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ST. CROIX COUNTY WISCONSIN ZONING DEPARTMENT f f M r ■ ■ ■ ■oss ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016 -7710 Phone: (715)386 -4680 Fax (715)386 -4686 September 15, 2003 Cities and Villages in St. Croix County (Villages of Baldwin, Deer Park, Hammond, North Hudson, Roberts, Somerset, Spring Valley, Star Prairie, Wilson, Woodville and Cities of Glenwood, Hudson, New Richmond, and River Falls) RE: Extraterritorial Plat Approval Jurisdiction To Whom It May Concern: The St. Croix County Zoning Department is requesting your assistance in updating our records regarding boundaries for extraterritorial plat review in St. Croix County. Section 236.10(1)(b) WI Statutes requires subdivision approval from any municipality exercising extraterritorial plat authority. Cities and villages that have adopted a subdivision ordinance or official map can exercise extraterritorial plat approval jurisdiction for three miles beyond the corporate limits of a first, second or third class city and one and a half miles beyond the limits of a fourth class city or village. We are primarily interested in maintaining and creating a geographical reference to any extraterritorial boundaries of record. Please provide this information via mail, e-mail, or simply provide the recording information if it has been recorded with the St. Croix County Register of Deeds. The information you provide will be used to determine whether extraterritorial approval is applicable for any proposed plat or certified survey map submitted to St. Croix County. If in the future your adopted boundaries are modified, please provide the revised information to the Zoning Department so that we may update our records. Thank you for your cooperation. S 7 Sonn�n � tag J Zoning Technician Cc: File ' WisconsirrtSepartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety arvI Suildig@ Division #4 ,. INSPECTION REPORT Sanitary Permit No: 515016 0 GII'NERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City X Village Township Parcel Tax No: River States Truck and Trailer, Inc. I Village of Roberts 176- 1082 -00 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: CYj • 34.29.18.633 TANK INFORMATION ELEVATION DATA i. '� ,��jg• , TYPE MANUFACTURER I • " CAPACITY STATION BS,.- HI FS ELEV. c {r.r if } Septic 36nv Benchmark l3esfng Alt. BM _ .. � � •� Aeration Bldg. Sewer S•--76 167. Holding St/Ht Inlet * ,7•73 O 7 TANK SETBACK INFORMATION St/Ht Outlet 7,97 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom ` Dosing Header /Man. f 1 y � ! Aeration ���,_ Dist. Pipe 1 Holding Bot. System / lr , 74, Final Grade PUMP /SIPHON INFORMATION 7 1� %�• Manufacturer Demand St Cover s•71 !r _ GPM Model Number TDH Lift Friction Loss S s ad T Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width r Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS a SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: ( , INFORMATION CHAMBER OR - Type Of System: UNIT i $ Model Number: a..ti]'t,� , ^�'i *.�h.� �^') ��.•. �.y, lei ��, DISTRIBUTION SYSTEM `{ , ,;:,_ % G l' G _1 Header /Manifold J Distribution x Hole Size x Hole Spacing Vent to Air I ke Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center !• ` Bed/Trench Edges Topsoil '— Yes E] No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / Z / 6Y Inspection #2: Location: 690 Star Lane Roberts, WI 54023 (NE 1/4 SW 1/4 34 T29N R18W) NA Lot �"` Parcel No: 34.29.18.633 -� 1.) Alt BM Description = 2.� 3 `",`^"'�� ek 2.) Bldg sewer length= ?'.s.,(�,�" P � Ow Q'�- s � - amount of cover = � r�1 J • • dj� w 4 e J. 1 J 1, Jim ebb d Plan revision Required? ❑ Yes No / Z7 6G 2 O i - -- ! I f ,, J Use other side for additional information. SBD -6710 (R.3/97) �! _ `�/ Date Inse or's S' ature Cert. No. r commerce .Wi.gov Safety and Buildings Division County 201 i sc o n s i n Madison 'I 53707-7162 Sanitary Permit Number (to be W. Washington Ave., P.O. Box 7162 ST. CROIX filled in by Co.) epartment of Commerce l 5/ o Sanitary Permit Applica State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate g_ overnmental — unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different an mailing ad ) submitted to the Department of Commerce. Personal information ndary STH 65 & 1 -94 p urposes in accordance with the Privacy Law, s. 15.04(1)(m), Stars. I. Application Information — Please Print All 14ortnation Property Owner's Name Parcel # RIVER STATES TRUCK & TRAILER 1 `200 1 7 ( p — 8Z — 0 Property Owner's Mailing Address Property Location P.O. BOX 2075 ST. CROIX COUNTY Govt. Lot NA City, State Zip Code FnonU um er NE /a, /4, Section 34 LA CROSSE, WI 54602 -6Q2 A "444 ' (circle one) II. Type of Building (check all that apply) Lot # T 29 N; R 18 W F - 11 or 2 Family Dwelling — Number of Bedrooms Subdivision Name NA NA Block # ® Public /Commercial — Describe Use 50 EMPLOYEES MAX., 2500 SQFT RETAIL & 2 FLOOR DRAINS NA ❑ City of CSM Number Village of ❑State Owned — Describe Use r a Town of ROBERTS III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ® New System ❑ Replacement ❑ Treatment /Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) — System B. F1 Permit ❑ Permit Revision 1:1 Change of ❑ Permit Transfer to List Previous Permit Number and Date Issued Renewal Before Plumber New Owner Expiration IV. Type of POWTS System/Component/Device: Check all that appl ® Non - Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank LJ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) t ...�c- V. Dis ersal/Tr atment Area Information: Design Flow (gp Design Soil Application Rate pdsf) Dispersal Area Req 'red (sf) Dispersal Area Proposed (s System Elevation 1138.5 ©�� � (oc.