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HomeMy WebLinkAbout040-1266-80-000 Wisconsin Department of Conamer69 PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division e INSPECTION REPORT Sanitary Permit No: 463479 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 Roett er, Robert I Troy, Town of 040- 1266 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 16.28.19.1450 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS �I FS , ALE . v Septic L,�J / ) � � 7 Benchmark M t 5. , 77 165.7 J or.) i sing �b� 3 Alt. BM Bldg. S we O c � �ias� 11, 93 93, - ding SUHt Inlet �z, lay .` TANK SETBACK INFORMATIO St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ` Septic 1 / Dt Bottom 5 V / S MA41 �a Dosing ' / 5" / M Header / q5 /OS Aeration ✓hA�. Di P ipe Holding got, System / Z UDJ 9AIr 5— / 3 Mr 1 � PUMP /SIPHON INFORMATION ,, �; 1 �� 'nal Grade ,4= f NP Manufacturer v� ( tv?iin.0 GPM d St Cover e7Y 7(� 6 3r Mode[ Number N J t Or L ((p J ) 163, ' 7 ✓� TDH Lift fc Friction L s System Head TDH Ft Forcerrain ength I Dia. Z r( Dist. to Well SOIL ABSORPTION SYSTEM QL✓ SO ,Q� e1c. Q 1, 9 BED /TRENCH Width Length No. Of Tr the PIT DIMEN S No. Of Pits Inside Dia. Liquid Depth DIMENSIONS („ �t7f: SETBACK SYSTEM TO V (� P/L Ci BLDG W� / LAKE /STREAM L G Manufacturer: INFORMATION AMB R OR Type Of m: s UNI Model Number: DISTRIB ON SYSTEM A u J Header anifo Dis tribution 46 x Hole Si te x Hole Sp Vent to Air Inta a /0 cyl 7 /, 7 u Dia 2 L h � Dia �� ZS Z Nt7 GZ�O Length Length 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 ( Q�" Bed/Trench Edges Topsoil Yes ,l No ;1 Yes No 1MMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / C) In pection #2: 1 9 1 / �� .on: 328 Soo Line Road Hudson, WI 54016 (NW 1/4 SE 1/4 16 T28N R1 9W) Glover Station 5th Add Lot 89 P rcel No: 16.28.1 p..1�150 1 Description = �6�.x^� 2 { t IC�IE�,// C.hc� `w • �" �e'� 8 t� va_r lgn gth = �.0 - Aac91 to �} of cover = y / tired? Yes /No __ CC - lditional information. - Date Insepctors Sign ture Cert. No. V D eea artment Safety and auilwap Uivisiion _ C 201 W. W"W11gton Ave.,. P.O. Box 7162 M&"W Wl 33707 - 7162 Number (tu be tilted in by Co. # of Commerce (608? 266.3151 Sm*ary Perm* Application Soft LD. � in accord with Cw m 93.21. Wis. Adm. code, Peraoad Wrmwoa you P. e x 1 R 3 My be u"d for seeoudary pttrptM Pnvary D.aw, 515.04(!xm) refs (i different than mailing address) I. App � _ Prime " W � C� zoN� Pareei a t of >r Prrty Owoar's ltd t Lnptian ^ - , I \r/ Sratt '� )A'' Z COd !� % � �-A. Sectwn Type (cdeelt ) T u � � ( y /� j N; Ru E O W 1 car 2 Fiuu»iiy Dtvelliog - Number of Bedrooms Subdivision Name CSM Numtter _ PubliclCommercW - Describe Use S t Saul Owned - Describe Use LICity LIVIllage (Township of fi 2Q- Type of Ptraalt: tt { Quiff see boat oe Out A. CsfaPlete life 8 if ) ` A. N Systeat ❑ RePlacemrm System U TreannentiHokiing Tank Replacement only �.) Other Modification to Existing sy I ! R• Permit Renewal [] permit Itevisirm Change of 11 Permit Transfer to New List Previous Permit Number and Date issued