HomeMy WebLinkAbout040-1312-15-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
uaFety and8uilding Division
' INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 514842 0
GENERAL INFORMATION State Plan ID No:
Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Hollister, Matthew & Charissa I Troy, Town of 040- 1312 -15 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
- / ob . 6 L 42 d 6 ate- � 04.28.19.2045
TANK INFORMATION I ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic L Benchmark
2Z 1 AI o d
Dosing /4- oU V-4tk AI
Aeration Bldg. Se
we Ittt
Holding SUHt Inlet
TANK SETBACK INFORMATION SUH Outlet O ,1 77-
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 6V ► , / / Dt Bottom
Dosing Header/ an. t "at g ( 9G, • D
Aeration Dist. Pipe
I ry
Holding Bot. System �/V q • (�
PUMP/SIPHON INFORMATION Final�ra� t 1
Manufacturer U Demand St Cover n ��� �y� 2 3 /
GPM G b
Model Number (�{~ / / ohs
TDH 1 1-ift m Head Friction TDH Ft h
Forcemain L 'gth Dia. Dist. to Well
SOIL ABSORPTION SYSTEM��
BED /TRENCH Width Length . No. Of Trenches PIT DIMENSIONS No. Of Pits Insi Dia. Liquid Depth
DIMENSIONS 0
SETBACK SYSTEM TO P/ BLDG 1WEL LAKE /STREAM LEACHING Manufactur �r
INFORMATION CHAMBER OR
Type Of tam: / i
f- n � f / / UNIT Model Number:
PMII� IBUTION SYSTEM
Header anif `d Distribution x Hole Size x Hole Spacing Air I take
/ / Pipe(s) � z �r
Length Dia Lengt Dia Spacing Z r
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 t /— Bed/Trench Edges Topsoil �7 Y{e�s No d Yes
COMMENTS: (Include code discrepancies persons present, etc.) Inspection #1:�! D ! U X 7 1t lnspection #2: ! /
, ation: 530 Old Highway 35 Souffi Hudson, WI 54 16 SE 1/4 SW 1/4 4 T28N R19W) Cottage Meadows Lot 15 Parcel No: 04.28.19.2045
TOP
M Description =
ver length =3 (ao �0 Zfr7 t&, 111 Sulufi�^
, f cover = \ I �) I Aj J f G� 4A� YYIu
:d? Yes VN �� ���ti :��"'� - /y��y�
ditional information. 'r _ �- �_ ,� —_�
Date Insepctor's Signature Cert. No.
r -
taO11N W Will ta' low Salt aw Bomilp D1vlaioo COMy
201 W. Waddatim P.O.8a 7162 ST. CROIX
M L 8 0 2 d� W1 7162 �i 5� 2
Sari Permit ca Nw1bK psk
h aooe0dnx wit s. CM& 821(2), was. Ada Code, ..e�abrim of dlts *= apps MA R
etsh tr ftlhad P n*ft ■ -*M r-& & ivy Anftw - h— ar wwe ow.e aR a a lies e> L Q0 CROIX COUNTY
4 lataraettttba - nun P OAN h4woodya ZONING OFFICE
Pmpaey Ow8w5 Name
1
Prspaty Owmrs Address hvpoy [mndoe /
City, MW Cade Pht allsarhar _( ► 1r,. try geyioo
ILTypeorawmiag
5]a2F�DwelYof- ofBeAtooss I4sma
0 pwasowwwad - uae MAR 2 W 75 200A 0 CW
0 st.b Owod- Daaibs `Q
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UL Tie of rwmrtt: (Clack o* e.e bw as Vw A. C..p1ab><.. is .wtll lb)
$Yom ❑ Re WN.0 G yea a -aat Qdy D OAer idodi e. d B�tl.. a
a 0 Pam* Ramwd 0 FMA It vwn 0 ch.. fs etpi�6ec 0 eemit'Itiasl�r a rh. tit Ilia" Nombar.ed Dow lssoed
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VL Took lab Capm iy h Iota a of his�aaar
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Taft Sepwaffollft j pe WIESER
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VII. Sbhert- be tray Rw bomodbe dlM PUM dw M do aNaelae
Plaetber s (Pltat) .. S Nauhtr Baaioes Pharos Numbrs
TODD C. FEATHERSTONE - �' " -- / 242514 715 - 381 - 1704
Pimbe s Add ma (Stew, City, Sale. Zip Carlo)
P.O. BOX 467 HUDSON WI 54016
VIIL Use
PesmRFae lsisi
50 3 2( ) 8
cii,�Re..e.ra� / � t n
IX. CoaAldt Septic effluent l pnsY j, 7 S'�L' o
dispersal cell must all tom maintained xt :! � G
as per management plan proWded by phtmber.
