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040-1306-16-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569544 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: B & L Land Development I Troy, Town of 040-1306-16-000 CST BM Elev: Insp.BM Elev: BM Description. 3m Section/Town/Range/Map No: /b� / r 1 r 6d5i 08.28.19.1843 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ; CAPACITY STATION BS HI FS ELEV. Septic `, �4 _ Benchmark ` '.5 165, r Dosing Goµ a P 7 �a t.BM } i Bldg. Sewer 6ec5 Holding St/Ht Inlet (z•7 92. St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Ve Air Intake ROAD Dt Inlet v Septic 6,7 Z7 /19 Dt Bottom � z ��• ! Dosing 5,� / z 7 Header/Man. Aeration Dist. Pipe , 17. Z 7.9 Holding Bot.System I PUMP/SIPHON INFORMATION Final Grade 66 Manufacturer Zo C ` l Demand St over /36 .3 / I GPM v o.► • g Model Number / ,5 / TDH Lift cfriction;1>sg System TDFj 1 Forcemain Length g Dial Dist.to well Z SOIL ABSORPTION SYSTEM It BEDITRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 / _ Z 7 re J�C� —� SETBACK SYSTEM TO lD P/L JBLDG IWELL LAKE/STREAM LEACHING Manufacturer INFORMATION CHAMBER OR Type Of System: UNIT et ) g O Z Q �3L Model Number: DISTRIBUTION SYSTEM �„�e�� !� /!o 4-1 to =3L Header/Manifold Z If Distribution x Hole Size x Hole Spacing Ve o Air n ke Pipes) �_ �- �� `�— �- ( Q Length 3 Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mou d Or At-Grade Systems Only. Depth Over Depth Over xx Depth o xx Seeded/S dded xx M hed Bed/Trench Center SS Bed/Trench Edges \ Topsoil es No Yes n No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: I / Location: 436 Jordyn Lane udso 1 54016(NE 1/4 SE 114 8 T28N R1 9W) Sunset View Lot 16 Parcel No: 08.28.19.1843 1.)Alt BM Description= C t//' '%jam �' Ide—k5 2.)Bldg sewer length= l 8 -amount of cover= Plan revision Required? Fs� Yes No r �� Use other side for additional information. 17:4 SBD-6710(R.3/97) Date Insepctor's Signat Cert.No. ro ` NJ �Y p � W W h It � � O v o v o � � o h V Q: • � 4~r0 J � a 0 � a V v � c4 o d r1 V A. • x h W r v IN tv n s Q v 0 n County I Industry Services Division _�'r Z/toi X ► Y.B' 1400 E Washington Ave Sanitary Permit Number(to be fill in by Co.) I P .Box 7162 P�. 0 g �ST Madison,WI 53707-7162 ion NumbW nitary Permit Application NN In accordance with SPS 383.21(2),Wis.Adm.Code,submission ofthis form to the appropriate govern ni is required prior to atitaining a sanitary permit. Note:Application forms for state-owned PC),WTS il"u mitte t;Address(if different than mailing address) the Department of 35afety and Professional Servies. Personal information you provide N/ purposes in accord nce with the Privacy Law,s.15.04(1)(m),Stau. 1. Application formation-Please Print All}information Pro rty Owner's ame f� NO �EUE o�MEnJIr G a S 11�rELE� OYO - /JoG-/G- a 0 Property Owner's ail ing Address Property Location /Q �Q .0 T� /�dE, Govt.Lot f (� City,State Zip Code Phone Number _� y,, Section 8 Sf'aa7 7/4 7G0'-07-0 T d8 N; R circle 11.Type of Buii linj(check all that apply) Lot# }or 2 Family welling-Number of Bedrooms /L Subdivision Name I. OK 04 Block# su.,sz- U/EtJ �EuECoPi'lE�J1r" ❑Public/Comme ;ial-Describe Use 8-6}"f ❑State Owned- )escribe Use CSM Number of XTown of 111. ype of Pe it: (Check only obe box on line A. Complete line B if applicable) 26 K A. XNew S rem ❑ Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑ Permit enewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Ex ration Owner,' 1 -�a�-a-�. I-+ P. IV.Type of P WTS S stem/Com onent(Device: Check all that apply) Non-Pressuri In-Ground ❑Pressurized In-Ground ❑At-Grade ❑ Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersaVr eativient Area Information: Design Flow(gp Design Soil Application Rate(g f) Dispersal Area Required(sf) Dispersal Ar opos sQ System Elevation yso y3 6� to�1 s V1.Tank Info Capacity in Total #of Manufacturer y Gallons Gallons Units „ B t j New Tanks Existing anks U 'vt u w g C7 a Septic or 18WORIk nk / /E�SER Lo.t1G't6rr Dosing Chamber GOB VII.Responsit ility Statement-I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans Plumber's Name Print) Plumber's Sipatuye MPRvFP'R6 Number Business Phone Number dt3 <3yG 7/3 G7,?