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Parcel #: 040 - 1304 -05 -000 ' z 2/� 12/08/2005 09:32 AM
& / KW PAGE 1 OF 1
Alt. Parcel #: 08.28.19.1811 040 - TOWN OF TROY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
09/08/2004 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
ARTHUR &MARILYN REV TR FEYEREISEN O - FEYEREISEN, ARTHUR & MARILYN REV TR
420 TOWNSVALLEY RD
HUDSON WI 54016
Districts: SC = School SP = Special Property ert Address ( es ) : ' = Primary
Type Dist # Description * 420 TOWNSVALLEY RD
SC 2611 SCH D OF HUDSON 416 TOWNSVALLEY RD
SP 1700 WITC
Legal Description: Acres: 24.708 Plat: 10/24- SUNSET VALLEY 040/04 LOTS 5/21
SEC 8 T28N R19W PT SE SW BEING SUNSET Block/Condo Bldg: LOT 05
VALLEY ('04) LOT 5 (24.708) CONSERVATION
EASEMENT Tract(s): (Sec- Twn -Rng 401/4 1601/4)
08- 28N -19W SE SW
Notes: Parcel History:
Date Doc # Vol /Page Type
09/08/2004 773695 10/24 PLAT
11/20/2003 747093 ``2//459/594 EZ
`�" - 76
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
104439 Use Value Assessment
Valuations: Last Changed: 09/0612005
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 55,000 231,200 286,200 NO
AGRICULTURAL G4 21.708 3,300 0 3,300 NO
UNDEVELOPED G5 1.000 100 0 100 NO
Totals for 2005:
General Property 24.708 58,400 231,200 289,600
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
Parcel #: 040 - 1037 -10 -050 08/06/2007 08:58 AM „
PAGE IOF1
Alt. Parcel #: 8.28.19.122A 040 - TOWN OF TROY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
09/08/2004 00 4
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - FEYEREISEN, RETIRED
RETIRED FEYEREISEN
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE
28N R19W SE SW EXC PT TO CSM Block/Condo Bldg:
17-4 SERVATION EASEMENT NKA PT
SET VALLEY ('04) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
Y f - _ 08-28N-19W SE SW
Notes: Sort l a �� ? d�� Parcel History:
Date Doc # Vol /Page Type
11 /20/2003 747093 2459/594 EZ
vv ' ` 07/30/2003 732925 17/4577 CSM
07/23/1997 5,51,15 -4 x- QC
07/23/1997 418T476 �UlS
2007 SUMMARY Bill #: Fair Market Value: Assesse with:
0
Valuations Last Changed: 03/16/2005
Description Class Acres Land Improve Total State Reason
Totals for 2007:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Totals for 2006:
General Property 0.000 0 0 0
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
N °00' 00" W 574.39' v
c - �Nj 0.0
EX Tl G 45X7 "
T
U OT 1 0
.62 CRE - - �.,' N
N � 2 ,206 S.F. �� y L� ` / 50' N
(LBO -888.0 B_ ,
w o 0 1.506 ACR S ;
°F. 65,624 S.F. N i
f�
89
, 3.0 c
j / /
/ �N
S \ �� l r
9.2
05.4
i x ��880 4V
582.4 X / �( ��/ X 904.9
co
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X 873.3 � y +' AP: ° u •
1 .:s DRAINAGE
x. 4 EME
0'x•5 �, .� 8 00 14 „ �;.,�,
S••' gy p` � 4
y0• L 909.7 .� SE ND DRI 1�
•5 0 T(y BE RE VEI
S
T 6 1 PLAT'
..,e6.
� °j X 971.
