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HomeMy WebLinkAbout040-1306-35-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 487915 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: Hewitt, Kari I Troy, Town of 040 - 1306 -35 -000 CST BM Elev: Insp. BM Elev: BM Description: _ Section/Town/Range/Map No: 6 m C15 08.28.19.1862 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Z.Z ,Z r aV Dosing Alt. BM P :.u— %, 75 M.1 21w-L Bldg. wer 1z " 03 ga Holding .. _ ... SVHt Inlet �.3•lp� � TANK SETBACK INFORMATION SVHt Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / - 72 ,y 7 0 i Dt Bottom 14 ` v5 Dosing , 1 Header /Man. Aeration Dist. Pipe `t a$ ....._.. -.. z. fad Ql�l�•V Holding Bot. System t'. d � Final ace �•• 7 , \ 97.1 PUMP /SIPHON IN �MATION CX Manufacturer Demand St Cove I'S �3 GPM V Model Number 1 T ZZ 53 • 1� TDH Lif�, Friction Loss Sy tem a T/3 Ft ; Z 1 ,7D 13 � 5 Lk Forcemaiin Length ; Dia., Dist. to Well /� ` Fn, Q -3 -J 480 SOIL ABSORPTION SYSTEM _ BEDITRENCH Width i Length No. Of Trenches PIT DIMENSIONS No. Pits Inside ONS 2 too l e✓ r_i VA Di = T u i epth DIMENSI` 3 " SETBACK SYSTEM TO P/L IBLDG WELL LAKE /STREAM LEACHING Manufacturer. - ; ''��� INFORMATION CHAMBER OR ,�V1R a Type Of S st ee y _ ' Z � 1 1 5 0 1 , / � A� UNIT Model Number. o DISTRIBUTION SYSTEM /v /�J ' 1 4' Header /Manifold to Distribution x Hole Size x Hole Spacing Vent to A' Intake Pipes) Length 17— Dia Length Dia Spacing I N._1 \ cy SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only P,/ , Depth Over Depth Over xx Depth Qf i m Seeded /S dded xx Mulched Bed/Trench Center (�7 Bed/Trench Edges \ Topsoil ` J Yes [ � No es No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / ! Inspection #2: Location: 409 Jordyn LaA Hudson, WI 54016 (SW 1/4 NE 1/4 8 T28N R11 9W Sunset View Lot 35 Parcel No: 08.28.19.1862 1.) Alt BM Description 2.) Bldg sewer length = 7Z. - amount of cover = ,7 4z" Plan revision Required? I r =J Y e sN o - /b I l 1 65 - - -- - — — Use other side for additional informa on — pate Insepctor ignatur Cert. No. ..� SBD -6710 (R.3/97) Safety and B in County O 201 W. Washington A" ve., P.O. Box 7162 _1 CrOI X NVY sconsin Madison, tary Permit Number (to be filled in by Co.) p (60 266- r f `' � O : er / �� De artment of Commerce Sanitary Permit Applicat on Sta Plan I.D. Number l ., �.0%, In accord with Comm 83.21, Wis. Adm. Code, personal informa on you provide / maybe used for secondary purposes Privacy Law, sl5. (1)(m) Pro ct Address (if different than mailing address) f . i;RQIA COLIN Y I. Application Information- Please Print All Information ZONINGOFFICE 09 vordyn Zane Property Owner's Name Pa Par cel # Lot # Block # M a i Y - ; o -1 0 - - aft G G2. Property Owner's Mailing Address Property Location 14 �'!., Section City, Sta at t ` e � p Zip Code � ' /., � PhoneNuummbeer Q /� T N; R E oti�V lI. Type of Building (check all that apply) y � s $1, or 2 Family Dwelling - Number of Bedrooms T dwS . Subdivision Name CSM Number // ❑ Public /Commercial - Describe Use ems 1 4-J ❑ State Owned - Describe Use ❑City_ ❑Village Wownship of � k III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B• ❑ Permit Renewal El Permit Revision El change of El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) 3 t X Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound 124 in, of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter XLeaching Chamber ❑ Drip Line ❑ Gravel -less Pipe