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,Wiscin4r_ )epw tment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Sate alr8 Building Division Sanitary Permit No:
YY INSPECTION REPORT 506264 0
GENERAL 114FORMATION (ATTACH TO PERMIT) State Plan ID No:
Porsonal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Lyon, Terri Tro , Town of 040 - 1232 -00 -000
CST BM Elev: Insp. BM Elev BM Descriptio Section/Town/Ran No
1 ( 61 r tCA 3.28.19.1146
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic �,n, � / �� b L Sehx►�., . I � � ��' � 9 � . 9 `�
Dosing 1. Alt. BM
cC3" .o X50
Bldg. Sewer
� � o 1"k 5z5
Holding ,�-- -- SUHtInlei -a -)6 Ie,75 W G
St/Ht Outlet �
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
o
Septic cJd� 7 75" 4 -7 ♦ Z / DtS'ottom
Dosing *7 56" 7 75♦ 07 / Z7 / ead
i .
%k t 1 ��
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer r / �( ��t GPM Demand St Cover
Mode! Number O f- C ? ()
TDH LiN Friction Loss System Head J TDH Ft
Forcemain Length Dia. 0 Dist. to Well 75
7
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO % P/L BLD WELL LAKE /STREAM LEACHING Manufacture .
INFORMATION CHAMBER OR
Type Of System: UNIT Model Number
DISTRIBUTION SYSTEM JJ
Header /Manifold 10istribution x Hole Size x Hole Spacing V t to Air Intake
�— Pipe(s)
Length Dia Length D
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of d/Sodded xx Mulched
Bed/Trench Center Bed /Trench Edges Topsoil Yes No i] Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2:
Location: 541 Trillium Lane Hudson, WI 54016 (SE 1/4 SE 1/4 3 T28N R19W) Country Wood Lot 10 Parcel No: 3.28.19.1146
M �.
1.} Alt BM Description = dt cx � c.�„�(L �� `l
&I -Jr.
2.) Bldg sewer length = � +
- amount of cover
Ae �w_. W14(
Plan revision Required? Yes )<No '7 G
Use other side for additional information. ` �J
Date In pctor's S' ture Cert. No
SBD -6710 (R.3/97)
li
� J Safety and Buildings Division County � / � J r
W 201 W. Washington Ave., P.O. Box 7162 L `-� k"
Visconsin Madison, WI 53707 - 7162 Sanitary Permit Nutn r (to be filled in by Co.)
Department of Commerce (608) 266 -31 50 Z LI
Sanitary Permit Application State Plan I.D. N r J
In accord with Comm 83.21, Wis. Adm. Code, personal inf rovide
may be used for secondary purposes Privacy Law, 5.04(1lbtleCRIV LPaLcel ress (if different than mailing address)
1. Application Information - Please Print All ormation 1It���ll�+ C Property Owner's Na me Block #
ST. CROI l Property Owner's MailingAddressr, cat�ijon
�L / /�✓�i+1. / � 7 � '/., C/ /., Section .J
City, State Zip Code Phone Number
circ )
� � N , R /� E le
II. Type of Building (check all that apply) T Kam]
1 or 2 Family Dwelling - Number of Bedrooms (3
Subdivision Name CSM N mber
❑ Public/Commercial - Describe Use
❑ State Owned - Describe Use ❑City_ ❑Villa ownship of
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) .. Z -
A. ❑ New S stem ❑ Replacement System Y p y � Trea "ding Replacement Only ❑Other Modification to Existing System
g.
❑ Permit Renewal ❑Permit Revision ❑ C ❑Permit Transfer to New List Previous Pennit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: Check all that ap 1
❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain)
V. Dis ersal/Treatment Area Information:
Design Flow (_ pd) Design Soil A pIi ation Rate(gpdsf) Dispersal Area Required (sfJ Dispersal Area Pro osed (sf) System Elevation i
� 1 . ,3�. 37.5 1 id y, s
VI. Tank Info Capacity in Total Number anufactmer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units > PncTete Constructed Glass
New Existing
Tanks Tanks �✓
Septic or Holding Tank
Aerobic Treatment Unit [/
Dosing Chamber
VII. Responsibility Statement- 1, the undersign 4, assume respo for insLallation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber' gnatu P PRS Number Business Phone Number
'
Y m ?5
PI n ddress (Street, ty, State, Zip C e)
VIII .oun JDe artment Use Onl
Approved ❑ v Sanitary Permit Fee (includes Groundwater Date ssue Issuing gent Sig tut o Sta ps)
Surcharge Fee) �'7111
❑ iven Reason for enial
7
IX. Conditions of Approval /Reasons for Disapproval
SYSTEM OWNER: -
1. Septic tank. - effluent MW and
dispersal cell must aff be services / maftikled
as per management plan provided by pk#nbbr.
2. AD se&w* requirernents mr* be mWrbkW
as per applicable code I ardilwAves.
i
Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size
SBD -6398 (R. 01/03)
SY/ 71 A/4,
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner /Buyer S 44,014 _. 1 lm iaa n
Mailing Address 5 7y1 / f/; 1{ 1 _4t. e,
Property Address 5_ T ali'41. , 4 * h
(Verification required from Planning & Zoning Department for new construction.)
City /State � �,,� _ �..L Parcel Identification Number O z/ 6 - / Z 3 Z - oo -' ObO
LEGAL DESCRIPTION
Property Location 5 1 /4 , 5 '/4 , Sec. 3 , T Z ' � 6 N R / W, Town of ) o
Subdivision Ca��� ado , Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # , Volume , Page #
Spec house yes no 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.
Uwe 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
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms 3
7 b2
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. 08105)
��� • ' � 4 II! {II IIII� I!{II Illil lflll Illlf II!{ I!!I {I SII{ 1111
* 8 5 5 4 5 1 1
855451
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
RECEIVED FOR RECORD
07/12/2007 11:45AM
WARRANTY DEED
EXUPT r
REC FEE: 11.00
TRANS FEE: 907.50
PAGES ;- _.} . .
