HomeMy WebLinkAbout040-1304-17-000 Wisconsin Department of Commerce v PRIVATE SEWAGE SYSTEM County: St. Croix
Safeqi and Building Division
INSPECTION REPORT Sanitary Permit No:
487995 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:
Welle & Hove Traditional Homes, LLC I Troy, Town of 040 - 1304 -17 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
/O o G tM. \ GS 1 08.28.19.1823
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
. YO
Septic � � Z ��-- Benchmark
t
Dosing Alt. BM
� yll 5� Lj., t k. not - 3.5� / .8 z
A watino n Bldg. Sewer
Holding / Inlet / - 7
TANK SETBACK INFORMATION SUHt Outlet 7 ,75 x ' 39
TANK TO P /L� WELL BLDG. Vent to Air Intake ROAD Dt Inlet
V ` \
Septic r ' � /,/1 z 1 2 1 Dt Bottom \ \\
Dosing / �" Header /Man.
Aeration Dist. Pipe q • 3
9
Holding Bot. System
Final Grade � /6�• 5 D
PUMP /SIPHON INFORMATION opr, \C�
Manufacturer Demand St Cov r t /
GPM C.J `I 3� �b �1 ,
Model N ber
TDH Lift Friction Loss S ead TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width r Length / No. Of Tr PIT DI EAA NSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS '3 /O q 3 �„ - _ 1 _ , �_ t
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer.
INFORMATION CHAMBER OR
Type Of System: / 5 r r O ' � p I UNIT Model Number. ^ /
C O AJ �� / V
DISTRIBUTION SYSTEM zU ec cL,
Header /Manifold i/ Distribution x Hole Size x Hole Spacing Vent t Air Intake
/` Pipes) \ \ \ 3r�
Length J Dia I Length \ Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over i Depth Over xx Depth o xx Seeded /Sodded xx Mulched
Bed /Trench Center Bed/Trench Edges Topsoil
- +— 3.(pq Yes No Yes No
'7 dit
COMMENTS nclude code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 439 Horizon Court Hudson, WI 54016 (NE 1/4 SW 1/4 8 T28N R19W) Sunset Valley Lot 17 Parcel No: 08.28.19.1823
,
1.) Alt BM Description = wa lk. ��- z C7 bil SJ� r vts�/cvi II
2.) Bldg sewer length = Z7
- amount of cover
! _ - - - -- — - --
Plan revision Required? No
Yes V
Use other side for additional information? I
Date Insepct s Signa re Cert. No.
SBD -6710 (R.3/97)
II'�
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Safety and Buildings Division Copy
201 W. Washington Ave., P.O. Box 7162 St Croix
�S���S,� Madison, Wl 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
(608) 266 -3151 r
Department of Comrilerce
Sanitary Permit App a n State Plan I.D. Number
Na
In accord with Comm 83.21, Wis. Adm. Code, personal on you provide Project Address (if different than mailing address)
may be used for secondary purposes Privacy Law, s 15.0 1 m
L Application Information - Please Print All Informatic m RECEIVED 439 Horizon Court
Property Owner's Name I Parcel Lot #
Arthur & Marilyn Feyereisen Rev. Trust lot
BUYER: Welle & Hove Traditional Homes, LLC O - 1 3o`F - I - oa0 . 9Z3
Property Owner's Mailing Address ST. CROIX COUNTY Proms Location
420 Townsvalley Rd. ZONING OFFICE NE '/4, SW V4, Section I
City, State Zip Code Phone Number
T 28 N; R 19 W
Heron, WI 54016 (715) 377-08L2
IL Type of Building (check all that apply) mid S „wi
Subdivision Name C3it�Iamber-
❑X 1 or 2 Family Dwelling - Number of Bedrooms 5 _ S.
❑ Public/Commercial - Describe Use Sunset Vall
❑ State Owned - Describe Use ❑City _❑ Village ❑ X Township of TrOy
U Type of Permit: (Check only one box on line A. Complete line B if applicable)
A ❑X New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS stem: Check all that applyy Three 3 trenches, 26 "Quick 4" chambers each 3' X 104'.
