Loading...
HomeMy WebLinkAbout040-1303-00-008 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 567210 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: Oevering Homes LLC, aka Oevering Propertie Troy, Town of 040-1303-00-008 CST BM Elev: Insp.BM Elev: BM Description:/� Section/Town/Range/Map No: q 7 y 0- 3 GS►— 22.28.19.1743 TANK INFORMATION nn ELEVATION DATA TYPE MANUFACTURER ,-06'1 CAPACITY STATION BS HI FS ELEV. Septic y ?•S , Benchmark D 7. oo . a �s , q .Desillg ..J 4_li ilea..., 'l Alt. BM G Go JA.. . �.Z /6o. Z Aeration Bldg.Sewer r' Holding — - St/Ht Inlet C/ . 7 St/Ht Outlet TANK SETBACK INFORMATION 7,6 91/. TANK TO P/L WELL BLDG. / ent to it Intake ROAD Dt Inlet \ �„ Septic Dt Bottom l i-1 /1* 3/ 1t2 Dosing Header/Man. 7. 4 93 O Aeration Dist. Pipe 7.1 93•c 7.4 93• Holding Bot.System 1. 8 f S. q 92. Final Grade PUMP/SIPHON INFORMATION L,o,,..f 5.1.4. 1. 5 97.9 Manufacturer GPM Demand St Cover F,t L, 66).4.A. ti AO ,Z Model Nu TD Lift Friction Loss System - - TDH Ft c-------"----- Forcemain "Lerfgtn Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length / No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 94 L INFORMATION AT pN SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER OR Manufacture _ nl,i�'7r a+- Type/Of System: r ^ �/ 412 /d� JJ►r J+J,�I I [�13/t,JGw�O /X/+ /g /� UNIT Model Number: t.IC. 4 `�/.,yAa.}/ DISTRIBUTION SYSTEM 6 — �/ �3.-1. 23 = it& fia ,P<is Header/Manifold, i' Distribution x Hole Size x Hole Spacing Vent t Air Int e Pipes) N.--... �_ `� („�ea Length a Dia Length Dia Spacing SOIL COVER / x Pressure Systems Only xx Mound Or At-Grade Systems Only e Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ie,4 Bed/Trench Edges \... Topsoil y No Yes fa No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 658 Tradition Trail River Falls,WI 54022(SE 1/4 SE 1/4 22 T28N R19W) Walnut Hill Farm aka The Tribute Lo Parcel No: 22.28.19.1743 1.)Alt BM Description= t `� G 4,,r N...- f- 2.) U 2.)Bldg sewer length= l L amount of cover= 5 I • ■ pSCJ�■^ $2 i Plan revision Required? Yes No (11 to 13 1 ! 03 c5 q, Use other side for additional information. � SBD-6710(R.3/97) Date Insepctor's •ignatur, Cert.No. PLOT PLAN PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX 9/18/13 BEDROOM 3 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 BENCHMARK V.R.P. Top of 1/2" conduit ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark a•Vent SYSTEM ELEVATION 94.8/94.7 4.5' below grade >6„ Quick4 Standard p f Cover Leaching Chamber 'rom'e Lind with 20.0 ft2 of Area All piping shall be SDR 30/34,within 10' 5.6ft^2/pair of end cappf tank,piping shall be Schedule 40. 4' Long Grade at System Elevation 34" B-3 3% SLo e Scale is 1" = 40' p unless otherwise 63' 98' noted 2-3' X 92' cells with>3' spacing Vents 4-0 99' B-1 --0 40' 11041 45' 53, 10' B-2 20' .M.* S 15' V Pro 3 Bedroom House 160' A Road - Court S~ c ~f~, ~ ;:Industry Services Division r r.FV 0 1400 E Washington Ave Sanitary Permit Ntnntber (to be filled in by Co,) S p.0. Box 7-1162 P Vol.- Madison, WI 53707-716'1(.4%li' 5l.v ~*rM'y,r T - - Transaction -7 2- N - anitary Perrrlit Application appropriate govern SEPmznf~l p In accordance with SPS 383.21(2), Wis. Adin. Code, submission Of this form to the `J is required prior to obtaining a sanitary permit. Note: Application forms for state owned POW,ulare submitte / Protect Address (if differentth an nailing ddress) the Department of Safety and Professional Servies. Personal information you provide may be usedq cC4a~ 6 xir oses in accordance with the Privacy Law, s. 15,04(1)(in), Stam - - _ ----tea, ----ti 1. Application Information - Please Print All Inlormatio Parcel # _ r Property Owner's Name Property Location / Property Owner's Mailing Addres, (,1743) Govt. Lot.