HomeMy WebLinkAbout040-1258-30-000 r - -
Wisconsin Department of commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building DNision +
INSPECTION REPORT Sanitary Permit No: 430520 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide maybe used for secondary purposes [Privacy Law, s.15.04 (1)(m)].
Permit Holder's Name: city village X Township Parcel Tax No:
Wooddale Builders I Troy Township 040- 1258 -30 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
1f = CZ- 24.28.20.1375
TANK INFORMATION V I ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic � `S Benchmark
Dosing t � � Alt. BM
Aeration �--') Bldg. Sewer
Holding
St/Ht Inlet
I 3 �0 84 6 7
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic t \ 1 Dt Bottom
Dosing `t t Header /Man. L 11 2. c iao 0
Aeration Dist. Pipe 9 Z
Holding Bot. System j0. IX
F inal Grads O I nn �
PUMP /SIPHON INFORMATION t.9j �pu rni tx.lL
Manufacturer M Demand St Cover ( 702 -90 � GPkAs
Model Nu b 1 �(
♦ N
TDH Lift Fricti .o n Loss System Head TDH Ft
.D 4 -- 3.}Z'
Forcemain Length �)a. f t Dist. to Well
SOI B ORPTI N SYSTEM
86WRENCW Width t k4-;b(eA engt No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENS S / Z ) SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Magufagotu 1
INFORMATION Type Of System: 1t CHAMBER OR (/�Nt
UNIT Model Number:
7 d
DISTRIBUTION SYSTEM o. w �un�r ft,
Header /Manifold tl Distribution x Hole Size x Hole Spacing ent to Air Intake
Pipe E !
Length Dia Length Dia Sparing
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 D Yes No
COMMENTS: (Include code dilcr,pencie jars s grunt, etc.) Inspection #1:�Y 0 1 211 3 Inspection #2:
Locatio :^ S 1 in ay Ro dson,, - 54016 N / /4 24 T28N R20W) Tr Village L t 115 Parcel No: 24.28. 137
_ �-.
1.) Alt BM Description -) �J� p
2.) Bldg sewer length = Z I 1 O+ps�p
3 - amou t of cover S �. p'( = d �Q_ .
Ack Plan revision Required? Yes X No O�
i
Use other side for additional information. j _ _ _._ —.^ ____� —. --
SBD -6710 (R.3197) Date In se or's Signature Cen. No.
{
1
l
Safety and Buildings Division City
` 201 W. Washington Ave., P.O. Box 7082
ns�n Madison, WI 53707-7082 Sanitary Permit Number (to be filled in by Co.)
e artment of Commerce (608) 261 -6546 05-2-0
Sanitary Permit Application State Pan I.D. Number
In accord with Comm 83.21, Wis. Adm. Code, personal ' R
may be used for secondary purposes Privacy La , sI S.'R� E I V ED �J� ress (if dif g than mai i address)
3 '1 1 L/nrsAy �`�
I. Application Information — Please Print All Information f
Property Owner's Name I Parcel # Lot # B #
W 00 L' AL AkI L - 0E ST. CROxCOUNT 5 "' I
Property Owner's Mailing Address roperty Location
5 ev 3 e 2- y
City, State Zip Code Phone Number A= Y.• Section
htiMUO' A)kA yt? Al - 0 EV .
