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HomeMy WebLinkAbout040-1249-60-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Sgfety and Building Division INSPECTION REPORT Sanitary Permit No: 488244 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)). P er's Name: City Village X Township Parcel Tax No: Frank, ike Troy, Town of 040- 1249 -60 -000 ST B ev: Insp. BM Elev: BM Description: Sectionr'own /R No: . 20 ' l . /a TANK INFORMATION ELEVATION DATA TYPE ACTURER C ACITY STATION BS HI FS ELEV. J P NUF ?L.sas' G Septic U Benchmark lrrt� S �2 Z ` � d UE� •d Dosing Alt. BM Aeration Bldg. Sewer Holding inlet o t t ut et TANK SETBACK INFORMATION N A � -�.•�... g�. 3 TANK TO P/L WELL BLDG. vent to Air intaKe ROAD I Dt In epic �... 177 070M Io•?»Sv 9 . /y osing ea er Aeration is t . P ipe o ing Bo t. ys em 7i F inal Grade PUMP /SIPHON INFORMATION anu ac urer eman over t \ _ a GPM b.� ., '�Z- 10 2, 7 6 m odel um er i nc ion LOSS ys em irleau o i DIMENSIONS INFORMATION CHAMBER O, � My System. IV. ?- L a-K-9- Length Did Length Dia Spacing 0— 5UIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Bed/Trench Center r' ff/Trench Edges Topsoil Yes No Yes No 11 Z M NTS _ Include c e 'screpencies, persons present, etc.) Inspection #1: Inspection #2: 27ILT�n Ct Hudson 1 54016 (W 1/2 NW1 /4 19 T28N R19W) Troy Village Lot 56 S Parcel No: 1.) Alt BM Description= ��C W � cl 2.) Bldg sewer length = l ( amount of cover = Z r $ • �" �'1/ - -- , - -- qua Pla revision Required? L ' Yes I j - rl ' � - Use other side for additional information. I f fi L_r �- te - -- - - orsSignature SBD -6710 (R.3/97) , 1 � Q a s � Safety and Buildings Division County 0 201 W. Washington Ave., P.O. Box 7162 — C � i Y NV Isconsin Madison, WI 53707 – 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 S8 Z t _ S 'ta P r ' Application State Plan I.D. Number In accord with n 8 , Wi Adm e, personal i ou provide N /14 -- - �- -\ may b o es Privacy La t, s15.0R ^� Project Address (if different than mailing address) I. Application Information - ease rent nformation a � C � t #� 7 v Cou/�r Property Owner's Name 4UUb Parcel # Lot # Block # , v �' 4 0 1 Property Owner's Mailing Address Property Location r,,�70 7- C6uIZ r �� I � ', Section City, State Zip Code Phone Number T N; R o W II. Type of Building (check all that apply) /I or 2 Family Dwelling – Number of Bedrooms � � � �p` t Subdivision Name CSM Number ❑ Public /Commercial – Describe Use 's ��l 41 PJ45 ❑ State Owned – Describe Use ❑City ❑Village Township of t/ � (Z III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. Y 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 apply) c l cukay 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 ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersalffreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Pro osed (sf) System Elevation �dcS k �7 F _/ I 9s.s 9s.9 9,6 VI. Tank Info Capacity in Total Number Manufacturer Prefab site Steel Fiber Plastic Gallons Gallons of Units (� P �j[py Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 