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HomeMy WebLinkAbout030-2139-09-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 538876 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: Ferski, Ireneusz & Gabriella St. Joseph, Town of 030-2139-09-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: t70 6 C.5T 04.29.19.2047 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. i Septic y Benchmark 3 16,0 Lit, e, et L- 3•~ ! `t!; 1 A 1 b k :25 Alt. BMA, I 60 Ib~ • ZQ /62 - c. Aeration Bldg. Sewer C /61 g 2 G4C 0. J .3 Holding St/Ht Inlet 5.7,3 9-3. 1 W TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet /AJ OrA,, ara i Septic / N Dt Bottom Dosing Header/Man.~j -7 a Aeration Dist. Pipe 7, Z9 Holding Bot. System 7 Z5 C, / (6 PUMP/SIPHON INFORMATION Final Grade 13. S$ /66 '3 Manufacturer GPrnMland StCover (b2. la+C( Model N 1P TDH Friction Loss System Head T Ft Forcemain Length ia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length AA No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS dS( Erd'S Z ~ew SETBACK SYSTEM TO D v P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer- ~ /q, INFORMATION n CHAMBER OR 1.& r 4,l Type Of System: (r w I UNIT Model Nurr/ber: LoL..J P. U DISTRIBUTION SYSTEM of 22.Ir- Z2 = I~o Header/Manifol9 l Distribution x Hole Size x Hole Spacing Vent to Air intake Pipe(s) Olo6tjJr, ~ Length Dia Length Dia `Spacing \ .n _"b SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only WA a01 S Depth Over / Depth Over xx Depth of ` xx Seeded/Sodded xx Mulched Bed/Trench Center 1,7 Bed/Trench Edges Topsoil _ Yes R No Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 1167 56th Street Hudson, WI 54016 (SW 1/4 NE 1/4 4 T29N R19W) Park Hollow Lot 9 Parcel No: 04.29.19.2047 1.) Alt BM Description = I CaJ~ f 2.) Bldg sewer length - amount of cover = J lT~ Plan revision Required? ❑ Yes No Use other side for additional information. Date Insepcjignaturv Cert. No. 4 SBD-6710 (R.3/97) tommercem l ~ Safety and Buildings Division County 01 W. Washington Ave., P.O. Box 7162 St Croix trlem '14 Cmwwc! C, 1~ ~N ks f ','A 11 ph is Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) 53!9`9 7(,o anima plication 71- State n Number in accordance with s. Comm. 83.21(2 .W' ssion of this form to the appropriate governmental unit is required prior to ob 'ning a Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department f Personal information you provide may be used for secondary 1167 56th ST purposes in accordance with th Law, s. 15.04(l m , Slats. 1. Application Information- Please Print All Information Property Owner's Name 3 (-CA e0bZ Parcel # F K& Gabriella Ferski 030-2139-09-000 Property Owner's Mailing Address Property Location 2407 Maple Ave S. Govt. Lot - (I 96,q 7 City, State Zip Code Phone Number SW y, NE Section 4 Bloomington MN 55431 612 865-3969 T 29 N, R 19 (circle one) H. Type of Building (check all that apply) yy Lot # Subdivision Name ~or 2 Family Dwelling - Number of Bedroo s 4 9 P~ t Block# Park Hollow ❑ Public/Commercial - Describe Use ❑ City of 0 0 n~ ati 1 ❑ State Owned - Describe Use i°O- 1. • CSM Number ❑ Village of own of St Joseph ZZ}ZZ M. Type of Permit: (Check only ode box on line A. Complete line B if applicable) A. ✓ ew System placement System F-1-tment/Holding Tank Replacement Only I ether Modification to Existing System (explain) LL~__JJJ B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) ltiA #1 on-Pressurized In-Ground essurized In-Ground D -Grade It-Grade astound > 24 in. of suitable soil