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Home My WebLink About018-1083-44-000~~ 1 r ~- r- ~_\ I I I I ~ ~ d ° ° N O ? ~ 7 C N OD 00 fl. ~ ~ ~ O N ~ C O O O ~ N N II O !D fD O O~ n O 7 (p ~ W 3 A ~ ~ o I v ~; cn ~ ~D ~ ~ 3 ~ c a o ~ ~ O O - ~ ~ ~ a Z ~ O W a o_ I ~ m ~ ~ ~ I~ m ~ I m I ~ 3 I O Z Z p O O N ~ ~ O N ~ rt ~ <. ? O 7 O ~ O N 3 C 7 z (D ~ ~ C !D ~ a ~ ~ O ~~ y ~ o m X N ~ N I ~ ~ ' N Q O a 0~ O o N o_ o N _ N N fD 7 S N X N ~_ O N i o 0 c ~' f ~ '~ ~ ~ ~ 'o `D m 3 r: v O v O O m y fyll ~ C - a a " ~ rn rn rn 0 0 0 0 N N ~~~,, ~ ~ 2 -" _" __ 3 ~ v v ~ -, ~o Q ~' N ~ ~ .. f~T A 0 A m ~ ~ 7 ~ f1 'fl fD tN/1 f1 ~ 7C N N V II tD ~ ~ ~ O C O. A N a~ G •^•' 3 !~ Z W G C 7 G Z 0 ~ ~ o l 3 n 3 ci ~ v ~i ?~ rn ~ 3 ~ ~° O ', OOD V a ~ ~ ~ O A 7 O y O C ~ :~* a .. ~ m r. A ~ fD N m __ (A A ? COi A ~ 3 < N O < t0 ~ Z A ;q A d ~_. m O O A .l' ^.1 N O O b A ti i.,, Oq O ~0 ~ ti ~ a Jun•10. 2009 2:29PM SUMMfT MORTGAGE No•0126 P. 1 ~f~f~ ,; ~, 605 North Highway 169 Suite 700 Plymouth MN 5544x Facsimile Transmittal Summit Mortgage Corporation Phone:;763-390-7245 Fax:763-390-7345 Email srttarcks@summit-mo.r~gage,com To: Fox: Front: SCOTT MARCKS Date: Re; Pages: 4 I] Urgent ~ For Review _ a Please RaplY _ r~~ Urgent Please Rushllll .S 11 ~~ ~~In' ~. ~ ~ / _i,~ / -: ,.~ ~.~ Fz~ '~ ~~, q~~~ ~ ~~ . ~,, ~~ ., Jun•10. 2009 2:29PM SUMMIT MORTGAGE No•0126 P• 2 1 UNIQUE LL NUMBER stae~ of w;.Privale water systems.Dl~l2 Rotel 3300-771r souRC~; WELL CONSTRUCTION - QJ296 °ip°r'"10mOf"'~'"~~`a°'~sex79zl c~ 1Z~oo~ Madison, W] 53707 lwner ~ Numb M 718 ..79e • 6A19 a n depth 105 FT ,d+rtae 989170TH ST T ~0w`t `~' s ' ~ ' oae of HAMMOND ;ity HAMMQN4 WI zip ° 34016 °r I~ 1°" 56 •••• ST, CROIX W •,~~~ v.nr~P,owvu iow ~lanullry 18 zoos ""'1~A1:Al3J~1T NL8 """rte awc~n= AUI~~.L DRILLING 95 , t ~ p >,°~ 9ootlon t 18 t 79 N R 17 6W ~ 4ot roege o PPS Rude beg. ~8 Min. 31 dB ~ 1171 CNTY RD T Longitude ueg a2 27.Z439 lain, A ppttm `~ 1. Wall Type 7 1 ^+New ng Method H MMOND WI 54016 1-RoPleoanent (see Ism Iz betoeu) iap e>1e~ otTmon a 3.lteceru~ekl~ ~~~ of aua ua quc unc11 f coOSttacld m ~„~ eelrotl for replatlpd or tbaon.~lruotcd ~Ve117 s. Well Servos M of holnem eed or NQM! High Capacity: WE (eg: h.m reetaurent ohumh ap eobool hd ae D LLING , , , y, o , u .) well? N h o~oz7w N--+ r ~ro w z ~» p e an P=Pr a~o -~orl.~ r7 N Pre x xonw~~ ~-r,~nad+ tr~,oop H•p~lq,nle P~t a well kid upslepe ar 1 npe o^ne Woll laealsed (n tloodplaln? N .ny enntamtnetan eouraaee, mdedmg than on na r 9. pownspeuN Y:rd riydrent Distanen In filet }tons well to neereat: (lnehbing propn9~) 1. Landfill 10. Privy 1 e 2. 9utld;ng owiterlg 1 I. Foandatlon Drnln to Clarvr.ter '~3. 9 1=Scpdc ~-1~oldin3 Tenk , z, l±oatldatlon flr+rn a, sew 70 4, Sewage Absorption Unit 13. 19uildin0 Dnun ~. N00aohflxmin Plt B 1'Cast ]ron or Planic ~thar 14, DIIllliogdewer I^Grevlry 3^Pl+ntluro 6. Buried Flnms ~eetlrt$ OII Tenk l~aa boil ar Plaetla 7K7pKr 7. Buried 1>et~oieuln Teak 1s, Oolleotor sewer: _, urdw _ In . diem. g. 1~IgreI1t10 Z~ Svr(trlltling 1?OOl le. ClarWetH Sump Front TO Upper Bnlarerd Drlilhok ~ Lower Open Badrauk _.~.,,r Dia.1n. tt ft -- l , Ropy ~ Mod Clmeletlen ~•••-- X ~ z ~~ - ~k TMC~ CLAY BR A 10,0 eurfhee --3. Ropey-Air and Form -...