�. `� (fra��,�' `34.x' VI. Tank Info Capacity in Total # of Manufacturer w A Gallons Gallons Units m o F F U U a a New Tanks Existing Tanks /_ / u� z o H F m < Yr Septic or Holding Tank 2500 0 2500 1 HLTF ® ❑ ❑ ❑ Dosing Chamber ❑ ❑ ❑ ❑ VII. Responsibility Statement- I, the undersigned, assume respgnsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu b 's S' V re MP /MPRS Number Business Phone Number RICK RUF 225949 715- 723 -9655 Plumber's Address (Street, City, State, Zip Code) 715-- (Z3 1280 W. RIVER STREET — CH IPPEWA FALLS, WI 54729 �/ 3l 11 VIII. Count /De artment Use Onl pproved Permit Fee Date Iss ed I Issuing M ent Signature _owner Giv easoi Denial $ IX. Conditions of A- roval/Reasons for Disapproval / nn A • n/� SYSTEM p'�VNER: 3) (�Ot�,�L �-� o+1.S „ E SL 1. Septic tank, effluent fitter and 1 dispersal cell must all be services /services /maintainer are_ 1 r ^ el C . 14,/� ,�_ �Q�{rH • Q� as per management plan provided by plumber. 2. AN setback requirements must be maintained appl lttach to complete plans for the system and submit to the County only on paper not less than S 1/2 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 ♦ \ \\ \ \\ '^\ `"'- \ \\ \,\\ 444 \ \\ \ \,� 44 a ', 64 \ \\ \ \ \''' \\\ \ \ \\ \ \, \44 \\4 \ \\ ♦4 4 \4♦ \\ 1,,444 \ \ \\ '+ `• \\ \ \ \\ 44 \ \\ Sj' a4\ \\ \�`'�\ \ #`, \\ \ \\ \ \\ 444 444 \ \\ \ \\ 4e \ \\ \ \ ^, ,. \ \ 444 ,\ \\ \ \\ 44 \ \ \, \ \\ `' \\\ \ '' 4 \ \\ \ \ .\ \\ `\\ \ \ \\ '•,, �\ \ \ 1 \\ \ \ 11x v F- vv ! .p � � IC. y, • A v A v `\ v \ V v�tC \ `' ''' ` "< v v , v ' ° "' \, v v v `* ` \` \\ \,\ \\ \ •,,. \ \\ \ \ 444 \ \ \\ \ \\ \ \a4 \4 \\,. \ e \ W \ � W \ \ Q W l0 ?> � O CO LL. N — \ e Q � V F Z LL. C v O = U. N R W d _ cc IL d V w Q Ecopy 3 L = CN ° o c6 L U x I N 0 0 W O M r__ — _N - - C Nw� v i az ° � c 24 E W m CD M 0 J II --� O I V Uf> 0 11 C Z 1 l- U LU ZO Cn y tD 0 ? 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N, �I ! q v I I J / x IN \ ti I N ,\ y \ Q W (D gym C� V A q q \ V A ' "'ow �q, v v w'v q vv v E" U3 \ t \ , CL ,u CO IN \ I N \ IN co r� I \ \ Cl- 404 I< 1 f \ \ 1 w I \ \ LLI ce_ !f CO) W m C)M ^Q' \ W Cr IX �UOW ZO CO Q I— /L ! a L LJ F- w h J N W \ 9Z yZ0 = 7 Z_r2 t /' yj LU LU co v D Z C) I W \ / w m Ci z co \ L) o � � L T Safety and Buildings commercemi. ov 3824 N CREEKSIDE LA g HOLMEN WI 54636 Contact Through Relay ' s c O n s' n www.commerce.wi.gov/sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Richard J. Leinenkugel, Secretary October 10, 2008 CUST ID No. 227819 AT7N: POWTS Inspector WILLIAM J BERGH ZONING OFFICE GEO TECH SOIL & SITE EVALUATION ST CROIX COUNTY SPIA 2667 113TH ST 1101 CARMICHAEL RD CHIPPEWA FALLS WI 54729 -6575 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/10/2010 Identification Numbers Transaction ID No. 1593314 SITE: Site ID No. 738909 River States Truck & Trailer Please refer to both identification numbers, St Hwy 65 & 690 Star Lane above, in all correspondence with the a enc Village of Roberts St Croix County NEl/4, SW1 /4� S34, T29N, R18W FOR: Description: Non - pressurized In- ground POWTS / New construction / Commercial Object Type: POWTS Component Manual Regulated Object ID No.: 1202181 Maintenance required; 1,139 GPD Flow rate; 130 in Soil minimum depth to limiting factor from original grade; System(s): In- ground POWTS Component Manual, SBD- 10705 -P (N.01 101) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. ' The following conditions shall be met during construction or installation and prior to occupancy or us:: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual referenced above. • 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 ofSec. 145.20(2)(d), Wis. Stats. • Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the effluent filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • 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: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. Conditioll l t APPRO VL". DEPARTMENT OF COMMER WILLIAM J BERGH Page 2 10/10/2008 Y • 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). • In the event this soil absorption system or any of its componert 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 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. Note: This approval does not include plans for the general plumbing systems or sewer piping leading eadin t�; o th septic/holding tank that may be required for this project See section Comm 82 20 Wis. Adm. Code to determine i plan submittal and approval is required. 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 may bemade 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, Fee Required $ 225.00 ' Fee Received $ 225.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WSMART code: 7633 jeny.switn@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. Richard A Ruf, , Bohl & Proulx Plumbing Inc (Plans Mailed To) Y= S c a Tmw a Srw DmN d 0so M eo Pr oudly Serving the Chippewa Valley Since 1994 G 834mPERC EVALU F SOIL & SITE �SO Cover Sheet Client: RIVER STATES TRUCK & TRAILER P.O. Box 2075 — LaCrosse, WI 54602 NON - PRESSURIZED CONVENTIONAL SOIL ABSORPTION COMPONENT USING GRAVELLESS LEACHING CHAMBERS Reference Component Manual In- ground Absorption Component Manual SBD- 10705 -P (N.01/01) Location: STH 65 & 1 -94 NE 1 /4, SW 1 /4, Sec. 34 T 29 N, R 18 W Town: ROBERTS County: ST. CROIX Designer's name and license #: William J. Bergh (License No. 1577 -007) I the undersigned state that the a plans a designed a d submitted unde my authorit . ••� s • •a Designer's signature: + • +' . . . Designer's address: 4255 N Pr w' w Road, suite 2 M" �: = Chippewa Falls WI 54729 �t1 Designers phone number: 715- 723 -5555 voice . So .� • ,..*'Q� �: 715 - 720 -1101 fax y ' "-••• »• "'' Q 715 - 577 -6838 cellular ••• +•#*game* billy @wastewaterpros.com email Contents Page 1 cover sheet Page 2 site plan (with system calculations) Page 3 leaching chamber x- section i Page 4 leaching chamber manufacturer specifications Page 5 management and contingency plan DIVISiO N A 7Y Ai�a ;, L- trlttios Page 6 management and contingency plan SEE CORR POD DENGEE Page 1 of 6 4255 S. Prairie View Road, Suite 2 • Chippewa Falls, WI 54729 LOCAL: (715) 723 -5555 FAX: (715) 720 -1101 w w w. w a s t e w o t e r p r o s . c o m • ' ^ INFILTRATOR QUICK 4 STANDARD -W LEACHING CHAMBER (typical) installations requires additional cells (not shown here) "DRAWING NOT TO SCALE" 4" SCH 40 pvc OBSERVATION PIPE (with removable watertight cap or vent cap if >12" above finish grade) SOIL TO PROMOTE (must have an open bottom) PLANT GROWTH ELEV = 100.5- 101.0' I I I I W must be anchored to leaching >12" chamber to prevent removal (screws or collars are acceptable) ! 