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HomeMy WebLinkAbout040-1304-16-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574356 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: Rudnick, Kelvin & Britt an Troy, Town of 040-1304-16-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: .0 /(��• U 1•s A, � 08.28.19.1822 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark c Dosing it S _ Alt.BM L v Aeration Bldg..Sewer ( �V .F T v S �t I Holding S Ht Net TANK SETBACK INFORMATION Ht Outlet H TANK TO P/L, WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic �r �,�, ��, �� 5 -� -_ Dt Bottom Dosing eade an. � � � l/D tt 'Sd Aeration Dist. Pipe rt p-S m Holding Bot.Syste ,J , - 9 3 Y 5.04/ Final Grade ���S 5 71� i r „ PUMP/SIPHON INFORMATION v - ���%/, Z Manufacturer Demand St Cover / GPM 3 CC�f�tJl. /C' •�� 0 3� Model Number s D5`-30- 3 96, o ,6Y TDH Lift Fric' oss System TDH Ft IT V o X2 .3 93, Zoy Forcemai Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM -22, BEDITRENCH Width Length No.Of Trenc s PIT DI ENSIGNS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L_5 JffLDG WEL LAKE/STREAM EACHI Manufactures_. INFORMATION Ty Of System: { CHAMBER 70 �•411A,�-1ti,'�l(,�'I i UNIT Model Number: DI IBUTION SYSTEM / '7 R-leadgAllanifold DisInbutio ! _, x Hole Size x Hole Spacing ent Air Intake ') } 1 Pipes) �� Length Y Dia _ Length Dia pacing� SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over 11 Depth Over xx Depth of xx Seeded/Sodded xx Mulched Depth Over Center ,2 Y-70 BedffrOver Edges Topsoil Yes No Yes No COMMENTS: (Include code discre encies.persons etc.) - ns ection#1.� "Inspection# • Location: 441 Horizon Court Hudson,WI 54016(NE 1/4 SW 1/4 8 T28N R`1 9W) Punset Valley Lot 16 � Parcel 08 28 19 1822 1.)Alt BM Description " e n �d � =/00, 36 2.)Bldg sewer length= d'I,' / -amount of cover= vl 3 is , [ 7"16J 4kxk�� -- l--- - - - - - -- - --- --- - Plan revision Required? ' Yes [ No �]j 1 � l Use other side for additional information. __1__ SBD-6710(R.3/97) Date Insepctors Signatu Cert.No. Pg of Private On-Site Wastewater Treatment System(POWTS) PLOT PLAN FILE INFORMATION PROPERTY LOCATION Owner '/4, Section T AN,xZ,�'_E o& PIN# Lf �j U - ((�,p(� OCity, OVillage,;ZTown of County,WI W.*E ou4tol- s 9 Qom, 19#) RVIO �lv, i0 /Z LOU are& cu/ -(�V -s' � ' 1 ®r+'?ildr� lir��t J l 4- 'i v .67 'i v \ County Safety and Buildings Division , r 201 W.Washington Ave.,P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) Madi `If tA711 � y Permit Application State T Number G � In accordance with Sk. li ),Wis.Adm.Code,submission of this form to the appropriate governmental unit is required prior tong'mg a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department o?Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law,s.15. 1 m Stats. Q rin !^� I. A licadon Information—Please Print All Information �// Property Owner's Name Parcel# /� a` l t �dnl Ko O�fD- /-y'/lv "GYSO Property Owner's Mailing Address Property Location /a?W oes7i fqPa� y r 1 &/,� �• fib'ZZ Govt.Lot City,State Zip Code Phone Number �f ,/4f /., Section 4 c en J / , Ws?