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HomeMy WebLinkAbout040-1306-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 572841 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: He en, Benjamin &Angela Troy, Town of 040-1306-10-000 CST BM Elev: Insp.BM Elev: BM Descriptio Section/Town/Range/Map No, /02.09 -- / C-57 06.19 837 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. r Septic /,a Benchmark i ZD ?) d la�A S u Alt. BM S.6 p6 1 dlz 5 z� t:,, ( oa / Aeration Bldg.Sewer Holding St/Ht Inlet ( 4C/.0/`? TANK SETBACK INFORMATION St/Ht outlet �••7 �, 3� TANKTO P/t WELL BLDG. Qenljo Airitaakke ROAD DtInlet Septic > cJ0 r / Dt Bottom zz7 S"4 —� Dosing Header/Man. Aeration Dist. Pipe f 39 Q Holding Bot. System T . -2 77. ?Q! Final Grades�� (7 `7 PUMP/SIPHON INFORMATION t7•� �, 3. O 163- 59 Manufacturer Demand St Cover t 3 �L 12. Model GPM ��t' 7 Model Number TDH Friction Loss System Head TDH Ft Forcemain ist.to Well SOIL ABSORPTION PYS TEM BEDITRENCH Width Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 9d Vo Z I Gam- SETBACK SYSTEM TO P/L JBLDG IWELL LAKE/STREAM LEACHING Manufacturer: �+ , INFORMATION CHA T 1 Type Of System: 5 CHAMBER OR Model Num er: Ge.�wtvt '.�ov%a�. 5-7 2 DISTRIBUTION SYSTEM p Header/Manifold / it Distribution x Hole Size x Hole Spacing Vent to Air Intake Length �� `5 Dia Length. Dia ��Spacing�� ` ��� .b SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 3 .'� Bed/Trench Edges ` Topsoil ��0 No r: Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: Location: 414 Jordyn Lane Hudson,WI 54016(SW 1/4 NE 1/4 8 T28N R1 9W) Sunset View Lot 10 Parcel No: 08.26.19.1837 1.)Alt BM Description= �G�-t t GO V�� �p,•t� 1 a C a v� 2. Bldg sewer length -amount of cover= ab /( N "A.dt Plan revision Required? ❑ Yes KNo Use other side for additional information. l `L� Date Insepctor' Signatu Cert.No. SBD-6710(R.3/97) e t,rJ 1 i r 1 i l� s � r � C4 r r r �b L2 is Al i Safety and Build' ivision County I commie 201 W.Washington Ave.,P. . ■ " Madison WI 53707-7162 Sanitary permit Number(to be i'tlled in by Co.} �scon�4� . 5 -7z State Transaction A(umber Sa��' rpP cation In accordance with s. rs, dm Code,submission of this form to the appropriate goverornentei unit is required prior to attaining a sanitary permit. Note: Application forms for state-owned POWTS arc Project Address(i£different draft mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary u ores in accordance with the Privacy Law s.15.04 1 in Stars. 1. Application Information--Please Print All Inforeetation Parcel p Property Owner's Name Pr operty Location / /�3 7 Property Owner's Mailinit;Addtt:ss C , Q 1 ti!1` aovt.lnt City,State Zip Coda Phone Number y., '/,, Section "Q (circle one s-`r Pe.u/ yl?,u 11.Type of Building(check all that apply) Lot d 5alxiivisioa Name 1 or 2 Family Dwelling--Number of Bedrooms /� r C_I Public/Commercial-Describe Use D City CSM Number ❑Village of State Owned-Describe Use, ..Town of ill.Type of Permit: (Check OlkN one box on line A. Complete liue B if applicable) zo X A. w System C7 Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing Systtxn(explain) it_ {]Permit Renewal ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New list Previoua Permit Namher and Date leaned Before Expiration weer 4r IV.T ypeofP0WTS§ystemfCoM oneut/Dtwicec Check all that a 1 Non-Pressurized In-Ground ❑Pressurized In-Ground ❑ At-grade ❑Mound>24 in.of suitable soil Mound<24 in.of suitable aol Holding Tank El Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersal/Tren ent Area Information: Dispersal Area Required(s Diapt rsai Area Pro sf) System Elevation Design Flow(gpd) Design Soil Application Rat gpdei) peJ /G7 2 •� G Total #of Manufacturer ' Vl, 5-10 Info-- Capacity in ° Gallons Gallons Units /n/ p � U New Tanks t-xisdng Tanks (/ / L 7L + Septic or Holding Tank Dosing Chamlter V11,Responsibility Statement-1,the undrirslgned,assplme reR essibility for 6istatiation of the POWTS shower on the attached plans. V11.Res Name iii(Print) Plumber's Signature MP/MPRS Number Brumes;Phone Number Plumber's Address(Street,City,State,Zip Codee)/� VI1 oun /De artmeat Use Only issuing A t Signature Permit Fee Date 1 ed g grab' p $ for Denial a X,Cond"IlISTE140NMeasons for Disapproval �n N 1 1.' Sepc tank,effluent filter and 3) dispersal cell must all be servlees/maintained at per management plan provided by plumber. • 2 i9seack requil'ern4nts must in0irixaiFt� ,�- 84 / ✓� --- G N1 -----'--'- Attach to cempinte Plant for the system and enbmN to the only only on Paper trot teee than It ra x 11 lochs to size SBD-6399(R.02/09) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name:Owner's Name:Name: lcca- rW Owner's Address: 2/ r/ Legal Description: Township: ova County: �7'�C Kei s V Subdivision Name: Lot Number: /6 Parcel ID Number: OYD - %f4ele ` el 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-o at Attachment . Soli Test& House Plans Designer/Plumber: _/ /'j�a „c Sou Mi-I�e��-- License Number: 2R Z l q Date: S-/ Phone Number -;;!/-,577--3 eA Signature Designed pursuant to the In-Ground Soil Absorption Component Manua!for POWTS Version 2.0 SSD-10705-P(N.01 101). Page 1 e,rJJ f�.(J tea. a L��10 Sw • e o u 7-reo, _. 1 1 ► 1 r y. � ba r c \� r F 1 d ► 1 r 1 49e>,- 4 Soil Absorption System Cross Section in2, 36 J&r BY ft Final Grade 4"Schedule 40 PVC Vent Pipe 1 With Vent Cap /64 '4�-q ft Leaching fq= /G Chamber a 2_ �. ft ~ System Elevation _ft S ft Soil Absomtion System Plan View g8 . ft a Leaching Trench 1 ft Vent Or Observation Pipe Chambers 4"Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model_ A� (/D,:._6 4 �j-j EISA Rating d96 sq ft per chamber Soil Application Rate l 1� _gpd/sq ft 11"I'6O gpd Design Flow+ +Z Application Rate + ,20 EISA= Chambers 2 rows of chambers each. Page of RECEIVED 2374 OCT N 1 4 SOIL EVALUATION REPORT Page 1 of 3 Wisconsin Department of CommereST.CROIX COUNTY ` in accordance with Comm 85,Wis.Adm.Code A.C.E.Soil&Site Evaluations {�rI4RMEN`i'y County "Attach complete site plan on paper not less than 8'/x 11 inches in size. Pla St.Croix include,but not limited to:vertical and horizontal reference point(BM),directio Parcel