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HomeMy WebLinkAbout040-1037-10-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569597 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: Johnson, Brian &Amber Troy, Town of 040-1037-10-100 CST BM Elev: Insp.BM Elev: BM Dgscripti Section/Town/Range/Map No: 95' 25 95 2,5' Z N� 08.28.19.122A10 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION dBS I FS Septic Benchmark �� ( JPZ Dosing Alt.fOM W C �i -t I'vl �/��n /v Aeration Bldg.Sewer 02,4 Holding t/ t I�et �) '�5C 4 ( / Q 2, Q Z S t Outlet TANK SETBACK INFORMATION S /0/. 7 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD DtInlet Septic / , I�/ r! Dt Bottom Dosing Header an.. / Aeration ��� C v Dist. Pipe / �� / d %y r fir? 77 /� Holding rl uh t 1;u Z s U` �,� �7b •37- o/� rade PUMP/SIPHON INFORMATION ��„•, ��JCD� �, - MId-�5 S -Q U4 s.75 lei •.j Manufacturer Demand St Cover [/ GPM ICdV(C: X�Z �.� Cl7 Model Number 1 —"� � 1 Imn TDH Lift io Loss System Head TER Ft k — 12a /D 3 2—>1- Forcemain Length Dia. Dist.to Well rr () SOIL ABSORPTION SYSTEM ZZ 6 ki&W t9 Xj BED/TRENCH Width I Length / No.Of Trer�chesc�L PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS T SETBACK SYSTEM TO P/L 5 BLDG WELL LAKE/STREAM Mactyf YEA 0 Z INFORMATION CT ype System: t t I nn > Model Number: DI TRIBUTION SYSTEM Bader/ anifold Distribution x Hole Size /'_r Hole Spacing nit Intake Uy�, / // Pipe(s) / /i / Length Dia Length_ Dia _ Spacing ] SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over I Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center �2 ZCj Bed/Trench Edges Topsoil 91 Yes [2 No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: 10 l / I `Y spection#2: Location: 443 Artisan Meadow Drive Hudson,WI 54 16(SE 1/ W 1/4 8 T28N R1 9W) NA Lot 1- `C Parcel No: 08.28.19.122A10 �9 r 1.)Alt BM Description= U7✓� G y 3�(l !j r W olv_ 'XU4'_ ' ' ' Cl t� C 2.)Bldg sewer length=Z d (,[/� //�@ /C1_11 •(�Gh� -12 c Z y -amount of cover V J-2 103-P Plan revision Required? ❑ Yes No Use other side for additional information. G ..-- --1 SBD-6710(R.3/97) Date Insepctor's Sign ure Cert.No AM \A CA A 1,14 zr S4 t-N lQ4 ZT- NZ4 A'4 County !�` Safety and Buildings Division 0 Y" ;'"' �'V E® 201 W.Washington 2 Sanitary Permit Number(to be filled in by Co.) $ j o Madi , son 5 P JUN 17 2014 5'('0 1� 51 Sr State Transactioq Number :oMMUN I mpffmit Application /_„/4 In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to oject Addre=7;;;different address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary 4.' ? r ourvoses in accordance with the Privacy Law,s.15.04 1 m,Stats. 'P��� I. A lication Information-Please Print All Information l !� Property Owner's Name I Parcel# D�f�So eV D4D l0?7—lD-/ d�iZ//� Property Owner's Mailing A;7s9Xz,9e;,,V Properly Location 13 S Z r �� Govt.Lot Ci/ty?/atee l l Zip Code / Phone Number�- y, �/. Section J7r!/6�7�/�/ �� ��d`(o �� J� T 2�' N: R � uclEone II.Type of Building(check all that apply) Lot# �" Subdivision Name X1 or 2 Family Dwelling-Number of Bedrooms Block# ❑Public/Commercial-Describe Use El City of b CSM Number 7�Z9Z ❑Village of El State Owned-Describe Use r0 y Town of III.Type of Permit: (Check only one box n line A. Complete line B if applicable) 26 At A' XNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) List Previous Permit Number and Date Issued B. El Permit Renewal El Permit Revision ❑ Change of Plumber El Permit Transfer to New Before Expiration Owner IV.Type of POWTS S stem/Com onent/Device: Check all that apply) a w gNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑Mound>24 in.of suitable soil ❑Mound<24 in.of suitable soil G 5 ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersal/Treatm t Area Information: Design Flow(gpd) Design Soil Applicat7_7 e(g dsf) Dispersal Area Required(sf) Dispersal Area posed(sf) System Elevation `A . 85'7, � 3 O D d VI.Tank Info Capacity in Total #of Manufacturer c 9 Gallons Gallons Units U _ H } New Tanks Existing Tanks ` L u �Q :� g � 1/r-t /.