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HomeMy WebLinkAbout042-1079-20-130 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538822 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: Oevering Homes LLC, Go Kenneth J. Oeverin I Warren, Town of 042 - 1079 -20 -130 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: QY1/� CST 29.29.18.450A30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ; CAPACITY STATION BS 1O � FS F Septic J rf (� u �t �w Z Jdd Benchmark , 167 ` / Dosing d'd0 �� f l \ j Alt. BNJ=,` CIR jO Aeration �e4A' Bldg. Sewer 6M �7T / )&q. Holding 1"'• SUHt Inlet x 161. TANK SETBACK INFORMATION SUHt Outlet TANK TO 4 WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic f� i Dt Bottom ,Q• D �7• t/ Dosing / an Header /Man. T Aeration Dist. Pipe Z • 13 � 65157 Holding Bot. System 7 e Final Grade o a ft PUMP /SIPHON INFORMATION D • ��(o • 6 Manufacturer 6 14 J� GP Ra St Cover t �A 6 / �4 III .S 1 L Model Number ,E t-{- ��' IIIJJJ 66. o ko., r 3. /63.1 TDH L jW Friction Loss System HeaA TDH1 . Q F D Forcemain LeZC th� Dia.. Dist. to Well SOIL ABSORPTION SYSTEM B DIMENSIONS Width Length No. O rench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S / 11 � SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type f stem: CHAMBER OR 4 / UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold �� Distribution Z x Hole Size I x Hole Spacing Ven Air Intake J Pipe(s) `/� Length 4 Dia Z Length JT Dia Z Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx M !;, Bed/Trench Center BedlTrench Edges Topsoil 04 1 Ys No Yes _, ! [ No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:IZ / Inspection #2: Location: 790 103rd Street Roberts, WI 54023 (NW 1/4 NW 1/4 29 T29N R18W) NA Lot 2 G t�i yeQ, rcel No:: 29.29.18.450A30 1.) Alt BM Description = • `• �V^ �vtJ`' Pld(r,,� P /a W d ' 2.) Bldg sewer length = 9 g - amount of cover = n n Plan revision Required? 0 Yes 'No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Si ture I Cert. No. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 538822 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: Oevering Homes LLC, c/o Kenneth J. Oeverin I Warren, Town of 042 - 1079 -20 -130 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 29.29.18.450A30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil F Yes 0 No Fm� Yes ® No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 790 103rd Street Roberts, WI 54023 (NW 1/4 NW 1/4 29 T29N R18W) NA Lot 2 Parcel No: 29.29.18.450A30 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? U Yes W No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) RE PA Comm .W1. S afety and Buildings Di ' n I - -- S i . t ikOIX C UNTY 201 Vi. Washington Ave., P.O. BoXTt63�.., ..rr t�C /• 0 1 SCO & 20NI G OFFICE I Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co ) Department of Com Q' Q Sanitary Permit Application State Trans Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental I l 1 1 unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted the Department of Commerce. Personal information you provide may be used for secondary a purpo in accordance with the Privacy Law, s. 15.04 I (m , Slats. e t a / I. Application Information - Please Print All Information Property Owner's Name Parcel # D--10 7 7 7 JO - 13D Property Owner's Mailing Address Property Location `I 33 t? an Ao cto P Govt. Lot_ r 5b ` J' 9 .3a City, State Zip Code Phone Number y, %,� Section II ype of Building (check all that up Lot # — 2 Family Dwelling - Number of Bedro _ _ Z Subdivision Name D!G 4. a 9 4n�-' Block — ❑ Public /Commercial - Describe Use f ❑ State Owned - Describe Use CSM Number ❑ Village of own of,.4e x7 (a y�_ III. ypr of Permit: '(Check only one box online A. Complete line B if applicable) _ t ❑Replacement System ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B• ❑ Permit Renewal ❑ Permit Revision ❑ ❑Permit Transfer to New Issued of Plumber Chan g List Previous Permit Number and Date Isd f Before Expiration Owner IV. Type of POWTS System/Component /De vice: Ch eck all that a ) ❑ Non - Pressurized In- Ground El Pressurized In- Ground ❑ At -Grade Mou d _ >_ 24 in, of suitable soil ❑ Mound < 24 in. of suitabl soil ❑ Holding Tank ❑ Other Dispersal Component (explain)_ -___ _ ❑ Pretreatment Device (explain) _ V. Disp ersal/Tr eat ent Area Information: Design Flow (gpd) Design Soil Application e(g :rsal Area Requir s Dispersal Area Propo System Efevarion VI. Tank Info apacity in Total # of Manufacturer Gallons Gallons Units ° o New Tanks Existing Tanks l w ° 0 g cG U in vi — - -- - — 111 Septic or Holding , runk -- -- Dosing Chamber VII. Responsibility Statement I , the undersigned, u e responsibility fin installation of the POWTS shown on the attached plans. Plumber's Name (Print' Plu Signature MP /MPRS Number Business Phone Nurm i k, c-;d D k _ -Z 7i alb - VII, Plumber's Address (Street, City, State, Zip Code) Z...