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HomeMy WebLinkAbout032-2172-04-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578928 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Kopp, Kris Somerset, Town of 032-2172-04-000 CST BM Elev: Insp.BM Elev: BM Description: n n r sT- SectioNTown/Range/Map No: 'V 1 1 18.30.19.1444 TANK INFORMATION -A� ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I I n�D Benchmark 00"V �� b 525 Alt.BM 'I �3 10- 2-5 Aeration Bldg.Sewer HeZ—ing SViHHnlet `1 TANK SETBACK INFORMATION StA*-Outlet b I r TANK TO P/L WELL BLDG. a to Air Intake ROAD D3t-tnlet U Septic �C) [�I I I I I-� I I n u�l Dt-8ettaFw-- _ Dosing JJ !V ` I I L Header/Man. �b, (�� A—er-allon Dist.Pipe I Z Holding Bot.System [� I TO, I PUMP/SIPHON INFORMATION Final Grade O 5 I�7 C�Q Manufactur � De d St Cover G 5 M Model N mber �, '� h L4.2 TDH Li Friction Loss System H TDH Ft 1 —10db (I 7b P Forcemain th Dia. Dist.to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width I L o.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS --- - SETBACK SYSTEM TO P/ /p� BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION T Of Sy st e CHAMBER OR Y g �� UNIT Model Number: u i L y r S� I 6N ON DISTRIBUTION SYSTEM Z S Header/Manifold I Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) l Length Diam Length Dia Spacing J / i n SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only (0 f f CC( Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes M No es Q No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 348 153rd Ave Somerset,WI 54025(NW 1/4 SE 1/4 18 T30N R19W) St.Croix National Southern Estates Lot Parcel No: 18.30.19.1444 1.)Alt BM Description= � (� ou( �� tf d' 2.)Bldg sewer length= l -amount of cover all vh6 Plan revision Required? Yes 00 Use other side for additional informati Vl L SBD-6710(R.3/97) Date Alnsep�ctoes Sigiliature Cert.No. o�yAan�r P"% County Industry Services D' ' 'o ,.W., , 1400 E WashVigtoruAvei - ° - - Sanitary Permit Number(to be filled in by Co.) APR s) P.O.8 2015 Madison,WI 53707 -- r 57 �� � to��� �o�, Olx cC7 Sane � t Application State Transaction Number In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit A7 is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address(if different than mailing address) purposes in accordance with the Privacy Law,s.15.04(1)(m),Stats. �{ n I. Application Information- Print All Information " r0� Abc_,,� Property O s Name / Parcel# Property Owner's Maili g Address Property Location _�,��b - i Govt.Lot City,State Zip Code Phone Number '/4, Section /fe (circle o ) r� T� N R E o(; II.Type of Building(check all that apply) Lot# 1 or 2 Family Dwelling-Number of Bedrooms Subdivision Name El Public/Commercial-Describe Use Q k t� Block# �. El �4 ❑ City of State Owned-Describe Use �'�� �- ❑ Village of f Town CSM Number 1 ( o �ss7 L,�s III.Type of Permit: (Check only ne box on line A. Complete line B if applicable) A. n New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) B. ❑ Permit Renewal ❑ Permit Revision ❑Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV.Type of POWTS System/Component/Device: (Check all that apply) El Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound?24 in.of suitable soil ❑ Mound<24 in.of suitable soil ❑ Holding Tank Other Dispersal Component(explain) ❑Pretreatment Device(explain) -��LLZJ V.Dispersal/Treat at Area Information: f v3 Design Flow(gpd) Design Soil Application Dispersal Area Required(sf) Dispersal Area Proposed(s System Elevation eAS Rate(gpdsf) 7/ VI.Tank Info Capacity in Gallons Total #of a E! ° Manufacturer 4 U 1, Gallons Units c ;; y > 2 New Tanks Existing Tanks 1./ pa �j 5 P. U rig . cn w 0 CL, Septic or Holding Tank v� S +'v ❑ ❑ ❑ ❑ Dosing Chamber I I I ❑ ❑ 1 ❑ 10 ❑ VII.Respgmsibility Statement- I,the undersigned,assume respopsibiljt4r installation of the POWTS shown on the attached plans. Plum Name tnt - / Plumber's Signa MP/MPRS Number Business Phone Number /->yi 7 Plumber's Address(Street,City,State, ip Code) VIII. un /De artment Use Only Approved Disappro Permit Fee Dat sued Issuing t Signature r Given Reason for Denial $ 'T� Z-7 IX.Condi#AT AWPVAWAReasons for Disapproval 3� �� eve t..:-Septic tank,effluent Mar and . .dispersal cell must all be sarvlcea/ late d as per management plan provided by plumber. 