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HomeMy WebLinkAbout040-1267-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 487986 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)]. 1O — "• A Permit Holder's Name: City Village X Township Parcel Tax No: Ranne , Terry & Jean I Troy, Town of 040- 1267 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: /CffC_> ' I C, - c� - C 1 16.28.16.1455 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. 3 . s Z 1G3. sz . CC— Septic 1 rZM kbeq, Benchmark q. /d �' Dosing �� AID M Aeration Bldg. Sewer ( ,,,, Q ) o • � S G� 4 Holding St/Ht Inlet �A) D St/Ht Outlet /AN TANK SETBACK INFORMATION l 12.32 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic > 25 t 00 ) 1 Dt Botto Dosing �i tt u t Header/ n. > 25 2.Z /0 1,32 Aeration Dist. Pipe Z Z. / @ / 3 .p Holding Bot. System PUMP /SIPHON INFORMATION Final Grade L/1 1 /0 - Z.3 z Manufacturer // St Cover AA l� it,-, l S GPM - Model Number WO - 41 1 7 TDH Li rre�, Friction Loss ISystern Head TDH Ft x'1.7 I , 03 Z . (z„ • 6 — o. 7' . 7g Forcemain Length D + Dist. to well �� L 1 3 - C2 SOIL ABSORPTION SYSTEM (' S •O$ �'t�t BEDITRENCH Width Length No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Liquid D epth DIMENSIONS �j /66 y �— SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of ystem: j UNIT Model Number: DISTRIBUTION SYSTEM (, ,, i ° L.Z Header /Manifold Distribution Pipe(s) j'� �,1 I x Hole Size 1 / j x Hole Spacin� V to Air Intake � Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center ( 72 Bed/Trench Edges \ Topsoil es No Yes ,; No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1 • z /I � Inspection #2: c -� p1 Location: 321 Empire Builder Drive Hudson, WI 54016 (SW 1/4 SE 1/4 16 T28N R16W)' lover Stt Add of 94 Parcel No: 16 1.) Alt BM Description 2.) Bldg sewer length = 7-1 - amount of cover = i Plan revision Re q uired? Yes No Use other side for additional information. _ —�___ - -- Date Insepctor' Signal Cert. No. SBD -6710 (R.3/97) RIF 201 W S afety h d Buildings Division I scom iii Coun Ington Ave., P.O. Box 7162 M adi son, Wl � Department of Com 53707 -7162 merce (608 266 -3151 Sanitary it u ber (to be lied in by Co.) 41 Sanitary Permit Applic • 0 to Plan 7 e In accord with Comm 83.21, Wis. Adm. Code, 1,D, Number may be used for secondary pur p oses privacy Law, s l .04(1 o scion you ravide Z S b �� ' C I. Application Information - P � 200 oject Address (if different than mailing ) lease Print All Information p Pro ST. CROIX COUNTY 1 n �' t pen er's Name Property Owner's iling Address h %Q I # Lot Block # , Pro ny Location , City, State c Zip C Phone Number %, ,Y., Section li {check all that apply) T Ty f Building ss (cE r ircle '] � N, R -W or 2 Family Dwelling- Number of Bedrooms Ole c-5 e' S P r - 54 M ' � 14C '�' -�-! 