Loading...
HomeMy WebLinkAbout032-2181-18-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building C' INSPECTION REPORT Sanitary Permit No: 556378 0 GENERAL INFORMATION (ATTACH TO PERMIT) State PIaq ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)). L. Permit Holder's Name: City Village X Township Parcel Tax No. Oeverin Homes LLC, aka Oeverin Pro ertie Somerset, Town of 03 181-18-000 CST BM Elev: Insp. BM Elev: BM Descri tipn: Section/Town/Ran No: 01.31.19.1542 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION -BS FS ELEV. j Septic Benchmark /060 6 -hi ir :3 .6 77 26, Dosing AIt.6M K., /O, 3_57 2- ~5 Aeration may- W Bldg. Sewer 3o31V- Z Holding -r St/Ht Inlet /C- AA L St/Ht Outlet TANK SETBACK INFORMATION CM. S Y4 TANK TO WE BLDG. vecLlo Air Intake ROAQ Dt Inlet / 'I /Vo I'A Septic V00 Dt Bottom - Y Z /l" Gam Dosin -3 ' 9 I:t3 YwAii Heade an.. /,-7 Aeration Dist. Pipe d Holding Bot. System [A I N . PUMP/SIPHON INFORMATION"~ i,Ut[1'~t Final Gate g9 ~D Manufacturer Demand GPM t Cover ~ P,~iy~ n .fir / X F5~ -77 Model Number TDH Li / Prim Loss Syste Head TDH I Ft/ t A r f Forcemain t b 2 4l c ~t1 CSI i~na. is Dist. to Well j L,,K,_j--1 ry kv -uzJms. _ U' Iq ~ - 4- i SOIL ABSORPTION SYSTEM x A BED/TRENCH Width r Len th No. Of Trenches PI DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /0 SETBACK SYSTEM TO P/L BLD W LAKE/ST E CH Manufacturer: INFORMATION CHA OR Type Of System: F UNIT Ip Model Number: Hntvl r DIST ION SYSTEM 1.1~_ ~ 40 Head r/Manifol Distribution / x Hole Sjz x Hole Spacing, Vent to Air Inta e pipe(s) 7 i rr ~ r LDia Length L / Dia Spacing r Y' )-1 I SOIL COVER x Pressure Systems Only xx Molun,11 r At-Grade Systems Only m- vgrr Depth Over Depth Over xx epth of- xx Seeded/Sodded x Mulched Bed/Trench Center Bed/Trench Edges Topsoil j 0 Yes No 2 Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2* Y/ / Z Location: 753 233rd Ave. 'e.New Rich/m~ond, WI 54017 (SW 1/4 SE 1/4 1 T31 19W) Woodland M~sead ws~Lot 18 % Parcel No: 01,31.19.1542 1.) Alt BM Description P 0~"'' ~n• (~JGi l! /}L(f/h/ S ~~jG~ 4tL A7 GL,~ (~'L2~~ ~j~ ((r aG { 2.) Bldg sewer length 303 ~sC/-/ C 6 C fL - S4ae- - amount of cover 4v 3 , J Plan revision Required? Yes W~o Use other side for additional information. 1 1 l I Date Insepctors Signature Cert. No. SBD-6710 (R.3/97) PLOT PLAN PROJECT Oeverino Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 SE 1/4S 1 /T 31 N/R 19 W TOWN Somerset COUNTY ST. CROIX SYSTEM ELEVATION 96.7' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top of telephone pedistal ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. same as benchmark 233rd Ave B.M.* ~T Scale -1 /W =1 ' Grading is to be done to divert run-off away from 3 Acre Pa -eel syste m ` B-2 B-1 96' ~ 95.7' 95' _ 1^r'el I is to meet all DNR, ❑ setback j 94 B-3 &0--t CL 5% Slope T nk is to be propxrly b dded and provided Bedroom House i t h l ockdown cover area 15' below sy tem is to ith approved warning remain undistur d bell Property Line Property Line ColmlllefCS' , Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 Departm ~~~0~ Madison, W1 53707 62 Snnii Brit Of CiCM~ ry )'craft Nurnbur (w bn IuA in by Co.) Sa t t" 'Application State Transaction Number In accordance with s. Comm. 83.2 ),'V✓is. Adm. Code, submission of this form to the a 2-unit is required prior to obtainin a sani pPwPri ae go meiatal` g sanitary permit. Note: Application forms for state-owned POW .,are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary u oses in accordance with the Privacy Law, s. 15.04(1 m , Stats. _ 1. Application Information - Please Print All Information J 2 3 , Property Owner's Name I pal-eel # LCG -ODb Property