# ' �ff 1�(circle one H.Type of Building(check all that apply) Lot# 0(1 or 2 Family Dwellin�g-Number oof Bedrooms rW) �� Subdivision Name Block# ❑Public/Commercial-Describe Use ❑City of ❑State Owned-Describe Use CSM Number ❑Village of Town of ��Q y RI.Type of Permit: (Check only one boa on line A. Complete line B if applicable) A. New S stem ❑Replacement S y ep tern ys ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV.TypevUOWTS S stem/Com onent/Device: Check all that apply) Non-P�Dispersat❑Pressurized In-Ground At-Grade�� ❑Mound/>2,4.inof suitable soil ❑Mound<24 in.of suitable soil ❑Holdin Component(explain) wC/w)z I Pretreatment Device(explain) V.Dispersal/Treatment Area Information: ctu4v Z Design Flow(gpd) Design Soil Application Rate(gpds Dispersal Area Required(sf) Dispersal Area Proposed sf) 1Sys—tem S feVia-tion 400 VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units U $ New Tanks Existing Tanks 0, c / r U vj A Septic orQoda@Jan c X 1 5V o ncr a. Dosing Chamber VII.Res onsibiili Statement I,the undersigned, me responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) P lunifierA Signature MP/MPRS Number Business Phone Number Plumber's Address(Street,City,State,Zip Code) Sans• i V P, Avdsoo tli' -6_-wlel,,F VIII our /De artment Use Only Permit Fee Dat Issu uing A nt Si • Approved ❑Disapproved OL ❑Owner Given Reason for Denial $ / IX.Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1.Septic tank,effluent filter and �QR �f d `�6eznj,62a dispersal cell must Le§_er_viced/maintained as per management plan provided by plumber. 2.All setback requirements must be maintained as per app licab lena b s for the system and submit to the County only on paper not less than 8 I12 x 11 inches in size SBD-6398(R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND/TITLE PAGE Project Name: �IJhIC'l>✓ .S!(1.�/I( to Owner's Name: 1 �r c/J rf��h� �� �!('� Owner's Address: L( Legal Description: Township: County: 5Y., Subdivision Name: Lot Number: Parcel ID Number: Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test& House Plans / o Designer/Plumber: r7�js s// License Number: O �J/ 4143 Date: Phone Number Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 Pg of Private On-Site Wastewater Treatment System (POWTS) PLOT PLAN FILE INFORMATION PROPERTY LOCATION Owner ,� 1/4, Section T_s&_N,R_E o& OCity, OVillage,MTown of 7 y 31�­ County,WI T � N !� W , \ so 9 � I W{ �Lro \ 1 (�QrQGQ � � .� �� 4� lof rner• 0 .1 / L 5 5d � ' .Bid UfI l � aq wEy areti /CUl-w -S' , I Ort��rt Ct i / � \e` -tooe SoU Absoration.System Cross Section I ���`'ft ' Final Grade 4':Vent 0 PVe Wp {----- ft a4 I-Oa f k IpG I Leaching Chamber --�► ft 4 System Elevation q— gyNl" Soil Absomtion.System Plan View �r ft ft -{ 1 ft Leaching Trench Vent Or Observation Pipe Chambers 4"Dia. Trench Header fd �k Leaching Chamber Specifications .� • r^ �U �°,' Manufacturer And Model f�rJ�[�7 EISA Rating sq ft per chamber Soil Application Rate o �.gpd/sq ft COO gpd Design Flow+ • �/ Soil Application Rate + EISA�Ch 2 rows of chambers each. j Pages—of i D � Z pp 9) p 2 w ITl c.rlCO °DFd � N = -z °c G7 c"n cn c = C z o C!) -0 _ c _0 2 O c m _ -�' r m c < OD _ zm c r � n n G) c m m Z c o m m Z v O ° Cn z I o - cn � 0o iv w o w w cn o ` N > a 0 O • „ �, � /% ��� � u�� � iii/� /� , r , ll�Cllr l l'll l�� � l ' r rr: ';' ��_ vvv�►'1VAR\\\\\qA\R\\\\\\\\\n�/ � • • / / / �' / // ��\UGu�o�oo�� \\\\l♦ /�j���/ ,,'/ Vii, • - llllllrllllll�lllllllll�lllll0/ll�lllllllll% � . r ' l l ;r/�irr�rr�rrrrrr;� r l l ll l 1 1 1, �%� j • / lllllllllllll�lllllll0/lllllllDlllll�ll l�/ --� �- --, - , I I I'i it�I I I� I Illi I I' III I IIII I C I i I � i I I i�l ll III III I, 'i I 1 il„ i I II j f',I ■�' �1 � � jl'I'`il III I � �� �::.