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HomeMy WebLinkAbout040-1303-00-021 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 561022 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: Bauer, Nathan & Briana Troy, Town of 040-1303-00-021 CST BM Elev: Insp. BM Elev: IBM Descriptio : Section/Town/Range/Map No: y9, s 22.28.29.1756 ~ TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER n. CAPACITY STATION BS HI FS ELEV. , Septic 3..5 1 r) 11 / ZGO Benchmark Z cep /g r Dosing ' Alt. BM t b (J Ih.J Q r , Aeration Bldg. Sewer Q , 9L. 1/3 a lak ^2~1Z v 7 + Holding St/Ht Inlet q 1 q,y. 7-7- U V I / / Z TANK SETBACK INFORMATION St/Ht Outlet TANK TO 4L WELL BLDG. V #t to Air Intake ROAD Dt Inlet Septic --y Z5 (I~ Z7 / J Dt Bottom (3. q~ •79 L7 Dosing 725 Z'7 / 11 Header/Man. 7. G 7, 0~ o, Aeration Dist. Pipe 7• •2 Holding Bot. System S c7lj W • O~ DD PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover Q~ t J).5 V1 d V GPM ~•1♦~ v 5.5 Model Number n 147 ~ TDH Li r Z,w Friction Los$ System He TDB 3 t i .4 1 Forcemain Length IDi~ / Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Di a. Liquid Depth DIMENSIONS /~z rgvtGM.1AV SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacture INFORMATION L) Q ~x( CHAMBER OR I rt(/ Type p~A01e dr '1I Ow/Ig, • I~ C1 /4 UNIT Model Ny1*>be"J,14 54. iII DISTRIBUTION SYSTEM ZS x 3 Header/,anifo ~t Distribution x Hole Size x Hole Sp ing V to Air Intake IT' Pipe(s) ` ~ v~JJ vp~ Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Iched Bed/Trench Center 3.7 Bed/Trench Edges ` Topsoil s No F Yes No COMMENTS: (Include code discrepencies, persons present, etc`.) Inspection #1: Inspection #2: Location: 266 Walnut Hill Way Hudson, WI 54016 (SE 1/4 SW 1/4 22 T28N R1 9W) Walnut Hill Farm aka The Tribute L Parcel No: 22.28.29.1756 1.) Alt BM Description = W R.0 G z CaJ tv~ SG~iJ S 2.) Bldg sewer length = 313 - amount of cover = 7 `I► a Plan revision Required? WA Yes o -q - - - - - I / , lQ Use other side for additional informat n. Date nsepctor s Si ure Cert. No. SBD-6710 (R.3/97) PLO - PLEA 2 f = :3o, i ,,tt ~ 2 ql 9 p~oNosEn s / ~ ~L $~~G tti~C 5~ nc5 13 P,, 1911kle-l-f /f AL~ /V n o- PoA zdf Z1 LL J R-2- a B~ ~ q9', 96 L~ County - - ~ze3 r~~ Safety and Buildings Division T- G ~x 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) a ~Madison, WI 53707-7162 p 622- KmN~~ State Transaction Number SanP it ApplicatiWp In accordance with SPS 383.21(2)1 •r. Code, st~bggisSrron of this form to overrtmental unit is required prior to obtaining a sanitary lier f%_..140k~~ X$phcation forms for state-owned arksubmitted to Project Address (if different than mailing address) the Department of Safety and Profr~~A~f'~`e7rvies. Personal information you providey b e r econdary purposes in accordance with the Pnvac Law, s. 15.04 1 m , Stats. W ALAI U1' (41 LL UJAX 1. Application Information - Please Print All Information Parcel # Property Owner's Name n l\1 4- P AJ AIA (9,4Uep_ O V .p c7.a z T Property Owner's Mailing Address Property Location Ge$ D G Govt. Lot City, State Zip Code Phone Number Section ZZ Q circle one) T z y N: R E or® H. Type of Building (check all that apply) Lot # Subdivision Name for 2 Family Dwelling - Number of Bedrooms /A, 6k ad Block# WALAA T 1+f C /ZM ❑ Public/Commercial - Describe Use ❑ City of CSM Number ❑ Village of r~ ❑ State Owned -Describe Use KTown of 7 7 5 +-z 5 75 ,r,Loei III. Type of Permit: (Check only one box online 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 ❑-Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner L , t IV. Type of POWTS System/Component/Device: Check