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040-1279-30-000 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 572812 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: Bond, James E. & Sue I Troy, Town of 040-1279-30-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 17.28.19.1565 TANK INFORMATION ELEVATION DATA TYPE 4ANUFACTURER CAPACITY STATION BS HI FS ELEV. t/V Septic V 1 14 Benchmark Dosing Alt.BM Sew Aeration Bldg.Sewer a 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 BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL 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 I Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx DeDtWf xx Seeded/Sodded xx Mulched Bedrrrench Center Bedrrrench Edges Topsoil E] Yes Q No 0 Yes 0 No COMMENTS: (Include code discrepancies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 493 Omaha Road Hudson,WI 54016(NE 1/4 NE 1/4 17 T28N R19W) Eagle Bluff Lot 33 1- Parcel No: 17.28.19.1565 1.)Alt BM Description= �O"`' �"'� (e," 2.)Bldg sewer length= ���Irj ►d� DOS -amount of cover= l Plan revision Required? Yes No Use other side for additional information. I Date Insepct s Signa Cert.No. SBD-6710(R.3/97) 4, ti 3 o I h ~ O M 0. 0 d: I a o c y O Y N c a> o CL — — cyco 'O O�Vl C ZD Cf) c 0-3 7 N t6 tl L m R L C_ �. N ` N 7= y �m o 0 0 *k coEMZca MB 3,o o .� Nyoma� C Z O C y y N 0 LL c O N O E a N oo 'a y cD c �S//*A 'O U T M O TT Q !n M... y y 3 � Z LU E N Z O 5 Z �1 '° I CD w Fl z a m c (� v o Z c p. V O d Z Q v� ►- .- m a E Y N � .7 O y y � O N cn O Z m Z N d m O y d v 4 G d ?� D M M ' o w M n. 0 • aaa ►� o. U) J U 2 0 00 O 'O N N 0 00 fp 00 O_ M_ p ^ 0 Z O O o 0 0 a O .+--' O 'O E M N I t 3 p N m a o � a)N I E � 0 2 M •�i,• �_ Q A V3 N Ol M 7 \j O O Wn I C O O LO O r U d O O Coll co) (O VM J N c C a 0 0 0 0 C pj C C C d O M n N W N • o IT- y y /4 y t_6 U 7 co M 0 - O N N N C N p d N EO OU O Z Y d to w I a 3 .� L:CL _1 A 0 aa 0V) UO r County 4st Services Bivision . C '; 0$ 140 a Sanitary Permit Number(to be filled in by Co.) PS; N P.O.Box 7162 y G� OVN QM� Madison,WI 53707-7162 5-7 2—<' 17L 0 O 5�'\, nitary Permit Application State Transaction Number In accordance with 3.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit is required prior to dtrt wing a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15.04(1)(m),Slats. �3 J(� I 1i1 I. Application Information-Please Print All Information / (� IC Property Owner's'Name t)C_ Parcel# �Awlt /)�0- /_ Property Owners Mailing Address Property Location Govt.Lot City,State Zip Code Phone Number 1/E' /ti N C �/y Section-L7- t4vJT IS,*16 &51,338--7'�lj (circle one 11.Type of Building(check all that apply) ( T?�n N. e�—E oW Lot# J&or 2 Family Dwelling-Number of Bedrooms �� Subdivision Name El I Block#Public/Commercial-Describe Use 1fto�r h''C.0-f C ❑State Owned-Describe Use n M Number ❑Village of / i LIE Town ot` Ill.T.ppee of Permit: (Check ly one box on line A. Complete line B if applicable) A. ❑New Svstem ❑ Replacement System ❑Treatment/Holding Tank Replacement Only 00ther Modification to Existing System(explain) £ 7 B. ❑ Permit Renewal ❑ Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 4120&7,Z, 7a /7 LEX IV.rype of POV TS System/Component/Device; Check all that apply) ID/Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound?24 in.of suitable soil/❑Mound<24 in.of uitable soil /o (�IFwS67Z-66 6Utr/�a'ir>•tA b Ui (11111[3 ❑ Holding Tank El Other Dispersal Component(explain) tr nt w E(explam) V.Dis ersalfri-ea ent Area Information: Design Flow( Design Soil Application Rate(gpdsf) Dispersal Area Required(sf) Dispe I Area Proposed(s System Elevation f 660 . 7 8 o ?Y11,29 ✓ VI.Tank Info Capacity in Total #of Manufacturer Ga�/orrs Crayons urrks er y New Tanks Existing Tanks Y t l 2 0 2! �H 2 A is 6i Septic or Holding Tank 60 lv ffFf Dosing Chamber VIL Responsibility Statement-t the mWer*,ucd,assmw respansibili jtv for installation of the POWTS show on the attached plans. Plumber's Name(Print) Plumber's Sign re MPlMPRS Number Business Phone Number �s a� /I PFmber's Address(Street,City.State,Zip Code)CD.l 4,x Vill.Coun /De artmi llse Onl Approved =��Reason Perm1it Fene Date 1 sued Issuing t Signature for Den ial 1 $ IX.Condit"VAI;ONMMeasons for Disapproval 'f. 3eptie tank,etfltir;!nt Ater and" � ✓•` � �,` t dispersal cell must all be servleps/maintained 3) as per management plan provided by plumber. L_ 2 Ab selkac� fe4t*9mentt*must De maintained (/(/I,G{.v`•1��rti+a+v1 t�� Attach to complete plans for the system and submit to the County only on paper not less than a 112 x 1 I�inches in size ' �G�✓lr�� �ia�QVO SBD-6398(110313) Private Onsite Wastewater Treatment System Title and Index Page Project Name: rti S Owner's Name: y 13 M& A4 #Q 0 Owner's Address: f'L 1 S (n J-J-_ Legal Description: (V f- A)S E3 7 Municipality: Town, ❑Village, ❑ City of O County: S 1.CIO O N, Subdivision Name: y Lot Number: 3 3 Block Number: Parcel I.D.Number: -0,4 O l A79- 3 O 000 Page I Title and Index Page Page 2 a M I IC4�MAJ Page 3 Ml}T�v7Xc r9�/' ,•► Page 4 v Page 5 k2 Page 6 Pla4- P)"AJ Page 7 D L£ Page 8 "1'U A-LAf£.