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HomeMy WebLinkAbout020-1059-00-175Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide maybe used for secondary purposes [Privacy Law, 5.15.04 (1)(m)]. 'ermit Holder's Name: City Village X Township Trinit Lutheran Church Hudson, Town of :ST BM Elev: Insp. BM Elev: BM Description: ~' t ~ Qr+~ TANK INFORMATION n, TYPE MANUFACTURER i CAPACITY Septic L^. ~ l,~ ~ e~ F; ~ z ~~~ {ri) (p ~ i~~ ~a~ S Aeration Holding TANK SETBACK INFORMATION TANK TO /L ~ot J.(.~ WELL BLDG. Vent to Air Intake ROAD Septic ~ 7 /IUD! ~ 3 ~ ~ ZN `- Dosing r Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Numb TDH Lift Friction Loss System Hea TDH Ft Forcemain Length ia. Dist. to Well SOIL A6SORPTION SYSTEM county: St. Croix Sanitary Permit No: 506367 0 State Plan ID No: Parcel Tax No: 020-1059-00-175 Section/Town/Range/Map No: 22.29.19.224A15 ELEVATION DATA STATION BS HI FS ELEV. Benchmark ~ , ~ ~a~. 7 9 ~' . ~o Alt. B ~ 1r-w Gb,~- 3.3 /~~~ Bldg. Sewer S . IS ~ ~' , $ 5 St/Ht Inlet ~ • 3 ~ S• 'S~ SUHt Outlet L ~ 55 9g ~/ Dt Inlet ~ ~ Dt Bottom ~ ~ Header/Man. g ` ~ ~ t Dist. Pipe ~' 7 9 Bot. System °~' '~ c~` .77 Final Grade ~, (~ /ba , St Cover ~ GO .~ 3.3 /d ~~ BED/TRENCH Width 3 Length ~ No. Of Trenc_he~„ \\ --`` PIT DIMENSIONS No. Of Pik Inside Dia.` Liquid Depth DIMENSIONS .~b Z 'rQ,v~,G,Y~,~ ~--- SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer- ~''. ~ N CHAMBER OR ~ '~ ~ t ~a INFORMATIO Type Of System ~ ~ /~ ~ Z ~ / ' ~~~ / /~ / /~ UNIT Model Number: Q ~ / ,C/) 1 W Otn. 0~4/e . lJ L/L„ T I~ISTRIgUTION SYSTEM ri I_ ~~ / b t~- ~6 - c.o Header/Manifold ', ` Distribution x Hole Size \ x Hole Spacing Vent to Air I take ~ ~ ~ Pipe(s) ~ ~ i Di ~ S ~ c! Z •~ Length Dia pac ng Length a Rl)II C:[1VFR „ o.e«.,.e c..~re.,,~ n., t., .•., Mnnnrl !1r Atd:ra/1e Systems (]nlv Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center ~ ` ' Bed/Trench Edges Topsoil \ Yes ~] No ~ Yes [; No ~~ COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / /__ Inspection #2: / / Location: 614 Badlands Road Hudson, WI 54016 (SW 1/4 SW 1/4 22 T29N R191W) NA Lot 1 Parcel No: 22.29.19.224A15 1.) Alt BM Description = ~` ~ ~ GaJ~" G NG,~ ,vs ~ ~~S O ~ 2.) Bldg sewer length = f g - amount of cover = Z / /1 !1 a t~ a~LX.~ --- _ _ - Plan revision Re uired. Yes No ~ ~ ~~~~ ~~ q ^ ~' I Z y b~ Use other side for additional information. I ____ __ ~ .-- Date Insepcto s Signat a Cert. No. SBD-6710 (R.3/97) commetcg.wi.gov Safety and buildings Uivisiots _ 201 W. Washington Avc., P.O. L3o;{ :')62 'i r S ^ O N ~ ~ ~ Madison, W [ 53',07-7 ' Coanty _ `~~~L~-~-- -j41 Sanitary Permit Number (tc• be tilted in by Co.) ~~~~~ Department of t„omsnerce ~•---- - k Sanitary P'er><nit Application In accordance with s. Comm. k3.21(2), Wis. Adm. Code.. subrntsiWt of tlus fprln to dk appropria vernm I Note' Application farms I'or state-owned S ar'u ermit n inin a sanitar ed r to obt i i Slate Transaction Number `c~~ ~-~ ~ y __ jest Address (if drffelent than mailing address} . g y p p r v a unit s requ ~ subrmit+erl to the Drt>aeunent oi' Commtcce. Personal inforntation yon provuie maJ he used for sec ry I U1~Xrses in accordance with the f'rrvacy Law, s [5.04(1)(rtl), Stars. ___ T_ ,~,,,.._ (~ ~y GtX.~"~Z~/..v ` J ~ "/~ _ ',_ /J~~/K~G C 1. Application Information -Please Print Atl loformatinn ~_ ----- 1'ropcrty Qwrler's Nsme Parcel ~ i Property net's M ding Address/; ~ ~G~/~~~ f" Pro rty Location / ~ ~/`~. ~~(( C v / ~ r l (~ T ~ GUY Lot City. State -. ~ ~ Lip Corte ~ 'ho a Nwn ~~ y., ltf ~.. Scctron ,i~ ' ~__ ~ ucle one) ~ ~ . E~ t s l a ' ' .,u ing (cher all th rll, l yp t apply) -_,__• I vision Name r j I or 2 Family Dwelling NUmhPr of Hectronms ..~_ __ _ _ ~ _~ N ^ ' ~ I3iuck p /'t' ~.~ __ Z'`CY ~ v ~Pubhc/Cammercia! - Desr,rbe i.'se _~_,y-ti r • ^ Crty of _ ~ ^_._._-.._. _. i _ ^ ~ ~ r'~ ' l.Y CS~~ 1`iUmbtr `.~ ^ VItla~;e U3 .~- -_ u Stole Uwnui -~ LtCSrrilx Zl:c _ ~~ ~q~~(j// /may' ~ 7/P ~ ~TUWn Oi ~GL I ~ / ~~ ( - -- __ ;III. Tyl~~te''''o``f Permit: (Check only one box on line A. Ct+nsp to line ti tf applicable) -~~-~--• __. __.__ ~1!(,I Nrew System p y ^ T 3 p' S I e~ Y ( p ~.t Re lacement S stern reatment/Heltlin Tank Flo iacrment Or----t ^ O.her Modilican=rr: tc lcxistin• 5 stem ex tarn) I List Prevraus Permit Number and Date issued fl, r.} Perrttit Renewal ^ d'erntit kcvision ^ C!'.ange of Plumber ^ Petmii Transfer to New I ~ ~ ~~ Before Erl>;ratinn Gwner ~(~ Z'Z-- ZG~} f l l__ ~ V. Tie of PO\'~"I'S SystemlCortgroneitUDevice: (Check sell tie~t irn sl ~ ~_~_ _ ' _ _ <4 m fsunabte st ~i[ r i3 Mo Z4 i f Gk - ~~ i G d C i r) M d > ^ ' . o n. o sw a : k roun F.-Grade on-Pressurized In-liround _ l ressruizad ln- . ,f+ou~~n ~~ t ~ ~ ~ ^ bolding'rank ^ ()they Dispersal Comprmert (exp!ain)~j~~'s"~i" reu ~atnrent Device (explain" ~ - ~ ~? ~_.~~ { \r. Dis ersal/Creatment Area In1'ormatian: ~ ~ _ _ _ _ Ueslgn Flow (gptf)~ Destgn Soil Application Rate{gpdcf; Uistxr'sa! Area itequireJ (sf) Dispersal Area Proposed (s t) System Elevafton ~ I t'l. rank Info Capacity in 'Cowl I d uf' Manufacturer ~ } C Gallonsv`allons I Ut11lS t, u rc /~ ;t .'~ NtwTanks ExisturgTOnks ~ ~ y ~ ~ ~ ~ .b ~ +Ud r 0. V [fr .n ~ t/r w J C.. Sr"~epuc or Holding lank -~~~-~ ~~ ~~ Dos~ in ~ G~unber w .-~-~ ~ I 'F'll. Rres~-onsibi{ity Statement- 1, fire untlersigntd, assume respon_sib(tity for lustalla as of to PO~i'T5 wa on the attic d plans. N P b ' n ' ~ um er hone P NSPRS Number ~ $usmess Plumber s Name (Pratt) P~lumbet s 5ig atult G Plumber's address (Street, :`ley, State, Zrp G'ode) -\'lll. Co ntvlf3e artment Use Uni ~~ i proved O Disapproved Permit Fer Datt issued S ~ ~ L~ ~ ~/~ U suing Agettt gnalure ^ Owner Given Reason for Denial ! v v'^~ 'L~y`~ n~i ' Altproval/Reasons tar Disapi.rovat l~rY~~`~21J l/N S~ 7/~ Q~t,( fi~G ~w~~ S~S~~M ~~G~V~R: _ o ~a 7 Septic tank, effluent filter and ~f >~., ~o 2 /~.u~" ~~ ~~2/~OlJ~''t ~- ~ i , / ,~ i1 dispersal cell must all be serviced /maintained ~ y~pf /~zo ~~~L, As per management plan provided by plumber. i~/.rL~'Z~f~-~~~~~ ~C NOT.l~1r~1'DD ~f (~. II setback reauiremantc turret t,o ......:.....:.._~ ~r-~-w, ~. --- - _ -- as per applicable cotes/~ttfil~dlY~t~t~ pious u: we ateur a+t submi f:aur3€y onl • • per not Icss than 8 1R x 1 I i clrcc in site St3D-639$ (R. 0)!OT}Vaiid thni G1/09 • 5 oil P~/a~~'o--r~o: ~ 6y -~•7~i~wrPlo~ co/~i/o/ ,4. Sc.~i cc.n a.~ y~~° 7 ~ / „~, G1~wc~~OroFui~Y iCoL`/, cs~ ,~i~ ~ s yi9,2 Swj~rswyy .Sic. zz, T. ,2.9~i: O '~ /9u~, T. of i~u.dsor, ~ •Wa,?~ ~ ~ ~ i ,oe/ Bozo- ior9- ca-its do%~ /f~70ac~cs• SCB, fto wsst prop. i~ ryc t X1.5 8 2 ,/';IsTM -303 S~ ~ -7.T.d~• 8~~' SC?, o • 4.Y /0 ~i~'~~Z.s~vr ~-SIGN C.~~a.., ~s P~p~tostd ~i~S~•-.Su,~Ce,P~ ?"wio(,~ fre.-,~s4,~ -~ 4 ~ Proposed c.J~estiCanc. ~ Aso ;.tQ sep~,~ f~.,,t' ~~ ~~~~ at o~/~. y"sue S/pP.vC.. ^ .~•.~ 8-3 Qr•~oos-ta( ~a,d StieCf ~ eo%le t~ a+-, ~4l~ty 21~ fo bt r, io% oo' r t~~acc~~ SySfam a-r•eA. e ~I~ ~. 3 0~'6 .,,, commerce.wi.gov i ^ . isconsin Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www. commerce.wi.gov/sb/ www.wisconsin.gov .Jim Doyle, Governor Mary P. Burke, Secretary July 23, 2007 CUST ID No. 227990 WILLIAM C SCHUMAKER SCHUMAKER PLUMBING 1070 SCOTT RD HUDSON WI 54016 ATTN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIItES: 07/23/2009 SITE: Trinity Family Care.Center 614 Badlands Road Town of Hudson St Croix County SW1/4, SW1/4, 522, T29N, R19W Lot: 1, Subdivision: CSM Vol 15 Pg 4192 Identification Numbers Transaction ID No. 1418084 Site ID No. 631942 Please refer to both identification numbers, above, in all corres ondence with the aQenc . FOR: Description: Non-pressurized In-ground, Commercial (Church Food Pantry) Object Type: POWTS Component Manual Regulated Object ID No.: 1142559 Maintenance required; 192 GPD Flow rate; 87 in Soil minimum depth to limiting factor from original grade; System: Conventional POWTS Component Manual, SBD-10567-P (R.6/99); Commercial System, Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. G,~~ No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stars. The following conditions shall be met during construction or installation and prior to occupancy or use: I Reminders SEE CG • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required • 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. Stars. • Inspection of the POWTS 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. Star WILLIAM C SCHUMAKER Page 2 7/23/2007 • Comm 83 22L'n 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. Owner Responsibilities: • Comm 83.52 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. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 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. 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 Safety & Buildings 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 maybe 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 to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ~i!0002^~~ ~ ~~~ Charles L Bratz POWTS Reviewer II ,Integrated Services (608)789-7893 , 7:45 am - 4:30 pm Monday -Friday charles.bratz@wisconsin. gov Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544 ,Friday, 7:00 A.M. To 3:30 P.M. y ~~ o V ~ ;J ~ ~ ~ J ~ NON-RESIDENTIAL CONVENTIONAL PPOWTS DESIGN INDEX AND TITLE SHEET Project: Hudson Trinity Lutheran Church accessory structure Contact: Neil Fredericks Address: 1205 6"' Street Hudson, WI 54016 Site Address: 614 Badlands Road Legal Description: SW1/4SW1/4. Sec. 22. T29N. R19W. Tn of Hudson, St. Croix County, WI. Subdivision: CSM Vol. 15, Pg. 4192 Lot No.: 1 Parcel ID Number. 