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040-1267-10-000
V°consi,>�epartment of Commerce County. Ss ty and 3uilding Division PRIVATE SEWAGE SYSTEM St. Croix INSPECTION REPORT Sanitary Permit No: 506163 GENE INFORMATION (ATTACH TO PERMIT) State Plan ID No: Persona. i,iformation 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 - 1267 -10 -000 CST BM Elev: Insp. BM Elev: escription: Section/Town /Range /Map NoZZ lt6 BM D 16. 19.1453 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER t,,rr� CAPACITY STATION BS HI FS ELEV. t Septic ; f Benchmark j 11,6,1 / M Alt. B M �', Aeration Bldg. Sewer Holding St/Ht Inlet ,/• b Cl �+ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Ole Septic . 5a, Dt Bottom Dosing Header /Man. ' Aeration Dist. Pipe Holding Bot. System 14 . S 9� 6tc /aQ e PUMP /SIPHON INFORMATION Final Grade jb. 5 Manufacturer Demand St Cover i • ` /a�f GPM , Model Number TDH Lift Fncfion Loss System Head o TDH ` Ft Forcemain Length Dia._ _ Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width 11-ength I No. Of Tren PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth f ` _ , * _ 1_ -- DIMENSIONS 3 ( , S ' l 1"" -•.. SETBACK SYSTEM TO T P/L JBLDG WELL LAKE /STREAM LEACHING Manufacture ; I 1 INFORMATION CHAMBER OR -1- W7 Type Of System / UNIT Model Number 7Z5 : 0 t / t `�( L i DISTRIBUTION SYSTEM i k '75 Header /Manifold li IDistribution x Hole Size x Hole Spacing ] Vent to Ai Intake Pipe(s) ` 1" �,,� 1 1-ength 3 b Dia Length_ Dia Spaci �a+ 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/10 Bed /Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2:_/ / Location: 322 Soo Line R d udson, WI 54016 (NE 4 PE 1/4 16 T29N R19W) Glover Station 5th Add Lot 92 Parcel No: 16.29.19.1453 1.) Alt BM Description / f 2.) Bldg sewer length = {� - amount of cover = 7 �$ 1 Plan revision Required? Yes No ifs/ Use other side for additional information. 1 6? - -- - — — — - - Date Insepctor's ignatu Cert . No SBD -6710 (R.3/97) cammerce.Wi. oV - T Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 s c o n s i n Madison, W i 53707-7t62 Sanitary Permit ( N (to ln: hued in by Co.) t3epartment at Commerce ; —`� -- V� Sta nansacuo -- Number re i Sanitary Permit Application In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriwa4wwerrinxiital unit is required prior to obtaining a sanitary permit. Note: Application amts r s own WTS are Project Address (if different than mailing address submitted to the Department of Commerce. Personal information y vi or secondary purposes in accordance wi the Privacy Law, s 13.04 I )(m Slats. r// 3 Z�Z - 1. Applica Informa - Please Print All Info 'o Ptope,ty Owner's Name !- Parcel A -u s�� CEIVED LI Property Owner's airing Address Property Location / 53)i k_y L 2007 Govt. Lot Zo ity� Zip Code Phone Number 1 Ste_ V, ,dY l (/ 1 /., Section ST. CROIX COUNTY (circle one) T N; R Lq E ot(�,y' C 11. Type of Building (check all that apply) �� p� Subdivision Name or 2 Famil t)u' y eiling - Nurn3. of Bedrooms � _ _ / Block ❑ Public /Commercial Describe Use ❑ City of ❑ State Owned - Ocscrilx Use _ _ P CSIv( Number ❑ Village of 5 � _ I, 15 �t.,,�.� j Town of � �,�- - 4- '�� Ge lS W 111, Type of Permit: (Check y on e box on line A. Comple tine B if applicable) Sm p y g p y (� Re S r� [reatmentaioldin [ank Replacement On Other Modification to Existing System (ex.plain) yste List Previous Permit Number to 76 6: B. Cl Pei Renewal Permit Revision ❑ Change of Plumber ❑Permit Transfer to New 5 Z 7 Before Expiration - Owner / I IV. Type of POW'TS System /Contponent/Dev Chec all that aI►lrl) a _ _ }V �t•Pressuriud In- G round ❑ Pressurized In- Ground ❑ radc ❑ Mound >_ 24 in. ofsuitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain} + ❑ � .. � Pretreatment Device (explain)__ V. Dis ersal/T'reatment Ar Informa u,' c ILJ� _ ' Design Flow (& Design So'I Application Rate(gpdsf) rsal Area Required (sd) tspe�sal Area Proposed / (st) 5ys / Etevativn V1. Tank Info Capacity in Total M of Manufacturer Gallons Gallons Units New'[anks 6xistingTanks U. Septic or Holding Tank I �;r�/�' e y Dosing (:Itantber I _— _ Vll. Responsibility Statement- 1, the undersigned, assume resp onsibility for iustallatlon of the P OWTS o an the a ttached plans. - Plumber's Name (Print) Plumber's Signature ti /MPRS Business Phone Number i { .. ' ra177' y� 7 �• 3l'�f Plumber's Address (Street, City, State, Zip Code) ' � � � G° �` i����`�G�� L..( �'�Y -' �� ✓J f� ice.= ... D- `__� ---� V111 Coun /De artment Use Only - Approved =�D.s-aAv Permit Fee �ate sued Issuing etx Signature - n Reaso De nial s ' °o 7 �p �-7 -� IX. CondiTeasons for Disapi.roval ` J , `n�e ° 3� e p 1. Septic tank,. effluent filter and dispersal cell must all be se mod" / ma t J 4 '� �-�— as per management plan provided by PkIM er. f 4� 2 AN sdtback MQuiremeftts must be mgntairwl 14 tint o comp ete plaits 0c t,re systan 2nd submit ttre County only on paper not less than a in s I I inches in size ` A- Go tiii) �� �_ 5�5� SBD -6398 R. 01 /07)Valid thru 01/09 � Mo L) J s' � P C L -5A /Y1du,a D� �d r7`v� y �� 6 Ad 14 � /D-S .��s� z -Al oU w it v� - - 3 !� r -e-* Q � e a► y �Q 71— D,;;;' r L Q � Ile �/,,�'� �✓ fB Y 1 �ti �. 2075 artment f Commerce SOIL EVALUATION REPORT P age 1 of 4 r yi of S ll afety y and B ' dings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations �( � A��gqcaccomplete site n on paper not less than 8'% x 11 inches in size. Plan must County St. Croix ir�cTude, b t :vertical and horizontal reference point (BM), direction and MP percept scale or msions, north arrow, and location and distance to nearest road. Parcel I.D. G�d�X Please not all information. 