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HomeMy WebLinkAbout018-2011-54-000a, o °~' ° I ~ I ` ~ ~ I c ~ w ~ ~ C ~ y O i~ ~ p N- ~ a C C C O = N O fa0 O N = d ~ L O~ ti ~ L ~ O N l4 .O- ( L n 3 d N •y N CO N O 00 Y f0 ~C _ w, C c~ 7 N N 'O. ~ O~ O I . . I '~ > ~ U aiF"'' 0 3~ Gt, 'aco~o`~ ~c~ °•' I Vl ~ f0 p .N ~ C ~ m '+ 3 y ~p L c p p~ U °- ~ N O y O Cp ~ ' ~ `> ~NL ~ w jY O-~ . O O C 'O N (0 ~3 m C ~ ~ i c V O ~ ~ Z C ~ ~ d ,~ w? N ~ m ~ ooo~ ~i a~ LL nty a ~ ~v rn~ a:~ a~ ac I ~ ~ ~ ~ L~v~ °c y ~ ~ I 'O L_ O_ aOa,, N ~ N E I ~ U Q~ 3 f0 V I ~ 3 ~ a i ~ Z N W Z = 0 ~ ~ V 0 ~ ~ Z ~ rn Z ° a m I I r > H o I o z ~* ~ c ~ I - t~ H ~ rn ~ o I Z c ~ ~ ~ f0 N M I N C • 7 _ ~ ~ ~ ~ I • ~l ~' N O ~ C I n. O ~ I O ~ , z ~Z ~ I ~ N a i I Z :: d ~ C N ~ _ .. ~ ~ ~ ~ U Q ` l0 °' _ °' I -o N a ~o w ~ N N ~ ' w ~ N ~ O eoa ~ w w ~ ~ tro N frA ~ 3 ~ ~ O O O z •N m vaaa ~ ~, a ~ ° ~' I ~ 7 O y ~ O O ~ w }~ } N J V B = N N ~ ~O " ~i j N N Z O O c r' ~ O O O ~ E Q ~ ~ m .- c d I ~ ~ ~ _~ Q A C4 ~ Q ~ ~'~ O N H H °0 3 ~ ~ c ~ O ~~+ " ~ O~ p U d 0 r \v, T i 1.n W .0 C 0 ~r-. O ` Y C C ~I O C f0 ~ y 7 N ~ N O~ ~ _ N ~ O O C~~ •~ ~ O M 2 m v O y Z C~ ~ U ~~ y ~ ~ ~ O ' •, v v~ d R of a € a ,_„ ~ 3 m ~ a ~, I • `f ~i r.+ c . ~ y c m c ~ w rr _1 A c°~a~ ov~c°~ Wisconsin aepartmept 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)]. 'ermit Holder's Name: City Village X Township Bast, Kernon Hammond, Town of ;ST BM Elev: Insp. BM Elev: BM Description: ~' v ,l ~ d ' ~ S~~ PVC.. ~ ~ ~-- ~ L TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic f Dosing .~- Aeration Holding TANK SETBACK INFORMATION f _~,,.~ TANK TO P/L WEL B~. Vent Air Intake ROAD Septic ~ ~ ~ ~ ~~ 2 I Dosing Aeration Holding PUMP/SIPHON INFORMATION ~~~ ~ Manufacturer Demand GPM Model Number TDH Lift Friction Loss em Head TDH Ft Forcemain Length ia. Dist. to well ELEVATION DATA county: St. Croix Sanitary Permit No: 463294 0 State PI~i ID No ay a Ali _ ---oc~ Parcel Tax No: Section/Town/Range/Map No: 30.29.17. STATION BS HI FS ELEV. Benchmark ~~/Yl Z ~ e~ ~D 5~ A->~J Alt. BM ~? r ~ /' ~!6`CfDV+,,. p,~ S~ Z. R Gj 9 .s`~1 Bldg. ewe ~ ~~ ~ ` ~ ~ St/Ht Inlet ~• d~ r! S~UH,t Outlet ~. I / A ! Dt Inlet _ Dt Bottom /- w,~,.- Header Man. ~.y ~Z.~u Dist. Pipe ~v, ~ 9 Z. I Bot. System -~ ~ ~/. ~ 9 J~ Q Fina~de !~ / ~ / ~, p .~ ~,/ 6 `~ St Cover ~-~~ / fN e/yS ~ ,r/ ~ ~. ~- ~~ SOIL ABSOI~FPTION SYSTEM '7 -~' l (o ~-J ~, BED/TRENCH DIMENSIONS Width ~ ~ Length / No. Of Trenches 3 PI' SETBACK N SYSTEM TO P/ BLD WEL LF INFORMATIO Type System: ~~~ ~~/,~ ~ ~ Y 7 ~V~ DISTRIBUTION SYSTEM .f~.t A/~~,..C od n~ ~` / r /ENSIGNS No. Of Pits Inside Dia. EKE/STREAM EACHING an CHAMBER OR // UNIT Model Nun ~., t~'L~ ~ d. Header/Manifold Length is Distribution ~ Pipe(s) C.