VOther (exp in V. Dispersal/Treatment Area Information: 0 Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (st) Dispe al Area Proposed (sf) System Elevation , �;S' ut C - VI. Tank Info Capacity in Total Number Manufacturer Pre ite Steel Fiber Plastic Gallons Gallons of Units C+�"�) Concrete Constructed Glass New Existing � Tanks Tanks Septic oP4&WiaS.T&nk �/ / eser Aerobic Treatment Unit Jl Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumb ignature MP /MPRS Number Business Phone Number Plumb Address (Street, City, State, Zip Code) �� i OI / W �• VIII. Coun /De artment Use Onl ,Approved ❑ Di ve Sanitary Permit Fee (in udes Groundwater Date Issued Issuing ent Signature (N tamps) Surcharge Fee) _ ❑Owner Given Reaso for Denial 3 fl IX. Conditions o A prova SYSTEM OWNER: / S� ► �2 1 Septic tank, effluent filter and 4.., ` 3 I dispersal cell must all be serviced / maintains -- tttAlcl•- z ) as per management plan provided by plumber. 2. All setback requirements must be maintained t as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x I I inches in size SBD -6398 (R. 01/03) Il ,/ ! SANITARY PLOT PLAN / e g i- q ' `"`C/� l Scale to"* � ' OWNERS NAME SANITARY PERMIT NO. BENCH MARK(A) #1 D(1 ' T�yj o,� ��p,� SEPTIC TANK #2 PUMP TA NK / SYSTEM ELEV. A _ ���p/v�p� EXISTING TANKS B 9.3 `� WELL N RTH C PROPERTY LINES NOTES- REPLACEMENT AREA 0 I I i I I � � I � , i l w Il eo l f1 17 i f 0, red ® /b ii, v i I j add /,T � � I 3�auJ� 61 I I �q�gl�s /e u r ra, ' i e � C op a � i smth 4- e"A 1,m:v v- J%, Ce MFRS 3186 647 -4682 / PLUMBERS SIGNATURE L ISCENSE N0. PHONE DATE SANITARY PLOT PLAN / " �w�9� ' u'C/✓ Scale V"* ' OWNERS NAME SANITARY PERMIT NO. BENCH MARK( ♦) # '7 j o� i,; p,� SEPTIC TANK � #2 i0 PUMP TANK SYSTEM ELEV. A EXISTING TANKS /Y B 9 `� WELLn N RTH C /�,'_ , ' _ ' PROPERTY LINES NOTES- REPLACEMENT AREA _ vOr o v�Uil q t I i I � � I .�I i t � t � t � I t /1000 Ado I � I 6gp a Nepo /e a r ra, — - -(— - svu -Ah 4re"Ay 1,n e.y- A;1 ce . MFRS 3186 647 -4682 PLUMBERS SIGNATURE LISCENSE NO. PHONE DATE =ff Quick4 STANDARD CHAMBER 52" Quick4 Standard Chamber 4 (EFFECTIV LENGTH) 6 r N € a a€ 12" g g� iijism M E IN i= H ER a s g —_ 34" SIDE VIEW SECTION VIEW MultiPort End Cap R O 12" — - -- - - -- - 34" SIDE VIEW TOP VIEW FRONT VIEW Quick4 Standard Chamber Nominal Specifications 4 MultiPort End Cap Nominal Specifications Size (WxLxH) 84 "x52'x12' Size (WxLxH) 34'xi6'x12' Effective Length 48' `t Invert Height. 8' or 1.25` Invert Height 8. INFILTRATOR SYSTEMS INC STANDARD LIMITED WARRANTY (a) The structural integrity of each chamber, and plate, wedge and other accessory manufactured by Infiltrator ( "Units'), when installed and operated in a leachfield of an ons,te septic system in accordance with Infift.tor's instructions, is wanantad to the original purchaser ( Holder - ) against defective materiels and workmanship for one year from the date that the septic permit is issued for the septic system containing the Units; provided, however, that if a Septic permit is not required by applicable law, the warranty period will begin upon the date that installation of the septic system commences. To exercise its warranty rights, Holder must notify Infiltrator in writing at its corporate Headquarters in Old Saybrook, Connecticut within fifteen (15) . • days of the alleged defect. Infiltrator will supply mplacerrlent Units for Units determined by Infiltrator to be covered by this Limited Warranty. Infiltrator's