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Home My WebLink About030-2141-00-011 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 561009 0 State Plan ID No Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 0)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Bird, Shaun R. St. Joseph, Town of 030-2141-00-011 CST BM Elev: Insp. BM Elev: BM Descrip . n: G r y p ! Section/Town/Range/Map No: y vfJ ` or 36.30.19.2061 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY ST TIO N S HI IFS ELEV. 13A Septic Benchma 4/ L ra .a ~g oS, Dosing Alt. BM-~ v Bldg. S er W put/ OLd r`-dj- p W Aeration Holding TWA ~9 l 0 7a St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/ WELL _ BLDG. Vent to Air Intake ROAD Dt Inlet / Septic 1 ~D Dt Bottom -L4ff- AA, Dosing Fdinp, Header Man. /0 4c A Aeration d / Dist. Pipe 7 Cif Holding Bot. System 9 Final Grade PUMP/SIPHON INFORMATION vtiy "Its Manufacturer Demand St Cover ~ GPM Z, (x7 S. Model Number j TDH Lift 'Friction Lo y d TDH Ft Forcemain Lengt Dia. Dist. to Well SOIL ABSORPTION SYSTEM S BEDITRENCH DIMENSIONS 31 Length No. Of Trenches PIT DIMENSIONS No. Of Pits :1nInside Dia. Liquid Depth DIMENSIONS IONS SETBACK SYSTEM TO P/L BLDG WELL It AC Man INFORMATION y ✓ ~j T~}e Of S stem: f CHAMBE OR (~I r s 3~ ~f v / o IT Model Number: DI IBUTION SYSTEM I¢ ead anifold Distribution 7r~r acing (n ( /f l~ ~ x Hole ize Ix Hole Spacing Vent to Air Intake G / / ~ Pipe(s) r 1 40111_ Length Dia Length Dia Spacing -Lo 0 ~ SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of 4Xxxxseeidded/Soddded Bed/Trench Center Edges Topsoil xx Mulched U Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:// / Inspection #2: / / Location: 1269 84th Street New Richmond, WI 54017 (SW 1/4 SW 114 36 T30N R19W) Natalie's Ridge Lot 11 ' q Parcel No: 36.30 V al" wk`' / .19.2061 1.) Alt BM Description - Q,{.t/~1 G~ q /T vt1Y( G/t / /2,~ 2.) Bldg sewer length Ph = / r (/~1^ ~SGt/Li C3 S /Lf (LG e-~'- ~G / ~J Y7 !T ►~rn - amount of cover = Plan revision Required? 0 Yes No Use other side for additional information. II I , ~y S Date SBD-6710 (R.3/97) Insepctors re Cert. No. PLOT PLAN PROJECT Shaun Bird ADDRESS 1432 120th St. New Richmond Wi 54017 SW 1/4 NW 1/4s 36 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 12/15/12 3 DATE BEDROOM CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 93.7/94.1' 4' below grade of tank, piping shall be Schedule 40. Vent Scale is 1" = 40' 699 Quick4 Standard Well is to meet all setbacks required by unless otherwise of Cover Leaching Chamber WDNR noted with 20.0 ft2 of Area 12" 10.2ft^2/pair of end caps 4' Long 3 4" Grade at System Elevation own Road 282' 2-3 66' lls with >3' spacinB 2 $I~~j` ti X15 ' ~rbr`7 Vents 5% SLope Pro 3 Bedroom ` house Q, 30' 0' B-3 ~V 1 138 " .Rr4 FN . i Town I,gfd 54' 12' 150' cotnfrtrarc@'~ g~tr Safety an(t Buildings llrvrsiorl--- 201 Co~,niy r . Can W. Washington Ave., P.O. Box 7162 LP S Madison, W). 53%07 -7I 6? Depathnew OfC MMvercB /OO ( ba, cal U m y _ -_-._~'1__.__ sa]Z~t l~ State -Lll-osaclionNutnber 44F, ,J ermit App~>icatio~ In accordance with s. Conan 83, Wis Adm. Code, submission of this forin to the pro mu c te r 8~ menisrl i unit is rug7th erl prior to obtautliig r sanilarX,puph-1. Note: Application torrrts for stn rwnetl PO - tt arr. Prgjec! A(ldrt s if different than mailing address) submitted e Department of Corrut~li{ f Mortal infonuatton you provide uray be us.IL for udtury PUT poses in accordance witty the P{frA Lt}ta s, 15.04(1 to Stats. 1. Application Information --Please t rltr , fur 'on - r,5. / Property Owner's Name Parcel 4 cS Property Owner's Mailing Address -.--_.