HomeMy WebLinkAbout040-1310-00-018 VVisc, nsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
(ATTACH TO PERMIT) 514833 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:
Scharber, Peter Troy, Town of 040 - 1310 -00 -018
CST BM Elev: Insp. BM Elev: BM Description: Sectionfrown /Range /Map No:
M 1 65T 17.28.19.2005
TANK INFORMATION Pty. ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 5 2S0 Benchmark 6 X 1 0&V ' 100.0
�n D
Dosing Alt. BM
�'I �Sr (rFIG �jh Bldg. Sewer 6,1y 1,YC
Holding St/Ht Inlet '
13,11f 9'x.66
TANK SETBACK INFORMATION SUHt Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
e t+ e - r .
Septic - % . 0 ' N* -1' t > 2 1 r Dt Bottom i •
� zd �qr1
Dosing ' ly 2 r >2.1 Header /Man. 11,1.7 �♦f �Z
Aeration Dist. Pipe tZ.G9'� 1V•!i
17.�tr
Holding Bot. System 19,0! 13. Ix
I 'W 4s.ts g
PUMP /SIPHON INFORMATION Final Grade 1 1.1V� 17. Y4
Manufacturer II++ Demand St Cove "� G A
4 4A~hL GPM 14v GVtf
Model Number � kc f i o o _ It I
T K j la. Yt'
TDH Lift °' Fric tii Z d System H ead 6 1 Ft
Forcemain • Length 37, I Dia. 2 I Dist.toWell tyA
SOIL ABSORPTION SYSTEM
BED /TRENCH Width t Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 0 2 41VILAt f _
SETBACK SYSTEM TO l P/L BLDG IWELL LAKE /STREAM LEACHING Manyfacturej:�
INFORMATION CHAMBER OR bje d! T
Type Of System: _ I. 2 t~^ UNIT Mod I Number:
4,^Vt A 4, .as l vts� G ';b
DISTRIBUTION SYSTEM !to 1 = �6
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s) � 3 �IDM i
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over 11 .1. 3 q Depth Over xx Depth of xx Seeded /Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil �— �,Q� es No Yes E] No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: s / 2 0 / 09 Inspection #2: / /
Location: 478 Meadow Ridge Trail Hudson, WI 54016 (NE 1/4 SE 1/4 17 T28N R19W) Meadow Ridge Lot 18 Parcel No: 17.28.19.2005
1.) Alt BM Description=
2.) Bldg sewer length = 4 0
amount of cover = 7
Plan revision Required? ❑ Yes ) 'No 5 01i
Use other side for additional information. �__
SBD -6710 (R.3/97) Date Inse toy's ature Cert. No.
r
Section I — Review •
Section I — Review
Keywords
■ Zoning
■ Police power
■ Permitted use
■ Conditional use
■ Special exception
■ Variance
■ 'Administrative appeal
■ Comprehensive plan
■ Alternate
■ Plan commission/committee
■ GoVrning body
Test Your Knowledge (answers on page 22)
Chapter 1- Introduction to Zoning
1) A zoning ordinance consists of two legally adopted parts.
What are they?
2) In addition to general zoning, Wisconsin communities may
be involved in shoreland zoning and other forms of special -
purpose zoning. Which types of zoning is your zoning board
involved with?
3) What is the relationship between zoning and the community's
comprehensive plan?
Chapter 2 - Introduction to the Zoning Board
4) What are the three types of decisions that zoning boards can
be authorized to make? Which of these decisions does your
zoning board make?
5) What is the difference between a zoning board of adjustment
and a zoning board of appeals? What is the name for this body
in your community?
Chapter 3 - Formation and Organization of the Zoning Board
6) Describe four desired qualifications for zoning board members.
