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HomeMy WebLinkAbout018-1083-31-000/* Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM * Safety7ind BUild}ngs Division t : INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)1 Permit Holder's Name: ^ City ^ Village ^ To of: Bonte, Ron Hammond"~'ownship CST BMElev.:- Insp. BM Elev.: BM Description: ~' , '3 Q 3 .S~ ~ Si TANK INFORMATION TYPE MANUFACTUR ER CAPACITY Septic / ~r / ~ 1 ~ C~ 0 osi n Aeration Hol g TANK SETBACK INFORMATION TANK TO P/ L WELL BLDG. vent to Air Intake ROAD Septic ' ~~r ~ / Z -~ r NA D sing NA Aeratio NA 'C=folding PUMP /SIPHON INFORMATION acturer Demand Model Number M TDH Li Lriction m TDH Ft F cemain Length Dia. Dist. To All AQ~ADDTIAAI~V~TG11A i., ~ i ELEVATION DATA County:st. CrO1X Sa n ita ry,P~rptl~,(~10.: State Plan 144DJNlllloyy.: Parcel T o (~~ ~-1083-31-000 STATION BS HI FS ELEV. Benchmark i Alt. BM Bldg. Sewer 9 - Ht Inlet `, Q~, f/ t Ht Outlet ~i 'f Header /Man. ~ L(S ~ , ~O Dist. Pipe • 3 Z 9y. 9s- Bot. System ~ 9• ~O `~;-fir 3- Final Grade k 9G, ~~ St cover 3~ 9 ~~ d BED / NC Width ~ Len th ~ ' No. Of Trenc es ~ p1T No. Of Pits Inside Dia. Liquid Depth DIMEN ( S L DIMEN I SYSTEM TO P I L BLDG WELL LAKE /STREAM LEACH{NG ~ aaYrer: SETBACK INFORMATION TypeO ZZ ~ * / 7 i ~--~-~- UNIT Mo a Num er: System: Q t ~ DISTRIBUTION SYSTEM Header / Mani old ~./ /~ ~ Distribution Pipe(s) /r / ~ x Hole Size x Hole Spacing Vent To Air Intake ~ Length ~ Dia. ( Length ~S Dia. /~ Spacing ~ l1~ y ~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ^ Yes ^ No ^ Yes ^ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: ~ /~ / ~ Inspection #2: / / Location: 1720 96th Avenu ,Hammond, WI 54015 (SW 1/4 NW 1/4 16 T29N R17W) - 162917603 Pheasant Hills -Lot 31 1.) Alt BM Description = ~ Cover y.~~ ~ 50: ~ ~~s f was U.~•~~~e.e~ n ~~ 2.) Bldg sewer length = ~/ ~ ~ So;/ ~~ 5f 1~ '~ Sd ff -amount of co~~ve,f(r = W i i( /`~ f/ ~ ~/~~ j..~ new ~cr~o ~ c o~~ o~ ~ (~f ~/~ t'av.~ 3)OI~SPro yaw.. V1~15 %t~S'tetl~~d lt~ Plan revision required? ~ Yes ^ ~o Use other side for additio al information. SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH ~~ ~. SANITARY PERMIT NUMBER: +# ~ '~ r Sanitary Permit Application r Safety & Buildings Divisioi In accord with Comm R3.21. N is. Adm. Coda 201 W. Washington Avc ~~.SCOI~J'~II1 See revtrse side for instructioets for comple 's.