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HomeMy WebLinkAbout030-2110-90-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 561011 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Field, Thomas & Damaris St. Joseph, Town of 030-2110-90-000 CST BM Elev: Insp. BM Elev: BM Description: Section7rown/Range/Map No 06.29.19.913 TANK INFORMATION ELEVATION DATA TYPE MANUFACTU 'J CAPACITY STATION BS HI FS ELEV. Septic r / t~ Benchmark Dosing 1t Z - X21 , °l o 1',, k ~Z S Alt. Ji- Aeration Bldg. Sewer 3 . Z /D 17. Z Holding St/Ht Inlet , 4. 7 Q /07 6 TANK SETBACK INFORMATION St/Ht Outlet / d 7` Z TANK TO P/L WELL BLDG. Ven toAiirrIntake ROAD Dt Inlet At Septic 7 56 A I 2* Dt Bottom Dosing /v Header/Man. 9Aeration Dist. Pipe 9 Holding Bot. System / .b 9Z•-I PUMP/SIPHON INFORMATION Final Grade IZ . ( 9L Manufacturer Demand St Cover GPM t-' ?off Model Numb / z~-r f . T". I 112.4 TDH Li Friction Loss Syst ad Ft Forcemain Length Dia. Dist. to well SOIL ABSORPTION SYSTEM BEDITRENCH Width I Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 96 Z I re SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer INFORMATION Type Of System: / J + CHAMBER OR Model er: , Gonvt. -ro.t r6 /66 UmbU, _ a DISTRIBUTION SYSTEM Z. Z'-Z_ Header/Manifol~ it Distribution x Hole Size x Hole Spacing VAir nke L , / Pipe(s) \ ~ d J U-7 Length ` P Dia 7 Length Dia Spacing e SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded 1xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil Yes L-] No es L- No It COMMENTS: (Include code Iscrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 317 Buck Run Hudson, WI 54016 (SW 1/4 SW 1/4 6 T29N R1 9W) Deer Haven Lot 12 Parcel No: 06.29.19.913 1.) Alt BM Description 2.) Bldg sewer length = 31 ,s - amount of cover = 1 fL/ a 1 ~a om. Plan revision Required. ❑ Yes 30 No I T c~3 [7~ 5a !3 Use other side for additional information. Date Insepctor's Sig ture Cert. No. SBD-8710 (R.3/97) STEEL'S SOIL SERVICE Gary L. Steed 1.554 200th Ave. CSTM2298'el C. Davis New Richmond, WI 54017 MPRSW-3254 Wk Wk S6-T29N419W (71.5) 246-6200 'town of St. Joseph ' lot ' #12-Deer Faven This soil evaluatian bras c=hwted to satisfy. a zoning require mt, it may or may not be suitable for your use. 'The location of the test may or may not be as shmam as pemaneut lot lines were not established at the time the test vas cmducted. .N BM-= top of NE lot stake @ el. 100' Alt. BM.- top of 2" pvc pipe @ el. 93.70' '0 t j3Z' S k1' j X F-D ire- "el py County Safety and Buildings Division t ° ^"201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) v 1P Madison, WI 53707-7162 S V G F c State Transa tion Number Sanitary,,PprMi~Application In accordance with SPS 383.21(2), WisrA&,`'Code, submission of this form to the approp a over t it is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS asubm' to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used forsecondary 17 ^ UU v k purposes in accordance with the Privacy Law, s. 15.04 1 (m), Stats. on Inf ation - Please Print All Inform I Parcel # L i Prop 0.30 - ~ 110 e06 - 17100 F Property Location wner's Mailin Idr s n 713 Pr perty O A Govt. Lot ~O! City, (J ZCode Phone Number S, 0 y, Section _,0 p G 10" T Cf9 N; R E o W 1. Type of Building (check all that apply) Lot # ubdivision N e p r 1 or 2 Family Dwelling -Number of Bedrooms lL. 41 -A Block # ❑ Public/Commercial - Describe Use 0. kX, ❑ Ciry of CSMNumber ❑ Villageof ❑ State Owned -Describe Use ® ~ ❑ Town of S~ e 1 ~i A :b~ LtJ ZZ~Z~ III. Type of Permit: (Check only a box on line A. Complete line B if applicable) A. [ New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal El Permit Revision ❑ Change of Plumber [0] Permit Transfer to New Before Expiration Owner( "'J., ~ IV. Type of POWTS System/Component/Device: Check all that apply) .Non-Pressurized In-Group ❑ Pressurized In-Ground El At-Grade El Mound > 24 in. of suitable soil El Mound < 24 in. of suitable sot Pretreatment Device (explain}~d ~ Holding Tank ❑Other Dispersal Component (explain) V. Dispersal/Treat ent Area Information: cation Rate pdsf) Dispersal Area Required sf) Dispersal Area Prop sed Systelm Elution 0 Design Flow (gpd) Design Soil Appli `7 b0S