(ci rcle MCI
II. Type of Building check all that apply) Name CSM Number T N; R_, L or
YP g ( PP Y) 1Y b P� Ski �'(�
Subdivision
1 or 2 Family Dwelling - Number of Bedrooms
le ❑ Public/Commercial - Describe Use -7 IZOy
❑ State Owned - Describe Use Z ❑City ❑Village Township of M6 �l
I1I. Type of Permit: (Check only one box on line A. Complete line B if appli le) _ 2 5_'9 — 30 -- mu C. 13
A" New System ❑Re
placement 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 appl
❑ Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland 18 Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter Leaching Char9ber ❑ Drip Line ❑ Gravel -less Pi ❑ Other in)
V. Dispersal/Treat ent Area Information: ()
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Propos (sf) System Elevation
o
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Tank �}!3U `/
Aerobic Treatment Unit
Dosing Chamber
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Si atu MP/MPRS Number Business Phone Number
w,� ��M ��►/uy c,�• 133�a 7i5 1 53 3)6
Plumber's Address (Street, City, State, Zip Code)
I 6 S d af5 - Sq Ga
VIII. Coun T rtment Use Onl
Cl A pprovedDisapproved Sanitary Permit Fee includes Groundwater ate Issued Issuing gent Signature o Stamps)
Surcharge Fee) 7
Owner Given Reason for Denial 25� '- -^ / • �� X3
IX. Conditions of Approval/Reasons for Disapproval t
SYSTEM OWNER: 3 � --� ft-
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 ea paper aot less 6411 81/2 111 inches is size
SBD -6398 (R. 08/02)
09/25/2003 16:28 17154256864 WEGERER SOIL TESTING PAGE 06
a PLOT PLAIT Page of ,
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Scale 1 -�
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09/25/2003 16:28 17154256864 WEGERER SOIL TESTING PAGE 06
s •
PLOT PLAN Page of
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09/25/2003 16:28 17154256864 WEGERER SOIL TESTING PAGE 07
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09/ ?5/2003 16:28 17154256864 WEGERER SOIL TESTING PAGE 08
Combination SeptjC;Tank add
PL IA CHAMBER CROSS SECTION AWD SPECIFIC &1014 ' PAGE OF
CUT CAP WCATNEIR FI<OOP
aucTIOAJ oox ,
4 VC AFFROVCD LOCKIUIG
1 FROM _ 0OM MAUMO COVEI A JrM
.11M00w OR PRCSK ? wl►SLI.IIUG L�gFt.
��i10U t� IpE S . cauoutr
• wlirit�lellT' t+s'P AJ,g,tA1TAKC
• Giro+`' � � _
Ie• AIU.
IJULEY
PROVIDE
�.a
•;
I lk, AtRrr4HT SCAL ( ! I I
Approved Ott r- w3 ! 1 1! Approved
joint w/ �-I�oo ! �! joint V/
PVC pip -! i� ALARM PVC pipe
C
•1
1 ou
Ct_C1� f
PUMP —.�• ""�
Off
0 Cou K rE
RIS EXIT pcx A, irc OW LtJ IF TAIJK MANUFACTURER NAS SUCM ArpROVAt. 3NApPAortD
.,L... 6a<bOt►rse
SCPTIC t 5PCC11FICATIOMS
DOSE
TAMA /MAIJUFACTURCR: — . � .NjfzM IJIIMACR Of DOSES: ._ PER DAV
• TAAJK 5IZC N Z;)b fb 0th __ GALLOWS DOSE VOLUME �
ALARM MAwUFACruts, R: IIk1CLUDIQra OAGKfLOV: �33•�I t,�ELQ�s
AODCL DUMBER: 10) "\AJ CAPACITIES: A=
S Tz PC: �1�?1 cuC __If ^ — ^ — tA1CAt.5OR 4 W' &ALLOyy
a = �iuci+es`bR� r;pLl.o+�s
PUMP 1AAMUFACTURCR: aOV Lr ->
C •r��._MALW OR X • `/ GA LL OIJS
MODEL UUMDf R: ` oI J ' � D= INCHES OK � ` GALL.)AJS
SWITCH TYPE: DOTE: PIJPtP AAI� 53 M 4 Q TO 10
DE `
MIMIMUM DISCHARGE • RATE ` "a -'3 CPM INSTALLED OM SEPARAYC cfRcUiTS
VERTICAL DIFFEREI4 DETWECU PUMP OFF AQD..O(5TaI5UTioM pwt.. S,Y3 FEET
f fAMJIMUtA AJETWOKK SUPPLY PKESSURC • ' Q � F EY
+ �" FEET OF FORCE PAIM X `Z9 f Jpp'LiU
FGTIOU FACTOR.. `�. t '0p FEET
• TOTAL O!dUAMIC. HEAL S .FEET
As per manufacturer ZZ.Z� gal /in. Liquid depth 36y
09/25/2003 16:28 17154256864 WEGERER SOIL TESTING PAGE 09
Goulds y o�-
Submersible
Effluent Pump
3 871 EPO4
EP05
APPLICATIONS • Fasteners: 300 series • Fully submerged in high ■ Motor Housing: Cast iron
Specifically designed for the stainless steel, grade turbine oil for for efficient heat transfer,
following uses- • Capable of running lubrication and efficient strength, and durability.