__A - Prop~y Loontioit - LT_ l 2 Z Govt. Lot ell' 26U 1 City, State Zip Code Phone Number 2 /l/~ %a. Section `.L ~~yy J cIc on Il<. Type of Building (check all that apply) Lot # I or2 Ftuuily Dwelling- Number of Bed,voins Snbdtvisiuu Name ak a-A I I ~IUGIi ~ ' _ Public/Cornmercud-Describe Use I City oP - CSM Ntnnbcr l~ ViIEu (of _ _ D Stage Owned Lk;scribe Use $ ' Type u Permit: (Check only one box on line A. Complete line B if applicable) New System I❑ Replaccutwit System U Treatineut/Holding `rank I(eplaueinent Only Ll Other Modification to Lmsting System (explain) 1;. F1 Permit l(cnewal ❑ Permit IiCv siurr ❑ Change of-Pl(unber 1-1 Permit'I'rarisler to New Last Previous Perutit Number and Date Issued Before Expiration Owner 11 V. Type of NO W t'S systenr/Conrpoocnt/Dewic (Check all that apply) - rI I - - - - - es.n~P+.C~ _ Non-Pressurized In-(around ❑ Pressui z.rd ln-Ground D At-Grade F1 Mound > 24 in. of suitable soil Ll Mound ,t 24 iu. of suitable soil h 1-folding Tank U Other Dispersal Coruponetrt explain)________.._____-____.____. ❑ T'rebt aUuerrt Device (explain)___ - - - `lr. Dispersalll'rea ent Area f(nformlttiun• T:k sign Flow (gpd) Ih ign Soil Application r1ak(gpdsf) Dispersal Area Required (s[) Dispersal Ar Proposed Nf stem Lleva _Ti 2"C V L Tam k !Info Ca3aorty in Total A of Manufacturer t iailons Gallons Ouits d JN.w'f:wks - - Exisilug ranks o si:ptic or Holding Talk Casing Chaunber V il(_ Responsibility Statement- 1, the undersigned, assu a espoasibility for installation of the POWYS shown on the attached plans.- Plumber's Name (Print) Llusubm- ature MP/MFRS Number Nosiness 1'ttone Number . Plurube 's Address (Street, City, State, Zip 049)-) z__ 1,7 - - - V III. Count /1?e artment Use Only _ - - - - - Approved Is Pennit Fee Date Is ued Issuing t Signature _ 'iyen Reason (ninl _ -T~:. Condi9 1(Reasons sun Disapproval 1. $eptic tank, effltlentfilter and" W 44,1 , A~l~ dispersal cell must all be services / maintained as per management plan provided by plumber. i All tielback requirements must be maintained ----------~i-Rte[-ablB ~clel_txtfinanrBa: - Atlach to complete Idaas for the systetu and submit IO the County only on paper out less than 8 to is l I inches in site SBD-6398 (R. 02109) . Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 12/15/12 Owner: Shaun Bird Location: SW1/4 NW1/4 S36 T30 N,R19W Lot 11 Natalie's Ridge St. Joseph System type: In-ground absorbtion system (co, nventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet , t e' i , Signature License number #22690 PLOT PLAN PROJECT Shaun Bird ADDRESS 1432 120th St. New Richmond Wi 54017 SW 1/4 NW 1/4S 36 /T 30 N/R 19 W TOWN St. Joseph COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/15/12 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. Top of 2" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 93.7/94.1' 4' below qrade All piping shall be SDR 30/34, within 10' of tank, piping shall be Schedule 40. Vent Scale is 1" = 4~~ Well is to meet all >6„ Quick4 Standard setbacks required by unless otherwise of Cover Leaching Chamber WDNR with 20.0 ft2 of Area noted 12" 10.2ft^2/pair of end caps Long Grade at System Elevation 34" own Road I 282' B-2 2-3' X 66' cells with >3' spacing Vents 5% SLope Pro 3 Bedroom house B-3 30' ST 30' B-1 78' 68' 138' Town Road 54' 12' 150' Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber p To be >1 above grade 10.2ftA2 pair of end plates Finish grade elevation Typical Installation 99.1' Vent Grade Vent 3' 4" 3' X30/34 Septic Tank 5' Long 191 5' S' Long VI 3617 Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A B 16 chambers per cell System elevations: A 94.1' B 93.7' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of BILE INFORMATION Owner , SYSTEM SPECIFICATIONS Permit # FE,nt ank Capacity gal ❑ NA ank Manufacturer , ❑ NA 7ESIGN PARAMETERS Filter iManufacturer Number of Bedrooms °Z L7 NA O NA Effluent Fil ter Model ❑ NA i Number