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040-1283-70-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 567257 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. 1 Permit Holder's Name: City Village X Township Parcel Tax No: Willaby, Lonnie& Karla Troy, Town of 040-1283-70-000 y _ CST BM Elev: Insp.BM Elev: BM Description: /� Section/Town/Range/Map No: �I$,3 1 106�O 0� S� A 09.28.19.1601 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 2.7 /6/.6 f 918. 5/ Dosing ()<-: 64-1` Alt. BM Aeration Bldg.Sewer J Holding ( St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION I TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing s(‘‘L 4 Header/Man. NV Aeration Dist. Pipe $' icy 92 -Vf Holding Bot.System g,�' 4/ 9. d, Final Grade PUMP/SIPHON INFORMATION 3.(Q c-7. '1/ Manufacturer Demand St Cover \ GPM Model Number Vat9t. Dale— IUCJ n.`f 92. co/ TDH 'Lift Friction Loss System He TDH Ft Forcemain Length Dist.to Well , ' - Alga.)I / , .. - 9P. 3 (e, SOIL ABSORPTION,SYSTEM BED/TRENCH Width Length / No.Of Trenches PIT DI ENSIGNS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 /0 °/(CM.riAAA __ INFORMATION SETBACK SYSTEM TO P/L / BLDG / WELL / LAKE/STREAM CHAMBER OR Manufacturer_v ^rc r�r Type Of System 54 5 UNIT Model Number � t-► DISTRIBUTION SYSTEM wey4..- WILL(45 zL+-zz r�.fl va i Header/Manifold /I Distribution x Hole Size x Hole Spacing Vent to Air Intake II '' Pipe(s) \ 1` Length (i Dia 't Length Dia N. Spacing \ �� SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over / Depth Over xx Depth Qf xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil \ Yes E3 No Yes 0 No COMMENTS: (Include code discrepencies, persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 512 Little Orchard Road Hudson,WI 54016(SW 1/4 NW 1/4 9 T28N R19W) Orchard,The Lot 7 Parcel No: 09.28.19.1601 1.)Alt BM Description= V K!1/L 1��6�i C ,1y — A /{ fG V1 j 2.)Bldg sewer length= tei t�∎^, Nor d ( e� 1 1 Or, 2 DO% amount of cover= M Q v` 1-1p t q d� Or, k# .. ■ = _� G.Plan revision Re uired? Yes to /�Use other side for additional information. _ i / A_ `� SBD-6710(R.3/97) Date Insepcto, Signature Cert.No. PLOT PLAN PROJECT Lonnie Wallaby ADDRESS 512 Little Orchard Rd Hudson Wi 54016 SW 1/4 NW 1/4S 9 IT 28 N/R 19 W TOWN Troy COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 10/30/13 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK 1260 9 allons LIFT TANK SIZE DOSE TANK SIZE MOUND SEPTIC TANK SIZE .7 AREA 890 44 kHOLDING TANK SIZE LOAD RATE ABSORPTION ARE # of chambers BENCHMARK V.R.P. Top of Rebar ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 90.6/90.7 6' below grade 250' B.M.* All piping shall be SDR 30/34,within 10' 20' of tank,piping shall be Schedule 40. 5 B-4 40' B-2 `� Scale is 1" = 40' • unless otherwise New 2-3' X 904 4 61i i qg.3 Cells with>3' 70' spacing 25' s dJ 610 ' 50' DiverterValve 10' Existing ST I 26' o' i Existing 4 G-1,., .g } Bedroom Existing Bio House Diffuser Chambers, _ eastern cell filled 40' with sand B-5 Vents B-1 ow Vent >6" LQick4 u Standard of Cover eaching Chamber with 20.0 ft2 of Area NI .6ft^2/pair of end caps 4' Long 291' Property Line 34„ Grade at System Elevation Little Orchard Road County C ~if c7 jx _ A-~' IndustryServices Division v, 5 t U '1400 E Washington Ave Sanitary Pcnnit Number (to be filled it by Cu.) P.O. Box 7162~• mill ~j Madison, WI 53707-7162 Z51 -eft n. ry Permit Application In accordance with SP 21 is. Adm. Code, submission of this form to the approp9{yte govrtfne~jqunit is required prior to ebtai ing a sanitary permit Note: Application forms for state-owr}ed P01 ue subWtdc7to Project Address rfdiflerent than maili ig address) the Department of Safety and Professional Servies. Personal information you provide may be os4wt r secan4try purposes in accordance with the Privacy Law, s. 15.04(I)(rri), Stats. O~ 1. Application Information- Please Print AN Information Property Own is Name Parcel # llerz 4 t 0 -0 ~~=77- Loo, Property Owner's Mailing Address Property f.ocabon 2- G / U/ - Govt Lot City, State Zip Code Phone Number , Seeli ( rte ones I ~ 1~.---- -f ZIl _ fv, 1< _l ~ H `tom/J Ill. Type of Building (chectc all that apply} Lott! 4r2FairtilyDwellittg-Nurnber6fBedrooiTts l Subdivision am BlockH - - 7171.71..