• Effluent systems dry without damage to heat transfer. ■ Motor Cover. Thermoplas-
• Homes components. tic cover with integral handle
Farms Motor. Available for automatic and and float switch attachment
manual operation. Automatic
• heavy duty sump • EPO4 Single phase: 0.4 HP, models include Mechanical p
• Water transfer 115 or 230 V, 60 Hz, 1550 Float Switch assembled and ■ Power Cable: Severe duty
• Dewatering RPM, built in ovedoad with preset at the factory, reed oil and water resistant.
automatic reset. ■ Bearings: Upper and lower
SPECIFICATIONS • EP05 Single phase: 0.5 HP,
115 V, 60 Hz 1550 RPM, FEATURES heavy+ duty y ball bearing
he
Pump: EPO4 built in overload with ■ EPO4 Impeller. Thermo construction. b
• Solids handling capability: automatic reset. plastic Semi -open design AGENCY 1J$TING
2 1e maximum. • Power cord: 10 toot with pump out vanes for
�. • Capacities: up to 55 GPM. standard length, 16/3 SJTO mechanical seal protection.. Canon SlaMtardtp�ocl�on
•Total heads: up to 24 feet. with three prong grounding m
f • Discharge size: I W NPT. plug. Optional 20 foot EP05 trnpetler. Thermo- (CSA listed model numbers
• Mechanical seal: carbon- length, 16/3 SJTW with plastic enclosed design for end in "F" or "AC ".)
rotary /ceramic - stationary, three prong grounding plug improved performance.
SUNA -N elaeomers. (standard on EP05). ■ Casing and Base: Rugged
• 'Temperature: thermoplastic design provides
104 °F (40°C) continuous superior strength and
140OF (60°C) intermittent. corrosion resistance.
• Fasteners: 300 series METERS FEE?
stainless steel to
' •
Capable of running
dry without damage to
components.
Pump. EP05 g ..._.
• Solids handling capability: 0 7 l
'Y" maximum. <
• Capacities: up to 60 GPM.
• Total heads: up to 31 fee#. 6 20
• Discharge size: i'h' NPT.
• Mechanical seal: carbon- c 5 15 I i
rotary/ceramic- stationary, a 4 ! ,
BONA -N elastomers. -
• 'Temperature: '- 3 10 ,
1041(40•C) continuous
140OF (60°C) intermittent. --
', 5
ba
✓' 0 0 0 10 20 _H
30 40 50 GPM
:
0 2 4 6 6 10 12 nVM
CAPACrTY
a logs Daft Pumps, rnc.
EtfecWe may.1995
aaa��
Wwconsin Department of Commerce SOIL EVALUATION REPORT Page of 3
b4ision of safety and Buildings
' . in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County �� • CZ C) lx
include, but not limited to: vertical and horizontal reference 11 % directi a nd
percent slope, scale or dimensions, north arrow, and locatio and _ Parcel I.D.
9 EC8 �°� ' vy {J- \ZS,9 -3 000
Please print all informatio Re ' wed by Date
Personal information you provide may be used for secondary purp es (Prifi Fpaw s. jrn)).
