HomeMy WebLinkAbout026-1149-00-005 sconsin p epartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
, afety and Building Division
INSPECTION REPORT Sanitary Permit No:
430085 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID
Personal informaiion 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:
Pettee, Scott Richmond Township Z4— 9' 00' GIGZS""
CST BM Elev: Insp. BM Elev: BM Descrip 'on: ` SectionlrowrdRange /Map No:
r� (� a f N � � �- � l� 15.30.18.
TANK INFORMATION ELEVATION DATA
TYPE MANUF �PACITY STATION BS HI FS ELEV.
liC
Septic / / ark 3 • 3 tS /
ry► / 0 33 6
Jo
Dosing / S A - 71 -I1 3
(J �ittL .I
Aeration Bldg. Sewer , '
Holding S Ht Inlet 2
TANK SETBACK INFORMATION St/ t Outlet
TANK TO V JJL jELL R Vent to it Intake ROAD Dt Inlet
Septic 5��/ � i Dt Bottom
' d �y
Dosing Sp. Header/Man.. d D g
I &A 0
Aeration - Dist. Pipe o
Holding Bot. System / i, Le 9 y 3
PUMP /SIPHON INFORMATION Fi Grad — Tq
Manufacturer - -- Demand St Cover
GPM
Model Num
i >%
TDH tift F tem HeaSl_ TDH .V t S
JilGl�
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM - v - 7 - 0 7 ]'4 L - 4 PX A61'tl
BED/TRENCH Width f Len If No. Of Trenches rIONS IMENS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
IC I
3 �lo
SETBACK SYSTEM TO P!L BLDG WEL LAKEJSTRE LEACHING M nufac��1LL1rr¢(��
INFORMATION CHAMBER OR S
Typ Of System:
j
7 ` UNIT odel Number: `
DISTRIBUTION SY TEM o W 1' P L ,tJ ,
Header /Manifol C Distribution / kg x Size x Hole Spacing ent to Air Intake
L Pipes. // �
� � 1
Length ' � is Length Dia p1
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
F
Depth Over / Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bedrrrench Center ed/Trench Edges Topsoil
[�] Yes I_1 No [_] Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:l�1 Inspection #2: ! /0
Location: 1263 152nd Ave New Richmond, WI 54017 (SW 11 j i4 8 ) erry nolls d PAcgt 0. 1 .3
1.) Alt BM Description = 5 C 33 4
i
2.) Bldg sewer length = 33
- amount of cover =� t i 1' 12 �/C�it(� .�- �Q c j C V�1 F'S L k ' W'" -r "t �' Z
1 4- _ j a o vs
Plan revision Required? Yes VNo Q
Use other side for additional information.
Date Insepctor's Si ature Cart. No.
SBD -6710 (R.3/97) e
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Safety and Buildings Division County
` 201 W. Washington Ave., P.O. Box 7082 t
isIconsin Madison, WI 53707 - 7082 Sanitary Permit Num (to be filled in by Co.)
Department of Commerce (608) 261 - 6546 300 195–
Sanitary Permit Application State Plan I.D. Number
in accord with Comm 8311, Wis. Adm. Code, personal information you provide
may be used for secondary purposes Privacy m Project Address (if different than mailing address)
1. Application Information - Please Print All Information 1 '62 9 5 ' 14 V.
Property Owner's Name MAY' 0 200 PAMPI ft Block ` ^n
Property Owner's Mailing Address 6 T ? ? x, U T , Property Location 2
loo ! 1f
City, State Zip Code Phone Number 5E.1, Section -
A/ J44sy (J�' J 7�/ �✓ -3��'� �ON; RI EorWe) r(9
IL Type of Building (check all that apply) _ s+au•,
K) or 2 Family Dwelling - Number of Bedrooms �- . ,, 0 c t"�' S bdivision Name CSM Number
❑ Public/Commercial - Describe Use Y[ c erl dL4.Ul . .
