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040-1032-90-000
rrw� 0 N O � 'v 0 C7 `�1 o o '. ID 3 - 3 " � a� o o o o ° S r J I Q O_ O. C O -� co �►�j Q , C m m -1 o r.r m m 5 m o iD w O" ^ Cam N O n O O 0 0 C M C O D C 0 A � W � � O 3 a a a O O to O y cn O C y C K w v_t Z D a m D d a 2 C Z CD C0 C1 lV o OOO o c r w o z rye E o cr v o o D O `2 ' m CD N " Cl) a) a m (D d N N v N - O CD Q r �\ D D 0 A O m O ' o. ro O cn (n CD C C N w co Q- C2. 3 E z co Ip �_ O C ? X A n O A Z O O W w OD a Z c s cf, o 3 m g CD A .» O N O C() O Fm �N m O O =r C T -. O C n N O Q d O O O 7c N d C N (n N N 0 N ? N O p O O r^ C I (D n n ago a (D a O Z a-0 O Z O N N n O . O N CD 7 Q co O NO N O V CD K •p CD kn O w Parcel #: 040 - 1032 -90 -000 07/22/2005 10:38 AM PAGE 1 OF 2 Alt. Parcel #: 7.28.19.10961 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): = Current Owner * GRETCHEN S BLOSS BLOSS, GRETCHEN S 405 CTY RD F HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 405 CTY RD F SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 4.038 Plat: N/A -NOT AVAILABLE SEC 7 T28N R19W 4.038AC SW SE LOT I OF Block/Condo Bldg: CERT SURVEY MAP IN VOL III PAGE 760 EXC THAT PART TO CSM 7/1870 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 07- 28N -19W SW SE Notes: Parcel History: Date Doc # Vol /Page Type 03/21/2000 619925 1496/590 WD 11/12/1999 613776 1470/414 SD 07/23/1997 1035/24 WD 07/23/1997 835/22 more... 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 4.038 66,000 137,500 203,500 NO Totals for 2005: General Property 4.038 66,000 137,500 203,500 Woodland 0.000 0 0 Totals for 2004: General Property 4.038 66,000 137,500 203,500 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 L__ Wisconsin Department of Industry SOIL AND SITE EVALUAT R EPORT Pag \ of 3 Labof and Human Relations Division of Safety & Buildings in accord with ILHR 83.O51 �Aqlifl.rC COUNTY Attach complete site plan on paper not less than 8112 x 11 inches in iz1a.P(an st r,lude, but•; •Ct_rJIX not limited to vertical and horizontal reference point (BM), direction o of s{o�e'sye aof PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest ro l7 L i gp APPLICANT INFORMATION- PLEASE PRINT ALL INFOR i AT.IONJ �2 I DATE 11 '8rl X"'1 A"' PROPERTY OWNER: r PROPERTY lWATION 1 C_YC \� �� C O` t tJ'�?} 1 M vsS 1/4 Se., 1/4,S - 7 T '�- ,N,R 1 °� E (or PROPERTY OWNER':S MAILING ADDRESS LOT #/ BLOCK # SUBD. � ME OR CSM # S v Ill V ; 1 fll� 0 / CITY, STATE _ ZIP CODE PHONE NUMBER EICITY []VILLAGE [@TOWN ZW�2 t�S !Ail S O ZZ l�[S) Z.S- R4 `C7� S. Foutc fit~. [ ] N truction U 6CI Residential 1 Number of bedroom L ; [ ] Addition to existing building t e[ ] Public or commercial describe b°O gpd Recommended design loading rate — bed, gpd/ft • S trench, gpdm Absorption area required bed, ft trench, ft Maximum design loading rate ' bed, gpd/ft - s trench. gpd/ft Recommended infiltration surface elevation(s) s � Qo`CL N ft (as referred to site plan benchmark) Additional design/ site considerations S uo� 'ZQ Parent material S t L� Ou tom. r2 Ou h,,,N• 1 9 , Flood plain elevation, if applicable N - 'F1 It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK ® ❑ U= Unsuitable for s stem S U ®S ❑ U E] S ❑ U RI S ❑ U ❑ S O U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed mnc h D -l� �O�'ltZ Z 1 1 — is t.1P , Np Ground 3 2,3 - o `-I. Vz elev. 1 8 9 .s Depth to 5 0 16_9( I 3 - 1 LZ Y1 - S limiting fact 6 ti C� nl S Z S O ° lo LL Wl F 1 I Cw S . - \J / 5 Remarks: Boring # _ R- J Z VS ws' V) Z »' Z Ib 31 Ie�lcz 3[i _ SO yn a. •� S . . -. 3 3) -Uo to`1 tZ zl d � si ► 2`Q s1J1 vn `�1- cw � • s . � Ground _ 1 el ev. ft. 4b -63 ) v L 1 W, S M TF - c�,�, �� • S Depth to l�� L t cc, .vs � Soo )t, Ll t� r=h s SI 1 Remarks: CS T Name Print Arthur L. We erer Phone' 715- 425 -0165 Address: Soil Testing & Design Service -P.O. Box 74 River Falls,WI 54022 Signature: / f Date: , CST Number: M00576 i PROPERTY OWNER SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. # O y l 3 9 t Depth Dominant Color Mottles Structure PD /ft i Boring # Horizon Texture Consistence Roots G n. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. , Y . � Bed ' Trench 3 t:� ft Ls ti c-s ) b1—, m y Ground 3 3� -U l0 `� [ l L — L Z `�' Jb 1�► `�1- e k, . S , `o elev. qft. Depth to S 9$ 10� limiting factor b" 1 co ►V 1J D 0 L l M `�'� N ` i Remarks: Boring # i Ground i elev. ' i ft. i Depth to i limiting i factor Remarks: Boring # I ? i ba'c fi' 3 ? i i Ground elev. ' i ft. i i Depth to limiting ` factor , Remarks: Boring # ark Ground elev. ` ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) . PLOT PLAN Pa 3 of SCALE 1"-"30 ' o� k4 tt s �, 4`g_o'on� Bo�vY -, c�F ltwsF s�D�n..�G. _ 4 6 Li - sea `t�c pi s � a �j n.I 6 z . 4 6' -- S V�sEw�Ajba2 LIZ" C �t[3 S B`� ► NF��' - 1 TL `tom M s Y-Nv�j 50 pf� V1ft)(. 10 & Zap. O�eNtiwE �- fti'C7' 'T�E�� L1��U�vS Pmn� �.lU�t'Tx�S fYt' `�� C�S 'S1ZUy1 0N . C)8 -13 8 ( 715 ) 42.5-0169 1400576 CST Signature Date Signed Telephone No. CST # Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page \ of 3 Labor and Human Relations Di% is;on of safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code _ COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL ID. # dimensioned, north arrow, and location and distance to nearest road. U y O - I. b3 Z- 90 APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION B DA .E �c fl PROPERTY OWNER: PROPERTY LOCATION -"�) l C1rC \�, �`j- G C C�(tJ 1 ?