VI. ank Info Capacity in Total # of Manufacturer Gallons Gallons Units c 2 U New Tanks Existing Tanks w U iii y rn w (7 !N ~ o V 0 6 D Septic or Holding Tank J Dosing Chamber v VII. Responsibility Statement- I, the undersigned, ume responsibility for installation of the POWTS sho attached plans. Pl Mfibsgnature MP PRS Nu r Business Phone Numbe/r~ Plumber's Name (Print) / 1) / A 10 et Ira 1 Plmn. s Address (Street, City, State, Z p Code) J n '97-1- 6 A4z 2DA -e Y- VIII. ount /De artment Use Only Permit Fee Date I ued Issuing nt Signature Approved $ ❑ Ow tven Reason for Denial J IX. Condi Wd.b1EdMeasons for Disapproval ` 4 1. eye` ptio tank, effluent fR®r and 'el ev d loft- t° ~e O dispersal cell must all be services !maintained t as per management plan provided by plumber. 2 AQ seltback requkemeMs must. be maintained D . 7 1"44A a~. 1 a' as per at PICAble cock / Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x II inches in sift SBD-6398 (R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE r S. Project Name: Q~ Al-mris Owner's Name: << f Owner's Address: Legal Description: Township: County: U a lk Subdivision Name: Lot Number: Parcel ID Number: 3 l Zt1 ^ qD - Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 _ Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber:j,D}W; JY License Number:a ~ya Date: J) I Phone Number Signature Designed pursuant to the In-Ground Soil Absorption Co ponent Manual fqr POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 STEEL'S SOIL SERVICE Gary L. Steel 1.5b4 200th Ave. B~niel CSTM2298 C. DAvis New Richmond, WI 54017 MPRSW-3254 SftS; * S5-T291~419W (71.5) 246-6200 fawn of St. Joseph ' lot'#12-Deer Haven This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shaan as pert lot lines were not established at the time the test was conducted. .N 1°=40, EM.= top of NE lot stake @ el. 100, Alt. EM-i- top of 2" pvc pipe el. 93.70' .dam X30' - - S Soil Absorption system Cross Section ft k4"VC Schedule 40 Final Grade Vent Piperth Vent Cap ft Leaching Chamber System Elevation Solt Absorption System Plan View Ubr) fl ft ft Vent Or Observation Pipe Leaching Trench 1 Chambers ~ 4" Dia. Trench 2 Header Leachins~ Chamber Soeciftcations Manufacturer And Model El- Rating sq ft per chamber Soil Application Rate + / gpd/sq ft pd Design Flow + -a- Soil Application Rate : hO EISA 4,001 as 11 NDw a I Chambers rows ofchambers each. Page of POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page or FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity l0?0 al O NA ` Permit # Septic Tank Manufacturer E'r 0 NA DESIGN PARAMETERS Effluent Filter Manufacturer PO/ ~2-5 ❑ NA Number of Bedrooms 0 NA Effluent Filter Model a ❑ NA Number of Commercial Units A Pump Tank Capacity al aNA Estimated flow (average) 1S gal/day Pump Tank Manufacturer ANA Design flow (peak), (Estimated x 1.5) aVda . Pump Manufacturer 2t-NA Soil Application Rabe , ai/da kF Pump Model U-NA Influent/Effluent Quality Monthly average Pretreatment Unit WNA ❑ Sand/C3ravel Filter ❑ Peat Filter Fats, Oil 8 Grease (FOG) 530 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODe) 5220 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 mg/L Manufacturer Pretreated Effluent Quality ❑ NA Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BODE) 530 mg/L elff In-ground (gravity) ❑ in-ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At-grade ❑ Mound Fecal Coliform (geometric mean) s104 cfu/100m1 ❑ Drip- line ❑ Other Maximum Effluent Particle Size Y. inch diameter - vahres typk;l for donwssc (non-coernerdao wastewater and septk tank effluent. Vakm typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ❑ year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume Inspect dispersal cell(s) At least once every ❑ months ❑ year(s) (Maximum 3 yrs.) Clean effluent filter * At least once every 3 ❑ months ,year(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ year(s) ❑ NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA Other. At least once every months ❑ year(s) ❑ NA M~' • Fceor,~a~ d1 /~'~k,K~ l/tPr o~~c ve•y 3YC#)I's.cvc~eco~aM~~ d t.GH" MAINTENANCE INSTRUCTIONS you. a l e.r» rt / ir} ey a ry P.