- Zo e t x j VIII oun /De artment Use Onl _ _ _ Permit Fec Date sued Issuing t Signature pp A roved �iven Reason for Denial IX. Condit ' &.?EJf 1 @9WRWasons for Disapproval \ Q n 1. Septic tank, effluent filter and J IQ t1• `iiJ�Gi dispersal cell must all be servle / maintained t is per management plan provided by plumber.` 2..M t> tegtlfl'em" must.be maintained , DKIMIft" _4 Attach to complete plans for the system and sulinjifto the County only on paper not less tha a 112 x 11 inches i ze I SBD -6398 (R. 01/07) Valid thlu 01/09 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 NW 1/4S 29 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 104.7' BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100° Filter BEST GF10 -8 ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark 102' B.M.* Property Line 6% Slope 103' 2 acre lot 13- 103.7' Area 15' below 104' system is to Scale =1 /4 n = 10 B-2 remain undisturbed Grading is to be done to divert B -1 run -off away from system Huffcutt Combo Tank Tank is to be properly bedded and provided with lockdown covers with approved warning labels Pro 3 bedroom. house 348' Property Line 103rd St. Safety and Buildings ,TOT b1E 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188 -3789 s Contact Through Relay c www.commerce.wi.gov /sb/ e www.wisconsin.gov Scott Walker, Governor ��OsSroNP�sti` Paul F. Jadin, Secretary August 15, 2011 ATTIC' POWTS Inspector CUST ID No. 226900 ZONING OFFICE SHAUN R BIRD ST CROIX COUNTY SPIA BIRD PLUMBING INC 1101 CARNIICHAEL RD 1432 120TH ST HUDSON WI 54016 NEW RICHMOND WI 54017 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 08115/2013 Transaction ID No. 1981137 Site ID No. 770386 SITE. Please refer to both identification numbers, Oevering Homes above, in all correspondence with the 790 103RD St a Town of Warren St Croix County NW 1/4, NW 1/4, S29, T29N, R18W Lot: 2, FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1329006 Maintenance required; 450 GPD Flow rat 30 2 oil mini d ess Distribution n Component S ystem(s): Mound Component Manua Vers 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 e n b een osed approved ved plans and AP PROVED. th any ompo ent manual(s) be constructed and located in accordance wit 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 he 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: This system is to be constructed and located in accordance with he enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD - 10691 -P (N.01 101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD - 10706 -P (N.01 101). �. o The float switch shalt be a type that does not contain mercury. 2009 Wisconsin nor to installation of float switches or relays that contain mercury. Please specify a hs 'opQRT . applying for a sanitary permit. No �iFNp• $ The building sewer and distribution network piping shall be of material list 0 -3 and 84.30 - C 5, Wis. Adm. Code. �RF In the event this soil absorption system or any of its com t hazar in he approved plans. in addition, the owner the property owner must follow the contingency plan as describe must comply with the operation, maintenance and monitoring duties as described in section VIII of the mound component manual. A copy of this information must be given to he owner upon completion of the project. Page 2 8/15/2011 SHAUN R BIRD All holding/treatment tanks are to comply with Comm. 84.25(7)(a). 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. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145. inspection of the private sewage system installation is required. Arrangements f or i ns ect n shall be made with the designated county official in accordance with the provisions of Owner Responsibilities: the operation Comm 83.52 Responsibilities. The in accordant w th chapter responsible nd t e approved management plan and maintenance of the POWTS occurs under s. Comm 83.54(1). Comm 83.52(2) 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. Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. opy of this letter and the POWTS management plan to the owner and any The above left addressee shall provide a c others who are responsible for the installation, operation or maintenance of the POWTS. Fee Required $ 250.00 Si ly, Fee Received $ 250.00 Balance Due $ 0.00 Julia Lewis OsborneJiSMAFLT,.c4de,fi3 POWTS Reviewer 2, Integrated Services (262) 397 -6005, Fax: (608) 283 -7481 julia.lewis@wisconsin. gov Cover Page Shaun Bird RECEIVED Bird Plumbing Inc. JUL Z 9 201 1008 192nd Ave SAFETY & BUILDINGS New Richmond Wi 54017 715- 246 -4516 Date: 07/ 27/11 Owner:Oevering Homes Location:NW1 /4 NW1 /4 S29 T29 N,R18 W 790 103rdst. Warren System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -8. Maintance and Contigency plan 9 -12. Soil test 13. Filter Specifi i s and cross section Shaun Bird Signature License n er 226900 h� y 6,u ��F PLOT PLAN PROJEC Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 NW 1 /4S 29 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 104.7' BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark 102' B.M.* Property Line No- 6% Slope 103' 2 acre lot B- 103.7' Area 15' below ' 104' system is to Scale =1 /4 i � = 10 B-2 remain undisturbed Grading is to be done to divert B -1 run -off away from system Huffcutt Combo Tank Tank is to be properly bedded and provided with lockdown covers with approved warning labels Pro 3 bedroom house 348' Property Line 103rd St. Mound System Cross Section and Plan View ` Dimension Feet . A _— B S i D T Y } :tt E r. im . W W is L Z G H J T s I a3 r i J 7 i _K r — L �� - --------------------- - - - - - -- - - - -' W K B Z Slope L .. " 1 = Topsoil = ASTM C -33 y = Clean aggregate = 4 in. sch. 40 pvc Cap Material sand fill '/z to 2 %Z in. dia. observation pipe Geotextile H Fabric k$ F ` `' ]fit D E '7 Ft Contour Plowed Surface Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour, Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is 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. ASTM C -33 quality sand is placed. immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10 /071gj Page of Pressure Lateral Layout Two Laterals — End Manifold -o- ­— Threaded Cleanout / Lateral Turn -up — —► Plug Manifold �/ M X --� Force Main Long ! 1 Sweep 90 Bend U ' Distribution Network Specifications Pressure System Construction Lateral Diameter Z In. Manifold Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) In. the pipe with a sharp drill bit and facie down. L Lateral Length) Ft. Lateral turn -ups terminate with a i1readed M (Manifold Length) Ft. cleanout plug and are enclosed in a 6 -8 inch Force Main Diameter In. diameter lawn sprinkler valve box accessible Force Main Length Ft. from finished grade. ••••• Grade ••••••• :b •••(1000• 6-8 Inch Lawn Sprinkler Valve Box Page of 03/05 lgj se tic Tank Cross Section And Pump Performance Specifications Pump Manufacturer -- --------- •r Manufacturer Pump Model Number Tank Model Number - Total — Tank Capacity 7 Alarm Manufacturer - eeelm Bury Depth Alarm Model Number 12 Max. Switch Type 'Wco - l am 1 Total Dynamic ead (FDFI) -- Feet Filter Manufacturer ff e Filter Model Wu 6L: la Elevation Head o zo Distal Pressure Network Loss '7 Minimitin Pump performance Required Force Main Loss ' —:- 1, j ` L yot., S Outlet manhole Min. 4 Above Grade With Manhole Min. 4'"Above Grade Looking Device. Inlet Manhole With Locking D V 6"' Below Gracie SCU10d Wutcrtimht Secure M ou nted Weather-proof Junction Box � IM Finished Grade — fftr t Vent Min. 12" Disconnect Above Grade Means With Vent Cap :x.. ()utlet Filter Inlet Baffle - - - -- - Inlet TA A V477 Switch Sett#igs and Reserve Capacity Weep C'rPI Role Tank Volume = ' Y B Dimension; Inches Volume Gal. (reserve) A! Off Elevation C al B 2 9S. 2 — Ft C 1K Bottom (dose) (dead) D. D Elevation F1 X Total , 117 .10,414 4 1 1 GENERAL INSTAOLIATION: The septiddose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the intinuffloturer may not be exceeded without pirior Approval. Manhole covers e xposed to grade have an effective looking device (padlock) ittings, and installed, Piping at the inlet and outlet is of approved material, connected to the tank with watertight f laid on stable soil t prevent settling or sagging. The force main is sleeved with 4" Sch, 40 PVC to bridge the tank excavation and the a l co ve is scaled watertight. Electrical service complies with NEC 300 and Comm 16.23. 