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040-1269-90-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430034 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)J. Permit Holder's Name: City Village X Township Parcel Tax No: Progressive Structures I Troy Township 040 - 1269 -90 -000 BM CST BM Elev: Insp. BM Elev: Description: Sectionlrown /Range /Map No: 10 0. (� D • b ti� ( e �o l 17.28.19.1486 TANK INFORMATION ELEVATION DA A TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , Benchmark( lot (✓0 /CQ tbR of i e (I Cl 110, Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet �,. 90 oY. od TANK SETBACK INFORMATION St/Ht Outlet 7.1 10 3.7 5 TANK TO P/L WELL BLDG. 5Vent t o Air Intake ROAD Dt Inlet Septic > 7 0 Dt Bottom Dosing / V an. L /o.bZ /00.26 V Aeration Dist. Pipe Holding Bot. S stem Nccr^ w o •a Of S d 4rw L r p PUMP /SIPHON INFORMATION Final Gr de & /0.1 /OD • $ 0 Manufacturer 11 Demand St Cover tp �r, v � .'t GPM O 107- Model Number ____ ............. ..._ 1 0 0 S 3 — 1 5 Is /a TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to well r ,- SOIL ABSORPTION SYSTEM BEDITRENCH Width en h No. Of T�s PIT DIMENSIO No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 / v lops 3 w SETBACK SYSTEM TO P/L BLDG WELL KE /STREAM LEACHING Manufacturer: A, INFORMATION CHAMBER O T r 7 H"Y`efb Type Of System: d/ UNIT Model Number: C nnu c k7+ I s / Z n n G' DISTRIBUTION SYSTEM j h k &Uvt +Y-e ta"!:, Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) li(v If L "T l l_ength Dia =� Spacin I SOIL COVER x Pressure Systems Only x M t r rade Systems Only Depth Over Depth Over xx Depth of xx Seeded /7 xx Mulched Bed/Trench Center Bed/Trench Edge Topsoil L No No COMMENTS: (Inclu a code iscr persons prese etc. Inspection #1: q / Zia Ins¢ e n !� 4 h of e� 1 uc 0T 'fa h 11- to Gl.v� � (i t� -- (0 6 J* A� Locatiod 448 Cro us Hill d Hudson, WI 54016 (NE 1/4 SW 1/4 17 T28N R19W) Troywood Lot 10Ci% P' Parce o:,17.28.19.1486 4 0 -) Alt BM Description = , 5 y%c rr t( � (lLn 4 w, d ` (2.) Bldg sewer length - amount of cover= 4Lt 12t1 t OA lti2ov k15 N[wl • / (/►' y 5 > 51� ll — n o 2" d. 4V -� ✓+� a 4 D SG� � S (3)obs wQ r . , #,, Qlu,,,�,�,,,- CE, � t?nd + PY°P -- - - -- - - - -. Plan revision Required? ;Yes Use other side for additional information. SBD - 6710 (R.3/97) Date sepctor's Signature Cart. No. I Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 r e 0/X 1 pis si . Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) DeF�rtment of Commerce (608) 266 -3151 _ Sanitary Permit Application I.D. Nu ber In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s1 5.04(1)(m % \Y ro c . ess (if i erent than mailing address) I. Application Information - Please Print All Information S 'j Property Owner's Na me Parcel # Lot # Block # a .��' �u 1-,► r � o a E.t�.r r O Property Owner's M ailing Address Property Location. �BS Yl /.✓e' �i7 /u! ale- 'k, S4/ 'k,Section /7 City, State Zip Code Phone Number r 1i vL i✓ S"s' /.7 / LSD (circle one) H. Type of Building (check all that apply) T � N; R � � S `"^'` Subdivision Name CSM Number 1 or 2 Family Dwelling - Number of Bedrooms .S � ❑ Public /Commercial - Describe Use on ❑ State Owned - Describe Use QciAy - vTftge k§Township of A.4 III. Type of Permit: (Check only one box on line A. Complete line B if applica le) --qoo kl A, New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ther Modification to Existing System B. El Permit Renewal El Permit Revision 11 Change of 11 