Loading...
HomeMy WebLinkAbout040-1270-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM oOunty St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No 538799 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)]. Parcel Tax No: Permit Holder's Name: City Village X Township Harris, Greg Jr. Troy, Town of 040 - 1270 -20 -000 I Section/Town/Range/Map No: CST BM Elev: Insp. BM Ele : BM Description: 0A 4 40 17,28,19.1489 TANK INFORMATION ELEVATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS Zf v ELEV. Aeration . Septic / � b Benchmark 3 ( (/ � Alt. BM It Dosing n Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION c � TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic ��r ! i Dt Bottom Dosing J Header /Man. Aeration Dist. Pipe , S 7 - 5 Holding Bot. System 9 Final Grade 7•Z 97� 1ty PUMP /SIPHON INFORMATION 7 Manufacturer Demand St Cover :1 ,47 q'T. J ? GPM .7• p� Model Number —U ew �. Z TDH Lift Friction Loss System Head TDH Ft 9 3. Forcemain th Dia. o Well �. �}.b SOIL ABSORPTION SYSTEM / ` BEDITRENCH Width Length . No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ; to � LEACH SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM CHAMBE OR Manufacturer: ; '. INFORMATION Type f System: / UNIT Model Number /I JP .� / t0 yet. � DISTRIBUTION SYSTEM / 16- 1 16 t ` ,/ Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air take /L Pipe(s) �. ` Length Di- 2i_ Length Dia _ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only De th Over xx Depth of xx Seeded /Sodded Ved Depth Over I' BedlTrench Ed es Topsoil \ es NYes t Bed/Trench Center �/ 9 COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 435 Crocus Hill Hudson, WI 54016 (SE 1/4 SW 1/4 17 T28N R19W) Troy Wood Lot 13 Parcel No: 17.28.19.1489 1.) Alt BM Description = r: �► CoJ c•�— S�o�ew... ,'n.6 �J G�wme+s- e� �:`,� 2.) Bldg sewer length = �� �✓�/�- �t� @.J e.�� - amount of cover Plan revision Required? 0 Yes No ` J� �i -- `v Use other side for additional information. Date Insepctor's ignatur - _ cent No SBD -6710 (R.3/97) R ECEIV ED 201 PA I D JUL 132011 1.g: Safety and Buildings Division County S OF ICE W. Washington Ave., P.O. Box 7162 - 9 Madison, WI 53707-7162 Sanitary Permit Number (to be filed in by i53 7 Sanitary Permit Application State Transaction Number In accordance with a. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental AIA- unit in required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different in mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary pit !I acs in accordance with the Privacy Law, a. 15,04(l)(m), Slats, Y33 I. A!pplication Information — Please Print All Informatio Property Owner's Nad'W 4, 07U41 r Parce l Property Owners LJ Jr ' .