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HomeMy WebLinkAbout018-1070-20-100Visconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division „ ' INSPECTION REPORT GENERAL MFORMATION (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 Pederson, Daren & Sue Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: ~3 GS T ~-~ o t - TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic ~ `j ~- ~~ ia~ Dosing Owe.`Q U / 6~ Ft ~~ ~ f~ Holding TANK SETBACK INFORMATION TANK TO P/L ~JaJ lNELL BLDG. Vent to Air Intake ROAD Septic q ~ ` , 7 S~' p ~ D ' ~~ l ~--. Dosing r ~ ~' ~v (~' 0 ~ f Aeration Holding PUMP/SIPHON INFORMATION t i Manufacturer ~ 1 ^ Demand 0~ 5 l ~~1- , GPM Model Number ~ /~ T TDH Lift J Frictio~ gs`Js ~ System Hamad TD ~~' ~t Forcemain ength~ ' Dia. // Dist. to well 7 ~i\i SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. CrOIX Sanitary Permit No: 479238 0 State Plan ID No: Parcel Tax No: 018-1070-20-100 Section/Town/Range/Map No: 32.29.17.484A10 STATION BS HI FS ELEV. Benchmark 5.a gas ~~ Alt. BM1 // ~: ~ t~u. (..O~Jt.~., ~., ~ y5 Bldg. Sewer / .b ~( SUHt Inlet s.d $5,~5 St/Ht Outlet ~ ~ Dt Inlet ~_ Dt Bottom Header/Man. ~ ~ ~ 5~ '/ / ~ Dist. Pipe a II 1 ~P ~5 ' ~ Bot. System ~d ~ ~P ~/ ~7 Final Grade ~. Z. ~17~ g St Cove ~ / a ~ ~ ~ ~ , g BED/TRENCH Width ~ Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ w Z Cr ~~ ~~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: . ~ ~ INFORMATION CHAMBER OR -L r~a~ ~1Q' i Typ~ to 15 / ~ ~ , cTT 1 ' ~ UNIT ^^ ,, Model Number: ~ L d /~. 0 J U c_]~1~J T DISTRIBUTION SYSTEM r N,.~.1.1. ~~ z ~. -~-zti = y~ ~~ Header/Manifold ~/ Distribution x Hole Size x Hole Spacing Ve(jt to Ainnr Inta/k 4 ~ i > \ ~ S ~ ~ Length Dia ng Length Dia pac 1 SOIL COVER Y Praccnra Svstams rlnty YY Mnunrl Ar At-Grade SvStemS Only Depth Over ~ Depth Over xx Depth of xx Seeded/So ded xx Mulched Bed/Trench Center ~ , 71 Bed/Trench Edges Topsoil \ Yes ~', i No f 'Yes ~ ' No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /. Location: 686 170th Strece~t Hammond, WI 54015 (NE 1/4 NE 1/4 32 T29N R17W) NA Lot 1 1.) Alt BM Description = ~` ~ ~ ~~~_ G1n~~ .~ ~"' ~,dG/GS 2.) Bldg sewer length = Z I ~ -amount of cover = 3 Plan revision Required? I ~Jl Yes i ' No Use other side for additional information. i . ~~.__l ~ ~ ~~ Date SBD-6710 (R.3/97) Inspection #2: / /_ Parcel No: 32.29.17.484A10 a~ ti... __~_~~~~ Cert. No. ^ T-- ~atety and Buildings Division County -" /~ .i 201 W. Washington Ave., P.O. Box 7162 s~`~yi~ I~~ ~n$,~ Madi ~ j 3707 - 7162 de airtment of Commerce (~ -3151 Sani Permit Number (to be filled in by Co.} ~ 2 9 3 Sanitary Permit Applic t State an T.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal info ton ; provMAY l may be used far secondary pur oses Priva L ~ 2 p cy aw, sl Project dd if diff ress ( er nt than mailing address} I. Application Informatiwt -please Print All Information gT. CR TY f%O ~ `p ~ E ~ ST BONING OFFI , ~ Property Owner's Na me / Parcel # Lot 81ock ~ Praperty Owner's M ai ing Address roperty Loc tion '~ City, Srate Zip Code Phone Numbrr ~-- ~A'~~Sd'Sec"e:' ~~+~~" r~..~ ~ ~ylJd ~- ~C~-_ ~'t~ 3 ~6' (circle one) II. Type of Building (check all that apply) ~ ~~ o p~ ~ - " T ~ N, RAE or~ ~ l or 2 Family Dwelling -Number of Bedrooms` ~ r pf Sutdivision Name CSM umber ~ ^ Public~Commercial -Describe Use ~` ~ ~ a ~ 7 Gl ~~ ~ _ '~~~ ~ q ^ State Owned - Aescribe Use . ~C (J ~~___~~ ~~~~ _ ^City,^Viltage nship of _ III. Type of Permit: (Check only one box on tine A. Complete line B if applicable) y A. ~, New ^ Replacement System ~ ----- ^ Treatment/Hoiding Tank Replacement Only I ^ Other Modification to Existing System 13. f ^ Permit Renewal CJ Permit Revision ^ Change of ~ ~ Permit Transfer to New List Previous Permit Number and Date Issued Before Ex tration P Plumber ~ Uwner IV. T of 1?'OWTS System: (Check all that appl~ ^~ ~- _ ~xi ^ Mound > 24 in. of suitable soil ^ Mound < 2a in. of suitable soil ^ At-Grade ^ Single Pass Sand Fitter ~ Co i:tland ^ Pressurised ]n-Ground ^ Holding Tank ^ Peat Filter ^ Aerobic Treatment Unit ^ Recirculating Sand Fitter ^ Recirculating Synthetic Media Filter Leaching Chamber ^ Drip Line ^ G avel-les Pipe ter (explain V. Dis rsallTreatment Area Information: h r - '- Design Flow (gpd) Design Soil Application Rate(gpdst} Dispersal Arca equired (s Dispersal a-Pra}w sf} System Elev ation BB p ~f ~VI. Tank Info Capacity in Total Number Manufacturer Prefab Site S[ee! Fiber , plastic Gallotu Gallons of Units Concrete Constructed Glass ~ New Existing Tanks Tanks Septic or Holding Tank r 0~ _ f ! e .