020- 1059-00-175 Plan Transaction Number: Unassigned Index and title sheet Paae 1 Daily flow calculations Paae 2 Site Plan Page 3 System Cross section Paae 4 System Management Plan Paae 5 Attached soil evaluation Paqe 6 reports by Schumaker & Thompson Designer: Bill Schumaker Signature: ~ ~~/ ~ ~~~~ ~OF r `~PONDEN License Number: 227990 Phone No.: (715) 386-3121 Date: June 18, 2007 System Design Calculations JOB DESCRIPTION: Trinity Lutheran Church accessory structure to be used 2 - 3 days per week as a collection and distribution point for food shelf donations. Floor drains to receive only cleaning water. Effluent quality anticipated to comply with standards enumerated in Comm 83.44 (2xa). See Management Plan for initial testing of effluent quality. ABSORPTION AREA SIZING: 1. Total daily wastewater flow; = 20~ R_Sn c'~n,_rl (6 attendants, all shifts) (13 gal. /employee) = 78.00 gpd (2 floor drains) (25 gal. /drain) = SOS Total daily estimated wastewater flow = 128.00 gpd Total daily design flow = (128.00x1.5 conversion factor) 192.00 2. Existing grade elevation: 99.72' ,1t R~.1 3. Depth to limiting factor: >96" (elev. = 91.72') 4. Proposed system elev.: 9s_no, (56" below grade at B-1) 5. Infiltrative capacity of soil at or within 36" of system elevation = 0 7 gp~c~ ft 6. Absorption azea required: 274 29 cq R 192.00 Gpd design flow / 0.7 Gpd = 274.29 sq. ft. Infiltrator "Quick 4 standard-W ' EISA per chamber = 20.00 sq.ft, EISA/pair end caps = 5.8 sq. ft. 274.29 sq.ft. - (5.8x2 pair end caps) = 262.69 sq. ft chamber area required 262.69 sq. ft. / 20.00 = 13.14 chambers required 7. Absorption area proposed: 45 T .6o s = ft_ (r~hsnrt-tinn cell to nvercized to ar nmmn_~1ate available areal (20 chambersx20.00 sq. ft per chamber) = 4on.nn sn F.TSA (4 pair end caps)(5.8 sq. fl/pair) = 11.60 cn ft F.T~A Number of trenches: ~ (~ 10 Tnfiltratnr "(dick 4-W ' mitc ach = 0 ham rc n al trench width (A) __2.54' trench length ($) a2_nri, trench spacing pia total area required @ 6' trench spacing: 1 n_nR' x 42.00' SF.PTTC'. TANK CAPAC'TTY• 1. Design wastewater flow = 192.00 Gpd 192.00 gpd/ 75 gpd = 2.56 gpd person equivalency 2. Minimum required capacity: 4't 5 'T S (;allnnc (192.00) + (11.61 x 3 * x 2.56) + (46.77 x 2.56) = 400.90 *(Requires a three year maintenance cycle) (192.00)(2.088 "magic number's = 400.90 gallon capacity required on 3 year maintenance cycle. 3. Proposed septic tank Capacity & Manufacturer: 750 gat_ WiP~Pr (' 4. Polylok PL-525 effluent filter to be installed at outlet of septic tank Pg. 2 of 6 • • Soil Pvu.~~'o--r~o: E by -~•77irwr~Olo~ ~o/~.~/off ~l• Sc,Qa.nec~ y~~o y //kds.,, T:h,~y,L. G~'c-+~~Oro~ty iCcti/, C5h1 t~I~ i S ~~ s//9.2, •Sw~~swyS~, S"c c..2.2, T. ~9~ O ~P. /y~v., T. of,~u.dsor•,, ~E .G~o~~c !e ~ ~ 6ci~ /fl.7oQC~as. • ,Q./rJ, : o off'-~'y `C,yq~•- `nc.6, ar ' Toro o~ ~~ ` ~P~" /,99.0/' /~~~~ L® G:n,G • ~sce ~Lo'p -~ -TT.82 ,f P~sr.ar ~,~s~-s~c~ Twe(,s~ t~en~4~ /,'rye ¢. 8f X S~Z, o ~ wV /O T7/~'~f/a~~vr (~-SIGt~C.-~A,,,~ ~+¢~S ~ ~%~sT~+l -303 s/ ~ eFF/uar,~ /.R~ P~o~oose pI GJreSuCaw,C. ~vTsv-,.tQ Seod.~~,,t' a t outJ.e~ • y "sc,(, s/OP. d.C. ,~~cd S tieL~' i ~ ~•Q~• o{s.>, ~ D.-sEr;bK~a., ~.~$3 ~Co%(ecf~ ~a c; l~ ty A.S.Q-~ ~niS~{td F/cbr elev~ fo bt =. ~o% do ~~ /~o aP~orc 0iQ6/e S/%u tl~~au~ti SyS~o.~•~ a~•e2. 0 Gc.L/~- ~~.30~6 -,- 9, Stem ~o.ts 5¢~~ion ~ f(.t~ ~ Scu~/c Trench Installation D~t<iil Sys~em de S~ .T2 Se low fir grade. -_~~ ~~~ P~- ~' °~ ~ Inspection opening or vent -~- - - - Conventional Septic System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Influent flow may not exceed maximum design flow specified in the system design and sanitary permit. Testing effluent quality Influent quality entering the dispersal component of the POWTS may not exceed 220mg/L BODS, 150 MG/L TSS, and 30 mg/L FOG. Testing of effluent concentration shall begin 45 days after the system is placed in service and will continue at 4 - 6day intervals for a period of 30 days with 6 samples being collected within that period. If concentration levels exceed Dept, of Commerce standards, a pretreatment component will be installed down stream of the septic tank, followed by a pump chamber that will distribute the effluent through pressurized distribution laterals. Results of testing will be submitted to the County Zoning Dept, with a copy forwarded to the Dept of Commerce approving agent. Septic Tank Septic tank servicing mechanics comply with Comm. 83.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be 5 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 1 13, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter carnidge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component, The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Soil Absoration Cell - . Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-February) dictate that the system be heavily mulched for frost protection. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan if the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Questions on the operation or maintenance of the system should be directed to installing plumber, Bill Schumaker at (715) 386-3121, or the Polk County Zoning Department. Pg. 5 of 6 ~ Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must indude, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. percent slope, scale or dimemsions, north arra~r, and location and dicta nearest road. Please pr~ r~>1i1~Q ie Personal information you provide may used for secondary purposes (Privacy Law s. 15.04 (1) (m)). ~ Property Owner ~UL 1 p ZUU I Properly Location ~~nr.•~+~"~~ 2083 1 of 3 A.C.E. Soil & Site Evaluations St. Croix 020-1059-00-175 Hudson Trinity Lutheran Church Govt. Lot SW 1/4 SW 1/4 S 22 T 29 N R 19 W Property Owner's Mailing Address ST. CROtX COUNTY Lot # Block # Subd. Name or CSM# 1205 6th Street 1 CSM Vol. 15, Pg. 4192 City State a hone Number J City _J Village ~/J Town Nearest Road Hudson ~ WI 54016 Hudson Badlands Road New Construction Use: JResidential / Number of bedrooms Code derived design flow rate 192 GPD J Replacement ~ Public or commercial - Describe:Food Shelf Distribution Center Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Soil evaluution cmpleted as addendum to A. humake evaluation report to expand available system area. Recommended dispersal cell elevatio = 95.00' . Boring # ~ Boring ~~ ~~ Pit Ground Surface elev. 99.72 ft. D in• smiting factor Sop Application Rate Horizon Depth Dominant Color Redox Descripfwn Texture Stnrcture Consistence Boundary Roots GP DIft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10yr3/2 none sil 2fsbk ds cs 2f 0.6 0.8 2 9-15 10yr4/3 none sil 2fsbk ds cs 1f 0.6 0.8 3 15-34 10yr5/4 none sil 2msbk ds cvv 1f 0.6 0.8 4 34-48 10yr4/6 none s 0 sg dl cw - 0.7 1.6 5 48-96 10yr4/6 none s 0 sg dl - - 0.7 1.6 a5 • a H#4 contains verical tongues of 10yr4/4 sl. ~~ 2 ~~ r Boring # J Boring ~~ ref Pit Ground S dace elev. 99.58 ft. Depth to limiting factor ~ in• Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Stnrcture Consistence Boundary Roots GP D/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-10 10y-3/2 none sil fill 3thickpl dvh as 1f 0.0 0.0 2 10-39 10yr4/3 none fixed fill 2msbk dvh aw - 0.0 0.0 3 39-48 10yr4/6 none s 0 sg dl aw - 0.7 1.6 4 48-51 10yr6/6 none sl m mfi aw - 0.2 0.6 54" 51-84 10yr4/6 none s 0 sg dl cs - 0.7 1.6 6 84-98 10yr5/4 none b I gr 0 sg dl - - 0.7 1.6 ~, ,d R ' Effluent #1 = BODS> 30 <_ 220 mg/L and TSS >30 < 50 mg/L Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signat e: CST Number James K. Thompson ~ ,~ ~- 3602 Address A.C.E. Soil 8< Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 6/21/2007 715-248-7767 Property Owner Hudson Trinity Lutheran Church Parcel ID # 020-1059-00-175 Page 2 of 3 I S I Boring # J Boring II ~~ II ~/ Pit Ground SurFace elev. 99.55 ft. Depth to limiting factor >87" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munselt Qu. Sz. Cont Color Gr. Sz. Sh. *Eff#1 *Efi#2 1 0-9 10yr3/2 none sil 2fsbk ds cs Zf 0.6 0.8 2 9-17 10yr4/3 none sil 2fsbk ds cs 1f 0.6 0.8 3 17-35 10yr5/4 none sil 2msbk ds cw 1f 0.6 0.8 4 35-65 10yr4/6 none s 0 sg dl cw - 0.7 1.6 5 65-87 10yr5/4 none s 0 sg dl - - 0.7 1.6 n n 5 -j Boring r Boring # J Pit Ground Surface elev. ft. Depth to limiting factor in. Soa Application Rate Horizon Depth tn. Dominant Color MunseB Redox Description Qu. Sz. Cont. Color Texture Stnrcture Gr. Sz. Sh. Consistence Boundary Roots `Eff#1 *Eff#2 ^ Boring # J Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil AppNcation Rate Horizon Depth Dominant Color Redox Description Texture Stnucture Consistence Boundary Roofs in. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. `Eff#1 *Eff#2 * Effluent #1 = BODS> 30 a 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 =GODS < 30 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. SBD-8330(8 07/00) A.C.E. Sotl ~ Slbe Evaluatlons • • So.'s e /a-~ccce ~i ~r-~ /o,'~ by 11:7riomps~ ~C/z//o7 by,~ scliwrra.(/ar Y/.3g~o ~~~ ~~~~ Cl~c.~~o~e/o., /o f CS ~ O do~P /S f~, S//9l .SwyySuJy~ rE. 8, : T a{ ~~V Sew. z2, .~..9r~, ~R /9~, CoAoa'/~~iot. E/ec!'= 99.Q0 r. oFfyu.J.r~ sf. Cro:X~e. cJl., b~e,'~ /~7o acres /Iur't2 ~rterv~cs z~Lot L,'•~ /, z99 0/~ ,OGJ• ~O~ -jos~9- cr~-r7S ~ ~ 8i ~ (3 Z ~' o+^ 70P of ~/t' ~~i9a'~+" • /OipC. SSu~'rGO/ 2./LV; . /GPJ, Gp~ q.s Li ~ ~ /jo ~~Pr-~ C~'ab/c 6 /opt s~ -tom wcst /a~/,:~ ,4. S, C .Q. 5. - B / prc/~osc d St1'u ~-fu.~f 16.6. . J Top off' a s~r~a. L~ a ~ o,-a.