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026-1167-19-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567216 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: Gorres, Nicholas & Jillian Richmond, Town of 026-1167-19-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: rI l 4 I^~ ? t_P ele a 27.30.18.1321 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic t /606 Benchmark 25 163.1 Dosing Alt. BM 1~d 1 a Sz5 x: ~ Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. ent I Intake ROAD Dt Inlet e f l-L- AI Dt Bottom r Dosing Header/Man. Aeration Dist. Pipe / • ! 73 c Holding Bot. System 16-4 9Z . 9 PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St C~e1GP Model Nu 7116F TDH Lift Friction Loss S s TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION YSTEM BEDITRENCH Width Length pJo. Of Trenches / ' PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Z elx . SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: ff INFORMATION CHAMBER OR Ln.9, t t-r • , r Type OJSystem, 7- -7 /'9 Q3 1 ^ UNIT Model Number. G Jv r~-- DISTRIBUTION SYSTEM d4t,_ 54 ,`r5 Weak- ZZ d~ Z 3 7 bi--S 4/5 Header/Manifold ~J it Distribution Ix Hole Size Ix Hole Sp in Ve~ t ~ir Intake 5 / Dia 1` Pipe(s) Length Length Dia Spacing ~e 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 Bedrrrench Center 61 Z Bedrrrench Edges Topsoil s L 0 No s No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1384 126th Street New Richmond, WI 54017 (NE 1/4 N 1/4 27 T30N R18W) Lundy's reserve Lot 19 Parcel No: 27.30.18.1321 1.) Alt BM Description = 2.) Bldg sewer length = G I r- p~e-5 q, A a/A d' d t ~ -5 e - amount of cover = G>66 I / UU r- e.t tw r-~r Aar' 3 - 1 LI - Plan revision Required? Ful Yes ;,No 13 j 3 Use other side for additional information. J ~ Date Insepctor' Signatur Cert. No. SBD-6710 (R.3/97) c ~r. 3 s~ Ilk- A3-~ ~6~~7 "ar County 4^ Safety and Buildings Division 5T, cA-O~ 'p $ 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 1' ' r S} ~ t zl State Transaction Number R Sanitary Permit Applicati In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropna tal unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide mused for secondary purposes in accordance with the Privacy Law, s. 15.04 1 (m , Stats. L STS 1. Application Information - Please Print All Information C Property Owner's Name abl to& 4- 360 Parcel # -1167- / aoo b (o Property Owner's Mailing Address , RO Property Location / l 1 ,~'`OUN Govt. Lot l 1 3Z I City, State Zip Code Phone Number l Section 07 ? 9 q4 lrcle one 715--766 T 3 D N; R a E o>aV EL Type of Building (check all that apply) Lot # E3 - / Subdivision Name l-or 2 Family Dwelling - Number of Bedrooms Bloc I- ❑ Public/Commercial - Describe Use ❑ City of CSM Number El Village of El State Owned -Describe Use rr Town of .7 8- e Ge Llw 2 Z. A-- 2 G Una. III. Type of Permit: (Check only one boa 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. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 1 a i•~- IV. T e of POWTS S 'Stem/Component/Device: Check all that a 1 Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: Design Flow (gpd) Design Soil lApplication Ra✓(gpdsf) Dispersal Area Required (s Dispersal Area Proposed fl System Elevaxion J D f /qd o 4 VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units 2 U N New Tanks Existing Tanks W d o 2 ) v~' /a(2 aU i vs wC7 0, Septic or Holding Tank r - `o0o I Dosing Chamber O VII. Responsibility Statement- I, the undersigned, assume esponsibili for ' lation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's ature VMPRS Number Business Phone Number z4?F11 C; 17 7i5'- 766' - ocl% Plumbe Address (Stre City, State, Zip Code) VIIL County /De artment Use Only Approved pp Permit Fee DatZIus ued ~3 Issing Signature ~ 7 en Reason for enial DL Condit vf* %Reasons for Disapproval 1 2.. dr 6PU0 tank, effluent filter and 3 Q~ ` q vq rH,e. Cj tS ~N-~ ;dispersal ciefi must all be services / maintained a • + as per management plan provided by plumber, i 01 S G°~ g: ; i~~ set ck requirernerk must be maintained as per app kable code r ordinal WAS .~-J a►.~-~n Attach to complete plans for the system and submit the County only on paper not less than 8 112 111 inches in size o SBD-6398 (R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: /v Owner's Address: l 3 a a 7~C-c Legal Description: s a? 7-30 1 1 g Township: County: Subdivision Name: 4 0 Lot Number: I Parcel ID Number: 0 L - l Ct _6 CEO Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: ~J 7 Ur~AIU/License Number: 3 Date: - Phone Number Signature Designed pursuant to the In- ound Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01!01) Page 1 i c ~ Ls s~ a - i _ ~ ~ - - X13-~ b~~7 i 12111 Absorptiontem Cross Section rt &4 edute 40 Final Grade ert Ripe ent Cap ft Leaching ~ ~ -Z-3 ft ft System Elevation ft I ft Soil AbSorption, System Plan View ft 99 I ft -ft Vent Or Observation Pipe Leaching Trench 1 Chambers 4' Dia. Trench 2, Header Leachin hamber S ed ca ions Manufacturer And Model EISA Rating s q q per chamber Soil Application Rate ~gpd/sq ft gpd Desi n' to = c~® 9 H!,.3oil~Application Rate odd E{SA= Y~Chambers r2 rows of a chambers each. Page of Quick4 Plus Standard Chamber Side and End Views 48" (EFFECTIVE LENGTH) :12- _I = 34" - Quick4 Plus All-in-One 12 Encap f=ront, Side and End Views 11.2" - 13" 8" INVERT8" INVERT 5.3" INVERT i _ i 33"~ Quick4 Plus All-in-One Periscope QUtCK4 PLUS Au-w-owE PEws- .f?~a'swivrt ) EQ 12.7" INVERT OUIC 54 P1 U5 i NowEfz E NDCADCAP 1 Quick4 Plus Standard Chamber Specifications Size (W x L x H) 34 x 53"x 12" (86 cm x 135 cm x 31 cm) Invert Height O.v", 5.3", 8.0"; 12.7" 48" (122 cm) (1.5 cunt 8.4 cm, 18.5 cm, 22.6 cm) Effective Length INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY ' a) The structural integrity of each chamber, end plate, wedge and other accessory manufactured by Infiltrator when installed a^d operated in a leachfield of an onsite septic system in accordance with Infiltrators instructions, is warranted to the original purchaser ("Holder') against defective materials and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units; provided. however, that if a septic permit is not required by applicable law, the warramy period will begin upon the date that Installation of the septic system commences. To exercise its warranty rights, Holder must notify Infiltrator in writing at is Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limlfed Warranty. Infiltrators tiabl!ity specifically excludes the cost of removal antl(or installation of the Units. (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS, INCLUDING NO IMPLIED WARRAN?lES OF MERCHANTABILITY OR FITNESS FOR .A PARTICULAR PURPOSE (c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty INFILTRATOR* does nol extend to incidental, consequential, special or indirect damages. Infiltrator shall not be Fable for penalties or liquidated damages. including loss of production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. systems ' inc. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse e; neglect of the units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions; failure to maintain the minimum ground covers set forth in the installation instructions; the placement of improper materials into the system containing 6 Business Park Road - P.O. Box 768 the Units; failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, or improper operation; or any other event not caused by Infiltrator. This Limited Warranty shall be void if the Holder fails to comply with all of :he Old Saybrook, CT 06475 terms set forth in this Limited Warranty. Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any 860.577.7000 - FAX 860.577.7001 third party resulting from installation or shipment, or from any product liability claims of Holder or any third party. For this Limited Warranty to apply, the Units must be installed in accordance with all site conditions required by state and local codes: all other applicable laws; and Infiltrator's installation instructions. $00.221.4436 (d) No representative of infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other then the Www.infiitratorsystems.COm original Holder. - The above represents the Standard Limited Warranty offered by Infiltrator.. A limited number of states and counties have different. warranty requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units. - j 113M U.S. Patents:. 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,1.16; 5,401,459: 5,511.903; 5,716,163; 5:588,778; 5,839,844 Canadian Patents: 1.329.959: 2.004.564 Other patents pending. - Infiltrator, Equalizer, Quick4 and Quick4 Plus are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. 19 a registered trademark in Mexico, Contour Swivel Connection is a trademark of infiltrator Systems he, 0 2009 Infiltrator Systems Inc. Printed in U S.A. PLUS0510101SI-2 O O ODD O i -Ir -IXr D DOm -I ~ -n ZO DOT. m Or ° N 1~' IPi'14111'111114'~N~~i 22 D Z O ccnn n m m-1 < C.0 wo Z D c O m co cn m -n n ;o m w C) _ = m c) Cl) -I C-1 O r cn C.0 0 m co -n ca Lin - m ?I 2 0 mm" Z p can cn K L-4 o a' 0 Cn U Z Cam') r0 -P o N Cn CA A IV OO y n W Cn O r -0 m C -1 cn a 2 C") .O C7 O ~ Cn po -4 IV ~ n ~ P 3 rn u N IOPiII W 0 -4 3 CO Oo w P f7 O N N ~ 4 N N W C1 ~ ~ O II u 0 © © O © p OI~ r M -I ~v z c„ ~o-n cs, Ccz O ° ;;o co C .p = M Z cr OD G) cN cn _ cn _0 - -D = 0 c r rT'nm ~ _ -n m r iZ7 ° C O~ X C < ~ 90 v' zm c S r ~ C-) c --i C32 m m z - IT7 o m 2 0 Zv 0 ~ O z I CT o - 0 cr CO W N -P W O ~ W W ~ O ~ N POWTS OWNER'S MANUAL & MANAGEMENT PLAN FILE INFORMA N SYSTEM SPECIRCATIONS N Septic "lank Capacity /DD d gal 0 NA prsrrrrslt Septic Tanis Manufacturer U NA 1"IG PARAMETERS Effluent Filter Manufacturer 0 NA Number of Bedrooms L1 NA Effluent Miter Model 0 NA Number of Public Facility Units 0 NA Pump Tarok Capacity gal 0 NA Estimated flow (average4 allda Pump Tank Manufacturer 13 NA Design flow (peak), (Estimated x 1.5) C> allda Pump Manufacturer 0 NA Soil Application Rate s ,j allda /ft2 Pump Model 0 NA Standard Influent/Effluent Quality Monthly average's Pretreatment Unit 0 NA Fats, Oil & Grease (FOG) 530 mg/L 0 Sand/Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BODJ 5220 mg/L 0 NA 0 Mechanical Aeration f ; Wetland Total Suspended Solids (TSS)_ 5150 mg/L 0 Disinfection 0 Other: Pretreated Effluent Quality Mond* average Dispersal Cep(s) 0 NA Biochemical Oxygen Demand (800J S30 MIX in-Ground (grey) 0 In-Ground (pressurized) Total Suspended Solids (TSS) 530 mp/L. 0 NA O At-Grade 0 Mound Fecal Coliform (geometric mean) s104 cfa/1100ml 0 Drip-Line 0 Other: Maximum Effluent Particle Size Ys, in dia. 0 NA Other: 0 NA Other. 0 NA Other: 0 NA "Values typical for domestic wastewater and septic tar* effluent. Other: 0 NA MAINTENANCE SCHEDULE Service Event Service Fre*wncy inspect condition of tank(s) At least once every: 0 m ar(*)) (Maxkmum 3 Yom) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals on"" (Y3) of tank volume 0 NA Inspect dispersal cell(s) At least once every: 0 month(s) (Maximum 3 years) 0 NA ear( Clean effluent filter At least once every: 0 month(s) a, earls) ❑ NA Inspect pump, pump controls & alarm At least once every: month(s) 0 NA 13 earls) Flush laterals and pressure test At least once every: 0 month(s) 0 NA 0 ear(s) Other: At least once every: 0 month(s) 0 NA D ear(s) Other: 0 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 pending of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 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 fife 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 Gomm 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. ~1 alua ' o ng0" lank e a~ ~'RaldlB rte ❑ 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 CSI W.CR IX coUNTY 'TANK MAINTENANCE AGREEMENT lkN, D OWNERSM CERTIFICATION FORM Owncr/Buycr A,~- Y Mailing Address S ( 1,76 Property Addntss 13 9 dl, ~ ST _ (Verification required hgat Pl&wiag & Departaaatt for pew conMction.) City/State _ _ .a.t,y' Parcel Wnati cation Number 694 11 6? - 1Y -000 LEGA, ~ ► Sf_- PTl4N , Property Location A, Sec. T 3 ON R 1 00 W. Town of _ Subdwisunn Mat:___~ Lot ft f / - Certif:ed Surrey Map # , Volume , Page # wat-rattly Deed # 7~(before za07)Volume 76 ,Page # ~ ypcc house n ycxKnno Lot tunes idewifiabk j~yas R 1 no SY TELN1 ;yLA TG;VAN!Qt AND OWNER CERTIFICATION Improper use and rnairttett11004 of youtr sysCam could result to its premature failure to handle wastes NOW mamienance consists of pumping out the septic tank etrery dmw years or sooner, if needed, by a licensed pumper What you put into the system can affect the ftutetion of the septic