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HomeMy WebLinkAbout040-1269-60-000 ST. CROIX COUNTY 'ZONING DEPARTMENT AS BUILT SANITARY REPORT Owner /E 77PfE stir �,dcit 3Go City /state f/ w /•S. ..rata Lcgal Description: (,J 000 {SOY l 1.28' /F, i Lot Block Subdivision/CSM # 7 YF3 1 1 , Alw 1 /,.s,tJ , Sec. / 7 , T N -RAW, Town of PIN # Dy0 • /Z Ci y • 60.OYly SEA' ITC 'TANK -- DOSE CHAMBER -- HOLDING TANK INFORMATION We -�� 1�.� W. 50 >so Wank manufacturer G Size ST/PC / Setback from: House Well P/L Pump manufacturer Model Alarnt location (HOLDING 'TANKS ONLY) Setbacks: Service road ent to fresh air intake Water Line Meter 'location Alarm location SOIL ABSOR TION SYS'T'EM � 3 y, 54 , 1311 0 or - FaSae a //S 3 3 5& ' Tyne of system: Width Length 3X CtZ Number of Trenches Setback from: House Well 7P/�L 4 ' Vent to fresh air intake ELEVATIONS �. „ Description of benchmark TOP o F �' PVC ���`�' Elevation ' i Description of alternate benchmark OG EXpojep S•T • AAwlw<.e _ Elevation 7. ,( Buildi -ii Sewer �� ST/IiT Inlet y r • /y, ST Outlet �5' ice(✓ PC Inlet PC Bottom Header /Manifold Top of ST/PC Manhole Cover Distribution Lilies ( ) O O Bottom of System ( S� � & 7 — Final Grade ( ) O ( ) Date of installation / / Permit number �2 r / 0 �/ State plan number I r ' Phimber's signature License number � S Date lnsptrtox �ic .vim✓ / cl /��S � ' Z� • �a3 Complete plot plan * i THIS PQy�/T SYSTEM Ulbricht & Associates INCORPORATE SHALL Private Sewage Consultants 83. INCORPORATE A PER COMM 2812 10th Ave. PR PER ZABEL Spring Valley,'Wl 54767 FILTER MODEL # � s ORIr7INAL to zf ti4' w� Q _. _ ----------- - -- - -" TO ( 1 c 3.7 T or -- - ®V G 1 1 d 5 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 429907 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Appletree Builders I Troy Township 040 - 1269 -60 -000 CST BM Elev: Insp. BM Elev: IBM Description: Section/Town /Range /Map No: 1 0 0 -6 / m 17.28.19.1483 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic - �� Benchmark 7►'t S &K bS•� /U� . Dosing _ r Alt. BM J 1 7. Aeration Id . S wer Holding St/ t Inlet t/ t Outlet �" / t- ' fo TANK SETBACK INFORMATION /p 5 V `f C S.7/ TANK TO � WEIR BLDG. Vent to Air Intake ROAD Dt Inlet / Septic / 0 ' I q C t " : Dt Bottom Dosing U Heade an. 3. Aeration Dist e . I/ Holding Bot. System 2 (3, q I- t o Final Grade PUMP /SIPHON INFORMATION 5a0, Manufacturer Demand St Cover / 2 3 y Model Numbe TDH Lift Fri o System Head TDH Ft Forcem ' Length Dia. Dist. to Vr SOIL ABSORPTION SYSTEM s'V,,{: -C,�, - - 3 s e - 74 0 eei v� BED ENSION H Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. liquid Depth DIMENSIONS Jl 7i / SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACH ING Man - , cturer: T INFORMATION CHAMBER OR Yj ' b • S7� Type f System: / UNIT Model Number: h D g j DISTRIBUTION SYSTEM i - 3 Header/ anifold, ^�- Distribution /_ x Hole Size x Hole Spacing Vent to Air Intake Pipe(s Length Dia length Di Spacing 7 r� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only fI& I n i d e U't K 644 Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center T y Bed/Trench Edges Topsoil Yes [ Yes 'No COMMENTS: (Include co S (screpencies, persons present, etc.) Inspection #1: ` / ,U� Inspection #2: / / Location: 436 Crocus Hill Road Hudson, WI 54016 (NW 1/4 SW 1/4 17 T28N R1 9W) Troywood Lot 7 J Parcel No: 17.28.19.1483 1.) Alt BM Description 2.) Bldg sewer length = +(,.� ��`` �� ���� ��� /,A �� • - amount of cover Plan revision Required? L Yes oI 7, / Use other side for additional information. L I i SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. F�01� NOUSE7 U/4-5 PIAca�v Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 J �p [,\ Visconsin Madison, WI '53707 - 7162 Site Address 1t Department of Commerce 1 4 ,3& Gh'OCUS Tr /�� Sanitary Permit Application Sanita Permit Number V In accord with Comm 83.21, Wis. Adm. Code, personal information you provide �if QD) may be used for secondary purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Worm - ---- -- - __..:.