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HomeMy WebLinkAbout040-1303-00-018 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569524 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: I City Village X Township Parcel Tax No: Westview Construction, Inc., c/o Aaron Cla Troy, Town of 040-1303-00-018 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: GS( 22.28.19.1753 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 1S CAPACITY STATION BS HI FS ELEV. Septic Tti i /z$ Benchmark p Li �.�. i•5 Alt. BM Z.15 /o/.�;5 Aeration Bldg.Sewer �.sz 99.�s( Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO LL P/L1/ WELL BLDG. 6endo Air Intake ROAD Dt Inlet \ Septic Zo i N Dt Bottom r /v� �S Go t,-- Dosing 76 Header/Man. 7. 2(, c) 3 bfi—10 Aeration Dist. Pipe _, Ak 94 `.7 Holding Bot.System g. Z 9$•y7 Final Grade PUMP/SIPHON INFORMATION •33 9-7 v� Manufacturer DeP^and St Cover it J ? ,S O L Model Number TDH Lift Friction Loss System Head TDH Forcemain Length la Dist.to well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length lNo.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Dept_ DIMENSIONS 3 G b y ,re, SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER LEACHING OR Man�ctureerr' I INFORMATION Type Of System: /ZS /^ UNIT Model Number: Co�Jtn�-.'•.�� 33 6�J vT' /lJ� L c�,.J /'ta �'• �-c DISTRIBUTION SYSTEM $o J4 /S yf = to U a •.� HeaderlManifol� Distribution x Hole Size x Hole Spacing Vent to Air bake y' \ \ 'I-, � `- 6-1-Length y Dia Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodd d xx Mulched Bed/Trench Center Bed/Trench Edges ` Topsoil Yes H No Yes (] No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 272 Walnut Hill Way River Falls,WI 54022(SW 1/4 SE 1/4 22 T28N R1 9W) Walnut Hill Farm aka The Tribute Parcel No: 22.28.19.1753 `d- 1.)Alt BM Description d 2.)Bldg sewer length= Z -amount of cover= > bd Plan revision Required? Yes No Use other side for additional information. 1 '— - - Date E)4�1�nsepctrs S' nature Cert.No. SBD-6710(R.3/97) PLOT IP&M WATJMT HILLS rM M. LOT /v Pg. 3 of'j 4 w contour elevation lines- = aackhoe Soil pits. Q = Benchmarks set, maR= WITS FLAGGED lathas. 112" steel conduit pipes. v ow k t = 30 � Gds scALa.- b° Nd . La r I've- lo' LOT, I ? ----• • /off c�_ - 6,-7 1 ..--.. A � A q SCb :o Ei O `Q r a �� -3 a 4 7 $° _� v � A.0r W �J u VON ariiFl. County Safety and Buildings Division T 0, Yc)t 4 *j 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) Madison,WI 53707-7162 SZ y .�g3ttri�tii Sanitary Permit Application State Transacti In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental u9it is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submittezr® Ad re s erent mailing address) 9 P g m'Y P pP M J � g the Department of Safety and Professional Servies. Personal informatio vide may be used for secondary u oses in accordance with the Privacy Law,s. 15.04 1 (m),Slats. I. Application Information-Please Print All Information �Z 40 Property Name i Parcel# O �,�j� �7 it 1 Ctl N S .f �� �Q ('i�F�(/f/1 Property Owner's Mailing Address Property Location / U J G r, c,-,v/",L/ Govt.Lot 1S C, I'7 53 City,State )"]� Zip Code Phone Number Numrb�er 5-4)'/e,�'/., Section 4O Z Z- r7[J ' / v " 9f�0 (circle ones.., ►/ II.Type of Building(check all that apply) ok- a,,6 T o� N; R 1 E or .