Owner's Mailing Addr Property Location / IL~ z) City, State Govt. Lot Zip ode hone Nrunber n , , 1 Section ~_A_1 rcle one V II Type of Building (check all that apply) Lot # r-~=- N: R E of w r 2 amily Dwelling- Nu~m/ber Bedrooms Subdivision N c Ilk S ~ o! gzdA f~( Q Block 4 l ,/yl ❑ Public/Commercial Describe Use ~~1~U°n ❑ City of s ❑ State Owned - Describe Use CSM Number 11 Viltago of Town oft i III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. El Permit Renewal 11 Permit Revision 11 Change of Plumber 11 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner / I IV. Type of POWTS System/Component/Device: Check all that a I r ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil v n ? ❑ Holding Tank ❑ Other Dispersal Component (expla' / ❑ Pretreatment Device (explain) V. Dis rsaUTreatment Area Information: Des' Flow (god) Design Soil Application Rate(gp f) Dispersal Area Re ui (s Dispe I Area P pos (sf) System Elevation `9~ 2 S //2 S 'VL Tank Info Capacity ' Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks ~ U y Septic or holding Tank (Dosing Chamber Ile, IVII. Responsibility Statement- 1, the undersigned, as a responsibility for installation of the POWTS shown on the attached plans. 1?1um er's Nam (Print) Plum Signature MP/MyPRS Number Business Phone Number , )lumber's Address (Street, City, State Zip C:ode~ cC ` 1 lz 9 S /e'(_4 I✓ . Count epartment Use Only Approved ❑ Disapproved Permit Fee 00 Da sued Issuing Ag Signat ❑ Owner Given Reason for Denial $ ~ Z 5- l 3 / IX. Conditions of Approval/Reasons for Disapproval :03 vyi s SYSTEM OWNER: 1. Septic tank, effluent filter and ~f2;/,t~Q'yC ~'Ulfa~ y dispersal cell must be serviced /maintained s/ d as per management plan provided by plumber. GJLL(Q- / Ljx~ 4 2. All setback requirements must be maintained /~/D~ as per applicable C plans for the system and sabmi fo ihrCoun only on paper no less thrn a to x 11 inch s in d (.l/✓,~ J 62 r " v ~~~i fuw~~e B ~1 'I3D-6398 (R 02/09) ~ , 0 RECEIVE'( Cover Page OCT 2 2 2012 ' FE i-Y & BUILDINGS Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/ 18/12 Owner:Oevering Homes LLC Location:SW1/4 SE1/4 S1 T31 N,R19 W 753 233rd Ave Somerset System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-12. Soil test 13. Filter Specificatio d cross section a Shaun Bird Signature r License number 6600 9y0 ~ ~Z ti~ PLOT PLAN PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 ROIX SW 1/4 SE 1/4S 1 /T 31 N/R 19 W TOWN Somerset COUNTY ST.C SYSTEM ELEVATION 96.7' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 450 # of chambers none BENCHMARK V.R.P. Top of telephone pedistal ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. same as benchmark 233rd Ave B.M.* Scale =1 /4" =10' Bradi ng is to be done to 3 Acre Parcel divert run-off away from system B-2 B-1 96 95.7' 95' 'dell is to meet all DNR ❑ setbacks 94' B-3 5% Slope Tank is to be properly Pro 3 bedded and provided Bedroom with lockdown cover House Area 15' below system is to with approved warning remain undisturbed labels Property Line Property Line Page Synthetic Covering ,4579:*?- ' Y-7 Distribution , Pipe Sand ri Q Topsoil 3 % Slope 9 7 r Force Main Plow Bed of 2 Aggregate From Pump Layer D Ft, Gross Section Of A Mound System Using E Ft. A Bed For The Absorption Area F ' Ft. G a' Ft. A a Ft. i- Ft, Signed: B Ft. License Number: KT, 2- Ft. L Ft. ZS f)~a to Ft. r L:C, Ft. IW341 Ft. L . Observation Pipe A L-_------------------ ~ Force Main Distribution Bed Of 2 2 2 Twrn l pipe Aggregate Observation Pipe Permanent Markers C ell Plan View Of Mound Using A For The Absorption Area Septic-Dose Iraink. Cross Section And Pump Perfonnarnce Specifications Tank _Ma_nufat,turer r•. , Pump Manufacturer~A Tank.1VlodelNumber - Pump Mode! !dumber T Total Tank Capacity -0 Alarm 'Manufacturer C S Alarm Model NumberG- y Switch Types c Filter Manufacturer Total Dynamic 1C3ead (TD13) Fed ~ f Filter Model 'N'umber Elevation Head Distal Pressure - F-7 Re_~ @ Ft - Minimeun Pump erfom m" aired Network Loss rve Main Loss _ w3 GPM Y t: TDH FnTOW Outlet Manhole Nfln. 4" Above Grade With Locking DeNi oe. h" Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Waurdaht Securely Mounted With Looking Device Wes'-proof Finished Grade Junction Box Vent Min. 12" Above Grade Disconnect with vent cap Mean /ILL ► Y. 1 Y/♦ t. L h h/ 1 4 1 4 :':i':':t:ti{:':':`:t:s: I$ 1 + ■ s . r . slt t r s~1 r a • . I + ."t ,1 4Yt1 {,1 LI 11 I'> Outlet Filter Inlet Inlet Bye ~1 ]~~pp~1.~f ~vin~ A ywlt\i ■ 1 ' F~ L7~M✓.7Vf ~e ~apwty •A ar Tank Volume -CUP-1 IY 1 ► Weep Dimension ; Inches Volume Gal. B Hole ~(reserva) Ai 06 lilt ~ {F"I N. YI R•~.aaa~liYJMi Off Elevation X; X Bottom Total Eev 131 ~t,■ 1 {,,4TfT {sY,'Y,TTf~Tfi'yF'al-s~F1t t . / . / . + I . '.'tilt, i~s~e"s"}ha , s" yr; . ht ~ 1 ati t t ,t l't r't","7tt'tit"Rtaf1"a"1a,"{"Iit'.ta"1".'+"1': "~':!1'~"{"/"t'++fYtlft rYa {Y 1'I': tY'"~ht/"1t►i,1, f , . 1 , r . t v , , 1 . , 1 , a f~ its a: {1{'l{ati■1 tf ,>'1'"hh11'h re'IL 1'L r1 Yt 1LYY1 L'.Y YL It YY 1 , 1 /,9rrt{+I It/at{1lt if fl llt/Ial/f +1...It GENER-41 INSTAlLI.ATION: The septio/dose tank is bedded and back filled in manufacturer's product approval speoiTosetiats. acooa+dance with the be exceeded without Approval. Maximum depth of bury as speoilled. by the manufacturer may not Br'ior Mauhalo cove's exposed to grade have an effective looking device ock) installed. Piping at the inlet and outlet is of approved material;, t laid on stable soil to prevent srettliun or sa Connected to the tank witfi watertight fittings, nttgsgs, a and d g gging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Wectriaal service complieB with NEC 300 and Comm 16.2K, 02105 Ll' page of. TOTAL DYNAMIC HEAD/CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING MODEL 152/153 MODEL 152 153 50. Feet. Meters Gal. Liters Gal. Liters 153 5 1.5 69 261 77 291 1 z 40 10 3.1 61 231 70 265 152 15 4.6 53 201 61 231 20 6.1 44 167 52 147 30 25 7.6 34 129 42 159 8 30 9.1 23 87 33 Q5 j 20° 35 10.7 22 E5 11 42 4 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) 10 - _ orasos 0. 20 40 60 80 100 GALLONS LITERS s i/a 0 80 160 240 320 3 x7/32 * 5/e - FLOW PER MINUTE 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS e Timed dosing panels available, 3 27/32 • Electrical alternators, for duptex systems, are available and supplied with l an alarm. Variable level control switches are available for controlling single phase l systems. • Double plggyback!varWie level float switches are available for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See F1101420. • Over 130°F. (5490.} special quotation required, 15T1153.Ssriea 12 1/e D L "800 Model vodte•PI g-jAZ~ m I 0u lax N462 11b 1 6 1 2or3 BN162 115 1B.5 included 2or3 E162 239 1 4.3 1 2 or 3 BEt62 23D 1 4.3 included 2 or 3 1 itfi 1 10.6 1 N23 BNi53 115 1 Auto 10.5 Included SELECTION GUIDE 230 1 Nan 5.3 1 1. Single piggyback variable level float switch or double piggyback variable level float SE163 230 lndudswitch. Refer to FM0477. n CAUT109 2. See FMO712 for correct model of Electrical Alternator E-Pak. All Installation of controls, protection devices and widag should be done by-At 4uaftd 3, Variable leveicontrol switch 10-0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety cedes should be followed Including the most or (4) float system. recent National Elsotrlo Code (NEC) and the Occupational.Safety and Health Act (OS.HA), RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO:. A.O.8516347 L9ulbile, KY 40256.0347 Manufecfurersof.. SHIP TO, 3649 Cone Run Road Loufsvl lls, KY 4021!