74" min & 84" max, C 1211 ) 12 11 ;4„ 4' 3.0' 34" —34" SYSTEM ELEVATION 94.00 27 NUMBER OF LEACHING CHAMBERS (per cell) 3 NUMBER OF CELLS 81 TOTAL NUMBER OF LEACHING CHAMBERS (all cells) DIMENSIONED PLAN VIEW OF COMPONENT 108' ,9n >... Y�. �l.', �....... y. ��� .........Y�P, \ .............y: ;: r ...._..y'. \ y �� , ,,__.i_ : �� \: :::::._.v....�,. y ... h `_.. _..; _{: y :_' �/\__....._ �. �. ��..._..._ �:: �' r� .__.._ ��•__:.:: _ _ A\ / �... \�, �j �n 'j z.`. �`'� / �jj'I`� r'`�\ ..., e <.. ;r� T J iY "\ jj � - r��. j'" \y j,�� _ i-?, -. INFILTRATOR QUICK 4 STANDARD -W CHAMBER - OPEN BOTTOM AREA =16.1 SQFT INFILTRATIVE SURFACE PER CHAMBER BASED ON EISA RATING= 20.0 SQFT QUICK 4 STANDARD END CAPS PER PAIR EISA RATING = 5.8 SQFT ALL MATERIAL AND PIPING SPECIFICATIONS AS PER THE CONVENTIONAL SOIL ABSORPTION COMPONENT MANUAL PAGE 3OF6 i ct4` STANDARD CHAMBER 52" Quick4 Standard Chamber 48" (EFFECTIVE LENGTH) e 12" 8„ 34" SIDE VIEW SECTION VIEW Multiftrt End Cap R O 16'• 12" 34" SIDE VIEW TOP VIEW FRONT VIEW "a r rte¢ '€ a„ s r „'� ^8r; vr,. 'r�� ° s yi” j 9 x T1 a Tx > ".)*% "r s d nxf II I l e f Y K'd Tl // �Ne'F tyf* a ,r '�° m. x 2 ,;, ., `.r r '` p ia 'r•�. >..�f , ?r''6 4 P' INFILTRATOR SYSTEMS, INC. STANDARD LIMITED WARRANTY (a)The structural inloynty of each <:hernber. and plate, wedge and other accessory manufactured by Infiltrator ( "Units " ;, when installed and operated In a leachefd of an onsite septic system In accordance with Infiltrator'. Instructions. Is warranted to the original puchaser ('Helder") against defective materials and workrnansYiip for One year horn the data that the Septic permit Is issued for the septic system containing me Units', provided, however. that If a septic penult is not required by applicable law, the warranty period will begin upon the date that Installation of the septic system commeen To oxareiso its warranty rights, Holder must nobly Infiltrator in writing at Its Corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) . / • . days of the alleged defect. Infiltrator will supply replacement Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrator's liability sprrif_11y excludes the cost of removal and /or installation of the Units. O R (b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH fa) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT SYSTEMS INC TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. tic) This Limited Warranty shall be void If any part of the chamber system Is manufactured by anyone other than Infiltrator The Limited Warranty does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of EnvironmentalOnsite Wastewater Solutions' production and profits, labor and materials, overhead costs, or other losses or expenses incurred by the Holder or any third party. Specifically .or.. from Limited Warranty coverage are damage to the Units due to ordinary wear and tear, alteration, accident, misuse, abuse or neglect of the Units; the Units bang subjectad to vehicle traffic or other conditions which are not permirted by the installation instructions; failure to maintain the 6 Business Park Road • P.O. Box 768 minimum ground covers set forth in the installation instructions; the placement of improper materials into the system containing the Units; failure of the Units or the septic system due to improper siting or Improper slzing. excessive water usage, improper grease disposal. a Improper operation or Old Saybrook, CT 06475 any other event not caused by Infiltrator This Limited Warranty shall be void if the Holder fails to compN with all of the terms set forth 'rn this Limited Warrant 860- 577 -7000 • FAX 860 - 577 -7001 Further, in no event shall Infiltrator be responsible for any loss or damage to the Holder, the Units, or any third party resulting from installation or ship- 800_221 - 4436 ment. or from any product liability claims of Holder or any third party For this Limited Warranty to apply, the Units must be installed in accordance with all site conditions required by state and local codes; all other applicable laws; and Infiltrator's Installation instructions. (d) No representative of Infiltrator has the authority to change or extend this LJmiled Warmnly. No warranty applies to any party other than the ongi- nal Holder The shove represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty requlre- rnen4s, Any purchaser of Units should contact Infiltrator s Corporate Headquarters in Old Saybrook, Connecticut, prior to such purchase, to obtain e copy of the applicable warranty, and should carefully read that warrany prior to the purchase of Units. U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839.844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer and SideWlnder are registered trademarks of Infiltrator Systems Inc. Infiltrator Is a registered trademark in France. Infiltrator Systems Inc. is a registered trademark In Mexico, Contour, Contour Swivel Connection, MicroLeaching, PolyTuff, Snapt-ock, ChamberSpacer, PosiLock, OuickCut, QuickPlay pECYCLEO°APER and Qulck4 are trademarks of Infiltrator Systems Inc. Q 2003 Infiltrator Systems Inc. Printed in U.S.A. 0 0 3HP-0 POWTS OWNER'S MANUAL MANAGEMENT PLAN PERMIT NUMBER: Owner /Agent: RIVER STATES TRUCK & TRAILER — STH 65 & 1 -94 POWTS Maintainer: Geo Tech Soil & Site Evaluation — Chippewa Falls, WI 715- 723 -5555 Local Regulatory Authority: St. Croix County Zoning Department — Hudson, WI 715 - 386.4682 POWTS Installer: Bohl & Proulx Plumbing Inc. — Chippewa Falls, WI 715- 723 -9655 Septage Servicing Operator DESIGN PARAMETERS Influent/Effluent quality (values typical for domestic (non - commercial wastewater and septic tank effluent) Fats, Oil and greases (FOG) <30 