HomeMy WebLinkAbout040-1270-00-000 Wisconsin Department of Commerce Count
PRIVATE SEWAGE SYSTEM St. Croix
Safety and - wilding Division
INSPECTION REPORT sanitary Permit No:
430524
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)i.
Permit Holder's Name: City Village X Township Parcel Tax No:
Sunde, Bruce I Troy Township 040 - 1270 -00 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No:
/ 6D D U &o� 17.28.19.1487
TANK INFORMATION ELEVATION IJATA
TYPE MANUFACTURER CAPACITY STATION BS HI I FS ELEV.
Septic Benchmark
/ a sD d a-s-f s 23
Dosing Alt. BM
Aeration Bldg. Sewer
Holding
St/Ht Inlet
TANK SETBACK INFORMATION t/ t outlet i
TANK TO P/L WELL LDG. Vent to Air Intake ROAD Dt Inlet
N OY�
Septic 1�;D, / / Dt Bottom
Dosing H ader / Mal b r7 R
Aeration Dist. Pipe 1 1
Holding Bot. System
z g•�C 3 �s
Final Grade
PUMP /SIPHON INFORMATION
Manufacturer Demand St Cover / r
GPM
Model Number
TDH Lift Fric' Loss System Head TDH Ft
Forcemain I 1,4 Dia.
SOIL ABSORPTION SYSTEM —
2
a 3
BEDITRENCH Width I Length / No. Of Trenches PIT DIMENS S No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS Z 'Y
SETBACK SYSTEM TO P/L BLDG WELL I LAKE /STREAM LEACHING nu turer:
INFORMATION CHAMBER OR
> L-0
Type Of System: / ZD / � 7S I / UNIT �odel'ber: um
DISTRIBUTION SYSTEM > ZS' /
Header /M nifold Distribution / x Hole Size x Hole Sp ading Vent to Air I take
N pipe(s)
Length Dia 4 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
Bed/Trench Center Bed/Trench Edges Topsoil
Yes No L Yes D No
COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1:�/ 2 7 / Inspection #2:
Location: 452 Crocus Hill Hudson, WI 54016 (NW 1/4 SW 1/4 17 T2 N R19W) Troywood Lot 11 Parcel No: 17.28.19.1487
1.) Alt BM Description = 5; rlCovullz Q 1 -.�L G�
2.) Bldg sewer length = ( g` / FAN Q s /d
- amount of cover = el
Plan revision Required? U Yes to
6 I L 41 7 __ 6�
-- II
Use other side for additional information.
SBD -6710 (R.3197) Date Insepctor's SignaWire Cent. No.
-- L
- Safety and Buildings Vivisiun County
W. Washington Ave., P.O. Box 7162 .5'�e y d r X
F ?n �� j t d ®!� Madison, WI 53107 - 7162 Sanitary Permit Number (to be fille ' by Co.)
Yy �f c0;!f ? 266 -3151 � c6
Sanitary Per t Application State Plan I.D. Number
In accord with Comm 83.21, Wis. Adm, Code, pora0ntet iafert�s+ac�ion,ypy rovicie ��
may be used for secondary purposes Privacy Law, y PA /P Project Address (if different than mailing address)
I. Application Information - Please Print AU Information
GG�5
Property Owner's Na me A Parcel N Lot M Block k {
Property Owner's M ailing Address °°- --••...� _ -_ Property Location - U
City. tate /�� '�. 's,Section
ty� ill Cade Phone Number 1� o
Building (circle d ' 70 r 7
ScJ r r .�yd l� T N; R j oiCld�/
II. Type of Bug (check all that apply) '�"
or 2 Famfl Dwelling Subdivision Name CSM Number
y ng - Number of Bedrooats
❑ Public /Commercial - Describe Use
' 2
❑ State Owned - Describe Use S"l C�(f 2 2 r oty_❑Viltagexiownship of D
III. Type of Penult: (Check only one box on line A. Com plete line B if applicable) _
A ' VNew System ❑ Replacement System ❑ Treatment/Hoidirg Tank Replacement Only ❑ Other Modification to Exalting System
B. ❑ Permit Renewal Permit Revision C: Change of C1 Permit Transfer to Now List Previous Permit Number and D Issued
Be fore Expiration Plumber Owner
I j !