❑ XNon - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter
❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Fitter
❑ Rec rctilating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dispersanreatment Area Information: 78 Infiltrator "Qucik 4" Chambers at 19.1 sq. ft. EISA/chamber + 3pr. end caps = 1,507.20 sq. ft. EISA
Design Flow (gpd) Design S i , Dispersal Area Required (sf) Dispersal At- Proposed (sf) Elevation
750 gpd 0.5 gpd�sq. ft. 1,500.00 sq ft 1,507.20 sq ft EISA 96.80', 96.30', & 95.80'
VL Tank Info Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units P PL SZ5 Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank 1,500 _ 1,500 1 Wieser Concrete Combination X
ST/PC used as 2 chambered ST
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility State ent- I, the v assume for Installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plum leer' igriattrre MP/MPRS Number [ Business Phone Number
James K. Thompson s---- MPRS #30021 (715) 248 -7767
Plumber's Address (Street, City, State ip Code)
340 Paulson Lake Lane, , Osceola, WI 54020
VIII. Coun /De artment Use Onl
Approved ❑Disapproved Sanitary Permit Fee (includes Date Issued Issuing ent Signature o Statnps)
Groundwater harge Fee)
❑ Owner ven Reason for 'al ���� !" -,13 -
IX Conditions pprov 1 3)
SYSTEM OWNER: �.T- C� i?ti5P f C S -� v -+ �4t-[
1 Septic tank, effluent filter and n (�
dispersal cell must all be serviced /maintained al�,�'C�b`�Q Stet �cn, S� ov�S� y.A t - ek
as per management plan provided by plumber. VV
2. All setback requirements must be maintained w - i
as per applicable code /ordinances. COCA- c _ 6,4-- 5�" o * )L y
Attach complete plans (to the County only) for the m pa n4 le;4v thsq 81/2: ` 1 it nchea in s ize
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vusconsin Department ofComme REGEIVEOL J ALUATION REPORT Page I of 3
Division of Safety and Buildings
in a ( c ` ith cordance w n C�omm Wis. Adm. Code
0 A� �� P1 . a must ST. CROIX
Attach complete site plan on pa Lnnd s n x
include, but rot limited to: vertic zontal reference poi nt (B Parcel I.D. (Pending)
percent slope, scale or dirronsi rr6� Z NI I Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /� 0 6
Property Owner Property Location ❑ El
ARTHUR & NIARIYLN FEYEREISEN GovL Lot — W 1/4 SW 1/4 S 8 T 28 N R 19 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name CSM#
420 Townsvalley Road 17 — Sunset Valley
City Stab Zip Code Phone Number village • own Nearest Road
Hudson, WI 1 54016 ( 715 386 - 2122 Townsvalley Road
E] New Construction UseE] Residential / Number of bedrooms 4 Code derived design lbw rate 600 GPD
Replacement Public or commercial - Describe:
Parent material outwash/sandstone Flood Plain elevation if applicable J L
General comments Conventional In- ground trenches - to be designed by installer
and recommendations: 0.5 loading rate� � 5�j�/y)
i9k 50"
EB- Boring # ❑ Boring
Q Pit Ground surface elev. 901.40 ft. Depth to limiting factor >92 in. Soo Rate
Horizon Depth Dominant Color Redox Description Texhire Structure Consistence Boundary Roots GPDNe
in. Munsell Qu. Sz. Coat Color Gr. Sz. Sh. 'Eff#1 '01182
10YR2/
1
0-5 1 — 1 2f-mabk mvfr ab 3vf-m 0.6 0.8
2 5 -17 10YR2/2 — I 2f-msbk mfr a i 2vf-m 0.6 0.8
3 17 -39 R(Hofizons — 1 2f-mabk mfr aw 2vf-m 0.6 0.8 f m
4 39 -48 — sl 1 f -lsbk dsh aw 2v 0.4 0.7
5 48 -92 — s Osg dl — — 0.7 1.6
4 & 5 have some gr.)
