HomeMy WebLinkAbout040-1331-29-000PRIVATE SEWAGE SYSTEM
INSPECTION REPORT
(ATTACH TO PERMIT)
Wisconsin Department of Commerce
Safety and Building Division
GENERAL INFORMATION
TANK INFORMATION
TANK SETBACK INFORMATION
PUMP/SIPHON INFORMATION
SOIL ABSORPTION SYSTEM
DISTRIBUTION SYSTEM
SOIL COVER
COMMENTS:
ELEVATION DATA
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name:
CST BM Elev:Insp. BM Elev:BM Description:
County:
Sanitary Permit No:
State Plan ID No:
Parcel Tax No:
TYPE MANUFACTURER CAPACITY
Septic
Dosing
Aeration
Holding
TANK TO P/L WELL BLDG.Vent to Air Intake ROAD
Septic
Dosing
Aeration
Holding
Manufacturer
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dia.Dist. to Well
Demand
GPM
STATION BS HI FS ELEV.
Benchmark
Alt. BM
Bldg. Sewer
St/Ht Inlet
St/Ht Outlet
Dt Inlet
Dt Bottom
Header/Man.
Dist. Pipe
Bot. System
Final Grade
St Cover
BED/TRENCH
DIMENSIONS
Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia.Liquid Depth
SETBACK
INFORMATION
SYSTEM TO P/L BLDG WELL
Type Of System:
LAKE/STREAM LEACHING
CHAMBER OR
UNIT
Manufacturer:
Model Number:
Header/Manifold
Length________ Dia________
Distribution
Pipe(s)
Length_________ Dia_________ Spacing_________
x Hole Size x Hole Spacing Vent to Air Intake
x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over
Bed/Trench Center
Depth Over
Bed/Trench Edges
xx Depth of
Topsoil
xx Seeded/Sodded xx Mulched
Yes No NoYes
(Include code discrepencies, persons present, etc.)
Location:
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Inspection #1:Inspection #2:
City Village Township
Section/Town/Range/Map No:
Plan revision Required?Yes No
Use other side for additional information.
Date Insepctor's Signature Cert. No.SBD-6710 (R.3/97)
5 -2O7, -0t/
Number (to be fl in by Co.)
coixCounty
Sanitary
tr t=,'*z r-4 tt \y tt=
MAR 0 6 2023
State Transactiott Numhr
lu accordance with sPS 383.2 1(2), Wis, Adm, code, submissiou of tlris form to the
Application forms for state-owned POWTS are submitted to
Personal irrformation you provide rnay be used for secondary
it Application
!T7\_E
a
appropriate goventmental unit
is required prior to obtaining a sanitary perrnit. Note:
the Departnrent of Safety and Profcssional Services.
purposes iu accordance with the Pri vacy Law, s. 15.04( l)(rn), Stats.
Project Address (if diffe:ent tlran
/\\o"lf,r
mailing address)
Nl.;ur'^VW Hnyrtr-s
Property Owner's Name
Zip Codc Phone N
Lot lI
'Lq
Block /l
CSM Number
,line'C i
Systern
ress
5r
T.y.pe,
-orD
Srown of
Owner ts lng
III
Subdiv ion Name
line0,A'j ;8.rlin box.oentif ',,.onceln
Qiry, Statc
Npa,u f,?Lu,Yt afid
t:(Check
lacernerrt Systern Io
!yp 9.0 f,B-.1i i ld in g (ch eck at appllr)
ffi
llage of
I or 2 Farnily Dwelling - Numbsr of Bedroorns
RT
tional Pretreatrnent Unit (explain)ther Modification to Existing Systern (explain)
Properry Location
0ovt. Lot
x 'lh*ur/,.
ity of
rnercial - Describe Use ..
Orured - Desoribe Use
B
[uoloins rant []orner Type (explain)B ln-Cround
(couventional)
! trdiriarul Site Desigoflt-c'uar Mound
C Renewal Before
Expiration
Revisiorr List Previous Permit Nunber and Date Issued
q' h)^un g{?il,nge of Plurnber f]transrer to New owner
IV.I f Area an I t:n1&tl TankDii6fl-Ged)Systerr Elevqtion
qq.(o 113,v
I Application Rate(gpd/sQ Dispersal Area Proposed (sl)
h5z
rea Required (sf)Di
Capacity in
CallonsTank Infonnation
Nerv Tarrks
I-oP_({o
E5
5t
lDt.P- trlv)6
o(.)
a
RHiio
(J
od
A.
Existirrg Tanks
Total
Callons
#of
Uuits
Manufacturer
I I
w
rinqt,Ii:tlrc u ndersl,e tr t:as!gncd,.,lad
Clrarnberrg
siblli
Septic or Holding Tauk
V.
