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HomeMy WebLinkAbout008-1028-30-075Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERkt~. INFORMATION (ATTACH TO PERMIT) Pers,~nal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. ermit Holder's Name: City Village X Township -lush, Gre & Tara Eau Galle, Town of ST BM Elev: Insp. BM Elev: BM Description: !~~ (~ /dp. ~ moo' -ems sic -~ ~n~w ~ur~r~e~nrlr~ul CI C\/ATI/lAl IIATA r~~~r~ ~~~~ vi~mr-~~ ~v~~ TYPE MANUFACTURER CAPACITY Septic ,/ , 1 ,~~/ .2~ Dosing ~~~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L ~h WELL BLDG. Ventt Airlntake ROAD Septic / ` / ) I l~ ~ Dosin I ~ / ~~ Aeration -- Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Modei Number ~ ~ / / 2/. ~~ TDH Lift ~ Friction Loss Syste Hea~ TDH Ft 23 X0,5 1 Forcemain Length Dia. Dist. to well / ~ ~ 2 `~ County ~, j mot. Croix Sanitary Permit No 506230 0 State Plan ID No Parcel Tax No 008-1028-30-075 SectionlTown/Range/Map No: 10.28.16.143A30 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer ~i ~~~ Z iou ~l 3• ~ Ht Inlet /~,'~ ~ `~ ~ i SUHt Outlet 1 ~ Dt Inlet Bottom ~ a. s g~. Z ade an. / ~ q ~ /`p Za l Dist. Pipe ~• ~~ , ~ il ~ Bot. System ~~ (y S Final Grade ~ ~ ^ ~ / / Sher ~ ' ~~ .~Z ~SrQ d yvj ~!~ C~~'`7 I :• ern ~iv,l~~ -g 4011 ~R4ORPTION SYSTEM Yai r -Hi J/1/D d Don , /J.C/~r/ivy BED/TRENCH Width / Length No. Of Trenches PIT DI ENSIGNS No. Of Pits Inside Dia.-Liquid Depth DIMENSIONS ~ ~ / /~ / lYl/ j SETBACK SYSTEM TO P/L BLDG WE LAKE/BYRE LEACHING Manufacturer: INFORMATION Typ f System: 3v / ` I !~/ ~ l~/ IT Model Number: 111CT~1~IITI/lAl CVCTGIIA J9"hl. ~Y ~9n / / IQiG.Y//.(l. /~A/~° Heade •Manifold / ~I Distribution C( Pipe(s) / ~~ ~ x Hole Size / x Hole Spacing ~ ! _ / i Vent to it I akg / 2 / ~i ,~ ~ •~ h~~ Di ~ / / Dia r , a Spacing 'lp / ~ u ~~ Len th ~ ~~ tP to a Lengt g _ /• 0 iOIL COVER x Pressure Systems Only xx fNound At-Grade systems vmy - - epth Over tlDepth Over xx Cep xx Seeded/Sodded xx Mulched ed/Trench Center IBed/Trench Edges soil ~d - 5,~ ~`~ Nr~ ~ Yes Nc l ' :OMMFNTS~ n.,,-i~~ap rnria rticcr Pnenriac narsnns nresent_ etc.l Inspection #1: ~ /~/~ Inspection #2:_~ / ~~/~ ~l Location: 473 County Road BB Woodville, WI 54028 ( W 1/4 NW 1/4 10 T28N R16W) NA Lot 3 ]'~~~ ~~ Parcel No 10~ 8~16.143A~~ 1.) Alt BM Description = /D~ ~ ~~ ~Q~ ~ ~G'~'~~~ /, ~~~~ (J' 2.) Bldg sewer length = ~~ /.~ ~~~~~ ~/,~s~~~`~-~~_ (/ -amount of cover ~ ~ / „~Q,,,~, 2g / 1. `Qp~ Plan rev+stott Required? Yes o ~ - ~, I _ _. Use other side for additional information. ~~ ~~ Date Insepctor's Sign lure Cc;rt. No. SBD-6710 (R.3197) gpmmgMR,Wi,gpy Safety and Buil ' iv' ' n County 201 W. Washington Ave., 2 St. Croix t ~~ Madison, WI 53707- 62 ~ Sanitary Permit Number (to be filled in by Co.) ~ Z3~ Sanitary Permit Application ~~ Transaction Number ~ ~ ~ ~ 3 In accordance with s. Comm. 83.2I(2), Wis. Adm. Code, submission of this form to the appropriate go unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned PO are submitted to the Deparartent of Commerce. Personal information you pro ' used for secondary pro~~ Address (if different than ling address) in accordance with the Priv Law s. 15. 1 m Stets. ~ ~~ my Road BB L A lication Informs ' P ' t All Information Property Owner's Natne f i # Greg & Tara Hush Propertyowtrer'sMailingAddrexs Location 6D$'-, ~dZ$'- c3~' 402 Lokhorst street ST. CROIX COUNT vt. Lot f0 City, State Zip Code one Number W %., NW %+, Section 105.13' Baldwin, YYI 54002 715.684-3~8 t °nOi ~ N T R Q U. Type of Building (check all tltat apply) 3 _ ,(~ t # ; 28 1g ^E W '"~' ~ ] or 2 Family Dwelling -Number of I?fedroorta9~ 3 Subdivision Name ~v ' ~ O W ~ Block # Public/Commercial -Describe Use ~ ~v - City of e1o~, State Owned-Describe Use CSM Number ^ Village of ~ /)/~ ~ "7 ~ ~ O ( Q/ Town of Eau Gape p x, / _ ^ O~ i ~ j III. T ype of Permit: (Check onty one boz on line A. Complete lit-e B if applicable) A. / New System Replacement TreatrnertUHolding Tank Replacement Only Other Modification to Existing System (explain) ---------, System B. Permit Pemtit Revision Change of Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner ~ E iration IV. T of POWTS S atent/Com nent/Device: Check all that a ~ ~' ' Non-Pressurized In-Ground Pressurized In-Ground At-Grade / Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil ^ Holding Tank ^ Other Dispersal Component (explain) ~Prekeatrnem Device (exp am ~~ V. VI'reatment Area Information: a Design Flow (gpd) Design Soil pplication Rate(gpdsf) Dispersal Area uired (sf) Dispersal posed (sfi System Elevation soo ,~ o.s ~ eao ~ pflp soo 1 ~ ~Z ss.7 / VI. Tank Info Capacity in Total # of Manufacturer Material Gallons Gallons Units New Tacks Existing Tacks ^ ~ ~ A L 1 ~C I . ! ~ l JC+v , ' t ` Septic ~ Holding Tack 1200 1200 1 Wieser Co aa~ebe Prefi b Dosing Clwober 800 800 1 Wieser Pre[ab Concrete VII, Res risibility Statement- 4 the undersigned, assume responsibility ~r 3asta0stion of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si MP/MPRS Number Business Phone Numbs Roger Nelson NIP 228487 T1S-273.4N4 Plumber's Address (Street, City, State, Zip Code) 122 East Summit Avenue, Eflsworfh, WI 54011 V Coun /De rtment Use Onl Approved _ prov Permit Fee Date I ued Issuing nt Signature wrier Gi eason Denial S / /y~ ~ tXj ~ ~ ~"7 IX. Conditions of A~pppproval/Reasons for D~ttpprova{ ~~~ A ~~ ro J~ (+C ~- s v STEM OV~l:- 3~ Ge ~.; ti o.~S -+~ f ~' t i . Septic tank,.tKlhlettt tester and di A a'~" t ~" ~~~'"~ w ~ ~~~ ~~~/ sperse) t~ tnttet ad be services /maintained as per ldmertt plan provided by plumber. , j ~) ~ ~~~ r /~ ~ " ` O + ~ ~ em J - 7 2..All ttt t~bgt~titettts trust be maintained 6 e.c.~ ~ 75 3A' '~'~ ~. w !'a tiNdlaFliiFihe system and submit to the Ceanty only oa paper not sea tlum//8 U2 a`11_ino/6~es in sae ` V SBD-6398 (R 01107) Valid ihru 01/04 ~~ ~c~~ r ~ _ _ _ ____. _~_ _ _ .~___._.. _ ._. . _ _ ...,' .rt.~~ l ~~ ~~~~_ ,,- ate- v. ~~~ ~ ,, __. __w ~ .__ _____.__ _ __ _ ____ ______ . ------ :~-~~ ~ ' ~_ ._._ _ ..~~ `! pt's ~1 "_ `~ T ,~ `~~4 .~... _ _ -;~---- _w_:.___.~ . _._._._. t _ ~ ~ 2_._g_7~..__. ~..~ _ _ ; _ __ _____ __... _ _._~.~. _ ._ __ J_.__ _..~~ __~._ ~._ __.. _.~ .._.~__..v___._... ,_. __ ._._. _ _... _ _.~.~~ . :...._.__.~._. s _. • '~ Greg Hush 402 L.okhorst Street Baldwin, WI 54002 SW i~, NW %, S 10, T ZS ~Y, R 16 W Eau Galle Township Sx CtoIJC County Scale 1" = 40' Weiser 1200%800 tank BM #1=100.00' top of steel fence post BM #2 =100.60'top of steel fence post 30' of 2»force retain C'ry 88 __ 713' pf~p=wry L.„=~~~cct/t, 4 '~ i ~` r ~ 38a ._c„ ~ \ 1 . wFtc y uu~~~-.o..~ T/O K S C ~~ !* ._''' ~ ~ y Pd~ ~l r4~ ~~ rs~ sn y° ~~ -~ h~ ~~~ ~ -w ~~; s~ ~ cf~,L;a~c~ h ~-r~.~ o ~~/~ ~ jw ~~ ,- ~ II 0 ~ ~ I 1 ~~ ~ tom' ~W h~ 5~O/~~ 3 { ~ ~ r ,, >3~~ a, i~.d ,_ - ~ o Page 8 of 8 4~ ~~ .-0 ._.o ~ N ~ v . Greg Hush ~ ~ ry C38 402 Lokhorst Street Pie Yr7` L.' Baldwin, WI 54002 P y '+_ z5-`~ ,~~~~-5 SWll.,NW%,S10,T28N,R16W ~'~- Eau Galle Township ~- Sx Croix County ~ Scale I" = 40' Weiser 12011/'800 tank • UIFLL BM #1=100.00' top of steel fence post BM #Z =100.60' top of steel fence post y B~~„o 30' of 2"force main ~O~.tsC 7f3' 3go'g1°r N ~- y pv~ _~ f ~i f~i F/rs7 Y'/~ 7"~t't,eK i i 1 t~ ~~C ~!~ ~2 ~ ~~ ~, • -~' } 'SY' Lsr CO.,, Cr ._~„ .. 1~ 1 ~ ~ 0 s ~ ~ ~II ~ AWL` 1W Na t ' 1~ t~ ~~ .~+ ~'~ ~~~ , S ~op~ S a ~ ti Page 8 oJ8 -b -'D 6` .n - `rR commerce.wi.gov isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi. gov/sb/ www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary June 12, 2007 CUST ID No. 226497 ROGER D NELSON NELSON PLUMBING 122 E SUMMIT AVE ELLSWORTH WI 54011 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/12/2009 Identification Numbers Transaction ID No. 1402703 SITE• Site ID No. 726112 Greg Hush Please refer to both identification numbers, County Road BB above'in all cones ondence'with the a enc . Town of Eau Galle St Croix County ___ SW1/4, NW1/4, 510, T28N, R16W FOR: Description: Four Bedroom Mound System /New construction Object Type:. POWTS Component Manual Regulated Object ID No.: 1134617 Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual -Version 2.0, SBD-10691-P (N.O1/O1), Pressure Distribution Component Manual -Version 2.0, SBD-10706-P (N.O1/O1) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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 component manual(s) referenced above. • 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. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited: • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83 22(7) - A copy of the a yrp oved plans specifications and this letter shall be on-site during construction and oven to inspection by authorized representatives of the Department, which may include local inspectors. P.©.V6/.T.S. Cniiditiorcally ROGER D NELSON Owner Responsibilities: Page 2 6/12/2007 • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system .Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) -The owner of a POWTS shall be responsible fox 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. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence maybe 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, /,s~ ~, e / /r Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon -Fri, 7:15 am - 4:00 pm j erry.swim@wisconsin.gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code:7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application R~C`~r~/ED INDEX AND TITLE PAGE ~~AY 2 ~ ~~~~~ --- Project Name: 4 bedroom Mound system ~~~~ =' ~ :t•. Owner's Name: Greg Hush Owner's Address: 402 Lokhorst Street Baldwin, WI 54002 Job address: County Road BB Legal Description: SW 1l4, NW 1/4, S 10, T 28 N, R 16 W Township: Eau Galle County: St. Croix Subdivision Name: Lot Number: 3 Block Number: Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer: Roger Nelson License Number: MP 226497 Date: 05/22!07 Phane Number: 715-273-4444 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01!81) Version 4.0 (R. 04103) Page 1 of 8 UfVtS~ut~ i~F SAt-tTY pND BfJfLDINGS L=E GGRKESpp~~pENCE Mound and Pressure Distribution Component Design Design Worksheet Site Inform ation (r or c) R Residential or Commercial Design 400.00 Estimated Wastewater Fiow (gpd) 1.50 Peaking Factor (e.g. 1.5 = 150%) 600.00 Design Flow (gpd) 4.00 Site Slope (°!o) 95.70 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 60.00 Dispersal Cell Length Along Contour (ft) = 1.00 Dispersal CeA Design Loading Rate (gpd/ftz) 1 influent Wastewater Quality (1 or 2) Pressure Diaribution Information (c or e) a Center or End Manifold 3.33 Lateral Spacing (ft) 3 Number of Laterals 0.125 Orifice Diameter (in) (e.g. 0.25) 3.50 Estimated Orifice Spacing (ft) _ 2.00 Forcemain Diameter (in) 30.00 Forcemain Length (ft) 87.00 Pump Tank Elevation (ft) 6.50 System Head (ft) x 1.3 9.37 Vertical Lift (ft) 0.30 Friction Loss (ft) 16.17 Total Dynamic Head (ft) Lateral Diameter Selection in. dia, o tions choice 0.75 1.00 x x 1.25 x 1.50 x 2.00 x 3.00 x Note: Sand fill (D) calculations assume a Table 83-44-3 in-situ soil treatment fog fecal Colifomt of <= 36 inches. 10.00 Cell Width (ft) Are the laterals the highest int in the distribution Y network? Enter Y or N If N above, enter the elevation ft of the highest point. 11.76 ft2/orifice Does the forcemain drain back? Y Enter Y or N 4.89 Forcemain Drainback (gal) 35.82 5x Void Volume (gal) 40.71 Minimum Dose Volume (gal} 21.01 System Demand (gpm) Manifold Diameter Selection in. dia. o tions choice 1.25 x 1.50 x x 2.00 3.00 Gallons/lnch Calculator (optional} Treatment Tank Information Totat Tank Capacity (gal) 1200.00 Se tic Tank Capacity (gal) Total Working Liquid Depth (in) Weiser 800-325-8456 Manufacturer gal/in (enter result in cell 649) floss Tank Information Effluent Filter information 800.00 Dose Tank Capacity (gal) Zabel 1-800-221-5742 Filter Manufacturer 22.24 Dose Tank Volume (gal~n) A100 Filter Model Number Weiser Manufacturer Project: 4 bedroom Mound system Page 2 of 8 Mound Plan View 1_ 1 /10 B • ' • ' • ' ~Obsenration Pipe . ~ . . _~- • K ,~, . „r• LI. ' ~ I L Mound Comment Dimensions . rr~~~i F 96.70 {ft) --- - Dispersal Cell 3[~, Elevation A 10.00 ft B 60.00 ft D 12.00 in 600.00 (ftz} Dispersal Cell Area 10.00 (gpolft) Linear Loading Rate Finished Grade 98.45 (ft) E 16.80 in F 9.00 in G 0.50 ft H 1.00 ft ~ 9.03 ft J 6.03 ft -T -~ -~ -I K 8.85 ft L 77.70 ft W 25.06 ft 1142.05 (ftz} Basal Area Available 6.00 (ft) 1h0 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area -I H ~ispersai ceu ~ 97.20 (ft) Lateral 1-.~- Invert D ~~: t ... .• ....... . .. . ... .. .:k: s ~-, -~, ~ ;`~ 95.70 (ft) Contour Elevation Shading Key 11~ Topsoil Cap © ~'fr{} Subsoil Cap • ASTM C33 Sand Tilled Layer © ~ Aggregate 4.0 °!o Site Slope Geotextile Fabric Cover $. ~ Dispersal Csli i ~ ""~ s ~"~`~ ~ I Q F 0 5 ft Typipl Lateral _ ~ ~iA ~ O T See lateral details on Page 4 for number, size, and spacing of laterals. Laterals are equally spaced from the distribution celPs centerline in the distribution c ~- ~- Project: 4 bedroom Mound system Page 3 of End Connection Lateral Layout Diagram Ceruer the laterals over the A fx B dimension •= Turn-up vrf ball valy® or olaanoutplug p, ,l All laterals arc identfoal lE X-~ I Hol es drilled on the bottom of the lateral 3 equally spaced Laterals k Force main of PVC Sch 40 3 [per COf+AM Tabte 84.30-5) . Force main connection via tee or cross to manifold at any point Number of Laterals Lateral Diameter Lateral Length (P) Lateral Spacing (S) Lateral Flow Rate System Flow Rate Total Dynamic Head Tank component is properly vented