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HomeMy WebLinkAbout040-1303-00-006 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574304 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: Oevering Homes LLC, aka Oevering Pro ertie I Troy, Town of 040-1303-00-006 CST BM Elev: Insp.BM Elev: BM Description: ,... Section/Town/Range/Map No: /14Y,/0 i i-7- C61- 1 22.28.19.1741 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER APACITY STATION BS HI I FS ELEV. SepticG U� 1 / Benchmark :l�.a. 7 Dosing GAIL► Alt. BM F4 4'r Aeration Bldg.Sewer . •a 167, 1 Holding St/Ht Inlet f /QQ �O TANK SETBACK INFORMATION St/Ht Outlet TANK TO ► P/ WELL BLDG. Vent t Air Intake ROAD Dt Inlet Septic Z 7 1 2 i Dt Bottom Dosing Header/Man. /_10 1�9. / Aeration i D Dist. Pipe �0• D 1 Holding Bot.System .2 PUMP/SIPHON INFORMATION Final Grade 3 ,0 16Z ` Manufacturer DePm1Aand St Cover Model Number T jL!:=:V. Friction Loss System T 7 Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 17-2. r ` SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR �^� Type9f System- / Of ,•6 i�� UNIT Model umb r: DISTRIBUTION SYSTEM ey lfo Header/Manifold It Distribution x Hole Size Hole Spacing Vent to Air Intake / Pipe(s) �.� �,- W--E Length Dia _ Lx Dia Spacing G SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Mulched Bed/Trench Center tj Bed/Trench Edges Topsoil T�Sodded Yes �] No �';; Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 654 Tradition Tr 't 1Ri er Falls,WI 4022(SE 1/4 SE 1/4 6 T28N R19 Walnut Hill Farm aka The Tribute Lot Parcel No: 22 8.19.1741 1.)Alt BM Description= , ` �— C3��" ` Z4 I..; 2.)Bldg sewer length -amount of cover= � qZ or` - -- - Plan revision Required? 0 Yes No Use other side for additional information. Date Insepctor's natur Cert.No. SBD-6710(R.3/97) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX 6/26/14 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 •5 ABSORPTION AREA 1216 # of chambers 60 IL BENCHMARK V.R.P. Top of 1/2" steel conduit ASSUME ELEVATION 100° Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 98.6/98.4/98.2 4.4' below qrade 149' Property Line All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. B-1 Scale is 1" = 40' 3% Slope unless otherwise 88 3-3' X 82' cells with>3' spacing noted ' 102' 147' Bts 25 9 78' B-3 B-2 ZZ 30' � 2 196' i5 Pro 4 Bedroom House Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.�ft^2/pair of end caps r4' Lg 12" Z. Grade at System Elevation 34" Town Road C�� G County c Safety and BwP*Vs Division r l JL 201 W.WaftjAj,J$Box 7162 Sandy permit Nmgbes(to be 5 w in by Co.) 5 • '/- O 0. J� �o�N pM Nt State Transaction 7X- 51' Pc1'mlt Application _ in accordance aith A6 1(2�V. Adm.Code.subw 4sDon of this fun to the appropriate govermaeatal unit is required prior to a sanitny perant. Nato:Applicabon fame for state-OvAnd POWTS sue submitted ID Prolcm Addrtss(if diffaeat thm marling address) the Depmimmt of Safety and Professional Servies. Personal inhnnabon you provide may be used for secondary is accordance with the Privacy Law,s.15. 1 m Stats L Application Wermation—Pose Print AN Information WWW (`►r, Property Owner's Name f 3 Parcel# — 06— property Owner's mnaing Property Location /W� /V, :�;, eel/ Gaut.Lot 7 ` City Stores I , Zip Code Ph000 Number �� V".: y4 Section I J Ti;�N; Rl W IL Type of Building(check all that apply) Lot# a 2 Fannly Dwelling—Number of Subdivision Name ak ati Block# lii� a r ❑PublidCommercial—Describe use ®. ❑City of ❑state owner—Describe Use �� ❑��---�� Li 2D 1p;z III.Type of Permit: (Check only ONCIOX on line A. Compleft lift B if applicable) 5,o