Before Expkafioa Plumber Owner ( Chedc all chat aofiv) _ � � - -4 •� 11 Non - Pressurised la rA Mound > 24 in. of suitable soil ._ L) Maud < 24 in. of suuabie soil U At Grade l } s;r,gte pass sari Filter U C:ommicted Wedaid (.0 Pressurized la- Ground Holdia8 Tank r. U Prat Filter IJ Aerobic Treatment Unit LU Recirculating Sand Fitter i ❑ Rerarullatiog Sync t � Filter p chamber U Li»e Gravel -less Pipe ❑ otter (e! } V. _ Pphcmm Ra - Flow Wit) DOW Soli Ate( SPrlsf) Dis{iersr! Area Regetutt+d (if) Dispersal Area i'toposed (st) System Elevation VI.. Tank Info Capar try in Taal Number Gallons Gallons Manufacturer Prefab Site Stcet Fifrer Plastic New of Units blew Concrete Constructed Gies ! Tanks Ts� lfottlrg Tank �( Aerobic Tr aunra unit t P S l' r:s , �Y 0 /` Dumn Chamber — ~' l rh o► Plumber's N Y Stsateoae - I, the respotta(ay far of the POWTS shows an the attaefied plans. ( s S gnature nether Business Phone Number O u� �prS -T ^� 1'hi Kw 3 Andre as (Street. City. State. zip Code) �— ��•� -� � � / !� mil. Use Only . 0 Appt>,vpp 0 Dist proved Sanitary Permit Fee (includes Grouudwarer Date Issued Issuirtg Agent Signature (No Stamps) In] Owner Given Reason for Denial Fee) �- iLAMM iota of Appra akiteasofs for TBs+pproval _ _ _ SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. - - - - . . _ _ . Atraet t+••• p. m° Casty zeb) tar Fla ;err., ai paper,a ter r#.o a1R s It toabs is anie _ 7 ()/ 7 .. IT G 10 ..... j i Pit Qo AZI , ( ,,/ r tb A.41.eJ i c am; Ice 1 ! { {� ' r _.. t i ' Q! l : ' , YY ^Y s_... —_ e r i 1 r : 1 , 7 E k I } I i t , l t , f r , , t 1 I r r i I I l ' i r : I r 1. • t 4 � t ' 1 4 I r i - I t I , : : p ! t v, : ! : ! Safety and Buildings 4003 N KINNEY COULEE RD commercemi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 www.w www.coe.wi.gov/s sin.go / De artment of Commerce iscosin.gov P Jim Doyle, Governor Mary P. Burke, Secretary March 29, 2005 CUST ID No.220537 ATTN: POWTS 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. 1122313 SITE: Site ID No. 696314 Derrick Construction Co Inc Please refer to both identification numbers, Soo Line Road above, in all correspondence with the agency. Town of Troy St Croix County NW1 /4, SE1/4, S16, T28N, R19W Lot: 89, Subdivision: Glover Station 5th Addn. FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1010527 Maintenance required; 600 GPD Flow rate; 29 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. 145.20(2)(d), Wis. Stats. Coll ,c ' A, IF ,.o..n. 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 cony 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. 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 TITLE SHEET DATE: , PAGE OF� pp�, MOUND SYSTEM �i FOR A 4J BEDROOM RESIDENCE This plan has been prepared in accordance with the EZ .FLOW Mound Component Manual VERSION 2.0 (N- o6/03)and the p ressure Dj stn - bu � dual VERISION 2.0 SBD- 10706 -P. (N. 01/01) LOCATED IN THE h1y) /4 OF TI I SV 1 /4 OF SECTION I A R T W, TOWN OF T(�ol , ST. CROIX COUNTY W ISCONSIN . 