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040-1303-00-025
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 574351 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: Clevering Homes LLC, aka Cievering Pro ertie I Troy, Town of 040-1303-00-025 CST BM Elev: Insp.BM Elev: BM Description: n Section/Town/Range/Map No: /60 )N� 1 (2 9—') ` 22.28.19.1760 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER S CAPACITY STATION BS FS ELEV. • S.2 /o iaa Septic '_„ ',I'J0 /boa Benchmark /� IJ U Ir'i I j,.,.,, r • • Dosing �, g Alt. BM �r` Gr 9 . S ftumr Bldg.Sewer f -l 4., Holding St/Ht Inlet IS• �. 3 TANK SETBACK INFORMATION St/Ht Outlet TANK TO 1 — WELL BLDG. ent to it Intake ROAD Dt Inlet Septic Dt Bottom /1,, 3 `lill 1,3 Dosing I r Mme' J Z. A /t 15 — Header/Man. 7S /6 1 Aeration Dist. Pipe Holding Bot.System 3 S gat --7 Final Grade ,/6 3• e S PUMP/SIPHON INFORMATION 1 , 75 7 Manufacturer Demand St Cover GPM Model Number / �� V•C/�- "� . a , 1 I L L�6 4/ r y 7 �00 Iv 1 !J d✓ TDH Lift •/L Friction Losss� System Heat. TDH �J 3 ol Forcemain Length Dia i/ Dist.to Well r� SOIL ABSORPTION SYSTEM N 9 Y BEDITRENCH Width Length _� No. Trenc PIT DIMENSIONS No.Of ii Inside Dia. Liquid Did D=pt- DIMENSIONS 5 `°- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Tyr System 16 ' S UNIT Model Number: 1 �a1) DISTRIBUTION SYSTEM gAt Header/Manifop f L! Distribution L �/ x Hole Size , x Hole Spacing V Air In k uu Pipe(s) �J �1 ..�J( Length T Dia Z Length 7-7 Dia ` Spacing Z SOIL COVER x Pressure Systems O xx Mound Or At-Grade Systems Only 4 Depth Over Depth Over xx Depth of xx Seeded/Sodded jxx Mulched Bed/Trench Center I •75 Bed/Trench Edges Topsoil , ` c- Yeses j No es L .f No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: /D / / /4' /C Insiarcell ecti #2: I / Location: 258 Walnut Hill Wa River Falls,WI 54022(SE 1/4 SE 1/4 22 T28N R1 9W) Walnut 11 Farm a�a The Tr�ut� No: 22.28.19.1760 r. Go�t� �a ( - 1.)Alt BM Description= r 2.)Bldg sewer length= 35a �.► / 6 O `� -amount of cover Plan revision Required? ' Yes No 4 1 Use other side for additional Information. Date Insepctor's S' ture Cart.No. SBD-6710(R.3/97) IV County�•.J (� G_/ Safety and Buildings Division 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) I n,'W1 X376 -7162 r 574351 cou oly VA �- State Transaction Number JpM►,�UN itary Permit Application n ®� In accordance with SPS 383.21(2),Wis.Aden.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 Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary -purposes in accordance with the Privacy law,s.15. 1)m,Stars. //n$ I. Application Information-Please Print All Informatio o` n Property Owner's Name / 3 Parcel# 0 L)C r(l 11 �o D M - Property Owner's Mail in Addz Property Location I 3�' 'e � ( Govt.Lot C State Zip Code t Phone Number L-� /, �� y., Section 1 1 .Z cle on T N; R�E� II. pe of Building(check all that apply) Subdivision Name r 2 Family Dwelling—Number of Bedrooms C ❑Public)Commercial-Describe Use U-,a City of CSM Number age of ❑State Owned--Describe Use J J40--of III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) B. ❑Permit Renewal Permit Revision ❑Change of Plumber [a[]Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration wner / M Type of POWTS System/Component/Device: Check all that a 1 v ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade and_>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑ er Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersaUTrea ent Area Information: Design Flow,(gpd) Desi Soil Applicati te(gp f) Dispersal Area Requ' (s Dispersal Area Propos (s System Elevation VI Tank Info Capacity in Total #of Manufacturer u Gallons Gallons Units a b o New Tanks Existing Tanks JA d o t n U rn h 3 Septic or Holding Tank �Jt� Dosing Chamber x:30 VII.Responsibility Statement-1,the undersigned,as Apple responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumb ignature MP(MPRS Number Business Phone Number Plumber's Address(Street,City,State,Zip Code) -7 ) C_ zoff - /7- C4 V tcj Countv/De artment Use Only Permit Fee Date �sZued, Issuing t Signal�re Approved ❑D' e 5 ❑ r@' en Reason for Denial V" ' /v IX.Condi asons for Disapproval )i..'iepfio'tank ,effluent fitter and 3 �;1 betI �b J I usf all sere es! aim i is� I ce t rrt � d persa be tc m to ned �� � - �c�., provided b lumber. 1..� as per management plan p Y P must be`malMained 2. mss ad t/ordinances. �T C�'L�C r,l�'/�'b� �A �� rD✓� P� Attacb to complete plain for the system and submit to the County on)y on paper R 217/, r S13D-6398(R• 11/11) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond W 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX 101.5' 9/10/14 3 SYSTEM ELEVATION DATE BEDROOM CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none Ilk BENCHMARK V.R.P. Top of foundation ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Walnut Hi I I Way Scale = 1 /4'1 _ 10' Grading is to be done to divert run-off away from system 1 Acre Lot Area 15' below 99' system is to 100' remain 4% Slope B- 1101 undisturbed B.M.* B-3 Pro 3 Bedroom Ho use B-2 Huffcutt Combo Tank Wei I is to meet al I WDNR setbacks 100.5' Tank is to be properly bedded and provided with lockdown covers with approved warning labels Property Line QD p hR A. DIVISION OF INDUSTRY SERVICES oZg1� °1P 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 3 K Contact Through Relay y http://dsps.wi.gov/programs/indus"-services t2� �G www.wisconsin.gov ps�rox�.�s Scott Walker,governor Dave Ross,Secretary October 01,2014 CUST ID No, 226900 A7Y'N.,POIYTSInspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/01/2016 Ident;fitUon Numbers Transaction ID No.2460706 SITE: Site ID No. 804694 Oevering Homes Please refer to both identification numbers, 258 Walnut Hill Way above,in all correspondence with the Town of Troy St Croix County SE1/4,SEI/4, S22,T28N,R19W FOR: Description:Mound Object Type:POWTS Component Manual Regulated Object ID No.: 1496700 Revision;Maintenance required; 450 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual-Ver. 2.0, SBD-10691-P(N.01/01,R. 10/12),Pressure Distribution Component Manual-Ver. 2.0, SBD-10706-P(N.Ol/Ol,R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.The owner,as defined in chapter 101.01(10), Wisconsin Statutes,is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P(N.01/01,R 10/12)and the'Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.,0%' SBD-10706-P(N.01/01,R 10/12). The building