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HomeMy WebLinkAbout040-1298-10-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538723 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: Rowekam , Todd & Shanna Troy, Town of 040 - 1298 -10 -100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: /�Q 641 1 G 1 09.28.19.1719A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER j CAPACITY STATION BS HI FS ELEV. Septic =_ Z, 'F Benchmark � Benchmark 3 5 ��3. � w �' LL Dosing O k 5 Z74 Alt M 4 / 6 .S 1 02 . 5 Aeration Bldg. Sewer (/4 3. Z / tt Z Holding St/Ht Inlet 1 4-37 7 1 5, St/Ht Outlet TANK SETBACK INFORMATION 41 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet �. Web J-- Septic 42 1 7 �� 36 , S ylov, _ Dt Bottom Dosing Header /Man. i Aeration Dist. Pipe q / DIp � Holding Bot. System Final Grade d7 PUMP /SIPHON INFORMATION 3 140 Manufacturer Demand Std` Model Numb G- TDH Lift Friction Loss System TDH Ft Forcemain 7r ""r_ia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length I No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 G ! Z %-- — BL � SETBACK SYSTEM TO / P/L DG WE `EL LL `t1 LAKE /STREAM LEACHING Manufacturer: , , G �+ INFORMATION Type Of System: CH OR DAV i��0 j\ �� ` UNIT Model NumbeA ✓, ;I 41 / DISTRIBUTION SYSTEM �(+ / Zj- + T Z. Header /Manifold ,� Distribution x Hole Size x Hole Spacing Vent to Air Intake ' Pipe(s) ` ', I _ 5 Length 5 Dia Length ` Dia Spacing ` p f �L, SOIL COVER x Pressure Systems Only x Mound Or At - Grade Sy stems Only S� a er Depth Over Depth Over xx Depth of xx Seeded /So ; xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ❑ No Yes 0 No t COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 401 N. Glover Rd. Hudson, WI 54016 (SW 1/4 SE 1/4 9 T28N R1 9W) NA Lot 11 Parcel No: 09.28.19.1719A 1.) Alt BM Description= "• T "`� � 62 6 J w` jj ,• , 2.) Bldg sewer length = 3 v - amount of cover = J / O(� 14 O U ` C _ Plan revision Required? R Yes )< Use other side for additional information. J ( SBD -6710 (R.3/97) Date Insepctor' ignature Cert. No. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 538723 0 GENERAL INFORMATION 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: Rowekam , Todd & Shanna I Troy, Town of 040 - 1298 -10 -100 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 09.28.19.1719A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 0 Yes FE� No R Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 401 N. Glover Rd. Hudson, WI 54016 (SW 1/4 SE 1/4 9 T28N R1 9W) NA Lot 11 Parcel No: 09.28.19.1719A 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? R Yes ❑- No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. commerce .wii.gov Safety and Buildings Division County 201 W. Washin�j�,A o O. Box 7162 S si c on-s i n m Madisot b2 i Sanitary Permit Number ( be filled in by Co.) t i Deparbm"t of commove b s3 8 Sanitary Permit Application State Transaction N ,� um l p In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental L /'s unit is requirbd prior to obtaining a sanitary Irermit. Note: Applica ' forms for state -owned g2WTS are Project Address (if different than mailing address) submitted to the Department of Commerce. (Personal information y pmv 11171M�l J p urpo ses in accordance with the Privacy Law s.'15.04 1 m Stats. I. Application Information -� Please Pri All Information Property O is Name Parcel # - NOV O 8 201 Property Owner's Mailing Address ST. CROIX COUNTY Property Location (g PLANNING & ZONING OFFICE Govt. Lot ,1J City, State Zip Code Phone Number 1:aL � `�_ /., S /., Section circle one T R H. Type of Building (check all that apply) Lot # 91 or 2 Fa//mil --y Dwelling- Number of Bedroom`s Subdivision Name n Block# tiC�L✓l r"�v�ldP I/hf7X I r �dD�Y� +.ti 0 Public /Commercial - 3escribe Vse !