�,� i t III I I I I'I!! 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When power result tired the excess or surface discharge r will During power g p be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may of effluent. 7o avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to grin ower to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump rest g p controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. pot not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption Reduction or elimination of the following from the wastewater strew cotton swabs; degreasers;rde dental floss;p diapers he life di the POWTS: antibiotics; baby wipes, cigarette butts; ater; fruit and vegetable peelings; gasoline; grease; herbicides; meat disinfectants; fat; foundation drain (sump Pump) scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. be taken to ABANDONEMENT: When the POWTS fails and/or in complia ce with ch. Comm 83.313, Wisconsin Administrative insure that the system is properly and safely Code: • All piping to tanks and pits shalt be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly removed o disposed he coof by a Septage vers removed and the void space • After pumping, all tanks and pits shall be excavated and 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: the location suitable replacement area has been evaluated and may be utilized f and compaction fande soil A suita p should not beinfringed upon system. The replacement area should be protected from disturbance re uired setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area by q will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement system must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soithe failednPOWTSng advances in POWTS Ii technology a holding tank may be installed as a last resort to Upon f is available a holding tank ❑ The site has not been evaluated to identify a suitable replacement If no replacement area t area. ailure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement may be installed as a last resort to replace the failed POWTS. d at- rade soil absorption systems may be reconstructed With lace thef�ulles in effect at l hat time. at t ❑ Mound 9 infiltrative ve surface. Reconstructions of such systems must comp y < <WARNING>> -LETHAL SEPTIC, PUMP A ND OTHER TREATMENT TANKS MAY CONTAIN UND E ANY SCIRCUMSTANCES.INSUFFICIENT DEATH MAYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK ND RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS: POWTS MAINTAINER POWTS INSTALLER Name Name Phone Phone LOCAL REGULATORY AUTHORITY SEPTAGE SERVICING OPERATOR (PUMPER) Agency a Cr0[X �On Name Phone Phone Wis onsin Administrative Code. Use of this document does not This document was drafted by the staffs of the Green Lake, Marquette and Waushara County Zoning and Sanitation agencies. This document meets _...__....,,.,.