-0(2 ,— � Mailing , ?s Addre Azo cx_� Property Location Govt. Lot — City, State Zip Code Phone Number _56— VX_ V4, Sect ion �r 0 /*1, orl T N; R W 41 0 t 0 0.1 Zip Cc 11. T ype 0 f Building (c k all that apply) Lot or 2 Family Dwelling Number of Bed or Subdivision Name ms ❑ Block 62 N iblic/Cominnercial -- Describe Use -------------- Ocity( Ehdale Owned -- Describe 11 Village of 12— Ci To of 4-_4-6 III, Fype of Permit: (Ch eck ady t � T o4lo. on line A. Complete line B if applicable) El New System A System El Treatment/Holding Tank Replacement Only ElOther Modification to Exist ng System (6xplain) B. ❑ Permit Renews it Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number a id Date Issued Before Expiration Owner �._Fyvl type o f POWTS ntemlqStn nen1UP i-Pressurized In-Ground 11 Pressurized In-Ground FJ At-Grade U Mound 24 in. of suitable soil ❑ Mound < 24 in ,oil El I folding Tank 11 Other Dispersal Component DPretreatment Device (explain)., — V. ' ])Is — persal/ — Tre - a - 4 - . — Area — I nt Information c3ign low (gpd) Design Soil Application T Di I Area Proposed (0) System Ele te6idaf) u— 12J9. I. Tank Info Capacity in , Fowl of Manufacilirer "o' Gallons Gallons Units Existing Tanks New ranks Sep i c or 1 o - 1d i n _gT ank lNising Chamber V11 1. Responsibility StatemeAt- 1, the undersigned, assume Iliffily for installation of the POWTS shown on the attached plans. Pli�� Name ( Print) P ulm bc r' B usiness Ph Number ,/ re MP I �z Plumber's Address (Street, City, State, 7ZiP ode ) 01'_ J0 00 V!lt Count y/De paliment Use Only I - Approved ed I Date Issued Issuin nt Signat Reason o , at $ Y751 I 7INY L.K. Condi sons for Disapproval Septic tank. ;iiilent filter and 1 6—/A6& dispersal cell must all be servIc" / maintained A4) AJ6 P.CA- aP as per management plan provided by plumber 2- AJI sofbiWk rvquiremerft must be maintained Iag"') 11 11 812t -�� �'n� -i �-' � l4 c.¢„ C�n,a.,,.�t.CS `� h,o,�e.. �t" l X16 Comp is pines for twe system and submit to the County only on paper not less It an 9 I I 1 1116 1 03D Int -63 98 (R. 0 1/07) Valid thru ( 1/09 Soil Test and System PLOT PLAN PROJECT Grea Harris ADDRESS 435 Crocus Hill Road Hudson Wi 54016 1/4 SW 1/4S 17 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 7/11/11 BEDROOM 4 CONVENTIONAL XXX IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1 I� # of chambers hL BENCHMARK V.R.P. Septic tank cover @ 98.35 �u�' 7, Filter Zabel A -100 ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark SYSTEM ELEVATION 94.25/94.1/94.0 4.5' below qrade Property Line Vent >6" Standard Biodiffuser Of Cover Leaching Chamber 80' with P t2 of Area 6' Long `f 34" Grade to levation �Q/ B -1 70' Plans Designed Using Conventional Powts Manual Version 2.0 Pro 4 Bedroom 20' B -2 House Q3 T Test done for 20' y 50' conventio rial by 0 , 1 Tom Gus m Vents ♦ 35' 30' B -3 10% Slope 10' i 70' B -3 Area of soils not - 7 5 A suitable for conventional ►-� -;In i 0 • ,S0_0 system 300' P perry Lin 'S-3' X fW Cells with Vents Spaciif- 10' B -2 Property Line 110 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 7/11 /11 Owner: Greg Harris Location: 1/4 SW1 /4 S17 T28 N,R19W 435 Crocus Hill Road Troy System type: In- ground absorbtion system(conventional) Manuals Used: In- ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4 -5. Maintanance and Contingency Plan 6. Filter Specification et Signature License n er #226900 PROJECT Grea Harris Soil Test and System PLOT PLAN ADDRESS 435 Crocus Hill Road Hudson Wi 54016 1/4 SW 1 /4S 17 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 