040 1267 - 10 - 000 SA P Revie By Date al information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). S Z 5 b roperty Owner Property Location Brushy Mound Partners, L.L.C. Govt. Lot SE 1/4 NE /4 S 16 T 28 N R 19 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# P.O. Box 405 92 1 1 Glover Station 5Th Addition City State Zip Code Phone Number J City J Village 0 Town Nearest Road New Richmond I WI 1 540171 Troy 1 322 Soo Line Road New Construction Use: 16 Residential / Number of bedrooms 5 Code derived design flow rate 750 GPD J Replacement J Public or commercial - Describe: Parent material Glacial Outwash Flood plain elevation, if applicable na General comments and recommendations: Soil suitable for conventional dispersal cell a(0.5 gpd oading r ate. Site is to be subcut to elev. = 100.50 to accomodate system installation at elev. = 96. Boring # J Boring e Pit Ground Surface elev. 103.66 ft. Depth to limiting factor >147" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 10yr3/3 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 8 -20 10yr4/6 none sil 2fsbk mfr gs 2fmc 0.6 0.8 3 20 -61 10yr4/4 none sil 2msbk mfr cw 2fm 0.6 0.8 4 61 -96 7.5yr4/6 none gr Ifs 0 sg dl aw if 0.5 1.0 5 96 -147 10yr5/6 none s & gr 0 sg dl - - 0.7 1.0 sl 0 0 Boring # I Boring e Pit Ground Surface elev. 105.80 ft. Depth to limiting factor > 159" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 1 0 -9 10yr3/3 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 9 -22 10yr4/6 none sl 2fsbk mfr gs 2fmc 0.6 1.0 3 22 -38 10yr4/4 none sl 1 msbk mfr cw 2fm 0.4 0.6 4 38 -80 7.5yr4/4 none f fsl lcsbk mfr gw if 0.2 0.6 5 80 -102 10yr5/4 none Ifs/s 0 sg dl aw - 0.5 1.0 6 102 -159 10yr5/6 none S s & gr 0 sg dl - - 0.7 1.6 H #5 is a stratified mix of 10yr5 /4 s & 10yr4l4 ing rate reduced to reflect reduced permiability of horizon associated with textural changes within the horizon. * Effluent #1 = BOD? 30 < 220 mg /L a TSS >30 < 40 mg/L * Effluent #2 = BOD S30 mg/L and TSS < 30 mg /L CST Name (Please Print) Signatur . CST Number James K. Thoml 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceol , 154020 5/3/2007 715 - 248 -7767 Property Owner Brushy Mound Partners, L.L.C. Parcel ID # 040- 1267 -10 -000 Page 2 of 4 F 3 - ] Boring # --I Boring W1 pit Ground Surface elev. 107.25 ft. Depth to limiting factor > 174" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3/3 none sil 2fsbk mvfr cs 2fmc 0.6 0.8 2 8 -33 10yr4 /6 none sil 2fsbk mfr gw 2fmc 0.6 0.8 3 33 -53 10yr4/4 none sil 2msbk mfr cw 2fm 0.6 0.8 4 53 -122 7.5yr4/6 none Ifs 0 sg dl aw if 0.5 1.0 r 5 122 -174 10yr5/6 none s & gr 0 sg dl - - 0.7 1.0 I � y , Soil evaluation pit excavated to 1M". Ad ditional depth of evaluatio com ple t ed with hand auger. 4] Boring # Boring 1++' Pit Ground Surface elev. 105.68 ft. Depth to limiting factor >156" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Ef1#2 1 0 -9 10yr3/3 none sil 2fsbk mvfr as 2fmc 0.6 0.8 2 9 -29 10yr4/6 none sil 2fsbk mfr cw 2fmc 0.6 0.8 3 29-42 10yr4/4 none sil 2msbk mfr cw 2fm 0.6 0.8 4 42 -82 7.5yr4/6 none fsl 1csbk dsh cw 1f 0.4 0.7 5 82 -126 10yr5 /6 none Ifs 0 sg dl gw - 0.5 1.0 6 126 -156 10yr6/4 none s rt 0 sg dl - - 0.7 1.6 Boring # Boring V1 Pit Ground Surface elev. 98.07 ft. Depth to limiting factor > 106" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -8 10yr3/3 none sil 2fsbk mvfr as 2fmc 0.6 0.8 2 8 -24 10yr4/6 none sil 2fsbk mfr cw 2fmc 0.6 0.8 3 24 -56 10yr4/4 none fsl 1 msbk mfr cw 2fm 0.2 0.6 4 56 -80 7.5yr4/6 none lvfs 0 sg dsh cw if 0.4 0.6 5 80 -106 10yr5/6 none Ifs 0 sg dl - - 0.5 1.0 * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg/L and TSS <_30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) A.C.E. Soil & Site Evaluations Property Owner Brushy Mound Partners, L.L.C. Parcel ID # 040 - 1267 -10 -000 Page 3 of 4 6' ] F Boring # Boring el Pit Ground Surface elev. 99.88 ft. Depth to limiting factor >117" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -9 10yr3/3 none sil 2fsbk mvfr CS 2fmc 0.6 0.8 2 9 -28 10yr4/6 none sl 2fsbk mfr gs 2fmc 0.6 1.0 3 28 -58 10yr4/4 none sl 1 msbk mfr cw 2fm 0.4 0.6 4 58 -117 10yr4/4 none fsl 1csbk mfr - 1f 0.2 0.6 H#4 is a stratified mix of 0 sg 10yr5/4 gr Is, 0 sg 10yr4/4 gr Ifs & Om 10yr4/4 gr fsl. Loading rate reduced to reflect reduced permiability of horizon associated with Om fsl bands. ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Etf#2 ❑ Boring # Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = SOD 5 > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD <_30 mg/L and TSS -s_30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07/00) A.C.E. Soil B Site EvaluaUm mv ► ev` = /cu. scale. s- A(C fv�'/i ra.c1Q /57 5/440e / !.o t 9.2 P/s of 6lov�• � .�.t�o /aC o n al A � •� S pl i ce' SC y1/h E %f! SeO /G of l/iJ��3Q��' E�ori ��o- id(v.0' J -', �.� S�•GO;x G� cJl 1"!'i�Vtary Sy5{cml4re4 r _ i b3 3'x 4WS<,d 5-6 edev- ti ►Pis/ ala.�ee 0 �Ct /Yt 9L Aq.1o/ POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE iNFORMATtON ST 4M SPECIFICATIONS Owner Permit # — Se ptic Ta Capacity f „ dal O NA Septic 'rank Manufacturer �,' �� r 0 NA DESIGN PARAMETERS Effluent Filter Manufacturer �a k Cl NA Number of Bedrooms _ 0 NA Effluent Filt Model l� J NA Number of Public Facility Units A Pump Tank Capacity 0 NA v D S - .. ��. � gal Est i ma ted flow (average) -d2y al/day Pump T ank Manuf r'ea' t - 0 NA - -- - - — - Design flow (p e a k), ( Estimated x 1.5) Purn Manuf O NA ?�'C1 gal/day p � Soil Application Rate gai1d8y /ft Pump Model lJ., —y -- 0 NA Standard InfluentrEffluent Goality Monthly average Pretreatment Unit O NA Fats, ail & Grease IFOG) 330 mg /L 0 Sand /Gravel Filter 0 Peat Fitter Biochemical Oxygen Demand iSOD,) :220 mg /L v NA 0 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 3150 nVIL M Di sinfection O Other: — Pretreated Effluent Quality Monthly average Dispemal Cells) [I NA Biochemical Oxygen Demand (SOD,,) 530 mg /L Q in- Ground tgravityl ❑ In- Ground Apressurized) Total Suspended Solids ITSS) S30 mg /L C1 NA ❑ At -Grade d Mound Fecal Coliform (geometric me an) < 10 4 cfu /100ml is Drip -Line 0 Other: Maximum Effluent Particle Size Ytf in dia. O NA Other! '-Y 1 N A atner C� NA OtlI;, NA * Values typical for domestic wastewater and septic tank effluent. Other � — 0 NA MAINTENANCE SCHEDULE Service Event Service Fve quency Inspect condition of tanks) At least once ever 3 months) (Maximum 3 ears) Q NA every: y Pump out contents of tank(s) Whzn combined sludge and scum equals one -third Q) of tank volume 0 NA onthis! Inspect dispersal cells) At l ve aris) east once every: (Maximum 3 years) ❑ NA _ _ _ Clean effluent filter . —.___ I At least once every; ❑ month(s) Cl NA Inspect pump, pump centrals & alarm A least once every: C3 month(s) 0 NA O year(e) Flush laterals and pressure test — At least once every: — 0 month(s) 0 NA D year(e) ocher: At least once every: 0 NA other; _ O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal calls shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POW S inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge anrd scum and to check for any back up or ponding of effluent on the ground surface. The dispersal call(s) shall be visually inspected to check the affluent levels in the observation pipes and to check for arty pending 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 (%) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of i -A 2 months, shall be performed by a certified POWTS Maintainer. A service report shaii be provided to the local regulatory authority within 10 days of completion of any service event. l 0"Itlea: 3uiuipy uisuoosiM '(c) 'A (Z) 'f t)v9'E8 pue l ;)'8(p)i I)(g)tZ)ZZ'88 ww00 iside4o tpim esusl}dwo:, ui pet;eJp Senn WOLU unp ti:41 9 ua4d euo4d 1 '' ° n ° �`: p� Goan N 1 OtAle 11=415V Aa01V11 oav wool (a3dwncl) volvi3dO ONIOIAa3S 30V1d38 sweN ' .rte` :.