A System ❑Replacement System ❑Traatmeat/Holding Tank Replacement Only ❑Other Modifies ion to F=tmg System(esplam) B. ❑Permit Renewal ❑Permit Revision ❑Chaa$e of Plumber ❑Permit Tralsfc to New List Previous Permit Number and Date Issued Before awiration owner 1 rAlryw ofPOWTB S om nent/Deviee: cheek all that apply) Nan-Pressurued In-Ground ❑Pressurized 1a-Ground ❑At4rade ❑Momd>24 is of suitable soil ❑Mound<24 ui.ui'sortbae soil elA A rts ❑Hoiding Talc ❑Other Dispend Component(explain) ❑Prohatmmt Device(ercplain) V.DispersalfrreatgArt Arm Information: / Design Flow W)d) Design Sol ApPlia4an Doe"Area Requaed(io MspcMd Ana ( s>n— J cl � 5 C ? . G g• , VL Tank Leto capacity in Ga1� 13� Mmufacuver 8� Gallons New Tads rmim6nx TWA= /,✓ ��ati rr r W c.t7 a a Septic or Holft Tads Dosing fiber VII.Responsibility Statement-L the a aw=rewpad4ity for installation of the POWIS she ea fie sitachd plans. Phnnbor's Now(Print) S' MP1At W Nmrber Business Phone Nmnber P,,,ice Phmsber's Addr=(Streek City.Staley ZP CO) �- Jc o eat Use OMh AP�'M �� Permit Fec tau Darned Issuing Signatrae ❑ Reason for S 475•°p 4-13614 DL CoeditiWtr W ;awttt for Disapproval 3, 8✓.11 .. I d�CaJ� T 'ffieptic tank,efflulantfjter and P 11�� dispersal cg'must all be services I maintaisted as per management plan provided by plumber, m'Q' 2 Alrke4up ! �mustpe�main4afried VIGJ �o�^"a-�'�-�•ntr;5 . Apaei fe comports pule for do e3 and saidt m tie CAMMq 9*K papv Nr teas oia a W III brebes is The SBD-6398(R.11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 6/26/14 Owner: Oevering Homes Location: SE 1/4 SE 1/4 S22 T28 N,R19W Lot 6 Walnut Hill Farm 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 Cont' ncy Plan 7. Filter Specifications Sh t 8-10. Soil test Signature License nu er#226900 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 6/26/14 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 .5 ABSORPTION AREA 1216 # of chambers 60 IL BENCHMARK V.R.P. Top of 1/2" steel conduit ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 98.6/98.4/98.2 4.4' below qrade 149' Property Line IN All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. B-1 Scale is 1" = 40' 3% Slope unless otherwise 88 3-3' X 82' cells with>3' spacing noted ' 102' 147' Vents 25' 78' 103' B-3 B-2 20' b l S 30' 196' Pro 4 Bedroom House Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 4' Long 12 5.�t^2/pair of end caps Grade at System Elevation 34" Town Road Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 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 102.5' Vent ACI Grade Vent 4' 4" 4' e;,�30/34 Septic Tank 4' Long 1 5' 4' Long 1)) 34" Grade at System Elevation 3491 Grade at System Elevation Spacing 5' 3-3' X 82' Cells Observation tubeNent Same on other end To be located on end of Cells %A B System elevations: C A_98.6' B_98.4' 20 chambers per cell C-98.2' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner 2 Tank Manufadurer/f� ❑ NA Permtt# tc [3 Dose [3 Holding Volare:� (gal) DESIGN P ETERS Tank Manufacturer: �NA Number of Bedrooms' ❑NA ❑Septic ❑Dose ❑Holding Volume: (gal) Number of Public Facility Units: Z NA Vertical Distance Tank Bottoms)to Service Pad, Estimated(average)Flow: (gal/day) Horizontal Distance Tank(s)to Service Pad: Specific servicing mechanics must be provided if vertical is>15 feet or Design(peak)Flow-(estimated x 1.5): �Cl (gaUday) If horizontal Is>150 teat. Specft Instructions to be provided on back. In Situ Soil Application Rate: .- — (gaYdaye) Effluent Filter Manufacturer: ❑ NA Standard(Domestic)Influent/Effluent Monthly average.. Effluent Fitter Model: Fats,Oil b Grease (FOG) 60•mg/L Pump Manufacturer: Biochemical Oxygen Demand (SODS) s22o mg/L: ❑ NA Total solids SS 's15o Pump Model: /!