7/11/11 4 )= CONVENTIONAL X DATE BEDROOM IN- GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1 # of chambers BENCHMARK V.R.P. Septic tank cover @ 98.35 Z1 2� ❑ BOREHOLE O WELL - H.R.P. Same as Benchmark Filter Zabel A -100 SYSTEM ELEVATION 94.25/94.1/94.0 4.5' below qrade Property Line E >6" tandard Biodiffuser of Cover eaching Chamber � ith 1 `2 of Area 80' 6' Lon `f a/ /r��t —e 34 Grade at System Elevation B -1 70' Plans Designed Using Conventional Powts Manual Version 2.0 Pro 4 Bedroom 20' B -2 House T Q R Test done for 20' 50' \ conventio al by 0' Tom Gus m Vents 35 30' B -3 10% Slope 1 i 70' B- -75 Area of soils not suitable for conv ntional system '3.-3' X 4W Cells with 300' P perty Lin SpacilT— 10, B -2 Vents Property Line 110 Cross Section of Standard Biodiffuser Leaching Chamber Typical cross section for 2 of 3 cells Standard Biodiffuser Leaching Chamber with ft2 of Area per Chamber Z5 � ; To be >1' above grade t �j Finish grade elevation Typical Installation 99 0 Vent Grade Vent 4 ' 4 11 30/34 Septic Tank 4' 4' Lon 1 " A , ** ' Coveri 1" 4' Long 3 4 ' Grade at System Elevation 34" Grade at System Elevation Spacing 5' I '3: 3' X ' Cells Observation tubeNent Same on other end To be located on end of Cells A B System elevations: C A_94.25 B__94.1 chambers per cell C —_94.0 � Z- Jul -12 -2011 07:21 AM St Croix County Plan /Zoning 715. 386.4686 12/15 Maintenance and Contingency Plant for a Septic System Maintenance Plan 1. Septic Tank Is to be pumped once every 3 years. 2. Effluent filter Is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance Interval of the filter. 3. Once every 3 years, calls are to be inspected via the inspections pipes at the ends of the cells. 4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed Is to be diverted away from system. a. Discharge into system is not exceed those required as per Comm, 83 Contingency Plan 1. I system fails, determine cause of failure, use alternate area and Install new system or Install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 916 -246 -45 St. Croix County Zoning 715386 -4680 Pumper Tom Mondor 715 -246 -5148 Shaun Bird #226900 ST. CROI K COUNTY SE MC TANK MARTMANCE AC RFRLMBNT AND OWNERSHIP CERTinCATION FORM Ownersuyer Mailing Adds ProPtrty .Add Bess (Vatificadm requi and from Planamg & Z ft Depart ftr now caanesshued m.) City /State _ _ Pami Identification Number 02 D Q j� Propen.�ty Lot~ ttion 3/ , x/. , Sec , T Z 9 N R �ZW, Town of Subdivision CertMed Sa rvey Map # . Volume , Page # Warranty Deed # 2 ) Volume Page # J j Spec house yes no Lot lines idandittable Ono M rEM NAMMUM AND OWNLR CFRTnrrr_AM Ingo Par use and matumenanze of your septic system could rtaalt m fts pre maim Affare to bundle wastes. Pia meiutraww000 of mstem ofptmopf4 out ere septfa tank avary times years or mover, if needed, by a liow ad pumpta WBet you pat into &e sy tcm can affbot the ft m tdm of the aptic tank as a ft=Mxmt stage in the waste disposal systeea. Owner mai>rt ax respozmNlitia we specified in #Comma. 