6 _PubliGCommercial - Describe Use & ✓t- Subdivision Name CSM Number ❑ State Owned - Describe Use X j — � OVdI, O J rt-A III. Type otPermtt: (Check only one box on line A. Complete line B if applicable) OCity ❑Villagel ownship of rQ A. New System 13 Replacement Syste ❑ Treatment/Holding Tank Replacement Only ❑ Other Mod ification to Existing System B• ❑ Permit Renewal ❑ Permit Revision El Change of List Previous Permit Number and Date Issued Before Expiration g Permit Transfer to New Plumber Owner IV. T of POWTS S stem: Check aIt that a ❑ Non - Pressurized In- Ground _ ✓L Mound > 24 in. of suitable soil ❑ Mound c 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter Constructed Wetland ❑Pressurized In- Ground E) Holding Tank ❑Peat Filter El Synthetic Media Filter g ❑ Aerobic Treatment Unit 11 Recirculating Sand Filter El V. ire er S y n ea ❑ Leachin Chamber ❑ Drip Line ❑ Gravel - less Pi tment Area Information: Pe C] Other (explain) �� Des �w gpd) Design Soil Application Rat �gpdsf) a Dispersal Area Required (s Dispersal Area Proposed (sf) System Elevation 6 n5� VI. Tank Info Capacity in Total � do � 1 Gallons ✓ Number Manufacturer of Units Prefab Site Steel Fiber Plastic New Existing /� Concrete Constructed Glass S ' Tanks Tanks w l StJF� eprio Holding Tank F'd trobr'c Treatment Unit Dosing Chamber g VII. Reg Ponsibitity Statement- I, the andersigned, assume responsibility for Plumber's Name 0 the 1P0 shown on the attached plans. Plumber's Sig i IMPRS ber Business Phone Number um is Address Street, City State, zip Code) IS -- !o Zia VIII. Colin U /I?e artment Use On Q Approved ❑ D' roved Sanitary Permit Fee (includes Groundwater Da Iss Surcharge Fee) Issuin gent Si ure o El en Reason for ial OWNER: 25 . 60 q IX. Conditions of Approval/Reasons for Disapp SYSTEM PProval t, dopinim cNt" m Awnl a r 0 tut aN le(' al's , `n. '— VV 2. IIY moment plan provWed by oArbW. (.✓ �-� 5 �.h l setback requhMilf is nwst be mak t kW per appNcable code / ord* / Attach complete plans (to the County only) for the system oa paper not less than >il/E z 11 inches in size SBD -6398 (R. 01/03) A p314wO 1W 'ry fRh . "rife! 7C"'! . t P# "dmul'k I:3 • +P �.: %y: ;.r-. "iur:v! 3f: .. . _ •.- r.�.....: �..,q� }!'�df:.;!a: Nj,. ot OL - f Y t ;� - ✓;- Las . � _ , _� � � : _- _- Co Aj 4 o t - ��4, - LL , , I , , , 1 f i I 1 I : I { : a i , , i , • t t : 1 s I s 4 I ' S f . - , i • r i I �r - i i A _ • q9 , 1 f � • i i . 1 = 1 ,f I _ i 1 1 1 1 s I I — i i _ l � , s�.l s 1t� TgN -_ Pf D( a ot OL ON w R le � 4,d Pi pA b rab' _• © - pQ , , _ C'F ;t � � f q� Ar- "fir °w► � i r , e r , , _ f , t _ _ II Safety and Buildings 4003 N KINNEY COULEE RD commerce.wi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 soon i n www.commerce.wi.gov /sb/ www.wisconsin.gov Department of Commerce Jim Doyle, Governor Mary P. Bu Secretary I November 03, 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: 11/03/2007 Identification Numbers Transaction ID No. 1210506 SITE• Site ID No. 706763 Terry & Jean Ranney Please refer to both identification numbers, 321 Empire Builder Drive 1 above, in all correspondence with the agency. Town of Troy St Croix County SWI /4, SETA, S16, T28N, R19W Subdivision: Glover Station 5th Addition; lot 94 FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1048725 Maintenance required; 600 