all that apply) P-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) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Desi Flow (gpd) ~5esign Soil Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed (s S}®m Elevazior>~ dU r l~~v ~D X6,6 ~6rf~ 96, Z VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks n J o 2 A a U vs y A Septic or Holding Tank I ZQ Q Dosing Chamber 00 / c) 0 ( t ,00 VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MPWN-3-Number Business Phone Number D t N~~ia^~ Z2~ q _7 7~s 2 73 KKP~ Plumber's Address (Street, City, State, Zip Code) mil` Ly~v c o VI oun /De artment Use Only Approved :Permit Fee Date sued Issuing t Signature 1-3 ~~i=venReaassoonnlor enial IX. Condit4%7% jW.Reasons for Disapproval 3\ ~a c L , 1 Septic tank, effluent filter and' J /j ;L4 a ` J dispersal cell: must all be services / maintained h- , as_per management plan provided by plumber. Q 2. AU setback requirements must be maintained 88 per oppliCable code / ordinances: Attach to complete plans for the system and submit to the County only on paper not less than 8 in x 11 inches in size SBD-6398 (R. 11/11) CD CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name: N A4 44,A .n/ d- 1 A N rt//q 8A U e2 Owner's Address: C-AI)4$ p l p yE- &A-CE Legal Description: S 5 c f 5 2 4 213.,r 2 2 1 w Township: K o 7 County: 5 4- ( / Subdivision Name: WALNJU24 W (LL r-,AA/Vl Lot Number: 2 Parcel ID Number. O D Z r Page 1 Index and title P~gF /d Page 2' Plot Plan PAS6 +ANle- Page 3' System Sizing & Cross-Section 3 A sEC~Ae~/ 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: b ~ / -yo License Number: Z Date: Z- Z0 / -3 Phone Number 7~✓~ Z73 Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 o p~7&\ ~j Z t~` = of 9 p~opotE+' we s t L sof, ,1oc s t DOO (3NaPI c \ plj Hof ZI e B~ qq, 96 V CAW) /ao, /o Z L~ i E Soil Absomflon System Cross Section DD, ft 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap ft Leaching --0,. Chamber6 i Z System Elevation 3 ft -ft ft Soil Absorption System Plan View ~n b ft 3 ft ft Leaching Trench 1 Chambers 4° Die. Trench 2 Header Vent Or Observation Pipe Trench 3 Leaching Chamber Specifications Manufacturer And Model I N u"~c 1~ s EISA Rating Zosq ft per chamber Soil Application Rate i pd/sq ft ``ll /S d0t'I ~V gpd Design Flow Soil Application Rate Z 0 EISA = Chambers 3 rows of S chambers each. Page of 1 uicl l Pitt Standard Chamber Side ~~6d Erg 48" (EFFECTIVE LENGTH) 12r sW ---34"- Quick4 Plus All-in-One 1 Encap Front, Side and End Views 11.2" 13" IN V+ ERT 8" INjERT I5.3" INVERT 33" -~I ~--18.2" Quick4 Plus All-in-One Periscope OUICK4 PLUS ALL-IN-ONE PERISCOPE (360- SWtVEL sn - LhdJ 12.7" INVERT ENDCAPriess ENDCAP Quick4 Plus Standard Chamber Specifications Size (W x L x H) 34" x 53" x 12" (86 cm x 135 cm x 31 cm) Invert Height 0.6", 5.3", 8.0", 12.7" (1.5 cm' 8.4 cm 18.5 cm, 22.6 cm) Effective Length 48" (122 cm) INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY (a) The structural integrity of each chamber, end plate, wedge and other accessory manufactured by Infiltrator ( "Units"), when installed and operated in a leachfield of an onsite septic system in accordance with Infiltrator's instructions, is warranted to the original purchaser ("Holder") against defective materials and workmanship for one year from the date that the septic permit is issued'for the septic system containing the Units; provided, however, that if a septic permit is not required by applicable law, the warranty period will begin upon the date that installation of the septic system commences. To exercise its warranty rights, Holder must