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Home My WebLink About040-1276-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561092 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: Koski, John R. & Lesa Troy, Town of 040-1276-30-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 6157 08.28.19.1535 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark /tInn go Dosing Alt BM '?,T- yZ W ► P.r d J AA., .dbl Aeration Bldg. Se r Z.►. e Holding A- St/Ht Inlet t TANK SETBACK INFORMATION St/Ht Outlet X /a` ~e $7- G TANK TO P/L WELL EBLDG. nt to Air Into R AD Dt Inlet 16•73 g7. a3 Septic 3 ,7 75 Dt Bottom Dosing 25 112. Lf2 / 12 / Header/Man. (0 Cq. -icy Aeration W Q'b Dist. Pipe nS.9,J $ / Holding Bot. System 7.20 'q *y • N'5 Watk 7.2 1''? - J/ PUMP/SIPHON INFORMATION Final Grade y.OS /d! ' S Manufacturer Demand St Cover Za ItCr l GPM x ~'•~J 9~• fez Model Number ~r . /•-Z6 97,74 '1257 76.5 B,t) 151 i . P TDH LiJ `7 Friction P Losss3 System Head TDI Forcemain I Length IDia.,Z j j Dist. to Well / SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 45` L SETBACK SYSTEM TO PL BLDG 71WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR j. A Type Of System: UNIT Model Number: ~a..~L {~,,•Q, DISTRIBUTION SYSTEM Li ~Z I = 7Z Header/Manifold . Distribution x Hole Size x Hole Spacing Ve~n1t to Air Intake S 5 Pipe(s) ~ /V n (A,.. iCJ Length Ilia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth f T Seeded/Sodded xx Mulche Bed/Trench Center i 41.65 Bedlrrench Edges \ Topsoil es Rd No Yes 0 No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 392 Omaha C rt Hudson, WI 54016 (SE 1/4 SE 1/4 8 T28N R1 9W) Eagle Bluff Lot 3 Parcel No: 08.28.19.1535 1.) Alt BM Description = P.0'? 6%1 Vq,~t}L i ti3~ ~ O~ 5~bkc• . 2.) Bldg sewer length = - amount of cover = y I%t+ f ' ~C ~ b ^ 5 G~,,'.• 6~ also ca~.~D a'1- .~1.r~'1,,, e,,~l Plan revision Required? 0 Yes o / Use other side for additional informatio 7 SBD-6710 (R.3/97) Date Insep is Si ure Cert. No. W w PUMP PERFORMANCE CURVE MODEL TOTAL DYNAMIC HEAD/FLOW 151/1521153 50 PER MINUTE 1445 153 EFFLUENT AND DEWATERING 12 40 MODEL 151 152 153 35- lo- 152 Feel Meters Gal. Liters Gal. Liters Gal. Liters 31 5 1.5 50 189 69 261 77 291 10 3.0 45 170 61 231 70 265 8 25 157 15 4.6 38 144 53 201 61 231 20 6.1 29 110 44 167 52 197 6 20- 1 25 7.6 16 61 34 129 42 159 30 9.1 - - 23 87 33 125 15 4 35 10.7 - - - - 22 85 10 40 122 - - - - 11 42 Shutoff Head: 30 fl. (9.1m) 38 ft. (11.6m1 44 6. (13.4m) 2 5 1 1+ ELI 0145088 0 GALLONS 10 20 30 40 50 60 70 80 90 100 LITERS 0 40 80 120 160 200 240 280 320 380 FLOW PER MINUTE 014608,4 Model 151 Models 1521153 - 67132 6114 37/8 450M 327132 4516 • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with an alarm. 3718 327132 • Variable level control switches are available for controlling ® 37/8 327/32 single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. ' • Sealed Qwik-Box available for outdoor installations. See FM1420. I I I • Over 1307. (54°C.) special quotation required. 1111/18 ' ' 121/8 I 15111521153 MODELS Control Selection Model Volts-Ph Mode Amps Simplex Duplex I dare 5116 N151 115 1 Non 6.0 1 2 or 3 BN151 115 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 2 or 3 BE151 230 1 Auto 3.2 Included 2 or 3 SK2444 SK2064 N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4.3 1 2 or 3 6E752 230 1 Auto 0 Included 2 or 3 N153 115 1 Non 10.5 1 2or3 BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2 or 3 BE153 30 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float a CAUTION switch. Refer to FM0477. 2. See FM0712 for correct model of Electrical Alternator E-Pak. 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL T0: P.O. BOX 16347 Z ® Louisville, Ky 40256.0347 Manufacturers of.. SHIP T0: 3649 Cane Run Road p Louisville, Ky 40211-1961 QVdL/TY PUMPS ~/iNCE ~~~~7 http.,IAvww.zooller.com F A PUMP CO (502) 778-2731. 1(800) 24 PUMP X (502)774624 © Copyright 2004 Zoeller Co. All rights reserved. County Safety and Buildings Division St. Croix 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 63707-7162 Sat ermit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit ~JIA is required prior to obtaining a sanitary permit. Note: Application forms for state-owned resubmitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide ma for secondary tJ/~^a purposes in accordance with the Privacy Law, s. 15.04 1 m Stats. Same I. Application Information ease Print All Information -IF Property Owner's Name t 0 Parcel # John R. & Lesa A. Koski 1 sr~4+ 4/ 040-1276-30-000 Property Owner's Mailing Address Property Location 392 Omaha Crt. o~+~ Govt. Lot City, State Zip Code Phone Number SE SE section 8 (circle one) Hudspn, WI 54016 715) xxx-xxxx T 28 N; R 19 E or W I1of Building (check all that apply) Lot # /Typeof Name or 2 Family Dwelling - Number of Bedrooms 3 Block # Plat of Eagle Bluff ❑ Public/Commercial -Describe Use 14t~• Na ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Vi of Z l + Na Town of Troy III. Type of Permit: (Check o e_box. online A. Complete line B if applicable) A. New System eplacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner 3S`3'10 I 30 3 3 . Type of POWTS System/Component/Device: Check all that apply) on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank 7-M-r-D-ispersal Compone ) ❑ Pretreatment Device (explain) V. Dis ersaL/Trea nt Area Informati a: 42 in Plus" standard chambers & 4 d s Design Flow (gpd) 4 Design Soil Application dsf) Dispersal Area Required (sf) Dispersal Area Proposed (s f) System Elevation 600 Gpd 0.70 Gpd/Sq. Ft. 857.14 sq. ft. 860.40 Sq. Ft. 97.50' VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New Tanks Existing Tanks i3 m H ~ iw C7 C, Septic or Holding Tank Na 1,200 1,200 1 Wieser Concrete X Dosing Chamber 1,000 Na 1,000 1 Wieser Concrete X VII. Responsibility Statement- the undersign ed, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Prim) Plumber's ignature MP/MPRS Number Business Phone Number James K. Thom son MPRS 30021 715 248-7767 Plumber's Address (Street, City, State, Zip e) 340 Paulson Lake Lane, Osceola, Wl 54020 14 VI oun /De artment Use Only roved isapproved Permit Fee Date Is ued ~ Issuing t Sign y 75teen Reason for Denial IX. Cond*gTE pEWRensous for Disapproval 1'. `Septic tank, effluarit filter and dispersal cell must all be servk:es / inaitit as.per management plan provided by piumbe>•. 2. AN seQiack requirements must be MuitttalnN its per epp 66le Coda F ordinances, Attack to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R 11/11) ■ 50;/ Q~la/Gr¢ tidni0/~ ♦ EXi s~;rig rake ¢lcu~ ■ 39.2o.,ra.~i4 ems. /e 6 Q 5~'ys%SEy see 8T1$K., Gc7."eW Gm«vkf /%c'~T, oCTray, S~. C!'a,X C'o,~ 1,2e~v Ir . Se C fx.-~ a P~ ;✓sed 9~ ;✓oh ,0 C/. `job -1,2 7(, 30-OW abet A-,ca e~Y/u~6 E ter Jd1~~ bel /.z a~1e5 El'is6~.,99 /-bu~TSd,S41 Af- cp (7.5 cl Lk)CC5e r Cc" c L'e/~ 7b bG/'eeonneC~e~ byi~s~/~aE~an of l,G~ 4aP ,QGavrl~O~'fio^'~'C/ Poo p[i✓6(Sivh l~R~d2. G V v ~•"-jst'ry i ~ ~ ova' '69 Eo Ck! I. Two 4t 3'X87' s.i o P.J.C. ~sirih. St f -ce.vta;h ercOL = 97-50,' no sropc -tkra* d; xacrso•p c.~cti . CmaAa, goad P5. ~ o~ lr Conventional POWTS Index & Tilte Sheet Project Name: Koski 4 bedroom Replacement Dose Conventional POWTS Owners Name: John R. & lesa A. Koski Owner's adress: 392 Omaha Crt., Hudson, WI 54016 Site address: Same Project Location: Subdivision: Lot 3, Plat of Eagle Bluff Legal Description: SEv4 SE1/4, Sec.8, T.28N., R.19W., Town of Troy, St. Croix Co., WI. Parcel ID 040-1276-30-000 Page 1 Index and Title Sheet Page 2 Site Plan Page 3 System Cross Section Page 4 Dispersal Cell & Dose Chamber Sizing Calculations Page 5 Dose Chamber Cross Section & Pump Curve Page 6 Dose Chamber Specifications Page 7 Existing Filter Specifications Page 8 Dose Conventional System Management Plan Page 9 Septic Tank Maintenance Agreement Page 10 Parcel Map Page 11 Deed Attachments: Soil Evaluation Reports I Mater umber Res 'cted Service: James K. Thom son, DSPS Credential #30021 Signature: Date: Page 1 Of 11 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01101) O :S I','/ Qda./cra. E,on~Oi~ gZ Sca/e: R 2/ 39zO.rta/i4 /-lads urn, uJ ~ SS~O/6 Q Seyf%SE`'4; See EXi~~ ~c7: c.s~ Ccn~r~e ,P. ~Jrc.7.~?n• o<'Troy, S6. C!-o~x Coy 1,2u0 9Q. Se'c 6u.-R'~ I~~opoSed u~/ A-~ca e~/a E E~t~r l/a!✓e be! /.2 4C('e5 (75~c~ WfeSe(' ~cri'fE. P,e/~ ~t✓bG/7co.~net~e.d /aeon of 4cr Pool pe, ve rs.-C~, ,:Q lde . v _ v J V "15'to✓~ decK y 1 /~.Ff / CJawrr) o9C ~Pcs~dP.ncG asP~ clr~✓e.w4jr 6 Ev s E ab l Beo 0Fua2/ V Proposc~lds("~aP E/QU: =id!7 cuI.