� ❑City of (/f2 :[C�GCO fjj `QG� CSM Number ❑Village of 0 State Owned - Describe Use _ 7oR 3 �b P. yqa 0 Town of III. Type of Permit: (Check only one bo on line A. Complete line B if applicable) A. (� New System ❑Replacement S�stem ❑ Treatment/Holding Tank Replacement Only 11 Other Modification to Existing System (explain) B• ❑ Permit Renewal 0 Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Com onen evice: Check all that appl Ig Non - Pressurized In- Ground 0 Pressurized In- Ground -- 0 7- �At -Grade 0 Mound ?:24 in. of suitable soil 0 Mo < 24 in. of 0 Holding Tank 0 Other Dispersal Compon t (explain) -Y�, 140 k ire vice ( xpl m V. Dis ersal/TreatmentArea Informatio Design Flow (gpd) Design Soil Application ate(gpdsf) I Dispersal Area Re?ired (sf) Dispersal Area Proposed (sf) System Elevation VI- Tank Info Capa io in Total # of Manufacturer Ga Ions Gallons Units o $ New Tanks Eixisting Tanks o ;' v 3 A. U rn rn iw 0 a Septic or Holding Tank Dosing Chamber VII. Responsibility Statement - I, the underolped, assume responAkdity for hlstatlation of the POWTS shown on the attached plans. Plumber's me rint) Plumber' Sign MP/MPRS Number Business Phone Number 3 /- Plum en's A ress (Street City, tate, Zip Code) VII . Coun /De artment Use Onl Approved ❑ Disapproved Permit Fee Date Issued Issui Agent gnature tQ1_Q= Given Reason for De "al 1 7 S i I v , Q I1.. ' n va vit� sons f r D' approval 1 Septic tan ruent filer ana `� Q rn dispersal cell must all be service/ maintained 1 as per management plan provided by plumber. 2. All setback requirements must b4 maintained as per a licable code /ordinanc s. Attach to complete pla#s for the system and submit to the County only on paper not less than S 1/2 z 11 inches in size SBD -6398 (R. 02/09) Valid thru 02/11 s - CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: Owner's Address. ,�j D__ Legal Description: 5 /_SE Township: County: Subdivision Name: Lot Number: Parcel ID Number: Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing Page 4 System Cross - Section Page 5 Filter Specs Page 6 Maintenance & Management Plan Page 7 Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Designer /Plumber: ),J,r� /� License Number: 2 Date: ' /f f� Phone Number -/s - ZLZ Signature Designed pursuant to the In- Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD- 10705 -P (N.01/01). Page 1 �� 6 ✓/ i A r J �/-Zvjl; a Soil AbsoLRLion System Cross Section w Final Gracie I4 Seheduie 40 f € PVC Vent Pipe ` With Vent cap Leaching --�► Chamber System Elevation .3 ft Soil Absorption S tem Plan View 9a ft ft Leaching Trench 9 Vent Or Obseruaiion Pipe Chambers 4" Dia. Trench 2 Header Leaching Chamber Specifications / Manufacturer And Model EISA Rating , �;::& sq ft per chamber Soil Application Rate �� gpdfs ft gpd Design Flow = _ Soil Application Rate '+ _->r7O EISA = Chambers 2 rows of chambers each. Page of PID LIAbox— Inc. INSTALLATION INSTRUCTIONS irnor ewa ter Praduc Precast, Drainace WA D 'son of Polylok foc. P L- 525 /P L -625 F I LT E R zste,�2s INSTALLATION INSTRUCTIONS i Center filter with opening [L' LU , K co �r Atltlftfonai pipe or Polylok Extend 8 Lok" Glue forcenfenng Step is Step 2: Step 3: (A) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the (B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the is positioned so the filter can be housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted in the housing. MAINTENANCE INSTRUCTIONS J [ } tl F 3 s Step 1: Step 2: Step 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back i if necessary, into the the housing making sure (B) Pull the filter out of the housing, the filter is properly alighed �— (C) Hose off the filter over the septic tank. and completely inserted. j USE RUBBER Gk&VES Make sure all solids fall back into the (B) Replace septic tank cover y CLEANING F ILTER septic tank. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page � of F:;;LE INFORMATION SYSTEM SPECFFICATiOIYS NA Septic Tank Capacity gal 1 e.