notify Infiltrator in writing at its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units. (b)THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE I N F I LT R AT O R® (c) This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, v S t E m S inc. including loss of production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions; failure e to maintain the minimum ground covers set forth in the installation instructions; the placement of improper materials into the system containing 6 Business Park Road • P.O. Box 768 the Units; failure of the Units or the septic system due to improper siting or improper sizing, excessive water usage, improper grease disposal, Old Saybrook, CT 06475 or improper operation; or any other event not caused by Infiltrator. This Limited Warranty shall be void it the Holder fails to comply with all of the terms set forth in this Limited Warranty. Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any 860.577.7000 • FAX 860.577.7001 third party resulting from installation or shipment, or from any product liability claims of Holder or any third party. For this Limited Warranty to - apply, the Units must be installed in accordance with all site conditions required by state and local codes; all other applicable laws; and Infiltrator's 800 221 ,4436 installation instructions. (d) No representative of Infiltrator has the authority to change or extend this Limited Warranty. No warranty applies to any party other than the Www.infiltratorsystems.com original Holder. The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty requirements. Any purchaser of Units should contact Infiltrator's Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, to obtain a copy of the applicable warranty, and should carefully read that warranty prior to the purchase of Units. aunt c~.. pti U.S. Patents 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5.401,459; 5,511,903; 5,716.163; 5,588,778: 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer, Quick4 and Quick4 Plus are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. PLUSO51010151-2 is a registered trademark in Mexico. Contour Swivel Connection is a trademark of Infiltrator Systems Inc. © 2009 Infiltrator Systems Inc. Printed in U.S.A. Sep, 25, 2012 8:19AM No. 4831 P. 3 A bb r 0 C m c~ C1 rn CD • ~w ~ a o w ~ n rn c D M rn _ pp p Y 2 L7 O n v o ~m rn 3 ~ $ v m rn f w ~ _ 8 iO A iV [a C) u 11 n O 'O =n 'O ~I O C 0 O Oil Qz~aQ O z u oQ,Q~ u . o ~ o ~ W n_ N~uci cv ~~a v • m C~ ~ ~ 0 O D C 0p r j °o ~~~C~ ` O 2CI)-D G7 2 ~ ~ r' o {~p~m<o D O m ~ r D a rn m 1 e, POWTS OWNER'S MANUAL MANAGEMENT PLAN Page FILE INFORMATION SYSTEM SPECIFICATIONS Owner A T4AAJ a R l A ~1N,9 6 A LLM Septic Tank Capacity 2 Q al ❑ NA Permit # Septic Tank Manufacturer (5 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z f} Q~ E L ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model '4100 ❑ NA Number of Public Facility Units 2 NA Pump Tank Capacity O Q al O NA Estimated flow (average) D gal/day Pump Tank Manufacturer tk)( ❑ NA Design flow (peak), (Estimated x 1.5) 10 Q(, gal/day Pump Manufacturer aCtL,a ❑ NA Soil Application Rate 0 gal/day/ft s Pump Model Lc ❑ NA Standard Influent/Effluent Quality Monthly average` Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD.) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average - Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD.) 530 mg/L XIn-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 510` cfu/100ml ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Ys in dia. ❑ ]NA Other: ❑ NA Other: ❑ Other: Q NA "Values typical for domestic wastewater and septic tank effluent. Other: I ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: p month(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 ® month(s) '(s) (Maximum 3 years) ❑ NA Clean affluent filter At least once every: ❑ month(s) 11 NA ® earls) Inspect pump, pump controls & alarm At least once every: month(s) O NA 3 H ear(s) Flush laterals and pressure test At least once every: ❑month(s) 13 NA ear(s) Other: At least once every: ❑ month(s) ❑ NA ❑ ear(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections 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 Include a visual Inspection of the tank(s) to identify any missing 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 ell(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 (Y,) 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 chapter NR 113, Wisconsin Administrative Code. All other services, Including but not limited to thaservicing•of effluent filters, mechanical or pressurized components,. pretreatment units, and any servicing at Intervals of 512 months, 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. GMW (4/01) Peg START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or oth micals 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. 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 of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator 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 following 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 scraps; medications; oil; painting products; pesticides; sanitay napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall 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 soil, 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 compliant replacement 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 and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ 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. ❑ . 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 I POWTS INSTALLER POWTS MAINTAINER Name p Lc 2 CL 5o>,V Name Phone S _ Z 7 , S<!f Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name s-~- G~6 u C~u~tL Phone Phone 7/57 3 6 This document was drafted In compliance with chapter Comm 83.22(2)(b)0)(d)&(f) and 83.64(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ~ rr Geer Mailing Address 13q65 C_qm)6r,-4 G Property Address _ "61t All U (Verification required from Planning & Zoning Department fbr new construction.) City/State Vive, Ail, ta Parcel Identification Number Q 01 303 000 S LEGAL DESCRIPTION Property Location .SE '/A , 51N V,, Sec. , T as iS N R W, Town of Tr)::,,/ r Subdivision Plat: W". hi 't' Hill ,r wI , Lot # a 1 Certified Survey Map # _N7015 J ttll~i~o1y03,~ , Volume Page # Warranty Deed # 96 90a 6 (before 2007)Volume , Page # Spec house': ! yesX no 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. - 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. I I/we certify that all statements on this for are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above. by virttle of a warranty eed recorded in Register of Deeds Office. Number of bedrooms SIGNATURE OF APPLICANTS 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 Narranty deed. (REV. 09/07) I` J d vl -41 u F 8„2297 Tx:4089266 STATE BAR OF WISCONSIN FORM 3 - 2000 969026 QUIT CLAIM DECD BETH PABST Document Number REGISTER OF DEEDS THIS DEED, made between Citizen State Bank, Grantor, and Nathan ST. CROIX CO., WI Bauer and Brian Bauer, husband and %%ife as survivorship marital 12/07/2012 EXEMPT#: 1:29 PM 29 property, Grantee. REC FEE: 30.00 Grantor quit claims to Grantee the