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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count y:
' Safety and Buildings Division
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.:
Personal information you provice may be used for secondary purposes [Privacy Law s.15.04 (1)(m)]. 363969
Permit Holder's Name: ❑ City ❑ Village ❑ T wn of: State Plan ID No.:
Hartman, Mike Troy Township
CST BM Elev.:- Insp. BM Ele - 3 BM Description: Parcel Tax No.:
S s 040 - 1252 -30 -000
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic W e- Z O Benchmark -� qZ �Q p V
_ ____ Alt. BM 3 Pt 9, 7
Aeration Bldg. Sewer
Holding St Ht Inlet P
TANK SETBACK INFORMATION Ht Outlet J, 2 ��' , U
TANK TO P/ L WELL t BDG, - Air i ntake to ROAD
Air Intake
Septic �Q > �S 3 p NA NA Header/Man.
om
G
Aerati Dist. Pipe CL Is �P
Holding Bot. System x t I pp6
PUMP/ SIPHON INFORMATION Final Grade � 2 • D
0
Manuf acturer Demand St cover x
Model Numl er� M
TDH ift Friction stem TDH t oss
Forcemain Length Dia. Dist. To
SOIL ABSORPTION SYSTEM ca c
BED / ENCR) Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS - K �i Z DIM EN I N
SETBACK
SYSTEM TO P/L BLDG WELL LAKE /STREAM L Manufa urer:
INFORMATION Type Of gMP E Moe Num er:
System: -�3 6 �d �b 0 6 T
DISTRIBUTION SYSTEM
Header / Margifold Distribution Pipe(s) x Hole Size x Hole Spacing I Vent To Air Intake
7
Length d Dia. �_ Length � Dia. Ajt Spacing S7
SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only
Depth Over 78ed h Over xx Depth Of xx Seeded/ Sodded xx Mulched
Bed/ Trench Center Tren ch Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.) q1
Inspection #l:la /ar' /op Inspection #2:
Location: 281 St. Andrews Drive, Hudson, WI 54016 (NE 1/4 NW 1/4 19 T28N R19W) - 1928191324 Troy Village 2nd
s Cr'�u .e:.
Addition - Lot 73 I � s y { em a.� k/Cs 1OCa> in r / o rnP </
1.) Alt BM Description =�ldov S;/ n th P :6 oo, I l° ad ry..g
2.) Bldg sewer length = %0'
- amount of cover= S {y d Le y _ 2 n V (, 1rA — if 6o,.)�,/tic
Plan revision required? ❑ Yes q No Use other side for additional information. (a Z (o L
SBD -6710 (R.3197) DatW pect ' ignature Cert. No.
- 1
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Sanitary Permit Application Safety & Buildings Division
In accord with Comm 83.21, Wis. Adm. Code 201 W. Washington Ave.
See reverse side for instructions for completing this application PO Box 7302
Personal information you provi ay � j or secondary purposes Madison, WI 53707 -7302
Department of Commerce [Priva 1�0 1 ( ) (Submit completed form to county if not
state owned.
Attach complete plans to the county o fort stem, not less than 8 -1/2 x I 1 inches in size.
County C D^ �� StaVg Pe it N �,ifllet$ ion to e ' application State Plan I. D. Number
I. Application I - Please Print all Infdroition Location:
Propert�00er Name J I t Property Location
°""_ ST CROIX 1/4 1/4, S ,N, or
'r- A
Property Owner's Mailing Address FFICE t Number Block Number
ZONINGO 0)
City, Sta Zip Code Subdivisio Name or CSM Number
,
II. Type of Building: (check one) ❑ city
Igo 1 or 2 Family Dwelling - No. of Bedrooms : ❑Village
• Public /Commercial r�ib��use = Town of
❑ State -Owned ( tom( tJ t vldU/./S�
Nearest Road
Cam) 3
x q3 - � s , t� s N Parcel Tax Number(s) [ 2S L 30
III. T ype of Permit: Check only one box on line A. Check box on line B if applicable) 1q. ? - S . 1 1
A) L X New 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to
System System Tank Only Existing System
B) Permit Number Date Issued
❑ A Sanitary Permit was previously issued
IV. Type of POWT System: (Check all that apply)
tI Non - pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland
• Pressurized In- ground ❑ Holding Tank Single Pass ❑ Drip Line
• At-grade ❑ Aerobic eatment nit ecirculatin ❑ Other:
V. Dispersal/Treatment Area Information: . *?"
1. Design Flow (gpd) 2. Dispersal Area 3. Dispersal Area . Soil Application 5. Percolation Rate 6. System levation 7. Final Grade
Required Proposed Rate (GalsJday /s ft.) (Min. /inc ' 0 . Z Elevation
i
®0
VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel • Fiber- Plastic
Information
Gallons Gallons Tanks Con- Con- glass
New Existing Crete s
tructed
Tanks Tanks
1 ❑ ❑ ❑ ❑
❑ ❑ ❑ 1 ❑ ❑
VIII. Responsibility Statement
I, the undirsigned, assume responsibility for installatio4 of the POWTS shown on the attached plans.
