Loading...
HomeMy WebLinkAbout040-1279-90-000 .)nsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Ay and Buildg Division INSPECTION REPORT Sanitary Permit No: 515060 0 GERE6L (ATTACH TO PERMIT) INFORMATION S tate 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: Sultan, Colin Troy, Town of 040 - 1279 -90 -000 CST BM Elev: Insp. BM Elev: BM Descriptio Sectionrrown /Range /Map No: / ,9' U V I •A m / 17.28.19.1571 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic f Benchmark Dosing Alt. BM Aeration r Bldg. Sewer 3t/ -tr )A � r n7 Holding S t Inlet ? TANK SETBACK INFORMATION outlet 6,. �D S .� C <, - TANK TO P/L WELL BLDG. Vent to Air Intake ROAD n 1 t Septic / r /Man. Dosing Head ,:` y Aeration . Dist. Pipe Holding B ot. y stem 3 DO S Final Grade 11 n PUMP /SIPHON INFORMATION U n c -ft; n ^ 7F Manufacturer /b f /,f OP GF nand St ver / ( C tx_ L ; c� Q Model Number TDH Lift Friction Loss Systerp ( � ^ Head TDH Ft Forcemain Length Dia. q Dist. to Well 1 SOIL ABSORPTION SYSTEM BED /TRENCH Width Q Length No. Of Trenches PIT DIMEN NS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS D f SETBACK SYSTEM TO P/L BL� W LAKE /STREAM LEACHING Manufacturer: INFORMATION HAMS System: Typ ' h � ' / / IT Model Nu er. DISTRIBUTION SYSTEM v ! 4 tfb Head ani q Distribution f�� _ n LHole i ze x Hole Sp acing Vent to Air I ake ' Dia Vy Length 1 Dia . v / � / 2 47r Length > Spacing I SOIL COVER x Pressure Systems Only x Mound Or t - Grade Systems Only Z Depth Over Depth Over qxx Depth of xx ded C xx Mul d '{ Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No 60 l� / _ COMMENTS (Include code discrepencies, persons present, etc.) nspection #1: 7// , 3 /o ;�' s cti0n #2: Location: 479 Omaha Road Hudson, WI 54016 (NE 1/4 NE 1/4 17 T28N R19W) Eagle Bluff ,L',ott -i9 / ^�y�Parcel No: 17.28.19.1 �1x - 1.) Alt BM Description � Z r l �t l S. j�1 Z ' v 1 � _ Led r 2.) Bldg sewer length = 24 � f� Pk , & kt - amount of cover = �k ( � f� r w . vision Required? ❑ Yes No °de for additional information. - Date Insepctor's Signature Cert. No. 3/97) r t commerce .wi.gov Safety and Buildings Division County 0 201 W. Washington Ave., P.O. Box 7162 St. Croix i sco n s i n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce 5/5 0 4p o State Sanitary Permit Application 1663233 Trans action Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for second 479 Omaha Road purp oses in accordance with the Privacy Law, s. 15.04 1 m , Slats. I. Application Information — Ple ri 1 Informs Property Owner's Name L/ Parcel # 040 - 1279 -90 -000 Colin A. & Mir'am A. Sultan 7 Property Owner's Mailing Address MAY 12 2009 Property Location 479 Omaha Road COUNTY Govt. Lot City, State Zip CD, NNING & Z er NE %, %, Section 17 Hudson, WI 54016 (circle one) II. Type of Building (check all that apply) C4. OK are, Lo T 28 N; R 19 w ® or 2 Family Dwelling — Number of Bedroo; 1 Subdivision Name 39 Plat of Eagle Bluff ❑Public /Commercial — Describe Use oc ` o a City of ❑ State Owned — Describe Use / CSM Number ❑ Village of I ` 7 6 ow l C e A ` Na ® Town of Troy III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement ❑ Treatment/Holding Tank Replacement Only L1 Other Modification to Existing System (explain) System B. ❑ Permit ❑ Permit Revision ❑ Change of ❑ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner / Expiration IV. Type of POWTS System/Component/Device: Check all that apply) J ❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ® Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) I/ V. Dispersal/Treatment Area Information: Design F d) Design Soil Ap ation Rate(gpdsf) Dispersal Area Re ' ed (sf) Dispersal Area Pr osed (sf) System Elevation low 600 0.50 600 sq.ft. 600 sq. ft. 4P 6 100.50' @ 12" abov 1 �O 99.50' contour VI. Tank Info Capacity in Total # of Manufacturer w a Gallons Gallons Units /// /�� ]]�� M o / /[/ /UlC. -ZS P4 O U New Tanks Existing Tanks z H w m a Septic or Holding Tank 1250 0 1250 1 Wieser Concrete ® ❑ ❑ ❑ ❑ Dosin Chamber 1000 0 1000 1 Wieser Concrete El ❑ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) P er ignatur MP/MPRS Number Business Phone Number Bill Schumaker �� 227990 (715) 386 -3121 Plumber's Address (Street, City, State, Zip Code) 1070 Scott Road, Hudson, WI 54016 VIII. Co u artment Use Onl ppr ed _ ve Permit Fee Date I sued Issuing t Signature ve n for Denial $ /_ Z5 M 5 2 45 1X. CondifttW for Disapproval 3) 1. Septic tank, filter and dispersal cell ll must all be services °I maintained as per management plan provided'by plumber. 2. All setback requirements must be maintained as per applicable code / otdinanm. Attach to complete plans for the system and su mit to the Calmly only on paper nol less than S 1/2 x 11 inches m s ` 4-o s t11 Pr°� `7 D- 8 R. 01/07 Valid thru 01/09 �J �G � 20t.: 64 % CIL ta� SB 639 ( ) Oc..Jv.t Q,v�dt I`�j r - ��5oile ✓a /ua�iori�J�'� by7komloson y/ /.z3 /o9 .So,% a ✓4 /ua- �iv•,,ai't b uJe�e.r^v� y /oo • �eca�eo/ S � Owt0.�rL iQoQd (fig 4a-639, � /e QIuFF 5er. /7, Tze1t, Q. /9u0., T. oF' rroy, 5t•Cr6X& de rq /. 0.2,9 a�re`� e. y p y p ro�5ecl ♦ werl IocC.f.+o— 3 t T- �7as�• E /e✓ _ /05.77' PropoSea( ��� 1Qe5i ��rIC.C. _5 c mQ 30 q3 P rops d U3 5--- 61 h `v �sa� 1 �3 e. t.G, vl'la,r�/: Tp 4 f' %Y�s�• �o � S -- 64, ` • - ZQ�,. 