`S y AI or 2 Family Dwelling-Number of Bedrooms ri �L(;� Subdivvision Name I/�2( k,-1 El Public/Commercial-Describe Use ���- Q��"� ❑City of ,❑State Owned-Describe Use I CSM Number ❑Village of '7 at�-Iocf5 ea (Town of r0\ III.Type of Permit: (Checlionly one box on line A. Complete line B if applicable) A. &cw System ❑ stem Replacement System y ❑Treatment/Holding Tank Replacement Only El Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner -A l IV.Type of POWTS System/Component/Device: Check all that ap r•A./ ig Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound?24 in.of suitable soil ❑Mound<24 in.of suitable soik5i ❑ Holding Tank ❑Other Dispersal Component(explain) Pretreatment Device(explain) V.Dis ersal/Trea ent Area Information: Design Flow(gpd) Design Soil Application Rate pdsf) Dispersal Area Required(s Dispersal Area Proposed(s System Elevation ©19 15 /1700 1 /-;;200 4, r • VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units p o New Tanks Existing Tanks n s a a p y U 14 v� Cti v� w C7 Ci Septic or Holding Tank ) S )��D G G h Dosing Chamber VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. PI u ber's Name(Print) Plumb 's Si na a MP/MPRS Number Business Phone Number 1a,y( 0 l)e1,s� t� p?o�d S �� 49Z Q�9f Plumber's Address(Street,City,,State,Zip Code) � I,I> 9o$ /140 6 ul/t vz' 141) j z�- VIII.County/De artment Use Only Approved �;w=eGien Permit Fee Date Issued Issuing nt Signature Reason for Denial $ 3 r IX.CondiS"T0&.9 MDI811 Reasons for Disapproval 3) 4� •�n_ /n _J.z ro i o�,,,�e '{:'�eptio'.tank,eftltilent filter end' � �,�-r`eri. dispersal cell must all be servtces/melateillad W j as per management plan provided by plumber. 2 ` is sck Fpctulrwwnta must beimuntalri6d n prr ePPNditi c6cw 10*0 c 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) Pg 1 of Private On-Site Wastewater Treatment System(POWTS) Index and Title Sheet W V Owner: IEVJ ( ON 5712 �Tl dn1 NC, Project Name and System Type: 06M):NtlONA - -TAz 60UXANp TEL-JeHZ--s Location: 27Z- (i ALA tAT ILL WAS/ Street A ress / sW y o� T"C- SIE'/yam szz 'fz�N Rt9t�l Legal Description TROY ) Gml X Township/ ounty Design Criteria(Check one): Holding Tank Component Manual: In-Ground Soil Absorption Component Manual: -1 7-P ❑ SBD-10571-P(6/11/1999) ❑ SBD 056 (R. 6/1999) ❑ SBD-10855-P(3/2007)Version 2 SBD-10705-P(N. 01/2001)Version 2 Contents: Page 1: TAIDEX AAJb r►TLE StfeEr Page 2: 'PLAA) V t EyJ Page 3: ?I-crr Pt X A) Page 4: F6 LAL5 OuJN'EK5 AkAN LAAL WAlhG-F-, e9 PLAn it If i f► d Page 5: is Page 6: Page 7: .S4-:P7-ic 711Alx Page 8: Page 9: t ents: -4&0(L eVAL UAWON lW'DaT 40``1 ►a 1 rL ,�4 K MAt.A)TEA A-A)e0 Ac 2 t T i . -1 +�A... arsrrr l a f J Pi ., 12 �� it P�J Signed: v/x/V// 7 Date: e �a�yl�m'liar ��59'- DD :3x/Po M till 7 O O r -gym. 1 �,,' ` 3y . =ago"OFIMMdalmn fl LDi�ioOM .�Iitt�W�� fo00 W ;` a0/LL PLOT- PI.71Q W1 YAWT SILLS FARM. LOT � Pg. 3 of`7 Q = Contour elevation lines. Backhos Soil pits. Q - Benchmarks set, maRSED WITH FrJUMM lathes. 1/2" steel conduit pipes. w s SCALE: to°- wo I've- Lot I � � t,e�c�► t' flREA) t � K r w�� � � .�M �r a 3 • � � X9.0 ' o ° 4 3Y4 c . 97, 80 v W 3 POWTS OWNER'S MANUAL MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner W E5T 5 TX IACTI 0 "NC Septic Tank Capacity /Z gal ❑NA Permit# Septic Tank Manufacturer �J i 6 Ste, 13 NA DESIGN PARAMETERS Effluent Filter Manufacturer DL Lo/ ❑NA Number of Bedrooms I OOgpd/bedroom ❑NA Effluent Filter Model 5Z!5- ❑NA Number of Commercial Units NA Pump Tank Capacity gal IM NA Estimated now average)* gal/day Pump Tank Manufacturer NA NA Pump Manu Design flow(peak),estimated x 1.5* D gal/day facturer `l� Ada Pump Model NA Soil Application Rate g Y W pretreatment Unit A Influent/Effluent Quality(NA❑) Monthly Average** ❑Sand/Gmvel Filter ❑Peat Filter Fats.Oil&Grease(FOG) < 30 mg/L ❑Mechanical Aeration ❑Wetland Biochemical Oxygen Demand(BODs) 5 220 mg/L 13 Disinfection [3 Other: Total Suspended Solids(TSS) Manufacturer: Model: 5 250 mg/L Dispersal Cell(s) Pretreated Effluent Quality❑ Monthly Average*** In-ground(gravity) ❑In-ground(pressurized) Biochemical