HomeMy WebLinkAbout040-1245-30-000 r
- ST. CROIX COUNTY ZONING DEPARTMENT
AS BUILT SANITARY REPORT
Owner .[��► �, �t?�e�s
Property Address -2-5"5 Tr�c G u, k
City /State w t s r
Legal Description:
Lot 1 3 Block Subdivision/CSM # � oa 4 1 1 , // o' �
2 l S Sec. �, T -R W, Town o Ti m PIN # �4�U — DS2.56�J J� � -
SEPTIC TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION:
Tank manufacturer Wc,ftr SizeOPC 1 z-;q Setback from: House Z0 Well —? P/L .;)-y
Pump manufacturer Model
Alarm location
(HOLDING TANKS ONLY)
Setbacks: Service road Vent to fresh air intake Water Line
Meter location
Alarm location
SOIL ABSORPTION SYSTEM
F ir- i C4"6e,- «
Type of system: Width 3 6 Length 7 7 - ** Number of Trenches -Z
Setback from: House qf Well _ .A-- P/L 5' _ Vent to fresh air intake 1 Uy f
ELEVATIONS N o. -v 13 4 - 1 -
Description of benchmark c-' Al G,/ of'� Elevation
Description of alternate benchmark ,L l/ . tc?t 44,-d Elevation r
Building Sewer 0 // ST/HT Inlet / O Yj' ST Outlet S' PC Inlet
PC Bottom Header/Manifold !�Z e, Top of ST/PC Manhole Cover
Distribution Lines
Bottom of System O %� . !` S" O F7- 01-3 ( )
Final GradeO Cie: ..2 3 - ( )
Date of installation /LL 97 Permit number 31 (ad State plan number
Plumber's signature License number Y�� -S `/ Date
Inspector
Complete plot plan �
NOTICE: Please provide the following: '
• A plan view sketch showing everything within 100 feet of the system.
• Two horizontal reference points to center of septic tank manhole cover.
• Show alternate benchmark if applicable.
PLAN" VIEW
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INDICATE NORTH ARROW
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• Alisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Count
Safety and Buildings Division
INSPECTION REPORT St. Croix
GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No-:
Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 3531
Permit Holder's Name: ❑ City ❑ Village ❑Down of: State Plan ID No.:
Town of Tro
CST BM Elev.:. Insp. BM Elev.: BM Description: Parcel Tax No.:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark S Wt So
60 . 0 f
Dosing Alt. BM 3 JOG 0
Aeratio Bldg. Sewer 7. to Z - 1(
Holding St /Ht Inlet $'�f
TANK SETBACK INFORMATION St /Ht Outlet JS Ol 3S
TANKTO P/L WELL BLDG. ventto ROAD
Air Intake
Septic '� 2,Q r ` NA Ot Bottom
Dosing A Header / Man. E
Aeration NA Dist. Pipe ° Q
Iz -SS'
Holding Bot. System 11.4 `I4 "?!r
E o3
PUMP/ SIPHON INFORMATION Final Grade
ManufaQ4 mand St cover 6' b 3 ��• 8
Model Number GPM
TDH Lift Fric TDH Ft
Fort Length Did. Dist. To Well
SOILA RPTION SYSTEM
Width f Len th I No. f Trenches IT No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS S a DIMENSI N
SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHING Manu rer:
SETBACK CHAMBER —�!
INFORMATION TYpeO 1 p I �2� OR UNIT Model Number: .114 System: l.a" v
DISTRIBUTION SYSTEM v V&-4 w o
Header / IylanifoId k Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake
Length e - ' Dia. Length ia. >Jt70'
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 ❑ Yes ❑ No
COMMENTS (Include code discrepancies, persons present, etc.) Inspection #1: // /S /'M Inspection #2:
Location: 255 Troon Court, Hudson, WI (SW1 /4, NW1 /4, Section 19 T28N -R19W) - 19.28.19.1255
zff 7 s CPA4
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N 0 wee- me- -�
Plan revision required? ❑ Yes � No
Use other side for additional information. 0 1 03 0»
SBD -6710 (R.3/97) Date Inspector's Signature Cert. No.
