HomeMy WebLinkAbout040-1034-90-050 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
' Safety land Building Division
INSPECTION REPORT Sanitary Permit No:
515049 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:
Burger, Daniel & Donna I Troy, Town of 040 - 1034 -90 -050
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
08.28.19.112C50
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER k y CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
19esitTg It. B _
A M
Aeration Bldg. Sewer
i7 ..
r �C].
Holding St/Ht Inlet
St/Ht Outlet �- t
TANK SETBACK INFORMATION 3.4(4
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
Dosing Header /Man.
Aeration Dist. Pipe
Holding Bot. System
Final Grade
PUMP /SIPHON INFORMATION ��� 7 • ' ��
Manufacturer Demand St Cover . .-
GPM
Model Number
TDH Lift Friction Loss System Head r DH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED /TRENCH Width �- Length ' J ". No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR t ✓�{ "�
Type Of System: r j f UNIT Model Number: JJ
DISTRIBUTION SYSTEM. %: `"• + ' '��I -�`~
Header /Manifold IDistribution x Hole Size x Hole Spacing Vent to Aij Intak
Length I Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only f `•, } ; t.c ,.._
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center y�, y N Bed/Trench rench Edges Topsoil Yes No Yes [� No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 483 Virgil Road Hudson, WI 54016 (NE 1/4 NE 1/4 8 T28N R19W) NA Lot 9 Parcel No: 08.28.19.112C50
1.) Alt BM Description
2.) Bldg sewer length = -,
- amount of cover =
Plan revision Required? ❑ Yes V No j d — l , �
Use other side for additional information. L___ L ; --
Date Insepctor's Signature Cert. No.
SBD -6710 (R.3/97)
k
N vi sconsin Safety and Buildings Division County N 201 W. Washington Ave., P.O. Box 7162 , 610 Madison, W I 53707 - 7162 Sanitary Permit Number (to be filled
in by Co.)
Department of Commerce (608) 266 -3151 515 DL` 9
. Sanitary Permit Application ��.� c Plan I.D
In accord with Comm 83.2 1, Wis. Adm. Code, personal information you p ov c
may be used for secondary purposes Privacy Law, s15.04(l)(m) Projec Address (if different than m address)
I. Application information - Please Print All I rmation RECEIV �C3 3 V ' ✓�// 1 �/�'��
Property Owner's Name CV Parcel $I / Lot N ( B k
&, a �e o ova D WD
Prop ner's Mailing Add ye�s/ #'j— Property Location /
VT
%, AG /., Section 99
City, State Z,ip Code / Phone Number /
J -f"' I II. Type of Building (check all that apply) QZ $tJb'% = � LorW
Subdivision Name CSM Number
❑ I or 2 Family Dwelling - Number of Bedrooms //
❑ Public/Commercial - Describe Use
O g tti
❑State Owned - Describe Use
Q, f ❑City_ ❑Villagc 7Township of
Ill. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. New S tem
ys C3 Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. Type of POWTS System: Che all that appl
XNon - Pressurized In -Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter Q
Constructed Wctland Pressurized In -Ground El Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit 11 Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter XLeachin mbcr Line ❑ Grav I -less Pipe (explain)
❑Other
V. Dispersal/Treatment Area Information. YA
t 4 4 Y l / /
Design Flow (g Design Soil Application Ra ispersal Area Required Dispersal Area Proposed (s System Icvatto 5
Vi. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New
I Existing j
Tanks Tanks
Septic or Holding Tank n
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS sho wn on the attached plans.
Plum s ]Name (Prin PluKb' ignature MP/MPRS Number Business Phone Number
- // ZZ�I�
Plumber' Address (Street, City, State, Zip Code)
0 03., �4 z
V"111. ountv /De artment Use Onl
pproved Sanitary Pcrrnit 'cc (includes Groundwater Date sued Issuin nt Signa c Stamps)
Surcharge Fce) 475 e
�� iven Reason or I
IX. Conditions of ApprovalfReasons for Disapproval
SYSTEM OMER: 3 ro $ y 5 >�WN_ e1C%k7 6V*n �o 15
1. Septic tank, effluent filter and / .n.•�'�e j
dispersal cell must all be services // thaintain
as per management plan provided by plumber. f
2. All setback requirements must be maintained
as per applicable code / ordinartces. b eiOtw
Attach complete plans (to the County only) for the system on paper not less than SU2 s 1 I inches in size
SBD -6398 (R. 01/03)
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Wisconsin Department of Commerce IL EVALUATION REPORT Pa e 1 of 3
Division of Safety and Building �Kccordance with Comm 85, Wis. Adm. Code g
County
Attach complete site plan off7ffPMTMM9 1111"n 8 '/4 x 11 inches in size. Plan must St. Croix
Include but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. O4 - 1034 90 -996�
Percent slope, scale or dimensions, north arrow, and BM referenced to nearest road.
