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Home My WebLink About018-1094-31-000 camp 3~n C ~1 ~ ~ ~ ~ ~ ~ ~ .. ~ ~ ` 1 I ~ O f7 ~ d to O O A W 'O -~ O ~ v r • , j~ ~ coo o y, ~ 3 0 ~ v p o I n.o m 3 a w \ 1 o ° ~ ~ I ~ co ~ ~ I ~ ~ w ~ O .~ C O ~ cI) z D ~ a ~ I m so D y a ~ .0 ( ~ W I 3 O o°'~ I ~ " N 3 0 I Z o o o h n r N N °w°w~ n ;. 3 ~ c ~• I '0 - t 1 , ~ o -o 000, cn m I ~ ~ Q ~ vv ~" ~ =° ~o ~ ~ c eo ~+ ~, ~ I N 3 3 °-', 1 a ~ I Z .. o ~ ~ o I .; ~' ~ ~ O ~ > > > I ~~ ~ o y ~ ~ a I o ~ y I ~~ ~ $ ~. _, ~ I w ~ o~ ~_ a a 'i = ~ ~ I Z ~ O ~ tD N ~ ... ~ _ A Z N n ~ A' a A Z O I N N ~ ~ 7 I ~ ~ a ~ ~ CC J C J ';~ i ~ Z 7 C : ~ ~ r O Z ~ ? t ~ 3 tl! m ~ i ~ W ? I I ~ O d fD O N ~ ~ m o ti0 ' I ~ m ~ m~_ ~ I ~ (D N N day y I o' m a fi > > y ~ Imo, ~~_~ . I ~ 3 ° N_ " 7G I~ ~I ~ m ~ ~ N ~ I` W ~~ O N N ~ A d I ~~, o ~ a I ~ ~ m ,ti :° I ~ I c ~ ~ ~ ~ ~ ° ~ ~' o Wisconsin Department of commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township S inks, Ernest Hammond Townshi CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ~C i ~','~~o-h.r -~ TYPE MANUFACTURER CAPACITY Septic ~~ ~~ ~ v ~ ~ Dosing c~~~ .~ ~ ~ G Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic "'YCy 75 ~ \ J ~ ,~-- Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift fiction Loss System Head TDH Ft For emain Length Dia. ' t to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: $t. CrOIX Sanitary Permit No: 430077 0 State Plan ID No: Parcel Tax No: 018-1094-31-000 Section/Town/Range/Map No: 17.29.17.771 STATION BS HI FS ELEV. Benchmark v ~,,~ 102 y IV•3 ~l ~ Alt. BM ~. i~z. 9 R •5!(~ Bldg. Sewer /~ Q ~~~ Y~ SUHt Inlet SUHt Outlet a.q Eq.SS Dt Inlet \ Dt Bottom \ Header/Man. s s~ t 3 ~`~ i3 - ~ Q• 84.38 Dist. Pipe T~ ~~t,~ ql 13. ~ .u~ .N g9y3 Bot. System ~ ~ t H • ZS ~ &s ~ ?) Final Grade 5. 3~ 97• St Cover BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ ,,. ~C? ~ -- ----- ~_ SETBACK SYSTEM TO P/L BLDG W L ~ KE/STREAM LEACHING Man facturer: ~ ( ~ INFORMATION CHAMBER OR h~ ~ ~ /~'~- ~ Type Of System: Cc~-,~~cm,F,~ ~.~ ~ Z~+ ^- 7Z ~ UNIT as ch. Model Number: T 1 ~,~ S' ~ DISTRIBUTION SYSTEM °"S Y ~'-'^t Z"''- ~ `^-` ~'~ Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake ~ ~ • h ~ i ~ pipe(s) _ ~ `-- _____ --~_ Lengt D a Length Dia Spacing 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 . v Bed/Trench Center .~ ~ Bed/Trench Edges _ Topsoil _ n Yes ~ No [_~ Yes ~~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~ C /~/ ~J Inspection #2: / /. Location: 993 167th St Hammond WI 54015 (NW 1/4 NE 1/4 17 T29N R17W) Prairie Run Lot 31 Parcel No: 17.29.17.771 ct:.~ et1~~:. t31ci+ TLw'i~ 1.) Alt BM Description = 3 6 } ~~ S ' 7 ,~ ~ * ~ \ ~ / ~ vb5! r/- 2.) Bldg sewer length = tom[ - 5 ,~ r--~"" ~,,-.~"`~,1 S-Tv~'+-~ (~' -amount of cover = > (o` ~Io~ ~ ~,, •-~?^~' ~~ ~ x~~ h~ ~/~/~ ~~ °lan revision Required? ~~ ,j Yes ~] No ~/ III L~ ~I~ ~I se other side for additional information. ' ~ ~ i 7 p / ~_______ _~ / ___--J ~ ( _~ Date I epctor's Signature Cert. No. ~-6710 (R.3/97) ~~993 /6~~' S~ . Safety and Buildings Division County ` m ~ 201 W. Washington Ave., P.O. Box 7 2 ~seons~n Madison, WI 53707 - 7082 Sanitary Permit Num u (to be 611ed in by Co.) De artment of Commerce (~8) 261-6546 3oD ~~ Sanitary Permit A ~._, State Plan [.D. Number In accord wiW Comm 83.21, Wis. Adm. Code, nal it l~tl~t~ may be used for secondary purposes Pri y