- ..._.. State Plan I.D. Number fqoj Property Owner's Name jffM Parcel Number /f 7 Property Owner's Mailing Address E Property IAmdon /0387 sue 6: v � /V)�I SW�.S / T� N,R City, State Zip C __ �Z — Lot Number - Block Number Gvo vD/3 v i2 / Z X0.5 • 3 S &J Subdivision Name CSM Number H. Type of Building (check all that apply) ❑City &r 2 Family Dwelling - Number of Bedrooms ❑Village ❑ Public /Commercial - Describe Use Township X ❑ State Owned Nearest Road 2 3 X 8� -� ti� �Q -' /`f��,ai C f,*ev ///il ;i'w III. Type of Permit: (Check only one box on line A (numbering scheme for interne use). Complete line B if applicable) A. I New 2 11 Replacement System 3 11 Replacement of 6 ❑ Addition to For County use S stem I I Tank Onl y Existing System B • &heck if Sanitary Permit Previously Issued Permit Number Date Issued `/ 2 QZ Alef i /a/ — ova 3, IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 KNon - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatme t Unit 49 ❑ Recirculating 30 ❑ er V. Dispersal/Treat ent Area Information: — Cp Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate Systim Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) 516e, Elevation 106 95 tF 70 , 7 11 ",v s VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank AO Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) PI ber's S ture igna �MP/MPRS Number Business Phone Number R . , IIo,R i G(�c 7 DzCe 3 - 7 Yy Plumber's Address (Street, City, State, Zip Code) VIII. County /De artment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Is A nt Signature (No Stamps) Surcharge Fee) ❑ Owner Given Initial Adverse . j V t • W 's Determination z IR. Conditions of Approval/Reasons for Disapproval s I a %% — — V&AA I btu O S „� cl► complete i } (to the County only) for the system on paper not ten than 81/2 x 11 Inches is size � a � SBD -6398 (R. 05!01 W}_ Pk,- \ THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL u FILTER MODEL # a 1`t " o l ov'r ( 33 yb �� F p � l °' ' 13 z &\ \ � \ `� A 611 q1, 0 t - $I --� s It- v s � T� 6 y r / 0 0,0 k s r ULBRICIiT & ASSOCIATES CO. 655 O'Neil Road • Hudson, Wl 54016 Reg..Vesirers of Fngineertng sysh 715- 386 -8185 Private Sewage Cvnsukants i� pill 05 t 2 i t� PROJECT INDEX y' f 7 L PLAN ID �� /� ���'-- DATE OWNER k4f /ele&a� - ��� ®� 5 G/� <'o S. 3.S6 PHONE ADDRESS /Q f - 7 c ty e2 ea" y�/� C1.7 ©t�l� U/'y� •' yc. LE DESCRIPTION `' p 7 -7/OOY' 400 1, So, .ac - 17 1 TOWN OF �J Q� COUNTY ST 4,9 i` h - -- LOCAL AUTHORI'T'Y/ SUPERVISION - X G1` PROJECT DESCRIPTION: REV S f , D A- 7� !'TU�,e S�•7�� ---- .�IiC�� ?`C�/ t l,��'C 1'�t -C- �i�'1�2'� —Q C�i TAT°— / W0- /4e a t3 E R '7•t i b� ► C l� Ulbricht & Associates Private Sewage Consultants 2812 10th Ave. Spring V ley, Wl 54767 V � M P /?S 2 � Ce f � Pg.l INFILTRATOR SIZING WORKSHEET P9.2 SYSTEM PLOT PLAN P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg • 4 11 it of if it it P9.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS P9.