} IV. Type of POWTS System;_ (Check all that apply)
I VNon - Pressurized In Ground d Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil 0 At -Grade ❑ Single Pass Sand Filter j
Constructed WetlandsW ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
❑
Rgclrcu1!gq Synthetic Media Filter LeacBing Chamber ❑ Dri L' ❑ r�ravel -less Pi ❑ Odler (ex lain) J.
V. D rsaVTreattnent Area Information - _
Design Flow (gpd) Design Soil Application Rate( SP Dispersal Area Required (sf) Dispersal Area P ( System Elevation
j VI. Tank Into Capacity in Total Number I Manufacturer P b Sice Steel Fiber Plastic
Gallons Gallons of Units j Concrete Constructed Glass
New Exisdng i I
Tanks Taus I
Septic or - Holding Tank
Aerobic Treatment Uulc
I Closing Cha %W
VII. Responsibility Statement- I, the Undersigned, assum responsibility for UAWlation o the P OWTS shown on the attached
PUM-
Plumber's Na me (Print) Plumber's Si gnature &EAIPRS Number Business Phone Number ;
Plumber's Addre as (Street. City, Stan, Zip Code)
VIII, Count /De oirtntent Use Only_
pprovpd ❑ Disapproved Sanitary Permit Fee (includes Grpundwater Date I Issuing Agert igna re
Surcharge Fee) 5� �1�I C I a7 Q
Owner Given Reason for Denial
IX. Condlt[ane of Approval /Reasotls for Disapproval �
6 YSTEM OV!'Nti;:
Septic tank, effluent filter . td 7T,,� SGtir/12 �� �• 7
dispersal cell must all be serviced / maintained
as per management plan provided by plumber
2. All setback requirements must be maintained Oh �� ► �vC 7` 1 G� � ,_ SO�tX
as per applicable code /ordinances.
Attach eotrtplate plain (to the t:ounty only) ter the system on pallor not kaa than $1/2 x 11 inches in also
SBD -6398 (R. 01/03)
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Wisconsin Department of Commerce PA! SOIL EVA LUATION REPORT Page- ' of _,
Division of Safety and Buildings
in a rdance with Comm 85, Wis. Adm. Code
County
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must
include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. �7�, �c
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. yA T 7 - 0—
Please � y�
Please print all information. eviewed Date
y
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Q
Property Owner Property Location
6r .1L )> Vex Govt Lot �(/GJ 1146*A S l ? T N R E (or) `2
Property Owner's Mailing Address / , Lot # Bixk # Subd. Name or CSM#
City State Zip Code Phone Plumber city ❑ Village Nearest Road
I J I( ) oY A
t!'In
JO New Construction Use: Residential / Number of bedrooms_ Code derived design flow rate GPD
❑ Replacement' ❑ Public or commercial Describe: ---_—_---_—_----_----
Parent material _ —_ _ —___— Flood Plain elevation if ap plicable _ - -- — — - -_ — h
General comments SY S �ty, U� �G��C v4'GvYv�
and recommendations: 11 ! /
c if/ YZd TT>
Boring
/ goring # j, -j�
�, Pit Ground surface elev.r-�i1U_ ft_ Depth to limiting factor _ in Soli Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF
in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 I 'Eff#2
S; 2
2- r n CS —
3 /. 2
Boring # E] Boring
pit Ground surface elev. ��0 __ ft. Depth to limiting factor % / in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKf
in. Munseli Qu. Sz. Cont. %«lor Gr. Sz. Sh. 'Eff#1 'Eff#2
c -
'f$ rant
Effluent #1 = BOD > 30 mg(L and TSS - .30 <-- 150_mg1L - -� Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
AT� ame (P ri t) Signature CST Number
LA 2_
Address Date Evaluation Cond ed Telephone Number
2.113 �Sdl e J - - 7 - OZ7 Ctl
' Parcel ID # __ - -- • Page -_ Z of - -�L .
Property Owner-
❑ (lD
Boring # Boring n.
