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HomeMy WebLinkAbout040-1266-10-000 Wisconsin Departmeat of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix 'Safety and Building Division INSPECTION REPORT Sanitary Permit No: 574381 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 LLP, c.o Michael R. Troy, Town of 040-1266-10-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: / 6 p 666 16.28.19.1443 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION f.BS /� LEV. I 5 FS / E� Septic 1 'r ems/ o >ZOO Benchmark 3 In 163,14 /d6 Dosing w Alt. BM / 7 3$ �d (. o a 1960 J-.ate'' w Aetatioa- Bldg.Sewer 9 / ;t o lak, L .LS Holding St/Ht Inlet .7. 7.77 TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. ant to Air Intake ROAD Dt Inlet t Septic 4 C /^/ Dt Bottom q J V� ' Z i 1 � Dosing `7, L L ' � I Z" Z _ Header/Man. Aeration `T Dist. Pi e 7 Holding Bot.System '{. /OG PUMP/SIPHON INFORMATION Final Grade 3. a /O Z. Manufacturer (� Demand St Cover I .� 13` to7 dc��fY GPM LnILf` ✓�i I. S Model Number 7`11 I 7 1 WSJ , 1 TDH ILift/ Q Friction os System Head 5a TDH ' t Forcemain Lengt�D Dia. / Dist.to well / SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No.Of T ches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS (' /� 2 SETBACK SYSTEM TO / P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of S s 5 �m: .. 1 UNIT Model Number: —� O✓rti ��/ DISTRIBUTION SYSTEM Header/Manifyd Distribution q ` / x Hole Size ly Ix Hole Spacing Vet Air Int e Z Pipe(s) t� / 5 1 Length Dia Length Dia Spacing 3 D Z v SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only )�„w Depth Over Depth Over xx Depth ofl xx Seeded/Sodded F xx Mulched Bed/Trench Center / 5 Bed/Trench Edges Topsoil L Yes No Yes No COMMENTS: (Include code discrepancies,persons present,etc.) Inspection#1: // / ✓ / / nspection#2: Location: 314 Empire Builder priye Hudson,WI 54016(NW 1/4 NE 1/4 16 T2 8N R19W) Glover Station 5th Add Lot 2 Parcel No: 16.28.19.1443 I;N 1`PP.,dd'''' GoJ�. 1.)Alt BM Description= ; 2.)Bldg sewer length= 53 -amount of cover= /r Plan revision Required? Yes Y'ti No Use other side for additional information. SBD-6710(R.3/97) Date Insepctor"s ignature Cert.No. BRUSHY MOUND PARTNERS, LLC 314 EMPIRE DRIVE ST. CROIX COUNTY/TOWN OF TROY SW 1/4 SE 1/4 S 16 T 28 N R 19 W PARCEL I.D. 040-1266-10-000 BENCHMARK #1 — 3/4" PVC ELEVATION 100 — BENCHMARK #2 — 3/4' ' PVC ELEVATION 98.2 SCALE — 1" = 40' .3f ItpJ 60, DUY E 4 � n ell? o � 2 6 V/ J { 3 aJ14i Safety and Buildings Division County Y 9 ST. CROIX 201 W.Washington Ave., P.O. BOX 7162 Sanitary Permit Number(to be filled in by Co.) m Madison W 1 53707-7162 5 7 39 � I Emit Application State Transaction Number q In accordance with SP &3. is. Adm. Code, submission of this form to the appropriate governmental 2 A / 1 / unit is required prior t �ng a sanitary permit. Note: Application forms for state-owned POWTS are Project Address(if different than mailing address) submitted to the D ent ofery and Professional Servies. Personal information you provide may be used 314 EMPIRE BUILDER DRIVE for secondary purposes in accordance with the Privacy Law,s. 15.04(1)(m),Slats. I. Application Information-Please Prin!,4414nformation HUDSON, WI 54016 Property Owner's Name Parcel# BRUSHY MOUND PARTNERS ' 040-1266-10-000 Property Owner's Mailing Address Property Location / � P.O. BOX 445 Govt. Lot 82 City,State Zip Code Phone Number SW y4, SE �/4, Section 16 NEW RICHMOND, WI 54017 715-246-2320 (circle one) T 28 N; R 19 E or 10 II. Type of Building(check all that apply) Lot l/ 1 or 2 Family Dwelling-Number of Bedrooms 4 N/A 0-7 Subdivision Name 6 k std Block# GLOVER STATION 5 4, 0W. ❑ Public/Commercial-Describe Use e, N/A ❑ City of ❑State Owned-Describe Use CSM Number ❑ Village of V✓ r_ � N/A / 91 Town of TROY X Ov III.Type of Permit: (Check only one box on line A. Complete line B if applicable) 2n e— A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System(explain) 6 B List Previous Permit Number and Date Issued ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑Permit Transfer to New Before Expiration Plumber Owner IV. T of POWTS S stem/Com vent/Device: (Check all that a 1 ) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade M Mound > 24 in.of suitable soil ❑ Mound < 24 in.of suitable soil ❑ Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) / V. Dispersal/Treatipent Area Information: I G v� Design Flow(gpd) Design Soil Application Rate(gpd Dispersal Area Required(sf) Dispersal Area Proposed t1 System Elevation 600 .4 1,500 1,500 98.25 VI.Tank Info Capacity in Total N of Manufacturer Gallons Gallons Units °o b New Tanks Existing Tanks c w y li✓ / O �DI� 5Z 5 a r v', Septic or Holding Tank X 12 1 WIESER Dosing Chamber 800 8 1800 1 1 1 WIESER X VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name(Print) Plumb ignat MP/MPRS Number Business Phone Number PAUL KOEHLER �--- ° 225410 1715-246-2660 Plumber's Address(Street,City,State,Zip Code) 321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017 unt Department Use Only ved sapprov $ it Fe�ej Daate I suQed� L Issuing t Signature vent Rtason�er Denial �`� / l u IX. Co nd � �1/Reasons for Disapproval / C', eptic;tank,efflulent fitter and 3� Ca y �}•off S i�- std �f - t ti' dispersal c6ft must all be service P` t..J l 0J6 ( ep�A. 1 at per management plan provided by plpmber. 1 n r 1 2. ]AI i46,sc(c liegiorements must be E8tllis} 81 i l.�L l- ,"/ YD fd J. se Code ordlnartGS; o`�+ o /1 P.�.�) d w�Go Attach to complete plans for the system and submit to the County my on paper of less than 8 1 2 X11 inches in s t SBD-6398(R. 11/11) PAUL R KOEHLER Page 2 9/10/2014 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. • 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. SPS 383.54(1). • 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 Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. Gerard M Swim When You Receive That Invoice, POWTS Plan Reviewer,Integrated Services Please Include a Copy With Your (608)789-7892,Mon-Fri, 7:15 am-4:00 pm Payment Submittal. jerry.swim @wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm K OtipAxT.ug�r DIVISION OF INDUSTRY SERVICES o� 3824 N CREEKSIDE LA 1P� HOLMEN WI 54636 3 Q' , Contact Through Relay www.dsps.wi.gov/sb/ www.wisconsin.gov Po StiQ �£S SI Scott Walker, Governor Dave Ross,Secretary September 10,2014 CUST ID No. 225410 ATTN.•POWTS Inspector PAUL R KOEHLER ZONING OFFICE COUNTRYSIDE PLUMBING&HEATING INC ST CROIX COUNTY SPIA 321 WISCONSIN DR 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/10/2016 Identification Numbers Transaction ID No.2447195 SITE: Site ID No. 740330 Brushy Mound Partners Please refer to both identification numbers, 314 Empire Builder Drive above,in all correspondence with the agency. Town of Troy St Croix County SW1/4, SETA, S16,T28N,R19W Subdivision: Glover Station 5th Addition;lot 82 FOR: Description:Four Bedroom Mound System/3%slope Object Type:POWTS Component Manual Regulated Object ID No.: 1499171 Maintenance required; 600 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade System(s): ICC Flow Mound Component Manual Ver. 1.2,05/25/10),Pressure Distribution Component Manual-Ver. 2.0, SBD-10706-P(N.01/01,R. 10/12),Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code CONDr requirements. APP No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, DEPT OF I stats. PROFESSIO The following conditions shall be met during construction or installation and prior to occupancy or use: DIVISION OF INC Reminders: • 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 EE O I the designated county official in accordance with the provisions of Sec. 145.20(2)(d),Wis.Stats. • 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 SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384,Wis.Adm. Code compliant. • The area within 15' downslope of the dispersal component shall remain undisturbed.Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. PAUL R KOEHLER Page 2 9/10/2014 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. • 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. SPS 383.54(1). • 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 Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. Gerard M Swim When You Receive That Invoice, POWTS Plan Reviewer,Integrated Services Please Include a Copy With Your (608)789-7892,Mon-Fri, 7:15 am-4:00 pm Payment Submittal. jerry.swim @wisconsin.gov WSMART code: 7633 cc: Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm A MG3 � .1 LJ a ICC FLOW TECH® MOUND AND PRESSURE DISTRIBUTION COMPONENT DEIGN Residential Application INDEX AND TITLE PAGE Project Name: BRUSHY MOUND PARTNERS Owner's Name: BRUSHY MOUND PARTNERS Owner's Address: PO BOX 445 NEW RICHMOND WI Legal Description: SW1/4,SE1/4,SEC16,T28NR19W Township: TROY County: ST CROIX Subdivision Name: GLOVER STATION Lot Number: 82 Block Number: ROVED Y Parcel I.D. Number: 040-1266-10-000 Nq AND ICE3 Plan Transaction No.: STRYSERVICES Page 1 Index and title Page 2 Data entry - Page 3 ICC Flow Tech mound drawin s� NDZNCE Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 PLOT PLAN Page 10 PERC TEST Page 11 SEPTIC TANK PUMP SPECS Designer: PAUL KOEHLER License Number: MP225410 Date: 08/07/14 Phone Number: 7/,s- Signature: �..•'/��� Designed Pursuant to the ICC Flow Tech Mound Component Manual(Ver. 1.2,05/25/10)and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS(01/81)and Pressure Distribution Component Manual Ver.2.0 SBD-10706-P(N.01/01,R. 10/12) ICC Flow Tech Mound Version 2.0(R. 11/12) Page 1 of 11 ICC Flow Tech® Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) r Residential or Commercial Design 400.00 Estimated Wastewater Flow(gpd) 1.50 Peaking Factor(e.g. 1.5 = 150%) 600.00 Design Flow(gpd) 3.00 Site Slope (%) 97.75 Installation Contour Line Elevation (ft) 120.00 Contour Length Available(ft) 30.00 Depth to Limiting Factor(in) 0.40 In-situ Soil Application Rate(gpd/ft2) Distribution Cell Information A 6.00 Cell Width (ft)3, 4, 5, 6, 7, 8, 9 or 10 Only 100.00 = Dispersal Cell Length (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution F Y Pressure Disribution Information network? Enter Y or N (c or e) C Center or End Manifold 3 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. �- 0.125 Orifice Diameter(in)(e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) = 6.00 ft2/orifice 2.00 Forcemain Diameter(in) 115.00 Forcemain Length (ft) Does the forcemain drain back? Y -� 88.00 Inside Pump Tank Elevation (ft) Enter Y or N 0.00 Forcemain Filter Loss (ft) 6.50 System Head (ft)x 1.3 18.76 Forcemain Drainback(gal) 9.75 Vertical Lift(ft) 90.37 5x Void Volume(gal) 4.01 Friction Loss (ft) 109.13 Minimum Dose Volume (gal) 20.26 Total Dynamic Head (ft) 41.19 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 x 2.00 x 1.50 x x 3.00 2.00 x 3.00 x Gallons/inch Calculator(optional) Treatment Tank Information 800.00 Total Tank Capacity(gal) 1200.001 eptic Tank Capacity(gal) 36.00 Total Working Liquid Depth (in) WEISER Manufacturer 22.22 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.001 Dose Tank Capacity(gal) IPOLYLOCK Filter Manufacturer 22.221 Dose Tank Volume(gal/in) 525 � I Filter Model Number WEISER I Manufacturer Project: BRUSHY MOUND PARTNERS Page 2 of 11 ICC Flow Tech® Mound Plan View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T 1/10 6 Observation Pipe 3 J :xlxx'xxr.n+xx�. `xJ`x8xrx� K xgxq,x;,xbx ..n.x vx",x.�xbx.,xtxbx°,x',xee<u,.lxtx.,. .,,..,,x..xhx°u.4x5.xb.'cx"nx'bx Sx..x•.xS.;x W.i•'c•R. /A xrxrxrx,pxrx,PR,^.,�xe•.r,. C rxrxrxrx^xrxr;r;r;Ard'xa xrxrx, .x,..q r;rxrxrx. •. `r.�xrxrxrx /'1 xq,:a,xg.bxb:°px°,:b+..�x...++ 5 x:,..�..+xb:Lx°°x::tx.�x:,x.,x'r x'hx',°eR..«.x W ^m°xrxx",r°.'=x'x8xrxrxrxrx s^xf.rxr.r..'xrxtxrxrx.`xrx8xd x rxr°.s.r.:'.r..x8xd°xrxr xr2r-l'.,..,.xr.,.x. . . . . . . . . . . . . . . . . . ..1. . . . . . . . . . . . . . . . . . . . . . 1.......:. .=. B . 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I L Mound Component Dimensions Down slope toe extension made. A 6.00 ft E 8.16 in H 1.00 ft K 7.77 ft B 100.00 ft F 12.00 in z 9.00 ft L 115.54 ft D 6.00 in G 0.50 ft J 5.50 ft W 20.50 ft 600.00 (ftZ) Dispersal Cell Area 1500.00 (ftZ) Basal Area Available 6.00 (gpd/ft)Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View ICC Flow Tech Dispersal Area Finished Grade 100.25 (ft) G t H .,,..,....,.,.. l F Dispersal Cell 98.75 (ft) Lateral 98.25 (ft)--.O. Invert Elevation Dispersal Cell :.:.: ?:? ? :;: : : : : :;. Elevation D ::::::::::::::: s: :::=::::::::::._ �.•. . K ... .i Contour Elevation 3.0 % Site Slope Typical Dispersal Cell Shading Key See Page 5 Q Topsoil Cap d a 8 2 ........ Subsoil Cap 2 c 2.0 ft Approved Geotextile Fabric Cover ASTM C33 Sand �► ® Till -T- A !6 x°r.r r;r°'bxtirx bx:}:rx � ed Layer :" 5 :x+r:°ss xr: �r:°r 5 brtirtir F :xrxr•rx 01 r bxbxbx b�+ "xbx x{�b.b.b. rtis�rtisti Flow Tech Media ,_ N r rxrxr.r xxr.r r.i.r rxrxrxr It C bxbx+y,x+.,x.,x•,. ,bx.,.b.bxb.b. $.•.b.bx°,xb. r.r.r.rx ;rxr°r r°r° °r.r°:•r°r•r bx.,x.,x.,xq,x. bx•.bxbx b°..bxbxb 0 0.5 ft ttir;r.r rtirtir.r r;rtis'r See details on page 4 for number,size,and spacing of laterals. Laterals are located in the 4"gravity distribution pipes as shown on page 5. Project: BRUSHY MOUND PARTNERS Page 3 of 11 ICC Flow Tech® Center Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below Fc"rrAnconn"donviateatardasstomar&aWatmvkart Laf�rats.arai nt�aal Celfic*s poirA up,e'er every Sh we K— pofrits dovm for drainage. ' O=TLm-up n. tell valve,cP f(-X-- t2xf2+1 Lauas&f6t0#r an ob PVC"4D cEeanoutpluD per SP$Tatia 38420-5 Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.01 ft Lateral Length (P) 49.25 ft Orifices per Lateral 25 Lateral End (Z) NA ft Orifice Density 6.00 ft2/orifice Lateral Spacing (S) 3.00 ft Manifold Length 3.00 ft Lateral Flow Rate 10.30 gpm Manifold Diameter 1.50 in System Flow Rate 41.19 gpm Forcemain Velocity 4.21 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and --► SPS 316.300 WAC 4 in.min. Disconnect Tank component is properly vented Z; L_ Alternate outlet location Forcemain diameter WEISER Manufacturer 2 in. Capacity 800.00 Gallons T Volume 22.22 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 19.09 424.23 B 2.00 44.44 C P� ump off elevation(ft) C 4.91 109.13 F D 10.00 222.20 D Total 36.00 800.00 ii I _J Dose tank elevation(ft) Bedding And Backfill As Per Manufacturer 88.00 Alarm Manufacturer JSJ ROMBUS Alarm Model Number IPS PATROL Pump Manufacturer IGOULDS 3885 —� Pump Model Number IWE05H Pump Must Deliver 41.19 gpm at 20.42 ft TDH Project: Page 4 of 8 ICC Flow Tech° Distribution Cell Media Layout 6.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross-section Arrangements (@(SQMqW 6 ft Wide Component Legend ® 6" ICC Flow Tech Bundle- FTS or FTSG 061, 5 or 10 Foot Lengths 12" ICC Flow Tech Bundle- FTS or FTSG 121 H-1 OC or 123H-1 OC, 5 or 10 Foot Lengths 12" ICC Flow Tech Bundle- FTS or FSTG 121 H-1 OC or 123H-1 OC, 5 or 10 Foot Lengths 0 4" Perforated Distribution Pipe With Pressure.Lateral Inside • Turnup Enclosure — — — — — Pressure Lateral Bundles are covered with approved geotextile fabric as per the their product approval. Distribution Cell Plan View Layout - Typical 6.00 Cell Width -A(ft) 100.00 Cell Length -B(ft) Center Connection Lateral Layout Diagram Project: Page 5 of 8 Mound System Maintenance and Operation Specifications Service Provider's Name DARRELL'S SEPTIC [ Phone 715-425-1025 POWTS Regulator's Name PAUL KOEHLER Phone 715-246-2660 System Flow and Load Parameters Design Flow- Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow-Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 m Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Inspect and clean as necessary at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test periodically Pressure System Laterals should be flushed and pressure tested every 3 years Mound Inspect for ponding and seepage once every 3 years Otherl CHECK AND CLEAN EFFLUENT FILTER ONCE A YEAR Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap and are secured in as shown in the ICC Flow Tech Mound Component Manual approved 5/24/2010. 2. Dispersal cell media conforms to ICC Flow Tech products approved for use with the ICC Flow Tech Mound Component Manual approved 5/24/2010. Media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis.Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished Grade ••������������..