~,{Iplication oses ° ~ d d PO Box 730. Madison. WI 537117-730 Department of Commerce r i purp e o o Personal information you provide may be e ~ (Privacy Law, s. I ~(~l ~`~ ~• (Submit completed form to county if s state owner Attach com lete Ians (to the count co ~ onk~) fo ~ste . o not 1 .1A 8-I/2 x 1 I inches in size. County Statt Sanitary Pem»t Number ^ if nevi us eppli t State Pfan 1. D. Number ` ~j ~ O 1. A lieation Information -Please Print all Information o Location: Property Owner Name SS GApIX Property Location ~~ ~ GOON FFIG~ ~ lJ 1/4Nl~Il4, S ~~T~ IN, Rl~ or g Address ~ y Owner's Maili n Prope R Lot Number Block Number ~ j ,/ ' ~U 7Q / /l cJ 8 t , 4 City, State Zip Code Phone Nu Subdivision Name or CSM Number lI Type of Building: (check one) / ^ C'ty O 1 or 2 Family Dwelling - No. of 13edrooms;_,,,~_ O village Town of 0 Public/Cammcrcial {describe use): . O State-owned III Type of Permit: {Check only one box on line A. Check box on line B if applicable) Nearest Road ~ 7 D ~1 / ~ A) I. .~ New System 2. ^ ReplacemeM 3. ^ Replacement of ~, ^ Addition to Parcel Tax Numtxr(a) 3 I -ODD p ~3 ~~ ~ _ ~ S stem Tank Onl £xistin S stem ~ _ Permit Number B) ^ A Sanit Permit was rcviousl issued ~• • l~ • ~~~ IV. Type of POWT System: (Check all that apply) ~ /q--10'O fi' ly8'Nore-pressurized In-ground ^ Mound ^ Sand Filter ^ Constructed Wetland ^ Presswized In-ground ^ Holding Tank ^ Single Pass O Drip Line ^ Aerobic Treatment Unit ^ Recirculating ^ Other: r ~ r ^ At-grade S D ~ - ~- rp ~ V Dis ersal/7'reatme ntAree Infa r at ion: m I. Design Flow (gpd) 2. DispersalArea 3. Disprrsak Area 4. Soil Application S. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed hate (Gals./daylsq. ft.) (Min~nch) '~ ;(. ,3 T ! E~~ tjpn~ ~~~~ yDo god , s ,~~- ~g, 3 ~~ ,a,. !~ VI Tank Capacity in Total f< of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gatlons Tanks Con- Con- glass New Existing Crete strutted Tanks Tanks s~~ ~~ ~, ~ /dad l ~~ Gee 9fC v ~ ^ ^ ^ ^ ^ ^ ^ ^ ^ VII Responsibility Statement the undersi ed assume res onsibilit fer installation of the POWTS show the attached laps. Pltunber's Name (print) Plumber's Signature (no stamps): MP PRS No. Business Phone Number CJ,`! ,'a rvs Suitt a v ~ ~ --~ ~?? 99® ?/S-3PG~3/2~ Plumber's Address (Svcet, City, State, Zip Codt) l 70 5'c o ~ ro../ 4~ ~ ~ S~O'~6~ VIII County/Department Use Only ^ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps) ~I.Approved ^ Owner Given Initial Adverse Surcharge Fco) ' a 8- (~ - 7 ! j ~ '`" ~( Determination 2~S . ~ o0 , U, ' ^ IX. Conditions of Approval/Reasons for Diaagprovsl: aE- tq~il y¢,`~1r~a.c,Qc.S "~ ~n.a~~t ~ ~s ~- Lo.QR- .nQ.~n~~.,,~S SBD-6398 {R 07/00) /3~ / /4d, d ~ , ~2 ~~ s ~~ ,5 t~', v~'(/ ~- ~`°~¢ ~ `rte 6 ~~bd6F.e ~~r~~t G~~ a~ ~'~~~ ~~5~a fpN .y J` b~ ~~ / Rd /Y ~1 oa, ~ a ~~ 0 ~~' ~jd~~ ~9/~4 ~~l ~~a ~ Wisconsin Department of Commerce ORIG11;~ AND SITE EVALUATION ' ' ° Di ion of Safety and Buildings rd with Comm 83.05, -Wis. Adm. Code Page 1 of 3 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 horizontalreteFence poia~(BM), direction and St. Croix ercent slo scale or dimemsions e north rrow and location anr~ 'stance to nearest road p p , , , . a Parcel LD.