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040-1098-40-000
County: St. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM c°u" Sanitary Permit No: Safety and Building Division INSPECTION REPORT 538885 0 (ATTACH TO PERMIT) State Plan ID No: GENERAL INFORMATION Personal information you provide may be used for secondary purposes privacy Law, s. 15.04 (1)(m)1. Parcel Tax No: Permit Holder's Name: City Village X Township 040-1098-40-000 , First National Bank of River Falls, foreclosures Troy Town of SectionlTown/Range/Map No: CST BM Elev: Insp. BM Elev: BM Description: m I 25.28.19.388C IOO ELEVATION DATA /.6 /01 /06 TANK INFORMATION BS HI FS ELEV. TYPE MANUFACTURER CAPACITY STATION 3, Id3 s /?jam Benchmark Z,T' Septic W e~5 E - t M Z b $ 9 , 9 Dosing Alit. B Bld .Sewer t Aerntion SI+iM~L 1 St/Ht Inlet TANK Holding SETBACK SUHt Outlet ' I , a $ `65 . 9Z INFORMATION TANK TO VE BLDG. Vent to Air Intake ROAD Dt Inlet %9 • +S Dt Bottom Septic - 4z Dosing ,•SY 1 !e f / Header/Man. Dist. Pipe Aeration Bot. System t _ 1QQ . Holding 1P PUMP/SIPHON INFORMATION Final Grade /G Demand St Cover q b , `JZ Manufacturer GPM c Iw~L Z6& kA Model Number nA) 16-5 '36 77 TDH Lift Friction Loss * System Head TDH Ft Dist. to well / Forcemain Leng~th~ Dia. Z it SOIL ABSORPTION SYSTEM No. Of Trenches PIT DIMENSIONS No. Of Pits uid Depth DIMENSIBED/TRENCHONS Widthl6 / Length '/7J S P/L B WELL LAKE/STREAM LEACHING Manufacturer: SETBACK SYSTEM TO CHAMBER OR INFORMATION / ~ ) UNIT Model Number: Typef~ystem: 5 ' 5a ~V~ DISTRIBUTION SYSTEM J / x Hole size 1 x Hole Spacing ven Air I ake Header/ManifolI Distribution a _ z `L 3 Dia Spacing Length_ (10 Dia Length f SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Mulched Depth Over xx Depth of xx Seeded/Sodded Depth Over Bed/Trench Center 3. +-i Bed/Trench Edges Topsoil 1 Xfe-s No ~ ~ / Insped• COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Location: 192 County Road U River Falls, W1 54022 (NE 1 /4 NW 4 ~ ' ~ N R19~etes & r-~rtI obLot ~ IF 1.) Alt BM Description = ~/~Y~ ~ ire 2.) Bldg sewer length= - amount of cover = i Plan revision Required? 0 Yes ,No { I ilQ~ ~l L - Use other side for additional information. Date Inse ctor s gnature SBD-6710 (R.3/97) A" `71 1 ingto Ave., P.O. Box 7162 ~ it ~ , commerce-Wl-gov Safet and B ildin f n unty Yo - PA on, 53707- 16 ; f~ ;M S itimy Permit Number (to filled m by Co. rug°r 5 8 S tnistilvord of ) ( Transaction Number Sanitary Permit Applicatio SP~aNT. Z8, ZONING OFF n in ante with s. 21(2)> Wis. Adm. Code, submission of this form to governmental Comm. in unit t is is r required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are P oject Address (if different hen mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary, ses in accordance with the Privacy Law, s. 15.04(1 (m , Stats.~ / 1. Application Information - Please Print All Information Parcel If t./~GG Property Owner's Name ^ / Property Owner's Mailing Address Property Location C h G- Govt. Lot • CrtY, State Zip Code Phone Number /'VL J J~'h, Se scion J -yam c le n E W J~ T_ N; R - - Lot # IL Type of Building (check all that apply) qY~! Subdivision Name l or 2 Family Dwelling - Number of Bedrooms Block # _ ❑ Public/Commercial - Describe Use - ❑ City of„ CSMNiunber ❑ Village of 'town 01' ❑ State Owned - Describe Use , III. Type of Permit: (Check only one bolt on ine A. Complete line B if applicable) A, 1 L1 El Other Modification to Exis+ing System (explain) New System lacement System ❑ TreatmenUHolding Tank Replacement Only ~/Q f List Previous Pe~iit er s nd Dak Issued B. ❑ Permit Renewal El Permit Revision ❑ Change of Plumber Ownermrt Transfer to New Before Expiration IV. T-10-0 f POWTS S stem/Com onent/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil Mound < 24 in. of suitable soil ❑ Pretreatment Device (explain)__ ❑ Holding Tank ❑ Other Dispersal Component (explain) _ - V. Dis erssUTreat nt Area Information: Flow (gpd) pesign Soil Application f) Dispersal Area Required Dispersal Area Propos tk System Eler ation Design Fl 411 ot I/ # of Manufacturer VI. Tank Info Capacity in Y 0A C Gallons Gallons Units New Tanks Existing Tanks t /l1 / t~ p U U) v, u c7 a+ AB A Septic or Holding Tank (s r LL Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume ility for installation oY^ the PO'WTSI~sP owwn of Number ched lane. Business Phone Number Plumber's S' 7.J I'll Plu s x C (Fria[) U Plumber's Ad ress (Street, City; State, Zip Code) C/\•+ v K VIII. Coon /De artment UUse Onl permit Fee Date I ued Issuing nt signatu Pproved $ ~ Z 5 . to I1 /,q ,q ~Fiiveln Reason o enial t G \ D t 5 ~ 6- IX. Conditions of ApprovaUReasons for Disapproval 3 SYSTEM OWNER` J 4~L t 1. Septic tank, effluent filter and \ •~-tte►n 5 t7 a• dispersal cell must all be services/ maintained. { j. 1 ~t as per management plan provided by plumber. I • ~j G~M.~ . 2. A11. setback requirements must be mantained l on paper aot lets 118 i!L x 11 iucl s In size Hachoeomp ns or the Sys in te and sub 't tog cnavty e v; 1 J , y~ r y SBD-6398 (IL 02/09) PLOT PLAN PROJECT First National Bank of River Falls ADDRESS 104 E. Locust St. River Falls Wi 54022 NW 1/4 NE 1/4S 25 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 100.8' 1.3' sand lift BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND )00( SEPTIC TANK SIZE 1200 gallon LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 450 # of chambers none Illk BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter Simtec STF-100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Please note: Deep Chisel plowing to be done to Property Line not to scale >1 6" to break up platy Cty Rd U structure Tank is to be properly bedded 4 acre parcel and provided with lockdown covers with approved warning Grading is to be done to divert run-off labels away from system Scale = 1/4" = 10' Huffcutt 630 Pump tank B-1 B.M.* Existing 3 bedroom B - 4 house Well Weiser 1200 N B-3 gallon tank ❑ B - 2 Area 15' below system is to remain undisturbed B - 5 4% Slope 99.5 Failed system location 98.5 97.5' Property Line p,PART ~NT Safety and Buildings 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 Contact Through Relay a A' www.commerce.wi.gov/slat www.wisconsin.gov °~Essror~PLS~ Scott Walker, Governor Dave Ross, Secretary November 09, 2011 CUST ID No. 226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/09/2013 Identification Numbers Transaction ID No. 2019812 SITE: Site ID No. 774056 First National Bank of River Falls Please refer to both identification numbers, 192 Cty Rd U above, in all correspondence with the Town of Troy, 54022 agency. St Croix County NWl/4, NEI/4, S25, T28N, R19W FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1345892 Maintenance required; 450 GPD Flow rate; 21 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Commercial System, 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 requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.01101). The building sewer and distribution network piping shall be of material listed in Table 8430-3teud 84.30- 5, Wis. Adm. Code. ~~9 - . -1 ' 4 In the event this soil absorption system or any of its component parts malfunctiWsoo Iat% th hazard, the property owner must follow the contingency plan as described in the approv ditioif, the owner must comply with the operation, maintenance and monitoring duties as describof the mound component manual. A copy of this information must be given to the owner upoof the project. C0~ All holding/treatment tanks are to comply with Comm. 84.25(7)(a). SHAUN R BIRD Page 2 1119!2011 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 145.19, 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. Owner Responsibilities: • Comm 83.52 Responsibilities. 