83 _ , R d. e.-.4ssuMod eluf = iay. c�.' Proposed /�ouma/a6 Z7.37X 9 39' 6 'x ce Tf re e a(,s /Qtc/a /S a / k X 73. SIY' W�y „ ori Ktes spactd afZ.os!' • I.4CICOPY • • 1 5oi � / - � e r ✓Q /ua�ron�0�'� by / n /0 son y q� /oy zz b uJe�en^a./ �S/os /� • � oca -Eed �Orof� S�,�c ' � Ko4 /1fY�lnErs! Sec. I7, �',28d.. O Q, i9u>., T oF' troy, 5t• crt��,rG� 6¢ir.q /. ol�acr'e z �v �we�► io�.��av, 1 T �pas�• E7et! _ 77' Proposed �'�. bed ,-oo, -, Res, - da nee. —4 "Se-4. ✓o Sewn. �CaMCrekf Wf25b7►iQ 7 15 � CFf' /uen /:nC � Qr oPoseea�;eSai 191 ,�Q1. � C.rn,�� - fie �1, - +•� ;9,4 oe.,.�a, h 83 �ropose� Moumd a •-, Z7..37X ri (-559' x7 d ','s ria/ % 7 - A ree&,s - 6 ;6a7o� 8 s � 73. VY' cY y "Pr: t r---s SP° ced aft. o �' t�z in Safety and Buildings commerceml.gov 10541N RANCH ROAD HAYWARD WI 54843 ■ Contact Through Relay i co n s i n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Richard J. Leinenkugel, Secretary May 08, 2009 CUST ID No. 227990 ATTN.• PO WTS Inspector WILLIAM C SCHUMAKER ZONING OFFICE SCHUMAKER PLUMBING ST CROIX COUNTY SPIA 1070 SCOTT RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/08/2011 Identification Numbers Transaction ID No. 1663233 SITE: Site ID No. 747520 Colin & Mirjam Sultan Please refer to both identification numbers, 479 Omaha Rd above, in all correspondence with the agency. Town of Troy St Croix County NE 1/4, NE1A, S17, T28N, R19W FOR: JP Mound, 4 bedroom residence Object Type: POWTS Component Manual Regulated Object ID No.: 1224619 Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; rill System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), SSWMP Pub. 9.6 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes / and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) c,FE referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compli with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. WILLIAM C SCHUMAKER Page 2 5/8/2009 i r • Maintain well and waterline set backs per COMM 83.43(8)(1). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Beginning October 1 2008, small wastewater holding tanks with estimated flows less than 3,000 gpd that are based completely on approved POWTS component manuals must be submitted to the appropriate governmental unit and will no longer be accepted by the Safety and Buildings Division for review. Please refer to s. Comm 83.22, Wis. Adm. Code for further information. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or nance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 a dorf POWTS Plan Review , Integr ed Services WiSMART code: 7633 (715) 634 -7810, Fa : (715) 6 -5150, M -f 7:45 am - 4:30 pm pat.shandorf @wisco in. cc: James K Thompson, A.C.E. Soil and Site Evaluations (Plans Mailed To) Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. i MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Colin & Mirjam Sultan 4 bedroom residential mound Owner's Name: Colin & Mirjam Sultan Owner's Address: 479 Omaha Road Hudson, WI 54016 Site Address: 479 Omaha Road Legal Description: NE1 /4 NE1 /4, Sec.17, T.28N., R.19W. Township: Troy County: St.Croix Subdivision Name: Eagle Bluff Lot Number: 39 Block Number: Na Parcel I.D. Number: 0V0- X279 - 90 - clap at Plan Transaction No.: N ?O N,�E Page 1 Index and title -� Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Attached soil evaluation report Designer: Bill Schumaker License Number: 227990 Date: 04/25/09 Phone Number: (715) 386 -3121 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Version 5.1 (R. 06/06) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150 % fecal coliform of - 36 inches. 600.00 Design Flow (gpd) 11.00 Site Slope ( %) 99.50 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.50 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 75.001 Dispersal Cell Length Along Contour (ft) = 8.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest oint in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 2.67 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.00 Estimated Orifice Spacing (ft) = 5.41 ft /orifice 2.00 Forcemain Diameter (in) 1 75.00 Forcemain Length (ft) Does the forcemain drain back? Y 92.50 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 12.23 Forcemain Drainback (gal) (� 7.50 Vertical Lift (ft) 101.08 5x Void Volume (gal) 3.17 Friction Loss (ft) 113.31 Minimum Dose Volume (gal) I, v 0.00 In -line Filter Loss (ft) 45.72 System Demand (gpm) 17.17 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.00 1.50 x 1.25 2.00 x x 1.50 x 7 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 1001.88 Total Tank Capacity (gal) 1250.001 Septic Tank Capacity (gal) 1 36.001 Total Working Liquid Depth (in) Wiese Concrete IManufacturer 27.83 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 1001.881 Dose Tank Capacity (gal) Pol Lok Filter Manufacturer 27.831 Dose Tank Volume (gal /in) PL -525 Filter Model Number Wieser Concrete Manufacturer Project: Colin & Mirjam Sultan 4 bedroom residential mound Page 2 of 9 • Mound Plan and Cross Section Views r� J 1/10 B .... Observation Pipe I( ' ; r. J• rr:.,r , / :r :: :: _:: J:;: J:J:::r:.•... ,.; .. ... l:p .:r:. :: .r. 'e .14 '.. +rL.•,Sr -C•. r.._ ..: •. �'.:1., L•L- • -.. -: :.,:���.Y'..,.Lr..rL.LC•- � , L.,.L.