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040-1316-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552345 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: Ross, Eric & Danielle Troy, Town of 040-1316-10-000 CST BM Elev: Insp. BM Elev: BM Descriptio~ns: Section/Town/Range/Map No: e.• 05.28.19.2066 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM S Aeration Bldg. Sewer Holding St/Ht Inlet G~ TANK SETBACK INFORMATION 5.5 p 3, TANK TO t P/I~ WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic ~ti(1,`,t`J Dt Bottom Dosing c7 Header/Man. Aeration Dist. Pipe g • 5 •qs Holding Bot. System of %.P 9.5 Final Grade PUMP/SIPHON INFORMATION • ~s Manufacturer Demand St over q GPM ( Model Number T Lift Friction Loss Syste ad 71!111-< Ft -11 Forcemain eng Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 2 17, 7""e.oxC n SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: A- INFORMATION CHAMBER OR Jh I ~rq,f-vt Type Of System A~ UNIT Model Numbed - cic- A4 DISTRIBUTION SYSTEM Z +-Z ( =4i? ✓s Header/Manifold Distribution x Hole Size x Hole Sp is n~ g Vent to Air Intake Pipe(s) ` \ / S Length Dia `t Length Dia Spacing ` GG.S SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded 1xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ❑ No es 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 525 Autumn Blaze Trail Hudson, WI 54016 (SE 1/4 SW 1/4 5 T28N R1 9W) Cedar Woods Lot 10 Parcel No: 05.28.19.2066 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover Plan revision Required? ❑ Yes No c '7 Use other side for additional information. J SBD-6710 (R.3/97) Date Insepctor's ignatur Cert. No. PLOT PLAN PROJECT Eric Ross ADDRESS 525 Autumn Blaze Trail Hudson WI 54016 SE 1/4 SW 1/4S 5 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/4/12 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 860 # of chambers 42 BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark New town Road Scale is 1" = 40' eI unless otherwise Existing 4 30' noted Bedroom House 15' 95' ST B. M. 25' 30' 30' 2-3' X 86' Cells with >3' spacing -3 45' 95' Vents 30' 91' 90' 15% Slope Property Line - Safety and Buildings l~lsi • x County coal erce.wl.gov i 1 W. Washington Ave., P.O. ox 7F 4l r0l x sc Madison, W1 53707-7162 anitary Perrot Number (to be filled by Co.) DeparUn. of C a•; yU ermit Application State Transaction Number ~ In accordance with s. Com . 3.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental A4~ unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Addr ss (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 1 (m , Slats. S4 1. Application Information - Please Print All Information Parcel # Property Owner's Name Aq -0-D Property Owner's Mailing Address Property Location Govt. Lot L City,. State r Zip Code Phone Number_ y,, i'/~, section trcie on T_. N; R E W I.I. Type of Building (check all that apply) Lot # Subdivision Name qr 2 Family Dwelling -Number of Bedrooms El public/Commercial -Describe Use Block ems- ❑ City of CSM Number ❑ illage of ❑State Owned -Describe Use -own of ? 111. Type of Permit: (Check only one box ne A. Complete line B if applicable) T A. ❑ New System eplacement Syste ❑ TreatmentJFiolding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Iss ed B. ❑ Permit Renewal ermit Revision ❑ Change of Plumber ❑ Permit Transfer to New /2, - 2 Before Expiration Owner 5 IV. a of POWTS System/Component/Device: (Check all that apply) 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. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevat V1. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units c~ U N New Tanks Existing Tanks o w U in rn w C7 ii. Septic or Holding Tank Z 1 Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume r sibility for installation of the POWTS shown on the attached plans. Plu er' Name (P in) Plumber' gn a MP/MPRS Number Business Phone Number Z/ Plumber's Ad Tess (Street, City, State, Zip Code) G/ VIII. oun /De artment Use Onl Permit Fee OV Date sued suing Agent Si a e Approved ❑ Disapproved $175' S~ v ❑ Owner Given Reason for Denial IX. Conditions of Approval/Reasons for Disapproval LOT - I aAO-A- J~C &d an"t-14 R I A _ ~ ~~~-E~ art % ~jr/ts I i• A. l y~ AlAM L// A. Ale r S Z Attach Incomplete plans for the system and submit to the County only on piper not than 81/2 x If inches in size SBD-6398 (R. 02/09) 3 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715-246-4516 Date: 5/3/12 Owner: Eric Ross Location: SE1/4 SW1/4 S5 T28 N,R19W 525 Autumn Blaze Trail Hudson System type: In-ground absorbtion system (conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-5. Maintanance and Contingency Plan 6. Filter Specifications She y ~ ;r Signature License numbee4226900 PLOT PLAN PROJECT Eric Ross ADDRESS 525 Autumn Blaze Trail Hudson Wi 54016 SE 1/4 SW 1/4S 5 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 5/4/12 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 860 # of chambers 42 BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark New town Road Scale is 1„ = 40, Well unless otherwise Existing 4 30' noted Bedroom House 5, 95' N ST B.M. 25' 30' 30' 2-3' X 86' Cells with >3' spacing B-3 45' 95' Vents 30' 91' B-2 90' B-15' 15% Slope Property Line Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 10.2ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 95.0' Vent ACI Grade Vent 3' 4" 3' X30/34 Septic Tank 5' Long 1" 5' S' Long 1 rade at System Elevation G 3619 Grade at System Elevation Spacing 5' 2-3' X 86' Cells Same on other end Observation tubeNent At end of cell A B 21 chambers per cell System elevations: A__90.5 B_89'.3 May-03-2012 08:39 AM St. Croix County Plan/Zoning 715-386-4686 9/11 ST. +CROM COUn' M , SVnC TANS MAUMMCS AGR T AND OVNMLqM CERTIMATION FORM OwaerAhW rA C. /2 M9ft Addres>a 1 l RgpwtY A (V ft=Plezmft9& 8 ~ Cit7r/sta~ . 4~- -f p,.paty L,ocagon See- V, rjl ^ 14 , SF6- L5~ _ ~rr ~ rT, TQ Adm Volume • - Ceed Btuvep 1VI~ # V01=0 P Warraaty Deed # Speck 3" Lot am mooff"Q~ ymm*= sib= toMAG%ago . popw ,opec vse end m~ml oP "=or loco% ftse" ty a li i~Op oan > 6uaGf i tokas a t ut Omt OP"the Wesbe a7►° . at speoWedtL lCm= 53.S{!) aunt at Chapor 12 - St: CML%Oc" ! diadw pls~ ~ ?.oniooS ~ ° o ~eaam, epmdbytias TM p:cy w am= Ovw to s&=a to s' p ca a lio~aredP =lobs *d (X) ~ On4ft his qwgft MUM= aft (2) aft kqWd= less flan oft + tw pt-o rawqp du ~ iiu,~d~ adUVO road tips abCm ~ and xT 1 aecaaGae. She of'4V'Isooms llL 2=2 OfCOMMMIUM Ifflid 90 tlonf gbeLvAp, Y~ ° ~sIXV= =at ~berg be ~aed .Wmd % *e r- coop czmty pls~ 41 meat rorltldm 30 &P offt t M YW cq*&* md+to. V,n p~{~H*4 ail shomuft oz 6b &M we tma to beat of mV/ ' =&=a tba oa {s) of ~o p asty 8wxl *cM byvf W ofa w =uV deodx+eoa1 ft Number of bedro4mr DAB sYC A Elf TpPUCANT(s) ra+►o]oed~►~ pis ~ xaaiog ..*p y thetls~ ynX& in*1Wdtat7►P ba am a xeoaocda ws+a kY deed from aw Ro&w o£Aeows ' °f tbld oaati8od aua~ey P vmrhsde whiet~ ~ . rye is ~ fo t&e waaars~3' deed. Owv May-03-2012 08:39 AM St. Croix County Plan/Zoning 715-386-4686 10/11 Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter Is being Installed In order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the Inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. ffin Into system is not exceed those required as per Comm. 83 y plan Osystem fails, determine cause of failure, use alternate area and install new ted replacement area. O ption #2. Install system at a lower elevation, by removing chambers, removing biomat, and Install new system. Option#3. No adequate area Is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 ly ds Y i i \law - ~ ohm C05 c m RECEIVED Wisconsin Department of Commerce S IL EVALUATION REP RTS pA age/ of 3 Division of Safety and Buildings Lnches FF''YY s ' in accordance witWls. r ~A.~ my 1b 6` Attach complete site plan on paper not less than 8 1/2 x 11 a0 !?4 (hWNTY include, but not limited to: vertical and horizontal reference poei"bG OFF! fCel I.D. percent slope, scale or dimensions, north arrow, and locati r a . 