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS. The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Treatment Systems. (Version 2.0) SBD- 1075- P(NOI /Ol. o 0 y �. Nil, b Q IJI m .JQ, -- n' 4 v, L � 1 V THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # F nu *A P P 3 � -- 3 *A — ,��c s 7- k r� yb� % - \ 1 T- f3 l `01 fia 6 y /,9 0,0 D i 4 3 i 3 et� 04 Iff e-5x 77, M I -- / J q3, p CPO 5 SE T pox) o, 2�S1A G— //V L 7)C,4 7 ,5 f� �13 i oDi h/ ►�, c',q�,Ac r ry „ S,��rr,,,v�,� '',yo�� � 3 'x G 'a. " L ov� r¢ IAOVep e", .A fcl sf pzt,, Sic iff S h' ED K Ile sc� �0 9iPAfPL S' U OVER: See Reverse Side for Vent/ Observation Pipe Details. PAGE 6 REVERSE SIDE OWNER's MAINTAINCE OF SEPTIC SYSTEM POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of this system. The owner is required by code to submit all necessary maintenance /inspection reports to the controlling authorities. SPECIFIC CONTACT AGENTS * Governmental authority/ inspectors: .3 0W'7V y *.Licensed installer, responsible for providing an operation/ maintenance "Users" manual: Ce 3 7 S * Licensed service / inspection agent other than installer: Tai - C)" sAAJ,1 r,4 710 3�>6 ~ z 130 Electrician, for pump, electric controls, wiring units: N 1 4 IMPORTANT OWNER MAINTENANCE REQUIREMENTS 1. Winter traffic (sledding, shoveking, etc.) across the area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the winter (a vacaction trip, resulting in no water use) can also lead to freeze ups. 2. Water conservation needs to be exercised! Or system can be hydrolically overloaded and destroyed. This system was designed for a maximum wastewater flow of gals. daily. S. POWTS are not designed to accomodate wastes from a garbage disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. 4. If a power outage occurs, or a pump fails, it may result in a temporary overload of effluent being pumped into the cell, which may adversely impact the cell (leakage). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative cover (the Bells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t he system. It IS NECESSARY TO REGULARLY WATER THE VEGETATION OVER A SYS'T'EM!! Effluent in the system beneath IS NOT sufficient alone tO maintain a grass cover. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated Into the system: on the mound basal area (effluent level inspection pipes), cleanout terminals on the pressurized laterals, at each tip - for flushing and cleaning the laterals out. The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly quali6ied person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County $-� • GRO i /� 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 horiz nee point (BM), direction and PSI I.D. Q Y D , 12 — /_ � • G O • M percent slope, scale or dimensions, north arr , andioeel}n arest road. 7 t(J Please print a information. awed by Date Personal information you provide maybe used seconds purposes (Privacy Law, s. 1 . i Z, Property Owner (,U . F7" Pr Location . Lot A10 114 1/4 S ` T N R / *(or W Property Owner's Mailing Address I N Q F r i L # Block # Subd. Name or CSM# /0 3 97 S /0.v e 1 7 - 1?O Y w oOt0S CRY / " ��� Q„ � state c Phone Number ❑City ❑ Village Neares � Town OGVS `�j Wv � d7V M,v 575 2 ( I 7 (- New Construction Use: (Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public co or p commercial - Describe: _. Parent material �� SS O yAL S yy Flood Plain elevation if applicable General comiTients and recommendations: Bort rig # [] Boring r [Pit Ground surface elev. �• 7b ft. Depth m limiting factor , //d in. son t Rate Hodes Depth Dominant Col Redox Description Texture Stricture Consistence Boundary Roots GPWIF In. Mtmsel Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 -10 is R3 SG 2,+,5hK /w � w 3 i s Nf 3W.49 7-5 YA S4 O d� a Borin # O Boring Q 1 Pit Ground surface elev. ! 7 • S b ft. Depth to limiting factor > / in. Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Efr#1 'Eff#2 Z /2 • z �•S 51L, Z dK �' -21 g GS /.mot CA/ -- p ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mgA- • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L csr Name � /PrM�; Ci,�/( — Signature I — CST ► q / Z'-4375 Address Date Evaluation Conducted Telephone Number �i / �� • 3oa 3 713' .3 B • 8i8s Private Sewage Consultants ?