� 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Lateral Ends at Last Orifice Where 7 Variable Length Cleanout Begins , y Long Sweep 90 or Two 45 Degree Bends Same ICC Flow Tech Media Diameter as Lateral 1.26 Feet Distribution Lateral ♦— Lateral Cleanout —i I Project: BRUSHY MOUND PARTNERS Page 6 of 11 Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm. Code General This system shall be operated in accordance with SPS 382-384 Wis.Adm.Code,and shall maintained in accordance with its'component manuals [ICC Flow Tech Mound Component Manual Ver. 1.2 5/24/10,Pressure Distribution Component Manual Ver.2.0 SBD-10706- P(N.01/01,R. 10/12)and SSWMP Publication 9.6(01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. Septic and pump tank abandonment shall be in accordance with SPS 383.33,Wis.Adm.Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound,defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Stats. The contents of the septic tank shall be disposed of in accordance with NR 113,Wis.Adm.Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm,the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment,maintenance personnel shall advise the owner as to when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However,if such products are used they shall be approved for septic tank use by the Wisconsin Department of Commerce. Pump Tank The dosing(pump)tank shall be inspected at least once every 3 years. All switches,alarms,and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. If the force main has a weep hole,it should be noted if it is functional during pump operation,and if not,it should be cleaned. ****No one should ever enter a septic or dose tank since dangerous gases may be present that could cause death.*'`*" Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter,and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic(other than for vegetative maintenance)on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations(October-February)dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODS,150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS,30 mg/L TSS,10 mg/L FOG,and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral,and it is recommended that each lateral be flushed of accumulated solids at least once every 3 years. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,and any levels above 4 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring. contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: BRUSHY MOUND PARTNERS Page 7 of 11 BRUSHY MOUND PARTNERS, LLC 314 EMPIRE DRIVE ST. CROIX COUNTY/TOWN OF TROY SW 1/4 SE 1/4 S 16 T 28 N R 19 W PARCEL I.D. 040-1266-10-000 BENCHMARK #1 - 3/4" PVC ELEVATION 100 BENCHMARK #2 - 3/4" PVC ELEVATION 98.2 SCALE - 1" = 40' J bo� I � r P,1� LiJ � c.St.b a 52� 1'- no to �J E PROPERTY OWNER_8`�� SetfULTZ SOIL DESCRIPTION REPORT Page?of ~3 PARCEL I.D.p Boring Horizon Depth Dominant Color Mottles Structure GPD/ft Gr. Sz. Sh. Consistence g in. Munsell Qu.Sz.Cont.Color Texture Boundary Roots Bed Trench 10`"1R- 3/Z s� I Z Sb ►�`FH cS 1 S .� Ground 3 Z3 3y 1-SVR VA — L LeSb►� ,��� �,,� _ ,� ,S elev. $It. y 3�!- S �•S `7lz �t� ��.5�2 slg scl o�,., h2`F; CS — IvP • 2 Depth to (�i -1 li G13 �SBk NP ►`►P limiting factor h 3 E=T- Remarks: Boring # A` t) Ground elev. f t. Depth to -- limiting factor Remarks: Boring # Ground elev. It. Depth to . limiting factor Remarks: 3oring # g> around 3lev. It. )epth to imiling actor Remarks:_ •h n•r•rnrn..r . .. Wisconsin Hu a n Relations ti Industry, SOIL AND SITE EVALUATION-REP, R T Page I of 3 Labe and Human Relations �`� - Division of Safety 8 Buildings in accord with ILHR 83.05, �8:11CfU°.Code « . S�• c. 1X Attach complete site plan on paper not less than 81/2 x 11 inches in siz plan must iniu'd�,but>. not limited to vertical and horizontal reference point(BR,direction and ,of slope,scale or '� PAR L I.D.# G dimensioned,north arrow,and location and distance to nearest road. '� — _ O � (13) APPLICANT INFORMATION-PLEASE PRINT ALL INFORMAT),ON { <;','jLj REVIEKD B DATE, PROPERTY OWNER: PRO k QN 66T S1.J`'114,S S' t T . �6 .N.R tq E c w PROPERTY OWNER':S MAILING ADDRESS• LO BLOCK 4 �S AME OR CSM# z S8 �-lV 2S EDE _DCLLUE 3O Z. I —`` L Smok, S T-A PrDD . CITY,STATE ZIP CODE PHONE NUMBER ❑CITY-[]VILLAGE ZrOWN ' NEAREST ROAD P�KU-S wl 5402:Z_hl5) q z-s-- 'aw _T�Zzll 0'1?`tRE 8�►LD D�- New Construction Use kj Residential/Number of bedrooms y [ J Addition to existing building [ j Replacement [ ] Public or commercial describe Code derived daily flow gpd Recommended design loading rate _bed,gpd$ - trench,gpd/ft2 Absorption area required S t)\'3 bed,ft2 SOD trench,ft2 - Maximum design loading rate • S bed,gpd/ft2 .b trench,gpd/ft2 Recommended infiltration surface elevation(s) C>\'F_S.—)S ft (as referred to site plan benchmark) Additional design/site considerations 'MUUKA�> ")"j �ZG p� S+' � FrL L_, Parent material_ L� C]U\�Z_J_IL.L ckAZT Flood plain elevation,if applicable t'-�P� ft S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U=Unsuitable for stem ❑S ®U 0S ❑U ❑S ®U I ❑S 93 U ❑S ®U I ❑S M U SOIL DESCRIPTION REPORT Boring Horizon Depth Dominant Color Mottles Structure GPD/ft g in. Munsell I Qu.Sz Cont Color (Texture I Gr.Sz.Sh. I Consistence Bar�lary I Roots Bed Tmnch 10-t IZ 2)L z s t l Z`Fz b►z Y Li. - (%- t •s {Y "� a-2$ l�`t R 31b — s I I Z�n s b k yn Ft- e.S _ • S •b Ground elev. ha U 04 .5 q8.) fL y' y3-6`i S `l rz 3 L3 tok Iz 61z L h L- - •3 -y Depth to limiting factors Remarks: Boring# 0-12 TZ3)Z Z S1 1 -Z44 b 1Z `„'�'F} �S V -S Z tz-3n 31 — wt�Fi- �S. - •S €-b 6 SlI 3`PSb� Ground 3 3b4sl -Sys 3/ �7Ssvasl8 SLc.l o� 1n`[-i �_s — e.►Q€ • Z elev. y kl_ 10`t R b 13 gam,) ft Depth to _ fimiting factor ' 30" Remarks: CST Name:—Please Print Phone: Arthur L. We erer 715-425-0165 ' egerer Soil Testing & Design Service-P.O. Box 74 River Yalls,WI. 54022 . Signature: Date: CST Number. 00-103-8 ? S -'I 220254 PROPERTY OWNER_BHC / SCltUL--Z SOIL DESCRIPTION REPORT Z 3 PARCEL I.D.I--� ��5 Page of Boring# Horizon Depth Dominant Color Mottles Texture Structure GPD/ft in. Munsell Qu.Sz.Cont.Color Consistence Bax by Roots Gr. Sz. Sh. „2 is Bed T c `1 R 3/Z s i I rends ..............�= z g� ioH2 �l6 - stl 3�sbk m�'>^ •b �w .s Ground 3 2, 3Y -1,S viz VA elev. L Le.sl,� mFt� SL,) — •�j .S aj_$It. y 24JIS 7•S `7 1131 y �.S fzfz Sit — NJ? Depth to -5 13 LS3z limiting factor Remarks: Boring # t>. Ground elev. It. Depth to limiting factor Remarks: Boring# S$ Ground elev. IL Depth to limiting factor Remarks: 3oring# ,round 31ev. ft. )eplh to milling 3clor Remarks: h r�9•�nrf,.��•• .• PLOT PLAN Page of 3 SCALE ' 1"= Sp ' +t- z - LL.. X3.2.'Om-3%46} ,31V DA PVC /PE �J/3.6't'15La PVC 1�p�ryZ12 �-!pt bolo B.1 ® 3' 3LL `al$7 5 o Ep'1�1�ZE - Sz CST Signature (_715 ) 4 2 5-n 7 (,S_ _ Date Signed Telephone No. CST# ` D Z X (n 53" AS 96" R m 41" EQD z z m c -+ D (A i n v UP 40" uOZI-0 m 4" CAS n m-I i 0 3" 44" 6" „ D � � I m I DM m X -1 Z1 D m 36° O r o m� D n N I N V I m A UP 38" c m 4" CAS m 4 I O _0 pa ---I J-- T C D 39" 0 ° m vai -i D I U) 2 D0 z Z O A � r- K > RE A A D c_ m m m D o� �� Otn D adz 0 ° ^gn omon r�iAm9 FnA>o mo>-cza z A_ E mmz z n o z a =z r z==r�* �Fz N X— a v F(n ° D Nv rn v Oc0 G)OZ c° r°.ry mom 9 = N a �zom>o _+rr°*.. ��ror� 0wN (n N OI> NN ANC F a Z Nw C,i I C nOJmZrn �tnm0; _ � � oz ° oInC/) n � <oCoo Fn =rnw w M r(n Z Nov DO 0 DN-IND� f*1�S'-1ps =� �\ v a zD =ACan r5= m o Nw v�imD i D �Km�° ob.- ?1 00 o a m u n l.J X .. ON �t rnv� Dr �� _ = v 0 N 2Z Zm m N O m m O7 -Ni ca c0 DO O -ZI Z DD mD� m0 °o v ; D D w m 3 m O Fm \ <C > \\ = z DO FuO n 0 m n c) Z rlr <O D r r O m < o m a H D �' C Z I'I 22 z�v CDC) (n r N Q � Z z o D v �o� oom NN A 0 9 C ° m-V r� OC Z 3 m -i o m r m O m o O > >a 0 ;a m Z M m \ cn WLP1200/800—MR m DRAWN BY: SME SCALE: 1 4"=1'-0" PRE-POUR: -, SEPTIC MANUAL 'EWER COOCOET DATE: JANUARY 2010 DATE:. POST-POUR: \ z W3716 US HWY 10 MAIDEN ROCK, WI 54755 0 ° REVISED JAN. 2010 800-325-8456 nLE: XMM/hW-W 4 /Q d ie// f , NGOULDS PUMPS Submersible . . - . -.� Effluent Pump COMPONENTS 7 . . Item No. Description " M1 1 Impeller ti 2 Casing 3 Mechanical Seal 5 6 WE S 4 Motor Shaft 4 5 Motor 6 Ball Bearings s 3 7 Power Cable 8 Casing C-Ring t v 2 MODELS PERFORMANCE RATINGS (gallons per minute) Order No. HP Volts Phase Max.Am . RPM Solids Wt.