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). • 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. 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. SFee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Julia Lewis-Osborne POWTS Reviewer 2, Integrated Services WiSMART code ,'633 (262) 397-6005, Fax: (608) 283-7481 julia. Lewis@wisconsin. gov E Cover Page .,min n.~e.z Shaun Bird Bird Plumbing Inc. IdOV - 7 2011 1008 192nd Ave SAFETY & BUILDIN New Richmond Wi 54017 715-246-4516 Date: 11 / 2/11 Owner:First National Bank of River Falls Location:NW1/4 NE1/4 S25 T28 N,R19 W 192 Cty Rd U Troy 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 Contige y plan 9-12. Soil test 13. Filter Specifications d oss secti n Shaun Bird Signature License numb 26900 PLOT PLAN PROJECT First National Bank of River Falls ADDRESS 104 E. Locust St. River Falls Wi 54022 NW 1/4 NE 1/4S 25 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 100.8' 1.3' sand lift BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1200 gallon LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Bottom of siding ASSUME ELEVATION 100' Filter Simtec STF-100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Please note: Deep Chisel plowing to be done to Property Line not to scale >1 6" to break up platy Cty Rd U structure Tank is to be properly bedded 4 acre parcel and provided with lockdown covers with approved warning Grading is to be done to divert run-off labels away from system Scale = 1/4" = 10' Huffcutt 630 Pump tank B-1 B.M.* Existing 3 bedroom B-4 house Well Weiser 1200 B-3 gallon tank ❑ B - 2 Area 15' below system is to remain undisturbed B-5 4% Slope 99.5 Failed system location 98.5 97.5' Property Line Mound System Cross Section and Plan View Dimension ~ ~ Dimension Feet A J I i. B S l ~ D I T A r I E F , S W i c^' G t V I; 'Z H I' v I I I 1 J I 7 I K K-T B 1 Z L Sloe = Topsoil ~ Ei! i i i j = ASTM C-33 = Clean aggregate = 4 in. sch. 40 pvc Cap Material sand fill 'h to 21/Z in. dia. 0 observation pipe Geotextile G H Fabric F Ft D E Plowed Surface t l ' Ft Contour 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 %a 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 Perforated Poe Dalai$ /0 Elio V~Lw Perfo~ot~a PVC Pipe +s Nola Localed On 11611W Are 6406111 booted t^Aa n vta . ~j4,rrvu-~. c1~~sr e- a SP T PVC Force Moia l/ FAST Nonni PAU r TO CAMMG ~ iotl PVC Moinifold Pipe tllRtrio ,on tV Pipe 4 r "'r , i Distribution Pips, Layout p Ft. R 3 Ff. X a7 InCheS V Inches Signed: Hole Diameter 5/30- -Inch L i conse Number ; La tore l Inch(es) Date: Manifold , Z . Inches Forte mg in " . Inches # of holes/pipe Z~ Invert Flev4tion of Laterals ~fll S Ft. . III Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer Minimum Pump Performance Fequired Tank Model Number G p 6 GPM Ft TDH Total Tank Capacity 3 C7Max. Bury Depth _ Total Dynamic Head H) • Feet Pump Manufacturer ~0 AElevation Head Pump Model Number l J Distal Pressure 3, Alarm M a n u f a c t u r e r e C~ N e t w o r k . Pressure Loss I , Alarm Model Number , j~ ~ Ll F Main Pressure Loss , p Jr Switch Type i~ Man hole Min. 4" Above Grade With Locking Device Vent Min. 12" Above Grade Weather-proof With Cap Junction Box Finished Grade - _ Depth of Cover Ft Disconnect SSA T Means >i t t; i t i t t K i t t i i Esi i i i i t i t t i t i E i t i i i f i{< t E i i t i i<< {>i ►t t 'i Outlet Switch Settings and Reserve Capacity Inlet Ft Tank Volume= IS GPI - - - } Dimension inches Volume Gal. t 41 (reserve) A o2 3 .S~ . S A }Y (alarm) 13 2 30 B fF4 Weep ;t (dose) C 5~ F< Hole Off Elev. C > < (dead) D S >3 Ft > K Total ► i Bottom of rank Elev. 56-5R D st i >t} ! Y a > > > Y > > 7-y 1, 17 Y > a > >i> a a > a > > Y > r > s > > > > } > > > > y > > > >i i{ t i t i i i C t E; K{ S S 9 E S K i E f i S i i t i K t t! i t i< f>ir< GENERAL INSTALLATION: The dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling; or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the excavation and is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 Wis. Adm. Code. 03/05lgj Page of TOTAL DYNAMIC HEAD/CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEwaTERING MODEL 152/153 ~ MODEL 152 153 J 50 Feet Meters Gal. Liters Gol. Liters 5 7.5 63 26'I 77 291 153 10 3.1 61 '231 70 265 12 40 15? 15 4.6 53 f201 61 231 ~ 20 6.1 44 167 52 197 L) 30 25 7.6 34 129 42 159 8 30 911 23 - 87 33 1?5 0 35 10.7 22 E5 q 20 40 12.2 _ 11 42 o Lock Volve: 38-0 Ft. (11-6m) 44.0 ft. (13.4m) 4 10 0 60 80 100 20 40 GALLONS LITERS s 1/a 0 80 160 240 320 Y 3 27/32 4 5/6 FLOW PER MINUTE 3 a7/ z I CONSULT FACTORY FOR SPECIAL APPLICATIONS anels available. ® 2-1/32 • Timed dosing p I • Electrieal alternators, for duplex systems, are available and supplied with an alarm. • Variable levy control switches are available for controlling single phase r systems. • Double piggyback variable level float switches are available for variable lave! long and short cycle controls. • Sealed Cmik-Box available for outdoor installations. See FMI420. 9r"3- • Over 130°F. (54°C.). special quotation required. 1? /6 I 1521153 Sodas' 1 on _ 5 1/ti Model VoltPh Mb L_Anpg S WW" Duplex l~e 1 2 or 3 N152 215 i Non 8.6 s+ DN152 115 :1 Auto 8.5 Included 2 or 3 E152 230 i . Non 4.3 1 2 or 3 SE152 230 1 Auto O included 2 or 3 Auto SELECTION GUIDE BN1fi3 153 115 115 1 1 Non 10.5 included 2o,3 E Etfi3 230 1 Non fi.3 1 2 or 3 1. Single piggyback variable level float switch or double Piggy hack variable level That 13E153 1 Aub 5.3 Indudad 2 or 3 switch. Rater b FM0477. IA CAUTION 2. See FMO712 for correct model of Els0*al Alternator E-Pak. All In"Alon of controk• pmtecdon devices and wiring should he done by a qualified - 3, Variable loyal control switch 10-0225 used as a control activator, specify duplex (3) licensed eleckkun. AN sladAcal and safety codes should he followed Indudine the most or (4) float system. recent Nadond L~edrio Code (NEC) and the Occupational.Safety and Health Act (OSNAy RESERVE POWERED DESIGN For unusual conditions a reserve safety-factor is engineered into the design of every Zoeller pump. W& TO., P.O. BOX 16117 VAIE* LoulsvJbs, KY 9025s-0347 Manufaclrlrerao(.. SHIP TO, 3649 Gana Run Road 0 )778-273, KY (800) 40211-1961 r p Praf~aa SNJ^f /93~9~ n,~:,~www.zo alrer.oom AAnlrlwo M (502) FAX (504 7144~r7rlMMr' Ijr~e~rr 0 Copyright 2000 Zoeller Co. All rights reserved. wTS