12�
Pit Ground surface elev. �!�- ft. Depth to limiting facto Soo Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont Color
Gr. Sz. Sh. 'Eff#1 'Eff#2
r C 2 -
r
Z _Z40 2
U o
[] Boring
❑ Boring # Ground,surface elev. ___ ft. Depth to limiting factor _— — in• Soil A lication Rate
❑ Pit
on
Depth Dom
inant Color Redox Description
Texh re Structure Consistence Boundary Roots GPD/fF
De
Horn p 1 'Eff #2
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Eff#
I
Boring
El Boring # Pit Ground surface elev. ___ —_ —__ ft. Depth to limiting factor _ —_ —_ in•
❑ Soil lication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff #2
' Effluent 111 = BOD 30 < 220 mglL and TSS >30 < 150 mg/L " Effluent #2 = 130 D, < 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 sery ices or
need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777.
M-8330
I -
PAGE - 3
NAME: _ LOT #LEGAL DESCRIPTION :AW/4_�p/4,Sn_TZN
SCALE: 1 ,2 = -
fok ELEVATION: �( • G' � ,
BM I DESCRIPTION:-Wc� qaL6400c am`
BM 2 ELEVATION:
BM 2 DESCRIPTION:
SYSTEM ELEVATION:
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SYSTEM TYPE: 0 VI v-e n 4w Ac J '-
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Safety and Buildings Division 1 County
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iseonsin Mad, W t� €WED Sanitary Permit Number ( be filled in by Co.)
Department of Commerce 8) 266 -3151 L � l3o Sanitary Permit Appli ti T 3.1 2003 State Plan LA. N
In accord with Comm 83.21, Wis. Adm. Code, personal imati yQu rovide A
may be used for secondary purposes Privacy Law5.0+it� { 1Yi��IX COUNTY Project Address (i different than mailing address)
ZONING OFFICE (2066/S /-llC�
I. Application Information - Please Print All Information
Property Owner's Na me Parcel N e Block //
Property Owner's M ailing Address -.. l�
17 X1 7 Property Location
�,�, 2 � 4 W,Section `7
City, State Zip Code Phone Number -A
�tii ,r/ 1 4 W , { �yQ� T r N; R ( c i rcle 9m) o
11. Type of Building (check all that ply)
A I I or 2 Family Dwelling - Number of Bed ms _ Subdivision Name CSM Number
tr.! Public /Commercial - Describe Use .3 !X P 7 d V xkvd
❑State Owned - Describe Use e ❑City of
III. Type of Permit: (Check only one box on ffqe A. Complete lin B if applicable)
A. I New System El Replacement System ❑ Treatmenv'H ing Tank Replacement Only ❑ Other Modification to Existing stem
i
B. ❑ Permit Renewal ❑ Permit Revision hange o ❑ Permit Transfer to New List P evio s Permit u lssued
Before Expiration Plu r I Owner
I _
IV. T e of POWTS System: (Check all that apply)
N - Pressuri In- Ground ❑ Mound > 24 in. of suitabi ii ❑ Mound < 24 in. of suitable soil At -Grade 11 Single Pass Satin Filter
❑ Constructed Wetland ❑ Pressurized n - Grn, n d H ing nk 1 Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter
L] Recirculating Synthetic Media Filt Leaching Cham ❑ vel -less Pipe 11 Other (ex lain)
_ Dispersal /Tr eatment Area Information: Design ca n r/
Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersa ispersal Area Proposed (sf) Syst a_ do i
VI. Tank Info Capacity in Total umber anufacturer Prefab Site Stee iber
Gallons Gallons of Units Concrete Constructed Glass
New Existing /
Tanks Tanks ' t/
Septic or Holding Tank
Aerobic Treatment unit
Dosing Chamber
VIP. Responsibility Statement I, the iinde igne assume responsi for u Ilation of the PO shown on the att ached plans.
Plumber's Name (Print) Plum is Si gnature P/ PRS Number J - Business Phone Number
Pl umber's Addre ss (Street, City, State, Zip C e)
6 !J j ,�'
VII Count /Depa Use O nl y
Approved Q Disapproved Sanitary Permit Fee (includes Groundwater Dat Issued suing Age t Signatur Stamps)
Surcharge Fee) �
❑ O wner Given Reason for Denial U 7 A
IX. Conditions of Approval /Reasons for Disapproval �y alfr,2 — Z �
C
/ � O ��
Y STEMOWNErt. an-- -Yvv✓t p Sy — OG•'1� ','
1 Septic tank, effluent filter and
dispersal cell must all be serviced / maintained
as per management plan provided y plumber
2. All setback requirements must b maintained �` I
as per applicable code /ordinances
Al
Attach complete plans (to the County only) for the on paper not less than 81/2 x II inches in siz
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APROVED
0PROVED i_.. SEAL 117 JOINTS WITH
PIPE 3 8 ALM f r APPROVED P iPE
JNTO SILIO , 'ON 3 ONTO
FOIL I c i sotto. SOIL
PUMP OFF BLEV , xT. '
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3" APPROVED BEDDING U.\D£R TANX HAS APPROVAL
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PECIF?CAT - LONS
SEPTIC r DOSE
TANX MANWACTtiR£R: NUMBER DOSES PER DAY
TANX SIZES: SEP TIC GA' T r ., ri
DOSE 4v �" GAL. LOSE vc: J. II�C��rNG
- .,�........._.. F LOWSAC X . i GA �, .