� n� �s _ u�,r �/i,•� I eu- — 1l3N1V1N1VW 81MOd sY311V1SN1 91MOd S1N3WW001VN0111(1aV '3181SsOdwi 210 11t owia as AVW XNVI V 10 VOIU31NI 3H1 WOW NOSHU V 3O 311093li '11!1M AVW NIV30 '93ONV'13Wf1Oala ARV 1l3aNll )Mi 1N3W1V31i1 WHIG HO dwnd '311d3S V V31N3 ION oa 'N30AXO 1N3iow: 9Nl aO /ONV 9399VO 1VH131 NIV1NO0 AVW S)1NV1 1N3W1V3lil d3H10 QNV dWlld '311d39 < <ONINUVM> > • 9 w i1 leyl le toe ; ;e ul saint 041411m Aldwoo lsnu; swe;sAs yons to suoilonJisuooed •00e ;ins OAlieillllui 842 1e 1e Luo(q 941 ;o leAau.iei Bu1MOIJOI eaeld ul p a i an iifiu oae i eq Aew swepAs u011 diosge lion 9Pei$ ie pue punoyy Q 'S1MOd Pellet 9 41 aaeldej 01 iiosei lsel a se pellelsui aq Aew xuei 6u(plo4 a alge(iene 91 Sete l uaw9oeldei au ;l 0eie Ws we0eld e i algel s e l eaoi o f pewioped 9q lsnw u a,rs pue Ws a SIMOd a41 to ainlle; uodn sale luawooeldai etc ;el(ns a A ;Iluepl 01 paienlane uooq 1cu sect ells eyl 'S1.MOd Palle; 844 eaeidai of liosei l se l a se peli aq Aew tlusl Bulplo4 a ABolou4-,191 SIAAQd ur se0uenpe BulJ.109 'suoilaliwil nos io /pue noegles o f enp e(gallene 1ou s( e91e luewaaeldai 9lgeling a 0 awls Mil 1E laage w selni 944 41►M Aldwoo Ism swa luaweoelded 'eaie ivaweaeldea algeilns a 4s11ge19e of uopeniena ells pue 1(os M9u a io; peeu e4l u linsei 111m ease luawooeldei 941 iaeloid of einlied '9119M Pug seal) 101 'ainlonils pasodoid pue Bunsixe u;oi; Spegles Frennbei Aq uodn peC�� p� ul aq lou pin04s pue u01loedwoo pus eoueginlalp woe; pelooloid aq pinays e&ie luswaoeldei e41 'welsA uogdiosge 1i08 lumeasldei a to uogeool oyl JO; M 3 q Aew nos pelerieAS ueeq 9014 Me lUaLue e(gedlr,s V Lj lueildwa0 epuo a apinoid o1 'uelel eg isnw 9li is 'ueeq eney s•inaeew Suirnollo; 941 pedei aq loUUe : welsAs iueweoeldai o pue Wei S1MOd 8 41 ;l NV1d AON301NIINOO - lelialeui PHOS Haul JOUIOUe io laAeiB 'pos pm pelll; aneds plop 941 pue penowei 8i9no0 flay! i POAOCUai pue paleAeaxe eq ile4s slid pue siluel lie 'nauidtund 1el;V • •ioleiadp 6uioinisS eBeldeS a Aq to pesodsip Apedoid pue p9AOw91 aq IIegs slid pue s 4uel lie ;o slueluoa 941 • 'P91998 sBuluedo od ;d peuopuege 844 pue p9439uuo061p aq !toys slid pue ajuel al Buidid 11V • :epee 9niieilsiuiwpV ulsuooslM 'EE u.lwoo ieldeyo 4liM 801ieildwoo ul p9uopuege Abe ;es pue Apadwd SI U18;5AS 9(41 1e'J1 sin Sul of ualei eq 11049 9dals 8UIM0110; Sul ealnii S ;O ) no Ue4el Allu9uewiad Si 1ai S lie; $I 0 1 Ua MOd 4 4M 1N3WNOCINVRV auliq 19U9 ;09 J9 pug 'SuodLuel :sul�ldeu Aiepues :9apiaiised :slanpoid Bwluled :lio :suoue,ipecu :sdei0s le9w 'sepiaigi '9 200A 'Qu'1ose8 :98upo e1ge498en puB lint; :1epm (dw nd dwns) uieip uollepuno; '1e; 'sluetaa ;uisip :siedeip .`sQOi} leluap :sias9918vp :sg A41 40 8 ;g 041 fualoid pue e0uewia ;fed a0142 anoadwl Aew ure9als 9MS uouaa :swopuoo 311ng 911e1eDI0 :s9dIM ,4 F Iq,l S1MOd q.q :sails i ue jetennelseM 041 woi;. Bulmo(lo; 9 ;o joileuiwfl8 io uailanpaa 'e9ie uolldiosge Ilos 0peie -4e 10 punow Aue to adols UMOp lea; g L u144ln4 me 9141 'loedwoo 10 ginlsip eswug4lo io '19AO flied 10 9 AIiP loo 00 '91100 IMOCIslp pue SNU JOA se13i lied JO en(ip loo 09 o1 sloiluoo di_und 944 Bulleiedo Alienuew u► lslsse of ieulgluna 4vel duird 941 u14iiM Slane! Ieuiiau eiolsei VY S.1MOd is iegwnid a laeiuo0 io d wnd 1uenl ; ;e ayi o4 1aMcad r5oliolsei 01 ioud ioieiedQ BuiolniaS aBeldeS 0 Aq panowai duel dwnd 941 slueluo0 ayl ereq uo!lenlis S)41 plone o ;o oBM4091p eae ;ins io dnjoeq 9 ue lgnsei Aew p ue ( ) e l Bul o ienO '880 OBJe euo w ( as asiadsi 0 oi e8 l e14aslp P (III 4 P$1 P I I P 41 p a4 INM 1elennelseM ss9axs 9yl paiolsai si 19Mod ua4M 'sienel 103eM481y 19wiau enoge iii; Aew s�luei dwnd s9Beino iernod Bu(inp '800;ins OA14 944 1$ uezoij ei suop. (ion u6 in00 IOU 11e49 do lie welSA S slueluoa at,i eney Ten a1 ioyd iolei9do 6ulal yo n ias 96eldes a Aq POAOW9l (S)NUe1941 ;o pe10e19p eie 9uolleilueauOO 4 If '(s)ilea igsiadeip eqi easwep io/pue sse0oid luew1ee11 841 epedwl Aew 1941 sieolwe 19410 io si0npoid Bulluled }o soueseid 9141 ia; (s)�luvi itleW1e911 10040 S1MOd 04110 92n 01 ioiid 'uollanilsuoa Mau i od N011Vt13d0 QNV dt11wV18 ,x START UP AND OPERATION pAge Ct { For new construction prior to use of the POINTS check treatment ta for the presence of aintin that �±a R p g products or other chemicals y impede the treatment process and /or damage the diapers&! cell(s), If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. ' SYstern start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell($) in one large dose, overloading the cell(s) and may result in the backup or surface dischargo of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring Gower to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Go not drive or park over, or otherwise disturb or compact, the area Within 15 feet down slope of any mound cr at -grade soil absorption area. Reduction or e?iminatior of the following from the wastewater stream may Improve the performance and prolong the life of the POWTS: antibiotics, baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine ABA NDONMEN T When the POINTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is property and safely abandoned in compliance w ith chapter Comm 83.33, Wisconsin Administrative Code- • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • 1 - he contents of ail 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. CONTIN PLAN If the POWTS fails and cannot be repaired this following measures have been, or must be taken, to provide a code compliant replacement system: f7 A suitable replacement area has been evaluated anu may be utilized for the location of a replacement 8011 absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. 0 A suitable replacement area is not available due to setback andior soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. © The size has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soii and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. 