HomeMy WebLinkAbout040-1310-00-009
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
556353
GENERAL INFORMATION (ATTACH TO PERMIT) 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:
DCCI Land Planners LLC, C/o William H. & Ma Troy, Town of 040-1310-00-009
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
Gf f , 3 g- 3 G e-, 17.28.19.1996
TANK INFORMATION. ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Q'N~ 5
Septic Benchmark
7,5 /dov (o, 9tl 9/4,3
Dosing Goo Alt. BM 't g 7
Aeration nn / Bldg. Sewer SL
l"e 6 J GAS 7 C~ Z
Holding St/Ht Inlet
yes ~ /s. 35
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P /t WELL BLDG. V~t to Air Intake ROAD Dt Inlet
d
e7 ie
Septic , Dt Bottom 7 1Z c~~
Dosing Header/Man. . /
Aeration Dist. Pipe t, c•
Holding Bot. System cy `
000, Final Grade
PUMP/SIPHON INFORMATION - Z 3 OZ~I • C~
Manufacturer L Demand St Cover 2-7. Z
GPM ~~t 7• ~r 5 l 1!~
Model Number -30
Ce ~
TDH Lift Friction os System H ad TDH Ft
Forcemain
I IW 1 i I Leng h f Dia. cif Dist. t well / /t 4.3
SOIL ABSORPTION SYSTEM /1/ ° I b . ( `f
BED/TRENCH Width Length No. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS / 56
JC
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type em, ~ . UNIT Model Number.
DISTRIBUTION SYSTEM 02 0
Header/Manifold Distribution x Hole Size 11 x Hole Spacing V t to Air Intake
I Pipe(s) r C 1 d
11-ength Dia ` Length L' • q"eia i'45'
' 4 Spacing 4 1
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only C /
Depth Over / Depth over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil Yes N No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 3Q/ 12- Inspection #2:
Location: 480 Meadow Ridge Lane Hudson, WI 54016 (NE 1/4 SE 1/4 17 T28N R1 9W) Meadow Ridge of Troy P0 9 Parcel No 17. .19.1996
1.) Alt BM Description = j`I4C ),CA. 1/_) ~0
2.) Bldg sewer length = 35
- amount of cover = ~ r
4L c ti c~
Plan revision Required? ❑ Yes No
Use other side for additional information. J L
Date Insepcto s t nature Cert. No.
SBD-6710 (R.3/97)
DCCI LAND PLANNERS, INC.
P.O. BOX 445
NEW RICHMOND, WI 54017
11/13/12
SCALE= 1"= 40'
BENCHMARK #1 TOP OF CONDUIT 915.9
BENCHMARK #2 TOP OF CONDUIT 915.9
SYSTEM ELEVATION 917.07
NE 1/4 SE 1/4 SEC 17
T 28NR 19W
TOWN OF TROY
P.N. 040-1310-00-009
480 MEADOW RIDGE LANE
HUDSON, WI 54016
1000 GALLON SEPTIC TANK
tnc~
WIESER TANK WITH 600'73 63
COMBO TANK l q3 C~n11Ur
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commercemi.gov Safety and Buildings Division County
201 W. Washington Ave., P.O. Box 7162 ST. CROIX
's c o n s i n Madison, WI 5 3 707-7 1 62 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce 55(o 35
Sanitary Permit Application State Transaction Number 40
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appriate 9 rnmenIA N/A
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-o OWT S are oject Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for
ary
pur oses in accordance with the Privacy Law, s. 15.04 I m), Slats. $0 MEADOW RIDGE LANE
1. Application Information - Please Print All Info
Property Owner's Name re&tp Parcel #
DCCI LAND PLANNERS INC 040-1310-00-009 "it Property Owner's Mailing Address rt A
Property Location q~q
113 1
P.O. BOX 445 ®"t
Govt. Lot ~ (D
City, State g 1 Phone Number
V4, NEW RICHMOND, WI P1NN1N 54017- Section e-
, NE, (circle one)
T 9- N; R 19-- E or W
It. Type of Building (check all that apply) Lot #
5d I or 2 Family Dwelling - Number of Bedrooms 3 Subdivision Name
