HomeMy WebLinkAbout040-1065-20-100 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safet*and Building Division
INSPECTION REPORT Sanitary Permit No:
538731 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:
Bird, Shaun R. I Troy, Town of 040 - 1065 -20 -100
CST BM Elev: Insp. BM Elev: BM Description: // �� Sectionlrown /Range /Map No:
/11)6 /J m GST 16.28.19.243C
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURERS CAPACITY STATION BS HI FS ELEV.
Septic 14 pC D Benchmark
F It e �-- /O Alt. 1l �. Ca �u. /• {o /a z . 5
Aeration Bldg.
Holding St/Ht Inlet
TANK SETBACK INFORMATION SbHt Outlet � /, ,3
TANK TO P /L WELL BLDG. Vent td Air Intake ROAD Dt Inlet
Septic '�— /— Dt Bottom
(off i✓� /5 it1�— —,.. `.
Dosing Header /Man.
Aeration Dist. Pipe 94 7
Holding Bot. System 7 13 .7
Ta. Z
PUMP /SIPHON INFORMATION Final Grade
,v 5G.9
Manufacturer Demand St Cover /
Model Numb rM
TDH Lift Friction Loss System Head TDH Ft
Forcemain Length Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length f► o. Of Tre nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS Z
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: n
INFORMATION CHAMBER OR ✓L I ��a.
Type Of System: / !lJ „ )� UNIT Model NumbeQ J `` J
DISTRIBUTION SYSTEM v (( � ZS /�j = �ly (/•J — ,_ J �
Header /Ma / nifol Distribution ` x Hole Size x Hole Spacing Air take
lG Pipe(s) \ \ 0 �
Length
Di Length Dia Spacing . - JH--
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bedrrrench Edges Topsoil
3 . �, Yes 0 No Yes � No
.7 1 COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / /
Location: 365 Ruthie Lane Hudson, WI 54016 (SE 1/4 NE 114 16 T28N R1 9W) NA Lot 3 Parcel No: 16.28.19.243C
1.) Alt BM Description = e' I k 66 Jam, C+ _ a vim.
2.) Bldg sewer length= 2 .
- amount of cover = //
Plan revision Required? 0 Yes >rNo
Use other side for additional information. (�
SBD -6710 (R.3/97) Date Insep is Signa a Cert. No.
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comma mi.gov Safety and Buildings Division Count — y
201 W. Washington Ave., P.O. Box 7162 �. �J'e7) -
filled in by Co.)
Mosparbnertotcommerce soon s i n Madison, W1 53707-7162 Sanitary Permit Number (to be
53 g `131
Sanitary Permit Application Sta Transaction u r
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental
unit is required prior to obtaining a sanitary permit. Note: Applic
rm ation fo ate -owned POWTS are Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you pro dary
a ma
purpo in accordance with the Privacy Law, s. 15.04 1 m , Stats. 3 / < V ��
�✓ .J
I. A ►ication Information - Please Print All r � — � — •
Property Owner' Na a arcel #
Ian `r 3 4Photic DEC 03 6 AR) - 16fv5 - 26 - / a 5
Property Owner's Mailing Address r roperty Location /
Govt. Lot -
Number �
City, State Zip Code y ,, Section
T � _. N, R L —( E IL
H. Type of Building (check all-that apply Lot
r 2 Family Dwelling - Number of Bedroo Subdivision Name
a r•c i n Blo #
El Public /Commercial - Describe Use '�i�.• ❑ City of
dr. 240
❑ State Owned - Describe Use CSM Numbe ❑village of _
Town of
�: f.�J zZ�—Z ✓� l 6Z —
III. Type of Permit: (Check only 6ne box on line A. Complete line B if applicable)
A. ew System ❑ Replacement System ❑ Treatment(Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal it Revision El Change of Plumber List Previous Permit Number and Bate Issued
❑ Permit Transfer to New
Before Expiration Owner
IV. T e of POWTS S stem/Com onent/Device: Check all t hat apply) _
n- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Component (explain) _ ❑ Pretreatment Device (expl
V. Dispersal/TreatUient Area Information:
Design Flow (gpd) Design Soil Applicatio te(gpdsf) Dispersal Area Requt Dispersal Are a ystem Elevation
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o
New Tanks Existing Tanks `'" o .°,
t fS. t3 in G um V} it, r3.
