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HomeMy WebLinkAbout040-1277-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463179 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: Vollmar, Warren Troy Townshi 040 - 1277 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: �d �. 5 Section/Town /Range /Map No: /0 0 , S ✓h � L� tj 1 : , c) , (c. 17.28.19.1544 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION - "° HI FS ELEV. N . 4 /oo Septic Ly- 2 . 5 103,47 /db "S Dosing Alt. BM / yrj Cc, LIU (�. t AeFakiera— / � V Bldg. Sewer ! &/0 n • w g Holding Val St/Ht Inlet � TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic /4/ . Dt Bottom Dosing '7 4Z t / 4 / Header /Man. ,�� ✓Od , J ZS Aeration Dist. Pipe Holding Bot. System 5.47 99,47 ok � PUMP /SIPHO INFORMATION Final Grade � 3 �`�� 101 � 1 Manufacturer Demand St Cover p P/�, GPM r 1 - 7 Z 17 . (, �� Model Number � 30, 75 o� of T TDH Lift�S Friction Loss System He T d DH Ft vol Z .'7� 6.5 z -4 ,55 Forcemain Length # Dia. 2 // I Dist. to well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenc es PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS �/ Q SETBACK SYSTEM TO ll> P/L 'J BLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: �/� UNIT Model Number: NA— � DISTRIBUTION SYSTEM Header /Manifold Distribution / x Hole Size �t I x Hole Spacing Vent to Air Intake Pipe(s) l `i J L Dia ' Length � I Dia \ 1`�' Spacing 3 Z $ Z-7 26 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 Bed/Trench Edges \ Topsoil Yes ] No es 1 No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: 1 Z— / / C Inspection #2: s / ZS (0 Location: 408 Eagle Bluff Drive Hudson, WI 54016 (NE 1/4 NE 1/4 17 T28N R1 9W) Eagle Bluff Lot 12 T �' Parcel No: 17.2 1 1.) Alt BM Description = F ' ` CtJe,,,_ CIS " wS d- �` �`�' e- tj V� 2.) Bldg sewer length = ) a i ,r� �A - amount of cover C— �—. b 1 Plan revision Required? [ ,'i Yes No ll "� Use other side for additional information. L SBD -6710 (R.3/97) Date Insepctoe ignatur Cert. No. � �� -�.. ',�` -`�� a� � � �Q� L �. Z ��n41 Safety and B ' ivision County 201 W. Washingto Ave . CROIX Nyl isconnsin Madison, 1 5370 - E® S 'vary Permit Number (to be tWad in by Co.) (608 266 -3151 J `3 I TI S Department of Commerce a Plan I.D. Number j Sanitary Permit APPlicat on 0114 'RAMS ID r 1075307 In accord with Comm 83.21, Wis. Adm. Code, personal info' yon yeti UkX COUNT may be used for secondary purposes Privacy Law, s15 IN oject Address (if different (hart mailing addrpi) . �og 11. Application Information - Please Print All Ltformatiun Properly Owner's Na me arcel N Lot! Z BIoC�I WARREN VOLLPLAR — o -1 �7- �0 l a k) A —___.. --- - - - - -- Property Location / 71044 ly Owner's M ailing Address ShLRWOOD ROAD — iti;J , NE k s ec tion 17 City, Zip CWC Phunc Number N 551 26 `651/461 -8421 t (le ) t iN _ -- 2b N; R 19 E or UW II. Type of Building (check all that apply) 12,er$ wNtFt� Subdivisi n Nanne CSM Nltmbat 1 or 2 Family Dwelling - Number of Bedrooms 3 s " CL u ,,L� Geuvie EAGLE BL�U1'F' ❑ Public /Commercial - Describe Use f .� ❑City_❑ ijlage I'ownship of ❑ SS4 TkO State Owned - Describe Use / _ - %Ai%A - cu. i 111. Type of p ermlL' (Check only one box on linek Complete liar 13 if applicable) A. a System ❑ Replacement System ❑ Trea [me nu Hold ing Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of FOPcrmit Transfer to New Before Expiration Plumber wner W. Type of POWTS System: (Check all that a I ) ❑ Non - Pressurized In- Ground [I Mound > 24 in. of suitable soil ® Mound < 24 in. of suitable soil ❑ At -Grade ❑Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized in-Ground ❑ Holding Tani: ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ex r 1 ❑ Recirculating Synthetic Media Filter ❑ Leach Vg Chamber ❑ Drip Line Grave ess Pipr ❑ Other ( Z � _ V. Dispersal/Treatment Area Information: X 4 • 7 0 Design Flow (gpd) Design Soil A licatio i Ratc(gpdsQ Dispers:,l Area Required (SI) Dispersal Area Prulwsed ( lai sl) System Elevation 450 l.O 450 450 99.47 Steel Fiber Plttatic VI. Tank Info Capacity in Total Number Manufacture! Prefab Site Gallons