3 Id -ozru Please print all information. Re 'ewes by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner_ Property Location ;r_r i(-, ~ Govt. Lot 5 1 /4 SV 1 /4 S S TZ 3 N R E (or W me or CSM# Property Owner's Mailing Address Lot # Block # N S ZZ city State Zip Code Phone Number ❑ City ❑ Village own Nearest Road ❑ New Construction Us Residential / Number of bedrooms Code derived design flow rate GPD eplacement ❑ Public % commercial -Describe: Parent material © Flood Plain elevation if applicable ft. General cormtents~~-c J and recorruriendations: 9 Q 9 System Type &A1 c9 System Elevation / d•/U!' 3 Boring # ❑ Boring M 23 Pit Ground surface elev. 0 ft. Depth to limiting factory-- 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-.20 l~- , 67- e ~ - 2 trn Boring # Boring Pit Ground surface elev9? l 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 ®-1 7 JO si ` - 6 Z- Effluent #1 = BOD > 30 1220 mg/L and TSS >30 1150 ' Effluent #2 = BOD 130 mg/L and TSS < 30 mg/L CST Flame (Please Print) Si a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401 715-246-4516 Property Owner _ Parcel ID # Page of Boring # ❑ Boring / © Pit Ground surface elev. S` Sft. 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 1.s- ~ s, ' Pte- o?K,- . ~ • 3 Ild 4Z 6-7 F-7 T-7 Boring # ❑ Boring F-1 ❑ 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 I 'I I F-1 Boring # ❑ El Pit Boring Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon ')epth 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 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 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. SOD-8330 (R.N00) Soil Test Plot Plan Project Name Eric Ross Shaun Bi' Address 525 Autumn Lane Hudson Wi 54106 C r#226900 Lot 10 Subdivision Cedar Woods Date /4/12 SE 1/4 S W 1/4S 5 T28 N/R19 W Township Troy Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of septic tank manhole cover System Elevation j HRpSame as Benchmark New town Road Scale is 1" = 40' well unless otherwise noted Existing 4 0' Bedroom House 15 95' ~k ST B.M. 25' 30' B-3 rkc=±5' 95' 30' 91' 90' B- ' B-2 15% Slope Property Line M2y-03-2012 08:39 AM St. Croix County Plan/Zoning 715-386-4686 8111 1;r~1YM•' r'+1~ .1' is CL -J11 ~!n l ~r~"I~r ;;1=..r 1' 9 ~ .fir l::%'!<; ..,ti N,; +a' • 7;J,r.r :r~~tr :1. •i,r ;i.~}V ;Lt;: „A d~Y: ~.T -T.,.. 1: ~ :7 ' Ll:~`. •.x..~• e+.e~.. r'°' a['.~, •~1. i• 1.', a• .Y.~ . 1': ?fi•!,': "~a:/ .r-iv.",• ''i•' Y , ;!27. ' ~'~y it .L ;',~~rytl,, ..1' u. J ':a r. 'tl 'v; I„ .^f.li .j'c 1,. r•,;J 71(l }{;;e. ,1~r:.M., :y'~..'': 1.Y~.: J ' j^ .{•i.i~~~l~. .ti... •.'v; 4e ii(f I!'h~l, n. ,u; IP~..4`~. ,!°,~':'l,$.,.y L'. :lr••.J.a 0.'i"' ia.. .,I j'k'~•r '1'1~ "d ~1~ .iS}~ (yi•'. ti~'r"-,• .t1•': +r'..f~, 111~i:'+. t,~'',. i'.~', , u ~ . }:e": ,.~s 1, ! LLw i, a':. „y13.'1~: .,t,•r` .Y' i~~%„ ''L S f.. y.~. ~ ':a"•a.'~'(t :a,,.t n''}r F:' "f'~i 1 rY :.i:'. t',J r;,: 7d. •,l~,~P,~J:. tV iy. ',f •ia,-4.~1 ~:~:1('Iii; ..Y }.k;, .1: p','.^~f.• :Lf•1 Y ~ !-.F `'1"4r .r 'fr." a}. L .d•~ :J.b .2 • ~r'~.;.d. ,'ll•'.1.'• .i~T`~.;i r.A~-.,.~ t.~ - .~:;:..~i• {jr(,,i,. :h pi iir:•1 e. ~el~,l~i'" s^`Ctl`• .,i 'S' r'z'~ :L ~ ~ SQ..! • a.•?~.. ' P ,'!r :4~'' '•+r.. ~:~,id,;~, :1;~~~+;: ..yi:~..'xp• i. f 't..: .n' ,7. 'c.;r' ; I'-,~t,.' 1;~.~,, a'S. ~'~i^~+t••:~:l~ r..' .t ~ 1.;,: coj' :L't~." irn~';:•.~Y,:. ~~..:a;, nti. ! •7i'd.;. • 1 ;4^i ..,h"~ .K~ p ~ N. r~ 1ti. .I 't': ~;(•r z,k, ' :r.T 'r. ::1 ~ ,tr,.' htQ31; ,~1~9~:r,!; 88-: ~.;2' CC '°'2y$'' r~'' a •k~.r. 1~A'r f i' a~~~l, 'r. ;tr,,,,. M".,:i,~ i4, 1~ ~ `-r. y,.l' ,L, r.," 's''L'y,~ ''.d:'~'G.. '>,'1~~.~'.;•,!'a,.,_~~" rr: ~.hi~:l•f.'.i~.''•~'~", ~tL;,. ;1 nth N' i~~'F'~' r s' ~ • ttY•. I+i~ • .a~ ~t`{,'.:. :"1".. '~~;it rr~~~'r F,3` f. l1+ 1~•''` ~ ~'•y '~3,• Ztw41 r. s s: ,~"E.'itf, t a-. . L:1 ,i: 1 •~bk«-C, ~ .a~,' 1';i'~L,~•. ..1-, t•1.v .L•^,la~,• i~'I4 g• y. .i;t'''~~iA711'fi.,_. •~ih:;,.. .5' 1 L r~ ...r,y.:ti,' •1~~ C . y1 N,i{fLr. rL,'~}Il-+: :%•~:l:.~.~:.1+{r ~p.f~~. i.: ' ~ - f4 I 1 LOT 10 i • : 5' drntnago 0.9 83,369 sf. LOT 9 'w 73,585 sf. .91 acres ,J 1.69 acres R' LOT 1 M .070j., 114,241 sf. N I~ 1 T 2.62 acres o ~ g I l 92,446 of. . ';4 2.12 arras LEI \ f ~M .y5 'AID 75.2 ' y$~ 1 ~ ~ \ ~ 1►. • / 1 1 w ,fig '1 $ 49t, OU TLOT ~l' j 11.1" L May-03-2012 08:39 AM St. Croix County Plan/Zoning 715-386-4686 11!11 i 1!111! dill Ilffl iillf iffll Iflf1 Iffl ~Iliii IIII fllf 8 8 0 6 3 2 6 1 State Bar of Wisconsi&Fotm 1-2003 906326 W"RA,NT~'h* BETH PABST REGISTER OF DEEDS Document Numbor Document Name ST. CROIX CO., WI RECEIVED FOR RECORD 11/0312003 08-30AM THIS DEED, made between G & L Land Development, Inc., a Wisconsin WARRANTY DEED Corporation T EItE11PT 4 ("Grantor;' whether one or more), REC PEE; 11,00 and Eric M. Ross and Danielle M. Ross, husband and wife, as survivorship marital TRANS PEE: 277.50 ~ropC~4V - PAGES: 1 ("Grnntee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the fb%*ing described real Riding Area estate, together with the rents, profits, fixtures sad other appurtenant interests, in 110 St. Croix County, State of Wisconsin ("Property! (if more apace is Name and Ratum Address needed, please attach addendum): Rivor Volley Abstract a: Tttte, Ina. 3200 Hesrord Sftd, Buhe 201 Lot 10, Plat of Cedar Woods in the Town of Troy, St, Croix County, Wisconsin. Hudson. wl $4036 File N 2802631 The Grantee hereby agrees that the subject premisas will be used as a single family residence and will be never sold or rented as a multi-family residence. 040.1316-10.000 t'r .1 PmelldendficationNumber (PIN) 4' This is not homestead propady. (Is) (Is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and fine and clear of encumbrances except: Easements, rntrictions and rights-of way of record, If slay. I Dated November 2 2009 G & L Land Development, Inc. - - - - (SEAL)S L 01, K/AI. (SEAL) * 4',Q(en Ivl. Wiese, President (SEAL (SEAL) e w AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on IDGET K. ) as, DOLO-We ) ARY PUBIl1C St. Croix COUNTY NOT STMOPMOM * At4onally carne before me on November $,2009 T1TLE; MEMBER STATE BAR OF WISCONSIN the abovo-named Glen M. Wiese. President of G & L Land Development, Inc. (If not, . to me kno be the person(s) who executed the foregoing authorized by Wis. Stat, § 706.06) instrument d a wl g e. THIS INSTRUMENT DRAF'I'13D BY., * Brid et K. DeLo Auornev-Doug Berg Notary Public, State of Wiaconsia 1200 Hosford Street, Suite 201 Hudson,,-WI 5401b My Commission as permanent) (expires: rR3 ) Olanatw" may ba sulbeatkated er acknowledged. Bath are cot necawry.) NO't'>rr THIS 19 A STANDARD FORM, ANY MODIgICA7'DONS TO THIS FORM SHOULD 139 CLEARLY IDONTIFIED. WARRANTY DEED 0 2N3 ETA'%' J 91F w115CONS1N FORM NO. 1.2003 • Typo Mme below signatures. I Of 1 1 C1 to O 3 'v n C7 r~ ° I ~ ~ 'lid ~ a S d d fl7 c cn rn ,0 N O ~]/1 A CD 'O 7 7 1p fD N to N W 'C \ N O m 0 C.7 1 C Oo lA\ ° m m m cc O CL N w co co o O 0 0 o 7 p tl! > O w (n v D ~ Co 3 a o _ U Q A fD CD -1 CL F~ Z O A ~I CD CD O= y O co C) cn a 3 a C N o CL • 0 0 0 7 Z W v n CL 3 y- vi a ° m CD v G O ° c CD rn r2 o 'i o I 3 d ' i D o O o ~ I v ~ N ~ p N C a N co c6 -i ca A Z N CL I 03 M m N CA a CD co z p A .Z) fn H < Z O A I A F iI a 6 fD T 117 C 7 7 OZ 0 fD N ° O O 0O S ~O C A Q GM 7 ~ ti O N C) O C O O ! (D oq f0 t.1 v7 O ti a f ° b °o OL ~7 ► v r - Wisconsin P4partment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Satety.ind Building Division INSPECTION REPORT Sanitary Permit No: 515201 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: Ross, Eric Troy, Town of 040-1316-10-000 CST BM Elev: Insp. BM Elev: BM Description: Sectionlrown/Range/Map No: c5 05.28.19.2066 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. i / ~ ~DL•~ ~ Septic Benchmark Alt. BM Z ZZ ~oS C J3 ebd- V ca /o ~a. Few j 3• 1 e Aeration Bldg. Sewer Holding St/Ht Inlet *)3.7 TANK SETBACK INFORMATION St/Ht Outlet - g5 II~~ o J,6-5 TANK TO P/L WELL B G. Vent to Air Intake ROAD Dt Inlet pG~ !AA s k Septic X Dt Bottom 25 /66 76 7 75 Dosing Header/Man. Q I~ c17 / Aeration Dist. Pipe $ 97 / 7, Z Holding Bot. System 9, (v 9 PUMP/SIPHON INFORMATION Final Grade ~o• d ~7' (O Manufacturer Demand St Cover .y, /OGPM Model Numb TDH ILiftN--__ Friction Loss S ead TDH Ft Forcemain Length Dia. Dist. to Well I SOIL ABSORPTION SYSTEM BED/TRENCH Width C Length r- No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS t3 B D CJS Z Its L - . SETBACK SYSTEM TO D P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: . / L ✓L INFORMATION Type Of System: \ e CHAMBER OR J `7 UNIT Model Number: Gnr.Je.~.