# APPLICANT INFORMATION - Please print~`~ll int`orma n , . Personal information you provide may be used for. second8ry~purpo5€s f~rivacy I_suv, ; 15.04 (t) (m)). z viewed By D tet ~_~,~ Property Owner ~ ~.. Property Location Bonte, Ron ~ _,:, 6 ~` ; i~el~ ~ r.~ ovt. Lot SW 114 NW 1/4 S 16 T 29 N,R 17 W Property Owner's Mailing Address ~ - CBGI ~ Lot # Block # Subd. Name or CSM# 1011 170th St. ~, ~uNT}' ,~'~. ,. 31 Pheasant Hills City State',, ' Code PhoneNumber-~' ~'` ^ City ~^ Village ®Town Nearest Road Hammond WI 01;5' ,2.1.5-796=52A ~„ ; I~unmond 170Th St. ^ New Construction ~ Residenfiaf~mber of bedrooms 3 ^Addition to existing building __ Use: _ _ Replacement ^ Public or commercial describe Code Derived daily flow 450 gpd Recommended design loading rate •4 bed, gpd/ft2 •5 trench, gpd/ft2 Absorption area required I I25 bed, ft2 900 trench, ft2 Maximum design loading rate •5 bed, gpd/ft~ •6 trench, gpolft~ Recommended infiltration surface elevation(s) 20" below contours ft (as referred to site plan benchmar install 2 - 5' x 90' shallow trenches on contours for 3 br Additional design I site considerations Parent material tilt Flood lain elevation, if a licable NA 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 X U .7VIL UCJI.RI~' I IVIV RC~'VR I Boring# 1 Ground elev 104.1 ft Depth to limiting factor 70" 2 Ground elev 99.6 ft Depth to limiting factor > 75" Horizon Depth Dominant Color Mottles Texture Structure Consistenc Boundary Roots GPDIft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ~ Trench 1 0-13 7.SYR 3/2 - sl 2 ~m sbk dsh cs if .5 .6 2 13-31 7.SYR 4/4 - sl 2 m sbk mfr cs if .5 .6 3 31-62 lOYR 4/4 - sl 2 m sbk dsh cs If .5 .6 4 62-70 l OYR 4/4 - is 1 m sbk mvfr cs - .7 .8 5 70-84 7.SYR 3/4 clp 7.SYR 5/8,5/3 scl 0 m mfi - - NP .2 horizon 5 also has some 5 02-3 D~ 4 4 scl me usions/molt mg 2t•re S"~.(, Remarks; nonzon ~ nas i v r x viv ac t u r n nip s mctnstons L 4~-~L-; some nortzon o mottling is nonzontauy strattneo; occaswnat gr, cob ~. s e ow pt wa re :sou pt wa as t er wt er tg er s m ustons m onzon 1 0-4 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 4-12 7.SYR3/1 - sl 2fsbk mvfr cs if .5 .6 3 12-31 7.SYR 2.5/1 - sil 2 m sbk mvfr cs if .5 .6 4 31-45 7.SYR 4/3 - sil 2 m sbk mvfr cs - .5 .6 5 45-57 l OYR 4/4 - sil 2 m sbk mvfr cs - .5 .6 6 57-75 l OYR 4/4 - Is 0 sg ml - - .7 .8 CST Name (Please Print) Signature: - Telephone No. Henry F. Grote ~ 715-665-2681 Address ertr >e of esttng D to CST Number Ref # P.O Box 57, Knapp, WI 54749 416/2000 222774 1059 Remarks: PROPERTY OWNER: Bonte, Ron PARCEL I,D.