State Bar of Wisconsin Farm 1 -2003
WARRANTY DEED
Document Number Dowment None
THIS DEED, made betw= Terri L Erickson formerly known as Tem L. Lyon
and David G Erickson, wife and husband — one . or
and Shane M. Gannon and Autumn G. Gathnoa
("Grantee," whether ono or mote).
Grantor, for a valuable consideration, conveys to Grantee the following described real Recording A R .T R )
estate, together with the rents, profits, fixtures and other appurtenant interests, in
St Croix County, State of Wisconsin ("Propert)e') (if more space Nina and Rn is B r Titl e
needed, please attach addendum): 7550 France Ave. S.
Fluor
Lot 10, Country Wood, in the Town of Troy, except part to Certified Survey Map First t MN 554
recorded in Volume I 1 on Page 3201 as Document No. 554333, St Croix County,
Wisconsin Central
040.1232.00-000
P" Idomifiadon Number (PIN)
Thi. j S - homestead property.
(L) (1. not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except:
Eastauents, rostriedons and rights -of -way of meord, If wry.
Dated June zi 2.007
(SEAL) (SEAL)
+ + Tem . En on
(SEAL) - _(SEAL)
+ + David G. Erickson
AUTHENTICATION ACKNOWLEDGMENT
Signatures) STATE OF ARIZONA A )
) ss.
authenticated on +�j} COUl3Ty
� z
Personally came before me on June . 2007 n D
the above -named Terri L. Erickson forroorty known as Terri O
TITLE: MEMBER STATE BAR OF WISCONSIN T.
L. L ndcaon nand David G. E wife and hu d
(if not to me kno to b the so ) w ex ed the foregoing m n r . n
au b Wis. Stat. § 706.06) instrume and kn � ° 25 ;K 1?0 - !5 - 1 i 03 c1 > 1 F_
THIS INSTRUNVINT DRAFTED BY- ? °c m
Attorney Doug Berg r r
1200 Hosford Street, Suite 201 Hudson, Wl 54016 Acomnussion Public, State of Arizona —
(is permanent) (expires: �
(Signatures may be aeaLeaaeated or adaowledged. Botk w.wt aecen.ry.) O
NOTE: TIIIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIRD. m w
WARRANTY DEED O 2003 STATE BAR OF WISCONSIN FORM NO. 1 -2003
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Wisconsin DerartmentofCommerce PRIVATE SEWAGE SYSTEM
Safety.and'Buildings Division • Count
INSPECTION REPORT
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: ST. CRO X
Personal information you provice may be used for secondary purpos [Privacy Law, s.15.04 (1)(m)j. 344674
M Pe %96tfiftk, GARTH ❑ C''1' Town of: State Plan ID No.:
CST BM Elev. - - Insp. BM Elev.: BM Description: Parcel Tax No.: f, ,/ ,
040- 1232 -00 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic X12 ! r '7 %.r �'�,� „� Benchmark ) . - +,b p, 0
Dosin �°%,, go a� Dl7 p2.o lov. U�
Aeration T _p _ Bldg. Sewer g,0 9 ,U
[ Holding __.,......- ,..�....�...-
St /Ht Inlet o 96
TANK SETBACK INFORMATION u e
TANK TO P/ L WELL BLDG. Ventto ROAD
Air Intake
ti Septic NA Dt Bottom
Dosing NA Header/ Man. /o( 3 o
5
Aeration NA Dist. Pipe ` S� (D6 -7-3
Holding Bot. System S ' 2 /o S • S3
PUMP/ SIPHON INFORMATION Final Grad
Manufacturer „ - -, Demand
Model Number e�1 . ��`
TDH Lift Friction A-j System a• TDH , , *t
L oss Head
Forcemain Length/,, Dia. j Dist- ToWell
SOIL ABSORPTION SYSTEM
Ke I Width �, Len No. f T nches PIT No. Of Pits Inside Dia. Liquid Depth
DIME I N 5 / DIME NSION S
SETBACK
SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER OR UNIT Model Number: i t , System: )G �e
DISTRIBUTION SYSTEM
Header/Manifold Distribution Pipe(s)/ x Hole Size x Hole Spacing Vent To Air Intake
Length Dia - Length Dia. -2 — 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 ❑ No ❑ Yes ❑ No
COMMENTS: (Include code discrepancies, persons present, etc.)
LOCATION• TROY 3.28.1 E SE 1 TRILLI LN - COUN RYWO D OT X0
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Ian revision required? ❑ Yes A No 2 ,
Use other side for additional information.
SBD -6710 (R.3/97) Ct s'Qector's Signature Cert. No
J
r' "
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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1 Safety and Buildings Division
SANITARY PERMIT APPLIC ON 201 W. Washington Avenue
Visconsin P O Box 7302
Department of Commerce In accord with ILHR 83.05, Wis. Stpd ��
�J Madison, WI 53707 -7302
• ` Attach complete plans (to the county copy only) for the syst pape]r u ty
than 8 112 x 11 inches in size. F
• See reverse side for instructions for completing this applic 1 �'�,� St __ nitary Permit Number
_r
Personal information ou rovide ma or secon ur o O 3
Y P Y be used f rye p ses Sj f`g>9 ❑ if rev�n fo�2�iious a hcation
[Privacy Law, s. 15.04 (1) (m)]. to gyp/ J
Jr S lan I.D. Number
� rr/ � <JUty! �i z �N ;
I. APPLICATION INFORMATION -PLEASE PRINT ALL I 2VQSS3
Pr erty Owner Nam Property c " r V 2 r �E -Fer)
No T 8, N R { "�
P operty Owner's Mailing Addres Lo Block Number
'967 f' s or
city, State ' e ' Phone Number Su ivision Name or CSM Numb
1 ( )
11. TYPE OF BUILDING: (check one) ❑ State Owned itr Nbueg arest Road
Village
Public 1 or 2 Family Dwelling � Pboo
III BUILDING USE (If building type is public, check all that apply) +f4ps ircel Tax Number(s) - I j _ ]14b
1 F1 Apartment/ Condo 0be"7 r( ] 0 ` " 0
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales /Repairs 11 ❑ Restaurant /Bar /Dining
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash
5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify
IV. TYPE OF PERMIT (Check only one box on line A. Check box on line B if applicable)
A) 1 New 2. ❑ Replacement 3 [] Replacement of 4 E) Reconnection of 5_ E] Repair of an
____System System Tank Only Exi sting System Existing System
B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued
V. TYPE OF SYSTEM: (Check only one)
Non - Pressurized Distribution Pressurized Distribution Experimental Other
11 ❑ Seepage Bed 21 RiMound 30 ❑ Specify Type 41 ❑ Holding Tank
12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy
13 ❑ Seepage Pit 43 ❑ Vault Privy
14 ❑ System -In -Fill
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2. Absorp. Area 3. ea 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade
Required (sq. ft.) o osed (sq ft.) (Gals/da /sq. ft.) (M /inch) Elevation
� j�� s �" eet Feet
Cap VII. TANK in allons # of r Prefab. Site
g Fiber- Exper.
