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018-1098-30-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division 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 Koo man, David P. Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: ~ ~ G~ T dO TANK INFORMATION n iYPE MANUFACTURER ~ /tit t CAPACITY Septic Jr ~,i. 3 lr G.~ t1 `~.t, { Dosing ~ ~ M W F ~" end- (~ F /O Holding TANK SETBACK INFORMATION_• .I_L.~t'~ TANK TO ~P~~ WELL B~ t °'7 Vent to Air Intake ROAD Septic 23 .IJ~ N f~ y5 y'S Dosing Li 3 ~ ~ / ^ / ~` / t15 ~ 1 Aeration ~ /$6 ~UGj Holding PUMP/SIPHON INFORMATION ,c.1! Manufacturer ~ , ~ ~ f ~ ~ .,,~.d'- Demand GPM Model Number ~~~ L fa, 3 TDH Lift Frictio ~/ os Z System Head ~ TDI~ ~ F Forcemain Length i~ Dia. ~~ Dist. to Well , q SOIL ABSORPTION SYSTEM BED/TRENCH Width Length DIMENSIONS ~ ~~ SETBACK SYSTEM TO P INFORMATION _ ,,, ,, ELEVATION DATA County: St. Ct'OiX Sanitary Permit No: 514992 0 State Plan ID No: Parcel Tax No: 018-1098-30-000 Section/Town/Range/Map No: 30.29.17.837 STATION BS HI ~Q~ • FS ELEV. Q~ Benchmark ~ I ~ /~' ~ ln) l / KJ Alt. BM / ., GCJ ~~ ~ ~ •~ C /~ ~ / Bldg. Sewer ,y T ~ ~~ ~. SUHt Inlet $ ~~ 9 3 Z SUHt Outlet Dt Inlet ` ~,,, Dt Bottom IZ-7 ~ - Header/Man. .yy Gam' ~ Z Dist. Pipe Z•Z ~. Bot. System ~ • q J y 7 • Final Grade ~ ~ Z ~~ Z St Cover f I ~ J ~ Fiv~- ~ 3 ~ ~l ~ • No. Of renc s PIT DIMENSIONS ~~ / BLDG WELL LAKE/STREAM 3 a ~6, ~ ~ ~~' ~ ~r- o. Of Pits Inside Dia. Liquid ~` t LEACHING Manufacturer: _~ CHAMBER OR UNIT Model Number: ~_ DISTRIBUTION SYSTEM CHIC. I '~_',_~.,1 Header/Manifold / / Length_~ Dia Z- Distribution / L Pipe(s) ~j Length ~ / Dia Z Spacing~_ x Hole Size ~{ 3 ~ ~ x Hole Spading ~ Ve to Air Intake J SOIL COVER r Pressure Systems Only xx Mound Or At-Grade Systems Onlv I ~~ ~ Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ' ~ Bed/Trench Edges Topsoil I ~~ Yes ~ No ~l'es ~ No 1~.~ /. / Q /~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~G 1~1 b~ Inspection #2: I J Location: 1529 73rd Ave. am ond, WI 54015 (NW 1/4 SW 1/4 30 T29N R17W) Emerald Acres Lot 30 Parse o: 30.29.17.837 1.) Alt BM Description = ~ . M~ S ~' ~~~ 2.) Bldg sewer length = ~~ e}~ f ~~~ - amount of cover = ~ `„ O ~,~ D Y\ rj' d,r~ ~- ~ a~S_ ~ Flo ~ ~. d-~ ~~- c Plan revision Required ^ Yes No ~f -/~ ' _+"~_ ~~; I_- - - _ _ _ _ - - - - ---- --II ~ - --~^ Use other side for additional mformation. ,______~__-.;.___i ~____ ~ ~~~__~ Date Insepct s Signatu Cert. No. SBD-6710 (R.3/97) ,yyl,gpy Safety and Buildings Division County ~~ ~) t_ l 201 W. Washington Ave., P.O. Box 7162 ~ 1 ~ /~O ~ ~ ~ Madison, WI 53 7 07-7 1 62 Sanitary Permit Number (to be filled in by Co.) ~ VV ~~ r/~men~t Sanitary Permit Application State Transaction Number ~ ~ ~~a~ In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to tite appropriate governor unit is required prior to obtaining a sanitary permit. Note: Application forms fors are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may used for secondary 5 ~~ ~~~~ , jl _ ' /Jj~2- . 1 m ,Stets. ses in accordance with the Privet Law, s. 1 / ~ I. A lication Information -Please Print All Information Property Owner's Natite ~~ ~ ~lvrQ ~~~ Parcel # 0~~- /09~'~3U-0~ Property s ing reaa SEP ~ -~ `~ ~ - p"°''°eey `.°°°°°° ' 0 3 ~ r G~~~t ~ ~ Zip Phon631 Sxtion /~ y. ~'b City, State / JJ ~~~,Z.7 ZONING OFFICE , , /(Aeon t a l ) k il th h l Lot # pp y a a ec diag (c II. Type of Bui ~ ~ ~ Subdivision Name or 2 Family Dwelling - Number of Bedrooms - C.4-l~tl ~, (/h-- Block # ^ Public/Commercial -Describe Use ~~ ^ City of CSM N~ber ^ Village of ^ State Owned -Describe Use wn of ~. III. Type o erlnit: (Check only one box on line A. Complete line B if applicable) A' System ^ Replacement System ^ Treatment/Holding Tank Replacement Only ^ Other Modification to Existing System (explain) B. ^ Chan e o List Previous Permit Number and Date Issued ^ Permit Renewal ^ Permit Revision g f Plumber ^ Permit Transfer to New Before Expiration Own f / / IV. ~~! T e of POWTS S stemlCom onent/Device: Check all that a l ^ Non-Pressurized In-Ground ^ Pressurized In-Ground ^ At-Grade Mound > 24 in. of suitable soil ^ Mound < 24 is of suitable soil ~2 ~~SGj/h l.