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HomeMy WebLinkAbout040-1269-80-000 ­n Department o}. Commerce PRIVATE SEWAGE SYSTEM County: St. Croix _arety and Building Division , INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 430447 0 GENERAL INFORMATION 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: Appletree Builders Troy Township 040 - 1269 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 4) / o D . o ` c , '12- " M e i 4L e /�� ��� 17.28.19.1485 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM ./�' - VYLiti Aeration Bldg. Sewer ce A - l l%' , e ' S c d k e T - ne'/ c "L' - /- t: S / Holding SUHt Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL ZBL . Vent to Air Intake ROAD Dt Inlet Septic 2 � t eI o9 v 11 Dt Bottom �k / t s Dosing Header /Man. 5 Aeration Disk -Fe z— 7� 73 �j7, Holding Bo"RyMemr PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM I� haunh�(X Y' t `OZ.t� Model Number Y�xiat Tv 6t f TDH Lift Friction Lo System Head I TDH Ft For ain Length Dia. ��l1DYli S� Y 7,7� �K SOIL ABSORPTION SYSTEM BED/TRENCH Width Len th No. Of Trenches 'Z PIT DIMENSIONS No. Of Pits Inside Dia. q"d no DIMENSIONS SETBACK SYSTEM TO P/L IBLDG IWELL LAKE /STREAM LEACHING Manufacturer: + INFORMATION CHAMBER OR i 0 C1 Type Of System: neV,) n; T c h UNIT Model Number. CZ- Avk I5 2 C 5I h / c F' DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(.) 1 / l Length Dia 7 Length G7 Di a Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over De th Over xx Depth of xx Seeded /Sodded xx Mulched Bed/T Bed/Trench ge - Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: �� / u3 / U'� Irysflcc4 Location: 444 Crocus Hill ( Road Hudson, WI 54016 (NW 1/4 SW 1/4 17 T29N R1 9W) Troyw000ld�tL�ot�9 Parcel No: 17.28.19.1485 1.) Alt BM Description = ID w� tu�twtl e G � S—� � U _ �� 2.) Bldg sewer length = / ax Pe 1 A -� - amount of cover = _ / 6 �y� 4/`/-t' G�LIh �.Sl O>tL jZ41 .' Plan revision R2quired ?� Yeso Use other side for additional information. 7 V J —� ✓._�L /. J x --- - SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. : y �.I • a?tJZ_. .v`''., trSY� ~ ,i �1 V 1 a / r .. 1 `1y , t • c f 3 At Jill lol i w �,,. !• .�� • ' ~• -.,._. �.. Vic, .^ • .���:. .84 r / _, .,� • i i 6T - � 7i�i Ate. � • '_. _ .�,,,;;,', -�: � -`�,. �, .'� •, • �'! • Air ��.�. _ .- 1..- r "`'"`f' � .;�, '� '�� 1 .. r _ 3 1.3 ,• � X 9. ,1 f 1 .87 �l X 946 r L� Safety and Buildings Division County 5� , L/Qb/• X an 201 W. Washington Ave., P.O. Box 7082 SCl�t �S'i/t Madison, WI 53707 - 7082 Sanitary Permit Number { fi in by Co.) Nv i Department of Commerce (608) 261-6546 Sanitary Permit Application State Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 141 may be used for secondary purposes Privacy Law, s15.04(1 xm) Project Add (if different than lin I. Application Information – Please Print All Information 4 ? CG(�/ P/N o y0 • /,��' • s'o • azra Property Owner's Name Parcel # Lot # 7 Block # �M • �� r So,J /3 t��'G -1��2s Ti?a y4v 000 Property Owner's Mailing Address Property Location /03 f7 ��� C�� �i� • c ' City,, n S p tate /� Zi Code Phone Number V*. S_ �i•. Section j II. Type of Building (check all that apply) _ ' T N; R I Eo W �1 or 2 Family Dwelling - Number of Bedrooms G Subdivisi N a CSM Number ❑ Public/Commercial - Describe Use ❑State Owned - Describe Use ❑City ❑Village ,Township of �r III. Type of Permit: (Check only one box on line A. Co - - A ' New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System. B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that app 7JS ST / .Non – Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Leaching Chamber Q Drip J. e ❑ vel -less Pipe ❑ Other (explain) A . V. Dispersal/Treatment Area Inf rmation: ff Fp,/S -- Design Flow (gpd) Design Soil Application Rate(gpdsf) Dis Tsai Area rc uired s Dis pe e4 (f) persal Area Proposed (sf) System Elevation 7 8 J 8 r� L .5 �p1�4 N VI. Tank Info Capacity in Total Number M u Prefab Site Steel Fiber Plastic Gallons Gallons of Units (� /��0 Concrete Constructed Glass New Existing y /�/ Tanks Tanks �IJ�FS�/l t septic or Holding Tank 25V �� v 4-OCt.I 6e Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Pl � her /MPRS Number Business Phone Number �• Z� /,6jZ � �� 7 /���t.Y z z c� 3 -� S 7�S • 7 �a 3 5/4r Plumber's Address (Sur / State, Zip Code 2- 912- H1.. 4 btic ,v VII Coun /De artment Use Onl Sanitary Permit Fee includes Groundwater Dat Issued in Approved 11 Disapproved �' g Agen Sign re tamps) Surcharge Fee) 6 `6 O ❑ Owner Given Reason for Denial J V IX. Conditions of Approval/Reasons for Disapproval 3 �{�' z STEM OWNERl el _ Septic tank, effluent filter and dispersal cell must all be serviced / Maintained as per management plan provided by plumber. 2 All setback requirements must be maintained as per applicable code /ordinances. 13-L13-1 Attach complete plans (to the County only) for the system on paper not less than SM x 11 inches in size nr»1 i•mnn in nninn� f O VA/ ; Sv �P ���lOi2 5 — D .v Gi:tJ.e ' • ; I se 7': 7' ®p or y sf p. /Do -v O f O ,, � roe• �( yy bb Ott t .' A , a ................ . V S> ' lvf9iP,�1, � 38 3 ps� THIS POWT SYSTEM SHALL INCOR ORATE PER COMM. 83.44(2 c A PROPER ZABEL FILTER ODEL # /60 5G41-�-` N 40T 33 G� dr✓�5 tl __c�— OLBRICHT & ASSOCIATES CO. 655 O'Neil Road - Hudson, Wi 54016 Reg. Designers of Engineeft Syste 715 -386 -8185 Privat Sewage Consultants r PROJECT INDEX OG ,v , 12— O� PLAN ID # �/� DATE OWNER ��i f .Q� fO.✓� �l p O �v � , J��Ii� S PHONE 'Z ' 0 j ADDRESS 103 97 ae LEGAL DESCRIPTION Ld 7 7;VO , w OOV RAI Dye - Ia6f .6'c ,VzV, S ! / 7. 7 -2 , /Pip' oar TOWN OF Re Oy COUNTY CSTM �� ?� /�l%iCl T a 203 S LOCAL AUTHORIT SUPERVISION 15 A6W C � G--- PROJECT DESCRIPTION: .vtv S 7--� �3�' �� f-���rs' ���►� /fie' s-� Ulbrlc hi ' ASSOCiates Private Sewan(- consultotS 2812 10th Spring Vallee, 'M 54767 THIS POWT SYSTEM SHALL 14#5 INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # 4 , 1 J-0 r/ a1 /& /T/%Vp Pg.l INFILTRATOR SIZING WORKSHEET P .2'SY g STEM PLOT PLAN P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. P9 .4 " if n It 11 rt P9.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS P9.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG•7 (OPTIONAL) PUMP PERFORMANCE SPECS. The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Treatment Systems. (Version 2.0) SBD- 1075- P(NOI, /01. L W --U LN y QN 6h # / S rr - r ®p o f - y s�e�.� pl;At leo•o _Pz� sal y g,o 3 .0 l' pAg 106,10 o fo I ga s © 0 �-)-° &I ` / 30 3 a o j,ot�t THIS POWT SYSTEM SHALL INCOR ORATE PER COMM. 83.44 {2 c A PROPER ZABEL FILTER ODEL # /T !bo V'f ge q�,� / " = 3d ,+� -PPS K- 35 • - .BRIG° �r'T ��� o Loft Y`�� 33 ..................... • � , � � C,fJcvG�r� 4PPI 04 /m U 7 b Iff Vm Cf0 SS SCc TioA TA!f 4.AAC 3 � 54 Aw Iff I tf/ f 1,01-1 -a _ L.