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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM county: St. Croix
Safety and Buildiig Division
« INSPECTION REPORT sanitary Permit No`3� 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:
�) 0 F� Tro Townshi 040 - 1286 -10 -000
CST BM Elev: Insp. BM Elev: BM Description:
4 7 3.9g , 9 • q - .dl- B
TANK INFORMATION ELEVATION DATA
TYPE ( � MANUFACTUR R CAPACITY STATION BS HI FS ELEV.
IOD 4.
Septic D B
f V4 w-) nchma4' 93.9
Dosing All. BM
Aeration Bldg. Sewer
3 94.6Y
Holding SUHt Inlet
TANK SETBACK INFORMATION SUHt Outlet 11D 41 If I
-
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic l 4 _____ Dt Bottom
Dosing Header /Man. �o. /o Gl� �tf
Aeration Dist. Pipe 1 • o
tk• �O •!.
Holding Bot. System 1 •20 0.
2• �
Final Grade u , `p `13.6 `f'
PUMP /SIPHON INFORMATION -4• J
Manuf turer Demand St Cover
GPM I -e
Model Nu er 1 _ C
TDH Lift riction Loss System Head TD Ft `�!
F wfemain Length Dist. to Well
SOIL ABSORPTION SYSTEM
JIIIFEF idth Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIM S 3 rjT •� eR•
SETBACK SYSTEM TO P/L I BL15G WELL LAKE/STREAM LEACHING Me fac6b _ �� s��b
INFORMATION CHAMBER OR ((��
Type Of S sty em: + , �I Z 3 f — � UNIT Model Number 'D t
DISTRIBUTION SYSTEM
Header/ anifold �� Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Li 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
Bedfrrench Center Bedfrrench Edges Topsoil
No
❑Yes ❑ No ❑ Yes
❑
CO.�M'WTS! cjp ,:In clude ppde discre n ' persons present, etc.) Inspection #1: Inspection #2:
Location: 50 l Orchard
L i The Orchard Lot 31 .� c Parcel No: 09.28.19.1625
1 d Drive Hudson WI 16 1/4 NW 1/4 9 T28N R19W )
1.) Alt BM Description
2.) Bldg sewer length = s f
zi y
- amount of cover = W
3) P : .
Plan revision Required? Q /
Use other side for additi
SBD -6710 (R.3/97) f 1 t Insepctor s Signature Y C '
PLOT PLAN
PtrOJECT Sean Coffev 002 Cl arence St. Maplewood Mn 55109
NW 1/4 NW 1 /4S 9 /T 28 jPDRE
TOWN Troy COUNTY ST. CROIX
MPRS Shaun Bird 226900 j DATE4 /14/04 BEDROOM 4
CONVENTIONAL )00( IN- GROUND SSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
.7 872
HOLDING TANK SIZE LOAD RATE ABSORPTION AREA # of chambers 28
ik BENCHMARK V.R.P. Top of 3/8" rebar ASSUME ELEVATION 100' Filter Zabel A -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
287' Property Line SYSTEM ELEVATION 90.0/89.0 4' below qrade
Plans Designed Using
Conventional Powts
Manual Version 2.0
B. M.
100' Well is to meet all
setbacks required by
WDNR 10'
110
20'
19-4
H -2 20'-, 20' 0' ;
2 -3' X 88' Cells with >3' Spacing 25' 15 0'
70'
15 -6
Pro 4
Bedroom
House
430' Property Line -3 13%
Slope
130'
:0-a ---
10' B -1 30' vB -5
Vent Vents
>6„ Standard Biodiffuser
of Cover Leaching Chamber
with 3 1. 1 ft2 of Area
6' Long 1191
Grade at System Elevation
34 99
Orchard Drive
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
County � �
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. /
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
O
Please print all information. R ewed by \ Dat
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner. Property Location
�,,) a -.I e Govt. Lot 1/4 �4 S To– N R E (or W
Property Owner's Mailing Address t # Block # I Subd. - , Plame or CSM#
�r -
I city S e Zip Code Phone Number ❑ city Illage wn Nearest R d
1
Construction U �Residential / Number of bedrooms Code derived desi66ow rate Q GPD
❑ Replacement ❑ Public or commercial - Describe: __ - --
Parent material eau 1L- . Flood Plain elevation if applicable o,►/ 1 ;4� ft•
General co
and reco
,A /J } � reco
Boring
Bon # pit Ground surface elev. tr ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Descxitor Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Gr. Sz. Sh. 'Eff#1 'Eff#2
`l J r
- / /V /10 A' 4 -
2.�'
F
Boring # a Boring
pit Ground surface elev. ft. Depth to limiting factor in.
Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
Effluent #1 = BOD > 30 1 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Sig CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address D to Ev on Co ted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 �� 715 - 246 -4516
Property Owner _ Parcel ID # Page of
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor _ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2
Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
F
Soil Application Rate
Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgll- ' Effluent #2 = BOD < 30 mgll- 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.
sa0.9330MAW)
RECEIVED
Safety and B ldings Division COYO
2®1 ngto Ave., P.O. Box 7082
V1.911consin EB ��4 WI 53707 - 7082 Sanitary Permit her (to be co.)
(608) 16546 (
Department of commerce N State Plan LD. Number
Sanitary ' 14
In accord with Comm 8311, Wis. Adm. Code, personal information you provide
may be used for secondary Purposes Privacy Law, s I5.04(1)(m) Project Address (if different than mailing add s)
I. Application Information — Please Print All Information �/V D� ��•
�� Parcel # Lot # Block #
Property Owner's Name �/
Z�?
Property Location /
Property Owner's Mailing Address
Section
City, State Zip Code Phone Number
crrc one
T
Y N;E r W
IL of Building (check aU that apply) Subdivision N
2 Family Dwelling - Number of Bedrooms `
❑ Public/Commercial - Describe Use
D ty ❑Village ❑Township o
❑ State Owned - Describe Use ❑Ci
IIL PEIPermit f Permit: (Check only one box on fine A. Complete line B If applicable)
A. w System ❑ Replacement System ❑ TreatmendHolding Tank Replacement Only ❑ other Modification to Existing System
B. Renewal ❑ Permit Revision nZ= o Ne List Previous Permit Nume Expiration IV T e of POWTS S stem: Check all that a
n - Pressurized in -Ground ❑ Mound >_ 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At-Grade ❑ Single Pass Sand Filter ❑
Constnucted Wetland ❑Pressurized =hing nd ❑ Holding Tank ❑Peat Filter ❑ Aerobic Treatment Unit ❑ Recircu
F*►ta
Recirculating Synthetic Media Filter Chamber C] Drip Line C1 Gravel -less Pipe El Other (explain)
V. Dis ersa)/Treatme Are Area Propo� (sf) Elm n
ds Dispersal Area Required (sf) Dispersal
Deli Flow (gpd) Design soil Application Ratelgpgp f�/ � 7 � �
�Q / ff P Site `J teel Fiber Plastic
V Tank Info Capacity in Total Number Manufacturer Glass
Gallons Gallons of Units , l � /�t/ Concrete Constructed
L
New Existing IN r
Tanks Tanks
Septic or Holding Tank 2 Q
Aerobic Treatment Una
Dosing Chamber
POWTS shown on the attached plans.
VII. Responsibility Statement- 1, the undersigned, me mspoaaibility for installation Of the Business Phone Number
Plum 'a Name (Print) Plumber's S' e
Plumber's Address (Street, City, State, �✓(/"
VIII. un /D epartment Use Onl
Sanitary Permit Fee (includes Groundwater Date Issued suing Ag Signature (N s)
pproved ❑ Disapproved Surcharge Fee) / S- , 0
❑ Owner Given Reason for Denial /
IX. Conditions of Approval/Reasons for Disapproval pd U-4 V YSTEM OWNER: - G� .
Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
as per management elan provided by plumber. _ - J._ - 7
All setback requirements must be maintain O� A
as per applicable code /ordinances. `U"�
a /' f
3 �pa less than 81l2 It loch �, J
�e?�C 1� 0 7TtiGk�G !!
