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HomeMy WebLinkAbout040-1057-40-005Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 648415 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Parcel Tax No: Kyle Huerd I TOWN OF TROY 040-1057-40-005 CST BM Elev: —F77F77 BM Description: Sectionfrown/Range/Map No: 14.28.19.223C TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM 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 BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO I P/L JBLDG 1WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR UNIT Type Of System: Model Number: DISTRIBUTION SYSTEM Header/Manifold I Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bedfrrench Edges Topsoil 0 Yes 0 No 0 Yes � No COMMENTS: (Include code discrepencies, persons present, etc.) Location: 789 GLOVER RD 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? [* Yes [* No Use other side for additional information. I� JI�I JI Date SBD-6710 (R.3/97) Inspection #1: Insepctor's Signature Inspection #2: Cert. No. Fn Industry Services Division County s '-s. ; • MAR 0,8 2023 4822 Madison Yards Way Madison, W1 53705 Sanitary Permit Number (to be filled in by Co.) .8 • P.O. 716 Madison, Q► 62 0 st. Croix Count, Commun?i -Jv opm mit Applatio State In accordance with SPS 383.21(2), Wis. Adrm. 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 to Project Address (if diffe-ent than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. -I. Applieationt.Info.rmatioin'` :Please PItint All Information Property Owner's Name Parcel # `i wl D Property Owner's M. ' ' g Address / Property Location jJ � l Gov(, Lot Cit ,State Zip Code cl<� Phone Number s ���,,C '� 1/4, SectioiI W.l 3 W 1I. ding # ,,ype%of_B. _(check alhahat:ap.ply) I or 2 Family Dwelling -Number of droolns Lot .r-� TL- N R E Subdivision Name 57 o�. Public/Commercial - Describe Use !:6�t) Block # _mot t� City of State Owned -Describe Use n`"'re CSM Number pb Village of ' Doi- = t ► 5 �-R I •town of Il, Type of,POWTS'Petanit. Check either "New" oc "Replaceinen't"•.and other.applicable'.on line A: Check one box o . pie'B Complete ine C if applicable a. A. fFewSystem oReplacement System ❑Other Modification to Existing System (explain) Additional Pretreatment Unit (explain) B. Holding Tank In -Ground t-Grade Mound ❑ Individual Site Design Other Type (explain) Of (conventional) C. enewal Before piration e3P vision 7Cliange of Plumber ransfer to New Owner ist Previous Permit Nurr.ber and Date Issued -, l IV, Dis ersaVTreatmenfArea and`Tan'k Informutio,n•: Design Flow (gpd) Design Soil A lication Rate(gpd/so is Area Required (so Dispersal Area Proposed (SOSystem Elevation S Tank Information Capacity in Gallons Total Gallons # of Units Manufacturer / `��- � V U New Tanks Existing Tanks w U in ti cn w C7 a Lim .. c�oc� 0- .'Responsibility Sta.t:emeilt-1I;;the.•undersigned .,:as.sume sp nslbihty: for instultation,;of the,+POW`I'S shown on the attached:plans Name ' Business Phone Nu er C is (Print) Jk,Ce.� Plumbe 1 ture MP/MPRSLNumber t'C �rt✓ _ 'Z G Plumber's Addr s (S rrALo Ci , State, Zip Code) —7 ' FIALA tti y VT.'Coun.. /Depar�trnerit'Usc Orily' Approved D Disapp Pen -nit Fee $ Date Iss ed / Issuing Agent Signatur � 4.OL� e n Rea r Denial /�� ;Z3 I. Conditions A rov I 1 H SYSTEM OWNER: +s s S. —�- l �S f3eptic tank, effluent filter and dispersal cell -- must be serviced /maintained as per 0 N.e UT anagement plan provided by plumber. 2. setback requirements must as per applicable code1t6Yt Yl r9 s�. plans for (lie i e e systeand submit to the Coupaper 4ty only on not less than 8 1/1 x I I inc ies In size Sm ��,,,*� 6�� 9Q SBD-6398 (R. 03/21) are �� e.�EC_4- �►.t �• ` s �''"� �-�--• ,DSPS System PLOT PLAN PROJECT Travis Dankenmever ADDRESS 687 Coulee Trail Hudson Wi 54016 SE 1 /4 SE 1/4S 14 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 103.0' 2/28/23 5 DATE BEDROOM CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT MOLDING TANK MOUND SEPTIC TANK SIZE 1585 gallons LIFT TANK SIZE DOSE 'TANK SIZE 950 HOLDING 'TANK SIZE LOAD RATE .6 ABSORPTION AREA 1260 # of Chambersnone BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL * H. R. P. same as benchmark ..,. 04 Scale = 1/4"= 10' Easement to Glover Ro d `g M„ 01 40' 80' I B.M.* Property Line B 2 6% Slope 102` 74 1031 Huffcutt Combo Tank z B - 3 1041 Grading is to be done to divert run-off away from system Pro 5 Bedroom House Well is to meet all WDNR setbacks Area 15` below system is to remain undisturbed Property Line G�PY Wisconsin Department of Safety and Professional Services Division of Industry Services 4822 Madison Yards Way PO Box 7302 Madison, WI 53707 March 7, 2023 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 20 - -7 Plan Revie : PWTS-032300004-M Shaun Bird 1432 120" St New Richmond, WI SITE: Dankenmeyer 789 Glover Road Town of Troy St Croix County SE % SE % S14-T28N-R19W FOR: Phone: 608-266-2112 Web: htto://dsps.wi.aov Email: dds s cwisconsin.sov Tony Evers, Governor Dan Hereth, Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES A_4� R449140ef SEE CORRESPONDENCE Description: S Bedroom-750 GPD — 42" to At -Grade Component Manual — Ver. 3.0 (May limiting factor -Maintenance required 2022-2027 Pressure Distribution Component Manual — Ver. 2.1 (May2022-2025) **Manuals Have Been UPDATEDII** 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) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance 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: Reminders • The site shall be properly prepared prior to plowing. Any grasses longer than 6" shall be cut short and removed. To avoid matting, any leaves or loose organic matter shall be raked up and removed. Cut trees and shrubs flush to the ground and leave stumps. Avoid operating equipment on the At -Grade site. If necessary, use only tracked equipment, during dry conditions, with minimal passes, to avoid compaction. • Components and soil removed from an existing drainfield shall be properly disposed of so that there is no risk to public or environmental health. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. 0 Inspection of the private sewage system installation is required. Arrangements for inspection shall Wisconsin Department of Safety and Professional Services Division of Industry Services 4822 Madison Yards Way PO Box 7302 Madison, WI 53707 Phone:608-266-2112 Web: http://dsps.wi.gov Email: dsps(d1wisconsin.gov Tony Evers, Governor Dan Hereth, Secretary be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. • 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. Owner Responsibilities The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SIPS 383.54(1). 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. The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services 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. 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, jmha,a11?ou*y Joshua Rowley POWTS Plan Reviewer, Division of Industry Services (715) 634-5124 Joshua.rowley@wisconsin.gov Shaun Bird Bird Plumbing Inc. 1432 120th St, New Richmond Wi 54017 715-246-4516 Date:2/28/23 Revision:052200765-C Cover Page Revised 03/07/2023 12o30-57 PM Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIVISION OF INDUSTRY SERVICES SEE CORRESPONDENCE Owner:Travis Dankenmeyer Location: SE1/4 SE1/4 S14 T28 N,R19W 789 Glover Road Troy Manuals Used: At -Grade Component Manual version 3.0 (May 2022-27) Pressure Distribution Manual version 2.1 (May 2022-27) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Specifications 8.-9. Maintance and Contingency Plan Attachments: Soil Test Shaun Bird Signature License numVV226900 Page 1 of 9 System PLOT PLAN PROJECT Travis Dankenmever ADDRESS 687 Coulee Trail Hudson Wi 54016 SE 1/4 SE 1 /4 S 14 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 103.0' DATE 2/28/23 BEDROOM 5 CONVENTIONAL AT -GRADE. XXX CONVENTIONAL LIFT IIOLDING TANK MOUND SEPTIC TANK SIZE 1585 gallons LIFT TANK SIZE DOSE 'TANK SIZE 950 HOLDING 'TANK SIZE LOAD RATE .6 ABSORPTION AREA 1260 # of Chambersnone BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL * 11. R. P. same as benchmark 4 Qf T Scale = 1/4"= 10' Easement to Glover Ro d 01 40' 80' I B.M.' Property Line Huffcutt Combo Tank Grading is to be done to divert run-off away from system B - 2 Pro 5 Bedroom House 6% Slope l 102' B - 3 1 04' 1 03' Well is to meet all WDNR setbacks Area 15' below system is to remain undisturbed Property Line At -grade System Sloping Site Cross Section and Plan View � 1 i I W A I i i i i I i i i i i E \ �-- 1 /6 B 4 / E— B -- LAft —1 = Plowed ftirti; = Clean aggregate 0 = 4 in. sch. 40 pvc 4 _ ; basal area :'ti�ti '/2 to 2 %2 in. dia. observation pipe Lateral with 2" aggregate over pipe Geotextile Fabric Topsoil Cap Slope Direction �♦ Dimension Feet — A 12 B _ _1 1 /6 B %ft*?1_ C !O- D 2.0 E 5.0 F 0.5 G 1.0 L W �. L Observation Pipe With Cap --, % Slope Topsoil Cap GENERAL INSTALLATION: The at -grade area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a '/4 inch soil wire when a sample is rolled between the palms of the hands. The A x B area is covered by clean aggregate deposited overhead by a backhoe. Special care must be used when placing the aggregate to minimize compaction of the plowed surface. After- the topsoil cap is placed, the entire at -grade is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. 