bound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) IL~J~JI I___I ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Informati n: Design Flow (g ) Design Soil Appli n Rate(gpdsf) Dispersal Area R uired (sf) Dispersal Area Proposed (sf) System Elevation 600 10.7 1858 1880 j ,j 197.60 ft VI. Tank Info Capacity in Total # of Manufacturer r Gallons Gallons Units o 2 New Tanks Existing Tanks ~o U `p /ak Z S Q. U in V CA w 6 a Septic or Holding Tank 1250 1250 Wieser oncrete Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation oft WTS shown on the attached plans. Plumber's Name (Print) Plum ignature MP/MPRS Number Business Phone Number Darrell Hubbell 221073 1715 307-1630 Plumber's Address (Street, City, State, Zip Code) N7988 920th ST River Falls WI 54022 rl~aun /De artment Use On VllI. pproved Disapprov Permit Fee Date Issued Issuin east Sign e lven Reason-for Denial $7~ ~d / IX. Condit Yoeasons for Disapproval 3) / vo arT&P 64e~ ~ b (A 1. Septic tank, effluent flier and f I .dispersal cell must all be setvk:es I maintained c~ LX . as per management plan provided by plumber. 2. All. setback requirements must be maintained as per applicable code / ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 1a a 11 inches in size SBD-6398 (R. 02/09) Valid thru 02/11 fet Plan Page 3of ? Property Owner FAIL ~ e"A5K~ ULA- FSWISKi 14oft. Legal illeSeliption tor Fmie, Pba-oo, -swVi 6P (except where noted) NE` 5 447'24A -ioWN Ur- Sr .3CXs8Ft+, a = Backhoe pit sr c4utx DVAITY W ESCOUSw~_010~ North 74 M,sa' ' O Em _ _ o (_WOO r 5 EfTy v Y.0 wt~ se 2 y-f rs tZOM PRT_-U(DLI5 1 v~ 1az94' YS~ C~- 1 i T 1 i 'I i i Site Locatiodl." 'A i t Pg va Private On-Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner. ET-A C C'a R t~ ~ +e`5K Project Name and System Type: (~D~1 \&AA ~ W A L- -7t,) K);D _ Location: Street Addrec= j LDT ~l +L u v+~~ t~4 bF ~F M1 S -T2-- FN 1 R't --t W f Leger' Descriptcn 'ST ~DS~Prf CRc~ TnwnshiplCounV Design Criteria (Check one): Holding Tank Component Manual: In-Ground Soil Absorption 41-Omponent Manual: ❑ SBD-10571-P (6/11/1999) ❑ SBD-10567=P (R. 5/1999) ❑ SBD-10855-P (3/2007) Version 2 SBD-10705-P (N. 01/2001) Version 2 Contents: Page 1: N SI X A N ID -t°t*7 LP- s H eie 1-r Page 2: FLAJJ Vlt-,W Page 3• PLo-r P L--A 1 Page 4: JtiA Ai rum P L-AA - Page 5: - Page 6• Page 7: mmAjTEvAAxt A z r,,AeEr&.-P-rl Page 8: - Page 9: - ~ SVlaetis % mbe'eSr~PP Signed: bey," q- Da7 Date: Cr ' sr f+r~~ar 1 k.,a c - I R©` - 4loft` CWMMWAN b! Oo &0 type tidal 8 ,i .1prtb~e1W~ Hild 1~ -7,66 ~/Is~~ly' "Man OWN .57 03 41 15 5 af)ftitr~;~ I1 FP Ll.~ 3S14N rr, ..tea= 2 TK LT t' 1 v ~l AV I T,5 ~adcft- 72 EOLVr, IOK SZZ `!17 -cAtJtbg:tl IA) Wt-e;~2 6~~LS 7- m ty! L t ri, tvv c P CIA a 0 sy l-gt 4 3 _ e-44 "ti f-M, m~'h clva h Drs 2 Tr ~c yes APO y2t~al ~ of 7 H" p of Plan _ Page 3of ? Propro Owner ~t~~ C~i48R1~!th ~~KE 1 = 40, ft. Legal ll escription L Es r g, ~ ~ ~ W b P (except where noted) 4 c~ = Backhoe pit 7tf"~ vE y~ S 4f ?L`7^S Rill W , TaWM UP Sr S'T cjzaEx - o wAa-ry wts40A sStA3, 3_0I0Act s North 00 74' l00,5$ LWOO s ~E gpvtc G~'~ o ~EV tr,MtER -r3,NK t"$, ~ 1ZDd+1 f~REVtt~tJS K I v t 1o2agi ~r~S`1' C r= 3 / I3 I Site Locatioa.,- o ,,x a 721~1F.