Attack complete plans (to the Coau nly�f� sys / , PsPer no
u '. a n
SBD -6398 (R. 08102) �` w� � /�, v �� �2e� •
PLOT PLAN
PROJECT Sean Coffev ADI� SS 2002 Clarence St. Maplewood Mn 55109
NW 1/4 NW 1 /4S 9 /T 28 N/R � W TOWN Troy COUNTY ST. CROIX
2/2/04 BEDROOM 4
MPRS Shaun Bird 226900 DATE
CONVENTIONAL XXX IN- GROUND PRESS CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28
IL BENCHMARK V.R.P To p of 3/8" Rebar ASSUME ELEVATION 100' Filter Zabel A -10C
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
287' Property Line SYSTEM ELEVATION 95.2/94.0 4' below qrade
Plans Designed Using
Conventional Powts
Manual Version 2.0
B.M. *
100'
Well is to meet all
10' setbacks required by
t. .M. To 10' WDNR
f 3/8" 20'
ebar C B -2 0' 0' B -4
105.7' 40,
V ents 13% Slop
r
0'
130' B -3
-3' X 88' Cells with >3' Spac
B-
1 3
40' Vents
a�
a
20' Vent
0
>6„ Standard Biodiffuser c
o Pro 4 Be oom of Cover Leaching Chamber
House with 31.1 ft2 of Area
6' Long
11"
Orchard Drive
4 Grade at System Elevatioi
.�
;�.
��
�"� a �► „,�,,, J
� g -' �.
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1409
Wisconsin Department of Commerce SOIL EVALUATION REPORT pop 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evalu ations
Attach complete site plan on paper not less than 8% x 11 inures in size. Plan must County
St. Croix
include, but not limited to: vertical and horgontef reference.point (BM), direction and
percent slope, scale or dhmemsiens, arrow, and location and distance to nearest road. Parcel I.D.
�' - 040- 1039- 70 -000, ID#9.28.17.133A
Please If ,r*'1nfOmwdon. R Date
.,
Per=W hformation you m4! used f (Privacy Law. s. 15.04 (1) (m)). L
y
Property Owner Property Location
Miller, Sam + Govt. Lot NW 1/4 NW 1/4 S 9 T 28 NR 19 W
Property Owner's Mailing `s -� -- Lot # Block # Sutx1. Name or CSM#
�. - - -�-
P.O. Box 151 � � - 31 _ Plat Of Miller's Orchard
city * Zip Code umbe - r , J City Vllage ✓i Town Nearest Road
Hudson I W1' , (715) 8t3 69 Troy Orchard Drive
New Construction Use: Res I of bedrooms 4 _ Code derived design flow rate 600 GPD
_J Replacement Public or commercial - Describe:
Parent meteial Glacial outwash Flood plain elevation, if applicable na
General cornmerfts
and recarnmendations: Recommend installing 2 trenches at 3' x 90.625', using 29 high capacity BioDiffuser infiltrator chambers at
system elev. = 92.50'.
Boring # i Boring
✓_f Pit Ground Surface elev. 99.22 ft. Depth to limiting factor >128" in. Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtW
'Eff#1
1 0 -21 1 Oyr3 /2 none $l 2fsb mvfr gs 2fm 0.5 ✓ 0. 9 ✓
2 21 -30 7.5yr3/4 none scl 2 f sb k mvfr cs 1fm 0.4 ✓ 0.6 ✓
3 30-38 1Oyr4 /4 none sl 2msbk mfr cs 1f 0.5 0.9 ✓
4 38-60 1Oyr5 /6 none s Os ml aw - 0.7. 1.2
5 - 6 1Oyr5/4 none s Osg ml cs - 0.7 ✓ 1.2
6 83 -128 1Oyr6 /4 none s O ml - - 0.7 1.2 ✓
Boring ,.
