Loading...
HomeMy WebLinkAbout040-1294-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safely andM:uilding [Zivision INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 430470 0 GENERAL INFORMATION State Plan 1D No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Muller, Craig J. I Troy Township 040 - 1294 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: S Section/Town /Range /Map No: • 6 9 �' d /3 Z — fa_ 16.28.19.1687 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark ey S2 Dosing / / Alt. BM k P1 Aeration , 1 BI Sewer / Holding St/Ht Inlet L. , C 40 4 aid" TANK SETBACK INFORMATION St/Ht outlet, Az a TANK TO �P /L WELL B . 5Ven it Intake ROAD Dt Inlet p r SG�'f U ex-1, Septic / Dt Bottom / > it b' n � Dosing �� G Header /Man. �� Aeration Dist, Pipe Holding Bot. System 7 q • j 7 Z 0. % 21 ­ PUMP/SIPHON INFORMATION Final Grade Sits _� 7.5 Manufacturer and St Cover GPM g 2 r hs4t 5.q /o/ Model Number � 102.3 TDH Lift Friction Lo System Head H Ft S6rY� ¢ Forcemain Le Dia. Dist. to Well S -ABSORPTION SYSTEM BEDITRENCH Width i Length / No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P &C BLDG YVELL LAKE /STREAM LEACHING Man ur r: INFORMATION CHAMB R Ty Of System: S/ NIT Model Number: 1 7 T aL D TRIBUTION SYSTEM - VAS 4 He Id Distribution x Hole Size x Hole Spacing Vent to Air Intake r7 I o Pipe(s) ! ��- - Length /.� Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center - Bed/Trench Edges Topsoil Yes No -'� Yes I No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: /�&/AV,0/, � YY Inspection #2: Location: 51 c: a Road Hudson, WI 54016 (SW 1/4 NW 1/4 16 T28N RI 9W) Piney Woods Lot 12 Parcel No: 16.28.19.1687 �T -Co ✓ �o-c �d h� -- S>a-k" a� - - L) W *n ctif 99' - xf i s won " 4 y 0' ►`n s it l �.r �Ocev +t4m-` ter/ rte s �,, a Yes dD nformation. Date Insepctor's Sign lure . �LrC�� u�.�D f Safety told Buildings Division Courtly N)Pisconsin 201 W. Washington Ave., P,O. l ox 7082 ST. CROIX " Mamdi%mi, W! 53717 - 7082 $unitary Pen (to be filled in by Co.) Department. at Commerce 430470 aQ�- ` Sanitary Permit Application - S tate Pl I.D. Number In amord with Ccmrm 8121. Wis. Adm. Code, personal information you provide may be used for seumlary purpose( Privacy Law, st 'i.04(l Xrn) Project Address (if differem spun mailing addrnsc) - - - -- -&H EAST COVE ROAD L Applicatiion information — Please Print All information 5 1 � Pro�y owlyor s N aaw �E IVED 1'arccl .# Lot Block # CRAIG J. AND SHEILA M. MULLER 040 - 1294 -20 -000 (16 ✓ ncoi ry Ownet's Mailing Add ENISLO - 6 - 2 2004 Properly ('n 1912 SHASTA DRIVE - SW NW ,, Se�k>Er 16 City, State: Zip Cvdc } y , FFIC E -t s� HUDSO WI 54016 715 - 386 -391 T 28 N, R 1 9%V V ---- -- - - - - -- IL Type of Building (check all that apply) I I ur 2 Family Dwelling - Numiser ofBedwvomra 4 AS PER SUBMITTED HOUSE PLANS 5titmdtvas "�" Name CShi `"°° ❑ Pubiwecimnaaal - lcscmibe use PINEY WOODDS o w � ❑ State owned -- oc eribc 1)sc S C (N 1 ❑City_ IVi!lage LT[ itsltip of T / _ - -- Ill. Type of Per (Check only one bore on tine A. Complete line B if applicable) _ A- A N Syswrn 1.' Repla.erneid S ❑ Trealmetd/lioklitg Tank Replacernent (ktl y odw Modification to Existing System $ • ❑ Permit Renewal Pennit Keviston ❑ Change of Permit TranSffer to New Ltsf. Previous Pennit Number and Date I ssued Before Expiration Number Owner 430470 10/22/03 IV. T of POW`17S S tern: Check all that it 1 1- Nom - 1'resaztrized lu- 0round IJ Ltcxuul > 24 in. of suitable soil F) Mourxl < 24 in. of suitable soil ❑ At -Grade L l Single Pass Sand Fifter Cot�ucted Wriland ❑ Pressurized In- Cirorumd 11 llokh g 'r.A ❑ Pe1eaiitcr (I Aerobic Tremtmero Unit ❑ Recd dating & and Fiber ❑ Rerirrmttating Cynthelic Media Fiber Le"ingCharnlxer H Drip line ❑ Gi- avel-leis Pip. ❑ o#= (expt V. Dispe rsal/Treatment Arcs_ formation: (2) 87.5' trenches - 14 BioDefulser chambers ea. total 28 chamber abel A -1 effluent Design I -low (Md) Design Soil Application Rate(gp(Lst) I)ispetsal Area Required (s em £levy 600 .7 `/ 857.14 3r . 