2. :qe illaintaitied as c;ol % . Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398(R03/14) —A o Y21 ,off a , .. .-- 3 8m i CONVENTIONAL COMPONENT DESIGN Residential application INDEX AND TITLE PAGE :t;: {�!,,��'���pp`4\��yyVYY��•'4�4`Cry� `•:-hr;:b`4+t:itvy��:�:�\\v`�' "i.� :::::y\i li ��''• •:•y. iJ[ii.A:•: •ri .`?iit.isiv:?::ini:tiiiXtit:�??!;` r ,P�:'�' kv�.. ......� .C�.,: . .,. .. ...:. ....:.. . Project > . : .y:.:"_,.i'-i;:;.<-.;k,..<::::1i ... .,,��:?:a:.:;; Name: s :,:yay� %':::'-:2'is�::"•�''��:>;>=:`:�:`�� I Owner s 4♦ V;i.,:1k::::.i'.••:riv:.i:.ti°;:ti v~'iC<;•:�.j::!Y:�<µ i:i'�•:+:i::is tii:\:. S Y•'\:2..•.0}.:y4� k Q,/yk�}..`[N��;.v,{ Q }� y$ty¢��4y.:f�'+v:S kti:t•:::�+�:y:;:r` yA,• ` `W; RF� 7iR::�,�:IIGi;�i :ji::y;i?ii:�;:'"-{kn Owner's •:1:..�ti:i J:..,i...,:\4:w\r.\`7�(%;���:�';.. ...�.n-::::::::::nii•.: Address: ::i:S?:;•.;;.�i2 :�'i=k'i�t:a`:'ir'��.:,;.i:::;:�::i? .::,`.:Y::.�..,y`:.`ii'.:j+'..;:<`:;:.:'- :` :tit�?:::_:.•.:x,.. ,.,;}?..,,. -4"pAy..1••,:i... _ ..�`\tl-`IX`y:•kk.;:•::\ii ki•:::.::::::i'.:�:.•:ti.,;ii';.,•�'�-..,`•.Y.:f•y`.•.,•::•:::.i:..::•...: � / :<:�:\ ��•ate.4�•�vy�',',;�-•..•,••.',:•`lk�:`.:<;;- <�i:;.`�;:: ���' "�,+: >}1:`:>4;<.�;\L4:;�i=. £;441'\;•>;i:•;��♦` `: •'.kNS\tia i;`�\�•t,�'•;:%`;':;`::: ' Ni $ :'3_• ry,•vr4':::•pis??:�:;-:ii{}`'}i".+I:.`-'.;iii:Jam: .h-.ANi 4•kC\\•4:kv:i`;•i++i\•.A,i•:i,i:;1 i}}:.;i<:kk:i;;:.^:i;vvn\i:;�i�'.::�i:{;;+ � Legal Description: 2f3o Subdivision: � ,�� � � r Lot# Town: County: Parcel ID# Designer/Plumb r: -' License Signature: Date: Comments n&ciernori neirceinntto tho in_rrniniri enii Qhcnrntinn rmmnnnant Manual fnr POWTS Vercinn ?,0 _ 3 ,t •�� CA icv SAiI A sar fln SVS t Cross;�ec#�oiri ~' Fib Grade 4°Schedub 40 pVC Vent Pipe p ,Sft NUS Vent Cap �----1 Leaching Chamber �` '" System Elevation —75: T- Sol,Absotation_ m Plaon VIIAM ft leaching Trench 7 t Vent Or Observation Pipe Chambers 47 Dia. Trench 2 Header � irrcr elaarrri>e�Saenif[satio�s e s�a /�ry Manufacturer And Mode[ �-n t�• f� Q �• EISA Rating ZU sy ft per chamber Soil Application Rate 1). (gi�/�Q ft ��� 7 Sorb Application Rate'. _7�� EISA=--/j --Chambers ___gpd Design Flaw: ^___.__ 2 rows of-- 7,2-- chambers each. Page of----- rA INSTALLATION INSTRUCTIONS INSTALLATION INSTRUCTIONS cerftruer - it,�,, �,� x••r's� ; s ,� J3 'C 3 ,,•i i-Sa• i'ftfY�iQY�� _�• -� �.�.EftS">`�t.�7• Step 1: - Step 2: Step 3: (A)Locate the outlet of the septic tank. (A)Before fnstallaODn,place the (A)Glue the t4'housing on the (B)Remove tank cover and pump tank fitter housing on to the outlet pipe. outlet pipe. if necessary. (B)Make sure that the housing (B)Msert the Nor cwwge in the is positioned so the fester can be housing,making sure"tom removed from the tank for carbMdge is properly aiWed and maintenance and service. completely Inserted in the housing. MAINTENANCE INSTRUCtI©NS �s n 3 ->�:'o a'•- t-t^+t`?: I`�+.�`5'"�-.��i�.•t�� -mot t-' v. k ��w�.�, r '-•6',o"`Le. �3`"Z T�Yr�,."„C.y'c• -'-'�^y'` y y��'e�`a "'" .>? Fk'-' � 3y sa•.• �A-rY rs-a+' Sy, ' ,tr:{., �w- t 2�:•-.::•.' `'-: >:r`•-" ".�;. 'v�''ii���,.,•,��`pct-,..� -t�"- • x Stop 1: sup Z- step 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A)Insert the Ow CarWW back if necessmy into the ft housing making sure t s = the M'Is try a ' (8)Pull the f�#eroutoft#�e housing_ (C)!-lose off the lilb overthe septic tank and compiebly fnserfed- R tic flank cover Make sure all solids ibH rack W the �) �P POWTS OWNER'S MANUAL. & MANAGEMENT PLAN Page—':L�lf FILE INFORMATtON SYSTEM SPECIFICATIONS Owner Septic Tank Capacity �S ^ al ❑ NA S Permit# Septic Tank Manufacturer - ❑ NA Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS Number of Bedrooms ❑ NA Effluent Filter Model r ❑ NA Number of Public Facility Units NA Pump Tank Capacity al NA Estimated flow (average) gat/day Pump Tank Manufacturer IWNA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer NA Soil Application Rate al 1day 1ft2 Pump Model Y avers e* Pretreatment Unit ONA Month) Standard Influent/Effluent Quality 9 Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑Other. Month) average Dispersal Cell(s) ❑ NA ff Pretreated Eluent Quality Y Biochemical Oxygen Demand (BOD5) :530 mg/L �d In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L V(NA ❑At-Grade ❑Mound Fecal Coliform (geometric mean) 510°cfu/100m1 O Drip-Line ❑Other: Other: ❑ NA Maximum Effluent Particle Size Ye in dia. ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other. - ❑ NA MAINTENANCE SCHEDULE Service Frequency Service Event ❑ month(s) (Maximum 3 years) ❑ NA Inspect condition of tank(s) At least once every: earls) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA ❑ month(s) (Mwdmum 3 years) ❑ NA Inspect dispersal cell(s) At least once every: 0year(s) ❑ month(s) ❑ NA Clean effluent filter At least once every: 0-year(s) ❑ month(s) O NA Inspect pump, pump controls&alarm At least once every: ❑ year(s) ❑ month(s) ® NA Flush laterals and pressure test At least once every: ❑year(s) Other: ❑month(s) ❑ NA At least once every: ❑year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an in carrying one of the following licenses or certifications: cing Operator. Tank Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servi inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) 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 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW(4101) Page—zo—of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankts) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cells) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides;sanitary napkins;tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall lie taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement are has been evaluated and may be utilized for the location of a replacement soil absorption a system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLE_R POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was drafted in compliance with chapter Comm 83.2212)(b)(1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TAI\rK A TTENANCE AGREEMENT AND OW--ERSIIp CERTIFICATION FORM OmmerBuyer Mailing Address Proper,Address �� t�'erification required from Planning&Zoning ent for new construction.) city/Stale T Parcel Identification Number C� LEG-4,L DESCRIPTION '/< . 1/< . Sec. . T, E2_N R ro W, Town of P Location P erty cation - ,Lot#�. Subdivision Plat: Certified Survey Map # , Volume ,Page# Warranty Deed# (before 2007)Volume ,Page# Spec house Eves&no Lot lines identifiable yes 0 no S'i;'STEM mAorr NANCE 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§SPS.383-52(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 1/3 full of sludge. Uwe,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 the Department of Safety And Professional Services 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 expiration date. Uwe certify that all statements on this fa�,deeed are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above,by virtue of recorded in Register of Deeds Office. Number of bedroa 17i7D1� 7A 72 E OF_ ICANT(S) DATE ***A.ny 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. V.0442) Property Owner -.5ee,2, Parcel ID# ll) 7-2 A:z—A 0 Page a []Boring# Boring Pit Ground surface elev.l/l}S�ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPDfft x in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. -ff#i ff#2 Al- / 4 Q R 1� ❑ Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ` ff#1 ` ff#2 Boring Boring# Ground surface Depth to elev. ft. De limiting factor in. Pit ❑ P 9 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. Eff#1 * ff#2 *Effluent#1=BOD a>30<220 mg/L and TSS>30 <150 mg/L *Effluent#2=BOD 5<30 mg/L and TSS <30 mg/L The Dept.of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. SBD-8330(RI I/11) RECEIVED APR 2 8 2015 � eWis.Dept.of Safety and Professional Services SOS Page 1 of Division of Safety and Buildings in accordance with SPS 385,mss. Adm. Code �T County Attach complete site plan on paper not less than 8 112 x 11 inches in size.Plan