of Public Facility Units - A Pump Tank Capacity Estimated flow (average) gal NA al/da Pump fork Manufacturer NA -a I Design flow (peak), (Estimated x 1.5) - - ' ..1~ al/da Pump Manufacturer NA i Soil Application Rate Standard Influent/Effluent Qualit aUda /ftZ Pump Model NA y Monthly average" Pretreatme tment Unit Fats, Oil & Grease (FOG) 530 m /L 1:1 SandiGravel Filter El Peat NA ~1' Biochemical Oxygen Demand (BODs) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Watlandilter Total Suspended Solids (TSS) x150 m L ❑ Disinfection ❑ Other: !Pretreated Effluent Quality Monthly average Dispersal Cell(s) - Biochemical Oxygen Demand (800s) s30 mg/L in-Ground ❑ NA (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (T,58) <30 ng/L /-41 NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric; mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: iMaximum Effluent Particle Size lti in di a. ❑ NA Other: (Other: ❑ NA NA Other. .I ❑ JNA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ MAINTENANCE SCHEDULE Service Event ~ Service Frequency inspect condition of tank(s) At least once every: \ rnont s) ears (Maximum 3 years) ❑ NA 1-14 y- ipump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume _ ❑ NA Unspect dispersal Dell(s) At least once every: month(s) ~ ~,year(s) (Maximum 3 years) ❑ NA (:;lean effluent filter At least once every: Q mont(h)s) ❑ NA i nspect pump, pump controls & alarm ❑ month At least once every; ❑ year(s)s) _ NR (::lush laterals and pressure test At least once every: p year(s)s) NA 1'Ither; At least once every: ❑ month(s) er: ❑ year(s) NA NA MAINTENANCE INSTRUCTIONS llnspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master (Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must linclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of icombined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be rosually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. 'The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local 1egulatory authority. IA(hen the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of Ike tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at intervals of <12 months, shall be performed by a certified POWTS Maintainer. IA service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals t ul may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of thj: tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge offloenie To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank, Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area, Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWT13: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation dialin (sump pump) water; fruit and vegetable peelings; gasoline', grease; herbicides; meat scraps; medications; oil; painting produc l0; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shalt be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with Milli, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code complirpnt replacement system: #-A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systslm. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requiijed setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the nEled for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the ruled in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technologN a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evalualion must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installedl as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltra-ilve surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL {SASSES AND/OR INSUFFICIENT OXYGEN. DO HIOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE 0 1 F A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS - i POWTS INSTALLER POWTS MAINTAINER Name