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HomeMy WebLinkAbout040-1162-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 567289 0 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: Starke, Dillon & Mak nen, c/o Margaret StaZeT Troy, Town of 040-1162-70-000 CST BM Elev: Insp.BM lev: BM Description: Section/Town/Range/Map No: g ,0 25.28.20.631 F TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS I / FS ELEV. S�ptic, �n r+ /O& Benchmark Alt. BM 3• 7 97 17q 8 T�o Aeration ( Bldg.Sewer • ttrYLI csflA — Holding St/Ht Inlet 'I � 3�1��� $s 3 TANK SETBACK INFORMATION St/Ht outlet O D� a Z g s 6 TANK TO P/L WELL BLDG. Vent Air Intake ROAD Dt Inlet �- Septic > I oO� + O `t0� Dt Bottom 10 Dosing /t Header , 5 Aeration Dist.t. Pipe 7-7• $ `. Holding Bot.System 76 , o PUMP/SIPHON INFORMATION Final ,ode Manufacturer Demand St Cover nn / r h3 �./•C Y l GPM � - 1 Model Number i *49 - r 3 1 y K �e 1 e- TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist.to Well 6• Lb /1101/ /6•/0 /OD SOIL ABSORPTION SYSTEM / -::7 S �G�drit5� h�T_ BEDITRENCH Width / Length No.Of Tr hes Pit DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 (J/„0 1_•m SETBACK SYSTEM TO 1 P/L BLDG JWSL LAKE/STREAM CHAMBER ACH G Manufturer: INFORMATION O I Ty OfSystem: /t / / UNIT Model Number. 2 � DISTRIBUTION SYSTEM �_CJI/t t H d r/ anifold ion x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 7 f `—�^ ' tr //,�, L Dia Length &n Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded Mulched Bed ch Center r/ Bed/Trench Edges Topsoil R 1 �j 0 Yes [] xx No 19 Yes 0 No COMMENTS: (Include code discrepencies, persons present,etc.) Inspection#1: / KI spe ction#2:Location: 122 Black BassRd.. River Falls,WI 54022(Gov't Lot 1 25 T28N RR20W) metes&bounds Lot A&B Parcel No: 25.28.20.631F 1.)Alt BM Description= ! / i' �"' "v�`c'� '�d ��• 71A %17��7� ��%T � S/ S ST(�1w•/�i�7�� 2.)Bldg sewer length= (Jib,►f�j -� ;6J r/ U "44y, �� -amount of cover= 4 _/„ n� Plan revision Required? �����// - --- _ - —G��►�_ Q ,.�. Yes VNo Use other side for additional information. SBD-6710(R.3/97) Date Insepctor's Si nature Cert.No. L' r ScaJe; "110� T.2 �; .PZOc.v, 5 v°°- � o�c.: 0 � w 1 a � � r t Q � Qr tj 3 r � -tp l a � � �,� County I = Safety and Buildings Division St.Croix lisp 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) =' Madison,WI 53707-7162 Ti\tass_, cc 7 2 6F7 Sanitary Permit Application See Transaction Number In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit Na is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Addrbss(if di an mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary - •p ac EAfC purposes in accordance with the Privacy Law,S.15.04(t)(m),Stats. C • I. Application Information-Please Print All Information 4-, l� Property Owner's Name , Parcel# ,� (O/j lf\Margaret Starke - 040-1162-70' a4p Property Owner's Mailing Address "' Property Location ''k F.) 13 Baillon Lane . Govt.Lot 6514)Y5/5(47)11)(�3� City,State Zip Code , Phone Number '4, ''A, Section 25 (circle one) St.M 's Point,MN 55043 (651)271-0495 T 28 N; R 20 E or W II.T of Building(check all that apply) Lot# 1 or 2 Family Dwelling-Number of Bedrooms a Subdivision Name WI R2th 112,h1,a/ Plat of St.Croix Cove Block# ❑Public/Commercial--Describe Use Na ❑City of CSM Number ❑Village of CI State Owned-Describe Use Na l3'town of Troy III.Type of Permit: (Check only anron linevA. Complete line B if applicable) A' ❑New System ( Replacement System '0 Treatment/Holding Tank Replacement Only 0 Other Modification to Existing System(explain) \ ❑Chan List Previous Permit Number and Date Issued B. ❑Permit Renewal 0 Permit Revision Change of Plumber ❑Permit Transfer to New Before Expiration Owner itierte., in kt✓ IV.Ty of POWTS System/Component/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 Component( 11 Pretreatment Device(explain) V*;�a,z a1/Treatment Area Information 45lnfiltrator' a-4 Plus"Standard chambers&6 endcaps,PolyLok PL-525 effluent filter Design Flo (gpd �t , Design Soil Application Rat F_'.1 r c -.. .-. • ..' -• ' stspers; . a• s•-c ■ -.r""°"rr 96 G.