INFORMATION Gallons Tanks Manufactu Name Concrete con Steel glass Plastic App
New Existin strutted
Tanks Tank
Septic Tank or Holding Tank _ 1000 ❑ ❑ ❑ ❑ ❑
Lift Pump Tank /Siphon Chamber (Oso ❑ I ❑ I ❑ I ❑ I ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plum Sig ture; s) Business Phone Number: Q
'- /
Plu
r ber's Add ss ( tre Tz Sta , Zip Code):
IX. COUNTY/ DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater ate Issued lss4u4,44ent Signature (No Stamps)
Approved ❑ Owner Given Initial ZS� Surcharge Fee) a /7' �
Adverse Determination I /0o 7
X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL:
SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber
INSTRUCTIONS t •.r ,
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the "
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608 -266 -3151.
To be complete and accurate this sanitary permit application must include:
I. Property owners name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete #of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for afl septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only.
X. County/ Department Use Only.
Complete plans and specifications not smaller than 81/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mains/water service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
----------------------------------------------------------------------------------------------------
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination- investigations
and establishment of standards.
1
! Safety and Buildings
t s , 15837 USH 63
HAYWARD WI 54843 -8107
TDD #: (608) 264 -8777
Nvisconsin www.commerce.state.wi.us
Tommy G. Thom Governor
Department of Commerce To v Thompson,
Brenda J. Blanchard, Secretary
August 24, 1999
CUST ID No.220357
ATTN.• POWTS INSPECTOR
ZONING OFFICE
BRADY J UTGARD ST CROIX COUNTY SPIA
110 KELLER AVE N APT 112 1101 CARMICHAEL RD
AMERY WI 54001 -1034 HUDSON WI 54016
RE: CONDITIONAL APPROVAL
APPROVAL EXPIRES: 08/24/2001 Identification Numbers
Transaction ID No. 240553
Site ID No. 178753
SITE: Please refer to both identification numbers,
Site ID: 178753 above, in all correspondence with the agency.
ST CROIX County, Town of TROY;, RIVER FALLS 54022
SE1 /4, SETA, S3, T28N, R19W
Facility: GARTH VANDERVOST, RIVER FALLS 54022 P•',
FOR: MOUND SYSTEM< 450 GPD Conti
Object Type: POWT System Regulated Object ID No.: 485344 APPR
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes EPARTMENT
D of SAFE
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in -
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
SEE CORRI
The following conditions shall be met during construction or installation and prior to occupancy or use:
1. This plan action is subject to designer comments on the plan.
2. The orientation of the mound system must be such that the mound's longest dimension is perpendicular
to the direction of maximum slope.
3. The area 25' below the downslope edge of the mound must remain undisturbed.
4. Maintain well and waterline set backs per COMM 83.10(1) and 83.14(4)(a).
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction /installation/operation.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
Sincerely, DATE RECEIVED 08/05/1999
REQUIRED UIRED $ 180.00
J Q
1 FEE RECEIVED $ 180.00
PATRICIA L SHANDORF , POW TS PLAN REVIEWER BALANCE DUE $ 0.00
Integrated Services
(715) 634 -7810, FAX: (715) 634-5150, M -F 7:45 AM - 4:30 PM
PHHANDORF@COMMERCE.STATE.WI.US WiSMART code: 7633
I
MOUND SYSTEM DESIGN
Residential Application
INDEX AND TITLE SHEET
Project GARTH & JENNIFER VANDER VORST
Owner GARTH & JENNIFER VANER VORST
Address 1353 AWATUKEE TRL Oily
TD HUDSON WI 54016
Of (J)tM rRCE
TY A ILDINGS
Legal Description SE 1/4 SE 1/4 S 3 T 28 N,R,19 W
:SPONDENCE
Township TROY County ST.CROIX
Subdivision Name COUNRTY WOOD Lot No. 63
Parcel ID Number PENDING
Plan Transaction Number
Index and title sheet Page 1
Mound calculations Page 2
Mound drawings Page 3
Pres. dist. calcs. and laterals Page 4
TDH and pump tank drawing Page 5
Designer BRADY UTGARD License Number 220357
Signature Phone No. 715 - 268-6995
Date 8-4 -99
Notice: Tampering with this file by unauthorized persons is prohibited.
Deliberate modification will result in disciplinary action under s. 145.10, Wis. Stats.
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
SBD- 10462 -E (R.05/98) Pagel of 5
1
MOUND SYSTEM DESIGN
Complete red boxes as necessary. 1000 gpd maximum design flow.
Inch - pounds Metric
Residential or commercial? R (r or c) (y or n) LJ Replacement system?
