HomeMy WebLinkAbout020-1104-30-050 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 569571 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Wegner, Elizabeth I Hudson, Town of 020-1104-30-050
CST BM Elev: Insp.BM Elev: BM Description- Section/Town/Range/Map No:
. t 34.29.19.412620
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic J �u ! Benchmark s` a+ / e. g 5�,
� Alt. BM rt S
7
Aeration Bldg.Sewer
Holding St/Ht Inlet 7.4w 97, f68
TANK SETBACK INFORMATION St/Ht Outlet 7.$5 °t7
TANK TO n P WELL BLDG. Vents Airy take ROAD Dt Inlet
Septic Lis / / i Dt Bottom \
1
Dosing Header/Man.
Aeration Dist. Pipe 9• .3S
/a. 94f. SY
Holding Bot.System
PUMP/SIPHON INFORMATION Final Grade -�' �,� s •g 9c?,
Manufacturer DeP Rand St Cover 3. 5 7S
F;I G .
Model Number
TDH Lift Friction Loss jSystemHead TDH Ft
Forcemain th Dist.to well
SOIL ABSORPTION SYSTEM 4b
BED/TRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth
DIMENSIONS /o U Z 3 �CX`
SETBACK SYSTEM TO ` P/L BLDG WELL LAKE/STREAM LEACHING Manufactu � �r �+
INFORMATION Type 9f System: I r CHAMBER OR ber Ir l
V �S UNIT Model N�mber:� S�
ut
DISTRIBUTION SYSTEM /Sf-/S 0-/6 44's fa
Header/Manifo?L (� ( Distribution x Hole Size x Hole Spacing Vent tq Air Int e
b+ 4 Pipe(s) ` a f
Length Dia Length Dia $pacing to I
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over /// Depth Over ` xx Depth of xx Seeded/Sodded xx Mulc!�Y:,
Bed/Trench Center �{ Bed/Trench Edges \\ Topsoil Yes H No s E] No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / /
Location: 603 White Oak Drive/Hudson,WI 54016(SW 1/4 SW 1/4 34 T29N R1 9W) NA Lot 2 Parcel No: 34.29.19.412G20
1.)Alt BM Description= �'f L__ Go �"" GKw,� �► (� ��
2.)Bldg sewer length= Cl�-3 } y =, /& r
-amount of cover
4 ® Yes No � --- ' "w`w�•._. �� Wd-<<C.
$e�
Plan revision Required? 18
Use other side for additional information. 1J t1j
SBD-6710(R.3/97) Date Insepctor's Signat Cert.No.
PLOT PLAN
PROJECT Elizabeth Weaner ADDRESS 408 Kennedv River Falls Wi 54022
SW 1/4 SW 1/4S 34 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX
MPRS Shaun Bird 226900 DATE 5/18/14 BEDROOM 4
CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 890 # of chambers 44
BENCHMARK V.R.P. Top of 3/8" rebar ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 95.0/94.2' 4.5' below grade
Vent
>6„ Quick4 Standard
All piping shall be SDR 30/34, of Cover Leaching Chamber
within 10' of tank,piping shall with 20.0 ft2 of Area
be Schedule 40. 5.1jft 2/pair of end caps
4' Long 12„ Z
341. Grade at System Elevation
B.
Please note: further testing is to
% Slope be done to find a more
ents
suitable area
20'
B-3
0'
2-3' X 90' cells with>3'spacing 97'
!�
5, B-2
� S
White Oak Dr. 3 0'
Scale is 1" = 40' , Pro 4
unless otherwise 61 Bedroom
noted House
65'
105'