~ Aerobic Treatroetu Unit ~ -I Dosing Chamber lrPi..SL°~ VIL KeSponslbility Statement- I, the -tndersigned, asstune responsibility for ' llatian of else POWTS shown an the attached plans. Plumber's Na me (Print) Plumber's Si gnature v1P/ P12S Number Business Phone Number ~ ~ Plumber's Addre ss (Street, City, State, Zip Code) i G7d ~~ ~ Y ~ K. ~~Q~ ~ •' ~ ~O- VIII. ount /De artment Use Onl ~ ' pproved ^ Disapproved Sanitary Permit Fee includes Graundw,at~r pate Iss ed O Issuing ent S' n e ( o Stamps-}- ' t ^ Owner Given Reason for Denial - ~ ~~O ~ Y Surcharge Fee} G~N~ J T IX. Conditions of Approval/Reasons for Disapproval ~ SyS~N-t e ~~" l/h A~CQ~~ 9'~ `3 (~ ~~ ~ - t . ~ SYSTEM ' 1 Septic tank, effluent filter and .3C~0 " C'.~~~ 17D~ ~~. '- CST~~neo~~~'~' O I , dispersal cell must all be serviced /maintained y ~~ ~ ~ ~/ ~~ ~ sV~~~ da ~~ ~ 30~ l mber !>/" t l id d b . p an prov u e y p as per managemen / I, 2. All setback requirements must be maintained {~Uad- ~(,(~2.. ~ 2c~/~ ~'to 2~ .~„C,¢- ~ f as per applicable code/ordinances. ~{~Ch[.- ~u,Q,L~.QQ, ~ ~Q,a SyS ~OZ"~/tp>1. bG ~tGia?!.~ ~~'~~~~ ~R. ~ ~ ~U3~ nuacn cu.utuere pt~ lt~ me ~-ount}' ~(~/ ror~em on~~no~~ ~/~/t.l.S ~n~e~rDt~'10/~~'l1~ SGT- ~-_ • ~ ,?'a r~ ,~/ ~.e. ~ 8 ysa~ ~ ~ 7- / C Ssn ~7/ ~ ~7 ~~s~ ,~ d..d ~ t Sti ~~,~. l ~ ~1U ~ ~^ r /5 i ~-3 4~ rrL.~ ~h&s ~`~ h~ I Se~f~ G ~`/s ast' S, '~'-c_ fy~o ~~ 7 994 /J` UY.f ,G ti ~z '~ .~ `~ ~/~f~S- ~~ ~i_.f~ r _ ~ ` ~ /t/ .SG,~~t ~ ~= ~lU < aa ,d ~~/~2 To v~ ~e~~c~~ti ~~~ .p~ ~- 3X ~!(~ ~re~ Gl~ e S /Oa'~l~:sd ~l 5eyof G Wt `fLl ~lr~ ~t ~ /op ~/dasc, n S. '~`'-L o~,/~ !~ \~ V ~~` ~G 2 ~ ~' ~~ ~~ '~ C~~ S ~e ~- J7~,~~ .Al ~.~ ~~ r~SU,91 ~ d ~`/ cs ~~ ~7 /.2 ~7 ~f~/L~ ~~ 6°,.f/~~ ~~ r ~ ~ i r = ,Gf p ~ Sf G~~fz_- • 2 sG ~ ~~~ ~~ ~~ ~~~ B~ ~- ~~~ ~~~~t ~' its ~~ ~~•cS >~ er ~° ~~~ ~ ~ ks i~ ~ ~~ ~ 1k9G v~v ~V~ C a "9ii o~sp~s~~ba 7i 6 ~ ~ I --~,,~ -~' Cry JL/' i ~ iO~~~JS1f~ //' ~~; ~~ ®r~~ 4; .° -~r~r~ N~ c-Q7~ ~~~~~ ~C C' ~ Uti~ .,d L " \ ~___ ~a ~!`- . ql,~r ~-~, ~ o~ 5T o~ I~ ~S~ ~ ~~'~. I-~ ~ ~ ~ ~ ~/ ~~1 ' I ~~~ SEPTIC 'TANK ~ °L'MP CHA~:SR CROSS SF:C:?L`~ Ati~ S~iCIr'I~:P.'1'1'J.ti~ 4" ~~CT~ U~EN•T•~i~IPE.~.1.2" M~N•-,`~-BQV,E GRADE ~ >_ 2S' FROM D40R, WINDOW OR " FRESH AIR INTAKE FINISHED GRADE 4 " C I RISER ----• 1.8" IN. 6" MAX. NLET i f~"~'1 J - WATER TIGHT SEALS ~.,. A ~~RavED -~. IPA 3' --~.- NYO SOLID ~ C OIL PUMP OFF ELEV . _~__ FT. --•~-~•~ D ~tEATHERPRQOf JUNCTION HOX WITH CONDUIT ~~'1 i ~, t~ ~ ~i GAS• ` TIGHTS ~, SEAL r I ~ 4N OFF APPROVED MANHOLE COVER W t PADLOCK E WARNING LABEL ~r e4 /APPROVED JOItVTS WItH APPROVED PIPE 3' OKTO SOLID 50Il. *~ RISER EXaT PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED_ BEDDING UNDER TANK CONCRETE FAD sP~clFZCATIONs 5E?TIC / DOSE TANK MANUFACTURER: f~,'~s~~- NUMBER LOSES PER DAY: y ~+w^+w n • TANK SIZES : 5EPTIC ~_... GAL. DOSE ~,~Q -GAL. ALARM MANUFACTURER: Lau~~a.v-1.-~ _.r._,._ MODEL NUMBER: ~~ r~ N ..r.~.'r SWITCH TYFE: . _ ~~r PUMP MANUFACTURER: la•aa~;/ ....._... MODEL NUMBER . ~~ a ~ ~~ SWITCH TYPE: ryrtr~ REQUIRED DISCHARGE RATE ~„_ GPM DO5E VOLUME INC LUDING F LOWBAC K :~~Z?~,~ GAL CAPACITIES: A = ~ INCHES ~ _„~ GAL. B = ~ INCHES = -3GAL, C = 8 INCHES =GAL. D = ,,,,~, INCHES = _•_GAL • PUMP ~ ALARM WIRING AS PER ILHR 16.23 WAC V ERTICAL DIFFERENCE BETWEEN PUMP GFF AND DI STRI 9UTI ON PIPE ~ FEET + MINIMUM NE'T`WORK SUPPLY PRESSURE ~ FEET + G~~ FEET F4RCEMAIN X ~, FTJ100 FT. FRICTION FACTOR ~ FEET TOTAL DYNAMIC HEAD = 1,,~•S7 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH DIAMETER _____„M LIQUID 13E'PfiF~ °' ~~,~ /,s~,~ ~- < , SIGNED: ~I, ` ~•=--~~~~ LTCENSD NUMBER: ?~?~At~ DATE: ~, ~' ~•~ ~, . 1/88 ~GOULDS PUMPS APPLICATIONS Specifically designed for the following uses; Effluent systems • Homes • Farms • Heavy duty sump • Water transfer • ikwatering SPECIFICATIONS • Solids handling capability: '/•° maximum, • Capacities: up to 60 GPM. • Total heads: up to 31 feet. • Discharge sae: 1'/~" NPT, • Mechanical seal: carbon- r~tary/ceramic-stationary, BONA-N elastomers. • Temperature: 104QF (40°C} continuous t40°F (604C} intermittent. • Fasteners: 300 series stainless steel. • Capable of running dry without damage to components. Motor. • EF'04 Single phase: 0.4 HP, t 15 or 230 V, 60 Hz, 1550 RPM, bath in overload with automatic reset. • EQ05 Singgle phase: 0.5 HP, 115 V, b0 Ii~,1550 RPM, built in averload with automatic reset. • Power cord: 10 foot standard length, 1613 S1TOW with three prong grounding plug, Optional d0 fool length, tti/3 S1TW with three prong grounding plug (standard on EP05}. 0 2000 Goulds Pumps ENective February, 2000 936)1 • Fuity submerged in high grade turbine oil for lubrication and e~cient heat transfer. Avallabla far automatic and marwat oparaRion. Auto• matlc models include Mechanical float Switch as~selnbled and preset at the factory. FEATURES ^ EP041mpedler: Therrropias- tk Semi-open design with pump out vanes for mechanical seal protection. METtiNS ,FEET 9 7 s s 5 0 ~ a 3 2 i 0 Submersible Effluerrt Pump 3871 EP05 ~ EP05 Impeller. Thermoplas- tic enclosed design for improved performance. Casing and oaae:Rugged thermopiastlc design provides superbr strength snd corrosion resistance. ^ Motor Housing; Cast iron for efflcfent heat transfer, strength, and durability. ^ Ailoto~ Cpver; Thermoplastic lover wkh Integra! handle and Nast switch attachment points. ^ Power Cable: Severe duty raved o~ and water resistant. i zs ,._ _., .. ~. ~ _:. • Bearings: Upper and Tower heavy duty ball bearing construction. AGENCY USTlNG ~,' tarrdlrn st+~dards Aswcfatlon (CSA listed mode! numbers end in "F" or "C".) Goulds vamps ~ rso 8001 mss. -# t-5 GPM { 2.5 Fr~ . . ; zo _ ._.. ;. _ .. _ _' `` j t5 .._.._..._....,. ~..... ,..._...._ ---- Enos ~.. _. E ` ._ °0 1U 20 3n as so G-M 0 2 4 6 6 10 ____ 1'2 m3/h cAr~ncltY Goulds Pumps iTT Industries ~..