--- - - 'a City _Phone N -------umber-~ - _Section J. , Stale r "Lip Code - clc, one , _ _ II. ype of iluilding (check. all that apply) Lot Subdivision Name _ r 2 Family Dwelling- Number of Bedrooms— Block ~/t GZ>Zi ❑Public!Commercial City or V - -Desc,nbeUse-__.-_ _s~- - illage or ❑ CSM NutTrber ❑ State Owned - Describe Use Z _k1lerlit: . 23 ,-z3 lll. Typ(Check only a box °n line A. Complete line D Kapp leabe) A' New System ❑ Replacement System ❑ Treatment/I folding lank Replacement Only ❑ Other Modification to Existing System (explain) _ - Lis[ Previous Permit Number and llate Is:.red pp B. ❑ PenYtit Renewal ❑ Permit Revision Change of Plumber Ierrnitt ransfer to Nrw rS' • ~ Before Expiration Owner 4^$ Gina Grp ` - . - - _ . - S System/Comp°nent/llevice: (Check all t t1 IV e of POWT that a~~)- Non-Pressurized In-Ground L.l Pressurized In-Ground El A6Giade, ❑ Mound 2I rn of suitable soil ❑ Mound 24 in I suitable soil Pretreatment Device (expltin).____ Holding `l'ank ❑ er Dispersal Component (explain)_._ V. - Dispersal/Treat cult Area Information: - w - - - System I_.levati r d) Design Soil Application Rate(gpd t) r>tspersal Area Required (sf~ Disp a! Area roposed esign Flaw (gp / n5 - - ~~r<tl # of - Mamrtitct r - Y, Vl. `I anlt info Capacity in N r N 'v . Gallons Gallons Units r ~L o ° 52 2_1! - Cxistin Tanks New Tanks g ~ Q p; U cn " cn u, t7 rs, Septic or !folding rank ' - - Dosing Chamber - - V11. Responsibility Staten i I, (he undersigned, assn -esponsibiiity for installation of the POWTS sit wn o l file etached IBashiess Phone Nu i/b r Phan er' Name (Print) Plumb - ignattrre Plumber's Address (Street, City, State, Zip Cod 7A , 1 sUr - Vill. Count /De artrncnt l)se Only-_ - - Issuii Signature Permit Fec Date I sued--- g t Approved P - ] Owner teason for Dental $47,51 _ 7`-`- J e p ram, ~,t appal 1X. Condit$111$'¢EI0kA1tiYlcasons for Dis rov T' ~°epttd tank,`efftusntfilter cif 1l r I, r Q^t ,.~c~ ,q W, l ~ f he ••J dispersal 6611 must all be services motin ".10 V►II ~ t t T L~ as per management plan provided byplumber• t 2• Att setback requirements--muit best nEalnad Ir/1 ' 1 r aa~e Cod11 / orb: ~o- / a~ - - v U as r s stem and subs n to rite County nr ly on paper nut less t gar rfa z 11 inches in sire Attach to canplete ptnnsfur the } 6 f ra t^ t~G SLVV'e SBD-6398 (80313) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 I 715-246-4516 Date: 9/18/13 Owner:Oevering Homes Location: SE1A SE1A S22 T28 N,R19W Lot 8 Walnut Hill Farm Troy System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specification Sheet 8.-10. Soil Test Signature License number ;26900 PLOT PLAN PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9/18/13 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 933 # of chambers 46 BENCHMARK V.R.P. Top of 1/2" conduit ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. SameasBenchmark Vent SYSTEM ELEVATION 94.8/94.7 4.5' below qrade >6„ Quick4 Standard f Cover Leaching Chamber Property Lind with 20.0 ft2 of Area All piping shall be SDR 30/34, within 10' 5.6ft^2/pair of end capsOf tank, piping shall be Schedule 40. 