120' 247' Property Line
Commty
Safety and Buildings Division � �x
201 W. i n e. Ox 7162 Sanitary Permit Number(to be filled in by Co.)
Od
MM
6a q5 7
o� State Transaction AN�
sS ermit Application /�'
In accordance with S 11,Wis.Adm.Code,submission of this form to the appropriate governmental unit
is required prior to o` a sanitary permit. Note:Application forms for state-owned PO are submitted to Project Address(if different than mailing address)
the Deptiftent of Safety and Professional Servies. Personal information you provide may be used for sewn /
wrposes in accordance with the P Law,s.15. 1)(m Stats. / 3 � tp
L Application Information—Please Print All Information ��✓✓✓ l
Property Owner's Name Parcel# 020 //0
Property Owner's Mailing Address Property Location
GOVL Lot `' C�
City,State p Code Phone Number '/y Section
��j k
l � T-fN; RE W
IL Type of Building(check all that apply) #
Subdivision Name
or 2 Family Dwelling-Number of Bedrooms
Block#
erc
❑Public/Commial-Descnlx Use ❑City of 1/1 A7
CSM N_� ❑Village of
❑State Owned-Describe Use �7 ] -�(�
2 �'rJ1' Cls W Z2-4,0Z �WA O / d Town of
IIf.'Type of Permit: (Check only one oz on line A. Complete line if applies
A' ew System ❑Replacement System ❑Treatm t/Holding Tank Replacement Only ❑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 .r
Tir.Type of PORTS S m/Com nent/Device: Check all that a 1
Non-Pressurized inn-Ground ❑Pressurized In-Ground ❑At-Grade ❑Mound>24 in.of suitable soil ❑ curd<24 in.of suitable soil JG 5
❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain)
V.Dispersal/Treatment Area Information:
Design Flow(gpd) Design Soil Application f) Dispersal Area Required(sf) Dispersal Area 176d(st) System ati
VL Tank Info
Capacity m Gallons Units Manufacturer Y
R v
New Tacks Existing Talcs an U.rn U.
t a Cg ., C7 CL
Septic or Holding Tank
Dosing Chamber
VII.Responsibility Statement-1,the undersigned,assumpp1ponsibilitty for installation of the POWTS shown on the attached plans.
Plumber'$Name(print) Flambe' MP/MPRS Number Business Phone Ntunber
Plumber's Address(Street,city,S�t/ate, 'p Code)
ou /De artmeat Use Only A
roved ❑ Perm�ijtFee Date Issuing Signature
ven Reason for Denial S
IX.ConditiQ� gons for Disapproval nl� �
1. "Septic tank,effluent fifer end �[ e4
.dispersal cell•must all be services/maintained
as per management plan provided by plumber.
A v bemeMs:musLbe mair ained:u K
Attach to complex pleas for the system and submit to the County only on paper not leas than s in x l l inches in sire
SBD-6398(R.11/11)
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 5/18/14
Owner: Elizabeth Wegner
Location: SW 1/4 SW 1/4 S34 T29 N,R19W 603 White Oak Drive Hudson
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Specifications S
8-10. Soil Test
Signature
License number 6900
PLOT PLAN
PROJECT Elizabeth Weaner ADDRESS 408 Kennedv River Falls Wi 54022
SW 1/4 SW 1/4S 34 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX
5/18/14 BEDROOM 4
MPRS Shaun Bird 226900 DATE
CONVENTIONAL )00( IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 890 # of chambers 44
BENCHMARK V.R.P. Top of 3/8" rebar ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
SYSTEM ELEVATION 95.0/94.2' 4.5' below qrade
jL_.—Grade Quick4 Standard
All piping shall be SDR 30/34, eaching Chamber
p p g ith 20.0 ft2 of Area
within 10 of tank,piping shall .�ft^2/ air of end caps
be Schedule 40. P P
3 4 at System Elevation
B.M.*
_1 Please note: further testing is to
10% Slope be done to find a more
ents
suitable area
20'
50' B-3
0'
2-3' X 90' cells with>3'spacing 97'
5' B-2 99'
S
White Oak Dr. 10'
Scale is 1" = 40' 0 4
unless otherwise Bedroom
noted ouse
65'
105'
120' 247' Property Line
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber
5.6ft^2 pair of end plates To be >1' above grade
Finish grade elevation
Typical Installation 99.5'
Vent 01 Grade Vent
3' 4" 3'
.A�30/34 Septic Tank
5' Long 119 5' S' Long 191
3 6" Grade at System Elevation Grade at System Elevation
Spacing 5'
2-3' X 90 ' Cells
Same on other end Observation tubeNent
At end of cell
A
B
22 chambers per cell
System elevations:
A-95.0'
B 94.2'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page Of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner ,, Tank Manufacturer. ❑ NA
Pemift# .67 ptic [3 Dose ❑Holding Volume: J,�� (gal)
DESIGN PARAMETERS Tank Manufacturer ANA
Number of Bedrooms: ❑ NA ❑Septic ❑Dose ❑Holding Volume: (gal)
Number of Public Facility Units: --NA Vertical Distance Tank Bottoms)to Service (ft)
Estimated(average)Flow: �(J Q (gal/day) Hod=tal Distance Tank(s)to Service Pad:
Design(peak)Flow=(estimated x 1.5): (g aY) Specloc servicing mechanics must be provided K or
G 0 If horizontal Is>150 feet. SpecUlc Instructions to be provided on back.