- r ❑ NA Septic Tank Manufacturer GS PARAMETERS Effluent Filter Manufacturer ❑ NA Nu­­"Ier of Bedrooms 4/ 0 NA Effl uent Filter Model ❑ NA - 9 ju 'j , , Public 'Faciii urift's NA Pump Tank Capacity gal i NA i _su f1C- (average) j gal/day Pump Tank Manufacturer _1� NA - Design (peak), (Estimated x i.5) ew galfday Pump Manufacturer 1!1 !3A Z Sol" Application Date - 7 ga ltd ay 1ft,2 Pump Model -0 NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit NA Fats, Oil & Grease (FOG) :520 mgt ❑ Sand/Gravel Filter ❑ Peat Filter B Oxygen Derr and (SOD 5220 mg[L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg/L ❑ Disinfection ❑ Other: I Pre ❑ T\JA Treated Effluent Quality Monthly average Dispersal Celts) Biochemical Oxygen Dem and (BOO,) 530 m91L .6 In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (T SS) 5 mg[L E9 NA ❑ At-Grade ❑ Mound t Coliform (geometric mean) :510` cfu/700ml ❑ Drip-Line 0 Other: Other: 0 NA hnjrn E Particle Size ax, - Y, in dia. ❑ NA ne ❑ NA O ther: 'kyP for domestic wastewater and sectic tank el'fluent- Other: El NA ` T , i7A!NTENANCE SCHEDULE Service Event Service Frequency 0 mth soect condition of tank(s) I ry At least once eve: (Maximum 3 years) ❑ NA - - - on (s) (s) um io out contents of tank(s) 1 When combined siudge scum equals one-third (Y,) of tank volume ❑ NA 13 month(s) -soect dispersal celf(s) At least once every: (Maximum 3 years) ❑ NA 0 year(s) h(s Clear effluent filter At least once every: -3 ye ❑ mon ar( ) 11 NA nssect (s pump, pump controls & alarm At least once every: ❑ 0 year(s ❑ month ) ANA (s and pressure test At least once every: ❑ 0 year ❑ month (s) ) Z NA ❑ month(s) At least once every: -Inl� NA ❑ year(s) 0 NA - OANTENANCE 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 cefl(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 o The tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code_ Ali athei­ set including but not limited to the servicing of effluent filters, mechanical or pressurized components, pre units. and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service - eoort shall be provided to the local regulatory authority within 10 days of completion of any service event- c -Az� � UP AND OPERATION Page -7— or nevi construction, Prior to use of the Pow- s check treatment tank(s) for the presence of painting products or other chemicals `at r^aY impede the treatment process and /or damage the dispersal celi(s)- if high concentrations are detected have the contents t s tank(s) removed by a septage servicing operator prior to use. sta T up shall riot occur when soil conditions are frozen at the infiltrative surface. Dur=ing power outages pump tanks may fill above normal highwater levels- When power is restored the excess wastewater will be 1isc ,arged to the dispersal celi(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. Duo n of drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area ,;; hin I 5 feet down s lope 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 P OW TS: antibiotics; baby wipes; cigarette buts; 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; ; P F 114 Products; pesticides; sanitary napkins; tampons; and water softener brine. ".RA.NDONMENT hen ,he POWTS Fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is p - apes iy and safely abandoned in compliance with chapter Comm 83 -33, Wisconsin Administrative Code: 11 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 the POWT3 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. 