�d High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mgfL Manufacturer: >220 m (BODs) gn. NA ❑Mechanical Aeration [3 Pow Filter SS) >150 m ❑Disinfection ❑Wetland Pretreated Effluent Monthly average ❑Sand/Gravel Filter ❑Other: (BODs) s30 mg/L Soil Absorption System Fecal Conform mean) s%W,mg/L �A .% Ind(grate) ❑In-Ground(pressure) ❑ NA ❑At e ❑Mound Maximum Effluent Particle Size )4 in dia.. ❑ NA ❑Drip-une ❑Other. Other: U ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) hen combined sludge and scan equals one-third()5)of tank volume ❑ the high water alarm is activated ❑ onth Inspect condition of tank(a) •At least once every: � m (s)s) (Maximum 3 years) [3 NA Inspect dispersal cell(s) At least once every: Month(s) (Maximum 3 years) P NA Clean effluent lifter At least once every: ri r month(s) NA ) Inspect pump,pump controls&alarm At least once�every: months) NA ❑Yaws) Flush laterals and pressure test At month(s) NA least once every:. ❑yws) Other: At least once every: ❑month(s) E NA 11 yews) Other: NA 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 of 512 months,shall be perforated 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(02/05) Page of START UP AND OPERATION products, solvents or other For new construction, prior to use of the POWTS check treatment tank(s) for the presence of Painting h concentrations are chemicals or sediment that may impede the treatment process and/ar damage.the soil absorption.system. 9 detected have the contents of the tanks)removed l y a Septage Servicing Operator(pumper)prier to use under these Pump tanks may fill above normal highwaW levels prior to startup or due to pump failures. Start up or restoration of power an conditions is not recommended,as the e)(0966 wastewater will be�olscharged to the soitdabs o avoid this situ at ion have the overload that may result in the backup or surface discharge of effluent and damage Y� tTO a point or canted a Plumber contents of the pump tank removed by a Septage Servicing Operator(pumper)prior to restoring power within the pump tank. or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored System start up shag not occur when soil conditions are frozen at the infiltrative surface. Do not drive park vehicles over tanks or soil sorption system.oil ab Igo not.drive or park over, or otherwise distu or or compact,the are$within 15 feet down slope of any mound or at-grade soil absorption sires. the life of the treatment 12eduction or elimination of the fdiowing from the wastewater stream rimy improve the performance and prolong Teasers, dental goes, tanks and soil absorption system: adds, antibiotics, baby wipes, dgaretter"butts, condoms,eel cotton swabs, deg �scharge,fruit algid vegetable peelings. gasoline, grasses, herbicides, meat diapers, disinfectants,fats,foundation drain (sumpp)d napkins,advents,tampons,and water softener brine discharge. scraps,medications,oils,painting products,pesticides,sanity ABANDONMENT When the POWTS fails andlor is perm taken otrt of sernrice the following steps shall betaken to insure that the system is p Y and safely abandoned in compliance with s.Comm 83.33,Wisconsin Adfiir lds 8NVe(rode: e All piping to tanks,pits and other soil absorption systems shag 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). s After pumping, all tanks and pits shag be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert-solid material. CONTINGENCY PLAN vide a code compliant If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to