OWNER'S MANUAL & MA@~iAGEM~T PLAN[ P490,01 t $Y'9T'~M gpGATK7~N9 _ . T /P s sSspec xW& WWnuftmrsr la NA OWNdW b NA 13 Oewi PJ ~T 3' ` i NA ~f t Model 5T- ~D 13 NA ~°f Bedo4RM PuMp•Tw* t WB* ~v Q NA /SMA Unks Pump Tank Manufduter O KA r(e+ y 2--) Pump mandidm C! NA- iffsenowd x '~A AvMW j9A aoHANAMOM no Purrlls eAoaret Unit !S3 Q E -Dom IAQoedlllll av+stalpe'" b is~rss~ F91W r Ci Pest Fier lrftierelell'J81Iri t Pies. &DMtlWW fS~ 5220 nV L. E3 ~n 0 Older: abdwmkwcww l _ *1 SO /L Towowrend~ DWPOAW Prate ~ Q :2%t ~ e~ tea? Q ci rnd nd ~ . At i1f 1 ~ am D Told SWP 8cltids (TM s30 mg~'1_ Q e CIA FwW ra>een S't Q` cfulit 00m1 vessuMbP>OWtex` danteM Gtoereronur~ecowrl«~+~+~ ~"a Eilft SK par" Sbe' K ~dlarrte~er tw* service Fraquen+ay sarvi" &Ont months s) (Maximum 3 yrs.) inspoa axw itlon of t ud4s) At least Once every When c,,nbbed sludge and scorn +r9~ one-thlrid CYO of tank volume Puaap out vcKlwnb of tans) Maldmurn 3 Yrs.) it,xpect ditpsnleu ess) At least once every C3 months r(s) 93 th At least On - every . ! s) ckasndMuentl s} oNA 0 nnd" snspsat pwnp, Co ararn At leaast Ofm ewtry At least Once sMSry O tnCrnths es) O' NA Rush b&rdb and FROOMM ~ o Tnnt*w 13 yNt(s) O NA. other At Janet once eeweny - oe.r At least ante every 0 wordto D yaw(s) t3 NA >aeNK IE Nw DWTwWT'OHG inspadkm oft#111I - old dbpWVW peliw *hall be, made by an ind Adual cwrviN WO of the iloliowktp Ocenses or oWjftOgWC• Mirpk nW, it "Plan ber Rewbicied Swoor. POWTS t gmdb n. Pt",lN S Umdrftbur: SWWQO Opp Tardt irapse~fons mist to dudes VhOA i irlspeolJOn Of the Uff*(e) to ldrnl!!y► any nli Ov or Was-, swvkft and to cbft* fOr WW bdm* UP hardwsra. i %ndly w exaoles or is ki6 Ihs valu ne of oQrnbUred sludge anrd seam ic io cheeiUaSkent aved crporAftof4MLWdcM 64WUnd - ThedleptaroWS) aWbe in to ohsa ofic,rl pVW and tO Ch#X* tOr any p 9 of e9 fluwd an the Cmund surf. The pondbV GO Wt on the g wxf5W nWQOM g n wW roguk w the imrrardiift noacwgbn of tho kwW rsg'ulakxY OAX- Whetl 11M t5ornbireed saxwwWWl of a aid scum to my link squab atteiS" NO Or MOM of ft tank vdUaw, the W" WfiWft Of ft W* shid be rt movW by a SePWP SWvldng Oparetior OW dbpoed o1' In W=d*nw Vdh ch. MR t i u. Wbo dM Adtttin ObefivCode- - - T)w aer& rV of dkot NbS. ffadwd%W Or prmurbmd POWTS a>mponenls, pta',1iVal t =Wonertw, and any a maonrw orel tg atkelnsb of i2 months or.kw. shag be poftyned by a W tied KWr5 M6r"'- wtvio A set vkp mpart a W'ber FaWded to the kXW tsgulatary auftrRy wittfn 10 days of oosmpt al t of any eat STARr EW AND A770N ether For tack/ ax~etl=6m, prier to Male of the POW'tS dock beatme nt tank(s) for the pras e Pgbft PWWO Or ahenlidlht tfist rrlatr trrpe~ tfle 6~a6n7ult ~ arWlor tiamaige~ #he1 di:ipeu'Iai eteii(erj. if I~ acne t1 d ban 6MM.Ow is of the tanija) removed by s sep0age aer+vkhV openebr prior to we. System start up shalt not Occur when sod'c onditions are frozen at the infittrative surface- Page,af_ Owing power owes Pump tanks tray fill above normal hi}hwater levels- When pones is mooed the avow vrashmater'vA be diedwilged to the dlsperZW tit(s) in one large dose. ov'erloadirig the aeff(s) and may rtesuit in the ba*W ar.surb0s dWChargre of t To avoid LIM wft=bon have the contents of the pump tents removed by a € 'move Senfti V Operator pdarAcV(w ufng power to the eMuent pump or contact a Plun tmr or POW S Meintalner tD as in malKoff ropersew Me pump'c=ws to restore normal levels wfthfn file pump tank. Do rot drive or park v over wlics and dlspMW CS&. Da not drive or palls over, or, oAW'Wbe d1 "VXb or eolflpaCt dos te wt Vdn 15 filet down slots of any mtxmd Or at-grade soft absorpbon also.. Reduction or4l1innatkui of fhe following from the wastewaW stream may improve the perkwmanoe and pn*xq Me a of Me POWTS_ anWtoW•babyv : -c 1gw6fW butts; condoms; coWn swabs,, degreases; denW lfoss; diaper dam; fat: buddgon diWR (isY vnp pump) wafer; fnrft and vegetable pea ftx gasafine; g • hwbkjdwb-, meat scxaps medications; olt; painting PmducW, pesticides; sanitary napkins. tampons; 'aid water'wftw er bdne. ABANDONN UENT When the POW T S facts and/or is patmar eritly.taken out of service the follovAng steps shaft its taken to k mm that the sys an is properly alndsafety abandoned In c ornprlance with ch_ Comm 83.33, Wisconsin Admkb tatii m Code_ Ail p4*g to tanks and pits shall -be disconnected and the abandoned pipe openings seaFed. Th--a&-ts of all tanks and Pft 5114116-- removed and properly disposed of by a Septage Servicing Operator. ` After pumping, at[ tanks arid pfts shalt be excavated and removed or their rovers removed-and the v,W space fitted with soil gravel oranotta3r inert solid material. CONTINGENCY PLAN If the PCWrS W6 and cannot be repah-ed the followfng measures have been, or roast be tale, to provide a code compliant neplooolnent system, 13 A surlfable Fares has been evaluated and maybe utilized for fhe location of a rerlent sort absorption system- The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot rues and wefts. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area Replacement systems must comply with the rules in effect at that time. 0 A suitable replacement area is not avaailable'due to setback and/or soil firnitattfons. Barring advances in POW rs technology a holding tank may be installed as a last resort to replace the failed POWTS. The site two not been evaluated to identify a suitable repfac:a-ment area Upon failure of the POWTS a soil and s evaluation must be perferrned trs locate a' suitable replacement area If no replacement area is available a holding tank may be installed as a last resort to replace the failed POW rS. Mound and at1pude absorption systems may be reconstructed in place fotfowing removal of the Monet at' Me lnfi(t Ufwe surface, Reaxtstrudfons of such systems roust comply with the rules in effect at that time. <<W4RNINY>s SEPTIC, PUMP AND OTHER TREATMEl11T TANKS IKAY CONTAIN LETHAJ!- GASSES ANIVOR FNSUFFiCfENT OXYGEN. 00 NOT ENTER A SEPTIC, PUMP OR QTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES_ DEATH MAY RESULT-. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR (MPOSSIBL& -ADOMC"ML CCWA1ENTf4 POWf`S INSTALLER POWTS MAINTAIMER tame Name /,z-.,, phone Phone sEPTAGE SEMCMe oPERAToR PUMP N Locac REGULATORY AUTHORITY Agency P L =-Jon- _ Phone " a,.