��,n�wE� 1"►N rn n Septic or4 Dosing Chamber �✓ VII.Responsibility Statement- 1,the undersigned,ass-wresponsibilitVXr installation of the POWTS shown on the attached plans. Plumber's N (Print) Plumb s tgna MP RS Number Business Phone Number Plumber's Address(Street,City,State,Zi Code) VM Coun /De artment Use Only Permit Fee Date Issue Issuing A Signature KApproved I ❑ �pPtme $ 75' Nner-Cn canon fo-r'benial IX.Condi"T�RUReasons for Disapproval 3> NC dl-- t 1; Se tic tank,effluant�fli ter /J 4 fb �^� ,dispersal cell must , servk es l trteiritalrted �f�,;A--V— e�-�-�VA^e u as per management to provided by p!tip i Z."<1AItk�4�must ber1!t?llnta ` ae per appYcable code/ordbiiirtcee. Attach to complete plans for the system and submit to the County only on paper not less than>i 1/2 x 11 Inches in size SBD-6398(R. 11/11) I 4 QfS v a ks. Q c� O N o - _ 4 _ IZT,- l IA ` W4 d `� Vo i t Private Onsite Wastewater Treatment System ? Index and Title Page Project Naine: �o Owner's Name: "�' ' � Owner's Address: Legal Description: Municipality: o Village, City of County: 15,Z"" /' d Subdivision Name: Lot Number: _ Block Number: Parcel I,D. Number: 0140' 103-7- 10 � l Page 1 Page 2 SC-P,77-i4 -77 U Page 3 Cot-Dt5S 5tc-1i 1 Page 4 tt �• r l at a✓� Page.5 1 Page 6 Page 7 Page 8 �U)vit`iY1 .JC1A'(r °�' Af �Z � r Page 9 Name of DesignJito � ►,��x.._ License Number: �t�Signature: Date: Date: '" ' Designed Pe o owing POWTS Component Manual PSPS E i 55' 47' 8' 3' 44' 5.75' 2' t]A D Sn N m /ICI 1 N A '*1 -1 20' 2' A Z T 10 'o ° r 1 . . I IO � m d S S LJ a r' x � Z* n m a c r-r-F r 0 r C m Z N 11 6.5' m D m m+nn �0 E3 vv= . a tD 13 u u n ° CA (n •-• Q Z II (7 N Z N Z �� o pm a �tyg �M Ll Cim A z vai D d C°S mr D D m c-f r z n> m r r N m m --1 t7 O ow a m m1 i °z m m r ° m m� ' �m tv _mllo o m a a Dm zm m m m Up m ty roll rn 45' 10' -a A r '� yd m n -' rAi o rn + 42' eD A �i DD O 6� r z t=l m vI m r°00 2' C O A ° o° _-__ A N o 63 r- r-m '�' m ym g eZZA y m N m r m v a oe 1m 4 a z M W a o ? z Il a cn �� a m ❑° D r rri T1 z d t7 n � �O N r D t7 a M V1 r W D m O m 0.0 m -A 0 O m Am m rrl r D N m z m ;u n m O X1 PROJECTI 4154 123rd STREET � $ N.P.C.A. CEnnED PLANT 1,250 GAL. LOW PROFILE HURCUTT CHIPPEWA FALLS, WI 54729 PUMP, SEPTIC, HOLDING, (715) 723-7446 w (800) 924-1516 MEMBER OF: OR GREASE INTERCEPTOR, C 0 A C R C T E. I A C FAX (715) 723-7111 w www,huf Fcutt.com NATN)NAL t WSCONSIN PRECAST CONCRETE AIMARM $oil Absomtion System Cross Section ft i0 XI f - 4'Schedule 40 Final Grade PVC Vent Pipe ft vuw,yerrt eeo f— <� ft System Elevation .J ft Soil Absorotiol] ftatem Plan View d� ft oZ $ ft ft Leaching Trench 1 Chambers 4'Dia. Trench 2 Header Vent Or Observation Pit2e_____---. ------- _.- - Leaching Chamber Seecifications Manufacturer And Model � � � ( 2 17 ��' �- `+ EISA Rating sq ft per chamber Soil Application Rate gpd/sq ft �00 gpd Design Flow+ • Soil Application Rate + EISA= Y'1 Chambers rows of q-�chambers each. Page of DIVISION OF INDUSTRY SERVICES ��in_►i7a�E�,r Plumbing Product R9VIeW �� • P.O.Box 2058 Madison,Wisconsin 53701.2456 TTY:Contact Through Rslay 'ra � Scott wsI►wr,Governor Dave Ross,Secretary March 12,2014 LIFETIME FILTER LUC MIKE HORNBACK 146 CLIFTON HALL COURT 8HEPH5FtDSVILLE KY '40165 i Re; Description: SEWAGE TREATMENT APPARATUS, EFFLUENT FILTER Manufacturer: LIFETIME FILTER LLC Product Name: LIFETIME EFFLUENT FILTERS Model N umber(s): LT 118, LT 1/16 LT 1/32 AN D LT 1/64 [SEE ATTACHED TABLE OUTLINING; FILTRATION SIZE AND RATINOS IN 13110D) Product File No: 20140048 The speelfications and/or plans for this plumbing product have been revlewed and determined to be in compliance with chapters SPS 382 through 384,Wisconsin Administrative Code, end Chapters 14 and 160,Wisconsin Statutes,' The Department hereby issues an approval based on the Wisconsin Statutes and the Wisconsin Administrative Code. This approval is valid until the end of March 2019. This approval Is contingent upon compliance with the