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HomeMy WebLinkAbout020-1448-35-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563861 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: Poser, Chad G. Hudson, Town of 020-1448-35-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: co Am ( GSr 32.29.19.2868 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark )L q / Dosing I ; l Alt. BpQ DrviO t~ 7. 'Yv C~ J 1 / ~i • $ Aeration LAQ Bldg. Sewer' 11A 77- Holding St/Ht Inlet ~ / • TANK SETBACK INFORMATION St/Ht Outlet TANK TO r WELL BLDG. Vent Air Intake ROAD Dt Inlet Septic J AA- 5to Dt Bottom g~• 3~/ ZZ . 7' Dosing 3 to / Header/Man. `.7 Ad/,17 Aeration Dist. Pipe - 77 Id /I '7. /,V . 3 Holding Bot. System 7• $ Final Grade PUMP/SIPHON INFORMATION fl-,' 3.~( /G• d~ Manufacturer Demand St Cover / v eS J` GPM U L ✓ g(j , $ Model Number L~ / f~ ! ram. 1.0, ~ s z /G Z . 7 TDH Litt` Friction Loss SystemHgact~ JT (y.•7Ft, r 9.5.7 9 .3 7 Forcemai/nJ Length Dial / Dist. to well ! / 41)6 AbC, SOIL ABSORPTIONAYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Z 4✓4 1/` SETBACK SYSTEM TO P P/L BLDG WGIEtL~LLAKE/STREAM LEACHING Manufacturer: INFORMATION f y~ CHAMBER OR Type oo•JSystem- GwT+a~-~Z / UNIT Model umber. C u k4 DISTRIBUTION SYSTEM 6 J Z 3 Z 3= ` fo~ r! Distribution x Hole Size Ix Hole Spacing 11peo Air Intake 1f Pipe(s) \ Length~Dia / Length Dia Spacing fo-G. SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx De of xx Seede Sodded xx Mu ed Bed/Trench Center C Bed/Trench Edges Topsoil / Yes 0 No es 0 No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: nspection #2: / / Location: 650 O'Neil Rd udson, WI 54016 (NE 1/4 SW 1/4 32 T29N R1 9W) Windsor Heights 1 st Add Lot 35 /larcel No: 32.29.19.2868 1.) Alt BM Description =J / CO 4-,,_ el 2.) Bldg sewer length = r - amount of cover = 117 /D / o t,- J_0_ Plan revision Required? F&I Yes No 9 ]3 3 Use other side for additional information. Date Insepctor's nature Cert. No. SBD-6710 (R.3/97) ~ a 5P~ y~y /,,4,1 .9,:20a ~n v Q h 1. O C r low o~ E F ~Q j Erb • r 63 gyp' 4 a / Safety and Buildings Division County s JC _ 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707-7162 5~3 / / l!j Y o~a~esstoxState Transaction Number Sanitary Pe rmi ~ ion r Wis. Adm. Code, ub to orm t the appropriate governmental unit in accordance with SPS 383.21(2), ermit No ton fo state-owned POWTS are submitted to Project Address (if different than mailing address) is required prior to obtaining a sanitary p an provide may be used for secondary the Department of Safety and Professional Servies. n on you P / Sd ©~~rL nlj u oses in accordance with the Privacy Law, s. 15.04 1)(m , Stats. ~ 0 ' I. Application Information - Please Print. All Informatio Parcel # Property Owner's Name C440 ZO S QOO t~ &r D Property Location ' Property Owner's Mailing Address C J~j V ~ o 6 L L ^ AJ~ ~D Govt. Lot ,Z /T City, State pY Number '/4, Section_ 2013 (circle one ! , I Zip Code U U Ur~Sv {1J W T~_N; 067 U. Type of Building (check all that apply) ~~COU Ty~ Subdivision Name ?;-,-or 2 Family Dwelling - Number of Bedroom Block / i bsv~ s s 6k o ~ ck # W ❑ City of ❑ Public/Commercial - Describe Use CSM Number El Village of -Town of ~11 Sd ❑ State Owned -Describe Use zz~-7,3 ex--s III. Type of Permit: (Check only on box on line A. Complete line B if applicable) ❑ Other Modification to Existing System (explain) $-New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ~-'--r List Previous Permit Number and Date Issued B. El Permit Renewal ❑-Permit Revision El Change of Plumber 11 Permit Transfer to New ~ ~ (7 N Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) Ply) 4 in. of suitable soil )kNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in.