~x e S~r~g Y / ~. 3 0~3 • i ' RECEIVED JUN 1 5 2007 Wisconsin Department of C mmerce S I L EV T Page ( of Division of Safety and Buildi gs ST. CROIX COUNTY in accordance with omm 85, Wis. Adm. Code County ~~ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must r include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Revie d by Da Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ ZD Property Owner Property Location j ~ / ~ ~GZ ` Govt. Lot ~~ 1/4Scv1/4 S ZZT Z N R E (or~V Property Owner' Mailing Address Lot # Block # Subd. Name or CSM# Cityy State Zip Code Phone Number ^ City ^ Village Q Town ..Nearest Road i I I ( ) /~~ rr,,,. I ~ (a ncQS ~ New Construction Use: ^ Residential /Number of bedrooms Code derived design flow rate /(~U~ -y P -I e - GPD ^ Replacement 1~ ,Public or commercial -Describe: ~°a~ ~fa=~ ~OV ,' (cG' c`~ ____ ___ __ ___ Parent material ~ U Tom' ~ 5 (.~ Flood Plain elevation if a pliable ~- ^ - , tt. General comments S \!~{ems ~2 / ~ U . C,~ ~ ~~0~-cJ ~ ~ J r~ d ~d ~ ~ ~"-' .~~ and recommendations: j G'1 ~-1 ~ Boring # ~ Boring o Pit Ground surface elev. l- CJ ~ ft. Depth to limiting factor ~~ ~ ~g, ~ ~~ in. Sal tiation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/f~ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 `Eff#2 j / / Z /~(' ~ l l ~`_ ~~~ mS~l w~ C Borin # ~ Boring ,2. 9 rn G o ~ ,~. ~ 7~ L v ~ LLJ rl[ v,uw,u ~unnVG n,cv. ~~u uepu, w nnnuny iacwt ! ~ ~ n,. Soil iation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Caor Gr. Sz. Sh. •Eff#1 `EfF#2 o.. / r3/3 -- r~ ~ ~r ~S ~ U 5 yG i l ~ ~ - ~- , ~ 'Effluent #1 = BOD > 30 < 22U mg/L and TSS >30 < 150 mglL `Effluent #2 = BOD < 30 mglL te[d TSS < 30 m9n- CST Name (Please ' t gnature CST Number Address / Date Evaluation Conducted Telephone Number r/ ~(9 ~ ~" .~~i.~oz Gv/. ~/~ `~ ~c~ - Q~ 7/S= 7~ o - 6Z,z r~ `~ { to ' a ~9YiI4w~ Vpcy;rw. Property Owner `-~/ tp /~ ~ ~ l` ~/ Parcel ID # Page ~ of Boring # ^ Boring ' ~~ f 2 O pit Ground surface elev. ~-ft. Depth to limiting factor in. Soil lication Efate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Dlfg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 l tg ~ - S'>l ~~s.~c ~ r ~f eU~ ..~ ~ ~ 3S-( ~ - 5 os m -- _ N ~- ~ o ~~~ # ^ Boring ^ ~tnt 1. i~ fa Pit Gwu~ ~u ~u~ yaw a~a.. p o im ng c..,~ ~~ ~. Soil lication Rate Horizon Depth Dominant Color Redox Description Teidure Structure ~ Consistence Boundary Roots GP D/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Q Boring # ^ Boring ^ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 'Effluent #1 = BOD, > 30 < 220 mglL and TSS >30 < 150 mglL • Effluent #2 = BODs < 30 mg/L and TSS < 30 mgJL 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(8.6/00) ~, c~ (.~ = U 6~ f t~~~ ~ ~ '' ~ S S ~« -~-~ U _ ~~ r • f/ ~O w ~G /1 ti ~~ ~~ _ ~ c ~ ~~~~~ /- ~ ~o ~ U, ~r_ ~-Z o ~ ` s ~aC~. ~ I ~ I ~~ r lr N L ~ r ~ ~I _ ~3 3 0 ST. CRUD: CUUN1`Y SEPTIC TANK MAINTEIvA.NCE ACrREEMENT AriTD OWNERSHIP CERTIFICATION FORM 'Vlaiting Address r ,-,•`~" `'~" • "-' ~.. ,a-~~,n~ s yea ~6ap loth' c,c1,~ ._ Property Address ._.. __..._. ___._ _,__ ~~--- ----- ~-- ('~'erification required from anniHg & Zoning Dep~ent for uew cans 'on.) - City/State ~~~~~~,t-l~.r;'.__.____. Parcel Identif`ieation Number ~ .. O2e '~/D~l ^ DD"-/00 LEGAL DESCRYPTIOh Property Location$~ '/~ , ,$~iJ ., ~/, .Sec. ~2, T ~2~:vT R ~~,~vvv, Town of _ ~c~~~4~ ___-._. Sttbclivisian s~ 2'j'i~rro ~ -flt.e~ G~,c;c-~,c~, ~-___-, l.,ot # _ / _. Certified Survey MaP +~ __6y~.~.~.~ -- , ~TC~lurne ._ /.S , Page ~ 4l g2 Warranty Deed # _____-~~,~ ~ ~3_ ____ ._._ _ , ~roiume _ _ / ~~~' ,Page # ...~1_ ~~_, Spec house pas no I.vt lines identifiable es no SYSTEM MAINTEi~AN~F' ANA OWNER. GEIt'.~~~`ICA,TIO~+ lrnpmper u c and maintenance of your septic systatrt could resuh in its premature failure to handle wastes. Frvper taintenance consists of pumping out the septic tank every thce years or sooner, if Herded, by a licensed pumper. What yav put into ttx. system can affect the function of the se-ptic tank. as a treatzncnt stage in the waste disposal system. Owner ttiaintcnance responsibilities are. specified *'n §C,otnm. 83.52(1) arx! in (.'hapter l2 - at. Croix Goutrty Sanitary Chdinance, "Che property owner agrees to submit to St. Croix County Plannin6 & 7.,oning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, rrstsicted pltrcuber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition ttntl/or {2) after inspection and pumping {if necessary), the septic t:attk is less than ll3 hull of sludge. Uwe, the unclzrsigned have read the above regt±irernents and agree to maintain the private sewage disposal system v~ith the. standazds set forth, herein, as set by the Department of Commc~'ce and the pepamnent of Natural Resources, State of V6'isconsin. GcrtifcatiaQ stsiiztg that your septic system has bete maintairsed rn~ast br.. cotnplcted and returned to the 5t. Croix C..t~unty Planning & Zoning Department within 3fl days of the three year expiration date. I~we certify dot all statements on this form are true to the best of my~our know?edge. Uwe amlare the owneris) of the prapet'ty deSGCtbed 8bvve, by virtue of a warranh~ deed recorded ip Register of Deeds Office. Number of bedrooms SIGNAT'L~tE OF APPLICANT(S) DATE '"**Any inf:,rntaticsn that is tuisrcpresented ~~, resttli in the sanitary• prrmdt bei*tg raval.ed by nc~ Plattxrireg ~Lonir-g Department. *'"' Include; with this ap}~licauon a recorded r~~rranty deed from t?te Register of Deeds Ctffi:~e attd at co~iy of the certified 4n-~ry ma~~ i!' reference is made ire the, wttttanty deed. Parcel #: 020-1059-00-175 10/11/2007 02:10 PM PAGE10F1 Alt. Parcel #: 22.29.19.224A-15 020 -TOWN OF HUDSON Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O =Current Owner, C =Current Co-Owner O -TRINITY LUTHERAN CHURCH, HUDSON HUDSON TRINITY LUTHERAN CHURCH 1205 6TH ST HUDSON WI 54016 Districts: SC =School SP =Special Property Address(es): * =Primary Type Dist # Description ' 614 BADLANDS RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 0.000 Plat: 4192-CSM 15-4192 020-01 SEC 22 T29N R19W PT SW SW BEING CSM Block/Condo Bldg: LOT 01 15/4192 LOT 1 (14.700AC) EXC PT TO HWY PROJ 8949-02-23 (0.98AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 22-29N-19W SW SW Notes: Parcel History: Date Doc # Vol/Page Type 07/02/2003 728476 2298/425 WD 02/16/2001 638732 1588/188 WD 07/23/1997 1148/200 OC 07/23/1997 1148/195 AF more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 ValUatlOrlS: Last Changed: 10/25/2005 Description Class Acres Land Improve Total State Reason OTHER X4 11.737 0 0 0 NO Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2006: General Property 0.000 0 0 0 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 Z6[it 3JVd S[ "lOA 659475 KATHLEEFi H. NALSH REGISTER OF DEEDS ST. CROfX CO. MZ RECEIVED FOR REC~ItD N t _ nn Jl`dMH~tH _ _ _ _ io-ia-zoos z:zs vn ~ 30V'1d3WOH covr FEE: ~.oo ~ - - - - - ~ N n ~. ~.~. N n O ~ RECDRDIM6 FEE: 15.00 Z98 30dd ~ "10/~ ~ ~ a ,w,S-O ~ i log ~ z lay ~ ---- ~ ~ ,87~'~ Lt M~S~.S'~.OON - y- -. ~- ~ ~- 85'Z6~ M ~`£`~£ - z i inn H •s - n , • .~ ~, ooZ£ ~ =.-w_ ~ - f t ~ ~: M SZ,~L685~' ~~` 3 ~ ~~ T '` ~~ ~ - ~- - - +o sutl 3aJY1 m r -1 ~qa i D i %' ~~ i '0 ~ 2+r' z 3 r A ~~~ ~ r- ~ ~ I g ~no~ ~ .~ 3~ ~.~ i ~D a ~U ~c ~ c a ~ I ~_ sin c ~ I ~ ~o ~ ~ n, ' r wo~~ l)D ~ ~ ~ O> 3.f O ~'.' ~ $ t ~~ ~ ~~ ODD ~ ~ f ~O `/ I o~ ~ ~ ~ m o~~ ~O~° ,D ~' N I ~i ~'tn F ~ D o v tys v ~ !y ~ ~ _ ~ Xz c ... `.' ~ m ~ , ~' ~ APPROVED I rn z •~ ~ n o _°., ~ o , ~'$~ sue. cRax ~xN ...-.r I ~ = o '° a g ~ s ~'~ 1 Plannitx+ 71.-,,,~ _ ~ a ~ eO~r . 0 ~ ~~ ! ~ ~ ~ OCT 1 8 2001 (~ o ~ $ ~ ~ ~ ~ t~ ~ ~D o ~ aA^" ~ ~ tt not recoroeo aNU~u~ ~~ Q m o Opn ~ # ~..~ ( t ~~~ nuM aid voidvoid ~ N ~ OQ s ? ~ '~'` 1 ,ZS"09ti ~, A ... ~ ~.o x g I ,g SaNb~l 0311b1dNf} ~~ ~ = O O c ~ ~~ o o~z ~ N c ~~ ID c °~o °~. c P.. ~ s J 0 I~ v ~ ~ I ~ ,!_~. ~ 2 O A ~ x ~ ~ 0 ~o ~ n C7 ~ (Z g a° 1 ~' p~_ g ~b~I i°N N a"~ 1 w ~s ~ p ~' C ''' t ~ C ~ tl1 1 ~ 3 ~ ~'~ _ !j ~ OD :O Q ~ n K O Q m 1 t~ .p ~ r .. r t0 Ate. N~ O ~, ~n '~ vs p m v ~ o~^ ~ : ~ ~ a ~~ ` ~+ ... 