2. All setback requirements trt * ba ff*k aV*d ' 7
M per MoNs"Ai ii iii s d=ft ftdb 4 leerhi n
sBD -6398 (R. 01/07) Vaud d n 01109
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CURRENT ST. CR. CO. APPLICATION 07.max
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FROM :LIFESTYLE HOMES / FAX NO. :b514364403 Mar. 13 2008 09:53AM P1
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TREES WILL BE A MLXTURE OF EVERGREEN
PINE TREES (IE: SPRUCE, RED, AND WHITE
1 ` PINE) AT A MINIMUM OF 6' IN HEIGHT. THE
TREES WILL BE PLANTED STAGED 24 TO 40
' TIS FEET APART TO SCREEN HOUSES FROM ROAD.
LANDSCAPE P CALLS FOR A NATURAL
1 ` TYPE SETTING OF TREES. TREES WILL BE
1 PLANTED WI MIN 6 MONTHS OF CERTIFICATE OF
S 88 w N---' — OCCUPANCY (WEATHER PERMITTING THERE
N $8 E WILL BE 16 TREES ADDED TQ LOT 14 AND 16 TREES
P_�f� _ E - ADDED TO LOT IS,
22.69 23$.50
Wisconsin Department ofm SOIL EVALUATION REPORT Page I of 3
Division of Safety and Building
*� in accordance with Comm 85, Ws. Adm. Code County ST. CROIX
Attach complete site plan on paper not lessa 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 0 0 - 1312 - 15 - 000
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Revie by Date Q
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 3 I Z,(.1 6 u
Property Owner Property Location
MATTHEW W. & CHARISSA R. HOLLISTER Govt. Lot - - -- SE 1/4 SW 1/4 S 4 T 28 N R 19 E (or)W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
12950 12th St. N. 15 -- Cottage Meadows
City State Zip Code Phone Number ity Village ■Town Nearest Road
Lake Elmo, MN 1 55042 ( 651 436-4404 Old Hwy. 35 - Troy
E] New Construction UseE) Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe:
Parent material Flood Plain elevation if applicable �lA ft•
General comments C nventional In- ground Trenches -- 0.7 loading rate
and recommendations:
MAR 2 0 2008 To be designed by Todd Featherstone
ST awai)(eeueq:m
ONING OFFICE
FTI goring # Z ._
Pit Ground surface elev. 100.14 ft. Depth to limiting factor 120 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/f?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
1 0 -6 7.5YR2.5/1 I 2fgr mvfr cb 2vf -m 0.6 0.8
2 6 -24 7,5YR2.5/1 I 3f -ma &sbk mfr cs 2vf -m 0.6 0.8
3 24 -34 10YR3 /4 / sl 2fabk mvfr I cs 2vf -m 0.6 1.0
4 34 -41 IOYR3 /4 ci7 S sil 2f- ms &abk mr cs 2vf -m 0.6 1.0
5 41 -51 7.5YR4/6 jl s Osg dl gw -- 0.7 1.6
6 51 -120 10YR5 /4 3 - s Osg dl -- -- 0.7 1.6
Horizons 3 & 4 have some gr (15 -20 %)
❑
2 Boring # Boring 101.89 120
Q pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2
1 0 -5 7.5YR2.5/1 1 2fgr mvfr cb 2vf -m 0.6 0.8