~ Length Dia ` `/ Spacing' ~ I x Hole Size x Hole Spacing ~/`~ Vent to Air Intake y "" SOII COVER v Drncm~rn Rvc4omc Only YY Mnund nr At-Grade $VStefl1S Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ~ Bed/Trench Edges Topsoil ~ Yes No ~J ,i;-1 Yes ;I No L`i fJ D~t COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ l'~/ Inspection #2: / / Location: 1532 78th Avenue Hammond WI 54015 (NW 1/4 NE 1/4 30 T29N R17W) Emerald Acres 1st A diti Lot 54 Parcel No: 30.29.17. 1.) Alt BM Description = J ~~ ~~ s~~ ~.,.~ c~l~ . ~:eu,~. ~1~-~~.. ~c,~il, eo-~,~~ icy r~~ z 2.) Bldg sewer length = t) /G~~p,~`!'~'r ~ 2.~ /~~ ~`~'~`~'~~B~~~/~ ~ /, -amount of cover = 7 "°-p ~ (~}~ ~~S Z~,2,$~I ~hJ -- Plan revision Required? I~ Yes I ~ No ~ ~ ~ ~ ~ ~/ ~ ~ r!'!,_ ~iv"!v' _ ~~~- ~~~ -- - i Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) / .) ~ chi n~le rs ~'rnenb~a.._.~~~~ ..: :. .~i~~/ILL ~ ~y~~ ~ _ -.___...._.______.__..._.....- ... ._.~ I ~~ ©~ ._.._..__... ----- ... cunt I . Q; ~~~ .~~~ c--.~.-_~~,, 1 I ~~ y ~_ ~ - ~~ ~`~ `~- \- ~~ ~ ; ~ ~~ W~~~~~ ~~~~~~~~ ~~ r -~~ ~,Q 1 u ~~ .h ~'e~ ~~~~ I" pV c ~ Irv- luu~b ~1-ev- 9.80 I ~~~ . Q M# d ~ -~~,~ ~ ~ ~ X8.8 0 ~bC~~ I~OivG~ CB1bD Chi ! ~ G h,~-~~C n ~ ' ~ ~bc; 1, ~~~,, ~~ '~ #~ ---~ ~ ~/~ ___ . _ ._ ~(pnu c,h, ~~ --- . -o -~ w~ ~ ~, - ~~ -~~ Safety attd Buildings Division 201 W W County ' . ashington Ave., P.O. Box 71G2 ~s~Ons ~~ Madison, Wi 53707 - ?162 Sanitary Permit Numixr (to.be Mled fn by Co.) De artment of (;ommeroe (fig) 266-315 i /~ • ~1 G1 .. Sanitary Permit Application Stag Plan L D. tVumber In accoM with Comm 83.21, Wis. Adm. Code, peraotal information you prnvkle /~ may be used for secondary purposes Privacy Law, s13.04(1)(m) Project Address (if differem than rraNing addrtat) ~ ~ 3 ~~ I. AppUcMltm Information -Please Print All Information ~ E ~ E ~ VE D p ~ ~ ~ ~ Property Owrter'a Na me ' ~ Parcel ~' N Block I ~ K ICFdA~2A J~1~1 `~ 5 ?005 ~~~~ l~ l~ Property Owner's M piling Addraa t-~ ~ S7, ~.~(Jlx Li);_~ A, ~ ,. ~ Proper Location ~' ~n V~b ZONiNG Ot=Fi~~: ~~ ~ City. State l '^ Zip Code Phone Num r ~,t, li.Sectbn s D N V~ ~ ~ (~ ~ ~-"-`~ Q (circle one) ~ °~ Ii. ype ~ Building (check all that app1Y) //11 V T t N; R ~ B or W or 2 Pamily Dwdiing -Number of Bedrooms ~ ~~ Subdiviskm Name CSM Number ^ Publk:/Commercial -Describe Use -_- ~), ~ ~~ J ^ Start Owtted -Describe Use ~ - // 1 ~ N_l ~ . ty (_1Viliage ~ITownthip of pl'tipA.p III. TYpe of Permits (Check on1Y one box on Tine A. Complete line B if applicable) A' New S stem ^ R eplacetnertt System O Treatment/Nolding Tank Replacemem Only ^ Other Modification to Bxhning System B. O Pirmh RettewN ^ Permit Revision ^ Change of ^ Permit Transfer to New List Prevkws Permit Number and Date Issued Before Bx~ntion Plumber Owner IV. T of POWTS S amt Check ell that a 1 ) ^sNon -Pressurized in-Ground ^ Mound > 24 in. of suitable soil LI Mound < 24 in. of suitable soil U At-Grade U Single Paso Sard Filmr ^ Ctxtetructid