Dose Tank Information Electrical as per NEC 300 and ---- Comm 16.28 WAC ~,_ Disconnect Weiser 800-325-845s Ca aci 800.00 Volume 22.24 Manufacturer Gallons gal/inch Dimension Inches Gallons A 22.14 492.41 B 2.00 44.48 C 1.83 40.71 D 10.00 222.40 Total 35.97 800.00 Orifice Diameter Orifice Spacing (X) Orifices per Lateral Orifice Density Manifold Length Manifold Diameter Fori;,emain Velocity tank. 3" Project: Alarm Manuafacturer S. J. Electro S stems _~ Alarm Model Number 101 HW Pump Manufacturer Goulds Pump Model Number PE 41 Pump Must Deliver r '21.01 gym at 16.17 ft TDH 4 bedroom Mound systerrt _- - A B C D in 17 11.76 ft`/od1 s.s7 ft ~ 1.50 in ~ 2.15 ft/sec Locking cover with warning label and locking device and sealed watertight ~4 in. min. ~_ f-- Alternate outlet location Forcemain diameter ~ 2 in. Weep hole or anti- siphon device ~~elevation (ft 87.83 D~nk elevation (R) 87.00 Page 4 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name Installed by Nelson Plumbin~~ Phone 715-273-4444 POWTS Regulator's Name St. Croix County Zoning Phone 715-386-4680 System Flow and Load Parameters Design Flow -Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow -Average 400 gpd Maximum BODS 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Fn3guencv Septic and Pump Tank Effluent Filter Pump and Controls Alarm Pressure System Mound Other Ins and/or service once eve 3 ears Should ins and clean at least once eve 3 ears Test once eve 3 ears Should test month) Laterals should be flushed and ressure tested eve 1.5 ears Ins ct for ndin and see a e once eve 3 ears Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished ,,~~~~........ ............... Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral ~1- Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: 4 bedroom Mound system Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code neral This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in akx;ordance with its' component manuals [SBD-10691-P (N.01/01 j and SSWMP Publication 9.6 {01/81)] and local or state rules pertaining to system maintenance and maintenance reporting, No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risen: and covers should t1e Inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the kompletion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. ySetrtic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stets. The contents of the septa tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shalt be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisbns are made to retain solids in the tank that may slough off the filter when removed from its enclosure. H the fitter is equipped with an alarm, the fitter shall tie serviced if the alarm is activated continuously. Intem-ittent fitter alarms may indicate surge fkwvs or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liqu~ volurrre of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise tl~e owner of when the next service needs to be performed to maintain less than maximum scam and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Departrnent of Commerce. Puma, Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verity proper operation. If an effluent fitter is installed within the tank it shall be inapeded and serviced as necessary. Mound and Pressure Distribution 3vsstem No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not rek~mmended since soil kmmpaction may hinder aeration of the infiltrative surface within the mound and snow Compaction in the winter will promote frost penetration. Colo weather installations {October-February) dictate that the mound be heavily mulched as protection from freezing. influent quality into the mound system may not exkared 220 mg/L BODs, 150 mg/L TSS, and 30 mglL FOG for septic tank effluent or 30 mg/L BODb, 30 mg/L TSS, 10 mg/L FOG, and 10` du/100 mL for highly treated effluent. Influent fkwv may not exceed maximum design flow specified in the permit for this installation. The pressure distributron system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at feast once every 18 months. When a pressure test is performed tt should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shatl be chedked for effluent ponding. Ponding levels shah be reported to the owner, and any levels above 6 indres considered as an impending hydraulic failure requiring additional, more frequent monitoring.. CQntlnaencv Plan If the septic tank or any of its components become defective the tank or komponent shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaks3d with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surhace, tt will be repaired or replaced in its' present location by increasing basal area if tce leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your kx;al POWTS regulator and service provider. Project: 4 bedroom Mound system Page 6 of 8 >.. .