~ ^ Holding Tank ^ Other Dispersal Component (explain) ^ Pretreatment Device (explain) V. Dis sal/Treatment Ares Information: Design Flow (gpd) Design Soil Appli 'on Rate(gpdsf) Dispersal Area R 'red (sf) Dispe ~Arra Pro red (sf) Systgm~ levatio~ ~ 0 ~ 7 1 ~ ~ ~J`~1 lira o. ~ d.G, i/z5 .J 7 ~ ~i . VI. Tank Info ~ Capacity in llons G Total Gallons # of Units Manufacturer a ~ New Tanks Existing Tanks aL', Fin ~ ~~ w' O a Septic or Holding Tank G Dosing Chamber G -. ~ ~'1 VII. Responsibility Statem - I, the undersigned, assam nsibility for installstlon of the POWTS shown on the attached plsoa. Plum Name (Print) Pltunber' store MP/Iv1YRS Number Business Phone N ~r / J~ 7~,r-off ~ /-~~C Plumber's Address (Street, City, State, Zip Code a ~ ~ ~ l ~ VIII. nun /De artment Use Onl Pemtit Fee Date Issued Issuing Agent igna Approved ^ Disapproved ~] /~ $ ~ ~ ~/ /' ~ ~ ~ ^ Owner Given Reason for Denial `~ v ~ D ~ " ~ IX. Conditions of Approvalllteea~ns for Dfsapprovat ~ ~3 ( 7~~~ ~(~ / YSTEM OWNER: r- J 1 Septic tank, effluent filter and ~ ~ S ~q/ ~r~LI lJ ~ S~t~~~ir.~ ~ ~ >'t~ ~ ' dispersal cell must all be serviced /maintained ~/ as per management plan provided by plumber. ~.p~~~~~ ~ (it ~GuC~- ~ • rem and submit to the County only on paper not kac the : I l lathes io size as per applicable co a ordinances. SBD-6398 (R. 01/07) Valid they 01/09 PLOT PLAN PROJECT David Kaovman ADDRESS 15i 8 73rd Ave Roberts Wi 54023 NW 1/4 SW 1/4S 30 /T 29 N/R 17 W TOWN Hammond COUNTY ST.CROIX SYSTEM ELEVATION 97.7' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter BEST GF10- 8 ^ BOREHOLE O WELL * H. R. P. Same as Benchmark 73rd Ave 2.5 Acre Lot Scale = 1 /4" =10' Pro 3 Bedroom House Grading is to be done to divert run-off /away from system Tank is to be properly bedded and provided with lockdown covers with approved warning labels Huffcutt Combo Tank ~o- 97' B.M.* 96'7' Well is to meet all setbacks found in 96' Comm. 83 v1 5% Slope ~ - `Q° Area 15' below 486' Property Line system is to remain undisturbed `~`,~~/ commerce.wi.gov isconsin Department of Commerce Safety and Buildings 3824 N CREEKSIDE LA HOLMEN WI 54636 TDD #: (608) 264-8777 www. commerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Jack L. Fischer, A.I.A., Secretary September 17, 2008 CUST ID No. 226900 SHAUN R BIRD BIRD PLUMBING INC 1008 192 ND AVE NEW RICHMOND WI ATTN.• POYVTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/17/2010 SITE: David Kooyman 73an Street Town of Hammond St Croix County Lot: 30, Subdivision: Emerald Acres Identification Numbers Transaction ID No. 1588218 Site ID No. 742481 Please refer to both identification numbers, above, in all corres ondence with the a enc . FOR: Description: Mound /Three Bedroom /Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1200685 Maintenance required; 450 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual- Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/Ol); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to ~cupancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the • The minimum distal pressure at the end ofthe distribution lateral is to meet three feet. This amount of pressure ill supply a discharge of 0.72 gallons per minute through the 3/16 inch orifice • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and' dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c Col7~? I ~ ~~ Rt'~IEN1 OF ~;~~ SEE CORRI • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SHAUN R BIRD Page 2 9/17/2008 • Inspection of the POWTS installation is required. Arrangements for inspection shall bemade with the designated county official in accordance with the provisions ofSec. 145.20(2)(d), Wis. Stat • Comm 83.22('n A cogYof the ap roved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~~~ ~ ~;.~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charles.bratz@wisconsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 9/11 /08 Owner: David Kooyman Location:NW1/4 SW1/4 S 30 T29 N,R17W Lot 30 73rd Ave Hammond System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01 /31) Pressure Distribution Manual Version 2.0 (01 /31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maint 9-12. Soil Shaun Birc Signature License ni RECEIVED S~? 