bK P~~ Block# MEADOW RIDGE OF TROY
❑ Public/Commercial - Describe Use ❑ City of
CSM Number ❑ Village of
❑ State Owned -Describe Use
5 •f- ct &-j-ni acU Town of TROY
g
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. a New System
❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. List Previous Permit Number and Date Issued
❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner G
IV. Pe of POWTS S stem/Com onent/Device: Check all that apply)
`
on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ Other Dispersal Compone (explain) ❑ Pretreatment Device (explain)
V. Dis ersaVTreatment Area Informati
Design Flow (gpd)., Design Soil Applicati Rate(gpdsf) Dispersal Area Required ( Dispersal Area Proposed System tion
_ Z~~
450 .2 2,250 2,250 9
VI. Tank Info Capacity in Total # of Manufacturer
AkW( 6LO
Gallons Gallons Units a to $ 2
7P 15 -6 V- ~ ~q
New Tanks Existing Tanks WEISER/POLYLOK 525
o 2 N
a U n H is. C7 FL
Septic or Holding Tank 1000 1000 W/POLYLOK 525 x
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) *77- 'nature MP/MPRS Number Business Phone Number
PAUL KOEHLER
1 225410 715-246-2660
1-1.
Plumber's Address (Street, City, State, Zip Code)
321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017
VIII. Count /De artment Use Only
Approved ❑ Permit Fee Date Is ued Issuin ent Signature
en Reason for Dental $ 3 12-
IX. CondigtWg&0VWNE4Weasons for Disapproval
1. Septic tank, effluent filter and 3) utS~ x- Dr c.~,r •
dispersal cell must all be servlces ! malnta111ed i /
as.per management plan provided by plUmb9r, \ I n
2. AN a~ack"regUireMents Must be'mainti it 1 ~ ~t~. ~ / 0%) 6 JQp_ A e.,j
ss
/
P4 ObICi* code / ,
Attach to complete plans for the system and submit to the County only on paper not less than' ~1/2Lx 111 ii ches in size
Q"K/. ~7 .dNf GY~WtrV~r V~•
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SBD-6398 (R. 02/09) Valid thm 02/11
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I DCCI LAND PLANNERS, INC
P.O. BOX 445
NEW RICHMOND, WI 54017
I - 10/02/12
SCALE 1"=40'
BENCHMARK #1TOP OF CONDUIT915.73
BENCHMARK #2TOP OF CONDUIT 5.94
SYSTEM ELEVATION .3
NE 1/4 SE 1/4 SEC 17
i T 28 N R 19 W
TOWN OF TROY
P.N. 040-1310-00-009
480 MEADOW RIDGE LANE
HUDSON, WI 54016
1000 GALLON SEPTIC TANK
WEISER TANK W/PL 525 FILTER
a 5-90' TRENCHES OF EZ FLOWS
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: SCOTT & SANDY JOHNSON
Owner's Name: DCCI LAND PLANNERS INC
Owner's Address: P-O- BOX 445. NEW RTCHMOND, WT 54f117
Legal Description: NE 1/4 SE 1/4 SEC 17 T 28 N R 19 W
Township: TROY
County: ST. CROIX
Subdivision Name: MEADOW RTDGE OF TROY
Lot Number: 9
Parcel ID Number: 040-1310-00-009
Pagel Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber: PAUL KOEHLER License Number: 225410
Date: 10/02/12 Phone Number 715-246-2660
Signature
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
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DCCI LAND PLANNERS, INC
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P.O. BOX 445
NEW RICHMOND, WI 54017
10 /02/12
SCALE 1"=40'
BENCHMARK #1TOP OF CONDUIT915.7:
BENCHMARK #2TOP OF CONDUIT 5.9,
SYSTEM ELEVATION .3
NE 1/4 SE 1/4 SEC 17
i T 28 N R 19 W
iTOWN OF TROY
P.N. 040-1310-00-009
480 MEADOW RIDGE LANE
HUDSON, WI 54016
1000 GALLON SEPTIC TANK
WEISER TANK W/PL 525 FILTER
5-90' TRENCHES OF EZ_FLOWS
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COX INSTRUCTIONS
rf POIC INSTALLATION
Mtnc.