Creviced bedrock site? n (y or n) S-Q-
$lope 7 %
Wastewater flow rate 450 gpd 1703 Lpd
Depth to limiting factor 32 in 81.3 cm
In situ soil infiltration rate 0.4 ft 16.3 Lpd/m
Contour line elevation ift&' , 5 31.85 m
Use standard fill depths? I x I OR Design depth? in cm
Place X in box to use standard depths (24 and A +4 inclusive) OR specify design fill depth.
Center or end manifold a (c or e) Hole diameter 1 0.25 in 0.125, 0.156, 0.188, 0.218, 0.25,
0.281, or 0.313 inch only.
Lateral spacing 0.00 ft Use 0 lateral spacing for trenches.
Estimated hole space 3.00 ft Not a final calculation.
Number of laterals 1 Pump tank elevation 95 ft Outside bottom of tank.
Forcemain length 100.0 ft Forcemain diameter 2.0 in 1.5, 2, 3 or 4 inch only.
2.067 in Actual I. D.
HOLE DIAMETER CONVERSIONS
1/8 = 0.125 1/4 = 0.250
SYSTEM SOLUTIONS Inch-pounds Metric 5132=0.156 9/32=0.281
Estimated daily flow 450 gpd 1703 Lpd 3/16=0.188 5/16=0.313
7/32 = 0.219
Absorption cell
Design load rate & area 1.2 gpd/fe 375.0 ft' 34.84 rn
Linear loading rate (LLR) 6.00 gpd /ft 74.4 Lpd /m
Design width (A) 5.00 ft 1.52 m
Cell length (B) 75.0 ft 22.86 m
Depth of cell (F) 10.0 in 25.4 cm
Sand filter
Upslope fill depth (D) Eft' in 30.5 cm
Downslope fill depth (E) in 41.1 cm
Basal area required (gpd/infiltration rate) 104.52 m
Supporting components
Topsoil depth 6.0 in 15.2 cm
Subsoil depth at center 12.0 in 30.5 cm
Subsoil depth at cell wall 6.0 in 15.2 cm
End slope toe length (K) 10.53 ft 3.21 m
Up slope toe length (J) 7.00 ft 2.13 m
Down slope toe length (1) 12.10 ft 3.69 m
Total mound length (L) 96.06 ft 29.28 m
Total mound width (W) 24.10 ft 7.35 m
Project: GARTH & JENNIFER VANDER VORST
Transaction Number: Page 2 of 5
MOUND PLAN VIEW
observation pipes (typical)
_
E T)f 24.1 ft q� A = 5.00 ft 1.52 m
7.35 m ::::::::....::.:: B = 75.0 ft 22.86 m
W B J= 7.00 ft 2.13 m
K I = 12.10 ft 3.69m
K = 10.53 ft L2 m
_ 96.06 ft
29.28 m typ. obs. pipe
(anchored securely)
1 = down slope dimension = absorption cell (AxB)
J = up slope dimension p = plowed area (LxW)
K = end slope dimension 6' (152 mm)
T
MOUND CROSS SECTION
subsoil cap
D = 12.0 in 30.5 cm
lateral topsoil � H E = 16.2 in 41.1 cm
invert 1 106.00 ft F = 10.0 in 25.4 cm
elev. 32.31 m JF G = 12.0 in 30.5 cm
T ASTM c 33 H = 18.0 in LA5.7 cm
D Sand Fill y
sys. 138: tt y
elev. 32.16 m = contour
31.85 m elev. 7 % ---�
03 • slope
D = upslope fill depth plowed layer
E = downslope fill depth Note: Absorption cell media will consist
F = absorption cell depth of aggregate and pipe with laterals
G = subsoil + topsoil depth at cell wall centered across AxB media. The cell
H = subsoil + topsoil depth at cell center media is covered with geotextile fabric.
Designer notes:
Project: GARTH & JENNIFER VANDER VORST
Transaction Number: Page 3 of 5
PRESSURE DISTRIBUTION CALCULATIONS
Absorption cell Inch-pounds Metric
Width (A) 1 5 Ift 1 1.52 Im
Length (B) L 75.0 ft 22.86 m
Lateral specifications
Number laterals 1
Holes/lateral 25 holes
Lateral length (P) 72.00 ft 21.95 m
Hole diameter 0.250 in 6.35 mm
Lat. dis. rate 29.13 gpm 1.84 Us
Sys. dis. rate 29.13 gpm 1.84 Us
Hole spacing (X) 36 in 91.4 cm
Lateral diameter Pipe diameter Design options De choice
Designer must 1 in (25 mm) Place X in red
X' one choice 1 1/4 in (32 mm) box of chosen
from the options 11/2 in (40 mm) diameter.
provided. 2 in (50 mm) x x
3 in (75 mm) x
Manifold diameter Pipe diameter Design options Design choice
Designer must 1 in (25 mm)
X' one choice 1 1/4 in (32 mm) None required.
from the options 1 1/2 in (40 mm) No choice necessary.
provided. 2 in (50 mm)
3 in (75 mm)
4 in (100 mm)
Distribution system contains: 1 Lateral(s)
LATERAL DIAGRAM - END CONNECTION
Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram into this area.
Laterals centered over the A & B dimension end cap
P
rHoles rilled next to end cap IE X-- 3I Laterals & force main of PVC Sch 40
d on the bottom of the lateral (per COMM Table 84.30.5)
ced
. = permanent end mar ker
Inch-pounds Metric
Lateral length (P) 72.00 ft 21.95 m
Lateral spacing (S) 0.00 ft 0.00 m
Hole spacing (X) 36 in 91.4 cm
Manifold length 0 ft 0.00 m
Hole diameter 0.250 in 6.4 mm
Lateral diameter 2.00 in 50 mm
Forcemain diameter 2.00 in 50 Jmm
Project: GARTH 8r JENNIFER VANDER VORST
Transaction Number: Page 4 of 5
TDH and Pump Tank Drawing
Total Dynamic Head
Operational head 2.50 ft 0.76 m
Vertical lift 10.30 ft 3.14 m Are laterals the highest pant in the
Friction loss 1.47 ft 0.45 m system Yes "X" here. r ---�
Total dynamic head 14.27 ft 4.35 m If no, what is the highest elevation
Dose Volume downstream of pump?