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) ONon - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sfJ Dispersal Area Proposed (sf) System Elevation 7so . S /Sao /say S8.2 J 9.04 ` 99.8 VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 149 Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the "unidersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's - g e MP /A4PR;5-Number Business Phone Number Plumber's Addre ss (Street, City, State, Zip Code) A,1 fir•. Y. .?S ,ro 41-2 sy 7.?e VIII. County !De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I u' Agent Signature (No Stamps) Surcharge Fee) ` El Owner Given Reason for Denial 22� oS 29 IX. Conditions of Approval /Reasons for Disapproval A41 dc- w be d h ( 4 C- C--k `rt Le AA�_ IMdIxM� ►�'�1 Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) I to N�j V o h� e • � � v V N� V 0 I ` 1� ! � � t o Z CN 'h Li W ti t N � d r v � � TTT v r o M O V V w• M ° Ao $ & \ o • NO ` ec M 1r r U Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _Z of _2 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code 7ntal __ _ ._... County Attach complete site plan on paper not less e. Pta must of include, but not limited to: vertical and horiz oft 6T�71directio and Parcel I.D. pe rcent slope, scale or dimensions, north a on and distance to arest road. Please print a r. 9 ZOOS Re ' d by Date Personal information you provide may be used foses (Privacy Law, s. 1 04 (1) (m)).ti0 J C 3 Property Owner S1 G Pro rty Location / ZO FFIG J J t'n >t y r a d s J Govt Lot � 19.W 19 S/ 7 T ,?,p N R/ f jC(or I�V Property Owner's Mailing Address Lot # I Block # Sub& Name or GSAMa~ City State Zip Code Phone Number Q-Qty 94411age ® Town Nearest Road �1 t A vG SS d S d - 0 Ae is orO. New Constriction Use: C9 Residential / Number of bedrooms S' Code derived design flow rate 7s'O GPD ❑ Replacement ❑ Public or commercial -Describe: Parent material l"Ir, Y r d Flood Plain elevation if applicable R General and recommend ons: /.dL�ra� ✓o 0o f, „fr z Loe.o�.44 .4.s rr 4,04%) ts. JS /X.4'0 f �tca.v viro ol F_/1 Boring # [] Boring o Pit Ground surface elev. 0.3 / ft. Depth to limiting factor >/08 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. '0101 'Eff#2 s" / v 8- Y 5' L .s .• 9 �$ 'Z / 4 ,a.•. ❑ Boring F:il Boring # i [2 - Pit Ground surface elev. /aZ C it. Depth to limiting factor > /e'lo in. Sob Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 d -9 a - S,/ . 0 S 9- f a y J ~ S. d 8 f - oY�t S Olt S do - z o Y4 *1 ✓ . - S 9 cJ /6 /Irb ' Effluent #1 = BOD > 30 220 mg/L and T 30 _< 150 mglL ' Effluent #2 = BOD < 30 mg/L and TSS 1 30 mglL CST me (Please Print) _ 'gnat CST Number G EL trr�' d Address Date Evaluation Conducted Telephone Nulmber So.? �r Z ,r 2�4_ry2bl S -2o -o3 7 .jr _r - deio - 1 Property Owner _�rr ucMi(,rx Parcel ID# Page of F31 _�� Boring # El Boring 01 [-pit Ground surface elev. 4o4 L ft, Depth to limiting factor /o J in. Sod — Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. - Eff#1 - Eff#2 J 7- Y m .t .t — ✓ ✓ 2 S - aY•c � G.o.ie� it �' - — ,.. F -/1 Boring # �oring - [] Pit Ground surface elev. /e X g ft. Depth to limiting factor --�Zo o in. - SoN — Appllcadon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Efl•#1 'Eff#2 R g1j 4 / 8 4,104 j ` - iA O / OY4 .rI Aswor0 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Sod icaIon Rate Horizon Depth FDomInant Color I Redox Description Texture Structure Consistence Boundary Roots GPDfrF in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. "Efr#1 - Eff#2 El ' Effluent #1 = BOD, > 30 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BOD, 5 30 mg/L and TSS < 30 mglL 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. sen -8330 (x.07/00) ` 9 H N W 7 R , (ll It f H G7 H O O C-0 L4 Fi!'cA c' H H a 0 n / C C) H H /Say. ;- / r. 0 j'oP Of' .