^em*dear arty louts afore J' ms miolmurn Gken LAM. Marquel#e and W gtrauaertoe the pertavmarzce of tM ~ POVIITS. areham County Zonlny 8W Sanimtien mgperlde,, This docufferlt meets raa of POWT e3 bHtX ~+,d e3-tic ft 3. (2) It (3). wsaxwn #i6mk9sbaffva rods. Use of M,Is dearmed does not . (,MWO01) Wisconsin DepartmantofCommerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8112 x 11 inches in size, Plan must County ro l Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel 1.0, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. . Please print all Intormatlon. Reviewed by Date Pwwonal lydbm rtion you provide may be used far se-u WV purpuses {Privacy Low, s. 15.01 (1) (m)). Property Owner Property Location 1+ l C le'a Govt. Lot 114 1M $02-15 T N R E( W Property Owner's Mailing Ad(k Lot # Block # Subd. Name or CSMN State p Code Mm- ❑ city ❑ Village Town Nearest Road J'e"ru& 142) 5 (2-si %46-- 6 71-o 41 1 ~4 ❑ Now Conetructim Residential / Number of bedrooms _Code derived design Bow rate CJ GPO Replacement n ❑ Public or cArnmercial - describe: Parent material fjLOfG1 rn_~ <G.,,. ,tom Flood Plain elevation if applicable Genaret commerts ft. and lemllnr0, datitx : G' jOl l 1`v %d - i/~ ~b .S System Type dw-aa V 3 Sa ~l7' System Elevations _p S A;17 r Boring # Boring M Pit Ground surbw elev. ft. Depth to MAN factor in. Rate _Soll Application Horizon [depth Dominant Cola' Redox Description TexRure Structure Consistence BoundaryRoots GPDff In. Mwsel Qu. Sz Cont. Color Gr. Sz. Sh. •Efl#1 •Eff#2 J 6' YO- 70 R-3 S r- 2 # o Boring Pit Ground surface elev. 2-11- ft Depth to limiting factor- in. Shc NnAicallon Rate Horizon Depth Dominant Color Raft Description Texture Structure Consistence Boundary Roots GPM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Elf#2 oy 0- rN j- A / Z 7- 79. /011~1 Mel 14/2 .3 • Effluent #1 = 800> 30 228 nVA. and TSS 40 < 158 . I fluent #2 - BOD ~ 30 tnglL and TSS 30 mglL CST Name Ploaee Print) `Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Da1a Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 11-a-11 715-246-4516 Property Owner - Parcel ID # Page of # ❑ Boring Pit Ground surface elev. it. Depth to lirni ing factor in. Rate Horizon Depth Dominant Color Redo, Description Texture Structure Consistence Boundary Roots SoA GPDl/F in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Efi#1 'EH#2 Z 4~ J EE::=] I Boring # Bones 13 Pit Ground surFdceelev. / g, Depth to irniang factor Horizon Depth Dominant Color Redox Description TexttWe Stnrcdrre Soit Application Rate Consistence Boundary Roots GPL)/1F in. MunseN Qu. Sz. Cant. Color Gr. Sz. Sh. "Eff#1 `Efff#2 Z. S TS ' 0 77 S Al , 7 J vC c r - "Ito, #,8oring ~ # Pit Ground surface elev. - ft 5 . Depth to 1 factor n. 9 ~ Horimn Sail Ncation Rate 'depth Dominant Color Red Description. Texture Structure Consistence Boundary Roots GPD/If In. MunseN Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfY#1 `Etl#2 OW L ` 46 a Z_ C 13 3 TT,771 A4 N Effluent #1 = BOD, > 30 < 220 mWL and TSS >30< 150 mglL ` Eftent #2 = BOD, 5 30 mg& and TSS < 30 mglL 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 thedepartment at 608-266-3151 or TTY 608-264-8777. seaA~otR.erool ' Soil Test Plot Plan Project Name First National Bank of River Falls Shaun Address 104 E. Locust St. River Fails Wi 54022 CS i226900 Lot Subdivision Date 12111 N W 1/4 NE 1/4S 25 T 28 N/R1 g, W Township Troy ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of Siding ystem Elevation 100.8' 1.3'sand lift *HRpSameas Benchmark Scale is 1" = 40' unless otherwise Property Line not to scale rioted Cty Rd U 4 acre parcel Scale= 1/4" = 10' B-1 B.M.* Existing 3 bedroom B-4 house o Well Weiser 1200 B-3 gallon tank O ❑ B-2 B-5 13 4% Slope 99.5 Failed system location 98.5 97.5' property Line k I I i r I I 1 k I, ,r II I! ~ I 1 81 ~ I I I I , 3-1, , I I l ! I I~ ! I I I I ~ it I I (I I I It t I I I I! ~,f 1 I I ~ I 1 l..f I I I k I I 11 k I ~I FUN ~I I it I I I I I I i I I i 1i jll I i~ )1l IE OG-598 HO TON GAY 01H Rn 1 MY* CITY, MI 49711 1-888-999-IM FAX 1 31-582-7 24 r..~_. SIM/TECH FILTER ASS" f~ FFTAII PATFMT 588545 ' l i J HBWERY _W_....._~......STF.w1.00 -r 11127/0'61" GARY KGTESKEY i1` NEk 50/60 39dd o3 dwnd Q3dc13U38d 89BLbL05ZL Lh-'Oi iin?"m/in ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 1 Owner/Buyer t ` c Mailing Address O v L~=k- l) OQ Property Address (Verification r ed from Planning & Zoning Department for new construction.) City/State Parcel Identification Number - LEGAL DESCRIPTION Property Location/V /a , i~ V4 , Sec. 2-~T G JN RTown of Subdivision Lot # Certified Survey Map # , Volume , Page Warranty Deed # , Volume , Page # Spec house yes,5 hot lines identifiable es 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. Vwe, 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. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property' described above, by virtue of a warranty deed recorded in Register of Deeds Office. N f bedrooms A 0 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. 08/05) E I E! Ill li I!I III I II I I I I it II Ii 1 II III III II I II !I I! III I! * 9 0 9 5 3 9 1 State Bar of Wisconsin Form 6-2003 909539 SPECIAL WARRANTY DEED BETH PABST REGISTER OF DEEDS DocumentNumber Document Name ST. CROIX CO., VII RECEIVED FOR RECORD THIS DEED, made between Valley Land Co. Inv. Partnelship. LLC, a Wisconsin 12/31/2009 12:15PM limited liability company, ("Grantor," whether one or more), and The First National SPECIAL WARRANTY DEED Batik of River Falls, a national banking corporation , ("Grantee", whether one or EXEMPT t 14 more). REC FEE: 11.00 Grantor for a valuable consideration, conveys to grantee the following described real PAGES : 1 estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property"): Part of the Northeast Quarter of the Northwest Quarter (NE of NW ) of Section Twenty Five (25), Township Twenty Eight (28) North, Range Nineteen (19) West, Recording Area Town of Troy, described as follows: Commencing at the Northeast corner of said I Northeast Quarter of Northwest Quarter on centerline of County Trunk Highway "U' , Name and Return Address thence South on said centerline 700 feet; thence Northwesterly 500 feet to a point 472 Thomas R. Schumacher feet Southwesterly of a point on North line of said Northeast Quarter of Northwest B~ NORMAN, S.C. y 990 Main Street Quarter 255 feet west of Place of Beginning; thence Northeasterly 472 feet to said point P.O. Box 54 on North line 255 feet West of Place of Beginning; thence East on said North line 255 Baldwin, WI 54002 feet to Place of Beginning. EXCEPT part to Production Credit Association of River b Falls, in Volume 624, Page 08, as Document Number 368817. Subject to C.T.H. "U" right of way. St. Croix County, Wisconsin. 040-109840-000 This Special Warranty Deed is given in lieu of foreclosure and in conjunction with an Parcel Identification Number (PIN) Agreement between Grantor and Grantee and Affidavit of Fair Dealing from the This is not homestead property. Grantor. This warranty deed is subject to the terms and conditions set forth in the Agreement and the Affidavit. Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances arising by, through, or under Grantor, except: Subject to municipal and zoning ordinances and recorded easements of record, if any; and a first mortgage to First National Bank of River Falls dated September 14, 2005 and recorded in the St. Croix County Register of Deeds office on September 19, 2005 as Document No. 8068691, vottxm.e oZ$C11 ~7ict~DPS 353 35`f. Dated F VALL Y LAND CO. INV. PARTNERSHIP, LLC VAL A D CO. PARTNERSHIP, LLC (SEAL) (SEAL) *.By: Chris M. Kusilek, Member * fty:Mark B. la, Member (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Chris M. Kusilek and Mark B. Sylla STATE OF WISCONSIN ) authenticate ) ss. COUNTY ) f * Thomas R. Schumacher Personally came before me on , TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Chris M. Kusilek and Mark B. Sala (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Thomas R. Schumacher, BAKKE NORMAN S.C. Notary Public, State of Wisconsin 990 Main Street P.O. Box 54, Baldwin WI 54002 My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. SPECIAL WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 6-2003 Type name below signatures. 