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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538814 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No 7 C&J Builders Inc. Troy, Town of 040 1303-00 OS CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No /IX) ~rn I G5r 22.28.19.1807 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ' 7-2 L 9 iu~• is Septic ~ " ~ /Z SQ Benchmark Dosing Alt. B 756V P6 (G J Z~ Bldg. Sewe P g• s5 q~i«4 Holding St/Ht Inlet V ] fZ. 0_5 TANK SETBACK INFORMATION St/Ht Outlet TANK TO W /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet W > 7 Septic 9L ✓ Dt Bottom .3 21 S 7 Dosing 73 t / Header/Man. T(c 17, 5V7 Aeration Dist. Pipe "_17' 41Holding Bot. System 7 7~ Final Grade .79 PUMP/SIPHON INFORMATION 2.q(o `n• q7 ak ock Manufacturer Demand St Cover aQ q / O • T 2 GPM ✓ 244 Model Number TDH Lift9 74 Friction Los Sys Hgad• Z~ TDH , Ft Forcemain Length f Dia. j( Dist. to Well z SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No. renc s PIT DIMENSIONS No. Of Pits Inside Dia. Ligaid Uegth'- DIMENSIONS /05V SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION f A 'I g CHAMBER OR Type Q~ystem: UNIT Model Number. DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size / / x Hole Spacing / Vent Air Intake Z • tJ _ CJ Length 3 / Dia Z Length .SO Dia Spacing 3 3 11(4 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only ` Depth Over Depth Over ` xx Depth of xx Seeded/Sodded xx Mulchee Bed/Trench Center I • Bed/Trench Edges \ Topsoil I (~L Yes No vrs N COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: D1Dspection Location: 259 Walnut Hil arm River Falls, WI 54022 (SE 1/4 SE 1/4 22 T28N R1 9W) Walnut Hill Farm. aka The Tribute Parcel N 22.2. 9.150' 1.) Alt BM Description 2.) Bldg sewer length = 2 S -amount of cover = y ~ / O~ Plan revision Required? ❑ Yes No 9.. ~t♦ `A %5 175 FV i Use other side for additional information. I _ Date Insepctor's ignatur Cer No SBD-6710 (R.3/97) . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538814 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No. Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Parcel Tax No 7 Permit Holder's Name: City Village X Township Troy, Town of 040-1303-00-0--~. C&J Builders Inc. Insp. BM Elev: BM Description: Section/Town/Range/Map No I El CST BM Elev: 22.28.19-1807 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. ark Septic FAIt.BM Dosing on Bldg. Sewer Aerati Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Dt Bottom Septic Header/Man. Dosing Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number rForc Lift F riction Loss System Head TDH Ft emain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Da. Liquid Depth DIMENSIONS LEACH ING SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER OR Manufacturer. INFORMATION Type Of System: UNIT Model Number. DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only rulched-- Deth Over Depth Over xx Depth of xx Seeded/Sodded P Bedrrrench Edges Topsoil 7, -1 Yes Nc BedlTrench Center Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2 / Location: 259 Walnut Hill Farm River Falls, WI 54022 (SE 1/4 SE 1/4 22 T28N R1 9W) Walnut Hill Farm aka The Tribute Parcel No: 22.28.19.1807 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = No--- Plan revision Required? ❑ Yes FM Use other side for additional information.- - Date Insepctor's Signature Cert No SBD-6710 (R.3/97) eommeree.wl.gov Safety and Buildings Division County ■ . 