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HomeMy WebLinkAbout030-2021-84-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County' St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 645497 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes(Privacy Law.s.15.04(1 Xm)I Permit Holder's Name: City Village Township Parcel Tax No: DELUXE GROUP LLC/NITO DEVELOF TOWN OF SAINT JOSEPH 030-2021-84-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 01.29.20.429A-35 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic .Benchmark Dosing Alt.BM Aeration Bldg.Sewer Holding SUHt 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 ILIft Friction Loss System Head TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No.Of Trenches PR DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO PA_ BLDG WELL tAKEISTREAM 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 Die Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes El No [� Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: Inspection#2: Location: 284 VALLEY ESTATES CT 1.)Alt BM Description= 2.)Bldg sewer length= -amount of cover= Plan revision Required? ❑e Yes [i No Use other side for additional information. Dale Insepctor's Signature Cert.No. SBD-6710(R.3/97) d,,,41 o (. .0yEs Sr4A/-2a 23 0 0 l ILt Industry Services Division County "tow 4822 Madison Yards Way 5.7=I�'r C F'tb '� JAN 0 4 2023 Madison,WI 53705 Sanitary Permit N6mberto be d in by Co.) F.' ? P.O.11016241 ^ .. ' Madison,W072 I ', 4\�, gD�i1 a a a: > U 3 StVte Transaction Number Coni5iSalglt;; ,.. gg t Application V In accordance wit ' 383.21(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 submitted 10 Project Address(if difTerent than mailing address) the Department ofSafety and Professional Services.Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,a. 15.0441Xm),Slats. I,A••(icaltoryfnfopmatlen=Please F rintAil) nformafon Property Owner's Name -.. • _ _ _ .1../ /�,, / / / n Parcel q ^' ir / Pro �-�--Y Q� 6 ro(0 Z 6 C/A.);Y-+7 [ e/Ato , • 030 d o°Li e- ea", ! " petty Owner's Mailing Address J"'" P party Location a E, PD P?n 2 Oovt.Lot City,State ZipCode ,t I Phone Number Lr K,/e-,'1`/ L/C/1 sV) I Y1./f� '/r Section ' I1.Typeof pllding,(checkaWfthat:ap 1yy _ JJJ Lotp g `J ((((((------tttttt''''-e ������ T 1 N R` E..ty FamilyDwelling-NumborofByyls Subdivision Name A �PubliclCommeroiel-DescribeUwE ) Block# �I/et `�� ■City of / �rr plate Owned-Describe Use CSM Number . illage of/ _4,0e- K, �' •wnofSf• 1i�IWii Type;ofPOWTS�Permit (((Check either.'New'"or'Replaeetnen'R":and athe-appUeable.on line.A: Check one box-o4 line a.eampiete:line C If Apollo 614:) \ ew System / ❑Replacement SystemOther Modification to Existing System(explain) ❑Additional Pretreatment Unit(explain) B. alolding Tank 4t,4• OM Grade (--� / ❑Mound Individual Site Design l OtherI Type(explain) C. 0 Renewal Before ■ nge of Plumber ['Transfer to New Owner List Previous Permit Num bar and Date Issued Expiration r. De/ •: f i / � i - . ii� DlspetsaVTrcatmentAreaand°lank'InfonmaUone qr, / Design Flow • X./!e.-f R.44cA.,, Tir1 t�14t,4�.�C . (,/ _ (gpd) DesignApplication Rate(gpd/st) • • Area Required(sf) Diape rea'1'roposed(sf) ten Elevati n Capacity in Total p of Manufacturer J Tank Information Gallons Gallons Units e"l Now Tanks / .a Existing Tanks ��� �� � � r� � to to tZ V a Septic or Holding Tank /.01 vl / / D _I�� (�{ Dosing Chunbu ( 17./Y") ( W Ir vl�i1� t�lr-i ��--•J ^—�I .'Rea onglblBDy L�l '—' i J L- V P Statimenf-,l tbe.vnderglg,Gdlasl sponzibllityl(orinstail Ionporthe!