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HomeMy WebLinkAbout020-1441-83-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and,suildirnq Division INSPECTION REPORT Sanitary Permit No: 430620 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: Bast, Kernon Hudson Township p a2--0 / yy/— 3 -00 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: C t 6 L ' 15 _ q 1 g -3 /.I _, , civ't- V � 1 -j`t� P(J 36.29.19./ TANK INFORMATION E LEV TT I BATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Vl 1 � � e l Z Benchmark l / ' L " 5 6C /OS 0 11-35 Dosing Alt. BM -A- - - CQ-r - - a4- rns�a r f -- �`• Aeration Bldg Sewer i f O Holding St/ t Inlet � ( w v c- & TANK SETBACK INFORMATION St/ t Outlet TANK TO , P/L t _ WELL BLDG. Vent to Air Intake ROAD Dt Inlet �^ Ct Septic 2o-17 , . t M\l / /-6 j i p Dt Bottom /,, __ Dosing vV (*a Header /Man. J , ,� -1 if 99 2 Ca 8,- I Aeration Dist. Pipe d/..0 7 9 l T' ` 9 7• S/ ---- Holding Bot. System 3 7 7 Final Grade / PUMP/SIPHON S 2 -1.0 S /SIPHON INFORMATION V� � "� 3 � i .n / O /. 6 Manufacture[ Demand Suter / y (f� 2 � ,Dy..�s Model Number IA) / `14 1I ( PiPeitL TDH'Lift Friction System Head H Ft Forcemgiq /( ength Dia. Dist. to Well SOIL ABSORPTION SYSTEM L 2IM. I/, -/-0 9 ,- 9 74/ BED/TRENCH Width / Length 1 No. Of Trench s PIT D II�U ENVONS No Of Pits Inside Dia. (Liquid Depth D 3 ��cYc� / SETBACK SYSTEM TO P/L B WE LAKE /STREA LEACHING ManufgcRyr t - INFORMATION CHAMBER Z� (� c F T Of System: y Ys ( L` h \ Model Number: / DIS IBUTION SYSTEM d Header nifo�d 1/(® Distribution 1 _ x Hole Size x Hole Spacing nt Air Intake h Pi t / t t .Y n l"/ „ Len / Dia Length �o o� Dia 1-P Spacing � SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over , Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center ( / ' Bed/Trench Edges Topsoil 4 11'1 Yes Ej No H Yes j No N. COMMENTS: (Include code ee e discrepencies, persons present, etc.) Inspection #1: 7 / (1 , 1 , 5.)(1 Inspection #2: / / Location: 638 Leah Lane Hudson, WI 54016 (NE 1/4 SW 1/4 36 T29N R19W) Cottonwood Ridge 1st Lbt 8 Parcel No: 36.29.19. 1.) Alt BM Description = 's - re.--- O � � ,LQ/ZR.0(/ � / a � t ri ezot 2.) Bldg sewer length = II 3 / , , � , gym A - / ,t, , } D J Q , Z L -� C a- tedcf� amount of cover = > 3 vim( 7 Q.�.' U��° , ,A . _- ..4 --, Plan revision Required? E' Yes No �'_ Use other side for additional information. _ v /� / ��G��` __ L _ IT i Date Insepctor's Si. ature Cert. No SBD -6710 (R.3/97) Safety and Buildings Division County U 2 01 W. Washington Ave., P.O. Box 7162 S / (r o / x sconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 3151 4 62 Permit State Plan I.D. Number Sanitary t A hcation PP _ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s15.04(1)(m) roject Address (if different than mailing address) I. Application Information - Please Print All Information c731' Zeal l a4e Property Owner's Na me — ( Parcel # Lot Z Block # e.� non .114 Ow ner's M ailing Address $cafion `7 4 /a . -/ cr e Woad- ile '4, ,Sll� '4,Section .34. City , State Zip Code Phone Number /� l ad -lO/li //V1 .n/f / 7/.� D V " 9/ /✓� (circle e) II. Type of Building (check all that apply) c vk. T „7 q N; R /9 E 46 f 1 or 2 Family Dwelling - Number of Bedrooms y Subdivision Name CSM Number ❑ Public /Commercial - Describe Use (0 -f f p/) 4000d / 51- 4CD t ❑ State Owned - Describe Use 2-) X i SO .