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HomeMy WebLinkAbout022-1072-10-180 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix ,Safety and+Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 563858 0 GENERAL INFORMATION 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: Florer, Travis M. Kinnickinnic, Town of 022-1072-10-175 CST BM Elev: 77~7 BM Description: Section/Town/Range/Map No: 26.28.18.401A30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark, Dosing ~a / 5v Alt. BM v 97• f CO Bldg. Sewer Zc Holding St/Ht Inlet 1 Z~ 9Z -<6 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/Li WELL BLDG. Vent Air Intake ROAD Dt Inlet Septic Dt Bottom I ~p /g D Dosing Header/Man. 9 Aeration Dist. Pipe .S /oo. y Holding Bot. System 5. Ce PUMP/SIPHON INFORMATION Final Grade 3. Manufacturer Demand St Cover pJ 5 GPM ~i✓ ~ ~ - T ~Model Number 01541 Z Z 7 c t w T TDH Lift I' Z Frictions 3~ System Head l TDH// 6 r s Forcemain Len Dia. Dist. to Well n ] SOIL ABSORPTION SYSTEM c $ . f 8 , 9p BED/TRENCH Width ~ Length No. ~~;n;~V PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type sOt~ n UNIT Model Number: DISTRIBUTION SYSTEM / Header/Manifold q Distribution ~ x Hole Size ~j it x Hole Spacing V ~Air 1 e Length lj'1* Dia /,?j L ngth ~ Dia ZJ Spacing 3 33 v 3Z V• + 4cf"A:67 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes 0 No Z Yes F-] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /13 ~Inspection #2: Location: 1394 Evergreen~rive River Falls, Wi (NE 1/4 NE 1/4 26 T28N R18W) NA Lot 5 ) Parcel No: 26.28.18.401A30 1.) Alt BM Description y = v ZZ')e f--b w 5G(ew5 2. Bldg sewer length = -amount of cover = 4)L D Plan revision Required? Yes No O Z7 [13] -1 i~~ ILA Use other side for additional information. c~ L-74- ' SBD-6710 (R.3/97) Date Insepctor's Sign re Cert. No. L 250' north lot line Thomas H & Susan K Florer 1394 Evergreen Dr. River Falls, W1 54022 0 z NE 114, NE 1/4, S26, T28N, R18W Town of Kinnickinnic, St. Croix county 2.57 acres Scale 1 40' i~' - 'Q' o"-- BM 1 top of 3/4" pvc pipe = 100.00 BM2 top of 3/4" pvc pipe = 100.10' Lot #5 50' of 2" sch 40 pvc forcemain BM2 ° BM1 ° ° B2 2%= ~ well B3 T Wl0,tt-d 3 bedroom K~ garage house Weiser 1000/650 tank ° B1 0 0 rn rn ~ 05 rn a 3 a~ a~ c c = o o 0 O CV CN Nr b Ffi~b 250' south lot line i 979543 BETH PABST REGISTER OF DEEDS ST. CO., W3E CROIX R RECORD ECE IVED FOR RRD CERTIFIED SURVEY MAP LOCATED IN THE NE1/4 OF THE NEI/4 OF SECTION 26, T28N, R18W, TOWN OF 05/30/2013 3:20 PM KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN, BEING LOTS 2 AND 3 OF CERTIFIED EXEMPT SURVEY MAP RECORDED IN VOLUME 21, PAGE 5263 OF CERTIFIED SURVEY MAPS REC FEE: 30.00 RECORDED AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE. COPY FEE: 3.00 AREA FOR tors-- PAGES: 2 NOTE: This Certified Survey Map is for the purposes of adjusting a lot line between Lot 2 of 112031 SQUARE FEET (2.57 ACRES) a Certified Survey Map recorded in Volume 21, Page 5263, no additional lots are created INCLUDING RIGHT-OF-WAY by this instrument All conditions, restrictions, notes, etc. fisted on the previous certified 105,019 SQUARE FEET (241 ACRES) survey map(s) are applicable unless otherwise indicated. Because both of Lots 2 & 3 are EXCLUDING RIGHT-OF-WAY owned by the same owner, no quit claim deed or warranty deed is required to move the lot NOTE: AN EROSION CONTROL PLAN / E SITE TOWN MAY BE REQUIRED TO BE SUBMITTED TO THE TOWN OF line between the two parcels. KINNICKINNIC AND ST. CROIX COUNTY ZONING PRIOR TO A BUILDING PERMIT BEING ISSUED. CONTACTTHE BEARINGS REFERENCED TO THE NORTH LINE OF THE NEY.OF TOWN OF KINNICKINNIC AND THE ST. CROIX COUNTY SECTION 26, LINE BEARS S88•41 3M ST. CROIX COUNTY ~n ~p ZONING OFFICE FOR MORE INFORMATION. COORDINATE SYSTEM, W.C.C.S. N.A.D.'83, ('21 ADJUSTMENT). &WhI I Z WL[ AMPS NE CORNER, SEC. 26 NY4 CORNER, SEC. 26 NORTH LINE OF THE.NE114 (ALUMINUM CAP FNO.) (2.25' IRON PIPE FND.) OVERALL DIST. -2654.48' S88°48'36"W `979.72' - - - S88°48'36"W ~ROINARY H1G 1 1674.76' ( R 1674.80') WATER CENTERLINE OF LEGEND CREEK + - ® -INDICATES SECTION CORNER (AS NOTED) i NOTE: 66CAT10N OF CREEK E -INDICATES 3/" DIAMETER IS APPROXIMATE. LOCATION- - REBAR FOUND o AS SHOWN ON PREVIOUS C.S.M. rn. / WA§,USED FOR LOCATION ® -INDICATES 1.25" X 24" IRON to PIPE WEIGHING 1.68 LBS. / S~IOWN HEREON. - J LINEAR FOOT SET - - INDICATES FENCE IC3 ' OOHS REMNANTS V/' 00 SURVEYORS NOTE: ~j W LU co ~I LANDS INUNDATED