(~000IDS PUMPS Submersible ~ Effluent Pump PE -TIOOtS designed for the • Mound Systems • l,i~posir,g Systems • tow Pressure Pepe Systems • easernent ~Sumpr 1~ris t~Er ao 35 10 23 2U /~, ~~ TD ~' ~ is 10 °a ~o ~~ AOflp -General: • O~large:l'h" NPT • Ternpera~Rlre:104°F NQ10U nlaldtnure, tomimrola when filly wbrrlerged. • Solids handling. 'r:" rtlaadnlum sphere. • llltbnlatic made!: inckrdcd float swl~h. • Manual lrlodels available. • Pumping range: see per(arnlence charts auve. t~E31 Asmp: * Maldmum 50 GPM • Maldlrnanl !teed: 2s' TOH ~~ mPa~7 6Q GPM • Maldmtrrn !lead: 29' 1DH PESt Pump; • Mseirrlum capaahr. 70 GPM • MercinMm heard: 3r Tt>f! ~~: • ~~ P~ • 60 He1tt • 115 vans • 8~itdn thanrlel arerbad pro- leclion wtdl aubnletic reset OiEfiged design. • strengdt Carbon sti:el staff, PE31 Mooer: • .33 hlP, 3000 RAN! • 12.0 AA~dnrlm amps • p~~ PEt1 Molar: • .~0 HP, 3400 RPM - 7.S I~Aaxirraarr craps • ~ PESt Nestor. • .50 HP. 3400 RPM • 9.5 Mlaaonwun amps ' PSC deslgr- ... :- i. ~. .L.. ..~.. ... .... _.. A... r.. y. ~ r..T ..i.. ..1... ...i.. y.. . - ~ .....~: . Mrc ,3d, .1.1, .60 . .~ .y .p. ... .... ...i...i... ( .}. I 1t T._I'{ 2 V-7M i' ., ._.... } t~M"Y .r . . .F'' .y. ,. ......... .. } . .. ~ so ao so so ~ to GPbI 80 0 S 10 15 ~/.O/ caPwcmr b 2001 Goulds limps ~~~ Effecdre No+~ernber, ZC02 VE31/41 ^ Corrosion tlsistart COn6puCtiOn. • Csst iron body. ^ Thennoplss6c and a7VEr. ~ Upper sleeve and lower hlavY duty be;l bearing canseructian. • Motes is perrr-anendy lubricated for txberided service liFe, t P'ovNered for cantirlrxxls ~~. ^ Aff ratings are wMhin dle worlorg iirnits of the motor. . tf tlidr disoontatt !tower cord, 20' standard tenglh, heavy duty 16/3 S11 W wl<h NEMA 5-15P, dree prong, 115 volt gnouadklg plug. • Corapk~te unk is heavy duty, Portable and compact. • AAedtanical s~i is catbar. ceramic, tl1~lA and stables: ~. tf $talnleSS steel faslenel5. ~~ s~~ c us raged to u17t8and cuuz fasirta.rd~ ~~ ialldt /lwrpt k lstll00/ tr4Nrarndt pa~~.?a~8 Gcx~s amps C~' iTt Industries Wisconsin Department of Commerce SOIL EVALUATION REPORT ~ Page ~ of~ pivision of Safety and Buildings "`+ 111 dlilN1UO11VC WIUI l,Vlllltl OV, YYIA. MUI11. I,VUC County ~ -~ , ~ ,1 ~ Plan must Attach complete site plan on paper not less than 8 1/2 x 11 inches in size J - . indude, but not limited to: vertical and horizontal reference point (BM), direction and parcel 1.D. O6 ~~ Q 7~ `~~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. - V 0 Please print all information. Revi ed by Date Personal iMortnation you provide may be used for aecondary purposes P ' 04 (1) (m)). ~1. Zg ~ Properly Owner R Pro erty Lon ~~ (- Qom, r, ~~ , .~, ' ~~~ Go Lot 1/4 /4 ~ ~ T ~ N R E ( ) W Property Owners M i Address 2 g ~ ~ Lo Block # r<-- Subd. Name or CSM# ,(~ ~ Q D 'D U l;,ity State Zip Code hone5t+~ur~¢OIX C ^ ity ^ Villag Town Nearest Road II 1 ) S~ 17 G ( ) ~l c t J a.w New Construction Use: sidential /Number of bedrooms Code derived design flow rate ~ GPD ^ Replacement Public or commerdal - Desaibe: __ ____ __ ____,______ __~ _ _ a~ Parent material Flood Plain elevation if applicable /~ ft. General oommerrts /a L'`, -7 f /~ .!, _ ~~ 7 J ~fl yL " and reranunendations: ~ ~~' ~ ~ System Type _ System Elevation ~h~2 ^ Boring # ° ~~ ~ p '~ '~ pit Ground surface elev~ ft. pepth to limiting factor ~ in. Soil lication Rate Ftorizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 -yo .s , c ~ ~ .~~ m - . o ~~ # ~ Boring ,~ Pit Ground surface elev. ~ r D ft. Depth to limiting factor ~ ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff<= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 L., -l ,- ~~ G ~ rt.~ r C ~ a~ ~~; ~/~ ~/~ , O 'Effluent #1 = BOD > 30 < 220 nxyL and TSS >30 < 150 'Effluent f/'2 = BOD < 30 mg/L and TSS < 30 mg/L CST Alarr>Q (Please Print) a CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~'~,r~ ~~ 715-246-4516 ~,. 8 _.,~~ Property Owner Parcel ID # Page of r Borng # ~ orin 9 l-~ i~ .~ pit Ground surface elev. t ft. Depth to IimiGng factor ~/ in. Soil liption Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~ ~ - ~-- ~,} ~7 L S / l ~( m ~/ ~ e ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon ')epth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Cdor Gr. Sz. Sh. 