Mao irew!sin pm-as, Drainage 44 A ion o;'°atyhk Inc, PL-525/PL-625 FILTER
§ Wasrewaf:r PmCuC
PL-525/PL-625 FEATURES & BENEFITS
Features & Benefits:
s Bated for 10,000 GPD
~ _ • PL-525 = 525 Linear Feet of 1/18" Filtration
PL-625 = 625 Linear Feet of 1/32" Filtration
r ~
PL-525 PL-625 *Accepts 4" and 6" SCHD. 40 pipe
The PL-525/625 Effluent Filter should operate efficiently s Built in Gas Deflector
for several years under normal conditions before .Automatic Shut-Off Ball when Filter is Removed
requiring cleaning. It is recommended that the filter be
cleaned every, time the tank is pumped or at least every *Alarm Accessibility
three years. If the installed filter contains an optional
alarm, the owner will be notified by an alarm when the • Accepts PVC Extension Handle
filter needs servicing. Servicing should be done by a
certified septic tank pumper or installer.
RECOMMENDED PRODUCTS
Polylok PVC Fitter
Extension Handle
" 3
~ i
_ I
Risers & Riser Covers Extend & LokM Riser Safety Screens Fitter Alarm Panel and
Polylok risers bring your Polylok Extend & Loki""' Polylok safety screens SmartF!IterTm Control
septic tank cover to grade. is a simple, easy to use prevent tragic accidents Switch
This allows locating and solution that can extend from happening by children Polylok filter alarm panels
servicing your filter easier the inlet or outlet pipe and and pets falling into open and switchs provid a visual
and time saving by el'imi- make filter and/or baffle septic tank entrances. and audible notification of
nating digging to find tank installation a snap. impending filter and tank
entrance. Fits 3" and 4" pipe. servicing.
For a full list of Polylok products please visit our web site at: www.polylok.com
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System Elevation
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Soil Absorption System Plan. View
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Leaching Chamber Specifications
Manufacturer and Model E I W 7A"ef
EISA Rating sq. ft. per chamber Soil Application Rate 12 gpd/sq. ft.
L S gpd Design Flow = 2 Soil Application Rate - -TO EISA Chambers
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\0 WLP1000-MR MIEBER COOCRETE REV.
n SEPTIC MANUAL DATE: JANUARY 2010 DATE:. POST-POUR:
\ z W3716 US HWY 10 MAIDEN ROCK, WI 54750
P REVISED JAN. 2010 800-325-8456 FILE: WMMD-e
i
ST. CROXX COUNTY
SEPTIC TANK MAINTENAbCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer '~1~-NO PLp~N~Z~ , >r•l y
Mailing Address .-J boy- ~ 4C7 ~ ~ cVy P t L-4 m a w--), W( 54cri l
Property Address 4 1ba M ';Z-js-~W: CJ L.~►-+~ 1=
(Verification required from Planning & Zoning Department for new construction.)
City/State 440 -->0 6--L W 1 Parcel Identification Number
LEGAL DESCRIPTION
Property Location 9{ C/4 , '/4 , Sec. 7 , T '?~bN R l" I W, Town of
Subdivision Lot #
Certified Survey Map # , Volume , Page #
Warranty Deed # C;? a C? 77 , Volume 42-7'5 , Page #
'S`7 1
Spec house es no Lot lines identifiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
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. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & 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.
I/we, 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 Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the j
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
:Numb f be ms
SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
•M
POWTS OWNER'S MANUAL St MANAGEMENT PLAN Page I cf
FILE INFORMATION SYSTEM SPECIFICATIONS _
OwnerDCCI LAND PLANNERS, INC Septic Tank Capacity 1000 ❑ NA
Permit # gal
Septic Tank Manufacturer WEISER ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer pOLYLOK ❑ NA
Number of Bedrooms 3 17 NA Effluent Filter Model 525 ❑ NA.