}� ugg GOV F t0T SW 1/4 SZ 1/4,S 7 T IS ,N,R 19 E (or PROPERTY OWNER'S MAILING ADDRESS LOT # I BLOCK # SUBD. NAME OR CSM # SU \)R Vl �l� — CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE DOWN NEAREST ROAD ' [ j New Construction Use [>Q Residential / Number of bedrooms Addition to existing building 6CI Replacement [ j Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate — bed, gpd$ - S trench, gpd/ft Absorption area required bed, ft 0 trench, ft Maximum design loading rate 4 bed, gpd/ft2 _S trench, gpd/ft Recommended infiltration surface elevation(s) 5 I'X - tom N • 3 ft (as referred to site plan benchmark) Additional design/ site considerations SLs�_ tio� <sQ Parent material S L L:� ov eV- L-t*r , •,-t.. Ov''% ip. 1 14 Flood plain elevation, if applicable N. A • ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ®S ❑ U ®S ❑ U OS [:]U RI S ❑ U [IS O U O S cab SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD /ft Boring # Horizon in Munsell Qu_ Sz. Cont Color Texture Gr. Sz. Sh. Consistence Bourx ry Roots Bed rfmnch '-g i n -tl \o`1tz z.[ I — lS Tag -- — - �,S -- tJp I NP Ground 3 2-3 - elev. Depth to S 9p_9 10`1[Z Y7(. TS C w 1�U`Fti^ - `�f •S limiting factor '�VN S - 2 S o LL i•✓t s > C1 Remarks: Boring # , . >.:;,v< o -► b 1 o K tZ z Vs %F" f< Z 1 31 lb�tz 3 IZ % 1 0 Sbk m cu �� S 3 31 -Uo X0 `1 � z! � � sI 1 - Z`�Sbk Yn `�1- Cw � • S . � Ground _ n 6 --S ft Depth to S b 3 q b 0 R yl f� s N S �n v` - • �4 S �� Lt[ ,vs ? s o � Jo LIM Remarks: CS T Name:PleasePrint Arthur L. We erer Phone. 715- 425 -0165 W ass: Soil Testing & Design Service -P.O. Box 74 River Fa11s,WI 54022 Sgnature: i Date: 6 , `� CST Number: �lS -[3$� M00576 PROPERTY OWNER SOIL DESCRIPTION REPORT Page _Z of „ 3 PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 o - Z3 \� 31-Z — s1riLS 1as 'b1� MU - cS -4 •s Z. Z3 -31 �� `-I z!t — sl 2`� Ground J l c. ti 1 �-'� sb 1n `'fit- k, 1 • S . `, elev. 9 aft. �l6 -6�F I0`�2 31L - s 1 Z�sb vn\j -4 •5 Depth to limiting — •� ~S factor 9b I Remarks: Boring # 4 i Ground elev. ft. ' Depth to limiting factor j i i Remarks: Boring # E 1 1 1 m , i Ground elev. ft. i Depth to limiting factor i Remarks: Boring # w• Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(R.05/92) PLOT P�it -v Page 3 of - J SCALE - 1 30 ' LL let" { g 4`8,0 a� $o�U+^t �F WWsE L'nNG. ILI �t11LI _ TUM PP ly 6 ��ot " V IF-3NL . bCZ - tY.t tctiL 1 4 tom, ei�Clt 3'x `z. 6' LbWG w�°iy 113 Q� r of -VtE Vh 6 H crn=fr -L` - %f 5 t��wuu�eR L ek1 Ctt Maenu B`i 1 �.1PLL`T9.�Pt'fOR Sl- s'r z , uu c. N rJ 1 `" lN . PL.AGL 1u'u c YZ w . 50'` � Don' Promo y" L. _ mac bo �. bZTZRmjwe Ll�fv7 'TSzevC4 Lbc4'pwS ?Pui�, Ltly s t'i'r of c�u S'tilzu�fiot.1. l�G!IZKv�1Z -� 6 (715 ) 42 -01 1;r, is00576 CST Signature Date Signed Telephone No. CST # FORM NO. 988.A .. ...e. S RVEYOR'3 RECORD CERTIFIED SURVEY MAP V Center of Section 7 I i I North Lke of SW1 4 - SE1 4 I I unplatted lands I� i -- — — — - - - -- 1 3 � S89 , 3 1 712.52' 2.5' 662.50` � B C 2 50' ^ „� 4 FEB Y 19 1 i to CI O 14.19 c res M I I co QUARRY �6i} �✓rac __ ¢ M -_ �0 3 SW -SE J ( = o vl- _ �p C� ai O a in OI 2 (, a = Cn � rn Z ++I U � TRUE BEARING �I 1 L 50' •0 M (A I M I +, -O I CLi = I (n W � I OI z TABLE OF INTERIOR ANGLE I� 662.50' °- a"0ii N89 °15'56" W N A= 91 166.61 284.74 �I B =88 0 16 1 17" +, I C =91 0 43'43" >- t° I D=88 Z Q I l.°�' " c I C I o OU H ❑ Q C) ° 0 1 LM 0 z �' 1 00 50, 5.86 acres cn Point of Beginning I A _ — 662.50' D "91/4 Corner N89 015156 11W Section 7 SE corn 712.521 sdu-i Section 7 T28N, R19W South line of SE114 SCALE IN FEET unplatted lands — — — — — — APPROVAL OF THIS MINOR SUBDIVISION 0 200' 400' DOES NOT MEAN APPROVAL FOR BUILDING SITE OR SEPTIC SYSTEM. REFER TO H62.20 APPRO ^ IV OQ This instrument drafted by Julie Kraemer N 7 1979 1 ST. CI)O!X C 7 Vol 3 Page 1 60 COMPREHENSIVE r..,,,.; , — JWD ZONING COMMI1 4 I ` k Parcel #: 040 - 1211 -50 -000 07/22/2005 10:37 AM PAGE 1 OF 1 Alt. Parcel #: 07.28.19.1004 040 TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner E NICK SCHMIT * SCHMIT, E NICK 509 NELSON FARM LA HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 325 W GROVE RD SC 2611 SCH D OF HUDSON SP 1700 WITC '4 Legal Description: Acres: 2.667 Plat: 2597 -WEST GROVE ESTATES SEC 7 T28N R1 9W LOT 5 WEST GROVE ESTATES Block/Condo Bldg: LOT 05 & 1/12 INT IN OUTLOTS 1 & 5 Tract(s): (Sec- Twn -Rng 401/4 1601/4) 07- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 984/467 WD 07/23/1997 784/400 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/22/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.667 80,800 0 80,800 NO Totals for 2005: General Property 2.667 80,800 0 80,800 Woodland 0.000 0 0 Totals for 2004: General Property 2.667 80,800 0 80,800 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 I SAFETY &BUILDINGS 'U , OF REPORT ON SOIL BORINGS AND �USTRY, DIVISION B°R AND /� P.O. BOX 7969 ;M RELATIONS PERCOLATION TESTS (115) MADISON, WI 53707 (H63.09(1) & Chapter 145.045) C= .TION: SECTION: TO HIP /NAY: LOT NO.:BLK. N .: SUBDIVISfON NAME: ;r 1 /4.,4Y4 — / /T VqW /R 1 OF 5 4 6go✓e ks-At* TY: OAR'S BUYER'S NAME MAILING ADDRESS: � � /f �� � �' In JJy� to DATES OBSERVATIONf MADE ry NO.BEDRMS.: COMMER DESCRIPTION: PROFILE TI NS: I NT STS: ./ ,esidence / lew ❑Replace ' ,TING: S= Site suitable for system U= Site unsuitable for system 7 0 5 � -- r7 r F ____ TIElu . I MDS � IN- GBOUND - URE: S�EM- I�LHOLDING TANK: REC MENDED SYSTEM: (optional) / - - L�IY U S � S ( t�Aj �'►7� 6�•d� 'ercolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the ;Jer s.H63.09(5)(b), indicate: <3 Floodplain, indicate Floodplain elevation: PROFILE DESCRIPTIONS ING TOTAL ELEVATION D PTH TO GROUNDWATER•INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH , 1BER I D OBSERVED OBSERVED EST. HIGHEST TO BEDROCK IF OBSERV D (SEE ABBRV. ON BACK.) 7, 7 S i PERCOLATION TESTS i'EST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES JP'BER 1 AFTER ELLING INTERVAL -MIN. PERT D t PER/ D P R PER INCH 2s' f 3 lyllt S �3 �)T PLAN: Shop: locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- to; and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent and slope. YSTEM ELEVATION S A 6,,., PeY N r (be I 27' 3 JL e By the undersigned, nereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin iministrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief, 4ME I TESTS RE MPLETED ON: DDRESS: CE TIFIC TION UMBER: PHONE NU BER(optionall: CST. IG T1JR ' .'TRIBUTION; Original and one copy to Local Authority, Property Owner and Soil Tester. S!iD& fR t�?'t32! OVER -- Wisprisin,0epartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 538711 0 GENERAL 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 Village X Township Parcel Tax No: Bloss, Gretchen S. I Troy, Town of 040 - 1032 -90 -000 CST BM Elev: Insp. BM Elev: BM Description: /� Section/Town /Range /Map No: U !'v\ 1 CSr 07.28.19.10961 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER .',� CAPACITY STATION BS HI FS ELEV. Af Septic �' / g y / Benchmark 6. /a • 7 /60 Deeii" LL �O�{• 5' AIM Aeration Bldg. Sewer �[ Holding St/Ht Inlet 5.az 9S, �g TANK SETBACK INFORMATION St/Ht Outlet 5 3 qs, TANK TO PP, WELL BLD . Vent to Air Intake ROAD Dt Inlet ` Septic /-a $� f y 56 , Dt Bottom � Dosing l!J / Header /Man. Aerati Dist. Pipe 11, Holding Bot. System �z • Z $ g • 5 PUMP /SIPHON INFORMATION Final Grade $. z, �Z • S Manufacturer GP Demand St Cover / J • / Z C7 ' GD Model N er TDH Lift Friction Loss System Hea TDH Ft Forcemain r 7777 r — . Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width 7ength No. �.. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / T� A.— %.— �_ SETBACK SYSTEM TO (� P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type f CHAMBER OR L./ur•� �tfy"a.,fa-t. 60y `O � n l 2, J� UNIT Model Numbe r: 4 , 1 � C T (.y1i/� (.�J DISTRIBUTION SYSTEM 154-15 *5 Header /Manifold �� Distribution x Hole Size x Hole Spacing Vent P P Intak� Pipe(s) � er► Length �2- 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 Fa No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 405 Cty. Rd. F �H - udson, WI 54016 (SW 1/4 SE 1/4 7 T28N R19W) NA Lot 1 Parcel No: 07.28.19.10961 1.) Alt BM Description = r- l tcw5 2.) Bldg sewer length =Z7 aid (� .,/1 +b 6 - amount of cover = i n qPe 94148k '�94148k � h3 �Jtl �B �a J Plan revision Required? Yes to Ib 2 Use other side for additional information. •J SBD -6710 (R.3/97) Date Inse or's Sign re Cert. No. Safety Division County commerce.w,gov Y and Buildings 201 W. Washington Ave., P.O. Box 7162 sco res y�, Madison, WI76 D1 Sanitary Perm Number (to be WWI in by Co.) i of Commerce 5307 State Trans" t' *mber Sanitary Permit ApF e;i tr--- --�' in accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this fonn to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned PO TS are Project Address (if different thanmail' ad s) submitted to the Department of Commerce. Personal information you provide may be se ndary , L A-/,A,5 p urposes in accordance with the Privacy A� Law, s. 15.04 I)(m), Stats. "��lTi L Application information — Please Print All Inform parcel # Property Owner's Name ' loss �� oho. / � z - 9� - 0 � Property Owner's Mailing Address GQU Property Location / /�� �5 Co. RA I �Q� �` Govt. Lot Zi Code P>m y,, s ', Section City, State P /4 ryy s Q � G (circle one) v �1� W J V T V N: R !_L-- E or W ti. Type of Building (check all that Lot # apply) Subdivision Name l or 2 Family Dwelling -- Number of Bedrooms c5' ' 1 Vol 1 Block v (J b v ❑ Public /Commercial - Describe Use ❑ City of CSM Number ❑ Village of ❑ State Owned - Describe Use r ` dL 3 {J b l.. 1 f.aJ J 7 [Town of 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ Replacement Only C1 Other Modification to Existing System (explain) ❑ New System �teplacement System Treatment/Holdin g Tank Re P B. ❑ Permit Renewal ❑Permit Revision ❑ Change of Phtmber ❑Permit Transfer to New List Previous Pernmit Number and Date Issued I Before Expiration Owner q, IV. Type of POWTS System/Component/Device Check all that a 1 -V Non- Pressurized I n- Ground ❑ Pressurized in- Ground ❑ At -Grade ❑ Mound? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat ent Area information: Design Flow (gpd) Design Soii ,4pplication Rate(gpd Dispersal Area Required (st Dispersal Area Propos (s f) System Elevation '�S� - 5 �� �0 417 '8'8 5 VI. Tank Tank Info Capacity in Total # of Y a Gallons Gallons Units o E tj y New Tanks Existing Tanks Septic or Holding Tank 106b , W, Dosing Chmnber VIi. Responsibility Statement- t, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI er's Sigtmatr MP /MPRS Number Business Phone Number �. b�nm # a�� 4by Plumber's Address (Street, City, State, Zip Code) )(D V�w 3S N I1Nasw4 � U V11.1. ount /De artment lAe Permit Fee Date 1, ued Issuin gent Signal e Approved ❑ Disa ve $ 7S Ow iven Reason o enial IX. Conditi t f Wasons for Disapproval �� '4 . Septic tank, effluent filter and J dispersal cetl must all be vi e! maintained as per management pro plan provided by plumber. 