Law, s15.04(1 xm) Project Address (if different than mailing address) I. Application Information -Please Print All Informs ion ~ ~~ ~,~ 1~ 6 2~~3 ~ „_,f,/~ /' Proputy Ownu's Name ., , ,. i ~ i ; , . i t ;,: ~ ) , ul '~~ ~~ Parcel # Lot # Block # ., ~ ^ ~ C ~ iING ~~ FICE ~'~-I Property Owner 's Mailing Address Properly Location / "' ~- ~ Section ~~ ~ % ~'/ Ci S i b ., ., ty, Z p Code er Phone Num ~, p (circle N; R LZE o~ , iG~L , S ~, V. Type of Building check alt that apply) ~ ~ ~a S bdi i i N CSt i IB b 1 to 2 Family Dwelling - Numbu of Bedrooms '~ q+.1.~Q S u v s on ame u - um er ^ Public/Commucial -Describe Use ? _ ^ State Owned -Describe Use ^City ^Vil a ownship of III. T ype of Permit: (Check only one box on line A. Complete line B if applicable) A' New S tun ys ^ R lacement S tun ep ys ^ Treatment/Holding Tank Replacement Only ^ Othu Modification to Existing Systun B• ^ Pumit Renewal ^ Permit Revision ^ Change of ^ Pumit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumbu Owner IV. T of POWTS S stem: Check all that a 1 Non -Pressurized In-Ground ^ Mound >_ 24 in. of suitable soil ^ Mound < 24 in. of suitable soil ^ At-Grade ^ Single Pass Sand Filter ^ Constructed Wuland ^ Pressurized In-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Filter ^ Recirculating Synthetic Media Filter ^ Latching Chamber Drip Li ^ Gravel-less Pi ^ Other (explain) t V. Dis ersaUTreatment Area Information: k Design Flow (gpd) Design Soil Application Rate(gpdsf) ' persa Area Required (sf) Dispersal Area Proposed (sf) System Elevation ~ ? L ~ 8, . Tank Info Capacity in Total Numbu Manufacturer Prefab Site Steel Fibu Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank ~_ s, Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, a ume responsibility for installation of the POWTS shown on the attached plans. Plumb 's a (Print) Plumb 's Si a e MP/MPRS Number Business Phone Number ~ 5 5 .S-' / et, City, S te, Zip Plumbu s Address (Stre e f-~ L~ ~ VIII. Cozen /De artment Use Onl Approved ^ Disapproved Sanitary Permit Fee (includes Groundwatu Date Issued s ' g Agent Signature o Stamps) ^ Owner Given Reason for Denial Surchazge Fee) ~ ~~ ~ IX. Conditions of ApprovaVReasons for Disapproval • ~ ~- ~ `l`~4/ t~ , G4 1 1nM~ ~~°`~ ~ G~U• 1 ~~tC.l -M~u.~>C ~ Wlb~.(.tti~ t F'K~l Yt.~ r.A.C.~ / Attach compkte pleas (to the County only) for the system on paper aot less ttan alll : 11 lathes fa size .0/ SBD-6398 (R. 08/02) ~ _ / . _ '/ ___ 7~ . _ ~ I ~ /60 ~, X JK --,-r----- ~- -+- - ---- _ - -- _ _~- ,_ ~ -~ - - _ ', i, ', r ~ dvs ~ / - - _ -- __-- _ - -- + - +-----t -~- 33 Y - -~----~ -- -- t_ ~ ~_ __-----~- -1-~-- ~-- ~ ~~---.-_ ~ _ ~~ ~. -~ .. ~~ Y ~ ~ -~ Y -~ _ __ .- Y 9 ~ ,, ` _ --- -- +- -- ~ ~ T-- _~ - --~----+---- -l-~j~dS~Qr ----- -~-- ~--------- ' --~~ ~- --~ -+---+----~ ', /~ ~~ 1 ---+- - r -- i-- --*--- --- w- - +- . --- - +- ' f' st4 w ~-~11 ...~- rC o ~ .._Y___.._ t._ r._.. -~- ~ - S r.. _.~-_....i _ i .__-r- 1-..... __-~- ._ _-._ ._ ....._y .._. ~_. ~_.___ _'~'__- _._~--_ ~ -.__.~'_ _a--_ _-.y-_- r ~, ~ r ;___ M``~ 1~_ _ _-- .--- ,-__+. _~_ _r ~-_ i _~___- ~ __~____-~____~_ __.~._____-y_._._t. - !~ ~ ~ f i ~ ! '. -~--T- !---- ~-- ~ ---~ ~__._.~._~ ~ .-- ~-T -i- ~- +--+- -t--------- ->-_ -- ~~ ~-~~~J~s ,raw %~ -~Il~/y- s.~~~~-~~9iV ~iy~1 _ ~ sr` _ _, ~~ ~` _ gg ~. _ ._ ~ ,B~i/-~ dqS 33 37 ~ ` ys,~ -- 3 l __ _ _ ,~ __---- ~ ~ ~ _. '. . ~-. _ _ _ 9~ ~ -~ _. 