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HomeMy WebLinkAbout040-1111-50-020 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569516 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)j. Permit Holder's Name: City Village X Township Parcel Tax No: Plummer, Me han I Troy, Town of 040-1111-50-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: 1/� 8 M � 29.28.19.452A TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER/,/,,,,,3 CAPACITY STATION BS HI FS ELEV. Septic .�+,�, ' 3 Benchmark t'esLk �J /Z5 `��9�e Alt. BM .&,4 !� ` F) Pa I a fc SZS F,'t S �o Aeration Bldg.Sewer y `,74 1,64 • 24 Holding St/Ht Inlet l J7.5 1XZ •f/Z TANK SETBACK INFORMATION St/Ht Outlet z -,33, /6Z • I 3 TANK TO P/L WELL BLDG. Vent to it Intake ROAD Dt Inlet l�1 Septic -7 50 Q �� f Z Dt Bottom 1 �0 Dosing Header/Man. >!• I � 1 ,71 Aerati Dist. Pipe •-73 I Holding Bot. System • 7 7$ . Z� L Z PUMP/SIPHON INFORMATION Final Grade T jQ Q /71 Z Manufacturer Demand St over P �(. X6(0 3 Model Numbe la TDH Lift Friction Loss System H TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM W,% BEDITRENCH Width Length J No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 107 re N_{ SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING Manufactwsier: I INFORMATION CHAMBER OR X✓,f-'i•/ Type Of System:J (� T lZ UNIT Model Numbef: 4 C� J �v.G.�'G V DISTRIBUTION SYSTEM =--96 f s Header/Manifold N Distribution x Hole Size x Hole Spacing VenAt Air Inta e Pipe(s) \ /v fl r� Length �� Dia T Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 3 Bed/Trench Edges Topsoil \ _s 0 No � Yes D No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: ??? Carlson Lane River Falls,WI 54022(NE 1/4 NW 1/4 29 8N R19W) mete &bounds L Parcel No: 29.28.19.45 1.)Alt BM Description= // 2.)Bldg sewer length -amount of cover= Plan revision Required? K Yes o 27 Use other side for additional Information. -0-6710(R.3/97) Date Insepcto r;001, Cert.No. Plot Plan. Page 3 of 7 Property Owner I" = 40ft Legal Description Prr, or- THe NEYy of Tyg NwVL{, (except where noted) -r?-f-/ -rd w,,,I OF 7 ay', s-t• C R+,€v =Backhoe pit North 1 3 -rp.NK 4 coy `10 . t Co v Site Location: 9 71 .Toy A - , I r3.�1 Z•- 4496` Of �1rC �) sp1Ke &V e 6�OCCeuD �. 7Zr ,480y r G �t�fy ra7.tff�� County . >FNl ° Safety and Buildings Division $ � 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) Madison,WI 53707-7162 \.,,trsro•cnr:- apitary Permit Application State ber In accord ce ith SP, �3 2),Wis.Adm.Code,submission of this form to the appropriate govemmwtal unit F NY is required kor4lit tatt ing a sanitary permit. Note:Application forms for state-owned POWTS are so � Project ess(if than mailing address), the Department of Safety and Professional Servies. Personal information you provide may be used for seco � R ? /7 purposes in accordance with the Privacy Law,s. 15.04 1 (m),Slats. �O CO �j� I. Application Information—Please Pri Information O(J �((5f Property Owner's Name / Parce zO ,. �r 4��, 1/ - SO -©6'G Property ner's Mailing Address Property Location 91x j Govt.Lot City,State Zip Code Phone Number _!Y •/e 1 ` ? 