Gallons of Unit Concrete Constructed Class New Existing Tanks Tanks septic or Hording Tuck 1000 1000 1 WIESER CONCRETE X Aerobic Treatment Unit Dosing Chamber 600 600 1 WTE ER CONCRETE X VII. Responsibility Statement- 1, the m undersigned, assume responsibility for uutullation of the POWTS shown on the attached laps. Plumber's Na me (Print) Plu is Si gnature MP/MP Number Business Phone Number BENNIE �iELGESOIu 715/772-3278 Plumber's Addre is (Street, City, State, Zip Code) W1229 770Th AVEINLE, SPRING VALLEY, '� 54767 VIII. County/Department Use Onl Sanitary Permit Fee includes Groundwater Date Issued uI gear Si a (No Stamp) Approved ❑ Disapproved Surcharge Fee) 2 ❑Owner Given Reason for Denial ✓� �� IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER: 1 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. Attach complete plans (to the County only) for the system on paper not less lh:m 81/1 x 11 inches 14 size �ti --C ►1 c a i Ij �� R .rt • o�, i i t opa "Y Vi / g 9 0 ti 5 / I e S � C( B-M , cc. , , d2EQ.eC� To o l" f vL pipe �� H �'e O t Safety and Buildings 4003 N KINNEY COULEE RD commerce .Wl.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 t i c - Department s co n s i n www. www.commer isco sin.go / of Commerce wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary October 27, 2004 CUST ID No.220292 ATTN.• POWTS Inspector BENNIE W HELGESON ZONING OFFICE HELGESON EXCAVATING ST CROIX COUNTY SPIA W1229 770TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/27/2006 Identification Numbers Transaction ID No. 1075307 SITE• Site ID No. 691480 Warren Vollmar Please refer to both identification numbers, Eagle Bluff, Lot 12 above, in all correspondence with the agenc Town of Troy St Croix County NE1 /4, NE1 /4, S17, T28N, R19W FOR: Description: Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 988467 Maintenance required; 450 GPD Flow rate; 22 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual, SBD- 10572 -P (R.6/99), Pressure Distribution Component Manual, SBD- 10573 -P (R.6/99); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, 0011 �'th slats. A The following conditions shall be met during construction or installation and prior to occupancy or use: DE RTMo4T C General Approval Requirements: OF FIE • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORE 0 "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat BENNIE W HELGESON Page 2 10/27/2004 • Comm 83.22(7) A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 G� Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 !e 0*& . .4 jej INDEX SHEET �z � �F! 6oIv PROPERTY OWNER: WARREN VOLLMAR °,k 1044 SHERWOOD ROAD SHOREVIEW, MN 55126 PROJECT NAME: WARREN VOLLMAR PROJECT LOCATION: iNfl /4) , S 14717, T 28 N, R 19 W EAGLE BLUFF SUBDIVISION MUNICIPALITY: TOWN OF TROY COUNTY: ST CROIX DESIGN: PRESSURE DISTRIBUTION MANUAL SBD- 10573- P(R/99) MOUND COMPONENT MANUAL SBD- 10572 -P (R 6/99) CONTENTS: Page 1: Plot Plan Page 2: Cross Section and Plan View of Mound Page 3: Distribution Pipe Layout Page 4: Septic Tank & Pump Chamber Cross Section and Specifications Page 5: WLP 1000/600 -MR ZABLE Tank Specifications Page 6: Pump Specifications malty Page 7: POWTS Owner's Manual & Management Plan - Pg. 1 N Page 8: POWTS Owner's Manual & Management Plan - Pg. 2 F COMMERCE ; L N GS PO NDECE Name: Bennie Helgeson Signed Address: W1229 770th Avenue Spring Valley, WI 54767 Credential Number: 220292 Date: October 18, 2004 Oct kd� o" Q _ ) C', rt i 3 -M I C'C'. POC A m a r3_E 3 g 70 Ta B, M, r3� T 04 Pjp4--, r - - 6 VC In t r gage Synthetic Covering Distribution Pipe Medium Sand Topsoil F —" p �i — E b C oo v. 3 Slope Plowed 2,2 Force Main Aggregate From Pump Layer D 4 Ft. E 1 ,91 Ft. Cross Section Of A Mound F , e0 Ft. G , S Ft. q $ Ft. H _ / Ft. Signed: B K F t. License Number: L Ft. Date: J Ft. T Z2, q Ft. Ft. L — - __ Observation Pipe K �} B -- - ------------------- - - - - -- ----- _ J T % Distribution L- Of 2 2 — '2 Pipe Aggfegat I I 17/ Observation Pipe &a5e„l A e = ( I L i ?. 5 Plan View Of Mound V., I - �Ia r Porlorolnrl Plp• Doioll SL C �Ectv j End Vltr P•rlorairo ((ul� PVC Pip( -40 .