HomeMy WebLinkAbout040-1306-13-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT sanitary Permit No:
574306 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:
Creative Homes, Inc., c/o Nathan Hidde= Troy, Town of 040-1306-13-000
CST BM Elev.. Insp.BM Elev: BM Description: Section/Town/Range/Map No:
qT,q , tjb� COrw 08.28.19.1840
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Ufa t ` Benchmark At P 6+ 10 Pe n -zv
1 19119
Dosing Alt. BM tw b� p
/1
Aeration Bldg.Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD ✓'
Septic 11 21 1 1 J�
Wr
G• 1, KaadadMaf'
Dist. Pipe
Holding Bot. System
PUMP/SIPHON INFORMATION Final Grade
Manufacturer Demand Si Cover
GPM l• /
Pllodel umber O
TDH ft Friction Loss Syste TDH Ft
Forcemain Leng Dia. Dist.to well
SOIL ABSORPTION SYSTEM
BEDITRENCH didth Length lNo.Of Trenches N In a
DIMENSIONS C� 22 PnC Liq th
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM CHAMBER OR Manufacturer: /
INFORMATION Type Of System, UNIT Model Number:
`��� ^
DISTRIBUTION SY E
Header/Manifol Distribution ' e x Hole Spacin ntake
Length Dia Length Dia_ ing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over //_./''/n Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center / Bed/Trench Edges Topsoil ;, Yes r No Yes ]No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2:
Location: 428 Jordyn Lane Hudson,WI .154016(SW 1/4 NE 1/4 8 T28N RJ19�W))SSunset View Lot 13 r'nPr'a'rrcell Not: 10/8.28.19.1840
1.)Alt BM Description= p 0� ,fbU► bbbf)
2.)Bldg sewer length
-amount of cover
� h)(ll ndrl�
Plan revision equired? 1 Yes (__ No
Use other side for additional information.
Date Insepctor's Signature Cert.No.
SBD-6710(R.3/97)
PLOT PLAN
PROJECT Creative Homes ADDRESS 707 Commerce Dr. Suite 410 Woodbury Mn 55125
SW 1/4 NE 1/4S 8 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX
6/28/14 BEDROOM 4
MPRS Shaun Bird 226900 DATE
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 891 # of chambers 44
BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Vent B.M.*
SYSTEM ELEVATION 93.0/92.9 5' below qrade
>6„ Quick4 Standard Scale is 1" = 40'
A6
Cover Leaching Chamber unless otherwise B-1
with 20.0 ft2 of Area
5.6ft^2/pair of end caps noted
4' Long 12" I
Grade at System Ele t'on 2-3' X 88' cells
3499 with>3' spacing
Property Line Vents 0'
Not enough slope o 30'
All piping shall be SDR 30/34,within 10' have contours �g -�3
of tank,piping shall be Schedule 40. 5', below g '7,.e
towards the east e
of cells 0'
fpe
�9l Pro 4 20'
