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HomeMy WebLinkAbout042-1085-50-400 Wisconsin Department Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division rParcel St. Croix INSPECTION REPORT Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 579061 p Personal information you provide may be used for secondary Purposes Privacy Law, s.15.04 (1)(m)). Permit Holder's Name: Madaris, Shane & Julie city Village X Township ax No: CST BM Elev: Insp. BM Elev BM Description Z Warren, Town of 042-1085-50-400 U Town/Range/Map No: TANK INFORMATION GS 31.29.11 478A04 TYPE ELEVATION DATA MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic J~S Benchmark 2400 2.5 fir, 9s q Alt. BM Aeration tl~ ~i jeA_ 6 •'S 9 7. Bldg. Sewer Holding 3,55 9y, y5 St/Ht Inlet M 11TANK SETBACK INFORMATION St/Ht outlet TANK TO 7 WELL BLDG. ent Air Intake ROAD Dt Inlet Septic /pp Dt Bottom Dosing Heade'Man. Aeration Dist. Pipe Bot. System PUMP/SIPHON INFORMATION Final Grade Manufacturer 3 , O 9S t~ Demand St Cover Model N r GPM 1 '55 9' 7, 7-51 TD Lift Friction Loss System Head, - TD Ft Forcemain Dist. to Well SOIL ABSORPTION SYSTEM BED/7.RENCH Width Length No. Of Trenches DIMENSIONS 3 96 PIT DIMENSIONS No. Of Pits Inside Dia. Uquidep`t`h` re SETBACK SYSTEM TO P/L BLDG WELL INFORMATION / +fZ LAKE/STREAM LEACHING ManufaacWref'i I T yp o ti011 System: / CHAMBER OR A~-- N~ UNIT Model Num r: DISTRIBUTION SYSTEM f SOL;. a. i /qJS HeadeNManif~ Id Distribution Z. ZrZ Z- 40. Pipe(s)-` x Hole Spacing x Hole Size t to ir Intake Length Dia Length V A Dia Spacing SOIL COVER x Pressure Systems Only 46 Depth Over y y xx Mound Or At-Grade Systems Only Bedlrrench Center r 41 Depth Over xx Depth of xx Seeded/Sodded ,r Bed/Trench Edges * _ Topsoil xx Mulched s ® No Yes ® No COMMENTS: (Include code discrepencies, persons present, etc. Inspection #1: / / Inspection Location: 948 65th Ave Roberts, W11 4023 (SW 114 NE 1/4 31 T29N R1 8W) NA Lot 4 Parcel No: 31.29.18.478A04 1.) Alt BM Description = cL 2.) Bldg sewer length = 50 do - amount of cover = 7 t' Z „ T 0 0~.1/CLIC/~ Plan revision Required? ® Yes No ~i r b Use other side for additional information. 3 cl/ S SBD-6710 (R.3/97) Date Insepc is Sign ure Cert. No. County C 8 j- - q^ a ety an Buildings Division 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, Wl 53707-7162 COUNTY -~""90T,Ary Permit Application State Transaction Nn her In accordance with SPS 38321(2), Wis. Adm. Code, submission of this form to the appropria a governmental unit ;F is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different tham mauling address) (/Qc JG the Department of Safety and Professional Servies. Personal information you provide may be secondary purposes in accordance with the Privacy Law, s. 15. 1 m , Stats. L A lication Information - Please Print All Information Prverry Owner's Nam Parcel # l Property Owner's Mailing Address I Property Loction Govt Lot C J 1,5-79 cl+ City, State ( Zip Code Phone Number Section I 19 7 / cle o N; R/ orW IL ype of Bui{ding (check all that ap Lot 1 or 2 Family Dwelling -Number of oms Subdivision Name ~bJ'yL- BI # aka ❑ Public/Commercial - Describe Use City of ❑ State Owned - Descnbe Use CSM Number /6141!33 Z ❑ illage of / Town of I/~/ t(~tO , 2 2La-7Z G~o Z7 I, 1ZS 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration owner z4 IV._Xype of POWTS System/Component/Device: Check all that apply) v5 -Pr 1n-Ground ❑ Pressurized In-Ground 13 At-Grade El Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil C ❑ Holding Tank ❑ er Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsal/Treat ent Area Information: Des- Flow (gpd) Design Soil Application Rate(g Dispers Rcqu' (sf) Dispersal Proposed (sf) Systran evati VL Tank Info Capacity in Total # of Manufaanrrer u Gallons Gallons Units a $ New Tacks