� UAL s y�T&-" , OVER, See Backside For Inspection Piper Vent Details PAGE 6 REVERSE SIDE OWNER's MAINTAINCE OF SEPTIC SYSTEM PGWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular Y g periodic inspections and servicing is necessary for the safe healthy operation of this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS * Governmental authority/ Y/ C Of eG * Licensed installer, responsible for providing an operation/ maintenance "Users" manual: - 7 ?A - �I �/Z k �f RC eG ,til 4 4e S * Licensed service / inspection agent other than installer: 30'6•/30 * Electrician, for pump, electric controls, wiring units: IV 1 IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic (sledding, shoveling, etc.) across the area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. 'Discontinuos use in the winter (a vacaction t rip, resulting in no water use) can also lead to freeze ups. <. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. ed. This system ' - - Y was des lgned for a maximum wastewater flow of &6v gals. daily. IW- / / ��d 3. POWTS are not designed to accomodate waste from garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy th is y s s Y stem. 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (leakkge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. - Neglect of the vegetative cover (the qells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent ' stem be in the system beneath IS NOT sufficient cient alone t0 maintain a grass cover. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated Into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly quali6ied person should be performing this work which involves health ' & severe safety risks. Evidence of effluent ponding in the system's t.re3tment cell shall also be regularly inspected. I� Wisconsin Department of Commerce SOIL EVALUATION REPORT Page l of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Aden. Code County $ f • `��O/ .Attach complete site Plan on paper not tens than 8 112 x 11 indses 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. Please print all Information. Re ' Da Persons! lnrormaWn you Mvide ftW be used for secondary purposes (Privacy taw. s. 15.04 (1) (m)). / I (,e 03 ProperlOwner Iffri nte= Property Location 4/ . ?E 7 ?SO"1 /J /q s Govt. Ld Alk) tl � 1/4 S / 7 T N R (or) W Property O~s Mailft Address Lot # Block # Subd. Name or e8W 7W6 W600 1403f 7 ' 1911e. Y State Zip Code Phone Ntxrlber ❑ ❑ Village ® Town Nearest Road �,00v/3v�2 ,Af,� 5 ( Ohi 905 •3,,, New Construction Use: 15 Residential I Number of bedrooms Code derived design flow rate GPD 0 Replacement 0 Public or commercial - Describe: _ Parent material _. IDES 0 LAZ y 00 JS'&, Flood Plain elevation if applic abte _VT�� ft. General comments and recorrxnendations: , Ae 7 & - 5'T& 5 / ie At) i v� a VWP f d •G� • % S . /j�o ���,�S�P TIT"a 6e /ls Boring # Boring Ground surface elev. X0 3.3 R� > / Depot to limiting factor in. Soli Application Rate Horton Depth Don*kWCdor Redox Description Texture Structure Consistence Boundary Roots GPQM In. Munseti Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 / 0-/0 /0 R 3/ Sid Z f s b/c- X 3 .5 • e 3 � 7s R G 441 S — o s ,• S L # 0 Boring ° `� 8 ° > //O Pit Ground surface elev. ft. Depth to iirniting factor in. Sol! Application Rate Horizon Depth Dominant Col - Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'M1 I "Eff#2 D• /O 3/ S/L 2 he q W 3 S , • s - S D l• ' Effluent #1 = BOD > 30 220 mgt. and TSS >30 1150 mg& ' Effluent #2 -130D < 30 nxfti. and TSS = 30 mglL M Nam "ease P" Signature Nurriber IQ Add D We Evaluation