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HomeMy WebLinkAbout040-1306-37-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 567296 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: Clevering Homes LLC, aka Oevering Pro ertie I Troy, Town of 040-1306-37-000 CST BM Elev: Insp.BM Elev: dBM Description: Section Town/Range/Map No: /�• z G5 08.28.19.1864 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER . CAPACITY STATION BS HI FS ELEV. Septic 3 Benchmark Alt. BM 3, Z,5 /DL -1 5 Aeration Bldg.Sewer _ S. 3 X7.9' Holding St/Ht Inlet 9 7 7 • Z St/Ht Outlet TANK SETBACK INFORMATION 7- 3 '7 L • T TANK TO P/4 WELL BLDG. ent Air Intake ROAD Dt Inlet Septic Ij n— 3 9 } 5� , y Dt Bottom 7 f� Dosing Header/Man. Aeration Dist. Pipe 97 9t, 5 Holding Bot. System /D• 75- (® 7S - PUMP/SIPHON INFORMATION Final Grade N• / /�Z• I Manufacturer Demand St Cover P , • .�.�.. 3.Z5 /,0Z •9 Model N ber TDH L' Friction Loss System Head TDH Ft Forcemain Leng IF Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of Trenches PIT DIME SjJ IONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS —2 1 _ .Z i feK`' `^ �—� `—__ SETBACK SYSTEM TO `l P/L BLDG WELL' LAKE/STREAM LEACHING Manufacturer: �/7 , " \ INFORMATION CHAMBER OR _r►r-1 I A*t.t�dt- Type Of System: n Z7 57 JA— r l UNIT Model Numger. Co.n JAB k DISTRIBUTION SYSTEM E -- n /- / Header/Manifold Distribution x Hole Size x Hole Spacing V Pipe(s) J Length o Dia / Length \`� Dia Spacing e SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth f xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil es 0 No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 405 Jordyn Lane Hudson,WI 54016(SW 1/4 NE 1/4 8 T28N R1 9W) Sunset View Lot 37 Parcel No: 08.28.19.1864 1.)Alt BM Description 2.)Bldg sewer length -amount of cover �0 O✓� Plan revision Required? Yes >No 5 Z r Use other side for additional information. _.___ SBD-6710(R.3/97) Date Insepct s Sign. a Cert.No. PLOT PLAN PROJECT Overina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 NE 1/4s 8 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 12/15/13 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 .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. B.M. #2 Top of lot corner ASSUME ELEVATION 100.2' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 96.0/95.6' 4.5' below qrade All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Pro Town Road I 100' 98' 100' I �p B- 50' So a Pro 3 Bedroom House B-3 50' Property Line 2-3' X 66' cells with>3' spacing 6% Slope Vent B-1 >6» Quick4 Standard Vents of Cover Leaching Chamber with 20.0 ft2 of Area 1 5.6ft^2/pair of end caps g 2 ' 4 Lon 34„ Grade at System Elevation Scale is 1" = 40' unless otherwise Property Line noted Property Line .....-0-i ii,4 County C r ,p , Industry Services Division �'. e CO/A ► 1p . . rit��3 ' 1400 E Washington Ave Sanitary Permit Number(to be filled in by Co.) ;• , RI t I. P.O. Box 7162 : \��' NTt Madison,WI 53707-7162 5(07z, Co Sanitary Permit Application StateTransacti Number In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the ap• L 'te f mmental unit is required prior to obtaining a sanitary permit. Note:Application forms for state-owne. i .• . - emitted to Project Address(if different than mai�g address) the Department of Safety and Professional Servies. Personal information you provide ma .- u •• :.se .ndary4_yO5 .Tpl. / T4rf„ JE_ .0 ..ses in accordance with the Privac Law,s. 15.04 1 (m),Stets. I. A..lication•Information-Please Print All Information —�_ , WU.LO` Property Owner's Name ( Parcel# .ever/r j&i 4LC . 