/S • 7-� ' 3 -5,14 5"z. — 2812 10th Ave. Spring Valley, WI 54767 �- �,�,�,� ORIGINAL le� T Property Owner Parcel ID # Page of F3 Borin # ❑ Boring Pit Ground surface elev. • y ft. Depth to limiting factor Y' M. Rate Horizon Depth Dominant Col Redox Description Texhxe Stricture Consistence Boundary Roots GPDW In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 o • �� �oy� s� z �M � y S 4t f F-1 Boring # [] Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Str Consistence Boundary Roots GPD/fE In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. '011#1 'Eff#2 F Boring # Boring ❑ ❑ Pit Ground surface elev. ft. Depth to rig factor in. Sa'I Application Rate Horizon Depth Dominant Color Redox Description. Texhxe S consistence Boundary Roots GPDtrf In. Munsell Qu. Sz. Cont Color Gr. Sj Sh. •Eff#1 'Etf#2 ❑ Boring # ❑ Borin ❑ Pit Ground surface elev. Depth to lirrritirrg factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff' I In. Munsell Qu. Sz. Cont Color. Gr. Sz. Sh. 'Eff#1 'EB#2 Effluent #1 = SOD, > 30 < 220 mg/L and TSS >30 1150 mgR. ' Effluent #2 = BOD 130 mgll. and TSS < 30 mg& 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. s80433C M-6M) I y 33 lo l ` r c s� �1 i I i i 7 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 429907 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village x Township Parcel Tax No: Appletree Builders I Troy Township 040 - 1269- 60-000 CST BM Elev: 777 BM Description: Section/Town/Range/Map No: 17.28.19.1483 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of eeded /Sodded xx Mulched xx S Bed/Trench Center Bed/Trench Edges Topsoil 141 Yes -7 No It, Yes j No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 436 Crocus Hill Road Hudson, WI 54016 (NW 114 SW 1/4 17 T28N R19W) Troywood Lot 7 Parcel No: 17.28.19.1483 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. 11 Safety and Buildings Division county ST Oi� 201 W. Washington Ave., P.O. Boa 7162 i seo ►ts►n Madison, WI 53707 - 7162 Site Address. DepartmAnt of Commerce -/3Co /'fO -rloS • • �---- �-�� —� Sanitary it Number San Permit t�pp 1 � D ye -� In accord with Comm 93.21. Wis. Adm. Code, persona Informs on you provide [] 29 k if Revision ma be used for second Privac w, 815. 1 m i I. Application Information - Plense Print All Information k �� ! 203 Plan I.D. Number A ' Property Owner's Name r C � ! f I'Parcel Number T Property owner's Mailing Address /� Property Location �1 • N83 ? 7 J:7DAJ -e Ct&I e P Q A] V yt 51 iA � S � / T l d p N. R I 4 �41 City, State �p Zip Code Phone Number Lot Number 7 Block Number 10 U/ , ` Y �N S 6/Z • yy� Subdivision Name .••�9ht- Number II. Type of Building eck all that apply) � ( ,i alas. Oci �l or 2 Family Dwelling - mbet of Bedrooms ❑village U Public /Commercial - Descri se ns 1ifTowhip 7/2 O ❑ State Owned Nearest Road -3 �hr�t C III. Type of Permit: (Check only J line A (numbering eme fo nternal use). Complete line B if applicable) A. Im New 2 U Replacement S stem X Y use p y NkOnly Replacement o 6 iJ Addition to Exi s S ate B• 11 Check it Sanitary Permit Previously issued it Nnm Date d IV. Type of Permit: (Check all that apply)(numbering a is for Internal use 44 XNon - Pressurized In- Ground 2111 Mound 47 Sand Filter o Ike dand 22 U Pressurized In- Ground 41 U Holding T Single Pass 45 Ll At - Grade 46 ❑ Aerob intent Unit 49 koala g er V. Dis ersal /Treatment Area Information: P, —Icy Design Flow (gpd) Dispersal Area Dispers rea Soil Application Percolation Rate System ovation F Required Propos Rate(G�al /bays /Sq. (Min./inch) VI. Tank Info Capacity in T Number Manufacturer Prerab Site Ste pl'hAlf Gallons G ons of 'tanks oncrete Consttucte 1 t' New