i 130' a
I j o � CURRENT LAN[
/ (} CURRENT ZONI
x
T 909.7
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0 1Nisransin Department f
ent of Industry SOIL AND SITE EVALUATION REPORT Page 2—
r Labor and Human Relations g _
"Division of Safety & Buildings in accord with ILHR 83.05, 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 % of slope, scale or PARCEL I.D. #/
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE
PROPERTY OWNER: PROPERTY LOCATION
At" f -c ViE RE15��1 GOVT. LOT SE 114.5 1l4,S T Z� ,N,R /9 E(ori Wo
PROPERTY OWNER':S MAILING ADDRESS LOT BLOCK # SUBD. N ME OR CSM #
�faD 7owaSadiiFy /P!o• �vvt S2 �� t2
CITY, STATE ZIP CODE P NUMBER ❑CITY (]VILLAGE ®fOWN NEAREST R AO
(71S) Thu Vn! /E V iPD
[ ] New Construction Use [X] Residential / Number of bedrooms 07_17 '�� Z) [ ] Addi . to existing building
j ] Replacement [ ] Public or commercial describe ,P� - �a v,� E� T i'o.� ► N w Ho4s� /� hb
Code derived daily flow 3 gpd Recommended design loading rate 7 bed, gpd/11 ° d trench, gpd/ft /
Absorption area required yLF bed, ft 37 ✓� trench, ft Maximum design loading rate . 7 bed, gpd$ " 0 trench, gpd/ft
Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark)
Additional design/ siie con ' lions - s °'�S � 7,07 //)/ CO/7E l .C� - y1114 17 fo p A
Parent material SGS c .S /B Flood plain elevation, if applicable y R
S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem ®S [1 U ®S E:] ®S ❑U ®S ❑U PIS ❑U ❑S M U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bolxdaly Roots GPD /ft
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed JTrerd
A <:n«t .� - zfi� /o y,� 3 - s,/ i, f s6 �,+► f,� 2 s /
Ground C 2, f_ / f ,, 2 /d
elev.
jq ft.
Depth to This test site APPROVED
f cr �g or a conventional pvc sys .
. 5o /s � o a�' �o-Y /i ,� To ft DC 7A_ 7`a //t
Remarks. � � 't T p 7
Boring #
elev
ft. gr
D pth to
tj � I U I I RL
li iting
f for
Remarks:
CST Name:—Please Print 655 O'NEIL RD., HUDSON, WIS. 54016 Phone: *71"r- 3 8 �_
C
Ad dress: 'V S. MASTER PLUMBER LIC. NO.
Signature: �� ��'?tNN. INSTALLER 3 DESIGNER LIC, NO, 00663 Date: d1i ly 2 g � �� CST Number �
�,.� 1 0
I
PROPERTVOWNER SOIL DESCRIPTION REPORT Page _of
i PARCEL I.D. I ,
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Y Roots[_ GPD /ft
I in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed IThnh
i
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
i4 Boring #
Ground
elev.
ft.
` Depth to
limiting
factor
Remarks:
Boring #
.. >.,...
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
'v8 }ti
RN+•i:..:n.::
Ground
elev. r M
ft.'
Depth to'
limiting
factor
Remarks:
SBD- 8330(R.05/92)
F
HOMESITE SEPTIC PLUMBING CO. �$ Csi L t ° 3 O
85b O'NLIL RD., HUDSON, WIS. 54016
ROBERT ULBRIGHT
hk. &9,51'E4 PLUMBER LIC. N0.3307 M.P.R.S.
klfik P&JAL ER x (DESIGNER LIC.140. 00663
o1/jo�il� O�IE"" 5 /'7E GE
i
• - - _.
y vE r
X i'S 71 u (r-
�i F XSTiv Cs tD
fitu.+rro,v 99. 90 T his test site APPROVED
for a conventional septic system.
i
To a/c: S //o s
I CoNCRtrE I-�i4D �/3f+S� ,
E LCVAT/ayS
3 99. Go
130 77o o�
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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No: t
. 488019 � �f �
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:
Fe ereisen, Arthur I Troy, Town of 040 - 1304 -11 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No:
1M\ 1 08.28.19.1817
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Z, S ( :;7 k4A Benchmark
5 I Z(, ®8'� Sao
9"440- 1 A Alt. BM
A Ida V: 9 9 , Z-5
Aeration Bldg. Sewer
z5
Holding St/Ht Inlet
x,51 95. - 79
TANK SETBACK INFORMATION St/Ht Outlet 4•7S cr5 . 5 3
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \
sepsc 1�� -> 56 / 39 1 — Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe - 7 y Z 9Z • /
Holding Bot. System
PUMP /SIPHON INFORMATION Final Grade �• $3 •
Manufacturer Demand St Cover �9
GPM :� �e�� b b$
Model N ber
TDH ft Friction Loss System H Ft ya 33
Forcemain Leng Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 Z �- `� ~
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: r - �
INFORMATION Type Of System: c / CHAMBER OR a 1 J�
J /r7b Model Number:
DISTRIBUTION SYSTEM /y
Header /Manifold 4 #/ Distribution x Hole Size x Hole Spacing Vent to Air Intake
I Pipe(s) La�.Ja�-
1 1-ength q I Dia Length Dia ` Spacing �� e, (�
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Q. ep v xx Depth of xx Seeded /Sodded xx Mulched
BedlTrench Center 5 . (—� �' a renc Edges \ Topsoil Yes No ;Yes ) ]No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2:
Location: 433 Sunset Drive Hudson, WI 54016 (NE 1/4 SW 1/4 8 T28N R1 9W) Sunset Valley Lot 11 Parcel No: 08.28.19.1817
1.) Alt BM Description= �- Loe4c. OII ` , --- �v-kl
2.) Bldg sewer length= 3(r
- amount of cover = I J
Plan revision Required? Yes ' No -� K - -- - - — -
Use other side for additional information.