96.75 VL Tank Info amity in Total Number Mamrfacturer Prefab Site Steel Fiber Plastic Galiawrt Gallons of knits Concrete Coogrucled Glass iiew Exasttnat T:nmks Tanks Septic or Uoldiqg 1ank X 1250 1 WIESER X Aerobic Treatment Unit FTnsin�A Chaimhcti Vii. Responsibility Statem mt- 1, the mrmlersigweC nsmune responsibiliq for pia otdir FONTS shorn ea time attached Fla Plumber's Name (Print) Plturaw' PRS Number }l�mvincge Phone Number TODD FEATHERSTONE 242514 715 - - - -- - - Plumber's Addr (Stroh, City, Sifafe, Lip ,o(lc) P.O. / BOX 467 H UDSON, WI 54016 Y trawl /1)e arttmeaI Use Oaf { Approvixl ❑ Disapproved Surcharge ernul Fee (includes � akx Date Isstme(1 I nmg Agerti .D -Iure } G/ ❑ (haws Given Reason for Deena! Conditions of ApprovallReasons for Disapproval 13 1 to am caniiy ady) for t �C an paper 17 k= than tall Il - ribe mod , �t�� ee #W4J- d4 y rte_ � .• `�•.: 3.11 q pg� gamma* 410,0, mg , '. mo ll ", M '' ' Ot 4 No M Dec 10 05:22p Mary Jo Hollister 7154261775 p.3 C'C FILM fryOAWP- MuLPER, Cry +tom t11? l2 �1101 W ODL�S 0 1 - SPiK�IN Kou�Q Assuan 7x8 w Ot (� sT CRO E� s R7r; o t= W Inca LI s► *!, NO COMM 83 5EVACK !' 1 ! "T►2on, Pip 6 F- r- ► oo. D F-75 I \ SLO t;L 102.70 . �p OF etAc C 'hit) �0` Sro lE rnY i A C fcw I � 11 s C a-iLLa. <k fin. 2 wfl bh - - - - -- P,! - Z r3 z TO �i ores s 3 a l maw _l r err �,► - it . � � ,-::,,�•� C� E ♦ 1 . fs 0 *got 0 V 'a o $� � rwN � � Q 1 r � � 1 ... dm � t EAGLE U e e, ............ ...... BL .. . FF :c k FND 2 ' IRON PIPE . 04 34' E 0. 62' NORTH L IMIE of THE SW li4 OF THE Nw 1i4, SE '' ' M SET IRON 331 3,3 N88 43 "E l 1302. 44' (TO NW COR. LOT 1 • 1 174. 10' l !6.02' y 79. 10' 231.82' •'44. ........... 33 6, 6 ' .. . .. 450. 04 .! h) ° ; 48 • QS' y� DRAIMAGE o _ g (819.26; THIS SF O p g �' EASEMENT ~ °'- �' _° 30' DRAINAGE Z�6 f1• S 14'38' 22' 14. �: • I c EASEMENT�a� r ✓9 �' oi �►; 1 S '37 f rr • q,1 �': ,-ra1.1i1► , 1 N88• I4' 38 E� •'� rr f ' 33' 33' 1 S32 29' E A� :1 - '\ 3 . - - " - - �, . 32 �• 1 f O7' 1 36.62' 3 • E ti. r g • k 100, 876 I t- 3 ' r ; r �'• 2. I4 ACRES EXC, .......... N ?d' 3? I 33'3.66' 32' ' I 83, 063 w 1 80,285 SO. FT. 66. 73' ,�' 1.36 ACRES EXC. i S E �; i O DRAINA EASE. I I .......................... v INA 1 : - - 38,04o - - - � / I 589 16 "E - - N88° 57' 43" E 220.99' ( S88 57 43 W 433.53 55.09 ---- - - - - -- 281 . 44 '----- - - - - -- -• 97.00' - ��i'� �� 10 • N L OT 15 2 1.35 ACRES ro 58, SO. FT. LOT 14 O N 46 5. 12 ACRES O O 222, 861 SO. FT. S89 59•W 279.63' w v a �v ro v ......................................... ............................... 739.03' 340.34' S88 ° 57' 20" W 1299. 57' UNPL A T TED L ANDS . ........ ............................... SYSTEM CROSS SECTION CRAIG & SHEILA MULLER - RESUBMIT 12/18/2003 2 MAN HOLE INSPECTION P IPE GRADE ►'G� cesi- 4- 1250 GALS. U E- ZABEL FILTER �....._...._��.»,. 87.5 � SYSTEM ELEV. 96.75 14 BIO DE US O O .._ 87.5 — -- Q 14 BIO DEFUSER C pip 040 - 1294 -20 -000 SW +/ NW y 4,$ 16 T 28 N,R 191E LOT 12 Bl.