� ❑Ci _ ❑Villa e Townshi of ���� ty g � P Ahc1 III. 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 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: (Check all that apply) L i4-- lap E (i „)t -t^t l hn Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable s Single P oil ❑ At Grade ❑ S gle ass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter 1714.,eaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal /Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area 85 Required (st) Dispersal Area Proposed (sf) -""System Elevation (o - '� 11,1140 L•9‘.0 � U VI. Tai.k Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks � Septic or Holding Tank / /0Z 0 / �ec' /, s r► / Aerobic Treatment Unit /) Dosing Chamber . VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me Print) Plumber's Si g re MP /MPRS Number Business Phone Number V / iYl > Ou/heesiLer o ci, .,k) 424 yD 1 . 7/.� 386 !dam Plumber's Addre ss (Street, City, State, Zie ( Y, Zip lAo ) / 744 35%t) Ali cL ail k).1 v /:6 VIII. County/Departnient Use Only ig Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I su' Agent Signature ( tamps) Surcharge Fee) �rr��11 ❑Owner Given Reason for Denial � .�.�v ---- • 2.2 2033 IX. Conditions of Approval /Reasons for Disapproval SYSTEM OWNER. 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. , 2. All setback requirements must be maintained as per applicable code /ordinances Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size i • SBD -6398 (R: 01/03) „, I -J..1 • x . _ ,_,_,.��,..1. ! - __ Q/]GL .. . �1 , � � r 2111111111 : u ��,. /�. - - ,- a , „ CO ON L) bop 61 L pal r - , - - - • ∎/9 1_c, l a QbJ . * All / A r/ • • t c( ISwK ooA, 0 , ,,,,,, ___ ......i _ jrii . g . i .___, ii .,,. 1 -c i r e •> ---:/, 44 J � a- G .--- 0 PY ,____,.. _______ • ”, ,„_. . , ,, 8 3 % I ` G . • r Lik ce K , 99,3 5 i, / y a il , � f IIIIII111111II - 1 - 1 9 ► b III 111111111111Iiiiii a) D I " haON Pair 11111111111111 li 7'7" 0+ GoxnK12 .57! .2 tIQI 1 S�JU 111111i111111ill � :. o - i : v E c � ' In co ® 111111111 111111111111111111 1 i 7 I II�I1i � .n o aa) -` E ^ N �ii1111111 111111 � E E Ti -c. x° c W j C' !I I� j I!III N el to 1 CI n r- IIiI T ' 3 (71 a , §_:;._, Ism 0 iii I IIhIIII� 3 ° _ � -- �II �nillllIlIhll W 13 w a w_ al 1 ___ - -- ; _ s') a "( _ X I m > at (1) � J L L U - .. = X V = cc) 01 C 0 P ,���,Q ' J u o = s N O 7 d 1 ! • • • • .F..___I ...,„i2 ..........,......... ._ ....: p A__ _ _riot r e .# ___CVICI . _S..; d e. Idinde...c...c__________ _ E A•' / / •, , Cu�loN It.) �� s ���� r . , . OP. 0.4 • s 410 I .7P 1 )JK , (D C.0 ° ID/ lir" e B oke /lilt s 2 7 'il c y n 'i • ( 4 62UKa un. , .0 • I ]GV5b) Ste L yUn,..t p -►oo fi ifit) V o- c �J 6` -T b , — • of., $ 3 J/ 1 • Nr Lk b co I IIIIIiiiiiIiii H 9�y►v � A cn IjflJfl!flijIfl 1 4—! L , ? G(p 0 IhiimIiIiIIIIII '� ° Gox o� nKk 111111111111 �° ° t 1.eV. 1 0 f :1I ! ' o IIIIiiIiii i i E 1 iiiiiUiiiIF!Hii; z - = . �� �� x N ej iiiii Im II N N cn -0 • U 'v la 111 __ � ,I III u) (11 0 T -1----- 111 � � cd a w hiliiiiriill� °' IIlli iIIIIIIflhi E �: "------"11 11 11 11111111111 I 11 22 S o ^ W III IIIIIIIIIII X as li ' - _ o "1 11 1 T d. • • • • f /31)y n DevE o pf 72 • KEPvvva /Ms r 3 Po,vN4 SFE T- 9 / i, 13A-R6-e RP • I/vpso 41/. s'f / , ' • . Wisconsin Department of Commerce SOIL EVALUATION REPORT / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches In size. Plan must County S r GR 0 indude, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. S-ee, 4G /6 w .