Wetland ^ Pressurized In-G ound ^ Holding Tenk ^ Peat Filter I _) Aerobic Treatment Unit ^ Recirculating Sand Palter ^ Recircula S ttthetic Media Filter Leschin Chamber ^ Drf Line ^ Gnvel-less Pi I~ Other (e sin) ~~ V. reattnatt Area Ltfortna on: 0 (( Dal Flow (gpd) Design Soli Application te(gpds vU ~ Dispersal Area Requfrecl (sf) ~ Dispersal Area Propoa (af) " System Bievatiat 3 ' ~~ ~ ' S a3, q# N g~3arh 9~•3b L ~,$b VI. Tenk Info Capacity in Gtll oral Number Mairofacturer Prefab Site Sled Fiber p{e~~ ora Galiont of units Concrete Cot~ttucted Gl New fiatttine w Sepik or ilokNag Tank Tanks ~ Tanks ~ ~ 1 ~ b c Aerobk Trcotment Unit • ~ ~ , '/ i Dosing CMtnber W VII. R Wllty Statement- it the ttnderJSigned, aastme rbptmslbWly for htsla0ation of the POWTS shown oa the attached Pltttttber'a Na nae (Print) PI is Si re MPJMPRS Number Buairteas Phone Number ~~~~~ a ~ a 9 oy ~ 15-~ a ~ - as ' Plumber s Addrc as (Street. City, State. Zip C ) b~~ w ~~ ~~,~s~u ~ .~~~/ Viii. /De t Use Onl Faov4d ^ Disapproved Sanitary Permit Fee (includes Groundwater D e Issued Issuing A Signature ( ) Surchar e Fee) ~ f g i ~ a0 , a ~ ^ Owner Given Raaon for Denial ~-F~ IX. Conditlone off Approv /Rt~ulons for Disapprov ~ .~hltis,~~,~?~t~Ilu-c ~st- YSTEMOWNER: ~,yf%~~ ~C~ effluen f ter tic tank Se , p dispersal cell must all be serviced /maintained iii, as per mans ement lan rovided by plumber. ~ 7~p,~,.~d Q~tJ~Cr.- ~/~~~%~~ `'~ 6~~~ ~ 2. se ack requirements must a maintame 5~~~~` as per applicable code/ordinancesC~~ Semis ~ ~ GQ~f1.~rs~ .~ < ~~ K~E.r Attaeh contolN .. tle rh• ......~. ~.~ r ..._ n~~ n ---•.r r y.yc. .nn .~~ man ova R ~ 1 IrICnl7 M StE! yJ~)~L.~/VwC ~V ~ " SBD-6398 (R. 01/03) / S c ~., «ik . ~~ 5 , cl ~ [.cJ~ ncl~ rs ..c~~c:.f .. _.... _ .._ _.. _ ..... _ _ / ~ ~. ~ _ ... ld.._.~J_~..~ .. L/CMG/),[; -ate ~yu..~.._.._.. _... ,_.__.._.______..._..._...... _ ._.,~ _ ~~ I i~ ~~ N._ . ~~~~ -a ~~,~~. ,~~' I" py c ~ Irv- Iv~~b ~~ p .~ .~~~- `~~ ys w~~~~U ~h~ ! ~- -t~n ~e~ QM# d a ~~~kt~1 ~8•8a ~ ~b Li. ~IZpNG~ ('(31b D1 F CAL 1 C }~ DIRh ~C h J ~ >J ~b ~ 1, ~r+PN t~ S~~ ~~kll U~bIIUUh. ~V~t wo t~, y i JJ k~ N 9a- o ~ -°~ ~ ~, ~v L ~ ~~.vti ~, ,,,,,.~-~-p ~I,,I~~~ .~''a' . // 9 .~ ~ r ~~. -~ ~ .h K ~ Jan 11 O5 12:44p Team Speer Hast 7153868660 p.l V 83/13/2991 16:21 ~ 7}53869479 _ ._, __._ tiDPY Ch7 PAGE 91 ar m~oYx ~aour~r.~r -SEPTIC ?ANK 1NAtN1'BW+N('B A~MBNT ANb OWNeR$NIP Cs1tTlpICAT1ON F.OIWt .ti tvrb.lfo. ~ Aaa, ~I.rw~ n~.s,.r tw.a. a..~a.cNan) Gc~MStir. /'!'I N'-tl ~l, ~, ~i(/,~Paroel ~eentiBod:,or Nwnba T ~' ~~ sGc,G . ~s ~! ~11L~eL 7ti.. ~ r_ f'G. Sca. ~ T~-RLZW. ToNm.of CNIMIM aney I~ N Vol..~s _. . lads M iY~no4 D.ei ! ~ () "I ? YWutrN 2--~ ~ -a ~° / ~~. 8p.e lowe~ T~ p ao Lot liw. ide.tifi.We~ ~p O .o ~Z ~h,~re.~ -~~ n: ~rrw~rt.irw~.,frw~+Mi..~..e.w ~ ra bwe...r.R14.~.~s+..abwww..Pw~...~ir...w ~1..~.KMw~ipbll~~~~~~~~+4~rrer9y~YN.