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HomeMy WebLinkAbout040-1306-32-000 Wisconlin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix S2$ty and BuildiSig Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 514807 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Van Don , Jack Troy, Town of 040 - 1306 -32 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: /Od 1 f� M l G5 c _ 08.28.19.1859 TANK INFORMATION nl ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV. i Septic Z^ Benchmark Q v F .'r��,,7 JZSa �. Z t Dosing N 7 1 Alt. BM AoFalliem Bldg. Sewer . 1 11 Holding St/Ht Inlet IZ . ti St/Ht Outlet IN -� TANK SETBACK INFORMATION TANK TO PP /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet I Septic 7,-j A— 1 _ Dt Bottom Z 71 Dosing Z y �'t' 7 D A J L U Header /Man. S ? 160.5 Aeration Dist. Pipe . O 160 . Z Holding Bot. System 40j4-k-- U. - I N 7 - a Final Grade PUMP /SIPHON INFORMATION 3• /0 2 • �S Manufacturer Demand St Cover oe_ I� GPM 4C q.1 Model Number n ' ,� 1 :5 �O TDH Lift Friction Loss J (S Head TDH Ft 5 0.7 Z. Forcemain Length Dia. Z " Dist. to well SOIL ABSORPTION SYSTEM BED /TRENCH Width ! Length / No. Of Tr enche s PIT DIMEN�IONS No. Of Pits — Inside Dia I Liquid Depth DIMENSIONS 3 1 QQ e. — SETBACK SYSTEM TO u o P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Of Syste �f (� UNIT Model Number: L, Type D Y�uC/'�� D ] Z �J I I AJ � � � 0 L4 G� �l DISTRIBUTION SYSTEM 5 L., z2_ 4-z7_-:- yy Header /Manifold 1 � Distribution x Hole Size x Hole Spacing Vey to Air Length Dia Length Dia Spacing L . 6 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 s No Iw Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: ! / Inspection #2: / / Location: 419 Jordyn Lane Hudson, WI 54016 (NE 1/4 SE 1/4 8 T28N R19W) Sunset View Lot 32 Parcel No: 08.28.19.1859 1.) Alt BM Description = 2.) Bldg sewer length = 51� G �5 6 ~ - amount of cover = r Plan revision Required? : Yes �,< No '-L a� J�3 Use other side for acladional information. 1 Date Insepctor Signat Cert. No. SBD -6710 (R.3/97) cprrlin @,�yj,$py Safety and Buildings Division County /� 201 W. Washington Ave., P.O. Box 7162 C T9 Madison, 537 71 Sanitary Permit Number (to be filled in by Co.) t (1 0- SK V� .r7! �, 51 Al '96 - 7 Sanitary Permit Applicat Stan Transaction I r __..,.., N In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for seco ��^ ses in accordance with the Privac s. 15 Law . 1 m , Stars. ( ✓ 1. Application Information - Please Print All 1 IM ' Propeny Owner's Name Parcel # (� EC 1 2007 IJyD -' 1,36(o - 3Z Property Owner's Mailing Address 0 Property Location � O 7 n ST. CROIX COUNTY Govt. Lot City, State r Zip Code t. % 3 F - - Se ction —L ) crrcle one) t4- D T �_ N; R Lr E 1 Type of Building (check all that apply Lot # Subdivision Name 1 -2 Family Dwelling - Number of Bedro e _- Ot Block LL /r L ❑ Public/Commercial - Describe Use 1 1 1- ❑ City of CSM Number ❑ Village of ❑ State Owned - Describe Use p, w 2Z Z Gl,,�. III.T YP (Check Check onl one box on line A. Complete line B if applicable) Type of Y A ' System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number Dare sued B. ❑ Permit Renewal emit Revision ❑ Change of Plumber Trans fer to New Before Ex iration 5�5/j/10 7 P IV. Type of POWTS S stem/Com onent/Device: Check all that a I on- Pressurized In -Ground ❑ Pressurized In -Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaVrrestment Area Information: Design Flow (gpd) Design Soil Applicatiop Rate(gpdsfJ Dispersal Area Required (,' Dispersal Area Proposed (st) System Elegy io —7 S ✓ Vt. Tank Info Capacity in Total # of Manufacturer Gallo Gallons Units U �+ New Tanks Existing Teaks �e I ' a 1 R 1. 