- ❑ 1'ublic/C01Tmercial Describe Use-----------„- - - - - - ❑ City ol, - ❑ State Owned-- Describe Use CSM NUITIbel' _ Village of t Town Ill.' ype 'Permit: (Chet ue Complete line B it'applicable) S - - A. Ystem to lar: Pement System t Replacement Only Other Modification to Existing ystr n (explain) w Treatment/Elofdin ;'frmk 5 B. ❑ Permit Renewal ❑ Permit Revision ❑ Change or Plumber ❑ 11erno€ l r rnsfer to New List Previous Permit Number and Dale slued - Before Expiration Owner 3 S 3 - - ll.'T pe of POWTS SyI q ice; >'onent/Device: Check all that a y) rl - ---------_-1'i kressurizzd In-Ground ❑ PreSSUrized In-Ground ❑ At-Grade ❑ Mound ' 24 in. o 'syit,11 sqiit Mound < 24 n, f Holding Tank ❑ 1 retrea Other - Dispersal Component (explain)__ Z - - r.... - n tent ev e xp am )7 V. Dispersal/Treat ment Area Ini'u-rma tion: / - - - lam - ~C - - eDp gi n Flow ow (gl rd) Design Soil Application Ratc~(gpds Dispersal Area Required (so- Dispc,rsal Area Proposed (sl) System Elevation CJ f~ - ~0 - -~!Ot-- - VI. Tank Info Capacity in Total 8 of Malutacturer a Gallons Gallons Units a; a New'I'aoks Existing Tanks v o 21 i-I a U cn t' rn w C7 0 Septic or Holding Tank , Dosing Chamber VV A V11. Responsibility State_meut- 1, the undersigned, astespoe n_sibility furinstallation of the PO1y_'fSshown ml the attached plans. mber's Name (Print)Plum - MP/MPRS Number Business Phone N inber Plumber's Address (Street, City, State, Zip Code Z~ --sf~-~-~/ IZ~- D1 7 - VTt . Count /De artment Use Only Pcnnit Fee Date Is 'ued suing-Agent igm re Approved D Disapproved `[T~ ❑ Owner Given Reason for llenial C/~ S IX. Co ~~1 t'Appp~roval/Reasons for Disapproval OWNER: 1. Septic tank, effluent filter and dispersal cell must as be s rviced / Maintained ned U C~ ~c~,t2 7° Per management plan provided by plumber. 2. All setback requirem _ _ _ "'t sabmit to the 'ounly auly o piper no[ Icss than ti Uz x t I inches sizo --mss-per applicablLtdyg~ rnarices. SBD-6398 (RO313) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. II New Richmond Wi 54017 715-246-4516 Date: 10/30/13 Owner:Lonnie Willaby Location: SW1A NW1A S9 T28 N,R29W 512 Little Orchard Rd Troy System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications S e 8. Existing Septic Tan ar Signature License rnber #226900 PLOT PLAN PROJECT Lonnie Wallabv ADDRESS 512 Little Orchard Rd Hudson Wi 54016 SW 1/4 NW 1/4S 9 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/30/13 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 890 # of chambers 44 BENCHMARK V.R.P. Top of Rebar ASSUME ELEVATION 1001 Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 90.6/90.7 6' below qrade 250' B.M.* All piping shall be SDR 30/34, within 10' 20, of tank, piping shall be Schedule 40. B- 40' B-2 Scale is 1" = 40' 00.0 unless otherwise New 2-3' x 90' noted Cells with >3' 70' spacing 25' 50' DiverterValve 10' Existing ST 0 -3 26' 0' Existing 4 Bedroom Existing Bio House Diffuser Chambers eastern cell filled 40' with sand B-5 Vents B-1 Vent >69) Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 12" 5.6ft^2/pair of end caps 4' Long 291' Property Line 3 419 Grade at System Elevation Little Orchard Road Cross Section of Infiltrator Quick 4 Leaching Chamber III Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.6ft^2 Pair of end plates Finish grade elevation Typical Installation 97.1' Vent Al Grade Vent 3' 4" 3' X30/34 Septic Tank 5' Long 199 5' S' Long 1 99 Grade at System Elevation 3699 Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A-90.6' B 90.7' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner -o r n r Septic Tank Capacity NA Permit# Septic Tank Manufacturer - e 0 NA e- 0 NA DESIGN PARAMETERS Effluent Filter Manufacturer Number of Bedrooms O NA Effluent Filter Model - 0 NA Number of Public Facility Units _~NA Pump Tank Capacity al NA Estimated flow (average) ~ aVda Pump Tank Manufacturer 11 NA Design flow (peak), (Estimated x 1.5) gal/clay Pump Manufacturer - NA z Pump Model NA Soil Application Ratite _ 7 al/da /ft Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) :530 mg/L O Sand/Gavel Filter 0 Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L 0 NA 0 Mecharical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L 0 Disinfection 0 Other: Pretreated Effluent Quality Monthly average Dispersal t;eli(s) 0 NA Biochemical Oxygen Demand (BODs) <30 mg/L In-Ground (gravity) 0 In-Ground (pressurized) Total Suspended Solids (TSS) :530 mg/L i:;~'<NA 0 At-Graae 13 Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line- 0 Other: - - Maximum Effluent Particle Size Ya in cila. 0 NA Other: NA Other: - NA Other. NA *Values typical for domestic wastewater and septic tank effluent. Other: ~ u` r NA MAINTENANCE SCHEDULE Service Event Service Frequency month's) Maximum 3 Inspect condition oi`tank(s) At least once every: Years} 0 NA Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume 0 NA ~ Years) 0 NA Inspect dispersal cell(s) - ~ At least once every: 0 month+ s) (Maximum 3 Clean effluent filter At least once every: - months s) - -_-0 NA _ / ~ear(s; _ Inspect pump, pump controls & alarm At least once every: - 0 moan his)- - NA Flush laterals and pressure test At least once every: 0 month's) NA 0 year(s) Other: At least once every: - 0 monthl s) NA ___T - 0 Year(s) - Other: NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells 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 crocks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent or the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to chec4: for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires thq immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (6) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordanc3 with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechar ical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWT 5 Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of an!, service event. Page of START 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(s) and may result in the backup or surface discharge of effluent. the To avoid this situation have the contents of thin pump tank removed by a Septage Servicing Ooerator prior to restoring power effluent pump or contact a Plumber or POWTE; 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. from the wastewater stream may improve the performance and prolong the life of the POWTS: Reduction or elimination of th following the antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants, fat; foundation drain (sump pump) water; fruit and vegetable peelings; asoline grease, • herbicides; meat scrape; medications; oil; painting products; gasoline; pesticides; sanitary napkins-, tampons; and wahE r softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be takr,,n to insure that the system is properly and safely abandoned in compliance with chaptor Comm 83,33, Wisconsin Administrative Code: All 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 Septagf. 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 site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a olding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation 'Must be performed to locate a suitable replacement area. If no replacement area is avaiinble 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 ANDIOR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATIVIENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS, POINTS INSTALLER POWTS MAINTAINER ___.-Name S Name l~C.c Phone Phone J SEPTAGE SERVICING OPERATO PUMPER LOCAL REGULATORY AU r'HORITY Name Epho amePhone ne This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Z-0 61 1 ll t Mailing Address .512-- , , A !_0 Property Address 50-1a (Verification required from Planning & Zoning Department for new construction.).) 3 s 7o _ City/State l~Tv _ Parcel Identification Number LEGAL DESCRIPTION Property Location '/4 Sec. T ZJ NR .1 W, Town of Subdivision -.Q r /It r~ , Lot # . Certified Survey Map # V'(Aume , Page # Warranty Deed # I Vo[tune , Page # Spec house yes no Lot lines identifiabl (Ayes 120 SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, it 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 wasi-e disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Departintnt of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by of a warranty deed recorded in Register of Deeds Office, I Nu er of bedr oms S "NA F PLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds C)ffice and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK 111hi.s is to certify that I have inspected the septic tank presently scrrving the c2 A AL mow, residence located at: Jc1J A~% , Section 9, TN , RW, Town o f Upon inspection, I certify that I have fOLlnd the to k and baffles to be in good condition, and it appears to be functioning properly. , .i..,ast time serviced: D vl 3) oi.d flow back occur from absorption system? Yes No (If,no, skip next line) Approximate volume or length of time: gallons minutes 4L'apacity: b G Construction: Prefab Concrete Steel Other Manufacturer: (If known) Age of (if known).: aoDI 5A6z- S'gnature) (Name) Please print (T t ) (License Number) hate form to be completed by licensed plumber (x.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) - _ Plumber (applying for sanitary permit) Certification: :Iii accepting the above statement regarding existing septic tank condition, certify that the tank to the be of my knowledge will conform he requirements of ILHR 83, Wi dm. Code (except for inspectitopening ove outlet baffle). ZName~~ / Signatur MP/MPRS `'L' G/ 20 .e r L-A ~~ea 19 ~ m r i II lil IIIlllllllillllllll I I I III 8035250 State Bar of Wisconsin Form I-2003 Tx:4025543 WARRANTY DEED 940518 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Brian Ellstrom, a married individual 08/23/2011 2:58 PM EXEMPT*: N/A ("Grantor," whether one or REC FEE: 30.00 and Lonnie Willaby and Karla Willaby, husband and wife TRANS FEE: 653.70 PAGES: 1 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): Lot 7, Plat of The Orchard Subdivision in the Town of Troy, St. Croix County, Wisconsin. aen 040-1283-70-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights-of-way of record, if any. Dated August 19, 2011 (SEAL) (SEAL) * B(SEAL) (SEAL) s * AUTHENTICATIO~j%r►rlu11881 ACKNOWLEDGMENT Signature(s) ~a DeM~~,~i `TOE • .;;4p' STATE OF WISCONSIN ) authenticated on ? • s=.