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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
453389 0
GENERAL INFORMATION (ATTACH TO PWAMIT)' 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:
Thompson, Dave I Troy Township 040 - 1291 -70 -000
CST BM Elev: Insp. BM E ev: IBM Description: Section/Town /Range /Map No:
- 7 _14 1 — !� 24.28.20.1664
TANK INFORMATION ELEVAN16N
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic
W Z (' Benchmark
O ( C
Dosing A � , / Alt. BM
Aeration Bldg. Sewer
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
jyS 1
Septic t � f �� � Dt Bottom
Dosing Header /Man. `
Aeration Dist. Pipe ,L -7 g
I el
Holding Bot. System
� g$S
PUMP /SIPHON INFORMATION Final G;d e
Ci/V� Gw �J1'v1
Manufacturer bernand St Cov p� G�
GPM
Model Number
TDH Lift Friction Loss System Hea TDH Ft
Forcemain Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width ! Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 C _
SETBACK SYSTEM TO P/L W JBLDGI WELL LAKE /STREAM LEACHING Manuf c rer:
INFORMATION CHAMBER
Ty Of System: 0 / ! U Model Number.
D !
TRIBUTION SYSTEM / o P��-F -Aee4- ( •'>--X—
Header/ " anifold Distribution x Hole Size x Hole Spacing Vent to Air Intake
Pipe(s)
Length 4 Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Uk
Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Centerer / �. Bed/Trench Edges Topsoil
n q j Yes No I Fol Yes No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:�/ Inspection #2:
I
Location: 319 Lindsay Road Hudson,,�WII 54016 (SE 1/4 SE 1/4 24 T28N R20W) Troy Village 5th Addition L_o-- 36 Parcel No: 24.28.2A1664
1.) Alt BM Description = • s� SsTk
J t
2.) Bldg sewer length
- amount of cover
- T - - - -- - - -- - - -1 to --
�_"/ Plan revision Required? L!j Yes -1 No 1 -7 9
Use other side for additional Information. �..___! _I Z..` !0 Y _ -
a �e ! pc t�or's ignature , n ^ n I /� 1� � ert. No.`
SBD -6710 (R.3/97) Date lns
w to l ur ,c�" w lx. C J rV�l
Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162
N!
r x
Vsconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce (608) 266-3151 p�
• State Plan I.D. Number Sanitary Permit Apphc
In accord with Comm 83.21, Wis. Adm. Code, personal info%�
may be used for secondary purposes Privacy;L,aw, sI5.04(l)(m) Project Address ( different than mailing address)
I. Application Information - Please Print All Infor
i 0 — —
P Owner's Name ° ® Parcel # Lot # Block #
Et _'°
Owner's Mailing Address Property Location a ip Pry y. 5 Section (s 7
Z City, State 23p Code Phone Number
GC/ � / T U N. R
II, of Build' check all at apply) PP
Subdivision Name CSM N
or 2 Family Dwelling - Number of Bedrooms
Pu (idConunucral - Describe Use /A-,D
State Owned -Describe Use bor. �� n . / city_ Village Xownship of
III. Type of Permit: (Check only one box on line A. Complete line Rif applicable)
A ew System Replacement System Treatment/Holding Tank Replacement Only Other Modification to Existing System
B. Permit Renewal Permit Revision Change of Permit Transfer to New Lot Previous Permit Number and Date Issued
Before Expiration Plumber Owner
IV. T e of POWTS System: (Check all that appl
on - Pressurized In -Ground Mound 2:24 in. of suitable soil Mound < 24 in. of suitable soil At -Grade Single Pass Sand Filter
Constructed Weiland Pressuriz7Lcachmg Holding Tank Peat Filter Aerobic Treatment Unit Rec times ter /
Recirculating Synthetic Media Filter Chamber Dri p Line Gravel -less Pi Other (ex
V. Di rsaVrreatment Area Inform- n:
Design Plow (gpd) Design Soil )Wlication Raw(gpdsf) Dispural Area Required (sf) Area Proposed ( on 3
o 5 g' ,a ,
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel fiber Plastic
Gallons Gallons or Units Concrete Constructed Glass
New Existing
Tanks T anks
Sepdroc Holing Tank 11 24a mil 1. .�
Aerobic Treatment Unit , . //
Dosing Chamber ( l !
