HomeMy WebLinkAbout040-1265-10-000 Wisconsin Department (I CommAme Count
PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Divi4]on > Sanitary Permit No:
� INSPECTION REPORT 463447 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:
Brushy Mound Partnership Troy, Town of 040 - 1265 -10 -000
CST BM Elev: Insp. BM Elev: BM Description: i� 1 ` Section/Town /Range /Map No:
/1:3.60 16.28.19.1433
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
1 -24 5.` /a . sc
Septic Benchmark
l.j k E=SA- 2c0 • B 1C)
Dosing I LA Alt. BM
Bldg. Sewer �,f+{+•
,0 %
Holding St/Ht Inlet
`F 8Z I 11D 51
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic f / I Dt Bottom I
- 7(14 �5 — $•sue (o.�-�
Dosing ' ( , t j _ Header /Man.
`• J Z P? 7�
Aeration Dist. Pipe
Holding Bot. System
3 • (o /�Z. tS �
�
PUMP /SIPHON INFORMATION 4V Final Grade /I-• 75
Manufacturer / �` n b S Demand St Cover
6 ,1 t'
GPM O. O I`t•��
Model Number v es 1 4 1 l 3
fl .3
TDH Li
.9d, Friction Los System Head ` TDH ,
Forcemain Length Dia.1) Dist. to Well r^ �
SOIL ABSORPTION SYSTEM
BEDITRENCH Width f Length No. ?9 s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 166
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: �� �/ C
INFORMATION Ls-�J
Type Of st� CHAMBER OR : i r UNIT Model Number.
V
DISTRIBUTION SYSTEM (Z
Header /Manifold 1111 Distribution ) x Hole Size �! x Hole Spacing 1 Vegt\to Air I e
3 2 Pipe(s) 5 0 I I ` V
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 /Sod d xx d
Bed(Trench Center 1 7 1 Bed(rrench Edges Topsoil 1 Yes No es No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: C - ltc / Lt —)p- Inspection #2:
pp Lw 4- t
Location: 340 Soo Line Road River Falls, WI 5 p1
2 (NE 1/4 SW 1/4 16 T28N 19W) Glover Statlon 5th dd Lot 72 Parcel No: 16.28.19.1433
1.) Alt BM Description = �.OJ�._ c�.V V,-16 c�-- �ct� aw_
I
2.) Bldg sewer length = ..
- amount of cover
I Ct
Plan revision Required? Yes <
Use other side for additional information. ' �
Date Insepct4S'nature Cert. No.
SBD -6710 (R.3/97)
Safety and 8uiidings Division Cam
4 . , 201 W. Wssitington Ave., P.O. Box 7162 ` C
Madison, WI 53707 - 7162 Satritary Fertnit Ntanber (w fitted in by Co.)
MDeart O Commerce (6N) 266.3 3 -Y , 7 17
Sanitary Permit Application � Plan M. Number �
In accord with Comm 63.21, %%s Adm. Gads, personal information you prov
any be woad far secondary pttrptraes Privacy Law. sl5.04(l Xm) �! (if different than mailing a d dress)
L Applicatltow Laformatplon _ Pkanse Print An Iw.
Atoraatalioa �Z 11 ! jCE 06 S v c L i Ax - 1C �
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P-Wrty Owner's Na lac
parcel x Lot x '7 slat k .
Owner it m Ad&i
I utxriort •
City. State Zip Code Phone Number - l� � -S
G I {circle
M Type of as ikIng kcbeck aN that apply) // dkj T N; R�E or
Ki a 2 Family Dwelling - Number of Bedrotmw � 45 r 115Q lr_,. Subdivision Name bar
O CSM
.( Z
❑ PttWic/Commrn /�t ( cia! - Describe Use
U State Owrted - Describe Use I
1 0City_OVillarre>6ownship of
III- Type of Pasaait: (Cb:ck ooiy ewe boat as line A. C npl to line a # appocabitt)
A.
Ntvv System ❑ "acement System ❑ Treatment/Holding Tank Reoscemew Only U Other Modification to Existing System {
R. ❑Permit Renewal ❑ Permu Revision Change of F1 Permit Transfer to New List Previous Permit Number and Date lasucd
Before n Plumber Owner
tV. 'Iyee of P�OWiS '�stetw: (Chat an that apply) co
❑ Non Pt>xstunled 1n Gra+nQ tCh
,W Mound > 24 in. of sumhte soil Lj Mourd < 24 in. of su Wbie soil U At- Grade ❑ Single Pass Sand Filter
❑ Constructed Weiland ❑ Prcmriaed to Ground U Holding C..t Peat Filter U Aerobic Treatment Unit U Recircula Sand Filter /
❑ Recirculating Synthetic Media Filter ❑ l.Caching Chamber U Drip Lure t� Gravel kss Pipe ❑ Other (explain) 1,
v- Anal Iwformaaow:
Flow (slid) Design Suit A
Rare(gpdsf) Dispersal A�re+a� ltegttired Dispersal Area Prapoaed ( System Elevation
V1. Sa91t Info Capacity in Tota Number ...:curer Prefab � Site Steel Fiber plastic
Gawas Gallons of Units Concrete Constructed Glass
New Existing
Tanks TMkA j
Sspue Holdiog Tank /.