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) Pler's S' nature MP/MPRS Number Business Phone Number Z4 0 Plumber's Address (Street, City, State, Zip Code) 4J) J-5 / - 7 AdC VIII. County /De artment Us Only Approved ❑ appT 1 Sanitary Permit Fee ( ludes Groundwater Date Issued Issuing gent S' nature o mps) Surcharge Fee) El en Reason fer eri IX. Condition ppro 1 /RepwmfurDbappx►*al SYSTE 3� ov, CS C� 1 Septic tank, effluent filter and � , �� ---�� -� dispersal cell must all be serviced / maintained � tpp�s���� as per management plan provided by plumber. c 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 than 8112 x 11 inches in size �t SBD -6398 (R. 01/03) _ CAt.- �d /j At r-,— 5 �r Q p / sal t-ti� � �Pn cs_L�1cK 2''6ehc4 ?`v .4 JVC I roo+.t <o....1' Ytc.c�c - Y -' Hwy u,ek"e ke cs¢d., Ilis6e a/ s LP 7 (fc�t f z l0 p— f'� f e. td. > v J � 00, _ I � 1 i co Op Webster Soil Testing Et Sewer System Design Charlie It Kris Webster, Owners N5815 770 Street, Ellsworth, WI 54011 Telephone: (715) 273 -3430 Fax: (715) 273 -4181 WI Licenses: MP220673, ST220673, ST 261669, PEI 8803 POWTS Index Sheet Page 1 of 6 Conventional System for a 4 _Bedroom Residence Property Owner/Proiect Name: Mike & Linda Frank Lot 56, Bloc_ k 1, Troy Burne 270 Troon Court Troy Township -St Croix County Co ntents Pa e 1 of 6 Title Paee Page 2 of 6 Sketch Page 3 of 6 Distribution Cell Detail Pie 4 of 6 Septic Tank Detail Pate 5 & 6 of 6 Management Plan SCQ CHARLES L Wr ST .. S E -18803 i CC O : i ELLSWORTY W Ac ��cd Frog scPt�c takt� s p vc K, c K '` in 7Fr d for s� S 7 m 0losciYl t�oh piwC 7 prey, -4 / ? !'Z Scrl �Y/ �.oh 6 tG r, f Yehchct + J�al� ( /yam c oh �+4r 6F� / G JrSIle— m/ I AIC C A Y C cc G 4 T/o /✓ S 7) 1 s u,cam'` 4u.y. it 3s�I,s., e� �✓�. / 7- i • S - ec��,M /�'le�k, �u} 1�I;1��. ��k ��[ t -d�l� �,� �' ,. `� P�+^av C. � Ioc -li, �? +►�! rf � CoYGYs' '4.11. N7•A.rsl ea >.. 'T ilt- lh.N•MN✓� 18.MC� 4 t Y e f'�' /w e•tir �; /t�h �t vit fsc..ed d �.NCd a 3�'t• ortta r <l•df Ar*A..#? 3 {e es �` p'^►�` l) vriry T R lkfj IC �04 f� 1 fPr Wi t I k ♦'o� �ifC l G CdJC Ci^+ lY/ //� 7' aw k S. 'f e T a•r k ;i.ie h s r 'a • z �e�� � /U 4 i`J't�/j J� C� C At X 66 'rIAC� POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ot �' .FILE INFORMATION SYSTEM SPECIFICATIONS Owner tit �/t�c r 0 % �: Septic Tank Capacity / 23" C, aI ❑ NA Permit # Z Septic Tank Manufacturer r P r esc�- C,,.,2 ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer /t c3 NA Number of Bedrooms ❑ NA Effluent Filter Model a ❑ NA Number of Commercial Units NA Pump Tank Capacity a l ❑ NA Estimated flow (average) G fl gal/day. Pump Tank Manufacturer lil,.7f 0 NA Design flow (peak), (Estimated x 1.5) b 0 gaijday . Pump Manufacturer It ❑ NA Soil Application Rate 0. aVda /ft Pump Model ' ❑ NA Influent/Effluent Quality Monthly average' Pretreatment Unit XNA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑Peat Filter Biochemical Oxygen Demand (BOD.) - mg/L ❑ Mechanical Aeration O Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other' Pretreated