~d*~pR, 1yLt1wPKMMryM~ erw~.t~.1. ~Y. w.fr~y'n.t.~ ..w 1ti. ~4' e+..r.p.n is ww M st t,1pIR ~,~ Dyrn..~. aMlllwfw Aay dp~1 b Ilr.w..r.ri irj-. 1rl.~r~ ~~MIo~M~l..r.rrr^pe.rl.br~.,~d„~~It)Mk...w...n...~4~ f~ • "i+i+~+st+r.R,.~ry~,w.~de wt 6 r.. r.. ~ w.,.~., ~~~~~~nl~M~epf1~~~M~ b~irlN.M rN1Nk w.~N ~4+d ~ ~ ;~.~w/ri ~~*Mf!1~r `r6Ni ~~.tMNMdItNe~wtillw~fwlMilMi.•Qe0lbrd~ ~g.~°t .,';, ~s,!Mao.~WrllwrrettslbSl.Cti~f.~•va!-ZwiliO~.~llil.]~ J ~r. :: ,. f ~ ~ . E. -p,Jl7, . wwa "w.eMb wp~ IMs ~.1k • ^ w M bra d ~q («a)1~.~w.. [ b+d i (w- dr•.f .did 41l ginlyd o..d~ OlRee. i l~ D/1'!' R4a~ it 1MB M~ dOui Nliw ~f wrp if n iM~.p 4 ~~s Iw M ww.sry ~q/ Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment . System (POWYS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- Table 1: System Desisin Specifications Sanita Permit Number a ~ Number of Bedrooms ~~ Desi n Fiow -Peak (gpd) te~~ Estimated Flow - Avera e ( d) 3 ob Se tic Tank Capacity ( al t ~~, Soil Abso tion Component Size (ftZ) 1 ~ a Ty a of Wastewater Domestic Table 2: Soi) Absoration Component -Limits of Reliable Oneratien Septic Tank Component Soil Absorption Com onent Desi n Flow -Peak pd) ,~ u ~ $a Maximum Influent Particle Size (in) ~ 8 1~g Maximum BODE (m /L) ~~ 0 220 Maximum TSS (m /L) I S~ 150 Table 3: Maintenance Schedule Se tic Tank Ins ect and/or service once every 3 years Outlet Filter ins ect once a ear and clean at least once eve 3 ears Soil Abso tion Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outset filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. if the Management Plan for a Septic Tank and Soii Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upgn the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain Lethal gases, and rescue of a person from the interior of the tank may be difficult or Impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Comaonent The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by ail occupants and the installation of water conserving plumbing fixtures are key factors in extending the usetui life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen Into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 7_ Management Plan fora Septic Tank and Soil Absorption Component • Plantings of deep-rooted trees and shrubs directly ever or within ten feel of the . component should be avoided since root intrusion into the component may obstruct wastewater flow. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office 386-4.680 Boumeester & Sons Excavating 386-9020 l .~ Wi,consin Departmerrl of Commerce SOIL EVALUATION REPORT pays _ 1 _ of 3 Division of Safety and Bufklnigs ((~~ Wis onnn 05 i ~ df~ ~ Code Actin , . . D n gr r r Cowdy ~ ~ Attacfr Wnrplele site plan on pap rvt % ~ ~ klCfre3 Irl 8129. Purl /nUAt - ~- hrclude, hart not Iimlled to: vertical and horizontal reference l ~ n err are tread Paruel LU. percent rope, scale or dimensions, north anuw, ocf ~~~r . Ho _ -- _ - -----___ -- .