8 CA m t•A W V 'ar Sepric or Holding Tank a S LL I Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume usibility for installation of the POWTS shown on the attached plans. Pl7 is Name (Print) Plumber' re MP/MFR Number Business Phone Number w 3 J 2� Plumber's Address (Street, City, State. Zip Code) 9 I* VIII. oun /De artment Use Onl Permit Fee Due s ued Issu gent Signature Approved $ Q !C3 Ow v R oReason for 0 I Z � 7 IX. Condit fL*6% easons for Disapproval I . Septic tank, effluent filter and dispersal cell must all be servtces / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained "P%" 'I ft A i riff Ifthe system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 Soil T t and lSysteni PLOT PLAN PROJECT Jack VanDona A #ORESS P.O.Box 227 Hudson Wi 54016 NE 114 SE 1 /4s 8 /T 28— 1 W:TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/8/07 BEDROOM 4 CONVENTIONAL IN- GROUND PR URE CONVENTIONAL LIFT XXX HOLDING TANK MOUND SEPTIC TANK SIZE 1 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of survey iron —T ASSUME ELEVATION 100' Filter BEST Filter ❑BOREHOLE O WELL *H.R.P. SameasBenchmark SYSTEM ELEVATION 99.4/99.0 3' below qrade 9 B -2 Well is to meet all setbacks required by WDNR Vent Plans Designed Using Conventional Powts )6 „ Quick4 Standard -W Leaching Chamber of Cover Manual Version 2.0 with 20.0 ft2 of Area 5.8ft ^2 /pair of end caps 276' property line 4' Long 12" Grade at System Elevation J4" Pro 4 Bedroom 152' Property Line House 0 OW 65' Huffcutt Combo Tank A - 0' 2 -3' X 90' Cells with. >3'spacing 45' B -3 4% $Lope 20 10 ents AL B -2 901 ► B -1 o' 1L 273' Property Line B.M. #1 STARESS dlSystem PLOT PLAN PROJECT Jack VanDona P.O.Box 227 Hu dson Wi 54016 NE 1/4 SE 1 /4S 8 /T 28 tV;xbWN Tro yl COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/8/07 BEDROOM 4 CONVENTIONAL IN- GROUND PR URE CONVENTIONAL LIFT )00( HOLDING TANK MOUND SEPTIC TANK SIZE 1 gallons LIFT TANK SIZE765 DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEST Filter ❑BOREHOLE O WELL H. R. P. SameasBenchmark SYSTEM ELEVATION 99.4/99.0 3' below qrade Q B -2 Well is to meet all setbacks required by WDNR Vent Plans Designed Using `6,f Quick4 Standard -W Conventional Powts of Leaching Chamber Manual Version 2.0 with 20.0 ft2 of Area 12" 5.8ft ^2 /pair of end caps 276' property line 4 Long 34" Grade at System Elevation Pro 4 . Bedroom 152' Property Line House 65' Huffcutt Combo Tank '- 09 2 -3' X 90' Cells with >3'8pacing 45' B -3 4% SLo'e P 20' 1 ents 0' B -2 90' B -1 0 ' 273' Property Line B.M. #1`r<; WiisconsinDepartment ofCommerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must l include, but not limited to: vertical and horizontal reference point (BNWecti and Parcel I.D. b s�� _ �31j✓p �Z �� percent slope, scale or dimensions, north arrow, and location and dift re oad. Please print all information. Revie d by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner rty Location �,���k RECEIVED 6/4 /1. DD Govt Lot t. 1/4�1_ 1/4 Sj T a 8 N R ( E (or) Propedy Owner's Mailing Address 1 1 7 Lot Block # Subd. Name or CSM# DEC 1 'i 2007 r s City State Zip Code hone Number ❑ q ity ❑ Village wn Nearest R6ad I T. CROIX COUNT L., I CZ ew Construction Us Residential/ Number of bedrooms Code derived design flow rate b lam- GPD ❑ Replacement ❑ Public o�r j ommerclal - Describe: Parent material Flood Plain elevation if applicable General comments �3c'1��� 13—o and recommendations: System Type �� IiC> �� �j %� System Elevation /I Boring # R Boring I Pit Ground surface elev. / ft. 