tank as a treatment stage in the waste disposal system. Owner maintenance Itsponsibili.ays are specified in ¢Comm. 83.52(1) mW in Chapter 12 -St. Croix County Sanitary Ordimaace- The prolrerty owner agrees to submit to St_ Croix County Planning & Zoning Department a cenificaUoo form, signed by the owner and by i rr.a w plumber, joumeyntart phanber, restricted plumber or a Licensed pumper verifying that (1) the on-site wastewater drepa at System is in prupcr operating condition and/or (2) tagcr mn pcction and pumping (if necessary), the ceptie lank is ;-ss ingo 10 roll ,nf sludge i/we. the undersigaed have read the above requirements and awce to Maintain the privam sewage disposal system with the standards set fordi. herein, as set by the Department of Com meaee and the Department of Natural Resources, State of Wisconsin. Cenifacatior, statirig that your septic System has ban maintained must be coFnpteted and returned to the St. Croix County Planning & zc7ning Depwiment within 30 days of the three year expiration date. f/wt ctrtify that all statements on this form are in to the best of mylour ImowWap. I/we attt/are the owner(s) of the fopetty describes above, by virtue of a wamirity deed re rded in Register of Deeds Office "Number of bedrooms , SIGNAURE• oc APPLICANT{S} -Any imimat.un that is misrepresattted may result in the sammy permit beung, revoked by the Plaaawl; & Zoning Depiurizent. include with this applicatsort n recorded warranty decd from the Rcgisicr of Dccuta O)ffiec and a copy of the certiticd survey rnap it >efererice is tinkle in the warnanry ieed. (1tFV 08/05) 8015048 • Tx:4011551 STATE BAR OF WISCONSIN FORM 3 - 2000 928717 Document Number QUIT CLAIM DEED BETH PABST REGISTER OF DEEDS THIS DEED, made between., Nicholas R. Gorres, a single person ST. CROIX CO., WI Grantor, and Nicholas R. Gorres and Jillian R. Luken, Grantee. 4 12/14/2010 12:27 PM Grantor quit claims to Grantee the following described real estate in St. EXEMPT#: N/A Croix County, State of Wisconsin (the "Property"): REC FEE: 30.00 TRANS FEE: 337.50 PAGES: 2 SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Land Title Inc 1900 Silver Lake Road New Brighton MN 55112 3 q~ 2"7 Together with all appurtenant rights, title and interests. 026-1167-19-000 Parcel Identification Number (PIN) This is not homestead property. Dated this 24th day of November, 2010. icho as R. Gorres * * AUTHENTICATION ACKNOWLEDGMENT STATE OF MINNESOTA ) Signature(s) WASHINGTON COUNTY. ) ss. authenticated this 24th day of November, 2010 Personally came before me this 24th day of November, 2010 the above named Nicholas R. Gorres, a single person . * to me known to be the person(s) who executed the foregoing wledged a same. 4 # TITLE: MEMBER STATE BAR OF WISCONSIN instrument and ac o (If not, / Y/MW authorized by § 706.06, Wis. Stats.) *Ka la Stani s THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Minnesota My commission is permanent. (If not, state expiration date: Larry Mountain, attorney ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature KAYLA STANIUS M 4 Notary Public State of Minnesota my commission Expires January 31. 2014 ~ M ~ QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000 1 of 2 EXHIBIT A Lot 19, Lundy's Preserve, Town of Richmond, St. Croix County, Wisconsin. 000 2 of 2 Wisconsin Department of Commerce / f orv County: PRIVATE SEWAGE SYSTEM St. Croix Safety acrd Building Division INSPECTION REPORT Sanitary Permit No: 514837 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: Glen Johnson Construction, Inc., Glen E. John Richmond, Town of 026-1167-19-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: - (o I~'t•a ('Jr 27.30.18.1321 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic / n LA_'_ Benchmark / 6 Dosing ~ Aeration taw Bldg. Sewer 3 Holding St/Ht inlet .35 TANK SETBACK INFORMATION St/Ht outlet l r TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet p I Septic 2G I / Dt Bottom / Dosing of ' Header/Man. Aeration ft> Dist. Pipe :777. I Z_ I V, ~ t d Id.'1 Holding Bot. System v t7l Final Grade PUMP/SIPHON INFORMATION 91- WAk). -tt.,-doK -1tit51~!'>~t Manufacturer Demand St Cover GPM ~r h J 2 / (D l~ Model Number Z TDH Lift Frictio s stem Head TDH Ft Forcemain r th Dia. Dist. to SOIL ABSORPTION SYSTEM 2 Z BED/TRENCH Width Length 2, No. Of Trenches , PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WEL LAKE/STREAM LEA IN Manuf INFORMATION Typ f System: f CHAMBER R 7 e~ UNI Model Number: S `-C ,Q:1 I D IBUTION SYSTEM YUU HDistribution x Hole Size x Hole Spacing Vent to it Intake Pipe(s) g i~ /Dia Length o Dia Spacing / SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of jxx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No 0 Yes 7~~No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Q RQ Inspection #2: Location: 1384 126th Street New Richmond, WI 54017 (NE 1/4 NE 1/4 27 T30N R18W) Lundy's Preserve"" Lot 19 Parcel No: 27.30.18.1321 1.) Alt BM Description = 1 U; ~7 w `~`~L rY{ UO,-/ 2.) Bldg sewer length = V~ `-3V31q W/qs v ~ o - amount of cover --f b b Plan revision Required? ❑ Yes ' No / /-lam Use other side for additional information. __~~~(i1!!il-~~ SBD-6710 (R.3197) Date Insepctor's Sign ture Cert. No. Al commerc ety and Buildings Division County ~ i 5c . CE VE®l W. ashingto ve., P.O. Box 7162 ,_Cyp / Q /~~1 c adison, VI' 70 tG2 Sanitary Permit Number (too be tilted in by Co.) t>aVVpartVmeVnt of Urns ipr 51/ ~ App itcati State Transaction QNumber Sa itary Permit "uv In accordance with s. Comm. 83. 