In Situ Soil Application Rate: (gal/daye) Effluent Filter Manufacturer:
NA
Standard(Domestic)Inlluent/Effiuent Monthly average.. Effluent Filter Model:
Fats,Oil&Grease (FOG) s30•mg& Pump Manufacturer:
Biochemical Oxygen Demand (SOD$) =0 mg/l. ❑NA NA
Total Suspended Solids SS s150 Pump Model: .
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg1L Manufacturer.
(BODs) >220 mg/LA ❑Mechanical Aeration ❑Peat Filter NA
SS) >150 mgA. ❑bisinfection ❑Wetland
Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other.
(BODE) s30 mg& Soil Absorption System
(TSS) s30 mg1L
Fecal Cdiform(geometric mean 510`" � 1f7-Gmxmd(gravity) ❑In-Ground(pressure) ❑ NA
Maximum Effluent Particle Size Ya in dia.. 0 NA ❑Drip-ode ❑Mound
❑Drip-Una ❑Other:
Other: NA Other. NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Pump out contents of tank(s) ❑When combined sludge and scrum equals one-third(%)of tarok volume
❑When the high water alarm is activated
Inspect condition of tank(s) "At least once every: v-E ye(s)s) (Maximum 3 years) ❑NA
Inspect dispersal cell(s) At least once every: 'm on sus) (Maxknum 3 years) ❑ NA
Clean effluent filter At least once every: month(s) ❑NA
i s)
Inspect pump,pump controls&alarm At least onowevery: 0 month(s) NA
yews)
Flush laterals and pressure test At least once every:. ❑month(s) VNA
Other: At least once every: ❑mornth(s)
❑year(s)
Other:
MAINTENANCE INSTRUCTIONS
Inspections of tanks 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 inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil
absorption system 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 the local regulatory authority.
When the combined accumulation of sludge and scum in any treatment tank equals one-third(%)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 Administrative Code.
All other services,including but not limited to the servicing of effluent filters,mechanical or pressurized components, pretreatment units,
and any servicing at intervals 01`512 months,shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 30 days of completion of any service event.
GMW-005(02105)
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other
chemicals or sediment that may impede the treatment process*and/or damage the soil absorption system. If high concentrations are
detected have the contents of the tank(s)removed by a Septage Servicing Operator(pumper)prior to use.
Pump tanks may fill above normal highwater levels prior to startup or due to.pump failures. Start up or restoration of power under these
conditions is not recommended,as the excess wastewater will be-,discharged to the soil absorption system in one large dose causing an
overload that may result in the backup or surface discharge of effluent.and damage to the system. To avoid this situation have the
contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to-the pump or contact a Plumber
or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
Do not drive or park vehicles over tanks or the soil absorption system. Do not,drive or park over, or otherwise disturb or compact, the
area within 15 feet down slope of any mound or at-grade soil absorption,area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the We of the treatment
tanks and soil absorption system: adds, antibiotics, baby wipes;-dgaretWbutts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain(sump pump)Discharge,fruit and vegetable peelings, gasoline, greases, herbicides,meat
scraps,medications,oils,painting products,pesticides,sanity napkins,solvents,tampons,'and water softener brine discharge.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safely abandoned in compliance with s.Comm 83.33,Wisconsin Administrative lode`.
• All piping to tanks,pits and other soil absorption systems 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(pumper).
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space tilled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have beery, or must be taken, to provide a code compliant
replacement system:
suitable replacement area has beers evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by required
setbacks from existing and proposed structure,lot lines and wells. Failure to protect the replacement area will result in the need
for a new soil and site evaluation to establish a suitable replacement area. 'Replacement systems must comply with the rules in
effect at the time of their permit Issuance.