0 Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. AD DITIONAL COMMENTS POINTS INSTALLER POWTS MAINTAINER N ame P^ , fi e y E Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Narne i Name • Cfo� ,l Co � z o r► J Phone Phone 1- 7/ Tt:s document was drafted in c omplianCe with chapter Comm 83.22(21(b)Itlld) &(f) and 83.64(l J , (2) & (3). Wisconsin Administrative Cade. commerce Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 St. Croix sco n s i n Madison, WI 53707 -7162 Sanitary Permit Number (to be filled in by Co.) Department c�1,lrrter�e 5 a t ! 3 Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental 1 unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary p urpose in accordance with the Privacy Law, s. 15.04 1 m , Slats. 322 Soo Line Road I. Application Information - Please Print ll rmation a In Property Owner's Name r G`` 'e Parcel # Brushy Mound Partners, L.L.C. 1 R V 040= 1267 -10 -000 Property Owner's Mailing A ess Q 1 Property Location Mph P.O. Box 445 Govt. L ot City, State Zip ode G Phone r NE ' /., SE ' /., Section 16 (circle one) New Richmond, Wl 540 T 29 N; R 19 w H. Type of Building (check all that ap ) OK /� 92 4 Subdivision Name 111 or 2 Family Dwelling - Number of Bedroo " 1 a► S�bth �,,,,,•,�- Block #,' Glover Station 5 Addition ❑ Public/Commercial - Describe Use C i t y Na ❑ ty of ❑ State Owned - Describe Use C ' 4 Number El Village of pia 11 Town of Tro III. Type o Permit: (Check only one box on line A. Com to l4k B if applicable) A. New System ❑ Replacement System ❑ Treatm olding Tank Replacement Only ❑ Other Modification to Existing System (explain) E List Previous Permit Number and Date Issued B. El Permit Renewal Permit Revision [I Ctge of Plum r ❑ Permit Transfer to New Before Expiration �—� { 4'i Owner IV. Type of POWTS S stem /Com onent/Device: eck all that appl ❑ Non - Pressurized In- Ground ❑ Pressurized In -Grou> ❑ At -Grade Mou > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (ex in) ❑ Pretreatment Device (explain) V. Dis ersal/Treatment Area Information: Desi Flow (gpd) Design Soil Application R gpdsf) Dispersal Area Requir sf) Dispersal Area Pr osed (sf) System Elevation gpd 1.0 ASTM C -33 s �15Q sq. ft. > sq. ft. 104.50' at 6" above , in -situ soil 1 W" 104.00' contour VI. Tank Info Cap ty in Total # of ufacturer >" d Gr Ions Gallons Units ,? New Tanks Existing Tanks [� t o f'D 1DL l 9 U Septic or Holding Tank 1, _ 1,585 1 WibserConc e X Dosing Chamber VAQ _ 950 1 1 Combination ST X VII. Responsibility Statement- 4the undersigned, assume responsibility for installation of the POWTS shown on t attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Num er Business Phone Number Bill Schumaker - r-1✓. � 227990 715 386 -3121 Plumber's Address (Street, City, State, Zip Code) 1070 Scott Road, Hudson, Wl 54016 VIII Coun /De artment Use Onl Approved Permit Fee Date ssue Issuin ent Signature Zen Reason Denial $ (o/A. °° 5 z a 7 IX. Condi$Y�l ro easons for Disapproval 3) 1. Septic to*, e/tltlsnt filter and dhperaal cell must all be services / maWdaked as per management plan provided by plumber. /� 2. All setbacK »�►errtsttts mud tle frutM*W �� f b� l��t., 1�0. 1a,. 4 ,-J0 ✓tno. ^C Oes " L 9 � s ; �r Attach to complete plans for the system and suffmit to the County only on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/07) Valid thru 01/09 1 e r , + e `( �„�, u w+w*"' o{' 3 /s� /,?,/ c. . G/,� tr,'(, �ibri /aka -.�s a /�;/;r 5�92s'' � ✓a, /k a �'ar, �, f s�"�b4n �: / JBrI�JP/9cO.7 o{ vv / '� � ffa G�:Gr1 x•/11 ioG,O' �n ' T "SuC. vo ,4✓. C. 0 w�A /,� /eat- �r�Q�•-�b.���, AsTM s 6l p�opasc d LOe !/ lo^opo s-c d y 6.e Armri, ReSr'c/eNCe . /0750' 0 09 I 0 Colo oosc d /noun d a f 2 t1.2,3 //6.3� " flssccm cd e /ra' : /0�.� So,•/ a- 6 /x!`:r yy.25' ,¢✓al a.6 �/% „o,.; L. 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TIC SE 1/4 OF THE NE 1/4 OF SECT11 16 T28N, g Isyl, DY 1�I�q �C ti C llfy �t�t 1NF �1 TirirrM .'t1f Goo JT.V10. �W![ ff1 SCZF # M { § 6. r * La �r ay�. x1`.rSGti_ L �vY, j� l a A r~ O, LnTw"�i MAP crc« i& m I e r r lavr crr 652 m .Y Y Yt' �• �d ,� f e 87� r�\ s n r a� «0"11 1 b SALE N FEET f 74 i ; �¢ 73 , 1 1 1 s a.i. ," a fa rrothx7 4 . _ 'k ' e n o { n ,gip vm tYw �!" �' � a f'�7' +kry � ^, v I , 'a I f !' - ~�• � � �,. r... ,,• �uizS J.... Y I � $ ' I� ��& ' " � sur;ar Cau nuw`..,00.irSw�t � f(vt e r c P sesxs,'' i rr. �arHL4 M n q r w: 1,+;4 t... I5!Fhs 3,111 S7C i 1'lYF r ai / p1 !'«M -1 RY � 54 I Nywa of A.C` to { / �, I' -. j(:�(las NI all rar'!r K 1 57Ti FCQS M � t ! 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Y.. �+«v'aT Wit Cr If IVIN, n 3 � VVV1t� -...,, .� - « t -�-�- .....___ �'k .J., r � � � � rnJk J . �+:. :',§°.`• ;Mm r.ar, �-«.n WM x v "I 1 4fJcA� 3 sfrx I,}i e ` Y ql a,pNFVw«[sw[w'nLU rtutK sxae«c 411 + rY <'^^_^°, r 1 S l :JW AC At NAF .**JM0S WI, 47« 4KT W t*,) M ae w a t xaam 4c xunnm a' c uNS eus �3" ay [ ru I,` •._. * «� ,%w � � NrNCasru�ar.rsrapsa(�amres w.«�ue�NeurUr«, I - � { « GY1y C9AwY14 (+.I «S4 WL YuIg1Y t(1r 41$, 1Ay41p 11�F,t, 04 A7K r DOTT - a W 10gt NIOW+K 1(4YlwLMM�, WT14 G[ St 47t (911pT.�«!C pE1 OF AY EI F DE1"AL OF MVEWAY EAWT nrri v , —� ' FI �rxcoa ( NxwMllYaO AIAQ �.. F« E.Q'C5 78 .71.:. ;� �.-! f 11' t'. � 7 t h ' 0 Xift ° - �,r'wCC G�iCYfDkUFR / 5 ?' r rs+AUanne+n+ur+naaorta,afurta r� �lZ�,E r 1 aarsrlmnefrltlatmR rNnaeNa r.. . «4 5 n Ezra y 7 v F' °' r a ,sasr 7 . 91 ti +16 ,5. slows y . r u sr w. r 4 GKi s i e � : 76 stn NiLlj II , t wlod - A wn it Yfare x k1'r'�D AsrS dlhtkf*Sr WX !�G rl al c., 7tlIS ! 'fi k "3 z d+ TN ' v_ „ t5f>µAE qr bK MI WI dF Ad IC r�k 3 �� r '. � a, � } - �� a ar`�M��r�w'dr „� i r A•a I # f? V a 1 t +� l �`pp 'e '' 7 31 .�' � "f Ml�a✓i+ ^� r I�y�i ��{ SY br a I � � 3�i7 fi � y F i .{ 'a L t r : 's'i yy f { k L w .Ht « •tiw�. '4� � sl La I se , l �� � � .T` ''� 1 �t {r ar ,� 5�'` & 1 F4z r ., Wisconsin Department ofIndustry, SOIL AND SITE EVALUATION REPORT Page I of 3 Labor and Human Relations 9 Division of Safety 8 Buildings . 44t�rfi. •COC �, F TY in accord with ILHR Attach complete site plan on paper not less than 81/2 x 11 inches inze. Plan mui�Ae, but S c,� lX not limited to vertical and horizontal reference point (BM), direction and% of slope, sbats or" '? EL LD. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION WEDBY DATE i , , PROPERTY OWNER: P 'LMATION cAim" S W1 E f; ,&) - UEQQ \S S C Hu L j z 68�- }�� 1/b''. 