-rwo(L) at 3'X87'-v ~ sl ~~~.5f0 P.J.C. 2•n<''~'uC S~~ce i ~ no srapc ttir«~ o.naha eoac( P5, z o~ 1~ C Soil Absorption System Cross Section /oz. v ft 4" Schedule 40 Final Grade PVC Vent Pipe With With Vent Cap -0 ft Leaching Chamber 7~ d ft System Elevation .2 63 ft 5 ft Soil Absorption System Plan View 87 ft 2.83 ft 5.p. ft ~Evl U1111111111IT111, Leaching Trench 1 Vent Or Observation Pipe Chambers I 4" Dia. Trench 2 Header Leaching Chamber Specifications Manufacturer And Model r~'/a~✓ ~d-~„ S~w+~u~~6~/cam EISA Rating X0.0 sq ft per chamber Soil Application Rate gpd/sq ft ('o 00 gpd Design Flow + y, 7 Soil Application Rate : 20 EISA = Chambers 2 rows of .2 chambers each. Page of Koski 4 bedroom Dose Conventional Dispersal Cell Sizing Calculations 1. (4 bedroomsx100 gallons estimated flowxl.5 design factor) = 600.00 Gp-d design flow 2. Infiltrative capacity of native soil = 0.7gpd/sq. ft 3. Absorption area required: $57.14 sq, ft. 4. Absorption area as proposed: 630.60 sq. ft. (42 chambers total) Infiltrator "Quick 4 Plus" Standard = 20.00 sq.ft, EISA/chamber, "Quick 4 Plus" end cap = 5.10 sq.ft, EISA 857.14 sq. ft. - (4 endcaps)(5.10) = 836.73 sq. ft. 836.73 sq. ft./20.00 = 41.84 chambers required Number of trenches: 2 @ 21 chambers tier trench Trench width: 2.83' Trench length: 87.00' Trench spacing: 8.00' on center Total system area w/ 6' trench spacing: 11.00'x 87.00' Trench Elevations: 97.50' Pump Chamber Calculations 1. Force Main: Diameter 2" pZ Length 220' Flow rate 20.00 gal./mi .t ZZQ Z16 Friction loss 2.02' (220'x0.92 ft./100') = 2.02 ft. 2. Total dynamic head: Min. supply pressure 0.00' (forcemain will discharge to distribution box & gravity feed to trenches) Vertical lift 11.00' (P.C. bottom = 86.50',Off float = 87.00', Dist. box invert = 99.00') friction loss 2.02' Total dynamic head = 13.02' 3. Pump selection: Manufacturer & Model number: Zoeller RN 53 Pump will discharge approx. 25.0 gpm @ 13.03' TDH (Flow Velocity 3.57 ft./second) 4. Dose chamber. Wieser P 100Q-MR - 36" liauid depth @ 27.83 gal /inch (1001 88 gal actual) A) One day holding capacity: 17.00" = 473.11 gal. B) Alarm setting: 2.00" = 55.66 gal. C) Dose volume: 5.00" = 139,15gal. (600ga1.x20%) + (.164x220) = 186.08gal. max. dose D) Reserve storage: 12.00" = 333.96 gal. Pg. 4 of 11 Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and - --0 lid Comm 16.28 WAC 4 in. min. Tank component is properly vented Alternat e outlet location _ Forcemain diameter Wieser WLP1000-MR Manufacturer 1.5 in. Capacityl 1001.88 Gallons -T Volume 27.83 gal/inch A Weep hole or anti- Nd Dimension Inches Gallons B siphon device A 17.00 473.03 B 2.00 55.66 C Pump off elevation (ft) C 5.00 139.23 87.50 D 12.00 333.96 D Total 36.00 1001.88 11 Dom se tank elevation (ft) 3" Bedding un er tank. 86.50 Alarm Manuafacturer SJ Rhombus Alarm Model Number SJE 1011421 Pump Manufacturer Zoeller Pump Model Number BN 53 TOTAL DYNAMIC HEAD/FLOW w PUMP PERFORMANCE CURVE PER MINUTE MODELS/55/57/59 EFFLUENTAND DEWATERING 6 20 MODEL 53/55/57/59 2 Feet Meters Gal. Liters i~o3' c 15 5 1.5 43 163 T 0 10 3.0 34 129 Q 10 15 4.6 19 72 oShut-off Head: 19.25 ft.(5.9m) 2 5 3 718 83118 4ye 1 12 -11 1R NaT 0 10 V 30 40 50 37/8 GALLONS S' M ~w ~ C r LITERS 0 80 160 FLOW PER MINUTE I PQ s0~u D Z A N :D A m 61 86" D z c n 42" C7 z r A m m N v "*z O m ' rTUP 41" N\~ 4" CAS x n I I 0 0 N m 3,. 36„ I 4„ p M O G I < D o (n m N W rr m I ~ I ro UP 38" A m 4" CAS \m A / ' N N A O M c v M ^ v O 4~ M D O X D s z ° 39" id 0<0 n (O D (n rM > l i W D 0> rA* AO D A A O r m xA x D z 0 M 0 -10 __4 ~O Am x D C m m v A v v 1 __q m AN RT+- mZ O nCO v Z D?Z pm0Z my0 ODD z R -C -Z D O M v ~ co vx ~ v m ymD m0 (n V w° 5 A 0r,(Zi,1 (nom mm cam v_1 (--(z y n AzO mD(n~ ir- r =O z~N f 88z z)-(n c Z n=A N o,mZOD M.P. ~ -D ~x Z0 3:(/) DO -N(zm oDm ~A r :r o s mvo mom ~(nZ Oo O Dm N y N q N Or-ioA ~rnp o pr,; O v D Z 0OODD ZD 0 -n(~ v (~nmy I m rCA-NP000- 20 ~ a v N Z ~N ' c W 0 -n Dr ~OsN v 0OV 0w TI O ° A D n ~O z _o c) mm(, V) co O Acv N CJ v, T1 Z C-'1 C (n O m v r 0D m D DO ~ (n0)m D m n° 0 V 'd M cu m -D.( (fin Z D r _w a D D ~I o m CcD`A' O yC G~AIO~ OA { m N v 0 m 0'O 0 O W V) l/1 m m m (n U) A A D 0 o X C A A O O m A 0 0 <3 O v Z r c 10 r W D H cz, A r M m m A 0 V (n WLP1000-MR DRAWN BY SME SCALE: 1/4"-l'-O" PRE-POUR: m MIENER I REV. m --q SEPTIC MANUAL CODCBETE E DATE: JANUARY 2012 DATE:. POST-POUR: \ Z W3716 US HWY 10 MAIDEN ROCK, N 54750 ° REVISED JAN. 2012 800-325-8456 FILE: Y0000-Wt w h ~ Zabel' A Division of Polylok Inc. FILTER TYPE FILTRATION GPD LINEAR FT. ZablA1801 4x18 1/16 8D ;;3 , , 80 ;a. Zabel A1801 4 x22 1/16" 800 80 p,` q Q A100 .'~O Y,Ca 1//16 1,800 1117 1 611 ~4QQ A100 12x20 VC 1 /16" 3,000 173 .r. :fir .Y::2..z81!. ~t h' 59Q5,~{ Yrj 2~ 1t~+^~~O ix1,l~~~eS.F:~, A 100 12X36 VC 1/16" 6,000 329 A30$X1.8.~C= 11 2 12,6 0 r Y 78 A300 8X26 VC 1/32" ~ 1,800 123 A3 n.,-p~j w 2t 2.405 [t fM7_ ga~x QO.8X32.1(5 L 5' q i l a i1 A300 12X20 VC 1/32'' 3,000 173 A300 12X36 VC 1/32" 6,000 338 "A60~.$ Y2fla4' A600 8X26 VC 1/64'' 1,800 123 r , ;A606, W2:V,C 62 A600 12X20 VC 1 /64" 3,000 173 QJU28VC 1/64"., A600 12X36 VC 1/'64" 6,000 338 P4.0011MYNOX-Inc. Innovations in Precast, Drainage & Wastewater Products log. i Dose Conventional Septic System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10705-P (N.01/01). All local and/or state rules pertaining to system maintenance and maintenance reporting shall be complied with. Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715) 248-7767 or the St. Croix County Zoning Department at (715)386-4680. Septic Tank Septic tank servicing mechanics comply with SPS 383.54(1)(e). Septic tank to be located within 150' of service pad, with bottom of tank to be 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1 /3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water rightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank. No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank, The pump (dosing) tank shall be inspected at least once every two years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed at the pump discharge, it shall be inspected and serviced as necessary. Soil Absorption Cell Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface within and above the system and will promote frost penetration during cold weather months. Cold weather installations (October-March) dictate that the system be heavily mulched for frost protection. Influent quality into the system may not exceed 220mg/L BODE, 150 MG/L TSS, and 30 mg/L. FOG. Influent flow may not exceed maximum design flow specified in the permit for the installation. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring. Continuencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil absorption cell to bring the system into proper operating condition. Pg. 8 of 11 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Ryan Cad ~ O'akgl Mailing Address 392 Omaha Crt, Hudson, WI 54016 Property Address Same (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number 040-1276-30-000 LEGAL DESCRIPTION Property Location SE '/4 , SE 1/4 , Sec. 8 , T 28 N R 19 W, Town of Troy Subdivision Plat: Eagle Bluff Lot # 3 Certified Survey Map # Na , Volume Na , Page # Na Warranty Deed # (before 2007)Volume , Page # Spec house OyesOno Lot lines identifiable OyesQno SYSTEM MAINTENANCE ANDO,3MB CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §SPS. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 4 4~2 _L1,2 x/-30 / /3 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 04/12) i K - t • w • S: f t !A Af EAGLE BLUFF 4 AND THE SE 1 /4 OF THE SE 1 /4 OF 9"+ OF THE SE 1/ THE NW 1 /4 OF THE NE 1 /4 AND THE NE 1 /4 16, AND ► OF TROY , ST.. CRO I X COUNTY* WISCONSIN , C 19W, TOWN CERTIFIED SURVEY MAP RECORDED IN VOLUME 9, PAG UNPLA TT ! I !1~ I~ LK OF IM S 1/2 OF NORTH ` 26" E I t TPE $E 1/4 N 58'37" . .1 12301.31' toOUTLOT 5.469 ACRES 238.241 S.F. i LOT-1 1 N 1 ' l CSM 1 I It VOL. 9 I l m 5 6 1427 ACRES / PA6E 2613 j 1 5w I a 44.7 s SF- DOC. 4s8 851 I _ 20 ~~tt,, 1 • 1.013 • / 5 +3 a 1 44,106 S.F. 21 ll St. • ~ ~ . 