@.OWTSabowneneheattacheed lanlI 'lees Name(Print) P 4 / Plu a ' ature MP/MPRS Number Business Phone Nu bar Pluytj>er Address(Street,City,State,, �ip C l/Y Z lo)4ED G -�/ `c I A /1 s�a / 7 VI.'Counly6De artment'T7se Only •• PitPermit Fee ''- Approved roved � �� Date ued I Issuln;gent S 5-3� t eaonforDenial D' 5 L1 Conditions g v _ OWNER: �)1(...a_ SeT • ar% $s;t °"^ ��,o ` 1.Septic tank,effluent filter and dispersal cell ' ' i pits I 1 r,� es :rQew -"�"`7 , /6 h,,Q must be serviced I maintained as per _' ""7 management plan provided by plumber. - -�e( 2.All setback requirements must be maintained �� rls-(4 ►:• a�Q a�' 1nd� f� 'a�Q as pa %se i I if! ' "4n auk- lie-f , t:iArg • e l�plana for the tom■ d submitto the -ounty avian paper nol s than a in z II Inches In size �CI SBD-6398(R.03/21) cm". n •� 0. SL/}7 ' • -- .------ _—_.System-PL-OT--PL--Arles --- - . -------- PROJECT Deluxe Grouo/Nito Development ADDRESS P.O. Box 22 Hudson Wi 54016 NE 1/4 SE 1/4S 1 /T 29 N/R 20 W TOWN St. Joseph COUNTY ST.CROIX SYSTEM ELEVATION 98.5/98.2/97.9 4' below grade 1/3/23 4 BEDROOM DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1200 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1219 # of chambers 60 , BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime Filter El BOREHOLE 4) WELL sH.R.P. same as benchmark t, .GOP Scale is 1" = 40' .Vent unless otherwise >6„ LQujc4 k Standard 519' Pro rt Line noted of CoverLeaching Chamber y with 20.0 ft2 of Area .6ft^2/pair of end caps 4' Long 34" Grade at System Elevation 1\1 \-r` 102' 103' \ 101' ci, T - , 10' gUi Pro 4 5' Bedroom R House \ A B.M.* 60' , 0' 4% St / _ 7 5744 B . 243' 3' X 82' cells with >3' spacing (c\ICO PY 284 Valley Estates Court Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 1/3/23 Owner:Deluxe Group/Nito Development Location NE 1/4 SE1/4 S 1 T29 N,R 20W 284 Valley Estates Court St. Joseph Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintance and Cont.ency Plan 7. Filter Cross Section /' Signature l/ License num. / •226900 System PLOT PLAN PROJECT Deluxe Grouo/Nito Development ADDRESS P.O. Box 22 Hudson Wi 54016 NE 1/4 SE 1/4S 1 /T 29 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 98.5/98.2/97.9 4' below grade 1/3/23 4 DATE BEDROOM CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1200 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1219 # of chambers 60 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION too' Filter Lifetime Filter ❑ BOREHOLE O WELL •H.R.P. same as benchmark Scale is 1" = 40' Went unless otherwise >6„ LQuick4 Standard 519' Property Linenoted of CoverLeaching Chamber with 20.0 ft2 of Area .6ft"2/pair of end caps 4' Long 34" Grade at System Elevation —A 102' 103' 101' _ $- 10' "qki T Pro 4 15' Bedroom House (\.\ — B.M.* 60' 111.0.41,_ t 4% Sl 0' ■ B 243' 13' X 82' cells with >3' spacing A 284 Valley Estates Court Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 6.6ftA2 pair of end plates To be >1' above grade / Finish grade elevation Typical Installation 102.5 Vent a Grade OVent ,3' 4 3 41-'30/34 Septic Tank 4' Long I 5' 4' Long I 34" Grade at System Elevation 34" Grade at System Elevation Spacing 5' Observation tubeNent Same on other end To be located on end of Cells 20 chambers per cell A B System elevations: C A_98.5' B_98.2' C_97.9' POWTS OWNER'S MANUAL. & MANAGEMENT PLAN Page of BILE INFORMATION SYSTEM SPECIFICATIONS Owner A"i Septic Tank Capacity A940 a gal p NA Permit* Septic Tank Manufacturer (,v 1���f ❑ NA ?ESIGN PARAMETERS Effluent Filter Manufacturer 1 O NA Number of Bedrooms A/ ❑ NA Effluent Filter Model iJ ri• p NA I Number of Public Facility Units [ 'IA Pump Tank Capacity B NA j Estimated flow(average) Z !