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 t ,t ® Boring # Q Boring ® 4 d' -� Pit Ground surface elev. Z Depth to limiting factor in. Soil Application 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/ /0 3 / z- -�� c!5 / IIJ I Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mglL 'Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL CST Name (Please Print) S' re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 /� __ 715 - 246 -4516 Property Owner _ Parcel ID # Page of Boring # ❑Boring F -P-Pit Ground surface elev. ��� A, �- Depth to limiting factor � in. Soil Application Rate Horizon Depth Dominant Color Redox Desorip n A T - Structure Consistence Boundary Roots GPD/fF in. 1 (/ Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 d 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 GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 `Eff#2 ❑Boring Bonng # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon 7epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 Effluent #1 = BOD > 30 < 220 nVL and TSS >30 < 150 mgA_ " Effluent #2 = BOD < 30 mg& 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.6(00) I Property Owner Parcel ID # Page of Boring # ❑ Boring t /�� 3 Pit Ground surface elev. ��� ft. Depth to limiting factor /� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 d a Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. — go — ilApplication 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 •Eft#2 r-1 Boring # ❑Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil ication Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I •Eff#2 I Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SOD -8330 (8.6/00) IC TANK Fi3MP CORM &ER CRi)SS SEC TI aN AND SPEC L i E CATI tTK$ SEP"T AtHER�RwF gpPR 3 V ED 12 �= M1 - Ast7vE O DE jU%CTT0H $flX p; # C4NMj IT M ANNt3LE cov ER G VT.WT IgDo w OR �i1 WI PAD�� £gO . DID09 W OWING LA$EL f' �� • IMXE �.IR T . rn M FAEa�* � KID - .•" ',FIN` ;•..i} � �� • _ 1• A. �u Mf �i- f _ • AS- . I T —�— G T A STS wITH WATER TIGHT SEAL PIS ..-- ;L7f�R 3 SMI�SOIL B C. qaj - T . � ,ID. mp otr EL£V - D SOIL i - B EDDING t3 �� gp,1+��C GpNCitETF PAS 3 r= APPR S pEC [ T i�fBEg D,aSES PER DAY = C DOSE r HE I C 3ZNa / U GAL- SEPTZ I- Ti3RER: u cy.� £ gwGK= = T-�� . 3 GAL. 'E'K rsA 5 G AL - Inc S TAIiK SIZES : SEPT ;C � GAL CApACgTI£5= A : �, R . USE I1�CBES �►LA i t1£wC 1-7 J' RICHES = fiA�• IH TYPE'' =?/ sw �f- l i l iR£R = 16,23 Pump /y1/ AS PF3Z I MODEL Q g A ,grc �tZFtZ - FE ITCH TYPE= "'�1- ���� �3iP P£ PZ. ECT REQ,IRED DZSCPARGE H HP OiF ANI% 31I'STRI BUT - -- FEET CAL 3 IF££g'F.NCE $ y - - g - £T • ri T.CTIO� - _ FEET ; iIfDN NmaRR S�3FF TJ 10 . ' TkL DY F££T £pRC£� X DIAM + ��. .% Pw TP►HN LENGTH �.--- LIQu 1I T NAis DItiENS;Di+iS D 1.-2 DATE LICEN 5 FGNEI yso TOTAL DYNAMIC HEAD /CAPACITY w w HEAD CAPACITY CURVE PER MINUTE U MODELS 53/55/57/59 EFFLUENT AND DEWATERING 25 — Model 53/55/57/59 6 20 Ft. Meters Gal. Ltrs. T ,4 0 w 5 1.5 43 1 :63 `"' 15 10 3.1 34 129 a >- 4 15 4.6 19 72 0 10 Shut —off Hecd 19.25 ft. (5.9m) o � I 2 5 �3 15/16 --6 5/32 — a 5/8 I �- 1 1/2 -11 '/2 NPT 0 U.S. GALLONS 10 20 30 40 50 LITERS 3 15/16 � $p 160 � FLOW PER MINUTE 009997 4 1/16 'r Variable level float switches available. Variable level long cycle systems available. Available with special cord lengths of 15', 25', 35' and 50'. Alarm systems available. 