Please print all information Re ' ed by Date
Personal information you provide may be a for vac Law, s. 15.04 (1) (m)) - �.fif�ytiw� L 3
Property Owner Property Location
Cyril Cernohous Govt. Lot NE %4 NE 'i4 s 8 T 28 N R 19 W
Property Owner's Mailing Address Lot # .� Block # Subd. Name or CSM#
486 Coulee Trail Z 3 5-I " ('F -: �. q
City State Zip C de ZONWPOFFICE ❑ Cit ❑ Village 0 Town Aarest Road
Hudson WI 54016 715- 386 -3476 Troy Virgil Rd & Coulee Tr.
0 New Construction Use: 0 Residential / Number of Bedroom Code derived design flow rate 450 GPD
❑ Replacement ❑ Public or Commercial — Describe:
Parent Material Loess over Outwash Flood Plain elevation if applicable N/A ft.
General comments and recgm endations: / n xda. "?," ? / 6
1
Boring Boring
g 0 Pit Ground Surface Elevation 99.7 ft. Depth to Limiting factor >120 in.
Soil ADDlication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fe
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -14 Frozen Frozen Frozen Frozen Frozen Frozen
2 14 -120+ 10YR4/4 - GRS 0 -sg ml - 0 -1f 0.7 1.6
Boring 0 Boring g OPit Ground Surface Elevation 94.5 ft. Depth to Limiting factor >120 in.
Soil ADDlication 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 1 *01#2
1 0 -17 Frozen Frozen Frozen Frozen Frozen Frozen
2 17 -27 10YR4/3 - SIL 1 -m -bk mfr gs 1 f - 0.4 0.6
3 27-40 10YR4/4 - LS 1 -co -bk mvfr as 1 f -m 0.7 1.6
4 40 -65 10YR4/4 - GRS 0 -sg ml cw if 0.7 1.6
5 65 -120+ 10YR4/4 -j S 0 -sg ml - - 0.7 1.6
1
* Effluent # 1= 110135> 30 < 220 mglL and TSS > 30 <_ 150 mg1L * Effluent #2 = BOD <_ 30 mg1L and TSS < :30 mg/L
CST Name (Please Print) Si CST Number
Mark Iverson 46672
Address Date Evaluation Conducted Telephone Number
P.O. Box 155 Hammond, WI 54015 January 8, 2009 715- 796 -5664
Properly Owner
Cvril Cernohous Parcel ID# 040 - 1034 -90 -000 page — 2 ,--of
❑ Boring >132 in.
Boring # Opit Ground Surface Elevation 96.25 ft. Depth to Limiting factor
- Soil Aimlication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *E GPD /f Eff#2
in. Munsell Qu. Sz. Cont. Color
Gr. Sz. Sh.
1 0 -19 Frozen Frozen Frozen Frozen Frozen Frozen
2 19 -38 10YR2/2 - SIL 2 -f -gr mfr gs 1f 0.6 0.8
3 38-4 10YR3/3 }ry1 ; SIL 2 -f-gr mfr cs 1f 0.6 0.8
4 45 -53 10YR4/3 - SIL 2 -f -gr mfr gs 1f 0.6 0.8
5 53 -70 10YR4/4 - - SICL 2 -f -gr mfi gs 1f 0.4 0.6
6 70 -80 10YR4/4 7.5YR4/6 c -2-d ICL 2 -f -gr mfi as if 0.4 0.6
7 80 -132+ 10YR4 /4 it S 0 -sg fml - - 0.7 1.6
3
❑ Boring Qf Sy $ 7
` 12
Boring # OPit Ground Surface Elevation ft. Depth to Limiting actor - in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *EGPD/ft2Eff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
❑ Boring
Boring # ®pit Ground Surface Elevation ft. Depth to Limiting factor - in.
Soil A lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *E GPD/82Eff#2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh.
I
* Effluent #1 = BOD5> 30:5 220 mg/L and TSS > 30:5150 mg/L * Effluent #2 = BOD <_ 30 mg/L and TSS 5 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
Need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 264-8777.
Page 3 of 3 0 ft. 24 ft. 40 ft. 80 ft.