❑o P e tabllensoil Device Moun ❑ Holding Tank ❑ Other Dispersal Component (explain) V1, Dis ersal/Treatment Area Information: Dispersal Area Required (sf) Dispersal Area Proposed so System Elevation Desi Flow (gpd) Design Soil Application Rate(gpds , / S ;9 ~O 67 Xo j. VL Tank Info Capacity in Total # of Manufacturer d Gallons Gallons Units / w C7 0. v~ h New Tanks Existing Tanks P U Septic or Holding Tank ( Do e sing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS sshoownnoon the attache d pllan` ess Phone Number /N Number Plumber' Name (Print) Plumber's Signature ju~~~~' • z z~ 7l j~ 7" Plumber's A dress (Street, City, State, Zip Code) If'-L / c4,/o e VI . Coun Department Use Only Permit Fee Date su Issti Agent Si Approved ❑ tsapproved $ t7~ g ~f ~ 3 ❑ n Reason for enial ~ ~~4 i IX. Conditi$l TMMM*4leasons for Disapproval 3~ d P DY d N 1. 5ej3tiC tank efi!Mht, filter and / dispersay gell•must all be services l maintained 4P, as per 'Management plan provided by plumber. r Ak) 2. AN se0aclt requirements must be maintained C~~ / 11 as per a"lic" code I ordinaACea. J Attach to complete plans -T!; system and submit to the County only on paper not less than 8 in x 11 inches in size SBD-6398 (R. 11/11) 1 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: p Owner's Name: 5 . Owner's Address: ALIM d N,0,5 d,-LJ ~ Legal Description: Township: 0~ County: S G~ dS~ Subdivision Name: D Sf.~~p Lot Number: Parcel ID Number: Page 1 Index and title /0 RNK Page Z Plot Plan C /LOSS SG~G Page 3': System Sizing & Cross-Section Page 4'. Filter Specs pu mP sP~e_.~ Page 5' Maintenance Information Page 6! Management Plan Page 7I St. Croix Cty Septic Tank Maintenance Form Page 8'', Warranty Deed Page 91 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: License Number: Z2 ~aJ' Date: 7Z ~D --j Phone Number Z73?~~SL Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 Prof LA z ry) 3 Z © 0W/K oeo 4 6rsa J.kefl~r,,h c®~J~Fo~r g /Y7 Z. /0/, 3r a~ r yo doll Absorption System Cross Section ft 5ft4" Schedule 40 Final Grade VC Vent Pipe With Vent Cap ft Leaching Chamber -ft ~ System Elevation ft Soil Absorption System Plan View ft i ft { ft Vent Or Observati i Leaching Trench 1 c n Pipe Chambers 4° Dia. Trench 2 Header Leachtq Chamber Specifications Manufacturer Arid Model EISA Rating Z sq 11 per chamber Soil Application Rate -E 7gPd/s, q ft ~T71 gpd Design Flow + i 7 Soil Application Rate* 95-13 EISA = Chambers 2'rows of 221- Z "'A'-chambers each. (Page of v' O o 0 e) N O CIJ LO C J Ci ~ O N M co co ~ U') co C.fl O Cl- o z W W O co W = W w z 5,- a. J CD w z cn 406 m X° p U W o U- W w v J z a_ co o "v C7 U3 _ J U Z ~ ~~m CS, C) C? C) C~b ff! U z ~ Q I~ POWTS OWNER'S MANUAL MANAGEMENT PLAN SYSTEM SPECIFICATIONS. R FILE INFORMATION DNA ~ Owner e ~ s Septic Tank