~. ) ss. ST CROIX COUNTY ) , • 5 Personally came before me on August 19, 2011 TITLE: MEMBER STATE BAR' • . the above-named Brian Ellstrom, a married individual (If not, ~~~~r~tanuN~~r authorized b Wis. Stat. to me known to be the person(s) o execu the foregoing by § 706.06) instrument and acknowledge THIS INSTRUMENT DRAFTED BY: i~ Lorr' . De hrs Attorney Doug Berg /Nola Public tate o 1200 Hosford Street, Suite 201 Hudson, WI 54016E miss on i tirt anent) (expiresAril 1, 2012 tgna urea m ay D au en wledged. Both are not accessary.) IFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. 1 of 1 I LO rl' b I-,! z rn_ 111223 Sq. Ft. co d 2.55 -Ac. C--~ C" 11Q928 `Sq. Ft' M x.55 Ac: o Q 283.01 S88'45'38' i s 33.01 0 t' LOT 7 LOT 4 co '109109 Sq. Ft. 1;15515 Sq. Ft. 250 Ac. 2.65 Ac. , l - 3z.. DEDICATED TO W -I DFMCA'FD TO X THE PUBLIC - THE PUB.iC 1 l N 182.48' S88'45 38"W a o ---LMLE ORCHARD ROAD -iZ . 6 CD 6a1 ~^7 180.53' N88'45'38"E m O QO Lo T '3 ~ N "1110109 Sq. Ft.~ LO 1 2.53 Ac. T } 6 g 127359 S"q. Ft. 1 t ~2.92 Ac. 34.11• ' S 77 t it Parcel 040-1283-70-000 10/03/2013 09:17 AM PAGE 1 OF 1 Alt. Parcel M 09.28.19.1601 040 - TOWN OF TROY Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - WILLABY, LONNIE & KARLA LONNIE & KARLA WILLABY 512 LITTLE ORCHARD RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 512 LITTLE ORCHARD RD SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 2.500 Plat: 08-054-ORCHARDTHE SUBDIVISION 040-01 SEC 9 T28N R19W LOT 7 THE ORCHARD Block/Condo Bldg: LOT 07 SUBDIVISION Tract(s): (Sec-Twn-Rng 401/4 1601/4) 09-28N-19W Parcel Histo : Notes: History: Doc # Vol/Page Type 08/23/2011 940518 WD 07/13/2011 938748 WD 02/07/2011 931766 SD 08/03/2007 856871 QC more... 2013 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.500 65,000 196,500 261,500 NO Totals for 2013: General Property 2.500 65,000 196,500 261,500 Woodland 0.000 0 0 Totals for 2012: General Property 2.500 65,000 196,500 261,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 395165 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: r VV I /City Village X Township Parcel Tax No: (builder LC t'V ` b Troy, Town of 040-1283-70-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 3) fi 011 364, D'i, S!' 09.28.19.1601 TANK INFORMATION EL VATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ~ / / Benchmark / p Dosing _ Alt. B ~ o ,Sr Z,s ~Aeration Bldg. Sewer U Si Holding St/Ht Inlet / TANK SETBACK INFORMATION St/Ht Outlet 6Z YvP6 / 92.9/ TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic r Dt Bottom g,Zs q2.s~ Dosing Head an. h 2h~ OY o~ vSf bet-r 9,3 g2•y7 Aeration Dise U/.ngd 'n tte rd W. - qJ,l Holding Bot. System daWYI ph VV. Final Grade PUMP/SIPHON INFORMATION A, 110)4 h a Piytcj V1 V/ 273 7 Manufacturer Demand St Cover 3 /VI,S~ nS 3• ~DS 97 Model Number TDH Lift Friction Loss System Head TDH Ft 1I p or/ Forcemain Length Dist. to Well 14 4 SOIL ABSORPTION SYSTEM - IV16YO-,d SQ-~ , e BEDITRENCH Width 1 4,, Length No. Of Trenches PIT DIMENSIONS No. f Pits Inside Dia. Liquid Depth DIMENSIONS '/3 G13, 5 2, SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM EACHING Manuf er1 D INFORMATION Type Of System: HAMB IT Model Number: DI IBUTION SYSTE I Hea anifold , is ibu on . k x Hole Si-- Imo,....- x Hole Spacing Vent Air Intake lI Pipe(s) s ZI7 d kvv Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only tnkK S Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched 150 Bed/Trench Center ) _ f Bed/Trench Edges Topsoil C(/ , s 7 Fa Yes H No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: O / 3 - Inspection #2: Location: 512 Little Orchard Road Hudson, WI 54016 (SW 1/4 NW 1/4 9 T28N R19W) Orchard, The,Lfoott,7~ Parcel No: 09.28.19.1601 1.) Alt BM Description 2.) Bldg sewer length = a gi 7ST C? - amount of cover / wl ytl%~✓0___ Plan revision Required? ❑ Yes 0 No ~d Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signatur Cert. No. t C 4 K L o?` .xt -L l3„r Try of )/l ~e~ is-cH►~wsAc~ = 91x,97` i e~ j t Ga c L ~S t "r ev6 ~e LL 60 4uyv% r f N S~I i t 10 E`I , gl qp,(o~ LOT I al noY44-\ ehd C ,QS - q~ . 