1. ~•'-0 1.210 r O • 52.729 S.F. I►GtES , 2 N 836' « _ ~v may. + 2447.02' . w 42 OUTLOT 2 W 1.415 ACRES sF. A 141 ' ' OUTLOt --6 X 3•;; 2 sF 1400 ~ 91. w~Y h ~ . •n ...J RAN~.Z 11111111111111111111111111111111111111111111111111 State Bar of Wixonsrn Form 6-2003 SPECIAL WARRAN'T'Y DEED * 9 1 3 2 3 3 1 3233 Document Number Docunmt Name 913233 This Deed, made between H&R Block Bank, ("Grantor," BETH PABST whether one or more), and John R. Koski and Lesa A. Koski, REGISTER OF DEEDS ("Grantee," whether one or more). ST. CROIX CO., WI Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant RECEIVED FOR RECORD interests, in Saint Croix County, State of Wisconsin (the "Property') (if more space 03/16/2010 01: 30PM is needed, please attach addendum): SPECIAL WARRANTY DEED Lot Three (3) of the PLAT OF EAGLL BLUFF, in the Town of Troy, St. Croix EXEMPT i County, Wisconsin. REC FEE: 11.00 TRANS FEE: 1200.00 PAGES: 1 Reowdin Ara Name and Return Addms h ~ an " r 040-127¢30-000 Parcel IdentIfIcadon Number (PIN) This is of homestead property c , Grantor warrants that the title to the Property is good, indefeasible, in fee simple and free and clear of encumbrances arising by, through or under Grantor, except 1 ID Dated this derY of Zo H&R Block Bank by (SEAL) bye (SEAT.) t. 411,4 - Sin', SEAL SEAL AUTHENTICATION ACKNOWLEDGMENT STATE OF KA~A~ ) Signature(s) ---authenticated this ^ day o~ ) ss. -.l D ptil x>4 COUNTY) Personally came before me this * day of F10. W10 the above named KOO" VA*4Gj , to me known to be the person(s) who executed the foregoing instrument TITLE: MEMBER STATE BAR OF WISCONSIN and acknowledged the same. (If not, - authorized by § 706.06, Wis. Stets.) THIS INSTRUMENT WAS DRAFTED BY Ryan H Wolter, Esq Notary Public, State of My Commission is permanent. (If not, state expiration date: 1 1 (wl2 091OR0193 (Slgaaturamay be audiedtatedor uimowledged. Both arenotseeessary) NOTARYPUBLIC - StateafKansas NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEA YID ~~~~~AA 5l OUP SPECIAL WARRANTY DEED 02003 STATE BAR OF WISCONSIN FORd~'sa2Wr • Type name below signatures My Appt. Expires 1 1 Of 1 r 97 e Wisconsin Department orcormneree SOIL EVALUATION REPORT pow ~ Of 3 Division of Safety and BuWings in accordance with Comm 85, Wis. Adm. 'Code Attach complete • County '57-- 'CA60 / X site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel Percent slope, scale or dimensions, north,anow, and location and distance to nearest road. Please print all Information. Re ' by Date Persorrar Wonmwn you provlee my be used for ._._e. 04 secendery Purposes (Wivacy Lsw, s. 15.04 (1) (m)). - /Z ---A PropertyOwner , Rropert~ Location ~~D Uief'11 SC ' "J R T Govt. Lc t S 1/4 ~ 1/4 O T 9N R E (or) W Property Owner's Mailing Address Bock # Subd. Name Ar C" Z o.441,Cr _ 3 City State Zip Code Number ❑ ❑ vilage ® Town Nearest Road uvso~ wL syoiG ~ i • ~a9~ , ❑NewConstruction Use: V Residential /Number of bedrooms Code derived design flow rate GPD ICF Replacement ❑ Public or commercial - Describe: Patent material Flood Plain elevation if applicable General and reconvinerKlations: comments owaeR lvisMes Ta f! 6,4tinoti. 4 2 yQ. 0z-0 71eE,ve.4_ S y5 TEAr C To "i'// 1- S'Vi.", U 6-- boo - ,y. ~v~~v ^i C+ Oe 7, .YeA/T C2//S F Boring# ® Pit Ground surface elev. /0Z . it. Depth to uniting factor in Sol Application Rate Horizon Depth DanfiaM Color Redwc Description Texture Structure Consistence Bocmdary Roots GPDW in. Munsel Qu. 'Sz. Court. Color Gr. Sz. Sh. •Eff#1 'Eff#2 o•/y io xe3/3 _4Z_ / sbk XMfe <i' cOTAD 2 1130 ioyRyG S/L -17777 i• /f Z •3 3 - ~ 3 vt-~ ~v~T SiL / ,C ~i • N - f} D i 4-eF4- of / • Nd T 1-52) I'M 19 1 a Boring # - . R Pit Ground surface elev. y it Depth to uniting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •E01 '0#2 o- g /o y/? 3 3 SG 2f5bk d5 w 3 Fi- , S . 9 2 /o Yk ~e vef/ SL If CS /7 3 a s - P S V. S i cs .-7 1. ~-sv fv 2 ` Effluent #1= BOO > 30 1220 rg/L and TSS >30 < 150 nV& • Effluent #2 = BO < 30 mg& and TSS < 30 mg/L S1gM'uraW4Ct&Z4-i- CST Norm Please P" Zl/~ /?/G~/ 7 Z ~-`~3 f ' Address Date Evaluation ConcDcled Telephone Number z/ - 0 3 '~/S •7.7 Ulbr!Cht & Associates Private Sewage Consultants 2812 10th Ave, Spring Valley, WI 54767 ORIGINAL ~ASZec /3 /v Flc~~ Property Owner / Q V0 1 - ` Parcel ID # 6 l /6 / • ~U P 2- 3 G ~ of 8 # Borne / 7 y Pit Ground surface elev. Q ft Depth to Nmitfng factor , in. Sod Rate Hotfnon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. •EW1 'Eff#2 X313 ~SL z Sh s 3- .57 Z io I iL s G Z . z . 3 0 • o .S R- S , S S . 1. Z S # ❑ Bcxing Bori Pit Ground surfaceelev. /D 2 ft. . Depth to lusting factor / in. Sod Horizon . Depth Dominant C;okx RedD* Description Texture Structure Consistence iDff Rate Bobrndary Roots GPD/ff in. Munsell Qu. Sz. Con! Color Gr. Sz. Sh. 'Eff#1 'Eff#2 s t~Tt a c VI) 0 M B°r 'g # PBorins; it Ground surface elev. Depth to farming factor 10 In. Sod Application Rate Horizon Depth Dominant Color Redox Description . Texture Structure Consistence Boundary ~ Roots In. Muansed Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#1 '092 /,0 V,4e Z114( 2- 1(od(O /7c Z F-1 7. L # Boring Q Pit Ground surface elev. ft. Depth to f W*V factor ' in. Sod Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundexy Roots GPDff in. Munsed Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ' Effluent #1 = BODs > 30' <320 nV& and TSS >30 < 150 tng& • Effluent #2 = BODE 130 mgll. and TSS < 30 mgfL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. 38"330(RAM) to f- 3 Property Owner / Q P0 1 Parcel ID # /6 M 3 7 ~v Page of ❑ Borirjp Boring • , / G Pit Ground surface elev. Depth to limiting factor 7 U in. Soil Application Rate Horizon Depth Dominant Cot Redox Description Texture Structure Consistence Boundary Roots GPD/fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Ef1#1 'EMW2 / o-& /a W313 SL a Sh s 3f S Z, V. - Iq io 1 1L s G Z . 2. . 3 6 fa s SiL sh a S /,L • Z 3 D• o stR s , S aS - ~•.Z ATe Boring ❑ Bering # Pit Ground surface elev. /D ' 2 • ft Depth to limiting factor a / 7 in. Sol ication Rate Horizon Depth Dominant Color Redo* Description Texture Structure Consistence Bouundary Roots GPD(fE In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Tff#1 'Eff#2 ~ t•~Tt a aBoring # . Boring • tJ Pit Ground surface elev. / ft. Depth to limiting factor in. . , Sol Application Rate Horizon Depth Dominant Color Redox Description- Texture Structure Consistence Boundary Roots GPM In. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 'Eff#2 / 0 • Vp /0 R z - S/L l :C ~rrr>~i2 Q S Z A9 1 l . 2- 82 . Z ❑ Boring # E] Boring tJ Pit Ground surface elev. ft. Depth to limiting factor ` in. Sol Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDfPF In. Munsefl Qu. Sz. Cont Color Gr. Sz, Sh. 'Eff#1 'Eft#2 Effluent #1 = B D,> 30,: <220 mg1L and TSS >30 < 150 mgtL ' Effluent #2 = BODE 130 mg1L and TSS < 30 mgtL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seoa»o ~6roo) w y-' 4 y -y 1 B 4 ' It a 4 `A to 9 • 1 9 f i _ f 7 P ~ ,,per{\o ~ •iy~'~ 4 ~ , ~ 1 pl s l i k c ell- I ~0- to 01 Q3~ %A-- ~1 1 t tom`-- . U 7 ~ Q . ~A Q V~ W v 3 C/) F O m m z O ww O7 z~ !n z c, w W C) :r • N A N O fD O m m O m j O 00 Oo Q 3 7 7 m N O y n O O N w a ~ CO O C rryll N c O O m m A d! O v hMj (v PO Q G 1 N , 0 0 N D) CD CD p O O O O A c (D c c C> Q (D c Q Q O Zn A~ 3 o Q n o a °o ? D V! N O C l` N N D 1 c w C w C/) D a N cn z D m a N t m co N N a p o D N a C) C 0 :3 Q a W Q I'a d O o~ A O QO °(0 n cn C) N N o z N c CD o O .Z O 0:1 i; cn O c !1 CL a !I :2 0 0 0? 0 0 0? I w m _6 c N N f~/1 N N m O 0 Q Q O' O m p O W fl m m q1 I x m m 3= ACD Ol O O c !l lVr CD CD 3 3 d rr! 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O O O C 0 o w vov m r? y C, a) o tv N " m I M N I A o a) z 0 N ~ o v ~ Al s m c cD A c C ' N a (D ' A Z {D ~ I N D O' e CL C 7 N ~ co w T m N a 0 Z 3 a C m co H Z F 4 a o I v c o a m I I ~ i y a. lv N °o H A O A (D k-j b C 0 ti W ° i F Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430334 0 GENERAL INFORMATION e (9TTACH 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: B'erstedt, Todd Troy Township 040-1037-60-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 08.28.19.1535 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size Ix Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes 7 No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 392 Omaha Court Hudson, WI 54016 (SE 1/4 SE 1/4 8 T28N R19W)/ Eagle OBluff LLoot 3 Parcel No: 08.28.19.1535 1.) Alt BM Description 2.) Bldg sewer length - amount of cover = y~ Plan revision Required? j Yes No - _-I Use other side for additional information. SBO-6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County S 201 W. Washington Ave., P.O. Box 7162 7 visevnsin ' Madison, WI '53707 - 7162 Site Address Department of Commerce 3 yZ 4M4-Ac_ 6_' - Sanitary Permit Application Sanitary Permit Number t,~ In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Ch-4i. C) 3 ~ / may be used for secondary purposes Privacy Law, s15. 