# Ground elev 101.0 ft Depth to limiting factor 57" Ground elev 104.1 ft Depth to limiting factor > 68" 5 Ground elev 100.0 ft Depth to limiting factor > 60" Ground elev Depth to limiting factor SOIL DESCRIPTION REPORT as Page 2 of `~ ' r , . ,~.~ Certified Soil __ esmg , . izon Depth H Dominant Color Mottles Texture Structure onsistence Bounda Roots ~ GPDI , or in. Munsell Qu. Sz, Cont. Coior Gr. Sz. Sh. ry Bed 1 Trench 1 0-3 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 3-10 7.SYR 3/1 - sl 2 f sbk mvfr cs if .5 .6 3 10-28 ~__-. 7.SYR 4/4 - sl 2 m sbk mvfr cs 1 f .5 .6 4 28-44 7.SYR 4/4 - z sl 1 m sbk dh cs - .4 j .5 5 44-57 SYR 4/6 - fin os 1 m sbk mvfr cs - .7 .8 6 57-60 2.SY 5/3 clp 7.SYR 5/8 scl 0 m mfr - - NP .2 ~r, f i , - KemarKS: ~~~~~°~"" Y IIUJ V\.".aJIVilCll IJ ll l\.lUJ1 VIIJ ~ VVVdJI V""41 J l l\ Tl7 Jl lI1VILLJIVIIJ ~V~ III UII~~ IlVI1GVll J 116J ! V 1 i~ V/J J VII WGJI ~~'QII `W YY- 1 0-3 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 ~ .6 2 I 3-6 7.SYR 3/1 - sl 2 f sbk mvfr cs if .5 .6 3 6-29 7.SYR 4/4 - sl 2 m sbk mvfr cs if .5 .6 4 29-60 7.SYR 4/4 - sl 1 m sbk dh cs - .4 .5 5 60-65 2.SY 5/6 - lfs 0 sg dl cs - .5 ~ .6 6 65-68 2.SY 7/3 ~Z y ~ fs 0 sg dl - - .5 .6 ----~ zt.4o/S~,L ~ rcemancs: 1 0-4 7.SYR 3/1 - sl 2 m gr mvfr cs if .5 .6 2 4-13 7.SYR 3/1 - sl 2 f sbk mvfr cs if .5 i .6 3 13-23 7.SYR 4/4 - sl 2 m sbk mvfr gs lm .5 I; .6 4 23-50 SYR 4/4 - sl 1 m sbk mfr cs - .4 .5 5 50-60 7.SYR 5/6 - s 0 sg dl - - .7 .8 Rem ' ~•'• t ' ~Jv~ I~Oti TQ~ ~ .1 ~OT `~~0.N `~.b~ , ~ b 5~.,.~ . ~~ . ~e - z~- ~~..~ 11 owv.;'~tc~ww o» 3~, o 4 S °"~~ '" = 6°~ o lv ~ ~~-+. z,.z~~-4 k~ ~~~`~ c Ors` ,L,n °~ QY `o• 13~ ,_ 019.65 2r,~s, ~~ 13K a~a.v((o~ NC ~~.~~too.o~ t~ Z"~y l3 +`'l 210,, o .~ N w ; ~ e r <<1 `S a bK~1~~,0~ : ~ ~ r aLI.L~ .•. ,:~ oaC a~ 3 ~~ 3 3~Y~.g4' 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 (POWYS) shall 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 1n-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Design Specifications Sanitary Permit Number 3 `~ o Number of Bedrooms 3~ Design Flow -Peak (gpd) "-~ Estimated Flow -Average (gpd) Septic Tank Capacity (gal) cstr0 Soil Absorption Component Size (ft2) `1~ Z Type of Wastewater Domestic TahlP 2' Soil Absorption Component -Limits of Reliable Operation A Septic Tank Component Soil Absorption Component Design Flow -Peak (gpd) arse c-o Z Maximum Influent Particle Size (in) 1/8 Maximum BODS (mg/L) 220 Maximum TSS (mg/L) 150 Tab le 3: Maintenance 5cneauie Septic Tank Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years 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 (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 ti and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall b- e- c- I a ed as necessary to ensure proper operation. 