Date Insepctors nature Cart. No.
SBD -6710 (R.3/97)
Safety and Build nt e1
201 W. Washington �V
Madison, WI Sanitary P it Number (to be filled in by Co.)
Nvisconsin
Department of Commerce (608) 2
Sanitary P a iy�A li tio I.D. Number
In accord with Comm 83.21, Wis. m. ation o
maybe used for secondary purposes Privacy Law, sl5.04(Iroject A (if different than mailing address)
I. Application Information - Please Print All Information '7' ;J
Property Owner's Name Parcel # Lot f / Block #
f Aur (� �b - 1 3d '- / /����
Property Owner's Mailing Addres Property Location
3 ` J
City, State // f Zip Code Phone Number �� � �' Section
Ttit1St7Yl GV 0` 74� - 3Q� Z�Lz_ � (circl
T�N; R &LhO W
II. Type of Building (check all that apply) 2 / Z coo.
I or 2 Family Dwelling - Number of Bedrooms .6+,,�,,,,,_ Aad c:,
Subdivision Nam ` CSM Number
❑ Public/Commercial - Describe Use
❑ State Owned - Describe Use Z U itilZ CP-�k5 LJ 1 4 f Iq C w.�a2�1 ❑City_❑VillageNTownship of Tj Qom,/
III. 'h'y'pe of Permit: (Check only one box on fine A. Complete line B if applicable)
A. ,New System ys ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System
B. ❑ Permit Renewal Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner �� / Pj /Z Q
IV. Type of POWTS System: Check all that apply)
L
❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wctland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
' Recirculating Synthetic Media Filter 91-caching Chamber ❑Drip Line ❑Gravel -less Pipe El Other (explain) B
V. Dispersal/Treatment Area Information: 64
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) S Ac m Elevation
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Stec] Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank
IX
Jl�2
Aerobic Treatment Unit
141 - ZA , 6 4
Dosing Chamber
V II. Responsibility Statem I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
PI u s Name (Print) Plumb is Signature MP/MPRS Number Business Phone Number
Plum 's Address (Street, City, State, Zip Code) I
3/ 0 do Vh A GU c `5 o Z
VIII. County !De artment Use Onl
Approved ❑ pproved Sanitary Permit Fee (includes Groundwater D�t Issu Issui Agent ign re mps)
Surcharge Fee) 4 76 , 6Q
n Reason fo I
IX. Conditions of ApprovalfReasons for Disapproval n
SYSTEM OWNER: 3 �eCN k- K J S i o✓\. �r C f de Sd t 6
t. Septic . tank, eftient fNter and a Oe
dispersal cell must all be.serVIM I maintained
as per.management plan provided by plumber.
2:- AN setback requirements must be maW t k*d
as per applicable code / ordinances.
Attach complete plans (to the County only) for the system on paper not less than 81/2 z I1 inches in size
SBD -6398 (R. 01/03)
JOB jr /A
TIMM EXCAVATING SHEET NO. OF
Route 1 Box 192' 3010
WILSON, WISCONSIN 54027 CALCULATED BY DATE _
(715) 772 -3214 =foam
MPRS #3224 WI CHECKED BY DATE
SCALE �
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............
. ..........
..........