- suB PINEY WOODS C� 242514 Dec 10 05:22p Mary Jo Hollister 7154261775 p.l Wisconsin Department of Commerce SOIL EVALUATION REPORT Page Of 3 Division of Safety and Buildings i n accordance with Comm 85, Wis. Adm. Code County St Croix Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 040 - 1294 - 20 - 000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, S. 15.04 (1) (m)). Property Owner Property Location Craig Muller Govt. Lot SW 114 NW 1/4 S 16 T 28 N R 19 E (or) Property Owner's Mailing Address Lot # Bloa # Subd. Name or CSM# 1912 Shasta Drive 12 -- Piney Woods City State zip Code Phone Number dY V - dlage - Town Nearest Road Hudson, W1 1 54016 ( 715 ) 386 - 3918 F. Cove Road Q New Constriction Use Residential 1 Number of bedrooms — - .4 Code derived design Flow rate — 600 GPD ❑ Replacement Pubic or commercial - Describe: -- - Parent material � rn,twach _- Food Plain elevation if applicable General comments conventional in- ground trenches to be designed by installer and recommendations: system elevation 94.00 11. a Boring # ❑ Boring o Pit Ground surface elev. 102 — .7 ft, Depth to limiting factor 204 in. Soil icatan Rate 'Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF in. Munsei Qu. Sz Cont. Color Gr. Sz. Sh. 'E"l - Eff#2 1 0 -9 1OYR2 12 sl 3f-mgr mvfr cb 3vf -co 0.5 0.9 2 9 -26 JOYR2l2 Is 2f -mabk ds cb 2vf -co 0.7 1.2 3 __ 2620 ' 4 ' 10 6 - s Osg dl - - 0.7 1.2 SOmC >3r; few ste VV. ILI 1 Boring # 11 Boring 98.00 186 2 F Q Pit Ground surface elev_ ft Depth to limiting factor ____ in_ Sal licatlon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Etf#2 1 0-4 10YR2/2 S1 3f -mgr mvfr cb 3vf -co 0.5 0.9 2 418 10YR212 Is 2f -mabk mvfr cb 2vf -co 0.7 1.2 3 18 10YR33 Is If- -mabk ds cb 2vf - co 0.7 1.2 4 27 - 10YR3 16 s Osg dl 9w 2vf -co 0.7 1.2 5 53 -84 10YR414 - s Osg dl lZw 1 of -co 0.7 1.2 6 84186 7.5YR3/4 - s Osg dl - - 0.7 1.2 r (some gr, few stoics.) ` Effluent #1 = BQD > 30 c 220 mg/L and TSS >30 < 150 mgrL ` Effluent #2 BOD < 30 mg& and TSS < 30 nri CST Name (Please Print) - Signature f �� CST Number M 7o Hollister 2 oa. S � 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Fails, WI 54022 12 - 06,07 - 03 (715) 425 - 1775 h !1 s- DWc 10.03 05:22p Mary Jo Hollister 7154261775 p.2 Muller, Cra ig Parcel ID # 040 - 1294 - 20 - 000 p age 2 of 3 Property Owner -- - - - - -- — 3 Borin � Boring g # pit Ground surface elev. _ 99.40 ft. Depth to limiting factor 16 — in. Soil A !ration Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ff in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 1 0 - 10YR2 12 — sl 3f-mgr mvfr cb 3vf-co 0.5 0.9 2 8 -14 10YR3/3 _ sl 2f -mabk mvfr aw 2vf -co 0.5 0.9 3 14-30 10YR3/4 — is If -mabk ds gw ivf-co 0.7 1.2 4 30-60 JOYR3 /6 -- s Osg dl gw Ivf -m 0.7 1.2 5 21 7.5YR3/4 -- Is lf- -mabk ds - - 0.7 1.2 (some gr; few stones) D Boring # Baring 100.00 210 r pit Ground surface elev_ ft. Depth to limiting factor--- in, F - SoIIA43Vicafion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. 3h. 'Eff#1 'Eff#2 1 0 - 8 10YR2 /2 - sl 3f - mgr tni eb 3vf - co 0.5 0.9 2 8 - 1 Q=12 sl 2f -mabk mvfr cb 2v1 co 0.5 0.9 3 20-30 10YR3 16 sl I f -mabk mvfr gw 2vf-co 0.4 0.6 4 30 -96 7.5YR3/4 -- s Osg dl gb lvf m 0.7 1.2 5 9 10 7.5YR4/4 __ s Osg dl -- -- 0.7 1.2 F Boring # towing -- Pit Ground surface elev. ft. Depth to uniting factor rct. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /Hr in. Munsell Qu. Sz, Cont. Color Gr_ Sz. Sh. - Etf#i I "Eff#2 Effluent #1 = BOO, > 30 i 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mgtl and TSS c 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. SED-8310Test (K.o . ") A ~ Wisoonsin Department of Commerce SOIL EVALUATION REPORT Page 1 of Division of Safety and Buildings in accordance with Comm 85. Weis. Adm. Code Counly St Croix Attach complete site plan on paper not less than 81/2 nches in sae. Plan must include, but not limited to: verkm) and hor¢onta) e�aa0d.. Parcel