VII. Resp onsibility Statement- I, the and a bllity for install -lion of the i'OVV1S shown on the attached ns.
Plumber' Name (Print) Plumber' MP/MPRS Number Business Phone Number
Plumbees Address (Street, City, State. )
VIII. Coun /De artment Use Onl
Ap roved Sanitary Permit Fee (includes Groundwater D (ssu g Signatu (N )
p °'Sapp Sur char Fee , a so i
Owner Given Reason for Denial L
DL Conditions of Appro pproval ( 3),44-
ST EM OWNE:
1 e i
dt9R rs _ aTcell must all maintain
T11 serviced / maintain
Q 4' S , � >is pv f�S 0
as per mana4emen Ian prnxidP.d�i�C plumber t ato —e?
e f 4
2. All setback requirements must be maintained S� yWC fJt �i'1
as per applicable code /ordinances. _ S� ,
Attach complete plans (to the County only),[ m on pjper not less thou $In x It inches i sine
P T PLAN
PROJECT Dave Thomoson/Laura Gerlach ADDRESS 2845 Eaale Vallev Circle Woodbury Mn 55129
SE 1/4 SE 1 /4s 24 /T 28 R 20 W TOWN Troy COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7 /7/04 BEDROOM 4
CONVENTIONAL XXX IN -GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28
BENCHMARK V.R.P. Top of 1 " Pipe ASSUME ELEVATION 100' Filter ZabelA -100
❑BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 887.0/886.6 4.5' below qrade
Plans Designed Using
Conventional Powts
Manual Version 2.0
115' 90'
Line Well is to meet all OD 3 ') P r
setbacks required by 1� 0 , 4 3
WDNR .�' C
Property Line
4% Slope >P
2 -3' X 94' Cells with >3'
spacing
2 ,
65 B -3
90'
Vents
s s� B_� 3 Pro 4
House
T Hou
operty Line
Vent
>6 „ Standard Biodiffuser
of Cover Leaching Chamber 1-of
with 31.1 ft2 of Area 13S
6' Long 11 Lindsay Rd
3 4" Grade at System Elevation
$9 oI test does not have alternate benchmark
as per county code�Drim benchmark is lL/� 1d1�r—
un wn
,. kno a will need to be established before � Q ov
rYtA�`� ps i nstallation P am hel ? , W / may, e:
SQ)/S P!P v4b w PL 136/,t I oI I � nv ShSdcl
P T PLAN
PROJECT Dave Thomason /Laura Gerlach ADDRESS 2845 Eaale Vallev Circle Woodbury Mn 55129
SE 1/4 SE 1 /4s 24 /T 28 R 20 W TOWN Troy COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 7/7/04 BEDROOM 4
CONVENTIONAL )00( IN -GRO D PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28
BENCHMARK V.R.P. Top of 1" Pipe ASSUME ELEVATION 100' Filter ZabelA -100
❑ BOREHOLE O WELL *H. R. P. Same as Benchmark
SYSTEM ELEVATION 887.0/886.6 4.5' below qrade
Plans Designed Using
Conventional Powts
Manual Version 2.0
115' 90'
Line
Property Well is to meet all OD ��l
setbacks required by /
WDNR .� S
Property Line
4% Slope
2 -3' X 94' Cells with >3'
spacing
2 ,
65 ' B -3
90'
Vents
$ S� B_� Pro 4
30' 25 Bedroom
T House
Property Line
Vent
>6 „ Standard Biodiffuser
of Cover Leaching Chamber /
with 31.1 ft2 of Area 135'
6' Long 1119 Lindsay Rd
Grade at System Elevation
34
of test does not have alternate benchmark
C as er coun code ' ary benchmark is ✓ —
tY
p �m
unknown a will need to be established before �lla�
i nstallation, Pam help? /�� ;�,/ � �Q �� ys � h
.S4,VS elOVd-fiW 0 L 1 36/13-7 1 r1 h no SA&Ay 6e
Vftwnatn Department of Commerce SOIL EVALUATION REPORT Page Of 4
OhMlon of Safety and Buildings
In accordance with Comm 85, Wis. Adm. Coda
Coun
Attach complete alto plan on paper not less then 8 112 x 11 Inches In size. Plan must r
Include, but not limited to: vertical and horizontal reference point (SM), direction and Parcel 1,0,
percent slope, scats or dimensions, north arrow, and location and distance to nearest road. 1) 1 4b - 1 7-9 1 - 74 - 0 0 0
Please print all information. Reel Date /'
Personal Information you provide may be used for secondary purposes (Privacy Low, a .1 5.04 let) (m))• v
Pral"Owner Property Location
CoM - t 1 riL.r , \ t.r_ P T C ri e- 5ti 114 114 S2 - T ZgN R - Z-0 W
Property ownera Melling Address Lot # IS lodd # Subd. Name or CSSW
I 1 9 6 6 A . ti ►z U r, ----)T, OD 1 - 1 f TAD y V 1 Lr-AG. 1 F'T4A
Zlir State a Number p City • D village Town Neareat cad
j?,LA t�_ ��� 5S4LI ( 757 -7568 TRb Y D5^\ F6
] New Construction Use:;&IResldentlal / Number of bedrooms t a sign rate GPD
Replacement D Public or commercial - Describe: v -- - --•--
Parent material U Ul Food Plain ale appii ble �• _�__ _ _ n.