----...- Please prfnf all In truatlon. viewed _ Uate Perwnel inforrrretion you provide maybe used fw eeco ary pur oao .(Pr' a L 45.04 (I irn-). I r ~ 6 PropertyOwner Property ocatiun ,`iChC.r"C~ S t l~.l!'}" . CROIX C0 ~~~t Lot NL~ 1la N w 1!4 5 3c~ 1~ 2°t N It 17 E (or~ Properly Owners Meiling Address ZONIN Ivr:k # ------ -- Sulxl. Nar-re a CShI/f ~3~ ~~.-~-c~kee Tr. 5 ~~ ~cre~ 1~ S ~ a~ -City State Z1p CCale Plrone Number ^ Cily U V iliaye town Nearest Road ~~cl~orl I W~ 15~1011p 10115 )~--(Q13~ ~c~m C~~/ Rd- -T `T ~9w Constructiar Use: I~-~Residenlial I Number of bedrooms ~~ Cudo derived desiyn flow rate _~~_~ Ltz~.____-_ GPD ^ Replacement ~, ~ ~ ^ Public or cormnerLial - Describe: _ --_-___-__________-__ ___-_-_-_ Parent materiel _-_r! ~.t_------------------ Flood Plain elovalion it aiilrlicabin ----_til~-.---_ _ General cornmerrts ~ 5-~ ~,~ ~ I e11 • 5 ~ ? ~N GInQ/l. arrd reconnnerrdaliars: Y w.t-ee ~ ~s -b ~~ ~~ 3io `- ~.~ syf~.. Boring q Bunny ~Pil Ground swlace elev. ~~ _~O It. Ueplh lu Ilnriliny lector __W ____ in. --- - _ _ __ _ _ ___ Sol Application Rate Florizon Uepyr Dominant Color Redox Description _ Texture Sbuclure Consistence Boundary, Ratis GPUfIt' _ in. Munsell Qu. Sz. Cont. Cobr Gr. Sz. Sh- 'EfffF1 'E(f#2 _ ~ o-~ (o~i-312 s,~- _2~~ ~~ c~_ __ )Y~ _ 5 , f 3 3- ~ 2 -` ~'~, ~-- m 1 .- _ - ~ - ~ Boring # pp~~~ Bonny ©[ i `~ - 17~-'F'it Ground surface elev. l "f • 4~ ft. Depth to tirnitiny factor - ` ~ in- Sol Application Rate - Horizon Deptlr Uaninarrt Color Redox Description Texture Structure Consistence Boundary Roots ~ GPDlItT in. Munsell Du. Sz. Crnrt. Cobr Gr. Sz. Sh. _ 'Eft#1 'ER#2 I d-i 12 ~-- ~ 1 Zmsbk mfr c~_ (~.' ~ 5 .~ ERluenl iM1 = BOD > 3U < 22U nry/l aril TSS >3U < i:r~ my/L ' EOluent #2 = BOU < 3U my/L and TSS < 3U my/L CS7 Narne (Please PrinQ Siynature CS"f Number ~m ~-ht, ~~J,zer ,~ _ _ _ _ Z533c?~ Address /~~ z ~'' Date Evaluation Conducted felephunn Number 2l1 ~"' mrer~t 1,11( .~ toZ.S" ,~ - ~ y _ ~ r .~ -------Cz~S~ ~~~ -az?9 _ ..., Properly Owner _ ~-~-UV~-_-_-_-- Parcel IU # ~QL_ S~______.__-- Paye __ Z ur (J Boring _ Born,g # q ~ , ~ Il Ue Ot lv GntiGn taclur - in• ~ F'it GruunJ surface elev. p g Suit ~ ,lica6a, Rate e cturE St Consistence Boundary Roots GPD ItF Horizon Deptlt UorninanlColor RedoxDescriplivn Textw ru •Errrr Egg2 in. Mtntsell Qu. Sz. Curt( Cubr Gr. Sz. Sh. ~ b-I(p (~ r31z -- Si ~ ~m5 ~ ~_ __c=~- ~ `~~ 5 _- c S L 1 t~ - 3~i l~ 4 - ~ 1 • Z> ` d~ .. o~~ Div./e~vr.~ Wz~• :~ LJ Boring ~`""~ _ Boring # .Ground surtac:e elev. __ tl. Uepih to limiliny (actor _-_ i"• Svll /1 lication Rate ^ Pil Textwe Structure Consistence Bvundary Rcx,ls GPDIIP Ilorizat Ueplh in. Dominant Cuk,r Munseil Redox Uesgiplion Qu. Sz. Cont Cobr Gr. Sz. Sh. 