sewer and distribution network piping shall be of material listed In Table A4" PILTIAMO-5, Wis. Adm. Code. APPRV DEPT OF F In the event this soil absorption system or any of its component parts malfunctiop ReFesolle a health hazard, the properly owner must follow the contingency plan as described in the option the owner must comply with the operation, maintenance and monitoring duties as desPrr""cc ig VIII of the mound component manual. A copy of this information must be given to the owner upon com on of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). SHAUN R BIRD Page 2 10/1/2014 Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19,Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s.SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 85.00 This Amount Will Be Invoiced. e?o�� When You Receive That Invoice, Julia Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2,Integrated Services Payment Submittal. (262)397-6005, Fax: (608)283-7481 WiSvIR 'code julia.lewis@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with"SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services. Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300" series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. RECEIVED Cover Page SEP 15 2014 INDUSTRY SERVICES Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 9/ 10/14 Owner:Oevering Homes Location: SE1/4 SE1/4 S22 T29 N,R19W 258 Walnut Hill Way Troy Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contgency plan 9-11. Soil test 12. Filter Specifications and c oss section i Shaun Bird + Signature ' License nurn 26900 `LY ED YETY AND k IAL SERVICES ,NDUSTRY SERVICES SEE CORRESPONDENCE 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 SYSTEM ELEVATION 101.5' DATE 9/10/14 BEDROOM 3 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of foundation ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. Walnut Hill Way AL Scale = 1 /4" _ 10' Grading is to be done to divert run-off away from system 1 Acre Lot Area 15' below 99' system is to 100' - 101 remain 49� Slope B- 1 undisturbed B.M.* B-3 Pro 3 Bedroom Hai use B-2 Huffcutt Combo Tank Well is to meet all WDNR setbacks 100.5' Tank is to be properly bedded and provided with lockdown covers with approved warning labels Property Line Mound System Cross Section and Plan View -- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -1 Dimension Feet i A 1 B D �. —�••4 L L .•YL•L•L•�•L�YL L•4•L•L•4•YYh•L••L•L•L•Y�L•�•Y4•L•L•L•L •YY�•1•L•Y1.4.1•L•Y4.4.1 L •LK•4•L•4 L I •r•J.r•r•r}f•i.r•}yr-r.r..r•l.J.l.r.J.J•.J.}.J.r.r.r.r.l.J•{• r}l.r.r.r J J J r l.J.r4r!r r.!!.!r N!r }}}i}i}i}. .L}:}}}t}}}:ir}}}}i}}r}i. }i}}}}}Li}}}}}r i}r}}}}r}i}}}r}}N}}}}}F}'r•}N1• 1•L}}}Li}i}}}i '. I E-' A I 1.4 L 4 L L•1.4.1•L•4 L 11• YL 4 4 .1 L Y4 1 L 1 L 1 L L L L•1K•L•L•L•L•1• }•L•YYL•Y ' , .}{!{{1r1i{ .'{{{{{{r{{{{'�{•.{{{•J1J1f\!•{1M{J{r{J 1r r{{J•J{},•}1J4JnJ h llrj•{{r{r{r•{Y{J' •1r{J1r.f{{{{ Mir J•r. r.!•r.J.r.i.J.J. J.r}}.h•.�}i}J•}.}S}� Lr N},}•r}}•r•! ' 1•Y{•{•1K!}}L•\•1.4.1•L.L.4N•1• 4 Y4•{.4•{•1.4 •{•{ L•{.1.1.Y{.1•1.Y{•1.1.1•1.1.Y{.L•1•YL••••Y r•!•J•J•J•!• !•!Nr•J•r•J•r•Nr}NNr}i• •J•NJ•N.2•J NJ•}•f•l•J•NJ•{•r•!•r•J.r J�J•NNNJ•J•!•!•l•J•! W I G Z � I H / �� 1 I 1 I J f i K �� L 7S 7 - - - - - w �� r K B Z , Slo e L Topsoil = ASTM C-33 }r: = Clean aggregate = 4 in. sch. 40 pvc Cap Material sand fill `'r� `/2 to 2 '/� in. dia. observation pipe L J 4 1•L it Geotextile G H Fabric .{•r rw•r•r{!•J.l.. Y1.1.1•YY /6 ,� D E .�' Plowed Surface, 5 Ft Contour Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a 1/4 inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07lgj Page of Pressure Lateral Layout Two Laterals — End Manifold 4 -- 'Threaded ` Cleanout Lateral Turn-up --► Plug Manifold M X —� I L, - Long Force Main Sweep ✓�-'J 90 j U Bend Distribution Network S ecifications Pressure System Construction tManifold l Diameter Z In. Diameter z In. Laterals are constructed of Schedule 40 PVC e Diameter .1)11'6 In. pipe. Orifices are drilled perpendicular to ifice Spacing) j 4 In. the pipe with a sharp drill bit and face down. L Lateral Length).... Ft. Lateral turn-ups terminate with a threaded M (Manifold Length) Ft. cleanout plug and are enclosed in a 6-8 inch Force Main Diameter �_ In. diameter lawn sprinkler valve box accessible Force Main Len th 'Ft. from finished grade. • • • • • Grade 6-8 Inch Lawn Sprinkler Valve Box Page ---—of ---- 03/0.5 lgj Septic-Dose Wank Cross Section And Pump Performance Specifications PUMP Manufacturer Tank Manufacturer ^Z_ � Pttrtt Model Number J S — Tank Model Number v Total Tank Capacity j ,� C Alarm Manufacturer M Depth ` Alarm Model Number Switch Type r Z Total Dynamic Head(TDH)- Feet Filter Manufacture Filter Model Number Elevation Head Distal Pressure v Network Loss Mini mtun pump erfonnance Required Force Main Loss GPM ,/j Ft TDH Total Z=s'� -- outlet Manhole Min.4"Above Grade With --� �6inhole Min.4"Above Grade ,kmg Device. inlet Manhole M o With Locking Device <6 Watertight secure Below Grade Sealed Weather-proof ----► junction Box - Finished Grade ' -' •• ••• _• ••• * Vent Min. 12" Disconnect Above Grade Means • With Vent Cap (hWet Filter ---......,,._i. Wet Baffle A 1/4» Switch S and Reserve Capacity Weep Tank Volume= / > GPI B Hole Dimension, Inches Volume Gal. (reserve)A Off Elevation. C (alarm) B 2 Ft Bottom (dose) C - ; r -y •. D Elevation :r; (dam) D r;; / Ft Total :: ..... . and -back filled in accordance with the GErtERp►L INST ALLATI4N: The septic/dose tank is bedded Specifications Maximum depth of bury as specified by the manufacturer may not manufacturer s product approval spec a have an effective locking device (padlock) be exceeded without prior approval. Manhole covers exposed to g� with watertight fittings, and inlet and outlet is of approved material, to 4 pVC to bridge the tank installed. Piping The force main is sleeved with laid on stable soil to prevent settling at rtig sagging-. lies with NEC 300 and Comm 16.2:1. excavation and the sleeve is sealed watertight. Electrical service comp Page of -- 02/05 U TOTAL DYNAMIC HEAD/CAP401 Y PER MJINUTE EFFLUENT AND DEWATERING HEAD CAPACITY CURVE , MODEL 152/153 � tJ3 � MODEL I i52 cn , a UJ w Lj I Feai k tileters Go. L tars i Gol.� biters 50 _ 261 77 29t s 5 69 �—j 153 --10 i 61 2111, ,' ' 65 12 40 15 4.6 � 53 201 1 611 23 i � '97 ' i1- G b I 34 I 129 �- 1 1_9 2 30 �5 -��T-125 9.'