ADDITIONAL COMMENTS AND SKETCH
SANITARY PERMIT NUMBER:
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Safety and B ildings Division
1 4sconsin SANITARY PERMIT APPLICATION 2 1 Box 730 ington Avenue
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 r I sd ty
than 81/2 x 11 inches in size. ,,• �� f raj
• See reverse side for instructions for completing this applicatio �� fC State Sa Mary Permit Nu ber
Personal information ou p rovide may be used for second previous appli ation
(Privacy Law, s. 15.04 (1) (m)].
Y P Y ry purposes 1 � �� ❑ Check i revision to I �..
'� �— 1 _
f .5 fate Plan ID. Number
I. APPLICATION INFORMATION - PLEASE PRINT ALL I MATAWky, I y
Propert y 0 nerName P Wion
S r T , N, R E (or) W
Propert Owner's Mai Z�Zg tNtir ".�"b Block Number
7 4 7S' r °X73 '
City, Statg I Zip Code Phone Number Subdivisi M S Number
�— re ✓ L I � ( J ) 731— .. 11111 -a
II. TYPE B ILDING: (check one) ❑ State Owned ❑ Cit Nearest Road
Village
Public ff,1 or 2 Family Dwelling - No_ of bedrooms Town OF !c
III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 7�7
1 E] Apartment/ Condo 0 KG — (-2— 4T 30
2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility
3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dini g
4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station /Car ash
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. New 2 E] Replacement 3. E] Replacement of 4_ ❑ Reconnection of 5_ CLepair an
l`'`Syst em ________ System______ ______ _Tank Only_- ___- ____ - -__ Existing System ___ - -__ stem
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 ❑ H (ding Tank
12� Seepage Trench 22 E] In-Ground Pressure ,/ , / 42 E] Pi Privy
13 E] Seepage Pit S s� /w..�.,� f t S 43 ❑ V ult Privy
14 ❑ System -In -Fill ,,� /Yi �� �Sr
VI. ABSORPTION SYSTEM INFORMATION:
1. Gallons Per Day 2_ Absorp. Area 13. Absorp. Area 4 Loading Rate 5. Per /. Rate 6. System Elev. 7. Final Grade
/ Required (sq. ft. oposed (sq. ft.) Gals/day /sq. ft.) in. /inch) I Elevation
��/ ✓ 75 _ [ 7 eet 10C Feet
Capacit
VII. TANK in Ca allo
g Total # of r Prefab. Site Fiber. Exper.
INFORMATION Gallons Tanks Manufacturers Name Concrete Con- Steel glass Plastic App
New Existin structed
Tanks Tanks / " , _ �g
S-e n Tank k" 2 / WC,CIt, LLl El 1:1 ❑ 13 1:1
Li Chamber I I I ❑ I ❑ I ❑ I ❑ 1 ❑ 1 ❑
VIII. RESPONSIBILITY STATEMENT
I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans.
Plumber's Name: (Print) Plumber's t e: (No U MP /MPRSW No.: Business Phone Number:
Pl umber's Address (Street, City, State, Zip
y O'
IX. COUNTY / DEPARTMENT USE ONLY
❑ Disapproved Sanitary Permit Fee (includes Groundwater D ate Issued Issuing Agent Signature (No Stamps)
Surcharge Fee)
Approved ❑ Owner Given Initial
Adverse Determination
X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL:
SBD- 6398 (R.'I'U97) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, owner, Plumber
INSTRUCTIONS
1. A sanitary permit is valid for two (2) years.
2. Your sanitary permit may be renewed before the expiration date, and at a time of renewal any new criteria in the
Wisconsin Administrative Code will be applicable.
3. All revisions to this permit must be approved by the permit issuing authority.
4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the
county prior to installation
5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever
necessary, usually every 2 to 3 years.
6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of
Wisconsin, Safety and Buildings Division, 608- 266 -3151.
To be complete and accurate this sanitary permit application must include:
I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the
system is to be installed.
II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling.
III. Building use. If building type is public, check all appropriate boxes that apply.
IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair.