following stipulation(s): • Installation and servicing of this product must be in accordance with the manufacturer's instructions. A Dopy of the manuftacturer's installation and servicing instructions must be given to the owner of the system. • Maintenance information must be given to the owner,of the tank explaining that periodic cleaning of the filter will be necessary, A manhvis extending to grade must be provided over the filter. • MAINTENANCE: Clean filter at inspection/pumping interval. Additional information is included as attachrnent(s)to this letter; sae attachment A. The department Is in no way endorsing this product or any advertising, and Is not responsible for any situation which may result from its use. Sincerely, �G Jo s, S. POWTS roduct Reviewer phone: (808)267-5265 ! fax; (608)287.9723 1 email: glen.Jones6wi.gov FII6 Ref:1400450i.DOC3 auri.i0164-E K10/97) 1ifet' . .ime Installation and Maintenance Instructions Installation Step 1 Dry fit the filter case onto the outlet pipe going to the drain field. Ensure it is centered directly under the access opening. (if outlet pipe is already in a fixed position, additional pipe may need to be added) Step 2 If utilizing the additional single side support and the two bottom supports: While the case is still dry fit to the outlet pipe, measure and cut 1"schedule 40 pvc pipe to the length needed to extend from the hubs that are pre-molded into the case to the side wall and the inside floor of tank. solvent weld pipe into the hubs that are pre-molded onto the case. Step 3 Solvent weld the case to the outlet pipe. Insert the filter cartridge into the case pressing down on the cartridge until it locks into place at the bottom of case. Step 4 if utilizing a vertical read switch: Insert switch into the hole pre-molded into the top of the filter.Press straight down until it locks into place Maintenance 1) Remove the access lid of the tank. Note:To ensure undesirable solids do not exit the tank and Into the drain field,the tank should be pumped out until the level of effluent is below the outlet level of the tank. 2) To remove the filter cartridge from the filter case, pull up firmly on the handle of the cartridge dislodging it from the case. (if utilizing a vertical read switch, removal of switch is optional) 3) Using an ordinary garden hose, rinse the filter cartridge ensuring all visible septage material Is removed. 4) Place the filter cartridge back into the filter case.pressing down on the cartridge until it locks Into place. 5) Place the access lid back onto the tank ensuring it is secure. Lifetime filter has a lifetime limited warranty: Lifetime filter LLC warrants the filter will be free of manufacturing and workmanship defects during normal use forthe period of time the original purchaser owns the product.Lifetime filter will provide a replacement filter in the event that the original filter was not damaged during the installation or maintenance process.Damage to this product caused by accident,misuse or abuse will not be covered under this warranty.Improper care or malfunctions resulting from product not being installed,operated or maintained properly will void this warranty.Lifetime filter assumes no responsibility for labor charges,removal charges,installation or other incidental or consequential costs. Contact:mlke(?Iifetimefilterllc.com Phone:502-724-2231 , 1 I I I 2- q" 140p 4 A . i I.9�yd l}:,`n l�,;';��14' N', � 1 OII�P.�r 1���.1������7!'1R(��1fi1►`".,�Il<�f i •;s!•r:4a.,,. '.}• .ir1 Y I�.rf.: I 1"7S ��T���"_"��'�-k'�Ci N I ,yi r(([�r�`J'f�+'l f � } .h 1,:, t� }�� r{ I• � �y}f N � �: ' �'' f � Iid•=�i�',Mr,l _1141 JIB 1�, �'r / ' ;1, 1�� Il � �.tA f(� ��1 s I �(.I;.'�1M14 tr�...�� � �.l��li: ,s ��5,i�p a r f ° Irl 1 � l e��� r1'S 1 �f.J�•�'i•,y '� :� �' �j71. ,:h a•ni� Oi�si1S.+! i,�,,it, 4 � r��'�t 1 i is } !;r,7 �'� S l i,l vl•i:%1:i:f;rr:>rJ Ntll<•. i')f 7 � I: '� l '. 1, T y. ) 14, Il �.Y.a.�r l'l b� t f.•y�' f ':.{',r.