~v,n. 7Z 7 7 /Od (,e, DISTRIBUTION SYSTEM ZZZ +-ZZ = Header/Manifo/ Distribution ole Size x Hole Spacing Vent to A' Intake Pipe(s) \ ` Ly. ~(a Length Dia T Length \_1 Dia x H Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 4-~- Depth Over / Depth Over xx Depth of xx Seeded/Sodded T Mulched Bed/Trench Center Bed/Trench Edges N_,1 Topsoil es 0 No Yes No I dr COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 525 Autumn Blaze Trail clson, WI 54016 (SE 1/4 SW 114 5 T28N RI 9W) Cedar Woods Lot 10 Parcel No: 05.28.19.2066 c 1 t 1.) Alt BM Description = ` ° J wA~ 0 c..r r"5 o G,~, / 11 2.) Bldg sewer length = /66 - amount of cover Plan revision Required? Yes No Use other side for additional information. Z> bJ - _ _ _ Date Insepctor's ignatur Cert. No. SBD-6710 (R.3/97) S;PAID ~.wLgov Safety and Buildings Division County C, I 201 W. Washington Ave., P.O. Box 7162 c]-f~ I >1, tricDepulmot of n isconsin Madison, WI 53707-7162 Sanitary Permit ber (to be filled in by Co.) Comnuirm _D I tion bet Sanitary Permit Application State Transac in accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary es in accordance with the Privacy Law, s. 15. l m , Stats. L A 4cation Information - Please Print All tion Parcel # Property Owner's Name / Property owner's Mailing Address / Property Location T. IX COUNTY Govt. Lot l// O (O / City, State Zip Code lpq@r8eY0NING 1 V, S&,-, Section LA ircle o Vl T~ F N, E pe of Building a ding (check all that pply) Subdivision Name 1 W - Number of Bedroo r 2 Family Dwelling Q• O 0,5A_ Blo G ❑ Public/Commercial -Describe Use ❑ City of CSM Number ❑ Village of ❑ State Owned -Describe Use wn of Z Celh Z2 t ZZ e C5 III. Typ f Permit: (Check only one box on line A. Complete line B if applicable) A' sum ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and bate Issued ❑ Permit Renewal 11 Permit Revision El Change of Plumber ❑ Permit Transfer to New 42~~~ B. I -.CA Owner , 4 Before Expiration e of POWTS S stem/Com onent/Device: Check all that apply) . on-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/Trea ent Area Information: Design Flow (gpd) Design Soil Application (gpdsf) Dispersal ALReq(gf) Di Area sed (d) System Elevatio g 19 2 s VI. Tank Ino Capacity in TotManufac tdrer Gallons GallNew Tanks E v. xi sting Tanks / a rn Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume r sibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's S' ,e MP/MPRS Number Business Phone Number n~ / ~ -off d iod Plumber's Address (Street, City, State, Zip e) 42~> VII our /De ent Use Only - Permit Fee Date ssued Issuing nt Signature pproved isapproved S q-1!5. CC Z~ ~q rven Reason for Denial / IX. Conditi pjjq easons for Disapproval 3) e r4C(a 4. Septic tank, etTltlbnt filter and / ~,f dispersal cell must all be services / maintained Z~ log rjLL 4"ttia as per management plan provided by plumber. Z 2. All is%acktigtrit'ements must be maintained /D A O 1 P7~l ~JC / "WreavillwirwrM system and submit to the County only on paper not las than 8 1/2 x I1 incbm in she t 6 15;r~` d)*N lov t4 f`7 SBIJ-6398 (R. 01/07) Valid thru 01/09 nDtJ'SL~ ~ $A~D S►Y X9L h Atli .le.w~~ /dab PLOT PLAN PROJECT Eric Ross ADDRESS 544 Briana Lane Hudson Wi 54016 SE 1/4 SW 1/4S 5 /T N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 11/21/09 /21 /09 BEDROOM 4 E CONVENTIONAL )00C IN-GRO P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK IZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 44 BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all setbacks required by SYSTEM ELEVATION 95.5/94.8' WDNR New town Road Scale is 1" = 40' unless otherwise 2;Lith uick4 Standard-W eaching Chamber noted 20.0 ft2 of Area 8f A2/pair of end caps Plans Designed Using 3 4Grade at System Elevation Conventional Powts Manual Version 2.0 Pro 4 Bedroom House ST 250' -3 45' 430'2-3' X 88' Cells with > M. g 90, B-1 10% Slope 461' Property Lin . lewAr)PY I PLOT PLAN PROJECT Eric Ross ADDRESS 544 Briana Lane Hudson Wi 54016 SE 1/4 SW 1/4S 5 j/T7NN/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 11 /21 /09 BEDROOM 4 CONVENTIONAL XXX IN-GRO P SSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK IZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 44 BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Well is to meet all SYSTEM ELEVATION 95.5/94.8' setbacks required by WDNR New town Road Scale is 1" = 40' Vent unless otherwise >6" Quick4 Standard-W of Cover Leaching Chamber noted with 20.0 ft2 of Area 12 „ 5.8ft^2/pair of end caps 4' Long Plans Designed Using 34„ Grade at System Elevation Conventional Powts Manual Version 2.0 Pro 4 Bedroom House 30' ST 250' 40' B-3 45' 2-3' X 88' Cells with >3' spacing 30' B.M. 90' B-2 B-1 10% Slope Iir 461' Property Line pAI Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 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. 090 ' -_7 Please print all information. Revie ed by Date Personal information you provide may be used for nda15(l ) (m)). ' ell Property Owner Location 1 /4,Sl,J1 /4 S T N R E (or G 12 D s Property Owner's Mailing Address Block # S Na or CSM# S"(11111 Q ST. S~ ROIX COUNTYY - / Z4 City State Zip Code hp ANNN06 ZONING ❑ Village Town Nearest Road ( ) //o i S~foi 69 New Construction Use)ELBesidential I Number of bedrooms Code derived design flow rate b7p GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 0 (.c~t Flood Plain elevation if applicable g i 1 ~ ft. General comments and recarmrendations: 5 eC System Type 'If6 n,,j System Elevation 5, S Boring # Boring a Rpit Ground surface elev. ft. Depth to limiting factor / a2 D in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 •Eff#2 Z ~k~ d iy G~ rns~~~ 1 ® Boring # ❑ Boring i Pit Ground surface elev. 7• J ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -do /0, '41-L_ 'al, r y Z a0-30 O -4 0-y7 Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 1150JOW ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Nam (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird lure 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54041/ 715-246-4516 Property Owner _ Parcel ID # Page of Boring Boring # SPit Ground surface elev. l~ • ft. Depth to limiting factor 1 ~l in. Soil Application Rate F 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 l 0-Iz 0~~ ~C / 1 Z-- 6 S 14Q I F t I Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDIff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg& 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. Seo-8330 (8000) Soil Test Plot Plan Project Name Eric Ross Sh Bi Address 544 Briana Lane Hudson Wi 54106 M #226900 Lot 10 Subdivision Cedar Woods p 11 /21 /09 SE 1/4 S W 1/4S 5 T28 N/R19 W Township Troy I Boring 0 Well PL Property Line County ST. CROIX ❑ BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe System Elevation 95.5/94.8 *HRpSameasBenchmark New town Road Scale is 1" = 40' unless otherwise noted 250' I B-3 45' 100' 30' 98' 114- No L--J 1- 30' B. M. 90' B-2 B-1 10% Slope 461' Property Line v ] y 1~~ Mi.~.AM ~M~•' ~ ' F . ~ J 11 C • ~IY~11 P i " 1r +Mjl~4"7 ~ ~ t LOT 10 LOT 11 l ' 83,369 sfi. I LOT 9 ` I . W I 73,585 sf. 1 1.91 acres M 1 114,241 sf. .69 acres / LOT 12 ~r C; 2.62 acres I o I I 'm o 92,446 s f. I I ~ R~ 2.12 acres O (A / f x` t~ 4 49 O S. J Is, O \ `'trt / LLWVent 15.22' tk 1~ •h~~~L i / \ \ \ \ LO ~t, f'~ \ 1 49 somas' ® © W _~a n I I ~!y\ , of ACA w I i i ,I a l i arks } i t H C' a _ v -77 .a a U F 40 ~nl r LO v> _ j Jam, i co UJ /i CV L-l ti / ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREMENT AND 0WNF,,1tSHIP CERTIFICATION FORM owner/Buyer c. Z s l Mailing Address G r 1 1 Property Address (V on requhvd from planning & Zoning Deparmunt for action.) City/State Parcel Identification Number dy6' ~3 d' I,~C,~AL DES~`R~bN Property Location S~ 1/. '/4 ,Sec., NR w,Town of J Lot #/_0 Sub&vidou CertiIIed Survey Map # Volume Page # ~ A n 3 , Warranty Deed # Volume, Page # ~ ~ . Spec house yes Lot lines identitfiable (y n0 SYSTEM "_1**~TENANt`E AND OWNER CERTIFICATION > ue to ha 1+e wsstes. Proper Impro1w use and mawlanSwe of Yom septic symam could result m ~ prey P=4=- What y~ pat lntD mainwamw consists of p sqyao teak every three Ye m sodas;; if weeded, by a ticati@Cd out the as a fireatmcat stage e in &C waste ~ Sys= Owner a the system can a$oct the fioaa ofthe septic tok 12 - St Croix County 3aaitarY Ordiae- ~ponm,10ties are specified in §COML S3.52(1) and in Chapter niag & Zoning Daft