10 1/16 ` W Duplex systems available. 3 3/32 SKM Single Seal control Seleaw Listings SEz ECTiON GUIDE Model votts Phase Mode ! Amps Simplax Duplex CSA UL 1. Integral float operated mechanical switch, no external control required. M53/55 & M57/59 115 1 Auto 9.7 1 —• Y y 2. Single piggybackµvadable level float switch or double piggyback variable level N53r55 6 N57/59 115' 1 Non 9.7 2 3 or 4 &S Y y float switch. Refer t0 FM0477. ' BN53 115 1 Auto 9.7 '— y y 3. Mechanical alternator 'M-Pak" 10 -0072 or 10 -0075. BN57 115 1 Auto 9.7 - N Y ' BE53J57 230 1 Auld a.8 y y 4. See FMO712 for correct model of Electrical Atemator. D53l55 & D57/59 230 1 Auto 4.8 1 -- Y y 5. Variable level control switch 10-0225 used as a control activator, with Electrical E53/55 & E57/59 230 1 1 Non 4.8 I 2 3 or 4 & 5 Y Y Alternator (3) or (4) float system. ' Single piggyback switch included. sc For information on additional Zoeller products referto catalog on Piggyback Variable Level Float Swftches, FMO477; x+ -s r ,a1 +r " +s pro' `• ,devxesandwYmnsn us �e oy + =s= Electrical Aftemator, FM0486; Mechanical Alternator, FM0495; Sump/Sewage Basins, FM0487; and Single Phase i.cerse car A lean+ al :d safety cedes st-.aald be.c!+ ned n ,ry ne n3st Simplex Pump ControliAlarm Systems, FM0732. ,t _, + +�. -sz ,.c Cade t N'Fcj and tt:e 0c:^upat nnai .,s.ety and `i aim Act �08i r.',. RESEPVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. - -- MAIL TO: P.O. BOX 'V_'? Louisville, KY 40250 ag s- = Manulecturers of. . Q SHIP T0: 3649 Cane Run Road O ® Louisville, KY 40211 -1961 QM&7,.74 S,vcE /�c�i7 http.1Avww.zeeller.c0m FAX (502) 777 4 -34 -3 PUMP !O. ( �n6 1.1(s2s PUMP -- --.---.___.._--_ - 624 0 Copyright 2002 Zoeller Co. All rights reserved. commerce.wl Safety and Buildings Division County � w 201 W. Washington Ave., .O. Box 7162 "�`, ro j s V O n s n Madison, WI 5 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce Sanitary Permit Application state 'rransaction4N ht accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the app \user ernm tal A unit is required prior to obtaining a sanitary permit. Note: Application forms for stat e Pr 'ect Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may b sec ry Q� p urposes in accordance with the Privacy Law, s. 15.04(I)(m), Stats. I L Application Information - Please Print All In forma t' n Property Owner's Name ' Parcel # / /� Property Owner's Mailing Address Property Location Q hww x � � � ST. CROIX COUNTY Govt. Lot' City, St to Zip Code P3"1#1C?nOFFICE y,, Section C - atircle one T f N; R E 9 UW If. Type of Building (check 1 that apply) - — pV Lot # Family Dwelling - Numb of Bedrooms d,�j n Sub Namur A Block ❑ Public /Commercial - Describe Use ftl ,^.� ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Town of .� b. ' , 64-620"S 22 t Z G III. Type f Permit: (Check only onk box onTke A. Complete line B if applicable) A. New 'N stem ❑ Replacement System ❑ Treatment /Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ' List Previous Permit Number and Date Issued B. El Permit Renewal C1 Permit Revision 11 \of Plumber ❑ Permit Transfer to New Before Expiration Owner In (W " IV. Type of POWTS S stem /Com onent/Device: Check alkhat apply) t Pressurized In- Ground ❑ Pressurized In-G ❑ At-Gra ❑ Mound ? 