(lbs.) Order WE03L WE03M WE05H WE07H WEIGH WE15H WE05HH WE15HH WE2OH WE0311 L 115 10.7 No. WE0318L 208 6.8 HP '/3 '/3 '/z 3/a 1 1'/2 '/2 1'h 2 WE0312L /3 230 4.9 1750 56 RPM 1750 1750 3500 3500 3500 3500 3500 3500 3500 WE0311M 115 10.7 5 86 WE0318M 208 1 6.8 10 70 63 78 - - - 58 - - WE0312M 230 4.9 15 52 50 70 90 - - 53 - - WE0511H 115 14.5 20 27 35 60 83 98 123 49 90 136 WE0518H 208 8.1 25 - - 48 76 94 117 45 87 133 WE0512H 230 7.3 m 30 - - 35 67 88 110 40 83 130 WE0538H 200 4.9 3 35 - - 20 57 82 103 35 80 126 WE0532H 230 3 3.3 ° 40 - _ _ 45 74 95 30 77 121 WE0534H 460 1.7 aa,,[60 - 35 64 86 25 74 116 WE0537H 575 1.4 v - - - 25 53 77 - 70 110 WE0511HH Y2 115 14.5 60 = - - - - 40 67 - 66 103 WE0518HH 208 1 8.1 �, - - - - 30 56 - 63 96 WE0512HH 230 7.3 '�' _ _ 20 35- 55 89 WE0538HH 200 4.9 - - WE0532HH 230 3.6 75 - 25 - 51 74 WE0534HH 460 3 1.8 80 - - - - - - - 47 66 WE0537HH 575 1.5 90 - - - - - - - 37 49 WE0718H 208 1 11.0 100 - - - - - - - 28 30 WE0712H 230 10.0 WE0738H 200 6.2 DIMENSIONS WE0732H 3/' 230 3 5.4 WE0734H 460 2.7 %U (All dimensions are in inches.Do not use for construction purposes.) WE0737H 575 2.2 70 WE1018H 208 1 14.0 WE1012H 230 12.5 3500 WE1038H 1 200 8.1 I<--11'/2° WE1032H 230 3 7.0 F 53/< WE1034H 460 3.5 RO ATION WE1037H 575 2.8 16" WE1518H 208 1 17.5 I 2"NPT WE1512H 230 15.7 WE1538H 200 1 .2 8Y WE1532H 230 3 9.2 3y;' WE1534H 460 4.6 WE1537H 1,/2 575 3.7 80 KICK-BACK �W. WE1518HH 208 1 17.5 WE1512HH 230 15.7 WE1538HH 200 10.6 WE1532HH 230 9.2 WE1534HH 460 3 4.6 WE1537HH 575 3.7 WE2012H 230 1 18.0 WE2038H 200 12.0 WE2032H 2 230 3 11.6 83 WE2034H 460 5.8 WE2037H 575 4.7 Goulds Pumps Goulds Pumps and the ITT Engineered Blocks Symbol are registered trademarks and tradenames of ITT Industries. PRINTED IN U.S.A. SPECIFICATIONS ARE SUBJECT TO CHANGE WITHOUT NOTICE. & ITT Industries [qGOULDS PUMPS Submersible Effluent Pump MODEL 3885 WE Series PROSURANCE AVAILABLE FOR RESIDENTIAL APPLICATIONS. APPLICATIONS ■Shaft:Corrosion-resistant, Single phase(60 Hz): can be operated continuously Specifically designed for the stainless steel.Threaded •Capacitor start motors for without damage when fully following uses: design. Locknut on all models maximum starting torque. submerged. to guard against component •Built-in overload with •Homes damage on accidental reverse automatic reset. ■Bearings:Upper and •Farms lower heavy duty ball bearing •Trailer courts rotation. •STTOW or STOW severe duty construction. oil and water resistant power•Motels ■Fasteners:300 series p ■Power Cable:Severe duty •Schools stainless steel. cords. •'/3 and'/2 HP models have rated,oil and water resistant. •Hospitals ■Capable of running dry NEMA three prong Epoxy seal on motor end •Industry without damage to provides secondary moisture •Effluent systems components. grounding plugs.•3/,HP and larger units have barrier in case of outer jacket damage and to prevent oil ■Designed for continuous bare lead cord ends. operation when full wicking.Standard cord is 20'. SPECIFICATIONS P y Three phase(60 Hz): Optional lengths are available. submerged. P 9 Pump •Class 10 overload protection ■0-ring:Assures positive • Solids handling capabilities: MOTORS must be provided in sealing against contaminants maximum. separately ordered starter and oil leakage. •Discharge size:2"NPT. ■Fully submerged in high- unit. g •Capacities:up to 140 GPM. grade turbine oil for lubrication •STOW power cords all have AGENCY LISTINGS •Total heads:up to 128 feet and efficient heat transfer. bare lead cord ends. Tested to UL 778 and TDH. ■Class B insulation on ■Designed for Continuous ® Csa221108Standards •Temperature: '/3-1'/2 HP models. Operation:Pump ratings are By Canadian Standards 104°F(40°C)continuous ■Class F insulation on 2 HP within the motor manufacturer's CM us FI say 1401(60°C)intermittent. models. recommended working limits, •See order numbers on Goulds Pumps is ISO 9001 Registered. . reverse side for specific HP, METERS FEET voltage,phase and RPM's 40 130 _+—_ _r_ SERIES:WE available. 120 SIZE:1/4'SOLIDS 35 — _-.------; _---- RPM:3500& 110 — - —j -t-- i 1750 FEATURES - - - — --' -— 5 GPM - - - - 30 100 ■Impeller:Cast iron,semi- 90 w + - - 5 Fr - open,non-clog with pump-out 2s 80 - -}- - vanes for mechanical seal - — -- -+- -- -- - -1- —i -+ protection.Balanced for Q 20 70 r i — smooth operation.Silicon r 60 bronze impeller available as a 15- So ° —- - - - -_T- - - - - an option. o - - - - - -' -f— ■Casing:Cast iron volute type 10 ao 30 for maximum efficiency. _I 2"NPT discharge. 5 z ■Mechanical Seal:SILICON 10 CARBIDE SILICON 0 00 sea CARBIDE sealing faces. 10 20 30 4 50 60 70 80 90 100 110 120 130 140 150 160 GPM � � � � Stainless steel metal parts, 0 5 10 15 20 zs 30 35 m3/hr BUNA-N elastomers. CAPACITY Goulds Pumps ©2003 Goulds Pumps Effective July,2003 www.goulds.com /*0 P <& ITT Industries 83885 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of FIi.E INFORMATION SYSTEM SPECIFICATIONS Owner _ RRURRY MOUND PARTNERS Septic Tank Capacity 1200 gal ❑ NA Permit # Septic Tank Manufacturer WJESER ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOK ❑ NA Number of Bedrooms 4 0 NA Effluent Filter Model 525 ❑ N9, Number of Public Facility Units 1P NA Pump Tank Capacity 800 gal ❑ N4 Estimated flow(average) 400 Pump Tank Manufacturer WIESER ❑ NA gal/day Design flow (peak), (Estimated x 1.5) 600 Pump Manufacturer GOULDS M NA gal/day Soil Application Rate .4 al/da /ftt Pump Model WE05H ® N Standard Influent/Effluent QuEd Monthly average* Pretreatment Unit Fats, Oil & GrOG) 530 mg/L E3 Sand/Gravel Filter ❑Peat Filter Biochemical Oxygen DemDS) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑Wetland Total Suspended SSS) 5150 mg/L ❑ Disinfection E3 Other. Pretreated Effluent Quality Monthly average Dispersal Collis) d N,� Biochemical Oxygen DemaD,,) S30 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended SoSS) 530 mg/L ❑ NA ❑ At-Grade ) Mound Fecal Coliform (geoman) 510' ofu/100ml Q Drip-Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: 0 Ntk Other: E3 NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency inspect condition of tanks) At least once every: 3 ���th(s) (Maxinwm 3 years) t] Nit Pump out contents of tank(s) When combined sludge and scum equals one-third (Ys)of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 month(s)af (MaxNrium 3 years) ❑ Nor Clean effluent filter At least once every: 1 a year(s) Q N/` Inspect pump, pump controls & alarm At least once every. 3 year(s)month(s) El ` Flush laterals and pressure test At least once every: '❑month(s) ❑ W. 1,5 year(s) Other: ❑ At least once every: month(s) 13 N19❑year(s) Other: ❑ NA. MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifications: Master Plumber: Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(sl 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 surfaca. 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 11:3, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmem units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. ' — - — :.,,. ✓a v apt► vv �.vivitvu t¢J UU START UP AND OPERATION Page 2 of?