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Wisconsin10epartment of Commerce Safety and Building DMision PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Gausman, Stanley W. & Susan I Hammond, Town of CST BM Elev: Insp. BM Elev: BM Description: 39 '7 /66 16I! • ' I 6-S TANK INFORMATION TYPE MANUFACTURER S CAPACITY Septic ,+ %< wt / A Dosing 39 '7 /66 ASM& Pa tdk 5�5 TDH Holding 3 7 166 TANK SETBACK INFORMATION TANK TO P/L iN LL BLDG. Vent to Air Intake ROAD Septic 39 '7 /66 /Ir Parcel Tax No: TDH Dosing 3 7 166 TDH Ft Z7 i f (p, `7 Aeration 3•Z Z3. Forcemain Length / D I Dist.toWell Holding St/Ht Outlet PUMP /SIPHON INFORMATION ,� r Manufacturer St. Croix Demand FS ELEV. GPM Model Number Inside Liquid Depth ` J Parcel Tax No: TDH Lift Friction Loss System Head TDH Ft 12.29.17.189A i f (p, `7 3.B 1 3•Z Z3. Forcemain Length / D I Dist.toWell _ y Vbl ELEVATION DATA County: St. Croix Sanitary Permit No: FS ELEV. 515294 State Plan ID No: Inside Liquid Depth ` Z3 Parcel Tax No: P/ BLDG 018- 1025 -60 -000 Section/Town /Range/Map No: Bldg. Sewer 12.29.17.189A STATION Width f Length '76 FS ELEV. Benchmark No. Of Pits Inside Liquid Depth ` SETBACK INFORMATION Alt. BM P/ BLDG WELL LAKE /STREAM Bldg. Sewer Manufacturer: Typ ystem: �v 13.(4 ' 994 4 1 St/Ht Inlet , /,,[L Model Number: L{, SS. y St/Ht Outlet Dt Inlet \ \ Dt Bottom Header /Man. /. S iD /• 31 Dist. Pipe 1.5� Bot. System 1 2.1 - 7 /06 • � Final Grade ` L 2 — 162-31 St Cover T. a� 1 4• 7 94d • 0 q 3.71 —1,9 SOIL ABSORPTION SYSTEM e .a Lj A U _ BED/TRENCH DIMENSIONS Width f Length '76 No. O Tren es V - Intakipes) PIT DIMENSIONS No. Of Pits Inside Liquid Depth ` SETBACK INFORMATION SYSTEM TO P/ BLDG WELL LAKE /STREAM LEACHING CHAMBER OR UNIT Manufacturer: Typ ystem: �v gf 0- , /,,[L Model Number: DISTRIBUTION SYSTEM /]Aril— - 15 61A) L,,) AX Header /Manilop Length Dia `• b P Distribution /, /S Length Dia pacing x Hole Size `V / x Hole Spacing � V - Intakipes) SOIL COVER - 31! +b x Pressure Systems Only xx Mound Or At -Grade Systems Only «" • •� Depth Over Depth Over xx Depth of xx Seeded /Sodded xx M ched Bed/Trench Center / / G Bed/Trench Edges Topsoil I R � Yes 0 No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 7 / r I / 16 0 Inspection #2: / ✓, > Location: 1050 Highway 63 BaldwirL WI 5 0 2 O` 1/2 1/4 1J22 _29N R17W) metes & bounds Lot LJA.rS(x Parcel No: 12.29.17.189A 1.) Alt BM Description = /+ Mi! N/ 2.) Bldg sewer length - amount of cover Plan revision Required? ❑ Yes No Use other side for additional information. ____ Z �o Flb' J _ I Q SBD -6710 (R.3/97) Date Insepctor's i ature Cert. No. cormneree i.gov Saf d Buildings Division Counq 1 Wa Ave., P. Box 7162 W1 53707 I sco n sin Sanitary Permit Number ( to be filled in by Co.) �V 5 Sanitary Permit Applica 3 t� 0 9 State Transaction Number' In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission ofthis form T goitntal Project Address (if different than mailing address) unit is required prior to obtaining a sanitary permit. Note: Application forms for POWTS are submitted to the Department of Commerce . Personal information you provide maybe *4 TM i►derY purposes in accordance with the Privacy Law, s. 15.04(l) Slats. 5/ L Applicadon Information - Please Print All Information Property Owner's Name Parcel # S 4A1LE Z A IVQ 5Y 5 , 41U 6AY5rn IgAl O/y- /025 - (D -G Property Owner's Mailing Address Property Location / /O5V >/G i7 wj 7 f W 3 Govt. Lot t) F se V, goo + — ! city, state Code Phone Zip Co Number L C01W J r 5 / OD Z q V, T �Z N; R IL Type of Building (check all that apply) Lot # Subdivision Name 1 or 2 Family Dwelling - Number of Bedrooms r3 i- . 2oa�, # Public/Commercial ❑ Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM ❑ Village of ®TMm of ZMMI"B /V io Number 7 7 / v HL Type of Permit: (Check only one box on line A. Complete line B if applicable) A New system ❑ Replacement System ❑ Treatment/Holding Tank Replacement. Only ❑ Other Modification to Existing System (explain) B. ❑ Pe Renewal. Permit Revisaon ❑Change of Phtmber [I Permit Traasfer to New List Previous Permit Number and Date Issued Before Expiration Owner !� IV. Type of POWTS stem/Com nt)Device: Check all that a pply) ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in of suitable soil( Mound < 24 ia. of suitable soil ❑ Holding Tank ❑ Od. Dispersal Component (explain) [11 vice (explain) V. DispersaVIrreatment Area Information: Design Flow (gpd) Deli Soil Appli cation Dispersal Area Requ ed (sf) Dispersal Area Proposed (sf) System Elevation i VL Tank Info C in Taal # of Manufacturer Gallons Units a, / , R le-�— g o v New Talcs F ""^g Tanks u S - 7 v ? // 7 Septic or Holdmg Tank 1000 0 O I I r g 'gi Chamber :S' O hVI c VIOL Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached glans, Plum Name (Print) MP/MPRS Number Business Phone Number © 5CW M / i T = 64, Z Z 71,p (D 1 71s - ?,!