I.D. 040 - 1294 -20-000 Percent slope. scale or dimensions. north arrow. and I r+�est Please Print all info by Date Personal adaffnadon you provide may be used far purpos ` { P ivac L iv. (�) t )• D Property Owner Property ■ Craig Muller ST CROIX C ytot SW 114 NW 1/4 S 16 T 28 N R 19 E (or) w Property Owner's Mailing Address # # Subd. Name or CSM# 1912 Shasta Drive 12 — Piney Wks City State Zip Code Phone Number ❑ Village own Nearest Road Hudson, WI 1 54016 ( 715 ) 386 - 3918 E. Cove Road New CansUUCtion lJseE) Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material nntwach Flood Plain d ee abon N applicable WA R General comme conventional in- ground trenches to be designed by installer C and recommendations: system elevation 94.00 ft_ l ` 1 �g # ❑ Boring t> l Q Pit Ground surface elev. 102.7 ft. Depth to irnilth9 factor 204 n. Soli Rate Horizon Depth Dominant Color Redox Description Texture Structure Co Boundary Roots GPDAfz in. Munsei ou. Sz. Cont. Color Gr. Sz Sh. 'F�1 ' 1 0-9 10YR2/2 — A 3f -mgr mvfr cb 3vf-co 0.5 0.9 2 9 -26 10YR2/2 — Is 2f -mabk ds cb 2vf-co 0.7 1.2 3 2 04 10YR3/6 — s Osg dl — — 0.7 1.2 (some gr: fcw sWW&) x () ? F n2 Boft # ® 98.00 186 J Pit Ground surface elev. fl. Depth to rNnitil factor n. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Rods GPDW in. Munseti Qu. Sz. Cont. Color Gr_ Si Sh. 'E##1 I - EfW2 I 0.4 10YR2/2 — sl 3f -mgr mvfr cb 3vf-co 0.5 0.9 2 4-18 10YR2/2 — is 2f -mabk mvfr cb 2vf-co 0.7 1.2 3 18 -27 l 0YR3/3 — Is 1 f -mabk ds cb 2vf-co 0.7 1.2 4 27 -53 10YR3 /6 — s Osg dl lw 2,fco 0.7 1.2 5 53 -84 10YR4 /4 — s Osg dl 9W 1vf-co 0.7 1.2 6 84186 7.5YR3/4 — s Osg dl — — 0.7 1.2 (some gr, few 7 .a•) Effluent #1 = BOD > 30 220 mg& and TSS >30 5 150 mq& Eftpt #2 = BOD < 30 rmgA. and TSS < 3D mglL CST Name (Please Print) Signature CST Number M 3o Hollister 224832 Address Date Evaluation Conducted Telepfone Number W9875 690th Avenue, River Falls, Wl 54022 12 - 06,07 - 03 (715) 425 - 1775 Muller, Craig Parcel ID # 040 - 1294 - 20 - 000 P Property Owner 2 3 a Boring # Boring 216 Pit Ground surface elev. 99.40 ft Depth to Wnifing factor n_ Soil Rate Horizon Depth Dominant Color Redox Description Texture Sinrcture Consistenoce Boundary Rods GPD1fP in. Munsefl 12u. Sz Corti. color Gr. Sz Sh. 'EIf#1 'Eff#2 1 0-8 10YR2/2 — sl 3f-mgr mvfr cb 3vf-co 0.5 0.9 2 8 -14 10YR3/3 _ sl 2f -mabk mvfr aw 2vf-co 0.5 0.9 3 14-30 10YR3/4 — Is 1 7b f bk ds 9w 1vf-co 0 -7 1.2 4 3 10YR3/6 — s dl gw lvf-m 0.7 1.2 5 60-216 7.5YR3/4 — is k ds — — 0.7 1.2 (some gr. few stones) 4 Boring # � ] R Depth to 1n►xtin9 factor 100.00 210 n- ■ Pit Ground surface elev. Sol Application Rabe orizon Depth Dornirant Color Redox Description Texture Structure Consistence Boundary Rooks GPD/It' in. Munsell Ou. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 1 L l ag 10YR2/2 — sl 3f -mgr mvfr cb 3vf-co 0.5 0.9 4W 8 20 10 _ s1 Zf -mabk mvfr cb 2vf-co 0.5 0.9 3 20-30 10YR3/6 — sl I f -mabk mvfr LrW 2vf-co 0.4 0.6 4 30-96 7.5YR3/4 — s OSg dl tb I vf-m 0.7 1.2 5 96-210 7.5YR4/4 — s Osg d1 — — 0.7 1.2 a Boring # 0 Boring Pit Ground surface elev. ft. Depth !o limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cork Color Gr. Sz- Sh. 