� For new construction, prior to use of the POWTS check treatment tanks) for the presence of painting products or other ehemicel that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the conterit 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 b, discharged to the dispersal oell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge o effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restori.il Power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls tr 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; fart; foundation drain (sump pump) water, fruit•and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ail; painting products; posticides; sanitary napkins;tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to Insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert Solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant replacement system: 4 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptkin system. The replacement area should be protected from disturbance and compaction and should not be infringed upon py required setbacks from existing and proposed structure, lot lines and wells_ Failure to protect the replacement area %ill result in the need for a new soif and site evaltlation 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. Th 24a bee —Upoo-failwe of the 120141 a .01,alua. ' lk te- o ►k be a are . Vkpl 4115 ne T . CaNS'M'VC7% ❑ 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 TREATMl=NY TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NC T ENTiER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY 13E DIFFICULT OR IMPOSSiElLE. ADDITIONAL COMMENTS f POWTS INSTALLER POWTS MANIITAINER Name COUNTRYSIDE PLUMBING Sc HEATING, INC Name PAUL KOEHLER Phone 715-246-2660 Phone 715-246-2660 SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name POWERS LIQUID WASTE MANAGEMENT Name s'j` Gr\,lJ t 2Dtil1�(1 Phone 715-246-5738 Phone "'] CIO- This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54111. (21 &(3), Wisconsin Administrative Code. ST.CROIX COUNTY SEPTIC TANK MA ENANCE AGREPIAM-T AND OWNERSIHP CERTIFICATION FORM Owner/Buyer Mauling Address—Po o ©V . 1-4 1;1 j 1;41,o Pro-- Adttt'ess PAY: (Verification required m Planning&Zoning Department for new construction.) City/State Parcel Identification Number 4`4 "'l Z.tp :-._L,EGAI✓"-HE-SCRIPTf-ON- -- - Property Location V4, '!a,Sec. T-1"9a N R ` W�Town of -C7A _ —�--- —- subdivision Ll Lay-- - © S ,Lot# 'Z-t _ _Certified.Survey Map# __. ,Voltztme ,page# Warranty Deed#_ C7 I<N C;r-).,, ,Volume ,Page## Spec house ' yes no Lot lines identiflable( yes no SFSTEl'VI MAIIY'I'EE1YAlVCE AND OWNER C-ERTMCATj()N Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of purnping out the septic tame everythrec 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§Conan.83.52(1)and in Chapter 12-St Croix County Sanitary ordinance. Thee property owner agrees to submit to St.Croix County Planning&Zoning Department a certification form,signed by the owner and by a master plumber,jou=yman plumber,restricted plumber or a licensed pwwcr verifying that(3)the ott-site wastewater disposal system is in proper operating condition and/or(2)after inspection and Pumping(if necessary),the septic tank is less,than 113 full of sludge. 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 starting 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 expitatioa date. Ilwe.certify that all statements on this rm are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property describ above,by virtue of a warra deed recorded in Register ofDeeds ice. Number ro 7 / ♦1/ g ST. ATI C3F LIC (S) DATE * , y,ittfotizifitai�ia that is misrepresented may result in the sanitary per nit being revoked by the Planning&Zoning Department. "* Include with this application a recorded warranty deed from the Register ofDeeds Office and a copy ofthe certified survey map if I rsfzsr!�ieP ist_made.it the warratt_ty�ed�'_._._ (REV.08/05) FEB-20-2006 11:07 FROM River Valley Rbst.ract TO 17152464848 P.02 STATE BAR OF WISCONSIN FORM 1 -1992 SoDDS REGISTER H. "WARRANTY DEED ST. CROIX emo., DocumentNamber I RECEIVED FOR RECORD Tb s head,made between C.hL Pye.hidivid ,and rennin Ii. el/09/2004 tll9 t 95AH and Sandra.C.Srhrdltx Revocable Tract,Dennis It.Sehttltz acrd Sandra C. Schultz,Trustees WARRANTY DEED EXFWT # 17 Grantor,and lkrstshy Maarrd Partners,L.L.P.,R Wisconsin limited 'f'FtEC F a EES 12. partner mi, COPY FEE: CC FEE: PAGES: I Grantee, Grantor;for a valuable consideration,conveys to Grantee the following described twat estate in St,Crok County,State of Wisconsla(The"PrgpeW)a Recording AM Name and Palate Address Lets 72 3,84,92,93,94,46,97,98,100, lei,142 wA 103,Gl ver a AC By* Station 5th Additl 258 PAverelda Drive on,Town of Troy,SL t�robt county.Wiscaonsin P.O,Sox 167 River Falls,W154022 040.1265-10-440,040-1268-00-000 Parcel Identification Number(MM This is not homestead property. C Cis net) T#ls dead s g�van in satisfia ction of 3a car�ru Land Contact between he l as ?nna 5, 2002 and recorded in the office of the SL Croix County Register of Doads an July 1$,2002 in Volume 1926 of Rco ads,page 553 as Document No. 684104 Additional PIN cumbers:040-1268-10-WO.040-1268-20-000,GAO-1266-10-000,040-1266-20-000,040-1266-30-000, 040-1267-10-000,040-1267-20-000,040-1 267-30-ODD,040-1267-50-400,040-1267-60-000,040-12'.x67-7O-000, 040-1267-90-000 Together with all appurtenant rights,title and ituerests, Csraatar warrants that the title to the Property is goad,indefhssible in fee simple and free and clear of encumbreaves except eascraants and restrictions ofrecoud and will warrant and defend the same. Dated this 6 day of ---� �^✓+rr r Z . Denals R.Sehacktz G'". artdra C.Schultz s AUTHENTICATION ACKNf7V4'i.EDGMENT STATE OF WISCONSIN ) Sigaararc{c} }sc. St.Ciralz County.} -_Pexsonally_caste before me this Le day of authenticated this day of , the above nsrne Dennis IL Schultz,Sandra C.Schultz and C.M.Bye 771'1 E. MEM85P,STATE HAIL OF WISCONSIN � .' }� •�`' (If trot, to me known to be the peraos(s ilia ex qua t qin mast and ackuowl 8 ad8a the tdra' ""ct' 3 — u authorimd by 0 706.05,Wis.Stets.) �� va THIS INSTRUMENT WAS DRAFTED)MY �s •`• C.I►i. " .: V j_. Q k Att arney at Law Notary Public,State cf Wiscrmsiik. a — t My Cacnsgc€ssion.i�_pes_.asset.Qtnot;gtal6 avyliia date. (Srg:iatui°d"iixiay�authenticated:tst ackriowtulgad.Both are not _ _. . .. .,..._ . _ .... aaeecaaty.) ---�. `NNW=of parsatz signing in any ospaeity should be typed or printed below dwir siguawres WAVLAAH YIMM $r4T&sAn4WWffiCOKM Plum tip I-tsar 64 F1;1RMATKO"PAOPUSSROKALS COMPANY POND VU LAC,Wt 690.65%.=l Tnrcx p no S.F.1 2.501 ACRES C*41 00 so w Ow W10 390AW loop T3, 8 2.734 ACRES 1190071 CULOCSAC as CASEMWo E 7.12 234.w , ' am low . , a lulm s39 SUrI'a gtqy" Lww a g r a 1 5 sort--- -r-7 d r^--�-�-r---� 4AI'!'YP i fi FEET. � � : ,� � � � �j s.,' �✓ tan }y+ ,� uai�= � �i :m�aranormwane�,rox rr�r,amt ' I . G1Fp�..,..""'�' .f i ��kWai � _4 OUT a MumwrM�-"` 'opy, pr>d�i acz w�atr. , "�` iaet5a' yi �.:�. �+ �:pnutaieclx �erw��. en 't, � k r Y�sr ar�ic rKtmm�s,rti Ott ' • 9 awru uxadrs �..�.a }}II�� rs+er�o[xt° 1,101 7flNti0iR9. .: i » Mt !E .:Iq�teDtir�AE m� er rtRda�1. M L . 1 t•`�'>�� 1 _.# � 'i1� E y �', � � i►�7Y#� IMIbr�CY4►t- 1� 71 0: lumv i c } d Mmax 1 --•,. a` _ .r--rwCtMewRMf. € r € ' 16 SIT ; 75' °� ,u capdrti[kxa> T 4 Maodrii li h h r� r e•s a u as y ;Pd - - Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix lz afety and `Building Division INSPECTION REPORT Sanitar Permit No: 514939 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 - 1266 -10 -000 CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown /Range /Map No: 16.28.19.1443 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer L Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom / Dosing eader /Man. _ Aeration Dist. Pipe Holding Bot. System PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head r DH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed/Trench Edges Topsoil E] Yes ❑ No 0 Yes E] No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 314 Empire Builder Drive Hudson, WI 54016 (NW 1/4 NE 1/4 16 T28N R19W) Glover Station 5th Add Lot 82 Parcel No: 16.28.19.1443 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes other side for additional infor [] No n es I — _ � SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. K i 7qLi Safely and Baiidings Division T 201 W. Washington Ave., P.O. 71 C r U t X i sco Madison, WI 53707 Permit Number (to he fillet in by Co.) 5/Ig9.3 Sanitary Permit Application 71 in accordance with s. Comm. 83.21{2), Virm Adru. Code. of this fora, to appropriate govenuneami � S / of 3 unit is required prior to obtaining a sanitary permit Notes Application forms fix state -roomed POWTS are Pmjed Address (if different than mailing address) submitted to the DgWunent of Coumnertx. Personal information you provide may be used for secondary purposes in scoordmce with the law. L 15. i m StdL 3 Ery y , lel� f} L Information - Ph a Print All Iuaforoaati on Property Owner's Name i # 8 r S M OLk," "_-t Property Owner's Mulft Adams JU Location , /A A /3 city, State Zip ZONING OFFICE F y''_�' section (click �k S G1 Q N R I W U. Type of BmIding (twck A that ) p k Lot t or