----- YHIr LIM~e Y8 H 4. Drill.7'Ittough Ltiaing Hammer 6,0 45 105 -. s, ltewne Ratary 6. Cable-hx~l Ait _ in. du -~ 1. Temp. Outs Ceelnp in, Ala. ~~ dcpdi tt Removod 7 Other M1. Gaeleg l.dur 3eren Makrial, Woight, 9peeifieLtlan FfCrtl To Man rlicrunr & of Aeeemhl (~) (ttJ 8.0 sTL HKK 18,G7A PE W!°LD 1r81'M 1154 turlhce ~ ~. ~........wr ....a 1 I. weft UI A Ore1e 60.0 fact g ground etarico M, A^Abow B^8elw ,.~vlbea 1F-erlo^ 12 10, Pump Tst Gveloprd7 Y Dia.(in.) ~fareefl IYP4 meoe e 1 es rom To parrying loud 80.0 ft, below aurAe- Diein~eted? Y Pa m al 16,0 CiPM 1,Oafre C°PP°~ Y 7. CJreet er OIMr 8wling Metsrld 12. Did yva nosily dx owner of the need to prnnan.oty aMndon aed fill aU Mopiod PRESS. TREMIE X01" To g ~ ontroad Ovalle oe glie ptopmRy9 Kind oP9ealing Maaerlal lft.) (ft•) t;,brnad !fed eayleia eurfeee I 1~, IAhlele el' Well C°mp~uolor or 9YpmvMory DMIM' 17ah, Sign 17, waeps«enr Sump 1e, Prved wnimd Barn Pon 19. Anbml Yard er $hds+ Z0. 9110 21, Ban Qutbr ,?Z, Meflme Pie 1^Qrevgy 1raPteeeio+/ I~Coel iron or Pleetio 3-OIMr 23. OchertnanvA glere~ s4. Diloh =s. OtherTllt sra waatc source Ju~•10, 2009 2~30PM SUMMIT MORTGAGE No•0126 P• 3 ncry i 4.~inu, ~ ....... aa.u 20 3 TA 11 S 1~ t YII qP N101! rr dA! St cs u2310~ Additonrl Conrmoaa7 varix~oe Tawedl Batch 723 Ownr~ 8rnt Lrbel4 Y irreA Orob~yT June 11, 2009 Summit Mortgage Corporation Scott Marcks Code Adtrunisttauori 13355 10th Ave N #100 715-386-4680 Plymouth, MN 55441 Land Information d Planning RE: POWTS Installation Inspection, Sanitary Permit #370266 715-386-4674 Real Properr} 715-38G-4ti77 Recycling 715-386-4675 Location of Property: St. Croix County, Wisconsin Municipality: Hammond Township Subdivision or Plat: Pheasant Hills NW 1 /4 of NW 'l4 of Section 16, T29N, R17W Lot Number: 44 Address: 989 170th Street Dear Mr. Marcks: A well setback inspection by county staff of the POWTS servicing the above referenced property was conducted on June 11, 2009. The distance between the well and the septic tank was measured to be 32 feet and the distance between the well and the absorption unit was measured at 70 feet. These measurements are consistent with the setbacks documented by the well driller on January 18, 2001. Therefore the setbacks for the well and the septic system are in compliance with WI Dept. of Commerce Comm. 83 and WI Dept. of Natural Resources NR812 code requirements. If you have any question regarding this wastewater treatment system, please contact our office at 715.386.4680. Sinc ly, Ryan arrin on, WTS Inspector #683475 PZC>CO. SA/NT-CROIX. WI. US ST CRO/X COUNTY GOVERNMENT CENTER 1 101 CARM/CHAFE ROAD, HUDSON, Wl 54016 71 X386-4686 FAx WWW.CO.SAINT-CROIX.WI.US Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j. Permit Holder's Name: ^ City ^ Village ^XOwn of: ~ n lev.: BM Description: TANK INFORMATION TYPE MANUFACTURER CAPACITY Se tic P ~~- ,~ ~ 2." C~ Dosing ~~^-~ U Aeration i ng `~, TANK SETBACK INFORIII~ATI(~111 /,~a TANK TO P/L WELL BLDG. vent to Air Intake ROAD Septic 5 (C%~ ~ "3 2. ~ Z ~ / NA Dosing >~QV ~ ~~ ~~/ NA Aeration A Hol ~ '~ PUMP /SIPHON INFORMATION Manufacturer ~ c ~/ Model Number , ~ ~ c- TDH Lift Friction Syyst L Fie Forcemain Length ~ Dia. ~, `/ Demand GPM TDH Ft 1 Dist. To Well CLCVHIIVIV UHIH Sanitary Perm an ID No.: ax STATION BS HI FS ELEV. Benchmark ~. ~ '~ ~~ ~ ~' Bld Sewer g. ~. ~~ z ~ 3 . ~ 3 St Ht Inlet (- z . ~ Dt Bottom S ~ ~ Header /Man. ~. U ~ Dist. Pipe ~ 7-z ~.z - YS `~ ~ . Bot. System Final Grade <<) "~ I R z v s Z ~' ~ Q f ~- ~ y .S ~~' ~, t cover ? ~ q ~. 