Septic or Holding Tank
Dosing Chamber
VII. Respons Stateme I, the undersigned, assume nsibility for installation of the POWTS shown on the attached plans.
Plum r' Name rint) Plumber's A to MP /MPRS umber Business Phone Number
(21L, 2 �pT.� 7 ✓v o�
Plumber's Address (Street, City, State, Z' ode)
VIII. ovin /De rtment Use Onl
Approved ❑Dis roved Perm mi it Fee Date 1s ed Issuing t Signature
wn tven Reason or Denial $
V
IX. ConditMIFEM110 l easons for Disapproval . -1
I. Septic tank, effluent filter and 3' 1✓ J' /�V ro '
dispersal cell must all be services / maintairtttid
as per management plan provided by plumber. kov"A. o ��� 1..11 � 4J4 " 4 -%A 'eA—
2. All setback requirements must be maintail o
as per applicable code / ordinanos: IA. f d f rt,a t"z ar Tl.
Attach to complete plans for the system and submit to the County only on paper not less than 8 in. I1 Inches In size
SBD -6398 (R. 01/07) Valid thru 01/09
S i st and System PLOT PLAN
PROJECT Shaun Bird A DRESS 1008 192nd Ave New Richmond Wi 54017
SE 1/4 NE 1/4S 16 /T 28 / 19 W TOWN Troy COUNTY ST. CROIX
o
12/2/10 BEDROOM 4
MPRS Shaun Bird 226900 DATE
CONVENTIONAL XXX IN-GRAkD RESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 44
BENCHMARK V.R.P. top of steel fence post ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Scale is 1" = 40' SYSTEM ELEVATION 94.7/94.0 4' belo qrade
unless otherwise
noted Glover Road
Plans Designed Using Vent
Conventional Powts
Manual Version 2.0 >619 Quick4 Standard -W
Well is to meet all of Cover Leaching Chamber
setbacks required by with 20.0 ft2 of Area Long
WDNR 12„ 5.8ft 2 /pair of end caps
4'
Grade at System Elevation
34"
B -1
Ruthie Lane 5 0'
25' 0920'
4 0 , b ��
B.M.* B -3 1 Pro 4
40' 0' Bedroom
House
7% Slope
2 -3' x 88' cells with
>3' spacing
75' 5'
B -2
y �V
150'
IF Property Line
Wisconsin Department of Commerce SOIL EVALUATION REPORT l f
p f1 age o
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County
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. a tv « 5 Zb .. /00
Please print all information. Revie ed by Date <,
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
r /
LL U Govt. Lot Se 1/4 1 /4 /j T Z N R E (or W
Property Owner's Mailing Address Lot # I Block # Subd. Name or CSM#
City State Zip Code Phone Number ❑ City ❑ Village own Nearest Roa
7 ( ) ��
New Construction Usef3esidential 1 Nu r o m '� a derived design flow rate O G GPD
❑ Replacement ❑Public r comme 'al - Describe:
Parent material I =System elevation if applicable f ✓l ft.
General comments � ✓�� /� �' FG �
and recommendations: `
F I_A
System Type levation
F T] Boring # E] Boring
a pit Ground surface elev. C= 7 ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 •Eff#2
t!2
i t
E2 Boring # ` Boring gg
Pit Ground surface elevb ft. Depth to limiting factor _Zs� in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fg
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'E02
L
7-a
- �S 05,
Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 uent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Hams (Please Print) nature CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 A; 715 - 246 -4516
I
Property Owner _ Parcel ID # Page of
Boring #
❑ Boring
pit Ground surface elev.� ft. Depth to limiting fador 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
0 b �.- v �° i r
��3 c
a >
F-1 Boring # E] 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 GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
❑Boring
F
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit 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
Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg& and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (8000)
i
Property Owner Parcel ID # Page of
F-71 Boring # ❑. Boring
1s4it `Ground surface elev. � ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
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
❑ Ong # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Iepth Dominant Color Redox Description. Texture Structure Consistence. Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/_ • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777.