Family `d9aclting- NumberofBedrooms -- 4 Su division Name s oZ Biotic # 1. = d �%� O PublidCommeciai - O Cit of 5 O State Owned -DesmU Use / CSM Number O Village of ✓ �Townof_ HI. Type of Permit: (Check only one box on live A. Compleft liae B if applicable) A New System O Replaewmart System O TieM.WHoidnug Tails Replacemrnt Only O Otha Modification to Exisfmg SYst— B. O Paten Renewal 0 Pamit. Revision 0 Chimp ofPtumber ❑ Permit T=nsfer to New I +st Previwus Peewit Nwuulxxsad Daft issued Before Fxpiwtion Owner IV. Tym of POWT3 SystierawAmponeaWDevice. Check alt that a L. i ' O Now*re surisod Io-Ground O Pnasurzed In -Ground O At -Grade Mound?: 24 in. of suitable soil ❑ Mound <24 in. of suitable soil O Bolding Tank O Otber Dispaasi Component {explain ' ` Prdreatatmt Device (explain) V. ti tit Ara bdormation near Fkwv { MOM Soil Anditxti on • Diapasal Area Required ( Dispersal Area Proposed System Elevation 00 zl5bb too VL Tank Isfo Capacity in Total # of Mau Gallons Gallons units _ � v New Tats t,g T w o a �-- Sep6e�Tack VII. Stespons"Iity Staterpeut- 1, the undersigned, m mme rib' for instaft lou of the POWTS shown oa the attatdted Pb"M phunluer's Name P s Signature MP/MM Number Businm Phone Number x%-537 7 S i �3 � Phunber's Address (Sled, City, S Tap Code) 1 61 1 kS A cs 41, GJ SIL l vtu. t Vse Permit Fe; Dale 1pued Sitl 7 b 4 -b L ID Coed SY T M easotas IX. f prn Pvat ,3) Q t) r1 G abpe"rG r /UGC �.J t. Septic tank,.e0k*nt fi ter old ' dispersal cell must all be servicWt maWWW o - owv�tf- "'Jr ►�' �' �' as mane mana p lan p rovided tuber. 1 P� 9� P P by � 2. AN selbackrequitert►erttsmust be rrtakitained ant�seipmll to t. �` 7 O° PaPK not ku tlua a uz� � SBD -6398 (R. 01/07) Valid thtu 01109 l w P UT• - p _ _ S LL - - Fr -- , -LA s Ad ck 31 eek%r ; t-'� f >"-t t � dle U ,j p aw - -- - 98, kz S - -- k ; _ a Safety and Buildings 3824 N CREEKSIDE LA commerce.wi.gov HOLMEN WI 54636 tiepartment of C TDD #: (608) 264 -8777 sco ns i n www.commerce.wi.gov /sb/ D www.wisconsin.gov Jim Doyle, Governor J ack L. Fisc A. I.A., Secretary July 23, 2008 CUST ID No. 220537 ATTN. POWTS Inspector CALVIN W POWERS ZONING OFFICE POWERS EXCAVATING, INC ST CROIX COUNTY SPIA 1969 185TH AVE 1101 CAR 41CHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/23/2010 Identification Numbers Transaction ID No. 1572341 SITE: Site ID N 740330 Brushy Mound Partners Please refer to both identification numbers, 314 Empire Builder Drive above, in all correspondence with the a' enc . Town of Troy St Croix County SWIA, SEIA, S16, T28N, R19W FOR: Description: Mound / Four Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1192708 Maintenance required; 600 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; System: EZ -Flow 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 occipancy or use: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. I • The changes made in red to this plan on 7/23/08 by this reviewer were acknowledged and approvedby the system designer. CR. tfd; • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component arm. Mir"" Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption SEE CORE area. chs. NR 811 & 812c • 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. CALVIN W POWERS JR Page 2 7/23/2008 • Inspection of the POWTS installation is required. Arrangements for inspection shall bemade with the designated county official in accordance with the provisions ofSec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) A copy of the approved lap ns, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors Owner Responsibilities: • Comm 83.52 Responsibilities. 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. • Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. 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 f� Fee Received $ 175.00 Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday charles.bratz@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M. RECEIV JUL 2 1 200EZFLOW MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application SAFETY & B U LUINGS INDEX AND TITLE PAGE Project Name: BRUSHY MOUND PARTNERS Owner's Name: BRUSHY MOUND PARTNERS Owner's Address: P O BOX 445, NEW RICHMOND, WISC. 54017 Legal Description: SW1 /4 , SE 1/4, SEC 16, T28 NR 19W Township: TROY County: ST. CROIX Subdivision Name: GLOVER STATION Lot Number: 82 Block Number. Parcel I.D. Number: 040- 1266 - 10400 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 EZFIow mound drawings Page 4 Lateral and dose tank Page 5 Distribution media Page 6 System maintenance specifications Page 7 Management and contingency plan Page 8 Pump curve and specifications Page 9 PLOT PLAN Page 10 PERK TEST Page 11 SEPTIC TANK/PUMP STATION S PECS Designer: CALVIN POWERS License Number. 220537 Date: 07/17108 Phone Number: 715 - 246 -5135 Signature Designed Pursuant to ow OV �D EZFIow Mound Component Manual (N. 06 3), and Of CONN -RCI SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) LDINGS c EZFIow Mound Version 1.2 (R. 02/04) Page 1 of 11 SPONDENC EZFiow Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) r Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 8344-3 in situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coirforrn of `m 36 incites. 600.00 Design Flow (gpd) 3.00 Site Slope ( %) 97.75 Installation Contour Line Elevation (ft) 120.00 Contour Length Available (ft) 30.00 Depth to Limiting Factor (in) 0.40 In -situ Soil Application Rate (gpd/fe) Distribution Cell Information 1 00 1 Cell Width (ft) 3, 4, 6, 7, 9, or 10 Only 100.00 = Dispersal Cell Length (ft) Dispersal Cell Design Loading Rate (gpd/fe) influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Distrbution Information network? Enter Y or N (c or e) c Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) = 6.00 if /orifice 2.00 Forcemain Diameter (in) 115.00 Forcemain Length (ft) Does the forcemain drain back? r Y -� A88.00 Inside Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 18.76 Forcemain Drainback (gal) 9.92 Vertical Lift (ft) 90.37 5x Void Volume (gal) 4.01 Friction Loss (ft) 109.13 Minimum Dose Volume (gal) 20.42 Total Dynamic Head (ft) 41.19 System Demand (gpm) Late Diam Sel M anifol d Diameter Selection in. dia. options r choice in. dia. options choice 0.75 1.25 x 1.00 1.50 x x 1.25 x 2.00 x 1.50 x x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 800.00 Total Tank Capacity (gal) 1200. 00 Septic T ank Capacity (gal) 1 36.001 Total Working Liquid Depth (in) WI ESER Manufacturer 22.22 gain (enter result in cell B49) Dose Tank information Effluent Filt information 800. Dose Tank Capacity (gal) 1POLYL Filter Manufacturer 22.22 Dose Tank Volume (gain) I PL525 Filter Model Number WIESER I Manufacturer Project: BRUSHY MOUND PARTNERS Page 2 of 11 Mound Plan View .............. :.3. J - 1110 B 'Observation Pipe -: A W f. B _— I I J L 0 Mound Component Dimensions Down slope toe extension made. A 6.00 ft E 8.16 in H 1.00 ft K 7.77 ft B 100.00 ft F 12.00 in z 9.00 ft L 115.54 ft D 6.00 in G 0.50 ft J 1 5.50 ft W 20.50 ft 600.00 (fe) Dispersal Cell Area 1500.00 (fe) Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 10.00 (ft)1 /10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.25 (ft)% . / /AII! / /J / /JINIIJJ /I /II JI /IJ /!1/1/11 /II /I /II I F Dispersal Cell 98.75 (ft) Lateral 9$.25 (ft)---* invert Elevation is I 3: 1 D rsa Cell Pe `:- E D= �...; v n Ele atio h . 97.75 (ft) Contour Elevation 3.0 % Site Slope 7 Typical Dispersal Cell Shading Key a See Page 5 [] Topsoil Cap c c Geotexxtile Fabric over 0 / // / /r / Subsoil Cap a 2.0 ft � l0 .- :rte. %.r. jrs "'' = r- r�? ASTM C33 Sand v Z : "'� w r r r r i' . r -r•r•i r -s. : .