37 Z d AA ~ sad ~ t1 AC fl /G ?1 t:, . , f WI Parcel 040-1283-70-000 10/03/2013 09:17 AM PAGE 1 OF 1 Alt. Parcel 09.28.19.1601 040 - TOWN OF TROY Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - WILLABY, LONNIE & KARLA LONNIE & KARLA WILLABY 512 LITTLE ORCHARD RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description " 512 LITTLE ORCHARD RD SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 2.500 Plat: 08-054-ORCHARDTHE SUBDIVISION 040-01 SEC 9 T28N R1 9W LOT 7 THE ORCHARD Block/Condo Bldg: LOT 07 SUBDIVISION Tract(s): (Sec-Twn-Rng 401/4 1601/4) 09-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 08/23/2011 940518 WD 07/13/2011 938748 WD 02/07/2011 931766 SD 08/03/2007 856871 QC more... 2013 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.500 65,000 196,500 261,500 NO Totals for 2013: General Property 2.500 65,000 196,500 261,500 Woodland 0.000 0 0 Totals for 2012: General Property 2.500 65,000 196,500 261,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 8 0 3 5 2 5 0 State Bar of Wisconsin Form 1-2003 Tx :4025543 WARRANTY DEED 940518 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between Brian Ellstrom, a married individual 08/23/2011 2:58 PM EXEMPT#: N/A ("Grantor," whether one or REC FEE: 30.00 and Lonnie Willabv and Karla Willaby, husband and wife TRANS FEE: 653.70 PAGES: 1 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): Lot 7, Plat of The Orchard Subdivision in the Town of Troy, St. Croix County, Wisconsin. ILZM 040-1283-70-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights-of-way of record, if any. Dated August 19, 2011 (SEAL) (SEAL) * Brian Ellstrom (SEAL) (SEAL) s * AUTHENTICAT11%J00tltlt+I~~ ACKNOWLEDGMENT Signature(s) L: DeM.~i~~. ) STATE OF WISCONSIN authenticated on ST CROIX COUNTY ) ss. - ) ~.ds~. A. •G * '.~f~' , • g Personally came before me on August 19, 2011 TITLE: MEMBER STATE BAR' • • the above-named Brian Ellstrom, a married individual (If not, 14ttuntu0.~ to me known to be the person(s) o execu the foregoing authorized by Wis. Stat. § 706.06) instrument and acknowledge THIS INSTRUMENT DRAFTED BY: * Lorr' De hrs Attorney Doug Berg Nota Public Late o 1200 Hosford Street, Suite 201 Hudson, WI 54016 M ommiss on i rmanent) (expires- -April 1, 2012 ) (signatures may D en or acknowledged. Both are not necessary.) +inTC. ru,c ,c • cr~iur. ~ nn mn.., • NV ...nnIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. 1 of 1 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and F uildind Division Sanitary Permit No: INSPECTION REPORT 395165 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: Miller, Sam Troy Townshi 040-1283-70-000 CST BM Elev: Insp. BM Elev: BM Description: 4 t r vo c ~T 1b Wt t' 9 2 9 ~q, /0o f TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark .5 Dosing Alt. BM • Aeration Bldg. Sewer 7 Holding St/Ht Inlet R.2d 93•z/ ~ • SD 92, ~ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic t Dt Bottom Dosing Header/Man. l2 • :2 b6' Aeration Dist. Pipe l Z Z ' , Holding Bot. System Final Grade i PUMP/SIPHON INFORMATION g.fl 9~'y~ Manufacturer Demand St Cover 8.3 9~.a 9 Model Num r M TDH Lift Frict1 s System Head H Ft Forcemain Length Dia. Dist. to Well / SOIL ABSORPTION SYSTEM 5 `l, BEDITRENCH Width I Length No. Of Trench 6s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS T3• W Z SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer- INFORMATION CHAMBER OR Type Of System: 1'f , _ UNIT Model NumbIerA, DISTRIBUTION SYSTEM Ulo Header/Manifold U Distribution +Hole_S_iz_e___ Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing o + SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of T eded/Sodded 1xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No ]Yes No COMM NTS: (Include code gi 3epe~es, pereso s present,,eettc.) Inspection #1Qw~-1~/~ Inspection #2: 4) w v~ C616+ u cat Y OCat 6fi- 512 Little Orchard Road Hudson, 154016 (SW 1/4 NW 1/4 9 T28N R19W) The Orchard L 1 Parcel N,LO: 09.28.19.1601 1.) Alt BM Description = 1oQ oC ~/tjc,~tlfnAr _ _ a.,axe 2.) Bldg sewer length = amount of cover = Plan revision Required? En Yes ,No Use other side for additional information. o Z Da e Insepctor's Signature Cert. No. SBD-6710 (R.3/97) r - f /O y ' Safety and Buildings Division CoOOry 201 W. Wat>itmgton Ave., P.O. Box 7162 l~ Madison. WI 53707 - 7162 ~ Address NVISconsin n s ~Z o t~ 8rtm8ftt of COmmBfCB Sanitary Permit sear r Sanitary Permit Application 3 9 S • In accord wilt Comm $311. Wis. Adm. Code, persooIudorm~g 3 m ' 0 Check if Revision be used for Slue Plan I.D. Number L Appiiatim btlarowdlon - Please Print AB IIntarmation t.: Pawl Number Qyp-1z~3--7 0-000 properly Owosr's Name 5 TI I `t F it property owner's iM wft Addrm _ FT-7, PM" Locanon ST C,AOIX k'j 'A U~s slorx TZ-rN Number R / n, Lot Number aw, Stets Zip Code Subdivision Name CSM Number f fc/nS o N V) I Sy®/ G.T T/fF oRCHA'An y ~3 (.a ocity IL type of Buildiot ( all beat apply) 1 9 or 2 Funk Dwdift - Number of BO&OOMs PubiwCommmial - Describe Use ° /ZO oad NwRoad O 2MM Owned rt if 2 Le O/t,~l~►AitQ (a' 93,'S'T2FiU~N~s to i ors =177 ~flam6ar 1II. Type of Parma: (Check adz one boat oa line A (numbering me for internal ua). Complete lint B if applicable) of 6 1131 Addition WD Camty use A• 1 Now 2 O Repkeemes System TO 1 Replaceme nem Only stem Permit Number Dace Issued B. ❑ Check d Samary permit Prsv Y Issued scheme use) _f fh4mgE+C-5 - iv. Type ofPermit: (Cbwk all that apply)(numbwing is for internal wetland C H 4 7si( Z 44,Q Noa -Pmoviaed In-Ground 210 Mound 47 ❑ Sand Filter so 0 Constructed ,S `TeTA L 22 