❑ State Owned - Describe Use ❑City V a �'[ownshi of
III. Type of Permit: (Check only one box online A. Complete line B if applicable) -
A. $(New System yst ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
B. ❑ Ptmit Renewal ❑Permit Revision ❑ Change of ❑Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumb r er
L
IV. Type of POWTS System: Check all that appl
$(Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Application Rate(gpdso Dispersal Area Required (sf) Dispersal Area Proposed (sf) System EI nation QJ- SO P
�7SO d Da$.� '�° 9_ , o
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel riber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank f / S0
Aerobic Treatment Unit i (7 /
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for Jpgallation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plum be Si re M PRS Number Business Phone Number
09P0352 _71s - d4B - In 9 yt�
Plumber's Address (Street, City, State, Z'p e)
VIII. Colin /Department Use Onl
X Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date issued Is uin gent Signatu ( Stamps)
Surcharge Fee)
❑ Owner Given Reason for Denial I A,1L D
IX. Conditions of Approval/Reasons for Disapproval Le ,
AJ SzR` - dt� WAAAA LP_
e
Attach complete plans (to the County only) for the system on paper not less than 81/2 x It inebes in size
SBD -6398 (R. 08/02)
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Wisconsin Departure ito:`Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of safety ara Buildings
in accordance with Comm 85, Wis. Adm. Code County St. Croix
Attach complete site plan on paper not less than 8112 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. Da
Please print all information.
te
ev' ed by
Personal information you provide maybe used for secondary purposes (Privacy law, s. 15.04 (1) (m)). /
Property Owner Property Location
Steve Derrick Govt. Lot SW 114 SE 114 S 15 T 30 N R 18 E (or) W
Property moo ��g. Andreas Lot # Block # subd: Nor or C"
1438 County Road G 5 - Cherry Knolls
city State Z'eft Code Phe rte Number i<y �liage Town' Nearest Road
New Richmond Wl 54017 ( 7J5- 246 -3120 County Road G
0 New Construction UselE Residential ! Number of bedrooms
3 to 4 Code derived design flow rate 450 to 600 _ GPD
Replacement Public or commercial Des-
fil
Parent material Flood Plain elevation if applicable
General' Site suitable for a conventional below grade system
g
and recommendations: * W/ several pockets of sicl, 7.5yr4/4, f2d5yr4 /6
1 do not consider thi a liMirirfg lac` r due W M6 liffift0d Wffftt
Boring >104
Boring #
P!"L t }s elv+v. 104.70 ft De.W to-tir�ti#ing f In Soil A !cation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff# EH#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 0 -9 10yr3/2 -
sit 2msbk mfr cs 2f .5 .8
2 9 - 18 7.5 4/4
sicl lmsbk mfi cs if 2 3
3 18 -24 7.Syr4 /4 set lmsbk mfi cs • •
-
4 24 -53 7.5yr4/6 sl Om mfi cs - .3 .5
5 53 -104 7.5yr4/6
s Osg ml - - .7 1.2
2 goring 6eri 1()(1.55 > 1 I0
Q Pit Ground surface elev. _.��____. ft• Depth to limiting factor in. Soil Ap ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 Eff #2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
1 0 -12 10yr3/2 sit 2msbk mfr cs 2f .5 .8
2 12 -20 7.5 4/4 sicl lmsbk mfi cs if .2 .3
3 (20 -29 7. Syr4 /4 -
set lmsbk mfi es - .2 .3
4 29 -36 7.5yr5/8 is 2msbk mvfr cs .7 1.2
-
5 36 -58 7.5yr4/4 *sl lmsbk mfr cs 4 6
8 -78 7.5yr4/4 ifs lmsbk mfr cs - 4 6
7 78 -110 7.5yr6/4
8 O ml _ - 7 1.2
s. # _<
* Effluent #1 = BOD > 30 220 mgll and TSS >30:E 150 mg/L BOD 30 mg1L and TSS _< 30 mg/L CST Number
CST Name (Please Print)
227387
Thomas C Nelson "-' "
Date Evaluation Conducted Telephone Number
Address 715- 246 -2454
1432 120th Street, New Richmond, WI 9 -25-02
n1T A�'A TA^IMA
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 2
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity 146 a l ❑ NA