Existing Tanks f u n a A Septic or Holding Tank Y I Dosing Chamber J VII. Responsibility Statemen the undersigned, ass responsibility for installation of the POWTS shown on the attached plans. Plumber' Name (Print) Plum ignature MP/MPRS Number Business Phone Number Plumber's ,Adress (Street, City, Zip ) Z-7'132-- r 57/, /L~ t -_:~Iz)l 7~ ounty/De artment Use Only e Approved Permit Feel, Date Issued / Issuing . Signatur4= Zvcn Reason for Denial S 147 66. DL ConditiSWAMI lFiW asons for Disapproval 1 1. Septic tank, effluent filter and 3) pdispersal cell must all be services maintained as per management plan provided by plumber. i 't~ic~„regkdtnCn~a~tFfC►tait t~eirtdint$iFt~cF_ n im COd~ / QftlifliltOti, Attach to complete plans for the system and submit to the County only an paper not less than 8 is i 11 inches in size SBD-6398 (R. 11/11) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/6/15 Owner: Julie Madaris Location: SW /4 NE1/4 S31 T29 N,R18 Lot 4 65th Ave Warren Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Co i gency Plan 7. Liftetime Filter Specif' tions Signature License number 26900 PLOT PLAN PROJECT Julie Madaris ADDRESS 724 159th St. Roberts Wi 54009 SW 1/4 NE 1/4S 31 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 94.0/93.2 5' below grade 8/6/15 4 DATE BEDROOM CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 1 " pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. Same as benchmark All piping shall be ASTM SDR 30/34, within 10' of tank' piping shall be ASTM F891 Pro 4 pmg ~ Bedroom House 713' Property Line r ~ s Scale = 1/4" = 10' B- 96'97' 81 25 99, ,Mo 5' 10% Slope 2-3' X 90' cells with >3' spacing B-3 5' -2 60' 40' Vents 100' B. V >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 60' 4' Long 12" 5.6ft^2/pair of end caps 34" Grade at System Elevation 65th Ave PLOT PLAN PROJECT Julie Madaris ADDRESS 724 159th St. Roberts Wi 54009 SW 1/4 NE 1/4S 31 /T 29 N/R 18 W TOWN Warren COUNTY ST. CROIX SYSTEM ELEVATION 94.0/93.2 5' below grade 8/6/15 4 DATE BEDROOM CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 ,BENCHMARK V.R.P. Top of 1" pvc pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL * H. R. P. Same as benchmark All piping shall be ASTM SDR 30/34, within Pro 4 10' of tank, piping shall be ASTM F891 Bedroom House 713' Property Line 25' S 96'97' Scale = 1/4" = 10' B- 25 8' 99' 5' 10% Slope 2-3' X 90' cells with >3' spacing B-3 5' B-2 60' 40' Vents 100' B.M.* Vent >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps 12" 0' 4' Long 3 4" Grade at System Elevation 65th Ave Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 99.0' Vent Al Grade Vent 3' 400 3' ~~30134 Septic Tank 5' Long 1 9~ 5' S' Long 119 3691 Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tubeNent At end of cell A 22 chambers per cell B System elevations: A-94.0' B-93.2' POWTS OWNER'S MANUAL $ MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Tank Manufacturer: ❑ NA Permit # Septic ❑ Dose ❑ Holding Volume: (gal) DESIGN PARAMETERS Tank Manufacturer:A Number of Bedrooms: ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: A Vertical Distance Tank Bottom(s) to Service Pad: ✓~~/71(ft) Estimated (average) Flow : (gal/day) Horizontal Distance Tank(s) to Service Pad: ' / (ft) Specific servicing mechanics must be provided rf vertical is >15 feet or ► Design (peak) Flow = (estimated x 1.5): (gai/day) if horizontal is >150 feet. Specific Instructions to be provided on back. In Situ Soil Application Rate: , (galJdaytW) Effluent Filter Manufacturer:Ar ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: Fats, Oil & Grease (FOG) :530 mg/L Pump Manufacturer: Biochemical Oxygen Demand (BODs) s220 mg/L ❑ NA NA Total Suspended Solids (TSS) s150 mg/L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer. (BODs) >220 mg/L NA ❑ Mechanical Aeration ❑ Peat Filter (TSS) >150 mg/L / 1 ❑ Disinfection ❑ Wetland Pretreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ other. (BODE) 530 g/L AA Soil Abso lion System (TSS) 530 mg/ Fecal Coliform (geometric mean) 5_10' Ground (gravity) ❑ In-Ground (pressure) ❑ NA ❑ At-Grade ❑ Mound Maximum Effluent Particle Size X in dia. ❑ NA ❑ Drip-Line ❑ Other: Other: NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) hen combined sludge and scum equals one-third (f) of tank volume en the high water alarm is activated Inspect condition of tank(s) At least once every: ❑ onth(s) (Maximum 3 years) ❑ NA year(s) Inspect dispersal cell(s) At least once every: month(s) (Maximum 3 years) ❑ NA r(s) Clean effluent filter At least once every: , month(s) ❑ NA ear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every:. ❑ month(s) NA ❑ year(s) Other: At least once every: ❑ month(s) NA ❑ year(s) Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certificate s: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on the ground surface. The soil absorption system shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on. the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any treatment tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code: All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. GMW-005 (02/05) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be, discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette'-butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitAry napkins, solvents, tampons, and water softener brine discharge. 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 s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems 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 (pumper). • 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: 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 h the ulesed for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK 1r SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINT NER . Na c Name 71 ) r Phone 7/~. 4111,1011 Phone SEPTAGE SERVICING OPERATOR PU ER LOCAL REGULATORY AUTHO TY w Name ! Names' Phone Phone This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections Comm 83.22(2)(b)(1)(d)8(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. WN &jfuk ~a R { s a{i ' f ~O ~+7 M- V O O CP j a I i 0 4 C a s 4 fl i-- O U LLI 7 1 S1'. CROIX C;O IJNT''' SEI TIC TANK, MAINTFNANCE YiGREEMENT Ahi1) OWNERS14111 CEJ? IFWATIC~N FORM owner/Buyer Mailing Address Properly Address Verification required ft-orn Planning, Zoning Oc,pattnent furl consuuct.io:u.) City/Mate Parcel -56 LEGAL 1DESCRIPTIOloi Property Lot;at1on-50 i r Sec;. 3 I I 1114 ,1\ W, Town o ( eC lr (Q.r~../ Subdivision Lot Certified Survey Map # nn Warranty Deed P. 0 VIS Spe( ; house yes nt. Lot. line; identifiable yes no SYSTEM MAINTENANCE ANI) OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its pr,tnta n.re failure to handle wastes. I'roper maintenance consists of punrpirtg out the septic tank every three. years or sooner, it needed, by a licensed pumper, Wilat you put into the system can affect the function of die septic: tank as a treatment stage in the wasie disposal system. Owner maintenance responsibilities are specified in §Comrn. 