`Ocr 0` Holes Located on Bottom are Equally Spaced :.�1LSL_IJe'� /�� v2 ,[ T -�' c� r' •: rn i o{ W . l IE'Ea,GKt.�� �� oltl,lbullun... Pip* Discribur ion Pipe Layout P� R S X 7 •� Y Hole Diameter Inch Signed: Lateral Inch (es) License Number: 1 Manifold." � Inches Dace: Force Main " ` Inches PO(CS Pe, 19— / cx be r o X11 +�1- = k 3 7 S" V o 11 rn a-r Page 4 Of SEPTIC TANK E PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 4 " FIX_ VENT PIPE 12" MIN. ABOVE GRADE E WEATHERPROOF 2:25 FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK E WARNING LABEL MIN. zy w 18" 1mrN. , �B MI1�• INLET � I' WATER TIGHT SEALS GAS• , TIGHT j 1 VAPPROVED _� A SEAL FIL E R JOINTS KITH APPROVED ZA JW_ A - 100 ALM APPROVED PIPE (a PIPE 3' "x /f ON B ' 3 ONTO ONTO SOLID SOLID SOIL C SOIL PUMP OFF ELEV . �,6 fT. —f OFF D 3" APPROVED BEDDING-UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE � t ��r3 7 X `�' S '. TANK MANUFACTURER: tiyt -e5ie r r TANK SIZES SEPTIC 1006 GAL. DOSE VOLUME INCLUDING DOSE x„60 GAL. 18, 75'6,Ak ..-->FLOWBACK: D,6 GAL• ALARM MANUFACTURER: - e �-v CAPACITIES: A = 19• INCHES = 30149 GAL. MODEL NUMBER: SWITCH TYPE: a c. B = 2 INCHES = 33 -S_­4 GAL. PUMP MANUFACTURER: ? o,--I(f1— C = 6 INCHES = JX), s( GAL. MODEL NUMBER: S SWITCH TYPE: D = /U INCHES = E GAL. RE UIRED DISCHARGE RATE O . 'GPM PUMP 6 ALARM WIRING AS PER ILHR 16.23 . WAC Q 7_ VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . 17,q1 FEET MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . 4.s FEET + FEET FORCEMAIN X „p FT /100 FT. FRICTION FACTOR _O, FEET 1L — — TOTAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH WIDTH DIAMETER y LIQUID MTV - 3 > SIGNED: LICENSE NUMBER: DATE: 1/88 CL D a J z mu �- it _j Q�� Nd wa LO wz tL0 Q ' ��O z kW v.. In O = I o cia 2 4 O Y w� o �qN �wU O O� vn: Q f wF c Q O m.� ZZ o I co, VW c 6 Q � � ������ � --y--�� ^ � H- cn Q c OJ JV _j -J 1....JI.J dam' �'. o w Vi as Z = 1 � Wi r / O vi �N Www (n QJ ' U D 4 N < vv V • • F_ p CO • eD w . 0 W pQ0 N to� In Q <Wy a p 0 Z �VJ • OOO��rn �II mNhW N� O < .f 0 O j_ J I F- Q ► - • N11D W� Q' WJ�U L } Z 0 "' ;n .In '' � Z w � r W F F' (n c� Q Z 6i x E� O O 5 �� Y � p Q Q �3mPj��m�3 zd �� U z w Q z Z J J i J „z* z : - °--- - - - - -- LLI I' . • I . I I f I , I I I w 1 , S \ 5 �f w ~ U V Lu . 1 1 . , I I i ' I. 1 I I I F- ��6 C „95 S / 3 V I I 'Yl • ILTAL DYNAMIC NEAD/CAPACITY HEAD CAPACITY CURVE PER MINUTE FFfI UE NT AND DEWATERING N MODEL 152/153 X MODEL 152 153 50 Feet Meters Col. Liters Gal. Liters 153 5 1.5 69 261 77 291 12 40 10 3.1 61 231 70 265 qc 152 15 4.6 53 201 61 231 t� 20 6.1 44 167 52 197 x cv 30 25 7.6 34 129 42 159 8 30 9.1 23 87 33 125 0 20 35 10.7 -- -- 22., 85 0 40 12.2 -- -- 11 42 �- 4 Lock Volve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) 10 014 0 20 40 60 80 100 GALLONS 6 1/4 LITERS 0 80 160 240 320 3 27/32— a 5/8 FLOW PER MINUTE 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS _ - f • Timed dosing panels available. ® 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase i systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. l • Sealed Qwik -Box available for outdoor installations. See FM1420. • Over 130 °F. (54 °C.) special quotation required. i 1521153 Series 12 1/8 152115) MODELS Control Selection Model Volts-Ph Mode Amps Simplex Duplex 5 1/8 Ni52 115 1 Non 8.5 1 2 or 3 ON152 115 1 Auto 8.5 Included 2 or 3 su2oe4 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 8NI53 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE E153 230 t Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float BE1531 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. O CAUTION 2. See FMO712 for correct model of Electrical Altemator E•Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 - 0225 used as a control activator, s pedfy duplex (3) licensed electrician. All electrical and safety codes should be followed including the most 4 float recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (� system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 LouisviUe, KY 40256-0347 Mandacturets of. , SHIP TO: 3649 Cane Run Road t • Louisville, KY 40211.1961 Qcraary14"Ar /99.9 httpJ/www.zoe!lercom PUMP M, f � 7 FAX (502) 7736248 PUMP © Copyright 2001 Zoeller Co. All rights reserved. 'POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of i FILE INFORMATION SYSTEM SPECIFICATIONS Owner y /Ax!<EIti VULLilAh Septic Tank Capacity 1000 gal 1 O NA Permit ft ,4((� 3 Septic Tank Manufacturer WIESER CONCRETE O NA Effluent Filter Manufacturer ZABEL O NA DESIGN PARAMETERS ❑ NA Effluent Filter Model A_100 1 x 2011 O NA Number of Bedrooms 3 Number of Public Facility Units �l NA Pump Tank Capacity 600 G a l O NA Estimated flow (average) 300 al /day Pump Tank Manufacturer WIESER CONCRETE Q NA Design flow (peak), (Estimated x 1.5) 450 gal /day Pump Manufacturer ZOELLER PUPlf CO 'O NA Soil Application Rate 0.5 al /da /ft Pump Model 153 O NA Standard Influent /Effluent Quality Monthly average ` Pretreatment Unit ® NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter 13 Peat Filter Biochemical Oxygen Demand (BOD,,) 5220 mg /L 4 NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) O NA Biochemical Oxygen Demand (BOD 530 mg /L ❑ In- Ground (gravity) O In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L Iff NA ❑ At -Grade 6 Mound Fecal Coliform (geometric mean) 510' cfu /I00ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y. in dia. ❑ NA Other: O NA Other: ❑ NA Other: 9 Other: O NA `Values typical for domestic wastewater and septic tank effluent. MAINTENANCE SCHEDULE Service Event Service Frequency O month(s) (Maximum 3 years) O NA Inspect condition of tank(s) At least once every: Q y earis) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y,) of tank volume O NA ❑ month(s) (Maximum 3 years) O NA Inspect dispersal cell(s) At least once every: X$ year(s) 0 month(s) O NA Clean effluent filter At least once every: 13 O year(s) X$ month(s) O NA Inspect pump, pump controls & alarm At least once every: 13 ❑ ear(s) ❑ month(s) p NA Flush laterals and pressure test At least once every: 3 A2 year(s) ❑ month(s) 0 NA Other: At least once every: Cl year(s) Other: O NA MAINTENANCE INSTRUCTIONS made by an individual carrying one of the following licenses or certifications: Inspections of tanks and dispersal cells shall be Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks Or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y or more of the tank volume, the entire In accordance with chapter NR 113, contents of the tank shall be removed by a Septage Servicing Operator and disposed of Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/011 OWNER: t�ARREiv `OLLPIAK Page 8 of `STARTUP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may Impede the treatment process and/or damage the dispersal call(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power Is restored the excess wastewater will be discharged to the dispersal call(s) in one.large dose, overloading the GaAs) and may result In the backup or surface discharge of effluent To avoid this situation have the contents of rite pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or cornPA4 the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and p,,tolorlg the We of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental 5ow' d1opew disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline' fire> . heMokles' meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine• ASANDON11MENT When the POWTS falls and/or is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned in compliance with ch. Comm 83:33, Wisconsin'Adminlstrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall*be removed and properly disposed of by a Septage Servicing Operator.. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: O A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compactionand should not be infringed upon by required setbacks from existing and proposed structure, lot litres and wells. F811M to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules In effect at that time. • A suitable replacement area is not available due to setback and/or soil limitations. Barring advances In POWTS technology a holding tank may be installed as a last resort to replace the falled POWTS. • The site has not been evaluated to Identify a suitable replacement area Upon (allure of the POWTS a soli and site evaluation must be performed to locate a suitable replacement area. If no replacement area Is available IS holding tank may be installed as a last resort to replace the failed POWTS. IX Mound and at -grade soil absorption systems may be reconstructed in place following removal of the bkunat at the infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that time. < <WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND10R INSUFFlCIF.NT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOS4113M ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name 11ELGESON EXCAVATION INC Name JOHNSON SANITAT Phone 715/772 -32783 Phone 715/273- SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Namel JOHNSON SANITATION Agency Phone 1 715/273 -5811 Phone 1 715/386 -4680 This document was drafted by the staffs of the Greon Lake, Marquette and Wausharn County Zoning and Sanlfsallm agancl & Thla doiwrAW a1eNs the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)3(Q and 83.54(1), (2) 6 (3), Wisconsin Adminlstrative Code. Use Of M dOtlrr=9dOM rA guarantee the performance of the POWTS. GYW t?I01) ?Visconsm Department of Commerce SOIL EVALUATION REPORT Page l of Division of Safety and Buildings in accordance with Co ` {,>z ode ( must County Attach complete site plan on paper not less than 8 1/2 x 1 inche an include, but not limited to: vertical and horizontal reference oint (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and locati n and ¢j$ta�tcedo�teoad. ' Please print all informatio � JJ 11 II GG Re ewes by Date ANT Personal information you provide may be used for secondary purpo s (Prig 1�3 A Property Owner Y Location d 1 Govt. Lot N C 1/4 1/4 S 1 T N R E (or Property Owner's Mailing Address Lot # Block # Sub Name � CSI # 1o S -m l � .e U City State Zip Code Phone Number ❑ city ❑ Village own Nearest Road / t Wd 1 :55Ia4 (��'�) 48 r© New Construction Use: U.- rt esidentlal / Number of bedrooms 3_ Code derived design flow rate e{SU GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material _ L ©C _ Flood Plain elevation if applicable ft General comments C ) 6 Ct��S �o f `" and recommendations: K ®rt c t w�lj eu b Boring # ❑ Boring - Lf Pit Ground surface elev. 9 7 � 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 0 - - �? 1 1 5 �-sLiL h� G ff - _/ VYJ Uj c � ©`f C 5 Ir • `I 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 I *Eff#2 * Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BCD ,: 5 30 mg/L and TSS < 30 mg/L CST N e (Please Print) ignature CST Number Address g —Evaluation Conducted Telephone Number Property Owner Parcel ID # Page of 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 a Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. i Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Boring F pit Boring # Ground surface elev. ft. Depth to limiting factor 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 'Eff#2 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. S 13 D -8330 (R- 07/00) i L C�UL�F V' �. LOOLr eV't Vot l 6✓�a L,- L 04 Eag 86rF- ,v yd 0 To f o t= w p c ew / 4 SG S° le T 0c i A"30 -2004 03:24 CONTINENTAL DIAP CORP 763 757 2532 P.02/04 stiioons:e a of caasn.ae SAIL EVAL! 1A l iaN gE.aRT a+w L 3 irwo r at 3ar+s1► atto euraaroe ,n aoWrdW=M % Mn Camne at A& AdM COCsr Camw ST. CROIX ,i�lf � � are v�M notlas ilstree 8 1 x Z 1 i �R11s Mt sicA. Plan n�W4 but'natlwom tat moms am tqf m i ndwm4 Pmg (WA. afro Pared LM willa.soliewc noeae ;wrtm am -- soreaea aifarifeC I totwesatro" PRamow M*w aY iO*NVMWMM RaNaw�! by OaoM s++ r�rt�Mls ns �r�► rM�M+ awsrvwslata .MnAwerArMra�N��rn�sRS, tsos111(nhl. { ops,ctyoom MARX= S. COOK Pfa ww Loan= = g # �DNTnjENTAL ©EVELOPMENT CORPORATION Goa ac ta. -- 1µ 9 Z6 T28 N 1 :19 §t4 �► srtrdctF SUOLNwooresw 11800 ABERDEEN ST. NE, STE 100 112 ' BLtlFF q, sow coos. PltOtes freaasiee Qc�r MW Taws newwtEi<aas ELAINE I MN 55449 { ( 763, 757 - 756$ TROY . EAGLE BLUFF DR. N4wcaaw&mm U4wZjReesawmsjNrmwQtb@dmonn Ceif♦defftiattaaagnilawrela �56e -- coo artt er+aeresa. Loe 5 S D are i raw Ptsin ewA* n if appptsebis N.A. efesiwl a�flraeeMe �4 r II I I pl , C,tontreseattemaw. L039.3 Dtepefrrto tam 36 :^- sd ao Roes ,orsxa. oa e i Rom r�s ! slum* I eaes,ome� ` eosuadn� } Rom I �aorl! nwf+aseu I cw. sr cam cow I Gc Sr- 31t. I I A 0 - 4 1o YR 312 # -- ! sll # 2fgr lmvfr # 2vf—m 0.5 0.8 # BZ 4-25 I LOYR 4/6 -- ; s:Ll 2mabk Ids -- 1 2vt — 0.5 0.8 B2 IZ5 -36 , LOYR 4/4 I -- sl l lcsbk Ids ! -- ( ?