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Parcel #: 040 - 1243 -30 -100 04/07/2008 05:02 PM
PAGE 1 O F 1
Alt. Parcel #: 03.28.19.1242B 040 - TOWN OF TROY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
03/08/2007 00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - MEURER, WENDY K
WENDY K MEURER
528 TRILLIUM LA
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description ' 528 TRILLUIM LN
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 2.650 Plat: 5369 -CSM 22 -5369 040 -07
SEC 3 T28N R19W PT SW SE FKA LOT 78 Block/Condo Bldg: LOT 02
COUNTRY WOOD SECOND ADD - N (2.51 AC)
BEING CSM 22 -5369 LOT 2 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4)
03- 28N -19W
Notes: Parcel History:
Date Doc # Vol /Page Type
03/08/2007 846104 22/5369 CSM
03/08/2007 846103 QC
12/28/2006 841407 QC
05/24/2002 679973 1898/67 q
mor ..
2008 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 03/26/2007
Description Class Acres Land Improve Total State Reason
Totals for 2008:
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
Wisconsin Department of commer PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
408289 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:
Meurer, Wendy I Troy Township 040 - 1242 - 70-000
CST BM Elew Insp. BM Elev: BM Description:
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS _ FS ELEV.
Septic j Benchmark 3 ri A9
Dosing / Alt. BM
/off. 39
Aeration Bldg. Sewer
3 . a l oo . �
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet 7� g
Tr
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ��./ Dt Bottom
Dosing He er /Man.
Aeration Dist. e AP
to
Holding Bot. S stem t
PUMP /SIPHON INFORMATION Final Grade 3
Manufacturer Demand St Cover /b
0
Model tuber 7
TDH Lift oss System Head TDH Ft
Forcemain Length Dia. ist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width .I— Length Z No. Of Trenches PIT DIMEN�LAtQS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 1 :4 L 6 X �
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM L ING M ufactur
INFORMATION AMBER OR y
Type RR f System: `� UNIT Model Number:
� 12 S / -T
DISTRIBUTION SYSTEM S�
Header /Manifol Distribution / x Hole Size x Hole Spacing Vent to Air Intake
L Pipes) A" r. 1(
Length Dia Length 2 Dia p ci g I ::1
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over Depth Over xx Depth of 1 xx Seeded /Sodded xx Mulched
Bed/Trench Center Bedfrrench Edges Topsoil L
U
' Yes No Yes ( No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1:/ / Z Inspection #2:
Location: 528 Trillium Lane Hudson, WI 54016 (SW 1/4 SE 1/4 3 T28N R19W)) Countrywood Ad n. [I Lat 78 Parcel No: 03.28.19.1236
1.) Alt BM Description = s �CZA_ — JCjp Cis 6r. CNan�a(• p 4 -- V ` Of S X , S 4 4.1 -
2.) Bldg sewer length = t(/V I ( V 4 �(C C��f��W ,yi�,c S P�L�QJ� ►+l �-
- amount of cover =
<1%je41-- wt �ta,�,der <r
Plan Required? a Use other de for additional information. Yes o
! do
SBD -6710 (R.3/97) Date Insepctor's Signa ure Cert. No.
,
I
4 2j-
/
' Safety and Buildings Division County '
201 W. Washington Ave., P.O. Box 7162 5
,SconSirn Madison, WI 53707 - 7162 Site Address c
Oe artment of Commerce 'f -rq-da �� c�
. Sanitary Pt...:.�u.
n r
Sanitary Per Applicatio 1032$q
In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision
may be used for secondary purposes Privacy Law, sl5. 1 m
I. Application Information - Please Print All Information State P hn-I.D. Number
Property Owner's N Parcel Number f I ;LLI IZU
D - 40
Property Owne
St
s Property con ^� )
ill -A LIE-A. 5 TOt �, R / E
City, State Zip Code Phone Number Lot Nundvr Block Number JA*
Subdivision Name CSM Number
/ S,So ti�
H. Type of Building (check all that apply) ❑City
)k1 or 2 Family Dwelling — Number of Bedrooms ❑Village
❑ Public/Commercial — Describe Use O wnship
/`'� �,�p
11 State Owned/ ^ ^ l� D i I e / ( Nearest �to d f
M. Type of Permit: (Check only % / ne box on line A (numbering scheme for internal use). Complete line B if applicable)
A �ForCounitywe
1 New 1�2 �[E] EReptac-em:en:t System 3 11 Replacement of 6 o stem Tan k ON Em
B. ❑ Check if Sanitary Permit Previously Issued
Permit Number Date Issued
IV. Type of permit: (Check all that apply)(ntrmbering scheme is for internal use)
44 Vf Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland
22 ❑ Pressurized I Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line
45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recircula ' ❑ Other
V. D' rsal/Treatment Area Information: ) DD
Design Flow (gpd) Dispersal Area Dispersal Area Soil Application
ls ys Percolation to stem Elevatio� Final Grade
Required Proposed Rate(Ga./Da/Sq.Ft.) (Min./Inch) 7-1 9
Elevation
7 - F/ "
VI. Tank Info Capacity in Total Number Manufacturer
Prefab Site Steel Fiber Plastic
Gallons Gallons of Tanks Concrete Constructed Glass
New Existing
Tanks Tanks
Septic or Holding Talc m v `
Dosing Chamber
VII. Responsibility Statement - 1, the undersigned, assume res po»srlrllity for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumbe MP/MPRS umber Business Phone Number
Rdo 3,�7 ?1.� � 8 -�
Pl m r' A ress (Street, City, State Zip Code)
VIII. Cotmt /De artment Use Onl
Sanitary Permit Fee (includes Grormdwater Date Issued Issuing Agent Signature o Stamps)
Approved ❑ Disapproved Sure ge Fee)
❑ Owner Given Initial Adverse 2z (- 0 DQ `
Determination
11C Conditions of �PPro easonl forDisapprova
.- WW a 6-c,
Ora ttr
Attach COO the County only) for the system on paper not kss than 81/2 x 11 tnches In size
SBD -6398 (R. 05101)
r6f IU C-
45 �UL
7'-3
x
fK- a
13-6 13Y
� Yip
1061
Wisconsin Department of Commerce SOIL EVALUATION REPORT / Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Steel Soil Service
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 I.D.
pending
Please ptint all information. Re BSc. Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). 4 oq Z
Property Owner Property Location 1
Stout, Richard Govt. Lot SW 114 SE 114 S 3 T 28 N R 19 W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1353 Awatukee TH. 78 na Country Wood Second Addn.
City State Zip Code Phone Number City Village e5 Town Nearest Road
Hudson WI 54016 715 - 549 -6731 Troy Tower Rd.
New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe:
Parent material Pitted outwash Flood plain elevation, if applicable na
General comments
and recommendations: system elevation for primary site,94.15ft trenches spaced and depth to code 3.00ft below grade
5y le ✓, for 14 (+ernlf-t M 0 w" lX /o3.9Sfraasod 4 - coo?'641 L; n e /0Z•96i'+
a Boring # i Boring
Pit Ground Surface elev. 103.15 ft. Depth to limiting factor 120 in. F Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
*Eff#1 I *Eff#2
1 0 -11 10yr3/3 none I 2msbk mfr cs 1f .5 .8
2 11 -18 10yr4/4 none sil 2msbk mfr gw 1f .5 .8
3 18 -39 7.5yr4/4 none sl 2mgr mvFr gw na .5 .9
4 39 -120 7.5yr4/6 none cos osg mvfr gw na .7 1.6
This boring evaluation is for the aftemate site
* Effluent #1 = BOD 5> 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD 30 mg/L and TSS <30 mg/L
CST Name (Please Print) Signature: CST Number
David J. Steel /' 248956
Date Evaluation Conducted
Address Steel Soil Service // Telephone Number
1564 CR GG, New Richmond, WI 54017 8/6/2002 175- 246 -5085
31 Boring # Boring
„t°` Pit Ground Surface elev. 100.95 ft. Depth to limiting factor 84 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft=
*Eff#1 *Eff#2
1 0 -10 10yr4/4 none sicl 2msbk mfr cs 1f _4 .6
2 10 -28 10yr3/4 none scl 2mgr mfr gw 1f _4 .6
3 28-84 7.5yr4/6 none cos osg mvfr na na .7 1.6
This boring evaluation is for the alternate site
Property Owner Stout, Richard Parcel ID # pending Page 2 of 3
4] Boring # Boring
Pik Ground Surface elev. 99.45 ft. Depth to limiting factor 80 in.
F So Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
*Eff#1 *Eff#2
1 0 -11 10yr3/3 none sicl 2msbk mfr cs 1f .4 .6
2 11 -35 7.5yr3/4 none scl 2mgr mfr gw na .4 .6
3 35-80 7.5yr4/6 none cos osg ml na na .7 1.6
This boring evaluation is for the alternate site
F-s 1 Boring # - Boring
Pit Ground Surface elev. 98.45 ft. Depth to limiting factor 80 in. $oil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
*Eff#1 *Etf#2
1 0-8 10yr3/3 none sil 2msbk mfr cs 1f .5 .8
2 8 -12 10yr4/4 none sicl 2msbk mfr gw 1f .4 _6
3 12 -24 7.5yr3/4 none sl 2msbk mvfr gw na .5 .9
4 24 -70 7.5yr4/6 none cos osg mvfr gw na .7 1.2
5 70-80 10yr7/4 fracturedlimestone na na na na na .0 .0
This boring evaluation is for the alternate site
F71 Boring # "1 Boring
0 Pit Ground Surface elev. 97.15 ft. Depth to limiting factor 120 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD&
*Eff#1 *Eff#2
1 0 -14 10yr3/3 none sicl 2msbk mfr cs 1 f .4 .6
2 13 -36 7.5yr4/6 none sUls 2msbk mfr gw na .5 .9
3 36 -120 7.5yr4/4 none Cos osg mvfr na na .7 1.2
� tr
C d- a3.0
This jL is for the primary site
* Effluent #1 = SOD ? 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
Property Owner Stout, Richard Parcel ID # Pending Page 3 of 3
F-8 Boring # Boring
Pit Ground Surface elev. 93.85 ft. Depth to limiting factor 120 in. Sod Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft
*Eff#1 *Eff#2
1 0 -7 10yr3/3 none sil 2msbk mfr cs 1f .5 .8
2 7 -14 10yr4/4 none scl 2msbk mfr cs 1f .4 .6
3 14 -23 7.5yr4/4 none Is osg mvfr cs na .7 1.2
4 23 -42 7.5yr4/4 none cos osg mvfr gw na .7 1.6
5 42 -51 7.5yr4/6 none ms osg ml gw na .7 1.2
6 51 -120 7.5yr4/4 none cos osg mvfr na na .7 1.6
," C1 1,0 t This boring evaluation is for the primary site
F -9 Boring # Boring gq Pit Ground Surface elev. 93.85 ft. Depth to limiting factor 120 in. 9 Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
*Eff#1 *Eff#2
1 0 -5 10yr3/3 none sil 2msbk mfr cs 1f .5 .8
2 5 -16 10yr4/4 none scl 2msbk mfr cs 1f .4 .6
3 16 -32 7.5yr4/4 none cos osg mvfr cs na .7 1.6
4 32 -68 7.5yr4/6 none Is osg mvfr gw na .7 1.2
5 68 -120 7.5yr4/4 none cos osg mvfr na na .7 1.6
3 4• L 4Y - - This boring evaluation is for the primary site
10 Boring # Ij Boring
/ Pit Ground Surface elev. 97.15 ft. Depth to limiting factor in. F Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W
*Eff#1 *Eff#2
1 0 -7 10yr3/3 none sil 2msbk mfr cs 1 f .5 .8
2 7 -14 10yr4/4 none scl 2msbk mfr cs 1 f .4 .6
3 14 -36 7.5yr4/4 none cos osg mvfr cs na _7 1.6
4 36-48 7.5yr4/6 none Is osg mvfr gw na .7 12
5 48 -120 7.5yr4/4 none cos osg mvfr na na .7 1.6
GO
This boring evaluation is for the primary site
* 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
STEEL'S SOIL SERVICE
David J. Steel 1554 Cty Rd GG
CST- POWTSM 'charC� s'foc� >L New Richmond, W154017
Lic, #248956 Sw �4 SC��, -Si?, 3, I z81V, ? 15 C (715) 246 -6200
I own O�Tro S -A. CRe)/r ^ o. (715) 246 -5085
CcJao 52 C 0 7d
11 Hof 7f
Z36 Alor E.o� LinG
A = (349,1 cal mar 2� IeVQ 116, IOD.
r of i /z„ pvG P; /--,e-
®= 14 14 13e xh /star � ev4�r bn i0C). Z`f
1 4 " Pic
f to t/4L I t'o n S
5
/3 /06 S5Ft ,�tagr
Cfi, A55 -PL
Irene 2. -
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9'7-
9 ? i5 Ft `�.�5 rviou ,1rd /
AJO
6
fs a ' 4t
9485 i38 $ ` 1 3
75'
e�
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Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT Page 1 of 3
Labor and Human Relations
D�`tion of Safety & guil. ings in accord with ILHR 83.05, Wis. Adm. Code
COUNTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. aR ' 1� �, S rrr)iX
not limited to vertical and horizontal reference point (BM), direction and ° C pe, le or �° PARCEL I.D. #
X>
dimensioned, north arrow, and location and distance to nearest road. � fy , ; pendin
APPLICANT INFORMATION— PLEASE PRINT ALL INFORM ' EVIEWEDBY DATE
PROPERTY OWNER: PA& M L C TION -
Richard Stout GOVT.,;OTCR: '�j v4 ' /4,S 3 T 2g AR lg R(or) W
PROPERTY OWNER':S MAILING ADDRESS S `,�AME OR CSM #
1353 Awatukee Trl. 7
na
T
CITY, STATE ZIP CODE PHONE NUMBER ]V,ILLAGE.;WOWN NEAREST ROAD
Hudson, WI. 54016 (71J 549-6731 R8
[x] New Construction Use [ )4 Residential / Number of bedrooms 3 [ ] Addition to existing building
I ] Replacement [ ] Public or commercial describe
Code derived daily flow 450 gpd Recommended design loading rate • 7 bed, gpd /ft2 . 8 trench, gpd/ft
Absorption area required 643 bed, ft 563 trench, ft Maximum design loading rate .7 bed, gpd /ft .8 trench, gpd/ft
Recommended infiltration surface elevation(s) starting 113.47' ft (as referred to site plan benchmark)
Additional design /site considerations trenches spaced to code installed 3.33 below surface
Parent material 'Pitted outwash Flood plain elevation, if applicable na ft
I S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE I AT -GRADE SYSTEM IN FILL HOLDING TANK
U = Unsuitable fors stem iD S ❑ U f] S ❑ U I CA S ❑ U EIS ❑ U ElS ❑ U [IS ® U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bouindary Roots GPD /ft
in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench
1 0 -1.1 10 r3 3 none 1 2msbk mfr cs if .5 .6 S
La 11 - 10yr4/4 none sil I 2msbk mfr gw if .5 .6 .S
Ground 3 18 -39 7.5 r4/4 none sl 2myr mvfr �w na .5 .6 •S
elev.
11 ft. 4 39 95 7.5yr4/6 none cos osg mvfr na na .7 j.8 .I
Depth to t
limiting S , L
factor
+96"
L 4G
�R
Remarks:
Boring #
1 0 -12 10 r3/3 none sicl 2msbk mfr cs if .4 `:.5
2 2 12 -21 10y r4 4 none sil 2msbk mfr gw if .5 .6
3 1- a sl 2m' r mvfr ,w na .5 .6
Ground .�,
1 elev t. 4 1 35-80 7.5 r4 /a none ms os�� mvfr na na .7 .8
Depth to
limiting
factor --T
+80
Remarks:
CST Name:— Please Print Phone:
Gary L. Steel 715 -246 -6200
A ddress: 1554 200th. Ave. New Richmond,
WI. 54017 m02298
Signature: Date:
8 - - CST Number:
f
PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 1 of 3
PARCEL I.D. # pending Lot #78
Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed jTrench
3 1 0 -10 10 r4 4 none sicl 2msbk mfr cs if .4 .5 -{
2 10 -28 10yr3 /4 none scl 2mgr mfr gw if .4 .5
Ground 3 1 2 8-84 7.5 r4 6 none cos osQ mvfr na na .7 .8
elev.
1 15.0 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 1 0 - 11 10 r3 3 none sicl 2msbk mfr cs if .4 .5 •`�
... « 2 1 11-35 7.5yr3/4 none scl 2mgr mfr gw if .4 .5
" 3 1 35-80 7.5yr4/6 none cos osg ml na na .7 .8 �
Ground
elev.
113 ft.
Depth to
limiting
factor
+
Remarks:
Boring #
1 1 0-8 10 r3/3 none sil 2msbk mfr cs if .5 .6
5> 2 1 8-12 10 r4/4 none sici 2msbk mfr yw if .4 . .... .............
Ground 3 1 12-24 7.5 r3 4 none sl 2m r mvfr na 5
ll 1 9 ft. 4 124-70 7.5 r4/6 none cos osg mvfr gw na .7 .8
Depth to
5 1 70-80 10 r7/4 none Fract ed Limestone -- -- -- --
limiting
factor
Remarks:
Boring #
1 1 0-8 10 r3/3 none sil 2msbk mfr cs if .5 `:.6
6 ' < 2 18-24 10yr4 /4 none lfs osg mvfr gw if .5 .6
U
3 1 24-90 7.5 r4/6 none cos osq mvfr na na .7 .8
Ground
elev.
1
Depth to
limiting
factor
+80
Remarks:
SOD- 8330(R.06/92)
PROPERTY A1l-4LaLU oL.vut, JVIL. ucJVnIr I IVn nU-rVn I ayc y u
PARCEL I.D. # pending Lot #78
Boring # Horizon
Depth Dominant Color Mottles Texture Structure Consistmve Boundary Roots GPD /ft
z. Bed
in. Munsell Qu. Sz. Coat r. h. Color G S S rerxfi
3 = 1 0 -10 10 r4 4 none sicl 2msbk mfr cs if .4 .5
2 10 -28 10yr3 /4 none scl 2mgr mfr gw if .4 .5
Ground 3 28 -84 7.5 r4 6 none cos osq mvfr na na .7 .8
1 15.0 ft.
Depth to
limiting
factor
+84"
Remarks:
Boring #
1 1 0-11 10 r3 3 none sicl 2msbk mfr cs if .4 .5
4 h 2 1 11-35 7.5 y r3/4 none scl 2mgr mfr gw if .4 .5
3 35 -80 7.5yr4/6 none cos osg ml na na .7 .8
Ground
elev. 7�7
113 ft,
Depth to
Nmiting
x + 80"
Remarks:
Boring #
k 1 1 0-8 10 r3/3 none sil 2msbk mfr cs if .5 '.6
x 5 '' 2 1 8-12 10 r4/4 none sicl 2msbk mfr gy if .4 .5
3 12 -24 7.5 r3 4 none sl 2m r mvfr na X-' 5
Ground
11 9 4 24 -70 7.5 r4/6 none cos osg mvfr gw na .7 .8
Depth to 5 70 -80 10 r7/4 none Fractpred Limestone -- -- --
limiting
factor
Remarks:
Boring #
1 L0 -8 10 r3/3 none sil 2msbk mfr cs if .5 .6
6~ 2 1 8-24 10yr4 /4 none lfs osg mvfr gw if
.5 .6
3 24 -80 7.5 r4/6 none cos OSQ mvfr na na .7 's.8
Ground
elev.
1
Depth to
limiting
factor
+80
Remarks:
SBD- 8330(R.0"2)
r
v � .
STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout 1554 200th Ave.
CSTM2298 SW4SE4 S3- T28N -R19W New Richmond, WI 54017
MPRSW 3254 town of Troy (715) 246 -6200
lot #78- Country Wood Second Addn.
r
/N
i 1 " =40'
ABM.= top of SE lot Stake C el. 100`
�r
2
E �q0
1
n' 10
o'
I S`
® f�
ISO
Gary L. Steel
8 -14 -96
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa of
FILE INFORMATION SYSTEM SPECIFICATIONS ip
Owner Septic Tank Capacity O a l ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model — go ❑ NA
Number of Public Facility Units NA Pump Tank Capacity al KN A
Estimated flow (average) U ® gal/day Pump Tank Manufacturer A
Design flow (peak), (Estimated x 1.5) t✓ gal/day Pump Manufacturer ANA
Soil Application Rate r al /day /ftz Pump Model *CNA
Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ILIA
Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD : 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) :_150 mg /L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BOD : 530 mg /L AIn- Ground (gravity) ❑ In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound
Fecal Coliform (geometric mean) :510 cfu /100m1 ❑ Drip -Line ❑ Other:
I
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
"Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: ❑ month (s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: ❑ month(s) ❑ NA
years)
Inspect pump, pump controls & alarm At least once every: ❑ month ❑ year(s) ) ❑ NA
sl
❑ month(s) ❑ NA
Flush laterals and pressure test At least once every: ❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s)
Other: ❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at -grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or•must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
n required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
,• comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name Name
Phone _ Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name T
Phone Phone 7��
This document was drafted in compliance with chapter Comm 83.220(b)(1)(d) &(f► and 83.5401, (2) & (3), Wisconsin Administrative Code.
S'1' C1tO1X COUNTY
SUPTIC `YANK MA1N'1'UNANCU AGIUMMUN'('
AND
' 1 OWNURSIIII' CERTIFICATION DORM
Owner /Dwyer Q►nc(✓ ,K. M eure-v-
Mailing Address v 'Q CZ min DS
Properly Address - bat 7 C w► e - r -
(Verificaliou tcquitctl lion( arming Dcpallmcn( for new conshuction)
City /Slate UdS ht/( 1'nrcel Ideolificutit►n iJunll►er (.BYO - IA7 e 2 — 7v "OOc
LEGAL DESCRIPTION
Properly Location nW. ' /,, SG ► /,, Sec. 3 , _j_�? Town of / f^
Subdivision Co%,Afry tk)ooc/ 62Cc c� „� 1_of /I
Certified Survey Mali it
Warranty Deed I/ Volume 1 540 Page I/ 1 QS�_
Spec house ❑ yes L no . Lot lines idell illable ) yes ❑ no
SYSTEM MAINTENANC
Improperuse and ntaiutenanceof you► septic system could Icsttll iu its pt cilia fill e fuilute to handle wastes. Propermainteuance
consisls of pumpiug out (he seplic tank evct y duce ycats or sooner, if needed by a licensed pun►per. Wl►al you put into Ilia system
can affect the function of the seplic tank as a Itealu►cnt stage in the waste disposal syslctu.
The properly owner agrees to submit to St. Croix Zoning Depailmetil a cetlilicafion fonu, signed by file owner and by a
n►asler, pluutber, journeyman plutuber, tcslt icled plun►ber or a licensed im"'wer vet ifying Ihat (I) the on -silo was(ewalerdisposal system
is ill proper operating condition and /or (2) alter inspectitw and pumping (if nbecssaty), the scpfic lank is less than 1/3 full of sludge.
I /we, the undersigned have read the above millitentcnls and agree to utaittlaln the private sewage disposal system with Ilia standards
set forth, herein, as set by [lie DepathileW of (,onnnctce and file Depatllucnf of Natural Resources, Slate of Wisconsin. Certification
staling that your scptie system has been mainfaincd tuust he completed and teluu►cd to the Sl. Croix County Zoning Ofree within 30
days of Ilia li►ree year expiration data.
O Z—
DATE
OWNER CER'I'II+ICATION
I (we codify Ilia( all slalcn►culs on Ibis fitnu ate title to file best of my (out) knowledge. I (we) ant (arc) the ownct(s) of
file property described a ovc, by vitUlc of a wauanfy deed Iccotded in Itcgislcr of Dccds Office.
r <. LICA
4
RE O I' NI' / /9/ dZ
DATE
* * * * ** Any information (flat is ulis- tcprescnlcd n►ay tcsull in file sanitary pennil being revoked by file Zonhrg Department. '
sr * * *t
*• Include ivilh fills appilcalioll: a stamped warranty decd front IIIe Rcgislcr of Deeds office
a copy of Ilse cettificd survey map if reference is Ittade in the wartanly deed
�a
STATE BAR OF WISCONSIN FORM 2 - 1998 622ZSS
WARRANTY DEED KATHLEEN H WALSH
�.
REGISTER OF DEEDS
Document Number
15'07FFi "� 152 ST. cROIx WI
....... RECEIVED FOR RECORD
This Deed, made between 05- 02-2000 10:00 AM
RICHARD O - STOUT
- WiRRANTY DEED
- EXEMPT N
--- -• --- _.. Grantor. CERT COPY FEE:
and WrENDY .K MP..fiRRR Aad X. OLSOM T COPY FEE:
TRANSFER FEE: 170.70
RECORDING FEE: 10.00
_ — - PAGES: I
Grantee.
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate in St- Cro i x County, State of Wisconsin:
tiec Aica
Lot 78 Plat of C ountry WQQd Second A ddition, Name and Return Address
of Troy, St. Croix County, Wisconsin. Aor
f
l
04 272 -70 -000
Parcel Identification Number (PIN)
This 1s not homestead property.
(is) (is not)
Exceptions to warranties: easements, restrictions, rights -of -way and covenants
of record.
Dated this 1st day of May 2000
R '•,�. O � _ o rt (SEAL) (SEAL)
(SEAL) (SEAL)
*
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) State of Wisconsin,
ss.
St t`rni x County.
authenticated this day of Personally came before me this 1St day of
M , 2 p a() the above named
Richer O. Stout
TITLE: MEMBER STATE BAR OF WISCONSIN _ to
(If not, me known to be th C fecutecl the foregoing
authorized by §906.06. Wis. Stats.) Instrument and -STA ktl eCiONSIN
KERNON J. BAST
THIS INSTRUMENT WAS DRAFTED BY --
Janet P. Stout
1353 Awatukee Tr, r '
Hudson, WI 54016 Notary P lic, State or Wisc n in
My co missI es / @ rma I. (If not, stale expir tlon date:
(Signatures may be authenticated or acknowledged. Both are not v ` - )
necessary.)
• N — of persons signing in any capacity must be typed or printed below their signature.
STATE BAR OF WISCONSIN Wiswnsin t_eo Btank C.o., tne.
WARRANTY DEED FORM No. 2 - 1998 Milwaukee, Wis.
33
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ACRES o O 2.75 ACRES S85
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2.24 ACRES 78 �0
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2.51 ACRES
W 109,130 SO. FT.
O V* 2.13 AC. EXC. ESMT.
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P O M
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3 5
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4 $ S8
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is 15
- Cr(jx cAinty Register �f �
Sach Parcel shorn on this map (plat) is subject to State, County an(
Toeaship laws, rules and regulations (i.e., wetlands, minimum lot size,
aco"s to parcel, etc.). Before purchasing or developing any parcel contact
the St. Croix County Zoning Office and appropriate Town Board for advice.
f