3 SOIL AB ORPTION SYSTEM ~fi BED / ENCH Width ~ Length No. Of Trenches No. Of Pits Inside Dia. Liquid Depth DIMEN ~~ S ~ ~ DIME anufacturer: SETBACK SYSTEM TO P/ L BLDG WELL LAKE /STREAM INFORMATION TypeO ° _ ~ .~ ~ ~ _-_____:. CH BER NIT O (Number; System: ( ~y,,~ /~ ~, - ~ ~ U DISTRIBUTION 5YSTEM 7D !~~//~t7`j Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake ~~ Length __./(ti r Dia- ~ / Length 2-C ~ Dia. ~+~ Spacing (; Z `~ ~ ~ ~ Z 9 > 2.S ~ SOiL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only bepth 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: +~ / /~, / Ua Inspection #2: / / Location: 989 170th Street, Hammond WI 54 15 i,NW 1/4,NW 1/4 16 T29N R17W) - Phe sant Hiills -Lot 44 1.) Alt BM Description = .~i` c o ~' ~'~ ~~~ ~,wy, ~.(,.~,,,,,~,~,~,, G;~ 5 ~ a.r~ft- ~ /~~,~ t~,,, ~ s f~ 2.) Bldg sewer length = Z ~ Sc,.~c,~;~ rtv; S,r;~ - viru ~ya/'c .-~~ :,,. ~ ~rx.,,,,,~ fC- ~~ c l`, ~~ ~ -amount of cover = 7 3 ~, ~ ` ~~~ ~~+ r v c. , `~ '~ ~'~ ~ w'd ~~ ~ ~ ~ `~~ ~~ rt.h+L r R / 0., td~ ~ r t ~L ! •!< Q~"r'Ll Plan revision required? ~`] Yes ^ No Use other side for additional information. rv SBD-6710 (R.3/97) Date Inspector's Signature Cert. No. m~. __ .._ ~. ._ m __ e~ v E ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: ``~~- ~~isconsin Department of Commerce SANITARY PERMIT In accord with Comm 83.D'rt • Attach complete plans (to the county copy only) for the s~ste than 8 v2 x 11 inches in size. ~ - , i~FCom. Cori ~r~ on p~~ess Safety and Buildings Division 201 W. Washington Avenue P O Box 7162 Madison, WI 53707-7162 • See reverse side for instructions for completing this appl{~'ation ~~ ~'~ G ~~ Z~QO ta't>~ Sanitary Permit Number t sr r,~ax ' s 3 ~0 Z (,,.fie Personal information you provide may be used for secondary purposes '~ C~ttN7Y eck ii revision to previous application [Privacy Law, s. 15.04 (1) (m)]. p p q ~O~ ~ ~~\•; , :`:, ZUMI~f3~ / a Plan Review Transaction Number I. APPLICATI N INFORMATION - PLEA E PRINT ALL I TI Property Owner Name S'c he ~ ~ ~ r y o n Zia, S T „~ , N, R E (or~V Property Owner's Mailing Address ~ ' Lot Number Block Number i!J ~. G~~O ~~ ~ Q Cit ,State Zip Code Phone Number Subdivision Name or CSM Number r ( ) 7 ~l t~ S4 .t/ I1. TY E IL ING: (check one) ^ State Owned Ity Nearest Road Public 1 or 2 Famil Dwellin - No. of bedrooms ^ Village own of a. !~ ~s~ b~ l ~ III. BUILDING USE: (If building type is public, check all that apply) Parcel lax Number(s) ~ ' ~' ~D / 1 ^ Apartment/Condo .mod aere6r~'~°'" `~ I b 'til. I 2 ^ Assembly Hall 6 ^ Medical Facility/ Nursing Home 10 ^ Outdoor Recreational Facility: 3 ^ Campground 7 ^ Merchandise:Sales/Repairs 11 ^ Restaurant/Bar/Dining 4 ^ Church /School 8 ^ Mobile Home Park 12 ^ Service Station /Car Wash S ^ Hotel /Motel 9 ^ Office /Factory 13 ^ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) q) 1. New 2_ ^ Replacement 3. ^ Replacement of 4. ^ Reconnection of S_ ~ Repair of an E i t E i i S S ~ x em ng ystem ___-____ stln~ ~s x ystem ________ System -_ Tank Only_____________ st ___ B) ^ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other . 