0 A suitable replacement area is not available due to setback andfor soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 0 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POVV7S a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS- 0 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the in f iltrative 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 POW I S INSTALLER ' POWTS MAINTAINER blame I _ / Name Phone ' G Phone S EPT AGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY va ,e Name J' Phone Phone _ r.;3 docu• e-:; ••. as c - e-=_= o_ -o' -ante with chapter Comm 83.22(2)(b)(I)(d) &(f) and 83.540), (2) & (3), Wisconsin Administrative Code. f M CRODr ODUN TY tnwrw TAM mA1N' AvtAIm AGacc ANT i AND OUMMMP CIIRT1FiCXZ'E Fam >aadt<ete oz- Glme GA3' µUPO) 44rzenJag pt�opnty Addeaas Ef0/ IVs � ' W • ,�ZL ` ( �OortIN�iD�sm�at�eewwa�aalias) I cny ee ,vr r � • Paroei r a Y 0 J .) V - 1 o 1 b ,6 i LEG AL DBSCR�NS, s E 1 q Pm a ty Lecoeo0 � 96 f4 Smt-T * 1�W, Tara Subanrisioa e kMA L j&-, `/ LoliR_ i wwmw Dww t . Z d {{ spa boos ya 41W I of lines identi6abta yae no i i SY3Ttl:M MA>1rIT�:NA�,,,NC'_R satp�'oPer °� eMLsaa�eoeeoe cf yossaelAie sys6an ooidd readt it: p�fwe Dane to lust®e wo�Ree. Pngw =Woleeasae moults ofpt ogft *a dw septic tam a my tlmx yam at aoarei. ifusWW by a licaa d peer. W6atpou{wt iela thesg►saanOao adect the fwadm of tb0 esprit tmk as a bommm* ! d� s� a lase waste 1 7 >bPropae'tyo*uwaiar10.wbmkto st. Croat zmma Delay s stidcshan ftn. dwed bydo owaw andbya J oQxdy plumber, faskiewpinm6aas HrAumdpmpQaaci$ri dw(1)604W i alts wmtO*mtsa diapasl syaeamir:In pex apeu�o600mditivn andrar (2) aka ipepectioo and P p (ifneoatary� the updo ask is Ira dine U91W1 e[slndr- { i Uwe. die snd a0ree to maipaain the pivrMe se�rs8e disposal system wigt dw MmWifta sat f irk b min. as oat by th Dgmtmw of COmmme and wa Ow DaPa ftli t Of Notmt Resoa me Stdoetwimoosm_ tLety c syeEsmllasbeenmein edumabboomptatodmdreetsedto dw St. Cmuc Comfy Zooko Ofoe wridik 10 days of the dmee yen' eatpit ft dt k MONATMS OF i ifcf pnopoeed bedroom: ' i OwNZA r FICA ION 1 I (we) catify dot au saftmeM aw t1}is tam ale true W IM beet of my (our) kaoa� I (We) rs ( are) do catraer(s) of do property dmnW above, by virtue of a vu n aty deed recorded in Register of Omm- i I or Atxr ease' A►+ �t:. ae. duvs�► trrtikm�EetPam�tBi +aeaweMsibym.ImleiDap.rtort�""' rcf.`.. allitii. �pl maas�aawaaaoeyb .dtiame�.w�dDaadaa�ia. .a�y�tl�sorR�i aewyasy i[e�wr.e. isre.;.A�. rme�q,�aed. i i Wisconsin Department of Commerce SOIL EVALUATION REPORT Page — L of Division of Safety and Buildings in accordance Ci ' i Code A�w Count Attach complete site plan on paper not less than 8 1/2 x I I irik in size. a st include, but not limited to: vertical and horizontal reference point d Parcel I.D. /1 Q percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all rmatiop R 4 wed b ` Date Personal information you provide may be used for s dary p "IA 15.04 ) (m)). Property gTer Prope Location ovt. L 11� 1/4 S T N R E (orXq Property Owner's Mailing Address of # Block # Subd. Name or CSM# ST. CRQIX GQUN , -?Z4 J zz J"'�Y 12 AMO A AQ-1— �/.J— ��L 117- 4 City State' Zip Code P ❑ Village P9 Town =R15ad ( ) New Construction Use:,M Residential /Number of bedrooms Code derived design flow rate GPD ❑ Replacement / C1 Public or commercial - Describe: Parent material e9111 ,11KI-1 Flood Plain elevation if applicable ft. General comments �J � 6 and recommendations: / sro�cts�v M Boring # Boring , ® Pit Ground surface elev. ft. Depth to limiting factor in. SoI Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/FF In. Munsell Qu. Sz. Ciont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Jio IV /I 7 4 9 - 3 , s' . S I 5q"/ (a S Boring # Boring 7 &04A(YU Aft A6 Way✓ 0+ 11 4,c. ® pit Ground surface elev. ft. Depth to limiting Nctor in. 7 S;i � lApplicafion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. )Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 5' - - 4 4 E en 1 = B > < 220 and TSS >30 < 150 mglL 'ET t #2 = BOD < mg/L and TSS 1 30 mg/L CST Name � Print Signature CST Number --K Address Date Evaluation Conducted Telephone Number 4�2L�� ZL,-2,10 Property Owner Parcel ID # Page of _ n Boring # Boring 9y1 pit Ground surface elev. ft. Depth to limiting factor , Z in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfif in. Munsell Qu. Sz. nt. Color Gr. Sz. J Sh. 