a o on f=w. sinned by the JU property owner agrees to snbmat to St Croix County Plaaa or a licensed Pumper v6sfymg the (1) the once o by master ~ con restricted M (2) after inspection and pumping (if wcag aty), the sepdc tank is less than 1/3 f fi of sh d$e: the se;'waSe disposal Sys ` wide the I/we, the a have read the above regnimmeats and agree to masatauaof Name! Resonaues. Serte of Rriscoasin• & standards set forth, ham, as set by ffie D o b p d to so St C mix County PI-Ong tepaum within 30 days of the tilts" yew expiration date. uftroents this fo~mn sre: true to the beat of my/our knowledge. Lwe a Wwe toowner(s) of ties I/we ratify that all s on Ragistm of Dodds Officer". property dwribed above, by virtue of a wMirlY dead romrded m Number of bedrooms /DATE S1CNATURE OF APPLICANT(S) ..:pay ;afoamation that is misrepresented may se~anlt in the sanitary pernxit boin~'O p8 8 Dapar chide with this applicadon a recorded w...ty decd fiom the Register of Deeds Office and a copy of tare certified survey map if reference is modes in the waaranIty dead. (REV. 0&" Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Eff luent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 tinge y Plan Option #1 If system fails, determine cause of failure, use alternate area and install new in tested replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. Plumber: Shaun Bird 715-246-4516 St. Croix County Zoning 715-386-4680 Pumper Tom Mondor 715-246-5148 Shaun Bird #226900 ~~~~II ~III~ 1~1I~ IIIII II~I~ ~III~ ~lil ~IIII~ I~~I IlII * 9 0 6 3 2 6 1 State Bar of Wisconsin=Form 1-2003 906326 WART.ANTy ED BETH PABST REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI RECEIVED FOR RECORD 11/03/2009 06:30AM THIS DEED, made between G & L Land Development, Inc., a Wisconsin WARRANTY DEED Corporation EXEKPT t ("Grantor," whether one or more), REC FEE: 11.00 and Eric M. Ross and Danielle M. Ross, husband and wife, as survivorship marital TRANS FEE: 277.50 property PAGES: 1 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in tl' St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): River Valley Abstract & Title, Inc. 12W Hosford Street, Suite 201 Lot 10, Plat of Cedar Woods in the Town of Troy, St. Croix County, Wisconsin. Hudson, wl 54016 File # 2902631 The Grantee hereby agrees that the subject premises will be used as a single family residence and will be never sold or rented as a multi-family residence. 040-1316-10-000 Parcel Identification Number (PIN) r 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: Easements, restrictions and rights-of-way of record, if any. Dated November 2, 2009 G & L,Laand Development, Inc. (SEAL )y 01, O P_ (SEAL) Wiese, President (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on BRIDGET K. DELONG ss. St. Croix COUNTY ) NOTARY PUBLic STATE_ for. WISGONSm. * Pp&nally came before me on November 2, 2009 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Glen M. Wiese, President of G & L Land Development, Inc. (If not, authorized by Wis. Stat. § 706.06) to me know be the person(s) who executed the foregoing instrument d wlp0gq¢ me. THIS INSTRUMENT DRAFTED BY: J * Bridget K. Delon Attorney Doug Berg Notary Public, State of Wisconsin 1200 Hosford Street, Suite 201 Hudson, WI 54016 ' My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE" OF WISCONSIN FORM NO. 1-2003 ' Type name below signatures.` Y 1 of 1 Nov 30 09 11:12a Evergreen Irrigation Inc. 715-796-5246 p.2 7r5- 38c,, - L4 t, Sio Wisconsin DepsrtmentofCommerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code I Corn Attach complete site plan on paper not less than 8 yz x 1 I inches in size, Plan must St. Croix Include but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Percent slope, scale or dimensions, north arrow, and BM referenced to nearest road 040-1022-70-000 Please print all information Reviewed by Date Personal informationyou provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) Property Owner Property Location G&L Land Development, Inc. co.2 Lot SE i SW A S 5 T 28 N R 19W E (or) w Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# W12491 890' Ave. 10 Cedar Woods City State Zip Code Phone ❑ City ❑ V-illage H Town Nearest Road River Falls WI 54022 715-386-2928 Troy Coulee Trail / FF 21 New Construction Use: 0 Residential / Number of Bedrooms Code derived design flow rate GPD 0 Replacement ❑ Public or Commercial - Describe: Parent Material Flood Plain elevation if applicable tL General comments and recommendations: * Layers in horizon 45 of boring #I and horizon 44 of boring #3. B-1 was completed during the preliminary soil assessment on July 22, 2005. The lot lines were not clearly marked during completion of the final soil assessment Sufficient area is available for installation of the POWTS, however the plumber prior to installation of the system must confirm the location of the lot line. E .L lBoring l # Boring H Pit Ground Surface Elevation 101.0 ft. Depth to Limiting factor >110 in. Soil Awlication Rate i Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots t DlRZ li unsell u cont. for Gr. Sz. Sh. '6ff#1 'E02 1 0-9 10YR312 None SIL 2-f-gr dsh as 2f 0.6 0.8 2 9-21 10YR414 None L 1-f-sbk dsh gw if 0.4 0.6 3 21.33 10YR4/4 None L 1-0-sbk dh aw 1f 0.4 0.6 4 33-39 10YR4/4 None S 0-sg ml 9w if 0.7 1.6 5 39-110 10YR5/4 None S 0-sg ml - None 0.7 1.6 5t 10YR4/4 None FS 0-sg ml aw None 0.5 1.0 5- 10YR414 None GRVS 0-sg ml aw Norte 0.5 0.5 2 ] Boring # O Boring HPit Ground Surface Elevation 99.8 ft. Depth to Limiting factor >120 in. Soil Aoolicabon Rate Horizon Depot Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fls K Mun 1 Cont Color Gr. Sz Sh. 'Efr#1 'Efr#2 1 0-13 10YR211 None L 2-f-sbk mfr gs 2f 0.6 0.8 2 13-22 10YR312 None SIL 2-f-sbk mfr gs 2f 0.6 0.8 3 22-33 10YR413 None SICL 1-m-sbk mfr cw 2f 0.2 0.3 4 33-41 7.5YR414 None S 0-sg ml gw 2f 0.7 1.6 5 41-120 10YR514 None S 0-sg ml - None 0.7 1.6 • Effluent #1 = 60Ds> 30:5220 mg/L and TSS > 30:s l50 ntg/L ' Effluent #2 = HODs 530 mg/l, and TSS 30 mg/L CST Name (Please Print) Signature CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 December 20, 2005 715-796-5664 'L Nov 30 09 11:13a Evergreen Irrigation Inc. 715-796-5246 p.3 Property Owner G&L Land Development, Inc. Parcel rD# 040-1022-70-000 page -2 -of 3 ❑ Boring F Boring # opit Ground Surface Elevation 97.7 ft. Depth to Limiting factor >110 in. Soil Acolication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDI s In. Munsell u. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Efi#2 1 0-11 10YR212 None L 1----r mfr gs 2f 0.4 I 0.6 2 11-24 7.5YR4/4 None SL 1-f-gr mfr gs 2f 0.4 0.7 3 24-34 7.5YR414 None S 0-5g ml cs 2f 0.7 1.6 4 P34-1 10YR614 None S o-sg ml - None 0.7 1.6 4 10YR514 None GRXS 0-sg ml - None 0.5 0.5 ❑ Boring Boring # ppit Ground Surface Elevation ft. Depth to Limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eif#f "Eff#2 4 Boring Boring # j L1Pit Ground Surface Elevation ft. Depth to Limiting factor in. Soil Gcation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenoe Boundary Roots GPD ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr91 'Eff#2 i i + Efrlumt i+ I = BOD,> 30 220 mg/L and TSS > 30 5150 mglL ; Effluent #2 = BODs<_ 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. Nov 30 09 11:13a Evergreen Irrigation Inc, 715-796-5246 p.4 , `y Site Diagram i Page 3 of 3 - - _ i _ ~i I 96~ ~2vA~'• cAi a I 97' 8'' 1 9, 1 0' i 1 I ~ t I ! B-3 f ? 101' 2 I B- - o ki 1 1.0' d s i t Y. ~ B-2 f 99.8' 0 ft. 24 ft 0~ So ft. BNi#1 - Top of 12"PVC Pipe 100.0' - = Lot Lines E3M# & Description = Bench Mark B-1 - Boring Location & Elevation House and well location to be determined Elevation 100. - 9 Owner. G & L Land Development Inc. Site Information: Completed By: Mark Iverson, PSS #197 W12491 890th Street SE 114, SW 114, S5, T28N, R19W 680 Larcom Street River Falls, WI 54022 Town of Troy Hammond, W154015 St, Croix County 715-796-5664 Phone: 715-386-2928 CST# 46672 I QOmIldAt3o.YIf1.gm Safety rise awidko "lvwon 201 W. Washington Ave., P.O. Non 7,162 Courtly Madison, WT 53707 7162 tt,, Q 9saiWy Ptrtuit Narttbar (lo be F" in by Co. Wnsin ~ hataa Sanitary Permit AAplication reset farmtdiaa Afuaber In ftwoul rtoe with s. Comm. 83.21(2)„ Wk. Adm. Code, submission of this Patrai is the miproprltao ®DYetaaeaai unit is required prior to dMaining a sanltary permit. Note: ApplieWon t'ouns for atoto-owned POW'i'S ae Pmjest Addans (ifdif elm. don mWOM address) submitted to the DeparlirmA of Cumumve. Personal ieftniation yon provide, may be used for secondary Pirposesift, ooordnwe with the Ptiva Law a 15, i m Stets. 