Existing Tanks I Tanks W / Septic or Holding Tank 1A Dosing Chamber VII. Responsibility Statement- I, A undersigned, assume responsibility for installatlon of the POWTS shown on th lached plans. Plumber's Name (Print) Plumber's Signature /MFRS Number Bus Phone Number." �'ol307" �11hIT /� `lam i z 2 & 3 7 s 7i 7a • 3 y/z- Plumber's Address (Street, City, Pte, Zip Code) VW. Count epartiticsfUs e onl 0 Approved U Dis proved ' Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) - U Owner Given Initial Adverse Determination 1� -xr IR. ondittvns of Approval/RZasons for Disa troval �� v� r , n / , � rs2 C�d w�c 1 t Attach complete plans (to the county only) for the system an paper not less than ass a it Inehea to also SBD -6398 (R. 05101) � � 1 ~� O 0 N Io \min Oi m -- '� IW t < 1 5 �1 RIC � • 0 D 0 3 -Sk z Z i4v in ` A C b 4 k 1 �d �� h I I t' tp I OWNER's MAINT of SEi'TIC SYSTEM r POWYS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servicing is necessary for the safe healthy operation of.this system. The owner Is required by code to submit all 'necessary maintenance /inspection reports to the controllinq,authorities. SPECIFIC CONTACT AGENTS * a6vernmental authority/ inspectors: sT C�aIX C Tj! 3 * Licensed installer, responsible p e for r v idin an 0 maintenance "Users" manual: p g operation/ * Licensed servIc e / inspection agent other than installer: * Electrician, for pump, electric controls, wiring units: IMPORTANT_ OWNER • A1NTENANCE RE UIREMENTS i. Winter traffic (sledding, shoveling, etc.) across the area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. biscontinuos use in the winter.(a vacaction trip, resulting in no water use) can also lead to freeze ups. 2• Water conservation needs to be exercised) Or system can be hydrolicall.y overloaded and destroyed. This syskem was designed for a maximum wastewater flow of gals. daily. 3• POWYS are not designed to accomodate wastes from a garbage, disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. 4• If a ower 6v:t p age occurs, or a um fad P p ls, it may result In a temporary overload of efflupnt.being pumped into the cell, which may adversely impact the cell (leakhge). It is recommended that a licensed pumper empty the dosing tank, !i allow he 9 pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5. Neglect of the vegetative cover (the cells insulation & erosion preventive) can lead to failure. Compaction or heavy traffic also can destroy t fie system. It IS NECESSARY TO REGULARLY WATER T11E VEGETATION OVER A SYSTEM11 Effluent in the system beneath IS NOT sufficient alone to maintain a grass cover. 6. Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated Into Elie system: on the mound basal area (effluent level Inspection pipes), cleanout terminals on the pressurized laterals' at each tip - for flushing and cleaning the laterals out. Tile filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly quallOied Person should be performing this work which involves health & severe safety risks. Evidence of effluent ponding in the system's treatment cell shall also be regularly inspected. . y. ULBRICHT& ASSOCIATES Co. 655 O'Neil Road • f Judson, WI 54016 neg..VeNgners of F.nglneedng Systems 715-386-8185 ravate sewage Consuhnnts PROJECT INDEX PLAN I n � ._ BATE OWNER � P��� �U/G� O�1�G PHONE AbbR C� /�- eT�ilSON�A0 3 y 7 X10 -2y/ 0 "14 Ae LEGAL DE SCRIPTION 4900,1 6&,, 1v �l�U. Ss'/Z,� TOWN OF COUNTY Cs'TE1 7O �[�sT?•l� -I -,� �.2.'