1 5 2008 SAFETY ~ BUILDINGS '~rrlty ~~/ED c0~-~ce 9"0 -NCs 'ONDENC PLOT PLAN PROJECT David Koovman ADDRESS 1518 73rd Ave Roberts Wi 54023 NW lia SW iias 30 ~T 29 NCR 17 w TOwN Hammond couNTY ST.CROIX SYSTEM ELEVATION 97.7' CONVENTIONAL AT-GRADE BEDROOM 3 CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter BEST GF10-8 ^ BOREHOLE O WELL * H. R. P. Same as Benchmark 73rd Ave 2.5 Acre Lot Scale = 1 /4" =10' Pro 3 Bedroom House Grading is to be done to divert run-off away from system Tank is to be properly bedded and provided with lockdown covers with approved warning labels Huffcutt Combo Tank B-1 ~ B-3 .A 486' Property Line B-2 _ 97' B.M.* 96'7' Well is to meet all setbacks found in ' 96' Comm. 83 5% Slope Area 15' below system is to remain undisturbed . ...,-- ~» . _ ;fit ...~ go :~, Dote w 4" Observattoa Pige Perorated Btla~r Filter Fabric ~[ C 33 Sond "Topsoil . 1t I4oa=Woven Filter FBbzi.C • ~Disttinut'son. Pipe ., K.~ o __a:~-r f i is ... _ D _ ~~ r ~ Sups . J 5ee~ ai ~~ 2 %Z ! Farec f~o~ Drain Rack From Pveetp . i Grass Section 0! A 1~oand -Srstera Lisilt4 A 8e 6 Far Tl~e Absor teen .Arta R ~ Ft_ ~ r~ ~ ~~ ~,n ~ ~ s_ . ~, - Ft_ < ,• .3 °' A a W «~ c w . ~ O i -f: -0' ~~ . - Q"Qbs+ervoian P=pe-~ t . e ;~.~., ~"'~~ j ~,. • QIS~TIt33t~iQf! ~~~ ~~ ~ "•' Z = Pipe - Di-~ir~ RocK 4 t~bi:cvo 'so'n PiQe ~~~a Pe~tr~c~ee; i~Iori~tr Ptah Yiex ~t.~lounti tSs a Rid •fQr Tit j~~sprpssvn Acso ~ . .. ~/. ~,~ '~ = a ~.`Pi~rre ~ - 1_~xsc ~, .+ .e~ ti O ~y.. . ~ ~ -mil--~=- ~ ~~ ~~. ~~~~~ K ..'^' i -~ Farce, tao;n Ftclrrs PvmP ~- F~-Gtr,~~'....-.' i ~, ~. . . ._ ~ ~ Eo~r ~~ ~, ~~~ . ~~ ~ ~~~~ - ~. i .~ 1 Ft. ~/~ w L3 Cet3Se Nei": ~ ..-•.~.::. ~nifo~e - ~_ I~fres tyre : ,.,.......~._._._.:._._., Force !lain . " ~= ~ ~~ des ____... I~ ~ of hQ~eS/~Ae ~ ,. . Invert ~ev$tian o~ laterals, ::,,:: ~ ft. "- - / ~ 2. r ~ ~• - ~ ~ .. ~~ ' ~ • g 6RA1)E ~ ~ ~L~~i'. _ ~ _~ 81~~ ZZ6~t . S~T~ . ... ..~F~~-T~.'R • ....--~--- z ~ ~~+ ~Y~ .: .~- 5f3IL . ~~~ i,T€~ ~~T . _ ~: . . ;. ~ s~ ~ .. i s ("s~~ • a ~~ • • ~ y ~ . ~ 8 ~ : ' . '~'" . ~ C. ~ z "~-~ . .~ ~l~A~i~~.~~ ~ 1i! F1~Dt~~- ~: f ~~ Y a,R„~..+.~i~ ifZ~ ~S ~' i ~~ • 9~L ~_ UI~3E'~ ~ ... P~1 ~' ~ APi'RpttF~' BE3?t-T~I~6 .. r j~ .. CC~E 1 ~r R~+ i ~~~~ iFlYeZr'~~~ 1.C,. ~ ~E ;ii4£~3lfE• ~liE'~~I~' ~~~ ~., .i.. ~L-- .. X gg DES : '3~;Ck a~~p~~ 61~L' ~ ~ ;;5 ~G~EiFS , a b ~ X11 .....~-- x~~ ~ '~ ~tZIO6 w~ P£~ _~ t3 ~~ ~~P~ - ~ ALi~H ~ PIPS - w FEET g1rRE~3 Dt~ - ~~ ~ ' ~;gtlt~~T` - - ~'%~'~~ FEE? y YFIIZ~p~''LY pR~SURE - ~ }-g;~TI~ ~ ~f~ _j,~,~-FEET.. ~ i ~~ . 6 : vz~ .._.. { ~ s ~ ~ u7~'fr'JP ONDENCE ~~~ ~ ~ ~f~~~a------- . Y TT~nsr c mgr ~~pp ~: ~ ••-~}A'~'~= .J- r ti ~ ~~8` • ~ LaserJst 3100; 1~ 71b ~ ~~~ eacy-o-va ~.:~--,., . ~y~ ~.~ Sent By. ~ ~ - ~` ~ ~ ~ ~' ,,,,~''' ~ ~ ~ .,....E ...~ _.~~ EH 5~RlE~a SUMP/~F`F'~-~E~'~" PUMPf 9 tirs ~ ~ ~ e~sc ~ ~^~ r +e ~ ~ w rib ~ ~ A~i yi7.5etiea ~,yp ggQgge Bl~ESt aRi t!S 8N !3Q 100D AI & ~ Ct ~ 72 sa tiAi s 7e sr s ~,st:ss- ~ ~ ifs 21e aN e5 100D ~r k ~' „ Sp riA ~ ri as sn&=w i~ ~- iAi 11S 8M 1i,0 ~ ~ ~ ~ ~ ~ lttsl:tle 5® . J ~ Pavva Cocd Mochtniort Sbatl Seal - N~ rviRb carbon and . . ~ oanseic faces ~ . F Snentesc SaeeE• __ _ ...._. ~ ., Shy Sn~nias Smd __Y Uppac ~a er+d i.o~w~er Ba[t 8 ~~ ~~' ~,...~~rr~atu-~ Mere E~ i~ roim 9vb0eS-o~Aai c,,aw- txta~ana~E p~,ryp p~ ~ntv£ usv spa QowTS awNER's ~u~- ~ Mpt~AGENf ~~ ~ xs ~.nese soe~ tom} {Bo 9oeds ~~ ~~ ~ p~de sme . ~~~K/-rEt~ ~~ serria Ceti ittSpeCt ~'~' °f banic~s) PucnP opt c~ocsCecsts of fsrsfgs) Inspect eeft{s Cze~ast meant ftl~et ~F:,, fain a ei~ ! Flustc latesam acid feet -----""-"' wSeptlcTamsicL IIl~iA g~y~ . TatfK ~ D N~ r~' ~ G ~ n ~ ~ i~ ~lA ' puntp•Tarflc tom' ~ n NA PAP Tf~nk ~~ ~ NA va ~ .~.r---- ~ t~ ~JE~ ~ ~~ .r ~~~ i ~ ~~~ .PismP Q ~ ~Q f 9~ ~ , ~,~,~ravsr~- o - f3 ~~ n Witlee~d S3Q sf~gli. ri2U sslgiL U ~ G ~ n sec: .s3om~ Qj ~ seo ~- p e o - S•ff3` ~,s/~OOrnI - va~s~doee+esdG~°'mOe~'""i°""'""•na ~ ~~~ ~ vesa"s.a . .. setvts;e FisiQs~ .3 D rrsont3es s) Effigy 3 yrsj HL least prlCe eve~Y ottd^~ ~ ~ f~Ak Yoftess:e When aocr+bined yfudge acid sccsm m4~ s) ~f~ss~drnum 3 ~~ . . rnocslhs AilesstotfCa ~+ecY ~ © s ~ At feast once e~Y ' f3 ~ D ts>ot~ ~ ©l~iP- at feet enc. enrary 3 D nw~1e s) Q NA A-t feast ocsoe every O moesn'~ n years? 