9 _ _-- ~ _ ~'~~~ _ Pv spa ~~~~( _ , _ _ _ _ ._ lj,~,J~w~;Y ._ ./ ~~ ~ " = ~ ~ ,~ ~~~f/s ~ 3X~~ ya - l /~/~s . ~~~~- ' Wisconsin'DeparfmentofCommerce SOIL EVALUATION REPORT ~ Page / of .~ Division of Safety and Buildings ~~77`` .,~a~..~o..,ttit, r~.,...... Qc ~nr,.. na... r..a.. County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 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. Rev' ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~"~~ 121 Property Owner Property Location j (Z.., S P/ Q~l k..- Govt. Lot 1/4 - 1/4 S T N R E (or~ Property Owner's Mailing Address Lot # Bock # Subd. ame or C-9ivl# ~~~~ City State Zip Code Phone Number ^ City ^ Village ~ Town Nearest Road ( ) New Construction Use Residential !Number of bedrooms ~ Code derived design flow rate GPD ^ Replacement ^ Public or commercial -Describe: Parent material ~~~ Flood Plain elevation if applicable ,~%~ ft. General comments / ~ ~~ ~~ ~ ~ / /~ ,p n and recommendations: `~~.5'`-t''^ / ~ (~ ~~ ~~ f l~ / ^ Boring U ~' ~ 0 "V Boring # _ V ~ Pit Ground surface elev. ~,~?.~7 ft. 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 3 . ~-. S - ~' 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 I ~- s ~' s o .gz .~ * Efflu t #1 =GODS > 30 < 220 rrfg/L and TSS >30 < 150 mg/L * E uent #2 = B D < 30 mg/L and TSS < 30 mg/L CST Nam (PI se Pri ~ Signature CST Number v` r / Address ate Evaluation Conducted Telephone Number JDL-OJJ V ,LTV // V V Property Owner ParcellD # Page ~J of ~_ Boring # ~ Boring Pit Ground surface elev. ~~_ ft. Depth to limiting factor /s S~ in. $oil 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 I ~~ ^ 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/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ^ Boring Boring # Ground surface elr;v. ft. Depth to limiting factor in. ^ Pit Soil Application Rate Horizon Depth Dominant Color Redox i~escription Texture Structure Consistence Boundary Roots GPD/ftz 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 ~~pportunity 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. SB0.8330 (R.07/00) _ ~.3a~3 ,. .~,,~,%~~.S~~S ,(/~~/~.{~~ ~ -see /7- >~7~'//- ~°/rr~' ~~~~o~~ l L~,~ .~~~~ _ _ __ __ . ~, _ -~~1.~ ' _ _ ~f~w2B1__ 37~ ys~ _ _ _ _ __ __ _ _ t _- _ ~ ._ S,; _ 3 ya,~~o~ i 1t - _ ~---- _ _ _ --- _ a -- ------~- ._ _ . l a~/~~ ~ _ _. _ - - _- - b ~f~/ ___ ,t~yr.~,,,~ _ _ _ - __ __ _ _ ._ ~ ~~ • 1 ~ J =~ ~ J~ _ _ ' ~ 3 __ - _ __ __ 1'U~ti''I',5 UWNLIt'S MANUr1L ~'k Mr1NAGi:M1/N'1' PLAN ~wY~ ~.~~~ ;~:~;~. . FILE INFORMATION Owner ~ Q• SPr~kS Permit N ~~~`' n~etr_U geueMtiT>:.RS yuv•v.. . r.........-- __ Number of bedrooms o NA Number of Commercial Unit ~'NA Estimated flow avers e ~ al/da Desi flow eak , Estimated x 1,5 ~ , al/da Soil A ~lication Rate _ gal/da /ft Inl1ucnl/LI'I'luent Cluality Nlvu~lily ~\v~r,ib~* hats, Oils Sc ~11'l:ilSl: (I~OG) <:~U iiig/l. Biochemical Oxygen Dcmund (BODs) g22U mg/L Total Suspended Solids (TSS) < i 50 m L Pretreated Effluent Quality O NA Monthly Average'""` Bioehemicul Oxygen Demand ([30Ds) <:~0 m~;/l. Total Suspended Solids (TSS) <3U mg/L Fecal Coliform eometric mean <10' cfu/IOOmL Maximum Effluent Particle Size '/~ inch diameter MAINTENANCE SCHEDULE SYSTEM SPE IFIC I Se tic Tank Ca acit al o NA Se tic Tank Manufacturer o NA , Effluent Filter Manufacturer o NA Effluent Filter Model - a NA Pum Tank Ca acit al .ANA Pum Tank Manufacturer ~a NA Pum Manufacturer ~-NA Pum Model .