I.D. percent slope,scale or dimemsions,north arrow,and location and distance ti: 040-1306-10-000 Please print all information. Reviewed By Date _ Personal information you provide may be used for secondary purposes(Privacy Law,s. Property Ownei Property Location B&L Land Development,LLC Govt.Lot SW 1/4 NE 114 S 8 T 28 N R 19 W Property Owner's Mailing Address Lot# Block# Subd.Name or CSM# 7925 Arnold Town Road 10 na Sunset View City State Zip Code Phone Number City Village ✓' Town Nearest Road 40214 Troy I Dylan Cr. e New Constructior Use: ✓ Residential/Number of bedrooms 4 Code derived de/sign flow rate 600 GPD Replacement Public or commercial-Describe: vt Parent material Glacial Outwash Flood plain elevation,if applicable na General commente and recommendations: Soils suitable for cony. dispersal cell at 0.7 gpd. Recommended linfiltrative surface elev's to be 36"-60"below grade at elev. =98.5'. /'• S ' Yh ��; �vrlwj� wr•�, a ring# Boring ✓% Pit Ground Surface elev 102.36 ft. Depth to limiting factor >112" in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots *Ef GPD/fN in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh 1 0-6 1Oyr3/2 none sil 2fsbk ds as 2vf,fm 0.6 0.8 2 6-12 10y3/3 none sil 2msbk dsh cw 1vf,fm 0.6 0.8 3 12-17 1Oyr414 none sil 2msbk dsh aw 1vf,fm 0.6 0.8 4 17-26 1Oyr4/6 none gr sl 2csbk ds aw 1vf 0.6 1.0 5 26-32 7.5yr4/6 none gr Is Osg dl gs lvf 0.7 1.6 6 32-112 1Oyr5/4 none s Osg dl - - 0.7 1.6 1� y qL 2]Boring# Boring If��Q• ✓% Pit Ground Surface elev 105.89 ft. >117" in. Soil Application Rat Depth to limiting factor APP Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh I *Eff#1 *Eff#2 1 0-8 1Oyr3/2 none sil 2fsbk mvfr as 2vf,fm 0.6 0.8 2 8-17 1Oyr4/4 none sil 2msbk mfr cw 1vf,fm 0.6 0.8 3 17-20 1 Oyr4/6 none gr sl 2msbk mvfr aw lvf,f 0.5 1.0 4 20-23 7.5yr416 none gr Is Osg ds cw 1vf 0.7 1.6 5 23-60 1 Oyr5/4 none s&gr Osg dl cw - 0.7 1.6 6 60-117 1Oyr5/4 none s 0sg / dl - - 0.7 1.6 ��2• I *Effluent#1 =BOD 30<220 mg/L an TSS>30<1 mg ent#2=BOD6<30 mg/L and TSS<.20 mg, CST Name(Please Print) natur . CST Number James K.Thompson 4N2 '3°0'7'1 Address A.C.E.Soil&Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane,Osceola,Wl 54020 10!6/2014 715-248-7767 Property Owner B&L Land Development, LLC Parcel ID# 040-1306-10-000 Page 2 of 3 a Boring# Boring ✓` Pit Ground Surface elev 101.75 ft. Depth to limiting factor >106" in. Soil Application Rat Horizon Depth Dominant Redox scription Texture Structure Consistence Boundar Roots GPD/ft' in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh *Eff#1 *Eff#2 1 0-10 1Oyr312 none sil 2fsbk ds as 2vf,fm 0.6 0.8 2 10-15 1Oy3/3 none sil 2msbk dsh cw 1vf,fm 0.6 0.8 3 15-20 1Oyr414 none sil 2msbk dsh aw 1vf,fm 0.6 0.8 4 20-28 1Oyr4/4 none Ifs Osg dl Cw 1vf,f 0.5 1.0 5 28-51 1Oyr5/6 none s&gr Osg dl gs 1vf 0.7 1.6 6 51-106 10yr5/4 none s Osg dl - - 0.7 1.6 F-1 Boring# Boring �} Pit Ground Surface elev ft. Lpt to limiting factor in. Soil Application Rat Horizon Depth Dominant Redox Description Texture Structure Consistence Boundar Roots GPD/ft' in. Color Qu.Sz.Cont.Colo Gr.Sz.Sh *Eff#1 *Eff#2 *Effluent#1 =BOD?30<_220 mg/L and TSS>30<150 mg *Effluent#2=BOD 5<30 mg/L and TSS<20 mg, 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. SBD-8330(R07100) A.C.E.Soil&Site Evaluations r � .Soi/QYa✓ua�'o�f1.