Permit # 30 0 3S_ Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer T ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model — Q ❑ NA
Number of Public Facility Units ❑ NA Pump Tank Capacity a l ❑ NA
Estimated flow (average) Q g al/day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) 0 gal/day Pump Manufacturer ❑ NA
Soil Application Rate a , gal /day /ft2 Pump Model ❑ NA
Standard Influent /Effluent Quality Monthly average's Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) S30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODJ 530 mg /L ❑ In- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: 13 NA
"Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month
ear( )(s) (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: Q 0 month(s) (Maximum 3 years) ❑ NA 0 year(s)
Clean effluent filter At least once every: month(s) ❑ NA years)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA
❑ year(s)
Flush laterals and pressure test At least once every: ' ❑ month(s) ❑ NA
• year(s)
Other: At least once every: ❑ O year (s) ❑ NA
1
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer, POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the 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 (Y 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.
Page �' of. y
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) 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 cell(s) 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 be 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 area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon 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.
T
alua " a o ing ank
CflN5772CJG
be IZU� -lt8
❑ 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 INSTALLER POWTS MAINTAINER
E me r Name
b Phone
ne /� j p -- jp
7
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY �AUTHORITY
Name Name 15t. � ( V, d 20/lf I tU
Phone Phone — 7jS -- 3 &'40- q (010
This document was drafted in compliance with chapter Comm 83.22(2)(b)0 )Id) &(f) and 83.54111, (2) & (3), Wisconsin Administrative Code.
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Oarl er1Buy e"' ��� � c 1 I C,
-n e e St' 1 [4 V8 S -n � Ul
Z4
Pray: erty kA .n ass 171. 1 SZ ', AV L tC� .
(Verific ition required from Planning Department for new construction)
City State . C�o C6y� ,MA1, Parcel Identification Number ZL - ► P U - �� . _ _.
LE( A.L D It 9 +i ; RIPTIO; J
Prc }: srty La ac uu, :on ' /., C Ala, Sec. � T 3 1 -R�W, Town of � �QG�.�JhSn +�
Sub, ivisiou ..akept'i K 0121.i 5 , L.ot # S __
Ceir1: ified E u ey Map # . Volume Page # - 7 7 3
Ws i ranty 1 o: it # � 7 -5 -0 . Volume o? 3 �,, Page #
Spec, house [ "I ;des ❑ no Lot lines identifiable ❑ yes ❑ no
SY'i, fEM ] .% C NTENAI ;CE
Improll c: use and mai atenanceof your septic system could result in its premature failure to handle wastes. Proper m; .:a xtenance
cons is of pvw pi tg out the s;:ptic tank every three years or sooner, if needed by a licensed pumper. What you pact into i e system
can a feet the P ri :.'ion of the >eptic tank as a treatment stage in the waste disposal system.
The , I,& a; ", :rty owner ,agrees to submit to St. Croix Zoning Department a certification form., signed by tho ownei and by a
mast r plumb c „J+: tuueyman p umber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater dispoaa system
is in roper o;:ae i 1 ing condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 fit11 : +t' sludge.
ilwc:, he undc-,n. i; ; aed have rei. d the above requirements and agree to maintain the private sewage disposal system with thc:: ;l.andards
set !ii th, here in, Ri t set by the department of Commerce and the Department of Natural Resources, State of Wisconsin. Ce.,i t fication
statitt r b ,i..rptic system has been maintained must be completed and returned to the St. Croix County Zoning; Oi'ficc; r:z ithin 30
days gar ex ' on date.