~ /1 to W V&iaF a P^~ -L IftM~ d t.,r•WGj +he w f*,ter- Inspections of tanks and dispersal cells shall be made by an individual carrying one of; a following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer, Septage Servicing Operator. Tank inspections must Include a visual inspection of the tank(s) to identify any rrilssing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually 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 regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatfinent components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event 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 that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Page _ ZLof 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 exc m 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 of effluent , To avoid this situation have the contents of the pump tank removed by a Septage Servicing OperMor prior to restoring power to the 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 foliowin%from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs, degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat soaps; medications; pit painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONIh' ENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system Is property armd safely abandoned in oompl'ia= with ch. Comm 83:33, WisconsWAdministradve_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 soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replaoement system: ❑ A suitable replacement area has. been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing; aW proposed structure. lot lines, and wells. Failure to protect the replacement am will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules In effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. O Mound and at-grade soil absorption systems may be reconstructed in place following removal; of the biomat at the Infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES--AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER=ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Name Phone _ Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATOR( AUTHORITY Name OW "Ih Agency a Phone _ Phone 9 ` Th'is document ww drafEsd W the staffs of the Green Lake. Marquette and Waushara County Zoning and SaNtafion agencies. This document meets the minimum requirements of ch. Comm 83.22(2)(a)(!Xd)&M and 83.54(1). (2) & (3). wmxmsinAdmmnistmum Code. Use of this document does not guarantee the performance of the POWTS. GMW (2101) Page of System start up shall not occur when soil conditions are frozen at the Infiltrative surface. During power outages pump tanks may fill above normal higtrwater levels. When power is restored the excess wastewater will be discharged to the dispersal cep(s) in one huge dose, overk~adktg the cell(s) and may result in the backup or surface discharge of effluent. To avoid this sift have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the elfluent 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"rade soil absoption area. Reduction or elimination of the following from the wastgwaterstream may Improve the performance and prolong the life of the POWTS: w0gotics; baby wipes; dgaretlat butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; tali foundation drain (sump, pump) water, fnrl and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oa; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONN ENT When the POWTS falls and/or is permanently taken out of service the blowing steps shall be taken to insure that the system is properly and safely abandoned in compliance with ch. Comm 83:3:1, Wisconsin Administrathre Code: • Ali piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shaltbe removed and-propedy disposed..of bye Septage Servicing Operator. • After pump, all tanks and pits step be wwavatad and removed ordwk coves removed and the void space filled with soil, gravel or another inert solid materiel. CONTINGENCY PLAN If the POWTS fad and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: 13 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be inf kVW upon by required setbacks from w6ftand proposed structure, lot lines and