❑ A suitable replacement area Is not available due to setback and/or soil limitations. If the soil absorption system cannot be
rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a last resort
❑ 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.biamat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
WARNING TREATMENT TANKS, PUMP TANKS, AND MOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK
SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY
RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE.
ADDITIONAL INSTRUCTIONS:
POWTS IN ALLER POWTS MAINTAINER.
Name <-' Name ✓-�
Phone /�'� — r Phone
SEPTAGE SERVICING OPERATOR(PUM LOCAL REGULATORY AUTHORITY
Name Name i ! ,
Phone - _ Phone
This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections
Comm 83.22(2)(bx1)(d)&(f)and 83.54(1),(2)&(3),Wisconsin Administrative Code.
ST. CROIX COUN1'le
SEPTIC TANK MAIN'T'ENANCE./kGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer �
Mailing Address
�o
Property Address
(Verification required from Planning&Zoning Department for new c n ruction.)
City/State _ Parcel Identification Number 0Z6--//0* - 36 - 65C>
LEGAL DESCRIPTION
Property LocatiarVV4'-,J%4 Sec , T N Raj W, Town of
Subdivision — , Lot# zi .
Certified Survey Map# �j l� ` _ , �V Mime l ,Page#
Warranty Deed# 7 / ` �j , Voltune ,Page#
Spec house yes no Lot line., identifiable&, no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner,ii needed,by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance
responsibilities are specified in§Comm. 83.52(1)and in Chapter 12-St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St.Croix County Planning&Zon mg 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 system is in proper operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is
less than 1/3 full of sludge.
I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Planning&
Zoning Department within 30 days of the three year expiration date.
I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the
property described above,by virtue of wa ty deed recorded in Register of Deeds Office.
Numbe of edro ms
GNA PLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary pernrit being revoked by the Planning&Zoning Department. ***
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV.08/05)
FILTER
CARTRIDGE INSTRUCTIONS
Instanation
STEP 1 Dry Ile the ARM'case onto dhe end of the outlet pipe to ensure R is
centered under the access upenftp. V not„then goor Moen!none pipe into the
tank dww.*b the outlet or savant weld(*a)additional pipe onto the Outlet
Pipe.
STEP 2 Whik the case is sW dry Attad an the outlet pipe,nessure the i.ngth
of ii-inch pipe needed to brace the filter to the tank end wen if utMb ng the
options!supplements{side support,If side support method.IS not uUkmd,
proceed to step four:
5--FP 3 For installations utilbing the optimal side support:
sove+ht weld the%-inch
sneol
Pipe onto the fiM�er ass. H side support n+ethod is not
utib".proceed to step fora'
Solvent weld the Alter woe onto the outlet
cartridge into the case, Pipe. Insert the Alter
the case. Pressing down until the taker tacks itKo the bottom of
clockwise a inert switch is umimd:it into the filter and kick by turning .'.•,'�.,
mabitmance
1. The effluent ARe►should be elected every time the septic tank is
serviced.
2. Open the outlet access opening to inspect the tank and(Ater a
3. Pump tint septic tank aw"ph tely,malting sure to remove the sludge "
layer on the bottom of the tank and not just the scum and of luent
<. Once the elihent level has been kwmred below the invert of the
outlet Pipe,finnly Pull up on the Alter handle to dislodge the >:
cartridge from the case.
S. Slide the cartridge up and out of the ass for cleaning.
6. If a VRS switch coruhaded to an alarm is present,the switch `
should be removed by ttr ring atuAeedodkwite 90e and cleaned
with water only.
7. White holding the cartridge on its side(large flat surface facing e
down)nonce the OCCOM opening,rite Off the cartridge with water
only,making sun aA septage miRariel is rfrwd balk into the tank,
tf. If VRS switc Is utwlse 90e�ca by in5Bf ing into After and 1-e
9. Insert the filler cartridge back Into the ease,pressing down until .,e • :V1
the Alter locks lento the bottom of the case.