4 NA At test once every Q sreosst~ n yeasts) t3 NA Ai least ance eves3l -- or ~eW~CE S+l ~ ~ sew fas~ made lyy a~ oc o? ttse taietiQe} ~ ideeri!!y sa~Y beta uP SeMdr~il T ~ ~ ttee vo~~ed s ~ eaten ~ ~ ~ t~ateiarmss. idees~Y aslY ~ or cfispers~ as1Ks) std ~ sttt~~ Urfa of ,-«~ observa~ss P~ a~ ~ asst ~'~rec~ir+es t3se Ycnrstidf~s sso' oaf tt~e Ioc~f ~e e s i ' or mas ~.lt+e tafric ~ ~ctxa~d :~ ~ e snd seucsz to ~Y tank ~~ ° ~ of h s ~ t~. lriaot ~ ~~a~~ n,afts; and any 313 ~ Af~n~ CO'd~ car P01At~"5 oofn~• P bYn~ P ~ °f ~ ~ ~ ot.~2 mantes oc ~ silau be ~ ~ o~any sdr~.. o~er,r ~ ~ ~ ~ ~~~ shy ~iri 'i0 days srART t!P /tAtO ppERATU?~t ~# ~k(S} ~t f e Fot c~ croon. ' m sfse of the POW~'S ctlac~c.tre~ ns au~e ctsemics3ls fiat nsaY lYSSloeds !hs ~ S erfdJor d~ ~ LD t~ ~ haYE ~ of the tas>x(s} rema~+ed lay s seP~9 . . /~ i p~2~?/ '' Strati not Gicxut wAeti sod conditions are frozen at the "rn~it,c-ative sut"Faoe_ 'sbR up ~ above aortnal titghwaLer ~re~. 1tlfhen pon~c is n~t~ed tfte outaQas t~+P tarnks mwy the cep fs) and maY in. ute ' t r oeii(s} in one large dose, avetfo~9 - ,~Yirli tae ~ m ~ ~avoki ~ si(tra4ioc'~ henna the +col~nLs of the pcimP leak ranio+re~d try a bacioup a+o~d°O °~~ Ppwet' fie the efiuoM pump or coct~ $ t or POWTS Matra~tner Zo .~~ ~ tt~iefe [lofTTtat revels within fhe pump . . ~ mancra~y opar'a6r~ ~ ~~ _ ~. Do rfat dove ~ park o~erj ~r i~t d'ts~irb to taonnp~t, Do trot diiYe or park v~ehides otr~ ~ d e soil abscicp~on area ~ arm '[5 fleet down sbpe of any tnourtd of ttte ~ lirnm the wastewater sireatn may imptt~ve tfle petfiorrnaaoe ~ g the 6Ft Redttt~iact ar-~ ~~ btlits; condoms; saotb~n swabs; degrl: dallier tk~ ~ the POW[S4 ~~/- v,rater; fruit and vegetable peed S% Sre~' ~ ~ ror~ ~ wry "aptd'is' tampons: •and water sol~ettei' die. ~~ fairs sndlor is p~Y-~~ out of service trie fnlta~tng sflePs si'+atf ~ tin ~a fisut~e that the yS prpperfy salary abandoned in aompIiance with ch_ Comm 83.83, VYcsoortsin Adtit~rsistra8~ C•~ ~ ffi !attics and pits std ~be dtsconneded and the abandoned pipe ope~tings Sea~ed- r All lx>~s shoo be removed and property disposed ~ by a Septage •Setvis~rtg ~~ • . 'n+e mntien~ trf art ~ auk ~ ~ be e)acavafed 8~id t+emoved or ft'-ett covers rersso~'~~ the word spade • After purrsp~g, ~! tanks and p~ ftt[ed wait sort $tav+e! or arty' inert sof}d tnateriaL . CD2~7~NtsENL Y Pl.EIN ltse tialtowing measures have been, or must be faiCet>;~ ffi ptm+iciB a cods If the POW'r5 fasts and r,~nnot ~ complrarrt r+~ O A suCabie ~~~~ it2ts ts~ti evaluated and may tae crh~ized for the t arrd ~ ~ shontd rat awn SY~- The mptacetnent area should be protected from drsturbance setl~ fr+otrr existing and proposed strcrdure. tot Frees and virr3Ks. Failure no be infringed upon by requ~ m establish a sctt<able proved the t+epta~ent at~ea vet riesuit in the need for a new soft acrd site°evatuaf7caa~ r~ a~_ ~p~menL syster*-s must comply writh the rules in effied at that fsne_ large is not ava7abte~due tp setback andlsx soft rrrnitaEiflrts_ Sarrir-9 advances in PQWY'S D A sutbable ~P~ as a Last resort to replace the fat7ed POINTS. ' technotogY a t~tg tank n~Y ~ ~~ larlute of ~e POVYi'S a soa.and e site teas trot bee+rr, e~aiuabsd to identify a suitable reptaaernecit area. Upon erase is anraitat~le a- Stte ev8tctatiOn mast t7B pe ffi locate a suitable replacement area ff no rept~*+~ tank may tie &~ttOd as a last resort to r~epiaoe the failed POuY {'S_ rtrrriovat of the biornat at Mound and s;-grade soli a s'~Y be rieconsiruc~ed in place fiot(o~rinS one of such systems must comply wtih the rotes in elfe~t at trial: ttrrte. #fre irt3RLraflsne - Rec~on <cWARNtNG» TANKS &tAY CONTAM LETHAL C3ASSES pNgIOR WSt1FFiCtE]VT OXY~,t?~t. SEP7'tC, PUtilIP ANt? OTHER TRFAT'jia[ENT ANGES- C3EATH tiAAY DO BLOT H~(TER A SF.P'tIC. t?iJlfl[P QR Q7~ti=R'i7~FJ4TMEAIT TAN[C UNDER TINY GEC t2ESULY _ RESC[JE OF A p~SON FROM THE tNTEWOR OF A TANK MAY SE B[FFiCidLT OR tiRP.OSSiBLtr- ~4DDii70NN_ t50NC111[ENTS _ . POwt's sivsTni.;.eR rYarrte ~x, u •/ r~ Phone ~ S" " ~/~ pOW!'S MAIATTAiNER Namz ez.ee ,~,/ Ptlone ~ --' .i 1 SEPTAGE SF~ttiliCtNCs QPERATt?R LOCAL FZEGtlLATt}RY Ai7TNORt[V . Agency ~ . G J` 8LG/! Etiame ~ rtti ~ C phone ~ -- 8 Phone ~ - 'J l a v meets and Waushars Comb ?