VII. bikt9 statzment I. the y for Powys ttbowa an the sttar8ed plaw. i
's Na me 7j bV S grtaprn hisiness Phone Number
s Addre ss (Street, City, Slue. Zip Code) -
1� if tog
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Approved 0 ed Sanitary Permit Fee (i udes Groundwater Date Issuing Si ( S ) Surcharge Fee) ❑ G Denial 6o 5 6 d
OL of A for Dhapproval _ .
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nquiremeMs must be maintained V �O�f � � S i vti-� ` ✓��5
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Safety and Buildings
4003 N KINNEY COULEE RD
commerce.Wi.gOv LA CROSSE WI 54601 -1831
TDD #: (608) 264 -8777
i sco n s i n www.w
www.coe.wi.gov/s
sin.go /
Department of Commerce iscosin.gov
Jim Doyle, Governor
Mary P. Burke, Secretary
March 29, 2005
CUST ID No.220537 ATTN.- PO WTS Inspector
CALVIN W POWERS ZONING OFFICE
POWERS EXCAVATING, INC ST CROIX COUNTY SPIA
1969 185TH AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 03/29/2007 Identification Numbers
Transaction ID No. 1122058
SITE: Site ID No. 696253
Derrick Construction Co Inc Please refer to both identification numbers,
Soo Line Rd above, in all correspondence with the w enc .
Town of Troy
St Croix County
NE 1/4, SW1A, S16, T2 8N, R19W
Lot: 72, Subdivision: Glover Station 5TH Add.
FOR:
Description: Proposed Four Bedroom Mound System
Object Type: POWTS Component Manual Regulated Object ID No.: 1010315
Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s):
Ezflow Mound Component Manual, (N.6/03), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P
(N.01 /01); Biofilter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in
chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
• This system is to be constructed and located in accordance with the enclosed approved plans and with the
EZ Flow Mound Component Manual (June 6, 2003).
• The pressure network is to be constructed and located in accordance with the approved plans and with the
"Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems Version 2.0"
SBD - 10706 -P (N.01 /01).
• The distribution pipe being inserted into the 4" corrugated pipe located in the EZflow product shall also have
one out of every five orifices installed at the 6 o'clock position. The remaining four orifices shall be installed at
the 12 o'clock position. All pipes must drain fully after every dose.
• The manifold and lateral turn-up ends shall extend out past the exterior end of the cells at both ends. The
observation pipes shall also be located in between where bundle(s) come together. These requirements must be
followed so that the aggregate bundles will not be damaged during the installation process.
• A sanitary permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 144,((24)r)kis. Stats.
Collcdrtionully
APPROVED
DEPARTWuT nc ...... -___
CALVIN W POWERS JR Page 2 3/29/2005
• The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil
compaction in this area is prohibited.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided
per Comm 84 product approval conditions.
• Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site duriLig
construction and open to inspection by authorized representatives of the Department, which may include local
inspectors.
Owner Responsibilities:
• The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating
to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and
maintenance manual and/or owner's manual for the POWTS described in this approval.
• Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and
maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s.
Comm 83.54(1).
• Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption
system or any of its component parts malfunctions so as to create a health hazard, the property owner must
follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized
in the POWTS.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the
installation, operation or maintenance of the POWTS.
Sincerely,
Fee Required $ 175.00
Fee Received $ 175.00
Balance Due $ 0.00
Gerard M. Swim
POWTS Plan Reviewer - Integrated Services
(608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633
jswim@commerce.state.wi.us
cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544
r -
TITLE SHEET
PAGE
DATE • � -- I
MOUND SYSTEM
FOR
AA BEDROOM RESIDENCE
This Plan has been Prepared m accordance with the EZFLOW Mound Component
Manual VERSION 2.0 (N. 06/03)aml the Pressure Distnbution Manual VERISION 2.0
SBD- 10706 -P. (N. 01/01)
LOCATED IN THE _LW 1/4 OF THE W 1/4 OF SECTION) (,,; ,T2_p,
R4W, TOWN OF T r , ST. CROIX COUNTY, WISCONSIN.
INDEX
PAGE I OF 8 TITLE SHEET
PAGE 2 OF 8 PLOT PLAN
PAGE 3 OF 8 PLANVIEW CROSS SECTION
PAGE 4 OF 8 DISTRIBUTION PIPE LAYOUT
PAGE 5 OF 8 PUMP CHAMBER CROSS SECTION
PAGE 6 OF 8 SYSTEM MANAGEMENT PLAN
PAGE 7 OF 8 PUMP CURVE
PAGE 8 OF 8 CROSS SECTION OF E Z FLOW
PREPARED FOR
PREPARED BY
#2205 7
POWERS EXCAVATING INC.
1969 185 AVE.