N
Site Location
U /e� Ar ai/ X
Sec ion 8
r
13-2 Proposed Lot Corner
94.5'
6
r0A O
r0 .0, S�
NE corner of B- g+ c
proposed 99.6' —
house
2
a
BM#1 - Top of nail in power pole
96.2'
Ah
i
Proposed Lot Line Proposed Lot Corner
BM# & description = Bench Mark B ' 1
Elevation = Boring Location & Elevation
100'
Owner: Cyril Cernhous Site Information: Completed By: Mark Iverson, PSS #197
486 Coulee Trail NW1 /4, NE1 /4, S8, T28N, R19 680 Larcom Street
Hudson, WI 54016 Town of Troy Hammond, WI 54015
St. Croix County 715 - 796 -5664
Phone: 715 - 386 -3422 CST# 46672
I b
889116
BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., H)I
RECEIVED FOR RECORD
02/19/2009 01:00PM
CERTIFIED SURVEY MAP
VOL: 24 PAGE: 5606
CERTIFIED SURVEY MAP REC FEE: 13.00
PAGES: 2
LOCATED IN THE NE1 /4 OF THE NE1 /4 AND THE NW Y4 OF THE n
NF OF SECTION 8, T28N, R19W. TOWN OF TROY, ST. CROIX `12
COUNTY, WISCONSIN, INCLUDING LOT 9 OF THAT CERTIFIED LEGM
SURVEY MAP FILED IN VOLUME 23, PAGE 5557. _INDICATES SECTION CORNER
(AS NOTED )
OWNER BEARINGS REFERENCED TO THE NORTH - INDICATES 3/4' IRON RE -BAR FOUND
O ASSUMED • INDICATES i' X 24' IRON PIPE
4 Cyril Ce1 Tra ts LINE M THE ED TO N89°05SECTION , ST. WE NG 168 LBS 7 UN. FT SET
t)6 Coulee Trit M 09'E, ® _ INDICATES 1' DIAMETER IRON PIPE
Hudson, WI 54016 CROIX COUNTY COORDINATE SYSTEM. FOUND AT POSITION.
- 0 - INDICATES 1 1A4' IRON RIPE FOUND
I NE CORNER, SECTION 8
NIA CORNER, SECTION 8 ( BERNTSEN ALUMINUM
(BERNTSEN ALUMINUM I CAP FOUND)
CAP FOUND) N89 °OS'09'E 2653.3(Y
Y 7326.65' — — — 1326.65
$ NORTH LINE OF THE PEY OF SECTION A. - /
UNP1I LANDS N89"0233'E 255.14' T26N, R1 9W, TOWN OF TROY
OWNED 13Y OTH EkS sty aide set" NOM THIS PARCEL OF LAND IS BEING. ADDED TO LOT
— 9 OF THAT CERTIFIED SURVEY AMP RECORDED IN
VOLUME 23, PAGE 5557. THIS A ION I
RECORDED IN DOCUMENT NO
CURMOOIOlad170N . I
I 1 1 UNPLeAT LANDS I
CENTRAL ANGLE= 35'05'00' 100' 1n1IIl � I I ° 6WM D MY PIL ATTOR I
CHORD =4827 !3 j
N16'26'43E aelbeck Lyl AHI �'
®� l ARC LENGTH = 48.96' �9 �� 1
TANGENT IN = N01.0S47'W � I I N88 °53'02E $60.82
C-1 OUT= N33' NINE
Rai
N88
!1 I a PROPOSEDAY L 50 aide seC 787 LO T
9 150 560" I a
1 1
388 °51'57'W B25 5T ( 6.01 ACRES
PREVIOUSLY DAS L _ 50's{deaeAmlic, _ J III
I LOT 6 (R N89'4T 625.56) mkt 330.78' I 1
ICIERT11F_ @E® S 9LEY PAAP I " � � S88 "53'02'W 580.74'
�I I C r- i y Lk)#kE v®, PAGE 2853 I GIB PIFI�® SoDrNaV>E1f I UfN1PLJ. TTED LANDS
I CcTtR9Nl® C�@Y PL�TT�P
�) EXISTING LOCATED �„
D VO -UafE 9 I
DRIVEWAY LOCATION
IU
UN � (:mi l ANDS I UWPIL/�1T D LANDS
OWNED 03V OT S I I
NOYE.' NO NEW LOTS HAVE BEEN CREATED. THE
�S O S/y
ADDITION LANDS To EXISTING LOT 9 OF CERTIFIED I I I
= SURVEY MAP FILED IN VOLUME 23, PAGE 5557 IN THE
ST. CROIX COUNTY REGISTER OF DEEDS. STATE,
= G C. OUNTYANDTOWNSHIPAPPROVALSARENOT I OWNED ,BYOTHERS I I
S- 5 REQUIRED PER STATE STATUTE AS STATED UNDER
NEW RICHMOND 238.45(2) (3)- THIS MAP IS INTENDED TO REPLACE
W I THAT CERTIFIED SURVEY MAP AS FILED IN VOLUME 23,
uR OQ. DOCUMENT HNO � D S CORDED IN ( I I
- - -- COULEE- TRAIL- -1-
Stev
r SCALE IN FEET 1" =200'
ENGINEERS • PLANNERS - SURVEYORS
Mr 1680 LIVINGSTONEE ROAD • HUDSON, WI 54076
FE L 0 1 1 00' 200' Oar (715) 386 - -5819 • (651) 436 -2075 • FAX; (715) 386 -5879