24 in. of suitable soil ❑ Mound < 2 in. of suitable so I ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: r a4,A1 Design Flow (g� Design oil Application Rate (gpdst) „�; Dispersal Area R fired t) Dispersal Area Propd (sf) System v i� < 2, b i'� VI. Tank Info Capacity in i r Total # of Manufacturer Gallons Gallons Units U 2 New Tanks Existi�Tanks ��/ c ;; Y a A a U rn ti rn w C7 a Septic or Holding Tank ,fir Dosing Chamber VII. Responsibility Statement 1, the un rsigned, assun)W.01risibility for installation of the PO TS shown on the attached plans. Plum e Name (Print) Plumber' re P /MFRS Number Business Phone Number /� �c Iii � c sl Plumber's Address (Street, City, State, Zi ode) �i p! VIII. Count /De artment Use Opy ' A 71 Permit Fee Date Is ed Issuing A t Signature Approved Disapprove S � // A . �Re.as.n r De nial � IX. Condi1m *vbwwwasons for Disapproval t �/,,�.� 1. Septic tank, effluent filter and n f � t a'�' lb or, ' n� dispersal cell must all be'services I maintained Ce /� I (, J n � t � as per management plan provided by plumber. 2. All setback requirements must be maintained t r ) l � Attach to complete plans for the system and submIt-the omrty only on paper lot less than 8 1/2 x I I ' ches in size 5 LA �� Jz, SBD -6398 (R. 01/07) Valid thru 01/09 t lief 6� I r, � -� � V, P C PLAN PROJECT Jack VanDona ADDRESS P.O.Box 227 Hudson Wi 54016 NE 1/4 SE 1 /4S 8 /T 2 /R 19 W TOWN Troy COUNTY ST. CROIX ,f MPRS Shaun Bird 226900 f'` 11/20/07 4 DATE BEDROOM CONVENTIONAL )00( IN -G ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 IL BENCHMARK V.R.P. Top of Wood Post _ASSUME ELEVATION 100' Filter BEST Filter ❑ BOREHOLE O WELL *H. R. P. Same as Benchmark SYSTEM ELEVATION 89-9/90.2'6.1' below qrade Please note: additional boring Well is to meet all may be done to lower system setbacks required by evation WDNR Vent Plans Designed Using >6,p Quick4 Standard -W Conventional Powts of Cover Leaching Chamber Manual Version 2.0 with 20.0 ft2 of Area 4' Long 12" 5.8ft ^2 /pair of end caps 276' property line y' . 3 4" Grade at System Elevation 4 2- X90' Cells ' h >3'spacing 6% pe B -2 B -1 25' B.M. #1 75, 30' 50' Vents 30' ST / 20' B -3 Pro 4 Bedroom House 152' Property Line X P PLAN PROJECT Jack VanDona ADDRESS P.O.Box 227 Hudson Wi 54016 NE 1/4 SE 1 /4s 8 19 W TOWN Troy COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 11 /20/07 BEDROOM 4 CONVENTIONAL )00( IN -G RE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 ,BENCHMARK V.R.P. Top Of Wood Post ASSUME ELEVATION 100' Filter BEST Filte ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 89-9 belo q Please note: additional boring Well is to meet all may be done to lower system setbacks required by elevation WDNR Vent Plans Designed Using >6 „ Quick4 Standard -W Conventional Powts of Cover, Leaching Chamber Manual Version 2.0 with 20.0 ft2 of Area e 4'`Long 276' property 12„ 5.8ft ^2 /pair of end caps p p rtY line 3 4" Grade at System Elevation y 7 �* ry 2 -3' X 90' with >3'spacing 6% Slope B -2 B -1 25' B.M. #1 75' ' 30' 50' Vents 30' ST 20' B -3 Pro 4 Bedroom House 152' Property Line O OI0 OOo �3 00_42'16 "W 271.61' � I \ �- 2 1' \ - � .--� vi X 86 • � �, 4 �"E 49 5 \ \ �, I I O O O , L L Oti \ \ 6 ' \ p c' \ co \ od \ \ \ / Z p � o @C) \ £' to 00 11-0 CY'D i o \ \ •z�. Zo �Z� 5'� =� \ U So 11 9 s O S 2 ,/ 6 I /� E .-. LC LC CC say 2 0 \ �� o \ \ p Ly W �s� F S N 2 6 �. � \ O LC LLJ N Zn u i 00 f oC�N 152.8b' 244.86' N CYD \•�s'•s. °/ 1. J Q' O O \ ci 00 44• eZ °0 ti 1 0 M E-� rn � � N 00'40 41 "W �0 I I p C O .