1 / N /., Section givev Full `_ �j 4fa Z-Z—. ctrcleor T�N; R�Eore II.Type of Building(check all that app n o Lot# 1 or 2 Family Dwelling—Number of Bedro s 4 17 it!Y) Subdivision Name Block# �}'— ❑Public/Commercial—Describe Use ✓ tJ (q,r C .6 ❑City of ❑State Owned—Describe Use �p G�ps�j�-;ti (� CSM Number ❑Village of Town of T I'y Y `off Z - III.Type of Permit: (Check onlf one box on line A. Complete line B if applicable) x A. ($New System ❑Replacement System ❑Treatment/Holdin g Tank Re p lacement Only Other Modification to Existin g System(ex p lain) B. El Permit Renewal El Permit Revision El Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner -� IV.Type of POWTS System/Component/Device: Check all that a I u.r Pi Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil G ❑Holding Tank Other ispersal Component(explain) ❑Pretreatment Device(explain) Ito V.Dispersal/Treatmgnt Area Information: Design Flow(gpd) Design Soil Application Rate(g sf) Dispersal Area Required(sf) Dispersal Area Proposed(sf) System Elevation 0,0 Vf J ©DD /0 Q .s" �, z VI.Tank Info Capacity in Total #of Manufacturer Y G be�5 Gallons Gallons Units New Tanks Existing Tanks I-P f✓O Z a U Septic or Holding Tank Dosing Chamber VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumlber's�ignature MP/MPRS Number Business Phone Number Car /�`t/6,� G!2�4 ao?DSS Plumber's Address(Street,City,State,Zip Code) 40-4 710 /'LG vel Fq ZL VIII.Count /De artment Use Only Approved ❑Di Permit Fee Date Issued Issuing A e Signature Iven Reason r Denial $ 1475 31� /� IX.Condi� �1� �easons for Disa Pp roval � 1; teptic tank,effluent filter and 3) / "�^� !v v� 5 3Z dispersal cell must all be servtces/maintained /] as per management plan provided by plumber. 3. A ,s ck requirements mutt be':Maintained / as per appk*ble co&ford : Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398(R. 11/11) 1 -_ Private On-Si te Wastewater Treatment System(POWTS) Index and Title Sheet Owner: rlW%ML —rK& Project Name and System Type: Location: 0 Street Address ' Legal Description 0 s C.WX Townshi /County Design Criteria(Check one): Holding Tank Component Manual: In-Ground Soil Absorption Component Manual: Ho g El E] SBD-10571-P(6/11/1999) SBD-10567-P(R. 6/1999) �f SBD-10705-P(N.01/2001)Version 2 [3 SBD-10855-P(3/2007)Version 2 Contents: Page 1: DEX D �Tt� Page 2: P A Page 3: fF DT "A I s o � s uA� a 1WT LAN Page 4: �ow�7' w"n1 D ti Ji r Page 5: JI ,r Page 6: Page 7: T,AJ�1 SP�rs Page 8: Page 9: aQ��tie . DfL EU "*I DnI #,(-�7 PoK �i. f,e T d a .. _.,.. Signed: ' b P tun bee�Sler: ry _--- N Date: �`° edi ntial Num*OW-. v filon► �rP 16D IVI!A) Di3�- � � �- E/►I D GAF s = 82� TdT�� X kdmn+.. s i IMSMO a m �J t/ Taib i3AM3. ate, *a n�i�i bayTobN. - zw�e 4 W AAA.CMe j 7 J(v � 73 - - I,i.M.�tow - sumr -41 ,64byoan bweLLW6 x iso,qpd Zoe 9pd -47�a 600 ©� O4& & i Z gz�vf 1.B 00 z - � �CI�A e A-rl !,.�. _ , --TIV F)L-TA- 7),< It V 17- x 5e REQttleEn OR • L W ;-5�k' -mNX I L,SV PO Ly6 O,(' SAS FATE,� par 2 orb Plot Plan Page 3 of 7 Val ��n CA.� m �r Property Owner I" = 40ft Legal Description Parr: oF- -rHE n1 y 6F Tt/E Nt��/�, (except where noted) sec a 2 umy. To KjAl OF WCOV, s-t• C R(►x =Backhoe pit CQUAJ T w e 54QAI S r Al SQ sf C KF5 `/ North e ��� �npcs�d 4�dvh b ;r m-/Do r rpNK NsTM � ye , �a 9 Site Location: tN 7Z' 4601;it Iz 6t<ocu+� 6kou��` A 551A AA9v �dc�.00 s J V POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner �51y bl S/[.