mg/L, Biochemical Oxygen Demand (BOD) <220 mg/L, Total Suspended Solids (TSS) <150 mg/L Soil loading Rate (SLR) = 0.7 gpd /ft SYSTEM SPECIFICATIONS The components of this septic system are intended to serve a commercial building generating employee (domestic strength waste) — ALL INDUSTRIAL WASTE MUST BE DISCHARGED INTO A SEPARATELY APPROVED HOLDING TANK! The components include a Huffeutt model 2500 septic tank with an approved outlet effluent filter and (3) non- pressurized distribution cells using graveless leaching chambers. A total of (81) Infiltrator Quick 4 leaching chambers are required when applying an EISA rating of 20.0 as specified by DCOMM. All parts of the components must comply with WI Adm. Code COMM 84 and be installed per manufacturer specifications and approval letters. DESIGN CRITERIA o "Design of conventional Soil Absorption Trenches and Beds ". R.J. Otis — ASAE Publications 5 -77 and Design Manual — Onsite Wastewater Treatment and Disposal Systems:. EPA 625/1 -80 -012 October 1980 ✓ SBD — 10567 -P (R.6/99) "In ground Absorption component Manual" o SBD — 10705 -P (N.01 /01) "In ground Soil Absorption component Manual" Version 2.0 MAINTENANCE & MANAGEMENT Inspect the condition of the treatment tank(s) and dispersal cell(s) a minimum of every three years. The septic tank contents must be removed in accordance with Chapter NR 113, WI Adm. Code when the combined sludge and scum equals one -third (1/3) the tank volume. The effluent filter should be inspected annually to ensure maximum performance. START UP For new construction prior to use of the POWTS check treatment tank(s) for presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage - servicing operator prior to use. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of wastewater will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also, the brine or waste from water softeners, iron removal units, and other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. The system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit peels and seeds, bones, and food solids such as those produced be a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins, condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics (medications), solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain regular steady flow by spreading the laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the unit may cause it to freeze up. o Alarms Alarms should be tested on a regular basis by the homeowner. If an alarm sounds, contact an individual licensed to serve POWTS. There is normally a one day reserve capacity under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surface. Page 5 of 6 i `� • cf i INSPECTIONS Inspections shall be made by a person carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule) ✓ Septic Tank Component Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks of leaks, measure the volume of combined sludge and scum and to check for any backup or surface discharge of effluent. Access openings used for service of assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental of unauthorized entry into the tank. The outlet(effluent) filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank during cleaning. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating properly. o Pump Chamber/Treatment Tank(s) Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must me made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. ✓ In- Ground Gravity Component dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. o Divertor Valve The divertor valve shall be switched to serve the opposing distribution component every three years (when the septic tank is due for it regular maintenance). However, if ponding is observed in the observation/vent pipe of any cell, the divertor valve shall be switch to the opposing component. Furthermore, ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. All piping to tanks and pits shall be disconnected and the abandoned pipe opening sealed. The contents of all tanks and pits shall be removed and properly disposed of be a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system. ✓ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure(s), lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. • 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 SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OF OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. Page 6 of 6 f i!!f!i 1lfff i[!fl IIII{ IIIII IIIII III{ 111 {II 1NI IIN * 8 7 9 0 8 3 1 State Bar of Wisconsin Form 2 -2003 879083 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document Name ST CROIX CO., WI RECEIVED FOR RECORD 07/28/2008 12:45PH THIS DEED, made between D &B Equipment, LLC, a Wisconsin limited liability _ WARRANTY DEED company EXEMPT t ( "Grantor," whether one or more), REC FEE: 11.00 and River States Truck and Trailer, Inc., a Wisconsin corporation TRANS FEE: 4500.00 PAGES: 1 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following Recording Area described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property ") (if more Name and Return Address space is needed, please attach addendum): River Valley Abstract &Title, Inc. All that part of S % of SE '/4 of Section 34, Township 29 North, Range 18 West St. 1200 Hosford Street Suite 201 Croix County, Wisconsin lying Southwesterly of new Interstate Highway. Hudson, wt 54016 #2699720 N 'A of SW ' /4 and SE ' /4 of SW '/4 of Section 34, Township 29 North, Range 18 West, St. Croix County, Wisconsin lying Southwesterly of Interstate Highway "94 ". 