'Eff#1 'Eff#2 • Effluent #1 = BODS > 30 < 710 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BODS < 30 mglL 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 the department at 608-266-3151 or TTY 608-264-8777. SB0.6330 (8.6/00) Property Owner Parcel ID # Page of ^ Boring ~ ~ Boring # Pit Ground surface elev. ft. Depth to limiting factor v ~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 / / Z, 7a ~--'-- / c, I 1 ~ 7s ,- ~ ~--- ~ ~ a~~ ~ - ~ ~ G r~ ~ / ^ Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure 'Consistence Boundary Roots GP D/fN in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. •Etf#1 'Efffr2 a Ong # ~ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon ')epth Dominant Color Redox Desrxption. Texture Structure Consistence Boundary Roots GPD/ff in. Mansell Qu. Sz. Cont. Color Gr. Sz Sh. •Eff#1 'Etf#2 ' Effluent #1 = BODS > 30 < 220 mg/L anc: TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 mgA, 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-8730 (R.6/Op) Soil Test Plot P Projeet Name Grey Hush Address 402 Lockhorst St. Baldwin Wi 54002 Lot Subdivision ------ Date ~I'1VI #226900 12/1 /06 S W 1/4 N W 1/4S 10 T 28 N/R16 W Township EauGalle SE Boring 0 Well PL Property Line Co__unt ST. CROIX Assume Eleva n 100 ft. \Top of Steel Fence Post BM or VRP ~ ~2 System Elevation 96.7' C-o~ -v HRP as enchmark Alternate Benchmark Top of Steel Fence Post @ 100.610IOt; B.M. ~I = I~*B property Line i i\ ~ou1 .tA v' ~ ~~ Scale is 1" = 40' unless otherwise noted 60' 4% Slope 20' 45' -1 25' B-3 40 Acre line (old Fence Line ~ 96' 3-2 95' Rd BB 05/21/2007 22:00 7156882132 ncwauir-iE u G~MNOiATURE ~' PAGE 01!01 ~ "' X001/003 ~''~ ..., ~o ;~ '` ~ k J j r ~i ~] fl ~~ ~ ~ ~~~ ~ ~ ~~~ ~~ ~~ ~ ~ A sotq aSvg 8t taa ~~~ ~~, ~ ~ ~~ ~ ~ z ~ ~ ~~ ~~~~ ~~ ~~ x~ ~ ~ A i; tw r 1 ~~ ~ ~~ r. ~ ~ ~ i . ~ ~~ ~' i ~~ ~r ~~ ~~~ r ~ ~t/~ r ~ ~t . +~ d ~ ~ ~ ' ~; ~; ~'~`~ ~~ ] ~ i ~~ ~ r `QQ` ~ A~~ ~~ O ~ ~ f T ~ ~ -` ., ~~~ , ~~~~~~~ ~ ~~~w~~ s~~$~~~~ ~` o ~~ O~ M d11N,, ~1 ~'~£'kGL i ~ ~ ~; ~~ ~~ ~ ~'~ _~' : ~~ ~ ~ ~~ ~ . ~ ~'•. -/tMN ~Nl a1e! 11-36 ~ ~ 3f~Y'7 2S9Nt. as ~ ~ . ~ ~ 5~~ ~ ~~ ~~~ ~ ~~_ ~.~~ ^-- --___--.oo..~ ~ ~oa.~ootre---~, _~-~ ~ NtiNw~Hay03M'IS~INS t ~~~"+~1`.~ I ' ~" ,~ i ~~' ' .. /. ` •' Ir i1; (,..,,....~n.~,., ...-...............~ Q !Jl! ~~ !1t ~- ~` f ~f i r j ~ ~' r ~ ~~ ' ~ ~ 'x ~; ~o-28-Ib NW CORNER CERTIFIED SURVEY MAP o °aa cnHo~ s sEC11oN 10 LOCATED IN THE SWi/4 OF THE NW1/4 AND PART OF THE SE 1/4 ~' °w'ow .. a ~~ ~ -T OF THE NW 1 /4 OF SECTION 10, T26N, , R16W TOWN OF EAU ~ W ° ' ~ a a '~ ~ OWNER GALLE, ST. CROIX COUNTY, WISCONSIN. ~ .rr~ q aSC~(r ai~c'i ° »N w I CHRISWANGEN SURVEYOR I NOTE: N114 CORNER SECTION 10 ~.Q a EDWIN C FLANUM I N I~ m~+° W ••W I~ ( 471 CTYRD'BB' NORTHLAND SURVEYING, INC.I FURTHER SUBDmSION OF THE LOTS ~~ W ~"~ NWW WOODVILLE, WI 54028 SHOWN ON THIS CERTIFIED SURVEY *~ 00 ~ >~ WWW" i P.O.BOX14 I ~ ~ Nt1W~ ~Wp.W R I EXISTING R08ERTS,WI54023 I rtAAP~~~BEREQUIREDTOPROVIDEA ~I A ;~~~a~ w~o~ ------~ FIELDDRNE M(_'n~_1p1 e1~~D ~~D~ I ~~CO`UMYZO~NNGOFFICECROIX - -- -- `, c~ '- S88°51'31 "E I ~ o g ~ 33.04' . 7710 oa ~~ 2641.55 MaPdp r~~D dQaDD ~ I ~ ,~ ~ ~ --- ---- ~~~ ~ ~ LOT 2 ~~ 0 1895.51' ------------------------- 1r+ EXISTING I b r ~ NORTH LINE OFTHE St/2 OF PRNATEDRIVE Nago'aos~o ~WIDEACCE - - -----~ ga ~ • THENWt/4 I 33.x' ~ ~'1~ N ~~ z I : ^ ~ 13.84' BENCHMARK z ~ p (~ i w ~ D~rvE ~ 1288.91' TOP OF REBAR ~ ~ ~ ~ ~~ ~i ~ I ~ ~eui~nirvcs S85°46'00'E 1321, BENCHMARK ~ ELEV. =1149.03 LOT 3 " ~ ~, ~- Ho, ^ _ _ _ TOP OF REBAR o ~ ~` ~ ~ o0 i ~ ; ~ ~ ~ ~ x vo~D oA sTU~o oRroE To ELEV. = 115320 v SEE ABOVE ~ ~ ~ ( ro O~ nR i ~I ~ J ~ ~ BE LOCATED T POSfTION ~ 3 NOTE 0 a j P+ 0 ~ 6 i v~i N ~ .. ~ ~ r~ 25.39 AC. Y ~ ` I °° w o ~ ~ 3 N ~ ; ~ ~ ,. ~~j ~ 1,105,886 SO. FT. __ ~ ~ ~~ ,-~ Z~ (~pdi ~ r w• Of o _ .Z p Qi O Q~ w ~ p ~ '~(~,~~' J -- b ' ~ ~ 75' SETBACK FROM EDGE OF -- ~ ~iifJ ~ ~ a ° , ,~ ; CENTER, OF QRY RUN DRY RUN (fYP.) [l'~~ pp p ............ ...... . . a i M [!~" ¢ CJ i W O 8'~~ - v, i 0. a; ~ ~.Z LOT i z ' ; / ,''p I ~ SEE ABOVE NOTE ~ N n 1 d N88°51'3 j "yy 1319. ° ffi~n---- -- dQ[~JD~ LEGEND ~~ ~.._._ • , ' ~ o ~~ ~'~ /m~ O I 30.65ACRESINC. R/W = ~ ~ Iff -- wp~ ~ IY[S® __4-- ----- ' ¢ o+ : ~ (+ar ; 1,335,051 S0. FT. ~ 3 ~ ~ ~ ~ mU (I~; ~i ~ ? (X Ow ~ a ~ ALUMINUM COUNTY SECTION ~ ~~ ~:~. - CORNER MONUMENT FOUND tet's a 3 ~; p) ~ I 29.87 ACRES EXC. R/W w F ~ N t ~ ~ ~ ' ~ h I I' 1,301,209 SO. FT. Z w 'L "~ ~ ~ f V~ ' ! ~ ' ^ I ~ O ~ l,~~ O" 1' STEEL SURVEY MARKER FOUND Di " J a c~ ~ ~, ) d i ~I X NORTH LINE OF THE SOUTH 60' OF ~ d' p ~ THE 5W1/4 OF THE NWi/4 3 ai C • 15/16" O.D. IRON PIPE FOUND o A ~a ~ N00°10'19"E I ~~~ o s ~ ~,~~ ~~ 1266.12' p ^ 3I4' X 18" IRON REBAR SET WEIGHING ~~ ~~ ------ _ E1I4CORNER 1.50LBS.PERLINEARFOOT a- --I _ N88°53'12"W 1319,17' ~ SECTlON10 Uw g~g ~ W114 CORNERPOSITIONED - - - _ S1/4 CORNER t 6.