201 W. Washington Ave., P.O. Box 7162 i sco n s i n Madison, WI 53707-7162 Sanitary Permit Number (to filled in by Co.) Department of Commerce O O 53 --Zy-- Sanitary Permit Appli n State TransactionNumber In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of form t~g>~ppmmen 1 WIZ2 4 unit is required prior to obtaining a sanitary permit. Note: Applicati form s e S e submitted to the Department of Commerce. Personal information Provide may erect Address (if different tl>$n mailingaddress) purposes in accordance with the Privac Law, s. 15.0 1 in , Stats. yo be used for sewn +Df 1'N]dltf rlT/ 11 (•V h tc~ t 1. A lira Ion Information - Please P Al I rmatio All Property Owner's Name C- Parcel # T ST. Ck j;-: !;uN l Y Property Owner's Mail d s PLANNING R. ; C►d O V - 13 a 00- d / ~ Property Location Q - /80-7 City, State Govt. Lot Z Zip Code Phone Number I ~L 6 y., Section t / /r1 V{/ r- ?i -?J," 9 ? -3 f scrrole one II. Type of Building (check all that apply) of # T N; R ! Y E o<b l 1 or 2 Family Dwelling - Number of Bedrooms 9 21 Subdivision Name ❑ Public/Commercial -Describe Use 6k- 46 ❑ City of Gee ❑ State Owned -Describe Use CSM Number I ❑ Village of 0 ✓ ~ Town of 1 r 0 III. Type of Permit: (Check on y one boz on line A. Complete line B if applicable) A. New System ❑ Replacement System D Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision D Change of Plumber D Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner l IV. T of POWTS S Stan/Component/Device: Check all that apply) D Non-Pressurized In-Ground D Pressurized In-Ground D At-Grade KMound > 24 in. of suitable soil l ound < 24 in. of suitable soil D Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (explain) 01 V. Dis ersaU'I'reatmentArea Informatiqn: Design Flow (gpd) Design Soil Appli 4Ra (gpdsf) Dispersal Area Required (s Dispersal Area Propo (sf) System Elevation VI. Tank Info Capacity in Total # of , Manufacturer L Gallons Gallons Units c New Tanks Existing Tanks 9 U c,/ 1'd lad, Septic or Holding Tank C i 1 Dosing Chamber J l ati ' d~ yL VII. Responsibility Statement- L the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI ber's Si MP/Iv4'RS Number Business Phone Number V to S',- l / r7 ~t Plum is Addtess (Street, City, State Zip e)~ ~s - `Jl i 1 s 'I~1 r ¢a VIII one /De artment Use Only Approved F-M Permit Fee Date Issued Iss ' ent Sigma ven Reason for vial $ ( 0,25 • C6 IX. Condi ' ' easons for Disapproval ~ 1. Septic tank, efNuent finer and dispersal tell must all be ae &N/MM okmd r as par management plan provided by U `A'` Q A-'^ Numbef, 2. se aCkrequ eli:lents must.bel,"W ibw Attach to complete plans for the system and su t 10 the C o on per not less 81rz 1 11 In In size' , t SBD-6398 (R 02/09) ~r~~~aaor~ a~Lart , Cor ~v UD i 1 v1 ;1 a _W_r- PP [}~y -1 ( J, n1 H4c,ter! J (55 ~ err r Safety and Buildings Commerce.Wl.gov 3824 N CREEKSIDE LA HOLMEN WI 54636 Contact Through Relay i www.commerce.wi.gov/sb/ epartment of Commerce www.wisconsin.gov Scott Walker, Governor Paul F. Jadin, Secretary August 02, 2011 CUST ID No. 220554 ATTN.• POWTS Inspector CARL P HEISE ZONING OFFICE CARL HEISE EXCAVATING ST CROIX COUNTY SPIA W9905 710TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/02/2013 SITE: Jeff Husby Identification Numbers 259 Walnut Hill Way Transaction ID No. 1979284 Town of Troy Site ID No. 770112 St Croix County Please refer to both identification numbers , SE1/4, S22, T28N, R19W above, in all correspondence with the agency. Lot: 72, Subdivision: Walnut Hill Farm FOR: Description: Four Bedroom Mound System / 8% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1328081 Maintenance required; 600 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System(s): Ezflow Mound Component Manual, (R. 8/07), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter 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 l_ 011"di 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, ANT stats. DEPARTMENT The following conditions shall be met during construction or installation and prior to occupancy or use: DIVIS+DN Of SAF Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the SEE CORRE requirements of Sec. 145.135 and 145.19, Wis. Stats. • 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. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A cony 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 CARL P HEISE Page 2 8/2/2011 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. 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 Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. 