Dose is > 10 times lateral volume Forcemain drain
Lateral void volume 12.5 gal 473 L back to tank? (")C one)
Minimum dose 125.0 gal 473.2 L x Yes
Drain back 17.4 gal 65.9 L No
Dose volume 142.4 gal 539.0 L
Typical Pump Chamber Layout
In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC.
approved manhole carer with
weather proof warning label and locking device
grade levels junction box `—� g rade levels
disconnect
alternate eate
4" vent pipe electric as per NEC 300 d ::: F— pit
Comm 16.28 WAC location 18" (46 cm) min.
wall of pump L approved
chamber or outlet joint
combination tank
A Provide 1 /4" weep hole or anti -
alarm on siphon device as necessary
pump on B
Grade levels
pump 95.7 ft C - pump tank manhole = 4" (10 cm)
off elev. 29.2 m minimum above finished grade
D - vent = 12" (30.5 cm) minimum
above finished grade
95.0 ft Pump tank elevation
3 " (75 mm) of bedding under tank 29.0 m bottom of tank
Tank manufacturer MID WESTERN
Pump tank capacity 17.1 gal /in
Pump tank volume 650 gal
Pump manufacturer IGOULDS I Inches Gallons
Pump model number IEPO4 o A 22.7 387.9
'rn B 2 34.2
c
Alarm manufacturer ILEVEL _ E C 8.3 142.4
Alarm model number 1DLV p D 1 5 1 85.5
Project: GARTH & JENNIFER VANDER VORST
Transaction Number: Page 5 of 5
f
a
Goulds
Submersible
Effluent Pump
EPO4
3 871 P
l_.
E 05
APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron
Specifically designed for the stainless steel. grade turbine oil for for efficient heat transfer,
following uses: • Capable of running lubrication and efficient strength, and durability.
• Effluent systems dry without damage to heat transfer. ■ Motor Cover: Thermoplas-
• Homes components. Available for automatic and tic cover with integral handle
• Farms Motor: manual operation. Automatic and float switch attachment
• Heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical points.
• Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty
• Dewatering RPM, built in overload with
automatic reset. preset at the factory. rated oil and water resistant.
SPECIFICATIONS • EP05 Single phase: 0.5 HP, ■ Bearings: Upper and lower
115 V, 60 Hz, 1550 RPM, FEATURES heavy duty ball bearing
Pump: EPO4 built in overload with construction.
■ EPO4 Impeller: Thermo-
• Solids handling capability: automatic reset. plastic Semi -open design
/4 maximum. • Power cord: 10 foot with pump out vanes for AGENCY LISTING
• Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection. Sp Caaadianstandarosnssociahon
• Total heads: up to 24 feet. with three prong grounding
• Discharge size: 1 NPT. plug. Optional 20 foot ■ EP05 Impeller Thermo- (CSA listed model numbers
• Mechanical seat: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC ".)
rotary /ceramic- stationary, three prong grounding plug improved performance.
BUNA -N elastomers. (standard on EP05). ■Casing and Base: Rugged
• Temperature: thermoplastic design provides
104 °F (40 °C) continuous superior strength and
140 °F (60 °C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEET
stainless steel. 10
• Capable of running
dry without damage to s 30 ►s -scPM
components.
Pump: EP05 8 -Z5FT
• Solids handling capability: c 7 25 3
/A" maximum. W
• Capacities: up to 60 GPM.
• Total heads: up to 31 feet. 0 6 20 .�
• Discharge size: 1 NPT. z 5 aCf
• Mechanical seat carbon- 0 15 I 1 - 7 r
rotary/ceramic- stationary, Q 4
BUNA -N elastomers. o EP05
• Temperature: 3 10
104 °F (40 °C) continuous Erma
140 °F (60 °C) intermittent.
_
0 00V 10 20 30 40 50 GPM
�( v o 2 4 6 8 10 12 m°ih
CAPACITY
7 1995 Goulds Pumps Effective May, 995
a
[QGOULDS PUMPS Submersible
Effluent Pump
EPO4
38 71 EP05
._ 4 s
APPLICATIONS • Fully submerged in high ■ EP05 Impeller. Thermoplas- ■ Bearings: Upper and lower
Specifically designed for the grade turbine oil for tic enclosed design for heavy duty ball bearing
following lubrication and efficient improved performance. construction.
g uses: heat transfer. ■ Casing and Base: Rugged
• Effluent systems thermoplastic design provides AGENCY LISTING
• Homes Available for automatic and
superior strength and corrosion
• Farms manual operation. Auto- Canadian standards association
• Heavy duty sump matic models include resistance.
• Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end
• Dewatering assembled and preset at the for efficient heat transfer, in "F" or "C ".)
factory. strength, and durability.
SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds cps is 154 9001 Mgt
FEATURES cover with integral handle and
• Solids handling capability: float switch attachment points.
' /e maximum. ■ EPO4 Impeller. Thermoplas- m Power Cable: Severe duty
• Capacities: up to 60 GPM. tic Semi -open design with rated oil and water resistant.
• Total heads: up to 31 feet. pump out vanes for mechanical
• Discharge size: 1 NPT. seal protection.
• Mechanical seal: carbon-
rotary/ceramic-stationary,
BUNA -N elastomers.
• Temperature:
104 (40 continuous
METERS FEET
140OF (60°q intermittent. _ I
10-
• Fasteners: 300 series t . _ . ..., ... _.. ... _
stainless steel.
9- 30 T -- -- — —
_... - — _► 5 GPM
• Capable of running
dry without damage to $ 3 2.5 FT
.
components. 25 . ..
...._ ... -------------- -- -
° - .
{
Motor: i
• EPO4 Single phase: 0.4 HP, L U e
.2 T. d .