9 00'e t` 1 At ©r\ Raid o L :Rp) — INDEX PAGE 1 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 PREPAR FOR //�� �'...�`• s�r..cc�� can 0-In � PQ BY 2205 POWERS EXCAVATING INC. 1969 185 AVE. NEW RICHMOND, WIS. 54017 PHONE: 715- 246 -5135 FAX: 715 - 246 -5135 - ' V CELL: 715- 381 -9920 _rARTMEN1 OF COMMERCE DIVISiAN SAF T ND BUILDINGS SEE CORK PONDENCE r Giok),e�- ;a4 'U" 41 i Iv 0?A , t L)- - SY'O r c rr� ter /,r�CSc� l gi�[> da" Z �4 Li `' ';1 t O el� Cam. i *S t ���. 1 (._$j►� y Svc �;�i / ao Cc uL.. 1 °. e Q, , l : ^ t , PR on b r , s' : 1 r , I�� I Page 3 Of Synthetic Cov ,.ring Distribution Pipe MTM- 03 Medium Sand 0 Topsoil - _ai D 3 E of x slap. Bed Of ( Force Main Plowed Layer D /a UN Cross Section Of A Mound System Using F , 7� The Absorption Area G �_ „ . No E; 20 Er_ t2.03Hott H? 8v,jbLEs �RnPvsEC A Ft. H ."� e'. r a t c3 t7 ] t' . g Ft . ;a K qr Ft. L _j 4R. J _�Lj Ft. Position i /d,s Ft. of w Ft. Force Main Observation Pipe s K a y w cep O f lo Distributior} .:- Pipe l Observation Pipe Clnc�+a se c•a r�t� Plan View Of Mound Using A Bed For The Absorption Area a \x . • .age _ � ` l �l D p a puut 13 It Lbu L t'lp�' . 1�Q � r t x,11. -.3 t ilt, t i.1 � 1 t,Y e pis rpe and e ve .� t.r, 'J)n ttie botto' o t pi�)e. � the and Of CWh IMOMW YAP w� tW UK Of '#=& ttt[zt at 4S d Pow cf dw ftm1 VmdL Tm==* ds � tef ** l— "Ob a value fan or ��►l� aet� 1'�oaD 1�1 ��' � fbC �► ��� � Q 1� �- r `rt�C$zS 'Law" �v:, R L liRa�le iat�M I V R �CtTri g4X M++Y11 .S OAST o1e f � �� FRA-d 4m,, o f emu. For AL l. ATI�-R4 LS . P � Ft Hole Diameter f $ Incn s it. Lateral 1 Inches ) x Manifold tnches Forte Main Inches t of holes /Piiw -9-5 Invert Elevation of Latera Ze Ft. 4" Cl VENT PIPE 12" MIN. ABOVE GRADE WEATHER PROOF 25' FROM.DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR IfTAKE WITH CONDUIT MANHOLE COVER W/ PADLOCK E y WARNING LABEL ---- ---� -- -4t' MIN. NLET + ; 1' WATER TIGHT SEALS GAS. a TIGHT + [ 7AA SEAL + PROVED ,I PIPE --�-- ; ' ALM INTS W/ GI 3' ONTO B i PE 3' ONTO SOLID � + , ON SOLID SOIL Q C + SOIL PUMP OFF ELEV . 77 FT. •- - --- ►-' OfF 't RISER EXIT D PERMITTED ONLY IF, TANK MANUFACTURER HAS APPROVAL 3 APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATION SEPTIC / DOSE LL TANK MANUFACTURER: ��?.�S �1 NUMBER DOSES PER DAY: �! TANK SIZES SEPTIC o0 GAL. DOSE VOLUME INCLUDING DOSE GAL. FLOWBACK: GAL. ALARM MANUFACTURER: 2 CAPACI "IES: A = /9%5INCHES = _ / 7 GAL. MODEL NUMBER: , —� t� O SWITCH TYPE: a`(� - B = 2 _ INCHES = GAL. PUMP MANUFACTURER: �� . � C = (�stJ INCHES = /c�+Urr GAL. MODEL NUMBER: o j 1, SWITCH TYPE: b �-- D = p� INCHES = �f GAL. REQUIRED DISCHARGE RATE GPM PUMP & ALARM WIRING AS PER ILHR / . 23 WA( VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE PEET + MINIMUM NETWORK SUPPLY PRESSURE . . . ... . . . . 5 FEET + 10 FEET FORCEMAIN X 3 FT /100 FT. FRICTION FACTOR r FEET 3 -�L /20. TOTAL DYNAMIC HEAD 1 c� FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER LIQUID DEPTH J v . P4WT � S O'WNER'S MANUAL & MANAGEMENT PLAN paw 142 2 of 1TlON sYSTf�M 0", t to Tan* Maecufactunerv?