~. u~c~r4 STANDARD CHAMBER Quick4 Standard Chamber 51DE VIEW MultiPort End Cap ~~ ~ `~ r- - r~ ~ y_--- f~ ,,~ ~ , ~ ` ~ ~~ I err ~ ~ ~ ~ J ~ , ~ .~ ' ~ ~~ ~ (~ 1 ,' r I ~• 510E VIEW FRONT VIEW ,y+ " 'a ' M~r~ ,a , S ~~' ° 3 ~' d,'4p~S~ t";~, _~, rw,n.~ _~ ~ Qu~ck4 Standard~Chamber Nominal S ecif3calions'~ Size W x'L x H 34 x S2" x 12" "~ Effective length 4S" Invert Height S,r TOP VIEW J / %~ FT'r .nd Cap Nominal Sp~cihc~fipns`~ ~~ ~'~` T ~: x H) . -. ,,. `,34" x 18' x 12" Mc Invert Height - S" or 1.25" INFILTRAi'OR SYSTarMS INC STANDARD IT WARR~I~TY la1 The structural inloyrity of each onamber. end plate. wedya and ether acrn~sorr mar"rtac'tun# by UrNerela ("Units"h w1>e?t a~sta,kxi and -mar~5d ki a ICacrdield of nn onsep snplic system in accortlar?ce ,oath intdlraor's trrsr7Naip:?s ?s warranlad to aha nriyval Purchasar ^addar", against dsfecuvp nuYerials and wurkmansRip for a,e year !mm ft>e dale that tha septic penrul a iseryd fa' the snplic syslam ccxtladtir?g Iha Urals: proved, hawauar, that A a snplic permit is rrat requirr7d by apPkca[de Iaw, the wa rsMV period wllf tx3gin upon tho date Uwl imlallatiun PI II>e sephn syst?~? cpnvnenpas. -TO a~slrlse its wananly nghts, Hodder must rgfify InGNralor ar wrifin{f at its Gnpnrala 4leadcl nrtrK in r7kf Saybo;Dr, CAtrx?gc;tsaR w,?I:In Gfleen (15) days, of II>B idtayetl fleteGt. nOflratOr Will syg'xy rL•paCprf?[rA Uririg idn Unii:; delarminvv try M:lirakx ;u bn coverad by this LIm.tT7 Wananly. inii:tratur`5lial;hiiy Spa ,ificalry excludes the r]091 Pf removal andinr irstahauon of the Units. ii)i IHL LrM1T[D WARRANTI' AN[i REVIEOIES pV SUNpAFtAOAAFH fat AR .::XCLUSIVE, 11 IGRk ArtE nlp Otr1ER WARRANT1Eu Wirn~ RESPECT r,,) rRC JN TS, iNl,l ~U1N~s N(i IPARUEO WARRANTIES OF h1ETiGHAfJTAFS1417Y OR Ftl'Nt Rlk A PARTICULAR PURPOSE. Ica 7 its I ImtloC Warranty shall I a vrid ii any part W ttte chamber system 's n ~u?u:arAUre n rry_nrx: other Then MWlraloc The i 4nrtad Warranty does not EttE~nd to irc denial nose ir?aniial, spacial pr indirect damages. Inlillralo -shat{ rIW be hahia for per?alih?.^, .x hquitfalr# darnaya +ncWding iOSS W ex~eded Iran ~n~f loaf Warrarairyocovorage are tlam~ga ~o the Unilfsatluet ~udinary wear arxf !ear, ae alto a accidanl ymisuse, abu>i6ieglect o! IhP. Uri'~,ts : !no Units haing subjo-.:ted to vehiWe Iraaic or Whar Wntlilipns Whktt are not 4~ermillr# by the Installation in5lmchdr\5: failure to maintain the minimum grotno covers net iPnh in the irKlallalion InstfaCliglS; the placement n} imprUPw matenal5 into the Syslern Contalnirg the UnAS; Itiure of Ina Units a ale septic si slam cue to imprpper silirxj br rnprg78r sizing, excussh+e water usage xnpr;7par graasa disp(15ai, or inpropar r?(rration; cK any other avant not causEd by InfrlvaWr. This i_imatw Wananly shall be vbrcf if 1ne HoM1da la!IS t:? campy wish all S iho ferm,¢ sal torah in this tfmiled Wanant y. Ruthar, in no e+cnl sha:i Inflllralor ba resPOnsitye la any toss or rfunaga to tfM rroidar, raw Units, or any tnln 7 pang rasu¢vn3 Iran instanalion or ah,p- ment, ur ttom any product Ila[7111IY claims of Holder Of any Mird pony Fnr Thu I_imd W Warranty to apply, the Urals mtsi 0a inataded !0 ~cprdddca wish ax sate :anefifk7ns requiran by s:a[e arKl boat Cod+ls: alt JIPMr applicable laws, and Inflbaior`s u'~stallattrJn inslru0ticns. jd' Nu rr'LNfiGr!r?talive ul bbiitralw has the atltlxuily b uunnya ur a"tor~tl This Elinor.} Warranty. No wanvxy applies Ic. any party Wl!er than Ure nriry- nal Hnidar. TY:o aupve mPrase;?ts u,e Sta?Card Lrnulan Vyarrany okaron 5y InlAirator. A lir nitucl rwnV,er M stab and cnt.,xws have oiUarrxrt warranty ruguire- mcrNS, /4,y purU~sur w Urdu should Cdrdact Mfilirator's Corporate Flaadriunrlars in Old Saybmolc. Connacli,wl, poor to suuh pwcna:a, to oGlain a ropy e' Irta applicable warranty, any should carelufy read that 'warranty prior to the nrrcchase of Urlils. SYSTEMS INC ~ Ernrlr~nmentaJ Oeslte Wastewater Sdution5'" 6 Business Park Road • P.O. Efox 768 Old Saybrook, CT 06475 860-577-7000•FAX 860-577-7001 800-221-443 U. S. Patents: 4,759 661; 5.Ot?,041; 5,156,488; 5,936,017; 5,401,11fi; 5,401 450; 5,57 1.90.3; 5,716.163; 5,588,778; 5,839,844 ` Canarkan Patents. 