V. Type of system. Check appropriate box depending on system type.
VI. Absorption system information. Provide all information requested for numbers 1 through 7.
VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and
manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and
holding tanks for this system. Check experimental approval only if tanks received experimental product approval from
DILHR.
VIII. Responsibility statement. Installing plumber isto fill in name, license number with appropriate prefix (e.g. MP, etc.),
address and phone number. Plumber must sign application form.
IX. County/ Department Use Only..
X. County/ Department Use Only.
Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must
include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic
tank(s) or other treatment tanks; building sewers; wells; water mainstwater service; streams and lakes; pump or siphon
tanks; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served;
B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume;
elevation differences; friction loss; pump performance curve; pump model and pump manufacturer; D) cross section
of the soil absorption system if required by the county; E) soil test data on a 115 form; and F) all sizing information.
------------------------------------------------ - - - - -- -------------------------------------------
GROUNDWATER SURCHARGE
1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can
effect groundwater.
The monies collected through these surcharges are used for monitoring groundwater contamination investigations
and establishment of standards.
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wiswnsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3
Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code
• Environmental By Design
Attach complete site plan on paper not less than 8%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 - Pleasg l'inntafl ;f nfo mation. Rev y Data
Personal mforrnabw you provide may be used for y.Purp '(� +w�Y law, s. 15.04 (1) (m)). y
I'll I l �.
Property Owner k,
�. Property Location
Kootenia Homes r^1, ;; GovL Lot SW 1/4 NW 1/4 S 19 T 28 N,R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
7975 Afton Rd 13 Troy Village
City State Zip Code PC) netiltper ❑ City ❑ Village ® Town Nearest Road
Saint Paul NW ; 551<25� �r �� ` ,� l,. Troy Troon Court
❑ New Construction Use: ❑� Residential / Number of bedrooms 4 ❑Addition to existing building
Replacement ❑ PUdik�, CornrneFci deWA be
Code Derived daily flow 600 gpd Recommended design loading rate •7 bed, gpdff •8 trench, gpd&
Absorption area required 857 bed, ffs 750 trench, fl? Maximum design loading rate .7 bed, gpd/ft .8 tr ench, gpolfF
Recommended infiltration surface elevation(s) 97' ft (as referred to site plan benchmar
Additional design / site consideration Site has been graded removing overburden
t Parenl material LOESS OVER OUTWASH SAND Flood lain elevation, ff applicable na ft
ble for ste m Conventional Mound In -Ground Pressure AT -Grads stem in Fill Holdi Tank
itable for system ( ®S ❑ u' ❑ S ®U ®s ❑ U , ❑ S Z U EIS M U I 0S E U
SOIL DESCRIPTION REPORT
goring# Horizon
Depth Dominant Color Mottles Structure GPD/ft
in. Munseil Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistent Boundary Roots Bed Trend
1 1 0 - 10yr3/2 - A 2msbk mfr cw if .5 .6
2 7 - 76 7.5yr6/4 - s Osg nd - - .7 .8
Ground
elev
100.02 ft
L
Depth to
limiting
factor
>76
Remarks:
2 1 0 -16 10yr3/2 - sil 2msbk mfr cvkr if .5 i .6
2 16 -26 7.5yr6/4 - s Osg ml cw - 7 8
Ground 3 26 -30 10yr3/2 - sil 2msbk mfr cw - .5 .6
elev
102.03 ft 4 30 -36 10yr4/4 - sl 2msbk mfr cw - 5 6
Depth to 5 36-98 7.5yr6/4 - s Osg nA - - 7 8
limiting
factor
>91, s
Remarks:
CST Name (Please Print) Signature: Telephone No.