2. All setback tequirernents must be maintained per Attach to complete p ans or to system and submit to the County nly on pape not less than 8 in x t t inche i size � SBD -6398 (R. 01/07) Valid thru 01/09 /) o a me, G izA+c- keN S. � A4 Ir �u m Zo omiion . N 7 S _ St I r-v 0 D��1� ?��►� A� S,� S �Jlw6a s Co )Ltie(z 'FI-�v I od.S0 C7Q 3 y vo n do D t� , i CONVENTIONAL NAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: C-� B) us Ii Owner's Name: f _. Owner's Address: U u�s b k 1' Legal Description: ' � l� �j � I S q Township: �jrZV County: Subdivision Name: Lot Number: Parcel ID Number: Oy y 3 — 7 y - © 0 b Page 1 In and title Page 2 _ Plot Plan Page 3 System Sizing & Cross - Section Page 4 Filter Specs Page 8 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenanc Form Page 8 Warranty Deed Page 9 CSM or Plat Atitachments: Soil Test & House Plans Designer /Plumber: r, Qj,1 __ a _ _nN IC License Number: Date: $ Phone Number 3 TD.� Signature ` Designed pursuant to the In- Ground Soil Absorption Component Manual for POWTS Version 20 SBD- 10705 -P (N.01 101). Page 1 1 . o a A4 md 370m 'Ba t -fie .Iriees r �Ga.lon yas cn T N 1 <J 3 3 edgoy, d �ePl'�e 1 �ppp�p F sfi i rj� Dry G O da j�� yy� L r 5t? )lYt /� . I�OWP j� `/ T,7 3- ra�� D IC Y „ S CJoM6g s" COQ - hJQJL Iev 10 5 0 veg�N� °a3 i i Soil Absorption System Cross Section 3.1 ft ft 9 _ 4" Schedule 40 Final Grade PVC Vent Pipe With Vent Cap . 89 So ft Leaching ♦ ' Chamber ~ System Elevation 3 ft Soil Absorption System Plan View 40, ft 39 ft { i 3- ft Leaching Trench 1 Chambers 4" Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 Leaching Chamber Specifications n l' Manufacturer And Model _ T,N c ),It6t0 +0it S Q %A 4 - t 7 EISA Rating . a b sq ft per chamber Soil Application Rate -5 7 gpd /sq ft 9S(:) gpd Design Flow- S Soil Application Rate - QO EISA = _ yS Chambers L 3 rows of chambers each. Page of PL -525 Effluent Filter - Effluent Filters.. Polylok Inc. Page 1 of 2 Polylok Inc. 3 Fairfield Blvd, Wallingford, CT 06492 Call Toll Free 888 -765-9565 Small poi lok.com You are Here: Home, > Product Details E FILTER 's Raising the bar in filter teehnolo ' riESa i � s`iCCOt'JNT: i APP PL -625 Effluent Filter's'; Description POLILM-- ! Effluent Filters Polylok, Inc Is pleased to add its new commercial filter to its existing line of quality effluent 1 Extend & LokTm „..._.- filters. The PL -525 is rated for over 10,000 GPD (Gallons Per Day) making it one of the ; largest commercial filters in its class, It has 525 linear feet of 1116" filtration slots. Like the Risers & Riser Covers Polylok PL -122, the new Polylok PL -525 has an automatic shut off ball installed with every i filter, When the filter is removed for cleaning, the ball will float up and temporarily shut off i Distribution Boxes anc the system so the effluent won't leave the tank. No other filter on the market can make that I Accessories claim! Our Pumps, Basins, Pump n'n „ I and Step Systems :.! 0 Ordering information R equest a Quote Related P roducts I Seal! Gaskets I Features I Baffles, Sanitary Tees Deflectors + Rated for 10,000 GPD (Gallons Per Day) + 525 linear feet of 1116" filtration j Rebar Spacers Enlarge for details + Accepts 4" and 6" SCHD. 40 pipe Handles and Rec eiver, e Built in Gas Deflector e Automatic shut -off ball when filter is removed e Alarm accessibility I Signs e Accepts PVC extension handle I Landscape / Drainage The PL -525 Effluent Filter should operate efficiently for several years under normal 1 Forms&. Clamps conditions before requiring cleaning. It is recommended that the filter be cleaned every ;- .__.... ...,._ ., ...... time the tank is pumped or at least every three years. If the installed filter contains an i Butyl Sealants optional alarm, the owner will be notified by an alarm when the filter, needs servicing. i••---------- •--- = - - - -• -- Servicing hould be done b a certified septic tank pumper or installer. 9 Y P P P Concrete Accessories Maintenance Instructions: ,pressure Filters }Odor Crontrol Product 1. Locate the outlet of the septic tank. 2, Remove tank cover and pump tank if necessary. I Rebar -Lok and CMU 3, Do not use plumbing when filter is removed. Accessories 4. Pull PL-525 out of the housing. S. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. Rebar Safety and ID C: 6, Insert the filter cartridge back into the housing making sure the filter is properly ?' aligned and completely inserted. Decorative Landscape 7. Replace septic tank cover. PL -525 Installation; Ideal for residential and commercial 1 waste flows up to 10,000 Gallons Per Day (GPD). Technical Speci°flcatiol Installation Instructions: d ated Products i Pump, Filter and Sun 1. Locate the outlet of the septic tank. 24" x 12" Riser 2. Remove tank cover and pump tank if necessary, Filter Alarm Panel an 3. Glue the filter housing to the 4" or 6" outlet pipe, If the filter is not centered under SmartFilterTM Control the access opening use a Polylok Extend & Lokim or piece of pipe to center filter. j 4. Insert the i L -525 filter Into its housing. httn /xAivvxh,, T dll� 1990E "Nl,,, dotgilc ncn`)Prnrhu Trl =1 W d l l: 6 O � Oz `II �!111VfiIlUd'[IIQIIIfIIGGII U RI n u, I, eioil000�u, uuuuun „u,i,i III, 6111 I��I�{ I �I�' ll,ll � � �1.! IIGIrI II''L/ I� ����i11111��' dIIIGI�Ii�llllll 6illlflli11 If�Ilili111161�Nt IV�II����l�f�ii> �n�l�llllld' llllll1����illllhll6h`'' lilllll111111�1111�h 'llh�lillBliNl'�N�6' 466111111' 11��! IIIIIIIIIP ! "'ll4f���lillliil�;�. 