02/05 LJ Page — of AP LaserJet: 3100; l 71b bbl tRfG1 may -.7 -VG e_.:Jurm, ir i 9EH SERIES SUMP/EFFLUENT PUMP r 8.95 4- - 0 spMWIQations 111M ea um 6 ► Hats mom t9lttii R N E16hOQNl MW am ISM NL w Nikki 4~11 9 It if ar Rte � Ir< Itils1 Ir,c.Lt 88fiAt 508830 KOMA Vo 115 3M 13.0 1000 70 64 55 41 32 13.11 2V 24 0.17 attfi4x6!14 out-am 50D34D MAI Vc 230 30 6.5 1000 70 64 55 41 32 13.8 W 24 811 a 1l b4 x a.114 sel.cwar6 5mw W96A . 400 115 30 110 t000 70 64 55 A V 13.6 W V 6.11 a 11.64 x 8.114 egMIN r we Ell 280 39 a 1000 70 54 55 Al 32 17,9 2y 21 9.1 :17.61x6 Cootiegmgo yp w— '11NNOmtW*mA*wWmiP'an t*dcoMi M sdt$YSbn0as4NyamnmwOkiftWLFolladraAl PI@rtNwWMV FLOW - LITERS /HUM Constnr♦adon 0 t000 2000 3000 Motor Housing Epoxy Coated Cast Iron _ ] Materi al _ Poly Carbon Io I_mpeller Closed Vane 3 o Volute — _.._.. ABS —. - •--- - ,S o Power Cord J SJTW -A z0 Mechanical Shall Seal Nitrile with carbon and ceramic facts Fasteners Stainless Steel W a ... _ —.. _. La = Shah — S Im. Steel , a.s Bearings - _ — Upper Sleeve and Lower - — A r Ball Bearings 0 0 0 Po 40 60 80 FLOW GAu.ONS /_MINUTE PUMP PERFORMANCE CURVE Little Giant Pump co. Lt5V 60HZ P7) 9a: 17936.0"408 City, OK 7311!7 Ptinw. 5 l49.]Sll • Fu: 4053A6.1050 &�Yatl: cNHOmen.rric.(�lattt�lot�c.. WWW.LittleGlantrump-coln form 946435 -07403 .. _ POWTS C)WNER'S MANUAL. & MANAGEAAFNT PLAN plc m Sy'S`M.-M SPE Flt E NNNFOHMATee► SeptNo Tank C at E] NA CkVrw Septi Tank ManuftGUa< NA P'etlNt #. filBr3( 1Nanufs�cn'Br �T 11 NA PARAWRS 0 NA Claret l�'beN' Model G' = a NA MA pump -Tank �' c5 ; v n Na tl nbatafCgOUMMW UFlb Pump TankMlinufActunu tiow(a�r) .Pittrip tvtatne '^ r� ow t x N.5) Pump Model - C7 NA 3oH APPS' F y Monthly SVOM W © Unite Cl Peat M lkw inn SandIGMvel f3raaese (FOG) .530 M101L o Medonjeert Asrar on 17 Vltetaad � Demand (BOD S720 mg/L Q Disfiteaion Q Mier- some {1"SS} Mtmft a gv Di3pos {s3 13 Mund (pt+ Mfted) nsaaaoed Demand f 8p s) . s30 mgiL Q -g ) eld � O 000onn-w"e� mo [ - Ma t mwn Effluent Fead K lnchdiameter v� for tnon4=wnsec,teU ow Parade Site -+ V�llres Pn oeoftd waslaw5w. AN ttrllAtN7 ENCg SCHEDULE $ Fraqu*ncY Senefte Event `� D rnonths s) pylaxgrnurn 3 ym.) Fnsps�conc0don crttank(s) At feast once every on (Q of tank volume ?atop out oanbants of tanks) ) When combined sludge and scum At least once every D rno Ks} (Ntaockmursr 3 yrs ) lnspea dfap®rsaN ceU {s) 0 At least onas every , Clean effluent fiber p more s} © Nil . oDnVols alarm At least once every resparnt purrep, p P Q own s) O [dPI. Mush �� mid �� t� .4t least once 'Ovary At least once evsrY 0 months II year(*) i.7 W!, on>«: : Cl W s D ) �iwez once every Q tnor� th YOW( WWMKANCE 1NSTOWC77ONS t be made by an individual c arribW arse of th � lir ertites� i�r inspe ct bit Offtft and dWPWIW o0 ta POWTS Maintairtar: yw'ie Via:. meow cow Pkanber. fyNp Pturrsber Rsste Sewer: Pp1Art'S l broken 5tervks� ()PSF C. Tank ba"M Ito " must Nadude a v i s ual Inspection of the tartk{s � ° �� � up hardwom. k(arl y any' Qar W or teaks, me"urs the volurrsa of combined Slu lsu ny koprc ed c� ledc the ejv lavelr or pOtufrftp of &t2XW on 'dW ground surf Aw The dispersal caU(s) *hall be vleccral!)' .� pondng of �lGa snt on um the obeeew>S'xr t>� and tro otwok for any p�kS of effluent an ow ground Suftave- authority gwow aluf W n" a t wadidOn and roge wvm th Immed6fw nofffi�ori of the kroai regrrFamory ' e and soiun fn any tank AQUWS onfa Ird W or more of to tank Yctfume. the �VfrN! the ootflbl aoaurrrrta of siudg a Sf rtvic�n9 Operaf>ar and disposed °f to sm ordancto with ch. NR enbu of W* be remove by 143, WNcotasfrl ACIMMUMM Code. t fsornponetts', and 3nY l�raf or pressorbwd POWrS components. pn POWT'S iuflwutt The ng of aRorm at of,92 Month$ ar.k=, sheii be �� �:;�' � ar nrat�vring of compl�on of arty sew Arent. A saw ngxxt steeR provided too the karat regcltabnry autho* within 10 dam START UP AM OM AXON of poi no prodUdS or Other For clew oncISWOort. prix tc um Of the POWrS eh,ac;k_freatrnf�rtt tank(s) for the prat aonoentra6on:� ors c h wn k a ft Vmt may knoWe the tresblIGOt p++ocess andfor damage the disPenUd crefi( (lateClled haVe th oorlt+ejft of the tanl4w) removed by a septage servicing operator prior to tree System start up shall not occurwhensoil "conditions are frozen at the infi trative surface_ page Dumg pow ar outages pump tanks may till above normal highWat+er levels_ When power is cestXed the mess wastewmff Will be d1scl78lW to the