1 m 1. Application Information - Please Print All Information State Plan I.D. Number Property Owner's Name Parcel Number 7-0©~ 13JE1eST~D7' ~ oyp•> b37-moo . S~ Property Owner's Mailing Address Property Location Q 312- oM %SE iA; S g T Z" N, R E City, State Zip Code Phone Number Lot Number 3 Block 3i rrftMT- Subdivision Name -eebtiftirrm i yr, 113 ~uf II. Type of BuDding (check all that apply) ,b PA_I S S ❑City .Mai n 194 or 2 Family Dwelling - Number of Bedrooms OVillage ❑ Public/Commercial - Describe Use 61'ownship 7~ o ❑ State Owned atest Road &4x 0,44,7~ III. Type of Perm : (C ox on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 ❑ New 2 AReplacement System) J 3 ❑ Replacement of 6 ❑ Addition to For County use System Tank Only Existing System B • Check if Sanitary Permit Previously Issued ermit Number Date Issued 390 ~ ~ 9 IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 )6 Non -Pressurized In-Ground 2111 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In-Ground 410 Holding Tank 48 ❑ Single Pass 510 Drip Line 45 ❑ At-Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 3011 Other V. Dispersal/Treatment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) (Min./Inch) Elevation X57 9-70 ,-7 VI. Tank Info Capacity in Total Number Manufacturer refab Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing 1 &,s 4 Tanks Tanks Septic or Holding Tank /2 Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Si re ItNP/MPRS Number Business Phone Number 7,-.-- ~z-Ce31 71s ' 77Q 3 V i/ Plumber's Address (Street, City, State, Zip Code) aZ $l Z._. /p /IV I 5y7 (~e VIII. Count /De artment Use Only Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I ing A nt Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse Detern9agjdQv 2S70 IX. Conditions o pprov n nn 1 S CJL(t.~1.tott~C n¢~rQA.c.Q-~l~e.~x ~,l~nti... ' auQ Ene,,OWNER: SYSTEM OWNER: ~1 Septic tank, effluent filter and 1 Septic tank, effluent filter and dis ersal cell must all be serviced / mailun 'AMA 'ft as per mar P age~ne11 n pan I Wn paper' not less than 8V2 x 11 inchesab per managemen y plun All setback requirements must be maintained 2. All setback requirements must be maintair SBDy6398 (R. OS/UlIs per applicable code/ordinances. as per applicable code/ordinances. r . 44~ Kill V 1 ~ -I o ~A 4 cn ~ I vN- 1 'r cD 1 m p 1 1 I Ioi CALL T j m .v 7 N 9 y~N C-Z- ~ '1 ' Ga ~ X44 J ULDRICI-11' & ASSOCIATES CO. 655 O'Neil Road • Hudson, Wl 54016 Reg..aeslrem of F.ngkvering S"1c 715-386-8185 Private sewage Consvlla„Is PROJECT INDEX , PLAN ID /IJf~-~ , Z S oJ? ~~jj 6 BATE OWNER TO/W A ~ S7 &V / PRONE 5~TE AvvRcss 3 y~ OM Cf • f-IaOSo,v Zvi S. S~oi 4 LEGAL DESCRIPTION GO yf--zU 3 G/~~U'F7G ~J/V bt~p, f'~j37• Sac . 9, 7"1900 Rif tv TOWN OF '~/C 6 St x COUNTY CSTM LOCAL AUTHORITY/ SUPERVISION S~•%,t/ Gy`p' v~,V PROJECT DESCRIPTION! e 4V iSff~-~ 710 if 134,V,42d x-; 171* 440 1,4~5G-- 14 P 2 -i~--& r3" r. 'Nfile •c~ T- Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, Wl 54767 /1P/?5 # 2zCe3-7s A 'TO/TON d- SLO aaqeMa~se a I-QSS (p • Z uots.zaA) suiaqs,IS quauzqea.zy M ~zsup a~enTad zo3 Tenueyl quauodwoO uoTgdaosgV punozo-uI„ uo paseq aje suotgeoljTOads pue sueTd pagoegqe agy *MNVJ, ONISOQ HOd SOddSSQNKNNOIOOgSdSSOHp (`IKNOI.LdO IZdO) g•bd SOddS Hds'IId gaaVZ '4 SNVgd INaWaDVNVN 2I M ) L • Od ~ dN 0 S ' bd SNOIIVAaaa HIIM 'WdSSAS 30 NOISOHS SS02IO C • bd NVId SOU WaISAS Z-bd bd Z. .I,ddHSMHOM ONIZIS HOIVHIgIdNI T •bd cp-sz-~2W `1 'a ~ 01 Atilt PCI i fir. ~ ~ o y o r (n Q . 3:1 AV N N. . - - - C6 14 N i i Ira ~ m 01 i N @ y N col lo{ s V 411 k 'e C//, N € ~rr fir K 1 9 ~ Chlcv~~*~D o 19P"AU&P UE,v T T a~ iivSpEC T/ov ~D~~ I7iv. /2 Iff j I/M scll. ~ N R4 rjjt7p ~i,~v, y g, S U NL~-T- To 1) 1"5 T Box- /00-0 C,Vo 55 SEC Tiox) o,oc'- Z9 CA?A AA Orr&P V60 7- c,9/° ~ U,v ~,vsp Ec T~ov p,/~Q„ /fin/. 2 iff 101,5-0 Il N - ~T&M / y OVER, See Backside For Inspection Pipe/ Vent Details Leaching chamber tops are at or below the original grade. Leaching chambers are placed directly on the bottom of the distribution cell. The locations of leaching chambers are in accordance with Table 3 of this manual. Observation pipes are installed in the distribution cells and are provided with a means of anchoring to prevent them frtim being lifted up. Observation pipes extend from the infiltrative surface for stone aggregate systems or from the inside of leaching chambers to a point at or above finish grade. The portion of the observation pipe below the distribution pipe for stone aggregate systems is slotted while the portion above the distribution pipe is solid wall. Observation pipes for leaching chamber systems are attached to the chambers in accordance with the chamber manufacturer's printed instructions, extend from a distance > 4inches above the infiltrative surface through the top of the leaching chamber up to or above finish grade and terminate with a removable watertight cap_ All observation piping has a nominal pipe size of 4 inches. See Figure 5. Water tight cap 1 4" min. dia. Top of leaching Repair couplings chamber Slot 6" min. s" min. Infiltrative surface 4" n►in' Water Closet Collar 'Bar(318" min. dia.) Figure 5 - Observation pipes Vent pipes, if installed, connect to the upper half of the gravity flow distribution laterals and extend up to at least 12 inches above finish grade. Vent pipes terminate with the vent opening facing downward by the means of a vent cap or fittings. Vent caps must allow a free flow of air between the distribution lateral and the atmosphere. All vent pipes has a nominal pipe size of 4 inches. PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS P,4 1E- `f of ~o ovi vOocJ, OOR />t sa ,fib b VEIJT GA PiPE ? /O -DOOR D VEBT PIPE ~ WEATHER PROOF APPROVED LOCKING JUMCTION BOX MANHOLE COVER 12"MIU. 014vA,ep10dr IA13CI ~~t5r<NC~ GRADE I 9~ - I 4" MIN. mu COIJDUIT-~ (j~lE`UAft• 7 ` PROVIDE I - INLET AIRTIGHT SEAL I III ~1 I I I APPROVED JOtN7 A gI~EK I III APPROVED JOIU W/ PIPE !UM I III W/ PIPE EXTENDIM& 3' ONTO 30~~(~ ► I II ALARM ETO O SOLID S JNTO SOLID solL B r _ I i I • 5C-4.4o POc g lD~ ~D 1, 3 '3 Sc4 ¢U I I oti ELEV. FT. ! PUMP --j Z/SE- 3 I ti. OFF 0 1.2 ~lO~f'E °F ,(AN K ` t PP/'' I + BLOCK Sitrvl~ /E VA f ioAl j,GD>i~1 RISER EXIT PERMITTED CNJL4 IF TAUK MANUFACTURER HAS SUCH APPROVAL. - SEPTIC E 5 P E C, I F I CATI OKI S DOSE (DUMBER OF DOSES: PER DAS TANKS MANUFACTURE. TAIJK SIZE: GALL/O_AlS DOSE VOLUME ~O GALLON! e ALARM MANUFACTURER: L.tyr.~ 19~ rt `T! INCLUDIMG BACKFLOW: /q 3b MODEL NUMBER: CAPACITIES: A= INCHES OR / GALLOM! SWITCH TYPE: ~ld` g=•~' INCHES OR 50 GALLON! PUMP MANUFACTURER: 20e11En C =y INCHES OR /70 GALLOW MODEL NUMBER'. D=~~•_ INCHES OR 3-125 GALLON! SWITCH TYPE: MOTE: PUMP AUD ALARM ARE TO BE MINIMUM DISCHARGE RATE Z S GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFEREMCE IJETWEEN PUMP OFF AND DISTRIBUTIOU PIPE. 1).35 FEET -rAA,L SPEC s + MIMIMUM NETWORK SUPPL9 PRESSURE . . . . . . . . . . . '0% FEET• EAC(A, O Dt + 220 FEET OF FORCE MAIN F~O FTFRICTIOM FACTOR.. FEET ZS t"~vr I s TOTAL DYNAMIC. HEAD = FEET p INTERNAL DIMEIJSIONS OF TA►JK: LENGTH /01 ;WIDTH ;LIQUID DEPTH 7-- n ~ • yN LET Tv ~~eoP /5T. /S0X b • D IV 61p l)D 10,"'e *,t 2-1o BUG = 3 S - THIS POWT SYSTEM SHALL cC X T 5 TI ,l INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # /f- 116.0 !if'`'A- - SEPTIC TANK, per Comm.83.44 (2) (c) shall be equipped with an outlet attached approved filter device (Zabel fliter). Tank shall have an approved above ground locking manhole cover for regular (every 12 months or less) inspection & servicing by a I f' . ZOLLER EFFLUENT PUMP MODEL 98 NEAO CAPACITY CURVE s 7/e a I 1 30- MODEL "Ow- 25- 3 q s/0 Yr 1 O I rJ- 4 3/14 e Io- 1 I/2-11 1/1 NPt a- 46- o- tl.li, 44LONS ID 2 Jo Intns 40 F50 60 70 so 160 240 0 FLOW PER MINUTE Met M-,o H[Ah1tOW tI,I l~.iUit [t/ltHNl ure txw~toewn . i s tA►ACily Dn Pitt, IrETIRI I,rns 1-111 213 !.Q! I7/ u 4.or 41 110 10 tie 2S os Lock v," a` CONSULT FACTORY FOR SPECIAL APPLICATIONS s Electrl iuppMd aAwUhahaler@n &larm. f for duplex systems, are available and • Mercury 0081 switches are available for contfoNing single and 1 Mechenicat atlernatore, fat duplex systems, are ovtillable three phase systems. TMAItotA ~m twhciH*• with or • Double piggyback mercury 111081 switches are avallable for variable level long cycle controls. Standard all models - Weight 39 lbe - tl,p, IIELECTION ou1DE 1. Inleprai Itoat operaled ?pole rnechenieal switch- no "'"net eonUol r N ierles I. Single PIOeYbeek meteuty Qod ewkeh a double tpuhed. Control Selection switch. {Mier to FM0/71, PiOybaek mercury,11001 kel Ypl+e-Ph Mode Am a Elm lox Duplex 3. Mechats"ahetnatot 1o0072or t0007S. " 1 I - 1 U10 0.6 lot I &L - 4. $40 FM0112, 'of correct model of EkcUlcai Allerrutor, , E•Pak • Its 230 1 l4do2 Q( 2~~ e• rcwy NMO► now swtich 10-0Q23 laid y • corwd acNvaror .pee~• 3 Its 1 101197 - Pt•r W) 01 141 aoal system 2]0 t Non 45 2 l e• ."K01 h* "-t PIV. PncdM602 1 t er &'Plea oP•ratlo,% to 0002. lo[ riitev11p111 eotlrleetlon at w4ed h •kn• pMr 1. iwe P) has P•i~ . lo/ wMet1lplle oo[lrl..__.,.N opllee. F•e Nraulbe M addM[w ~,er McJucb re/« M catato0 en Cembinr.don Bun« f►AOt111; t M Fdb111j EYc4ker ANe,nelm FMOtee; NOChenkel AMrMtor, AN i6on loa el CAUTION "*I"- Ptdeettoa 4eQbae end wk Ft+el1( 21ro P••A•f•. 