-;�...r•, -r F Tilled Layer m 11Y 5 r. .w. HJJSrL t :. �• { ✓• Q EZFlow Media '+— r•ry 1r •.;1 r See details on page 4 for number, size, and spacing of laterals. Laterals are located in the V gravity distribution pipes as shown on page 5. Project: BRUSHY MOUND PARTNERS Page 3 of 11 i Center Connection Lateral Layout Diagram Place Appropriate Lateral Diagram From Right Below Force main connection via tee or or to manifold at arg point. Laterals arc Wr idoal orifk= point up, except every sh one K --- P poles clown for drainage. MW i= Turn -up v lball valve or IE- Laterals 8 kxoe main of PVC Soh 40 olesnoutplug per COAW Table $4.30.5 Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.01 ft Lateral Length (P) 49.25 ft Orifices per Lateral 25 Lateral End (Z) NA ft Orifice Density 6.00 fe /orifice Lateral Spacing (S) 1 L Agpm ft Manifold Length 3.00 ft Lateral Flow Rate gpm Manifold Diameter 1.50 in System Flow Rate Forcemain Velocity 4.21 ft(sec Dose Tank Information Locking cover with warning label and locking device, and sealed watertight Electrical as per NEC 300 and --► Comm 16.28 WAC Disconned 4 in. min. Tank component is properly vented E— — Alternate co outlet location Forcemain diameter WIESER Manufacturer T _ 2 in. Capacity 1 800.00 Gallons Volume 22.22 gal/inch A Weep hole or anti - Dim In ches Gallons B siphon device A 19.09 424.23 B 2.00 44.44 C Pump off elevation (R C 4.91 109.13 88.83 D 1 000 222.20 Total 1 36.00 800.00 — Dose tank elevation (ft) Min. 3" Bedding under tank. 88.00 Alarm Manufacturer SP Alarm Model Number JOBSERVER 100 Pump Manufacturer IGOULDS 3885 Pump Model Number Pump Must Deliver 41.19 gpm at 20.42 ft TDH Project: BRUSHY MOUND PARTNERS Page 4 of 11 EZFlow Distribution Cell Media Layout fi.00 Cell Width (ft) 1.50 Sidewall to Lateral (ft) Distribution Cell Cross - section Arrangements Drag appropriate drawing to space below. 6 ft Wide Component Legend ® 6" EZFlow Bundle - EZ0601A, 5 or 10 Foot Lengths 12" EZFIow Bundle - EZ1203H, 5 or 10 Foot Lengths 12" EZFIow Bundle - EZ1203HP, 5 or 10 Ft Lengths O 4" Distribution Pipe With Pressure Lateral Inside 0 Tumup Enciosure – – – – Lateral Distribution Cell Plan View Layout - Typical 6.00 Cell Width - A (ft) 100.00 Cell Length - B (ft) Center Connection Lateral Layout Diagram Drag appropriate drawing from left to space below. A ,— Force Main -- – – – – – – – 6ft Wide Center Manifold ------------------- i Mound System Maintenance and Operation Specifications Service Provider's Name CALVIN POWERS Phone 715 -246 -5135 POWTS Regulator's Name ST. CROIX CO. ZOING Phone 715- 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 If Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and a once eve 3 rs Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the EZFlow mound component manual. 2. Dispersal cell media conforms to EZFlow products approved for use with the EZFlow Mound Component Manual approved 6/3103. EZF[ow media is covered with an approved geotextile fabric. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration, Lateral Turn -up Detail Finished .• ............. ••••••••••••••• Grade Threaded Cldanout 6-8" Diameter Lawn Sprinkler Valve Box Plug or Ball Valve Lateral Ends at Last Orifice Where Variable Length Cieanout Begins Long Sweep 90 or Two 45 Degree Bends Same EZFlow Media 1.26 Feet Diameter as Lateral ,-- Distribution Lateral Lateral Cieanout Project: BRUSHY MOUND PARTNERS Page 6 of 11 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shalt maintained in accordance with its' component manuals [EZFIow Mound Component manual WNW and SSWMP Publication 9.6 (01181)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pwnp tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 84nches In diameter shall be secured by an effective locki ng device to prevent accidental or unauthorized entry into a tank or component Septic Tank The septic tank shah be maintained by an individual certified to service septic tanks under s. 281.48, Stab. The contents of the septic tank shall be disposed of in accordance with NR 113. Wis. Adm. Code. The operating condition of the septic tank and outlet titer shah be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The fifer cartridge should not be removed unless provisions are made to retain solids In the tank that may slough off the truer when removed from its enclosure. If the fir is equipped with an alarm, the fitter shall be serviced if the alarm is activated continuously. Intermittent filter alomts may indkaste surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 113 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenanoe personnel shall advise the owner of when the next service need to be performed to maintain less than maximum scum and skudgs accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance In generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump ( dosing) tank shall be inspected at least once every 3 years. AN switches, alarms, and pumps shall be tested to verity proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. MW Pressure D WrIbudge No bees or shrubs should be planted on the mound. Plantings may be made around the mounds perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration- Traffic (other than for vegetative maintenance) on the mound is not recommended since sod compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote front penetration. Cold weather Installations (October - February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L 8013 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD 30 nV& TSS, 10 mg/L FOG, and 10 ctu/100 mL for highly treated effluent. influent flow may not exceed maximum design flow specified In the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and lt is recommended that each lateral be flushed of accumulated solids at lint once every 18 months. When a pressure test is performed A should be compared to the Initial tent when the system was installed to determine if orifice dogging has occurred and I orifice cleaning is required to maintain equal disintxution within the dispersal celL Observation pipes within the dispersal cell shall be checked for effluent ponding. Pondrng levels shad be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continuencv Pian N the septic tank or arty of its components become defective the tank or component shall be repaired or replaced to keep the system In proper operating condition. t the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be im mediatsly repaired or replaced with a component of the same or equal performance. ff the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced In its present location by increasing basal area If toe leakage occurs or by removing biology egged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 6 of this plan for the name and telephone number of your local POWTS regulator and service provide. Project: BRUSHY MOUND PARTNERS Page 7 of 11 I 1 N 4 t P- # P 'l .t { �• I 1 I, ! — _ I 1 . _ ' r P r 1 .r. !i / /# / /rii#iw 'N riii! /rlii,~•. ^� / ww /> �Nww#riiwrlr*��+�s�r7iriir �" "'°!� \wwwiiwrrril ■ / /rii / #iii wwOrwi=;Z"##wwr wl ■w /arwiriwir w wnrwritw�.:.i # #i�..,_.= . ^.j /rw //# qLL ► i. t dA:�# om i ! w r il � l � %��� #i�l��aA% a iw wl�iiir#iriiiiiiw / rwrr ^. iwwwlQ / /.ZRwww /� �iowi /r/ r ° �� wii►!�Iw /►f #Ni#��rr #wwi /www /r // _,. he`�rru:!� /,: ri�i / /iwa •M /w#wi #w!w • 1 r, _ w�iwi i +�lii�*�'iiiiwwl!!{Rwiwwrriwi#r d-- �lirilu'�www +�,wwi /rw►Yiiiiwi!##i 1 � ��i� �'.' � a- , '�r�ay+� , � , �riwi•- �rrrir /i irl► i �� w riwt►!�7!llNiwibz /iiiiri i#wY: /li ►iw /now �""" "'lr�► aYa #ww ►. L";!\wwwa�i /i►� /wwi#■ '.= 10woirq.�w iwt•�il�Z�IiirY:• # #� \wiriw ' , ... w •• `'�li"w► �iiliii�►7wwfriiltw #wwwii < . iw/ rw wis.._ �� lfYl.