Z Ong # !� Pit Ground Surface elev. • 99.19 ft. Depth to limiting factor ' >132" in. Sol Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots .E GPDtfe
1 0-8 1Oyr3/2 none sl 2 f s bk mvfr as 2fm . 0.5 ✓ 0.9 ✓
2 8 -18 1Oyr4/3 none Is 1m mvfr es 1f m 0.7 1.2 ✓
3 18 -25 1Oyr4 /4 none s Osg ml gs - 0.7 ✓ 1.2
4 25 -58 10yr5 /4 non s Osg ml gw - 0.7 1.2/
5 - 58 -132 1Oyr6/4 none s Osg ml - - 0.7 ✓ 1.2 ✓
/
' Effluent #1 = SOD ? 30 < 220 mg/L and TSS > < 150 mg/L ' = BOD s mg1L and TSS <-30 mg/L
CST Name (Please Print) Sig re: CST Number
James K. Thompson — 3602
Address A.C.E. Sal & Site Evaluations ���� E�% e luafion Conducted Telephone Number
340 Paulson Lake Lane, Osceola, WI 54020 4/23101 715- 248 -7767
isto9
p Miller, Sam Parcel ID# 04 0-1039 - 70-000 ID* Page 2 or 3
F3 # Boring
Pit Ground Surface edev. _ 96.34 _ ft. Depth to limiting factor - > 124" in. Sod A Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP
'Eff#1 'Eff#2
1 0 -20 1Oyr3/2 none sl 2% mvfr gs 2fm 0.5 0.91/
2 20 -35 1 Oyr3/3 none sl 2fsbk mvfr cs 20m 0.5 ✓ 0.9 ✓
3 3 3 7.5yr4/6 none Is Osg ml cs 1fm 0.7 1.2 ✓
4 43 -77 1Oyr5 /6 none s Osg m gs - 0.7 ✓ 1.2 J
5 - 77 -98 1Oyr5 /4 none s Osg MI gw _ 0.7 1.2
6 98 -124 1Oyr6/4 none s Deg ml - - 0.7 ✓ 1.2 ✓
F Ong
4 � # i/ Pk Ground Surface elev. 93.94 ft. Depth to limiting factor ' > 120" in.
Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GFVr
"Eff*I •Eff#2
1 0 -9 1Oyr3 /2 none sl 2fsbk mvfr gs 2fm 0.5 ✓ 0.9/
2 9 -18 1Oyr3/3 no sl 2fsbk mvfr Cs 20m 0.5 ✓ 0.9 ✓
3 18 -24 7.5yr4/6 none Is Osg ml cs 1fm 0.7 1.2 ✓
4 24-44 10yr5 /6 non s Osg ml gs - 0.7 ✓ 1.2
5 44 -72 1Oyr5 /4 none s Osg mi gw - 0.7 ✓ 1.2 ✓
6 72 -120 1Oyr6 /4 none s Dag ml - - 0.7 1.2 ✓
F -s I Boring # Boring fol Pit Ground Surface elev. 94.84 ft. Depth to limiting factor >118K in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ME
'Eff#1 "Eff#2
1 0 -16 1Oyr3/2 none sl 2fsbk mvfr gs 2f 0.5 ✓ 0.9 ✓
2 16 -28 1Oyr5/3 none sil 2fsbk mvfr cs if 0.5 J 0.8 ✓
3 - 28 -36 1Oyr4 /4 none sl 2msbk mfr cs 1f 0.5 ✓ 0.9 J
4 36 -58 7.5yr4/6 none Is O MI gs 1vf 1.2
2�
5 58 1Oyr5 /6 none s Osg ml Cs -
J
6 70 -118 10yr5/4 n s Osg ml - - J O.7 1.2 ✓
Horizon #5 contains 1" - 2" bands of Om 7.5yr4/4 Ifs. Loading rate of horizon adjusted to relfect reduced pemtiability associated with banding.