_ �s d NA r d P # c� ❑ vat. ov eel Tank Mane > �zS? ` (b m a O NA Ign w /_f ►APANEI llS vol. gal Number of Bedroom 0 NA 0 S ©Heieietf) of Pubic FaciyitY � 0 NA Effluent F� Ma ror y P Lo L7 NA Each t flow J-S)j FOW Model — S Design 1peaic) flow _ ! +� Nasp f+da s� t DNA Sal Appon Rate hump Model Standard Irtfluent� Quanfit trvsraif�y O NA Filter Fats, Oil & Gre gri. O i 0 Post &ocinsnrnical OxYgsn Decrns englL 0 NA 0 AAadwdcal Aer+�n► O Watbnd Total SusparMied So mSti. D Oisintactiexs D Other. Pretreated Effluent Oa alty MoMNY nsverape Manufacturer ) 0 NA Biochemical Ox"an Demand (800 !930 mg Di O)n- Qround +td) Total 9uepandsd Solids nTs% sap "%a& 0 NA ;�; ) Fecal Coiform !� nnetn) 51fl chdloor"i O NA D OtMe►: Maximum Eff bent Particle Size Ys 0 NA O NA •Values tWosi far donnnsstic war end � etfkm*t• t7 NA MAitLftENAlMtS; fissdoe Rt own ov Salo event MeWipwim 9 Yews) O NA inspect condition of tanks) At least once evwV- When combined sludge and saran equab one -third (V 01 10 voluma 0 NA Pump out contents of tanks) when the fn ah vraw ahem N'� 3 Years) ❑ NA Inspec 0900) At lsest once every: ) ❑ NA Ciaan effluent fifter At best once event: a) O NA )repent pump, pump controls &alarm At )east Drina every. ) _ El NA Flush laterals and prossure test At bsst once every: d mronxthlsl DNA At West taI evwY- Q ?' 0 NA MAtNTENA"CE NiSti' IXTIOM pig of the foNc►wrng licenaess w sbficatiansc inspections of tanks an d caspersai calla shalt be made by an widwidual ca"Yb6 Sergi pp� !pumper). Master Plumber: Maaw Plumber Restricted Sewer, POWTS inspector, POD Maintannar: S°Pt�° an y crocks w of the Mctal to identNY army mis&V or broken hardware, identify Tank ink must bnckide s vbcsst i� m WW scum and a dock for eery back UP of po ndkV of effluent on the ground leaks, measure the vokane of combined sludge ud c to deck for anY surface. The dispersal c"W shall be vieue" � to check the effluent levels in a � condition and pondng of effluent on the graund surface. The P of etfhsesnt an the Wound rogc#es the knmedtata notification of the local rengub wY authowhy- When the corttbned accumulation of sludge and scum in any treatment tank equals One-third (y3) or more a! the tank volume, the entire contents of Ow tank shall be removed by a SwvttbV f and disposed of in accordance rrtttn chapter NR 113 Wisconsin Admirdstrative Code. pressurize components, pretrsatmen AN other services, i b9 but not limited to the asry crop of effluent fU a certifiwl POWTS Mme. madnarucai un its, and any servicing at intervals of 512 months, sly be performed t►Y a to the local a thaft within 10 of completion of anY service event- A service report SW be provided <3MW (2 /01 - I START UP AID OpERgTbN Page of For now construction. prior to use of the POWTS chemicals that may knPede the treatment c h eck treatment tank(s) for the Presence of painting Products. solvents or other have the of the tankts! removed by � Astor Prior . eels). if high concentrati are detected System start up shag not occur when sod cOndftWG we frozen at the infiltrative surface. During extended power outages PUMP tanks may