� Septic Tank Capacity 2 gal L`NA Permit# Septic Tank Manufacturer S ❑NA DESIGN PARAMETERS Effluent Filter Manufacturer LLD [3 NA NA Effluent Filter Model Z ' Number of Bedrooms 100 m ❑ S ❑NA Commercial Units NA Pump Tank Capacity g� NA Number o Pump Tank Manufacturer U NA Estimated flow(average)* 000 --PUMP Manufacturer A Design flow(peak),estimated x 1.5* ao gal/day Pump Model gNA Soil Application Rate Q,(o pUday fV Pretreatment Unit A Influent/Effluent Quality(NA❑) Monthly Average** p Sand/Gravel Filter ❑Peat Filter Fats.Oil&Grease(FOG) S 30 mg/L ❑Mechanical Aeration ❑Wetland Biochemical Oxygen Demand(BODs) 5 220 mgt ❑Disinfection ❑Other: Total Suspended Solids(TSS) Manufacturer: Model: 5 250 mg/L Dispersal Cell(s) Pretreated Effluent Quality❑ Monthly Average*** ;B In-ground(gravity) p In-mound(pressurized) Biochemical Oxygen Demand(BODs) < 30 mg/L ❑At-grade ❑Mound Trial Suspended Solids('1'SS) � 30 mg/L ❑Drip-line E3 Other Fecal Coliform(geometric mean) <10 cfu/100m1 $Leaching Chamber Manufacturer Maximum E ent Particle Site 1/8 inch diameter Model APPro Stipulation *Wastewater Flow Verification on and calculations: Soil Application Rate Area Req. (Other than bedroom based) Absorption Area Credit per unit 2 f� Minimum Number of Chambers fffl:M ❑Aggregate Design Flow&oiding Rate= fe min ** Values typical for domestic(non-commercial wastewater Materials:all materials must comply with WI Adm.Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ***Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ❑"Wisconsin At-grade Soil Absorption System,Siting,Design&Construction Manual"(Converse et.al.1990) ❑"Wisconsin Mound Soil Absorption System:Siting,Design&Construction Manual"Converse,J.C.and E.J.Tyler. Publication 15.22 p"Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems"Publications 9.6 ❑"Design of Conventional Soil Absorption Trenches and Beds". R.J.Otis-ASAE Publications 5-77 and"Design Manual- Onsite Wastewater Treatment and Disposal Systems".EPA 625/1-80-012 October 1980 ❑SBD-10570-P(8.6/99)"At-Grade Component Manual Using Pressure Distribution" p SBD-10567P(8.6/99)"in Ground Absorption Component Manual" JWSBD-10705-P(N.01101)"In Ground Soil Absorption Component Manual"Version 2.0 ❑SBD-10628-P(N.6/99)"Recirculating Sand Filter System Component Manual" ❑SBD-10656P(N.6/99)"Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572-P(8.6/99)"Mound Component Manual' ❑SBD -10691-P(N.01101)"Mound Component Manual"Version 2.0 p SBD - 10595P(8.6/99)"Single Pass Sand Filter Component Manual" ❑SBD -10657 P(86/99)"Drip-line Effluent Disposal Component Manual" ❑ SBD -10573-P(R 6/99)"Pressure Distribution Component Manual" p SBD - 10706-P(N.Ol/01)"Pressure Distribution Component Manual"Version 2.0 ❑Drip-line Effluent Dispersal Component Manual for Multi-flo Onsde Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑months year(s) (Maximum 3 yrs.) Pump out contents of s) When combined sludge and scum equals one}-third(1/3)of tank volume Inspect dispersal cell(s) At least once every ❑months years) (Maximum 3 yrs.) Clean effluent filter At least once every ❑months year(s) Inspect pump,pump controls&alarm At least once every ❑months ❑year(s) Vf, 4A Fhish laterals and pressure test At least once every ❑months ❑year(s) A Valves At least once every ❑months ❑year(s) A Other: At least once every ❑months ❑year(s) NA Page-7—of rART UP )r new construction,prior to use of the POWTS check treatment tank(s)for the presence of painting products or other chemicals that ay impede the treatment process and/or damage the dispersal cell(s).If high concentrations are detected have the contents of the nk(s)removed by a septage servicing operator prior to use. istem start up shall not occur when soil conditions are frozen at the infiltrative surface. �PERATTON he property owner is responsible for the operation and maintenance of the POWTS and submission of required reports.The quantity id quality of the wastewater stream will affect the