Name j Phone J~_ l Phone ? `,9, 1 S SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Marne j_r~>-J~ Phone Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. f FILTER ~ RTRIDGE INSTRUCTIONS Installation S'reP I Dry fit the fitter case Onto the and of the outlet pipe to ensure it is centered under the access opening. If not,, then either Insert tAOre pipa into the tank through the outlet or so4tot weld (glue) additional pipe onto the outlet pipe. S' FCC a While the case is still dry fitted on the outlet pipe, measure the iengtfi of 44-inch pipe needed to brace the alter to the tank and wall if utilizing the Optional suppiemantel side support. If side support method. Is not utilized, proceed to step four. 5•ri<•F' x For irnstallations utilizing the optional supplemental side support-- solvent weld the %-inch pipe onto the filter case If side support hiethbd is not utilized, proceed ko step four. Solvent weld the filter case onto the nutlet ipe. " cartridge into the case, pressinit down until the flterluckElinto the button, of r-; the case. If a VAS switch is utilka--d= insert into the Met' and lock by turning r `$Fi clockwise 900, I I pry,k Maie rtenance 1. The effluent filter should be tioaned every time the reptic tank is serviced. 2, opeh the outlet access opening to Inspect the tank and filter, - 'L s. Pump the septic tank conrplotely, making sure to rarnuve the siudga layer on the bottom of the t ink and not Just the scum and effluent. 4. once the affluent level has baett lowered below the invert of tho I outlet pipe, firmly pull up an the filter handle to dislodge the i cbrtNdge hem the case, k 5. slide the cartridge up and of W of the case for cleaning. . 6, it a Vfts switch connected to an alarrri is lrrksent, the switch ~ should be removed by tu-inq counterclockwise 901, and cleaned with water only. Y. 7. While holding the cartridge on Its side (large flat surface facing down) over the access upeniiiy, rilrse off the cartridge with water , only, making sure all septaga +naterfai is rinsed back Into the tank- a. if VRS switch is utilized, replace by Inserting into fitter and turning clockwise 94 , _ ....i, 9. Insert the filter cartridge back into the case, pressing down untif the filter locks into the bottonn of the case. 10.11aplace and secure the of celis upening on the tank. .:1:••.:h':~"c"'•°It`9r;:Q01~~t':d1Sri! L12W.WV1.1.1i WWw.beatmonAtexom 87e7.1ILAMTUR• (653-4583) , W4 V)rtA I- rm:$ ~y,Qy`022h TED LANDS ORTH-SOUTH 1/4 UNE HOO-19.19•W 5267.71' UNPLATTED LANDS - - - - - - NOO°19'19'W 1527.26' r 282.48 88 o322.1 jk a w k t BLOCK dST - 832.00' Oqc dST -36498 g g • a KB 33' 33' -2 ~ _ - o I I 8 Y I I; a Sa I ( 70'~~t K,_W fig 40 t I n m cl t m t C, I I N g; T5~ I V w -c I I I Cs_m vvp Jed~j rmtq N O G L75 N J . r 7g•-► I I I n / , -4162:49- 2MO! 4r- C:L 500'19'19'E 309.70' 50019'19'E 584.96' '~n m ~ io - 84TH STREET- • a 64TH STREET ' 40 a J N001WWW 584.96' " H3 N00'19'19'W 310.24 4'S IF N Cam` t t O ~ 33' 33 ~ I / lg~ o H ~ o c • 1NKlr- I I ,o,, J I _ .1 O Otl G I C'k $j x-75' I r' *ar / / 1 ? 1 \ W / \ I ST. CROIX COUNTY SEPTIC TANK NIA]NTE)V.ANCE AGREEMENT AND U'-NEIZSHIP CERTIVICATION FORM Owner/Buyer Mailing Address Property Address _ 40 ~ (~`eriaahon required from planning Zoning Department for new ronstructio - City/state n ) Pawe)1dentification 'Number 0 30 - c2 1 ~f 4 X ____.AAC. DE CRr.-T ON Property Locatio L~ _ %a , ~4 "See. 34y V- Q N'R Y W Tawr, o:F,~ Subdfivigrion _ Certlt>ed - - _ _ - - Lot # _ Survey Map # Page, Volurue Warranty Deed # - - - - - - .y V oltrxne Pa - ge # Spec house yfiS no - - Lot lines identifiable yes no SYS-~TErit______rIAINTE~CE AN UWNER CER'T'YYCAT~U .N Improper use and maintenance of your septic ;system could.result in its premature failure to handle wastes, Proper maintenance consists of ptunpn opt the septic to the system can affect the every three years or sooner, if needed, by a li ,ended pumper. Who tixnatic:ir of the septic tank as a treatment stage in the waste disposal systern. Owner maintenance responsibilities am specified in,! f,omtrtn. 