►?f,4 Page 9 Name of Designer: kr--f 1461tCe Telephone Number: — License Number: �Vj�.d yf�"9` Date: 10 Designed Pursuant To The Following POWTS Component Manuals And Comm 81-85 Page 1 of We �� �ol _�?! fl1l= . ......_ iii_ vu.aa�,.e,� IDZ,0 zil iq uc s3so a ��e 811A a -Ti�N��1 3x Viso . all �5� y PJPD 6firi� f � 0 r 93Y 78 OCT. 10. 2014 9: 19AM First Supply LLC NO. 8460 P. 1 Orenco, Technical Data • . 1B-inch External tim cent Filter Basin Applications General The 1 8-Inch(450-mm)Extemal Effluent Filter Basin provides an ideal Externai Effluent Filter Basins are composed of an 18-inch(450-mm) solution for retrofitting existing residential septic systems.External diameter section of ribbed PVC pipe with a fiberglass base,and an Filter Basins eliminate the need to make costly,and ofterr hazardous, 8-inch(200-mm)diameter BlotubeO Effluent Filter(U.S.Patents No. modifications to existing septic tanks with restrictive access openings 4439323 and 5492635), or to unusable outlet baffles or tees. Orenco Biotube Effluent Filters are used to improve the quality of efflu• ent exiting a septic tank.The Biotube cartridge has an extendible han- dle for easy removal.The FTBt 824 is designed to connect to 4-inch (100-mm)diameter schedule 40 PVC pipe,using a 4-Inch(100-mm) diameter grommet on the inlet side,and a 4-Inch(100-mm)diameter Schedule 40 PVC fitting that Is solvent-welded to the ribbed pipe for Grade ring Inset '�— — the discharge side, When connecting to 4-inch 000-mm)diameter 3034 pipe,order a Handle assembly 171`83034KIT,which contains an O-ring for the Inlet grommet,and an adapter coupling for the discharge outlet An 18-Inch(450-mm) diameter grade ring insert is supplied,but the riser and a fiberglass lid should be ordered separately to bring the basin up to grade. Vault Standard Models Influent holes FTB 1824-0812 BOON)filter FTB3034KIT--for connecting to 4-inch 000-mm)3034 pipe CaRfidge Product Code Diagram FTS 18 24 0812 Maf+erials of Constructions Filter cerondge height Fitter Basin, Ribbed PVC Pipe 12 = 12 Inches(300-mm) Filter Basin Bass: Fiberglass Reinforced Polyester Filter diameter. Biatube Enclosure: PVC 08 = 8 inches(200-mm) Basin height. Slotube Cartridge: Polypropylene and Polyettrylene 24 = 24 Inches(600-MM) Biotube Handle Components: Sch.40 PVC,Stainless Stwl Basin diameter Inlet Grommet: EPOM RuNer 18= 18 inches(450-mm) Olmharge Riling: PVC ErwtubO effluent finer basin Specifications Btotube Mesh Openings: Ndminal i/84rfch(3-mm)diameter, nominal 30%open area Ovoneo SydwsO Inc..014 Airway Ave.,Satheft,OR 97479 1118A•bU0.346-9643.541459.4"0•w RIPMO tee,com N111-FtY-MI OW.1.1.O NA4 PWtof1 OCT- 10- 2014 9:20AM First Supply LLC NO. 8460 P. 2 Orenco" 18-in. External Effluent Filter Basin Applicadons Standard Features&Benefits Orenco's 18-In.(457-mm)External Effluent Filter Basin,featuring patented'Biotube® Complete packaged kit Large filter area resists filter technology,is an ideal way to improve performance of existing residential septic ready to instal;reduces clogging and increases systems by reducing solids discharge to the drainfield.External Filter Basins eliminate cost and simplifies cleaning intervals the need W make costly,and sometimes hazardous,modifications to existing septic installation Easy to clean by slmM tanks with restrictive access openings or to unusable outlet baffles or tees. Removes approximately hosing off fitter car- two-thirds of suspended tridge6 solids,on average Corrosion-proof con- Flow control discharge struction ensures long orifices limit the flow lee rate feavr'ng the basin 1/8th-inch diameter Extendible cartridge holes reduce suspended handle simplifies filter solids by an average of Inspection 67% A Basin can be extended to match depth of exist- ing tank outlet ,I Biotube Filtering Process Effluent from the rela- Effluent then enters the tivefy clear zone of the annular space between septic tank,between the housing and the the scum and sludge Biotubes, utilizing the layers,exfis the tank entire surface for filter- via the tank's outlet ing,Particles larger assembly and enters than the mesh of the Blotube Effluent the Biotube are Filter through inlet holes prevented from Orsrrcog External Effluent Flier Basins am the best solution for ren tring existing in the filter housing, leaving the tank. nssiderrtial 8e*systems.The 841.(203•mry Awnefer Blotude°Filer'has almost 5 fir(0.5 0)of titter area,to resist clogging We pmvlding tWmum long-term pmro.