+~. Fem. POWTS OWNER'S MANUAL MANAGEMENT PLAN SYSTEM SPECIFICATIONS E3 NA FILE INFORMATION Septic Tank Capacity gal Owner G' 5 Septic Tank ManufacturerIz - NA Permit # Effluent FilterManufacture - Pvthc 17 NA DESIGN PARAMETERS E$hrent ell" Model s - NA NA Number of Bedrooms 100gpolb oom [3 NA pip .Lank Capacity gill] Ntunber of Commercial Units Pump Tank Manufacturer NA Estimated flow (average)* .707) gal/day Puma Manufacturer NA Design Sow. (Peak), estimated x l.5* g~~Y Pump Model NA Soil Application Rate 0 .Y Pretreatment unit NA InfluettlE cent Qnalrly A Monthly Average"c` p Sand/Gravel Filter p feat Filter Fats. Oil & (FOG) 30 mg/L p Mechanical Aeration Cl' kretland E3 I.Aher. Biochemical Oxygen Demand (BODs) :5 220 mg/L D Disinfection ME del: Total Suspended Solids (TSS) Manufacturer= < 250 mg/L Dispersal Cell(s) pretreated Effluent Quality D Monthly Average**# p In-ground (gravity) D I rgtourrd (Purize~ O Mound Biochemical Oxygen Demand (BODs) < 30 mi O At-grade Xhar Total Suspended Solids MS) 5 30 m91L E3 P-~e r3 t Fecal Coliform (geometric mean) <Wvcfu/l00m1 D Leaching Chamber Manufactt~er! ? Model Approval ; upulation Maximum Effluent Particle Size 118 inch diameter p,~ Req,_~^7 I S fl Soil Application Rate (i "7 *Wastewater NOW Verification on and calculations: Absorption Area Credit per unit - 2-C (Other than bedroom based) "jumum Number of Chambers 4 3 p Aggregate Design Flow/Loading 11 to= min Materials: all materials must comply v th WI Adm. Code Values typical for domestic non-commercial wastewater Cob4M&4 and be installed per mgaufac.tauers $Pecificxd°ns and septic tank effluent. and approval letters. ***Values typical for pretreated wastewater. DESIGN CRITERIA ❑ "Wisconsin At-grade Soil Absorption System, Siting, Design 8c Canstnrction Mamial" (Converse eta1.4 E. J. M "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. ac,cl E.. Tyler. Publication 1522 " Publications 9.6 M "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems n "Design of Conventional Soil Absorption Trenches and Bede % RJ. Otis - ASAE Publications 5-77 ant, "Design Manual - Onsite Wastewater Treatment and Disposal Systems". EPA 62511-80-012 October 1980 ❑ SBD -10570-P (8.6199) "At-Grade Component Manual Using Pressure Distribution" p SBD -10567-P (8.6/99) "In Ground Absorption Component Manual" M SBD -10701(N.01/01) "In Ground Soil Absorption Component Manual" M » ion 2.0 C3 SBD -10628-P (N.6/99) "Recirculating Sand Filter System Component O SBD -10656-P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" p SBD -10572-P (8.6/99) "Mound Component ManuaP' p SBD -10691 P (N_01101) "Mound Component Manual" Version 2.0 C3 SBD -10595-P (8.6199) "Single Pass Sand Filter Component Ma Ir ❑ SBD -10657-P (8.6/99) "Drip-line Effluent Disposal Component Manual" p SBD -10573-P (R 6/99) "Pressure Drstnbution Component Manua" p SBD - 10706-P (N.01101) `Pressure Distribution Component Manuap' Version 2.0 M Drip-line Effluent Dispersal Component Manual for Multi flo Onsite Wastewater Treatment Units p MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Frequency Service Event - Inspect condition of tank(s) At least once every 5 months year{s} Wwomum 3 ym ) out contents of tank(s) When combined sludge and scum equals one-third (1/.3) of tool: volume Pump InsPect dis Penal cell(s) At least once every p months ~ Year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months ;0 year(s) inspect pump, pump controls & alarm Al least once every ❑ months ❑ year(s) _W NA Flush and pressure test At least once every r-1 months E3 year(s) Valves At least once every 0 months p year(s) NA ye2s{s} r3 months o~ At least once every ❑ NA d Page-!f-of ce of painting products or xther chemicals that TART new cottstruetion, prior to use of the POWTS check treatment tank(s) for the presen ini ede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have th': contents of the any p ark(s) removed by a seepage servicing operator prior to use- system start up shall not occur when soil conditions are frozen at the infiltrative surface. aPERATiON tan and maintenance of the POW i'S and submission of re aired i; /ports. The quantity rile property owner is responsible for the operat' d quality of the wastewater stream will affect the performance and longevity ofyour POWTS. 