3 j ~+ o a t ~ ~' ~ .a ~~ a A O t O `- O ~ ~ ~~ • ~ t~ O) ~G Is6~' CERTIFIED SURVEY MAP That part of the southwest %. of the southwest '/. of Section 22, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin HIGHWAY SETBACK RESTRiCTION3 No improvements or structures are allowed betwoen the right-of-way and the setback line. Improvements include but are not lianited to signs, parking lots, parallel driveways, wells, septic systems, drainage facilities, etc., it being expressly intended that this restriction shall constitute a restriction for the benefit of the public according to section 236293, Wisconsin Statutes and shalt be cnforceabk by the Department of Transportation. Contact the Wisconsin Department of Transportation District Office for more information. The phone number maybe obtainod by contacting your County I-lighway Department. NOISE NOTE This property may experience noise at levels exceeding the levels in Trans 405.04, Table 1. These levels are based on federal standards. Ov~ners of these Lots are responsible for abating noise sufficient to protect theses lots. ACCESS RESTRICTION CLAUSE As owner we hereby restrict all lots and blocks so that no owner, possessor, user, licensee, or other parson may have any right of direct vehicular ingress from or egress. to any highway lying within the right-of-way of U.S. Highway l2, as shown on the division map; it is expressly intended that this restriction constitute a restriction for the benefit of the public as provided in s.236.293, Wisconsin Statutes and shall be enforceable by the deparaaent or its assigns. Each parcel on this map is subject to state, county, and township laws, rules, and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and the Town of Hudson for advice. The Wisconsin Depsrrznent of Tn~nsportation anticipates obtaining additional right of way along U.S. Highway 12. Contact Transportation District at (715) 836-2891 for further information. ~~ CJ" 2 Sheet 3 of 3 VOL. 15 PAGE ~19Z ~~ CERTIFIED SURVEY MAP LEGAL DESCRIPTION That part of the southwest 114 of the southwest 1 /4 of Section 22, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin, described as follows: Beginning at the southwest corner (the POINT OF BEGINNIIVG) of said Section 22; Thence North 00 degrees 35 minutes 35 seconds West along the West line of the southwest quarter of said Section 22, a distance of 492.58 feet; Then<x North 89 degrees 48 minutes 44 seconds East 1299.00 feet; Thence South 00 degrees 32 minutes 15 seconds East 493.52 feet to a point on the Sculls line of the southwest quarter of said Section 22; Thence South 89 degrees S 1 minutes 14 seconds West along the South line of the southwest quarter of said Se'on 22, a distance of 1298.53 feet to the POQJT OF BEGINNING and there terminating. This parcel contains including right of way 14.70 acres (640,343 S.F.), excluding right of way ]2.911 acres (Sb2,419 S.F.). Subject to easements and restrictions of record. SURVEYOR' CERTIFICATE I, Clarence E. Schultz, Registered Land Surveyor, hereby certify: That in full compliance with the provisions of Chapter 236 of the Wisconsin Statutes and the subdivision regulations of St. Croix County and the Town of Hudson, and under the direction of Trinity Lutheran Church, owner of said lead, I have surveyed, divided, and mapped the above described parcel, and that such map is a true and connect representation thereof_ 7 Clarence E. Schultz, Reg. No. S-2013 Date Melchcrt Walkky, Inc. 749 Highway 12 Hudson, Wisconsin 5401 b ? 15-386-7736 __~~ _ alb E. ~~ 2031 = ST. PAUL /J!N Z~ VOL. 15 PAGE 4142 Sheet 2 of 3 ST. CROIX COUNTY ZONING DCPARTMENT AS BUILT SANITARY REPORT Owner ~ N~ Tr/~u-n~?~-~fZt ~cff- ~~.~r i~ y'~:~t.r~2 , Address /~os~ G ~- ~, City/State /-~r,~/J~Sc~y ~, S-~/yiG Legal Description: / Lot ~ Block - Subdivision/CSM # ~~jy g J - S '/6c.~ %,~ c•~ , Sec. ~, T~N-R /mil W, Town of _~ d S cvJ PIN # oho- /oSf/_~,. ~o 020 - ~osg- qo SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: Tank manufacturer l~cJ~Eh~~2 Size ST/PC~~J / Setback from: House /3- Well oo'p/I,/8~~$ Pump manufacturer - Model -- Alarm location r-- (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: ~ ~l c tt Width ~ ~ Lceg~ >oo ' Number of Trenches ~ Setback from: House moo' Well ~~' P/L/~ yeast to fresh air intake Ga' ELEVATIONS: Description of benclamark~OtK~ iv io?""asp Tp~~ Elevation /oo •~' Description of alternate benchmark ~i.disrf ~LomQ ~.J /~/~..~ !j[p. Elevation X09'- ' /0,~. Gg~ /0.•38" Building Sewer /03- y3 ~ ST/HT Inlet ~c9 ~ • 3a " ST Outlet / of• ~S " pC Inlet -~~ I~i1xl i Faso ~. /O 7 $y ~' : /!~(o . g ~ PC Bottom Header/Manifold 98 ~~' Top of ST/~Manhole Cover~~•/o'7. ~~'p , ioG_ y? Distribution Lines ( ) () () Botto of System (f~ ~ ~8 a~ " ~~ l~'G- So ~ ~~ -r~S;ao' ~G N~ 93 ' y S,~T - . oo FinalGrade (~~) /0,5;ou' (~) /D3,c7y' (~) /oo.oo' ~ ~~7.00' Date of installation~,62~/nt Permit number 3~i95/g~ State plan number GS4a~3 n / f-.. Plumber's. signature ~~ ~~ ~-~- License number ~~, e/ ~ Date ~/di/ o~ Inspector ! r~1 ~91.'~~$~`l ('omplete plot plan p' NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. PLAN VIEW ~`s - ~- wE~~ o J~£w gU/<D~iJ~ oQ 93~~3~~Gt5G5 y s«+ yi, P~~ ;Ew~Q ~ ~.•I E - 3 ~ S ~S~,~c~.~ ~ /~ETw~ ~o' TI 7't T ----__ 3p° .- ~/. ~• ~ 3s' .I ~ ' 3~ lo~1t . w, ES '° S~ ~fc T.aM Ks ~~ Zo~~cfQ i7o -ooi7 ~ Afi Ok~4.Er o~5~o'-ic TANK INDICATE NORTH ARROW /JD SC/ILG~ - ~8' .~ ,~, y . 'v,, ~- ~, N~~Q ~oxES 7Er `lo ~ v~nl~ y /66' T s~k ~~~vE~r~ 's ~QO•~r ~sc~/!5 ~~5~ ~+P~P~f ~~~ Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) 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 Trinit Lutheran Church Hudson Townshi CST BM Elev: t Insp. BM Elev: BM Description: ` TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic / Z ~ 2..~~-t/ - 3 ~'D ~ ~'f~ Dosing ~ Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. L Vent to Air Intake ROAD Septicy~( ~ ,~ f ~ __.. S~z, ~ (S~a ~ 7 4( Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Model Number TDH Lift Fr oss S' Forcemain ength i~ SOIL ABSORPTION SYSTE ENCH Width t Length DIM ~ I ~ SETBACK SYSTEM TO INFORMATION Type Of System: V- DISTRIBUTION ShfSTEM 1~ t~~~ ~$ ELEVATION DATA county: St. Croix Sanitary Permit No: 399481 State Plan ID No: Parcel Tax No: 020-1059-00-100 STATION BS HI FS ELEV. Benchmark 2.O (~2.0 t ~~ •D Alt. BM 2.S~i Oq,~~' Bldg. Sewer SUHt Inlet ~,' 9.D b3~ O I St/Ht Outlet ~, 1 °~'Z$ ~ 02•x-2 Dt Inlet Dt Bottom Header/Man. Dist. Pipe s °~-- C. Bot. System 5-~- ,rrMU`>r¢- Final Grade l St Cover 5~ 2 t,~ .~~' •3~. 02.~~' •~v Ib2.3o~ ,,,~~ ~ ~ ( Iz.ez 99.3a f (oG Z a ~ ~~ U ..L L.,~ .1.~ ~ _ n o. Of Pits Inside Dia. Lip LEACHING Man rer. CHAMBER OR UNIT Model I~u~be~r•.r_ ti Head r/Man'fo Distribution x Hole Size x Hole Spacing Vent to Air Intake p• e(s) f ..~ 2 Len th ,/' Dia ~ Le Dia Spacing ~ SQF4~VER r PrRSSUre Svstemc ~nlv Yr Meund Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes ® No ~ Yes ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:~/ ~j / a ~ Inspection #2: -'7"-T'b Location: 614 Badlands Road Hudson, WI 54016 (SW 1/4 SW 1/4 22 T29~ R19W) NA Lot 1 Parcel No: 22.29.19.224A 1.) Alt BM Description =~ti-.l'~M,~ ~p('q ~,,,, r„-.(,-~-~ .. °t J 2.) Bldg sewer length = ~j~ p ' r - amount of cover = 3) ~ ~ ~~ - ~~~ ~• Gtr (~.,~-~~2~ - Plan revision Required? [] Yes No ~~ ~ ~ ` Use other side for additional information. ' SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. ~. '~ S s V~~ 1 LZ • ~Z, ~gq.z8~ ~ `f. ° 1 ~$'O~J x•30 ~ R~•98~~ C9~ a \ ~ S' ' ` ~~b 38> (q~-~3' 9~•3~ s~ ~~6 ~~ i s --~ 96.2 `~'') ~~ ~ q ~~ ~ ~ -~ ~ ~ ~~.~.~ l ~9~.8 i ~~~ss~ ,s q i.as> /~ • ~s_ ~ii.8s~ Safety and Buildings Division 201 W. Washington Ave., P.O. Box 7162 Coun 1SC0~~l~ Madison, WI 53707 - 7162 Site Address Department of Commerce ~ ~• Sanitary Permit Applic ~-~-~ _ s""`ffi'y3q~ yg/ r In accord with Comm 83.21, Wis. Adm. Code, personal ' thin you~pv' ~ ^ Check if Revision ma be used for seco ses Privac La , s13' 1 I. Appflcation Information -Please Print All Information 1 rate Plan I.D. Number ~ 6 , ;~~~ ~!R t Property Owner's Name arcel Number ~ /~ Cry ";C ~ E a . ~ •~ __ ailing Address \ ~`~ ~,qlt~- , d,~ M Property Ow~r's Property Location / ~ f' , 1 Sk ~ 5i: S T N, R E Ciry, State Zip Code P a~Niyabei ~, ~ Nlumber Block Number Subdivision Name CSM Number - ~ 6 S9'~'f'8 ~~' ~ ~~~~~ w~ a 6 ~- . II. Type of 'ding (check all that apply) ^Ciry ^ 1 or 2 Family Dwelling -Number of Bedrooms ^Village ® Public/Commercial - Describe U ~ ~4 ~•I'ownship ^ State Owned ~s~ ~S t Nearest Road 'ZZ ~L`y, f y , ZZ5/ ~j _~, III. Type of Permit: (Check only one box on line A (nttmbering scheme for internal use). Complete line B if applicable) A 1 ~ New 2 ^ Replacement System 3 ^ Replacement of 6 ^ Addition to For County use S stem Tank Onl Eris ' S stem B. ^ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(nllmbering scheme is for internal use) 44 ®Non -Pressurized In-Ground 21^ Mound 47 ^ Sand Filter 50 ^ Constructed Wetland 22 ^ Pressurized In-Ground 41 ^ Holding Tank 48 ^ Single Pass 51 ^ Drip Line 45 ^ At-Grade 46 ^ Aerobic Treatment Unit 49 ^ Recizcttlating Y. D' ersal/Treatment Area Informati on: ~„ Design Flow (gpd) Dispersal Area Dispersal Area Required Proposed Soil Application Perco anon e s em eva on e Rate(Gals./Days/Sq.FtJ {Min./Inch) ~rQ = 9U:1.''J Elevation oG~ys, T= ~ ~' 0~.3. S E*l = .9S.OD TNH~2 ~ ~.N = 93 sv , o, Tank Info Capacity in Total Number VI Mamifacturer Prefab Site Steel Fiber Plastic . Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank a _ _ _ _ Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature i!rfP/IvfPRS Number Business Phone Number ~ oCo~ oC ~~ ~ ~ d' -' O Plumber' Address (Street, Ciry, State, Zip e) ~ ~~~ ~ D VIII. Count /De artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Approved ^ Disapproved Surcharge Fee) ~ ^ Owner Given Initial Adverse ~f ~'' u Z "J • Determination ` IX. Conditions of Approval/Reas"o~n~s ,f,o"r Disapproval 5 ~ ~,,,,-~{~ t~Q, ,,,,,(.~ .~ 5~ ~ , -" T~ n i^" ste.w,. -s r z~ ~ ~ ~• S Q i ~ • `~ ~" ~ ~ _ ~ - Y c,,p.M..v~. s~ ~e~r ~ .p~~- s`Y ` - ~oo.rQ~S ~'HL.~A.OfZ- 1 5~(S~ w~.l ~ ~ b+'e1/ n ~ p~t;W ~ Q ~ re, u . . , o, ~ ~~ ( ~ ,,~`•~. wr~w~" L7~C... CJ~o~RD~ u~'-~4I~ 1 V'2L,~-titt.N~dl .... .... .... n..f Inca fhnn A1f2 ~ 77 inchde U dze ...a..,.......r...... f,......•,• ..............~ .....,,, ...- -, SBD-6398 (R. OS/O1) a Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT -~1~~b d 3 Page ~ of - m accoraance vwcn ~,omm oo, vvis. rrurn. wue County ~ , C~ Jx Attach complete site plan on paper not less than 8 1/2 x 11 inches in size Plan must ~ . inGude, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. o Z Z ~~ ZZ4 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 2, I , . Please print all information. sewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~/~ Property Owner /' e L ' ^ Properly Location ~ Q 5 1/4 SZ2 T Z~ N R ~ / E W -cN QA~ I..NV' (~~ uL 1 1T Govt. Lot 1/4 - (or) Property Owner's Maili~" Address S Lot # Block # Subd. Name or CSM# 4t 1 L %,,~©S It ' "' ` S T ~ ~ 1 t~l+PLd TT~ City State Zip Code Phone Number ~ City ^ village Town Nppea'rest Road ~c,dS~ we S~4~G ( /S~).3~G C~S6~J ~~ OA~la4~1~S New Construction Use: ^ Residential /Number of bed i~s ~C d d design flow rate /9.