1(2), RCs isision of this form to the appropriate governmental / yr t unit is required prior to obtaini a sa t 1bFN12W Applic ion forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of r n you proeide may be used for secundary pu poses in accordance with the Privac Law, s. 15.04 I (m , Slats. Th 1. Application Information -Please Print All Information Trott Owner's Name JA,,_ / Parcel t+ 62(- /J.7• !9 ood Property Owner's Mailing Address Property Location u Govt. Lot City, State Zip Code Phone Number v Z),o-'/., section o2T _ (circle one) Ald~ T2,~f N; R /9- EoX If. Type of Building (check all that apply) Gk t.ut NN j~ Subdivision Name or 2 family Dwelling - Number of Bedrooms _13-lock OF- ❑ Public/Commercial - Describe Use _ _ ~a+l 0 -T ❑ State Owned - Descrilx Use CSM Number ❑ Village of % w1 Gf~~ ATuwnuf_ +G^ /~.rJ- ~I Z rCJx`J~ LL5 c -dl 23 1 ! lll. Type of Permit: (Check my one box on line A. Complete line B if applicable) A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) 1 _ List Previous Permit Number and Date Issued R. ❑ Perrot Renewal ❑ Permit Revision ❑ Change of Number ❑ Permit Transfer to New I Before Expiration Owner tV. Type of POWTS System/Component/Device: (Check all that ally) _ X Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mou ^ l3r{itabie soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain)__ _ Pregeatment Device (explain). V. Dispersal/Treatment Area Information: !c yS o f t Design Flow (gpd) Design Soil Applic 'n Rat gpdst) Dispersal Area Re 4fT'ti rea Propos at) System Elevation V1. Tank Info Capacity in Total N of' Manufacturer Gallons Gallons Units n ° + New Tanks Existutg Tanks = e~ / C) (o t a U -2 ii C7 a Septic or Holding Tank Vd / Dosing Dumber 4- C/ /Ll /-C VII. Responsibility Statement- 1, the undersigned, assure responsibility for installation of the POWTS sh a on the attached plans. _ Plumber's Name (Print) ~Plu.nber's Signature -I P PRS Number Business Pilot* Number I/~i,.•~'`; ~ /lz 5Gh tc~d~ler ~.~-A; Trf s.~_ 3 ~G-31.?J S'lumber's Address (Street, City, State. Zip Code) f I 14112 7y VIII. Count /deparunent Use Only ti 11 46- Approved ❑ Dis Permit Fee Date sued Issuir; gent Signature 456 g;~t I ❑ •wyl Zen Rees r Denial IX. ConditAAMeasons for Disap).roval 3\ by►,l~ / n~ ~ ~ O✓f ~x! /fOtuCCt.~n~, 1. Septic tank, effluent filter and / ` iC! tJG' 1 j dispersal cell must all be services / maintained ( as per management plan provided by plumber. ` 2. AN se4baclt requirements must be maintained Q - n Arrach to Complete pians to: the system and sub it lit the County only on paper not less than a IA x t t inch s in size n ,~o !Pa► O 5 6 k4 ke, d a t c-ln ~►,N.1u c~ a-~~.c bt 4-b Pl c-- %A - 0416 S13D-6398 R. 0 07 Valid hru 0~U9 pr-- f 1 31!`41 n11 a 1► j`1 ' U S U a e vg C 0 5• `t'om ~ a,llr' Sv 5~ 3 ~0A GU 5 s L C_s ~CGB~j'e ~G~e 3 + v e S ~~d Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County i Attach complete site plan on paper not less than 8 1 /2 11 in Re ~1 rwr dust include, but not limited to: vertical and hodzonWrefer ce poin i direction and Parcel I.D. percent slope, scale or dimensions, north arro , ~ and distance to nearest roa Please print all i orm ' n.J U N 0 1 2004 Revie Date Personal information ou rovide ma be used for secondary urposes (Priva Law s. 15.Q4 (1) (m)) J Y P Y i 1, Property Owner ZONING grty Loca ion Al~/4 S.r~ T N R E (o W Govt. Lot 1/4 Property Owner's ailing Address 40fty Name or CSM# CRY State Zip Code Phone Number ❑ Village wn Nearest R Of ( o t:~ /%G~ %LJ~Y New Construction Use. Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement d Public or commercial) DD scr/ibe: Parent material ~ FI Plain elevation if applicable General 93,1 3. '/and recommendations: 7J.~yt/~Sf~'~^cil .6r ~uGJ J 4d. ' Boring # ❑ ".g F/_1 Pit Ground surface elev. r ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF j in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. yy~ •Eff##1 'Eff#2 ( 6-17- 10 r 3r1 L e. 6 t d- ,-:s -S c-, m 1 10- -°7 a 9- Boring t7 Boring Pit Ground surface elevft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •Eff#1 'GPD/fFEff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. '0 a L~u 1-.7 3 2 - ~Sl c l ' S I oL -7 t ' Effluent #2 =B "D < 30 nxA and TSS < 30 mg/L Effluent #1 = BOD > 30_< 220 mg/L and TSS > < 1 • Number CST CST Name (Please Print) 226900 Bird Plumbing, Inc. Shaun Bird ~r_ Telephone Number Date Evaluation Conducted Address 715-246-4516 1008 192nd Ave, New Richmond, WI 5401 c~ i Property Owner Parcel ID # Page of 531 Boring # Boring I ;t Ground surface elev. ft. Depth to limiting factor in• Soil Application Rate p - 9 - Horizon Depth Dominant Color Redox Description Texture Structure consistence Boundary Roots GPDHf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 . .0 s „s/ , e - 3 1-7 y/ S L7sc 1.6 i1 ,t Z F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munselt Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring a Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit - Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff •Eff#1 'Eff#2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Effluent #1 = BOD; > 30 1220 mgll and TSS >30 1150 mg/L • Effluent #2 = BOD, 130 mg/1. and TSS 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD•8330 OL6=) ti Soil Test Plot Plan Project Name Environmental Holding L.L.P. Shaun B' 'Address 706 19th St. S. Hudson Wi 54016 CST 226900 Lot 19 Subdivision Lundy's Preserve Date 5/24104 N 1/2 NE 1/4S 27 T 30 N/R 18 W Township Richmond F-I Boring Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Fence Post System Elevation 93.8/93.4 *HRPSame as Benchmark Alternate Benchmark Top of Survey Iron C 96.0' y~e~ r lW► 100' 579' Property B-3 Line 50' 0' 40' 13- 98' ' 50' 41- B-1 5% Slope Scale is 1" = 40' unless otherwise noted 400' Please note:Soil test was done to satisfy county zoning requirement. Soil test may not be suitable for owners desired building location. B.M. 10 tilL • 202' Property Line r - RECEIVED O JUN 01 2004 Lundy's Preserve Comments: ST. CROIX O00NTY ZONING OFFICE The soils in this subdivision are quite variable and differ across the 80 acres. Some consist of a clean outwash sand, other consist of glacial tills. In certain areas, the medium sands have a very deep red color unlike I have seen in all of St. Croix county. The color does not indicate high ground water because the color is so consistent. If you go through the red sands then the sands turn off white/yellow but not those of a sand stone. In talking with Pam Quinn from zoning, she commented that there could be a different chemical reaction with a sands. I believe this is the case for the sands have a consistent size and no mottles were found above or below the sands. Sometimes bands were present, but were very slight, and were mentioned to have the systems sized a little bigger in order to accommodate for any inconsistencies in the soil. Also it is worth mentioning that the intersections of lots 6,7,8, and 9 have a extremely poor soil present not suitable for a mound system. The surveyor and I discussed this condition, and the resulting tests were spaced as far away from this area as possible. All the soils tests were done to the best of my ability and I hold no liability for anomalies and other oddities that can be found on this site. Shaun Bird CSTM #226900 5/28/04 1`11I ffem2T1 Mann Fit LUNDY'S PRESERVE Ar1EY0R5C WOTE W~ x mw W Se Lam wag NMI COgR1aId5 wT0 ra ImX ST. 