1. A lunges tafonnW-m - Plitt Priest All taioraatttion PmpwW Owner's ]Verse Parcel # G yQ n G el B,J 70' Properly INmcr-s ~Maailfig Address / s Pa"" Locsdon Xv -'a- Govt Lot city, state zips ode ftaneNgtnbor SLy,, S'~J y4, 8aal.m 3J D~ ~s ~3SG - .49oZ7 tae t°~ 1i a'ype of BtdWWg (thick AN that apply) Lot # T a gN: A / Q Q E Vb or 2 Family Dwelling Number of Hadenottm `O Ns SS alodc # ~Gec~Y Gv 0 t? Q PublidC_onsnerebtl Deseibe Use City of l I State Owned - f es"ibe Use C9M Nurttber VilIW of Ttswrt of 'rY 6 ttl. 1 qpe of PsaNalt: (Cheek only one Doti en One A. Complata One B If oppliwWo) A. New system Replacement Twouv rgMlding Tmk Rt4tiacmntmt Only' Odw Meddtlct on In 1 6 SYMM (mAlOw) srnCIn B. Permit 1'etnit ltevisinn am of of Palmer Tnpsfer m List Ptaviotss Pewter Nuat6er and Data Issued Renewal Deft" Plumber New Owner RAVINE IV. Tye2 of POW i'i3 aaeot/Daviee: Check all that to Non-Pressured In-Omund Peea=d=d In.Ornt dr At4kado Masted _:2A m. of admble soil Mmmd < 24 in. of ORISI a Poll Holding Tank ❑ Othar Disperse, Comp nein (04 tin) QPtC dttelR Device (a ode) V. D irri mttaaent Atilt i<wfatnsltdon., ~'ad0n assign Flaw (gpd) Design Soil Appliattion RtNe(gpds~ Dispersal Aron RegabW (00 Dispersal lAtns Pla{stsed 'so cop `aQ~ I mo 4l ~~~a~; ~o~ V1. 's'ank Info Capacity in Total # of h4o"OfINCIOM Msltetittl Mons Gallons U111111 MmTimb t3xiedngTetAce Sepdc nr ilaldinR rM1, / l r Q hosing CJtsmber d O t/ ~ $ Vtt. ?aspsuBiMNq Statem m- I. theaaeetstPedtassaae tbribs * afitAePt7NtT8 atgteMbleM~ Bohm Plutttber's Name iPrhttl Plumber's Slgaatute ArtPhS Nnttdar Phoanl+hwstte tot 7! ' l1 4 1x Plinrlffet'a Address (Surer; City, Smle, Tp Cade) VIII. Cwln r m at Use Q Approved D +m'ed Permit Fee D* Issued issuing Ages; 8 Owns Given Reason for Dome, $ IX. C_nnrlitteas of A sons for MAMMA 11 - ANaah Ioeetapletr 1 eta stesaa artd eWtaitt tetras C a~M! i*e tssw Asa a 11111 tether * site Sat)-6348 (1t. 01/07) Will thnt 01/09 41 l,a cA 5 %~G XI s~jpa J 5e,17'1,1 a ~ v ` rn~ 1011 X/6 r Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings In accordance with Co 85, Wis. Adm. Code PAJ County . St. Croix Attach complete site plan on paper not less than 8 x 11 inches in size n Include but not limited to: vertical and horizontal reference point (BM), directio and Parcel I.D. O4O- - -O Percent slope, scale or dimensions, north arrow, and BM referenced town fCst reod~. - - Review Date Pase ~ Personal information you provide m be us n es vacy Law, s. 15.04 (1) (m)) fz L8' d Property Owner Property Location G&L Land Development, III c. DEC 2 7 2005 Govt. Lot SE v4 SW s 5 T 8 N R 19W E(or) W Property Owner's Mailing Address Lot # Block # rSubd. Name or CSM# W12491 890th Ave. ST. CROIXCOUNTY 10 edar Woods City State ❑ City ❑ Village 0 Town Nearest Road Id. River Falls WI 54022 715-386-2928 Troy Coulee Trail / FF 0 New Construction Use: 0 Residential / Number of Bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or Commercial - Describe: Parent Material Flood Plain elevation if applicable ft. General comments and recommendations: * Layers in horizon #5 of boring #1 and horizon #4 of boring #3. B-1 was completed during the preliminary soil assessment on July 22, 2005. The lot lines were not clearly marked during completion of the final soil assessment. Sufficient area is available for installation of the POWTS, however the plumber prior to installation of the system must confirm the location of the lot line. 6'a MX,4.*, dzk- 70 j F-1 1 Boring # ❑Boring 0 Pit Ground Surface Elevation 101.0 ft. Depth to Limiting factor >110 In. Soil ADolication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPM' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-9 10YR3/2 None SIL 2-f-gr dsh as 2f 0.6 0.8 2 9-21 10YR4/4 None L 1-f-sbk dsh gw 1f 0.4 0.6 3 21-33 10YR4/4 None L 1-c-sbk dh aw 1f 0.4 0.6 4 33-39 10YR4/4 None S 0-sg ml gw 1f 0.7 1.6 5 39-110+ 10YR5/4 None S 0-sg Ml - None 0.7 1.6 5* 10YR4/4 None FS 0-sg ml aw None 0.5 1.0 5* 10YR4/4 None GRVS 0-sg ml aw None 0.5 ❑ ❑ Boring 30 do Go 1b Gra k-Q- o,"7 Boring 2 # 0pit Ground Surface Elevation 99.8 ft. Depth to Limiting factor >120 Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-13 10YR2/1 None L 2-f-sbk mfr gs 2f 0.6 0.8 2 13-22 1OYR3/2 None SIL 2-f-sbk mfr gs 2f 0.6 0.8 3 22-33 1OYR4/3 None SICL 1-m-sbk mfr cw 2f 0.2 0.3 4 33-41 7.5YR4/4 None S 0-sg ml gw 2f 0.7 1.6 41-1 10YR None -9 ml - None 0.7 1. 5 20 5/4 S O s 6 * Effluent # 1 = BOD, > 30 220 mg/L and TSS > 30:5 150 m~L ' Effluent #2 = BODs 30 mglL and TSS 30 mg/L CST Name (Please Print) Signature CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 December 20, 2005 715-796-5664 Property Owner G&L Land Development, Inc. Parcel ID# 040-1022-70-000 Page --2 --of 3 ❑ Boring ❑ ~ 3 Boring # Spit Ground Surface Elevation 97.7 ft. Depth to Limiting factor >110 `din. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-11 10YR2/2 None L 1-f-gr mfr gs 2f 0.4 0.6 2 11-24 7.5YR4/4 None SL 1-f-gr mfr gs 2f 0.4 0.7 3 24-34 7.5YR4/4 None S 0-sg ml cs 2f 0.7 1.6 4 34-110+ 10YR5/4 None S 0-sg ml - None 0.7 1.6 4* 10YR5/4 None GRXS 0-sg ml - None 0.5 0.5 a Boring # ❑ Boring Wit Ground Surface Elevation ft. Depth to Limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ t2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 a Boring # ❑ Boring OPit Ground Surface Elevation ft. Depth to Limiting factor in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD-, > 30:5 220 mg/L and TSS > 30:5 150 mg/L * Effluent #2 = BODs<_ 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. ,I Site Diagram Page 3 of 3 + N i I r) ; L [ I I LOT 10 L - 'M 6 Mi ~ , I roA ~ - r fIP 1 cA,oe 97' 8''1 9' 1 0' I a i i Y B-3 I 9 r 101' I +I B o 1 1.0' 1 r - i i 1 f B-2 J~ { 99.8' a ago ray _ o~ BlVW1 - Top of 1 /2"PVC pipe 0 ft. 24 ft. 80 ft. 100.01.=Lot Lines BM# 8l Description Bench Mark B-1 Boring Location & Elevation House and well location to be determined Elevation _ 100' Owner: G & L Land Development Inc. Site Information: Completed By: Mark Iverson, PSS #197 W12491 890th Street SE 1/4, SW 1/4, S5, T28N, R19W 680 Larcom Street River Falls, WI 54022 Town of Troy Hammond, WI 54015 St. Croix County 715-796-5664 Phone: 715-386-2928 CST# 46672 Oct 11 09 09:02a J, Haas Excavating 715-749-3269 p.1 10-12-'09 05:56 FROM-J&L STEEL Ylidedwb 0'L r-yW reed volt r- rul W FS r DqmMm s CrCMSWM SOIL EVALUATION REP RT r+ _ 1 . of 3 b aeoordmaev.iue Comm $5, Wis. Aft coat iaelsWo tt~ not Lioafped "A taro utWt bt- Croix tot vaticat aed hodx ud -ftmce p0im (BA's dkocam ad Pe+o~t a10po, tooak ar dt~m We& rmgb armay sad BM itrWnrad to =,M mad, Pert . 044-1022-70-ao MA print am iefermadett MMM by tome Pla IM11 ~foomtrtian }uu Rmnae oft be wed f w MMUG rr D+Avocta (PtIYMRy Law, a r s w (i) (m)) . Propaprowaar ~ GAL Land QPQWM Ina, Gaut 1At SE V. SW %S 5 T 28 x R 19W ROpsry Owner a Maift Adthess LN B 510* Subd Draase W12491 890M Ave. arC3r 10 Cedar Woods 3sax Zip code Pltas,e River Falls WT U01 '7149 *o< -fn,. © City 13 ViUago B Town /v~lae ax t J JOt]~LYLU 1 ro COUleg Trail ! FF NCW OnU ncticu Um 0 ftfdoatfal ~ Nwnber Of BB&MM Code daivad deWgn flow =IC t3P7 la Public Or COnUcerciid - )Descnbe_ Patrwt Ma~r~ Flood (Plain eievatWn d licabto Geceral comments and reoomm 0; • i,ay,~ts is bDrizon i tff borktg #1 and betided 4 botiog l the pirHminery fson or at pn oa m005. #3. B- was ~npl~ during The lot linos wsxe ooLcJdirly tattrlaed diatiag Pf Of the tFssal soft t Suffi desis available forio8>afiatitm attbe y 2he Po, 2 2 , cient howevcr the plumber payer to ittsfallt do of the systm nWgoonQrmthe lCK ti efthtC!at tiaa # ® Pit (xom.d snrhma XMvittton 101.0 . •_0. Depth to Y.imifing facbr >110 m. . "MUM DePth Dorakwvt Color fteaolc Ottsutp~pa Tefttg 1 tih in. uOm CorlEi6beac6 SOUnt)aty F1oaC6 WR' CO Gr. •Ewi "EfftR2 1 0-9 10YR312 None SL 2-f-r dsh e~ 2f 0.6 0.8 2 9-21 10YR4f4 Nolte L 1-f" .2r. ~ xi~ 10YR414 ~ if 0.4 0.6 None L 1-v-sbk dh aw if 0.4 0.6 4 33-39 10YR414 None S 5 9-110+ 10YR5f4 Mona ~ ml w_ If 0.7 1.S . 