~0 GPD ^ Replacement ~ Public or commercial - D ~ ?o~___--~_7~ _ __- Parent material 1 R'I ~ I lain el do if applicable / V ' ~ ft. e ~ ~ ~ men and recom dations: ~ ~ T 2 ? 2001 N %- ST Ci~O-X Borin ~ ~` ~~ Boring # g /U .j' ' ~.~i pit Ground surface elev./~Z•s ~ F~C~ imitingfactor~~9~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP DIff° in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 -4°~ /DY ,~ - S ~ L % r" sbx yh r C,S - ,Z . 3 ~ -192 / v 4 ~i: .- S Sir n- ~ O. /. Z Boring # ~ Boring Pit Ground surface elev. 9~. 3 ft. Depth to limiting factor 7 ~~a in. Soil ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. 'Eff#1 'Eff#2 A -ll 2 1 ~ -- ~n-,s~K n~ ~ cs 2 ~.4 l~. r ~/ Z1 goy 4 3 -- S ~ Z 1 ~, Sb K >^ cs ~ a . 3 'Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` Emuent rrz = t3vu < ;io mg/L and T SS < :i0 mg/l. CST (Please Printyta N ~~ ignature CS~Number~7 JJ !J Address Date Evaluation Conducted Telephone Number Po Q/ 1,~~ ~ s~ ~ X11 s4o %b J~r~ 7 ~a ~ ~~ 400 ~, ` R Property Owner `r~, N ~ T r L • ~' Parcel ID # Za •2 ~ ~• ZZq Page ~ of Boring # ~ Boring c,` pit Ground surface elev. ? ft. Depth to IimiGng factory ~ ~1 in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 A ~- r' 4 Y 3 '-~ L !! rn )'Yl r S Z 3M Q r4' - ~gp ~ --- G S SL, /h ~ D , 1, ~, Boring # ~ Boring ~/ ~b ® Pit Ground surface elev. ~a1.4 ft. Depth to limiting factor in. Soil liration 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 A /dYR3 / - L 1-"- SDK rn r GS Z 0 ,4 d ,~ z6 y 4 3 -- S~ ~ bK ~- ~ cs - ,z o,3 ~ F Q C S SG m _ ,7 /.4 at glY.o~ •8 m. Boring // Boring # Ground surface elev. d• ~ ft. Depth to limiting factor ~~~~ in. Pit ~ Soil ication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/f['- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 J t z~ y+2 4 3 - S, ~ ~ S k 1~ GS - 6.2 ,3 ~ q~•s • Effluent #1 =BODE > 30 <_ 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 =GODS < 30 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. SBD-6330 (R.6U0) L~{JTC~LI-J~ U S J~iG~Jf,,.-AY + ~~~ W n ~,, ~` u~ r ~ ~ D z L C~ ~d r~ I~ Z Z ~ ~~ 1 f _ _ ~ - p~ - - _ - ~ R, 0_ ~- ~ \ ` 1 ~ _9 ~ ~ ~ ,+ ~ t~ .C '. .. ~ o ~~ _- c~~ ~ _ ~ ~ G ~ Ns ~ i/~ 1~1 N= ~ a ~ G N r L ^ 7v~ v g~~ ~i ~° ~~ cJt (V ~ ~ ~ °' ~ . ~ ~ ~ a~ ~~ ~ A L /\ ~.'FLAYFIEID ~~`" " ~ ~~ i ~ ~{ ~ ~'/ ~' ~ PROPOSED BUILDING '~N,s~F<~~~,~~~~ SAS lc3J'bp~ ©R vy S~~~t~~ vin r ~~ ~• ~ooo{ P~~ !~~ , p~ ~ P Q~' t / 4 t,/D` ~. 4 .. 4G / / // 4 4 O ~ C ' o ~ p j ~~ 4/ /. /// / / ~ 00~ 4. v ~~ ~ ~ 4 v L ~ y Y j I !~~ \ \ f \ ~u _~~ r~ir~,i2c ~ ~~~ \ ~ ~ ~~ I ~ /~ ~ Y ~N.E CURB ~ 9a ~ .. 2 ~ -20' ~ C2 ~ ~ l /~ o ~ ~~ 4 ~ 4 ` ~~ .. ~. a..i...~ ~%rz~. ~t.~;' 24.00' YP). ~. c9 ~R Safety and Buildings ~/ ~,O 4 ~ O 5 . ~1~{~'PFiP 5' CONC. WAUi vQ~p. o ~~°~ ..o 1 ~~'~ G o t cr.~ Gv,~s~l ol« T~t~ c.~ ITH SCC p..~/~ ~ y ~~rJt1-{ /f 9 / rY. hr?i( S'~//~~ L %S1 ~ ' ~,~ uses ~.~~. = rig ~3. -. ~} ~~ c~.fo 7v ~q rr /ROAfR7Y ~'"f ~ _~ LTiE _] ~__ ~r°E~Tjz ~l~q,./ /oo' /JE~t1C, p? ~(SG,S' ~•U ~ ' ~ s `h~itinf•E7S r ot-7~'£n-cH "u +~UUUL1_ ~Q ~f~~ 1 / ~E7z/~tl Tt;.IcNgS V~nIT~ 3-~ L~ RirlBt~S ~~~n( FnIU o~ Tic ~ /O 5-----v~ ''~" ~-~5 ~ To So~-r-t~ ~2~PzQ~y- ~..~,f Q ~~ ~ A a /V c7 S~..c.. , . . .~ ~' ~ ~ ~scons~n Department of Commerce Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi.us/sb www.wisconsin.gov Scott McCallum, Governor Brenda J. Blanchard, Secretary July 03, 2001 CUST ID No.222373 GARY T ZAPPA 715 SIXTH ST N HUDSON WI 54016 ATIN.• POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/03/2003 Identification Numbers Transaction ID No. 656213 SITE• Site ID No. 631942 Trinity Family Care Center -Badlands Road Please refer to both identification numbers, St.Croix County, Town of Hudson above, in all cones ondence with the a enc . SW1/4, SW1/4, S22, T29N, R19W FOR: Description: Commercial Non-pressurized Leaching Chamber System - 2895 Gallon Design Daily Flow Rate Object Type: POWT System Regulated Object ID No.: 799189 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. 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 "In-ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10705-P (N.O1/O1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. The owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the conventional component manual are complied with. A copy of this.letter including instructions and information regarding proper use and maintenance of the system must be given to the owner and each subsequent owner upon completion of the project. • The leaching chambers must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • A state approved effluent filter is required. 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 Comm 84 product approval conditions. • This approval does not include plans for the general plumbing systems or sewer piping leading to the septic/holding tank that maybe required for this project. See section Comm 82.20, Wis. Adm. Code, to determine if plan submittal and approval is required. • 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. • 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. ~ ~ ~ GARY T ZAPPA Page 2 7/3/01 • Comm 83.52(3) The activities relating to evaluation and monitoring mechanical POWTS components after the initial installation of the POWTS in accordance with an approved management plan shall be conducted by a person who holds a registration issued by the department as a registered POWTS maintainer. • The changes made to this plan on 7/3/01 by this reviewer were acknowledge and approved by the system designer. 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 Safety & Buildings 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 maybe made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, /~~ Gerard M. Swim POWTS Plan Reviewer -Integrated Services 608-789-7892 Mon -Fri 7:15 AM to 4:30 PM j swim@commerce.state.wi.us FEE REQUIRED $ 225.00 FEE RECEIVED $ 225.00 BALANCE DUE $ 0.00 WiSMART coder 7633 cc: Dean Knudson -Trinity Lutheran Church a Z r ~, ~ ~ '+ r ~~ l ~ n ~ o O ~~ a ~ ~' ~ c ,~ -~ -~ ~ ~ ~ ~ ~ a ~ ~~ ~ ~A '~ ~ Z ~ ~ ~ ~ ~ C ~~ ~ op ~ ~. ~~. y ~ r ~ ~ l~ ~ ~ ~ ~ Q ~ N ~~ ^~ (~ m m C "~~' n `n ~~ ~ o ~ ~ ~'~7 ~ • . O O ,~ $O A N~ ~T~ ~ ~~ `~ ~ © , ~~ ~N 1 '° R ~ w ~ ~ __~ , D 2 ~~~~~ ~ ~ -~v ~ ~ ~~ J ~ o `1 ~n ~ ~ 1 ~'~ ~~ 'I~ ~~ ~~~ ~ ~= ~~ 1 n ~ ~`~ ~ ~ ~ ~~O ao, i Vv ~~4 ~~~~ ~ ~ ~, ~ ~ w ~, ~b~ .yoy~ ~~yn n 'n ~~ ~~ ~~ fi n '~ n~ ~ . n Q ~ Z g....::_..:_ ..1 ~ ~~ ~~ ~ o ~~ ,~ G cI~ _~ 3J 1~ ~~ -.~ ~ y y ~n ~ c ~ ~ h ~ ~ ~ ~ ~~, S _.. _ ~r' ._ ,~ v~ C' /~ 'D In /I/o2.h' licaNEitrY fa~/t~r< PLATFIELD ~y ~~ 4 ` _'. 4 O 6 / 4 O ~yO~~~~~P 5' COMG WALK v P~ P: PRUPUSED e ~~~~~ BUILDING SGS /c31-oaf ©R o y ~P . OQO-~ ~~P 4 / l~~,~., O~ ~ QYP ~p ~ ~ „hGF~ YD I~UL 7L`LJ~yC ~ i ~'~ ~n,'lLLoiJ lc.Ji~/i~? Pl«'rit~/~ GJ/TH ~ / 4 No C2 / ~ 4 c' .. / nn 4 // 4~ o ~, ~ !j'~~O„~p~-Q`i ~J~>Jzl-~I'/Jt~/f/C t~ / `' ' 4 ~/l l \ , g5 \ use ~ y ~ S ~c.~v. _ ~! d /3 " .4. tJ it c:~.4o 7J %t'AST q //20AE~TY 4 - V4.. 4 '.4 \ L.TivE //~~ \ q ~~,. \ Q~ \ ~R~E~.~, \ ~ IJCI i V~ iN~ ~ rEGT/ON ~ S~ S C ~{ifJ!!/~Er~s YYrCd ~ ~ / ~ ~I~CYr/ T O .~iroFrrrr, Lrvr ~ 9~ ` ~~, ~ f T~'G,tl L H /vo' 6612 CURB \ i Q c2 / ~ __ ~ /.?"ASS ~~~' ~,~~~. ~caoJ~ 4 4 4. 4 4 ~ ~~ ~ ~ ©R ~fSGS L~/. _. ~ 1. ~ ~.. •` ~ za,oo'.. 3.S~SD,~c/ ~ ~~n~~ T~/JCi/~S J='r~o~~us ~.~a . lJ.~ir~~v. . ~~> ~- E-- .1U.00'(TYP) . ~iJTj 3~~ L rtrq,BE~S ~ c7r~/ ~.~Il~ otz ~cJJC If /Q s! ~~ '~ ' ~-~S ~ To So~-r!f a -- `~ r, _i~ b M -l (~z - ~. ~ ~ Invert 11'---I b n r •~ !1 w ~ ~r ~^~~~ a ~ ~ ~ X ~ M ~ 3 '~ _ C F ~ `1~ i Z ~ ~ r N p ~ : 1~ ^ ~ e 'p ` O Z M r ~ ~ d ~ T L ~ ~ ~ ~ ~ 2 l b ,1 ~ . e '+ ~ M ~ ^~ > m L ~ M x po 3 ° - e 0 n 1 Q F ~~ ~h ~~ ~ r ~ ~~ ~ Z M ~ } ' 1 ~ ~, -L ~ G M c ~ ~ , ~ ~ p (nl i~ ,1 ~ '~ ? , ~ ~ ~ 'b W ~ `ll + ' ~ n ~\ ~ ~ ~ ~ 1` c : fr ~- f i `~ h e o• r~ ~o 1 . ,r L b a ~~ ~ ~ ~1 N `\ R^ n, ~ ~ x a ~. h ~~ I ~~ li\ ~C. ~~ ~o Ib ;O i.. ~l _~ r ~ ~~ t~ ., ~ ~ ~ ~D c ~~ 6 ~ ~ ~ a ~` ~ n 'd ~ -~ ,~ -~ '~ ~ ~_ ~ . ~ ~ ~~ ~~ ~~ r rr ~1 ~ 0 ~ o ~Q ~ 4 ~ c i o ~ o ~ 3 ~ ~ ~ r ~ ~ ~ ~ ~ 3 r0 ~` ~• a r ' ^t 1" ~ ' *~ r r ..p ~ t ~~ ~' N _T, A ~, ~~ ~~ 0 k w k 0 Q O ~ X ~ ~ ~ ~ G Q ~ ~ \ d A w d S 0 a 0 _ - ~i ~ ~ ~ . o ~ .. G p ~ ~ v ~ N r O ~ d b ~ ~~ ~ ~ s ~ ~ ~ ~ x ~ ~ ~~ ~ °4 ~ ~~ ~ Z ~ \ _ ~ ~ W b ~~~~ ~~~~ ~~ b o ~ G ~ (R O v~ s lJ r _~ r G ~ k x x (A ~~ C d ~ \ ~ o W 0 d d kappa ~ro~h~r~ Ins. 715 Sixth St. too., fiiud~on, WI 54016-1074 0 f f ie~: T15-386-250 ~'aX: 715-3~6-0323 Trinity Family Care Center POWTS Operation, Maintenance, and Performance Manual OWNER: Trinity Lutheran Church 1205 Sixth St. Hudson, WI 54016 Contact: James Schreiber 715-386-9313 DESIGNER: Zappa Brothers Inc. 715 Sixth St. North Hudson, WI 54016 Contact: Mark Stahnke 715-386-2850 Fax 715-386-0323 INS~'ALLER: Zappa Brothers Inc. 715 Sixth St. No. Hudson,~Wl 54016 Contact: Mark Stahnke 715-386-2850 Fax ?15-386-0323 GOVERNMENTAL AGENCY: St. Croix County Zoning 1101 Carmichael Road Hudson, WI 54016 Contact: Rod Eslinger Kevin Grabau John Sonneata~ RECEIVED JUN 15 2001 SAFETY & BLDGS D1V. Department 715-386-4680 715-386-4680 ~ 715-386-4680 715-386-4886 In the event of component failure or malfunction notify Zappa Brothers Inc. or Tri-County Sanitation, Hudson, WI Contact: Ben Morgan 715-386-2130. P.o.wonatly Cpnd>lt ovEo AP P R f COMMERCEN~ OEPARTMEN~ M tl11.p~ .