PRODUCT 205- 1t�Inc., Groton, Mass. 01471. To Order PHONE TOLL FREE 1- 800- 225 -8380
L
RIGINA'
r
SOIL EVALUATION REPORT
$CDlISi/f #2428
Department of Commer in accordance with Comm 65, Wis. Adm. Code Page 1 of 3
' Division of Safety and Bull )ng Certified Soil Testing, LLC
Attach complete site plan on paper not I 8' /z x 1 inches nsizzee.E!�E� County St. Croix
include, but not limited to: vertical and horizo fere a poi BM), direction and
percent slope, scale or dimensions, north arr nd to tion t t est roa Parcel I.D. , dRs �� - - _
040 1304 -11 000
Please print all informatio 77 - f r Reviewe Date
Personal information you provide may be used for secondary p rposes PfiVala�v�l�IO# ('I) (m)) S O (p
Property Owner i
Feyereisen, Arthur & Marilyn Govt. Lot S11/4, SW/4, 4, T28N, R19W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
420 Townsvalley Road 11 Sunset Valley
City State Zip Code Phone Number ❑ City 0 Village ® Town Nearest Road
Hudson WI 1 54016 1 715 386 - 2122 Troy Sunset Drive
New Construction Use: Z Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement,
Public or commercial - Describe;
Parent material loess over outwash Flood plain elevation, if applicable NA ft.
General comments install ' " nventional" in- ground trench system w/ system elevations 4.0 below surface contours 0.7
-_ Y Y @
and recommendations: gpolsq ft loading
❑ 1 Boring # Boring
X Pit Ground surface elev. 96.9 ft. Depth to limiting factor > 96 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
1 0 -13 7.5YR 3/2 - sl 1 f -m sbk mvfr gs im .4 .7
2 13 -36 7.SYR 3/4 - sl 1 m sbk mvfr gs im .4 .7
3 36 -49 7.5YR 4/4 - s 0 Sg ml CS 1m i .7 1.6
4 59 -96 10YR 4/6 - 5 0 Sg ml - - 7 1.6
2
Boring Boring
g X Pit Ground surface elev. 94.1 ft. Depth to limiting factor > 96 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistenc4 Boundary Roots GPD /ftl
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - 'Eff#1 'Eff#2
1 0 -11 7.5YR 3/2 - sl 1 f -m sbk mvfr Cs im .4 .7
2 11 -29 7.5YR 4/4 - s 0 Sg ml Cs 1m .7 I 1.6
3 29-50 10YR 4/4 - s 0 Sg ml gs im .7 1.6
4 50 -96 10YR 5/4 - s 0 Sg ml - - .7 1.6
Effluent #1 = BOD 30 < 220 mg /L and T >30 < 150 mg /L ' Effl e — BOD < 30 mg /L and TSS < 30 mg /L
CST Name (Please Print) Si n ure: CST Number
Henry F. Grote 222774
Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number
E. 4366 353rd Ave. Menomonie, WI 54751 3/27/2006 715 233 - 0398
SBD -8330 (R 07 /00)
1
Property Owner Feyereisen, Arthur & Marilyn Parcel ID # 040 - 1304 -11 -000 Page 2 of 3
3 Boring
Boring # Pit Ground surface elev. 94.1 ft. Depth to limiting factor > 100 in.
X Soil Application Rat
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft=
in. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. 'Eff#1 - Eff#2
1 0 -11 ` 7.5YR 3/2 - sl 1 f -m sbk it r cs lm 4 7
2 11 -100 7.5YR 4/4 - s 0 sg ml - im .7 1.6
Al
1 m roots to 40"
Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L " Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
,OD -8330 (R.07/00) Certified Soil Testing, LLC
I
Property Owner Feyereisen, Arthur & Marilyn Parcel ID # 040 - 1304 -11 -000 Page 2 of 3
❑ 3 Boring F
Boring # X Pit Ground surface elev. 94.1 ft. Depth to limiting factor > 100 in.
Soil Application Rat
Horizon Depth Dominant Color Redox Description Texture` Structure ConsisteRgo Bouf Roots GPD /ft
in. Munsell Ou. Sz. Cont. Cola Gr. Sz. Sh. 'Eff#1 'Eff#2
1 ! 0 -11 7.5YR 3/2 - sl 1 f -m sbk i> ifr Cs im 1 .4 .7
i
2 11 -100 -
I � 75YR44 _
I s 0 sg ml lm .7 1.6
I
i
1 m roots to 40"
� r
Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD <_ 30 mg /L and TSS < 30 mg /L
The Department of o
p Co mmerce is an equal opportunity service rovider and employer. [f ou P y 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.