- percent scope, scale or dimensions, north arrow, and location and distance to nearest road. . Please print DIP mtolI pp pp ����J! �'t VV 1 R w by � date Personal Information you provide may be used for secondary Liw. s. 13 04 ( (m)). J/ 71/0,3 Property Owner Property Location 14/ -r Q NE/'L w /Lea�C5ON ov JAN 0 9 2003 G . tot s€ 114 110114 � S3 T 2 ` N R/ 1Ti (or) W Prope Owner's Mailing Address L � Bl 1 t o ck # Cr CSM# � tJO N 1� 5 / / G,9¢ / T Y " / 4 CT's!. y. // ST. Cf :OiX COUNTY �"d �� (, t�j / �Y ! v'T 44 ZONING OFFICE /v City State Zip Code City ❑ Village 14 Town Nearest R N • ,,I OO ,t) l ev /. i f i i (7 31(6 -"All h - i 1-/-toy, . iCt -New Construction Use: (Xi Residential / Number of bedrooms 3-y Code derived design flow rate y5 — 6 Or GPO ❑ Replacement ❑ Public or commercial - Describe: _. Parent material /& S 5 ' 1/4 0 /4 1 t 7C-e • Flood Plain elevation If _ app_li / ble , N �� - - - � ft. General comments an recommendations: S /'TE SC' /f/fd /�" /9/e ,L /eV - M1 /', p j /iv , €'J sus r�� -r zt's� u — /S 54c'i jl cee (j),. 3 g # d 0 Boring 6 .,G t / Boring Pit Ground surface elev. 1 1 20 Depth to !knifing factor . ' Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ f M. Mutsef Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 / o• /O» 33/ y L. /FIN ,417 /,v 3 t • V • Co 2 8 '/ /o y4 Ylt{ 5 213 4 CS /f . . .2 _3 Y• 20 7. SO ref . S/a /fse f,' as — , 2- . 3 Ar- 2 z7,0 AP/o,--f . r (f I 2. I Boring # � / C b Z • fp� " Da Pit Ground surface elev. R. Depth to limiting factor i in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EfB12 / o -lT /DY/ 3/y — G. hes/K nVIfR w 3 f . r 2 6 •/g /ofg Y/6 tic /-7e5h/t n.-► c/ ' a. S - 2_ .3 47 lit E ST& I r?/ 1 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD _ 30 mgll. and TSS < 30 mg&L �e �/�. , CST Name Ro (Please 7 Zt' /M'/ ctl r S / �' " ? t 2 2 G tisull'er S Address Date Evaluation Conducted Telephone Number Ulbricht 8, Associates -- 2)2(...- - 2e �'L 7 /5' 3 26. • iiieS C55 O'Neil Rd. Hudson, WIs. 54010 .V- PI/)5 N£ o� s o .2.6 • / /oy• y, . crero s E of NO ©2n- //09 2C0 •oat , • • t h • Go th 0 3.0.1 /0 yo•oaa Property owner /f/ /i L W i/L 0 K SON 0).0. //b y• • 0� 2 3 Parcel ID # Page of 3 Boring # ❑ Boring J Dep th to limiting factor /e • l7S -Pit Ground surface elev. y✓ �s T e. O " Horizon � Soil Mplic:atiaon Rate Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. *Ent •Eff#2 / o • 5 / 3/3 1 /fshXX A.pricR � ) 3c . 9 . 2- S • /v /Ng 5,1 2{56K 44, cw r f . S • .3 ! Z fi /av ,'c - S/G /-7 44 , • . Z .. . 5 -- 3 / ? "--> G /.y Jolo Are_fe. , I I Boring # ° Boring - ❑ Pit Ground surface elev. R. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfW in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I 1� Boring El Pit Ground surface a ev. ft. Depth to limiting factor in. Horizon Soil Application Rate Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff In. MunseN Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 'Eff#2 Boring # ❑ Boring ❑ Pit Ground surface elev. R. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence " Boundary Roots GPD/fP In. Munseil Qu. Sz Cont Color Gr. Sz Sh. •Eff#1 'Eff#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mgll. 