Number of Public Facility Units ❑ NA Pump Tank Capacity gal] N 4
Estimated flow (average)
300 Pump Tank Manufacturer
al/da y N.4
g
Design flow (peak), (Estimated x 1.5) 450 qal/da Pump Manufacturer 112 NA
Soil Application Rate • 2 al/da /ft2 Pump Model NA
Standard Influent/Effluent Quality r-S220 thly average* Pretreatment Unit ® NA
Fats, Oil & Grease (FOG) mg/L E3 Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODS) mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) d N,4
Biochemical Oxygen Demand (HODS) 530 mg/L (R In-Ground Igravityl ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometrio mean) 5104 cfu11OOmI ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ N'k
Other: O NA Other_ ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: 3 ❑ month(s) (Max;
year mum 3 years) ❑ NA
lsl
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ Wt
3 a1 year(s)
Clean effluent filter At least once every: ❑ month(s) ❑ NA
ear(s)
En pump, pump controls & alarm At least once every. ❑ month(s) $7 N/,
❑ ear(s)
aterals and pressure test At least once every: ❑ month(s) )b N/,
❑ year(s)
At least once every: 13 month(s) 13 NF,
❑ ear(s)
❑ N6,
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or pending of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels In the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may Indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (Ys) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmerit
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Mainta)ner.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
- ~V 4v11114" t¢JUU
START UP AND OPERATION Page ot7.1
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemic iI
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the content
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will b,
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge o
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls tc
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the arei
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or.elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to Insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or, must be taken, to provide a code compliant
replacement system:
C! A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptkm
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot limes and wells. Failure to protect the replacement area a ill
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWYS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
alua '
W/91
be ' o ung atrk
e are '~fta~.ll8rr~ ~NST1Zil~-a'tC►~
❑ Mound and at-grade soil absorption systems may be reconstructed In place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NC T
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name
Name
Phone Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name
I E Name ~-j-. C ( 24DAI1 AJ
Phone Phone
This document was drafted in compliance with chapter Comm 83.22(21(b)(1)(d)&(f) and 83.54(11. (21 & (3), Wisconsin Administrative Code.
7t3S~53
2 7 3 1 P S 5 KATHLEEN H. WALSH
REGISTER OF DEEDS
ST. CROIX CO., MI
RECEIVED FOR RECORD
LEWTED WARRANTY DEED (11/1412005 O L : 00PK
WARRANTY DEED
Document No. EXDPT 1
REC FEE: 15.00
This Deed made between VALLEY LAND TRANS FEE: 10950.00
COMPANY, a Minnesota corporation, Grantor and CC
COPY FEE:
E:
CC F
DCCI LAND PLANNERS, INC., Grantee PAGES : 3
Witnesseth, That the said Grantor conveys to
Grantee certain real estate in St. Croix County, State
of Wisconsin, legally described on Exhibit A hereto
(the "Property"),
Together with all and singular hereditarnents RRETVR
and appurtenances thereunto belonging.
This conveyance is without warranty,
except Grantor covenants and represents the
Grantor has not made, done, executed or Tax I.D.: -14 (0 suffered any act or thing whereby the above- '
described property or any part thereof, now or 7
at any time hereafter, shall or may be DS/rJ '/07~
imperiled, charged or encumbered in any
manner, and Grantor will warrant title to the
above-described property against all persons
claiming the same from or through Grantor as
a result of any such act or thing, provided, however, that the conveyance hereby made and the
warranty of Grantor is further limited by and subject to those matter set forth on Exhibit B hereto.
Dated this _ day of January, 2005.
VALLEY LAND COMPANY,
A Min corporaqo!)