/ Z A 0
F VrM (;'F A,PPLICAT T DATE
aVi;`T It ;. CLFLC 7 ON
+: I cnts on this form are true to the best of my (our) knowledge. I (we) am (are:) the o va er(s) of
the ;', r a: i;bed above, by ' e of a warranty deed recorded in Register of Deeds Office.
IGt ATUR.E C if APPLICAT T DATE
Any cn mation that is mis- represented may result in the sanitary permit being revoked by the Zoning DepartmeO. * * * * **
** In :lode wilt! f !iris application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is trade in the warranty deed
PA 3 13
wiscgnsin Department of Commerce SOIL EVALUATION REPORT Page T of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
' County S Cr'O/ 4!
Attach complete site plan on paper not less than 81/Z 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.
Please print all information. Reviewed by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. M04 (1) (m)).
Property Owner / e- LN ^; Property Location
STe Ve ^ t C.k Govt. Lot 5 \,,J 1/4 SE /4 S I.5` T3() N R [q E (or W
Property Owner's Mailing Address Lot # Block # I Subd. Name or CSNW
IL1 5 1 Ch 61
City State Zip Code Phone Number ❑ City ❑ Village 0 Town Nearest Road
o ( , ) Zq 4,- 312,0
O „New Construction Ilse: ?I- Residential /Number of bedrooms Code derived design flow rate �{,-+` z /s. C'n GPD
❑ Replacement ❑ Public or commercial - Describe:
Z1 7RE -'`�
Parent material Flood Plain elevation i ft.
_
Genera comments IVED and recommendations: �/IS �(e V %. SO
V- 96. 2002
Ix COUNTY
F] Boring # Borg ZONING OFFICE
Q pit Ground surface elev. `75 • -Qk� ft. Depth to limiting factor in.
Soil Applicatfikon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
I
6-10 Ib 3/?- 5r 5
3 `f- `— Zrrngrk
e4 q 6 -6 f 31 C 2{�1, W 61- bk
Boring # Boring
❑
Z n () or .38 in.
❑ �Si Pit Ground surface Bleu. Q T q ft. Depth to limiting fact Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2
I d - lo Id 3 Z b K
Z- ( r l c k- c
-3g /0 r 314-' r" 5 ` ZmSbk,
IJ
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg /L ' Effluent #2 = 1300, < 30 mg /L and TSS < 30 mgtL
CST Name (Please Print) _ Signatur CST Number
Lirr�&xk 2 S336 7
Address Date Evaluation Conducted Telephone Number
1 S cul (715)2y7 -41668'
Property Owner � e rf C 1L parcel ID #
P Y
Page � of
3
D E — E Boring # E] Boring
1 15 1 0 Ground surface etev. 9O.56 ft. Depth to limiting factor En. Soil A fication Rate
Horizon Depth Dominant Color Relax Description Texture Structure Consistence Boundary Roots GPD /fig
in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2
2 _ t C 7 .5 4
��� Baring # ❑ Boring
L? ❑ Pit Ground surface elev. fi. Depth to limiting factor _ __ in. Soil A itcallon Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
[1 Boring Boring # Ground surface elev. _ ft. Depth to limiting factor _ _ _ _ in.
El Pit Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G IfF
in. Munseil Qu, Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
Effluent #1 = BOD, > 30:5 22o mg/t. and TSS >30 1150 mg/! ' Effluent #2 = BOD, _< 30 mgt-_ and TSS 1 30 mg/t.
The Department,of pommerce is an equal opportunity Service provider and employer if you need assistance to access services or
need snaterial in an alternate format, please contact the department at 608 -266 -3151 n or 'j"i*Y 0{18-2644777.
. t
' PAGE 3 OF
NAME 19- LOT# LEGAL DESCRIPTION 5w f S I ,S �S T !)0 N R,
SCALE: 1 "=
BM I ELEVATION /GO • G
BM 1 DESCRIPTION
BM 2 ELEVATION !'9.O U
BM 2 DESCRIPTION Sa
SYSTEM ELEVATION
ALTERNATE ELEVATION •t/ /�
CONTOUR ELEVATION co
7_,c', o 0
Y7. oo
$ �2
S
n
e �?