�G LOCAL AUTHORITY/ SUPERVISION ST GLo/X Cr' �ilJ,'� PROJEC DESCR L ORIGNAL 2. Wale/ i 7_ THIS POWT SYSTEM SHALL Uibricht & Associates PER COMM. Private Sewage Consultants A PROPER ZABEL 83.44(2)c 655 O'Neil Rd. FILTER MODEL # 4-1 Hudson, Wis. 54016 ,Ae 41 �� Pg.l INFILTRATOR SIZING WORKSHEET Pg.2 SYSTEM PLOT PLAN P9.3 CROSS SECTION OF SYSTEM, WITH ELEVATIONS. Pg.4 it if 11 to of to Pg.5 OWNER MANAGEMENT PLANS & ZABEL FILTER SPECS Pg.6 (OPTIONAL) CROSS SECTION AND SPECS FOR DOSING TANK. PG.7 (OPTIONAL) PUMP PERFORMANCE SPECS. I The attached plans and specifications are based on "In- Ground Absorption Component Manual For Private Onsite Wastewater Treatment Systems." (Version 2.0) SBD- 1075- P(NO1 /O1. 1 o H ill N m �z HIM N � Jill � Ilia 'J _ - IV.-Ory . c-1 r 41P b y,. w o � Q�o t - TY c ClIz, warn 0 N 0 -0 m I, � - omm �N w d cp z _ a � M r �� i- � jg •�� '�! �� ¢ ?�// .� w� M r! � �9 �. �., �� ,. ��� u�hO,J r-- ��� dT 0 AP F,� � F cat Iff 0 � 1 , sue. Qo 97 0 Ac ffl%ItZS7 g �S� rPriVtD 7 &tW-t Cva f u SEC Tio) T/f IA- l/V i G 7elf 7 Or('S' 'oR /3i 0. AP6 Usti 7 iff 1 N �i�v, �12•Sp p� p t, t O r F&vq -,a4 OF cgec l 0) f I/ , 7- ew 1,v spEc rle,v `oWE-5 7- — CI'O ,5 J -S) 7 D� T/5�/V t:% S it �f J� MJ ( FT To T9 -e+ ^ • or OWNER's MAIN'1'AINCE OE SECTIC SYSTEM .- -.-�` w POWTS (landowner) is reponsible for proper operation and maintenance of this system. Regular periodic inspections and servir_ing is necessary for the safe healthy operation of. this System. The owner Is required by code to submit all necessary maintenance /inspection reports to the controllinq,author.ities. SPECIFIC CONTACT AGENTS * Governmental authority/ inspectors: ST C/�aIX Gay 3 * Licensed installer, responsible for providing an operation/ maintenance "Users" manual: * Licensed servdce / inspection agent other than installer: T1 I - G 7 '�- SAV ,1'r,,9 -U b G— <D . * Electrician, for Pump, electric controls, wiring units: IMPORTANT OWNER MINTENANCE REQUIREMENTS I- Winter traffic (sledding, shoveling, etc.) across the area shall not be permitted, or frost can /will penetrate into the cell, freezing up the system. Discontinuos use in the winter.(a vacaction trip, resulting in no water use) can also lead to freeze ups. ' 2• Water conservation needs to be exercised! Or system can be hydrolicall.y overloaded and destroyed. This system was designed for a maximum wastewater flow of gals. daily. 3 . POWTS are not designed to accomodate wastes from a garbage. disposal unit, or any other unnatural sources of waste. Any introduction of such waste materials will overload and destroy this system. 4. If a power 6ntage occurs, or a pump,fails, it may result In a temporary overload of effluent being pumped into the cell., which may adversely impact the cell (leakkge). It is recommended that a licensed pumper empty the dosing tank, allowing the pump to return to dosing the correct amounts. Consult your installer immediately for advice. 5• Neglect of the vegetative cover erosion (the cells insulation & preventive) can lead to failure. Compaction or heavy traffic also can destroy t lie system. It IS NECESSARY TO REGULARLY WATER T11E VEGE'T'ATION OVER A SYSTEM11 Effluent in the system beneath IS NOT sufficient alone to maintain a grass cover. 6• Periodic inspections by the owner, or his agents, is necessary. Inspection pipes and ports have been incorporated into the system: on the mound basal area (effluent level Ins pection pipes), cleanout terminals on the s laterals, at each tip - for flushing and cleaningtheZlaterals out. The filter system in the tanks (via a locked above ground cover /manhole). Only a licensed properly quali6ied Person should be performing this work which involves health severe safety risks. Evidence of effluent ponding in the System's tre-itment cell shall also be regularly inspected. y. e 's 1325 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Gustum Septic Service Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal refer t BM), direction and parcel I.D. percent slope, scale or dimemsions, north arr °��°`` lion �q dunce to nearest road. pending Please print 4nr ition. R By Date Personal information you provide may t Used f ecund ry pu s (Privacy Law, s\ 5.04 (1) (m)). 