83.52(1) and in Chapter 12 - St Ccoix Caomrty Sanitary Ordinmce,. T�G P v0paly owner Fees to submit to St Cron Couwy Plaunn g & zont* a aardfilcetion foam, signed by the ov mr ami by a L mast phnnbm jow ayumm plumber, reastiated phm*w or a lfcemed pwmpe r vedfgfag eat (1) the on-dite waaWwaft dim Poul syskm is to proper operating comdit m and/ car (2) after kgxxdon and pumpdng (ifueoeasery), the septic tank is less titan 1/3 A A of du4ge: Uwe. the nmdersfgaed ire read fire above requiremeats and ag - to maintain sale Vdvato wmV disposal syst+erQ with the xtm&u set 9 nft fin, as not by the Deperbmwt of Com� and the DepaCnag of Nal aal Resoamae, Statt; of Wisconsin. Ccrliiicarion s rating that your septic system bas been ffmm itaed =W be completed and ratmmeed tp ft 9t. CMM Calmly Plff=Mg & ZD= g Depan maul wftbim 30 days of &e f m year eoitation date. Uwe Mtify that all statements an this form we true to the best of my /our bwwWp. Uaro amdare the owner(s) of the property dead abed abaft, by vktn of warranty deed recorded = Register of Deeds Office. Numb t b J fi F 2/ � / � O APPLICANTS) DATE """A,ny infor Twin m eat is mfatmpr s ntaed may Mak in the sanitary permit being revolted by the PLmmgg & Zonft Deparlmant. • *" hrlude with t Ws VPHC&dm a recorded Maaraaiy deed from the Register of Deeds Office and a copy of do certified survey map if rden=e is m ads in the warranty deed, 0mr. 48/Or� r f _ r � • 1 III► ■ f t � J ..e:..�r..�.� " IS I �� ..... ►..... ".�.. lil ir'i � ar■i�ratii4iiii'i, r A a• A r r A r• r• r L� 61 k% 16%, LN ��, ({ o �'r , 1 0 , 00 I a rol'il ro IiiIGlrul�lntluilGlil I-1i RRRRR i-I/1 Mlrr' No LLLL LLlLL ' LLLL ,� L ` \ / • Gi�l�I �IGIan +iANZ alltilG{�I loom a � a r � � .• i� pr. � rr, rr r- R ,� .� • � � !'I; � jl'I I I'li I�I,�jl�li ��I t�ia� jl, s �•' +�� Gw'�rMrw�'a� r��f °; ` ii{■ I =Ii6Gl�l�hlrol ■(iilsialiliiCl il I ifllll !1111 Ilflf lillf VIII Ifill illf 111111 Ills IIII * 9 1 2 2 8 9 1 STATE BAR OF WISCONSIN FORM I - 2000 912289 Document Number WARRANTY DEED BETH PABST REGISTER OF DEEDS THIS DEED, made between James J. Morgan and Kelly M. Morgan, ST. CROIX CO., WI husband and wife, Grantor, and Gregory A. Harris Jr and Molly M. Harris RECEIVED FOR RECORD husband and wife, Grantee. 02/24/2010 03:30PM WARRANTY DEED EXEMPT II Grantor, for a valuable consideration, conveys to Grantee the following REC FEE: 11 .00 described real estate in St. Croix County, State of Wisconsin (the TRANS FEE: 1334.70 "Property"): PAGES: 1 Lot 13 Plat of Troy Wood in the Town of Troy, St. Croix County, V MSZ - Onsin �... Recording Area Name and Return Address: ' T + ©hx- Together with all appurtenant rights, title and interests. 040- 1270 -20 -000 Parcel Identification Number � 1M This r homest Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear encumbrances except Roadways, easements and restrictions of record. pt Dated this 22n of February, 2010. Jatn * Kell . Mor an * * AUTHENTICATION Signature(s) ACKNOWLEDGMENT STATE OF WISCONSIN ) authenticated this 22nd day of February, 2010 ST.CROIX COUNTY. ) ss. Personally came before me this 22nd day of February, 2010 the above named James J. Morgan and Kelly M. Morgan, * husband and wife to me known to be the person(s) who