Its:
ACKNOWLEDGEMENT
STATE OIL/
) SS
COUNTY OF
Personally came before me this day of January, 2005, the above named Gary B. Valley, as
President of Valley Land Company, a Minnesota corporation, having full authority to do so and
to me known to be the person who executed the foregoing instrument and acknowledged the
Sam
blic, State of
commission (expires):
U 2 7 31 P 5 5 2 122704
LEGAL DESCRIPTION/PLANNERS
EXHIBIT A
PARCEL A
LC3CATED.IN THE SE'I.OF THE SE'/; S?W.-1/ OF THE. SE AND PART OF `THE-NW 4/ OF^THE-SE Y4
-NE Y40 . F THE SE SW % OF THE NE AND* THE SE OF THE NW YALL IN SECTION.17,
TOWNSHIP 28 NORTH, RANGE 19 WEST, TOWN OF TROY, ST: CRbtX COUNTY, WISCONSIN:
BEGINNING A'T THE SE CORNER OF SAID. SECTION 17; THENCE 888°51'3M, ALONG THE SOUTH
LINE OF THE SE % OF SAID SECTION, 2629.36 FEET TO THE WEST LINE OF THE SE %.OF SAID
SECTION; THENCE N00005'44"E, ALONG SAID WEST LINE, 2660.38 FEET TO THE CENTER OF SAID
SECTION; -THENCE 58864522"W, 18.79 FEET. TO A•POINT ON A 148.00 FOOT RADIUS CURVE
CONCAVE NORTHWESTERLY, WHOSE CENTRAL ANO E MEASURES. '10°1U'57", WHOSE CHORD
BEARS N45°44'30!E AND MEASURES 26.27 FEET; THENCE NORTHERLY ALONG THE ARC OF SAID
CURVE'AND SOUTHERLY R16HT OF WAY OF FAST COVE ROAD 26.30 FEET TO SAID WEST LINE
-OF THE SE-%; TIJENCE N00°05'44"E, ALONG SAID WEST LINE 124.75 FEET; THENCE N88°51'31."E,
249.43 FEET; THENCE S00°05'44W, 413.44 - FEET; THENCE N88°51'31 "E, 2042.11 FEET TO THE
CENTERLINE -OF TOWN • ROAD (TOWNSVALLEY ROAD) BEING A POINT ON A. 3754,00 FOOT
RADIUS CURVE, CONCAVE SOUTHWESTERLY WHOSE CENTRAL ANGLE MEASUR S 9°28'28
WHOSE CHORD BEARS S36043'35"E AND MEASURES 620.06 FEET; THENCE SOUTHERLY ALONG
THE ARC OF SAID CURVE, 620.76 FEET TO THE EAST LINE OF THE SE % OF SAID SECTION;
THENCE S01007'30"W, ALONG SAID EAST LINE, 1886.26 FEET TO THE POINT OF BEGINNING.
I
I
. I
EXHIBIT A
U 2 7 3 1 P 553 122704
011305
011305-2
EXCEPTIONS
EXHIBIT B
a. Reservation of any minerals or mineral rights to the State of Wisconsin.
b. The building, use, subdivision, zoning and environmental laws, ordinances
and regulations (local, state and federal) applicable in any way to or any
extent to the Property or any part or portion thereof.
C. All easements, covenants, conditions, rights, rights-of-way, restrictions,
reservations and exceptions, if any, of record.
d. Any lien arising out of any government sponsored conservation programs
relating to the Property.
e. Utility and drainage easements, if any, that are not of record (excluding
those granted by Seller).
f. Encroachments, if any.
g. All real estate taxes and special assessments.
h. Liens, encumbrances, adverse claims, or other matters which Buyer has
created, suffered or permitted to accrue.
i. [Intentionally omitted.]
j. [Intentionally omitted.]
k. A certain conservation easement given by Grantor and Grantee to the
Town of Troy, Wisconsin.
#306590311
EXHIBIT B
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vwsconsin Deparanent of Commerce IL EVALUATION REPORT page 1 of 3
Division of Safety and Buildings
. e
County St. Croix
Attach complete site plan on paper not Q^.ndl- hes in size. Plan must
include, but not limited to: vertical a nt (BM), direction and Parcel I.D. y},
per.;.°r:t °.lcr...:. ~!e or dlsre..,.,..c. ra:tl:
Please print all ini onn n. Rev' uy ^udtC
Personal information you provide may be used for secondary pu (r>R61isG9Wl~~)~'m)).