liability specifically excludes the cost of removal and/or installation of the Units. Oa (b) THE LIMITED WARRANTY AND REMEDIES IN SUBPARAGRAPH (a) ARE EXCLUSIVE. THERE ARE NO OTHER WARRANTIES WITH RESPECT SYSTEMS INC TO THE UNITS, INCLUDING NO IMPLIED WARRANTIES OF MERCHANTABILITY OR FITNESS FOR A PARTICULAR PURPOSE. (q This Limited Warranty shall be void if any part of the chamber system is manufactured by anyone other than Infiltrator. The Limited Warranty does not extend to incidental, consequential, special or indirect damages. Infiltrator shall not be liable for penalties or liquidated damages, including loss of Environmental Onsite Wastewater Solutions'`" production and profits, labor and materials, overhead costs, or other losses a expenses incurred by the Hoder or any third party. Specifically excluded from Limited Warranty coverage are damage to the Units due to ordnary wear and tear. alteration, accident, misuse, abuse or neglect of the Units; the Units being subjected to vehicle traffic or other conditions which are not permitted by the installation instructions; failure to maintain the 6 Business Park Road • P.O. Box 768 minimum ground covers set forth in the installation instructions; the placement of improper materials into the system containing the Units; failure of the Units a the septic system due to improper siting or improper swing, excessive water usage, improper grease disposal, a improper operation; a Old Saybrook, CT 06475 any other event not caused by Infiltrator. This Limited Warranty shall be void if the Helder fails to comply with all of the terms set forth in this limited 860- 577 -7000 •FAX 860-577-7001 Warranty. Further, in no event shall Infiltrate be responsible for any loss or damage to the Holder, the Units, or any third party resul irg from installation or ship- 800-221-4436 ment, or from any product liability claims of Holder a any third party. For this Limited Warranty to apply, the Units most be installed in accordance with all site conditions required by state and local codes; all other applicable laws; and Infiltrators installation instructions. (del No representative of Infiltrator has the authority to charge or extend this Limited Warranty. No warranty applies to any party other than the origi- nal Holder. The above represents the Standard Limited Warranty offered by Infiltrator. A limited number of states and counties have different warranty require- , ments. Any purchaser of Units should contact infiltrator's Corporate Headquarters in Old o Saybrook, Connecticut, prior to such purchase, to obtain a - copy f the applicable warranty, and should carefully read that warranty prior to the purchase of Units. I U.S. Patents: 4,759,661; 5,017,041; 5,156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5,716,163; 5,588,778; 5,839,844 Canadian Patents: 1,329,959; 2,004,564 Other patents pending. Infiltrator, Equalizer and Sidewinder are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc. RECYCLEOPAPER is a registered trademark in Mexico. Contour, Contour Swivel Connection, MicroLeaching, PolyTuff, SnapLock, ChamberSpacer, Posil-ock, QuickCut, QuickPlay and Quick4 are trademarks of Infiltrator Systems Inc. © 2003 Infiltrator Systems Inc. Printed in U.S.A. 0011203HP -0 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner Ll. PI � rl / q� Septic Tank Capacity /� V gal ❑ NA Permit # O 1 1 5- Septic Tank Manufacturer - er ®�r NA DESIGN PARAMETERS