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Home My WebLink About040-1243-30-000 a county Safety an Uildings Division x 201 W. Washi on ox 7082 W Ivladiso WI ED anitary Permit Number (to be 511xd in by Co.) onsin ( S) 261.6546 / 0 Department of Commerce State Plan ID. Number Sanitary Permit A t'OMAR 1 0 2004 � s � � 110 nsl in trrtgtion you provide Project Address (if different than [nailing address) In ac cord with Comm 83.21, Wis. Adm. Code Fors° � _ may be used for secondary purposes Privacy ISW, 15 1�( I ( "I CUl1N i }- 6 Z T �L LI U�� ZON I. Application Information — Please Print Alt Information i Parcel # Lot # Block # Property Owner's Name J / 3 0//O — 12 Property Location Pro a' ding Addr�gs C 3 z /z Zip Code Phone Number City, S e le (circir e e � . T e of Building (check all that apply) j Subdivision Name CSM her or 2 Family Dwelling - Number of Bodrooms , ❑ Public/Commercial — Describe o � 5/k ocity E ip of C) St owned — Describe Use 0 IIL Type otPermit: (Check only one box on line A. Complete line B if applicable) Treatment/Holding Tank Replacement Only Other Modification to Existing System A w System ❑Replacement System Change of ❑ Petatit Trans fer to New List Previous Permit Number and Date Issued B. ❑Permit Renewal El Permit Revision Owner Before Expiration Plumber IV. Type of POWTS S tern: Wheck all that a i [I Non — Pressurized In-Ground > 24 'n_ of suitable soil ❑Mound < 24 in. of suitable soil 13 At-Grade ❑Single Pass Sand Filter a 0 Peat Filter [I Aerobic Treatment Unit ❑ Recirculating Sand Filter Constructed Wetland [3 Pr urized ln-Ground 113 Holding Tank lain r Recirculating [3 I. Synthetic Media Filter eachiag Chamber [I Dri Line 0 Gravel -1 s Pipe Other (explain V. Dis ersal/freatment Area Information: Dis real Area Pr posed (sf) System Elevation Design Flow (gpd) Design Soil Appli ion Rats�((� f) Disp 1 Area Re uired (sf) a _ n 5��1. 6rU / S� 1) Q J Manufacturer fab Sue Steil Fiber Plastic Tank Info Capacity i6 Total Ntrtttba , / n Q Concrete Constructed Glasa Gallons Gallons of Units New Existing Tanks Tanks septic or Holding Taal[ Aerobic Tra =at Unit Dosing Chamber (, A IQ t undera ne me re for installation of the POWTS shown on the attached plans. tern nt 1 be Nu mber VII. Responsibility Sta is Business Phone Nu Plumber's ?"Me (Print) Plumbers re MP/MPRS Number ,J Plumber's Address (Stree4 City, State, Zi oun /D eipartinent Use Onl Sanitary Permit Fa (includes Groundwater Date iss Issuing Ag [ Sig<tatur Stamps) Approved ❑ Disapproved Surcharge Fee) 41. 3 � 3 1 O ❑ Owner Given Reason for Denial � IX. Conditions of Approval/Reasons f or- Disa proval oh s4� Y "OWNER�� S ST 1 S ar4 dispersal cell must all be serviced / maintained r moon ement Ian provided b lumber a e g p y P P P 2. All setback requirements mus a m�ili(� as per applicable code /ordinances AMp complete plans (to the County only) for the system an paper not less than 81/2 z 11 inches in size SBD -6398 (R. 08102) PLOT PLAN PROJECT Grea Brunckhorst ADDRESS 1212 Grandview Dr. Hudson Wi 54016 SW 114 SE 114S 3 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 2/29/04 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none hk BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 105.8' Scale = 1" = 40' Trillium Lane Well is to meet all setbacks Pro 4 found in Comm. bedroom 83 house t e wa 106' P oper ty / Line B - 2 3"i Huffcutt Combo Tank 10 5' � _ 104.8' Tank is to be properly B-1 bedded and provided with 104' lockdown covers with approved warning labels B -3 v grading is to be done to 5% divert run -off away from Slope system Area 15' below system is to remain undisturbed Upon inspecting the lot, it was measured to be 5% slope 1,13. 230' Property Line Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Visconsin www.commerce.statemi.us /sb Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary March 08, 2004 CUST ID No.226900 ATTN• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 I CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/08/2006 Identification Numbers Transaction ID No. 974410 SITE: Site ID No. 671214 Gary Brunckhorst Please refer to both identification numbers, Trillium Lane above, in all correspondence with the agency. Town of Troy St Croix County SW1 /4, SE1 /4, S3, T28N, R19W Subdivision: Coup Wood; lot 84 Country , FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 944561 Maintenance required; 600 GPD Flow rate; 32 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.01 /01); Biofilter 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 approved plans, the "Mound Component Manual for Private Onsite Wastewater " Systems Version 2 SBD- 10691 -P .O1 /O1 . The pressure network is to Y � ) p be constructed in accordance with publications SBD- 10706- P(NO1 /O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0 ". • 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 below the mound system 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 inspectors. C OQ, - L -7-S SHAUN R BIRD Page 2 3/8/04 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 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, &44)G-� Fee Required $ 175.00 Fee Received $ 175.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 i BAR _ Cover Pag( z zoQ & �tDGS Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 2/29/04 Owner: Greg Brunckhorst Location:SW1 /4 SE1 /4 S 3 T28N,R 19W Lot 84 Country Wood Troy System type: Mound System Manuals Used: Mound Component Manual version 2.0 (01/31) Pressure Distribution Manual version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve '' VED -8. Maintance and Contigency plan DEPARTMENT OF COMMERCE 9-11. SA"!YAND BUILDINGS 9 -11. Soil test SEE CGRRE ONDENCE Signature License numbe 226900 PLOT PLAN PROJECT Grea Brunckhorst ADDRESS 1212 Grandview Dr. Hudson Wi 54016 SW 1/4 SE 1 /4S 3 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 2/29/04 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1 ABSORPTION AREA 600 # of chambers none hL BENCHMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100 Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. SameasBenchmark SYSTEM ELEVATION 105.8' Scale = 1" = 40' Trillium Lane Well is to meet all setbacks Pro 4 found in Comm. bedroom 83 house 106' P operty Line B - 2 3"i Huffcutt Combo Tank 105 � 104.8' Tank is to be properly B-1 bedded and provided with 104' lockdown covers with approved warning labels B -3 p grading is to be done to � 5% divert run -off away from Slope system Area 15' below system is to remain Upon inspecting the lot, it was undisturbed measured to be 5% slope 1-7' B. M. * 230' Property Line 24f � Designer No Date Non -Woven Filter Fabric 4" Observation Pipe Perforated Aistribution. Pipe Below Filter Fabric ASTM C -33 Sand , Topsoil � .\ i E r ` � 1 % Slope Bed Of tr'- 2 %Z Force M•oin \`Flowed 2 From Pump Layer Drain Rock i Cres Section Of A Mou System Using F S� A Bed For The Absorption Area G ew A i7esr�� Loa . Ft. I / Ft.- �J Ft. K D -� Ft. L Ft. e W a��S�Ft L 4Observation Pipe—.,,,,, 0. A . � J n --- _ _ ---- - - - - -- T 1 1 7Force Moi W - - -! _-- .�._._— From Pump 0 . c • ° Distribution Bed Of 21 2 Pipe Drain RocK I 40bservation Pipe_,-.CciJeJ Permanent Marker �S¢!�,'' �i?✓n. , p ipe or Rods SGI f X16 Plan View Of Mound UsInq A Bed For The A Area � PAGE Perforated Pipe Oetaii / 0 End Vies �Pcrlororsa .�' PVC Pipe lot ° O pos Males t.OLOted 00180110m Are Equo"Y $POCfd f Ir 4 D PVC Face Main FIRST IOLL et1ExT re ConntC }'on PVC f Manifold Pipe L S� fi Of'e, Oisinaua�on Pipe distribution Pipe Layout P Ft. I X Inches Y Inches Signed: Hole Diameter�� Inch Lateral " ? Inch (es) License Number: Mdnifold ' Inches Force Main " Z Inches of holes /pip Invert Elevation of Laterals . G F CROSS 5£CTiQN AND SPECIFICATIONS SEPTIC TANK P43MP CliAMBER W£sTN£RP120UF 4» C VENT PIPE" MIN. ABOVE GRADE JUNCTION BOX APP Li t , ` FROM DOOR, wrNoow DR WITH CONDUIT W/ PADLOCK FRE;H SLR INTAKE WARRING LABEL GRADE 1 L rn�" 4 MIN. i 2v MiN• I a INLET a GAS WATER TIGHT SEALS - T - TIT, `' NT E WITH FILTER -_}__ ; ALM ' QED PIPE ON SOLID SOIL APPROVED PIPE 3' C t OFF om SOLID - + — ,, 3 F T . SOIL PUMP OFF ELEV. � -- D EDDING UNDER TANS 8 � APPROV � B 4NCRET£ PAi7 SpECIFICATIONS �R QO SES PER DAY: SEPTIC ! DOSE ZFt1MBE FACTURER C / - GAL - i ANK PIANU DOSE V O LV ME F Lo sAc _ ��' GAL . TAIiK SIZES: SEPTIC GAL. _ �` 3�INCHES = J o DOSE CAPACI S t TIES - --- GAL. MAN L;rACTuRERj: �i�� l.rr S y Ste_ B = �2 _ INCHES =�. ---- ALARM MODEL NULKSF•R = " ✓ GAL - SWITCH TYPE' C 7 , INCHES = /a ----- pUKP MANUFACTURER : D = / INCITES �-- KODEL HUt' S = " �� PER z LNR 15.73 �►C ' pLUMp F AL-Fak f idIRING AS SWITCH TYPE= RATE - t,Pi�i /J� FEET RE4U ;RED DISCLfARGE PIP£ • y-�z— FEE? pU1°FP O£F AIdB DIS.IgIgUTION FEET vER'�ICAL DIFFERENCE BETWEEN PU RE - � FRZ .TIQN FACTOR FEET + MIN UAL NETWORK SUPPLY � FT / 10 0 • pT - IN X �_: --- TpTAL DYNAMIC ti£ADi ! � 3� F££T FORCEMA, 7•� - yf3T ; DIAMETER LENGTH FNTERt4RL D � MENgIONS 4F PUMP TANK= LIQUID ��- -= �-- ---'._ DATE= LICENSE NUMBER = S� S IGNED: :188 TOTAL DYNAMIC HEAD /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING MODEL 152/153 W n MODEL 152 153 LJU Uj — 50 Feet Meters Gol. Liters Gal. Liters 153 5 1.5 69 261 77 291 12 40 152 10 3.1 61 231 70 265 0 15 4.6 53 201 61 231 a _ 20 6.1 44 167 52 197 30 z 8 25 7.6 34 129 42 159 ? 30 9.1 23 87 33 125 0 20 35 10.7 -- -- 22 85 40 12.2 -- -- 11 42 4 Lock Valve: 38.0 Ft. (11.6m) 44.0 Ft. (13.4m) 10 - -- 0145M 0 20 60 80 100 GALLONS LITERS 80 160 240 320 6 1/4 0 3 27/32 4 5/8 FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS 1 3 27/32 • Timed dosing panels available. OO 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. I • Sealed Qwik -Box available for outdoor installations. See FM1420. • Over 130 ° F. (54 °C.) special quotation required. I 1521153 Series 12 1/8 1521153 MODELS Control Selection Model Volts-Ph Mo Amps Simplex Duplex 5 115 1 Non 8.5 1 2 or 3 BN15 BN152 115 7 Auto 8.5 Included 2 or 3 sK20e4 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 8NIS3 115 1 Auto 10.5 Included 2or3 SELECTION GUIDE Ei53 230 1 Non 5.3 1 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float BE153 230 1 Auto 5.3 Included 2 or 3 switch. Refer to FM0477. o caurtoN 2. See FM0712 for correct model of Electrical Alternator E - Pak. All Installation of controls, protection 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 electrician. All electrical and safety 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. MAIL T0: P.O. BOX 16347 ` Louisville, KY 40256 -0347 Manufacturers of. . r P.. SHIP T0: 3649 Cane Run Road { ® Louisville, KY 40211 -1961 QViJL�Ty�UMP9 , /iNCE ��,�i] (502) 778 - 2731.1(800) 928 -PUMP hftp:1Avww.zoeller.com PUMP AO FAX (502) 774 -3624 0 Copyright 2000 Zoeller Co. All rights reserved. —consi �,Llepartment of Industry, SOIL AND SITE EVALUATION REPORT Page 1 of 3 s Lalx�r,ar, Human Re ai ns , Division of Safyty & 6luildings 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. PI t�d4�iu�t ;� St. Croix not limited to vertical and horizontal reference point (BM), direction and % 1-ale or �'``:'fi `. PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. � in ' v ED B DATE APPLICANT INFORMATION PLEASE PRINT ALL INFORMAT, rl ; PROPERTY OWNER: I , , PR% 00TIONd . Richard Stout GOVT. LOT ,$T _ 1ASE ;° - 1i ,S 3 T 28 AR 19 AXor) W PROPERTY OWNER':S MAILING ADDRESS l� OT # Q4f SUB Ff: jV E OR CSM # 1353 Awatukee Trl. 4 c ijria =F_;;' ry Wood Second Addn. CITY, STATE ZIP CODE PHONE NUMBER CITY.. IGE NEAREST ROAD Hudson, W 54016 (7 15) 549 -6731 ' - Tower Rd. [ New Construction Use [ Residential / Number of bedrooms 3 ( j Addition to existing building L ] Replacement [ ] Public or commercial describe Code derived daily flow 450 gpd Recommended design loading rate • 4 bed, gpd/0 .5 trench, gpd/ft Absorption area required 375 bed, ft2 375 trench, ft Maximum design loading rate • 4 bed, gpd/ft •5 trench, gpd/ft Recommended infiltration surface elevation(s) 105. ft (as referred to site plan benchmark) Additional design/ site considerations system el. based on contour line of el. 104.8' Parent material limestone uplands Flood plain elevation, if applicable na ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem 11 S [2U ®S ❑ U ❑ S KI U ❑ S CCU ❑ S CCU ❑ S L31J SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bou day Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -12 10 r3 3 none 2f .5 .6 ................. 2 12 -32 10yr4/4 none sicl 2csbk mfr gw if .4 .5 3 32 48 7.5 r4 k my na n 6 c2 7.5 1 sb fr a .4 .5 ...... n �.�.. �_ r5 6 sl c G round G Y / � Y / elev. Q .2 105 ft. 4 48 -60 5yr4/4 none scl m na na na I Depth to limiting factor 32" Remarks: Boring # 1 0 -10 10 r3/3 none sil 2msbk mfr qW 2f .5 .6 << 2 2 10 -28 10yr4 /4 none sicl 2msbk mfr rw if .4 .5 3 28 -36 7.5 r4/6 none sl lcsbk mfr na na •4 .5 Ground elev. 4 1 36-55 5yr4/4 none scl m na na na 9 . .2 105 ft. Depth to limiting factor 36" Remarks: CST Name: Please Print Phone: Gary L. Steel 715-246- Address: 1554 200A,. Ave., ew Rich WI. 5401 m02298 Signature: Date: 8 -8 -96 CST Number: PROPERTY OWNER Richard Stout SOIL DESCRIPTION REPORT Page 2 of. PARCEL I.D. # pending k ' Lot #84 ' Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 0 -10 10 r3/3 none sil 2msbk mfr gw if .5 .6 2 110-27 10yr4 /4 none sicl 2fsbk mfr gw if .4 .5 Ground 3 127-33 7.5yr4/6 none scl m na gw na .4 .5 elev. 103 ft. 4 1 33-601 7.5 r4/4 none scl 2csbk mfr n n a .4 .5 Depth to limiting f 60'1 Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 13 Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: SBD- 8330(8.05/92) PROPERTY OWNER Nicn ara Jtout o v i L u c o L, n i r i i v n nu-f v n a PARCEL I.D. # penaina Lot #84 Depth Dominant Color Mottles Texture Structure Consistence Y Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Tterxh 3 1 0 -10 10 r3/3 none sil 2msbk mfr gw if .5 .6 2 10 -27 10yr4 /4 none sicl 2fsbk mfr gw if .4 .5 Ground 3 27 -33 7.5yr4/6 none scl m nor gw nor .4 .5 ? elev. 103 ft., 4 33 -60 7.5 r4/4 none scl 2csbk mfr na na .4 .5 Depth to limit + 0il Remarks: Boring # E 3 Ground elev. ft. Depth to limiting factor Remarks: Boring # 3�� b:�.' a:::xSi.+ Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft Depth to limiting tacror Remarks: SBD- e330(R.05/92) STEEL'S SOIL SERVICE Gary L. Steel 1554 200th Ave. CSTM2298 Richard Stout New Richmond, WI 54017 MPRSW 3254 SW 4 SEq S3- T28N -R19W 715 246 -6200 town of Troy lot #84- Country Wood Second Addn. N 1 =40' BM.= top of mid lot survey stake C el. 100 /I Z 3y b Q �� 1 �^ rj i 21 s �O P & tX1 74 117 mm ary L. Steel 8 -8 -96 SMYnC TANK MARaMNANCE AMMEMWF AND OVRjMtSlIIP (MRTmCATION FORM Ownet-lBuyer - Mailing Address 91 C7 i a O�i Gc�./ ��- •�- -D/L Property Address �, ` ►� oti�/ (ve eLrm ice rcquited from Planning Deparunce for new a on) (Uy Parcel Identification Number 0 /-) Z 3 - 3 6- -1 0 R1�AT DESCZtiI'TTIOI�i d 2 Z/ pl y Location � %. y., Sec. U N -�w' Town of Lot # Ceard&d Survey Map # . Volume / Page # /' Warranty Deed # �� 3 . volume` -3 7 --- , Page V Spec 1» p jam" Lot limes ideutifiab j ❑ no Iu�opanaeaadnnambe�oeofy�rsq�csy�emeaoldt�esaitffiit s�ma�nefa i� + etoh an � evnts6es.Pto p a Consists of peening out the septic tank every three years or sooner, if n c&dby a live Umd pampea: What yaw put rote tlm system cm affect the fimfim of the sew tack as a haatment stage is the waste diqmosal system. The property owner agrees to submit to St. Cmix Z Deputumeart a cmtfi=dmfmu- siped by do owner and by a ---- planibc4joonwymmplmbc4nddcftdplr acaliowsedpa nges dut(1)dwan -sits lam proper operating cmditioa and/or (2) after and pmpfmg Ctf I), gw txptic talc is lass toms. l/3 fuU of stodge. Uwe:, the unde n igmd have head the above requivenents and agree to umimbkSc privaft mwaV &V ood SYSUMV0 boa se* Sortb, bman, as set by the Dgmrtmdnt of Comnnex do and D of NatUVa1 te R, State of W S y= septic systembas been maintai nedtunst be meted and teMmad to the St. Croix Camay Z.00aiug Oboe within 30 naps o t�.►ytar expiration date - Sits' IOTA PUS. DATB 4wrrn� c�Tn�cATton I (we) certify beat all statemems an this foam are hue to the best of my (our) 1e I (we) on (are) the owner(s) of the above, by virtue of a warranty deed recorded is Regislef of Deeds Office. SIONA OF AM It.AW DATE ss *sss Any infounatian that is mb4c m cz to d may result in the sanitary permit being revakod by the Zoaimg DAL s *sss* *+° Include with this application: a s warranty deed from to ReWSW of Deeds office a copy of flue certified sgrvey map if refeKcmo is made in die warranty deed ' - POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of SYSTEM SPECIFICATIONS FILE INFORMATION septic Tank Capa�Y al NA Owner G ,� i2 ff Permit. Septic Tank Manufacturer ❑ NA Effluent Filter Manufacturer ❑ NA DESIGN PARAMETERS ❑ NA Effluent Filter Model ❑ NA Number of Bedrooms ❑ NA NA Pump Tank Capadtp �� at Number of Commercial Units ❑ NA Estimated flow (average) 7C;7 al/d pump Tank Mant rfak�urer pump Manufaicbftw . 0 NA I DeSign flow (peak), (Estimated x 1.5) ��O aVd S 13 aUda f1 Pump Model Sots A mmon �� 51 Pretreatment Unit NA Influent/Effluent Quality Monthly average' P. Sand/Grivel Filter ❑Peat Filter Fats,. Oti & Grease (FOG) S30 mg/L p Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOD 920 mg/L ❑ Disinfection ❑ Other. Total Suspended Solids (TSS) 5150 m /L Manufacturer Pretreated Effluent Quality Monthly average" Dispersal Cell(s) p In (pressurized) 530 mg/L ❑ In- ground (gravity) �� und round ( Biochemical Oxygen Demand (BOOS) 530 m g/L [3 At -grade ,— "� Total Suspended Solids (TSS) 9 ❑ Other. Fecal Coliform (geometric mean) s10 cfu /100m1 ❑ Ori ine Y, inch diameter • values typical for domestic (non comn�rdeA wastewater and Maximum Effluent Partide Size septic tank effluent •• values typical for pretreated wastewater. MAINTENANCE SCHEDULE �cl ice Frequency Service Event Maximum 3 yrs.) At least once every onth s ar(s) Inspect condition of tank(s) y) of tank volume Pump out contents of tank(s) When combined sludge and scum equals one -third ( , At least once every ❑month ar(s) (Maximum 3 yrs.) Inspect dispersal cell(s) ❑ months ar(s) Clean effluent filter At least once every controls 8� alarm At least once every c3 months earls) O NA Inspect pump, Pump ❑ months ears) O NA At least once every Flush laterals and pressure test ❑ months O year(s) ❑ NA 0ther At least once every Other At least once every ❑ months 13 year(s) E3 NA MAINTENANCE INSTRUCTIONS n one of the following licenses or Inspections of tanks and dispersal cells shall be made by an individual car S Inspe ctor. POWTS Maintainer, Septage certifications: Master Plumber, Master Plu include visual the tank(s) to identify any missing or broken Servicing Operator. Tank inspect' a and scum and to check for any back up hardware, identify any cracks or leaks, measure the volume of combined sludg to check the effluent levels or ponding of effluent on the ground surface. Th n's of effluent cell( the ground surface .TThe podding of effluent on the in the observation pipes and to check for any Po 9 reg ulatory authority" ground surface may indicate a failing condition and requires the immediate notification or moeof the tank volume, the When the combined accumulation of sludge and scum in any tank equals On thin disposed of in accord ' ct'" NR entire contents of the tank shall be removed by a Septag e 113, Wisconsin Administrative Code. onents, pfe treatfinent components, and any The servicing of effluent filters, mechanical or pressurized POWTS comp b a certified POVVTS Maintainer. other maintenance or monitoring at intervals of 12 months or less w 0 perform of any service event. A service report shall be provided to the local regulatory authority START UP AND OPERATION for the presence tions are of painting Products or other For new construction, prior to use of the POVVTS check treatment t 1 Cetl s chemicals that may impede the tre rator pr high concentra process and/or damage the dispersa ( or to use. detected have the contents of the tank(s) removed by a septage servicing ope - 7 b�� Page of Z --' s o il - conditions are frozen at the infiltrative surface- shall not occur when so System start up ig powe is restored the excess During power outages pump tanks may fill above normal h' hwater levels. When wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cen(s) and may result in tgte backup or surface discharge of eftlpent To avoid this situation have the contents of the pump tank removed by a Septage Servicing operator ptior.tp restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump con norms! levels within the pump tan trols to Restore k 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 1s 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: diaper herbicides; jmeat disinfectants; fat; fouridation draln (sump pump) water, fruit and vegetable peelings; gasoline; grease;. scraps; medications; oil; painting products; pesticides: sanitary napkins; tampons; and water softener brine. ABANDONOMENT h tie taken to insure th tithe When the POWTS falls and/or is permanently -taken out of service the following steps s system is property and safely abandoned In compliance with ch. Comm 83.33. Wisconsin Administrative Code: • Alf piping to tanks and pits shag be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operlator. • After pumping, all flanks and pits shall be excavated and removed or their covers removed and the void splace 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 to provide a cods be taken compliant replacement system: ❑ A suitable reptaeement has been evaluated and may be utilized for the location of a replacement shit absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot 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 ce with the rules • at that time. 11 A u repla a ea is .6i a e to ack an soil firnitations. Bamng a van in P WTS t not hiding tank ay i stall a la re out t ep1 iled PO S. h not n e i t to a u ble re ment area. U ilu f PO `S -r}sei and site u ti n us be ed to Iocate a uitable replacement area. If no replacement area is availa0le a old g nk may be stalled as a last resort to replace the failed POVYI S. nd at -grade soil absorption systems may be reconstructed in place following removal of the biomt 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 tNSUFFICIENir OXYGEN. RE NOT ENTER A S SULT. RESCUE O F A P PU FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPO BLE- M REF A PS ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name FNarne � Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name '�.,� EPhne Phone J �--Z meets s. This (I me This document was drafted by the staffs of the Gwen lake. Marquette and Waushara County Zoning and Sanitation �E11de the minimum requirements of ch. Comm 83.22(2)(b)(1)(d)&(t) and 83- 54(1), (2) & (3), Wisconsin Administrative C ode. Use of this document s not - GMW (fit) guarantee the performance of the POVVTS. 9 LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF TROY COMPUTER NUMBER 040 - 1243 -30 -000 Parcel Number 03.28.19.1242 OWNER NAME: First GREG E Last BRUNCKHORST PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 502 TRILLIUM LA SECTION 3 TOWN 28N RANGE 19W %160 SE 1 /440 SW Line Description Line Description TOTAL ACREAGE 2.750 PLAT COUNTRY WOOD 2ND ADD'N LOT84 BLK 01 SEC 3 T28N R1 9W PT SW SE 15 02 LOT 84 COUNTRY WOOD SECOND 16 03 ADDITION 17 04 2.75 AC 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit LEGAL ST. CROIX COUNTY, WISCONSIN OLD TXSCR02 REAL ESTATE TOWN OF TROY COMPUTER NUMBER 040 - 1243 -20 -000 Parcel Number 03.28.19.1241 OWNER NAME: First GARY D Last BRUNCKHORST PROPERTY ADDRESS: Hse # 1/2 PD -- Street Name -- Type SD Apartment 504 TRILLIUM LA SECTION 3 TOWN 28N RANGE 19W 1 /4160 1 /440 Line Description Line Description TOTAL ACREAGE 2.010 PLAT COUNTRY WOOD 2ND ADD'N LOT83 BLK 01 SEC 3 T28N R1 9W PT SW SE 15 02 LOT 83 COUNTRY WOOD SECOND 16 03 ADDITION 17 04 2.01 AC 18 05 19 06 20 07 21 08 22 09 23 10 24 11 25 12 26 13 27 14 28 F1- General, F4 -Prev. Parcel, F5 -Next Parcel, F7- Valuations, F8- History, F10 -Exit STATE BAR OF WISCONSIN FORM 2 — 1982 ,{ .. WARRANTY DEED �r DOCUMENT NO. 37 VoL 13. PacE ' - REGISTER'S OFF ICE R TrRA Rn m sun IT ST. CROIX CO. WI Rea'd for n4sord JUL 0 2 1998 E . BRUNCKHOR 1:30 M •_� conve and warrants [o St$F��i _ — It sfsr of Coad ?.• ' A, THIS SPACE RESERVED FOR RECOR01t G DATA } ; - 'LAME AND RETURN ADDRESS 1 the following described real Pstme in St. Croix _County, State of Wisconsin: Lot 84, Plat of Country Wood Second Addiition, j Town of Troy, St. Croix County, Wisconsin. • •o PARCEL IDENT FICATION NUMBER 4. .; A ` l ¢ :1. 4 } TRARSFER 't r i { t This i s not homestead property. _ (is) (is not) Exception to warranties: easements, restrictions, rights -of -way and covenants of record, if any. eN . r Dated this list day of J u ly A.D., 19�` 8 _. Richar (SEAL) (SEAL) } y (SEAL) (SEAL.) r AUTHENTICATION ACKNOWLEDGMENT ' t Signature(s) State of Wisconsin, > ' +t t` NX ' s — r St. C roi x County. +� authenticated this day of .19— Personally came before me this 1St day of t • July ' 19 98 the bovenamed 'f Rich ard 0. Stout TITLE. MEMBER STATE BAR OF WISCONSIN p o �ain } (if not, Brenda pu blic authorized by X706.06, Wu. Stabs.` Notigp wn to be the rson who executed he foregoing S tate Of w in run, and ackno ge the same. a, ! THIS INSTRUMENT WAS DRAFTED BY `r1 Janet P. Stout l L� v i Hudson Wi . 54016 Notary Public,ounty, Wis. s c� (Signatures may be authenticated or acknowledged. Both are not hly commission is permanent. (If no • at C ion date: e I necessary) y A, *Nimes of persons signing to any apathy should by ty Jxd or r .intcd below their sler rures. SIATL BAR OF WISCONSIN W�uonsn Lega Awdu kee. Ws. .. its, WARRANTY DEED Form No. 2 — 1982 .lwa f W �5 2 �4 � S 8 9 9 0 , F - - II � i / ' M /® N 8 o — 84 3 �n 2.01 ACRES c O 2.75 ACRES 87,639 SO. FT. `0 N 119,679 SO. FT. 1.92 AC. EXC. ESMT / 67,639 SQ. FT. ti S s4 Q9,0 9 /,g _0 m F 0 80 150.00' O 25.40' N 240.00' 345.40' N 2. 52 "E 15 ACRES S85 °25' 230.00' 93,866 SO. FT 495.40' PC. EXC. ESMT. 3 79 CY i