~ NA Pretreated Unit ~~~ 4;uid/Gruvul Filter t'~ I'e;tl I'ilt~~r ri Muuhanir;tl nw•ation u W~~tlund o Disinfection o Other Manufacturer Dispersal Cell(s) ~ln-ground (gravity) o In•ground (pressurizedl o At•grade o Mound o Drip•line o Other. • Values typlonl fordomosUc (non•commerciol) wastewater and sopttc tstnlc effluent. •• Values typical fot ptouatod watowator. Service Event Service Fre uenc Ins ect condition of tanks Ac least once ever o months ,3 ~( ears Maximum 3 rs Pum out contents of tanks When combined stud a and scum a oats one third '/~ of tank volun [ns ect dis ersal cell s - At least once eve o months ,~ .~' cars Maximum 3 r~ Clean effluent filter At toast once ever o months ~ our s ,~~ Ins cct um aim conu~olx & alarm ~t IetlSl once uvur u months o eur s Nn Flush laterals and ~restiure test At least once ever o months Q y eur(s~ ~ NA Other; At least once ever o months o ears ~' NA Other: At least once ever o months o eur s ANA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certificatio; Master Plumber; Master Plumber Restrictod Sewer; POWTS Inspector; POWTS Maintainor; Soptage Servicing Operator. Tank inspections must tnclud~ a visual inspection of the funk(s) to identify any missing or broken hardware, identify ~,ny cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on u ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground stufaea tray indicate a failing condition and requires the immediate notification of the local regulatory authority. ~, When the combined accumulation of sludge and scum in any tank equals one-third (''/s) or more of the tank volume, the ent~ contents of the conk shall be rc;movcd by a Septagc Servicing Operator and disposed of in accordance with ch. NR I I a, Wisconsin Administrative Code, The. servicing of effluent filters, mechanical or pressurized POWTS components, pretreutrrtent components, and any other maintenance or monitoring at intervals of 12 months or lesti shall be performed by a certified ~OWTS Maintainer.: :~- . A service report Shull be provided to the local rc~;ul;uory authority within 10 days of completion of any service event. START UP AND OPEKA'I'ION For new construction, prior to use of the POW'I'S check treatment tank(s) for the presence of painting products or other ehetnieals that my impede the treatment process and/or damago the dispersal call(s). If high ConoonitAtlons tiro detected hay the contents of the tanks(s) removed by a septage servicing operator prior to use. Owner: • System start up shall not occur when soil conditions are frozen at the infiltrative surface.• Page _,o(! During power outages pump tanks may fill above normal high water levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Uo not drive or park vehicles over tanks and dispersal cells. Uo not drive or pork ovw•, or otherwise disturb or compuca. Thy urea within IS feat down slope of any mound or ut-grade soft absorption are. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONEMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be token, to provide a code compliant replac °ment system: A suitable replacement area has bean evuluuted and m~y be utilized for the location of u replacement loll absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from.existing and proposed structure, lot lines and wells. Failure to protect the replacement. area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. q A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. .. _. ""` •q" "~Tlre'site~ttas"'i'tot~beon~evaluated~to~identifya suitable replacement area. Upon failure-of the POWTS a soil and~site •-°~ evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding .,..tank may be installed as a last resort to replace the failed POWTS. d` Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at the time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND/OR INSUFFICIENT OXYGEN. DO,NOT EN~'ER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER A1~lY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR pF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTAL" ~~ ' Name ~ / Phone ~ - - - SEPTAGE SERVICING OPERATOR PUMPER) Name Phone ,.._ :;::. POWTS MAINTAINER Name Phone LOCAL REGULATORY AUTHO TY Name ,' ~ ' Phone -~ .:~ . v~'~ `> ,~. ~~ ~'.e~ ( _ ST CItOIX COUN'T'Y SEPTIC TANK MAINTENANCE AGREEMENT (~ ~~, ~ o • AND ~J Vv O EILSHIP CERTIFICATION FO1tM ~ ~ ~ -~ s-f - . homer/Buyer ~~ hailing Address - 'roperly Address ~ ~9`3 eritication required from Planning Department for new construction) Parcel Identification Number ~~ amity/State LEGAL DESCRIPTION /,~ '/,, Sec. / 7 , `~-N-~-~--w' Town of Property Location ,,~.'/,, ~Al~-- ~ /,! , .Lot # ~L.~.• Subdivision Cerfiifed Survey Map ## Warranty Deed # 7/ 7 ~`~ Spec house D yes ~ no Volume ,Page ## Volume ~ ~ ~ Page ## --`'~~ -• Lot lines identifiable ~ yes ^ no SYS~i M r,7AINTENANCE remature failure to handle wastes. Proper maintenance Improper use and maintenanceof your septic system could result in its p um r What you put into the system consists of pumping out the septic tank every three years or sooner, if needed by a licensed P Pe can affect the function of the septic tank as a treatment stage in the waste disposal systeur. the owner and by a The property owner agrees to subnut to St. Croix Zoning Department a ce ~~tii ~e~'~ t~ ~terdisposal system oume n lumber, restricted Plumber or a tiee~~sed pumper verifying ( ) masterplumber, j Yma P if necessary), the septic tank is less than 1/3 full of sludge. is in proper operating condition and/or (2) a fter inspection and pumping (~ e the undersigned have read the above requirements and agree to maintain the Private sewage disposal system with the standards Uw , Office within 30 set forth, herein, as set by the Department of Conunerce and the Dep a a a i tum~a~ 1~ es~ ~~ix ~O~ry ~g ~ ~~f ~~on stating that your septic system has been maintained must be comple days of the three year expiration date. ~ / b ., - DAT SIGNAT[JRL O ~ PLICANT ., OWNT;R CERTIFICATION am are the owner(s) of I (we) codify that all statements on this fonn are true to the best of my (our) lmowledge. I (we) ( ) the Properly described above, by virlue of a warranty deed recorded in Register of Deeds Office. / r' / DATE' SIGNAT[IRL' Or AP ICANT ,~,~**** An information that is mis-rcpreswitcd may result in the sanitary permit being revoked by the Zoning Depar~ent. •tsw•s y *« Include with this Application: a stamped warranty decd froinnt~h~'Rf reference isemadc in the warranty deed a copy of the codified survey ~~ ~ ~ ~~ ~~~~ ~ ~~ ~E~ ~ G Pd ~~~ Wisconsin'Department of Commerce SOIL EVALUATION REPORT • Page ~ of Division of Safety and Buildings in accordance with Comm $5, Wis. Adm. Code County Attach complete site plan on paper not lass than 