Bedroom
House
Jordyn Lane
Property Line
t" r County ..� (1
Safety and Bindings Division • 1! 1
201 W.Wei Wmgton Ave.,P.O.Box 7162 Sarhacy Permit Number(to be Mad in by Co.)
M7-7162 L/
stem e:
Ti
Sanitary Permit App rtn es�;� — n
in a owls one with SPS 38321(2 m.Vrn.Ad Code.submission of this farm to dw appropriate unit
Nate: forms for state named POWTS are sobmittod m Project Address ditil�than merging address)
is regWnA prior to obtaining a senimy p 0° be S a for bmilbe stY
the Department of Safety and Profasiooal Setvus. Pe:wind information you provide may
VarPOIN is$0001111111M With the Law s.15. 1 m Stets
L n Infornatifon-Please Print All Wornation Parcel#
Property owner's Name
C1- .o ff Pra)erty Loc.r an
Property owners Mailing Address
Govt.Lot /
yip Code Phone Number -y., '/. 5axim
�e/ Jet✓ -SJ�Z �J ��02$ 6�lTU T N: R/ W
II. of BaiWittB( all that app)y) Lot#
/ Subdivision Name
1 or 2 Dwdling-Aber of J r )
GC
❑Pub Block# i('.t•t/
pe"
idCaaomercial-Deaeacbe Use ❑City of
CSMNumber ❑VrMageof —
❑State Owned-Dracribe Use ATawn of_
DI.Type of Pamir: (Check only one box an tine A. Compinie Use B if applicable)
sya. ❑Repiaoemeot system ❑Treotment/Holding Tact Replacement Only ❑other Modifi bon to E=tmg System(eaepbrm}
B. ❑Permit Renewal ❑Permit Revision ❑Chnor of Phmrbe;r�TMMfa List Previous Permit Number and Date Issued Betiore Expiration
IV. of POWT S Con eot/Device: Cheep all that a 4/�0.y� 1e /�
Non-Prms�xod io-Grtamd ❑Praeurized Ice-Ground Q� El N >24 m.of, le soil es 7'►'k fp✓"t
❑Holding Tank ❑odw Dispersal CampmeM(exp 7 T
V.Difsoeirsanreatment Area Isfornation-
De sigh Flow(Ipd) Design Sorg Appliafion Bahr) Dispersal Area Regarted(st) Dispersal Area PiMmed(st) Sls�
Total #of Maaufacnaer
VLTask Info 1° Gallons knits
Nar Tadca FEET a a cT7 0,
Sapuc a Holbms Tads
Dosing Cbu*w S
VII. . Shtement-I,the mderngaed,umm for iastaNaties of tie Pow"shown ea at @ices
Plumber's Nape(Print) Plumber's S' MP/MPRS Number Business Phone Number
Phnnber's Address(Street.City,State,Zip Code) /�� �\-••�,`.J`
z I �
VU ty/D use o
Di.,wed Perwk Fee Dates Issued Issuing ABA i
Owner Givm Reason for Denial s ( 7S• 0130 o Z 0/
DL CO�WNW enwm for nisapproval 3 � �
1.Septic tank,effluent filter and wdp-`-"
dispersal cell must t? d A '
as per management plan pro ded by plumber. u fk
2.All setback requirements m �{y-a�e�
t` S
sa4aoit to e Canty
PaP¢ u� ll�
V"'" la-&�
SBD-6398(R.11/11)
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 6/28/14
Owner: Creative Homes
Location: SW 1/4 NE 1/4 S8 T28 N,R19W 428 Jordyn Lane Troy
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 Sheet
8-10. Soil test
Signature
License number#226,94
PLOT PLAN
PROJECT Creative Homes ADDRESS 707 Commerce Dr. Suite 410 Woodbury Mn 55125
SW 1/4 NE 1/4S 8 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX
6/28/14 BEDROOM 4
MPRS Shaun Bird 226900 DATE
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 891 # of chambers 44
kk BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100° Filter BEAR Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
B.M.*
Vent SYSTEM ELEVATION 93.0/92.9 F below grade
A Quick4 Standard Scale is 1" = 40'
Leaching Chamber unless otherwise B-1
with 20.0 ft2 of Area 2" 5.6ft^2/pair of end caps noted
Grade at System Ele t'on 2-3' X 88' cells
3 4" with>3' spacing
Property Line Vents 0'
Not enough slope to 30'
All P�P g i in shall be SDR 30/34,within 10' have contours B-3
of tank,piping shall be Schedule 40. 5' below grade
towards the east end
of cells 30'
Pro 4 20'
Bedroom
House 0
Jordyn Lane
Property Line
I
i
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 To be >1' above grade
5.6ft 2 pair of end plates
Finish grade elevation
Typical Installation 98.0
Grade Vent
4" 3'
X30/34 Septic Tank
,&V,ent
5' S' Long 1 3 6 Grade at System Elevation Grade at System Elevation
Spacing 5'
I
2-3' X 90 ' Cells