93.52(l) ~u put into i ~ and in Chapter 12 - St. Croix County Sanitary ()rdlnance. maintenance The property Owner agrees to submit to St. 0, owner and by oix County Plaruun & Zoning Department a certification form, signed by tl,c wastewater disposal System is in u e umber, ,restric,ted plurnber or a licensed less than 1/3 till). of sludge. Proper OPerating condition and/or pwrrPer verlfyiag that (1) the on-site (2) after tnspcation and pumping (if necessary), the septic tank is X/we„ the undersigned Lave read the above requirerrcents and agree to standards set north, herein, as set by the .Department of Co maintain the private riewage disposal system th wi the Certifrcetion stating that yours s mrrrercc and tile Dartttrent of Natural 14 esotu ces, State of Wiscn nsnn. Zoning Department within 30 daptic ys of bey maintained must be completed and return tjW three ed to the St. Croix Co year expiration date. lritty Planning & i r/M c tfy that all statejna* on this form are true to the best of my/our knowlad 1le. 1/w rn/are tits owrre oi' the Property described above A 'virhle of a warranty deed recorded in Register of Deeds 0 ce, e a r~s ) Number o4be APPLZ .AC NT(S} / Any infamtation that is mist DATE epresented may result in the sanitar Y permit being revoked by the Phknning & Zoning Department. * * * 1Ir1c:lude with this appl,icution a recorded warranty deed from the Register of De preference is made in the warranty deed. ~ Office and a copy rrf the certified survey n'aP i f- IIIIIIIIIlIIIIIIIIIlllilllal~ . 81122.91 Tx:4089283' STATE BAR OF WISCONSIN FORM 3 - 2000 969022 Document Number. QUIT CLAIM DEED BETH PABST REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, a Wisconsin banking ST. CROIX CO., WI corporation, Grantor, and Shawn Bird, a single person, Grantee. 12/07/2012 1:23 PM Grantor quit claims to Grantee the following described real estate in St. EXEMPT#: NA Croix County, State of Wisconsin (the "Property"): REC FEE: 30.00 Lots 4, 5, 6, 11, 13, 20, 21, 26, and 27 Natalie's, Ridge, St. Croix County, TRANS FEE: 764.10 Wisconsin. PAGES: 2 Lots are sold `as is' with all faults. Recording Area Name and Return Address: Title One Premier Group 706 19th St S Hudson. WI 54016 #18811 Together with all appurtenant rights, title and interests. see attached Parcel Identification Number (PIN) This is not homestead property. Dated this 7th day of December, 2012. Citi n tate Bank P * Gene Haberman, Vice Chairman * * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST CROIX COUNTY. ) ss. authenticated this 7th day of December, 2012 Personally came before me this 7th day of December, 2012 the above named Citizens State Bank by Gene Haberma, * Vice Chairman to me known to be the person(s) who executed TITLE: MEMBER STATE BAR OF WISCONSIN the foregoing instrument and acknowledged the same. (If not, authorized by § 706.06, Wis. Stats.) *Ja field THIS INSTRUMENT WAS DRAFTED BY N u lic, State of Wisconsin My, co ission is permanent. (If not, state expiration date: Michael H Forecki, Attorney 8/7/2016 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their s p-atY`ure~: PFAIFIE- I~ i `.lctary Public 0 Wisconsin 1 of 2 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000 ~O ~ l~M 17A11 y a-r1 TF Q~Q - ~ a 17iOla g S18 Sill u ~ a r NC i A-M FF lick Jug.