1 /4,S J j0T .N,R lq E ( W 8U PROPERTY OWNER':S MAILING ADDRESS • LOT BLOCI(' " . NAME OR CSM Z S 1Z.1U�2S lDE �D2r UE a1�2 i /'-' 61. T1t`T) SDlu 5 i'ri�D CITY, STATE ZIP CODE PHONE NUMBER OCITY EIVILLAGE ®TOWN ' NEAREST ROAD 1�1U JCL S Iwl 5y0j:LtjS) uZS*- $tbl Soo L)N --�zz New Construction Use kj Residential/ Number of bedrooms Y [ ] AddibQn to existing building [ J Replacement [ J Public or commercial describe Code derived daily flow boy) gpd Recommended design loading rate • 3Z bed, gpd/ft - trench, gpd/ft Absorption area required SOD bed, ft Sob trench, 11: Maximum design loading rate --- bed, gpolft •U trench, gpd/ft Recommended infiltration surface elevation(s) lOS_0 ft (as referred to site plan benchmark) Additional design/ site considerations f'AOLI`-Ab W / ° c r Y - W a eb . tr--i I w . U- aF St1'h 1 LL. Parent material LO L'3s Flood plain elevation, if appricable N-;� ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE IN FILL GRADE SYSTEM LL HOLDM TANK U= Unsuitable for stem D S ®U 0S ❑ U ❑ S ®U I AT GRADE S R U O S R U I D S T U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Botndaty Roots GPD /ft in. Munsell I 11u. Sz Cont Color Gr. Sz. Sh. I g� tEndi ` lv � 8 Zo 1.0`�,IL37( — s� S Z'FSbk H2�fi- cr.�, — •S •� Ground 3b 'T S ` rL 315 s 1 L�S wt v'Fi. e g - •� -S elev. ft y 36 .•8g V1 - �6 Depth to limiting fac Remarks: Boring # 1 Z Z lO =Zb• 10 31 V Ground 3 2z- 2 R t fL 314z toll 31 Depth to S Z-6� •S `t IZ V/ (� - 1�'s p �,,� rn U'�L• — . Ll . S limiting factor Remarks: FTName:— Please Print Phone: Arthur L. We erer 715 - 425 - 0165 ' egerer Soil Testing & Design Service -P.O. Box 74 River.Falls,WI.54022 Signature: p O �Z13 , Date: S ! Q _� CST Number.. l 220254 1 PROPERTY OWNER " H �, / SCb+U LT , SOIL DESCRIPTION REPORT � Page? of � PARCEL I.D. +D 1 ij G Boring # Horizon Depth Dominant Color MotUes Structure GPD �, •� in. Munsell Clu. Sz. Cont. Color Texture Boundary Roots /ft Gr. Sz. Sh. Consistence Bed Trench ,....., R11 b - 9 10 , 1 2 3 L 2 Z q -3(3 s) 1 Ground 3 30-39 7 .S `72 Y / ' elev. S1 2 rv, 36V 1�S.5 It. �t 231y - wt � L e irP ; I•►P Depth to limiting factor 39 14 Remarks: Boring # �: ZiMti» Zy Ground elev. —ft. Depth to — limiting factor Remarks: Boring # Ground elev. It. Depth to limiting factor Remarks: 3oring # j4± F_ F F_ around ?lev. ft. )epth to imiling actor Remarks: _ PROPERTY OWNER Q SCI-W LTZ SOIL DESCRIPTION REPORT -' Page ? of PARCEL f.D.# "N;� 1j Boring# Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Texture Consistence Qu. Sz. Cont. Color Gr. Sz. Sh. Bourd3y Roots Bed Ttench 3 0 -9 lb`12 312 - s! I Z'Psb►z ►vr N cw L� - S .� Z q -3q !u y Ii 31 Ground 3 a0 -39 7 `72 y f S 1 Z > Sbtt h� - Z° . S elev. W 1bS.s rt. 4 39 =?I s `t231y — s ] v wE54h�� Depth to limiting factor Remarks: Boring # ...,...,,:.•x,.., Ground elev. ft. Depth to — limiting factor Remarks: Boring # Ground elev. It. Depth to I , limiting factor Remarks: 3oring # around Aev. It. )epth to imiting actor Remarks: i Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of 3 Labor and Human Relations 9 _ Division of safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code ' COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but S`[' • not limited to vertical and horizontal reference point (BNI), direction and % of slope, scale or PARCEL I.D. 9 w G dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION 0 - kiM`� S E A'kD _Y_-EQ)V `S S C lJU C Z GP9. 6 8T Mkt 114 SE 1/4,S ]•6 ,N,R 1g E (or W PROPERTY OWNER':S MAILING ADDRESS, LOT 9 1 BLOCK;: SUED. NAME OR CSM # TIA Z SS `D2ZWE q ? - — GL ST ou S ftt) . CITY, STATE ZIP CODE PHONE NUMBER ❑CITY []VILLAGE ®TOWN NEAREST ROAD lkiQ(E Z jr�S wl 5q0 cLrjL5) qZs 8-16t � Lwe trt> New Construction Use Residential / Number of bedrooms (] AdditiQn to existing building [ ] Replacement (] Public or commerdal describe Code derived daily flow b e0 gpd Recommended design loading rate • 3 Z bed, gpd1ft - trench, gpd/ft Absorption area required SoD bed, ft Sob trench, ft Maximum design loading rate • S bed, gpd/ft - � trench, gpd/ft Recommended infiltration surface elevation(s) \OS.O ft (as referred to site plan benchmark) Additional design /site considerations MOW C ) W/ `>L G at') Parent material Lo t' av m • p 3, Flood plain elevation, if appricable _ M ft S = Suitable for system CONVIRMONAL I MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN RLL HOLDING TANK U = Unsuitable for stem ❑ S ®U ®S ❑ U CI S ®U I CIS ®U ❑ S ®U I ❑ S 0" SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color I Mottles (Texture I Structure ICons�tence �Y I Roots GPD /ft in. Munsell Qu. Sz Cont Color Gr. Sz. Sh. Bed mrxh ] LO'-t tZ 3 L 2 — s i I 2.`Qz)o 1�'LT esv l� • S •� Z 8 Zo Lo tL316 — S; 1 Z'Fsb h Wz�- C&, - . S . L Ground 3b __7 15 K2 3 q s tL y V16 9 wt ) Depth to limiting factor Remarks: Boring # , 0 -1U lob R 312 E l Ground 3 zo 3i 1(3'1 tz316 L R D ft. 3z-qZ Iri 1R- 3tb Depth to S limiting factor • 32.'' . Remarks: FT Print Phone: Arthur L. We erer 715 -425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River Ya11s,WI.54022 Signature: O p \ Date: CST Number. . �+ S' -00 220254 ' 3 3 PLOT PLAN I Page °f D U hJO�' �cl'"►� �T � OVL D 1 S ZvYz� ` tl S ►MQTA 6'Z L o io7.6'oN 8 "�tt6N, 31 y" DIN . ITV C p.I M Imo/ ►!: 0 ►ii6N L1-905 �\2S� PV C ��C2 Y1cL ��I P .e 3�1 - eL. Ito. p ors "'� �-► nuC P IPE, W/ 3.4 5 m6ti eve hmtl�cse alp �S,lot�-- u e- 0 h,1 %Z klLjoq.0 eaY�or 0l~ 13e> L•L luS.o I # 1SD 'ON auoydalal paUBIS ales ainle 1ST. Tszc)ZZ Zb Fa1 "OQ Opp Safety and Buildings 4003 N KINNEY COULEE RD commerce.Wl.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 www.commerce.wi.gov /sb/ ent of C www.wisconsin.gov isconsin • Departmommerce Jim Doyle, Governor Mary P. Burke, Secretary April 25, 2007 CUST ID No. 227990 ATTN. POWTS Inspector WILLIAM C SCHUMAKER ZONING OFFICE SCHUMAKER PLUMBING ST CROIX COUNTY SPIA 1070 SCOTT RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/25/2009 Identification Numbers Transaction ID No. 1386764 SITE: Site ID No. 724375 Brushy Mound Partners Please (refer to both identification numbers, 322 Soo Line Road above, in all correspondence with the Agency Town of Troy St Croix County NEIA, SETA, S16, T28N, R19W Lot: 92, Subdivision: Glover Station 5TH Addition FOR: Description: Mound / Four Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1127041 Maintenance required; 600 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 101), 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: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and re dispersal prohibited. P Con 4h • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c IT 490 r I IL TWENT I • A Sanitary Permit must be obtained from the county where this project is located in accordance with the OF ' FTI requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated 'SEE CORl2E; county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat ` WILLIAM C SCHUMAKER Page 2 4/25/2007 • Comm 83.22(7) A copy of the approved plans, Mecifications 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 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. L4 t l UND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Q� ��� Residential Application v� V I II P INDEX AND TITLE PAGE Project Name: Brushy Mound Partners 4- bedroom residential mound Owner's Name: Brushy Mound Partners, L.L.C. Owner's Address: P.O. Box 445 New Richmond, WI 54017 Site Address: 322 Soo Line Road Legal Description: NE1 /4 SE1 /4, Sec.16, T.29N., R.18W. Township: Troy County: St. Croix Subdivision Name: Glover Station 5th Addition Lot Number: 92 Block Number: na Parcel I.D. Number: 040 - 1267 -10 -000 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan & Diversion trench detail Page 9 Attached soil evaluaiton report Designer: Bill Schumaker License Number: 227990 Date: 04/06/07 Phone Number: (715) 386 -3121 Signature - 4z . lly Designed Pursuant to the O Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and )FCOMINERCE Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Version 5.1 (R. 06/06) Page 1 of 9 3P0 NDENCE �J 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 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 600.00 Design Flow (gpd) 15.00 Site Slope ( %) 104.00 Contour Line Elevation (ft) 32.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 100.001 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.001 Dispersal Cell Design Loading Rate (gpd /ft 11 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution 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) 2.00 Estimated Orifice Spacing (ft) = 6.00 ft /orifice 2.00 Forcemain Diameter (in) 80.00 Forcemain Length (ft) Does the forcemain drain back? Y 96.50 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 13.05 Forcemain Drainback (gal) 7.50 Vertical Lift (ft) 62.76 5x Void Volume (gal) 2.79 Friction Loss (ft) 75.80 Minimum Dose Volume (gal) 0.00 In -line Filter Loss (ft) 41.19 System Demand (gpm) 16.79 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 x 1.25 x x 2.00 x 1.50 x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information 800.64 Total Tank Capacity (gal) 1200.001 Septic Tank Capacity (gal) 36.00 Total Working Liquid Depth (in) Wieser Concrete IManufacturer 22.24 gal /in (enter result in cell B49) Dose Tank Information Effluent Filter__ Information 800.641 Dose Tank Capacity (gal) I Pol Lok_ JFilter Manufacturer 22.241 Dose Tank Volume (gal /in) PL -525 Filter Model Number Wieser Concrete Manufacturer Project: Brushy Moun Partners 4- bedroom residential mound Page 2 of 9 Mound Plan and Cross Section Views T :�: J 1 Observation Pipe _:� = ° s ° sr �•:� °tip °�� A ... .... .......................... I .................. ................ z Mound Component Dimensions A 6.00ft E 16.80 in H 1.00ft K gift ft B 100.00 ft F 9.25 in z 14.57 ft L ft D 6.00 in G 0.50 ft J 3.66 ft W 600.00 (ft Dispersal Cell Area 1 2056.82 (ft Area Available 6.00 (gpd /ft) Linear Loading Rate 1 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 106.27 (ft) --► � ,rrrrrrrrr 2 rrrrrrrf.. • j .rrrrrrrrrrrrrrr rr rrr rrrrrrf.. T F : ; Dispersal Cell 105.00 (ft) Lateral 104.50 (ft) -► Invert Dispersal Cell Elevation E . D ' r ? 104.00 (ft) Contour Elevation 15.0 % Site Slope Geotextile Fabric Cover Shading Key $'. - T Dispersal Cell See lateral details on 1❑ _ Topsoil Cap c a 1.5 ft .° •..•.e••: .;;;., Page 4 for number, size, © rrrrr Subsoil Cap y 5 �a °" '' _° and spacing of laterals. © ASTM C33 Sand ` ' ` Laterals are a uall ❑ Tilled Layer m 0.5 ft Typical Lateral °• • ° •:'�w° spaced from the ❑ 'titi'• ° .tl I distribution cells 5 r•r• A ggreg ate o ' °r• -� "° ° ° centerline in the distribution cell (AxB). Project: Brushy Moun Partners 4- bedroom residential mound Page 3 of 9 i Center Connection Lateral Layout Diagram Force main connection via tee or cross to manifold at any point. Laterals are identical P S Ak- 1k •= Turn -u p wlball valve or If X�� x12 i x12 ;1 Laterals & force main of PVC Sch 40 cleanoutplug per COMM Table 84.30 -5 Hales drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.01 ft Lateral Length (P) 49.25 ft Orifices per Lateral 25 Lateral Spacing (S) 3.00 ft Orifice Density 6.00 ft /orifice Lateral Flow Rate 10.30 gpm Manifold Length 3.00 ft System Flow Rate 41.19 gpm Manifold Diameter 1.25 in Total Dynamic Head 16.79 ft 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 18.28 WAC Disconnect 4 in, min. Tank component is properly vented F- Alternate outlet location Forcemain diameter Wieser Concrete Manufacturer 2 in. Capacityl 800.64 Gallons Volume 22.24 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 18.59 413.48 C B 2.00 44.48 P T ump off elevation (ft) C 3.41 75.80 —t 1 97.50 D 12.00 266.88 D Total 1 36.00 800.64 JF Dank elevation (ft) 3" Bedding uncTer tank. 96.50 Alarm Manuafacturer ILevelArm Alarm Model Number I DLV Pump Manufacturer J Goulds Pump Model Number 13871 EP05 Pump Must Deliver I 41.19 gpm at 16.79 ft TDH Project: Brushy Moun Partners 4- bedroom residential mound Page 4 of 9 r Mound System Maintenance and Operation Specifications Service Provider's Name Bill Schumaker Phone 715 386 -3121 POWTS Regulator's Name St. Croix County Zoning De 't. 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 ft' 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 ears 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 Ins ect for ponding and seepage once every 3 ears 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 mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 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 • ............... M Grade _ Threaded Cleanout 6 -8" Diameter Lawn Sprinkler Valve Box Plug or Ball Valve Distribution g Lateral Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Brushy Moun Partners 4- bedroom residential mound Page 5 of 9 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 shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD I I' 10706 -P (N. 01/01)] 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 pump 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 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 of 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 Department of Commerce. Pump Tank The pump (dosing) 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. 