9 -1..5.D‘'-.37 COO Property Owner's Mailing dress Property Location /r � �P7V ( c JwitX-, Govt.Lot City,State ) Zip Code Phone Number 5c2/ y.4/k v.., Section Cam/ /C_./ /� l jj�j lrcl ! -7.2. --N; R/ or W II.Type of Building(check all that apply Lo ((( yor 2 Family Dwelling-Number of Bedroo Subdivision Name 2 u• .atufe., Blo°lm.......-___ _Su/J 01 e.C.(/ ❑Public/Commercial-Describe Use • _ ❑City of •❑State Owned-Describe Use I //// l_ /l_ CSM Number ❑Village of 2 01: 4- CeAs I.J <(0 7�/tP ,.ri.,_(� own Of--,� III.Type of Permit: (Check only one ox on line A. Complete line B if applicable) A. Llew System ❑ Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑ Permit Renewal ❑Permit Revision '❑Chan. hange of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration . Owner .Pe � . /J IV.Type of POWTS System/Component/Device: (Check all that apply) 4. al.):ek, 4. .�.d1 ' Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑ Mound<24 in.of suitable soil iJ� ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) K r5 V.Dispersal/Treatm nt Area Information: r 5-l'3et!sc ) q.'' Design Flow(gpd) Design Soil Application Rate(gp Dispersal Area Required(s Dispersal Area Proposed System Elevation / VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units s, II c's , New Tanks Existing Tanks 'a CUa, " a U in � v; t7 Cti. Septic or Holding Tank !�'r9 / / ,� /� / G r (_.tom LLL Dosing Chamber VII.Responsibility Statement- I,the undersigned,assume y /nsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) ' Plumber's f re MP/MPRS�Number Business Phone Number --1 0�ACC4,(.)L- l7/ ✓C / �'�l� zG Kil. 7/J',1 -/-(7,i Plumber's Address(Street,City,State,Zip ode) Y Z ZO < 4/ '. /� / f �VIII.I.County/Department Use Only / I�1CApproved ❑ Disapproved Permit Fee Date Date I sued Issuing t Signatur ' ❑ wn ven Reaso r Denial '$ +'" ' I�'�2/?3 / IX.Condi ' easons for Disa roval ' n ���� /n► - l- .' Septi an ,effluent filter and pP ,3) Av:� '/he. 40 %ra ,7-cae+ AetA �,,`I�G01...A . dispersal cell must all be services I maintained 1, t'A.�r'.r4-a-.�+'e+� . as per management plan provided by plumber. /Ai"�` `3 2. All sefi¢ack requirements must be,thaintained • as per applicable code 1 ord naricas; Attach to complete plans-for the system and submit to the County only on paper not less than 8 I/2 x 11 inches in size SBD-6398(R0313) • Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 12/15/13 Owner: Oevering Homes Location: SW1/4 NE1/4 S8 T28 N,R19W Lot 37 Sunset View 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 Specifications She,. ::a::Test License number#22:00 PLOT PLAN PROJECT Overina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 NE 1/4S 8 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX 12/15/13 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 .7 ABSORPTION AREA 651 # of chambers 32 BENCHMARK V.R.P. B.M. #2 Top of lot corner ASSUME ELEVATION 100.2' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 96.0/95.6' 4.5' below grade All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Pro Town Road A 100' 98' 100' B- _ 50' • 50 20' 20' Pro 3 ST A Bedroom House 3 ► II %.3 50' Property Line 2-3' X 66' cells with>3' spacing 6% Slope 40 Vent B-1 >6,, Quick4 Standard Vents of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 4' Long Grade at System Elevation Scale is 1" = 40' 34" unless otherwise Property Line noted •-41 Property Line Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leachin g Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 100.5' Vent Grade 00 Vent ■ 3' 4" 3' A 30/34 Septic Tank 4 Alk Oft5' Long 5' 5' Long 36" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 66' Cells Same on other end Observation tubeNent At end of cell A 16 chambers per cell B System elevations: A 96.0' B 95.6' POWTS OWNER'S MANUAL & MANAGEMEN1 PLAN Page of___._ FILE INFORMATION SYSTEM SPECIFICATIONS Owner _— Septic Tank Capacity . gal ❑NA . OPJe7 i fit. _ � - Permit# Septic Tank Manufactui er / czy.