'a-Replace and secure the access opening on the tank. .�
Y.t it,:nbt-a'•arc"`S:•N'R:r1(� riv @••'t r..:t iret';.R:.v;,k�i.iv•.
WWWbear+a dte cDM 877•MMIMRS(6S3-4583)
UNOFFICIALCOPY -
7 7 7 6 9 6
VOL 19 PAGE 4864
KATMEEH H. IALM --------
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
CERTIFIED SURVEY MAP CERTIFIED 01:30PA
CERTIFIED SURVEY NAP
LOCATED IN PART OF THE NW 1/4 OF THE NW 1/4 OF SECTION REC FEE: 13.00
COPY FEE: 3.00
3,T28N,R19W,TOWN OF TROY AND IN PART OF THE SW 1/4 OF PAGES: 2
THE SW 1/4 AND IN PART OF THE SE 1/4 OF SW 1/4 OF SECTION
34,T29N,R19W,TOWN OF HUDSON,ALL IN ST.CROIX SURVEYOR:
i COUNTY,WISCONSIN. DOUGLAS ZAHLER
` S&N LAND SURVEYING,INC.
2920 ENLOE STREET
OM HUDSON,WI 54016
IN LL
PREPARED FOR:
TOM FELDMANN
�2 HUDSON,WI
a w ,'7/W `� `�\ \ OF ►NHS
LU P0
DOUGLAS J. 0Z
ZAH
S-2145
HUDSON,
S.
LOT 2 °
LOT•1
G 1 01 ACRES
2.53 ACRES \
'. 2. 2 \
(110,309 SO.F.T)
® (87,545 SO.F.T) \ \
//q HOUSE \ \ \
S.UNEOFTHESE114
SW COR.
EXISTING OF SW1/4 OF SEC.34 S114COR.
'PS SEPTIC TOWN OF HUDSON
SEC.34 � � � SEC.34
�.�.—880.21' 247.73' 168.94'A a 1341.32'
�,. 416.67' 114
•— N1l4COR.
.NW COR. b N.UNE OF THE NE1/4
(SEC.3 a� S89°40'421V2638.20' ``�0,�. OF NW1/4 OF SEC.3 SEC.3
OL"LOT 1 TOWN OF TROY
.f, � dd 1.21 ACRES
(52,858 SO.F.T)
rO'a 7 NOTE: OUTLOT 1 IS AN UNBU4.DABLE PARCEL
g �5dd UNDER CURRENT LOCAL ORDINANCES AND
MUST REMAIN UNDER COMMON OWNERSHIP
p – WITH LOT 2.
(EAST 1040.881 i \
4G3QC�
Number Radius Length Central Angle Chord Bearing Chord Length Arc Length Tangent In Tangent Out
C1 631.91 40°3001' N37°3725.5'E 437.43 446.67 N57°52'28'E N17°2725'E
C2 487.87 30°13'09" S41°1T4.5'E 254.34 257.31 S56'190391E S28°OB'30'E
LOT 487.87 08°58'56" S51'5010"E 76.41 76.49 S56°19'39'E S4r20`41'E
LOT 487.87 21°14'11' S36°4315.5'E 179.79 180.63 S47°20'41'E S26°08'30"E
C3 1176.92 03°00'21• S2713640.5"E 61.73 61.74 S26°OB'30'E S29°08'51'E
W1/4COR. AppROVED
SEC.3 ST CROIX COUNTY LEGEND
pMnnkg Zanhg and Pn*` FOUND ALUMINUM COUNTY SECTION
CORNER MONUMENT
OCT 2 1 2004 0 FOUND 11 OUTSIDE DIAMETER IRON PIPE
SET 1*OUTSIDE DIAMETER BY 18"LONG IRON
If not t�/° W be PIPE,WEIGHING 1.13 LBS.PER LINEAR FOOT
SCALE IN FEET P 15Qka w4 volid (X)OOO9 PREVIOUSLY RECORDED DATA
PROPOSED DRIVEWAY
150 0 150 •••••••••.• BUILDING SETBACK LINE
THIS INSTRUMENT DRAFTED BY:WES ANDERSON
JOB NO.6378.01 DATE:1/19/2004 REVISED:9/7/2004 SHEET 1 OF 2 SHEETS
Vol 19 Page 4864
969296
STATE BAR OF WISCONSIN FORM 1 —1998 BETH PABST
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
Document Number 12/12/2012 08:00 AM
This Deed, made between Thomas J Feldmann and Dorothy J. EXEMPT * NA
Feldmann husband and wife , Grantor, and Elizabeth M.Wegner, REC FEE: 30.00
sinale , Grantee. TRANS FEE: 262.50
Grantor, for a valuable consideration conveys to Grantee the following PAGES: 2
described real estate in St Croix County State of
Wisconsin (the"Property"): --The above recording information
verifies that this document has
been electronically recorded
rt returned to the submitter
Recording Area
Namepgaq6pwrV&?dress
Burnet Title
5151 Edina Industrial Blvd. 0500
Edina, MN 55439
Attn: Post Closing
0-- LoIoS
020110430050 -F o 0100 t b,5S
Parcel Identification Number(PIN)
This estead property.