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I' III�IIP�' IIdI�I, a��llNlllllllllll4111111�11111111��1 111111111111111111 'lll�IIUI�iI(II�1911'I IIII' III' IIIIIIIIPI' I�I�I' lllliif�ill' ��IIPIIIIIIIII' �I' �IlPllll' I��II' lllllll�l��ll�l�,l'J111IIlilh ��;��.._. —_ ��ull�` ��1 llWllll�ll�llll�lllls !l1Ill�C.11llilV�111fllll,!� , � ill �11�1 I, ���i 11�1i1111IIflfl11111 'IIIIIf1�l�fllll'I��IIIi� I I� �� YII,II,II,III I �� � � � I ' �_. — �� (I; .:III 1,,1�, 1 11111 it r nrr , r � !(l � ,. l �l rir ,,� •, o. �...v c� � v) '' • �/ r i'd 112 2 l'�r rl 11 X111, 4 ! l / � r I I rl! l ! 1l 1N/ � -• 'rr I 'll / ur'rrlrl�l'Il 1111 Ir dl i 1 r r rllgrl r r�/ ! r rr r' � / Oct, 14. 2010 9:12AM ' " �' No, 3066 P. 3 p r c CD :a m r � > O m G7 S -t -, , _0 C) ° C �j S r m n m-I �m m m $ 0 S m Q � o O J cn V O - III O CTi N � 0 r� - POWTS OWNER'S MANUAL_ Rr MANAGEMENT PLAN FILE INFORMATWN r' Mla e/ Owner �» SYSTEM SPECIFICATIONS _.__...\,? R ; C' C)J S, S Septic. Twnk Capacity Parrett �b S ' U UU ` gat 0 NA Septic - rank MAntrfacttwer W �� �� ❑ NA DESIGN PARAMETERS FffluAnt Fitter Marulfar.Urrer '- o F Bedrooms 0 NA - -- _ _ . _ -- . - _... _ 01 Public FAcili Units 13 NA Eflitiew Filter Model � 11 NA - r(r'vo111ank rnt,nt. .it.Y flaw (average) --��1NA '_� runrl► Tenk n iEstimated (peak), Q NA gal /day P MAnufortmp mlon Rate 19+NA — - -- -- "_— ___Naiidaylit' Pump Model fluent /Effluent Cl uaNt Monthl — �3.NA Y average* PretttratrnAnt unit - _ " Fats, nit & Grease IFor1 <30 tt►g /t t Ox i -1 . /(;ravM Fih�r I.1 PPar Filter ygnn hArnflnrt {Fif)hr) - .77t) n1011 1 1 N/1 Total Suspended Solids (T "SS) 615(1 n,g /( 1 1 Mnrhmiir ni /1ornrinrl 1 I V1/nfit►"rd - - — - - - -- Prelreatetf Effluent 011ality _ - — - -'- - Lt bislrlfertiOn _........._ t_1 (liner: Mntrnd Mn►r1f11 Bioche►nical Oxyy"t,r t7ern">lr,d a Y average Dispers;tl t'All(sl iflOO 1 <30 mg /(, tj�tn t;rn►rnt! L:1 NA Total Suspended Solids II 1 530 ►ng /l I 1 NA (grnvityl C-1 h, Grormd (pressurized► Fecal Coli/orn I I At t;rn(la i_'i (geom etric, inea",) 510" cif► /100m1 -__ - - - -- I-I Urip -Linn Maximum Effluent Particle Size . O Oliver- ! in rlia, I] N/1 rrthr.r _ - ❑ NA 1:1 NA "Vnlue4 lypiGnr irrr ±nrnnagc wnsiw,wrtt�r ,nrf s"lnrlc Mr1k rllhrnnt. - -- 11 NA (')tiler MAINTENANCE SCHED1jLE O NA Service Event Inspect condition of tnnk(al Service Frequency - -- — !l1 leant ogle ❑ monthfs) __- - ❑ ear s( (Maximum 3 years! . O NA Pump out contents of tank {s) When combined sludge and setae equeis one-third IY�1 of tank voturt�� inRpert dispsfll 0911 {R) 0 NA At leant once : "very — -� —` - -- ---- _-_ --_- -. U R1on1t11R) Clean effluent filter _ - f,)1` ____ yea►fs) (Maximum 3 yeas) ❑ NA !1t least t,nrn — —_ _ - ___�_ -- - " CI months) Inspect punt ' 11 NA Pump pump controls & alarm - - -- _ . ___— Yeerls) - At least once every; ❑ ntonUr(R) - Flush laterals and pressure test ` - -- — ❑ year(s) NA ------ - --- -- At least once every: ❑ rnonthlsl Year (a) %qNA r -- - -- Other: At )oast once every: D tnonthlsl MAINTENANCE INSTRUCTIONS rANA Inspections o f tanks and dispersal cells shah be made by an individual carrying one of the f Master Plumber; Master Plumber Restricted POWT I �ena� or certifications: insperttons must Include a visual Inspection ofS tile t to identity any missing or broken hardware g S Inspector; POWTS Maintainer, Septage Servicing pperator, Tank measure the volume of combined sludge and strum and to cheek for any back up or ponding of effluent on the r The dispe cog(s) s , identify �, cracks or Lanka, shelf be visually inspected to ctbftk the effluent levels in the observation pipes and to check for MY Of effluent on the ground surface. The ondin g ound surface. immediate notification or the local regulatory author tfy��l on the ground sur may indicate a falling condition and reyu When the combined accumulation of sludge and scum in any tank evtlals nnn_d, r1., __ contents of the tank clan r.." ._ _ I ART UP AND OPERATION Page _____ of or new construction, prior to use of the POWTS check treatment tankfa) for the presence of painting products or other cltsmioafs met may impede the treatment process and /or damage the dispersal collie). If high concentrations are detected have the contents f this tankta) removed by a septage servicing operator prior to use. t yetem start up shag not occur when soil conditions are frozen at the infiltrative surface. udng power outages pump tanks may fill above normal highweter levels. When power is restored the excess wastewater will be Ischarged to the dispersal eee(sl in one large dose, overloading the collie) and may result in the backup or surface discharge of Ifluent. `fo avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring ewer to the effluent pump or contact a Plumber or POWTS Malntalner to asslat In manually operating the pump oontrole to mstore normal levels within the pump tank. o not drive or park vehicles over tanks and dispersal calls. Do not drive or park over, or otherwise disturb or compact, the area . r)thin 16 feet down slope of any mound or at - grade soil absorption area. leduction or elimination of the following from the wastewater stream may Improve the performance and prolong the He of the OWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasere; dental floss; diapers; disinfectants; tat; oundstion drain (Sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meet scraps; medications; oil; ainting products; pesticides, sanitary napkins; tampons; and water softener brine. ANDONMENT Then the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system Is roperly and safely abandoned in compliance with chapter Comm 83.33 Wisconsin Administrative Code: e AN piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. 