Plum er s ame nt) > Plumbe r' igna o ps) MP/MPRS No. Business Phone Number
c.
1 bees Address (Street, City, State, 'p Code)
IX. County/Department Use Only
❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Signature (No stamps)
',Fl4[Approved ❑ Owner Given Initial Adverse S harge Fee
Determination M Z6Od
X. Condi of Approval /Reasons for Disapp ov�l:
2` 2— f
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IL
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Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3
Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code
En vironmental BY Design
Attach complete site plan on paper not less than 8'h x 11 inches in size. Plan must County
include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix
percent slope, scale or dimemsions, north arrow, an9.tgS and distance to nearest road. -
Parcel I.D.#
APPLICANT INFORMATION - e"jpr rtt -aN in f ation. v Date
Personal information you provide may be fq( sondary pu (Ptivalcy s. 15.04 (1) (m))•
2(0 .21h1D
Property Owner ® Property Location
Continental Develo meet ~s A Govt. Lot NE 1/4 NW 1/4 S 19 T 28 N,R 19
Property Owner's Mailing Address r ) �� I -_ ; Lot # Block # Subd. Name or CSM#
12301 Central Avenue NE °St#te 230, >t _19 73 Tro Village 2Nd Addition
City a . Zgge umber j;;:` El City ❑Village ❑Town Nearest Road
Minna olis c � GOFF/ / Troy St. Andrews Drive
N New Construction Use: tt� ' q edrooms 4 ❑Addition to existing building
❑ Replacement ❑ lal describe
Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpolft .8 trench, gpolff
Absorption area required 857 bed, ff 750 trench, ft Maximum design loading rate •7 bed, gpd/fF .8 tr ench, gpd/ft
Recommended infiltration surface elevation(s) By Designer ft (as referred to site plan benchmar
Additional design / site consideration
Parent material Loess Over Glacial Outwash Flood plain elevation, if applicable ft
S= Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system ®S ❑ U ® S❑ U ® S❑ U ® S u ❑ S N u ❑ S N U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ff G,
Boring# Horizon in Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consisten Boundary Roots Bed Trench
1 1 0 -25 10yr3/2 - sl 2msbk mfr cw 2f .5 .6
2 25 -35 10yr4/4 - sil 2msbk mfr cw if .5 .6
Ground 3 35 -48 7.5yr4/4 - s osg ml cw if .7 .8
elev
889.8 ft 4 1 48 -140 7.5yr6/4 I s osg ml - - .7 .8
Depth to
limiting
factor
>140
Remarks:
.� 1 0 -36 10yr3/2 - is lmgr mvfr cw 2f .5 .6
2 36-43 10yr4/6 - Is lmgr mvfr cw if .5 .6
Ground 3 43 - 10yr4 /6 - sit 2ms bk mfr cw - .5 .6
elev
892.58 ft 4 61 - 140 7.5yr4/6 - s osg ml - - .7 8 .4
Depth to
limiting S� L( /
factor
t
.
>140
o s oy
Remarks:
CST Name (Please Print) Signature: �� ��_ Telephone No.