GPD Flow rate; 26 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.01 101); 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.01 101). • The distribution pipe being inserted into the 4" corrugated pipe located in the EZflow product shall 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. The laterals shall 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. • The submitted plot elan shows the Wslope of the EZflow cell not on the 99.7' contour cell needs to be shifted slightly to the southeast to maintain consistency with the design elevations. • 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 witW]A S designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats �F %j Conditionally APPROVED CALVIN W POWERS JR Page 2 11/312005 • 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 O� FO TITLE SHEET S',gF�ry� 200s DATE: -- is --C PAGE_OF_3 MOUND SYSTEM FOR A BEDROOM RESIDENCE This plan has been prepared in accordance with the EZFLOW Mound Cornpone t Manual VERSION 2.0 (N. 06103)and the Presses DistniNdion Manual VERISION 2.0 SBD- 10706 -P. (N. OUOI) LOCATED IN THE S I/4 OF THJS '�--' 1/4 OF SECTION L(O,Ta&N, R W, /TOWN C S �.ROIX , CO WISCONSIN. dd :Vpv\ co U INDEX PAGE I OF 8 TITLE SHEET PAGE 2 OF 8 PLOT PLAN PAGE 3 OF 8 PLANVIEW CROSS SECTION PAGE 4 OF 8 DISTRIBUTION PIPE LAYOUT PAGE 5 OF 8 PUMP CHAMBER CROSS SECTION PAGE 6 OF 8 SYSTEM MANAGEMENT PLAN PAGE 7 OF 8 PUMP CURVE PAGE 8 OF 8 CROSS SECTION OF E Z FLOW PREP Mp FO he.rP `{�IJ�2ct r Ci hn �t y '4 4 4 Ao�As% (1-XL p"ar o� D /7 # 0537 ( POWERS E CAVA G INC. 1969 185T" AVE. NEW RICHMOND, WIS. 54017 PHONE: 715 -246 -5135 FAX: 715 -246 -5135 CELL: Lci'Are +: �f 5°j81 -5f5�1 D) \'1S�Q Of SAFETY AND GC iL'JtNGS i Approved Barrier CoveraQ e �° /4S1 -Gill Material Distribution Cell Cap ;'� .�� G ,;�- - _. �_ .. _ t G � �. �?'_ � g •rte /D /I � y ,�' = f - -- - t✓i loo 7 - - ,. d Area - Slope Figure 3. Detailed cross - section of a mound D f n Cross Section Of A Mound System Using E 13'5 tl E Z r—� "For The Absorption Area F 1 -�- -- n A 6 Ft. H B /� Ft. K 9 - � -Ft . L // . l:t. Ft. of Position t C f. Ft. Force Mein W Ft. d Observation Pipe K Gi --------------------- A -�le __ O Distributiorw Of 1p u) S Pipe t Observation Pipe QAcho r s cw mI Pion View Of Mound Using A Bed For The Absorption Area i DISTRIBUTION PIPE LAYOUT Page__ ( of ^ � Place 4 holes on the top side of the pipe and every 5` hole on the bottom of the pipe. Extend the end of each lateral up with the use of long turn or 45* fitting to a point within six inches of the final grade. Terminate the ends of the laterals with a valve threaded cap or threaded PhW. Provide access from final grade for the valve, threaded cap or threaded plug. t Lateral _ Manrfold Lateral x x x x xf2 x!2 x x x x Lateral Len h Lateral Lenqth Distribution Line Lateral Access box Mani#'oId -- Force main P 510 ft ' Hole diameter / inch S .:3 ft ' lateral X Manifold ��� a inches Force main �_incles # of holes/pipe q5 Invert Elevation ofLaterals /e/j &t. Q 4 Cl VENT PIPE 12 MIN, ABOVE GRADE S WEATHER PROOF 2 5 ' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR _INTAKE WITH CONDUIT MANHOLE COVER WARNING LABEL 4 f ' MIN . 