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HomeMy WebLinkAbout040-1244-60-000 T ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner Do t Property Address ,3Qa to City /Stat Legal Description: Lot _ to Block Subdivision/CSM # Sw ' /a /4, Sec. lam, TQJ,,-N -R c� W, Town o o PIN # QUo - 1 yT- - wo SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION: I Tank manufacturer Size ST/PC 1 ,3 , ,4p / Setback from: House �* Well P/L Pump manufacturer Model Alarm location (HOLDING TANKS Setbacks: Service road Vent to fresh_ air- intake Water Line 6, Meter location Alarm location SOIL ABSORPTION SYSTEM �o Type of system: Width �_ Length -5 "46 Number of Trenches --'� Setback from: House a 7 Well Pj kP- P/L j` Vent to fresh air intake 69 ELEVATIONS Description of benchmark TaD W cM Elevation / OV Description of alternate benchmark Elevation Building Sewer 9K, ST/HT Inlet T ` ST Outlet 9 7 a PC Inlet PC Bottom ► J Header/Manifold �� ! Top of STAW Manhole Cover Distribution Lines (e ) 97 3 (�) 7 3 3 (3) 9 Bottom of System 0 P) 1 % p Final Grade 6/1 (3) Date of installation �� / 14 / ? Permit number 3 '� 1- 7 ` 2 --State plan number `— ' number Date Plumber's Sig at License nu �� `T _ Inspector aA Complete plot plan f NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. I Two horizontal reference points to center of septic tank manhole cover. • Show alternate benchmark, if applicable. i ' PLAN VIEW INDICATE NORTH ARROW Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count Safety and-Buildings Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitaryPermitN 34459 2 X 2 Personal information you provice may be used for secondary purposes [Privacy L 21 s.15.04 (1)(m)j. Per DE H RRICK a CONSTRUCTION, INC ❑ C't,�AY r Town of: State Plan ID No.: CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel T x N .: •O X60,0 $48- 1244 -60 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 12� Benchmark BY Dosi ng Aeration Bldg. Sevve Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet , q7 — -7. S1 TANK TO P/ L WELL BLDG. Air ir I ntake ROAD Septic / --�" NA Dosing NA Header /Man. Aeration NA Dist. Pipe �� 32 Holding Bot. System •YS ; 5`L PUMP/ SIPHON INFORMATION Final Grade , 94 .S2 Manufacturer Demand S, 2 2L Model Number GPM TDH Lift L oss riction Syestem TDH Ft cemain Length Dia. He ad Dist. To Well SOILAOSDRP TION SYSTEM R EBL H idth ength No. f T nches PIT No, Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 ti" DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufactyr �' W. 7' INFORMATION Type O CHAMBER Mo e.1 Num er: System: , 5 ' OR UNIT IT r — in r l l k Li DISTRIBUTION SYSTEM Header/ nifolcl Distribution Pipe(s) x Hole Size I x Hole Spacing I Vent To Air Intake i Length 5 Dia Length 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 Topsoil ❑Yes []No ❑Yes [I No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION OY 19.28 9.1248 SW,NW 266 ST. ANDREWS DR — TROY VLG LOT 6 Leola, Plan revision required? ❑ Yes No Use other side for additional information_ Fiz o 6 P SBD -6710 (R.3/97) Date Inspector's Signature Cert. No i W -0 - 9 7 k � Safety and Buildings Division 10sconsin SANITARY PERMIT APPLICATION 2 1 o 7302ngt Avenue Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8112 x 11 inches in size. S C M • See reverse side for instructions for completing this application State Sanitary Permit Number 3 J4 J4 S7 A Personal information you provide may be used for secondary purposes C heck if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Property Owner Name Property Location Q % r�c�:o n�NN 54U1/4 W 114, S T , N, R E (or W Property Owner's Mailing Address Lot Numbe Block Number SOS (a -5 -0 & )c A Lo — City, State Zip Code Phone Number Subdivisio�me or CSM Num r New � " II. TYPE BUILDING: (check one) E] State Owned E] its ge Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms VII a III BUILDING USE (If building type is public, check all that apply) Parcel Tax Numbers) 1 ❑ Apartment / Condo 0 4 4 l — 1Aq y _ 100 — 00 o-D 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant /Bar /Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station / Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/ Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. LXNew 2. ❑ Replacement 3. E] Replacement of 4 E] Reconnection of 5. C] Repair of an __ _ysterri ----- ___ System ____ ______ ___Tank Only__ __________ ExIstingSystem ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number _3f 5� -Z_ Date Issued ;?