'The instal7~tion i►f wafer-saving ux with prompt repair of leaks reduces the wastewater volume. Also the brine orvaste froth water appliances and fixtures along softeners, iron removal units, other clear water treatrnentdetvetoandoe drains should be dischargdi to q ,e ground surface whenever possible. Note' this does not include laundry sposal of greases food and 'I'bis system. is designed to luauhdie domestic strength wastewater, by a garbage disposal should be min d, Tot a tissucegis oniy peals and seeds, bones, and food solids such as those produced ~ ~ vita napkins tem. Other non-biodegradable items such as baby wipes, tamp s, . rY paper it that should be discharged into the it, condoms, cigarette butts, dental floss, and d tt swabs should of be flushed into the system eas they can seriou~l d Qage your~ au t should not enter the system POWTS disinfectants, pesticides, antibiotics, solvents, etc and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. Valves Valves shall be operated in the following manner. I /leer:>ed to service contact an p Alarms divid Alarms should be tested on a regular basis by fire home conditions, owever waternshou dupe con:;served until any pgiWTS, 7'Liere is normally a i day reserve hider regular operating problems with the system are corrected to Prevent back-up of sewage into the dwelling or surfacing. INPEC S inspection shall be made by an individual carrying one of the following licenses or certifications: Mast:r Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached MainteIiance Schedule). Septic Tanks Component any missing or broken hardware, identify any cracks Tank inspections must include a visual inspection of the tank to identify Y $ or onctin oeflIu it t to the ground check for backup or ace measure the volume of for seervicoruassessment shalt be sealed and/or locked upon comptetio i of service. Any surface. Access openings osed openings greater than 8 inches in diameter shall be securtfl with an effective defects shall be promptly corrected. Exp into the tank. locking device to prevent accidental or unauthorized entry When the combination of sludge and scum in any tank exceeds one-third ~(I/V or acmore of th cordance wtank ith voliu e , the entircontents and disposed Cho NRI 13, Wisconsin of the tank shall be removed by a Septage Servicing Operator Administrative Code. The outlet fitter(s) shall be inspectedand cleaned to remove any ode to retain solids in the tank. Filter cleaning may be heel ssary g'.taiuorer's specifications. Provisions are to be frequent intervals than stated in the maintenance schedule to keep the system operating. p pump Chamberfrreatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A vise a l check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the cetdition of the filter. Any service needs or repairs shall be promptly taken care of. 