fill above normal WW wastewater will be dWdmwgW to the dispersal cefts, in one large does water When power le restored the excess discharge of effluent. To avoid this sittattion here the corrtaras of the pump tank removed them { in the backup or or pu ce ng power to the um effluent pp or tact a Plumber or POWTS Mah er to mist Op�'at prior to O controls to restore normal levels within the pump tank. Y the pwnp Do not dries or Park vehicles over tanks and dispersal calls. Do not drive or whin 15 feet down slope of any mound or at -grade soil absorption aroa. Pak over. a oriorvrisu disturb or compact, the area Reduction or elimination of the following from the wastewater atraett ma POWTS: aattibiotics, bale Y improve the Pe+forrrertce and Y wipes; cigarette butts; Prolong the 0% of the foundation drain ( �: ttTttem swabs; degreasers: dental foss; di Puny) discharge; fn* and %Vgetabb peeWW- pssoli "; 9 e: herbicides: meat �a disinfectants; fall; Painting Products; pesticides; sanitary ; tom; and water softener brim. sue+ medications; oil; ABANDOIIf RENT When the POWTS falls and/or is permanently taken out of service the follo Properly and safely abandoned le compliance with �p uw Comm 83.33. shag be taken to insure that the system is a AudkrrriNetrativar Code: Ali to tanks P and puts shall be disconnected and the abandoned pipe openings sealed. e The cOrvtwft of all tanks and pits shag be removed and property disposed of by a Septage Servicing Operator. • After Pumping. ON tanks and pits shag be excavated and removed or thek covers removed and the void space filled with soil, gravel or another invert solid material. COMTNVGEMCY PLAN If the POWTS falls and cannot be named the fogowIng measures have been. or must be taken. to provide a code compliant ntphwernent systern: �tt7 A suitable raphwAwnent area has been evaluated and may be utilized for the location of a (/ system. The replacement area dmxdd be protected from disturbance and compaction and should not replacement be mad upon by sod absorptio upon by required setbacks from exfsft and Proposed structure. lot fines and weft. Feguue to protect the replacemant area win result In the used for a new soy OW alto evaluation to establish a suitable replac area. Replacsnrent systems must cormply with the nudes in effect at that time. ❑ A suitable repiacerrrent area Is not available due to setback arxUbr " limitations. fogy a holding tank may be Installed as a last resort to replace the failed POWTS. advances in PCIWTS ❑ The site has not been evaluated to identify a trh suitable replscsrrursutt ware. farilure evaluation must be Performed m locate a suitable � of the POWTS a soil and site rarPtacetteatt arena. !f no replacement area is available a holding tank may be installed as a l est resort to replace the failed POWTS. ❑ Mound and st -grade soil absorption syst may be reconstructed in place following removal of true bicxnat at the infiltrative surface. Reconstructiorm of such systems must eanply with the rules le effect at #let time. < <WAFAW W' i* > S8gX- PUMP