performance and longevity of your POWTS.The installation of water-saving -)pliances and fixtures along with prompt repair of leaks reduces the wastewater volume.Also the brine or waste from water )fteners,iron removal units,other clear water treatment devices and foundation drains should be discharged to the ground surface ,henever possible.Note:this does not include laundry waste,showers,dishwater,etc. his system is designed to handle domestic strength wastewater,however the disposal of food based greases and oils,vegetable/fruit eels and seeds,bones,and food solids such as those produced by a garbage disposal should be minimized.Toilet tissue is the only apex that should be discharged into the system.Other non-biodegradable items such as baby wipes,tampons,sanitary napkins ondoms,cigarette butts,dental floss,and cotton swabs should not enter the system.Chemicals such as petroleum products,paint, isinfectants,pesticides,antibiotics,solvents,etc.,should not be flushed into the system as they can seriously damage your POWTS nd contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week.Avoid vehicle traffic over all system components. ,ompaction of snow over the dispersal unit may cause it to freeze up. :1 Valves Valves shall be operated in the following manner: :1 Alarms Alarms should be tested on a regular basis by the home owner.If an alarm sounds,contact an individual licensed to service PO W T S,'There is normally a t day reserve under regular operating conditions,however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the dwelling or surfacing. [NPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications:Master Plumber,Master Plumber Restricted Sewer,POWTS Maintainer or Septage Servicing Operator(per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surfare.Access openings used for service or assessment shall be sealed and/or locked upon completion of service.Any defects shall be promptly corrected.Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one-third(1/:4)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 NRl 13,Wisconsin Administrative Code. The outlet fitter(s)shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications.Provisions are to be made to retain solids in the tank.Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. ❑Pump ChamberPrreatment Tanks Component The inspection must include a test of all electrical equipment such as pumps,alarms and floats.A visual check must be made for leaks,backups,surfacing,missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. f In-Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding,if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge.Any discharge to the ground surface must be promptly reported to the regulatory authority.Ponding at depths greater than 75%of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page ofl- ❑ Mound,At-Grade,' -Ground Pressure The inspe include recording the levels of ponding,if any in the observation tubes and a visual inspection for any evidence of ce seepage or discharge.Any discharge to the ground surface must be promptly reported to the regulatory authority.Ponding greater than 75%of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing.The laterals should be flushed at least once every three(3)years.Pressure checks of systems with multiple laterals should be done to . ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance,inspection,and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch.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 other 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: yaf 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 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 CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN.DO NOT ENTER A SEPTIC,PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT.RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name 12L. }FE i Name rA&L µFl 5Ge Phone 4051-.LigZ- I 6qq I Phone (obi. y9Z. 59 SEPTAGE SERVICING OPERATOR(Pumper) LOCAL REGULATORY AUTHORITY Name UA Kyr.L.s .sE i -% I Agency --1: CA01)( ugft ZO / 6 Phone 715- 9,45- 102-5' Phone )i5- 39(9, 1/6 6 KAWPDATAIEMPOWTS OWNER'S MANUAL.doc �y Page // of / ANA 52j" AS 84" REQD c 41" D Z A nN. 8 O UP 5" � 1 4" CAS t �_ -1� a N 3" 44 " 5" iN m N 36" > m F j. UP 7" �A 4" CAS m� a3 39" in a I D I m D r C Z D O 0 C Z Z Ri g 6 g Fn F OWF g �y m � �� -15�° � * g ' � (,f) N r� a �D M � ZC A z CA " G 0>D $OND r \ g D Z ap � O°-'� ns X77 a v N NZ O.. a 0 D� s p I > ° \o z �� > ".� AW c ooh P -n 3E '"� -DI N ) 2-Z p� O Cyr � � z o v O H A �� w Z ?m a W O m -", w X z F'v y G7 �o M 8 -4 Z m > m _ $ g W � cn 0 IMP m v �-► N WLP1250-MR �? DRAWN BY: WCP SCALE: 114--l'-OW" RE-POUR: SEPTIC MANUAL MHER C®ACIETE DATE: 00 00 00 T- _a \z W3716 US HWY 10 MAIDEN ROCK, WI 54750 oATE. OS POUR: ° 800-325-8456 RLE: UrM-0 of .7 ST.CROIX COUNTY SEPTIC TANK MAINTENANCE AOIUMM04T AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address h s -`��(1/.� Property Address /$� C�C'1 sa,, `�>) . (Vertficabon requzwed fin Planning&Zoning Departs for new eo ,��ct m) � City/State Parcel Identification Number LEGAL DESCRIPTION Properly Location ."Ja V4. N w %,,See. 7-q ,T 1q N R Town of TR 8 Subdivision Plat: ,Lot# f Ceram Survey Map# Volume ,Page# Wanwaty Deed# 99 -71 M (before 2007)Volume ,Page# Spec house U yes Lot lines idenfifiable'yes U no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Imptoper use and maim of your septic system could result m its premature failure to handle wastes. Proper mazes 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 tivatnient stage in the waste disposal system. O mcr 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 8t Zoning Department a certification.focra,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 m proper operatic condition and/or(2)after inspection.and pumping Cif may),the septic tank is less than 113 full of sludge. a Uwe,the undersigned have react the above requirements and agree to maintain the private sewage disposal system with the standards set forth,burin,as set by the Dot of Commerce and the Department of Natural Resources,State of Wisconsm Certification stating that your septic system has been maintained mast be completed and returned to the St.Croix County Ply dt Zoning Department within 30 days of the three year expiration.date Uwe certify that all its on thishrill are tune to the beat of my/our knowledge. Uwe amlare the owner(s)of the property described above,by virtue of a vr deed rid m Register of Deeds Offt e Nunibmef bedrooms SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoimd by the Plimming&Zoning Depart.sss Include with this application a recorded warranty deed from the Register of Deeds Offtoe and a copy of the certified survey map if refeereaae is made in the warranty deed. (REV.WArn it lllllfihllllilfllifllli fl ll) State Bar of Wisconsin Form 2-2003 8 1 8 7 0 8 3 Tx:4155055 WARRANTY DEED 987189 Document Number Document Name BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED,made