/ gal O P Pum Tank ank Manufacturer NA I Design flow(peak), (Estimated x 1.5) 6 GG ffaUday Pump Manufacturer NA Soil Application Rate alda /ft� Pump Model NA, 9 Y Standard Influent/Effluent Quality Monthly average" Pretreatment Unit NA Fats,Oil&Grease (FOG) 530 mg/L 0 Sand/Gravel Fitter 0 Peat Filter Biochemical Oxygen Demand (BODO) 5220 mg/L Cl NA 0 Mechanical Aeration ❑Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection 0 Other. !Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODE) 530 mg/L 0 In-Ground(gravity) 0 In-Ground(pressurized) Total Suspended Solids (TSS) 530 mg/L 0 At-Grade 0 Mound Fecal Cohform(geometric mean) 5104 cfu/10Om1 0 Drip-Line 0 Other: !Maximum Effluent Particle Size )6 in dia. 0 NA Other. 0 NA 70ther ` Other: 0 NA "Values typical for domestic wastewater and septic tank effluent Other. 0 NA MAINTENANCE SCHEDULE �. f• I Service Event Service Frequency inspect condition of tank(s) At least once every: •j la month(s) (Maximum 3 years) 0 NA rear(s) Pump out contents of tank(s) When combined sludge and scum equals one-third(Ya)of tank volume 0 NA Inspect dispersal ceN(s) At least once every: ❑ month(s) -- — (Maximum3 gyear(s) years) ❑ NA Clean effluent filter At least once every: l ea)monrt(s) h(s) 0 NA 'nspect pump, pump controls&alarm At least once every: ❑ onth(s) 0 NA ❑year(s) Flush laterals and pressure test At least once every: ❑ month(s) NA ❑year(s) Dther ❑month(s) At least once every: El NA bther: --- i NA MAINTENANCE INSTRUCTIONS 'Inspections of tanks and dispersal cells shall be made by an individunt carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector: POWTS Maintainer;Septage Servicing Operator. Tank inspections must include a visual Inspection of the tank(s)to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually Inspected to check the effluent levels in the observation pipes rind to check for any ponding of effluent on the ground surface. 'The ponding of effluent on the ground surface may indicate a failing amdltjo•i and requires the Immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (36)or more of the tank volume,the entire contents of !:he tank shaN be removed by a Septage Servicing Operator and disposer: of in accordance with chapter NR 113, Wisconsin Administrative Code. Ail other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at Intervals of 512 months, shall be performed by a certified POV•/TS Maintainer. 14 service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page___of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may Impede the treatment process damager operator hprior e duispersal cell(s), If high concentrations are detected have the contents of the tanks)removed by a septag System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal hlgtwoater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s)in one large dose,overloading the cell(s)and may result in the backup prir surface torestdischargeoring p of of l uent.this To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park Vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact,the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides;sanitary napkins;tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safety abandoned in compliance with chapter Comm 83.33,Wisconsin Administrative Code: • Ail piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN ' If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant rep nt system: suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelm. he replacement area should be protected from disturbance and compaction and should not be infringed upon by requhied setbacks from existing and proposed structure,lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules/in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANI UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Slid./-T� • / • Name S/rQv. / e. Phone 7 r-a-"/- jj d Phone ��f 2�h -5(fl r SEPTAGE SERVICING OPERATOR LIMPER) LOCAL REGULATORYJ /� AUTHORITY i Name � ]/n e f/- ( 1/9/Y- 4v O4/ 6-- Phone as oZ%I4 -- /C/2 Phone 7/ - O x This document was drafted In compliance with chapter SPS 383.22(2Xb)(1)(d)&(f)and 383.54(1),(2)1(3),Wisoonln AdmkUitrMN•Cods. \y 7,..1 _( ._-1-,,,,e____- t- , /ici di Illy' o. I) i ��Ril 11111111-1-1 IIII ll IIB El :'--'':11;1:>'' : 147'' —410,71,Air;4110 In Qso 1 d P „) 0 • so 1, ) l i Q.i ----.............,r ...... Nil 1 /I i „,, 1 1........,_________---11.,6 . • -cc. / r coa / •v % :•• • / • o •..te . . <...• 1.,a a CD szzr I • r - 1 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings In accordance with Comm 85,Wis. Adm. Code C7�'— ro , h`' r ` Y Attach complete site plan on paper not less than 8 1/2 x 11 Inches In size.Plan must Include.but not limited to:vertical and horizontal reference point(BM},direction and Parcel I.D. percent slope,scale or dimensions,north arrow.and location and distance to nearest road. Please print all information. Reviewed by Date preset information you provide may be used for tatendery purposes(Privacy Law.s.15.04(1)(m)t. I Property Owner 1 tt--�� Property Location NI /—Q - Q,(JQi l o /}1 Pry Govt.Lot ,Vf 114 f£ 114 S/ T N R z o E(oCND Props owner's Maill Address Lot q Block N Std.Name or CSMp / . o , 0k zrZ 11 — No U ^ S4.112, t+ty State lip Code phone Number 0 City ❑Village vm Ne Road ar.1. ..,, }w____///IIi��--SL(O1 i ( ) $Sf- .ToS-ems i y}�., &u l I 0wConsWdion Use�A�sidentlal l Number of bedrooms ���/ Code derived design ZJ GPD 0 Replacement //0 Publicprrcommerdal-Describe: __. ____ _ Parent material � Flood P elevationta if applicable /l/,I c'`/ It. General comments and r000nrrrndaiiixi :,,,, _ to ,?y�.r— r�"a'PtY�V L' t++G� J ' r System Type_ W+L L/tDir.. ./Ar-- System Elevation ! t� • 1 Boring N ,„D a Boring / ! �y''� lL�pit Ground surface elev. /o 1. 12 ft. Depth to XMting factor /i (J in. III Application Rate Horizon Depth Dominant Color Redox Desaiptlan Texture Stricture Consistence Boundary Roots GPM! in. Munsel _ Qu.Sz. Cont.Color Gr.Si.Sh. 'EtfN1 •ERN2 1 4'S /6 � i _ ----- 5i _, r. .,n ('3'/ c r 6 //-0 a s-2V /Of i/ • - _rr/ , ,;- r 12-f/ -F - 4( . ,h 3 -r0 0,/, Try, nsr‘ zil / /,4 , iq • 7 /. �� [_ Boma N Boring n 7 _l pit Ground surface eiev//`1 n. Depth to limiting rector/G' CJ in. ' Soil Application Rate Horizon Depth Dominant ColorTextureConsistence Redox Description Structure Boundary Roots GPDRF In..I 1,_-,,,__Munsel Qu.Sz. Cont.Color Gr.Si.Sh. r 'EIf#1 -E1H12 ..