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HomeMy WebLinkAbout042-1088-20-030 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569510 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: 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 Parcel Tax No: Langer, Gregory& Nancy Warren, Town of 042-1088-20-030 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 31.29.18.489A05 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg.Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot.System PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width DIMENSIONS Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia 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 Bed/Trench Center Bed/Trench Edges Topsoil Yes 0 No D Yes 0 No COMMENTS: (Include code discrepencies, persons present,etc.) Inspection#1: / / Inspection#2: Location: 959 65th Ave Roberts,WI 54023(NW 1/4 SE 114 31 T29N R1 8W) NA Lot 6 Parcel No: 31.29.18.489A05 1.)Alt BM Description= 2.)Bldg sewer length= -amount of cover= Plan revision Required? 0 Yes Z No Use other side for additional information. hh SBD-6710(R.3/97) Date Insepctor's Signature Cert.No. r, County Safety and Buildings Division t> S � 201 W.Washington Ave.,P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) . ; P Madison,WI 53707-7162 f - . ary Permit Application State Transaction Number In accordance with8 (2),Wis.Adm.Code,submission of this form to the appropriate governmental unit is required prior to o taming a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary j�► purposes in accordance with the Privacy Law,s. 15.0 1 m,Slats. I. Application Information.-Please nt All Information Prope Owner's Name Parcel# r J Property Owner's Mailing Address Property Location Govt.Lot City, fate Zip Code Phone Number N� y� `5 ` 1 4, Section le one T _N; R or� I .Type of Building(check all that apply) Lot# 0 1 or 2 Family Dwelling-Number of Bedrooms / Subdivision Name FF dk CA Block# CY L'o 0 . 8 p ❑Public/Commercial-Describe Use vr•-• C ❑City of — ❑State Owned-Describe Use I CSM Number 9,S�as'/ ❑Village of X� Town of Ge_�l s t,J 2Z d- 7,7- G� e �c III.Type of Permit: (Check ont one box on line A. Complete line B if appli le) A. �,New System ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV.Type of POWTS S stem/Corn onent/Device: Check all that a 1 e.f -5 ,Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil Gka ❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dispersal/Treatment Area Information: n Design Flow(gpd) Design Soil Application Rate(g Dispersal Area Required(sf) Dispersal Area Propo d(sf)it System Elevation 14 O.. D' 12 5P VI.Tank Info Capacity in Total #of Manufacturer , Gallons Gallons Units 1, o ,�, New Tanks Existing Tanks n a �� „ o cn ra a � y U) wc� a Septic or Holding Tank Dosing Chamber VII.Res risibility Statement-I,the undersigned,assume responsilbillity for installation of the POWTS shown on the attached plans. Plu s Na (Pr' t Plumber' Si MP/MPRS Number Business Phone Number & S- � lumber's Address(Street ity, tate,Zip Co VII oun /De artment Use Onl Approved ❑D' Permit Fee Date I sued Issuing A Signature ❑ $ sf 75.06 2 L� '� ner=n:ieason for nial IX.CondiJVSTgWV1"Eq Reasons for Disapproval 3� nroe� ��� • �,•, Kok 4 Septic tank,effluent filter and J dispersal cell must all be services/matnEairted 5�`� ✓mod�- w as per management plan provided by plumber. (� � 2 ,_4 setpbck 1?pquirem tta iTiust be malMatned �Q L2�0 Z 4 2°. D2.. 