General comments 0 C T 1 4 [� U L 7 S hk.� ,d �n
and recommendations: r o M -T-,xJ TI - Tk:EA C- (F• C�
ST. CROIX COUN `
ZONING OFFICE �a•
Cyi 13 (o 0-4 u/ / 3 S
Bering ❑ Boring
# Pit Ground surface elev. Depth t limitin
_� �,� _ h. epo tln factor In
g > 9r 7 . Soll A Rate
Horizon Depth Drxninant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft
In. Munseii Qu. Sz. Cont. Cola Gr. Sz. Sh. •Eft#1 'Etf#2
Z D -b l0y�z�l L f -^� b mJ c: '"•vf =tD
3 ILI 1 2 /1 t- z'N ( a b zv(
14 --7 lrn -1 rYt 1. f� O.Z. (),
n) 7 t 1� t -35 G
LJ
Bori Bing
❑
pit Ground surface elev, h. Depth to limiting factor !_..__ in• Soil Applicatiorl Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
in, Munsell Qu. Sz. Cont, Color Gr. Sz. Sh. 'Eff#1 'EfI*2
• Effluent #1 ■ BOO. > 30 < 220 mg/L and TSS >30 5150 mg/L ' Effluent #2 ■ 800 < 30 rrat and TSS _< 30 mall
CST Name (Please Print) Signature CST Number
s0 H t-L s o ZZ483z
Address Date Evaluation "clad Telephone Number
W98 ?5 egd'Aoe, ?,jVEFZ WT 5402z -o Z o - 1t5 y26 -1'775
Wlsoonsln Depanrrwnt or Carnmsrce SOIL EVALUATION REPORT Pa __ � of _`3
DMslon of safely and Sulwirgis
In occardamea with Comm 85. Wis. Adm. Code
Attach complete site plan on paper not less than 8 tl2 x 11 Inches In alts. Plan must County ST. c F201 � (
Include, but not limited to: vertical and hoAzonb) rderonos poMl (BM), direction and Parcel I.O.
percent slope, scale or dimenalons, north arrow, and location and distance to nearest road. 0 LI O - IZ9 I — ( - OD 0
Please prinf all Information. Reviewed by Date
Psmontf IMwmeftn you pmvidtr N used few "ewndery purpoaoo (►rlvocy Low, •. 16.04 ( (m)1•
Properly Owner Property location
CA NT WaAxrAI ZvELOPMs_WT C0 e- .5C 1m 5E 1/4 S 2.y T 7r R �0 E W
Property Owner's Malting Address tat M 1 Block a Subd. Name or CSMa
l l A E..r'c.DC _rJ `"►, n> >✓ . Su Ire 100 1 - TKD\ V I LL. AtZ- '� PT%A AWK).