-9867 / iw/.w smew I9uf F#Fo/ 802) 778.2731.1 fdq B28•PUMP 6ttpFAXf592)7T4-3624 0 Copyright 2000 Zoeller Co. All rights reserved. f: Wisconsin Department of eQ 2012 SOIL EVALUATION R&--! Page of ~ Division of Safety and Buildings ce with Comm 85, Wis. Adm. Code County c pWNµING& ZONIN1P Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, 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. - Please print all information. viewed b ` Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). O v Property Owner Property Location G`e~Q i ~ p i7 ~2 Govt. Lot~(r~ 1/4 1/4 S / T N R E (or Property Owner's Mailing Ad Lot # Block # Subd. Name ' Lr~d rM# /YS3 6e City Stat Zip Code Phone Number ❑ City ❑ Village own Nearest Road ) Z 3 Ate, New Construction Useesidential I Number of bedrooms y_ Code derived design flow rate yJy GPD ❑ Replacement P lic or commercial - Describe: Parent material Flood Plain elevation if applicable ~2 CIT::,~ ft• General continents and recommendations iSQL- System Type /Ji /-L-tV System Elevation ❑ 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 ® Boring Boring # 471 - q it 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#1i I 'Eff#? • IJ '7 Z Effluent #1 = BOD > 30:S 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54 - 715-246-4516 Property Owner _ Parcel ID # Page of Boring L _3 Bon # .J © Pit Ground surface elev. Lft, 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 77 z - 4 s L' b d -3 F-1 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 F-1 Boring # Ground surface elev. ft. Depth to limiting factor Pit in. ❑ Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 30 mg/l- and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SOD-8330 (8.6/00) Soil Test Plot Plan Project Name Oevering Homes LLC Sh ird Address 1433 Cernohous Ave Suite A New Richmond Wi 54017 69TM #226900 Lot 18 Subdivision Woodland Meadows Date 10/17/12 S W 1/4 SE 1/4S 1 T 31 N/R 19 W Township Somerset ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of telephone pedistal System Elevation 96.7' *HRPSame as Benchmark 233rd Ave 210,0 B.M.* Scale is 1" = 40' 1 3 unless otherwise 'Scale =1 /4" =10' noted 3 Acre Parcel B-1 B-2 96' 95.7' o ❑ 951 94'- y~ f 5% Slope Property Line Property Line,4 Loc Sou th we r S88 0157 oy8 0 Drama, Ij o 'Easerp e WE ~ 10, 190 8.. rn S8 0195-719E -N 8'01'57"l 210.09 i ( 137.05' 8.44; N z A J. 00 b U' a / Z 0- 0 N CA C O o v 00 C~ I -u I D CN ° 18 m Q3 m -I N Total Area.- I r j w N 131, 943 sq. ft. I N w w 3.03 acres L.B.O. =993 0' I> 0) I z w ~~~o. ~ Drainage v.O Easement p 991.0 4i v O N N88 0J 5_"yO 125.05' o O o ~1 c 2010'' / Dc~ 0 Wisconsin Department of Corrirr EtLLWi4corn S 1 TION R EPORT Page 1 of 3 Division of Safety and Buildi , PCC~ ~•FA~Ad.?t~le County St.Croix Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference int (041 Vire)atid~ ara ``fit Parcel I.D. Pendin percent slope, scale or dimensions, north arrow, and locati n and distanceto nearlt road. S J Please print all infonnat- n. ! u x Reviewed by Date Personal information you provide may be used for seconds pu Z l I G~.6 (m)). I r g a -r 4 Property Owner Property Location AHRH Properties LLC GqA Lot SW 1/4 SE 1/4 S 1 T 31 N R 19 (or) W Property Owner's Mailing Address ;X; Subd. Name or CSM# 404 Screen Avenue Woodland Meadows Cty State Zip Code Phone Number lage E ]Town Nearest Road New Richmond WI 54017 ( 7 f 5-222-0169 CTH El New Construction Used Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 