� �f�h_ comm $3.221211b11111d)&lf) and 83.54(11 12) & POWTS OWNER'S MANUAL & MANAGEM` JT PLAN Pager—of FILE INFORMATION SYSTEM SPECIFICATIONS Owner `- r Septic Tank Capacity al ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer IQ� ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Commercial Units ❑ NA Pump Tank Capacity gal ANA Estimated flow (average) Q� gal/day Pump Tank Manufacturer :9 NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer J0 NA Soil Application Rate o gal/day/ft2 Pump Model ICI NA Influent/Effluent Quality M,anthly average* Pretreatment Unit JO NA Fats, Oil & Grease (FOG) :530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BQDS) <220 mg/L ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <150 mg/L ❑ Disinfection ❑ Other: Manufacturer Pretreated Effluent Quality Xf NA Monthly average** Dispersal Cell(s) Biochemical Oxygen Demand (BOD5) <30 mg/L 1K In-ground (gravity) ❑ In-ground (pressurized) Total Suspended Solids (TSS) <30 mg/L ❑ At-grade ❑ Mound Fecal Coliform (geometric mean) 510' cfu/100ml ❑ Drip-line ❑ Other: Maximum Effluent Particle Size %e inch diameter * Values typical for domestic (non-commercial) wastewater and septic tank effluent. ** Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months R year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third %) of tank volume Inspect dispersal cell(s) At least once every ❑ months 40 year(s) (Maximum 3 yrs.) Clean effluent filter At least once every ❑ months J? year(s) Inspect pump, pump controls & alarm At least once every ❑months ❑ year(s) j NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) )I� NA Other: At least once every ❑ months ❑ year(s) JZ NA Other: At least once every ❑ months ❑ year(s) ?I NA 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. 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 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 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 tank equals one-third (%3) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatement components, and any other maintenance or monitoring at intervals of 12 months or less 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. START UP AND OPERATION: For new construction, prior to use of the POWTS check treatment tank(s) 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. ST. CROIX COUNTY g SEPTIC TANK MAINTENANCE AGREEMENT V AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �e I u l n W rrll Mailing Address MU f �# ;Nl flfdtn ffilL, Mn 1 -- Property Address (.040 {,, 1 � Verification required from Planning&Zoning Department for n/ew/construction.) City/State T wun (m Parcel Identification Number LEGAL DESCRIP,T/IION Property Location `/4 _ '/4 , Sec. , T acc N R 9—W, Town of �r0 W Subdivision rJ 1✓Q / . , Lot# . Certified Survey Map # G U l �/� , Volume , Page# Warranty Deed # q ( / , Volume __7 age # Spec house yes no Lot lines identifiable 0 no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner,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§Comm. 83.52(l) 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 Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning& Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 6-V 6201- SIGN T OF APPLICANT(S) 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.08/05) ICI — RRE LAND SE=RESSIDEW. IAL IAL RED BRICK+ADD, ING G ICU T'�'RE R SI ENT 1 8 8 E i ZON �' X i 900.4 970.8 EAST-NEST N ' 14" E 1328.11 .29' _ i I \ C LOT 19 o 00 a� o .604 ACRES I OD B P 15l - I \ 6 ,875 S.F. N � \ LOT ;15 m cn 1.557 A`CRES� - I _ o ' �� O 96.8 ' N °41�4 E 844 S�F. \ � 0. Un 0.o I y�0� x ' m1 O % O O ' •��o \ \ 1 1O' \ � �t0 L. \ \ \ \ 15, V0 ',,ACRES o `sue; \6 ,356 S.F. 91 \ \ tJ N \\/\\ N ti9 C 1p 1 5 A RCS - 0' 5, 0 Sf- \ 75' O � N ��• r \ , n G O � � �L0 oo � • �09.0 \,� k� 1\7 0�, 8199 CS -b �F�F ti \ 33• LWJ o • ° l��O V ' \O O O 12 0 X �, 13 0 o 9 _°00 00" 1 05' co) z En N 000' 00" V 0 � �/ •� D. `� UT OT 1 �= j 2 ,206 S.F*o� i CP ` ' •5 p �O .75ARS 7 80 Wisconsin Department of Com OIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings 0/ cte " TcTrd�nr Comfi it.85,W Adm. Code ll 11��� county ST.CROIX Attach complete site plan on r not less than 81/2 x 11 i e an include,but not limited to: I a poi percent slope,scale or dirnensi ns, on a I is ce to n Parcel I.D. Plea e�in orm�ation. R6� 7 by )fie Personal information you provide may be used for secondary Purposes(Privacy Law,s.15.04(1)(m)). ` r /6 Property Owner Property Location ❑ El ARTHUR&MARIYLN FEYEREISEN Govt.Lot —ME 1/4 SW 1/4 S 8 T 28 N R 19 E or W Properly Owner's Mailing Address Lot# Bbdc# Subd.Name or CSM# 420 Townsvalley Road 16 - Sunset Valley City State Tin Code Phone Number [-]Village ElTown Nearest Road Hudson, WI 1 54016 1 ( 71) 386-2122 i TZQY I Townsvalley Road DNew construction 11seE] Residential/Number of bedrooms 4 Code derived design ftow rate 600 GPD ❑Replacement ❑ Pubic or commercial-Describe: Parent material outwash/sandstone Flood Plain elevation if applicable NA- ft. General ODD Conventional In-ground trenches-to be designed by installer and rcxommendations: G a- s 0.7 oad rte V W'+-4WC R� r - 32 4 g3 - . (06 " . PB- Boring# ❑ Bourg El Pit Ground surface elev. 901.40 ft. Depth to limiting factor >92 in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu.Sz. Cont.Collor Gr.Sz.Sh. 'Eff#1 'E102 1 0-5 10YR2/1 - 1 2f-mabk mvfr ab 3vf-m 0.6 0.8 2 5-17 10YR2/2 - 1 2f-msbk mfr ai 2vf-m 0.6 0.8 3 17-39 10YR3/4 - 1 2f-mabk mfr aw 2vf-m 0.6 0.8 4 3948 10YR3/4 - sl If--Isbk dsh aw 2vf-m 0.4 0.7 5 48-92 10YR4/4 - s Osg dl - - 0.7 1.6 (Horizons 4 &5 have some Sr.) ❑B Boring# [] Boring 898.6 >102 El Pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth DorninaM Color Redox Description Texture Structure Consistence Boundary Roots GPD/(F in. Munsell Qu.Sz. Coat.Color Gr.Sz.Sh. `Eff#1 'Etf#2 1 0-5 10YR2/1 - 1 3fabk ds cb 3vf-m 0.6 0.8 2 5-14 10YR2/l - 1 2f-mabk dsh ci 2vf-m 0.6 0.8 3 14-19 IOYR3/2 - I If--mabk mvfr as 1 vf-m 0.4 0.6 4 19-36 IOYR3/6 - s1 Imsbk mfr as lvf-m 0.4 0.7 5 36-50 7.5YR4/4 7sYR416 s&sil Osg/2fabk mfr cs lvf-f 0.6 0.8 6 50-102 10YR3/6 - s Osg dl _ - 0.7 1.6 Horizons 4& 6 have sore gr.) Muent#t=BOD >30<220 mg1L and TSS>30<150 mg1L 'Etfluert#2=BOD <30 mglL and TSS<30 nxyL CST Name(Please Pmt) - - na(cxe CST Number _MM Jo Hollister Z I h'1 I., %/Lw 224832 Address Dale EvaNstion Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 01- 13&07-08-04 (715) 426-1775 Property Owner FEYEREISEN,Arthur(Lot 16) Parcel ID# (Pending) 9 g) Pa e 2 of 3 � o # Born El Pit Ground surface elev. 900.91 106 ft limiting Depth to lim factor � in Sod Appkabon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW lo. Munsell Qu.Sz Cont color Gr.Sz.Sh. 'Eff#1 'Eff#2 1 0-4 IOYR2/1 — I 3fabk dsh cb 3vf-m 0.6 0.8 2 4-15 IOYR2/1 — I 3fabk dsh ci 2vf-m 0.6 0.8 3 15-20 10yR3/2 — I 2faabk dsh ci 2vf-m 0.6 0.8 4 20-34 I0YR3/4 — A 2f-mabk mfr cs 2vf-m 0.6 0.8 5 34-40 IOYR4/3 flf IOYR3 4 A 2fabk mfr as 2vf-m 0.6 0.8 6 40-46 I OYR4/3 I OYR5/6 sit I msbk mfr as 2vf-m 0.4 0.6 7 46-106 I0YR3/6 — s Osg ml — — 0.7 1.6 F1 Boring# U Boring VU Pit Ground surface elev. ft. Depth to limiting factor in. Soil AppkaWn Rate Horizon Depth Dominant Color Redox Description Te)d re Structure Consistence Boundary Roots GPDftF in. Munsell Qu.Sz. Corrt.Cow Gr.Sz.Sh_ 'Eff#1 TRW F-I Boring# Boring Pit Ground surface elev. ft_ Depth to limiting factor in. Sal nation Rate Hoizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff? in. Munsell Qu.Sz. Cont.color Gr.Sz.Sh. 