2 5 -18 7.5YR2.5/1 1 3fa &sbk mfr cs 2vf -m 0.6 0.8
3 18 -24 10YR3/3 - sil 2fsbk mfr cs 2vf -m 0.6 0.8
4 24-38 10YR3/4 q • sl 2fsbk mvfr cs lvf -m 0.6 1.0
5 38 -48 10YR6/3 - sicl Ifsbk mfi cs Ivf-f 0.2 0.3
6 48 -55 7.5YR4/6 s Osg d1 gw -- 0.7 1.6
7 55 -120 10YR5 /4 s Osg r dl -- -- 0.7 1.6
* - > < >30 < 15 m ' Effluent #2 = BOD < 30 and TSS < 30 mg/L
Effluent #1 - BOD 30 _ 220 mg/L and TSS _ 0 g/L mg/L _
CST Name (Please Print) Si CST Number
Mary Jo Hollister Hollister's Soil Testing & Design) 224832
Address Da Evaluation Conducted Telephone Number
W9875 690th Avenue, River Falls, WI 54022 03- 19-08 (715) 426 - 1775
r
Property Owner
HOL LISTER, Matthew & Charissa Parcel ID # Page of
040 - 1312 -15 -000 2 3
3❑ Boring # j Bon 100.89 120
■ Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -12 7.5YR2.5/1 -- 1 2fgr &sbk mvfr cs 2vf -m 0.6 0.8
2 12 -18 10YR3 /4 -- J. sl 2fsbk mvfr cs 2vf -m 0.6 1.0
3 18 -30 1OYR3 /4 01-3--if" sil 2fs &abk mfr cs 2vf -f 0.6 0.8
4 30 -40 7.5YR4/6 - s Osg dl gw Ivf -f 0.7 1.6
5 40 -120 10YR5/4 s Osg dl -- -- 0.7 1.6
Horizons 2, 3 & 4 have some gr 5 -10%
F Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑Boring # Boring
Pit Ground surface elev. ft. Depth to liming factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. E - Eff#1 I *Eff#2
* Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 - 264 -8777.
SBD- 8330Test (R.07 /00)
Plot Plan for Site and Soil Evaluation Page 3 of 3
Property Owner R
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{ ept where noted)
Legal Description _� �s, co � Dv ws - _ e pit
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Site Location: �-
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SYSTEM GROSS SECTION
MAN HOLE INSPECTION PIPE
GRADE
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SYSTEM ELEV.
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Dot # mall
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VIOL 7 PG. 2027 L. _ - -'� Lou C.S.M. V p A M T{ - -
- VOL. 7 PG. 2027
VOL. 3 P° 20 27 - STATE PLAT
LOCATION MAP -- - - - - -- _ � L J TOWER ROAD Ilmb � '
0 oSUE, . N ST1, 44NE COTTAGE MEADOWS
gclrcw 4 R p. N 88V44' E
S 88'33 41" E 5284 7a' E 1/ 4 CDR
ssc4I=� -- --7 - -- -- - - - - - SEE.4FOUND
wR Rp 034.99' " -S 02'41'23" VI N 88'33'41" W 414.94' 4249.80 Y 3" ALUM. LION
LOCATED M
Nw � NE � 33.01' LOCATED PART OF THE NWT /4 OF THE 5N 1/4 AND IN
�
F- - - - -- - - - - PART OF THE NE 1/4 OF THE SW 1/4 AND IN PART OF THE
2 I N 88'33'41" IV " -- \
SE 1/4 OF THE SW 1/4 OF SECTION 4, TOPMSHIP 28 NORTH,
N No m 60.15' m N 07'11'47" W RANGE 19 NEST, TOWN OF TROY, ST. CROIX COUNTY, YRSCONSIN.