13" MIN �1 i NLET i ri L WATER TIGHT SEALS GAS. TIGHT i f ', A SEAL f APPROVED I PI 5'75 ... � � LM JOINTS W/ CI 3' ONTO E3 i PIPE 3' ONTO SOLID _v_ i ON SOLID SOIL r 'QI L G PUMP OFF ELEV . 93' 2 - FT T. - -- -- v OfF '� RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS ^ SEPTIC i DOSE Lp TANK t'IANUFACTURER: l } � t ��,a NUMBER 'DOSES PER DAY. . TANK SIZES SEPTIC / 00 GAL. DOSE VOLUME INCLUDING DOSE GAL. FLOWBACK: GAL. ALARM MANUFACTURER: 5;a_ CAPACITIES: A = 17 -S INCHES = V01- 7 - GAL. MODEL NUMBER: SWITCH TXPE: B = 2 INCHES = 1 �2- GAL. PUMP MANUFACTURER: C = INCHES = �'1�Li 2 " GAL. MODEL NUMBER: W -- J SWITCH TYPE: D = 4+ INCHES = / 93,E GAL. REQUIRED DISCHARGE RATE_ GPMe -27 P ALARM WIRING AS PER I LHR 16. 23 WA( VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . . 5 FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . ... . . . . . .S FEET t /LQ FEET FQRCEMAIN X 3 FT1100 FT. FRICTION FACTOR . S;.Z� FEET TOTAL DYNAMIC HEAT! _ I cL 7 I T FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER LIQUID DEPTH FILE INFORMATION g POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pag of Owner mot, SYSTEM SPECIFICATIONS Permit T Septic Tank Capacity -lane a( ❑ NA DESIGN PAH�S Septic Tank Manufacturer to i �Sa2 r NA oi�ri Effluent Filter Manufacturer 1 ❑ NA rEstim timated umber of Bedrooms ❑ NA Effluent Filter Model nt � ❑ NA umber of Public Facility Units O NA Pump Tank Capacity al 13 NA flow (average) al /da Pump Tank Manufacturery V � 0 NA Design flow (peak), (Estimated x 1.5) 0 0 allda Pump Manufacturer S CI NA Soil Application Rate al /da /ft2 Pump Model 3 N Standard influent /Effluent Quality Monthly average' Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG► _530 mg /L ❑ Saul /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD,,) 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetiand Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑Other: Pretreated Effluent Quality Monthly average Dispersal Cells) o NA Biochemical Oxygen Demand (BOD,,) 530 mg /L ❑ In- Ground (gravity) D In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade XMound Fecal Coliform (geometric mean) _510 efu /100mI ❑ Drip -line ❑ Other: Maximum Effluent Particle Size Y in dia. p NA Other: JONA Other. C1 NA Other. "Values typical for domestic wastewater and septic tank effluent. Other: MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) gleast ce every: ❑ rno years) yews) (Maximum 3 ears! DNA Pump out contents of tank(s) bined sludge and scum equals one -third (Y.) of tank volume ❑ NA Inspect dispersal cell(s) ce every: ❑ month(s) year(s) (Maximum 3 years) DNA ❑ Clean effluent filter ce every: 0 month(s) o NA year(s) Inspect pump, pump controls & alarm ce every: ❑ month(s) O NA years) Flush laterals and pres sure test ce every: ❑ month(s) p NA Other: years) At least once every: ❑ month(s) NA Other: 0 year(s) EEE103 ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cells) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. 