~ and S~~atioa '~' This . 7lus was 6tal6od hYtlre starts of the t~san Wct, ~ e Gods th's of tl+ic doasnrsnt does tgt me mitdtnma ~ of ck C.orrsa ~(bxlX and 83-`~(1). CZ) ~ CS?. w+S~~n •46c=sU>~Y gMyy tyDtl gvaraniee the ifPJfoatt3ceoe of tl+e i~5. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OwnerBuye Mailing Address . Property Address SI $ 73r L+J ~ JY"v d- S ~ 3~ - - (Verificationrequired from Planning & Zoning Departrnent for new construction.) f ~ i ~ , 3a ~~ City/State I`Z~/ri~m,cTn.c~ . (/~/~ Parcel Identification Number a ~ ~ ~' y LEGAL DESCRIPTION ` g3~ Property Location u~ 1/4 ,5W '/4 ,Sec. ~ ~ , T ~~ N R~W, Town of ~4',~ N~ Subdivision ,~ ~-~~ ,Lot # ~~ Certified Survey Map # ,Volume ,Page # Warranty Deed # ~ ~ ~ ~ -( ~ ,Volume _ "-- ,Page # '- Spec house yes ~ Lot lines identifiabl yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION '.Improper 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 pumper. What you put into the system can affect the function 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 wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than: i/3 full of sludge. Uwe, the undersigned have zead the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expira#ion date. Uwe certify that all statements on this 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 warranty deed recorded in Register of Deeds Office. Number of bedrooms SIGNA'~URE Q~JAPPLICANT(S) "~' - ~j f~ ~D ~' DATE ***Any information that is misrepresented may result in the~sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/OS) OWNERSHIP CERTIFICATION FORM wlsconsinpepartmantotcommeroe SOIL EVALUATION REPORT Psge of ..,.,~......,,. ~.__, _--- __---- v- in accordance with Comm 85. Wis. Adm. Gods Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must utdude, 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. Reviewed by Dam Please pr/nt all information. PerspW iMoma6on.Ya+ provide may tie used for secondary P~D~ (~~Y l.aw, s. 15.Ot (1) U+U1• y Owner Properly Location t Y~ Govt. Lot /4 s~4 S (~T ~ N R E pyoperiy Owners Matting Address Lot # Block # Subd. Name or CSM# ~ ~ 3 ~ -3 -' n` -r ~, 'code p city viua9e 7 .- /fi o a! '~ ( New construction Use: esidential / Number of bedrooms ~ Code derived design flow rate '~~'~-~ GPD ^ Replacement ~ Public or oornrneraal -Describe' - ~~ f~ ~ Parent fnatefial ~ Flood Plain elevation if applicable General oonYnents and r~acam~endationa: ''''~] ! ~~ Type ~,~~~ ~ System Elevation ~~+ ! Pit Ground surface elev. ~/ R Depth 1b limiting factor S ~. ~ Rate Fbriaort Depth Dominant Redox Description TexAlre Stnx~ure Consistence Boundary Roots PD/fF •Eff#1 •Eff#2 in. Munsel Qu. Sz. Core. Color Gr. Sz. Sh. / Pit Ground atrface slev ~/ ~ R. Depth to limiting fador ~ in. ~ ication Rate D # ~.. fiorizort .Depth Dominant Redox Desaiption Texture Stnxxure Consistence Boundary Roots GPDMF in. Munseti Qu. Sz. Cont Color Gr. Sz. Sh. 'Etf#1 'Eff#2 d ~1 U . 3 ----- 2 -z .s ~ ~ • Efikrertt #1= BOD > 3 0 <_ 220 mglL and 75S >30 <_ 1 50 mglL ' Etruent #2 : 80D <_ 30 mglL and TSS < 30 mgll C5T Nettle ( PriW cST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 9-~~ ~~ 715-246-4516 z Y ~~ Percel iD # ^ S.~ eorir~ # Pit Ground surEaos ~. ft.. D~ to --~~--'". a ~. Flo~on ~~ po~~ Redox Desalptloa Texture StrucEure Cor>satenoe Bound in. Munse~ Qu. Sz Cont. Color Gr. Sz Sh. ~ ~ •Etf#1 'Eff#2 /~ ` Z L- r .` _ ~_y x S ,- Boring # ^ ~~ Ground surface elev. R Depth to fsniting favor i^• ^ Pit Redox pesglpSioa Texturo Stnx~ure Cors~stence Boundary R°0ts Flaapn Depth Dominarrt in. Murs~ L1u. Sz Cont. Cobr Gr. Sz Sh. a ~~ # a P Ground sur face elev: _.