4' Long 12" Grade at System Elevation 3419 B-3 3% SLope Scale is 1" = 40' 63' unless otherwise 9s ~ noted 2-3' X 92' cells with >3' spacing Vents 99' B-1 40' 45' 53, 10' B-2 20' M. S 15' Pro 3 Bedroom House 160' Road Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.6ft 2 pair of end plates Finish grade elevation Typical Installation 99.3 Vent Grade Vent 3' 4" 3' X30/34 Septic Tank 5' Long 1 5' 5' Long 1 36" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 92' Cells Same on other end Observation tubeNent At end of cell A B 23 chambers per cell System elevations: A-94.8' B 94.7' ST. CROIX COiJ.NTI- SEPTIC TANK MAINTENANC,1E AGREEMENT AND OWNERSHIP CERTIFICATION FORM Mailing./ ddress x p 1--__` 1 C t ----q-lrOA Pro perty 1 Wdress L W_.------------------- (Verification required ,from Planning & Zoning Department for new construction.) City/Static; :Parcel Identification NUmber (LEGAL I ►ESCRIPTION Property 1. ocation s±C. la , sec. 2 -2-)'1' N W, Town of Subdivisia a. i L _ F ✓ Jot # Certified ; ►urveY Ma P Volume Page # ---r~_-.. Warrant.-.V Deed Volu ne "Page # Spec, hour yes rlv Lot lines identifYalr e yes no SYSTEM WAINTENANCE AND OWNER CERTIFICATION Imp open use and maintenance of your septic system, could result in its premature failure to handle wastes.. Proper maintenance :onsists of•purnping out the septic tank every three years or sooner, if needed, by a. licensed pumper. What you put into the system ca i affect the function of the septic tanlc as a treatment stage in the waste disposal system. Owner maintenance responsibilitir s are specified in §Comm. 83.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. The >roperty owner agrees to submit to Sr. Croix County Planting & Zoning Department a certification form, signed by the owner and by a master plumber, ,journeyman. pliunlaer, restricted plumber or a licensed .pumper verifying that (1) the on-site wastewater di iposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less dean 1/3 f ill of sludge. 1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with file standards set t ,rth, herein, as set by the Department of Commerce and the Department: of Natural :Resources, State of Wisconsin. Certification s acing that your septic system has been maintained must be completed and, returned to the St. Croix, Comity Planning & Zoning )3epari anent within 30 clays of the tlrce year expiration date. 1/we ertify that all stat:emerrts on this form are true to the hest: of my/our knowledge. 1/we an-dare the owner(s) of the property descr bed above, by virtue of a warranty date recorded in Regisler of Deeds Office. Number of bedrooms--" YJ C NATU f)F APPI,IC.ANT(S) DATE ***.Auy inforn ation that is misrepresented may result in the sanitary permit being revoked. by the Planning & Zoning Department **X Include with th s application a recorded warranty deed from. the Register of Deeds Office and a copy of the certified survey map if reference is ma le in the warranty deed. (REV. 68/05) POWTS OWNER'S MANUAL, & MANAGEMENT PL.AN PIL.V INFORMATION SYSTLM SPECIEICATICINIS-__ Owner Soptic Tank Capacity cal V] N/\ Permit # Septic Tar k Manufactur et I Nil DESIGN PARAMETERS Effluent Filter Manufactinel -1 NA Number of Bedroorns ❑ NA Effluent Filler Model l NA Number of Public F=acility Units A PLInip Tan lc Capacity 1 NA Frurnp `ll anlt Manufactur i 11 NA C_stirnated flow (average) ~7~ gal/day. Design flow (peak), (Estimated 1.5) ~J cfal/day PURIp Mar ufacttlror IA NA _ Soil Application rate ~aUdaylftZ Purnp Model i NA Standard Influent/Effluent Quality Monthly average' Pretreatmcnt Unit 1 NA Fats, Oil & Grease (FOG) X30 rng/L. ❑ Sand/Gavel Filter- I..l Feat Filter Biochemical Oxygen Dernand (BOD.5) <220 rngh. L.:I NA 13 lViecharical Aeration I I Wetland -total Suspended Solids (t-s5) X150 m9/1- IA Disinfec lion 11 Other: Pretreated Effluent Quality Monthly average Dispersal .eli(s) 1-1 NA Biochemical Oxygen Demand (BODs) <30 mUll._ ri-Grottrid (gravity) 1-1 In--C-3totind (pros: urired) Total Suspended Solids (-I_SS) <_30 mg/L. I NA F] - T-Cirace 1-1 Mound Fecal Goliform (geotnetric mean) <9()4 cfu/loor 11 C:l Drip-L.ine [ I Other: Maximum Effluent Particle Sire ill dia. 0 NA ptheE. 