1 39,959; 2,004,564 Other patents pending. l~J{Wll~l Intiltra or, Equalizer a. d SIdeN/finder aro Yeyialered trademarks of Infiltrator Sys tm, me InhLrator is a regisferod trademark in Fr~ice. Infiltrator Systems Inc. i5 a n;gistered tradenl3rk # M8xrC0. (i01'tOllr, l:oni0ur SwNel CprinOCtlOt1, MICIULeiACitilly, Pnly?uf!, SnapLOCk, ChambefSp3cer, Pasii_ock, GurckCOt, C~uickPlay AECYCCEp PAPFR and Qujck4 are trademarks of Inliilrata SyStemS Inc. Qa 2003 In`dtrata SVS1anU hr. Pnnfad in U.S.A. ~....,............ SECTION VIEW I Soil Test Plot Pl RECEIVEQ Project Name Sue Pedersen S Bir qpR 2 8 2005 Address 1506 Park St. #7 White Bear Lake Mn 55110 sz cROilcco cEY M #22690 Lot Subdivision ------- Date 11 /20/01 NE 1/4 NE 1/4S 32 T 29 N/R17 W Township Hammond Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" Pipe System Elevation 92.8 *HRPSameasBenchmark Alt. BM Top of 2" Pipe @ 99.9' Ali B.M. Not enough slope to 10' 10' establish contour 45' B-3 lines Cou Road J 30' <1% Slope 95' 600' B-1 B-2 20' Pro 3 i--~-. Bedroom 630' House (,(la.a~ -1 ravv~ ~ rb~ i ~.~~~~ ~ emu. Yl/~y~-~-~ ~3~'l i 5~~~,w»~.a~ _, 170th St. ~~ Z ~'(~ ._. .. S /~~wc.Q,~' l~i~.t~ ~4 ` ~ ~ ,/ten-cam ~~~il~-' ~ . ~ Soil Test Plot Pl. Project Name Sue Pedersen S Address 1506 Park St. #7 / White Bear Lake Mn 55110 ~] Lot Subdivision NE 1/4 NE 1/4S 32 T 29 N/R 17 W Boring 0 Well PL Property Line BM or VRP Assume Elevation 100 ft. Township Hammond County ST. CROIX T®p of 2" Pipe System Elevation 92.8 *HRPSameasBencnmarK Alt. BM Top of 2" Pipe C 99.9' 30 B- 630' Pro 3 Bedroom House RECEIVED Bir APR 2 4 2005 ST. CROIXCOUNTY ~ -, ICE Date ~ 11 /20/01 Not enough slope to establish contour lines B-2 600' ~ Viler ~%fG'~?r~r~2_.- s~ r~ y6~( 13~~~ ~ sU,~~ lUv~' ~~ld ~~ d .~ y SST S~ldvc.Qal ~~-- ~" Road J Alt 20' B.M. 10' 10' 45' B-3 <1% Slope 95' O ~ ~ 15 ~ U HUl7 ( Q ~ F _~ e ~ ~ - ,>,~ H H Z N 3 z -~ o 0 D m 0 m O ~ O m D ~ o O m 0 O O ~ ~ •`. ~. m 41xD~ ~ H ~ A z Z ~ C7 ~$~m r~ ~ Z f..~ 3 m~ o nm z ~~ 3 -~ m m H Z O H m~ -~ a H C] N n D r m F.. II o ~~ I~ fT1 ,v I~ i~ Vl Z v ',/ ~.~Z '~_ BEARINGS REFERENCED TO THE EAST LINE OF THE NE i/4 OF SECTION 32, ASSUMED TO BEAR S00° 37'11"W. m m H ~ m nm `$ N c ~ ^~ - ~'~ N tD ~ NO ~~ .~ lD ~ O O SJ~~ ~ m ,_ ~cDi~ nD . - n~ N -~mm-~~m ~ . T~ ~ ~ pp O~ v N ~ ~m{g ~ ~ UIVPLAYTED LANDS S00°37'11"W 250.00' N00° 37 ' 11 "E 184.00 ' ~~ias~ 'tiJ'~L ~5 ~°~~IEw:. 4250 I~.A7NE:~~ H. WALSH -"-"~"~~~~ kEGISTEFt OF DEEDS aT. CROIX CO. WI RECEIVED FOR RECaRD 0~-15-2002 14:04 AM CDPY FEE: 3.40 RECDRDING FEE: 13.00 32 ' `t' 6'` /r~U~ V 3~ ~~ ~~~ ~" /~ot`°~ / ~ ~ ~ ~~/ " `~' ~ oor-i-i ~.n ti-i ". ~ '~. n Hm~~m ~> - ~ '? ~ ~ z~- m ~'° L ~T ~ ~"' oc~nrr :„ u: tv :~ ~ ~ m~~(n~u'zo -- v 3 CAF R ~: ~ ~v~ro (~ ~~°~Z rn ~° ~ r~~rmg l0 I~ Z~~D~ mrn ocn ~~ o(~] ~m 41 IL $0371D ~ ~ m -' 0 ~~ °~~~n n ~ ~ m • NZ~O ZQOt-iZ ~~1H Z~ OTI[Ai.+ 3O m~rno E~m~ r. -=i~~ rnoo i~~ ~~~ zn~~ omH ~~Z < Gl / _ G?~ :T G) ~~h~~. ~ ~~~. y ~~ OE Y ~rn~~ °m... i w ~ m 3 O ~~o=-+ m o--' 's o ~ N H ~ WO1Arn to o m ~~ ~ A Nan ~rn~ Hm mrm oy~ zrm o~~ O H .... D O OZ N ~ (~! i ~ 47 to • ~ N A ~~~ to o~ ~ ' Rl Cil cn N S 00° 37' I I ~~ W _ - 198 .40 ' ,,, 0° 37' i E "~!U 66.00' ___ ~6-- - -- ~ W S00°37'11"W ~ 0 66.00 '$ ~ 580.18' / Z D 00 H 3 Z ozrn - Zm ~m ~~ ~~ X~ m ~v o m (/~ ~m C _ /~ --~ ~~ O ~ Z zn . ---i o Z W IU --1 IU CO Z v f _~ . Wisconsin Department of Commerce Divi''4on of Safety and Buildings SOIL EVALUATION REPORT ~( 2ae ~b ~7 Page ~ of Counry~ ~ ~ Attach complete site plan on paper not less than 8 1!2 x 11 inches in size. Plan must r O / include, but not limited to: vertical and horizontal reference point (BM), direction and l i i i Parcel I.D. ~ !i ~ percent slope, sca ons, north arrow, and locat e or dimens on and d stance to nearest road. , ( Please print all information. 'Review d Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ;~• ~~,~;C-~/'~,~,L ~' .C 2 ~i~ Property Owner ~ ~e Property Location L t G 1/4 /i/ 1/4 S~~ T N R / ~E W (,L Q~ r ovt. o ~ (o Property Owner's Mailing A ss // J_ ~ Lot # Block # Subd. Name or CSM# r ~f~ ~'~~ ~ ~-. ~ l~` .ST ~'~J 7 City Sate Zip Code Phone Number ^ City ^ Village Town Neare Ro d New Construction Useesidential / Number of bedrooms ^a,~ Code derived design flow rate ~/ -~U GPD ^ Replacement ,.s7 ^ Public /or commercial -Describe: Parent material (~~-~ L~/c~ Flood Plain elevation if applicable /'~' -ft. General comments / r..- ~ ~i 3~~avuL st- and recommendations: ~ ~~T '~'"~`~ ~ /~ v~~'l~ ~~ ~ .i~*„ ~n ,' ~ ~y ("-~ v ~~~ ,;, ~. Boring "~ Boring # ~ /~'~~ cry pit Ground surface elev. ft. Depth to limiting factor / dF. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure ;Consistence Boup> oots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EfF#1 *Eff#2 1 / ~ l" ~` .--~- /~ ,~ 2. ~ '- mss/ --~ ~ ~ .~' ~ s ~~- ~ -- S .~ ,J w ' ~ ~ ~ - 2 s ~ .--, s ~ ~~~ ti,-~ . S' - Boring `~•-- Boring # / ,~. Pit Ground surface elev. ~ft. Depth to limiting factor / ~ ~in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EfF#2 j Ci- 3l Z '-~ ~' ~~ ~~ ~,µ- .S- Z- 1 ~"3-~ ~ -5' ~" f/~ /' ll~ ~ f~ - J r".