6A 3 A, as per applicable code/drdinal im. Attach to complete plans for the system and submit to the County only on paper not less than 8 in x 11 inches i9,size ,33' r � r l�� J 1 / �p lljr 6h1jG(L c �� I II CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: _ a6:2a =2x:641/1, Owner's Address: ° Legal Description: -�/ Township: �� County: .q, Subdivision Name: Lot Number: to Parcel ID Number. 01,1 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing Page 4 System Cross-Section Page 5 Filter Specs Page 6 Maintenance& Management Plan Page 7 Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat i0 Designer/Plumber: / License Number. ,7 Date: Phone Number t Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 r.J 33� i a�sr G��r= Ily t s���l s�,,�G �3m� C�tG s�.�G�,P ' f©� � � ��i°6�J� 4�t5.c S",�%e �,�"- _ r s�is- fit= �7T� = 8��7i�"� '�� �� v,�.�'." 'D G� � 2I c� ��� /� Gd�,�L Soil Moon System Cross Swdon �ft 4°Sd%HXJute 40 Flnal Grade PVC Vent Pipe VM Vent Cap ,[ ft Leaching 2 t Chamber System Elevation Soil Absorption Sysfient Plan View �! ft .3 ft 1 Leading Trend 9 Vent Or Observation Pipe Chambers -� '474A n 5 4 Dia. Trench 2 Header Leaching Charnber Saecifir±affOrm Manufacturer And Model — it 2Uk� s EtSA Rating,sq ft per chamber Soil Application Rate , gpd/eq ft gpd Design Plow . 7 Soil Application Rate EiSA= t4'7 Chambers L rows of chambers each. PMl.owe 01 INSTALLATl+��i tSTRUCTIQNS ZabW PL-525/PL-625 FILTER INSTALLATION INSTRUCTIONS c8raer�er f ' w th opembg i R.S r' .s tt"+.t� � � is'��'�✓h.� - r S Ste p 1: Step 2: Step 3: (A)Locate the outlet of the septic tank. (A)Before installation,place the (A)Glue the filter housing on the (B)Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. if necessary. (s)Make sure that the housing (B)Insert the fitter cartridge In the Is positioned so the fitter can be housing,making sure the filter removed from the tank for cartridge is properly aligned and maintenance and servim completely inserted in the housing. !MAINTENANCE INSTRUCTIONS 1+'Y S 'rte fi�r"�i�r. x r �H.-•-v' �"er r 'r� "rk°i�r`.' v' gg r svg. "�sis• �'.'i.i ;.�j�''r5`}-s�fC�.-'�1•i a _ Step 1: Step 2: Step 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A)Insert the filter cartridge back if necessary. into the the housing maldng sure • NOT USE PLUMBING (B)Pull the fitter out of the housing. the filter is properly sighed REMOVED WHEN FILTER IS and completely inserted. (C)Hose off the filter over the septic tank. -USE RUBBER Make sure all solids Bali back into the (B)Replace septic hank cover .:,..'J4/HE}±i GLEANING FILTER septic fa* POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_of FILE INFORMATION SYSTEM SPECIFICATION Owner - Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer s E o NA Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Model o NA Number of bedrooms ❑NA Pump Tank Capacity al ptNA Number of Commercial Unit NA ­Pump Tank Manufacturer 25 NA Estimated flow(average) al/d4 Pump Manufacturer &NA