Z LS D
Property Owner El
DCCI Land Planners Inc Govt Lot NE 1/4 SE 1/4 S /17 T 28 N R 19 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1505 HWY 65 9 Meadow Ridge Of Troy
City State Zip Code Phone Number ity E]Village own Nearest Road
New Richmond WI 54017 ( ) Troy East Cove Road
E] New Construction UseEj Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
Replacement n Public Or commercial - Describe:
Parent material Loess over glacial till Flood Plain elevation if annlicable
General comments * with several layers, 1-2", sl, 0m, 7.5yr4/4 ,
and
Boring
uw"ay a
■ Pit Ground surface elev. 917.07 ft. Depth to limiting factor 65 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfW1 'Eff#2
1 0-16 10yr3/1 sil 2msbk dsh as 2f .6 .8
2 116-33 tn.,Faia - I sil I lm.,sbk I dsh I cw I If I .4 I .6
3 33-43 10yr4/4 - sl Ifgr dsh cW - .4 .6
4 43-65 10yr4/4 s Osg dl cw - .7 1.6
5 65- 10yr4/4 f2d5yr5/8 - sicl Imsbk dsh - - ~2- .3
f
I [H] Boring # Boring 16.91 >130 ✓
F 2
pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate
Horizon Depth Dominant EO-Q Redox Description Texture Stricture Consistence Boundary Roots GPOW
1 in. Mansell Ou. Sz. Cont. Color I Gr.. Sz Sh_ I -EM1 l -E§V
1 0-20 10yr3/1 - sil 2msbk dsh as 2f .6 .8
2 20-37 1 4/4 - sil lmsbk dsh cw if .4 .6
3 37-69 10yr4/4 - ls* One dI cw _ .2* .6*
59-13n • / 7 1.6
iyiwu - s Osg dl - -
Effluent #1 = BOD- > 30 < 220 mg/L TSS >30 < 150 mg/L ` Effluent #2 = < mglL and TSS < 30 mg&
C.ST marnw i Print,) Sinnahim MT Mirnhw
Thomas C Nelson 227387
Address Date Evaluation Conducted Taeptl m Number
1432 120th Street, New Richmond, WI 9/18/05 715-246-2454
DCCI Land Planners Inc Pending
Properly Owner Parcel ID # ~ Page of 3
3 Boring # Boring Ground surface elev. 916.30 >130
E] Pit Depth to limiting factor in. Sal Application Rate
Horizon Depth Dominant Colod Redox Description Texture Structure Consistence Boundary Roots GPDIfF
I I in. I Munsell I Qu. Sz. Cont. Color I I Gr. Sz. Sh. -Eff#1 •Eff#2~
1 043 10yr3/1 - sil l msbk dsh as 2f
.4 .6
2 43-52 1 /4 - sil Imsbk dsh cw if .4 .6
3 52-69 10yr4/4 - sicl lmsbk dsh cw _ .2 .3
A 0-130 7 c...n IA : A-*
t •r I ...~.~,T I - ~ ; t w£j ua I - t - I I t
i
I Boring# BWn~y
U U Pit Ground surface elev. it. uepm w ircncang rector in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Efr#1 -Efr#2
~ I I I i i I I I I 1 I
❑ Boring # Bwft Pit Ground surface elev. ft Depth to limiting factor in.
Sal Application Rate
Horizon Depth Dorinant Color Redox Description Texture Struture Consistence Boundary Roots GPQ1fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Efr#1 -Eff#2
F1lhwnt 91 = Ron=> 30 _ X90 ffW aril TSS >30;S 150 mgA ' Fflhoint V = RAt11j a, In molt arxt TS.S 5 V nW
.r
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777.
sBD433ffm OL07/00)
DCCI LAND PLANNERS, INC. • SOIL BORING
Lot # 8 -MEADOW RIDGE OF TROY O178ir ' • '
NE 1%4 OF THE SE 1/4 OF SECTION 17, BENCHMARK •
-TOP OF CONDUIT L•.+s LOT1
T28N, R1 9W, TOWN OF TROY, ST.