~ ''- S ~v / ~~ ~ S ' - trrwenr ~~ = es~us ~ su < zzu mgru ana i ss Hsu _< ~ 5u mgiu - crrwem ~z = ~ws < au mgiu ana i ss < su mgiu CST Name (Please Print) 'nature CST Number Address , Date Evaluation Conducted Telephone Number ~~~~ i~~~~',-~~~~~~~~ w.~'~li '.s~~ ~ ~/,~v-61 his-~~.~-Y~i ~Rn_R~~n rumron~ . ~ Property Owner n ParcellD # Page of .> ^ Boring ~ Boring # Pit Ground surface elev. ft. Depth to limiting factor `vin. 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 /~ /J `z 1^-3 ~6 'G ~S ~------~ S ^ Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ^ goring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) r Property Owner Parcel ID # Page of Boring Boring # Pit Ground surface elev. ft. Depth to limiting factor .. ain. 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 'Z -3 ~ o ~5 .~---- .3 ~ l ~~.~ ~' .s' ~s ~` % ,. Boring # ^ Boring ^ pit Ground surface elev. ft. Depth to limiting factor in. Soil Appligtion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2 * Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SB0.8330 (R.07/00) ,• • Soil Test Plot P1 Project Name Sue Pedersen Address 1506 Park St. #7 White Bear Lake Mn 55110 Bird Lot Subdivision ------- NE 1/4 NE 1/4S 32 T 29 N/R17 W Boring Q Well PL Property Line BM or VRP Assume Elevation 100 ft System Elevation 92.8 Alt "' ` 'C~STM #226900 Date 11 /20/01 Township Hammond County ST. CROIX Top of 2" Pipe * H R PSame as Benchmark .t` ~~~, Wisconsl:r Department of Commerce SOiL EVALlJAT1aN REPORT Page. of Division of Safety and 8uiidings ... r,,..~,.,,a,.,,.~ v....,.......,.., ~~...,~_ ~~.... ~.W~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County ~ r~ include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel 1.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. /L ~ Please priint a!! inforrnafion. Reviewed by Qate Personal information you prov!da may be used fnr secrondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner ~( ' ~'?~ Property Location 1/4 1/'1/4 S~~ T W N R ~ ~E .,~ ~ , Govt. Lot % {o Property Owner's Mailing A ss Loi # Block # Subd. Marne or CSM# // )) City State Zip Code Phone Number (~ City ^ Village Town Nearest Ro d New Construction Use'.-~tesidentiai / Number of bedrooms Code derived design flaw rate `'~ ~U GPD ^ Replacement ~ ^ Public~or c`ommercial -Describe: Parent material '=~LG~'4'~,~lcid/"' Flcod Plain elevation if applicable ~/~ ft. General comments ~~~~~~ ~? ~~ vc~-~~ ~~ and recommendations: Boring # t.J Boring ~~' pit Ground surface elev. ~ ft. Depth to limiting factor / J in~ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfftz in. MunseA Qu. S•r_. Cont. Color Gr. Sz. Sh. 'i3ff#1 'Eff#2 1 _ ~ r '1~ - ~ ,;s. a ! • f .fib'' >- ~ '^T' ~ ~ ~ rv ~ - ~ 1. 2 ~"'~ Boring # u Boring -z. ,~, Pit Ground surface elev. ~ft. Depth to limiting factor,~~ ~-'in. Solt Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consis#ence Boundary Roots GPDift2 in. Munsefi - Qu. Sz. Cant. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 "Effluent #1 = GODS ~ 3©< 2t0 mg/L and TSS >30 _< 150 mglL `Effluent #2 =GODS < 30 myiL and TSS < 30 mglL CST Name {Please Print) 'nature ~~ C Number Address / /`~ Date Evaluation Conducted Telepzh~one Numb~e`r ~/7'Jy .•~~~-~i.L! >~~...~'~~r1','~(~~~,!,~.~/~ 2Z^.- r'%~ 6~~ l~/~;~~ //~~C~~~f ~~J fc'~ ` ~ ~ ,J ~ a 3 ~~ ~ ~ ~ ~ • .9 Proj~~~t Name Soil Test Plot Plan ~~ Shaun Bind ,~' ,,, t ,~ ~ .~ Address 1506 Park St. #7 ~ i ~' White Bear Lake Mn 55110 CSThvI #226900 Lot Subdivision ------- Date ~1~1~/20/01 NE 1/4 NE 1/4S 32 T 29 N/R17 W Township Hammond ® Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 2" Pipe System Elevation 92.8 *HRPSame as Benchmark Alt. BM Top of 2" Pipe @ 99.9' I 10' Sue Pedersen 30 B-1 n' ~5~ ~~,' B.M. 10' 45' B-3 <1% Slope 95' ~ Not enough slope to establish contour lines 600' ti 0 c 0 U ,I B-2 20' Pro 3 Bedroom ,•.-~""~' ~: House ,~ v y 9,,, ;' i~ ~ ~ 11+1 r~ 1','v,,~ ~l~a C'_'" a ' i -o, ('~ 'V15 , ~, ~,.: iJ ~ V ~~ 1, ~i ly~~ ~.e~~• yi.rlJ~~~ ~~ ~ lI~,i~~,~1J~ ~Y'~~~,~f uJ~~~~ ~1 i \5 1 t. • ~ ST CROIX COUNTY SEPTIC TANK MAFNTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer s"~i ~- ,1' ~ r~.J ~e ~ ~.d~~ a~ Mailing Address ~d a ~ / ~l~ r~y~ ;~,t,~~%~`..~/ I~r` ~yD'~ ~ Property Address ~ ~ ~ l 74 (Verification required (roar Planning Department for new City/State ,~a~~~',~~~r, Parcel Identification xumber ~ ~ ~' ~0 70 ~ ad v ~0 d LEGAL DESCRIPTION Property Location ~ %., ,~~ t/,, S$c. ~ T ~~' N- ~ W, Town of ,~.c~ ti~ 6.,v c~ Subdivision - _. Lot # ^/ Certified Survey 1Viap # , ~~i°z~T ,Volume ,,,_,(~.