Thomas C. Nelson -'`�- 715 - 246 -2454
Address Environmental By Desi Date CST Number Ref #
1432 120th Street, New Richmond, Wl 54017 2 ,a - '1 227387 254
I
PROPERTY OWNER: Koami- Home- SOIL DESCRIPTION REPORT Page 2 of 3
PARCELLD1 EnvironmenW By Design v
D�Pll DorninantColor Mottles Structure GPD/fF
Horizon in. Munsell Qu. Sz. Con, Color Texture Gr. Sz. Sh. �nsisten� Boundary Roots Bed i Trench
3 1 0-6 10yr3/2 Sil 2msbk Mfr Cw if .5 .6
2 6-76 7.5yr6/4 S Osg n
.7 i .8
Ground
elev
100.30 ft
Depth to
limiting
factor
>76
Remarks:
4 1 0-5 1 Oyr3/2 Sil 2msbk Mfr Cw if .5 .6
2 5-84 7.5yr6/4 S Osg n-A
.7 .8
Ground
elev
99.03 ft
Depth to
limiting
factor
,84
Remarks:
5 1 0-5 1 Oyr3/2 Sit 2msbk Mfir Cw if .5 .6
2 5-78 7.5yr6/4 S Osg n-A
.7 .8
Ground
elev
%.94 ft
Depth to
limiting
factor
>78
Remarks:
Ground
elev
Depth to
limiting
factor
Remarks:
r N
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4 �
Yom Nftkt
tiny ! �—
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___ New - - -. ------ _.___ ____________ __ ____ ___ ____ ____ ______________
+ PROM : THExNELSONSxxxxxxxxxx PHONE NO. : 00000000000000000 SEP. 10 1999 05:58PM P1
yyln DepartrnBntot Cm
orneroe SOIL AND SITE EVAI..UAY'ION Page —_ ._ of 3 ........ --
Division of Safely and Buildings in accord with Comm 83.05. Wis. Adrn, Cade Enviroam"al 1b; U-ign
Attach campldta eft plan on paper curt less tl�an sA x t t kx*m n m
skre. Plan must County
hlude, but not linAed to: vertical and h dal reference point (BM); cbecoon and — St, Cioix_
percent slope, scale or dimensions. north al' row, ar►d laeason 001 dir, Q to nearest read. Pa►tlei f.D.#
APPMANT INFORMATION - Ph"e Plot all lnfornrratroa, Date -
Pananal kdkx nation h>w Provide mqy be t*wd far aeomd y Pw (Prow ie , s- 1"4 (1) (+ft)? ^
qty Owndr fkickS rty 3 Location
Troy
KO Otetlna Hom es_. Lot - SW 1/4 NW U4 S 19 T 28 K
19 W
Property Owners Mai Addnhes S 7975 Afton Rd . -- -. _- _ _ Village
State Zip Code PhoneNumber ty (c] VYIaCe ®Town iZearsstRoad
Saga Paul N(N 55125 Troy f Troou Count
® C.o st Use: ResidedW I Number of bedrooms 4 - -- []Addl6dit e*** buildng
�] ReplacerfreM n Public or earrtttetcW dwcMe --
trestG4h, f
Code Derived daily 11ow - — gpd Rdtanrnended design loading YM .' bed WW---&B
Abeor " n area required _ . 1157 bed, W 250 bench, iF Maximum design loading raw 7 - _,,. bed. gPoff -- -- 8 V emk g
Recommended irAW116on surface eleva60n(s) 07' ft (39 refieffed b tie Olen bendlmar
Addr6onal design / site consklera&= Site has bew rmovuv overburden
Parentm010dal L06SSUv'S>t 4r. , wn l;land eievabart,if Ica R
S OorlYerdionat Mound Ip.Ground Pressure AT - Grade SYMMI in F'lt Holdsrg Tank
1 U--Umsu'bWebr$YSWn RS ❑ U C7 5 0 U. ®S ❑ U i7 5 U ❑ S ®U ❑ S U
SO L OMRIPTION REPORT
D
l n wnMd Color Texture res GPDAWF
Boring# in. MtrneeY Chu. Sz Co & Color Gr. SL Sh. Roots .Bed Trench
0 - 1 Dyr3 /2 Sit Zmsbk mfr cw If 3 i .6
2 7 - 7_Syr6/4 - S - osg _ f Ed - -
7
Ground -- ....., _
1 00. 02 tt _
liffog
>76
1 4-16 10yr312 - sit 2tmsbk aufr ew If S 6
2
2 16-26 7.5yr6/4 s Dsg nil.. cw - 3 .8
GMURd 3 26-30 10yr3)2 -... - - - - - - sit 2msb mfr `._. - . .6
ales
102.038 4 30-36 10yW4 sl 2rasbk I mfr cw - S 6
Degth to 5 36-98 7_5 /4 - -.._.. Y -- & -- -- - - ...:7... $
Itrrting -
_
Renuaft:
CST Name (Please Prim Stnaww. Telephone No.