-Sa" Plumber's Addre (Street,City,State,Zip Code) ,,e" /V Ga?Ve Sr. 4,w Y. ,?S. Z& u�e AN0 LJ� .5 5'7t3G VIi1 oun apartment Use Only Approved ❑ Permit Feee Date I sued Issuing ee Signature or Denial $ �`' lil/g )q iX.Condit n Dn�p,�a ' sa roval Ae tP CSi9nK, QPiitP5t1 PP 3 ( (` �'LJ t dispersal cell_must all be services/maintained ;S .� ti n c� i as per Management plan provided by plumber. sef egck:tog*ernents must be maintainW ap �' n per applicable code/ordin WAS. '`4) �actt. 2� t a Y12.. � Attach to complete plena for the ayatem and submit to the CoJhty only on paper not 1053 than a to x t t inches in size SBD-6398(RC 313) P6. / ox—7 rivate Onsite Wastewater Treatment System Index and Title Page Project Name: 0""Z 41do f/EU�LOProEwJT- .�,lea �.JLROU.✓O l�owss w/UAL- sr,rr�o,� Owner Name: 1 Z I vo ,DEvE[oAi+�E.�r �� -%A.yES uEOEa Owner s Address: rd ��E — �/iGSa,� CJr .SVao?7 7/-f Are o 7o y eve sE ' Legal I escription: .s'E ,vE Munic' ality: Town. Vii1ft9e, of Coup S7' Ca o.x Subdi sion Name: sa,",-r 4/i w "gkaeto�is-E�r Lot Nu mber: /G Block Number: Parcel D.Number: O 00- /.?de -/e- 0,0.0 Page 1 1AWXx T- Page 2 d'Gor• 6�LAw/ �/���oss .SEc 1-ie.y + /'t�•� 11iEw - Page 3 .SEPT�c %ANK /�uwP �if�i9�J'Qeit ��oss-.S�c rio.✓ Page 4 �v�ry o'E.0 Fo�C�sR�o G u2 dE Page-5 AowrS OcJ.✓E2 S /Y�.✓uRL f /'JA.✓�6E/'JENr /�LR.J Page 6 •� Page 7 /r/G fE�t �A�nlT6.✓R•✓tE �.►!Fo Page Page S ��"TA�,�rodds' SaiG C /JIPLUATio.✓ �E.00�7`' Nair e of Designer: -J o�Y� �£GK!E License Number: Date: f S gnature: - Designed Pursuant to the Following POWTS Component Manual and Comm 81-85: In-Gr and Soil Absorvtion Com onent Manual for POWTS er.2.0 SBD-10705-P . 01/01 M 11 . N3 o J J �\ � j v eC •' v W i 10 L V o - v � a o < J � � 3 IN to oo o � v v Nq \. ti • SE TIC TANK- �' PUMP CHAMBER CROSS SECTION� AND SPECIFICATIONS a. WEATHERPR00F APPROVED 4" CT NT PIPE 12" MIN. ABOVE GRADE JUNCTION BOX MANHOLE COVERS y /_-I OM DOOR, WINDOW OR WITH CONDUIT W/ PADLOCK 6 FRESH IR INTAKE H ----� —WARNING LABEL G �'rvds��� GaRuE •t�..4 ei MIN- IN. . INLET GAS. WATER TIGHT SEALS ,QES r TIGHT i tIAPPROVED A SEAL ; JOINTS WITH ALM APPROVED PIPE 1PPROVED B ON t a . 'IPE C , OFF %* RISER EXIT PUMP OFF ELEV . 8`T- PERMITTED ONLY D IF TANK MANUFACTURER HAS APPROVAL 311 APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC. / D SE' ' / DAY: /9 9 TANK MANUF CTUREIt t �//ESE Lo�JtitErE NUMBER DOSES PER 89`1 � l/. � - TANK SIZES: - SEPTIC /000 GAL. DOSE VOLUME INCLUDING DOSE Goo— GAL.. FLOWBACK: 160.8 -GAL. ALARM MANU ACTURER: o&dos CAPACITIES: A_ 9 a7o INCHES = 33 GAL. —r—' MOD NUMBER t L r Z" SW CH TYPE; ,/yEc yA•yic we 14.8 44c 5. $ = �?� INCHES PtrMP MANU ACTURER: ZoE-acE�„_ /^'c'`� C = _f` INCHES GAL. MOD NUMBER: `�/S/ SW CH TYPE: /IECN�ic.yc D = �w INCHES = /.3y Y GAL. REQUIRED „ SCHARGE RATE g-o GPM PUMP & ALARM WIRING AS PER ILHR 36.23 WAC -VERTICAL'D FFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 8.o FEET t MINIMUM ETWORK SUPPLY PRESSURE . . . . . FEET } 7o FEET FORCEMAIN 'X _FT/100 FT. FRICTION FACTOR _7 T FEET TOTAL DYNAMIC HEAD = �8 Z 'FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH .573 // ; WIDTH 78 ; DIAMETER — LIQUID DE°P R_ W UMP PERFORMANCE CURVE TOTAL DYNAMIC HEAD/FLOW so MODEL 1511152/153 PER MINUTE EFFLUENT AND DEWATERING 74 45 753 12 40 MODEL 151 152 153 35- . Feet Meters Gal. Liters Gal. Liters Gal. Liters 9 10 152 ' �e„ 5 1.5 50 189 69 261 77 291 = 'v v 30 10 3.0 45 170 61 231 70 265 Z • �r 15 4.6 38 144 53 .201 61 231 a t51 20 6.1 29 110 44 167 52 197 4$ 25 7.6 16 61 34 129 42 159 ° 6 20 30 9.1 — — 23 87 33 1 125 15 ?e 35 10.7 — — — — 22 85 a 40 122 — — — — 11 1 42 10 Shut-off Head: 30 ft.