Effluent Quality E3 NA Month e Manufacturer IY ave ra g e" Dispersal Cell(s) Biochemical Oxygen Demand (BOD 530 mg/L Xin -ground (gravity) ❑ In -ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ At -grade O Mound Fecal Coliform (geometric mean) 510 cfu/100m1 ❑ Drip-line ❑ Other Maximum Effluent Particle Size Y inch diameter • Values typical for domestic (non- commercial) wastewater and septic tank effluent *• MAINTENANCE SCHEDULE Values typical for pretreated wastewater. Service Event Service Frequency Inspect condition of tank(s) At least once every ,� ❑ months >year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume Inspect dispersal cell(s) At least once every ❑ months )(year(s) (Maximu 3 yrs.) Clean effluent filter W- At least once every 3 ❑ months ,(year(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ year(s) XNA Flush laterals and pressure test At least once every ❑ months ❑ year(s) XNA other. At least once every ❑ months ❑ year(s) J <NA Other At least once every ❑'months ❑ year(s) >(NA �F M�' eCo1s,Yten C✓fG /C1N,%t JE'i /iPr ohc� g ve. Y •3yr# r- 4"Ckecoft,* ad t4I MAINTENANCE INSTRUCTIONS Y�w� e /c.1r, F: /!�� eye Y A'w to ?v.lo/ a„� ►•L /e MS d u.M•h� ♦ he Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: 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 (7;) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWTS components, pretreattment components, and any other maintenance or monitoring at intervals of 12 months or less 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 START UP 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 cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. P'ld4 Page of 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 cells) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a S ptage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to a II sist in manually operating the pump controls to restore normal levels within the pump tank. Db not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction orelimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONM E When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is property and safely abandoned in compliance with ch. Comm 83:33, Wisconsin`Administrativa 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 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 fails and cannot be repaired the following measures have been, or must be taken, to provide a code comps' t replacement system: l k" 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 and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. O 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. 0 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. 0 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 GASSES 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 ti pw7 Name Name Phone _ 6 —.