ed Telephone Number o�� . /o• `03 115 • - 77a• 3 yyZ Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 ORIGINAL 1 S Go T Z 3 Property Ovuner Parcel ID # � � page of # ❑ 4 i P � m t Grad surface dev. ID /• ft. Depth to Fmitrig tailor > • v in. Rate Horizon Depth Dominant Color Redox Description Texture structure Consistence Boundary Roots GPM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 SG If S � • i � Z / SSG C cs Z •3 D 7.5 Y LS /•w, c •7 /. - 2.S S 6 a-S — l • Z II S 6� S D ^7 c Bolt # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Souk Appl ication Rate Horizon Depth Dominant Color Redox Description Textrxe Structure Consistence Boundary Roots GPDff IrL Mu nse8 Qu. Sz- Cont Color Gr. Sz. Sh. '81#1 'E1142 E Boring # ❑ Boring , ❑ pit Ground surface elev, ft. Depth to limiting fad in. ' SOfl Application Rate Horizon Depth Dominant Color Redox Description- Texture Structure Boundary Roots Pmff IM Munseell Ou. Sz. Coat Color Gf. Sz. Sh. `Eff #1 *Eff#2 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to Eirrriting factor Soft Rate Horizon Depth Dominant Redox Desaiption- extvre StrucUxe consistence Boundary Roots GPD1tF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Etf#1 *Eff#2 j Effluent #1 = BOD > 30 < 220 mgA- and TSS >30 150 OKA " Effluent #2 = BUD < 30 ffKA and TSS 1 30 mgiL 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. SND -!SM (R -6tl6} r f °vVD . .SU RUE 5 � �► - r4/v /r 3 IS 30 Y rt� y x ( Z t LS V fly, , 3 ti 0 s lb° ,! 30 11ar � 33 l 05/29/2003 10,07 .7153914232 NIELSEN PAGE 04 s 1827 Wisomsin p+parinant of Commeme BOIL EVALUATION REPORT pop . 1 C 3 Oiviaon of gall* and 9uildinga In emordanoe with Comm 85, Wis. Adm. Code Guaturn Septic 5®rlim Adtach mmpots site pion on pafasr not Nee than 8% 11 �rohos to si=e. Plan moat CW* Induea. but not HTAW tai veftw end hw uorm mWOVe point (", d aciim end _ _ ... St Croix Pescent sbpe, loft or dmamsiana, nor81 mm, and k=iw and ft" b nearest road. Penal l,D. pend'ng , Pusses Print aw trAfamnfto%. Kt viru+red By Data P�eISOnW aMa++reen Yeu provide mry be wN rot �d1r pwpQw (P*W law, 1.16.01(1) (m)} Ply t�wnar i�mparty trotxltion Hutslbird Land Cc oration Ooxl Lai 19 SW114 17 T 28 NR _19 W t'roverty tdwn 3 t1lr1 ft Address 81ook d 18 1 . Ntima or G" _ — 339 Minnesots Street, East 1404 nfe Troy Wood Subdivision b fit.*± > Gods i�r�oriG raancia _ .. . _. ` _.... _.. _ - faun twaerowt itosd �i J �► J►;� .,,.....,.�,...�....., Saint Paid i MN , 55101 881- 222 -5683 Tin E Cava Rd t Crocus Hilt Raid l d fNaw Casobwchon LIM 16 Fmi0entlai 1 Number of badrva m 3 Code derlml design flaw rile 450 GPIs j Flaplacartnnt r „J PUdiG or Cnrtarserzial - UeaCrtbe _ Perrl+it rnalariet outwtash p t sins Mow inn dwaw. It Wptieabte No General oornerwo and mo m nan hail ns: Part of 1.70 acres#. 8M IF1e 100.0', SM QrA 76.0'. Reoommend systern elevation 9S.0' along 97.8' contour. i P4+4 tlorIng s J Oaring d Pit GrW4 Surreal aiov. 82.0 ft. Dq* to i mft factor >75 in. Sol Ap ksllm Rate 1 Don eeaip m :esduro tr"we Casletanw laundry I 'EfAii1 `f?tpt2 1 0-S i0ys212 I non mil 2mcr mutt " as } 2f,1m 0.5 0.8 2 9-16 1 0yt3/4 none sil 2m4bk mvfr ow if 01 0.8 3 16 - 10yr4l4 ( none . ��sw � 2msbk mvfr I cw � - � O.b 0.8 . ! - S 1 35 75 r418 none ell 2msbk rnvfr ow 1 0.5 0.8 10 .....�..__ .. } _..___._. � _ _.L.._ .__..... Y g >sbk mvfr - I 0.7 1.2 ate J Ad Pk Gmund Surft m aim —9 R Depth to limiting factor Y74— Freo WdatimpZ Hartton OapM► insM Dior R cnptltxt 1 eslna stmciure j srsteaca ( l"dwy I ate W. f I • Yr 1 0 - 12 10 12 nano ' gr. sl 2msbk I rovfr 1 as 1 I 0. 