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 its enclosure. If 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. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall 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 accidental 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 OSHA 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 POWTS component. Soil Absorption Component The soil 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 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 failure 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 cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 -' ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT . AND OWNERSHII' CERTIFICATION FORM OwnerBuyer ~ ~ a ~% i ~v~%~~ Mailing Address /d /l 174 T~ s /,//~,,,~ ~a~ ,! cJ ~° 3- yo/S" - Property Address (Verification required from Planning Department for new City/State Parcel Identification Number DEGAL DESCRIPTION Property Location ~-`/4, .J~ `/., Sec. T6 , TAN-R/7 W, 'I ~wc- of ~~a ~ ~.p•~-® Subdivision ~~~ ~-s~-.~~ l~f~~j5 __.._- I,ot # . ~/ . Certified Survey Map # ,Volk me _ - -.,.Page # Pa e # ~ Warranty Deed # ~~ `~~ 1 S ~ , Vo ~ k ~ ~ ~ ~: 1 ~~-_~-~ g Spec house ®yes ^ no Lot lutes identifiable dyes B no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result in it=premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licer ;sed pumper. What you put into the system can affect the function of the septic tank as a treatment stage is the waste dig ~p : ° . ~l : cyst em. The property owner agrees to submit to St. Croix Zoning Departm:,ur, a certiCrcationform, signed by the owner and by a ourae lumber restrictedplumber or alicensed pumper vc -ifying ghat (1) the on site wastewaterdisposal system mastcrplumber, j YAP is in proper operating condition and/or (2) after inspection and pumping (if n~ ~s.ary),, the septic tank is less than 1/3 full of slu e. Uwe, the undersigned have read the above requirements and agree to ~ ~ iau~'''' the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Dep~srtureut ~. f Natural Resources, State of WisconsO ~ ~~ 30 stating that your septic system has been maintained must be complete cl and re urned to the St. Croix County Zoning of the three year expiration date. ~~- ~ ~~ ~ ~ is iC~b DATE SIGNATURE OF APPLICANT OWNER CERTIFICATION I (we) certify that all statements on this form ate true to the best <~; -,y (cur) knowledge. I (we) am (are) the ovner(s) of the property described above, by virtue of a warranty deed recorded iu Re ~', st<:r o•:~ ~ ==.