(9.1m) 38 ft.(11.6m) 44 ft(13.4m) 2 , otawea 5 Model 151 Models 152 J 153 10 0 30 40 50 so 70 80 90 100 GALLONS t� 87132 LITERS 0 40 rl,�,20 160 200 240 280 320 360 I 67132 ---3716 �-+ 45!6 3718 46M FLOW PER MINUTE 0145011A r 3718 3718 _. . ..; 3 718 3�i •Timed dosing par Is available. •Electrical altemat rs,for duplex systems,are available and j supplied with an ilarm. •Variable level con rol switches are available for controlling single phase Sys ms. •Double piggybac variable level float switches are available for variable level ng and short cycle controls. •Sealed Qwik-Box available for outdoor installations.See 1111/16 12116 �! I FM1420. — �•, •Over 130°F(54" )special quotation required. - F 415116 5318 SK2444 SK2064 151115211113 MODELS I Control Selection Model Vohs-Ph Mode Amps Simplex Duplex N151 115 1 Non 6.0 1 2or3 ON161 115 1 Auto 6.0 Included 1 2 or 3 E151 230 1 Non 3.2 1 2or3 BE1511 230 1 ! Auto 3.2 Included 2or3 "Easy assembly" N152 115 1 Non 8.5 1 2 or 3 (pump&discharge pipe BN152 115 1 Auto 8.5 Included 2or3 not included.) E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 kidded 2or3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2or3 BE153 230 1 Auto 5.3 Included 2or3 1. Single piggyback i ariable level float switch or double piggyback variable level float switch. Refei to FM0477. Reduces potential dogging by debris. 2. See FM0712 for o rrect model of Electrical Alternator E-Pak. Replaces rocks or bricks under the pump. 3. Variable level con Made of durable,noncorrosive ABS.I switch 10-0743 used as a control activator,specify duplex = Raises pump 2"off bottom of basin. (3)or(4)float sys m. Provides the ability to raise intake by adding sections of 1'/z" O CAUTION or 2"PVC piping. Attaches securely to pump. Accommodates sump,dewatering and effluent applications. L, NOTE:Make sure float is free from obstruction. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. ©Copyright 2008 Zoeller Co.All rights reserved. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page S or 7 FILE INFORMji 710N Owner Q L SYSTEM"SPECIFICATIONS Permit# �� ,lIE1/E zoP/'lE•„!r Tank Manufacturer: VIESE.¢. 0 NA Septic 0 Dose 0 Holding Volume: /oa p (gal) DESIGN PARAkETERS Tank Manufacturer: G✓iEsE•c Co--jc.cErE DNA Number of Bedrooms: 2 0 NA 0 Septic ®Dose 0 Holding Volume: 660 (gal) Num r of Public Facility Units: I�'I NA Vertical Distance Tank Bottom(s)to Service Pad: 8 (ft) timated(average)Flow; 300 (gal/day) Horizontal Distance Tank(s)to Service Pad: /60' (ft) Design(peak) Flow=(estimated x 1.5): Specific servicing mechanics must be provided if vertical is>15 feet or (gal/day} if horizontal is>150 feet. Specific instructions to be provided on back. In itu Soil Application Rate- (gal/dayfft?) Effluent Filter Manufacturer: /QES r Standard(Dor tesitic)Influent/Effluent Monthly average Effluent Filter Model: ❑ NA Fats,Oil&Grease (FOG) s3D mg/L Pump IVjanufacturer: zoELLE/C Biochemic 1 Oxygen Demand (BODs) 6220 mg/L 0 NA ❑ NA To !Suspended Solids(TSS) 6150 mg/L Pump Model: /S/ High Strength nfluent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L - Manufacturer. (BODs) >220 mg/L 0 NA K NA (TSS) >150 mg/L ❑Mechanical Aeration 0 Peat Filter Pretreated Effl jent 171 Disinfection 0 Wetland ❑Sand/Gravel Filter 0 Other: (BODs) s30 mg/L Soil Absorption System (TSS) 530 mg/L 0 NA Fecal 0oliform(geometric mean) sio`" It In-Ground(gravity) 0 In-Ground(pressure) 0 NA Maximum Eifl an Particle Size ' ❑NA 0 At-Grade ❑Mound /e in dia' 0 Drip-Line 0 Other. Other: 0 NA Other. 