Bu:iness Phone1i,-L Number . I
r,l t,-ffilb
MPA4PRS Number
1tL{oq[i)U
Plurnber's Address (Street, Ci )
u -t
tale, Zip
:[Js e
SI
fl Approvcd E Disapproved
D Owner Civen Reasorr for Denial
Pennit Fee
$
Dale Issued lssuing Agent Signature
Conditions of Approval/Reasons for Disapproval
sBD-6398 (R. 03/21)
Attnclr lo contplele plarrs for lhe sl,slcm nnd srrbnrll lo the Counly only orr papcr nol lcss than 8 ll2x I t lncltes ln slze
t
P.O. Box 7 162
Services Division
Yards Way
wt 53705
wt 53707-7t62
,I.A
varcet tt 7240- 17'.,
CtfrYtSVt
l4T- c,t*nD Ho trb *to 5rr)+e. k
Section l4
--'n
.(^
n
u 4J
S
Cover Page
Shaun Bird
Bird Plumbing lnc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date'. O3lOOl2O23
Owner: Oevering Homes
Location: N1/2 NW1/4 515 T28 N,R19W Lot 29 Moelter Ln, Troy
System type: ln-groundabsorbtionsystem(conventional)
Manuals Used: ln-ground absorbtion system (version 2.1)
Pressure Distribution Manual (version 2.1)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
+5. Maintanance and Contingency Plan
6. Filter Specifications Sheet
7. Dose Tank C
8. Pump Curve
Signature
License numb 6900
ross Sect
PROJECT oeverino Homes
N rtz I'l\l/ tllS
SYSTEM ELEVATION
CONVENTIONAL
MOUND SEPTIC TANK SIZE
HOLDING TANK SIZE
BENCHMARK V.R.P. 2" pipe
tr BOREIIOLE
182' Property Line
97.5',
99.5',
B.M.-
B-l
2-3'x 66'cells >
3'spacing
Vents
B-2
WELL *g.a.p. same as benchmark
ASSUME DLEVATIoN 100' Filter Lifetime Filter
Vent
System PLOT PLAN
ADDRESS 1433 Cernohous Ave Suits A
15 tr 28 N/R 19 w rowx Troy COUNTY ST. CROIX
94.6/93.6 5'belowqrads 3t6t23 BEDROOMDATE
CONVENTIONAL LIFT XXX HOLDING TANK
1000 LrFT TANK 9129650 DOSE TANK SIZE
LOAD RATE .7 ABSORPTION AREA 653 # of chambers 32
3
Scale 114'10'
>6"
of Cover
Quick4 Standard
lraching Chamber
with 20.0 ft2 of Area
6.6ft^2/pair of end caps
at System Elevation
Wieser
combo tank
95.5',
40'
30'
107o Slope
-J
49'
294' Propefty Line
4' l-ong r2"
Pro 3
bedroom
House
22'
16
39',
=
PROJECT oeverino Homes
N rtz I'l\l/ tllS
SYSTEM ELEVATION
CONVENTIONAL
MOUND SEPTIC TANK SIZE
HOLDING TANK SIZE
BENCHMARK V.R.P. 2" pipe
tr BOREIIOLE
182' Property Line
97.5',
99.5',
B.M.-
B-l
2-3'x 66'cells >
3'spacing
Vents
B-2
WELL *g.a.p. same as benchmark
ASSUME DLEVATIoN 100' Filter Lifetime Filter
Vent
System PLOT PLAN
ADDRESS 1433 Cernohous Ave Suits A
15 tr 28 N/R 19 w rowx Troy COUNTY ST. CROIX
94.6/93.6 5'belowqrads 3t6t23 BEDROOMDATE
CONVENTIONAL LIFT XXX HOLDING TANK
1000 LrFT TANK 9129650 DOSE TANK SIZE
LOAD RATE .7 ABSORPTION AREA 653 # of chambers 32
3
Scale 114'10'
>6"
of Cover
Quick4 Standard
lraching Chamber
with 20.0 ft2 of Area
6.6ft^2/pair of end caps
at System Elevation
Wieser
combo tank
95.5',
40'
30'
107o Slope
-J
49'
294' Propefty Line
4' l-ong r2"
Pro 3
bedroom
House
22'
16
39',
=
Cross Section of lnfiltrator Quick 4 Leaching Chamber
Typical cross section tor 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
6.6ft^2 pair of end plates
/
To be >1' above grade
/ Finish grade elevation
f ee.6'Typical !nstallation
Grade VentVent
Sp acinq_5'
System elevations:
A_94.6',
B 93.6',
at System Elevation
Grade at System Elevation
2-3' X 66' Cells
Same on other end Observation tubeA/ent
At end of cell
A
B
16 chambers per cell
r
/I
\
^Prol34 Septic Tank 3'
5',5' Long 5' Long
CUVOwner
Permit #
ILE INFORMATION
GT{ PARAMETERS
*Values typical for domestic wastewater and septic tank effluent.