h w z A7 ", cc m mzsn r I I 22.63'
N E
SE mras• r m r. ,4 . I I
Har 7
sW
OUTLOT I Q " I /OUTLOT 4 ' 1
'IN 31 I 11 1
37557 S.F. p d
PLAT LOCATOR 0.86 Ac. a 0 0 : 174088 S.F. 1 1
CxUVe3N T.�4vq+ 0i' ry I � `": 408 NO. .I
v im R sm 3 ' f � ° E "� axmrsexn nvnl I ' I
LEGEND - UNPLATTED ANDS
- - - -
o.
IN °
TOP 8.4. OF
I i I
OUTLOT 2 e
y e P ES t 'm. O]' I 318 IRON PN
® PROPOSED DRIVEWAY LOCATIONS 23686 S.F. N 00 I I � EL = 915.55 � I I I
3/4' 26 b A
N PIN u�rrAanmnn� m II QI I N 86'20'09' w 346.79' I I NAPS Y-N[: � =ro5
- - BUILDNG SETBACK EL = 906.14 W- ns9 vc sW 2 I I � G IDD o0
Zn wv
153.16' 193.62' I 1 NOODo
W- No
- - - DBDNAGE EASEVENT LINE 9 8 83344 W 28700 11967 T o I +4! 97,03 1 �� 1 1 1
44.10 278.90' N z F J N I t0 O 1908 - 1 LOT 7 p, I
-- - - -- 12' UTILITY EASEMENT _
�- Iw I ? 3 I W LOT 6;,
43574 S.F
aF I 1.00 Ac P I 1
FOUND J /4' IRON PIN ,� s LOT 1 , y zw a, ED I n a 43572 Sf n m !
o� 'a 43572 SF w I ED I n I n m 1.00 k A m ry I I / Jlwl 7 LOT 1
z ". LCO Ac. .N q N 4. M I "' o f a m a m 50' I 1 }
FOUND I IRON PPE �� o; O S. N 8P o ° I c n CERR S
FED I m�
N
J 2f,,, WW.ppW61 ro E o. m f y I Iz h mr 43567 SF. I 11 I MAP >WEI
o v 190.509WW, d��, I 12 2 TOO Ac
$ SLOT 2 -� a I, I v9 _ol i aria I in:
COUNTY SECIICN CORNEA FOUND AS NOTED �I e. � I m
f 1 438675E - k�,' 4 a•�,I � � 4° ,C I 1S 1� � �
NCO Ac E0. n 39.43' % N'hO, .I I 11. �� N 814844" W 525.92'
23.5 y y I I
1 SET 1 1/4' BY 18" IRON PIN AT. 4.173 LBS /FT.
a
z ,-
Sy; N 882009 W ti9' 1 I ° m I wI0
T SET 3/4' B` 18' LRON PIN a
P X75 0• / m __ o - 153,74
WEIGHING 1.50 POUNDS - 4 J 8' m ' m Q n LOT 9
PER LINEAR FDOT AT ALL - ' H ®/ 4 " m m ^ l SO'{ Gl
OTHER LOT CORNERS Wi N� / iA 198 'I BB ODS N ^ n" / 43s6D SF.