ALARM MANUFACTURER: , �,g CAPACT.71 S: A = , .Z i:vC!?ES r u
MODEL NUMBER: � 1G .---_ „„ �aAL
SWITCH TYPE: •�•• jn etc 8 �, 2 Z:v'CHES r
MO DEL N N UMB
PUMP MUMBER t ER : C I INCHES = l, ✓� _GAS.
"�` n0FT SWITCH TYPE t ZINCHES S REQU D RAT PUMP £, ALARM WIRING AS : ER iLKR 16.23' WAC
1E2RT;CAi. DIFFERE,yCE BE AND • PIPE
MINIMUM NETWORK SUPPLY PRESSURE !a raT
FEET rORCEMAIN X F FT130{� v FT'. �FRIC:ZiOk F'ACxGR ` FEET
TOTAL DYNAMIC DEAD : / L-7 r E FEET
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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 reference pant (BM), direction and Zi percent slope, scale or dimemsions, north arrow, and locatiorn -ano distance to
nearest road. P
Please print all infgni* n. ` ed Date
Personal information you provide may be used forsecbrld�ry purposes (Privacy Law, s. 15.04 (1) (m))- D
Property Owner rr' /, _� Property location
Humbird Land Corporation ' Govt. 4 t 1/4 SW 1/4 S 17 T 28 N R 19 W
Property Owner's Mailing Address y r' y Lot # ! Block # Subd. Name or CSM#
332 Minnesota Street, East 1404 .i lftQ 11 n/a Troy Wood Subdivision
City State Zi(b Code Phone ity - j village ✓ Town Nearest Road
Saint Paul MN 55101 I 1 5 �, �� Troy E Cove Rd / Crocus Hill Road
1r New Construction Use: a Resident a4k"t rrn*� — f 3 Code derived design flow rate 450 GPD
--.f Replacement J Public or corrirrt2rsiaL_2
Parent material outwash plains Flood plain elevation, N applicable n/a
General comments
and recommendations: Part of 1.5 acres. BM #1= 100.0'. BM #2= 97.0'. Recommend system elevation 104.6'. P47 from
preliminary boring work done 5 -5 -00. 3
[ P47] Boring # - I Boring
d Pit Ground Surface elev. 95.6 _ ft. Depth to limiting factor >75 in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
*Eff#1 *Eff#2
1 0 -10 10yr3/2 none sil 2mcr mvfr as 2f, 1m 0.5 0.8
2 10 -18 10yr4/4 none gr. sl 2msbk mvfr cw if 0.5 0.9
3 18 -28 10yr5/6, none gr. s 0 sg ml cw - 0.7 1.2
4 28-42 10yr4/6 none gr. Is 1 msbk mvfr cw - 0.7 1.2
5 4 -75 1 10yr5/6 none gr. s 0 sg ml - - 0.7 1.2
Boring # I Boring
1/ Pit Ground Surface elev. 107.6 ft. Depth to limiting factor >72 in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
*Eff#1 *Eff#2
1 0 -11 10yr2/2 none sil 2mcr mvfr as 2f, 1m 0.5 0.8
2 11 -19 10yr3/3 none sil 2msbk mvfr cw 1f 0.5 0.8
3 19- 1 10yr4/4 none sil 2msbk mfr cw - 0.5 0.8
4 31 -51 10yr4/6 none gr.ls 1msbk mvfr cw - 0. 1.2
5 5 -72 10yr5 /6 none gr. s 0 sg ml - - 0.7 1.2
3Co s vh' , -7 s
* Effluent - 5> 30 < 220 mg/L and TSS >30 < mg/L * Effluent #2 = BOD 5 mg/L and TSS <30 mg/L
CST Name (Please Print) Signature: CST Number
Tom Gustum 227618 MIC4