-M. .caw W by 0.5,parent nruneera 5,492,635 and 4.439,825 To Order Call your nearest Orenco Systems*,Inc.Distrbutor.For nearest Distributor,call Orenco" Orenco at 800.348.9843,or visit www.orenco.com and click on"Whore to Buy." Orencv Systems°,incorporated a oh AM-M-1 Drones system*Inc.,014 Airway Ave.,S01a10%on 57471 USA My,14 O 11/13 641-4&4".www.oro W'COm ftp1 OCT- 10, 2014 9:20AM First Supply LLC NO. 6460 P. 3 Orenca 18-in. Wernal Eft/lient Filter Basin 6. Model Codes for Ordering Effluent Filter Basin with Extension to Grade 18-in. External Effluent Filter Basin Lid FTB 18 24 08 12 f '' (ordered separately) 1W Mimi*h*hr 12"w mO 81110d" hr Tdlamete.8"(203 mm)sward Wn helft 24"(810 mnd slandud Bann alameur,18"(457 mm)dtanfrd r Riser eialuDeeBkientAherbesln �� �� (ordered separately) 9,b91f�'� Handle assembly (extensions fu. : , not included) 4 e A rt�W Grade ring insert i ~' (included with 24-inch tall basins) Vault Influent holes Biotube"filter cartridge Distributed By: APS-ml omme SysUnO be..014 Akwey Ave.,Soft lln.OR 17478 USA R"1.8 O 11/13 6*04 4W 9 541-459-4449•www.orwwxem Pop 836779 �/ KATHLEEN H. WALSH State Bar of Wisconsin Form 6-2003 REGISTER OF DEEDS ST. GROIX CO., MI SPECIAL WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 10/17/20% 10:15AN WARRANTY DEED EXEMPT # THIS DEED,made between First State Bank and Trust REC FEE: 11.00 TRANS FEE: 1590.00 COPY FEE: ("Grantor,"whether one or more),and CC FEE: James E Bond and Sue A.Bond husband and wife 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 St. Name and Return Address Croix County,State of Wisconsin("Property")(if more space is needed,please attach Rover VaIiQV Al?^trPGt TlflP 111C.J addendum): Lot 33,Plat of Eagle Bluff in the Town of Troy,St.Croix County,Wisconsin. BOX 149 WI 5 4 0 16-0149 040-1279-30-000 Parcel Identification Number(PIN) 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 arising by,through,or under Grantor,except: Dated (SEAL) (SEAL) * *First State Bank and Trust BY: W - President (SEAL) (SEAL) * s AUTHENTI CA N ,�\�G ACKNOWLEDGMENT Signature(s) _ authenticated on n'�`a t'�=G STA OF p� ) b� )ss. COUNTY TITLE:MEMBER STATE BAR OF WISCONSIN Personally came before me on (If not, the above-named First State Bank and Trust authorized by Wis.Stat. §706.06) BY: Peter J. Clements ITS: president THIS INSTRUMENT DRAFTED BY: t e own to b the persons) who executed the foregoing i ac e e t sam Attorney Kristina 021and Hudson,WI 54016 Not ry Public State of 1J My Commissi n(is permanent)(expires:\1-7-L 1 (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. SPECIAL WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NO.6-2003 Rpe name below signatures. INFO-PROTM Legal Forms 800-855-2021 www.infoproforms.com ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Z� f S S611-r-1 Mailing Address II 0/4 A 14 A RC Property Address (Verification required from Planning&Zoning Department for new construction.) City/State A JdSvN Parcel Identification Number QLJQ 000 LEGAL DESCRIPTION Property Location Nt- '/4 , NF '/4, Sec. I T v?S N R W,Town of 3WOX Subdivision Plat: R /r R u F , Lot# �3 . Certified Survey Map# ,Volume ,Page# Warranty Deed# ' 3(o_77q (before 2007)Volume , Page# 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§SPS.383.52(1)and in Chapter 12 of the 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. Uwe,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 Safety And Professional Services 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. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above,by virtue of tarranty deed recorded in Register of Deeds Office. Number of bedrooms y �2� bzk'� ID //49 SIGNATURE OF APPLICANT(S) 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.04/12) II IIIIIIIIIIIlIIIIIIIIIIIIIIIII 8262122 Document Number Document Title Tx:4214221 St. Croix County 1002787 AEROBIC TREATMENT UNIT(ATU) BETH PABST SERVICING AGREEMENT REGISTER OF DEEDS ST. CROIX CO., WI tate Plan Trans ction Number- RECEIVED FOR RECORD V 10/10/2014 3:57 PM Name—(Owner)Typed or printed EXEMPT #: Being duly sworn,states,under oath,that: REC FEE: 30.00 He/she is the owner/part owner of the following parcel of land located in PAGES: 1 St.Croix County,Wis n I ecorded in Volume Page Document Number St.Croix County Register of Deeds Office: Rewrdin Area A I of land I din the '/.of the '/4 of Section 7 N e and R d T N—R W.Town of St.Croix � 6 County,Wisconsin,being duly described as tb ows(include lot no.and 1�✓ Omaha Rd. subdivisiott/CSM or detailed legal description): HofParcel IdeAtiftwiton Nu (PIN) Agreement Date: l01 ) l As an inducement to the county to issue a sanitary pennit for a POWTS equipped with an Aerobic Treatment Unit on the above-described property, we agree to do the following: 1. Owner agrees to conform to all applicable requirements of SPS 363,Wis.Adm.Code relating to Aerobic Treatment Units(ATU)and the maintenance requirements for the proposed POWTS(Private Onstle Wastewater Treatment System)technology. If the owner fails to have the POWTS end ATU property serviced in response to orders Issued by the governmental unit or the Department of Safety&Professional Services(DSPS) to prevent or abate a human health hazard as described in s.254.59.Stats.,the governmental unit(St.Croix County)may enter upon the property and service the tank or cause to have the tank to be serviced and charge the owner by placing the charges on the tax bill as a special assessment for current services rendered. The charges will be assessed as prescribed by s.66.0703,Stela. 