__,__ R. Depth b Cx~9 ~~ I^' Horlxon ~ Dot Redox pespiptlon- Texttae Strucdae Cor~tenoe Bounds-Y Roots ;~, MunseA Qu. Sz Cont. Cobr Gr. Sz Sh. ~ : Bpp < 30 nglL and TSS _< 30 mplL • EftNiern #1 = BODs > 30 < 220 mDll. and TSS >30 < 1S0 rrlglL EfMient ,. •E1f#2 The Department of Commerce is an equal opportunity service provider and emptoyer. If you need assistance to access servrces or need material in an alternate format, Please contact the department at 608-266-3151 or TTY 608.264-8777. ssn.wotR.aoo> . r i Soil Test Plot Pl Project Name David Kooyman Address 1518 73rd Ave Roberts Wi 54023 Lot 30 Subdivision Emerald Acres N W 1/4 S W 1/4S 30 'r 29 N/R 17 W [) Boring ~ Well PL Property Line BM or VRP Assume Elevation 100 ft. ~T'M #226900 Date 9~1 ~ /08 Township Hammond County ST. CROIX Top of 2" pipe System Elevation 97.7 *HRPSame as Benchmark 73rd Ave Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of Division of Safety and Buildings m accordance wnn t,vmm oo, vvis. r+am. t.uue County ~ Z n ~ I J Attach complete site plan on paper not less than 81/2 x 11 inches in size Plan must J~ . indude, but not limited to: vertical and horizontal reference point (BM), direction and ' Parcel I.D. ©/ r) ~/ ~ ~ _UQ percent slope, scale or dimensions, north an ow, and location and distance to nearest road. 4 Please print all information. Re ' ate D Personal information you provide may be used for secondary es ( acy , s. (1) (m)). ~ ~J / Z a Properly Owner ~ /~ ~ ,-C' perty Location } t 1 /4 ~L~i1'~4 S L~T 2 N R E( ) W Prope Owner's Mailing A~dd~ ss ~ C E'v ~ Block # Subd. Name or CSM# !! ~ ~ /h . ,~ City State Zip Code Ph a Nu r ~ City ~ yllage o Near st dad NewConstrurdion Use: esidential I Num er of bed I IX UNTY Cod derived design flow rate "Y..S7~ GPD E ^ Replacement ~ Public or commeraal - Descn ________ __ _ _______ ___ Parent material Flood Plain elevation if applicable ~~~~ ft. General oorrxnerns and recornnrendations: /~ ~ System Type ~~C~~C h~C.L~ System Elevation ~i ~~ # ~ Boring pit Ground surface elev. ~~ / ft. Depth to limiting factor ~ '~ in. Soii ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 o- / ~ _ 3 z l---... .n rn ~.~-~ - 3 sy ,- S --~- ~ ~ ~ o~/ .v dif. .v - Boring # BO^~ pit Ground surface elev. 7~ / ft. Depth to limiting factor ~ ~ in. Soil licatron Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dfff in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. •Eff#1 •Eff#2 °~ / C'1 ~ ~ I~'~ ~ .v /~ a!r' 'Effluent #1 = BOD > 30 < 220 rrglL and TSS >30 < 150 mglL 'Effluent #Z = BOD < 30 mg/L and T55 < 30 mglL CST barns (Please Print) Signatur CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~ ~~ ~~ 715-246-4516 Property Owner _ ® ~~ # ^ Boring Parcel ID # Page of ,S'~ ~• pit c~rouno surface elev. ft. Depth to IimiUng factor ~n• Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 2 L- rj ,~, .~ /~~ ~ l ~ ~ 3 ~-y ~ b C z s ,- - ~,~ ~i i~ ~, ,v, Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to IimiGng factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftt 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 ication Rate Horizon 'lepth Dominant Cdor Redox Description. Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eti#2 `Effluent #1 = BODS > 30 < 220 nx,1/L and TSS >30 < 150 mglL 'Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL 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 (8.6/00) Soil Test Plot Project Name David Kooyman Address 1518 73rd Ave Roberts Wi 54023 Lot 30 Subdivision Emerald Acres N W 1/4 S W 1/4S 30 T 29 N/R 17 W Boring ~ Well PL Property Line BM or VRP Assume Elevation 100 ft. Date 911 /08 Township Hammond County ST. CROIX Top of 2" pipe 1 System Elevation 97.7 *HRpSameasBenchmark 73rd Ave t Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT in accordance with Comm 85, Wis. Adm. Code 1337 Page 1 of 3 Steel Soil Service County Attach complete site plan on paper not less than 8'/ x 11 inches in size. Plan must St. Croix indude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I D percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. . . Please print all information. '~ "viewed By Dat Personal information you provide may ~ sed for r'.p~`(Wivie~i Law, s. 5.04 (1) (m)). ~ l/ 7 Property Owner roperty Location Stout, Richard ~ govt. Lot na NW 1/4 SW 1/4 S 30 T 29 N R 17 W Property Owner's Mailing Address t # Block # Subd. Name or CSM# 1353 Awatukee Trl. 1 30 na Emerald Acres City State Zi Code Ptyone~Nuriiget ,`.. ~ ~ City _f Village ~ Town Nearest Road Hudson ~ WI 54016 715-549-6731 Hammond 150Th St. Ii New Construction Use: ~/f Residential ! Number of bedrooms 4 Code derived design flow rate Replacement J Public or commercial - Describe:na Parent material Arland,Sandstone uplands Flood plain elevation, if applicable General comments and recommendations: Mound design, System elevation 103.40ft based on contour line elevati~~n 102.40ft. ~~:!'