0 NA MAINTENANCE SCHEDULE St rvice Event Service Frequency Pump out cont nts of tank(s) Er When combined sludge and scum equals one-third(%)of tank volume 0 When the high water alarm is activated Inspect conditi n of tank($) -At least once eve ❑month(s) D`' 3 ®year(s) (Maximum 3 years) 0 NA Inspect dispere,at cell(s) At least once every: ❑month(s) (Maximum 3 years) 0 NA 3 ®year(s) Clean effluent I iter At least once every: 13$1 month(s) ❑ NA 0 year(s) inspect pump, lump controls&alarm At least once every: ❑month(s) 0 NA 3 ®year(s) Flush laterals E I id pressure test "Af least once eve ry 0 month(s) Other: " 0 year(s) ,�(NA At least once every: 0 month(S) p NA Other. ❑year(s) 0 NA MAINTENANCE INSTRUCTIONS inspections of auks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator(pumper). Tank inspectio is must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks, measure the vi ilume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil absorption sys am shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of It ie local regulatory authority. When the com fined accumulation of sludge and scum in any treatment tank equals one-third(%s)or more of the tank volume,the entire contents of thE tank shall be removed by a Septage Servicing Operator(pumper)and disposed of in accordance with chapter NR 113. Wisconsin Adn inistrative Code. All other servic s, including but not limited to the servicing of effluent filters,mechanical or pressurized components, pretreatment units, and any servid ig at intervals of<_12 months,shall be performed by a certified POWTS Maintainer. A service repoi t shall be Provided to the local regulatory authority within 30 days of completion of any service event. o START UP AND OPERATION Page t of 7 For new cons ruction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other Chemicals or ediment that may impede the treatment process'and/or damage the soil absorption system. if high concentrations are detected have he contents of the tank(s)removed by a Septage Servicing Operator(pumper)prior to use. Pump tanks y fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is t recommended,as the excess wastewater will be:discharged to the soil absorption system in one large dose causing an overload that nay result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contentsofthi pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to-the pump or contact a Plumber or POWTS Mi stainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start tj shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive park vehicles over tanks or the soil absorption system. Do not drive or park over,or otherwise disturb or compact,the area within 15 eat down slope of any mound or at-grade soil absorption area. Reduction or klimination of the following from the wastewater stream may improve the performance and prolong the life of the treatment tanks and so absorption system: acids, antibiotics, baby wipes,-cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers,disln ctants,fats, foundation drain(sump pump) discharge,fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps,medic 3tions,oils,painting products,pesticides,sanitary napkins,solvents,tampons,'and water softener brine discharge. ABANDONME When the P01 ITS falls and/or Is permanently taken out of service the following steps shalt be taken to insure that the system is properly and safely abi doned in compliance with s. SfS383.33,Wisconsin Administrative Code`. • All pil ing to tanks,pits and other soil absorption systems shalt be disconnected and the abandoned pipe openings seated. • The ntents of all tanks and pits shall be rerhoved and property disposed of by a Septage Servicing Operator(pumper). • After umping, all tanks and pits shalt be excavated and removed or their covers removed and the void space filled with soil, grave or another inert solid material. CONTINGENC PLAN If the POWr, falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement s stem: A sui a replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The r lacement area should be protected from disturbance and compaction and should not be infringed upon by required setba from existing and proposed structure,lot lines and wells. Failure to protect the replacement area will result in the need for a n soil and site evaluation to establish a suitable replacement area. 