'Eff#1 'Eff#2 `Effluent#1=MD.,>30<220 mgtL and TSS>30<150 ffqL 'Effluent#2=BOQs<30 mg/L and TSS<30 rnglL need material in an alternate format.ptease LvnbjLt the deparumerk w 6a 8-•6a-*ii 51 sar q"e a I II J P�Of P PAa-,Iff owN cmw: /I: 50 N Pipe S 9 it0 sG C Rv � s �-50l.Bf1�IG W/ BfIGp10� NO COMM W 5MACK MVMXM5 1.5't� ReidEs c8�8)F649 VL Fah Z ,gp a� B-16C 910 �. 9 , LOT 16 �` 910.8 B 17 90 .40690' 1 RRE LAND SE=RE�SLDE� �IAL`, RED BRICK+ADD, 1 1 8 8 E ZONING G�ICU T RE-R*S1 ENTIAL I x u. I 900.4 9 10.8 EAST-WEST _ G l 1141' E 1328.11 Nc .29' 0 78 ---- 2 cn � Z O LOT 19 O a \, .604 ACRES ° co i oo P I .P B Fl - I 6 ,875 S.F. l o t O /004.9 I LOT /1 5 m 8982 0 1.557 AIQRES, -4;y E - 844 S. �, 096.a` N 4 1 r. co \ B 19 0. 0 o�� �pp� �� \ o \\ � �-\sue'F ..— i •��� In � � `. 'tom LQ 1 ` 15 0 `ACRE ' \6 3�6 9 O / o �9 ci 910.8 15 ACRES � \ V G 5 0 S,F. 5 7 i ti \ &Mp-,0 ' N °• ' \ oo' 09.°Wc DLO 7 ` 0 81.99 W �+ . 1. 1 AC S 65, 9 F. o s B— 12 o0 O• O �• �y°� .°j' • ;. ? . 71. 5 2 .2 0 o Ji .. X �\� _ +r; ; . •�. Op N 000' 00" V G°c °: 5g UT OT 1 1b -/ .62 CRE X -- s J C.4 IP- 2 206 S.F. / O '910.8 ,c O Fj _` ' \ Off• O � � : .` • �, •D<<L� mss- / 0 8 ,o .7 5 A R S a� X i 8244221 State Bar of Wisconsin Form 7-2003 Tx:4199813 TRUSTEE'S DEED 998772 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI 07/17/2014 3:12 PM THIS DEED,made between Arthur N.Feyereisen and Marilyn E.Feyereisen EXEMPT#: NA as Trustee of The Feyereisen Revocable Trust dated December 28,1995 REC FEE: 30.00 ("Grantor,"whether one or more), TRANS FEE: 150.00 and Kelvin Thomas Rudnick and Brittney Lynn Rudnick,husband and wife PAGES: 1 ("Grantee,"whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St Croix County,State of Wisconsin("Property")(if more space is Recording Area needed,please attach addendum): Name and Return Address River Valley Abstract&Title .Lot 16, Plat of Sunset Valley, St. Croix County, 1200 Hosford St. Suite 201 Wisconsin. Hudson WI 54016 File 400673 040-1304-16-000 Parcel Identification Number(PIN) I �I Dated July 16,2014 \ (SEAL) (SEAL) *,Arthur N.Feyereisen,T stee *'Marilyn E. Keyereisen, (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on )ss. • ST CROIX COUNTY ) STATE OF WISCONSIN * Personally came before me on July 15,2014 TITLE:MEMBER STATE BAR OF WISCONSIN the above-named Arthur N. Fe er ' n aqd Marilyn E. (If not, Fe ereisen Trustees of the Fgy reisen R64cable Trust authorized by Wis. Stat. § 706.06) to me known to be the pe on(s)w e e uted the foregoing instruiinGR ac e e i THIS INSTRUMENT DRAFTED BY: '* Lo L.;DeMars Fran Iverson 1200 Hosford St. Suite 201 Not Public,S e isconsin Hudson WI 54016 Commission(is permanent)(expires:March 20,2016 ) (Signatures may be authen' Both are not necessary) FF pNOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. J,, U R' $ 1.998772 Page 1 of 1 ©2003 STATE BAR OF WISCONSIN FORM NO.7-2003 ype name cow ignatures. 1 SURVEYORS CERTIFICATE LEGAL DE5� h O 1 I / \ j 1 \ �G \ \ \ r \ LOT SQ. FOOTAGE 65,909 PWAM PLR ELEVATE BUILDERS P'PEPARED er: HEDLUND PLANNING ENGINEERING SURVEYING rg�y�.y��,y0'�{u .m prq.w.mm �4 x.,LE W iFET M,r�m DsY i1, �m D11atY ODN W DAR A„p K=4 _ n 0