11 ^ Seepage Bed 21 ^ Mound 30 ^ Specify Type 41 ^ Holding Tank 12 Seepage Trench 22 ^ In-Ground Pressure ~ 42 ^ Pit Privy 13 ^ Seepage Pit ~ ~ X Zo ~ 43 ^ Vault Privy 14 ^ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Etev. 7. Fina! Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) g~ ~ Q' Elevation a ~e ~U / ,~Q ~ l r S w Feet ~` Feet VII. TANK INFORMATION Ca acct in altos g Total # of Manufacturer s Name Prefab. Site COn- l St Fiber- Plastic Exper. N i E ti Gallons Tanks Concrete ee glass App . ew x s n straded Tanks Tanks epticTari rJipldiag~ank Ud / ,` G c' .rJ ~~yy fad9-- ^ ^ ^ ^ ^ Lift Pump Tank !Siphon Chamber ^ ^ ^ ^ ^ ^ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite se age system shown on the attached plans. Plumber's Name: (Print) Plumber's Signature: No S amps) MP PRSW No .: Business Phone Number: ~ G D~ ~ ! /J ~ /C Plumber's Address (Street, City, State, Zip Code): ~ Sc d -. ~ d ~~ Z~rJ ~ IX. COUNTY / DEPARTMEN USE ONLY ^ Disapproved Sanitary Permit Fee (Includes Groundwater ate ssue Issuin Agent Signature (No Stamps).. Approved ^ Owner Given Initial Surcharge Fee) ~2 ZS Ud Adverse Determination . / 0 X..~C[ONDITION/S OF AAPPROVAL / REA5UN5 FOR DISAPPROVAL:~Sysf~ r~+ s~ t~ ~ stiQ<lew,~bcc~7C~..~~r;v- r'ItrC Al4s>< T/C iL A~ ~ "~ nn ~~`r~ fAY~r; n ^ ,// -~ nn ~jK'~/,C I'Oo~ t~ ~ Pr•(~r..t~t/ SL a~a< S)ISf-~h.~ l.G~i«~ dw~S~dc~ 6Y- T'fi~C ~~'~ /,{/e~l/ ~t ViC/ d¢ f~i*.Tr~~la-sr~ C~a Yy~ . ~ ,~:5 svs F~.r, ~s s: ~.d -~ Q y ~.~~ e~ ~arn~ , v4„u~ ~ s~.o< ~x r ~~ ;,~ w;d ~~, SBD-6398 (R.12I99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer; Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608-266-3151._ To be complete and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the I~ga1 description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use, If building type is public, checly all appropriate boxes that apply. IV. Type of permit. Check only one online A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experirr1ental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g'. MP, etc.), address and phone number. Plumber must si~jn application form. IX. County/ Department Use Only. X. County /Department Use Only. Complete plans and specifications not smallE include the following: A) plot plan, drawn 1 tank(s) or other treatment tanks; building se tanks; distribution boxes; soil absorption sys B) horizontal and vertical elevation referen~ elevation differences; friction loss; pump pe of the soil absorption system if required by tl than 8 1/2 x 1 1 inches must be submitted to the county. The plans must ~ scale or with complete dimensions; location of holding tank(s), septic versa wells; water mains/water service; streams and lakes; pump or siphon ems; replacement system areas; and the location of the building served; a points; C) complete ~~pecifications for pumps and controls; dose volume; formance curve; pump model and pump manufacturer; D) cross section e county; E) soil test data on a 115 form; and F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. ,,. ~~ ~ ~T 1'~p a 0 O .