03/05 lgj Page 2 of g �_ Page Of Distribution Pipe Detail For Two Lateral Network ACC E SS bo X `� 1 �j TuRN -up" (CURkou T) _fgHoles Located On Bottom Are Equally Spaced PVC Force Main * V -1-fti PVC Distribution Pipe H X P P Last Hole Should Be Next To TURN- UP P Ft. Hole Diameter ` 1.5Z Inch / X Inches Lateral Diameter Inch(es) Y Inches Force Main Diameter-' Inches 1 # Of Holes/Pipe �?/ 1- J � Invert Elevation Of Laterals ��J �� Ft. Signed: License Number: Date: -Dose' 'Se tican.k. Cross Section And Pump Performance Specifications p � Tank Ma_nufac.turer Lu; e .s.�� Tank Model Number Total 'Tank Capacity / -Max.'Bury Dopth 8 ;E�ilter Manufacturer ' " � Filter Model N'umber Inlet Minimum Pump Performance Required GPN :* Cu7 / S rt T 3H Outlet Manhole NAin. 4" Above Grade With Looking Device. Inlet Manhole < 6" Below Cn ads Sealed Watertight iiwitch Sott;ngs and Reserve Capacity ^^rank Volume s- GPI _Dimension:_ Inches Volume Gal. (reserve) A; of016 (alarm) B 2 5v _ (dose) C (dead) D / 5� _ Total S Pump Manufacturer Pump Model Number Alarm Manufacturer -- 4- . ,l� ��- ✓ Alarm Model Number Switch Type _ ��, Lfvd_�Gc /yt Total Dynamic _Elevation Head Distal Pressure Network Loss Force Main Toss Total H) - Feet Manhole Min. 4" Above Grade With Locking Device 1 Disconnect Means Bottom Elevation ,.5 Ft GENERAL INSTALLATION: The septicldose tank is bedded and back tilled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer inHy not be exceeded without prior Approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and'outlet is of approved material, connected to the tank with watertight fittings, and laid on st.abli soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank uxcavatiun and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28. 02/05 L) Page of 280-SERIES 1/2 hp Submersible Effluent/Sump Pumps The Liberty 280-Series provides a cost effective "mid- range" pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. Designed around Liberty's unique "Uni-Body" casting, the 280-Series will provide years of reliable performance All Models Feature: - Vortex style impeller permittitIg passage of solids Up to 3/n • 416 stainless steel rotor shaft - Permanently lubricated upper and lower ball bearing Epoxy powder coat finish All fasteners - corrosion -resistant stainless steel - 1'/z" Discharge Stainless steel bottom screen - easily removable - Maximum fluid temperature:1400 F. 280-Series Cord Lengths Model 10' 25'(-2) -----35 -3 —____ 280 Standard Optional Optional_ _50' -5 _ Optional 281 Standard Optional Optional Optional 283 Standard Optional Optional N/A 287 Standard Optional N/A N/A _ 10' cord length standard on all models. For optional lengths, add "-2,-3 or -5" suffix to modol number. Example: for model 280 with 35' cord, order 280-3 Motor Specifications ''/211p 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) Model 280 Model 281 Manual, I Wide angle no switch float switch with quick - disconnect ssprIA icp CERTCEDcus Certified Specifications are subject to chango without notice, Performance Curve: 280-Series 40 �-T-> - - i-FTT rT-T-TTr T-1-FTTTiT1-lTiTTT 12 35 30 25 L 20 15 M 10 5 11 9 8 6 5 3 2 v 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 U.S. Gallons Per Minute 0 38 78 114 156 192 228 270 Liters Per Minute Dimensional Data: Weight: 29 lbs. Height: 13" Major Width: 10" (model 287) Minimum Sump Diameters: Model 281, 283... 14" Model 287 VMF... 10" 2" Factory switch Model 281, 283 Model 287 settings VMF Turn on level 13" 9.5" Turn off level 7" 4.0" The Model 283 features a fully adjustable wide-angle float. Differential adjustments can be made easily by tethering the float to the dis- charge pipe or other mounting point. Vertical float modol 287 is not adjustable. Model 283 Wide angle i float switch with series (piggy -back) - plug Model 287 VMF-Series Vertical mag- netic float for - smaller pits - will operate in a 10" diameter sump liberty Pumps - 7000 Apple Tree Avenue - Bergen, New York 14416 - Phone 800-543-2550 Fax (585) 494-1839 www.libertypunips.com copyright © Uborty i u nps, Inc. 201 i Ail rights rosorved. LLIT 2000 R05/17 0. un -7 ��9 -t . ... - -.- I -..- POWTS OWNER'S (MANUAL & MANAGEMENT PLAN (FILE INFORMATION 1Y C4tk&0jS Owner '� t Permit # DESIGN PARAMETERS Number of Bedrooms p NA I Number of Public Facility Unitsq Estimated flow (average) dal/day I Design flow (peak), (Estimated x 1.5) 0-- al/da Soil Application Rate Standard InfluenUEffluent Quality -- gal/daylft2 Monthly average" Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODE) 5220 mg/L ❑ NA Total Suspended Solids (TSS) 5150 mg/L Monthly average Pretreated Effluent Quality Biochemical Oxygen Demand (BODs) S30 mg/L Total Suspended Solids (TSS) 530 mg/L'�-f�lA Fecal Coliform (geometric mean) 5104 cfu/100m1 iMaximum Effluent Particle Size in dia, ❑ NA Other: - i NA "Values typical for domestic wastewater and septic tank effluent. 11�IAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Page _ of Septic Tank Capacity S jgal ❑ NA Septic Tank Manufacturer i ❑ NA Effluent Filter Manufacturer / t �� --� ❑ NA Effluent Filter Model r� Y ❑ NA Pump Tank Capacity S� gal ❑ NA Pump Tank Manufacturer �.� r ,� ❑ NA Pump Manufacturer _ `�t, �� ❑ NA Pump Model ❑,NA Pretreatment Unit XIA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other: Dispersal Cell(s) — ❑ NA ❑ In -Ground (gravity) ❑ In -Ground (pressurized) At -Grade ❑ Mound ❑ Drip -Line ❑ Other: Other: --- V- ❑ NA -- Other: --- NA Other: - - -------- ---- ❑ NA Service Event IlInspect Service Frequency condition of tank(s) At least once eve every: ❑. month(s) '�year(s) (Maximum 3 years) ElNA IPump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA Ilnspect dispersal cell(s) -- - — At least once every: --_ _ ❑ month(s) (Maximum 3 years) )J yea. (s) El lean effluent filter At least once every: / month(s) year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: _ ❑ month(s) year(s) ❑ NA I=lush laterals and pressure test At least once every: _ '� `'? ❑ month(s) �year(s) ❑ NA -_ _ I)ther: At least once every: ❑ month(s) ❑ year(s) tiA tither. - - - - ---- _ INA , I MAINTENANCE INSTRUCTIONS ilnspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master (Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must iinclude 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 and to check for any ponding of effluent on the ground surface. 'The ponding of effluent on the ground surface may inaicate a failing condition and requires the immediate notification of the local I-egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (f) or more of the tank volume, the entire contents of [he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, hnci any servicing at Intervals of 512 months, shall be performed by a certified POWTS Maintainer. A 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 pOVVTS check treatment tank(s) for the presence of painting products or other chemicals thEit may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of th tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will b� discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to th;e 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 with'n 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the �vaslewater stream may improve the performance and prolong the life of the POWT'u: antibiotics;-, wipes; cigarette butts; condoms; cotton swabs; dogroasers; dental floss• diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting produci;s; 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 safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN the following measures have been, or must be taken, to provide a rode compli,;int If the POWTS fails and cannot be repaired replacement system: 0 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system, The replacement area should be protected from disturbance and compaction and should not be infringed upon by requitjed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the nEied for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruler! in effect at that time, ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POV'FFS technology a holding tank may be installed as a last resort to replace the failed POWTS. ` The site has no,, been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evalual,hon r us 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 POVVTS. Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative ace. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT, RESCUE O� A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE, ADDITIONAL COMMENTS POWTS INSTALLER Name �C_>� `r' ( Phone POWTS MAINTAINER _ Name Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY t t , Name Ddf�• �� �t Name - _ `('� , t Phone s-_ - (� — Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. n f L F� II W • (l l� C (? �►. Z(l'11 Wiscansln Departmen! t Commerce D visio^ of Satet , end lidinos St. Croix Cuurlty Community 6�Ai$MaH Attach complete site plan on paper not less than 6 112 in:U6, but not limited to: vertical and horizontal refere percent elope, scale or dimensions, north arrow, and l: Please print all inform Persons! Informalior, you p+ovioE rne), b6 urod lot L600ndary Property Corner Property miner's Maliiry Address _ I Ctt1; State Zip Code Phons N �14ewCwsbructx) Llsb esidenbal J Number of ❑ Replaoamenl [l Public or cornn-ie,'d Parent material Gwmns! canYrwnts and rex�nunerxiatiazs: System Type aving # El BoringLZI (j� t Plt Ground surface elev. o)�boring # Boring / -Pit Ground surface ele� 1 MO MIWA MM M M Effluent #1 = BOD, > 30 < 720 m;;rL ana f 55 >6ulvwmgrL - tmuant sc = avv, Z av ii FWL- u1 ti _ . —W' CST Name (Please Print) Signature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation ponducted Telephone Number 1432 120th St, New Richmond, WI 54017 / �—� 715-246-4516 Property Owner — Boring # ❑ Boring Pit Parcel ID # Ground surface elev. V ' ft. Page _ __ of Depth to limiting factor In. I O-A Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPO.ff 'Etf#1 'Eff42 �! /� C/ /- -j Z '" 5 j'� /� e J t�`� .................... ❑ Boring.