��i / #a'� +`fw�wwii�w ►! #wwi wi / !w /w1�w /Yr.' -`�w� iwii` /!t#iw#�►.lA iiw# ,e #wiiriiilii! #al�rrrwi /r #i wrw i rr wr #wiii#ffw / /lrii # /i�iww#liir + !r s _t Wisconsin Department of Industry SOIL AND SITE EVALUATIO AEEQRT Page of 3 Label and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, gal bode AU NTY Attach complete site plan on paper not less than 81/2 x 11 inches in siz plan must in��c�e, but ST -�-OlX not limited to vertical and horizontal reference point (8M), direction and A o� slope scale or R P L I.D. # G dimensioned, north arrow, and location and distance to nearest road. '� i � r ` '' — Q — / (13) APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION p ',;fie REVI DB DATE PROPERTY OWNER: PRO k4 ON 7 � CZL�S c fi`iVD ��IV `S S Cl� Li sew -6 e� S>�'tia s) {�T Zb ,N R lq E ( w PROPERTY OWNER':S MAILING ADDRESS • LOT 4" Bi.QCK A S . AME OR CSM # z S8 2tv 2S I DE �2LUE �Z t L J 1Mokj 5 � CITY, STATE ZIP CODE PHONE NUMBER []CITY []VILLAGE OrOWN ' NEAREST ROAD 1?.1QEEz Sq o ZZ hI S) q jaI61 � -( r- BvILD D�- �(] New Construction Use kj Residenti al / Number of bedrooms [ ] AdditiQn to existing building j) Replacement [ ] Public or commercial describe Code derived daily flow 6M gpd Recommended design loading rate _ bed, gpd/0 trench, gpd1ft Absorption area required S (Q bed, ft S 0'D trench, ft Ma)amum design loading rate s bed, gpd /ft trench, gpd1ft Recommended infiltration surface elevation(s) CI1'?). - 1 S ft (as referred to site plan benchmark) Additional design/ site considerations "UyN-A ti/ g'c 63 ' -p , r� I Aj Fr I. Parent material Less C�u)6Z 11 LLZ �T*P_ Flood plain elevation, if applicable N ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE U SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S ®U 0 S ❑ U ❑ S 91U '❑ S 0 ❑ S ®U I❑ S Q U SOIL DESCRIPTION REPORT Con Texture Boring # Horizon Depth Dominant Color I Mottles I ( Structure ( GPD /ft sistence Boundary Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerxh J 0- 9 10`1. IL 1L z s t) Z`F5 b � YvL`Fy- cS l� • s � 2 a -zB 1o"1f 2V 1. — sa Zvn m Fi- cS _ -s •b Ground .k( S elev. q 8.1 ft 9 \L3 -b`L S Ll 2 3 �3 � c 7 - 61 z L �'� Depth to limiting fac tor Remarks: Boring # , 13 0 -12 �o 'l rz 3)Z — Sf 1 z`�sb S'F' 2-45 l� -S 31 Ground elev. � t4 l _ l o`Z R- 6 l3 LS S 2 Depth to limiting factor Remarks: CST Name: — Please Print Phone: Arthur L. We erer 715- 425 -0165 ' egerer Soil Testing & Design Service -P.O. Box 74 River.Falls,WI 54022 Signature: Date: CST Number.. 00- 1D3 -8Z S -4 �-C� 220254 PROPERTY OWNER 8`L� SCtfUL-T-Z SOIL DESCRIPTION REPORT Page? of V3 PARCEL I.D• # ��y Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsetl qu. Sz. Cont. Color Conslstenoe Boundary Roots ,.. <� G . °I • � — � 1 O " I. R 3 / Z -- Bed Trerxh 3 - l Z Z b pvt cS 1 s b Z io ti rz a/6 - s1 I e - -s •b Ground 3 Z3 3y 1.SYR VA - L n elev. ,1 cXw • � .S �:$tt. y 2t4AS -1 •S`i 23 1 Y �.Sk2.3IZ sc) oti►-, `r Depth to I lZ 613 LSg� limiting _ NQ factor Remarks: Boring # Ground elev. It. Depth to -- limiting factor Remarks: Boring # Ground elev. It. Depth to limiting factor Remarks: 3oring # ♦.....n.':yijY ;round Aev. if. )eplh to imiting actor Remarks: _ •rl n•r •rnrn .,r ...• 4 PROPERTY OWNER B`t� SC SOIL DESCRIPTION REPORT Z 3 Page of PARCEL I.D, Boring # Horizon Depth Dominant Color Mottles Structure in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Botxrdary Roots GPO /ft Bed Trench =i 1 3/ Z g -23 lOtiIZ :lA s1I 3 m`f�• cw - .b Ground 3 Z3 3 y 1•SY2 elev. Le_sb� Yvl,`FV- •S `j IZ 3 /yr �' Z .S Lt fZ SI Depth to U3 `Ili 613 limiting I Kill' factor 1 �`t f I Remarks: Boring # r Ground elev. ft. Depth to — limiting factor I Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: 3oring # .round Aev. ft. )eplh to miling aclor Remarks: rl r=•= rr .ir . .. PLOT PLAN Pa -±> of 3 SCALE 1 X5- Z 1�t�16{{,�ILI D 1 PVC t{� 'J/3.6 "tttg'1 pvC h 1 L i Pt oT 12j -- \ \ L-La 6$ solo - TIt -1 i1 lc' vZ 25 , �.qa! B•1 3 �' 3l�`DlF1.PVC PIPS. W� c 1 7 5 J� EM > y 00 _l 03- Sz zzalsy S ' 9 (715 ) 475 —n1F,5 CST Signature Date Signed Telephone No. CST # - -�''�t 7-3 w I 9568- -SZ£ -E3ff8 9M - WP %1321 ` CD =-Iva VH M .� t ass 2�f- -QOQ/IX�LtdlAll m � U an #S Ta Jul a g a - Ac p~ U 4 w� d! gD w� w!� w86 r� 1 2.50 1 ACRES Os S.F. 1 co 33 33 .7 7 1 S.F. CULDESAC EASOWENT, SEE NOTE 4, 23440" (41a! a ; xr _ s '�` s s 4 r fo r L ! S { 1�� , k � L � { • '?hr I } l ( � y t . ,rr I ' } f 1 � . t Ri �� t yf A � 3���• ,. MN t l k 'k 4. r* j � �`� `""•'"�� � ' . �`� ` .... �- + r� f , , , �, , � � � �' �� ` ��c�r r. � [ SC�E.E N FEEF �.k t �4 1 .''""e t) 93 � .�'� ��,� ,y� ,'', $'�. + �• � 1 s � ?, tlq • I igSp.Ayg. � e ,� � � � roMtr f&1,aaD�O+nnEk�A0.�e1M':iW{. Q a, �i f '1jg4�4 j) Jl L,,,., R • r n�01 Pa PoVt< M:K7� W e N`1', f rim pa, s !il!HI'�`'E T L7.MftdI�17N=�f. d ...... 1K AR tM r ` .... -- s +r- + ' 4 " `;.... r...+. -�y e W /Pt �.L1��t[•wAI7l7' . IF "eu ,yaaor sm j t { i �'e \ Y., t k�r M...:�'.:.1+!!f9e�M W'4F I�f4YSitli YlpirAlm7• awe 84 " i � '3` �g w. ��� �' � E6S Mik ' �': i ' • � �'<' ' ��. # � � .r..- fi.9mttrMt�f' it �`! �� � ..'j. _ '�f � ;+nom ` � ' ,� �g� "., ,�•47 "• � � M � . ,..: �rrsF�oe. , a t � t1E'if1�.�' �JE1VA1f,EF'i� i ' �� •,. � ' x �` '� {� Ai6 t�S 7� =kl1 77 1 fit' �aa�L+r .yp ��..ia. ., 1ANilAI idle ' rriwr W j I y } � �� �f��.• ;r, } �°'��; t '� s a � fi r , � f i i� M l M � ir�` >� 4 '` � Via, ��s� ��* wa 142- I LL a 11 T I c i v ��� � � £ l , ���' �`r�, ��^� 1"�IW�YICI•�N4'�IF �� t � � y� rua7§ ✓.T'S� �...y v l ,�+� _,-{ •al } " l �"� � W a. FEB -20 -2006 11:07 FROM River Valley Abstract TO 17152464949 P.02 J 1 tZI J WALSH STATE BAR OF WISCONSIN FORM I - 1998 KATHLEEN O DEEDS RgeisrER of DEEDS WARRANTY DEED ST. CROIX Co., VI Document Number RECEIVED FOR RECORD This Deed, made between C. M. Bye, individually, and Dennis R. 01/09/2004 09:45AN and Sandra C. Schultz Revocable Trust, Dennis R. Schultz and Sandra C. Schultz, Trustees WARRANTY DEED EXEMPT * 17 Grantor, and Brushy Mound Partners, L -L.P., a Wisconsin limited REC FEEj 11.00 FEEz partnership COPYSFEE: CC FEE: PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin (The "Property "): Record Area Name and Return Address C . Lots 72, 82, 83, 84, 92, 93, 94, 96, 97, 98, 100, 101, 102 and 103, Glover M. Bye 2 Station 5th Addition, Town of Troy, St. Croix County, Wisconsin 258 Riverside Drive P.O. Box 767 River Falls, WI 54022 040- 1265 -10- 000,040- 1268 -00 -000 Parcel Identification Number (PI14 This is not homestead property. (is) (is not) This deed is given in satisfaction of that certain Land Contract between the parties dated June 5, 2002 and recorded in the office of the SL Croix County Register of Deeds on July 15, 2002 in Volume 1926 of Records, page 553 as Document No. 684104 Additional PIN numbers: 040 - 1268 -10- 000, 040-1268-20-000, 040 - 1266 -10 -000, 040- 1266 -20 -000, 040- 1266 -30 -000, 040- 1267 -10- 000,040- 1267 -20- 000,040- 1267 -30- 000,040- 1267 -50- 000,040- 1267 -60- 000,04 1267 - -000 040 - 1267- 90-000 Together with all appurtenant rights, title and interests. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except easements and restrictions of record and will warrant and defend the same. Dated this day of - J 1Q n!!t a �_� . . Dennis IL Schultz , r C. M. By 'S andra C. Schultz • AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. Signature(s) St. Croix County. r Personally came before me this e b." day o f authenticated this day of '\ ' the above named Dennis R. Schultz, Sandra C. Schultz and C-AL Bye i r,1 TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person ):%li'o. ex d If not the f' qin g ( ins meat and acknowledge the authorized by ¢ 706.06, Wis. Stnts.) w THIS INSTRUMENT WAS DRAFTED BY �i �+ G, �' —' C. M. Bye Attorney at Low Notary Public, State of Wisconsin ., . ........ ��, +� (Signatures may be authenticated or acknowledged: Both - are not My Commission i ��ent. (If ndt stela �isaiiop date: necessary.) .Nantes of persons signing in any capacity should be typed or printed below their signatures SrATZ BAR OF WISCONSIN wAR9tAMY DR" FDaM N.. 1 - 1999 INFORMATION PROF88S10NAt.S COMPANY FOND DU LAC. WI 900.655 -Mi TnTal P A7 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer tC - }+15,G S ELI, i.4S 6al-4 5 4 t..t.D P S Mailing Address p a 0?o u Property Address '� 14 etA LYE 1�ju t Lo( 'Rs �1 (Verification requ om Planning & Zoning Department for new construction.) City /State 5 U ! - 1 Iftic 1 Parcel Identification Number - LEGAL DESCRIPTION Property Location 5W /4 , 5 C '/4 , Sec. T - Z-gb N R L W, Town of Subdivision _ t�1 �V - S o to.-1 , Lot # ig� Certified Survey Map # , Volume , Page # Warranty Deed # C 7 lc , Volume , Page # Spec house yes no Lot lines identifiabl yes 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. i The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or ( 2 ) p pumping after ins inspection and (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. I/we am/are the owner(s) of the property describ above, by virtue of a warranty deed recorded in Register of Deeds Office. Number addro s 7/ tc? SIG A OF LIC T(S) DATE I ** *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_ismade in the warranty deed. (REV. 08105)