�� } t..:. ' y �:,: :•:,::,r4rN. f, <C C.,: •= ,.,,,rHLr• - .. - : 1.i,. \;�. L.L•, L ::: : }. }- J.J.h: .Jr {� • J.J•J•J•J•J , r -• ..11,M1rti: :•r .V ;L: �_.�: . ..�: /:}:J.J.:.r.J.•.. -: - ?- /. r:• J• J. .••.•• r ._ :.-�- /.r•r•.r.r.r:J.r..� -- 6 • y . . . . . . . f Tt - . . . . . . . . . . . . . . . 1 L Mound Component Dimensions A Al2.00 ft E iO. 56 in H 1.00 ft K 9.70 ft B ft F 50 in I 14.20 ft L 94.39 ft D in G 50 ft J 5.17 ft W 27.37 ft 600.00 (fe) Dispersal Cell Area 1665.11 (ff) Basal Area Available 8.00 (gpd /ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.29 (ft) N / / /N/// / / / / / / /N: • G 1 ....... 101.00 (ft) Lateral 1 F Dispersal Cell 100.60( • — Invert Dispersal Cell =Q Epp - Eleva .50 ) Contour Elevation 11.0 % Si Slope Geotexlile Fabric Cover Shading Key v p T — Dispersal Cell See lateral details on s r . : ., ; ..: Page 4 for number, size, 0 r Topsoil Cap 1.5 ft s • + :;.:,;.�c.�. : {::,:;:;.L ;:tis•J::'�• • = - • � � and spacing of laterals. Subsoil Cap � I �':•:;- ` ,., Laterals are equally ASTM C33 Sand �° ;: �.,_: - ::::':J • =::: r• P rat. - �''• , , F spaced from the Tilled Layer e 0 ft �'0• : J ' r ' distribution twit /•: ,•L:.. _ ce nterline 1rti31 Q Aggregate o •. /.. .J..•.J.: /•, •: J .� p A distribution cell (Ax8). Project: Colin & Midern Sultan 4 bedroom residential mound Page 3 of 9 ZOOM 'rIVA3 3ZIS V 1IOS 3 a V ML Orz BTL YVd OT:LT 600 End Connection Lateral Layout Diagram Cenar the labials over tlw A 68 dwwnsion •w Turn -up vlballwalvaror oloanoutpluy P J AN laterals ue identical tE y[ —�) Holes dr1Nd on the bottom of t he tat eral S equaftg spaced Laterals 6 force main of PVC Sch 40 S (per COMM Table 84.303) Face main connection via ire d cross to manifold at ang point. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.04 ft Lateral Length (P) 73.44 ft Orifices per Lateral 37 Lateral Spacing (S) 2.67 ft Orifice Density 5.41 ft /orifice Lateral Flow Rate 15.24 gpm Manifold Length 5.33 ft System Flow Rate 45.72 gpm Manifold Diameter 2.00 in Total Dynamic Head 17.17 ft Forcemain Velocity 4.67 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -► Comm 16.28 WAC - :r 4 in. min. Disconnect ��_ Tank component is properly vented E Alternate outlet location _ Forcemain diameter Wieser Concrete Manufacturer 2 in. Ca aci 1001.88 Gallons Volume 27.83 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 17.93 498.95 B 2.00 55.66 C Pump off elevation (ft) C 4.07 113.31 ~- 1 93.50 D 12.00 333.96 D Total 1 36.001 1001.88 Dose tank elevation (ft) 3_ a ding un er tank. 92.50 Alarm Manuafacturer LevelArm Alarm Model Number DLV Pump Manufacturer JGoulds Pump Model Number I EP05 Pump Must Deliver 1 45.72 gpm at 17.17 ft TDH Project: Colin & Mirjam Sultan 4 bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name [-- Bill Schumaker Phone 715 386 -3121 POWTS Regulator's Name St. Croix County Zonin De 't. Phone 715 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1250 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Moundl Inspect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished ............... Grade ................. ................ ................. ......... ........ ........ ......... 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Colin & Mirjam Sultan 4 bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump 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 a tank or component. 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. 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 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 sludge and scum 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 a triennial 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. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg /L BOD 30 mg /L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continaency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 9 GOULDS PUMPS Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS ■ EP 5 Impeller: Thermo las ■ Bearings: Upper and lower Fully submerged In high 0 p p 9 pp grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. • Effluent systems ■Casing and Base: Rugged ' Homes Available for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto- superior strength and corrosion $A Canadian Standards Association • Heavy duty sump matic models include resistance. _ • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron • Dewatering assembled and preset at the for efficient heat transfer Goulds Pumps is ISO 9001 Registered. factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 3 /4" maximum. ■ EPO4 Impeller: Thermoplas- ■ Power Cable: Severe duty • Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1 NPT, seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA -N elastomers. • Temperature: 104 °F (40 °C) continuous 140 °F (60°C) intermittent. METERS FEET - _ __� i ._�� • Fasteners: 300 series 1 ° . -..- _{ + _ stainless steel. • Capable of running s 30 . —s GPM —►� dry without damage to i - -- - - - - � - -- - - - - - -� 8 components. 25 — o Motor: _ • EPO4 Single phase: 0.4 HP, v_ 6 20 - �-- — 115 or 230 V, 60 Hz, 1550 . 