Thomas C. N y _ _�_ _ CSt N
Address
1432 By NM Design achraand, WT S4p17 W 4 �� 2
FROM : THExNELSONSxxxxxxxxxx PHONE NO. : 00000000000000000 SEP. 10 1999 05:59PM P2
PROPERTY 0WNER:�oQ%iw-l12q— SOIL DESCRIPTION REPORT 254 1 P By of 3
D640
PARCEL LDS hn
NO U0"trk1AtC0l0r MON$ b-Mre GPDflF
Hod= Munn ` (lu. Sz - Cork Color Texture (;r. Sz. I : 1�om"Me lull(lar, Root . Trench
.
"t 0-6 10yr312 2msbk mfr aw if 5 6
3
2 &76 7.5yr6/4 .7 i .8
c'mund
i0oxi
iador
Deo
Remarks:
1 0-5 Ic 2msbk mfr ow If .5 '6
2 5-34 7.5yf6/4 OSS M1 .1 .8
GmmtmdF
Depth to
bow
Rem
r 1 G-S 10yr312 sil 2msbk mfr ew if 5 .6
2 5-78 7.Syr&4 0 % TW
J .9
99.94 ft
Dwth to
limiting
twkw
ff was:
Ground
.... .... . ..... .
D"
Remarks ......
FROM THExNELSONSxxxxxxxxxx PHONE ND. : 00000000000000000 SEP. 10 1999,05:59PM P3
[ MVf*POMA[K T AL 0 15 16 M
1432 120 STREET, NEW RICHMOND. WISCONSIN
715- 246-2454
Tom Nelson
Cer i6ed Soil Tester 227387 -- Registered Sanitarian SR00713
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer U = � 7�(J _
J �� ���
Mailing Address 2 �� t l �"l �,GI �- � 0 -1W L G . WMPP�V 94 0
2 c.�5
Property Address � j�J CO()
(Verification required from Planning Department for new construction) y ,
City/State Parcel Identification Numbe
LEGAL DESCRIPTION
Property Location ` �Lz Sec. Z�, T-2, N -R W W, Town of
Subdivision - l ' iW V L G 4 61F Lot # l
Certified Survey Map # , Volume , Page #
Warranty Deed # S�S� Volume 2 Page # 2 -&�
Spec house ❑ 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 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 septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of th ee ear ex iration date.
SIGNATURE OF APPLICANT
DATE
ER CXR11FICATION
t I e) c tify that all state is on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
thpropc des ve, by v of a warranty deed recorded in Register of Deeds Office.
OF APPL ANT DATE
« « « « «« informa ' 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 �- certified survey map if reference is made in the warranty deed
56838 STATE BAR OF WISCONSIN FORM 2 -- 1996
D NO. WARRANTY DEED
Troy Dev Corporation, a Minnesota
Corporation, Grantor
conveys and warrants to
r
Kootenia Homes, Inc., a Minnesota Ra�'d'�^
Corporation, Grantee NOV 1 1 1997
11:30
R R I itor of DMaattar
the following described real estate in St. Croix County,
State of Wisconsin: RETURN TO
Lot 13 of the Plat of Troy Village in the Town of Kootenia Homes, Inc.
Troy, St. Croix County, Wisconsin. 7975 Afton Road
Subject to Declarations of Covenants, Conditions Woodbury, MN 55125 -1544
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.
TRAA NS f ER
EE
This is riot homestead property.
(is) (is not)
Exception to Warranties:
Dated this day of ,19 7.
(SEAL) (SEAL)
* Charles S. Cook, President "
Troy Development Corporation
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signatures) STATE OF W1300MM M i n n e s t o
ss.