lolloR111a described real estate TRANS FEE: 53.70 I-SC r County, State of Wisconsin (the "Property"): PAGES: 1 Lot 21 o ~ahtut Hill Farm, Town of Troy, St. Croix County, Wisconsin. Lot is sold "as is" with all faults. Recording Area Name and Return Address: 1 Together %vith all appurtenant rights, title and interests. (40-1303-00-021 Parcel Identification Number (PIN) This is not. homestead property. Dated this 30th clay of November, 2012. Citizen Sta Bank 'dl~ ~,4 io * Gene I itwnian, Vice Chairman * * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST.CI:CIX COUNTY. ) ss. authenticated this 30th day of November, 2012 Personally carne before me this 30th day of November, 2012 the above named Citizen State Bank by Gene * Haberntan, Vice Chairman to me known to be the person(s) who executed the foregoing instrument and acknowledged TITLE: MEMBER STATE BAR OF WISCONSIN the same. (If not, authorized by § 706.06, Wis. Slats.) THIS INSTRUMENT WAS DRAFTED 13Y Ja P `I 7eld NdNQjj P lic, State of Wisconsin 2L AajLf( My commission is permanent. (If not, state expiration date: &M20.16 ) (Signatures may be authen sated or acknowledged. Both are not necessary.) 'Names of persons signing in any capacity must be typed or printed below their signature JAY P. PENFIELD L Notes !?ublic State of Wiscansist 1 of 1 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000 . uq rJ ~ , 22 / \ v { 1758 N + ; IJ co zo ao sort CLAIMER:TNemap b sot gwrentead ro Oe CLAIM . T," armn6 or mmpy nM cdtUValone dravet ere the fegtdtti$i111Y d the oast. 1 V y/~j_'] y91 re r to ail Cep D~ ~PjCarv~ °d ! T h rU e,-o;o, 715 386 6144 P.0 APR-12-2005 16:28 FERGUSON ENT HUDSON [QGOULDS PUMPS Submersible JD Effluent Pump PE ' ~~NT PuM► e~ SPECIFICATIONS MOTOR FEATURES Pump - General; General: ■ Corrosion resistant • Discharge: 1''A" NPT • Single phase construction. • Temperature: 104°F (400t7 • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 arid 230 volts 'a Thermoplastic impeller and fully submerged. • Built In thermal overload pro- cover, • Solids handling: tectlon with automatic reset. ■ Upper sleeve and lower maximum sphere, • Oass B Insulation. heavy duty ball bearing • Automatic models include a • Oil-filled design, construction. APPLICATIONS float switch. • High strength carbon steel ■ -Motor Is permanently Spedally designed for the Q Manual models available, shaft, lubricated for extended following uses: • Pumping range: see PE31 Motor, service life. • Mound Systems performance chart or curve, • .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 115 volts operation. • low Pressure Pipe Systems • Maximum capacity: 53 GPM Q Shaded pole design ■ All ratings are within the • Basement Draining • Maximum head: 25' TDH PE41 Motor working limits of the motor. • Heavy Duty Sump/ PE41 Pump: 40 HP, 3400 RPM' ■ Quick disconnect power Dewatering • Maximum capacity: 61 GPM • 11 S and 230 volts cord, 20' standard length, • Maximum head: 29' TDH • PSC design 1heavy duty 16 15 or 0 vo/groT thigh PE51 Pump: PE51 Motor. plug. • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Com lets unit is hea du • Maximum head: 37' M14 • 115 and 230 volts portable and compact. duty, • PSC design ■ METERS FEET Mechanical seal is carbon, 40 I ~~r~1r I I I ' I i MO08s: P5 1, Pf4ceramic, BUNA and stainless PEST Steel. BS t r I I i I HP.33, .ao, so ■ Stainless steel fasteners. 