6 S1 irrfflMitlli•at Kill io*#A Kmw Mww inri im fA kAkAor o wrr wAliYe6lo 011*11111111U1 N4 i66 M MrWlMigir kiM4140hs wpa -Aiwh e After pumping, all tanks and pits shall be excavated end removed or their covers removed and the void apace filled with Boll, gravel or another Inert solid material MINGENCY PLAN the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant 'placement system: " A suitable replacement area has been evaluated and .may be utilized for the location of a replacement soil absorption` system. The replacement mss should be protected from disturbance and compaction and should not be.infri mW upon by required setbacks from existing and proposed structure, lot Knee and wells. FaWre to protect this r"Iscement area wo result in the need for a new sop and site evaluation to establish a suitable replacement area. Replacement systsmS must comply with the rules in effect at that time. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances M POWTS technology a holding tank may be Installed as a last resat to replace the failed POWTS. ❑ The site hat; not been evaluated to Identify a suitable replacement area. Upon failure of the POWTS a soil and situ„ evaluation must be performed to locate a suitable replacement area. if no replacement area is avell" a holding tank may be installed as a last resort to replace the•faW POWTS. ` •6 `,• 0 1 007 fit; j Q Mound and at -grade soil absorp be reconstructed In place following removal 00" blomat at the Infiltrative surface. Reconstructions' must comply with the rules in offset at the <WARNING> > iEPTIC, PUMP AND OTHER TREATMENT T#NKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. 00 NOT . . ENM A 80TIC, PUMP OR OTHER TREATMENT TANK ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PHIM FROM THE INTERIOR OF A TANK MAY 711 D KILT OR IMPOSSIBLE. M w DDtT1 RAL COMMENTS (► it e. :Y'#Z1 # r .. , A - •i ",t ��► 11:.. ,, OWT8 iNSTALLER A -` POWTS MAINTAINER Name -e Name Js: 411114, ' Phone �'�� 7 d _ + ►;�:i .. Phone EPTAGE SERVICING OPERATOR (PUMPER) f. f r + LOCAL REGULATORY AUTHORITY Name ei n" 14 ±` i1144 gym 4 Name Phone a� ' �r•E,t r '.;;. Phone - Ig L j t.l. d,.....�.......... d..f��d t.. - ..� ...at.. t..��. P- WA f OBVIket.11 t UA L94% 4 0% MAt t t 17► L Mt U A.- ......t.- A —' -'- 16 - N-d. ART UP AND OPERATION pe" -- of or new construction, prior to use of the POWTS check treatment tankle) for the presence of painting products or other chemicals tat may impede the treatment process and /or damage the dispersal collie). If high concentrations are detected have the contents t the tankle) removed by a septage swvlcing operator prior to use. ystsm start up shall not occur when 800 conditions are frozen at the Infiltrative surface. 'wring power outages pump tanks may fill above normal highwster levels. When power it restored the excess wastewater will be / Ischerged to the dispersal ceiflsl In one large dose, overloodf ng the collie) and may result In the backup or surface discharge of fftuent. `ra svold this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring ower to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to store normal levels within the pump tank. I I, o not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the eras +thin 16 feet down slope of any mound or at -grade soil absorption area. !eduction or elimination of the following from the wastewater stream may improve the performance and prolong the He of the OWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs: degreasers; dental floss; diapers; disinfectants; fat; mutation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; most scraps; medications; oil; efrtting products; pesticides; sanitary napkins; tampons; and water softener brine. ANDONMENT Alen the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system Is roperly and safely abandoned In compliance with chapter Comm 133.33, Wisconsin Administrative Code e All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. E "�� si1IN>i iflffi•iri ill) IONIC koMi oisti w01011 fflh wrr NWNAn11 Almislllfi fti ilia a o bi*41$ih• 00.0441i • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with Boll, gravel or another Inert solid material. MTINOENCY PLAN the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant ipbeement system: _b A suitable replacement area has been evaluated and may be utilized for the location of a replecemennt 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 wo result to the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must compiy with the rules In effect at that time. 13 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 felled POWTS. Ci 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 thwfalted POWTS. ` .. .r �3a [] Mound and at -grade soil absor be reconstructed M lace following r P p g emovdi of�whr blo nat at the . a t r �� r ion Ik alive surface. R econstruct Mrns must c ompl y with the rules M effect at the it �. ►�•• - PY tl.. .. mow. _.