________ ,,,,,,_, .,, . , 2- 6 3� - C,( 4V)(` z-t1 At/ � /` L `3 36-g0/O ,- '� (,. . 7; 4J ! ( r `7 `, / c j RQ-tongs-f r �� 5/ — n?/ V/ v/,i_ , 7 , Effluent N1 a BOD.>30 S 220 rngrL and TSS>30<150 / 'Effluent N2 n BCD,<30 rngrL and TSS<30 rg& CST Name(Please Print) �t re CST Number Bird Plumbing, Inc. Shaun Bird i7 226900 Address / Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 ///—/r-r 9 715-246-4516 L • Property Owner_ Parcel ID# Page of_ 3 Boring ft kBzoring It Ground surface a /lev.{. a 11 /tt. Depth to limiting factor /LTD in. So ANlication Rate Horizon Depth Dominant Color Redox Desaipticn Texture Structure Consistence Boundary Roots OPD/ff in. Muruell Cu.Sz. Cont.Color Gr.Sz.Sh. 'ERN1 'ERp2 a-b ,,6 r:�l� `— S/ o Cr a,L- - ( 747 Boring N ❑ ..,...g, ------- Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Solt Application Rate Horizon Depth Dominant Color Rados Description Texture— Structure Consistence Boundary Roots GPDRI' In. Munsall Ou.Sz. Cont.Color Gr.Sz.Sh. 'Eifel 'ENV ❑ Boring ❑ Pit Ground surface elev. R. Depth to limiting factor h. Soi Application Rate Horizon 'lepth Dominant Color Rados Description. Texture Structure Consistence Boundary Roots GPO/ti' m. Munsell Du.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'ERB2 •Effluent ft1 =BOO,>30<220 ng/L and TSB>30<150 ngtL 'Effluent p2=BOO,_30 mg/L and TSS<30 ng/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. Seoa))e(a N00) Soil Test Plot Plan Project Name Nito Development Sha �fr:ird Address P.O. Box 22 _ Hudson Wi 54016 <C #226900 Lot 4 Subdivision North Valley Estates Dat-. 11/1/19 NE 1/4 SE 1/4S 1 T 29 N/R20 W Township St. Joseph Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation TBD *HRpSame as Benchmark 519' Property Line. Scale is 1" = 40' unless otherwise noted 102' 103' 101' B-2 ■ 5' B.M.* 60' 11 45' B-1 50' 4% Slope ■ B-3 243' 114th Court SANITARY SYSTEM File#: T.S C R TY. Office Use Only ,�scarescr OWNERSHIP/ADDRESS FORM Created 2/2021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online,you can do so by using the Property Files Scanned weblink. 1 •OWNER/BUYER.INFORMATION _ . Owner/BuyerDeLL[-V.P� 6 r(vea L.L.I� NI4D Pot-Ct� N Mailing Address tf� i l 01c. Z2 • City/State/Zip /t-4-. 04J 7�f� Phone Number(required) ../-- ;e — G 7 33 /� /� Email Address (required) ne 5-S/in._, 4, u l �/) �Illl e(. /Xe d (.107V---1 Parcel Identification Number 4 3O��O (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Locatior/E Y•jt '/, , Sec. 4N , T jnn ofi —5�� `1 Subdivision Plat: C`/.t L/ F-5"Zt -t'vs�/ , Lot#y . Certified Survey Map # O, Volume Page# ' . Warranty Deed#a I 1 b7-6 l ki (before 2006)Volume '-- , Page# . Number of bedrooms y Spec houpACL. es ❑ no Lot lines identifiables ❑ no OFFICE USE ONLY New Property Address _-//e -.f pifr i t 66 96-669 (Verifica ion of ew address wired from Community Development Department for new construction.) °I 0,7 ( a itials) (D ) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System:include with this form 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. Community Development Department-Land Use Division 715-386-4680 St.Croix County Government Center 715-245-4250 Fax cddCasccwi.gov 1101 Carmichael Road, Hudson,WI 54016 Www•sccwi.9ov . sw66il poop AIs suo dasno BM Mai WTI A M31A83A18 IF 1 arid'uss w vow 1 OM •ea wow= y _ ; I 'R/N 111 /M t 1 1I 'V j Ill V1iri nil ,/ 1 f i. �.4!C7 oi.Hadl :I�r. .l, it �L:�rsa1\\\\.I1 u . 