'Eff#1 'Efr#2 sb Q 4 9 F-1 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/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff1Q Boring ❑ Boring # Ground surface elev. Depth to limiting factor in. ❑ Pit ft. Sal Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAf in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD, > 30 1220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD, <_ 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. SBD -8330 (8.6W �a9A .�� Ans S S, , r i 9 � 4 1 �eIza 7 0937 V O L 17 PAG 44b IL5R — REGISTER OF DEEDS RECEIVED * kECORD 02/12/2003 03:30PM CERTIFIED SURVEY MAP COPYFFFEEE: 13.00 LOCATED IN THE SW 1/4 OF THE SE 1 SECTION 9 AND THE PAGES, 2 NW 1/4 OF THE NE 1/4 OF SECTION 16, ALL IN T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN, BEING ALL OF LOTS` ,2,3, OUTLOT 1 AND 7 OF THE PLAT OF GLOVER GLEN. — — — — — mI A / SCALE IN FEET '-� LOT 10 Q e I (SEE NOTE #3. r �I n PAGE 2) '� N 0 75 150 300 ACRES 102,7 ,0 2,749 S.F. s 77.30, ciI ,n 7778 1 27,76, " n T s 7t' �, � -- — — — — — — — — — �'' 2W$9 AC S 8� 1 j" f APAQOXBiGi T£` N 100.098 S.F. WI �p v • S' DRAAfrELD y0 °31' 3 SO i LOCATION Q �z N _ z 139.66' S£Pr1c `� F I nv TANK m 4 •� ^I �N N N J 5D' o LOT 12 1 ACRES / 3 135,300 S.F. TILL S 3.106 0 ' Q7" W 9.85 /N 42°45' 00" /! /`� SE CORNER \ \ 21.00' r^ SECTION 9 S 1 CORNER 0 J�� ) 0. N T28N, R19W SECTION 9 T28N, RR19W/�V� 584\\` __ s� v,6� / __� �- �— ' 24" 284'\ � R .�' • 12.49 „' N tee 67,12, W / SE SOU TH LIN SECT F HE 9 s LOT 13 � / eg k ► s ° b 87,214 SCRES POINT OF o,✓ \ . / n”' ' BEGINNING J`dE PtdTSrf`_ Q41eRB laLEA! 9 LEGEND COUNTY SECTION CORNER MOUNIAMENT.�\ ALUMINUM CAP, FOUND. 2 3/8" IRON PIPE, FOUND. F AQ / / I R 1 /4 P I (UUNLF�� SE NOTED) - - - \ / / 0 1 5/8" z 24" IRON PIPE WEIGHING �0'I 3 2.27# /LINEAR FOOT SET. PLA T OF \ / _BUILDING SETBACK LINE 25 GLOI/ER STATION UNLESS OTHERWISE SHOWN. \ -x — XEXISTING FENCE. EXISTING 12' WIDE UTILITY EASEMENT *NOTE: ALL IRON PIPE (FOUND AS RECORDED ON THE PLAT OF GLOVER GLEN. OR SET) ARE DIMENSIONED AS OUTSIDE DIAMETER.* THIS INSTRUMENT DRAFTED BY JEROD A. FM PAGE 1 OF 2 Vo1.17 Page 4460 U 2 1 y y P 6 2 0 7 1 0046 f STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. NALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX Co., 1iI Document Number RECEIVED FOR RECORD This Deed, trade between TERRY E. PIRIUS 02/17/2003 03:10PK EXEMPT # RfiC FEE: 13. 00 Grantor. TRANS FEE: 270.00 and.--..--, JAME TODD ROWEKAMP AND SHANNA _- _ COPY FEE: LEIGH RO Husband and wif as Joint_ CERT COPY FEE; -- — -- PAGES: 2 Tenants - ----- -- - --- --- --....- --- --- - - -= -- - -..... ... . _._..__... Grantee. !� Grantor" for a valuable consideration" conveys and warrants to Grantee the following described real estate in ST CROIX County. State of Wisconsin: Recording Area Name and Return Addresa TERRY PIRI 400 SOUT SECOND SUITE 100 HUDSON I 54016 See attached A/00 S a • *Z3 ?35 . l I kJ son W 040 1042 95 000 I Parcel Identification Number 6414) This 1S nO tomestead property. !I (is) (is not) - I is t i f i Exceptions to warranties: easements restrictions and rights -of -way of ! record, if any. Dated this 6th day of November 2002 (SEAL) t '" (SEAL) l f » Ter P iriu s (SEAL) (SEAL) �1 AUTHENTICATION ACKNOWLEDGMENT - Signature(s) State of Wisconsin. IJ 59. St. Croix County. authenticated this day of Personally came before me this i th day of Nnuem1n4--r, 7007— , the above named j - Tt —ri7y, i ri is jey Have 1 TITLE: MEMBER STATE BAR OF WISCONSIN O ary to �! Of not, me known to be t 1SW the foregoing i authorized by 5706.06. Wis. Slats.) 