5' 10YR4/4 5 O-ag Ml Kane 0.7 1.t3 None FS 0-sg mfi aw Nate 0.5 1.0 1arn4r4 Norte L3 130 ' GRVS • n~i a1N Node 0.5 0.5 l - # SOS Wit ~ Ground &rftc Ek,&m 99.8 . it nePtit to LieiSm fatt~ >120 g m. ftarv4n Ogtlttl DominerrtCator Redaxt]esrr{ptl0e Terre amuck" 1 fin g tnaa 8oa06gr Roots 1 0-13 1aYR?J7 cant r A22-4-44bbkk `ti't 'efGI1Z None L mfr g. 2f 0.0 o.e 2 t3-22 tOVR312 None SfL raft 3 22-33 ! OYR413 None 9s 006 t).8 S1CL 7-rrt-st* n* cw 21 0.2 0.3 4 33.41 7.5YR4f4 Norte A - 5 41 20 1 OiYR614 Norte 34 mi 9w 2f 0.7 1.6 S 0-89 rat - None 0.7 1:6 •E®uonti11=8prjs>3d5x20atgfl andT59>30<130 : t,ST Ntmat (PresmeRioQ BtHoeat Ifs • B[IDa S so ~ eudTSS < mkt. an CSTNtanber Mark Iverson addrm 46672 P.O. Bflac 155 etOA'h0A``r EnLnond, WI 54015 December 20, 2005 715-796-5664 1 Oct 11 09 09:02a J. Haas Excavating 715-749-3269 p.2 10-12-'09 06:56 FROM-JR 5TEEL 7158080502 T-467 P003/004 F-781 RopMj own" G&L Land Development, Im. Pascei MN 040-1022-70-000 Page-2 of 3 Q Boring # M Boring . Wit GrO uad Srtr'faco EL-vatkm _ 97.7 $ Dmth to Limitiafactr►r > 110 in t n• Horizon Depth Domieant Color Redox Deapipt" Texture Structure Consistence Boundary ROOM GPD/Rz iri• u. 5z Cont kr S 'EWi -EfW2 1 0-11 ICYR2/2 move L 1-t-gr mfr gs 2f 0.4 0.6 2 11-24 7.5YR414 None SL 1-f-gr mfr 95 2f 0.4 0.7 3 24-34 TM414 None S O-89 ml CS 2f 0.7 1.6 F 4" 4 34-110+ 10YR5/4 None S 0-w ml - None 0.7 1.6 10YR514 None GRXS "g mi - None 0.5 0.5 Boring # 1313or'img OR Grow d Sarfaoe Elovation fL Depth to Limiting factor iL A licati Rack -SQ Horizon Depth DonnirwrR rr9tpf PdQ)l DwGtSO.3r! Testa Sht=ra wnbib~enuer ~ dwnu3ry icG3% ~ In_ Mu I Color Gr. Sz. h. 'EflMt 'ERg2 F Boring 4 O 130ring oft Grom d Surface Elevation ft. I?Cpth to i-ir RW9 fttetoar in. Soil Aonfimflun Rat fiorimn Depth Dominant Color RedoxOescripGoo Texhue Structure Consistence Boundary f7oots C.PDN Irv. sett Qu_ Sz. cam, mr or. 84 Sh. `MI 'EW#2 I •Micnrfi=SO%>30<nomefLandTSS>305150row. •EMentAi2=ROlh63UmWLand7n:5300& E The Depaetmeat of Commerce is so aqua( opportunity serviceprovider and czgdoyer. if ynu need assistance ao access wnivas of Need matmial in an atternaw fonta4 pIgNm cents(( tlttdepanmoet at 6ti&26&3151 or TIY 648-264-M7. Oct 11 09 09:02a J. Haas Excavating 715-749-3269 p.3 10-12-'09 06:56 FROG-J&L STEEL 7158080502 T-9fi'r 1'Idltl4/10164 E•-ltil Site 13lag(am Page 3 of 3 83-,,36-9 sf% N P 1.91 acres 10 LO I V ti.3+~ 9T as Oil s 1 .01 L s-a.- ~ 'P r' 24 R so R. eval - Top of 1 J2"P i low f •+*■••e• =Lot unes eiv a orison lion Bench Marls 8-; Boring Location .8 Elevation House and well location to be determined Elevation )caner: G & L Land Development Inc. Site Information: Completed By: Mark Iverson, PSS #197 W12491 890th Street SE 114, SW 114, S5, T28N. R1 SW 680 LarCOM Street River Falls, WI 54022 Town of Troy Hammond. Wt 54015 St. Croix County 715-796-5654 'hone: 715-386-2828 CST# 46672 01 { ~o U- (o)/ \ \ O "t N ir) cv N N 0) N NE / 00 0 0 CD O ' 4-+ N D LO C) acs ~ / C C w I EI I co 00 0 U) I I L a a v N I Q `n r! 1 Ln 4-j > U) \ Ln a a0I u' 0 0 l~ - Z - - S1 of Q \ v vi 3„L 1,9Z.00N 3 z Q 1 E o- w ,CZ-0n - ` 00 J o W I W 0 0•U N M 1 c a F- _ \ C Z v -0 00 00 N I ~ z ° O Z I cn O_ r o I rn 0 \ cD w O n ~ r p ~ N M Z 1;7, N 0) r• I O W C C 0~0 4-j L ~ a a 00 461.13 Z 140751 09 Li 0 D :3 > 4-0 O 0 0 N W fA (n Q) I 00 ° M 1 I- N / I 00 / ~ I 1 O X60 p9' 3, ' n z N I U- I li'° 0 r, F-- U) L' CO Q) % V / 0 0 o o T- -7 Imo- ° n 00 F-- ° N CY) C-4 O co D~ 0- N L West line of SE/SW ,Z9'S LZ L 3„96,90. LON ' 60Z'LLZ L p a% \ C~ I Fn I l/1 (U CD Z G! v N U;. ? p\ 4.`n30 I M 4-a c LV a> E N } c'^o~ v` CL o aLn LA- r- LLJ > 3 c QC s+,, M 3 in =0 POWTS OWNER'$ MA14UAL & MANAGEMENT PLAN Page _ of FILE INFORMATION Y TOM SPECIFICATIONS Owner <5; ~ ~ ~ zd `SOAtic lank Capacity al ❑ NA Permit # S E7 $eptic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer `dc-lf ❑ NA Number of Bedrooms ❑ NA Etfluent Filter Model ❑ NA Number of Public Facility Units Q NA Pump Tank Capacity g Q ~ al ❑ NA Estimated flow (average) ('00 Pump Tank Manufacturer S~ [11 NA ev, U3 ray K, Design flow (peak), (Estimated x 1.5) ~ o 0 i P9,mp Manufacturer Q91 0 VI, a ❑ NA Soil Application Rate Ild !ft? Pump Model [I NA Standard Influent/Effluent Quality , Monthly averop I P±rytreatment Unit ❑ NA Fats, Oil & Grease (FOG) s30 mg/L Gl Sant)/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/i. Q NA Q Mechanical Aeration ❑ Watiand Total Suspended Solids (TSS) 5150 mg/L Disinfection ❑ Other: Pretreated Effluent Quality Monthly average plaperssl Collis) ❑ NA Biochemical Oxygen Demand (800,,) 530 mg/h 0In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/i, Q NA Q At-Grade ❑ Mound Fecal Coliform (geometric mean) 5101 cfu/I90ml Q Drip-Una ❑ Other: Maximum Effluent Particle Size Y8 in dia. Q NA l7ther:- ❑ NA Other: _ NA Other: El NA *Values typical for domestic wastewater and septic tank effNant Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At leas; once every: [3 months} ear(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When cor-hbined sludge and soum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(sl At least once every, ❑ month(s) (Maximum 3 years) ❑ NA Td year(s) Clean effluent filter At least once every: d months} 17 NA BC year(s) C3 month(s) Inspect pump, pump controls & alarm At leapt once every: ❑ NA ❑ year(s) Flush laterals and pressure test At least pncq every: D month(s) ❑ NA ❑ year(s) Other: At least once every: _ ❑ month(s) ❑ NA O year(s) Other. ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made (?y on individual carrying one of the following licenses or certifications: Master Plumber: Master Plumber Restricted Sewer; POWTS inl Ae¢tor POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(i3) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum end to check for any backup 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 cane-third (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage $efvicing 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 s12 months, shall be performq 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. r Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tankisi for the Presence of painting products or other chemic ations that may impede the treatment process and/or damage the dispersal cell(sl. If high concentr are detected have the contents of the tank(s) removed by a septags servicing opera(or 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 highwat thlevels. When a pow a Is es orb he excess ater Will of discharged to the dispetsal cell(s) in one large doss, everle ! e Servicing Operator prior to discharge of effluent. To avoid this,,situation have the contents of the pump tank removed by a Septag 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. and prolong the life of the Reduction or elimination of the following from the wastewater stream may imdeprrov~'e the data, flotmance oss; diapers; disinfectants; fat; POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; sers; grease; herbicides: meat scraps; medications; oil; foundation drain )sump pump) water; fruit and vegetable peelings; gasoline; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT Comm 83 33 old s ingsrn Administrative Code; insure that the system is When the POWTS fails and/or is permanently taken u of service the properly and safety abandoned in compliance with chapter • 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. removed and the void space filled with their covers its shah be excavated and removed or 4b After pumping, all tanks and p soil, gravel or another inert solid material. CONTINGENCY PLAN taken, to provide a code comp~ant If the POWTS fails and cannot be repaired the following measures have been, or.must be replacement system: soil absorption ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required lot lines and wells. Failure to protest the replacement area wil .ted setbacks from existing and proposed structure, c result in the need for a new sot) and site evaluation to establish a suitable replacement area. RePlacem systems mss' comply with the rules in effect at that time. advances in POWT` mitation E3 A suitable replacement area bis not e installed l as la fast resort to replace /the failed rPOWT •-S s ~nng due to setbck a technology a holding tank may sit, 13 -4F abil and tan TIN 6'W. ~IA of the biomat at th removal in it e follow g onstructed in p lac e. a and rf soli ru por tlon systems m Y be r ec with the rules rn effect at that ti m [3 Mound at-grade infiltrative surface. Reconstructions of such systems must comply OF < <WARMING> > INSUFFIC SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAI AY LETHAL GA SAN ND/ DEATH YIN RESULT. RESCUE NC ENTER A SEPTIC. PUMP OR OTHER TREATMENT TANK UNDER PERSON FROM THE INTERIOR OF A TANK MAX BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS pOWTS MAINTAINER INST ALLER E Name Name Phone Phone ? SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name (lime Phone P '10hA This docwnerrt was drafted in compliance with chapter Comm 83.22(2)(b)(f J(d)&(f) and 83.54f 1). (2) & (3), Wisconsin Administrative Code. SEPTIC TANK PUMP CHAM$ O IQN AND SPECIFICATIONS 4" Cl VENT PIPE 12" MIN. ABOVg QtEATNERpROOF ? 