17; a wee• eu4y FM 0.e1; am (Yma•. In Moeneed eleolrlo6n All a inf •he rN w done tiY a "a* t onsd tf Mw 1`0410•1 end *a* eed.e et,. uy MNowe1 ina.4. we+t r.e.nl NNlen.l Ebe4b CedO (NEC) .M H we C Ne"I t at eeNA Ad )OINA} •O°P0 •Ir .nit RESERVE POWFPED DESIGN For unusuAi conditions a reserve saley factor la dngineered Into the design of o fiery Zoeller pump. --z - {waft ra r.u. cox 163il t oulw;re; xv 40256 ts Manulacturefs Of... 2N1~ >'O: 380 04~ Ari1Mn I NV M f~+~ r,; rrr r6 Qua, rr os ,f ~vcr / 115011778.2731:. reri502)714-3624 9.x'9 vwlYr;R's MAINTAINCE OF _ ` ^n SEPTIC SYSTEM ~ ti. A POWTS (landowner) maintenance of ) is repohsible for this system- Regular proper operation and g is necessar Periodic inspections and system. The owner serviciny for the safe health maintenance is required healthy operation of. this /inspection by code to submit all necessary reports to the controlling,authorities. SPECIFIC CONTACT AGENTS * Governmental authority/ inspectors: Pr--PT - 396- y~ F o * Licensed installer, responsible for ma ntenance "Users" Providing manual: an operation/ * Licensed serv&ce / inspection a 74 gent other than installer; 3t6 • -2/3 0 * Electrician, for ' pump, electric controls, wiring units IMPORTANT OWNER MAINTENANCE RE UIREMENTS i• Winter traffic area shall not (sledding, shove*in permitted o can across the the cell, freezing u the s' or frost can /will winter.(a vacaction up ystem. Discontinuos use In to into lead to freeze ups, trip, resulting in no water n the use) can also 2• Water conservation needstv hYdrolicallY overloaded be exercised! Or system can be designed for and destroyed. This svs a-m9ximum wastewater flow of / Gem was 3. POWTS are ~PQ~~ gals. daily, not designed disposal disposal unit - to accomodate wastes from a or any other unnatural garbage Any introduction of such waste sources of waste. destroy this system. materials will overload and 4' If a power 8,~itage occurs In a power 6 ' or a pump ,fails, it ma temporary cell, which ma overload of effluent bein y result recommended y adversely impact the cell pumped into the allowin that a licensed pumper em (leakage)' It is Consult g the pump to return pt' the dosin Your Installer to dosing the correct amg tank, ounts. immediately for advice. 5• Neglect of the vegetative erosion preventive) cover (the cells traffic can lead to insulation REGULARLY also can destroy failure. Compaction WATER THE VEGETATIONSYstem. It IS.NECESSARYrTOeavy the system beneath 1S OVER A S E ' grass cover. NOT sufficient alone to Effluent in 6- Periodic maintain a ' inspections by the owner, neces~hey_ Inspection or his agent into system: on the Mound and ports have s, is inspection pip., mound basal area (effluent Porated laterals, s' at each ' tip terminals on level out. Thep - for flushing the Pressurized system in and cleaning the laterals ground cover/manhole). Only a licensed locked above qua & severe should be Performing this work which in y Ives lled nil safety risks. Evidence which nvolves system's tr e?tment ce of effluent health cell shall also be p°nding in the regularly inspected. ~ y. A' aWisco sin D n r SOIL EVALUATION REPORT Page / of 3 in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County ,S T C.40 0 i X include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I.D. L,/ Percent slope. scale a dimensions, north.arrow, and location and distance to nearest road. Q / & 3 7 cO Please print all Information. Reviewed by Data Personal ardor txm you provide n" be used for secondary purposes pW Ocy Lary s. 15.04 (1) (m)). Property Owner Property Location (J r19D U~ I: sC J R~ TE Govt lAt j 1/4 S61/4 S O T 9N R If (or) W Property Owner's Mailing Address n 'Lpt # Block # Subd. Name or i:SM# ~.RZ 014107-4 C7-- State Zo Code Phone Nuxrlber ❑ CiN ❑ Village ® Town Nearest Road ffvoso~ w/. Syo/4 ~61)zy~•/a99 o D.yq.. CT. ❑ New Construction Use: Cd Residential / Number albedrooms Code derived design flow rate GPD g Replacemerut ❑ Public or commercial • Describe: _ All Parent material Flood Pledn elevation if applicable - + _ ft. G and recoffirnendations. eneral o mrnents OWAIER tail #45's' Ta f} 6144JP0A.I. 2 yiP oLO TjPE.veA- S y5 7~5.Le C To i.VS X411 ,v&w ACc+ -Foie Tre+r,,4verA - cell-5 F-/1 Boring # ❑ Boring 107 --0 ® Pit Ground surface elev. fL Depth to flrnituug factor - / / in. Rate Horizon Depth Domirwd Redox Description Texture Structure Consistence Boundary Roots M*Eff#II In. Munsefl Qu.'Sz. cord. color Gr. Sz. Sh. f#2 ~ •/y io ye 3/3 s~ 1 she .Mfe Q'e ' z -~c A go f Na T s0 17 /e~- a Boring # Pit Ground surface elev. y ft Depth to Iindting factor in. Sol Application Rate Horizon Depth Dominant color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsefl QU. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 o- $ /o y~ 3 3 SL z-fshk s w 3 2 SL /f CS Cp 3 a k 1w -P S. s ;Q cs I• Z sv fo 2 • EMuerd #1 = BOD > 30 S 22o mg& and TSS >30 < 150 mglL • Effluent #2 = 80% < 30 mg& and TSS < 30 mglL cst ~ NO" memo 7S ER~ 7l// iG~r 7_ Sipe Y--n _ L Z`~3' ufftmW ' Address Date Evaluation Telephone Nurn1w z/- 63 -?/1.7-7 a 3 Y~•✓ Z Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 ORIGINAL L 3 iFASZt 13 /0 Flc~ Property Owner 1-& PO 1 Parcel ID # 1.63 7 - 6a P 2- J age of # ° " J~s >s6 Pit Ground surface elev. Depth to NnAM factor in. Sod Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots WON In. Mumsed Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 / o - & /a I 3 SL a Sh S zcJ .3f- S io f ~L S~ c Z . • 3 S 49 317 # Pit Ground surface elev. /Q 2 ft Depth to Nmi4ing factor - / in. Sod Depth Dominant Color Redo* Description Texture Structure Consistennce Application Rate Boundary Roots GPD/ff in. Mtn►sed Qu. Sz. Cont. Color Gr. Sz. Sh. •Eif#1 *0102 s ,e_t'Tj TO . 4- le --t- V/-) BO1ir'g # pit Ground surface elev. /O/ • ft. Depth to limifiruy factor ~ In. : Sod Application Rate Horizon Depth DordnaM Color Redox Description- Texture Structure Consistence Boundary Roots in. Munsed Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Etf#2 /0 R z S/L /-Ir a IM-AR at S / . Z . /L Vitjik /M-fl- S 7.s 0, cs .Z $2 2. Bori ng ❑ Pit Ground surface elev. ft. Depth to dndtirlg factor ' in. F-1 # ° Sod Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPDM In. Munsed Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD6 > 301220 mg& and TSS >30 < 150 mg& • Effluent #2 = BODE < 30 mg& and TSS < 30 rnWL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. 58D-130 (R-6110) Ll 1 1 CT. ~ i CL_ lbs. ~ S 'o+ +01 Qm-- m I I f e o I 00 °11 No7 T n N l w ~ i v w SI La~-~~ ST. GROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the 10,9 ~JF~iST~7 residence located at: 51/4, _1141 Sec. d T IN, R If W, Town. of Upon inspection, I certify that I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced Did flow back occur from absorption system? Yes No (if no, skip next line) Approximate volume or length gallons t e s capacity: Construction: Prefab Concrete Steel Other Manufacurer (if known) : W l,e 41NCt-e /,e eb Z--- Age of Tank (if known) : '7 (Signature) (Name) Please Print (Title) (License Number) (Date) Form to be completed by licensed plumber (s.145.06, Wisconsin Statutes) or Licensed Disposer (NR 113 Wisconsin Administrative Code) _ Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge will conform to the requirements of ILHR-83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name Signature----__ MP/MPRS Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring Valley, WI 54767 ST CROIX COUNTY SEPTIC 'I ;ANK MAINTENANCE AGREEMENT *4 ` AND OWNERSHIP CERTIFICATION FORM 8S Owner/Buyer Tt>AD 13J e; sT&D7-- /7/-s • 3 3 Mailing Address Property Address - ~v (Verification required from Planning Department for new construction) City/State fl V 0S0'J Parcel Identification Number o7 O - /cO3 / - 60- 00-0 LEGAL DESCRIPTION Property Location S,C_ s~ Y,, Sec. a , T W N-R 7 W, Town of T/ilOy Subdivision ;f IE-,~3~vTT Lot # 3 Certified Survey Map # , Volume , Page # Warranty Deed Volume , Page # Spec house O yes no Lot lines identifiable Ayes Ono SYS'T'EM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification slating tlt r septic system Itas been maintained must be completes; and returned to the St. Croix County Zoning Office within 30 days the three y r ex ' on a D F 1` j PLI T DATE OWNER CERTIFICATION I (we oce hat all star ments on this form are true to the best of my (our) knowledge. I (we) 'Am (are) the owner(s) of 4pert bove, by irtue o f a warranty deed recorded in Register of Deeds Office. CAN DATE Any information that is mis-represented Wray result in the sanitarypermit being revoked by the Zoning Department.