(is is not)
See Exhibit A attached hereto
Together with all appurtenant rights,title and interests.
Grantor warrants that the title to the Properties good, indefeasible in simple fee and free and clear of encumbrances
except /(
Dated this JO day of 2012.
(SEAL) (SEAL)
* d
Thomas J. Feld n Dorothy J. ann
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
state of Wisconsin,
fit— c
County ss.
authenticated this day of 60 day of
� �Pesp n�ai�yc�?UP before me this Y
/uRru'11� U _2012 the above named
Thomas J Feldmann and Dorothy J Feldmann husband
and wife to me known to be the person who
TITLE: MEMBER STATE BAR OF WISCONSIN
executed foregoing instru nt and acknowledge the
sam .
(If not,
authorized by§706.06, Wis. Stats)
THIS INSTRUMENT WAS DRAFTED BY "
Burnet Title-Scott Tranby Notary Public,State of Wisconsin
5151 Edina Industrial Blvd,#500
Edina, MN 55439 My commission is permanent. (If not,state expiration date:
12-20108 _ le+ww yowrllllFR )
(Signatures may be authenticated or acknowledged. NOTARY PUBLIC
Both are not necessary.)
14T&TIL OF W1SC0 SIN
*Names of persons signing in any capacity must be typed or printed below their signature-,g 1 l
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co, Inc.
WARRANTY DEED FORM No.1 —1998 Milwaukee,Wis.
1 of 2
EXHIBIT"A"
Legal Description
File No. 12-20108
Part of the Southwest Y.of the Southwest%4 of Section 34, Township 29 North, Range 19 West,
of the Town of Hudson, and part of-the Northwest%.of the Northwest%.of Section 3,Township
28 North,Range 19 West, Town of Troy,all in St. Croix County,Wisconsin, described as follows:
Lot 2, and Outlot 1, of Certified Survey Map filed as Document No. 777696 on October 21, 2004
in Vol. 19 page 4864.
1
2of2
e
V l
s � m
°
- - a
a
9
uffi9IIRfT m�.vu. a
MAIN FLOOR PLAN
vuwrnuw�gm+ccwee.c� �"°
r..o vrmnro.mwunorvoaeweue � � i
_ ,..r .,, _ u.•_ ___ ,.aur sa __
tOR4
a
s
IT
oiWill
9' a
U
VVVVV
6 _
e
E o�csvwtm
+ �t --a--- !I
@A9RMRNT FLOOR PLAN _.. -..
�romw¢wremwm w»axx
e.o.s eorro.arwuwma.nwmer � ��§�� 4
■OP.
S
� e
N gg
- -
lODFHdN `:
mm E I
LLJ
4
gp - EE EE -
° l•°�,• _ __-- W LEFP ELEVATION b
YOF4
9g 5�•
0
-- -
U 11
Asp Avg...
REAR ELEVATION Av,m,m
MCA
MMOUDDO
pom�4--L=jL=jDUI NUALADD
,om
H"HT ELEV
FBONT ELEVATIQN
i p
C f O �
IB
FIT
ar El
5 9
1 OP 1
RE11ocation
7 1760
NOV L VALUATION REPORT
Wi�orfsin Department of Coin page 1 of 3
Division of Safety and Buildings 1 A.C.E.Soil&Site Evaluations
ST.Ck0C m 85,Wis.Adm.Code
County
Attach complete site plan o QMttl ize. Plan must St.Croix
include,but not limited to:vertical a ),direction and parcel I.D.
percent slope,scale or dimemsions,north arro , istance to nearest road. prt of 020-1104-30
Please print all information. Revs ` I e
Personal informal"you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)).