83.52(1) and in Chapter 'l2 - fit. Croix. C:oiinty Sanitary t_)rdinancc. The property owner agrees to subrrrit to St. Croix. County Pianrurtg d'r Zo.n ~.ng l.)epartrncm it c-crtification form, signed bar tltc owner and by a master phm7ber, journeyman plumber, zestricicd plumhcr or a licensed pumper verifying that (1) the cut-site wastewater disposal systent is in proper operating condition and/or (2) after tnspcc.ion and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/sae, the undersigned have read the above rcyuirrrncnts and rr;rec to n-snir,taur (ire prig=ate sc <cagc disposat systent with III,' standards set forth, Herein, as set by the Department of Commerec and the De,partincnt ol'Natural Ikesoruces, Stare of Wisconsirx. Certification stating that yore septic system has been m ainiairted must be complew, ( and returned to the St. Croix County Platntnr}? Zoning Departirtent within '30 day„ of the three year ex p.iration date,. ]/we certify that all statements on thi Morin arc: true to the' bast of-rny,'out k nowledge. lAve arruare the omriler(s) o,1-the property described above., by viiti_w of a war ~rrtty deed recorded in Register oi' llee~ is Office. Nut r of bedrooms SIUNA'L'[1 t E{, Ol AP'LIC"A'vI i)A'T') Any information that is misrepresented may result in the sauitaty permit being o!voked by the Planning & Zoning h)epai mt. Include with this application a recorded warranty deed troast the Register of llt (ds 'Afice and a copy of the certified survey reap If' reference is rrtade in the warranty do.ed. (REV. 08/05) Exhibit A Legal Description i Lot 4 of Certified Survey Map filed June 29, 2015 in Volume 27 of Certified Survey Maps, page 6128, as Document No. 1014532, located in Part of the SE 1/4 of the NW 114; Part of the SW 1/4 of the NE 1/4 and Part of the NW 1/4 of the NE 1/4 of Section 31, T29N, R18W, Town of Warren, St. Croix County, Wisconsin, Being Part of Outlot 1 of Certified Survey Map Vol. 24, Pg. 5685, Doc. No. 912384. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000 St. Croix County 1017305 Page 3 of 3 . Parcel 042-1085-50-400 08/24/2015 01:23 PM PAGE 1 OF 1 Alt. Parcel 31.29.18.478A-04 042 - TOWN OF WARREN Current ~X] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 06/29/2015 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - STOUT, RICHARD O & JANET P RICHARD O & JANET P STOUT C - ROSCON PROPERTIES LLC ROSCON PROPERTIES LLC 1353 AWATUKEE TRL HUDSON WI 54016 Property Address(es): Primary " 948 65TH AVE Districts: SC = School SP = Special Type Dist # Description SC 2422 SCH D ST CROIX CENTRAL SP 1700 WITC Notes: NEW FOR 2016. CSM TOOK PART OF 042-1085-50-025 & 042-1086-10-051 FOR LOT 5 AND PART OF 042-1086-10-051 & Legal Description: Acres: 8.000 042-1086-40-071 FOR LOT 4. ALSO REMAINDERS OF 042-1086-10-055 & SEC 31 T29N R18W PT SE NW & PRT SW NE r BEING CSM 27-6128 LOT 4 Parcel History: Date Doc # Vol/Page Type 06/29/2015 1014532 27/6128 CSM 11/26/2014 1004801 LC 07/30/2013 983266 26/5944 CSM 06/23/2006 828166 WD more... Plat: Primary Tract: (S-T-R 40% 1601/4 GL) Block/Condo Bldg: * N/A-NOT AVAILABLE 31-29N-18W SE NW 2016 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/06/2015 Description Class Acres Land Improve Total State Reason Totals for 2016: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 24~k~gy . 4 Fl~ " zv y a N 59m ^e~sgp .m r Q o h x z Z hum 111.11I huffil 1111,121 1 . , . j 1 I I I I I I I I I I I I I I 1 I I I I _ 6 1 1 I I I I I I~ I I - I _-_-_1 I I I 1 1 1 1 ~ I I I I I 1 I I I 1 1 1 I I I I I I I I I I ` 1 a l I I 1 I 14. I 0 IN I 1 I I'. I I I 1 I I 1 1 1 1 I 1 I I I I I I I I 1 1 I I I 1 I 1 I J I I I I I 1 I 1 I I 1 1 1 I I r-- ~~r--~ . 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I bl I i Ilk u in! pop i I ~ i i o~~ ~k~BE'a _p € ~ s E ^Ogx s~eSC~ N w g m § o o o ego cg&m a o w U) o 20 m 4 gig g` W N W s ALL= a him Im 11-11 111;.