'AIn-Ground Gravity Component Dispersal Cells ection for any The inspection shall include recording the levels ofponding, if any in the observation tubes and a viseu insp to the regulatory evidence of surface seepage or discharge- Any discharge to the ground surface must be promptly rept authority. Ponding at depths greater than 750/6 of the height of the component may indicate overloadi u& or impending hydraulic failure necessitating more frequent monitoring. pageof ❑ Mound, At-Grade, In-Ground Pressure The inspection shall include recording the levels of ponding, if any in the observation tubes and a vis ualmspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly rep Tted to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or imf±lmding hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for ; lushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterali, should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to -nsure:that the system is properly and safely abandoned in compliance with Ch. 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 Servic ng operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and th void space filled with soil, gravel or other 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 c de compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement' foil absorption system. / The replacement area should be protected from disturbance and compaction and should not be infring-,d upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement E rea will result in the need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the re i lacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacer i --nt systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances m POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS It Soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holdingtank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at grade soil absorption systems may be reconstructed in place following removal of the 1-iomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR 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 D: E'FICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER PArctJL R Aj Name ttRRtLL }i I.tF C Name Phone Ll t s :30-7 -4 -;!:;D Phone -7 , ~zlv - SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHOnrry Name '-'(121- ~t?Irt Arty pi 5pofo I- Agency ° ao. I Phone Phone OLEO K:\WPDATMEMPOWTS OWNER'S NL4MAI..doc Page_j~ Of Oct 26 11 09:08a Hollister's Soil Testing 715-426-1775 p.l ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnedBuyer I ,~L d G a6 r e f (cc F ei-0-<1c Mailing Address 2 LI 0 7 /14,4P4,0 a ve S R Lo o ~g7G~~ Ik N ,L 14 3/ Property Address / I G 1 S 6 r h 57r (Vaifica Lion required from Planning dt Zoning Department for new conMuctiaa) City/Stabs Uri S 6,M W/ I Parcel Identification Number 030-21?1-02-000 LEGAL DESCRIPTION Property Location 52" , lV r" , Sec. L . T 2 q N R 19 W, Town of Sf To Se/-9A Subdivision Plat Pa kte Ho l l den Got # Certified Survey Mspa# . Volume , Pasp # Wa n mty Deed # -r / ~y -l O 0 6) (before 2007)Volume , Page # Spec house U yes U no Lot lines identifiable U yes U a► SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenauce of your septic system could result in its premature failure to bmudle -am es. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed p+mspe - What you pat into the system can affed the function of the septic tank as a treatment stage in the waste disposal system Owner m: mrtename responsiibil ies are specified in §Comm. 83.52(1) and in Chapter 12 - SL Croix County Sanitary Ordinance. The property owner agrees to submit to St Croix County Planning & Zoning Department a certificebw i form, signed by the owner and by a toaster plumber, jowneyman plumber, neWu trod plumbw or a licensed pumper verifying that (1) the on-si tc wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if amessar y), the septic tank is less than 1/3 full of sludge- Itwee, the used beve read the above requirements and agree to unur tan the private sewage dispo mil system with the standards set forth, herein, as ad by the Department of Commerce and the Department of Natural Resowzs, Sur to of Wisconsin. Certification stating that your septic system has ban maintained must be completed and returned to the St Cnrr c County Planning dt Zoning Department within 30 days of the throe year enpuation date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe amlare the c wner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedroom SIGNATURE OF APPLICANT(S) DATE sss,~y that is m uclime had may result in the sanitary permit being revoked by the Plammnug dt L ming Department, sss Inchrde with this applica im a recorded warranty deed from the Register of Deeds Office and a copy of the cerb lied survey map if refen ce is made in the warranty deed (REV- ttM7) III 1111111 II IIII III IIIII (IIII II 8002064 STATE BAR OF WISCONSIN FORM 1 - 2000 Tx:4001718 Document Number WARRANTY DEED 919000 BETH PABST THIS DEED, made between Thomas P. Datwyler and Tatni M. REGISTER OF DEEDS Datwyler, husband and wife, Grantor, and Ireneusz Ferski and Gabriela ST. CROIX CO., WI Ferski, husband and wife, Grantee. RECEIVED FOR RECORD 07/13/2010 3:23 PM Grantor, for a valuable consideration, conveys to Grantee the following EXEMPT described real estate in St. Croix County, State of Wisconsin (the REC FEE: 30.00 "Property"): TRANS FEE: 232.50 Lot 9, Plat of Park Hollow in the Town of St. Joseph, St. Croix County, PAGES: 1 Wisconsin Recording Area Name and Return Address: Together with all appurtenant rights, title and interests. 030-2139-09-000 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Roadways, easements and restrictions of record. Dated this 9th day of July, 2010. ~ av~ M * Thomas P. Da ler * ami M. Datwy 1 * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ST.CROIX COUNTY. ) ss. authenticated this 9th day of July, 2010 Personally came before me this 9th day of July, 2010 the above named Thomas P. Datwyler and Tami M. Datwyler, * husband and wife to me known to be the person(s) who executed TITLE: MEMBER STATE BAR OF WISCONSIN the foregoing in tdged the same. (If not, authorized by § 706.06, Wis. Stats.) *Jay P. Pe teld THIS INSTRUMENT WAS DRAFTED BY Notary Public, tate o iscon in My commission i anent. not, state expiration date: 8/26/2012 ) Michael H. Forecki, Attorney (Signatures may be authenticated or acknowledged. Both are not necessary.) JAY P. PENFIELD *Names of persons signing in any capacity must be typed or printed below their signature N ft P~~ State of Isconsin WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1-2000 1 of 1 - - - 749.40 - . , . . • LOTS : w LoTo 700 sq. (I. . 11 acres `,3 '006 sq. IR. 3. Of acres r • i . may. ~ Cri a 0. 