-,.f I 0.4 I 0.6 # El 36 -40 # LOR.Y 8/6 # -- i linst Ivf -- ! I - 1 3 :21 Bomq # r pit Gino surtaose�ar. TL it Doom to tmvir i f2t>�t .�.....2 = in. t� I Sal Amt Rate -- HoWWn j paplll t)aetl[tlartt C , RW= Daseo'MUMn i exaJre I SuLm=e # Co�10R Bmidw Roo= s Offf � i 1a ( mu.9 O I Clu. ?. cw color I cam• Sr_ sh. I mm � a 1 - l a Yx 3/Z s� 2fgr l tavfr l aw I 3vf -l: 0.5 ( 0.5 i 0.8 ! 11 3 —ZL # toYR 4 4 # it 2msbk hafr cw 2f—ta # R 22 -30 10YR 8/6 -- east #-- -- if -- — eW > 30 < 7Z0 AWL arse T33 P30 1150 r"WL ' Mont xz = 800, _ 30 mq►L am Ts$ < 30 MglL ° CSC (=r maim owsm P"m 2952 JAdES D. FILKINS ��70� ?2295Z Does f= vatuaoDa C andseeesa totrrorsosts Nun►Der s OGt)EN ENGINEERING COMPANY 11 - -99 113 t4ST 11ALNUT ST .. RIVER FALLS. WI 5 4022 3-7-1) 3 -8 -00 715-4z5-763i ^ ^� 08/30/2004 RON 14:27 1T% /R% NO 57321 AUG - -2004 03 24 CONTINENTAL DVLP CORD 763 757 2532 P.03iO4 on.as r CHARLES S-. to a G K PRrre! 2 'x 'Z f mop Q amq ��. LM pt croma fammm. IO 46.0 it D"m to ka 019 taw 31 is Sod Rays i mms®et 04M OanwUm cow" Rm n OseR.tmtsan i een Swomw Can�nos Oau�oalY Raub ' �s?Olfl� ! In. AMXM » o. SZ Cacti cow I I (3r. 3x sip � � 1 Al 10 -5 10YR 3/3 -- I sil I 2fgr mvfr I aw 1 2vf -M 0.5 1 0.8 at 15 - 10YR 4/2 -- I sil { 2fsbk I mvfr cw 2vf 0.5 { 0.8 B2 115 -31 110YR 4 j j scl 2cabk dh w j 2f-c.1 0.4 0.6 1 C 1 -72 10YR 5/6 -- sl Icabk dsh I 1 lv I' 0.4 j 0.6 ! I 1 i I I I I f I I I I I j I I ► ! 1 ?5 3 B&TV it Pit Ciouna surwos ew 1038.9 rt. Doom to 6fro erq taaar 27 .n. Sot A000ee1+ Rana E morE me Dam c QU. 2z. ca Ooa mum coy i ReeoK 00@ ctt� m � ream Stara � Con magrm 9ouaaan►1 Roar ��.., riPt3lf�' �AUm dl { nt. cow at Sz. � � -mm ( - am i A 0-7 10YR 3/2 ( Isil 12f &r Inrr 1cw I3vf -m 1 0 . 5 1 0.3 B1 7 - 13 i 10YR 4/4 1 -- jail 12msbk ta ]gar 12f - co 1 0.5 0.8 37- I3 -27 j 10YR 4/6 --- l sicl 12cabk Infr jc 2m 0.4 p, 27 -30 10YR 8/6 j -- 11mst f I 1 P5� 9oa+4w (y� GRrunasurfaoga�ev L04 L . 3 tt. 0000101komAetg fall 3 In. _Sae fact Rant t HoSli7e! OeOtR ! DOiitMlterlt Re= CW@WAMM I roan 1 Sys I corom om 9aNCmmy ( ROM f apf 1 ct. I tvletn�ll Qu. az cam cow 1 Cf SL Sit. A 10 -5 1 10YR 3/2 1 Isil j2fgr l fr j 13vt - 1 0._ 5 :0.8 1 «. 331 15-12 1 10YR 4/3 -- - Isil I2taabk 6fr jgw 12f -m 1 0 I B2 112 -ZO LOYR 4/4 -- lsi.cl 12mabk p =r jcw 1 - m 1 0.4 333 20 -37 10YR 4/6 1 Iis I I.cabk 4s Icw 1 1 0. R 37 -40 11 OY31 8/6 -- !Lm — I • t .4atcene 1N = eoq 3 = ?Z10 nVL am TSS: 1 90 ITIOL • MUM tit z t300, <_ 30 ffopL arcs T5$ 1 nt L The Oepwaete:it oe commerec is an equal vppormalty service provider attd emviover. if you need zmrtmee to access servtcos or Rood, rrMwai in an altcrrtax format. pkasa contact the dCga micrit at 608 - 266.3151 or TTY 6033.2544777. 08/30/2004 MON 14:27 [T% /R% NO 57321 AUG'30 -2004 03:24 CONTINENTAL DVLP CORP 763 757 2532 P•04/04 SITE PLAN i M 1 0 2 . 0 � r i .--�� 103 Tr ,..-� �� •mss. i f t 8422 A E: 1 1 31 1 Bench marks ace ground elevation at base of 4' wooden lath near each boring location. OGDEN ENGINEERING Co. JA t� RAINS. 222952 Civil Engineers & land Sur�ors 113 W, Walnut Si. River 5315. W! 54022 OATS ll 7 ©� (715) 425 -7631 TOTAL P.04 08/30/2004 MON 14:27 [T% /R% NO 57321 vywwormn cam ti, of Catnmeroe SAIL EVALUATION REPORT pVe 1 of 3 ' OMscort of Safety and Bucldin9s in accordance SAM Comm 85. WIS. Adm. Cade COwW ST. CROIX AVAMh complete Scte PM on Paper not lisp than 8 1 /2 x 11 i nctim to sae. Plan must incude, but notlineted to: vm x- and honxontal retwwlicePont direatiort and Pat cal 1.0. percent 360pe, stye or dintenstons. north avow, and taceW dlstartcs to nearest road. Plans& punt all i ¢ rte', R by Date `.. Pananl kwan"Man you plawli f "w bo us" for I � ae.