. "L3 87 3_• /G 85—{I 1 42 r- ¢ I 40 I 1 2 2 �o I �d C 11 5 44 C Ft b 011 4 _ � Gi4508 I 10 60 SO 100 1-10 0 3`/ 0 4 20 I GALLONS / LITERS 160 240 1-20 _ 3 27/x2_-i �__�..-� 0 80 ---a—�—[ FLOW PER MINUTE 27',/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS b 3 o 3 27,32 •Timed dosing panels available. Electrical alternators,for duplex systems,are available and supplied with an alarm. I Z� •Variable level control switches are available for controlling single phase Systems. �1-� c3 ZZ' 2/7 •Double piggyback variable level float switches are available for variable �—--- - --- �o level long and short cycle controls. 23 ,� •Sealed Qwik-Box available for outdoor installations.See FM1420. Over 130°F.(54°C.)special quotation reglaired. 3 1521153 Series 1521153 MODELS Control selection R fry 5 t/8 Sim lex 1 Du lex I Model VoltsTPh Mode pmss �— 2 or 3— sx2064 N152 115 1 Non Auto 8.5 Included 1 2 or 3 BN152 115 1 — BN15 230 1 Non 4.3 1�1 BE152 230 I to 4.3 Inclosed 2 or 3 10.5 1 I 2or3 SELECTION GUIDE N153 115 1 Non 10 5 Included 2 or 3 piggyback variable level float BNi53 115 1 Auto back variable level float switch or double pi gy E153 230 1 No- n_ 5.3 1 2 or 3 1 Single P199Y E153 230 1 Auto 5.3 Included I 2 or 3 switch. Refer to FM0477. BE 53 2. See FM0712 for correct model of Electrical ARemator E-Pak. lax 3 FA 3 CAUTION . Variable level control switch 10-0225 used as a control activator,specify dup All installation of controls,protection devices and wlnng should be done by a qualified or(4)float system. licensedrece t National Electric lCode(NEC)and athe Occupational Safety and Health Act(OSHA).electrical and RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL 70: P.o.BOX 16347 Manufacturersol.. Louisville,KY 40256-0347 SHIP TO:3&g Cane Run Road n Lour K MP V 40211.1961 AIIrr/C/ �2HCf /999 Z (�2) 8-2731 FAX(502)774-3624 htt p://www.zoetl er.com (D Copyright 2000 Zoeller Co.All rights reserved. I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page.of i FILE INFORMATION SYSTEM SPECIFICATIONS I Owner (� Jtaf r <. Ls S� Septic Tank Capacity /jC�'Tc� al ❑ NA Permit# Septic Tank Manufacturer ❑NA --� DESIGN PARAMETERS Effluent Fitter Manufacturer - ❑NA Number of Bedrooms __23 ❑NA Effluent Filter Model ❑NA Number of Commercial Units Pump Tank Capacity ) al NA Estimated now(average) __:s Z7E::aaVday Pump Tank Manufacturer _ NA Design flaw(pear,(Estimated x 1.5) > alid Pump Manufacturer ❑NA Pump Model 7� ❑NA Solt Application Rate C..7 al/da /ftz P �� J Influent/Effluent Quality Monthly average' Pretreatment Unit Fats, Oil&Grease (FOG) S30 mg/. [3 Sand/Grevel Filter ❑ Peat Filter Biodhemical Oxygen Demand (BODE) - ❑ Mechanical Aeration ❑Wetland 220 mg/L ❑ Disinfection ❑Other Total Suspended Solids (TSS) s150 mg/1- Manufacturer Pretreated Effluent Quality Monthly average" Dispersal Cell(s) Biochemical Oxygen Demand (BODs) 530 mg/L ❑ In-ground(gravity) ❑ In-ground(pressurized) Total Suspended Solids (TSS) s30 mg/L ❑At-grade :'mound Fecal Conform (geometric mean) -10`Cfu/100m1 ❑ Drip4ine ❑ Other. Maximum Effluent Particle Size Y,inch diameter values typical for domestic(non-commerclaq 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 7. onths ar(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third(Y3)of tank volume Inspect dispersal cell(s) At least once every oaths ear(s) (Maximum 3 yrs.) Clean effluent filter At least once every J r the ar(s) Inspect pump,pump controls&alarm At least once every U months earls) ❑ NA Flush fatbrals and pressure test At least once every C::: ❑months s) ❑ NA Other At least once every ❑ months ❑ year(s) ❑ NA Other At least once every ❑ months ❑year(s) ❑ 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(Y,)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. ical or pressurized POWTS components, pretreattment components, and any effluent fitters m n Po The servicing of efflue P 9 other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A se rvice report rt 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 e the treatme nt process and/o r damage the dispersal cell (s). If high h concentrations are detected have the contents of the tank(s)removed by a septage servicing operator prior to use. Page of START UP AND OPERATION N. if high concentrations are detected have the contents of thi: w construction, prior to use of the POWTS check treatment to i k(s)for-the presence of painting products or other chemicals tht i For ne may impede the treatment process and/or deaomag damage dispersal cat tank(s)removed by a septage servicing op p System start up shall not occur when soil conditions are frozen at the infiltrative surface.over is restored the excess +wastewater will be During power outages pump tanks may fill above normal ding the levels. a result in the backup or surface discharge of effluent. operator Prior to restoring power to the discharged to the dispersal cell(s) in one Large dose,overloading the cells)and may erarvi the pump controls to restore normal levels To avoid this situation have Plumber to n POWTS Maintainer to assistdin by S manually op servicing ng Ope P effluent pump or contact within the pump tank. sp the area within Do not drive or park vehicles over tanks and diersal cells. Do not drive or park over, or otherwise disturb or compact, 15 feet down slope of any mound or at-grade soil absorption area. ion the fife of the POWI'' diapers; disinfectants; fat; foundation drain Reduction or elimination of butt following from the degreasers;�dental efpk)ssp diaP a an prolong painting products; antibiotics; baby wipes; cigarette gasoline; grease; herbicides; meat scraps; medications; oil; pa (sump pump) water; fruit and vegetable peelings; 9 pesticides; sanitary napkins;tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out f service the following sieprst hallbeetaken to insure that the system is propel y and safely abandoned in compliance with chapter Comm 83.33, • 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 Operator. • After um ing, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with rcuil, P p gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compli<pnt replacement system: soil absorpte on Y steam. s 13 A suitable replacement area has been evaluated and may be utilized for the location of a replacement The replacement area should be protected from lines ells dFai u ea orp protect the replacement area will result in the need setbacks from existing and proposed structure,lot with the ru1F�i in