'Etr#1 'Eii#2 U Boriny Boting # GrounJ surface elev. ___-____ tt• Uepth to limiliny taclor _ _ __ in. __-- ^ Pit _ _ Sort A ,lica6on Rate Horizon Depot Dominant Color Redox Desgiptivn Texture SUudure Cvnsistenoe Boundary Rcwts GPD/fF in. Munseil Qu. Sz. Cont Cobr Gr. Sz Sh. 'Ett#1 'Etf#2 • ElAuenl #1 = BOUS> 30 < 220 rnylL and TS5 >30 < 1 ~ my1L ' Eilluent tf"L =BUDS < 3U mylL and TSS < 30 nty/L 'Ihe Ueparttnent of Cotnnteree is an equal opportunity service provider and employer. If you aced assistance to access services or need material in art alternate format, please contact the tleparLncnt at GU8-2GG-3151 or "I°l'Y G08-2G~1-8777. sao-at,o ra.miorry s T ~ NAML': S~J~_ I.IJI'!1 S~ I.I?C~r',I. I)I:S('Itll'"111)IJ:N~ U~lAluJli-i,`~~~ I Zc,~l,lt,l~-I;(ur~ /. _-_ -- --- j~y~i L•LL'VA'I~ION _ IOd ~O_ _-_-_ - _ ,. ~ ~ .. , :. r1- _ Bhi I DL• SCRII' CIOt~I: ~a~o~ ~~--Q!!c_ ,f'-~~~ _----____-- BM 2 GLGVA'1lUN: _ __~g,~G- __------- - _ ---- ~ BM 2 DL•SCIZII'"1'(Ot~l: aa~~_~-~JV_~_~<'~~-_-_- . SYS'CL'•M LLL:Vn"I'I~ )iJ: R`3 ~-s ~. -_-_ _ -_-- `. . SYS'1'LM'1'YI'I~,:___ ~~d-~?r-'~t,2sna~.` N~IoE `~ _ ~~ '~ fi _ ____ _ ~~,5~ ~;~ ~ v ~~, ~ ,oa ~Z 6 ~^' ~ SIGNA"I'URG: - _ _ Un"f L: _~'-~-_0 a~~-s~ Safety atxl Buildings Division County ` m ~. Waahirtgt _ e., P.O. i3ox 71G2 ('Olk ~$COnS~n I ~' Madis<o~rt 07 - 7162 ® ary ermh Numtxr (to be filled in by Co.) De artment of Commerce u Iv Sanitary Permit Application - s"'° Pla i.D. "umber In accord with Comm 83.21, Wis. Adm. Code, persomi information you rovWe, ~N 1~ ~ ~~~ may be used for secondary purposes Privacy Law, a13.04(I)(m) Pro t A ress (if diffeQrent than rtnUing addrea) I. Application Information - Pleatse Print All Information iNG p U~3 B~~Je ZON Property Owner's No me Par I a/ Lot a/ Block ~ 1 - Owner's M Hiin Addrcaa / Property Location State ~_ '4.~~'~.Section ~_ ~Y+ Zip Code Phone Number D ~j ~ ~p (circle iI. Type of Building (check all that aPP1Y) ~ U1.~Q_ T ~zs_.,~_ N; R~~E or Wj ,~l or 2 Famfiy Dwelling -Number of Bedrooms Subdivision Name CSM Number ... .^ Public/Commercial - Describe Uae - ^ State Owned -Describe Uae --`--- -- -- --___ _.~___ -- -- I~City_L.~Village If~i•fowrrship of~~~ lIi. TY~~pe''of Permits (Check only one box on line A. Complete li e B If a Iicable) • A' ,c~lvew S stem ^ R Y eplacement System ^ Trestmeru/ olding Tank Re acement Only ^ Other Modification to Existing SyaKrrr B. ^ Permit Renewal ^ Permit Revision ^ Chang of ^ Permit Trans r to New L evioua Permit Number and Date Is:uM Before 13xpiration Plumbe Owner .~ IV. T of POVY'I'S S stem: Check all that a ) C"IANon -Preanrimd in-tiround ^ Marnd > 24 in. of s table soil U Mound < 24 in. of suitable s I U At-Gr e U Single Paa Sand Filter ^ Constructed Wetland ^ Pressurized In-Ground Holding Tsnk ^ Peat Filter ~_) Aerobic Tr ment Unit U Recirculating Sand Fiker ^ Recircula S rrthetk Medk FOter ^ Leachin tuber ^ Drf Line ^ Grsvel-Iqa Pi U r (e sin) V• reattneat Area Wormatioa: ~~ Plow (~ Daign Uon Ra Dispersal Area Required (sf) Dispersal Area Propos at) System evasion ~ - 3 I ~ (ate ~'~a-fib L-~~-30 VI. Tank info apacity n oral tuber Marmfecturer Prefab 'te Steel Fiber Plaffik ..