Same on other end Observation tubeNent
At end of cell
A
B
22 chambers per cell
System elevations:
A-93.0'
B 92.9'
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LSD 62LK IM 'Slltl3 VA3ddIHO 31I3021d MOl 'ltl9 OS2'I $
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PROJECT: 4154 123rd STREET R N.P.C.A. CERTIFIED PLANT
HUFFCUTT CHIPPEWA FALLS, WI 54729 �� _
0 1,250 GAL. LOW PROFILE
OR GREASETINTERC INTERCEPTOR FAX((715)7723-711 w www,huffcuttcom NATIONAL&WISCONSINE PRECAST OCONCRETE ASSOCIATIONS
ry concaeTC, inc
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner G �� Tank Manufacturer: ❑ NA
Permit# 3 0(e peptic ❑Dose ❑Holding Volume:/o2,5 (gal)
DESIGN PAWETERS Tank Manufacturer:
Number of Bedrooms- Y ❑ NA ❑Septic ❑Dose ❑Holding Volume: (gal)
Number of Public Facility Units: 14 NA Vertical Distance Tank Bottom(s)to Service Pad: (ft)
av flow: (gray) Horizontal Distance Tanks)to Service Pad: fv 1A (ft)
Estimated(average). �Q
Spec fjc servicing mechanics must be provided if vertical is>15 feet or
Design(peak)Flow-(estimated x 1.5): �j (gaVdaY) If horizontal is>150 feet. Specft instructions to be provided on back.
In Situ Sal Application Rate: (gaudaye) Effluent Filter Manufacturer: / 'A'A , p NA
Standard(Domestic)Influent/Effluent Monthly average.. Effluent Filter Model: 0/'�` S
Fats,Oil&Grease (FOG) s30.mg/L Pump Manufacturer: A
Biochemical Oxygen Demand (BOD9) s22o mg[L ❑NA Pump Model: .
Total Solids SS s150 rrdL
High Strength Influent/Effluent Monthly average Pretreatment Unit
(FOG) >30 mg/L Manufacturer.
(BODs) >220 mg/L ❑Mechanical Aeration ❑Peet Filter
SS) >150 m
❑Disinfection [3 Welland
Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other.
(BODE) s30 mg/L Soil Absorption System
(TSS) sW mglL ❑NA
.. Fecal Colfform mean s10'' and(gravity) 13 in-Ground(pressure) ❑ NA
❑At-Gra ❑Mound
Maximum Effluent Particle Size 36 In dda.. ❑ NA ❑Drip-Line ❑Other.
Other: NA Other: ❑ NA
MAINTENANCE SCHEDULE
Service Evad Service Frequency
Pump out contents of tank(s)
;EVAfbjm combined sludge and scum equals one-third()S)of tank volume
❑When the high water alarm is activated
Inspect condition of tan k(s) At least once every: mO"s(s) (Maxbnum 3 yeah) ❑NA
Inspect dispersal cell(s) At least once every: S(s) (Mwcknt n 3 years) ❑NA
months) ❑NA
Clean effluent filter At least once every: s)
Inspect pump,pump controls&alarm At least onowevery: morth(s) NA
❑years)
Flush laterals and pressure test 'At least once every:. morth(s) NA
.❑Year(s)
Other: At least once every: 0 mix"(s) NA
Other:
MAINTENANCE INSTRUCTIONS
Inspections of tanks and sob absorption systems shall be made by an individual carrying one of the following licensee or certifications:
Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper).
Tank inspections must include a visuaal 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 shad 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 of 512 months,shall be performed by a certified POWTS Maintainer.
A service report shad be provided to the local regulatory authority within 30 days of completion of any service event.
GMW-005(02/05)
Page of
START UP AND OPERATION ucts, solvents or other
For new construction, prior to use of the POWTS check treatrnant tank(s) for the presence of painting p i u h concentrations ere
chemicals or sediment that may impede the treatment process•and/or damage-the soil absorption system. 9
detected have the contents of the tank(s)removed�y 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•td the system. To avoid this situation ia umber
contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power to-the pump
or POWTS Maintakter 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 sal absorption system. Do not.drive or park over, or otherwise disturb or compact,the
area within 15 feet down slope of any momW or at-grade soil absorption.area. .