Thomas C. Nelson 715- 246 -2454
Address Environmental By Design Date CST Number Ref #
1432 120th Street, New Richmond, W1 54017 2/3/98 MO2605 24
PROPERTY OWNER: Continental Development SOIL DESCRIPTION REPORT 2 Page 2 of 3
PARCEL I.D.# Environmental By Desi
Horizon Depth Dominant Color Mottles Texture Structure nsistence Boundary Roots GPDlfts
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ! Trench
1 0 -8 1 2msbk mfr cw 2f .5 .6
3 10yr4/4 - s s
- 2 8 -25 10yr3 /3 - sl 2msbk mfr cw if .5 .6
Ground
3 - - va if 5 .6
elev 25 34 10yr4 /4 sil 2csbk mfr c
891.02 ft 4 34 -130 7.5yr5/6 I - s osg ml - - 7 ! --8 �J
Depth to
limiting
factor z z
>130
Remarks:
4 1 0 -21 10yr4/4 - sl 2msbk mfr cw 2f .5 .6
2 21 -41 10yr4 /4* - sl 2msbk mfr cw if .5 .6
Ground
elev 3 41 -51 7.5yr5/4 - s osg ml cw if .7 .8
890.01 ft 4 51 -61 10yr3/3 - sl 2msbk mfr cvv - .5 .6
Depth to 5 61 -98 10yr3 /3 - sil 2msbk mfr cw - 5 6
limiting
factor 6 98 -140 7.5yr5/4 - s osg ml - - .7 .8
>140 c, a 2 /,03. 7 — f'A- G 911017 s 4 -A-- 7
Remarks Horizon 2 contains several broken bands of sl (10vr3 /1) of the same consistM ea, " 7 . 1
5 1 0 -45 10yr3 /1 - sl 2msbk mfr cw 2f .5 .6
2 45 -57 10yr3/3 - sl 2msbk mfr cw if .5 .6
Ground
elev 3 57 -135 7.5yr5/4 - s osg ml - - .7 .8
888.58 ft
Depth to
limiting
factor
>135
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
1�V1;ONMENTOL BY D SIGN
1432 120 STREET, NEW RICHMOND, WISCONSIN
715-246-2454
PROJECT NAME: TROY VILLAGE 2nd ADDITION
DESCRIPTION: NE%, NW/4, SECTION 19,,T 28 N, R19W
TOWNSHIP: TROY COUNTY: ST.CROIX
LOT.- 73 SUBDIVISION: TROY VILLAGE 2' ADDITION
3
rs
j /
L3
scm.E I"=40' e Tom Nelson
BM 1 SE corner post ground surface elev. cstmo2605
BM 2
ST CROIX COVNft -;
SEPTIC TANK MAINTZNANCE AORJIVIaNT—
AND
`°�
OWNERSHIP CERTIFICATION FORM
Owner /Buyer
w Ake
_ Mailing Address / � � �
.Property Address a� 1 J I
(VcnfIcouon tcquucj (runt planning Npartment for now construction)
City/State
• Parcel ldontification Nurnbsr
��
i.F T, I)ESCRIPT>i S ;
Pre cmy Location ' /•. „f = ' /., Se T N•R j Town of N
p ; I - . 0 Y
LotM
Subdivision , Co
l Certifled Survey Map M , Volume , Page M
36
Warrnnty Dced q
2G �/ Volume I SIS , Page M`
Spec house yes O no lot lines identifiable yes O no
SYSTEM MAINTENADICFa
system :ould re.ult in its premature r
failure to handle wastes. proper maintean;r.
Improper use and rnairtenantxof Y06! a• tti:
co -isists of rumptna out the septic tank c�cry I:rce years or sooner, If needed by a licensed pumper. whit you put into tite system'.
ca- •lYecr the function of the Sep i tank as a ucatmeni stage in the waste Oaposal system. ;;
The property owner arrees to subrtu to Si . Croix Zoning Department a certification four, signed by the owner and by.'';
master plumber, journeymen plumber, restricted p' umber or a I;censed pumper verifying that (t) the on•site wastewater disposal systti
a tpeeiion and pomp ng (if necessary), the septic tank is loss Char. 1/3 full of sludge:
ie n proper operoting condir anNor (2) o`c
!'we, :he ondcrsiglcd 111vc - -ad ;hc above rcyt: r:iwnts and at,icc to mai.ltain the private scwa`c disposal system with the stsrduds 'I
it , fonh, herein, asset by the Dcpar,n ew or (:wnnurcc and the Ucpzrtment of Nstu :al Resources, Sea of Wisconsin. Certtfauon.+
stating ths: your septi: system has beer ma�rtaincd must ye eo and returned to the St. Croix County Zoning O!Act within "0
days o1r he thr ' year a pirotten date.
---- DATE t.
SI .,NATURA t A ('L CANT
OWNER (_'ERTIFIC&LON_
I (we) certify that all statements on '11:1 fora+ are true to the best of my (our) knowledge. ( (we) am (are) the owneRs)
the Vp y crib obore, by virtue ot• a w4rranty deed recorded in Register of Deeds Office. j s r r
SJv'NATRa' of APPUCANT CATS
L' ,
•••••• Any infvnnauon that a m;s•reprcuntcd may result to the unitary permit being revoked by the Zahing Deperttment. "• "•
,, warra •• Include with this applltetlon• a scam a eq+y of the cenifled survey map if a
referenDt vw
made in the mttty deed
Ice's *attbtl.VZrorl MIN ti Ld.A V3x3 21ft139 wd 0t:0t t *— It — 39
voi.1528 363
C=.2 CS, S 19
STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
Document Number RECEIVED FOR RECORD
�i This Deed, made between 47 -21 -2000 12:30 PM
II Troy Development Corporation, a Minnesota Corpo WARRANTY DEED
EXEMPT #
l -
Grantor, CERT COPY FEE:
and COPY FEE:
Hartman Homes, Inc. TRANSFER FEE: 299.70
a isconsin orpora ion RECORDING FEE: 10.00
PAGES: 1
Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate In St Croix County, State of Wisconsin:
Area
Lot 73 of the Plat of Troy Village 2nd - -
Addition in the Town of Troy, St. Croix County, Name and Return Address
Wisconsin. Hartman Homes, Inc.