—.2 V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 C] In-Ground Pressure 42 E] Pit Privy 13 Seepage Pith' / 43 ❑ Vault Privy 14 ❑ System -In -Fill �. c� V ABSORPTIO SYSTEM INFORMATION: 0 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate S. Perc. Rate 6. System Elev. 7. Final Grade Require d�(sq. ft. Pro o (sq. ) (Gals/da lsq. ft.) (Min. /inch) Elevation um 1 A t Feet 9 Feet Capacit VII TANK in Ca g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existin structed Tanks Tanks Septic Tank Ia,SD I W � es-e,l ❑ ❑ El El Lift Pump Tank /Siphon Chamber ❑ 1 ❑ ❑ 1 ❑ 1 ❑ 1 ❑ VI11. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. PI u ber's Name: (P ) PI tier's Ignatu No S ps) MP /MPRSW No.: Business Phone Number: r E?w �1rs 5 - 0 " 4 0 -.51 35 Plumber's Address (Street, City , � State Zip Code): /� 1 9 1 9(09 S� u N-eV-) �� O✓� WX S Ot IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater D ate I ssued Issui g Agent Signat re (No Stamps) Approved E] Owner Given Initial Surcharge Fee) Adverse Determination J�D `� —�� t> X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 4 /99) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber I 4 s `t ti R l4 w �ecr`•� -� �Or� s�r�Cnn 4 &X Swig ti W ( lc� l9' � , (05 - P / � ro y u t V \4 �O 5 O 0 _ o N� {��c�nmon� t� Y ry ���� �� '� -I aY �.l�D o 0 Lfo�s SYo t b loZ c7 W .eS.e,s lwo ` --� ICS -9.9 c � aa�37 b r� k � s� G I �l s ` So L • C g O { J N N s I � w o � laanUJ —►I cd 0 =3 1n A c6 ,E V d �3 NEB° Cl C L7 co y 6 C ► . x vi O C O O �. S2 0 U n _ ;- C E X 0) M - ca Z5 co � co U M -A. T y L � i7 N .-• ►.. N L y, N Cl) , �,,0 C �ccoa `_N Nf E S ti- U canJw � V a N C 2 N a 'p co ►_ D � O Q Z ++ E x �_ ccf N C V $ 0) 'O C co J U- '0 66= x G L m = 3 S 0) +. U .0 O `� co J �O J 0 cn = ti d • • • • .a �s $ N � E a� N m U e& � E ^a .T-m 9 Z L U ® N � it 8 , 59 3 . . a cra � j 1� M t C O w N ^$ p N q CO co E 0- U aCO a b i LL (V U o o c !t 3 N co A Wisconsin Department of Commerce SOIL AND SITE EVALUATION Division of Safety and Buildings Page _ / of 3 Bureau of Integrated Services in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include; but not limited to: vertical and horizontal reference point (BM), direction and - $Y C h d ► x percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D, # O � / ;� 4) � Abp 2SD� APPLICANT INFORMATION - Please print all information. Re liewed_by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner } �~ Property Location & V I f , \ �. S` \ (• 10� {�y� G. Govt. Lot S Vj 1/4 IVW 1 /4,S j (` T N,R 1 fRor) W Property Owner's Mailing Address Lot # Block# Subd. N ame or CSM# IS 0_5 S — I r6 Y V � �e City Stat4 Zip Code Phone Number ❑City El Village Town Nearest ad dawQJnYm Wr K New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow � 0 gpd Recommended design loading rate 7 bed, gpd /ft trench, gpd /ft Absorption area required V, __ bed, ft 7,50 trench, ft2 Maximum design loading rate r bed, gpd /ff ) O trench, gpd /ft Recommended infiltration surface elevation(s) o ft (as referred to site plan benchmark) Additional design /site considerations Parent material "t L o's Flood plain elevation, if applicable N L ft S = Suitable for system Conventional Mound In- Ground Pressure AT -Grade System in Fill Holding Tank U = Unsuitable for system CK S❑ U S ❑ U [X S ❑ U [0 S U ❑ S ®U ❑ S X U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Bed Trench r 6 — I S a SI 0- — fg Ground m t, o S l►1 r 7 ?S elev. Depth to ( 24 limiting factor Remarks: Boring # six rrA Ground elev. j�ft. Depth to limiting factor > in. Remarks: C& Name (Please Print) Si lure Telephone No. 04L ) 111 n Lk) ?S WQ Ir> 7iS` - :2 Y6 - 5/3y' Address Date CST Number ' Auk- PL6kX&hd U)IF- 3tol 17 a PROPERTY OWNER De r V 1 C.k- C(fYl� IL DESCRIPTION REPORT Page PARCEL I.D.# rya - Boris # Horizon Depth Dominant Color Mottles Structure 2 9 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. { Bed ,Trench (1 b h am S rn 7 r p D Ground el � , Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # Ground elev. ft. Depth to limiting factor ' Remarks: Boring # ::.:..................:... Ground elev. ft. ' Depth to limiting factor in. Remarks: SBD -8330 (R. 07/96) err; �►�5 ��Y.�v�. Swy4 N u - :, / S MT Piq w —r" ro Y 0 �� 0�. LOT to tN 1 c�nYWAU 5'yo p�� � 0 'yo -- IQ A lpo_ 0 c '4& ' Ta Q W a�'t< �SF- b Oov- I 1 p' f� S s hoK� s . Safety and Buildings Division SANITARY PERMIT APPLICATI N 2 01 W. Washington Avenue Wisconsin O P O Box 7302 .Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. 0 See reverse side for instructions for completing this application State Sanitary Permit Numj6 3yq -"2- Personal information you provide may be used for secondary purposes ❑ Check if revis on to previous application IPrivacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number � I. APPLICATION INFORMATION -PLEASE PRINT ALL INFORMATION Prope Owner N Property Location r.V011 a a r C /4 /UQ1 /4, S l ! p T .2&N, R jC( E (or)§) Property Owner's Mailing Address Lot Numb r Block Number 1 50—S 5 D A - City, State Zip Code Phone Number Subdi Name or CSM Nl ber II, TYPE 0 FB1JIL _ DI _ N _ G _ .