Reduction or elimination of thre#dlowing from the wastewater stream may improve the performance and prolong the life of the treatment
tanks and soil absorption system: adds, antibiotics, baby wipes,-cigarette?U tts, condoms, cotton swabs, degreasers, dental floss,
diapers, disinfectants, fats, foundation drain(sump pump) isc barge,fruit qpd vegetable peelings, gasoline, greases. herbicides, meat
scraps,medications,oils,painting products,pesticides,sa4 napkins,soivents,tampons,.and water softener brine discharge.
ABANDONMENT
When the POWTS falls and/or is permanently taken out of service the following steps shad be taken to insure that the system is properly
and safely abandoned in compliance with s.Comm 83.33,Wisconsin Adrrlinistrative Code`.:
e All piping to tanks,pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed.
e The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator(pumper).
a After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with 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 compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorp by sy
The replacement area should ba protected from disturbance and compaction and should not be infringed upon y
setbacks from existing and proposed structure,lot lines and wells. Failure to protect the replacement area WIN result in the need
for a new soil and site evaluation to establish a suitable replacement area. •Repiacemem 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 sod 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 bean evaluated to identify a suitable replacement area Upon failure of the POWTS a sod and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed.as a
last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
WARNING TREATMENT TANKS, PUMP TANKS, AND HOLDING 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 INSTALLER POWTS MAINTAINER.
Name Name Q ,tip J
Phone — y Phone
/J
SEPTAGE SERVICING OPERATOR(P2=R) LOCAL REGULATORY AUTHORITY
Name Norte
Phone /J �� �' Phone a ��
Grow Lake, Marquette and Waushsra County POWTS regulatory agencies in compliance with sections
This document was drafted by the staffs of the
n Ad
Comm 83.22(2)(bx1)(d)&(f)and 83.54(1),(2)&(3).Wisconsi Code.
FILTER CARTRIDGE INSTRUCTI®NS
SnP 2 Dry 1k the filar Casa soft the tad of the outlet pipe to ensw*it is
cantered under the access apooft. V sot,d"sow insert mars pipe into the
tank through the outlet or solver*weld(2W)odditicnal pipe onto the outlet
Pis-
STEP 2 While the caaa Is 01 dry fitted an the outlet Pipe,rrasswe Ow huryth
of M-inch pipe needed to bean the filter to do tank and wad if utAt dng the
optlonal supplmmewl"a snpporL V We support mathad.is not utilized,
proceed to strap foot:
5.7F.P 3 For ilMI I Il n utft ng the optional suppiaranW side support:
solvent weW the%4 nch pipe onto the fter case. If side support method is not
utilized,ptocud to step fora:
Solvent WOW the ft" onto the Outlet pipe. Insert the Ater `
cartridge Into the case,pressing down untll the Altar kicks lotto the bottom of
the ease. :y
If a VRS switch is utflbed:Insect left the Alter and brit by tummy
Maintenance
1. The effluent Alter should be cleaned every time the septic tank is
serviced.
2. Open the outlet access opening to inspect the tank and tilts: a
3. Pump the septic tank completely,nU k ft sure to remote the sludge
layer on the bottom of the tank and not Just the scum and effluent.
s. Once the effluent level has bean lowered below the irwart of the \
outlet Pipe,firmly Pull up on the Rite[handle to dislodge the is
cartridge from the case.
S. •Slide the cartridge up old out out of the case for cleaning.
y��
K Y a r,V switch iNN�to an a�is present,the sw&h •�• M .
should be removed by turning eourtwdockvidat 90'acrd cleaned
wkh water only.