~ ..~i+1.~ 600 GPD na Boring # ~ Boring /J Pk Ground Surface elev. 102.70 ft. Depth to limiting factor 41 in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 1 0-8 10yr3/1 none sil 2msbk mfr cs 1vf .5 .8 2 8-16 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 16-27 10yr4/4 none scl 2msbk mfr gw na .4 .6 4 27-41 7.5yr4/4 none sl 2msbk mfr di na .5 .9 5 41-72 10yr8/4 sandstone esiduu om mfr na na .0 .0 Boring # J Boring Pit Ground Surface elev. 102.70 ft. Depth to limiting factor 50 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 `Eff#2 1 0-8 10yr3/1 none sil 2msbk mfr cs 1vf .5 .8 2 8-30 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 30-50 7.5yr4/4 none sl 2msbk mfr gw na .5 .9 4 50-72 10yr8/4 sandstone esiduu om mfr na na .0 .0 "Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and T55 < 30 mg/L CST Name (Please Print) Signature: CST Number David J. Steel 248956 Address SteefSoil Service Date Evaluation Conducted Telephone Number 1564 CR GG, New Richmond, WI 54017 7/16/2003 715-246-5085 Property Owner Stout, Richard Parcel ID # Page 2 of 3 Boring # Boring tl'' Pit Ground Surface elev. 100.50 ft. Depth to limiting factor 46 in. Soil Application Rate Horizon th De Dominant Color Redox Descdption Texture Structure Consistence Boundary Roots p in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 1 0-11 10yr3/1 none sil 2msbk mfr cs 1vf .5 .8 2 11-30 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 30-46 10yr4/4 none sl 2msbk mfr gw na .5 .9 4 46-72 10yr8/4 sandstone residuu om mfr na na .0 .0 ^ Boring # .-1 Boring _J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots in. Munsell Qu. Sz. CoM. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ Boring # .~ Boring ~J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eif#1 "Eff#2 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L "Effluent #2 = BODS < 30 mg/Land 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. t ' Page 3 of 3 David J. Steel CST-POWTSM Richard Stout Lic. #248956 NW1/4,Sw1/4,S30,T29N,R17W Town of Hammond, St.Croix Co. Lot, 30 ~Z~ STEEL'S SOIL SERVICE INC. ~ ~ ~~° S~~ ~s~ i62~ a z ~n~ ~I~ ~~ ~7~ S~ slop- ~ iS~kr~ ~(?k~ ~6 ~/ ~ L~ fib` ~, I'~+-- 1564 Cty Rd GG New Richmond,WI 54017 Bus.(715) 246-6200 Fax (715) 246-9372 Legend 1" = 40' • =Benchmark Ele. 100.00Ft Top of 1/2" PVC pipe • =Alt Benchmazk Ele. 101.30ft Top of 1/2" PVC pipe ^ =Borings Boring Elevations B 1 = 102.70Ft B2 = 102.70Ft B3 = 100.50ft B4 = OO.OOft ~~~ ioz, ~a ~,~ =~° oli' ~~ , ~ "`~ iaz y~~ ~'!. ~Op °~~,~ ~ L=~~~`. ~, ,-~-a3 i ~ 1 ~ .. ~, ~i ` i ~ r , ~ IN `~` ~ , _ , •'~ •i ~ ~I ' ~ t. {r ~ Vi ~ 1 ~ ~1 ~ ~ ., .s ~ , • .._ ~~ ~ I. ?.~ I 1 ~ -~ I i ~ I'sr I I ~'~ ~ I W ~ ~~ ' ~ I r~. I i U I ~`et i • I ~ ~ I '~ I 4 ~ ,- W I 1 ),~C ~Q~ ' Y 1 i 1 ~ ~i~ lMf f N ~~ S0a 0SS ' ON 99£99£dddd00L59bZS i L f J~l~ti321tiN I Q3 Z£ ~ 9 i £00zi5 i iL0 . ' W~sin Department of Commerce Division of Safety and Buildings (o SOIL EVALUATION REPORT ~~ - Page ~ of ........~,...~....,........,.,,......,.,....~. ~,...,..,....~ County ~ C Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must . r01 indude, 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 b Date Personal infom~ation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1 } (m)). w . ! ~ Q Property Owner Property Location R1CC~'~a2~ "`' Govt. Lot 1/4 Sc.~1/4 S ~p T z N R (~- E (or)t~ Property Owner's Mailing Address Lot # Blodc # Subd. Name or CSM I 53 -ee ~~ 3a ~meri_a~c~ es City 1 State Zip Code Phone Nu~m/beer ~~ ~ ` ~1 ~ (~ City ~ Village ®Town Nearest Road ~ ~ TI 1 P t ~ ) ~J'~'7 -~D S t ~ m rrto r1 ~ l New Construction Use: ® Residential 1 Number of bedrooms 3 "~ Code derived design flow rate . ~ Replacement 1 Public or commerdal -Describe: Parent material T' ~` ~ ~ Flood Plain elevation if applicable General comments SY 5~~~'''` G (~ ~ , ~: and recommendations: ~,o~ ~'u ~ ~t-ev, ~ QD ~_. l a 1' ~~ GPD l~ i ~, JJ ft. •l"Lir~~ e,l~~( X_ / Borin # ^ Boring S ~ ~7 ~~ `~aSt~vV :, •, g ®Pit Ground surface elev. ~ • ~ _ ft. Depth to limiting factor m Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary ~taots-` GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 l D -l~ /v r~312 5 'l Zn-~ab~ m-~ ~s -~ . 