State zip coos Phorto MArbef 0 City ❑ Wage '4 Town Nearest Road
1_A ► fJ 15 491 F763) - 757-151,J' 'T Ko L +r.1 D ;A4 R. 0 A D
New Consfructson tJse:FT Rea(dentfal / Number of bedrooms = = Code darN*d design flow rate ___ GPO
❑ Replecament ❑ Rbllc or commercial - Oseatbe: _
Parent maiertat � J'' vJ ✓151 1 Flood Plain elevation l(appticeble
General ownMents
and recommendations:
0,7 tonovJta RATE
D Boring ❑ Wn
Pit Ground surface ai . _W It Depth to IkWdN factor _ �Z q In.
SoY 8pplication Rate
Horizon Depth Dorninant Color Radox Des Texture Stricture Consistence Boundary Roots P tf
In. Munsell Ou. Sr- Cortt. Color Or. Sz •Effa1 •EfW2
► b -to l ays Z�► rn�� 4 m 0.5 01
L -10 I " /t Ab m 2 VP- r�
3 to - +Z o S OL5 Ck M C5 Z rA
(Z - (J C S v{ rv 0 1 1
3z. 10 vl-y/ -- 's od I vJ D•� 1, Z_
7 y3-9S y 5 m s 05
h6oln
❑ B � (N o ¢ 17 0
Pit Ground surface elev. $�q. 7 ft. v � �t), a ctor S In.
SoM Icatior+ Rate
exture Structure Consistence Boundary Roots GPM
Munsell Uu. Sz. Cont. Color Gr, SL Sh. '001 'EfIW2
I0 (LZ t- bi 01 0,$
�1 0ab a- _1
3 -tom 0 rL� s l b-2 L Z
-- 5 -- 0,
5 20 -2� it 1A _q15 C ea
• Effluent 01 ■ BOD ). 30 220 rrWL and TSS ?30 1 150 mg& ' Effluent tf2 = BOO t 30 rrg& and TSS 130 mg1L
CST Name (Please PrW) nature CST Number
�o H �. sr� d zZ483—
Addrea Date Evatusilon Conducted Tstephone Number
w9875 r•90 +h avE, RIVE f t.�.s WT 54022 p9 - 02 -0z_ - 71S y26 -i-17S
. 3
Wlaoara n Department of Commeroe SOIL EVALUATION REPORT Pape _ of _�j_y
OMslon of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than 8 112 x 11 lndws In size, Plan must �T, C 201
lndude, but not limited to: venial and horizontal reference point (BMA diraetlon and Pared I.D.
percent elope, sub or dimensions, north arrow, and location and distance to nearest road. O UD I L9
Please print all Information. Reviewed by Oslo
PorreMt Worn Wen you prodde Rey the used for secondary purposes (YrNssy Uw. s. 16.01(%) tm)1•
F Owner Property Location
041 1 M L- t4j \ 114 Ski 114 S ty T 28 N R 2b W
property Owner's Melling Address Lot M Bloa a Subd. Name or CSMe
�l A�LA CA -51. �. v too t3'l R Vl t_t,A C-E - FIFI
WF State Zip Cbds Phone r City OV91aas MTcvm Nearest Road
AIA) L 5 64491 (745) 75 7562 KO � OAD
New Construction User Residential /Number of bedrooms Code dertvsd design M1ow rate -_ GPD
❑ Reptsoement ❑ Pubk or commercial - DeacHbe:
Parent mate" Flood Plain elevation it applicable
Genera) comments
and recommendet)ons: C1�AIVEN t lOnlAl - RE+JGftES
Boring # Boring
❑ pre Ground surface stay. - $ 90. �O ft. oath► nmating actor
Soil icatlon Rate
C
,k1 eqzon Depth Dominant Color Redox Description Texture trudure Conelelenco Boundary Roots Gp
Gr. Sz. Sh. 'Effr11 j 'EM
toYk I . l Sb r . ryt N) 5 0.$
Z {, I'/ t o V -- ( } --1 sk d 2A- 0. Z-
tZ. yd M MjI Q.5 'A O.D O• C7
I -Z8 -7,54 Q 44 D:sq en as
4D P, ` 3 ti -� f►x�' S D,c7 0 .O
c� q0 —q �l -- 05
Ire 1 51wv) S yO�. b tzo► b ti -A5 z - 3D
a 80*vX ° Wng
Pit Ground surface elev. �Q Z , 5 n. Depth to Mm)ting factor --
soil tcatlat Rat.