21
t x
Commerce.Wi.gov Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 St. Croix
i sco n s i n Madison, WI 53707- 7162 Sanitary Permit Number (to be filled in by Co. )
Department of Commerce !1 Z1 3 3 3
Sanitary Permit Application State Transaction Number
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form t the priate A)A
governmental unit is required prior to obtaining a sanitary permit. Note: Application forms r sta ow Project Address (if different than mailin address)
POWTS are submitted to the Department of Commerce. Personal information you provide ma e u for - nn
secondary purposes in accordance with the Privacy Law, s. 15.04(1)(m), Slats. �� �CQ4u�
I. Application Information - Please Print All ormation r A ,
Property Owner's Name ' Parcel !1
040 - 1310 -00 -018
Pete & Melissa Scharber
Property Owner's Mailing Address Property Location
e Trail Z
478 Meadow Rid 005
g ST. CROIX COUNTY Govt. Lot ( ,
City, State
Zip p Code NE 'A, SE ''A , Section 17
Hudson, WI 54016 (circle e)
Type of Building check all that apply) Lot a T 28 N R 19
II. T
YP g ( PP Y) 6k cfA
1 or 2 Family Dwelling - Number of Bedrooms 4
18 Subdivision Name
Block a Meadow Ridge of Troy
❑ Public /Commercial - Describe Use ❑ City of
11 State Owned - Describe Use
CSM Number ❑ Village of
w �¢ �/ Q WTown of Troy
III. Type of Permit: (Check o ly one box on line A. Complete line B if applicable)
Id
A. New System ❑ Replacement System y p y ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain)
B • ❑ Permit Renewal El Permit Revision El Change of El Permit Transfer to New
List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
1 -
IV. Type of POWTS System/Component/Device: (Check all that appl L,
JQ Non- 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 (explain)
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil Applicati Rate(gpdsf) Dispersal Area Req red (sf) Dispersal Area Propofs 1 (sf) System Elevation _
600 V 0.67 857.1 900 EISA ✓ 92.6/92.0 te a- ~'•
VI. Tank Info Capacity in Total N of Manufacturer
Gallons Gallons Units 2 o
New Tanks Existing Tanks
4 ✓ 8�st� [.t.. a U H to _0 _
Septic or Holding Tank
1250 1250 Wieser �S
Dosing Chamber 750 750 " x
VII. Responsibility Statement- I, the undersigned, assume responsibility for iniallation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature P /MPRS Number Business Phone Number
Jim Hurlburt 1( !. MP 222997 715 283 - 4851
Plumber's Address (Street, City, State, Zip Code) M,s
N 260 CTHW D, Eau Galle, WI 54737
VIII. (County Department Use Onl
Approved Permit Fee Date ssued Issuing ent Signatu e
= 7ve. Reason enial $ `75� ' 3 1/
IX. Conditions of Approval/Reasons � al /Reasons for Disapproval \ /)
SYSTEM 0%?46R: ) �/�n A� 5�.-- L `' LA_
dispe " txd must all be'services / maintaMed I
as per mehagement plan provided by plumber.
2. AN setback requirements mast be mW ttaif»d
code / Wdinumes.
Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size
SBD -6398 (R. 01/07) Valid thru 01/09
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ORIGINAL
Visconsin SOIL EVALUATION REPORT #2564
Department of Commerce in accordance with Comm 5, Wis. Adm. Code Page 1 of 3
Division of Safety and Buildings Certified Soil Testing, LLC
Attach complete site plan on paper not less than 8'/2 x 11 inches in siz . Ian County St. Croix
include, but not limited to: vertical and horizontal reference point (BM), di ion
percent slope, scale or dimensions, north arrow, and location and distance ear r Parcel I.D.
040-1310-00-018
Please prin fhp r R [ � vie d By Dat
Personal information you provide may be us s�op
d for r ``,, Q6A�(eW L , acy s. 15.04(l )).
Property Owner I Iroperty Locatio
Scharber, Pete & Melissa MAR 0 Q 2005 ( ',ovt. Lot NE 4, SE114, S17, T28N, R19W
Property Owner's Mailing Address lot # Block # Subd. Name or CSM#
478 Meadow Ridge Trail ST. CROIX COUNTY 18 Meadow Ridge Of Troy
City State 4p CodezOl%Wn"d6h%%r City E Village ® Town Nearest Road
Hudson I WI 1 54016 1 Troy I Meadow Ridge Trail
X New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement D Public or commercial - Describe
Parent material loess over pitted till Flood plain elevation, if applicable NA ft.
General comments install "conventional" in- ground trench system @ system elevations 3 -5' below grade w/ 0.7 gpd /sq ft
and recommendations: loading
-
❑ Boring # -- Boring
Pit Ground surface elev. 101.2 ft. Depth to limiting factor > 100 in. 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
1 0 -7 7.5YR 3/1 - sl 2 m gr mvfr cs lm .7 1.6
2 7 -18 10YR 4/3 - sl 2 m pl mvfr gs lm 0 .2
3 18 -24 7.5YR 4/4 - Is 1 m sbk mvfr gs 1m .7 1.6
4 24 -100 7.5YR 4/6 - s 0 sg ml - - .7 1.6
some sl inclusions in H3
Boring #
r] Boring
Z Pit Ground surface elev. 96.2 ft. Depth to limiting factor > 110 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. C61or Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -5 7.5YR 3/1 sl 1 m gr mvfr gs im /c .4 .7
2 5 -20 10YR 4/4 - sl 1 m sbk mvfr gs lm /c .4 .7
3 20 -26 7.5YR 4/4 - Is 1 m sbk mvfr gs 1m .7 1.6
4 26 -60 7.5YR 4/4 - s 0 sg ml cs - .7 1.6
5 60 -110 1OYr 4/4 - s 0 sg dl - - .7 1.6
r1 Z-• ,
occasional gr & cob in H4
* Effluent #1 = BOD 30 < 220 mg /L and TSS r30 150 m /L * Effluent t#2 = OD _ and TSS < 30 mg /L
CST Name (Please Print) Sign to CST Number
Henry F. Grote 222774
Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number
E. 4366 353rd Ave. Menomonie, WI 54751 5/15/2007 715 - 233 -0398
SBD -8330 (R.07 /00)
Property Owner Scharber, Pete & Melissa Parcel ID # 040 - 1310 -00 -018 Page 2 of 3 ,
3 Boring
❑ Boring # Pit Ground surface elev. 994 ft. Depth to limiting factor > 109 in.