'I NA - Orher. NA Other: 1NA "Values typical for domestic wastewater and septic tank effluent. Other. I-l NA IVIAINITENANCE SCHEDULE' Service Everst Service Frequency torttft s) S, (Maximum 3 ye~ 5) 1 1 NA Inspect condition or tank(s) At least once every: El Purnp out contents of tank(s) When combined sludge arid scorn equals one-third (f3) of tank volurne I _I NA Inspect dispersal cell(s) At least once every: El raionth,s) (Maximum 3 yea rs) 1-1 NA --~>4~par(s I D-1 r iorithi s) Clean effluent filter At least once every /J e ar(s; C 1 NA Inspect pump, pump Controls & alarm At least once every: Ll monthl s) l NA C"T year(s_ unthlJ Flush laterals and pressulle test At least ante every C1-11 m year(s)) I-1 NA Other. At least once every: 1.1 rnonth[s) l l NA El year(s) Other: C`I NA MAINTENANCE INSTRUCTIONS Inspections of faults and dispersal cells shall be made by an individual carrying one of the following licenses or certificz tions: IVtaster' Plumber; Master Plumber Restricted Sewer, POWTS Inspector: POWT::i Maintainer; Septage Servil:tng Operator. Tank im pections must include a visual imipection of the tank(s) to identify any missing or broken hardware, Hentify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or punding of effluent or the ground surface. The dispersal r eIl(s) shall be visually inspected to check the effluent levels in the observation pipes arid to checl: for any ponding of effluent on the gi Lund surface. The ponding of effluent on tlae ground surface may indicate a failing condition and requires the irrrmediafe notificatio i of the local regulatory authority. When the combined accumulation of sludge and scum in any lank equals one-third (6) or more of tl re tank volume, the ant re contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordanc.r witty chapter NR '1' ;E, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent titters, mechar ical or pressurized components, pretr wtnrent curits, and any servicing at intervals of ~A2 rnonths, shall be performed by a certified POWT~; IViaintainer. A service report shall be provided to the local regulatory authority within 10 clays of cot nplation of ant, :service event. START U F1 AND OPERATION 1=o1- new construction, prior to use of the POW1:3' check treatment tank(s)for the presence of panting products or oil er chemicals that may irnpede the treatment process and/or darrage the dispersal cell(s). If high concentrations are detected have if e 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 ab3ve normal highwater levels. When power is re-stored the excess v astewater will he discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface dis .harge of effluent. lo avoid this situation have the contents of th i pump tank removed by a Septatge Servicing Orerator ~.rrior to rests ring power, to the oftluent pump or contact a Plumber or POW"; Maintainer to assist in manually operating the purnp controls to rest ire normal levels within the purnp tank. On not drive or park vehicles over tanks and diftpersai