'FJF#1 '1002 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 ffKA ' Eftxx t #2 = BOO 5 30 mg& and TSS < 30 nWL 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- 8330TCA 1K.0710D1 r i..v i r env flAa-3-ff 3 M50r": ta7 12 F 1Ng W oaas BMc = sPt KC- iN F �c u�iD ftssunn .DCAzn 1Ai'T +C SW Y y t "► lO Al W 4. SEC - Ma 60 )F z ^). m ATE F W ��C1113 S► �) t��PKOMG -MX 9 /Z "AQOd6 GA 50L "N6 "WG W/ OALKIJM 10 P ti 1 jgo) PI ne - pROP�T�� CD�f� y eL 100.0 S ,� o sco 4EL- 102- Of 3 �$M ® 42- y ewle of eAACK ?UP o� RID G' 16 19 WEST, TOWN OF TROY, ST. LESS THAN TWO(2) ALL DRIVEWAY OR i EROSION CONTROL P toll 943. NI - G'. - t HWE= 7.00 ©r ° ORAfNAGE �! �v / / / 8 / 55 /. N.B. 1.9 Ac. p .6 / x 918.0 I � 20.2 F.E. 91992 630 RAD. N H8 74 3 E 22Qe99 FT AD / X N v N 88'57 •• E 9 6 FT. 281 4_F - -- x 9 1 x LOT 15 -J22.7 X 914.6 I 5$32 S.F. j 1.35 Ac. // / 74 PI.B. 58832 ° I / N \ 915.x J N.B. 1.35� cc. / o N. �� �� � \ 917.S 89'40 W-- 279.64 FT. _ X 918.4 X -� \ x 914.7 10.2 OWNET Y. i � BARB \ Safely and Buildings Division county 201 W. Washington Ave,, P.O. Wx 7082 ST. CROIX Pisconsin Madison, W 53707 - 7082 Rani tav Permit Number (to be filled in toy Co.) Department of Commerce ,\) (608) 261-6 Stak N Sanitary Permit Application Plan I.D. uinber In accord with Comm 93-21, Wis. AdFM Code, pmxinal information you provide may be used lur swowlary purposes rnracy Law, sul." 1)(m) "od Address (if different Vian mailing address) L Application Information - Pkase Print All Informau on &,5 Property Owner's Navie 12 Block CRAIG J. AND SHEILA M. MULLER 129 - 2-0 -cft-6.101 Properly Owner's Mailing Address Property Location 191 SHASTA DRIVE _ __._ _ __. SW v., NW�/,,sdi 16 City. State zip Codc Phone Number HUDSON WI 54 1 6 715-386-3918 T 28 N; I= 190= W I IL Type of Building (check all that apply) �de IX I or 2 Family Dwelling - Numbw ol"Bed. 4 Subdivision Nam CSM Number tj r),--Wxibt Uw PINEY WOODS State O - Lkamrihc, 1-1. Hcity_LjyA`af,,- PlTownsllup of TROY 111. Type of Permit (Check only one Ims on line A. Complete line B if Applicable) A- New System 0 RqAtioemem SyMm [J Tr"triwWRokling Tank Replacerrient Only 6dwmficaion to E)6sfir System Z B. n Permit Renewal ❑ Permit itevision ❑ Change of I Permit Trwwrer to New ust Nu -Grade te issued Before Expirabon Plumber owner R . IV. T Y of POWTS System: (C k all that 11 ----------- NNan Prcs&wiz,.dla-(Jmmd LiMixind-1 11 in. mound < 24 in. of s -Ciradc H Singic Pass S,%nd F H- p u Oble sou ❑ At mber Elf Constructed wetland Ll Pressurimd In -Ground J.kfig ❑ Peat t:ittc, FJ Ae T,.Aniont Unit El Recirculating :n ut RevirmilAting Synthetic Media Filter f] initChain HT)wij. Fjcma,04esspipc 0 Otter (cwtaw) V. Dispersalfrreatment. Area Information: 3 Cells a.1b BidDefuser chambers per cell -total 39 ---��Zab Design Flow (Wd) Design Soil Application Ratefgpdsf) Red (. Sy Ar- r-5 600 .5 17 1228.5 VIL Tank b1b C ity in TOW Number N Prcfitb Steel Abeir Plastic m ft, oi. (is lons Galkwo of I inits ConcratA C �- FT - i4w Emst T-wiks Septic or Holdirg Tank x 1250 1 WIESER X nrwne chnnher V11. Responsibility Statement- 1, the te'. Rims f the Pi) the aftwbed pWw Plumber's Naaw (Print) Pkw0w' re PRS Number thm"w-n% Phone Number TODD FEATHERSTONE 242514 715-381-1704 Plumber Address (Street, City, State, Zip C >4 P.O. BOX 467 HUDSON, W1 54016 VIR Comae partipnewl Use Only Permit Fee (inchides Groundwater Dale Imued �� ,,-d a Di sapproved Surcharge Fee) I 0 11 / - ANO Stamps Owner Given Reason for Denial I � 2 TD .tz/o IX Conditions of ApprovalfReasons for Ihsapproval 3) T n A �� SYSTEM OWNER: 1 Septic tank, effluent filter and 4- dispersal cell must all be serviced / maintained If> as per management plan provided by plumber. 2. All setback requirements must be maintained¢ � Sc as per applicable code/ordinances, Mach C ty"*Owdws-YAM �iCS t bw�= CV " �K J e� wj �104 - LS 0 C.-Na&4N, �zu k�i� p6z I r MAO- ACV– MAQNS *�sa�ras�a• ISO E 143a Oi LU a R In w ob :•: d- P,v • • � a�i�t�i�f�s�a��r�aaayi• • a c 0 3t 33 '' ' ` N t • as iw a* do ar •rr 4w •r .r .0 wa e t3 Fe 00 �,:, o r E • OWN t0o 01" 400 Aw I L do f / ♦ In on . ., t #a do OP 4m dob irE >^•1'Y . I a • t _. . • • a .