WWW. STEVENSENGINEERS. COL1 JOB NO. 40048-D61 SHEET OF
Vol. 24 Page 5606
CERTIFIED SURVEY MAP
LOCATED IN THE NE1 /4 OF THE NE1 /4 AND THE NW Y4 OF THE
OWNER NEY4 OF SECTION 8, T28N, R1 9W, TOWN OF TROY, ST. CROIX
CYA Cemohous COUNTY, WISCONSIN, INCLUDING LOT 9 OF THAT CERTIFIED
486 Coulee Trail SURVEY MAP FILED IN VOLUME 23, PAGE 5557.
Hudson, WI U016
OESCR/PT/OM-
A PARCEL OF LAND LOCATED IN THE NE11/4 OF THE NE1 14 AND THE NW A OF THE NEY OF
SECTION 8, T28N, R18W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN, INCLUDING LOT 9
OF THAT CERTIFIED SURVEY MAP FILED IN VOLUME 23, PAGE 5557. FURTHER DESCRIBED AS
FOLLOWS:
COMMENCING AT THE N114 CORNER OF SAID SECTION 8; THENCE NOW0309'E 1326.65 ALONG
THE NORTH LINE OF THE NEY4 OF SAID SECTION 8 TO THE EAST LINE OF THE NW Y. OF THE NEy
OF SAID SAID SECTION 8; THENCE S00'58'36'E 105.81' ALONG SAID EAST LINE TO THE POINT
OF BEGINNING; THENCE S00 290.86'; THENCE NSS *SX02"E 560AZ: THENCE
S00'5339"W 233.26': THENCE S88 560.74' TO THE EAST LINE OF LOT 5 OF THAT
CERTIFIED SURVEY MAP FILED IN VOLUME 10, PAGE 2853 IN THE ST. CROIX COUNTY REGISTER
OF DEEDS: THENCE N00'56'36"W 105.73 ALONG THE EAST LINE OF SAID CERTIFIED SURVEY
MAP FILED IN VOLUME J0_ PAGE 2853; THENCE SSS'S1'57'W 625.57' ALONG THE SOUTH LINE
OF LOT 9 OF THAT CERTIFIED SURVEY MAP FILED IN VOLUME 23, PAGE 5557 TO THE EASTERLY
RIGHT OF WAY LINE OF VIRGIL ROAD; THENCE N01'0547W 20.03' ALONG SAID EASTERLY
RIGHT OF WAY LINE: THENCE NORTHEASTERLY 48.98' ALONG THE ARC OF AN 80.00' RADIUS
CURVE CONCAVE TO THE SOUTHEAST WHOSE CHORD BEARS N16'26.43'E 48.27; THENCE
N68'51'57'E 356.15 ALONG THE NORTHERLY LINE OF SAID LOT 9; THENCE N00'5727 35295'
ALONG THE WESTERLY LINE OF SAID LOT 9; THENCE N89'02'33'E 255.14' ALONG THE
NORTHERLY LINE OF SAID LOT 9 TO THE POINT OF BEGINNING, CONTAINING 261,823 SQUARE
FEET ( 6.01 ACRES) MORE OR LESS AND BEING SUBJECT TO ANY EASEMENTS,
RESTRICTIONS OR COVENANTS OF RECORD.
SURVEYOR'S CERWF1G47E
1, JOSEPH W. GRANSERG. REGISTERED WISCONSIN LAND SURVEYOR, HEREBY CERTIFY THAT
BY THE DIRECTION OF THE OWNER. CYRIL CERNOHOUS, 1 HAVE SURVEYED AND MAPPED THE
LANDS SHOWN AND DESCRIBED HEREON IN ACCORDANCE WITH OFFICIAL RECORDS,
CHAPTER 236.34 OF THE WISCONSIN STATUTES, THE TOWN OF TROY SUBDIVISION
ORDINANCE AND THE ST. CROIX COUNTY SUBDIVISION ORDINANCE AND THAT THIS MAP AND
DESCRIPTION ARE A TRUE AND CORRECT REPRESENTATION TO SCALE THEREOF.
THIS INSTRUMENT DRAFTED BY: JOSEPH W. GRANSERG S -2295
DATED THIS 11TH DAY OF DECEMBER, 2008.