5 . 8 Z /~f ~f !d ply --' Sicl Zms ~S - . ~ -- d Boring # ^ Boring ®Pit Ground surface elev. ~~ ~j~ 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 ~ O 1 Z ld ~2 -- S i d Z-r,~ctbl r>~r ~ 5 I v-~' 2 iZ.~o lD -- S~cJ b rr~r ~3 ~ . ~ 3 46 Sze f ~ ~~2 /F 7.S r ~l(o V-~'s O m ( - ~- Co 1 r - trnuent ~i = tsVUs > 3u < zw mgiL and rss >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mglL CST Name (Please Print Kelm ignature CST Number f_~ m ~ uma ~~~-~ ~ 2s33a9 Address Date Evaluation Conducted Telephone Number 213 gds-' ~~ -~-~er5e-f-, (,c~~ ~S~dZ 5 / Z-~~-o / ~~is~Zy~-yao~ Property Owner S-~~~-~ Parcel ID # Page 2- of Boring # ^ Baring ~, ©. 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 r -!0 2 -' S i l 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/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 `Eff#2 Y ~ , -j • \~- . ^ Boring `+ .~ . - ... , Boring # Ground surface elev. ft. Depth to limiting factor in. ^ Pit 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 mg1L * 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. SDD-8330 (R.07100) ., , '. PAGE~OF~ ~TAD~E S~ u ~" TOT# ~ T EGAL DESCRIPTION Alc~ ~Sw i4 ,S .X T Z9 ,N,R, ~ ~ E(orY~U SCALE:I"= ~~~ BM 1 ELEVATION ~,(~, (~ BM 1 DESCRIPTION ~,,. ~, .~ ~ ~~ OYC BM 2 ELEVATION ~' 9,' 30 BM 2 DESCRIPTION -{~~,~~ ~ ~~ p~L SYSTEM ELEVATION 9 ~. 5 U SYSTEM TYPE /n C~ c s ,nt1 ~.i~ t-erM CONTOUR ELEVATION 9~. C50 r. 9~ ao ~oa SIGNATURE L i~~U _ __~~/_, c~_------- ~ DATE ,S- -/ ~ ~ ~~ ~' 6 r ~s ~ ~~ e~ r ~ ~ ~~ STATE BAR OF WISCONSIN FORM 2- 2000 WARRANTY DEED THIS DEED, made between Richard O. Stout and Janet P. Stout, husband and wife, Grantor, and Cornelia A. Kooyman, a single person and David *. Kooyman, a single person;~and Sylvia Kooyntan Nelson, a married person, Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Lot 30, Plat of Emerald Acres in the Town of Hammond, St. Croix County, Wisconsin. * as to an undivided 1/3 interest Name and Return Address: Edina Realty Title, inc. 400 S. 2"~ St. -Suite 115 Hudson, WI 54016 852262 Recording Area Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. 018-1098-30-000 Parcel Identification Number (PIN) This is not homestead property. Dated this 2nd day of September, 2008. Richard O. Stout et .Stout ,Attorney in Fact AUTHENTTCATTON Signature(s) authenticated this 2nd day of September, 24~gri Brow * ~.si~~~~xv ~u~1io c iAfeCf`.nr~~`~ TITLE: MEMBER STATE BAR OF W` (If not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Peterson, Fram & Berman -Steven H. Bruns 50 East Fifth Street, St. Paul, MN 55101 (Signatures may be authenticated or aclmowledged. Both are not necessary.) 'Names oFpersons signing in any capacity must be typed or printed below their signature c,.C~- .~:L~.t- anet P. Stout 1111111 IIIII IIIII 1111111111 IIIII 1111111III IIII 111! * 8$ 1 2 9 7 1 88197 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX GO., WI RECEIVED FOR RECORD 09/11/2008 12:15PM WARRANTY DEED ' EXEMPT i REC FEE: 11.00 TRANS FEE: 150.00 PAGES: 1 ACKNOWLEDGMENT STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. Personally came before me this September 2, 2008 the above named Janet P. Stout, as Attorney in Fact for Richard O. Stout to me known to be the person(s) who executed the foregoing i~trurtrent_and acknowledged the same. *Cheri lil'BvGn " ~ " Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: 2/27/201 I ) WARRANTY DEED STATE BAR OF WISCONSIN tofl FORM No.2-2000 T - . a' `3vV N ~ ~ ~ 2 ~~~ ~~ ~ ~ ~ '' QQ=, W ~' '' h O •~l~~ ~ \ ~~~~ Q ~ O ~'' ~ ~ °~~ti ~ _ N ~ ~ ~ ~ I No ~ \ \ I ~ s s' I Z I 20 E 487.49' I m I g07° X36" ~ ~ ~I ~ ~ ~ ~~i0 O ~ ~ WQ ~ ~p~~ ~ ~ \~ I N C I ~ ~ QO ~ \0~~ N O Cl p ~ ~v1 j i N N o 252' ~ ~ ;~o 33' 133' I ~ 6 ~Z6~ ~~~ I ~ ~ ~V O I I I i SOO°34'S1 "E 485.23' ~ `~~.. N I ~ ~~ ~ j100- ~ ~ 90~a N CD DO I W Q M *; I ~~ L I Q~N ~ ( m ~ `~ ` I ~~°o I N O N I O 0f W ~ N I I '~ 00 ~ N ~' ~ a a ~ i N ° 125' z~' O>t ~~ I d' I j I I N a0 ~ I F I Z + I SOO°34'S1 "E 486.52' ~ I I ~I I I I I I I I I r 5a M I ~L I i j ~ II .` ( I I ~ . I 1 I t ~~ SHEET 1) ~I ~I I ~I ~I I ~I ~I I a' ~' a