P.O. Box 326
Subject to Declarations of Covenants, Conditions and Somerset, WI 54025
Restrictions for Troy Village, recorded in Vol. 1241,
Page 256, as Doc. No. 559964, and the Declaration of
Golf Course Covenants, Conditions and Easements, 040 - 1252 - - 000
recorded in Vol. 1241, Page 301, as Doc. No. 559969, 19.28.
all as appearing in the office of the Register of Deeds j�arcel Identilicalion Number (PIN) for St. Croix County, Wisconsin, and such other
easements, reservations, restrictions and reservations This is not homestead property.
of record, or in use, and obligations contained in the Os) (ts nol) Ii
Purchase Agreement for this lot.
i
�i
4
I II
Exceptions to warranties:
t!
10th Jul 2000 �I
i Dated this day of y Ij
i� II
(SEAL) (SEAL) !
Charles S. Cook, President
Troy Development Corporation
(SEAL) (SEAL)
ij AUTHENTICATION ACKNOWLEDGMENT
it
Signature(s) Minnesota
!! State of Wrst -orrs• ir,
Anoka
Count
y s5.
authenticated this day of Personally came before me this 10 h day of
;! July ,the above named
_C harles S. Cook, President
! Troy Development Corporation
M
TITLE: MEMBER STATE BAR OF WISCONSIN to
Qf not, me known to be the person who executed the foregoing
authorized by §706.06, Wis. Stats.) Instrument and acknowledge the same.
� THIS INSTRUMENT WAS DRAFTED BY
�• �.
iI TROY DEVELOPMENT CORPORATION Nancy L Clift
II Notary Public, State ef- WiseoASlwAnoka County, Minn.
My commission is permanent. (If not, state expiration date:
li Jan uar 31
(Signatures may be authenticated or acknowledged. Both are not � 2005 .)
necessary.)
• Names of persons signing In any capacity must be typed or printed below d>,!tr signawre.
STATE BAR OF WISCONSIN Wisconsin Legal Blank Co., Inc.
�I WARRANTY DEED FORM No. 2 - 1998 Milwaukee. Wis.
♦�� . NANCY L CLIFF
PIOTARY PlJ�1G -�'g'�
MY COMMISSION EXPIRES
JANUARY 31, 2005
J
'.78 S.F' 3 �? w N 88 °00' 00" W
16 ' ACRES 0 0 1 318,00 3 3
1s o o I o 0 OUTLOT 7
3 5.88 0Zg o 0 - - - --
00 9 , �I N .� o IM 75 w o o
�.N 80 E o
I N• q i 44441 S.F. M N N
91 `„ �; Z I 1.020 ACRES " �° 0
46156 S.F. V N 90 0 00' 00" W
1.060 ACRES ' I 3t8.ts'
N -7 ��. 74 -
278• 45251 S.F. o'
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1.039 ACRES
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92 N 88 °00' 00" W
44040 S. o �+ 33s.ts'
1.011 ACRES
- N 75 °00• 46539 S.F. ti
N ? o> >6- w N 1.068 ACRES
N 76 °5 k °h
1 2' w 5 ��h OUTLOT 11
1
oo 931 1 r N 40198 S.F.
44397 S.F. " 1 1 v, 0 0.923 ACRES
1.0191 ACRES
I 1 1 72 _ �w
` 1 I o N BENCHMARK TOP OF 1"
1
10.96 1 6 1 48117 S.F. N o IRON PIPE. ELEV. = 881.92
�. .. 1.105 ACRES °- a
00 00 W 6.40 _ m
0.20' o m
7 000' 00" E 2 4.48' o I o IN I $ 7g 24 .,
I _ o N 84 56' 00 E S 79 °24' 1616 E 324.47'
94 o o- 233.8 16 2.11' E 3 2 3.98 ,
43970 S.F. °,',� m � o 1 0 1 161 .88'
1.009 ACRES N. �, ' ''o I �
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71 N
I N o 44304 S.F. � 0 1
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I 154.47' m 0
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o Sao �" W 2 30 . 5$ 1 � °
i °oo, o m TROY V
I I 1 OUTLC
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ROY VILLAGE QI I I 1
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