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 BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg/L BOD 30 mg /L TSS, 10 mg /L FOG, and 10 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 18 months. 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 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Continuency 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 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 9 Labor and Hum _' RelaCons J' bUIL AIVU 51 I t tVALUA [ION REPORT Page 1 of Division of Safety & Buikkrrrs in accord with ILHR 83.05, Wis. Adm. Code COUNTY S C�O Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (W, direction and % of slope, scale or PARCEL I.D. 9 W G dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION �5 (3 C l-}U L71 z saw Ee f va SE va,S I TT ' N ' R EIS w PROPERTY OWN ER':S MAILING ADDRESS• LOT ! BLOCK x SUED. NAME OR CSM # Z S8 2Ik3H2S I.DE _D R.IUE q 2 — 1 6L \) ST" 0i S � F��D _ CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE Ec fOWN NEAREST ROAD 1�1U� - 12 LS wl SyoZZ hlS) ZS - $lbl��{ Soo L1�tr ;zot�p p(J New Construction Use Residential / Number of bedrooms Y [ J AdditiQn to existing building (J Replacement Public or commercial describe Code derived daily flow gpd Recommended design loading rate • �Z bed, gpd/ft - tench, gpd/ft Absorption area required 500 bed, ft Sob trench, ft Maximum design loading rate • S bed, gpd1ft trench, gpd/ft Recommended infiltration surface elevation(s) OS.O ft (as referred to site plan benchmark) Additional design / site considerations t`' W /'S `x 6 � i? wl I U . 1Z OF– Spr� 1 Parent material Lo t'- ovzq • Flood plain elevation, if applicable N ft F U= = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FLL HOLDING TANK Unsuitable fors stem I [Is ®U RIS ❑U I [Is ®U I [IS ®U I ❑S ®U I [IS ®U SOIL DESCRIPTION REPORT Boning # Horizon Depth Dominant Color Mottles Texture Structure Consistence B Roots GPD /ft Bed I r N in. Munsell Qu. Sz Cont Color Gr. Sz. Sh. I _�`�': ► o -� Lost R-� Li - s i I z..�b` 1n� ew � l� • S � -� Ground 3 20 3b `12 3 e!ev. a s ft y -8g - )JVIL VA - s o S9 ,� J - �� •� Depth to fimiting factor O0.N Remarks: Boring # IZ 11 12 - S> Z �S1�k v'i z ' • S - E> Z l0 Zp. lug R it V Ground 41 31-4 Si1 n�w -L elev. ft Z 10 R - 3 I b � -S`1r� 511 qs O''v1 Depth to � Z-b� - 1�'S p �,� rn U'�L — `1 .S limiting factor • 3Z� 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: S _Q CST Number. l 22025 PRO,P.ERTYOWNER Q`i� Sct+u LT z SOIL DESCRIPTION REPORT Page ? of ( PARCEL I.D.k 7 ;) E D 1+yG Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 3 0 -9 102 3/Z - si I ZPsb�r wr f cr" t� .S Z q -3� Ground 3 30 39 s `72 Y� S1 elev. CJGH @,h - M� i K J'P Depth to limiting factor — Remarks: Boring # Ground elev. i ft. Depth to — limiting factor I Remarks: Boring # i I i Ground I eiev• ft. Depth to limiling factor F Remarks: 3oring # around flev. fl. )epth to imiling actor Remarks: P 3 of 3 PLOT PLAN Pa g • scaL� 1'' = So ' DU NUT e U�t���T OYt b \ 51�Nt -Q %��/ �� 31 k Drl9. hVC hlP�. W� U :U rti6N y ZZ V a Y�P�LcI2 \' P e. e�t - t!., too '5I�" oral 3� 3 PUC Pl\? w / t�16l N t I-I mtk( -n P IK s 0- 0>JTzw�L tt ,IUy.O @oYT�r1 or l3ND �t to S,o E PUMPS [4 GOULDS Submersible Effluent Pump 3871 EPO4 EP05 APPLICATIONS • Fully submerged in high ■ EPOS impeller. Thermoplas- ■ Hearings: Upper and lower Specifically designed for the turbine oil for tic enclosed design for heavy duty bats bearing following uses: lubrication and efficient improved performance. construction. • Effluent systems heat transfer. ■ Casing and Base: Rugged • Homes AvalWA for automatic and thermoplastic design provides AGENCY LISTING • Farms manual operation. Auto- superior strength and corrosion do • He resistance. 4 men SUMW* Aswadbn avy ry sump metic models include • Water transfer Mechanical Float Switch • Motor Housing: Cast iron (CSA listed model numbers end • Dewatering assembled and preset at the for efficient heat transfer, In "F" or "C ".) factory. strength, and durability, SPECIFICATIONS ■ Motor Cover Thermoplastic coin Pow 6 ao 9001 koswW- • Solids handling capability FEATURES cover with integral handle and 'h" maximum. float swltch attachment points. • ■ f Semi Impeller. n with plan 2 per Cable: Severe duty • Capacities: up to 60 GPM• tic Semi-open design with Total heads: up to 31 feet. pump out vanes for mechanical rated oil and water resistant. • Discharge size: V /s• NPT. seal protection. • Mechanical seal: carbon - rotary/ceramic•stationaly, BUNA -N elastomers. • Temperature: 104OF (40°C) continuous 140•F (609Q intermittent. METERS + FEET • Fasteners: 300 series 10 stainless steel. ---.. 9 30 SGPMI- • Capable of running , dry without damage to a 25 Fr components. ?S :. _.__ ...:.. Mora: ; • EPO4 Single phase: 0.4 HP, zo - ., ........ 115 or 230 V, 60 Hz, 1550 RPM, built in overload with 5 automatic reset. 4 15 • EP05 Single phase: 0.5 HP, o` 115 V, 60 Hz, 1550 RPM, � 3 1 a built in overload with EPO4 automatic reset. 2 • Power cord: 10 foot s _ _... standard length. 16/3 SJTQW with three prong I 10 z roundln o f 00 - g 9 plug. Optional 20 0 30 40 l _ so GPM length, 10 SJTW with three prong grounding plug ' -I -+ ' (standard on EP05). 0 2 4 6 a 10 12 mI /h CAPACITY Goulds Pu mps O 2000 Goulds Pumps ITT Industries Effective fehfumy, 2000 $3071 42006 11 :07 FROM River Valley Abstract TO 17152464948 P.02 I U v 1 G - 7 t-5 3. t2r _s . e KATHLEEN H. WALSH STATE 13AR OF WISCONSIN FORM 1 - 1998 REGISTER OF DEEDS WARRANTY DEED ST . CROIX CO.. WI Document Number I RECEIVED FOR RECORD This Deed, wade 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. WARRANTY DEED Schultz, Trustees EXEMPT t 17 Grantor, and Brushy Mound Partners, 1..L.P., a Wisconsin limited REC FEE: 21.00 TRANS FEE: partnership - COPY FEE: 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"): A rea Name and Return Address C. M. Bye Lots 72, 82, 83, 84, 92, 93, 94, 96, 97, 98, 100, 101, 102 and 103, Glover 258 Riverside Drive Station 5th Addition, Town of Troy, St. Croix County, Wisconsin P.O. Box 167 River Falls, WI 54022 040- 1265 - 10.000,040- 1268-00-000 Parcel Identification Number (PIN) 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 St. 