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040-1010-70-250
r Wisconsin, Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety aid Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 515163 0 GENERAL INFORMATION 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: Paulson, David & Kristy Troy, Town of 040 - 1010 -70 -250 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 6 / G 03.28.19.42A50 TANK INFORMATION 0, 1 1 ELEVATION DATA TYPE MANUFACTURER i CAPACITY STATION BS HI FS E4 V. EV. ! 7./ /07,19 Septic y,/� Benchmark 6. 1 105, / /dd ;l Dosing INti r � i Alt.: 11�,... ' b Bldg. Sewer ZL, Holding St/Ht Inlet 7 TANK SETBACK INFORMATION St/Ht Outlet TANK TO A P/L ` WELL ] Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom 76 � .r ' D a Dosing 1 Header /Man. 70 I 5A7 _ W - 7Z Aeration Dist. Pipe y, 4 161. Holding Bot. System PUMP /SIPHON INFORMATION Final Grade / dZ 7 `� 1 d (� Manufacturer _ ` GP M nd St Cove Model Number q5, � �J� s . TDH �o Lift 5 � Friction Lo System H ad ` TDH t 1 � �� y J `.a�( Forcemain Len 6th f Dia. Dist. to Well Z SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length j No. Of Trenc s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 7 $! 7z SETBACK SYSTEM TO 7 P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: ` INFORMATION CHAMBER OR n Type Of stem: �� G C 9/ / I Q_ UNIT Model Number: I to N �`+ DISTRIBUTION SYSTEM ° Header /Manifold Distribution 7 x Hole Size �/ x Hole Spacing I VePo Air Intake Length 3. 5 Dia L n gth ` 2. Dia / Spacing ' S/3 Z 2 • 5 SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges � Topsoil �y / � � � �—; T x t1 -'. Yes L] No Yes iii; No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /6 / / / ! G Inspection #2: / / Location: 618 Tower Roa u son, WI 54016 (NW 1/4 SW 1/4 3 T28N R1 9W) NA Lot 4 CL-.. _0001 Pl bL_ T Parcel No: 03.28.19.42A50 1.) Alt BM Description = " t � _ ( �Sa� A. 2.) Bldg sewer length = 39 - amount of cover = :5 a� � 3.) Contour = Plan revision Required? El Yes No ' Use other side for additional information. _ SBD -6710 (R.3/97) _ Date Insepctor's Sig ture Cert. No. i I 1 Q �� �� �� � � � �r ' / �� � `� 'I,� t:omft7et'O9.WI . gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 % c C le© 1 1C n Madison, WI 537 71� Sanitary Permit Number (to be filled in by Co.) Sanitary Permit Application p to Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate / / governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned Project Address (if different than mailing address) POWTS are submitted to the Department of Commerce. Personal information you provide may be used secondary purposes in accordance with the Privacy Law, s. 15.04 1 m Stats. I. Application Information - Please Print All Information 44 Property Owner's Name RECEIVED Parcel # DA VIO AIVQ ;� P1 4(4(.S0AJ 0 q(9 - 1010 ;7 -zs0 Property Owner's Mailing Address UU1 U 9 2009 Property Location 6 i o nto e w- �2,o . �Uum Y mot. Lot City, State Zip Code ZONING 1 t ti 1 %, 5 3 (.0 4)St7I W 51-101 (0 T�—� N , c R /q ( ) II. Type of Building (check all that apply) pk Lot # — L 1 or 2 Family Dwelling - Number of Bedrooms d,6 Subdivision Name '5 A.' Block # ❑ Public /Commercial - Describe Use A ❑ city of f ❑ State Owned Describe Use CSM Number O ® Town of T20 $5. III. Type of Permit: (Check only one box on line A. Complete UnA If applicable) A ' New System ❑ Replacement System ❑ TreatumWHolft Tank Replacement Only ❑ M to Existing Symm (explain) i B. ❑ permit Renewal ❑ Permit Revision ❑ Change of E00,we-ni, Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber y0 (V // C3 Z� 7 IV. of POWTS System/Component/Device: (Check all that a 1 ) ❑ Non - Pressurized W-CIro and ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil Mound < 24 in of snitab� soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (e ) V. Area Information: a Des' Flow (gpd) Design Soil Application Rate f) Dispersal Area Required Dispersal Area n f) System Elevation rb0 0, /ono /0�. 03 � VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units /� L� a i _ , New Tanks E> Tanks h/ [/ /,A ✓�� � M 'v C'�7 � Septic or Mourning Tact )zoo f z 00 1 W S ` Dm* eo son r I,� , k sh k1 VII. Responsibility Statement- 1, the undersigned, assume resparsr'biiity for insta8atim of the POWTS shown on the attached phm. Plumber's Name (Print) MP/MPRS Number Business Phone Number Tflt4 1 r5(Yin(TT Plumber's /��� Z-2-3760 Plumber's Address (Street, City, State, zip Code) V)II. Count /De Use Onl Approved ❑ Permit Fee Daaci �J Issu ing S' ❑ rven Reason rLDenisl $ �� ' � �� 11L. Conq gg LO I/Reasons for Disapproval �, Ge..,Q o� i `,� c .x.Q� 4- -e - .• �'"'- ", I . Septic tank, effluent filter and 'a dispersal cell must all be services / maintained ` o 4.4 +. to 0&P^-1: as per management plan provided by plumber. 2 All setback requirements must be maintained as per appAcabie code / orditwim. Attach to convlete plans far the system and submit to the County only not paper not lees that 8 r!2 a it luilm to size j - -- - - - - - - - -- -- AIR i i '00 L ►N 0 - - - -'' B3 o - -- AM - - -- 1 200100 , 0 \ - - -- -- Pp, oez SEdrie tDes -- - - — — -- k}cus �= TA&W co►n t3o \ -- - mctfJva H ® f3 M / 7eij Da z Pvc r - -- v D g Z 1P - -- ®� C - C2 TO D r_ 19 ST!+ L L E O i.1 U j�— I Z �� E 4-65 _ P— C W h W i Wr if ... - __ - -- - - -mow R Iz n R/ EEC,cc ►w_' y,_ S"w/ , 53; Z� , �'t9 i�J- — Al.P NOP- TJ-I G 1< LINE juAl — —® - GAeAL - o - 63 o AM IN -- &� 0 cp±eo ®ht - s EPr / c fi 005 6 - 14 5 GO -- -- - - -- -- - - - - - - -- - - - fed, z3 x z ,_�zc AU'8 ih el- _ - L to to 01 Z 1?VL p apt - -- S * o dt- = 6 n - - lY %Ex EL 14 2FS -- - -- -- N OTr �d �C r —/ti1 JA) r _ D c D0 574 L L E 6 - LQji1UC - - -I Z _ op- ._LESa TP-, ,UC_ff LV oTrf - - - - - - / — - - - -- LUX 6 - - �c -a 'T� t!2 Id - ( C�► l �O l �T �r 4 yr C Ci�L a r /7j W /4,_53.jT2:PX` P1. 5 � L r Safety and Buildings commerce.wi. OV 10541 N RANCH ROAD g HAYWARD WI 54843 Contact Through Relay 'scons'n www.comm vAsco ov Department of Commerce www.wisconsin.g Jim Doyle, Governor Richard J. Leinenkugel, Secretary October 06, 2009. CUST ID No. 223760 ATTN.• POWTS Inspector JOHN F SCHMITT ZONING OFFICE SCHMITT & SONS EXCAVATING ST CROIX COUNTY SPIA I 586 VALLEY VIEW TRAIL 1101 CARMICHAEL RD SOMERSET WI 54025 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/06/2011 Identification Numbers Transaction ID No. 1711575 SITE: Site ID No. 751696 David Paulson Please refer to both identification numbers, Tower Rd above, in all correspondence with the agency, Town of Troy St Croix County NWl /4, SWIA, S3, T28N, R19W FOR: Description: Mound, 4 bedroom residence Car" Fit Object Type: POWTS Component Manual Regulated Object ID No.: 1241737 <� � a' n M mte ance required; 600 GPD Flow rate; 23 in Soil minimum depth to limiting factor from original grade; Syste Mound Component Manual -Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Versio = ME 2.0, SBD- 10706 -P (N.01 /01), SSWMP Pub. 9.6; Effluent Filter j S The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be cons ed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The force main is to be installed in the downslope area (see plot plan). The trench for the force main may not be wider than 12 inches per Mound Component Manual. • The proposed pump is near its limit with the proposed total dynamic head. If upon installation, the total dynamic head increases, the proposed pump must be reevaluated and may be inadequate. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder JOHN F SCHMTT Page 2 10/6/2009 • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. • Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsibl e tallat* n operation or maintenance of the POWTS. Sincerely, / Fee Required $ 250.00 > Fee Received $ 250.00 Balance Due $ 0.00 Patrici handorf POWTS Plan Reviewer tegrate Services WiSMART code: 7633 (715) 634 -7810, Fax: ( 15 -5150 , M -f 7:45 am - 4:30 pm pat.shandorf @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www. commerce. wi. eov/ SB/ SB- BuildingContractorProgram.html i MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Paulson Mound Owner's Name: Dave & Kristy Paulson Owner's Address: 618 Tower Road Hudson, WI 54016 Legal Description: NW1 /4, SW1 /4, S3, T28N, R19W Township: Troy County: St. Croix Subdivision Name: NA Lot Number: 4 Block Number Parcel I.D. Number 040 - 1010 - 70-250 Plan Transaction No.: , co ,� 4 Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications i 1 Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Page 9 Tank Specs Page 10 Effluent Filter Information Page 11 Soil Evaluation Designer. John Schmitt License Number: MPRS 223760 Date: 10/01/09 Phone Number: 715 -760 -0486 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.8 Design of Pressure Distribution Networks for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Version 6.0 (R. 04108) Page 1 of 11 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table W -44-3 in4tu soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 600.00 Design Flow (gpd) 6.00 Site Slope ( °k) 99.95 Contour Line Elevation (ft) 23.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd/ft Distribution Cell Information 85.72 Dispersal Cell Length Along Contour (ft) = 7.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft?) 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifold 3.50 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.156 Orifice Diameter (in) 2.00 Estimated Orifice Spacing (ft) = 7.14 ft /orifice 2.00 Forcemain Diameter (in) 40.00 Forcemain Length (ft) Does the forcemain drain back? Y 84.00 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 16.63 Vertical Lift (ft) 77.12 5x Void Volume (gal) 1.66 Friction Loss (ft) 83.64 Minimum Dose Volume (gal) 0.00 In -line Filter Loss (ft) 45.23 System Demand (gpm) 22.83 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. op tions choice in. dia. options choice 5 � 0.75 1.25 ' 1.00 1.50 x 1.25 x 2.00 x x 1.50 x x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1200.001 Septic Tank Capacity (gal) Total Working Liquid Depth (n) Wieser Concrete I Manufacturer gattin (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.001 Dose Tank Capacity (gal) Pol Lok Commercial Filter Manufacturer 22.241 Dose Tank Volume (gal /in) 525 Filter Model Number Wieser Concrete Manufacturer Project: Paulson Mound Page 2 of 11 Mound Plan and Cross Section Views 1 /B ; • observation Pipe 3❑ ; J K — T sod s °gig A - - B E F . �• I L Mound Component Dimensions A 7.00 ft E 18.04 in H 1.00 ft K 9.26 ft B 85.72 ft F 9.50 in z 10.23 ft L 104.23 ft D 13.00 in G 0.50 ft J 6.04 ft W 23.26 ft 600.04 (ft Dispersal Cell Area 1476.58 (ft) Basal Area Available 7.00 (gpd /ft) Linear Loading Rate 8.57 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.83 (ft) —► .f,.rrfr� 2 G j I_ ..�..., }..........._f....... ..,. F Dispersal Cell 101.53 (ft) Lateral 101.03 (ft) —► Invert Dispersal Cell; Elevation E D: • 1, .�4 ; { .� � { { , ,{ ti ''�_ � •�'w• { 1? � 'A.. x +..l r ] , , , ; ti _ •. � -. 99.95 (ft) Contour Elevation 6.0 % Site Slope Geotextile Fabric Cover Shading Key $ a', 1 — Dispersal Cell See lateral details on Q Topsoil Cap c 1.5 ft ,_ Page 4 for number, size, 0 } Subsoil Ca a 5 ° ao� = .o p o _ "k � ° e F � ° '` r and spacing of laterals. ©�:�:�� ASTM C33 Sand `— Laterals are equally o ° _ %b t °° o s z F 4 y T ° ical Lateral Tilled Layer c m 0 .5 YP _ _ _ spaced from the 5 A r5 distribution ce ll's Ag gregate II s to � 0 centerline in the A' distribution cell (AxB). Project: Paulson Mound Page 3 of 11 Center Connection Lateral Layout Diagram Force main connection Yla tee or cross to manifold at any point. Laterals are identical i P s •= Turn -up wlba II va Ive or IE x --> J+W2' x12 +1 Laterals & Force main of PVC Sch 40 clennoutplug per CONN Table 84.30.5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.156 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.05 ft Lateral Length (P) 42.03 ft Orifices per Lateral 21 Lateral Spacing (S) 3.50 ft Orifice Density 7.14 f /orifice Lateral Flow Rate 11.31 gpm Manifold Length 3.50 ft System Flow Rate 45.23 gpm Manifold Diameter 2.00 in Total Dynamic Head 22.83 ft Forcemain Velocity 4.62 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -► Comm 16.28 WAC L Disconnect 4 in. min. --!!-- Tank component is property vented F9 r LForcemain ARemate outlet ocation diameter Wieser Concrete Manufacturer 2 in. Cap acityl 800.00 Gallons Volume 22.24 gal /inch A Weep hole or anh- Dimension Inches Gallons B siphon device A 19.31 429.46 C B 2.00 44.48 Pum off e levation (ft) C 3.76 83.64 t 84.91 D 10.90 242.42 D Total 1 35.971 800.00 D ose tank elevation (ft) 3" Bedding uncT tank. 84.00 Alarm Manuafacturer I Se troni Tank mate Alarm Model Number JTM1 �— Pump Manufacturer JZoeller Pump Model Number 1153 Pump Must Deliver 45.23 gpm at 22.83 ft TDH Project: Paulson Mound Page 4 of 11 Mound System Maintenance and Operation Specifications Service Provider's Name I John Schmitt I Phone 715- 760 -0486 POWTS Regulator's Name St. Croix County Zoning Phone 715 - 386 -4680 System Flowed Load Parameters Design Flow- Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600.04 fl? Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Freauency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once eve 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and see a once every 3 years Other Miscellaneous Constru ion artd Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(1), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements In Comm 84, Wis. Adm. Code. 4. Tillage of the basal area Is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Tum-up Detail Finished ............... Grade 6-8" Diameter Lawn . Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve ...... ...... Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Paulson Mound Page 5 of 11 I ' Mound System Management Plan Page 6 of I1 Pursuant to Comm 83.54, Wis. Adm. Code Gener This system shall be operated in accordance with Comm 82-64 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD- 10691 -P (N.01 /01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD -107MP (N. 01/01)) and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole 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 a tank or component. SerMc Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet titter shall be assessed at least once every 3 years by inspection. 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 finer when removed from its enclosure. if the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance Is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent finer is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soli compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 10 cfu/100 mL for highly treated effluenL Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the and of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Conti W 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. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWfS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Page 7 of]] TOTAL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING MODEL 152/153 W MODEL 152 153 50 Feet Meters Gat. Liters Col. Liters 15 5 1.5 69 261 77 291 12 40 152 10 3.1 61 231 70 265 15 4.6 53 201 61 231 = 20 6.1 44 167 52 197 U 25 7.6 34 129 42 159 8 c - 30 9.1 23 87 33 125 20 35 10.7 -- -- 22 85 40 12.2 i0 4 Lock Volve: 38.0 Ft. (11.6m) 44.0 Fl. (13.4m) • . oi asoe 0 20 40 1 60 80 100 GALLONS LITM 0 80 160 240 320 6 1/1 3 27/32 4 5/8 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/32 • Timed dosing panels available. ® 4 Electrical alternators, for duplex systems, are available and supplied with 3 27/32 an alarm. • Variable level control switches are available for controlling single phase , systems. Double piggyback variable level float switches are available for variable level brig and short cycle controls. • Sealed Owik -Box available for outdoor installations. See FM1420• • Over 130•F. (54•C.) special quotation required. 