NEW RICHMOND, WIS. 54017
PHONE: 715 -246 -5135
FAX: 715- 246 -5135
CELL: 715- 381 -9920 ` �
DIVISION 9 SAFETY AND BUILDINGS
REC GORRE ONDENCE
EIVEp sE�
MAR 2 5 2005
SAFETY & BUILDINGS
_ Page Of
Synthetic Govvrinq
Distribution Pipe
A M - 0 3
Medium Sand
G �
Topsoil F //3
3 ,
% Slope Plowed
Bed Of Force Main
) Layer
�> 0
D 49
E v
Cross Section Of A Mound System Using F !cam
E Z F) The Absorption Area G .�,,
N q - E ; 20 E Z 1201 Fl WZ N,P f 041>( PX0FD5CC>
A Ft. M
a
f
B Ft.
i?T
K /V13 Ft.
L Ft.
513 Ft.
Position I 17#3 Ft.
of -- --�. W .3. l;� Ft.
Force Main
---- L
Observation Pipe
r!o , v
JA --------
_�----- - - - - -- ----- - --.�v
Distribution'
fic) 0 f
Pipe,
I
Observgtion Pipe
anchor Sr cw m"Y
Pion View Of Mound Using A Bed For The Absorption Area
uts
y
�ip e Le C a _
r1 t 4 Maui- urr t. t,�p icle tr.e Ajine 'I every tr; ti 0 1
uri ti bottwn t#e pine.
E.VMW tbC and of Cacti WUW qp WS[b ter un o f I 0=,x 45' Etna$ to s paM MIt3uII :ctX
93ch= Ofa s lot made. Teen uft tie cads of ter imab "106 a vaire. - ffit , 4 C" or
rara�eded pdt& provide SCI= ft= fAW Bade fat ffie >dV% ded asp ar dsaaed piv
TO
A
h rtS,l \ P0�
t.AST CkR i EKoM iEMD of
CW-L. VOK - LAT - RAL6.
P _j �' Ft Hole Diameter /j! Inch
S
3 Ft, La teral � Inchies)
_ Inches Min4fold v� inches
Force Heir a InChes
* of holes/pip:-Q-
Invert Elevation of Laterals /3,5 €t.
i
P TANK 6 - PUMP CIJAMBLK l:nu�a or,�,AUA. six,. -
-
-7;;=
4 CI VENT PIPE 12 " MIN. . ABOVE GRADE WEATHER PROOF 0
25' FROM.DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR I - NTAKE WITH CONDUIT MANHOLE C OVER
WARNING LABEL
—L— qn MIN.
r
... .......
18" IN
LNLET
WATER TIGHT SEALS
GAS-
TIGHTS
SEAL APPROVED
C PIPE _!_ ALM JOINTS 411 CI
3z ONTO B ON PIPE 3' ONTO
SOLID �^ , SOLID SOIL
SOIL PUMP OFF ELEV l0 FT. — y r' Orr ** RISER EXIT
D PERMITTED ONLY
IF. TANK .
MANUFACTURER
HAS APPROVAL
3 APPROVED BEDDING UNDER TANK
CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE
TANK MANUFACTURER: �0or\( UMBER DOSES PER DAY: -�
TANK SIZES SEPTIC J aC GAL. DOSE VOLUME INCLUDING
DOSE Cr GAL. FLOWBACK: 33. GAL.
ALARM MANUFACTURER: S _ CAPACITIES: A = i,5 INCHES =? GAL.
MODEL NUMBER: UL5 .. ' f,,Z GAL.
SWITCH TYPE: j'� B = 2 INCHES =
PUMP MANUFACTURER: 1,,,i,� d S C = INCHES = �/3 y GAL.
MODEL NUMBER: W Lj
SWITCH TYPE: L D = /O INCHES = 2 6 6. Z GAL
REQUIRED DISCHARGE RATE GPM PUMP E ALARM WIRING AS PER I�L WA(
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE T FEET
+ MINIMUM NETWORK SUPPLY PRESSURE .. 5 FEET
+ FEET FORCEMAIN X 33 FT /100 FT. FRICTION FACTOR, FEET
TOTAL DYNAMIC HEAD = FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER
LIQUID DEPTH
a
NT PLAN, Pag of ,�
pOWTS OWNER'S MANUAL & MANAGEME Tfof�
sYSt�ri sires
i R11T10M Tank mw* lA.) QS L?P s M Q NA - 1q Owner r - � g� G7 DOW D Hotdtrn4 - got
Permit Cc� wt O NA
Twvk Maw , �S a2._,r 3,
II�LPA1iTEtiS Done 0
%,w. go U gat
O HA a Sap'tic � DNA
Number Cf 0 NA E ffluent Fkw Manus 0 y LO K
number of PubSc Facility Units Effl Fawr Model L. -
Es*rwted (average) a s a NA
w - meted x t .5t Q V
FwmA Manufacturer
Design painp maim (0 ep 3 )) rn
Sail Appftoation Rabe O NA
SWOM unit
Standard GUM" O Same! Ffltar ❑Past Fffca
Fats. 05 & Grease (FOG) 530 M91L 13 Med d Aeration O Wetland
Bid 0xlnisn Demand MODJ 5220 M91L O O Ob*J&Gdm O Other.
Total Suspended Solids (TSSI 5150 mg/!.