Oxygen Demand(BODs) 5 30 mg/L ❑At-grade ❑Mound Total Suspended Solids MS) 5 30 mg/L ❑Drip-line ❑Other: Fecal Coliform(geometric mean) _<Ivcfu/100m1 >ffil=ching Chamber ufacturer Maximum Effluent Particle Size 1/8 inch diameter Model Approval Stipulation *Wastewater Flow Verification on and calculations: Soil Application Ratn_gpd/f Area Req. iz00 fe (Other than bedroom based) Absorption Area Credit per unit �2 ft? Minimum Number of Chambers GD ❑Aggregate Design FlowA oading Rate= fe min ** Values typical for domestic(non-commercial wastewater Materials:all materials must comply with WI Adm.Code and septic tank effluent. COMM94 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 ❑"Design of Pressure Distribution Networks for Septic Tank-Sod 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 R&99)"At-Grade Component Manual Using Pressure Distribution" ❑ SBD—10567—P(8.6/99)"In Ground Absorption Component Manual" XSBD—10705—P(N.01 101)"In Ground Soil Absorption Component Manual"Version 2.0 ❑ SBD—10628—P(N.6/99)"Recirculating Sand Filter System Component Manual" ❑SBD—10656—P(N.6/99)"Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD -10572 P(8.6/99)"Mound Component Manual" ❑ SBD -10691P(N.01101)"Mound Component Manual"Version 2.0 ❑ SBD - 10595—P(8.6/99)"Single Pass Sand Filter Component Manual" ❑ SBD -10657—P(8.6/99)"Drip-line Effluent Disposal Component Manual" ❑ SBD - 10573—P(R 6/99)"Pressure Distribution Component Manual" ❑SBD - 10706—P(N.01101)"Pressure Distribution Component Manual"Version 2.0 ❑Drip-line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑months M year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third(1/3)of tank volume Inspect dispersal cells) At least once every 3 ❑months J*Tear(s) (Maximum 3 yrs.) Clean effluent filter At least once every /, ❑months $year(s) Inspect pump,P AP controls&alarm At least once every ❑months E3 year(s) ❑ NA Flush laterals and pressure test At least once every ❑months ❑year(s) ❑ NA Valves At least once every ❑months ❑year(s) ❑ NA Other: At least once every ❑months ❑year(s) ❑ NA Page of START UP treatment tank(s)for the presence of painting products or other chemicals that use of the POWTS check ( ) � for to . For new construction,pr may impede the treatment process and/or damage the dispersal cell(s).If high concentrations are detected have the 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. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of,required reports•The quantity m will affect of the performance and longevity of your POWTS.The installation of water-saving and quality of the wastewater strea f leaks reduces the wastewater volume.Also the brine or waste from water appliances and fixtures along with tl w prompt softeners,iron remoras units,other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible.Note:this does not include laundry waste,showers,dishwater,etc. This system is designed to handle domestic strength wastewater,however the disposal of food based greases and oils,vegetable/fruit peeLs and seeds,bones,and food solids such as those produced by a garbage disposal should be minimized.Toilet tissue is the only paper that should be discharged into the system.Other non-biodegradable items such as baby wipes,tampons,sanitary napkins condoms,cigarette butts,dental floss,and cotton swabs should not enter the system.Chemicals such as petroleum products,paint, disinfectants,pesticides,antibiotics,solvents,etc.,should not he flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. 