`F 1 5.04 (1) 0+16 ProMMOwnw CHARLES S. CO o y g CONTINENTAL DEVELOPME T. CORPORATION t.oc -- 1/4 v4 S 16 T28 N R19 gr0ow ptoperty Owners NAaritt9 Address F " ` 7 81oat 0 Suo L Name or CSW 11800 ABERDEEN ST. NE STE 1 00 cROIX r- 2 -- EAGLE BLUFF cay Slile Cade Phone / cmY' village Town Neweat Road BLAINE MN 55449 ` (. 7 6 3j 1 1 1 t' 2° 5 ICE 6� TROY EAGLE BLUFF DR. ® New Cortsaucoon Use ® Restdareft / Nuntbet4*4 Goole datnved da@W tiow rate 6 0 0 GPD Replecerrters Q Pab11C or LntrKtterctal - Oesctbec Flood Plain elevatxxt if apptttable N.A. ft parent mauves Loess. Do om i P General mmrrtertb and r Zct)� P 31 Boring # Q Banrg ao,� 6 ® Pit G roun d etev. 1039.3 ft Depth to timttirg factor 36 Sal Aopli canon Rats Homan Deptlt Oonnnant comer Redox Desatpoott Texture Sft =" tas Boundary Rom GPD/fF in. Munsw Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft 1 EfT1l2 A 0 -4 10YR 3/2 -- sil 2fgr Imvfr I - 2vf -m 0.5 0.8 F BI 4 -25 IOYR 4/6 -- sil 12mabk Ids - 2vf -m 0.5 0.8 B2 25 -36 10YR 4/4 -- sl lcsbk I ds - 2vf -m 0.4 0.6 R 36 -40 1ORY 8/6 -- lmst -- -- - lvf -- -- e I FP 2 Boring Q Bortrtg ® Pit Ground surface etev. 1037.3 ft. Depth to tirndM factor 22 in. Soil Appl ication Rate B Roots GPO /ft Harmon Depth Dominant Color Red Oesctpbort Texture Structure I Corscstertce Boundary in. Munsw Qu. oz. cant Color Gr. Sz. Sh. � � 'Effe2 A 0 -3 10YR 3/2 -- sil 2fgr `mvfr aw 3vf -f 0.5 0.8 B -22 10YR 4/4 -- sil 12msbk Imfr Cw 2f -m 0.5 0.8 R 22 -30 10YR 8/6 -- imst -- - -- if -- -- -- .2 l- Effluent #1 = BOD > 30 < 220 mtyL and TSS >30 <_ 150 mg1L ' Effluent 92 = 80D 30 mq/L and TSS < 30 mglL CST Name (Please Pnnt) Slgftsaae CST Number JAMES D. FILKINS 700 222952 .adds Date Evaluation Conducted retepftorte Numtw OGDEN ENGINEERING COMPANY 11- 22 -99 113 WEST WALNUT ST., RIVER FALLS, WI 54022 3 -7 -00 3 -8 -00 715- 425 ^7631 ^ ^w —^, Progwiv ownr CHARLES S. CO OK Pal 10 # Page 2 3 Q �� # oaring P22 . Q it Groundsurfaaeelev 1046.0 ft. Depth to lirrMktg factor 31 in. Sod Aoobca Rate H== Depth Dortnnsnt Color Redox OeeCfpdon Texture Strums Consistence Boundary Roots GPO/fr in. Munsw Qu. Sz Corn Color Gr. SL Sh. 'EfMlet 'Eff10l2 Al 0 -5 lOYR 3/3 -- sil 2f gr mvfr aw 2vf- 0.5 0.8 B1 5 - 15 iOYR 4/2 -- sil 2fsbk mvfr Cw 2vf 0.5 0.8 tC BZ 5 -31 10YR 4/6 -- scl 2cabk dh cw 2f -col 0.4 0.6 1 72 lOYR 5/6 -- sl lcabk dsh -- lvf 0.4 0.6 l P eann9 At Q Baring © Pit Ground surfaceetev 1038.9 k. Depth to limitlng factor 27 in. Sal Apoicasion Rate Harmon Depdn Dominant Color Redox Oesmotion Texture I Structtue Consistence Boundary Roots O/W in. Munsell Qu. Oz Cont. Color Gr. Sz. Sh. "Q_ffflt I 'Eff#2 A 0 -7 lOYR 3/2 -- sil 12f gr 6f cw 3vf -m 0 .5 0.8 B1 7 -13 10YR 4/4 -- sil 12msbk fr gw 2f - co 0.5 0.8 B2 13 -27 10YR 4/6 -- sicl 2cabk fr cw 2m 0.4 0.6 R 27 -30 lOYR 8/6 -- lmst -- - -- -- -- -- P BonM # Q eanr+g 2 Pit Ground surface else. 1041. 3 ft. Depth to linntlng factor 3 T- 11 Mr Sod A rcatlon Rats tionlon Depth Dominant Redox Description Texture Sttucwm C lnsrstence Boundary Roots GPOMP in. Munsed Qu. SL Cont. Color Gr. SL Sh. Efftlet 'EffAn2 A 0 -5 lOYR 3/2 -- sil 2fgr fr cur 3vf -f 0.5 0.8 B1 5 -12 10YR 4/3 -- sil 2mabk fr gw 2f -m 0 �( B2 12 -20 10YR 4/4 sicl 2mabk fr cw 2f - m 0.4 .� B3 20 -37 lOYR 4/6 -- is lcabk s cw 1vf 0.7 R 37 -40 10YR 8/6 -- lmst -- -- -- - —' " EfMrew #1 = 800, > 30 5 220 mgll. and TSS >30:S 150 mtyL ' Effluent #2 = 000,_ 30 ng1l. and TSS < mq 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. BO-U)0 (R.O7I001 PAGE 3OF3 SITE PLAN c.D / 103 I j S B— / o / t t i � � \ e- 5S ( p � O Y1_ f \ � r A E: B-,P22 1 � P31 OT E: , B nch marks are ground elevation at base of ' wooden lath near each boring location. �`t� - � rolf"' ' OGDEN ENGINEERING CO. JAMa D. FILKINS, 222952 Civil Engineers & Land Surveyors `l D 113 V; . Walnut WI 54022 DATE: 15) 425- 7631 10 /19/2004 11:0 FAX 6 517312 31 4 KOOTENIA HOMES QD001 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner/Buyer iZ t ry a v ��`,>� G Mailing Address Y ®� Property Address DT 2 L T a (Verification required from Plaluiing Depa ent for new construction) City /StateToJvn s I-eo Parcel Idetiti•fication Number LEGAL DV. RIET10N Property Location A / , Sec.g l 0 T Z8 N -R lq W, Town of -"'o Y _ Lot # Subdivision Certified Survey Map # Volume , Page # Warranty Deed # G .