~.. ~.. . ~ FROM WITNESS x ° 1 ~ ~ 3/4' REBAR FOUND SECTION 10 MONUMENTS OF RECORD V wp~d - 1 r R~ 8........:.. a M a -" -----D ~!N_~~ SETBACK LINE (AS SHOWN) SCALE IN FEE? 1" = 300' -X-X EXISTING FENCELINE THIS INSTRUMENT DRAFTED BY SAM ADAMS SHEET 1 OF 2 SHEETS ~~ ~ SOIL TEST JOB N~ DATE 6-07-04 300 0 300 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address ~jI (~7~f ,~ ~~ ~'L~.~~:/~.~ ~' S~Dl$ Property Address ~~3 C~ ~ t~~ ~~t u~c 'S~"iO (Verification required from Planning & Zoning Department for new construction.) ~- ~b 2$-~ G -- o ~~ City/State ~ f lf,~ ~o Parcel Identification Number ~=~/p z g - ,~o - o ~ ~ LEGAL DESCRIPTION Property Location c`7~c•'- '/a , 1yw 1/a ,Sec. f~ , T Z~ ~R~W, Town of ~,pu ~F,,td.~ Subdivision ~ _ _ ,Lot # 3 Certified Survey Map # ~ ~ ~ ~j ~ ~ ,Volume ~ ,Page # ~ ~~ Warranty Deed # ~~ ?j ~ ~ ~ ,Volume r--- Page # Spec house yes no Lot 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. Uwe, 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 arri/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of b .TUBE OF APPLICANT(S) ~~~~~ DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) U 2651P 185 1 STATE BAR OF WISCONSIN FORM 2 - 2000 Document Number 1 WARRANTY DEED This Deed, made between Chris D. Wangen and Arlene J. Wangen,' husband and wife Grantor, and Grev H. Hush and Tara M. Hush, husband and wife as survivorship marital property Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more space is needed, please attach addendum): LOT THREE (3) OF CERTIFIED SURVEY MAP IN VOLUME EIGHTEEN (18) OF CERTIFIED SURVEY MAPS, PAGE 4805, AS DOCUMENT NUMBER 771301, FILED IN ST. CROIX COUNTY REGISTER OF DEEDS OFFICE ON AUGUST 10, 2004, BEING LOCATED IN THE SOUTHWEST QUARTER OF THE NORTHWEST QUARTER (SW 1/4 OF NW 1/4) AND THE SOUTHEAST QUARTER OF THE NORTHWEST QUARTER (SE 1/4 OF NW l/4) OF SECTION TEN (10), TOWNSHIP TWENTY EIGHT (28) NORTH, RANGE SIXTEEN (16) WEST, TOWN OF EAU GALLE. Together witih access easement over Lot 2 on said Certified Survey Map. ka Arlene Wangen Chris D. Wangen ~~(~~ * Arlene J. Wan en Part of 8-1028-30-000 and 8-1028-40-000 Parcel Identification Number (PII~ Q i///~~ This is not homestead property. 5~ (is) (is not) Exceptions to warranties: easements, restrictions and rights of way of record, if any. Dated this 1~ day of Au ust, 2004. Sisrlature(sl AUTHENTICATION authenticated this derv of C/ TITLE: MEMBER STATE BAR OF WISCO~E ~ (~~~ ~,P ~:' . - _ (If not, Notary Public to me known to be the person(s) who exer$it2tt ate foreggot~te authorized by X706.06, Wis. Stats.) State of Wt5COfl5lA instrum~and acknowledged the same.; _ }At t' THIS INSTRUMENT WAS DRAFTED BY ~ ~ ~ 4 OLSON Joseah D. Boles -Attorney at Law * ~~ ~• ~'••. River Falls. WI 54022 Notary P 1' ,State of Vl! 1 +r,,_ OE W ~' My Co 'Sion is pe e . (If not, state expJJ u-~btsAa~` (Signatures may be authenticated or acknowledged. Both are not necessary.) ~~ ~o ~ t~+ .) lames of persons signing in any capacity must be typed or printed below their signature. INFO-PRO (800)655-2021 www.infoprororms.com Recording Area ?73683 KATHLEEII H. wALSH REGISTER OF DEEDS sT. cltolx co. , wt RECEIVED FOR RECORD 89/08/2804 08:88AM wARRAN'l'Y DEED EXEMPT ! REC FEE: 11.08 7RAlilS FEfi: 29'9.48 COPY FEE: CC FfiE: PAGES: 1 Name and Return Address ~~~ ~L~ ~~ ~1~~v,,J~~U l~~~, ACKNOWLEDGMENT STATE OF WISCONSIN ) ss. PIERCE County. ) Personally came before me this r' 1-~'1 derv of August , 2004 the above named STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 2000 I l~l =1 ~I I ledge-------ll~ ~I i ---- ----~ li i ~ ~ II o ,\\ u ' Ii ~ ~ LIVINCz R001"I 16'-8" x l~0'-8" II' CEILING 1~'-3~" I~ ~r - ~ II II 11 II I II ~~~~~~'F' O I ~ I ~ I~ ~I ~~~ I I 1"I. ~3EDR001"I I, I II II 12'-2" x 15'-8" I I I 9' CEILING I I w/ TRAY TO 10' ~ I 1 II I' I I it II 11 I II II L - _ _ - _JJ L _ _ _ - . 3'-9~a" 9i_2~I I F -4.. 4~_1~4~~ L_ -S~~ r, "~ aoTt<k above - I I I ~o I ~ 0 ~ I i- - - - - - - - -i I ~ 0 ~ ~ ~ I I II I~ II II ~ I I~ 4 " DININCx II ' ' 1=oY1=R I I 10'-~Du x 12'-8u ~ I m I I III CEILING I 9' CEILING w/ I TRAY TO 10' I I I I I - ~ I ~ II I I I m I~ II I I II ~ lu I j ~~--___===-~I 11'-3" I I ,'0'-~a~,4u ct1 z~, 3'-O" Is•• _Q I.n Tr, 0 I W GOVER~D PORCH 7 fV z 0 O ~V 3~ N ~ N Q1 ~. _i 1- O $AtN _ 9' CEILING it 11 ~d ° ~ ~ o ' a~ 3~-3° ~ o ~w ~ X~ ~ O~ e ~ m O BATH 9' CEILING ~/\ Z.