Property Owner Property Location
Thomas J. Feldman Govt.Lot SW 1/4 SW 1/4 S 34 T 29 N R 19 W
Property Owner's Mailing Address Lot Block# Subd.Name or CSM# � a p J
604 Gilbert Road 2 -Proms ed '7
City State Zip Code Phone Number ity j Village � Town Nearest Road &
Hudson WI 54016 1 715-386-3609 Hudson I White Oak Dr.
yl New Construction Use: Ae, Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD
_; Replacement _._I Public or commercial-Describe:
Parent material Glacial outwash Flood plain elevation,if applicable na
General comments
and recommendations: Install two trenches at elev.95.00'using 28 leaching chambers.
❑Boring# _j Boring
Pit Ground Surface elev. 99.48 ft. Depth to limit ing factor 106" 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. 70.5#1 'Eff#2
1 0-9 10yr3/2 none sil 2fcr mvfr as 2fmc 5 0.8
2 9-22 10yr4/3 none sil 2fsbk ds cw 2fmc 0.8
3 F22-_33 10yr5/4 none Is 1msbk ds cvv 2fm,lc 0.7 1.2
4 33-58 10yr4/6 none s 0 sg dl gw if 0.7 1.2
5 58-106 10yr516 none s 0 sg dl - - 0.7 1.2
I
Boring# .J Ong
✓j Pit Ground Surface elev. 99.73 ft. Depth to limiting factor >108" 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
1 0-4 10yr32 none sil 2fcr mvfr as 2fmc 0.5 0.8
2 4-9 10yr4/3 none sil 2fsbk ds cw 2fmc 0.5 0.8
3 9-33 10yr5/4 none sil 2fsbk dsh cW 2fm,1c 0.5 0.8
4 33-38 10yr4/6 none Is 0 sg dl gW if 0.7 1.2
5 38-108 10yr5/6 none s 0 sg dl - - 0.7 1.2
I�
Y
Effluent#1 =BOD 30<220 mg/L a TSS>30<1 mg/L uent#2=BOD -E.30 mg/L and TSS<,0 mg/L
CST Name(Please Print) Signatur . CST Number
James K.Thompson 3602
Address A.C.E.Soil&Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane,Osceola,WI 54020 11/132003 715-248-7767
. Property Owner Thomas 1. Feldman Parcel ID# prt of 020-1104-30&0440-1077- Page 2 of 3
Boring# ! Boring
1111 ��� 1111 Pit Ground Surface elev. 98.52 ft. Depth to limiting factor >92" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
1 0-8 10yr3/2 none sil 2fcr mvfr as 2fmc 0.5 0.8
2 8-17 10yr5/4 none sil 2fsbk ds cw 2fmc 0.5 0.8
3 17-31 10yr5/4 none sl 2fsbk dsh cw 2fm,1c 0.5 0.8
4 31-35 7.5yr4/6 none Is 1msbk ds cw 1f 0.7 1.2
5 35-45 10yr4/6 none Is 0 sg dl gw - 0.7 1.2
6 45-92 10yr5/6 none s 0 sg dl - - 0.7 1.2
❑ Boring# -j Boring
_j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
F—I Boris# Boring
--j i Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2
*Effluent#1 =BOD 5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5 S_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.
l
/76
■ So;/eta/cuc�'v.��;-�
` I1C h ri1 cu^�.
7-,,10 O4 Yr rl'e ba r-
f{sstFm�
wo'
8r • 9� S/off, .\ �`
�i q�F�'1 ■ 63 `
�l
62
® ,, �O,;oe. Elev�
70
P.3o{'3
�
.'
Lj�-LB-
�4�,7�4 )j,opurtv a �'id shows I-hj
QI
sc�LE /00
CHECKED
3r 28 51 CONSULTING ENGINEERS
LOC 3 29 9 RIVER FALLS, WI.
'