•i Itv 1, Y',� I�r� U 1 f j�s 6{ i:.. V {. t �( 1 v} ix.l,' ' } (� tI � ���� �� � III `� � 1 �,I f 'Y .:11 V � 1�;%. ,y, .� V'/,r•• �Y%1�'4 !' )Cii1C:�f� � �fl,�,�'� Y,U,i�.r�T�� V, o✓i :�, �l ,, 1 '1i �a�f':, :a 1���•, r°�'�A F 1`S.. {°�1i4•: ,�•a D�' 'vi'�d116 i 1, !$'b� � r » v q ♦C =r j(� 1 l,l���{f'�1:�'7 lt;�ai... t„T.118 BLACK 3500 3000 2500 2000 1/8'' ' 00 1500 111 G" i LT-1 1/16 �Q R EY 3350 2750 2 0 .f ALT-1132 GREEN 3000 2500 1375 1500 1132 i 'ITT-64 WHITE 2500 2000 175Q 1500 1/64° i t *TO BE USED IN COMMERCIAL APPLICATIONS, DUE TD DUE E SHORTL OF FILTRATION, AUDIO VISUAL ALARM IS RECOMMEN 4 SERVICE INTERVALS. INSPECT-AS NEEDED, ' I 1 i I r 1 I l I II*1/ I Y�y � h A• � Y. E �► >s Q I � � �•� 11 ") I' co t Li 1 I i I I �• t i I E �E I I N i i I 1 � P"(�'INTS OWNER'S MANUAL & MANAGEMENT ALAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner 'FZI+AJ so f' Septic Tank Capacity gal O NA Permit # Septic Tank Manufacturer F-FC V T7" O NA DESIGN PARAMETERS Effluent Filter Manufacturer b re Ti wt c ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model Lr /Z& ❑ NA Number of Public Facility Units .-►IMA Pump Tank Capacity al--G;-NA Estimated flow (average) 4+4>0 gal/day Pump Tank Manufacturer r.&NA Design flow (peak), (Estimated x 1.5) &00 gal/day , Pump Manufacturer a2-1NA Soil Application Rate 068 gal/day/ft' Pump Model .$'ITA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ,•$'1GA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) 5220 mg/L O NA ❑ Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other; Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD,) :530 mg/L X<-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) :530 mg/L ❑ NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size Y8 in dia. [3 NA Other. O NA Other: ❑ NA Other: ❑ NA "Values typical for domestic wastewater and.septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: V?_ Ap months) (Maximum$years) 13 NA ear(s1 Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume O NA Inspect dispersal cell(s) At least once every: ®nth(s) (Maximum S years) O NA Clean effluent filter At least once every: O months) D ti/t� ❑ NA ear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ,&NA O year(s) Flush laterals and pressure test At least once every: O month(s) �NA p O year(s) Other: O month(s) At least once every: C3 ear(s) �NA Other: ,OXNA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tani inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any pondinf of effluent on the ground surface. The ponding of effluetnt•on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y3) 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 NR 113 Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmen units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 0 f ♦ ; Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that 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. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) In one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls tc restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the argil within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat, foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil, painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system h properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Opsrotor, • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled witt soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or,must be taken, to provide a code complian- replacement system: 9A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptior system. The replacement area should be protected from disturbance and compaction and should not be infringed upon bW required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wil result In the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems mug comply with the rules in effect at that time. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWT: 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 sit, evaluation must be performed to locate a suitable replacement area. If no replacement area is-available a holding tan! may be installed as a last resort to replace the failed POWTS. O Mound and at-grade soil absorption systems may be reconstructed in place following removal of`the biomat at th, . infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NO' ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT, RESCUE OF I PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name /A ` Phone "" — . ';� ,.41 C Phone s � I7d SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name ,.. ,plAl 2, G OUP-- Name Phone — '7 Phone Wisconsin Admi ative Code. This document was drafted in compliance with chapter DSPS St- 385 11/f ' AM � a o= � `.. J � V CA c� V � ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer ►J Y�A v� �' V�V`^'J P(' �P �► SP v� Mailing Address S A A r rf k � e by- / HLj r1 S D­1 T t✓ T-- 5`Lo 4 L4 L4 Property Address r'�i S Q I " ! P G G b W �-V D�S o�., �J T S [d 1(0 (Verification required from Planning&Zoning Department for new constr-ct on.) City/State } V G�Sd � "Parcel Identification Number ol-y© /0 37 /0 " LEGAL DESCRIPTION Property Location £- %a,-S"V '/4, Sec. �, T a2_N R 1 W,Town of �CO Subdivision Plat: 1-0+5 1-9 �S { Co rc.�t 30 -03 See_ be[L(. , Lot# �- Certified Survey Map# volurne_ � Page# 15� Warranty Deed# I l©0 I I (before 2007)Volume , Page# Spec house Clyesm] o Lot lines identifiable esDno 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,if needed,by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in§SPS.383.52(I)and in Chapter 12-St.Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning 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 Safety And Professional Services 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 t - 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 a w ranty deed recorded in Register of Deeds Office. / 7!ZSIGNATTOEO�APPLICANT(S)bedrooms J JI DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. .(REV.04/12) 7 3 2 9 2 5 VOL 17 PAGE 4577 KATHLEEN H. WAEg REGISTER OF DEEDS ST. CROIX CO. . MI RECEIVED FOR RECORD CERTIFIED SURVEY MAP 07/30/2003 03:45PH CERTIFIED SURVEY MAP LOCATED IN THE SE 1/4 OF THE SW 1/4 OF SECTION 8. T28N. COPY FEE A. R 19W. TOWN OF TROY, ST. CRO I X COUNTY. W I SCON&O,ROVED PAGES: 3 ST.CROIX COUNTY 3 Planninq Zoninn an7 Pwkit CLmm""N 1/4 CORNER JUL 2 9 2003 SECTION 8 C> M. ao � SCALE IN FEET ,r„� aays T28N, R19W ~v Ec S to PPMVW GGo 0 75 150 300 "" �SfS"aie �o NOTE: THIS MAP IS BEING REVIEWED AT THE TOWNSHIP 4• °O LEVEL AS PART OF AN 80.30 ACRE PRELIMINARY w 6 o PLAT OWNED BY ARTHUR AND MAR i LYN FEYERE I SEN. I I ' I UNPL A T TED WN9 I UNPL A T TED LAND L AND ARTISAN I I s0 , MEADOW p r `\•�s 48 LOT 4 \,� � '°o4rso ,%a E - - — — — — — - N ~' 2.263 ACRES p2 B-4B 98,593 S.F. B 4A N 87°01' 08" E 'n 3` \� 8-3A -3C 435.65'- �R�O' �^ -- ` I ° ° � G LOT 3 ,-►�`� Wig\ z 2.001 ACRES , '°a� s�, aDo- cl ' 8-3B 87,167 S.F. �. ak�6. „w c e \ o� ui 50 S 84°30.00'E-�' '01 e%�rl;.:' DRIVEWAY �� ►_- \ 151 278.94' 6e %I'- � EASEMENT It° io ,50. \ / 1 FOR LOTS 50' S Q E S 30 _ ®� LOT 2 ; ^ 66.0'00" 0 I vWi I B-2B/ / ro z 3.197 ACRES ® %•;, LOT 1 139,262 S.F. / A ..-�`�° / B-1B 3.802 ACRES $$ B-2A.,®H r; ® 165,623 S.F� lL v o S 1/4 CORNER L I to ::� 460.00' Lo SECTION 8 15' WIDE DRAINAGE S 88°23.W'--W-700-00' SOUTH L T28N, R 19W r•j LINE OF OF I �I EASEMENT, 7.5' 0 THE SW 1/4 I POINT OF EACH SIDE OF LOT LINE, � BEGINNING EXTENDING TO CUL-DE-SAC. ?o LEGEND I o I LINE TABLE ALUM NUM CAP, FOUND.COUNTY SECTION COURSEI CORNER MONUMENT, JI 1 N BEARING I DISTANCE \-7— ' 1 . 