� C4 z to O 40 /J /P! p s O /e4c � 1 3,. r �— e l © e O /, 1 \ pu t 0 V a\ FidaO 9 \ r • ya ' 4 r « �ROAOJro f a y0 A. y yJ .� ,6 0 ,, o' yo' o 4wex Iro c e firs /Gdaac. / s3 , 4tf 444 Co.wr. 8"* srna.o � s rr r' �pot�o P pp,JljA Y YAArs � Y A `udA�d6coPso� L or � C4G- /•7d -S.I G ICAW of Iao c a s /vest • Z abel A 100 an C ommercl # al Ef SPECIFICATIONS APPLICATIONS: The A100 is used in residential and commercial septic systems. It �--- -� is effective in multifamily housing, rental property, schools, offices and everywhere wastewater has high suspended solids content. 3 4 m6 FLOW RATE: 3, OOOBpdperfilter. lnstalltwoormorefiltersinaPVCorconcrete for detail s. j to achieve flows of 6,000 gpd or more. Check with Zabel j for derail FILTRATION: The 26 Disc Dams 0 1!16 inch provide 198 lineal feet of filtration. INSTALLATION: The filter may be installed inside the tank or installed m a Zabel Container Assembly outside the septic tank. SERVICE Service residential installations whenever you pump the tank. t . t .... I 5' O.D. 4.12' I.D. Q J ..... � 9 4 .,.._ 11.13116' MA �- 3 -9/16' 3._ ' 16' q 1 off n„ 11-Ml' DIA. ---� item an . Description Material Spectflcationa I Case Cases, Lids, Reducers Rigid Vinyl PVC 87371 u�t. 2 26 Filter dire 3 1 Cover Discs High Impact Polystyrene LW 4 3 Rod Rod, Nuts High Density Polyethylene S 3 Rue U.S. Patent No. 4,710,295 Call 1- 800 - 221 -5742 or Fax (502) 267 -8801 for further information. /So 0- Maintenance The interval for servicing septic tanks is set by state and local code. Throughout the United States there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel'" filter, which does not increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped. However, our filter is virtually self - cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged particles to disintegrate and fall to the bottom of the tank. If ycur filter contains a SmartFilter' alarm, you will be notified by an alarm when the filter needs servicina. To service the filter: "Servicing any Zabel filter should only be done by a certified septic tank pumper or installer. Locate the outlet of the septic tank. F� 3... Firmly pull the filter handle 9 2 and slide the cartridge out Remove the tank�"c! '� of the catSA, ' and pump the t�►i`t11#� * Note: A tee handle may hA necessary to p to be used if the filter Is roa fM� any solid below ground level to escaping to th Contact Zabel for info when the f handles rem s4 ,r While holding the certtidg6'60V ,C the access opening rins9 Off::tt1V cartridge with fr�stl �iteri11 insert the fllter`eerfrid0e careful to rinse all ge back in the cage hiakin " b sure the filt 1� properl *Note: It is not neces completely i "spotless'. The biome ;I aides in the pretreatme be left on the filter. (If n may be disass Replace t • MADE IN USA The product(s) shown are covered by one or more of the following patents: U.S. 5,762,793, 5,580,453, 5,591,331, 5,759,393, 5,683,577, 5,582,716, 5,779,896, 5,593,584,5,795,472,5,736,035, 4,710,295, 5,382,357, 5,482.621 U.S. Des. 386,241, 349067, 4605501,5098568, Des. 309007, Australia: 134440; Canada: 2,135,937; Israel: 111574; New Zealand: 264824, Other Patents Pending Call for a free ZABEL ZONE An Onsite Wastewater Magazine 1 -800- 221 -5742 - Website http: / /www.zabel.com A100/300- 1- M,61499 r Private On -Site Wastewater Treatment System (POWTS) Index and Title Sheet Owner: r ut Project Name and System Type: Location: Z4 Street Address O!