~ _p A 1 r ~ ~ ...1 a ~ a z ~ ~ ~ b W ~ Cb fi 1\ 3 Q, 0 ~y ~ ~~' ~~ e ~ e v vZ ~ ® a ~ o \~ (~ Q O ,^ ~~ _-c. N of r ~ ~ toao.a - ~__ ~..._..._.N89°55"E 8TT.88 _ '•.._ ~ `~~ ~' ----- _ , :.....sEreQCK'~~ ...:................ ..:._.. ..... ..... ..~ iHF......... ...... ~ LOT ~~~ •~ ~~ OT 42 $ ,45~ LOT ' 2K26 ~ .ACRES ~. R ~ ~ ~ Stii 2.5 ORES. ~` :a 98;.449 50.. F T. _ RE~,;~- • t l2, l38 FT. ~,, ~- ( 24 ACRES) _ ~ ~ ~o _ 130, 312 S F T ~, ~ :046. ~~ C 2. 5T ACRl'~) m ; .c~ ~ ~ w 4 AC ) ~ 43.3 : ~ :~ j ? 046.9 -/ oo ~ _-~ t ~ 0 ~--~..J ~ + 48.7 ' J.y ~.: : j ~ 8~~ /. J ' ~ r ~ '._._,/ i ~ ~~ t ~0~~ ~, i 249: 06~'~ . _ . 282. 0T ~ ~ ~"',~ ' ~,l /' ` i ... ./,~.,S89°36' 1. E 531, j.3~ :....:............... f~~ `~="" ~ 'r i , ~ ~ Y, 1049.: ~, . ~ ,~ r ~~ T (~ % .4 t c4~: t ~~ HIGH Wi4TER ~ '~ ~ ~ .~ '~ ~ E ~ ~ . I ' • ' •* ~. .~ ?045. ~ 1047.9... j ~ ~: 1 . t x .. O . /+. I . .. ' ~ '' ' LO 1048.7 .- i". ,. ,, ,, 1. :, ; ,, w ., 19TH. 8 ~ 5 : / ~' N .:+ ~ e ' . 'Z / ~ ; ;~ ~ 1.00' 1' ~~ «' `,,~ ~?~ 1044.1 1 9.8 ., , i ; ~ ~5h04~.3 8Z ~~ r I ~: ~ w4s.,N '~ _._ ~, ~ oi9.2 ?94130 ~ ~ ~ + - t y~ y/j 146:6 .tit-'r .;• :~ 1 1'~~ V ,~~'- 1. ''V' ~~. i~~T`~ 9' 3• ~..' ~.,,,.C•;r't"`rt" VV tQ + ~. '1 ., 4, 1 ~~ ••1039.1 ~ I ;~ ' 4 . , `~ o l 135. 2. ~ . 6 tti `.wAREA ~ t o5 .5 X `._~.,, t 051. x ; 28 / ~. ; ! r-`_`~-._~ • 441 .9 ~ ~,ji .! '~~, ~ 2 0 ' ip' p) :,, 8: ,~ ' ~'~~' '1 4.8'5 ~~.i~: , FAT. ,r, i.aso.e x • r .; y ;„ --,~ a t - ~ ~i ~ t05 ;, ~~ N h RR .,. ." '~. ~. ~, ~j .~. ' e~ +Y .. ~~ .. ,' ~:~r~ ~° -~. ~ ~ c,c,:. l 1 • ~ ^.. Wisconsin Department of Commerce ~~RtG'IAND SITE EVALUATION Page 1 of ~ '-'Division of Safety and Buildings 1H with Comm 83.05, Wis. Adm. Code Certified Soil Testine Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal referen~e-Point (BM), direction and St. CrO1X ad l di i rth t51~ l a~ i t e t l ti t o near . percent s ope, sca e or mems ons, no arrow,-e ~ ance s ro oc3 on s ~'> ~ ~ ~ Parcel LD.# APPLICANT INFORMATION - Pls~ ~printl informat~~tn , . ~ Personal information you provide may be usedr(r~r secbndar~ur ~s,,(g(ivacy Law; st 15.04 (1) (m)). d y Date R a Property Owner Property Location Bonte, Ron ., ,( Govt. Lot NW 1/4 NW 1/4 S 16 T 29 N,R 17 W Property Owner's Mailing Address r•,,,; L®t # Block # Subd. Name or CSM# 101 1 170th St. , ; ,-,; '' 44 Pheasant Hills City State Zi Code NUeIN` 5 X - ;City f-~ Village Town Nearest Road Hammond WI 0.15 715-796-5240 ammond I 170Th St. New Construction ~ Residehtlall Numb efbedrooms 4 ^Addition to existing building Use: ~-_, Replacement I~ Public or commercial describe Code Derived daily flow 600 gpd Recommended design loading rate •3 bed, gpd/ftZ •4 trench, gpolftZ Absorption area required 2000 bed, ftZ 1500 trench, ftz Maximum design loading rate •5 bed, gpd/ftZ •6 trench, gpolftZ Recommended infiltration surface elevation(s) 96.9/96.2 ft (as referred to site plan benchmar Additional design I site Consideratlons'nstall 2 - 5' x 150' shallow, center-fed trenches on contours 99.2 & 98.5 w/ sys elev 28" below contour