2. The owner agrees to maintain a contract with a Ikensed POWTS maintainer for the life of the system.The POWTS maintainer VA perform periodic inspections and maintenance as required by the manufacturer and the DSPS,including,but not limited to:the blower,electrical controls,and treatment unit operation and sludge depth.These Inspections are to be scheduled every 6 months for the first two years of operation and yearly thereafter. 3. The owner agrees to contact the POWTS maintainer immediately upon any malfunction of the treatment unit and to maintain the unit to as to not create a human health hazard as described In a.254.59,Slats. 4. The owner recognizes that the county.DSPS,or POWTS maintalner may make periodic inspections of the components to complete performance monitoring of the unit. 5. The owner or the owner's agent agrees to report to the department or designated agent at the completion of each inspection,maintenance or servicing event in a manner specified by the department or designated agent within 10 business days from the date of Inspection, maintenance or servicing. 6. This agreement will remain In effect only until the county office responsible for the regulation of POWTS certifies that the aerobic treatment unit no longer serves the property. In addition,this agreement may be cancelled by executing and recording said certification with reference to this agreement in such manner which will permit the existence of the certification to be determined by reference to the property. 7. This agreement shag be binding upon the owner,the heirs of the owner,and assignees of the owner. The owner shag submit this agreement to the Register of Deeds,and the agreement shag be recorded In a manner that will permit the exstence of the agreement to be determined by reference to the property where the Aerobic Treatment Unit is Installed. Own Names)-Please Print Subscribed awom to before me on this date: �e d o/ N Owners Signs re(s) No blic 111/� Governmental Unit NW'Ti0"fti*aV'Ti0 ....M ��''''. My Commis *ITres Governmental Unit Olfi ro Drafted by. Perssnal in anon you for secondary purposes lPrtvacy Law s.15.04(1xm)) N�, PU �,�►/•0 OF ��`• " "THIS PAGE IS PART OF THIS LEGAL DOCUMENT—DO NOT REMOVE" This infomhation must be completed by submitter document bite named return address.and PI (if required). Otherinformabon such as the granting douses,legal description,etc may be placed on this first page of the document or may be placed on additional pages of the document.&&Use of this cover page adds one page to your document and,1Z.00 to the racon*W fee. Moconsin Statutes,59.517. St.Croix County H&H PLUMBING, LLC 200 Bremer Avenue,Suite D PC Box 10 Colfax,WI 54730 Ph.(715)962-4155 Fax(715)962-4156 Email:handhplumbing.colfaxwi6a gmail.com October 10,2014 TO: Ryan Yarrington—St. Croix County Zoning FROM: Kent(Sid)Hoke, MP#224199 RE: 493 Omaha Rd,Hudson WI 54016 Ryan, Please be advised that H&H Plumbing, LLC will inspect& service the White Knight Pre- treatment system,every 6 months or as needed, at the above mentioned property. This service agreement is valid for 2 years from date of installation. Any questions, feel free to give me a call at 715-556-7621. Sincerely, Kent Hoke Owner/Partner e RT DIVISION OF INDUSTRY SERVICES A M Plumbing Product Review 025 ( s P.O.Box 2658 s `` J Madison,Wisconsin 53701-2658 y TTY:Contact Through Relay 9 Scott Walker,Governor O�FsSION Dave Ross,Secretary October 29, 2013 KNIGHT TREATMENT SYSTEMS MARK C NOGA, PRES. 281 COUNTY ROUTE 51A OSW EGO NY 13126 Re: Description: CHEMICAL OR PHYSICAL RESTORATION FOR POWTS Manufacturer: KNIGHT TREATMENT SYSTEMS Product Name: WHITE KNIGHT MICROBIAL INOCULATOR/GENERATOR Model Number(s): WK-40,WK-78,WK-150 AND WK-200 Product File No: 20130302 The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance with chapters SPS 382 through 384,Wisconsin Administrative Code, and Chapters 145 and 160,Wisconsin Statutes. The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of October 2018. This approval supersedes the approval issued on 10/02/2008 under product file number 20080513. This approval is contingent upon compliance with the following stipulation(s): • This product must be utilized in accordance with the manufacturer's printed installation instructions and this product approval. If there is a conflict between the manufacturer's installation instructions and the product approval,the product approval requirements will take precedence. • The elevation of the