-~ s7ffice• (°~ /N /~ DATE SIGNATURE OF APPLICANT artment. ****** ****** Any information that is mis-represented may result in the sanitary ~ hermit being revoked by the Zoning Dep ** Include with this application: a stamped warranty deed from the Rcgi ster of Deeds office a copy of the certified survey map if rc ;ferena ~ is made in the warranty decd got 1'37~~ Fair ~. ~ 4 • ~T.~7E BAK l)F W'15t_:~~Nti1N f`.)RRI 2 - 19K2 ' W'ARRINT1 DEED D~:.UMtNT NO. -.--~ger___E._Lind~uis_t_~nd_Oune_1.__Liad~uist..____ _--. __ _..-twsband__~nd~rif~__.__---------~.___ _____-- --.--_-__.__ _. _. __ .onirts and Harrtnts to ~ R~ald. _~ ~4I11ie_._dtld .~ltle h1._. BQ[Lte, __,husband_~._}~ifs._s'I5_~~r~ti_YO~'shi~lnar.ii:a.L~roperty ___ the following drscrihed rea! estate is _.__-_-- St;Cr01X ___-__ -- __-_ -- Count,: Mate of ~Yi;eunsin: The Southwest Quarter of the Northwest Quarter, except the West 363 feet of the North 600 feet; The Southeast Quarter of the Northwest Quarter; ..^,11 in Section 16, Township 29 North, of Range 17 West (in the Town of Harrnnond). TRA~SFER si~_.._ E This 1s_n4t.._---_-- huntrstead pn;!-rertq ~p~ lti nu0 [xcepnon :n w°arrantiei. 19th November Dated this ___-___ da} ui _-_~__--_ _-_ iSE:iLI (SEAL? AUTHENT[CATI~N Sign. uri(s1 authrnncated the -__-_ __ dad „i Tft LE `.E[6IE3[R ~T;iTE 't.~R t)F ~'t ISCONSIti authorized by §7~6.0t~, 4\ rs. Stats l KATHt_EEN H. WAL3H REGIStEk OF DEEDS 5T. CROIX CO., +.OI RECEIVED FOR R~CORL 532188 11-23-1998 9:30 M IIi~RSRlTY DEED RECORDIiBi FEE: lO.Ot PAb'ES: 1 *H ~~ sin:; r r. ~cavF ; -~_H v>=c~a_ ~ha nara ~p aJ FIRST NATIONAL BANK Of 81,LDWlN 994 Maul Street Baldwin. WI 54402 _ G18-1034-$Q__,____ =nd~EG ~CEN?~PCo'iG^~ hums: 018-1035-00 ~~~ ~z_ -~ ~ -RCS _ tSE~U = RQQer E . _~ ~ ~~ - ---------- ne ~ . l i ndgu i st___ _____ _______ ACKNOW'LEDGbtEN"C State of Wisconsin, -------- St . Croix ) -------______-. - ~__ count?. - -- Ey___._ Pers.,zia}h' .ante ~'..:c +ne ~h„ -19th _ - --- day of --- ' ~ Nuvembc-r _ _, 1a 58-_, tht th.~~r naza:d - - - _~ --- -~- ' , ~ '~, Roger E __~i nd u _~~ an_d June _tz . ,~;, ; . - -4- - - - --- ,.,;. __ _._ -------<y -~ _ , ~_>~ t ndqu i s t-~_ h~~ban~~n._ w i . e _ _. ~ ~ ttil'.47t (~ Elr Ihi ~'rx,n ~_ -_ WhU eCiiuled the IOreg.rin~ 4t L:~,~ ilj~*A'.~trLahinf and a~l:no' i.rlyi t~ ---- ~~ d ~~ ~ 7HIS INSTRUMENT VJAS DRAFTED 8Y Z V •'a~ ,e° '~ etas ' ~! t% .. _._ _.- -. --- - --- M~rk_Q. _~obberf~h111_I12E1Y__& ~QB~ERill r~~`' .~kV'ISL°~ Daniel G. S~nmtt 425 E._l.aSalle Ave.i_Parron~__WI-__5481- _ Nuttr~ ft:hn_ st. cruix ___ ___ ~.~unty.'.ti(~ i5ignaturis ciay h•• authem«atcd u: arkneN~lidped &,t;: are n_u ~!} :~ n,..•„ ~,:'. ,~ n ,.:,a..... ~ L' no: sta'..