0 Valves Valves shall be operated in the following manner: C3 Alarms Alarms should be tested on a regular basis by the home owner.If an alarm sounds,contact an individual licensed to service POWTS,There is normally a 1 day reserve under regular operating conditions,however water should be conserved until any problems with the system are corrected to prevent back-tip of sewage into the dwelling or surfacing. INPECTIONS _� Inspection shalt 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 surface.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 tie combination of sludge and scum in any tank exceeds one-third(1/lp 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 AIR 113,Wisconsin Administrative Code. The outlet filter(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 Chambertfreatment Tanks Component The inspection must include a test of all electrical equipment such as pumps,alatms 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. In-Ground Gravity Component Dispersal Cells The inspection shalt 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�of_l ❑Mound,At-Grade,In-Ground Pressure 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 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: 1'ZVA 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 Hal SE Name L M515& Phone 1-L�Gj2-$59 Phone &5-1-44q?— SEPTAGE SERVICING OPERATOR(Pumper) LOCAL REGULATORY AUTHORITY Name DA-KR�—s C 5OZ IC`& Agency � I ZO Phone 715,41 19 !O 2,5- 1 Phone KAWPDATA\EH\POWTS OWNER'S MANUAL.doc Page_(Pof ? 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'"' , •�,9 j Q M '/ �/'r •� rr_rte' ~~ _ I�`'`��oi� `� � i ' ' �T 1 qp- OD My 0000 Nb s'` is ti i co ch �! I Vi � 1 4 _i d rt 1Z Y n M !- 'J .� � 0. W , � . l � 2 � ,0`• W 505.60 2 _ -- - \ \� �' •s wool � r� ST.CROIX COUNTY SEPTIC TANK MAMI ANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Ownm'34 yer &STV/Flit/ aNsT9btL x101✓ -Z;VC• _.7_1 Mailer Address zA 56�p EAWV C61 &—t Property Address Z7Z WALA t rt- H 1 LL_ WAY (Va ficetian row f a m Planning&Zoning Depart nevv coon.) City/State 1 U&K use WT Parcel Identification Number 040-1303 �d g LEGAL DESCRIPTION Property Location -Sw V,. a/,,Sec. 27-,T 7-C N R)9W,Town of --MO Y Subdivision Plat: W A<LM tkT A 1 LL :FA" tie 1 S tt 7E ,Lot# Caroled Survey Map# Volume ,Page# Warranty Deed# (before 2007)Volume_ ,Page# Spec house U yes U no Lot lines identifiable U yes U no SYSTEM MAINTENANCE AND OWNER CERTIFICATION I Improper um and maintenance of your septic system could result m its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,if needed,by a licensed pumper What you put into the system can affect the fimction of the septic tank as a gent stage in the waste disposal system Owner mar t mnce 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&Zonmg Department a certification form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal systems in proper operating condition and/or(2)after hispection.and puniping(if y),the septic tank is less than 1/3 hill of sludge_ Uwe,the undersigned have read the above ruts and agree to maintain the private sewage disposal system with the standarols set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of%womin. stating that your septic system has been mainfai ed must be completed and returned to the St Croix County Planning& Zoning Deft within 30 days of the three year expiration date. Ilwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/am the owner(s)of the property described above,by virtue of a deed recorded m Register of heeds Office. Number bedrooms 311 S A =rmaay (S) DATE /---Aw information that ilt in the sanitary permit being revoked by the Planning&Z,onmg 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 nude in the vvm:anty dead. (REV.09AM II III IIIIIIILIII ! IIIII111 • I lil I II I IIIIINIIi R a I IIININ . 