POWTS OWNE,i'S MANUAL & IbIANAGEMENT PLAN pase-or_
SYSTEM SPECIFICATIONS
f] NA
f,run
t'.rJ FIA
tr i'iAOther:
Number of Bedrooms
-... ?( -'t) g-:?,/{ql
L{ 5D qal/dav
1 sat/day/ftz
Monthly average*
<30 mg/L
{22O mg/L fl NA
<150 rng/L
Monthly average
s30 mg/L
s30 mg/L
3104 cfu/100m1
X*o
Number of Public Facilig Unils
Estimated flow (avenage)
Design flow (peak), (Estimated x 1.S)
i Standard lnfl uenUEffluent Quality
Fats, Oil & Grease (FOG)
Biochemical Oxygen Demand (BOD5)
Total Suspended Solids C[SS)
Pretreated Effluent Quality
Biochemical Orygen Demand (BODs)
Total Suspended Solids (TSS)
Fecal Coliform (geometric mean)
tlVlaximum Effluent Particle Size
;Soil Application Rate
1a in dia DNA
lother:NNA
al
rlI
Tf NA
trNA
Eft]uent Filter Model
Effluent Filter Manufacturer t] NA
DNA
sal fl NAPump Tank Capacity UIZ
Pump Tank Manufacturer l-O,Cr5ef trNA
Pump Manufacturer trNAi', hrnril
Pretreatrnent Unit
tr Sand/Gravel Filter
El Mechanical Aeration
tr Disinfection
Dispersal Cell(s)
I$ tn-cround (gravity)
tr At-Grade
D Drip-Line
[] NA
D l.,lA
trNA
Xun
Pump Model
Other:
tr Peat Filter
E Wetland
fl Other
E ln-Ground (pressurized)
tr Mound
E Other:
Service Event
At least once everyllnspect condition of tatrk(s)
iPunrp out contents of tank(s)
lnspect pump, pump conlrols & alarm
l:lush laterals and pressure test
llnspect dispersal cell(s)
lllean effluent filter
)ther:
NTENANGE SCHEDULE
ti-Service Frequency
At least once every
CAt least once every [,I S year(s)
(Maximurr 3 years) [-] lr,r\
DNA
(Maximurn3years) trNA
DNA
When conrbinerd sludge and scum equals one{hird (%) of tank v6lume
trtr month
S
D month (s)At least once overy:If NA
At least once every:rnonth S fi,*otrr(s
At least once every n (s
Xtr year(s)
n
IT,IAINTENANCE INSTRUCTIONS
llnspections of tanks and dispersal cells shall be made by an individual carryi(g one oI lhe following licenses ot certifrEtions: Mai;tsr
iPlumbel Ma8ter Plumber Restriclsd Sswer: POWTS lnspeclor: POWTS Maintalnsr; Septago SeMcing Operator, Tank inspec{ons nlJst
linclude a visual inspection of the tank(s) to identify any missing or broker: hardware, identiry any cracks or leaks, measure the vohrne of
bombined sludgB and scum and to check for any back up or prroding ct[ eflluent on the ground surface. Tho dispersal cell(s) shall tg
visually lnspected to check the effluent levels in lhe obsewati(rfl pipes a|rd to cher)k for any lJonding of effluent on the ground sud'ace.'Ihe ponillng ot efflueot on the ground surface rnalr in.iicars a hiliry crlndltie,t and requirgs the immodiat€ notilicatlon of the lccal
fegulatory authority.
When the combined accumulatlon of sludge afid scum in any U]nk equals one-lhid (16) or more of the tank volume, the entire conteflts af
lhe tank shall be removed try a Septage Servicing oljerat)r ard disposed of in accordance with chapter NR 113, Wisconsin
iqdministratlve Code.
l\ll other services, including but not limited lo Ure servicing of er{luenl iiltr,:rs, menh*nical or pressurized componenls, pretreafnent units,
lrnd any ssrvicing at inlervals of <12 months, shsl! tle FrErfornled h)l u Qoniti€d lao\r,/'f$ Maintainer.
l\ servlce report shall be providsd to the local rEfrulatory authaiil j' ,Mihin l0 days ot collpletion of any service event.
,5
Septlc'Iank Capacity l(ffQ
Septic Tank Manufacturer Wlehf
l.iPr,+ln l, -
4-qD
-) [] month(s)5 E[ vear(s) '
{)then
I
START UP AND OPERATION- ioi'no, .onrt .ton, pdor to use of the PowTS check treatment tank(s) ifl|tr 3ffifln":#'H:itf#fiiJilffi'*iHf:ttH:
mev lmpsdo the traatmsnt process and/or damag€ the dlspersel cell(
iii'rriiffii,,i,J 6v; septale ser$cing operrtor pdor t0 us.'
Syst6m stan up shall nol occllr when soil conditions arc trozen at the infllratlve surfacs'
}#m,,f fmm*4##mmm*l:*+e*:*r**r*ueSm-rym
wnhln the pump tank.
DO not ddv6 or part( yehld€E ovsr tanks and die.persal cels. D! not dlve Or paft OVOfr Or Oltlolwlse distulb or compact the araa withln
rs,,1x;5*,,1fi,1d-f;tr**il
"tt[iiii&-Lw *tpas: dsereite butt!; condoms; couon swaDs; oe
Affi;;;;;-;"8"r; ti ,at-"tu veg€tabl€ Pselingsi gasoflnei glear
peetilols; dinitary napkirc: tanpons: and water sorgner Dnne'
ABANDONIiEI{T^uir,'"liu,Ji,oriis rair. and/orls permanenrrv takonoout or;:I:ffi,S,['J^*.3,il3fli"*"tli"?'"n to insura thal the svstem is propeflv
and safdy abandoned ln comPlla
.AllpiplngtotanksandPitsshdlbedbconnededandtheabandonedplp3op€nin$sealed.