~ p1VIS10N ~ DENCE SEE CORR,ESP ' ~ - , . r« ..3, s'..~ . 2 7. o' p,_ ~~;' _ g: s+;,9t. f~ ~ ~h ,~_~ _ ~ ...F ? ~L S rr Page ~ of o~. MANAGEMENT PLAN This Private Onsite Wastewater Treatment System (POWYS) has. been designed, and is to be installed and maintained-ie according to Comm 83, Wis. Admin. Code, the In-Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems (SBD-10567-P; June 11, 1999), and the Marathon County Private Sewage System Ordinance. This POWYS has been designed to accommodate a maximum daily flow of ,s';? 7O gallons of domestic wastewater- per day. The quality of influent discharged into the POWYS treatment or dispersal component shall be equal to or less than all of the following: < • ~~"G/tea monthly average of 30 mg/L fats, oil and grease. := •~~~~6/~ a monthly average of 220 mg/L BODS. ~ •isv~~/c a monthly average of 150 mg/L TSS. Wastewater shall not be discharged to the POWYS in quantities or qualities that exceed these limits or that result in exceeding the enforcement standards and preventative action limits specified in ch. NR 140 Tables 1 & 2 at a point of standards application, 'except as provided in Comm 83.03.(4), Wis.:Admin. Code. 2. The owner of this POWYS is responsible for system operation and maintenance. The following maintenance shall occur within three (3) years of the date of installation and at least once every three.years thereafter: The septic tank shall be pumped by a certified septage servicing.operator, licensed under s.281.48, Wis. Stats, unless inspection by a licensed master plumber or other person authorized to make such inspection, finds less than one-third (1/3) of the tank volume occupied by sludge and scum. More frequent pumping maybe necessary to prevent solids from exceeding one-third (1/3) of the volume of the tank. Wastes shall be disposed of by the pumper in accordance with ch. M2 113, Wis. Admin. Code. At each pumping the pumper must visually inspect the condition of the tank, baffles, rizsers and manhole cover and verify that any required locks are present. 2. The soil absorption component(s) shall be visually inspected by a licensed master plumber, certified septage servicing operator or POWYS inspector. Inspection shall check for evidence of discharge of sewage to the ground surface and for ponding of effluent in the distribution cell. 3. The tank filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. The filter cartridge shall not be , removed unless provisions are made to retain solids in the tank. Cleaning o'f the filter at more frequent intervals maybe necessary. 4. Any pump, alarm or related electrical connections shall be visually checked for defects and tested to confirm that they are operating properly. 5. Reports for all system maintenance shall be submitted to Marathon County in accordance with Comm 83.55, Wis. Admin. Code and the Marathon County Private Sewage Systems Ordinance. 3. Defects or malfunctions identified during maintenance described in item #2 above shall be repaired in conformance with Comm 83, Wis. Admin. Code, and the Marathon County Private Sewage Systems Ordinance. The User's Manual, provided to the owner of the POWTS includes the names and telephone numbers of the properly licensed individual(s) to contact for such repairs. 4. Anytime a failure or malfunction occurs, it shall be reported to the person(s) identified in the User's Manual for this POWTS. Repair or correction of such failure or malfunction shall comply with Comm 83, Wis. Admin. Code, and the Marathon County Private Sewage System Ordinance. ~. No one should enter-a septic or other treatment tank for any reason without being in full compliance with OSHA~standards for entering a confined space. ;The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. 6. No product for chemical or physical restoration. or chemical or physical procedures for POWTS maybe used unless approved by the Department of Commerce in accordance with Comm 84, Wis. Admin. Code. 7. In the event that this POWTS or a component of this POWTS fails and cannot be repaired, the following contingency plan is proposed: t 'c~rhNo~~F~Y7~ ZN /~GT~/Iit/.~'!E i9/Z.EA GvN~'/LE fQ2L ~1.iivtt,~ivT.LoN t,~,vS /~F/ttoivnt/~ iRt' ~F/L U/tGWiv[.. /JOGvTS .O~'.fz~./ /QL/9N.. FZ ~i !L ~7Nt:./1 ~/17 i cr O/2 i~/rLFL/ ,r'T7 ~n~r /I.c.Diig~c ~~ /? /J.!' /IFOG[7i1~j Cur,r~ , ~3..33~ ~/.ss. /dGtirl7iv. C~o~ l If this POWTS is replaced, or its use discontinued, it shall be abandoned in accordance with Comm 83.33, Wis. Admin. Code. Application: Commercial septic or grease trap filtration for ZOELLER 24' DIA. removing hair, flour, lent, grease, etc. from the Waste Stream. SEPTIC TANK RISER Filter Area: 240 Linear feet of 1132" filtration Flow Rate: 3,240 gpd Materials: All materials are noncorrosive in the septic tank environment (Polyethylene, buns-n, PVC, 300 Series stain- 9,DMAT less steel). CYLINDER Easy to install or retrofit: The Zoeller Septic System Filter fits onto any 4"schedule 40 septic tank outlet pipe. Slide the filter on the tank's outlet and tighten the all stainless steel worm clamp. The system is now protected from discharging solids greater than 1/32". Easy to maintain: A routine maintenance schedule should be set up to maintain each filter properly. More frequent cleaning will not hurt the filter and could even improve the performance of your system. For installations that exceed the design flow rate of one filter use a manifold type arrangement to add as many filters as required. 5 11/16' 22 t/2" 16 13/16" 'NOTE 4' PVC PIPE (SUPPLIED BY~~ OTHERS) FILTER OUTLET CONNECT WITH ° ALL STAINLESS d STEEL HOSE CLAMPS 11 7/I6" u DIA. ° TANK SK1717 'NOTE: Stateand kxal plumbing codes may require a specific liquid penetra- tan. For example, 25°k - 4596 into the liquid depth or 9' off the tank bottom. Better than a screen: The Zoeller filter with its biomat cylinder design is better than a screen. (1) Screens typically have a smaller filtration area than a filter. The Zoeller Commercial filter is designed with 240 linear feet of 1132" filtration. (2) Screens typically do not filter particles as small as filters. The Zoeller Commercial filter can filter particles as small as 1/32". (3) Screens typically are not as rigid as filters. The rigid design of the Zoeller filter adds to the protection of your lateral system. (4) Screens are typically much larger in size than a filter. The compact design of the Zoeller filter aids in installation and servicing of the system. (5) 100% of the Zoeller filter area is below the outlet, therefore 100% of the advertised filter area is used. (6) With a filter installed, a gas baffle will not be required because gas induced floating particulate will be kept in the tank . Lifetime Warranty: Every Zoeller filter is guaranteed to be free from defects in materials and workmanship for the lifetime of the homeowner/purchaser. Free repair or replacement, excluding labor, will be made on return of the filter prepaid to the factory. This warranty is limited to product proven to be free from abuse or improper installation. ALL ZOELLER ONSITE WASTEWATER PRODUCTS MUST BE INSTALLED IN ACCORDANCE WITH LOCAL AND/OR STATE PLUMBING AND/OR HEALTH DEPARTMENT CODES. ---- MAIL T0: P.0. BOX 16347 ~ l ~ 7 ~ }_ Louisville, KY 40256-0347 Manuladuerso/. . SHIP TO: 3649 Cane Run Road % ~ 1 ~` `\' Louisville, KY 40211-1961 ® / / ~ (502) 778-2731 ~ 1(800) 928-PUMP QUaurr PUMP6 SNCE /939" httpJ/www.zoeller.com /~LI~P ~~ FAX(502) 774-3624 © Copyright 1998 Zoeller Co. All rights reserved. p SECTION: 3.20.050 QU.4L/TY ~UMPS ~NCE ~~~~1 ~~ ~ °~~~ ~ ~~~ FM1554 aco ,F4 ~ ~ '~ ~ ~ 1098 No`` Mp ~ ~ ~ ® ~ Supersedes Product information ~~ 0 0498 presented here reflects PUMP l0. conditions at time of publication. Consult factory regarding discrepancies or MAIL Tt): P.t). BOX 16347 • Louisville, KY 40256-0347 VisitOUrWebsite: inconsistencies. SH1P T0: 3649 Cane Run Road • Louisvrlle, KY 40211-1961 http:!