ssn- 8330tab/oo>
V
` commerceml.gov ty uildings Division County 7
ion Ave., P.O. Box 7162 J� y�
t soon si n adison, W 1 53707 -7162 Sanitary Permit Number (to be filled in by Co.)
of Commerce 5 D 7 3 _
Sanitary Permit Application State Transaction Number
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental Akl
unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information y be used for secondary
u ses in accordance with the Privac Law, s. 15.04 1 m , Slats. /� t G
I. A ication Information - Ples P ' o ation �✓ rK LA. Q_
Property Owner's Name Parcel # C 6
S/ �j G- s-
t�
Property Owner's Mailing Address Property Location /, ���
t �q S 1. rA 7 COUNTY Gov Lot __ C
City, State Zip Code �t= '/ )% '/ +, Section ,
/
L I !E`11 D ircle o
II. Type of Building (check all that apply) Oh Lot # s
r 2 Fantily Dwelling - Number of Bedroo ' ubdivision Na
t�'� -• Q' B oek #
❑ Public /Commercial - Describe Use _ »/ - ❑City of
❑ Village of _
❑ State Owned - Describe Use
7i �.
III. Type Permit: (Check only on box on line A. Cum to line B if applicable)
A. w System ❑Replacement System ❑ Treatmen olding Tank Replacement Only El Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision El Change of Plum El Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner
IV. Xype of POWTS S stem/Ctmt onent/Device: Check all that 1
- Pressurized in -Ground ❑ Pressurized In- Ground ❑ At -Grad ❑ Mou > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank [I Other Dispersal Component (explain) 4 ❑ Pretreatment Device (explain)
V. Dispersal/Treatgnent Area Information:
Design Flow (gpd) Designl Applicatio te(gpdsf) Di _ Area Required (s . Dispersal r `f) Sy tern Ele
0
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units "
New Tanks Existing Tan // ` c N a A u 4
U irn �o m t+.
Septic or Holding Tank /a� J
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assum sp risibility for inst allation of the POWTS shown on the attached plans.
Plumber's Na (Print) [ �Plumbcr'rc MP_ /MPRS Number Business Phone
Plumber's Address (Street, City, State, Zip Co _
VIII. un 1De nt tme Use Ord _.�
Approved Disapprov Permmiitt Fee Date 1s ed jIssuing nt Signature
er Given Reason for e ' 1 $ - / 75 � '' / � h
IX. Condit {i�[{ y� *casons for Disapproval n ./ ,_ / /)� J �o� aI" e AA-4,
1. St3ptic tank, effluent °'' / D i /�
-dispersal cell mt.si + unte_ / tf S lei ;ti ' � ,
his per management urnw.
1, 04etbackrequirenw tea. ataintid
Attach to complete plans for the system and submit to the County only on paper not less than 8 112 x I I inches in size
SBD -6398 (R. 01/07) Valid thru 01/09
PROJECT Shaun Bird PLOT PLAN
ADDRESS 1008 192nd Ave New Richmond Wi 54017
SE 1/4 NE 1/4S 16 / T 28 N/R 19 W TOWN Tro COUNTY ST. CROIX
MPRS Shaun Bird 226900 11/18/10 4
DATE BEDROOM
CONVENTIONAL )00( IN- GROUND PRESSURE
CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872
IL # of chambers 44
BENCHMARK V.R.P. top of 1" pipe
ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
Well is to meet all SYSTEM ELEVATION 96.5/96.0
setbacks required by
WDNR
Ruthie Lane
Scale is 1" = 40'
unle '0 a1sthA fgyd4Ssing 40'
noted onventional Powts
Manual Version 2.0
B.M.
10'
B -3
6 8% Slope
30' ,
a
B -1
0, Vents
10'
ST 25'
20' B -2
Pro 4 2-3'X 88' cells with >3' spacing
Bedroom
House
Vent
>6 Quick4 Standard -W Glover Road
of Cover Leaching Chamber
with 20.0 ft2 of Area
Lon
4' g
12" '9 5.8ft ^2 /pair of end caps
3 4" Grade at System Elevation q �I
Cover Page
Shaun Bird
Bird Plumbing Inc.