CL's Parent material till 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 ~ v U ®S ^ U ~ S^ U ~ S^ U ^ S l~ U = S X U ~7VIL NGJ<rRlr I IVIY RGI-VR 1 Boring# 40 Ground elev 99.2 ft Depth to limiting factor __ > 72" 2 Ground elev _ 98.4 ft Depth to limiting factor _ > 72" , Horizon Depth Dominant Color Mottles Text r Structure Consistent Bounda Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color u e Gr. Sz. Sh. ry Bed ', Trench 1 0-8 • 7.SYR 2.5/1 - sl 2 m gr ds cs lm .5 ', .6 .~ 2 8-14 ~ 7.SYR4/4 - sl 2msbk dsh gs if .5 ~ .6- 3 14-69 • 7.SYR 4/4 - s 0 sg dl cs - .7 .8 ~ 4 69-72 SYR 4/4 - sl 0 m mfr - - .3 .4 r~ q . 2~. ' h3.G'~ Remarks: some gr, wo a, occaslonar sl oelow t4 1 0-3 ~ 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 3-9 . 7.SYR 2.5/1 - sl 2 f sbk mvfr cs 1 m .5 .6 / 3 9-34, 7.SYR 3/4 - sl 2msbk mvfr cw if .5 .6 4 34-48. IOYR 4/4 - sl 1 m sbk mvfr gs - .4 ~ .~ / 5 48-72 • l OYR 4/4 - is 0 sg dl - - .7 .8 / I I Y'`2 y ,. Remarks: uccaslonal gvcoorsi oelow ~4.. CST Name (Please Print) Signature: Telephone No. Henry F. Grote - 715-665-2681 4ddress ert, ie of estmg Date CST Number Ref # P.O Box 57, Knapp, WI 54749 4/15/2000 222774 1055 PROPERTY OWNER: Bonze, Ron SOIL DESCRIPTION REPORT ~ Page 2 of 3 PARCEL I.D.# Certified Soil e"1' sting Horizon Depth in. Dominant Color Munsell Mottles Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. onsistence Boundary Roots GPD/ft2 Bed Trench I 0-5 • 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 2 5-24 ~ 7.SYR 3/4 - sl 2 m sbk mvfr cs lm .5 .6 ~ 3 24-36 ~ 7.SYR 3/4 - sl 1 m sbk mvfr cw lm .4 .S 4 36-64 , 7.SYR 4/6 - s 0 sg dl - - .7 .8 ./ Kemancs:.,.,.,~..,..... b..,...,,r ., , ~.,,,.,,,,,, ,,,,,,,,,,,,, 1 0-3 ~ 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 .6 / 2 3-9 ~ 7.SYR 2.5/1 - sl 2 f sbk mvfr cs if .5 .6 / 3 9-24 • 7.SYR 3/4 - sl 2 m sbk mvfr cs if .5 ~ .6 / 4 24-34 ~ 7.SYR 4/4 - sl 1 m sbk mvfr cw - .4 ~ .5 / 5 34-64. 7.SYR 4/4 - is 0 sg dl - - .7 .8 I KemafKS: s ........... .........~.,..., 1 0-4 ~ 7.SYR 2.5/1 - sl 2 m gr mvfr cs if .5 ! .6 2 4-10 - 7.SYR 2.5/1 - sl 2 f sbk mvfr cs if .5 .6 3 10-28. 7.SYR 3/4 - sl 2 m sbk mvfr cw If .5 .6 4 28-60. 7.SYR4/4 - Is Osg dl cs if .7 .8 5 60-64 • SYR 4/4 - sl 0 m mfi - - .3 ~ .4 9 .9 z~/CS~ ~, KemarKS: b. w ~.,~ ~~r..~,~.,, .,~ ...,..~~.. Ground elev Depth to limiting factor Remarks' '~ r •- ~ ~~ ~. ~ S ./ ' 0 ~ ~ ~ 6 ~ fi I ~~ ~ 3 ~-~ .~ 3 ~~ ~~ r -~- D 1 ~I Q S 0 0 .~ r '" r ~ ' 0 d d fl ~ ~ P ~ d ~ O .~ ~• - ~- O h ~ C~ f b ' ~ ~ '~- f 3 '~ 1 ~ ~ t 1. ~ ~ ~ ° ~ s ~ ~ t ~~ ~ ~. ~ ~ n £~\ ~ d' ~q ~' ~ Ji y ~ ^ Q- Q' J ~ ~ ~ w go V ~~ 0 s .. d /~ ~ '~ r ~'-+ I N J ~ \ n M io N I .~ lY1 ~ ~ O ,~ 9 ~d' c+- V 1 O `,~ c u ' J P K ,iF ,~ T ~~ ,n I -~ -9 '_ ~ ~ 0 ~- a ~' ~~ ~ ~ ~- d'.~ ''n v d ~ ;(~~ 1 'tom S n (~p~~,~~J ~. `ZJ 1,. I ~ 08/08/00 07:37 FAQ 715 243 , 73,E CHIQUITA PROCESSED FOODS ~UU2/U11 -- FAX N0. 7153663121 .Tun. 09 2000 07:03AM P2 FROM Schumdker Plurnbinq ST CROlX fJOUN'~'1l SEPTIC TM1K MAt ~ANCt3 A4Re~BMBNt' OWNBRSHtP CBR'CIFICA''1"1Ots FORM p~~ey~ S~~ ~ a 7~ s d e~ Prope1c~Y Addtaa~ ~~ ~ 7 G ~ ~ ~ (Ymi~oedoo ~m i ~°` aeMt . C~tylB~ -~~"~ ,~`. Patoel I4tiOa Kte~rec L~31~3~~5?