� j 3 -Phone SEPTAGE SERVICING OPERATOR PUMPER OGAL REGULATORY AUTHORITY Name Agency y ,� Phone Phone Th d S is document was dratted by the staffs of the Green Lake, Marquette and Waus am County Zoning anah`6tion agencies. This document meets the minimum requirements of ch. Comm 83M(2)(b)(1)(d) &(f) and 83.54(1). (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. fj—r �X C ,t �� ?CfN / GMW (2101) } Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page __L of 3 I•abor, and"Human Relations DiAsion or safety & B uildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site Ian paper not less than 8 1/2 x 11 inches in size. Plan must include, but ` sr, Co PI P on P P not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance � APPLICANT INFORMATION- PLEASE PRI R I D (3Y GATE PROPERTY OWNER: o OPERTY LOCATION E Y2 T :nVAI (5,412,4A'IQJ'r - 0f f ly, Wi,S 19 T 2 ,N,R 19 W PROPERTY OWNER':S MAILING ADDRESS LO a.# BLOCK # SUBD. NAME OR CSM # 21,0 C•T. N , F APR 13 19$7 — T"If v i LZA&C- CITY, STATE ZIP CODE , HONE N / QVILLAGE OWN NEAREST ROAD I+(AmZiOAI WS $y 01 b "' JJ) u TRO C.T, E4. F �Q New Construction Use [� Residential / `tier of bedrooms ' (] Addition to existing building [) Replacement [) Public or commer Code derived daily flow 44 0 gpd Recommended design loading rate 0 .b bed, gpcW .'l trench, gpd1ft Absorption area required 1000 bed, tt trench, ft Ma)dmum design loading rate aj bed, gpd /tt o,g trench, gpd/ft Recommended infiltration surface elevation(s) Th RI~ OeT0 MI Nep my fLl as jefo to site plan benchmark) Additional design / site considerations Parent material �A MO S TON E l Q2LAC-IAL - LL- _ Flood plain elevation, if applicable AtA. ft S - Suitable for System VENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN HOLDING TANK U =unsuitable for Stem S a u cgs ❑ u WS o U MS O U a S EM ®u FILL ❑ s o il SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consisterl� Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trer& 0 - j 5 to — 4S { rn sb 1'r, Yr\ 4S — 0.4 Z 15-Z S Y K 1 13 -s ` r Os MI w Ground 3 z4 -St0 7, 5\/A3/4j _ S 0 S mI — — 0.7 QX elev. lKyla. ft. Depth to limiting factor 1J Remarks: fft�IZ0A1 I P•A11416 b A4 14258 W 3 MA5 56MC C 06L. Boring # _ 1 0 - i2 Iny z1f — 1 s 1 rhsbK ry\4r oS 0.7 0.8' 48Z Z ►L- z5 5 YLI 313 _ S 9 1 ew 0.7 10,9 3 zs - 14 ID v K -3/4 — 5 0 — — 0 X Ground elev. *ff I ft Depth to limiting. factor Remarks: 0 f -Ad-eL- T Name: — Pleas. @ Print Phone: ht 7i 25-918 493 6504 r F wz S 4 Z 2z Sign • Date: 74A, M 7 J CST Number: AI ou, t M03�O7 PROPERTY OWNER 4 SOIL DESCRIPTION REPORT Page _Z. of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bw Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tram o-►2- I O `F �4 Z - is I ! - 0.'7 z 12--19 Joyp Z/ t - Si 1 Z "NsbK mfr Q 5 - 0- Ground 3 19 -241 l oyrZ 3& - ::;I) I mS b K 0 , Z 0.3 SbLZ ft. y 24 10 14 s j r 1 - - 0.7 0. Depth to limiting factor 7QZ '� Remarks: 13f VE S01AE G eAA) 4t el dME Z m I rn q Y Boring # 1 o -10 - 10 y Z/Z_ - s! I msbl< m Ct - 0.5 Z- K. -3 1e - s►1 1 Y►•sbX r - 0 . 0.3 Ground 17 -5 - 7•5 - YR 3 14 - S I CS 0.7 0.7 y >.S 3 S rnl - - 0.7 `0.