pro replacement system: uated and may be A suitable replacement area has been oval mpaction and should not be infringed upon y'utilized for the locetion of a replacement sort absorption system.required The replacement area should be protected from disturbance and co setbacks from existing and proposed structure,lot lines and wells. Failure to protect the replacement arm c mill�the rules need for a new soil and site evaluation to establish a suitable replacement area'. Replacement systems must comply effect at the time of their permit Issuance. beorpti on system cannot be .O A suitable replacement area is not available due to setback andlor soil limitations. If the soil a rehabilitated and barring advances in POWTS technology,a holding tank may be installed as a lest resort. ❑ The site has not been evaluated to identify a suitable replacement aria. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement gran. If no replacement area is available a Holding tank may be installed.as a last resort to replace the failed POWTS. [3 Mound and at-grade soil absorption systems must«x rrrrPlY with the �in place effect at that time.remoal of the.biomat at the infiltrative be recon surface. Reconstructions of such system WARNING TREATMENT TANKS., PUMP TANKS, AN13 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 Phone Phone .j" SEPTAGE SERVICING OPERATOR P PER LOCAL REGULATORY AUTHORITY Name Name Phone 7J� 1 Phone This document was drafted by the stedfs of the Green Lake, Marquette and Waushara County CWT regulatory agencies in compliance With sections Comm 83.22(2)(bX1)(d)&df)and 83.54(1),(2)&(3),Wisconsin Administrative Code. ,? , .r:� FILTER CARTRIDGE INSTRUCTIONS STEP 1 Dry R rte IW W cm onto the esd of the outlet pipe to etsuxe it is ce4ered under the access apanM- . it no%then either W%Mt mare pipe k to the tank through the outlet or solvent weld(due)oddilonal pipe onto the outlet pipe. STEP 2 While the case is still dry lkbed on the outlet pipe,measure the length of Di/-inch pipe needed to hate the fltar to the tank end wail if utlttsing the eptlonal supplemental side support,If side support method.is not uftnd, proceed to stap tout: 4 TFP 3 for hetalletions utraing the optional=Wplen,"gal side support: -Went weld the%-Inch pipe ado the Afar case. If side support method is not utilised,proceed to step four. , Solvent weld the Alter cMW onto the outlet pipe. Insert the filter `t, •:° cartridge into the case,passing down until the filter locks into the twtbmn of a° : the rase. dockwist we. If a VRS swltd is utilized:insert into the fifer and lock by turning Maintenance 1. The effluant filter should be cleaned every One the septic tank is serviced. 2. Open the outlet access opening to Inspect the tank and fifter a + 3. pump the septic tank cornpbtdy,making sure to remove Nu sludge - layer on the bottom of the tank and net jufit the scum and effluent. <. Once the eAkw*love!has been lowered below the inved of the ' MW*t pipe,firMl!►Pull up on the titter handle to dislodge the cartridge hmn the case. S. Slide the cartridge up and out of the case for cleaning. 6. V a VR5 switch connected to an aiarnh is present,the switch � should mater b► ^9 900 and donned ny. 7. While holding the cartridge on its side (hype not surface hcby .t. .. down)over the access opening,rinse aft the cartridge vdth water orft krkaidns sum of she mMWW is rinsed back Into the tank. a If VRS switch's utilized,replace by inserting into RRer and turning dodneise g0-. 