FB] ❑ M� 898 9 >102
� # Q Pit Ground surface elev. .6 ft Depth to limitlog factor in. Rate
Sol Application Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPD/fF
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in. Munseil Q Sz. Cont. Color Gr_ Sz. Sh_ Bou - Eff#1 '01#2
n 1 0_5 10YR2 /1 — 1 3fabk ds cb 3vf -m 0.6 0.8
2 5 -14 10YR2/1 — I 2f -mabk dsh ci 2vf-m 0.6 0.8
3 14-19 10YR3/2 — 1 if - -mabk mvfr as lvf-m 0.4 0.6
4 19 -36 10YR3 /6 — sl lmsbk mfr as lvf-m 0.4 0.7
5 36 7.5YR4/4 mzp 7.SYR4 %6 s & sil Osg/2fabk mfr cs 1vf f 0.6 0.8
6 50 -102 10YR3 /6 s Osg dl — — .7 1.6
Horizons 4 & 6 have some gr U. 2 �l
' Effluent #1 = BOD, > 30 220 mg(L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Sign CST Number
M Jo Hollister C 224832
Address Date Evaluation Conducted Telephone Number
W9875 690th Avenue, River Falls, WI 54022 01 - 13 & 07 - 08 - 04 (715) 426 - 1775
Property Owner FEYEREIS Arthu (Lot 17) Parcel ID # (Pending) Page 2 of 3
Boring
�nn9 # Pit Ground surface elev_ 899.69 ft. Depth to limiting factor 106
F 0 in Sol Rate
Horizon Depth Dominant Color Redox Description Texture Structure Ca>sistence Boundary Roots GPDM
in. Munsell Qu. Sz- Cont. Color Gr. Sz. Sh. `Eff#1 `Eif#2
1 04 10YR2 /1 -- 1 3fabk dsh cb 3vf-m 0.6 0.8
2 4-19 1 3f -mabk dsh ci 2vf-m 0.6 0.8
3 19 -24 10YR3 /2 -- I 2fabk mvfr cs 2vf-m 0.6 0.8
4 24-34 10YR3 /4 -- sit 2fabk mfr as 2vf -m 0.6 0.8
5 34-41 10YR4 /3 -- sil 2fabk mfr cw 2vf-m 0.6 0.8
6 41 -82 10YR3/6 — s Osg ml gs — 0.7 1.6
7 82 -106 I OYR3 /6 — fs Osg ml — — 0.5 1.0
❑ Boring # 11 Boring
Pit Ground surface elev. ft. Depth to limiting factor in. Sal ication 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
F Boring Boring # Ground surface elev. ft. Depth to limiting factor in.
Pit Soa ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fl
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *Eff#2
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page f of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner J& Ltd— Septic Tank Capacity $� a l ❑ NA
Permit # '
Septic Tank Manufacturer w ( &�+ ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer O L.. L OK, ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model L„ S'Z ❑ NA
Number of Public Facility Units NA Pump Tank Capacity al I J & A
Estimated flow (average) j gal /day Pump Tank Manufacturer A
Design flow (peak), (Estimated x 1.5) 0 gal /day Pump Manufacturer A
Soil Application Rate . S al /day /ft2 Pump Model PCNA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit PA
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD :_30 mg /L XIn- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) <30 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) :_10 cfu /100ml ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: A
Other: ❑ NA Other: PA
* Values typical for domestic wastewater and septic tank effluent. Other: PkNA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
y ear(s)
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA
years)
Clean effluent filter At least once every: ❑ month(s) ❑ NA
years)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) RNA
❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) �kNA
❑ year(s)
Other: ❑ month(s) r�
At least once every: ❑ year(s)
Other:
IC NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of :_12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start uR shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or -must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at -that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
tj T
M--.FR- of the 1200.9TS soil ar'd
alua ' a o ing tank
b e ai a ?9, 044113 1T1T�-- 9"D i N6%, at JS7 (JC- - A 0"
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name - �TAOV_ - "r8W1P1 Name
Phone �$ Z Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name s^( C l ou& 201 I
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.5411), (2) & (3), Wisconsin Administrative Code.
r
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
//
OWNERSHIP CERTIFICATION FORM
Owner /Buyer top Ile 5e 4,Ae x . it. a
Mailing Address 70 7 va/eo -� i �Q, �� %'� /Da �5o;--3, Col
Property Address 3 0*. i wY'�
(Verification required from Planning & Zoning Department for new construction.)
City /State Parcel Identification Number
{ - -1� -s�flC 1823
LEGAL DESCRIPTION � _ 1 30
Property Location / 1 /a , Scc1 1 /4 , Sec. , T c N R /9 W, Town of 7 d K
Subdivision 50- t75y6 JIL& v ,Lot # 17 .
Certified Survey Map # , Volume — , Page #
- r2usT
.1 _ S 6-6b ;
Volume 212-5 , Page # 29Z—
Spec house yes no Lot lines identifiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. $3.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, 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
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
Itwe certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of Irooms
L c
SIGNATURE OF APPLICANTS) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
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2 - 02 5 P. 2 81 1629
KATHLEEN H. WALSH
State Bar of Wisconsin Form 7 -2003 REGISTER OF DEEDS
TRUSTEE'S DEED ST. CROIX CO., MI
RECEIVED FOR RECORD
Document Number Document Name 11/09/2005 18: 00AN
TRUSTEES DEED
EXEMPT #
THIS DEED, made between Arthur N. Fevereisen and Marilyn E. Fevereisen REC FEE: 11.00
as Trustee of the Fevereisen Revocable Trust TRANS FEE: 352.50
( "Grantor," whether one or more), COPY FEE:
CC FEE:
and Welle and Hove Traditional Homes, LLC PAGES: 1
( "Grantee," whether one or more).