% Depth to limiting factor�� Remarks: 140 l°17AAIS 1 L 4kUE 50ht& C.gAvEL KIZM 2 AA& SaME SA Q Boring # io Y - zJL S I m s QL 0 :, 0 4 85 2 tp -z'7 t0 1 mS s a 3 _45 loY �► - s rn 1 - � a 7 � 0.8 Ground elev. -� gb4.'i ft. Depth to limiting 7 NM I r Remarks: Boring # Ground slew. ft Depth to limiting factor Remarks: • Page 3 of 3 PLOT PLAN Property Owner tZ Legend / �Exc. w+Me{ Legal Description LOr 56 , rgoO BM _ ® TOP O F ba ANYAM IL wc N1 - T= - Q W e 1 �2, 32A FL.4�iED- ' 2 Al R vJ w' /L s i q r 2-SA) �y t S , zo , K19W TWA OF - rnv ) STCWI)c coup Y S� C3 = soil boring w /backhc T ) �- V> (,S - Lt2VEY M h03 rizq Coxreer Lffr u A) 'E AAI&LPS, �aT a a Lj 6473 EL 865 - CL VW.71 S &aP- ❑ P,yb5 EL $ut.7 DoT 0 5% � L gby.9� \ D &4gLJ \ a \ k (•� i Signed CST Mo37o7 Date NOY.Zb. 19910 ��� IW fX. z 7, / 9177 Jun 12 06 07:50a Mike Frank 415- 402 -4339 p.2 JUN -12 -2008 MON 09 :44 AM WOODDALE BUILDERS FAX NO. 9523450544 P. 02/02 ST. Cgtoix COUNW SEPUC TANK MA)NTTNANCE AORMMU AM OwNERSM CERTWICAnON F ORM ow=Muya Yn; kc 3 L Pmmy Add �� jv�ise.slaaa tsair6ad ttatn r lmtalisp a Io.aat nep+u� far aetr eettettttetion.) CitylState u legoga 0 wx ptreal IdmettifimWoo Number L9 q -' Z `� 1 _ 60 00 0 r WAL rrx2023 m Plop" 1,ocatl n ,'A , �., . Y. , Sea. . T R W. T own of '�„'�.�__. Subdivisica . �n J,j . Ltx d Caged sovey map # . Volttma papa d �. Wumty Dad VoLum : Ngo # _ ppm: bows yet ,.�T� Lot Vm ideaf� so 1�tnpernaa and tatdeoeo®eC of ytatr t� sYatam oeRtd mssaB is � pttetrrattns dtiia�e set l>ttadle wapeR Ftrapa untie s�atgiaas otpampittt ord 4ke sapae aadt etreq► ehox Yenta a stw�aar, itttaade� by a liesseed P�Pet Tp° Pw° ** gym= Csn aL'.aa�a lbd� 0f dO to a tat&" ttesanCM snt�m itt ltle � � sy�m Owner tishtteaaaee xespona ate apeei&d j, rAam 83.520) and fitCbapter 12 - OL O mh COW Sseboy Ir6 e m ° � eQ rltbtt� to Sl<. Ctnk Cou�►Plme6ti 2iottiat t °°t a attire tcatt Fora *seed by Oo aver sad by' a mmaoer ,1aw�l�>t't• tast<icrmd i at a ]3eaw.d pataper t�tMyiet ttl.t ir) lire ttaasitm wssl muw trspmatl "mo its m proper optttttUat t amdiliott teed* m ,nff nspaeden and pn:niaet (ifamms"), dw sop* taeb is leas deter 14 tall t►Cdo PL f1tYe, cbs >tatr. iaa the rba+e vWft tt I I I tad agae to mmwn do oaft sewaom 0tptattl �ysemz" 13' as sas tba siteaaat st!'.aamn®a atd 4w nmp enoW at" m d ttaaosess SON at Wkm mhL tar j&lt sat toter, > dy i y nee OW 11 tad:etattrd tot w St. Ctobt Coaaty plmm t # woe aratittp atn y� mv� >�+� tseea ttadmabted m" Dep"taaratt teid&so my: of ow on* yM aepbul" date, trvra eettitytbmr sll �stt;ateoFs err ails � tae teat; t4 dte imemt eftny►aet kpa„rlodt0e. um ssahne � prmc:(s) of tba �q,e:ty domed. roe. � vitese: oC t aetrHtf deed iecaara En °t' Do•aa oniee. Nrlmber dbWW"rra S10NA OF�PippLlCltil►)T(S) DATE *"My m1mum tam may taunt to dte -situ, ream bon "ev°loed byerpmembs dm Z� tb��"� •■ a mdrda with dis apps adm a vowidad •rani 04 doed & m dw ftVff ar atDeeds 041" and a wry of dw t etlW4d smvfY>dP if xali..M it tnslla Oft wamcalx dad. JQ7Zr j•d 4 92 =B4 $O ZO dad gc75lZi5 • '' KATHLEEN H. WALSH REGISTER OF DEEDS State Bar of Wisconsin Form 1 -2003 ST. CROIX CO., WI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 