0 Replacement Public or commercial - Describe: Parent material Loess over glacial till Flood Plain elevation if applicable N A- ft, General comments Site suitable for a moLnd system &)t and recommendations: aAw-~-' FjBoring # 0 Boring ED Pit Ground surface elev. 100.10 ft. Depth to limiting factor 20-30 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 'Eff#2 1 0-7 10yr3/2 sil 2msbk mfr as 2f .8 2 7-14 1 4/3 sil 2msbk mfr cw 1f 4 .6 3 14-20 10yr4/4 silcl 2msbk mfr cw if .4 .6 4 20-30 10yr4/4 f2f5yr5/8 sicl lmsbk mfr .2 .3 F2 Boring # Boring 98.10 25-39 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(ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 1 0-7 10yr3/2 sil 2msbk mfr as 2f .6 .8 2 - 8 l 0w413 sil lmsbk mfr cw if .4 .6 3 -25 10yr4/4 sicl 2msbk mfr cw if .4 .6 4 25-39 10yr4/4 f2f5yr5/8 sicl lmsbk mfr - - .2 .3 ' Effluent #1 = BOD > 30:5 220 mg /L and TSS >30 < 150 mg/L ' Effluent #2 = M:< 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature L~ CST Number Thomas C. Nelson 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, Wl 11/17/04 715-246-2454 nTT n1~n Tn.~/ni~ s Property Owner AHRH Properties LLC Parcel ID # Pending Page 2 of 3 -3 ] Boring # 1 Boring F 102.60 21-38 ■ 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 0-4 10yr3/2 - sil 2msbk mfr as 2f .6 .8 2 4-13 1 4/3 - sil IM PI mfr cw if .4 .6 3 13-18 1Oyr4/4 - sicl 2msbk mfr cw if .4 .6 4 18-21 10yr4/4 flf5yr5/8 sicl lmsbk mfr cw if .2 .3 5 21-38 7.5yr4/4 - fs1 Om dvh - - .2 .5 ❑ 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 F-1 Boring # H 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 *Eff4Q * Effluent #1 = BODS > 30 < 220 nVL and TSS >30 < 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330Tem (R.07/00) i Woodland Meadows Scab 1 = 30' BM1 Top of conduit 100.0' Lot 18 SM2 Top of conduit 102.60' 131100.101 82 88.10' 83102.60' c 60 83 31 l sl.P ~a2 l8 Thomas Nelson -z 227387 8 0Tx94075402 0 State Bar of Wisconsin Form 2-2003 965533 WARRANTY DEED BETH PABST REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI 10/17/2012 2.20 PM EXEMPT#: NA THIS DEED, made between The Burnside Registered Limited Liability Partnership, REC FEE: 30.00 a Wisconsin Limited Liabilitv Partnership TRANS FEE: 54.00 ("Grantor," whether one or more), PAGES: 1 and Oevering Homes, LLC ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (ifmore Recording Area space is needed, please attach addendum): Name and Return Address i Lot Eighteen (18), Woodland Meadows, Town of Somerset, St. Croix County, Polk County Abstract Wisconsin. Suite I, 825 US Highway 8 St Croix Falls, WI 54024 032-2181-18-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: All easements, conditions, covenants, and restrictions of record. October 012 Dated T ~r It - i P(Vd Limite Liability Partnership (SEAL) t 'f I / (SEAL) * * b Kenneth M. uncan• General Partner (SEAL) (SEAL) * * AUTHENTk-ATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on /y ) ss. ST dA'&1 y_ COUNTY ) * Personally came before me on October, 2012 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Kenneth M. Duncan (If not, authorized by Wis. Stat. § 706.06) to ye,,~. ga+mt~ be, t lie'"n(s) who executed the foregoing t: inst ~iac~wledge the same. THIS INSTRUMENT DRAFTED BY: r i Susan D. Lee Lee Law Office, LLC Nodar-.Iy- y ?'blic,SiJ efbVisconsi7I MAW orcxmission i permaneno,,(expires: l~ ) (Signatures may be authenticated or ac :Ips,W2&., Both"arc not~ni:eessary.) NOTE: THIS IS A STANDARD FORM. ANN' NIODIFICATIONSt!LflISJ~ U_RNIhol'•D BE CLEARLY IDFNTIFIFD. WARRANTY DEED © 2003 STATE 13AIt OF- FO S11~. 1 FORNI NO. 2-2003 * Type name below signatures. 1 of 1