�D . Plmnber's Address (Street, City, State, Zip Code) lvJ /-5 7 d V6 , -S Z 5 IDe artment use Only Approved ❑ Disapproved Permit Fee Date hswittg 3ignatute ❑ Owner Given Reason for Decrial 2'NZ UC Conditions of ApprovalMeasons for Disapproval 0 J; Attach to complete plans for the system and subs Alto the County only on paper not less than 8 in x 11 incises in size n iUi , '- T - la LiNr ZE 40eF Poe Cf', Attach complete plans (to the County only) for�sbem " ' " r sot ems than SW z 1 bathes is size :r) WE Poly i�/ I SBD -6398 (R. 01/03) Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 7162 S% C A?Q / X I0ns,n Madison, WI 53707 — 7162 Sanitary Permit Number (to be ad in by Co.) Department of Commerce (608)266 -3151 P A j Sani tary Permit Applic 1110 EC IVED Plan�D. Number In acc ord with Comm 83.21, Wis. Adm. Code, personal inf ation you pmvh 30 my be used for secondary purposes Privacy Law, i 15.04(1 xm) Project Address (if different than mailing address) L Application hdormation - Please Print AD Information J U L I LUTU Property Owner's Name PLANNING X Z^NING OFFICE 1 # Lot # Block # , 5 7 — 1 VIO �505AA) 8 - /(-)Z,5 0 - 0 6 Property Owner's Mail Address Property Location , I / /- Ltd V� 3 � y S t y., Section City, State zip Code Phone Number 0 { 4�j //V V �' L 7 D� •, T n N, R circle oge) _� II. Type of Bmtding (check all that apply) �' �" Subdivision Name CSM Number 1 or 2 Family Dwelling - Number of Bedrooms i 7 10 j" G _ ❑ Public/Commercial - Describe Use ityi❑Village�Iownshipaf 14/r1HtOrt//� ❑State Owned- Deseribe Use '- IIL Type of Permit: (Check onl a line A Complete fine B if applicable) ` New System laoement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. [I permit Permit Renewal Permit Revision ❑ Charge of ❑Permit Transfer to New b List previous Permit N erpgti D� W Before Expiration Plumber Owner IV. Type of POWTS stem: Check all that apply) 2UlF.f t-C ❑ Non Pressurized In- Ground ❑ Mound a 24 in. of suitable s ' � Mound < 24 in. of suitable soil At Grade ❑ Single Pass Sarni Filter ❑ Constructed Wetland ❑ Pressurized in -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Trestment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Cruvel -les ❑ cr ( ") / V. Dispe rsal/1 reatment Area Information: Design Flow (gpd) I y5 0 Design Soil Applic Rato(gpdso ©. (o Dispersal Area ReW' (af) Dispersal Area ed (so System Elevation fs 1 5�' S- r/ sz /57 /© /. VL Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Bxiating Septic or Holding Tank `J QD I G SC l� 1..0 � L •�L / C Aerobic Treatment Unit Dosing Chamber VIL Responsibility Statement- I, the urderskeed, assume responsibility for installation of the POWTS shown an the attached plans. Plumber's Name (Print) I Phan S' w W MP/MPRS Number Business Phone Number v M � � �'6 f9 HrU �c�F`v11 T r' r i ,?a 3 0 7i s - 76 Plumber's Add— (Street, City, State, ) VO Z S - VI Corm /De artment Use Onl V App..d 1 ❑ Disapproved Sanitary Permit Fee eludes Groundwater Fee) Date Isss -1 f uimr ❑ Owner Given Reason for Daniel � a S /ued 1 l IX. Conditions of Approv&Reasons for Disapproval SYSTEM OWNER: 1 Septic tank, effluent filter and �J �¢��� y � dispersal cell must all be serviced / maintained 7- ' e c.'ee a � h �dGu:4'a,�n OYl y�G�o as per management plan provided by plumber. L 2. All setback requirements must be maintained as per applicable code /ordinances. S4 a4e r r► Attach complete plans (to the County only) for�sbem " ' " r sot ems than SW z 1 bathes is size :r) WE Poly i�/ I SBD -6398 (R. 01/03) _, t commercemi.gov �sconsin Department of Commerce t Safety and Buildings 1 PO BOX 7162 MADISON WI 53707 -7162 Contact Through Relay www.commerce.wi.gov/sb/ www.wisconsin.gov Jim Doyle, Governor Aaron Olver, Secretary July 02, 2010 CUST ID No. 226375 ROBERT W ULBRICHT ULBRICHT & ASSOCIATES CO 2812 10TH AVE SPRING VALLEY WI 54767 ATTN. POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/02/2012 Identification Numbers SITE: Transaction ID No. 1813080 Stan Gausman - Dwelling Site ID No. 757902 1050 Us Hwy 63 Please refer to both identification numbers, Town of Hammond, 54002 above, in all correspondence with the agenc St Croix County SE 1/4, NE 1/4, S12, T29N, R17W FOR: Description: Mound Object Type: POWTS Component Manual Regulated Object ID No.: 1271512" Maintenance required; 450 GPD Flow rate; 22 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits i required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. t In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. ROBERT W ULBRICHT /rE el Priv ate Sewage SF,O , , Integrated Services (608)266-2889, 1430 Hrs pete.pagel@wisconsin.gov Page 2 7/2/2010 Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent,. issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www.commerce.wi. gov/ SB/ SB- BuildingContractorProgram.html 281210th Ave. • Spring Valley, WI 54767 RED;._. Reg D Sewage Engineer i g S 715- 772 -3442 ter) JUN PROJECT INDEX Plan I.D. Date Owner STAN 6;jZ .S1'(4N • Phone 7/S • 6 Address .:5� /�/ . 6_3 �i¢ w /�tJ GC! /• S ypp Z Legal Description VO 44e c - sF y Ng y S4 /L 7-. y v, R17 4 U Town of l���l/�J�f ti!