884.5 I*omwndnl r - ~ 20 ILA C%j .I 1 r 1 t, ` fosne+rt , r (114 YYisoonan DeparbnenkafConrruence SOIL EVALUATION REPORT paw I at 2 Divisioru of satdy and Beridsrgs n accordance win Coen, S5. tlifs. Adm. Coale COU* PIERCE Attach oornplele ails plan on paper not less tiara 812 x 11 ncbes n size. Plan must ncirde, but not Curried lo: we ica l arm norizorrld reference point (ell). dwecion and Pamd W. 0 "In - 2139 - 09 - 006 pernentslope. scaleordinermions. north arrow, acrd location and dratasrcelonearestroad. Please pdnt aff boommem by ode r r- rr-,d9-r roe arsee rws.rx d-y pu#"+acr Law. s. 15.04 (a) Properk0wner PlopertyLocalion . ERIC & GABRIELA FERSKI Govt. Lot SW Im NE 114 S T 29 N R 19 E (a) W Ptnpenly owner's MarFaV Address Lot # 0, # Subd. Name or tSW 2407 Maple Avenue S. 9 - Panic Hollow Ciy Slate Zp Coale Phone lumber Duy Wage ■ own Nearest Road Bloomington, MN 1 55431 ( ) nk S" Shiest St loseph rEw. wCondmiction Lbe e Residenial t Number of bedrooms 4 Code derived dign low rate 600 GPD lamnent Pubic of comtwrrial - Dedial ourtwash Plain eie Cation d applicable l oomn deli Convention in-ground trenches - 0.7 loo ding rate and AdddkwW borings required to extend system area and verify loading rates_ Pwvioue test attached as part of this report El Boeog # ® BAD a pit Grand surface eiev 100.58 IL Depth b reniirrg factor 110 in. Sol Race Morison Depti DorrrYwt Color Red= Descriplion Terdue S6uctae Consistence Boundary Roofs GPOW in. Misled CAL Sz. Conk. Cal" Gr_ Sz St. 'EM 'EW2 t 0-5 I0YR2/2 - l 3f ibk ds cw 3vf-co Ob 0.8 2 546 10YR4/2 - 1 2fabk ds cw 2vf-co Ob OB 3 16-31 10YR4/4 - Sit 2fabk dsh CS 2vf-m 0b 0.8 4 31-52 73YR4/6 - s OS9 c s Ivf-f 0.7 lb 5 52-94 7.SYR4/6 cos OS9 ml car - 0.7 tb 6 84110 7SYR4/6 ~p s OS9 ml 0.7 1.6Horizoes 48e s ~sa*e 2r+ 25s ; b-ai- 6 has I--20Y. g . tlor on 3 has si ds 2 ® Bourg 1.00-60 I t2 # 0 Pt Ground suface elev. t Depth to firniirg 61 . in Rafe HorizoDepti D o nine nt Color Redox Descriplon Texbrre Sbuclrre Connsielenoe Bourdauy Roots n. Misted Au. Sz. Conk. Color Gr. S¢. Sh. W2 l 0-5 tOYR2/2 t 3fa"gr ds eb 3vf-co .S Tc 2 5-24 lOYR4/3 I 2f-mabk ds ew 2vf-co .8 3 24-30 7SYR4/6 - Is OS9 ds cw 2vf-m 0.7 t.6 4 30-54 73YR4/6 - nos OS9 dl cw t vf-m 0.7 1.6 5 5476 7SYR4/4 r l s OS9 dt sb _ 0.7 1.6 6 76-86 7SYR4/6 tl cos OSg di cW - 0.7 1.6 7 86-112 7.5YR4/4 - s OS9 ml - - 0.7 1.6 ' EAuenk #1= BOD > 30:5 22D nV& and TSS >3D:5 19D mglL 'Firers #2 = BOO < W uV& and M:5 W nV& CST Name (Please P** CST Number May Jo Holtiste's Soil TeWng & Design, ---/NTrAUA 224832 Address uded Tdeplrone Number W9975 690th Avenue, River Falls, WI 54022 10-23-11 (715) 426 -1775 i Plot :Plan for Site and Soil Evaluation Page of 3- i Proper*7 Uwner 1»=40ft Legal ZOescription (except where noted) C~ Packhoe pit TNT ~E ~ ~a 54472-aA Rte W , To,r~N o~ sT. ~3cas~ pt+, sr. GRa►x i-Dl~NTy win-comsiP3 North N ~b / pcSSWA loop /OG (-W Oobs~ 5F: ~gov ~~DU t.8 ~3~ F p2tiL'tot~ 3• t~29q~ `rt-s`C ~l Site LocatiouO ~ 3 h h '~lVE1Q., 1'~ l` RECEi`o~EC. p ~.t a 1755 SAN 1004' SOIL EVALUATION REPORT Page 1 of 3 .1 6 Wisconsin Deparhnent of Corn € Division of Safety and Building ST. CI~(gltdarloe with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations ZONING OFFit = . County Attach complete site plan on paper actin size. Plan must St. Cr ix include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D If) percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Pending fro - Please print all information. viewed By Date Personal information you provide may be used for secondary pupoaes (Privacy Law, s. 15.14 (1) (m)). ?iZ if property Owner Property Location Govt. Lot SW 1 /4 NE 1 /4 S 4 T 29 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 151 9 Park Hollow City State Zip Code Phone Number City Village ✓ Town Nearest Road Hudson WI 54016 (715) 386-2769 St.Joseph River Road ✓ New Construction Use: ✓ Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments CS` and recommendations: Install three trenches at elev. 94.50' using 39 leaching chambers. aon4 ❑ Boring # Boring ✓ Pit Ground Surface elev. 99.29 ft. Depth to li iting factor >116" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots +E GPD/ft2E in. Munsell Qu. Sz. Cont. Color Gr. Sz. S . 