8 1/2 x 11 inches in size. Plan must _ ~r4~ K include, but not limited to: vertical and horizontal reference point (BM), direction and paroet I.D, percent slope, scale or dimensions, north arrow, and IocaUon and dlatanoe to nearest road. Please print all Information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (t) (ml). I Property Owner Property Location '`~ Govt. Lot i(iC/ 1 /4,{~,~;- 1/4 S (~- T Z- N R ~ ~- E (or) ~ Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# City State Zip Code Phone Number ^ City ^ Village [1~ Town N/earest Road ~- ~ ~.Ld wl t'yai S- (~/ S) ~'G-1 ~y 3 n-r rvto 2 ! ~~'~ ® New Construction Use: ~] Residentia{ /Number of bedrooms 3 _ y Code derived design flow rate ~ '0~ ~ ~~ _ GP; ^ Replacement T ^ Public or commercial -Describe: ,Parent material / ~~~~ Flood Plain elevation if applipbl ~~ ~ ft. ~~ General comments S Ysf r ~ C /ev r ~j S • ~ ~ ; t ~' /~O '~. ~~ 'and recommendations: ~L,.,~, E'/Z V , c1,5"• g v ~~ ^ Boring # ^ Boring ~ ~~ ~ ..,; ~ ~ _ . •,:!~ ® Pit Ground surface elev. ~~jO' 3U ft. Depth to IImIUng factor~_ : ,.• , plipUon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roos GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Effi`i2 I a-I to ~ l .~ .5 . ~ Z t !o- ~f2 10 `f _ Si C.l C 5 -- • ~`{ 3 4~2-50 / y D -- -- • 7 /. 2 Z Boring # ^ Boring ®Plt Ground surface elev. ~U°' 3 c ft. Depth to limiting factor ~_ In. Soli Icatlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/RZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh: 'Eff#1 f#2 'Ef j~ Q ' tttluent iF1 = 13UU6 > 3V < Z~U mg/L and 155 >30 _< 150 mg/1. • ETiluent iFZ = BVUs < 3V mg/L an0 T55 < 3V mgn.. CST Name (Pleas P~r1nt) lI nature /' / CST Number ,arm m ~ ~n t 1 ri v~ ~J Pl' ~~ l- ~.4~ ! _ ~ ~ ~ ~ [7 9 ~'J (R07 } Property Owner ~~l~f-)_s Parcel ID # Page Zof 3 Boring # ^ Boring ~ pit Ground surface elev. 9.8U ft. Depth to Umiting factor ~_ in. Soil Appliption Rate Horizon Depth Dominant Color Redox I:)escription Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 I b- l0 ~ ~~-- i 2 ~ CS ~ • 5 .8 ~ _ ~.._ r, c 5 ,,,_ 3 - ~tl ~-- s ~ ~ ~- -~ i, 2 n I I Boring # ^ Boring ^ Pit Ground surface e!e i. ft. Depth to limiting factor in. Sal Appligtion Rate Horizon Depth Dominant Color Redox {)escriptlon Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. wont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ^ goring # ^ Boring ^ Pit Ground surface ele ~, ft. Depth to limiting factor in. _ Soii ligtion Rate Horizon Depth Dominant Color Redox C-ascription Texture Structure Consistence Boundary ROOts GPD/ft= in. Munsell Qu. Sz. „ont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 'Effluent #1 = BOD` > 30 < 220 mg/L and TSS >30 < 150 mg/l. ' Effluent #2 = BOD` < 30 m~/L and TSS < 30 The Department of Commerce is an equal o aportunity service provider and employer. If you need assistance to access services or need material in an alternate fon nat, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) r PAGE 3 OP~ lyt1M~-t~c,~.~hs.~.t LOT# 3~ r EGAL DESCRIPTION,Uw ~A/E ~~,5 l ~- T zq ~N R ! ~ E(odf~ SCALE: 1"= ~O BM 1 ELEVATION (Q~ • C) BM 1 DESCRIPTION•~P ~,.~ 1 ~ ..,pvc, P' p e BM 2 II.EVATION q q, ~a BM 2 DESCRIPTION~Q c1.G ~ 1 ,Puy p~ p e SYSTEM ELEVATION q S', `!SO ALTERNATE ELEVATION q S ~ o U CONTOUR ELEVATION `( ~U d- ~OO.3 I ~~ r .Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings ~~ ~ts~D Page ~ of County ~ C Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must Y OI include, but not limited to: vertical and horizontal reference point (BM), direction and l t l di i rth d l ti d di Parcel I.D. ~/ ~ /]~'~ ~ ~ - percen s ope, sca e or mens ons, no arrow, an oca on an stance to nearest road. b - Q 9 3 (w - P/ease print all information. Rev' Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). - ~ Property Owner Property Location ~~l Govt. Lot ~iG/ 1 /4,(jt„ 1/4 S ! ~- T Z-~ N R / ~ E (or) ~ Property Owner's Mailing Address ~~ l ~ ~" ~ Lot # I Block # Subd. Name or CSM# ~ ~ • e u City State Zip Code Phone Number ^ City ^ Village [~ Town Nearest Road ~n't'W~n.d w( ~y6/S (?~s)/~9'ly-z~f3 /7~r"•,nto2 l~°-~ , ® New Construction Use: ~] Residential /Number of bedrooms 3 _ y Code derived design flow rate ^ Replacement ~- ^ Public or commercial -Describe: Parent material / ~ ~~ Flood Plain elevation if applicabl ,; General comments S ysff /+'t e/{v~ Q S' $~ 'and recommendations: ~G./, e%(V , cfs. ~ cJ )` GP~ ft. ~.~~ Boring # ^ Boring ~`x .. ~'~ r~.~ '~ ~` ® Pit Ground surface elev. ~~'~'' 3~ ft. Depth to limiting factor ~~ i»„` , ~ `` ,~ . _~1" pplication 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 I a-t ~D . ;/ L l .~ . 5 . ~ 3 ~2-So / ~ v D „~ - - . ~ 1. 2 Z Boring # ^ Boring ® Pit Ground surface elev. ~U°' 3 ° ft. 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-15 l~ ~ t l c ~ • 5 .~ Ns-~5 `-- ~c,J CS - • ~ ~ 3 5~5-~3 - - -- ~7 1. * 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) i nature CST Number ~ ~ 3 9 Address Date Evaluation Conducted Telephone Number 3 ~'~" -~ ~I--z g ~ai ~ ~a JtSll-iSSSU (KV //UU) Property Owner ~~~~/f'l_S Parcel ID # Page Zof ^ Boring Boring # t~ Pit Ground surface elev.99 8U 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 2 1 - 3 `_ i ~'~' c s `- 3 - ~i `t~ ~-- 5 O l ~- `- ~ 1, Z ^ 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 GPDlftz 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 Application Rate Horizon Depth Dominant Color Redox C~escription Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. ~~ont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L ar~d 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) . .. o PAGE 3 OF ~ NAME f~s„J k , ~ ~ T OT# 3~ T EGAL DESCRIPTIONAIw ~d/E ~ ,S t "~- T Zg ,N,$, 1 '~ E(o~ SCALE: 1"= ~D BM 1 ELEVATION ~Od • O BM 1 DESCRIPTION •~P n-~ ~~ ~~vc. P~'pe BM 2 ELEVATION ~I q, , 4 BM 2 DESCRIPTION -~,p o-~ ~ ; ~PU~ p. p e SYSTEM ELEVATION qs', ~O ALTERNATE ELEVATION ~ ~ ~ O CONTOUR ELEVATION `j~f• `1ST d- ~~ •3y N x~ -~- .g ~G. 1 ~- . t _. _' CGG f= Avt . ___.. ~_ a_. 8' A 0 ~S r ~:. $-3 Qyn\ FjM2 TUBE ~ 4~•~ -~- ~ ~ DATE / -/ Z - a/ Wisconsin Department of Commerce SOIL EVALUATION REPORT ' Division of Safety and Buildings ~~ ~~ Page ~ of County C Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must r 1 include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Persmxmal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location ,~~ Govt. Lot fir,/ 1 /4,{/,~ 1 /4 S ! ~-- T Z--~ N R ~ ~ E (or) ~ Property Owner's Mailing Address ~ ~ Lot # Block # Subd. Name or CSM# ~~ l ~ ~ ~ City State Zip Code Phone Number ^ City ^ Village [~ Town Nearest Road ® New Construction Use: (~] Residential / Number of bedrooms 3 _ y Code derived design flow rate `'~~ ~'~• GPO ^ Replacement T ^ Public or commercial -Describe: ~ .