Property Owner LL r A - 0(-
Property t.ocatio
— ��C)��Pc` i12 1i SE 1/4 SZ� TZU N R?� E(o W
Property Owner's Mailing Address Subd. Name or CSM# y
U NJ
State Zip Code Phone Number E] City ❑Village ®Town Nearest Road
Im7c il)yi — �l bu {2f'� V1i'V SS3L,3 (aSZ )3qS -ti543 Z.C�-I' Ll►vt -n lZD
[� New Construction Use: (g Residential / Number of bedrooms Code derived design flow rate 10 U 0 GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material �yS OU Flood Plain elevation if applicable Y ft
General comments
and recommendations: Z `� i.. 3 +-�. t r K u r r
� � 3" rte ,1 T• ._
a Boring # ❑ Boring ,
❑ pit Ground surface eiev. C) O S - V ft, Depth to limiting factor 1 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texts - e Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. S Sh. 'Eff#1 'Eff#2
O —1 � O" ► (Z31 Z S 1 l 3'�q,1�1�c Yyl' ' Ir- C. �J 1 - S • v
2 1ZZg,
3 � -t(, 1v7tZ 3Jb -- � i ! lC a.b�c l��:l• CS _ , Z . �,
y its -t o� t2 y! 6 — S O
e�
E 1 Boring # r] Boring
pit Ground surface elev. C l S T ft. Depth to limiting factor 3 � 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
M
0-10 1U1 CL-3 I Z S t ti 3�°� 1�k w1`�- �` • S Y�
I =ZY ..I u- a 3t2
L0-t m:)16 si 1 Csb 4 Cs
LIZ 1�0 -i 2 VA
Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mg/L Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L ,�-
CST Name (Please Print), r Signa CST Number
ArQ ur Ti � iiegerer 03 - l'1 S .. 220254
Address
W e e r e r Date Evaluation Conducted
g Soil Testing & Design Service TeleptwneNumbe
421 ii. Hain St. River Falls, WI 54022 C� — ZS—U.3 715 -425 -0165
r
Property Owner wUU�17'Ptk- E`Q AZS, Parcel ID# ���i– Page Z of 3
Boring # ❑ Boring C
® pit Ground surface elev. ft. Depth to limiting factor Z 9 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
o
Z 1p Z 1 10`� 2 Z /Z
31V
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 /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
F-1 Boring # ❑ 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 /ft
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, 130 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.6/00)
I
PLOT PLAIT Page 3 of
✓ Scale 1'
r �
0
� I ��
J
3 1 - C
715- 425 -0165 220254
CST Signature Date Telephone ITo. CST No. .rob NO.
` Wisconsin`De of Commerce SOIL AND SITE EVALUATION, Page 1 of 3
Division of Safety and Buildings in accord with Comm 83.95, Wis. Adm. Code'
Environmental By Design
Attach complete site plan on paper not less than 8% x 11 inches in size. Plan t ,., ,�, County
indude, but not limited to: vertical and horizontal reference point (BM), directi n 3 [ E E St. Croix
percent slope, scale or dimensions, north arrow, and location and distance rest ro
Parcel 1.D.#
APPLICANT INFORMATION - Please print all informant Revie ' Date q
Personal information you provide may be used for secondary purposes (Privacy law, (1)�( y at j 7 L
Property Owner rty Locat6�DiUNTYN
Continental Development t ZoNtWOFfsf4F Ik4s , 1!4 S 24 T 28 N,R 20 W
Property Owners Mailing Address L 3 ock # me or CSM# fd
12301 Central Avenue NE Suite 230 1 Tro Vill
City State Zip Code PhoneNumber u City l aqe Town Nearest Read
Minneapolis MN 55434 Troy Lindsay Road
I New Construction Use: Z Residential / Number of bedrooms 4 Addition to existing building
E] Replacement E] Public or commercial describe
Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpolft? .8 trench, gpdffP
Absorption area required 857 bed, W 750 trench, W Maximum design loading rate .7 bed, gpd/ff .A tr ench, gpd/fP
Recommended infiltration surface elevation(s) 99.15 ft (as referred to site plan benchmar
Additional design / site consideration 1, 2, 3
Parent material Loess Over Glacial OutWash Flood plain elevation, if applicable Na ft
S= Suitable for system Conventional Mound i In - Ground Pressure AT -Grade System in Fill Holding Tank
U= Unsuitable for system ( NS o u ® S❑ U , ® S❑ U Z S❑ U El S® U I El S® u
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure GPD/ft
Boring# Horizon i in Munsell i u. Sz. Cont. Color Texture Gr. Sz Sh iConsistence Boundary Roots
Bed Trench
i 1 i 0 -10 i 10yr3 /2 i - i sil i 2msbk i mfr i cw i 2f i .5 .6
2 10 -40 10yr5/4 - sil 2msbk mfr cw
Ground 3 40 -90 7.Syr4/6 - s Osg m1 - - .7 .8
elev
102.60 ft I ,
Depth to
limiting
factor
'90 �►.�{
Remarks:
2 1 0 -19 10yr3/2 - sl 2msbk mvfr cw 2f .5 .6
2 19 -42 1O - sil 2msbk mfr cw - .5 ! .6
Ground 3 i 42 -96 7.5yr4/6 - I s i Osg ml i - - .7 .8
elev
102.98 ft
Depth to
limiting
factor
>96
Remarks:
CST Name (Please Print) Signature: Telephone No.