~ y ~ ys, Boa ~ T ~ rN.g~W, Taws of ~ ~ ~''~. Propacly Load+~ ~._...a S~~d'ivl:t~aa tea- Q~ T -~ ~S Lo! M ~` - Yete~...~„~- d Brte~q 1Kap ~ ~ - ~ ~' ~ _~ ~' ~` 3 vo~mms Sa/..5~- P±~so 1~ Cr $pe4 t~0 ~ yw ..~! n~o IAt ~aet h Q yM ~ no • ~i~t~t~~11~11~1~0~f7~'~~~'~a~~stvl~udl4 ~~ ~meo 1'hC ~ er~MieR Nt~os~erleo~+1-a~.ryre~rarreaaor~~ts~ ~~~MyAd, ~ppopaegra~r e~rywle ~~ie 1~e. am$c ~ s~dodfaamam~, ef~d 1p ~~ eod itlayeo~yetgiaslio~ ~depdo~lt~4~Mr~ ~/i~diatr~ ~, ~ bsMe~er~4iu a6oeeeoedrrroeio~~ ~ ~~- dea a iet ~4eueis.~ai s~t6ar drenlpe~mrtyt~tbeooo~leeedeerleeeom~d eodfe la. Oe~i~c~- ai~dat ~~ ~ IAN ~der<~ Y {~ ere~r dnt sY ~ ~ ~ eie r~ to ~ here ~ my tea~,F browl•dp. i (w.) •~ (~) dy- °'~:) ~' dm ~ dwee~d bs dye eta+ daed aeee~dedln ~ atDredr~ Oboe. ,..r.. is m..~n+ono- ~ ~ dye ".... ~,~r dtee~r m~mw eere~ •• YtneLyds ~reeb sGh xpptta~ti.n: R rleayyed - 6eed tram dye Ro~rhec of naeir ~ e Dopy eF dw aeetGed Bey roep t! m[iaeme is msda to dye wasa~aty deed STATE BAR OF WISCONSIN FORM 1 - 1998 623953 WARRANTY DEED KATHLEEN H. WALSH ~~~ i515PAGf 4o REGISTER OF DEEDS Document Number ST. CROIX CO. WI ~; - -... ,_ - - _•_. _. ,.: - = -:- --. RECEIVED FOR RECORD This Deed, madebetwecn Ronald C. and Dine M. 05-31-2000 10:00 RN Bonte, husband and wife ___ Y~ANiY DEED _ - EXERT A __ _ _ ,Grantor, !:' CERT CORY FEE: and SCOtt L, and Janice J. Donkersg_oed, _ __ COPY FEE: husband and wife - -_ TRP#ISFER FEE: 99.00 ~~SDIR6 FEE: 10.00 _ _ _, Grantee. j Grantor, for a valuable considera[LOn, conveys to Grantee the following i described real estate in St. CroiX _ County, State of Wisconsin the 'Pro erl ~ ~~ frt Ord ighei -- ~~ Name and Return Address Lot 44 of Pheasant Hills Subdivision Document iY622544, Volume 7, Page 86 (Township of Hammond) Scott L. Donkersgoed 1220 Vine Street Hammond, WI 5401 S 018-1034-70-000 Parcel Identification Number (PIN) This i5 nOt homestead property. (is) (is not) i Together wf[h all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except highways, easements, and restrictions of record. D~(ate~d,~th_Ls~(2~6~th dayrofy,M~dy~ 200n0 t~., ~/~ 1~1CJ"l9-~<.7- ~ - Y`9J'"'''~, (SEAL) /X1/~JO~ 7 //. 7~ 7(~J (SEAL) . By: Ronald C. Bonte By: .Dine M. Bonte (SEAL) Signature(s) AUTHENTICATION authenticated [his day of ACKNOWLEDGMENT (SEAL) State of Wisconsin, lII } 5:5. St. Croix County 1 Personally came before me this 7fit-h day o[ M a ,~ n n n ,the above named ewe/ate C. /,~on ~ G•ra~ di~~ ~'/. ~og +'~ * utni TITLE: MEMBER STATE BAR OF WISCONS[N wv~a~-• ;4MQ~,i~ to .~Q. •• (If no[, ~ n . ' ~p ;p~+ me known [o be the persons who executed the foregoing authorized by §706.06, Wls. Scats.) _ ; ~ ~~ ~1,. ~ t rument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY 3 - Ronald C. Bonte %'~l'~,fil.:A(/BL~f'_aca~'r ~ , ~loG ,.> L oi~r e~p ~ ~~ 1 0 1 1 1 70th St Hammon9~~F~„5~~1•b 1 5 Notary Public. State of Wisconsin My commission Is permanent. (If no[, state exp(ration date: (Signatures may be authenticated or acknowledged. Both are not __ ~' a~ - 4~ ~ ) necessary.) ' 'Names of persom sign4ng In any capacity most bt typed a printM below their signature. 1 ~~ STATE BAR OF WISCONSIN W~scon5al Lepel Blank Co.. Inc. WARRANTY DEED FORM Na. I - ]998 MAwevkei, was. ,. ~ ~ I ~ ~ p0' s 1 ~ ~ _~ - -~ 'n I ----. _ _.