115 or 230 V, 60 Hz, 1550 ¢ _
RPM, built in overload with > 5 c
automatic reset. 4
• EP05 Single phase: 0.5 HP, 0 EPOS 3
115 V, 60 Hz, 1550 RPM, 3 10 -
built in overload with
automatic reset. 2
• Power cord: 10 foot 5; l
standard length, 16/3 1 _ ........
.
S1TOW with three prong
.... ............. _ ..... ,
grounding plug. Optional 20 ° ° 0 10 20 0 40 50 GPM
foot length, 16/3 S1TW with
three prong grounding plug
(standard on EP05). 0 2 a s s 10 12 ml/h
CAPAC
Goulds Pumps
29•ISq�„�
® 2000 Goulds Pumps c`!! ITT Industries
Effective February, 2000
83871
I
WscoinsinDupartmentoflndustry, SOIL AND SITE EVALUATION REPORT 9 10 e? of 3
W: for ano h' man Relations O
Divt.;lc of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
C
Attach complete site plan on paper not less than 81 /2 x 11 inches in size. Plan must include, but t ' In
not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or
dimensioned, north arrow, and location and distance to nearest road. P
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION IEWED B ST CAOIh
PROPERTY OWNER: PROPERTY LOCATION TON�Ng DP�fCP
Richard. Stout _CQYT.._LOT SE 1/4 SE t/ T 28 N ; R. ��' (or) W
PROPERTY OWNER':S MAILING ADDRESS s LOT # LOCK # SUBD. NAME 0 wo# , L
1.353 Awatukee Trl .4"3. na I sCbuil
CITY, STATE ZIP CODE PHONE NUM - - -- []VILLAGE MOWN NEAREST ROAD
Hudson, Wi. 54016 (711 549 -6731 1 Troy j Tower Rd.
New Construction Use [x J Residential / Number of bedrooms 3 [ J Addition to existing building
j J Replacement [ J Public or commercial describe
Code derived daily flow 45G gpd Recommended design loading rate • 4 bed, gpd /ft ' S trench, gpd/ft _
Absorption area required 375 bed ft 2 375 trench, ft Maximum design loading rate • 4 bed, gpd/ft ' 5 trench, gpd/ft
Recommended infiltration surface elevation(s) 104.54 ft (as referred to site plan benchmark)
Additional design / site considerations system e?_ . based on contour line of el. 103.54'
Parent material limestone highlands Flood plain elevation, if applicable na ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLD TANK
U = Unsuitable for system ❑ S ® U ® S ❑ U I 13 S [au ❑ S C3d1 I ❑ S ®U ❑ S ING ® U
SOIL DESCRIPTION REPORT
Boring # Horizon) Depth Dominant Color Mottles Texture Structure Consistence`Bojxlary Roots GPD/ft
in. Munsell LDu. Sz. Cont Color Gr. Sz. Sh. II Bed !Trench
... •.1 1 0 -11 10 r3/3 none 1 2msbk mfr qW 2f .5 .6
2 11 -30 10 /4 none sic) 2msbk mfr 9w if .4 .5
Ground 3 30 -40 7.5 r4 4 none scl 2msbk mfr 9W na .4 .5
elev.
104 ft- 4 40 -55 2.5y7/2 none Fractured Limestone
Depth to
limiting
factor
4:0"
Remarks:
Boring #
1 0 -15 1G r3/3 none 1 2msbk mfr 2f .5 .6
v 2
2 15 -32 10 r4/4 none sic) lfsbk mfr if .2
Ground 3 32-41 10yr4/4 c2p7.5yr5/8 cl m na gw na np� np
elev. 4 41 -55 2.5y7/2 none Fract red Limestone
10
Depth to
limiting
factor
321,
Remarks:
CST Name: — Please Print Gary L. Steel Phone. 715 -246 -6200
Address: 1.554 2 0 h Ave., NeV Richmond, Wi. 54017 10-27-
Sonature: Date: CST Number. MO2298
I �
PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Paget of . 3
PARCEL I.D. # pending
Boring # Horizon I Depth i Dominant Color Mottles I Texture I Structure Consistence �Boun i I Roots Bea D//ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
3 `< 1 0 -16 10 r3/3 none 1 2msbk mfr qw 2f .5 .6
2 16 -37 10 r4/4 none sicl 2msbk mfr qw if .4i .5
Ground 3 37 -55 2..5 7 2 none Fractured Limestone
elev.
102 ft.
Depth to
limiting
factor
37 "
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor F-T
Remarks:
Boring #
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
Boring #
Ground
elev.
ft.
i
Depth to
limiting
factor
Remarks:
SRMAMOIR_051921
STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout 1554 200th Ave.
CSTM2298 SE4SE4 S3- T28N -R19W New Richmond, WI 54017
MPRSW 3254 town of Troy (715) 246 -6200
lot #63- Country Wood
N
1 =40'
BM.= top of 1" steel pipe C el. 100
Alt. IN.= top of 1" steel marker pipe C el. 102.20
0 d/
110
t73
I p , � Z
Cj
Sf
.3
Gary L. Steel
10 -27 -95
J 1
,std °qN
s kl I
�•
1,. 1
!a ct cc I
Ir
Y �p
a 5 � I ,
i _
/nos'.6'IS'w ..s.ez' 1+A \ � �,•
M.IE.££.ION
I N
=of•ss
I '.