Effluent Filter Manufacturer _2 ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units JK NA Pump Tank Capacity g'po gal ❑ NA Estimated flow (average) - g allday Pump Tank Manufacturer kZj5 C L� 11 NA Design flow (peak), (Estimated x 1.5) ®L gal /day Pump Manufacturer Zo L.LEA ❑ NA Soil Application Rate i g al/day/ft' Pump Model T ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit .ANA Fats, Oil & Grease (FOG) <30 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD <220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD <30 mg /L X In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) <30 mg /L J( NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) <10 cfu /100ml ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic lank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 ears) ❑ NA IT Kyear(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once ever n ❑ month(s) y' vt X year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ❑ month(s) ❑ NA 9 year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA X year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA Xyear(s) Other: At least once every: ❑ m ) ❑ year(s) RNA year(s) Other: q NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of <12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page ?__9f Z _ _ START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replac ent system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. • A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. • The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. • Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS I POWTS INSTALLER POWTS MAINTAINER Name Name Phone W-6__ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name 5 r fk y' Phone Phone This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. I Wisconsin Depanment of Commerce SOIL EVALUAT Page / of Division Gt Satery and Buildings in E in accordance with Comm 85 Wis. �#w CJ C pl Attacn complete site plan on paper not less than B 1/2 x 11 inches in s e. Plan must inuuae. out not limited to: vertical and horizontal reference point (BM), ireclioq'and :! P D. percent slope, scale or dimensions, north arrow, and location and dis ce to nearest road. Please print all information. 51. �KUIx COU (R ed by Date FFI E Fersonai information you provide may be used for secondary purposes (Privacy W. S. 1 SEE 3 Property Owner / l Property location Wo 1 � /!(f/� C,! CiOVt. Lot SlV 1/4,0114 S T N R 1 E (or Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# /q e City State Zip Code Phone Number ❑ City ❑ village $(Town Nearest ,Road K New Construction Use: D. Residential / Number of bedrooms Code derived design flow rate &V GPD ❑ Replacement 9 Public r com / mercial - Describe: Parent material Flood Plain elevation if applicable o tt• General comments 1 / p / and recommendations: JOf 13 6aal d re&. p/ - >��'C'O i� �j� ,S ll'o / /o�tl .24 " efiG•�atD �� / Boring [] • / Boring # [ � 3 ( 9 pl pit Ground surface elev. /('� (t: Depth l0 limiting (actor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bound( Roots Gp Q ltf in. Munsell t]u. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Eft*2 (J— lav / — S S' — o `P a , - s/ �" R7-o 33•(e & Boring 1 Boring 9 pi( Ground surface elev. 