(check one) ❑ State Owned E] Cit I Nearest Road ❑ Village Public 1 or 2 Family Dwelling - No. of bedrooms own OF 1 sr t*nh Ill BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 E] Apartment/ Condo © � b - J� � �' V �° 9 19. 1 2-LO 2 ❑ Assembly Hail 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales / Repairs 11 ❑ Restaurant/ Bar / Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1. St New 2 C] Replacement 3 [3 Replacement of 4_ [] Reconnection of S. [3 Repair of an System System Tank Only System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 Seepage Trench 22 E] In-Ground Pressure 42 C] Pit Privy 13 Seepage Pit I f 43 ❑ Vault Privy 14 E] System „Z7 3 ��- 12L +ris► VI. AB SORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4_ Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade ' ^,n^,� Required (sq. ft.) Proposed (sq. ft.) (Gals/d y /sq. ft.) (Min. /inch) c . Elevation 1.11 fP 3. r"i Feet 9 , 7 Feet Cap acity VII. TANK in Ca allo g Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existin structed Tank Tanks Septi Tan+*9 1 - ❑ ❑ ❑ 1 ❑ ❑ Lift Pump Tank /Siphon Chamber ❑ ❑ ❑ ❑ ❑ Vlll. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for insta ation of the onsite sewage system shown on the attached plans. PI ber's Name: (Prin Plu er's Signa re: o ps) MP /MPRSW No.: Business Phone Number: (it 0 5 - 7 1S ( 0 S Plumber's Address (Street, Cit ��St� Zip Code): 5 o ` IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (includes Groundwater ate ssue Issuin gent Signature (No Stamps) Approved []Owner Given Initial ��..-- Surcharge Fee) Adverse Determination C cc) 1 -7 / 10 / 5 9 F X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD- 6398 (R.11 /97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber P(O fRam ��ti•:c,� �o.s� ruC��� v�, S w`�� N � �/y S 1 � 7'� N lel4 c� tS ox 4w y t0 Po16 Tro N .k ,*,.:,, Rc c-6r \o r, vST-' S Y01 '7 Tro it a �{ c 7 1'7- _ e L. t A°� 3y a 7' d 15 w4 v y C -1 ✓ U ne Se� �,,, I; • � !! e G af |k ) | M TJ m , c CD 3 |f §9 . .r \ 14i \ 7 C \cr = U} § \ § 0 U■a «■ F� 2 � |t $t | � @ $ / / | 7 a o E C « 2 � 3 R : @ 7 { x 7 ƒ � � CD x U � 3 K , « x 0 c ! U c o § ¢ i D � 0 CD 0 0 7C-®m= o © m . 3 \ o U co / C D \ k -P- =r ƒ m r 2 2 x. 2 CD � c cn 7 0 $ §_ � E �� - :�� , q 0 7 E / « W� . | 0k | 3 k • \ E \ \ invert 1/ f % - 2 � | 9 � ON Page 1 of 3 VYiscorisin Department of Commerce r IL� LU D I E VAATI Division of Safety and Buildings in rd with Comm 83.05, Wis. dm. Code Environmental By Design Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must R ECEIVE 0 4nty include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow, and location and dista to nearest road, I I.D.# qqq APPLICANT INFORMATION - Please print all inform Gax g Da Personal information you provide may be used for secondary purposes (Privacy F5.04 (1) ( L f , I - TV ( i? G. S Property Owner r�pe ,`L . Derrick Construction Inc. ,� NW i/4 S 19 T 28 N,R 19 W Property Owner s Mailing Address lot Name or CSM# 1505 Hwy 65 6 Troy Village city State Zip Code PhoneNumber ❑ City ❑ Village ®Town Nearest Road New Richmond WI 54017 Troy } St. Armes Parkway ❑ New Construction Use: Z Residential J Number of bedrooms 4 ❑Addition to existing building n Dnnlnnnwnn� n Dnhlin nr nnmmnrsi.fl .lesnrihe Code Derived daily flow 600 gpd Recommended design loading rate . 7 bed, gpdr .8 trench, gpd& ADS01VOOft area required 811 bed, tr 750 trench, ttr Maximum design loading rate .7 bed, gpd/fF .8 tr ench, gPdffl Recommended infiltration surface elevations) 95' It (as referred to site plan benchmar I I Additional design / site consideration This evaluation done to provide a replacement area for this lot—Primary area on soils evaluation dated 11 -14 -97 Parant material T rwcc Myer Marini (Uifivach Clr.^ii nloin elaim i ^n K onnr^.h M% R cvcfam c" S= Suitable for system 1 =1 Inc - Conventional ^ Mound Im - Ground Pres :ure AT -Grade System in FRI Holding Tank iiifohla fn_rr n� e n �i n N_ �i o n �i n 1 1 n 0 " 1 n o I� 1i �_ _i ... -... I vy v u � u I vy u I u vy I u v • I u w � SOIL DESCRIPTION REPORT Ueptn uornmant t oior momes structure GPFJ* g� Horizon in. Munsell Qu. Sz. Cent Celaf Texture Gf. St Sh Consistenc Boundary Roots Bed Trench r, sbk( I tL e�ev a 7. IS Sc _ l�l r' g(,� i. ' '7 o ,) I aS , d s� P) I g j — j �? 8 Depth to Y r 7, S Ilmirinn � � factor Remarks: [ 0 -1 Iv f - 312. S, Bleu Grou 2- 17 9- (()V(- y 3 3 5� TYYC s C Depth to I 7, S r S — i 9 I .