* I N w ~ d ~ f 1 c N ~ M ' 4 ~ ■ I ~ I 1168 Wien Department of Commerce SOIL EV QRT Page I of 3 bivision of Safety and Buildings in accordance' h C is. Adm. Code Tom Schmitt Attach complete site plan on + gt Courriy paper not less than 8/: x 11 inch in size. Plan m~ 9 2QQ~1 St. Croix include, but not limited to: vertical and horizontal reference poi (BM), d~'~ IR arAi percent slope, scale or dimensions, north arrow, and location a d dis6n to nearest mad,,,,, arcel I. D. co ? r Please print all information. C~O0 ~J oZ ST OFFiUE -fteviewIp By Date Personal information you provide may be used for secondary purposes ( y Law,-IQ 5 9 d Property Owner Property Location Grand Properties, LP Govt. Lot SE 19 NW /4 S v36 T 30 NR 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 712 Rivard Streeet, Suite 300 11 Natalie's Ridge City State Zip Code Phone Number J City _j Village e Town Nearest Road Somerset WI 54025 715-247-5900 St.Joseph Cty. Rd. A Y' New Construction Dce: 0 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD J Replacement J Public or commercial - Describe: Parent material Outwash Plain Flood plain elevation, if applicable na General comments and recommendations: Area is suitable for a conventional system with a 0.7 gpd/sgft rating. Possible system elevation for Area 1 is 95.50'. Slope is 5%. Boring # I Boring 0 Pit Ground Surface elev. 99.08 ft. Depth to limiting factor 94 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' `Eff#1 'Eff#2 1 0-14 1Oyr3/3 none sl 2msbk mfr as 2vf .6 1.0 2 14-66 1Oyr5/4 none cos Osg ml cs .7 1.6 3 66-94 1Oyr5/6 none grms Deg ml - 7 1.6 It f r 'all ft Boring # Boring 1/ Pit Ground Surface elev. 99.08 ft. Depth to limiting factor 100+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF 'Eff#1 'Eff#2 1 0-12 10yr3/3 none sl 2%bk mfr as 2f, I lm .6 1.0 2 12-20 1Oyr4/3 none ell 2msbk mfr 9w 2vf .6 1.0 3 20-32 1 Oyr4/6 none gdcos 1 csbk mvfr cs .7 1.6 4 32-62 1Oyr5/6 none s Osg ml cs .7 1.6 5 62-79 1Oyr5/4 none vgrcos Deg ml cs .7 1.6 6 79-100 1Oyr5/6 n none grs Osg ml .7 1.6 fs ~ 77 ` Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt "I'-, 227429 Address Tom Schmitt Date Evaluation Conducted Telephone Number 1595 72nd St., New Richmond, WI 54017 4/12/05 715-247-2941 Property Owner Grand Properties, LP Parcel ID # Page 2 of 3 Boring # Boring II IIf Pit Ground Surface elev. 96.88 ft. Depth to limiting factor 104+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0-9 10yr3/3 none I 2fsbk mfr as 2vf .6 .8 2 9-14 10yr4/4 none sl 2fsbk mfr cs 1vf .6 1.0 3 14-21 10yr4/6 none vgdS 1 csbk mvfr cs 7 1.6 4 21-30 10yr5/6 none s Osg ml cs .7 1.6 5 30-84 10yr5/4 none vgrcos Osg ml cs .7 1.6 6 84-104 10yr6/4 none s Osg ml .7 1.6 F-1 Boring # Boring 1 1 Pit Ground Surface elev. ft. 9wD th to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 ❑ Boring # Boring _i Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots MIT *Eff#1 *Eff#2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS < 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. Page 3 of 3 Conducted by: Conducted For: Scbmitt Soil Testing, Inc. Name: Grand Properties, LP Thomas J. Schmitt, CST 227429 Address: 712 Rivard Street 1595 72nd St. City, State, Zip: Somerset, Wl. 54025 New Richmond, Wl. 54017 Phone: 715-247-2941 Subd.Nanne: Natalies Ridge Lot No.: Legal Description: '~t 1/4 IVIA /4 S36 T30N R1 9W Township of St. Joseph, St Coix County Bench Mark El. 100.00' Top of 2" pvc pipe Alternate Bench Mark El.~ Top of 2" pvc pipe Slope= S`,V, Contour Line El. k)/ Scale 1" = 40' r~ 1 / j" "V f I,- X30' /7~ Sys ~a' 9' iy> This soil report was done to fulfill a zoning requirement. It may or may not be in a location suitable for your use. x`0 r po~~ Nw I . woo O coooo O o w ► I °N° C~ w co ~ m co x w lzt3 V N r O II W W 13 w ry~~ W c w W W I x .o N r .sc-►; x ~ c I um, coo Lv -4 C) CA) I~ a i x 110. a n A I i N I LA I ~ I I N i 9 I : ~ n O• x ~ZSZ Z£ L 2~7 9 x ti/LMN 3H ti/L3S (3gfdo 3N1'1 1S Iscimv HJLIV~