# F] Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. SnI! Annliralinn Rn}n Horizon Depth, In. Dominant Color Munsell Redox Description Qu, Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'Eff#1 'Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft, Depth to limiting factor in. Soil AApNcallon Rate Horizon 'lepth in. Dominant Color Munsell Redox Description. Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'Eff#1 'Eff#2 ' Effluent #1 = BODE > 30 < 220 rrxyl. and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 rng/L and TSS < 30 mg/ - The Department of Commerce is an equal opportunity service provider and employer. if you nced assistance to access services or need -mate rial_in_an-altemate_format, please.contact-tlie-department_at-608.266-3151-or.TT-Y-608�26A-87.77. SUD4330 (R.&W) Soil Test Plot Pla Project Name Travis Dankemeyer S ird Address 687 Coulee Trail Hudson Wi 54016 CSTM #226900 Lot ---- Subdivision ------ Date 12/1/21 SE 1/4 SE 1/4S 14 T 28 N/1319 W Ej Boring Q Well PL Property Line BM or VRP Assume Elevation 100 ft System Elevation TBD Township Troy County ST. CROIX Base of survey stake *H R PSame as Benchmark ST. CR01 NTY SANITARY SYSTEM File #: rl; Office Use Only OWNERSHIP/ADDRESS FORM Created212027 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. Owner/Buyer 1, Mailing Address �] City/State/Zip Phone Numbe Email Address Parcel Identific (found on the property tax bill) OWNERRUYER INFORMATION NEW SYSTEM: LEGAL DESCRIPTION Property Location � 1/4, -.�g 1/4 , Sec. /I/, T 2-4 R W, Town of Subdivision Plat: q V , Lot # � Certified Survey Map # Jl,� I - 1 I , Volume 2- Page #��� Warranty Deed # �53 (before 2006)Volume Page # r- Number of bedrooms J Spec house 0 ye ,Pdno Lot lines identifiable e's O no OFFICE USE ONLY New Property Address ud aei-- 6% e-IL (VV;4;7-3 w address required from Community Development Department for new construction.) i')�� ( to f Initials) (Date) 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 71 S-24S-42S0 Fax cdd@sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi..gov Parcel #: 040-1057-40-005 03/08/2023 02-33 PM PAGE 1 OF 1 Alt. Parcel #: 14.28.19.223C 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 04/20/2022 00 0 Tax Address: KYLE HUERD MADELINE HUERD 5755 W 132ND ST SAVAGE MN 55378 Districts: SC = School SP = Special Type Dist # Description SC 4893 SCH DIST RIVER FALLS Owner(s): O = Current Owner, C = Current Co -Owner O - HUERD, KYLE C - HUERD, MADELINE Property Address(es): ' = Primary * 789 GLOVER RD SP 0100 CHIPPEWA VALLEY TECH Notes: 2022 FOR 2023 RETIRING 040-1057-40-000 & 040-1087-20-000 FOR NEW 040-1057-40-005 LOT 5 CSM 32-7106. (COMBINED 2 PCLS) Legal Description: Acres: 22.620 SEC 14 T28N R19W PT SE SE SEC 23 PT NE Parcel History: NE CSM 32-7106 LOT 5 Date Doc # Vol/Page Type 07/11 /2022 1155763 WD 04/20/2022 1151791 32/7106 CSM 10/14/2021 1141215 WD 08/01 /2017 1051725 WD more... Plat: * = Primary Tract: (S-T-R 40% 160% GL) Block/Condo Bldg: * 7106-CSM 32-7106 040-022 14-28N-19W SE SE LOT 05 7106-CSM 32-7106 040-022 23-28N-19W NE NE LOT 05 2023 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/02/2022 Description Class Acres Land Improve Total State Reason Totals for 2023: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Total 0.00 Special Charges Delinquent Charges 0.00 0.00 789 GLOVER ROAD RIVER FALLS, Wl PROJECT CONTACTS OWNERS: SHEET INDEX KYLE AND MADDIE HUERD SHEET DESCRIPTION 5755 W 132ND ST A-1.0 TITLE SHEET SAVAGE, MN 55337 A-2.0 ELEVATION PLAN 218.280.2465 A-2.1 ELEVATION PLAN A-3.0 FLOOR PLAN DESIGNER: A-3.1 FLOOR PLAN GEOWALL DESIGNS, LLC S-1.0 FOUNDATION 3 FRAMING PLAN KYLE HUERD, PE S-1.1 FRAMING PLAN KYLE. HUERD@GEOWALLOESIGNS.COM C-1.0 EXISTING CONDITIONS 952.303.4843 C-2.0 SITE 3 GRADING PLAN RW-1.0 RETAINING WALL CONSTRUCTION NOTES SYMBOLS RW-1.1 RETAINING WALL CONSTRUCTION NOTES FAN RW-2.0 WALL 1 ELEVATION RW-2.1 WALL 2 ELEVATION TW 990.00 FINISHED GRADE CALLOUT RW-2.2 WALL 3 ELEVATION BW = RW-3.0 SECTION A -A �' OUTLET RW-3.1 SECTION 8-8 4 I RW4-0 CONSTRUCTION DETAILS RIVER FALLS THIS DRAWING IS BEING FURNISHED —I FOR THIS SPECIFIC PROJECT ONLY. 6 ! ANY PARTY ACCEPTING THIS _ DOCUMENT DOES SO IN r_. CONFIDENCE AND AGREES THAT IT 4 SHALL NOT BE DUPLICATED IN } 3-}_ WHOLE OR IN PART. NOR DISCLOSED TO OTHERS WITHOUT 2 �t _ THE CONSENT OF GEOWALL DESIGNS 1 I 12 FEB 2023 STRUCTURAL AND CNN. ADDED KH KH KH C 0 1 09 JAN 2023 CONSTRUCTION SET KH KH KH 02021 GeoWaN Deelpna, LLC. . NoT DRIB Rmwgn pawn DeW Chem ' TITLE SHEET DESIGNS 789 GLOVER ROAD RIVER FALLS, WI BUILT FROM THE GROUND UP' WM1VT.S01A. 1549(76T ROM E.61RNS\ILLE. WN.I1;• 0.2 W141% SINGLE FAMILY HOME DEVELOPMENT PLAN (1M.t10.A110 IMSn W'(M)OM(XM I- E SI RE�oww '_0 916..440 W Wv UEOW AL!DESIGNS WW P-qw Na 6o!e. �s"No: 22ODPO29 09 JAN 2023 N.T.S. A-1.0 rns N>tedna - LL ----------------- RV - - �J _ - ,, now KwWs BELOW. CALL before you dig. - - - - -- , , THIS DRAWING IS BEING FURNISHED'' FOR THIS SPECIFIC PROJECT ONLY. 6 ANY PARTY ACCEPTING THIS_.._ DOCUMENT DOES SO IN J--..... _ :. .._. __. _.. _.... — -. __...-... _ .... ... . �. I - CONFIDENCE AND AGREES THAT IT . SHALL NOT BE DUPLICATED IN WHOLE OR IN PART, NOR 3--It TO WITHOUT 2 -- -- -- - ..-- - - --- ---- -- - i-- �- pHSCL ONSENT OTHERS E COSED ALL I.. -.. _ .� DESIGNS 1 12 FES 2023 STRUCTURAL AND CIVIL ADDED KH KH KH O 2021 GeoWa1 Dm9m. LLC. 0 09 JAN 2023 9D%CONSTRUCTKIN SET No.. 0410 ReeenD KH KH KH 0n DOW Ch" ------------------------ 1)� _ - coot wlfJl lOE •.1]NIt.(MI NOTE: 1. REFER TO STRUCTURAL DRAWINGS FOR ELEMENT DIMENSIONS AND SPANS. 2. REFER TO CIVIL DRAWINGS FOR ENTRY PORCHES, PATIOS, STOOPS, WALKS, DRIVEWAYS, WALL STEPS, ECT NOT SHOWN HERE. 3. REFER TO CIVIL DRAWINGS FOR ALL BUILDING LOCATIONS, GRADING, AND FINISH FLOOR INFORMATION. 4. REFER TO RETAINING WALL PLANS FOR ALL STRUCTURAL RETAINING WALLS AND PLANTING INFORMATION, NOT SHOWN HERE. 5. ELEVATIONS ARE FOR VISUALIZATION. OWNER TO SELECT PRODUCTS SUBMITTED FOR APPROVAL. 6. FOUNDATION WALLS TO BE 8' ICF FOX BLOCKS OR APPROVED EQUAL. FOLLOW INSTALLATION METHODS AS SHOWN BY MANUFACTURER. 7. LOCATE SUMP PIP, ELECTRICAL OUTLET, AND WATER SERVICE LOCATION. 8. ALL WINDOWS AND EXTERIOR DOORS TO BE MARVIN WINDOWS ESSENTIAL COLLECTION IN A STOCKED COLOR (TBD) UNLESS NOTED OTHERWISE. 9. STONE VENEER SHALL BE SELECTED BY OWNER 10. SEAMLESS OVERSIZED GUTTERS TO BE SELECTED FROM CONTRACTOR OPTIONS. u� SCALE UNIT 1 10 5 0 10 20 I I Ter ELEVATION PLAN -�--�--_ DESIGNS. ---- - ---- - 789 GLOVER ROAD "BUILT FROM THE GROUND UP" RIVER FALLS, WI ML\NESOIA. I4X CLIFF RUAD F, BL'P-MVILLF. Mn 493- SINGLE FAMILY HOME DEVELOPMENT PLAN i/INt)RAIKt IefI W(NK)\KMHIIMI\'FM 1'ff: S111,M0\I.MF\"I.IT)WII' p4-Na...-.- IDLY-....- .Sr ' f ea+o 2200P029 09 JAN 2023 1' = 10' A-2.0 N'N'\\ ,..AIN,tLLDF]If:tiS CM1 FOUNDATION PLAN (SEE SCALE) 35 I ! --- — 34.W Now wAars BELOW CALL before you dig THIS DRAWING IS BEING FURNISHED 7 FOR THIS SPECIFIC PROJECT ONLY 6 ANY PARTY ACCEPTING THIS - -- - -- - - - - ' - - -- DOCUMENT DOES SO IN 5 CONFIDENCE AND AGREES THAT IT C _- SHALL NOT BE DUPLICATED IN --- - - - - - - - - - WHOLEORINPART,NOR 3 DISCLOSED TO OTHERS WITHOUT 2 - THE CONSENT OF GEOWALL-- DESIGNS 1 12 FEB 2023 STRUCTURAL AND CIVIL ADDED KH KH KH 0 09 JAN 2027 90 A CONSTRUCTION SET KH KH KH ® 2021 GeoWall DeWws, LLC. No - Dale R-w - - - Drawn Desgn Check BASEMENT PLAN (SEE SCALE) NOTE: 1 FOUNDATION TO BE ICF 8- FOX BLOCKS (OR APPROVED EQUAL) UNLESS OTHERWISE SHOWN. 2. INTERIOR FIXTURES, CABINETS, APPLIANCES, UTILITIES ECT TO BE SELECTED FROM CONTRACTOR OPTIONS BY OWNER. 3. FLOORING FINISHED TO BE AS SHOWN BELOW: EL = ENGINEERED LAMINATE C = CARPET T = TILE PLANKS HC = HEATED CONCRETE 4. ALL EXTERIOR WALLS SHALL HAVE 3.5- (MIN.) CLOSED CELL SPRAY INSULATION. 5. ALL INTERIOR WALLS SHALL HAVE r TYPE "X' GYPSUM BOARD. WRAP ALL STRUCTURAL ELEMENTS. 6. OWNER TO SELECT OUTLET AND LIGHTING LOCATIONS WITH CONTRACTOR. ALL ROOMS SHALL HAVE MINIMUM OUTLET AND LIGHTING REQUIREMENTS PER LOCAL CODES UNLESS OTHERWISE SHOWN. 7. ALL BATHROOMS, STAIRS, HALLWAYS, AND CLOSETS SHALL HAVE LOW VOLTAGE LIGHTING PLACED AS DIRECTED BY OWNERS. 8. SMOKE DETECTORS SHALL BE PERMANENTLY WIRED, BE INTERCONNECTED, SHALL HAVE BATTERY BACKUP AND SHALL HAVE AN ALARM AUDIBLE IN ALL SLEEPING AREAS OF THE DWELLING. 9. ALL BEDROOMS SHALL HAVE CEILING FANILIGHT IN CENTER OF ROOM. L\ SCALE D E UNIT 10 5 J 10 20 •� TW. FLOOR PLAN o,onn DES)(_i1rS 789 GLOVER ROAD "BUILT FROXI THEGROG.11 i i' RIVER FALLS, WI sllN%ESOTA. 149 CUFF RaAn E. BI INSVR LF. MN-1- SINGLE FAMILY HOME DEVELOPMENT PLAN —.01190 I'IaI*ADO IXW w(Ma)AKKM 1)R11'F )t I(1: 101. W^111, a'alsa No. 'DM 5— S-- iw A ..63NDFSK;nacON wwuc;S�wA220OP029 09 JAN 2023 1' = 10' A-3 0 I FIRST FLOOR PLAN (SEE SCALE) } DRpE.