„ ❑NA DESIGN PARAMETERS Effluent Filter Manufacturer_ , - �'� __DNA_ Number of Bedrooms 3—��D�-NA Effluent Filter Model —_ �` --- 0 NA Number of Public Facility Units -15-NA Pump Tank Capacity _ ••al a NA• Estimated flow(average) — (j gaUday Pump Tank Manufacturer III NA Design flow(peak), Estimated x 1.5) 41,j'22 Pump Manufacturer — — �� NA` g } ( } gal/day_ Soil Application Rate ' g al/da /ft y z Pump Model —_ ►i NA __ Standard Influent/Effluent Quality Monthly average.' Pretreatment Unit it NA Fats,Oil&Grease (FOG) _.30 mglL 0 Sand/G•avel Filter ❑Peat Filter Biochemical Oxygen Demand (BODs) 5220 g/L 0 NA 0 Mecharical Aeration ❑Wetland Total Suspended Solids (TSS) <15O g/L ❑Disinfection ❑Other --- Pretreated Effluent Quality Montitly average Dispersal�:.ell(s) 0 NA Biochemical Oxygen Demand (BODs) 530 nag/L ►' n-Ground(gravity) 0 In-Ground(pressurized) Total Suspended Solids (TSS) <_30 mg/L 7NA ❑A-Gracie ❑ Mound Fecal Coliform(geometric mean) 5104 cfu/100m1 ❑Drip-Line ❑Other: — Other: NA Maximum Effluent Particle Size in dia. DNA ,____—_,—_—____Y_______ _.A Other — --- __ A Other. ---- _ _ ------ NA *Values typical for domestic wastewater and septic tank effluent. Other. NA MAINTENANCE SCHEDULE Service Event Service Frequency O month`s) Maximum 3 years) ❑ NA Inspect condition of tank(s) e` s) — At least once every: � 7 years (Maximum y ) Pump out contents of tank(s) 1Nhen combined sludge and scum equals one-third(1 )of tank volume — __ 0 NA — —"-- — -- --, D months) Maximum 3 years) DNA Inspect dispersal cell(s) At least once every: year(s,� _ ( __im— Y } Clean effluent filter -- -- At least once every: _ D eats s) s NA -.----------- — — / Ci months) —___ _ Inspect pump,pump controls&alarm At least once every: , ❑year(s) — _ I NA Flush laterals and pressure test At least once every: fl month`s) n NA t 0 years,_ __ Other: ------ ---____.__ 0 months) NA At least once every: p year(s) —_—____ Other: ----______— — — --_ .n 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 POWYS 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 or the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to checi: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(6)or more of tl ie 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, mechar ical or pressurized components,pretreatment units, and any servicing at intervals of 512 months,shalt be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of an!!service event. Page --of, START UP AND OPERATION For new construction, prior to use of the POW1 S'check treatment cell(s). If the presence of painting products or detected have therconteMs chemicals oftthe may impede the treatment process and/or darrage the dispersal ( ) high removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be uent. discharged to the dispersal cell(s)in one large dose, overloading the cell(s)and may result in the backup or surface discharge oofffo tnt. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact,the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain 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 biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC,PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS • POWTS INSTALLER POWTS MAINTAINER • Name Name�7a Ll vL% b j:10, iv � // OF Phone 7/lam Q2/4` P hone �/ �- 7J SEPTAGE SERVICING OPERATOR(P MPER) LOCAL REGULATORY AUTHORITY Name .x.21< �- Lim ..