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. Sincer~elyy,~ Fee Required $ 250.00 *erard Fee Received $ 250.00 Balance Due $ 0.00 M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. JUL 2 2 2011 L ~.FETY & 3UILDINC';' Total Excavating,, N8618 1090th River Falls, WI 54022 Tel (715)426-1777 Fax (715)425-7314 TITLE SHEET MOUND SYSTEM FOR BEDROOM RESIDENCE Lo T 72, LOCATED IN THE _5g_1/4 OF THE 1/4 OF SECTION T,2_ N, R_L W TOWN OF T ROV ST ro)~ COUNTY, WISCONSIN. INDEX PAGE 1 OF 7 TITLE SHEET PAGE 2 OF 7 SYSTEM MANAGEMENT PLAN PAGE 3 OF 7 PLOT PLAN PAGE 4 OF 7 PLAN VIEW - CROSS SECTION PAGE 5 OF 7 DISTRIBUTION PIPE LAYOUT PAGE 6 OF 7 PUMPING CHAMBER CROSS SECTION Clonally PAGE 7 OF 7 PUMP PERFORMANCE CURVE VVED COMMERCE PREPARED FOR I'rAND BUILDINGS 'Se~-t Au4y 514 57ectl~eaA 17r 'P DENCE Pcvi►- F,013 WX S4o~ 2 PREPARED& Carl Heise CST/MPRS 220554 W9905 710th Ave. River Falls, WI 54022 Cell 651-492-8594 Fax 715-425-7314 This plan has been prepared in accordance with the SBS Manual Z j=10 6) `40(LhP (R, 43/07 Cor,npe4 end rcSS ute- D)5 t Po1iGw7 SFjD _ 10 70/ N 01 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L BODS, 150 mg/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD-105;942 IR..102)j and local or state rules pertaining to system maintenance and maintenance reporting. S ST>41j°tz P ( XJ C, t/o o +(K . T, ~V No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a componerit of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector. fit?! k- a A ' r~.l bD, DD L bt C, OYhGy o~ 1 1 l1 ~ 1 a. y ~a /vr c~ PF~~©s ~ aaYn, N~Gme, 155" 4 ofi '7 Approved Barrier Cover Filt Material- ` Distribution Cell Cap-.. y 4J. i .P),: G ~ ~ ~ ' 7~. a ~ ~ ifs i i~ p ~ j .y .'r __-_$d - Tilled Area Slope +Figure I Detailed cross-section of a mound Cross Section Of A Mound Systrrn Usin4 E 0'4 A Bad for Ttte Absorption Area P L G 0. A Ft. H 1~ s Ft. I )j0 Ft. . Ft. Y, Ft. Alternate Pcsiticri L Ft. • of W. Force Main W w._ s r J' Observoiivn Pipe-.~ o Fro aq o i .W... w m d t7istributicn ~Sed Of !fir- 2 ~2. Pipe Drain Rack I M • ~ t~btarvatioati Pope Permanent. Marker - P1pe or Rods # : Plnri Viewf.,lound llslrr _ Sod For The Absorpilon - 4~2`n=AY_t'~. ,•.3p+•i.~..'.• _ Y.~.^r ar.-«'c'. ~"•~_y„`~5:~\-i.'~a ~.:.7~~.:_:. tr;•' LUND PUILDERS INr, Distribution Pipe Layout p,$ge S of place the holes at the bottom of the distribution pipes at equal spacing, Remove all burrs from the pipe and holes, Extend the end of each lateral up with the use of long t= or 457 fi ' Inches of the final 91ade. Terminate the ends of the laterals with a val e tt a point within si,Y cip 0. threaded plug. Provide access from final ~e for the valve; threaded ~p of threaded d plug;,. . ay. -PNJ C. Ma i~kl~ PV C. • tatQr~l ...,i~~i;., x x x s2 xa x r l rfrnl tnclh - x Lrt- erai Unmh - P oin;~b~on 'nt ` PLt~N V~~ p . 07. S IVNdLf_ T' G`60 0 CtCGK. + PEP,47-:P W._._ P~~F F- Hole Diameter inch S 7 Ft~ t Lateral -_Z _inch (es ) x 2 -Inches Manifold " 2 inches Force Main if _ inches #of holes/pipe_ Invert. Elevation of-Laterals Ft . G.P.M. Page 0f SEPTIC TANK &'PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4" VENT PIPE 12" MIN. ABOVE GRADE & 25' FROM DOOR, WINDOW OR WEATHERPROOF FRESH AIR INTAKE JUNCTION BOX APPROVED WITH CONDUIT MANHOLE COVER FINISHED GRADE W/ PADLOCK & WARNING LABEL f ~._--4" MIN. 1B IN. 6" MAX. INLET , WATER TIGHT SEALS GAS- , ` lea `1 T -'lLT TIGHT i `A SEAL \1APPROYED APPROVED , ALM JOINTS WITH PIPE B ~ APPROVED PIPE ~ ON 3' ONTO PUMP OFF ELEV. FT, SOLID SOIL OFF RISER EXIT D PERMITTED ONL IF TANK MANUFACTURER 3" APPROVED BEDDING UNDER TANK HAS APPROVAL CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE TANK MANUFACTURER: jam, ~OIUG NUMBER DOSES PER DAY: TANK SIZES: SEPTIC 50 GAL. DOSE VOLUME INCLUDING DOSE - GAL. FLOWBACK: GAL. ALARM MANUFACTURER: Sg ~~~-Q CAPACITIES: A MODEL NUMBER: 0 1-~ _ INCHES = _ 4_QQ____GAL. SWITCH TYPE: ~ ,µy B = 2 INCHES = d?.f_GAL. PUMP MANUFACTURER: C MODEL NUMBER : _ r INCHES = _L 32,L& GAL. SWITCH TYPE: gt,C. r, D = JZq INCHES = REQUIRED DISCHARGE RATE GPM ,q GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE + MINIMUM NETWORK SUPPLY PRESSURE . 