/E Z .?L,►/, .1,9. L r /o, r o r �✓ooa Jc.doyi✓ Legal Descr J'd o"r Township /County Contents: Page 1: Page 2: rye .✓ Page 3: �O w 1"1 D[JN e n `1 it o.,icr.e t " /yo.✓•a t ltr r.r r dL.e.✓ -- Page 4: Page 5: Page 6: Page 7: Page 8: Page 9: Attachments: �ai� w.ot �.. rye.✓ �e �'aa r Z�.GE� wit r�.c ��,✓ a /,r.�a Plumber r: Signed: -tom Credential Number: , gyp- y/L Date: 1$ 3 POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner r,►drs Septic Tank Capacit /G s' gal ❑ NA Permit # Septic Tank Manufacturer _ xllrxs ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 0.4eE,4 ❑ NA Number of Bedrooms 100 room ❑ NA Effluent Filter Model –loo ❑ NA Number of Commercial Units — NA Pump Tank Capacity RNA Estimated flow (average)* a gal/day Pump Tank Manufacturer ❑ NA Design flow (peak), estimated x 1.5* so gal/day Pump Manufacturer ❑ NA Soil Application Rate , s' g al/day ft Pump Model ❑ NA Pretreatment Unit LWPA Influent/Effluent Quality (NA ❑) Monthly Average** ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) < 30 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODO < 220 mg/L E3 Disinfection [3 Other: Total Suspended Solids (TSS) Manufacturer: Model: < 250 m Dispersal Cell(s) Pretreated Effluent Quality ❑ Monthly Average * ** M(- ground (gravity) ❑ In- ground (pressurized) Biochemical Oxygen Demand (BODS) 5 30 mg/L E3 At-grade 13 Mound Total Suspended Solids (TSS) :s 30 mg/L ❑ Drip-line line ❑Other: Fecal Coliform (geometric mean) <10 cfu/100m1 G3- *aching Chamber Manufacturer /,✓.wiz 1'.r/T•�- Maximum Effluent Particle Size 1/8 inch diameter Model n1,a* o 1 1-A Laying Length/Chamber or 1 ' *Wastewater Flow Verification and Calculations: Soil Application Rate_, S gpd/W Area Req. /_fro ft (Other than bedroom based) Infiltrative Surface/Chamber -ESIA Rating fV Minimum Number of Chambers ❑ Aggregate Des Flo w/Loading Rate= ft min ** Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code and septic tank effluent. COMM84 and be installed per manufacturers specifications ** *Values typical for pretreated wastewater. and ap roval letters. DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual' (Converse et.a1.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual' Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis – ASAE Publications 5 -77 and "Design Manual – Onsite Wastewater Treatment and Disposal Systems ". EPA 625 /1 -80 -012 October 1980 ❑ SBD – 10570 –P (R.6/99) "At -Grade Component Manual Using Pressure Distribution" ❑ SAD – 10567 –P (R.6/99) "In Ground Absorption Component Manual' ar§ – 10705 –P (N.01 /01) "In Ground Soil Absorption Component Manual' Version 2.0 ❑ SBD – 10628 –P (N.6/99) "Recirculating Sand Filter System Component Manual' ❑ SBD – 10656 –P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual' ❑ SBD - 10572 –P (8.6/99) "Mound Component Manual' ❑ SBD - 10691 –P (N.01 101) "Mound Component Manual' Version 2.0 ❑ SBD - 10595 –P (R.6/99) "Single Pass Sand Filter Component Manual' ❑ SBD - 10657 –P (R.6/99) "Drip -line Effluent Disposal Component Manual' ❑ SBD - 10573 –P (R 6/99) "Pressure Distribution Component Manual' ❑ SBD - 10706 –P (N.01 /01) "Pressure Distribution Component Manual' Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequenc Inspect condition of tank(s) At least once every ❑ months 3 ear(s ) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (1/3) of tank volume Inspect dispersal cell(s) At least once every ❑ months 3 ears) (Maximum 3 yrs.) Clean effluent filter At least once eve ER- months ❑ ear(s) Inspect pump, pump controls & alarm At least once every ❑ months ❑ ear(s) M-NA Flush laterals and pressure test At least once every ❑ months ❑ ear(s) ❑ NA Valves At least once every ❑ months ❑ ear(s) ❑ NA Other: At least once eve ❑ months ❑ y ear(s) ❑ NA Page = of S START UP 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. OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable/fruit peels and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. ❑ Valves Valves shall be operated in the following manner: ❑ Alarms Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a I day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. INPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). M eptic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NRI 13, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. ❑ Pump Chamber/Treatment Tanks Component The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. 0 Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page_t�_of S ❑ Mound, At- Grade, In- Ground Pressure "The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. 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 ofby 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 other 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 replacem nt system: 0A 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 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. p The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. C3 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 CONTIAN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. FESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name Ana /rW .PVIZ Name Phone 71 e ;W - Sd 4 Phone SEPTAGE SERVICING OPERATOR (Pumper) — ,,� LOCAL REGULATORY AUTHORITY Name Agency r. C e o o.✓ „� f Phone Phone 7i15 BL - «o K. WPDATATERPOWTS OWNER'S MANUAL.doc Page � of -f- ' ST CROIX COUNTY SEPTIC TANK M A INTENANCE AGREEMENT AND P a-u 0V VN -FJRS, -P CCERTIFICATION FORM ien ttyer : ii o /1 U I ke- r b s f 4 C 1 r'za b etG. IUe ont.- . H t ?:laming Amass -1890 5K 41 ('r , e r E ma n . 4 1 lU Ss-/ a / �e� Address `� 8 G r 0 C U S W` S o l ('Verification rile and fmm Planning Deparrtmeerir for new nsuucti;n) City/State Parcel Identification Number 0 40 — i U 9 — 90 -OC LEGAL DUSCRIMON PtoDerty Location W Y, sec. 17 T N -x-d lkj, Tcturn of � o Srzh-jd?xision Tr o v W d o Lot # 10 Warranty Deed � O � $ � � V olumc a ! y Page W G Spec hots 0 yes no Lot lines den fiable } no SYgmfTENCE ImproM use and zutintenanc- of your septic ."em could result in its prematire fsilum to handle waste's. Prtaper maint consaft of pumping orrt the septw tame cv ft= years or scorner, if needed by a ltc=sed pumpeL Wbat you pet into tbc system can affect the funchou of the septic tank as a treatment stage in the waste disposal systc= The property ow to subunit to St Croix Zor Z Department a ceruffication form sigh by the owner and by a masterp h=bc r, jourstcymati plumber, restrtctu plumber o a 1 . i c ansed pamper veruyi2 ttat i i j the on -a ft wasu * disp me, swm is in prow operatmg condition andlor (z) afkr inspection and pumping (if necessary), tht septic tank is Iris than 113 Rill of sludge. Ywc, the undera` d have read the sb*ve requirements