1 ^ F i t !^ a ! • 1 t _ _ r 171 i a _ 1 •r 1f s n i I _ R ! � t R Ir - 1 t i _ Ml 7 1 E I C' • i 1 R ♦ / t• t � lwtii ! /iii w in ww w #!!wi w ll/ #!!ii # w�rt iiiwlNiiltr l!!w lu �►= +�- fwls♦lsaYllatre►a�+rrs lair /�i} ' P •"'�r rsi!lwla.�ii1 •! #ww!!! // r.wli. /Nnite:�x� //t ■Nl�lrrr Wa NOON■ �►. ■Orr /►��'�� no in a4! /!ia !l! /!!liiw #N #! /w ► � ►uanlmm /iwiw lvO� mammon •' , •' ..r ; 1 �'',• . \�.�i!!w' ,iii! \�'friiills►'.Vwiliiliiliw i f A /sra ►i!llirl:+l r " 10rll� memo rA►aia \i►i /O!!Ai! /!NN #i! ��� /. /O/ /llil: iii /saw /! a / ►._ itt^ R: ,. �,;•isl�s�arsl�:M!lis.v/l!!wn t" � "�ti \li'.s. +!7l�t♦ \_ /OO►;� / /w. hills►• / / / /!! �'�`_�*��' •' �wOIM►iial.�a;� /wi►'!iw►�si /i /w ^! � lii ► �a`lwll�i: 1 \'#a�fili \� /iiliii n . . lri �NU N w.�l�i rl WMft, %l wiriw ■ili ii istli••� � \� 'ii!! /ir►. \� i#!/ f/ li iiiiliRi•iili►' \.; !!�i!!l !wwliwiNow lilt! / !!Biwa /!i� / #lllOiall : fl 1 f. R R i • t.;p„ }- IL Ina a; q �M A a! 'L3 y g C fF i 1. g 7T •O Qom. AD ' cs' oil t9 CP •► N mo ^ f { ° .� tp R sq . M1 �n �+ � cr o tp _ �-- 0� a ro m < w m �o 0 o f11 CD � ° v c Wisconsin Department ofIndustry SOIL AND SITE EVALUATION REPORT Page 1 of 3 Labor and Human Aelations - - - 9 DivisAn of Safety & Buildings x in accord with ILHR 83.05, dM. Code i COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size �ha (must i�FFlutl�'but S-7 not limited to vertical and horizontal reference point B direction and.of a f'T P EL I.D. # pE)v W dimensioned, north arrow, and location and distance to nearest road. , 0 Z RETAPPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION AiEVI D B DATE .1 .- II A/ PROPERTY OWNER: -- I — PRORRrAMnON e rCZ L� e fA.'D - Va3K 1 \S S cliu l j Z E4 <'_�4 S 1 ,S j �, T N,R l g E (a W PROPERTY OWNER` MAILING ADDRESS • # ` • BLOCK*_: BTi' AME OR CSM # TI Z S8 1Z1vE12S tDE �2f,uE � , °, � St�o>v 5 PrI�D . CITY, STATE ZIP CODE PHONE NUMBER OCITY DVWS OrOWN ' NEAREST ROAD 1Z1U� lJ-S w1 S�oZZC1tS) �ZS - �16t �Zp�{ k 1PIfM BUtLD�R New Construction Use pQ Residential / Number of bedrooms (J Addition to existing building (j Replacement ] Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate bed, gpd/ft - trench, gpd/ft Absorption area required SOD bed, ft SOO trench, ft Maximum design loading rate S bed, gpd /0 ' trench, gpd/ft Recommended infiltration surface elevation(s) 1.00• - ft (as referred to site plan benchmark) Additional design / site considerations M Ouh-� W /9 '�c 6 3 ' 8 ej�:) . Y-1 1 A.) . 1 Z,'` o F Fi LL Parent material LolzmS au\sn t-rh -► Ti,ki __ Flood plain elevation, if applicable ft S 71 i ystem CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U stem [IS O U I ®S O U O S OU O S 0 I] S 21 I ❑ S RrU SOIL DESCRIPTION REPORT Depth Dominant Color I Mottles I Structure Consistence Bartdaty Roots I I GPD /ft Boring # Horizon in. Munsell Ou. Sz. Cont Color Texture Gr. Sz. Sh. Bed ffiartdt vNvs+k�rocvx ) b_tu ti0�IZ3bZ — sl.l Z�b�r wt•�1.