14922 Tx:41753366 STATE BAR OF WISCONSIN FORM 3 -2000 993153 QUIT CLAIM DEED BETH PABST Document Number REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, Grantor, and Westview ST. CROIX CO., WI Construction LLC,Grantee. 03/04/2014 2:51 PM Grantor quit claims to Grantee the following described real estate in St. EXEMPT*: NA Croix County, State of Wisconsin(the"Property"): REC FEE: 30.00 TRANS FEE: 68.70 PAGES: 1 Lot 18 of Walnut Hill Farm,Town of Troy,St.Croix County,Wisconsin. Notwithstanding anything to the contrary set forth in this agreement buyer is relying solely on buyer's inspection of the property and buyer acknowledges and agrees that the property is being sold "as is with all faults" and seller makes no representations, warranties or covenants, express or implied with respect to the property. To the fullest extent permitted by law, seller Recording Area expressly disclaims any and all implied warranties, representations or Name and Return Address: covenants with respect to property. Title One File#20429 Together with all appurtenant rights,title and interests. 040-1303-00-018 Parcel Identification Number(PIN) This is not homestead property. Dated this 3rd day of March,2014. Citizens State Bank *Shawn Tyler,Vice President AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST CROIX COUNTY. )ss. authenticated this 3rd day of March,2014 Personally came before me this 3rd day of March, 2014 the above named Citizens State Bank to me known to be the * person(s) who executed the foregoing instrument and TITLE:MEMBER STATE BAR OF WISCONSIN ackno edged -same. (If not, / authorized by§ 706.06,Wis.Stats.) - or THIS INSTRUMENT WAS DRAFTED BY ..•••"�'••• *Evel tae er :'d\yr•— Notary Public,State of Wisconsin :•`�'' •: My commission is permanent. (If not,state expiration date: •NOTARY•; t Michael H Forecki,Attorney 12/11/2016""" ) (Signatures maybe authenticated or acknowledged. Both arell n *Names of persons signing in any capacity must be typed or printe ure St.Croix CgvW(2W; 5h%jge 1 of 1 STATE BAR OF WISCONSIN FORM No.3-2000 A EROSION CONTROL PLAN must be kc wis wwn Depwtment of Commerce SOIL EVALUATION RE completed before sanitary permit issuance Division of Safety and Buildings in accordance with Comm 85,Wis. Adm. Code County Attach complete site plan on paper not less than 81/2 x 11 inches in size.Plan must include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. percent slope.scale or dimensions.north arrow,and location and distance to nearest road. Please print all Information. R wed b /���1 ,` ? �. Penw W Womadon You r aft may be used for sewndary PaP��t �Y Law.s 15.04{t)t+n))• / li'7 Q J V P O p 133 ERS TC7fl T— C�d Alf'c"' #4 �Location lrl� �y4 5�1/4S ZL T 2•B N R f / E(or)W Property Owners Mailing Address Lot# Block# Subd.Name or CStugf d S C,4 tt U- AV-P- • I-Z& WA�W O r ��[1 City SAA W Q State Zip Code Phone Number ❑city ❑Village W Town Nearest Road bQ 0C HTs MN 5S-07(p ( o5t) zy8• tog? ?--ROY so. &100e:R _ o PL New Construction Use.IA Residential/Number of bedrooms _ Code des flow0te D ' L _GPD ❑Replacement ❑ Public or commercial-Describe: T Qe,�Z Parent material /OFS S 00ti, SAND y 0 0 T W�'� flood Main elevation i#applicable ft General conxnerts and recommendations: f�lP�� TE57 f2o v-vv /Yu-�'-Q-tAlr�',M a-QY— 6,P 0/7f f ❑ Botig Boring# ® Pit Ground surface elev. 10 ft. Depth to kni V factor in. sail Rage Horizon Depth DominantColor Redox Description Textga Suture Consistence Boundary Roots GPDIfC` Mtnsell Qu.Sz Cont.Color Gr.Sz.Sh. 