1 of 1 WisconsinDepartrnen ` oS IL EVALUATION REPORT Page 1 of 3 Division of Safety and uildings In rdance with Comm 85, Wis. Adm. Code County St. Croix Attach comp to site $iiion ~ hper less than 8 : x 11 inches in size. Planmust Include but n t limited to: vertical and laptizontal ference point (BM), direction and Parcel ID 040-10 8-40-000 Percent slope, cale ormensi BM referenced to nearest road. P► k '1' in all information Revie y Personal information yo provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) Property Owner Property Location First National Bank of River Falls Govt. Lot NW ~i. NE s J T 2 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 104 E Locust St. City State Zip Code Phone ❑ City ❑ Village 0 Town Nearest Road River Falls WI 54022 715-426-3169 Troy 192 C . Rd. U ❑ New Construction Use: 0 Residential / Number of Bedrooms Code derived design flow rate GPD 0 Replacement ❑ Public or Commercial - Describe: -/0.6 ~ I, ~ 0, ~ Parent Material Loess / Sandstone / Colluvium Flood Plain elevation if applicable N/A ft. General comments and recommendations: These soil profiles were completed as an addendum to Shawn Birds original soil test completed for the property. I recommend deep chisel plowing of the mound area to a minimum of 17" below surface to break up the platy structure. *When the 2-f-pl structure in B-4 is disturbed it breaks to a 2-f-bk structure. Therefore I recommend that following tillage an Eff# 1 loading rate of 0.4 GPD/ft be applied. Z L ~ l.r a ~.ti 4 Boring # Bormg H Pit Ground Surface Elevation ft. Dep to Limiting factor 21 in. Soil Aoolication 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 0-9 10YR2/2 - SIL 3-f-bk dh cs 3 f-co 0.6 0.8 2 9-12 10YR3/4 - SIL 2-f-pi dh gs 2-f-co 0.0* 0.2 3 12-15 10YR4/4 - SIL 2-f-pl dh Cs 1f 0.0* 0.2 4 15-21 10YR4/4 - SICL 2-m-bk mfi cs 1f 0.4 0.6 5 21-24+ 10YR4/4 7.5YR5/6 f-1-d CL 2-m-bk mfi - - 0.4 0.6 Boring # ❑ Boring Elpit Ground Surface Elevation ft. Depth to Limiting factor >22 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 0-6 10YR2/2 - FSL 2-m-bk dh Cs 2f 0.4 0.8 2 6-13 10YR2/2 - FSL 2-co-bk dh cs 1f 0.4 0.8 3 13-17 10YR3/4 - FSL 1-f-pl dh gs 1f 0.2 0.6 4 17-22 10YR4/4 - FSL 1-co-pl dh - - 0.2 0.6 _L _j * Effluent # 1 = 13OD5> 30 220 mg/L and TSS > 30:S 150 mg/L * Effluent in = BOD5 < 30 mg/L and TSS 30 mg/L CST Name (Please Print) Signatu CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 Novemeber 2, 2011 715-796-5664 RECEIVJFF sconsin Department of C merceN V T; r L EVALUATION REPORT Page of I ision of Safety and Buildin s i t1FAMMOMmm 851/is. rl PLANNING & LON1 ,A~ County 1 , ~ro I l Attach complete site plan has in size. Plan mu include, but not limited to: vertical and horizontal reference point (BM), diredi Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest roa yQ - - Please print all information. Re ' ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). -X-f-- VY) Property Owner Property Location r Govt. Lot 1 /4 1 /4 1o25 T N R/ E ( W Property Owner's Mailing Addre,.s Lot # Block # Subd. Namdf or CSNW City State, Zip Code Phone Number ❑ City ❑ Village Town Nearest Road lv 5 c ~.nYa~- 6 -0 ❑ New Construction Us . Residential /Number of bedrooms _ Code derived design flow rate yJ y GPD Replacement ❑ Public or commerciall- Describe: Parent material Qil m20A-- 5 Q,Aer0 Z4MIL Flood Plain elevation if applicable K/ 14 ft. General C ' ~OIaGcJ f U rd fv d~eCt/~ /0 All' System Type OG/ / 3 System Elevation 0 M Boring # 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 GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 2 8-13 3 z s 1 r s 0 511, F2--]Bodng # °Boring pit Ground surface elev. L ft. Depth to limiting factor ~ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 0 Q r 31 y-ILI 41 .3 - A) 14- S o` N ! Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signs CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 U-0,11 715-246-4516 Property Owner _ Parcel ID # Page of ❑ Boring Boring # gq ~ Pit Ground surface elev. ~ ft. Depth to limiting factor in. ff*Eff#l Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. / 'E'fff##2 Q'r2 L~ v < r U Z _ Z lo. 3 -7 .3 b 5u5 2. r Boring # ~ 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 GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0 ;/L ff S C~ S' 0 31V C- ~J e 02~ Boring # Boring 99 qq ~ ❑ Pit Ground surface elev. ~ ft. Depth to limiting factor Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 0- lz- S G~ r z -1 " a d c S 13-)7 Iv 3 s 17-2 Z~LZIY -,v M ~ N 1a Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS 130 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. SBD-9330 (8.6100) Soil Test Plot Plan Project Name First National Bank of River Falls Shaun Address 104 E. Locust St. River Falls Wi 54022 CS #226900 Lot Subdivision Date 12111 N W 1/4 NE 1/4S 25 T 28 N/R19 W Township Troy Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Bottom of Siding ystem Elevation 100.8' 1.3'sand lift *HRpSame as Benchmark Scale is 1" = 40' unless otherwise Property Line not to scale noted Cty Rd U 4 acre parcel Scale = 1 /4" = 10' B-1 B.M.* Existing 3 ` bedroom i B - 4 house SD Well \ Weiser 1200 B-3 gallon tank ❑ B-2 B-5 4% Slope 99.5 Failed system location 98.5 97.5- Property Line •$/10/2011 Property Full Report, Single Family Residential, MLS#: 4075962 192 County Road U, River Falls, WI 54022 Status: Active ' List Price: $145,000 s~ Original List Price: $145,000 Map Page: 126 Map Coord: D4 Directions: North on Main St. - North i on Hwy 35, (R) on Cty Rd U to 192. 