1521153 Sad" 12 1 /8 ISM53 MODELS " ' Control Selectlon Model Voks•Ph Mode Amos Simplex Duplex 5 1/e 115 1 Non 85 1 2 or 3 SN1 BN152 115 1 Auto 85 s Ytdilded 2 a 3 ' sKZOw E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Aub - 4.3 •• Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Aub 10.5 Included 2or3 SELECTION GUIDE E153 230 1 Non • 1 53 1 2 or 3 BE153 230 1 Auto - 53 Included 2 or 3 1. Single piggyback variable level Boat switch Or double piggyback variable lavel float switch. Refer to FM0477. 4 CAUTION 2. See FM0712 for correct model of Electrical Alternator E -Pak AS Installation of controls, prolsction devices and wiring should be done by a qualified 3. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) licensed eredricim AM electrical and safsty codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. AWL T0: P.O. BOX 16347 Lar,:,KY 402560347 Manufacturers of. SHIP TO. 3619 Cane Run Road, - - Louisvi%, KY 40211. 1961 '-_ < lfuau P u�w B S,vct /aJiJ�! httpJiSvwwswLsrcom PL f �� FAX (502) 774-3624� 0 Copyright 2001 Zoeller Co. All rights reserved. Page 9 of 11 an -aoe ooZLdW 99 - 08 -9Z€ -008 80OZ 'Nt1f 'A321 Boot mvnNw :31va osivs YA ADw miv 'o sn gu Z \ � 313 ®9 l`df1Nt/W OLLd3S ui :ova 'ON n3a aw —OOS OOZLd w � J Z W W cz W W oc J N W Q O Z I— J 0: Z U W w w o: Z Q0 M Fa N U d N N V �O w aj O O Z N W N O N m Om �OCC�� cr P O U U 0. Q Q d O O0 mcn JWW OCJ Z z O a U J IWW mgt 0 O O W 0 LL. �ri� w aWtn ` o W Q z r w v s O O cr (n H m W M cV p N x W 1 :: I ,-- Oo O Q N ( w �W t7mNInmCDZOmVPJ�V Ntn � �y '�'�V O O F- > J F- N fL N 6 0 0.0 ~� ..3 OQY OOW Q W 2 m F m U W CL 910O<MZOWpr Zc,QZNO U O Y J z QNO Nm m J Y z3m U 2x J 3mJ ast0 FF O Z ZZ3 Q V ZZZ O Z W W W D O ~ Y aU Q J J Q O Z Z W ,Q_ O y Ir NQ O Q W � O � a U 2 O W e Q r6£ Cn jj Y z a U' I I I w LLJ > �\ J 0- I I Q cn J li i m r9 rb� / II II 11 y � e M W J Z r96 rl6 S9 II fo 6 aged PL -525 Effluent Filter -Effluent Filters.: Polylok Inc. Page 10 of 11 Made in the U.S.A. Polylok Inc. 3 Fairfield Blvd, Wallingford, CT 06492 Call Toll Free: 888 - 765 -9565 Email: polylok.com .................... ...................... . ................ ..................... ................... d.......................... ._...,_............... ............... ....................... ........ .....,.............................. ............................... .............. ....._.... ....... ...... ............. _ ................... ..__. ................. ........ .... .. __..... ...................... ........ ........ You are Here: Home > Product Details e EFFLUENT FILTERS Raising the bar in filter technology About Polylok New Promotions; ;New Products Resources Orderinji Contact lus f�i-=Queslr o^T.-LOG �QIJEST�A ® NNW AOOOWT APMXATION PL -525 Effluent Fitter PRODUCTS BY POLYLOK Description -- Polylok, Inc is pleased to add its new commercial filter to its existing line of quality effluent Effluen F filters. The PL -525 is rated for over 10,000 GPD (Gallons Per Day) making it one of the Extend & largest commercial filters in its class. It has 525 linear feet of 1116" filtration slots. Like the Polylok PL -122, the new Polylok PL -525 has an automatic shut off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off Risers & Riser Covers f the system so the effluent won't leave the tank. No other filter on the market can make that ; — claim! Distribution Boxes and Accessories Q Ordering Information R a Quote Related Products g g ® _ Pumps, Basins, Pump Stations and Step Systems Features Seals I Gaskets Rated for 10,000 GPD (Gallons Per Day) I Baffles, Sanitary Tees & Gas 525 linear feet of 1/16" filtration ! Deflectors Accepts 4" and 6" SCHD. 40 pipe Built in Gas Deflector �R Spacers Enlarge for details Automatic shut -off ball when filter is removed Alarm accessibility Handles and Receivers Accepts PVC extension handle The PL -525 Effluent Filter should operate efficiently for several years under normal Signs conditions before requiring cleaning. It is recommended that the filter be cleaned every time La i ndscape / Drainage Products 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 Forms S Clamps should be done by a certified septic tank pumper or installer. Butyl Sealants Maintenance Instructions: Concrete Accessories 1. Locate the outlet of the septic tank. Pressure Filters 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. I Filter and O Acces 4. Pull PL -525 out of the housing. 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. Rebar - Lok and CMU 6. Insert the filter cartridge back into the housing making sure the filter is properly Accessories aligned and completely inserted. 7. Replace septic tank cover. PL -525 Installation: Ideal for residential and commercial Reber Saf et y and ID C waste flows up to 10,000 Gallons Per Day (GPD). C aps Installation Instructions: Technical Specifications 1. Locate the outlet of the septic tank. Related Products 2. Remove tank cover and pump tank if necessary. Filter and Sump Basins Fi mp, 3. Glue the filter housing to the 4" or 6" outlet pipe. If the filter is not centered under Pump, x Fi Risers the access opening use a Polylok Extend & Lok- or piece of pipe to center filter. Fitter Alarm Panel and 4. Insert the PL -525 filter into its housing. SmartFilt Control Switch 5. Replace the septic tank cover. Promotions Contact Us for Pricing 888 - 765 -9565 PL -122 Effluent Filter Poly IV High Pressure Boot Sea! (Accepts 4" Pipe) Riser Safety Screen 20" and 24" Technical SpecifiCations NlGet Acrobat Reader Download CAD Drawings Stacking Slab Bolsters I 1 New Products Charcoal Filtration Device Stacking Slab Bolsters New 1 "Locking Wheel Chair for i Wire -95 Bar http: / /www.polylok.com/ products _details.asp ?Product_ID =3 9/10/2009 Wisconsin # 1614 SOIL EVALUATION REPORT Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 4 Division of Safety and Buildings Schmitt Soil Testing, Inc. Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 1010 - 70 - 250 Please print all information. R ewed By 2110 Personal information you provide may be used for lRrivacy Law, s. 15.04 (1) (m)). - Property Owner VV Property Location Paulson, David & Kristy Govt. Lot NW1 /4, SW1 /4, S3, T28N, R19W Property Owner's Mailing Address Lot # Blodc # Subd. Name or CSM# / 618 Tower Road xt;UUN *FY 4 CSM 22 - 5323 4 /t-6'L City State Zip NINA L] City Village X Town Nearest Road Hudson WI 54016 715 - 760 - 1123 Troy Tower Road Z New Construction Use: X Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial - Describe: G 2,14t Parent- materilif Glacial till Jewett Silt Loam �- Flood p a elevation, if pp icable General comments and recommendations: Area is suitable for a mound system. System elevation is 101.04' based off contour line 99.95'. Slope of area is 6 %. Depth to limiting factor is 23 ". Boring # Boring Pit Ground surface elev. 99.52 ft. Depth to limiting factor 28 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 -11 10yr3 /4 none sl 2mgr mfr cs 2m,2f .6 1.0 2 11 -15 10yr4 /4 none sl 2msbk mfr gw 2f .6 1.0 3 15 -28 7.5yr5/6 none sl 2msbk mfr gw if .6 1.0 4 28-44 7.5yr5/4 c2d 7.5yr6/6 2. 5yr6/2 sl Om mfi a - - - - -- 2 6 5 44 -70 7.5yr4/4 m2d /6 7.5yr6 /i r6/1 fsl Om mvF1 - - -- -- - - -- .2 .5 F2� Boring # E] Boring Z Pit Ground surface elev. 100.85 ft. Depth to limiting factor 23 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3 /2 none sil 2mgr mfr a 2m,2f .6 .8 2 8 -12 10yr3 /4 none sil 2fsbk mfr gw 2m,2f .6 .8 3 12 -23 10yr4 /4 none I 3msbk mfr gw 2f .6 .8 4 23 -32 10yr5/6 c2d 10yr6/8 fsl Om mfi cs - - - - -- 2 5 10yr6/2 m1d 10yr6 /6 5 32 5y5/3 10yr6 /2 cl Om mfi a - - - - -- 0.0 0.0 ld 7.5yr5/6 6 41 - 64 5yr4/4 m 7.5 r6 2 scl Om mfi - - -- - - - - -- 0.0 0.0 * Effluent #1 = BOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD s30 mg /L and TSS S mg /L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt , _ �. 