o The contonts of all tanks and pits shall be ramoved end p]op3 ly dlEposed of by a sePtage s€rviclng operator'
. Aft6f pumping, all tanks and piE shal be excevated and r€moved o] thcir covstB tlmovsd and lhe vold space flled ttith soil'
gravei or inother inert 6olid matelial'
Page
-
of
-,
CONTII{GENCY PLAN
lf lhe POWTS ialls and oannot be repaired the following msaoures have baon, or must b€ takon' to provide a code Compli4nt
ADDITIONAL GOINMENTS
POWTS INSTALLER POWTS NTAINER
Name 5
Phone -bttl
replaqpmenl system:
t A sultable replsc€mEnt area has been evaluated and may be utillzod for lhE location of a rePlacoment soil absorption systqm'
| \ The raplacemant af€a should be proteded from dtsturtance "ail[".lrr-i,,i"ir"ii il should. nol-be idrinsod upon by r'quhied
serbacks fom exisum and poposid strudurB, rot rines and wer[i]"r]ii'i, i""i'pt"a Ge rePlacenent araa will rssult in lhe nqed
for a nsw soll and slte
"r.f,i"U6n
fo ot Ufish a suitable replaoeienGilJ
'hipf"""tt"t syelems must comply with lha ruls$ in
efhc,t at lhat time.
E A suitable roplacement ar€a Is not available due to satb*k and/or soll limitations' Baring advancas in POWTS technology a
= ;'"ilili;i;rGlndalled as " tast rcsort to repla- thc falled Powrs'
E Ths site has not ba€n evaluated to tdentry a suirabb r8placemenl area. upon failurc oJ $3 POWTS a soil and sits evalua$on
must be pertormed ro rocaie a suitabte refaoame]rr ares. rr ^J'[ir![r"iiirii-'i-ir"iiable
a holdlng tank may be lnstalledl as
a la6t ]€sort to r€placs the failed POWTS'
E Mound and at{rado so[ absotption systsms may be reconslruct8d ln eEce ql1i19 removel of the biomat at the inlilttalivo
suface. Reconstru"ton" t'iiil ii"ti'i must cimpry wittr ttra rules in 6fi€ct at lh€t ume'
<<WARNING>>
sliiii'ili,uup nD o-rHER rREAmiENr rAirKs uAy colr4lN hEyr8tdm?ii#"rilli.',ltif55J,,?f?ELi8JElEliiii s-ii'nq iul,tp oR ornen rREATlltEl{r rAl'lryullDERr
Fiinsiiiiiiori i'iatxreruon oil rluxurv Er otFnculr oR lllPcEtslBLE
- tlq
S s OPERATOR
Name D,
1 t5-5-107Phone
LOCAL REGU I-ATO RY
/5-lg- L1
Name
Phone
5Narne
Phone
This document was drafred in compliance with chapter sPS 383.22(2XbX1 Xd)&(f) and 383.54(1 )'(2) & (3), Wsconsin Admlnbtrative Code'
UAl"l t'5--5e
r-i{s.*,^<.- ;; lle,u
dt
(t)
(.::i
,;;.:
,-|
_.)
in:)
( 'ji,
l-.
t.r.l
.":l:
<r>
i'):l
t1,
:-.i
i.:
D
0
6o
:
o
0o
8
g
s
!:t:"i
! r.t
$
zo
t--otU
L/)
@
.q'
o
()
=f
C)
C{
tuili[i
@ :
i
tt
::lt I
d
t
0
'fank Manufaclturer
'l'turk Model }.l'umbor
"l otal 'Iank CapacitY
Max. Bwy Der,pth
Soptic-Dos"T'*kCrossSectionAndPumpPerformanceSpecifications
,Filter Manuftircturer Total DYnam ic Flead (TDH) - Iieet
F ilter Model Number D+r I
Minimr,rm Purnp Required
GPMr
Outtet lManhole Min. 4" Above Grade With
Locking Deiioe. Inlet Manhole
< 6" Below Grade Sealed Watertieht
\rfltl E Finished Grade t d
1'otal
Securoly MounBd
Weather-proof
Junction Box
rrifrEr--E
--+
Vent Min. 12"
Above Grade
With Vent Cap
,5
Manhole Min. 4" Above Grade
With Locking f)evioe
J-
<-\-t
Inlet
Disconneot
Means
t/4"
W"ep
Hole
Bottom
ElevaUion
JsJ o'
GENER.AL INSTALLATION: The soptic/doso tank io bsddsd and back fillod in accordance with the
manufaoturor's produot approyal spooifisatione, Maximum dopth of bury as spsoiftod by ths manufaoturer may not
be exceodled without prior 4pproval. Manholo covors cxposod to grade havo an offootivo looking dovics (padlock)
installsd. Piping at the inlot and outlet is of approvod matorial, connoctod to th6 tank with watsrtight fiftings, and
Iaid on sl.abll soil to ptovont mttling or sagging. The foroe main is sleovod with 4" Sch. 40 PVC to bridge the tank
excavati(n aId the slsovo is eealed watertight. Blschical service complios with NEC 300 and Comm 16.28.