'S`► J ft. Depth to limiting factor 2'' ,P1 in. S A Rate L I J Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #t .092 - _ si 6 _ s rid _ ' Effluent #1 F BOD > 30 220 mg& and TSS >30 150 mg/L ' Effluent #2 = BOD < 30 mg1L and TSS <_ 30 ff*L Signature CST Number CST Name (Please Print) g S Date Evaluation Conducted Telephone Number Address p PrG;.enj Goner 1 7 e4W1 1 A& r— / Parcel ID 0 Page of BGr,ng n ❑ Boring 09 pit Ground surface elev. �,'� h. Depth to limiting (actor in• Soil A IiC3aon Rate horizon Deptn Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAW in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Effal 'EfM2 - _ Z" 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 .E GPO/fP in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil A iCation Rata F horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots .E GPO/fF E2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I Effluent #1 = BOD > 30 _< 220 mg/L and TSS >30 <_ 150 mg/L ' Effluent #2 = 800, : 5 30 mg1L and TSS 130 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. �UU (1))0 (R 011001 r Y LOT FLA N SCALE 1 "= �FT. PAGE of i �Gnlr; ELEVATIGNS BENCHMARK *ELEVATIONS B -1 �� ' BM #1 &V ' DESCRIP'T'ION OF #1 � t I� 2 B -2 Y- 5 - - BM #2 DESCRIPTION OF #2 ` B -3 93 B -4 _ LEGEND - -- Ak = BM (BENCHMARK) B -5 _ Q= SOIL BORINGS ®= WELL �Gn� NO H NOTES 0r d n .Lance Z 0 1 - ,?/4 I I i I � -- I ( � � I V I I 9.5,d I 9G.d a a Feu x 4 S'rJtJ�h Prro 1 t 1710 221483 _715- 647 -4682 n3TMO MCi ATURP CSTMO# CREDINTIAI,# TELEPHONE # DATE Page 1 Of COMBINATION SEPTIC TANK /PUMP CHAMBER 4" CI Vent Pipe m; cn (No Scale) Approved Cap, 15' .Approved Locking Manhole Cover From duil.lings With Warning Label Attached Weatherproof Approved Yent Cap -; Junction Box 12" Mf nim6..n 6" Min Crade ; 4" Minimum Quick 18" Minimum - -- Disconnect i 1 /4" Veep Hole Baffle Approved Joint r , A N /C.I. Pipe Zabel q 100 7r I Extending 3' Fl.lter Alarm QV B Approved Joir. Onto Solid Soil On 6; w /C.I. Pipa or PVC I C Extending 3' _ ' Onto Solid S: PUMP•OFF RIM . Off or PVC 0 Conc. Slccl, 3" of Bedding Under Tank -/ Lateral Volume i , ' y ,, Gal. Min. Dose. (5 X Lat. Vol.) /, . Gal. Max. Dose (20% of DWF) 120 Cal. Note: Pump and Alarm Are On Separate Circuits Flowback /6106,0�1r,Y, A / 9 , - Cal. Max. Dose W/Flowback f/(Go,3 Cal. Tank Manufacturer: WIESER CONCRETE PRODUCTS Tank Size - Septic /Pump: 1200/800 -Gallons, Alarm Manufacturer. S: J. ELECTRO Model Number 101 RICH WATER Capacities: A �J inches or P Gallons + B 2 inches or A Gallons Pump Manufacturer: _Zoalor + C or Gal Ions Model Number: + D inches or // Gallons Minimum Discharge Rate : _ 7 , GPM Total .....= . nches or Gallons Vertical Difference Between Pump Off and Distribution Pipe: Feet Mini um Required Supply Pressure:........................... - Feet Feet of Force Main x 3.0 Friction Factor /100 Feet: + Inch Diameter Force Main Total Dynamic Head: ... = � e Feet Internal Tank Dimensions: Gal. /Inch ,o Liquid Depth _j Page 6 of 8 HEAD CAPACITY CURVE �- MODEL 66 98" 30 25 20 lb 15 10 5 GALLONS 10 20 30 40 50 60 70 8C 80 160 240 0 FLOW PER MINUTE Eveqipag IVEQ Wisconsin Department SOIL EVALUATION REPORT Division of Safety and l f1n/� Page \ of • 2in?Ag with Comm 85, Wis. Adm. Code Attach'complete sitet I s County ` t 1 8 1/2 11 inches in size. Plan must include, but not limite1 4I refere ce point (BM), direction and percent slope, scale 1 Parcel I.D. l n location and distance to nearest road. N� 'NG Please print all information. Revi wed by "Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). \ I •� Z z� 25— Property Owner ,VVW/u 3 Property Location L 7 �v�tp7:%rNJ1' S� 1/4M1`1/4-S T ZC3 N R �� E(or W Proper Mai ©n re 3 L ot S Block # Subd. ty Owner's Add Name or CSM# P o. City State Zip Code P r e hone Numb I S St� ❑ City ❑ Village Town Nearest Road t3R �1 lRh-E �vJ 5 << $10 (� I S ) -33S I T1ZO�r — New Construction Use: Residential / Number of bedrooms — ( Code derived design flow rate � S Q — `j UCH GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable N It) ft General comments and recommendations: ti� �� f✓ / )� �,�� 2 L` ` h 81j� p1 BLS irj` � Boring # Boring 2a� S• ® Pit Ground surface elev. C Z - 1 3 ft. Depth to limiting factor 7 �� in Horizon Depth Dominant Color 1 Redox Description Texture Structure, _ Cgnsistence Boundary Soil Ap plicatio n Roots GPD /ftz Rate in. Munself Cu. Sz. Cont. Color Gr. Sz. Sh. 'Ef'#1 'Eff #2 Z s 2 w1`T�r C� Z` - Y, ca- S. - • 5 3 3g -az V-1 12- y l6 �•� i Boring Boring g# ® Pit Ground surface elev. S- ft. Depth to limiting factor ? O 3 in. Soil Application Rate j Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 I 'Eff#2 1 0 - tl 1.oK2�/3 — L_ 2 w� ;1�n rn`F�- ci,� W • � • � .� 1t -30 1 W -- f 2 3! 6 3 3 x_93 t0`� 1Z V/G S O S9 ' 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) Siggature Arthur L. Wegerer I- 0 3 --Z)S —3S CST Number Address g 220254 l iege e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Iiain St. River rails, UI 54022 lZ_Z2L_D3 715 -425 -0165 1 f Property Owne ` F - ) 1 1 J'j-- Parcel ID # G Page ' of F� ]) Boring # E] Boring r .� ®Pit Ground surface elev. q. � ft. Depth to limiting factor -7 � � in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /flz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 . o - `2 l o�►� 313 � L Zra sbk w1`f h c w 2.� - s • 8 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 /fl= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 a 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 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. SBD -8330 (R.6/00) I PLOT PLAid Page of Scale 1' =�0' OS �OA'D SM r+ - Z \4) I S r i Aj . �3 aAa4 y� F1 u. Az� �v X � Low' 3 S LvT 3 y ?I PQ - LU T COR -IJLZ ?N 9'`'r PCLL , 3/8 UI A 1 •., l LArn 715-425-0165 220254- 03 -2 lS - 3 S CST Signature Date Telephone Into. CST No. Job NO. Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page \ of c in accordance with Ccmm 85, Wis. Adm. Code Attach complete site plan on paper not less than a 1/2 x 11 inc ,es in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and U Percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 1� NLJ'cJG Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (P^vacy Law, s. 15.04 (1) (m)). Property Owner Property Location - �� J ` Property Owner's Mailing Address 1(4 �E 114 S •� T ? N R E (cr) Lot # Block # Subd. Name or CSM# P• o. Sox 3 3 3 S Cit State Zip Coce Phone Number S U N S� L� 5 C > 1 ❑ City ❑ Village Tcwn Nearest Rcad ►�v) I 1101 (�I_)�l�; -3�S I T1Z -0`1' - - New Construction Use: 3 Residential / Number of bedrooms LI ❑Replacement ❑ Public or commercial - Describe: Code derived design flow rate S Parent material G L�el } TL �� j Flood Plain e!evaticn if applicable 1� f-1 General comments f;. and recommendations: 6>•''1 t o )_ �� =� S � . � rat ! tv _ � 8 r�tin� � P�'� • S � � � ��-� . F T1 Boring # ❑ Boring ® Pit Ground surface elev. C �'1. ` y ft• Depth to limiting factor � �? in. Horizon Depth Dominant Color Re p Soil Aoplicaticn Rase dox Descri lion ` Texture I Struc Structure Consistence l Boundary Rccts