6ENERAL A0077CESrA7EWENT
THE PARCEL SHOWN HEREON IS SUBJECT TO STATE, COUNTY AND TOWNSHIP LAWS, RULES
AND REGULATIONS ( i.e., WETLAND RESTRICTIONS, MINIMUM LOT SIZE. ACCESS TO PARCEL.
ETC.) . BEFORE PURCHASING OR DEVELOPING ANY PARCEL CONTACT THE ST. CROIX
COUNTY ZONING OFFICE AND THE APPROPRIATE TOWN BOARD FOR ADVICE.
* J ••�$ ):R S * EXEMPTION VERIFIED UNDER SECTION 13A 83.A3) OF THE
I i ST. CROIX COUNTY LAND DIVISION ORDINANCE AND
t NEW A HMOND s SECTION 236.45(2 ) a) (4) OF THE WISCONSIN STATUTES
WI J
{ Q
~ ...... �� � t�� 8Y rep( �a. ur n DATE
QIM NO NEW LOTS HAVE BEEN CREATED. THE
PURPOSE OF THIS MAP IS INTENDED TO SHOW THE
ADDITION OF LANDS TO EXISTING LOT 9 OF CERTIFIED
SURVEY MAP FILED IN VOLUME 23, PAGE 5W7 IN THE
ST. CROIX COUNTY REGISTER OF DEEDS. STATE,
COUNTY AND TOWNSHIP APPROVALS ARE NOT
REQUIRED PER STATE STATUTE AS STATED UNDER
236A5(2)(3). THIS MAP IS INTENDED TO REPLACE
T14AT CERTIFIED SURVEY M4P AS FILED IN VDLIMiE 23,
PAGE 5557. THE ADD171 LANp6 IS RECORDED IN
DOCUMENT
.0
Stev
ENGINEERS - PLANNERS " SURVEYORS
16BO LININGSTONF ROAD - HUDSON. WI 54016
(715) 386 -5819 - (651) 436- -2075 - FAX: (715) 386 -5679
WWW.STFVENSENCINEERS.COM SHEET 2 OF 2
2 of 2
Vol. 24 Page 5606
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer D111V d p o/UNA- &v
Mailing Address 'I 3
Property Address
(Verification required from Planning DepartmeWt for new construction)
City/State Alv) s orL Lc Parcel Identification Number i lO — ( ; n
LEGAL DESCRIPTION
A& + Al w Yy
Property Location OF the / v2 %y of Sec. Z . TAN -RAW, Town of aO
Subdivision Lot #
Certified Survey Map # R9q 1, . Volume Page # 5604!5
a
Warranty Deed # )QG q r J !� Volume . Page #
Spec house ❑ yes A no Lot lines identifiableeK yes ❑ no
SYSTEM MAINTENANCE
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.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
master plumber, journeyman plumber, restrictedplumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal 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.
Uwe, 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 Zoning Office within 30
days of the three year expiration date.
SIGNATURE OF AllftICANT DATE
OWNER CERTIFICATION g 8 t j r o e `-- k a u 5 c
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this application: a stamped warranty deed from the Register of Deeds office
a copy of the certified survey map if reference is made in the warranty deed
System Management
.Management of this system is critical. As a condition of approval of these plans this system management section must be
e eyed �� ith the owner, and the owner must be provided with a complete set of plans including this management section. if problems
,e� elop with the adsorption system or any other system components, the installing plumber, Timm Excavating, 715- 772 -3214, or the St.
roix County Zoning Office, 715- 386 -4680, should be contacted for assistance.
General
Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows
into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the
outer and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and
, greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or
ompartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water
n a manner to protect ground water quality and public health.
If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure adherence
to contaminant load design criteria.
install water- saving appliances whenever and wherever possible.
Repair even small water leaks as soon as possible.
fever pour grease or oil down any drain or stool.
Garbage disposals are not recommended; if you must have one, use it sparingly.
c '�o paper products other than tissue should go into the system.
�o chemicals should go into the system.
8 a %o d surge flows of water; try to spread laundry throughout the week.
Maintenance
The septic tank must be inspected every three years by a properly licensed person.
necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume
equals one third of the tank volume.
�� hen the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into
,he septic tank to remove accumulated material.
Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell.
Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption
cell
If this s contains specific treatment components other than those mentioned here, maintenance requirements will accompany
their specifications.
The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump
if the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows resen e
:apacit, to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or
u days should pass before any necessary repairs can be made.
A�uij compaction such as vehicle traffic within 15' down -slope ofthe adsorption system.
s A � o d disturbing the system itself such that might encourage erosion or disturb the required seeding of the system.
Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth.
Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area
Contingency Plan
Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitortn2
-nay become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83 54
Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing,
and or installation of additional treatment components or conversion to a holding tank may be necessary.