• � < •: �. � � � � ti s �� • /� �t . ` 1� �.7 _ �. . ' -` __ a • • 1 • • � � � � SYSTEM CROSS SECTION MAN HOLE INSPECTION PIPE GRADE Apo. ZABEL FILTER 1250 „ 62.50 1 @ 56.25 SYSTEM ELEV. 9 - 11 BIO DEFU SERCHAMQFRS 1250 �- 56.25' 10 - 11" BIO DEFUS 65.50' 10 - 1" BIO DEF SER CHAMBERS 65.50' r10 -11" BIO DEFUSER CHAMBERS 65.50' PID # 040 - 1065 -70 -000 SW �/, NW + /4,S 1 28 KR 1�YllE LOT 12 BL SUB PINEY WOODS C 0 Y O T FM3 242514 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code _ Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. \ I h1 G percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. evi ed by Date c. o....o. .:..;,.:..c..•... j :... .:::...:.c God ✓a wc.. .. ao...... Nu�,.Jaca �I"6 acs/ ..cr.. a. 1J.v. l/ trill- ` to Z Q Property Owner Property Location 9 N RIZD Pr L 6e%4 SQ 1 /4MIJ 1/4 S) b T Z8 N R 19 E (o Property Owners Mailing Address L # Block # Subd. Name or CSM# ?L (v WOflp S S°t City State Zip Code Phone Number ❑ City ❑ Village ®Town Nearest Road R1 U )2. Ft' U-. by 1 Std o IL 15) 1 4 2S- L - ) q Z q New Construction Use: Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material O U ICJ Flood Plain elevation if applicable General comments , and recommendations: �L e,� 3 I X ZS 'l—OW G ki / l UN 1`1's t-lvs-rro C T— deu-S - vz� 8t�F 3 ,aft A+ 0 4 2002 ST d1jyjalk ❑ Boring Boring # tf Pit Ground surface elev. 40 ft. Depth to limiting factor S in. r' . ii Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary G in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. EEff#1 'Eff#2 G -� 7 16 L>Z 311 Z- L \esbk mu` ew �fL Boring # ❑ Boring pit Ground surface elev. 3 ft. Depth to limiting factor ' -2 6 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 0-$ lo y1Z 3 IZ — L lcsbVT- vnVf - — - 6 Z � -NCO 1o`tr?- — l ZQ- sbk YIN \ )i@- S ,9 ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signa4ire CST Number Arthur L. Wegerer Ol -31g — 11 220254 Address (, e g e r e r Soil Testing & Design S e r v i c e Date Evaluation Conducted Telephone Number 421 W. Hain St. River Falls, VI 54022 11 715 -425 -0165 F�] Pa Property Owner Boring # Boring rcel ID # C� Ip l G Page Z of ❑ Pit Ground surface elev. �0 Z • d ft. Depth to limiting factor 7 7 S In. Soil Application Rate Horizon Depth Dominant Color Redox Descri ption Texture Structure Consistence Boundary Roots GPD /ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eft #1 •Eff#2 0 -1S layrL -jl z - L �csbk mvf�- cg _ .L4 . 6 Z 1S-1� IOLI 1Z31 it Z msbk ,,� r ,S _ 3 36=15 lOy S1ro — S t IS OS w► 1 — - t. Z F-1 Boring # ❑ Boring ❑ Pit Ground surface eiev. fl. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 F-1 Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Sli P ucture Consistence Boundary Roots GPD /ft z In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 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 opportune service provider and employer. h' P 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. SOD -6330 (RN00) t PLOT PLAN Page 3 of 3 Scale Z2� �r U r----- - - - - -- M \ CA \\ 35' 10\ 3S %m wz, E -, °1.4.9' , \Z - -0 1 715- 425 -0165 220254 01 -3IS- 1Z CST Signature Date Telephone No. CST No. Job NO. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa I of 2 FILE INFORMATION SYSTEM SPECIFICATIONS Owner , e(LA 1\"LL -LeV, Septic Tank Capacity 2 al ❑ NA Permit # O �� Septic Tank Manufacturer W C(�j( --(L� ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer C—(„_ ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model — (Q (j ❑ NA Number of Public Facility Units IV A Pump Tank Capacity a l ONA Estimated flow (average) al /da Pump Tank Manufacturer OFNA Design flow (peak), (Estimated x 1.5) &D gal/day Pump Manufacturer PA Soil Application Rate © .So al /da /ftz Pump Model A Standard Influent /Effluent Quality Monthly average` Pretreatment Unit "A Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Fitter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) :5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD :530 mg /L i t In-Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) :530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric me _ :10" cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other ❑ NA Other: ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank ❑ month(s) Maximum 3 years) ❑ NA s) At least once every: ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ (s) (Maximum 3 years) 13 NA Y ear( 1 Clean effluent fitter At least once every: ❑ month(s) ❑ NA year(s) Inspect pump, pump controls & alarm At least once eve ❑ m ) ls) � NA every: ❑year (s) ❑ month(s) Flush laterals and pressure test At least once every: ❑ year(s) r Other: ❑ month(s) � bNA At least once every: ❑ yearls) 7 Other: A 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 cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third IY 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. Page Z of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals, that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power 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. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; 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. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or: must be taken, to provide a code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil 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. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. till, T aluat' a o ing tank b e ai ?RDq rreZ�, fOR- A/OV 406JS`TRUC ❑ 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. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name p C� Name Phone S'. Q f Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name f5t Ckb ( b 20AI1 �t1 Phone Phone — 71S — 3W(0- 49 O This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &(f) and 83.5401, (2) & (3), Wisconsin Administr #tive Code. ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address f �1���5�� ty�/�SGh et/j- S yD�f Property Address ERs T C 'B )n-,P--- (Verification required from Planning Department for new construction) City/State tTLeld �'� l/I/T Parcel Identification Number 0 - 12 AI Zo - 000 C. 16 g }) LEGAL DESCRIPTION Property Locatiowf46 %,, �Gl /., Sec. T N -R-ZZ-W, Town of /�o fr Subdivision i✓�E L��oa S . Lot # /o;:Z Certified Survey Map # . Volume . Page # Warranty Deed # _ 3 BOO - ----- , volume . Page # Spec house O yesAno Lot lines identifiable yes O no SYSTEM MAINTENANCE Improper use and maiatenanceof yuor septic system could temp i a its prrunatume farTume to handle wastes. Propermaratenance consists of pumping out the septic tank every duce years or sooner, if neededby a licensedpamper. What you put into dre system can affect the function of the septic tank as a treatment stage in the waste disposal systems. The property owner agcas to submit to St. Croix Zoning Department a certification foam, signed by the owner and by a madwplund)e4journzymanplunilm nstrictodphmrber or a h=sedpamper verifying that (1) the on-s to wastewaterdisposal system is in proper operating condition and for (2) afta Ins; mzbon and pun 4=g.