for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply effect at that time. CI A suitable replacement area is not available due to setback and/or soli limitations. Barring advances in POWTS teehno ogN a holding tank may be Installed as a last resort to replace the failed POWTS. site has not been evaluated suitable replacemennttiarea. tiff replacement o replacement area is available aPOWTS ho ding tank may be installed'as must be performed to locate Zas".d resort to replace the failed POWTS. removal of the biomat at the infiltrarlive � and at-grade soil absorption systems may be reconstructed in place following surfae, Reconstructions of such systems must comply with the rules in effect at that time «WARNING>> ENTER PUMP C, P OTHER OTHERiA REATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT,RESCUE OF x CONTAIN LETHAL GASSES ENTER A SEPTIC, PUMP OR OTHER PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name -- Name Phone > Phone j SEPTAGE SERVICING OPERATOR PUMP LOCAL REGULATORY AUTHORITY ... Name !_ Name -- Phone �' °_�� �._ t j Phone This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f)and 383.54(1),(2)&(3),Wisconsin Administrative Code. T MIDGE I S -40'". F"AT," CARI S'T"KP I city ut"Ir H&W, tw1ittdrud atsdirt.t6 Wk.Wo teak thi,wAW owl, "j,,w"t v,,ww Wlift) plprr. Ulu lrltye Ull the uuthli* mkrriy Ow ur%-imd,"ion W0,1414 t*liftavo.,aw #*tAlk ahIj WA it Ulu' "tj t-1144 jup""O#VUPWVMWW"&;UIbPOjrL If Wdu Aiwvourt jttwl, In**(WK IAJ 11;Wit ljrljtljj, Rte ingbAlaskkkow %FPl0it;vw#SupwUhmpital 4fiv "Weist WWJ did%-i**Wl rv"r utplizvw,pruft1w tu 'Solv*hk WWJ Ow Intel (Am We thk cWtihiriw into ttle Jowl)aftni ttw tilt Urirslu. fift6v 9oske liritt,tile irst 4kdu(*%t" a *Kul Mm,luiAc try Currgri�down""W"IT 011% ama*&wpwahqj to 1$144"t tile LWOC 411d 3, PLWT%P 14*6 WaPtic twok"w#pWjAWjj, I"Ukj"q Sorrd to tUrrjt1i)V dull ittvw,to"the 60"VI of Ow to"k 4"w Visit ju"tile NL;Ijwl bWVW thft VIV611,III the 044twir goatidle to qjWl%jjllo wetwwo#Mal;tke U"U. tits Sod"the VaHrWaa up4 f'the CJMU Use switl ii Wkd duakdjaj WWI Water(Icily. Usti&A74"0""44g,V4$4v UN ilia 7, While hUWkIq the tAWtVMUV C41 ts Aidw flar"a MIA 44, I-Oakiwo Mira am 81110480 1111awV111 is rwt COMBO wwt "0 uaa itita t1jo tank.. x1 8, if VR,16 wAkds b uua"d,ivphtco toy lips"*into ftot 1'.Ut*gik$O ClOt*AW&V 00". J, iks¢rt th'a tow cartHdow"ek 1414;0 tf/H tPIS 111LIEW I"-"'WNW thia hoitcoll of jjjIw cg", �)w"6*Jv dowel Owl KjObte Ond aliaLury the 4cAAWjj jtjSj*jU off qFj th Jj I ri Wisconsin Department of Commerce 1 1, SOIL EPORT Page of Division of Safety and Buildings CO � i ``�� O 'Xi 85,Wis. Adm. Code My � Li - Attach complete site plan on pa . sC Q 8 1/2 x 11 inches in size.Plan must include,but not limited to:verti zontal reference point(BM),direction and Parcel I.O. percent slope,scale or dim s,north arrow,and location and distance to nearest road. --C Y C –d_3 6; j —L'✓`L' �`� Please print all information. Reviewed by Date O -7 Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). Property Owner Property location 0ieL'�l Govt.lot �� 1/4,-� 1/4 S,9f7— T L Z N R E( W Property Owner's Mailing Adbfess Lot# I Block# Subd. or CSM# S � ". City State Zip Code Phone Number ❑City ❑Village Town Nearest Ro ew Construction Use sidential/Number of bedrooms S Code derived design flow rate GPD ❑Replacement Public or commercial-Describe: Parent material Flood Plain elevation if applicable General comments and recanrnendation�sy:1 Avl �Z System Type t7 L! System Elevation aBoring# ❑ Boring '0 Pit Ground surface elev. ft. Depth to liming factor S( in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munseh Qu.Sz. Cont.Color Gr.Sz.Sh. /1 'Eff#1 I •Eff#2 Z /5--v �— r ` z _ ,J n /S O -176 i I aBori ng# ❑ Boring %pi( Ground surface elev.ov. 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 G- -5 C s / -422- / Effluent#1 =BOD.>30<220 mg/L and TS, X30<1 'Effluent#2=BOD_<30 mg&and TSS<30 mg/L CST Name(Please Print) rini<ur CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 540 -- C 715-246-4516 Property Owner_ � Parcel ID# Page of © Boring# Boring Pit Ground surface elev. Depth to limiting factor 1�in. Soil i t, Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 I •Eff#2 I -/5— L /j 3 - - - - 1 Boring# ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. -§R-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 Boring# El Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. ❑ Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •042 Effluent#1 =BODS>30 1220 mg/L and TSS>30 1150 mgll- 'Effluent#2=BOD3 130 mg/l-and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBDD8330(R.W00) I i Property Owner CIN Parcel ID# Page --of Boring# [:] Boring U'Pit Ground surface elev.��ft. Depth to limiting factor in. Soil Application Rate Consistence Is Structure Consistence Boundary Roots GPDM Horizon Depth Dominant Color Redox Description Texture 'Eff#1 'Eff#2 in. Qu.Sz. Cont.Color Gr.Sz.Sh._ <)- Boring# Fj Boring in F-1 pit Ground surface elev. Depth to limiting factor Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM *Eff#1 *Eff#2 in. Munsell Qu.Sz. Cont,Color Gr.Sz.Sh, o Boring# Boring Ground surface eiev. ft. Depth to limiting factor in. fion Rate ❑ Pit Horizon ')epth 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 =BOD,>30<220 mg/L and TSS>30<150 mg/L Effluent#2=BOD5!30 axA and TSS!30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services Or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. S868330(RAM) Soil Test Plot Plan Project Name Oevering Homes Shaun B' Address 1433 Cernohous Ave Suite A New Richmond Wi 50417 C'S #226900 Lot 25 Subdivision Walnut Hill Farm Date /10/14 SE 1/4 SE 1/4S 22 T 28 N/11119 W Township Troy ❑ Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Foundation System Elevation 101.5' *HRpSame as Benchmark Walnut Hill Way Scale = 1 /4" = 10' 1 Acre Lot 99, 100 4% Slope B- 1101 B.M.* B-3 Pro 3 Bedroom House B-2 100.5' Property Line County ao�6 Safety and Bul'ldings Division 201 W.Wasf*VW Ave.,P.O.Box 7162 Sanitary Permit Number(m be filled in by Co.) Madison,WI 53707-7162 k PA I 6 -7q 35 StsmeTm�onNn6 tfutary Permit App �atir"►II 2 l/� g In aamra uwe wi9t 11(2),Wis.Adm.Code,submission of thus fora to the appropriate unit is required Prior a asnazy permit Note:Application farms for awned PO saw Pmjcct Address Cifd�a wr-fi�an ma�mg address)may be=W lbr the Department and Professional Service, Personal information you Prim in scoordx t the Law,s.15. 