Soil Application Rat
Horizon Depth Dominant Color Redox Description Tex 'e Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Cola' :-?r Gr. Sz. Sh. `Eff#1 Eff#2
X
1 0 -4 7.5YR 3/1 - sl' 1 m gr ds gs lm .4 7
2 4 -20 10YR 4/4 sl 1 m sbk mvfr gs 1m /c .4 .7
3 20 -32 7.5YR 4/6 - ; Is 1 m sbk mvfr gs 1m .7 1.6
4 32 -60 10YR 4/4 - s 0 sg ml Cs - . 7 j 1.6
5 60 -109 10YR 4/4 - s 0 sg dl - - 7 j 1.6
irregular, discontinuous sl band @ 47 -50"
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.
SBD -8330 (R.07 /00) Certified Soil Testing, LLC
Property Owner Scharber, Pete & Melissa Parcel ID # 040 - 1310 -00 -018 Page 2 y of 3
3 Boring
Boring # ' Pit Ground surface elev. 99.4 ft. Depth to limiting factor > 109 in. Soil Application Rat
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft'
in. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -4 7.5YR 3/1 - SI 1 m gr ds gs im .4 .7
2 4 -20 10YR 4/4 - sl 1 m sbk mvfr gS im /c .4 .7
3 20 -32 7.5YR 4/6 - Is 1 m sbk mvfr gs lm .7 1.6
4 32 -60 10YR 4/4 - s 0 Sg ml cs - .7 1.6
5 60 -109 10YR 4/4 - S 0 sg dl - - .7 1.6
I
I
irregular, discontinuous sl band @ 47 -50"
Effluent #1 BOD
* -
* = 220 m /L and TSS >30 150 m /L Effluent #2 - BOD < 30 m /L and TSS 30 m /L
_ g _ g _ 9 _ mg
/L
> 30 < < s <
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 (R.07/00)
Certified Soil Testing, LLC
Wsconsi'n SOI V PORT #2564
Department of Commerce in ac da it ro Adm. Code Page 1 of 3
Division of Safety and Buildings Certified Soil Testing, LLC
Attach complete site Ian on paper not less than 8'/2 x 11 inches in size. Plan must County
p P P P St. Croix
include, but not limited to: vertical and horizontal reference point (BM), direction and
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D.
040 - 1310 -00 -018
Please print all information. Reviewed By Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location
Scharber, Pete & Melissa Govt. Lot NE1 /4, SE1 /4, S17, T28N, R19W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
478 Meadow Ridge Trail 18 Meadow Ridge Of Troy
City State Zip Code Phone Number C' City ❑ Village ® Town Nearest Road
Hudson WI 1 54016 1 Troy I Meadow Ridge Trail
X New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement ❑ Public or commercial - Describe
Parent material loess over pitted till Flood plain elevation, if applicable NA ft.
General comments install "conventional" in- ground trench system @ system elevations 3 -5' below grade w/ 0.7 gpd /sq ft
and recommendations: loading
1 Boring #
Boring
Xi Pit Ground surface elev. 101.2 ft. Depth to limiting factor > 100 in. 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
1 0 -7 7.5YR 3/1 - sl 2 m gr mvfr cs 1M .7 1.6
2 7 -18 10YR 4/3 - sl 2 m pl mvfr gs 1M 0 .2
3 18 -24 7.5YR 4/4 - Is 1 m sbk mvfr gs 1M .7 1.6
4 24 -100 7.5YR 4/6 - s 0 sg ml - - .7 1.6
some sl inclusions in H3
Boring # -' Boring
Pit Ground surface elev. 96.2 ft. Depth to limiting factor > 110 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munseli Qu. Sz. Cont. C61or Gr. Sz. Sh. •Eff#1 'Eff#2
1 0 -5 7.5YR 3/1 - sl 1 m gr mvfr gs 1m /c .4 .7
2 5 -20 10YR 4/4 - sl 1 m sbk mvfr gs 1m /c .4 .7
3 20 -26 7.5YR 4/4 - Is 1 m sbk mvfr gs 1m .7 1.6
4 26 -60 7.5YR 4/4 - s 0 sg ml cs - .7 1.6
5 60 -110 10Yr 4/4 - s 0 sg dl - - .7 1.6
occasional gr & cob in H4
Effluent #1 = BOD 30 < 220 mg /L and TSS 30 < 150 m /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L
CST Name (Please Print) Sign to CST Number
Henry F. Grote :�_ I , 222774
Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number
E. 4366 353rd Ave. Menomonie, WI 54751 5/15/2007 715- 233 -0398
SBD -8330 (W07 /00)
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FINAL PLAT OR MEADOW RIDGE OF TROY S &N LAND SURVEYING INC
LOCATED IN PART OF THE SEIM OF TXE SE114, PART OF THE K114 OF THE SE114, PART OF THEHW714 DOUGLAS &ZIN ER
OF THE SE114, PART OF THE SW114 OF THE SEIM, PART OF THE SWAN OF THE NE1p AND PART OF THE 2920 ENLOE STREET
SE114 OF THE RW114 OF SECTION 4, T2811, R19W, TOWN OF TROY, $T, CROIX COUNTY, WISCONSIN, SUITE 101
HUDSON, WI 54016
ONPL 70 L.WS aaa NNN taI PREPARED FOR:
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SURVEYORS CERTIFICATE _..�1,A Rd3
A DWau a ZAUR REGISTERED WSCCGN LAND WRNYDR HEemY MI TWIT N PILL Cal"M M TH THE KMONS OF CHAPTER 216 OF
THE WSWNSN STATUTES AND THE 511050 KWAMNS OF DIE TOWN OF TROY, AN am FR THE DKW OF DOOR LAM ROM 664 We
OF SAD LAST t NAVE SURWMED, DNmED MO NAPPED MEADOR RITYE OF TROY; MAT 9X11 RAT VFlECRY REP RESENTS ALL E M1WR OWNIGMES nl
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DISTANCE OF 268136 FEET TO TN SIR OF $W SECTION 12, TINNY ALaD TIE DST - NEST QUNITER ALE OF SAM SI n Sar1903 A
DISTANCE OF 137858 RET TO THE SOUTHWEST 00 OF SAM SOUTHEAST WATER OF THE RORNPST MR THENCE AUX THE 9TH ENE OF NICE
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THE ARC O F SAID WOW A STANCE DI a m2,s2 FEET M THE POW OF rANaICD NICE NSOIA391 A DIST OF 43101) FEET TO SO NORTH - ;°
sWTH WAR19 NAM ALCG EAST SAM ALE SNDSSrW A DSACE 1 43x29 RED RANE X114 A DITME a 241.54 FEET; Ifl � : � j e V:dA «7E `_,
HENCE SWITI IN A INSTANCE OF Hsu FEET Moxs 01WI9T A GGIANCE OF 2DQli FEET 10 THE (INTERIM OF T@XSVW Ram, &W 01 a I 3 N g
TONTERUHE BONG THE NTH or A 315LN FOOT A,mAD WRSE WNG'h 9WIN ESRRY, RBI A CENTRAL ARGUE OF 92F36', A WORD THAT BEAN IW 11 0 q , = i
SWW421 NTH NEhSURE5 62034 FEET. THENCE SOUTHEMY ALM SHED CEN1RAE AM THE NTH OF SHED WWE A DISTANCE CE 62891 FEET M
BE DST WE OF THE SOUTHEAST QUARTER a SAD SECIHN 17; THDNE ALONG $4 FIST LINE S011n" A DISTANCE OF 7336 FEET; INRE
N43w'45w A DISTANCE OF 14117 FEET, THENCE N71'354e'R A DISTANCE OF 69867 FEET REIa M4 REST A OSTARM OF 47360 FEET To BE rl t a t R � LOCATION SKETCH
BEGINNING OF A 567,00 F0)I awuS WRAF CORCAYE GMRY, RN A MM NIWE OF 716'x', A MWG THAT HEWS S729115E AID KWU 1�719� 4 I �, I j, N TOWN OF TROT Z;;
7366 FEET, TOM SOUBEASMU AUMO THE Nm a Sal) WNE A DISTANCE a 1364 FEET M THE PENT a TANW, TOM 5365032E A
DISTANCE OF 63.67 FEET TD TH E PONT OF CURVATURE OF A 26310) FOOT RADIUS WAN, MOVE WESTIEV RN A CENTRAL MOLE OF 2895r, A
EHam THAT BEARS S21%357 NID NEASIRES IC11 FEET; HENCE WRITT Y ALONG THE ARC ar $0 WISE A DISTANCE OF 1412 FEET TO BE
Paar
OF a TANGENCY; THENCE SD?IUWE A DISTANCE a 16x4 F2ET; THENCE S6Td'2'W A DISTANCE a N.0) ROT, THENCE "C"T I'E A DRNXE
1974 FEET 10 THE pMT a WRVATK a A M7.0) X02 RAI1US WRN, MOW Y67RN NTH A aM NFIE a x5957, A OMTR iKAi cog
SEARS N219D'361 AND NAM tQ7.43 ROT, RElla NORTHERLY ALONG THE ARC OF SAID WRE A DISTAN OF 1236 FEET 10 N Pair OF 121 c{
TMODICD TENCE 11351(1 A DRTAR.4 a 6567 FEET X THE PONT a WRVAMRE a 60,00 A FOOT RADIUS CHIN. MOVE EASNLY, NTH A No,S ,25' 64519 , ' 1 V 1 SCALE IN FEET I' •
LOT
CENTRAL MOLE OF 16'413r, A CHORD THAT BEANG X AMT, NEA9.NFS 1114.13 ROT, P NCRMKY ALONG TOE a E A SAID GAVE A
DISTANCE a 164.79 FEET; THENCE N107fiY5W A DISTANCE a 121.36 FEET; THENCE muss' A DISTANCE a 3222 FEET, ME Xe254181 A ;AST CJ ''r 10®