m d, ) l i0 i 15364 - n 1 I
/ Aa y l r o\ q A DD AG. 1 -A I I LOT 14 n I 9
��us6DSF' A a. ��v o�� 1 ® I I y� 14
NNE • 1141.70 HIGH WATER ELEVATION 1
n / s
n m 1 1 140627 S.F,
IOU Ac' I i I pW I E
190. Ywo LOWEST BUILDING OPENING n' I 1 .h h NT n \ N 83'42' 1 I 1 I 3 23 At. 1 n
®� m ' OUTLOT 5 11 s 233.1 ' I e .d W
- z ➢.,.I m I 7 sD', nnvwm
58563 S.F. 1 P. I '(r h wmlw7n }„
N � ICJ1 ; I � N � ao l q-NiKID I ry
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u -.-I I ' Q 1 ®�ei L4 5 Ss. -- -_
o -Na 1¢ I 4 SO'I 0 1 11 1_ I N Ixl m
mL�O 0 �, ,�21 I [x2 1 QNO n I .-No
1.00 Acl I II 0 Cy 01
NOTES. AO 1�� ® C3 n 6 �� I 1 1 �J� 1 a N 8958'21' W z � I <I
3 ' �PU r <� In 59 1 1 N6 p m.� I B 431.68 JI
DEMINGS 172 W WR THE EAST47 UNE a m as a < < 1a
DEAR % ®A 6y I 1 m of
2L�3.S BE PR m �'«� ""� WATER LOT 4 �;�� • � ®�. �oo � ° � s l < a6 LOT 13
� ® Ca ®2''S• V_I 11111 11 � 01
lTat n I
EVeTCH NOT LESS W M(A FEET )NEW T NCR WA>AR o� m, 43082Sf h P a e�
W tip LOT 5 �9. Z s� D' I
Ell "A LW A M s 43Sfi6 Sf ro ? J LOT 11
nACRS INDENT . 75 PEAS = 25' DOE - 25' (LMS Q' 0 �. N 1 GD P! '' a" 2 6,
Gam, z 43614 Sr m IDL ;' LOT 12 �. A, �I 1 I LOT 15
a I CO Ac a NIL • DI0.J2 2 43560 S F 0 0 p0 AG. , SO' l I
wLol Nonx I AmTnPol lwuAs omsTY z OC
�� LED • W2517 oa AT 1� I 2' 7843 S.F. I
ST. aaG auen _ _
auEmm 1 -6 ua LOS 14-15 CONM THE CONDER taN 136,51 - `11.81 1 1 02.63 381 184.88' 227. 27M a 2759 PG X 5.00 At.
EASEMENT AAA . ML PQ 41 - 448.38 ' 11 I'
2l P" 2P1 M -- 72a.29'- 11 I 1 t5C'
S 89'09'46 E 126112' ISO'
I LANDS UNPLAITED LANGS OT I I LOT 2 II 1 H7w7u j I
SIDE SETBACK EXCEPTION - - - - 99 W' - - - - -
` I 90.05'
ANDARDS: 11
CERTIFlED SURVEY FROM DESIGN ST MAP
VOL. T P 720 N cs, a 1 1 Ux l
WTu.IlkEir12•46 IZ
UTILITY EASEMENTS: 1
I
EXCEPTION FROM DESIGN a aim9 10 16ap lriWBl on to
1 I w
NG PPF o m WW5 !%myE vsil GM T4A1 lb .noo6�
raWSruuTCHWam $ feA 27615 ,ti6.IQ77620aT82M21(I) and (2p 9
STANDARDS FOR FRONT DS sA nP�� AA's � WsSm.az�dea6 3 ,s,u.l2,WmS�
LOT WIDTH AT ROW VIOLATION OF SECTOR 7783211"TAI SOAT,h[ UTN1'
UE.1 FORTH ARE FOR THE Offa f.GRifi ,20
REm M AA9 PWVAT:/PUWIC UiEW.s RAMC A d 4 ( W
R51,m SAW THE All ,r OUTLOT 6 ' 1
1011, 2, 1, 5, i, 9,LL1a L7 1
DRAINAGE EASEMENT NOTE: a 16444 sq. ft 1 "-
I
�U • 0,38 Acres 31 01
WO GW¢T oe 0 ENT EVIL Do ANWG WWN ALAN I ml. 1777. n a I @ N
NTWAta Wm OR CRABS THE MEN OF M Depallmeot of AHmioisRalion k m a �2 11 1 E I
ARNE)e CO WATER "Al NW a
GENERAL NOTICE STATEMENT, M"M ILA« oB5IT= WK 6 F. Ul
EXCAVATING, OR MIND Arc PEW EAWI NA8 IN \ ,
EACH PWaL sRom CHI ONE RAP (PLAT) Is s1DWC1 m DRAW DIM IM MANS WATER axsml5 _ -
sTAIE, mot a noWRSRr LAn ms Ala PEras OR GRAt9 SEOM m S 88'59'32" W
KaT.1Ta6 ILE WE9AAM "No LET sIl A= m - - - - - - - E
PA�7, ETt) 3E0W RWlWA911G GA MINING 1W1' N 88 . .