Design flow(peak), (Estimated x 1.5) e 0 gallday Pump Model 6 NA Soil Application Rate 7 gal/day/ft Pretreated Unit Influent/Effluent Quality Monthly Average* o Sand/Gravel Filter o Peat Filter Fats, Oils & Grease(FOG) <30 ing/L n Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand(BODs) <220 mg/L ❑ Disinfection o Other: Total Suspended Solids(TSS) <150 m Manufacturer Monthly Average" Dispersal Cell(s) Pretreated Effluent Quality ❑ NA i8(In-ground(gravity) ❑In-ground(pressurized) Biochemical Oxygen Demand (BODs) _<30 mg/L ❑ At-grade o Mound Total Suspended Solids(TSS) <30 mg/L ❑ Drip-line ❑Other: Fecal Coliform(geometric mean) <104 cfu/IOOmL Maximum Effluent Particle Size '%inch diameter * Values typical for domestic(non-commercial) wastewater and septic tank effluent. ** Values typical for pretreated wastewater. :MAINTENANCE SCHEDULE Service Event Service Frequency Ins act condition of tank(s) At least once every ❑ months 16 ears (Maximum 3 rs) Pump out contents of tank(s) When combined sludge and scum equals one third('/3)of tank volume Inspect dispersal cells At least once every o months li ear(s) (Maximum 3 yrs.) Clean effluent filter At least once every o months ear(s) Inspect pump, pump controls &alarm At least once every o months o year(s 2 i f NA Flush laterals and pressure test At least once every o months ❑ ear(s) ig NA Other: At least once every ❑ months ❑ ear(s) to NA Other: At least once every ❑ months ❑year(s) t NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber;Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer;Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the 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 surface may 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(%3)or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components,and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shalt be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction,prior to use of the POWTS check treatment tank(s)for the presence of painting products or other chemicals that my impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks(s)removed by y-a septage servicing operator prior to use. Page_of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. i During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the 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 operating the um controls to ' r to assist in manually p g pump power to the effluent pump or contact a Plumber or POWTS Maintainer restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. 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. ABANDONMENT 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 chapter 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 taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil 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 wit, 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. ❑ 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. ❑ The site has not been evaluated to identify a 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. ❑ 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 that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLE4 POWTS MAINTAINER Name Name Phone _ '7 Phone L_ SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name o Phone Phone s _J This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1), (2) &(3),Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK.MAD4 TENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Properly Address ke- ,Q. (Verification requited from Planning&Zoning Department for new construction.) City/State Parcel Identification Number �Q-- LEGAL DESCRIPTION IVA) s,� Property Location su) i/4, _V4,sec._ ,T ;2? N R /,Q W,Town of Subdivision lc Lot rr Certified Survey Map#_ ��,�1 ,Volume_ �Page#�-1 Warranty Deed# 3� �� ,Volume ,Page# Spec house yes L40 Lot lines identifiable C� no SYSTEM MAINTENANCE AND OWNER CERTIFICATION proper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper ;maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pimnper. What you put into the system can affect the fimction of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§Comm.83.52(1)and in Chapter 12-St Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site :,-astewater disposal system is in proper operating condition and/or(2)after inspection and pining(if necessary),the septic tank is less than 1/3 fall of sludge. L`we;the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the stazdar�set forth,herein,as set by the Department of Commerce and the Department of Natmral Resources,State of Wisconsin. Cer'df cation stating that your septic system has been maintained must be completed and retuned to the St Croix County Planning& Zo-ning Department within 30 days of the tutee year expiration date. Ikvm certify that all statements on form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above,by virtue of a irranty deed recorded in Register ofDeeds Office. Number of bedrooms /V�� � �L 0/ NA PLICANT(S) DATE *'*any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department *** ode Rzth this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if t ce is made in the warranty deed. - S ATE BAR OF WISCONSIN FORM 2 - 1998 �i�l�i fff WARRANTY DEED 8 1 7 2 2 8 3 '(x:4141`8U) Document Number !�63 241 This Deed, made bettveen_ — BETH pABST R1CU_AR1L_Q__SS_TQ[JT Anil REGISTER OF DEEDS husband and wife, — ST. CROIX CO,, WI Grantor, 07/30/2013 € 8:44 AN and —GR N C'CiRY T_ _j CERR and_-�IAN.CY.._A_—L.ANGER-► -- E�E�tf�`�"#: �Yi� husband and wife, REC FEE: 30.00 ro �AWS FEE: 135.0U ----- --- - _ Grantee. Grantor, for a vaivabie consideration,conveys and warrants to Grantee the following described real estate to---_St• Croix _ County, State of Wisconsin: Hecorri.ng Anna Located in part of the NW 1 /4 of the SE 1 /4 Name and Return Address and in part of the SW 1 /4 of the NE 1 /4 of Gregory J. Langer Section 31 , T29N, R"18W, Town of Warren, 24 Bridgewater Tr. St. Croix County, Wisconsin; Being part of Hudson, WI 54016 Lot 1 of Certified Survey Map, Volume 25, Page 5889, Doc. No. 967309 ; More fully described as Lot 6, Certified -- --- -- Survey Map filed for record in the Office of the St. Croix County Register of Deeds on 06/25/2013 a s Document #9 81 0 51 1'n Vol ,( , 2(d r Parcel Identification Number(PIN) QI 4 6 9 3 3 , This is not homestead property. P (is) (is not) Exception,; to Warranties: easements, restrictions and rights-of-way of