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 7/24/2009 715 - 247 -2941 SBD -8330 (R.07 /00) Property Owner Paulson, David & Kristy Parcel ID # 040 - 1010 -70 -250 Page 2 of 4 3 ] F Boring # Boring Pit Ground surface elev. 99.0 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff #1 *Eff#2 1 0 -9 10yr3 /2 none A 2mgr mvfr cs 2m,2f .6 .8 2 9 -14 10yr3 /4 none A 2fsbk mfr gw 2m,2f .6 .8 3 14 -22 10yr4 /4 none sl 2msbk mfr gw 2f .6 1.0 4 22 -28 5yr4/4 none sl 2msbk mfr gw if .6 1.0 5 28 -38 5yr4/4 cif 7.5yr6/6 7.5yr6/2 sl lmsbk mfr cs if .4 .7 6 38-45 5y6/4 c1d 7.5yr6/6 sicl ifsbk mfr cs - - - - -- .2 .3 7.5yr6/2 7 45 -71 5yr4/4 cld 5yr6/6 sl Om mfr - - -- - - - - -- .2 .6 5yr6/2 4] Boring # Boring Pit Ground surface elev. 86.4 ft. Depth to limiting factor 33 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 -14 10yr3/2 none sil 2mgr mfr cs 2m,2f .6 -8 2 14 -16 10yr5 /3 none sil 2fsbk mfr gw 2m,2f .6 .8 3 16 -29 10yr4/4 none sl 2fsbk mfr gw 2f,2vf .6 1.0 4 29 -33 10yr5/6 none Ifs lmsbk mfr cs 2vf .5 1.0 5 33-44 7.5yr4/4 c2d 7.5yr5/6 sl Om mfi gw - - - - -- 2 6 7.5yr6/2 6 44 -60 7.5yr5/6 c2d 7.5yr6/8 lvfs Om mfi as - - - - -- 2 5 7.5yr6/2 7 60+ Fractured Limestone ---- - - - - -- ------- - - - - -- --- - - - - -- - - -- - - - --- 0.0 0.0 F - s I Boring # E] Boring pit Ground surface elev. 87.2 ft. Depth to limiting factor 27 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 -8 10yr3/2 none sil 2mgr mvfr as 2m,2f .6 .8 2 8 -14 10yr3 /4 none sl 2fsbk mfr gw 2f,lvf .6 1.0 3 14 -21 7.5yr5/4 none sl 2msbk mfr gw ivf .6 1.0 4 21 -27 7.5yr4/4 sl lmsbk mfi gw - - - - -- .4 .7 5 27 -32 10yr5/4 c2d 10yr6 /8 10 r6 2 vfsl Om mfi cs - - - - -- 2 5 6 32+ Fractured Limestone ---- - - - - -- -------- - - - - -- --- - - - - -- - - -- - - - - -- 0.0 0.0 Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 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 TTY 608 -264 -8777. SBD -8330 (8.07/00) Schmitt Soil Testing, Inc. Page 3 of 4 Conducted by: Conducted For: Schmitt Soil Testing Inc. Name: David & Kristy Paulson Thomas J. Schmitt, CST 227429 Address: 618 Tower Road 1595 72nd St. City, State, Zip: Hudson, Wl 54016 New Richmond, Wl. 54017 Phone: 715- 47 -2941 Subd.Name: CSM 22 -5323 Sign cam , Lot No.: 4 D _� I / C/z� Legal Description: NWl /4 SWl /4 S3 T28N R19W Backhoe pit Township, County: Town of Troy, St. Croix County A Bench Mark EL 100.00' Top of 2" pvc pipe Q Alternate Bench Mark El. 101.12' Top of 2'" pvc pipe Slope= 6% Contour Line El. 99.95' Contour Length 90' 6r; Scale 1" = 40' IVy Pr,` Z / hl All � GUM7`ovi 2 n�FL E -c 7S S / ' � p N <. � �� �q, , Casf of Of ��Y f-��p gu,'ic�,ny Steer a�s'3 m"rp"".,'= _ n*°'- »:gi _ t ..R� b:: - . •� � l .� wn • ��� li �. s; (.. '� � ,�;,• ' wry � •t ,piq 7• i Pik .i ^. °"�' t µ s.F�f a As' -t « lk" fir• �i,.: _ . .. •�� #,..,,,, �{ � �• • , � .. .�+ -•� � I «: �•�� �._ s r - - _ A F i fi v r, e. . £Z£S 0 SRa ZZ TOA cc _ 7y� Z M 3 0 L 133HS � e3 R JLO V &BJL 11 U V �c�J r+ .99 '8'l•£ M.G*.0 L OOS 5 ry 00 4 H I D RA l c c V C LO of cv W a 1 . 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Q3AI3OHa IA ' '00 KIOBO "IS sa33a -du aa.iSls3a � N •H x3 olvx La 9 l NYC' £Z£S 3` vd ZZ lot% Z=- #D OS, 6IE:@ ST, CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OOwner/Buyer D r/ Vi k) -t ' 4 0 L 5 0 AJ Mailing Address 6 , 1 0 - TO W C (e ied . )4&1 1 5 41 01 6 E Property Address S+ t (Verification required from Planning & Zoning Department for new construction.) City /State N U J S 0 10 Ll l l Parcel Identification Number Q 4 1 LE9AL DESCRIPTION Property Location l vi 1 /4 , rl.� t/a , Sec. 3 , T ZLN R I q W, Town of �C Subdivision , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # Volume , Page # Spec house yes n Lot lines identifiable (�§o 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 tbree 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. I/we certify that all statements on this form are true to the best of my /our knowledge. I/we am/are the owner(s) of the property described above, by virtue f a warranty deed recorded in Register of Deeds Office. 7 N of Q IGNATURE OF APPLICANTS) 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) I = 111!1!1 dill dill cliff Ilffl Illif llll !lllfl IIf1 il11 * 8 8 8 2 3 9 1 State Bar of Wisconsin Form 2 -2003 888239 WARRANTY DEED B vL SETH PABST REGISTER OF DEEDS Document Number Document Name ST. CROIX Co., WI RECEIVED FOR RECORD THIS DEED, made between Jon M. Sonnentag and David E. Paulson 02/06/2009 01:15PM WARRANTY DEED ( "Grantor," whether one or more), EXEMPT o 5 and David E. Paulson and Kris A. Paulson, husband and wife REC FEE: 11.00 PAGES: 1 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other interests, in St. Croix County, State of Wisconsin ( "Property") (if more Recording Area space is needed, please attach addendum): i e ne remier Grou 706 1 g� Street South P Lot 4 of Certified Survey Map filed in Vol. 22, Page 5323, as Document No. 839902, Hudson, WI 54016 being a part of Lot 3 of Certified Survey Map filed in Vol. 12, Page 3492, all being a part of the NW '/< of the SW %< and the SW 'h of the NW '/. of Section 3, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin. 040- 1010 -70- 2450 Parcel Identification Number (PIN) This homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Roadways, Easements and Restrictions of Record. Dated January 28, 2009 . (2 �;� - (SEAL) (SEAL) * Jon M. Son to * avid E. Paulson (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on ) ss. ST. CROIX COUNTY ) * Pers a before me on January 28, 2009 , TITLE: MEMBER STATE BAR OF WISCONSIN pm Jon M. Sonnentag and David E. Paulson (If not, Ala Q s� authorized by Wis. Stat. § 706.06) m1 own to be the person(s) who executed the foregoing s t ac owl ged th same. THIS INSTRUMENT DRAFTED BY: Michael H. Forecki, Attorney * Evelyn M. Mc Eau Claire, WI Notary Public, State of Wisconsin My Commission (is permanent) (expires 8/26/12 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED C 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. t I Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix �S ,Iety and Building Division INSPECTION REPORT Sanitary Permit No: 50 11 _ 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: Tran, Linh & Nguyen, Thu Troy, Town of 040 - 1010 -70 -250 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 03.28.19.42A50 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATIO TANK TO P/L WELL BL Vent to Air Intake ROAD Dt Inlet Septic Dt Bot Dosing der /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer mand St er PM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Weil SOIL ABSORPTION SYSTEM BED /TRENCH Width Length o. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO L JBLDG IWELL LAKE /STREAM LEACHING ufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Mode umber: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length 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 xx Mulched D e p /Trenc r Center Bed /Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 618 Tower Road Hudson, WI 54016 (NW 1/4 SW 1/4 3 T28N R19W) NA Lot 4 Parcel No: 03.28.19.42A50 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3197) ♦ y Safety and Buildings Division County NVi sconsin 201 W. Washin gto on A Ave., e., P.O. Box 7162 Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266 -3151 eYO I0/6 ZO 2 ,60 aft Sanitary Permit Application State Plan I. . Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, sl5.04(1)(m) Prod ddress (if different than mailing address) I. Application Information — Please Print All Information�� Property Owner's Name arcel # Lo Block # , l'!