€ ~ 3#~ 8 I LL ~ J EO "am aIn J _ a I I I I I I I I ( I I I ----i I T- I I I I I i I ~ i I I I i I I ' I I i I ' `fig n x I a 3 b P a nx $Qd - ax x 8 s I , i - p ~ p i Z x , s i i i i i i L-Jl I 8 ~4 [FE' ow 51 ~sa$# o O $ km `7m ~ - - - - - - - - - - - - - - - - - N Os8$~~e h co J N C:l 10 Q m C ~ I ~ N I I i fi ~ I ® q I - - - - - - - - - - - - !!11 _J R~ o~® ® x ~x b xx ii s- q 11 i; 1 ~ t 1 I ~ / $ } II R~ } 11 I I I ' I n a II s ; I Rv _a I x I ' x x I !f 6 0 s x ~ x x R `s a ® ® x I ~ I i I I I I i Bs b I RECEIVED MAY 2 8 ZOib Wwconsisv.e ismj r SOIL EVALUATION REPORT of f@1A ~6s~1 d Page Divic PMENT d in accordance with Comm 85, Wis. Adm. Code c Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must 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 by Date Personal information you provide may be used for secondary purposes (Priva w, s. 15.04 (1) (m)). V z / Property Owner Property Location 100, `G r Q Govt. Lot ~Lj 114 '1/4 T ~ N R ~ E ( r) W Property Owner's Maili Address LqMP, Block # Subd. Name or CSM# t7- j 3 Z -I-(,t," T'r Lod- ✓ol z 7 (.e ~z8 State Zip Code Phone Number City ❑ Village 5kTown Nearest ad 1:54/0 ( / ) S ew Construction Use; t esidential / Number of bedrooms Code derived design flow rate 0600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material C"7U_-,t l Ct` . ✓ FI lain elevation if applicable ft. General comments v 3elp- J lol/ and recornmendations: 140 System Type /tJ t> CC21- System Elevation F T1 Boring # E] Boring 0 ,pit Ground surface elev. v , 4 ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 1- c..- , Z 4,1- ' / ~ • -30, Ay? 7 3 _ t Bodngla p Boring _ ® ;Pit Ground surface elev~ ft. Depth to limiting factory in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsll Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 ooo? ~T- Effluent #1 = BOD. > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent p = BOD, < 30 mg& and TSS < 30 mg/L CST Name (Please Print) Sig CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 .17 / 715-246-4516 Property Owner _ Parcel ID # Page of Boring # E] Boring r- Pit Ground surface elev. Depth to limiting factor in. Soil Application Rate ® Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. 'Eff#1 /•Eff#`22 f a, F] 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/ff in. Munsell Qu. Sz. Cont. Colo Gr. Sz. Sh. -Eff#1 'Eff#2 Ong # ❑ Boring F-1 ❑ Pit Ground surface elev. ft, Depth to limiting factor in. Sal icati0n Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 -Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30:< 150 mgA. ' Effluent #2 = BOD, < 30 mg/L and TSS 130 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 (8.6/00) Property Owner Parcel ID # Page of a Boring # ❑ Boring c- )n it Ground surface elev. ft Depth to limiting factor.. in. Soil icaaon Rate Horizon Depth Dominant Col Redox Description Texture Stricture Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I .s I 7i r ~c a~ 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 GPDtff in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ❑ Boring # ❑ Boring - ❑ pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence . Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BOD5 > 30 1220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mgA- 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. SBD43w (eA=) Soil Test Plot PI Project Name Roscon Properties n Bird Address 1353 Awatukee Trail Hudson Wi 54016 CSTM #226900 Lot 4 Subdivision ate 5126/15 SW 1/4 NE 1/4S 31 T 29 N/R18 W Township Warren Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1" pvc pipe System Elevation TBID *HRpSame as Benchmark Scale is 1" = 40' 713' Property Line unless otherwise noted 96'97' B-1 98' 99' 10% Slope 5' B-3 5' B-2 60' 40' 100' B.M.