}/E n9�y(VK�E tO0.U0l I oaAr - - 1 1 i � I � I 1 1 Y! I 9DNGrtTE Oa I unm M7" 1 ' M Mq puEj I S. rtmeawooa} x ------ --- --- ------------ OOa" f � � ' Q 1 I ar ' neom I I + I i i I I I ' I I I , I I rwu. ' I •-rT •aea" N ' 1 1 � I I I Ti I VML+M M ) u.o � II I / �TI1ry�L I I 0+4 YO Y" 1 I Tj Know w4ufa BELOW CALL belae you dig THIS DRAWING IS BEING FURNISHED 7 , FOR THIS SPECIFIC PROJECT ONLY 6 ANY PARTY ACCEPTING THIS -- -- - -- - - - - -- -- - - -- - '—_ DOCUMENT DOES SO IN 5 CONFIDENCE AND AGREES THAT IT 4 SHALL NOT BE DUPLICATED IN - - - - ----- - -- - + - WHOLE OR IN PART. NOR 3 DISCLOSED TO OTHERS WITHOUT 2 THE CONSENT OF GEOWALL --------- - - DESIGNS 1 12 FES 2023 STRUCTURAL AND CIVIL ADDED KH KH KH 0�09 JAN 2023 90% CONSTRUCTION SET - KH KH KH ® 2021 G-W.11 Des.9- LLC w Dale R-n — - - • Drawn Desgn Cana SECOND FLOOR PLAN (SEE SCALE) a}�}awin awa - w.nwel �eraa ,.�r+wrw asa wowauM+D+KI 1 ' crow so t000a �,_ 9• ,- wow �.a 000a p r El -� amrow MTwbor I •y� .oa 1 • a LL ra 1 PITCHED SPACE >! FROM ROOF LINE ri 3 q e t } '. I�YIIQIV • r c «i� ,�m � m 9 �s - ce.cT NewoE.raa rm a> ow"er �I I HV � � � vnOL1p1 wl rl ROOM T I •� I a =DESIGNS - "BUILT FROM THE GROUND UP'• ML,NE%OTA. I SI" (LFE ROAD E. OI:RNSV LLE, MN a' 7;' •H:.W7.Ilia ! c II A)RAIID InN� W(nR)"KK)R INU\'E 4'fD: Al, McwlrMEti f. fl) Mil )' '_`0.926.eaK1 WWw GLOw'AU DESIGNS COM NOTE: 1. FOUNDATION TO BE ICF 8' FOX BLOCKS (OR APPROVED EQUAL) UNLESS OTHERWISE SHOWN. 2. INTERIOR FIXTURES, CABINETS, APPLIANCES, UTILITIES, ECT TO BE SELECTED FROM CONTRACTOR OPTIONS BY OWNER. 3. FLOORING FINISHED TO BE AS SHOWN BELOW: EL = ENGINEERED LAMINATE C = CARPET T = TILE PLANKS HC = HEATED CONCRETE 4. ALL EXTERIOR WALLS SHALL HAVE 3.5' (MIN.) CLOSED CELL SPRAY INSULATION. 5. ALL INTERIOR WALLS SHALL HAVE r TYPE 'X' GYPSUM BOARD. WRAP ALL STRUCTURAL ELEMENTS. 6. OWNER TO SELECT OUTLET AND LIGHTING LOCATIONS WITH CONTRACTOR. ALL ROOMS SHALL HAVE MINIMUM OUTLET AND LIGHTING REQUIREMENTS PER LOCAL CODES UNLESS OTHERWISE SHOWN. 7. ALL BATHROOMS. STAIRS, HALLWAYS, AND CLOSETS SHALL HAVE LOW VOLTAGE LIGHTING PLACED AS DIRECTED BY OWNERS. 8. SMOKE DETECTORS SHALL BE PERMANENTLY WIRED, BE INTERCONNECTED, SHALL HAVE BATTERY BACKUP AND SHALL HAVE AN ALARM AUDIBLE IN ALL SLEEPING AREAS OF THE DWELLING. 9. ALL BEDROOMS SHALL HAVE CEILING FANLIGHT IN CENTER OF ROOM. SCALE �k # Ta FLOOR PLAN o.gea. 789 GLOVER ROAD RIVER FALLS, WI SINGLE FAMILY HOME DEVELOPMENT PLAN ".J- No Deb. Sc 'i s— No. `22ODPO29 09 JAN 2023 1' = 1D• WARRANTY DEED THIS DEED, made between Travis Dankemeyer, a single person, Grantor, and Kyle Huerd and Madeline Huerd, husband wife, as survivorship marital property, Grantee, WITNESSETH, that the said Grantor, for a valuable consideration of One Dollar ($1.00) and other good and valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: See legal description attached hereto as Exhibit A_ 1155763 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 07/ 11/ 2022 11:55 AM EXEMPT#: REC FEE 30.00 TRANS FEE 1,056.00 PAGES: 2 "The above recording information verifies that this document has been electronically recorded & returned to the submitter RETURN TO: Kyle and Madeline Huerd 789 Glover Rd. Rivcr Falls, WI 54022 040-1057-4(}-0U5 Parcel Identification Number Together with all and singular the hereditaments and This is not homestead property. appurtenances thereunto belonging; and the Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances, except municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, and general taxes levied in the year of closing, and will warrant and defend the same. DATED this day o , 2022. ,��Q,.j N ,.. 7,q� Ali .'L '•: � o AUTHENTICATION Signature of Travis Dankemeyer authenticated this day of , 2022. (Print Name) TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY: Attorney Jordan C. Sundell Ruder Ware, L.L.S.C. Per Legal Description Provided �TA,1 Travis Dan eye • "'•., �9�� . ... P,�' OF 0G ACKNOWLEDGMENT 14",1 11 1111111% "*0% STATE OF WISCONSIN SS. COUNTY OF I ersonally came before me this lay of' 2022, the above -named Travis Da emeycr, to me known to be the person who execute the foregoing in.trument • nd acknowledged the sate I ivhL . -Sherry tabenow (Print Name) Notary Public, State of Wisconsin j /3 r� / My Commission: (Ql 124, St. Croix County 1155763 Page 1 of 2 EXHIBIT A Legal Description Lot Five (5) of Certified Survey Map filed in the office of the Register of Deeds for St. Croix County, Wisconsin, recorded in Volume 32 of Certified Survey Maps, Page 7106 as Document No. 1151791; said Map being located in the Southeast Quarter of the Southeast Quarter (SE 1/4 of the SE 1/4) in Section Fourteen (14) and in the Northeast Quarter of the Northeast Quarter (NE 1/4 of the NE 1/4) in Section Twenty-three (23), all in Township Twenty-eight (28) North, Range Nineteen (19) West, Town of Troy, St. Croix County, Wisconsin. Tax Key No.: 040-1057-40-005 Property Address: 789 Glover Rd., River Falls 4891-3324-7526, v, 1 St. Croix County 1155763 Page 2 of 2 CERTI FI En S V RVEV MAP LOCATED IN THE SE7/4 OF THE SE1/4 OF SECTION 14 AND 1N THE NE1/4 OF THE NE1/4 OF SECTION 23, T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN. NOTE: THIS CERTIFIED SURVEY MAP IS PLATTING TWO PARCELS OF LAND RECORDED IN DOCUMENT NUMBER 1141215 AS ONE LOT. DESCRIBED PARCELS APPEARS TO HAVE BEEN CREATED INITIALLY IN AUGUST 1982 IN DOCUMENT NUMBER 379174. Moss%% Nr U w LU r w ,- cn w co w o b C' w N o w o b z w O w Z w SI/4 COR. SEC. 14 N 88°47'08 "W 1298.31' N1/4 COR. v- SEC. 23 , `� o z w o �� w c� S w; w pl z z r WI = v �I H o 0 O �I � z zS1 L� 1151791 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 04/ 20/ 2022 09:21 AM CERTIFIED SURVEY MAP VOLUME: 32 PAGE: 7106 REC FEE: 30.00 PAGES: 2 GLOVER ROAD r n EAST -WET 1 4 LINE, SEC. 14 -S88°20'35"E 92.60' DRIVEWAY EASEMENT AGREEMENT DOC. #972030 �I w�— rn 1-4 ♦ `", I AIM CD o r \` O r—n O I .M-1 O O Z UNPLATTED LANDS "' Ln 3 Q, SOUTH LINE OF THE NORTH 132' OF THE orn H / cZy :, V112 OF THE SEI/4 OF THE SE1/4, SEC. 14 = S88033'49"E 651.28' 67.79' c.`v ~ LOT 5 22.62 ACRES 985,345 SQ. FT. SOUTH LINE OF THE SE1/4 OF SECTION 14 649.15' 660.07' N88047'08"W 2596.62' NORTH LINE OF THE NE1/4 OF SECTION 23 SOUTH LINE OF THE NORTH 330' OF THE NE1/4 OF THE NE1/4,SEC. 23 N88'47'08"W 660.07' LEGEND Q ST. CROIX COUNTY SECTION CORNER POSITIONED FROM COUNTY COORDINATES. POSITION VERIFIED WITH FOUND ALUMINUM MONUMENT v- CJ w • 1 1/4" IRON PIPE FOUND v w LU w SURVEYOR 0 EDWIN C FLANUM p NORTHLAND SURVEYING, INC. w P.O. BOX 1S2 'n c.�� AMERY, WI 54001 w ►n p g� OWNER � LU p TRAVIS DANKEMEYER CI'SI 687 COULEE TRAIL w I HUDSON, WI 54016 .`�- U- o zl U-o O CO.) w z u� BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE NE1/4 OF SECTION 23, BEARING N88047'08"W. (ST. CROIX COUNTY COORDINATE SYSTEM). THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON JOB NO. 22-12 DWG - CSM DATE 2/09/22 S88047'08"E r 10 92 SE COR. SEC. 14 N88047'08"W 638.24' N w �I NE COR. SEC. 23 o wO cn ? V- N O ? p ZI cr7 w:�i U �ZN 1 F - a= = I v z0z N O ww gl ~ y %.D SCALE IN FEET 1" = 200' 0 200 400 UNPLATTED LANDS St. Croix County 1151791 Page 1 of 2 SHEET 1 OF 2 SHEETS Wisconsin: Departr ten D'vtsia-: a` anc P A i - y� OiL EVALUATION REPOPT Face �f LrJr•1T u�. F�tftS. n3r*':. COoe countYo5- ktiac h co►npiete site plan cc paper not less than 6 ' 2 x inches ir: size. Pian mast in�t, no uda. but limite tc: ve. tica and 'io� �zonta reference in r B� , direci on and Parma pe-,-ent siope, scaiE or dimensions, norr*. arrow, and location and distance tc nearest road. i Please print all infarrnaVor. Re "awed r~v Date Per son& intormatior vo.r provide MSS be use6 for se=naary purposes (e^vacy Lau, s.'•..C>E 1 t Prope-rt O%ner / ' rroperh' t_ocatan n Repia�mertt t �// Parent material �� r_ .1� Goa: corrrneits �0 'art recorr mendatians: A Public or ='Mmei Cade derived design f w rate GPD Fiood Piain elevation if applicabie / Y / ^�� x fL 17 Bones Boring # I� pit Ground surface elev. V �� It. Depth tt; limiting -`actor in. � Soil .4ppiica6ort Rate j 1-folizon Depth in. Dominant Color! Munseff Redox Descripfaw, I Qu. Sz. Cont. Color F Textm Structure ; Gr. . Sz. Sh. Consistence ( Boundary ! r Rood 3PD.� `Efi#� { 'Eff#2 /a, 36L LIZ E t i Bering # 2 Boring p Ground surface elev(/ -2-�_ f. Depth to limiting factor �"� in. { SniE Anntiratinn Rain 4 Horizon Depth in. Dominant Color Munsell Redox Description. Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPDIfF `Eff#Z 'Eff#2 7 L, s I iC, N �— Effluent # E = BOD. > 30 < 220 n yA and TSS ><^ rr � Effluent #2 = BOO. < 30 mglt_ and TS5 < 30 mgI CST Marne (Please Print) Signature CST Number Bird Plumbing, inc. Shaun Bird 226900 Address �, Date Evaluation "onducted Telephone Number 1432 120th St, New Richmond, Wl 54017 XZ�71 ——� 715-246-451 Property Owner - Boring # ❑ Boring Pit Parcel ID # r1 i Ground surface elev. v ft. Depth to limiting factor in. Page of Soil Annliration Rato am Redox Description 7 - - Structure - 61� M----EEWr.��r�a��aFea .14 M /M M WA 1:1Boring.# ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in Soil ADDlication Rate WNreMPIMM."T Off MfP-;W Redox Description Qu. Sz. Cont. Color Structure Gr. Sz. Sh. 0❑ ❑ Boring Boring # Ground surface elev.. ft. Depth to limiting factor in. Pit Soil Anolication Rate MWMNMI�� Qu. Sz. Cont Color "WIM�MMOLUM., MM M �MMMM MM M��M=Mm Effluent #1 = BODE > 30 1220 mg/L and TSS >30 < 150 mglL ' Effluent #2 = BOD5 < 30 rng& and TSS < 30 mg1L 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. SOD-8330 (R.6=) Property Owner Baring # ❑ Boring J4 Pit Parcel ID # Ground surface elev. ft. Depth to limiting factor in. Page _ of _ 4nil Annliratinn p � Horizon _T_ Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'Eff#1 'Eff#2 Boring # ® Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Anniiratinn Rata Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'Eff#1 'Eff#2 1:1❑Boring Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil Application Rate Horizon ')epth in. Dominant Color Munsell Redox Description. Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fl? 'Eff#1 'Eff#2 ' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 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 TT-Y_-608-264-8777. SBD-8330 (RAM) Project Nam Address Soil Test Plot Pelae Travis Dankemeyer ird687 Coulee TrailHudson Wi 54016 M :a,71e 0 Lot ---- Subdivision ------ Date 12/1 /21 SE 1/4 SE 1/4S 14 T 28 N/R19 W Boring 0 Well PL Property Line kBMorVRp Assume Elevation 100 ft. Township Troy County ST. CROIX Base of survey stake System Elevation TBD *HRpSame as Benchmark IroCCIRG Ix cour,ry ST S OWNER KYt.E �i�OEuru PLUMBER BLOCK No. 648415 ARY PERMIT PREVIO NO.-4qj??(t SUBDIVISION CHAPTER 145.135 (2) VWSCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ED ISSUING OFFICER - DAT !q 2AZ3 UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE F OM THE ROAD FRONTING THE LOT DURING CONSTRUC IO Sat"Sat"f�TKtE EfrOR�N► N 1w � � SBD-06499 (RI 1/20) t,� ��6if"VA Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s 15.04 (1)(M)] Permit Holder's Name. City Village Township Travis Dankenmeyer TOWN OF TROY CST BM Elev Insp. BM Elev: BM Description I ANK INF-UKMA I IUN TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMAWN TANK TO P/L WELL DG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Model Number TDH Lift Friction Loss System Head Forcemain Length IDia. Dist. to Well SOIL ABSORPTION SYSTEM De GF M■ ELEVATION DATA County: St. Croix Sanitary Permit No 641974 State Plan ID No Parcel Tax No 040-1057-40-000 Section/Town/Range/Map No 14.28.19.223C Berichmark �I St/Ht Inlet iSt/Ht Outlet lw�==F. Mh.M 'St Cover I Ir ►-Jt1 pm%mm BEDITRENCH Width Length No. Of Tr hes PIT DIMENSIONS f Pres Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L DG WELL LAKE/STREAM LEA G Manufacturer: INFORMATION CHAMBE R UNIT Model Number: Type Of System: UIJ I MIOU 1 IUIV J T J I tIVII Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Spacing Z GUVtK x Press4e Svstems Only xx Mound Or At-Grarlp Svstems Only Depth Over epth Ov xx Depth of xx Seeded/'Sodded xx Mulched Bed/Trench Center led/TrenchEdges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Location: 789 GLOVER RD 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional information. Date SBD-6710 (R.3/97) Inspection #1: Insepctor's Signature Inspection #2 Cert No Py"RT" o= Industry Services Division 4822 Madison Yards Way County ��. / �� a.;Pla Madison, WI 53705 Sanitary Permit Number (to be filled in by Co.) N r� 'S P.O. BOX 7162 oix C��ntY ent Madison, W 07— 9 (O qtState LommU ry ermit Application Transaction Number �' In accordance tih PS 383.21(2), Wis. Adm. Code, submission of this form to the app t ovemmental unit ('� y D �� Project Address (if different than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(1)(tn), Slats. Oq LO, -� I. Application Information Please - Print All Information Property Owner's Name Parcel # Property Owner's Mailing Address 6 •� C Property Loca Z JGovt ��J�'/,, SecII. C� ,State 'Lip Code Phone Number [[[ /Lot N R E pe of Building (check all that apply) # division Name l or 2 Family Dwelling - Number o edroom �� a's � � Block # ublic/Commercial - Describe U4_ Yam_ City of O State Owned - Describe Use Of CSM Number 32 .. �(j lage of �Ril -� �r , own of III. Type of POWTS Permi • Check ei Q el eplacement" and other appy le on ' e A. heck 041 e B. Com a line C if a e. A.Pew System ❑Replacement SystemKtherfication to Existing Sy Addi %ret eatment Unit ( lain) [folding Tank In -Ground and v' ual Site Design Other Type (explain) Li'�:p (conventional) C. ❑ Renewal Before Revision ❑Change ofNPerjransfer 141 to New Owner vious Permit N er and Date Issued Expiration 1V. Dispersal/Treatment Area and Tank Information: Design Flow (gpd) Design Soil Application Rate(gpd/sf) Npers �Ar�ea R ire Dispersal Area (so Sy§te Elevation .; lq�CJ 1 Capacity in Tota # of �oNew Tank Information Gallons Gall Units >Manufac�turer o Tanks Existing Tanks� a U iZ rn w 0 4. Septic or Holding Tank Dosing Chamber V. Responsibility Statement- I, the undersigned, aSA/reSPAf sibIlity for installation of the POWTS shown on the hed plans. Plumber's Name (Print) Q Plu is Si re MP/MPRS Numbe Business Phone Nuraber W A Plumber's Address (Street, City, Slate, Zipf VI. County/Department Use Only IP Approved ❑ Disappro unit Fee Date Issued Iss ing gentSignature r ` ❑ caner en Reason for Denial 645-r l YSTEConditM OWNER:f A !/ 31 ,�A �e-✓)s ��w► J� S�S at.4.Q_ w% 'S Septic tank, effluent filter and v> " -- dispersal cell must be serviced / malntalne n jIf as per management plan provided by plumberu VI -de All setback requirements must be maintained as per applicable code/ordinances. Attach to complete plans for the system and submit to (fie County only on paper not less than 8 1,2 x 11 Inches in size SBD-6398 (R. 03/21) P_& System PLOT PLAN PROJECT Travis Dankenmever ADDRESS 687 Coulee Trail Hudson Wi 54016 SE 1/4 SE 1/4S 14 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 103.0' 17 acre parcel per GIS 4/24/22 3 DATE BEDROOM CONVENTIONAL AT -GRADE %XX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of Chambersnone BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION loo' Filter Lifetime ❑ BOREHOLE WELL *H.R.P, same as benchmark Scale = 1 /4"= 10' M Property Line Huffcutt Combo Tank Grading is to be done to divert run-off away from system N terials, fittings,st comply with84.40 Easement to 40' 801 rN �� =AM M 1 :�—­B-3 Veil is to meet all WDXsetbacks 3 Bedroom Ja 9 .M.* 1041 Area 15' belov7Notem is to remain undisturbAld roperty Line I IAPxRT T o I 3 , DS P May 5, 2022 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 2024-05-05 Plan Review: PWTS-052200765-C SHAUN R BIRD 1432 120th St New Richmond WI 54017 SITE: Travis Dankenmeyer Glover Road Town of TROY St. Croix County Total Amount: $250.00 DIVISION OF INDUSTRY SERVICES 2331 SAN LUIS PL GREEN BAY WI 54304-5211 Contact Through Relay http://dsps.wi.gov/programs/industry-services www.wisconsin.gov Tony Evers - Governor Dawn Crim -Secretary Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIV SION OF I STRY SERVICES 7,1& SEE CORRESPONDEJCE FOR: Description: Three Bedroom At- rade system loped Site Pressure Distribution Component nual — Ve .0, SBD-10706-P (N.01/01, R 10/12) At -Grade Component Manual - Ver. ,SBD 0854 (N.03/07, R. 1/12), 450 gpd, 42 inches to limiting factor from original grade, Maintenanc q ed, effluent filter, New construction The submittal described above has been re ed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statu s. a submittal has been CONDITIONALLY APPROVED. This system is to be constructed and loca d in ad rdance with the enclosed approved plans and with any component manual(s) referenced a ve. The o r, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance ith all code re ements. No person may engage in or work at p mbing in the state un licensed to do so by the Department per s.145.06, stats. The following conditions shall be met uring construction or installation a rior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Prior to construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper soil moisture content can be determined by rolling a soil sample between the hands. If it rolls into a 1/4- inch wire, the site is too wet to prepare. If it crumbles, site preparation can proceed. If the site is too wet to prepare, do not proceed until it dries. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter. Owners shall also receive a copy of the appropriate operation and maintenance manual(s) and be responsible for ensuring that POWTS is operated and maintained in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • 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. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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. In granting this approval the Division of Industry Services 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. 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, <eai* %�� e.1 POWTS Plan Reviewer — Wastewater Specialist Department of Safety & Professional Services I Division of Industry Services email: Katie. Petzel(a-wisconsin. ov Cell: 608-574-1189 Cover Page Shaun Bird Bird Plumbing Inc, 1432 120th St. New Richmond Wi 54017 715-246-4516 Date:4/24/22 Owner:Travis Dankenmeyer Location: SE1/4 SE1/4 S14 8 N,R19W Glover Road Troy Manuals Used: At -Grade Compo nt Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distributio anual version 2.0 SBD 10706-P(N. 01/01 R. 10/12) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Specifications 8.-9. Maintance and Contingency Plan Attachments: Soil Test i r` Shaun Bird Signature ' License numbo5r�6900 Conditionally APPROVED DEPT. OF SAFETY AND PROFESSIONAL SERVICES DIV SION OF I STRY SERVICES SEE CORRESPONDEWCE Page 1 of 9 System PLOT PLAN PROJECT Travis Dankenmever ADDRESS 687 Coulee Trail Hudson Wi 54016 SE 1/4 SE 1/4S 14 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX SYSTEM ELEVATION 103.0' 17 acre parcel per GIS 4/24/22 3 DATE BEDROOM CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of Chambersnone BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELL * H . R . P. same as benchmark Scale = 1 /4"= 10' 0' 40' 80' f Property Line B-2 i Huffcutt Combo Tank f Grading is to be done to divert run-off away from system Easement to Glover Road Slope :r-B-3 B.M.