BY Q1 ^ 99 - NATURALLY LMT Q ' . a rn Q CIO OCCURRING SHED ° o Jl NAVIGABLE WATER BI w O i N g ~I ARE SUBJECT TO THE N Cr I<- SEPTIC tY - ~I WISCONSIN PUBLIC v ~ ? N TRUST DOCTRINE. X T al ° d' I~ o ® ch w J WELL 1--- rn I N89°10'02"E 250.05' Z SURVEYOR'S NOTE. M HOUSE w Ej EUNICE POST FROM THE SCALE IN FEET LO7" ~ J 11- _J DEPARTMENT OF NATURAL LOT 5 w 0' 100' 200' 1,069,255 SQ. T. M O RESOURCES VERIFIED THE SEE ABOVE ORDINARY HIGH WATER MARK 1' - 200' . ) ) (24 55 AC °D FOR AREA < Z 7 ON MAY 2, 2006. INCLUD4 co ° . O N89°10'15"E 302.69' ` I- 60 SURVEYOR'SNOTE: RIGHT-OF-WAY w o 60 SOIL TEST 'n o O E ST. CROIX COUNTY REOUIRES A 1,056,870 SC FT. is C 4 AREA \ cv Z w SPECIAL EXCEPTION PERMIT (24.26 A.) v 0 0 APPLICATION TO BE COMPLETED EXCLUDIf Z PRIOR TO ANY GRADING & ro . S11<'9 N N RIGHT-0 F- AY FILUNG WITHIN 300 FEET OF NAVIGABLE WATERS. N89-10-15"E ~ 672.94' 422.89' 250.05' `V 7' . - - - ~g O NSA - - - - - - Zo 423.41' - - - - 2500 _ _R£REEM DRIVE 30-E - * r • EPH W. i * - - - - - - - - - -i NBERG s 5-2295 PREVIOUSLY MAPPED AS THE NEW RICHMONDf og SOUTH LINE OF THE NE1/, OF THE NE% W w ~I ~ o C.S.M. s u.. Qi 2229 1 ~3 VO~e 4 NE CORNER, SEC. 26 z° Z51 ~l (ALUMINUM CAP FND.) G) LAND SURVEYOR: PREPARED FOR: S SOLUTIONS JOSEPH GRANSERG TOM & SUSAN FL ORER DRAFTED BY: JWG 1235 CTY RD. E 1386 EVERGREEN DRIVE JOB NO. 100-164 SHEET ivBEBG .SOw/vEM,>r G NEW RICHMOND, WI 54017 RIVER FALLS, N 54022 DATE: 05/20/13 1 OF 2 Vol 26 Page 5923 County Q 10 Safety and Buildings Division 82~j= w 201 W. Washington Ave., P.O. Box 7162 Sanitary P2tumm ber (t o be filled in by Co.) a LD S ',fi K Madison, WI 53707-7162 '5~ p~ oo'cs~oxs~s~ State Transaction Number Sanitary Pe ca n Z Z 7 3 6 S Wis. Adm Code, s on of orm to the approp governmental unit In accordance with SPS 383.21(2), a submitted to Project Address (if different than mailing address) is required prior to obtaining a sanitary permit Note: ca orms for state-owned secondary the Department of Safety and Professional Servies. Personal information you provide may be purposes in accordance with the Priv Law s. 15.04(1)(m), Stats- L A lication Information - Please Print. All Information p~ parcel # Property vner's Name rW 1~ ST CRO/X Z 2 C, Z. to 0 D m a- (,f /q ~Hry Property Location Property Owner's Mani/ng Address av/" 3 V l~'~lC/ V&' Govt. (J Lot Z I& Zip Code Phone Number section City, State circle one) Rio T~N; R~EorW Lot aY . II. Type of Building (check all that apply) Subdivision Narngej / -1 - It1 or 2 Family Dwelling - Number of Bedrooms (9 K Block 0 J~ ❑ City of ❑ Public/Commercial -Describe Use CSM Number ❑ Village of ❑ State Owned - Describe Use '.Town of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ❑ Other Modification to Existing System (explain) =1K ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only List Previous Permit Number and Date Issued B. El Permit Renewal- r - ❑-Permit Revision El Change of Plumber El Permit Transfer to New Owner Before Expiration G t 11 IV. Type of POWTS S stem/Com onentlDevice: Check all that apply) Non-Pressurized In-Ground [I Pressurized In-Ground ❑ At Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable sod ❑ ❑ Pretreatment Device (explain) ❑ Holding Tank ❑ Other Dispersal Component (explain) V. Dispersal/Treat ent Area Information: Dispersal Area Require (sf) Dispersal Area Propose sf) System Elevation Design Flow ®d) Design Soil Application te(gpdsf) -7 / 75- o 1 ~ 1.04 apacity in Total of Manufacturer VL Tank Info Gallons Units tg Gallons l/ to SZ S w o Y ; New Tanks Existing Tanks 1,4e e- Se g Tank g Cbamber D 1 t~ k attans. VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTSWssho~w Numbeached Bus Hess Phone Number lumbe 's Name (Print) Plumber's Signature T7 Plu er's ddress s (Street, City, State, Zip Code) VI . Coun /Department Use Only Permit Fee Date Issued ing Agent ign re l Approved ❑ Disapproved Owner Given Reason for Denial (P „ L n o3 IX. Conditions of ApprovaUReasons for Disapprtival SYSTEM OWNER: 1. Septic tank, effluent filter and I m 'ntaine dispersal cell must be stryi I._gJ_--nAe Q✓~(N/~'t JD'0 G~ as per management plan provided by plumber. L,bT ~Ga 3d 2. All setback requirements must be maintained ns for the system and submit to the County only on pap not less tha 1/2 x es in size SBD-6398 (R. 11/11) DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA 9 HOLMEN WI 54636 U S Contact Through Relay www.dsps.wi.gov/sb/ 9~0 1 P S `Gw