17� _ - - - _ - - - -- - - - - -- - - -) RPM, built in overload with D-11 2>� 5 0 15 - automatic reset. a 4 ---------- { -- - -- - - -EPOS • EP05 Single phase: 0.5 HP, o 115 V or 230V, 60 Hz, 1550 3 10 - - + -- -- RPM, built in overload with - - - - - - - -- - -- - - 4 - -- -- - - - - -- - EPO automatic reset. 2 • Power cord: 10 foot 5 - standard length, 16/3 1 -- I SJTOW with three prong _ grounding plug. Optional 20 0 0 0 10 �20 30 40 50 GPM foot length, 16/3 SJTW with x,/5..7,2 .�• �Y! % n , i num d , ac�(o �d We ed. e three prong grounding plug '7 �e ' (standard on EP05). 0 2 4 6 8 10 12 m' /h CAPACITY Goulds Pumps © 2002 Goulds Pumps ITT Industries Effective September, 2002 83871 q a. 2156 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8 %x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. 040- 1279 -90 -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 Colin A. & Mirjam A. Sultan Govt. Lot NE 1/4 NE 1/4 S 17 T 28 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 479 Omaha Rd. 39 j Eagle Bluff City State Zip Code Phone Number J City J Village i/ Town Nearest Road Hudson I WI 1 54016 1 Troy I Omaha Road f/ New Construction Use: Ii1 Residential / Number of bedrooms 4 Code derived design Flow rate 600 GPD Replacement !#J Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable Na General comments and recommendations: Eval. completed to expand originally tested site by Wegerer. Site suitale for mound with 12" of ASTM -C 33 sand placed on 101.00' contour. System elevation to be 102.00'. Boring # A Boring ✓J Pit Ground Surface elev. 100.80 ft. Depth to limiting factor 24" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr3/2' none sil 2fsbk mvfr cs 2fm,1c 0.6 0.8 2 10 -18 1Oyr4/4 none sil 2fsbk mvfr cw lfmc 0.6 0.8 3 18 -24 7.5yr4/6 none sicl 1msbk mfr cw 1fm 0.2 0.3 4 24 -33 7.5yr4/6 f2f 7.5yr5/8 sicl 1csbk mfr - - 0.2 0.3 Boring # Boring 16 Pit Ground Surface elev. 94.51 ft. Depth to limiting factor 36" 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 I *Eff#2 1 0 -12 1Oyr3/2 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 12 -26 1Oyr4/4 none sl 2msbk ds cw 2fm,1c 0.6 1.0 3 26 -36 7.5yr4/6 none sl 1csbk dh gw 1fm 0.4 0.7 4 36 -68 7.5yr4/4 f2f 7.5yr5/8 sl Om dh - - 0.2 0.6 • Effluent #1 = BOD 30 < 220 mg/ and TSS >30 _ 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) CST Number James K. Thompson Signa re: 3602 Address Date Evaluation Conducted Telephone Number A.C.E. Soil &Site Evaluations P 340 Paulson Lake Lane, Osceola, W154020 4/23/2009 715 - 248 -7767 Property Owner Colin A. & Midam A. Sultan Parcel ID # 040- 1279 -90 -000 Page 2 of 3 a Boring # Boring 0 Pit Ground Surface elev. 98.92 ft. Depth to limiting factor 27" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0 -9 10yr3/2 none sil 2fsbk mvfr cs 2fm,1 c 0.6 0.8 2 9 -19 10yr4/4 none sil 2fsbk mvfr cw 1fmc 0.6 0.8 3 19 -27 7.5yr4/6 none sicl 1msbk mfr cw 1fm 0.2 0.3 4 27 -35 7.5yr4/6 f2f 7.5yr5/8 sicl 1csbk mfr - - 0.2 0.3 ❑ Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtftl in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # I Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L " Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) A.C.E. Soil & Site Evaluations � • b �r�ia9 b CA.) �S/os /oo . • ,Coca-Eea��O�oF�• S- (,a.�c Owt0.l�tz Koad /7, �'18iIy T. of Troy,St. ozyac-(-es �u �a / h g3 bl , 9yso `� 83 az • Wi rSepartmentofCommerce SOIL rV r te - A RE ORT Page of Z Divi.wion of Safety and Buildings �\ , in accordance with Comm 85; is. } P�r1t �¢g t ip CL1VL1! Attach complete site plan on paper not less than 8 1/2 x 11 in os in size. Pan must ' c.. include, but not limited to: vertical and horizontal reference poipt -(BM) , d're tin and F) rce LD. percent slope, scale or dimensions, north arrow, and location and distarim. n�drest roatu� � � G! , J _. - Please print all infonnation. -',, 5T cROlx evi ed by Date COUNTY Personal information you provide may be or secondary p oses (Privacy �awzory*M fff4f Property Owner S . p " ;Rrq,p LQ ri� � 114 1J E1/4 S 1 T ZS N R 19 E (or W Property 0 ers Mailing Address Lot # Block # Subd. Name or£ft0# 118 b0 1 S� r N E , I 0 39 _ L-'R-G LE )3 L.UFf City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road L �� N ss�f`✓9 (�b�) z -�S6a 'T M o►�Ir� A �o © New Construction Use: Residential / Number of bedrooms _Y Code derived design flow rate 60 o GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material LJOR_ � OUP Gl f'� I..Prf_ 1'LLL Flood Plain elevation if applicable N- Ply g eneral comments and recommendations: Y" 1 p vtk_� Vil 9 ' (, - ' -r 3LS T)Z. aU`no0 j L° �TLLL Boring # ❑ Boring L� pit Ground surface elev. Depth to limiting factor 3 Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell. Qu. Sz. ' Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 "6' Z 1S -3Z Lo 'I2 3L — S 1� Z�'sb m-Ft- �s — • S , a V-Iw� OF -Sv 3!y my -, c S IA`iri X13 In `Fh p>» Slc) - F11 Boring # ❑ Boring ® pit . Ground surface elev. 2Z. - I ft. Depth to limiting factor L � S in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - 'Eff#2 � o =�• !0`'L.R -3l2 _ - • S1 � Z Sbl2 »1'Fh �t�l _ • S ZI )o'� s )). l eS b,z m 'Ft- c-S Z- S 4S �Q �' 'F�'� 1,S X 12 S�� �#- • .p _ p IuS 1 / 0�, M'�- 1_ L y C:>Yl m Fs 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) Slg ature CST Number Arthur L Wegerer 40 =31 S - 220254 Address W e g e r e r Soil Testing &. Design S e r v i c e Date Telephone Number 421 N. Bain St. River Falls, WI 54022 �_ -0� 715 -425 -0165 ` "Property Owner L`.