GP Gr Dfftz in. Munsell Qu. Sz. Cont. Color ( c . Sz. h. ff#1 'E � �L( {L 3g -°tZ 1v (L V I Boring ❑ Boring a # ® Pit Ground surface elev. S ft. Depth to limiting factor 3 in. Horizon Depth Dominant Color Redox Description Texture SVucture Consistence Boundary Roots Soil Application R ate in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 � � -tl loKiZ� /3 3 3_93 t0�1Z ��� �. - `�.iS6'2 wi'C -ice S �= • — •� I S OS� �M � - .1 1•Z ' Effluent #1 = SOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = SOD < 30 m CST Name {Please Print) — s _ 9/L and TSS < 30 mg/L . Si ature CST Number i Arthur L. Wegerer - f. O3 Z. — Address 220254 Wegerer SOil Testing �& D e S 1 g n Service Date Evaluation Conducted Telephone Number 421 ;3• Bain St. River calls [7I 54 lZ_ZZ_p3 715 -425 -0165 r Property Owne `���( �/���� Parcel ID # Page Z of -� - a Boring # ❑ Boring n r ® pit Ground surface elev. — t l7 C) ft. Depth to limiting factor 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. 'Eff#1 •Eff #2 1 0 — ! WW 313 - -- Z rM S6v w!`f h C w 2 - S • 8 a 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 i 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 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. 5 ©0.8330 (R.6/00) PLOT PLA.3 Page :S of Scale 1' =SQ3 % I P1`J1�OSQ- t> 8 1 � I l `vT 3b ' LvT 3 � vj BUT 1Z --zz 715- 425 -016 -- 5 220254. CST Signature Date Telephone I-To. CST No. Job No. AC DRAINAGE 52* 13 '1 1 " ` 9 � 5.86' 404-41% E �4 w S 87`40'2 'E 54.27' L4 6'ri 1 3 N 8 504.27 @ 25.37' 7C. 0' 98. rft% IF LOT 3 4 I LOT 35 4 LOT 36 i'+' s7s S. 1 52620 S.F. 58 9 99 S.F. t w f 1.5 Ac. l c%j I I I Iz 1 t iz LBO 901.00' i I LBO = 9 00.00' 1 1 6 9.95' 1 99. 1 2 Cr UNPLATED LANDS E -W CABLES ARE TO BE PLACED SUCH THAT THE DISTURB ANY SURVEY STAKE. OR OBSTRUCT VIS OR STREET UNE. Sep -28-05 1 :22am From -AMC SOFTLINES +6123045559 T -447 P -01 /01 F -075 SEPTIC TANK MAII'MNANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM owner /Buyer % Mailing Adds 5ss �q c° S ° 5 / &4 Property Add -ess Ord y`iv�S (Verification required from Planning & Zoning Department for new construction.) City /State w Parcel Identification Number LEGAL GAL DE; 5'CRIPTION Property Loc ition� t /4 , /�� `/4 , Sac. T _ a - - N R � W, Town O Subdivision /` Lot # 35 . Certified Su rvey Map # Volume Page # Warranty D eed # Z- Volume 2 8 , page #9 S p ec house yes no Lot lines identifiable es no SYSTEM Ty AINTENA CE AND OWNER CERMCAT O Imprc per use and maintenance of your septic system could result in its premature failure oe handle wastes. Proper maintenance o , nsists 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. fawner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The p op e rty owner a g r ees to submit to St. Croix County planning & Zoning Department a certification form, signed by the gr owner and by ; master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater dit aosal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 fti 11 of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set E mb, herein, as set by the Department of Cotru fierce and the Department of Natural Resources, State of Wisconsin- Certification s ating that your septic system has been maintained must be completed and returned to the 8t. Croix County Planning & Zoning ep D ar ment within 30 days of the three year expiration date. I/we :erdfy that all statements on this form are true to the best of my /our knowledge. Uwe