AND OTHER TREATMENT TANKS MAY CONTAW UnVIAL GASSES ANWOR iNSt�gliT OXYGEN. DO NOT A SEPTIC. KW On OTHER TREATIY/T TANK UIIR ANY TAl110E�S. DEATH MAY RESULT. RESCUE OF A FERN FROM THE INTERIOR OF A TANK MAY BE DIFffCULT OR WOS=ILE. UXXT OlUAAL COMMENTS i "M UNTAUER POWTS MAg fIrA1NER Name ' Name Phone I t S j j SS Phone El'iAGE SERVICWG OPERATOR {PUMPER) LOCAL REGtLATORY AUTHORITY Name 'hone Name Phone t s � cr es document was drafted by the staffs of the Graaa t aka. Corrxrr 83 . 22 f2)tb1(t)(d1 &!f1 and 83.54111. 12) 8 (3). Wisconsin Adr k*&ative Y Zot�eq and a9e�cies ice �^` Coda. 1 • { { a. 1 , ti { • u a 4 Auk to •r s 1 7lia.i irr rrilriaiiiaiiiiii 5 ia+R+ �� +a ` il iliririr /iiiiriili� is ri ii it li rr ii mm-m a,.lfA irir `'i•Nrraril ones ll ■ i!a! t: o l Un a!!a!!!l sr!! a!r! rara•:�iilrlalal, ■ ■!!r..c' _� %����il�L' liiiliarii! 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' � ' -• kF tff % ti. fit p p . .-► a '.! =: _� io w r- p r o m CO .tb. °D m CD c Wisconsin Department of Industry, SOIL AND SITE E V A L U AT I OA-•R E PQR T Page I of _ Labor and Human Relations _ . DiviGion of Safety & BUlc5ngs , in accord with ILHR 83.05 Adirr.toide'` r S`T C,�ZQ 1 Attach complete site plan on paper not less than 81/2 x 11 inches in siz� Play must i6Q 4i; ? not limited to vertical and horizontal reference point (BM), direction and A/o of- slope, scale or " PAR LLD. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMAY110N at f �` " DBY DATE PROPERTY OWNER: PROPE�'1W94_A� e L� $ E. f� 1JI`1 \S 3 C �iU C Z X69 -E6T IJW 1/4 4 S I pT ,N R l g E( W PROPERTY OWNER':S MAILING ADDRESS• L B C{K# NAME OR CSM # Z S� 1ZI l� !DE T�CLiuE g �: G CSM# >u S _r CITY, STATE ZIP CODE PHONE NUMBER EICTTY []VILLAGE MOWN ' NEAREST ROAD 1�4�J��(L CIJ-S w1 Sg0lZ(IIS) �1ZS 8161 `-f �o UKt!: pq New Construction Use Residential / Number of bedrooms y [ [ AdditiQn to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow G60 gpd Recommended design loading rate 1 4 bed, gpd/ft ` trench, gpd/ft Absorption area required Soy bed, ft Soo trench, ft Maximum design loading rate - S bed, gpd/ft � trench, gpd/ft Recommended infiltration surface elevation(s) LO 4- S It (as referred to site plan benchmark) Additional design / site considerations 1" 1DUN-n� Vj/ t' x 63 ' t3 e�> , &I I iv . 1 Z. `` o F S1t'► f= c � Parent material L u t�5S 9VZZ Flood plain elevation, if applicable N A ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TAM( U = Unsuitable fors stem 11 S OU 'I S El U ❑ S ®U I I] S RU [I S IRU I ❑ S ICU SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Motties Texture Structure Consistence Boundary `Roots BPD /ft w r in. Munsell I Ctu. Sz. Cont Color ( Gr. Sz. Sh. I rem t; 1 a -1 1p` -tIZ 3IZ 1 si 1 Z'�'sb 7vt�r �s t� •s .b Z -� z u �c rz 3! 6 s i ( Z'Fsbk m fti �s • S .b Ground 3 Zc� csb Z- -3 elev. y ft y' 9 3S LOklZ.6f3 _ ZSQ R — J`►P =>..ip Depth to limiting factor Z�1 s Remarks: Boring # � - 10''l R 31 Z . S i I Z'FS 1, l In.`�1- �S t�' • S =.