1 rument and acknow edg�. �` 1 THIS INSTRUMENT WAS DRAFTED BY - rC Ij A(I ldd Joy Have Terry Pirius Hudson Wi 54016 Notary Public. State of Wisconsin 1! My commission Is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are riot 7 - 10 - 2005 ) �I necessary.) _ �i • Na,nes of smu sl nln m en ca ... .. .. !I P� °'� R R Y packy must be lytwnl or printed below their signawre. torn non nMv nr.cn STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. lnc. J 2 14 9 P 621 LEGAL DESCRIPTION Lot of Certified Survey Map filed February 12, 2003 in Vol. 17 of Certified Survey Maps, Page 4460, as Document No. 709370, Located in the SW1 /4 of the SE1/4 of Section 9 and the NW1 /4 of Of the NE 1 A of Section 16, all in T2 8N, R19W, Town of Troy, St. Croix County, Wisconsin, being all of Lots 1, 2, 3, and 7 of the Plat of Glover Glen. Wisconsin Department of Commerce SOIL EVALUATION REPORT / -3 I liviston of Safety and Buildings Page of In accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point IBM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Q EV , Please print all Information. 1 z: by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z� Property Owner Property Location Govt. Lot SA) 1/4 5 f- 1/4 S T Z N R .0 (or) W Property Owner's ddress Block # Sub d. o d. Name 3 9 9 N 6 /DU��' �� ' V o iV City Slate Zip Code Phone Number �/ G/ �/ �S Cit y Villa a Town �'/U9SO,J S p ❑ ❑ 9 ® Nearest Road y� ,sy� •� c ) Co 2 � y3 �,�a ��s � ,� New Construction Use: KI Residential / Number of bedrooms 3 " Code derived design flow rate ys0 — (p D D GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material �O 5' MEW ,.;�� 1 0 � l l�J>ff�1 Flood Plain elevation If applicable n. General comments ^ and recommendations: 1 [e�;Ell BCD VC �'`Q.Q "�' aS MAY 1 5 ? Boring ❑Boring q� D 20 g r ' �� 7 �d NI NG / ` OFF ICE ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Horizon Depth Dominant Color Redox Description Texture Structure Csis ence Boundary Roots on I Soil App GPD /il 2 Rate In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft #1 'EH#2 l o 7 �o y2 zl SL 2.wf s hk ily v�jt? cs �3 I , s 2 �o yie y/y GS 140 �1 I ,e s , Z + 3 2-2'3 ' o s s. D ,Q �. Z -+ r ��-� E Boring # ❑ Boring q Z >� Pit Ground surface elev. / ft. Depth to limiting factor U in. r6EIApplication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' In. . . Munsell Qu Sz Cont. Color / r7 • /- lgy� z3 Gr. Sz. Sh. 'Eft #1 `Eff#2 (� 5.(- 2M1s/ ` 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) Signature G�� CST Number Address � �4 3 7S Dale Evaluation Conducted Telephone Number 3 4PIP Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 ORIGINAL Gaff G /oo'R �il� S d y0 • .. __,�/) Property Owner W Parcel 1D # /D � - �� lJCJ `� Page 2 of 3 F 3 Boring # ❑ Boring Cj Pit Ground surface eiev. / 7 O fl. Depth to limiting factor 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 #t 'Elf#2 / 0 7 /0 ylf 2 /3 5 4- 2 nsf S 3 -z 7.20 /o ye i 1-s ,t��t C s .� ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 'EfI#2 Boring # ❑ Boring ❑ pit Ground surface elev. R. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /Ill In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #t = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L r The Department of Commerce is an equal opportunity service provider, sand 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. SAD -RJJO (R.6�M/) �- �lov�i2 Arley - Property Owner ^ Parcel ID # i(© - 106, . Page of Boring # ❑ Boring 5 Pit Ground surface elev. /' O It. Depth to limiting factor in. Soil Application Rale Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary . Roots GPD/ft: In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eft #1 Eff#2 ' 0-'7 10 L Y� S 2 /.3 s io S. D r wx ❑ Boring # ❑ Boring ❑ Pit Ground surface, elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /tt' In. Munsell Qu. Sz. Cont. Color Gr. Si. Sh. 'Eff #1 'Ef #2 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence @oundary Roots GPD /0 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#t 'Eff#2 EEE Effluent #t = SOD > 30 < 220 mg/1- and TSS >30 < M mg/l- ' Effluent #2 = BOD < 30 mg/- and TSS < 30 mg/- The Department of Commerce is an equal opportunity service provider, qnd 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. S(104330 (R AMM I 1 & p�sso��oasal\a f%ts �1btich 40wa Ft Rd' 54 018 Ws. p O F WU� Yk 5 9g , yD G�' 0 1311 T-5 _t 13/0 DiffvS �14 T D' � �pf to y'�, Sp r o . 1