• ii `L 0.50 Gpd/Sq.Ft. 900.00 sq.ft. J 930.60 Sq.Ft. t/ 77.5',76.5',&75.5' ' nk Info Capacity in Total #of Manufacturer 2 Gallons Gallons Units �-^� t t: _ 9 New Tanks Existing Tanks _ / � `i-p/ynQ, g o °)3 l'i .? �Vj z1-5/ /� /�rr�U vi �, vt 'u, t7 Septic or Holding Tank 1,060 Na 1,060 1 / Infiltrator 1 X Dosing Chamber VII.Responsibility Statement- I,the unde :igned,assu:, responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumber'•Signature MP/MPRS Number Business Phone Number James K.Thom 1 son 111K-CO. - . A.,,,,,,,-__ MFRS 30021 715 248-7767 Plumber's Address(Street,City,State,Zip Code) 340 Paulson Lake Lane,Osceola,WI 54020 VIII. ounty/Department Use Only _ ,� / Permit Fee Date Issued . uing Agent S'.■ :, ■J LYApproved ❑Disapproved $ psi 2 / ���� - ❑Owner Given Reason for Denial /5' 1 `5-/.211, IX.Coos gbob ral/Reasons for Disapproval Ls V, 4)0,;;;J:-FLU $O 1 6'7 G Jed C 1.Septic tank, effluent filter and 44-ax-/Y+3' e %1 � PIA 1� '"' dispersal cell must be serviced/maintained 0 'T�NL ( d U t' `n as per management plan provided by plumber. �� �(/f�� 4L rd�_i{,/ 2.All setback requirements must be maintained l/ ��S 3�3. �3 �"' AA"'' '`"' ''t";�-'-ns for the system and submit to the County only on paper not less than S rR a 11 inches in sire SBD-6398(R. 11/11) Conventional POWTS Index & Tilte Sheet Project Name: Starke 3 Bedroom Replacement Conventional POWTS Owners Name: Margaret Starke Owner's adress: 13 Baillon Ln.,St.Mary's Point,MN 55043 Site address: 122 Black Bass Rd.,Hudson,WI 54016 Project Location: Subdivision: Na Legal Description: Gov't lot 1,Sec.25,T.28N.,R.20W.,Tn of Troy,St.Croix Co.,WI. Parcel ID#: 040-1162-70-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 Dispersal Cell Sizing Calcualtions Page 4 System Cross Section Page 5 System Management Plan Page 6 Filter Specifications Page 7 SepticTank Cross Section Page 8 Parcel map Page 9 Septic Tank Maintenance Agreement Page 10 Waranty Deed Attachments: Soil Evaluation Report Mater 'lumber Res''cted Service: James K.Thompson,Dept.of SPS Credential#30021 Signature: '�N, Date: 4/2A Page l Of 10 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS,version 2.0 SBD-10705-P(N.01/01) • .So//e J- fi t • EV.56'n,rade OW. L•l /i ScaJ ' .-s/O/ rAnezdrAmosm Al' ,7_233 4 /22 d/uc tent,. d. „tke4 rti ovE./ /(swy0,4a ,: �yc,� v) T. Troy 5 .mix e; W/. C:'\°F t ,,,‘N k ,. 0, ,0 ,o,./. ,i,V 0-fiG.z-?t,--aX7 .�—, o i1_��_ Q// Cod 6:4eS.. oV 0 v '0 ids_ W / . ` p '' 1 >50',4/0.71 sy_si:c r,,zeek• a / o al oMo t k t 1 t I Z t,, , ,` ` 1 ` ,, 1 L; �k % \/' �� � \i o oh � >, -3--0 q_- . ...?..- - - \ k_.1,4 H k-& _ \ '%' M a y b 51... -11 firi Q■ .i.\ & c, 6 k ') --- 4 -, ':., v�j c��f O % �•il 1 1 41 � 1 _ 1 is `� l 1 1 t t ∎ I �• o r 1� • .� ■Q l 1 1 1 � 1 �d —� i a t,11) to to 0 ' 0 • A "v 5a ''1 a I. Po,2 o,fio STARKE DISPERSAL CELL SIZING CALCULATIONS 1. (3bedroomsx100 gallons estimated flowxl.5 design factor)=450.00 Gpd design flow 2. Infiltrative capacity of native soil=0.5 god/sq.ft. 3. Absorption area required: 900.00 sq.ft. 4. Absorption area as proposed: 930.60 sq.ft.(45chambers total) Infiltrator"Quick 4 Plus"=20.00 sq.ft.EISA per chamber,Infiltrator"Quick 4 Plus"end cap=5.10 sq.ft.EISA 900.00 sq.ft.—(6 endcapsx5.10)=869.40 sq.ft. 869.40 sq.ft./20.00=43.47 chambers required Number of trenches: 3(2i 15 chambers per trench Trench width: 2.83' Trench length: 63.00' Trench spacing: 9.00'on center Total system area w/9'center spacing: 21.00'x 63.00' Pg.3 of 10 Soil Absorption System Cross Section 8/.o'- I,_ 8.—s!°' ft 80.0,- I 83.0 ft 4"Schedule 40 Ss,' ' Final Grade PVC Vent Pipe 95 II With Vent Cap , 7B7•S ft 75 s� Leaching 76.S ?_÷(Th Chamber 1"." ft System Elevation 3 ft c, ft ft Soil Absorption System Plan View (a3 ft 3 ft { OI _ IIII 1 1 # to ft Leaching dil Trench 1 rChambers I I 0 III • - 0 C 4"Dia. Trench 2 Header Vent Or Observation Pipe I I _ I 0 E-- Trench 3 Leaching Chamber Specifications Manufacturer And Model `/pia 4rr, -4 4 f/us 560.4ok-o/ EISA Rating „20.6 sq ft per chamber Soil Application Rate 0.5- gpd/sq ft <1S0 gpd Design Flow+ 0.5 Soil Application Rate .; .20.0 EISA= Y4" Chambers 3 rows of /S chambers each. Page of /D Conventional Septic System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General The conventional septic system shall be operated in accordance with SPS 382-384 Wis.Adm.Code,and shall be maintained in accordance with component manual SBD-10705-P(N.O1/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system should be directed to the installing plumber,Jim Thompson at(715)248-7767 or the St Croix County Zoning Department at (715)386-4680. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(lxe). Septic tank to be located within 150' of service pad,with bottom of tank to be S 15'below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1/3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code,by an individual certified to service septic tanks under s.281.48,Stats. If the contents of the tank are not removed at the time of a biannual assessment,maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank.The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,the filter shall be serviced if the alarm is activated. Septic tank manholes risers,access risers,and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,defective,or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33,Wis.Adm.Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce,Safety and Buildings Division. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic(other than for vegetative maintenance)over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March)dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS,and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional,more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Pg.5 of 10 '}'f 77ljh f7 � • Y N �k k - i : poLt o Filters PL-525 EFFLUENT FILTER (k 1, ;7(.1%'.41.) Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent filters.The PL-525 is rated for over 10,000 GPD Alarm 71/ (gallons per day) making it one of accessibility Accepts PVC the largest commercial filters in its extension handle class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the new Polylok PL-525 has an automatic shut off ball installed 525 linear feet with every filter. When the filter is of 1/16" removed for cleaning, the ball will filtration slots Rated for over 10,000 GPD float up and temporarily shut off the system so the effluent won't leave the tank. No other filter on w;ax the market can make that claim! Accepts 4"& 6" SCHD.40 Pipe " apt __ \j. PL-525 Maintenance: The PL-525 Effluent Filter should operate efficiently for several years under normal conditions before 4 w. requiring cleaning. It is recom- mended that the filter be cleaned every time the tank is pumped or at least every three years. If the *� installed filter contains an optional : ,,. alarm, the owner will be notified ` by an alarm when the filter needs servicing. Servicing should be `'` `�`° l� Gas deflector w3unsi as done by a certified septic tank ""' Automatic shut-off pumper or installer. ball wh en filter is removed 1. Locate the outlet of the U.S.Patent No#6,015,488 septic tank. 5,871,640 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 1. Locate the outlet of the 3. Do not use plumbing when septic tank. filter is removed. Ideal for residential and corn- 2. Remove the tank cover and 4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary. 5. Hose if filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the 4" or 6" outlet pipe. If the tank. Make sure all solids fall filter is not centered under the back into septic tank. access opening use a Polylok 6. Insert the filter cartridge back Extend & Lok or piece of pipe into the housing making sure to center filter. the filter is properly aligned and 4. Insert the PL-525 filter into completely inserted. its housing. 7. Replace septic tank cover. 5. Replace the septic tank cover. 10 (�, G o-C to 0:Technical Resources New/02-ISIJ'roducts/TanksMjecibn-Melded Tank/FL/FLIMI060_22compartment 0 n@ D F,', 'olow.,wwn w N° Z I-- -N } .'.f D O I ��,.aIll III. ;M11 911 ICI 21" \I/' rlJ 2 MT.O...§W' r i rirmagi 0 lea NM* j 10.16.4;-/ o - y Fl rumor>_.I.�i. V _�;•,. fA y f 1 @ o "-rim S�ms c. a. z m o 1;i�_ ilimr.ro m c 2 rn r,. m 5 t * .4 P 3 .Op Q m F� N fi � �� to z fn tri o 20 P m f �_ r m z $ y 1 6 511111 m; i�., ii11 1 x 0E 3 T "' _ V J '��f�iw�!►��1, 1+.I,�!!fw■ivr'� m c O 11 g o53 m Y t- p 941 mo p P h = .., z en -a lil g _ ��,= � 3 en 2 1._ _.„.rte—_1, m rn • 1 ellillWaillIMP5 i i-,', m 1 m .3 m II xfim=i ImI- . 01,4 A (7 i O 8 cyn 1 o_ am g m z Z p s � z -M i?"— il 0! I IU !OS a 11 m -� C tlp A �b 1 5 • LJ Ei 0 i Pas 5-' P \ `_r �� r- ro r 0 2 l C o n "yJJJIII m - M 2 Q y r P m i^ $ E ym :_____ o I P� 70.0° , , Aleal /? /1/11{ OJe AgacJ4Y /aeiviri,td -• 2333 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85,Wis.Adm.Code A.C.E.Soil&Site Evaluations \ County Attach campl n ? :t, not less 818118%x 11 Inches in size. Wan must St.CroiX includ: , ,•► , ., and horizontal reference point(BM),direction and �- Parcel l.D. percent or d word,avow,and location and distance to nearest road. �C 040-1162-70-000 /. (v 3/ 4F, Please print all information. (� Da Personal information you provide may be used for secondary purposes(Privacy Law,s.15.04(1)pn))S b ` - (vyw� I i /l3 Property Owner Propertyocation 64'0 j // Margaret M.Starke Govt.Lot cRo, 4/4 1/4 S 25 T 28 N R 20 W Z/ Property Owners Mailing Address Lot# Bldc o4, Subd.Name or CSM# Z 2/.