� i W I f� CL I► j I limiting - I factor r B° Rema CST Name (Please Print) Signature: Telephone No. F dress Environmental By Design ate CST Number Ref # I I 1_4 39 tzo��, S� nk..� ��� -la - -1 1� �I -��u 9 X37 245 PROPERTY OWNER: 12 -rick Construction Inc. SOI DESCRIPTION REPORT 245 1 Page 2 of 3 PARCEL 1.0.0 Environmental By Des, Depth Dominant Color Mottles I Structure GPD/1t I- Inri�nn 7cv4nro .nncictanra Rnnnrlary Ronk in. I Mu n s eil I St u. bz. t;ont. color I I uc sz. bh. I - - -- -- - - -- Bed i french f� 2; 1 18 -361 1 0 k r Y1 1d2 v tt1 C ,S I Ground plav 17 5 . Deth to `+7 I � O limi p ting i (i'� �,S �rS/C� S �s { I S i t r y tact°r ` f I I I I 6a - r - - a9 •S�bS.S Remarks: r A 1 0-9 10y3 /1 )( Si l lms k mvfi cW 2f Z i 3 2 9 10yt3/3 - ad Im t11A ew if .2 .3 1 vivwiu fey , 3 116 -31 I 10 y r4 /4 I - ' sit f 2msbk I mfr cw I - ` 1 5 ;6 I 91.74 tt ' 4 ' 31 -50 I 10yr4 /6 I - Is , 2msbk mvfr cw - I .7 .8 Depth to limning ' - - ov ,.Jyi - s vas uu factor n RemarkS: surface soils compacted by traffic 5 i V -iv ivy-,/I - su imsbk mvn cw zi 2 3 2 10 1Ovrll/3 _ cil 1mchk mvfi cw 1f I. 'i I Ground elev 3 16 -32 10yr4 /4 - sil 2msbk mfr cw - 5 6 98 23 4 32 -53 10yr4 / - is 2msbk mvf ow - 7 8 I Depth to 5 53 -82 7,5 4/6 - s 0% ml - 7 ,8 l I 4 � I I l � � �- i M >82 I I I ! I I I 4 R emafks t s urface soils compacted by traffic 6 1 0 -10 10y3 /1 - sil lmsbk mvfi cw 2f 2 3 2 110 -17 I 10yr3/3 I - ail I 1 msbk mv CW If . 2 ; .3 r;miind 1 T elev 3 17 -32 10yr4 /4 - s il 2m mfr cw - 5 6 I i � I I I I I i 4 1 Vyr4J b 1S ZmSDK mVlf CW Depth to 7 Svrd /A _ c No hrnibng factor >PA I r r rr KeflldrKS: 3wi4w byiib wniy"icu uy uuui� I _ c �� I a A ,00 t JAL z f f S2 D� 4 i E) f 'AL4f)nJol. T a, P �. P l Q i r M el 2 �Q) _. 2--2,7-387 F Wisoo;s Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Ws. Adm. Code Environmental 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 dimensions, north arrow, and location and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - Please print all inform ` n. Personal information y ou provide may be used for secondary purposes (P ' s. 15.04 (1) (m)). Reviewed By Date Property Owner Property L fn Derrick Construction Inc. �, A t Govt. SW 1/4 NW 1/4 S 19 T 28 N,R 19 W Property Owner's Mailing Address of # Block # Subd. Name or CSM# 1505 Hwy 65 6 1 Troy Village City State Zip ode Phone mb ❑ City ❑ Village ®Town Nearest Road New Richmond W1 54017 Troy St. Armes Parkway ❑ New Construction Use: ❑ Residen ' / Number of bedrooms 4 ❑Addition to existing building ❑ Replacement ❑ Publi or commercial describe Code Derived daily flow 600 gpd Recommended design loading rate 7 bed, gpd/ft? .8 trench, gpd/fl? Absorption area required 857 bed, ff 750 trench, fts Maximum design loading rate .7 bed, gpd/ftz .8 tr ench, gpd/f 2 Recommended infiltration surface elevation(s) 95' ft (as referred to site plan benchmar Additional design / site consideration This evaluation done to provide a replacement area for this lot ... surface soils tightly compacted by traffic Parent material Loess Over glacial Outwash Flood plain elevation, if applicable.. Na 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 EIS M U ❑ S H U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistenc Boundary Roots GPD/lt2 Boring# in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench 1 1 0 -9 10y3 /1 - sil lmsbk mvfi cw 2f .2 .3 - -= - -- 2 9 -16 10yr3 /3 - sil l msbk mvfi cw If .2 i .3 Ground 3 16 -31 1Oyr4 /4 - sil 2msbk mfr cw - .5 .6 elev 97.74 ft 4 31 -50 10yr4/6 - is 2msbk mvfr cw - .7 .8 Depth to 5 50 -80 7.5yr4/6 - s Osg ml - - .7 i .8 limiting factor >811 Remarks: 2 1 0 -10 10y3/1 - sil lmsbk mvfi cw 2f .2 i .3 2 10 -16 10yr3/3 - sil lmsbk mvfi cw if .2 ! .3 Ground 3 16 -32 1Oyr4/4 - sil 2msbk mfr cw - & .6 elev 98.23 ft 4 32 -53 10yr4 /6 - is 2msbk mvfr cw _ .7 Depth to 5 53 -82 7.5yr4/6 - s Osg ml y - limiting factor >82 Remarks: CST Name (Please Print) Signature: Teleph Thomas C. Nelson 715 -246- 4 Z Address Environmental By Design Date CST Number 1432 120th Street, New Richmond, WI 54017 7/7/99 227387 245 `PROPEkTY OWNER: Derriok Construction lne. SOIL DESCRIPTION REPORT zas Page 2 of 3 PARCEL I.D.# Environmental B v Design Depth Dominant Color Mottles Structure GPD/ftz Horizon in Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. onsistenc Boundary Roots Bed 'Trench 3 1 0 -10 10y3/1 - sil lmsbk mvfi cw 2f .2 .3 2 10 -17 10yr3/3 - sil lmsbk mvfi cw if .2 .3 Ground elev 3 17 -32 10yr4/4 - sil 2msbk mfr cw - .5 .6 98.89 ft 4 32 -52 10yr4 /6 - is 2msbk mvfr cw - .7 ? .8 Depth to 5 52 -84 7.5yr4/6 - s Osg ml - - 7 8 limiting factor >84 Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor I Remarks: i • IHViP0HA[MTAL 6Y 0[516N 14 3V _ 120 STREFT, ,INEW rurFforjr), wrsco 715- 246 -2454 Tom Nelson C-eititied Soft Tester .:27387 - -- Registered Sitmtar,an SR00713 T i r11 r� ��t.,.