� O II u I w I z Q W i N i (p — ° o U) DRAINAGE ~ to EASEMENT a 00 0 o 5 ' W N 00'04'31 "W 347.31' ^ I z �"� wI ------------------ O �. o i N I f d 0) I � N N O O cp Z II I o o O Q , ( Lo ►n o U CD co m I x M " is yl $ S^E d co 6 3 „ N , N N O ,. In w O co CO 0 C4 230.25' =- r2? in I� i SUNSET VIEW DEVELOPMENT VIONNY NAP EOCATED N THE EW 1/4 OF THE K 1/4, IKE SE 1/4 OF ONE NA 1/4 p NaiIN W III NNE m 1/ OF THE SE 1/4 AND N TIME NE 1/4 DE Of SE 114 OF R 0 Y SECTION B, rDNO \ \, \ ` SECTION a TIP, MON, TOWN OF TROY, 9.MY CRI N15CONHN NW- NWINE-NW NW -NE NE -Nc Fo $ sL UOLX CaNrr \ ----------- - - - - -- --- --- - - - - - -- - -- dE u AAMIX IIOAR1ENr UNPIAT ED LANDS U LANDS I \ ° \` - - - -- - •* A S Iti1'11T _ a I sR a x K N R5'00'0R1 47174' C� op \ N n 53fb1' ]214 _ _ _ - - - - - ° `\ SW -NYi E NW SW -NE SE NE -- - - - - -- � CTNRD. "FF ",p R \ — VJJ ��hb�ER '0 P7aJ — a3S22 S,I, LOT I CSN va° PACE 1273 - - - -- R O NERSI'0'[K3OD' n INw- SwNE-SW %NW -SE NE -SE °° L r2r. IN. LOT J �T a�aw, 1 c ra K x«oa a a E q\ NW Ae n F� "K LI k \J c n\ �� /f � twiP[ m Nuaxc r-- - - - - -� - - i y SV4 , nw L. nPN a SE S, / Y [ C91 wl.. vAG[ 128 - - - --- E 16x1 sE �N _ I �i I E J8 f n. \ P 4 s L ° nEm m". um o ! i v v 4 4 o I g] ! rortsm All ME mmm aa O V 2 462 for t P E. s LOT 19 a m It 441 Of sataA 4 V 73 1 LOT 6\ n W 2337 ' '. i 254830 SQ.FT j PnvARm u N a31'Nq S 1 0 Am IF 1 ° A2 n! 5,85 Ac. LEGEND Sq�� �0 1.02 A, E O9'7bC g ?J r j e y o . S17 2315 -0L X I8• IRON PIPE I 2 V,2 8 i� g C, cW -N. So 1901xea' A RJ6NINC 7.°h 185 PER ONCAN FOOT I ' ° d OT s.rt O 0 s LOT 7 ° 1 \ . +' -'k muNO 4 • r D a uoN ME N COI k., E \ , LOT ,3 s - - - -- , u � e' I ' I I I ° m Darn. ' i 'l R 6J' 'E, 113 IIMLAR I' DD. L )W' DION PH 4'E�CIML aDD a 44980 OTHFA IN'F COfA2K. 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S 3446 ,p1m' '3 J1 U' �`� ti O �IUJI O ` 1 1,01 Ae. 1 ALL Lois NO I ACA[ A[7 PWCT MG f REDRA . 4s' 43' - 7 g y �d $ v In -- i � , N. � / ,. -° i LOT 34 �' ' '- \\ � „ � w 6'gie � � 1•�. B RJCK LOT 35 1 C RCLE s� 2825 �ORDYN LONE —� / ^ Sssn sr 33 $ c 1 LOT B. ( LOT 36 i" Est k D \ MOT I, LOTS 10. IA, n, 20 Avc v xs 4446 m c OHQF A pN FASDA?R AAAREA 4 9' H O 9 62820 S.P. „ x888 RR ' R BBW6 S.F. e ° ( LOT 12 - -- +n° \ 1DS k 503N 9F. . I'• " F LSS AR 10 t i S�wV351W V.01' / L TIT IH. � �h ! a xcnwa'� i nl & 115 Aa L 7, p 4 � LOT 37 \ : 2 12246 S.F. +�. \.n.fxto 06 k LSN wt. r7, PG 4576 ° • 1 ',. I Liz . noa � [ . n9x /A ' 0 i 2 NO Ono OR IlSOENI wu DD wim mat R'OAO NOE M IN OR ENNnE ONE i L0 . 6 _ -- + j / - OPER01% a 1M APPRAtO [ONFREWI SAL WATER WRAGE AND 5% OW MN - _ ` z i 8 ro ObiROCIN6. AUPS K, - - - - -J ___ i 1 TOR T HIS PAC. nAS Nawts NR N Hof INKED YlEA99 RNN 95.65' E 16995' _ J i 1 v �. ( / LOT 3 L FANG, OA DGVAm x PLANTNK N N7X POND FAS[INKR, 00 pAW7i DNd[S i 4 N s1'W0 199.17' ':77.K' /LOT X2'1 49734 S.F. 1 ; "TER RKNAM NAIVE a,4Na55, MS ON CRASS $00 I (44sxsr a.' � R I 102 At /j4 � A 111 Ai bl UNPLATTED LANDS .,i /73 ° 111 \ Th. mr° _ - i _ - - _ _r -. PV� 1 _ \ PNfiorntu PlR+il mean o. Sa41 W i1621111Rd1h 4 'I 4 A / O AAUF4n W cfeaw _ _ _ _ Q P / 1 7977 y / 1 UN1fY IL � // � A nnFK NO POLE 0119JNED CJ&LS ARE 10 BE PLACED SUCH THAT THE / \_-- INSTALLATION WOAD as n ANY ww SAKE OR OBSUOCT VISION / C NnIIARIn' I SOUTH 444 UNNEP, AIX AA'C LDT NR 01 sum INNE III LOT 31 , 4 Q SECTION R, fum THE mum OF A SAMd $191 TN NNK S A NOUTON OF 411317 3.f /y ST EROIX COUNT, S M 21612 OF M IMM STAWIES. LITIP EASENEWIS AS 1,18 k .W / l�/ Il " PPP W � W � W �11 / A ALU4INU- KWKNT HERE N SEE IRWIN ARE FOR OW USE OF K" 10013 NO PRNAII NW MMES HIM IN( NOR IT) SUM uE AREA aI / y /LOT 30 h / IN smTHE $AAm No ON THE WR ARE sURIEtt TO STATE fi.F 7R 1w CM A40 COAX LAK