SDD -83 ;u (K 07/00) Certified Soil Testing, LLC
t1 1
�Y�• -�KY' CL"tA ' �1M �Q- QJv Q-.% 9�... - O 1 �I0.`� L
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1.155PA,S 15 I
DEC 2 8 1995
9:00 A
e. y
QUITCLAIM DEED L
ARTHUR N. FEYEREISEN and MARILYN E. FEYEREISEN, his wife hereby
Y
grant and convey, _o ARTHUR N. and MARILYN E. FEYEREISEN, TRUS-
TEES OF THE FEYEREISEN!REVOCABLE TRUST, all the real estate they
own in St. Croix County legally described as:
The E 1/2 of the SW 1/4, the S 1/2 of the S 1/2 of the SE 1/4 of
Section 8, the W 1/2 of the NW 1/4 of Section 16, the N 1/2 of
the NE 1/4 and the SE 1/4 of the NE 1/4 of Section 17, all in
Township 28 North, Range 19 West,
EXCEPTING parts previously conveyed. FEE
ARTHUR N. FE SEN MARILYN E FEYEREISEN
STATE OF WISCONSIN) ACKNOWLEDGEMENT
ST. CROIX COUNTY ) 1
Personally came before one on December 28, 1995 the above - named
ARTHUR N. and MARILYN E "� FEYEREISEN, to me known to be the per-
sons who executed the foregoing instrument, and acknowledged the
same.
.Notary Public. Permanent commission.
�. Drafter: C. W. Malick, 413 Brookwood Dr., Hudson.
2 %j
T
Safety and Buildings Division County
NVi sc l oonssiont 201 Washington Ave., P.O. Box 7162 �� 11 Madr Sanitary Permit Number (to b filled in by Co.)
Department of Commerce fig) 2 fit,
Sanitary Permit p li tion ' r State Plan I.D. Number
+ ►tlt
In accord with Comm 83,2 1, Wis. Adm. Code, son ation yourovide
may be used for secondary purposes Pri y .04(1)(m) Project Address (if different than mailing address)
I. Application Information - Please Print All Informati 'F CROIX COUNT' q33 .S4� �•
Property Owner's Name Parcel # Lot # Block #
r
Property Owner's Mailing Adtfress Prope Lo
Yz
Cr State ' " 2 A, �� K, Section 17
�Z!ip / Code Phone Number
y' ) /& A4_ to 7 T 2 1 ? ) N; R (ciro.
_ v
l � W
H. Type of Building (check all that apply) 2 P/ 27.� J
1?�
/
1 or2 Family Dwelling - Number ofBedrooms Subdivision Name CSM Number
ttf �,O�t
❑ Public(Commercial - Describe Use
❑ State Owned - Describe Use ❑Ci
ty ❑Village ;K7'ownship of
III. Type of Permit: (Check only one box online A. Complete line B if applicable)
A, New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B- El Previous Permit Number and Date Issued
❑ Permit Renewal ❑Permit Revision El Change of El Permit Transfer to New
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all that apply) :5T , _
Non Pressurized In- Ground ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In -Gr d El Holding Tank El Peat Filter El Aerobic Treatment Unit El Recir Iter 11 g Synthetic Media Filter
Recirculatin chin Ch p Gravel -less Pipe El Other (explain) 3y'
er ❑ Dri Line El
V. Dispersal/Treatment Area Informations --- — US
Design Flow(gpd) Design Soil Applicati Rate(gpdSO Dispersal Area Required (sf) Dispersal Area Proposed (sf) S Elevation -r ,gj
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber P] c
Gallons Gallons of Units Concrete Constructed Glass ,26
New Ddsting
Tanks Tanks
Septic or Holding Tank
Aerobic Treatment Unit fjJ / r
Dosing Chamber
VII. Responsibility Statement- I, t undersigned, ass ume responsibility for installation of the POWTS shown on the attached plans.
Pl er's Name (Print) Plum Signature RS Number B Ph�oone Number
Plumberl Address (Street, City, State, Zip Code)
Z Q )_�)P_ Ae, u1`I
VIII. Codo /De artment Use Onl
pproved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued )sluing Agent i tamps)
Surcharge Fee )�/ (� i2 hs , C-
❑ Owner Given Reason for Denial tt pp (/
SW@MiQr 6lpproval/Reasons for Disapproval i
1 S eptic tank effl uent filter and w�
dispersal cell must all serviced ! maintained
as ru p provided by plumber.