cells. Do not drive or park over, or otherwise disturb or compa :t, the area within P -J feet down slope of any mound or at-grade soil absorption area. REaductinn or elimination of the following from the wastewater strearn may irrrprove the performance and prolong the Ii a of the POWTS: antibiotics; baby wipes; cigarette butts; condoins; cotton swabs; degreasers; dental floss; diapr,.rs; disinfectants; fat foundation drain (surnp pumt.J) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scrape ; medications; oil; I ainting 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 t ystern is properly and safely abandoned in compliance with chaptrir Comm 83„ f3, Wisconsin Adrrllni~trative Code, " All piping to tanks and pits shall be disconnected and the abandoned pipe openings seaie:f. Tile contents of all tanks and pits shall be removed and properly disposed of by a SeptagEe Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their, covers removed arid the void spa ;e filled with soil, gravel or another inert solid material, CONTINGENCY PLAN If the PDWTS fails and cannot be repaired the following measures have been, or rrrust be taken, to provide a code compliant repla ment system! able replacement area has been evaluated and may be utilized for the location of a replacement soil at sorption system. I he replacement area should be protected from disturbance and compaction and should not tae infringed t port by required setbacks from existing and proposed structure, lot lines and wells, F=ailure to protect the r :placernent area will i asult in the need for n new soil and site evaluation to establish a suitable replacernent area. Replacement systems must complt with the rules in effect at that time. [ :I A suitable replacement area is not asmilable due to setback arid/(.)[ soil limitations. Elarring advarlePs in POA FS technology a holding tank may he installed as a last resort to replace the failed F101Nt-S. The site has riot been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil ar, 1 site evaluation must be performed to locate a suitable replacernent area. If no replacement area is avaNtble a holding t-atlk rm y be installed as o last resort to replace the failed POW'r S. 1:1 Mound and at-grade soil absorption systems may be reconstructed in place following ri rnovat of the biomat it the infiltrative surface, fteconstnictions of such systi-ms must comply with the rules in effect at that time. <<WARNING>s SEPTIC, PUMP AND 01-HER TREA°rME:NT TdNKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT Ox) GEN. ISO NOT k:N'TER A SEPTIC, PUMP OR CYrHE R TREATiWENT TANK UNDER ANY C IRC:UMSTANC:E& DI' ATH PRAY RESULT, RESC OF OF: A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.. ADDITIONAL COMMENTS POW S INSTALLER NA rnO Name / _Phone --7) -Pfo- lL) =v?r %j,l_ SE IPTAGE SERVICING OPERATQRL tUMPER LOCAL REGULATORY AW"HORITY Name 1..-- c v - - r'hnne hW _21 `1_ Phone i'his document was drafted in eornpliance with chapter 8PS 3f33.22(2)(b)(-l)((t)&(t) and 383.54((), ;2) & (3), Wisconsin lidrninistrative Code. w _ TER CAWFRIIDGE . INSTRUCT.10 ff •Llbtil~.. ~IYtii~#Ir~~~1<rtrt : r r'.v 't Ory tit Ow sulxil' dart" MW tht OW 14 Ills rmtlrtC 011W trr Lr►gurrt it ix Cwfrtura+l rusdpr' rim Lce yc rrlr+►esilly. It tun, tiergt tdtltvr 11%61•t trrulir 0100 itew ttuf tank Hrrauyl► ftkio uuiUt 4r traivaot V#Wd tyluerl 4dr4ltitmal pipe tNric ttlli ituttr►t Motes_ :aYap .1 VYh4the 4100 dtY t1~ tltt titre o(ittet trip's, srwaiaw a 610 ieagtih ul 3* -irwA pip, nwdirpl 4141`4101 