10 2 GPM I i I j t I I 30 •~E4 - t I r AGENCY LISTINGS .r I 1 FT 25 ~ Ck ? if1 'tl riI S a , ~ I ~~I 1 - ~i- 20 Tested to UL 778 and CSA 222108 Standards 15 r ' I - ' ( I By Gad= standaa AS,twWon I ' I I I t I , Fik #UG&W ,.I -r 10 i w i „L I i I 4 ! . Goulds Pumps IS ISO 9001 ReglMrod -t ( i -I I i o o ~ I .l.,.l .I. I I I 0 10 20 30 40 5o 60 70 GPM 80 ° $ 10 15 m3/h Goulds Pumps CAPACITY ® 200= nT11VatQrTechnology, InC' s;;4,'~"• =0°` ITT Industries mbinatio.n Se?*,ic:.Tank and Co PUMP CHAMBER CK05 5 SECTION ANO SPECIFICATIONS - VE}JT CAP: WCATHCK PI~DOP JuQCTIOU DOX . APPROVED LOCKIWG ti'C.I. VEMT PIPC MAU1}0LE COYER wI jQ' FROM~DOOIC. u,P.RNIUG l.t~ 6EC.. ',1IWDow OR FRC5H oo,aDU1r ~rJ3P~11oIJ IPA AIR iMTAKE r w / i'r~tzT~ s tti" trrf' i j~ 6K.nW. lQ0 T I I Ib'MIN. i., PROVIDE I I - AIRTIGHT SEAL. I III MILE T eA I I I I i APPROYED J014T: I I W/C.l'. PIPF~' APPROVED JOIWT ZfS$~ Ft4h~R W/C.T. PIPEaR Tank construction I IIi ALARM I shall comply with ~I I( ILH "3.15 and 33.20 ° I I ow C (I I OFf LCCOWC~KZTE 3" APPS~~: RISER EXIT PERMIT(-ED DULY IF TAWK MAlJUFAr-TURC.R HAS SUCH APPROVAL $FpptNG SPECIFICATIOUS SEPTIC f DOSE W ~IE:5 ~--7t C-WiCf T>= IJUMISER OF DOSES: PER DA-~ TAWK MAsJUFACTUIZCR.: TA1J K :,IZE : 1 Z.©oOGA,LLOWS, DO5E VOLUME POK 0 S ALARM MAWUFACTU ~1ST?1s iNCI_UDIUr, tSnclcfLow: ? GAuoNs 11 R,ER: MODEL IJUM5CR: LOl Nw CAPACITIES: A= Z- ?19 IWCHC5OF, CALLOUS SWITCH TAPE: ~ ~~"I B = Z• IWCHES OR 1(4, G(LLOUS -7 2 HUMP MAfJUFACTURt<R: ©~~~[/p G= IUCHES OR :L-' ` tLL4U5 MODEL IJUMBER: 1" E / l Da 4-7~0 iAXHES OR 6Z l ,CALLOUS . SWITCH TYPE: r`UA ,`Lf WOTC: PUMP AMD ALARM ARE 1-0 GL INSTALLED W1 SEPARATE CIRCUITS MIWIMUM'DI5CHARGE RATE GPM VERTICAL DIFFEREMCE DETWEEIJ PUMP OFF AIJD..DISTRIBUTIOW PIPE.. 6, 0 f EET t MIUIMUM IJETWORK SUPPLY PRESSURE , ; o FEET / FRICT101J FACTOR-.1-/- FEET ' + 3 O FEET OF FORCE MAIN X ' FTIOOF> . / TOTAL OtIMAMIC HEAD -71 FEET As per,nanufacturer r gal/in. a o~ 1.03 Ac. 7 5 3197 S. F. . 1,45 AC. .ti ` /t> 20 ` W. 48751 S.F. 57 - 1.12 Ac. , - 04, 31 21 49041 S.F. 1.13 Ac. 23 X 45236 S.F/W 40 r~1 ,c• r'ir 1.04 Ac 5V . / \ / 1.30 66'IYCRd L'Hd a viavsia•~x~ioi~ss~oui SNIOLLtlA313 WHYdT11H1,(1N1YM q •mo~acw.ut~rs • a iarvvauvuv • mrriam~x ;0➢A m "m F = r.1 VNMO'VUVN mu s ii B I! 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I 1s€1$k5 €4i•E3i iii' WJonsinDepartment ofCorrom a SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code C YJ* x-- Attach complete site V - - L v N indude, but not timitec Parcel W. T / percent slope. scale0 EROSION CONTROL PLAN must be P IC P/ f>r- b completed before sanitary permit issuance wed b Date Personal Wof natty YOU y .,..w ...•7 w a.ac.• .v. •a..nwa.7 f^+°°a {r.nw7 u.., a.v~ ~n7/. Property Owner TODDProperty tior' 8 To pD 133 E RS TTC7flT' /0 f}1/d 'YA Govt. Lot 411 JR 5 S 114 s Zt, T Z N R / 9 E (or) W ~ Property,Ownees Mailing Address Lot # Block # Subd. Nana or CSKW & o 15 CA H-i LL AV-'e- • :~-I wA/,NO r wi l d 3AYWR State 2p Code Phan Number ❑ city ❑ Village W Town Nearest Road H7-5 MA) 5S-0Wo ( &51) 2-9k. toff ---Roy So. erlovek 0 D ' ov GPD ~ NOW Construction Use: Residential i Number of bedrooms Zfy- Code derived design flaw rate ❑ Replacement ❑ Public or commercial - Describe: to Parrett material ~o f 6U~v SA.t~D 0 A•~^ Flood ton if a ble 'V R F General comments ~ and recommendations: 7- 57' s()/•7`--46/4" Re 4w 1NgleeU'VI> . o. 40 . 7'5 desl* 4*7257 of . 416V 53) ~ f N r Bong # ❑ Boring / d a .8 ❑ ® Pit Ground surface elev. . R Depth to limiting factor in. Application Rate Sol Horizon Depth DomlriantCollor Redox Description Ted" Structure Consistence Boundary Roots GPQ fg int. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. 3 •Etf#1 '01#2 C o.