wells. Failure to protect the replacement area will result in the freed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 0 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances -in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. • The site has not been evaluated to identify a suitable. replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area if no replacement area is available a holding tank may be installed as a fast resort to replace the failed POWTS. O Mound and at-grade soll absorption systems may be reconstructed in place following removal, of the blomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER-TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Namex Name Phone _ .Phone 5 EPTAGE SERVICING OPERATOR PUMPER LOCAL. REGULATORY AUTHORITY Name ow te&'~ Agency Phone Phone ` This document was drafted by the staffs of the Green U gm M qua to and Waushara (;amtr'Zoning and Suftion agencies. This document meets the minimum requirwriffft of oh. Comm $322(2)(bX1Xd)&M and 8&SM), (2) & (3). Wisconsin Adminisbutiva Code. Use of this document does not guarantee the performance of the POWTS_ GMW (2/01) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM LEL"s~d Owner/Buyer Tm Mailing Address SD n (tom 31101,9 Property Address 3(7-, P-.,Iteld Git (Verification required from Planning & Zoning Department for new constriction.) City/State sba 1 - Parcel Identification Number LEGAL DESCRIPTION l Property L ocation '/4 k:-) '/a Sec. , T aN R W, Town of -Z_ Subdivision INNSWOU De-e r 001 Lot # lo?. Certified Survey Map # , Volume , Page # Warranty Deed # Y V , Volume , Page # Spec house yes V Lot lines identifiable yes 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. I/we, 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 NaturafResources, 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 orm are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a w ty deed recorded in Register of Deeds Office. Number of bedrooms y?/16lz- SIGNATURE 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) 133,467 SQ. FT. 61 Ns . ' BUCK 67 5.40' JOINT lggUA- DRIVE O ss, / ) W 3.103 ACRES 135,153 SQ. FT. 3.008 ACRES N00'27'04"E a.ao - 131,030 S9. FT, S00'27'Q4"W - .t ° SOW N 4n W / 420.26' / 310.4$' 7.5'+ ' JOINT--`-L3' J 43.29 L07 DRIVE 12 • . . . • • • . . 3.460 ACRES 150,736 SO. FT. n C J 13 4.254 ACRES s 3 185,287 SQ. FT. 3.010 ACRES ` 131,113 SQ. FT. g s, , La Z 10 r !SAG 881 'o . .22'--' 29 W52,"10'"E 1226321 SOUTH LINE-OF j*n~~T i ! . (yy+~-~'■[(/ J~~{ •i~I /T~'- S ~ A 5 r'~S •I~ ~ I ~t ~ ~ _ UN L ' .Lr/ 7,.......%...:... 7-V l State Bar of Wisconsin Form 7-2003 8 0 6 6 3 4 2 TRUSTEE'S DEED Tx:4048432 959946 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Daniel C. Davis 07/13/2012 2:48 PM ~ EXEMPT#:NA as the Trustee of the Daniel C. Davis Trust REC FEE: NA 30.00 ("Grantor," whether one or more), TRANS FEE: 225.00 and Thomas G. Field and Damaris Field, husband and wife PAGES: 1 ("Grantee," whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix Recording Area County, State of Wisconsin ("Property") (if more space is needed, please attach addendum): Name and Return Address David J. Estreen Estreen & Ogland Lo 12 Deer Haven in the Town of St. Joseph, St. Croix County, Wisconsin. 304 Locust Street Hudson, WI 54016 4WI- 2005FA 030-2110-90-000 Parcel Identification Number (PIN) Dated (A )A, AAAIA-0W (SEAL) (SEAL) *D"a'_ni`e'l°C'. Davis, ~TT'~Tir``-ustee (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) Daniel C. Davis authenticated on 'y 7i0 (y" STATE OF ) ) ss. COUNTY ) *Kristina O gland TITLE: MEMBERS TE BAR OF WISCONSIN Personally came before me on , (If not, the above-named to me known to be authorized by Wis. Stat. § 706.06) the person(s) who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Kristina 021and, Estreen & Oeland 304 Locust Street, Hudson, WI 54016 Notary Public, State of My Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. TRUSTEE'S DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 7-2003 * Type name below signatures. INFO-PROF" Legal Forms 800-655-2021 www.infoprofbrms.com 1 of 1 l Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page 1 