- cS 1� .s .6 .4 Z lD 2 ✓e 10`'lR 3b� - S I 3�sb1z CQ! S • b Ground zb -S9 ) -s'I Z Ll! elev. `eft y s9 - l0 6 l3 ti� f NP Depth to limiting factor Z6� Remarks: Boring # o -$ 1 Z 1 S 2'�ab1� wz`� �S ti� -S Z Z g -1$. Wy rZ 2x Ground 3 �$ -�� � `/IZ 31 y — sic 1 11n sb� �,,-� eS — z- '• ' 3 elev. U M -q L I (Yf ( L G �J, > 1 CO. 0 ft - Depth to limiting factor T __T_1___ L] 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: i/ Date: S ` 9 C* CST Number.. ' oo -►off -q 220254 J PROPERTYOWNER SCI+ULTZ SOIL DESCRIPTION REPORT Z w Page _ of 3 PARCEL LD. # C. Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bwxiary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1= .:....:::., 0 -9 low 2 3 t i s i J Z sb tiv, fi- �--S 1� • S • b u q -t9 1 U`t fZ �� Si 1 Ground 3 t9 -2S L vii IL 316 S) l ZM 510k kf't- :LS — g • b b elev. C19 ft. y z 32 --).5v2 �1 y Depth to S LS8 R - - - �p luP limiting factor Remarks: Boring # Ground elev. It. Depth to — limiting factor Remarks: Boring # 11:." Ground elev. It Depth to I limiting �. factor Remarks: 3oring # � gin. <::•:.;f . 'round ;lev. It. )epth to imiling actor Remarks: _ z PROPERVOWNER l SCgULTZ SOIL DESCRIPTION REPORT Page? of 3 PARCEL I.D. s< ! ��eijzuv C— Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Bourd3y Roots 9 1 Bed Trench 0� �`i23(Z 3 s i t Z Sb m fi- :!-S Y -S •, v St 1 Z sbh Ground 3 l9 -ZS L 6Lt 2 316 S I Zen. Sb1t h2fl4 qs — . S b elev. R -o It. y ZS 32 -SY2 31y S tC J 1 In S h1z ►n'�l- �I.v — , 2_ -� Depth to S 2 limiting — factor Remarks: Boring # r "M �a Ground elev. It. Depth to — limiting factor Remarks: Boring # MW:;v' ,i Ground elev. It. Depth to imiling 'actor Remarks: loring # .'round lev. _ It. ►epth to siting rclor Remarks: rl rr •r •rn.n ..r..... ' PLOT PLAN Page 3 of 3 SCALE 1 "= S� ' ly A �loo� N B.z r C26KPI�--T 012 3�' � i b �S1v�Zg - ►1� P�R� i EL. viU.O ON �� L(utti PLpE Q; T Q S x. 1 - I q,Ot.p' QQ 1" llZO PIpL 00.1 o3 -q4 •G. S —q —Op Z 2oZ, ( 715 ) 425 -01 CST Signature Date Signed Telephone No. CST ##+ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address J ay C41,.--C �t p�, � � , - ' tuj� A'o r" r aL Property Address -2 ? 2 -1 Zm f ft &/L,6%:; &L (Verification required from Planning & Zoning Department for new construction.) City /State IX4 -0-S0 1�4 , 4.r Parcel Identification Number 0 LEGAL DESCRIPTION Property Location SW 1 /4 , S£ '/a , Sec. N R I'i W, Town of Subdivision - L CA \r 'L j ;0T-(XJ 5TI4 4-o o (77 o &4 , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # , Volumc , Page # J Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52 1 and in Chapter 12 - St. Croix County Sanitary P () p ty 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, restrictcd 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. I /we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the owner(s) of the property described above, by virtue o a warranty deed recorded in Register of Deeds Office. Number of bedrooms -- rZ 4 '� W. SIN TURF OF APPLIC ( 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) 1 u, 2 7 Z 6 P 3 0 2 78426 1 WARRANTY QFFn KATHLEEN 9. WALSH REGIS -aF DEEDS THIS DEED made bobveen Brushy Mound Partners, LLP, a 5T. CEOIR CO. , MI Wlscondn LNaked L.blbft Phlrbters* ('Gr *xl and Terry M, RECEIVED .