exec ted TITLE: MEMBER STATE BAR OF WISCONSIN the foregoing instrument d ac wledged the same (If not, authorized by § 706.06, Wis. Stats.) *Ja P. Penfiel THIS INSTRUMENT WAS DRAFTED BY Notary Public, S of Wisc My commission is permanent. (If not state expiration date: Michael H. Forecki, Attome 8/26/2 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) J P, AENFjE ota *Names of persons signing in any capacity must be ty e 0 ate o ped or printed below their signature St PUblk� f Wi s�onsln WARRANTY DEED STATE BAR OF WISCONSIN 1 of 1 FORM No. I -2000 1 > W O 2.qQ ACfiES I c ffi 87 So. FT. co a I"" 2Cr RAJNAOE C EASEMENT S 0 13 a r j 2. ACRES III s �r 87,0 ✓ lot �3 4e 1 1 5 O%Vftrm Page 1 of' i Go back to the Manufact rer All habetical Listin start a e Plumbing Products Register Products approved for: ADVANCED DRAINAGE SYSTEMS, INC. ADS � ) ADVANCED DRAINAGE SYSTEMS, INC. (ADS) LEACHING CHAMBER Attention: DAVID MARTIN 4640 TRUEMAN BLVD HILLIARD, OH 43026 Telephone: 614 - 658 -0284 Fax: 614 658 -0204 Please note that the listed "Product File No" will be a link to the Product Approval Letter in Adobe PDF file format. You will need a PDF reader /viewer, such as Adobe Acrobat Reader, to view the document. Note, for Water treatment devices the listed "Product File No" may be a link to the approval letter or may contain a listing of links for various contaminants. LEACHING CHAMBER Go to toD _of Page Product Name: BIO DIFFUSER Model Number(s): BIO 3 (EISA with out fabric = 24.2 sq. ft. /chamber, EISA with fabric = 19.2 sq. ft. /chamber w /fabric, Laying length = 7.15 ft., Width = 22 inches, Height = 12 inches, Min. depth of bury = 0.5 ft., Max. depth of bury = 8 ft., Open bottom area = 11.5 sq.ft. /chamber) Product File No: 20070202 Product Name: BIO DIFFUSER Model Number(s): 11" STANDARD (EISA with out fabric = 31.1 sq. ft. /chamber, EISA with fabric = 25.4 sq. ft. /chamber w /fabric, Laying length = 6.21 ft., Width = 34 inches, Height = 11 inches, Min. depth of bury = 0.5 ft., Max. depth of bury = 8 ft., Open bottom area = 15.2 sq.ft. /chamber) Product File No: 20070201 Product Name: BIO DIFFUSER Model Number(s): 16" HIGH CAPACITY (EISA with out fabric = 31.1 sq. ft. /chamber, EISA with fabric = 25.6 sq. ft. /chamber w /fabric, Laying length = 6.21 ft., Width = 34 inches, Height = 16 inches, Min of bury = 0.5 ft., Max. depth of bury = 8 ft., Open bottom area = 15.3 sq.ft. /chamber) Product File No: 200, 60S48 http: // Commerce .wi.gov /php /sb- ppalOpp /manuf result.php /1960 /ADVANCED_DRAINA... 7/13/2011 Wisconsin Department of Commerce SOIL EVALUATION REPORT Division of Safety and Buildings Page of • in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on a County s° f /1 p per not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information R 'ewed by Date Personal information you provide may be used for secondary Purposes (Privacy Law, s. 15.04 (1) (m)). Properly Owner ! �� Property Location ^� J`� r� Govt. Lot 1/4/4 S T N E or) Property Owner s Mailing Address Lot # Block # S Name or CSM# city State Zip Code hone N ber 11 /.3 7 ❑City El Village own Nearest Road New Construction