www.wisconsin.gov ~O ssloNN Scott Walker, Governor Dave Ross, Secretary July 25, 2013 CUST ID No. 226497 ATTN: POWTS Inspector ROGER D NELSON ZONING OFFICE NELSON PLUMBING ST CROIX COUNTY SPIA 122 E SUMMIT AVE 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/25/2015 SITE: Identification Numbers Tom & Susan Florer Transaction ID No. 2273682 1386 Evergreen Dr Site ID No. 793088 Town of Kinnickinnic, 54022 Please refer to both identification numbers, St Croix County above, in all correspondence with the a enc NE1/4, NEl/4, S26, T28N, R18W FOR: Description: Three Bedroom Mound System / 2%o slope Object Type: POWTS Component Manual Regulated Object ID No.: 1438600 Maintenance required; 450 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01101, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. CON The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code 14 requirements. DEPT O No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, PROFESSI stats. DIVISION OF IN The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the SEE CORK requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. ROGER D NELSON Page 2 7/25/2013 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 •ard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WISMART code: 7633 jerry.swim@wisconsin.gov cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. Z J04 ?013 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN'S rq Residential Application ELI//~,~n INDEX AND TITLE PAGE Project Name: Tom and Susan Florer Owner's Name: Tom and Susan Florer Owner's Address: 1386 Evergreen Dr. River Falls, WI 54022 Legal Description: NE 1/4, NE 1/4, S 26, T 28 N, R 18 W Township: Kinnickinnic County: St. Croix Subdivision Name: Lot Number: Block Number: - )/T1ON 0tt y Parcel I.D. Number: V~ S,qF Fry. Plan Transaction No.: OUSr`S'FRV/ CF Page 1 Index and title RYS~R~ CES Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications NoENCc Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan i I Designer: Roger Nelson License Number. MP 226497 Date: 06/28/13 Phone Number: 715-273-4444 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 5.1 (R. 06/06) Pagel of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note:. Sand fill (D) calculations assume a 304.04 Estimated Wastewater Flow (gpd) SpS 383-44-3 °1-sku SQ1l tmatment for fecal 1.50 ~I"b Peaking Factor (e.g. 1.5 = 150%) of 36 inches- 450.00 Design Flow (gpd) 2.00 Site Slope (°1°) 98.90 Contour Line Elevation (ft) 30.00 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information 45.00 Dispersal Cell Length Along Contour (ft) = 10.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpole) Influent Wastewater Quality (1 or 2) Are the laterals the highest oint in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point- 0.156 Orifice Diameter (in) 3.00 Estimated Orifice Spacing (ft) = 10.00 fe/orifice 2.00 Forcemain Diameter (in) Y 80.00 Forcemain Length (ft) Does the forcemain drain back.; . i 88.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 13.05 Forcemain Drainback (gal) 11.07 Vertical Lift (ft) 41.61 5x Void Volume (gal) 1.04 Friction Loss (ft) 54.66 Minimum Dose Volume (gal) 0.001 In-line Filter Loss (ft) 24.23 System Demand. (gpm) 16.66 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter. Selection! in, dia. o tions choice in. dia. options choice ! 0.75 1.25 x 1 x 1.00 I 1.50 x I 1.25 x I x 2.00 i 1.50 x 3.00 4 2.00 x i 3.00 x Gallonslinch Calculator (optional) Treatment Tank Information Total Tank Capacity!(gal) 1000-00i Septic Tank Capacity (gal) Total Working Liquid Depth (in) Wieser manufacturer gal/in (enter result in; cell 849) Dose Tank Information Effluent Filter Information 650.00 Dose Tank Capacity (gal) Poly Loc Filter Manufacturer 17.001 Dose Tank Volume (gaUin) 525 Filter Model Number Wieser Manufacturer Project: Tom and Susan Florer Page 2 of 8 Mound Plan and Cross Section Views 3O ~ - •:•:•rv: - 1110 B • t K • J 'Obseation Pipe p A W 8 I z Mound Component Dimensions Down slop e toe extension made. A 10.00 ft E Aft in H 1.00 ft K 7.11 ft B 45.00 ft F in 6.67 ft L 59.23 ft D 6.00 in G J 5.01 ft W 21.68 ft 450.00( ) 2Dispersal Cell Area 750.00 (fe) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 4.