• •~~ ,;. :,.,n ,!.ir: ,,....v,~.t Ph !E(71F1 K'27_S~'lF 10/20/ ?G0~ {;t#cXx PHEASANT HILLS L OEA TED 1 N THE NE t ~4 OF THE NW t i4, SE 1 i4 JF THE NW I i4 AND PART OF THE SW 1 i4 OF THE NW I ~4, AND PART OF THE NW t i4 OF THE NW t i4, ALL 1 N SEC T t OPJ T. 29N. , R. t ~W. , TOWN OF HAMNiOND, S T. CRO t X COUNTY, W I SCONS 1 N I f 100TH aVEJruF 'ET LOT 23 `~. { 4 -_ ~~O ~ ~~~~ ,, /~ , ~.~j; `~ _ ~ LOT I T -~ ~ _ ~; ~, N ~T, ro ~ SEA m ~b 'b' ~~~`' L 0 T 15 v SHEET ~ O a a ni - --~ i ~-~ . --------j- ------ -1-------- -~--_---- I I ~ ~ t.ocarrar s«crc>< ftCTrbr ~t. 1. 1f... R. itE. TQw a wr.b+ 1.or ro sckr r UT 1 L t 7Y EASEII~NTS "1 a y THE t o, NO POtf CR Bl1R1c'P CABLES ARE TO BE PCACE9 Stitt: THAT T-rE 1NSTaCCATiON NOlJLO OrSTURB ANY SURVEY STAKE. OR OBSTRUCT VJSrGN 4L ONG ANY LOT LINE OR STREET LINE. THE DISTUR@ANCE Oi A SvavEr STA!<E Br ANrQ1tE 15 A vlaar:~. ~ SETJFORTH3ARE~rOR w~C~ErOF$PUBC CSBOOTES1Ah0 oq~iEN£5 JT.iCJ+FaES~M MAY7NG THE RIGHT TO SFRVE TO AREA. LEGEND f i0tlNO J' IRON PIPE o SET 2'xJO' IRON P!PC M'ErGMrVG ~. 63 185. PER l I NEAR f 00T N07E: SET 1'x2' IRON PIPE YfIGHiNG 1. 1! C9S. PER C IhFAR F00T AT ALL OTHER LOT CORNERS ~ UTrt J7r EASEIIEN7 (7YP. 1 ---i-- -~.. -- Q -- '' SEE _ -- - N h ~ n~ t .. SETBACKS ~ DRra•Fwar ~aATroNs ~~ ~ ~ ~'""''"` ~Q~ 0-oG,~1, 3~.~.S~~f ~f;I$TEItS pfFICS ~~ C~~~ ~ Raowwd thr Racac'd ars .f ~ of d~.~._A D a9.Q~ 4 ~s~Z ~~~,Irl. Rsooedd is ~...~- ~ ~ ~ ~~~ , `~,,b . ~~~ T_ ~ _~ , . _ ~ r ~• ~ ~ ~ ~ ~ r ~ ~ ~ ti ~\ ~ 31• E ~ ~ ?) 1 CI' ~~ ~ ~ sl4eyy t• ~ ! H~ 1 ~ `: ~ ', ~ as' aJ ~ ~ .r+ 1- ti ~ r~ V N 790' ~ ( ~ 'J N 1` N '~ `~ ~~ ~,'• -~ ~' CSC ~ `` yea. ro' ~ a ~ _ ~ ~ e- ,r -'"r l94' W p ` ~,/ ~ . t K x3~• 324 /~W r~ ~,\ ~~ `... 2,w ,3 3Q. 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'O / ~ ~ i ~ ~ ~ ~ ' i ~ ` i . ~ / ~ ' \ i rye' 1 ~ i Jp.: ' ,~. o rL/ b e \ r i , ~ I P ~ r ~ ~ ~0 ~ f® , ~ ~ Jy ; ~ ~~ 1 ~ ~I ~ I(~ O^ O/ e O ^'~ I N r1 a0 n h O ~ N i ~ I ° i unn0 4A' /1 ~N W L ~ ~ ~ Wisconsin Department of Commerce ' Division of Safety and Buildings SOIL EVALUATION REPORT ~~~-3-0~ Page / of 3 m accoraance wim ~.vmm ao, vvis. ream. ~.vve County e~ - /' Attach com lete site lan on er not less than 81/2 x 11 in n size Plan must a J V p . p p p include, but not limited to: vertical and horizontal refere of ~ lion and Parcel I.D. percent slope, scale ordimensions, north arrow, an oi~ii~o. di ~ j Barest road. Please print all i tiOn..~. ~ Re 'ew by Date Personal information you provide may be used fors `~ ry purp~~` .aw, s. 15.04 ) (m)). Property Owner Property ~ocation ~,~~`' Q ~ ?