• Effluent #1 = SOD ? 30 < 220 mglL and TSS >30 < 150 mg/L • Effluent #2 = SOD <30 mg/L and TSS <,.0 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 devarlment at 608-266-3151 or TTY 608- 264.8777.
r
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Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
C cy Plan
ption #1. f system fails, determine cause of failure, use alternate area and install new
sy min tested replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option #3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715 - 246 -4516
St. Croix County Zoning 715 - 386 -4680
Pumper Tom Mondor 715 - 246 -5148
Shaun Bird #226900
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT` - 0 &
AND'
OWNERSHIP CERTIFICATION FORM
i
owner/Buyer Lc,�iriTL.� s
Mailing Address
LP J
r
Properly
Address J�
(Verification required from Planning Department for new construction)
/�� /� �(D
City /State T �-�) tv�� / Parcel Identification Number Did �a1��
LEGAL DESCRIPTION n /� a 6 Z
�tY 1 /., Sec. T 4 N -R W, Town of
Property Location / +,
Lot # 3 /
Subdivision
r —
-c-- , Volume _— Page #
Certified Survey Map #
e Page #
Warranty Deed #
Volume
Spec house El y�no Lot lines identif es ❑ no
SYSTEM MAINTENA remature failure to handle wastes. Proper maintenance
Improper use and maintenance of your septic system could result in its p
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
P r veri that 1 the on-site waste water disposal system
masterplumber, journeysnanplumber , restrictedplumber or a licensed fig ( )
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 s stem has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of a three y piration date. 3
lo
DATE
SIG A'JURE OF ICANT
OWNER CERTIFICATION
JTMURE ) certify that all statements Register of on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the escrib a ove, by virtue of a warranty deed recorded in f Deeds Office.
DATE
SIG PLICANT
* ** * **
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 Registe of D made ffi the warranty deed
a copy of the certified survey map if
STATE BAR OF WISCONSIN FORM 2 - 999 0 iGATHLE6EN8N9MALSN
Document Number WARRANTY DEED REGISTER OF DEEDS
ST. CROIX Co., III
a single person RECEIVED FOR RECORD
This Deed, made between Sam E. Miller. Grantor, and Sean J. Coffey
and Kimberly M. Long, a s joint tenants, Grantee. 04 -22 -2002 10:30 AM
Grantor, for a valuable consideration, conveys and warrants to Grantee
the following described real estate in St. Croix County, State of Wisconsin (if WARRANTY DEED
more space is needed, please attach addendum): EXEMPT t
Lot 31, Plat of The Orchard Subdivision in the Town of Troy, St. Croix REC FEE: 11.00
County, Wisconsin. TRANSFFEE. 195.00
COPY CERT COPY FEE:
PAGES- 1
Recording Area
Name and Return Address
Attorney David J. Estreen
304 Locust Street
Hudson, W154016
040 -1039- 90-300
Parcel Identification Number (PIN)
This is not homestead property
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights - of - way of record, if any.
Dated this Y day of Z 2002
Sam E. Miller
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF Wisconsin )
) ss.
St Croix County )
authenticated this _ day of —7�(.
Persopa ly came before me C ! :- - day of
(e 2002 the above named
•
Sam E. Miller, a single person _
TITLE: MEMBER STATE BAR OF WISCONSIN �yl•` _
(If not, _ : to kn pe
n to be a 'son(s) who executed th foregoing
authorized by § 706.06, W is. Slats;.) z ti -m and nowledged the same.
THIS INSTRUMENT WAS DRAFTED
Attorney David J. Estreen 4 � �.,, ••- - te r
304 Locust Street, Hudson, WI 54016 _ ip„ STA to Ns p` otary Public, State of
My Commission is permanent. (If ot, state expi��Lt date:
(Signatures may be authenticated or acknowledged. Both are not necessary.) 7 3 .)
• Names of persons signing in any capacity must be typed or printed below their signature. Infomuuion Professionals Co.. Fond du t.ac. WI
STATE BAR OF WISCONSIN 900 -655 -2021
WARRANTY DEED FORM No. 2 -1999
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18" of cover is
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Universal End Cap
' . 14 High 16 High
Avcdlable Sizes Capa
Length 76" 76" 76"
Width 34" 34" 34"
Height 11" 14" 16"
Invert 6.5 9 11.3
10
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
OwnerBuyer . 24 M iA ! LL,+f fZ .