`E �IV�tJ'xj �/'adt a Gt✓, cu�o/iavS ,ge 6v.,w1r), /SQL dev�lo�oln��,o�a. 0 >. .r.,�e./p�,7-1. O.1d-/9010-lO-doo bee ey 6.374eyes 0 loG.SAS'/�wlj� A 1 ,S�fie Of .\ fit \ �\ o�• 1 � � ` ,B3 -� A Tole of Fri i r'r i -Tor'ol yK ' . 3 ooe3 I F- LU U �- O LY N O v W p fn � v dot S! N L6 W V m Z M M r6 ® s LU O � Z � Z o CLOQ oQ H Cn U O �d �d OQ o v rn � co w M � M > W O N ch 9 M U Lq 00 M C7 � (O u u u O ~ � r CO N O U lA N u co H O Z W �Y O U p U W O X Z CO FL-u O O CL IM H W U = w U U ¢ O ? C/) O Vr W m Z W M U co O � a > � Lu = N Ea wZ � � CL ® Ugh- W N CD W OLD ¢ I— J Z d zz W «� a cn w , _ Q > LCD , = Of `60 (D LL- Z ZI— J N W Cl) J m L? 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I��� �������� II I� � � � I II L\�� ,y '���I���� �I�I -� /l,/r ��� 1 �l/lllllllllllllllllllllllllllllllllllllllllllllllll�llllllllt, _ .� ._ l lllllllllllll i • � ��, !%llllllllll!l,ll�lllllllllll !�lllllllllllll � - IVWI XF"/��l/111/�/, l�l:l ' l�l��rl ill l l 1 � • : • l rrr r l ..::� • •• �, 111111 l lI/lll�,i� '� POWTS OWNER'$ MANUAL. & MANAGEMENT PLAN Page I of y FILE INFORMATION #WTjiM SPECIFICATIONS Owner P e,�-��� �,(v Septic Tank Capacity �,�5 © al E3 NA it # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS effluent )=liter Manufacturer !�'�ka:�h ❑ NA Number of Bedrooms [ NA ifflueat Filter Model' ❑ NA Number of Public Facility Units NA Putrlp Tank Capacity g Q 11 NA a! Estimated flow (average) Ffump Tank Manufacturer U3 ❑ NA Design flow (peak), (Estimated x 1.5) p um Manufacturer ❑ NA_ GO� Soil Application Rate dl/ ft? P u!mp Model ❑ NA Standard Influent/Effluent Quallty Monthly Inver$ 0 , Ftetrestment Unit ❑ NA Fats, Oil& Grease (FOG) 530 mg/L 0 Sand/Gravel Filter O Peat Filter Biochemical Oxygen Demand ($OD6) 5220 mg(L Q NA D Mechanical Aeration ❑ Wetland _ Total Suspended Solids (TSS) 5150 mg/L I Disinfection ❑ Other: Pretreated Effluent Quality T Monthly average [?lappc&el Cells) ❑ NA Biochemical Oxygen Demand (800g) 530 mg/l, 0 Irt-Oaround (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) s30 mg/L Q NA A At-Grade ❑ Mound Fecal Coliform (geometric mean) 510"cf090ml CI Drip-Line D Other: Maximum Effluent Particle Size Ye in die. Q NA ether; El NA � N A athtar ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: 0 NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least ono [3 month(s) 0 every (Maximum 3 years) 0 NA P�year(s) Pump out contents of tank(s) When 0904Ined sludgo and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once aver-y; 11 months) R yearls) (Maximum 3 years) ❑ NA Clean effluent filter U month(s)At (east once every l C] NA -- _ ► R year(s) Inspect pump, pump controls & alarm � At lesl;'t 4rts®every; '--... ❑ month(s) � - ❑ NA © year(s) Flush laterals and pressure test At least RnoQ every; ❑ month(s) D NA ❑ year(s) other ❑ monrh(sl At least onco aver}►: ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer; POWT$ Irlipector; POWTS Maintainer; Septage Servicing Operator, Tank inspections must include a visual inspection of the tank(sl to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and.to chock for any beck up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to cheek ills (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 (Y3) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing. Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall 09 performed by a certified POWYS Maintainer. A service report shall be provided to the focal regulatory authority within 10 days of completion of any service event. Page 71 of 7� 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. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cells) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: • A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. T )'v aluati a o ing�ank mAKle AL (19 71 ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS P POWTS INSTALLER POWTS MAINTAINER Name Name Phone Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY / Name Name ST. C� ( o(J& 2Cj11��/v Phone Phone "�(S— 3 g(P_ (p 8CD This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST.CROIX COUNTY SEPTIC:TANK MADMN ANCE AGREBUNT AND OWNERSHIP CFRTWICATION FORM Mailing Address� z/fK..--4-sz ?� i �4�✓[- oa��S`S/C'/ . . PropWy Addws% {1,'gr.Mrai0ta tturadi Pt for new cofttructintt,) �! Parcel Identification Number /30(e - /U-GY.Y.) LXGA Property''Locaita S' tla,/ /�►,See, _.,T l R, f W,T'Dvm o �.�----"- ------._..�. Lat# f® Sulidivisioti (.1ertifi ed Survey Map#_ ,Volume Page Warranty Deed#� /U� -3 �fi��_ ( ///y z-o Vol=e__ �' e� --._... Vie:ltuusc y ex Lot Bales ichmtifialtle no a a' UN Iniproper use and Irmitatunwe of your septic system could result in its pttsmatuce(alum to ltatadle ww1w, proper rnaiotenaacc Consists of pumping out the Septic tZat every 13ttoo,years or sorrier,if rm.dad,by a licensed pumper. What,you pnt into the sysWIp Gan,WxTt t1w fwwtion of tlao aepdo tank as a ixvatm(mt**go in tltc wasto disposal systom, Owner maint aftnec 1'"T wsibilities Axe,specifled tti.OCOMM, S3,5A J.)and in('hapto 12-St. Cr<.?ix CM11ty Sanitary 0r4iww4V. 1"lie property owner a grass to subxrxit ro St.Croix C;nunty 1'tai~,tiitng$t latiiitggaittttt a co>'cication tbx7m,signed by the nvvriur and by a master.pluixibcr ,joumeyraaii piumber,restriot+ed pluxnbe or a licensed paver vc�tymg that(l)the pit-sine ivustewater digv)sal cysitem is in proper t t*ccittdition atidlitr(2)abet;inspeutim and pttt Vh1g(if necessary),the Naptic i nk is {e4s titan 1/3 full of'sludge. t,/we,the undersigned lisve road the above require tennis and agree to imi%sm the private sewage diPPO'Sat sytttesra with the atandtu ds sec fcA*,Weir',as set by that Dcpatttneilt Of C:omrtuirve and t1w Daparwwnt or Naval ReamnVes,State of Wisconaiit, certmostion stating,that yoo r septic system leas been nuintaitied must.bt♦ceatt Icted and mtumed to the St.t ix Cnutity Placating& 7Anitig T)cptutitiont wltl z 3o clays of the three expirntion date. Vwe