0 42 - 1097 - 30 - 000 Parcel Identification Number (PIN) PIN 176- 1082 -00- 000, 176 - 1082 -10- 000,176- 1082 -20- 000,176 - 1082 -30 -00 This is not homestead property. (is) (is not) Exceptions to warranties: Easements and Restrictions of record, if any. Dated July 28, 2008 D& quipment, LLC (SEAL) (:, — - _(SEAL) * * Ronald C. Bonte,�m�emmber Of (SEAL) r /• (SEAL) * * Steven M. Dalton, member AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN N a thenticated ) ) ss. �}T RY PUBU� St. Croix COUNTY ) %TAY OF WISC * _ Personally came before me on July 28, 2008 TITLE: MEMBER STATE BAR OF WISCONSIN the above -name nald C. Bonte and Steven M. Daltom, members E ui me LC (If not, to now to be the p on(s) who executed the foregoing authorized by Wis. Stat. § 706.06) ; 'rum and ackn d the same. THIS INSTRUMENT DRAFTED BY: * Douglas Berg, 1200 Hosford St. #201 tary Public, State of Wisconsin Hudson, WI 540]6 My Commission (is permanent) (expires: 3 " ae) �� ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOIILD BE CLEARLY IDENTIFIED. WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 2 -2003 * Type name below signatures. 1 of 1 i ArcIMS Viewer Page 1 of 1 f a i http: / /www.landinfo.co. saint- croix.wi.us/ website /LRPortal /ARCIMS/MapFrame.asp ?PIN= 10/17/2008 Wisconyin Department ofCommerce SOIL EVALUATION REPORT Page 1 of 4 Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code • County Attach complete site plan on paper not less than 8' /s x 11 inches in size must St. Croix Include but not limited to: vertical and horizontal reference point (BM), - i d Parcel I.D. Percent slope, scale or dimensions, north arrow, and BM referenced earest /� !o 0 Z — Please print all information Review by D e Personal information you provide may be for secondary purposes (Privacy Law, s. 1 (1) (m Property Owner R E C E{ V E D Property Loca River States Truck &Trailer Govt. Lot NE �i, SW T v< s 3 29 R 18 w Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 2075 JUL 15 2008 City State Zip ode ST. CROFP 6UNTY ❑ City 0 Village ❑ Town Nearest Road La Crosse WI 5 Zo C78*d 147 1 1 Roberts Hwy 65 & I94 0 New Construction Use: ❑ Residential / Number of Bedrooms Code derived design flow rate GPD Max 50 employees, floor drains ? (25 GPD each), <2500 sq. ft retail (58GPD), ❑ Replacement 0 Public or Commercial — Describe: and 2 showers with 77 lockers. GPD to be estimated by the desiPner. Parent Material Loess over Glacial till / Outwash Flood Plain elevation if applicable NA ft. General comments and recommendations: Install conventional system in sand located 63 to 83 inches below surface between borings 5, 6, 7, & 8. Ale4 S61 :5t aeu w,F- c7#• S 1 OB ormg IF 1 Bormg # 0 Pit Ground Surface Elevation 100.1 ft. Depth to Limiting factor2 & >138 in.� Q.4— S oil Aoolication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -14 10YR3/2 - SIL 2 -m to co-pl mfr gs if 0.0 0.2 2 14 -22 10YR4/4 - SIL 2 -m -bk mfr gs if 0.6 0.8 3 22-46 10YR4/4 7.5YR4/6 & 10YR4/2 f -2-d CL 3 -m -bk mfr gw 1 f 0.4 0.6 4 46 -70 10YR3/4 - LS 1 -co -bk mfi cw - 0.7 1.6 5 70 -138+ 10YR5/6 - S 0 -sg ml - - 0.7 1.6 4 ❑ Boring 2 Boring # Opit Ground Surface Elevation 99.7 ft, Depth to Limiting factor2 & >135 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EfF#1 *002 1 0 -17 10YR3 /2 - SIL 2 -m to co -pl mfr gs if 0.0 0.2 2 17 -27 10YR3/2 - SIL 2 -m -bk mfr gs - 0.6 0.8 3 27 -51 10YR4/4 7.5YR4/6 & 10YR4/2 f -2-d CL 2 -m -bk mAI gw - 0.4 0.6 4 51 -80 10YR3/4 7.5YR4/6 f-1 -d SL 1 -co -bk mfi cw - 0.4 0.7 5 80 - 135 10YR5/6 - 1 S 0 -sg ml - - 0.7 1.6 IV I ' Effluent #I = BOD 30!5 220 mg/L and TSS > 30:S 150 g/L * Effluent #2 = BOD, 5 30 mg/L and TSS <_ 30 mg/L CST Name (Please Print) Signature CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 May 7 & July 11, 2008 715- 796 -5664 Property Owner River States Truck & Traile Parcel ID# Page - -of 4 Boring Boring # ®Pit Ground Surface Elevation 99.3 ft. Depth to Limiting factor5 & > 130 in. Soil Aoolication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eft#1 *Eff#2 1 0 -10 10YR3/2 - SIL 1 -m -pl mfr gs if 0.4 0.6 2 10 -20 10YR3/2 - SIL 2 -m -bk mfr gs if 0.6 0.8 3 20 -35 10YR4/4 - SICL 2 -m -bk mfr gw - 0.4 0.6 4 35 -55 10YR3/4 - CL 2 -m -bk mfi cw - 0.4 0.6 5 55 -74 10YR4/4 10YR5/287.5YR46 f -1 -d CL 2 -m -bk mfi cw - 0.4 0.6 6 74 -120 10YR5/6 - GRS 0 -sg ml CS - 0.7 1.6 7 120 -126 10YR4/4 - SL 0 -m mfr as - 0.2 0.6 8 126 -I30+ 10YR6/4 - S 0 -sg ml - - 0.7 1.6 Boring # 0 Boring Wit Ground Surface Elevation 101.8 ft. Depth to Limiting factor3 & >105 in. Soil AiMlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EfW2 1 0 -15 10YR3/2 - SIL 2 -m to co -pl mfr gs 2f 0.0 0.2 2 15 -23 10YR3/2 - SIL 2 -m -bk mfr gs if 0.6 0.8 3 23 -30 10YR3/3 - SIL 2 -m -bk mfr gs - 0.6 0.8 4 30 -75 10YR4/4 7.5YR4/6 c -2 -d CL 2 -m -bk mfi cw - 0.4 0.6 5 75 -95 10YR611 Layers of 5YR 4/6 m -2 -p S 0 -m mvfr cvu - 0.7 1.6 6 95 -105+ 10YR4/6 - XGRS 0 -m - - - 0.5 0.5 ❑ Boring 5 Boring # ®pit Ground Surface Elevation 100.5 ft. Depth to Limiting factor >144 in. Soil ADDlication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10YR3/3 - SIL 2 -m -bk mfr cs 1f 0.6 0.8 2 9 -16 10YR4/4 - SIL 2 -m -pl mfr cs - 0.0 0.2 3 16 -33 7.5YR4/4 - SCL 3 -m -bk mfi cs - 0.4 0.6 4 33-49 10YR4/4 - SL 1 -co -bk mfr gs - 0.4 0.7 5 49-65 10YR4/4 - GRLS 1 -m -bk mvfr cw - 0.7 1.6 6 65 -144+ 10YR4/4 - S 0 -sg ml - - 0.7 1.6 Il * Effluent # 1 = BOD5> 30 <_ 220 mg/L and TSS > 30 < 150 g/L * Effluent #2 = BOD5 <_ 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. Property bwner River States Truck & Trailer Parcel ID# Page __ _of 4 13 Boring [- 6 Boring # ®pit Ground Surface Elevation 100.3 ft. Depth to Limiting factor >138 in. Soil Application R to Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *001 *Eff#2 1 0 -11 10YR3/3 - SIL 2 -m -bk mfr cs 1f 0.6 0.8 2 11 -20 10YR4/4 - CL 3 -m -bk mfr gs - 0.4 0.6 3 20 -25 7.5YR4/4 - CL 3 -m -bk mfi cs - 0.4 0.6 4 25-63 10YR4 /4 - S 0 -sg ml aw - 0.7 1.4 4A* 25-63 7.5YR4/4 - I LS 0 -m mfr aw - 0.7 ** 1.4 ** 5 63 -114 10YR4/4 - S 0 -sg ml aw - 0.7 1.4 6 114138 10YR8/1 - S 0 -sg ml - - 0.7 1.4 ❑ Bori*g4A = Lamellae 0-5 to 2 inches thick ** Recommend 0.2 GPD / sq.ft. ❑7 Boring # ®pit Ground Surface Elevation 99.5 ft. Depth to Limiting factor >135 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10YR3/2 - SIL 1 -m -bk mfr cs 1f 0.4 0.6 2 10 -19 10YR3/2 - SIL 2 -m -bk mfr gs - 0.6 0.8 3 19 -31 10YR4/4 - CL 2 -co -bk mfi gw - 0.4 0.6 4 31-45 7.5YR4/4 - SL 1 -co -bk ml cw - 0.4 0.7 5 45 -83 10YR4 /4 - S 0 -sg ml cs - 0.7 1.4 5A* 45 -83 7.5YR4/4 - LS 0 -m mfr cw - 0.7 ** 1.4 ** 6 83 -135+ 10YR4/4 - S 0 -sg ml - - 0.7 1.4 * 4A = Lamellae 0.5 to 2 inches thick ** Recommend 0.2 GPD / sq.ft. ❑ Boring 8 Boring # ®pit Ground Surface Elevation 101.9 ft. Depth to Limiting factor >130 in. Soil Application R to Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 - Eff#2 1 0 -10 10YR3/2 - SIL 2 -f -bk mfr cs 1f 0.6 0.8 2 10 -18 10YR4 /4 - CL 2 -m -bk mfr gs - 0.4 0.6 3 18 -26 7.5YR4/4 - , CL 3 -m -bk mfi gw - 0.4 0.6 4 26-64 10YR4/4 - LS 0 -sg ml cw - 0.7 1.4 4A* 26-64 7.5YR4/4 - LS 0 -m mfr cs - 0.7 ** 1.4 ** 5 64 -107 10YR4 /4 - S 0 -sg ml cw - 0.7 1.4 6 107 -130 10YR8/1 - S 0 -sg ml - - 0.7 1.4 * 4A = Lamellae 0.5 to 2 inches thick ** Recommend 0.2 GPD /sq.ft. • Effluent # 1 = BODs> 30:5 220 mg/L and TSS > 30:5 150 mg/L * Effluent #2 = 130135 :5 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. ` M#3 - Top of 3/4 "PVC Pipe � 100.1 - 0 ft. 24 ft. 40 ft. 80 ft. N B - Page 4 of 4 100.3 B -7 O� 99.5 ' s B-8 ti '9r N� Ar 01. O i • L' B -5 O " 100.5"/ 0 3/4 "PVC Pipe B _ ( .5 9 99.3' ` 1 � t9 ~ O .1 > 'OOH• ��� o f• os O• o Or O' oy a �o Aro c .0 c ° s @a CL B_1� m 100.1' 7 ' B-2 .00� 99.7' � A O� a� A 00 B -4 B -1 101.8' Boring Location & Elevation BM# & Description O Bench Mark Elevation Owner: River State Truck & Trailer Site Information: Completed By: Mark Iverson, PSS #197 P.O. Box 2075 NE 1/4, SW 1/4, S34, T29N, R18W 680 Larcom Street LaCrosse, WI 54602 Village of Roberts Hammond, WI 54015 St. Croix County 715- 796 -5664 Phone: 608 -784 -1149 CST# 46672 ,I 8aing # U Being 1 ❑ pit Ground s xbce elan _ - -_ - -_ fi. Depth to limiting factor - - - - -- in. 8al Application Rate Horizon depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPEW in. Wtunsdl Qu. Sz. Cont. Color Gr. Sz. Sh. 'EIMI - 2M ti a Boring # ❑ acting pit Ground siaface elov. _ - - --- ft. depth to limiting factor _ hr. Shc ApNication Rate Horizon depth Dominant Cobr Redou description Texture Structure Consistence Boundary Rods GPOMP in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ett#f 'EM2 3 /ti - 33 L 3 nn v -7 // BOHL &PROULX 715 723 1272 10/20 1 08 10:31 NO.385 02/02 VLI LU - LUUV %nun/ II.I- Rx'.Oeto�Time OCT- 204006(NON) 09 =01 P., Do? OCt/2'07•20000N •09;19 BADMAN CCMTItUCf LON FAX No: 715 723 9466 • 1 ST COX Co' ZONING Col a uz ip /17 /OS FitI 10:12 FAX 715 368 44515 S7. CROIX COUNTY SE=PTIC TANK MAWTEENANCE AG D OWI SRSHIP C1:A TMCA'I ON FORM Owner /Buyer tL,�vtl' ���_ rt.rc� �- I('a..ltrt- npiss e- Milling Address " Property Address (Veriiic�stion mquinett frotrl Plinv4ns dt Zoning Deparhn�L for nev► consteVatws -) Parcel Identiffitaation NUM b" city/state LEG1�L DESC,rON . ' l���l•4.�c- • Ptoperty Location E /• . �i /IS w �e�rn of Lot* Subdivis;iory Plan Cerdtied SorveT Map Volume Page JV Wtrrr+rnty Deed 1f 7 9 0% ? (befog 2007)votUMe �."�,: pag N ` ----= Sp" lbouse Y,;4. yr ; Lot lines i frabte y09 no SYSTL MA1h1TElY I: A MP a \YNIrR Cti�lt =>FiC�►T IQtprvPgr use and tnsinteatanCt oEyour septic systean Could result in its pmMatvie'15►me& to handle as a tIvOu wa:tes.� y pe� t into coi +sists of putnfllnC out tlta xoptic tank every ttuee )teats of sooner, if needed, by a lict:nSIA W ���� the sy%swn ern a P° Cfeet the i4neciou of tho C optic tenet nent a1111M in Ctrs rlraSla di $anjj s Ord once. respentibi6lies ate sP =iPted in Watstnt. 83.52(1) and in C apta• 12 - St. Crots C'.ersnty Sanitt+ty Ordinance. ro submit w St. Croix County Plitnni►rg & Zoning Depat'tttlent a oertlficatisn Writ. sivitidby this T1ta property Owner esters owner and by a mnster plumb&&. journeyman plumber, telttrlclGtl plutnbit' or A tleettsed yutnper Y ping i that t t) ), i jjeppc tank is wocte -+Nwr dispesol system is itr prorrer vptii sting eoedillon and/or (2) aftw inep�eiott rind Pum in tf nercatwy)� less than V3 full orsludKe. 1 1.re, the un dersigoad have read t1re above requiretumts and a gme to maintain the private sewage disposal fosysum wit n the swtdards set fartb, herein, vs act by dte DVIrttrlern of Cotnmera attd t;,stt Til Drysrtunent ofNamrat Resourexs CeRitleatiprt stating that your aep tio ern Iuas b9m tttatntainW rt umt be completed and tob+rned to the St. 00 nty Pruning & Zoning DepaSrllcrtt within 30 days of the thfcts year cipirdiou date. Uwe certify that nit slatetvMiS oil Q Cis focm We true b the best army/cur k owl edge. 1 1we arn1we the owner(-&) of the �c ugcri�0 above, by virtue of a warrattity decd re_ee in ltegieter of Deeds OCS Z'So� are- 6l tJ Z t OR%•.S jb N A MICANTM DATE i Sc Zonia De artment. it being ►cooked by the plttttia ng t: D 'r�'Any lnCam t thot in misrotrrestntcd twey r�x utl in tM aa4i[ary 1R� . Include with this application a mwr+dc'd wa,rnnty deRi from the Register of Ikcds OtTiee and a copy or the aerlified survey if reference is made in the warranty deed, (RE owns) ST. CROIX COUNTY ' SEPTIC TANK MAINTENANCE AGREEMENT AND n OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address P. - IJax 2-67� 1 �- Property Address 6 / o 5�'r k-' f_ &d ex`s W ,- (Verification required from Planning & Zoning Department for new construction.) City /State P66 61_6 (^-jl— Parcel Identification Number __ 17 4o - 1682 —16 —606 LEGAL DESCRIPTION C ' (O J "<<ac r , Property Location /yE '4, 6 '/,, Sec. 34 , T Z- N R /g W, -own of Subdivision Plat: , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # " 7 6% 3 (before 2007)Volume , Page # Spec house yesx° Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I /we certify that all statements on this form are true to the best of my /our knowledge. I /we am/are the owner(s) of the pr perty descri d above, by virtue of a warranty deed recorded in Register of Deeds Office. J 5o E 10 �5 N s / J Z500 r+ 2 .; Z �Ico( SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) r t^ ' Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 lAvision of Safety and Buildings In accordance withPun risldm. 