Capacity t al D NA Permit +f Septic Tank Manufacturer ( O NA ' - Effluent Filter Manufacturer DESIGN PARAMETERS ❑ NA f~+l4+R Effluent Filter Model A' ~ZJ Number of Bedrooms v al ❑ NA Number of Public Facility Units ~ NA Pump Tank Capacity O NA Estimated flow (average) M al/day pump Tank Manufacturer , ❑ NA a' t✓~ Design flow (peak), (Estimated x 1.5) LOO gal/day pump Manufacturer 0 CA- ❑ NA 7 Soil Application Rata al/da /ft2 Pump Model ❑ NA Monthly average• Pretreatment n Standard Influent/Effluent Quality Sand/Gravel Filter D Peat Filter E3 , Oil & Grease (FOG) 530 mg/L Fats Biochemical Oxygen Demand (BODa) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland 5150 mg1L ❑ Disinfection ❑ Other; Total Suspended Solids (TSS) ❑ NA Monthly average Dispersal Cell(s) Pretreated Effluent Quality (3 530 mglL It In-Ground (gravity) In-Ground (pressurized) Biochemical Oxygen Demand (BODE) ❑ Mound Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade 510• cfu/100m1 ❑ Drip-Line ❑ Other: Fecal Coliform (geometric mean) Others D NA Maximum Effluent Particle Size Ys in dia. O NA O NA Other: DNA Other: D NA Other: "values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Frequency Service Event ❑.month(s) Inspect condition of tank(s) At least once every: 3 19 ear(s) (Maximum 3 years) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume ❑ NA ❑ month(s) (Maximum 3 years) D NA Inspect dispersal call(s) At least once every: 3 ® year(s) ❑ month(s) ❑ NA Clean effluent filter At least once every: ® earls) 12 month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 3 8 ear(s) ❑ mnth( os) O NA Flush laterals and pressure test At least once every: -0. ear(s) ❑ month(s) O NA Other: At least once every: ❑ 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 gn the ground surface. The dispersal c:011(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 (Y3) 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 the:servicing•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) her chemicals START UP AND OPERATION g products For new construction, prior to use of the POWTS check treatment t cell(s) o If h pr sense of pal tin a detected rot the content that may impede the treatment process and/or damage the dispersal 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. power ewater ess the will During power outages pump tanks may fill above normal dose, hIghwater ng thee cell(s) andnmay resiult Intthe b ckupcor surface d scha ge of discharged to the dispersal cell(s) in one large Septage Servicing Operator prior to restoring effluent; To avoid this situation have the contents of the pump tank removed by a controls to power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump 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. fa e Reduction or elimination of the following from the wastewater stream may improve the performance and prol disinfectants of POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss, diapers; foundation drain (sump *pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; -pesticides; sanitary 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 b(omat 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 NO 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 "K o & rz C L, 50-^J Name Phone -7 1 5- Z 7 3 7 T Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name G Z0 Phone Phone 7f" g ~b This document was drafted In compliance with chapter Comm 83.22(2)(b)(11)(d)&(f) and 83.54(1). (2) & (3), Wisconsin Administrative Code. c~Tank and C 0 Combination Sept. CROSS SECTION AM0 SPECIFICATIOM5 _ POMP CHAMBER yE}JT CA,P WEATHER PIt00F JUIJCTIOLI 60X . APPROVED LOCKIMG ti` C. I.. VCMT PIPE MAy~I{OLE COYER wt ~ 10' FROM DOOR, yvARtJI1JG -,iwooW OR FRCSH aouDUIT ~t.