~,, Page # - ~,~ S~ Warranty Deed # ~ ~ ~ ~~~ ~ Volume a~ ~ ~ _, Page # 3 3 ~ Spot house ^ yes ~, no Lot lines identifiable dyes ^ no ~~~ MAIN_TENANCE improper use and maintenance of your septic system could result is its premature failure to handle wastes. Proper maintenance Consists of pumping out the septic tank every threw yoars or sooner, if needed by a licanscd pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a cefification form, signed by the owner and by a msstCrplumber, journeymanplumber, restrictedplumbcr or a ticenscdpumper verifying that (1) the on situ wastewaterdisposal system is is proper operating condition and/or {2) aRcr inspection and pumping (if necessary), the septic tank is less than ll3 full of sludge. Lwa, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by flit Deparbaicnt of Commerce and the Departrncnt of Natural Resources, State of Wisconsin. Certification stating that your septic system has been tnaintaiaed must be completed and returned to the St. Croix County Zoning Office within 30 of the throe y x " tioa date. ~ Jcl~l ~ SIt3NATURE OF APPLICANT DATE OWNER CERTIFICATION • I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (wc) am (are) the owner(s) of the property described a e, y virtue of a warranty deed recorded in Register of Deeds Office. / ~ SIGNA OF APPLICANT DATE «,~«««« Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. «««««« «« Include with this application: a stamped wat~rattty deed from the Register of Deeds office a copy of the certified survey map if reference is made fn the warranty deed POWT'S OWNER'S MANUAL & MANAGEMENT PLAN Page ~ of ~7i FILE fNFORMATION Owner ~ i:~.R.. ~„ ~~, Permit ~ z3 DESIGN PARAMETERS Number of Bedrooms ~ ^ NA Number of Fublic Facility Units ^ NA Estimated flow (average! ~ gallda Desig+i flow speak}, (Estimated x 1.5} ~-~ gal/day Soil Application Rate al/day/ftZ Standard Influent/Effluent Quality Monthly average" Fats, Oil & Grease (FOG} S30 mg/L Biochemical Oxygen Demand (BODSI 5220 mgfL ^ NA Total Suspended Solids lTSSI 5150 mglL Pretreated Effluent auaiity Monthly average Biochemical Oxygen Demand (BOD51 S30 mg/L Total Suspended Solids iTSS) 530 mg/L ~NA Fecal Coliform tgeomeiric mean) X10° fu/ OOmI Maximum Etfiuent Particlo Size YB in die. ^ NA Other: ^ NA iValues typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE SYSTiEM SP'ECIFICA'TIONS Septic Tank CapaCitY Q'~ (~ dal ^ NA Septic lank Manufacturer ires~ ^ NA Effluent Filler Manufacturer ~6 ~ ^ NA Effluent Filter Model ~ ~d ^ NA Pump Tank Capacity ai ^ NA Pump Tank Manufacturer sey DNA Pump Manufacturer ~aG ~ ^ NA Pump Model ^ NA Pretreatment Unit ^ Sand/Gravel Filter ^ Mechanical Aeration ^ Disinfection ^ Peat Filter ^ Wetland ^ Other: ~NA Dis er 1-Ceil(s} n-Ground tgravit O At-Grade ^ Drip-Line ~ O NA / In-Gro nd tpres urizsdl -- ^ Mound ^ Other: Other: ^ NA Other: ^ NA Other: p NA Service Event Service Frequency Inspect condition of tankisl At least once every: ~ monthts) {Max>hnurn 3 yearo) ear(s) ^ NA Pump out contents of tankts) When combined sludge and scum squats one-third tY3) of tank volume DNA Inspect dispersal celits} At least once every: ^ monthts) IMaxirtwm 3 years) .~ ~' ear(s) ^ NA Clean affluent filter ~~~~~ At least once every: montlrta) / ~ year(s) r t ^ NA Inspect pump, pump controls & alarm At least once every: -+ ;~. ^ month{s} ^ yeartsl ^ NA Flush laterals and pressure test At Isast once every: ,..~ ~ ^ month{sl ^ yeartsi ^ NA Other: At least once every: a year{s}ts} ^ NA Other: ^ NA MAINTENANCE INSTRUGTIQNS inspections of tanks and dispersal cells shelf 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 tankis} 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 ~n any tank equals one-third fY,) 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 chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of S12 months. shall be performed by a certif'~ed POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATtON 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 ceN(sl. If high concentrations ark dstecied haY.a the contents of the tank{s) removed by a septage servicing operator prior to use. System start up sfiatl not occur when soil conditions era frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater wilt be discharged to the dispersal cell{s} in one 4arge dose, overloading the cell{sl and may result in the backup or surface discharge o1 effluent. To avoid this situation have the contents of the pump tank removed by a septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls tc 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 are2 within 15 feet down slope of any mound ar 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 straps; 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 i; property and safely abandoned in compliance with chaptzr Comm 83.33, Wisconsin Administrative Gode: • 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 d'osposed of by a septage Servicing Operator. • After pumping, ail tanks and pits shall be excavated and removed or their covers removed and the void space filled wit/ soil, gravel or another inert solid material. CONTINQENCY LAN If the POWT fails and cannot be repaired the following measures have been, or must