O Pressurized InAkound410 Holding Tanlt 48 0 Single Pass 51 ❑ Drip Line IC, 46 ❑ Aerobic Treamsent Unit 49 ❑ Rec' 30 0 Other 43 ❑ At-Grade Y. Area tntor7natiOn: Percolation Rate System Elevation Final Grade Dispersal Soil Application Elevation Flow Design R q~`uiced Pmd 3~ Rate(Gab./Days/Sq.FL) (Min-1100h) ~J,b© L200 ✓ ~O ✓ t ✓ -70, Z) ✓ Prefab ire Steel Fiber Plastic VI. Tank Ltto C in Manufacturer ~ of Tanker Concrete Constructed GIM New Exisdva Toots Tads Septic or Holft Toot FR- V z RB L /o A VII. Respond bility Statement- T, the underdgoed, assume responsibility for installation of the POWTS shown on the attached plans. phtmberI S. MP/MPRS Number Business Phone Number Phamber•~ ~ (Print) ~ ~ b - g' /o n di s (Stmt Cuy. Sttea. Zip code) Z_O ees Addres I~•NA~ ✓ L w ( s v /,6 ?a /De ent use Onkr (No Stamps) ved 0 Disapproved Sanitary Permit Fee (includes Gwater ttf Appro Sltrchuge Pee) ❑ Owner Given Initial Adverse O Determination IX. et tar Diaapprovd 5 vcC•rvtlh. DI,Ts Atesdt osrapiete ts~ (a tie Coraty ady) nor tM s7ster M MP- set leas trot al/2 a 11 lOcbw Y dse SBD-6398 (R. 05101) SArni~~~► Aso O tU ~ A k L o7 xt 7 L•~'L-13, /y1. ToP ©f s .,as4p a s-I z 1/7l OP-14 4AD r? D. 6 7'aP a far st~,~~ SGT c to ~6, --t2ENcl4ES p/N iS-cN►~n~EAs ~Ach ~ - 9D, °I7 DOc) 4 J 3o--WrAL r«~ :rL25n 3(o 4 t 6.3t Ga 4CI L S W1 #4.3 el /ooA ~ 1 (60 l.. y_,aEp2o~.r+ 04 RA►n~L~2 IVY s y t3• S 0 ti 7 L OT 1 Zo° " E NA-* s I - Fife H T'fZj;,44cH 3Q s BioDfffuser Specffications 76" - 0o two coo 00 00 00 00 00 00 OD OO DD OC_J OD OO DD OO OD OD OO ~0 OO ~o OO OO Chamber DD COO 00 OO DD OD OD DO Height DD CEO 00 t~D OO DO OO t~l~ Do 00 00 00 00 0o r~o 00 00 00 0o coo 00 00 00 ~0 00 ot~ o0 00 0 00 00 00 0 • o0 0~ All three BW#fur sim withstand H 10:loads MMk#~f1 installed with prow gnaded, Chamber and compered soils. A mini- Height mum of 12" of hover is rEnd requ ired<for H•10 loads. The iew 1 4a High Capacity BioDiffuser is desigloed for M-2,0 loads. A minimum of I W of cover is 34° r*% 1 St fAt h1a20rH ls, 4" Knockout [Universal End Cap Avcalable Sizes High- Dimensions Length 1,7699 76" 76" Width 34" 34" 34" Height 11" 14" 16" Invert 6.5 9 11.3 10 1385 V Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations Attach complete site on paper not less tbarttl7: ii., l loo es,in size. Plan must county plan St. Croix include, but not limited to: vertical and re}erence point (OKI direction and - - percent slope, scale or dimemsions, *th arrow, and loca8on afid.dis*7 to nearest road. Parcel I.D. 040-1039-90-300, ID#9.28.19.134D Pleasent all in rngl~on. _--By Date - Personal infortnation you provide , ay be used for 0ril'purposes Rriwacv Law, s~ 15.04 (1) (m)). As vV Property Owner c Property Location Miller, Sam SW 1/4 NW 114 S 9 T 28 NR 19 W Property Owner's Mailing Address s ~,x F Lot it Block # Subd. Name or CSM# ¢a~ 7 l Plat Of Miller's Orchard P.O. Box 151 City - State,, Zap Cale Pht>tie Numb . J City J Village Town Nearest Road Hudson I WI 54016 . (71;5 38t 69 Troy Little Orchard Road . 0 New Construction Use: ~ Resi lentia I Number of bedrooms - 4 Code derived design flow rate ---600 -GPD Y I Replacement f Public or commercial - Describe: Parent material Glacial outwash Flood plain elevation, if applicable na General comments and recommendations: Recommend installing 2 trenches at Tx 90.625', using 29 high capacity BioDiffuser infiltrator chambers at system elev. = 91.60'. QBoring #ng in. Sal Application Rate Pit Ground Surface elev. 97.60 ft. Depth to limiting factor ->135" Horizon Depth Dominant Color Redox Description Texture Shucture Consistence Boundary Roots 'E GPD/ft2 ff#1 *Eff#2 h 1 0-13 1Oyr2/1 none sl 2fsbk mvfr gs 2f 0.5.- 0.9 2 13-18 - 1Oyr3/3 - - none sl - 2fsbk mvfr cs 1f 0.5 0.9-- 3 18-30 1Oyr4/3 none sl 2msbk mfr cs - 0.5 r 0.9 4 3049 10yr416 none is Osg ml ; gs - 0.4 0.6 5 11 10yr5/6 none - s Osg ml t_cs~_ 0.7 1.2 6 81-135 1Oyr5/4 _ none s Osg ml - - 0.7 1.2 Hori 04 ax><ains 1" - 22 barxis of Om 7.5yrM4 Ifs. Loading rate of horizon adjusted to retfect reduced pe~miability associ2ted with banding. Boring # Boring - 0 Pit Ground Surface elev. 97.10 ft. Depth to limiting factor _ > 130" -in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 1 0-6 1Oyr4/3 none sl 2fsbk mvfr as 2f 0.5- 0.9 2 6-18 10 r4/6 - none ~Is- - 1msbk mvfr cs 1f 0.7 / 1.2 ~r 318-31 10yr5/6 none s Osg ml gs 0.7 1.2 10~ 4 31-82 1Oyr5/4 none s Osg ml - 0.7.,- 1.2 5 82-130 10yr6/4 none s Osg ml - 0.7,/ 1.2 * Effluent #1 = BOD 5> 30 < 220 mg/L. and TSS > < 150 mg/L) #2:= BOD5 < 30 rng/L and TSS <-,30 mg/L CST Name (Please Print) Sign ure: CST Number James K. Thompson s-- 3602 - Address A.C.E. Sal & Site Evaluations Dlffe Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, W154020 4/23/01 715-248-7767 • 1385 property owner Miller, Sam Parcel ID # 040-1039-90-300, ID# Page 2 of .3 3 Boring # Boring 97.13 