~ ~a yR 3/ .S,(G ,e S c w • z 2- 3• 23 /o 31z' / Shy A e4) AF • v~ /6 G D s GS- - . S .9 a 5 S d,s •7 0 n 2 Borim ❑ Boring ~d0 •D 7 ❑ in. Ground surface elev_ ft. Depth to lector 7 m [Sol Application Rate Horizon Depth Dominant Color Redgx Description Texture Structure Consistence Boundary Roots GPDW in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. `EW1 `01#2 0-12, io Yle 3 1L /f .e SA eV -2 . Z . 3 N y • Z S1 s C4) • Z N /o G S D cs • s 7 -441 r n~•Q~P . S 4 --79 7 Efltuent #1 = SOD > 30 1220 mg& and TSS >30 < 150 mglL ` Etfluent #2 = BOD 30 mg& and TSS : 30 mglL csT Name (Please Print) R . -A LB R i C 1n.T- ~ 3 5~ Address UC Date Evaluation Conducted Telephone Number Uibricht & Ass9ciates • Privet /I , .2-60,3 715. 77,E • 3 yy z-- 2812 1 Oth Ave. Spring Valley, Wl 54767 PANS' f'o~e ,q-pOieo x . a yo ~ its i.a d yo • /0,?G • 2-0. OVV o y • /096 &o ' M oy•10*6• 70- 6M o yD • io~h N ' L ?bDP Ow"er Paroel ID# Z67- a/ Z 3 Q ~j j F3- I Ground surface elev. /O ft. Depth to 6rrsFti V factor y hioslzxitt Depth Dominant Sad Rate Redox Descr%*on Texture structure consistence Boundary Roots GPD,fff in. Munsell Qu. Sz. Conc. Color Gr. Sz. Sh. l D • y o y/~3/ ,Sic / ~ °Eff#1 ~ ~ z f- • Z 3 z ~a o SL c w _ e j F-1 Baring # Boring Pit Ground surface elev. ft. Depth to fimiting factor fn. Sod icWon Rate Horizcxn Depth Dorninard Redm Description Texture She Cornsisterx~e Bouratiary Roots GPDff irs Munsert Qu S7- Copt Color Gr.. Sz. Sh. `EftltS °Etf# E Big# fl ' Pit Gro" Surface elev. ft. Depth to factor irt. Soil A 'on Rafe _ppkafA GPDM Horizon Depth Dominant Redox Description_ Texture Structy(e Consistence Boundary Roots in. Munsell Qu. Sz. COOL Color Cal. Sh. °Eff#t °Eff#2 s F-1 Pit Ground surface elev. ft. Depth to Wff" factor in. Sod Appikation Rate Horizon Depth Dominant Color Redox Description Texture Slrudure Consistence Boaridary Roots 43PON In. Mum Qu, Sz. Cori. Gr. Sz. Sh. `Eff#l °Eff#2 ` Effluent #1 = 8005 > 30:S 220 mgt and TSS >30!i 150 mg1L ° Effluent #2 =13005 < 30 rngR. and TSS < 30 rnWL 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 608-264-9777. serYal~o~~no) Tov~ T3 e s 7'EDT- Properlyowner ParcellD# Z G 7- 02. / page of 3 t3or;r,~ F3-1 t Groundsurface elev. e7~• IS ft Depth to OmMV factor > ~7 creation Rate Hod= Depth Dominant Cot Redox Desrziption Texture Shtacttrre Consistence lacwmdary Roots Gfli~ in. Mansell Qu. Sz. Cont. Coto,- Gr. Sz. Sh. "Elf#i 'Eif#2 I D 9 o y2,3/ S/1- If X c~ z Z, 3 z /o G S CS /-F o SG c w o T ; _ ~Bonng# Q 130dng F-1 pit Ground surfaceelev. ft. Depth to Limiting factor in- Sol 8pj±cation Rate, Horizon Depth [ nasal Color Redox Destxi lion Texture S§trCtwe Consistence p Boundary Roots GPfalft: MunseII Qu: Sz. Cont. Color Gr. Sz. Sta. 'Eti#S 4092 Boring # Boring E Ground surtsce elev. ft. Qeplta to limiti #atator in. s M titan Rate t Wzon Depth !Dominant Color Redox Description- Texture a Consistence Boundary Roots Gt~i7 In. Munseff Qu. Sz. Cant. Color sr. sh. 'Etf#i 'Etf#2 Baring # tr- fi Boang F]' E._.# pit Gf°und surface elev. ft. Depth to limiting factor In. Svc tcation Rate Horizon Depth Domlrtant Redox 0escrlption Texts" Structure Comistenee Boundary Roots 43POM Munsell Qu, Sz. Cunt. C04 Gr. Sz. Sh. 'Eff#•l "Etf#2 ' Effluent #t = BODs > 30 220 nag& and TSS >,V IN mg11. ° Effluent 92 = BODs < 30 mg1L and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or treed material in an alternate format, please contact the department at 608-2166-3151 or TTY 608-264-97'17. sea-esw lrzsmo7 r r - pg. 3 of 3 `PLOT PLAN WALNUT HILLS FARM. LOT # © = Contour elevation lines. Backhoe Soil pits. p = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. Q SCALE : 1 FI L / f s yy ~~,vc goo, ~a Holes JAC) y 6% v 9 9• ~o y° 501vo R ~a vN t~ ' ~~CN i n7' Z~S