� County s r eiedv? x C.S.T. ZZ(o37S R • 7f�,fJ/C% C J` ww Instal ler.ViQy •ee- G►! /-e �Z-r Local Authority/ Supervision .5r. 4ROI C PROJECT DESCRIPTION 7 /,S • 3 -F6 - New roN s TRV c Ti 19 , FOA /t / a,Pa�os �-� 3 8�tir• 45U S. PR0 l lyoSe -o : /►- C yeti r� o414 1- 14400,0P sYS I Z{5 /NG- /tf " -5�tvp ����1Ui1�� I W ULBRiCtHT D1fi50 HUDSON. WS 4 � ' A Pg.l PLOT PLAN VIEWS Pg.2 SYSTEM CROSS SECTIONS & SYSTEM PLAN VIEWS (REVERSE SIDE DETAILS INSPECTION PIPES & FABRIC /TOP FILL DETAILS) Pg•3 PIPE LATERAL LAYOUT (REVERSE SIDE SHOWS DETAILS OF LATERAL CLEAN OUTS) Pg.4 DOSING CHAMBER CROSS SECTION & SPECS. Pg.5 PUMP PERFORMANCE SPECS (REVERSE SIDE SHOWS PUMP DETAILS) e A31TTfTTALT v * ^V oVnT TTDL'IuC VMQ fVVATFRGF GT RRnWR b o °L i I . ZD d s N � a' N H � H �CP m o � o � b � c i I I � � II 1 d a CIA W � 0 n D S� I i i � r r � ' � , r 1 D 0 4 n Q �r R1` m i too n D I I j D O d O i i � r r � ' � , r 1 D 0 4 n Q �r R1` m i n D I �p 7'C � O `n I r � 0 /p a DRIVE a4 y W c mo 0 O C r 0 `n I �p 7'C r � 0 /p a DRIVE a4 y W c mo 0 O C r 0 GROSS SECT of MouAji> wir Beo vtsTpi(3uTt Cs• Tk Gkis C6 9 pi r� of T° P S o (L Iv/ UP FORM TO W — =I n+►sD.. 9 TIO RA . 1 SAMP , ////Piowco % slopS F'oRCE -- F_LEvAno S --- 0 iNVERr OF Z -4. 1ATCRA(S To p o f R o ck [D2,77 S 1 ' T OF 1 4, IATERA - - PLAN VIEW OF MOUAJD -- Wi rat B f r_1 7 FT. FORM MMO Fr. F /.d FT• G .5 F T. H /. v FT. -- F_LEvAno S --- 0 iNVERr OF Z -4. 1ATCRA(S To p o f R o ck [D2,77 S 1 ' T OF 1 4, IATERA - - PLAN VIEW OF MOUAJD -- Wi rat B I \ Be of ' /," PVC. cgpprtp To 1 ? A 0 CAE C9(35ERVhTtO�t �� ®/t-( P f P e s /,Oe f :a,�s : �- 4 0 /0 Ge z z - BUD 0ev OF ro A s ysr�M E o N /o . 5 i um i FORM E t EVATAoa U,J OER FORM MMO A �o Fr 13 7 5 F r K /U Fr i 3 0 o Fr w 30 H' I \ Be of ' /," PVC. cgpprtp To 1 ? A 0 CAE C9(35ERVhTtO�t �� ®/t-( P f P e s /,Oe f :a,�s : �- 4 0 /0 Ge z z - BUD 0ev OF ro A s ysr�M E o N /o . 5 i um i FORM E t EVATAoa U,J OER 71S • 3 86 • -Y60 o * Licensed installer, responsible for providing an operation/ maintenance 'Users" manual: W4 47X7 Vie hkur9y N4C vi //-�e. 7rs • 7f9. 33 Z - .?- * Licensed serv&ce / inspection 7��6RI * C67 - ,a W/ P/A16- agent other than installer: -- 71S • ysep • f y5�o * Electrician, f.-or pump, electric controls, wiring units: � v�� • �� LDS 's / 7W I'�'ryt,�J IMPORTANT OWNER MAINTENANCE AE UIREMENTS 1. Winter traffic (sledding, shovetring, etc.) across the area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the winter.(a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This sys�em was designed for a maximum wastewater flow of 1" gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage . disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system.. 4. If a power outage occurs, or a pump fails, it May * result in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (leaka'ge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. RF Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated Into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pres laterals, at each tip -- for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly qualibied person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's tre -atment cell shall also be regularly inspected. J�4� D 5. Neglect of the vegetative cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO the REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in _�ystem beneath IS NOT suf ficient alone tO maintain a y� ;cover. YAK ,e6lil. Wisoonsin Departrnent of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings In accordance with Comm 85, Attach complete site plan on paper not less than 8112 x 11 inches in size. Plafffift Include. but not fimited to: vertical and horizontal reference point (BM), direction I.D. 0 / . percent skips, scale or dimensions, north arrow, and location and distance to nearest Please pnftn ^ r Da Pemomo kftn wn you povMle "My be for se�Aeses t*�+vacY law. .15.U1 hl (m1) Prom 17 .5 7 * , fAl 6-Asl'SY fAl 2010 Loot 114 N � 114S l Z T Z? N R E (or Property Owners Mailing Address # # Subd. Name or CSIM /O SO V. S• f � � S7. CR0- COUNTY FIC p s PAR T- of r.401 I 7N, Stale zip Code City ❑ Tillage ® Town Nealest Road MOWN , ui 1 6 yo '>L f 7i5) (P8y 2-%!m YAR140ND NewCorminxtion , Use: 0, Residential 1 Number of bedrooms 3 Code derived design flow rate GPD ❑ Repiaceirient a Public or commercial - Describe: ~� Parent mate" by kk5Y OUEX 5 1WVY / YES Flood Plain elevation it applic R General comments Y and rasoorrulnendations: Area _ L . Spot Tested suite * f0Fa mound (P.O.W.T.S.) system using .�[.�.. sand Rq. Balm Boring p ✓� • S..S . # ZZ 10� O ft. pit round G surface Slay. Depth to limiting factor in. sod Rate Horimn Depth DM*Wnt Redox Desaiption TeMure St UMM CoWatenoe Boundary Roots GPW I K munsetl ChL Sm Conn Color Gr. Sz. Sh. 'Eff#1 OEM D• K /0 YR y 2 -1 4 2f S b K rm f R 15 -2f & s z. 8 - t q /o Ice L 1 2-f sbk rm Gs I • 6 3 W . Z io YA �0 --- 5L 2. f b k fmtFg 1 -- . re /. yz,- y .s YR 4 c 2 - SL Z#% bx rm V-P CS -- . G /o 2 f. 45 em3p Z-Syk Mops sr>� Boring# 0 loo. 7e 2.7 555 Pft Gmnd surface eiev. ft. Depth to fimiting be" Ian. - , sd Rao Horimn I Depth Dominant Color Redox Description Texture Sauctnxe Consistence Boundary Roots GPM i In. Munseq Qu. Sz Cont. Color Gr. Sz. Sh. *EM I *EW 16 - 7 /0YR 2. ----- L i f s W -60 �- 17 `/e m Y 59 $L 2fSbK cwt f R CS ! . 