MantwY aweraga Manufactn� O NA
pretreated E kwd Ousdh► pi rani CaM(sl
siocdwrdcat Oxygen Demand 1900 930 mgA El M-Q (mil O tr ground �ed
Total Suspended Solids (TS5) 530 OWL O NA
rrnaarnl silo, du/i00mi Cl Ai -Grade
Fecd Cdif+orim (� O Omar:
Mean Effluwvt Pert Y. in die. O NA
ide Size O Drip e Q NA
O NA 2c Z IZo H
O NA
Values tYpical for domesm water
and +optic tank efihrsM- Off'
SCHEDULE BrarMloM
Service Evem rrlaitndnt nwa 3 VsWW O NA
knePect condition of tankfal At isast once avert; one-tl d -(Ki of tank volume O NA
When combined
pump out contents of tw*ts) 0 Whan tla Huh Vsmw darm 3 yews) O NA
Inspect diAlpersall oa bo At bast once every►: O sl
l O NA
Chan effluent fftw At bast once every: r fa anon htsl O NA
Inspect pump, punnp sa'ntsolls 8 +llarm
At best once ovary- O NA
Mgt At best once e+rwY: a
Flush latards and pressure Q rte i(s) O NA
At liast'a�os aMenY� O NA
or certifications:
NaWTENAN GE WSTi91CT10N carrying s °f Orator (pumped.
dsaps smell be roads by an individual
inspections of tanks and POWTS k*POC POWTS Mare ' kh an y cracks of broken hwdvf*n
Master Tank inspections inchde a viswl insPe' of the tsniclsl t+? Yf ar of effluent on tine ground
and scum and a check ` ` for any
leaks. mare the voknrrne of combined akidge to dne�ck the sffk+ant levels in the ob�rrvahon Pia and to dnack
ceN( etsaU b e viava111i surface n wv Indicates fs Hof n d
pond an q Th surface. The PwWb g of affluent on tine g
n � radfics"on of the local regurfstorY suthoft. uaAs orna -thad iY�l a more of the tank volume, ttA
When the combined acxurrWsUon of sludge and scum #n ant tteatrnnent t and disposed of in accordance with chapter NR 113
entire contents of the tank shah be removed by a SOUP Savir*V Operator
Wisconsin Admkifstvdve Code. of effluent fitters, �urunicrd
d of ixessurized com ponents, pretreatmen
Al other ser ices, i�+n9 but not #smiled to the sarvicinp s p81.bfied POWTS Mir•
of 512 monon, by
units, and any se/Yid:�n9 sx i WwA be performed withirn to days of oompieb°n of ant sarvirx► event'
A service report e� be pr�ovkled to the local re y authority GMW 12102
START UP AND OPERATION f _
N ,
For new construction. prior to use of the POWTS deck treatment tankfs) for the presence of painting products. Solvarits or other
chemicals that may impede the U e�t�t Wocsss arltilor damage the eau dispersal C@ (8). If hi¢n concentrations
have the cornterft of the tenk(s) nenoved by a ssptage sefvidrq operator prior to use. are detected
-System start up shall not occur when sod conditions are hVion at the infiltrative surface.
During extended P outages pump tanks idl
wastewstar will be �► above normal hWtwatar bunts. When power is restored the excess
�sdu�sd to the dispersal cWt) in ate Isige, dose and may overload therm resulting In the backup or surface
discharge of effluent. To avoid this situation have the comments of the Pump tank removed by a Septage Servicing Operator prior
to Ong Pow to the effluent pump or contact a Plurobw or POWTS MaikMWW to assist in mernmily operati controis to restore normal beefs w m
within the pup tardy.' Dor^p
Do riot i d rive or P ark 5 feet down vaNclas aver tanks and dlsPwssl cab. Do not drive or park over. or otherwise disturb or Pact, the area
elope of arty mound a at-yrade soil absorption am.
Reduction or eNnnena m of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; c4ovtte butts; eardorna; cotton lnimhe; degreasers; dental floss; diapers; disinfactents fat;
foundation drain (surnp Pump) frult
dish; and
"'° � tir'ne; grease. herbicides. meat .
Painting products. pesticides; sanitary ; tampons and a water saftener brine. ; off;
ABANDT
When the POWTS falls and/or is permanently taken out of service the following Steps shad be taken to insure that the syst m is
Property and safety abandoned in compliance with chapter Comm 83.33. Wisconsin Administrative Code:
e AN piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The cordw is of all tanks and pits shall be removed and property disposed of by a Stage SarvWkV Operator.
• After pumping, sA tanks and pits shall be excavated and removed or their covers removed and the void
space filled with
sod. gravel or another
inert solid matenal,
COIW MGENCY PLAN
If the POWTS fails and carrot be repaired the following rneasayss have been, or must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a rent soil absorption
S
ystem. The replacement area should be protected from disturbance and compaction and should not be. wed upon by
r *wsd wMacks front and proposed structure, lot km and wells. Failure to protect the replacement area will
raw* in the toed for a new send 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
technolo a holding tank may be kvnm ed as a last fasort to replace the faded POWTS.