9,00 FEET + 5 FEET FORCEMAIN X FEET S FT/100' FT. FRICTION FACTOR FEET T.OTAL DYNAMIC HEAD = LS 0 FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH LIQUID ~T DIAMETER s HEAD CAPACITY CURVE TOTAL DYNAMIC HEAD/CAPACITY PER MINUTE MODEL 15/153 EFFLUENT AND DEWATERINC J MODEL 152 153 50 Feet Meters Cal. Liters Go[. Liters 153 5 1.5 69 261 77 291 ;2 40 152 10 3:1 61 231 70 265 0 a 15 4,6 53 201 61 231 cv 30 20 6.1 44 167 52 197 Z 8 25 7.6 34 129 42 159 30 9.1, 23 87 33 125 s 20 35 10.7 o 22 85 40 12.2 11 42 a 10 Lock Volve: 38.0 Ft. (11.6m) 44,0 F' (13.<m) aids" 0 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 s 1/4 3 27/32 4 S/8 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/32 Timed dosing panels available. Electrical alternators, for duplex systems, are available and supplied with 3 27/32 an alarm. Variable level control switches are available for controlling single phase systems. Double piggyback variable level float switches are available for variable 1 I level long and short cycle controls. Sealed Owik•8ox available for outdoor installations. See FM1420, ' Over 130'F. (54•C.) special quotation required. I 1521153 Series 12 1/8 ' 1521153 MODELS Control Selection 14odeI i yoKs•►h Mode Am s she lex Du bx Nt52 ' its 1 Non 8.5 1 2or3 5 1/s BN1521 115 t Auto 8.5 included 2or3 E 152 2J0 1 Non 4.3 1 1 or3 s+aae. BE 152, 230 1 Auto 4.3 included 2o(3 N153 : 115 1 Non 10.5 1 2or3 8Ni53 115 t Auto 10.5 IncAlded 2or3 SELECTION GUIDE E i53 230 t Non 5.3 1 2 or 3 BE 153. 230 1 Auto 5.3 IrKAlckd 2 or J 1. Single piggyback variable level float switch or double piQpybadc variable level fbal switch, Refer to FMO477. o CAUTION 2. See FM0712 for correct model of Ebctrical Abrrlator E-Pak. Ali installation of controls, protection devices and wiring should be dam by a qualified 1•censed electrician. All electrical and safety codes should be followed Including the most 3. Variable level txxltrol switch 10-0225 used as a txxltrol iClivitor. specify duplex (3) recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA)., or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. LWL ro; Po. BOX 18347 ! Louiayft, KY 40266-0347 A Off. SHIP TO. 3649 Cane Run Road • Loulasilie, KY 40211.1961 hrrP://wsvw.zoaller.com AM U& 49, (502) 778.2731.1(800) 928-WJA4P ~P SAC! 19a~9 FAX (502) 774-3624 0 Copyright 2001 Zoeller Co. All rights reserved. 6 0 3 8 4 STATE BAR OF WISCONSIN FORM 3 - 2000 Tx:4021836 DocummtNitmber QUIT CLAIM DEED 938028 BETH PABST THIS DEED, made between Citizens State B REGISTER OF DEEDS ank Grantor, and C & I ST. CROIX CO., WI Builders Incorporated, Grantee Grantor quit claims to Grantee the following described real estate in St 06/24/2011 08:56 AM Croix County, State of Wisconsin (the "Properly'): EXEMPT#: NA REC FEE: 0.00 Lots 33, 43, 44, 49, 55, 58, and 72 of Walnut Hill Farm, All in the Town of TRA i NS FEE 3 23.40 Troy, St Croix County, Wisconsin.. PAGES: 1 t Recording Area Name and Return Address: Title One # 16514 Together with all appurtenant tights, title and interests, 040.1303-00-072, 040-1300-00-049, 0401303.. Property sold ras is'. 00-058, 0401303-00-043, 040-1303-0x044, 040-1303-00-055, 040_1303-00-033 Parcel Identification lYumber tPIN) This is not homestead property. * omas W. Van Pelt, President & CEO AUIIIENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN =f ST. CROIX COUNTY. ) )ss authenticated this Personally came before me this l 7th day of .Lune, 2011 i # the above named Thomas W, Van Pelt, President & CEO of Citizens State Bank, to me known to be the person(s) who TITLE: MEMBER STATE BAR OF WISCONSIN executed the foregoing instrument and acknowledged the (If'not, same authorized by § 706 .06, Wis Slats) I'HTS INSTRUMENT WAS DRATTED BY pA• JPO~P 7 E~r1 p`s~r el M ae er o{ Notary Public, State of Wisconsin Michael