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 101.17 (ft) 1! ..iirrr:..... H 1 .rrriiirrr 2 G rrrrrrrr. irr r r rrr r.. F r Dispersa..... ~l ateral ell 99.90 (ft) L 99.40 (ft)-► Invert Dispersal Cell p t Elevation E 98.90 (ft) Contour Elevation 2.0 % Site Slope Geotextile Fabric Cover Shading Key I - Dispersal Cell See lateral details on Topsoil Cap ° 1.5 ft Page 4 for number, size, © rirrr Subsoil Cap a c 0 T and spacing of laterals. ASTM C33 Sand T F Laterals are equally 0 Tilled Layer m 0.5 ft Typical lateral spaced from the a ❑5 distribution cups F51 Aggregate c centerline in the -A- * distribution cell (AxB). Project: Tom and Susan Florer Page 3 of 8 End Connection Lateral Layout Diagram Center the lateral-, over tho A rr M dlrn n.ion ®=Turn-u p wl bni l vulva Or C1 Ognout pi u p P ' All dentical l~ XHoles drilled on the bottom of the lateral $ aquallq rpaaad t wwals er iprco main of PVC Soh:40 S por SPS tattle, 384.30.5 Onnacclon via to o r arors to manlfold at ang point. Number of Laterals 3 Orifice Diameter 0.156 in Lateral Diameter 1.25 in Orifice Spacing (X) 3.11 ft Lateral Length (P) 43.54 ft Orifices per Lateral 15 Lateral Spacing (S) 3.33 ft Orifice Density 10.00 fe/orifice Lateral Flow Rate 8.08 gpm Manifold Length 6.67 ft System Flow Rate 24.23 gpm Manifold Diameter 1.25 in Total Dynamic Head 16.66 ft Forcemain Velocity 2.47 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight • Electrical as per NEC300and (SPS 31628 WAC' Disconnect 4 in. min: Tank component is properly vented X Attemate outlet location Forcemain diameter Wieser Manufacturer 2 in. Capacityl 650.00 Gallons Volume 17.00 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 23.02 391.34 C B 2.00 34.00 P~ umF~ elevation (ft) C 3.22 54.66 88.83 D 10.001 170.00 p Total 38.24 650.00 Dose tank elevation ft Bedding un er tank- 88.00 Alarm Manuaaacturer S. J. Electro S stems ~1 ar - R 14 we IQt1 CO) Alarm Model Number 101 H ht t.) Pump Manufacturer Goulds Pump Model Number I PE 41 j Pump Must Deliver 24.23 gpm at 16.66 ft TDH Project: Tom and Susan Florer Page 4 of 8 Mound Svstem Maintenance and Operation Specifications Service Provider's Name Nelson Plumbing Phone 715-273-4444 rt~ POWTS Regulator's Name i St Croix Zoning _ m I Phone 715 386 0 -468 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1000 gal Maximum TSS 150 mg/L Soil Absorption Component Size 450 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for pondin~ and seepage once ever r 3y ars Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1 , have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30(6)(1) Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384 Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box T. - - Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Tom and Susan Florer Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code ~ngn[ This system shall be operated in accordance with v 382 - 3g4 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD 10706-P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with M J83.33_, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, State. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet fitter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fitter is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent fitter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent fitter is installed within the tank it shalt be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODE, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 10° dull 00 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice dogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 8 GOULDS PUMPS Submersible Effluent Pump PE SPI ORWONS MOTOR FEATURES Pump - General: General: ■ Corrosion resistant • Discharge: 1'A" NPT • Single phase construction. • Temperature: 104°F (4M • 50 Heat ■ Cast'ron body. maximum. COMM ous when. • 115 volts a Thermoplastic impeller and fully submerged. • kilt-in thermal amioad pro- cover. • Solids handling: 'h• section with mhlm" is reset ■ upper sleeve and lower maximum sphere. • Class 6 insuia w. hew/ duty ba l bearing APPLICATf01+lS • Automatic models include a • Oil-Nied design. tarntruction. fkhat switch. • High strength carbon steel ■ Motor is permanents Specially designed for the • 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 contnums • Ef wnyDWng Systenhs PE31 Pump: • 12.0 Maximum amps operation. • low Pressure Pipe Systems • Maximum capacity: 50 GPM • Shaded pole design ■ AN ratings are within the • Basement Draining • Maximum head: 25' TDH PE41 Motor. working Wnits of the motor. • Heavy Duty Sumpi PE41 Pump: • .40 HP, 3400 RPM a Quick disaonnect power Dew'atering • Maxi m rn capatr±y: 60 GPM • 7.5 Maximum amps cord, 20' standard lend, • Ma43mum head: 29' TDH • PSC design heavy duty 16/3 S!T W with NEMA 5-151), tlwee prong, PESt Pumix PE51 Motor. 