4. Insert the Ifltrr cartridge bade hhto the case,pressing down unW ,. the titer locks into the bottom of the case. 10.Replace and sewn the access opening on the tank. .:tr•.:h s�f"plc"7S:01-AtUXte AVE-"f n.:L fnt't.k`:VwKst:a •. WWWA aro0dWXM 877-MUti.MS(6534583) /z f� - ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND 0VMR.SH1P CERTIFICATION FORM O nerMuyel Mailing Address C� c Property.Address (Verification required from Planning&Zoning a _ ning Department for City/State Parcel Identification Number LE DESCRIPZ'YON Property L,ocatiogG- y,,,;E '/a, See. =, T?jN W, Town of_ Subdivision CeirMed Survey Map# ___ . Lot# C-. ----�----, Volume Page#_—Warraunty Deed# -- . , Volume ,Page# Spec ho yes no Lot lines identifra le yes no SY3_TEM 11�LArnrrF..�N NCTi A1�OWNER CE'R�,'II�'YCAT7t?N 'lop"'use and maintenance of Yom septic system could result in its i ntenance consists of pumping out the septic tame every three years or sooner a f'Hut a to handle wastes. Proper the system can affect the function of the needed,by a licensed tle Maibil can are s septic tank as a treatment stage in the waste di pumper. What you Put into pacified in§Comm.83.52(1)and in C !ry Ord, Owner nuiMtenance chapter 12-St.Croix County Sanitary pralinance. The proper('owner agrees to submit to St Croix County planning& owner d�a master plumber,journeyman to restricted plumber or a license Department a certification form,signed by the disposal system is in proper operating condition and/or(2)after' pub Ve1�s'ing that(1)the on-sift less than 1/3 full of sludge. inspection and piunping(if necessary),the septic tack is I/we,the undersigned have read the above req.ir standards set forth,herein,as set by the D enxnts and agree to maintain the private sewage di Certification listing that your septic system t f Commerce and the D r spore system with the ePamaom d returned Resources,State of Wisconsin. Toning Department within 30 days of the three Maintained i d must be completes and returned to the St.Croix County Planning& Year expiration date, Uwe certify that all Statements on this are true to the best ofmy/our knowledge. Uwe am/are the owns s of property described above,by virtue of a deed recorded in r( ) the Register of Deeds Office. Number of bedrooms IGNA F APPLICANTS) DATE ***Any iuforniation that is misrepresented may result in the sanitary Pmt being revoked by the Planutirug Bt Zoning Department. *** fnclndrefeme nce wis ith this made appliciu the ation a recorded warranty deed from the Register of Deeds Office and a warranty deed, copy of the certified survey map if (REV.08/05) ` 40 ^ Z µ OS'- r l r L- ,g lot co St ss C1t- u 13 goo ZZ as CA �4 vi a� , � � �� � f I -w 2n0•n '�9i w h N 00"00'32" w 279.47 I N t 3 r _ .t, �� Vi V Ui so Intl 4 II II I II Iliilllllflllll�111111 8194391 Tx:4161632 STATE BAR OF WISCONSIN FORM 3-2000 988962 QUIT CLAIM DEED BETH PABST Document Number REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Citizens State Bank, Grantor, and Oevering 11/12/2013 2.46 PM Homes,LLC,Grantee. EXEMPT#• N/A Grantor quit claims to Grantee the following described real estate in St. REC FEE: 30.00 Croix County,State of Wisconsin(the"Property"): TRANS FEE: 636.90 PAGES: 2 Properties sold`as is'. SEE ATTACHED EXHIBIT A Recording Area Name and Return Address: Title One File#20076 a Together with all appurtenant rights,title and interests. see attached Parcel Identification Number(PIN) This is not homestead property. Dated this 8th day of November,2013. !