system's infiltrative surface must be above the estimated highest groundwater elevation or bedrock by the distance prescribed in column entitled "Fecal Coliform>10000 cfu/100 ml"in Table SIPS 383.44- 3,Wis. Adm. Code. • A copy of this approval letter and the manufacturer's printed installation instructions must be supplied to the buyer of this product. • The outlet baffle of the septic tank,which has this product installed, must have installed an effluent filter capable of filtering particles of 1/8 inch in size or larger. • This product must be installed by a properly licensed plumber. • A state Sanitary Permit must be obtained when this product is installed. • The IOS-500 inoculant must be exchanged at least on an annual basis. • This product is approved to be installed in existing and new treatment tanks to rejuvenate failing soil dispersal areas. The product may be installed in single or two compartment tanks. . The product may be installed in the second compartment of a septic tank;preference is to have the product placed in the main compartment or inlet side of a two compartment tank. . To promote having an area of quiescence and that of settling in a single compartment tank, locating the product off center--towards the inlet side of the tank-- is the preferred procedure. SBD-10564-E(N.10/97) File Ref:13030201.DOC KNIGHT TREATMENT SYSTEMS Page 2 October 29, 2013 Product File No: 20130302 • For installations where the access opening is not directly above the desired product location within the tank, a standard installation practice involves the use of a flexible air line between the air supply's riser entry point and product; in some installations to existing tanks, access modification may be needed. The department is in no way endorsing this product or any advertising, and is not responsible for any situation which may result from its use. Sincerely, Glen Jones, M.S. POWTS Product Reviewer phone: (608) 267-5265 fax: (608)267-9723 email:glen.jones @wi.gov Wisconsin De p artment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 420622 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: Coleman, Larry Troy Township 040 - 1279 -30 -000 CST BM Elev; Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ' ! , Qa � a Benchmark L Dosing W / Alt. BM Aeration — — Bldg. Seer Holding St/Ht Inlet 3- 9s i.3 TANK SETBACK INFORMATION St/Ht Outlet ! 3• (r� 9�f - TANK TO P/L WELL BLDG. Vent to Air I take ROAD Dt Inlet ,\ Septic ^ t /) f - Dt B om Dosing p(t _ eader/M n. Aeration Dist. Pipe o �� •,�� Holding Bot. System I / - I I • J Final Ppde PUMP /SIPHON INFORMATION s� 1 er 2 ?) Manufacturer mand ver GP ---- a•� 2 f a' 2 5 A ;_ Model Number T • 1�• , o qz q z TDH Lift on Loss System Head TDH Ft Force? Length Dia. SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length 1 No. Of Trenches PIT DIM ONS No. Of P Inside Dia. Liquid Depth DIMENSIONS t' -1 SETBACK SYSTEM TO 1 P!L BLDG IWELL LAKE/STREAM LEACHING Maoft tgrer: it INFORMATION CHAMBER O P r o ✓t—� Type Of System: ' �� UNIT Model Number: DISTRIBUTION SYSTEM j Header Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intap �� Pipe(s) o �_ ``� Length_ Di- Length D Di a Spacing �— / t SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only oil d r' ?MW Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bedti rench Center BedlTrench Ed es To soil g p 0 Yes [] No [IN] Yes No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: AD /U Inspection #2: ! / Location: 493 Omaha Road Hudson, WI 54016 (NE 1/4 NE 114 17 T28N F19 EAGLE BLUFF Ldt Parcel No: 17.28.19.1565 1.) Alt BM Description 2.) Bldg sewer length /S`� - amount of cover = ! Kr - - DoT 3 Plan revision Required? ;? Yes /No D "t' 6 � - Use other side for additional information. 1_ �� J SBO -6710 (R.3197) Date r/�� Insepctor's ignature n CAS B ' s Sanitary Permit Application 201 W. Washington Ave. Nvisconsi In accord with Comm 83.21, Wis. Adm. Code PO Box 7302 Department of commerce Personal information you provide maybe used for secondary purposes Madison, WI 53707 -7302 (Submit completed form to county if not [Privacy Law, s. 15.114 ( 1 )( m )) 3K/ K,- state owned. Attach com lete tans to the count co only) for the system on r not less than 8 -1/2 x I I inches in size. County C r0+ State anitary Permit ❑ Check if revision to previous application State Plan I. D. Number I. Application Information - Please Print all Information Location: CG Propert Owner Name .. � Property Location I � A C6jernpm C�I PMp� Qar,,� N 1J4NE {/4 S I7 �$ Property Owner's ailing Address T ,N R 9 or W Lot Number ✓ Block Number '7l� 3� e t � ST 3 3 111 A , city, tote Zip Code FiCE Subdivision Name or CSM Number /U ��5 - �A L BILtIff II Type of Bui ding: (check one) 0 City J21 . I or 2 Family Dwelling -No. of Bedrooms: ❑ Village 13 Public/Commercial (describe use): 5 Town o 0 State -owned - -- - 2 V III Type of Permit: only one box on line