2. All s et b ack r must be maintained
as per applicable code /ordinances.
+ P / �OA, eg �,
� ttech complete plans (to the n s m o an 1 inch m site \
J� — .gel( t� 8.r7�1�1r2c� KT q0o.37 = Q92, � ���Il•$I
SBD -6398 (R. 01l03)
Joe
TIMM EXCAVATING
Route 1 Box 192 SHEET NO. _� OF
WILSON, WISCONSIN 54027 CALCULATED BY_ /¢ �� DATE
(715) 772.3214 (715) 386 -5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
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TIMM EXCAVATING SHEET NO. OF
Route 1 Bok 192 '
WILSON, WISCONSIN 54027 CALCULATED BY ¢'� r ^' DATE � " 2 S
(715) 772 -3214 (715) 386 -5443
MPRS #3224 WI MPCA #696 MN CHECKED BY DATE
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RECEIVEti._ .
wsconsin Departrrrent f
and kung ` 2
tre SOIL EVALUATION REPORT Page t of 3
ff
Division of Safety
in � anoe WM Comm 85,1Nis. Adm. Code
�y ST. CROIX
Attach complete sit plan WWWtwwi�n 11 inures in size. Plan must
include, but not Gm' I point (BM), direction and Paroel I.D. (Pending)
Percent slope, scale or dimensions, tion and distance to nearest road.
Please print all information. n �, D R Date
Personal information you provide may be used for secondary Purposes (P ' S. 15.04 1 // /p Q f
Properly Owner Property Location ❑ El
ARTHUR & MARIYLN FEYEREISEN G Lot ---- NE 1/4 SW 1/4 S 8 T 28 N R 19 E (or W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
420 Townsvalley Road 11 — Sunset Valley
City State Zip Code Phone Number [:] Village jjjTown Nearest Road
Hudson, WI 1 54016 1 ( 71) 386 - 2122 1 T40Y I Townsvalley Road
I] New Cor►struction Use[] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
❑ Replacement Public or commercial - Describe:
Parent material outwash/sandstone Flood Plain elevation if applicable 1`�T,w R
General comments Conventional In- ground trenches - to be designed by installer
an h S / , 0.4 or 0 5 loading to d ding on location of trenches /L d mendatiats: t n W'A f° CA Kt UAt �— Pal ,`T �9 3 3 " C YU
SJA— „3
PB- Boring # 0 Bones Wr "�+ 1
El Pit Ground surface elev. 891.81 Depth to limiting factor >93 in. Sol Application Rate
Horizon Depth Dominant Color Redox Texdxe Structure Consistence Boundary Roots GPDIff°
in. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. *001 1 *092
1 0-4 IOYR2/2 — 1 2f -lsbk mvfr cb 3vf-m 0.6 0.8
2 4-17 IOYR2/2 — t 2f -msbk mfr ab 2vf-m 0.6 0.8
3 17 -36 10YR3/6 — I 2f -msbk mfr aw 2vf-m 0.6 0.8
4 36-41 10YR4 /4 — A l f- -msbk Mvfr as 3vf-m 0.4 0.7
5 41 -56 10YR4 /4 — s & gr Osg dl cs — 0.7 1.6
6 56-93 10YR4/4 — fs Osg dl _ — 0.5 1.0
(Horizon 4 has 20-25 gr.)
& ' B "'
Boring # Boring 883.03 (� �� >96
I] Pit Ground surface elev. ft. Depth to fimiting factor in. Rate
on Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
in. Mtn Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *EfF82
1 0-5 10YR2/2 — sl 2fabk ds cb 3vf-m 0.6 1.0
2 5 -17 10YR2 /1 — l 2mabk ds all 2vf-m 0.6 0.8
3 17 -27 10YR3/3 — I 2fabk mvfr ab 2vf-m 0.6 0.8
4 27 -52 10YR3 /4 — 1 2fabk mfr cw lvf-m 0.6 0.8
5 52 -96 IOYR5/4 — s Osg MI — — 0.7 1.6
* Effluent #1 = BOD > 30 220 mgfl. and TSS >30 150 rrg/L Eruenit 82 = BOD < 30 mg& and TSS < 30 mglL
CST Name (Please Pry) Mj — CST Number M Jo Hollister f 224832
Address Data Evaluation Conducted Telephone Number
W9875 690th Avenue, River Falls, WI 54022 01 - 13&07-08-04 (715) 426 - 1775
Property owner FEYEREISEN, Arthur (Lot 11) Parcel 108 (P ending) Page 2 of 3
Boring El PiBrtnng Ground surface elov. $ 86.92 ft. Depth to limiting factor >104 in.