NO A BECAA710A5 REM. f�.A. y us Ac N ;' LOT 29 "UN l0f SE, ACC[SS ED AM KFAY FEW" al X.ti OFNCE ANC TAW PENN OF NTT FOR MdClat. aX WUNTY EdnC , I ' 19581 F.F. /R 100 AT � T PLAI S LDCAIED N AN AaNLLOAW. WU NCN — mmu � I ' DOW WA FAN RELATED ALTIMS THAI KA NEIL _ HD IRS DIEI�EO UAS T O"TOK ETC . °__ _ L___- MoD D 100 2a0 OCT) IsLiW' 24sso % w III CR10RK OAD THAT W ALTER M, CAPACITY OF TIC[ SKAW WATER VMACE EASEYENi AREA $ Sp'04'JW"N 1440.RS cAWIOC SCALE - fEEf S PROHIBITED. , q 'HIS INSTRUMENT ?;ArT[D 4 LAMES M �TBCR SHEET 1 OF 3 I Wis;onsin Department o Com EC v E Y _ .Division of Safety and Bu (dings SOIL EVALUATION REPORT Page of 12 arrprdance +th Comm 85, Wis. Adm. Code Attach comp lete site I on LlJl14 County S 1 C P P P of less than 8 1/2 x X11 inches in size. Plan must include, but not limited t : verti I _ percent slope, scale or mensifreferen a point (BM), direction and Parcel I.D. L �rh(�Frnd Io tion and distance to nearest road.��� �G i ase print all information Revi ed by "Date t Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner �►��J 1w1X�At ZZ 2015 Property Location ; N W 1/4 - S e• T v N R 1 E (o() Property Owner s Mailing Address Lot # Block # Subd. Name or CSM# IS�r V��,� - v, City State Zip Code Phone Number ❑city ❑Village Town Nearest Road vv) (I I S) q s .33 S 1 New Construction Use: 3 Residential / Number of bedrooms �4 _ Code derived design flow rate Q ❑ - GPD Replacement ❑ Public or commercial - Describe: Parent material G l_\P }4 Flood Plain elevation if applicable t� General comments ft• and recommendations: - 'EY-DM � to cs {o be I c.4a: �*rs ' W � C( 1 lApL �i�, a Boring # ❑ ring Y � ® pit Ground surface elev. S ft. Depth to limiting factor 7 �� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EffR1 •Effx2 7 3 tg -3 1 •s` - I - L 3 / !� -I I . z i i i a Boring # ❑ Boring ® Pit Ground surface elev. °1 6 ft. Depth to limiting factor 7 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz j in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I C) 30 -y C7 l0` -L 31 (, Sl I Z. SbyC YV) TIC L - S •j3 ' 3 tlb -S � ) 0'1 �z31 l� � •� si I L csbk M f 1- cs _ . z_ . 3 L Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 CST Name (Please Print) s _ mg/L and TSS < 30 mg/L S' nature CST Number Arthur L. iJegerer 03 Z 1S -3 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 ;1. Hain St. River Falls, WI 54022 0 a 715 -425 -0165 1 R a Property Owne M Parcel ID # � ���) fV r' (S P age e g of Boring # ❑ Boring 9 s ® pit Ground surface elev. ft. Depth to limiting (actor 7 1 S in. Horizon Depth, Dominant Color Redox Description Texture Structure Soil Application Rate Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 — 101 1rz 0 -LAJ q/L - S o f F-1 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 GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F-1 Boring # ❑ Boring El Pit Ground surf e lev. ft. Depth to limiting factor in. So(I Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact die department at 608 - 266 - 3151 or TTY 608 - 264 - 8777. SDD -8370 (R.6/00) Property Owne -/1 &J't— Parcel ID # 6 Page of N Boring # ❑ Boring — ® pit Ground surface elev. �' s ft. Depth to limiting factor �$ in. Horizon Depth, Soil Application Rate jMunsel minant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 R3 w S�23� G�- Vs L) W ettiJ S o (�Lj m 1 _ •� t. , F] Boring # E] Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth DgantColor Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. - Qu. Sz. Cont. Color Gr. Sz. Sh. • Eff#1 'Eff#2 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 CPD /f12 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. • Eff#1 • Eff#2 Effluent #1 = BOD, > 30 < 220 mg /L and TSS >30 < 150 mg /L • Effluent #2 = BOD < 30 mg /L and TSS < 30 mg/L Tlie 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 Qic department at 608 - 266 - 3151 or TTY 608 - 264 - 8777. ;DD18330 (R.6/00) . PLOT PLAN Pale 3 of ? Scale 1' =5p' G Lug- 3 3 % a ` K \ \, zzs i I / I / i FL'lyctz� �R. Pa Sr . _ B► ? -=_ LQO_.1_�_ _o�v Nt?