- ,221'Black Bass Rd na na y Na City State Zip Code Phone Number _J City ____I Village s# Town Nearest Road/2.7i Hudson i WI I 540161 Troy l ?it/Black Bass Road J New Construction Use: ✓J Residential/Number of bedrooms 2 Code derived design flow rate 300 GPD J Replacement _j Public or commercial-Describe: N&' CGY4';9 vw./ Anvil - 11 o Ch Parent material Glacial Outwash Flood plain elevation,If applicable S4na� General comments and recommendations: Site suitable for conventional POWTS dispersal cell with 0.5 gpd/sq.ft./day loading rate.Recommended infiltrative surface elevation=66"below existing grade. 1 Boring# J Boring ✓__1 Pit Ground Surface elev. 84.18 ft. Depth to limiting factor >114" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont Color Gr.Sz.Sh. "Eff#1 *Eff#2 1 0-4 10yr3/3 none I 2fgr mfr cs 2fm,1c 0.6 0.8 2 4-23 10yr4/3 none Ifs Osg ml gs 2fmc 0.5 1.0 3 23-39 10yr4/4 none Ifs Osg ml cw 3fmc 0.5 1.0 4 39-44 10yr4/6 none s Osg ml aw lfmc 0.7 1.6 5 44-57 10yr5/4 none sil 2fsbk mvfr aw 2fm,1c 0.6 0.8 6 57-114 10yr3/6 none cos Osg ml - - 0.7 1.6 2 Boring# _.I Boring I1/ Pit Ground Surface elev. 79.60 ft. Depth to limiting factor >109" in. Sob Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/R= in. Munsell Qu.Sz.Cont Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-5 10yr3/3 none I 2fgr mfr cs 2fm,1 c 0.6 0.8 2 5-178 10yr4/3 none Ifs Osg ml gw 2fmc 0.5 1.0 3 18-28 1Oyr4/4 none sicl 2fsbk mvfr cw lfmc 0.4 0.6 4 28-36 7.5yr4/4 none sl lfsbk mvfr cw 1fm 0.4 0.7 5 36-50 10yr5/4 none sil lfsbk mvfr aw 1fm 0.4 0.6 6 50-109 10yr5/4 none s Osg ml - - 0.7 1.6 *Effluent#1 =BOD5>30<220 mg/L :nd TSS>30<150 mg/L *Effluent#2=BOD5<30 mg/L and TSB<_30 mg/L 1 CST Name(Please Print) Sign, ure: CST Number James K.Thompson .. cl�S._-- 3602 Address A.C.E.Soil&Site Evaluations 1 ( Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane,Os• a,WI 54020 6/18/2013 715-248-7767 , Property Owner Margaret M.Starke Parcel ID# 040-1162-70-000 Page 2 of 3 3 Borg# J Boring N Pit Ground Surface elev. 83.22 ft. Depth to limiting factor >108" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. *Eff#1 *Eff#2 1 0-5 10yr3/2 none I 2fgr mfr cs 2fmc 0.6 0.8 2 5-33 10yr3/6 none Ifs Osg ml gs 2fmc 0.5 1.0 3 33-43 10yr4/4 none Ifs Osg ml cw 2f,1m 0.5 1.0 4 43-50 7.5yr4/4 none sI lmsbk mvfr aw 1vf,f 0.4 0.7 5 50-67 10yr4/4 none Ifs Osg ml aw - 0.5 1.0 6 67-108 10yr5/4 none Ifs/s Osg ml - - 0.5 1.0 Boring# —1 Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu.Sz.Cont Color Gr.Sz.Sh. *Eff#1 *Eff#2 Boring# J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth 'Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/lt' in. Munsell Qu.Sz.Cont Color Gr.Sz.Sh. *Eff#1 *Eff#2 4 *Effluent#1=BOO s>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS w30 mg/L and TSS<_30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or IT?608-264-8777. SBD-8330(8.07/00) A.C.E.Soil&Site Evaluations , . 411/eva/a.44On fit E0S6nt.,grade eWe✓ Scat,' 'sip' te./././41E Jr A 'It 4 /,222 Q/ac,f 4a.c.Pd. �s (� c ov6./06/�sWy/3w;r�, kiQ p ee_.�sr;e/; ,e2au; •:t yb,• v vl 73-1.gcTroy 3,.mix C'.k 44..V. N..) �� '' ��r be,-y180 44/Z5 4 v A �c o V a o v o o'tCr Q// L.o� G:re P 's o a ari °� ► >64'�.n n sys „acek. �. Di ► t it a Q w o 0 1 , ►► ► , \ ` ► \ 1 1 I 1 1 1 ;II ■ ; i tl 1 Li...--i. .... t 1 ,\_ 44 \\ 4 \ 1■s 1 ■ \I -t%its ► '\ a,‘ \11 ►Q► nt • \C r • 1■ 1�1 1 1 '► N '� , \gtr , \ , ' v 1 ► , N. S �a 1 , 1 i + 1 l � 3 D � � � � 1 ► s► ► 1 o Q l� % ►1 i i t Z d 3 � ; ,...i .. ---`1 A,, 0,. v, z,r,- •,Q, z --,-. -i. , C9 • 0 o vj A c q O N .Q t. (30,3 W3 Parcel #: 040-1162-70-000 09/10/2013 09:27 AM PAGE 1OF1 Alt. Parcel#: 25.28.20.631 F 040-TOWN OF TROY Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner JOSEPH E DILLON 0-DILLON,JOSEPH E MARGARET M STARKE,ET AL C-MAKYNEN,E, MARGARET M C- AKY ELIZABETH A 501 N WINTER ST C-DILLON,THOMAS E RIVER FALLS WI 54022 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *122 BLACK BASS RD SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 25 T28N R2OW PRT GL 1 COM NE COR GL Block/Condo Bldg: 1, S 50 FT,W 400 FT, S 24 DEG W 325 FT; S 10 DEG E 40 FT TO POB: S 56 DEG W Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 299.3 FT TO STAKE,CONT ON SAME COURSE TO 25-28N-20W SHORE LK ST CROIX, SLY ALG LK TO PT= WITH&210 FT FROM PREV LN,TH N 56 DEG more... Notes: Parcel History: Date Doc# Vol/Page Type 04/18/2013 977119 TI 12/05/2011 946701 EZ-U 08/21/2009 902503 TI 09/14/2007 860530 TOD more... 2013 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 08/20/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 3.800 426,000 63,400 489,400 NO Totals for 2013: General Property 3.800 426,000 63,400 489,400 Woodland 0.000 0 0 Totals for 2012: General Property 3.800 426,000 63,400 489,400 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 11/21/2012 Batch#: 12-08 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 MIN 1111 * U V V ..1 LO r�V L T TRANSFER ON DEATH DEED 860530 KATHLEEN H. WALSH Document Number Document Name REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD THIS DEED.made between Joan M.Dillon,a single person 09/14/2007 11:00AN TRANSFER DN DEATH DEED EXEMPT 1 ("Grantor,"whether one or more),and Kathleen M.Dillon,ElizabethA.Makynen, REC FEE: 13.00 Thomas E.Dillon,Margaret M.Starke,and Joseph E.Dillon,as joint tenants PAGES: 2 ("Grantee,"whether one or more). Grantor transfers on death to Grantee(pursuant to Sec.705.15 Wis. Stats.),the following described real estate,together with the rents,profits, fixtures and other appurtenant Recording Area interests,in St.Croix County,State of Wisconsin("Property") Name and Return Address (if more space is needed,please attach addendum): Jennifer A O'Neill-Lommen Abdo Law Firm Grandview Professional Building g Legal description attached hereto as Exhibit"A" 400 South Second Street,Suite 210 Hudson,WI 54016 040-1162-70-000 _ Parcel Identification Number(PIN) This is homestead property. (is)(mat) THIS DOCUMENT IS EXEMPT FROM THE REAL ESTATE TRANSFER RETURN AND FEE BECAUSE IT IS NOT DEFINED AS A CONVEYANCE BY SEC.77.21(1),WIS.STATS.,FOR PURPOSES OF REAL ESTATE TRANSFER TAXES BECAUSE IT IS A TRANSFER ON DEATH DEED UNDER SEC.705.15,,WIS.STATS.,AND ON THE DEATH OF THE GRANTOR WILL BE EXEMPT UNDER SEC.77.25(11),WIS.STATS. D d September 12,2 ' �Ly✓ l/�f �a (SEAL) (SEAL) oan M.Dillon (SEAL) (SEAL) * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) of Joan M.Dillon STATE OF ) )ss. authetticate, on/•September_2,20r, COUNTY) c' G_ ` . ���� Personally came before me on_ _, the above-named TITLE:MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by Wis.Stat. §706.06) instrument and acknowledged the same. THIS INSTRUMENT DRAFTED BY: * Jennifer A.O'Neill-Lommen Abdo Law Firm Notary Public,State of Hudson,Wisconsin My commission(is permanent)(expires: ) (Signatures may be authenticated or acknowledged. Both are not necessary.) TRANSFER ON DEATH DEED Information Professionals Company 02006 *Type name below signatures. INFO•PRO"Legal Forts•(800)655.2021•infoprofomms.com 2 of 4 ADDENDUM TO TRANSFER ON DEATH DEED 040-1162-70-000 GRANTOR: JOAN M DILLON GRANTEES: KATHLEEN M DILLON ELIZABETH A MAKYNEN THOMAS E DILLON MARGARET M STARKE JOSEPH E DILLON LEGAL DESCRIPTION: Parcel A: A parcel of land located In Government Lot 1,Section 25,Township 28 North,Range 20 West,Town of Troy,St.Croix County,Wisconsin,further described as follows: From the Northeast corner of said Government Lot 1 go South a distance of 50.0 feet,thence West parallel with the North line of said Government Lot a distance of 400 feet;thence South 24 degrees 30 minutes West a distance of 325 feet;thence South 10 degrees 45 minutes East a distance of 40.0 feet to point of beginning of parcel to be conveyed;thence South 56 degrees 29 minutes West a distance of 299.3 feet to an iron pipe stake at the brow of the hill;thence continuing on same course down the hillside to the shore of Lake St. Croix;thence Southerly along the shore to a point on a line which is parallel with and 210 feet distance from the previous course;thence North 56 degrees 29 minutes East up the hi along said parapet line to an iron pipe stake at the brow of the hilt;thence continuing on the same course a distance of 247.8 feet;thence North,10 degrees 45 minutes West a distance of 227.5 feet to point of beginning;together with an easement