H. Forecki, Attorne My commission is pennanent. (if not, state expiration date: (Signatures may Be authenticated or aclmowl 8/26/2012 edged. Both an not nec ) 'Names of persons signing in any capacity must be typed or ) printed below their signature i QUITCLAIM DEED STATE BAR OF WISCONSIN 1 of 1 FORM D►o 3-2000 O 00>>O I r-1;0 r Dr Z r iU? {MCI If \\\\\\\\\\~\\\\\\,`i G T O -n O r r W r A r x T0ocri, C/) O cN1,"liuV~l\\\\\O\\V T n ;0 r- D Z O cNi, --I ICI I I II m m ^ w . Mrs r 0 ~~w m y ° cnrs m o ~mOT C) m- 0 on _-n Xa=' m Dv n ~O0 o; cn cflO m = N T 'J X cyl C/) M C') C.0 ~w m 0 D c v \h~~ \ ® O 0 ° i) = Z C') (n r ~ . III ! rn = O O En ~ u ~ III I tV CO) C7 W N D O r C7 m c -i W D 2 n 70 n °v mom Cl) O V N ~ A O CT rn v~1 ~ O N ~ IOP1 ? O W Ui A V 00 O O S _ 0 ? W O N n N N N 3 u C _ O O A 3 00 O N V 3 W Ul O O A "I u © O O O p ® ® ® O ® 111111111110111111 II -0 -0 D , m N ion cnc) O o~ m Q N O r D OD ~ cC C ' Z _ n c C m z r o ~ C C/) M C ° c z x c n rn x ? c rte- m m °z m -J T = m m rn °m ~ zCD 0 o O Z fn v 0 a~ 00 W O W W Jam. O W N Cr 0 O 7 1€ I ` I I E ATTET1 Iµ0SIowl D Br ANµIs.P~n~,A~R~ E 1/1 cORNKa 69011 WALNUT HILL FARM ~ K89'iF45'E132D.11' of 12 1 ,w.a' u1.1!' 721N' 1u.u• gall tN.li n~le' Nuslyr N2.". 8 1 :l ---I• 1----, I---- --42 --i. LOCATED IN PART OF THE SOUTHEAST 1/4 OF THE SOUTHWEST Wrotor 7 M1 I \ \ I Bl 45 I I 4/ 51287 5F I" 1/4 AND IN ME SOUTHEAST 1/4 OF 48 11E SOUTHEAST 14 AND IN I IR 43 8 / 8 Ac a / W \ 1 Al +6u3 sr. 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LEGEND 1,34 At. lost 8147 At n rmuiu wwaa worrom N ~a~'~. I y 1 el 1.01 At, PROPOSED OAAEMY 1 Pon I' WOKE APE r .k -1, q r, LOOAOKNIS PUAO CC6FS D oky EASE6B8 Y AIANRIW YONUUOt J%Us ` 1 s au7m' W 11rw 2 si n~1\ / : 5 IADNCSEEB106 N V11/4'BY18'goAN \ 25~~~ sa9TVIf226.30' INb,r It UTILITY EASOfNF SJn6 >4 R 01 ,c 11 Ac e5 29 7 10N1,- (NlE55 OTHEM IgTE0) V. 1172 LIS./PT. s 3 1 22 a1' \ I 12 = r , _ ~ - - - PAW EASIMNS ~ >fl 3/4' r II' WON AN NINE • 0 WATER U WRKIN 4 ALL Ore LOT M%m a'raeAa~~ I'~ 71'96711 S.F.I^ - 81 1- -1 g 1 I 2 + O''lryr LBO • Loasr Rat09t OrEx _ > n f V dA ^I 1.14 Ac, IOU 61 27 1„ 1 2B I1na2 Sr ,V=nl I- E' 761 SrIu 1 J. A $5 E - - - - 1 6 . 145273 S.F_ tl 1 10 , i POPES 5.m 3UFM SPAO 1 ` 1.27 Ac s 8 L - - - J h( ~I 11.04 k" u1 29 1 SI p'1 / 32 ary 17 31/75 S,f V M1 i / 15261 $c OUD4T 4 ra v b oa / . _ ,1 rl 1 197625 p. 11 : 1 t 1 1.25 31 4.54 Amt 1 'N~ i I ^ 15109 S.F. '_J 1 1^ , 1.01 At ~ 7- - - 14 06!' , 97.OJ' .9rJ l 707.55' qa 75716a-iJS 2)29.11' - SOUTH LINE OF D( SE 1// SE CONNEa S 8915'16' W 2362.12' M'IATTEQUNOS SEC 21 . MD-fr9Tin RCIAZ a/E6iC3 SHEET 3 OF - ~cd w/ Wisconsin Department ofCo~ EIS SOIL EVALUATION REPORT P Division of Safety and uildings Page of in accordan with Comm 85, Wis. Ad c Attach complete site Ian on er o 8 1d12 11 inches in size. Plan 71st T 1 include, but not limit to: vertitand horizontal refece point (BM), direction and l` percent slope, scale r dimer sid6gPi "Nk andd ation and distance to nearest road. Parce1T D. a P NING & ZONING 00FICD -~3U3 -DD -.8 8101%wol tion. viewed Date Personal information you provide may be used f r seconds ry purposes (Privacy Law, s. 15.04 (1) (m)). "7 2.P KS Properly Owner Property Location i Govt. Lot 1 /4 1 /4 S T Property Owner's Mailing sTe `S N R j(or)1N t Lot # Block # Subd. Name or CSM# 17r, 1.JA1 N r'I City State zip Code Phone Number VY) ❑ City ❑ Village ~ Town Nearest Road a 5 46ZZ 1r% ) - 73 rt'R 5 GIM58 F ew Construction Use: Residential /Number of bedrooms Code derived design flow rate Ma 51 to" 00 GPD eplacement ❑ Public or commercial - Describe: nt material Flood Plain elevation if applicable N A ral comments ft. and recommendations 7 I ST 14 L 4 MOUND W/M j N 6" APPJ?O V r p 59N D ON C0N70UR x.1.91 © Boring # Boring pit Ground surface elev. -0-ft. Depth to limiting factor_ in, Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Applicati GPD/fon Rate in. Munseii Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 d- % t F W ® Boring # ❑ Boring © Pit