1008 192nd Ave
New Richmond Wi 54017
715- 246 -4516
Date: 11 /18/10
Owner: Shaun Bird
Location:SE1 /4 NE1 /4 S16 T28 N,R19W Lot 3 Ruthie Lane 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 -5. Maintanance and Conti ncy Plan
6. Filter Specifications S, t
Signature
License number #226900
- . PLOT PLAN
PROJECT Shaun Bird ADDRESS 1008 192nd Ave New Richmond Wi 54017
SE 1/4 NE 1 /4S 16 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 11/18/10 BEDROOM 4
CONVENTIONAL )00( IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 44
IL BENCHMARK V.R.P. top of 1" pipe ASSUME ELEVATION 100' Filter BEST Filter
❑ BOREHOLE O WELL H. R. P. Same as Benchmark
Well is to meet all SYSTEM ELEVATION 96.5/96.0
setbacks required by
WDNR
Ruthie Lane
Scale is 1" = 40'
Unle,,9MATVi 49sing 40'
notedonventional Powts
Manual Version 2.0
B.M.
10'
B-3 y .
60' 8% Slope
3 1 }
B -1
0' Vents
ST 25'
i -
20' B -2
2-3'X ' cells with >3' spacing
Pro 4
Bedroom'
House `
Vent
>6„ Quick4 Standard -W Glover Road
of Cover Leaching Chamber
with 20.0 ft2 of Area
4' Long
12" 5.8ft ^2 /pair of end caps
3411 Grade at System Elevation
Cross Section of Quick 4 Standard -W Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard -W Leaching
g
Chamber with 20.0 ft2 of Area per
Chamber 5.8ft ^2 pair of end plates To be >1' above grade
- / Finish grade elevation
Typical Installation /� 100.0
Vent A Grade Vent
4 ' 4„ 4'
.30/34 Septic Tank
4' Long 1 57 4' Long 1
Grade at System Elevation
3 4" Grade at System Elevation 34"
Spacing 5'
2 -3' x 88' Cells Observation tubeNent
Same on other end Located at ends of Cell
A
B
22 chambers per cell
System elevations:
A_96.5
B 96.0
: ST. CROI K COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIr ERTIFICATION FORM
Owner/Buyer / / t-1- r ✓ /
Mailing Address ZM N O2 �
Property Address " 2- -c c t —) a�� .
(Verification required from Planning & Zoning Deparhuent for new construction.)
City /State Parcel identification Number
LEGAL DESCRIPTION
Property Location ;E 'K , '/a , Sec. T21 N R '1'9 W, Town of _
Subdivision Lot # .
Certified Survey Map # S c� l� , Volume Page #
Warranty Deed # Volume Page #
Spec h e yes no Lot lines identifiably no
SYSTEM MAINTENANCE AND OWNER CERTI
lmproper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
or sooner, if needed, by a licensed pumper. What you Put into
maintenance consists of P=4=9 out the septic tank every three years sal Owner maiintenance
the system can affect the function of the septic tank as a treatment stage in the waste dispo Ordinance.
responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary
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 p that 1 the on-sift
o lumber, restricted plumber or a licensed pumper verifying ()
wastewater disposal systems 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/wt, 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 DeparunclIt 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.
Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are tine owner(s) of the
property described above, by of a warranty deed recorded in Register of Deeds Office.
Number of bedr
GNATURE OF APPLICANT(S) DATE
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Dept * #*
Include with this application a recorded warranty deed from the Register of Deeds office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
Maintenance and Contingency Plan for a Septic System
g Y p Y
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 gen y Plan
Option #1. system fails, determine cause of failure, use alternate area and install new
in 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
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* 9 1 7 1 8 3 1
STATE DAR OF WISCONSIN FORM 6 - 2000 i 9 17183
Docuinau Number SPECIAL WARRANTY DFAD ` BETH PABST
REGISTER OF DEEDS
THIS DEED, made between Anchor Bank, fsb fka S &C Bank, a Wisconsin ST. CRDIX CO. WI
banking corporation, Grantor, and Shawn Bird, a single person, Grantee. RECEIVED FOR RECORD
Grantor, for a valuable consideration, conveys to Grantee the following 06/0 7/2010 12:10PM
described real estate in St. Croix County, State of Wisconsin (the
"Property SPECIAL WARRANTY DEED
Lots 3 and 4 of Certified Survey Map fled February 19, 1997 in Volume 6, EXEMPT 1
Page 1779, as Document N umber 9_?�S2F ^ he St. Croix County Register REC FEE
of Deeds Office, being a part of a parcel of land located in the Southwest TRANS FEE: 262.50
Quarter of the Northwest Quarter (SW 114 of NW L of Sectian 15 and the
Southeast Quarter of the Northeast Quarter (SF. 1/4 of NE 1/4) of Section PAGES: 1
16, all in Township 28 North, Range 19 West, Town of Troy, St. Croix
County, Wisconsin.