-- Name � _ S 1 Phone —,S7‘73 Phone 7/, This document was drafted in compliance with chapter f#PS 383.22(2)(b)(1)(d)&4 and 383.54(1),(2)&(3),Wisconsin Administrative Code. ��.t 1�R'11(f ... I - - -__I� FILTER CARTRIDGE INSTRUCTIONS_„ ____ S TM lu Installation - STEP 1 Dry fit the filter case onto the end of the outlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the , tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. - STEP 2 While the case is still dry fitted on the outlet pipe, measure the length of 3/4-inch pipe needed to brace the filter to the tank end wall if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3/4-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressing down until the filter locks into the bottom of the case. STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 90°. - Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. 2. Open the outlet access opening to inspect the tank and filter. M, 3. Pump the septic tank completely, making sure to remove the sludge , I _' layer on the bottom of the tank and not just the scum and effluent. - s- 4. Once the effluent level has been lowered below the invert of the _ ` NM III outlet pipe,firmly pull up on the filter handle to dislodge the cartridge from the case. 5. Slide the cartridge up and out of the case for cleaning. "" 4 �,. 6. If a VRS switch connected to an alarm is present,the switch , . , should be removed by turning counterclockwise 90° and cleaned with water only. is -I..} t 7. While holding the cartridge on its side (large flat surface facing down) over the access opening, rinse off the cartridge with water _ l . only, making sure all septage material is rinsed back into the tank. 8. If VRS switch is utilized, replace by inserting into filter and turning clockwise 90°. 9. Insert the filter cartridge back into the case, pressing down until - -_ ` the filter locks into the bottom of the case. °. _ 10.Replace and secure the access opening on the tank. BEAR ONSITET"FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY Bear Onsite filter cartridges are warranted to be free of defects in material and workmanship for five(5)years from the date of consumer purchase. BEAR ONSITET"Filter Case-Lifetime Limited Warranty Bear Onsite warrants the filter case will be free of defects in material and workmanship during normal use for the period of time the original purchaser owns the product. If a defect is found in normal use,Bear Onsite will,at its election,repair,provide a replacement part ort product,or make appropriate adjustment.Damage to a product caused by accident,misuse,or abuse is not covered by this warranty.Improper care or malfunctions resulting from units not installed,operated,or maintained in accordance with instructions provided will void the warranty.Proof of purchase(original sales receipt)must be provided to Bear Onsite with all warranty claims.Bear Onsite is not responsible far labor charges,removal charges,installation,or other incidental or consequential costs. In no event shall the liability of Bear Onsite exceed the purchase price of the product. uIr III • - Oc" e)34 1` E-� c°v c�v 4•5 6.-.;) Q 7■ I _-coy; 1 �,� ., \---' Z'°_mil I. tt E-4 ir:0 t Ln T A\\** -in 0-c ' 2 L - r ' ' A < tw �. - ' fy � CO o4.1 41C ; (4 ��� t .4.1 \'e'.4.---- o © N � I • '05 ,...,‘-'i CV ' . *CI\ \1-4 It In vt ........"'..-' libi'(.4 . /lin v) .0\ A. w• @ .�'' W09 47;iv! . 1 1 SQ.9S• I D o I REC. AS NO0'05'30"W N 1 .—< �: o • w I 7Q-rat y_ -'10� 1 E`l e u I c' a o f ¢ H i, ` t in in o a f I #+)1M' a --It .