06/15/2006 09: 45AN WARRANTY DEED EX9PT i THIS DEED, made between Wooddale Builders, Inc., a Minnesota Corporation REC FEE: 51.00 TRANS FEE: 795.00 ( "Grantor," whether one or more), COPY FEE: and Michael L. Frank and Linda K. Frank, husband and wife CC FEE: �-- -- �� PAGES : 1 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix - County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed, please attach addendum): River Valley Abstract &Title, Inc. 1200 Hosford Street, Suite 201 WI 54016 Lt , Plat of Troy Village in the Town of Troy, St. Croix County, Wisconsin. Hudson, File #: 26868 9214 14 PIN: 040 - 1249 - 60-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights -of -way of record, if any. Dated Wooddale Builders, Inc., a Minnesota Corporation (SEAL) (SEAL) (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ) ss. authenticated on Tracy L. T urn St. Croix COUNTY ) _�/ * Notary r " tj l ql Personally came be ore me on m 4/6 the above -named TITLE: MEMBER STAT Wooddale Builders Inc. a Minnesota Corporation (If not, to n t e t rso s) who executed the foregoing authorized by Wis. Stat. § 706.06) i t d e THIS INSTRUMENT DRAFTED BY: Attorney Doug Berg 1200 Hosford Street, Suite 201 Hudson, WI 54016 y Co tc, fate i n y Commission (is permanent) (expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 1 -2003 * Type name below signatures. I . e A• �_ 4 y � � da a� t k'� n y � •, a r `k v s 7�... A r �, +, 7�ry� x '� ..� t�` ,� � 1 � . '. i + ' �� 5 $�� { �• P 'w'.� 11 771y, d ........... AMSO 4M1 # x T $ 2 1 l OUTL PL � 44 � N a x 4 E x. ys =- h r �- t 4ti [IwnYca► f1, r�+s i 1 �# w _. ., 0Ch0, 'a ° O y c ?; o d A ' m to H' ,2 T C T� fn T. x rn o '', m o P C • G <__ C O 0 7 :O IV Fr O C 73 , . 7 7 0 A F � co p N O O p � A C w v5 z D fD m D w a W o CL fa a z o o C7 r co p N o c rn rn 0 0 0 o A rt C o O O v 0 to CD 3 3 m N fD CL N z z O D O O � v', ° w CD CD ; o c n A N N CD p R _ C N W p N A O. d 3 n 7 z O C p O p A Z n CL 3 c A v o y n � iI � a IC I W 7 O. N Z 0 Z 3 co N G7 CD A A � 7 O a fD p- t `O< O T n D7 C o CL CD CD CL N N cr y Q 0 O n � W � fi m v.. N 0 0 I D p" A O fpD DAO N 0 C) CD ? a o D- ti Wisconsin Department of t / l� PRIVATE SEWAGE SYSTEM county: St. Croix Safety and Building Divis Q INSPECTION REPORT Sanitary Permit No: 488244 0 GENERAL INFOI `` 1t (ATTACH TO PERMIT) State Plan ID No: Personal information you Z I rr 'Privacy Law, s.15.04 (1)(m)]. P er Name: JJJ city Village Township Parcel Tax No: Frank, ike 3� Troy, Town of 040 - 1249 -6 0 -000 ST B ev: ll t is Section7rown /Rang No: TANK INFORMATION ELEVATION DATA TYPE NUFACTURER C ACITY STATION BS HI FS ELEV. Septic U Benchmark UA 6 S6-tz _ Z d (JO • c7 Dosing Aft. BM Aeration Bldg. Sewer .3p H olding t Inlet St/H Outlet TANK SETBACK INFORMATION •�� - (L.,�„ TANK TO PIL WELL BLDG. V ent it Intake ROAD Dt Inle S ept ic t B ottom 10. Z40 osmg Header/Man. Aerat Dist Pipe H olding got. System F inal ra e PUMP /SIPHON INFORMATION �•3 anu ac urer GPM e n over o e Number I Friction LOSS Syst mea orcemai