Recording. Area
Nance and Return A775
Land Title Inc.
1900 Silver lake Road #200
New Brighton, MN 55119-1789
040- 1065 - 20-100
Together with all appurtenant rights, title and interests. 040- 1065 -20 -2 _—
Parcel Idenmificauon Number (PIN)
This is not homestead property.
Grantor warrants that die title to the Property is good, indefeasible in fee simple and free and clear of encumbrances, arising by,
through or under Grantor, except
�oS�MARY��� 4
Da 25th day of May, 2010.
Anchor nl , fsb =I!
* roes I-Ioemke, ls Pro - sides * _ 10
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) _ _ _ STATE OF WISCONSIN j
DANE COUNTY. ) ss.
authenticated this 25th day of May, 2010 1'e son rn
all y came before me this 1 a of
as the above name nchor Bank,
fsb fka SIC Bank, a Wisconsin banking corporation to me
TITLE: MEMBER STATE BAR OF WISCONSIN known to be the person(s) who executed the foregoing
(If not, _ _
it t and acknowledged the same,
authorized by 1 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY * .
Notary Public, State of Wis n,In
Lac Mountain, attorne r 1 �My commission is permanent, (If not, state expiration date:
MEr , 9- 23 = , ,20 ,) t
— )
(Signatures may heauthouicatedoraeknowledged .OMltan: not necessary.) * *James Hoemke, 1st V ice President of
'Names of pers<ms signing in any capicily mu>l be tytxd or tamtcd betnw their signature.
SPEMAI. W'ARRANYY DEED STATE aAR Or WISCONSIN FORM No. 6 -21)(00
1of1
4Z�u�f;
CERTIFIED SURVEY MAP
LOCATED IN THE SW 1/4 OF THE NW 1/4 OF SECTION 16, AND IN THE SE 1 /4
OF THE NE 1/4 OF SECTION 16, T 26 N ,R 19 W, TOWN OF - TROY, ST. CROIX
COUNTY, WISCONSIN.
Surveyed for: Roger Schwartz
F ` Rt. #3, River Falls, WI 54022
A P P R � Y� F QK/LTA F_I7 R _ 4-UFX C Y- ItA p-
FEB 35 ' .
• 71.54
35.f15'
ST. CROiX l.. i i.' NE CORNER
COMPwEi?c?ISiyt �,LR'�J F'L4: +NiNG v!! SEC. 16
AM ZONING C:OMMITTB®
O, (
CENTER OF SECTION .1
1/4 CORNER �/ °1.4
SECTION 1 6 Z / c eA °•
s I � \/� f o ^s R�•7" w O
1p
.✓ 1~
FILED A � 1 � 3 't7 O O al
FEBI�J7987 \ �'
E n N cD;� D � s.
i9Mm St D55* t \' �• v A `_d �t 1d of a� o
4 d54 < N $"A, m W r =I a) � C
11111�1i� \' p E- n:Id 3
= o
SCi EAST 1/4 COR\. ,' ` a O 3 °. S o' H cy
SECTION 10 ° ♦6 y Zi W �O W' Z N
T 2 6 N R I S M `��. „ b b / I.., - + y M F• N fd ^4'
W p Q O O i+
SCALE IN FEET t "= 2 \ a G; � / M E, y Q N 41 .