— —-.A if) ‘.- -.- -.1 :4 . NJ I: Cloi - N.' p__ ' 2 'g C, „ I Z '^`J > C) CJ �ti W V ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM • Owner/Buyer (9ecd e r L 11, Mailing Address /,71 s �P/�a v1a�� � �� Au Z,` / % i�7J 7 Property Address k90 7-.be l ZA-gc (Verification required from Planning&Zoning Department for new construction.) City/State F UL)SO Parcel \ Identification Number 07'Y )3v �'7- - ) LEGAL DESCRIPTION Property Location)c. ) Y ,NE E Ya, Sec. , T 2 N R l W,Town of /70 Subdivision et S v l ef—C-Y ��?� , Lot#3 �. Certified Survey Map# , Volume fI ,Page# Warranty Deed# 97 19 55-2/ '---- Volume ,Page# Spec hous Ofp no Lot lines identifiable no SYSTEM MAINTENANCE OWNER CERTIFICATION; Improper use and maintenance of your septic system could result in its maintenance consists of pumping out the premature failure to handle wastes. Proper Pump $ 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 P owner and by a master himbez 'o p � P tanning&Zoning Department a certification form,signed by the plumber,journeyman lumber,restricted lumber 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 on are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above,by virtue of a anty deed recorded in Register of Deeds Office. Number of bedrooms- ' IGNA O APPLICANT(S) �`'�l/s 17�'T DATE y 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) 101 I 101111111111111 I, • State Bar of Wisconsin Form 1-2003 8 Tx0 1 993 6 WARRANTY DEED 990552 •Document Number Document Name • BETH PABST — — — --- ------------- REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED;made between B& L Land Development,Inc.,a Wisconsin 12/19/2013 11:35 AM Cnrpnratinn EXEMPT#: NA ("Grantor,"whether one or more), REC FEE: 30.00 and Oevering Homes,LLC TRANS FEE: 179.70 • • PAGES: 1 • • ("Grantee,"whether one or more). Grantor,for a valuable consideration,conveys to Grantee the following described real Recording Area .estate,together with the rents,profits, fixtures and other appurtenant interests, in -St.Croix County,State of Wisconsin("Property")(if more space is Name and Return Address needed,please attach addendum): River Valley Abstract&Title 1200 Hosford St. Suite 201 Hudson WI 54016 • Lot 37, Plat of Sunset View Development in the Town of Troy, File: 400037 St. Croix County,Wisconsin. 040-1306-37-000 • Parcel Identification Number(PIN) Dated December Z/ , 2013 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: Easements,restrictions and rights-of-way of record,if any. B& L Land Development,Inc.,a Wisconsin Corporation • <=- � (SEAL) (SEAL) *ALy Weatherholt,President/Treasurer (SEAL) (SEAL) * • * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF KENTUCKY • authenticated sin )ss. �/�Li"SON COUNTY ) * • Personally came before me on December i9 ,2013 TITLE: MI MI3ER STATE BAR OF WISCONSIN the above-named Lyle T.Weatherholt, (If not; President/Treasurer Ifnotized by Wis. Stat.§706.06) to me known to be the person(s)who executed the foregoing instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: Fran Iverson.. rti •. 1200 Hosford Si. Suite 201 Hudson WI 54016 Notary Public,State = Ken ucky My Commission(is permanent)(expires: ��' r � (Signatures may be authenticated or acknowledged. Both arc not necessary.) NOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDE NTIaI;< Poi,e . WARRANTY DEED m 2003 STATE BAR OF WISCONSIN FORMt14 t1.4003#,J• �" �,' •Type name Wow signatures. �' .g,t • 1 of 1 . .,.