-OR RECORD Ranrwy and Jean M. Raney, husband and wife, as swviYOrafr;p mhar" Prnpeft("Gmrlhel, 01/95/2ft3 01 :00P?l WRNESSETH, OW ON said Grantor, for ramble aorWdwadon �� , f ON +H de ad I soots to Crobc WAR RANTY E1�w it Staft REC FEE: 11. Lot Kns4- four (9d), Plat of Glovrr Sr�on FNW Adddio" In the TRANS R FEE: 345.00 Township of Troy. sL Crok County, WfeoonsM E FA) 13 d A )rKVA 1 ck- Part of NO.1267- 30.000 (ramr ttlemar Bw Pt-wo ThislaAMP aOde pop ly Grantor, Brustw AAmm Pard►=. L P, a Wfsoptshn LhnW Lle r PertnemHp, is an afMMS of Denidc Homes, LLC. a W'wond n United LW Ay Corporation • Grantor develMs land and Derr* Homes, LLC Is a home construction cm*actor: GrOAOr a®rees to sd tirb lot to t3 on the 0wdMon dut Dwridt Flues. LLC old be the Wider of the hours for Grantw If Grantee doss not oolm ma oa>&trucom vAb Denldt Horns, LLC as the cmdrac6orA w tWO (2 ) ydara Of the data of safe of this Id to Gra vW Granite gfvee C tuft the k► as dam to set ft � Grantor for k Mw Grahttee bought k pwdwesr before owwft ** a home upon ft bt Grantee glut Grantor the dgN of" nWumW to rs Vw bt for the &m" pica as Grantes pall am . en for ti wh Gtanim bought k from Grantor: booed Oft 27maeyofII@MMb c Ste its AUTHOMATION ACKNOWUEDGUAM 3klraturo{s STATE OF WISCOMN ST. emm COLWTY aud►entlraaed tt>n _ tlay or tg em &bon nWftd 111ehael 911 M and RoMW Qwdd, a4 pmvb of mil► U*wW Partrn LL.K a y p, a ,p y , s LbdNd Llebfaty Psrvae* wn fo me kno W be who 9W knPOON kw&wnwg and (YVO or Dakar naraa the - T L F- I Et sTATE eAR of WLgco lsaz ' J-RUTLEDGE aua,orked by - 7WAS. WmL Ste) bva or PUMIC TW R&IRU P(r WAS t BY � dy . 200L V naln 0 Box 4445 9iinwa of 0«torJS siprirq In er4caveolb srrorattl be fles4 ar NowRichrnond, WI 54017 mUdadbalswarelralarataaa. 1 0 , IF ul NJ V 3 .. SJ ...®r I y I i PI M p � C g a. O m d EMPIRE BI L DflIVE V 4i I�r 8 p i . Parcel #: 040 - 1267 -30 -000 11/09/2005 02:33 PM PAGE 1 OF 1 Alt. Parcel #: 16.28.19.1455 040 - TOWN OF TROY Current ' X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner TERRY M & JEAN M RANNEY O - RANNEY, TERRY M & JEAN M 4461 JONNY CAKE RIDGE RD EAGAN MN 55112 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description " 321 EMPIRE BUILDER DR SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.515 Plat: 1999 - GLOVER STATION 5TH ADD'N '00 SEC 16 T28N R19W SW SE LOT 94 GLOVER Block/Condo Bldg: LOT 094 STATION FIFTH ADDITION Tract(s): (Sec- Twn -Rng 401/4 1601/4) 16- 28N -19W SW SE Notes: Parcel History: Date Doc # Vol /Page Type 01/05/2005 784261 2726/302 WD 01/09/2004 751052 2488/129 WD 07/15/2002 684104 1926/553 LC 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/23/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.515 99,500 0 99,500 NO Totals for 2005: General Property 2.515 99,500 0 99,500 Woodland 0.000 0 0 Totals for 2004: General Property 2.515 99,500 0 99,500 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i wisconsinOepartmentofIndustry, SOIL AND SITE EVALUATION