DISTANCE OF Ifi7,32 FEET; BHNa X361062'1 A DISTANCE OF U1933 FEET, THENCE Se70181 A VANCE OF IR97 FEET; MEND Nr4e)n A
DISTANCE OF VIVO FEEL THENCE MY49VW A DISTANCE a 251.31 For; TENCE SM712DR A DISTANCE CE 297.66 FEET; WCE S14'm'1TE A 1 1 ROAD
DISTANCE OF 5752! FEET, THERE $Mimi A asTM'a a 21532 FEET; Tom Sx5512t A DISTANCE a 101.56 0. TOM NW1111E A
DSTMOM OF UGS42 FEET, THENCE WAN'45'W A DISTANCE or 407.61 PEET, THENCE %mail A DISTANCE or Ia1.N ROT, THDM 5X17181 A Tb;:a are Go obploos to N5 plat with Itv 10
OSTANM OF 51.62 FEET M DE SOUTH IRE a SAID SGUYW WARIER CE IOU 17; THENCE kK SAD SOUTH IN 93654'X'1 A DWMM or Secs, 316.15, 236.16,23620aod 7)121(11 aed(2)' S,Nad 9A
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152112 FEET M ME PONT OF NGINDIG Wk Sxts. as p by S 23612.11'is. Stoz.
Gas INS mtko1Y OF � Xis of I cen ficd b�k9U� .2T, � \ °
urER ' G SECTION 17, T28N, R19W
MOLAS 4 YAIRLR R9 2141 !!4460X,
S e X LAM S A*W,, INC. '4 ^S. �R'
291 ENLa STAGE �A V/ Depmxnt DI IMSN9hon 6 ' 4'
SATE IX SD 16010,E
USDA 1 5406 \j16
NOTID , ,�Sgr49'2��
THIS NSTR AINT WE BY MAIN NNE as NO 6MI ax N/N/XN VD- 097D6/XN SHEET 2 OF 3 SHEETS
Wisconsin Department of Commerce IL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings
e/ntal with mm 86, Ws. Aden. Code
County St. Croix
Attach complete site plant on paper
include, but not limited to: vertical and ce ' Parcel I.D. Pending
percent slope, scale or dimensions and distance to nearest roat
Please print all inform lion. S n 2 I 2 0 0 r. Review y D
Personal information you provide may be used for secondary I urposes (Privacy Law, s. 15.04 (1) (m)). 3
Property Owner ST. CROIX Loca on
DCCI Land Planners Inc ZONING t./4 SE t./4 S 17 T 28 N R 19 E (
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1505 HWY 6 18 Meadow Ridge Of Troy
City State Zip Code Phone Number ity 13Viflage ■ own Nearest Road
New Richmond I WI 1 54017 1 ( ) East Cove Road
El New Construction t)seE) Residential r Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPO
0 Replacement 13 Public or commercial - Describe:
Parent material Loess over glacial till Flood Plain elevation if applicable NA ft.
General comments * � several small pockets sl, Om, 7.5yr4/4
and recommendations:
onventloltaaT a ow grade system
� 14. c-�4-�xrs tM bc- r cek : 1 s tAc6,v4 - etc
IJI
1 I Boring # 0 Big
lI _JII Pit Ground surface elev. 967.89 ft. Depth to limiting factor X100 in. Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eif#1 - Eff#2
1 0 -9 10yr3/2 sil 2msbk dsh as 2f .6 .8
2 9 -22 1 4/4 - is Osg dl cw 1 f .7 1.6
3 22 -36 7.5yr4/4 sl Om dh cw - .2 •
4 36 - 56 7.5yr4/4 is Osg dl cw - .7 1.6
5 56 -100 7.5yr4/6 - s Osg dl - - .7 1.6
[ - 2 Boring # D Borin E] 960.71 >100
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil AWligation Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eft#2
1 0 -8 10yr3 /2 sil 2msbk dsh as 2f .6 .8
2 8 -20 1 /4 sil 2msbk dsh cw I f .6 .8
3 20 -29 10yr4 /4 sicl lmsbk dsh cw _ .2 .3
4 29 -50 7.5yr4/4 - sl Ifgr dsh cw - .4 .6
5 50 -100 7.5yr4/4 - s* Osg dl - - .7 1.6
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOD < and TSS < 30 mg1L
CST Name (Please Print) Signature Number
Thomas C Nelson " CST 227387
Address Data Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, WI 9/18/05 715- 246 -2454
DGCI Land. Planners Inc Pending
Properly Owner Parcel tD # Page of
7 Borin # Boring
g !) Pit Giaund surface elev. 965.20 Depth to limiting 16ctor > 100 in.