6 0,9 2 12.18 f OV414 nena gr. $1 2msb mvir i — cw - 0.5 0.9 1!!•+43 10yr5l6 none s 0 sg i m1 � cw � - � 0.7 � 1,2 4 43.75 tQyrSM none s 0 tap m! I 0,7 + 1.2 Effluent 01 g WID 30 < nwL and T$3 3-30 4 1 So mglL ' Tumnt $2 = SOD S.30 rrIWL end TS8 SX MA CST Narne (Plwa inlet) Sign ut� CST Number Tom Guatum 227518 Dat Coeduatad N1 3�D $t Now Auburn, WI 54787 1 716�-058� 134u�.. _.._.. Nopep.y S1wnw rtumara 4 CorypratW Paroe! it} a pending_ Pape 2_ot � Grd rrt) 94.3 ft to Nmimg factor JQ 8urtaca eia+,. _ 72. _ .. --- ....._.._ SaN Rate APD�n Habn Dept DOM4; — M da ux Dfto io7ft Taxtm e*m ! Bwndwy Roots 1.. — I ; 1 ©yrm I none ail 2msbk mvfr ss 2f i m ' 0.5 4.8 11 -24 10yr414 none Be 2msbk mvfr cw t ! If 0.5 0.8 3 2435 � 7.5yr ( n one gr. s! 2m mvlr ew j - 0.5 0.9 4 36+-48 low" _ none 1 _� lmsbk mvfr._ I Cw �..._ 0'7 4M5 1 f Y� Wane IS l msbk mutt ow _ 0.7 1. 2 6 53.72 1Oyr616 - -� none_ is 1 mspk m r �. �- - 0 --�— „ „ i t�k urf 47. ft to lk* factor > Ad 5 aC@ elay. _._ .. n9 iro .._�_ �..7z._._ . soNApphoa0on Rata Hmkw ooaurR OR I x axture Coulstdnce awnclarf I o cam_ i "E1fY1 'Em1#2 1 1 2 none ail 2msbk 1 mvfr as __ --.. _. ... 2f.1 m i 0.3 0.8 2 12-26 i 1Dyt314 nano ell ' 2msbk mutt { cw 1f,1rn I 0.6 ! 0.8 3 26 10yr414 none ail I 2msbk mvlr cw 1f 0,5 O's 4 i 33.38 7.5yr4t6 none ! gr, !s ! lmsbk i mvfr i cw y 0.7 1.2 � �37 , 3 1cyr516 Wane gr. s o a8 i m I av ! f 0.7 j 1,2 $ ; 47 -72 10 r6t8 none M i lmsbk mutt O J Rlor(r� f Pt C*attrid 8urfacee a�ay. s to I'mxtinp fader W Abp , Pite ot= 000 DWNW4 cow Ratx N — Wptbn ! Poxtnnt � re � C "Et1lf1 ” I fff ` rrMJ nt 01= 800 30 a 220 nVj and T88 X30 c 30 a' ,? ffW- Effluent AK2 = t30D -1.30 rrlgtL and T99 <,.X n'ig% The Depart bent ofContmerce is an equal o ppo =itr service provider and employer, if you need as jpng414 i4VA S@rVj M or need material In an altemAw format, V ' WA a nud t:4c dcna.*trnant at 606-266-31151 or 7TY 609. 2644777. 4.v (eat •.17y - 73 - - - -- — tu kJ ►' b 0 C.0 i r• ■ 00 N A Go ro A N II II I� C> r r O a m " Lo < < r O --I N A p O O — 0 2 a op a Y Ln VI e A m O cr, - - e co aD t0 07 Co - 0 0 in °1° CD ,n0`u0 a in°1lj0� 96 to m co _ c w sue' cp G) i n 3 �mQ4,�Y C 5 z R S SL 0 � a � _ � v 3' r c i D 2 3 y p p 1 0 2 733565 i STATE BAR OF WISCONSIN FORM 2 • 1998 KATHLEEN H. WALSH W ARRANTY DEED REGISTER OF DEEDS W S T. CROIX CO.. WI Document Number RECEIVED FOR RECORD This Deed, made between Day Farm Investors, LLC, a Minnesota Limited Liability Company 08/04/2003 10:00AN WARRANTY DEED EXDFT i Grantor, and Appletree Builders, Inc REC FEE: 11.00 TRANS FEE: 278.70 COPY FEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recordina Area Name a nd Return Address Lot 9 Troy Wood, Town of Troy, St. Croix County, Wisconsin /�'r�i D3 - /OVb 040- 1269 - 80-000 Parcel Identification Number (PIN) This is not__ homestead property. (is) (is not) Exceptions to warranties: Subject to notes, easements,restrictions covenants and rights of way of record, if any, including but not limited to those for drainage,water retention ponding,and or utilities as may be shown on the plat of Troy Wood recorded in Vol. 8 of Plats, page 28,St. Croix County, Wisconsin.The warranties of this deed, either expressed or implied are limited by the grantor to the grantee, or anyone in the chain of title, to an amount not to exceed the consideration