for an access road to the above parcel North and East to connect with the present town road as now travelled. The above parcel being subject to an easement for an access road over and across the East 50 feet as now opened and travelled. • Parcel B: A parcel of land located in Government Lot 1,Section 25,Township 28 North,Range 20 West,Town of Troy,St.Croix County,Wisconsin,further described as follows:From the Northeast corner of said Government Lot I go South a distance of 50.0 feet,thence West parallel with the North line of said Government Lot a distance of 400 feet,thence South 24 degrees 30 minutes West a distance of 325.0 feet to point of beginning for parcel to be conveyed herein; thence South 85 degrees 17 minutes West a distance of 131.2 feet,thence South 56 degrees 29 minutes West a distance of 349.0 feet to an Iron pipe stake on the shore of Lake St.Croix,thence Southeasterly along the.shore to a point which Is on a line parallel with and 100 feet distant at right angles from the previous course,which line is also the Northwest line of the parcel previously conveyed to the above named grantees by deed recorded in Volume 316,Page 505;thence North 56 degrees 29 minutes East up the ha to an Iron pipe stake at the brow of the hill;thence continuing on the same course a distance of 299.3 feet to an Iron pipe stake;thence North 10 degrees 45 minutes West a distance of 40 feet to the place of beginning,together with all riparian rights and land lying Southwesterly of the above described land and within extension of the above property lines; Together with an easement for an access road to the above parcel Northerly and Easterly to connect with the present town road as now traveled,the above parcel being subject to an easement for an access road over and across the East 50 feet as now upended and traveled,and to all recorded easements and reservations. Exhibit"A" 3 of 4 ,.� 147 6 ill SCALE I N FEET I" = 200 ' O 100' 200' 300' 400' 500' I W 1/4 COR. --�� ' ,-- - S EC. 25 1867/321 630 E 630F-10 --------- – 630A-10 ___j________6(orn°°/:----"-- NW //4 - S W //4 . \s- 6 30 C 630 B 0 . 1- 6 30 D ����� ' �` 99 � C.S.M. OUT ':;' 56.:•' V. 5, p. 1333 \ LOT 6 30 G 10/2710 SLAG) \ 18 95 70.• . — — LOT i - 644.27 63 I K.; ;-' P LOT4 631A-15 -631 I ,� �;���� i\�' LOT 3 CI}` Vr;. y 324.83 IC.S.M, ` \.�? ,�\' `63I C YQL ,24,a6 ,� MAP v. 5, p.1333 \70ERTIF' ED SUR' 252.19 k � ,„5 (0 \ cv 03 y ,y .Q ,e\ V ,,)\2 -63I D - � -,* 5-L-vec P,be, _ri, %\ 0 \'''' ',. .ik' ad ' o 13) , N ivi)3 . ,i()P , , ,t. go- ii. 8 4i4i) • TRANSFER ON DEATH 1111111111 11111 liii liii!111111111 111111 III III TO BENEFICIARY * 9 0 2 5 0 3 4 * Use black Ink 902503 BETH PABST DECEDENT'S NAME DATE OF DEATH REGISTER OF DEEDS Joan M. Dillon 07/30/2009 ST. CROIX CO., WI ADDRESS OF DECEDENT Al DATE OF DEATH CITY ' ST 21P RECEIVED FOR RECORD , 122 BLACK BASS ROAD RIVER FALLS WI 54022 08/21/2009 12:20PM TRANS ON DEATH TO BENEFICIARY EXEMPT II 1111 PRESENTATION OF DEATH CERTIFICATE REC FEE: 25.00 I certify that I have viewed a certified copy of the decedent's death PAGES: 4 cer ' 'cate. _ REGISTER OF DEEDS-SIGNATURE D`A Recording area Interest in property is terminated under: Name and return address: 4 s.867.046 which pertains to nonprobate transfer of real property under 705.15. MARGARET M STARKE An interest in real property may be transferred without probate to a designated 13 BAILLON LANE TOD beneficiary on the death of the sole owner or last to die of multiple owners. ST MARYS POINT MN 55043 (You must provide a copy of the document establishing interest in property.) 040-1162-70-000 Presentation of recorded document establishing Interest in real estate. t(-0 3 o Parcel Identification Number DOCUMENT# VOLUME/REEL PAGE/IMAGE RECORDS/DEEDS Description of the real estate. ® See Attached ill 1 DECLARATION: i(We) declare that this document is, to the best of my(our) knowledge and belief, true, correct and complete and is in conformity with the provisions and limitations of the Wisconsin Statutes. (If more space is needed, attach pages.) Name and Address Applicant's Applicant Signature(Notarized) Date (List all beneficiaries) Interest in Property (Print or ty.e name below signature) (is: beneficiary) KATHLEEN M DILLON BENEFICIARY ELIZABETH A MAKYNEN BENEFICIARY / 2 ,i ( Y Cl i THOMAS E DILLON BENEFICIARY % i MARGARET M STARKE BENEFICIARY JOSEPH E DILLON BENEFICIARY L