� St►J L Z�� . t (} 2 \_ • Parcel ID # �V�1 Page Z of Boring - -- - ❑ Boring # _ pit Ground surface elev. 0 1 Z_? fl. Depth to IImIUng (actor '� 1 In. Soil Application Rate Horizon Depth Dominant Color Redox Oescrip0on Texture Structure Consistence Boundary Roots GPD /ftl in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff #2 1`) IU` ?IL 5f6 S)1 47 YVI'l c l y S a J S t L' C_lY1 51:�t'7 }Y1 <°is ;.,/ • ',� . U S U j > `7 S 3/ y 1 g S `1 S/g s t O Boring # Bo F ❑ ring ❑ 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 /fl= In. Munsell Qu. Sz. Cont. Color Gr. 5z. Sh, 'Eff#1 •Eff #2 LIE L Ej Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In, Soll Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. .Eff #1 I 'Eft#2 Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg /L • Effluent #2 = BOD < 30 rng /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 departrnent at 608 - 3151 or TTY 608 264.8777. SBD4330 (R N00) - PLOT PL Pa -,e of _ Scale 1' =L40' i 1 LOT 4q °mss i \ I ; Ct-S -0 71 5- 425 -0165 2 U 2254 00 - i 1S -3� CST Signature Date Telephone No. CST No. Job NO. 2156 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 040 - 1279 -90 -000 Please print all information. P A I / I evie By Date / Personal information you provide may be used fors l[)acy l aw, Property Owner Property Location Colin A. & Mirjam A. Sultan Govt. Lot NE 19 NE 19 17 T 28 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 479 Omaha Rd. � 39 Eagle Bluff City State Zi$ t er _j City _J Village a Town Nearest Road Hudson I WI 1 54016 1 Troy Omaha Road II New Construction Use: y_f Residential / Number of bedrooms = Code derived design flow rate 600 GPD I Replacement Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable Na General comments and recommendations: Eval. completed to expand originally tested site by Wegerer. Site suitale for mound with 12" of ASTM -C 33 sand placed on 101.00' contour. System elevation to be 102.00'. Boring # J Boring 0 Pit Ground Surface elev. 100.80 ft. Depth to limiting factor 24 " in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr3/2 none sit 2fsbk mvfr cs 2fm,1c 0.6 0.8 2 10 -18 10yr4/4 none sit 2fsbk mvfr cw 1fmc 0.6 0.8 3 18 -24 7.5yr4/6 none sicl 1 msbk mfr cw 1 fm 0.2 0.3 4 24 -33 7.5yr4/6 f2f 7.5yr5/8 sicl 1 csbk mfr - - 0.2 0.3 Boring # J Boring .� Pit Ground Surface elev. 94.51 ft. 36" in. Soil Application Rate Depth to limiting factor pp Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -12 10yr3/2 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 12 -26 10yr4/4 none sl 2msbk ds cw 2fm,1c 0.6 1.0 3 26 -36 7.5yr4/6 none sl 1csbk dh gw 1fm 0.4 0.7 4 36 -68 7.5yr4/4 f2f 7.5yr5/8 sl Om dh - - 0.2 0.6 * Effluent #1 = BOD? 30 < 220 mg/ and TSS >30 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L CST Name (Please Print) Signa re: CST Number James K. Thompson � 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 4/23/2009 715- 248 -7767 Property Owner Colin A. & Mi 'am A. Sultan Parcel ID # 040- 1279 -90 -000 Page 2 of 3 3 ] F Boring # Boring / YJ Pit Ground Surface elev. 98.92 ft. Depth to limiting factor 27" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 1 0 -9 10yr3/2 none sil 2fsbk mvfr cs 2fm,1c 0.6 0.8 2 9 -19 10yr4/4 none sil 2fsbk mvfr cw 1fmc 0.6 0.8 3 19 -27 7.5yr4/6 none sicl 1msbk mfr cw 1fm 0.2 0.3 4 27 -35 7.5yr4/6 f2f 7.5yr5/8 Sid 1 csbk mfr - - 0.2 0.3 F-1 Boring # I Boring _f Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 - Eff#2 Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L ` Effluent #2 = BOD < 30 mg /L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (8.07/00) A.C.E. Soil & Site Evaluations •�Soile�a /ua •Ei'on �� • 6 7kom son y/,a,3 /o9 Y P / .5e,7 ✓q by • , �oca - Eed,O�ol�• S'� Owtal�z� �04d •° %t'f e QIuFF G 11E�'��Ers! Sec. 17, z8d, ozgac-(-es 3 , e\0V L, L� g3 • b2 , • q3 �\ 61 6�0 � h`� �. �,lirkr- i3 � �1 y L(p. r �/: Top of %�S�• �o '� B3 so h 6z s 1N`�sconsin Separtment of Commerce SOIL EdtQL�, bi4,0fRgRT Page of ' Divysion of Safety and Buildings �% �> in accordance with Comifn't95? Wis. Attach complete site plan on paper not less than 8 1/2 x 11 in 8s in size. Phan must include, but not limited to: vertical and horizontal reference poi t.ia -M ), r n Ind n • percent slope, sale or dimensions, north arrow, and location end dista refit r �a@0 Fi�ree I .D. � / J l J Please print aft information. ,r cr�o�x �tgvi ed by Date CiOU N'Y Personal infomiation you provide may be or secondary p ses (Priva Y LawZ0fll "offoB Property Owner S . 0 :Propey L, 1/4 M8-1/4 S 1 T 2{� N R E (or W Property O hers Mailing Address Lot # Block # Subd. Name orb l is oo �° oe�1.� SIF T N E , t 0 3q — L La BLUrf City State Zip Code Phone Number ❑ City ❑ Village ® Town , / Nearest Road L1��N !3 94 Y9 c �6�) zs� -� 5 � Ttio�{ ol"t zopfz ® New Construction Use: Residential / Number of bedrooms _ Y Code derived design flow rate 60 O GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material GLrml-Frf,,, - rL\-L Flood Plain elevation if applicable 1 General comments and recommendations: l vl 9 'X (z, L �TLLL Yet) AJ LPZU x-t FI F 1-1 Boring #• ❑ Boring Ej Pit Ground surface elev. C 1 Z Z ft. Depth to limiting factor 3 - Z in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft In. Munsell. Qu. Sz. ' Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 �owtz - Nz — si► 2`Fsb rn �i- et;�, — : S .