****** Include with this applleallon: it stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed r< -VQL 1613PAGE 362 STATE BAR OF WISCONSIN FORM I - 1998 PAR -W FEN H.W6 H WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO., WI ' RECEIVED FOR RECORD This Deed, made between 04-04-?001 11:30 AM Troy Development Corporation, a Minnesota Corporation WARRANTY DEED EXEMPT N Grantor. CERT COPY FEE: and Todd A Bjerctad and T1aniG p cr r COPY FEE: 2.00 ~hti.Shand and ..ifa t.. _ TkANSFER FEE: 201.60 p mar-it•al RENRD.tNG FEE: 10.00 P-Opprry P.Ao"ES:. 1 Grantee. Grantor, for a valuable consideration. conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the 'Property*): Recording Area Lot 3 of the Plat of Eagle Bluff in the Town of Name and Return Addreas Troy, St. Croix County, Wisconsin. Todd and Denise Bjerstedt Subject to Declarations of Covenants, Conditions and H 1106 udson, eWIv54016rive Restrictions for Eagle Bluff, recorded in Vo1.15702 Page_IFI as Doc. No.er o as a 5t~. Croix arin in the office of the County, Wisconsin, and such other easements, reservations, restrictions.and reservations of record, 040-1037-60 or in use, and the "Buyer" obligations contained in Parcel Idenbrication Number (PtN) the Purchase Agreement for this lot. is not This homestead property (is) (is not) Together with all appurtenant rights, title and Interests. Grantor warrants that the title to the Property is good, Indefeasible In fee simple and free and clear of encumbrances except Dated this 15th day of March 2001 J (dom. (SEAL) (SEAL) Charles S. Cook, President Troy Development Corporat on (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) Minnesota State of Wtaeeneln; ss. authenticated this Anoka County. day of P,et~o~n"Ll rams befor` r~~s/ !s~~ Be ^+C day of CharlS. Cook President the above named troy Development Corporation TITLE: MEMBER STATE BAR OF WISCONSIN (if not, to me known to be the person who executed the foregoing authorized by 5706.06. Wis. Slats.) irtstrument and acknowled the same. THIS INSTRUMENT WAS DRAFTED BY T. rov Development Corporation nc . Clift Charles S. Cook, President Notary Public. Stata.o6~l -Ln Anoka County, Minn. necessary not My commission as permanent. (If not, state expiration date: (Signatures may be authendca[ed or acknowledged, Both are ) 2005 ) Names or persons signing in any capacity must be typed a printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORM No. i - 1998 Wisconsin Legal plank Co.. Inc, Mlwaukaa, W.S. NANCY 1.. COFT jy NOTARYg1)LIC-41A MY COMMISSION EXPIRES JANl1ARY 3t, 2(Xl5 - t 4J ~ 0 0 ao UZ~ ~~~St\ ,lam (n v► SOD to O W • l 0 (n OD ` CV Z I,Q ` 3 "'"V 3 Q \ JI- l0 O ~1 4? 00 Q O Go af r l ~i 000 z o $ I / g l N N ~ e,►~ Y , ry ✓ 22e~ 47• - 0 Cq.~ ~~81'g0'8f` SOt = .ry 3! ~ ~ / / 5 2g5 ~t' b o Z ;<< g~ •Op ~ 100 W / / ryN 15'00 / / N w -~oy0 RSA' one N 02 (0 kk. N ot° G~ p! w N C~ 0 J oN N co L N l 185~~ GAO ° F-- Cr a N 08°00' 00" Mr OD e ° d 0 a in Z M ! to _J NANO W $08_'00' 00" E \ z 1-" N Z / o _ N 401 Y co LO a~ ~L~QO~~ try. / yl W iN z N n , /00 k5 i ~6~j~~• ep0' ~~G15F chi 40 o I ~ - r g + p s+ k~. 1h wo ~O N 32 a~ Q 99 x~~ i` /S• 51'40.97 ~h n / l / o0 E ab~; a co ;D Prj LL: / G / N r 32.99' t0 e~ on , a orol • f9~ _ I ro \ 99Z $ o 0 N M - o ~ o O ~(p Q N (tD_^ 1 aD 0) ^ N of N NOD O ,f4 990 8l - - T IZ us co \ S6 0 C> o O is `Q N r co COI ~I ~ h 00 co ov, ct: l o-~ Q 001 10OW I z1 691 .89 0~~ I ,Z,re0o S e .80'stiZ I 3 .,99,c£elo s co g*z o~.,~\ N i i OI a 1 0 ` M „Z[ .0*°l0 N", Y) I J 1 ~Qn M; 'V I Q I cv Q Q •I I W 3 h I NI I > 1 _ n (n & z 00 I N i I 0 w* ►~.....r.... I O- - o I I 1 Parcel 040-1276-30-000 04/12/2005 04:24 PM PAGE 1OF1 Alt. Parcel 08.28.19.1535 040 - TOWN OF TROY Current k ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * BJERSTEDT, TODD A & DENISE A TODD A & DENISE A BJERSTEDT 392 OMAHA CT HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description * 392 OMAHA CT SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.210 Plat: 1924-EAGLE BLUFF 01 SEC 08 T28N R19W SE SE SEC 17 T28N R19W Block/Condo Bldg: LOT 03 NE NE LOT 3 EAGLE BLUFF Tract(s): (Sec-Twn-Rng 401/4 1601/4) 08-28N-19W SE SE Notes: Parcel History: Date Doc # Vol/Page Type 04/04/2001 642106 1613/362 WD 02/21/2001 638939 1589/491 TD 2004 SUMMARY Bill M Fair Market Value: Assessed with: 28289 408,300 Valuations: Last Changed: 07/23/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.210 87,900 321,200 409,100 NO Totals for 2004: General Property 1.210 87,900 321,200 409,100 Woodland 0.000 0 0 Totals for 2003: General Property 1.210 79,900 296,300 376,200 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 0 n (fi 3 m > > 3 v n z I cf) (D 1 o w 00 -t, n0, LI < y O CD O N O FBCD 0 I ID CD 5' Z OD Q. p y Co N lAl N C G) p a O . V 1 o a = Q wO1 A tD C CI CL On b 3 v+ w o O C N O I 0 ? y `W a O (D C: 3 OD ~ n CD C) 00 o o c n o c y N ' 17 a 0 3 v A o c cn ~ w m CO) y (7 O IQ M. 3 o cc C) C, -v a 0 o m Si v C, m M N 3 fu N =3 CD z N z z c y o o o o U) ( cc (o N. c S N W D o CL a 3 z (D -1 N p _o Q A Z CD ' Z CL A 7 G) 0 z w W v a `o c z 3 » z C m y z _ CD A A ~ _ I p > > Q d C N 0 WO N O O S N C d ' (D 0 0 z d m o F, ~ m N 3• -o CD I 9g • 0 0 ° ~ o o y ° Q3 a d o ye a y b CD CD y y N ti 3 3°E Q° i f a O t-j CD DO C di Q ti W O ~ I ti ~ oSTC 104CfKo AS BUILT SANITARY SYSTEM REPORT omm .1 11 l3 i s 7'&--,o 7- OWNER ADDRESS 0/44,1-4,f ~Q U/p 7- SUBDIVISION / cSM# 6-Aer 1310-F P- LOT SECTION . T Zg N-R W, Town of 7-/? L ST. CROIX COUNTY, WISCONSIN PLAN VIEW SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM ORIGINAL INDICATE NORTH ARROW Provide setback and elevation information on reverse of this form. Provide 2 dimensions to center of septic tank marltole coves.. s , C s T s 3/y 141G AY f-C- BENCHMARK: ALTERNATE BM: Cp~e,~.lt ve-v?- 92 7. G 2 ' SEPTIC TANK /pump ER / HOLDING..TANK INFORMATION p Manufacturer: /L~'SE Liquid Capacity: Setback from: Well } 9~ Hotzse_ Other Pump: Manufacturer /y//' Model#~ Size Float seperation Gallons/cycle: Alarm Location :SOIL ABSORPTION SYSTEM / t Width: 3 Length 2• Number of trenches 1 fT' J Distance & Direction to nearest prop. line: Setback from: well: 8 7 House 412. Other e ELEVATIONS i ~ 2- S. 3,5 Z S. Building Sewer ST Inlet; ST outlet. PC inlet PC bottom Pump Off Header/Manifold Bottom of system Existing#Grade Final grade DATE OF INSTALLATION PLUMBER ON JOB: NUMBER: 2 2-6e 3 S LICENSE INSPECTOR: g- 57.3P 3/ 9 3: j t UlbdCht & Associates P,ivate Sewage C060111n • 655 O'Neil Rd. Hudson. Wis. 54016 t Uv z„ c 1\ lot! Z v g p Q. s Q • Ir o -mac 1 1+ 16~\ 1 ~ w _ rn 3 ~1 1 x NJ 1 `ftN. 1 -Ac 1 q - S 0 I w 41 y O ~ m PL: U_ % Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Saftaty and Buildings Division Count t. Croix INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitar38E3"610.: Personal information you provice may be used for secondary purposes [Privacy Law, _-X15.04 (1)(m)]. PerI §e"All9C PafeSdd ❑ City ❑ Vf>fft[jr6Wfl@ lip State Plan ID No.: CST BM Elev. Insp. BM Elev.: BM Description: Parcel TY40-01:276-30-000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic L,-)Et Lo - Benchmark `j,3 9 ZT Z 3` *mt. am IVI Dosing 93 cr2-f - 62 f Aeration Bldg. Sewer Holding St/ Ht Inlet Zfl qZS% 3S TANK SETBACK INFORMATION St/ Ht Outlet `f 3 °[2T% 2.1 TANK TO P/ L WELL BLDG. Ventto ROAD Dt Inlet Air Intake Septic NA Dt Bottom Dosing NA Header/ Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade .fig 91 T7 St ruvel Manu acturer Demand Model mber GPM TDH Lift Friction System T Ft Forc ain Length Ia. Dist. To Well Fi SOIL ABSORPTION SYSTEM 0 RENO Width I Lengtq No.. OTrenches PIT No. Of Pits Inside Dia. Liquid Depth DIME (.2•i-.a~e.t DIMENSION SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING ~ ~ Man f t SETBACK ur r: INFORMATION Type CHAMBER O i I g D OR UNIT Mo el Number: r System: DISTRIBUTION SYSTEM 43 Header / Manif Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing -t 445 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded / Sodded xx Mulched Bed I Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Da/241/01 Inspection #2: 'TT' Location: , Hudson, WI 54016 (NE 1/4 NE 1/417 T28N R19W) -1728191535 EAGLE BLUFF -Lot 3 1.) Alt BM Description = {ate. s ~AJW 2. Bldg sewer length v -amount of cover = t S 5 11~~~9 183 =~[6.}Z ~~`~"~~ll•Y4<<» -9~g.15' C__ Il•931-°Il~,ton 13.a~o-alf..t' Qr s 1(-92 = gl~•63~ C~~ It . `tl} e - (a~,a = ~~•ss 3`~~,*,vK,~... Plan revision required? No Za~ I Use other side for addition on.I SBD 6710 (R.3/97) go/~j i^% G•S" "~-w . D to Inspector's Sig Cert No. I ADDITIONAL COMMENTS AND SKETCH ' SANITARY PERMIT NUMBER: i 3 E E r . i 3 i . j , x f 1 r . t • S _ Sanitary Permit Application Safety & Buildings Division In accord with Comm'83.21, Wis. Adm. Code 201 W. Washington Ave. ~ See reverse side for instructions for completing this application PO Box 7302 -#SconSln Personal information you provide aw, s. 1may5be.04(I)(usedm)] for secondary purposes Madison, WI 53707-7302 Department of commerce [Privacy (Submit completed form to county if not state owned. 