H H Z +' m
o so• loo 200 ' coo' \\ �� p p W o
\ a Z.4 v 3 3 oa
SEARINSS REFERENCED To THE dP 4p2•gI. O U U
EAST LINE OF THEME 1/4 Of U
SECTION I5, ASSUMED \ 4• m rd
N 01. 67.64 "E 4• m co 1 0
LEGEND a s. a`�,� q �� j , Y (
SECTION CORNER MONUMENT \ / y ,yam y0
W �
b
1 1" ROUND IRON PIPE FOUND
o Cd
O 1 "X 24" ROUND IRON PIPE WEIGHING \ n O y �O U
1.65 LBS. /LIN. FT. SET M C)
Cd
h B b
EXISTING BUILDINGS TF \ � rd,�
Q y
Vol. 6 Page 1779 ` � O \ m }'
��` \ �' H .4 0
TABLE OF LOT AREA \ ., •
Lot No_ Including Right -of -way Excluding Right -of -way +•;•,
Square feet Acres Square feet Acres
1 108444 2.490 89827 2.062 E 1/4 CORNER
2 513611 11.791 505534 11.606 SECTION w
3 103 570 2,370 92784 2.130 466. sae
4 234593 S. 386. 207052 4.753
DESCRIPTION
A parcel of land located in the SW I/4 of the NW1 /4 of Section 15, and in the SE1 /4
of the NE t /4 of Sectio:. 16, T28N, R 19W, Town of Troy, St. C _.x County, Wisconsin,
described as follows: Beginning at the E 1 /4 corner of said Section 16; thence
N87 ° 15 I "W (assumed bearings referenced to the East line of said NEI /4 of Seec:tion
16, bearingg assumed N1 ° 57'54 "E) 322.65 along the centerline of Glover Road;
thence northwesterly 212,86 along the centerline of said Glover Road on the arc: of
a 200,00' radius curve concave northeasterly whose chord bears N56 0 45 1 46,5""`
202.76'; thence N26 "W 473.27' along said ceiite.rline; thence N41 ° 53'46 "E
(recorded as N41 0 53 1 26 "E) 707.49 along the southerly line of Lo! 4 of that Certified.
Survey Map recorded in Volume 3, page 796; thence S48 °06 "E 1644.31 thence
N83o49 "W 995.11' along the East -West 1/4 line (centerline of said Glover Road)
of said Section 15 to the point of beginning, containing 960218 square feet (22,044
acres), more or less, and being subject to Town Road right -of -way as shown on. the
attached map, and also subject to an undelineated easement for electric lines as
re�cor•ded in V>>'ume 535, page 548, and tlsrs subject to all othca_ easernents, r(t-
;t rictions and covenants of record,
I, James E. Rusch, registered Wisconsin Land Surveyor, do hereby certify that
I have surveyed and mapped the above described property; that such plat is a
true avid correct representation of the exterior boundaries of the land surveyed;
and rtlat I nave fully complied with the provisions of Section 236.34 of the WA(is-
c.onsin Statutes, the St. Croix County Subdivision Ordinance, and the Town of
Troy Subdivision Ordinance to the best of my professional knowledge, under-
standing and belief.
James E_ Rusch
/ Professional .Land Surveyor JAMESE Z
L /Ri,sch Surveying, Inc. ItuSCH
407 Second Street •-1371
rir:ort, WI 54rf 16 S� li t Ei:._
1k gy p ' .,
D this, s^ day of J ut. t �8to y Su
n - - es F Rusch re gistered Wisconsin Land Surveyor, do hereby I, J. a. g Y Y certify
thaa.t I ha.vc surveyed and mapped the above described property; that such plat.
's a true and correct representation of the exterior boundaries of the land
s� rve) ed; and that I have fully complied with the provisions of Section 236.34
of tF1rs Wjsc Statutes, the St. Croix County Subdivision Ordinance, and
the.. Town of "Croy Subdivision Ordinance to the best of my professional icnowl -
edge., understanding and belief.
'Phis map is hereby approved by the Town Board of the Town of Troy.
j >. Ma cir�i:.Sz:hi3t}?en, Town G:r:�
NOTE: Lot 4 cannot be further developed.