1 m Stets. S t` L n Infer w2doa—Been Print All Parcel# Property Owner's Name eoe c b2 Property Oower's Mating Property Location /q3 � LIP coot Lot l�� CiLy Stsw Zip Code Pbone Number y.,_�e ya, Scotim IL DW of BatTding(check all that apply) Sys Name err 2 Family Dwelling—Number of Bedrooms t�� ❑Pubfidcommercial—Descxbe vae ❑city of e� ❑State Owned—Describe Use t f CSM Number ❑Vi lw of -- 57 M.Type of Permb: (Check only one box on line A. Complete tine B if wpllck Ze,o e_ ?� A New System ❑Replacement System Jsm:wVWdj T R&llect Only ❑Oduer Modification to Existing System(aplam) B. ❑Permit Rearewal ❑Permit Revision of PSr Permit Transfer to New Previous Permit Number and Date Issued Before Expiration v Owner IV. " of POW TS S our neaVDevilm' t_;o ❑Nun d brGrwmd ❑pressurized b-Ground At-Grade Mound>24 im of awls and 0 Mond<24 is of )3M ❑Bolding Tank ❑0dw Disperaai CamPooeat(c0ill) Prdteatment Dev�cx(explain) act Ne!+L �Z!/ V.Dls eat Area Inf Design Flow(gpd) Design Sor7 Dispersal Area sf) Dispersal Area Sys Elevation .� VL Tank lnfo Vii° (TOW #Of M=Rthcff= NewTaoksETa� W �� 'm i a a. OCCs� r Septic or Holes Tanis Dodua C bled r VII.Res"nul iM'y Statement—I,the mderaigr ad,auame for ia:tafttioe of the POWTS slaws ea the attached plea:. s Name(Print) Plamber's S' MP/1vIPRS Number Business Pbcm Number Plumber's Address(sweet,Ca,V3 � State,Zv Cam) �. own earl Use Fee Dame I suinS A66A Signature ❑ m for Denial 13L Co asioins for Disapproval 1 `optic tank,efihfatitt�feritittf .�) ;tlisptrsal cell-must all be sere cc s%'ltiaittitairted _�ti.Jv l.�J ✓���`" ✓`c�" cSt / r0 as per management plan provided byplurn_d f. 2. _i1�lernenta iceI n Atlaeh tb a picas forer a syaem and,, the Cosmq G*ea PaPw act lees am a to x 11 isel"is She V SBD.6398(8.11/11) 0N R r o� DIVISION OF INDUSTRY SERVICES �o 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 Contact Through Relay Gw www.dsps.wi.gov/sb/ ti www.wisconsin.gov Scott Walker,Governor Dave Ross,Secretary August 12,2014 ^- CUST ID No. 226900 ATTN. POWTSInspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES. OSJ12J2016 Identification Numbers Transaction ID No.2442684 SITE: Site ID No. 804694 Oevering Homes Please refer to both idea fteafi©rt n m{ rs, 258 Walnut Hill Way above,in all conUI Pondence with;the Town of Troy St Croix County SE1/4, SETA, S22,T28N,R19W FOR: Description:Mound Object Type:POWTS Component Manual Regulated Object ID No.: 1496700 Maintenance required; 450 GPD Flow rate; 25 in Soil minimum depth to limiting factor from original grade; System(s):Mound Component Manual-Ver. 2.0, SBD-10691-P(N.01/01,R. 10/12),Pressure Distribution Component Manual -Ver. 2.0, SBD-10706-P(N.01/01,R. I0/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.The owner,as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved IRD a"Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P �n64f)and the"Pressure Distribution Component Manual for Private Onsite Wastewater Treaspfsot�m�"BE N 2.0" SBD-10706-P(N.01/01,R 10/12). 'AFT DIVISioN oSSlom-,.L• The building sewer and distribution network piping shall be of material listed in Table 3F4� 384.30-5, Wis. Adm. Code. In the event this soil absorption system or any of its component parts m o create a health hazard, the property owner must follow the contingency plan as described in the approve addition,the owner must comply with the operation,maintenance and monitoring duties as described in section VIII of the mound component manual. A copy of this information must be given to the owner upon completion of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). SHAUN R BIRD Page 2 8/12/2014 Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county-where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4)shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. I A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installatior,/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sin c Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2,Integrated Services Payment Submittal. (262)397-6005, Fax: (608)283-7481 'WiSI' 1AX" 'I'-'1633, julia.lewis@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with SPS to recognize the relocation of the Division of Industry Services from the former Department of Cotmnerce to the Deparixnent of Safety&Professional Services. Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300" series. For future reference,the Wisconsin Commercial Buildin g Code will be addressed by SPS Chapters 360-366. Cover Page RECE/VED g JUL 2 5 _ 2014 IND US TRY SERVICES Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 7/21/14 Owner:Oevering Homes Location:SE1/4 SE1/4 S22 T28 N,R19258 Walnut Hill Way Troy Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil test 12. Filter Specifications and cros ection Shaun Bird Signature ' '�FS License number 226 C,,. Vs 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 7/21/14 BEDROOM 3 CONVENTIONAL IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none 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 All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 103.0' of tank,piping shall be Schedule 40. Walnut Hill Way 100' 9% Slope 101 ' 1 Acre Lot 102' 103, Scale = 1 /4" =10' B- 1 104' B•M•* Tank is to be properly bedded and provided B-2 with lockdown p covers with approved warning labels Huffcutt Pro 3 Combo Tank Bedroom B-3 House Area 15' Well is to meet all below system Grading is to be done to WDNR setbacks is to remain divert run-off away from undisturbed system Property Line Mound System Cross e'dion and Plan View lliwensien Feet tt' x:. A B D l t�' T - t A E +� W F `i G t r=• I e I r . I J Y?' y K : m ti-&1 " r•'iT°YrP'.�r- Gin=wi•'WiYN`y�'Ki' +' '!J .••6• «,'- ` -GWYIW-'YifY• "+i`r' i•-aiirrrtiYr'^'iw- +'iYyrrtI W K —B 1 Z L Slope Topsoil =ASTM C-33 =Clean aggregate 4 in. sch. 40 pvc :.: Cap Material sand fill 1/z to 2 %s in. dia. 0 observation pipe Geotextile Kp H Fabric G F J _ D a E Ft Contour Plowed Surface Slope-Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area(L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a '/4 inch soil wire when a sample is rolled between the palms of the lianas. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one. foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 0 10/071gj Page of Pressure Lateral Layout Two Laterals — End Manifold Threaded Cleanout Lateral Turn-up Plug Manifold M X --� i L Long Force Main ` Sweep 0 p Bend Distribution Network Specifications '� Pressure System Construction Lateral Diameter Z In. Manifold Diameter . In. Laterals are constructed of Schedule 40 PVC Orifice Diameter In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) In. the pipe with a sharp drill bit and face down. L (Lateral L Ft. Lateral turn-ups terminate with a threaded M old Len Ft. cleanout plug and are enclosed in a 6-8 inch Force Main Diameter In. diameter lawn sprinkler valve box accessible Force Main LenSt from finished grade. • • Grade • • • • • • :� �: • • • • • • • 6-8 Inch Lawn Sprinkler Valve Box Page of 03/051gj i f Sepoc4Dose Tank Cross Section And Pump Perfonmwe Specifications Tank Maau$actu[er P=P ManuSi____Cttit+er i Tank Model Number 1 otnp too Mudd Number .5 0 TOW TankCapacity Aha M u'�' �e Msuc.Bury Drepth t Alaam Mudd Ntmal i— i Sw�ah'I�+pe FiYber M Af Trial Head(TDH)-Feat Filter modd Nvmbea F.Jsvaatiost Held C7 Disw Pmm" 3. - Netaoeh Lwrt M Puma p Olt luimd Fame Maio LAW C3 Pt MH Total IS' OWA M=hOIo 4"Above Grade With hJubala Min.4"Above Cnade Locb*Dvd* Inlet MObtd+e Moussrd 'W� Device <6"Ba 0w&4mb so"Wmwd& . runctioin Hcoc ra�. . ANN* �' r s'ai�►os amda vat Mme. i2" Diacotmect A� W t1h vat Cap bag•• � •aR wwwww :w ..w f• A. f swig and Ramarve w«P Tank V e J OPI B Hole Dimon I Iavi+ea I Volume Gal. ..• .. B'! 2. 3v � C • alsrm �• ,.5� Ft 7..i ;; '• BO J- Elevation (desk) DI Ft Total RW G 'TION: The. � .tom is bedded and * not f ue+er's Pte' GIs oc ,mph to grade 1m am laoidaf device(padlock) be e�rreeded without L o6mmomed tQ die tmik WM w "286,and itettd�• p*g at to itdet and outlet u of nip w*a&fit V wC%ww"the tank laid oe ebdde aa�1 t ° > C300 rind Cosmn 16.2x. sow nandtLO.a{�eii�e.it . +me�tt •:P .e ► p --°f 01105 11 �►��� .•�. 4/10 hp Submersible Effluent Pump, 3/4" Solids 20 6 �. ���i , 0 40 60 80 sw Ur SP I n rtu�� T av (� Franklin lalwatric 11 , Strfft�Btuffl:M IN 46714 260.824.2900 11 260.8241909 1 Form 9M99 7-11 POVVTSOWNeR'S mANu1AL&mAmAGeMeNT PLAN Page— a FICA War Ownr 0�, J To*Cw"m 4► c3 ru�r - TW* MA Pam�. F 'F°r o MA aan SWAW O€ ` ;°: Pump TtnlcY — SO Q Ntf1 pupnR'tae�ic N MA -t. Ow A; . w0whow 'POI Q M A ------ x ©: C3 P FMW BkdvW"O J DftvnWd f3 E11tier: 'row suqwAw SWS Olt" Q Q�har: ftsede Sipe K MCht wrw. *�"td psi At e + (3 WOO-6) ►3 ) L - 1 03 AElwawd ate► -9 E3 nwwh%7t48wW At-ie. WWOM r l 1 f� ;�f rt&3 000100i aw ac►a+v i Atfna s; �3 NA �a ad p east At hrwE en*MY At fist and sn�cT G © j fl At fr�srrt ae o M 7611 Mf *nTRi+icT�E O ona cf fha tvYwwi� cx s of fw" � *go ba m o by an� p, 8, OF wow Ts c in�wpe s s s�dwrr oe4 rat fba j$rft#.I%idw*& i •I �fMl� !► Cw No". ft WbA r of t pi�ad ait+dpe own= cl c#�x !1 baAlc.uP a taF a#irnt a►# sue. TAI,aiwP ? iws v1�+wly► ° sbi famtkNas j*ibw►d am to cfwe�4c kw� ���' � °��+e .MW wdwcaw a 9�aid flia As of fl+s bc�wi f►bW^d "MI*A COMMrAdsommuMion of shod"old scum in aAgf Wk 414 jk OA04 nd(4)or at f aavAlh L of i► with d� tuft slom ao at ih+two sf+a#he +e<no�b�►:sv �:�� , aNx�� 11 ,1iYia ►Ads Code.,. and MY The s of eft sum. or P����PMU'a er�er�r��a or�e of,12 mr b.m dW be Pa 'd a woo PU M!'S! A setvk*fapcet shad be proMidecf fo fhs focal croey s wa in loft"cif servias STAW"UP J1NQ OPStATM For naw onlwcthn.Pk to use of"POWTS ahsdc k d` of° w sm �lhat per► Ow Waft Awt A saM odEsl 1f dalacled hs�re the of tM t t$3 nmxr ed by a s+f ��O �"use. pop of ode ftR START UP AND OPERATION (*}for," �o of thO For new aorrstruc*n, Prior'to use aF the pOWTS c3�edc andbr damage� rya). If high Macy Impede the treeltment operator PfW to use. tank(*)wnoved by s sePt"s are frozen at the Infili stive surface• System start up shall not omw when edl conditions will is restored the sure** During Power outs�pss pump tanks may flit above rwrmal hlghwateT thvela. in fdn backup ur surb"dMcfiarge of&Musa• dis&dwpd to the dispersal osM(s)fn a y �ybs°Sepvps Servk 9 pp r pAor to R�r GIs 9 sm��P fact a Plumber POWTS S r to asdst In menUf ►WKS"ow p'� °0 °N to "O�Ofe normal within to pump tank OW,0 p$tetwlae dMW'b or WMP"the area Within Do not drive or park vst**O over tanks and dispert<al eat. Do not drive or Park 15 feet down stops Of sty mound or atjrade 8011 OMPW ares" *rid Ixo1mv the we of tm POWT:5: Reduction a eNmMatbn of the foNowktO iron the�stl'etbtt MGY kn ; dMN�fiabsnls; K foundtrtlon dngn • baby wipes: dger� haft Dorton*, codon rN g d hwblcides: mast *WV6; rnedic0ons; ON; Pa ap ptOd ' (sump pump) wafer; fruit and vapata A sof; 9&WWW , pesticides;sanitary napkirw:tarnPWW and waW ABANDt NT taken ouk of service the fotlawlna steps shall be taken to IrWre that the optem is ploRO� When the PCy1NT3 fails artdlor is Pem►ensntlY Comm 83.33,Wisconsin Mff* Cads. and safety abandoned In wnpbnoe writ'd,. • Ail piping to tanks and pits"be disoonnec:ted and the abandoned pipe oW*W good. • The contents of all tanks and pits shay be rernovad and property dls"W of by a Opsrabar • After pumping, all t.nlrs and pits shatN be sacsvated and removed or their Covers removed and the vokt space tiled with 8cpii, gravel or a v*w Inert soNd material. CONTINGENCY PLAN have been. or must be taken, to provide a Code ooM00"t If the POWTS fags and cannot be roPeired replacement system: p A suriabio repMoemerrt area tuts been vvaWaNad ands �for � at>cxatd ��wdau rogaai�ed The ropiaoernent era, should be ,lot Nees and wells. Feaure to PE'oW the rspbownent aim wN re"in the naiad seWar ks from a Wft and W 4"Wownwd syatarns must cam*with the ruleO in for a now soil and a"avakaaticn to egW*sh a aWb bM replacement effect at that tftne. t7 A sultabM t tIMceanent area b not avaltabie cue to satba&erWor sol 0mitstions. 8amng adwmm bt POWTS lschrtologM E hokgN tank r�be Metalled as a Met resort to mph"the faked POINT8. has not been eveluatad to Identiy a sultLtbta rrlpMCatrtent wee. Upon f&jm cf 8W POWTS a swN and ells availed a must be performed to locsate a suibble repMosr+aant area. if no replacement area id ava lebie a hokWV tank may be inetallsdl au a test resort to replace the failed POWTS. �lOI i� wid st-grede soli on system* may be reconstructed it a tdtowinq rarnoval of the bforrwt at the itttiltrativ� surface. RecOnShm"m Of KmM syOr"s must c:omPly with tM rules In~at that thne• caWARNINGa> R 0MFFICNENT OXYGEW DO SEPTIC,PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL.GAS=AND/O ENTER A SEPTIC,PUMP OR OTHER TREAT "TNT TANK UNDER ANY o f ANA• DEATH MAY RESULT. talMSCUE O PERSON FROM THE INTERIOR OF A TANK MAY W q .T OR} iBLL ADDITIONAL COMMENTB POWTS INSTALLER POWTB MAINTAINER Name Name C/ Phone j EFTA"SERVICING OPERATOR PU LOCAL'REGULATORY EE Name l Phone �I= �f Phone /J = O This downset was dWW in ow0encs with ahepbr 8P8 3e3.22(2xbx1)O)"end 383'W'),(2)16{3),MMmrusM ►� UlProperty Oymer et 10 ! f Z s Z ar 3 I Ground surface etev. Depth to dmltirig factor ` ins S S Horizon Depth Dominant Redax Sort Rate D t Texture Structure Consistence Boundary Roots GPDW in. Description Qu.Sz. Corti.Color Gr-Sz.Sh. °Ea ��y s A4 f cs S CZ O Tf C G i►ri e�, D U 1 1 1F] Bonrg!