catty that all statenvitts on tliis to.true to the beat oftxty/+car ltaiowledp, 1/we atrilart:the owner(0 of the property described abovo,by virtue of A, deed recorded in kagistot'of'l;?O&Office, X Number of be dxA4fpila S Cr ATI,�RF 06F APPLICANT(') DATE "*Any infennnlldj n iliac is aniarepreacnwd nzy rosult in thi;sax',tttatV liorm4it being ravaaccci by t3te 1?lartning do�srtin�]tir�mrtr�cttt. *"* bichaieF with this appiie;ration.8 re�e.R�rci�d wat�ranty decd fexdtti the Regtwr of Deeds Offi co kind a copy Of tltG c�iified�t rvey ex�p ef. ref ennee is made in the warranty cdoe& (REV.08 105) 1003828 BETH PABST State Bar of Wisconsin Form 1-2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD 11/04/2014 08:00 AM Document Number Document Name EXEMPT # NA REC FEE: 30.00 THIS DEED,made between B&L Land Development,Inc.,a Wisconsin TRANS FEE: 278.10 PAGES: 1 Corporation ("Grantor,"whether one or more), **The above recording information and Benjamin Heyen and Angela Heyen,husband and wife as survivorship verifies that this document has marital property been electronically recorded ("Grantee,"whether one or more). &returned to the submitter Grantor,for a valuable consideration,conveys to Grantee the following described real Recording Area estate,together with the rents, profits, fixtures and other appurtenant interests, in �,, ("Property") if more S ace iS Name and Return Address St.Croix County, of Wisconsin (� p needed,please attach addendum): Ii�olG Lot 10 Plat of Sunset View Development in the Town of Troy, St. Croix t een- ' r" S24>5e�P14MN Cou`ty Wisconsin * e. Vf 6W 1%rl--0 51 A a-&4, 040-1306-10-000 Dated October l(] ,2014 Parcel Identification Number(PM) This is not homestead property. (is)(is not) Grantor warrants that the title to the Property is good,indefeasible in fee simple and free and clear of encumbrances except: Easements,restrictions and right-of-way of record,if any. B&L Land Development,Inc., a Wisconsin Corporation c (SEAL) (SEAL) * Ly T.Weatherholt,President/Treasurer (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT 1 i..L J � r Signatures) STATE OF KENTUCKY )j.,3cc'Ah��''� • �y� �1r" Y authenticated on JEFFERSON COUNT ` .. �'J("rte.....• : � ' Personally came before me on October( * the above-named Lyle T. Weatherholt,Preside for..t,4' ' TITLE: MEMBER STATE BAR OF WISCONSIN of B&L Land Development,Inc. �Y •,`T (If not, to me known o be the person(s ; hoe ecuted the:-#ofeg01 authorized by Wis.Stat.§706.06) instrument d ack wled h s e. i THIS INSTRUMENT DRAFTED BY: & l° Fran Iverson Not ubllc,State sc nsin 1200 Hosford St. Suite 201 Hudson,WI 54016 My ommission(is permanent)(expires: J (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE:THIS IS A STANDARD FORM, ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED..1-1003 WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM *Type name below signatures. St.Croix County 1003828 Page 1 of 1 Parcel #: 040-1306-10-000 11/05/2014 10:34 AM PAGE 1 OF 1 Alt. Parcel#: 08.28.19.1837 040-TOWN OF TROY Current OX ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 