be taken, to provide a code complian reptacem 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 b~ required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wil result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems mus comply with the rules in effect at that time. ^ A suitable replacement area is not available due to setback and/or soil {imitations. Barring advances in POWT; technology a holding tank may be installed as a last resort to replace the fatted POWTS. ^ T site d sits e tan ^ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at th infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNINO> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DU NO' ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF ~ PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER Name ~r~s~/.~u ,,,~~ ~BY~ y~~ L Phone ~ / - _ ~ ~~ POWTS MAINTAINER Name Phone SEPTAGE SERVICING OPERATOR {PUMPER) LOCAL REGULATORY AUTHORITY Name Name ~r ~D~~~¢~/I/Gf ~~J~ Phone Phone ~] (S ' (p. ~ Q This document was drafted in compliance with chapter Comm 83.22(21{b)i11(dl&If1 and 83.54;1), {21 ~ {31, Wisconsin Administrative Code. U; 2?97P 332 DOCUMENT NO. + ~~ , STATE BAR OF WISCONSIN FORM 16-1982 TRUSTEE'S DEED Gene and Audrey Aune Revocable Trust, Gene E. and Aune and Audrey J. Aune, initial trustees, or either of them acting as sole trustees, with full power to convey for a valuable consideration conveys without warranty to I)~ect A- arYi Susan C. Pederson, Grantee, the following described real estate in ST. CRO1X County, State of Wisconsin: Ld'iC.L.G - (SEAL) ' Audrey Aune Trustee M~EPENDENCE STATE BANK p~ Not MsnomonroSt PO Box 325 OI Mound. Uli 5473>a Tax Parcel No: OIS-1070-20-100 Lot 1 of Certified Survey Map, recorded in Volume 15 of Certified Survey Maps, Page 4250 as Document #671287. Located in the NE 1!4 of the NE 1/4 of Section 32, Township 29 North, Range 17 West, Town of Hammond, St. Croix County, Wisconsin. Dated tgh~is day of~A.p~+1~2005. ~~+-~ ~ (SEAL) '" Gene Aune Trustee Signature(s) AUTHENTICATION authenticated this day of Apri1,2005 TITLE: MEMBER STATE BAR OF WISCONSIN (lf not, authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY (Signatures may be authenticated or acknowledged. not necessary.) *Names of persons signing in any capacity should be typed or printed TRUST'EE'S DEED Ylli Vision Fofm SDDOtWI Rev. 07/09/86 7 9 4 1 9 9 /~ KATHLEEN H. MALSH REGISTER OF DEEDS ST. CROIX GO. , MI RECEIVED FOR RECORD 05/05/2005 11:20A1f TRUSTEES OEEO EXEIPT ~ 8 REC FEE: 11.00 TRA?1S FEE: COPY FEE: CC FEE: PAGES: 1 ACKNOWLEDGMENT STATE OF WISCONSIN ss. ST. CROIX County ~~/(~~,~ Personally came before me this y - -day of Ate, 2005 the above named Gene Aune and Audrey Aune to me known to be the persons who executed the foregoing instrument and a+Ptlcnowled¢e the same. _~-. c8 ~' .~ :- ~'~ y Cotnmissimi r.) ri - = .. F ~ fi`s ~' , ,~~ ieir si~t6rZ5'. ;.~-~~unty, Wis. is permanent. (If not, state expiration date: - ~ ~a ~ File # 05000865 Parcel #: 018-1070-ZU-~ 0~ 04/20/2005 02:55 PM PAGE 1 OF 1 Alt. Parcel #: 32.29.17.484A-10 018 -TOWN OF HAMMOND Current X i ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): " =Current Owner *AUNE, GENE E & AUDREY J TRST GENE E & AUDREY J TRST AUNE 1708 CTY RD J HAMMOND WI 54015 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description * 686 170TH ST SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 2.05 Plat: 1431-CSM 15!4250 018/02 SEC 32 T29N R17W PT NE NE BEING CSM 15/4250 LOT 1 2 050AC Block/Condo Bldg: LOT 01 . Tract(s): (Sec-Twn-Rng 401/4 1601/4) 32-29N-17W NE NE Notes: Parcel History: Date Doc # Vol/Page Type 07/02/2002 683242 1921/44 QC 02/15/2002 671287 15/4250 CSM 2004 SUMMARY Bill #: Fair Market Value: Assessed with: 56558 Use Value Assessment Valuations: Last Changed: 07/14/2004 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 2.050 200 0 200 NO Totals for 2004: General Property 2.050 200 0 200 Woodland 0.000 0 0 Totals for 2003: General Property 2.050 200 0 200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Nov 29 01 11:24a Joseph Granberg [7151 246-4598 p•1 ,~~ ~a~r'~~ 1/e~e~sa~ ~" S~yS ' Ivo~ ~ ~'h,'S oL fie.!) ~e r-~' yov 71~w, k=S ~iS_z~/6 -~s~9 0 ~,. a w ~ o z o ''' n to n a r m o: 0 0 ~- ~i o ~ C D O N O N ~ ~ cr < <+ m .. m m N .. fD a •' .. ` N u ~o ~ ~ a N O O C ~ ~ d ~ ~ O m ~ ~ ~3'~,' '~j J ~ ~~ ~~ 5 ,- ~~ z . ~ 9y- ~//Sc~ 763-65'y - 4//~ ~~^~ _._ 671287 ,4~i~L. ~5 F•A~~ 4250 1%ATHL:EEK' H. WALSH kEGISTEk OF DEEDS ST. CkOIX CO. WI RECEIVED FOR RECdRD 02-15-200 10:00 AM CORY FEE: 3.00 RECORDIRG FEE: 13.00 -- ^ x N 0 n i m v L ~i m ~~ i Z'- BEARINGS REFERENCED TO THE EAST LINE OF THE NE i/4 OF SECTION 32. ASSUMED TO BEAR S00° 37 ' 11 "W . O O O c~ >? a .D H n N n s r m IV O O ii ~..~ O O • -~{ •' `~ rn Wxa~ N H NAZZ H O ~ ~~°~ r~ ~~ o z o~ -.