I Lengiff -- l a. mm to vvu.l IL AH )RP N SYSTEM orzu -r4%.rl "lu"ll jLQ[l9Lll I I el lul leh 111blur Uld. ILlf4ulTj DUP111 DIMENSIONS Ivi SE INFORMATION CHAMBER OR, t UNIT M2.6 33 HtiddErIM.11 ill-Ulu' Pipe(s) Length Dia Length Dia Spacing x Pressure Systems Only xx Mound Or At - Grade Systems Only Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes 1 No z lc N NTS:_ nclude c e 'screpencies, persons present, etc.) Inspection #1: ®a l. ( Inspection #2: - ° �--- on: 27 �Tj4eCllXon Ct Hudson,11 54016 (W 1/2 NW1 /4 19 T28N R19W) Troy Village Lot 56 s _ `_ Parcel No: 1.) Alt BM Description = j -Z 2.) Bldg sewer length = I - amount of cover = t. Plah revision Required? Yes j No - - - -- _ - Use other side for additional information. Date -1- - -J `- -- - - - - -- insepetors- Signature - -- — -- - -- - Cert! - No. - SBD -6710 (R.3197) • Safety and Buildings Division County Al W. Washington Ave., P.O. Box 7162 C 12 ) Y Iscvnsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) p (608) 266 -3151 p Q 2 De of Commerce 0 0 / S 'taA T r Application State Plan I.D. Number In accord with 8 , dm e, personal i ou provide '— may b o es Privacy La r, s15.0%1m EIv Project Address (if different than mailing address) 7 v T2D d x.� I. Application Information - ease not n ormation # � Co u /LT Property Owner's Name Parcel # / # Block # w 0A R }�ao► s 1 Property Owner's Mailing Address Property Location 0 70 7'2v0k) C 6 01Z'T Ikr '/ N(Ar'14 Section City, State Zip Code Phone Number NL4 o S 6A.) W t T � N; r l R _1_L o W II. Type of Building (check all that apply) L ✓/ ( r Subdivision Name CSM Number 10 I or 2 Family Dwelling - Number of Bedrooms bu i ❑Public/Cotnmercial - DescribeUse .$ ❑ State Owned - Describe Use ` ❑City_ ❑Village ?rTownship of 1 _6 (/ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 0 - f 2 — 60 . / A. Y 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 a 1 GIB {)✓ a 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 ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dis ersaVFreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (st) Dispersal Area Pro osed (sf) System Elevation VI. Tank Info Capacity in Total Number M ufacturer _ Prefab Site Steel Fiber Plastic Gallons Gallons of Units ( P J Concrete Constructed Glass New Existing. Tanks Tanks Y ` Septic or Holding Tank �� n 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) P - bber's S ' MP/MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) 4J �i- l 7 C�,5-7' VIII. Coun /De artment U Only Approved ❑ Disapprove Sanitary Permit Fee (' ludes Groundwater Date Issued Issuing Q gentS,nature �Io amps) �' Surcharge Fee) ❑ Ov @iven Reasoii'for_Denml IX. Condition pprov l/Reasons-forDisapprnval SYSTEM WNE 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained ( - Cd'i✓ -�� tt as per management plan provided by plumber. 1 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 than 81/2 x I I inches in size t SBD -6398 (R. 01/03) - f PZ- o 7 Ho j � - .S� ys�,� r� y s , 5'Fs c� �' 3 , �+, �, a l 7'r �h rocs �l C�` •e ..t c� �-1- 3 aZ� r -��! 