dispersal cell(s) in one large dose, overioading the cegsj and F ors may inesult irk the rrrfaos dt9cfiarge of effluent To avoid this situation have the can nts of the ptanp tank renu;Ned bya = Sept�e SelYkang OPetBtior i to I EDt>fV Power to the effluent pump ma a E or contact! a P tutnbec ar PQWT g Vile to t st�st f( masy operating the Pump 'caonMs to restore nonnal teve wiB tfie pump tank Do not drive or park vehldes over bnk6' and dispersal tells. to not drive or park over or otherwise cr5wrb or corrtpac, the area wMb 15 feet down slope of any mound or at -grade sorrl absorption area- Reduction ot':erffninatlon of the folb wing flour the wastewater stream may improve the perfomurwe and pfokmg the Ke Of the POW anObOok baby wqxw. ' cUarette butts; condoms; cotton swabs; degreasers; dental floss;' drapers' dam;; t3t fouddat bn dralrt (sump P�P) water, fruit and vegetable peermgs= gasothe, grease;. herbUdes; , saa¢s; medmm t . Ck ftatnSn9 prc duc t&. pesticides: sanrb W napkins. tampons; 'and wa (Bf softermt briny. AHANt? AOMENT When the POINTS fails and/or is Permanlentiy.taken out Of ser woe the hallowing steps shall tW taken to Insure that they sysoern is properljt artd Safiely abandoned in compliance vAth ch- Comm 83.33, Wisconsin AdmIrdstingve rode` All piphtg to tanks and pits shall-be disconnected and the abandoned pipe openings seated. The ecalionfs of all tanks and pits shall be removed and properly disposed of by a Septage Servicilti filed CQperator_ • Auer pumping, all tanks and piss shaft tae excavated and removed or tfrelr covers r,erc,o,, ad and the void spate lled wfth sotf, gravel or another inert solid material. CONTINGENCY PLAN if the POWT'S /;ails and cannot be r3ep2ired the following measures have been, or must be taken, to provide *i code compliant mpWwnent system O A sui6 b4e neplsaem ent'ama has been evaluated and maybe utilized for the location of a replacement soil absorption system_ The replacement area should be Protected from disturbance and ContpaCtiort anc:f should not be infringed upon by required setbacks from eaosting and proposed structure, tot lines and weirs. Failure to Protect the replacement area will result in the need for a new soil and site evaluation to estabfish a suitable replacement area_ Replacement systems must compl with the rules in effect at that time. O A suitable replacement area is not available due to setback and/or soil limitations_ Barring advances in Povv TS technoiollr a holding tank maybe installed as a last resort to replace the failed POWTS. The site Iias not been evaluated to identify a suitable replacement area - Upon failure of the POWTS a: soil.and site evaluation must be performed too locate a suitable replacement area. If no replacement area is av::uiable a X holding think may be installed as 2 last resort to regiace the failed POWTS_ Mound and at -grade sot! absorption systems mar be reconstructed in place following removal of the bi<:trnat at the inf5(trative surface., Recortstruclions of such systems must comply wish the rules in effect atthattime. <cWARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETKAL GASSES ANDIOR INSUFFICIENT OXYGEN, DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT­. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDRIONAL COUNIENTS POWT IN STAII - POWTS MAINTAINER Name Name Phone �/J oZi/ l r Phone 7/� 6 y ;EPTAGE SERMIN OP ERATOR LM IFER) LOCAL REGULATORY AUTNORtTY Name � Agency Phone Phone rnis doa eras drppp�l by Ora staf of file Grmn Lake. Aft Maetta and Waushara County Zoning and Sanitatirxr _ This dnamrettt meets � � (:artuo 1r�xiHQ)�ft1 and 83-54(1). (z) & (3). Wisconsin AdmfrtEsra6re Cod, Us , of this daarmmt crams not Val alit the perform at ft p rrs. GIWW RAI) 07/27/2011 14:32 7152464200 OEVERING HOMES PAGE 01/04 Jul -27- 2011 01:07 P" St. Croix County Plan /Zoning 715- 386.4686 114 1787 WWWA DeportrnentOfCOMM ce SOIL EVALUATION REPORT pip -L-of, 3 D Ift of Satiny and sulld1w to edeot dance with Comm 85, Wis. Adm. Cede _ _ A.C.E. Sall & albs 8vek 1100 Alba h oomploto wile P� m paps County r not tees than 816 z 11 Indroa in eEte. Plan rowel / Indude, but notlimbd to: wft slandhaiaonbinhnence pant (am),dredlonam Parcel pttisottt slope, rtala or rtnrannal m, n0h en w, and Ioma n and ditanna to nearest toad t42A67L20„gpg.. D N OIL } at e ftaw n6"Ift youtuw Flop" owrtar Rte/ � Pr°�'raaetlon t. am. Lot NW 114 NW 1 r4 29 ' 9 R IS W 7nna PmpertyOww'aMalMngAdrha Lot# Mock# Subd Name orC9tIM� r 7� 704103rd Street S'r , �i� s ' iv_ 2 � = C- CRY vi - Z J ahy _j %All■ne h!I Town Nearest Road Robert& I WI 1 54029 716- 74M442 I Warren 103Rd 9t id New ConekWkn Use: lid R Number 0f badrooma 4 _ Code derived deetgrt bw nett 600 OPD Replacement J AubAc ar cemmtralal - nvrcdbe: _ ., Parent maltrtal t3larflsll Till Flood plain 811GY91 0, if appllN& Ra — General oomments and mo mmtindatlona: Instat! mound walm at elev,104.27' at 6" above 103.77' eantour. �e# JSoring Id Ph around Sudaaa aNO►. 