/www.ZOeller.COm (502) 778.2731 • 1 (800) 928-PUMP • FAX (502) 774-3624 8O6666R ON-SITE WAST~WAT6R PRODUCTS /N4'RODOC/IYG 8O6LL6R SHPT/C SYSTEM P/bT6BS x": -..... The Zoeller Commercial filter is a wastewater filter de- signed to filter out solids to 1/32". The filter will greatly reduce the amount of grease, hair, lint, flour, food particles, and high rates of suspended solids in the waste stream. Problem: Restaurants discharge large quantities of by products into the waste stream every year resulting in thousands of dollars in maintenance costs and fines. Grease traps and interceptor tanks provide some pretreatment of the effluent but if they are not serviced properly the effluent stream is not helped significantly. Properly maintained systems can even discharge unwanted material. Solution: A Zoeller commercial filter can be installed on the interceptor tank outlet to aid the removal of grease and particulate from the effluent stream before it is discharged into the environ- ment. The filter allows easy servicing of the system by the restau- rantstaff. Installation: The filteris installed to the outlet pipe in the interceptor tank and securely fastened with an all stainless steel hose clamp. Recommended peak flow thru the filteris 3,240 GPD. For installa- tionsrequiring a greaterflowrate, multiple filters can be manifolded together. Servicing: A routine maintenance schedule must be set up for each specific application. During the first month of the filter installation, the filter should be checked daily. At the end of the day, pull the filter cartridge and allow liquids to drain back into the tank. Weigh the filter and record the weight. When the weight of the filter stops increasing from day today, the filteris becoming full. The cartridge should be cleaned at this point. Cleaning the cartridge can be performed by either the restaurant personnel into a waste grease container or a service company. If a service company is used, then the used cartridge should be placed in a large plastic bag and wait to be picked up by the service company. A clean cartridge should be placed back into the .grease interceptor tank. Extra filter cartridges should be kept on hand by the. restaurant as well as the servicing company. Depending upon the amount of waste grease the restaurant discharges, cleaning intervals may be as short as a few days. Distributed by: --~ ~ ` , \ JJ !! PL/MP l0. © Copyright 1998 Zoeller Co. All rights reserved. SK,7,8 Covered by US Patent No. 5,762,790 t ~ ~' Wisconsin Department of Commerce Division of Safety and Buildings SOIL EVALUATION REPORT Page I of rn accoraance witn Comm co, vvis. ram. ~.ooe County S ~~ l X Plan must er not less than 8 1/2 x ~ 1 inches in size ite lan on a l t h A ~ . p p p ttac comp e e s include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. ~ / ~ 22 `t Z~ percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 2, , . - Please print all information. Reviewed by Date Personal infortnalion you provide may be used ror secondary purposes (Privacy lsw, s. 15.04 (t) (m)). Property Owner / /' L Property Location p W ~ 1/4 SZZ T Z 7 N R f' ~ E ~ 4sf S ~~u~lo~ I.NU~~.N 1 7T (or) . 1/ Govt. Lot r, Property Owner's Mailin Address ~ Lot # Block # Subd. Name or CSM# - -~ L~~~ ~~~5 ~ srt. - ~~L,~~ City/ State Zip Code Phone Number ^ City ^ village Town Nearest Road New Construction Use: ^ Residential / Number of bedrooms Code de 'vied design flow rate /9~ ~O GPD ^ Replacement / ~ Public or commercial -Describe: ~U ~~~ ~~.--_ __- Parent material G,1 L,JCIG l 1~ L (~/ h-"'~7~ S i~ __ __ Flood Plain elevation if applicable ~ Y ' ` ft. General comments RECEIVED and recommendations: 'tic, goon PC S"$- ~t~ - ~~~- gu~kl~~ep~r- ~'~d- ~luo; JUN 15 2001 a I Boring# 0 B°nng i7AFETY & BLDGS t~t~ pit Ground surface elev.IOZ.s ft. Depth to limiting factor ?~~~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP D/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 49 / Y 3 -- S ~ ~ ~ ,~,., sb~ m r cs - .Z . 3 ~ -l9Z / v 4 d. ~- C S S~ n- - /. Z Boring # ^ Boring ' / 3a pi( Ground surface elev. q~. 3 ft. Depth to limiting fadbr in. Soil lication 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 A -lf' Z) --- ~ry,sl~lC rn r CS ~ ~.4 1,. >>~, goy 4 3 - SQL 1 ~,sbK H cs -~ d.3 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ` ttnuent ~r1= aw < 3U mg/L ono I ss < 3v rtxyL CST (Please Printh i nature CST Number A JdNN 5drv Z. 2757 Address Date Evaluation Conducted Telephone Number ~ ~ 4/ 1,~~~ sd>u (..~ / s4oJ6 J~,iv~ 7~~1 ~~- q~o~ Div. ,~ Property Owner ~fG / IV 1 T y ~ . ~. Parcel ID # Z~.~ ~ ~. ZZ~' Page Z of 1 Boring # ~ Boring c Pit Ground surface elev. ~~ ft. Depth to limiting factor 1 ~ 6~ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 D-1 ~ v 3 ~-- L 1 rh n~ r ~s ~ vh o ~4 - Z ,~~~~ 3 - g ~ rr1 sb~ r~ es - z 6,3 .~gp ~ ~-- GS SG /h -- 1. 4' Boring # ~ Boring pit Ground surface elev. ~a1.4 ft. Depth to limiting factor ~' ~ g~ in. Soil lication 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 A /dY~23 l - ~ I -'+'- SbK rh r CS Z n? 0 ,4 ~ ,b -2~ v 43 - S~~ sbK ,M r C5 - ,z 0,3 Boring / / Boring # Ground surface elev. r>• ~ ft. Depth to limiting factor ~~4U in. Pit Soil lication Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GP D/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 -~ i~y23 ~ - L 1 Mcb~ r c Zr~ 4:4 b~6 ~ d Z~ 4 3 - s, t, ~. s k ~- ~ s - a Z ,3 7-~~6 lOY2~ -- GS SG .7 /. 'Effluent #1 =BODE > 30 < 220 mg/L and TSS >30 < 150 mg/L 'Effluent #2 =GODS < 30 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. S8D-i3301RdU01 ~~ ~ ~ ~ , (_~IJT~~LIw11a US ~IGIJI..IAY ,IZN Db `~ w r~ n~ ~` n ~ I" ~~ D z ~ gb ~d ~~ ~~ 1 i F-- ~ 4° i i~ .~ ~`~ - - - - ~~ O ~ ~ 1 -. A ~ « / • / I i\~_ ~'^ L ~ ~ '~ ~- IR N= ~' ~ r-~ N= ~+a v~ c ~b~ v _~ ~i~ g. ~ ~ ' L ~ ~_ Q ~~ ~ A ~ ~ ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer ~ ~'~ ~ ~ ~VI ~ [ V 1~ ~Q.(~ (il~ 1l~(,I~~ Mailing Address ~ S S~ X, S~~ TTti~lGt~lJ~ ~ (.(~~ J~~~~ Property Address ~ ~ '~ ~ a ~ ~ Q Vl c~ 5 K pGl.t~+ _ ~,~_ (Verification required from Planning Department for new construction) City/State ~u.~r~..~ ~ - Parcel Identif cation, Number ~~9 -/c~S 9- oo- dSot7 v~ o -~ v S ~'- 9v LEGAL DESCRIPTION Property Location .r~.,~ '/,, ~.Cw '/,, Sec. ~ o`) , T~N-R~W, Town of „/,~~,,r~•,i Subdivision ,Lot # Certified Survey Map # ,Volume ,Page # Warranty Deed # _ ~3~,,.~3 ,Volume /S'~ ,Page # ~~. Spec house ^ yes l9 no Lot line`s identifiable ~I yes ^ no ~k SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or alicensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of W isconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days the three year expiration date. ~~,,,~I S NATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the operty described above, by virtue of a warranty deed recorded in Register of Deeds Office. IGNATURE O APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** ** Include with this application; a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ' - ~ vot-1588PAt;E 189 ~~ ~~ 638733 Document Number WARRANTY DEED KATHLEEN H. WALSH kEGT=,TEk OF DEEDS ST. CkOIX CO., WI This Dsed, made between KENNETH W ROHL RECF?VED FOR RECORD 02-1ti-2001 11:00 All ,Grantor, YARRAH?Y DEED AND TRINITY LUTHERAN CHURCH, HUDSON, E%EI~T li WISCONSIN CERT COPY FEE: COPY FEE: Grantee, TRAHSFEP, FEE: 16~0.~0 kECOkDIHG FEE: 10.00 Witnesseth, That the said Grantor, for a valuable consideration of one PAGES: 1 dollar and other valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recordin Area This IS NOT homestead property. Name and Return Address ~~, l' C~ s Together with all and singular the hereditaments and appurtenances 'ti~,(lrJ~f ~~~ Y6,~* thereunto belonging; And Grantor warrants that the title is good, f indefeasible in fee simple and free and clear of all encumbrances except easements, covenants, and restrictions of record, and will warrant and defend the same. THAT PART OF THE SOUTHWEST QUARTER OF THE SOUTHWEST QUARTER AND THE NORTHWEST QUARTER OF THE SOUTHWEST QUARTER OF (parcel Identifigtion Numbor) SECTION 22, TOWNSHIP 29 NORTH, RANGE 19 WEST, TOWN OF HUDSON, ST. 020-1059-00-000 CROIX COUNTY, WISCONSIN, DESCRIBED AS FOLLOWS: 020-1058-90 COMMENCING AT THE SOUTHWEST CORNER OF SAID SOUTHWEST QUARTER OF SECTION 22; ~3 THENCE NORTH 00 DEGREES 35 MINUTES 35 SECONDS WEST, ALONG THE WEST LINE OF SAID SOUTHWEST QUARTER, A DISTANCE OF 492.58 FEET TO THE POINT OF BEGINNING; THENCE NORTH 00 DEGREES 35 MINUTES 35 SECONDS WEST, ALONG SAID WEST LINE, A DISTANCE OF 1444.88 FEET; y, ~ THENCE NORTH 89 DEGREES 41 MINUTES 23 SECONDS EAST A DISTANCE OF 1300.39 FEET TO A POINT ON THE EAST ~'r LINE OF SAID NORTHWEST QUARTER OF THE SOUTHWEST QUARTER; THENCE SOUTH 00 DEGREES 32 MINUTES IS SECONDS EAST, ALONG SAID EAST LINE OF SAID NORTHWEST QUARTER OF THE SOUTH WEST QUARTER AND SOUTH WEST QUARTER OF THE SOUTH WEST QUARTER, A DISTANCE OF 1447.65 FEET; THENCE SOUTH 89 DEGREES 48 MINUTES 44 SECONDS WEST A DISTANCE OF 1299.01 FEET TO THE POINT OF BEGINNING AND TH.E~yRE TERMI~N~A[TING. SUB)ECTTO ALL EASEMENTS OF RECORD. Dated this/1~Mda~ /~tAr-~.~ ~'y , 20d . 'KENNETH W ROHL l/,t;,,e-/i:~1 xn ` AUTHENTICATION Signatures ACKNOWLEDGMENT STATE OF WISCONSIN COUNTY OF ST. CROIX authenticated this _ day of _ signature type or print name TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Personally came before me this t ~ ~ da of ~ , 20Di' the above named KENNETH W R(~HTrt"'''~~ ~: ~r9 to me known to be the person(s) wltd~~ed the fpt~agoing instrument~ac owledge ~he~~~ J~f U t , , . D . J .:: ~., _ signature i. pry--°- - type or print name ~yC GV Notary Public ST. CROIX qt , ~. ~~,.~ My commission is permanent. (If not, sf~tb expiration date: - ) Robert F. Wall 'Names of persons signing in any capacity should be typed or printed Below their signatures. ~~~ ~o~ 1588 ~ E 88 ,~ Document Number WARRANTY DEED This Deed, made between ROBERT L ROHL ,Grantor, AND TRINITY LUTHERAN CHURCH, HUDSON, WISCONSIN ~a oS G '` s i ' ~u o~so ~ G.J ~ s `rO ~ ~ ,Grantee, Witnesseth, That the said Grantor, for a valuable consideration of one dollar and other valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: This IS NOT homestead property. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of all encumbrances except easements, covenants, and restrictions of record, and will warrant and defend the same. THAT PART OF THE SOUTHWEST QUARTER OF THE SOUTHWEST QUARTER OF SECTION, TOWNSHIP 29 NORTH, RANGE 19 WEST, TOWN rIL, f}OF HUDSON, ST. CRO1X OUNTY, WISCONSIN, DESCRIBED AS FOLLOWS: /~~ 638732 Y.ATNLEEN H. WALSH REGISTER OF DEEDS ST~~,CROIX CO., WI RECEIVED FOR RECDRD Oct^16001 11:04 AM WARRRNTY DEED EXEMPT Y CERT CDPY FEE: COPY~FEE: TRANSFER FEE: 503.70 RECORDING FEE: 10.00 PAGES: 1 Recording Area N~am,,Ie~and Re~um Address ~/ uG ~~G~l ~~~e~ ~ .