Horizon Depth Dominant Color Redox Description Texture Structwo Consistence Boundary Roots GPD /ff
in. Muraell ou. Sy- Cont. Color Gr. Sz. Sh. 'Eff#1 IM
! 0 - to v 1 7--f -L.a6 a5 ? OS Or
2 _q L _ lab ) rn r c 0 Co
3 - i 7 ti Y 11 trl, o
J-7- s" ( i 0 • z-
5 2 Z Z -754A 'jq r 5 0 �,! �ti �� o, ►.z
2
Eltluenl 01 - BOD > 30,1220 mg/L and TSS >30 130 mgk ' Effluent M2 a SOD 30 mg/L and TSS <_ 30 mWL
CST Name (Please Print) lure CST Number
AIARV o H w_ stE ZZ483Z-
Address Dee Evelu.tion Conducted Telephone Number
W`t�75 GQp + ~ AV�� RIDE F LLS WT 54012 09 -04 X15 y�6 -x'175
R(Y Cow t , �ti►.RAL v� P- . i' 50
RP'
.S T
' F 500 M6 W/ DK V
NO COMM 65 SETDKK PRODt-EM5
ab
A
i
e Peadb, ��� �'I - s P•
/
1 12 1
35 /13e 136
a. P S r �
/ 135A
�e9.e
135
►T
22-
7 {
SEC, Z4 SIGNED Cyr �yC�� _
2zyY32
x
9tAuJv� oK.1 DATE:
WtsconsinDapartmentofIndustry, SOIL AND SITE EVALUATION REPORT Pa ge I of 3
Latxrhnd Human Relations g
Division of Safety a Buildings in accord with ILHR 83.05, W�,.is� Adm. Cod9
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. PI must include, but
not limited to vertical and horizontal reference point (BM), direction and % otslope, scale or PARCEL j 6.
dimensioned, north arrow, and location and distance to nearest road.
APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION' Imo. Y _ DATE
all "t
4
PROPERTY OWNER: P OPEPTY Ll�CA bN
CoU-� t-) �)EVZ N T �t� s� 1/4 -.e 1/gs'24
PROPERTY OWNER':S MAILING ADDRESS • L # IG# I $UBD NAME OR CSM #
\Z T1Z Oy \) O_l_f rz PM V) .
CITY, STATE ZIP CODE PHONE NUMBER OCITY LIVILLAGE [MOWN ' NEAREST ROAD
e L.tYt,fu � , wt N s s 4�y c � TQ-oY �, �,� s �,o �-►�
[XI New Construction Use Residential / Number of bedrooms _ y [ ] Additign to existing building
I ] Replacement [ J Public or commercial describe
Code derived daily flow boo gpd Recommended design loading rate - bed, gpd$ . `b trench, gpd/ft
Absorption area required '� bed 1 - So (t? �a esi n loading rate • - 1 bed, gpd /ft trench, gpd1ft
Recommended infiltration surface elevati a�8 °— CScsmW T �11'ts (as referred to site plan benchmark)
Additional design / site considerations S Ik40'M W sTVt.uL-M�_ O►J v
Parent material L..o en4 oU %M Gw*yo_t}r. d„ H Flood plain elevation, if applicable Nfa It
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable fors stem IRIS D U I NI S E1 U CC'S ❑ U I OS ❑ U 91 S O U ❑ S Ul I
SOIL DESCRIPTION REPORT
Depth Dominant Color I Mottles I Structure I GPD /ft
Boring # Horizon Texture Cons'�stence Bwxbry Roots
z in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trends
3:a A s �- \Z L 3lZ - S \ 1^'l Sb�t m •S b
G roun d 1$ _Il �'S `� R 3l .g
3 7 SeLGM oSg
elev.
� °tl•o
to
limiting
factor
Remarks:
BoZ n #
��
o_� �o�ttZ Utz sit 1+�t ash , •'Z i.3
B Z 1i 3� !o `iR 3!6 _ s � ( Z >n s �k
3 b -uy 1• S4fl- Sl - s �G► sg v�� - ,-L :�
( ; d
ev e 3 a ft.
Dep to
limiting
factor
2 L Lq'
Remarks:
CST Name:— Please Print Phone:
Arthur L. We erer 715- 425 -0165
egerer Soil Testing & Design Service -P.O. Box 74 River_Falls,WI. 54022
Signature Date: Z CST Number: .