OVU 114W tO #re tank OW a it tAttIZk10 the uptifrred Suitpltrruateilui ►:rrtu -t- IV sisiw aeppurt trWhad li, wt a i[Ud, ltretamw in AOP t 111* a -~VP .3 Far M"9400-j{Nttllairig Oft upttartriauopowta+frrtati striu support: selvaai vald Igoe 46-•6nch lm at,i:u thin fitttt rase- if altar SUI ►utt. MBttidrl y twat utNiaed, teroshtttd to *1W-11 four. j/ ''tM ~W V SetW ut tit 'itltil cage tttltq thu t+tlilbt },iur _ lb,a t,rt Clem lilts l ° t.4 4M cartodgrr rrito ~tw taartr, wousing duvwe alat'N' ttps fi.': ri.u rasv_ IFur striate, irises tarts i►ur~n,s, vl'' ~;5;~ ?l;r If d VJIL' ul *111 s in uHli:twd- Ihnn:•t le►ta tl.,e °;ry rklekWite y0'', afeu i,rt;it try lurtruig M'r~te>rt~alpw~ 7'hre etiiUunl4 iVltr►r prlroryd kle tlr#;rlresi every ilrrakt tit,; ruutlc; I.uph i serviced. l.. 004m the utoflet ettcasd ulfrri,testp to 1rY51taGt thck tun k• atril Nitctt, JrUrrrp tira argtytte' raerfk' ts+enp~ulttlY, teYakfrid utlrti to r t Itryasr uri that+buktes" of J'J#w E"+rtk urnl ttit7t L'fasl 5(Utl~ae, r ►tnt Jura ttrv arUrrr 40 airs u, il'rq:r, tlrn etal~utuvt trtrvrrl ham L•itruri tvwwrae) bolo s9ryliluttl.. aketttnE 006, lirnelp 0011) a/lr rrs, ttrtr Hltrtr irnrrdlrt ( lieu ertVrJl't rrV t'itU 6r ebwtrie v" burr t(llrg ktamjJ ditlhtd a ulla S; stlriu for rartr tllr +ttrd orw, at'tlre Omar ttlr ileutlietg, !r 1( IktS swkt!!0'fe,t tywwruclrnl to ,Tito- aiiarirl is 11htttrtret, struuld t►e rrtrrtuvetJ by treralnrY rrurrtxtrdraCkWltlcy ${le Wftir W:ttrrJ' atria. ~ieU swats h kAd t4willod 7. WNile wably lakes r.'a "Ohilso 06 Ols ari(Jal it, i dawn) utror Oil 4Mw;z a raw dart s t' aniyr iYFOINIOtl pttrdtN3r 1141619 171~'the t: vitrFg~o racirYp , U111-0 :rMl tr ulrlallm rullettyrtJti isr ~f'rldlirr tNittt w "t. t1_ rl V10% switrit is utili;cW t'Itra►tttt tMek 1 trlc,Y +N kWl'. twr►riklO ri'er9kwise ilr ~rlrtlf 1► iry Illgartll ttl'a ttre I+drrl . ~ prha Hitar tvrtd . ~ ~ J, 11+yvrC"0 iiltt ewrteid " i aia. i isle ti►e tUtrrr ItMkO logo t'hu LrrHrw•r tit; ~d~elt , Art11y1d drtWrr 111rtii 1 ~ the cwrsn. `y"'1 ' L' Ito. ttapiatn btld 5tgt)lira tram . a at''uw' I1filtliliYi t y ly"'' 11 the jttq t'~rJtl(. ft, r.: tr• :Ir .L. • "!:I Yr:. Vpl:"Ita~rYtf I: uV1 wyl' , rp• • c IfWt i.d: .ry.:,d4f . j i ~ata9. 4t $ Tx:41 ~ 1398 4 18 9 STATE BAR OF WISCONSIN FORM 3 - 2000 975248 QUIT CLAIM DEED BETH PABST Document Number REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, Grantor, and Oevering ST. CROIX CO., WI Homes LLC, Grantee. 03/20/2013 09:08 AM Grantor quit claims to Grantee the following described real estate in St. EXEMPT#: 0 Croix County, State of Wisconsin (the "Property"): REC FEE: 30..00 TRANS FEE: 449.70 PAGES: 2 Lots being sold `as is'. SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Title One File 19240 Together with all appurtenant rights, title and interests. see attached Parcel Identification Number (PIN) This is not homestead, property. Dated this 15th day of March, 2013. Citizens State Bank - A~c /4-( ~2- Zez *71A H Van erBroeke, Ice Prest ent * * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST CROIX COUNTY. ) ss. authenticated this 15th day of March, 2013 Personally came before me this 15th day of March, 2013 the above named Citizens State Bank, Alan H VanDerBroeke, * Vice President to me known to be the person(s) who executed TITLE: MEMBER STATE BAR OF WISCONSIN the foregoing ins ent and acknowledged the same. (If not, 7~, authorized by § 706.06, Wis. Stats.) Evelyn Jaeger ` THIS INSTRUMENT WAS DRAFTED BY Notary Public, State of Wisconsin My commission is permanent. (If not, state expiration date: ) Michael H Forecki, Attorney 12/16/2016 (Signatures may be authenticated or acknowledged. Both are not necessary.) 