CURVE DATA TABLE
Curve Lot Radius Central. Arc Chord Chord Tangent
No. No. Angle- Length Length Bearing Bearing
I - 200.00' 60 0 58'49 11 212.86' 202.96' N56 "W N26 0 16 1 22 "W
N87 15' 1 i "W
4 167.00' 60 ° 58'49" 177.74' 169.47 N54 0 45'46.5 "W N26 ° 16'2Z "W
N8 7 (> 15' 1 1 "W
1 '417.0!?' 45c58'17" 133.9q' 130.4Z' N2,I "W NI ° 1.0'55 "l -'.
N44 17 "W
4 3 80.00' 74 1.03.74' 96.62' N81 °56' 15 N44 °47' 17 "W
S60 0 54'47 "W
�> S0,00 127 '177.51 )4'.,.;_ i.755 "W S63 54
ISIS "0? � r1fs
56 :9'50" 79, 12 75.')3 _ 14' 42P t1 W
x r- -<� ' -
U1 .{ :t.0()' i'4 uR -34' n' N ^., I': )9
Z Vol. 6 Page 1779 �1
1.0
! iPAID
t J
Wisconsin Department of Commence SOIL EVALUATION REPORT Page of
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
O i
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County 6 C
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.
Please print all information. Re ' Dat /
Personal information you provide may be used f w, s. SA4 0) (m)).
Property Owner Pr perty Location
G Lot j` 1/4 �/ �1/4 S& T 2 N R E (o W
Property Owner's Mailing Address AU Lo t# I Block # Subd. Name or CSM#
l —
City State Zip Code Phon ONING OFF City ❑ Village Town Nearest Roa
PIANN
C
New Construction U Residential / Number of bedrooms Code derived Mesign flow rate 40 0 GPD
❑ Replacement ❑Pub' p or commercial - Describe:
Parent material Flood Plain elevation if appli ble ft.
and ro co l oomm data ons: J� c In- u4 (,V � 2�gQyry t7�L 4kti 1
and remmen dati O
System Typ _ N.'a r System Elevation
F-R Boring # ❑7t Boring G �/
0 Pit Ground surface elev. Y-L' --t.— ft. Depth to limiting factor Z Z in.
Soil Application 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 •Eff#2
I (0
517— — L' �— o?'-0-
Z -1 /d `� c` ,-r� A
ell
►I
,i
a 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 GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I •Eff #1 I •Eff#2
1 6 �z ------ - M-- '61/-
- 1 b C 1 11 n y✓
9
, o �_
• Effluent #1 = BOD > 30 220 mg/- and TSS >30 < 150 ' Effluent #2 = BOD < 30 n A and TSS < 30 mg(L
CST Name (Please Print) CST Number
Si re
Bird Plumbing, Inc. Shaun Bird 226900
Address Date Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 5401 U-2 715- 246 -4516
♦ I
I .
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 GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2
Z AfWdA -- c Al
F-1 Boring #
Boring
pit Ground surface elev. ft. Depth to limiting factor in.
7To — ilApplication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
a Ong # C] Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2
E±
Effluent #1 = BOD > 30 < 220 mgIL and TSS >30 < 150 mgA_ ' Effluent #2 = BOD < 30 wAA and TSS <_ 30 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777.
SBD -8330 (8.60))
Property Owner _ Parcel ID # Page of
® Boring # ❑ Boring
Pit Ground surface elev. ft. Depth to limiting factor i
Soil Ap lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2
0 110
Z
b
F Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
SON 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 •Eif#2
a Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDAf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 "Eff#2
Effluent #1 = BOD > 30 < 220 mg/L and TSS >30:S 150 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.
SB"330 (8.6/00)
i
Soil Test Pl7te6124/1 PI
Projedt Name Shaun Bird rd
Address 1008 192nd Ave
New Richmond Wi 54017 #226900
Lot 3 Subdivision Vol 6 pg 1779 0
SE 1/4 NE 1/4S 16 T 28 N /R19 W Township Troy
Fj Boring (D Well PL Property Line County ST. CROIX
BM or VRP Assume Elevation 100 ft. Top of 1" pipe
System Elevation 96.5/96.0 *HRpSame as Benchmark
Ruthie Lane 0A9 MERE i
Scale is 1" = 40'
unless otherwise 40'
noted
98' B.M.
10'
B -3
60' 8% Slope
100' 30'
B -1
90'
10' 25'
B -2
Glover Road