1 I, • 1l!,i� llll� I .Tl ■ i \oil,. g i 4-111 lI IIIIIII / • I �� C® i 11 11110111 1 II in :1■ . rip — I� 1 �i• _I Rill !a 1 `' V•' , i r1Fi.., ,� /1 dill I1l� . 1111 II 1 le mr !/ 1111i• MI 111 ®, ` A I Al \ I — E1" _ �i (. / in ���1 \ il n l �. ;► .�nu _s _II :lc t 1 �`,_--1• �� soul :ft :� b it ulll i1 i� it : '9 , ui •=— a i � I `.. . r It ��uY11 �1 ki ��_ mil d I .. 1.. b ,. 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Ii liki iilli I :11 . � C1 ...., N. i}= (�i _ � oII L L aN J ��i4,dru a �❑I ri_i _ r a ,ifIa. AN AND � 1 N N !1 N N la 1162694 BETH PABST State Bar of Wisconsin Form 1-2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD 12/30/2022 02:01 PM Document Number Document Name EXEMPT#: --- -- - - REC FEE 30.00 THIS DEED,made between NITO Development,LLC,a Wisconsin limited TRANS FEE 525.00 liability company PAGES: 2 ("Grantor,"whether one or more), "The above recording information verifies that this document has and Deluxe Group,LLC,a Wisconsin limited liability company been electronically recorded &returned to the submitter ("Grantee,"whether one or more). • Grantor,for a valuable consideration,conveys to Grantee the following described real Recordinc Area estate, together with the rents, profits,fixtures and other appurtenant interests, in Name and Return Address St.Croix County,State of Wisconsin("Property")(if more space is needed,please attach addendum): Land Title.Inc. See attached Exhibit A 2200 West County Road C,Suite 2205 Roseville.MN 55113 LT File No.671455 030-2021.84-000 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 except: Easements,Restrictions and Covenants of record,if any. Dated December 30,2022 NITOga Iopment,LLC (SEAL) `%- If (SEAL) * Todd Franck,Managing Member (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT 45 t:adeGA Signature(s) STATE OF Wisconsin ) ' aOTA?;. ss. authenticated On • St.Croix COUNTY ) ...'OUBLIG y�y.,,�,.F 1'_15�:� ., . Personally came before me on December 30,2022 the above-named NITO Development, LLC.a Wisconsin TITLE: MEMBER STATE BAR OF WISCONSIN limited liability company by Todd Franck,Manakins Member (If not, me known to be the rson(s) who executed the foregoing authorized by Wis.Stat. §706.06) u nt and ck led s me. THIS INSTRUMENT DRAFTED BY: « eft a J. Bune Larry S. Mountain,Attorney at Law Notary Public,State of cousin My Commission(is permanent)(expires: 10/17/2025 ) (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. WARRANTS'DEED 02003 STATE BAR OF WISCONSIN FORM NO.1-2003 «Type name below signatures. St.Croix County 1162694 Page 1 of 2 LT File No. 671455 EXHIBIT A Lot 4,County Plat of North Valley Estates,Town of Saint Joseph,St.Croix County,Wisconsin. St. Croix County 1162694 Page 2 of 2 1 hi ! Y i to 7— ii—, a 1j1I i1 1i1h11111 f44. lilt 1'I pIIIE1 .wmwa�.unw ' c. J S i! 1 it 5 3 I !I I�1 P°ile; 1 e o o a c • t • t a A B : t ? ' ? ! E 0 6 11 I�.� 1 ..,_,-IN, ce_ 0 • o " 4 ii ' 1N IIII ii sp1y11 • 1 1# I 1 C 1 9_ i wM„,5..TwA INo' e I � 1 I -- ' — 4— — ¢ ;III ! ,< ;11 p '—'' ~ I: l i , I 1 'I 1 I, I 918 1. . .zzlsz 1 6.s . I ! Ic Z \a r + �n• if e •Fi/6e�1 �`r 1 \..�.n.= J�`. Vfp o i 1 g , �A 22 • 1 [ 1 FLLI .0 wee FFFF 11111111 laiiiiiiii .yy .. b� \ kAI 5 M."wt�. 