Soil ication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
I n. - Munsell flu. Sz. Cont. Color Or. Sz. Sh. *0#1 1 sflv'I
1 - 0-4 Y0yr3 /2 - sil 2mcbk dsh as 2f .b .8
2 9-23 1' 4/4 - is .() dsh cw if -.7 I.6
3 23 -35 7.5yr4/4 - sl Om dh cw _ .2 .6
4 35 -55 7.5yr4/4 _ is Osg dl cw - .7 1.6
5 55 -100. 7.5yr4/6 _ s Osg dl - - .7 1.6
F-1 Boring #
spit Ground surface elev. ft. Depth to limiting factor in.
Soti Application Ram
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. '011#1 1 'Eff#2
I
F-1 Boring # Boring
Pit Ground surface etev. ft. Depth to limiting factor in.
Solt AAAcabw 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 > 30:5 220 mg/L and TSS >30:5 150 mg/L ` Effluent #2 = BOD, < 30 mgA_ and TSS < 30 mg&
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 605- 266 -3151 or TTY 608- 264 -8777.
SBD- 8330Test M07Po0)
DCCI LAND PLANNERS, INC. o
Lot # 18 - MEADOW RIDE OF TROY ® SOIL BORING � ,,,,y
RIDGE \�
NE 1/4 OF THE SE 1/4 OF SECTION 17, BENCHMARK ,, y \
T28N, Rl 9W, TOWN OF TROY, ST. -TOP OF CONDUIT
CROIX COUNTY, WISCONSIN. ALT BENCHMARK • t
-TOP OF CONDUIT • • • • • •
TOM NELSON CST - Lie. # 227387 NOTE: THE CONTOURS IDENTIFIED •
ENVIRONMENTAL BY DESIGN ARE PRIOR TO CONSTRUCTION. .mot, aT +p
1432 120TH ST. CONSTRUCTION GRADING WAS IN
PROCESS DURING SOIL TESTING. wr w W,T.
NEW RICHMOND, WI 54017 CONTRACTOR MAX NEED TO
ph. # 715- 248 -2454 CONFIRM FINAL CONTOURS • ,,,,to
DURING INSTALLATION. • •
SCALE IN FEET t - 4WW • ainara
t00 0 t00
959 9 4 7,r7-_._
~ 58. � 83
3 \� 9 .1 � B 965.2Q
960. 1
o ~�
� 1
F j
' POWTS OWNER'S MANUAL MANAGEMENT PLAN Page &
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner P 1-UT a 1-k VtVuf'�, C � K Septic Tank Capacity I 5 - � g al ❑ NA
Permit # Septic Tank Manufacturer ha t ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer Yf titr ❑ NA
Number of Bedrooms 100 d/bedroom ❑ NA Effluent Filter Model Cry 1 ❑ NA
Number of Commercial NA rump Tank Capacity gal ❑ NA
Estimated flow (average)* 7Z; �-gd/day Pump Tank Manufacturer ❑ NA
Design flow (peak), estimated x 1.5* ho-- al /da Pump Manufacturer ❑ NA
Soil Application Rate �� �, aUda ft Pump Model t�► \rF - to ❑ NA
Influent/Effluent Quality (NA ❑) Monthly Average" Pretreatment Unit ❑ NA
Fats. Oil & Grease (FOG) ,� ❑ Sand/Gravel Filte ❑ Peat Filter
Biochemical Oxygen Demand (BODs) 30 mg/L ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) < 220 mg/L ❑ Disinfection ❑ Other:
S 250 m ✓ Manufacturer: Model:
Pretreated Effluent Quafi ❑ Monthly Average*** Dispersal Cells)
Biochemical Ox en De d Wn - ground (gravity) p In- ground (pressurized)
yg Ds) 5 30 mg/L ❑ At- g rade O Mound
Total Sus ended So '
p TSS
Fecal Coliform (ge etric m n)
5 30 mg /L ❑ Drip -line ❑Other:
1O * cfu/I OOrri ❑ Leaching Chamber Manufacturer 'A O S i
Maximum Effluent Particle Size 1/8 inch diameter Model S> r Kcwz 3t: Approval Stipulation
'Wastewater Flow Veri cation on and calculations: Soil Application Rate gpd/ft Area Req.
(Other than bedroom base Absorption Area Credit per unit tt`
Minimum Number of Chambers 16
❑ Aggregate Desi n Flow/Loading Rate= ft - min
'• Values typical fordo is (n - commercial wastewater Materials: all materials must comply with WI Adm. Code
and septic tank eff] nt.
p COMM84 and be installed per manufacturers specifications
'•'Values t ical pretreated wastew ter. and approval letters. !
DESIGN CRITERIA
❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al•1990)
p "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler.