Page 8 of 8
(11!111 (illl IIIII 1!111 IIIlI (fill I(fi !11!11 I(II IIII
* 8 8 9 1 1 5 1
State Bar of Wisconsin Form 6 -2003 889 11 5
SPECIAL WARRANTY DEED BETH PABST
REGISTER OF DEEDS
Document Number Document Name ST. CROIX CO., WI
RECEIVED FOR RECORD
02/1912009 01:OOPM
THIS DEED, made between CYRIL C. & PATRICIA M. CERNOHOUS SPECIAL WARRANTY DEED
LIVING TRUST EXEMPT e
( "Grantor," whether one or more), and REC FEE: 11.00
DANIEL A. & DONNA M. BURGER TRANS FEE: 144.00
( "Grantee," whether one or more). PAGES: 1
Grantor for a valuable consideration, conveys to Grantee the following described real
estate, together with the rents, profits, fixtures and other appurtenant interests, in
SAINT CROIX County, State of Wisconsin ( "Property ") (if more space is
Recording Area
needed, please attach addendum):
Name and Return Address
A PARCEL OF LAND LOCATED IN THE NE' /4 OF THE NE 1 /4 OF SECTION 8, T28N, CYRIL CERNOHOUS
R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN, FURTHER DESCRIBED AS 486 COULEE TRAIL
FOLLOWS: HUDSON, WI 54016
COMMENCING AT THE N'' /4 CORNER OF SAID SECTION 8; THENCE N89 05'09 E 1326.65' TO
THE EAST LINE OF THE NW '' /4 OF THE NE %4 ; THENCE S00 56'36" E 396.46' TO THE POINT
OF BEGINNING; THENCE N88 53'02" E 560.82'; THENCE S00 55'39" W 23316'; THENCE S88
53'o2 W 560.74' TO SAID EAST LINE OF THE NW' /4 OF THE NE 1/4; THENCE N00 56'36" W
233.26' ALONG SAID EAST LINE TO THE POINT OF BEGINNING, CONTAINING 130,806
SQUARE FEET (3.00 ACRES) MORE OR LESS AND BEING SUBJECT TO ANY EASEMENTS, �� IO'S — ~' 1,!� 0
RESTRICTIONS OR COVENANTS OF RECORD. Parcel Identification Number (PIN)
THIS PARCEL OF LAND IS BEING ADDED TO LOT 9 OF THAT CERTIFIED This IS NOT homestead property.
SURVEY MAP FILED IN VOLUME 23, PAGE 5557 IN THE ST. CROIX
COUNTY RIGISTER OF DEEDS. NO NEW LOTS ARE BEING CREATED. (is) (is not)
Grantor warrants that the title to the Property is good, indefeasible, in fee simple and flee and clear of encumbrances arising by, through, or
under Grantor, except:
Dat FEB UARY 16 09
(SEAL \ (SEAL)
* CYRIL C. CERNOHOUS * DANIEL A. BURGER
• (SEAL•) �`� .
* PATRICIA M. CERNOHOUS * DONNA M. BURG O
AUTHENTICATION ACKNOWLEDGMENT :0 op Z
Si STATE OF WISCONSIN G ILI
authenticated on \,� . D t ,A COUNTY
* Personally came before me on YK- + 00�
TITLE: MEMBER STATE BAR OF WISCONSIN the we -named M i a i
t k O h
(1f not, to me known to be the person(s) who exec ted the foregoing
authorized by Wis. Stat. § 706.06) instrument and cknowledged the same.
THIS INSTRUMENT DRAFTED BY:
CYRIL C. CERNOHOUS & Au� =2
'
715- 386 -3422 Notary Pub , tate of Wisconsin
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.
SPECIAL WARRANTY DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 6-2003
1 of 1
Parcel #: 040 - 1034 -90 -050 04/15/2009 08:25 AM
PAGE 1 OF 1
Alt. Parcel M 08.28.19.112C -50 040 - TOWN OF TROY
Current OX ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
02/19/2009 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - BURGER, DANIEL A & DONNA M
DANIEL A & DONNA M BURGER
7402 IMPERIAL AVE S
COTTAGE GROVE MN 55016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 483 VIRGIL RD
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 6.010 Plat: 5606 -CSM 24 -5606 040 -09
SEC 8 T28N R19W PT NW NE & PT NE NE FKA Block/Condo Bldg: LOT 09
CSM 23 -5557 LOT 9 (3.01 AC) BEING CSM
24 -5606 LOT 9 (6.01 AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
08- 28N -19W NW NE
Notes: Parcel History:
Date Doc # Vol /Page Type
02/19/2009 889116 24/5606 CSM
02/19/2009 889115 WD
02/17/2009 888804 QC
09/12/2008 881323 QC
more
2010 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 03/31/2009
Description Class Acres Land Improve Total State Reason
Totals for 2010:
General Property 0.000 0 0 0
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
J ,
? Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 '/2 x 11 inches in size. r mu'I St. CT01X
Include but not limited to: vertical and horizontal reference point (BM), ctio I Parcel I.D. 0 - 1034 - - 890 — '
Percent slope, scale or dimensions, north arrow, and BM ced to nearest road.