115 volt grounding plug. • Maximum capaclty. 70 GPM • .50 HP, 3400 RPM a Complete unit is heavy duty, • Maximum head: 37' TDH • 9.5 Maximum amps • ~ design portable and compact. METERS FEET ■ Mechanical seal h carbon, 40 ceramic, Sl1NA and stainless fE~t + r i MOOED: fE~1, PE41. Pe5 steel. 35 ■ Stainless steel fasteners. A ~ ; { 2 GPM a• - + AGOICY LISTINGS ap a t t i hFT L7 s.. s...l.. i , 25 t c0lus f . .r 4 -1 20 J Y Tesbd ID UL 7713 and f o { - = _`.-1••= CSA 222108 Standmds .-i.. eyOwaftnspritsAeodan t 2 , tie } T 6011kk t+uphpt h IS0 9001 RpiglAd s 10 t t t y._ i.. 4 .4 F ..4.4.. r t i F ~ - 1. t f hz. 0 00 10 20 30 40 so 60 ' 70 GpM 80 pQq~. 7p T n to is s mss GOUI✓ds RNYVs U^CITY 02002 Gould%Rumps ectivSK31/e November. zao2 PIT) <& ITT Industries EP J250' north lot line Thomas H & Susan K Florer 1394 Evergreen Dr. River Falls, WI 54022 0 z NE 1/4, NE 1/4, S26, T28N, R18W Town of Kinnickinnic, St. Croix county 2.57 acres Scale 1 40' ao' o BM1 top of 3/4" pvc pipe = 100.00 BM2 top of 3/4" pvc pipe = 100.10' Lot #5 50' of 2" sch 40 pvc forcemain BM2 0 BM1 o ° B2 2% s--'-°ee well B3 3 bedroom garage house Weiser 1000/650 tank 0 131 0 `O o rn CO rn M m 7 L C C y O 0 F/ O O N N ~t 250' south lot line Evergreen Dr. Page 8 of 8 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND A OWNERSHIP CERTIFICATION FORM Owner/Buyer ` o w-~c~ O c- LT6-01V'11 p C"-C- - O C0 ~a Mailing Address Property Address (Verification required from arming & Zoning Department for new construction.) City/State RC-fQ-C Foa.~~ s Parcel Identification Number O l-7 ' LEGAL DESCRIPTION Property Location WG: 1/a 1/a , Sec. 2 T N R Fr W, Town of Subdivision Lot Certified Survey Map # S'Lf , Volume , Page # f 2 Warranty Deed # I $O 233 , Volume , Page # Spec house yes 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. 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 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/we certify that all statements on this form 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 warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 7 / /6/ 3 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) 979543 BETH PABST REGISTER OF DEEDS ® ® ST. CROIX CO., WI CERTIFIED SURVEY MAC ECEIVED FOR RECORD LOCATED IN THE NE1/4 OF THE NEI/4 OF SECTION 26, T28N, R18W, TOWN OF 05/30/2013 3:20 PM KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN, BEING LOTS 2 AND 3 OF CERTIFIED EXEMPT 4: SURVEY MAP RECORDED IN VOLUME 21, PAGE 5263 OF CERTIFIED SURVEY MAPS REC FEE: 30.00 RECORDED AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE. COPY FEE: 3.00 AREAFOR LOT 5_ PAGES: 2 NOTE: This Certified Survey Map is for the purposes of adjusting a lot line between Lot 2 of 112.031 SQUARE FEET (2.57 ACRES) a Certified Survey Map recorded in Volume 21, Page 5263, no additional lots are created INCLUDING RIGHT-OF-WAY by this instrument. All conditions, restrictions, notes, etc. listed on the previous certified 105,019 SQUARE FEET (2.41 ACRES) survey map(s) are applicable unless otherwise indicated. Because both of Lots 2 & 3 are EXCLUDING RIGHT-OF-WAY owned by the some owner, no quit claim deed or warranty deed is required to move the lot NOTE: AN EROSION CONTROL PLAN /s1T6 PLAN MAY BE REQUIRED TO BE SUBMITTED TO THE TOWN OF line between the two parcels. KINNICK INNIC AND ST. CROIX COUNTY ZONING PRIOR TO A BUILDING PERMIT BEING ISSUED. CONTACT THE BEARINGS REFERENCED TO THE NORTH LINE OF THE NEY. OF TOWN OF KINNICKINNIC AND THE ST. CROIX COUNTY SECTION 26, LINE BEARS S88'4V38'W ST. CROIX COUNTY 2 ZONING OFFICE FOR MORE INFORMATION. COORDINATE SYSTEM, W.C.C.S. N.A.D.'83, ('91 ADJUSTMENT). LANDS NE CORNER, SEC. 26 W4 CORNER, SEC. 26 NORTH LINE OF THE.NE114 (ALUMINUM CAP FND.) (2.25' IRON PIPE FND.) OVERALL DIST. -2654.48- S88 °48'36"W `*079.72 ® S88°48'36"W _ OROTNARY HIGH 1674.76' WAT (R 1674.80') OQa~ya~':: r - _ ERnZgRK CENTERLINE OF LEGEND 15y~D' / CREEK + - ® -INDICATES SECTION NOTE:-66CATION OF CREEK CORNER (AS NOTED) -INDICATES % "DIAMETER c0 IS APPROXIMATE. LOCATION- ® o REBAR FOUND AS SHOWN ON PREVIOUS P.S.M. Q ` / WASrU.SED FOR LOCATION ® -INDICATES 1.25" X 24" IRON PIPE WEIGHING 1.66 LBS.! i S)(OWN HEREON. LINEAR FOOT SET 6,, ~ / p: O~r iF INDICATES FENCE REMNANTS G~v~O tf cep ~1 r I ICZ'o A40 Al? I SURVEYOR'S NOTE: I ch r r ~~r OI I ~1 Q _ . J r r W ~1 LANDS INUNDATED BY 29 Z, NATURALLY III d rn rr I aQl OCCURRING SHED N g di co NAVIGABLE WATER 03 LLJ Yt ARE SUBJECT TO THE d~ ac ~ SEPTIC CC j N WISCONSIN PUBLIC °dl v ~~r co to TRUST DOCTRINE. I i~ Qtr I NI g 0n d' M LU z CD suRVEVORSNOTE: N M HOUSE WELL I N89°10'02"E 250.05' w o EUNICE POST FROM THE SCALE IN FEET LOT 5 W - DEPARTMENT OF NATURAL 69 O RESOURCES VERIFIED THE O 100' 200' 1,069,255 SO. FT. SEE ABOVE ORDINARY HIGH WATER MARK 1" s 200' ( 24.55 AC ) FOR AREA iD 9 > ON MAY 2, 2006. 