PATaLaLW0.CCNTP D T45[ BOA WO FORA24 - - - - - - - - WIG OUTLOT STATEMENT; VALLEY VIEW DRIVE m S 82269off� 238.50
PpI AND THE WPRCNOA BOA FOR WKKE r
THE PuEAOSE OF TOE DOLOT WIG 6 TO PROVIDE FOR
DI EN SPACE AND ACCpNODAT: "AM WA
nwWE9 n5 aEUl 796a1 SHEET 1 OF 2
vm 91MPTS
U 2868 P 024
the restrictive covenants that may have such an effect. The Town Board shall have the
sole discretion to determine whether any such proposed change has the potential to
adversely affect the economic, aesthetic or property value expectations of a potential or
existing lot owner and to approve or not approve such changes.
Following ownership of a majority of the Lots by individual Lot Owners any amendment
or modification hereof shall require majority approval by the Lot Owners, including Lot 1
of the said Certified Survey Map, however, no such amendment or modification shall
cause Lots 14 and 15 of the Plat and Lot 1 of the said Certified Survey Map to incur any
additional responsibility or be subject to any assessments other than as already provided
herein nor shall it affect the exceptions to these Covenants herein granted.
Exceptions and Special Provisions applicable to Lots 14 and 15 of the
Plat of Cottage Meadows and Lot 1 of the said Certified Survey May
Lots 14 and 15 of the Plat of Cottage Meadows have been designated as "Farmettes"
which permits the operation of a farm as an enterprise, business or hobby thereon,
consistent with the Town of Troy and County of St. Croix ordinances and subject to the
Conservation Easement affecting such Lot. Irrespective of and notwithstanding the
conditions, requirements and prohibitions, otherwise, contained in these covenants, Lots
14 and 15 of the Plat of Cottage Meadows may at all times be used in a manner consistent
with the operation of a farm and for general agricultural purposes including, without
limitation, general farming, including beekeeping, egg production, floriculture, fish or fur
farms, dairy, licensed game management farms, forest management, livestock, poultry
raising, sod farming, nurseries, greenhouses, vegetable raising, raising of grain, grass,
mint, seed and ginseng crops, raising of fruit, nuts and berries, and other similar uses,
including placing land in federal programs for payment in kind or enrolling land in the
conservation reserve program but excluding farms operated for the disposal or reduction
of garbage, sewage, rubbish or offal, being subject only to approved farming and
agricultural practices and usages as permitted by the Town of Troy and County of St.
Croix and subject to the Conservation Easement affecting such Lot.
Further, any house and outbuildings on Lots 14 and 15 of the Plat of Cottage Meadows
may be constructed, maintained as, improved as and replaced with buildings which are
consistent with agricultural and farming purposes and operations. The construction of
any building shall not require ARC approval as otherwise provided in these covenants.
The specific building requirements and restrictions otherwise set forth in these covenants
shall not apply to Lots 14 and 15 of the Plat of Cottage Meadows and Lot 1 of the
Certified Survey Map recorded on October 14, 2004 in Volume 19 at Page 4858 as Doc.
Number 776973.