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City/State _nCJ C.JaCn6fa~ Parcel Identification Number o2ke << to7 -19- OLD LEGAL DESS;j%JPTI0LK w irr~r i~ ,Sec.71 T 0 N R l~ W, Town of ' r Property Location , Subdivision ~2f L Lot 4 rl Certified Survey Map # Volume _ „ , Page ft _ Warranty Deed # -3Z ------_.,Volume 77(a Page # -56 Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENAN AND OWNER CERTIFICATION In Vroper 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, jounnoynsatt plurnbor, restricted plumber or a lictmed plumper verifying that (r) the on-site . wastewater disposal systorn is in proper operating condition andior (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 Commons and the Department of Natural Resources, State of Wisconsin- Certification stating that your septic system has been maintained must be completed and returnod to the St. Croix County Planning & Zonirig Department within 30 days of the three year expiration date. l/we certify that all statements on this form are titre to the best of myl ottr 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. drooms, Numbe17N APPLICANT(S) ATE A OF '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 Doeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) r POWTS OWNER°S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SMCIF(CATIONS Owner Septic Tank Capacity 6d d al ❑ NA Permit Septic Tank Manufacturer r ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer e7/* Q NA Number of Bedrooms 3 ❑ NA Effluent Filter Model zi-xi ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer shy ❑ NA Design flow (peak), lEatimated x 1.5) al/day Pump Manufacturer X04 13 NA Soil Application Rate al/da /W Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L O Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) :=O mg/L 0 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 (BO05) 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/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other ❑ NA `Values typical for domestic wastewater and septic tank effluent. Other: O NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: month(s) (Maxkmm 3 years) la NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: Q_month(s) (Maximum 3 ears) 0 NA J ear(s) y Clean effluent filter At least once every: ~7,month(s) ❑ NA /I / a4 year(s) Inspect pump, pump controls & alarm At least once every: [3 month(s) ❑ NA r-- ❑ ear(s) Flush laterals and pressure test At least once every: month(s) ❑ NA ❑ year(s) Other, At least once every: CI month(s) ❑ NA Other: Y ❑ 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 (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 513 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. •apOO 0A49JISK, ji PV u+suOaslM '(El v in 'i ovg9 a Pus 1)) ►lp}{ tllgl'( lI;> 'Eg wwo:) Jeldego y1!M a0uegdwo3 ul pe4sip som luawnoop 5N.L' 9ua4d AMBER Avolvi - gL79v04d ]0v1004du9N awely a3NIV1N! W 04 U311VIONI S1MOd S1N3 IWOO IVN011100V 31viseom w0 JinOIJAC 38 AVIV XNV1 V J0 HOINUNi 3H1 MW NOSU3d v d0 3Il3S3m '1'lf1S3lI AVW H1V3Q '23ONVISWA0016 ANVo d30NA >INVI MW1VUI, a3H10 WO diNnd '311d38 V a31N3 ION Oa 'N30AX0 1N31OIddlnSNl 801ANV S3SSWO 1VN1l'1 NIdIN03 AVW SXNV! 1N3W1VU1 H3H10 ONV dWnd '3LLd3S < <ONINUVM> > .awll le41 38 1o0;;e uI salnj 0141 4;lm AldwoS lenw $Wel$A$ yons;o suoil:rr,lisuoo9a •aoel.ms anlie11i1;ui a43 1e 1ewolq 9141 ;O lenowei 13uiMOl;o; 0oeld ul polmitiuooel 64 ARUJ swelsAs uolldlosge pas epe&-1e pue punow* ❑ 'SiMe)d 13efle; aq; eaeldel 0131osai Ise( e s 9lle q Aew We1 Bulp104 a alge)Iene so eaie lueweoeldel ou g -ea1e luatc; 36041 014841k a 91e0ol of powao;jad eq ARk uollenlena t~ UPS pue PPS a S1M0d 041 ;o etnpal uodn -ee1e wou19d9Idw omnins a Ajiluapl oa palenleAO ua lou s9 ails 041 ❑v~~ 'SIMOd pellet 943 o0oldea o; Wow asel a to pollelsul eq Am duel Suip104 a ABOlou4301 S.LPA0d u! seauenpe BuuJeB •suolaei!w!I Ilos ao/pue p6qa6v of 9np eigellene IOU sl o9Je 4uewe0e1de1 9lgezlns b C3 'awl; 1241 ie 40949 ui selnl 941 ullnn Aldwoo isnur swalsAs luawaoeldell •eaje luewaoeldei elgellns a Wrtlge;Be of uo)lenjene ells pue pas Meu a jo; peou eyi ul tlnsai Ilion eaje iuaweoeldej 941 ioeloid of einlle j 'sl1am pup 6&UII 101 '0m3on1ls posodoid pue Bullsixe woi; sXoegies paiinbei Aq uodn pabulrlui aq lou pinoys pue uopoedwoo pup oouegjn;sip Wba; pel5eloid eq p1mis ease wouisoeldai 941 uJOISAS uolldiosge Ilos luoweoaldal a ;co uo,leool 041 JOj pe21111ri Oq Aeua pug peldnlene uaaq se4 e9Je luawaaeldel elgepns y :easAa sIig; S 1MOd Od 0 idea iuelldwua apoo a eplnoid a3 'ue~ ei aq lonw jo 'ueeq aney seinssew 19urnnollo; eq~ pelledei aq 101lue0 pue 41 3( NVId A3N30NI1N03 P II 1 1e1J8lew PHOS caul J8410ue JO Iene1B 'lios yllnn e i ands PIona41 pue p9nowa/ slenoo l1e41 to penowaJ Purl p93eneax0 eq I1e4s slid pue S4ue4 lie '6uidwnd 091;y 'imied0 8UI0IAJ9S aftIdaS a Aq ;o pasods p Aliaadoad pue panowea 9q pens slid pue 94uel lie ;o siue4uo0 ay,L e 'peleas s6uiuodo adid p0wopuraga Ay; pua pe3oeuuoaslP aq l(e4s slid pue s4uei of Buidld lid • :apoO 8AlleJlslulwpV ulsuO0,1111 ly '£E•gg u1u,oO Jajdago 431M eouelldwoo ui peuopuege Alain pue Al.iadold sr welsAs 941 leya a,nsul 01 uellel eq 11048 sdels ftmolloi 944 oolAaeS ;a ino ueNei Apueuewaed si to/pue slle; S.LMOd 941 U94M 1N3WNOONV@V •94J11q 1aue3;E0s 1a3enn pus .'euodLue; .sui4deu Aaeliues :soplolised :sionpoid 6u13u1ed :ira ,suoileaipaua :sdaJas 3eaw ;saplnlgiey :ese0i6 Seullo20g ts.U11e0d Olggl*egA pue 1ina; :.ra4enn (duand dwns) uieap uollepuno; 'lei 'Slueta9;uislp 'siaduip 'ssol; leluop t9laeeei6ep ,Sg6mv u0nod ;vuJopudo ;siinq eileleB o :sed M A e eyi ;o GA ayi Buoloid pue oouetuloped ayi anoidall Aei4/ U**A4S 4eleM9490M ayi wo1; SulmO11o; ayi ;o uol3euiw>ler jo uoS npoU .e01e uolidroagv 1100 ape1B-le ao punow Aue ;o adols uMop Sae; g L u1431M eeJe ayi 1laedwa0 Jo glnaslA aslnnleylo 10 `aena lied 1o enllp Sou 0(3 `silao Iosledsip pulp saluel JOAO SSIO140A Ted Jo aAIJp IOU o0 of slojlua0 dwnd ay; Bulleledo A1lenuew tJl 151858 01 letl g1U a Nupi dwnd eyi u1411M Slen91 Iewlou alolsoi SwsolsaJ of Loud ioaeledp 6urolnleg edelda e A I ! W 51tNOd Jo regwnid a loeluao 1o dwnd Iuanll;e eyi of lennod o eB re 001 S q peADUIiJ lluii &U(1d 041 ;o Saueluoo ayi GA04 uol;en3js s)41 prone o,L ';uani;;a 1 4 p aoe}1n8 1o gnaloeq eyi ul llnsat Aew pup (s)Iloo 043 pujpaOlar AO 'osop eBiel quo ur (e)Ilaa lesiadslP ayi of pg8Je43slp eq liim 191eMelsem 5990X9 043 pe101$94 so lannod u94M 'sleAel 404OM40141~uWou 9AOg9 111; Am slue; dwnd 9 e8elno lennod Buena •aoe;,ns aA+leJlll►W 041 it, u0ao1; 61O oluolirpuoa 1108 uayM .maoo Iou Ile4s do 11els welsA, slueluoa a 3 ane '0(tn o1 jalxl i0aeledo Bu1o1n19s 9Beades a Aq p0nowai 4 y pelaelep 9Je suoi1e13ueouo3 yBly I! 