� e -";;44.i.pety RECE" Wisconsin Department of Co erce S 41 I L EVALUATION REPORT Page \ of - ' Division of Safety and Building. p 0 2 2004 M".rn accordance with C'mm 85,Wis. Mm. Code County S 1 C�p)Attach complete site plan on aper grist td �� Kx 11 in. es in size. Plan must include,but not limited to:ve cal anctiii.,r - _ - - - 'suit(BM),direction and _ ,�y, percent slope,scale or dimen•.. o 1 arrow,and location and distance to nearest road. Parcel I.D. ` Z r �-�-'U Please print all information. 1 Re, ewed by ''Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). " '" �""u, Property Owner Property Location 1 8 L --\- w .z-0 Al r�"J 1- S w 1/4J 1/4*S • T Z8 N R Zel E(JW Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# • o. fox 3 -- 3�1 — Sor,, ,z-i- v1. - E\), City State Zip Code Phone Number ❑City ❑Village 0 Town Nearest Road 3R M LR r ON► I S X1 %.10 l (--11 S )LJgS-33 S 1 T1Z-01' I IZI New Construction Use:3. Residential/Number of bedrooms —Li, Code derived design flow rate L-1 S 0 — j 00-_ GPD ❑Replacement ❑ Public or commercial-Describe: Parent material G L'e) V-;- .. _j&'i ' H Flood Plain elevation if applicable N.)1- t. General comments and recommendations: .•, ' M 1U-cL 3 wt DL cell_S /)n l--7(271-?-4N710 Z L 86 110 I'vl 01= C--. -S 1i Yom)kJ LIZ, Ps'.)� y -X S q 4 '� t � 1 1 I Boring# ❑ Boring _ _ � C, cy�• ® Pit Ground surface elev. )�V. ft. Depth to limiting factor > C1 in. ���' • Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure I Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 i 1 0—`Z. l VI re-3/3 — L 2 mS`o( Yrl`f`r' Ct,v Z, • S ,(P Z vz.:321.S•-tIZ 3 l 3 y \s o S� I w) I w - ,, i,� .3z 93 to-trZ �I/ — S 0 S9 vvt I — .--� " - _ Boring# ❑ Boring ® pit Ground surface elev. \)O ' Z ft. Depth to limiting factor a 7 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 'Eff#2 O—\Z \ )L 3 - L Z.1'vrS 2 W 1— CL-,.) Z•P -S -C3 1,g, Z 1Z-3b -1.S`1 IZ3/y — \g 0 S') wi I CL,../ — --2 1, Z I.7_ 3 30 aAl toy rZ sl 4, / S p S9 wt 1 ^ ) \, ` .� Ci."7\-- II , • Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BCD,<30 mg/L and TSS<30 mg/L CST Name(Please Print) e� Signa a CST Number Arthur L Wegerer 03 Z1S — 37 220254 Address tl e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 li. Hain St. River Falls , (II 54022 \Z- aZ— O 715-425-0165 Property Owner ` Parcel ID# N G Z Page ' of -' I 3 I Boring# ❑ Boring C� ® n.Pit Ground surface elev. U 'Oft. Depth to limiting factor 7 "7 In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/tl2 in. Munsell Qu.Sz. Cont.Color Gr. Sz. Sh. ` Eff#1 •Eff#2 O VZ I U`!2 3/3 W\4\1-- S •$ Z ‘.-z- 5 t O�-f 2 316 — si I Z�I s bk r� P1- e s , S .8 2 3 S`3Z tort `//6 - S U rn I - .-i - Z I 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 •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 •Eff#2 • •Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD5<30 mg/L and TSS<30 mg/L The Department of Conunerce 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. SOD-8330(8.6/00) Property Owner € ` w����()[7 N� �— Parcel ID# J J 6 Page ' of Boring# ❑ Boring n. ® Pit Ground surface elev. 61 S 4 U ft. Depth to limiting factor 7 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 •Eff#2 "O 1-Z 1 u`12. 3/3 — Z �Z " `�h e w -2=9 • 5 . 6 Z ‘..z.