6 3 . 2-7 7. yR 6 ---, .s1- Fab ,c cw --- . 7 2 • too 7 s 4 0 13 P. -, . s yQ IL o s f Z 5 g ^'k - t:HKI r in = tfns JV 1 zw nrgn. am 1 u'3 2 -3U c 1w rnwL . w a CST i"M ( P" ,Qo /3,, 7 11 BRiCA 7` 2 � 3 7 5 Address Date Evaluation Canducted c Telephone Number ll Q mcen�in +ec+ 1�(.�+Vl� Z Z0l0 /•� ' 7 72• • 3 y �{Z Consultants zoo z 1 urn A ve. ' Spring Valley, WI 54767 O y� 4 A S 0/k . ,0 A ll- 3 0 . vav z. 3 Property Owner Pamei ID # Page of FS] Borin g # D Boring too• � 0 2 y 5ss 5(Pit Ground Surface elev. ft. Depth to Iterating factor Sea Hodmn Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz Sh. Consists Boundary Roots GPDM 'Etf#1 '0#2 0• y o ye -- 2f5 ,� nM•FR, e s 2 -F 6 . . o yR YZA= -- L / L�� c5 • / 0 ,e 5 .SSG If s bk ra,P R C s / • 4 • • 2L 7• Y R. 4 5 L If5h rn f R C5 -- • Y • 7 5 •60 7• SYR k M3P MOTS SL 0 �a►►-F • Z • w 1•s YX s ■ Effluent #1 = BOD5 �, 30 < 220 mg& and TSS +3l) 1 150 mWL. ' Effluent #2 = BOD f < 30 nVIL and TSS < 30 rrV& The Department of Commeme 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 508 - 266 -3151 or TTY 608-264 -8777. seo4s3o(RAM) Effluent #1 = BOD5 �, 30 < 220 mg& and TSS +3l) 1 150 mWL. ' Effluent #2 = BOD f < 30 nVIL and TSS < 30 rrV& The Department of Commeme 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 508 - 266 -3151 or TTY 608-264 -8777. seo4s3o(RAM) Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, Wl 54767 M M PUPO s y5T- �AJ ad o. 7 S I0o- 79' a • l 38 1 y/� t I i ' 1 AL lie { E eF 50 �G�NIr wtf�'TE' S T EAL i3 ��= ToP °F CA o ram) P ee � �� . nao 4f,91AJ 6- ! ©D -4 9 f PRoposeD N &w w &// Dar D RtP� /1IUW4-r,-W 3 coR, 4&t-C--e_ ,r/"f. -- � /0:2 Cr 8d If ry `05 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer _ ,, } qJ 0,4 US 1 11 A- Ill Mailing Address 1 C>57 0 Hwy 63 /¢LpW1 rj t :57 410p Z Property Address � ✓�' (Verification required from Planning & Zoning Department for new construction.) City /State 6 ALr1 WI rV Parcel Identification Number 01:9-1 0 - L-5 - -60 - 000 LEGAL DESCRIPTION (' /y514) Property Location N15 '/4 , SL %4 , Sec. , T Z 9' N R_17 W, Town of NAM )" ®nl D Subdivision Plat: 2~0 VAg" Lot # Certified Survey Map # , Volume , Page # Warranty Deed # - 1 3 D tz/ovz — 7 �olume � 3 U ,Page # DS� Spec house: I yes Orslo Lot lines identifiable P -t no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, 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 Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. I /we am /are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number f be 3 SIG TURE OF APPLICANT(S) 7 / - i0 DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) Parcel #: 018 - 1025 -60 -000 07/14/2010 10:25 AM PAGE 1 OF 1 Alt. Parcel #: 12.29.17.189A 018 - TOWN OF HAMMOND Current 1XI ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Class Owner(s): O = Current Owner, C = Current Co -Owner Land Improve O - GAUSMAN, STANLEY W & SUSAN M State Reason STANLEY W & SUSAN M GAUSMAN G4 14.000 2,300 1050 HWY 63 2,300 NO UNDEVELOPED BALDWIN WI 54002 2.500 3,800 0 Districts: SC = School SP = Special NO Property Address(es): "= Primary G7 Type Dist # Description 24,500 " 1050 HWY 63 199,000 SC 0231 BALDWIN - WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 20.000 Plat: N/A -NOT AVAILABLE SEC 12 T29N R1 7W N1/2 OF NE SE 20A Block/Condo Bldg: Tract(s): (Sec- Twn -Rng 401/4 1601/4) 12- 29N -17W Notes: Parcel History: Date Doc # Vol /Page Type 03/16/1998 575130 1306/056 WD 03/16/1998 575129 1306/054 TD 03/16/1998 575126 1306/049 QC 2010 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 06/11/2009 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 14.000 2,300 0 2,300 NO UNDEVELOPED G5 2.500 3,800 0 3,800 NO OTHER G7 3.500 24,500 174,500 199,000 NO Totals for 2010: General Property 20.000 30,600 174,500 205,100 Woodland 0.000 0 0 Totals for 2009: General Property 20.000 30,600 174,500 205,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 116 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Parcel #: 018 - 1024 -10 -000 07/14/2010 10:25 AM PAGE 1 OF 1 Alt. Parcel #: 12.29.17.177 018 - TOWN OF HAMMOND Current XX ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner Use Value Assessment O - GAUSMAN, STANLEY & SUSAN STANLEY & SUSAN GAUSMAN 1050 HWY 63 BALDWIN WI 54002 Description Class Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description Total State Reason SC 0231 BALDWIN - WOODVILLE AREA 22.000 SP 1700 WITC 0 Legal Description: Acres: 35.000 Plat: N/A -NOT AVAILABLE SEC 12 T29N R1 7W NE NE EXC PT TO CSM Block/Condo Bldg: 9/2667 Tract(s): (Sec- Twn -Rng 401/4 1601/4) Totals for 2010: 12- 29N -17W Notes: Parcel History: General Property Date Doc # Vol /Page Type 27,400 07/23/1997 1040/128 WD 9ni n CI IMMARV Bill #: Fair Market Value: Assessed with: Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Use Value Assessment Valuations: Last Changed: 11/04/2008 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 22.000 3,800 0 3,800 NO UNDEVELOPED G5 13.000 23,600 0 23,600 NO Totals for 2010: General Property 35.000 27,400 0 27,400 Woodland 0.000 0 0 Totals for 2009: General Property 35.000 