and agree to maintain the private sewage disposal system will: the standards act forth, set by the Department of Commerce and the t of Natural Rest urm, State of Vfi isconsin. Certification stattrg system has been maintain must by c and rcttirncd the t. Croix County Zoning Clfficc within G day of tion date. Sfax 0 t DATE 0'%'*DER C TION all statements on this form are utae to the best of my (cau) irvt =lctle. I (we) am (art) the owner(s) of tl _ S by virtue of a warranty decd recorded in Feuer of Deeds Cave. I LICANT LATE l Any infomiation that is mis- represented may result in the sanitary permit being revoked by the Zoning Depart rtent *f••" •* Include with this application: a stamped warranty deed from the Register of Deed -; office a. copy of the certified survey map if sefcsence is made in the warranty deed 2 .0 2SI ' STATE BAR OF WISCONSIN FORM 2 - 1999 WARRANTY DEED Document Number This Deed, made between Day Firm Investors, LLC, a Minnesota 0 4 6 3 7 L imited Liabilit oy mpost ._ __,• _ XATNLEEN N. MALS)1 REGISTER OF DEEDS ST. CROIB CO.. MI Grantor, and Jon Paul Herbst and EBzabeth N. Herbst,hDSband and wife RECEIVED FOR RECORD as u e p a prop r y -- - 01/07/2003 08t30AN EXEMPT 4 Grantee, REC FEE: Grantor, for a valuable consideration, conveys and Warrants to it. Grantee the following described real estate in St. C roix TRANS FEE. 278.70 County, State of Wisconsin: CERT Copy FEE, Name and Return Address of 14 Troy Wood, Town of Troy, St Croix County, Wisconsin 5 — QZ. 040 -1269- 904000 PAmel Identification Nundwr (FIN) This is rwt homestead property. (is) (is riot) Exceptions to warranties: Subject to Dotes, easementSAStrictions,covenants and rights of way of record, if any, including but not limited to those for draimge,water retention,ponding,and or utilities as may be shown on the plat of Troy Wood recorded iA Vol. 8 of plats, page 28St. Croix Colmty, Wisconsin. The wanaoties of this deed, either expressed or implied are limited by the grantor to the graritee, or atrydne in the chain Of title. to the consideration exprossed herein. that being the stun of $92.900.00. Dated this 2nd — day of Japuary _ , 2003 Day Farm Investors, LLC • . by �., President r - • • Austin J. Balilon _ AUTFIENTICAT(ON 7 � ACKNOWLEDGMENT SPATE Or MMRPM ) Signaluro(s) ) so. Personally came before me this 2ad day of authenticated this _..._day of _.. ..__ ...._ J anuary , 2003. _ the above flamed TITLE: NEMBER STATE BAR OF WISCONSIN to me known to be the persons) who executed the foregoing (If not, inattum t and ack aowled a the same. authorized by §706.06, Wis. Stets.) / J � gM THIS INSTRUMENT WAS DRAFTED BY cr rJIV Paul A. Banton, Attorney at Law 'Pa A. Saitlon�,...' •' " ` "' ' .. Notary Public, State of Wixoiidiri" r :.z• , s s ,.,,; a -: r (Signatures may be authenticated or acknowledged. Both are not My Commission is PermattrmG Of Dot.. "W a',tcpiR c: , necessary.) Jawary31 2005 _ ) • Names of pcesom signing in any capacity should be typed or printed below nett aignalum W AaaANTY b9ab OaASC Ma Or W ]aCONSn1 FORA[ Nei 1 •1!!a 04FT.1naaATfON PlAFaleiONALl COMPANY FOND DlTLAC. WY W0 eIf -J03I TROY WOOD E %4 OF /4 / OF $=ION !7 4AND TH E Si4Or THE /4HOFs E�CTION 90 ALL, IN Ti'8 , MV, .TOWN Or TROY, ST, CRID% CWj, WISCONSIN mkmw air 'ma wL or Am µ d!NM 40 I I f j AW L Al • ' rte! ' .