record. Dated this 26th _day of___ July —_, _ 2013 v C '\ (SEAL) (SEAL) Richard O. Stout Janet P. Stout — ------ ------- (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signatures) —_ --- State of Wisconsin, ss. St. Croix County. Personally came before me this 26t] _ day of authenticated this_ day of - July 2 0 13 , the above named Richard 0. Stout and -------------- --- -- — Janet P. Stout ---- - ----— to TITLE: MEMBER STATE BAR OF WISCONSIN —_ _ ----- me known to be the person s who executed the foregoing (If not. authorized by 8706.06, Wis. SCarS.) instrument and acknowledge the same. THIS iNSTRUMFNT WAS DRAFTED BY Janet P. Stout 5, ''�:�'�•, 1353 Awatukee Trail -` Hudson, W1 5401 6 Notary Public, Star of Wisconsin sta My commission is permanent. (If �tr: go eal� 3 u n - �r -100 } 1t4�^-1ix$5-St1-0z6 -050}" 68A VOL 042-1085-60-1 ° Cis 6 042- -o5a 66TH AVC g. .v , s v �.i SRI�QN."Mf�M1f " +. aF {�i19+]µN. }n` .: ��.�k, # � �l .k MM.'�' �RIA M r♦ n r.A 165TH H '969 65TH 973 t k -1 OM20-18 60 w 51 65TH F, .•" In 042-1088-20-035 � g y � � I A h n. 2-1085-, Al t r w a „n m 042-1088-3"80 -080 0 \ !!/ ( §E C ;e0 a® U k § ! ! a \ ■ { ! ) \__ ._ ~ ; 2 ' ! ■ | o g r r . a ! . ! m ( § 2 o aE§k& ® ) k 2 ® / ' ƒ k | ! k . ■ ■ } 2 ' ] ( 7 @ - `2§ $ 0 A ! ! � � � o � � � � (L F- d ❑ d ■ | | | / , � if , <» .& Parcel #: 042-1088-20-030 02/07/2014 03:48 PM PAGE 1 OF 1 Alt. Parcel M 31.29.18.489A-05 042-TOWN OF WARREN Current ❑ ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 03/12/2012 03/12/2012 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner 0-STOUT, RICHARD 0&JANET P RICHARD 0&JANET P STOUT 1353 AWATUKEE TRL HUDSON WI 54016 kropFrty Address(e "=Primary "9 TH AVE Districts: SC=School SP=Special// 65 �C Type Dist# Description SC 2422 SCH D ST CROIX CENTRAL --_-- SP 1700 WITC Notes: NEW FOR 2013;TAKES PT 042-1088-20-030 (489A-10)& PT 042-1088-30-050(490A-05) FOR CSM 25-5840 042-1088-20-035 (489A-10)& REMAINDER 042-1088-30-075 Legal Description: Acres: 32.300 (490A-07) SEC 31 T29N R18W PTS NW SE& NE SE&SW NE; BEING CSM 25-5840 LOT 1 (32.300AC) Parcel History: Date Doc# Vol/Page Type 03/12/2012 952364 25/5840 CSM 02/07/2011 931775 CSM 05/02/2008 873945 QC 02/21/2006 818902 EZ-U more... Plat: *=Primary Tract: (s-T-R 401/41601/4) Block/Condo Bldg: "5840-CSM 25-5840 042/2012 31-29N-18W NE SE LOT 01 5840-CSM 25-5840 042/2012 31-29N-18W SW NE LOT 01 5840-CSM 25-5840 042/2012 31-29N-18W NW SE LOT 01 2013 SUMMARY This parcel will not get taxed. It exists soley Assessed with: for parcel history tracking purposes. Valuations: Last Changed: 08/24/2012 Description Class Acres Land Improve Total State Reason Totals for 2013: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i Wisconsin Department Co SOIL EVAL ftft REPORT Page / of Division of Safety in accordance with Comm 85,Wip' dm. Code crU/r/ County Attach comi�its on paper not less than 8 1/2 x 11 inches in size.Plan �tZ 7 reference point BM coon and Q include but►�htdfmi d to:vertical and horizontal 3 Parcel I.D. po � )�d percent slope,scale or dimensions,north arrow,and location and distancb"pre road. F�(� v�2_1 Q gX—�D3 5 0 b Date VN Re ' Y Please print all information. ry Personsi information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 