Anoka County. /�
authenticated this day of ,19 , Per me before me this day of
A ,19 9 the above named
Charles S. Cook
TITLE: MEMBER STATE BAR OF WISCONSIN
(If not, to me know to be the person who executed the
authorized by § 706.06, Wis. Slats.) foregoing ' trum nt an acknowledge the e.
THIS INS RUMENT WAS DRAFTED BY �l
a
J 'J * Kathy M. Coo
3�7 _ Notary Public Anoka County,N& MN
(Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. (If not, state expiration
necessary.) Janua 31
date: Y � c200 �
" Names o1 persons signing in any capacity should be typed or printed below their signnlures. KATHY M COOK $B2 NTF 0021A
WARRANTY DEED STATE BAR OF WISCONSIN rm9 I+IBft1Q0 CBVy, 1 54307 -0208
Form No. 2 -- 1996 ANOKA COUNTY
MY COMM. EXPIRES 1- 31.2000
O 4ovv i
1.102 ACRES 3i o> v o, /44667 S.F. o'
"ARK, MP OF 1 Co N c0 V ^ � � 1.025 ACRES � �
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_ 54 4 1• wJ� "
0 00' 00" w "
3 o V O, 295.52' ti
54054 S.F. / 0 21.57
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E 3 21 ° °0• o �i O ��S 90 °00' 00" E 3
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a8' N 18p 62, = o / 1.014 ACRES
w° 5 2 S 87 0 00' 00" E
S 87 °00' 00" E 303.95' co 312.87'
0 47106 S.F. %
° 51 0 1.081 ACRESo 1 0. 0 14f.95' 159.00'
158.40' Me - 56197 S.F. - °-°° 53 SL, Icy
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WIDE UTILITY
EASEMENT ��
Wisconsin Department of Industry. SO AND SITE EVALUATION REPORT P2 e of 3
LAbor and, Human Relations 5
Division of Safety & Buildings 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 5T r- ft C
not limited to vertical and Horizontal reference point (BM), direction and % of slope, scale or PARCEL 1.0. N
dimensioned, north arrow, and location and distanc ad.
�` I / REVIEWED BY DATE
APPLICANT INFORMATION - PLEASE P N ./�L'L' IKFdlltd'
PROPERTY OWNER: cn , PROPERTY LOCATION I- Z 5 Z4, TZB� , Zo W
0M r T X45 ME CEI�/ W W ncr,S \9 T 18 N.R 11 6jeW
PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM #
0 C.T. P . F � 1 �! I — ?Kby VIu.. A66
CITY, STATE ZIP C I< PHO OCITY OVILLAGE VOWN NEAREST ROAD
u Sot) I M T K.D
�Q New Construction Use 4CI Resident [)Addition to existing building
I Replacement [ I Public or coi
Code derived daily flow "D gpd Recommended design loading rate 0 • o bed, gpd/ft Q. trench, gpd/ft
Absorption area required I n oo bed, ft g 5R trench, ft Maximum design loading rate f_.'1 bed, gpd /ft 0.4 trench, gpd/ft
Recommended infiltration surface elevation(s) i3& Qje �%AN: 0 Civ brit (as fferr d to site plan benchmark)
Additional design / site considerations
Parent material 61 -17 w Rood plain elevation, if applicable n1J4. It
S = Suitable for System AL MOUND I IN GROUND PRESSURE GRADE SYSTEM IN RILL I HOLDING TANK
U= Unsuitable fors stem S ❑ U A S O U ® S O U S Cu 0S 0 S X U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boux�ry Roots GPOM
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITrench
' o -ib to yp Zj2
�
a go Z I0-ZZ lbyrz 3 /4 Stl
Ground 3 Zz- L I msb K m.Yfr e- 0,
elev.
C[OLL ft. -47 10 V 5 9r 1 05 0,7
Depth to S 47 10 YK y U 0- - 7 ' 04
limiting
factor
Remarks: N ORt20N Z 4A F, 5 o ~ I o z1 f-bti 20jv 3 0 - M
Boring #
10 Y 2 s't l rc t4 -I r S
Sio#> Z -z5 10 Y& 5 1 1 4 — stl 1 i, �r s — as 0.(
Ground 3 Z5 -34 10 Y 3 4 5 IF. S 1 5 ! 0. �
9 2. ft. y Ll - 10 Ye, 4 4,
Depth to
limiting
factor
I
7TZ
Remarks:
T Name: ease Print \ Phone:
A ddress:
6SO4,h ST K1 AE Z SLi
Signa Date: CST Number:
A 0 V. 2 1 Q 410 M4 7 4 1
PROPERTYOWNER IZLtEMME g �A SOIL DESCRIPTIQN riEPORT z..