Thomas C. Nilson 715- 246 -2454
Address EnvIrOnmentalBYIN gn Date CST Number Ref #
1432 120th Street, New .Richmond, W1 54017 2/17/99 227387 99
r
PROPERTY OWNER: Continental Development SOIL DESCRIPTION REPORT ® Page 2 of 3
PARCEL LD1 Environmental By Desion
Horizon Depth Dominant Color Mottles I Texture i Structure Consistence) Boundary I Roots GPDlftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -16 10yr3 /2 - sil 2msbk mfr cw 2f .5 6
2 1 16-42 1Oyr514 I - A 2msbk I mfr I cw I - 5 6
Ground
elev 3 42 -96 7.5yr4/6 - s Osg ml - - .7 .8
10308 ft I I I I I I i
Depth to I I I I
limiting
factor
y7.1
Remarks:
I I I I I I I
4 1 0 -19 1Oyr3/2 - sil 2msbk mfr cw 2f .5 .6
- 2 1 19-42 10yr5 /4 I - I sit I 2111sbk I mfr I cw I - I .5
.6
Ground
elev 3 42 -96 7.5yr4/6 I - I s i Osg I mi I - - I 7 .8
100.92 ft
I I I I I I I I I
Depth to
limiting
factor
>96
Remarks:
1 0 -20 10yr3 /2 - sil 2msbk mfr cw 2f .5 .6
2 20-44 10yr5/4 - A 2msbk mfr cw - .5 .6
Ground I I I I I I
elev 3 44 -98 7.5yr4/6 - s Osg ml - - .7 8
103.69 ft
Depth to
limiting
factor
>98 I I I I I I I
Remarks:
I I I I i I I I
I I i i I 1 I I I
Ground
elev ! I I I I I I
Depth to
limiting
factor I I I I I I I I
I I I I I I i I
Remarks:
ENVI'PON
1432 120'' STREET, NEW RICHMOND, WISCONSIN
715- 246 -2454
Tom Nelson
Certified Soil Tester 227387 --- Registered Sanitarian SR00713
********************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * **
TROY VILLAGE -- Lot
NVVv4 , SEY4, SECTION 24 T 28 N, R 20 W
Troy Township, St. Croix County, Wisconsin
Page 3
-rr Or—
I
� lo �. X102 i
(� I ACU'' e `a
set b�-
w '// s6
M
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SCALE 1" =40 Tom Neb t
BM 1. Top of iron pipe SE lot corner ELEV 100' .�
BM 2. Top of iron pipe SW lot corner ELEV 11 S.98'
�� 1
v
[KV1 �Y 0[51
1931110 MEET, NEW OWN, WiS(MM
IA51 SAVER BYIiIO 45 NEISON
M- 146-201
TROY BURNE VILLAGE — Lot
NW' /4 SE %4, SECTION 24 T 28 N, R 20 W
Troy Township, St. Croix County, Wisconsin
Page 3
2�
97 �6
/30
7 5
Z lop-c.
FmJt da
a� 4
4- o
a
aM2
SCALE 1" =40 Tom Nelson
BM 1. SE LOT CORNER Top of iron pipe ELEV. 100' 4 n 227387
BM 2. SW LOT CORNER TOP OF IRON PIPE ELEV. 115.98
E
f
..... SY5T1i4 � • ,
HAMid>rttiy;s page- d
ilartng ser n , a intdtiattce of I t hid itystem 'is ctitit•a1 to its proper
opetiltidn end longeviLy, Tho gystetit uatxer range bd provided with d .