* ene LHabe :Bank tman,'V ice Chairman * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST CROIX COUNTY. )Ss. authenticated this 8th day of November,2013 Personally came before me this 8th day of November, 2003 the above named Citizens State Bank to me known to be the person(s) who executed the foregoing instrument and * a same. TITLE:MEMBER STATE BAR OF WISCONSIN (If not, authorized by§ 706.06,Wis.Slats.) ���y°M•INSTRUMENT WAS DRAFTED BY NOTARy'. Notary Public,State of Wisconsin My commission is permanent. (If not,state expiration date: ••PUBLIC 12/11/2016 ) Michael H Forecki,Attorney '% .. (Signatures may be authenticated or acknowledged. Both are not net+az .�• *Names of persons signing in any capacity must be typed or printed below their signature FOR 1 of 2 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No.3-2000 File No.: 20076 �f EXHIBIT A Lots 1 30,34,41, 64,and 71 of Walnut Hill Farm,Town of Troy, St. Croix County,Wisconsin. Lot 41 f Walnut Hill Farm, Town of Troy, St.Croix County,Wisconsin; together with driveway easement over lot 42 as shown on said plat. PIN 040-1303-00-001; PIN 040-1303-00-006;PIN 040-1303-00-030; PIN 040-1303-00-034 ; PIN 040- 1303-00-041; PIN 040-1303-00-064 ;PIN 040-1303-00-071 2 of 2 ------------------------ 1 1 I I j I 1 1 I I I I MIMITMgTM EE` I T _ I 1� An.• R 11 A..• 1 1 a I 1 R 1 1------- 1 1 1 A"�ItA-�.`\I j I �qpl I� 1 G � ■ 1 1 I 1 I s I : --- 1 11 I I 1 I I ili I I ---- - ___________ -----a—_____I_j--- . _1 _________ ___ j----------------- i rn.lnnn°Owmow i �F I I 68 4 Wisoonsiii Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 ^Wslon or Safety and Buildings In accordance with Comm 85.Wis. Adm. Code nry Attach e but n nog t EROSION CONTROL PLAN must b include.,but Parcel I.D. percent slope, completed before sanitary permit issuance ad, df�0/3�3 �i`J Re ' wed Date 4 �, Personal Infomnation You provi .may be used for secondary purposes(Privacy Law.s.is.uv lv tm)). 3 J Property Owner TAODO /� Property Locatio a To p1� SS ER,s T-C7 v 7— %a �1/�101. Govt Lot Al f DAm 5�1 M S IL- T ZB N R // &(or)w Property Owners Mailing Address Lot# Biocic# Subd.Name or CSM# 69 015 CA HJ U— AU-P— (9 LvALv,>*r Kill FA RA-( � City --rNWR State Tip code Phone Number ❑City ❑Village (Town Nearest Road m treov� Hr� MN 5so7e ( &5t) I- - ���� TRoy so. CftouER _ o New Construction Use:C§ Residential/Number of bedrooms Code derived design flow rate GPD ( ❑Replacement ❑ Public or commercial-Describe: Parent material ZQ&'SS P 01-t, .5,4A1 d V D I#W/},l 4 Flood Plain elevation if applicable General comments and recommendations: �E* 7Z77&.-) SO/;rf 6/E' tie sfA/ �.f tj/t'�v vv '( D• LD.T.S • n 0" D.`� w recte= [] ring z N r F/I # ® Pit Ground surface elev. I �'• ft. Depth to limiting factor >� fO in. Soil AppikationRate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPQff In. Munsell Qu.Sz. Cont Color Gr.SL Sh. 'Eff#1 'Eff#2 •// 10 y,Q *3 fshlt XSA 15 w - z / • 3 /o ----- S�� 1�s / z • 3 7.s SZ. 2-fShe es 9. 2Q O Z- Boring 0 � # ❑ Boring /o3. 10 ® Pit Ground surface elev. ft. Depth to limiting factor In. Soft Application Rate Horizon Depth Dominant Col RedQx Description Texture Structure Consistence Boundary Roots GPDM In. Munseli Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 'Eff#2 D• ! io 3 L IfSh SA 10 z l •Z • 3 N 3 2S. Y6 L. Z-FShK d5 A c • S �i r � to Effluent#1=BOD >30<220 mg1L and TSS>30 l*ffKPLI Effluent#2=BOD <30 mg&and TSS 130 mg1L tignature CST Name(P'Print) 7943 R i C-1, t' x7.6315 Address Ulbricht &Ass9ciates Date Evaluation Conducted Telephone Number Private SEp 7". 3 - P-" 7U- 77x.