27,400 0 27,400 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 I DOcow. a ND. 57510-© TMIS DEED, made betwmn Bernice F. Gaus)nan, Grantor, and &lzley W. Gauman aad S Ll n NJ. Gaumz=, )- ..sband and wife as smvivorsbip mm iia! prop". Gsamniee, WITNESSE.TH, Thai the said Grantor. for a valuable c.onsiticntioo of om do&.,r and Other sainable considerat.ibn cotter s to Gran3ee the fotiodring gibed r&j ts4we in St. Croix Corwty, State of %scovsin: SF-E ATTACKED LEGAL DESCI:tEIMON Bye {Norman, S.C. 900 Main Suet Baldwin, Wi UW2 NAME AND RETURN ADDRESS WA.RRA DEED _� TE r , Thu is m hoattstecd property. (SEAL) a _(SEAL) Tagt wi(h ail asd singular the hereditaments and appuriemuices thereunto belonging; .and Grantor warrants that the tislt: iS good, femdblc tip f� simple and free and c!esr of encumbrances except: Easm trx , ., blgbwabs, :rtWty rights and reservations of rword, and will warrant and defend the same. Baled this // day of March , 1998 ' (SEAL) ■B,;rax� 1� C am»• - �•� (SEAL) Al. ITIFNriCAT)ON Stsoamrrts) of Be=e F. Gau;nwn ..Kh.....ti_ �n ILYYO 14 ' 71fonta5 R. Schutrnzbx r 8 i 014954 :1TLE s IDABER STATE BAR OF V'1SCONSIN tff oo+. _ audw_ a by s 704.06. Wis. Slats.) TFIi L�',STRUMENT WAS DP.AFTED BY: 11am2s B. Sclitrrn2cher BAKKE NORMAN, S.C. BALDWIIN, li LSCOI SF Names of person.~ signing in any capacity should be .typed or printed below their stgnmures. STATE OF WISCONSIN ST. CROIX COUNTY EOtTER'. QMCE I -r. ti fr.r (ON41; ® MAR i 6 19 9:30 A M RECORDIENG INFORMATION (Parcel Idendficarion Number) ACKNOWLEDGrMEN T t } ss. ) Personally came before me this day of , 19 . the above named to me known to be the person who executed the foregoing instrument aril acknowledged the same. ,'Votary Public, County. Wisconsin My Commission is permanent. (If not, state expiration date: 19 VO r �,6�Arj ; LEGAL DESCRIC MON Tine Southeast Quarter of the Northeast Quarter (SE 'A NE !G), the North Half (9 '%) of the Northeast Quarter (NE 'a) of the Southeast Quarter (SE %); Northwest Quarter (NW %.) of the Southeast Quarter (SE V4); and the Southwest Quarter (SW %) of the Northeast Quarter (NE 'A) alt in Section Twelve (12), Township Twemy -zee (29) North, of Mtge Seventeen (17) West and the South Two Hundred Eight and Five - tenth. (52 09.5) feet of the North one fractional Southwest Quarter (!w 'fz Frac. SW %) of Section Seven C-7), Tovmship Twenty (29) North, of Range Sateen (16) 'hest, containing One hundred Forty -six and Five- tenths (146.5) acres, according to the United States Government Survey thereof. RollohomoO by Wide MftSydmK.hr. POBUNO 2MEFOMMSTREET j U. to a r, 3 U. Pm*mft No. 42294 PAGE: I CW I ft - L —� � R . = �I�11111���lI1����.I11�� "di CD CL is 1 ' 1 'I:I;t:laaaaa:ta: is so + U. 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CIO 0 ■ In I I OVOSOd a ° � t �al v*-jz RETAIL CUSTOMER aml BUILDER This is CUSTOM DEMN pmrwM n mm Wd mwm i oro Thb plan i$uModtosd=onml and may ro**e changes w a resuk Local bukft cod" ft�mwm MY rGqu1m&Wft dhwaftm lotl* plan Tho=Mm of ops" muy ab m This PIN cwwwt be cots wd or befit until 1* COW b MWMW WW UM sbmtwo dboM the =Aww and t h e bma Sb ow0m ameptwm of this plan as pmear4ed Changes to tft PIM may MWM addkmd dwosL .._. . ■ _= � is= �_= II �� 111111111111111111 � = _= l � _= � � r - _. `rG °ter = -� -� ! e- �- � = ` =•! — .._ ____ —_.. �`_is- �s - - == __ — .��= e =i■ - �'� ' -r - -- � • lll{ �. Ii111i1111111111lI � - - ■s � -•- Illllll�llllllll�t' °== = =_=� - Illli ►l�IIIIIIII�I�IIIII�EII� = _' - -: °_ I�!1 , - -- r ( !(1 q L_ . - -s �— I - ME 1 i c i - -__- - -- LW Lm Al s i- t ,Z _ - �����.����� ►�� ► ►,� Ln -! —� "` -_ - -_..: -` - —. =_ IIIIIIIIIiINlllll = =_= -___ � !� -� ■e- -lam _� mar -�!. _ _ _ — �:. — .•�_ — �. titlleitl111lillil r ! E EC ■ �: .._. . ■ _= � is= �_= II �� 111111111111111111 � = _= l � _= � � r - _. `rG °ter = -� -� ! e- �- � = ` =•! — .._ ____ —_.. �`_is- �s - - == __ — .��= e =i■ - �'� ' -r - -- � • lll{ �. Ii111i1111111111lI � - - ■s � -•- Illllll�llllllll�t' °== = =_=� - Illli ►l�IIIIIIII�I�IIIII�EII� = _' - -: °_ I�!1 , - -- r ( !(1 q L_ . - -s �— I - ME 1 i c i - -__- - -- LW Lm Al s i- t ,Z _ - �����.����� ►�� ► ►,� Ln -! —� "` -_ - -_..: -` - —. =_ IIIIIIIIIiINlllll = =_= Page 1 of 1 Pam Quinn From: Pam Quinn Sent: Wednesday, July 14, 2010 8:41 AM To: 'Joyce, Jean - COMMERCE' Subject: Question about abandonment of failed systems Hey Jean, I rarely have to bother you with questions, but have come up with a situation that needs your input. Have a 1939 - ish farm house that burned and the family has to replace the house and a POWTS a few hundred feet away from the old foundation and septic & drywell system. The soils barely make A +4" conditions for a mound, so the in- ground drywell can be considered as category one due to its discharge into high groundwater. Here's the catch — this farmstead includes another small family home only 30 feet away from the burned house that shared the old drywell system! Since the houses are on the same parcel, can the owners apply for grant funding to replace the old system, but delay abandonment of