1 -7/, r Property Owner ``�� � Property Lo ii fr �,� / q Grey L Q/t e,- t>,c / Govt.Lot � 1/4 1/4 S� T ( N R (13 it(or)(N Property r s M 1 ing Add ss Lot Block# Subd.Name o CS10 y /rr e Wafer�/ct; l�l ZS City /1 State Zip Code Phone Number ❑City ❑Village To N (nest Road H[.c�So�t I U) ,-'/O/6 I ( ) I Ltlarren 6stb Cove ❑ New Construction Use:❑ Residential/Number of bedrooms_ Code derived design flow rate ®p GPD ❑Replacement ❑ Public or commercial-Describe: Parent material ©k%� f w4f�7 a%�f' G Flood Plain elevation if applicable A tt• General comments and recommendations: I0 Boring# Boring q pit Ground surface elev. ft. Depth to limiting factor �b in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 I *Eff#2 0-�2 y /OM % ///4 SL l biK M U�r G c.�- !iI? D� `� D,7 2 2 y yQ SV U/ A 5L 9rn f,6k /'her Cc S 1 n) r /,0 3 V- 7l IoYR 6 /� lns of �� � � 1� a. 7°` Y 7/-IV lb 111A h?S Ds9 1Z'1.41 0111, tt • ❑ Boring# E] 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 GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 31Z IVIv SL Jrns�� MVp.- c CAW 2 1 3 Y '2ms /*1 �U- oN �,a 3 7Y6-C /0m /V4 �tS Cis m� 0,74 Gr- 41* o w 6l N4 YnS cis ,me a 7� IV *Effluent#1=BOD >30:5 220 mg/L and TSS>30:5 150 mg/L *Effluent#2=BOD <30 mg/L and TSS<30 mg/L CST Name(P Print) Signature CST Number ✓i a" Q rit P�� ll�-- 2— /Y / Address Date Evaluation Conducted Telephone Number Ai Z- 6� l- 13 /S-L 3Z 03 i Property Ovmer6re7 ct,, el Parcel ID# Page.' 1 of 3 F3-1 Boring# Boring � Pit Ground surface /6 , elev. r ft. Depth to limiting factor / in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 0-// l di,�Z S'� ms61r- MV41- C U-1 r2 of o, -7 2 11--26 Vq I A/ s(- s6jc rh-P" 0,6 /16 3 5-6 10f % IVA MS DS m L- c 1 0, 7- F G�/6g�o 4/s IVA Yes 7e c F 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/fP 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/fP in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Efr#1 *Eff#2 * Effluent#1=BODe>30<220 mglL and TSS>30<150 mglL *Effluent#2=BOD6<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-5330(R.07/00) i A Ar j `4 �k Property Owner&-e L a,, _fir Parcel ID# `!',agei`. of 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/fP in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 1 *011#2 X z S� /mss/c Mv4l- C w //-1 ©,y 0, -7 2 VIt A,�A r-P r C w l m 0,6 , 3 56 0 �;61 IVA Ms DS (n L C - 1-lP- Df 7"E � F `{ G°/68 CD s /yA Ms 7 Y E ❑ 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/fF 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/fF in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 *Effluent#1=BOD,>30:5 220 mg/L and TSS>30<150 mgA_ `Effluent#2=BOD6 a 30 mgA_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 608-2648777. SBD-8330(807/00) 'OWNER Page 3 of 3 Name G��,f ����-�� Brian Parnell Address CST 231314 Date ©O( A Benchmark 1 1�p I,�11POC P;p e o A Benchmark 2 p� 1,v 00 —ell e �d�i- ❑ Soil Boring ;_ i Suitable Area 1" =40' Scale b u G, A e f � I I e I 2 3 s I � ! I D M sis r^ e r 1011 0 b- t • it RECEIVED JUN U 7 1013 Izi1. —il,lxWtilmI Y ZONING OFFICE CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW1/4 OF THE SE1/4, PART OF THE NE1/4 OF THE SE1/4 AND IN PART OF THE SW1/4 OF THE NE1/4 OF SECTION 31 , T29N, R1 8W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN. N1/4 CORNER SECTION 31 OWNER SURVEYOR ROBERT McVEY EDWIN C FLANUM 979 65TH AVENUE NORTHLAND SURVEYING,INC. "d z ROBERTS,WI 54023 P.O.BOX 152 j AMERY,WI 54001 SURVEYOR'S REPORT SCALE IN FEET 1"=250' oI LOT 5 IS PLATTING THE COMBINING OF LOT 2 OF CERTIFIED SURVEY MAP RECORDED IN 250 1 0 250 C I VOL.17,PG.4560 AS DOC,NO.729654 AND THAT PARCEL DESCRIBED IN A DEED \b °z RECORDED IN DOCUMENT NO.XXXXXX BEING PART OF LOT 1 OF CERTIFIED SURVEY MAP RECORDED IN VOL.25,PG.5889 AS DOC.NO.967309,NO ADDITIONAL LOTS/PARCELS \b ARE CREATED BY THIS INSTRUMENT. N _i —w — _ - - - - — — _ _r, ___ 65j, 1( VUE_ EXISTING CENTERLINt_- S89°52'42"E 283.13' '_ _ NORTH LINE OF THE cD 39'± �� �IS89°52'42"E 282.75'-00 �t CN1/2 OF THE SE 1/41 'eici ii I� Q`G� w Fla N p I I I_ Q _j cy __j Lo C4 ---i QP T I Ly cf� 0 I LOT 1_� I LOT2 t SFQ 05 v v Q I N ~O t ---- I 3 ti a M En J I C.S.M. VO .X25,PG,5758_ 9 920 Zg165 ~O m 1 I a N rn a - - - - S89°52'42"E 1 480.00' 1 �° 'o a3'"1 Cs J z SSj09, IJ 240.00' xxE240.00' 3 SHED SHED 0"NIS; TOP OF IRON PIPE ELEVATION=1010.68 `� LOT 2 C.S.M. 0 WELL o I `� ` VOL 17,PG 4560 '.,El, G.....O,: HOUSE 61'+/ �` p CONCRETE ry�N ^OHWM ELEVATION=999.1 \� `� a gyp '` FOUNDATION y p� AS SHOWN ON C.S.M.IN I `� W VOL.17,PG.4560 I b I N o V T \b� LOT 5 w� �\ I POND C� 30.9 ACRES+/-TO MEANDER LINE N 32.8 ACRES+/-TO OHWM �m I N, S89"'+/- W OJ z (INCLUDING R/W) y r` N 16'+/. ! � f ?�335p0 �610'��� M U (ol+ X20'+/- \—X--X--4X—X—X cl) a �'X X 1314.96' m 6.5T M X—o0 M SOUTH LINE OF THE N1/2 OF THE SE1/4 N89°32'56"W 1671.53' UNPLATTED LANDS M I x ' Exemption verified under Section 13.1 B.3.a.3)of the St.Croix County Land °I Division Ordinance and Section 236.45(2)(a)(4)of the Wisconsin Statutes. wl By Date z z o o °C m ZI LEGEND ° ° oo ST.CROIX COUNTY SECTION CORNER 3/4"IRON REBAR FOUND Lu w� S1/4 COR.SEC.31 MONUMENTED AS NOTED cn a ALUMINUM 1"STEEL SURVEY MARKER � W r MONUMENT FOUND 3/4"X 18"IRON REBAR SET WEIGHING FOUND a z w 1.50 LBS.PER LINEAR FOOT v) X X EXISTING FENCELINE z r 1-5/16"O.D.IRON PIPE FOUND Q c THIS INSTRUMENT DRAFTED BY ED FLANUM OHWM ORDINARY HIGH WATER MARK m vi z JOB NO.12-05 DWG,CSM7 DATE 2-7-12 0 1"O.D.IRON PIPE FOUND SHEET 1 OF 2 SHEETS I r t 6999 a2sd SZ ToA S-MHS Z 30 L 133HS 09Z O 09Z ZL-L-Z 31V0 L%NS3'9MO SO-ZL ON BOP Ma WnNVl3 O3 Ail O313VaO 1N3Wna1SNl SIHI Z b m .09Z = :I L 1334 NI 3•IVOS ° s 9 ONn03 3dld NOW"O'0,,L � XatlW a31VM H9IH AaVNIOaO WMHO ONn031N3WnNOW ONnOA 3dld NOW'0"0.9 L/S-L e ti m m / WONI A00 ° 3NI133N33 9NIlSIX3 X X L£'33S Ia03 4/LS 1003 14tl3Nll aid'Sill OS'L `��% ^� � _� ON003 9NIH913M13SaV93aNOal..8LX.6/E _ �, `a0 a3)wvW A3nans 1331s.L O 0310N Stl 031N3WnNOW .o m 461 y�s ONnOJ aV93a NOW JI/E a3Na00 N01103S ALNn00 XIOaO'lS Q CMaDa-1 N ##fees; SOIVtf]0311Y1dNn XS•LL9L M.99.ZE.69N J9,996 X X X X 96'bl£L r_—X- X X \ b/L3S 3H130 Z/1-N 3H1 30 3NIl H1nOS X ce I•y,��cO I ��O�� ` '13"OS 56S•SEE'L - h ;a, (M/a 9NIOnlJX3) to y�� 3NIl 830NV3W Ol S3133V 99-0E Z O I� /+Z£ q\�� 1 y�u► ld'pS 6SZ'SSE,L o �N I 2%N (NW WonlONI) \�\ WMHO Ol-/+S3110V E"ZE q\ cq r 3NIl H30NV3VI 01 S380V L L'LE ; q N u 1 _ 1 \1 ) % N C h I 111 I 0956 Od'Ll lOIA 10 L 10-10-0 h M'W'S"3 NO NMOHS SV