REPORT Pag I of 3 Labor and Human-Reladons g _ Division of Safety 8 BuikSngs 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 not limited to vdrtical and horizontal reference point (8m), direction and % of slope, scale or PARCEL I.D. # 1u� 11v G dimensioned, north arrow, and location and distance to nearest road. ' APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWEDBY DATE PROPERTY OWNER PROPERTY LOCATION e' ZLZS $ E SC�JU C Z ^W ei SW 1/4 St, 1 /4,S JJOT ,N,R Lq E(or W PROPERTY OWNER' :S MAILING ADDRESS. 7 # BLOCK # SUBD. NAME OR CSM If ZS8 v_ S IDE — D2LUE I q GL STtmoru S !T")D. CITY, STATE ZIP CODE PHONE NUMBER OCITY OVILLAGE ®TOWN ' NEAREST ROAD 3 ? , A QE )t ] K S w1 Sgoj:LhL5) q s"- al6l �Zp� -{ tE�"1Pl(Ze ButUDE'R New Construction Use pQ Residential I Number of bedrooms [ J Addition to existing building (J Replacement [ J Public or commercial describe Code derived daily flow b0O gpd Recommended design loading rate ' `f bed, gpolft - trench, gpd/ft Absorption area required SOO bed, ft S00 trench, ft Maximum design loading rate S bed, gpd/ft2 _ trench, gpd/ft Recommended infiltration surface elevation(s) - It (as referred to site plan benchmark) Additional design / site considerations I ' " 1 ouh­�� w 19 ')e 8 3 ' 8 a�, . M l Aj . 1'Z,' O S-Pp� Ft iL . Parent material L S nu Lt -t roki Flood plain elevation, if applicable hJ P, ft S = Suitable for system GONVE MONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL MOM TANK U= Unsuitable for stem 0 S ®U ®S O U O S IOU I D S J U 0S IC 10 S a U SOIL DESCRIPTION REPORT Boring# Horizon Depth Dominant Color I Mottles (Texture I Structure (Consistence lBarrlaryIRoots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rftr& S -b Ground R q! S�RS18 elev. qqL-1fL y s9- 101.rz6 Depth to limiting factor Z6h Remarks: Boring # o -$ 1f3-1P•3LZ sit 2-Q�b� w, t - �S l� •S .G Z• Z 5 -18. )bvz 3/6 sji 1 w, Ground 3 1$ - Z$ S `Y►z 31 Y s icJ 11n S�� m-Q� Z € • 3 elev. y -cl I c�Li 2 613 t oo. 0 tL - Depth to limiting facto 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 _ CST Number:. ' " 220_54 PROPERTYOWNER Sef}(JL - rZ SOIL DESCRIPTION REPORT Page? PARCEL I.D. # 6 l) /U G Depth Dominant Color Mottles Structure Boring # Horizon Texture Consistence Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bourtd�y Bed Trench _.. 3 „= 0 1 �� 2 3 l Z s i) Z Sb f'r- �S 1'� . S • b q - t9 Ground 3 l9 -2S l Uk k 3A, S �) S elev. C M -C) It. y 2-3- -S'IrZ 31y S is J 1 �vr S L�1z w�`FI- �W - • 2- �'J I Depth 9 to S - — 1.3Q �D factor Remarks: Boring # Ground elev. ft. Depth to — limiting factor Remarks: Boring # i:t''•:2` 4h :2i� Ground elev. It. Depth to i limiting factor � Remarks: 3oring # ;round ;lev. It. )epth to imiting actor Remarks: _ •h rr •r •rnrr. •'.r .• PL P LAN Page of 3 SCALE 1 "= S� ' !y Q N 82 r C - 7 p NOT '�26KPPe-7 OtiZ La r Q. S "L Q)' O v l" t�4 P, IpL I 00 .1 o3 —q� -CO (715 ) 425 —n� �s CST Signature Date Signed Telephone No. C # - ArcIMS V At Page 1 of 1 1U I http: //72.21. 230.178/ website /LRPortal /ARCIMS /MapFrame.asp ?PIN= 12/27/2005