between Frank Cernohous and Lois Cernohous, 10/07/2013 2:32 PM husband and wife EXEMPT#: N/A REC FEE: 30.00 ("Grantor,"whether one or more),and Meghan Jo Plummer.a single TRANS FEE: 540.00 PAGES• 2 ("Grantee,"whether one or more). Grantor for a valuable consideration,conveys and warrants to Grantcc the following described real estate,together with the rents,profits, fixtures and other appurtenant Recording Area interests,in St.Croix County,State of Wisconsin("Property")(if more Name and Return Address space is needed,please attach addendum): �y�E� � So 1F`(u1-V- Ar See attachment for legal description. aw. ('� t Cet'' ae t" FORS,0% 1 4-( 040-1111-50-000 and Part of 040-1111.80-000 Parcel Identification Number(PIN) This is not homestead property. (is)(is not) Exceptions to warranties: easements,restrictions,and rights of way of record,if any. Dated Ol.�lo� 3, �6 j 3 (SEAL) _ �� ) (SEAL) * *Frank Cernohous�f�/� �-�/ (SEAL) ��O (SEAL) * *Lois Cernohous c O cAUtTyHENTICATION ACKNOWLEDGMENT Signatures) .��t`(;�'4 STATE OF �c,� h ) CHARLENE A.M D ss. au hegticated on Notary Public COUNTY) State of Wisconsin r Personally came before me on 0C-+0 "f i"it.1ri l the above-named Frank Cernohous and Lois Cernohous TITLE�'MEMBER7STATE BAR OF WISCONSIN ito 1f t�'+ ( to me known to be the person(s) who executed the foregoing authorized by Wis.Stat.§706.06) inst n MT and acknow .edged a same. (l nt o_ t1 THIS INSTRUMENT DRAFTED BY: * Maxfield E.Neuhaus-Attorney at Law Notary Public,State of ' rver Falls,VvI 54(122-038 My commission Eierew;,nrteet)(expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATION TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ®2003 STATE BAR OF WISCONSIN FORM NO.2-2003 'Type name below signatures. INFO-PRO"'wwwJnroproforma.can 1 of 2 The Northeast Quarter of the Northwest Quarter and the Southeast Quarter of the Northwest Quarter of Section 29, T28N,R19W, Town of Troy, St. Croix County, Wisconsin; EXCEPT Lot 1 of that Certified Survey Map recorded in Volume 5,Page 1499, St. Croix County Register of Deeds, and EXCEPT Lot 1 of that Certified Survey Map recorded in Volume 12, Page 3261, St. Croix County Register of Deeds. ALSO EXCEPTING the following parcel of land: Commencing at the North quarter comer of said Section 29; thence, along the north and south quarter line of said Section 29, S00'10'59"E a distance of 1282.20 feet to the point of beginning; thence S89°57'56"W a distance of 342.82 feet;thence southwesterly a distance of 203.62 feet along the arc of a 167.00 foot radius curve, concave southeasterly,with a central angle of 69°51'38", a chord that bears S55°02'07"W and measures 191.24 feet; thence S20°06'18"W a distance of 126.01 feet; thence southwesterly a distance of 283.25 feet along the arc of a 233.00 foot radius curve, concave northwesterly, with a central angle of 69°39'06", a chord that bears S54°55'51"W and measures 266.13 feet; thence S89°45'24"W a distance of 551.71 feet to the west line of the Southeast Quarter of the Northwest Quarter; thence, along said line, S00°14'36"E a distance of 915.09 feet to the southwest corner of said Southeast Quarter of the Northwest Quarter; thence, along the east and west quarter line of said Section 29,N89°29'38"E a distance of 1312.65 feet to said north and south quarter line; thence along said north and south quarter line, N00°10'59"W a distance of 1286.87 feet to the point of beginning. I' Subject to a 66-foot wide easement for access located in part of