4 � 0 1 1/4" x 18" IRON PIPE WEIGHING 1.68#/LINEAR FOOT, SET. 4 ' 1 ' • 2 3/8" IRON PIPE, FOUND. _ BUILDING SETBACK LINE (25' UNLESS OTHERWISE NOTED). OWNERS AND SUBDIVIDERS 10' WIDE UTILITY EASEMENT. ARTHUR AND MARILYN FEYEREISEN 420 TOWNSVALLEY ROAD (R'- ) PREVIOUSLY RECORDED INFORMATION. HUDSON. WISCONSIN 54016 B-28 SOIL BOR I NG PERFORMED BY *NOTE: ALL IRON PIPE ARE DItfNSIONED ® MARY JO HOLLISTER. AS OUTSIDE DIAMETER. PROPOSED DRIVEWAY LOCATION. THIS INSTRUMENT DRAFTED BY JEROD A. FINK PAGE 1 OF 3 Vo1.17 Page 4577 wiaaonsln Department of Commerce SOIL EVALUATION REPORT Page of Division of Satary and 0ulldings In accordance with Comm 85,Wls. Adm. Code' co -unty STT,. CKO,i Attach complete site plan on paper not less than 8 112 x 11 Inches In site.Plan mutt Include,but not limited to:vertical•cad horizontal reference point(BM),direction and Parcal t.D. percent slope,scale or dimensions,north• location and distance to nearest road. Please print l lnla�l'frt( E 1 V E R°� Date Personal Information you Provide maybe need( r secondary purposes(Privacy Law,u te. (t)Irnll G Property Owner /�. �' 5 2003. r rty Location sE va SW va s f T 2-4 N R I`t Pool w Property Owner's Mailing Address ,1 c k C,) y i Lott Block b .Name or CSM# '7— t1Z0 -TOWNS) E RO{ b [0^ INS (`FriCt } City State [;one Number City Village EffTown Nearest Road !fAUZ 04 jk s-1640t(o TKO ow MAN, New Construction Use;U Residential I Number of bedrooms Code derived design stow rats____I2 D __GPO 0 Replacement D Pubic or commercial-Describe: --- Parent material f T 4&A.5b Flood Wale elevation if applicable General comments and recommendations; TN-<oIQ�U•ND C013tlE�)T10/J�►L TRENGtiES 'tp 6E I�E51�1JED B4 �NST1°►t�-�� 0.-7 1AA01A)& 7411E "Skw�ir.,rt t Jv.Ck- d LtW , iVA rib ? Boring F-K] n Cdrt O-S ' l Boring b ,� Pit Ground surface elev.AL1,19 ft. Depth IimilNtg factor 7 9L fn. Soil Application Rate � ' Horizon Depth Dominant Color Redox Oeseripllon Texture tnrcture Consistence Boundary: Roots in, Murtsell du.Sz. Cont.Color 11.Sz.Sh. '091 Ettb2 .40 1 0-10 10YKT>/Z — Lf5 mSbK s -yn O•S T Z 0- 10 vg,2/1 -m vi 0.5 O, -(0 3 _33 OV�t3/3 — 51ti_ .rnsbK W 1 0.S O,E� .4 �{ 33-4Z o rc3/ st 2-f-Mh A 0.5 ,8 •L M 5 z-yq 10,40/4 — s - ojK r a 1�rF-f 0.� 1-2 (o - 10,W 3 -- ) — O,-7 t,z r, Boring b [] Boring X Pit Ground surface elev. 10'5.g 2 R. Depth to limiting factor�f OQ in. Soil Application Rata Horizon Depth Dominant Color Redox Description [iTextwe Structure Consistence Boundary Roots GPD/ff In. Munsell Cu.Sz. Cont.Color Gr.Sz.Sh. 'E"I 'EthY2 1- -I o vK3/� 3 -25 fo 51 Lr 0.Z O y z5-34 io 40ho s • S' 5 8 -la Dv y1y -- .s _ 0.'7 irZ - t '1 Effluent N1 -BOD >30 5 220 mWL and TSS>30<150 mgtL 'Effluent b2-BOD <_30 mg/L and TSS S 30 mg/t CST Name(Please Print) 1pnatun _ CST Number A Zo HDWSTF-K AdAjj, fy sk, 2Z 9 9 3Z Addreae 'D-Wa Evaluatlon Conducted Telephone Number Wg875 690 AVE.0-F1IvEA, F6LLS1 WT 5y02Z - 2la 0;--b L`tt5 y�.b-1'l7s (LDT I -t Property Owner��966P-V Parcel IDN pElL1DlNG� Page Z of EBoring N ❑ Boring el pit Ground surface elev._q , KI_M. Depth to limiting factor In. Solt AspolicatIon Rate Horizon Depth Dominant Color Redox Description Texture Structure Conslatenee Boundary Roots GPOrtf in. Munsell Ou.Sz. ConL Color Or.Sz,Sh. 'Efta1 'Effit2 0-IZ to 4K41 L t-sb 5 di IS 0.g • Io Z z-)S I g VL3J to u - .5 to -� -Z? 0 K3j Stl. -LabK mfr &VJ -rn 0.Z 5 . `F ❑ Boring N ❑ Pit pit Ground surface slay. R. Depth to limiting factor In. Soil A pplicabon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOlff In. Munsell 01).Sz. Cont.Color Gr.Sz Sh. 'Effa1 I -EffN2 Din 4 — Stt_ LAUag 12M EEPS& Boring o Boring N Ground surface slay. ❑ Pit _ ___ W_M. Depth to limiting factor „tn. Soil Application Rate Horizon Depth Dominant Color Redox Description Tenure Structure Consistence Boundary Roots GPD/ff in. Munsetl Qu,Sz. Cont.Color Gr.Sz;Sh. 'Elfgt 'Efta2 Emuenl at =BOO,,30 1220 mg/L and TSS 3,30<150 mgi Effluent 02■SOD,<30 mglL and TSS<30 mWL 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. 3aDp)01a,A,OU) i v v l 1 v/ u v tern-�tir� F�o�►m OWN��: FEV�1 spa ftK-ntvi,iR Nn: /',Sb� Le EL LoCAT'eD ft- * = YC IPC • �`146�I N Sb 0 t SWY44,SF.0. 