0 TAX INFORMATION MLS Area: 805 - Western Wisconsin Year Built: 1957 Property ID: 040109840000 Style: (SF) One Story Bedrooms: 3 Tax Year: 2010 Const Status: Previously Owned Total Baths: 2 Tax Amt: $3,520 Foundation Size: 1,512 Garage: 1 Assess Bal: $0 Above Ground Finished SgFt: 1,512 Acres: 4.10 Tax w/assess: $3,520 Below Ground Finished SgFt: 300 Lot Size: Irregular Assess Pend: No Total Finished SgFt: 1812 Fire Homestead: No List Date: 8/9/11 Received By MLS: 8/9/11 Days On Market: 1 General Property Information Legal Description: SEC 25 T28N R19W PT NE NW COM N 1/4 COR SEC 25, TH S 700 FT, NWLY 500 FT TO A PT 472 FT SWLY C County: St. Croix School District: 4893 - River Falls, 715-425.1800 Mfg Home w/HUD ID No Complex/Dev/Sub: Common Wall: No Restrictions/Covts: Lot Description: Tree Coverage - Medium Assoc Mgmt Comp: Assoc Mgmt Co Phone Road Frontage: County Zoning: Residential-Single Accessibility: None Remarks Agent Remarks: Bank owned property. Age is approximate. No PCR. Sold as is. 2 outbuildings/sheds not included. Public Remarks: Nice rambler style home with main floor family room on 4+ acres located just north of River Falls. Protected hillside setting, wood fireplace, some wood floors, great value. Structure Information Room Level Dimon Other Rooms Level Dimon Heat: Forced Air Living Rm Main 12x20 Recreation Room Lower 13x13 Fuel: Natural Gas Dining Rm Main 10x12 Air Cnd: Central Family Rm Main 13x17 Water: Well Kitchen Main 9x17 Sewer. Private Bedroom 1 Main 14x14 Garage Stalls: 1 Bedroom 2 Main 9x11 Garage Stall Bedroom 3 Lower 9x10 Bathrooms: Total: 2 Full: 1 Other Parking: Bedroom 4 3/4:1 1/2: 0 1/4: 0 Pool: None Bath Description: Main Floor Full Bath, Master Walk-Thru, 3/4 Basement Dining Room Desc: Living/Dining Room Family Room Char: Main Level Fireplaces: 1 Fireplace Characteristics: Family Room, Wood Burning Appliances: Range, Dishwasher Information Deemed Reliable But Not Guaranteed. © 2011 Regional MLS of Minn., Inc. All Rights Reserved. Page 1 of 1 y (8/10/2011 Property Full Report, Single Family Residential, MLS#: 4075962 192 County Road U , River Falls, WI 54022 Basement: Full Exterior: Wood Fencing: Roof: Asphalt Shingles, Age Over 8 Years Amenities-Unit: Deck, Patio, Natural Woodwork, Kitchen Window, Hardwood Floors Parking Char: Attached Garage, Driveway - Asphalt Special Search: Main Floor Bedroom Financial Cooperating Broker Compensation Buyer Broker Comp: 2.4% Sub-Agent Comp: 2.4 % Facilitator Comp: 0 % Variable Rate: Y List Type: Exclusive Right Sellers Terms: FHA, Conventional, Cash Existing Fin: Free and Clear In Foreclosure?: No Lender Owned?: Yes Potential Short Sale?: No List Agt is Owner?: No Listing Agent: BETTY MOST-BAUGHER 715.426.1504 Listing Office: Edina Realty, Inc. Appt Phone: Use BookAShowing Office Phone: 715-425-8700 e This Report Prepared By: KEN LEE 715.426-1510 Information Deemed Reliable But Not Guaranteed. 0 2011 Regional MLS of Minn., Inc. Al Rights Reserved. Report for Parcel #040109840000 1 St Croix County, WI Page 1 of 1 2010 Property Record I St Croix County, WI Assessed values not finalized until after Board of Review Property Information is valid as of 5123111 Years In red have delinquent taxes NOTICE: All payments received by County Treasurer will be posted the next day. Property Description Billing Information Parcel ID: 040-1098-40-000 Name / Attn.: 1ST NATIONAL BANK OF RIVER FALLS Map IDs 25.28.19.388C Address: 104 E LOCUST ST Municipality: TOWN OF TROY City, State, Zip: RIVER FALLS, WI 54022 Public Land Survey: SECTION 25 28N 19W Ownership Quarter: NE NW Primary Owner: 1ST NATIONAL BANK OF RIVER FALLS QQ /Tract: Secondary Owner: NO SECONDARY OWNERS LISTED Plat: - NOT AVAILABLE I Description: Deed Information SEC 25 T28N R19W PT NE NW COM N 1/4 COR SEC 25 TH Volume Page Document # S 700 FT NWLY 500 FT TO A PT 472 FT SWLY OF A PT ON 909539 N LN NW 1/4 WHICH IS 255 FT W OF POB TH NELY 472 FT 848096 TO PT ON N LINE 255 FT W OF POB TH E 255 FT TO POB; EXC A TRIANGULAR > PARCEL ADJ TO ELY SIDE OF LOT 2 2891 344 806866 AS DESC.IN-V 624/8 703 589 399037 Property Address: 192 QTY RD U 509 247 Total Acres: 4.10 ACRES Other Assessed Value ' Fair Market Value $227,000.00 Valuation Date: 11/09/2009 Assessment Ratio: 1.0088 Assessment Acres Land Improved Total Net Assess. Val. Rate: 0.016078445 Type Value Value Value G1-Residential 4.10 81,000 148,000 229,000 School Districts: 4893 - SCH DIST RIVER FALLS Totals 4.10 81,000 148,000 229,000 Tax Detail Installments Net Tax Before Lottery, First Dollar Credits 3,681.96 Please pay your 1st installment or full payment to County Lottery Credit 90.55 Treasurer, 2nd Installment to the County Treasurer, 71 82 Period Due Date Amount First Dollar Credit Net Tax After 3,519.59 1 01/31/2011 1,714.52 2 07/31/2011 1,805.07 Amt. Due Amt. Paid Balance Total Taxes 3,519.59 Net Property Tax 3,519.59 1,714.52 1,805.07 Special Assessments .00 .00 .00 Tax Payment History Special Charges .00 .00 .00 Date Receipt Number Amount Delinquent Charges .00 .00 .00 01/25/2011 288701,714.52 Private Forest Crop .00 .00 .00 FIRST NATIONAL BANK OF BALDWIN Woodland Tax Law .00 .00 .00 Paid By: CHK #61488 (2 PARCELS 276-1117-0 Managed Forest Land .00 .00 .00 Penalties .00 .00 Specials Interest .00 .00 Category Amount Total 3,519.59 1,714.52 1,805.07 http://stcroixwi.mapping-online.com/StCroixCoWi/ParcelReport.j sp?keyword=040109840... 5/24/2011 Septic System: The septic system has failed. The reasons for failure are: 1. The water level rises in the. . .c tank after 5 minx of running water. 2. The septic system was partially installed across the lot line to the south. 3. The system has to much fill located over the system to be legal. 42" of cover was the code in 96. 4. The system was partially destroyed when the new municipal storm sewer and water lines were installed to the south. After dimension the system from the paperwork on file and having the St. Croix County Zoning office verify these facts, the storm sewer and water lines must have intersected with the septic system. Solution: do a soil test and install a new septic system. The storm sewer line and water service to the south is on private lands and does not provide service to this property. Well: The well is located in a alcove(basically a small closet attached to the basement that houses a well). The casing has been extended to a legal height above grade. The deck area would need to be temporarily removed if the well would need to be serviced. This is very common for this well location. The well can be serviced making this a legal well. 61001" D Z~ o~ a a r f =r / w v j N VT , vy ~ i x 63 mill n C 3 00 7 O C C 0) C N c NICND W Y/ CJ1 nl 'A N F~ O~ 7 CS 3 N CD' 41 CD! O'O N' CD O N ;t.l c r (D i t_ a y wow VISO 1612,41 Ile W SIJ 01 & 5e~k~ ~y6+e v~ef '4r,' 1~,~ 1e~5 f ost. i ~ obasu~~a.. 1 .eQ Aqt~,~- b;o,Ma,ct kvdr",Itc, odc!'/ REQpRZ ~ ~gg6 0 4 1 STC SYS~OM SY C~X T SAWZ~ARY Z~i1 SCE ti A5 B~zv S 2~ ~`~1y DoT OWW$R AOORESS 2 dv OIVISIpW Z W'R~ SYST~t~ SVB ~S ~ SCOWSZN ZEW of S~C~ZpN QTY Wl 4~~W lop F ST• cRpZX V~RY2x1W0 Wl KOW r A F ~trv ALUiyNll~ ~N I Lrc~Ns~ °N NSA~cTo ~t°1 i d °f st aid elevate°r nee de set~acl~ 1°rs o ce Pr°vi di~e~s e 2 4r°v id BENc~A RK: ALTE~A~E a r Mai 8,%,rc T , OF ANK tbacctUter: / ppNp c SL a k Ito ~i ~ BER PU OP well / xOZDrNc Fl ° aot s o , TAN Ala a t sepeta ti Urer °crse Liquid ca x rNFORTr ~ Lo~at• Oil paojtY: °N z°h other GC-1 j Z °ns Mod el c3 width. Size .OjstahCe\ Leh9t .s°rL ABs 1etbaok ft Oitect~On h °~PTrON SY o~ ~ we j 1 • to neared NU~et sTEM °r t o S - - reoCh~s ding Se oche. wet t let NS /Mahl PC Inlet fold bott010 Grade Sp F Bottom Of Pump °ff oUtlet PAL~TroN 9tade 8• - 21 ~r Wisconsin Department of Industry, PRIVATE SEWAGE SYSTEM County: Labor andHumanRelations INSPECTION REPORT ST. Ct2OIX Safety and Buildings Division (ATTACH TO PERMIT) Sanitary Permit No-: GENERAL INFORMATION 262399 Permit Holder's Name: ❑ City ❑ Village Town of: State Plan ID No.: TEPPEN, RICK TROY CST BM Elev.: Insp. BM Elev.: BM Description: Parcel Tax No.: TANK INFORMATION ELEVATION DATA A960 12 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /00= Dosing Aeration Bldg. Sewer 7 7' S ' Holding St/ Ht Inlet -1 31 C? TANK SETBACK INFORMATION St/ Ht Outlet TANKTO P/L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM 96,59' TDH Lift Friction System TDH Ft oss Head Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width- Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSIONS LEACHING Manufacturer: SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM INFORMATION TypeO CHAMBER Model Number: System: Z OR UNIT DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake 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 ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY.25.28.19 +1, NE, NW, CTY U 0I aj- Plan revision required? ❑ Yes ❑ No Use other side for additional information. 