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. $aoa330 ta.6v00r • For issuance of permits and designing Contact: Ulbricht & Associates Registered private wastewater consultant and plumbers 655 O'Neil Road 5`4 /I ; f " 3o Hudson, WI 54016 . 715 -386 -8185 or 715-772-3442 PITS 4,,e S �S7PD n a v -up s yam"' /- e�,�r >o v y11ys s �•� fi l( /0 wi ig s 4 L or #lI ,,,, it 1 ft A T n � oU , c 9! 3 (9 Ulbricht & Associates 9 5 �' Private Sewage Consultants • 655 O'Neil Rd. ? ,, Hudson, Wis. 54010 4 k O V a I. 0 \ i37. il u,1 . \ 1 ■ • ■ \ '— g 3 , I2 \ ________-- 4 1 74 Ai (FORM /y ° th D u % \ 2 Vi , a i i b A 9 S sy 2 / o j3� . / .5 r ? - fi e Top of y " S fL 19,.M. /d0 0 SO . LOT L- . (p " (Wow 9,4 P P . 0 litt.P.t s 4 it, v0 ) /.% . Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number 430 (02 0 Number of Bedrooms > Design Flow - Peak (gpd) ( ( () Estimated Flow - Average (gpd)%-- 1 -0 - 1) Septic Tank Capacity (gal) 1 1, Soil Absorption Component Size (ft') ( R`( Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Desi•n Flow - Peak (e pd) ..ip. Z 60- Z` 0 Maximum Influent Particle Size (in) ' 6 1 1/8 Maximum BOD (mg /L) D D 0 220 Maximum TSS (mg /L) 1St) 150 Table 3: Maintenance Schedule _ Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tan an outlet fill shall be assessed at least i ection. The utlet filter ha as necessa to ensure per( veara n$p once ev ry proper operation. The filter cartridge shou not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must • be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 • • Management Plan for a Septic Tank and Soil Absorption Component • Plantings of deep - rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. When system fails,,e will replace with another system / at owner's expense. Alternate area must be left undisturbed. St Croix County Zoning Office 386 -4680 Boumeester & Sons Excavating 386 -9020 Tri- County Sanitation 386 -2130 3 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer er - /10 z 66r 5' Address i .ct 7 O/A Mailing ,1 Lea Property Address (n 38` G� a (Verification required from Planning Department for new construction) City /State /(Vdferfr / _ _ l Parcel Identification Number LEGAL DESCRIPTION Property Location/1)f: '/., 1/A) ' /a, Sec. 3l0 , T2 N -R /9 W, Town ofilVd5. Subdivision 7 £+_.• l fd i'4 i( H0 , Lot # 3 . Certified Survey Map # , Volume , Page # Warranty Deed # 70 OQ Td , Volume 07335 Page # 35�• Spec house ❑ yes Kno Lot lines identifiable ,'yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a that (1) the on -site wastewater disposal system licensed r verifying ( ) pumpe erifying 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 ha e d the above requirements and agree to maintain the private sewage disposal system with the standards set forth, here' ' ` t • ; ; D • • • s ent of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating tha • ur s : • tic uu tem has e s •. • intained must be completed and returned to the St. Croix County Zoning Office within 30 d ays . he , .y .'7 , iration. . mute— /d 01/03 SIGNA P OF ' ' ICANT DATE O R CER 00N I (w � j : tements on this form are u to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pro, de ri • if v' • of a warranty deed recorded in Register of Deeds Office. /d / ) 7/ 03 SIGNA 'i OF •LICANT DATE * * * * ** permit being revoked by the Zoning Department. * * * * ** Any information