(if necessary), the septic tank is less than V3 full of sludm ifwe, the nmdersigaod have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth. berein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Catifieation stating that your septic system has been maintained must be oompletod and retu mad to dre St. Croix County Zoning Office within 30 der f the three year expiration date. T . SI OF APPLICANT DATE OWNER CERTIFICATION . I (we) catify that all statements on this form are true to the best of cry (our) knowledge. I (we) am (are) the owna(s) of the descrrbed above, by of a warranty deed recorded in Register of Deeds Office. SIGN OF APPLICANT DATE ssss «s Any information that is mars - represented may result in the sanitary permit being revoked by the Zoning Department s «ssss ss Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed •, * J 2329' 132 - 7 31aOO STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH REGISTER OF DEEDS Document Number WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD J. Joyce and Jo dahl This Deed, made between Donald O. R odahl Y 07/24/2003 09:30AK Rodahl, husband and wife, WARRANTY DEED EXEVPT # 17 Grantor, and Cr aig J. Muller and Sheila M. Muller, husband and REC FEE: 11.00 wife, TRANS FEE: 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 (if more space is needed, please attach addendum): Recording Area Lot Twelt (12) iney Woods Subdivision in the Town of Trov. St. Croix Name an �� OGLAND County, Wisconsin. —� ATTORNEY AT LAW P.O. BOX 359 This deed is given in fulfillment of that certain Land Contract between the HUDSON, W154016 parties hereto dated January 17, 2003, recorded January 23, 2003, in Vol. 2119, Page 315, as Document No. 706924. Part of 040-1065-70-000 Parcel Identification Number (PIN) This is no t homestead property. 00 (is not) - Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this '2.177 VI( day of J uly 2003 + Donald O. Rodahl P -- • Joyc(piodlll AUTHENTICATION ACKNOWLEDGMENT Signature(s) Donald O. Ro dahl and Jo J. Rodahl, h STATE OF WISCONSIN ) and wife, ) ss. Y ay �� - - -- - -- County ) authenticated this of July _ 2003 Personally came before me this day of the above named • Kristina Ogland TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not instrument and acknowledged the same. authorized by § 706.06, Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY • Attorney Kristina Ogland Notary Public, State of Wisconsin Hudson, WI 54016 My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not necessary.) ') ' Names of persons signing in any capacity must be typed or printed below their signature. jnlormation Protaubnals company. Fond du l e , W1 600-655 -'021 WARRANTY DIED FORM BAR OF WISCONSIN FORM No. 2 - 1999 Parcel #: 040 - 1294 -20 -000 10/18/2005 08:06 AM PAGE 1 OF 1 Alt. Parcel #: 16.28.19.1687 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 CRAIG J & SHEILA M MULLER 0 - MULLER, CRAIG J & SHEILA M 512 E COVE RD HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 512 E COVE RD OR SC 2611 SCH D OF HUDSON SP 1700 W1TC Legal Description: Acres: 1.840 Plat: 2331 -PINEY WOODS SUBDIVISION SEC 16 T28N R19W SW NW LOT 12 PINEY Block/Condo Bldg: LOT 12 WOODS SUBDIVISION 381 CEDAR CT Tract(s): (Sec- Twn -Rng 401/4 1601/4) 16- 28N -19W SW NW Notes: Parcel History: Date Doc # Vol /Page Type 07/24/2003 731800 2329/132 WD 01/23/2003 706924 2119/315 LC 418/476 2005 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/06/2005 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.840 94,900 333,200 428,100 NO Totals for 2005: General Property 1.840 94,900 333,200 428,100 Woodland 0.000 0 0 Totals for 2004: General Property 1.840 94,900 32,500 127,400 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