� Z Z 9 - 10'-! fz 3/6 — s i I Z b>z yn -F� '25 • S .6 Ground 3 Z.9 3� 7 •S`t2 3L — SicJ l�sbl� m'Fc- es � - Z .3 elev. 1 04.7 ft Depth to limiting factor Remarks: 7 Name: — Please Print Phone: Arthur L. We erer 715 - 425 -0165 ress: egerer Soil Testing & Design Service — P.O. Box 74 River Yalls,WI.54022 . Signature: OO` (� & 9 Date: CST Number:. 220254 t PROPERTY OWNER SV- Huu'rZ SOIL DESCRIPTION REPORT Page L of 3 PARCEL I.D. Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botx>da� GPD /ft �,.v in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. y Roots Bed Trertch r :i 3•.2„ ) 0 -1) 16 `Z 1Z 3 - 11 1 3 vZ Ground 3 Zy - 31 I(Y-1 P- 3 ,16 - S11 Zvn sbk h `�� e s • S •� elev. Ott. 3► -L/ 31y l 1eSb� mkt es •z - Depth to LD 1 C `1 tz 61.3 - LSi3R - � tip - fact Remarks: Boring # Ground elev. ft. Depth to -- limiting (actor Remarks: Boring # Ground elev. It. Depth to limiting factor Remarks: 3oring # around Aev. it. . )eplh to imiting actor ti Remarks: _ •h n'rhnrn •.� + .• PLOT PLAN I Pa 3 of 3 2 F�►`1 ,- ETti .l��.Z -� 0?v 3 I� Y D�R . Pv C PIM W / 3/� Y PUS Wl bt�2 iwe a i i � ,/ Do Yvu eow�p{�U orc M2�m- a , CDUtn�, �1..1n�•S "' '��`�, �_ �- .lt�•O ay. q��� , 3Jy�D1A OoYNM.t OF I �...�ov.s Qvc ��iaE w /3•�`�n Pve ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer /��� � , • �Tfica ��'�- Mailing Address d ` t ° � 4►2 t ��r L.4�Ic - 3t1 �! SS i L g Property Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number d 4/fl _ / Z �° is " S Q O j 0 LEGAL DESCRIPTION r Property Location NuJ %4, ' /4, Sec. b , T Z B' N -R ! 9 W, Town of 7z o Subdivision (9 1 - 0Vt2t 3TA-t7(3& f Lot # Certified Survey Map # Volume , Page # Warranty Deed # ° Volume �� `� . Page # Spec house ❑ yes o Lot lines identifiablexes ❑ 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 pllintber, 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 that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of ee year ex iration SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prop described above, by vi of a rranty deed recorded in Register of Deeds Office. /� 0 A SIGNATURE OF APPLICANT 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 (A 279 6 P 200 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO.. MI THIS DEED made between Brushy Mound Partners, LLP, a RECEIVED FOR RECORD Wisconsin Limited Liability Partnership ( "Grantor ") and Robert J. Roettger and Julie R. Roettger, husband and wife, as survivorship 05/04/2085 10:38AN marital property, ( "Grantee "), WITNESSETH, that the said Grantor, for valuable consideration WARRANTY DEED conveys to Grantee the following described real estate in St. Croix EXERT # County, State of Wisconsin: REC FEE: 11.1 TRANS FEE: 323.70 Recording Area COPY FEE: Lot Eighty -nine (89), Plat of Glover Station Fifth Addition in the Name and Return C. Township of Troy, St. Croix County, Wisconsin ES: • 1 Brushy Mound Partners PO Box 445 New Richmond, WI 54017 040- 1266- 80-000 (Parcel Identification Number) This iILM homestead property. Grantor, Brushy Mound Partners, LLP, a Wisconsin Limited Liability Partnership, is an affiliate of Derrick Homes, LLC, a