02l0s LI Page_of_
Pump Manufacturer
Model Number
Alarrn Manufacturor
Alarm Model Number
Switch Type
Elevation Head
Distal Pressuro
Notwork Loss
Force Main I-oss
Ft TDHWw,s
A
B
C
D
liiwitch S ngs and Reserve CapacitY
T ank Volums :,() GPI
Dimension,Inches Volume Gal.
2
dose) C CJt
d D OL
\B (!LlhTotal
- .__.-_Outlet Filter
Inlet Baffle
,}
L}
a
I
a)l
.l
I
a
t
at
t
a
t
a
I
t
alI
I
t
I )t
I I
l
a
)!,t_I
-t
I
t
ilir
ao
I
'I
l-ib
?-T,
T
fttec 'hl,lArL{L
I
I
I
Off Elevation45,r!, yt ,
_(rese:'ve)Al
(alarm) B
q 3.6
lo
I
250-5ERIES
1/3 hp SumplEffluent Pumps for Professionals!
ALL MODELS FEATURE:
. Ruggedl13 hp moton oil filled with
thermal overload protection.
. 1/2" solids handling.
r 1 -112" discharge.
. Hermetically sealed motor and switch cavities,
and permanently lubricated bearings.
. Liberty's UNI-BODY casting - a solid, one-
piece housing that eliminates the lower motor
seal ring found on other pumps.
. Epoxy powder coat finish
. Vortex style impeller for superior
solids-handling. Made of high temperature
engineering polymer.
. Fasteners - all non-corrosive stainless steel.
. 416 stainless stee! rotor shaft.
25o-series Gord Lengths
M OTOR SPE C I F I CArrOruS.'
1/3 hp 115V 5.2 amps 60Hz
Thermally Protected & Permanently Lubricated
(PSC) Permanent Split Gapacitor
Maximum Fluid Temperature: 140"F
DIMENSIONAL DATA:
Weight: Model 257:20 lbs.
Height: 10.5"
Major Width: 9.6" (manual model 250)
PERFORMANCE CURVE
PERFORMANCE CURVE
25
\
\\
7 \/\\
\
\
to 20 30 40
U.S. Gallons Per Minute
38 78 114
Liters Per Minute
156 192
"t0r_
Ioq)
o-
='
o
o
@
6
5
3
2
20
5
o
5
o
4.,oll-
.E
E
G
OJ
E
P
0
500
Model 25O
Manual, no switch.
Model 251
Quick-disconnect
wide-angle float,
mercury-free.
Model 253
Wide-angle float with
series (piggy-back)
plug, allows manual
operation of pump.
Model 257 VMF
VM F switch, magnetically
operated veftical float -
operates in a 10"
diameter sump.
.@:.certified Dual safety cefiification for
the United States and Canada.
Specifications are subject to change without notice.
Liberty Pumps. TOOO Apple lree Avenue . Betgen, New York 14416. Phone 8OO-543-255O Fax (585) 494-1839
wwwlibeftypumps.com copvdght o Libertv Pumps, lnc. 201 7
Model 10r 25'(-21 35'G3) 5o'(-5)
250 Standard Optional Optional Optional
251 Standard Optional Optional Optional
253 Standard Optional Optional N/A
257 Standard Optional N/A N/A
10' cord length standard on all models. For optional lengths,
add "-2, -3 or -5" sutfix to model number.
Example: for model 250 with 35' cord, order 250-3
EFFLUENT MODELS
ssP
CERIIFIED
SUMP
tr ffi. r,h ii "ffirtzJ bq
r TIR.T LIATI OTl'
-RE
P O RT
o5T-?-oz"- 01 q
Page
-.
of
-
\Msconsin Dapartment of
Divisic;: of Safety ani
85, Vrfis. Aim. Cccie
in erze. Plan must
M), diredion andAttea\ ocmdete site plan
inCuda, bui not linniteC to:verticai ancj honzontalreferene Plirt (B
percent slcpe, scale or cjimen sions, noilh anow, ang locaticn and distanc€ tc nearesi road'
Flease print all information.
Ps*Onrl iffOrmatiof, you provide rr,a1'bc usod tor Gccsnoar)'purp?tss (Privtcy Llu', t lS'01 (1)(m))
Ccunlv tJ-
'-ll'ffi
by
frcw'rate
LJdttl
("Z
Procertr'Location
Gcvt Ld fr./>T NR E(w
a:rn
l,lenr Co.rsEudior
Repla-nrent
Parent meterial
Ggtraloerments
a:"j iegnnrencietiars:
Systam Typ
Bfiing #
Residential / Numbsr of CcCe
I
if applicabie
a+tt.
FlooC Plain eleva6cl
0 ur\ 14A^d f,ftz1rqs
F{*
34L I Groundsurfaca o"r. ?F, I o
I e"atq
Ground surrace
","u. fLA-
BorirE
Plt
fr.Dept, to limiting fador
Depfr to lirniting fador
in.
n.