0 County Attach complete site plan on paper not less than 8 % x I I inches in size. Plan must St. Croix Include but not limited to: vertical and horizontal reference poi w ;ti— ;n Parcel I.D. �Q Z — ()av /_^� Percent slope, scale or dimensions, north arrow, and BM referenced to nearest road. r (� 7 Please print all information Revie 76 D Ha 3 S/ Personal -' ation you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)) / Property Owner Tg CE I VEP Property Location River States Truck & Trailer Govt Lot NE v. S v, s 34 T 29 N R 18 W Property Owner's Mailing Address Lot # Block # S P.O. Box 2075 JUN 03 2008 - 9�/ — city State Z Code Phone ❑ City ® Village ❑ T n Nearest Road ST. CR IX COUNTY La Crosse WI 602 ZOM QW84El 147 Roberts Hwy 65 & I94 ® New Construction Use: ❑ Residential / Number of Bedrooms Code derived design flow rate GPD Max 50 employees (650 GPD), floor drains ? (25 GPD each), <2500 sq. ft retail ❑ Replacement ® Public or Commercial — Describe: (58GPD) Total estimated stallons per day 785 GPD Parent Material Loess over Glacial till / Outwash Flood Plain elevation if applicable NA ft. General comments and recommendations: Ceti dvn0z) in' /LPG - 303 -C. 1 � o `J 9� 1 l Bonn # Boring I ms,µ g ® Pit Ground Surface Elevation 100.1 ft. �""' DBp ht to Limiting factor2 & > 13 8 in. f o M' S oil li n Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GEDe in. Munsell Qu. Sz. Cont. Color Gr, . Sh. "Eff#1 *01#2 1 0 -14 10YR3/2 - SIL 2 -m to co -pl mfr gs if 0.0 0.2 a 2 14 -22 10YR4/4 - SIL 2 -m -bk mfr gs if 0.6 0.8 3 22-46 10YR4/4 7.5YR4/6 & 10YR4/2 f -2-1 CL 3 -m -bk mfr gw 1f 0.4 0.6 4 46 -70 10YR3/4 - LS 1 -co -bk mfi cw - 0.7 1.6 5 70 -138+ 10YR5/6 - S 0 -sg ml - - 0.7 1.6 4� F 2 ] — 0 Boring Ly Boring # OPit Ground Surface Elevation 99.7 ft. Depth to Limiting factor2 & >135 in. Soil Aoolication Ra Horizon Depth Dominant Color Redox Description Te Structure onsi Boundary Roots GP /fe in. M n ell Qu. Sz. Cont. Color Gr. Sz. Sh. 'E 1 0 -17 10YR3/2 - SIL 2 -m to co -pl mfr gs 0.0 lI 2 17 -27 10YR3/2 - SIL 2 -m -bk gs - 0.8 3 27 -51 10YR4/4 7.5YR4/6 & IOYR4/2 f -2-d CL 2 -m -bk mvf gw - 0.4 0.6 4 51 -80 10YR3/4 7.5YR4/6 f -1-d SL 1 -co -bk mfi cw - 0.4 0.7 5 80 -135 10YR5/6 - S 0 -sg Ml - - 0.7 1.6 * Effluent #1 = BOD 30 <_ 220 mg/L and TSS > 30 <_ 150 mg/L * Effluent #2 = BOD5 <_ 30 mg/L and TSS 5 30 mg/L CST Name (Please Print) Signature CST Number Mark Iverson 7- = - 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 May 7, 2008 715- 796 -5664 V Property owner River States Truck & Traile Parcel ID# Page 2 of 3 3� Boring # 13 Boring Wit Ground Surface Elevation 99.3 ft. Depth to Limiting factor5 & >130 in. S oil Application R ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10YR3/2 - SIL 1 -m -pl mfr gs 1f 0.4 0.6 2 10 -20 10YR3/2 - SIL 2 -m -bk mfr gs 1f 0.6 0.8 1! 3 20 -35 10YR4/4 I SICL 2 -m -bk mfr gw - 0.4 0.6 �q 4 35 -55 10YR3/4 - CL 2 -m -bk mfi cw - 0.4 0.6 5 55 -74 10YR4/4 10YR5/2 &7.5YR46 f-1 -d CL 2 -m -bk mfi cw - 0.4 0.6 6 74 -120 10YR5/6 - GRS 0 -sg ml cs - 0.7 1.6 7 120 -126 10YR4/4 - SL 0 - mfr as - 0.2 0.6 8 126 - 130+ 10YR6/4 - S 0 -sg ml - - 0.7 1.6 4] Boring # ❑ Boring Wit Ground Surface Elevation 101.8 ft. Depth to Limiting factor 30 in. S oil Amlication R ate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Efi#2 1 0 -15 10YR3/2 - SIL 2 -m to co -pl mfr gs 2f 0.0 0.2 2 15 -23 10YR3/2 - SIL 2 -m -bk mfr gs if 0.6 0.8 3 23 -30 10YR3/3 - SIL 2 -m -bk mfr gs - 0.6 0.8 4 30 -75 10YR4/4 7.5YR4/6 c -2-d CL 2 -m -bk mfi cw - 0.4 0.6 5 75 -95 10YR6/1 Layers of 5YR 4/6 m -2 -p S 0 - mvfr cw - 0.7 1.6 6 95 -105+ 10YR4/6 - XGRS 0 - - - - 0.5 0.5 F-1 ❑ Boring Boring # Wit Ground Surface Elevation ft. Depth to Limiting factor in. Soil ADDlica Rat Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Pi in. Munsell Qu. Sz. Cont. Color Gr. S S h. *Eff#1 *0#2 ' Effluent #I = BOD 30:5 220 mg/L and TSS > 30:5 150 mg/L • Effluent #2 = 13013 :5 30 mg/L and TSS 5 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. v � Page 3 of 3 ` 0 ft. 24 ft. 40 ft. 80 ft. N Pond Area s BM#2 - Top of 3/4 "PVC Pipe B_ 99.5' O� 99.3' •Q. � cS A � a 100.1' Sl` B Top of3/4"PVC Pipe 100.0' 99.7' d� R O 3 O [Q C O Z B4 co o ence Old F 101.8' line c =r o - °, w tT � c m a B m N BM# & DescriptionAL a Benc Mark B-1 Elevation 100, = Boring Location & Elevation Owner: River State Truck & Trailer Site Information: Completed By: Mark Iverson, PSS #197 P.O. Box 2075 NE 1/4, SW 1/4, S34, T29N, R18W 680 Larcom Street LaCrosse, WI 54602 Village of Roberts Hammond, WI 54015 St. Croix County 715 - 796 -5664 Phone: 608 -784 -1147 CST# 46672 P,orcel #: 042 - 1096 -30 -000 06/12/2008 04:05 PM If P 1 OF 1 Alt. Parcel #: 34.29.18.532B 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/07/2005 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - D & B EQUIPMENT LLC, RETIRED RETIRED D & B EQUIPMENT LLC Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 34 T29N R18W PT NE SW PT S OF HWY 94 Block/Condo Bldg: NKA 176 - 1082 -00 (633) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 34- 29N -18W NE SW Notes: Parcel History: Date Doc # Vol /Page Type 12/07/2005 813767 2940/290 ANNEX 04/05/2005 791337 2777/327 PR 02/11/2005 787280 2748/081 TI 02/11/2005 787279 2748/079 TI more 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/09/2006 Description Class Acres Land Improve Total State Reason Totals for 2008: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2007: 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 Parcel #: 042 - 1096 -40 -000 06/12/2008 04:05 PM v PAGE 1 OF 1 Alt. Parcel #: 34.29.18.533 042 - TOWN OF WARREN Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/07/2005 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co -Owner 0 - D & B EQUIPMENT LLC, RETIRED RETIRED D & B EQUIPMENT LLC Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 2422 ST CROIX CENTRAL SP 1700 WITC Legal Description: Acres: 39.500 Plat: N/A -NOT AVAILABLE SEC 34 T29N R1 8W 39.5A NW SW ANNEXED Block/Condo Bldg: (12/07/05) NKA 176 - 1082 -10 (634) Tract(s): (Sec- Twn -Rng 401/4 1601/4) 34- 29N -18W NW SW Notes: Parcel History: Date Doc # Vol /Page Type 12/07/2005 813767 2940/290 ANNEX 04/05/2005 791337 2777/327 PR 02/11/2005 787280 2748/081 TI 02/11/2005 787279 2748/079 TI more 2008 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 03/09/2006 Description Class Acres Land Improve Total State Reason Totals for 2008: General Property 0.000 0 0 0 Woodland 0.000 0 0 Totals for 2007: 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 .. -CERTIFIED SUREW MAP • s � rn VOLUME ]0, G PAE2854' LOT 1 \ rR` N .