~sP lOIJ P lPE A-IR tmTAKE c r • w ~ rYtczlZ ~ q-T-' ~rS' ~ ~ I • b~i~c ~ i / I y~ MIAI. I~ 6°.nW, l00 T - I I 16' Al U. i., PROVIDE AIRTIGHT SEAL. T I►JLE BA~L.~ I I I APPROVED JOl>aT: APPROVED JOIAIT Zt'tT3~t Fi A I III I W/C.T. PIPE~Kp- W/C.O-Pip EOIZ Tank construction I II ALARM shall comply with ~I II ILHR ()3.15 and 33.20 a I 1 OQ C I PUP'%P OFF 0 COIJCREre 6LOCx r;TZ, v 3" APPSNc RISER EXIT PEKMMED OIJLy IF TAUK MAlJUFACTURCK HAS SUCH APPROVAL $FpptNG SEPTIC SPECIFICATIOfJS F DOSE W 1 5~t C-~ICC T~ IJUMdEK OF DOSES: PLR DAB TA11K MAWUFACTURCR- TAMK :AZC: GALLOWS D05FL VOLUME UUFACT CR: S,S,~-lam Z~ S~1SlM '1~ INCLUDING DAGKfLOW: GALLONS ALARM MA UR ~~~QQ MODEL WUM6ER: I01 Nw CAPACITIES: A=-ZI IMCHES OK GALLO►J5 5WITC.H T~PC: I-b 5= Z IUCHES'OR lz-G(LLOU5 PUMP MAMUFACTURER: v ~1L~ C: IUCHES OR LLOU5 MODEL hJUM15ER: / c ! O=~I►~1CHE5 OR LZI-'d CiALLOIJS SWITCH TYPE: ~DA- 4- MOTE: PUMP AND ALARM ARE TO dL 3✓ INSTALLED OW 5EPARATE CIRCUITS GPM M1IJIMUM'DISC1iARGE RATE VERTICAL DIFFERENCE DETWEEIJ PUMP OFF A1J0..D15TRI6UTIOW PIPE.. /6 rEET + M~WDIMLIX IJETWORK SUPPLY PRESSURE FLIT + 0 FEET OF FORCE MIM X JWYloorLFKICTIOU FACTOR.. t S~FEET TC7TAL Oy}JAMIC MEAD = ~r 5`~FEET As per-manufacturer, gal/in. a y FERGUSON ENT HUDSON 715 386 6144 P.01 • APR-12-2005 GOULD5 PUMPS Submersible Effluent Pump o. IT] gol 11 PE .3 . "W ai rump SPECIFICATIONS MOTOR FEATURES Pump - General; General: ■ Corrosion resistant • Discharge: l 'A" NPT • Single phase construction. • Temperature:104OF (4000 • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 and 230 volts Thermoplastic impeller and fully submerged. • Built-in thermal overload pro- cover, • Solids handling-1h" tectlon with automatic reset ■ Upper sleeve and lower maximum sphere. • Class s Insulation. heavy duty ball bearing • Automatic models Include a • Oil-filled design. construction. APPLICATIONS float switch. • High strength carbon steel ■-Motor Is permanently Spedeliy designed for the • Manual models available. shaft. lubricated for extended • Pumping range: see PE31 Motor. service life. fo nuses: Systems performance chart or curve. • .33 HP, 3000 RPM ■ Powered for continuous • Mound • Effluent/Dosing Systems PE31 Pump: • 115 volts operation. • Low Pressure Pipe Systems • Maximum capacity: 53 GPM • 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: ■ Quick disconnect power • .40 HP, 3400 RPM cord, 20' Standard length, Dewatering • Maximum capacity: 61 GPM a 115 and 230 volts • Maximum head: 29' TDH • PSC design heavy duty 16/3 SJTw with PE51 Pump: PE51 Motor. 115 or 230 volt grounding • Maximum capacity. 70 GPM • .50 HP, 3400 RPM plug. • Maximum head: 7' TDH ' 115 and 230 volts 0 Complete unit is heavy duty, • P5C design Portable and compact. ■ Mechanical seal is carbon, METERS FEET 40 Qt EI51 r + 1 7 I I - I I _T ceramic, BUNA and stainless MODELS: PE31, steel. 