Grantor conveys to Grantee, without warranty, the following described real estate, Recording Area
together with the rents, profits, fixtures and other appurtenant interests, in St. Croix Name and Return Address
County, State of Wisconsin ( "Property") (if more space is needed, please attach
m):
Lot 17, lat of Sunset Valley in the Town of Troy, St. Croix County, Wisconsin.
Part of 040-1037-10-000 _
Parcel Identification Number (PIN)
Dated
(SEAL) ' �r2�_oi�_ o� J (SEAL)
* R o g er evers Arthur N. Feyereisen
NOta r%',; Public (SEAL) p (SEAL)
* State O iSCOflSIn *Ma ilyn E eyereisen
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
authenticated on STATE OF �� )
) ss.
COUNTY )
*
TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on
(If not, the above -named Arthur N. Feyereisen and Marilyn E.
authorized by Wis. Stat. § 706.06) Fevereisen, trustees of the Fevereisen Revocable Trust
to me known to be the person(s) who executed the foregoing
THIS INSTRUMENT DRAFTED BY: instrument and ledged the same.
l
Attorney Kristina Ogland
Hudson, WI 54016
N` oVy Public State of
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.
TRUSTEE'S DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 7-2003
• Type name below signatures. INFO -PROTM Legal Forms 800855 -2021 www.inloproforms.eom
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Wisconsin Department of Commerce UATION REPORT Page 1 of 3
Division of Safety and Buildings Wis. Adm. Code A.C.E. Sal & Site Evaluations
County
Attach complete site plan on paper must St. Croix
include, but not limited to: vertical a and
percent slope, scale or dimensions, earest road. Parcel I.D.
Pending from 040 - 1037 -10 -000
Please print all information. Reviewed By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Welle & Hove Traditional Homes, LLC Govt. Lot NE 1/4 SW 1/4 S 8 T 28 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
707 Rodeo Drive, Suite #102 17 Sunset Valley
City State Zip Code Phone Number _j City J Village N' Town Nearest Road
Hudson WI 1 54016 1 (715) 377 -0822 Troy 1 439 Horizon Court
New Construction Use: 0 Residential / Number of bedrooms 5 Code derived design flow rate 750 GPD
Replacement I Public or commercial - Describe:
Parent material Glacial outwash Flood plain elevation, if applicable na
General comments
and recommendations: Soil evaluation completed as addendum to report by M.J. Hollister to expand tested area to accomodate
POWTS dispersal cell.
a Boring # - Boring
N Pit Ground Surface elev. 101.57 ft. Depth to limiting factor : 1 ' 108 „ 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. `EN#1 `Eff#2
1 0-6 10yr3/3 none Ifs 2fsbk mvfr as 2fm,1c 0.5 1.0
2 6 -24 1Oyr32 none sil 2msbk mvfr cw 2fmc 0.6 0.8
3 24-48 10yr5/4 none sil 2msbk mvfr aw lfm 0.6 0.8
4 48 -52 10yr4/6 none s 0 sg ml cw 1vf 0.7 1.6
5 52 -108 10yr5/6 none s 0 sg ml - - 0.7 1.6
F2 ] Boring # J Boring
f Pit Ground Surface elev. 98.43 ft. Depth to limiting factor in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tt
in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. I `Eff#1 `Eff#2
1 0 -19 10yr3/3 none sl 2fsbk mvfr as 2fm,1 c 0.6 1.0
2 19-46 10yr32 none sil 2msbk mvfr cvtr 2fmc 0.6 0.8
3 46-62 10yr5/4 m2d 7.5yr5/8 sil 1 msbk mvfr aw 1 fm 0.4 0.6
4 62-68 10yr4/6 none s 0 sg ml cw 1vf 0.7 1.6
5 68 -96 10yr5/6 none s 0 sg ml - - 0.7 1.6
Redox. concentrations identified in H#3 arg4ue to greater matric potential of sid lying directly above Osg s creating tension saturated soils. Comm.
(3)3 applied to discount redox. concentrations as limiting factor.
` Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 L uent = BOD S mg/L and TSS < V mg/L
CST Name (Please Print) Signature: CST Number
James K. Thompson 3602
Address A.C.E. Sal & Site Evaluations ate Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, HIV l 54020 11/17/2005 715- 248 -7767
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