� , s ; a z.s�tZVlL �Fzdl �SY2S1$ st�1 Y0 b wi�i eS — . �- 4u�s� �+ — • o . o i � z OF S � 'f I6`i R- X m prm S 1 l — F-7-1 Boring # ❑ Boring ® pit . Ground surface elev. 27L. - 1 ft. Depth to limiting factor i<1 S in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft In.' Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - 'Eff#2 � o =�' �0`'�R -312 — ... S1 1 Z Sbli »'1'�h �(..� _ • S -,� - Zl -3 S l og 2 VA — :S) 1. L CSb k rn fit, (2-S 0 S rn Y. Z- tuS -- )SLttz JV, OM }n.'(�- L. s� �l w�� . �..S�li y Om r4Ufl- �s ' 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) Sig ature CST Number Arthur L. tJegerer 0 -39 220254 Address We ge r e r Soil Testing &. Design Service Date Telephone Number 421 N. Alain St. River Falls, WI 54022 � �_ g_p� 715 -425 -0165 L i Property Owner QY�1�f\l� �r.11�t1 �� . t�YL� , Parcel ID # P�y�l �J� Page Z of 3" Boring F-31 Boring # ❑ ❑ Pit Ground surface elev. � 2�- O ft. Depth to limiting factor 3 -7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0 - lb`9R 3/ Z — St I Z`f'Sb1z Z g -11 1�`tR 3/b — si Z Fsbk h1'F1- Civ 3 1 -37 ioyR- VA 1 0- 1 Z-M sblT Yi1'�i c%v • 4 3� -DIY tu�lz s13 1� - )-SL/D S/6 S, I caw, W, Cl.'j D S U�1 S`7 - 2.S - JP 3JV — 1 g 0 Yn �.S�Vsl. S 1 o w, m`k- - • . 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 /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 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 /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD -8330 (R6100) I ; Property Owner 0-Y N - bN . cm \� , Parcel ID # p0yVD1 N � Page Z of 1�1 F3-1 Boring # ❑ Boring ❑ Pit Ground surface elev. 2 -7 - 0 ft. Depth to limiting factor 3 -7 In. Soil Application Rate Horizon Depth Dominant Color Redox Description - Texture Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0 - IoHR 3/Z — Si' Z`fsb1•z WI ew _ • s . )oy2U /6 stet Z►nsb>z yy�`FI cw •4 , s ' Q s - 7 -).SLrtz 31y — 1 s 0 4- s� -6� -s yrz y/y 3 -1 1Z s/e s 0 w, M -�, - • o • o Boring # ❑ Boring ❑ Pit Ground surface eiev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ❑ 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 •Eff#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD -6330 (R.6/00) Wi sconsin Department of Commerce SOIL EVALUATION REPORT Page of Z Qivis(on of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ST• �° 0 �K include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 7 e )1v percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 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 C }rpc2. S , C0 p IZ Property Location � 1N�1J t- D�jNtOPML C QZPo1'Zt1ii LO'-Li rJ� 114 NE1/4 S )7 T Z.8 N R 1g E(or W Property Owner's Mailing Address Lot # Block ubd. Name or JEEW I kS OO �° �t o 1v SIZZErET AJ E , S u ter ► u o 3c� # S — 1-'R La Ia LUG City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road 3 LP�ily� I MN I 55VV I ('7 Z S7 -ZS66 TI�O� OM 1�+VA R.Op ® New Construction Use: Residential / Number of bedrooms Y Code derived design flow rate 60 O GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material GI --f\\ LPr(. -'Ll -L Flood Plain elevation if applicable General comments and recommendations: Wl Ovty;Z lnil 9 r K - - U)tS11ZLaC I nop j C EL L Y-11 AJ U l(j x.r (� ` O r= s r'�x 6 FI. tL . Boring # ❑ Boring Pit Ground surface elev. e l R Depth to Ilmiting factor 3 - Z. in. Soil Application Rate Horizon Depth Dominant Color . Redox Description Texture Structure Consistence Boundary Roots GPD /ftz In. Munsell. Qu. Sz.' ConL Color Gr. Sz. Sh. 'Eff#1 'Eff#2 3Z z -- s i ► 2 sb1z rn. �Fl- etti S)1 Zsbh- m•ft- — • S , g V `�Zo� -- )S `t2Sf8 sle.l LOLSb Yvi �O--S$ � M � � � — • O .O 0* sic f - FL Boring # ❑ Boring _. ® pit Ground surface elev. Z.Z.. -1 ft Depth to limiting factor L l S in. - Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz In.' Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - 'Eff#2 � o =�'- !O`'[R312 - — .. _ S1 1 Z sbk m •F� �t,,, - , S' �� � - � = Z ) Zhl.sbk m'f-� Lu — • `� -8 l csb k - in '& C`S z 5 4S �p �l� 7,S Sig . : o. LvS s K IZ ! 0�, >+�t i L . s c.l w 1rW -) -S -j c Y y c)f M Ufl- it #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) Sig ature CST Number Arthur L. "- Wegerer 220254 Address Wegerer Soil Testing &.Design Service °ate Telephone Number . 421 N. Bain St. River Falls, WI 54022 � �_ S-00 715 -425 -0165. •` PLOT PLAN Page 3 of 3 Scale 1' =q0' • G� 2 0. LoT 39 Lug- yo 8 �3 LUT 38 `� • �\ ti sv,4ZS 0' eL �tZS.S 0 +vOT U m p PI--r / 4 0 otiZ P�s�vz..s �1tLS 1z� • Z3 r3rvl �t`f L� - tS-UO 715- 425 -0165 220254 0 -a" s - 39 CST Signature Date Telephone No. CST Igo. � Job NO. /oc / . .. :,� :�,y— 1b A(:Kt, 9, L.5 �� 1.168ACRES/, 3 \ �`� 0, 1501 �, 109,668 S.F. / o0 p� C 150 874 S.F. , os / N' o ' \ � N ^ o _ _NORTH LINE OF _ _ s _ 174 ,o 1.210 ACRES .. ^ N 52,729 S.F. ��' ';� 0 .� �' ,� N� / v / l S 00„ J , (0 /N 88 36 10 E N e, 2 . l .