> s (p d n w 1`f S c., t T 2- � N R t 9� d T r a y w �u J n S ,(� Q. } � too f 5 f p g� 61 r 7 C?� Z � 1 6.2. SCAM 1" = 3 0 TOM N BM1. — rop o Shp 5")r) BM2 To O Cu{t,,,n r Q`1.7-1 rfiscomipOepartmentof Industry SOIL AND SITE EVALUATION Page I of 3 i Laborer Human Relations DivW�t of safety and Buildings in accordance with s. ILHR 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County r • include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Prope Owner Property Location ( 2- o S r to C� I t7 r rt C_ Govt. -Lot S 0 /4 h LJ 1 /4,S 1 9. T a$ ,N ,R ►9 w Property Owner's Mailing Address Lot # Bloc k# Subd. Name or CSM# 9 s O.5 H o y ( CA City (� ` State Zip Code Phone Number Nearest Road Village (Town tJ " tChn f7�10 El city ❑ (,J I 5qc 17 (1 ) 9c.�(v 232 Cit (� r'O New Construction Use: Residential / Number of bedrooms 4 Addition to existing building ❑ Replacement �(000.� -. ❑ Public or commercial - Describe: p Code derived daily flow S7-J -O gpd Recommended design loading rate - 7 bed, gpd/ft , trench, gpd /ft Absorption area required �3 5 bed, ft -1 0 trench, ft Maximum design loading rate 7 bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) 9�Ig d ft (as referred to site plan benchmark) Additional design /site considerations Parent material 1 5A c.e. i c 1 O J Q t..5 l \ 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 Lf S ❑ U P S 1 : 1 U S ❑ U �] S ❑ U ❑ S � U ❑ S ,NJ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munseil Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 7 1 0 -i5 Io 2 3 none S a rn s 6K rn PR .9,. 2 S I I 2 ^► S b K r*► �'12 w 1. `,�.. `3 Ground elev. 3 ? 2`} 5YAJ - 1 H 1 t 1 S 059 M IZ w (1 � Z l , 85 q apt. y ;Lq - 1 . S �Rl��y 'S 059 ( w n R 7 . g Depth to 5 41 -1 7. S 055 ; 8 limiting factor Remarks: Boring # � I 0 -17 1D e 3 z Xn Sb1.' ir, -P2 Q w 1 1. 1 ? -y 1 OYR L113 pgP(Z Li I F 2- �O3 3 42- 51 7.S R 5 t l b s r1 1 w rn a. - 7 . 8 Ground y 541 y 7, 5 y 2 5/4' t r S O S 1'►l I n c ' • 7 O elev. ` D to limiting factor 714) Remarks: CST N ame (P lease Print) y� Signature —� Telephone No. I 1' r S ' IQ.`Sah Zl5 •2q(. Address Date CST Number IL4 3OL. Wks 11 -1+97 C strno z (05 L - SOIL DESCRIPTION REPORT PROPERTY OWNER Page �- of r3 PARCEL I.D.# Bonn # Horizon Depth Dominant Color Mottles Structure 2 g in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench I 0 -IS 10� 3 2 YZOY1 C. . Q � �' 1 2 r1 s b 4t n F(L w 2� s 2 ;• 43 1 18-34 to R 1 4/3 LmsdK (nPCL 9,.3 1 Ground ?� 3 4- 69 7.5 R S !o Y10 c C S OS 5 r'► w h $ elev. 7l ` T q 49.7 7 ., ♦ R 5 y ►-� o ., c S p S Tn ra vi k •. _$ 0.V Depth to 5 74 -102 .S 2` mo S moo t ► G S O S �'�1 w in .7 . `d limiting ; factor in.? Remarks: lr_st S %'AL o �' born �rto` eon a► VNT & CV- D Q o ckel Boring # SjA l .5 V tf I c 2 P Ground elev. ft. , Depth to limiting factor in. Remarks: - Horizon Depth Dominant Color Mottles Structure GPD /ft Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # Ground elev. ft. Depth to , limiting factor in. Remarks: Boring # Ground elev. ft. Depth to limiting factor in. Remarks: SBDW -8330 (R. 08/95) erf' Hoy Sw'[y nL,/,i s 15 r2aN J t5 roy 1 v ° l T O Q e o 1 L o N � a � 90 •s � 1 k ° ow 1 C 5 I r 2. 4 C>5 s : VOL 1 ?93 PAC[ 189 AFFIDAVIT OF CORRECTION'" TROY VILLAGE REGIST R'S OFFICE ST. CROIX CO. WI I, James D. Filkins, Registered Land Surveyor, Read tar P.ycord ' S- 2246, hereby certify that the Plat of Troy Village, recorded in Volume 6 of Plats, Page FEB 041998 89, Document No. 559959, St. Croix County 9:30 A M Registry, located in the Town of Troy, St. � Croix County, Wisconsin, shows Note No. 5 on try Sheet 2 which states "The following Lots Ra st.r of Dead$ must have mound systems: 1 through 10, 15, 16, 18, 19, 21 through 45, 47 through 49, 51 through 55, 59 through 64, 69 and 70." This note is hereby changed to read as Francis H. Ogden follows: Ogden Engineering Co. 113 West Walnut St. "The following lots must have mound systems: River Falls, WI 54022 1 through 5, 16, 18, 19, 21 through 45, 47 through 49, 51 through 55, 60 through 64, 69 and 70." Dated this 3 day of B2Li�Zy' , 1998 Parcel I . D. Number i.ns S-2246 � Ja . Filk State of Wisconsin ) ILLKINS j s s . 