- __ a -. ~-- - 6'9 ~ -_-- s~ - ~ ~' n ~ I (" ~' i ~ "' ` O 0 I / ~ V ~,~ ~~ ' I A ~ I-- I ~ - cfi / ~ ~~ a 7 I ~ ~ b ~D, ~ ~J z'~ ~ ~ ~ S ,~ . • Y (~ I I N00° 00' 00" E (~ , ~'Q \~r om,'; ~ J, 1 16.32' , = ~ ~ - cP ~ ~ ~ c~ } I ~ ~ hh 5 ' . - ,vf4 .O ~ W M cY O `^ ~. I ,' ' moo, : ~ ~ ~ ~ ~ 2 m z ~ '. O O cv J3"~ 33' ; ~ w .~ O rnp .'~, ~icn I '' ~ ~ O ~ ~ J m, ~ N "' -~ N R o ~ ~N c7 4 p ; ~ i~ - I~ 0 I-- I I Ih t' ~ ~ ,1 Q ; c _ . '' c ~ ~ Q ,~, I Z ~ ~ -' ~ r T -L C~ ~ ~ I ~ ~ ~ ~ S 00' S I ' 02' E 72 5. 9 7' ,~ 00' ~ j I d I ~ 100' • ~? 4. $1 j ~-L 2 _ z '" I Z' 399.31' \.~ ~ 75 ). 16 O ~ ; o ri U~ U ti ' I . r i ~ ~' W ~ ~ W O ( N~ ~ 0 1 U ~' VQ wo v I ~~ ~} O "'• ~ W ca. Q ro m ~ O I-- r. ^~ n i. ~ m N ' ~ I N i Q W J t~j ~~ t ~,~ m CI} I w Q o ' ~0 ~ ~ ~- h ~ tl, $ z ;' I - ~ ~ NOO• a3' OS' W 396. 9 S' O O ~ ~ • I ~ .; ro ~ ~' ~ ~ I ' m ~ ~ I 1 w ~ ~, ~ Q V- Mr• ~D .r v cn cD °; f T( I I ~ iACK v S .y„~ I CJ O c0 ~ J N s .. N h $ ' ' ' N Q I ~ p i W NOO°39 03 12 19.57 - ^ I `--------- ~ ---- ---- 394.85.-- -::.:.----------- ~ -------------------- 491.29'------•--- ------------ - DEDICATED TO THE PUBLIC ~ ;O ~_ ._ . , ~_70~~'1 - - - -- - -- ~ - -- ~ -- N00° 39' 03" W _125 I_97' -- - -- - -- -- I O Z~ I "~' wt ~ 4. S .~ Ci 1 Z U TO 1° ~... . 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E ,• P bj _ P1043. # 104 * 1050. • J * OT PROPOSED POND ~~ r HIGH WATER MARK = 1044 ~/~ I ~: 1', I - 1 ~ PM1O.ECT: 41EET NQ 11 PHEASANT HILLS SUBDIVISION ~~~ar ~w PRELIMINARY PLAT In street endfneers p~~p ~; Rllf s 252 land Sune~on TOWN OF HAMMOND le, 41 54025 ConaWctlon Mena~er. p~ ~: 193_ppt,p~ s-ece-aa4o r.:: CIS-ace-s<+- DETAILS X09 NuwaErt 193-007 June 2, 2009 Summit Mortgage Corporation Scott Marcks Code Administrar.ion 13355 10t" Ave N #100 715-386-4680 Plymouth, MN 55441 Land Information ~ Planning RE: POWYS Installation Inspection, Sanitary Permit #370266 715-386-4674 Real Property 715-386-4677 Recycling 715-386-4675 Location of Property: St. Croix County, Wisconsin Municipality: Hammond Township Subdivision or Plat: Pheasant Hills NW 1/4 of NW'/4 of Section 16, T29N, R17W Lot Number: 44 Address: 989 170t" Street Dear Mr. Marcks: An inspection by county staff of the POWYS servicing the above referenced property was conducted on August 16, 2000. At the time of the installation inspection, this Private On-site Wastewater Treatment System (POWYS) was found to be code compliant for a four (4) bedroom home. However the plumber was required to submit revised paperwork to complete the permit. This paperwork was never turned in and therefore the inspection report was not signed by the inspector. The maintenance record indicated that the system has never been inspected/serviced within the Wisconsin Dept. of Commerce Safety & Buildings' recommended 3-year interval from date of installation. If you have any question regarding this wastewater treatment system, please contact our office at 715.386.4680. Sincerely, Ryan Yarrington, POWYS Inspector #683475 ST. CRO/X COUNTY GOVERNMENT CENTER 1 101 CARM/CHAFE ROAD, HUDSON, Wl 54016 715-386-4686 FAx PZC~CO. SA/NT-CRO/X. W/. US W W W . C O. SAI NT-C ROIX. W I. U S