PARCEL I.D. #
Boring # Horizon Depth (Dominant Color I Mottles (Texture Structure ConsistencelBour: % Roots GPD /ft
in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrend;
' Z �_1 i/Z s•l 2. m ) mv� CS — NP 0. Z
Ground 3 4 - 1
I
4Q ft. 4 1q IOV '6 'ri +.5bK Yyl4vr I — O.S 0.6
Depth to S 32 -33 l 0 3 I S YA if V' - 1 6.7 0• `C
limiting I _ Q O
factor (. 8-91 V 3 s r,
Remarks: H oft ZAAI S PhrcrS - T o O' 8 .
Boring # —
(D s, I l
I 1 c N j 0'�
'vj1Ls' Z 0- to 3/z S•1 2msb I -F cs O.S O.b
3 -
to 4 S11 zm _ S O.Iv
Ground
elev. q _ 0 3 5 r 5 m l 0. 0� g
Q oz. 0 0 ft.
0.9
Depth to
limiting
fact
Remarks:
Boring # _ l
P3b 4z - sal I 5i3{ 0 3 — s a - 05a vnl c S - 0:7 0.
Ground _
q0 ft.
Depth to
limiting
factor
79'7
Remarks: 140 ►ZOtA Z f+as gOnnE SILT C0 'S
Boring #
a
Ground
elev.
ft.
Depth to
limiting
factor
Remarks:
S60- 8330(8.05/92)
Page 0° 3
' PLOT PLAN
Property Owner ��I�MM�LC - / XCM W��l'E
Legend : 1 _ym
Legal Description Gtr 131 -rK3Y BM � a �
`OeA - MD iN -rttE 6 ► 4, 3z4. Tz ?nl , K ZO VJ R-A GGz D
i E" ,+TI0N 90 3. 4M i
W / SIQ, TZBN, R19w� To N OF -rrCoy�
ST W IX tOUAM V►SCjNWAI, Q = soil boring r /backho
(,S� SUS /L y Mr4P Fob CSIeKE�7"
oa
t_0 2
L D1 �y
0e 5uq
6 ti
sx-
govt a5�,
O
Signed CST R4�
�lZ M03707
D �, Date
.
EL
a0
r
Wisponsin Department of Industry. SOIL AND SITE EVALUATION REPORT Page of 3
L�abpr and,Human Relations
Division of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY Y
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but
ST CleolA
not limited to vertical and horizontal reference point (BM), direction ° of slope, scale or PARCEL I.D. #
dimensioned, north arrow, and location and distance to near o 4r
REVIEWED BY DATE
APPLICANT INFORMATION- PLEASE PRINT AL
PROPERTY OWNER: I tt:-: l a �� ROP' LOCATION L S ZN� TZ8' ZO W
04W 'T EkS �.NM r t*t / *,S 1q T 2_y N.R ] W
PROPERTY OWNER':S MAILING ADDRESS 707 # 8 OCK # SUBD. NAME OR CSM #
0 C.T. N, s :; _ 7KIY VIU.A6E
CITY, STATE ZIP CODE PHONE M8 �R COUNT" OCI ILLAGE [MOWN NEAREST ROAD
u S40 i to (715 -� f W&F(E • I
�Q New Construction Use K Residential/ Number of s 6 ( ] Addition to existing building
j ] Replacement [ ] Public or commercial d
Code derived daily flow 1#00 gpd Recommended design loading rate 0 bed, gpd/ft 0.'1 trench, apd/ft
Absorption area required _I n �o bed, 11: j 5g trench, ft Maximum design loading rate _L bed, gpd /ft 0 4 trench, gpd/ft
Recommended infiltration surface elevation(s) referred to site plan benchmark)
Additional design /site considerations —
I Erg
Parent material 6L-ACI A4- - 17LL- Flood plain elevation, if applicable A .4 ft
F u - Suitable for system MOUND IN- GROUND PRESSURE GRADE SYSTEM IN FILL HOLDING TANK
= Unsuitable fors stem 5' S 0U 4 S O U ®S O U � S O U I Cl S U I CS U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles Structure I GPD /ft
Boring # Horizon Texture Consistence Bound* Roots
in. Munsell Qu. Sz. Cunt Color Gr. Sz. Sh. 1 Bed Mmnch
t lo-lo l oy a Z jZ — 511 Z i thl 4;r b
`<i Z 10 -2-Z 5'►t
2 m sb K rn-f< cs ,
Ground 3 Zz. - I rm4b K rwV -cr C s 0
elev.