~ O H m~ -~ v ~O fZTt O ~ ~ ~ ~' a m c n ~ ~ ~ ~ o,-°~ o ~- t`~irn~m ~ ~!o UNPLATTED LANDS S00° 37 ' i i "W 250.00 ' ~ m ~-+ ~ ~ m 11 tv ~ ZNO~Nm G~ N o u~ ~n I'Tl $ ~7 cn o ~DD~aD ~J~ ~`~ ~ ~ tv i~m mm -t1. ~ N -tt ~ to d N m V ~v ~ ;.. N t 1r m i ~ ~ g ."~ I /~ ` { '~ ~ NOC° 37 ' i i "E 184.00 ' ,v -~-, ~ ~v ,~ d ~ ~ ~~ ,- C _ ;, ~; „~ O i° •. ==~ ,~~. ~ ti7 "~ ~ , T-- ~ • * _iy r ---..-y--- ~ ~. bi rn ~'? ~• ,..,~ N A ~m ~a~ ~r~~~777m `"' ~ H N S00° 3711 "W ,L ~ 1983.40' ,,, } ": ,; s' n: :; rn ~ `' A' °rnoo~ -, .' cn ,' n Q a~rn~~ '~ ,~ _, ~ ~ ~„ ;~~ C7 r~~ '; ~ -1 }~{j , C urea-~ N ~c~~~H --1 I Z ~ ~$~ a N I~ ~ D m pC~~~'O ~D~ `-' H `r ~, ~v ° cn ~~ ~~ ~ ~ ~ ~~~~ ~ 0 ~~~~ ~~cnr, . ~ ~ ;~ ~S~Z~ a F 3 ~~ O ~rO ~ ~ I~~ ~^ ~ -~ ~~$ 0° 37' i E "~N 66.00' _ _ _ _ _ ~~ - - w S00° 37 ' i i "W 866.00's ~ 580.18 _ n ~- nn° a~ •~ ~ ^F emeer w -I r z~ O ~ = H D Z 3 ~ 3 o ~' m m -~ nA T 0 0 1Ti x o -..) o rn (n ~m C H A O~ Z n . ~ H Z N tV Z v V`~\ ~ ^^ ^`V VVt•~ ~ ^ ^ • ^ LOCATED IN THE NE'/.OF THE NE'/, OF SECTION 32, T29N,R17W, TOWN OF HAMMOND, ST. CROIX COUNTY, WISCONSIN. DESCRIPTION: A parcel of land located in the NE'/. of the NE'/. of Section 32, T29N, R17W, Town of Hammond, St. Croix County, wsconsin, further described as foll6ws: Commenting at the NE Comer of Section 32; thence S00'37'11'VU 580.18' along the East line of the NE'/. of said Section 32 to the point of beginning; thence N89°22'49'VN 733.75'; thence SODc 37'11'VII 250.00'; thence S89°22'49'E 222.12'; thence N00°37'11'E 184.00'; thence S89°22'49'E 511.63' to the sad East line of the NE'/. of Section 32; thence N00~37'11 "E along said East line 66.00' to the point of beginning, containing 89,298 square feet (2.05 acres) more or less and being subject to any easements, restrictions and covenant of record. SURVEYOR'S CERTIFICATE I, Joseph W. Granberg, Registered Wisconsin Land Surveyor, hereby certifir that by the direction of the owners, Gene b Audrey Aune, I have surveyed and divided the lands shown hereon in accordance with offitial records, Chapter 236.34 of the Wisconsin. Statutes, the Town of Hammond Subdvision Ordinance and the St Croix County Subdivision Ordinance and 8~at this m~ and description are a true and correct representation thereof. THIS INSTRUMENT DRAFTED BY: JOSEPH W. GRANBERG DATED THIS 6TM DAY OF DECEMBER, 2001. AP~'E:~\~cU ~ 15 2002 ,,, a_:;:, .~t If n,,r ~~., ,",..,., ..., -y t.e aw10Y91 dJt.) d,~PU~~idl 5hn null u~xl v.iirl PREPARED BY: GRANBERG SURVEYING 1239 C.T.H.'E' NEW RICHMOND, W1.54017 PHONE (715) 246-7529 JOB N0.01-053 SHEET 2 OF 2 Vo1.15 Page 4250 I~$-c) MINOR SUBDIVISION APPLICATION ST. CROIX COUNTY - NOTE:. The submittal deadline for certified survey maps is the 4~" Tuesday of the month two months prior fo the month of presentation for approval by the Planning, Zoning & Parks Committee. The committee typically meets the 4~h Tuesday of each month. ~ ) (s~~n~rl~ SClfye.~,~nc Property owner C~e~C ~ Ac1G~f'~Y ~~ Agent (if not owner Mailing address /7~$ Cfy ~• -~ , ~-.-"''-ry"~ ~ Mailing address Daytime phone ~ I S " ~ ~ ~ - Z 3 ~ ~° Daytime phone /~ Address l Z 3c1 ~ • 7 /~ ; ~ E- " /~l~ ~'c h ^G^C7~ ~/~ - Surveyor ~rcn b~ S Survey Phone ~~S'"-Z~1C' ~Sz~ FAX ''// !"7 W, Town of NCti~r''G~r~ .Property location ~E 1l4 1J JE 1!4 Section 3 ~ T z ~ N-R ~4~ n~ No. of lots ~ Total acreage of lots 2 •C~s AC• Size of original parcel ~t Q ~ ~ - ~ Q ~ v ZD , t:~Zoning District of parcel ~^ •- k'e 5 Parcel Identification no(s). ~~ MAKE A SKETCH IN~THE BOX SHO I G HOW THE NEW LOT(S) FIT WITHIN THE ORIGINAL PARCEL i"' GAO ~g~` Sa~Q~,rQ ~ ^OQt, `~~ '3~ aaa\be ,..t~ er ot~cA~d~e ~~a`o°\a ~~aQptoJa ov~~ -+ ~1 ~ ~ . no sc~ a~; ~, Page number of the St. Croix C,9u~nty Soii Survey ~ Soii types - ~~ wc"TT~ c we Limitations l ~ ~ cie-c~, ~- r ~ .t s~~hml al to include: ll~'~~.~- ~ ~ ;~ ~~ ~ E:Y One (1) copy of the preliminary certified survey map ~ Applicable fees G]' Township approval (a copy of the map signed by the Town Chairman or a member of the Town I ~.. A copy of the soil test for all proposed lots not having a residence on the lot (soli test location to be shown on individual lots) ^ DOT certification letter if the proposed lot(s) is on a state highway ^ Road plans, if required. .r ," 1 ~ p~C~ pp,X g~~ -. ~~ya f~ a.. A preliminary certified survey map is to be submitted for staff review. The applicant/agent will be notified of any required revisions. A final map, reflecting all requested revisions, as well as town approval and soil test if required, must be submitted 10 days Prior to presentation to the Planning, Zoning ~ Parks Committee for approval. These deadlines are firm. The committee may approve, approve conditionally, or reject the certified survey map. PLANNING;.ZONING 8~ PARKS COMMITTEE ACTION Approves ~ Rejects Conditionally approves ignature of ee Chal-man Date COUNTY USE~~~ONLY ~. ~~ ~ y~ i = U ~plication accepted~,gnd completa,,~~," ~~`~ 1'., ~' gy" ~ifapdumber ~ ---- .. _... _ . 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