Further, farming equipment and machinery consistent with the operation of a farmette for
farm and agricultural purposes are permitted on said Lots 14 and 15 in the Plat of Cottage
Meadows, irrespective of any prohibition otherwise contained in the covenants or
regulations as set forth herein. Any amendment, modification, augmentation or recission
DRAFTED BY:
D. Peter Seguin, Attorney
110 Second Street 10 of 4 13
Hudson, WI 54016
ST. CROIX COUNTY 53 a W 91 lja I M
SEPTIC TANK MAINTENANCE AGREEMENT u �
♦ AND
OWNERSHIP CERTIFICATION FORM
O wn er/Buyer —
Mailing Address A jot o c
Property Address 53 5 ��(j S 4-0 1
( Verification required from ing oning Department for new construction. )
O
City /State Parcel Identification Number D 3� a — 5� 0 0
LEGAL DESCRIPTION
Property Location y '/4 ,',% , Sec., TZLN R_4�, Town of _r
Subdivision ��{ k�� -s�, Lot. # o'
Certified Survey Map # O f 1.5 Q$vn Volume Page �.
Warranty Deed # Volume . Pa, e � .
Spec house yes no Lot lines identifiable Oyes J no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle w-asre; 1'roper
maintenance consists of pumping out the septic 6A- every three years or sooner, if needed, by a licensed pumper. -t iat you put into
the system can affect the function of the septic tank'as a treatment stage in the waste disposal system. Owncr mail r•rance
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 ccrtification t r:: ,. signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that { ) tl � -n -site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessarv) t i ie septic tank is
less than V3 full of sludge.
I /we, the undersigned have read the above requirements and agree to maintain the pnvate sewage dtsposa ; stem with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources. State • )f Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Cn: tx ( rtty 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 %arc the ow cr r s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
SIGNATURE OF APPLICANTS) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning: & ',',on t� Department. *�
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the cenifit i .n vey Wrap if
reference is made in the warrany deed.
(REV. 08 /05)
' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 1 of 2
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner fi'r` , Septic Tank Capacity ! '" r,^,! a l O NA
Permit # Septic Tank Manufacturer WI ER D NA
DEWN PARAMETERS Effluent Filter Manufacturer ZABEL D NA
Number of Bedrooms L D N Effluent Filter Mo A100 ❑ NA
Number of Public Facility Units D NA Pump Tank Capacity al ❑ NA
Estimated flow (average) g al/day Pump Tank Manufacturer WIESER ❑ NA
Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer ZOELLER ❑ NA
Soil Application Rate gal/day/ft- Pump Model ❑ NA
Standard influent /Effluent Quality Monthly average` Pretreatment Unit NA
Fats, Oil & Grease IFOG) 530 mg /L D Sand /Gravel Filter D Peat Filter
Biochemical Oxygen Demand IBOD 5220 mg /L Xl NA O Mechanical Aeration 0 Wetland
Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection D Other:
Pretreated Effluent Quality Monthly average Dispersal Collis) Q NA
Biochemical Oxygen Demand IBOD 530 mg /L O In -Ground (gravity) J1 In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L X NA D At -Grade ❑ Mound
Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other:
Maximum Effluent Particle Size Y in dia. K NA Other: XINA
Other: b NA Other: X1 NA
* Values typical for domestic wastewater and septic tank effluent. Other' ECNA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: 0 op ) a) (Maximum 3 yeara) D NA
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y of tank volume D NA
Inspect dispersal cell(s) At least once every: 0 month(s) IMaximum 3 years) D NA
p D
ar(s) yfarys)
Clean effluent filter At least once every: MON161 l DNA
arts)
Inspect pump, pump controls &alarm At least once every: L3 monthlai D year(s)
D
Flush laterals and pressure test At least once every: O mont h D years ) ) D (
Otter: At least once every: 0 mart )is) D NA
Other: D NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal calls shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to Identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface, The ponding of effluent on the ground surface may indicate a failing condition and requires the
Immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent fitters, mechanical or pressurized components, pretreatment
units, and any servicing at inters als of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event,
ST.CROIX.POWTS MGMNT PLAN.max
Page _2 —of . 2
FART UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(sl and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• AN piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be Infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and' "bite 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.