I
CW,L ft. -47 10 V — 5 yr O I 05
Depth to S 47 -8 l0yK y 0•1 U, 6
limiting
factor
S"
Remarks: N Owl ZOIN Z 4A. FSLIC a t= I o 2 / Ht ej p - M
Boring #
o-9 1 0 4 2 3 14 s'tI ?M � 40i fr s —
510 < Z _z5 10 ye 0 "5
Ground 3 S -34 Io Y2 -3 4' 5 f r. 5 1 s J OR
qn. ft. y 3 1 ��b — S � d — ,7 1 0
Depth to
limiting
fac tor
'gs
Remarks:
T Name: ease Pant ` Phone: 715 4ZS -yl$8'
A ddress:
Al q - 36 3 650' ST Kk I S
Signa r Date: CST Number:
A OV. 2 _ I Q 4fo M4 7 0l
PROPERTY OWNER J1 1A E ►+A SOIL DESCRIPTION ii EPORT Z _ •�
PARCEL I.D. #
Depth Dominant Color Mottles Texture Structure Consistence ,Bou : r , boats GPD/ft
Boring # Horizon in. , Munsell I Ou. Sz. Cont. Color Gr. Sz. Sh. Bed ITrend;
10 -I 2-/Z i o. z
Ground 3 y –! I L I rn s M g 5 — �. S
I
elev.
4Q3. ft. 4 14 -32 10 Y 3 r I 5 r>n-Fr 1 — 0.5 '. 01 6
Depth to 5 32 -31 I by 3 I S YA if r
limiting I Q,7 0.
fac 1. 8-91 \1 3 S r.
Remarks: TQ Z" P' 7 '
Boring #
f -►0 IQ
to 3 4z 5.1 2rmsb K O.S O.b
Ground
elev. _ 0 3 _ 5 r 5 q _ 0.7 0' g
tbL ft.
9-47 to -s/ - 5 0 a m -' 0•g
Depth to
limiting
fac tor rr
Remarks:
Boring #
1 - 10 4z -
5i3 0 3 - s I F� s
3
3b- 444 gr vv�l c s - .
Ground m - elev. _87 4 - 5
Depth to
limiting
factor
�
Remarks: E Z 1+A.S 50nnr5 '31L CDR'S
Boring #
z
Ground
elev. ft
Depth to
limiting
factor
Remarks:
S80- 8330(R.05/92)
Page 3 o 3
PLOT PLAN
Property Owner I,�eMMr=LE r ?)(,C 9, WOE k'15
Legend : � —�
Legal Description L'aT 13,T Ka , /ILLAG9 BM
LacA w 7HE �5��, 5L4, TzyAj, r ZoW R-A a= O
W I/2 S14� T2$N/ R►9W - nwN F EJL 7 4 ?a 3. 4 M
1 � T+CoY�
ST WIX IDUAM AJISCONs,n1, C2 = soil boring :r /backho
CSC sur--1L=Y A4YW Rr—CJjtM CT
1.DT - u•V A.46 LE s.)
C°
� 00a
L10 %
Lo ��3
� 1650 q
\ EL q�. -
otk �o
A °v " ,
JOV
pa ,
ti� 403.3
Signed CST
512 ,"103707
fl �, Date
L
Ell.
Z'