it? The owners have to install the mound needed for the new house, but can't connect both dwellings to the replacement POWTS. The small house may need a holding tank, just because it is surrounded by barns, outbuildings, etc. and running a forcemain 500' out to the new mound doesn't appear feasible. Can the owners submit for a holding tank as well as the tanks and mound? I have to document that the existing system is failed and order replace ment....just want to make sure I check out their options and that we document this properly! Thanks, Pamela .Quinn, Zoning Specialist (POVIS' ) St. Croix County Planning & Zoning Dept. not Carmic6iael Road Hudson, - WI 54o16 715- 386 -4680 pamq@co. saint - croix. wi. us 7/14/2010 Page 1 of 2 Pam Quinn From: Joyce, Jean - COMMERCE [Jean.Joyce @Wiisconsin.gov] Sent: Wednesday, July 14, 2010 11:08 AM To: Pam Quinn Subject: RE: Question about abandonment of failed systems Hi Pam, Sounds like an interesting situation. Let's cover the mound system first. This applicant would be eligible because they are replacing a failing system. Even if they are building the home and installing the new system a few hundred feet away, there isn't anything in the rules that requires it to be installed within a certain distance. This applicant could apply as a PR or a SCE, whichever works best for them. The second home on the farm might also be eligible for a grant because it is also served by a failing system that is being replaced. Who occupies this home? They obviously couldn't apply as a PR if it isn't the owner's PR but they could apply for the system serving this home if it's an active part of the business. Is it occupied by someone that works on the farm? They would then need to apply as a SCE. What if the income of the person that owns the PR is over $45,000, they could apply as a SCE for both homes but would be subject to one grant award and the total would be $7,000. We would combine these two applications in one fiscal year to bring the total received by the SCE to $7,000. As far as the abandonment, there isn't anything in the state plumbing code that would prohibit this and you aren't limited by any Wis Fund rules because Wis Fund rules just state a system installed according to the state plumbing code. But, we recommend that the abandonment be done as soon as possible because from past history, once the property owner has their new system in, they can neglect the other system. You may want to have the owner complete an affidavit that you create stating that the work will be completed by a certain date, including abandoning the old system. And to further encourage this to be done, they wouldn't be eligible to received a grant award for either home until the new systems were both installed and the failing system abandoned. Hope I've hit all of your questions but if I've missed something, please let me know. Jean PS - Leave for Yellowstone eight weeks from Saturday! From: Pam Quinn [ mailto :PamQ @CO.Saint- Croix.WI.US] Sent: Wednesday, July 14, 2010 8:41 AM To: Joyce, Jean - COMMERCE Subject: Question about abandonment of failed systems Hey Jean, I rarely have to bother you with questions, but have come up with a situation that needs your input. Have a 1939 - ish farm house that burned and the family has to replace the house and a POWTS a few hundred feet away from the old foundation and septic & drywell system. The soils barely make A +4" conditions for a mound, so the in- ground drywell can be considered as category one due to its discharge into high groundwater. Here's the catch — this farmstead includes another small family home only 30 feet away from the burned house that shared the old drywell system! Since the houses are on the same parcel, can the owners apply for grant funding to replace the old system, but delay abandonment of it? The owners have to install the mound needed for the new house, but can't connect both dwellings to the replacement POWTS. The small house may need a holding tank, just 7/14/2010 Page 2 of 2 because it is surrounded by barns, outbuildings, etc. and running a forcemain 500' out to the new mound doesn't appear feasible. Can the owners submit for a holding tank as well as the tanks and mound? I have to document that the existing system is failed and order replacement .... just want to make sure I check out their options and that we document this properly! Thanks, Pamela Quinn, Zoning SpeciaCist (PO St. Croix County Planning & Zoning Dept. not CarmichaeCRoad Hudson, -VI 54o16 715 - 468o pamq a casaint- croix. wi, us CONFIDENTIALITY NOTICE: This electronic mail transmission and any accompanying documents may contain confidential and legally privileged information. If you are not the intended recipient, you are strictly prohibited from any disclosure, copying, distribution, or storage of the contents of the information contained in the transmission. If you have received this transmission in error, please notify the sender and delete the message. Thank you. 7/14/2010 Jul 12 10 07:32a Thomas J. Schmitt 715 -247 -2941 p.2 #'1630 'wilco sin SOIL EVALUATION REPORT Page 1 of 4 Depm1ment of Commerce in accordance with Comm 85, Wis. Adm_ Code Schmitt SoN Testing, Inc. Division of Safety and Buildings County Attach complete site plan on paper not less than 8'/: x 11 inches In size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.O. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 018-1025 -60-000 Please print all information. Reviewed By s,.,. .�I 7 10/6 . -. - --r--. - rn.a t — a 95.04 r1) rm1). /ht 1 B c C - 1 � IJ i F Boring # Boring Pit Ground surface elev. 99.18 ft. Depth to limiting factor 17 in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Property Owner Property Location erty Ow NE1 14, SE1 /4, S12, T29N, R17W Ga Stanley &Susan Govt. Lot 20 0 A Name property Owners Mailing Address Lot # Block # S A cre Pa 1050 Hwy 63 na City State Zip Code Phone Number City Village `�, Town Nearest Road Baldwin 54002 715 - 6842166 Hammond State H 63 New Construction Use: X Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD u Replacement Public or commercial - Describe: Parent material Outwash plain (Sattre Series) Flood plain elevation, if applicable NA ft. General comments and recommendations: Area is suitable for a mpund system. System elevation is 100.63' based off contour line established at 98.96 Slope of area is 2 %. Depth to limiting factor is 16 0 . Boring Boring # ❑ pit Ground surface elev. 98.62 ft. Depth to limiting factor 16 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 0 -9 10yr3/2 none sil 2mgr mvfr as 2f,2vf .6 .8 2 9 -16 10yr4/4 none sil 2fsbk mfr gw 2vf .6 .8 3 16 -27 10yr4 /4 `li0yrr6 /2 Sid 2msbk mfr gw 1vf .4 .6 4 27-44 7.5yr4/4 m 1 l �b /2 g rls lcsbk mvfr gw - -- .7 1.6 5 44 -56 10yr5 /4 m2d 7 5yrb /2 7.5yrf sd imsbk mfr -- ----- •2 •3 F Boring # Boring Pit Ground surface elev. 99.18 ft. Depth to limiting factor 17 in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Soil Application Rate GPD/ft' 'En#1 *EfW2 1 0-9 10yr3 /2 none sil 2mgr mvfr as 2f,2vf .6 .8 2 9 -17 10yr3 /4 none sil 2fsbk I mvfr gw 2vF .6 .8 3 -34 7.5yr4/3 m2d 10 vrG[2- grs] lmsbk mfr gw .4 .7 4 L 17 3457 7.Syr5 /4 m2d ; � /2 sl imsbk mfr — ---- •4 •7 • cse „e.,r Al - anr3 > 30 < 220 ma /L and TSS >30 < 150 mg1L ' Effluent #2 = BUU < Ju mg/L ana 1 ;�D a au MWL- CST Name (Please Print) Signature: CST Number Th omas J. Schmitt "r'- -a 2274 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 7/812010 715 -247 -2941 SBD -8330 (RA7I00) Jul 12 10 O7:32a Thomas J. Schmitt 715 - 247 -2941 p.3 V-PV y v......• (J Borin Depth to limiting factor in. Boring # ❑ Pit Ground surface elev. ft. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. [a Boring 98.27 8• Depth to limiting factor 16 in. Soil Application Rate I a 1 Boring # rr---- ----�� 17] Pit Ground surface elev. structure Consistence Boundary GPD /fe Horizon Depth Dominant Color Redox Description Terre Sh. �EM✓Rt •Eff#2 in. Munsell Qu. Sz. Cont. Color 1 0-9 10yr3 /3 none sil 2mgr mvfr as 2f,2vf .6 .8 2 9 -16 10yr5 /4 none Sil 2msbk mfr 9w ivf .6 .8 c2d 7.5yr6/2 sl imsbk mfr 9w - "- .4 .7 3 16-23 7.5yr4/6 7.5 r6 8 m2d 7.5yr6/2 sl imsbk mfr -- ---- .4 .7 4 23 -58 7.Syr5/6 7.5vr6/8 LJ Borin ng �y Boring [� Pit Ground surface elev. 96 .66 tt. Depth to limiting factor 0 in. it Application Rate Horizon Depth Dominant Color Redox Description Texture structure C Boundary Roots •Effat GPO/ft' in. Munsell Qu. Sz. Cont. Color G . 1 0 10yr3/2 f1f 7.5yr6/1 sit 2mgr mvfr as 2f,2vf .6 .8 2 8-16 7.5yr4/4 c2d 7.5yr6/2 sid imsbk Mfr lvf 2 .3 • • 3 16 -35 35 7.5yr513 m 75 r6 /8/2 imsbk mfr gw --° .2 .6 m2d y57 r6/1 sl 0 mfi -- - --- 4 35 -46 7.5yr5/4 7.5yr6/8 (J Borin Depth to limiting factor in. Boring # ❑ Pit Ground surface elev. ft. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Soil Application Rate GPD Ez Effluent #1 = BOD 30. 220 mg/L and TSS >30-S.1 50 mg/l. ' Effluent #2 = BOD <" 30 mg/L and TSS S 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 gr TTY 608 -264 -8777. SChmiK SOM Testing, Inc sec -8330 (t.07/00) Jul 12 10 07:33a Thomas J. Schmitt 715 -247 -2941 p.4 Page 3 of 4 Conducted by: -Conducted For. Schmitt Soil Testing Inc. Name: Stanley &- Susan .Crausman Thomas J_ Schmitt, CST 227429 Address: 1050 State Hwy 63 1595 72nd St. City, State, Zip: Baldwin, W154002 New Richmond, Wl. 54017 Phone: 715-247-2 1 Subd.Name: NA Si -zco Lot No.: NA o a , B 7 / - / O Legal Description: NE1 14 SE1/4 S12 T29N R17W E Backhoe pit Township, County: Hammond, St. Croix County A Bench Mark 1 El. 100.00' Top of 2" PVC pipe at Hwy 63 Rite -of -way d Bench Mark 2 El. 97.91 Top of 2" PVC pipe, just north of calf barn Bench Mark 3 El. 93.75' Service door threshold on NE end of 60' x 128' pale shed Slope= 2% tour Line Length 110 Contour Line El. 98.96 fV,- � e_ Scale 1" = 40' ,4 t�D� /9 / °"V �` Q, �' P5 .. D '� G o /•�/t' rrt I'31- ©G..3,�/ O PV L *6 IYOR W4 Lime OF 20,44449 V1 � 163 i Y _ n A n A n.