the Northeast Quarter of the Northwest Quarter and the Southeast Quarter of the Northwest Quarter of Section 29, T28N,R19W, Town of Troy, St. Croix County, Wisconsin, lying adjacent to and northerly of the following described line,which is the southerly boundary of said easement: Commencing at the North quarter corner of said Section 29; thence, along the ' north and south quarter line of said Section 29, S00°10'59"E a distance of 1282.20 feet to the point of beginning; thence S89°57'56"W a distance of 342.82 feet; thence southwesterly a distance of 203.62 feet along the arc of a 167.00 foot radius curve, concave southeasterly, with a central angle of 69°51'38", a chord that bears S55°02'07"W and measures 191.24 feet; thence S20°06'18"W a distance of 126.01 feet; thence southwesterly a distance of 283.25 feet along the arc of a 233.00 foot radius curve, concave northwesterly,with a central angle of 69°39'06", a chord that bears S54°55'51"W and measures 266.13 feet; thence S89°45'24"W a distance of 551.71 feet to the west line of the Southeast Quarter of the Northwest Quarter and there terminating. Subject to Carlson Lane right of way. St. Croix County, Wisconsin. 2of2 Parcel #: 040-1111-50-000 01/02/2014 08:44 AM PAGE 1 OF 1 Alt. Parcel#: 29.28.19.452A 040-TOWN OF TROY Current 1LX1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner FRANK&LOIS CERNOHOUS O-CERNOHOUS, FRANK&LOIS 498 CTY RD MM RIVER FALLS WI 54022 Property Address(es): '=Primary Districts: SC=School SP=Special ON tN 4� Type Dist# Description ( 6 N U(.tJ SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Notes: Legal Description: Acres: 34.500 SEC 29 T28N R19W NE NW EXC P452B&EXC PT TO CSM 12/3261 "�—' Parcel History: Date Doc# Vol/Page Type 05/10/2013 978427 TD 12/31/1997 570615 1285/443 QC 07/23/1997 900/300 07/23/1997 704/246 more... Plat: '=Primary Tract: (S-T-R 40%160%) Block/Condo Bldg: "N/A-NOT AVAILABLE 29-28N-19W 2013 SUMMARY Bill#: Fair Market Value: Assessed with: 235199 Use Value Assessment Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 34.000 2,800 0 2,800 NO UNDEVELOPED G5 0.500 100 0 100 NO Totals for 2013: General Property 34.500 2,900 0 2,900 Woodland 0.000 0 0 Totals for 2012: General Property 34.500 2,900 0 2,900 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 4 Wisconsin Department of Commerce DEC rf OIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accor�©Uwith Comm 85,Wis. Adm. Code ST County ST.CROIX Attach complete site plan on paper not le�*4®@ j 2 x 11 inches in size.Plan must include,but not limited to:vertical and horizontal reerence point(BM),d' ';�on n parcel I.D. 040- 1111 -50-000 percent slope,scale or dimensions,north arrow,and location and nst0 reo Please print all information. ► -% R sewed by Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). uCiyt/y._ (/!i Zoe Property Owner Property Location E( ■ FRANK&LOIS CERNOHOUS(Buyer:Meghan Plummer) Govt.Lot ----NE 1/4 NW 1/4 S 29 T 28 N R 19 E(or)W Property Owner's Mailing Address Lot# I Block# Subd.Name or M# 498 C.T.H.MM -- -- —2,V• L►Mites �� S City State Zip Code Phone Number Mity Village Town Ne River Falls, WI 1 54022 1 ( ) Carlson Lane E] New Construction Usee Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD 0 Replacement E] Public or commercial-Describe: Parent material outwash Flood Plain elevation if applicable General comments Conventional in-ground trenches--0.6 loading rate and recommendations: ❑ Ov V1, 1 Boring# 0 Boring g g a 68 pit Ground surface elev. 102.48 