oB Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but St. Croix not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # Q dimensioned, north arrow, and location and distance to nearest road. 034 -L.' L9 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION MREVIBY DAT8 fv ~f~ PROPERTY OWNER: r~ PROPERTY LOCATION c GOVT. LOT SW 1/4 SW 1/4,S 6 T 29 AR 19 A (or) W _DMftMT_C_.1rdVT_S_ t> &-vif PROPERTY OWNERS MAILING ADDRESS LOT # BLOCK # SUED. NAME OR CSM # 1129 30th. St. 12 na Deer Haven CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE [SOWN NEAREST ROAD Hudson, WI. 54016 (715 381-5264 St. Joseph 30th. St. [x) New Construction Use [ Residential / Number of bedrooms 4 [ ] Addition to existing building I Replacement [ ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/ft2 .8 trench, gpd/ft2 Absorption area required 857 bed, ft2 750 trench, ft2 Maximum design loading rate .7 bed, gpd/ft2.8 trench, gpd/ft2 Recommended infiltration surface elevation(s) 94.2-92.0-90.70 ft (as referred to site plan benchmark) Additional design / site considerations na Parent material outwash Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem KI S❑ U C$S ❑ U CIS ❑ U 0 S ❑ U F7 SE U ❑ S 1 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bourtdar)r Roots GPD/ft Boring # Horizon in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0-16 10 r3 3 none 1 lm 2 16-43 10yr4/4 none sil lmsbk mfr gw if .2 .3 Ground 3 43-84 7.5yr4/4 none ms Osg mvfr na na .7 .8 elev. 96.0 ft. Depth to 2 1 limiting factor +84" Remarks: Boring # 1 10-9 10yr3/3 none sil 2msbk mfr 2f .5 .6 >>2 2 9-24 10yr4/4 none sil 2msbk mfr gw if .5 ::.6 3 124-84 7.5yr4/4 none ms Osg mvfr na na .7 .8 Ground elev. 7 L.._ 98.2 ft. w~ Depth to limiting -4 , factor t-' T °8 +84, Remarks: 2o►v,~y CST Name:--Please Print Gary L. Steel Phone: 715-246-6200 Address: 1554 200th. Av . New Rich nd WI 54017 Signature: Date: 7-24-98 CST Number: m02298 PROPERTY OWNER DAniel C. Davis SOIL DESCRIPTION REPORT * Page 2' of 3. - PARCEL I.D. # 030-1024-70 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tm ch 1 0-8 10yr3/3 none sil 2msbk mfr cs 2f .5 .6 3 2 8-22 10yr4/4 none sl 2fgr mfr gw if .4 .5 Ground 3 22-84 7.5yr4/4 none ms sOg mvfr na na .7 .8 elev. 97.9 ft. Depth to limiting factor Remarks: Boring # 1 0-12 10yr3/3 none sil 2msbk mfr gw 2f 1.5 .6 2 12-42 10yr4/4 none sil lcsbk mfr gw if .2 .3 3 42-84 7.5yr4/4 none is Osg mvff na na .7 .8 Ground elev. / 94.7 ft. a , 7 Depth to limiting 1 factor +84 Remarks: Boring # 1 0-12 10yr3/3 none sil 2msbk mfr cs lm .5 .6 5 2 12-37 10yr4/4 none sit lcsbk mfr gw if .2 .3 3 37-60 7.5yr4/4 none is Osg mvfr gw na .7 .8 Ground elev. 4 60-84 10yr4/4 none co s Osg ml na na .7 .8 ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: 6BD-8330(8.05/92) PROPERTY OWNER DAniel C. Davis SOIL DESCRIPTION REPORT Page2 e 3 PARCEL I.D. # 030-1024-70 Szre Consistence Bouixfary Roots GPD/ft~ Boring # Horizon in. Depth MuDominantnsell Color Qu. Sz. Mottles Cont Color Texture GrStructuSh Bed rench . . . T rti 1 0-8 10yr3/3 none sil 2msbk mfr cs 2f .5 .6 2 8-22 10yr4/4 none sl 2fgr mfr gw if .4 .5 Ground 3 22-84 7.5yr4/4 none ms sOg mvfr na na .7 .8 elev. 97.9 ft. Depth to limiting factor +8411 Remarks: Boring # 1 0-12 10yr3/3 none sil 2msbk mfr gw 2f .5 .6 2 12-42 10yr4/4 none sil lcsbk mfr gw if .2 .3 3 42-84 7.5yr4/4 none is Osg mvff na na .7 .8 Ground elev. / 94.7 ft. D Depth to limiting 1 factor +8411 Remarks: Boring # 1 0-12 10yr3/3 none sil 2msbk mfr cs lm .5 .6 5 : 2 12-37 10yr4/4 none sit lcsbk mfr gw if .2 .3 3 37-60 7.5yr4/4 none is Osg mvfr 9w na .7 .8 Ground elev. 4 60-84 10yr4/4 none cos Osg ml na na .7 .8 ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD-8330(R.05/92) w. STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Daniel C. DAvis New Richmond, WI 54017 MPRSW-3254 SW4SW4 S6-T29N-R19W (715) 246-6200 town of St. Joseph lot#12-Deer Haven This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of the test may or may not be as shown as permanent lot lines were not established at the time the test was conducted. N 1"=40' BM.= top of NE lot stake @ el. 100' Alt. BM.= top of 21.1 pvc pipe C el. 93.70' Iz~ ?A 0" 13 Z' b di Gary L. Steel 7-24-98