A. Check box on line B if applicable) Nearest Road �ltu/�SV _alb �lrlA�la A) I ' 6b New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Num er(s) lt7 . System Tank Only Existing System - ' D B ) ❑ A Permit was previously Permit Number issued Date Issued IV. Type of POWT System: (Check all that apply) �;,7 - }j&-puc- �j i c i$Non- pressurized !n- ground 0 Mound ❑ Sand Filter ❑ Constructed Wetland maize In-ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line j ❑ At -grade ❑ Aerobic Treatment Unit = _0 Recirculating ❑ Oth V Dis ersaUTreatment Area Information: 1. Design Flow (gpd) 2. DispersalAres 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required Proposed Rate (Gals. /day /sq .) (Min. /inch) Elevation 87 U $ 3 y. - 7 8 z �38.7g VI Tank Capacity in Total # of Manufa er Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks �} Con- Con- glass New Existing `t/f� ^ � l Crete structed 'ranks Tanks sop ❑ ❑ ❑ _ 0 - -- 0 ❑ ❑ VII Responsibility Statement I the undeni ned assume res onsibilit for F q(fei( lation of tfie POW7'S shown on the attached laps. Plumbers Name (print) Plumber's tt0 ); MP/MPRS No. Bmikiiss Phone Number ,Tri ��kM -(\ 12 a �a9 a`I `� Is�7c,v- of Plumber's Address (Street, City, State, Zip Cod _ o10 w 3S L ns o N �,..� C• VIII County lDepartmen se Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued uing Ag Signature s) Approved ❑Owner Given Initial Adverse Surehirge Fee) 1` 2 2 5 1 o-- / Determination "7 a �% i% IX. Conditions of Approval /Reasons for Disapproval: a�v�c 2. Scl�d e- 07 - 2 s e10,V. 9 mod/ f va e L r � - a 4� c ,� � - i� tu , Y,f e�f�at �,�, Pef�P 24 �o -m�,�. �'3,'`�3 —/ � /rtl /��'�lAl2 �J f u•kt _5 , cl e id/ ncl e rs BIIA -Mb B O rv? 6 'g � 1 a 33A a - Tkp N C ►mot .� 3x INA i �mQ t1l� Cotzo — t oo�� t - 1 o t / r/ p , ,kz _5 ,. d e- uJi nine r,5; ---------- 7 7 ) z - 0 -T /- I I /I (333A a - Tr�►� C� s G►�p h p �o 93Y - 78 l oo� ul ro .g Evm _ � U m S'IK� s 3 � a o d O N ►� in tz - Fi LU -0 v �i tt N -C d x M o _ -- ...- ...... �.,, rn 5 a rn = C y Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of Division of Safety.and Buildings , in accordance with Comm 85 Wis. Adm. Code � County g'(', CK_01x Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must /1 / Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 'I 3 K� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. U - I QU(J Please print all information eview by Date Personal information you provide maybe used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). G(,!^j�y. f a 7 0 Property Owner Property Location- AJC 1 /4A)E 1/4 S ('7 T 28 N R 19 WW Property Owners Mailing Address Block # Subd. Name or CSM# W OO A6G r✓IrIJ 5V. NE 3u1T 100 q c�ity City State Zip Code Phone Number ❑ Village RI Town Nearest Road B1.AWe I IAA t4 ( ) 57 -756 T"z "( - OWA152 LL" RO. ® New Construction Use: ® Residential / Number of bedrooms _L_ Code derived design flow rate (o 0 - GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 5AAI.D5T )nfE Flood Plain elevation if applicable M X General comments 2- - T2e 1 G14 rz S and recommendations: S �cLtr� - t10N �}, 7 S� / L � Vt l � i `s i ` 1 COUN?y f ` Boring ZON!NG OFFI ® Boring # CE pit Ground surface elev. 3g,7 S ft. Depth to limiting factor > in. Soil A lira ' te Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary is ' i . �GPD1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#2 I 0 - 7 )0 2 )2 - — { 3 � - d.s GS 3 -k . 5 0,S Z 'r - 22 D Y 3 ' SI { Z SbK 5 3 2Z- 3 5 r I 2 �A 5 zd - o 0,� y 2A 7<9 1 3 /y 2rm 2 0.5 0. B6 S 1 rn o W 1 0,7 1,2 1 5(� 7 bb' 4 tans r 0.w t F.►, 0 t, 2 16Ud 711-4 ❑ Bo nn�c sJb — 5 O�6 vrnl 0,1. t z. Boring# ®Pit Ground surface elev. '.�� 11 ft. Depth to limiting factor 7 QS in. Soil A tication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ffz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 `k 1 0 -4 i0924 1 3 -1 r ds ab 3Jf 0.5 0.(0 L 4 - IZ 10V '3 t sb1C C s 2�� r,n AZ 0,3 3 It - ID 0 5th S 24 0- S O.. 4 ZI 7.5'16 5 msbl d 5 is q 0,"7 I, Z 5 4159 7.3YR 4 1 Im / mi ab I a I b 5Q - 7.5Y2yI S OS mti a-b 1f -m 0.1 I,Z b"i -`1 10 51 m 1 — — 0 t Z Effluent #1 = SOD > 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) nature jj CST Number M 'A1'- "k- W'F Address Date Evaluation Conducted Telephone Number ti1QB75' O& 2\U!✓ F k-3T S`(O2L Z IO -2$-00 715 ?ln-Il ?S Property Owner ('O CV%ACL- -- Parcel ID# __ Page Z of F-cl Boring # �❑,t Boring ►Z pit Ground surface elev. _ 3g. 9 ft. Depth to limiting factor 7' 9b in. Soil Application Rate Horizon Depth Dominant Color Redox Des Texture Structure Consistence Boundary Roots GPD/W in. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 O -3 0 t2 -1Z. — a ab 3 lo.-2b -5w,14 -` i ! 