Address Gustum Septic Service Date Evaluation Conducted Telephone Number
N13450937th St., New Auburn, WI 54757 11/16/00 715 -658 -1344
property Owner Humbird Land Corporation Parcel ID # pending Page 2 ' of 3
F2 I Boring # J Boring
Id Pit Ground Surface elev. 106.7 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 *Eff#2
1 0 -7 10yr3 none sil 2msbk mvfr as 2f, 1m 0.5 0.8
2 7 -12 7.5yr4/4 none gr. sil 2msbk mvfr cw if 0.5 0.8
3 F26-53 7.5yr4/6 none gr.Is 1msbk mvfr cw - 0.7 1.2
4 10yr4 /6 none gr. Is 1 msbk mvfr cw - 0.7 1.2
5 10yr5 /6 none gr. s 0 sg ml - - 0.7 1.2
!o �' 4- 3 i>
2.S -3.o s s
[ ] Boring # J Boring
Id Pit Ground Surface elev. 107.6 ft. Depth to limiting factor >72 in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots __.._ GPDW. -- - __.
*Eff#1 *Eff1Q
1 0 -12 10yr2/2 none sil 2mcr mvfr as 2f, 1m 0.5 0.8
2 12 -18 10yr3/3 none sil 2msbk mvfr cw 1f 0.5 0.8
3 18 -36 10yr4/4 none sil 2msbk mfr cw - 0.5 0.8
4 36 -55 7.5yr4/6 no ne gr. Is 1 msbk mvfr cw - 0.7 1.2
5 5 -7 10yr5/6 none gr. s 0 sg ml - - 0.7 1.2
F4 ] Boring # J Boring
Ad Pit Ground Surface elev. 114.0 ft. Depth to limiting factor >72 in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 Eff#2
1 0 -10 10yr2/2 none sil 2mcr mvfr as 2f, 1m 0.5 0.8
2 10 -15 10yr3 /3 none sil 2msbk mvfr cw 1 f 0.5 0.8
3 15 -27 10yr4 /4 none sil 2msbk mfr cw - 0.5 0.8
4 27-48 10yr4/6 none gr. Is 1 msbk mvfr cw - 0.7 1.2
5 4 - 10yr5/6 none 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 < 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.
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ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer 922- = e , e_ Stat-,v at
Mailing Address v9 V1 - 7 /C X o�/ Gd 5`lal�
i
Property Address
(Verification required from Planning Department for new const1710n) _
City/State Parcel Identification Number �)y
LEGAL DESCRIPTION
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Property Location _ "0 ' /., Sec. �, T Of N -R_Z�W, Town of /rd�
Subdivision rd'a ,/ �Jt',?crl.� . Lot # �.
Certified Survey Map # , Volume . Page #
Warranty Deed # �' , Volume �2 L / V , Page # 3t
Spec house ❑ yes A no Lot lines identifiable 2 yes ❑ no
SYSTEM 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.
The 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 wastewater disposal system
is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of e three ye exp' tion date.
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
WNE
I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of
the . p described above, by virtue of a warranty deed recorded in Register of Deeds Office.