06/17/2004 00 0 Tax Address: Owner(s): O=Current Owner, C=Current Co-Owner 0-B&L LAND DEVELOPMENT INC B& L LAND DEVELOPMENT INC 7925 ARNOLDTOWN RD LOUISVILLE KY 40214-4501 Property Address(es): "=Primary *414 JORDYN LN Districts: SC=School SP=Special Type Dist# Description SC 2611 SCH DIST OF HUDSON SP 1700 WITC Notes: Legal Description: Acres: 6.370 SEC 8 T28N R1 9W PT SW NE&SE NE BEING SUNSET VIEW DEVELOPMENT('04) LOT 10 Parcel History: (6.370AC) Date Doc# Vol/Page Type 06/17/2004 766198 10/09 PLAT Plat: *=Primary Tract: (S-T-R 40%160/,GQ Block/Condo Bldg: * 10-009-SUNSET VIEW DEVELOPMENT 040-04 08-28N-19W SW NE LOT 10 10-009-SUNSET VIEW DEVELOPMENT 040-04 08-28N-19W SE NE LOT 10 2014 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 6.370 83,700 0 83,700 NO Totals for 2014: General Property 6.370 83,700 0 83,700 Woodland 0.000 0 0 Totals for 2013: General Property 6.370 83,700 0 83,700 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch#: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 neo esrwe ac�ca ww'�w'v ..wa iwwccrc g =r `r 93WOH w'S�.� V )O Lu Oo d 2iO3 3:)N3aIS38 a m SJacl � o r I EE (LL{{LL LL I tTI tp W I n rl L..J u m cq i cq LL >- iii , III ' I 1 °n Q III T v oz z LL d a Q ttttllll o 4 W (:3 ' W a I f C, U Q � d �m xW t �� m N Z lu HI I l�r IQ� c � 1k1 i ' r_ a a a� N �I _ I� Z W x a 8 E � u a z Z F8 V Oo N Q cr b O ® ® 1 sm zp V z O j Q tu �I El' E UL z ®0 4 -n d J W � w >mN io 1`— fl R� vm l W tu r � qu m r _Z YQ go� m wmz Z ®® > UJ c r r 0 N ti G Z 0 u C a a O M Q d) I I i I I I i I I I I I I I I I L–, I I I I I I I I j I I 1 I Q I I I V 1 1 I Iw W I I I Ir I 1 I I I I 1 I I I 3 I 1 I I i I I -----------------J I L I I O I 1 x -------------- L O LL i t 1 w---_---- I I '+ I I 'o•o,rsi � I y i z IU I I I 3 d ('�3 :3 i I Fsaesna.t aoo,d.,at� I I �� Q�Q I I w I 1 _1 t-- I I asvr+o iorw aainoad I I R I I I I lU F-- ZLU 1 I w :3 CL d) I I z 1 i ao L-ci I I Q I I (n IL D � to I I c r• � — I � I I m (A 3 � m FrrsR I I X I I IIII � d�ii v m I 1 I I I IIII a u�m I I I I I } IIII $ o E om II oo u IIII u �r IL a /, o\� L----, I� •o r– - _ o L,si r- Qp Q r I s3ssnal co-w„si µ dl i o lupin 0 ° I I ml i I L .9,f o I �u AI o I R I I lno�lwm _ I_J Lno>IOO� L--- ---- I ------------ ---------- ------ ------- d oi*z-z 6 O N 9-.B V .o-% O v C CL OD r---------- N � I N o I I 3� 4 Ij = Ip b I� m o OL---------- � 1 _ 1 S o I 1 IU u I 1 �ry I 1 J I 1 1 1 � 1 I Ig �e .6 4O.4Z I 1� s3s�9na1 I 1 7„94x.9/£9L I p 1 ^ b- Y o� o 0 0 ------Y— • rim na F� Qi J LL 2 LL l� II Y � Rod v3 Y � a Mo I U zad U- ? a q � 4 1 ra � I m uSZ y N NUJ II 0 d m o Q ---- - 1- z p - �/ N U 0-11 I I it 0-11 II 0 4 4 191or� III 4 4 II III s-s �I b II II Coon III m I M y III u W x II �u LL I m o-.b II m Q III�=a zag IL wol 5 'f KtO LL O Q m Ej �: .,9-.1 .9-.f LL 9NI4NVl ii0„4L xi Z-9/1x9/[ yy dW31 1��I xi Z-9/Ix9/Z OIxZ-[ N Q�'1 H9 9 9x9/£ Q k OIxZ Z 3 43X6 O Ex9/£ 3 xZ-Z O N v C .9-.0 .9-.