-3s t `�f R. 3/6 S i t Z�'t') s bk myP>- e> _ - S z o 3 3S`?Z td`-f y/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#1 •Eff#2 Boring# El 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 'Eff#2 Effluent#1 =ROD,>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOO,<30 mg/L and TSS<30 mg/L The Department of Conunerce 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. S©D-8330(R.6/00) Wisconsin Department of Commerce SOIL EVALUATION REPORT Page • cf Division of Safety and Buildings • ' in accordance with Comm 05,Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Count must y S t include,but not limited to:vertical and horizontal reference point(BM),direction and . .C� percent slope,scale or dimensions, north arrow,and location and distance to nearest road. Parcel LD. ;N -)1 Please print all information. Reviewed by G . "Date Personal information you provide may be used for secondary purposes(Privacy Law,s,15.04(1)(m)). Property Owner Property Location Property Owner's Mailing Address r J .114.k.);.-:-1/4 SS i Z N R E(or)'N Lot# Block# Subd.Name or CSM# - 0- Sox 33 --1 City State Zip Code Phone Number S�� � V l�N �`� LR Iw 1 15�) g1 (L = )� J-23 S 1 ❑City Village Town Nearest Road ,B PIA-Si:144 New Construction Use:E Residential/Number of bedrooms � -L-L. derived Code derived design flow rate L1 S - U�- ❑Replacement — Gpn ❑ Public or commercial-Describe: Parent material G L,p.)el \_ 111vl°) ; Flood Plain elevation if appli�ble (�[`1 General comments ft. and recommendations: �" --..--,..),..)\:::; , \,�L. -1 r-,1 LU t [D� S ta/7)/1.(=t L jl?1.,}L I L'\ L p C+ 1,,P-`I f,Ei V iBoring# ❑ Boring - ® ` Pit Ground surface elev. '-%` ft. Depth to limiting factor ? 3 in. Horizon Depth Dominant Color Redox Soil Application Rate ex Description Texture I ructure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz. Ccnt.Color O_`Z )p"f 23/3I _ I I Cr.'- Sc.Sh. 'E1 'E f?2 Z �Z�3Z7•S�,Z 3 cy _ rn \'G� I \m 1r- I `',V -` I S 3 I S I o �� °I I S I0 -2 ► rilI I - i .-1 t, I 1 . I I I i 2 Boring# ❑ Boring I 11 I I 1 i Pit Ground surface elev. \:\-'� ft. Depth to limiting factor ?V in. Horizon Depth •Dominant Color Redox Description Texture Structure I Consistence Boundary Roots I Soil App Rat? in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 O-\Z 1o`-1 tZ3II - L Zi'iS`D2I h1.`Fl Lfv Z.- S ,$ Z R.-3b .S`-r 12_3/y - 1g L1 S V4 I Clv - --I \., Z 3f.)qA 10,-t2vit, S 0 S wt1 — ,--) k, -7 I - - • 1 • Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD <30 m CST Name(Please Print) s 9�-and TSS<30 mg/L . �_ Signature CST Number 5 4 -Arthur L Wegerer 03 2.15 _ 37 Address Wegerer Soil Testing & Design Service 220254 Date Evaluation Conducted Telephone Number 421 N. Hain St . River Falls , t11 54022 \Z_ ? Z-- U-3 715-425-0165 PLOT PLAN Page 3 of Scale 1T = SO ' • `L 'C\ L DT 3� LoT 37 D cp I , -7 \ I Io \, X3:3 vVZ iti/ Pr,,,,z L�15 3•1 33 I 43w 1- 1(0Ao CI GMLA c>∎)1kT OF eue2v` -�� mar , ,w• � � K • avykl. 715-425-0165 220254 . 03 -2.1S -37 CST Signature Date Telephone No . CST No . Job N0. Parcel #: 040-1306-37-000 12/19/2013 09:02 AM PAGE 1 OF 1 Alt. Parcel#: 08.28.19.1864 040-TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 06/17/2004 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner 0-B& L LAND DEVELOPMENT INC B&L LAND DEVELOPMENT INC 7925 ARNOLDTOWN RD LOUISVILLE KY 40214-4501 Property Address(es): *=Primary *405 JORDYN LN Districts: SC=School SP=Special Type Dist# Description SC 2611 SOH DIST OF HUDSON SP 1700 WITC Notes: Legal Description: Acres: 1.080 SEC 8 T28N R19W PT SW NE BEING SUNSET VIEW DEVELOPMENT('04) LOT 37(1.080AC) Parcel History: Date Doc# Vol/Page Type 06/17/2004 766198 10/09 PLAT Plat: *=Primary Tract: (S-T-R 40%160%) Block/Condo Bldg: * 10-009-SUNSET VIEW DEVELOPMENT 040-04 08-28N-19W SW NE LOT 37 2013 SUMMARY Bill#: Fair Market Value: Assessed with: 236802 54,100 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.080 61,600 0 61,600 NO Totals for 2013: General Property 1.080 61,600 0 61,600 Woodland 0.000 0 0 Totals for 2012: General Property 1.080 61,600 0 61,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00