Wisconsin Limited Liability Corporation. Grantor develops land and Derrick Homes, LLC is a home construction contractor. Grantor agrees to sell this lot to Grantee on the condition that Derrick Homes, LLC will be the builder of the home for Grantee. If Grantee does not commence construction With Derrick Homes, LLC as the contractor/builder within two (2) years of the date of sale of this lot to Grantee, Grantee gives Grantor the irrevocable right to re- purchase the lot for the same price as Grantee paid Grantor for it When Grantee bought it from Grantor. If Grantee desires to sell the lot to another purchaser before constructing a home upon this lot, Grantee gives Grantor the right of first refusal to re- purchase the lot for the same price as Grantee paid Grantor for it when Grantee bought it from Grantor. Dated this 3W day of heal-, 200. L o L. De ock r I R. t ens AUTHENTICATION ACKNOWLEDG NT Signature(s) STATE OF WISCONSIN ST. CROIX COUNTY Personally came before me this = day of Ma, 200, the authenticated this _ day of , 20_ above named Michael R. Stevens and Ronald L. Derrick, as partners of Brushy Mound Partners, LLP, a Wisconsin Y - mlitezl Liability Part to me known to be the persons signature who exec ed the going i trument and acknowledge the type or print name same. TITLE: MEMBER STATE BAR OF WISCONSIN signature E J. RUTLEDGE (If not, authorized by ' 706.06, Wis. Stats.) type or print name P try Pubk Notary Public St. Croix County, Wisconsin. Ste% THIS INSTRUMENT WAS DRAFTED BY My Commission Expires: July 27th 2%&. Brushy Mound Partners *Names of persons signing in any capacity should be typed or PO BOX 445 printed below their signatures. New Richmond, WI 54017 Trial And Road Map For Glover Station o � .. ................ r 9 8 7 6 5 4 i0 3 ROAD 2 19 24 21 2 23 1 12 24 r 25 13 IB 17 31 26 16 27 26 29 32 14 i5 3 44 5 43 41 39 3a 37 36 33 34 42 44 471b r R 48 50 59 52 53 55 45 o 46 b 54 so 49 60 1 M 70 62 61 91 66 71 63 90 64 69 72 65 87 74 73 SO 93 SCALE IN FEE 79 eo 75 85 94 95. 0 no 400 aw 64 76 77 LL� E.._ 8 / 83 96 97 g6 101ru10" 2W 82 am 3ilr0 CO. zo y �113SR. IIMr fig JfMOyOrB 141 1W 9s �►w (715 415 -7431 1 ACP 103 102 Et 1.. t... tar iE). C.W. WM rto OIANE L. DW 1 OMS R. SUH&TZ AM swaa C. 90 U TZ DATE; 5 -3000 P.O. BQL 1!T 711 15 1/2 AVOW •rvEa Fk�s. eoa+sm s+o ca48MJM. W1 IN sus 99 - 2380 I � 2.301 A \ q►' 106,944 + 90 \ / , / ,��0 r •'' + + 2.514 ACRES r 1 S.F 09.523 S.F � Oil 4> .0e JV ! 89 2.655 ACRES ` . , 115 S.F. t p `. 'ao • ; �. +` ? 2.502 A CRES 88 + 148.979 S.F. + ° `'�'• 2.506 ACRES 40 + 109.182 S.F.�,,. ~ Fm �, � __ �, •, � 1x.12' � �` .. r c�: $ _ , . _ 0 I 37 4 yo` 2 2 ©.50' 155 _ �- x 222 1' N bg.10► ' .. w 93 � ° ' ` 156' 2.510 ACRES r- 3 , E$ 109,341 S.F. N C1' NORTH t.W OF THE ; SW 1/4 OF THE SE 1/4 �;�' 10# d" W N 8 8"10',36" W 524.15' h ' � Ir 7 0, 100.03' 1 .00' - 150.00' — 04 ao 94 5 1: 2.515 ACRES it I g 109.547 S.F. c --: 4.379 ACRES .r as p 190,737 S.F. N 26 44" E 50.45 1.94 "bw ► 1 200.00' 149 1' 7 , N 88 0' 6" W 5Z et 2.30 f15' o +L N 88.10' 36" W 501.50'