'Replacement systems must comply with the rules in effect the time of their permit issuance. ❑ A suit a replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabil ated and barring advances in POWTS technology,a holding tank may be installed as a last resort. ❑ The all has not been evaluated to identify a suitable replacement area Upon failure of the POWTS a soil and site evaluation must b 1 performed to locate a suitable replacement area. if no replacement area is available a holding tank may be Installed.as a last rt 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 surfs Reconstructions of such systems must comply with the rules in effect at that time. WARNING TR rFICIENT ENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SU OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RE . ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL I UCTIONS: POWTS iNSTA J.ER POWTS MAINTAINER• Name o _013 Name v QE E E!./CE urs /✓d Phone 71,61 `2 Phone /S — W G SEPTAGE SEFIVICiNG OPERATOR PUMPER —WW nJaw.J LOCAL REGULATORY AUTHORITY Name Name 3; �loix laili•�L 4Ff/GE Phone Phone AAs v Eli 4) Y ' uEv;Z - fr d s= ! v o E 0 CL E N o �F ,yG� C N ate+ v U tS f cu • Ll .y LU V W 4 O uP OP O u Ox m > N 'p� u � C Q yt A■ S.w N .�+ 2 2 N a rn a '.0 iJ ' v= E .cm W m m �:, ro = v d O ®p®y -C m.a y o Y N Ll C t ~N O m m 91 to Q W r i On n t o m v cc N uj > SHIMENES V u O y `ice N ° CL y Q y L E 20 L y O O L O P� s t m m 0, O e. y " C O O icy W '5." a 0 , mosommis= d 3 an ON as m � — v ,.- 3 U L C d L91 fb p� O y C7 O, vet w c is mannewaffAin O Q V N c o a N « O " H N a+ LL V'r m +• E O Y m E m a� n lu o S c E 3 a QJ ? a m a m v " y c N d N 0 51. � O 3 N m W N N v°i E WA a.c Y c Qn �r tA ou ° v b 4 O y MR zom wo as � �s� H u u � c py `✓ i"^"1 ST. CROIX COUNTY SFPTIC'i ANK MAINTENANCT AGREEMEN I' AND 0Wner!Rtjy:,r � __ OWtiERSIiP('FRTIT�it ATI )N FORM �"���--L�G'-��a /nt. Mailing Addrcss hoperty Ad iress Ly , 6rd (%'CtificatiOn required horr Plaaway nx epai,n ieni for new comutiction) City/State / 11'`'A Parcel ldent,,ficalloriNumher U kA&A-L_DE S C R I P T 10 N Ive- Property 1xx ation . .Sec. R/ W,Town of _ . Subdivision Lo --- --- I t ft A-AV — # Volume 6.0 page 4 Volume — Page 0 Spez no of tines identifiable c.v no SYST M INTENANCE AND OWNER CERTIFICATION ImProi er ubc and inainienance of your septic system Could rt5uh in its premature fiailuic to handle wastes. Prom maintenance co isists apurnping out tie septic lank every three vcan or%,inner.ifneeded,by a licensed pumper. What you put into the system can ffect die function of the.septic tank m a treatmeat stage in the waste deposal system. O-AmeT maintenance responsibilities re speciricd in Wornin.83,52(1)and ir.Chapter 12-St (-'TO"<County Sanitat y Ordinance. Thep petty owner agrecs to.quhtmt to St.Croix(:nnty pl.,julitIg Zoning I)epartnicni a qxrtifi"tion form,signed by the owner and by a naxter plumber,jouin.