1 -1 Attach complete plans (to the county co only) for the system, on t less than 8-1/2 x I I inches in size. County 517 ~RQ! J State Sanitary Permit Number ❑ Check if revi t p aDUs app i ion State Plan 1, D. Number N/+ O 1. Application Information - Please Print all Information Location: Property Owner Name Ly6\ ` opBerty Lo2,on I / T'oDD-P~vli Ste' 13 J ER s T E'D.. 1/4 I/4, S TLf,N, R E or W Property Owner's Mailing Address 7 7 t; « Number Block Number 1/O C,f s 7-0leto O/~ • 1 sT CAOIX 3 City, State Zip Code Phone Number ? ubdivision Name of So•J G~/. S yap ~ II Type of Building: (check one) ❑ City 1 or 2 Family Dwelling - No. of Bedrooms: "J ` ❑ Village ,Town of 77 ❑ Public/Commercial (describe use): y ❑ State-owned III Type of Permit: (Check only one box on line A. Check box on line B if applicable) Nearest Road dMf} c r. A) 1. ~New System 2. ❑ Replacement 3. ❑ Replacement of 4. ❑ Addition to Parcel Tax Number(s) !~t System Tank Only Existing System B) Permit Number 1,10 _ ~ r3O ~,l Date Issued ❑ A Sanitary Permit was previously' issued D / 6 U L. 1 L 15 IV. Type of POWT System: (Check all that apply) Al- (M AA0j114__.1_ 4< !I • .Non-pressurized In-ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In-ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At-grade 1 t ❑ erobic Treat ent Unit ❑ Recirculating 11 Other: 2 93•~s ~0 92/• So V Dispersal/Treatment Area Information: 1. Design Flow (gpd) 2. DispersalArea 3. Dispersal Area 4. Soil Application 5. Percolation Rate 6. System Elevation 7. Final Grade Required S Proposed SQ -FT. Rate (Gals./day/sq. ft.) (Min./inch) Q/ 7. 1/0 Elevation VI Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing GOG.~ IP/QOF/Ie . crete structed Tanks Tanks /2~0 lL~d / ~i~Si ❑ ❑ ❑ ❑ VII Responsibility Statement I, the undersigned, assume res onsibilit for installation of the POWTS shown on the attached plans. Plumber's Name (print) Plumber's Signature (no stamps): /MPRS No. Business Phone Number ?o(sL'QT Zll0. ,picC,1- z z ~3 7S 7/S • 3 ~l 601,P 5 Plumber's Address (Street, City, State, Zip Code) & S 5 0 'tie,f/ ADO (~~S0) d! VIII County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date Issued Issuing Agent Sign cure (No stamps) Approved ❑ Owner Given Initial Adverse SuI e Fee) (70 - - Determination 5- - t IX. Conditions of Approval /Reasons for Disa proval: s~(' Ind I X44. 5, - (o~nr-tee t,~~- C r~r~ 2 to /tAQ 5&~ f S YS t~ i6cs' eQ2o t~jit . pok cec~s ~uS~ b~- Yv i~ CeST es+Q2 ~11t S AA&UZA7 DA14~ LC, 4J VGA a, Fj.,- ►^ti iN►e~S S ' SBD-6398 (R. 07/00) 4 0 ~ CL- O cal v ~ M eax~ of oa ~ -o v' C:4 ` O i f -I \0 goo lot lu ( ( s II II ~ ~ ~ ~ I I I I a I I IX v j I I 1 1 Q f`(~ II I ~ J Qc W to I I 11 ob i 153 i ~C loll- INI g~ ~~rz • I-13111CHT & ASSOCIATES CO. 655 O'Neil Road • Hudson, WI 54016 neg..Veslgners of F.ngtneertng Systems 7 15-386-8 185 Private Sewage Consultants PROJECT INDEX PLAN ID # DATE n i C O OWNER 70fltq::;; Xjp44I,SE- 13 jE95TEDT PHONE J P6 ' 3 051 ADDRESS //DCQ C/~~'STV ff1Jl9,~elLl S 6/0/Co LEGAL DESCRIPTION LET 3 >ir~s~-~ 131U7'7c. //-A) dy~'/p.37'(000'~U s q, 5~ % 5-t. V, T w TOWN OF -rko /y COUNTY 57T C~o! K C S'I' M /D "l • ; - /A 11/57-6X 'z- Z V93 Z LOCAL AUTHORITY/ SUPERVISION PROJECT DESCRIPTION: f6-L f3t~v~pM top Sr'~ Flo w ~D D So/ls /f/P6~- lj,~ ~6 C,¢.-1-/°,,) a.4 /,1, -7-;t- ~o~/ Tod b3` S MPs Uibricht & Associates private Sewage consultants 655 O'Neil Rd. l Hudson. Wis• 54016 O Lam/ P9.1 INFILTRATOR SIZING WORKSHEET Pg.2 SYSTEM PLOT PLAN Pg.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg. 4 11 If of to if Pg.5 OwNER MANAGEMENT PLANS & ZABEL FILTER SPECS Pg.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS. The attached plans and specifications are based on "In-Ground Absorption Component Manual For Private Onsite Wastewater Treatment Systems." (Version 2.0) SBD-1075-P(NO1/01. I of y y 0 Ns Q fi y ~ o g (Aj Ln N CQ cy~ `3 0 Sx- y~ 9 C-sq 46/_ Y\~ tl- of oat. °y 4 II ~ \ clic, O ~ I I I ! J I I I I f` ~ v I I I- ~ / ~ z I~ lI~J~ ~ I lIM~~ I-- ,I II ~ W ~u 10 to) ~ M° r I C~lc v ~~F T ED IS i"41v"- 6-,9t ~ U~ ~,uspErT~ov 1ff_ M s~• Qo 9~~4i~~ 9~l 5 .g . I C 'Ve P11 le~ D Til°t S v~ TAM y CRo 55 SEC TioA o~ .TIVE W5 IA) IN 2- 7,C4 7-0t(>,5 *J-& "x 6 w tot 7, y SQ jt4t, 5716-C T. % 1 U.v ~NSp~~T~ov p~l~ 11/A/. iff I/// 43~ ' 1 TiPEti ~ ~ Sy~T~M OVER: See Reverse Side for Vent/ Observation Pipe Details. An observation pipe may serve as a combination observation/vent pipe providing it terminates in the same manner as required for vent pipes. See Figure 6. -Vent capes Rehm bend Cap 7 12" mhr. 11 12" min. Final grade WJ Aggregate Distribution lateral irp. 1 hm. `System elevation Figure 6- Vent and combination observation/vent pipes Leaching chamber tops are at or below the original grade. Leaching chambers are placed directly on the bottom of the distribution cell. The locations of leaching chambers are in accordance with Table 3 of this manual. Observation pipes are installed in the distribution cells and are provided with a means of anchoring to prevent them from being lifted up. Observation pipes extend from the infiltrative surface for stone aggregate systems or from the inside of leaching chambers to a point at or above finish grade. The portion of the observation pipe below the distribution pipe for stone aggregate ' systems is slotted while the portion above the distribution pipe is solid wall. Observation pipes for leaching chamber systems are attached to the chambers in accordance with the chamber manufacturer's printed instructions, extend from a distance > 4inches above the infiltrative surface through the top of the leaching chamber up to or above finish grade and terminate with a removable watertight cap. All observation piping has a nominal pipe size of 4 inches. See Figure 5. ' J Water tight cap Top of 4" min. dia. leaching Repair couplings chamber Slot 6" 6" min. min. 4" Mir infiltrative surface. Water Closet Collar Bar (I/11" min. dia.) Figure 5 - Observation pipes r Vent pipes, if installed, connect to the upper half of the gravity flow distribution laterals and extend up to at least 12 inches above finish grade. Vent pipes terminate with the vent opening facing downward by the means of a vent cap or fittings. Vent caps must allow a free flow of air between the distribution lateral and the atmosphere. All vent pipes has a nominal pipe size of 4 inches. OWNER's MAINTAINCE OF SEPTIC SYSTEM Pg. 6 Continued. POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of this system. The owner is required by code to submit all necessary maintenance/inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS S 7- y * Governmental authority/ inspectors: ~IL P^ , 3.0G• * Licensed installer, responsible for providing an operation/ maintenance "Users" manual: R OIL ~7- /L1.4~ S -P--- Z.Z. ft 3 7 S Ilo * Licensed service / inspection agent other than installer: G * Electrician, for pump, electric controls, wiring units: IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic (sledding, shoveling, etc.) across the mound area shall not be permitted, or frost can/will penetrate into the cell, freezing up the system. Discontinuos use in the winter (a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This system was designed for a maximum wastewater flow of (PCB gals. daily. 3. POWTS are not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the i cell, which may adversely impact the cell (leakkge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYSTEM!! Effluent in the system beneath IS NOT sufficient alone tO maintain a grass cover. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover/manhole). Only a licensed properly quali6ied person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. VIA Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of Division of Safety and Buildings in accordance with Comin 85, Wis. Adm. Code County 5'~T. Lf~Ut1( 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 referee nt (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow,, *Td1goati ~n,42fistance to nearest road. Please print a~,rsi{1fcrhaton. --1 R iewed by Date ,I I Personal Information you provide may be use r 3e~onda pur~es P ivacylaw, s" , I SA~ .}15.04 (1) (m)). Zo f) Property Pr~edY Location Z of -T . Owner ~ ' • CI'1~121ES 'St CbOK "f 04 t S>✓ 1/4 SE 1/4 S 19 T Ztf N R 19 W i4n Property Owners Mailing Address _ + Lot Block # Subd. Name or CSM# 1 1800 ~16E1°~IJE>`IJ ST. N HsulCc~T - °'x - EAALIE BLIAPf City State Zip Cod / PhoneZl~4. ~,pFRCE City El Village Town Nearest Road bLAOJi NN 554 U-76-7 -7 > TRO t s New Construction User Residential/ Numl a ed om - Code derived design flow rate (11,00 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material 5Ah) 0510M C Flood Plain elevation if applicable AIA ft. General comments :3 and recommendations: 54STie M EL JE\1A-Tt 0A) Q l 4' gg FAI # Boring Ground surface elev. Q23. 