£ .9-5 A-.91 A-1 .fY.bE 2 V C a a O a s ----------------------------- _ N I I E I I s I I I I I I i I I I I I I L—� I I 111 I I j z I I !pl O X00 1 Q m O AL-1 1-4 Z d OIxL-Z I I zs H9 O/bx9/Z I I ZO I § I o O $ I Cid i u e .A•.9 .9.Z —Q I s ez 3 9 I O I€Q DO� `��pF p Y m '� V I W I v I I ICU� pkk� o z Dl'v 'N19 ...I.1 O Q N r I O` R .0-.9 mO aF i N ..99 OO U m Qaaa3 4 y> 3 mry N q � ,0•.E 33 •Rr n b Y � �� ,9•.E .9-1 . 5 p E ° e PI Rry b W � Q ..9'.E I e 'L�d 191 339 N .O.E V .P.EL .8-.Z 1>•1 .6.LL U.K SZ iX a a O Property Owner ` w���U(�NI0,/`r-- ParcellD# /�/ Page ' of FEI Boring# ❑ Boring , ® Pit Ground surface elev. fl. Depth to limiting factor > - 9 In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont.Color Gr.Sz. Sh. 'Eff#1 •Eff#2 C5 -) C-1 V- 3/Z Z'F CjAj Z'F • S . 8 (p Yh`Fr e S 1-F -S . 8 t� mot- 9�• zo F-1 Boring# ❑ Boring ❑ Pit Ground surface eiev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz. Cont.Color Gr.Sz. Sh. •Eff#1 •Eff#2 I F-1 Boring# ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. •Eff#1 •Eff#2 Effluent#1 =BODS>30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD.,<30 mg/L and TSS<30 mg/L The Department of Cotnmerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate fonnat,please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330(R.6/00) Wisconsin Safety and �VED SOIL EVALUATION REPORT Division of Safety and Page \ of in (a�ccordan with Comm 85,Wis. Adm. Code Attach complete site AsNgla4 8 1/ x 11 inches in size. Plan must County include,but not limit horizon I refer nce point(BM),direction and — percent slope,scale Parcel I.D. 3 i and I lion and distance to nearest road. 3a(r-, OFFIC m ormarion. Re, ewed by ''Date Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)(m)). 'A,w' � � n Property Owner Y ZZ Property Location fl>-.Ji,� U�h� i;�•J 1– S� 114IJC-1/4.S E T z 8 N R E(d)W Property Owner s Mailing Address Lot# Block# Subd.Name or CSM# P o. 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Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 •Eff#2 1 o-1Z to`crz31Z — S� ( Z�s b� m Z ►Z-3� �u���lb — s i I zw1 s � wt'i� cS l . 5 .� � 3 y q8 u�2 S(A — c) 'Effluent#1=BODs>30<220 mg/L and TSS>30<150 mg1L •Effluent#2=BODS<30 mg/L and TSS_<30 mg1L CST Name(Please Flint) Signatyre CST Number Arthur L". Wegerer 03 Z1S - �� 220254 Add W e g e r e r S O i l T e s t i n a & Design Service Date Evaluation Conducted Telephone Number 421 N. 14ain St . River Falls , WI 54022 \Z—ZZ—o3 715-425-0165 4 Y Property Owner L �-'���� (7M /� Parcel ID# /��/U G Page ' of N Boring# ❑ Boring S ® Pit Ground surface eiev. �8* ft. Depth to limiting factor 7 7 In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 .0 -j(/ ».y tz. 31Z - s>' I v shf-c mfti- cPU -Z:f - S - 8 Z 1q- 2 NoLl R-3l6 — si, 1 Zm sb YIK`f-1- es v~ -S - 8 3 yZ q Q lb-tM V/L _ s o sg In = .--i. ;.Z ❑ Boring# ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= In. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 'Boring# ❑ Boring ❑ Pit Ground surface alev. ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= 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=BOD,<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. 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