tnntc, 1 17i11-6A/1-6,— /1- i1 f7tie G'— This document was drafted STATE OF , County of WA ssi )t. by:(print or type name below) Subscribed and sworn to before me on: MARGARET M STARKE A7.tat Ig 0Y19 by the above named person(s): J140_rghicf wt. $ .1Ce_ J rf'e„ NOTE: SEE DIRECTIONS. - Signature of Notary or other person ` . �,� ( -ieElizabethJohf�O Wisconsin Register of Deeds authorized to administer an oath (as per ,/:r: . _ r,.WiTARYPUBLIC-MINNESOTA Association Form TOD-110 s 706.06, 706.07) I '1: �TMole I"'- e I Website Version 03/2007 L_, `,',r, Print or type name:M; Ellza_befk Thnsc .' EXPIRES JAN.31,2010 Title: NektAy 19:„..4,/,,;, Date Col mission Expires: /aj , 1 of ,.� L, �5 /0 i 1 D - . 2008 Real Estate Tax Summary 08/18/2009 08:14 AM Page 1 Of 1 Parcel#: 040-1162-70-000 TOWN OF TROY Alt. Parcel#: 25.28.20.631F ST.CROIX COUNTY,WISCONSIN Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner JOAN M DILLON 0-DILLON,JOAN M 122 BLACK BASS RD RIVER FALLS WI 54022 Districts: SC=School, SP=Special Property Address(es): •=Primary Type Dist# Description `122 BLACK BASS RD SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.000 Plat: N/A-NOT AVAILABLE SEC 25 T28N R2OW PRT GL 1 COM NE COR GL Block/Condo Bldg: 1,S 50 FT,W 400 FT,S 24 DEG W 325 FT; S 10 DEG E 40 FT TO POB:S 56 DEG W Tract(s): (Sec-Twn-Rng 401/4 160 1/4) 299.3 FT TO STAKE,CONT ON SAME COURSE TO 25-28N-20W SHORE LK ST CROIX,SLY ALG LK TO PT= WITH&210 FT S PREV LN,TH N 56 DEG E TO STAKE,CONT 247.8 FT,TH N 10 DEG W 227.5 FT TO POB ALSO FROM NE COR GL 1 GO Parcel History: S 50 FT,W 400 FT;S 24 DEG W 325 FT TO POB:S 85 DEG W 131.2 FT,TH S 56 DEG W Date Doc# Vol/Page Type 349 FT;SELY ALG SHORE TO A LN=WITH& 09/14/2007 860530 TOD 100 FT FROM PREY.LN,N 56 DEG E TO 01/29/1974 320342 507/385 QC STAKE,CONT.299.3 FT,TH N 10 DEG W 40 267634 382/461 WD FT TO POB 245084 316/505 WD Tax Bill#: 260494 Net Mill Rate 0.014753200 Installments Gross Tax 8,728.87 End Date Total School Credit 859.51 1 01/31/2009 3,842.03 Land Value 400,000 First Dollar Credit 33.00 2 07/31/2009 3,918.18 Improve Value 133,400 Lottery Credit 1 Claim 76.15 Total Value 533,400 Net After 7,760.21 Ratio 0.8977 Fair Mrkt Value 594,200 Amt Due Amt Paid Balance Bal.Codes Deeded Tax 7,836.36 7,836.36 0.00 Special Assmnt 0.00 0.00 0.00 N n Bankruptcy Special Chrg 0.00 0.00 0.00 Delinquent Chrg 0.00 0.00 0.00 f A g reement Private Forest 0.00 0.00 0.00 L) Foreclosure Woodland Tax 0.00 0.00 0.00 Managed Forest 0.00 0.00 0.00 Prop.Tax Interest 0.00 0.00 I Environmental Spec.Tax Interest 0.00 0.00 n Do Not Generate Prop.Tax Penalty 0.00 0.00 Notices I Spec.Tax Penalty 0.00 0.00 I Other Charges 0.00 0.00 0.00 TOTAL 7,836.36 7,836.36 0.00 Over-Payment 0.00 Notes: Payment History: (Posted Payments) Date Receipt# Source Type Amount GPT SA Int Pen. Total 12/03/2008 C L 76.15 0 N 0.00 0.00 76.15 01/13/2009 20194 C T 3,842.03 P N 0.00 0.00 3,842.03 07/24/2009 45199 C T 3,918.18 N N 0.00 0.00 3,918.18 Key: Balance Code: D-Delinquent, P-Postponed, N-No Balance Payment Source: C-County,M-Municipality Payment Type: A-Adjustment,L-Lottery,R-Redemption,T-Tax 4 of 4 '1 . ,, A.C.E. Soil & Site Evaluations Applicant: Margaret M. Starke 122 Black Bass Road Hudson,WI 54016 Agent:, James K.Thompson 340 Paulson Lake Lane Osceola,WI 54020 Permit Request: Land Use Permit- Filing& Grading,<10,000 sq. ft. outside Slope Preservation Zone within the Lower St. Croix Riverway District as required by §17.36 F.2a.2 Project Description: The site is located 122 Black Bass Rd.,Gov't.lot 1,Sec.25,T.28N.,R.20W.,Town of Troy,St.Croix County,WI.,identified by the St.Croix County Real Property Listers Office as parcel#040-1162-70-000. The parcel is located on the St.Croix River. The proposed project includes the replacement and abandoned of an existing hydraulically failed POWTS septic tank/drywell. Abandonment will be accomplished by removing all liquid waste and filling with compacted sand fill. A connection will be made to the existing building sewer at approximately 3W below grade and will be extended from the southeast side of the house within a trench at 4'wide and 3'/2'deep. Total trench length will be approximately 80'. A 1,060 gallon plastic septic tank will be installed requiring an excavation of approximately 7'wide, 16'long and 7'deep. The trench will then be extended approximately 30'to the beginning of the in ground dispersal cell. The