❑ The sift has not been evaluated to identify a suitable n*lacwnent area. Upon failure of the POWTS a sou) and site
evaluation must be performed to locate a suitable roplacernernt anon. N no replacement area is available a holding tans:
may be Installed as a last resort to foptece`the faded POWTS.
❑ Mound and at -grade soil absorption system may be reconnsbucted in Place following removal of the biomat at the
infiltrative mace. Aac.�orlate. Ain N of such systemrs must comply with the rules in effect at that time.
< <WAAVOM> >
381W. PUPAP AND OTHER TAEATR'WT TANKS MAY CONTAfNfI LETHAL GASSES ANDIOR INSURRCIERIT OXYGEN. DO NOT
ENTER A SEPTW. PUMP OR OTHER TWATWIENT TANK MOM ANY t3MllitJSTAN CES. DEATH MAY RESULT. RESCUE OF A
P ERS ON FROM THE FOR OF A TANK MAY BE Dg:RCULT OR IWOSSWLE.
ADDITIONAL CoiMhu3M
POINTS INSTALLER POWTS MAWYANMTt
Name u"� S Name Phone i S Q Phone ,
SEPTAGE SERViCINtrt OPERATOR (PUMPER) LOCAL REGULATORY AUTHOPM
IVarrne
Eohne
hie docurnant wm drafted by the staffs of des Careen Lem. Mwgtwm and YYauehartt Dw" 2 and Sanitation weir in compliance with
Conlin 83.22(2)(b)I1)(d) &ff) and 83.54(1). (2) & (3), Wisconsin Adrrtirtims m Code.
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND .
OWNERSHIP CERTIFICATION FORM
Owner/Buyer U i► -p proi E z YAA t u-t Ae - al t — t-1 S
Mailing Address �n u 4 4,r, z 0:1a [eC,A�tAkO&J -bf W1 S40 1
r
Property Address � �d �a I.-u.
(Verification required from Planning Department for new construction)
City /State W OsO u , f Parcel Identification Number 040 ° LZb 5 ` La
LEGAL DESCRIPTION
Property Location Wic.. '/4, 5'0�t 1 /4, Sec. , T 200 N -R 19 W, Town of 1 �
Subdivision _ 6l.a VC V Lot #
Certified Survey Map # . Volume . Page #
Warranty Deed # (0 Q (3 , Volume Z. k 4- 0 . Page #
Spec house >(yes ❑ no Lot lines identifiableXyes ❑ no
SYSTEM 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 pltirnber, 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.
Uwe, 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 tha our se 'c system has en intained must be completed and returned to the St. Croix County Zoning Office within 30
days of three a ex *a* date.
SI ATURE F APPLICANT DATE
OWNER/C ERTIFICATION
Apr-desc e) certify that all statem is on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of
' ed v e of a warranty deed recorded in Register of Deeds Office. Z PP I E F ALIC DATE
* * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * **
** Include with this 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
Wisconsin Department of Industry, �^
SOIL AND SITE EVA , A fd' N REPO Pa I 3
Lahor and Human Relations Pag _ of
Ory lion of Safety 8 Buildings in accord with ILHR $3 Wis ,�0de
FUN
Attach complete site plan on paper not less than 81/2 z 11 inches i¢i'?iZe. Plan must include, ptai ;
not limited to vertical and horizontal reference point (BM;, directior nd 7o of ape, scale'or st dimensioned, north arrow, and location and distance to nearest ;•cad ST
CRO;' APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION ouro'y BY DATE
�GitiiVGU�F +::�:
PROPERTY OWNER: ` PROPERTY LOCATION, �
lr Zf -l�6i ►_�? tw �f4 S W 1 /4,S NOT T ZE� ,N,R
PROPERTY OWNER'.S MAILING ADDRESS. LOT # BLOCK # SUBD. NAME OR CSM #
ZS8 2IUREZS tDE _D21UE — )Z I — 6L Smmoi S Frbt> .
CITY, STATE ZIP CODE PHONE NUMBER (]CffY ❑VILLAGE MOWN ' NEAREST ROAD
1Z1U�"f2_ P C S wl 5g01 r1n q i. $tbt SDI Lvu C r
p(J New Construction Use Residential / Number of bedrooms [) AdditiQn to existing building
j Replacement [ ] Public or commercial describe
Code derived daily flow l, gpd Recommended design loading rate • 3 3 bed, gpd$ - trench, gpd1ft
Absorption area required Std bed, ft S 613 trench ft Maximum design loading rate bed, gpd$ - S trench, gpd/ft
Recommended infiltration surface elevation(s) L l I.0 It (as referred to site plan benchmark)
Additional design / site considerations Moues 1n, /8 'Y- 63 ' 8® . HIM • VZ' Of Sft-b FILL
Parent material G L&M-t P•t„ 11 U.. Flood plain elevation, if applicable ft
S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL H0LDWG TA
U = Unsuitable for stem ❑ S RU ER S ❑ U ❑ S ® U [Is ®U EIS ®U ( [IS �
A P"M'n*+j V- uK wepicE buE
'rh SOIL DESCRIPTION REPORT
I u )o SLOPE X.S ZZ�'D .