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 - 1267 -50- 000,040- 1267 -60- 000,040- 1267 -70 -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 - -��N ✓w ►r o ZQOy + Dennis R. Schult • C. M andra C. Schultz • AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. Signaturc(s) St. Croix County.) Personally came before me this Le day of the above named authenticated this day of Dennis R. Schultz, Sandra C. Schultz and C -M Bye TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the persons Ko. ex d Oic fdtwgihg (If not, i ment and acknowledge the .o" i`C7• :7 Aj authorized by $ 706.06, Wis. Stars.) s THIS INSTRUMENT WAS DRAFTED BY C. AL Bye ' Attorney at Law Notary Public, State of Wis0onsii1 - -. I ( My Commission is pc5manent. (If not; ataA as4fsa�i P ate. (Signatures may be authenticated or acknowJedgod. Both are not necess tlry.) 'Names of persons signing in any capacity should be typed or printed blow their signatures SrATZ MAR OF WISCONSIN WARRANTY DRlD FORM Na I - 1599 INFORMATION PROFESSIONAL$ COMPANY POND Iw LAG MI 900.e53-7031 TnTCI P Gil ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address kbigy, 44(; k4'41 5 4-0 - Property Address �Z `7�e� L j ";E5 12,o A-o (Verification required from Planning & Zoning Department for new c truction.) Cit ( h' `� Parcel Identification Number � � '" � �-� LEGAL DESCRIPTION Property Location W '/ , -4 3C / , Sec. [to , T 'b N R 19 W, Town of Subdivision (�Jl.43\1--n, Lot # - Certified Survey Map # , Volume , Page # Warranty Deed # - I C 7 4 �/ , Volume , Page # Z 1 Spec house yes no Lot lines identifiable yes do 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. Wbat 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 'Co P mm 1 . $3.52 and is Chapter 12 St. Croix County u s? 13 () Chart ty Sznuta y Ordinance. 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 andior (2) after inspection and pumping (if necessary), the septic tank is less than 113 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. I/we certify that all statements on this form are true to the best of my /our knowledge. Uwe amlare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Numb f edroorns �- � --.- C-, )�Zfve 3 I Z3 - 7 SIG OF APPLICANT ) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08105) St. Croix County Final Property Report Page 1 of 1 St. Croix _County_2006 Pro 9erty_Rep-ort ' - Print Report Generated: 3/28/2007 7:58 :01 AM Data Updated: 3/28/2007 1:00:00 AM PARCEL COMP 040-1267-10-000 AR L LITER NUMBER: PARCEL MAP NUMBER: 16.28.19.1453 2002 2003 2004 2005 2006 2007 VeiClick on the year to select the annual record. (* & dark red in uent Property Description Billing Information Municipality: 040 - TOWN OF TROY Name / Attn.: BRUSHY MOUND PARTNERS Document Number: 751052 Address: PO BOX 445 Volume & Page: V2488, P129 Public Land Survey: SECTION 16 T28N R19W City, State, Zip: NEW RICHMOND, WI 54017 Quarter: SE Country: USA QQ / Tract: NE Ownership Plat: GLOVER STATION 5TH ADD'N '00 Primary Owner: BRUSHY MOUND PARTNERS Description: SEC 16 T28N R19W NE SE LOT 92 GLOVER STATION FIFTH ADDITION Secondary Owner: Total Acres: 3.02 ACRES Site Address: 322 SOO LINE RD Assessed Value Other Valuation Date 7/23/2004 Fair Market Value: 109,100 Assessment Type Acres Land Improved Total Assessment Ratio: 0.9122 Value Value Value Net Amass, Val. Rate: 0.014466938 G1 - RESIDENTIAL 3.02 99,500 0 99,500 School District: 4893 -RIVER FALLS Totals - -> 3.02 99,500 0 99,500 Tax installment Dates r Tax Detail Period Date Due Amount Category Tax paid Balance 1 1/31/2007 719.73 Amounts Due 2 7/31/2007 719.73 Real Estate Tax Due 1,439.46 Total Taxes - -> 1,439.46 Lottery Credit ( -) 0.00 Tax Payment History Net Property Tax 1,439.46 719.73 719.73 Date Paid Receipt Number Amount Special Assessments 0.00 0.00 0.00 1/22/2007 16298 719.73 Special Charges 0.00 0.00 0.00 Paid By: BRUSHY MOUND PARTNERS Delinquent Charges 0.00 0.00 0.00 Total Payments - -> 719.73 Private Forest Crop 0.00 0.00 0.00 Woodland Tax Law 0.00 0.00 0.00 Specials Managed Forest Lands 0.00 0.00 0.00 Category Amount Penalties 0.00 0.00 NONE Interest 0.00 0.00 Totals - -> 1,439.46 719.73 719.73 http: //72.21. 230.178 /website/LRPortal/total _process .asp ?IDValue =040 - 1267- 10- 000&new... 3/28/2007 PLOT PLAN Page 3 of 3 Du r eci APrve -T `R1"l S NrRC�(1 9•Z 2S� � o � -ez, IoZ,b'oN 8 °tt1sN, I:V I� ' l>U C 1hPC2kl \�I PE' . gam, loo•o o►Q �tGtj, 3 iq tt16N P ve YIKRklS2 PIPls `S e, lU S — BoYTO►� or l3� t*L l0 S,0 L1� (71S qZS- W1 S; Z ZOzs( •CST Signature Date Signed Telephone No. CST # RECEIVED Safety and Buildings �+ 4003 N KINNEY COULEE RD commerce.wi.gov LACROSSE WI 54601-1831 APR 2 5 2007 TDD #: (608) 264 -8777 seo ns i n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov ST. CROIX COUNTY Jim Doyle, Governor Mary P. Burke, Secretary April 25, 2007 CUST ID No. 227990 ATTN: POWTS Inspector WILLIAM C SCHUMAKER ZONING OFFICE SCHUMAKER PLUMBING ST CROIX COUNTY SPIA 1070 SCOTT RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/25/2009 Identification Numbers Transaction ID No. 1386764 SITE: Site ID No. 724375 Brushy Mound Partners Please refer to both identification numbers, 322 Soo Line Road above, in all correspondence with the Town of Troy agency. St Croix County NE1 /4, SE1 /4, S16, T28N, RI 9W Lot: 92, Subdivision: Glover Station 5TH Addition FOR: Description: Mound / Four Bedroom / Sloping Site Object Type: POWTS Component Manual Regulated Object ID No.: 1127041 Maintenance required; 600 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), 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: Reminders • This system is to be constructed and located in accordance with the enclosed approved plans and with the component manuals listed above. • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. 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 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. • Inspection of the POWTS installation is required. Arrangements for inspection shall be made with the designated l WILLIAM C SCHUMAKER Page 2 4/25/2007 t county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stat • Comm 83.22(7) 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. 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 sane 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 Charles L Bratz POWTS Reviewer 11 , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday Charles. bratz @wi sconsin. gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M.