-yrnar p1jimbet,ic.Ntricted plunf�gj ul a licensed wAl pliniper verifying that 1 1)the on_sIte wastcL water lisp sal s),steni is iu plul)ef operanng cotuliuon and('or(21 affur inspection and pumping(if necessary),the septic tank is 1055 than F3 ful of sludge Pwe,it!UiWcnigncd have real the abuvc requirements dad agree to maintain the private sewage disposal system with die standards set fo , Iereb;,as set by thr Department of Goniauetce ajkl the Department of Natural Resources,State of Wisconsin. Certificat,on stal ing that your septic qN-stern has been Maintained rnwst be cirripIrted and icttancd in the S, Croix County Planning& Zoning Departmut Widlir 30 t6ys of three year expl-ation,,ule. Fwc cel nfy that ail statemen's on 4111P f,017111 d1c lr,,Ir to the best of iny,,otr. knowledge I. am'aic the ownerls)of the prupo-ity dcscribi d above,by virtue of a ntv deed recorded fit Registc:of Deeds office, Number of bedrooms 7 ATT-/- ***Any informal On that is Misrepresented may result in the sanitary pernut bring revoked by the Nantuiig&Zoning Dcpartfrient. lulude with this Lplilication a recorded waffanty deed frorn the Register of Deeds OfLvc and a copy of the certified survey map if reference is na& in the warranty deed (REV.08105) go to / O . ��'asd'pr ►-7 g 275 g5 w n cm I a r I t.-----J •- •ham N 00'00'56—236_41 fj I } E- Q 0o I 00 o IN "'l LL 3.00_00.00 N n \ I m I < I N N N N 0 00 56 238.06 z \-` -- � p bt i bo 0. i" @ (X) z CV N 00'42'16 271.61 ^ as I � � o � � r. �' ci JI ^ y Z ♦T �g4°o .� A86.2C 1 �49 S q '1\ �` .� \ \ \ a 1 I O 0 ! C\1 E- O '^ L Ofz 3. -'- N S \ em •5 E- 00 'e \,? O 4 \ \1 C— 0 U 2 5 14 P 18 5 7549 i 1Z KATHLEEN H. WALSH STATE BAR OF WISCONSIN FORM 2-2000 REGISTER OF DEEDS Doc t Number WARRANTY DEED ST. CROIK CO., WI This teed,made between Norman Feyereisen and RECEIVED FOR RECORD fhirle A. Feyereisen, husband ana wire 02/23/2004 11:00AN WARRANTY DEED EXEMPT # Grantor,a d B&L Land Development,Inc.,a Wisconsin Corporation REC FEE: 13.00 TRANS FEE: 3710.40 COPY FEE: CC FEE: PAGES: 2 Grantee. antor,for a valuable consideration,conveys and warrants to Grantee following described real estate in St.Croix County,S1 ite of Wisconsin(if more space is needed,please attach addendum:) Please set attached Exhibit"A" Recording Area Name and Return Address River Valley Abstract&Title,Inc. 1200 Hosford St.,Suite 201 Hudson,WI 54016 C91-Ill 0�- 040-1035-10;040-1035-40;040-1037-20-100;040-1037-30 Parcel Identification Number(PIN) This 1-10*�Tiomestead property. (is not) Exceptior i to warranties: easement,covenants and restrictions of record,if any. Dated thi 20th day of February , 2004 * *Norman Feyereisen * *Shirle A.Feyereisen 0— AUTHENTICATION ACIC14OWLEDGMENT Signature s) Norman Feyereisen and ShlrlegA.Feyereisen STATE OF WISCONSIN ) )ss. ST CROIX County ) authentic a day of February , 2004 Personally came before me this 20th day of February 2004 the above named * vG Norman Feyereisen and Shirley A.Feyereisen TITLE:N EMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s)who executed the foregoing auth rized by§ 706.06,Wis.Slats.) instrument and acknowledged the same. IS INSTRUMENT WAS DRAFTED BY Heywood, an&Anderson,S.C.,1200 Hosford St.,Suite 106 Notary Public,State of WISCONSIN P.O.Box 125,Hudson,WI 54016 My Commission is permanent.(If not state expiration date: (Signatures riay be authenticated or acknowledged.Both are not necessary.) ) "Names of iersons signing in any capacity must be typed or printed below their signature. WARRAN DEED STATE BAR OF WISCONSIN INFO-PRO (800)656-2021 www.infoproforms.com FORM No.2-2000 U 2519P 186 i EXHIBIT A parcel of land located in the SW 1/4 of the NE 1/4, in the SE 1/4 of the NE 1/4, in the NW 14 of the SE 1/4 and in the NE 1/4 of the SE 114, all in Section 8, Township 28 North, nge 19 West, Town of Troy, St. Croix County, Wisconsin Described as follows: mmencing at the South Quarter comer of Section 8-28-19;thence N00°56'46"W along tt e North-South Quarter section line, 2942.21 feet to the Point of Beginning; thence c ntinuing N0005646"W along said line, 1010.47 feet to the Northwest comer of the SW 14 of the NE 1/4; thence N88°52'26"E along said line, 337.51 feet;thence S01°01'11"E, 3 2.14 feet; thence S56°12'32"E 906.33 feet; thence NO101833"W, 550.92 