Boring # Horizon Texture Consistence
Depth Dominant Color I Mottles I Structure I I Botrxtry I Roots GPD /ft
in. Munsell Cu. Sz. Cont Color Gr. Sz. Sh. Bed ITtrich
y: . 1� • S .6
Z 6 -23 Lo -tV 3L6
Ground 3 2-3 -3 -1, S K2 3/y — Gi S �S k M U-fir �S • y - 5
elev.
L` S�f �.SY23L5t s� o m'(� Ct� - •� •Y
Depth to 5 S4 -so S V- V!c — �S O Sg
limiting
f actor M
Remarks:
Boring #
o_S Lo`t6Z31Z — s� f Z'FSbk rh�►- �S • S €.6
t-vi:fk CS - S
Ground ► b�� - �. S •i y!Y S) VrtU1- � • .S
elev. 3 b S6 - 1 .S k (Z '�Ly
\ o - ).S ft. s
Depth to S Sb -80 V /6 — c� sS ►n _ 5
limiting
factor
Remarks:
FT Print Phone:
Arthur L. We erer 715- 425 -0165
egerer So' Testing & Design Service -P.O. Box 74 River .Falls,WI.54022
Signature: Date: CST Number..
2 5 -4-00 220254 J
PROPERTYOWNER �`l ! SC{Ul'TZ SOIL DESCRIPTION REPORT •
Page of 3'
PARCEL I.D. # 1)1 G
Boring Horizon Depth Dominant Color Mottles Structure
g Texture Consistence Roots F B GPD / f t 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bour>dary ed Ttench
IA3 /
Z'('sb
Ground 3 Z( 32 - z 5 '1R Y!y - SC Z�' Sbl7 y�`e►� CS` .t( . S
elev.
i�z.o tl. 3Z--U) S�k ivt`�h Ct.�J 1 • S
Depth to S 3 �,.s�rz �1t3 st L �sb k WtFI- .Z •3
limiting
factor
60"
Remarks:
Boring #
is? Z S -!9. toL tz 3IG n y .S
r<z:•1 * 1.., S 1 CJ T ct�D�r X31 1 C S
3 1°► -�[3 - ) , S L I2.3 1y 5,i� s /� st �� v sbk >n�� �S • 2_ .3
Ground
elev. u3 � `2 2 /l, - S C) s9 Yvl - • 1 . t3
�tq.S ft.
Depth to /
limiting NS C 0/ Lwie�r- �Zlt C61?
factor /�
Remarks:
Boring #
3 _ y -- 2 ,s Ll rL
Ground
el. II D It. tL(-69 Z_S Vly �t -� •S `1R Sig e C� Yv►`�j - �p . Z
Depth to
limiting
factor
Remarks:
3oring #
} ?<
around
Aev.
It.
)epth to
imiling
acto
10
Remarks: _
'rl n•r •rnrf. .✓ ..
L
• PLOT PLAN Pa 3 of 3
SCALE 1 "= SO '
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CST Signature Date Signed Telephone No. CST # '
I
Wisconsin Department ofIndustry, SOIL AND SITE EVALUATION REPORT Page I of 3
Labor and Human Relations g _
Di 7sian of Safety & Buildings in accord with ILHR 83.05, Wis. Adm. Code
' COUNTY
Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but
ST c,Cc� �X
not limited to vertical and horizontal reference point (84, direction and % of slope, scale or PARCEL I.D. W G
dimensioned, north arrow, and location and distance to nearest road. '
APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION REVIEWEDBY DATE
PROPERTY OWNER: PROPERTY LOCATION
e''tkM`� $ E ft' D -'�:�),1 \.S S C!-fU L j Z sGVT.6 NE 1/4 Sw 1/4,S JJOT Z.!E� ,N,R Lq E(or W
PROPERTY OWNER:S MAILING ADDRESS• LOT S BLOCK ;# SUED. NAME OR CSM #
Z SS i DE 'fl ZWF- I --- Z — t Sm O)u S Pr°J D.
CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE Qc TOWN ' NEAREST ROAD
1Z QkEz ,-S wl 5y,uZZhLS) q z - s , - law Lwj �of1D
pq New Construction Use (A Residential / Number of bedrooms AdditiQn to existing building
j } Replacement } } Public or commercial describe
Code derived daily flow 6 �Q gpd Recommended design loading rate • 3 3 bed, gpd/ft - trench, gpd/ft
Absorption area required Soo bed, ft S 63 trench, ft - Maximum design loading rate • `E bed, gpd/ft - S trench, gpd/ft
Recommended infiltration surface elevation(s) I.0 ft (as referred to site plan benchmark)
Additional design / site considerations Y.tl8 'Y- 6.l r 8m . MIN • k2. OF- Ste, FILL ,
Parent material G L.Pat Prt- - n LL Flood plain elevation, if applicable N ft
S = Suitable for system cONVENnoNAL MOUND IN- GROUND PRESSURE AT GRADE SYSTEM IN FILL HOLDING TANK