* 60' 65th Ave 1014532 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 06/29/2015 10:11 AM LOCATED IN PART OF THE SE-1/4 OF THE NW-1/4, PART OF THE EXEMPT 4: SW1/4 OF THE NE-1/4 AND PART OF THE NW7/4 OF THE NE-1/4 OF REC FEE: 30.00 SECTION 31, T29N, R1 8W, TOWN OF WARREN, ST. CROIX COPY FEE: 3.00 COUNTY, WISCONSIN, BEING PART OF OUTLOT 1 OF CERTIFIED PAGES: 2 SURVEY MAP VOL. 24, PG. 5685, DOC. #912384. THIS INSTRUMENT DRAFTED BY EDWIN FLANUM JOB N0.15-47(14-96) DWG. CSMS DATE 5/19/15 LEGEND N ® ST. CROIX COUNTY SECTION CORNER POSITION VERIFIED WITH TIES OF RECORD OR MONUMENTED AS U. S. INTERSTATE "94" NOTED - 3/4" IRON REBAR FOUND _ - p 3/4" X 18" IRON REBAR SET, WEIGHING 1.50 LBS. PER LINEAR FOOT © SOIL BORINGS I e. 0i cp- S84°02'16"E 459.96' QpB,O, j6 3 c Ci l OJ~~ / ti 0f°I O~ c m I ~~~Oi / LOTS C.13 NI UNP~TTEa Qi / 28.19 AC. INC. R/W ~i LANDS 1,227,848 SO. FT. LOT_~ m _ 27.40 AC. EXC. R/W 800 AC. INC. R/W = 1,193,675 SO. FT. 0a ~o~O/ r 348,528 SO. FT. ° n /Q/off o 0 7.49 AC. EXC. R/W 326,276 SO. FT. ©I © O I B OB O SEE DETAIL B 464.01' N89°52'42"W 1498.99' 1034.98' 65TH AVENUE C1 (BELOW) N89°25'09"W - 192.37' 33.00' 1034.67' - - - - - ' _ ' _ 2403.55' 57.41 33.03 A 93 W1/4 COR. SEC 31 N89°25'09"W I o N89°25'09"W 2633.42' E1/4 COR. SEC. 31 ALUM. MON. 272.01' EAST -WEST 1/4 LINE SOUTH R/W LINE FD I .r, %c~ I I ALUM. MON. FD. cn al _ S.M N LOT 7 I _ LOT 2 "Z) / I ~~ry~ ry~ LOT 1 - Cg15, ( C.S.M. VOL. 25, PG. 5758 V.C7, P_ - 2 ua - - DOC. 931775 0 Q]~0 V' "'tea I O 43198 o I / CIO = ao w - ° OWNER SURVEYOR o z ROSCON PROPERTIES, 1-1-C EDWIN C FLANUM / C1 NORTHLAND SURVEYING, INC. N82"W 14 8.99, w m 6; RICHARD 0. STOUT & JANET P. STOUT P.O. BOX 152 u 1353 AWATUKEE TRAIL AMERY, WI 54001 33.03' o Woo HUDSON, WI 54016 ` 89°52'42"W 1227.04' y z 8 DETAIL SCALE IN FEET 1" = 250' y \ (NOT TO SCALE) / Z NMIRRY 250 0 250 %i`9iL vwkq SHEET 1 OF 2 SHEETS St. Croix County 1014532 Page 1 oft S(IRV~~O~~ Vol. 27 Page 6128 3 2 2 4 STATE BAR OF WISCONSIN FORM 2 - 2000 8 Tx:4 66544 13 Document Number WARRANTY DEED 1017305 BETH PABST THIS DEED, made between Richard O. Stout and Janet P. REGISTER OF DEEDS Stout, husband and wife and Roscon Properties, LLC, a ST. CROIX CO., WI Wisconsin Limited Liability Company, Grantor, and Shane M. 08/20/2015 9:15 AM Madaris and Julie A. Madaris, husband and wife, Gran-fee EXEMPT#: NA Grantor fora aTuable consideration, conveys and warrants to REC FEE: 30.00 Grantee the following described real estate in St. Croix County, TRANS FEE: 234.00 Wisconsin: PAGES: 3 SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF Recording Area _ Name and Return Address: 3 Edina Realty Title, Inc. 400 South Second Street, Suite 115 Hudson, W1 54016 1108049 Exceptions to warranties: Pt. of 042-1085-50-025 Easements, restrictions and rights-of-way of record, if any. Pt of 042-1086-10-051 Pt. of 042-1086-40-071 Dated this July 2015 Parcel Identification Number (PIN) This is NOT homestead property. Richard O. Stout J t P. Stout Roscon Properties, LL~~C,,~a Wisconsin Limited Liability Company BY: Ul i ao_~ Richard O. Stout, trustee, member BY - J n t P. Stout, , trustee, member WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000 St. Croix County 1017305 Page 1 of 3 14 AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF COUNTY OF authenticated this July 24, 2015 " Personally came before me this the above Richard 0. Stout and Janet P. Stout, TITLE: MEMBER STATE BAR OF WISCONSIN husband and wife and Richard 0. Stout, trustee, (If not, member and Janet P. Stout, trustee, member of authorized by §706.06, Wis. Stats.) Roscon Properties, LLC, a Wisconsin Limited Liability Company, husband and wife to me known to be the THIS INSTRUMENT WAS DRAFTED BY person or persons who executed the foregoing Martin D. Henschel instrument and acknowledged the same. 6800 France Avenue South, Suite 410 Edina, MN 55435 ` (Signatures may be authenticated or acknowledged. Both are not necessary.) v0ay- A. rafstrom-Corman *Names of persons signing in any capacity must be Notary Public, State of Wisconsin typed or printed below their signature. My commission is permanent. (If not, state the expiration date: 2/12/2017) GAYLE A. GRAFSTROM-CORMAN NOTARY PUBLIC STATE OF WISCONSIN WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000 St. Croix County 1017305 Page 2 of 3