35 Pf41, _ ■ Stainless steel fasteners. HP.33.40, so _ ' ` I ! I E 10, 2 GPM - f I I I AGENCY LISTINGS 30 I 1 FT 2E I I i l l, ; i I s+ V 25 I I + i i I , r, I c 20 ) ! Tested to UL 778 and x - I CSA 222108 Standards BY Gnadian Standees Anodadon i r I r I I I I file #L rAq 10 Go" pwnps is ISO Wo, Registered. s I.. ~ 'III , I I'1 •~;~1 ~ ~•f ' I 1 I-f I ~ ~ ~ -j I ~ i 0 0 I i -1...! i.. III 0 10 20 30 40 50 60 70 GPM so 0 5 10 15 m3M Goulds Pumps CAPACITY 02004 rrrw•urTut,noloeY, u,c ITT Industries Effective June, 2004 BYE7 T/41 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ON CLC~ ~Ose'r -4 e_ Mailing Address (.0 ~-m eke <AUvj VJ S 1t p I Property Address $^D (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number d 2 0 (~7-- OOd LEGAL DESCRIPTION Property Location ~ '/a Sec. 3 Z, T Z'IN R-Z7W, Town of 6u ,0S" /t/ Subdivision 1,04® lo IlElqwf S l Lot 7 Certified Survey Map Volume , Page # Warranty Deed Volume , Page # Spec house yes no Lot lines identifiable C~ 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/we certify that all statements on this rm are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a wary ty deed recorded in Register of Deeds Office. Numbe o edroo 1A 7 /1,57ZoB 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) 8 0 8 4 3 1 3 50 Tx:4064064 962968 BETH PABST STATE BAR OF WISCONSIN FORM 6 - 2000 REGISTER OF DEEDS Document Number SPECIAL WARRANTY DEED ST. CROIX CO., WI 09/05/2012 4:20 PM THIS DEED, made between AnchorBank, fsb, Grantor, and Chad Poser EXEMPT#: NA and Heidi Poser, husband and wife, as survivorship marital property, REC FEE: 30.00 Grantee. TRANS FEE: 150.00 Grantor, for a valuable consideration, conveys to Grantee the following PAGES: 1 described real estate in St. Croix County, State of Wisconsin (the "Property"): Lot 35, Plat of Windsor Heights I' Addition, Town of Hudson, St. Croix County, Wisconsin Recording Area Name and Return Address: Land Title, Inc. LTl # 334187 2200 West County Road C, # 2205 Roseville, MN 551 13 Together with all appurtenant rights, title and interests. 020-1443-35-000 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances, arising by, through or under Grantor, except Easements, Restrictions, Reservations, Roadways, and Rights of Way, if any, of record. Dated this 3rd day of August, 2012. Anchor nk fsb Vice "President AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) COUNTY. ss. authenticated this 3rd day of August, 2012 Personally came before me this day August, 2012 the above named K_I the V P of An I to me known to be the person(s) who execut4TN TITLE: MEMBER STATE BAR OF WISCONSIN i~ (If not, instru and acknowledged the same. Y authorized by § 706.06, Wis. Slats.) P!-A-12 0:0- THIS =Z INSTRUMENT WAS DRAFTED BY Pgeg& --A All Q'~ r • Z Notary Public, State of Wisconsin ~ 10 ~p I Z* My commission is per~aertznlr (If not, state e. tic ateQ Larry S. Mountain - Attorney At Law o " / ~~i_ ls?~A PI 1 r_ (Signatures may be authenticated or acknowledged. Both are not necessary.) 