Ground surface elev. JA' o ft. Depth to limiting factor in. tion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil GPD/fF in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#i `Effit2 Cad .S 1D ~ ~ ~ 3 ` Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD < 30 CST ame (Please Print) - _ mg/L and TSS = 30 mglL Si a CST Number Address 5 L Date Evaluation Conducted Telephone Number 4 -S9) LJ s 9 nnr~ o~~n mirrmn~ J ~ LoT 7 2 W~ n k ~ 141 1 1 FIX Property Owner Parcel ID # Page ~ of a Boring # ❑ Boring q Pit Ground surface elev. _ g, Depth to limiting factor -2a_ in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff l 'Eff#2 i -C)-/Z jolk 4 S. ! _ 7f 3 _4 j o C2d ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Descrip Soil Application Rate lion Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring Ground surface elev. El pit ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-~ ' Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 m g/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SED-8330 (R07/00) -FLA k) 0 i 3 zOT 72 WALNUF 141L1 FArm SCALF I : 54 ' ~,V CEPTWN5RF I)I'MEI~Sir) nED _ IAC F3 h44 1 ~Tpp ol Pe nk! La 1 COVncy Ot,4h w N - I - Trees a ~fu5h 'JI p (b l ' _ QN 2.7 ?4 ql, 8 S LOT G o,-tr I Parcel 040-1303-00-072 07/27/2011 12:56 PM PAGE 1 OF 1 Alt. Parcel 22.28.19.1807 040 - TOWN OF TROY Current 0 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner CITIZENS STATE BANK O -CITIZENS STATE BANK 375 STAGELINE RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 259 WALNUT HILL WAY SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.100 Plat: 09-092-WALNUT HILL FARM 1/75 040-03 SEC 22 T28N R19W PT SE SE WALNUT HILL Block/Condo Bldg: LOT 072 FARM LOT 72 (1.100AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 22-28N-19W SE SE Notes: Parcel History: Date Doc # Vol/Page Type 03/05/2010 912825 SD 03/28/2006 821622 WD 12/10/2003 748768 2471/594 WD 11/19/2003 747018 9/92 PLAT 2011 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.100 48,800 0 48,800 NO Totals for 2011: General Property 1.100 48,800 0 48,800 Woodland 0.000 0 0 Totals for 2010: General Property 1.100 48,800 0 48,800 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 . B-0` 3=215` 24'-0* - - 0 e' Daum uwl___ - - r , , e•O' Nigh , - . - - - p`'• ` 4Vi"IYrd ~D 5'-6" x 2.2ii° 6'-3Y~ ° O Fut Faintly Room u+mw,m m s' ug Mech. urmNtim U~xcavatcd %5'-p9ia <'-455° ~ 4 ,I 1 I' 1 1 1 1 1 1 !'O x 6'e' s'~ ..O p r-i--i-• ~l r-0• . 6~~• p ' 514 ' I 4 a3, -lf- - - ' 1 a . - gg _ O d e:; Bath .r m m i , . - - - U^excevated 1 . - O - 2 2' -0" y 32 6 ° a` c~oundation Man Scale W P-o 1156 sq. F, ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer t -1 J : t ,fit' Mailing Address T S~ c Y, Property Address 5 I (Verification required from Planning & Zonin epartment for new construction.) City/State 1r T Parcel Identification Number 0 E 4G paLEGAL DESCRIPTIONProperty Location _5J '/4 Sec. vPt , T,9 9 N R P? W, Town of T r 41 r, Subdivision Plat:_ 1AA)h L4- 4 r , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # q 3 8o 0?1 (before 2007)Volume , Page # Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms Vk - g/9/avfl SI NATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) STe CROIX COUNTY NPLANNING ZONING EROSION & SEDIMENT CONTROL PLAN Site location: 259 Walnut Hill Way, lot 72, Town of Troy Owner(s): C&JBuilders Inc. Parcel ID #22.28.19.1807 Code Administr., ion 715-386-4680 Under St. Croix County Zoning Code 17.70(3)(b) 5: "The (Zoning) Administrator may attach reasonable erosion prevention conditions to a permit approved for issuance." In Landlnformatimi ti addition, Wisconsin Uniform Dwelling Code Comm. 21.125 requires the building permit Planning applicant and/or landowner to follow erosion control procedures and maintain them until 715-386-4674 the site has been stabilized (Uniform Dwelling Code Comm 21 is available on-line at: www.commerce.state.wi.us/SB/SB-DivCodesListing.html) Real Property 715-386-4677 The Owner of the