824 County of Fes. _ vtin O Q. SURD Personally came before me this �� da of q"ir » it.t � y GC , 1998, to me known to be the person who executed the foregoing instrument and acknowledged the same. My mm i ' on Expires -Z pp / O NOTARY ST. CR IX COUNTY 4� PUBLIC APPROVAL CERTIFICATE �F W1 Approved for recording by the St. Croix County Zo ffice Date 2 • y' 98 &� " - w , f �x(F,_SLrh � This instrument was drafted by James D. Filkins, Ogden Engineering Co. 113 West Walnut Street, River Falls, Wisconsin 54022 SAFETY & BUILDINGS DIVISION t ' State of Wisconsin Department of Commerce January 27, 1998 Field Operations Bureau 13 East Spruce Street Chippewa Falls, WI 54729 THOMAS C. NELSONr ENVIRONMENTAL BY DESIGN 1432 120TH STREET'. NEW RICHMOND WI 54017 RE: PLAN ID 46515 FEE RECEIVED 80.00 TROY VILLAGE LOT 6 PLAT ID 20751 SW, NW, 19, 29, 19W TOWN OF TROY COUNTY OF ST CROIX MOUND RESTRICTION WAIVER The Department has reviewed the above - referenced submittal. The Department has reviewed the request to waive the restriction on the above referenced property. This request is supported with information that indicates this property is acceptable for development with a below grade soil absorption type private sewage system. Therefore, the Department waives the above mentioned restriction and has no objection to the development of this property, provided that the private sewage system is constructed in accordance with the applicable requirements of ter Comm 83 Wisconsin Administrative Code. PP q Chapter Conditional approval is hereby granted to waive the mound system restriction provided the following condition(s) are met: i 1. That the release and waiver of this lot restriction be incorporated into a correction instrument under s. 236.295, Wis. Stats. This should eliminate future questions regarding the restriction on the recorded plat. 2. That land surface area for both an initial and replacement below grade soil absorption system be set aside for use. Said areas shall be at least 50 feet from any well, 25 feet from any habitable building or dwelling or building with a below grade foundation, 5 feet from any lot line, and shall not be within or below a compacted area. This approval does not include review of the design for the proposed private sewage system. All other applicable criteria, as contained in chapter Comm 83, Wisconsin Administrative Code, must be met prior to issuance of the sanitary permit for a project at this site. All permits required by the city, village, township or county shall be obtained prior to installation. SSE)-7997 (R.11/96) i 'r SAFETY & BUILDINGS DIVISION State of Wisconsin Department of Commerce January 27, 1998 Lot 6, Troy Village Page 2 of 2 Inquiries should be directed to me at the telephone number listed below. Please refer to the plan number shown above. Sincerely, Leroy . Jansky Wastewater Specialist, Senior Ijansky @commerce.state.wi.us E -mail (715) 726 -2549 Fax (715) 726 -2544 Voice CC: DOA - Plat Review St. Croix County Planning and Zoning SOD -7997 (R.11/96) I w mconsio . 0aoarm —t of Industn/, SOIL AND S EVALUATION REPORT Page L of 3_ L and'Human Reia llOnS Division of satery s f3uddngs in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but . CROIX not limned to vertical and horizontal reference point (BM), direction and % of slope, scale or PA RCEL I.O. rs dimensioned, north arrow, and location and distance to nears , APPLICANT INFORMATION- PLEASE PRINT AL L A S REVIEWEOBY DATE - PROPERTY OWNER: + P LOCATION E 1/2S 24T 28 NR 20 W TOM RUEMMELE &JOHN AND BARB RU ''LE ' `'` GOVT. 114W 1/2S 19T 29 NR 19 -64er1 W PROPERTY OWNEF':S MAIUNG ADDRESS ~ SUBO. NAME OR CSM rt 260 COUNTY ROAD F TROY VILLAGE CITY, STATE Z1P CODE P UMBER "' IJNTY Il1AGE OWN NEAREST ROAO HUDSON W 54016 71 Ad Ds? lSow D4 New Construction Use J Residential I Number y Addition to existing building j I Aeo went [ I Public or commercial d 0 Code derived daily flow 600 gpd Recommended design loadatg rate 1P I' bed, gpdtlt � trench, gpdM Absorption area required DO bed, ft DD trench, 9 Maximum design loading rate D. S bed. 9NM L'! trench, 90* Recommended infiltration surface elevation(s) BY DESIGNER ft (as referred to site plan benchmark) Additional design / site considerations SSE NOTES DA/ 1i4*16 3 Parent material `D�S Dr/TlyiS/� Flood plain elevation, if applicable N/A ft S - Suitable for system CONVENTIONAL MOUNO I N-GROUNO PRESSURE AT -GRADE SYSTeA IN FILL HOLDWG TANK U= Unsuitable for system I D S Z'U I WS O U O S ICU I D S �U I ❑ S C'U I OS xU SOIL OESCRIPTION REPORT Horizon Depth Dominant Color Mottles I Texture Structure I GPD/ft in. Munsell Du. Sz. Cont Color Gr. Sz. Sh. Bed ITrmM Bonng # A 1 0 - 15 10YR 3/2 - -- sil 12msbk mfr cw 3vf -4 0.5 M418 B1 15 -29 10YR 4/4 I - -- sil 2msbk mfr gw 3vf- 0.5' 0.6 B2 29 -37 10YR 5/4 - -- sil 2msbk mfr cs 2vf 0.5 0.6 Ground elev. C1 37 -44 10YR 5/6 ( - -- s Osg ml cw lvf 0.7 0.8 9 01.5 ft. C2 44 -72 10YR 5/6 If2d 5YR 5/8 s Osg ml - -- lvf -- - -- Depth to limiting 44 11 Remarks: Boring # A -9 LOYR 4/2 I - -- sil 2msbk mfr cw of - 0.50.6 sB OYR 5/4 - -- sil 2msbk mfr cs of 0.5:0.6 C 6 -72 LOYR 6/6 - -- s lOsg ml - -- Lvf 0.7 0.8 Ground elev. 9 OL ft Depth to limiting factor 211 t Remarks: - F Nam s :—Ilsase Print jAM ES 0 �q� Phoiw (715) 425 -7831 OGDEN ENGINEERING CO., 113 WEST WALNUT ST., RIVER FALLS. WI 54022 Oauc 4 //o Q 7 CSTM03988 PR4PE}a7YAyVNEA SOIL O E S C R I PTI O N REPORT Page of _3 ' PAACIILI). >t Depth Dominant Color fulomes Structure GPO Horizon Texture C j Boring # A 0 -22 10YR 3/1 - -- 1 2msbk mfr cw 2vf 10.5 0.6 :i1568'a B 22 -37 10YR 4/4 - -- sicl 2msbk mfr cs 2vf—t 0.4 1.0.5 Ground 37 10YR 9/6 - -- - -- luf 10-7 0 AR elev. 8 99. l ft. Depth to limiting =r I > 72" Remarks: Boring # 1 elev� 1 ft. Oepttt to I I limiting 71 factor Remarks: Boring # I i , Ground elev. tt. I I Oeptn to timrting I tamtor Remarks: Boring # elev. ft D El epth to lirtbtirrg fa= Remarks: 58O8150(ii.OarOZ) PAGE 3OF3 SITE PLAN b SCALE: 1 " = 40' GAT 7 ¢Zo a Geq 5 NOTES: PROVIDE MINIMUM OF 1' SAND BETWEEN BOTTOM OF BED AND EXISTING GROUND. MOUND TO BE A MINIMUM OF: 25' FROM DWELLING; 50' FROM WELL; 5' FROM LOT LINE. OGDEN ENGINEERING CO. JAM D. FILKINS, CSTM03988 Civil Engineers & Land Surveyors 113 W. Walnut St. River Falls, WI 54022 DATE: �e�� 7 (715) 425 -7631 '.W6c6ns1'o.0eowtm*ntof SO AND SITE EVALUATION REPORT Page _1 of 3 Labopand Human Reia CwYwn of safes s eWid'ngs in accord with ILHR 83.05. WiS. Adm. Code COUN IY Attach c P a omplete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but . CRO not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or RCEL I.O. a dimensioned. north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ` r-, TI REVIEWED BY DATE - PROPERTY OWNER: PROPERTY LOCATION E 1/ 24T 28 NR 20 W TOM RUEMMELE & JOHN AND B n, OVT. LOT 114W 1/2S 19T 29 NR 19 x640 W PROPERTY OWNER':S MAILING ADDRESS L T s 81:9 K 0 SUBO. NAME OR CSM it 260 COUNTY ROAD F 1r -.14 1 TROY VILLAGE CITY, STATE ZIP CO P ME 1897 TY C3VILLAGE MrOWN NEAREST ROAD HUDSON WISCONSIN 5401 (71 5) - T Y I .S-r Ad z%? tVa D4 New Consm don Use J Residen / ttiff Aftle I IE (� Addition to existing bwk>irtg [K I 1 Replacement [ J Public or co escnbe Code derived daily flow 600 gpd ` ed design khadrq rate ,!P, 1 ed. gpolft : trench, gpdMt Absorption area required DO bed. ft DO trench, ft Maximum design loading rate D, S bed. gpdMt P) trench. gpdMt Recommended infil=on surface elevation(s) BY DESIGNER ft (as referred to site plan benchmark) Additional design / site considerations Sri 4 1 5 IV4 !S Off/ p/ftE 3 Parent material `_, 4 . Rood plain elevation, if applicable N/A ft S . Suitable f or system CONVENTIONAL MOUNO IN- GROUND PRESSURE AT -GRADE SYSTEM IN FU HOLDING TANK U= Unsuitable for system I Q S Ku I WS ❑ U I 0 S ICU ❑ S CKU I ❑ S C'U I Q S KU SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure I I GPD /tt Horizon in. Munsell Qu. Sz. Cam Coles Texture Gr. Sz. Sh. Cow �� Roots Bed ITrertdt Boring # A 0 -15 IOYR 3/2 - -- sil 12msbk mfr cw 3vf -4 0.5: 0.6 418 B1 15 -29 10YR 4/4 - -- sil 2msbk mfr gw 3vf -4 0.5 B2 29 - 10YR 5/4 1 - -- sil 2msbk mfr cs 2vf 0.5 0.6 Ground elev. C1 37 -44 10YR 5/6 I - -- s Osg ml cw lvf 0.7 0.8 9 C2 44 -72 10YR 5/6 f2d 5YR 5/8 s Osg ml - -- lvf -- - -- Depth to li miting fa=r Remarks: Boring # A -9 LOYR 4/2 - -- sil 2msbk mfr cw of -f 0.5 0.6 `42 „{ B -26 OYR 5/4 4 r 2 - -- sil 2msbk mfr I cs 2vf 0.5:0.6 Ground C 6 -72 LOYR 6/6 - -- s losg ml - -- Lvf 0.7 0.8 ftlev. 9 00.7 ft Depth to lifnipng factor 2 Remarks: - Naine —Aew Print jAMES 0 FILKJJS (715) 425 -7631 OGDEN ENGINEERING CO., 113 WEST WALNUT ST., RIVER FALLS, WI 54022 r ' Date: `� <f f7 CST N= C M03988 PROPER'`'�WNER SOIL DESCRIPTION REPORT Page _Z_of 3 Oepttt Dominant Color Moines Texture Structure Cor> w nce Eb MY Roots GPOift- Honzon T mrcri Bonng # A 0 -22 10YR 3/1 - -- 1 2msbk mfr cw 2vf 10.5 0.6 568: "x g 22 -37 10YR 4/4 - -- sicl 2msbk mfr cs 2vf- 0.40.5 Ground - - -- - -- elev. 8 99. l ft. 080 to limiting factor 72 Remarks: Bonng # Ground elev. ft. OepM to I I limiting factor Remarks: Boring # I I I l I i I I L Ground elev. OepM to limiting factor Remarks: Boring # y I i Ground elev. it 0epin to I lirtntirtg factor Aemautcs: f1.0WM i 1 PAGE 3 OF 3 SITE PLAN h N hN SCALE: 1 " = 40' Z- - r 7 �o T 6 E3 NX14. /N �`a ® �b O 8 - S�8 O GoT S NOTES: PROVIDE MINIMUM OF 1' SAND BETWEEN BOTTOM OF BED AND EXISTING GROUND. MOUND TO BE A MINIMUM OF: 25' FROM DWELLING; 50' FROM WELL; 5' FROM LOT LINE. OGDEN ENGINEERING CO. JAMES FILKIIN CSTM03988 Civil Engineers & Land Surveyors DATE: T(��(97 113 W. Wain (7 15) 425 - 76315 W 1 54022 ST CROIX COUNTY . - SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address 1 5o5 H W Y &5 ! PD.. !