ft. Depth to limiting factor '>128" in. Pit Ground Surface elev. - Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots VD/ft?. _ _ *Eff#1 *Eff#2 1 0-14 a 1Oyr2/1 none SI 2fsbk mvfr gs 2f 0.5./1 0.9 2 14-22 1Oyr3/3 none sl 2fsbk mvfr cs 1f 0.5 0.9 3 22-33 ( 10yr4/3 none sl 2msbk mfr cs - 0.5 0.9 4 33-43 1Oyr4/6 none is Osg i ml gs - 0.7 1.2 _ - - - - - 5 43-77 1Oyr5/6 none s Osg ml ; cs - 0.7 1-.2 ✓ 6 77-128 1Oyr5/4 none s Osg 1 ml - 0.7 i 1.2 F4]Boring # Boring 1 Pit Ground Surface elev. 9830_ ft. Depth to limiting factor > 126" in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW *Eff#1 *Eff#2 1 .I 0-8 1Oyr2/1 none sl ( 2fsbk mvfr gs 2f } 0.5 .1 0.9 - SI 2medPl mvfr GS 1f none 0.4 0.6 2 8-16 1Oyr3/3 3 16-28 j 10yr4/3 none j sl 2thickpl ~I mfr cs - 0.4 0.6 - - ✓ ✓ 4 28-37 1 0yr4/6 none Is 1 msbk i ml gs f 07 1.2 5 37-80 1Oyr5/6 none s Osg ml cs - 0.7 ✓ 1.2 ✓ - - - - 0.7 1.2 Osg ml 6 80-126_ _ yr5/4 - none S Q Boring # Boring - Pit Ground Surface elev. 98.26 ft. Depth to limiting factor > 125" in. gpplkan Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 " Eff#1 *Eff#2 1 0-11 1 Oyr2/1 none sl 2fsbk I mvfr gs _ 2f 0.5 v 0.9- 2 11-17 10yr3/3 none sl j 2fsbk mvfr _ cs if - 0.5 0.9 ✓ 3 17-24 10 r4/3 none sl 2msbk mfr cs i, 0.5 ✓ 0.9-11 4 24-29 1Oyr4/6 none Is j Osg ml gs I 0.7 ✓ 1.2 ✓ 5 29-62 10yr5/6 none s Osg ml cs - 0.7 it 1.2 ✓ - - - - 1 - 0.7 1.2 6 62-1251 1Oyr5/4 none s Osg * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS - 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, viease contact the department at 608-266-3151 or TTY 608-264-8777. Q so.cn2nL Mark: To o-F ■ ■ ~2 ASSc.mecl bK Lb 8.m.: To o~ e)ed. = 100.49.' (o f st~~ 0- Cc r'ner' 0{~~JroP. 1~ ■ '1 ~ B3 V So; / s~oP ~ ■ Ob.ser'dc~'d j0;6 cr h Q ■ bs ■ dl ~o~ 7 /~'f;//c~:5 ~~cha~d 5ec9, T. o~'T~o y, 1_i'-&&1e O/' C h a/d ko a al i Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In-Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In-Ground o Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System_ Desi n Specifications ' Sanitary Permit Number Number of Bedrooms f Design Flow - Peak ( pd) Q Estimated Flow - Average ( pd) 6 0 a Septic Tank Capacity (al) cS Soil Absorption Component Size (f) S-A 1 FT 7-- Type of Wastewater Domestic i Table 2: Soil Absorption Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak ( pd) 1"040 Maximum Influent Particle Size (tn t-ac 1/8 Maximum BODE (m /L) 220 Maximum TSS (m /L) 150 i Table 3: Maintenance Schedule Septic Tank Inspect and/or service once every 3 ears Outlet Filter Inspect once a year and clean at least once eve 3 ears Soil Absorption Component Inspect once every 3 ears Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servicing Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of th k and outlet filter shall be assessed at least once every 3 years by inspection. a outlet fil sh I be cleaned as n gassary to nsu ro er operation. The filter cartridge should not tie removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the j Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of scum and sludge in the tank exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of an assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. Manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other 1 treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. N 2 is Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep-rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. T 44 a., 4_C- LA) 4.- L)_SQJ y fir, l~ s t f. 2.. -03( W V45 -z- 1 C r r r Y ( .C 0~ r1 ! o i l I 1 j 3 I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION OORM Owner/Buyer s~ /Ll 1~7 Mailing Address ~X 11,601 Property Address 5 I L ff <<-- O R.C 1m K-D b (Verification required from Planning Department for new construction) City A/ y DZ a At Lt/ i Parcel Identification Number i Rc AL DESCRUM Property Location :5 w '/a Sec. T L V N-R Town of T~ f1E O2c H A Q to . Lot # a"ivision`T # ~ 3 (r o Volume Page # -s~ Cer1I1W Survey Map b 3 Z 9 . Volume Z S Page # Warranty Deed # Spa; house yes ❑ no Lot lines identifiable yes ❑ no MAD~ME Imp "w use and maintenance of your septic system could result in its premature failure to handle wastes, Proper tnsmtenance of pumpmg out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system caisistf can affect the fuactian of the septic tank as a treatment stage in the waste disposal system. t a certification form, signed by the or%r and by a 'The property owner agrees to submit to St. Croix Zoning Depart on-site waatewaterdisposal system masterplumber. journeymanplumber. restrictadplumber or a licensed pumper verifying that (1) the tank is leas than e1/3 r fall of sludge. septic is in proper operating condition and/or (2) after inspection and pumping (if necessary), the that i and agree to maintain the private sewage disposal system with