expressed herein, that being the sum of $92,900.00. Dated this 21st day of July 2003 Day Farm Investors, LLC . by President . Austin J. Baillon AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature ss. s) Ramsey County. ) 4 Personally came before me this 21st day of r authenticated this day of _J , 2003 _ the above named Austin J. B aillon TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledge the same. authorized by § 706.06, Wis. Stats.) A- &IA a THIS INSTRUMENT WAS DRAFTED BY PAUL A. SAILLON Paul A. Baillon, Attorney at Law ' Paul A Baillon NOTAPY PUBLIC•AIINNESOM Notary Public, State of Wi s (Signatures may be authenticated or acknowledged. Both are not My Commission is perm ' necessary.) January 31 2005 ) \ •Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2 .19918 INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI 800,37.2021 S'1' CROIX COUNTY - sumr 'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CER CORM Owner /Buyer ��IJ/Y►•l �_ �� / �! s �� GLtT�I� ���� �� � /yut� G•C,(�i1 S' Mailing Address Properly Address 7 (Verification required from Planning Department for new construction) City /Slr � e� �( Parcel Identification Number © ya MG SUSCRWHON 0 2-8 ( 7 - o Ptopetly Localivn ' /,, ' /�, Sec. i' N -R i W, Town of Subdivision _ 7 )eoy V 0 1O , Lot # / r CeNitied Slil i1•Inp # , Volume Page # Wnrtnnly Deed # SAP , Volume 3 , Page # L Spec house yes C3 no Lot lines identifiableA yes O no SY S'I'I',l* t r , _ � N�AIN � GN improper Ilse and maintenance of your sep4;c system could result in its premature failure w handle wastes. Ptoper maintenance consists -of pumping out file scplic lank every three years of sooner, if needed by a licensed pumper. What you put into the system can nffeA the function of the septic lank as a ltealntent stage in (lie waste disposal system. .1 he property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a rnaetet plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site waslewa(erdisposal system Is in proper operating condition and/or (2) alter inspection and pumping (if necessary), the septic lank is less than 1/3 full of sludge. 1 /we, file undersigned have read the above regviremenls and agree to maintain the private sewage disposal system with the standards set forfh, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification Mating that your scplic system Iran been maintained nnrsi be completed and returned to the St. Croix County Zoning Office within 30 ys of th V oPPLICANT piration dale. S1 a U DATE OWN CE RTIFICATIO N 1 (we) certify that all slatcnrenls on this form ate late to the best of my (our) knowledge. I (we) Am (ate) the ownet(s) of the ptn erty describe above, by virtue of a warranly deed recorded in Register of Deeds Office. r. Or AP 1CAN r DATE r * * ** • .11 ny information that is nis- represented tray result in [lie sanitary permit being revoked by the Zoning Department. r' # r* • ** inelntle rcillr Ills application: a stamped wattanly deed ftbm the Register of Deeds office a copy of (lie cetlified survey snap if reference is made in (lie warranty deed alt R f ✓ Ik ?