Us Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or mercial - Describe: Parent material �� -- - - - - -- -- __— Flood Plain elevation if ap livable �f General comments 9 and recom �j'? — z �-- � ---- - - -- -- ft. mendations,s -� , �� l ' �� RECEIVE[) J° OCT 10 2003 Boring # Boring ( A ST. CIOIX CUUN i , Pit Ground surface elev. ft. Depth to limiting factor L� In. ZONING OFFICE 7 � Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounds Gr. Sz. Sh Roots Soil . 'Eff#1 Ica F Rate in. Munsell Qu. Sz. Cont. Color �' GP ' 'Eff#2 I 9 S• a � ,t f ) I Boring # Boring Pit Ground surface elev. ft Depth to limiting factor Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bounds Roots Soil lication Rate in. Munsell Qu. Sz. Cont. Color ry GPD/ft' Gr. Sz. Sh. App 'Eff#2 ll L S � l) Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 JW CST Name (Please Print) 'Effluent #2 = BOD < 30 r and TSS < 30 mg/L Bird Plumbing, Inc. Shaun Bird Si CST Number ri ddress 226900 0 08 192nd Ave, New Richmond, WI 54017 Date Evaluation Conducted Telephone Number �— r�3 715- 246 -4516 Property Owner Boring Parcel ID # Page of Boring # � / Pit Ground surface eley. ft. Depth to limiting facto in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil D Rate in. Munsell Qu. Sz. Cont Color �' GPD/ff —' Gr. Sz. Sh. 'Eff#1 •Eff#2 Jr t 93.3° tl O Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Soil ication Rate P ucture Consistence Boundary Roots in. Munsell Qu. Sz. Cont Color GPD/fF Gr. Sz. Sh. •Eff#1 •Eif#2 Ong # ❑ Boring ❑ Pit Ground surface elev. tt. Depth to limiting factor in. Horizon Depth Dominant Col Redox Description. Texture Structure Soti lotion Rate in. P ucture Consistence Boundary Roots GPD/ft° Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 • Eff#2 Effluent #1 = BOD > 30 < 220 ng/L and TSS >30 < 150 mgL Effluent #2 = BOD < 30 mglL 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- 2648777. SOD -9330 (RA/W) Q o a o o a o 0 n O O o ul ^• y o° c I — "� '� -p N N 3 m of N I cai a Qm a o� �o E C, o o Cri a Q� M = ° o E o ° ° >p 0. CL (1) 5 a 2 a�° �� ° o N N N 7 N a a Q 3 > O M j a C N O M N N= > Q = 6 a N a a) Q M a) C cu _OC O O L N O c O 2 a O N C m = N aaima3 �° mwN a co —° c 3 ° 0 a) CO aJ C O > .0 a) a C N w a) °C O Q iz 3: Q 76 0 a) C) N C O >. C (D W a a) ° CO O a Z y 0 d cp 3 Q f0 l LL N a) ` Q' a) _m a O O CO a) a _ C N N = a) NC a) ` C Na ° rn E a� E o N� 'S; E CL w Q Z a m U o T) 10 w o a`) o f � c Q Z Q� ns U o 3 � > Z y N = O Go f� N W I a m c (7 O Z v l a r d Z? o Q N rn U) C w c a) � E a) � E N r = N • N N I N Z m z li 0 ii E L)4 rL � w > 0 U ) cn = O O O a m m = v = a m m II a a n. a a a a COU _0 I' M J U I — M O O O N N U Q N N Z 0 N c N N Z Z a 0 0 0 O Z 0 O °) p 0 0 0 0 Z tE Z 0 0 0 N N O O O U D p a p a° t-- � _ p a N N N LO mI .- C r C CL N 7 O\ v O z .N- I l , N Cn V 2) O In V co C C d N Q A U) A Sn N V 07 27 a) N Lo q 6 Q A 6 A U) N to CO O I O N C C a+ 0 _ a ~ O U C U G N C m N f0 f6 N OC V a 0 0 U= 7 = j CO O M- L 0 3 0 0 0 0 m m co m C d o 0 Q ^ 0) O y N @ N m '° N N N N d O V a 0 0 0 0 `- �- 7 0 C CI C7 C7 > C N^ N C N (` N a N N N N YH O N >. L M a) C C C ` w a 0 f� N v C7 0 C7 > .CO. j N N N • .