'Names of persons signing in any capacity must be typed or printed bel maul bC EVENo~oryW,~nst~ state 1 of 2 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000 File No.: 19240 EXHIBIT A ots VIN 040-1303-00-008;Lot 9, PIN 040-1303-00-009; Lot 23, PIN 040-1303-00-023;Lot 28, 040-1303-00-028 and Lot 40 PIN 040-1303-00-040 of Walnut Hill Farm, All in the Town of Troy, St. Croix County, Wisconsin. 2 of 2 HOW lad 1 r- Q J z g ~t= o ob, 1111 Al lob! 1~2t 11 I i ~z i 1 4 -I .y. V-. I H ; •1 I l I gg I ~~y 1 I „e.na v. xn YZi4dnYexc I I I aaulnWUanvovYexvz 1 ~ I ' I Y~iv 3xnv,vx oxwUV i" ; i I I I ~a ~ I I u I I l t I I I I I YUZ vcuvuti:m I I~ I 1 a II I~ s.Y zn~U I l $ I I e I I I U I I I I % Y lynx I I - I I I I I I w I I ® f0 I I u .x A l I I I W ~x I I .e~Y .Y 1 I Y ~ I I l y I OI J I _.n L V I I In® l~aa C ____J .I L__J1 r I YY I Is' § I I I I q I I vsui vswnuiUCnus' m I f I I I ~I ; I I I I ; I I I 1 t ; I v~~3rvn~iYM490YW u lilt '6S Vl o~ j° - - - E J ~ r I~ Q e w k t t5 3 sp as cn M J Q him Illm Illm 1!!111 ;g ~ utltmm o .u .ut J J x . to ui ~.r Q :fi uy~ gy Igo ggy~~5 Q Iu>y'l 9~i i ~ yLL C1 ~ LOU', :S'S 0 J z z ~ I s4~': a Qa ~ ~ ~Z~ m I I / i i i - L. I n.n.ueTVO I Vi k W rv J y~ ail _ i 1 I.n :S i. I k I 8 ~ ~b , 447.M' J Vu I a/ C avu./1 cy o2 67. 373.79' S 00072 ' E 332.54 _ ,y N 169.49 4: . bi N, 14, 40 in Boa n$ 'ie / r+ N~ ' 'i 1 NN+S~~I• ~~~y+ Mn ? I~~ n 1 , 1 0 1 ! V T• t 218 + 1 y~ µ 12b '0~ y1 927 Ilk W ~i: J" 11 1 ; 1 ` w 39t.1~ w ~~.qq] + 'r { O $N 1 ~c~► o •o j M t2~906 ` r^ 1 col to 3142 W W 1 r 345.11 8 1 Snl 1'` l µ ! U16 $ 1~ f -Al 1V CNI Vi ti m► 68 I~f 3~ ~o .431 cra In loy 73 Y z 49 0 V1 \ Z . t. , .0 co § 0 22 z 40 pow 1. >~W CSC iN,9'\2~i 4 / i-L-~ '~~i • ws vw ^ Ul -----N °1 Mgt 4 i Wis~ in Department of commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code county ST. G~ 0/ x-- •V Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must L vT /N 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. VeAJA9lJ3 G^'" Zl Please print all Information. evierved b Date J~~ Per**" kt(ortnation you Provide mey be used for secondary purposes (Privacy Law. s.15.04 (1) (m)). 11131U Property Owner C TaDO Property Location t Z8 O 'j-'Opp 133ERST-e7D ~ /O 4114^' JY/t'1• ~ Lot 1411 OUMt 5- 114 S T N R E (or) W Property Owner's Mailing Address L Bb& # Subd. Name or CSM# o i S CA tE i LL AV-R- W 41A1, w v T' Iti t I FA JeA-( t~ city _Icmwr2 State Zp Code Phone Number Q City ❑ Village W Town Nearest Road 61POVE H n_jl4AJ 550760 ( &5t) 2,98' IDf ~ -r-,eoy S4. C r 100 E 12 0 reP GPD D ' New Construction use-. I9 Residential ! Number of bedrooms Code derived design flow rate ❑ Replacement ❑ Public or commercial - Describe: - tA Parent material ID Ef S dU-C~ OV AW 4-4 -ski WOS Flood Plain elevation if applicable ft. t General carrnents _ and recommendations: TeS T eZ-) ~ 0 / 7-1 r~ JRn el fl f /e0 UA)v SA d. c,~• T:s . bw_ Ham`- 3 s vv Boring soft ®p Ground surface elev. ~ 7 fL Depth to rrcrnitirng factor in. a# ~ Application Rate Horizon Depth Oomiriant Color Redox Description Texture Structure Consistence Boundary Roots GPDW -1 in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. *M1 'EfW2 \ /0 Yle 313 z- ;4shX 79 -A Tzo .3 f- Z ' 3 Z N. 27 / •S/ G~fJ 174- %A 0 Boring LS l • Gt./ ~9 # ® Pit Ground surface elev. • Z ft. Depth to limiting factor>_ / in. Sol Rate Applicadon Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffEfl#2 in. Munsell Qu. Sz. cont. Color Gr. Sz. Sh. 