7`ICn cs L 7�6Ch�h n, �Srw. ct`;- r t ;- f'1�Jtot� '�HitS_Sepd.a7`� e J se�d���.a. -i fo es�l'c�De cL /tPvn)i'e dvcZ �r, 3_ S'o :/ 6� < -�, ltica�•�- .SS /� acs GAP � Sic S la rs s w-x-A l pp gam= rop �-� P` Q p � , � • - 7 tr �. +ri,QC -�,- � -7� ekta7.5 S + e c�y ar �s 6 }r co �e r eIz �' c /� J�os�. G► ih .S l / f _- d -. O PI 7 rssn�°W ^ >.�*.^a. atraa>m� - main uraes�ura�azWrsww�5oraw�z' ^,�"." �", _. - 'E T1 1` N E O O engineering Mendota Heights Office Coon Rapids Office 2422 Enterprise Drive CIVIL ENGINEERS LAND PLANNERS LAND SURVEYORS LANDSCAPE ARCIRTECI'S 201 85th Avenue N.W. Mendota Heights, MN 55120 Coon Rapids, MN 55433 (651) 681 1914 Fax:681 9488 Mendota Heights Office (763) 783 1880 Fax:783 1883 } Certificate of Survey for WOODDALE BUILDERS 270 TROON COURT, HUDSON, WI' BUYER: MIKE AND LINDA FRANK I p ch °° LOT AREA = 44,442 SQ FT C) a HOUSE AREA =3,378 SQ FT 2s� X k Qi /a;•� y X S0 ,/� 2 ° rl/ ��� Qi c 1 a EXISTING k 63 HOUSE !; / (STAKED) (VACANT) HOUSE DETAIL NOT TO SCALE A \ S A27 fr r; 9 50 56 O f 5 6 ' c 50 r � A t h I i � — ago 30 47 BENCH MARK: / - 3 Oa � r � TOP OF SPIKE r,C 51 ELEV.=M G PR A r 45 / / OO '20��0. ' 3 3 (35 ,`3738 r x423 46 4 40 13 S: 3� 40 1 R��� p S E 2 13 Q�u� 32' 34 pRIP w� \ 2� . � 'r26' /28 `� `��� , 56 " FR p _ r \ a A 4 2 i SEE HOUSE DETAIL �q P \ '� / 22 / FOR DIMENSIONS ?' v v v a \ / 24 \ S S 0, 6 o \ N jj O 58 x �! s— O \ \ O 13 f \ 's 4 , 1Y t ' \ \ O y zl 1 2 \ M i4 J` EXISTING `�.° 9 6 v 5 HOUSE i ° \ "d- O $ BENCH MARK: (STAKED) BENCH I MARK: o v �� TOP NUT HYDRANT TOP OF SPIKE ELEV.= (VACANT) ELEV.= p� 55 x 41 a NOTE: PROPOSED GRADES SHOWN PER GRADING PLAN BY: OGDEN PROPOSED HOUSE EL VATION 1 NOTE: BUILDING DIMENSIONS SHOWN ARE FOR HORIZONTAL AND VERTICAL LOCATION LOWEST FLOOR ELEVATION: x 5 C OF STRUCTURES ONLY. SEE ARCHITECTURAL PLANS FOR BUILDING AND FOUNDATION DIMENSIONS. TOP OF BLOCK ELEVATION: NOTE: NO SPECIFIC SOILS INVESTIGATION HAS BEEN COMPLETED ON THIS LOT BY THE GARAGE SLAB ELEVATION: D — A SURVEYOR. THE SUITABILITY OF SOILS TO SUPPORT THE SPECIFIC HOUSE PROPOSED IS NOT THE RESPONSIBILITY OF THE SURVEYOR.' NOTE: THIS CERTIFICATE DOES NOT PURPORT TO SHOW EASEMENTS OTHER THAN z THOSE SHOWN ON THE RECORDED PLAT. X 000.00 DENOTES EXISTING ELEVATION NOTE: CONTRACTOR MUST VERIFY DRIVEWAY DESIGN. ( 000.00) DENOTES PROPOSED ELEVATION ; — — — DENOTES DRAINAGE AND UTILITY EASEMENT r NOTE: BEARINGS SHOWN ARE BASED ON AN ASSUMED DATUM DENOTES DRAINAGE FLOW DIRECTION -- DENOTES SPIKE I. —9 DENOTES OFFSET HUB i " WE HEREBY CERTIFY TO WOODDALE BUILDERS THAT THIS IS A TRUE AND CORRtCT REPRESENTATION OF A x SURVEY OF THE BOUNDARIES OF: 49 LOT 56, BLOCK , TROY VILLAGE ST. CROIX COUNTY, WISCONSIN IT DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCROACHMENTS, EXCEPT AS SHOWN, AS SURVEYED BY ME OR UNDER MY DIRECT SUPERVISION THIS 5TH DAY OF JUNE, 2006.. evised: SIGNED: PIONEER ENGINEERING, P.A. 9 xx —xx —xx xxx " SCALE : 1 INCH = 40 FEET BY: r Peter J. Hawkinson License No. S 2493 -008 f 2857 106130000 MTW r s y +� C }. 14