____� Volume # Spec house Cl yes & no Lot lines identifiable 4-yes IJJ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its prcmature failure to handle watastes, p you P of pumping out the s tank eve three years or sooner, if needed by a licensed pump p c ever 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 tile owner hY a masterplumber, journeyman plumber, restricted plumber or a licenscd pumper verifying that (1) the O"'to wastmterdrspo tryst is in proper operating condition and/or (2) after inspection and pumping (if nceessary), the septic tank is less thin 1/3 full of sI staaduds I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal f � with p set forth, bercia, as set by the Department of Commerce and the Department of Natural Resources, OtSee within 30 stating that your septic system has been maintained must be completed and returned to the St. Croix County niag days of the three year expiration date. /y ; - / 1� / /I- ��-- DATE SIGNATURE OF APPLICANT OWNER CERTIFICATION W. (me) the °w°ec{ =) of I (we) certify that all statements on this form are true to the best of my (out) knowledge, I ( ) am ( the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. 1 DATE SIG ATURE OF ,APPLICANT 001PO•9 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 certificd survey map if reference is made in the vrArtanty deed STATE BAR OF WISCONSIN FORM 1 - 1998 7 7 7 Z5 9 1 10 U 2 6 6 7 P y 3 9 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number ST. CROIX CO., WI RECEIVED FOR RECORD This Deed, made between _Troy Development Corporation, a Minnesota Corporation 10/01/2004 12:30PN Grantor, WARRANTY DEED Judith and - Warren E. & Judi M V011012 EgEWT # -- REC FEE: 11.00 TRANS FEE: 719.70 Grantee. COPY FEE: CC FEE: Grantor, for a valuable consideration. conveys to Grantee the following PAGES: 1 described real estate in St. Croix County, State of Wisconsin (the "Property ")' Name and Return Address Lot 12 of the Plat of Eagle Bluff in the Town of Tro y, Y Croix County, Wisconsin. Warren E. & Judith M. Vollmar 1044 Sherwood Road Subject to Declarations of Covenants, Conditions and Shoreview, MN 55126 Restrictions for Eagle Bluff, recorded in Vol. 1589 , Page 516, as Doc. No. 638946 , as appearing in the office of the Register. of Deeds for St. Croix County, Wisconsin, and such other. easements, 040- 1277 -20 -000 restrictions and reservations of record, or in, use, Parcel ldentiGoelion Number (PIN) and the "Buyer" obligations contained in the is not Purchase Agreement for. this lot. This __ homestead property. (is) (is not) Together with all appurtenant rights, title and Interests, Grantor warrants that the title to the Property Is good, indefeasible In fee simple and free and clear of encumbrances except. Dated this 30th day of September _ 1 2004 (SEAL) , (SEAL) « Charles S. Cook, President Troy Development Corporation (SEAL) (SEAL) TEMPORARY OJL—#X —'SAC i UNR A T rf'D L AND EASEMENT, Rmfjot , _. S 22'55" 21" E 86.01' �s T€3 "RADKJS POINT NORTH LINE OF THE 5 1 /2 OF THE SE 1/4 OF THE SE 1/ TEMPORARY CUL—OE -SAC 1 �- i�► EASEMENT, R -#80' . mar P 2 13 � �► w ?.495 ACRE +n t ` rn ° 1.628 ACRES N T 1 108,698 5.F, N 1 � 70,930 S F. kCR S 1 S.F to E lot 8 ACRQ 1 1 127 ACRES . N 1 68,94 ACRES *' ,136 S:F. 88.940 S.F. z 00 K t" 1 0* . % '% — i 8 tP /y1r' ,, •/ w w cl AV m R 2.518 ACRES . to Pol � + 109,668 S.F. ,/" �1 / ----- NORTH L �- !-- -- _C? i idE CQfthR .. t SECT 17 /'� ry /� g� T28N, R 19W .' �� . *H 88-36 264702' �fol OL 4. ci ' t c .l A NIJ lAIILUI U1 I, 1.LN 1 1 t I tV JUNVt T MAI KtIA)IlULIJ IN VULUML bF, t'Att. Zb iJ. UUUUMLNI #4V0,)ti:" q�l A M A SCALE IN FEET 13 4W; S(,AIS, 2000 Al 4 v .. . . . . . . . 19 nn.e Fw f PA . OUTL,2T OUTLOT III A %\ 1 O�r Z2Z L'I'm w 7 43 ZXV 17 TOWN VALLE Y ROAD . 19, _4 44-- —.00A - 2 njj I If 25 1 32 '.37 zv T 0 T 2 � 1 4i V I j#fY A LUT r 4A S ' .11 —.T S—Fl