above parcel is responsible for notification of all contractors performing construction activities on this site that an Erosion & Sediment Control Plan is in effect and the Recycling following activities will be required in order to maintain compliance with the plan: 715-386-to73 1. Maintain existing vegetation wherever possible to minimize erosion and sediment movement. The primary source for construction site runoff will be the house foundation and driveway excavation, well drilling, and soil stockpiled until final gradin<-1 and stabilization is complete. Septic system installation adds to temporary disturbance, but establishing cover on exposed soils will prevent erosion. Apply seed and mulch as recommended in #5 below. 2. Install construction entrance before any excavation begins!! Construction equipment and vehicles must utilize a stabilized driveway access off public road for heavy equipment; this includes cement trucks, well drillers, and other contractor's vehicles that require access to the property during construction. Avoid muddy, rutted conditions that may allow contaminated runoff to reach waterways and/or drainage ditches. Property owner must repair damage to ditches resulting from multiple access points and sediment tracked on public roadways must be removed at the end of each workday. 3. Do not allow contaminated runoff to be directed onto neighboring property or into surface water conveyances. Create temporary diversions graded ALONG CONTOUR between excavated areas and any potential receiving waters (this includes driveway & road ditches) by routing contaminated runoff into vegetated buffer areas on owners property. (A specification sheet for temporary diversions is available from coun(y). 4. It is likely that contaminated runoff will not be contained with temporary diversions, so installation of approved sediment control products (straw wattles, silt fence, etc.) as shown on engineer's site plan will be required. The POWTS inspector and/or building inspector will evaluate ESC plan effectiveness and recommend additional action required to comply with applicable regulations. Control measures should be installed prior to mound plowing. ST. CROIX COUNTY GOVERNMENT CENTER 1101 CARMICHAEL ROAD, HUDSON, W1 54016 715..386,1(;b C, ; nX PZPCO.SAINT-CROIXWI. WWW C Q.SAINrCRoix i u-,, Page Two - ESC Plan Acknowledgement Form 5. hilize exposed soils (septic system included) with seed and mulch immediately after installation - 1_~O i OT wait for final stabilization and/or landscaping of entire site to establish permanent cover on the site. V'hep late-season weather conditions will not permit seed germination, a heavy straw mulch cover will preN ernt erosion until vegetation can be established. Erosion control matting can be applied any time of year and.. if installed properly, will provide protection even if seed germination is delayed. The owner ofrecord during site construction will be responsible for compliance with state and county code requirements as specified in this Erosion & Sediment Control Plan. Please feel free to contact me with questions regarding erosion & sediment control product installation. PLAN PREPARED BY: RYAN YARRINGTON, SOIL EROSION INSPECTOR #683475 Owner ackrno~wled ement of ESC Plan requirements: / /2011 (Please sill and return original ESC form to Planning o ling ept. A copy is attached to the owner's permit and mainteiiance agreement, which is given to the plumber at time of permit issuance.) Provide copies for excavation contractor, plumber, and town building inspector as needed ST. CROIX COUNTY GOVERNMENT CENTER 110 1 CARMICHAEL ROAD, HUDSON, W1 54016 15 3f~G r5r'c f lx PZPCO.SAINT-CRO/X.W1.US WWW,CO._SAIN[_CRJIX ill.',;<_; SOIL EVALUATION REPORT Page of 3 Wisconsin Department of Commerce Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code CountyST = G~' 0/' t~ Attach _ H include, but notE EROSION CONTROL PLAN must be Parcel I.D. pe'.vptAn, 6-- percent 'S completed before sanitary permit issuance