1 0-8 10yr3/2 none sil cr ds as 2fm 0.5 0.8 (o 2 8-18 1Oyr4/3 none sil 2fsbk ds cs 1fm 0.5 0.8 ( 3 18-40 10yr514 none sil 2msbk dsh cw 1vf,f 0.5 0.8 (o d`~•~ 4 40-56 7.5yr4/6 none gr Is 0 sg dl cw 1vf,f 0.7 1.2 5 56-88 10yr5l6 none gr s 0 sg dl gs 0.7 1.2 q~ 6 88-116 1Oyr6/4 none s 0 sg dl - - 0.7 1.2 aBoring Boring ✓ Pit Ground Surface elev. 99.13 ft. Depth to limiting factor >123" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 1 0-10 10yr3/3 none sil 2fcr mvfr as 2fm 0.5 0.8 2 10-23 10yr5/4 none sil 2fsbk ds cs 1fm 0.5 0.8 y5s~ 3 23-34 10yr4/6 none sil 2msbk ds cw 1fm 0.5 0.8 ~ Ott - 5 4 34-46 10yr4/6 none Is 0 sg dl cw if 0.7 1.2 5 46-68 10yr5/6 none strat. s 0 sg dl cw - 0.5 0.9 6 68-123 10yr6/4 ne strat. s 0 sg dl - - 0.5 0.9 S Loading rates of & 6 reduced to relfect reduced permiability due to stratification of sand materials. ' Effluent #1 = BOD ? 30 < 220 mg/L and SS X30 < 150 L fW6nt #2 = BOD < 30 mg/L and TSS <.30 mg/L CST Name (Please Print) 'Si mature: CST Number James K. Thompson 3602 Address A.C.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 11/132003 715-248-7767 Property Owner Sam Miller Parcel ID # Pending from 030-1014-50-000 Page 2 of 3 F Boring # Boring Il/ Pit Ground Surface elev. 98•04 ft. Depth to limiting factor > 105" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr3/2 none sil 2fcr ds as 2fmc 0.5 0.8 2 4-14 10yr4/3 none sit 2fsbk ds Cs 2fmc 0.5 0.8 3 14-29 10yr5/4 none sil 2msbk dsh CW 2fm,1c 0.5 0.8 4 29-40 7.5yr4/6 none gr Is 0 sg dl cw 1fm 0.7 1.2 5 40-91 10yr5/6 none gr s 0 sg dl gs - 0.5 0.9 6 91-105 10yr614 none s 0 sg dl - - 0.5 0.9 19 H#5 & 6 contain 1/8" -1 /4' bands of 10yr4/4 Is at 16" - 24" intervals. Loading rates reduced to reflect reduced permiability of horizons due to banding. - it Boring # PBoring 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Bori ~ # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate ❑ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPDAf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <.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. • /O Cat`~d ~o~ ja ~rCe A IE. B. ~l a;(~ n I5~ "El~►-► twee. Cale; o' /arE y P/a.~ of F~.r~'h~w/ow 43 ° Qe~' ~ 7ss Q `p 99'90' O a Ce) I S,oPa' s re Assumed 62 a le% . ioo. O 1 P,3o-r3 Parcel 030-2139-09-000 03/11/2008 04:42 PAGE 1 OF 1 F 1 Alt. Parcel 04.29.19.2047 030 - TOWN OF SAINT JOSEPH Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 05/21/2004 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - DATWYLER, THOMAS P & TAMI M THOMAS P & TAMI M DATWYLER 601 6TH ST N HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 1167 56TH ST SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.010 Plat: 10-006-PARK HOLLOW 030-04 LOTS 1/12 SEC 4 T29N R19W SW NE BEING PARK HOLLOW Block/Condo Bldg: LOT 09 '04 LOT 09 (3.010AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 04-29N-19W SW NE Notes: Parcel History: Date Doc # Vol/Page Type 03/04/2005 788813 2759/271 WD 05/21/2004 763511 10/06 PLAT 04/21/2003 718249 2214/03 WD 07/23/1997 573/500 more... 2008 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 06/01/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.000 64,300 0 64,300 NO Totals for 2008: General Property 3.000 64,300 0 64,300 Woodland 0.000 0 0 Totals for 2007: General Property 3.000 64,300 0 64,300 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