/ 0 1/ Property Owner's Mailing Addre Property Locati /viw '/, 1 A Section 2 City, State Zip Code Phone Number O /l RECEIVED N R EoeJ ,Ja 11. Type of Building (check all that apply) 1 or 2 Family Dwelling — Number of Bedrooms ubdivision Name Q CSMgNumber ❑ Public /Commercial — Describe Use ❑State Owned — Describe Use X 41 , 4 ,, j ST, CROIXCOU ]City _ ❑VillagTownshipo �^Q' III. Type of Permit: (Check only one box on line A. Complete line B i app rca e A. XNew System ❑ Replacement System ❑ Treatment/Holding Tank Repla ent Only O / E in e --- B. ❑ Permit Renewal 11 Permit Revision ❑ Change of El Pe Transfer to New Li re us it N mb Before Expiration tuber Own / IV. Type of POWTS System: Check all that apply) J ❑ Non — Pressurized In- Ground R > 24 in. of suitable soil Mo d < 24 in. of suitable soil 11 At-Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland 11 Pressurized In- Ground El Holding Tank t Filter El Aerobic Treatment Unit El Recirculating Sand Filter El g S yn thetic Media Filter Recirculating ❑Leaching Chamber El a ravel -less Pipe El (explain) V. Dispersal/Treatment Area Information: a . 2 Design Flow (gpd) Design Soil Application Rate(gpdsf) Dist al Area Require Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Num Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of its Concrete Constructed Glass New Existing I I NZ Tanks Tanks v ` ` 1 Septic or Holding Tank c J'L Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the unde igned, assume responsibility for installation of the POWTS shown on the a ed plans. Plumber's Name (Print) PI is Signature MP /MPRS Number Busine hone Number Plumber's Address (Street, City, State, L ode) � `411 �� l c t► ��G'4" VIII. Coun /De artment Use Ohl Approved ❑ Sanitary Permit Fee (includes Groundwater ;22 suKo Issuing t Signat tamps Surcharge Fee) u E] �Wgea, f or Denial 1 p ( J IX. Conditions of Approv /Reasons for Disapproval SYSTEM W. rn I 11II l t. Septic to effluent filter and t.J 4." S d'ISpersal cell must all be services / maltttaiite� as per management plan provided by plumber. ,1 (� 2. All ssi Wk r****y ettts must be md"3111tad y, fi t ,,_ ta•C�. � � � C 1 tD �Or: ae per spplcW e: code I Attach complete plans (to the County only) for the system on paper not less than 81/2 x I I inches in size SBD -6398 (R. 01/03) , tE �l�o` �r /off /CIE SC4/2 • O /y c G;n /ey l L Z b/u¢ , IZI/G1 (o3 ,f <� dfiJt�ey 0 I � r � I / P �I lam -4r`� o T" �►� ? i 1 f� be b add ec/ a s per Corn. 8z. 3c (i /)('el l�ropoStd (.c9.'tsel Cr/nC/� (r.9Ll� /, 2GO / &CO • MQ Crn„b%,a�E %o+'� j. �o/ S2 S" L "w. % U be dae5.r,owl /a z z Ta>,�&-, e aFCcrrm. /yC,emalen nafcrla/ z5v6e tv be . I c v h v - r Sca /e 77 272; iy7 �G ;nl¢y�j5 /tea fJ� %riEy, ,t G3 - c c� d.riJt�ay I X0.0 q t 6 . c�_ ✓(a; f 5" Goo, r LA LA if eon•�pK� ti/'eE. � /¢d.'= /03.82. r � / r o / 1 flea d� l cJ�od�d 5, �e 3 a LK;n tai 6 eddec ( aseer =11. al. 30 /)(c) �ill Sul¢ 4 4SPc,- Cmrrivf.fj2.30�i(���J. � \ 1�i'apostd [.c7: use/ GmC /�.e c.�Ll���a0 / &�0 • M�Q Crn•nb. %ic..E %or � / be be 6cdcle&Q5 o 1Y/ l�Gp E . cF Cornet. /7Gnen -/ ma. f 4r i o / to &e bcdd,n� /o- b ui' / dr� sc�ac y �J �J \ \ Y V 1 i v J Safety and Buildings 4003 N KINNEY COULEE RD commerce.wi.gov LACROSSE WI 54601 -1831 ,ti TDD #: (608) 264 -8777 ��0�� www.commerce.wi.gov /sb/ epartment of Commerce www.wisconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary March 16, 2007 CUST ID No. 220853 ATTIC• POWTSInspector DALE E HUDSON BOLDT'S PLUMBING & HEATING, INC. ZONING OFFICE 820 MAIN ST ST CROIX COUNTY SPIA PO BOX 78 1101 CARMICHAEL RD BALDWIN WI 54002 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/16/2009 Identification Numbers Transaction ID No. 1380405 SITE: Site ID No. 723296 Linh Tran & Thu Nguyen Please refer to both identification numbers, 618 Tower Road above, in all correspondence with the agenc Town of Troy St Croix County NW1 /4, SWIA, S3, T28N, R19W FOR: Description: Four Bedroom Mound System / New construction Object Type: POWTS Component Manual Regulated Object ID No.: 1122337 Maintenance required; 600 GPD Flow rate; 9 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD 10691 - P (N.01 101), Pressure Distribution Component Manual - Version 2.0 SBD - 10706 -P (N.01101) The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manual(s) referenced above. • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally down slope of the dispersal cell shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(7) - A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspec tors. P.O.W.T.S. Conditionally APPROVED DALE E HUDSON Page 2 3/16/2007 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 —. Balance Due $ 0.00 &rd Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. f MAR 2007 MOUND AND PRESSURE DISTRIBUTION COMPONENT DEg Residential Application u Vrrr�r(aS INDEX AND TITLE PAGE Project Name: Linh Tran & Thu Nguyen 4- bedroom residential POWTS Mound Owner's Name: Linh Tran & Thu Nguyen Owner's Address: 616 Tower Road Hudson, WI 54016 Parcel Address: 618 Tower Road Legal Description: NW1 /4 SW1 /4, Sec. 3, T.28N., R. 19 W. Township: Trou County: St. Croix Subdivision Name: CSM Vol. 22, Pg. 5323 Lot Number: 4 Block Number: Na Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Soil Evaluation Report Designer: Dale Hudson License Number: 220853 Date: 01/04/07 Phone Number: (715) 684 -3378 Signatur Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 4.01 (R. 09/04) DivisioN OF SAFETY AND BUILDINGS Page 1 of 9 1 SEE CORR PONDENCE Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) _ R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow d Table 83 -44 -3 in -situ soil treatment for fecal (gp) coliform of <= 36 inches. 1.50 Peaking Factor (e.g. 1.5 = 150 %) 600.00 Design Flow (gpd) 10.00 Site Slope ( %) 100.75 Contour Line Elevation (ft) 9.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd /ft ) Distribution Cell Information II I -- 90.00 Dispersal Cell Length Along Contour (ft) = 6.67 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ff) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution ! Y Pressure Disribution Information network? Enter Y or N (c or e) c Center or End Manifold 2.22 Lateral Spacing (ft) if N above, enter the elevation (ft) 6 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.22 Estimated Orifice Spacing (ft) = 5.00 ft/orifice 2.00 Forcemain Diameter (in) _ 40.0 Forcemain Length (ft) Does the forcemain drain back? Y 94.0 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 6.52 Forcemain Drainback (gal) 8.56 Vertical Lift (ft) 84.61 5x Void Volume (gal) 1.95 Friction Loss (ft) 91.14 Minimum Dose Volume (gal) 17.02 Total Dynamic Head (ft) 49.43 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options ch oice 0.75 __ 1.25 1.00 x - - -- 1.50 x 1.25 x x 2.00 x 1.50 x 3.00 2.00 x I - -- -__ _. _ -- i 3.00 x -- - -`J Gallons /In ch Calculator (optional) Treatment Tank Information 800.641 Total Tank Capacity (gal) i 1200 -800 1 Septic Ta nk Capacity (gal) - _ 36.00 Total Working Liquid Depth (in) Wi eser Concrete C orri Manufacturer 22.24 gavin (enter result in cell B49) Dose Ta nk Information Efflue Fi Information _orm_ 800.64 Dose Tank Capacity (gal) 1Pol Lok _ Filter Manufacturer 22.24] Dose Tank Volume (gal /in) ; P -52 i Filter Model Number W ieser Concrete ]Manufacturer Project: Linh Tran & Thu Nguten 4- bedroom residential POWTS Mound Page 2 of 9 Mound Plan View T 1/10 B . :a; J F K y _ _ Observation Pipe . . . . . . . . . . . . W 'B. -. . . . ........... . . . .. I L Mound Component Dimensions A 6.67 ft E 35.00 in H Aft ft K 13.06 ft B 90.00 ft F 9.25 in z ft L 116.13 ft D 27.00 in G 0.50 ft J ft W 32.74 600.30 (ft Dispersal Cell Area 1 2215.61 (ft Basal Area Available 6.67 (gpd /ft) Linear Loading Rate 1 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 104.77 (ft) --► H F ; : ; : 103.50 (ft) Lateral Dispersal Cell 103.00 (ft) Invert Dispersal Cell Elevation E D; i . 