~ I3,z4s.7q~~~ (Parcel Identification Number) 020-1059-00-100 o~ COMMENCING AT THE SOUTHWEST CORNER OF THE SOUTHWEST QUARTER OF SAID SECTION 22, THE POINT OF BEGINNING; THENCE NORTH 00 DEGREES 35 M[NUTES 35 SECONDS WEST, ALONG THE WEST LINE OF SAID SOUTHWEST QUARTER, A DISTANCE OF 492.58 FEET; THENCE NORTH 89 DEGREES 48 MINUTES 44 SECONDS EAST A DISTANCE OF 1299.01 FEET TO A POINT ON THE EAST LINE OF SAID SOUTHWEST QUARTER OF THE SOUTHWEST QUARTER; THENCE SOUTH 00 DEGREES 32 MINUTES 15 SECONDS EAST, ALONG SAID EAST L[NE, A DISTANCE OF 493.52 FEET TO THE SOUTHEAST CORNER OF SAID SOUTHWEST QUARTER OF THE SOUTHWEST QUARTER; THENCE SOUTH 89 DEGREES 51 M[NUTES 14 SECONDS WEST, ALONG THE SOUTH LINE OF SAID SOUTHWEST QUARTER OF THE SOUTHWEST QUARTER, A DISTANCE OF 1298.53 FEET TO THE POINT OF BEGINNING AND THERE TERMINATING. SUBJECT TO ALL EASEMENTS OF RECORD. Dated this/Slay of ary 2001. ~a,~, ~~ `ROBERT L ROHL -- ITICATION ACKNOWLEDGMENT O • ~ gTnTE nF WISCONSIN COUNTY OF ST. CROIX 503• Personally came before me this /~~ da of F~6 , 2001 3 ' - ~f the above named ROBERT L ROHyL, 1C~'1 °6 G~3~ to me known to be the person(s) ~yf((ho executed tha Foregoing ,_ ~ „ ~ instrumerlt.atid ~cknowledQe the same, ., S //2 SEC. ~, ~~w ~~ ~~s~_ o; ro WN SCALE !N FEET l"=200' /~ ^~~ n ~ ? ~ ~ ~ y ~ a Yf~ ~ e~ ~J~ o~- O /00' <'L~O ~ 300' q0O' 3~' V p( d J ..~--- 2~ ~`` ~~ ~ ~ o q ~~~. tea. ,~, ~~- 35 w,s~s~gic~~ 223A ~'VWl/4-SWl/4 ~~ C~c ~ ~~igl i~~ S W l/4 - S W l/4 ~ --~~~~ 224 ~ NE l/4 - S W l/4 222 -~ ~,,, ~ ~.. O~tti.rr.eac F 4 ~_ S0.UG,~1' 2. ~ I~Sss(~8'i- - ', ,~, ~i(c~ ~e, I SE l/4 -S N ,~,.,_^,,. ~~ UG e~f~~ 6I ADD 2 24 A-~.u.r ~~...~..~ a`olFt ~~;:... I ~' .EAST PART a • 1 i HU®SON _ _ T29N:-R.19W. -- SEE PAGE 4/ ~_ W/L OW .20 /ari Ph /PP/r~~ - ame u~ ~~d +" '~ r°'E s .? Rih/e f Richa d 40 usf.~ 4'..b, Inc. / ER A ~ .e3err da// q 6 ~ S TAT /60:. ~°~ E) 2,2 - ~ 9~ Syn¢n VCS oer~ eN_ K! gtis ~ yC~Vp ~~f~':rco/ui., t er. y:: ..;.:• ~res s~.n c„ ~ ~ e~ /a6o2 h~ N~` scv/ ces <~ :< en e cnoi K ~ g / / ~~ ~~ ,~~ o ~ ~ :.~. ~Q.::::.::x'`~ G `V/T "°I itin ~ g~ /~e~' /oe.e Ka c.~h fer '~JGE/~anEV'e as "l, z4 . 3849 r i :s..r ~ .B/'vwn s. o J - •• s • ~ n ~~ J • Ly/e ~ • .. ~ p ~ Terson .eaB~ ~ • • /7.34/ '~e~~ ~ o ' G>/ ouf Cam ci/ tl ~ V ~ /3.i ~ • tj y $ eo fS Croix V h tl . / H, ti /a//ey \ ~ 9/iC /Se ~~ /mat gMALI....... tl C c Ivor f ~r1~;c:5:::: '~e~ f .Q c 60 p o i3S .Ba,E.Eei .2idiord C V l tl n 7O Bo £Don¢/dR • - ~ o ~ ~ ~ : ~'Po tt Ci ,`~ BQ/<S4l /SD ~ ~a CfsQ~-/G .s Fi// ~ ~ohardson a. "` Ee r.se 'e " s%`e Nor/a~Fe, ~ /i4 s ern [[``!oi Z - y Waxon Y!NeS U s7 ~z g N• sH ~~i' ~! 7o rt • ros ~'?tcncTS v N .. it • h V Y s q W .\o Ly/E' .r3 •.r /2 ~c../ y . ..r.~ 's ate- N 4 ~Q V0 f36r ~ i42.6s M ron C7a/e e Y Ke ~rt/4 ~ 9 {Iuabe// ,Be o F.~v s W~~n/ a// /s ~`'lA,y a/ a 1~ ~~~ \ 'l 75 • Roh/th 7 /BS ~ -t/¢//e ~~~~vn ~eY J"~/ /5375 W H 6o ASSOC .f ( •i0 9 F~ ~l 'S /yo D¢vid 0 ~~ u 3 ' Key/y ' 'p °` cs.:,;~ " ~ `. Ne/s /vw e o .wos q ss • s~ V F m, :. ~e 5H vi.~ • i°o/en dsa //e t- o ~ • ~ ~h cty cso., /o c9ctis. 6~S N • v<: 9/ago ~ fJerna d G t /1/e/s t y • Mar f K:~ne /°o/en ~fux o s • Larse NGL V a J` Ber.~rt d ~ B7B Poi'af on ~ C K:srcy c ~ 9 2 9e.: /~3e Q~ .aia./ ~ /Go "J tl 9/fir Pat ;c; .9er.>a d sr+y uS Fsh e JS Rae..chnol ~^ a'w avid K is~ey .... ~ ~ G1/%/a~ N/iL Co ~o ai/bn • oa iYcd Minin Tama Ne '~"~~" ~~ k ~~ ~ rp' Sv 9B ~CSon :::::: ' o ~~ 1 ~ O /iy z Pa. 94 ss ...... . i a a re ~. os JS /2 - : :::: .z 3 ~T2rw°s S C u Labor .Ba e~/yn ~s. ~ ~ ~ - ~ .s n'~^ 4~ 32.2 ' "'~~~: O ~ /O ~5 3 ~y iilACC /32/B 6 / Yer, efy • T.~4' /NE R a N K .~ ~1 1 ~ ~ • ~ ~9 Wi/~O 1 ~ C/a Cj eo/' e ~ FR _.. 9 :many . h~ym Sy/vesPrr J ~y q die ~/ a n ~ ~ ~ \~ .B¢,Eri ~ Q be ~ p 41 g~ 29/.G c. ~ :..~:: ~'FO :339 U`,~ 1j F Mh C~¢r S ~M/, ::K c SMA::: / ~~ ` Q, H 1 N • . trek/ M <tS ~ /9B2 Ro dMaPP ,(r, mac. ~ S PAGE v^.C o x o...>tyW'v. t 1~~ + , ~nll~ ^~ ~" 77 ~ ~ ~~ ~~~~~ ~~~"~ -Nis STATE REPRESENTATIVE ~~n9 things y •`d growing things $O$ ~~~~~ making things D' ' taking care of things 1\ making something new 29th DISTRICT v ' ~~ ,. ,. A •~ '~ ~ . loS9S~~~ L Q1 C L O U c O '~ +~ U ~ to ~ ~ a 0 L a~ v a a~ C \ O ~ N ~ X ~ ~ c ~~ cn ~ a~ C .J U a .!-~ N N C Ql 0 O I o~ m~ ~o w°r ~3 m- E`o c4 z ~ Y ~a r L th p N ` l/J c ~ o w ~~ o 0 ~i_ . UNPLATTED LANDS o -- -- M e S00'32'15"E 493.52' 460.52' -~ 1 Ln ~ ~ ~ N C ~~11 ~ ~ QI i 3 m ~ p H~ ~ ~ O) ~ ~, ~ r J Q.) z I ~ ~ in ~ ~~ i ~ ~- c O 'c~ ` ¢ ~ U ~ (~ N C ~-3°'~ ~~ LL1 `n ~ ~' ~ c ~~ ~ O Z x ~ ~~ ~o ~ a~ N N ~ W ,=3c Lt.. ~~-.'~ ~ O ~ ~N= QO O W ~ N O U ~~,~ N N O v U ~ ~~ o a~ 3~ 'Q c t~ 4 o a ~. ~ .. w ~ I O - m O QI u N ___J o N' ii u L o+ O = ••- i-- v Z ° ~ --~ ~~ o ~ Z ~ .~ X ~ w ~ a~ Q ~ O O V ~ ~ i i ~ ~ U N ~ oU .o~~~~ N O Ntnr U J .~ co ~`A~ pM CQZ7tf) 7 'i N ~ r- N_ z m .~ L ~ "C7 +~ ~~ to N i ~~ i ~ ~ ~ ~ ~ r ~ ~ ai i ~ N N O O ~, z ~av a~ o\v Z ~ D ~~ ^ i~~: ,nti ~ ~~~ i~ ~~ ~ ~r~ i^n v~ eF. ~ I M 0 0 N ~ O N W ~r ~' DD Z a w West Line of N00'35'35"W the sw ~ /4 33' 13.20' r ~ O ,\ `` -"-M ~.,~ - - N00'35'35"W 2134.48' - ~. ~ ~~.« AI/1MZC.'Z~nlAl ` I l~1IJ (~ ! _L.)li i ~{T~~' ,.n~.{ i 1ST'. ~ I~ S ~~~y ~ y ~ ~o ^) .rO vp ~ cD ~b ~ ~ o ~ I ~ ~S ~ 3 I~ L ~ ~~ t ~ Iz r O 3 I ~. 1 u7 O ~~ I M~ M~ M~ O ~ N ~ z z A /~ /i / ~ i ~ / ~~ ~ ~~ ~~~ ~ ~ ~> 589'24'25"W ;~ ~ 32.00' ~ G..~ ~ '3~_5"W 492.58' ~~ Westerly R.Q.W. 33' .~ U.S. Hwy 12 ~~' 70,77 f1R' --~''~ ~ QI I~O~ ~~ ~ i oI ~ I o I ~.,.,~ M J ~ ~ ~ N Y N OI r -` ~ 3 ~ ^I QI ~ r 00 N ~I o! ~I I ~ ~~I + Q, I JI m) ~~~ om~ NAM ~ m ~ ~M ~~v~ ~ ~i v x~,~ ~xaw v ~ ', '~ 40 V'~ ~'' ~~~~' W a~.~~'' x~~~ ~ ~~~' W q ~ q ~ ~ '~ ~: W~ ~ .~ o/ I Q a ~I 303^ n- ~ d' ~ (V t/') I ~ v ~~,, z a ~ z ao~o~ QI a= J (]I U~UN Z W~ m ~ ~ O V ~tp ~ tD j ~N ~ Z i d ~ ~ t 3~o J ;' ~ ci ~ I ~ ~ ! 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H WY 12 M £ 3° Z 3aauS • NW t lf1Vd ~1S : -eoa uinHOs T",~ : '3 3~N3klYl~ &8tt~ 3Jdd St •~On aiBQ ~ ~ 2 -~~ 9£LL-98£-SiL 9 i ObS u?suoos?M `uospnH ZI ~nnn~?H 6tiL 'ouI `~IisM ~auolaYli £i0Z-S •ol~i'~a2i `~InuaS •g aoua.~I~ -~- ,~ ~oa.~ay~ uo?~~uasaidai ~oauoo pus aru~ s si dew cans ~scp pun `Iao~d paquosap anoq~ a~ paddnw puu `paptntp `pa~ianms and I `pu~i pres ~o .:aunoo `uomq~ u~aacpn~ ,uruu,I, ~o uot~oaicp a~ aapun puB `uospnH ~o annoy aq~ pun ~uno~ xTO~~ •~S ~o suoT~nln~a~ uoisinipgns aq~ pug sa~n~s~S uisuoostM a~3o 9£Z ~a~d~q~~o suotscnozd aq~ q~rnn aountidwoo iin~ w ~eu,L :~t~zao ~ga~aq `io~anmS P~'I Pasa~s?8ag `ziingoS •g aouarei~ `I ~.I,~~I3I,L2I~~ ~2IO1~~A2If1S •p.~ooa.~3o suor~ou~sa~ pug s~uawassa o~ ~oafgnS '(•3'S 6Ib`Z9S) sa~os I i6•ZI ~~nn~o ~~u 8utpnioxa `(•3•S £~£`O~b9) sa.~on OL•t~i ~nnn3o ~u`du 8uipniout sure~uoo Iaored stcl,I, •8ugnuTUUa~ a.~aq~ pun rJ~~rJ~g 30 ,LI~IIOd aq~ o~ ~aa~ £S•86ZI 3o aou~sip ~ `ZZ uo?~oaS pis ~o .za~nb ~sannglnos auk ~o auti ~noS atp ~uo~ ~saM spuooas }, i sa~nunu I S saa.~ap 68 cpnoS aouau,I, `•ZZ uo~~oaS presto aa~nb ~sanncpnos a~~o au?i u~noS aq~ uo ~utod ~ o~ ~aa~ ZS'£6b ~~~ spuooas Si sainu?w Z£ saaz8ap Op q~noS aouaq•I, `.iaa3 00.662 i ~~~ spuooas ~, sa~nu?ut g~ saa.~ap 68 ~aoN aoua~, `.~aa~ gS•Z6t~3o aou~stp ~ `ZZ uo~oaS presto .za~nb ~sann~nos a~3o auti ~saM a~ 8uore ~saM spuooas S£ sa~nu?cu S£ saa~ap 00 tp~oK aouau,I, `•ZZ uopoaS pres ~o (O~~O~g •30 •LNIOd ate) .~awo ~sanntpnos auk ~n 8u?uut~ag :smollo~ s~ paquosap `utsuoosiM `~uno~ xto~~ •~S `uospnH ~o unno,L `~saM 6 T a8uug `ETON 6Z dnisunnol, `ZZ uor~oaS ~o ~/ I ~sannq~nos a~ ~o I,/ I ~sannq~nos aq~ 30 ~d ;nq,I, I~IOI.LdRI~S~Q 'IdtJ~'I CERTIFIED SURVEY MAP That part of the southwest'/4 of the southwest'/4 of Section 22, Township 29 North, Range 19 West, Town of Hudson, St. Croix County, Wisconsin HIGHWAY SETBACK RESTRICTIONS No improvements or structures are allowed between the right-of--way and the setback line. Improvements include but aze not limited to signs, pazking lots, pazallel driveways, wells, septic systems, drainage facilities, etc., it being expressly intended that this restriction shall constitute a restriction for the benefit of the public according to section 236.293, Wisconsin Statutes and shall be enforceable by the Department of Transportation. Contact the Wisconsin Department of Transportation District Office for more information. The phone number may be obtained by contacting your County Highway Department. NOISE NOTE This property may experience noise at levels exceeding the levels in Trans 405.04, Table 1. These levels are based on federal standazds. Owners of these lots are responsible for abating noise sufficient to protect these lots. ACCESS RESTRICTION CLAUSE As owner we hereby restrict all lots and blocks so that no owner, possessor, user, licensee, or other person may have any right of direct vehicular ingress from or egress to any highway lying within the right-of--way of U.S. Highway 12, as shown on the division map; it is expressly intended that this restriction constitute a restriction for the benefit of the public as provided in s.236.293, Wisconsin Statutes and shall be enforceable by the department or its assigns. Each parcel on this map is subject to state, county, and township laws, rules, and regulations (i.e., wetlands, minimum lot size, access to parcel, etc.). Before purchasing or developing any parcel contact the St. Croix County Zoning Office and the Town of Hudson for advice. The Wisconsin Department of Transportation anticipates obtaining additional right of way along U.S. Highway 12. Contact Transportation District at (715) 836-2891 for further information. ~~~~('tp rii a `, ~~~~ `~~_ • "~ ~~~- ~~ c2-}z l~f.o z) 12• ~ ~~F ~ ~ I~"~ L$ ~ S`•LZ -~~ I~ • ~° I ~ ~ , S--