Sot 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 I 'Efr# 2
1 0-6 IOYR2 /2 — is 2fgr ds cb 3vf-m 0.7 1.6
2 6-23 IOYR3/3 — sl 2f -msbk ds cb 2vf-m 0.6 1.0
3 23-70 10YR3 /4 -- is if -msbk mvfr gs — 0.7 1.6
4 70-104 IOYR3 /6 — s Osg ml -- — 0.7 1.6
Borin # 0 Boring
a Pit Ground surface elev. ft. Depth to rm-Mug factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'ER#1 TRW
F-1 Boring # Boring
Pit Ground surface elev. ft. Depth lo limiting factor in.
Sort Rabe
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. - Eff#1 'Eff#2
Effluent #1 = SOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or 7TY 608- 264 -8777.
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ST. CROIX COUNT
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FOTZM
Owncr /Buyer
Mailing Address -- - - - - --
Property Address L } -
/ (Verification required from Planning R: Zoning Department for new const.ruction,) }
City /State ��; Parcel Identification Nuzlr;;ber �t
LEGAL DESCRIPTION
Property Location ��� '/a , .SLJ Y4 , Sec. e , T Z9 N R l I W, 'Town o('_7
Subdivision _— -� ' NtitSeir V ti-�� t ^ - -- _ Lo ft _I j
Certified Survey Map # _ , volume — , Page #
Warranty Deed # J ,volume J r � , Page #
Spec house yes no Lot littcs identifiable yes uo
SYSTEM MATNTFNANCF AND OWNER CERTIFIC'AT'ION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes, Proper
maintenanec consists of purnping 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 trcatnment stage in the waste disposal systern. 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 Oeparuncnl a certification limn, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on•site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
lc-,s than 1/3 full ol'sludgc.
1 /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
stwidurds set forth, herein, as sct by the Department of Commerce and t)tc Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintaincd must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
1 /we certify that all statements on this form are true to the best of my /our knowledge, 1 /we arn/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in kegister of Deeds Office,
Number of bedrooms
5 NA OF APPLICANT(S) DATE
0 "Any information that is misrcpresented may result in the sanitary pcnnil being revoked by [lip. Hanninf; & Zoning I)ch:utmont. • **
Include with this application a recorded warranty decd from the Register of Decds Office and a copy of the ecrilfied survey map if
reference is made in the warranty dcrd.
(REV. 08105)
System Management
Management of`this system is critical. As a condition of approval of these plans this system management section must be
re� ietied with the owner, and the owner must be provided with a complete set of plans including this management section. If problems
develop with the adsorption system or any other system components, the installing plumber, Timm Excavating, 715- 772 -3214, or the St.
C roi.x County Zoning Office, 715- 386 -4680, should be contacted for assistance.
General
Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows
into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the
better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and
contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or
compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water
in a manner to protect ground water quality and public health.
1 . If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure adherence
to contaminant load design criteria.
Install water- saving appliances whenever and wherever possible.
Repair even small water leaks as soon as possible.
Never pour grease or oil down any drain or stool.
Garbage disposals are not recommended; if you must have one, use it sparingly.
6 No paper products other than tissue should go into the system.
- `o chemicals should go into the system.
8 Avoid surge slows of water; try to spread laundry throughout the week.
Maintenance
! The septic tank must be inspected every three years by a properly licensed person.
If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume
equals one third of the tank volume.
When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into
the septic tank to remove accumulated material.
Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell.
Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption
cell
If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany
their specifications.
6 The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump
If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve
capaciry to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or
two days should pass before any necessary repairs can be made.
\ oid compaction such as vehicle traffic within 15' down -slope of the adsorption system.
8 avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system.
y Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth.
! 0 Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area.
Contingency Plan
Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring
ma become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54
2j. Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing,
andlor installation of additional treatment components or conversion to a holding tank may be necessary.
Page 8 of 8
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