7-f sb U3 2 Ln 0.5 $ Y2 IS 0 ml Gtr I -1'-m 1,2 5 71 Y kq 1 1 C7p,t 9L NU- MOYUzuA rr t, Boring # ❑ Boring F — i ) ] 6d pit Ground surface elev. �t'�� 7 ft. Depth to limiting factor q Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fP In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I p - 10 YV 2-12 -m ar CL5 ab 3.4 F 0 - 5 - 0.6 Z -111 313 s) 1 K ds 2� ,z 0,3 3 11 I0 4 R4/ O.S o.8 Ll I O Y r2 44 b y z 3� a �r 0.7- 3 5 34 -N5 ►Uy ( aO oa RZ b Ioyrzy -- 5 M 1 4 F rn 0, %.Z 1 rot .� F-1 Boring # ❑ Boring — ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 ' Effluent #1 = BOD > 30:S 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 fonnat, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. S80.8330 (R.6=) PLOf PLAN pt?O��t;1Y OWN�t;: Do K CHA - ES Ot-�eNt N1°, "t ,A.[� VCAM7: I .i T 33 Erb G Le A LU FF (3M UWATED w -Rte F ti r) - P o sEC Q. T ' 2 - qN , ► v 3 y S PIA E i i'R N E I—]` 501L PRING W/ PACM NO COMM 65 %IDPCK FROMM � g ; t f � 1� x Qy k 6, mo f . 51CAW Gr ZZid�3 PATS: 1 -2 PAGe '4 OF 4 Co) , moLkK woes FOR LOTS f EAGLE I LWLFF %kA%ID. 4 10 - - - - - - - - - - - -- /- - 7 / , y 34 B-34D tj 04- 33A 8- 33D -34F Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity in- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number d O (o Z 2 Number of Bedrooms Design Flow - Peak ( pd) 4 Estimated Flow - Average ( pd) 3 N Septic Tank Capacity (gal) I ab0 Soil Absorption Component Size (ft 1 870 Type of Wastewater Domestic Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak ( pd) (, U v $7 b Maximum Influent Particle Size (in) 1/8 Maximum BOD (m /L ) 220 Maximum TSS (m /L) s e 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. if the h Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or Impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely within below the limits of reliable maintenance, and system use h or operation. Good water p conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep - rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. When system fails, we will replace with another system at owner's expense. Alternate area must be left undisturbed, St Croix Count Zoning Office 386 -4680 g Boumeester & Sons Excavating 386 -9020 Tri- County Sanitation 386 -2130 3 S'I' CROtX COUNTY Sf3PTiC TANK MAINTeNANCP. AGREEMENT AND / OWNERSHIP CBRTIFICA'CION FORM Owner/Buyer L, a l Mailing Address ^1 tll' Property Address" , (Verification required from Planning Department for new construction) -54vvC--- City /State ___ Lc G� Q O W, i Parcel Identification Number D it�EGA , DES ON Property Location &-� r / Sec. /� , 'CN -RW, 'Town of Subdivision C..Gf Ie, , Lot N �..�' Certified Survey Map # Volume , Page # Warranty Deed # `_ EC��,�1, . Volume ► Page # �- (pec house (ye no Lot lines identifiable D yes C] no 'mProPa use and m*Wewmceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pamplag out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the AwWon of the septic tank as a treatment stage in the waste disposal system. TU PAY owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a iu 0 erplambetr, jourmeymtusplumber, restrictedplumber or a licensed pumper verifying that (I) the on -site wastewaterdbgK0el system PrnP� operathxg condition tmdlor (2) in" o[ a it ecNon and pumping (if necessary). the septic tank is less din a U3,i a dadlge• Uwe, the undersigned have read the abov ` / s w0 i „and agree to maintain the private sewage disposal mtaadardm set forthk herein, a met by the Departrment mW the Department of Natural Resources, State of 1Almcoar6% C�erNttctrtioo stating flat YM septic system ha been me twtrst be completed and returned to the St. Croix County Zoning Oft025m witbM 20 days of three year exp date. R APPLICANT DATB OWNER I (we) certify that all statements on ; tits, fotrp are true to the best of my (our) knowledge. I (we) am (are) We owner(s) of the Ply described above, irhre of a,warrauty deed recorded in Register of Deeds 01tice. I OF APPLICANT 4LL�1 -. is 1' DATB Any information that Is mis - repr �paay mutt in the sanitary permit being revoked by the Zoning t. •• +• +« Include with this ippilcatlon: a stamped deed from the Register of Deeds office 0 copy of due eertifled survey map if reference is made in the warranty deed 2078' 295 STATE BAR OF WISCONSIN FORM 1 - 1998 WARRANTY DEED DOct trot Number This Deed made bet—,, _ -- Troy Development Corporation, a t4lnnesota C orporation_ - _ — Grantor. 