612D SG R F - FA too-o- ' 2c N 9W TDW OF ST.CROP = PlfS 4Z' F- uWT Gn KND sulC a +Kmaw q5s 0-50L u W/ Wool a NO COMM 83 5EIDAa t'MEM5 / �_ ODKINQs NOT uueo �Co►JTou� 1,1/JE.S �A+R'E {t'E/RL �� r N ` / MAO Lur 1 At a ' �' CT 1 w sir ,I I vv d Elea 9 tn C5r L-L Z2.y83Z X� Ru. nAlf X 29-U'S PLOT F�AN R0Mm 4` vm r=EV Uml SEA AKT K MX Le : / -,,5b P95UJE�M: -A r-L LocATBa (3M- *t vc ip iPE a'k tc 5E F Y SW 5EC. 6kDUjkp stdlQF/! ED IID 00' tJ 9 QWA) O R p� = P P8 Z E T 1 Ol3s1tJ. �uH� sWC A 3k '. -501L C"W W/ a K E�-- NO COMM 81�5EIDACK �s Do e_l A)4. MO-r ? t RECEIVED IJUL 1 0 2003 E ST C! OI X COUNTY BONING OFFICE ti o o/ �s Lo-r l a C�►'��. � �s; vas ��� ("Alf J6 �o . Ion (dEp�Bit n. b , d � Sin csr 204 X` 2Zy83Z R°' PAT-. OS-Z4-O'5 . P1 Of PLAN M OM,fR: FEY COX-`SEA AK-Tt+uR �,76 A EL wcA*TP-o M- s!. rc 1ps . E SE F r SEG, cRAW,K� sURF LvAez IJ 4 0 s�2a SbP_oF QYC P�QE_.It oNs�a. r-r�o aND �U.If,�J�Gic�t O Cc I �-5OL OOM W/ DPC NO COMM 83%fDACK PRMeM5 IR. Bogjp446 No•r Lkseo CCPN � UmEt,. y}4 E flr-N"' AV, LoT l a x $_a C- r-- r�'c(fEjXe ut+e)r w�• I O YOD D s� $ 5{GNt:D Of 7 r Zzy832 3 2 9 2 5 VOL 17 PAGE 4577 KATHLEEN H. wALW--___. REGISTER OF DEEDS ST. CROIX CO. . WI RECEIVED FOR RECORD CERTIFIED SURVEY MAP 07/30/2003 03:45PH CERTIFIED SURVEY NAP Rpe t5.00 LOCATED IN THE SE 1/4 OF THE SW 1/4 OF SECTION 8, T28N, COPPY�FE�Et R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONA"ROVED PAGES: 3 S7.CROIX COUNTY 3 Planninq Zoninn and Parks CMMl t"N 1/4 CORNER JUL 2 9 2003 T28N, R19W o SCALE IN FEET t. O 75 150 300 1 w ~ NOTE: THIS MAP IS BEING REVIEWED AT THE TOWNSHIP LEVEL AS PART OF AN 80.30 ACRE PRELIMINARY I I PLAT OWNED BY ARTHUR AND MAR I LYN FEYERE I SEN. I ' I _UN_PL_AT TED Jag I UNPL A T_TE_D LAND L AND ARTISAN I � ° I so' , MEADOW J� LOT 4 \'� N .,°°,6� �O' ?ww — — — — — -- - o, 2.263 ACRES `r B-48 98,593 S.F. �I to B-4A - - / �SCi \� I - Nh —N8—j4017 08" E 3 vl B-3A -3C_435.65'_ _ Ri80' ^�ol �I o ' LOT 3 z , ® 2.001 ACRES o, a-3B 87.167 S.F. .cA kN k6 "W `�° S 84°30.00" E -J °1.NcDF., DRIVEWAY 278.9 ' e �`?• Y 4 63 � EASEMENT 1S�•3? ',�`3•••%SD' FOR LOTS _ . .5' � / 1 AND 2 50D g I �i S 30°00'00" E I ^ LOT 2 66.00' B-2B/ z 3.197 ACRES ® so�•:r`" LOT 1 —II 139,262 S.F. :�:`�� / B-1B 3.802 ACRES m $$ � 11-2A,,®ry/.� � ® 165,623 S.F. �I — s0,=•'2 !c B-1C S 1/4 CORNER W I _ a°.00• 460.00' SECTION 8 15' WIDE DRAINAGE S 88-23-30" W 700.00' SOUTH LINE OF I T28N, R 19W EASEMENT, 7.5' O THE SW 1/4 I POINT OF d'I EACH SIDE OF LOT LINE, BEGINNING EXTENDING TO CUL-DE-SAC. ?-p LEGEND I 01 ��' COUNTY SECTION CORNER MONUMENT, J LINE TABLE \y�v� ALUMINUM CAP, FOUND. I A 4 O 1 1/4" x 18" IRON PIPE WEIGHING 1.68/1/LINEAR FOOT, SET. 5 2R 56 45 , • 2 3/8" IRON PIPE, FOUND. BUILDING SETBACK LINE (25' UNLESS OTHERWISE NOTED). OWNERS AND SLIBD I V I DERS 10' WIDE UTILITY EASEMENT. ARTHUR AND MARILYN FEYEREISEN 420 TOWNSVALLEY ROAD (R'- J PREVIOUSLY RECORDED INFORMATION. HUDSON. WISCONSIN 54016 B-28 SOIL BORING PERFORMED BY *NOTE: ALL IRON PIPE ARE DItfNSIONED ® MARY JO HOLLISTER. AS OUTSIDE DIAMETER. � PROPOSED DRIVEWAY LOCATION. THIS INSTRUMENT DRAFTED BY JEROD A. FINK PAGE 1 OF 3 Vo1.17 Page 4577 09/01/2005 04:05 PM :. Parcel #: 040-1037-10-100 PAGE 1 OF 1 Alt. Parcel#: 8.28.19.122A-10 040-TOWN OF TROY Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-owner 0-SKILLINGS, CHERYL A&CYNTHIA CHERYL A&CYNTHIA SKILLINGS 1717 EVERGREEN DR WOODBURY MN 55125 Districts: SC=School SP=Special Property Address(es): '=Primary Type Dist# Description ' ARTISAN MEADOW DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 3.802 Plat: 1758-CSM 17-4577 040/03 SEC 8 T28N R19W PT SE SW BEING CSM Block/Condo Bldg: LOT 01 17-4577 LOT 1 (3.802AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-28N-19W SE SW Notes: Parcel History: Date Doc# Vol/Page Type 06/04/2004 764883 2589/270 TD 07/30/2003 732925 17/4577 CSM 07/23/1997 1155/154 QC 07/23/1997 418/476 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.802 60,500 457,500 518,000 NO Totals for 2005: General Property 3.802 60,500 457,500 518,000 Woodland 0.000 0 0 Totals for 2004: General Property 3.802 60,500 457,500 518,000 Woodland 0.000 0 0 Lotter Credit: Batch#: Y Claim Count: 0 Certification