• 3Y&'Z- 2812 1 Oth Ave. Spring Valley, WI 54767 ®ya • 1095 • OY© . /ok(p yp . /0 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division or Safety and Buildings in accordance with Comm 85.Wis. Adm. Code County :51-. Gie of X-- 'V dude,but o' EROSION CONTROL PLAN must be ` (� PameilA. ad. PE•�tr//� G--'.DSO/303 percent slope, completed before sanitary permit issuance R Date Pecso"kvfortn&Wn ym provide may be used for secondary pun m es(lacy�•s.ls.va 1 V um)). 3 r Property P�o� SJE�T-e7fl 1 C/!� A��G^' illy Govt.Lot „`t o S 1/4 S�L T 2v N R // E(or)W 9 Property Owner's Marling Address Lot# Bbdc# Subd.Name or CSM# �0t5 CAWiI-� ��- • P* IVALNur Kill FAR""( `QN City SrvULR State Zip code Phone Number ❑City ❑Village (Town Neairest Road G�,�ov� tfT5 MN 5so7(P ( &S() zy8• Ion f _TROY SD. [flouER 0 g New Construction Use:M Residential/Number of bedrooms Code derived design flow rate r Da GPD ❑Replacement ❑ Public or commercial-Describe: Parentmaterial,0� DV -SAvV V DvTLt!/¢ �rFlood Plain elevation ifapplicable ^� 1L General comments and reccrrrr,erldatiorls: 4*e, • 7797" Stp tr.WIE7 -)Fk 'fAl /;E f1e0 J.vv ? D. L0.7:S• rl n "nil O�rI fwi � N Boring# ® Pit Ground surface elev. ft. Depth W frrrtng%CtOr in. F-EM t� Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots PD/i(t in. Munsell Qu.Sz Cont.Color Gr.Sz.Sh. T02 C •// �o ye 1/3, L fsh� s w�o � -7-s VIV sZ_ z-FSAe es -- O • Z '� Bo" 0 2 # ❑ /o3. 10 ® Pit Ground surface elev. ft. Depth to Nmiting factor in. Soti Application Rate y� Horizon Depth Dominant Color Redqx Description Texture Structure Consistence kc Roots GPD/lF in. Mu nsell Qu.Sz. Cont.Color Gr.Sz.Sh. •ow •Efl'#2 (� p• / io Z- / Sit ��f (` .� .z --- S i S K - _3 N 3 .s ._ c. Z-FShk' d c • S 2S- A9 5,/ r to •Efliuent#1=BOD >30:5 220 mgn-and TSS>30 1150 mgA_ 'Effluent#2=BOO <_30 mglL and TSS<30 mglL CST Name(Please Print) •.0 a FZ i C kT— srg uitu a /' Z2 T 5 per Address Date Evaluation conducted Telephone Number Ulbricht &Assipciates S, 7 3 - 3 715. 77a.- 3 yy Z' Privat 2812 10th Ave. Spring Valley, WI 54767 P;Ns FOR 4PRRO X . 2- yO 4 Ucs 0Y 0 . 10*5 . �, �, '�, o yo • �o�� . �o • oroa dyp- /��� • �.D • o� oyo • /o8G - �D � o yo - /o g6 - 70 . o y� . io�� g'O • Mo L.D parcel ID# Pop of T- 170 E Ground surface etev. �� . ft_ Depth to Igniting factor kL Rate Hot= De *=t Redox De scr"on Texture Sfnrcture Consistence Boundary Roots GPl3A�F unseff flu.Sz Cont.Cotes Gr_Sz.Sh. 'EtT#l 'Eff#2 0•7 /0 i 2 3 L. ��SfJ� G� Lr Gv ?� Y Sid k c • Z 3 �•S a SAKI CS 0 7•S L r �� t3orirxl� Sofings pit Ground surface elev. tf4 1 G r Depth to limiting factor Sol Application Rate 3 ficxizon Depth Dominant Redox Description Texture Skuch -e Consistence Boundary Roots GPF31f ill. firfutrsett Qu.Sz Corn Color Gr.Sz.Sh. 'Effli•9 °E1i#2 Q pit Ground surface elev. ft. Depth to k7 €actor_in. Sol Rate H0dzor► Dar*mffl Color' Redox Description_ Texture Consistence Bamdary Roots GPM #t. Munsell Qu.Sz Coal Cola Sh. °Eflftl °Ett#2 4 q or {ng F-I Sating Ground surface etev. ff. Depth to farmer in. pit Sod kypikaflon Rafe Hortzon Depth Dominam Color Redox Description. Texture Structure Consistence Boundary hots GPOff in. MunseB tit.Sz Cont. Gr.Sz.Sh. °Ef t °Eff#2 e Efficient#1=WDs>30:S 220 mgtt and TSS>30<150 mglt_ °Effluent#2=BOD5<30 rngIL and TSS<30 mg(L The Department of Commerce is an Nuaf opportunity service provider and employer. tfyou need assistance to access services or Med material in an alternate format,please contact the department at 608-266-3153 or TTY 608-264-8777. seoa3m tr:_cmot PLOT PLAN WALNUT HILLS FARM. LOT # Pg. 3 of 3 = Contour elevation lines. • = Backhoe Soil pits. D�'S 0 = Benchmarks set, maRKED WITH FLAGGED S p� � ��, lathes. 1/2" steel conduit pipes. SCALE: i " _ 3o E No . Lo T" °� M # ! ' /a0.0' t 101•2,0 DoT 7/ t o d 1` 1 d j3Z � j 133 13M4 Z / ©1. o oa . yo 7— � �