Mailing Address 130 X S i
Property Address SID Q c µ} p b R� u F_
(Verification required from Planning Department for new construction)
City /State H U p `YO Parcel Identification Number
LEGAL DESCRIPTION
Property Location Al LV '/,, ' /,, Sec. . T Z N -R Town of T P- Y
'Sk"ivision T N 4 E C N F1 tt a Lot # _
x
Certified Survey Map # 4p y , Volume . Page #
�, 2 9 Z
Warren Deed # �0 3 , Volume � - ssS . Page #
Spec house 0 yes ❑ no Lot lines identifiable `A yes ❑ no
SYSTEM ME
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
masterplumber, journeyman plumber, restricted plumber 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 yzar expiration date.
/07-/ 0 )
�- -&I NATURE ISIF APPLICANT DATE
—VMR CERTIFICATION
4i i !(we) certify that A statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
descrilLeLabove, irtue of a warranty deed recorded in Register of Deeds Office.
a � 61.
IGN O>! PI.YC NT 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
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
Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD-
10567-P (R.6/99).
Table 1: System Design Specifications
Sanitary Permit Number
Number of Bedrooms
Design Flow - Peak (gpd) ( o
Estimated Flow - Average (gpd) o c-)
Septic Tank Capacity (gal) - z- So
Soil Absorption Component Size (ft') S p -T z
Type of Wastewater Domestic
Table 2: Soil Absorption Component - Limits of Reliable Operation
Septic Tank Component Soil Absorption Component
Design Flow - Peak (gpd)
Maximum Influent Particle Size (in) Sor7) 1/8
Maximum BOD (mg /L) 220
Maximum TSS (mg /L) 150
Table 3: Maintenance Schedule
Septic Tank Inspect and /or service once every 3 years
Outlet Filter Inspect once a year and clean at least once every 3 years
Soil Absorption Component Inspect once every 3 years
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 the se and outlet filter shall be assessed at least
once every 3 years by inspection. T e outlet filte shall be cleaned as nec to ne sure ?``
proper operation. The filter cartridge should not be removed unless provisions are made to
retain solids in the tank that may slough off the filter when removed from its enclosure. If the
I
r
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 1/3 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
completion the com P
of service. An y opening o enin 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
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
i
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.
2
l
' 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.
TK , S s ea-
TA
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�• STATE BAR OF WISCONSIN FORM 7 - 1998
6 3 2796
TRUSTEE'S DEED KATHLEEN H. WALSH
DOD,,,,a,eNumber VOL 1555PACE323 ST. ICE C DEEDS
ST. ROI CO., MI
DANIEL S. SOLBERG AND Y.ARLA J. SOLBERG
RECFIVO FOR IECORB
Il-01-2000 Is30 RR
TRUSTEES BEER
as Trustee d EXEMPT
�A r� SOB KARLA J. SOLBERG REVOCABLE MAY COPY FEES
TRUS FA?ED UR3r26,' 2000 - COPY FEES
TRANSFER FEE: 11/0.30
RECORSIN6 FEE: 10.01
for a val consideration convoys without warrant to PROES: i
SAfi E. MILLER, A SINGLE PERSON
Necaox we;,
the (allowing described rest estate In ST . County ?Name and l'etut Address
State of Wisconsin: SAN MILLER
P.O. BOX 151
PART OF-THE NWk OF THE NA AND THE SA OF THE NWk AND THE 1 HUDSON, WI 54016