'q• I , : i N w _ fff( 444
Y, r
gyp,
'I N \ � 111•• N "'„ � ~ 219 � � � Ir h QN
CO
F7s.77• f ``p1�•h° n1 "W ♦�` \a'n
s1s.77 ` � N _ � 9 ��
).O0 = =6.00 1M.Od n r"
N U= i
00' ff
f �� N , • ' \. a .._ - �,. 00.99 Ah.fS.60.00M
cn s
— ,00'6H _ 3.iQ60.00i � I
•\ -- O nl
od Y. Y I cc)
—� ,96 9fc 3.sa,to,00M
t4o At'"
, p p � IM,si,ti
O- O
sistf /j / I N �` L g
3.00 OG. 90f a g€ I o- Fo
,s6'1Z4 � 1 65'61C 3.63,topo" I p If� iy ^o1
IW sx
O w y y . 1[� U •� r ± Y � N N NI .T.1 I� .j
a of 141
1
.£9'91► M�6a,tO.oOS �•
I I ,COAL► 3.K,t0.00M
w Z -
f
,OI'RZ I .11 AZ . , ►B'90► 1 7 I .A.Ws" _I ].60.ta p OMl _
M.6Z,L0.00S MI3i 341 >D 3NII titl3 ' ,00'919 M.t=,L0.00f
w 068841 M
�3 51L IIVZ Q31! t ldNll Fn3c 3Ml >0 3Mn tcr3
'3
dR-
4 '
AW SOIL AND SITE EVAL Ji,710N REPORT Page 1 of 3
in aCCo1d with ILMR 6 ; 5, NA. Adm. Code
• u�
�''" Atlads OOiM ilta Nan an bapar not i asatRan 8 112 x 11 inebls in fi2�. F`•an must ifKf udo • but St. Croix
art JOW"d b W *fW t And horifl W reWafte Ogg (8m), t*ft 14n and `i. c fbp�, flit Or F L !. . d
drA egem +aO two se few, ww sac"" a d'da"me ma n mew vmw, pal
APPLICANT 1NFORHAVOW- PLEASE PAINT A -INFORUV40N OA
AAOPERTY C+WNE+A 163 LOCATION
Richard Stout SE v4SE V4,33 1 28 XR A h(a)w
PROPERTY OW PA MAIIJYO ADDRESS L,OCK# SUED. NAME OR MS , al I f. - STATE rTy
RUdeM, Ni . 54016 ( 710 549 =6731 Trot► OMVN 7 c '
M New Cone J=ft UIS Pi: j PMWW'aai/ Mumeor Ct b@ftM O AdOiWjo+* ft btrilslp -
1 1 t ; 1 Pubk W mtataetdsl ditwbe
Cafe do dais► Ibw .` 50 ad Reooran MW design qa ra •' bed. • �S Yvwll �~
Abw*n well tuquM 375 bw. It2 375 ti " tt Mmm wt design W* qae _4 ,petl, WO* 3 j
k
RawmM ended i ft Tian surow ) 104.54 >t tae teUned 0 IN Wen bent mom
Ad$WM sy stw e1. based on contour line of t i. 103..A l .
p1w1+ne*W ti Y hiAbl ds C , d
�me .. ,... dam- . � ._..... lood Pten eteratm opiiudfic
S = Si ptaQ b room t oNVEVl+OFMt + Nt7tJ!do prt P"SMAE ArdY1DE 1 tRL t 10 r ,
u=ut for (dS i�u WS Ou as au 0 Du 1 �s �u_ �s »u
SOIL DESCRIPTION REPORT
9orirtg tt Horizon Oew Dominant Cola momm Textwr Stumm c4rdeftnoJamet"y Roots GPDH;
in. Mussel! Ou. S•. Co% Corot I Gr. Sz. Sh. Bea mw
1 1 0 -11 i r3 3 now 1 2m+isblC of r 2f .51 . E
2 LI -30 10' r4 4 none sici 2mbk mofr 1f .4
i
t30uno 3 30-40 7. none scl bk mfr gy na .4
104 t 4 40 2.5y7/2 rorle Fractdred Limes one
�b
40"
Rtuuaner.
Boring 0
1 0--1 i0 r3 3 none i _ 2eaabk mfr •5 ° •6
2 2 15 - 321 1 r4 4 none + MCI I fsbk mfr if .2
3 32-41 10 r4/4 C? 7.S r5/8 C1 m na na nP' n -
G+otnd -
tU QB• 4 41 -55 2. S 7/2 none Fractured Litres nQ
TNa�r- �wathnt Plena. 715- 246 -6200
Cary L. Steel
2-5 2 h Ave.g ya Richmond. Wi • 5- +017 -
"C1
5:
'CN YU-4
W�Z5:b0 6661 5-2 '1*'I 66�ELSrstL l Clft ei3:]IvHfi .J'�1.j
1'OW�tiA Richard stout SOIL pEgCR�Ptiflli ASPaR7
►Actlza • esnin 9 2 :
$cR,p typ` a ' D O*Minant C,6 Structure f .
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Doty L. Steel Plichazd stout
CSTM22�g. SEAM s3 - 2'2eM -R19w 1554 200th Ave.
MPRSW 3254 town of Troy t*w Mc"Ond, W 54017
lot %3- Country %30d (716) 248 -6204
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(Vanfiestiot►rowked from Plattaiae Dgsaftwat (or new coasQttctiod) gJaw".4 _r...^
:iAyiSttle — Parcel Identification Number U YQ- d 4 a c_ na
/.. ' /�. S4c, , _� T ;.N -R 1LW, Town of _ "� „ - � � P /G�;# rnhF
tlbdivi ax +art .S.Q" a W4 l � -- _ it'ggf 4a4 /��}% C�� �..4t � .� Y ;S 1of �` /0
. :, +tewUd S8 Ilwey Man p , Volume,. Page tE ....._..-
Narrak, 0 ;Yt e d i -3 , V01=c z ysl Page N 01 L
�p h6. Uix yes Q no Lot lineta idrntffiable� yes ❑ no
I` A
k pt7k r,'gpar lane tad ;nmWttat usceof you steppe. MMM eculd Penult in its gremseim fair to hWWIA rwW PfQW Wi aewtisee
ottai:tt i ai ;utt{siat out the septic' tank tewty three years or sooner, itf aaeded by a tieeneed pumper. What you put itsso the :stein
an "MV1 tjxe; lwoction of t he sqr* taint as a taeam►aut atafe in tbta waste ttisposai system,
"III a j 4,operry mve at agrees to subtait to pt Croix Z, nittg Depas mat a rw%ificatitm fom sitned by the; orvtter. AA by a
d r �,ustar pl tl .& 'C, jourrecyrnru phtmbo r, test imed plumber or a licensed pumper verifying that (1) the on -site w "Ic*atei di2p�t'e;ysun
R is propeec q: e:estlttg eendatioa atrd/or (2) after inspection and puanpint (if ow -mAry), to septic aak is less dun 15 full of :.44,s!}te.