11111 o w i oo ►J- O T N89 10'15"E 302.69' INCLUDIN SURVEYOR'S NOTE: RIGHT-OF-WAY c o SOIL TEST A Cc O 4 ST. CROIX COUNTY REQUIRES A ~ 1 ,056,870 SQ. FT. N AREA \ av Z W SPECIAL EXCEPTION PERMIT I L ®%l 9 c?. M _ (24.26 AC.) v APPLICATION TO BE COMPLETED .`rr EXCLUDING S PRIOR TO ANY GRADING 8 fly ~ 4, _5 RIGHT-OF- AY FILLING WITHIN 300 FEET OF I P~ V c i _ NAVIGABLE WATERS. o N89°' 0'15"E -:66 672.94' u~'a I c° M 422.89' N 250.05' - L~ - - - `S O NSA - - - - - 25 - - _ _R_6R_E_EN DRIVE_ ~ 42 1' * EPHW. * I - - NBERG_W8S7'4dS ) S-2295 I OQI i PREVIOUSLY MAPPED AS THE `r'r, I F NEW RICHMOND A F SOUTH LINE OF THE NEY4 OF THE NEY4 w ;u Ctr o t SuR Qi I I~OLa ` - gal V I ~ V~~e dI NE CORNER, SEC. 26 z ~I (ALUMINUM CAP FND.) ) LAND SURVEYOR: PREPARED FOR: 5s' S SOLUTIONS JOSEPH GRANBERG TOM & SUSAN FLORER DRAFTED BY: JWG 1235 CTY RD. E 1386 EVERGREEN DRIVE JOB NO. 100-164 SHEET BERG<4•SONN N A~ NEW RICHMOND, N 54017 RIVER FALLS, N 54022 DATE: 05/20/13 1 OF 2 Vol 26 Page 5923 MAX Irv, -~OI V UATION REPORT 3100 'pVT r-le4 &k- #1847 Department of Comm rce ST. CROtX COON in acco h C m 85, Wis. Adm. Code ~•Q ~~C Page 1 of 3 Division of Safety and uildings Steel's Soil Service Attach complete site plan on paper not less than 8'/: x 11 inches ins .an must County include, but not limited to: vertical and horizontal reference point (BM), direc nd St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel LD 6)r} , A _ -7-1 -7 - Please print all information. Revie By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). G Z a~ Property Owner Property Location 6 ~J - o Tom And Susan Florer Govt. L t na E1/4, 4114, S26, T28N, R18W Property Owner's Mailing Address Lot # Block # Subd. Name CSM# _ 1386 Evergreen Dr. ( (oS-~ _ na C S M Z(o 59Z3 City State Zip Code Phone Number City E] Village Town Nearest Road 3C ` ` RiverFalls WI 54022 715-425-8798 Kinnickinnic Evergreen Dr. ❑ New Construction Use: ❑ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ❑ Replacement ❑ Public or commercial - Describe: na Parent material Sream terraces and outwash plains underlain sandstone Flood plain elevation, if applicable na ft. General comments Mopund Design, system elevation 99.40ft based on contour line elevation 98.90ft. minimum of 6 19 7 Ines and recommendations: class 33 mound sand. Mal AWA 5 Q_W p~}r0A-/ Ef s, r` Co~I~.E"!o l L4r lV~J fav. goal- 1 d-;trv~ . Boring # ❑ Boring ❑ Pit Ground surface elev. 99.10 ft. Depth to limiting factor 30 - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots, GPD/ftz in. Munsell Qu. Sz. Cont:,Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr3/3 none sl 2msbk mfr cs 2f .6 .8 2 4-16 10yr4/4 none sl 2csbk mfr gw lvf .6 1.0 3 16-30 7.5yr4/4 none scl 2msbk mfr gw na .4 .6 4 30-57 7.5yr4/4 fld 7.5yr5/6 sl om na cs na .2 .6 5 57- 10yr8/2 cld 7.5yr5/6 ;andstonr residuum na na na .0 .0 2] Boring # ❑ Boring Pit Ground surface elev. 99.10 ft. Depth to limiting factor 32 /in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/3 none I 2msbk mfr cs 2f .6 .8 2 8-25 10yr4/4 none sl 2csbk mfr gw lvf .6 1.0 3 25-32 7.5yr4/4 none grls osg mvfr gw 1vf .7 1.6 4 32-52 7.5yr4/4 f2d 7.5yr5/6 grls osg mvfr na na .7 1.6 * Effluent #1 = SOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 S30 mg/L and TSS <-30 mg/L CST Name (Please Print) Signaturq.r , CST Number David J. Steel 'Z--~ 248956 Address Steel's Soil Service Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 4/26/2006 715-760-0347 SBD-8330 (R.07/00) PropertyOwner Tom And Susan Florer Parcel ID # pending Page 2 of 3 lj~ Boring # ❑ Boring ❑ Pit Ground surface elev. 98.50 ft. Depth to limiting factor 30 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2 1 0-10 10yr3/3 none I 2msbk mfr gw 2f .6 .8 2 10-20 10yr4/4 none sl 2csbk mfr gw 1vf 6 1.0 3 20-30 7.5yr4/4 none grls osg mvfr