Corselets adt of plans inclttditig Hid Btpnt,geMt! tit shctidh,
CeitERAL
proper func tio,tit,g o ails L e of on -gi Le
t io
dependent or Llte anlottnt of aster enteeitig thdgy,tt:emdttd the of til t qudlity
t' arteri The lbwet Lhe volume of Watet attd tite over the level
bf contamittaitts the mote efficient alid lodger ld sti•i:ig, the sysL
i+ili bu,
Tppit ail aydtem r include d Septic 'tank to nettle out -and
btaak dated adlidg, dti brrjuet,t filter dt ttid sapLic tank outlet to
t;iltat dUt tat 911 piitticleg a pump tatik y1th nu t:fflueflt .pump arts
cotitroid attd alt absorptibtt tell to dispobd' bf tilt v ate r
tttticti trill prdtbct the groundwate nerd public health. i t a tdanuer
CZ�cat�tlt;NiSAII ott5
zhdttill b attik gat:iitg devicds whd and vhdd possible.
�. kepnit any trdtat ienkd dh goon nd
J. bd not P iut gtpaaeg, oils, thpmiaaln paint or p d 1nL
thiiltrdtd into thb by dLwii.
4, If ktU rearm n gdtbdgd disposal, Use it apdtingly
5, bb htit dispose ul= do �ti ter ,
sest p 1 I products other tbati tissue into the
6L Tty td Avoid excessive - flour of Va ter iii g , '
port periods of time,
. set- et�aing:,cjdtties Wajltind tl ti- oUg ltout th le ek i;; recomtite
FtA.I ri•i� '
1, file adptic tank 2hotild be ii,spectod by a lieerlsed putnpur every
tlitda suety of l est' and pu,l�ped it necestlary to remove solids
find st ura,
2, tile. t'CflUdht tiitut must be elcdhed periodically Lb remove any
dcMaUiet pdr:Liclel, TL should be ivdghed back into tiie se •Lic
dt b dddth itrtorvdia of as per the lnallufddtUrerlm ttcomtdendaLiun,
d� P01-Itiditr '"fiecti nt rite obsdrvaL - jW) pIpdg should be made b
Hit utill6e to detdtmi,ie if any i is thkitig place ill the y
il doi jtltiti te
if t dots 11, Also check i'or dtiy dadlidgt to the ground surraee:
iatatrt Wadin vt seepage fa 'to ted, d lir erased plumber
tihbuid b@ dWiLdNt @d,
4 ` ' 6 A dl,tdtitNitt9 a ti Aldtm which hoist be indLalldd ott it sepa rate
tfk6lit ft:rilh tba pUntl;•, it deli altitte ALEl
;arid f~oNttfctt g llednttpd plumber imtd(!diatelytev) nti,ilmize vatet use
C
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if ptbblattts davoldp, Htihitfiring aruat bd done ad" pet bf C d,�`
OMN gM), PUMPI.1 -tg slid d is pb sdl nf. ttddtew t
the reduitetne
Nu6tpet tads• ba ticcedndt - y tlille andl}�dit, arts rettdird r y
i, kgfityd rhdutid eyAterdy Inay rL�gtiird tdinbvdl •artd dim duel df
a ibt'ili 'illliid fill and repla cirig it 'VILII p the
lift ilartfgie tat a saris or ihstdllirrg
ttdatment 11111 to nddtd or eliminatd ti,iy clogging
that Lhit Wily bd. (�rrkbbelit
Z, th it vdil ebttotpti6n dy nEdmv of
Hid 1ti9htij dt grade systems may requite
df t}te ily tEidn u.f an gptubit stbru, Adclitiottgl site and soiltdwaluatinttg may Ed
bii ddria iltid add pidr, a ut,ry tsddd td bd br tp itacdmettt
suite dvad by tied sdfdty and lsuilditigit bivisl,ot>'
ttf 'd61>i� @YbQ,
,4VACA j 0 C � n/J 0 2m ) i
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
— OWNERSHIP CERTIFICATION FORM
Owner/Buyer -- __ hJoo-dde,It by, lo4e�o- S :r~
4 3 je
Mailing
Address
Property Address
(Verification required from Planning Department id new nstnrction.)
City /State Troy, Wisconsin Parcel Identification Number
pro — 25 — 3a -= �. t
LEGAL DESCRIPTION
Property Location A/ t _� %,, Sec. -ON . T R LO - W, Town of 'Tiey
Subdivision 'ri'o y �J : l / c. <G 3 .K � .1�( , =} : d .-, . Lot # 1 /
Certified Survey Map # , Volume _, .Page #
Warranty Deed # 2 , Volume z `�`E3 . Page # �f
Spec house lI yes
no Lot lines identifiable yes ❑ no
,'YSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. 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.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signets by the owner and by a
mastcrplumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your ti been maintained must be completed and returned to the St. Croix County Zoning Office within 30
P.�t S Cie nfi :
f
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
I (we) certify that eats on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
the o warranty deed recorded in Register of Deeds Office.