'ie}llao l»s1edSl lslaluel ay; jo P ay; 980LUep 101pue 8690aid lu9w4e9,r4 943 apadwl Aaw 19yt sleolwaya ja4lo 1o sionpoid Builuled to aoues9ld 041 Jo; 19MUei luowlp4A X10040 SINOd eU1 ;o esn of jol1d uallonilsuo'o Mau JOZI jo° afied NOLLW 13d0 (INV do.LVv.La r START UP AND OPERATION For new constructiort, prior to use pp ye of . e of the P0' N TS 1~TS ch that may impede the treatment ®ck treatment tank(s) for the presence of painting process r and/or damage P products or other Of #h her chemicals the iankisi removed b the dispersal colfisl. If high c cats by a septage servicing operator prior to ueo concentrations are detected have the contents use. System start up shall not occur when soil conditions erg frozen at the infiltrative surface. During power outages pump tanks may fill above rimmal highwater levela. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, oyerloadinp the cell(a) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank rssrrlaved by a Se#~tage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintalner to assist in manually operating the pump controls to restore normal levels within the pump tank, g Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb within 15 feet down slope of any mound or at-grade soil absorption area. Or compact, the area Reduction or alimination 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 paintin pe+islingp; lfaeolkte; grease; herbicides; meat scraps; medicaiion g products: pesticides; sanitary napkins; tampons; s, oil; and wptor ao ft+ener bring. ABANDONMENT When the POWTS fails and/or is permenentty taken out of service the followin ste s shall p and safe) abandoned in compliance with chapter Comm $3.33, Wisconsin Administrative Code; insure that the system is • All piping to tanks and pits shall be disconnected and the abandoned Pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated anti removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POWYS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system; ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot linos and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 13 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a lost resort to replace the failed FOWTS. r,~~AE7 The site es not on evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site tVV evaluation be performed to locate a suitable replacernant area. If no raplacement area is available a h may b • tatty s a fa oldin tank fast resort tar 8 ,$'r'T~ solace the lei . led l°C3WTS. E7 Mound and at-grade soil absorption systems may be reconotructed 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 kATHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TA1 K UNOjiI ANY CLFiCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE, ADDITIONAL COMMENTS POWYS INSTALLER WTO Name PQ MAINTAINER L w alm ,nn e Phone -71.r _ 3 8 -3 / aL / Phone 8EPTAQE SERVICING OPERATOR (PUMPER) LOCAL., E.QULATORY AUTHORITY Name , cn" C..e'jr. zo I. Phone . E91 ' 1'. ~is document was drafted in compliance with chapter Comm $3.32(2l•lbl(1 )id)&(fl and $3.54(1), (2) & 43), Wisconsin Administrative Code. J SEPTIC TANK 8 PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" CI VENT PIPE 12" MIN. ABOVE GRADE 8 JUNCTION APPROVED 25' FROM DOOR, WINDOW OR WITH CONDUIT MANHOLE COVER FRESH AIR INTAKE W/ PADLOCK & FINISHED GRADE WARNING LABEL 4" CI RISER 4" MIN. 18" IN. 6" MAX. 'NLET - • , ' WATER TIGHT SEALS GAS TIGHTS ~s \/APPROVED A SEAL JOINTS WITH { ALM APPROVED PIPE PPRdVED B IPE 3' ON SOL~DTSOIL ONTO IL SOLID ; OIL PUMP OFF ELEV. FT. - pgp RISER EXIT PERMITTED ONLY D IF TANK MANUFACTURER r HAS APPROVAL 3" APPROVED. BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: f~,'e SeY NUMBER'DOSES PER DAY : _ TANK SIZES: SEPTIC 10de GAL. DOSE VOLUME INCLUDING DOSE _g_,2-z5 GAL. FLOWBACK: GAL. CAPACITIES: A INCHES = GAL. ALARM MANUFACTURER: U Y MODEL NUMBER: g2.iy GAL. SWITCH TYPE: mel-~ - B = 2 INCHES = 9Q _ LGAL. PUMP MANUFACTURER: L~ `~Z C = 8 INCHES = she MODEL NUMBER : e 41 D = INCHES = GAL. SWITCH TYPE: ~-e~c REQUIRED DISCHARGE RATE GPM PUMP ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE • FFEET EET MINIMUM NETWORK SUPPLY PRESSURE . • • • • • . . . . . . . . FEET + FEET FORCEMAIN X ,2.GdFT/100 FRICTION FEET H DIAMETER INTERNAL DIMENSIONS OF PUMP TANK: LIQUID d WIDTH ,1&1, /~G r l SIGNED: ,c,-- LICENSE NUMBER: DATE: 1/88 [IGOULDS PUMPS Submersible Effluent Pump k EP04 3871 EPOS APPLICATIONS • Fully submerged in high i EPOS Impeller: Thermoplas- ■ Bearings: Upper and lower Specificalldesigned for the grade turbine oil for tic enclosed design for heavy duty ball bearing y lubrication and efficient improved performance. construction. following uses: heat transfer. ■ Casing and Base: Rugged • • Effluent Noames systems Available for automatic and thermoplastic design provides AGENCY LISTING Homes • Farms manual operation. Auto- superior strength and corrosion stdrldards • Heavy duty sump matic models include resistance. • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C".) factory, strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds pumps is lso 9001 kowema FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. W, maximum. ■ EP04 Impeller. Thermoplas- ■ power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi-open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge site: I lh" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 104°F (40°C) continuous METERS FEET 140°F (6000 intermittent. • Fasteners: 300 series 10 stainless steel. ' • Capable of iunning dry without damage to a ? _ *2. F components. 