ~ ~ NW-NW _.'_' 1 _ ~-- ` ~~ ~~®~ ~ ~~ ~ `moo L DT 23 ,, ; cfl '~` ~ - - ~ O i .~~~ .- G\~~ ~~ ~~ 3 ACRES . ~> > ` / •~. ~~ Q '~ 4 S0. FT. x' /~ ~'~ ~~ ~ `, t0 ~.~q CRES ~. ~' `~,~~ / ~ y '~ Q ~ - .. /~ 9 ~~ c ff ® ~ ~ r. . ~ '0 __ . , ,p---~tCR~S ~"`~ Z~a `, B- , ~ B -, X30 ~Q. , ~ - ~o : ~ _ ~. , ! .~ ~ ~~ ~~ - g~. ~ ~ ~~ ~~ ~ pT 16 ~ ~~ i ` \ ~r ~ 2. 53 ACRES 3 ;~~ . _~ I L oT F ~ ~ f'' _ __ ~ Q- ', 092 SQ. 10. M :: -•'''0~0 f --- - ~N ~ ~,1 ~~` (2. 53 ACRES) v . ~. . ~ O ~ ~. h lQo6 ~~ +ti w `fl ~. - 9~ 292g~ `ACRES) _ ' \~,- ~ - ~y _ B 12_------.--- _ _ _ - ,~` f _ . ~ .- ~ _ ~ ___ - , ., _ ,~~~'',,J JJ~~ g/ ~~ ~.~~ l ~~~a s°~ .~,~ P~~ ~/s~ To ~~ .~ ~~ ~ ~a ih der G~ _ ~- y s~l.~~t ! rc ~ h'U / ~/y7~D ~ m ~ s. ~ //.~/1D , a I,`/ ~1 y W ~tl.~S<- 5 ~`~ ~ ~~ ~ ~G /ap4 S~ ~/D ~, : t~, Qa6~~ 3® ~~.~-.wd 8 ,. s• ~ t ~ z-3 x QS' Tre,vc~e s ~ ~~ o i ` ~_ ~ ~~.~--~, =f.~ ~~ 1 1 .~~=__~ ~/`- X02 ? 9~Lr /l~.~P~o / .. , Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of Division of Safety and Buildings Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ~~ ~~ (' include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Re ' we by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ Z 3 Property Owner Q ~ '~'~ Property Location ~ ' f ,© Y\ '(~ - Govt. Lot $~ 1/4~/G~/1/4 S ~p T ~ J N R /~ E (o~ Property Owner's Mailing Address Lot # Block # Subd. Name or CS # City State Zip Code Phone Number ^ City (] Village ~ Town Nearest Road w s ~~s cis > > ~ -szya ~~r ~. > ~'=`' s,/. New Construction Use: ~ Residential /Number of bedrooms .3- Code derived desigrrflow rate ySU a 6 GPD ^ Replacement 11 ^ Public or commercial -Describe: ~- Parent material T~ ~ ~ Flood Plain elevation if applicable ` /U//-1-~ ft. General comments ~y~ V~ ~, ~Q.~f , / Y y and recommendations: s~ ;?K?ti 'C1t"Hi'tC90~v~~' Boring # ^ Boring C .~ Pit Ground surface elev. 7 7_ 7Dft. Depth to limiting factor ~~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~ - a-1z ~0 31z sal 2 k ~ c I v~ . 5 -$~ Z- t 2 -4 1 5%~ bk mFr c g --- 5 . 8~ 3 , yb-~~, l3 SC. - - . 5 . 0.~ ~y, yo' 39.~ Boring # ^ Boring ® Pit Ground surface elev. ~~ eft. Depth to limiting factor $~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ~ • b -I z ` ~ X312- - 5 i I b k mS h~'r c. s 1 v~' . 5 , $ ~ Z IZ-~ ~ I ( L ` , r UR n'1't 1~ ~ S - rj '' 3 • ~-SQ p ~{ b --- ~S my 'r cS - ~. 2 ~ y - 1 -- 5i s k rn~'i _ - `~ g ~ a~ 9y, yv " 33~ ~muern ff ~ = esws ~ 3u < «u mgic ana i as eau < i ou mgiu - tmuent ~~ = ti~u5 < Su mgiL and i ss < su mgiL CST Name (Please Print) _ Signature ~ _ CST Number Address Date Evaluation Conducted Telephone Number ~ . Property Owner .~['S0Y1 ~ e. Parcel ID # Page ~ of Boring # ^ Boring Q Pit Ground surface elev. 97. ~ ft. Oepth to limiting factor ~ U ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EfF#2 I • o-t4 2 Si l Z ~ I ~ . 5 ~ . S ~ 2 ~ I~ • ~ rr-~ r c 5 - $~ ~- - - t 31~O ~- S~ 2 ~, _ - - 5 9 ~ ~ ~f! yU ~ 7.~ 332 ~ ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/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 ~ NAME ~n ~ ~ LOT# I ~ LFGAL DESCRIPTION S ~ ~ Uie1 ~ ,S ~ Co T Z `~ ,1~I,B., ~ ~" E(or)~ SCALE: 1 ~~ = yy BM 1 ELEVATION /DU ~ o BM 1 DESCRIPTION •}pQ b~' ~.-('+o ~oo~ ~' BM 2 ELEVATION _ BM 2 DESCRIPTION - SYSTEM ELEVATION 9~• `~~ ALTERNATE ELEVATION 9 ~~ ~{~ CONTOUR ELEVATION .Uo SIa ~ ~ I 1 t~ I s ~c • f 6 G,o~ ~ ~~' l y ~~~ F~3 R. i'F"' ~ 13 2. ~~ W1 ~~ V ~~ S 1 ~ .514Q e" B' ~ ~ ~~~ l ~ 6'3 ISI ATURE ,~~c~----~~~ DATE /~ ~ ' o~