-4.. 2.-4u ~ i ~ ~helvi~g ~i i Q ~ i ~ ~ i ~ i i i ~ u i ~ 2'-S - ~ U1.LG. ~ ~ 3~--1%4" 2~-6" 4~-4%a" ~ ~~-3~a" ~ ~ OFFI` i~ 10~-0" x 11~-0" 9' CEILING Parcel #: 008-1028-30-075 o3/2s/2oo~ 04:30 PM PAGE 1 OF 1 'Alt. Parcel #: 10.28.16.143A-30 008 -TOWN OF EAU GALLE ' Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 08/10/2004 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -HUSH, GREY H &TARA M GREY H & TARA M HUSH 402 LOKHURST ST BALDWIN WI 54002 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description " 473 CTY RD BB SC 0231 BALDWIN-WOODVILLE AREA SP 1700 WITC Legal Description: Acres: 25.390 Plat: 4805-CSM 18-4805 008-04 SEC 10 T28N R16W PT SW NW & PT SE NW CSM Block/Condo Bldg: LOT 03 18-4805 LOT 3 (25.39 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 10-28N-16W SW NW 10-28N-16W SE NW Notes: Parcel History: Date Doc # Vol/Page Type 07/03/2006 828771 EZ-U 09/08/2004 773683 2651 /185 W D 08/10/2004 771301 18/4805 CSM 07/23/1997 850/619 W D 2007 SUMMARY Bill #: Fair Market Value: Assessed with: Use Value Assessment Valuations: Last Changed: 07/06/2006 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 0.500 7,500 13,600 21,100 NO AGRICULTURAL G4 6.350 700 0 700 NO MFL BEFORE 2005 OPEN W7 18.540 9,500 0 9,500 NO Totals for 2007: General Property 6.850 8,200 13,600 21,800 Woodland 18.540 9,500 9,500 Totals for 2006: General Property 6.850 8,200 13,600 21,800 Woodland 18.540 9,500 9,500 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Tota I 0.00 0.00 0.00 R Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ~ of~ ' Division of Safety and Buildings m accoraance wRn t,omm oa, vvis. ram. ~.oae /f County . er not less than 8 1/2 x 11 inches in size Plan must Attach com lete site lan on a ! ~ ' p . p p p indude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. ~ ~C Please print all information. y Date Reviewe d PeBOnal information you provide m cy Law, s. 15.04 (1) (m)). ~I ~ ~,~c-c.~ p~.~~p Property Owner ~ s ~ w-<• -°/- ~-~ ~ ~` ~ ~ Property Location /~ ~ ' " ~ -2..- L~, ~ N R E (o /4 S CJ T 1 /4 /I/ Govt. Lot ~ Property Owners Maili ddress I ~ Lot # Block # Subd. Name or CS Gty State 'p C ; • ~ f ^ City ^ Vill e Town Nearest Road ~? ~ ' ;GON OFFI ~ ~ ~ ~ C New Construction Us Residential /Number of bedrooms __ Code derived design flow rate ~ G~ d GPD ^ Replacement ~ Public or commerdal -Describe: ,___-___ __-_,________.__ __- Parent material JQ ~c -~~~^ t~l~J~~ Flood Plain elevation if applicable h~~ r~ ft. General corrrrrer>is and recommendations: _ 9f n l ~ I Boring # ~ Bonng ~ , -~, / / ~ pit Ground surface elev. ~% 0~`" ft. pepth to limiting fador~_~ in. Soil ication Rate Horizon Depth Dominant Cdor Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ~-~ ~~ ~~zn ~ a~ ~ ~ ~ - ~/,a ------ .sue S ^ ~'~ # ^ Bonng ~ Pit Ground surface elev~L~v~3 ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 ----- s ~~~- ~ C r 'Effluent #1 = BOD > 30 < 220 ntglL and TSS >30 < 150 n1g/L r=!~' "Effluent #2 = BOD < 30 nxyL and T55 < 3o mgiL CST Narr>Q (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird ~~' 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 ~~~~- `~ G~ 715-246-4516 r Property Owner _ n Boring# ^ Boring rX Parcel ID # ~~. > " ~~~ Page of I v i ~ Pit vrounosurracee~ev. iT~~. uCpui w wiuuny iauu~ ~ ~ u~. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/if in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 ^ Boring # ^ Boring ^ Pit Ground surface elev. ff. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 a Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 'Effluent #1 = BODE > 30 < 710 mg/L and TSS >30 < 150 mg/L `Effluent #2 = BODS < 30 nxyl. 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. saaa33o ffe.aroor Project Name Grey Hush Address 402 Lockhorst St. Baldwin Wi 54002 CSTM #2'6900 Lot Subdivision ------ Date 4/24/04 S W 1/4 N W 1/4S 10 T 28 N/R16 W Township EauGalle Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1 /2" pipe System Elevation AT-Grade *HRpSameasBenchmark Alternate Benclimark Top of 1/2" pipe @ 10~Q' B.M. B.M. 150' 1320' Property Line 10' ~ Scale is 1" = 40' unless otherwise noted Rd BB Soil Test Plot Plan Shaun Bird 65' 100' 99' -2 6% s' B-3 20 5' / B-4 ~ Not suitable for any system! @98.0' appears to be in a area of drainage B-1 1320' Property Line