D 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 GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name TODD FEATHERSTONE Name FEATHERSTONE EXC. , INC.
Phone 715- 381 -1704 1 Phone 715 -381 -1704
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name PINKY'S Name ST. CROIX CO.
Phone 651- 439 -4847 Phone 715 -386 -4860
This document was drafted in compliance with chapter Comm 83.220(b►It ►Id► &If► and 83.54(l),12) & 13►, Wisconsin Administrative Code.
ST.CROIX.POWTS MGMNT PLAN.max
State Bar of Wisconsin Form I- 2003 8 6 6 6 9 7 1
WARRANTY DEED 866697
Document Number Document Name KATHLEEN H. WALSH
THIS DEED, made between Dean E. Flackey and Kim R. REGISTER OF DEEDS
Flackey Revocable Living Trust dated March 11, 2005 ST. CROIX CO., WI
( "Grantor," whether one or more) RECEIVED FOR RECORD
and Matthew W. Hollister and Charissa R. Hollister, 01/04/2008 11 :15AM
husband and wife as survivorship marital property WARRANTY DEED
( "Grantee," whether one or more). EXEMPT 1 9
REC FEE: 11.00
Grantor, for a valuable consideration, conveys to Grantee the following PAGES: 1
described real estate, together with the rents, profits, fixtures and other
appurtenant interests, in St. Croix County County, State of
Wisconsin ('Property") (if more space is needed, please attach addendum):
LOT 15,PLAT OF COTTAGE MEADOWS, TOWN OF TROY.
Recording Area
Name and Return Address
D. Peter Seguin
PO BOX 469
Hudson, WI 54016
040 - 1312 -15 -000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
C„ lntor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except:
Easements, Restrictions and Reservations if any of record.
Dated ` c�
(SEAL)
Dean E. Flackey, Trustee
j
(SEAL) (SEAL)
*Kim R. Flackey, Trust e
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Dean E. Flackey and STATE NWISCONSIN
)
Kim R. Flackey, Trustees ) ss.
authenticated on ga COUNT )
Personally came before me on
the above -named Dean E. Flackev
* and Kim R. Flackey Trustees
TITLE: A4EMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the
(If not, fore o' g ' s ent and acknowledged the same.
authorized by Wis. Stat. § 706.06) KATY A. PEAVEY
THIS INSTRUMENT DRAFTED BY: 1211BI If'
* �.
D. Peter Seguin, Attorney
Notary Public, ate of Wi onsin
PO_ BOX 469, Hudson, WI 54016 My Commission (is permanent) (expires: )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 1 -2003
"ZYpe name below signatures.
Mudge, POd",lundeen PO Box 469 Hudson, WI 54016 -0469
D. Peter Seguin Phone: (715) 386 - 3200 Fax: (715) 386 - 5447 Flackey Trust
Produced with ZipForm- by RE FormsNet, LLC 18025 Fifteen Mile Road, Clinton Township, Michigan gar 48035 www.ziofonn.com
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SI.CROMOUNTY
Wisconsin Departrrierit of Commerce
SOIL EVALUATIO GOFFICE Page / of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code r• �d/ X
county . S
Attach complete site plan on paper not less than 81/2 )i 11 "inches in size. Plan must
include. ` �/
ude but not tinned loo: vertical and horizontal reference point (BM), direction and Parcel LD. V o / y _ Wv
percent slope, scale or dimensions, north arrow. and location and distance to nearest.road.
Please print all fnfonnation.
` Reviewed Date
Personal fMormaiion You provide may be used for secondary purposes (Privacy law. s. 15.04 (1) (m)). / D / L A 5
Ply Owner Property Location p
nDV !J f` �T E v Govt. Lot Al G 1/4 51/4 S T V N R /� E( W
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0 Rment D Public or commercial - Describe:
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General comments 00t W AASA
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The Department of Commerce is au 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.
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