100.75 (ft) Contour Elevation 10.0 % Site Slope Geotextile Fabric Cover Shading Key �, a Dispersal Cell See lateral details on 10 _ Topsoil Cap c a 1.5 ft ;; ; Page 4 for number, size, Subsoil Cap c and spacing of laterals. ASTM C33 Sand Laterals are uall Q ``] Tilled Layer d 0.5 ft ' Typical Lateral F spaced from the []5 : �::• }: Aggregate a �5 distribution cell's ° centerline in the A -'* distribution cell (AxB). Project: Linh Tran & Thu Nguten 4- bedroom residential POWTS Mound Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical S T I Fl S y • = Turn -up vi'ball valve or I<- X I<- x12 I K124I Laterals & force main of PVC Sch 40 of ea n out pl u g per COMM Table 84.30.5 Holes drilled on the bottom of the lateral. Number of Laterals 6 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.27 ft Lateral Length (P) 44.27 ft Orifices per Lateral 20 Lateral Spacing (S) 2.22 ft Orifice Density 5.00 ft /orifice Lateral Flow Rate 8.24 gpm Manifold Length 4.45 ft System Flow Rate 49.43 gpm Manifold Diameter 1 - Z- Total Dynamic Head 17.02 ft Forcemain Velocity 5.05 ft/sec Dose Tank Information Locking cover with warning label and locking device and �1 sealed watertight Electrical as per NEC 300 and --► Comm 16.28 WAC Disconnect 4 in. min. Tank component is properly vented E-- Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Cap acityl 800.64 Gallons Volume 22.24 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 18.65 414.82 B 2.00 44.48 C P ump off elevation (ft) C 4.10 91.14 94.94 D � 11.25'. 250.20 D Total 36.001 800.64 i � Do se tank elevation (ft) 3' Bedding uncTer tank. 94.00 Alarm Manuafacturer LeveIArm Alarm Model Number DLV Pump Manufacturer Goulds Pump Model Number !WE05H Pump Must Deliver 49.43 gpm at 17.02 ft TDH ,/ Project: Linh Tran & Thu Nguten 4- bedroom residential POWTS Mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Dale Hudson Phone (715) 684 -3378 POWTS Regulator's Name St, Croix County Zoning Phone (715) 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1200 -800 gal Maximum TSS 150 mg /L Soil Absorption Component Size 600.3 ft Maximum FOG 30 mg /L Type of Wastewater Domestic I Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years in and seepage once eve 3 ound Inspect for pond a every y ears y _ Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished ••........•.•. _ � ............... Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve •. Distribution Lateral 'y Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Linh Tran & Thu Nguten 4- bedroom residential POWTS Mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code G eneral This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01 /01) and SSWMP Publication 9.6 (01/81)} and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole 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 a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. 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 lter hall serviced ' i continuously. In rmittent filter alarms may indicate sure flows or an impending e s be se ce if the alarm s activated to y g pe 9 continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation, If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg/L BOD 30 mg /L TSS, 10 mg /L FOG, and 10 cfu 1100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this Installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as 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. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: Unh Tran & Thu Nguten 4- bedroom residential POWTS Mound Page 6 of 9 GOULDS PUMPS Submersible Effluent Pump let 3885 PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■ Shaft: Corrosion - resistant Single phase: ■ Bearings: Upper and stainless steel. Threaded • Built -in overload with lower heavy duty ball bearing Specifically designed for the design. Locknut on three phase automatic reset. construction. • Homes g uses: models to guard against • All single phase models ■ Power Cable: Severe duty Farms component damage on feature capacitor start rated, oil and water resistant. •Trailer courts E poxy accidental reverse rotation. motors for maximum E ox seal on motor end ' • Motels ■ Fasteners: 300 series starting torque. provides secondary moisture • Schools stainless steel. •' /3 and 1 12 HP - 16/3 SJTOW barrier in case of outer jacket • Hospitals ■ Capable of running dry with 115, 208 and 230 Volt damage and to prevent oil • Industry without damage to three prong plug, wicking. Standard cord is 20'. • Effluent systems components. • 1 /4 -2 HP - 14/3 STOW with Optional lengths are available. bare leads. ■ 0 -rin Assures ositive ■ Designed for continuous Three phase: g' p sealing against contaminants SPECIFICATIONS operation when fully • Overload protection must submerged, be provided in starter unit. and oil leakage, Pump •Solids handling capabilities: •' /z -2 HP -14/4 STOW with bare leads. %1 maximum. MOTORS AGENCY LISTINGS • Discharge size: 2" NPT. ■ Fully submerged in high- ■ Designed for Continuous • Capacities: up to 140 GPM, grade turbine oil for lubrication Operation: Pump ratings are Tested to UL 778 and • Total heads: up to 128 feet and efficient heat transfer. within the motor manufacturer's CSA 22.2 108 Standards ® By Canadian Standards TDH. recommended working limits, Association • ■ Class B insulation. can be o orated continuous) ic us Temperature: P Y File #LR38549 104 °F (40°C) continuous without damage when fully 140 °F (60°C) intermittent. submerged. Goulds Pumps is ISO 9001 Registered. • See order numbers on voltage s for specific HP, METERS FEET _ _', _. ,. _. l �...._�:_ - _ __ T SERIES 3sas - �' i P r 130 ._ __.. - _ _ RPM. 3500 LI available. hale and RPM's I. 1750 3< SOLIDS 35 �_._. 100, -WE2QH ��GPM 1 _l. �... .; 110 FEATURES 30 ■Impeller: Cast iron, semi- w zs �. open, non -clog with pump out = Er q" vanes for mechanical seal 70 E Eo H - T protection. Balanced for Z zo j 1.. l > 60i i.. -r- - - -- — __ smooth operation. Silicon Q 15F 50! woo 7__ bronze an option, im peller available as 10� 30 40`_wEO ■ Casing. Cast Iron volute type for maximum efficiency. .ot 2 "NPT discharge. 7741 /1 lo. -- I - - ■ Mechanical Seal: SILICON o Q 0 __ _ !...___ _.. __ __._ t ..._ __.__._ __ CARBIDE VS. SILICON 10 20 30 10 50 60 70 80 90 100 110 120 130 140 150 160 GPM CARBIDE sealing aces. L - � - - -1 g 0 5 10 15 20 25 30 35 m /hr Stainless steel metal parts, APACITY BUNA -N elastomers. S/Q � nt %n��nu•nSKp�°y r'tyu�� -off o Goulds Pumps 2002 Goulds Pumps ITT Industries Effective October, 2002 www.goulds.com 83885 �G 707119 l d 1970 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations Attach complete site plan on paper not less than 8%: x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel L D. 040 - 1010 -70 -200 Please print all information. Reviewed By Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Roger Huerta Govt. Lot NW 1/4 SW 114 S 3 T 28 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 616 Tower Road _ 3 CSM Vol. 12, Pg. 3492 City State Zip Code Phone Number J City J Village e Town Nearest Road Hudson WI 1 54016 1 (651) 775 -2432 Troy Tower Road New Construction Use: V/ Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD —; Replacement J Public or commercial - Describe: Parent material Glacial drift over sandstone bedrock. Flood plain elevation, if applicable na General comments and recommendations: Site suitable for mound system with 27" of ASTM C -33 sand fill placed on 100.75' conotur. Site limited to linear loading rate of 4.0 gpd. FT] Boring # — Boring 1J/ Pit Ground Surface elev. 100.62 ft. Depth to limiting factor 9 in Soil Application Rate Horizon ! Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in Munsell I Qu, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -4 10yr3/2 none sil 2fsbk mvfr cs 2fmc 0.6 j 0.8 2 4 -9 10yr4/4 none sicl 2fsbk mvfr aw 1fmc 0.4 0.6 3 9 -20 10yr6/4 none SSBR Na Na - - 0.0 1 0.0 H #3 consists of hard sandstone plates 1" thick, ranging in size from 3" x 3" to 16" x 16 ". FT Boring # I Boring vi Pit Ground Surface elev. 100.77 ft. Depth to limiting factor 18" 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 0-4 10yr3/2 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 4 -10 10yr3/6 none sicl 2fsbk mvfr aw 1fmc 0.4 0.6 3 10 -18 10yr6/4 none SSBR Na Na - 0.0 0.0 H #3 consists of hard sandstone plates 1" thick, ranging in size from 3" x 3" to 10" x 10 ". Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 1 mg /L ffluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Signatur . CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osce a, WI 54020 2/28/2006 715 - 248 -7767 I - - V • Property �wner Roger H uerta Parcel ID # 040-1010-70-200 Page - - 2_ .- of 3 37 Boring # -J Boring ✓ Pit Ground Surface elev. _._._.- 99. ft. Depth to limiting factor 18" in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 1 in Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 — - - -- -- ! - -- - - 4 10yr3/2 none SII 2fsbk mvfr cs 2fmc 0.6 0.8 2 4 -9 10yr4/4 none sit 2fsbk mvfr aw 1fmc 0.6 0.8 3 9_18 10yr3/6 none slcl 1msbk mvfr aw I 1fmc 0.4 0.6 4 18-28 10yr6/4 none - SSBR Na Na — 0.0 0.0 i H #3 consists of hard sandstone plates 1" thick, ranging in size from 3" x 3" to 16" x 16 ". ❑ Boring # -J Boring - Pit Ground Surface elev. _ __ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color ! Redox Description Texture Structure Consistence Boundary Roots n. Munsell Qu. Sz. Cont. Color Gr, Sz. Sh. 'Eff#1 'Eff#2 - - - -- - -- - -- - - Y -- -- j I ' I ! I i i I i i I I i i ❑ Boring # Boring — i Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence 7Founclary Roots in Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. 'Eff #1 Eff#2 i I I i � Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L l he Department of Commerce is an equal opportunity service provider and employer, ll'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. 5BIM33u (R 07x00) A.C.E. Soil & Site Evaluations I� 01 /,Uj. /07 THU 13:36 FAX 715 386 4686 002 j /I /'add EX MC- G;n/ay ///a¢iz Pro��cy /of 3, CS 12VJV12 /�li:iysu r SE -GroiX Ce, c -' x,53 L& �o -t +jCL M S.. afr Con�� t/•Ce. E /¢C!, = /03.82 pI r i r , r I� l,�ea df l u�cod� 5, 4 ` m I i I I ti „o W v II �. 1970 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page f of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Ad . Coft lk A.C.E. Soil & Site Evaluations j Attach complete site plan on paper not less than 8% x 11 inches in size. Plan m St. Croix Include, but not limited to: vertical and horizontal reference point (BM), direction cat percent slo pe, scale or dimensions, north arrow, and location and distance to nearest road. 040 1010 -70 -200 Please print all information. Revi Date Personal information you provide may be used for s. 15.04 (1) (m)). Property Owner Property Location Roger Huerta Govt. Lot NW 1/4 SW S 3 T 28 N R 19 W Property Owner's Mailing Address NO V 2 Z130b Lot # Block # Subd. Name or CSM# 616 Tower Road 1 3 1 1 CSM Vol. 12, Pg. 3492 City StateZip (�gfieCA'tflt3(al r J City _J Village ✓J Town Nearest Road Hudson I WI I 54016 Troy I Tower Road tA New Construction Use: 16 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD J Replacement J Public or commercial - Describe: Parent material Glacial drift over sandstone bedrock. Flood plain elevation, if applicable na General comments and recommendations: Site suitable for mound system wit 27" o ASTM C -33 sand fill placed on 100.75' conotur. Site limited to linear loading rate of 4.0 gpd. Boring # J Boring 16 Pit Ground Surface elev. 100.62 ft. Depth to limiting factor 9 in. Sot Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/l? in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr3/2 none sil 2fsbk mvfr a 2fmc 0.6 0.8 2 4 -9 10yr4 /4 none sicl 2fsbk mvfr aw lfmc 0.4 0.6 3 9 -20 10yr6 /4 none SSBR Na Na - - 0.0 0.0 H#3 nsists of hard sandstone plates 1" thick, ranging in size from 3' x 3" to 16" x 16 ". Boring # I Boring 16 e Pit Ground Surface elev. 100.77 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP Ift' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eft#2 1 0-4 10yr3/2 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 4 -10 10yr3 /6 none sicl 2fsbk mvfr aw 1fmc 0.4 0.6 3 10 -18 10yr6 /4 none SSBR Na Na - - 0.0 0.0 H#3 consist"f hard sand T ne plates 1" thick, ranging ins' from 3" x 3" to 10" x 10 ". * Effluent #1 = BOD? 30 220 mg/L and TSS >30 < 10 rrl! ffluent #2 = BOD S30 mg /L and TSS <_30 mg/L CST Name (Please Print) Signatur . CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane Os a, W154020 2/28/2006 715- 248 -7767 ' Property owner Roger Huerta Parcel ID # 040- 1010 -70 -200 Page 2 of 3 3 Pit Boring # Boring Ground Surface elev. 99.42 ft. Depth to limiting factor 18" in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10yr3/2 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 4 -9 10yr4/4 none sil 2fsbk mvfr aw 1fmc 0.6 0.8 3 9 -18 10yr3/6 none sicl lmsbk mvfr aw 1fmc 0.4 0.6 4 18 -28 10yr6/4 none SSBR Na Na - - 0.0 0.0 # nsists of hard sandstone plates 1" thick, ranging in size from 3" x 3" to 16" x 16 ". ❑ Boring # Boring Pit Ground Surface etev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F-1 Boring # I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD S > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD <30 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 TTY 608- 264 -8777. SBD -8330 (R.07 100) A.C.E. 5011 & Sft EvadHtlws - 4 /o���7e Aw "1f-G;nl¢y / //u¢ice. 0 /oE 3, cs.i / S ,/.3y9z, ec C. 3, T. Ze 1 ,Q /9cJ. 7Tn dF 7�ay, S6 -Croix Ce.,�i. 6 �3 f{ AIE. VS. trl ✓(ad r? S i t bf r r f � f � I i h/ ail ly cJ4O&d S,te 3 51 Ja,Ckin \ A \ \ O\ � O\ � m W Ass um 6 & Llelt ti d 01 o� 3 0 �. 3 0� 3 v 839902 VOL 22 PAGE5323 KATHMN H. WAUGH REGISTER OF DEEDS ST. CROIX CO. VI RECEIVED FOR ORD 12/04/2006 06 -"AN CERTIFIED SURVEY HAP to A C Z GY7 b �'� z y ® • o REC FEE: 13.16 Lo PER- 3.00 PAGES: 2 ' •� �\ J J Eli � e is � -. � � a ' s ► ., t, \ u s C x THE WEST u NE OF THE Sw1 /4 of SECTION 4 $ y �► 3 BEARS S00I06'04 "E AS REFERENCED TO rw THE ST. MX COUNTY COORDINATE SYSTEM c� SOO'08'04" 2630.6 'All 2211.89 418. �p n� WEST LINE S NE OF THE WI /4 -3 & -++ r� .11 s W �$ LOT 2 C.S.M. ON V OL. 12 PG_ � pi (NO t U4'00 "E 461:69') r NOt'06't2 "E 461.72' °9 � .. ................:.............� i i W i r \ pp N a 1 ;p r I-4 p c 31 a aw iO l o ` o C � S 888 pia tpz x•��■ _ N r HIM[ 3'wv+ 3r y$ s I RA . �¢ W 9 9 ym (SOo1WoB-w)S00'10' 348.55 TRACT SHEET 1 OF 2 Vol 22 Page 5323 6L CERTIFIED SURVEY MAP LOCATED IN PART OF THE NW 1/4 OF THE SW 1/4 AND IN PART OF THE SW 1/4 OF THE NW 1/4 OF SECTION 3, T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, NSCONSIN, BEING LOT 3 OF CERTIFIED SURVEY MAP RECORDED IN VOLUME 12, PAGE 3493 AT THE ST. CROIX COUNTY REGISTER OF DEEDS OFFICE. SURVEYOR'S CERTIFICATE: I, Ty R. Dodge, Registered Wisconsin Land Surveyor, hereby certify that by the direction of Unh Tran and Thu Nguyen, I have surveyed, divided and mapped part of the NW 1/4 of the SW 1/4 and part of the SW 1/4 of the NW 1/4 of Section 3, T28N," R19W, Town of Troy, St. Croix County, Visconsin, being Lot 3 of a Certified Survey Map recorded in Volume 12, Page 3493 at the St. Croix County Register of Deeds Office, described as follows: Commencing at the West Quarter comer of said Section 3; thence, along the West line of the Southwest Quarter of said Section 1 SOO'08'04 "E a _ distance of 418.71 feet to the northerly right —of —way of Tower Road; thence, along said right --of -way, N79'16'27"E a distance of 667.28 feet to the southwest comer of said Lot 3 and the point of beginning; thence, all the following being along the exterior boundary of said Lot 3, N01'06'12 "E a distance of 461.72 feet; thence N89 49'02 "E a distance of 653.94 feet; thence S00'10'49 "W a distance of 348.55 feet to said right —of —way, thence, along said right —of —way, 583'21'38 "W a 'distance of 174.88 feet to the point of curvature of a 1666.00 foot radius curve, concave southerly, with a central angle that measures 05'29'24" and a chord that boom S80 36'56 "W and measures 159.57 feet; thence, westerly along the are of sold curve and along said right —of -way a distance of 159.63 feet to the point of tangency, thence, along said right —of —way. S77'52'14W a distance of 193.38 feet to the point of curvature of a 4900.00 foot radius curve, concave northerly, with a central angle that measures 017413" and a chord that bears S78'34'20.5 "W and measures.120.04 feet; thence, westerly, along the are of said curve and along said right -of -way a distance of 120.04 feet to the point of tangency, thence, along said right —of —way, S79'i6'27W a distance of 24.29 feet to the point of beginning. Containing 6.010 Acres (261,797 Sq. Ft.). Subject to all easements, restrictions and covenants of record. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that 1 have fully compiled with the provisions of Chapter 236.34 of the Wisconsin statutes and the land subdivision ordinance of St. Croix County and the Town of Troy in surveying and mapping the same. REV P -13 ` ��pmtmlu,A dge RLS #2484 Date `40 �SCONS /H`� land Surveying ; .......••• 2920 Enloe St. 3 " �..:' Ty R. �`'�* Hudson, WI 54016 _ DDDGE S -2484 t % CLEAR LAKE, COUNTY TREASURER'S'CERTIFK�t�' 1 2006 '��,, fg U STATE OF WISCONSIN If not mwr '� wNhIn 30 � of gVmvai r WPMVM Md be COUNTY OF ST. CROIX)SS W void 1, CHERYL SLIND, BEING THE -DULY ELECTED, QUALIFIED AND ACTING TREASURER OF ST. CROIX COUNTY, DO HEREBY CERTIFY THAT THE RECORDS IN MY OFFICE SHOW NO UNREDEEMED TAX SALES AND NO UNPAID TAXES OR SPECIAL ASSESSMENTS AS OF AFFE CTING THE LAND INCLUDED IN THE CERTIFIED SURVEY MAP. CHERYL SLIND, DATE COUNTY TREASURER DRAINAGE EASEMENTS NO OWNER OR RESIDENT SHALL DO ANYTHING WHICH WOULD INTERFERE WITH OR CHANGE THE OPERATION OF THE APPROVED COMPREHENSIVE WATER DRAINAGE AND SOIL EROSION PLAN FOR THIS PLAT. THIS INCLUDES BUT IS NOT LIMITED TO BUILDING UPON, OBSTRUCTING, ALTERING, FILLING OR EXCAVATING, OR PLANTING IN ANY POND OR DRAINAGE EASEMENTS, WATER DRAINAGE DITCHES, WATER RUNWAYS, WATER CULVERTS, BERMS OR GRASS SEEDINGS. THIS INSTRUMENT DRAFTED BY: IMLUAM XANE ,HOB NO. 6589 -01 DATE: 10/20/2006 SHEET 2 OF 2 Vol 22 Page 5323 i p 2 -1 tft t-n z 2 ty/f N m m � z�� V O �- I z $N I r. m c� c � o ' �m = 0 1 �� xz z �ro 'A A� � p K g 0 fil A A C 0 -1 > THE WEST UNE OF THE SWI /4 OF SECTION 8 z 2i 3 BEARS S0OWO4'E AS REFERENCED TO m THE ST. CROIX COUNTY COORDINATE SYSTEM L07 2 C W VOL _1_2 Pty. M93 Ni (NO 7 "E 461.69') ---- - - - - -- _tea w N01'0612 "E 461.72' z. � o, 'W M R ....... ............................... ;5 ♦ a IG' V I A C VI ,4 N w a W . � � (a � a '1� ,�. ✓ = 1 I'l •�'�•••'" - O $ MME sw ___ = = $Z� 8 888 ,1O ° —`�_�� .'�� 1 E 221.23 00= Q nC sI Kim s0370's5'E ieo�r 0 _N -_ - - CAR d �1 1. IRA DUI (A rA IQ x.1 = = '' • ►V$ � O �t+i 0 CA - $ 7 Z I�liu I I 1 - u �� z O VNa b ID ^ �N I� La I-5 -t 19 m a I . ......................... �3° 1 4 i 343.25' N ^ NN In ^-0 ` ~� V y V V V y Y 1 i �, I (Soo oe'oa "W)SO0'10'49 "W 348..55' N W #.011' f�O c�JN/U k LL TRACT U l g I , SHEET 1 OF 2 //- - - - --7 x - - - - - va r/ a m -- \ \\\ \ \ \ \ % _ x % 1 \ 1 , o N 1 XI - N o x V 11 x p fV A O 1i 1 3 ff fP N 101 -�Y _ y v ,p A �/ OD ID 4 QJI i p 1 d adN� QW 31yWIX0 / X 1 , , / / v--• A'� .'OJ / r % - s E,�IY' 1 ^'�ir' .`i.. • �, N , 1 OD / i ° w () N N _ 1 `'_`° ` % ro �ru \ 9' mry x /Q 1 m / I ,n (D \' am o I \ \ \ i \ g r A A ry ,w z 8 I ) ru a p I / I � /k C --) X 6\ w �� , 1 ~ -•! _ _ _ / � % I �' O i I i- -- - -- r --- --- - -- ?�' W ' p � ru 1 �IIIIIIIIIII ' / / 0 0 ro Cl) O ro CD N Jr / - --- II t`\ �W -- LOT OVERVIEW — 618 TOWER RD. M— TIM TRAN SECTION 3, TYSN WOW — TOM{ OF TROY ST. CRO X COUNTY. M '�� "'�� f✓p w. asu-m Auth•Consulling/mMiAtes SH land Snty pg 01/04/2007 12:18 7156475181 WIESER CONCRETE PAGE 02103 aw oortdv+ avd 99bS- 5L� -fla8 90OZ 'Nvr 'AA 90Iu {pi 3 40 tlSt1S iM 'JMO� N3wm m"li Sri OUTM 1N►s ae w�rnD ����9 �� G? 31up ON A 3311 , t = . ► /tom ofdti1 Nyi -009 00Z ld-A V. H CA W z w us a �s W Ir w + v� W p �i ' W F Q U W N_ Q - 4? W r � VI t Q °W t`i i z a o ca m tu [ LL. ' ��� O 0 M O OG tip � m W r5 N O 10 Z> ow ;{ O'.: b r m <t O i w a iA W - � •• < W o Z Q G7 2 SS U O X .j 0 QO"t �iJ �WCW 4vo-c — s-' Y z o z *^ CL < LE w u w 3 ~ 3G ~ in o os r z 0 Ir n If Q I I • R � II W x B t II l W J .96 SLIP _£9 834419 KATHLEEN H. WALSH State Bar of Wisconsin Form 1 -2003 REGISTER OF DEEDS ST. CROIX CO., WI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 09/13/2006 03:30PH WARRANTY DEED THIS DEED, made between ROGER A. HUERTA and DIANNE L. GAYLORD, EXEMPT # both single persons REC FEE: 11.80 ("Grantor," whether one or more), TRANS FEE: 1785.08 and LINH N TRAN AND THU NGUYEN COPY FEE' CC FEE: PAGES: 1 ( "Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address 1 needed, please attach addendum): exectrA ! �b4d4 S' T; Part of the NW '/4 of SW '/4 and Part of the SW '/4 of NW %4 of Section 3, Township 1 5 , 4 66 UUayhn x 91W D 28 North, Range 19 West, St. Croix County, Wisconsin described as follows: Lot 3 WAy-b4 MN Mq of Certified Survey Map filed August 4, 1998 in Volume 12, Page 3492, as Document No. 584323, St. Croix County, Wisconsin. 040 1010 70 200 Parcel Identification Number (PIN) This is homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, reservations, restrictions and rights -of -way of record, if any. Dated 9 A 2006 i � (SEAL) (SEAL) * * Ro Huerta (SEAL) am- ?v (SEAL) * * ianne L. Gaylord AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN authenticated on St. Croix ' Q 01�EgpS o * Personally came b ' TITLE: MEMBER STATE BAR OF WISCONSIN the above -named anne L. Gaylord r ;� sk (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) instru ut and acknowl ed the same. THIS INSTRUMENT DRAFTED BY:� �' Attorney Rose M. Allen 1 oker Hudson WI 54016 Notary Public, State ofA144eaea4n MIAOIC59M My Commission (is permanent) (expires: V /�/6 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1 -2003 4 Type name below signatures. loft ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer '1. �d Tlt /I .1p , Mailing Address Cry j Property Address 1 OGVe (,f (Verification required from Planning & Zoning Department for new construction. City /State �'7't�/l'�SOI''� 4 Z � , Parcel Identification Number 4.5 /41U ``'O W LEGAL DESCRIPTION Property Location AU/ ' /4 ,- 1 /4 , Sec. - , T .2 N R W, Town of Subdivision , Lot # 2 Certified Survey Map # -���� , Volume ,Page # Warranty Deed # Volume //Z , Page # ..� Spec house yes 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. 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 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Numb of bedrooms 7 - Z 3 /.3/ 0� IGNATURE 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) Parcel #: 040 - 1010 -70 -250 03/23/2007 04:46 PM • PAGE 1 OF 1 Alt. Parcel #: 03.28.19.42A -50 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 12/04/2006 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - TRAN, LINH N LINH N TRAN C - NGUYEN, THU THU NGUYEN 13748 NEVEDA CIR SAVAGE MN 55378 Districts: SC = School SP = Special Property Address(es): ` = Primary Type Dist # Description 618 TOWER RD SC 2611 HUDSON SP 1700 WITC Legal Description: Acres: 3.001 Plat: 5323 -CSM 22 -5323 040 -06 SEC 3 T28N R19W PT NW SW & PT SW NW FKA Block/Condo Bldg: LOT 04 LOT 3 CSM 12/3492 BEING CSM 22 -5323 LOT 4 (3.001 AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 03- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 02/16/2007 844632 AFF 12/04/2006 839902 22/5323 CSM 09/13/2006 834419 WD 03/23/1999 599922 1412/595 WD more... 2007 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 01/12/2007 Description Class Acres Land Improve Total State Reason Totals for 2007: General Property 0.000 0 0 0 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00