CRODC COUNTY, WISCONSIN. ALT BENCHMARK . { • • LOT is
-TOP OF CONDUIT
+ +
TOM NELSON CST - Lie. # 227387 N NOTE THE CONTOURS IDENTIFIED Lwo two
ENVIRONMENTAL BY DESIGN ARE PRIOR TO CONSTRUCTION. t
CONSTRUCTION GRADING WAS IN
1432 120TH ST. PROCESS DURING SOIL TESTING. • / ' •
NEW RICHMOND, WI 54017 CONTRACTOR MAY NEED TO • • • • •
ph. # 715-246-2454 CONFIRM FINAL CONTOURS . •
DURING INSTALLATION. Is-
Low 1r
SCALE IN FEET 1' - 40' ►orw wr,r
1100 0 100
-17
77 OF ~ SON
E 3.48
916.30
915.73 B
• 1.0 -75 0 15.94
N
91 .11
$ 62 9 6.91
. 1
.07
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sconsin Department of Commerce SOIL EVALUATION REPORT page l of 3
!vision of.Saf* and Buildings
in accordance with Comm 85, Wis. Adm. Bode
County St. Croix
Attach complete site plan on Paper not less than 81[2 x 11 inches in: size; Plan must
fnaTude, FxE 7~at lirrn"ta);e vertica_l,and hoental references, point (BM), directitn err!. Pavel t<a
Pending
percent slope, scale vrdimensions, north arrow, andd location and distance to nearest road.
!last- t a# wif0 Sill7tbt't. searievred by Date
Perrsonal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m}}.
Property Owner P tocation
DCCI Land Planners Inc Covt. Lot 1M. SE W
IU4 S ITT 28 NR 1:9
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1505 IHWY 65 8 Meadow Ridge Of Troy
State Z!p Code Phone Number
[Pity Village Town Nearest -Road
New RicbmQad Wl 54017 • East Cave !toad
)
New Construction Use( Residential I Number of bedrooms 3 to ,4 Code derived design flow rate 450 to 600 GPD
[3 Replacement Q Public or commercial - Describe:
Parent material Loess over glacial till Flood Plain elevation if applicable NA ft
General
recom comment endations: * with several layers, 1-2", sl, Om, 7.5.yr4/4. Sizing for these layers would then be .2 and .6 accordingly.
and
As these massive layers have a teadency to restrict septic. effluent movement in the soil, it might be worth
considering a shallow system above these restrictive layers, Additiotlal pits reviewed on 12/2/05, 4 and 5
A OM, massive sandly loam!
a Boring # Boring
Q Pit Ground surface elev. 924.68 ft. Depth to limiting factor X98 in
Sal Application
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPQff
in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. *Eff#1 *Etf#2
1 0-14 1Oyr4/3 sit 2msbk dsh as 2f 6 8
2 14-34 7,5w4/4 - sl Ifgr dash cw If .4 .6
3 34-51 7.5yr4/.3 - ]s Osg dl cw - 17 1.6
4 51-98 7.5yr5/4 s Os dl - - ,7 1.6
❑ Boring # ®ng 91:6.91 >130
Pit Grcwndsurfaceelev. ft.. Depth-.to .limiting-.factor. in.
Solt- -.ice=
it Hr nj. Daptt, : .-DominaritCaiwi Redox asallplim: Tsxfdm : Struck = rXinsisteam .