103.77 . 1 Daptn to Nmllhtg festal' — �_...in• A9pll non Depth Dominant Wor arlption Teolure baolure ovellatow 3 Roots In. Mun9dl Qu. Odor fat. $t:. 8111 _ 1 0 - 10yr319 none rfl 2Nbk mvfr 01 2,1fm 0.6 0.8 2 9-20 7,6yr4/4 none Sol 2rebk mfr ^ ov if 0.4 0.0 9 2020 7,5yr418 none at 2rmbk mfr gkv If 0.8 1.0 4 29-M 7.5yr414 none all imsbk mfi ON 1vr 0,4 C1.7 3 36.62 7.15#18 f2f 7.8yr5/8 e1 l mabk M11 y - 0.4 0.7 F 21 emnat J wmg r. A PR around Surface eiev. 103.7 fl. depth to emSin 0 –g war —� —in. 8011 Applo toti Ride Depth DDotananf Ca for Re"046*ttos Texlaa 9tntcture isrenoe iundary onto in. Muneall Qu, 8z Dent Color far. 8z $h. 1 0-6 '10yr9/9 none all 2%bk tnvfr a s 22f,9m 0.8 0.8 2 9.01 10yrS/4 none aid 2febk mfr os 1vr.1 CA (148 3 29 7.5yr4/4 no act 2febk mfr tpN ivrf 0.4 (tb d 30-48 5yr4le 12d 7.6yr618 sal 1 oabk raft - 0.2 0.3 "Effluent #I = SOD 31) = mglL end 68 40 e 1 mg L #2 SOD 4j 9 mglL and Tab -6V mWL CST Name Please P&M c Jame& K. Thompson %.__ 3602 Addroeo A.C.E. 8d & Sea Evalurmone Date Evaluawn Ccndt rtod Tdephtxra Number 340 s ! she lm 0n0e010 ( 64020 4/2612004 _ 71"48-7787 07/27/2011 14:32 7152464200 OEVERING HOMES PAGE 02/04 Jul -27. 2011 01:07 PM St. Croix County Plan /Zoning 715 - 386 -4686 2/14 Propeliy OWW Glary st Gail Mater Panel to 042-IM2MO Pado 2 of. 3 1 3 1 # J �n9 tt -- �i J Pit Grouna Surrace etev. , . — ft Depth to INY+HIng fRetar L,_ tn. 8d n Dambeiii Color RedwDesoeft Taftre akualura Con 9 -ert0e wrdary R oble In. Mumall Clu. 8a. Celt. Color Car. Sz, Bh. _ T01 "1192 1 0-11 10ytw none e11 2febk mvfr as 21,1m 0.8 'O,B 2 11 -19 10yr5/4 none slot 2fabk mfr ae lvft 0,4 0.6 a 19 -35 7.5 W4 none at 2me4k dah ON 1v1f 0.6 1,0 4 S640 Spa 12d7,Byr61B 81 lmsbk dah Boring J BortnB 8, Depth to Ilmltitla faotar _! In. J Pit around 8udiraa slay. ft, AppiaNlon Rate HAM 010 Dowdeflicolor WoRm Taatura §Ealuie Corlebtaece I aaidary RMW " w Manses Ou. Sz, Coal. Color Ot. sz. 8h. _ sola+p # J Pit _ R Dwill to smlNnp factor m. n Aeta ,J Pik Ciroundesafaosatay. ,_, hMrtcal► DO Domliumt0olor pllon TeolWra kualure Cana noa mdary cola "1�AlM in. Mansell Cu. sz. Cont. Color Or, 8z. Sh. " Effluent #1= BO[) 30 {?20 mgtL and T88) 160 mp/L ' EMuent#2 eob 0 rnplL and Tee IN tng& Tho Aopmtment of Commerce i6 an equal opportunity sa 4w provider end employer- Tf you need se�uatanoe to aooaK sorvIoas ar need mataxial in as attomatb fomut plaaao oontaok the dapartrrmnt at 648.2663131 or' T Y 6C8,264 -9777. 07/27/2011 14:32 7152464200 OEVERING HOMES PAGE 03/04 Jul -27 -2011 01:07 St. Croix County Plan /Zoning 715. 386.4686 3 /4 a b • - rp.064 16to- ail in r► aa� ,Pa I70r • is UWA47 tZ I te, a /CV. do.' cl ed: - /C do! IlAd too . ' r rr * Iag • / r�. �, / '� r y tar �„ •'" �,+2 •�'/PPe�OI: 1 � r r � r f r r r W �O - R ++ i�rrrir �ii r r or AN r to r lU aW i t r an \ \tt t \ \tt\ \ \t 1's 4„ y i , 1, � I 1 1 6 1 1 I l l i l l l l II l i �I�JJ�J J1lJLLJlJ ��E►► ►► ►►►►►� ►a►!,►L 1, soonwwwr" ♦�kwl����tirl��'�r'��� atJJJ JLJLJ i; ir iL' • 1 1 .► � i !/ 1t ii it ftdb Aw. � �wr go ww��w i � Wisconsin Department of Commerce SOIL EVALUATION REPORT 17s7 Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site Ian on County p p paper not less than 8'� x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 42 - _ 179 -20- 999 Me& -- _ ' Personal information you provii e may bff%Pj;;�s (Priv Lew, s. 15.04 (1) (m)). viewed By Date /�✓ Property Owner Property Location U J v " APR 3 d Govt. Lot NW 1M NW19 S 29 T 29 N R 18 W Property Owner's Mailing Add r Lot # Block # Subd. Name or CSM# /j I [/C 7 794 103rd Street , t;Gix UU,' 2 CSM S� City State M6 O di41 1stumber City I Village V1 Town Nearest Road Roberts I WI n 54023 1 715 - 749 -3442 Warren I 103Rd Street ✓J New Construction Use: 0 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Glacial Till Flood plain elevation, if applicable na General comments and recommendations: Install mound system