_j. r 0 1 /// Or vm W i J ! i / cc 0 0 \ j / vW / M Vo 0#0 IN #00 000 n \ \ 1 �/ .s 1327 Wisconsin Department of Commerce SOIL EVALUATION REPORT P 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Gustum Septic Service Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal c p direction and percent slope, scale or dimensions, north aaoiy, ap r 'o0 aoid,dis ce to nearest road. Parcel I.D. Please pnn 11hf6imatiorj. � Reviewed By Personal information you provide may '7n u'� ftir second osp� (Placy Law, s. (m)). Property Owner % Property Location Humbird Land Corporation ". t << ^ Govt. Lot 19 S W 1 /4 S 17 T 28 N R 19 W Property Owner's Mailing Address r. `�Oi X. Lo i# me # Block # Subd. Na or CSM# 332 Minnesota Street, East 140 ( -'OUN 9 n/a Troy Wood Subdivision City State `�ip,ccd b1Bti1 W �' _j City J Village ej Town Nearest Road Saint Paul I MN 0�1 _�51 2�25�� Troy E Cove Rd / Crocus Hill Road N New Construction Dce= pe' Residential / rooms 3 Code derived design flow rate 450 GPD Replacement ,J Public or commercial - Describe: Parent material outwash plains Flood plain elevation, if applicable n/a General comments and recommendations: Part of 1.70 acres. BM #1= 100.0'. BM #2= 76.0'. Recommend system elevation 95.0' along 97.8' contour. P Boring # Boring ✓� Pit Ground Surface elev. 82.0 ft. Depth to limiting factor X75 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' *Eff#1 *Eff#2 1 0 -9 10yr2/2 none sil 2mcr mvfr as 2f,1m 0.5 0.8 2 9 -15 10yr3/4 none sil 2msbk mvfr cw 1f 0.5 0.8 3 15 -24 10yr4/4 none sil 2msbk mvfr cw - 0.5 0.8 4 24 -35 10yr4/6 none sit 2msbk mvfr cw - 0.5 0.8 5 35 -75 10yr4/6 none gr. Is 1 msbk mvfr - - 0.7 1.2 Boring # I Boring ✓� Pit Ground Surface elev. 98.1 ft. Depth to limiting factor >75 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= *Eff#1 *Eff#2 1 0 -12 10yr3/2 none gr. sl 2msbk mvfr as 1f,1m 0.5 0.9 2 12 -18 10yr4/4 none gr. sl 2msbk mvfr cw - 0.5 0.9 3 18-43 10yr5/6 none s 0 sg ml cw - 0.7 1.2 4 43 -75 10yr5/4 none s 0 sg ml - - 0.7 1.2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 50 mg/L * Effluent #2 = BOD <30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450937th St., New Auburn, WI 54757 11/16/00 715 -658 -1344 Property owner Humbird Land Corporation Parcel ID # pending Page 2 _of 3 2] J Pit Boring # J Boring - Ground Surface elev. 94.3 ft. Depth to limiting factor >72 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ' *Eff#1 'Eff#2 1 0 -11 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 11 -24 10yr4/4 none sil 2msbk mvfr cw 1f 0.5 0.8 3 24 -35 7.5yr4/6 none gr. sl 2msbk mvfr cw - 0.5 0.9 4 35-48 10yr4/6 none Is lmsbk mvfr cw - 0.7 1.2 5 48 -55 10yr5/6 none Is 1 msbk mvfr cw - 0.7 1.2 6 55 -72 10yr6/6 none Is 1 msbk mvfr - - 0.7 1.2 F Boring # Boring Pit Ground Surface elev. 97.8 ft. Depth to limiting factor >72 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD& 'Eff#1 `Eff#2 1 0 -12 10yr2/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 12 -26 10yr3/4 none sil 2msbk mvfr cw 1 f,1 m 0.5 0.8 3 26 -33 10yr4/4 none sil 2msbk mvfr cw 1f 0.5 0.8 4 33 -38 7.5yr4/6 none gr. Is 1 msbk mvfr cw - 0.7 1.2 5 38 -47 10yr5/6 none gr. s 0 sg ml cw - 0.7 1.2 6 47 -72 10yr6/6 none Is 1 msbk mvfr - - 0.7 1.2 Boring # I Boring Pit Ground Surface elev. -_ -. _ - __ ft. Depth to limiting factor - in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 'Eff#1 'Eff#2 i ' Effluent #1 = BOD 30 < 220 mg/L and TSS >30 < 150 mg/L ` Effluent #2 = BOD <30 mg/L and TSS <�30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608- 264 -8777. 1 C L i �J N L+ OD O z N c-C) C 0 0 o a �o� o a o cn 'o OD m o " "- f� CN 03 CD g' 6 L a no�uo � --- an °1u �o Cli 0, cn I � c 3 �cn�zr�cnwmx 3r m oo rNAc 0 - Z 3 m � r S --I _ c j � o a Z 0� n o $,y C7 cn O n 0 W o 0 W O G W C O G 7 m t - 3> pJ C7