'E1f#1 -Eff#2 C in. 0-5 /o fA 31 SiL z,.V,sh A 2(t) Z . S v\ 2- • 23 /o y9 y6 316 J „S G � tA 3 i io ye 1s /4, 5 a 0 5/Dy 7 — I. Z a� — ►• Z � /O y/�v tardl•�. oGif% if G2 `i: • -7 a LS D,•w� Q-C' . S . -USI. 17LC f���u tZl4 pt Ground surface elev. I ft Depth to wrov won }/d in. Soli Rate '1 Horizon Depth Dominant Redox Description Texture Struxture Consistence Boundary Roots GPD/tt= In. Mtmsell Qu.Sz. Cont.Color Gr.Sz.Sit '81#1 Ts- (� 0,1)- Io y� 3/ /L-• 2' ,w Sh S 4 C'lv - f . S, N /a -2 S' j o SQL z,IM b / ' S N -90 0 • s d, s . -2 t• Z r� Lii- 41/ 9,4AJ 2S " / 74 /' Effluent#1=BOD >30<220 mg,L and TSS>30 1150 mg& •Effluent#2=BOD <_30 nV&and TSS<_30 mglL CST CST Name(Please Prat) ,.0 t G 1,-F— Sgnature 22 5 Address Uibricht &Assgciates Date Evalua'on CAx Te�phone Nuxrtrer S 17- a 7!S• 77A• 3 yy 2- Priv t 2812 1 Oth Ave. IF Spring Valley, WI 54767 ���� r r � �z- °ya • /ohs • so • � oyo v . /o • ow dyp . log6 • zo • ov'o oyo • /o,'l, /o 70 oats _ _----�T.-�. oyo • �� o ya- L 7'OOv T✓1 E 5 TEDT- proporlyowner Parcel ID# # D Boring 87c ft).tln�. Munsell Ground surface etev. 17•Q #t- > o��,��,ta«�r �on Soil - Rate ant Redox Description Texture Structure Consistence Bcxtnc�ry Roots GPDAT Qu.Sz. Cont.Color Gr-Sz Sh. "EtF1 "Etr#2 YR 3 �SiG Z,,w Sh't C&A Crti 3 . S Z / /oy? a F—] # Pit Ground surfaceelev. ft. Depth to limiting factor Sal Application Rate+ Horizon Depttt Do*wd Color Re*x Desaip w Texture She C.ons9stence Boundary ,Rom GPDff #� Mansell Qu.Sz. Corti.Color Gr.Sz.Sh. -EM 'Et ! pit Ground stxlhoe eiev. ft. Depth to limiting Sort Rate iiortmn Depth _Dorrdr►a Redrnc Desaf fitiort_ Texture Str�ture Boundary Roots GpCff In. MUM# Ou Sz. Cola color 15-r Sz.Sky 4 'EfI#2 Barb V tj Boling F -1 list Grc c staface elev. Depth bd bru6ng factor in. Sod Appkation Rate Hortzon Depth Dom1nant Colm Redox Description. Texture Stru tore Consistence Boundary Roof GPON �. Munsell flu.Sz. Cont Gr.Sz.Sh. 'Et1#1 'Etf#2 °Efterd#1=BOD.>30<220 ffK A.artd TSS>30<150 nigh. 'EMLwA#2=BODs 130 mg&and TSS<30 mWL The Department of Commerce is an equal opportunity service provider and employer. if you treed assistance to access services or need material in an alternate format, please contact the department at 608-266-3159 or TTY 608-264-8777. Sa[Y-1330(R6iN0) r a , •a � G��N�T"r ffi// TOlJl� f3•T E�5 T-ED7- leio Paroei lE)# 1-0 7— Page Z or 3 30 t Ground surface elev. �• ft. Depth to iimtGreg factor > 70 in Soi( ieatiorr Rate Hortzort t)ep a Dominant Cairo Redox Description Texture Structure Consistence 8oundwy Roots GPDAT in. Munseff Qu.Sr- Cont.CoW Gr_Sz.Sh, 'Eff#1 Tff#2 o•i2- /.D YR 3 �SiL 2,,w Sh s �4� 3 f . s Z / /OYR Sh .5 i t�I %ring# a.scuirig Q Pit ., Ground surface elev. R; Depth to Umiftng factor in• Soit is fon Rate Horizon Depth Dominant Cokif Redox Mscdption Texture ' SbvZture C.ortsis4ence Boundary Rote GPDtff irr MUnsett Qu.Sz. cont.color Gr.Sz.Sh. 'Efl#1 'E Bong ❑ 8onng Grov nd surfaa�elev, f4, to lirti fa frt. . pit DepBe rUr►9 Svii cation Rate Horizon Depth ,Dcrninant Col fiedmc Description_ Texture Structure s1sterece &xindary Roots ke. l4lunsel qu.Sz. Cont.Odor Cor•Sz-Ste. 'Elf#1 'Eff#2 F-1 Bonne . Pit Ground surface etev. Depth to flMiting factor in. ' - Soii ftplicalipp Rate Horizon Ctepth Dominant Coi Rector Description- Texture Stru,%" Consistence OartWwy Rarts GPt?ffg in. Munseti Qu,Sz. Cont. Gr.Sz.Sh. 'Eff#1 'Eff#2 t °Effluent#1=BQD,>30 220 mgil.and TSS>30!i 150 mg/L °Effluent#2=B006:S 30 rngl4.and TSS<30 mgfL i 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 608264-8777. sAd asao pt�mo) r ICI J PLOT PLAN WALNUT HILLS FARM. LOT # Pg. 3 of 3 © = Contour elevation lines. • = Backhoe Soil pits. Q = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. 1IJ Y!v A s SCALE: lit _ ✓ U to a� A LIO 13, 100- 10 o M ' ' -------- /00. 3 0 �.------ 1 .--- d 79,v 0 '33 ate w' w