'Eif#1 ' n / Y /3 Z- 75-T 3 -5 N Z 1--- S~~ cw 1 • 'Z • 3 N 46 -31 m 00 3 3(,3-q 75 • G-S 2. ' Effluent #1 = BOD > 30 < 2M nVL and T >30 < 150 mg& ' Effluent #2 = BOD < 30 mg& and TSS < 30 nWL CST Name (Please Pfit) R ..u t.(3 R l C; 1►~ Signature "iC 22 G j "j 5 Address Ulbricht & Ass9ciates Data Evaluation Conducted Telephone Nun-Ow Private 2812 10th Ave. Spring Valley, WI 54767 yo s P/Xs FOR 4PRR©x . 2- r rya ' ~o~ s • so . z. D yo . fo . ~o • o~ • zo • oaa 0'Ya • log(, o yd - /096 • ~4 70• a oY0- /0 *6 ~'o -cad 0 %0 • /a e& s. a Cvti V T` firi//tt,PM ' ?o.PV /31e e STEDT- ~J aa 3 t Ground surface eiev. . 7• YO ft. Depth to Smiting factor > U IrL Fbrtzon Depth Dominant calm Redox Desa"ort Texture shumme CO Wstence Sat Rate Roots GPM in. Aricstse Qu. 5x, cont. Color Gr. 5z. Sh. 'Etf#2 •s S G / s c y oo, • C• C1 Sodng F-1 # ° ❑ pit Ground surface . Fit * Depth to limiting factor in. son Rate 4lorizorn, D" DominaM CZo, Redox De6"on Texture Structure consistence Boundary Roots Murseii Qu. S•z cunt color Gr. Sz. Sh. 'EW Tff#2 1 Boring # ❑ t3orrrrg , ❑ Fit Ground surface elev. ft.. Depth to tirnffing factor In, Applicadon irate Svc Horizon Depth Dominant Color Redox Description- 7 Structure Consistence Bot"ary Roots G -PM In. Mtnsell Qu. SZ Cont. cow C . S. Sh. 'Eff## 'Etf#2 j k s f., F Boring # ❑ Boring ❑ Fit Ground surface elev. ft. Depth to isrirting factor in. Sod Application Rate Horizon Depth Dornjnani Color Redox Descdpdan_ Texhre Shuctue Consistence Boundery Roots OPON Mural Qu. Sz Cont. Color Gr. Sx. Sh. °Eff## 'Eff#2 • Ef kwd #1 = BODs > 30 1220 mgtt. and TSS >30-,c 150 nsglt. ° Effluent #2 = BOD$ < 30 mgA. and TSS < 30 r nWL The Department of Commerce is an equal oppoilunity service provider and employer. If you creed assistance to access services or treed material in an alternate format, please contact the department at 608-266-31St or TTY 608-264-9777. aea.ai" Ouw) laertyOwner Parcel ID# Pam ` of 3 C) fog 3 t Ground surface eleu 7' ft. Depth to 11M.tting factor i 4MtZOn Soil ie Rate _ Depth Dtxrtinant Color Redox Oesaiption Texture Strudute ttxesisterree f3cxt~tttary Roots ff ~ Munsell Qtr. Sr. Cont. Color Gr. Sz. Sh. `E#T#1 'EM / d i Z- ~0 3 L -',5h t S w 3 F . Y . .S / w if .Z .3 .s SG l s c Y . c•Z Bodng # t3oattg Ground surface elev.. • • ! ft. Depth to limiting factor in. Soil ic4on Rate .k Dominant Cokq 0d= Cba6'pfrcan Texture Structure Consistence Boundary Roots GPC3ff - Munseif Qu. Sz. Cora Color Gr. Sz. Sh. `Eft#4 'I_ft#2 Boring El E] Pit Ground surface elev. ft. Depth to lirri trop factor ire S tOn Rat Horizon e Depth DorMnant Color Redox Destxip6on_ 7 Structure Consistence Boundary Roots Gl'I1 Murrseil Ou. Sz. Cont. Color Gf- Sz. Sh. `Eti#1 'Eff#2 Fl' Elating # Boring pit Ground surface elev. ft. Depth to W" factor in. 'on Rate Sort tiortzon Defrt0l Domlrtant Redox Description. Texture Structure Comistence soundsty Roots 43POffe In. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#t `Eff#2 ` Effluent #1 = BOD, > 30:S 220 mg& and TSS >30,c 150 mg11. ° Effluent #2 _ BODs < 30 mgll. and TSS < 30 rnA The Department of Commerce is an squat 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 609-264-9777. &8DlSrO {RbrtlO) • - PLOT PLAN WALNUT HILLS FARM. LOT # Pg. 3 of 3 = Contour elevation lines. • = Backhoe Soil pits. O = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. SCALE : 1 " = J F1 yo `1 a .3D 63 39o 2 !o 9 1 T3,Al ~M z 1 1 &tAl ©v~~ Lai