the*. dry . -,Wgned leave read me shah "irenooft sad arse %majamio the Private sewage disposal symem with the ,ibvulanb
a (ork Ati Kitt, as set by the Depaccom tof Cowwrce and the Depaeawl of Natural Rnomes, teats of Wiaee *4n. Can jNxatioc
,ae}rr6 tlt it i �i tr septic systtm has been ttaistained avast be cotttpteeted attd retetrued to the St, Croix County z0giat of sce M ii up ?G
c'ays oft �kl1,�tes year ex ' lira
If MA'ti,t fi a APPLIC kNT
i DATE
ceetlry that ell tx ace that fans arc true to the bei a of my (our) knawledge. t iwe) ant (arc): the o%4V"^(s) or
e;prrape t} r abed sbea�-e, by Qt deed t! ist Registea of Xkads O[lice,
IQ
NA .►N k :0F A PMf4t 1NT
n A
TE
"' �famutean V:cat is nrtwepr:asentetdraay ft in *A StAiUry pt:rrni! being rt w*cd by the Unirq Department .. "•�••
Iodate ! is it this Rppli yatksas 's samped v attransy d+eerd fteen the Ilesgiatwr of OOds 001co
a cagy o( the centrOd a
array raaap t! reAerrersat ss at>,ade is the warranty dmsd
ZB 3E)Vd to dOr L5 5b:0Z 666L/0E/80
STATE BAR OF WISCONSIN FORM 2 - 1998 609223 I "
WARRANTY DEED KATHLEEN H WALSH
(, REGISTER OF DEEDS
Document Number fil 14HPA�1 461 ST. CROIX CO. WI
ti RECEIVED FOR RECORD
This Deed, made between RTCHARn n _ST 08 -25-1999 11:00 AM
VARRANTY DEED
Grantor, EXEMPT N
CERT COPY FEE:
and r-A]RTH E VANDERITORST and —TRN NTPRR
A. COPY FEE:
VANDERVORST husband and w ife RE DING�F 104
C 00
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate in $+- County, State of Wisconsin:
Recording Area
Lot 10, Plat of Country Wood, Town of Troy, Name and Return Address
St. Croix County, Wisconsin.
7
_ 040 - 1232 -00 -000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
i
Exceptions to warranties: easements, restrictions, rights -of -way and covenants
of record.
Dated this 10th day of A uq) s t 1999
Ric- h a rc3 Q S t rn i t (SEAL) (SEAL)
(SEAL) (SEAL)
* *
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
State of Wisconsin,
ss.
St Croi County.
authenticated this day of Personally came before me this 1 n t day of
A» clu s. t 19 9 9 , the above named
Rieh 0.. — Stout
*
TITLE: MEMBER STATE BAR OF WISCONSIN to
(If not, me known to be the person who executed the foregoing
authorized by §706.06, Wis. Stats.) �,Y1� instrument and acknowle a the same.
as 40 b >>� o
THIS INSTRUMENT WAS DRAFTED BY
Janet P. Stout o $�tlO aiy U,,trv��'
1
to * G
Notar y mission is perm P bllc, State of Wiscon�� �sin
1353 Awatukee Tr.
Hudson, Wi . 54016 M n n (If not state piration date:
(Signatures may be authenticated or acknowledged. Both are not � )
necessary.)
' Names of persons signing in any capacity must be typed or printed below their signature.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co.. Inc.
WARRANTY DEED FORM No. 2 - 1998 Milwaukee. Wis.
ant by» E, NA REALTY HUDSON WISCONSIN 7 386 1502; '•
46 t
A--� ,
1
ADDENDUM TT
k {t: 3'lJ3tCHASE AGREEMENT l)ATEU "7 t , 14 BET
RICHARD U. 5'1'()U'l', 51rLl,t.R, AND C" 7-' BUYERS. FOR LOT #. ,..
R COUNTRY WOOD
lid
I �
OF COUNTRY WOOD, ec)I)NTRY WOOD I sT . ADDITION 0
�
1. 9uyners•arcLnowWge that preliminary lot # is final plat lot # �U
2. Buyers acknowledge reocipt of recorded subdivision covenants -
3. 13uyers are aware that driveway locations are noted on their copy of the recorded plat of their lot # IQ.
a. Boyers acknowledge that they have received a copy of the final plat of lot # 14
5. Buyers are aware that a owbuildin is ""ot allowed on their lot # —/
6. Buyers ate aware that no permanent structures are allowed in ponding or water flow casements as
noted on their final plat copy. '
7. B11yers are aware that setback requirements are: designated on the final plat.
B_ Buyers acknowledge that tot # /o has at
'
r or a hoWvrxt'ade so il test. liottse location Oil
the soil Leon f or
the lot may necessitatc another soil test which may or tnay not be the same as tha t Of
the final plat approval. Any cost associated with a new soil test is the responsibility of the buyers.
9. Buyers aekttowlWgc that their lot #A0. has 3.13 acres•
10. Buyer acknowledges that the seller is not responsible for any: Excavating, fill, driveways or culverts,
site preparatimi, further engineering, or additional sanitary soil testing above and beyond that
previously provided to the coun for final plat approval.
11. Any outbuilding constructed, if allowed by Country Wood covenants for that particular lot, must be
sidW similar to, be shingled the saute as, and be set further to the rear of the lot, than the primary
dwelling.
S IGNED TE
sirjN' u .11di -
SIGNED _ UATL
Seller
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