# Boring Q pit Ground surface elev. tt. Depth to biting factor �. tionzon SON icallon Rate Depth Dorrinant RedoxDescriptioon Texture Structure Consistence Boundary Roots GPO ire. MtwMen tau.Sz. Cont Color EaY.Sz.Sh. `EWI .� Bonne# ❑ � Pit Ground surface elev. fi. ' factor IM Depth Dorran�ant Redox Description- Texture � Rate Consistence Boundary Roots - MrsrseR Qu.Sz. Cont Color Q.r.Sz.Sh. °EM1 °Elf#2 a s F-I S-dng# Boring pit Ground surface elev. fl. Depth to +9 factor &t. Sort Rate HOMM Depth Dornina tt Color Redox Descri - Texttme Structure Consistence Boundary Roots GPDlte in. Munse% Qu.Sz Corti C06W Gr.Sz Sh. °E4f#1 'Eif#2 Efifuwd#1=Buts>30<220 melt and TSS>30<150 rngll °Effluent#2=BM,:S 30 mg&and TSS<30 mWL The Department of Commerce is an squat opportunity service provider and employer. If you need assistance to access services or treed material in an alternate€ormal, please contact the department at 608-266-3151 or TTY 608-264-8777. seo.eata tRC,not Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance with Comm 85.Wis. Adm. Cade qty 5711. C-AOM- Aftach°��s EROSION CONTROL PLAN must be Parcell.D. 407— 090 --1 �^ p®rc entslope.sc completed before sanitary permit issuance 1' P D!A Cr-r b eviewed Date Personal kNortnabon you f may be used for secondary purposes(Privacy Law.s.15.04(1)(m)). ryj U4-xt� Property Owner TOA9 Property Location Q Q 17� B3 EI�T-e7D C/d Govt.Lot 19I I Dyi4 5 1/4 S L T�v N R /! lr(a)W Property Owners Mai mg Address , Lot# I Block# I Subd.Name or CSM# la a 15 CA IV LL AV-p- • 25 Cvm/vv r w i I FA-Rif -CMWR State Zip Code Phone Number ❑city ❑Village 1:@ Town Nearest Road 6.006 H P; MN 5S07(* ( &51) iq r- to9� T-Roy so. 610068 g New cormuction use M Resider w/Nurnw of bedrooms 3 Code derived design flow rate Da GPD ❑Replacement ❑ Public or commercial-Describe• Parent material /o kSS ov,,�-Vi DP�Se- 71-175— Flood Plain eievatic�if •v General comments 17 and recommendations: • `/¢ TES T�� ��9V%c��'S 4 Mo V Ti o ig L 100 VWP YS 77. ❑ D• yD -S•SS•• �' F7] aorirlg# ® Pit Ground surfaos elev. /y .ft. Depth to rin>MV factor Z � - M. Rate I Soil Application Horizon Depth Dornmarit Color Redox Description Texture Structure ConsWence Boundary Roots GPDW b fn. Munsell Qu.Sz. Cont Color Gr.Sz.Sh. 'Efr#1 'EM! L. I S � 2 S K Cw / 5 D czdt MO 7-5 L e fr 0 - � # ❑ Boriry rDy z s.ss • . ® Pit Ground surface elev. ft. Depth to limlft factor at. Sol Application Rate Horizon Depth Dominant Color Redgx Description Texture Structure Consistence Boundary Roots GPD/fF 11►t In. Munsell Qu.Sz. Cont color Gr.Sz.Sh. `011#1 '042 IN d- /o /e 2-1 / s ,� fe w 3 y �, z io f /?3 L s /ki le c s N 3 25 �o C-51- s 75 C-240- Mori CZ- Eftiuertt#1=BOD >30<220 mq&and TSS>30 1150 mglL `Effluent 42=BOD <30 mgAwW TSS<30 MR- CST Name(Please PrirR) •^u 1 G�� Signatwe Z2�5 Address Ulbricht &Assgciates Evaluation e Privat � 7f• �73 y Z 812 1 Oth Ave. Spring Valley, WI 54767 • rya �o�s • s� • oyo - io�� • �o • can dyp • /��G • ZD • aaa oyo • 'Vo o yo • io 066 - 70 0M ?OD7 31 E e>S TFD7`aJ4GN U 7— h111 �iPM ProtOr(y �� Z-0 f Z 5' Z. 3 # ❑ 1OMV Page of R Ground surface etev._ft. Depth to Nmtting factor ____- in. 140riZOn Dominant Redox Gesaiption t `SO Rate in. MunseN strums Consistence Boundary Roots GPM Qu.Sz Cont.Color Gr.Sz.5h. �' s �-6? w 34- s �S' /!�y S Yle C P Tr CG �wr e�, o o ,o F8onng# C1 Bating Q Pit Ground surface elev. !t: Depth to fimiting factor in. _ Horizon Depth Dominant So1C ir�bon Bate Redax Description Texture Strurxur$ Corrsisterx�e Bottr►dary ftrx�is GPD ff in. 142t{nsett Qu.Sz. Coat.Color Gr..Sz.Sh. ' fW Ong# [] Ing Pit GrOUri surface elev. f. Depth limi'ti ng factor #n,t t�orizOn Depot dominant Cofer Redox Description_ Texture a SL+i< PRle Consistence Boundary Roots GMunseif Qu.Sz. Cont.Color Cr S Sh. ll ng El Pit Ground surface elev. ft. Depth to limiting factor fn. Scx7 lion Rate' Horizon Depth Dorrtlrtant Co(or Redox Descdpti . Texture Shucture Consistence DOMK ary Roots 2PDfr3P In. Munsell Qu.Sz Cont.q6w Gr,Sz.Sh. 'El1#1 °f ffi12 °Effluent#f=BOD$>30 s 220 mgtL and TSS>30<150 n3glL °Efltuerd 92=800s:s 30 mg&and TSS<30 mgli- "If he Department ofCornmerce is an egttai opportunity service provider and employer. if you treed assistance to access services Or treed material in an alternate format, please contact the department at 608-266-3151 or TTY 609-264-8777. S9Ud370 frtf�+t60I r ter. S PLOT PLAN WALNUT HILLS FARM. LOT # �/ Pg. 3 of 3 0 = Contour elevation lines. o = Backhoe Soil pits. O = Benchmarks set, maRRED WITH FLAGGED lathes. 1/2" steel conduit pipes. SCALE: Jh- zi a o ds � O ti O Q) P ►�' • -• at� r G b o' w v' g♦�� 1 kA v P w 0 �- N� F CARTRIDGE ILTER INSTRUCTIONS s;r" S TM Installation = STEP Z Dry fit the filter case onto the end of the outlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet P I pipe. STEP 2 While the case is still dry fitted on the outlet pipe, measure the length 3 - utilizing of /a inch pipe needed to brace the filter to the tank end wall if ut g the optional supplemental s id e support. If side support method is not utilized, proceed to step four. STEP 3 For installations utilizing the optional supplemental side support: solvent weld the 3k-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. STEP 4 Solvent weld the filter case onto the outlet pipe. Insert the filter -, cartridge into the case, pressing down until the filter locks into the bottom of the case. r STEP 5 If a VRS switch is utilized: insert into the filter and lock by turning clockwise 900. r .. aao;,ret .° rya r Maintenance 1. The effluent filter should be cleaned every time the septic tank is serviced. i2v h 2. Open the outlet access opening to inspect the tank and filter. ` 3. Pump the septic tank completely, making sure to remove the sludge " layer on the bottom of the tank and not just the scum and effluent. 