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 0-13 IOYR2/2 sl 3f-ma&sbk mvfr cs 2vf-m 0.6 1.0 2 13-20 10YR3/2 - sl 2f-msbk mvfr cs 2vf-m 0.6 1.0 3 20_44 10YR4/4 1 2fa&sbk ds cs Ivf-m 0.6 0.8 4 44-68 10YR3/6 sit 3fabk mfr as Ivf-f 0.6 0.8 5 68-75 10YR3/6 c2f 10YR4/6&10YR6/2 sil 1 fabk mfr as -- 0.4c 0.6 6 75-80 10YR3/6 m2d 10YR5/6&10YR6/2 sil Om mfi -- -- 0.0 0.0 Horizons 3& 4 have many si cts. ❑2 Boring# 11 Boring 99.88 96 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 I *Eff#2 1 0-14 10YR2/1 - 1 3f-mabk mvfr cs 2vf-m 0.6 0.8 2 14-19 10YR3/2 1 3f-mabk mvfr cs 2vf-m 0.6 0.8 3 19-40 IOYR3/3 I 3f-mabk ds cs lvf-m 0.6 0.8 4 40-55 10YR3/4 sil 3fabk dsh as Ivf-m 0.6 0.8 5 55-96 10YR5/8 s Osg dl as lvf-m 0.7 1.6 6 96-106 10YR5/8 sl Om dh __ -- 0.2 0.6 *Effluent#1 =BOD >30:5 220 mg/L and TSS>30:E 150 mg/L *Effluent#2=BOD <30 mg/L and TSS<30 mg/L CST Name(Please Prim) Sign t CST Number MARY JO HUPPERT Hollister's Soil Testing&Desi 224832 Address Date Eva u ion Conducted Telephone Number W9875 690th Avenue, River Falls,WI 54022 11 -07- 13 715-426-1775 Property Owner CERNOHOUS,Frank(Buyer:Plum Parcel ID# 040- 1111 -50-000 Page 2 of 3 3 Boring Boring g Q pit Ground surface elev. 104.28 ft Depth to limiting factor 80 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 I *Eff#2 1 0-16 10YR2/2 -- I 3f-ma&sbk mvfr cw 2vf-m 0.6 0.8 2 16-22 10YR3/2 __ I 2f-ma&sbk mvfr cw 2vf-m 0.6 0.8 3 22-63 10YR3/4 -- sil 3fabk mfr cw Ivf m 0.6 0.8 4 63-80 10YR3/4 -- sil If--mabk mfr as Ivf--f 0.4c 0.6 5 80-86 10YR4/4 c2d 10YR5/6&IOYR6/2 sit If--mabk mfi as -- 0.4c 0.6 6 86-94 10YR5/6 c2d 7.5YR4/6&10YR6/2 s Om dh -- -- 0.5 1.0 L i –1 1 1 F-1 Boring# Boring Pit Ground surface elev. ft. Depth to limiting factor in. -'So­ilApplicafion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 Boring# S Boring Ground surface elev. ft. Depth to limiting factor in. F-1 Pit Application Rate Soil Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 I *Effluent#1=BODS>30<220 mg/L and TSS>30<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. SBD-8330Test(R.07/00) Plot Plan for Site and Soil Evaluation Page 3 of 3 Property Owner efts �eNo 140 us r6NflA PL; WkME'101 I» = 4o ft. 8 � Legal Description NE/4 oFTE ,,,�►�/; � xr,__ (except where noted) -7�nI, tz 1,9 vi -ro VA OF -r OY sr, CPO I x c d U 7 - = Backho e pit North F4J 1 ' �D F 0� n 'Cv �zMAP 0 Y, zo0 -0 71+nfK Site Location: st��x � �.�PPRO_X�����?17C/►�ecsonl G�J. s-rod' pF WC nlfs Ryan Yarrington I From: Harings, Mark W - DNR <Mark.Harings @wisconsin.gov> Sent: Friday, February 28, 2014 2:33 PM To: Ryan Yarrington Subject: RE: Navigibility determination Yes Ryan, I would agree. This is a wetland. Thanks for inquiring. From: Ryan Yarrington [mailto:Ryan.YarringtonCabco.saint-croix.wi.us] Sent: Thursday, February 27, 2014 10:24 AM To: Harings, Mark W - DNR Subject: Navigibility determination Hey Mark, I am looking at a property in St. Croix County(parcel number 040-1111-50-000/ NE,NW,29.28.19 Town of Troy) that has a mapped wetland on it by the DNR surface water website. I have looked back at historical photos from 2008 and 2005 and there doesn't appear to be any observable water. I was just wondering if you would agree with my assessment that this feature is a wetland but doesn't appear to be navigable. The owners are going to build a home approximately 300 northeast of the wetland and I am checking to see if our Shoreland zoning will apply. Thanks Ryan Yarrington St. Croix County Land Use Technician 715-386-4680 1