U= Unsuitable for stem ❑ S ®U I ID S❑ U ❑ S RI U I ❑ S ®U EIS ®U 0S Q U
14, P, V -M � \)N'wri>✓Ce buE
TD w ° /c SLOPE S SOIL DESCRIPTION REPORT
X. ZzQb.
Boring # Horizon Texture Depth Dominant Color Mottles Structure GPD /ft
Consistence BoLrx;ay Roots rErxtt
in. Munsell Du. Sz Cont Color f I Gr. Sz. Sh. I I I I Bed
I - LD•'i lZ j L 2 - 9 L Z' �^iL`` ' GS • S 6
6 -23
LC) `t2 3L6 - s> I ?'�Sbk �1T�- cW
Ground 3 2.3 " 3y S `12.3L y - . �Sb k rn U`Fy- e-S • S
elev. Z 3 Y z
ti \ -L. s it. 3 5` - s � o'^� vrt.`�t- Ct.,.� - • 2-S � `I
Depth to 5 -S Lf P- VIC — �s U S9 wt - . S L
limiting
factor
>So
Remarks:
Boring #
S
o_S Loy � Z3tz — st ( z -Fsbk ►� cs .6
Z z S -1f�- sLC } 3��bk wl,ck cs
3 I b .s Lf R- Yly s I I. e s b k vn U'Fl- cQ w • q . S
Ground
elev.
\ o-).s ft s I o� m�f� �S • 3 ' q
Depth to
limiting
factor
Remarks:
CST Name: — Please Print Phone:
Arthur L. We erer 715 -425 -0165 '
ege rer -So testing & Design Service -P.O. Box 74 River .Falls,WI. 54022
Signature: Date: CST Numbe .
•�_ : 00 -103 -� 2 5 -4 - -00 r 22 0254
PROPERTYOWNER �t f~ SC tJI`T'L SOIL DESCRIPTION REPORT Page -of 3
PARCEL I.D.#
Boring Horizon Depth Dominant Color Mottles Structure
g in. Munsell Texture Consistence Roots GPD /ft
Qu. Sz. Cont. Color Gr. Sz. Sh. ��
Bed Trer>ch
3 t= 0 _8 Lp`t�z_312 - S 1 Z S1a12
ITSbt7 wf cs
Ground 3 2 - 1 -32 - 2 S`ZR Vly Sbl7 yv!`(�b-
elev.
1 \2..0 f t. 3 2 _b0 -� ,5'` -12 � `/ S 1 °� S�j 1Z IM `��- L° W • �{ • S
Depth to - I.S -f P- Yly -F �-I. -m 51 s7
limiting
factor
bo" ff
Remarks:
Boring #
Z S- !9. to Ll lZ-
Ground �� S \Z 5 l5 St. Q-1 L CS)�l2 w�`FI� �S • L .3
elev. U3 -9 9 - 12 A - S Yv1 � • � . i3
\lg -S ft. O S9
Depth to —
limiting 3 WW NS O Ltwtesn�� F S
factor
Remarks:
Boring #
Ground y l s 2 S��y s t �J esbk vn`f1- �w • Z 3
,
M1 It. 'L-S `I V/Y � S `tR S 0 - �>� rn j
ll ,D — IMP • Z
Depth to
limiting
factor
Remarks:
3oring #
hound
;lev.
ft.
)epth to
imiting
actor
Remarks: _
'h r•i •.nrr+ r.r . ..
PLOT PLti 1.V Page 3 Of 3
SCALE 1 "= SO '
0
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CST Signature Date Signed Telephone No. C # -
Trial And Road Map For Glover Station
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1 N N
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10 3
L1 OMAMA ROAD 2
19 20 21 22 23 �� 1
d
12 24
2 25
13 18... t7 31
30
26 MILMI` o�
16
27 28 29 32
14 15 c� 35
40
41 39
43 38 37 36 33
34
44
42
IERII p ROAD
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48
50 59 52 53 54
45 0 46
49 ._ .........
68. 0 67 b 56 92
57 .
69 58
0
70 62 61 ` 91
so
71 .66 63
64
72 65 88
74 73
so ss 93
79 SCALE IN FEET
v
75 85 94 95. 0 200 400 800
84
76 77 78 $1 LEGEND
n 83 96 97 .96 NOR- SIZED A TION
� 1 il<71E W WA
..
8Y THE OYNERS
ASSOCIATION 20' WIDE
WITH 5W RADIUS OOM
82 CHATTAIgOOA ORIVE At cmN Rs. mm
OIMMISE WDTED).
t CO. 2 LION- IbTCRiZED RECMTICN
Civil ngineers do and Surve Fors 101 By 1TW � INED
113 W. WdmA S1. RFer Fah. YA 54M2 100 99 AgSOCIATId/ (20' WIDE,
(715) 425 -7631 103 102 1D EI7��R SIDE�
}} 11� COIM7N LOT Ltw).