25" Motor. • EP04 Single phase: 0.4 HP, v 5 20 - 115 or 230 V, 60 Hz, 1550 ~ RPM, built in overload with s automatic reset. a • EP05 Single phase: 0.5 HP, o _ EpUS 115 V. 60 Hz. 1558 RPM, " 3 10, 4 _ built in overload with EP04 automatic reset. 2- • Power cord: 10 foot s _ standard length, 1613 1 SJTOW with three prong grounding plug. Optional 20 a 00 10 20 _.30 ao so GPM foot length, 1 6/3 S1TW with _ three prong grounding plug a z a 6 a 10 12 myth (standard on EP05). CAPACITY Goulds Pumps 0 2000 Goulds Pumps ITT Industries Effective Febwary. 2000 83871 KATHLEEN BAR OF WISCONSIN FORM I - 1998 y H. WALSN WARRANTY DEED I; kEG1STER OF DEEDS C:RUIX CU. , WI Document Numbers ii EC:EI YED FOR RECORD _ 4~8ird~til(d0E=• 1f0:;il0AM This Deed, made between Birch Park, L.L.C., _ WARRANTY DEED a limited liability company under the laws of the ; n sta It e of Min e -s-o-ta- Grantor, REC FEE: 11.00 - TRANS 4, 522.00 and Benjamin P. Williams and Collette E. Williams, _ COPY FEEEE..ff husband and wife, as survivorship marital -property---- CC FEE:,/ I! - PAGES: 1 Grantee. !j Grantor, for a valuable consideration. onveys to Grantee the following 11 St. Croix described real estate in County. State of Wisconsin (the -Property"): ! I loci r+sa I! l; Name and Return dreSS 4i I Pr ier Title j Lot 11, Birch Park ~I 7 00 Metro Blvd., #300 ~i dina, MN 55439 j~ Return to: ency, Inc. it Premier Title Insurance Ag I , t4 23 20-' 1 7300 MMN B ul vard #300 - - a Edina, 55439 952-842-8489 030-2125-10-000 Parcel Identification Number (PIN) ,I Is not This homestead property. ~ (is) (is not) j 1 I ~1 ,•1 li is ~I f'~ t+ Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is goo indefeasible in fee situp and free and clear of encumbrances except , all easements, reservations d restrictions o record, if any. ii li p Dated this C] _ day of -July 2006 'i I (SEAL) BIRCH P L L C. (SEAL) * By : ;1111 Ja es V. Waters, Its Chief Manager i i, (SEAL) (SEAL) ii AUTHE ICATION A KNOWLEDGMENT j; I' Signature(s) State of VW Minnesota t' I ss. Hennepin County. Q authenticated this day of Personally came befo ~ me thisO day of July, 2006 the above named ! James M. Waters he Chief Manager of I j Birch Park L.L. a Minnesota liability com an on behalf of the LLC TITLE: M BER STATE BAR URENCE HARRY AUB01' P: to it (If not, ~ r C,l}y TARYPUSILIC AMIJIIIESOTA me known to be the person who executed the foregoing Instrument and acknowledge the me. authorized by §706.06,_.;; M: ~:~ainien E>yses Jaa. 31, 2010 g S Nv a THiS INSTRUMENT WAS ORAFTEO BY O~,,e 104ZA1aqo4X )Z~~ Wilkerson & Hegna, PLLP r ~~LrN,y~ p N I~ 7300 Metro Blvd., 300 Notary Public. Smote or}Akeeer,s4w 77COTA, t Edina, MN 55439 My commission is permanent. (If state expiration date: (Signatures may be authenticated or acknowledged. Both are not d QN (~M~ f V 4610 ) { necessary-) i. , N- of persons Signing in any capacity or-t be typed or primed below their signatorre. STATE BAR OF WISCONSIN Wisconsin Legal Blank ct, InC. 111AAANTY OEFD FORM No. I - 1998 and-ukaa• Wis. i k~'rw, uc STANDARD GHAMRER , ®uick4 Standard Chamber j _ - 4a° - I i (EFFECTIVE LENGTH) ! - - - I r' - 111 1 I r - - - sa° - - 510F VIEW SECTION VIEW MultiPort End Cap s - "°°"`tY tom, ~ - . i, ( ~ ~~4` ~ ~ ~ ;F 1 ~ t2 ( } i 'r - i n. 'll i Ir s s av \~r : f _ ~ - ~t i L\ Y 11 _ _ - - f 3_.-- ! _-I-.J.6 !Y 34" - - - - SIM VIEW TOP VIEW FRONT VIEW ~ t ~'t i x ti y % `~N i~7r~q S'f, ~;.re~i~~t'sl ~ rr J 1 ~4"•i..,•~ I ~ ~ ~ ~ ~.~ti X115 .q,~ , ,h t t I Qut~k4 Standard Chtmbetabmhal SpecI ce~io40; ~r INgitiP.p C~ Spe~(1iCetlo~s i Size 1,W x L x H) _ '34„ x 52' is 12 siz 'W _ : w___34' x 16' x 12° 1 Ettsctive Length 49~ Irtv~tt Her tt; 8' or 1,25'_ Invert Height 1 INFI,~IR+E~IS~~{ ~YsSt.~t~.1L.~.J~TAN3?AR~41Mt?~.~Q 3 Y ,i.' N I~f1.hv,ltllrr_lpUnl:fl~wNl14l XY!'tY,YI ArlBFt+r1^Y nrJ't•1tf 1Y.tI/VU InY OSA ":i1W91 Warr •'YWI~61f qY ''f+1 t , , H.t m a ~ ierr x, x r'j7r1C" wqn InMt Ala s ~ t,l rr iyn ~n w A Intl W R r I ~r,d WuJ IIAP l k4tA OA A Jr•w ~ uor v ; Nr Im; r K tnr rAA, Ytr rM: thltw thY NNf AAC'IK n+r 1 s SbYN M •Io!x.'v&1e, I "11ftk1A1~ Nth lL '4+ t r rJe4 rnw ; t ! m kwri !w aowjwf,. u !wu me war arty trn: mJ vb 0'x1 .•.M I M. AM•a LnNI I Iahd rYr ul Me 4bNK. Yram cen:mer~. . • y ' . wa a• - awrtl num'QhIv Irarioul n •Aa ro n l[xr}a71A NpKM vxus Y, UrI SyrL>n fAl nP At I xarg, lw c .~10 ra,o• A Yjaob,evide w t+.Aw• I at r.'01 p w•1 s urlltrNnl t .M r'taYJtocs 17r 6 e r>1r1M v+W alYl•v, l:- t Il nhat 1 y ' 1A a ~4N7as iW cn51 rAnrn'rt ArY)10 ~ crxl~tlur~ I uw IMe 1. n ,•t F') WARFAN \ ANC 4iIN 1C ES W SI+F?}+d 8"L"o' ' iy APF ! X t ll dirt: J A. i'. ^K f r)tY1}71 Wp~npµt~ Wrtl+ H!iN. ';t SYcTE M 1 i 11! f Y`J r i !.;p•Y,: !vl) IFM4.'E!? WARFiMITIFS OF Y,1~R(;:-IMJ Ay311''!)• vci slt W' u: ! lJi i A ald ! .~-0AFI ellf'ifYQt~l-' Myst~w~Mr 5olut(ons " ~ ! ~ Aa) as r e'.,I a vi a IxW veR b ttar I;ttpr'oN •r^lehl s m anul,::t„re'1 py +/yr'u 9MAP .!tu, YM1X1,y!x TIq Lrt naa WJYItl'IV tam, I, p C Ar,,gl ~r tIl ~d ha ratrlo aY tan n+lWwA ;;tytd~lrld =t''Y+MtktY •v1ttlMn hwA ErIYMoMxr~ritlt !t7?IfIM <i +n n I , wrrtrtllld, sclpClr ^n mdYlJGl 9aray>'K- ` ! +♦,yclyJ Or OM mMd lylplb br"Mt' + Q riff ~o~V •',,Q . Box T% •1ue I( r.rt>'nlxy vnrar er'tl tljrU ;I,yll.'tYp'• KtT'~Mlt, +MU4lt, aC uNl. at nA;jIaC1 .7I G p~ f Y r g1 It1t. 1S iJn' !N 1 rMSpIW4, OYRRY/M coRta tN aM+x `iYb'F%c'' ,J4~`•~Y I~GVRfi !'Y ~ I tai tBYYM ic! IwryMAin ;+M U C,7USII~~S a 1~ 1 , I rrM 'i t .acts !rvaage tW 17tlnapY M the JnA4. .MArddr~ N'o WJf; Ire Or Otd Saybrook, C1 {Q ]~:J I,p I 1 p b •ut hr. ec. ;fr MY51.Jn aBtMC W 1A/181 ~Orrd •~G~c• ilMi •M v*/.+'~o/fl^t „ll~Afl!Yt111~19"hyWN tl n HIM' nr i 4.: u not Cr1n r,9 MrtliatYU rMtruruo.. Itw w a trncr ~+r 7-7bD0 • F SGV 6 i 7 TO()1 l Is t, III a,t.! yarn r ,rI.P 'U `mnrofr~ Nllnp a Y-Y ro,in ^st'rW v. YsSra^ waft. uca3' YtY11Y..y aW tho w•►tn falls 1~ x r Wr I d vie wms ael Iq! „ IrY* t na1Y 860 - 5 eoen , ,1.,i, nY edarvu Tnw umil0o war wr s!~+ B00-Z21-4438 .^.a a YVrn p!404101 p uh10 o+en'. er•nc MN.l.arer it n~yxnl:~Wa rnr dr+Y'•r'rra ur clanw~,7a fµw rLewxraror w e+a':N!eY aa.www NI aocndrte• I B anY t(Yr.'. Y•r xr.IN f 4"s of 11LIh111 Vt Mr thdtl rWrr• f wa ,>'sYe aKx. n, ;Yq,,~~f%; Y1Y 4leIB 9rrd k><AI C~P4:'~ a~ 4l•w aPC'+::uMrtNra. ,trW YWIriMtr'a~IW,tA9a{a]!! Fillvla4w' i !M, I'te r„a. t0 C!1i11 i1fi, t)I A%1r/rl(! This U Alk" WflR3'!y M walla ny WIPM kl a11Y fY7r1'~ 91 'F'! i 17,r) raa,ltt MlIM1Uv9 i'~:t:S1lYu7 t,SS t:lA ai.