* B.- 1- 102' 1 0 3' 1 0 4' -neet all WDNR hacks Area 15' below system is remain undisturbed Property Line g materials, fittings,ts must comply with4.30-84.40��~ds. a At -grade System Sloping Site Cross Section and Plan View .-_ _ _ _ _ --- _ _ ■- w - _: - _ _ _ _ _ _ _ _ r _ _ _ _ _ _ _ _ _ - E i t �L��.••■.ti.•,■�■•,■•L■•,■L•L■L•L•L.L.,,.L•L,.�•L,'i,L,L,�,L,L■•,.•�.■,■L,L■L,•■.■�,L,ti,■�■L■•�■ti■ti■L. I j.,r.J•J.j.j■J.j.j.J■J•r■J■J•r•r•r•r•r•r•J•r•:•j.j�j.j.j.J■j■j.j.j.j■j■j■j■j.J•J•J•J•. 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L _ obser ion pipe Dimension Feet A z B 7 1 /6 B C D 2.0 E 5.0 F 0.5 G 1.0 L W Slope Lateral with 2" Top '1 Cap F aggregate over pipe Observation Pipe Geotextile G With Cap Fabric •L•ti� J'' Ft L ral In .r.r.r.r■r E'1� ,f.j.j.r■j.■.j. ■j■jij:J:J:rij:j:J■ L•L•'.•L•L•L•L%L•L• L••.•L•ti.•L•L•L•L•L•L• Topsoil Cap .j■j■j•J•J•J•r•J•J■r'r•r•r•r•r•r•r•r•r•r•r ■•L■ti•1�•L•'.•L•L•5� �■ •5.•L•L■L•L■L■L•ti■L•'L 43L r■J■J■r■r•r•J•r•r•, F �r :•:•:::: f: f: f: r: r: f: r: r: r: • 1■j■j.j�j■j■j.j.j■, .j j.f. .j■j. • - .ti.ti••.■ti;ti;,ti...Lr Chi . F ontour ti.ti.L.ti.,,.ti. ,j.j■j.j.j.j■ .j■ :_• t•L■L•L•L•L•L•L L•L• --•=a:f: r:r:r:r:r.j•j•r•r.r-J•r•r•r •r ..s.r.r.j.j`r�j.r•. 1 ti ti ,ti D ti Plowed Surface C Slope Direction GENERAL INSTALLATION: The at -grade area is staked out along the desigri contour. Existing vegetation is mowed and raked off the site. The basal area (L x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a 114 inch soil wire when a sample is rolled between xhe palms of the hands.. The A x B area is covered by clean aggregate deposited overhead by a backhoe. Special care must be used when placing the aggregate to minimize compaction of the plowed surface. After- the topsoil cap is placed, the entire at -grade is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. �2 ^'� 03/051gj Page ''> of Fc Pressure Lateral Layout One Lateral —End Manifold Distribution Network Specifications Lateral Diameter In. Orifice Diameter 12 In. X Orifice Spacing) In. L Lateral Length) Ft. Force Main Diameter Force Main Length � -0 Ft. �---- Threaded Cleanout Plug ,ong Neep 90 trend Pressure SysteConstruction Laterals are con cted of Schedule 40 PVC pipe. Orific are drilled perpendicular to the pipe wi a sharp drill bit and face down. Lateral t -ups terminate with a threaded cleario plug and are enclosed in a 6-8 inch diary r lawn sprinkler valve box accessible fro finished grade. 71 ••••• Grade •••�•••� 6-8 Inch Lawn Sprinkler Valve Box i 1 03/051gi Page of Septic -Dose "tan k. Cross Section And. Pump Performance Specifications Tank Manufacturer Pump Manufacturer, 7"tcnk _Model T!'um_ber -r- Pump Model Number Q� I'ota.l 'Tank Capacity _Alarm Manufacturer Max. Bury Df.pth _ T _ Alarm. Model Number :Filter Manufi.tcturer -Filter Model lumber Minimum Pump :performance Required _ ---�. ' j GPM. I @ Z Ft TDII Outlet Manhole Njin. 4" Above Grade With Locking Device. Inlet Manhole < 6" Below Grade Sealed Watertight �____ • -- —— Finished Grade •,. I.s • � s..�u Outlet Filter `y Wet Baffle ly.il_ Switch Settings and Reserve Capacity Tank Volume =_ �}- GPI y Dimension. Inches _ Volume Gal, (reserve) A; 4, ? -_ (alarm) B ' 2 3 0 (dose) C : (dead) D Total Total Dynamic Head (`rDH) - Feet Elevation Head Distal Pressure • 5 _ Network. Loss Force Main Loss Manhole Min. 4" Above Grade Securely Mounted With Locking Device Weather-proof Junction Box --- t� Vent Min. 12" Disconnect Above Grade Means With Vent Cap A. ' I3 Off Elevation C XIs y— Ft ' '•' T-1'��i-"TTTT'f 1'�s�rr�c��-�i't'1Z- 'cZ-r{-1-f--T-r- ' '' . l,!•{ I I I t 1 a 1{ 1 1 1 1 - t a 1 1 1 l/ 1 1 1 1 1 1 1 1 1/ f 1 1/ I t 1/ 1 1< I','1.1 t 1 1{{/ 1{ I I/ I l a t a 1/ I t 1 1{ 1 't'{ t t 1 1 1.{ I t•, 1 . , 1 • r 1„ r ♦ ♦ Y,i , „ l , / „ / 1 1 , 1 , 1 1 , , , 1 , > 1 1 ♦ . ♦ ! t ♦ I I , 1 1 Y 1 ! , 1 / 1 , T / T I / 1 / T Y ! 1 / / , 1 / / 1 1 , • „ 1 r 1 . , 1 1 , •�.•.'. /.'.•.'.'. •. .•.'. .•.'.'.'. •.'. .'.•. .•.•.'.'.•_ .•. 1. I. .. 1. •. 1_..1_{ ♦_•_ . t •. t.{ a l 1 ♦ . 1 ♦ a t 1 1 ! l 1.1 1 t / I.t 1 1. {. 1.1 , 1. 1. 1. •. t. 1. 1. •. 1. %a" Weep Hole Bottom Elevation Ft GENER. L INSTALLATION: The septic/dose tank is bedded and back .filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be excee(led without p7rior 4pproval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet andoutlet is of approved material, connected to the tank with watertight fittings, and laid on st:ablc soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation aLd the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28. 02/05 U Page of4-- 280-SERIES 1/2 hp Submersible Effluent/Sump Pumps The Liberty 280-Series provides a cost effective "mid- range" pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. Designed around Liberty's unique "Uni-Body" casting, the 280-Series will provide years of reliable performance All Models Feature: • Vortex style impeller permitting passage of solids Up to '/" • 416 stainless steel rotor shaft • Permanently lubricated upper and lower ball bearing Epoxy powder coat finish • All fasteners - corrosion -resistant stainless steel • 1 Y2" Discharge • Stainless steel bottom screen - easily removable • Maximum fluid temperature: 140° F. 280-Series Cord Lengths Model 10' 25'(-2) 35'(-3) 50'(-5) 280 Standard Optional al Optional 281 Standard Optional Option Optional 283 Standard Optional_ Optional N/A 287 Standard Optional N/A r. 10' cord length standard on all models. For optional lenA. add "-2, -3 or -5" suffix to model number. Example: for model 280 with 35' cord, order 280-3 Motor Specifications Y2 hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) Model 280 Manual, no switch ,M 11111 Model 281 Wide angle float switch with quick - disconnect n C us Certified Specifications are subject to change without notice. P 1\ Performance • 35 30 a)25 L 20 "a 15 = 10 5 11 9 8 6 5 3 2 O 1 1 1 1 r 1 I\1 0 0 5 10 15 20 25 30 35 40 45 50 55 60 65 70 U.S. Gallons Per Minute 0 38 78 114 156 192 228 270 Liters Per Minute Dimensional Data: Weight: 29 lbs. Height:13" Major Width: 10" (model 287) Minimum Sump Diameters: Model 281, 283... 14" Model 287 VMF... 10" N C Factory switch Model 281, 283 Model 287 settings VMF Turn on level 13" 9.5" Turn off level 7" 4.0" The Model 283 features a fully adjustable wide-angle float. Differential adjustments can be made easily by tethering the float to the dis- charge pipe or other mounting point. Vertical float model 287 Is not adjustable. IU Model 283 Wide angle float switch with series (piggy -back) plug 6) Id 1-4 'N Model 287 VMF-Series Vertical mag- netic float for smaller pits - will operate in a 10" diameter sump Liberty Pumps • 7000 Apple Tree Avenue • Bergen, New York 4416 • Phone 800-543-2550 Fax (585) 494-1839 www.libertypumps.conl Copyright © Liberty Pumps, Inc. 2017 All rights reserved. LLIT 2000 R05/17 8 s fT- 0 04.5200 I 1'.i000 1iA000 A 1.1921 • VA464 .01 Gop between Case and Serpentine 9.4356 c r � `'�".•J ., *�,;• . inn �L:LDif�taV SECTION A —A mWeE �bc OwUp POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION Owner Permit # J)ESIGN PARAMETERS Number of Bedrooms - ❑ NA i Number of Public Facility Units A, NA j Estimated flow (average) 3b-a gal/day Design flow (peak), (Estimated x 1.5) Jvgal/day Soil Application Rate `� allday/ffz i Standard InfluenUEffluent Quality Monthly average* Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (BODY s220 mg/L ❑ NA Total Suspended Solids {TSS) 0 mg/L Pretreated Effluent Quality Mont .average Biochemical Oxygen Demand (BOD5) S30 mg/L Total Suspended Solids (TSS) 530 mg/L Fecal Coliform {geometric mean) 5104 cfu/100m1 'Maximum Effluent Particle Size in dia, Nq Other. i ❑ NA "Values typical for domestic wastewater and septic tank effluent MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity ❑ NA 9 r_ al Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer �' (� ❑ NA Effluent Filter Model ❑ NA 'Pump Tank Capacity 1� 30 al ❑ NA Pump Tank Manufacturer � 0 NA Pump Manufacturer ,L ❑ NA Pump Model 0 NA Pretreatment Unit /C NA ❑ Sand/Gravel Filter ❑ Peat Filter ❑ Mechanical Aeration ❑ Wetland ❑ Disinfection ❑ Other: Dispersal Cell(s) ❑ NA ❑ In -Ground (gravity) ❑ In -Ground (pressurized) j-Grade ❑ Mound ❑ Drip -Line ❑ Other: Other: ❑ NA Other: O NA Ot ❑ NA i Service Event Service Frequency Hnspect condition of tanks) least once eve every: �� ❑ month(s) (Maximum 3 years) ❑ NA R'year(s) IPump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA !inspect dispersal cell(s) At least once eve every: �-; ❑,month(s) - -year{s) (Maximum 3 years) ❑ NA ISlean effluent filter At least once every: -- _ / ❑ month(s) year(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ months) .