94d SBD-6710 (R 05191) Date In e s Signature Cert. No Safety and Buildings Division SANITARY PERMIT APPLICATION Bureau of Building Water Systems 201 E. Washington Ave. In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 1/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Nu ber The information you provide may be used by other government agency programs ❑ Check if revision to previous application (Privacy Law, s. 15.04 (1) (m)]. State v .q~~er' 1. APPLICATION INFORMATION - PLEASE PRINT ALL INFORMATION r/-t( ip Property Owner Name Property Location ,r114,ol 14,SR5 - T "zN,R E(or Property Owner's Mailing Address Lot Number Block Number . 14 7V- 7 .Z City, tate Zip Code Phone Number Subdivision Name or CSM Number T ©1- (kAp 4,1V 57 II. YPE F BUILDING: (check one) ❑ State Owned City Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms ❑ village of L GG III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number( 1 ❑ Apartment/ Condo e) ila ' q 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) 44 e 00 A, v/Tr A) 1. El New 2. Replacement 3, E] Replacement of 4. E] Reconnection of 5_ Repair of an System System Tank OnlyExisting System ExistingSystem B) ❑ A Sanitary Permit was previously issued- Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 410 Holding Tank 12 La Seepage Trench 22 ❑ In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ ault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM ll~f ORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp- Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq- ft.) Proposed (sq_ ft.) (Gals/day/sq. ft.) (Min./inch) 7+'t X3.0 Elevation 11~~ Feet f'7.D Feet VII. TANK Ca in ala t uots Total # of Prefab. Site Fiber- Exper. INFORMATION g Gallons Tanks Manufacturer's Name Concrete con- steel glass Plastic App New Existing strutted Tanks Tanks Septic Tank or Holding Tank ❑ ❑ ❑ ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of a onsite sewage system shown on the attached plans. Ptu ber's Name: (Print) Plumber's Signature: (No S ps) &4P4MPRSW No.: Business Phone Number: 3 1 t 7 -3 .sue' er's Addr ss (Street, ty, Stat Zip Code): cr O IX. COUNT / DEPARTMENT USE ONLY ❑ Disapproved S itary Permit Fee (Includes Groundwater ate Issued is g Agent Signature (No Stamps) X Approved ❑ Owner Given Initil Surcharge Fee) Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SOD-6398 (R. 05/94) DISTRIBUTION: Original to county, One copy To: Safety &.Ruili ings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Administrative Code will be applicable. 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD-6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained.-, The septic tank(s) must be pumped by a licensed, pumper whenever, necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the Sfate of Wisconsin, Safety and Buildings Division, 608-266-3815. To be complete,and accurate this sanitary permit application must include: 1. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system, Check appropriate box depending on system type. VI. Absorption' system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new/or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump/siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. IX. County/ Department Use Only. X. County/ Department Use Only. Complete plans ancf'specifications,not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must include the following:. A} plot plan; drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section of the soil absorption system if required by the county;. E) soil test data on a 115 form; and-F) all sizing information. GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) fora number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. y f PLV perk Testes 6 ~~r sc~ ' 3O #323 a 9ROSd 11 = Bw, / /ft~i,w►t /mo.0' boa ,~vtc tI4~. Ph;~ I Gri/ /~r L X = 6e ri~/n1s / 1 n 7 p , ,Veu) Ve&t4l ly x s #i a *3 T ~ T,? 1 k r/<d; vE~r f~ T 93 T~~~ p s 9r~ L Trev"e11 S`wf `_~uuaQ /~f- CDYntr~ s S/ d t v lq1' S•%- /{a (C(' F.r-)t' s O #'3 Ne-I 1,-2" S T• i L~4TE/c14~ T° l NnTF ; Nd ~cc Fern iqv ~ T~ fc / CAS 6~ ~NLL VNL v~ i ~'q✓Yt? t ~ I ~ ~ ` I j-zs'ri4acES = b~- fQ t 74 71bf 14-4"C'A rv T a~ H aa' fi l = s X / 5'e r i ?IPPW ✓F►V 6 ~D ~rrnCA l /q a ~j 1 z ~u.u p~a0 d co / la see C9l/ !ui i ~r~tv i f~7"BQGl We-.1 4 I DAVE FOGERTY PLUMS MG Licensed Perk Tester & Plumber #32y33 93299 ROSE~~T3, -WI ONSim Road Phone 749-3656 L y ~yEl M goo ' - I = R~ 4 2 yrr ~f-'71- 3 j!o ct; ~3 r fCCL ff►,GA~i I x rr i a~ i SSuc f`rvu~ e o Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of labor and RRuman Relations Division ofPafety & Buildings jn HR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less n /2 x 11 inches ~ ~vl Plan must include, but not limited to vertical and horizontal refere int (Bh4), d'ion an ~i4r slope, scale or PARCEL I.D. # dimensioned, north arrow, and location a lance ffl~art APPLICANT INFORMATION-PLEA 121 jJT ,LL INFO' TION, REVIEWED BY DATE PROPERTY OWNER: LOCATION ~ROPERTY OVT. LOTyff- 1/4 , At/ 1/4,SZ5--7 Z j, ,N,R E (o(2v PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # CITY, STATE ZIP CODE P (CITY (VILLAGE (SOWN NEAREST ROAD ER F~ uS ( ) - 6s~S o CT L[ [ J New Construction Use Residential / Number of bedrooms Addition to existing building j) Replacement [ ] Public or commercial describe Code derived daily flow 40 gpd Recommended design loading rate .7 ed, gpdfit J trench, gpd/ft2 Absorption area required bed, ft2 752p trench, ft2 Maximum design loading rate __._2 bed, gpd/ft2=trench, gpd/ft2 Recommended infiltration surface elevation(s) 4L.2- 91-3 ' It (as referred to site plan benchmark) Additional design/ site considerations Th i /'j c ne 'Ai Parent material Flood plain a evationwplicabl~ 9 , ~G ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE E SYSTEM IN FlLL HOLDING TANK U= Unsuitable fors stem 0S D U D S f7 U 0S O U D S Ou D S [Z U 0S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trott 0 -Zh _51- 17M -56K e'-.5 LYE- Ground Z? 3 - 3 i c C56 rrrFS G S 2 ,3 elev. - j Ord ft. J' Depth to c FX~ S 1 -3 3 .5'3,K Af limiting factor V /-/o4 _ S o S~ L - Remarks: Boring # Z -35 0- y c s rR cs co 57c ~2 Ground elev. L S f¢S - . ft. Depth to limiting factor Remarks: CST Name:-Please Print BFI T Phone: Address: ~ 2 91 ~ .