"N4 0 141 1 —f
S GNATURE OF APPLICANT DATE
•••••• Any information that is mis- represented'may result in the sanitary permit being revoked by the Zoning Department. « « « « ««
`• 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
I
POWTS OW T P �/
, OWNER'S MANUAL & MANAGEMENT PLAN P of
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FILE NNFOItMATNON SYSTEM SPECIFICATIONS
Owner
Septic Tank Cspacity Z d a1 0 NA
Permit 4 Septic Tank Manufacturer c eA 0 NA
DESIGN PARAME'T'ERS Effluent Filter Manufacturer e ❑ NA
Number of Bedrooms y 0 NA Effluent Miter Model Cry 0 NA
Humber of Public facility Units NA Pump Tank Capacity al O NA
Estimated flow leverage) ��'Q g al/day Pump Tank Manufacturer r� s,o y ❑ NA
Design flow (peak), (Estimated x 1.5) 0!�'er g al/day Pump Manufacturer O NA
Soil Application Rate al /da /ft' Pump Model i:3 NA
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA
Fate, Oil ih Grease (FOG) 530 mg /L 0 Sand /Gravel Filter 0 Peat Filter
Biochemical Oxygen Demand (BOD 5220 mg /L O NA 0 Mechanical Aeration 0 Wetland
Total Suspended Solids (TSS) 6150 mg /L Cl Disinfection 0 Other:
Pretreated Effluent Quality Monthly average Dispersal Collis) 17 NA
Biochemical Oxygen Demand (600 530 mg /L Xin- Ground (gravity) 0 In- Ground (pressurized)
Total Suspended Solids (TSS) 530 mg /L NA 0 At -Grade Mound
Fecal Coliform (geometric mean) 510 –` cf4100r, CI Drip -Line 0 Other:
Maximum Effluent Particle Size Y. in dia. 0 NA other' 13 NA
Other: ❑ NA Other' ❑ NA
"Values typical for domestic wastewater and septic tank effluant ate: 0 NA
MAINTINANCE SCHEDULE
$WWI" Event Sarv)ce Frequency
Inspect condition of tank(s) At least once eve month( tMaxbnum 3 years! O NA
3 ear a!
Pump out contents of tank(s) When combined sludge and scum equals one -third (Y5) of tank volume O NA
Inspect dispersal cells) At least once every: monthl e) (Maximum 3 years) 0 NA
Clean effluent filter At least once every: a) 0 NA
Inspect pump, pump controls A alarm At least once every: .— monthis) O NA
D ar(s)
Flush laterals end pressure test At least once ovary: mo nth(s) O NA
Q earls!
other: O month(&) 0 NA
At least once every: -- p ear(s)
Other:
Q NA
MAINTENANCE INSTRUCTIONS
ln&pectfona 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 tanks) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volu f
o ume o combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal oell(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 weacs 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 lYa) or more of the tank volume, the entire
contents of the tank shaft be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wiaconsan Administrative Code.
All other services, including but not limited to the servicing of effluent fliters, 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.
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T449E3 - 1
STATE BAR OF WISCONSIN FORM 2 - 1999 KATHLEEN H. WALSH
WARRANTY DEED REGISTER OF DEEDS
Document Number ST. CROIX CO.. MI
This Deed, made between Day Farm Investors, LLC, a Minnesota ED FOR RECORD
Limited Liability Company - N/200;3 09:50AN
C :ARRAHTY DEED
EX
Grantor, and Bruce IL Sunde and Sandi Sonde, husband and wife FEEE: : d
RfiC F 11.00
TRANS FEE: 284.70
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:
Pecopline Area
Name and Return Address
of )-y Wood, Town of Troy, St. Croix County, Wisconsin
040- 1270 -00 -OW
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Exceptions to warranties: Subject to notes, easernents ,restrictions,covenants and rights of way of record, if any,
including but not limited to those for drainsige,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 an amount not to exceed the consideration
expressed herein, that being the sum of $94,900.00.
Dated this 6th day of October 2003
Day Farm Investors, LLC
i by President
i i Austin J. Baillon
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
) as.
Signature(s) Ramsey County. )
Personally came before me this 6th day of
authenticated this day of October 1 2003 the above named
Austin J. Baillon
i
TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing
(If not, instrument and acknowe the same.
authorized by § 706.06, Wis. Slats.) R
THIS INSTRUMENT WAS DRAFTED BY 10 PAUL A. BAILLON
Paul A. Baillon, Attorney at Law ' Paul A Baillon * . +orr, Pusuc uo rso -=
Notary Public, State of Wisc s
(Signatures may be authenticated or acknowledged. Both are not My Commission is petmaneift o s exptra on e:
necessary.) January 31 20115 )
*Names of persons signing in any capacity should be typed or printed below their signatures
WARRANTY DEED STATE RAR OF WISCONSIN
FORM No. 2 . 1991
INFORMATION PROFESSIONALS COMPANY FOND DU LAC. WI 900 -2021
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CENTER OF TEMPORARY
CUL DE -SAC IS SOV43'34' W
86.84' FROM THE
SOUTHEAST CORNER OF
LOT 11
1.191.1 N
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W I 2.00 ACRES 1 CD
/ 87 SG. FT.
39 6' 1 11
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