_G s.Z t� 6 `� �� A ._wood 1 � ws7-. l Z _Z2_03 715- 425 -0165 220254- 03 _ZlS - 3Z CST Signature Date Telephone lio. CST No. Job NO. i * 8 6 4 9 2 7 1 State Bar of Wisconsin Form 1 -2003 864927 WARRANTY DEED KATHLEEN H. NALSH REGISTER OF DEEDS Document Number Document Name ST CROIX CO WI RECEIVED FOR RECORD 11/30/2007 10:00AM THIS DEED, made between B & L Land Development, Inc., a Wisconsin WARRANTY DEED Corporation EXEMPT # ("Grantor," whether one or more), REC FEE: 11.00 and Catherine J. Van Dong and Jack S. Van Dong, wife and husband TRANS FEE: 285.00 PAGES: 1 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Name and Return Address needed, please attach addendum): River valley Abstract & Title, Inc. 1200 Hosford Street, Suite 201 Hudson, WI 54016 Lot 32, Plat of Sunset View Development in the Town of Troy, St. Croix County File # 2696428 Wisconsin 040 - 1306 -32 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights -of -way of record, if any. Dated November 46—,2007 2007 C (SEAL) � (SEAL) * B. Geisin er — (SEAL) c- (SEAL) AUTHENTICATION 0 ACKNOWLEDGMENT Signature(s) 4 � �, M STATE OF WISCONSIN ) G ) ss. authenticated on a St. Croix COUNTY ) * Personally came before me on November , 2007 , TITLE: MEMBER STATE BAR OF WISCONSIN the above -named B. Geisinger (If not, to me known t the person(s) who executed the foregoing authorized by Wis. Stat. § 706.06) i t e t n n 1 d the same. THIS INSTRUMENT DRAFTED BY: Attorney Doug Berg - tary Public, Ntate of Wisconsin ` 1200 Hosford Street, Suite 201 Hudson, WI 54016 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. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 1 -2003 * Type name below signatures. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer C a o el Mailing Address i 1 �nx� 7 1 Property Address 1 /1 9 J r- (Verification required fro lanning & Zoning Department for new constructio City /State Parcel Identification Number LEGAL DESCRIPTION Property Location 1 /4, 50 1 /4 , Sec. O , T 9 N R &W, Town of 774 Subdivision Su rt s 'e� L/i lr c/ , Lot # 2 : Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house yes �/ Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner($) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Nu er of be rooms —�G- -- IGNAT OF APPLICANTS) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 0810 Maintenance and Contingency Plan for a Septic System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. 8. Discharge into system is not exceed those required as per Comm. 83 Plan Cjtio7 intes s ted m ystem.fails, determine cause of failure, use alternate area and install new replacement area. Option #2. Install system at a lower elevation, by removing chambers, removing biomat, and install new system. Option#3. No adequate area is suitable for replacement area, and system elevation cannont be lowered. Install holding tank as last resort. 3. Replace any other failing components as needed. 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