7. While holding the cartridge an its side(large flat surfaca facing s
down)carver the saxes;openkcg,ri isa off the cartridge with water
maft making sun.09 SePtoN metwid is rWoW bads into the tank.
t
8. 3!VRStu n� e Oe by ensetling into fileer and
9. Insert the filtw cartridge back into the case, down until
praseien0
tins Aker locks,into the bottom of the case. � �;� •,;
10.Replan and sawre the access opening on the tank. `
ea tr..:Ka i"+Sc•' c;:V117AUXte -VC.-°r r..:t if-It'i.1::M:.iW..r-•.
rwww.belin'ronilli�ecom 877- ttS(6534583)
ST.CROM COUNT-Y
SEPTIC TANK MAINTENANCE AGREPAIENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer-1/1
wner/Buyer /
Mailing Address k�r
Property Address
�� ��= or�'
____(Verification reqom arttrmnt far new on.)
City/State � tk Parcel Identification Number 0 Y4— /3 2 6 i 3—otr o
IfR , t UCKMON
Property Location %,/'V V4 ,Sec. T 2JLN RL;L W,Town of TTD
Subdivision •5cr A's ; e t-A--� f _ . Lot#
Cerdfled Survey Map# ,Volume ,Page#
Warranty Deed# �, `�� ,Volume Page#
Spec house no Lot lines,iaeuiift le no
SYSTEM MAINTENANCE AND OWNER CERTIFYATION
I mpmper use and maintenance of your septic system could result in its premature tithes to handle wastes. Proper
maintenance consists of punapimg out the septic tank every three years or sooner,it needed,by a licensed pumper. What you put into
the system can mart the fraction of the septic tank as a treatment stage in the waste disposal system. Owner fiance
responsibilities are specified in§Comm-83.52(1)and in Chapter 12-St.Croix County Sanitary Ordinance.
The property own=agrees to submit to St.Croix County Planning&Zoning Department a carti&cation foram,sighed 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
lass than 1/3 full of sludge.
I/we,the undws,&wd have read the above requirements and agree to maintain the private sewage disposal system with the
standards sot forth,herein,as set by the Department of Commerce and the Departrnant of Natural Resourm a,State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St.Croix County Plarming&
Zomiag Dept within 30 days of the throe year expiration date.
Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe amlare the owner(s)of the
Property dt~9C bad above,by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
. I/- dA
SIdAtbRE OF APPLICANT(S)
DAN
***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
I'davace is made in the warranty deed.
(REV.MS)
8233393
Tx:4190949
State Bar of Wisconsin Form 1-2003 996579
WARRANTY DEED BETH PABST
REGISTER OF DEEDS
Document Number DocumcatName ST. CROIX CO., WI
05/30/2014 3:40 PM
EXEMPT#: N/A
THIS DEED,made between B&L Land Development,Inc.,a Wisconsin REC FEE: 30.00
(`.nr�nratinn _ TRANS FEE: 539.10
("Grantor,"whether one or more), PAGES: 1
and Creative Homes,-Inc.._2.:Mirinesota Corporation
('Grantee,"whether one or more).
Grantor,for a valuable consideration,conveys to Grantee the following described real Recording Area
estate,together with the rents,profits,fixtures and other appurtenant interests,in
St.Croix County,State of Wisconsin(`Property")(if more space is Name and Return Address
needed,please attach addendum): River Valley Abstract&Title
1200 Hosford St. Suite 201
Hudson WI 54016
Lots 4, 13, and 17, Plat of Sunset View Development in the Fite: 400449
Town of Troy,St.Croix County,Wisconsin.
040-1306-04-000,040-1306-13-000&040-1306-17-000
Parcel Identification Number(PIN)
Dated: May 2014 This is not homestead property.
(is)(is not)
Grantor warrants that the title to the Property is good,indefeasible in fee simple and free and clear of encumbrances except:
Easements,restrictions and rights-of-way of record,if any.