that is mis- represented may result in the sanitary p g Y g p ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed • r t. PE • TrsT aN odke /°,pie Ts o f Lo r. Wisconsin Department of commerce SOIL EVALUATION REPORT Page 1 of 1 Division of Safety and Braidings in accordance with Comm 85, Wis. Adm. Code p Attach complete site on not less than 1„ inches in size. Plan mu r 5/ G /e o" include but ti nnited to: and horizonta re /2x po (BM). direction " and st Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. • Please print a it ill .. �/ • p�� I . ����p�" •y1■�yy R. by / Date n Persons! in(o ation you provide may be used . socol 7 �CL� `rE -"• s. ... � 04 (1) (m ll• •I ....' . Aill ' • 1 03 Property Owner IS • - Location . O A V 1 3 ! 4 5 IIIIMPIE 1 / 4 $ "1 S3 T N R /9 ; (or)W Property Owner's Mailing Addr ss : 3 # � Block # Name CSMII r / i 6- = i - /,b O 1/ •9 4- State Zip Code • • = !1•' • - r a City ❑ Village .Town Nearest Road M iPst'1v 1o1 sYace i (7 /s) 3(6/7175 '5 w;ucd - `3)a • Ilia New Construction Use: IFLResidential / Number of bedrooms 3 — s i Code derived design flow rate yfd - a GPO o Replacement 0 Public or conannerciai - Describe: __ _ _ Parent material Jogs s d 1)44. MP oO*(444I Flood Plain elevation if applicable A/ — ft. General comments and : • /f 1-40 e i P , / 1 ' 7 $7 vCOfT4$ /O //f' 44/ /I) ff e ox-' D ea woTiO6 4 P O.te,. 7 • ( le.41/MisiaJ2. W'E,�Jui0 s) / Bang# 0 Boring /0/.30 ® - Pit Ground surface elev. ft. Depth to Orati factor in. Soil Application Rate Horizon Depth ' Dominant Color Redox Desaiption -- Texture Structure Consistence Bounday Roots GPD/ft in. Mu nse0 Qu. Sz Cont Color Gr. Sz. Sh. " Eff#1 'Etf#2 / o -/d /0YRNY - L fshie i►.tafR 3'F • 5 . I d�- /L /f ,F/ c5 •z • 3 /o • � s cwt / � . 3 " 17.3 2 7 5 v/2 f/!� _ /GL 12, •r► iw, of i* a.5 a 0 . V r Ya 7• S yR y /! ---- -- s L 2f 3 hK, Am. fie, a. 5 .- . 5 • �J 5 •s i 9D /o y2 s/ ors 402,2. • 7 (.2_ • Boring # 0 Boring /01. .0 > , . Gro und surface elev. ft. to limiting factor in. Pit Depth Soli Application Rate horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fW in. •unsell Qu. Sz. Cont Color • Gr. Sz Sh. 'Eff#1 'Eff#2 o • q io yg3 /y _.-- _ L zfsh>� 3 •F . 5 . y/1 9•l5 /o- Fit. /7ccS4e A44.6 C5 />c • z . 3 Y�� — 3 ( •2g 7•Sy/e V6 --- 5 Z- / f6k wt -- � C5 • z . 3 1 . . 1 1 • ' 1 . S Y / 2 ' A ---- 5G 0, 4, n+1-F-i' . 0 . . S ` • 3 -5 3�r 5 3g• 5o -76 VRy''L'e 5 _0r5 4,Q — .7 /.Z Cn .7a16 /00 s6" 444dl.,S 'S , e , . ? .2 • Effluent #1 = 806 > 30 < 220 mglL and TSS >30.c 150 mglL • Effluent #2 = BOD < 30 mgr. :.• TSS < 30 mg&L • CST Name (Please Pat) Signet= -- • CST Number 22.6e 31 5 Address Date Evaluation Conducted Telephone Number ' 940 0. 2Z' ?-00 7f5 Ulbricht & Associates 2'6'49 z Private Sewage 0/6-i v14L Te5 T 2$12 10th a Consultants Spring Valley, WI 54767 �l aU,�o SY S C4Ai/ Asa in/f /Q-014-60 4 , - ee 7M le417 - 4'P M01)2v 7.1 / 6 oye 4 t ) /2z5i2 5 •ShoI,L/) it /074Q q1 14,t,'" O R!Gi N AL • 'J 2135 P 355 - 71zsgazaeo, WARRANTY DEED REGIST O D REGISTER OF DEEDS ST. CROIX CO., MI Neil L. Wilcoxson and Mary J. Wilcoxson, a /kla RECEIVED FOR RECORD Mary Jo. Wilcoxson, husband and wife, conveys 02/07/2003 82 :9ePf and warrants to Kernon J. Bast the following EXEMPT 4 described real estate in St. Croix County, State of np/+ p * /�� REC FEE: I L 618 Wisconsin: TRANS FEE: 2888.88 COPY FEE: CERT