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R �//Ja�t/�f�/) /�}7/(J{/J� Personal Infmmae0n you provide miry M used tot secondary purposes(Privacy taw s.15.04(1)(rrr)). Tfi /* , Imo' I �l W/V�V"" Property Owner Property Location Ali � r7)2+✓2.toe/iIe►hA. Gait Lot A/— 1,45£ 11 S/ T 02 9 N R Z Q E 0(D Lot+� Blocks Subd.Nuns aCilY State CSAw- tP Code Phone Number 0 City 0 WageRoad f IL 'j)<- ill LI ( ) 57'- JOs? '/ I Y& (�t[H't' 7 eiv ConstructionUselcreldential l Number of bedrooms 3/y Code derived design flow rate f)V OReplaosment /6 bd GPD CL�dal Describe:Parent _ -ZP1 General materiel Flood Plain elevation if appscada /L/f� 1JC[ IL and n'°c"a'Irtdetla//n'c erts Sot•••- 15 LA. Qom' s� System,Ype r-f/rLt1ec,.tt2fV J — D �1�( Gtk�^uy� System Elevation 1 1.� p(,�(P�.(��,�r�aw + O p,� ltuu 41' p1u�. iri Ban; lik.Pn Ground surface elev./0 I. (I it. Depth b riling factor /1'?) ln. Mpdicalion almn Depth Domnart Color Reda(Detvipllon Texan Structure Corsistrps Boundary Roots Sal G Ra1e in Mumma Qu.Sz Cott Color Gr.Sz.Sh. VW •Efls2 10 i I r31z 5/ P3— 0, 6 / Oag-zy10 / — el ,Y -ih = f2� - - / k3 `-ln./ 4-, _ ._ a ,r.¢ Le( e © Bating aBeeingP ft Ground surface ekl Z� . Depth to limiting radon f[nz)in. Soil APPMae on Rate Horizon Depth Dominant Color Radox Description Texture Shinn Consistence Boundary Roots GPDNF in. Mussel Qu.Sz. Cat Color Gr.Sz Sh. 'Eifel 'Erle2 I 0—I 1.,,,__ — ,/ ,, ,,t cr /. Z 6-3b p '—� c./ of•..;4,1� 41,� Ai/ ii L ip se-gv/O r J� c ' -- ,2, '"? ,ti../ ./7 i -7 i 9 J ?S SD .4 .0 4- c,.,vr ,r `6 Y •EAuent ai■BOD.>30<220 and TSS>30<150 'Merit 02 a Bop.<30 mglL and TSS<30 mpiL CST Name(Pease Print) re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Eva)uatlon Conducted Telephone 1432 120th St, New Richmond, WI 54017 l�'—/^ Number /9 715-246-4516 il Property Owner Parcel ID 0 Page of 1,3 Boring# []j Boring L�Qit Ground surface elev.( C 2' VfL Depth b muting factor /irJ in. Sol Application Rate Horizon Depth Dominant Color Redox Description Teztue Structure Consistence Boundary Roots GPM! in. Muneel Cu.Sz. Cont.Color Gr.Sz.Sh. 'E1f#1 'E1f#2 ` G fro t� ��/z ^ S/ " C.r c L 47 t col-- o 4. tom. Boring# ❑ Boring 0 Pit Ground surface elev. ft. Depth to lending factor in. Soli Application Rate Horizon Depth Dominant Color Redox Description Texere Structure Consistence Boundary Roots GPDN! in. Musel Qu.Sz. Cont Color Gr.Sz.Sh. "EMI 'VW Boring# 0 Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor n. Sol Application Rate Horizon lepth Dominant Color Redox Description. Texkre Sambas Consistence Boundary Roots GPDRf in. Munsel Qu.Sz. Cont.Color Gr.Sz.Sh. 'E1f#1 'Eff#2 'Effluent#1 =BOD1>30_220 mg/I.and TSS>30<150 rug& 'Effluent#2=BOO,<30 mgiL and TSS<30 rig& 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. seauuo mmm Soil Test Plot Plan Project Name Nito Development Sha `, :ird Address P.O. Box 22 .A Hudson Wi 54016 S M #226900 Lot 4 Subdivision North Valley Estates Dat-,11/1/19 NE 1/4 SE 1/4S 1 T 29 N/R20 W Township St. Joseph El Boring C Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of survey iron System Elevation TBD *HRPSame as Benchmark !OS' 519' Property Line 4" Scale is 1" = 40' \iC 1 unless otherwise ______ke\... 3,41,, noted 4 102' 103' -\.- lot' B-2 I ` . 35' B.M.* 60' 45' ii B-1 50' 4% Slope \ V B-3 243' 114th Court 3,^ v tlul rS �`_ --_ ''®t1"r ___ __ I_ S '1 <' .- �Z_- - ly '- _ --i= ^ ♦1 ::, 1 - 1 •:ie l 1 / r . 1 1 : •`:�: .' 1 — lid 1 li `. 1' , ;^: a sE'+ea er::;:• Z y, fi ••! .•. 1P. ;..E �j 9 • 7 cp lix —1 �' ,rr_i j' :'#if'is :'' iiq SE. 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