02 ft. Depth to limiting factor '7 I5 in. ®Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff In. Munseil Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-5 10Y 1 1 F r YY\ -1-16r- p,b _ 0-5 p 2 5-12 10 4 2 2/ 2 1 Z n'l skr rn -c 0.5 3 12.20 I o 12y/3 S` 1 2 m-t-sbK ds Cs f m . S 0S 20-9 10 *4 12 31.3 Si l 3-Fsb bh S 7,f-m 0. s Q. S S D-3q ID~~ S' 1 3 s dh s N m 0.5 0.8 b 39-4 10 \19 3)4 '511 h S z-f -''h 0. Z O.3 7 42-45 7, 54r~4L 4 1sE9r 059 l ('S if-m rJ. 1,2 I. Z Boring # ❑ Boring a pit Ground surface elev. 923-52- ft. Depth to limiting.factor 7 CI b in. Soil iication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-'1 Ip BIZ - 1 3~-m r Y- 0-b 34{'-co O.,- 0, 8 Z 7-14 o >ZF/1 _ I 1 s K rn~r C$ 9- 6.4 0. 3 t4-Z3 16\1012, 3,\1 1 M5,01< 51'1 A b 2-f-r+l 0,2 0.3 4 23-36 10403 - 5,1 1~-r bK JSk C5 74-m 2 0.3 5 3b-bt) ID gV3/L - 5%~ 1 m-usiok dh 6LL3 1f-m 10,Z 0.3 -7 4 0, eo-q tI-7, S v2y I s o "rA%Z0N A5 t>ME C_ VEL • Effluent #1 = BOD > 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 224832 Address ~Ij Date Evaluation Conducted Telephone Number W9875 b9oth vER F~4LLS Ws S~ID2~ 11-62-00 C-71524Z6-1-7-►5 LAS" 3 Property Owner C'tf A- KL---S Parcel ID# Page 2 of Boring # E] Boring 0 Pit Ground surface el v. _ q ~9 egg f Depth to limiting factor In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff° In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 (WY LAN AV- ~orzaN `I1~•`Fo Boring ❑ Boring # pit Ground surface elev. it. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 E Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.6100) Property Owner FEYEREISEN Parcel IO # page 12 of 21 - 3 P Bong # Bong pit Ground surface elev. 941. 8 0, Depth to limitlttq factor > 80 in. Sod A Rate Harmon Depth Dominant Color Redact Description Texhus Skucam Coneistenos Boundary Roots GPW in. Murtso Qu. SL Cart. Color Gr. Sz. Sh. 'EM 'ERaY2 A 0-9 lOYR 3/2 sil 2mgr mvfr aw 3vf-m 0.5 0.8 BI 9-18 IOYR 4/4 sil 2msbk mfr cw 3vf-m. 0.5 0.8 18-27 10YR 4/6 sicl 2msbk mfr cw 2vf 0.4 0.6 C1 27-36 lOYR 4/6 g rls lcabk mfr gw 2vf 0.7 1.2 C2 36-80 7.5YR 4/ s Osg ml lvf 0.7 1.2 P 4 B # fQ~ eonn9 ~ ~1.S6~S- c~ t1 pit Ground surface elev 927.1 Depth to limro > 8O in. S011 Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOtft in. • Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EW 'Eff#2 A 0-7 lOYR 3/2 sil 2fgr mvfr cw 3vf-f 0.5 0.8 B1 7-18 lOYR 4/4 sil 2mgr mvfr cw 2f 0.5 0.8 B2 18-38 10YR 4/6 sil 2msbk mfi gw 2f 0.5 0.8 C1 38-54 7.5YR 4/ is lcabk mfr gw lvf 0.7 1.2 C2 54-80 10YR 5/6 g rs Osg ml lvf 0.7 1.2 ~z a Boring P35 Baring pit surface elev. 928.7 ft. Depth to limiting factor > 84 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. 3z. Cont. Color Gr. Sz. Sh. 'Eff#l 'Ef1Yi2 A 0-4 10YR 4/3 sl 2mgr mfr cw 2vf-f 0.5 0.9 B1 4-9 lOYR 4/3 sil 2fabk mfr cs 2vf-f 0.5 0.8 B2 9-22 10YR 5/6 sil 2mabk mfr cw lvf 0.5 0.8 C1 22-30 7.5YR 5/ r cos Osg ml gw lvf 0.7 1.6 C2 30-40 lOYR 5/6 s Osg ml gw lvf 0.7 1.2 C3 40-47 10YR 5/6 s Osg ml gw 0.7 1.2 C4 47-84 10YR 4/6 s Osg ml 0.7 1.2 EfBuent #1 = BODs > 30 < 220 mglL. and TSS >30 < 150 mgIL ' Efffuent #2. = 8003 < 30 mglL and TSS < 30 mgfL 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 fotmat, please contact the department at 608-266-3151 or TTY 608-2648777. S ao.u70 f 8.07100) pI pI I VO~ I V/ \I V ? 3 PGr;.-C~ ~ cooK CttAK -,2-S L~G~Nn. `y0' - AT L c6& GE5CPKGN; LDT3 t✓A6LE IBUK F .[3M- * I -TOP OF ILIA) N HC- 5V/ L- SV OFTtt-r-- GO(Ijon SVU2F>4CE -0-2- f0eOff SeC. 15, T2 2,Q 9 1-1 W 13 RtJll- l"PVC PIPE 7'A86veQ2o o c 51. C oix uA)Ty Wl5 5iA- 17- SGIL 130t;ING W/ 6Aal -'a NO COMM 83 5~T ACK GnO~LW5 ,o1o , q fi r 3 0~~~$3 oLZ q\j.qf' q 0- 27t 1 , 23' OwA, Ti,q~ ~nEft- ~~'341 t,. ~ 51609 C51 2.14932. x PAT: 11-oz-00 PME 4 OF4 T- i ~ B-3P 46). 1 \14 .9 \ i 9,36.4 -7p ` ST CROIX COUNTY • SEPTIC TANK 14AINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 7"a~D /3j-,'=-X ST&D-1- 3 3 Mailing Address &06 Property Address (Verification required from Planning Department for new construction)` City/State 11 mo'J Parcel Identification Number o 7 D - /0 3 7 - 60- Oz7n LEGAL DESCRIPTION Property Location S~ S~ Sec. a , T )'p N-R l W, Town of 77ilOy Subdivision Lot # Certified Survey Map # , Volume , Page # Warranty Deed , Volume &13 , Page # Spec house ❑ yes no Lot lines identifiable Ayes ❑ no SYS'T'EM MAINTENANCE Improper use end maintenanceof your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards ' set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification slating th r septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days the three y r ex on a D F PLI T DATE OWNER CERTIFICATION I (we certify that all star ments on this form are true to the best of my (our) knowledge. I (we) 9m (are) the owner(s) of the p erty esc ' e above, by irtue of a warranty deed recorded in Register of Deeds Office. y / / O ' APP CAN DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department.****** Include ivitit (Iris application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed rr~~ ~ v VQL 1.~.1JPAGE~6~ I 106 STATE BAR OF WISCONSIN FORM 1 - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI Document Number RECUVED FOR RECORD it 04-04-2001 11:30 AN This Deed, made between Troy Development Corporation, a Minnesota Corporation NARRANTY DEED EXEMPT R Grantor, CER1,,COPY FEE: COPY FEE: 2.00 and Todd A Bjprctedt and DenicP A RjPr4tPrd1-. TRANSFER FEE: 201.60 hiiGhand and wife as sunduorchip marital RECORDING FEE: 10.00 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (the "Property"): Recording Area Name and Return Address i Lot 3 of the Plat of Eagle Bluff in the Town of Todd and Denise Bjerstedt Troy, St. Croix County, Wisconsin. 1106 Crestview Drive Subject to Declarations of Covenants, Conditions and Hudson, WI 54016 Restrictions for Eagle Bluff, recorded in Vol., Page Sj(O , as Doc. No. as appearing in the office of the Register of Deeds for St. Croix County, Wisconsin, and such other easements, 040-1037-60 reservations, restrictions,and reservations of record, or in use, and the "Buyer" obligations contained in Parcel Identification Number (PIN) the Purchase Agreement for this lot. This is not homestead property. (Is) (is not) Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Dated this 15th day of March 2001 (SEAL) (SEAL) . Charles S. Cook, President ■ Troy Development Corporation (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) ?4innesota State of VAseeasitr, I as. Anoka County. authenticated this day of Peeoonally came before me this day of the above named Charles S. Cook, President Troy Development.Corwration TITLE: MEMBER STATE BAR OF WISCONSIN _ to Of not, me known to be the person - who executed the foregoing authorized by §706.06, Wis. Stats.) instrument and acknowled the me. `i l THIS INSTRUMENT WAS DRAFTED BY i+ j~ -Troy Development Corporation aicy Clift ~j Notary Public.Staw-awsrcackt Anoka County, Minn. Charles S. Cook, President My commission is permanent. Of not, state expiration date: II (Signatures may be authenticated or acknowledged. Both are not January 31 2005 ) I+ necessary.) j • Names of persons signing In any capacity must be typed or printed below their signature. STATE BAR OF WISCONSIN Wisconsin Lapal Blank Co., Inc. WARRANTY DEED FORM No. 1 - 1998 Milwaukee, Wis. $ - NANCY L. CUFF - NOTARY Pl1Bl IG-MM~ESOTA MY COMMISSION EXPIRES JANUARY 11, 2006 A /lk. EAGLE BLUFF AND THE SE 1 /4 OF THE SE 1 /4 OF WH OF THE SE 1/4 4 OF THE NE 1/4 AND THE NE 1/4 16, AND THE ~ 1/ 19W, TOWN OF TROY, STCROIX COUNTY, WISCONSING,iHi CERTIFIED SURVEY MAP RECORDED IN VOLUME 9, PA P 1 UNPLA T T' I - i pHl 1 NORTH LINE OF THE S 1/2 OF THE e 12648.40' N 88 37 26 E THE SE 1/4 618.24 s ' _ _ - - l 2301.31' I W ( 150, I S OUTLOT 1 8 _ - -R - a 5.469 ACRES I o / y I 1 238.241 S.F. Z 11 EHiOUS£ I I W i ` 82 o0' 0M0 E 00„ • / E I 1 o N , l L O T 1 1 I 134.66 _ N 62000- I ~ N 147.6 t ` l C S_M._ 1 8 1 ~o`O h z r- l VOL. 9 5 / - 726 1 V1 ~ry 1.027 ACRES 6..* \1 501 I 44,736 S.F. P_A GE 13 j 1 ' cp l 4983851 20 65 / 1 S 4' 104.04' 9 /498385 ( I 1 03 E 1.0 13 108 S.F. ACRES R-80' 515e 111- 2 / X150 874AS.RFE. S XZ a 0 • _ A J S r) - - - - - $ td 1.210 ACRE - ' S? 52,729 S.F. n it OR'q4N S?•0 1 y 4/~Q'r e36' 10" E t f AH ~qD F C3 h~ C~ Q'`~ • N 82647.02' Sems, ' C4 - rn cP; X10 ~ ~ 000, 42 W 1615 ACRES 68.26' OUTLOT 2 . \ N 70,358 S.F. I• 41 OUTLOt N, \ 7.292 ACRES c i $0~/1.000 ACRE ~ 317,625 S.F. Z 43.563 SF / o~ 263.911 .6 \