B&L Land Development,Inc.,a Wisconsin
Corporation
L_ (SEAL) (SEAL)
Ly
* e T.Weatherbolt,President/Treasurer
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
STATE OF KENTUCKY )
}ss.
authenticated on
• JEFFERSON COUNTY )
* Personally came before me on klay,.2 Z,2014
the above-named Lyle T.Weatherholt, ,,, '•,
TITLE:IVIEMBER STATE BAR OF WISCONSIN president/Treasurer of B&L Land Development,Inc-'Y'`fix'` `r' '�''-
%
(If not
' to me known to be the rson(s)who execut the fofegoittg d` y
authorized by Wis.Stat.§706.06)
instrument and/ackno edged t� e.� i r i .°_' 3
0.
THIS INSTRUMENT DRAFTED BY:
Fran Iverson ,
1200 Hosford St. Suite 201 Hudson WI 54016 Notary ublic,State ofKeilgcky
My Conunission(is ermanent (expires: •..
(Signatures maybe authenticated er acknowledged. Both are not necessary.)
NOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED,
WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO.1-2003
*Type name below signatures.
St. Croix County 996579 Page 1 of 1
- w
Property Owner 't" �Et ` U(7//� �— Parcel ID# 1��"kJ`�I hi G Z
❑ Boring# ❑ Boring Page ' of
® pit Ground surface elev. q f3,d ft. Depth to limiting factor 7 In.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftt
In. Munsell Qu.Sz. Cont.Color Gr.Sz. Sh.
Eff#1 Eff#2
� � -lZ Lp•-(VZ3 1 � Sl ` �Sb1z h�l`Fl- CW ..S . 8 ,tp
3 Io l t o (L y/6 _ S •+�
F-1 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
HEFT
❑ 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/ff=
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2
Effluent#1 =BOD5>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BODS<30 mg/L and TSS<30 mg/L
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SBD-8330(R.W00)
L
Wisconsin Depa%entc 1VE� SOIL EVALUATION REPORT Page \ of
Division of Safety a Buil�
n corda ce with Comm 88,Wis. Adm. Code County
•� U44
Attach complete sit plan Q� eNA less than 8 1 x 11 incnes in size.Plan must
include,but not limit d to:V�Yt!i and h pfiUl refe nce point(BM),direction and Parcel I.D. Q
percent slope,scale r dimensi k a cation and distance to nearest road. 3
S� G.0
Pie all information. Re,iewed by ''Date
Personal information yo provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)).
Property Owner Property Location yQL _S� GYn lAvl
I
1/4� 1/4-S T Z.a N R E( )W I
Property Owner's Mailing Address =
Lot# Black# ubd.Name or CSM#
o- Sox 3 3 13 — Sur�,seT VLF 7 L�
1State Zip Code Phone Number ❑City ❑Village ®Town Nearest Road
37C411 s�r� IRh.E �v a 15�� �ZO (�I S )�$S-33 S ' TZ-0`7' —
New Construction Use:3 Residential/Number of bedrooms 3 ` Code derived design flow rate _� S Q) — lj UCH GPD
❑Replacement ❑ Public or commercial-Describe:
I
Parent material G l_\a,,C) R L O 1 ttis }- Flood Plain elevation if applicable
General comments r I
and recommendations:
Fl� Boring# ❑ Boring 0,6 L>, F63, Zmo 4
® pit Ground surface elev. a ft. Depth to limiting factor 7 in. lJ
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eft#1 'Eft#2
2 �y-pis 1OK231b — �� I 2ms�k m� C� � • s -
3
i
I
a Boring# ❑ Boring
® Pit Ground surface elev. 1 Z 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
I O-1,Z 1 D"1`2 31 S ( Z`Fs�>Z n2`�- LL-,u 24- •`� .y.
Z \Z-UD 1 0`' 2.316 — S i ( Z!-rl k rY c S
.3 b qh loLl nylb — s v sg w► ) — .� �. Z .�
T--
Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BODS<30 mg/L and TSS<30 mg/L
CST Name(Please Print) Si tore
Arthur L. tlegerer �- g 03 Z.1S — � 3 220254 Number
Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number
421 N. 1--lain St. River Falls , tJI 54022 1Z-Z�Z-03 715-425-0165
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