� ARNING > > . . IlirM, PUMP AND OTHER TREATMENT TAaKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. 00 NOT BITTER A SEPTIC, PUMP OR OTHER TREATMENT TANK _UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERM FROM THE INTERIOR OF A TANK MAY OR IMPOSSIBLE. ANAL COMMENTS irr 0WT8 INSTALLER POWTS MAINTAINER Name Name t s: 41111,, , b Uf yh Phone 1AL ' d' ,P�_ + ,1�.� i .� Phone •y��1a„ �;:, WAGE SERVICING OPERATOR (PUMPER) � , LOCAL REGULATORY AUTHORITY 1 04 10140 � ' , +_, .. ���+ Name �� : ►� Nam p R11R S rr►?hrrilak.3a#1�{ ,w^ S Phone Phone 'V. A.L 001 9 t 1tAlf.14t -..A 47 CA, t t VH Z ,'!l %AM__ ...mot.. t °.- •_�_� -- yr /'�.v ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 0%". ern.3uycr Mailing Address _ t� �_�, -� � Property Address � - 1� - I_ v� D �L� �1 --�! — �� City/Stat✓ V �o U A — Parcel Identification Number LEGAL DESCRIPTION Property Location V" Sec. �, TX� R Town of Tic qj P j n Subdivisio Lot Certified Survey Map 9 _3� Volume Page # & 0 Warranty Deed 4.1 1 0/ q (7,4 Volume Page # Spec house Spec YCG�fio Lot lines identifiable yes no SYSTEM E AND OWNER CERTIFICATION Irmroper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septi tank every three years or sooner, if needed, by a licensed purrilm. What you p into the system can affect the function of the septic tank as a treat s in the waste disposal system. Owner maintenance responsibilities are specified in §C.omm, 83.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance, The PmPe*.V owner agrees to submit to St. Croix County Planning & Zoning Depattfftnt a certification form signed by the OVH ter and by a manster plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in p ro p er operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less then 1/3 full of sludge. F l/ e, the twidersigned have read = 41,10r;0i 1 1� Aments and agree to maintain the private sewa dispoW m syste with th lr& stw& set forth, herein, as set by the ' I I `1" = * umteTce and the Department of Natural Resources, &ate of Wi scons i n . Certification stating that your septic system has three bMn ' twined must be completed and returned to the St. Croix Count/ Planning & Zoning'Departmiat within 30 days of x yasz�% p pin ' 4iadon date. , _ l/we certify that a ll s on this fort "ge. tnw to the best of my/our knowledge. 11we am/are the owner(s) of the Property described above, by v e of a wwanty dQ r ecorded in Register of Deeds Office. Number of bedrooms L / _d / _L 0 • A A OF APPLICAW(S) DATE Any information that is misrepresented MV 190 in.the sanitary permit being revoked by the Planning* Zafing Department. Include with this application a recorded war: aty 6ed fri;in the Register of Deeds Office and a copy of the certified survey imp if reference is made in the warranty deed (REV. 08105) ld9S AGr� 590 STATE BAR OF WISCONSIN FORM 1 - 1998 619925 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST. CROIX CO., WI This Deed, made between Edward J. Wagner RECEIVED FOR RECORD 03 -21 -2004 1:50 PM WARRANTY DEED Grantor, and Gretchen S. Bloss, a single person EXEMPT # — CERT COPY FEE: - —_ -- -_ _. COPY FEE: TRANSFER FEE: 312.00 - -- RECORDING FEE: 10.00 Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property "): -- Recordin Area Name and Return Address _ A parcel of land situated in the Southwest 1/4 of the Southeast 114 of Section 7, William J. Radusevich Attorney at Law Township 28 North, Range 19 West, further described as follows: 502 Second Street Lot 1 of Certified Survey Map recorded in the Office of the Register of Deeds Hudson, WI 54016 for St. Croix County, Wisconsin in Vol. "3" of CSM, Page 760, as Doc. No. 354857, except that certain parcel described as Lot l of Certified Survey Map recorded in Vol. "7" of CSM, Page 1870, as Doc. No. 429245. 040 - 1032 -90 -000 Parcel Identification Number (PIN) This is not homestead property. (ix) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this day of February 2000 • Edward J. er AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signatures) ss. �E It O S11A County.) 1 Personally came before me this ,. day of authenticated this day of February, 2 000 - — the above named W agner -- - - - - - -- -- - - - -- - TITLF,: MEMBER STATE BAR OF WISCONSIN to me own to be the persons) who executed the foregoing (If not, inst e d acknowled th e. C� authorized by § 706.06, W is. Stats.) THIS INSTRUMENT WAS DRAFTED BY William J. Radosevich, Attorney at Law ' L ll e /7 L _ L 4 t 5 '� • . 502 Second Street, Hud WI 54016 Notary Public, State of Wisconsin My Commission is permanent. (If not, statg expit oL`�da {e- (Signatures may be authenticated or acknowledged. Both are not , / a — c C� Cl) necessary.) *Names of persons signing in any capacity should be typed or printed below their signatures STATE BAR OF WISCONSIN - WARRANTY DEED FORM N.. 1- 1998 te � + • •' INFORMATION PROFESSIONALS COMPANY FOND -- L rr�, 7 ,y&c.yJtEDdXs3 - 2021 FORM NO. 985•A HC='ta 11 CERTIFIED SURVEY MAP { Center of Section 7 North line 1 l of SW 1 4 -SE 1 4 I 1 u9_pj ted lands C 1 13' S89 0 20 1 57 11 E 712.52' 2.5 B 662.50' C � I y 3 50' • Y l Cal O •a t c t m 14.19 acres m I i QUARRY ry r c ;� 3 SW -SE J = o WI c I =o o LA v C TRUE BEARING +,I (A 50' •cn m . I m CI a, °1 w ns I 71 'oo z � TABLE OF INTERIOR ANGLE �~ F r6 662.50' 'oI N89 °15'56" W N j A =91 °48'44" 284.74' *a B=88'16'1'1" 