gw ivf .7 1.6 4 30-57 7.5yr4/4 c2d 7.5yr5/6 grls osg mvfr na na .7 1.6 ❑ 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#f *Eff#2 ❑ 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/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Etf#2 * Effluent #1 = BODS> 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. SBD-8330 (R.07/00) Steel's Soil Service ~ I f STEEL'S SOIL SERVICE 3 of 3 David J. Steel Tom and Susan Florer 994200 th St. CST-POWTSM NEl/4,NE1/4,S26,T28N,R18W Baldwin, Wl 54002 Lic. 4248956 Town of Kinnickinnic, St. Croix Co. Direct 715- 760-0347 CSM Lot 3 Fax 715-684-3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. Legend N 1"=40' ♦ = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 100.1 ft Top of 3/4" pvc pipe ❑ = Borings . ~5 y Boring Elevatio ' B1 = 99.10 ft B2 = 99.10 ft B3 = 98.50 ft B4 = 0.00 ft t t 4~ f ~V~ 1 r V ~ tFI t / f t 8 1 6 0 9 3 2 State Bar of Wisconsin Form 1-2003 Tx: 4131683 WARRANTY DEED 980233 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Thomas H and Susan K Florer 06/11/2013 1134 AM ("Grantor," whether one or more), EXEMPT#: 8 an ravis M Florer REC FEE: 30.00 PAGES: 1 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys 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") (if more space is Recording Area O , please attach addendu Name and Return Address Li CSM fr3 record e on 5-30-13, Vo126, page 5923, ocument # 979543 Thomas and Susan Florer roix ounty, previously recordecTaS 0 p e ec 26 T28N R18W 1386 Evergreen Dr PT NE NE (part of what was previously lot 3, parcel #26.28.18.401A-30). Value of River Falls wl 54022 $12,900. A parcel of land located in the northeast quarter of the northeast quarter of SEC 26, T28N, R18W, Town of Kinnickinnic, St Croix County, Wisconsin, being lots 2 and 3 1eO of that Certified Survey Map filed in volume 21, page 5263 of certified survey maps part of- oaa -i07, -10-i75 in the St'Croix County Register of Deeds. Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Dated (0-10-13 C. H012 s X~Sm ®~A. (SEAL) f. PUBLIC K r(SEAL) Z1 (SEAL) - 44oo0F a tee v° A HENTICATION ACKNOWLEDGMENT Sign ure(s) STATE OF WISCONSIN ) ss. authenticated on COUNTY ) Personally came before me on /D ll * Thomas H Florer Susan K Florer the above-named TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: v Susan K Florer Notary Public, State of Wisconsi o My Commission (is permanent) expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY tMODIFICATIONS TO I'll IS FORM SHOULD 13E CLEARLY IDENTIFIED. WARRANTY DEED © 2003 STATE 13AII OF \VISCONSIN FORtNI NO. 1-2003 1'** name below signatures. Parcel 022-1072-10-175 07/30/2013 05:06 PM PAGE 1 OF 1 Alt. Parcel 26.28.18.401A-30 022 - TOWN OF KINNICKINNIC Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 08/21/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - FLORER, TRAVIS M TRAVIS M FLORER 1386 EVERGREEN DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 1394 EVERGREEN DR SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 20.040 Plat: 5263-CSM 21-5263 022-2006 SEC 26 T28N R18W PT NE NE CSM 21-5263 Block/Condo Bldg: LOT 03 LOT 3 (20.04 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 26-28N-18W Notes: Parcel History: Date Doc # Vol/Page Type 06/11/2013 980233 WD 08/21/2006 832569 21/5263 CSM 07/23/1997 890/228 2013 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/07/2010 Description Class Acres Land Improve Total State Reason PRODUCTIVE FORST LANDS G6 20.040 100,000 0 100,000 NO I Totals for 2013: General Property 20.040 100,000 0 100,000 Woodland 0.000 0 0 Totals for 2012: General Property 20.040 100,000 0 100,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 979543 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI CERTIFIED SURVEY AP ECEIVED FOR RECORD LOCATED IN THE NEI/4 OF THE NEI/4 OF SECTION 26, T28N, RI 8W, TOWN OF 05/30/2013 3:20 PM KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN, BEING LOTS 2 AND 3 OF CERTIFIED EXEMPT SURVEY MAP RECORDED IN VOLUME 21, PAGE 5263 OF CERTIFIED SURVEY MAPS REC FEE: 30.00 RECORDED AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE. COPY FEE: 3.00 AREA FOR LOTS: PAGES: 2 NOTE: This Certified Survey Map is for the purposes of adjusting a lot line between Lot 2 of 112,031 SQUARE FEET (2.57 ACRES) a Certified Survey Map recorded in Volume 21, Page 5263, no additional lots are created INCLUDING RIGHT-OF-WAY by this instrument. All