P ��i�tion Red wed by DatteA v
Personal information you provide m y be u dary purposes ( ivacy Law, s. 15.04 (1) (m)) Y 3 0
Property Owner Property Location
Julia Cernohous Z ZOO$ Govt. Lot NW 'i. NE 'i< s 8 T 20 N R 19 W
Property Owner's Mailing Address TY t Block # Su Name or CSM#
487 Vervil Rd Vrr / ST•CROIXCQI __j
City State Z Code one City ❑ Villag Town Nearest Road
Hudson WI 54016 715- 386 -3476 Troy Virgil Rd & Co Hwy FF
e onstruction Use: ® Residential / Number of Bedrooms 3 Code derived design flow rate 450 GPD
Replacemen El Public or Commercial — Describe:
Pa t M tal Loess over Outwash Flood Plain elevation if applicable N/A ft.
General comments and recommendations: ci,`lSh� t Cti U
Boring
1 Boring # ® pit Ground Surface Elevation 100.0 ft. Depth to Limiting factor >110 in.
Soil ADDlication 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 -10 10YR3/2 - SIL 2 -f-gr mfr Gs 2f 0.6 0.8
2 10 -15 1OYR3/1 - SIL 1 -m -pl Mfr Gs 1f 0.4 0.6
3 15 -27 10YR4/3 - SIL 1 -co -bk Mfr Gs 1f 0.4 0.6
4 27 -38 10YR4/4 - SL 1 -co -bk Mfr Gs 1 f 0.4 0.7
5 38-43 10YR4/4 - S 0 -sg MI As - 0.7 1.6
6 43-63 7.5YR4/4 - GRCOS 0 -sg MI As - 0.7 1.6
7 63 -110+ 1OYR5/4 - S 0 -sg ml - - 0.7 1.6
a # Boring
Boring OPit Ground Surface Elevation 99.6 ft. Depth to Limiting factor >I 10 in.
Soil ADDlication 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 -10 10YR3/2 - L 2 -f -bk mfr cs 2f 0.6 0.8
2 10 -23 10YR3/4 - SIL -m to co -bk mfr as 1m 0.6 0.8
3 23 -34 10YR4/4 - S 0 -sg ml as 2f 0.7 1.6
4 34 -51 7.5YR4/4 - GRCOS 0 -sg ml as - 0.7 1.6
5 51 -110+ 1OYR5/4 - S 0 -sg ml - - 0.7 1.6
*
Effluent #I = BOD 30:5 220 mg/L and TSS > 30:5 150 mg/L * Effluent #2 = BOD 5 30 mg/L and TSS 5 30 mg/L
CST Name (Please Print) a CST Number
Mark Iverson aL 46672
Address Date Evaluation Conducted Telephone Number
P.O. Box 155 Hammond, WI 54015 Mav 27.2008 715- 796 -5664
Property Owner J ulia Cernohous Parcel ID# 040 - 1034 -90 -000 page 2 of 3
Boring # O Boring
OPit Ground Surface Elevation 99.3 ft. Depth to Limiting factor >110 in.
S oil Apolication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -13 10YR3/2 - L 2 -f -bk mfr cs 1f 0.6 0.8
2 13 -21 10YR4/3 - L 2 -m -bk mfr gs 1 f -m 0.6 0.8
3 21 -31 10YR4/4 - L 1 -co -bk mfr gs 1 f -m 0.4 0.6
4 31 -37 10YR4/4 - GRS 0 -5g ml Cs 1f -m 0.7 1.6
5 37-49 7.5YR4/4 - GRCOS 0 -sg ml cs - 0.7 1.6
6 49 -110+ 10YR5/4 - S 0 -sg ml - - 0.7 1.6
a Boring # 0 Boring
EIPit Ground Surface Elevation ft. Depth to Limiting factor in.
Soil ADDlication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fe
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2
M Boring # Boring
®Pit Ground Surface Elevation ft. Depth to Limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/S
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
* Effluent # 1 = BOD > 30:5 220 mg/L and TSS > 30:S 150 mg/L * Effluent 42 = B0135:5 30 mg/L and TSS <_ 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
Need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777.
Page 3 of 3 0 ft. 24 ft. 40 ft. 80 ft.
Site Location
FF X
Sec ion 8
B_2 B - Top of 3/4 "PVC Pipe
V 99.6
12j st
B -3
99.3
B -1 BW - Top of 3/4 "PVC Pipe
100.0
O
00 .