feet; thence 8 052'26"E 1573.74 feet to the NE comer of the SE 114 of the NE 1/4; thence 0 056'04"E along the East line of the NE 1/4, 1313.16 feet to the E 1/4 comer of said ction 8; thence S00050'03"E along the East line of the SE 1/4, 366.31 feet; thence 9 004'16"W 1440.85 feet; thence N00 040'41"W 447.87 feet, thence N87°40'26"W, 3.47 feet; thence N00 00947"W 159.98 feet; thence S89023'35"W 333.01 feet to the Ant of beginning. Contains 82.45 acres or 3,591.410 Sq. Ft. I� Dlu � m 4� E3D c O z I i I i o I 0 4'r O d Z 8 D Oz, e Z - e i , I I'li i ,u i' i A Z C R 3 1 0 y w WATERS EDGE CONSTRUCTION vaoxa. vKE IRro REAID920F.L•_,.T__..,'•.d— 75401ERCIAL SPEC 2014 EXTERIOR ELEVATIONS 19211 Fnl1t Slral,Smm 101_liudvw.W7 54016 PN 715.181�975A I i I I ----------------------------- �. ------------------------- ------------------------- ---------- ....... lz D ° & 99 ------------------ : E .I' q t . i ii ° „ .......................................................... .............. ---------------- t---------------................... --------- moo' J71� � e i ' M ' l nz� 6 Z PIS. 5 F � � g WIIIUER: �o z $ I WATERS EDGE CONSTRUCTION A b IgWEII: MAIWO: RESIDEM'L11•MUL'RFA8IRY•LIGHT SPEC 2014 FOUNDATION PLAN 29.8 P.n1—Sv sw.IUI-xmu,..W35 16 PH.715.181.9758 ........... .............. -------------------- Op o---------------- WATERS EDGE CONSTRUCTION -0 lro 01 m m. PAU INfo: p SPEC 2014 MAIN LEVEL PLAN PH 715-M-75, 0 Property Owner Et L ���(7N� `f Parcel ID# ��'k./`I�1 jl/G Page ;of Fq Boring# ❑ Boring ® Pit Ground surface elev. ��b^3ft. Depth to limiting factor 7 q( in. Soil AppliP'E #2 Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP In. Munsell Qu.Sz. Cont.Color Gr.Sz. Sh. •Eff#1 I o-�o �u�R_3 t — S t Z`Fs bl-t YvL`�r Z 117-3.� tO`�1fL. 316 — S1 � Zwt S b� wl.'Ft- cS l� .S •8 3 36-q9 to�1R �lIL — S o .� IE Boring# ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application gRate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu.Sz. Cont.Color Gr.Sz. Sh. •Eff#1 'Ef ❑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 =BODS>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BQD3<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-8330(R.6/00) r> 'CE�v W�onsi Department fCo rce SOIL EVALUATION REPORT Division o Safety and ildings nn((�� Page of M�R o an10"ance ith Comm 85,Wis. Adm. Code County Attach mplete site pl non paper not lep��FV2 1/2 x 11 inches in size.Plan must S l Cam) include,but not limited :ve;al(�r3Q b f�njprefer a point(BM),direction and percent lope,scale or imensi(L"t3 and location and distance to nearest road. Parcel I.D. V � lease print all information. Re iew by ""Date i i Person I information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). AkAA Pro p e rty O er Property Location fit_,,S � ��V�Q7 N�•JZ" S� 1/4)ViE.1/4-S T Z8 N R �� E Prop O ner's Mailing Address 3 Lot Block# Subd.Name or CSM# SUrvS�- C+ty State Zip Code Phone Number -• f ❑City []Village �0 Town Nearest Road New Cc ristruction Use:IS Residential/Number of bedrooms — Code derived design flow rate S 0 — `j U(7 GPD ❑Replace nent ❑ Public or commercial-Describe: Parent material Flood Plain elevation if applicable (� ft. General cor iments and recomn iendabons: Z �Y�P�Yt'�rJ� 3 +1 . � / lti L Bori ig# ❑ Boring ae Ffe,Zge rr � ® pit Ground surface elev. �� b�� ft. Depth to limiting factor '7 �b .in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPQ 1ft2 in. I Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 *Eff#2 Z — Sl1 Z`Fsb)z h��- Cw Z�' •5 -� Z q-30 10�t YZ 31 e S') � Z h2s bLc ��>r cs . l�4' •S .S �.tf to�fZLjl6 i i i �� aBorlr g# ❑ Boring ® pit Ground surface elev. l7 O Z ft. Depth to limiting factor in. Soil Application Rate Horizon epth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 lo�tVz3Cz - stS '+Sn`2 �^nr` Cf,, Z� •S -� tr Z ) Yf2 3t 