Arts. . e.4v7t" l /a 1 l Ao o 3
SIGNATURE OF APPLICANT"` DATE
* * * * ** 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 certified survey map if reference is made in the warranty deed
r
- 7 4486 L?
2 9 4 3 P 4 7 5 KATHLEEN H. WALSH
REGISTER OF DEEDS
STATE BAR OF WISCONSIN FORM 2 - 1998 ST. CROIX CO.. WI
WARRANTY DEED RECEIVED FOR RECORD
D octa1e11 N 11 b er - 10/27/2003 11:30AM
WARRANTY DEED
This Deed, made between EXEWF #
T roy Development corporation, a Minnesota Corporation REC FEE: 11.00
Grantor, TRANS FEE: 509.70
.and Wooddale Builders Inc COPY FEE:
CC FEE:
PAGES: 1
Grantee.
tor, for a valuable consideration. conveys and warrants to Grantee the following
bed rea tate In St Croix County, State of Wisconsin:
' .I RCerou.q Nat
Lot 115 f the
at of Troy Village 3rd
RM dit n the Town of Troy, St. Croix County, Aaassa
Wisconsin. 3-1��6
pd ale gilder
Subject to Declarations of Covenants, Conditions and 54 a oa
!! Restrictions for Troy Village, recorded in Vol. 1241,
Page 256, as Doc. No. 559964, and the Declaration of Min tonka, MN 55434
Golf Course, Covenants, Conditions and Easements,
i recorded in Vol. 1241, Page 301, as Doc. No. 559969, :I
040 - 1258 - 30 - 000
all as appearing in the office of the Register of Deeds i
! for St. Croix County, Wisconsin, and such other Pa 10er 1�
!! easemente, restrictions and reservations of record, This is not homestead property.
or in use# and the "Buyer" obligations contained in (13) (i not)
the Purchase Agreement for this lot.
.I
II
II
I:
1
11
I
1;
Exceptions to warranties: i1
Dated this 21st day of October 2003 I'
E
(SEAL) (SEAL) !I
I�
• Charles S. Cook President I
Troy Development Corporation f
(SEAL) (SEAL) II
AUTHENTICATION ACKNOWLEDGMENT (j
Signature(s)
Minnesota ;
State of Wtacosra+t:,
Anoka County. I II
authenticated this day of Personally came before me this 21St day of
October 200.3 above named
Charles S. Cook, President
Troy Developmnt Corporation Ii
TITLE: MEMBER STATE BAR OF WISCONSIN to
(U not, me known to be the person _ who executed the foregoing
authorized by §706.16, Wis. Stats.) instrument and acknowledge the same.
I .
.
THIS INSTRUMENT WAS DRAFTED BY
II
TROY DEVELOPMENT CORPORATION R ick A. Johnson
' Notary Public, State- @&WMeo"MwAnoka County, Minn.
+� Charles S. Cook, President My commission Is permanent. (If not, state expiration date:
(Signatures may be authenticated or acknowledged. Both are not January 31 2005 ,)
necessary)
�' • Name er p.rrwr r1a„Ma m any c.p.rey n.d M,ypd ar primd below .Iwr Han.u,ro. ,'
STATE OAR OF WISCONSIN �YIAIW --- .. eb.
WARRANTY DRRD FORM Nu. 2 - 1990 RICK A Maw . Wis. I
JOWHNMSON
NDAW RBl1C- AMiESM
MY OOW&MION EXPIRES
JANUARY 31,2M8
"°
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* * 2422 Enterprise Drive
Mendota Heights, MN 55120
* PIONEER LAND SURVEYORS . pVIL ENGINEERS (651) eat -1814 FAX-OM
0
* 011 Weer
ring uwD P w+NERS. WOSCAPE ARCHTECTS 625 Highway 10 N.E.