7.1 2403 ,r -. s , f -art r Property Owner ~_ " ' Loo perty Location Humbird Land Corporation „. , , .Lot 1/4 SW 1/4 S 17 T 28 N R 19 W Property Owner's Mailing Address j -° " Block # Subd. Name or CSM# 332 Minnesota Street, East 1404 S1 CHOX f 7 n/a TroX Wood Subdivision City State\Zlji bode _j City _f Village ✓; Town Nearest Road Saint Paul MN 651 - 222- 5*`% Troy E Cove Rd / Crocus Hill Road N New Construction Use: 6� Residents rooms 3 _ Code derived design flow rate 450 GPD _J Replacement _f Public or commercial - Describe: utwash plain ion if Parent material o Flood lain elevation, P P applicable n/a General comments recommendations: M #1= 1 0.0'. BM #2= 100.1'. Recommends stem elevation 96.0' along 98.5' and ecomrr�n Part of 1.87 acres. B 0 Y contour. ❑ Boring # 1 Boring N Pit Ground Surface elev. 98.5 ft. Depth to limiting factor >75 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft *Eff#1 *Eff#2 1 0-6 10 y r3/2 none sil 2msbk mvfr as 2f,lm 0.5 0.8 2 6 -13 10yr4/4 none sil 2msbk mvfr cw 1 f 0.5 0.8 3 13 -21 7.5yr4/6 none sil 2msbk mvfr cw - 0.5 0.8 4 21 -29 7.5yr4/6 none sl 2msbk mvfr cw - 0.5 0.9 f 5 29 -51 10yr5/6 none s 0 sg ml cw - 0.7 1.2 4� 6 51- 10yr5/4 none s, gr.s 0 sg ml - - 0.7 1.2 Boring # J Boring >72 in. Sal ✓_J Pit Ground Surface elev. 94.9 ft. Depth to limiting factor App lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft *Eff#1 *Eff#2 1 0 -9 10yr3/2 none sit 2msbk mvfr as 2f,1m 0.5 0.8 2 9 -17 10yr4/4 none sil 2msbk mvfr cw 1 f 0.5 0.8 3 17 -26 7.5yr4/6 none sit 2msbk mfr cw - 0.5 0.8 4 26 -30 10yr4/6 none Is 1 msbk mvfr cw - 0.7 1.2 5 30 -39 10yr5/6 none s 0 sg ml cw - 0.7 1.2 1 6 39 -72 10yr5 /4 none s, gr.s 0 sg ml - - 0.7 1.2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD - 30 mg/L and TSS <,30 mg/L CST Name (Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St., New Auburn, WI 54757 11/16/00 715 - 658 - 1344 I property Owner Humbird Land Corporation Parcel ID # pending Page 2 of 3 F31 Boring ;;,, Boring # 98.5 ft. Depth to limiting factor >75 in. �J Pit Ground Surface elev. _ Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIft' •Eff#1 •Eff#2 1 0 -5 10yr3/2 none s il 2m m as 2f,1m 0.5 0.8 2 5 -13 7.5yr4/4 no ne sil 2msbk mvfr cw 1f 0.5 0.8 3 13 -23 7.5yr4/6 none gr. sl 2msbk mvfr cw - 0.5 0.9 4 23 -34 7.5yr4/6 none gr. s O.sg ml cw - 0.7 1 5 34 -55 10yr5/6 none s, gr.s 0 sg ml cw - 0.7 1.2 6 55 -75 10yr5/4 none s 0 sg ml - - 0.7 1.2 F� Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1It2 - _ _ -_ •Eff#1 •Eff#2 Boring F-I # r.� ;,� Pit Ground Surface elev. ft, Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDJft •Eff#1 "Eff#2 ' Effluent #1 = BOD 5 > 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. �ro Woo Svb Lo� Om �3 q6.7 Clio 0 r 8� Q _ $Z pa r� 1, V7 Ac re-5 ® M - J�/ EL T aF 3h1( :Pov% p,� P/L Q - Fop a fvc- P pe- X II � r go;) �pdin�S Sca e- q6 WI �ccC��o� P -2 ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSIIIP CERTIFICATION FORM Mailing Address l0 -/ Property Address V 6 e4l'!t44S hw ✓ t o (Verification required from Planning Department for new construction) City /Starr' /�`x rtr� Parcel Identification Number LEGAL DESCRIPTIUN l�! Properly Location ' /4, S� '/,, Sec. 17 N -R W, Town of T R . Subdivision _ - rp 0 r (.t, 00 D , Lot # Certified Survey Map # , Volume , # Warranty Deed # 71(f J , Volmile � , Page # Spec }touseJ yes Cl no Lot lines identifiable yes D no SYSTER MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. T - he property owner agrees to submit to