•ra_ ^'".' � `` `, 94 1 1 sa ey u �� O wr•w�.s•� M { Now taw I � r j + a i �ALSR N f . f r / / Po o If woo _— Ole J0 00 a • ` i tom/ 1 0 / i� O r dOl Opp was 1 . fop 1 r y9K�, r Q 1 a y� ��� y � 1 - w � t i p 1 N cos _ 1 a 40 f C r ... x.10' • 1 "6.05, ---- -- 23s� — "--ems f ®� NOR'"'O QUARTER LINLF age W RADIUS TEMPORA OUL•DE -SAC ! O M TO 1W I' -U ^T=At.LY WMNQ UPON ROAD UXTENSMON a , .. l3' 4ti e �'1. �,/p'` ..YR;'l, : 4� »_�"�., a;"',,,•. eyr ,,,....:.''es'` r, ; . 37. x'11 .'�"� ;?• •. .86 AC 1.335 a� 1.87 A / k; 13 -41 1328 Wisconsin Department of Commerce SOIL EVALUATION REPORT P age 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 reference point (BM), direction and Parcel I.D. pendin percent slope, scale or dimensions, north arrow, and e to nearest road. Please print all i 4 n c g Reviewed By Date Personal information you provide may be used rs,"ary purposeWacy Law, s. 15.0441) (m)). Property Owner r ; +.= C ._! ;� Prop* Location Humbird Land Corporation " Gdut. La 1/4 SW 1/4 S 17 T 28 N R 19 W Property Owner s Mailing Address - 7 ,�,Q(j Lof f I Block # Subd. Name or CSM# 332 Minnesota Street, East 1404 13r CROIX 40i n/a Troy Wood Subdivision City State Zi"a Phone I `-4 city J Village e,, Town Nearest Road Saint Paul MN 55 4' ` . 651 -2�� 49 i Troy E Cove Rd / Crocus Hill Road H' New Construction Use: Residential T _ s 3 Code derived design flow rate 450 GPD Replacement Public or commercial - 15escribe: Parent material outwash plains Flood plain elevation, tf applicable n/a General comments and recommendations: Part of 1.60 acres. BM #1= 100.0'. BM #2= 102.0'. Recommend system elevation 108.4' along 110.1' contour. Boring # Boring iI Pit Ground Surface elev. 110.1 ft. Depth to limiting factor X72 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft *Eff#1 *Eff#2 1 0 -10 10yr2/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 10 -18 10yr3 /4 none gr. sil 2msbk mvfr cw if 0.5 0.8 3 18 -32 10yr4/6 none gr.Is lmsbk mvfr cw - 0.7 1.2 4 32 -37 10yr5 /6 none gr. s Osg ml cw - 0.7 1.2 5 37 -72 10yr6/6 none s 0 sg ml - - 0.7 1.2 Fil Boring # -I Boring N Pit Ground Surface elev. 107.9 ft. Depth to limiting factor >72 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 I *Eff#2 1 0 -8 10yr2/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 8 -17 10yr3/4 none gr. sil 2msbk mvfr cw if 0.5 0.8 3 17 -32 7.5yr4/6 none gr. Is 1msbk mvfr cw - 0.7 1.2 4 32 -43 10yr5/6 none gr. Is 1 msbk mvfr cw - 0.7 1.2 5 43 -72 10yr6/6, 4/6 none sl 2msbk mvfr - - 0.5 0.9 * Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 50 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 Property owner Humbird Land Corporation Parcel ID # pending Page 2 of 3 F31 Bonng # _j Boring Id Pit Ground Surface elev. 111.8 ft. Depth to limiting factor >80 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -11 10yr2/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 11 -19 10yr3/4 none gr. sit 2msbk mvfr cw if 0.5 0.8 3 19 -32 7.5yr4/6 none gr. Is 1 msbk mvfr cw - 0.7 1.2 4 3246 10yr none gr. Is 1 msbk mvfr cw - 0.7 1.2 5 46-80 10yr6 / 4/ none sl 2msbk mvfr - - 0.5 0.9 Bonng # _j Boring j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Desaiption Texture Structure Consistence Boundary Roots GPD/ft' _ *Eff#1 *Eff#2 F-1 Bonng # _ J Bonng �j Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence: Boundary Roots GPD /ft *Eff#1 *Eff#2 " Effluent #1 = BOD 5> 30 < 220 mg& and TSS >30 < 150 mg/L Effluent #2 = BOD < 30 mg/L and TSS < 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. r ° CD Q Y L k L x N v ao Q O o M � Il Y 16 . i II i y O. �o 0 cc� c►. o O CI Y U � L 'Q 1_ S 3 Q o r o © n W J J 7 O J (n W W V !n ■ N m m ° O .