at elev. 104.27' at 6" above 103.77' contour. Boring # I Boring W1 Pit Ground Surface elev. 103.77 ft. Depth to limiting factor 36" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10yr3/3 none sil 2fsbk mvfr as 2,1fm 0.6 0.8 2 9 -20 7.5yr4/4 none scl 2fsbk mfr cW if 0.4 0.6 3 20 -29 7.5yr4/6 none sl 2msbk mfr gW if 0.6 1.0 4 29 -36 7.5yr4/4 none sl 1msbk mfi cW 1vf 0.4 0.7 5 36 -52 7.5yr4/6 f2f 7.5yr5/8 sl 1 msbk mfi - - 0.4 0.7 Boring # J Boring Pit Ground Surface elev. 103.75 ft. Depth to limiting factor 30 " in. FSoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *Eff#2 1 0 -9 10yr3/3 none sil 2fsbk mvfr as 2f,1m 0.6 0.8 2 9 -23 10yr5/4 none sicl 2fsbk mfr cs 1vf,f 0.4 0.6 3 23 -30 7.5yr4/4 none scl 2fsbk mfr cW 1vf,f 0.4 0.6 4 30 -46 5yr4/6 f2d 7.5yr5/8 scl 1 csbk mfi - - 0.2 0.3 * Effluent #1 = BOD 5 > 30 < 220 mg/L and SS >30 < 1 mg /L * ffluent #2 = BOD < 30 mg/L and TSS < mg/L CST Name (Please Print) Signature CST Number James K. Thompson �,._.— 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, 154020 4262004 715 - 248 -7767 1 t Property Owner Gary & Gail Maier Parcel ID # 042 - 1079 -20 -000 Page 2 of 3 3] Boring # J Boring II Pit Ground Surface elev. 102.75 ft. Depth to limiting factor 35" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -11 10yr3/3 none sil 2fsbk mvfr as 2f,1 m 0.6 0.8 2 11 -19 10yr5/4 none sicl 2fsbk mfr cs 1vf,f 0.4 0.6 3 19 -35 7.5yr4/4 none sl 2msbk dsh cw 1vf,f 0.6 1.0 4 35-46 5yr4/6 f2d 7.5yr5/8 sl 1 msbk dsh - - 0.4 0.7 F—I Boring # Boring f Pit Ground Surface elev. ft. Depth to limiting factor in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP / in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD ? 30 < 220 mg /L and TSS X30 < 150 mg /L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. a¢rn T "1797 ` ep /ads . tE. B -n , : Q;l:n once �E 5S urn 2�W = icy. 00." El e • io �. oo C - a l / - 1 / 0 vz 1op fi g•' ■ So, "l e ✓a lua�i� � of _ _ loll' p I& l0 64 ■ , ,' , � o � ay , ,,' • /o eked ,4 rdp. ���wr 1a3�7'_ io conEour 66a,4e k6M 8� lo � W W O do � �o �, Z83. 1,2 ' StrZxt P� 3of,3 ST. CROI K COUNTY SEPTIC TANK 1MAINT MME ACRF�I►+IB1VT AND 0WNMMI8IP CERTIFICATION FORM Ownersu Oe 0 Q. r r± fL I-- Mailing Addr =88 3 _ 1 r1l t `1 0 t Proper Add v D S Naffintkumpind ibm Pbmaing & Zonmg Department ftr now oonAmcdaox c ity /state Parcel identification Number _ 0 `f a ^ . /� - o - 1 3 tD IM ICBU== Propara -ty I.oc ra ion 442 _ 1. , l�t.2 % , Sec. T N R W, Tomom of U� u ✓ f,2tit✓ Subdrnmm _ , Lot # Ceramed su rVey Map # / l , 'volume � , page # 4 1 Warranty Dwd # W _._ volume / � P # spec no Lot linen id�ab* ver no 5 7��I N AMONA= W OWNER CERTIFXCATXON �' It m Poor nee and noinlemanae of your septic sy esem could result in fts penaasaa:ttaa 11 Mato tao btimdla rvad". Prom n�aiabas ame a msisw of p llo o t the septa taasak every *m years or soone4 ifnsedod, by a Hoemsed gong - i r Van you pat into fire sffl tem earn elfw6efteden of ft segtao ft* ss a tteaunw aka in the waft diapoeat aysteen. Owm maimlenum respott aTMlkiea are epeoifed in #Comom 83.52(1) and in Ch@pbarr 12 - St Croix County Sanitary OWhoo . The p mpmty owner spew to submit to St Oren County Pig & Zonmg Deparfaoemt a oarll�tion foem, by the owner and by 1 , malbw p an joww1u Plumber. rwWaked piumbw our a Howeed Pnmpar veaa dfat (1) the can -eft wasurwomear dab posal nvk moa is iapaasapear opmatimg condition. =&or (2) aftw inn wdWn and I (if mosbary). the septic tank is lees ttasa 1/3:0 A of sludge: Uwe. flea nadeesigoad lea" read tba above requuemnen a and agree to mainbin, the pdvaee ss**V disponl syeeem with the sa.adnxds aft ! mk b=Wn, as am by alas Deputmemt of Co=nft a and thaws Dqm m W &Nat uab Resources, Slate of Wisoonein. Castiiication s Mli ng dent your septic syxbem lme beam maiabiased must be complaled and retaraed to the St C`rosa roomy PI 8t Zoni>r g Depw meat within 30 days of fite tiros year wvirstim date. Ilwe WtifY fiat all sfabnwnta an this fW= an true to the best of'my/bur bwwladge. Uwe am/are ft ownw(s) of the Ptah' de m &ad sba>'ve, byvktoe ofa warxamgy deed reeooaded in RegWw ofDeeds Office. Number of bedrooms -C��- L IZ GNATURE OF CANTS) DATE ***A Ay inft natinat out is mierepnesemaped nmy nook in the sanhuy pa aarmit baring revolmd by &e Pb dqg & Zc mtq Departmamt. *''r hZIDde wfdt t iris appbicat*n a reatoaaded a►SMSZV deed $vm the Register of D=& Office and a copy ofthe oertlSed survey asap if rdwmce is n ado