COPY FEE: PAGES: 1 Exception to warranties: all easements and restrictions of record. This is not homestead property. Parcel Identification Number(s): 20- 1109 -40 -000; 20- 11 -9 -20 -000; 20- 1109 -10 -000; and 20- 11 -90 -55 -000 Name and n 1c ' A parcel of land located in part of the Southeast "/4 of the t t lin a ea Ti tle Northwest 1/4 , part of the Southwest '/ of the Northwest 400 South 2nd Street 1/4 , part of the Northeast % of the Southwest) /4, and part Suite #115 of the Northwest % of the Southwest'/~, all in Section 36, r �� ,fit ison, W l 5401 6 Township 29 North, Range 19 West, Town of Hudson, St. ,' 1 Croix County, Wisconsin described as follows: Commencing at the South `/4 corner of said Section 36; thence North 00 degrees 10 minutes, 01 seconds West along the north - south' /4 line, 1634.77 feet to the Northeast corner of a parcel of land described in Volume 526, page 259 at the St. Croix County Register of Deeds Office, being the point of beginning; thence continuing North 00 degrees, 10 minutes, 01 seconds West along said North -South 1 /4 line, 1977.22 feet to the South line of the North 350 feet of said Southeast 1 / of the Northwest '/; thence South 88 degrees, 49 minutes, 51 seconds West, along said South line and the Westerly extension of said line, 1324.14 feet; thence South 00 degrees, 09 minutes, 43 seconds East 2,096.73 feet to the centerline of County Trunk Highway "N" being a point on 1,999.00 foot radius curve, concave southerly, whose central angle measures 03 degrees, 00 minutes, 19 seconds, whose chord bears South 80 degrees, 02 minutes, 21.5 seconds East and measures 104.84 feet; thence Easterly, along the arc of said curve and centerline, 104.85 feet to the point of tangency; thence South 78 degrees, 32 minutes, 12 seconds East along said centerline, 712.54 feet to the West line of said parcel described in Volume 526, Page 259, thence North 00 degrees, 10 minutes, 01 seconds West along said West line 304.75 feet to the North line of said parcel; thence North 89 degrees, 49 minutes, 59 seconds East along said North line 523.00 feet to the point of beginning, all in Section 36, Township 29 North, Range 19 West, St. Croix County, Wisconsin. Dated this _ day of GG - , 2003 ,,e L. :tcox .n Mary J. W�,r i n \ ACKNOWLEDGMENT t: °Z;w,�;; STATE OF WISCONSIN ) .,, P(/�,i+kt COUNTY OF ST. CROIX ) .. IA- J . Q {f�, Personally came before me this _ day of JLi99 2003, the above • =med Neil L. Wilco d Mary . i� Wilc to me known to be the persons who executed th fo oing instrume ; acknowledge the me r N Public ' ,/, _ - �► My commission expires: C ' ti SP # `a This instrument drafted by Robert F. Wall. WilcoxsontoBastWD03 -1 O W`S -IP W a I \ f � J I LpT Si w I 2.08 ACRES o L OT 84 ` I ; • b 2.16 ACRES 90,623 SQ. FT. .' / 0 \. g 94,298 SQ. Ff • 1 I 6 I 6 • • N ®‘k 19 I X16 • I 1 ��E�00' t- . 1 / N89 °55'2 Ell n U n ��I 541.76' \ V N89 °55'21 "E 214.93' 1 0 \ 15 C5 �, . C 86 CRES � LOT 82 `to CI sa• L 83 0 2 .23 ACRES t 2.11 ACRES o 96,934 SQ. • 703 SO. • -� cn m . I °42'32 °E 394.12 523.00' 281.50' N89 ° " 241.50' pUTLOT 2 0 SHED I 0,12 ACRES •pT 87 g N89o49159pE 523.00' 8 5230 SCE. S 2.74 ACRES o � r-� 19,218 SO. FT � � D o �y7 O p r I P � p -GD wag © [`i]r. — _ _--- NOT \----- Z N IS TO BE DEEDED TO AN O OUTL ADO I NING LANDOW r I - Z AY M. — ___", _____ ____ _____ , __ ___ I