* * * * Blaine, MN 55434
(763) 70 -1880 FAX:783 -1883
Certificate of Survey for: 904.8
341 LINDSAY ROAD TROY TOWNSHIP, WISC IN 904.2
I M lW
:. 1.
/
NOTE: PROPOSED GRADES SHOWN PER GRADING PLAN BY OGDEN ENGINEERING CO. (RIVER FALLS)
NOTE: BUILDING DIMENSIONS SHOWN ARE FOR HORIZONTAL AND VERTICAL LOCATION
OF STR TIOURES ON DIM
ARCHITECTUAL PLANS FOR BUILDING AND /
NOTE: NO SPECIFIC SOILS INVESTIGATION HAS BEEN COMPLETED ON THIS LOT BY THE O
SURVEYOR. THE SUITABILITY OF SOILS TO SUPPORT THE SPECIFIC HOUSE
PROPOSED IS NOT THE RESPONSIBILITY OF THE SURVEYOR. / / 0
/ / O
NOTE: THIS CERTIFICATE DOES NOT PURPORT TO SHOW EASEMENTS OTHER THAN
THOSE SHOWN ON THE RECORDED PLAT.
NOTE: CONTRACTOR MUST VERIFY .DRIVEWAY- DESIGNS /
NOTE: BEARINGS SHOWN ARE BASED ON AN ASSUMED DATUM ,Q /
/ Ap /
PROPOSED HO
LOWEST FLOOR ELEVATION:
TOP OF BLOCK V
ELE ATION:
GARAGE SLAB ELEVATION: �g at'� �JP
TOB 0 LOOKOUT ELEVATION: 9oe.7 � )q-
V '� •
X 000.00 DENOTES EXISTING ELEVATION / 905.5
( ODO.00) DENOTES PROPOSED ELEVATION -
-- DENOTES DRAINAGE AND UTILITY EASEMENT O j Q
-�-► DENOTES DRAINAGE FLOW DIRECTION / 1 *
- -� r - DENOTES SP /
IKE /
B DENOTES OFFSET HUB /
Q O
0)
0,0�
v / 906.
1 /
BENCH MARK i
s'TOP �017-4k'SPIKE
ELEV.= ;. 904.83
/ A X0� '
/e O�R'o0 / M i
/ ( Ty'` p YD D ry
904.9 �_ •1 pj�
905.5 + �6i' / 1 O �,$O # 899.8
/ 904.5 / `S 899.5
po 33 ,* /
/ �.`� L- 26.7 --
` 0 ' X8 0
X tt
/ h ' 898.0 '
• / BENCH MARK S, 904 N Ov 0 / ) 1 N
/ TOP OF SPIKE - ��� /CA �D�7 �` 1, p J�
ELEV.= 903.96 `�� ���� 9o4.t / o$ N O q,1 3� Q ��o p= N
/ 0 O 904.5 O Q 0
905.1905.0 7 0 00 /
B ` � X5.00 12. o h
903.7 903/4 X2.9? - 904.0 9 GPR 901.8
ory -Y 903.4 l��•6 t. 233 CJ�
ply
904.1 897.
39 13 � 04.1 / 89(7.7 X896.3
�N
N ; 902.9
896.6 11 5
900.3
`Jq Q 01V � �-
S
JOHN VOT;
WE. HEREBY CERTIFY TO WOODDALE BUILDERS THAT THIS IS A TRUE AND CORRECT REP SENTATION RS i
OF A SURVEY OF THE BOUNDARIES OF: tc{(.c�) S -2317 ! +
894.4 891.¢ / LAKEVILLE,
ft
LOT 115, TROY VILLAGE THIRD ADDITION "or�ra ` ®�'� """ •��
ST. CROIX COUNTY, WISCONSIN I ®� �i�'•. `,�
IT DOES NOT PURPORT TO SHOW IMPROVEMENTS OR ENCHROACHMENTS, EXCEPT AS SHOWN AS fO i ®O
SURVEYED BY ME OR UNDER MY DIRECT SUPERVISION THIS 12TH DAY OF SEPTEMBER, 2003.
SCALE 1 INCH = 30 FEET REVISED 9 -18 -03 STAKE HSE SI NED: PIONEER ENGIN RING, A.
BY:
2859 103221.000 TJW /PDS John C. Larson, L.S. Reg. No. S -2317