amlare the owner(s) of the property desct bed above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms _ C � ai3llfn SIGNATURE OF APPLICANT(S) DATE ** *Any infor nation that is misrepresented tray result in the sanitary permit being revoked by the'Planning & Zoning Department•'"* Include with t his application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey asap if reference is u 4do in the warranty deed. (REV. 08105, rn �n� nWT 1WA4 Meq I 1 TMI1 -I Z89S�- 2179 -9TL 617 5���i /13Zf60 m6592 U 2 8 8 9 P S 6 9 g KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI RECEIVED FOR RECORD Document Number Document Name 89/16/2005 89:56AN WARRANTY DEED EXW I1 THIS DEED, made between B & L Land Development. Inc., a Wisconsin REC FEE: 11.00 Corporation TRANS FEE: 314.70 ("Grantor," whether one or more), COPY FEE: and Nathan V. Pachl and Kari Hewett, CC FEE: PAGES: 1 ("Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property") (if more space is Vot nkd, on please attach addendum): Plat of Sunset View Development in the Town of Troy, St. Croix County, sin. 040- 1306 - 35-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. S 15 2005 Dated P � ti t SEAL SEAL ' T ur ner B & L nd D elop Inc. Tracy L (SEAL) (SEAL) * W a . tt 0 I Wiscon s AUTHENTICATION ACKNOWLEDGMENT Signature(s) authenticated on STATE OF Wisconsin ) ) ss. St. Croix COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on SMtember 15, 2005 , (If not, the above -named B & L Land Development. Inc., a Wisconsin authorized by Wis. Stat. § 706.06) Corporation to me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: i e an ac dged the ame. Attorney Kristina Oaland Hudson, WI 54016 * 1 N Pu c, State of isCOnsin _ 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. 2-2003 ' Type name below signatures. INFO -PROTM Legal Forms 800855 -2021 www.infoprofonns.corn OT 9 89 LOT L I o I 86 °" ' \ � � ��� 27725 L- - - -- v,A 44362 S.F. I °o_ 6.3 8\ °o\ 1.02 Ac. I o N S.F. \ NJ t-j L4 � DRAINAGE � °' / o R / 0\ 1 EASEMENT D 404.41 \� - -- s N 52'13'1 1 "E _ 95.86 ........... 46.15 . 14 w S 87'40'26 "E 500.27' 15 - JORDYN -- NE- O w N 87'40'26"W 500.27 , so 32 25.37' D 170.10, _ 196 -� 3 ,_ _ -�- __ - -�,�Q 67� O D 1 1 [ ��,� , 45 ��`L � - - - - -� r- - - - --y 45 �— \ a � 33 � �� � I� I I°' LOT 34 � Z i� I LOT 35 I 68576 S.F. i o N � LOT 3 O C LOT 36 I w m z 68995 S. 589 F. I w 1.57 Ac. 1 ; D 52620 S.F. I Lo I z c' 1 1.58 Ac 1.35 Ac. o i - -� "' 1 \ 1.21 Ac. N // \\ d \ I o I I o i J ILBO = 900.00' LOT 37 \ \ I Z I i Z 47246 S.F. \ I LBO = 900-00'1 LBO = 900.00' 1 HWE = 898.00 I 1 1.08 Ac. 295.65' 91.15' 169 199.12' I 1 127.60' N 8T40 26 UNPLATTED LANDS ...... — _ — — — — E_yy QUARTER LINE Z EASE�[ENT3 $ VO OR BURIED CABLES ARE TO BE PLACED SUCH THAT THE NSTALLATION WOULD DISTURB ANY SURVEY STAKE, OR OBSTRUCT VISION 4LONG ANY LOT LINE OR STREET LINE. THE DISTURBANCE OF A SURVEY STAKE BY ANYONE IS A VIOLATION OF SECTION 236.32 OF THE WISCONSIN STATUTES. UTILITY EASEMENTS AS NW-SE UTILITIES TIES HAVING FORTH HE ARE RIGH T T E O SERVE THE AREA.IC BODIES AND PRIVATE NOTE: THE PARCELS SHOWN ON THIS MAP ARE SUBJECT TO STATE, v COUNTY AND TOWN LAWS, RULES AND REGULATIONS I.e. WETLANDS, MINIMUM LOT SIZE, ACCESS TO PARCEL, ETC. BEFORE PURCHASING OR DEVELOPING ANY PARCEL, CONTACT THE ST.CROIX COUNTY ZONING OFFICE AND THE TOWN OF TROY FOR ADVICE. THIS PLAT IS LOCATED IN AN AGRICULTURAL ARZk MCI E SHOULD TIVITIES cvocr TYPICAL FARM RELATED AC