the standards Vwe, the undersigned have read the above requh awto set forth. herein. as set by the Department of Commerce and the Departrnent 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 o the three year expos 'on date. _7hJ1 APPLICANT DATE ATUN i•{wa) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the vwner(a) of ~ the desca bove, b rtue of a warranty deed recorded in Register of Deeds Office. DATE P CANT ted may result in the sanitary permit being revoked by the Zoning Departmmat. "0' Any information that is nits-represented 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 op STATE BAR OF WISCONSIN FORM 7 - 1995 632796 TRUSTEE'S DEED KATHLEEN H. WALSH GI DEED OoCtaMie Ntaapar VOL 1555PAGE323 ST. CROIXOCO., WI RECEIVp FOR RECORD I DANIEL S. SOLBERG AND KARLA J. SOLBERG 11-01-2000 4:30 RI TRUSTEES 10 as Trustee of EXWT 1 DANIEL S. B J. SOLBERG REVOCABLE CERT COPY FEE: APRIL TRUST DATED - COPY FEE: TRANSFER FEE: 2610.31 RECMIN6 FEE: 10.00 for a valt,sble consideration conveys without warranty PERSON PAGES: I SA44 E. MILLER. SINGLE PERSON 'i Rocaronp Area . Grantee. the following described real estate in ST. CROIX County. 'Name end Ratwrt Adome State of Wisconsin: SAM MILLER PART 0F;THE NW16 OF THE NA AND THE SWk OF THE NWk AND THE H ?i HUDSONBOX 151 NO& OF THE Nth AND THE NWk OF THE NEk AND THE NWk OF THE HUDSON, WI 54016 SWk OF SECTION 9. TOWNSHIP 28 NORTH. RANGE 19 WEST, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN AND MORE PARTICULARLY r.-::.:::__.-- DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHWEST CORNER OF 040-1038-60 040-1039-60-000 : SAID SECTION 9. THENCE SOO650'5410E ALONG THE WEST LINE OF 040-1039-70-onn SAIDNA 2626.30 FEET TO THE WEST QUARTER CORNER OF SAID Parcel waeaon m Number IP" SECTION 9; THENCE S00045'32"E ALONG THE WEST LINE SWk OF SAID SECTION 9 150.31 FEET: THENCE S56'24'38"E 70.00 FEET: THENCE N59015'17"E 850.85 FEET THENCE ON AN ARC OF A CURVE TO THE RIGHT 102.10 FEET AND WHOSE RADIUS IS 403.00 FEET AND i CHORD BEARS N07032'30.5"W 101.78 'FEET.; THENCE N00021'49"E 569.05 FEET; THENCE 588'45'38"W 250.00 FEET; THENCE 1100'50'54"W 350.92FEET; THENCE S88'57'07"W 512.29 FEET; THENCE NOO050'54" 100.00 FEET; THENCE N88'57'07"E 250.31 FEET; THENCE N03°10'51"E 202.31 FEET; THENCE N32019'49"W 95.25 FEET; THENCE N02'24154"E 136.96 FEET; THENCE S8703i '25"E 198.63 FEET; THENCE SO1'54'33"W 149.41 FEET; THENCE N89'46150"E 148.76 FEET; THENCE S2°27'16"W 256.95 FEET; THENCE N88'57107"E 1065.55 FEET; THENCE H89°12'30"E 325.61 FEET; THENCE 500047'30"E 10.00 FEET; THENCE N89'12'30"E 554.46 FEET; THENCE NO1'23'32"E 587.22 FEET; THENCE N55'31'03"E 651.90 FEET; THENCE N38'09'35"W 413.25 FEET; THENCE S89'31'02"W 142.03 FEET TO THE NORTH QUARTER CORNER OF SAID SECTION 9; THENCE 589'12'35"W ALONG THE NORTH LINE OF THE NWk OF SAID SECTION 9. 2666.45 FEET TO THE POINT OF BEGINNING, SAID PARCEL CONTAINS 96.52 ACRES AND.IS SUBJECT TO ANY EASEMENTS OR RESTRICTIONS OF RECORD. .I Dated this day or OCTOBER 2000 Q l~►• uYQ F lbw l (SEAL) 6 1 flta~~~ (SEAL) I DANIEL S. SOLBER . KARLA J. SOLBERG twee nrtee I AUTHENTICATION ACKNOWLEDGMENT State of Wisconsin, Signature(s) ss. Count. ,~.t P~tonAby came before me this day d authenticated this day of (~~b~~~ the above named TITLE: MEMBER STATE BAR OF WISCONSIN ) w (if no(. me known to be the person `who executed the foregoing authorized by 5706.06. Wis. Sots.) I rument and acknowledge the e THIS INSTRUMENT WAS DRAFTED BY Poo, HEYWOOD6 CARI. S.C. 204 LOCUST STRFFT _ S.f,. ef wisCof:tin HUDSON, WI 54016 Notary Public. State of Wisconsin i My commission is permanent. (if t, state expiration date (Signatures may be authenticated of acknowledged- Bah aM not necessary) • N.m or pmcm u&vA% In "ry c.pseay mw be typed or panted blow tlrr &Wwwm STATE OAR OF WISCONSIN wuconsln L"o Or* Co.. K TRUSTEE'S D690 FORM No. 7 - 1998 = s"aa,A.w. Wa ' I I 235.64 276.65 ' MATCH LINE CSM_ LOT -#4 I I I VOL.-7 PAGE 1885 1 In - I I r ml I ~l O I) Z SLOT 6 O LOT 5 \ Sq. IFt. \111068 N of ulI 2.55 AC. rn M o 11 672 Sq. Ft\ - I I 54 Ac. N.B. 2.55 A Ind IIol Q . 111068 sq ~ N . B 2.5 ~ ft. 'L 4 C. N` I I I ~ 283.01' S88'45'38"W N.B\ 110672 s ft. s 250.00' I I QI ~y 33.01' I ZI \ \ s° N I LOT 7 109095 Sq. Ft. iOT 4\A 1 ~ 5648 7q. Ft. 215 0 Ac. M ~ 2.65 AC. / N.B 2.50 AC. 165 AC. N. 09095 sq. ft. N.B. 2I 33 115648 sq. ft. ' 33' , ® I I \ / DEDICATED TO Lij I / \ TO THE PUBLIC 1 DEDICATED I LL, ~ THE PUBLIC / \ O 588'45'38"W o z Z LITTLE ORCHARD ROAD- o :M In I 0' ~6 180.63' S88'45' 38"W a to L N 66hh I , , T 3 I 110355 Sq. Ft. A" LOT 1 2.53 Ac. I 2.53 AC. N.B. ~ 127359 Sq. Ft. B. 110355 sq• 1 2.92 Ac. 34,11' I~ y> N.B. 2.92 AC. 00 L N B. 127359 sq. ft. ~ 00 / nT 2\ 1 . L 'e rk /1~ w cle) ' .~..t Y n p' YI f r\ ~ \ 3,ZS,SLIpI,ZZ'LOS ►-o< - Y; - - O •i 116 f 1 fill a Y of 3x^ yt. 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