St. Croix 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 wasiewalerdisposal system is in propel operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Mve, the undersigned have read the above requirements and agree to maintain tine private sewage disposal system with the standards set forth, hetein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification sfafing lit t your septic systet has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 da of fie three year xp' lion date. S NATURE Op PLICAN 1 DATE OWN R CERTIFICATION (we) certify that al statements on this form are true to the best of my (our) knowledge. I (we) Am (are) the ownet(s) of I r erty describe ab , by virtue of a warranty deed recorded in Register of Deeds Office. /�, F if SIGNATURE APPLICANT DA'rE ** * * ** Any information that is nis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** include Ivitlt this application: a stamped warranty deed from the Register of Deeds office R copy of the certified survey map if reference is made in the warranty deed J 2 19 6 P 6 16 7 1 6 1 -4 Il STATE BAR OF WISCONSIN FORM 2 - 1998 KATHLEEN H. WALSH WARRANTY DEED REGISTER OF DEEDS Document Number ST. CROIX CO. WI This Deed, made between Day Farm Investors, LLC, a Minnesota RECEIVED FOR RECORD Limited Liability Company 04 /07/2003 09:50AN WARRANTY DEED - - -- EXEMPT # Grantor, and Appletree Builders Inc. REC FEE: 11.00 TRANS FEE: 257.70 COPY FEE: CC FEE: Grantee, PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Rccordine Area Name and Return Address Lot T roy Wood, Town of Troy, St. Croix County, Wisconsin 040 - 1269 -60 -000 Parcel Identification Number (PIN) This is not - - homestead property. (is) (is not) Exceptions to warranties: Subject to notes, easements,restrictions,covenants and rights of way of record, if any, including but not limited to those for drainage,water retention ponding,and or utilities as may be shown on the plat of Troy Wood recorded in Vol. 8 of Plats, page 28,St. Croix County, Wisconsin. The warranties of this deed, either expressed or implied are limited by the grantor to the grantee, or anyone in the chain of title, to the consideration expressed herein, that being the sum of $85,900.00. Dated this 28th day of March 2003 _ Day Farm Investors, LLC . b y President v _ . Austin J. Baillon AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature ) SS. Ramsey _ County. ) Personally came before me this 28th day of authenticated this day of — - March 1 2003 the above named Austin J. Baillon TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrumen nd acknowledge a same. authorized by § 706.06, Wis. Slats.), ✓� , wwwn THIS INSTRUMENT WAS DRAFTED BY - F 4.it A B ,.ON P aul A. Baillon, Attorney at Law ' Paul A. Baillon Notary Public, State of Wisconsin ' t (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. (If not; slafe a iFsiitifio'it'date: " °" necessary.) January 31 2005 ) 'Names of persons signing in any capacity should be typed or printed below their signatures WARRANTY DEED STATE aAR OF WISCONSIN FORM No. 2 � 1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, W1 800 -655 -2021 r IR \ 3 MOO d�" �� � 1.69 ACRES 10.37 ACRES / .\ ' 75,717 SG. FT 651,908 SG. FT. .00e / oTE: FURTHER Ile / / \ . -DMSION OF THIS LOT / / d!i / i PROHIBITED ,�a• \ y /'' '' 8 \\ ,ay' AINAGE EASEMENT / 1.86 ACRES \ 80,971 SG. FT, y j / ate / � � � / / � Ole N. / < / 7 y / ,��► , \ ` 1.87 ACRES � r � -- 81,450 80. FT. I / \V % 114% 1 �\,1.77 ACRES i'Y o o, 77,274 SG. FT. / / ^ \ \\ // . // 1 d \ \ c Z o �! � " /' \ \ ' \ .95 CRES �. / \ 1 $ / \\ \ ;85,133 SG. FT. $ o y d �\ 1.99 ACRES \ \� � \ 86,641 SG. FT. 0 o \ \ f 20' DRA*GE EASEM 50.00 ��• CROCUS \ b LOT 3 �, °b� da b fe z \ \ 15 \