�o x A Property Address � ST- NAAye WCi 1)y 1 (Verification required from Planning Department for new construction) City/State N � P &O MO ND Identification Number 040 Z _ (40 _COO LEGAL DESCRIPTION Property Location '/4, , '/4; Sec. ) , T 'klo N -Rj'1 W, Town of 1 � Subdivision 7R0Y V I L-1- 66T , Lot # Certified Survey Map # Volume , Page # Warranty Deed # 3 , Volume , Page # 1308 3 (v3 Spec house P' yes ❑ no Lot lines identifiable yes ❑ no SYSTEM 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, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal 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 De artment of ommerce and the Department of Natural Resources, State of Wisconsin. Certification . stating it our septic syste a been in tained must be completed and returned to the St. Croix County Zoning Office within 30 days o three ear expir lion date. /l3 / X GNATURE OF APPLICA11fT DATE OWNE CERTIFICATION we certify that al st tements this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr rty desc 'bed abov , by virtue warranty deed recorded in Register of Deeds Office. 7 .2f G14ATURE 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 •.� c VOL X308 PACE. ' 575670 STATE BAR OF WISCONSIN FORM 2 — 1996 I3OCUMENT No. J WARRANTY DEED _Troy Development Corporation, a Minnesota REGISr_�R's 'OFFICE Corporation, Grantor ST. �CROIX G®,, WI r.tl�' d fv, nsrQr 1 " conveys and warrants to MAR 2 4 1998 Derrick Construction Co., Inc., a 9:45 q Wisconsin Corporation, Grantee 'r+ �1�� l Re later of pt�e the following described real estate in St. Croix County, Stale Of Wisconsin: RETURN TO Lot 6 of the Plat of Troy Village in the Town of Derrick Construction Co., Inc. Troy, St. Croix County, Wisconsin. 1505 Highway 65 Subject to Declarations of Covenants, Conditions New Richmond, WI 54017 -6502 and Restrictions for Troy Village, recorded in Vol. 1241, Page 256, as Doc. No. 559964, and the Declaration of Golf Course Covenants, Parcel Identification Number (PIN): Conditions and Easements, recorded in Vol. 1241, Page 301, as Doc. No. 559969, all as appearing in the office of the Register of Deeds for St. Croix County, Wisconsin, and such other easements, reservations, restrictions and reservations of record, or in use. TR A�N a SFER 5 __-. FEE This is not homestead property. (is) (is not) Exception to Warranties: Dated this 44 24 day of February 19 98 e "-t o 'r 6 : ° — ' (SEAL) (SEAL) * Charles S. Cook, President Troy Development Corporation (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF u>r: 900WPJ M i nne s t a ss. Anoka County. authenticated this day of 19 Personaliv came before me this 2 4 day of February _19 the above named Charles S. Cook President of roy Development * Corporation TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person who executed the authorized by § 706.06, Wis. Stats,) foregoi nstr men and acknowled he same. THI INSTR MENT WAS DRAFTED B 7- r / )I. a * Kates. ok Notary Public Anoka CountyVfs. MN (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. (if not, slate expiration necessary.) Janua n u a r 31 date: Y * Names of persons signing In any capacily should be typed or printed below their signatures. NOTARY PUBLIC —MfNNE OTA S82 NTF 0021A WARRANTY DEED STATE BAR OF WISCONSIN elc0 FoR�, 0ree Bay, W154307-0208 Form No. 2 -- 1996 MY COMM. EXPIRES 1.31.2000 • a •jr � r 3. B U R N E V-1 L L A G ' TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN — — I SMir cove WAO i z \ I. 1 ? — — —. 11.0660 Ac - 66 �. OUTLOT 10 7 - f t ,_ 80 1.127 AC y 1p 1.003 Ac 6p.00 7 9 85 5 2621• i w 1 17 0 AC 1.441 AC. 83 1.025 AC 3, 8 a 78 86`� 1.446 SCALE: 1 " = 400' 1.036 AC J 1.073 AC 20.17 26q 'OJT ' 112 ,690 tw„ • „ WALKPATH „1.�7Ac p4 .37� �' t.OM AC WALi�ATH � � I 6 t. AC �' 89 iD6 i 1 .0 AC 1.016 OUTLOT 11 A h 31600 0.923 AC °� • ,� 3 100 c - ` 1.15 AC ' 10' 5 50 $ A 0 � � 1 V '. 31 74 SCALE IN FEET 92 1039 AC 56 s a 1 4 ,$, 1.011 C 9.19' 59 73 ,1020 °' 002 AC 10 . 7 . 1.0” AC y Q ZQt] ¢QO 800 55` toz AC 0 : t099 A GOLF COURSE 1.525 AC '� .'O e x'5,4 � 72 1.1 AC 226. F` 1 103 AC go ? ? 41 .�• _ �ev 52 / t.o,4 Ac 100 71 za 61 A¢ 5 c "^ 1. 17 AC ' 1.o2t s' � A """" C ���� 63 64 g ,a999AC'' 7� „ t� �1. AC 1.003 Ac 1.000 AC 1075 AC 68 t M } 8 wAIKPATH a 3 �1 ST. AWES PARKWAY. 5 6 w 124 A / MU — 9 - -8 1 1.032 AC 1.160 A �!1. AC ° 2 1.006 AC 0 1.011 AC ry',•, A U 1.154 AC N $ 1.155 AC d7 4 —COMMOI�i� . 6 • ° ,.003 AC - REA —PO 1.003 Ac ,.05 Ac 1 03 12 ?e u 11004TAC ' �a+ MEN ENGNEERM CO. ►t' 1.156 AC ' J CM Er *mm & LOW Surveyors a 3, W6 1 13 W. 14 1.022 Ac `. �d'A Y1„t St., Mw Fa16r M 34022 1 Ac '$ (713) 425 -7631 s GOLF COURSE WALKPATH DATE: 2 -22 -99 96 -2179