conditions, restrictions, notes, etc. listed on the previous certified 105,019 SQUARE FEET (2.41 ACRES) survey map(s) are applicable unless otherwise indicated. Because both of Lots 2 & 3 are EXCLUDING RIGHT-OF-WAY NOTE: AN EROSION CONTROL PLAN/ SITE PLAN MAY owned by the same owner, no quit claim deed or warranty deed is required to move the lot BE REQUIRED TO BE SUBMITTED TO THE TOWN OF line between the two parcels. KINNICKINNIC AND ST. CROIX COUNTY ZONING PRIOR TO A BUILDING PERMIT BEING ISSUED. CONTACT THE BEARINGS REFERENCED TO THE NORTH LINE OF THE NE'/. OF TOWN OF KINNICKINNIC AND THE ST. CROIX COUNTY SECTION 26, LINE BEARS 588.48-36-W ST. CROIX COUNTY /7///~ ~/1 ~1l~I ZONING OFFICE FOR MORE INFORMATION. COORDINATE SYSTEM, W.C.C.S. N.A.D.'83, (51 ADJUSTMENT). VU~/lYL~ 27X© LANDS NE CORNER, SEC. 26 NY4 CORNER, SEC. 26 NORTH LINE OF THE.NE1l4 (ALUMINUM CAP END.) (2.25- IRON PIPE END.) OVERALL DIST. -2654.48' S88°48'36"W 979.72' ® S88°48'36"W _ 1674.76' ~ROIAARYHIGH~ _ WATER MARK (R 1674.80') SOP y>:' 1 / CENTERLINE LEGEND ~y`~~°? . i CREEK + - i INDICATES SECTION kq-, CORNER (AS NOTED) i /-NOTE: -60CATION OF CREEK ® INDICATES 3/" DIAMETER p / IS APPROXIMATE. LOCATION- ` . REBAR FOUND O AS SHOWN ON PREVIOUS P.S.M. Q WAS~USED FOR LOC_ATIION ® -INDICATES 1.25" X 24" IRON - ` PIPE WEIGHING 1.68 LBS. / SbIOWN HEREON. LINEAR FOOT SET - -INDICATES FENCE 1 -7 0./' OI REMNANTS w ~Qp °~i 00 ~I 00 Q4 z ~p Gj1 ~I Q I SURVEYOR'S NOTE: -Al W Z-> W LANDS INUNDATED BY QO i v co ~O • ~I NATURALLY q{j OCCURRING ~I o SHED g d NAVIGABLE WATER QI 2 w O I N Z ~I ARE SUBJECT TO THE d~ Lr I` SEPTIC CC_ WISCONSIN PUBLIC c*) to TRUST DOCTRINE. o ' I ch w I_~ ~J WELL N89'1 0'02"E 250.05' Z CID SURVEYOR'S NOTE: M HOUSE _ EUNICE POST FROM THE SCALE IN FEET LOT LOT 5 ~ W --j DEPARTMENT OF NATURAL O O' 100' 200' 1,069,255 SQ. FT. L C w w RESOURCES VERIFIED THE SEE ABOVE ORDINARY HIGH WATER MARK 1" a 200' (24.55 AC ) FOR AREA ED Z ON MAY 2, 2006. J N89°10'15"E INCLUDIN 302.69' ~ w l ED I O SURVEYOR'S NOTE: RIGHT-OF-WAY o o SOILTEST c O ST. CROIX COUNTY REQUIRES A 1,056,870 SQ. FT. N AREA \ " Z w _ (24.26 AC.) v 0 c1l SPECIAL EXCEPTION PERMIT I Q~I~ II ~ APPLICATION TO BE COMPLETED y~ .'°r, EXCLUDING Z PRIOR TO ANY GRADING & ~9y N RIGHT-OF- AY FILLING WITHIN 300 FEET OF I Pa. AM Z14 NAVIGABLE WATERS. M N89° 0'15"E c6 672.94' O 422.89' 250.05' N ~g O /VSO - - - - - - Io 423.41' - - - - 25 .07' - - EEN DIRE 5raDwEF • _ EPHW. (iR7P~8J°4♦~rJC~ - -u-3 a~a * NBERG $ * I S-2295 = p~I i PREVIOUSLY MAPPED_ S THE I ^ ~I NEW ti RICHMOND i //,IupQQ SOUTH LINE OF THE NE % OF THE NE%14 x C. S. M. LAMPS 0 doh, ~~pC 2220 o z i;A'" . d ~3 Od a RI I $aI~ 1 i NE CORNER, SEC. 26 z C (ALUMINUM CAP END.) G) ~D SURVEYOR: PREPARED FOR: S SOLUTIONS JOSEPH GRANBERG TOM & SUSAN FLORER DRAFTED BY: JWG 1235 CTY RD. E 1386 EVERGREEN DRIVE JOB NO. 100-164 SHEET 7V8€RG}$•sONNE/vTAG ' NEW RICHMOND, N 54017 RIVER FALLS, N 54022 DATE: 05/20/13 1 OF 2 1011-1 Vol 26 Page 5923 i r CERTIFIED SURVEY MAP LOCATED IN PART OF THE NEIA OF THE NE1/4 OF SECTION 26, T28N, R1 SW, TOWN OF KINNICKINNIC, ST. CROIX COUNTY, WISCONSIN. OWNER SURVEYOR TOM & SUSAN FLORER EDWIN C FLANUM 1386 EVERGREEN DRIVE NORTHLAND SURVEYING, INC. RIVERFALLS, WI 54022 P.O. BOX 14 ROBERTS, WI 54023 NE CORNER w UMPd TTD-I1,G1Mg SECTION 26 SECTION N26R NORTH LINE OF THE NE1/4 888°493& W 979"72' e S86°4836'W - `yw 1674.80' W U oc" qt j- Attu m U VU LD I r~ I C51 i M I iL ~\`It? ` ~5 Off, I ` O I j r S59°59 Y9 E $72.59' LO 3 ai W SHED 20,04 873CRESO.C.R/W ~i = SEPTIC r ~ i m ~t a _ LOT 2 s a 19.78 ACRES (Q 861.435 SQ. FT. r 08 ACRES INC. RNV s HOUSE 308,225 SQ.FT. 15.30 ACRES ± TO O_H.W.M. 0 ACRES EXC. R/W -WELL EXC. R/W Z I g 300.441 SQ.FT. q 6.67 ACRES ± TO O.H.W.M. I ^ c? Iu O EXC. R/W w I 1 = N 10'15 I ~ f- m1' C n G N r4 I 2 W LOT 1 AREAS r~i - 221aCR INC.R/W LOT 1 2 96,141 SO.FT. o 2.00 ACRES D(C. R/W I w 67,120 SOFT. w ¢ N J q N89-10'15"E 96629 w w 295,36 __ZS .2,V 294.61' 253. 410.08' 4a 9(FRn EfN - I ~ © SOUTH LINE OF THE OOH Map~~r4~_D d I NEt/a OF THENE1/4 y~ w i 51 n_ v 0 v~/1y"(i o f Z \Ji' Oar ( Q~ q i I 0" o f Q~ q~ LEGEND C~. Q- I CORNER ALUMINUM COUNTY SECTION EXISTING FENCELINE SECTION 26 CORNER MONUMENT FOUND --X-X 2 3/6" O.D. IRON PIPE FOUND ' ' ' ' ' . 50' BUILDING SETBACK LINE i"O.D, IRON PIPE FOUND A SOIL TEST O.H.W.M. ORDINARY HIGH WATERMARK SCALE 114 FEET 1 " - 20W ~ 314" X t8" IRON RE8AF1 SET WEIGHING 1.50 LBS, PER LINEAR FOOT SHEET 1 OF 2 SHEETS 200 0 200