6 — S 1 J ZYn S bk In` es l •S -8 3 3 —qg �o�tZ�il6 _ le C) s Effluent#1 =BODS>30<220 m9A-and TSS>30<150 mg/L •Effluent#2=BODS<30 mg/L and TSS<30 mg/L CST Name lease Print) Sig na re CST Number -Arth r L Wegerer PucL i- 03—z 1S — 16 220254 Address WiEge r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 2i Hain St. River Falls , UI 54022 lZ-ZZ_ p3 715-425-0165 .Wisconsin Department of Commerce SOIL EVALUATION REPORT " •*Division of Safety and Buildings \ of --% in accordance with Comm 85,V`/is. Adm. Code ' Attach complete site plan on paper not less than 8 1/2 x 11 inches in size.Plan must County Page include, but not limited to:vertical and horizontal reference point(BM),direction and S l Cam) percent slope,scale or dimensions, north arrow,and location and distance to nearest road. Parcel I.D. Please print all information. Reviewb� .'Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Y Property Owner � ! Property Location t�E � �.1` Property Owners Mailing Address 1/41V�1/4-S F-5r• T Z8 N R �� E(cr)W Lot# Block: Subd.Name or CSMn P •o. fox 3 3 k:� — Sur.�s Crty State Zip Code Phone Number V l� ❑City []Village own Nearest Road �R�?M �Rl-c.� Iry► 15�l g10 I (�I E )�1�5,3�S � TZp`1' New Construction Use:® Residential/Number of bedrooms-3 - Code derived design flow rate Ll S Q - 1,j UCH GPD ❑Replacement Public or commercial-Describe: Parent material G Lie) 1; Flood Plain elevation if applicable 1� General comments ft. and recommendations: Z `0 h1p��JL � r ., <ZLLZ r I aBoring# ❑ Boring ® pit Ground surface elev. h- ft. Depth to limiting factor 7 ^ in. Horizon Depth Dominant Color Redex Description T7-Texture Structure Consistence Bcunda RSeil App lication Rase in• Munsell ry GPD/ft Qu.Sz. Cont.Color Gr.Sz.Sh. Efi`1 'Ef N2 b�1r23Lz 0`-tIL 31e •s .s 3 3b-�i� to-1fL II EBoring# ❑ Boring ® Pit Ground surface elev. l O O Z ft. Depth to limiting factor '2 8 in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Sorl A GPD/ft2 Rate in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Effn2 o - lo`21z3 t.z s` ` --:� Z )0 3b �0�2 3t6 — s i 1 Zlnsb>z �n 3 3�-qg 10�-11Z�L16 _ S O sq ►M 1 - .� t. Z I Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BOD <30 m CST Name(Please Print) - s- 9/L and TSS<30 mg/L Signa re CST N -Arthur L: 'Wegerer �. 03 2,1S - �6 - umber 220254 Address W e g e r e r Soil T e s t i n a & Design Service Date Evaluation conducted Telephone Number 421 11. Iiain St. diver calls , UI 54022 \Z-2Z_ p3 715-425-0165 ID Property Owner ` ��w 7 Nl�l�/�-- Parcel ID# G Page Z ' of Boring# Boring p Pit Ground surface elev. ��b`3 ft. Depth to limiting factor 7 1 in. Soil Application Rate Horizon Depth ominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munseil Qu.Sz. Cont.Color Gr.Sz. Sh. •Eff#1 •Eff#2 St3 tz — SO --. b'r Z 1D 3� tq tZ 3J b — sl Z S b� MT cs l'� .5 .SO o�R ❑ Boring# ❑ B°ring El pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth I ominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 I I F-1 Boring# ❑ oring ❑ it Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dc iinant Color Redox Descriplion Texture Structure Consistence Boundary Roots GPDM2 In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 I •Eff#2 Effluent#1 GODS>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BODS<30 mg/L and TSS<30 mg/L The Department of ommerce is an equal opportunity service provider and employer. If you need assistance to access services or need m erial in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. SBV-8370(R.6/00) PLOT PLAN Paae 3 of Scale 1 ' =50 ' L00.0' Ohj t"t�,tr1• \-Nz- ►J PtP� UT ec,Z1 R i C��'1 Ct Z `t \ 0•-J C�`J G�J.lr S v�21-=R Q �-T �T � Q c S ti a l pC)7 SM Z - 0p _ �O s' � 4 3.3 ¢i Srn'rk�l __- Svt�3L� C``ZL S I i i 715-425-01 3 65 220254 b3- -21 LS- l b CST Signature Date Telephone Ito. CST No . Job NO .