�.� �cnc q w LOT2 I ND499.502•E I • g N00 12'42 "E 1306 22 t NOOO12'42'E 1255.72' I PARCEL DESCRIBED IN j,- o rn WEST LINE OF THE SWi /4 VOLUME 257. PAGE 175. O _ 3D LOT2OF I gL �".� �8.: rk' n CERTIFlEDSURVEVMA� �rA ❑ I m �� V/OLUMIE 13, PA_GE3571e -� mz I ar�p O I1 �w D UI � YZY-^1 -1 Hm m b p a ; bg �xgr r ox q ❑ p a O 8 �m�� o Z� cn o a mmm e cn {-nm� �m T7 L' . 11 � -{ a -(-1 -1 r' w cn I I ft) r m a z s �r�F,ri{ - n - m O E mm z °D �5��n � a= m l O w y >o �� Z qH I 1 x I .1 $ nargPP m A m N m�i�i rt nNi .D `L N a c� ~ ram m �i a �v < � � a I �° Nu o a n N BEARINGS REFERENCED TO THE EAST -WEST 1/4 $ / I� o Nm 7 m 0 m SECTION LINE OF SECTION 34, ASSUMED TO ; r*NC -n z < ^> BEAR N89 "E. / aw WEST LINE OF THE SES /4 OF THE SWi /4 — / ® z„ N00 "E 1306.87''� I cn � CC-1 ° � IR C �� ti • Z g$ M o ' •• l a // 3 I 1 1 I I 1 m �cnv�v� � (( a yy � � v �:: �z 1), // ^m En chN U1 Nm(/7�T( m� `•'r`� wmo-mN.��r1 SR M 4. � tn ^N mm d 2Z M M l / / -nl V�`� / Zy / a ( Q � DZ�Z - IN (AN Z (�7 ° m b C3 In n <Z � �mp,m=gr \N-I.L HZ 1 Z U <- (D N Eno / fmn C Z,�G1I A A -I RID� ym X� y °o \ p , sn nt hi ��Y <�tnata� d I� o to ' �i���rnmm iw r- p��as� •. o O ZAv /m ii44``II szs vi O$�\ �a O , 4 m� o S� m En mm -I0 gg ',Ii,N a�a - � a N� 0 07 m - D l n n \ 21 -I Rl €fiT � °2 X M m i E zuumi� �i r ' �'c�nA Ki- aDC�'�i y '� f m Z A \O N N / �[n anE n - a< °H� • �'g�'.. rn xm O CO Q z O � b y y m rif (n nnlnrn < ..�� .erg mf f - I�� m / / •� / 17 o o < `ohm Ny e F, .� Z D c- o� p0 p � A q , i l 5 , m a 3 Z X\ O = m O , $ A, rjvn°ir..°_ ���� �f� RI mi 21 H �� / � / H Efi J - ti G) `n �m c- � `/ 1 a� ��c` r Z D m -imJ �. {IJ �Im� roNm`�r -rqT D En { �� 0 ' I � �" m gm i lriq Qn� -.I �i1� I ( ~0-i nm Z� far^ �o - ie z (n n'rIS v2 v 01 a c� < N - 1 0 m Wm c�FaArsR xmmr5r <n P . L H�� �� O o gs< mm �\ i 1 a a a �°A O LD O O rn Bt.� ,- Lb a 68��4 VOL 16 PAGE 4303 .lAt� 2 0 KATHLEEN H. WALSH L REGISTER OF DEEDS ST. CROIX COUNTY I ST. CROIX Co., MI l SURVEYOR'S RECORD j RECEIVED FOR RECORD - Certified Survey Map No 4303 16 4303 05 -29 -2002 10:20 A Volume ,Page rrRT1R?ro SURVEY He BEING A PART OF THE SOUTHWEST 1/4 OF THE NORTHWEST 1/4 OF SECTION COPY FEE.- 15.00 34 AND THE SOUTHEAST 1/4 OF THE NORTHEAST 1/4 OF SECTION 33, CAGES: 3 AND ALSO THE NORTHEAST 1/4 OF THE SOUTHEAST 1/4 OF SECTION 33, TOWNSHIP 19 NORTH, RANGE 18 WEST, TOWN OF WARREN. ST. CROIX CO. WI. BEING ALL OF LOT t OF CERTIFIED SURVEY MAP RECORDED IN VOL. 10. PAGE 1854. APPROVED W 1/4 Cor'. ST. CROIX COUNTY Sec 33, T29N - R18W PREPARED FOR: Planning Zonina and Parks Committee Berntsen Alum. Mont. Robert Holdsworth TMI Properties Inc. MAY 2 9 2002 (Vo ry061 \\ 1 _' S 622 Star Lane N'%dth) S . Roberts Wisconsin, 54023 If not recorded within 30 days of No — approval date approval shall be A% s 7.0 i null and void f • 4Sq Note: The parcels on this map are subject : - I I No I'' °' to state and county laws, rules and re 10 n; - cess (i.e. wetlands, lot size, access to parcel, Etc.) I, ��„ o" �.. before purchasing or developing any parcel contact I,,�� 40` M 0 7 9 2' the St. Croix County Zoning Office for advise. 1 N� ?Z A , �'`, ' �`���'� LEGEND 13 `�� _ _ .........Government Corner (as noted) Rx pate /Time OCT- 20- 2.00B(MON) 09:01 P. 002 0CT /20/2008/MON 09:19 BAUMAN CONSTRUCTION FAX N0.715 723 9466 P. 002 X14'%17%08 rRI 10:12 FAX 715 886 4686 ST CRX CO ZONING RECEIVED ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT O 2 3 2008 AND owaERsmP CERTIFICATION FORM ST. CROIX COUNTY ZONING OFFICE Owner /Buyer Q lvf-f - Mailinu Address _ P 0 • IJau 207 Grote ' Property Address (Verification required liom Plaiwing 8c Zoning bepartmcnt for new construction City /State d �,Cf" (i.-1� 1?arcel ZdentiEcatiot� NumUex. lA -- 1d'9 2 - t� �J C, 6, 31 LEGAL DESCRIPTION /J �7k /. , ,Sec. �, T Z,9 N R /S W, n of Property Location. � /s ; Lot'# Subdivision flat. Certified Su rvey rvlap # , Volume M ,Page # Warranty Deed # 1 % - 7 1 9 O (before 2007)Volume page # Spec house yes Lot lines idcntifiable !:, yes; no SYSTEM MAINTENANCE AND OWNER CERTIFICATION improper use and maintenance of your septic system could resu m tilt in its premature failure to handle wastes. Proper maintenance consists of pumping out tie septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect dho function of tho septic tank as a treatment stage in the waste disposal systanl. Owner maintenance responsibilities arc specified in Wohnnn. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or it licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and /or (2) after inspection and pumping (if noccssary), the septic tank is less than M fun of sludge. i /we, the unde nave real the above requi and agree to maintain d - ie private siiv vage disposal system with the standards set forth, lhcrein, as set by the Department of Commerce and the Department of Natural Resources, St of County Pl m Pun n i Certification stating that your septic system has been inaintainod must be completed and returned to the St. Croix anning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our kno%vledgc. I /we aurt/are the owncr(s) of the p party descried above, by virtue of a warranty deed recorded in Register of Deeds Off ca. 50 E So ems i N FnfIrm is // 3 , rJrP 2500 l-t-a 2� Alp NA PL'ICANT(S) DATE rmit b eing revoked b the Planning & Zoning Department. " r� xM *Aa th at is misrepresented rnaty result in the sanilarY pe $ y Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey trap if reference is made in the warranty deed. t (I21CV.08/ 05 )