�_ 220254
PROPERTY OWNER C.U►J SMITE- 'Z)ZQ . SOIL DESCRIPTION REPORT Page Z of 31
PARCEL I.D. # Np) /y G
B rin # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourtdaty oots R GPD /ft
�g in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITi
l>Jy23lZ _ S11
a
st l Zr� sbk m'F►� "a • s ,6
Ground 3 30 �� S `i R u�6 1 S 6 ►- O Sg rn cS — '-1
elev.
aq 3 a ft. y Sly _ S Gr 0 i
Depth to
limiting
factor
Remarks:
Borin #
:z� \ >> ,��f►- � - N� ' . z
Ground L-) -vw - 1- SL1kz-3�y _ SGT o .913 �, \ •—� 1.�
elev.
�Z -S fl.
Depth to --
limiting
factor
7 t. ZO
Remarks:
Boring # _\Z.
1 0 ���1� 31Z s►1 1.�►sbk ��t �-s - -Z� . -3
>: >::, e .: >: Z t2 =31 I,0 `-LR �l b � c,� s Let Z,►n Sb12 h�'� i cW _ .� � . S
lvt Sbk ►rte �S
Ground
e lev. s rt. X13 -SZ Io \-t2s /6 �,.s.�tzsls srl lwisbk rn�►- eS _ .-Z1.3
- S SKI
Depth to SZ - ll9 �.Z Sly — S el 6� S9 w
limiting
factor
�ttg �.
Remarks:
3oring #
I
around
;lev.
ft.
)eplh to
imiting
actor
Remarks: _—
J
( J
PLOT PLAN Page 3 of 3
SCALE 1 "= SO '
131._ -LL p��11•SV_ oi.r_1'� \_PIPIT
P rT 5 Low 6
TP
�5 m ��' fi r.. ,� •
h.-�-
tL
2 v
�(7
r-
v
�C�TG Cf� f�Cl�(�•f S� p�.1�M�L2. LC�1.'F -= e.t�t ?"t�LRS-
CMG L 1— 9 --Z 7
( 715 —
CST Signature Date Signed Telephone No. CST #
' PLOT PLAN Page 3 of 3
w
SCALE 1 "= SO '
� G a`y�
- 61
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e t}�n�it'TE �T Ff�'3
-5 °
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( 715 ) 425 _
CST Signature Date Signed Telephone No. CST #
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage and water conditioner discharge into the system.
5. The owner agrees to save this plan. �D N oy" D iS k tR-J s � -
14 z- I- A-roN-P� - Tires e
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
ncy Plan
Option 1. f system fails, determine cause of failure, use alternate area and install new
in tested replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option#3. No adequate area is suitable for replacement area, and syste m elevation
cannont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715 - 246 -4516
St. Croix County Zoning 715 - 386 -4680
Pumper Tom Mondor 715 - 246 -5148
Shaun Bird #226900
UNTY
ST CROIX COCE AGREEMENT
SEPTIC 'TANK MA N TENAN AND
RSHIP C R ICATION FORM
Ova t O- L4r�
owner/Buye
r
Mailing Address o2
S
Property Address ed from p • g Deparanent for new constcuctio
(v requir
parcel Identification Number
City!$tate
S gIPTIO
LEGAL DE _R w, Town of
2 T�f . f
• �✓ l�i 1 � 4 a � 1 r^
Location Sec. - l !J
property #
Subdivision t--
Volume page #
.�--
�. -----
Ma #
Survey P
c ( �
C
Volume � Page # �
Deed # D � � �—
Warranty es ❑ no
Spec house 0 Y no
Lot lines identifiable
e wastes. Proper maintenance
failure
to haadl
SYS : w 1NNANCE tic system could result in its Pr emature What you put into the system
Improper use and m a i nte nanc e ery t years or sooacr, if needed by a licensed punlpor.
out the septic tank every a is the waste disposal system
consists t Pump tic tank as a treatment stag
can affect the function. of the se p tic sign by the owner and by a
to submit to St. �ent a certification form, sign osal em
owner agrees Croix Zoning Department er verifying that (l) the oa -site wastewater disp �
The Property the septic task is less t 1/3 f of sludge.