~ll>"Ir • • 4,t~ -.7r r tlltlAtcOVe r70ttlA garrpnlyrlYquvQ• et h uarttl• r1Y1 F+iIYUr~, G• .,I1tNa%l%)l~ pAOr W NVe• 1YArv4IBA. IQ Nit A t r tl ~Ye a a, ,N~ Ira `.-:anr},r.f w„nn WlwAn1Y ~PoNQ OY mltumCY A NNIAW rt, tlher o! A1AIN•f dl Arry i, ~I:hAE.Cr :A Und3 S`Ixli4 WnlAC! YWArd9•'S F~o1R,r P ItAlyd N•;••.. ,y/WfYY t817J t1lel 'AWYtiY'0' 10 4t1a •n r:Y:11W JI JrdIB , _,ly+ v A wo"c te'.B wtlrantY, and IOW . t tE: 5,dG1 Aft ~'a11,9Q't' 'a ?1$ 5133. fr r+F10 T79,'~•Lt9a.fSA4 5 33Ct.U1 T 5,~0'' . w In; n4Crcr aw euN,. sar5~.r OILpAt .1:f8.4N!;.• kl'?r18M1{,6, 4JMunlo' ^.nr..,'^I iYV"•U r t.3' U.Q. NQ. ? ~Xa Uvurr t-afantli p9nl]Inp. (~l a~' c f Ac! IrYdKwM!t= d Inf11r6inr fiS'91.E+! h IM'. l lUN!91W IA it IBgi6ifl'k.3 T%aFnbW BI. pWi4.~(k. t:U!Gk(~iU1. .n t - 'fin . lxxt .nwW~r,d« a,- r~9!►,ar • •N,mte ea :rdrlr+•`tJ•N m Mv+uco ';prtla:r, (.%OnYOlrr 5wHel QOM7lWtwr Ya•.,ir!~t~C`PIU+tdQ ttl U S~t.K1i.Ql.k. {'dfartttinrSO~ . trln4ltl(1llrptabvslAr~s U 2611P 5 0 7 -7 IS 63 1 Z3.2 STATE BAR OF WISCONSIN FORM I - 2000 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO.. WI This Deed, made between Environmental Holding RECEIVED FOR RECORD Company, LLC 07/07/2004 01:26PH Grantor, WARRANTY DEED and Glen Johnson Construction EXENPI 4 REC FEE: 11.00 TRANS FEE: 969.60 Grantee. COPY FEE: Grantor, for a valuable consideration, conveys to Grantee the followin GC FEE: g PAGES: 1 described real estate in St. Croix County, State of Wisconsin (the "Property") (if mor ce is needed, please attach addendum): Lots 12, 13, 16, 17, 18, 19, 22, 23, Lundy's Preserve, Town of Richmo Recording Area Name and Return Address Title One Premier Group 706 19th Street South Hudson, Wisconsin 54016 Partof 026-1078-10-000 Partof 026-1078-30-000 Parcel Identification Number (PIN) Together with all appurtenant rights, title and interests. This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, Easements, and Restrictions of Record. Date his 30th day of June 2004 *BA 1 Sherman *Jeff Warren Environmental Holding Company, LLC Envirionmental Holding Company, LLC * * AUTHENTICATI AY PACKNOWLEDGMENT -(P STATE OF WISCONSIN ) Signature(s) ) ss. St. Croix County. ) authenticated this day off ]k I KAY V. i Personally came before me this _ 30th day of PALM June , 2004 the above named t Bill Sherman and Jeff Warren TITLE: MEMBER STATE BAR OF (If not, to me known to be the person s who executed authorized by §706.06, Wis. Slats.) the foregoi g i ment d a o ed th same. THIS INSTRUMENT WAS DRAFTED BY * Ka lm Michael H. Forecki, Attorney Notary P tic, State of Wisconsin Eau Claire, Wisconsin My Commission is permanent. (If not, state expiration date: (Signatures ma be authenticated or acknowled ed. Both are not necessary.) December 12 2004 . 'Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000 homey Michael H Forecki 3452 Oakwood Hills Pkwy Ste 1, Eau Claire WI 54701-7928 Phone: (715) 835-3029 Fax: (715) 8354112 Michael P. Forecki T4632009.ZFX Produced with ZipFonn T" by RE FormsNel, LLC 18025 Fifteen Mile Road, Clinton Township, Michigan 48035, (800) 383-9805 r ` Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code s C~ i7 Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County S' 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 st road. ~,O /D O O p Please print all inf rma v' Reviewed by Date 2 ff'OF Personal information ou provide may be sad for secon ary purposes (Privacy Law, s. 15.04 (m)). Property Owner u ~ Q pe Location (Tts'D e r'f1t~ ~ A Govt. Lo ,5~E 1/45~ 1/4 S T N R IWr) W Property O er's Mailing Address S1 1.ot # Block # Subd. Name or CSM# loo s f} ~ City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road V4N eove 10R 98dS3 (360)89- 6i6 F"oRes- o2/D go New Construction use: [K Residential / Number of bedrooms- Code derived design flow rate yid GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material G / L L Flopd Plain el ration if a-pp7~ a/V 4 Gen comments bl ft. and recommendati ns; 0/o Y m Meets eawe Mogiva/ s s Boring Boring # Pit Ground surface elev. q.S ft. Depth to limiting factor in. Soil 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 /a tv e 7~' G - /VF B ?a Boring # Boring pit Ground surface elev. ft. Depth to limiting factor 2o in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 -Eff#2 /a a MS6 k Its - C S . 8 0-13 Ir , d l -J0 MYR31,11 SQL a M AJ FR ~ S a F 14 3 - /ot ~~5 ~/d c AG M - - d SR s ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signat CST Number ~ 41 e, b-) S i7` .2 Address Date Evaluation Conducted Telephone umber _ Property Owner ea a Z,-)es/~4# k~ Parcel ID# 000 Page -'?--Of Boring # ❑ oring d ® Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 / '9 o Z IA -I L .2 M Y Z A- Lay? 3Z& SQL a/Aj 4 F G'S F- / '3-W-341 /a -WYRJ~k c / d Vc AJ4- M Z SPo 7~S a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 Boring ❑ Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 ' Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(R 07/00) i 0 L7 el u/j - s _ _ _-I---- - - _ - - - I ni- Izi i 0-0 rAt Alp . I I I I i ' i ! i ~ I I ~ 1 - _ - - I - - - - - - - - - - - ; I 4 I ~ L I i I I_ ~ i I I I ~ I I I i I I I i ! ~ ~ ! L y I I ' _ I II _ , _ l I_ i i ~ I I I I I- ~ I _ ~ I I ~ I _---f --I ! -1--- I ~ i -I 1 II : I ( r • 4 Parcel 014-1031-70-000 02/1312008 12:33 PM PAGE 1 OF Alt. Parcel 14.31.15.224 014 - TOWN OF FOREST Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - GREGG, CHRISTY M CHRISTY M GREGG 2307 BOTH AVE BALDWIN WI 54002 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description SC 1127 CLEAR LAKE SP 1700 WITC Legal Description: Acres: 40.000 Plat: N/A-NOT AVAILABLE SEC 14 T31 N R1 5W SE SE Block/Condo Bldg: Tract(s): (Sec-Twn-Rng 401/4 1601/4) 14-31 N-1 5W Notes: Parcel History: Date Doc # Vol/Page Type 07/16/2007 855621 COAF 07/16/2007 855620 COAF 06/11/2007 852516 TI 09/02/2005 805332 2881/068 QC more... 2008 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 10/18/2005 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 40.000 80,000 0 80,000 NO Totals for 2008: General Property 40.000 80,000 0 80,000 Woodland 0.000 0 0 Totals for 2007: General Property 40.000 80,000 0 80,000 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