4
Q
6
SIGNATURE DATE
f ,
_f
I
Property Owner Steve Derrick
E --- -
Boring # Boring -- Parcel ID # Page 2 of 3
Pit Ground surface eiev. _ 9 8'60 >110
— ft. Depth to limiting factor in.
Horizon Depth Dominant Color Redox Description Soil A lication Rate
P Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color
Gr. Sz. Sh.
I 0 -11 10yr3/2 - "E1f#1 . *Eff#2
2 1 120 sil 2msbk mfr cs 2f 5
7.5 4/4 - sicl lmsbk mfi 8
3 20 -29 7.5yr4/6 cs If .2 .3
.2
4 29-63 7.5yr4/4 scl Imsbk mfi cs .3
5 63 -110 7.5yr6/4 sl Om mfi cs - .3 .5
s / Osg
r
U Baring # Boring
Pit Ground surface elev. ft. Depth to limiting factor
Horizon Depth Dominant Color '�-- �
Redox Description Texture Structure Consistence Boundary ots Soil A ro /f F Rate
in. Munsell Qu. Sz. Cont. Color D' GPDt
Gr. Sz Sh. *Eff#1 * Eff#2
E l Boring # Boring
®p,, Ground surface elev. _ _ft. Depth to limiting factor in.
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary oots Soil A iication Rate
in. Munsell Qu. Sz. Cont. Color GPD/fF
Gr. Sz. Sh. *Etf#1 *Eff#2
* Effluent #1 = BODS > 30 _< 220 M91L and TSS >30 < 1 SO L
� *Effluent #2 = BOD < 30 mg!L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608-264-8777.
M- 8330rest (R07/00)
2 2 3 4 P 2 4 0 �amssra
r
KATHLEEN H. WALSH
STATE BAR OF WISCONSIN FORM 1 —1998 REGISTER OF DEEDS
WARRANTY DEED ST. CRorx Co., WI
RECEIVED FOR RECORD
Document Number 05/08/2003 09:00AN
This Dead, made between Steven J. Derrick. a married person
Grantor, and Scott A. Pettee and Michelle Pettee. husband and wife WARRANTY DEED
Grantee. EXEMPT t
Grantor, for a valuable consideration conveys to Grantee the following REC FEE: 11.00
described real estate in St. Croix County State of TRANS FEE: 128.70
Wisconsin (the "Property"): COPY FEE:
CC FEE:
PAGES: 1
Recordin Area
Name and Return Address f ,
ee
152nd enue Q Ir fo -ly-a A*
ew �c 1540
mN 554'5
—t
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Lot 5, Cherry Knolls, St. Croix County, Wisconsin.
Together with all appurtenant rights, title and interests, none
Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances
except
Dated this 9tt day of Agril, 2003.
(SEAL) (SEAL)
t
Steven .Derrick
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
WENDY SWATZINA } ss.
authenticated
NO�',ARY PUBLIC St. Croix County
t ' .�,.fE " F'
cu n Personally came before me this 29th day of
April 2003 the above named
Steven J. Derrick, a married person to me known to be
• the pe on who a ecuted the
edge th foregoing Instrument
TITLE: MEMBER STATE BAR OF WISCONSIN nd ac owle sam
(If not, t�
authorized by §706.06, Wis. Slats)
THIS INSTRUMENT WAS DRAFTED BY Notary Public, S to of Wisconsin
Coldwell Banker Burnet
1301 Coulee Road My commission is erm non. (If not, state expiration date:
Hudson, WI 54016
3 -30354 �� J
(Signatures may be authenticated or acknowledged.
Both are not necessary.)
' Names of persons sig ning in any caeacIty must be typed or printed below their signature.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc.
WARRANTY DEED FORM No. 1 -1998 Milwaukee, Wis.
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