masterplumber, jo�ymanplumber, restrictedplumber or a licensedp necessary),
operating is is proper co ndition and/or (2) after inspection and pumping (, system with the standards
private sewage disposal
d have read the above re and agree to maintain the
t of Comm Department of Natural Resources, State of Zoniong O ff � � 3
I/we, the undersigned
C and the Dep
set forth, herein, as set by the D eP tained must be completed and returned to the St. Croix County
stating that your septic system has been main
dof year xpiration date. /
DATE
S APPLICANT
ICA ) knowledge. I (we) am (are) the owner(s) of the nWNER CERTF
I (we) certify that all stat onn deed recorded in Register of Deeds office .
the pr perry described ove, by virtue of ZZ10
DATE
SIGNATURE OF APPLICANT
rmation Dep artment-
An y info
that
aar
t is rnis. represented may result is the sanitary Permit being revoked by the Zoning p
a ss
n deed from the Register of Deeds office warra deed
lieation: a statr►ped warm h` 'f reference is made in the wa ty
this
a �
ss a with PP d serve map
I nclud e a co of the ce rtified Y
Y
P
1
U 2608P ass
7 6 7 C. 4 3
STATE BAR OF WISCONSIN FORM 2 - 1998
WARRANTY DEED W KATHLEEN O H. WELSH
ST.
ST. WI
Document Number
RECEIVED FOR RECORD
j� This Deed, made between 07/02/2004 09t45AH
+� Troy Development Corporation, a Minnesota Corporation WARRANTY DEED
{, EXEIPT #
,i Grantor,
and vi Tp son a L ura Gerlach Joint Tenants _
REC FEE: 11.00
TRANS FEE: 539.70
( COPY FEE:
ii Grantee. CC FEE
Grantor, for a valuable consideration conveys and warrants to Grantee the following PAGES 1
i t described real estate. in St - Crai County, State of Wisconsin:
5 Lot 136 of the Plat of Troy Village 5th Re�rtnne ��
' Addition in the Town of Troy, St. Croix County, Name and Batten Address
,
Wisconsin. The First National Bank
11 PO Box 89
Subject to Declarations of Covenants, Conditions and New Richmond, WI 54017
Restrictions for Troy Village, recorded in Vol. 1241,
Page 256, as Doc. No. 559954, and the Declaration of
Golf Course Covenants, Conditions and Easements,
recorded in Vol. 1241, Page 301, as Doc. No. 559969, 040 - 1291 - 70-000
all as appearing in the office of the Register of Deeds
for St. Croix County, Wisconsin, and Iguch other Parcel Idetattloation Number VI
easements, restrictions and reservations of record, This is not homestead property. l
or In use, and the "Buyer" obligations contained in (is) (is not) (I
the Purchase Agreement for this lot. ;I
y
R
I.
'i
I.
Exceptions to warranties:
Dated this 30th day of Jl.R1e 2004 I r
�C�6At v (SEAL (SEAL) !�
W Richard Halup , Vice President W }I
Tr oy t • ti
TT y Dev"slopmen �5orporation
(SEAL) (sIIAL) jl
AUTHENTICATION ACKNOWLEDGMENT l
Minnesota
Sigrratura(s) State of W*&co=rsi•nr.
as.
Anoka County.
authenticated this day o f Personally came before me this 3 day of
04C_r. _ _, the above named
a_ u�t iok , Vice- s_<k nt
Trov DevelgRment Corporation
W
TITLE: MEMBER STATE BAR OF WISCONSIN to
(If nor, 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 q
ti TROY DEV=PHEM CORBORATICN Carrie Ann Albrecht !}
Notary Public, Sawa o;- WutsaPelwAno4m County, Minn. ;
Charles S. Cook, President My commission !s permanent. (If rot, state expiration date: 'I
(S"turw may be authenticated or acknowledged. Both are not ) �y
necessary.) !
Names of Pers^e .lanWg In etty cmp=tty mua be typed a printed below their Agrtetum
STATE RAR OF WISCONSIN w!+awu!n Lapel elrnt oa, kw. V
WARRANTY DEED FORM No. 2 - 1998 MUweuMee. Wk.
CARRIE A ALBRECHT
NOTARY PUBLIC - MINNESOTA
MY COMMISSION EXPIRES
JANUARY 31.2001
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