\ \ S 8 0 �C4 h a pp P O 2647.02 r24, 30, 00,, 1 00 0 O �00 /°. e" W % 16 00 0, p W )h , � , y " , :D 8 . y O W 68.2 , / '. I OUTLOT 3 (� v A CRE �� ^ i� OUTLOT \\ \ ��. 7.292 ACRES o 00 ` Q R 80 33 S.F. /•� I 263.9 , \� \ 317.625 S.F. pp/ 9 Ld 9� �- A 134 69 \ _ ..129.22' 3/4 � C t 9 '\ �► 3.000 ACRES o � 13054 Z 130,6>39 S.F. " o o O 12 E 631.07 ' 3/4„ I o o Boa � � o d o _ c to 4u U� N J, O nW _ - � ' p / I I I .mow � • � soo s\ ° � 1 o a,0 n� �O, �O• . /N o o� 1.470 ACRES N 1 „ \ 0 , V 64,045 S.F. ✓P \% �� S 81 059 29 116.75 ' - P J L4 \ N 40 I I c 1.087 ACRES \ I v► N47,336 S.F. ^� �, \ 1 o N N qtr c\ o t�D p 0 \ 0 ,4 Lo I m , � ti ��a g 32 I 1 , AC ,� c _ 1 I 1.029 ACRES .� �, � C68 • 1 44,824 S.F. 14.1 �.`V ti , I 4 _ 1 ; �9 �� 38 o . - V , Ln 9 , ^� o I >>� y �/� e� /1.030 ACRE v� �o I o N 1 S "� I� I w o I S 44,868 S.F. 0 � w I '� �� �"' 37 ' �� 351p01 �I o 1 N 7 i � p,CRE rn ro 3 6 1 1,063 ACR S °_ 3/4" 80 17 1 " S), S 1 \, / X1.063 1 S F° 1.050 ACRES 2 6 289 S.F. �T o' V 6, I iT 4 '546.50„ W 426 ,76 SS,, � ► � 45,721 S.F. m I , I S 7956 A 0 L __ i2" I 2 S31 1" 179.61 176.70' W N 89 W 356.31' I I I OUTLOT 6 10.558 ACRES 459,904 S.F. I 1331.11' SOUTH LINE OF THE NE 1/4 OF S 88 15" W 2652623' UNPL A T T 1. ALL LINEAR MEASUREMENTS HAVE BEEN MADE TO THE NEAREST ONE HUNDREDTH OF A FOOT AND ALL ANGULAR MEASUREMENTS HAVE BEEN MADE TO THE NEAREST FIVE SECONDS AND COMPUTED TO THE VALUES SHOWN. 2. THE PARCELS SHOWN ON THIS MAP ARE SUBJECT TO STATE, COUNTY, AND TOWNSHIP LAWS, RULES AND REGULATIONS (I.E. WETLANDS, MINIMUM LOT SIZE, ACCESS TO PARCEL, ETC.). BEFORE PURCHASING OR DEVELOPING ANY PARCEL, CONTACT THE ST. CROIX COUNTY ZONING OFFICE AND THE APPROPRIATE TOWN BOARD FOR ADVICE. i'a..(. 01111 M I L— nP M A ^1Vh Aoc A l^ fff11 1 M ►1C . y' i EAI�EI�b Ilk 10CATON MAP . : �� Mee Uymf54Ylm/ M RCr10A1 Mn 1QCAIEQ {N THE SW }l4.QF THE, E :TAANVIHE`$E 14 R OF THE E fi/4 QF SECT }QN•9 THE NPI 1/4 QF Y eps[rmn wdntr SHE H6Y 114 CT10N AND �N 114'QF THE NE 114' ( THE NE :7 j4 OF THE t+� 1/4 OF S€CTIQtJ ? n .wd ra«r Aa n wntaxn affair 17 Ali 'fN T28N, 81 Y T( 4N OF`TI V ST •CROIft t ITY TYISCONSlN; 1t�1 Q13}NQ ALL QF OT } g 9 11 ROt ANO IOT TOr THE.IRT1 O SURVEY MAR!zlCbRQEft }N VOLUME 9 PACE 36t�� QCCUl�NT N4g8�85 � ' 'o x"x}rx {r#a�xar� �I ldJEkA1Tp tAAU ' (9i�l.A Mt �' s 71xan r er 1 1 - '� r�r � � - 'nrwlsrart - 1W�r a � agti+r[ _t�4eo[swainsiudnt " r�� r - tl : ruaut a+;na M u,n Sr )r�t z,re ? AeterlL 7 7Ned —+ "I A E-- �� SCALE. EJ FEET; za na ` , ;7xrsi UsfiWl5r7 A4 ' ° Ai rA J Krc J *xt.m m s7 1b�II \ I 11 °° 8 .�YM+'SFEIMN <E�GI WArOR } t ._ . ri 77 M" � .� •KWInY O+r nluo evRO17a SSroa tin IS<e niF 17). y 5¢�Ipf,7iY y 5 I f i �r 1 I ) iK111177 1D.10 M1VE#a K71t81 i 'l ,. CSVENUI 7tO1P i fl „ ��W�`y10FNt1M1 rcW[Xr ;- �'�, S • , � � '.� :� + ��'� i � � '"' � • ' ' ' � rNO 4 r ;- 1 ix MoN roo ,.. aNrwasWW Ici�a7ga sar5 ug Vpl 4 _ "`t 11. Lre sr >a 74ry[ rnatw a h +wv i sit 7 tSTANOE +anC p7rir €M1hDltl r nxwb vOr R16F16 }3 r nds B 3aAwas wo�7 at �aMwcm wnxa amV,Mpamoa . �. s��`� , tPCJ�98 4� rrmv yr k OAn,wAYxmaa twurlm i �! tII \ tA�EATTE9IAI@4 A nA a�7x i �� {; , 2 {._ � •. �+ ankle sf,� - ail7DOaE il �,, EXtEFSgA ;, .; 7- 705,,7 s 114 A ma pan C£ H 1, i d�G17E0 c0 0t tS[tnae , Y u L- r ,/; a S� ,�ls ' Smt A+7A 9EeY71•+G: '4777 t .�..a�ways. xers�77 tltn, � � ! ��,� a7e7+u T �ycr 7 1 M \ e �narxaSJ !o r A 7 - fan i xF ;i5mei0A ���'' 9 , $ �� ,� ;�� °.1'Y.��`p mgpfi r 8� �• /) F y F� hf � Q�1T�l0�T 3 � �:r. f �Y. :� � � \;° ��, n. r < o s GSM ,. �� 70p f p( OJiLfl��6 7mw[s'4. (��� �a n7wxs� m Tq iCf 1569 �k f >mas m o7ws g:2 V 1 DQG i�A ? ? ?a C�77 {{,sy we7sr R II N emiras E. t�rZiar �mau 7 nm : �� Sy r iu l:A7AnRS a .-.- v Cgd5EBV7,11tM + r w4 � 7 � �a � SF ✓p'� ai { FAQ ENt i TOWMALL 7 y ROAO � ` 7 owux rp O tt ;'u �I { lIi � �l + i ! � �' it 1 ` � .t�\. 4��'� -_.-, v � f✓ A flw f ,.i^?'p! r v�8 A -., �a�_��. � � �� 1 ' {�� � ��"� • �pMAHA •Tp ze 1 �� +SIP. �, �i?' t 39 �„ n �• Naas J 199 CSf snav� Z��, 24 $ v gas . f � � i ci '' +. 7 ,�� �'I • �� X94 b ' .u� � � �•a erosr/ � �� 26 r e 6r ' M •'�, g d . '� � � y �� �. 1F •� I r ;� �G77f� � � Oyu 1 � 1 r Y r • , .E � 7470 Sr i. � _t! ' 7A� %Aare MIA JMFM YAL .%1pMila U M IE tN aMiF i71 - jt . 1pfi11MU1ltM7NEFM MA Q' 3, . t�b'tATtER iaA� � <7,y makra xruea lloF ,!4rest nx - g y arya6 +iAtt+ rRS t. Nl [II(A! IIe Oa rgW7NU #tW7NA kl MWtm �..: IPMD,F RIA .'7 I� ttuamasM.aanoswa mnnmmM,vkuascw I . e M MgFSS 5aNm twlsWpr+s itrxn m sett: cairn, uo mxwn Lvs wka as PP(AfT6p nm5 ,zxnxosalAw>smslawnsmwrncx 1Rnc+unui5a ✓}� ancu as ton�n�i<amraxrcm r lwmlQE, TKW Iart �ao e 'itasaroagrowwrerrnAn ur g CQk3 1 T` rm mrrct Sac D6111J616.1761,OAed73871171�R6 - As 4 Y of 2246 , CY 7 U fl W E 4mt A5 r fQ m3: Vow aueaa a prr SP O OUe . OR _ -VWI CF N ;a M 0I70Q +Nan FQr IWS'N7 me M 77a'Am OD AI[ I74Y M Nno" VO m 140 Mi NW VUL Im 1015 i AD'IY - 9101 ' , 117 vEsT wALw smr. I[ YS[C rm lutgM4 0M4m+'t� -� a11wYM U fe` 7P Tglgi t lr I U1 HOYAOE WTIM WY %IFalID ro 7a �m' LOS MID Y71 li M OntNµ m M 5✓tMFSI rRplk IN M,�D,Wnr tD5 IS )D F� 14 OT 1 4 rU' Ym AI a 435 't� +nArwm5r:5�M5GD 1W Lis _ - e Mea tmlr SUS SWl watt vNim ROW PW e55YATO Sm w ubn Imam A' fl �� J DAtEO T4 7Y11 R D p1 AO 40a 2 I ' s 1/4 raiPs.tms,e -uo +7, e; lomaswoalm.ea.o - ' s $UfE a! PEnSEO K 77tH Y df pEdfuBER 4060.1 1 1 1 6 �i A[nkoJ a iii DAY a 20M �• !!" a AuU a1R01e1111gANnlACSWM ro A Wdi 1r1 A1 dbOD Ya *' � 4555 NSiAU�@5 aRNi(a 8Y D+IN4! P (76Qi, � 1 SNadM74Po17FYmAhAI-0SdK¢ (�! At ro x nA041nN1Y Alm7@ lAal, SIIHt E57pe7m. itkFl a 7x ;Z I • . try } ak` i ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND i OWNERSHIP CERTIFICATION FORM Owner/Buyer, Olin `. /; t Y - Vl S U 1 t�n Mailing Address :- 7 o4- *'Cc- tG_ Po e-J t c" 1 e- y Property Address `T 7� Q t cJ c- (Verification required from Planning Department for new construction.) City /State 1 4 U da o (AJ1 Parcel Identification Number 0'10 - ?5 " -� 0 i LEGAL DESCRIPTION Property Location /u t t/s , A %4 , Seo, j ? g T �Q _N R__Lj_W, Town of 1/04 Subdivision L'_ 1 V.