must Include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. percent slope,scale or dimensions,north arrow,and location and distance to nearest road. - / - P/ease print all information. Zby Date O Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). I. Property her Property Location Govt.Lot 1/4 J C 114 S T f N R E(or Property Owners Mailing Address Lot# Block Subd.Name M# City State Zip Code Phone Number ❑City ❑Village 29Town Nearest Road (o New Construction Use:❑ Residential/Number of bedrooms Code derived design flow rate fD -(a GPD ❑Replacement ❑ Public or commercial-Describe: Parent material O"I Flood Plain elevation If applicable • IV If- General comments and recommendations: Boring# Boring 11vv11 / pit Ground surface elev. /QS!95- ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 * ff#2 122- s YZZ _ L? 9 n m Boring# H Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. * ff#1 * ff#Z 4 Q a 9 *Effluent =BOD >30:5 220 mg/L and TSS>3 <150 mg/L Effluent#2=BOD <30 mg1L and TSS <30 mg/L CST Name(P Print) _ Signature CST Number Address Date Evaluation Conducted Telephone Number SBD-8330(R11/11) Property Owner Parcel ID# � �-,�/ i J�S/—! ?l1 Page of •� El Boring# Boring Pit Ground surface elev.lei ft. Depth to limiting factor in. Soil Iication Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPDfft Y in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. :ff#1 ff#2 o 4 4 3 A4Z q it a Boring# Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft : in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ` ff#1 ff#2 Boring ❑ Boring# Ground surface elev. fL Depth to limiting factor in. ❑ pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. ff#1 ff#2 Effluent#1=BOD 5>30:5 220 mg/L and TSS>30<150 mg/L °Effluent#2=BOD 5<30 mg/L and TSS <30 mg/L The Dept.of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. SBM330(RI1/11) l w af� -- A, Zee 1, - i ��__�., �-�` ' 1 -�` _ j` �_ _ -- ~ ' . ' \ ' ! \ | / / . � i / / � | / co Pelt 40 T4 CD En to . z 7az to � � | � tall � `` �II`IIIIIIIII ff III�IIII 1 II IIIII�II 8285298 State Bar of Wisconsin Form 3-2003 Tx:4233954 QUIT CLAIM DEED 1008101 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI 02/19/2015 1:19 PM THIS DEED,made between aoE>_ l2N-EZ'i EXEMPT#: NA ("Grantor,"whether one or more REC FEE: 30.00 and l�R o5 KaPP ,/ TRANS FEE: 168.00 PAGES: 1 ("Grantee,"whether one or more). Grantor quit claims to Grantee the following described real estate,together with the rents, profits, fixtures and other appurtenant interests, in County, State of Wisconsin ("Property") (if more space is needed, please attach Recording Area addendum): Name and Return Address ACt2E S 3. 4`e� v'03 Hfi 2�/MRS S7-" SEC i�, -F 30 N , 2 1`i , NjL,,) '/Ll vr- SE 'j4 �o!t-can- r c.� t SyoZS SEC.. l(b, T3bN 21gW PT tJLO 6E 5T C-Q-DIK Q32.- 21-7 Z - D4- O 00 Parcel Identification Number(PIN) i JA l(On3 A-"L._ SITU-C +60.1`-) �ST�'T S �C71� This /5 homestead property. Dis not) Dated 2 �I o F E CJ (SEAL) (SEAL) (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDG WKELLEY VANTASSEL Signature(s) STATE OF WI G0N-SiN I�'Mk Notary Public Minnesota Ex res Jan 31,2020 authenticated on '��� Personally came before me on * the above-named TITLE:MEMBER STATE BAR OF WISCONSIN (If not to me known to be the person(s) who executed the foregoing authorized by Wis.Stat.§706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: 4<P) f�P Notary Public S to ofWis�Vle(L`V� My Commissio (is permanent)(expires: l (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. QUIT CLAIM DEED ®2003 STATE BAR OF WISCONSIN FORM NO.3-2003 *Type name below signatures. St. Croix County 1008101 Page 1 of 1 d § (D q 0 - � k } � r R LO G ] � 2 )2 � ƒR � a0 CY 0 z t2 ƒ 44 /rz _e k \ \ c 7 22 � « $ w z / ® 8 z § 2 2 § z a ■ B z k C ' ■ - # k k 7 k E t \ 04 § s . \ \ I d § & & z \ z (D .. 1 Witt 0 © # z Lek \_ j 2 # 2 & ° ) § Im a = k CO _ ■ _§ o § k k k 1 01%4 4i / a a a \ g B ® m o ) D z 0 2 g \ e cn : s n < t < ® z m § % C) } \ ) ° 8 , 2 \ } \ C `Mn ® S 2 ¢ 7 ) = c \ { -� � \ \ \ / \ o z \ / z � ■ � z E � 2 « k - , _ 2 " a E 2 ' k a § & L) a 2 0 U) J