. Efrr.rcnt #1 = BOD. > 30 J 220 mJL anC TSS >30 S 1 aM TSS S 30 rng/L
RrcF,tlvir
MAY 312fi27 soi
st. &6,St0?,?Bu'dh
C'vner (
I
'Df ihiam€ or CSIH ,t ,ls
-u
*Lot
2
Blc.dl #
CitvT,Town l,iearesl\4llagen
I Scil Appticatiol-Rate
Flrizo'r Deptt
in.
Dcninant
t.ltun-csli
Raicx DesoipSor
Qu. Sz. Cont Color
Text*'e Stsudure
Gr, Sz, Sh
Ccnsistence BcunCary Rocts GPD/ff__
'8ff#1 I 'EE_
I 0-tL /{),.-) I r .e-r-__.fl ,^?r i{r /'.),r-6 To
7"?tt/6 , L./I b13lIlrn/l,rVA {Csl /n/U,4
7 ry r_
RateSoil
GPD/ff
.Eff#1 'Eft#z
RootsBoundaryConsistenceStuctrre
Gr. Sz.
TextureRedox Description
Qu. Sz. Cont Color
Deptl
in.
Oorninant
lv{unsell
Horizon
If(ll'
-aZ
5
CST Number
226900GST Name (Ptease Prlnt)
Bird Plumbing, lnc. Shaun Bird
Telophone Number
715-246-451614321201h St, New Richmond, Wl 540
Address (^Date Evaluation GonductoC-r '2
' Elfluent #2 = BOD. S 30 rng/L
t.D,
Bcrirg #
ru
D-W /d,.9c/,(/?^.?/)k ,,Jh Uil IL
\)-7
Parcel lD #Page
-
of
PnopeQ Ormer
Boring #ff** Groundsurrace "*r.? tJo.Depth to limitirq fador
Ground surfaca elev.
-
ft. Deph to timiting tacior
-
in
Ground surhce elev. --- ft. Deptr to limiting f'actor -- in'
tn
Boring #I eoritp
I pir
Boring #I eodng
tr Pir
. Etttu€.{ #1 'BOq > S22O nEtr snd TSS >3OS 150 mgiL 'Ernuent i2 = BOq530 rng/L End TSS:30 r{'4'
The Dcpartmcnt ofcommcrcc is an cqual opportunity scrvicc provider 8nd cmploycr. lfyou nacd sssistsrcc to,acccss scrvicts or
nccd maGri.l in .n sltcaat. fo#"t, pl"u""
"onra"t
thc dcpartment "t eOS-ZOe-ftSt or TTY 608'264'8777'
3 Soit AppllqglpqRate
GPO/ff
,Eft#1 | 'en*e
RootsBoundaryCmsistenceStrucUre
Gr. Sz. Sh
TextureRedox DesoiPtion
Qu. Sz. Cont. Color
DepUt
in.
Dominant Color
Munsall
Horizon
b 1,01.w(]tw1)T r5lI0'/ o 'bur?a
4 lpIfli,,.1 _b,YlW'l;\tblr-ct4(-/0-jL 'birqla
t.b1/l/nWYvl tct*5lr)r"{o3
I
Soil Application Rale
Horizon DopUr
in.
Dominant Color
Munsell
Redox DesoiPtion
Qu. Sz. C,ont, Color
Texture Stntcture
Gr. Sz. Sh.
Consistence Boundary Roots GPDIff
'3frfl1 | 'et*z
Soil Applicatlol 3g!g-
Horizon .}eptr
tn.
Dominant
Munsell
Redox Descriptm.
Qu. Sz, Cont. C,olor
Texture Stsr.rc'ture
Gr. Sz. Sh.
Consistence BouMary Roots GPDIE-'-
'Eff#1 ,8fr#2
s8D.t$0 (R.6ro0)
{-
1l-/tf,
(71 5)24&3010
NOTICE!
Felidty tlorEs
MAIN LEVEL
A3
BMCED IMIL UNE
',iiti
iii
ii!
iii
I
Eae
oil -tiiir-
r{r
l:1r
oi
I
t,:.il':iil
'...,::iiili6i
ffig
s so. FT,
M^lN LEVEIS
-l
ii
I
I
I
bt
!l
iI
i
I
:t5
fiti
if
r-[
,-..
n
6!
n!
t!tl
i;ti
a6t!
II
ItI
II
I
It
I
i
t.l.
i
I
I
I
h
I
rlt!at
!
!l
I
3
I
q
!I
2
oI
a
I
,
I
!
.i{ --
I
I
J
ri
I
Et
I
i
I-l'-Ill-
ii
- ----.-.---]
I
;I
E
I
EI
FI
E
I b.
s
II
I
I
i
L
I
i
Il-
l*
I'
I
I
!
I
i
I
:
I
i
I
I
It
I
I
dczo
z
'!
Ez
H
G
I
l8
th
h
F
$
tfr
ltIt
ii
o
=mr!
noqN2^
EY:i (,ll
z
E
:
a
-tt-..-
I
F
I
o I
I {t
it
IIt
5ii
It
i
I
I
i
!
I
I
I
i
I
I
I
I
I
l
I
1
I
I
I
:tla
It
r!