� C , Lot # -3 i Certified Survey Map # , Volume , Page # Warranty Deed # v a- a J4 J S , Volume , Pagel# i Spec house yes no Lot lines identifiable es no ! SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle was 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 mai i tenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. 1 The property owner agrees to submit to St. Croix County 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 dispos system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, Stat .-of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Department within 30 days of the three year expiration date. q 14 / o / ATURE OF APPLICANT DATE OWNER CERTIFICATION 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 des c ' ed abov , by virtue of a warranty deed recorded in Register of Deeds Office _ f I/j GC' ` S NATURE OF APPLICANT DATE Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** 1 Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the cer i6d survey map if reference is made in the warranty deed. s' ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer a (l �� x'1 r G vv) l �- �- • Mailing Address v A r C c;iJ c. c,. Property Address 7`� 0 /KCA hC'k /20C�L-cj (Verification required from Planning Department for new construction.) City /State au d'son a) / Parcel Identification Number b a - /x7 0 1 0 0 0 LEGAL DESCRIPTION Property Location 0 %a , A)& %4 , Sec. , T au N R I Town of 1; o Subdivision ��c e �� a /U Lot # Certified Survey Map # , Volume Page # Warranty Deed # Volume , Page # Spec house yes no Lot lines identifiable yes no 0 SYSTEM MAINTENANCE 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 ma' tenance responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County 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 i vastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is 1 ss than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage dispos 1 system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, Stat of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Dep7enl;ior of the three year expiration date. 1L ldv 5 I ATURE OF APPLICANT DATE OWNER CERTIFICATION I/we certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the ov mer(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office SIGNATURE OF APPLICANT DATE * * * * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certifi d survey map if reference is made in the warranty deed. KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX Co., WI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 0 03 :30PH WARRANTY DEED THIS DEED, made between Kim Elizabeth Albrightson, a single EXEKP 0 person, Grantor, and Colin A. Sultan and Mirjam A. Sultan, husband and REC FEE: 11.00 wife, as Survivorship Marital Property, Grantee. TRANS FEE: 402.00 Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE: the following described real estate in St. Croix County, State of Wisconsin: CC FEE: PAGES: 1 Lot 39, of the Plat of Eagle Bluff in the Town of Troy, St. Croix County, Wisconsin. Metro Legal Services EDff Er 501281 A 589276 WD 416856 Recording Area Name and Retu ddress: Edina Realty tle, Inc. RETIIRN TO: 400 S. 2n t. — Suite 115METRO LEGAL SERVICES, INC. Exceptions to warranties: Huds , WI 54016 330 01TE 2i4i) AVENUE, SUITE 150 Easements, restrictions and rights -of -way of record, if any. 50 81 MINNEAPOLIS, MN 55401-2217 040- 1279 -90 -000 Parcel Identification Number (PIN) This is not homestead property. Dated this 16th day of June, 2006. * Kim Elizabeth on * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST. CROIX COUNTY. ) ss. authenticated this 16th day of June, 2006 Personally came before me this June 16, 2006 the above * named Kim Elizabeth Albrightson, a single person to me known to be the person TITLE: MEMBER STATE BAR OF WISCONSIN sttument and aclmowledg (If not, NOTARY PUBLIC authorized by § 706.06, Wis. Stats.) --STATE -OF WISCONSIN THIS INSTRUMENT WAS DRAFTED BY *Pamela J. Goulet Notary Public, State of Wisconsin 50 East Fifth S Peterson, Fi S re Bergman l Steven Bruns My commission is permanent. (If not, state expiration date: S treet, St. Paul, MN 5510 1 10/11/2009 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 IofI �� s Cd a '� � I'w� �� S � m .� +- a NT' i �, 7 J r a uA S J � N — nn 9 r� AV v y3 a� A a � o� �I �o fi� 3 d+r _ v.� / v r� 00 a P.ai I s r d �j S 1047PCIfl I� i 1 _ - rte`, if O - �: ` s n s J I i A p i m - I 4, i I EB •