Date: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i ARRANTY DEED -- BY CORPORATION STATE OF WISCONSIN -- FORM 2 8 1 9 9 4 R 4 THIS INDENTURE, Made this 3`d day of December. D.,2013, between TX:4165454 ASSOCIATED BANK N.A. duly organized and existing under and by virtue of the laws ofthe United States of America,CONVEYS and WARRANTS TO: 990499 BRIAN.I,IOHNSON AND AMBER M R)HNSON BETH PABST AS JOINT TENANTS REGISTER OF DEEDS Witnesseth,That the said ST. CROIX CO., WI party of the first part,for and in consideration of the sum 12/06/2013 2:53 PM of One Dollar(1.00)&Other food&Valuable Considerations to it paid by the said NA party of the second part,the receipt whereot is hereby confessed and acknowledged,has EXEMPT#: .0 given,granted, bargained,sold,remised,released,aliened,conveyed and confirmed,and REC FEE: 30.00 by these presents does give,grant, bargain,sell,remise,release,alien,convey TRANS FEE: 195.00 confirm unto the said party of the second part, its heirs and assigns forever,the followin PAGES: 2 described real estate situated in the County of ST. CROIX,and the State of Wisconsin, to-wit: See Attached oI ,► SPACE; RESERVED FOR RECORDING tYlw+� J J tbNv.U>A am_4 Ar1�vw F-t Jr�1,u su„ 0 -Sfiatie fky- PL_ IS w to 040-1037-10-100 PARCEL IDENTIFICATION NUMBER Commonly Known As: 443 Artisan Meadow Drive Town of Troy, WI Grantor warrants that (NECESSARY, i l DESCRIPTION f VERSE SIDE)is good, idefes ble n fee smpicand frean dr c encubranceexcept SUBJECT TO RESTRICTIONS. RESERVATIONS, EASEMENTS, CONDITIONS, COVENANTS AND PUBLIC OR PRIVATE RIGHTS OF RECORD, Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; nd all the estate right,title, interest claim or demand whatsoever,of the said party of the first part,either in law or equity,either in possession or expectancy of; in and to the above bargained premises,and their hereditaments and appurtenances. g. To Have and To Hold th said sad premises as above described with the hereditamcnts and appurtenances, unto the said party of the second part,and to its Its and assigns FOREVP' And the said Associated Bank N.A. party of the first part, for itself and its successors,does covenant, rant,bar Said party of the second part, its heirs and assigns,that at the time of the ensealin b bargain and agree to and with the above described, as of a good,sure,perfect,absolute and indefeasible estate of inheritance in the law, in tee simple,and that the satn b and delivery of these presents it is well seized of the premises clear from all incumbrances whatever, c,are free and and that the above bargained premises in the quiet and peaceable possession of the said party of the second every person or persons lawfully claiming the whole orally part thereof, it will forever WARRANT'AND DEFEND. In Witness Whereof,the said Associated Bank N.A. , party Part, its heirs and assigns,against all and Vice President-Asset Recover Manage .and countersigned)by: Dennis aP. Schenk, V ice President,at STEVENS POINT Wisconsin,Asst. Vice its corporate seal to be hereunto affixed,this 3"I day of December A D. 2013. SIGNED AND SEALED IN PRESENCE OF ASSOCIATED BANK N.A. Peter C. Laux \ Asst. Vice President—Asset Recovery Manager Dennis P. Schenk STATE OF WISCONSIN ) Vice President COUNTY OF PORTAGE � SS Personally came before me, this 3'`I-day of December A. D.2013, Peter C. Laux_Asst, Vice President-Asset Recovery Manager, and Dennis P. Schenk Vice President of the above Corporation to me known to be the persons who executed the fore= instrument, and to me known to be such Asst. Vice President-Asset Recover Manager and Vice P__ resident of said Corporation and mooing acknowledged that they executed the fo = �� I en as such officers as the deed of said Corporation, by its authority. O This instrument drafted bv: Y r y4vlts{1 Ra Notary Public Kimbe i lenna Wery s rly Rist app . Associated Bank A 4c 1114 0+ OF W )— y Commission Expires: ,l zh 15 finstruments to be recorded shall have plainly arinted or I.--___„