Ssmdary . Roots- GP-DW
Munw. 1. Qt;:Sz: t ont: FQlor Gr. S&- Sh:-
1 0-20 10yi3/1 - sit: 2msbk dsh as 2f- .6- 8
2 20-37 1... 4/4 - A lmsbk dsh cw if .4 .6
3 37-69 10yr4/4 Is* Ogg dl cw - .7* 1.6"
4 69-130 10yr4/6 - s Osg dl - - .7 1.6
" Effluent #1 = BOD > 30 < 220 mg1L and TSS >30:5 150 mg/L • Effluent 42 = B 30 mglL and TSS 30 mglL
CST Name (Please Print) nature
~ CST Number
Thomas C Nelson
227387
Address Date Evaluation Conducted TeMphone Number
1432 120th Street, New Richmond WI
> 9/18/05 8c 12/02/05 715-246-2454
I
property Owner DCCI Laud Planners Inc Parcel ID # Pending pap 2 3
Bori # Boring - -Of
Mng
E Pit Ground surface elev. 916.01 it. Depth to limiting factor >129 In. Soil Rate
Horan Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
In. Munsell Qu. Ss. Cont. Color Gr. Sz. Sh. *Eft#1 "Eff#2
1 0-11 1Oyr3/1 - sil lmsbk dsh as 2f .6 .8
2 1143 7.5 4/3 - Is Os dl cw - .7 1.6
3 43-110 7.5yr5/4 _ s Osg -dl - - .7 1.6
Pit Groundsurfaoe elev. 926.(15 R Depth to Nmfing favor >100 in.
aB
Htfrbft Depth Dominant Color. Nkft Descriptioh Texture Structure ` Caiwisterrce ; Boundary Rootfi GPDNE
in Munsell Qu, Sz, Cent, Color Or. Sm Sri, `Etf#1
1 0=9 10yr3/2 - sil 2nns& mfr as - .6 8
2 9-36 7.51s Os ml 91 .7 1.6
3 36-100 7.5yr6/4 _ s Os " m1 - - .7 1.6
5 Boring # Boring 919.23 >100-
■ Pit Ground sUrare elev. It. Depth to lirtlitirig fair hi.
SbN Rate
Horizon Depth Dominant Color Radox Description Texture . Structure Consistence Boundary Raft GPDW
In. Munsell Qu. SL Cont. Cow Gr. Sz. Sh. `EWI •Eff#2
1 0-9 10yr3/2 _ sil 2msbk mfr as - .6 8
2 9-18 / sir Imsbk mfr cw - .4 .6
3 18-41 7 S 4/6 _ Is Os ' 1111 In - .7 1.6
4 41-44 7.5 4/4 - sl Om** mfi cw - .2 .6
5 44-66 7.5yr6/4 - fs Os nil cw - .5 1.0
6 66-100 7.5 yr64 s Osg- . 7_ 1.6
' Effluent #1 = 900, > 301220 mg& and fSS >30 ~g 160 mgA- ' Effluent #2 = 800. L W nVIL and TSS 130 mglL
The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or
treed material in an alternate format, please contact the department at 608-266-3151 or TTY 608-2648777.
SBD-833ffbu (R071W)
ID PLANNERS, INC. . SOIL BORING ai,urr • • •
8 -MEADOW RIDGE OF TROY •
A OF THE SE 114 OF SgUnO 17, ♦ BENCHMARK
• .
-TOP OF CONDUIT
6N, R19W, TOWN OF TROY, ST.
ROM COUNTY, WISCONSIN, J ALT BENCHMARK
-TOP OF CONDUIT `""t • • n
i
i
TOM NELSON CST LID. # 227387 N N01E THE CONTOURS IDEN]>f1E~ urn w►o
ARE PRIOR TO CONSIMC'nON.
ENVIRONMENTAL BY DESIGN CONSYMC710N GRADING WAS IN •
1432 120TH ST. PRQ= DURING SOIL (WING. • ~ • • • • • •
NEW RICHMOND, Wl 54017 CON7RACMR MAY NEED TO
CONFIRM FNIAL C0N70UR5 •
ph. # 715-246-2454 OURINC INSTALLA710N. • 14"'
SCALE IN FEET 1" 40' WIS. uwty-
100 0 100
J,
B3 ~ V o
EL- 23.7 CN
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