___ w . -, allons of Units Concrete Const red Glass a VII. R billtr Statente<tt I, tRte undersigned, aaartme rbptmaibWty for butallatlon of the POVYTS shown on the attached Plr`rmbtr't Na ttre (Pritrt) Piu is lure MP/MPRS Number Busirresa Phone Number Phrttrber'a Addre a: (Street, City. Sgte, Zip C ) io ~~ ~ lU mud ~ ~.t~~ ~ ~~ VIII. Count /De 1 Use Onl ^ Approved ^ Disapproved Sanitary Permit Fee (includes Groutxlwater Date Issued ' Surcharge Pee) ^ Owner Otven Reason for Denial IX. C ti of ApproraUReasona for DlsapprovaJ ~ sT ~~t d2 ~`-lo~ezc ~-,~ w<~ yn a Septic tank, effluent filter and ~ -~ x.07 dispersal cell must all be servi d / sin ~~G~ U S/ S~Y~- ~r;~(/ as•per management plan provided by plumber. 3 2, All setback requirements must be maintained SZl/j'I~ f /~~~ ~~ „~ ~r~ ~,4 as per applicable code/ordinances. I ~U - at'.ct_- vn ~.~'~ VP r~ Allacb emnplNe phrr tlo the CgaalY only) fo~he ~2elrm paper qQl jeyaah~e,al/2 ~ t Ues to SBD-b398 (R. O1/03) issuing ~~~ Tyr Tw n. S ~ ~~ l~~ r n ~.~-trr~ti., . .l ~ U ~~'-=o (rte / C~'/u ~: / ~/ /., «~k~ ~ _5 ~ ~ ~l ~. cv~ ncl e r.s~ . ~ea^ ... ------~---......_ ._.,_[.~l ,~l~ l ~~ ~,~ . ~' c°~h 4 v (3I~# 1= J" PYcn ~Bi ~ GeV' IUD O • BM~~ ~~~~~ PVC f I~~~ ~ ~.`~ ~ p~~ ~ ~ ~ ~ Try ~ ~,~~ .~ 33 I$-C~,b~.,~~. J ~nc,~ ~i2ah,ch ~~" to 0 0~~ l ~~ ~~' i s y h~ ~,~' 3 13.Qrocxuut~, iJo n,~, k°,elr ~~ q~- ~ c, L ~~~~V ~. C fA w it to 0 K K ~I ~~~ ~ BM d ~~~V - 6h- ~ 1 F~V= to~.~ . N T ~~ n ' - .U 2597 P 300 - " ' I STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WAxxaNTY DEED This Deed, made between Gillis Farms. Inc. Grantor, and Kennon J. Bast and Richard O. Stout, tenants in common as to sA interest each Grantee. Grantor, for a valuable consideration, conveys and wazrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): NW '/.NW 1/., Except Certified Survey Map Vol. 14, page 3829 and also except Certified Survey Map Vol. 14, page 3829 and also except Certifies Survey Map Vol. 14, page 3967; NW t/. NE i/~, NE'/a NW '/s, All in Sec. 30-T29N-R17W. St. Croix County, Wisconsin METRO LEGAL SERVICES, i11lC. MINNEAPOLIS, MN~5540151111150 Metro Legal Services FL)Il2ET 433921 A Gi Faemc Inc. ~~A fib, -- -- - ! By: us ' ACKNOWLEDGMENT STATE OF ) ' --------) ss. County ) 37i-744 WD X40'_46 18-1066-60-000:18-1066-90-000:1&1067-00-000 Parcel Identification Numlxr (PIN) This is not homestead property (is) (is not) Exceptions to warranties: Easements, restrictions and rights-of--way of record, if any. Dated this ~ y' day of June , 2004 AUTHENTICATION Signature(s) Gillis Farms, Inc. authenticated this ~ ~ day of June ,2004 * Krishna Ogland TITLE: MEMBER STATE BAR OF WISCONSIN (If not, ___ authorized by § 706.06, Wis. Slats.) 