I
I
i
I
EI
$
;
E
I
F'
5
E
li
ItI
Elill
Eil
I
tlt
)f
I L
z
,,,30
46,038 SQ. Ff.
7.187 ACRES
LBO=941.7
," 29
t5
'ARc-1
.8
/>
o(9-
L GTHEN
024.2
+
' 47,463 SQ. Ff.
7,Un ACRES
*e.
?6.
957.0
."' 32
53,787 SQ. Ff.
LAI ACf,ES , //'
D
{PJ.
tS4O,OT'45"W
66.75',
(66.01')
o
(
27
t-&
o
Q1
,\a)23
%
oL
)66
\
.oo,/1-,' 3L
sr"173 SQ. Ff.
7.773 ACRES
LBO=94O.7 ,,
o
&
d(u
t5)
(1
/:
I
7I
(,^
\
(
FOR:
\s'v
0r, ..)*?
o
$v(28 x
pYg^
.t
)
P
I
WARRANTY DEED
Document Number Document Title
WARRANTY DEED
From: ASH Properties, LLC, aI,I,isconsin
limited liabiliry company
1 155526
BETH PABST
REGISTER OF DEEDS
sT. cRorx co., wr
RECEIVED FOR RECORD
07 /Os/202212:58 PM
EXEMPT#:
REC FEE 3O.OO
TRANS FEE 3,3OO,OO
PAGES: 2**The above recording information
verifies that this document has I
been electronically recorded i
& returned to the submitter :
I
I
:
To:0evering Homes Investments, LLC,
a Wisconsin limited liability
comPany
Dated: June 29, 2022
Recording Area
Name and Return Address
LPG Land,
t6233
L e, MN
120
Premler Title lnsurance Agenry, lnc,
7S0 Metro Boulevard, Suite 300
Edina, MN 5543$2302
GI
Parcel ldentifcation Number (Phl)
040.1328.32,000
Frorqlor TFilefruorzs
THIS PAGE IS PART OF TMS LEGAL DOCLMENT - DO NOT REMOVE.
This information must be completed by submitter: document tllle, name & return address, and PIN (if requ
Other information such as the granting clause, legal description, etc,, may be placed on this flrst page of
document or may be placed on additional pages of the document.
WRDA Rev. 1212212010
?
St, Croix County 1 155526 Page 1 of 2
State Bar of Wisconsin Form l-2003
WARRANTYDEED
DooumcltNuhrber Docu[rcntName
THIS DEED, madc betwccn
company
ASH Propcrtics, LLC, a Wisconsin limited liability
("Grantor," whether onc or morQ, and Oevering Homes Investfients, LLC, a
Wisconsin timitcd liability oompany
("Granlec," whether on€ or more).
Grantor for a valuable con$idcration, conveys to Gra[tee the following described real
eststc, together with thE rcDts, profits, fixturcs and othcr appurtcnant interests, in
St. Croix Cou y, Statc of Wisconsin ("Property") (ifmore sPace is
necded, please attach addcndum):
Outlot4, vistas ofSt. Croix, Town ofTroy, St. Croix County, wisconsin
R.cordirg Ar€a
NarDc rnd Rcturn Addrc!3
Leo A. Beskar
Attomey 6t Law
219 N. Main Streer
River Falls, WI 54022
040-t328-32-000
Psrccl Identification Numbcr (PIN)
This is lrot homestcad Propcrty.
(is) (is not)
Grsntor wsnants thal the titte to thc koperty is 8ood, indefcasible, in fee simple and free and clear of encumbrances cxcept:
easements, reshictions and reservations, if any, ofrecord.
June tQ,Qo'JQ
By:
E.W (sEAL)
(sEAL)
AUTHENTICATION
Signaturc(s)
authc[ticated ou
TITLE: MEMBER STATE BAR OF WTSCONSIN T
(Ifnot.
-
authorizcd by Wis. Stat. $ 706.06 )
THIS INSTRUMENT DRAF'IED BY
Lco A. Beskar, A at Law,2l9 N. Mair
I
,il;
NOTE: THIS IS A ST
WARRANTY DEEI)O2{)O3 STATE
+TypE n.mc bclow sisn.lurc&
ACKNOWLEDGMENT
STATE OF \^,tsCohJS , FJ
(sEAL)
(SBAL)
)
) ss.
sT . Cp'o lx _couNTY )
Personally came before mc oD E 1-02
thc d Mark Mutthcw Hicb *
to me be the penon(s) wto cxecutcd the fo
the same:*ti''To.rd ht\
qs
t|$t
G co
Notary Public, S of
^/
ssion (is pormanent) (expire6:
Bolh rrc not n.cara.ry)
THIS FORM SHOULD BE CLEARLY I
c (
St. Croix County 1155526 Page 2 ot 2 'ae,ltiiN
ISCONSIN
DENTIFIDD.
FORM NO, r-2003
ffiIi.lom!rm
)
I
RTCEIVED
MAY 3T ?O?? SCI
st. cr6ffitg1'196wtttt
l IIfLLI)CST-?-az"- oqqrzl bq
ETIR.T[JATTOfiiHfPORT Page of\Msconsin Department of
Divisicn of Safety ano
85, Vrlis. Adm. Cocie
Attech ccmplete site plan in size. Plan rnust
inCucle, bui not limited to: rrertical ano honzontal referencs point (BMi, diredion and
percent slcpe, scale or ciimensions, noilh ar?ow, and lcaticn and distance tc nearest road.