>_ - 07111/2010 19:22 715 - 549 -6651 SCHMITT PAGE 01 Total pages, including cover. J7- Schmitt Soil Testing Inc. 1595 72nd St. New Richmond, Wl. 54017 (715)247 -2941 07/11/2010 19:22 715 - 549 -6651 SCHMITT PAGE 02 Wis"nsin SOIL EVALUATION REPORT Department of Commerce in accordance with Comm a5, Wis. Adm. Coda DivbWn of Safety and Buildings Attach complete site plan on paper not less than 8% x 11 inches In alas. Plan must Bounty include, but not limited to: vertical and horizontal reference point (BM), direction and percent slops, scale or dimenslons, north armw, and location and distance to nearest road_ Petrel 1.0. Please print off lnformatlenr, Remtenwed By Par n wi infartrason you provide may be used for asoondary pwpom (Pdvary Law, a. 15.01(1) OV). ,. KTr; Paps _ _of 4 Schmitt Soil Testing, Inc. 5t. Croix 018 - 102.5 - 60-000 Date Gausman, Stanley & Susan Govt_ lot NE4 /4, SE1 /4, S12, T29N, R17W Property Owner's Malling Address Lot # Block # SuW. Name or CSMa 1050 Hwy 63 1 20 ACM Parcel Oily State Zip Code Phone Number Cit - ] Village 0 Tern Nearest Road Baldwin 1 1 54002 715 - 6842185 Hammond I Stab tm 63 II '� New Const� ion Use: �` Residential / Number of bedrooms '.J 4 Cods derived design flow rats 600 GPD L L] Replacement._ Public or commercial - Describe: 2mgr mvfr — Parent material Outwash plain SBttre Series .6 Flood plain elevation, ff applicable NA n. General comments 10yr3 /4 none sit 2fsbk and recommendations: Area Is suitable for a mpund system. System elevation is 100.533' fused off contour fine established at 2vf 98.96'. Slope of area is 2 %. Depth to limiting factor is 16'. .8 [K] Boring 0 ( Boring 98.62 17 -34 limiting factor 16 m2d 1 2 Pd Ground surfaoa elay. -_- fl. Depth to in. Sol Application Rate. Horizon Depth Dominant Color Redox Description Texture Structure 34-57 Consistence Boundary Roots GPDW -EfW1 - EM in. Munsell Qu. Ss, Cont. Color Gr. Sz. Sh. 1 0 -9 10yr3 /2 none sil 2mgr mvfr as 2f W .6 .8 2 9-16 1%"/4 none ail 2fsbk mfr gW 2vf .6 .8 3 16 - 27 10yr4/4 c1 10v W2 Sid 2isbk mfr gw 1vf .4 .6 4 27-44 7.5yr4/4 m1d 10w512 LMMw gris icsbk mvfr gw ---- .7 1.6 5 44 -56 10yr5 /4 n '� sd imsbk mfr .2 .3 - Ong �dng # n Pit Ground surface elev. 99.18 it Depth to limiting factor 17 In. Salt Application Rate Horizon Depth Dominant Color Redox DeSCtiptlon Texture Structure Consistence Boundary Roots GPDM1 In. mur"ll Qu. Sz. cent. Color Gr. Sr Sh. *ew '002 1 0-9 10yr3/2 none Sil 2mgr mvfr as 2f,2vf .6 .8 2 9-17 10yr3 /4 none sit 2fsbk mvfr gw 2vf .6 .8 _ 3 17 -34 7.5yr4/3 m2d 1 2 grsi lmsbk mfr gw ---- -- .4 .7 4 34-57 7.5yr5/4 m2d iW �/z 51 lmsbk n* — .4 .7 " Efflu 91 a 13UD 3U t ZZU mgr Ono TS-5 -3 c IOU mgrL - tmuem WZ = Buy c 3U rngfL and 13`3 c 3u mWL 'ST Name (P Print) Signature: CST Number rhomea J. Schmitt 227429 Adress Schmitt Sal Testing, Inc. Date Evaluation Conductod Telephone Number 1595 72nd Street New Richmond, WI 54017 7 010 715 247 - 2941 07/11/2010 19:22 715 - 549 -6651 SCHMITT PAGE 03 Boring # Baring (�] pit Ground surface elev. 9827 R Depth to bmiting factor 16 In. S ol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Conmstence Boundary Roots GPOW in. munseil Qu. Sr. Cont. COW Gr. Sz Sh. Em *1302 1 0-9 10yr3/3 none sm 2mgr mvfr as 2f,2vf .6 .8 2 9-16 10y6/4 Wane so 2m.5bk mfr gw 1vf .6 .8 3 16-23 7.5yr4/6 C2d 7.W2 A lmsbk mfr gw ----- .4 .7 4 23-58 7.5yr5 /6 m2d 7.5yr6/2 sl lmsbk mfr --- ----- .4 .7 .6 71 1 1�1 B°nng * Horizon Depth in. [�-j Baf Soil Application Rate 0 pH Ground surface elev. 96.66 ft. bepth to Ifanitin� fador Q in. Dominant Color Redox Deseripflon Texture Structure Consistence Boundary Roots GPDW Munsell Ru. Sm Cant Color Gr, Sz. Sh. 'EfM '8tAS4 1 0-8 10yr3/2 f1f 7.5W6/1 ail 2mgr mvfr as 2f,2vf .6 .8 2 8-16 7.5yF4/4 t2d 7.5yi6/2 sid lmsbk mrr gw 1vf .2 .3 3 16-35 7.5yr5/3 m2d 7-%W2 sd lmsbk mfr gw ---- .2 .3 '4 35 -46 7.Syr5 /4 m2d 7Syr6 /1 7.5w6/8 st OM m 6 -..-- .2 .6 E BoriM # Horizon Depth in. 0 Boring 0. Depth to iim$ing factor In. Rate 13 p4 Ground surface ei Sob Application Dominant Color Redox Description Texture Stu tture Consld once Boundary (toots GPDNr AilunseN Qu - Sr Cont. Color Gr. SL Sh. •FSrst - EW2 ` Effluent e9 = BOD 30 K 220 mgtL and TSS }30 a 150 Mgt ' MOM 62 = B00 -s 30 moil and TS$ < 30 mg/L Trio Dgmftwnt of Comm"M is so equal opporkunity service provider and employer. If you weed assistance to access sef yk4s or need material in an alternate format, please contact the depamnent at 60&266 -3151 4r TTY 608 264 sau.e »o (R97bo) Sftr& Sad Twwlq, rrr 07/11/2010 19:22 715 -549 -6651 SCHMITT PAGE 04 Pagel of 4 Conducted by: Conducted For: Schmitt Soil Testing Inc. Nome: Sway- & Susan Gausaw Thomas J. Sch mitt, CST 227429 Address: 1050 State Hwy 63 1595 72nd St. City, State, Zip: Baldwin, W1 54002.. . New Richmond, Wl. 54017 Phone: 715 -247 -2941 Subd.Name: NA lot No.. NA aoa z � ._ /l Legal Description: NE1 /4 SE114 S 129N R17W ■ Backhoe pit Township, County: Hammond, St. Croix County A Bench Mork 1 El. 100.00' Top of 2" PVC pipe at Hwy 63 Rita of - woy Q Bench Mark 2 El. 97.91 Top of 2" PVC pipe, lust north of calf born Bench Mork 3 El. 93.75' Service door threshold on NE and of 60'x 128' pole stied Slope= 2% tour lane length 11 Contour line El. 95,96' Scale I' = 40 6 06E /-7` lIV P, c' Ps 0. f (501we- �7 77" d G3 / '13q" .-=Ws r T� pu ST, �k ;ru oG 1 ci ��� i ..a ,: a •. • �., , } •y• M 6. �