Publication 15.22
• "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6
• "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis - ASAE Publications 5 -77 and "Design Manual -
Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980
❑ SBD - 10570 -P (R.6/99) "At -Grade Component Manual Using Pressure Distribution"
❑ SBD - 10567 -P (R.6/99) "In Ground Absorption Component Manual"
❑ SBD - 10705 -P (N.01 101) "In Ground Soil Absorption Component Manual' Version 2.0
❑ SBD - 10628 -P (N.6/99) "Recirculating Sand Filter System Component Manual'
❑ SBD - 10656 -P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual' �
❑ SBD - 10572 -P (R.6/99) "Mound Component Manual'
❑ SBD 10691 -P (N.0I /01) "Mound Component Manual" Version 2.0
❑ SBD - 10595 -P (R.6/99) "Single Pass Sand Filter Component Manual"
❑ SBD - 10657 -P (R.6/99) "Drip -line Effluent Disposal Component Manual'
❑ SBD - 10573 -P (R 6/99) "Pressure Distribution Component Manual' j
❑ SBD - 10706 -P (N.01 101) "Pressure Distribution Component Manual' Version 2.0
❑ Drip -line Effluent Dispersal Component Manual for Multi -flo Onsite Wastewater Treatment Units
Cl
MAINTENANCE AND MANAGEMENT
MAINTENANCE MONITORING SCHEDULE
Service Event Service Frequenc
Inspect condition of tanks At least once eve ❑ months ®' ears Maximum 3 s.)
Pump out contents of tanks When combined slud a and scum equals one -third 1/3 of tank volume ✓
Inspect dispersal cells At least once eve 3 ❑ months ®' ears Maximum 3 s.)
Clean effluent filter At least once every b 2rmonths ❑ year(s)
Ins ect um , um controls & alarm At least once eve ❑ months ® ears ❑ NA
Flush laterals and pressure test At least once eve ❑ months ❑ ears ® NA
Valves At least once every X ❑ months ❑ ears ® NA
Other: At least once eve ❑months ❑ ears 23 NA
START UP Page Z of 3
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that
may impede the treatment process and/or damage:.the.dispersal cell(s). If high concentrations are detected have`the contents of the
tank(s) removed by a septage servicing operator prior to use.. ✓
System start up shall not occur when soil cimdttions are frozen at the infiltrative surface. t/
OPERATION
The property owner is responsible. for the operation sifdrtUffiteriance of the POWTS and submission of required reports. The quantity
.and quality of the wastewater stream will affect�the perforrriance and lorigeVity of your POWTS. The installation of water-saving
appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water
softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface
whenever possible. Note: this does not include laundry waste; showers, dishwater, etc. ✓
This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit
peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only
paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins
condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint,
disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS
and contaminate your drinking water supply. ✓
Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components.
Compaction of snow over the dispersal unit may cause it to freeze up. ✓
p Valves
Valves shall be operated in the following ffiaer:
Alarms
Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service
POWTS, There is normally a I day reserve under regular operating conditions, however water should be conserved until any
problems with the system are corrected to prevent back -up of sewage into'the dwelling or surfacing.
INSPECTIONS
Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master
Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule).
Septic Tanks Component
Tank inspections must include a visual inspection of the tank 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 backup or surfacing of effluent .
Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any
defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective
locking device to prevent accidental or unauthorized entry into the tank.
When the combination of sludge and scum in any tank exceeds one -third (1/3) or more of the tank volume, the entire contents
of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR 113, Wisconsin
Administrative Code.
The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's
specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necsary at more
frequent intervals than stated in the maintenance schedule to keep the system operating, ✓ / es
_�ump Chamber/Treatment Tanks Component
The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be
made for leaks, backups, surfacing;'missing of bibkeii security devices and other hardware and the condition of the filter.
Any service needs or repairs shall be -promptly taken care of !
i
START UP Page Z of 3
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that
may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the'contents of the
tank
(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil cotdtdons are frozen at the infiltrative surface. t/
OPERATION
The property owner is responsible for the operation' and`tnt3iiitenance of the'POWTS and submission of required reports. The quantity
and quality of the wastewater stream will affeathe performance and lung' eVity of your POWTS. The installation of water - saving
appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water
softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface
whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. t/
This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit
peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only
paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins
condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint,
disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS
and contaminate your drinking water supply. t/
Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system co
Compaction of snow over the dispersal unit may cause it to freeze up. ✓ Y mponents.
p Valves
Valves shall be operated in the following er:
Alarms
Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service
POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any
problems with the system are corrected to prevent back -up of sewage into'the dwelling or surfacing. !
INSPECTIONS
Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master
Plumber Restricted Sewer, POWTS Maintainer or Se to
p ge Servicing Operator er the attached Maintenance �
(P Schedule). �
X septic Tanks Component
Tank inspections must include a visual inspection of the tank 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 backup or surfacing of effluent .
Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any
defects shall be promptly corrected. Exposed openings greater than. 8 inches in diameter shall be secured with an effective
locking device to prevent accidental or unauthorized entry into the tank.
i
When the combination of sludge and scum in any tank exceeds one -third (1/3) or more of the tank volume, the entire contents
of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with Chapter NR1 13, Wisconsin
Administrative Code.