~ 1 GOVt. Lot SC,~} 114 Nw 1/4 S T Z N R ~ E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# !o/I 1 ~v ~ ~. ~ ~~ ~ I {~ ~ lls City State Zip Code Ph e r ^ City ^ village (j~ Town Nearest Road (~ New Construction Use: ~ Residential 1 Number of bedrooms ~y Code derived design flow rate ySo ~ ~ ~ ~ GPD ^ Replacement / ^ Public or commercial -Describe: Parent material -C-i~ I( Float Plain elevation if appligble /t/~/~ ft. General comments $ ~/,s-{e vv~. G~2~~ dyP ~-rtnc h 9' 3. a v LG w~ r- q z. S'cs and recommendations: ~ L~. ~• I { tv p ~t ~GVI 9 y • av L d wt ~" ~ 3 • Sd Boring # ~ Boring 6 ® Pit Ground surface elev. ~ • ~ ft. Depth to limiting factor O 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. 'Eif#1 `Eff#2 I -IB ID 3r'Z -~-- Si - 2 irn~~ c I v~ . $ Z ~ I -32 I t'y s• ~-I Zmc,1~ ~r c5 -~ ~ ~ 3 - ~- yl3 - sv Zmtabk ~r c.5 -- . ~ 4 - 9 Ito m S -` - /. 2 i '2 „ ~~ ~ ~, Z- Boring # ~ Boring Q,\ ®- pit Ground surface elev. 9~. 9o ft. Depth to limiting factor ~ pU in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. 5z. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I b-~9 I(~ Ira s;) 2 ~s 1 ~~' . 5 ~ . 8 ~ 2 9- Sick ~ m~( ~-S - • L/~ r ~ - 31c~ s~. yr~bk - - 5 . ~ ~„ 'Effluent #1 = BODS > 30 < 220 m9n-and TSS >30 < 150 mglL " Effluent #2 = BODS < 30 mg/L_ and TSS < 30 mg/l. CST Name (Please Print) ignature CST Number ~c~~ S~I,~,r~,~~ ~ e r ~ ~- ZS33o Q Address / Date Evaluation Conducted Telephone Number Zl/3 ~'Cl~ ~~• .Saw~t.rS-2~, Wl~ ~~~'aZ~ 7~-~3 -G ~ ~~~~~zy ~-y~o~' -~ 't. Property Owner ~T a Parcel ID # Page ~ of '3 3 Boring # ^ Boring ©Pit Ground surface elev. ~/t!n • 5o ft. Depth to limiting factor ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Textun: Structure Consistence Boundary Roots GP D/tt? in. Munsetl Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *E1f#2 I o-~ 3 Z --~ S' 1 Il"f77 ~S I v . 5 .8 ,. Z I - lms rrr~r ~ - ~ ~ /. 2 3 - - t0 r'31i~ - SL bk r ~s - - 5~ . ~ ~ ~' ~ 5p- I ~ ~t~(p mS LAS vin ~ - . ~ /. 2 3..f ~ u ~2•, ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor ~n• 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 Boring Boring # Ground surface elev. it. Depth to limiting factor in. ^ Pit Soif licetion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/(F in. Munsell t1u. 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 mglL 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. SBU-8330 (R.07/00) PAGE 3 OF~ NAME Igo ~, ~-e LOT# 3 ( LEGAL DESCRIPTION SW ~~UW14 ,S /(o T Z q ,N,R, / ~ E(~~ SCALE:I"= ~/d BM 1 ELEVATION DO ~ O BM 1 DESCRIPTION ~ O Opp uc c. BM 2 ELEVATION qq~ ~ ~ BM 2 DESCRIPTION ~a p o ~ L~cc~e. vw.nf- d~vo r S~'~~ SYSTEM ELEVATION ~~ q~,po Lcu,~,r9Z. So ALTERNATE ELEVATION ~v ~ q~ d U Lower 9 3. S o CONTOUR ELEVATION q$-oa, 9(v.nn ~ g ~. a o ~~ ~~`N°~,~ s"°Q ~ ., :• ~~ ,~ i' "~ 9G~' 6,Z 95--' ° o --_ ~ q~,oa 9?•0`' ~~ ~2 W SIGNA ~~ ~ s-e- L a DATE ~ -zG - °l t