NFh OF THE NWk AND THE NWk OF THE NEI& AND THE NWk OF THE
SWk OF SECTION 9, TOWNSHIP 28 NORTH, RANGE 19 WEST, TOWN
OF TROY. ST. CROIX COUNTY, WISCONSIN AND MORE PARTICULARLY : _- : :
DESCRIBED AS FOLLOWS: BEGINNING AT THE NORTHWEST CORNER OF 040 - 1038 -60 040 - 1039 -60 -000
SAID SECTION 9, THENCE SOO'50'54 "E ALONG THE WEST LINE OF 040- 1039- 7n - nnn
SAIDNA 2626.30 FEET TO THE WEST QUARTER CORNER OF SAID hroel wentece M Ntrn ' (ft4
SECTION 9; THENCE SOO'45'32 "E ALONG THE WEST LINE SWk OF
SAID SECTIN 9 150.31 FEET: THENCE S56'24'38 "E 70.00 FEET: THENCE N59 1S E 850.85 FEET
THENCE ON JM ARC OF A CURVE TO THE RIGHT 102.10 FEET AND WHOSE RADIUS IS 403.00 FEET AND
CHORD BEARS N07 "W 101.78 - FEET; THENCE N00 "E 569.05 FEET; THENCE S88'45'38 "W
250.00 FEET; THENCE NOO'SO'54 "W 350.92FEET; THENCE 588'57'07 "W 512.29 FEET; THENCE
N00 100.00 FEET; THENCE N88 "E 250.31 FEET; THENCE NO3 °10'51 "E 202.31 FEET;
THENCE N32'19'49 "W 95.25 FEET; THENCE NO2'24'54 "E 136.96 FEET; THENCE S87'34'25 "E 198.63
FEET; THENCE SO1'54'33 "W 149.41 FEET; THENCE N89 "E 148.76 FEET; THENCE S2 "W
256.95 FEET; THENCE N88'57 01 E 1065.55 FEET; THENCE N89 ° 12'30 "E 325.61 FEET; THENCE
SOO'47'30 "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 "W 413.25 FEET; THENCE S89'31'02 "W 142.03
FEET TO THE NORTH QUARTER CORNER OF SAID SECTION 9; THENCE 589'12 "W ALONG THE NORTH
LINE OF THE NA 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 Of O CTOBER 2 .
(SEAL) I mo- ISEALI
DANIEL S. SOLBER
, KARLA J. SOLBERG
nrstu T rustee
AUTHENTICATION ACKNOWLEDGMENT
S18n+u�W State of Wisconsin,
Count .
P�Uy arm before me this day o( !:
authsnucNed tf W dsy of t above sand
TITLE: MEMBER STATE BAR OF WISCONSIN V to
(If riot, me known to be the person L who executed the foregoing
authorised by 5708.06. WK. Suits) I trumeIls nt and acknowledge the 7e,1 4 - CM11129 - 1
THIS INSTRUMENT WAS DRAFTED BY (\ �.i3dAi,c ,
rww
H EYWOOD& CARI, S G 204 L .UST ST FFT _ �f v WIiCO
HUDSON, WI 54016 Notary Public. State of Wisconsin I
My commission Is permanent. (if n I. state expiration date
(Signatures may be authenticated or acknowledged. Both are not � )
necessary)
• tt.nw of P,r.ntr used„ a M My c.p,c,ty Mile be typed a printed q.l„r tf,.r ,tp..tu
fTATR BAR OF WISCONSIN Ww. w I.asu See+ Co. K
TRUSTEES OB[D FORM No 7 - Ia" ,a� . Wu
I
DISTRICT OFFICE FOR INFORMATION. THE PHONE NUMBER MAYBE OBTAINED BY
CONTACTING YOUR COUNTY HIGHWAY DEPARTMENT.
4• ,
FOUND 3" ALIMINUM slo GIs, I
MONUMENT NORTHWEST I 1p Pi�R�
1
CORNER SECTION 9 I �ti ��M� I NORTH LINE NW
252.60' 287.60 05.95 316.45'
55' POND
2'24" E
1 72.29' S
LOT 32 /00 LOT 29
/ � / I OT 31 3 ,/
;E 2603 ` / 4 k 109052 Sq.
/ / / / �, /� 2.50 Ac
/// / o N.B.
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119902 S N.B. 8
N . Ft. � / ' ' \
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0 2.75 Ac. L
1094 /
N.B 2.51 Ac.
2.41 AC.
w V N.B. 105181 sq. ft. N.B. 2.33 AC.
!-v N.B. 101345 sq. ft. C\i
L 36.17' /
0 L
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p ^- 170_12' - -- 86.71'
0 0 _ ---------- - - - - -� 0 122.88
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NO 109035 Sq. Ft.
— 169.14 292.02' N 89'59'53j��� 21 \ 2. Ac.
N.B. 2.50 AC.
N.B. 109035 sq. ft.
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ENSION OF o �• /
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