- ' Parent material / ~_ ~~ Flood Plain elevation if applicabl ~V / ~ r ~ ~ ft. ',.. t General comments S ySfrA'i G/'~vc Q S• ~ ~ `~ F/~~ - and recommendations: ~G,~, e/t v . ys'• g v ~~-> a` ~,~~~, ,_ . •.~ '~[ Borin ~ ~ ~~ Boring # g GG• v gd ~r~' . __ - - .,-~~-~ ,y ® Pit Ground surface elev. ~ 3 ft. Depth to limiting factor alY pplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roo~§~~ GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 a-I ~o ' j c. / .~ . ~ . ~ Z !!o-`f2- 10 ~-t - Si CJ Y771r'- CS -- . ~-{ 3 ~2-so ~ . ~ -- o - - . ~ r. 2 Z Boring # ^ Boring ®pit Ground surface elev. ~U°' 3 ° ft. Depth to limiting factor ~_ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ! b~5 l ~ t l c ~ • 5 .$ I5-Sf5 ~c.l CS -- • `-~ . ~ ' ttnuent ~~ = rjw5 > su < c~u mgiL ana i ss >su _< ~ au mgiL - tmuent rr~ = rsvu5 ~ su mgrL ana m as < su mgiu CST Name (PleasCe Print) i nature / CST Number q Address Date Evaluation Conducted Telephone Number enn Q~zn inmmm Property Owner ,~r,,~k~r>,S Parcel ID # page Z~ ^ Boring Boring # Pit Ground surface elev. 99.80 ft. Depth to limiting factor _ [~ ~ in. Soil Application Rate Horizon Depth Dominant Color Redox [ascription Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ a- ~0 ~ -- it 2 Z ~- cs I ~ • 5 .8 ~ - ~_ i ~ c 5 ~-- 3 ~tl ~-- s ~ t ~-- ~- -~ i, 2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox C-escription Texture Structure Consistence Boundary Roots GPDJft2 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/ftz 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. sao-s~w fx.mroo> .- . • PAGE 3 OF ~ NA2.`lE ~~) •~^ S LOT# 3~ LEGAL DESCRIPTIONAIc~I ~A/ t4 S t ?- T Zq N.R. ! ~ Eton SCALE: 1"= O BM 1 ELEVATION (Od • 6 BM 1 DESCRIPTION -~~~.~ 1 r ~Pvc. Q~' pe BM 2 ELEVATION q q. ~a BM 2 DESCRIPTION -~v ~ o-~ )1 ~ ~~ p %p e SYSTEM ELEVATION q$; ~O ALTERNATE ELEVATION R ~ ~ v CONTOUR ELEVATION `lY• ~O d- !00.30 r 3 J 221 0 P `I 7 ? , DOCUMENT NUMBER WARRANTY DEED Midwest Equities, LLC, Grant r, conveys and warrants to ~rneat R- S inks and Shannon R. S ip nk~as joint tenants, Grantee, the following gibed rea e-T state-'in St. Croix County, State of Wisconsin: (~ Prairie Run, being the NW 1/4 of the NE 1/4 and part of the NE 1/4 of the NE 1/4, and part of the SE 1/4 of the NE 1/4, and part of the SW 1/4 of the NE 1/4, all in Section 17, T 29 N, R 17 W, Town of Hammon ` - 7' 1 7842 KATHLEEN H. MIALSH REGISTER OF DEEDS ST. CROIX CO., MI RECEIVED FOR RECORD 04/21/2003 09:00AM MARRANTY DEED EXEI~1 ~ REC FEE • 11.00 TRANS FEE: 92.70 COPY FEE: CC FEE: PAGES: 1 y~-trvbrw~' 'T.~L ~ /~ D ~,~na , ,`l /1/ ss~3` 016-1094-31-000 Parcel Identification Number This is not homestead property. Exception to warranties: All easements, restrictions and rights-of-way of record, if any. Dated this ~ day of April, 2003. %~ (SEAL) La J. We s, Ma gang Member of Mi a Equities, LLC AUTHENTICATION Signature(s) (SEAL) authenticated this day of 20_ (Signature) (Name Printed or TYOed) TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ,1`~~( authorized by 5706.06, Wis. Stats.) iN THIS INSTRUM&NT WAS DRAFTED BYt Leo A. Beskar Rodli, Beskar, Boles & Krueger, S.C. P.O. Hox 138 River Falls, WI 54022 3 - ~ ~,~-~ ACRNOWL8DC3M8NT (SEAL) (SEAL) STATE OF WISCONSIN ) I ) 89. sr"E' ~r o! ?C COUNTY ) Personally came before me this Lf day of April, 2003 the above named Larry J. 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