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLLOCOV&R PAD FINISHED GRADS WARNING LABEL 7 4" Cl RIS p 4" MIN. tt r 6" MAX. 18 IN. . ~ INLET WATER TIGHT SEALS OAS- f `TIGHT i t ;\/AAPPROVED £AL " S WITH ALM VED PIPE 'IPEa3' ON 3' ONTO SOLID SOIL )NTO SOLID 'OIL PUMP OFF ELEV. RISER EXIT " R OFF PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEId I TO CONCRETE PAD S PER 11 A, SEPTIC 1 DOSE 41 TANK MANUFACTURER : kZ ? DAY : QS PER IKE I NC LUD: NG ~ Jt^ ~ GAL. TANK SIZES: SEPTIC I ff GAL. 1.)QS~ VOW DOSE GAL. FLOWBACK. CArAOTTI£A: A = INCHES = y GAL. ALARM MANUFACTURER: 1 ~►i,~ ,a. MODEL NUMBER : D Ld & 2 INCHES q ~ GAL• SWITCH TYPE : C = D INCHES = _L~~GAL• PUMP MANUFACTURER : MODEL NUMBER : Pt's p = INCHES =_GAL REQUIRED DI SWITCH TYPE: m{'-&C CHARGE RATE L40 GPM Pu p, & A40M WIRING AS PER ILHR 16.23' WAC S VERTICAL DIFFERENCE BETWEEN PUMP O A pI5TRBUTION PIPE ---~a"~ FEET + MINIMUM NETWORK SUPPLY PRESSURE ~ FEET ^ + FEET FQRCEMAIN X F'RGON FACTOR - TMOT*L D NAMIC HEAD - FEET INTERNAL DIMENSIONS OF PUMP TANK: L£0 ~I'I ,WIDTH DID ETER SIGNED: LI O VNSX NUWR : -1---~-~-"- DATE : ~ iaa [qGOULDS PUMPS Submersible Effluent Pump A&I 3871 EPO4 EP05 III , APPLICATIONS • Fully submerged in high ■ EPOS Impeller: Thermoplas- ■ Bearings: Upper and lower Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing lubrication and efficient improved performance, construction. • Effluent uses: heat transfer. • Effluent systems ■ Casing and Base: Rugged • homes Available for automatic and thermoplastic design provides AGENCY LISTING superior strength and corrosion • Farms manual operation. Auto- resistance. sU"~ ~0f~101 • Heavy duty sump matic models include • 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 Pmps is 150 9001 Registered. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 1/4' maximum. ■ EP04 Impeller: Thermoplas- E 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 size: 11h" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA-N elastomers. • Temperature: 1041F (400C) continuous • FEE a - - - - r - 1 140°F (60°C) intermittent. METER10- Fasteners: 300 series l stainless steel. y so- .-sGPna • Capable of running R *25 Fr dry without damage to a L...._ components. ...1 ( _ 25' I D ] .t Motor: x U 6 20 • EP04 Single phase: 0.4 HP, - 115 or 230 V, 60 Hz, 1550 z 5 f _ RPM, built in overload with o 15 automatic reset. a 4 , EPOS • EP05 Single phase: 0.5 HP, o 115 V, 60 Hz, 1550 RPM, ~ 3 10' built in overload with EP04 automatic reset. 2 • Power cord: 10 foot 5. 1 t i standard length, 16/3 STOW with three prong i.__.. grounding plug. Optional 20 0 % 10 20 30 40 50 GPM foot length, 16/3 S1TW with three prong grounding plug 0 z 4 6 a 10 12 rW/n (standard on EP05). CAPACITY Goulds Pumps m 2000 Goulds Pumps ITT Industries Effective February, 2000 83871 817941 State Bar of Wisconsin Form 11-2003 KATHLEEN N. WALSH LAND CONTRACT RE ISTTER OF DEEDS (TO BE USED FOR NON-CONSUMER ACT TRANSACTIONS) CROIX CO., WI RECEIVED FOR RECORD Document Number Document Name 02/03/2006 02:00Pt1 LAND CONTRACT CONTRACT, by and between Glen M. Wiese and Lola M. Wiese Marital E1RK t Property Trust dated September 2, 1993 REG FEE: 19.00 ("Vendor," whether one or more), and G & L Land Development, Inc., a TRANS FEE: 2983.50 COPY FEE : Wisconsin Corporation CC FEE: ("Purchaser," whether one or more). PAGES: 5 Vendor sells and agrees to convey to Purchaser, upon the prompt and full performance of this Contract by Purchaser, the following real estate, together with the rents, profits, fixtures and other appurtenant interests ("Property"), in Recording Area St. Croix County, State of Wisconsin: Name and Return Address William J. Radosevich Legal description set forth on Exhibit "A" attached hereto. 502 Second Street Hudson, W154016 040-1035-60-000 040-1022-70-000 Parcel Identification Number (PIN) This is not homestead property. 03) (is not) This is a purchase money mortgage. (is) (imm) Purchaser agrees to purchase the Property and to pay to Vendor at W12491 890th Avenue, River Falls, WI 54016 the sum of $ 994,500.00 in the following manner: (a) $100.00 at the execution of this Contract; and (b) the balance of $ 994,400.00 , together with interest from the date hereof on the balance 0 outstanding from time to time at the rate of 3.83 /o per annum until paid in full as follows: interest on this contract shall be paid annually, on or before the 31st day of December of each year. Principal of this contract shall be paid upon the sale of individual lots by the Vendee, with Vendor required to release individual lots upon payment of $23,400.00 per acre, released acreage to include associated "Green Acres". i provided the entire outstanding balance shall be paid in full on or before the 31st day of December, 2013 ("Maturity Date"). Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. CHOOSE ONE OF THE FOLLOWING OPTIONS, IF NO OPTION IS CHOSEN, OPTION A SHALL APPLY: C7 A. Any amount may be prepaid without premium or fee upon principal at any time. B. Any amount maybe prepaid without premium or fee upon principal at anytime after January 1, 2006 F-1 C. There maybe no prepayment of principal without written permission of Vendor, State Bar Form 11-Page 1 817941 1 of 5 CHOOSE ONE OF THE FOLLOWING OPTIONS• IF NEITHER IS CHOSEN OPTION A SHALL APPLY: ❑ A. Any prepayment shall be applied to principal in the inverse order of maturity and shall not delay the due dates or change the amount of the remaining payments until the unpaid balance of principal and interest is paid in full. B. In the event of any prepayment, this Contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal and interest (and in such case accruing interest from month to month shall be treated as unpaid priniepal) is less than the amount that said indebtedness would have been had the monthly payments been made as specified above; provided that monthly payments shall continue in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded from this Contract. Purchaser shall pay prior to delinquency all taxes and assessments levied on the Property at the time of the execution of this Contract and thereafter, and deliver to Vendor on demand receipts showing such payment. Purchaser shall keep the improvements on the Property insured against loss or damage occasioned by fire, extended coverage perils and such other hazards as Vendor may require, without co-insurance, through insurers approved by Vendor, in the amount of the full replacement value of the improvements on the Property. Purchaser shall pay the insurance premiums when due. The policies shall contain the standard clause in favor of Vendor's interest, and evidence of such policies covering the Property shall be provided to Vendor. Purchaser shall promptly give notice of loss to insurance companies and Vendor. Unless Purchaser and Vendor otherwise agree in writing, insurance proceeds shall be applied to restoration or repair of the Property damaged, provided Vendor deems the restoration or repair to be economically feasible. ❑ Purchaser is required to pay Vendor amounts sufficient to pay reasonably anticipated taxes, assessments, and insurance premiums as part of Purchaser's regular payments [CHECK BOX AT LEFT IF APPLICABLE). Purchaser shall not commit waste nor allow waste to be committed on the Property, keep the Property in good tenentable condition and repair, and free from liens superior to the lien of this Contract, and comply with all laws, ordinances and regulations affecting the Property. If a repair required of Purchaser relates to an insured casualty, Purchaser shall not be responsible for performing such repair if Vendor does not make available to Purchaser the insurance proceeds therefor. Vendor agrees that if the purchase price with interest is fully paid and all conditions fully performed as specified herein, Vendor will execute and deliver to Purchaser a Warranty Deed in fee simple of the Property, free and clear of all liens and encumbrances, except those created by the act or default of Purchaser, and: CHOOSE ONE OF THE FOLLOWING OPTIONS; IF NO OPTION IS CHOSEN, OPTION A SHALL APPLY: ❑ A. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination, at the time of execution of this Contract. ❑ B. Purchaser states that the following exceptions set forth in the title evidence submitted to Purchaser for examination, at the time of execution of this Contract, are unsatisfactory to Purchaser: ® C. No title evidence was provided prior to execution of this Contract. State Bar Form 11-Page 2 817941 2 of 5 CHOOSE ONE OF THE FOLLOWING OPTIONS: IF NEITHER IS CHOSEN. OPTION A SHALL APPLY: ® A. Purchaser agrees to pay the cost of future title evidence. ❑ B. Vendor agrees to pay the cost of future title evidence. Purchaser shall be entitled to take possession of the Property on closing Time is of the essence as to all provisions hereunder. Purchaser agrees that in the event of a default in the payment of principal or interest which continues for a period of 45 days following the due date or a default in performance of any other obligation of Purchaser which continues for a period of 45 days following written notice thereof by Vendor (delivered personally or mailed by certified mail), the entire outstanding balance under this contract shall become immediately due and payable at Vendor's option and without notice (which Purchaser hereby waives), and Vendor may singly, alternatively or in combination: (i) terminate this Contract and either recover the Property through strict foreclosure or have the Property sold by foreclosure sale; in either event, with a period of redemption, in the court's discretion, to be conditioned on full payment of the entire outstanding balance, with interest thereon from the date of default and other amounts due hereunder (failing which all amounts previously paid by Purchaser shall be forfeited as liquidated damages for failure to fulfill this Contract and as rental for the Property); (ii) sue for specific performance of this Contract; (iii) sue for the unpaid purchase price or any portion thereof; (iv) delcare this Contract at an end and remove this Contract as a cloud on title in a quiet-title action if the equitable interest of Purchaser is insignificant; (v) have Purchaser ejected from possession of the Property and have a receiver appointed to collect any rents, issues or profits; or (vi) pursue any other remedy available in law or equity. An election of any of the foregoing remedies shall only be binding on Vendor if and when pursued in litigation. All costs and expenses including reasonable attorneys fees of Vendor incurred to pursue any remedy hereunder to the extent not prohibited by law and expenses of title evidence shall be paid by Purchaser and included in any judgment. The parties agree that Vendor shall have the options set forth in this paragraph available to exercise in Vendor's sole discretion. Following any default in payment, interest shall accrue at the rate of 6.0 % per annum on the entire amount in default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. Purchaser may not transfer, sell or convey any legal or equitable interest in the Property, including but not limited to a lease for a term greater than one year, without the prior written consent of Vendor unless the outstanding balance payable under this Contract is paid in full. In the event of any such transfer, sale or conveyance without Vendor's written consent, the entire outstanding balance payable under this Contract shall become immediately due and payable in full at Vendor's option without notice. Vendor may mortgage the Property, including the continuation of any mortgage in force on the date of this Contract, provided Vendor shall make timely payment of all amounts due under any mortgage, and the total due under such mortgages shall not at any time exceed the then remaining principal balance under this Contract. If Vendor defaults under such mortgages and Purchaser is not in default hereunder, Purchaser may make payments directly to Vendor's mortgagee and such payments will be credited as payments hereunder. All terms of this Contract shall be binding upon and inure to the benefit of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. This Land Contract is executed in accordance with the Purchase Agreement dated May 23, 2005, at which time the minimum interest rate of the IRS was 3.83%. State Bar Form I 1-Page 3 817941 3 of 5 Dated December 29, 2005 VENDOR: PURCHASER: Glen M. Wiese and Lola M. Wiese Marital Property G & L Land Development, Inc. Trust dated September 2,1993 / '9 jA L_WQ~ (SEAL) 4~qq . W a. e (SEAL) * Glen M. Wiese, Tr tee *Glen M. Wiese, President (SEAL) (SEAL) * Lola M. Wiese, Trustee AUTHENTICATION ACKNOWLEDGMENT Signature(s) of Glen M. Wiese and Lola M. Wiese, Trustees STATE OF WISCONSIN ) ) ss. authenticated on December 29, 2005 ST. CROIX COUNTY) Personally came before me on December 29, 2005 , * William J. Radosevich the above-named Glen M. Wiese, President of G&L Land TITLE: MEMBER STATE BAR OF WISCONSIN Development, Inc. (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. t THIS INSTRUMENT DRAFTED BY: *William J. Red evich William J. Radosevich Notary Public, State of WISCONSIN 502 Second Street, Hudson, WI 54016 My commission s y (i permanent) (aoapiRassxxxxxxxxxxxxxxxxxx ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. LAND CONTRACT 02003 STATE BAR OF WISCONSIN FORM NO. 11-2003 *Type name below signatures, INFO-PRO' Legal Forma • (800)655-2021 - aHOpaams.eom State Bar Form 1 I-Page 4 817941 4 of 5 i r . LEGAL DESCRIPTION Exhibit "A" to Land Contract A parcel of land situated in Part of Section 5 and in Part of Section 8, all in Township 28 North, Range 19 West further described as follows: Commencing at the South Quarter Corner of said Section 5, Thence N00°52'56"E, 38.09 Feet, to the Point of Beginning of the Parcel herein described; Thence N88°42'15"E, 83.66 Feet; Thence S00°56'40"E 259.33 Feet; Thence S89'02'1 7"W, 319.90 Feet; Thence S00°37'45"W 562.98 Feet; Thence N53°24'35"W 1355.82 Feet; Thence N01 °08'48"E, 1277.20 Feet; Thence N89°01'10"E, 1321.12 Feet; Thence S00°52'56"W, 1282.17 Feet, to the Point of Beginning, Containing 2,226,814 Square Feet (51.12 Acres), More or Less. The foregoing real estate having been previously described as follows: SE '/4 of SW '/4 of Section 5. Also E '/2 of NW '/a of Section 8, All in Township 28, Range 19, EXCEPT: Exception 1. the West 468 feet of that part thereof lying Southerly of the Town Road. Exception 2. Commencing at the intersection of the East line of said E % of NW %4 and the Northerly line of the Town Road; thence Westerly on said Northerly line 128 feet; thence North 172 feet to the Southerly line of the railroad right-of-way to the East line of said E %z of NW %4; thence South on said East line to the point of beginning. Exception 3. Part to Leo W. and Olive J. Crimmins in "537", page 530. Exception 4. Certified Survey Map filed August 24, 1978 in Vol. "3", page 659. Exception 5. Certified Survey Map filed August 24, 1978 in Vol. "6", page 1653. Exception 6. Part lying within Lot 1 of Certified Survey Map in Vol. "7", Page 2016. Part of SW %4 of SE %4 of Section 5 and Part of NW '/4 of NE %4 of Section 8, all in Township 28, Range 19, described as follows: Commencing at the center of said Section 8; thence North on '/4 section line 1675.42 feet to the centerline of County Trunk Highway "F" and Place of Beginning: thence North on said %4 section line 1000.0 feet; thence East 85.0 feet; thence South 1068.56 feet; thence N54032'00" W 104.36 feet to the Place of Beginning. EXCEPT Lot 1 of Certified Survey Map filed August 24, 1988 in Vol. "7", page 2016, Document No. 440805. 817941 5 of 5 i