~~33 Signature: a~ Date. CST Number. PROPERTY OWNER fr)f V SOIL DESCRIPTION REPORT Page .L of 3 PARCEL I.D. # Depth Dominant Color Mottles Structure GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trerch Ground elev. ?-Zi ft. Z 3- 0- c 3101 SA E F.z ~S c a o`, a Depth to limiting factor 3 Yy , S-- -s' B" S O S G - 8 Remarks: Boring # Ground elev. ft. Depth to limiting factor F-T- Remarks: Boring # 4:ti-:.... 1• Ground elev. ft. Depth to limiting factor Remarks: Boring # FOGWY VNG Ground elev. Licensed P Tester & Plumber ft. 0o~~#3 33 #3209 IF "0 Kong IROSER'TS, V ISCON IN 54023 Depth to Ph 156 limiting factor Remarks: DAVE I:OUM PLUMBING Licensed Perk Tester & Plumber F #3289 ROSE~RTSI, WISCONSIN 54023 Phone 749-3656 ~ L Clt ~ StaA / rr= 3~ r \ ~ d Tof f~ o x • 'uH~ 47 cvrAPY'f Q c0 = llluv~~~/ (>LiiL7'~ IL ser ~cDoTE - ~e►vy qq MMU 43001, WAG Al dF'2; I i • i I I gel. STC - 105 SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNEWBUYER zi / MAILING ADDRESS If PROPERTY ADDRESS Sc. (location of septic system) Please obtain from the Planning Dept. CITY/STATE PROPERTY LOCATION 10e 1/4, lt~W 1/4, Section ,z T -'.P N-R_ _W TOWN OF 7R~ ST. CROIX COUNTY, WI SUBDIVISION LOT NUMBER CERTIFIED SURVEY MAP , VOLUME PAGE , LOT NUMBER 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their system properly maintained. The property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum. VWe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system in accordance with the standards set forth, herein, as set by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year ex . ation date. SIGNI'D: DA IT:: - q _ - St. Croix County Zoning Office Government Center 1101 Carmichael Road Hudson, WI 54016 11/93 ' S T C - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner/contractor, (spec house), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of property %ND,, Location of property,&Ll/4_414e_) 1/4, Section .2s ,TAN-R1t W ,-40 V Mailing address -L ~T,L2~0 or 4C jr Township 74 Z1- eft" Address of s'i`te Subdivision name /ylielf Lot no. Other homes on property? Yes ji N Previous owner of property Total size of property / ..t 4c4e.""l Total size of parcel Date parcel was created Are all corners and lot lines identifiable? i/ Yes No Is this property being developed for (spec house) ? Yes c/ No Volume 7673 and Page Number s-S7 as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A WARRANTY DEED which includes a DOCUMENT NUMBER, VOLUME AND PAGE NUMBER AND THE SEAL OF THE REGISTER OF DEEDS. In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. Cf9'0!,j>.7 , and that I (we) presently own the proposed site for the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. A2, Signature o piicant Co-Applicant Date of Signature Date of Signature DOCUMENT NO. STATE BAR OF WISCONSIN FORM 3-1982 THIS !PACK RCSCRVCO FOR R[COROIN4 DATA j QUIT CLAIM DEED II RE 44TERS OffICE _...&~xex X J • Teppen-••---•-----•• • ST. CraX CO., WIS. Reed for Ramrd fNs 9th . - . - quitclaims to Rick......---Teppen---••----•---•-•-•-------•-•----•--•-• day of Tan A.D. 1985 t 8:30 A s A . ..........of s the following described real estate in t..... G X Q County, ` State of Wisconsin: R[TURN To Russell E. Berg 125 North Main Street River Falls WI 54022 I Tax Parcel No: Part of NE4 of NW4 of Section 2S-28-19 described as follows: Commencing;°at NE corner of said NEU of NW4 on centerline of County Trunk Highway 110" thence S on said centerline 700 feet; thence Nally 500 feet to a point 472 feet Sally of a point on N line of said NEU of NW4 2SS feet W. of Place of Beginning; thence NEIy 472 feet to said point on N lire 255 feet W of Place of Beginning; thence E on said N line 255 feet to Place of beginning, Except part described as follows: Part of NEU of NW4 of Section 25-28-19 described as follows: Commencing at the Nh corner of said Section 25; thence S010441W along the N/SAf line of said Section 25, 700.0 feet; thence N5700513511W 410.0 feet to the point of beginning; thence N57005'35"W 90.0 feet; thence N 23°13'42"E 472.0 feet to a point on the N line of said Section 25; thence S1205412011W 495.14 feet to the point of beginning. i i. This Deed is given pursuant to a divorce judgment granted in St. I~ Croix County, Wisconsin, on even date herewith. This'--- homestead property. (is) (is not) Dated this -th--------- day of ---Janu4Ty---------------------------, 19._g$ ------------------------•--•---(SEAL) - `..N-~ ._....(SEAL) Bever. Teppen t~y (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature (a) STATE OF WISCONSIN ST. CROIX ss. County. authenticated this ........day of 19...... Personally came before me this . A)! .......day of anua_ry-------_-, 19.. 85. the above named BeverlY..J. -Tenpen------....--•---•--•--••----•-- TITLE: MEMBER STATE BAR OF WISCONSIN E r--- An ' (If not, - ^w. authorized b . ~ y $ 706.06, Wis. Stets.) ;S Et to me known to be the person .r _ ~_ecu the forezoino instrumgn and acknAvAxi e the same- ,n i~ ; DOCUMENT NO. STATE BAR OF WISCONSIN-FORM 1 WARRANTY DEED 321118 THIS SPACE RESERVED FOR RECORDING DATA REGISTERS OFFICE' THIS DEED, made between -_Levi A. Paulson and Alma S. Paulson, ST. CROIX CO.. WIS. husband and wife. - - Recd for Record this_.13Z4__ - - - Grantor day of-mil------ AD.19_3k - - and Rick L. eppen and Beverly J. T~~n~_ A. T M. ~i husband and wife,-as_~oint tenants ~ it Grantee, Reg stet of D'eed~ O r Witne sseth, That the said Grantor for a valuable consideration ---Thirty__ -Thousand and_.No[100_Dollars - - - - ~30Z000.0.0 _ conveys to Grantee the following described real estate in St Croix -----County, RETURN TO ;i State of Wisconsin: 'I A parcel of land lying in the N11 of NW'Z of Section 25, ii S.T.H. Township 3528 Range West, lying follows: Beginning East lis y # I; I' ginning at a steel This _homestead property stake in the center of County Road U at the Northeast corner of the N~ of NW-4 of Section 25, T28, R19W, thence South along the center line of said road 700 feet, thence Nally 500 feet to a point which is 472 feet Sally of a point on the North line of the said N31 of the NW-4 which is 255 feet West of the point of beginning; thence NEly 472 feet to a point on the North line 255 feet West of the point of beginning; thence East 255 feet to the point of beginning. h TRANSFER ' -00 ,EEE ; Together with all and singular the hereditaments and appurtenances thereunto belonging; or in any wise appertaining, And Levi A. Paulson and Alma S. Paulson warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except and will warrant and defend the same. I i Executed at- _ River Falls, Wisconsin this __5th day of - _February 19 74 SIGNED AND SEALED IN PRESENCE OF (SEAL) Levi A. Paulson ll (SEAL) Alma S. Paulson - ~I ` (SEAL) ~I I, 1 I! (SEAL) Signatures of _ _Levi__APaulson-andAlma S . Paulson - - - 1-----.- _ - I~ i Authenticated this 5th day of February it - I C L. aylord !I Title-. Member State B r of Wisconsin or Other `Party } Authorized under Sec. 706.06 viz.