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g
C.M. BYF AND DIANE L. BYE OEINIS R. SCIIULTZ AND SANDRA C. SWULTZ DATE: 5-30—M
PO. BOX 167 711 25 1/2 AVENUE
RiVER FALLS, WISCONSIN 54022 CUMBERLAND. W1 1" 54829 .99-2380
U 1926.P 553
s <<
g, 68
1 STATE DAR OF wiSCONSM FORM 11 . 19R2 KATHLEEN 41 H. WALSH
LAND CONTRACT REGISTER OF DEEDS
trdvidmi and Carparare ST. CROIX CO. , WI
(TO RE USED FOR ALL TRANSACTIONS WHERE OVER REGEIV
S25.000 lS FINANCED AND ED F OR RECORD
Ht OTHER NON-CONSUMER Doeraurt NraNumber ACT TRANSACTIONS) . 07 - - 2802 9:30 AM
CONTRACT. by and between C. M. Bye, individnally, and Dennis R. and E C WT
Sandra C. Schultz Revocable Trust, Dennis R Schultz and Sandra C. REC FEE;
Schultz Trustees 15.00
TRANS FEE: 4320.00
COPY FEE.-
("Vend0e. whether one or snore) and Brushy Mound Partners, "P a C am? COPY FEE:
Wisconsin limited partnership, — ' PAGES: 3
( "Purchaser", whether one or more). Vendor sells and agrees to convey to Recording Area
Purchaser, upon the prompt and full performance of this contract by Purchaser, Naive and Return Address
C.
the following Property, together with the rents, profits, fixtures and other 25 M Bye
O
appurtenant interests (all called the "Property"), in St. Croix PO Riverside Drfve
P Box 16?
County. State of Wisconsin: River Falls, Wl 54022
040 -1265- 10-000
1! Lou 72, 82, 83, 84, 8 96. 97, 98, 100, 101, 102, and 103, Glover Station Sth (Pared Identification Number)
N N Troy, St
Croix County, Wisconsin Addition, Town
040- 1266 -10 -000
040- 1268 - 00-000 040 - 1266 -20 -000
040- 1268 -10 -000 040- 1266- 30 -000
040- 1268 -20 -000 040 -1266- 40-000
fit
040- 1267 -10 -000
040- 1266 - 50-000 040- 1267 -20 -000
040- 1267 -30 -000
040- 1267 -50 -000
040 -1267- 60-000
040- 1267- 70-000
040 -1267- 90-000 /
This is not homestead property.
(is nut)
Purchaser agrees to purchase the Property and to pay to Vendor at _
- the sum of S 1,440,000 in the following ma nner. (a iL-1 (30
at the execution of this Contract; and (b) the balance of S l ea 1�4 O r ,together wit atercm from data
hereof on the balance outstanding from time to time at the rate of men (A" % percent per annum
until paid in fuH, as follows: See attached
Provided, however, the entire outstanding balance shall be paid in full on or before the 1st day of
January , 2006 (the maturity date).
Following any default in payment, interest shall accrue at the rate of 10 % per annual on the entire amount
in default (which $ball include, without limitation, delinquent interest and, upon acceleration or maturity, the entire
principal balance).
Purchaser, unless excused by Vendor, agrees to pay monthly to Vendor. amounts sufficient to pay reasonably antici-
pated annual taxes, special assessments, fire and required insurance premiums when due. To the extent received by Vendor,
Vendor agrees to apply payments to these obligations when due. Such amounts received by the Vendor for payment of
taxes, assessments and insurance will be deposited into an escrow fund or trustee account, but shall not bear interest
unless otherwise required by law.
Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any
amount may be prepaid without premium or fee upon principal at any time after January I 2003 (OR
there may be no prepayment of principal without permission of Vendor.*
In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long
as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated
as unpaid principal) is less than the armor that said indebtedness would have been had the monthly payments been
made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds
Of insurance or condemnation, the condemned premises being thereafter excluded here from.
r
Purchaser shall be entitled to take possession of the Property on June 1 2002
• Cross out one.
LAND CONTRACT- Individual and
State air o(tYisoaasia
Corpnte Form No. It - 1992
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Parcel #: -040- 1265 -10 -000 05/06/2005 08:03 AM
PAGE 1 OF 1
Alt. Parcel #: 16.28.19.1433 040 - TOWN OF TROY
Current X' ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): * = Current Owner
* BRUSHY MOUND PARTNERS
BRUSHY MOUND PARTNERS
PO BOX A
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description * 340 SOO LINE RD OR
SC 2611 SCH D OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.652 Plat: 2000 - GLOVER STATION FIFTH ADDITION
SEC 16 T28N R19W NE SW LOT 72 GLOVER Block/Condo Bldg: LOT 072
STATION FIFTH ADDITION 326 GANDY DANCER
CIR Tract(s): (Sec- Twn -Rng 401/4 1601/4)
16- 28N -19W NE SW
Notes: Parcel History:
Date Doc # Vol /Page Type
01/09/2004 751052 2488/129 WD
07/15/2002 684104 1926/553 LC
2005 SUMMARY Bill #: Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/23/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.652 99,500 0 99,500 NO
Totals for 2005:
General Property 2.652 99,500 0 99,500
Woodland 0.000 0 0
Totals for 2004:
General Property 2.652 99,500 0 99,500
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
I