m� NOLLVONn03 CO 1 0666=NOILVA313 WMHO �C 31380NOO �O � p \\� -/+L9 ' 3SnOHw° 1 o I�~„ I 09S6'_d PLC '"10/1\3 ��J _ O 99'0 LO -NOLLVA313 113M 1 ♦ I l__ 6gl� O 3dld NOW i0 d01 I 03HS .00'06Z 4O'O4Z x- Nl I� 1 I In I I m h °f o BSLS'°Jd—9,1-70A W'S'O io Ir I j� l v n o zioi I c tol G)cn I� f7l n i i n, I 1 I I I I I ) a o IQ ' In cn b/l3S 3Hl j0 Z/1-N 3H1�0 3M1 H1aONI 1 _ — .09' 69 3.Z4 ZS.fiBS — '6E =r 3NIla31N30 9NI1SIX3 46'569 3.Z4,ZS.69S ° —3/1 j V 14159 I - --- - -- - -- - - - I i area U--r7Ci�J�r� salnlElS ulsuooslM ayI Io(4)(e)(Z)917'9EZ uogoag pue aoueui Jp uolslnl0 �o puel ALunoo xlojo"1S aLIL jo(£'e'E'0 L"EL uoOoeS iepun pal}uaA uolLdw9x3 I� L004S IM'Aa3WV I 1N3Wna1SNl SIHIAB 031V3803aV S130HVd/SlOI 1VN0111OOV 'z ZSL X08"O'd 91-045 IM'NOSOnH ON-113NMOONV-1 9NINIOPOV NV 01133aVd 1VN191a0 3H1 30 m '0NI'9NU3AanS ONVIHIHON lINa133Hnivmv ESEL latld 30 9N1033a 3H1)A313V 031V3a0133aVd 1NVNW3a V SI L 101 • WnNVl3 3 NIM03 InO1S 13NVP ONV OaVH31a HO.KaAans blaNM0 LENO0VA 1a0d3a S�a0A3AanS a3Na00 6/1-N 'NISNOOSIM `A-LNn00 Z =SaE)Vd X10HO '1.9 'N3HkIdM =10 NMOJL 'M8 LEI 'N63-L OWE :333 AdO:) ' LE NOI.L03S d0 V/L3N 3H-L =10 it/LMS aH-L -AO 00"OE �33d 7321 =� 1dW3X3 -LEIVcl NI GN b/L3S BH-L �O /L3N aH1 d0 -Ll:ldd Wd L£=T ZTOZ/ET/TT 't,/Las 3H I =10 V/LMN aH1 =10 -Ladd NI aa1H00-1 (3210:)321 Z10d 03AI30321 _JIWIM JLaJVIJ fIVS QM,A 11UAM�D IM 1'03 XI021:) '-LS S033U 30 213JLSIE)3W -LSgVd H139 60£1-96 981051 BETH PABST REGISTER OF DEEDS ,^' ST. CROIX CO., WI S ,. , , MAP RECEIVED FOR RECORD LOCATED IN PART OF THE NW1/4 OF THE SE1/4 AND IN PAR 06/25/2013 10:27 AM OF THE SW1/4 OF THE NE1/4 OF SECTION 31, T29N, R18W, EXEMPT #: TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN; REIN REC FEE: 30.00 PART OF LOT 1 OF CERTIFIED SURVEY MAP, VOLUME 25, COPY FEE: 3.00 PAGE 5889, DOC. NO. 967309. PAGES: 2 SURVEYOR OWNER EDWIN C FLANUM RICHARD AND JANET STOUT SCALE IN FEET 1" = 100' NORTHLAND SURVEYING,INC. 1353 AWATUKEE TRAIL P.O.BOX 152 HUDSON,W154016 100 O 100 AMERY,VNI 54001 UNPLATTED LANDS S89052121 312.81' 65TH AVENUE EXISTING CENTERLINE °' – —- — ---�-- � a o o EAST-WEST 1/4 LINE " c; S89°52'42"E 312.75' m RIGHT-OF-WAY A si � tD pi O N1,4 CORNER N SECTION 31 cc w; o LOT 6 0 N (� E:' 2.28 ACRES INC.R/W c 99,485 SQ.FT. cg u C/) w o 2.05 ACRES EXC.R/W W � 4 U; p 89,163 SQ-FT. m Z r Q n s N. o 0 h--; N• z w c�i x n C) ��� W r J: `t 5 LLo v c D 0 0 236 ¢z N Cr 6y Q = w �63o3g2p� a co 0 z LOT 1 — G.S.M. VOL. 25, PG,. 5889 w LEGEND 0 Iwo a ALUMINUM COUNTY SECTION / I w •► CORNER MONUMENT FOUND . ""���� i/ Q S 114 CORNER 1"STEEL SURVEY MARKER FOUND �",� r SECTION 31 r� tSU a�`��i Jt a f (/ 1"O.D.IRON PIPE FOUND (his Ceftified Survey Map is platting a remnant parcel after a portion of Lot 1 of 0 3/4"IRON REBAR FOUND Certified Survey Map fecorded in Volurne 25, Page 5889 was deeded to an 11 3/4"X 18'IRON REBAR SET WEIGHING adjoining landowner. No additional Lots have been created by this instrument. 1.50 LBS.PER LINEAR FOOT Exemption verified under Section 13.1 B. 3. a.3) of the St. Croix County Land Division Ordinance and Seeticn 236.45 (2) (a) (4) of the Wisconsin Statutes. Date THIS iIJSTRuN1ENT DRAFTED BY EDWIN FLANUM SHEET 1 OF 2 SHEETS JOB NO 13-33 DATE 6120/1"3 1 of 2 Vol 25 PaSe 5933