Reviewed by Date Personal Mfomm"n you provide may be used nor secondary purposes tFnvwY Lew. u.u% 171 IM)). Property owner C 7'0PD Property Location D!C ZL ZD / p z-'o0P 133EP5 T-e7fl T- Yn Ally 9 Govt. Lot All 1n 5 IM S T N R / / (or) W Property Owner's Mailing Address Lot # Block # nNarne oSIM ' t ( fA to o I S CA Its ~/vL>: City sNWa State Zip Code Phone Number, ❑ City ❑ Village R Town Nearest Road ~c &P#06 H13 MAJ 5S07CP (&5tj ZY8• TROY so. o- love: R o Q - D a New Construction Use: IA Residential J Number of bedrooms Code derived design flow rate GPD ~ 0 Replacement ❑ Public or commercial - Describe: A Parent material /0'es S Flood Plain elevation if applicable G and eneral comments Sys w~0%, ,2,- /f AJP # Boring ®Pit Ground surface elev. ft. Depth 9 factor ~ in. Sod Rate Horizon Depth Dom Redox Description Texture Structure Consistence Boundary Roots GPDff Dominant 'Etf#1 'Etf#2 ~ in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. i p• A0 3 Sig 2 s ~S w 3f . 5 ~ Z 7-,2 M o T-S 41 a 4 y6, G `r 0 sss ` ® Pit Ground surface elev. Soft. Depth to limiting factor in. Sod ication Rate ' t Horizon Depth Dominant Redgx Description Texture Structure Consistence Boundary Roots GPDJf* Color - Gr. Sz Sh. 'Eff#1 Etf#2 in. Munsed Qu. Sz. COM- Color 6•1q 0 3 S 1, 2 Shy 'i N Z, •3 6 S G/ S CS . 3 . S N 3 CZB N0 rs SL 'rv~ o Y2 ~f4 I -EE- Effluent #1 = BOD > 30 < 220 mglL and TSS >30 < 150 mglL ' Effluent #2 = BOD < 30 nQ& and TSS 30 Signature CST Nurrttremg/L r CST Name (Please R. W-B R i C k-7-- ZZ G 3~ 5 Date Evaluation Concluded Telephone Number Ate" Ulbricht & Assgciates © . ?t s. 77a. • 3 yy Z.. Private 2812 10th Ave. Spring Valley, WI 54767' ' W&onsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code County 57. Gie o/ A_- t• Attach complete C muds, but not EROSION CONTROL PLAN must be Parcel I.D. 1- 07- /N M tee's d. pe.vDN 6- completed before sanitary permit issuance b Reviewed by Date Personal information you provide may be used W secondary purposes (vrwacy l aw, s. mu% i V tm))- Property Owner Q/ 7'VA9 ,J Property Location p 0 O T"O AP Z3 ERS T-~fl T- /O A~~ ~/'l• Govt. Lot 1'11 tp S S IM S ZL T ZB N R E (or) W - TA Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 0 L5 CA I{-iLL AV-p- • WASNOr Kill FARA-( ~ City SNWR State Zip Code Phone Number ❑ City Q Village ( Town Nearest Road &PPOE if T5 MTV 5So7CP ( &5t)Zyff• to9~ _-Roy SO. MovER New Construction tJse: C§Residential! Number of bedrooms Code derived design flow rate 0 r Da GPD ❑ Replacement ❑ Public or commercial - Describe: tA Parent material AQ e-5 S OZZ , ~tnn.Q 'ti !/S Flood Ptm elevation if applicable ft. General comments e and recommendations: . ~ A- k/1 Sysr? 4i /dye. /2 S-v~7 7,1'/ j ❑ # ® PBoring 5*S5 Boring N it Ground surface elev. V. S o ft. Depth to limiting factor Z in. Sol Applicabon Rate Horizon Depth DominardClow'Worl Redox Description Texture Structure Consistence Boundary Roots GPDlff: b in. Mtnsell Qu. Sz. Cont.Color Gr. Sz Sh. 'Eff#1 'Eff#2 i D• 10 3 Sig 2 s d15 4- f w 3f , s N Z 19- _214 6 G c. Z • 3 kA r✓z M o r- G V6" • Z • 3 0 # ❑ Boring / / SSA a t3orirg ® Pit Ground surface elev. o ft. Depth to limiting factor 3Z in. Sol Application Rate Horlaon Depth Dominant Color Redgx Description Texture Structure Consistence Boundary Rows GPD1fft in. Mu nsell Qu. Sz. Cont color Gr. Sz. Sh. -Eff#1 -Eff#2 d• ~Y o 3 G 2 shy -5 N CS . z- N z 111-321 6 Y/ Z_ 3 czee No 15 SG nft-f . 3 . S i o Y/R Effluent #1 = BOD > 30 < 720 mglL and TSS >30 < 150 ngA_ ' Effluent #2 = BOD < 30 mg& and TSS 130 nglL C' Name (Please Pritt) •n , -fit LB R i c th-' Signature GC Ulbricht & Associates Date Ev~~0f1 COf Telephone Number Private D 9- 715- 77A • 3 Y l Z- 2812 10th Ave. Spring Valley, WI 54767+ y~ PLOT PLAN WALNUT HILLS FARM. LOT # Pg. 3 of 3 © = Contour elevation lines. = Backhoe Soil pits. Q = Benchmarks set maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. SCALE : 1 2 O FI N LNG Lo -r 13)q 33 ~ 30 s G 16Y GoT fAs 1' 133 "0 -AZA- a 7 9S 9 1 a 3 ovT Lo T