Please print all tnformation.
P8rtontl adormstion you provide may be useo for GGconciery puryose€ (Privacy !.ew, s. 15.01 (t) (m)).
tieir ConsEudi+r Resiciential i Number of Ccde
Rsplacement
Parent meteriai
Gerrcfialonr.nenG
alJ i Ecocnnrenciaticrrs :
Count.v t
fic*'rate GPD
4#FlooC Piain elevation
0 r.\4^A^d
if applicablef-(fl.&s
ft.
Si,stem m
Borirq #I gonns
F{*?f.L .DEptr to lirniting ,"o", //0
Bodrq #a
Ground surface elev
Ground surface elev ?"/
in
Boring
Pit
'Effiusrt #1 = BOD. > 30 S m *lf anC TSS >30 <
ft.Depth to limiting fador tn.
' Effiuent {2 = BAD.S 30 rng/L and TSS S 30 rng/L
ffi$r-c,p
Reviewed bv
U.^ t'ld,4=l -1cn|r,
L.r<ttE
-Wrl*,4n&a Property
Gcvt. Lc(
Locationil q lVfiJas i* 23. R tq
/I
E(
grocr. r iG-"raryre or CSilm r Arr'(M\ r
I u ; #d Vot 0 r, J" i tt *\
Pone fi v Ovmers l*alflfe {CEress/133 Ydn-:/rrt /k- 5,,i,fu-fr
#rLot
Z
CifvT Town Nearest\4ltage
I
SoilApptication Rate
f{sizofi Oepth
in.
Danrinant C.oloi'
Munseli
Re*rx DesoipEc:r
Qu. Sz Cont Coio.
Textir,.e Stsuc*ure
Gr. Sz. Sh.
Ccnsistence BcunCary GPDIff
'8ff#1 | 'Er*Z
I 0-/L //),-\ lt
-rr-
f/9^vr m[r (J &--,6 /,D
L p-rt !E u 2^-'.tlk /rrrlh ?UJ 6 ,L/I (,
Z /ILln
-
Cst /71/utl UM 2 /L/ry O
34L
SoilApplication Rate
Horizon Depth
in.
Dorninant Colo'
Munselt
Redox Desaiption
Qu. Sz. Cont Color
Texture Stuctura
Gr. Sz. Sh.
Consistence Boundary Roots GPD/ff
'Efr*1 | ',En*Z
I 0')L lDw12.5l L^r,n*t 0s 'Lw t,a I 0
Z /Z-7L tt>ri.5/4 LI aYnifu,ltn/:r etN t{-,l t!3 9-//r;t nvr4/u 5 DLU vnl lw Nlk -l [.[o
r.J
CST Name (Please Print)
Bird Plumbing, lnc. Shaun Bird
CST Number
226900
Date Evaluation Conducteci Telephone Number
715-246-4516iffii 2oth st, New Richmond, wt s4o/-9^ Ai-zu
Roots
/A
\)-l
Propefl Orvner
pit Ground surface elev
Parcel lD #
Depth to limiting fac{or
ft.Depth to limiting factor
--
in.
ft.Deptr to limiting factor
-
in.
Page of
Boring #
Boring #fJ eodns
n pir
H|i- Groundsurrace ^*.? /, 7 o.rn,
Borins # E
Boring
Ground surbce elev
' Effuent #1 = BODo > 30 5 20 nl€lLand TSS >30 5 150 mgL ' Effiuent {2 = BODI5 30 rngfu and TSS S 30 mgru
The Dcpartncnt ofCommcrcc is an cqual opportunity 3ervicc provider and cmployer. Ifyou nccd sssistancc to acccss serviccs or
necd material in an altemste format, pleasc cortact tfie department at 608-266-3151 ot Tfy 608-264,-8171.
3
Soil Application Rate
GPD/ffHorizonDepth
in.
Dominant Color
Munsell
Redox Desaiption
Qu. Sz. Cont. Color
Borndary Roots
'Eff#1 | 'effiz
Texture SEucture
Gr. Sz, Sh.
Consistence
b0-/ o tburV+CT 'b^)I 05l1-{n5r Vlrrtr
4L/c-]L r 4 flio l0at'll'ytObtr-wlv
///n ,t7 t.b3767//)lf)'un4lu 5 ob*r14 t N/ft
t
Soil Application Rate
Horizon Deptr
in.
Dominant Color
Munsell
Redox Desoiption
Qu. Sz. Cont. Color
Texture Stntcture
Gr. Sz. Sh.
Consistence Boundary Roots GPD/ff
'Eff#1 .Efrff2
Soil Application Rate
Horizon ')eptr
in.
Dominant Color
Munsell
Redox Desoiption.
Qu. Sz. Cont. Color
Texture SErlc'ture
Gr. Sz. Sh.
Consistence Boundary Rmts GPD/ff
'Eff#'t | 'er*z
s8D$10 G..6/00)
I