The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's
specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necsary at more
frequent intervals than stated in the maintenance schedule to keep the system operating. �/ es
Yump Chamber/Treatment Tanks Component
The inspection must include a test of all electrical equipment such as purrt�s, alarms and floats. A visual check must be
made for leaks, backups, surfacirig;'missing of broken security devices and other hardware and the condition of the filter.
Any service needs or repairs shall be promptly taken care of.
I
4 1.
°- Ground Gravity Component Dispersal Cells Page 3 of
The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any
evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory
authorit Pondin at depths greater than °
h' 75 /
g P o of the height of the component may indicate v
g gh c e o erloadin or impending
hydraulic Y 8 mP 8
h
d tc ail
f ure
necessitating mo fr e qu ent Y g e q ent monttortng.
❑ Mound, At- Grade, In- Ground Pressure
The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any
evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory
authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure
necessitating more frequent monitoring.
The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals
should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to
ensure that equal distribution of effluent is occurring to promote the longevity of the system.
REPORTS
Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative
Code. ✓
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is
properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code.
All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
The contents of all tanks and pits shall be removed and properly disposed of by a 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 other inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
YA suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
The replacement area should be protected from disturbance and compaction and should not be infringed upon by required
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the
need for a new soil from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must j
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 failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed
as a last resort to replace the failed POWTS.
S.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASES AND /OR INSUFFICIENT
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 MAY BE DIFFICULT OR
IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name T v" k4 Name
Phone - - - 283 -s t Phone
SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY
Name Agency ST. Co c.ou%4" 4o�%;�
Phone Phone � �S - 3Tb d0oWoo
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
., OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address 44 5{ l/ s wt
Property Address 47,q /0 �C/IJC4 A /rAt `)�tl �SGVt W r S o
(Verification required from Manning Department for new construction.)
City/State V CJ�ei (/J/
Parcel Identification Number (0 q0 " 13 10 r - - O
LEGAL DESCRIPTION
Property Location N %a , S %a , Sec. , , T L2 N R W, Town of
Subdivision w �U 'o Lot #
Certified Survey Map # , Volume , Pag #
Warranty Deed # O , Volume , Page #
Spec house ye no Lot lines identifiabl yes no
_ SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle waste s. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner ma' tenance
responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Zoning Department a certification form, signec by the owner and
by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site i vastewater disposal
system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is 1 ss than 1/3 full of
sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage dispos 1 system with the
standards set forth, herein, set by the Department of Commerce and the Department of Natural Resources, Stat of Wisconsin.
Cert' ati n statin yo seph system has been maintained must be completed and returned to the St. Croix County Zoning
Dep in 30 days the ee year expiration date.
vSl r�
SIGNATURLY OF APPLICANT DATE
OW Vde R'
ify his form are true to the best of my /our knowledge. I/we am/are the ov mer(s) of the
prope a deed recorded in Register of Deeds Office 5 Q21
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is misrepresented 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 and a copy of the certifi ,.d survey map if
reference is made in the warranty deed.
a41z 73rb
KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., WI
THIS DEED made between DCCI Land Planners Inc., a RECEIVED FOR RECORD
Wisconsin Corporation ( "Grantor") and Peter T. Scharber and Melissa
M. Scharber, husband and wife, as survivorship marital property, 12/15/2806 10:300
("Grantee'),
WARRANTY DEED
WITNESSETH, that the said Grantor, for valuable consideration EXEMPT #
conveys to Grantee the following described real estate in St. Croix
County, State of Wisconsin: REC FEE: 11.00
TRANS FEE: 345.80
Recordina Area COPY ME:
"P coo
Name and Retu
Lot Eighteen (18), Plat of Meadow Ridge of Troy, in the Township of
Troy, St. Croix County, Wisconsin The First National Bank of Hudson
307 2nd St., PO Box 187
Hudson, WI 54016
040- 1310 -00 -018
(Parcel Identification Number)
This 1L0,2t homestead property.
Grantor agrees to sell this lot to Grantee on the condition that Derrick Homes, LLC, Divine LLC, or
Dreamstnxtures, Inc. will be the builder of the home to be constructed on this lot.
Dated this 6th day of December 20Qfi.
Corp rate Nam
*e1R;,L%tweven. ec tary
STATE OF WISCONSIN
ST. CROIX COUNTY
Personally came before me this 6th day of December, 2006, Ronald L. Derrick, President, and Michael R.
Stevens, Secretary of the above named Corporation, to me known to be the persons who executed the foregoing
instrument and to me known to be such President and S o id Corporation, and acknowledged that they
executed the foregoing instrument as such officers as the d of said rpo , by' authority.
PAMELA J RUTLEDGE
Public
THIS INSTRUMENT WAS DRAFTED BY Pamela S. RW
DCCI Land Planners, Inc. Strata of N
PO Box 445 Notary Public St. Croix County, Wi sin.
New Richmond, WI 54017 My Commission Expires: July 27, 2006.
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