'Names of persons signing in any capacity must be typed or printed below their signature. SPECIAL WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 6-2000 1 of 1 I 04/04/2013 13:06 17154259559 LUND BUILDERS PAGE 04 3/3 Oct-04-2012 0917 AM St, CrOIX County PtanlZaning 715-386.4686 LOT-1 011.m~ 12T 2. CXX Ott I L::p t1Q347 ~1n I 7R,k.6 0012740" 6 1 /4 UNC HOW ae g 00165)16" E 1 ~S 00,651e0" 323,9 2733.62 r ~ , • it g !3 B oil wW t~ ~ I ti ~ I I I a i w 01 I R S 01007'63" E 132.48 v/ I P~ 'all /t, - - I r~ I N i A N jai 1 I ~ ~ ` C;Rbo~ ~ ~~y I W I j I ti~ I~ I 1 Om OL o N QO'S 4 W N p1'1o'a4. „,f lY7[ AC Bf OM'1!~ ~ 1~4 ~I f Received Time Oct, 4. 2012 10:16AM No. 21191 uNpu~~~ ' zo3~~aao0 zCL i-<OWF-Toi a ti N N N7 W~a I LOT 1 C.S.M. I LOT 2 C.S.M. I~ VOL. 5, PG. 1347 I VOL. 5, PG. 1347 I y DMZ I ~ I i R.A.=S 00'12'40" E ^ z z n s I NORTH-SOUTH 1 /4 LINE I-- H m z °m S 00'55'16" E_ _S 00'55'16" E 323.99":~- S 0'55'16" E 2733.52' 2234.22' Qr~Q N02'500' W 199.16 Z N O b N .241 16 ~w=6 - W<O NZZ(wj w O N NF- 1 W V<NO o in o z 3ZNZ mmoazZ< N o 5R a W wo < WO N OZ N-jZO X34 f.. 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Plan must include, but not lim- to: VgTic-al and horizontal reference point (BM), direction and p ~Q 020 - 1448 - 35 - 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road / Please print all information. Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m l / Property Owner Property Location ~I t3 CHAD& HEIDI POSER, Lot NE 1/4 o s~►'y1/4 S T 29 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or M# 756 Aldro Lane 35 Windsor Heights 1st Add. City State Zip Code Phone Number a dy village Taira Nearest Road Hudson, WI 54016 ( ) O'Neil Road E] New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial - Describe: Parent material sandy outwash Flood Plain elevation if applicable NA ft, General comments Conventional In-ground trenches 0.7 loading rate and recommendations: Property Address: 650 O'Neil Road Boring # 0 Boring El Pit Ground surface elev. 103.90 ft. Depth to limiting factor >92 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 1 0-8 10YR2/2 sf 3fabk&gr ds as 2vf-m 0.6 1.0 2 8-27 10YR3/4 - sil 2fa&sbk mfr cs 2vf-f 0.6 0.8 3 27-59 7.5YR3/4 Is lmsbk ml cs 0.7 1.6 4 59-92 10YR4/6 s Os dl 0.7 1.6 Horizons 1,2 &3 have some gr, cobs & stones. Off -71 Atu F2 Boring# 'Boring 100.00 >100 El Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-18 10YR2/2 sil 3fabk ds cs 2vf-m 0.6 0.8 2 18-100 7.5YR3/4 - s Osg dl 0.3 1.6 Horizon 2 has 35401/o gr; few cobs; one boulder * Effluent #1 BOD > 30:5 220 mg/L and TSS >30;s 150 mg/L * Effluent #2 = BOD < 30 mglL and TSS 5 30 mg/L CST Name (Please Print) S, n re CST Number Mary Jo Hu rt Hollister's Soil Testing & Desi 224832 Address Date Eval ucted Telephone Number W9875 690th Avenue, River Falls, WI 54022 07 - 27 - 13 (715) 426 - 1775 Property Owner POSER, Chad & Heidi Parcel ID # 020 - 1448 - 35 - 000 Page 2 of 3 3 Boring # 11 Boring Pit Ground surface elev. 100.00 ft Depth to limiting factor >102 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-19 10YR2/2 sil 3fgr&sbk ds cs 2vf-m 0.6 0.8 2 19-30 10YR3/3 sil 2fabk ds cs 2vf-f 0.6 0.8 3 30-102 7,5YR3/4 s Osg dl 0.7 1.6 Horizon 3 has 10-15% gr; few cobs; 1 stone. Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ❑ Boring # Boring spit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/(F in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 " Effluent #1 = BOD5 > 30 < 220 mg/L and TSS >30:5 150 mg/L * Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBI)4330Tmt(R.07/00) Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner C#41) f/Ei D 1 Pa5ER I"=40fx Legal Description L cT w ~N~sa~-► rs}, (except where noted) %rr4 n1. , NSA Dr- -7-- r Sw s 3a 3 71TA yI)4W, = Bockhoe pit 11 F .~tuDSe~ ; .Sr: c~o~X Cou u7y~ w ISCO/u51it/ j ~ ~,~,~~s North s~ N a~~'~-t- Q 1 - Z -Selo I O N ~~8 10 •01D ~V n Q I 000")o lte Location' ~r a ? s Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ! of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less then 6112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. to Please print all Informadon. R ed / 3 Q Personal information you provide may be used for seciirrrfary purposes (Privacy Law, s. 15.04 (1) (m)). ky Lake ~ U r I ei ~S GovL Cot NE 114 3W 1 /4 S 32 T 29 N R 19' E (or~ EPropeqrty / Props Logtwn Mailin Address ~D3 vo, k # SubName or CSM# 9 ~ CUrS /-ST•U.x City State Zip Code Phone Number ❑ Village E) Town Nearest Road : ua(3on Carria Lane 7j f{u~5orl GtJ~ ~lo~(o (...W...ufi. New Construction Use.-151-Residential / Number of bedrooms 3 Code derived design flow rate ysU /lo OD GPD ❑ Replacement / ❑ Public or commercial - Describe: ft Parent material U*~~ Flood.. Plain elevation N appliicab'lep~ r+ General comments and recommendations: S ~/S ►'7 e I EV a 0 `7 -50 5~0~ Boring # Boring ' ft. Depth to limiting factor ® Pit Ground surface elev. in. Sol ication Rate Structure Consistence Boundary Roots •EGPD Eff#2 Horizon Depth Dominant Color Redox Description Texture in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. v-r 31z si ! 2 e v 5 .B b-i2 I c! 2 Z Q-34 14 (o -Ilg I~ y~ 5 s m I _ 7 2 2mtsb cw F?- I Boring # ~I Boring G Pit Ground surface elev. 1 -So ft. Depth to limiting factor L2 J in. Soil Rate Pi Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i r cw S/• lam'' , 017b s"- NuAua Effluent #1= BUD 30:5 220 mg/l and TSS >30.5 150 mg1L ' Effluent #2.= BOD <30 mg/L.and TSS 30 mg/- CST Name (Please Prirlt) Signature CST Number Aktm //a ZC3 Address Date Evaluation Conducted Telephone a Number a C?! 7(DD^ 027 21l3 &A-~• ~merse,~ Cv ( - 1 Property Owner ~s Parcel ID # _ Page -Of-, ® Boring # ❑ Boring Pit Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate K Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 . 8 d- l I l0 f- 31Z S~ I 21 r4r- c I v-C .5 1 2 I "I Sr c 5 r- C w _ . Cv 3 Ltto s - 7 1.2- Boring ❑ # ❑ Boring ❑ pit ;Ground,surface elev. ft. Depth to limiting factor in. Soi Lion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fP In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 •Efl#2 ❑ Boring # Boring ❑ Pit Ground surface elev. ft Depth to limiting factor in. Sol Aj)plicadon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Efl#1 •Efl#2 • Effluent #1 = BODS > 30:S 220 mg/L and TSS >30:5 150 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. M-833018.07/00) t s 1-" PAGE3OF_ NAME: GAL DESCRIPTION:~1/4 cl/4,S T2g,N,R, E(or SCALE: 1"= go OT# gMl ELEVATION: 140.0 i BM 1 DESCRIPTION: v Dui D~ -f- BM 2 ELEVATION: f q. S~ se e, Z BM 2 DESCRIPTION: dap o ~ Pv c~ G SYSTEM ELEVATION: S~ SYSTEM TYPE: (tp ✓1 r/P/`1~ro rte f rI j ~ 1 0 6..3 ~ I I 1i/ y`lSk c - Bm2 SIGNATURE: DATE: