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HomeMy WebLinkAbout040-1037-10-300 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 488029 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: Schumaker, Michael I Troy, Town of 040 - 1037 -10 -300 CST BM Elev: ( Insp. BM Elev: BM Description: Sectionrrown /Range /Map No: CO Z CS 9,w ( = Pvc 10 tt�otR 08.28.19.122A30 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Z , Z .r Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer , r f ex . 20 3.33 S r n r Holding SUHt Inlet � 3 •g 3. } q8• So T4.NK'SETBACK INFORMATION St/Ht Outlet 't� 3•`1 2. r C at ZS I TANK TO P/L WELL BLDG. Vent to Air In 30 take ROAD Dt Inlet Septic t / 3�f r Dt Bottom 4 Dosing ` Header /Man. Aeration Dist. Pipe 1- 72 , 00 1 1-00, Holding Bot. System 10'2/f 10-M 'u" It•43 •z ' PUMP /SIPHON INFORMATION Final Grade Manufactur r Demand St Cover Model Numb 0"A j'r�e 5:I$ Ra • ao TDH Lift tion Loss System Head TDH Ft Forcem ' Length J Qia . . Dist. to well SOIL RPTION SYSTEM ) RENCH idth I Lenngth 1 No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM � O �`�l� • � SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHING Manufactur. r: INFORMATION CHAMBER OR t Od i Type Of System: f UNIT Model Number: N (o5 (X) ll.o DISTRIBUTION SYSTEM Header /Manifold tf Distribution �xHole Size �Hole pa cing Vent to Air Intake Pipe( > r / Length Dia Length Dia Spacing J SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only hed Bed/Trench Center Bed/Trench Edges Topsoil Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulc U Yes No `,- Yes No C M� MENT : (Include cod d riv iscreper}�ies persons resent,etcj, n Inspe do 1: 3ft � ?1z(v Inspection #2: ( tom- P P I 08.28.19 22A30 1.) Alt BM Description LbCation 446 Artisah Meadow D N ce N . e Hudson, WI 54016 (SE 1/4SW 1/4 8 T28N 19WJ SLot, 3 n n n a� N1 0 = /) ` {_t om �+4 aHt -XXAbC 'tr 2.) Bldg sewer length 1,Lp p - amount of cover= u0 - e„T r " .3 f �'. e,Qsu,a MC Sa e& Y S0� Q • �S s� ' " sue' � � � - > y5 s� r Use other side for `, � additional Yes No ,1 c� information. Plan revision SBD 6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and ro rv' ' ntY t 201 W. Washin - PcI ED ,SCO��,� Madiso n Sa nary Permit Number (to be filled in by Co.) Department of Commerce (61 I 62— Sanitary Permit Applicat on j Plan I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal informs on yo Rio COUNTY maybe used for secondary purposes Privacy Law, s I5. (1)(trP I ct Address (if different than mailing address) I. Application Information — Please Print All Information �y( ^ meala r Property Owner's Name / Parcel # Lot #/ Block # � C S �G� �L v-rtc � � e.r 16 L11) 7 ( � /v -- Property Owner's Mailing Address ) Property Location f Y �/ Y� dG p✓ Si %., ^" /., Section City, State Zipp Conde Phone Number i 7 N R ^7 f� ) 71 l'--Q. T ✓ / v /�' /Y .L& J circole 1 ZG ri J ✓ II. Type c f Building check all that apply) YP g( PP Y) ok «n Su�Or+�oA Subdivision Name CSM Number 1 or 2 Family Dwelling - Number of Bedrooms ❑ Public /Commercial - Describe Use 5 � ; El D; State Owned - Describe Use 2 ak a [L- L J l I N ❑City_❑VillageXTownship of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. X New System p y g p Y g Y ❑ Replacement System ❑ TreatmendHoldin Tank Replacement Onl El Modification to Existin S B. ❑Permit Renewal El Permit Revision. El Change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl K Non - Pressurized In- Ground ❑ Mound > 24 in, of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter X Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) k+ ✓s V. Dispersal/Treatment Area Information: 0, S Design Flow (gpd) Design Soil Application Ratc(gpdst) Dispersal Area Rcqu rcc � sf) I Dispersal Area Proposed (s S stem Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New I Existing Tanks Tanks � l L" " Septic or Holding Tank © t) rk 31 Aerobic Treatment Unit W Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum's Name (Print) Plum 's Signature MP Business Phone Number �2 ✓ vvi �c Z�SZ�Y l /5' - - 7?Z —,3Z/ Plumber's 1 ddress (Street, City, State, Zip Code) 3 l - Z- B cJ c ltim 14J E :� z 7 VII nun /De artment Use Onl Approved rs-7approved Sanitary Permit Fcc (includes Groundwater Date Issued Issuin gent Signs a Stam 1 Surcharge Fce) f 2 a5 n Reason for De ial IX. Conditions of Approval /Reasons for Disapproval SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must all be services / mairttainW as per management plan provided by plumber. 2. AN setback requirements must be main{ained as per applioabls Coda / ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) '513�441r0 M3T2Y2 OA ... 3S�r,+6ti7�t"t�:? i 9tx1J lft�iJllQ� yq q III JOB �� Y[ C S�'! L( I�YI G KC✓ TIMM EXCAVATING Route 1 Box 192 SHEET NO. OF WILSON, WISCONS1 54027 CALCULATED BY ` , DATE (715) 772 -3214 MPRS #3224 WI CHECKED BY f DATE SCALE n_ b !/h S 0�►�`7��iC.` ........................................... ............................... . ...4... .... .... .... ..... .... .... .... ..... ..... ..... .... .... ..... ..... ..... ... 1.. >.......... a .. .... .... € `'' 7 s ........... ................ ............ I . . . . : : . . . ..: . . . . : ; . Q ...: .... :... ............. ...:........ �. .......:... 2 ........:......:... ...:....... .............................. . ... :....................... :........... :... ... ....... ..: ... ....... ...... .:. ..... ............................... �o ------- ... .......... :.. '- 3 ........... .......... .� ......:... : : C v 1........ .:...........: ..... . ....... . .. ..... �V .. . . ... ... ........ .... _.. ... ......... .... P ... .. .. ..._. .. _.. ._.... .... e ., l ...... ..... _ __.. ... .. ... yyy .. .. .... <... . 444JJJ _ .. ... ...'. . .... ... :.. ... ........ ... _. .... .... .......... .... .. .. C ` s JV . . ......... �-�. ...... _ .. ..... Z T . ..... ....... . .. . . .. ........ ......................... ........... ----------- ................... W-11.1 ........... . ........... PRODUCT TOSI Inc., Grow, Mass, 01471, To Order PHONE TOLL FREE 1- M215 -. JOB P 1 r.R k' S�'7 G( l�Yl G KL✓ TIMM EXCAVATING SHEET NO. OF Route 1 Box 192 ✓� /, g _ WILSON, WISCO SIN 54027 CALCULATED BY DATE (715) 772 -3214 MPRS #3224 WI CHECKED BY DATE SCALE / = A ye u, ... ..... ..... .... .... .... ..... ..... ..... .... .... ... >........ ... ......... ..... ..... C" `..rL ...:... t _. ... .... ..... . ... ....... . ... . .... .. ......... :.. ..... ..:.... ..... :. ........... ...... t ...... .. ........ ....... . .....: __.. ........ ... .... .:. ...... ............................. ..................:............ a . ..... .... .... .... ................... ..... .................. .............. ,..... .. o . ....;... .. ... o ................ : ......:. ....... . .. v ,� . . ....... �" . ... .. �� .. . �' ..... �l . . . ... .a _ ..... L . . ......... f Z �s �L T ----------- ....................... .......... ................. .............. PRODUCT 205-1 �Inc. Groton, Mess. 01471. To Order PHONETOLL FREE I - 00!}2254180 - ` ��� -vs �*✓ UAJ7 L e� ICE VA77d rJ Wisoonsin Department of Commerce SOIL EVALUATION REPORT Page J- of - -3 Dhrtslon of Safety and Buildings _ In accordance with Comm 85, Wis. Adm. Code • c ounty S"T: CIQ,fl i �C Attach complete site plan on paper not less than 8 112 x 11 Inches In size. Plan must Include, but not limited to: vertical and horizontal reference point (BM), direction and Paroel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please p►! --- v-- .- -- -- - --I R Date �g a ` Personal information you provide may be e0 for 2��P &V.FM"y Laws.. 16.04 (t) fm))- /os - Property Owner ,Property Location K T Lk ("✓� ���K�E 0 � 114 SW 1/4 S� T Z 9 N R 19 r W property Owner's Milling Address , of i x Block Sutxi. Name tx CSM# ?1) Tou�►JSV �r ll�y R �, 1 3 �� 1 ? — S7 � State lap C P�jW IW tbfdr 'I;E iliage ,RTown Nearest Road Tf s V11 Ot 015 ._ 3gl6 --21ZZ TKO To VAu-ey RD• gajz� New Construction Use;X Residential/ Number of bedrooms Code derived design flow rate (& __ __._ .. — _ — GPO ❑ Replacement ❑ Public or commercial - Describe: �� � — Parent material (X1T1A��iJj'1 Flood Plain elevation if applicebie l �J:��__ General comments i� and recommendations; ZI�-GoYC.OV� -�� �1�1�£T�1 oN1'�''�'�'N��S 10 - BV- �' 1 NEO BV 113STflL�R, (D -I LoAOtx)G RATE, • Boring Boring # r Pit Ground surface elev. _ �q, Ofo ft, Depth to limiting factor ��_ In. Sail A Iication Rate P ! lure Consistence Bounds Roots G 01ff Texture Structure Boundary Horizon Depth Dominant Color Redox Description Terror "Eff4l 'Ett#2 In. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. '� . z 4 -t2 %4K L -L 5b6 65 Qt 3 2 'ZO 0`ffZ-5/4 NL Z MO lr CvJ 'fi- ;Z0 - LEI - 1 SL -Lab r W 24.E 0 r S 10 , 4K *6 — S 1 t 2u� -m - 1 s rz Boring # Boring or Pill R. GrounC surl2ce etev, � -r r Depth to limiting tailor In. ._�� wit Awicatlott Rate } lor{zon Depth Dominant Color Redox Description Textujre t Consistence Boundary Roots •E GPD /tf in. Munsell Qu. Sz. Cont. Color Gr. S z. . 1 5 IOy2 �/L 5L -rn s Cb - .5 9 6L L sb 0.1 0 '!5 0,9 r zfr`sbK C.5 -rn 0,5 O- z -�z 2-- 1 o 1 01 -- m 1 0, 1• z ;no Effluent #1 = B00 > 30 r 220 mglL and TSS >30 <_ 150 mg1L Effluent #2 = BOO << 30 nxg/L and TSS � 30 mg/L Signature CST Number CST Name (Please Print) ZZ $32- /AA '10 Ho LL I S -rF Date Evaluation Conducted Telephone Number Address W`ig ?5 6qO " AVI-. Rldrw FAli.s WT 5402 2 OS -31 -o3 �? CLOT 3) Properly Owner i ten! , Percef 10 0 _ UEA )J C- r— Pago ?n. of 3 -- Boring e ❑ Boring YY IL �Ji Pit Ground surface elev. _s$ n, Depth to li nitinp factor In. Sory Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOlff in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eftdt 'E1`12 1 0 -4 ro Z Ls d 5 b i- 6•-7 1. 1 4 -1 - 1 jp 4 It - 3 z �.5 Z { -[ ~Sb 3 •s Z 0) 7 1. Zr 3 11- 10 s uJ -m 0. 1. Z- 1 0 S -- 0.7 I.Z GKrB 8 Boring N ❑ Boring ❑ ❑ pit Ground surtaca slay. A. Depth to limiting factor ' _ In. Soi plIcLion Rote Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In, Munsah au. Sz. Cont. Color Gr. Sz. Sh. 'Etfol 'EffN2 + — E es es le I Boring N ❑ Boring -� -- — t �.—.J ❑ pit Ground surface slay, ft. Depth to limiting (actor in. Soil Applicatlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRf in. Munsett Ou. Sz. Cont. Color Gr. Sz. Sh, 'EffNI 'ERN2 ) i Effluent at = BOD > 30 220 mg4. and TSS >30 < 150 nV& Effluent #2 = 800. 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistanec to access services or need material in an alternate format, phase contact the department at 608.266.3151 or TTY 608.2)4 -A777. $60.9110 (R r. r P AGE:.1 FROMM OWNM =W: L-L La&TeD 'ftte sBC, T2 M 100 Op / row F T �T * �'� E • ' LAND IL NO COMM 83 5EI13KK PQOOLEM5 boilw. 4% NOT t4m LOW9- t / l.A"T y J Jo l �� '��` z� � ► S• P �p4srcT, Naa ��PEfn`I UNE I]' U - T 3 sn� P ie 1 iv o a.req , i �« S, a l g0-CGcS SIGW Of 2214 7 3 2 9 2 5 VOL 17 PAGE 4577 KATHLEEA H. WAESR ---- REGISTER OF DEEDS ST. CROIX CO.. WI RECEIVED FOR RECORD CERTIFIED SURVEY MAP 87/30/2003 03:45PH CERTIFIED SURVEY HAP LOCATED IN THE SE 1/4 OF THE SW 1/4 OF SECTION 8, T28N. Co PY FEE: R 19W , TOWN OF TROY, ST. CROIX COUNTY W I SC OIAP,, ROVED PAGES: 3 ST. CROIX COUNTY 3 F%nnirm zoninn and pans CemmM"N 1/4 CORNER JUL 2 9 2003 49SECTION 8 3 SCALE IN FEET T28N, R 1 9W :1 n � pP� 0 75 150 300 NOTE: THIS MAP IS BEING REVIEWED AT THE TOWNSHIP W ° d o LEVEL AS PART OF AN 80.30 ACRE PRELIMINARY I cc f- PLAT OWNED BY ARTHUR AND MAR 1 LYN FEYERE I SEN . I , UNPL A T TED UNPLA T_TED L AND_ I1 LAND _ ARTISAN 1 "0' �' \ I MEADOW Q I � LOT 4 �'\ � „E, � _ -- — — — — — - JI N 2.263 ACRES e -48 98,593 S.F. / W m B-4A �5 \/ W ^ I i� to te s N 87 E �� 3 �I B -3_ -3C 4 35.65 ' - _ -^� R =80 ' Ir • s :go co ' B -3e 87,167 S.F. �, • ?•:' c` Ns> Nw co $g \ S 8 278.84 O E _ 6 ° n ;' pRtVEWAY EASEMENT FOR LOTS I S 9? O / 0 1 AND 2 50' g \ te S 30 6 00 . 00” E 1 LOT 2 / ss.00' I , 8 -28 ' Z 3.197 ACRES ®so� LOT 1 ` d, \ 139,262 S.F. / ...rti / 3.802 ACRES m $$ B - 2A, 0 . . . ®B -1B 165,623 S.F. j JI e - 1C 2 S 1/4 CORNER W I 40.00' �� aeo.00 . SECTION 8 15' WIDE DRAINAGE S 88.23' 30" W 700.00 T28N, R 19W hj I SOUTH LINE OF ' I I EASEMENT. 7.5' THE SW 1/4 ( POINT OF EACH SIDE OF LOT LINE `� BEGINNING EXTENDING TO CUL —DE -SAC. LEGEND I I LINE TABLE �T 6 COUNTY SECTION CORNER MONUMENT. : f ALUMINUM CAP. FOUND. I A �Q�� p 1 1/4" x 18" IRON PIPE WEIGHING 1.68#/LINEAR FOOT, SET. • 2 3/8" IRON PIPE, FOUND. _ BUILDING SETBACK LINE (25' UNLESS OTHERWISE NOTED). OWNERS AND SUBDIVIDERS ARTHUR AND MAR I LYN FEYERE I SEN 10• WIDE UTILITY EASEMENT. 420 TOWNSVAL LEY ROAD (R'—) PREV i OUSLY RECORDED INFORMATION. HUDSON. WISCONSIN 54016 B -2B SOIL BORING PERFORMED BY *NOTE: ALL IRON PIPE ARE DIMENSIONED ® MARY JO HOLLISTER. AS OUTSIDE DIAMETER. PROPOSED DRIVEWAY LOCATION. THIS INSTRUMENT DRAFTED BY JEROD A. FINK PAGE 1 OF 3 Vo1.17 Page 4577 Dec 08 OS 02:11a p.l ST, CROIX COUNTY SEPTIC TANK MAn4TENANCE AGREEMENT AND OWNERSITIP CERTIFICA'T'ION FORM Owner/Buyer :�; ' k - m; Ne, t -? . w ry. - Ire Mailing Address 55? 9 3 4uc &o1?7 Property Address" `t'�o S Q. --� W (Vcrifieation requited from Platttring & Zoning DepattV=t for new construeh0 - ) r.;v City /State 4 o Par el Identification Number 6416 ' /d 3 LEGAL. DESCRIPTION Property Location 9,-45' '/. , S w '/. ,Soy. , T -� OR�w, Town of Q Lot # 3 Subdivision r t Certified Survey Map # Z�(�i , Volume o � Page # y5�7 � 7 - `Warranty Deed # / 3 2, , volume °� , Page # (o Spec house yes , - Lot lines idetrtifiable yf , no SYSTEM MAINTENANCE A" OWNER CERTIFICATION Improper use and mainta=ce of your septic system could result in its P=maturc failure to brandle wastes - What Y ou pik0l o put into consists of pumping out the septic tank every three years or sooner, if needed, by a licensed ptunper. 15 ern_ Owner maintenance the sysrcm can affect the function of the septic tank as a treatrfner►t stage in the waste disposa s y st em- responsibilities are specified in §Cpmtn. 83 -52(1) and in t�ap ter 12 - St. Croix County Sanitary O The property owner agrees to submit to St. Croix Counry Planning & Zoning Department a ccsRf� IIon� rrn' by the ourmyrnara plumber, restricted pluml-wr or a licensed purr�er verifying owner and by r~ rr►asoer plumber, j core and umpis►g (if necessary), the septic took is wastewater disposal system is in proper operating condition and/or (2) afka impec P less than 113 full of sludge. l/wc, the undersigned have read the above rcqu=n -a=m and aWce to maintain the private sewage disposal system with the standards set ford', hereiu, as sat by the Dcparturant of Commerce and the Dcpartrnerrt of Natural Resources, State of Wisconsin•►, Certification stating that your septic system bas been tainted tit be completed and rctuaoed to the St- Croix County Planning 8c Zoning Deparaneot witlr it► 30 days of the durc year expiration date. 1/we certify that all statements on t th his f are true to the best of my /our knowledge. Uwe arn✓are the owners) of the property described above, by virtue of a warxanry deal recorded in Register of Deeds Office - Number of bedrooms / DATE SIGNA E Off' AP LICANT(S) ... information that is misrepresctrted may result in rho sanitary pemtit being revoked by the Planzring & Zoning ptpartrnept- ••• Include with this application a recorded warranty deed from the $Lcgister of Deeds Office and a copy of the ccrtlfled survey map if reference is made in the warranty deed, (REV, 08105) 1\ V ...2936 P 567 61329(ZI State Bar of Wisconsin Form 7 -2003 KATHLEEN H. REGISTER OF DEEDS DEEDS TRUSTEE'S DEED ST. CROIX CO. WI Document Number Document Name RECEIVED FOR RECORD 12/01/2005 10:00AN TRUSTEES DEED THIS DEED, made between Arthur N. Fevereisen and Marilyn E. Feyereisen EXEMPT # as Trustee of the Fevereisen Revocable Trust REC FEE: 11.00 TRANS FEE: 330.00 ("Grantor," whether one or more), COPY FEE: and MICHAEL J. SHUMAKER AND ANDREA L. SHUMAKER, CC FEE: HUSBAND AND WIFE PAGES: I ( "Grantee," whether one or more). Grantor conveys to Grantee, without warranty, the following described real estate, Recording Area together with the rents, profits, fixtures and other appurtenant interests, in St. Croix Name and Return Address County, State of Wisconsin ( "Property") (if more space is needed, please attach addendum): Part of SE 114 of the SW 1/4 of Section 8, Township 28 North, Range 19 West, St. Croix County, Wisconsin described as follows: Lot 3 of Certified Survey Map filed July 30, 2003 in Vol. 17, page 4577, Doc. No. 732925. 040 -1037- 10-300 Parcel Identification Number (PIN) Dated A d q (SEAL) (SEAL) * *Arthur N. Feyereise Roder n. gevers � Nei e , -� .. �. � : _ (SEAL) C ` (SEAL) * *Marilyn E. eyereisen State of Wisconsin AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF ) ss. J/, COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on (If not, the above -named Arthur N. Feyereisen and Marilyn E. authorized by Wis. Stat. § 706.06) Fevereisen as trustees of the Arthur N. Fevereisen and Marilyn E. Fevereisen Revocable Trust THIS INSTRUMENT DRAFTED BY: to me known to be the person(s) who executed the foregoing instrum c wledged the same. Attorney Kristine Ogland Hudson, WI 54016 * No Pu lic, State of My Commission (is permanent) (expires: (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. TRUSTEE'S DEED 0 2003 STATE BAR OF WISCONSIN FORM NO. 7-20(13 • Type name below signatures. INFO -PRO°t Legal Forms 800455 -2021 www.infoproforma.com I POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page f of FILE INFORMATION SYSTEM SPECIFICATIONS Owner ►( Septic Tank Capacity IZ$p al ❑ NA Permit # $`d(�Z Septic Tank Manufacturer 0,'C5LA_ ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 2,. ❑ NA Number of Bedrooms 4j ❑ NA Effluent Filter Model fQ� ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity IJA gal ❑ NA Estimated flow (average) L7�Z gal /day Pump Tank Manufacturer N q— ❑ NA Design flow (peak), (Estimated x 1.5) (4 gal /day Pump Manufacturer 1 6+ ❑ NA Soil Application Rate 6 gal /day /ff Pump Model N ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit A Fats, Oil & Grease (FOG) <_30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD <_220 mg /L )"A ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ja ; �Q�_ ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L > In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) :510' cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. her ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA JR ear(s) 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 years) Clean effluent filter At least once every: A years) ❑ month(s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ' ❑ month(s) ❑ NA ❑ year(s) Other: ❑ month(s) At least once every: ❑ 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 Z 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 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. T alua ' 111011L UTWd. 11 11U 101JIsm"min apea is a o ing tank aRDI -/1 F3 TT1� N/ ofVS"TRC/�'l OnJ ❑ 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 — 7-7 2, — ?j Z I � Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name sue(-, C (()V Zo>J Phone Phone in compliance with chapter Comm 83.22 2) b 1 (d & f and 83.5411), (2) & 3 Wisconsin Administrative Code. This document was drafted p nce p ( 1 11 1 1 (1 (1, 73 9 5 VOL 17 PAGE 4577 KATHLEEN H. WA1rSH` -- REGISTER OF DEEDS ST. CROIX CO.. WI RECEIVED FOR RECORD CERTIFIED SURVEY MAP 07Y3012003 03:45PH CE RTIFIED SURVEY MAP LOCATED IN THE SE 1/4 OF THE SW 1/4 OF SECTION 8. T28N, COPPY F E: R 19W , TOWN OF TROY. ST. CROIX COUNTY W I SCONAl213ROVED PAGES 3 ST. CROIX COUNTY 3 Planning Zoninn a -7 P%Ak Comm"`N 1/4 CORNER JUL 2 9 2003 SECTION 8 SCALE IN FEET T28N, R 19W ~ fS 0 75 150 300 ^ "°.5d NOTE: THIS MAP IS BEING REVIEWED AT THE TOWNSHIP °O LEVEL AS PART OF AN 80.30 ACRE PRELIMINARY I PLAT OWNED BY ARTHUR AND MAR 1 LYN FEYERE I SEN . I' ( UNPL A 7 - TED UNPL A T TED LAND LAND MN ARTISAN I I I 50• r MEADOW pl � �,s. '• Zs .,a J� LOT 4 �'� N ��� 6 .�0 ,. . � 2 � � J � -- - - - - - - -- N 2.263 ACRES p �; B -48 98.593 S.F. to I B L Q �- N 87°01' 08" E �! -3C 4 35.65 ' R�80' _ Pad B-3 — - - oir u, I LOT 3 I s ® 2.001 ACRES m b o, !B 3B 87,167 S.F. ap kk 'tyW iD L �000 ap • .•• W Z... ^ � S S4 = 3o• , -. — - �' 6 a' !t • �`I'� ° SHARED � 1 � 00 E DRIVEWAY 1 ,N D r-1a1 �'� 2 78.94' a EASEMENT ro FOR a^ _ - — � - 's�09?3a{��% •'�O/ 1 AND 2 50 g \ zo •�� S 30000' 00' 6600" E I c rn . LOT 2 B -2B j I z 3.197 ACRES ®� .o j LOT 1 I �Wa \ 139,262 S.F. / ; ;a 3.802 ACRES p 8- 2A., ®N: ;b ®B -1B 165.623 S.F. lU l S 1/4 CORNER Q ao. ' ' �� 46O •� SECTION 8 15' WIDE DRAINAGE S W23'30" W 700.00 SOUTH L T28N, R 19W Mj LINE OF OF I � I EASEMENT. 7.5' THE SW 1/4 I POINT OF EACH SIDE OF LOT LINE � BEGINNING EXTENDING TO CUL -DE -SAC. �-p LEGEND I of LINE TABLE �� ACLOUM Y SEC MONUMENT. J BE ARING ��� 1 1/4" x 18" IRON PIPE WEIGHING 1.68# /LINEAR FOOT, SET. , • 2 3/8" IRON PIPE. FOUND. BUILDING SETBACK LINE (25' UNLESS OTHERWISE NOTED). OWNFRRS AND SLIBDIVIDFRS ARTHUR AND MAR 1 LYN FEYERE 1 SEN 10• W 1 DE UTILITY EASEMENT. 420 TOWNSVALLEY ROAD (R'-) PREVIOUSLY RECORDED INFORMATION. HUDSON. WISCONSIN 54016 B -28 SO IL BORING PERFORMED BY *NOTE: ALL IRON PIPE ARE DI4ENSIONED ® MARY JO HOLLISTER. AS OUTSIDE DIAMETER. PROPOSED DRIVEWAY LOCATION. THIS INSTRUMENT DRAFTED BY JEROD A. FINK PAGE 1 OF 3 Vo1.17 Page 4577 Parcel #: 040 - 1037 -10 -300 09/01/2005 04:05 PM PAGE 1 OF 1 Alt. Part;el :' 8.28.19.122A -30 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Ad: ress: Owner(s): O = Current Owner, C = Current Co -Owner ARTHU�� &MARILYN REV TR FEYEREISEN O - FEYEREISEN, ARTHUR & MARILYN REV TR 420 TO" -'VNSVALLEY RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * ARTISAN MEADOW DR SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 2.001 Plat: 1758 -CSM 174577 040/03 SEC 8 T28N R19W PT SE SW BEING CSM Block/Condo Bldg: LOT 03 17 -4577 LOT 3 (2.001AC) Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 08- 28N -19W SE SW Notes: Parcel History: Date Doc # Vol /Page Type 07/30/2003 732925 17/4577 CSM 07/23/1997 1155/154 QC 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Va Last Changed: 07/19/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.001 50,000 0 50,000 NO Totals for 2005: General Property 2.001 50,000 0 50,000 Woodland 0.000 0 0 Totals for 2004: General Property 2.001 50,000 0 50,000 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 PLOT PLAN it '►RiY �: a+�'s�a� --TAR- � : I" SD' EL qm EO t `. 1".00 Q THE 58C. T2 utlCD �SSkME� w F rKW. ST. COI PI E • cbmhtN a -.f W/ BALKIIO� NQ COMM M 5MALK PWOI.EMS RECEIVED DEC 1 3 2005 1_OT y ST. CROIX COUNTY 1 u►uM i� J y k v a I_DT 3 u W _ % S �8Rr CT.H n 5aW Of - Rey15W: X2-12- 4Sf; 3Z nArC- f VAJT7L L, &VA77bA A 1ti� f 8M - V- — OW,,5 , -eat 0 p OIL EVALUATION REPORT Page tNisoonsln Department of Commerce Dlvtslon of Safety and Buildings Q In with Comm 85, Ms. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 Inches In size, Plan must County S.T. r �C Include, but not Ilmited to: vertical and horizontal reference point (BM), direction and Parcel I.D. — /6 — 3 d percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please PH, � R Oate Personsi informarlon you provide may be u Pt ad for v aDYe5Q-y Low. . 16.04 (1) (m)). / Property owner roperty Location �T u F6 12�15� 0 ` 1/4 -$VJ 1/4 S T ?-K N R t 1 W Property Owner's Melling Address of # Block # Subd. Name or CSM# ZD TowASVAt_L.�y E ST. CR01X C0UN i 3 C�� l7 — S7 - 7 - State I�p C PB�~1 GI HUL ty ❑ Village ,Town Nearest Road nS 4 Ulf? -S 4 I VKU 159011,1 1 ('7 3916 -- ZI ZZ - TKO V I - TokX5 VAL Ey RD, gi New Construction Use Residential / Number of bedrooms Code derived design now rate t& __. __.� , GPD Q Replacement Cl Public or commercial - Describe: Parent material (XAT LA - rt Flood Plain elevation if applicable General comments :j and recommendations: tsrcOWJ� CA11d£1�t101JJhL'Tt2t:I� B� 1>�s 16./01'A 8 1►33TALI� r Boring # C] Boring ® Pit Ground surface elev. _ 9. Des ft. Depth to limiting factor In. Soil Application Rate i. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. 'Eff 41 •Eff#2 I 0 -y jLj& L - - IJ1 5 -tn 0.5 0. Z 4 A -1 '4K — L - 5b6 4 5 Q t 2'c -m 0,.5 0- 3 0W, l K �r c vJ �f- ,s 0.8 SL -L.a.b r V� 24 -M 0 r 5 , 4 K 3 16 5 1 oy� 5 1 _ 0,1 1.2- [� Boring # Boring Depth to limiting factor In. 9 LDomluna Ground surfece etev, ��� R. _Z� Solt Ilcation Rate for Redox Description Texture Structure Consistence Boundary Roots GPD /ff !Mon Dent Co P isell Clu. Sz. Cont. Co lor Gr. S Sh. 'Eff#1 'Eff#2 24L SL -rn s Cb - . 5 0,9 2 5_ 01 s L -L. A.l 0.5 0-9 -2 �3 St r z�r`sbK J C5 -rr► 0.5 0.q 7 -32 75 I{ 4h. AS 0. .Z Z - t Q R�4 M --� --' 0� I, Z- -CO Nas Effluent #1 : BOD > 30 < 220 mg/l. and TSS >30 1150 mgA. Effluent #2 = BOD 30 mgll and TSS < 30 mg/L CST Name (Please Print) Signature CST Number /AA -10 H OLD STS- ZZ 832 - Address Date Evaluation Conducted Telephone Number W`ia75 1"40 4K AVF - , , izivEP..j0NLLS 11 WI 54022 05 -31 -03 ( yob- 1"17,5 Ilk f - C LOT - 5) Properly Owner _ L' Perctl ID N _ L Qt_.6-.� �. ✓x Pego of N-- B oring N ❑ Bonng Pit Ground surface clay. _1Q `• L_ R. Depth to Ilrniitnq factor _� In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ff in. Muntell Ou. Sz. ConL Color Gr. Sz. Sh. 'EfMf 1 'EfX2 0' to z L5 d s b r - D'7 1, z 14- 1-1 - 7 z Ls zf -�sb d� tr 0,7 t. z _ q j 3 17-50 s vJ Z , 4 -M 0, 1. z 0V Ie 4 S 0.7 1. z GWA 8 i Boring N ❑ Boning ❑ pit Ground surface elev. ft. Depth to limAing factor , _ In. Soft Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff In, Munsah Ou. Sz. Cont. Color Gr, Sz. Sh. EtM •Ef#2 i - GtLS F Boring N ❑ Boring E] p Ground surface etav, fi. Depth to Ilmlthg factor ` in. Soli Application Rata ', Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDI f in. Munsall Clu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •EfW2 t I s 'Y { f 1 'Effluent at = BOD > 30 < 220 m end TSS >30 150 _ r _ S4- < _ rr+0�. ' Effluent N2 o BOD � 30 mg/L and TSS < 30 mglL i 4 1� 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 -R771. seo.nto(IL WWI Now —W R ` FR O M R: FE�lw-�-5E l"U Lf I = 6;; ' ML UVA E.O M- W F T bT ► 91 M / 00 00 P� E • / IL NO COMM &3 5ETVACK PROPLEM5 lJNCaS NOT Lot ''�� ; Cco�ov�K u NES �rca rc�n� Jilt i 5 lb F LDT LA 1 V l am" , ho ?- �j v, zl� Wo0.'T ��ROP &/'_tI uti OA" mot ka L t 2 P pi T _J 4 � _ a 00 C C S S a.re4. � tr n' Ii SiSC• 41 g �U WlS 51GNEn Of I ZzNS�32 D arE: 45-3( -03 r JOB / c �� Yl Gam! SCI �I�YI G KC✓ r� TIMM EXCAVATING SHEET N . 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