� . ,Q year(s) ❑ NA I=lush laterals and pressure test _ At least once every: _ `� month(s) _,❑. year(s) ❑ NA ��ther: At least once every: (s) ❑ ❑ monthmonthyear(s) ❑ NA IDther: , i ❑ NA MAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master (Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must 'include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of 'combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be Visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local 1,egulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (X) or more of the tank volume, the entire contents of I:he tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin Administrative Code. III other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, 13nd any servicing at intervals of s12 months, shall be performed by a certified POWTS Maintainer. la service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATIONng For new construction, prior to use of the POWTS check treatment tank(s) for the presence of paints de rod or other heroic is theft may impede the treatment process and/or damage the dispersal cell(s). If high concentrations tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is n the backed the surface discharge ter willlenle discharged to the dispersal cell(s) in one large dose, overloading the cells) and may result p power e to thle To avoid this situation have the contents of the pump tank removed nuaplta operatinge 'I t9eOpumpocont olsr prior otoeresto a normal levels effluent pump or contact a Plumber or POWTS Maintainer to assistY 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 andsipfectagtsh fatf efoundatioof the On drali,in baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss, diapers, antibiotics; p painting roduCll5; (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scra s; medications; oil; p 9 p 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 safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compli�Irn replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requliied setbacks from existing and proposed Structure, lot lines and wells. Failure to protect the replacement area will result in the nE{ed for a new soil and site evaluation to establish a suitable replacement area. Replaceme/Ing ms must comply with the rule:l in effect at that time, ❑ A suitable replacement area is not available due to setback and/or soil limitations. Bvances in POWTS technologN a holding tank may be installed as a last resort to replace the failed POWTS. She site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evalual;ion ,must be performed to locate a suitable replacement, area. If no replacement area is available a holding tank may be installedl as ' a last resort to replace the failed POWTS. and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infltrative W,-,Nl.ound surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O� A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS - SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name r 1 Name Phone %� - e� �- Phone _> t6/6 C� This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. 7 0 -f ')'- Wisconsin, Department of Commerce SOIL EVALUATION REPORT page of Division o'saiety ant Buiidinos in a=;-oanea v.Tth Cornrn 85, Vklis. Aden. Code C-ounh�� f ttac-h compiete site plan on paper not less than 6 1/2 x i , Inches in size. Plan must I,ndude, but not limited to: vertical and horizonta! reference point (6M), direction and Paro6 I.D. percent slope, scale or dimensions, north arrow, and location and distance tc nearest road. Please print all Informatlon. Reviewed by Gate r-8monoi information you provide mad• tst uwn for ebconoary purposes (Privy y L",, s 15.W (1) (m)). Property Owner Property Location Go��. Lot 1Ig5 !4 S T N R E Pmperty O titer's Malling Address Lot # Bloc" # Subd. Mama or CSM# State Zip Cade Phone plumber 0 city ❑ Village wn N arest Road < 2 / New Constructio7 t. w esidential / Number of bedrooms �� _ Code derived design flow rate GPD ❑ Replaa:,emenl [) Public or =-nimep' -/0 cribe --__-- _-- ---__-._- _-_— Parent material A/z,J.1J !(W A.v ZL-:>�j � Hood Plain elevation If applicable �� Gene!al oa-nments and recomT*ndatians: System Type._ Svstem Elevation`�J Bonng # Boring IZI Pit Ground surface elev. � �, ft. Depth to limiting factor in. Soil dnnlir-aHnn Frafa Rei:�Dx Description MOW, � err a MM MM � F,;—]�ng # 2Boring pit Ground surface ele120 ! ft. Depth to limiting factor in. Cnil Annh ntinn Pain Qu. Sz. Cont. Color SLructure IL_Gr. Sz. Sh. — W-W Mira== MIWA I MAA ` Effluent 91 a E3UU, > 3u < 11U M-7L 8nQ I Z�S M911- cinunr►rc c�vv, _ w .Eyw n. _ �- CST Name (Please Print) Signature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Oate Evaluation onducted Telephone Number 1432 120th St, New Richmond, WI 54017 / -- -2 715-246-4516 Property Owner _ Parcel ID # Boring # ❑ Boring Pit Ground surface elev. , 5 ft. Depth to limiting factor _ �(J in. Page of F Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Struc7Sh.. Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. SzI •Eff#1 I 'Eff#2 Boring # El Boring ❑ Pit Ground surface elev, ft. Depth to limiting factor In. Horizon ')epth in. Dominant Color Munsell Redox Description. Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Effluent #1 = BODE > 30 1220 mgrL and TSS >30 < 150 mg/L ' Effluent #2 = BODs < 30 nmglL 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 (RAM) Project Name Travis SOA Test eme er Plot pla Dank Address Y 687 Coulee Trail S ird Hudson Wi 54016 Lot Subdivision ------ CSTM #22690 0 SE 1/4 SE 1/4S 14 T 28 Date 1211121 -- ---- N/R 19 W Township Troy ❑ Boring O We11 PI, Property i y Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Base of survey stake System Elevation TBD *H R PSame as Benchmark ST. C RO � TY. SANITARY �YSTEIV( jWNERSHIP/ADDRESS File #: Office Use Only FORM created 212027 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 off'our ongoing efforts to PR, roved, 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. Email Address (required)Ovt� Parcel Identification Number (found on the property tax bill) 1 Property Location -$�_ 1/4 1/4 , SecXXI Lot A Certified Survey Map #_ 1 5 ! Vol J ume Page # DA.__D Warranty Deed # `i (before 2 Number of bedrooms Spec house 0 vest' Volume =-- . Page #, Lot lines identifiable -es 0 no 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 odd scowl aov 1101 Carmichael Road, Hudson, WI 54016 715-245-4250 Fax www.sccwi aov (2 LEFTELEVATION ill n RrO•+o•-0- OF OETA& n REAR ELEVATION V 1A• a 1'-0' n INSERTED 3D-2 FRONT ELEVATION 440 SO. FT. 2'124 SO. FT. r+w'•+'� GARAGE MAIN LEVEL 0 30 DESIGN LLC ArcAitectsrst Services (715)248-3010 c� AFlN� ACIr F. cAnM/Me AElN� ANFw FI ti •.Ar carIMIM�A AlFW AYw� FIwM •�r c� AY AYW F F. •wF1 NOTICE! BOLDER TO VERIFY ALL De4ENSKM. SIZES. AND LOCATIONS AND REPORT AM ERRORS PRIOR TO PROCEEDNG. Au ooMTAAcroM LNU•T FALSTATE. TMEMEEWEEIC0ALFEONIA.AW AMO lOtli NMp10 COOEE wMDM NAM' WTTEn. KFECT TOII EGUNBrt OM TY PROJECT, WNOT >►SCFMAtY STATED ON FIAM0M N NE ll I Mi. TIE AFFMOFMwTIn caoE swa ownN N3. OUATY. AHD OUAMTTtE AMO N� OF AL wows A Travis Dankemeyer SINGLE STORY ELEVATIONS FwM.M... R.2+24-2L-32 o.M 54.22 o.wn M BiA QMM•EMRan Al Nrr AS inOrJYA M'•P M _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ __ _ _ _ _ _ _ _ ___ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ 30 DESIGN LLC Architecteret Services (715)248-3010 11Y� FF. .r F cta�rw.w. w�eM Aam sn.r F. .wr NOTICE! BUILDER TO VERIFY ALL DMrENSIONS. SIZES, AND LOCATKM AND REPORT b ERRORS PRIOR TO PROCEEDWD, x i uL oawnucrw rulr ALWA IDT1 fiE1 LVU YwM ALL FED91xLrt�/C ND IO e1M10wOCODE/ wl.Cn. M=IMTTtoI. KflCr CT I "I OR ICWM l TAIID TIEII /R LANs spEcw fIlwwjiIET� OM PMni On w /1'ECIIIGTq" T111 L W . M CODE lu OO ftm ems. awm. Kw aEwlmes.no m or .0 wows A IAIE Travis Dankemeyer 4--f SINGLE STORY - - - - - - - - - - - - - - - - - - - - - - - - - - - FOUNDATION I vwwa..r R•2124-2LJ2 5.4.22 O ww W oil 17.P 'Ai.P i:1FOI11DATION DETAIL CMs.sq n 1.'.P A2 IUY 1w 6 104' I 1I I I I 1 1 I I I I I ------------------------------------ r I I I IxTfww snwr w.0 — -----� I Ir xe0 rilLL �OIxIED ODIIC. 1 I s� 1 DerrrafroiEE9le I I I I 1 I 1 1 I 1 1 1 1 I I I 1 I I I I r-- — --� 1 I I I I I I I I I I I I 1 I I I b I I I 1 I I I �i�i�io �towc g I I 1 I I I wr TOf M6DDOMNe I I I 1 1 I tOn YAe eursonr I I I I I 1 I I 1 b 1 1 1 1 � 1 I I I I 1 I I I S I I I I I I ¢ I 1 I 1 I I 1 1 I I MTin011fwDeT WAIL I I rx�o TNl wawloCac 11 I 1 I 1 I I I I I I I I E I I � I I I b 6 I 1 I I b 11 1 I I 1 I I 1 I I I 1 = I I I I I 11 I I I I I I I r.so.n. ofll.�D son I I No areal 000n I 1 I I I I I I I I I I I I I I 1 ? a•-P ,r.P 20-P s.P tt.a 1 I I I I 30 DESIGN LLC ❑ O _ _ _ _ _ _ _ _ =_i = __ i b Architectoret Seleices b b EAT MKITCNEN (715)248-3010 19.6 %,6.0 ? (-22) i u.P r i� r. a• _ Dw _ i _ b LIVING ROOM Amr. 42- 2. 2&IOX16-0 - 1 --------------------b CarF�NbA- 1abPOSTS I:1NOTICE! M.BEDROOM &11LDER TO VERIFY ALL DIMENSIONS -------------------- 1- rSIZES. AND LOCATIONS AND REPORT 12-10 % 11&O % 13-10_ _ —_—_—___—_—_—_—_ V ERRORS PRIOR 70 PROCEEDING. $ $ I b I b I At O Lyi j ALI CONTRACTGR9 NL18T L3TAniE 1 I a I I TNEMr[lVEB WITNALL FEpEMLaTATE.AM IOCAI rlNL01N4GOOEl E�CHWI N ANv NATTER. AffECTMATE I OREOUPYENT MI) ON iNB MOJEGT fNOT 9PECfIGLly STATED ON ESGI— MPRO ATE CODE SI—GOVERN BQE. PIANr OR W BPECIFIUT1G.18. THE _ 1 I 1 OGALRv ANO WF✓ITttES ANO WE OF All }� WORA y o.r b _—_—_—_-----_—_---, — I b I I A I b A rRTALRELEABE 5an � b ' e -____-____ I I I 1 t I I I 1 I I I 1 ,a.P 1z P I I 1 I I I I b I I I 1 b I I I I b 1 I I 1-140N 1 I I 1 I I — - — - — - — - — - — - — - — - — - — I I I >4 1 I I Travis Dankemeyer b I I I I 1 I 1 SINGLE STORY MAIN LEVEL TS.P to-P 2124 SQ. FT. - R-2124.2L-32 FINISHED °" s.4-22 MAIN LEVEI u � P .z � a =A_ MED DEC 01 2021 wisconsin Departrrrent t Gommer e OIL EVALUATION REPORT Page of Dimsion of Safety and Tidings St. Croix County Co m m u n i ty Dt@ h� h Coma 85, �Yis. Adm. Code CountyS , � l Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must �' include, but not limited to: vertical and horizontal reference point (BMI, direction and Pam I.D.