O
O
� c
/ J
O
� J
N
O
CL
0
a
Proposed Lot Line Proposed Lot Corner
BM# & Description = Bench Mark B -1
Elevation 100 =Boring Location &Elevation
Owner: Julia Com leted B : Mark Iverson PSS #197
Own e Ju a Cemhous Si te p y ,
487 Vergil Rd. NW1 /4, NE1 /4, S8, T20N, R19 680 Larcom Street
Hudson, WI 54016 Town of Troy Hammond, WI 54015
St. Croix County 715 - 796 -5664
Phone: 715 - 781 -1850 CST# 46672
r, y
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RECEIVED
NOW UNEOFT1�WXOFSECTi0N6,72MM, MAY 2 2 2008
R10W, TOWN OF TROY ____\
ST. CROIX COUNTY
UNPLATTED LANDS
OWNED BY PLATTER
37 .6 ' 150.03'
151YSETHACK
26 side ya(d and rear
-
r RUW '�i ( yard setback tines ( ( 25' side yard and rear
yard setback Rites �
s this portion or the cut -de -sac to be
d vacated upon future exienslon of
VIF99 Road Y
FUTURE LOT 10 i � � PROPOSED LOT
111,394 SWAM FEET
130.M SGLM FEET ( w
( ( ACRES) (3.0DACRES)
�
1 gM W
C! =' P.
A 620 -66'
� v
Iv N
D <
� C
m m
LOT 6
ED
T VOL PAGE 853 CERTIFIED O SURVEY MAP
1 I VOLUME 10, PAGE 2853 ,
Co
MAY 20,2008 18:47 page 1
RECEIVED
I IlIIII IIII''[ VIII IIII{lllll INI {{1111 Illy Illl
880905
KATHLEEN H. WALSH
SEP 1 7 REGISTER OF DEE
RECEIVED FOR RECORD
W.; wrAcouNm 09/04/2008 08:OOAM
CMS RECpF CERTIFIED SURVEY MAP
VOL: 23 PAGE: 5557
REC FEE: 13.00
COPY FEE: 3.00
CERTIFIED SURVEY MAP PAGES: 2
LOCATED IN THE NWY4 OF THE NEY4 OF SECTION 8, T28N, R19W,
TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN.
OWNER I SUBDIVIDER LEOEND
Julie C - INDICATES SECTION CORNER
487 Virgil Ro®d (AS NOTED)
Hudson, WI 54016 Q - INDICATES 1' X 18' IRON RE -BAR
WEIGHING 1.502 LES. I LN. FT. SET.
SEARINGS REFERENCED TO THE NORTH ®- INDICATES 1' MMIETER IRON PPE
LINE OF THE NEY OF SECTION 8, FOUND AT POSTION,
ASSUMED TO BEAR N89 "05'09'E, ST.
CROIX COUNTY COORDINATE SYSTEM, NE CORNER, SECTION 8
(BERNTSENALUMINUM
N114 CORNER, SECTION 8 CAP FOUND)
( BERNTSEN ALUMINUM
CAP FOUND) N89 "05'09"E 2653.3(r
1� 132M6.
NORTH LINE OF THE NE Y. of sECT — ^ 1326.65' — — ���,
T28N. R19W1, TOWN OF TROY
b?
N69'02'33"E,
' • � 50' Q ^ r f
* JJP•J P —.AL. m
&R 8E
NEW RICHMOND I settma line I "
WI , $ Z
~� SU11M V ULNPLA_'IIT LAND 4 OT 9 I�
131.117 SQUARE FEET
_
OWN By PLATTER t 3.01 ACRES) I (�
is
S 13
I I y
LOT 7 I ! , 100' front semedc I m I�
i� ► �� I
I N88'S 356.15
I I C-1 PROPOSED DRIVEWAY 280.15'. _.. —
I � 50' �setbedc
(� I
5 8
<
PREVIOUSLY RECORDED AS
(R N89'4T56"W 825.56')
I I I LOT S
I I I I I SOT OERTOFOE® SLFRVE MAP
CERTOFOIED SURVEY MAP � Q4®� 90. PAGE X63
I I S" r 1LOLUM1E '00, PAGE — — — — —
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ENGINEERS & PLANNERS
SCALE IN FEET 1 " =120 1690 UVIN0 ROAD NUDSOK M $Me
(715) 3666819 (651) 436.2075 FAX:4715) 39x9876
0 80 120' 240 TH INSTRUM RB DRAF G 8 -2295 WN'N.R8.COY
JOSEPH W. GRANBERG S•2295 87EVENSENGIIEE SHEET 1 OF 2
1 oft V01 62 —•Page 5557
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