1� m I C =91 °43'43" H D =88 °11'16" (� z o• j° ° ° ° L A O �I z M 5.86 acres ili ` 50' Point of - Beg innin I 1 A..r" 662.50' D S1/4 Corner N89 °15'56 "W i. SE er corn Section 7 712.52' Section 7 T28N, R19W South line of SE1 /4 . °JNl�70Z dMr "AISK;H374dWOD 09 o2ud C IOn H6� '. •aawaeax ailnr �(q pal }e.Ap juawnaisui sit .L �A0 'OZ'z9» o nm 'W31SA3 DI1d3S LO 31-IS ONIa1fnP dOd 1YAONddd Md3W ION S300 ,OOft loot 10 NOISIM(lenS SONIW SIHl 401dAOVddb L3a=l Ni 3l110S spuej paIIe u DESCRIPTION A parcel of land located in the SW1 /4 of the SE1 /4 of Section 7, T28N, R19W, Town of Troy., St. Croix County, Wisconsin, described as follows: Beginning at the S1 /4 corner of said Section; thence N1 ° 04 1 40 "W (true bearing) 1318.51' along the North -South 1/4 section line; thence S89 0 20 1 57 11 E 712.52' along the North line of the SW1 /4 of said SE1 /4; thence Sl °04 "E 1319.55'; thence N89 0 15 1 56 11 W 712.52' along the South line of said SE1 /4 to the point of beginning. Except the West 50.00' of said parcel for County Trunk Highway right -of -way. Contains 20.05 acres excluding highway right -of -way. Subject to a permanent roadway easement 66' in width and a tempoT.ary easement as described in Volume 583, Page 366 of the St. Croix County Register of Deeds. Also subject to utility easements of record. I certify that the above description and map are correct and that I have fully complied with the provisions of Sec. 236.34 of the Wisconsin Statutes and Section 5.4.2 of the St. Croix County Zoning Ordinance. Date: November 2, 1978. G�a z Ay� �Z Walter J. I S Job No. 78 -1088 Ogden Engineering Co. , , N �`NINt1p N , 123 E. Elm Street �►�� oN River Falls, Wisconsin 54022 • WAITER I *�z GREGORY S -1224 i RIVER FALLS, Wis. � �• �I �� SU R� ; 4 I her! ti fy that this map has been approved by the Town Board. Date: OWNER LEGEND EDWARD KRAEMER $ SONS, INC. PLAIN WISCONSIN 53577 COUNTY SECTION CORNER MONUMENT, FOUND. RAILROAD SPIKE, FOUND. • 1" IRON PIPE, FOUND. - �E -— >F EXISTING FENCE O 1 "x24" IRON PIPE WEIGHING 1.68 # /LINEAL FOOT, SET. v L� I 2230 Wisconsin Department of Commerce SOIL EVALUATION REPO Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site an on County p PI paper not less than 8/z x 11 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal reference point (BM), ion and parcel I.D. percent slope, scale or dimemsiorrs, north arrow, and location o nearest road. 0- 1032 -90 -000 Please print all i viewed Date Personal information you provide may ry purposes (Privacy Law, 15.04 (1) (m)). _ / _ `h Property Owner G cl ® roperty Location Gretchen S. Bloss 1 J 4 vt. Lot SW 1/4 SE 1/4 S 7 T 28 N R 19 W 405 Co. d. Mailing Address S� v� &` N�NGOFF\ 1 Bloc k# Subd. Name CSM Vol. 7, Pg. 1870 City State Zip umber J City I Village A Town Nearest Road Hudson WI 54 6 612 919 - 2188 Troy I Co. Hwy. F New Construction Use: t/ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD i� Replacement I Public or commercial - Describe: ..2� l ��(� yely — PA 4 crn Parent material Glacial Q utwash F lood plain elevation, if applicable Na General comments wrf� and recommendations: Sit suitable for conventional POWTS dispersal cell with 0.5 gpd /sq.ft. / day loading rate. Proposed trench elevations to be 88.50 Boring # J Boring 1+I Pit Ground Surface elev. 92.61 ft. Depth to limiting factor >109" in. Soil Application 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 I *Eff#2 1 0 -10 1Oyr3/2 none sit 2fgr mvfr as 2vf,f 0.6 0.8 2 10 -26 1Oyr4/4 none sl 2fsbk mvfr cw 1vf 0.6 1.0 3 26-42 1Oyr4/6 none s Osg ml cw - 0.7 1.6 4 42 -109 1Oyr5/4 none fs Osg dl - - 0.5 1.0 Boring # I Boring e Pit Ground Surface elev. 94.75 ft. Depth to limiting factor >1 15" in. Soil Application 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 1Oyr2/1 none sit 2fgr mvfr cs 2fmc 0.6 0.8 2 14 -30 1Oyr3/6 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 3 30 -36 7.5yr4/6 none sl 2msbk mfr cs 3f,1 0.6 1.0 4 36-48 1Oyr4/4 m2fd 7.5yr5/8 sil 1msbk mfr as lvf 0.4 0.6 5 8 -115 10yr4/6 none fs Osg dl - - 0.5 1.0 V � ox. conc ide ified in horizon #4 discounted as per Chapter Comm. 85.30(3)3. * Effluent #1 = BOD 30 < 220 mg /L a TSS >30 < 1 0 mg/L Effluent #2 = BOD <30 mg /L and TSS < 30 mg/L CST Name (Please Print) Signatu CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 10/5/2010 715- 248 -7767 Property Owner Gretchen S. Bloss Parcel ID # 040 - 1032 -90 -000 Page 2 of 3 3] Boring # J Boring t Pit Ground Surface elev. 91.50 ft. Depth to limiting factor >92" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2 1 0 -15 10yr3/2 none sil 2fgr mvfr as 2fmc 0.6 0.8 2 15 -33 10yr4/4 none sl 2fsbk mvfr cw 2fm,1c 0.6 1.0 3 33-42 10yr4/6 none Is Osg ml cw 1fm 0.7 1.6 4 42 -92 10yr5/4 none fs Osg di - - 0.5 1.0 F-1 Boring # I 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 GP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD 5 > 30 < 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 -8330 (A.07 /00) A.C.E. Soil & Site Evaluations • � —Toil edalrtia�o� ♦ ep:s 9radc e/eu cal Grttr-ken 6(oss pr&p. yFoS (20. N /{ad3o+� -J /. SVcl(- 1 4oe, dsmt/e% 7, 17 1870 3cv� -�; �: 1, T. 281•, 19cd 7 o,C7-,-o y /0". 0 /OJ2- 90 Qb 6e /�J � oho eras 9 0 Ask 6V..36V Well trcc v e rloill do 3 bedrao.n O qd 1�2 es�dc � Q �/ N � /C" " -+0 do 0 � t3'kpfe O 9S0\ b t�ecX P O 0 9 � v • .Ary X/I r he r�1 aba., o t of as t o cr codQ. 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