�a�� a , t _ 1 .qO , Q� percent slope, scale or dimensions, north arrow, and location and distance tc nearest road. Please Print aH dnformaVor. Re .ewed b Date Persons! infonsution you provide may be used for secondary purposes (Privacy Low, e. 15.04 (1) (m)}. Prope ty Omer je�Property Location ` ` . Govt. Lot 45 1 /4 � 114 S L T 2g N RIq E ( , Property 0wr *F's (Mailing Address � Lot # Block # Subd- Name or c8wfy1 City State , Zip Code Phone Number ❑ CAy Q \illage . own N giress Road New Construction vss/residential / Number of bedrooms �_ Cade derived design flow rate GPD M Replacement Pubfic or commet� - cribe: Parent material ( � Flood Plain elevation if applicable / °�z X ft_ Generat oonrnents ck-+DA Wyl tS. and recommendations: System Type -9 System Elevation��/� # Boring nn Pit Ground surface elev. V �� ft. Depth to limiting factor 5/ in. Snit Annlirafirs-rn RatF FROM Boring # Boring2 LL Pit Ground surface elej V _ ft. Depth to limiting factor �Z- in. Snit Annliratinn Rafe 0Structure I.,a�.r�r�n��•rr^. �ravo���o • Effluent #f = BOD. > 30 < 220 nv& and TSS > m—a-tl Effluent #2 = BOD< < 34 rng/L and TSS < 30 mgR. CST (Name (Please Print) Signature CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation onducted Telephone Number 1432 120th St, New Richmond, Wl 54017 � , -- �� 715-246-4516 Property Owner Boringg # Boring 51 Pit Parcel ID # Ground surface elev. 0 1 ' �) ft. Depth to limiting factor in. Page of _ Soil Anolirafinn Pn Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fg 'Eff#1 'Eff#2 7- z i I �Z' y Boring.# [:] Boring Q pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth. in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ff 'Eff#1 'Eff#2 Boring 1:1Boring # Ground surface elev. ft. Depth to limiting factor in. El Pit Sail Application Rate Horizon ')epth in. Dominant Color Munsell Redox Description. Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/fg 'Eff#1 'Eff#2 Effluent #1 s SODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD5 < 30 rrKA 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..- TY_608-264-8777. SBD-8330 (R.6J00) Project Nam Address Soil Test Plo:t;Pleae Travis Dankemeyer rd 687 Coulee Trail Hudson Wi 54016 C226900 Lot ---- Subdivision ------ Date 12/1 /21 SE 1/4 SE 1/4S 14 T 28 N/R19 W Boring Q Well PL Property Line BM or VRP Assume Elevation 100 ft System Elevation TBD Township Troy County ST. CROIX Base of survey stake * H R PSame as Benchmark CERTIFIED S V RVEY MAP LOCATED IN THE SE1/4 OF THE SE1/4 OF SECTION 14 AND IN THE NE1/4 OF THE NE1/4 OF SECTION 23, T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN. NOTE: THIS CERTIFIED SURVEY MAP IS PLATTING TWO PARCELS OF LAND RECORDED IN DOCUMENT NUMBER 1141215 AS ONE LOT. DESCRIBED PARCELS APPEARS TO HAVE BEEN CREATED INITIALLY IN AUGUST 1982 IN DOCUMENT NUMBER 379174. ti ^' 77 w Ln N Uj Cc z t. LL O o� cnW o� lLn a Iw o 0 z LL O S1/4 COR. SEC. 14 N88047'08"W 1298.31' N1/4 COR. :!!� SEC. 23 w N c Z Lj c0I W W �I LL W of Z Z r �1 H W N Sm :�I W O C aI � z -5 COD GLC C���/I�D MAR U 7 2022 St. Croix County Community Development 4f.51'1'1 -oto 3 a- - 0 19 M M GLOVER ROAD - DRIVEWAY EASEMENT —•-I �'-�'8 20'35"E 92.60' AGREEMENT DOC. #972030 ?:IFlir` Ln inlr"t OIL O rNi C) UNPLATTED LANDS N SOUTH LINE OF THE NORTH 132.00' OF THE W1/20F THE SE1/4 OF THE SE1/4, SEC. 14 .� �/ �onq'ti S88033'49"E 651.28' 67.79' c,'V 'V. Bore ®S ® ® LEGEND 0 ST. CROIX COUNTY SECTION CORNER POSITIONED FROM COUNTY COORDINATES. POSITION VERIFIED WITH MONUMENT AS NOTED OR TIES OF RECORD LOT 5 22.62 ACRES 985,345 SQ. FT. SOUTH LINE OF THE SE1/4 OF SECTION 14 NORTH LINE OF THE NE1/4 OF SECTION 23 SOUTH LINE OF THE NORTH 330.00' OF THE NEI/4 OF THE NEI/4,SEC. 23 N88047'08"W 660.07' I v wUv cn w F LL O Ln o, W 1ji �gi LL T_ 0 C w w ch a 0 LL o 0 y w z u� 3/4" X 18" IRON REBAR SET WEIGHING 1.50 LBS. PER LINEAR FOOT 1 1/4" IRON PIPE FOUND SURVEYOR EDWIN C FLANUM NORTHLAND SURVEYING, INC. P.O. BOX 152 AMERY, WI 54001 OWNER TRAVIS DANKEMEYER 687 COULEE TRAIL HUDSON, WI 54016 BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE NE1/4 OF SECTION 23, BEARING N88°47'08"W. (ST. CROIX COUNTY COORDINATE SYSTEM). THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON JOB NO. 22-12 DWG - CSM DATE 2/09/22 S88047'08"E 1U•92' SE COR. SEC. 14 1— N88047'08"W 649.24' u- �* 0 NE COR. SEC. 23 cnl o ; N O ZI M Wwu m �l zzw 3 U_ of (V ZOZ N ' O W Gko SCALE IN FEET 1" = 200' 0 200 400 UNPLATTED LANDS SHEET 1 OF 2 SHEETS C (3 — ged�roa+�) Sr elzo IXOUNTv NO. 641974 STATE ANITAI�Y�PERMIT n(LoVdt OWNER PLUMBE TOWN AND/O bAN MEYEe LOT rj BLO HIS PERMIT EXPIRES PREVIOUS NO. SUBDIVISION CHAPTER 145.135 (2)-'ISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. ORIZED ISSUING OFFICER - DATE UNLESS RENEWED BEFO POST IN PLAIN VIEW �Vzz THAT DATE VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20) State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number j Document Name THIS DEED, made between Nathan L. Maier and Brianne C, Hartung- Maier, husband and wife ("Grantor," whether one or more), and Travis Dankemeyer, a single person ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in Saint Croix County, State of Wisconsin ("Property") (If more space is needed, please attach addendum): 1141215 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 10/14/2021 03:26 PM EXEMPT#: REC FEE 30.00 TRANS FEE 600.00 PAGES: 2 "The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address: Travis Dankemeyer 1-�irdsen, uX-e:54- of 6 040-1087-20-000, 040108720000 and 040-1057-40-000 Parcel Identification Number (PIN) This is not homestead property. SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, r c rdder- bu lding and use restrictions and covenants, and general taxes levied in the year of closing. Dated: 1� Nathan L. Maier -L11 Brianne C Hartung -Maier AUTHENTICATION Signature(s): Nathan L. Maier and Brianne C. Hartung, Maier, husband and wife authenticated on TITLE: MEMBER STATE BAR OF W ISCONSIN (If not, _ authorized by Wis. Stat. § 706.06) THIS INSTRUMENT DRAFTED BY: Chris Staats, Scrivener EA-21-0809-P 4330 Golf Terrace, Suite 103 Eau Claire, WI 54701 ACKNOWLEDGMENT STATE OF - ):SS COUNTY OF Personally came before me on 0 the above named Nathan L. Maier and Brianne C. Hartung -Maier, husband and wife to me known to be the person(s) who executed the foregoing instrument and acknowledged the same. Notary Signature Notary Public, `(,"- My commission ( is permanent) l /3 t (expires). to (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. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 'Type name below signatures St. Croix County 1141215 Page 1 of 2 EXHIBIT "A" Parcel 1: The West 1/2 of the Southeast 114 of the Southeast 1/4 of Section 14, Township 28 North, Range 19 West; EXCEPT the North 132 feet. Said land being in the Town of Troy, County of St. Croix, and State of Wisconsin. AND The North 330 feet of the West 660 fi :et of the Northeast 114 of the Northeast 1/4 of Section 23, Township 28 North, Range 19 West. Said land being in the Town of Troy, County of St. Croix, and State of Wisconsin. Parcel 2: Together with an easement for ingress and egress over a parcel of land located in the Northeast 1/4 of the Southeast 1/4 and the Southeast 1/4 of the Southeast 1/4 of Section 14, Township 28 North, Range 19 West, as described in Document No. 972030. Address: Vacant Land Glover Rd. Tax Key Nos.: 040-1057-40-000 and 040-1087-20-000 (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. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 'Type name below signatures St. Croix County 1141215 Page 2 of 2 7� CERTI VI En S V RVEY MAP LOCATED IN THE SE1/4 OF THE SE1/4 OF SECTION 14 AND IN THE NE1/4 OF THE NE1/4 OF SECTION 23, T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN. NOTE: THIS CERTIFIED SURVEY MAP IS PLATTING TWO PARCELS OF LAND RECORDED IN DOCUMENT NUMBER 1141215 AS ONE LOT. DESCRIBED PARCELS APPEARS TO HAVE BEEN CREATED INITIALLY IN AUGUST 1982 IN DOCUMENT NUMBER 379174. N C/DI �I of �I I �I �I L) w ti � w N W a0 T w 3 0 o o" N o w o z o F- z � 0 w z S1/4 COR. S EC. 14 N88047'08"W 1298.31' N1/4 COR. SEC. 23 „ N c z coJ w S f1'f LL- I� W '0 I LU LU 0 Z Z r Ll l w N �I F-- o to w C QI w O Z jl GLOVER RO 1151791 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 04/ 20/ 2022 09.21 AM CERTIFIED SURVEY MAP VOLUME: 32 PAGE: 7106 REC FEE: 30.00 PAGES: 2 AD EAST`WEST 114 LINE, SEC. 14 or -88°20'35"E 92.60' DRIVEWAY EASEMENT--� AGREEMENT DOC. #972030 I w `n �s ~ i ol� O rn Z UNPLATTED LANDS "i SOUTH _^~i q� LINE OF THE NORTH 132' OF THE oML6 W1/2 OF THE SE1/4 OF THE SE1/4, SEC. 14 "/ /oti S88033'49"E 651.28' = 67.79' -~ 6 LOT 5 22.62 ACRES 985,345 SQ. FT. SOUTH LINE OF THE SE1/4 OF SECTION 14 649.15' 660.07' - - - N88'47'08"W 2596.62' NORTH LINE OF THE NE1/4 OF SECTION 23 SOUTH LINE OF THE NORTH 330' OF THE NE1/4 OF THE NE1/4,SEC. 23 N88047'08"W 660.07' UA(PLATTED LANDS St. Croix County 1151791 Page 1 of 2 Ww w to w F w 0 U) Q� W LC7 �r LEGEND Q ST. CROIX COUNTY SECTION CORNER POSITIONED FROM COUNTY COORDINATES. POSITION VERIFIED WITH FOUND ALUMINUM MONUMENT • C/DI of �I I 6-I 1 1/4" IRON PIPE FOUND SURVEYOR EDWIN C FLANUM NORTHLAND SURVEYING, INC. P.O. BOX 152 AMERY, WI 54001 OWNER TRAVIS DANKEMEYER 687 COULEE TRAIL HUDSON, WI 54016 BEARINGS ARE REFERENCED TO THE NORTH LINE OF THE NE1/4 OF SECTION 23, BEARING N88-47'08"W. (ST. CROIX COUNTY COORDINATE SYSTEM). THIS INSTRUMENT DRAFTED BY MICHAEL ERICKSON JOB NO. 22-12 DWG - CSM DATE 2/09/22 S88047'08"E 10.92' SE COR. SEC. 14 N88047'08"W 638.24' v N w �I NE COR. SEC.�23 o w 0 m Q} w ._i NCJ N9 = W �I ~ Z w w � O 0 I ~ Z N Z wCL I y N to � SCALE IN FEET 1" = 200' 0 200 400 SHEET 1 OF 2 SHEETS ��- %iD(o