dispersal cell will be 21'wide x 63' long and installed at 5W below existing grade. The total area of disturbance for the project will be approximately 1,500 square feet,complying with the requirements of the St.Croix County Lower St.Croix Riverway Zoning Ordinance,Chapter 17.36 F.2a.2. The proposed POWTS location is greater than 100' landward of the slope preservation area and located on an opposing slope which is not visible from the River. Slopes within the proposed project area extend away from the River with no slopes leading to Slope Preservation Zones. Slopes across the area of disturbance fall to the east and away from the River at approximately 16%. There are no drainage ravines present. The floodway and floodplain are greater than 200' form the project area. There are no wetlands on the site. The proposed area of disturbance will be stripped of topsoil immediately prior to construction of the POWTS. Topsoil will be stockpiled adjacent to the system area. A 100'undisturbed vegetated area will exist around the area of disturbance. Excavations for material installation will be completed immediately prior to,and will be closed immediately after installation of materials. Topsoil will be replaced within 4 hours of completion of installation. Re-vegetation will consist of spreading grass seed and/or straw mulch across all areas of disturbance upon completion of project.Eight trees of approximately 6"— 10"diameter will be removed to accommodate the installation. The remainder of the site will remain heavily wooded. A 1 40//ePtt/- -6pr)fie. • Ex,'si'n, rade ele✓ C,' at P■�___41.' 2233 4l Mar/art,611 .5a.ree, ` $,� sec. 7.--28/4 e.ZOu', ,:c yy� v ,c�V) 7-,-1. c,"Troy s&.Croix et WI. y) ir'0' I •y.vi' 1,e,-, 1 80 4/./X1 • p P v) . . ... , O ` ` ado (1// �6 GRCS V Q) y .% / o o v 1 1 >56 ,Lco-n Sy.Sfr-.,,acek. 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Jame s i p VSIE V ET V MOrgarelS 1 3 12 F ' x woodff No,mor s -;u Ia Pme RG N�Bm 'eve,esen y, ..LL SUNSET 91 B• 1 p P T -AfN3 E ,1-4 ;1':' 1 i, ,BLI f l o `.� 'n CR }3 SF I .4 VALLEY ;S 4 82 .,. ; ES TS T N 3 EAGLE BLVFF P - f Kh' ,Y - ':. ° l..,..a ti y0 3. -3 c EE '. valor o o F on IDnvsls Land M.. (1. ��if �tom c uc 73,9 oa I . tins. .J i I °$ �.� VLL VALLEY P,i J prVS �v D o ' q: 1 I H. SctiOgen :�. a k9sB%'t v o, ale < AW3 FABRICATORS,INC. 7y o C�� P BB 6 .} MRGT lil� Omes 7 TROY ; We are one of the top ten © e`® �m !WOOD ' F ell o nd Ion Woodruff 1139 I „ N ,68:::,,�� L C . �� manufacturing companies in St. �9 uWy/ ®® ; ,6,r6z; P Capen 9. FouMOI r>I RI GE I,'Y i James 0 k 4 Croix County. and still growing, ST CROI% ST ROI ,, tV89u a ,22 O Colette m Z BEACH _ OV. P6emmele r Z Our success depends on our ' &. l'''',.4 -I SG / i l"4 Sa .� employees, so we hire the . a_� €24 � !_ �0�tFY `o,F „an,E P it! 2 og- �� U4 LL°,-' FEl TROY Smad� T p best—and treat them like it. e 0 0 ov v e Loon .e 3 (���f JJ j.[� , Be ko 8 1�C- INRI E VIL GE 0 VALL 1 ESTS MO„,d O C h We Offer... 68.1 l� {e{��sis r 1VS.4F.. 1 VOle9]SYIo P5� p 3� app l IOI:� I NEI .+ Os • A friendly, supportive 0Cher7YWO0IS0,, V9 , pA T l3 JS24? g Lynn Celle ohs 0 3;` work environment scot a °!, 141 15.8 = -- ANO YJ ;° r 1$42 AG P I: Lens u c Aa ®' 513 aµ'7 IINdj©- Quill �! - Z %� { i"fh �� iLr hdt Ilk POOR 7, P • Great communication in 4- w-POL. ` Selig 9 ®B Johnson Tr 95.3 - Fran D ` all directions 4*i., i ®��• ,lid€ m�• vr, ` °e1r51d` e1U39 Armbruster Ir C nohous 133.6 43' _ ■ • Pay that reflects your VAYam Jr P fil 3, �'m MM lan ryams En JI MiII a skills and performance '3 ,,4YF°,m, ®�� X28 Rebecca Punch lLC 683 Glenn& P Li Eubank 1I eothelr.5 © o Moberg M ■ Toyro �,{�� 158.2 • Excellent benefits �� 36 674 Et .9 BMMOYeen P o ',: 36 Ji 8 W Alice P 4 C ft L Jennings 195 z ,� g 1 ee�I Sche9 U 4 - $ , 372 4c' • Twin Cities wages with- $ e .,,& © e,n , e• G ry n� Ros mary Dusek Jon a ry Orxy Jo _ out the long commute 95 WBOn15 339 �� F� _, ��e ar " n da M R.10.W. R.19.W _— P 92'46'0"W 02'45'0'W 92°44'05W 92°43'0'W 92'420'W r p If you take pride in . your work, s we want to meet you! REDMON LAW x CHAR 'TLRED Visit our web site at: Jeffre y A: Redmon www.oemfab.com Attorneyat Law,"" _ and apply on-line! 401 Second Sheet,Suite 200 Telephone: 715-386-0100 ` (715) 698-2111- Hudson, WiscotlSiA 54016 � r Facsimile: 7I5-386-0700 jredmon @RedcponLaw-com Saint Paul: 651.998.0900 IP Your Business Counselor 16 SO