7 6 IEy Qr '9 2 KATHLEEN }!. MALSH REGISTER C)F DEEDS ST. CROIX CO. , liI RECEIVEII F'OR RECORD 06!16/2004 01:20PM IiARRAHTY DEED EI(EMGT it REC FEE: 11.00 TRANS FEE: 3300.00 COPY FEE: CC FEE: PAGES: 1 Recording Area Na (me and Return Arkiress 3~c`j ~-~ctG~s ~5c~ ~,v ~Gvl Personally came before me this __ day of the above named to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY Attorney Krishna Ogland _ _ " ~ --_ _-_-- -__y Hudson, WI 54016 _ Notary Public, State of _ __ _ _ __ __ _ My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) .) * Names of persons signing in any capacity must be typed or printed below their signature. Information Professionals Co.. Fond du La . WI STATE BAR OF WLSCONSIN 800.655~t021 WARRANTY DEED FORM No. 2 -1999 1~ ~ f ° c ~ ~ W ~ ~ 3 r: obi N o ~ ~ n~i tD m N .y" p N : ~ ~ ~ ~ ~ O w y N cn z N ~ ~ ~ ~° ' ~ I D • a a W o O ~ ~ N = O 3 0 ~ v v °- ~ W ~ I~ ~ ~ ~ j ~ ~vv , ~ eo K y 3 °1 3 ~ 7 Z ~ Z D ~ O m ~ ~ m ~ m' ~ s c ~ 3 m m Q °- ~ ~ 3 m O y ~ O C 7 o. p ~ 01 1G~ ~• N Q O d O~ ~ O Q O ~•G A X ~ p O. O N O '~ O O p ~ d X Wa~'..F~i '~ ~ Z o m c ~ ~ N ~ C.J ~ O ~ N N ' 01 O- - O N O a ~ ~ S ~ CD fr O N F O CJ1 ~ ~ ~ fD (D ~ C n ~. O < < O n a~.w ~ ~ d ~ ... m~in~~~ ~ O L~ ~ ~. ~ ' 07 QC~, ~C O'1 ~ ~ ~ ~ ~ ~ X N O' ~ d 7 (n N • EA O O ~ O L ~ A °' 3 °o ^' 3 !^. z F A G C 7 a 3 d o ~' ~ v m ~ o = wo 0 w ~ 3 ~O No o ~ ~ , a o ~ F °o 7 O O y o c 3 :~ a .. ~ m m v a n N N .. a a ~ N ? ? A i ~ '_! A 2 O ~ 3 O .... Z ~. ~ z ~ m ~ A d A'+ i~' ~ ~ ~ Q ~ ~. r-i O /~ ~ \ 1 o ~~yy~,~ • v~ O ti~ fi H A 'b~ N a N O H Q ~A ti d0 ~ 1C w ti ~ ti SEE SHEET 1 I SOWN ROAD---_"!_ ~ ____ 0°oT3a'~w a12.oo~ ~ ~ , - - ---TOWN ROAD -- - - _ - _ -_- --- -- ---- -- -- -- -- ~ I --- -- -- -- --- 401.30'. S00°0T34"E 752.98' ~ - ------ m I I i X48 _ ~- fU I (Up r•• I 6I8' j ~ o Iv D ..' ..... I~ rol i-.. ~ O ~ 3p !U / ~ ~ V I~ ~I ............ ~ o r*i V ~ IQ AI a .,,~ ..............~ .. . Tlv~ I I ' y~ a / ~ -1 I I ~ ~ W v I A ~ ~ ~y I I I , OT'34"W 412.00' I I I in I ~ I _ I ~N00°0T34"W 401.1 T~ -` ~ n I ` iii m : I I I ~ ~ ~ Nld~6 ~- L56 _ .__. ~ / d / O N o P I Lb4 ~ ~~ ~' ~/ d ~ cn IU i S --~ .~ 0 ~ 11 o O ; o ? Iro N~W~ ~ ; ~~ ~ rU '`~- D ~ 1 i -.. - bi' "'~ ~ 0~ V ~'•_ p "'~ rIL58 N C ~"' ~ O I ~ i :i ~ti I - - ~ ~ I~s4 'W 4,2.00' , ~ ~_ I i ~ ~ ~` N 4= ' I l48 ~,~ '~,, I ~ ~ ... ... ,. ~i a~ j " . 401.04' 00 0734'W 80208' ~ I i I ~' 464.63' v rv ; 1oa ~ I . U o° P ~ Q i I i 00 Iro I -_~ i-. r I ~ V N N o° P V ~ a ~ ~ 0 ~ ~ ~ I I ,ar m yD I ~ I ~ ; ma m ~ m j ; -~iy I'~1412.00' i I N00°13'14"E 484.85' ._ I I I ~ ~ • I ~ ~ N00°13'1 4 601. ~ -___~ I I - f" Q `y'1 I -.. I IN ~ ___ ~ -' I ~ I -._ N00°13'14"E 484.85' ~ Iv ~ ~_ I ao A ~ iR I ~I ~ ~o ~o r ~ ~ ~ ~ ° ~- ~ Q