4. Once the effluent level has been lowered below the invert of they outlet pipe,firmly pull up on the filter handle to dislodge the cartridge from the case. { 5. Slide the cartridge up and out of the case for cleaning. , 6. If a VRS switch connected to an alarm is present,the switch should be removed by turning counterclockwise 900 and cleaned with water only. rt 7. While holding the caridge on its side (large flat surface facing down) over the access opening, rinse off the cartridge with water ` only, making sure all septage material is rinsed back into the tank. .; q � S. If VRS switch is utilized, replace by inserting into filter and turning clockwise 900. 9. Insert the filter cartridge back into the case, pressing down until " fit• the filter locks into the bottom of the case. 10.Replace and secure the access opening on the tank. BEAR ONSITE^"FILTER CARTRIDGE-FIVE-YEAR LIMITED WARRANTY Bear Onsite filter cartridges are warranted to be free of defects in material and workmanship for five(5)years from the date of consumer purchase. BEAR ONSITE-Filter Case-Lifetime Limited Warranty Bear Onsite warrants the filter case will be free of defects in material and workmanship during normal use for the period of time the original purchaser owns the product If a defect is found in normal use,Bear Onsite will,at its election,repair,provide a replacement part or product,or make appropriate adjustment. Damage to a product caused by accident,misuse,or abuse is not covered by this warranty.Improper care or malfunctions resulting from units not installed,operated,or maintained in accordance with instructions provided will void the warranty.Proof of purchase(original sales receipt)must be provided to Bear Onsite with all warranty claims.Bear Onsite is not responsible for labor charges,removal charges,installation,or other incidental or consequential costs. In no event shall the liability of Bear Onsite exceed the purchase price of the product e6adlrmv� �)e-co 4 i ST.CROIK COUNTY `* SEPTIC TANK MAINTENANCE AGREEAflW AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Mailing Address J , Property.Address r (Verification required from Planning&Zoning Department f uur City/State Parcel Identification Number LSE _GAL DESCRIPTION —` Property Location �5'r 1lq, K,Sec. 2 Z , _N R W,T.W.of Subdivision Lot# . Certified Survey Map# - _ , 'Volume , page# �! Warranty Deed# 1 ,Volume page# � Spec house no Lot lines idetttiftabk ES no sY�M 1�AIlVTENAhTCE �► OWNER C + TIFICATION II 11411per use and maintenance of your septic system could result in its maintenance consists of pumping out the septic tank every tbrae Pie failure to handle wastes, Proper the sydem.can affect the function of the tic years of ,if needed,by a licensed puuuper. What you put into responsibilities are P tank as a treatment stage in the:waste disposal system. Owner mace specified in§Comas.83.52(1)and in Chapter 12-St.Croix County Saul tart'Ordinauice. Thep%party owner agrees to submit to St Croix County p1ag&yob owner and by a master plumber,journeyman to restricted g Departuu�ent a ceulification forn,signed by the wastewater al plumber or a licensed pumper less than 1/3 full of s�e�. is in proper operating condition and/or(2)after inspection and pun�nv'g(if gnee necessary),the septic tank is I/we,the undersigned have read the above to u' standards sat forth,herein,as set by the 9 u'ements and agree to matntauu the private sewage disposal system with the Certification stating that your tic s tem�of Coerce and the Deparanaut ofNateaal Resources,� .Ys maintained must be feted and Stage of Wisconsin. Zoning ant within 30 days of the three CO's' retumod to the St.CaoEt County planning& year expiration date. Uwe certify that all statements on this fo ` are true to the beat of my/our knowledge. Uwe am/are the owner(s)of the Property described above,by virtue of a deed recorded in Register of Deeds Office. Number of bedroom IGNA F.APPLICANT(§) / ...Any informat m that is panted may result in the sanitary permit being revoked by the Planning&Zoning Department. *** Include with Buis 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.08Jb5) ii i 8248919 Tx:4203451 STATE BAR OF WISCONSIN FORM 3-2000 999810 Document Number QUIT CLAIM DEED BETH PABST REGISTER OF DEEDS THIS DEED,made between Citizens State Bank,a Wisconsin Corporation, ST. CROIX CO., WI Grantor,and Oevering Homes,LLC,a Limited Liability Company;Grantee. 08/08/2014 10:31 AM Grantor quit claims to Grantee the following described real estate in St. EXEMPT#: NA Croix County,State of Wisconsin(the"Property"): REC FEE: 30.00 TRANS FEE: 57.60 Notwithstanding anything to the contrary set forth in this agreement buyer is PAGES• 2 relying solely on buyer's inspection of the property and buyer acknowledges and agrees that the property is being sold"as is with all faults" and seller makes no representations, warranties or covenants,express or implied with respect to the property. To the fullest extent permitted by law, seller expressly disclaims any and all implied warranties, representations or covenants with respect to property. Recording Area SEE ATTACHED EXHIBIT A Name and Return Address: . Title One File#: 20924 Together with all appurtenant rights,title and interests. 040-1303-00-025 a Parcel Identification Number(PIN) This is not homestead property. Dated this 6th day of August,2014. Citizens State Bank *Shawn Tyler, ice President for Citizens State Bank * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST CROIX COUNTY. )ss. authenticated this 6th day of August,2014 Personally came before me this 6th day of August,2014 the above named Shawn Tyler to me known to be the * ,.••'� rsct(s) who ez the foregoing instrument and cci .... TITLE:MEMBER STATE BAR OF WISCONSIN ?a '.•.ac �ededged s ' (If not, NOTARY•M,�..._ authorized by§ 706.06,Wis. Stats.) PU •C tt THIS INSTRUMENT WAS DRAFTED BY •�•�'q'' P�l 'Public,Stat Wiscons• j ''�•Ivly'commission• (If not,state expiration date: ; Michael H Forecki,Attorney 7/1/2017 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature j I i QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No.3-2000 St. Croix County 999810 Page 1.of 2 PO4Z EXHIBIT A Lot f Walnut Hill Farm,Town of Troy,St Croix County,Wisconsin. i St.Croix County 999810 Page 2 of 2 40 sl NM f. J f�. f 06,33.�p" w57 "T h � Of r c /. rhni cv a ° J oil + 1 � . a r f` + 1 tit 40 N w m, �I : so 1 . � •Hi N �) � v' a 1 ter . + � , 1 ,, ca .53 �- �. .: r ,' 1 t c 901 : VIM 1N m i z I a z � X11 � 4 7 d _