7� 0 1 6 and Larry A. and Suz anne M. Coleman _��___ KATHLEEN H. MALSH REGISTER OF DEEDS — ST. CROIX co_ yI Crantor. for a valuablo consideration, conveys to Grantee the I'ullowing RECEIVED FOR RECORD described real estate In St. Croix _ County. State or Wisconsin (the 'Pry _, 12/12/2002 09:50AM Name 8nd Fision Address EXEMPT # CL� 33 of the Plat of Eagle E�luff in the Town of St Croix County, taisconsin. Larry & Swrihioleman 11,00 Subject to Declarations of Covenants, Conditions and 2525 Corn w:i #Q69.70 Restrictions for Eagle Bluff, recorded in Vol. 1589 Woodbury, P Page 516 , as Doc. No. 638946 , as appearing in the office of the Register. of Deeds for St. Croix County, Ilisconsin, and such other easements, 040- 1279 -30 -0 restrictions and reservations of record, or in use, PacdldenurcatmNUmbe wiN) and the "Buyer" obligations contained in the is not Purchase Agreement for. this lot. This homestead property. (Is) (is not) Together with all appurtenant rights. title and Interests. Grantor warrants that (lie title to the Property is good, indcfcasible in fee sinytle and rice and clear of encumbrance> except Dated this 12th day of November 2002 J C�b�o�K (SEAL) (SEAL) Charles S. Cook, President Troy revelopment Corporation (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT signature {s) Minnesota State of WHeen :kr, ss. Anoka _ co}apty. authenticated this day of Personal) carne before me this 11 LL LL day of November 00 - � - the above named Charles S. Cook, President Troy Development Corporation TITLE, MEMBER STATE BAR OF WISCONSIN to (If not, me known to be the person who executed the foregoing authorized by §706.06, Wis Slats.) i- wrument and acknowl the same. THIS INSTRUMENT WAS DRAFTED BY C��u�C� • IYI/( Troy Development Co) paration _ Rick J o h n s o n Notary Public, 4- a-alyd w-an Anoka County, Hinn. Charles S. Cook, President My commission is permanent. (If not, state expiradnn date: (Signatures may be authenticated or acknowledged. Both are not January 31 , 2006 ,) nn�nssary.) v„a e,p•,.,,4„ iry..q» viii•,, i„„tr111kd„w lliui a,xiw , WARRANTY DEED STATE BAR OF WISCONSIN w,aoosn L.Vr 91-k CO, nc. FORM No. I - 1098 ■ RICK A. JOHNSON N0VX PUBUC MY COMMISSION EXPIRES JANUARY 31, 2009 ■ t a t�I \I V S f� lJ I f P M, r- .trY COOK rw tt t.ES L GCW. 0 C g-I CAr— 6l U FF f'�i7 U12FAC Z- O u7 � �F P E 1rJ SreEE 1` " it 6 ou y W O N s l e 5011, POMNG W/ PACM NO COMM 83 %lDPGK FROMM DoT � Ar 4yo3o BM � � o E�- q 39 • Z � �i'S1o.y a S1GN�n CSr .T �0 2 2-49 3 V AT: 10 -� 00 Ir— ,MU.�S Parcel ID# Page Z., of Boring # J A pit Ground surface elev. ft. Depth to limiting factor In• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots "E GPD/fPEff#2 ✓ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I 0-14 z 1 ? ,,,� d5 S 4-f 0-5 a.® 2 t,{-f2 3 Z i 1V -►,sb J5 5 34F O - 0•6 3 12 l� OY 5tl Z-F�otb m 11" C5 Zd m 0.5 0.8 4 1 - 1 - 26v 4 � 5�� 3fabK CS 2 rn 0 -5 O,S 5 71,4 3 _ (S M M Y 2-f -m 0• 1 -Z 40 -4 Ya 3 s► lrnsb rn Tr 1v -m o,ti o.b 7 YS -57 7.5`f S1 m5b m Gt.u� 14 -m 0 1.7- F Boring # E] Boring o l &wi) tR Pit Ground surface elev. gate- 50 ft. Depth to limiting factor 7 g in• Si ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots "EGPD/ffEff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, (s i s rA A 0. vJ 1 m 0 11 I. Z F C] Boring Boring # Ground surface elev. 36L Z ft. Depth to limiting factor 1 108 in. y� Pit Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots "Eff#1 Eff#2 In, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ' 0 -3 %49. -M 1 ti T-3� s o b 3•t� CIA 0 2 3 3 Stl I F c� b d sh 3ll _V 0.3 n D� z- 3 -ZO 0 .3 50 z bK Cs �� - o•5 O.g 4 -30 10 Y 3 S` Z -M O-b S S 2v m 0- 0 5 - JO`f23 15 4L - 7.5 3 I Y dl t�_ o - 1. 52- 1511KLA Is , r dl afa — 011 l -2 g 7L --t04 10+4+2 5 dl o. ►, z • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent A2 = BOD < 30 mg/L and TSS <_ 30 mglL 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. SBO -8330 (RAW) SKETCH PLAN for A ROAD COLEMAN HOMES, INC. OMAH q n /' y rn 1 32.00 0 — y N � 8 . 0 4'00 E — — — 130 �5a °— — unU E PI SE I S 1, ` Sca /e: 1 " = 30' Bearings are assumed 1 � O Denotes Wood Stake Set ` For Excavation Only Q Denotes Surface Drainage / 1 1�1 f ( ) Denotes Proposed Elevation q f 1 Con e� x Denotes Ex/sting Elevation 6 oSs - Q G � 964.4 Top of Block Elevation 1 964. 960 1 ; � , 0 Gara floor Elevation 956.3 lowest Floor Elevation 2� 87 stoop N Type of Bu!lding: A Wood Frame House ` 7 87 d ALL BUILDING DIMENSIONS 9se (garage) ,7 8 6 7 � 87 ° AND FLOOR ELEVATIONS MUST o BE VERIFIED BY BUILDER. Proposed n'1 House ELEVATION AND LOCATION TO 7- w (956.3) a ,( q59 BE FIELD STAKED BY BUILDER. 9f6 � 1 Porch rl \ l t A ROD - r 9S o = R, WO \� C Coon R 1 ••. ►C..�'X�s�irs t G �, PIA .� !_ w 0 0 0 0 33 'g4a o " 00 S78� 0j Lot 33, r . EAGLE BLUFF, St. Croix County, Wisconsin. l hereby certlfy that this survey, plan or report was prepared by me or under my direct supervision and that l MIDWEST am a duly registered Land Surveyor under the laws of the State of Msconsln. and Land Surveyors & Civil Engineers, Inc. No certification whatsoever is extended to subsequent owners, mortgagees or title Insurers, unless this surrey 710 has been redated for this purpose by the surveyor. A Mn. 55303 East River Road Dated 5th do of December 2002 Ph. 763 712 - 9099 Fox: 763 - 712 - 9055 g e y � =�*��✓ - ate Reglstrotlon No. S - 1yQ Job No. 02 - 334 Book — Page DCF Aeod File 02 - 334 Rodney H. Halvorson — Wscons/n Registered Land Surveyor ©2002 — Midwest Land Surveyors d• OW Engineers, Inc. — All Rights Reserved Asbullt Dated this day of 20