is tine vnartay deed, 763949 VOL 18 PAGE 4759 KAT11EM11 H. VI - REGISTER OF DEEDS ST. CROIX CO., MI CERTIFIED SURVEY MAP RECEIVED FOR RECORD 05/26/2804 03:30PM LOCATED IN PART OF THE NW1 14 OF THE NW1 14 AND IN Y MAP ERTIFIED SURVEY PART OF THE NE1 /4 OF THE NW1 /4 OF SECTION 29, T29N, C EC FEE: SURVE R1 8W, TOWN OF WARREN, ST. CROIX COUNTY, WISCONSIN COPY FEE: 3.00 INCLUDING PART OF LOT 1 OF CERTIFIED SURVEY MAP PAGES: 2 RECORDED IN VOLUME 8, PAGE 2284. / m BEARINGS ARE REFERENCED TO THE ST. C(/RVE OgTq n CROIX COUNTY GPS NETWORK. Ip�TEO / O 97 S0G'00'41'E 1322.87 RKU! _�_�_D L�L?1G�D� SHEET20N J z Z SOO °00'41 "E 1289.81' soo°ao'arE 33. cn WEST LINE OF 1255.41' 34.40' -4 a THE NW7 /4 I� C-) ► Q f I Ina D APPROVED I ► ST. CR00000tWrY z l f ol f f Piero" Zoning and Parka CnmmMm O o MAY 2 6 2004 �Z1� iP r --ml ol o QQ l idl� _ I oe� g' z H not mwrded vAgm 30 days of 9I C� T A nuo MW Vold 33 33 o w ym w 0O I A a N 1 II 0) A Q X O Z j g" c" 1 n , A o IQ o. of O m to cn , N �:I 9 0 I 00 js o A Z M PI N I m i ll I I 6 I I 66 ip1 N00 °42'36'E 1243.48' w O j �s 1 352.84' 33.00'- _......, n 289.55' ► p1 ► p. 284.7U ► 0.283.40 NOO °42'36 "E N ► N► N IN. I N 385.84' i I m N N 10 V _ d N N I o 1> � � - 11 w D g D II Z War w S �O o°° n �C to ¢ G'I@ f�8 ZmmI Nab a cn m ^' m 0 N 'n� t ."1 n N m 9A m O 1 w go pII I �i> O 1 mw fJm OZ A Rt fJX pZ y Qcn (n cn .i W Im d 0 m P� �� ��W w P. Oz A`I ® i� Zf .. e � ami .. Q .. ...,' -a ........ a ..... ..:. ........ 2 t�1111 ® 'e I (s� �m <� w a 1 x v . ml G Z i o N01 °03'47 "E! 852.96' o v 1 D �� I'� N _+ _ +284_87' _ 1284.73' 283.42' m z I A O -� 284. - 284.73' _� I_ O � w O --T — _ N01 °03'47 "E 852_50_ 103RD STREET --- - - - --- I �Mn P�GI rl _© dQGJD�S T x - v Z m 37 v L0 6', I LEGEND 2 0 0 0 0 N O A D S @ F 1 i 0 1 ALUMINUM COUNTY SECTION CORNER O = z { ` d I MONUMENTFOUNp v' � Ox T m rj :D D Z 3/4' X 18" IRON REBAR SET, WEIGHING 1.50 k Z 57 I LEIS PER LINEAR FOOT. :*: c n � C rn �SJt� 1 y cp N III X11 1 • 1 5 /8" O.D. IRON PIPE FOUND � o O o 1 o EXISTING POWER POLE m r' w ---- PROPOSED DRIVEWAY A SOIL BORING Z SHEET 1 OF 2 SHEETS THIS INSTRUMENT DRAFTED BY EDWIN FLANUM JOB 04 -36 DATE 4 -7 -04 Vol 18 Page 4759 8033686 Tx:4024313 939474 STATE BAR OF WISCONSIN FORM I - 2000 BETH PABST REGISTER OF DEEDS WARRANTY DEED Ch+cnmcnt Numtl,r ST. CROIX CO., WI THIS DEED, made between The River$ank, a Minnesota banking 07/29/2011 08:37 AM corporation, Grantor, and Oevering Homes, LLC, a Wisconsin limited EXEMPT #: NA liability company, Grantee. REC FEE: 30.00 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 90.00 described real estate in St. Croix County, Stale of Wisconsin (the PAGES: 1 ' "): Part of the NWI /. ol'the NW', and the NE'IA of the NW'i, of Section 29, Township 29 North, Range 18 West, Town of Warren, St. Croix County, Wisconsin, described as follows: Lot 2 of Certified Survey Map filed May 26. 2005• in Vol. 18 of C.S.M., pg. 4759, as Doc. No. 763949. Recording Areti ERich mond, Address; Abstract And Title Co., Inc. Ave. New WI 54017 5FA8412 Together with all appurtenant rights, title and interests. Parcel Wnlifictuion Nanther tl•IN) 042 - 1079 -20 -130 This is no t homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except casements, covenants, and conditions of record. Dated this221 day of July, 2011 The Riverbank Minn sots banking corporation • 4.Jean�ine r AUTHENTICATION ACKNOWLEDGMF,NT Signature(s) STATE OF WISCONSIN COUNTY Polk authenticated this Personally came before me thi so?� day of July, 201 [the above named The RiverBank, a Minnesota banking ' corporation by Jeanine Sandberg, Chier Financial Officer to TITLE: MEMBER STATE BAR OF WISCONSIN rte known to be the person(s) who executed the foregoing (If not, instrument and acknowledged the sane. authorizxd by 706.06, Wis. Stats.) THN INSTRUMEN F WA.S DRAFITI) 111' 4 Nota Robe rt L. Lober L Publric. State of Wisco ��� §Iql t t nth My c mmi •si (51 on is erna�iplA 1'e tYycxpiration date: Lobe r nny Office Imp,/ _ / )•17UIlIrCS In11)' I7C 11 U1I7C11111'tllyd tit :It.'k11nU'IrdErd. Iluih an nut necessary.) -' ���Q` • — — � S __ _ ) •Names of rxrsats si - vnmg in an> a :tphtilp most he h ped or pruned J eloa their sipnaturc p T A \:ARRAN 'fl' DF:F.D STA �'Lp '�U \G • Z TE BAR OF WISC'ONSM B �- i 0.2oo0 1of1 �s N ' � N N r i _. IW "Raw M to h �g ow p � � � N �� � � • a as Rio AiS N W � � - � L - � p F VAL. m — slow fly I " � W a " . r t all { r � Po � 1 � M M V r