^- O c O N N N N • c C- 4 L � 'j 'j '� = N O t` u7 V U) u V) V �I = E ° I m a `MV r CL rrww O Ii N O O N o 0 O O ° 0 Q) o c tt o 0 ti c o 0 cL . c O CL , r a t I a M a) o E O I, O C(n w D �� aN o 7 a D Q O_ E O �� d �a a a3 - Q °= y a o M N 7 a C N> !R O a) tr C N O N C a N m- N O N O '� L �• °- aim 3 c oNm N CO •� v� Cu aaiw �. m ca - 0 3a ui � ink roams o O yo aco 3 am aairi c c >.o c Z�� a y o a) a Z � O a cfl 3 CL Ij LL m —p a�. L �� N �_� a o co a�a _ c N w m a� L O c O v)E a) E o .NO > c 3a E O L 7 U 3 a c m> o Q Z o0! mU �' Q Z (D a� �U o a��i � 3 v v y rn I' Z E 0 � U) li o z�l� nNw am _ o w a m _ EE i E b-0 N -- Z co z U I� -ri .. E 1 -0 _��. r C - ca > c c v N d V a) L L (o N > D O a cq co 1 t2 • 2 0 0 0 a m m .v o aaa a a m a l a ' 0 O O 0 0 0 N a) N Q o �j (A J V ! 2 N N w0 Z O �- �_' Z a) j CN n CO 00 p .. U N N Z Z 0 0 O O O O O U o O O O z `+•- z tip O o 0 U O = 0 .O N N N a . O O O O O p O p m .�- n 04 p O N N N M m C C d N 7 4 ( O N 7 n N V m fA O n LO V co n (n n (n O Q V' U) : r U) � r- Lo V �+ O N C C O O p rn w O O ap o N U 7 7 7 E CO C 111 , M O V N o 3 °D n vap 'm 'm c a' o C n O (q N N N a N N N N a d O U a 0 0 0 0 G1y (N f'- 7 0) C (� CI > C N n n c N N N a N N N N 7 C6 • v n I . 7 > > '> O n� V r m C C C , N -Q � N M V o N Y Y Y o o y .� -C o v z N Y Y Y V1 k E . Q it 0 d E CL c c w c _1 A tia�,;'oait� Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division ' INSPECTION REPORT Sanitary Permit No: 430369 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: Morgan, James I Troy Township 040 - 1270 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: � (� Section /Town /Range /Map No. lc,c,. �, CS Y 17.28.19.1489 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing /C Alt. BM I Aeration Bldg. Sewer Holding St/Ht Inlet 7.$ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic _, �—j f _ Dt Bottom Dosing Header /Man. Aeration Dist. Pipe ing _ Bot. System�� �o • ss 3 2� PUMP /SIPHON INFORMATION Final Grade Manufacturer Demand St Cover Model Number TDH Lift 5;J ion Lo System Head TDH Ft Forcemai Length Dia. Dist. SOIL ABSORPTION SYSTEM LA*i BED /TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ` R'0.4' 3 r SETBACK SYSTEM TO P/L jBLDG WELL LAKE /STREAM LEACHING nufa tur INFORMATION CHAMBEROR V11 ��' Type Of System: r Si i UNIT 13 N del Number: f DISTRIBUTION SYSTEM Header /Manifold Distributi r x Hole Size I x Hole Spacing Vent to Air Intake !� y If Pipes) - Lengt j Dia Length Dia Spacing -- SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center �_� Gv Bed/Trench Edges Topsoil "� Yes 0 No E Yes LJ No COMMENTS: _(Include code discregencies, perso s esent, etc.) Inspection #1: /o / 17 / G3 Inspection #2: Location: 435 Corcus Hill Road Hudson, WI 5401 (6 SE 1/4 SW 1/4 17 T28N R19W) Troywood Lot 13 Parcel No: 17.28.19.1489 1.) Alt BM Description = T (. 2.) Bldg sewer length = ---- 30 r - amount of cover = ';X 4 t Plan revision Required? Yes r _ - - -- - Use other side for additional informati n. No ` _ _.1 Si L _ SBD -6710 (R.3/97) Date epctor's gn at ure Cart. No i 0 `1 t , _ ia�co . � , _ l Vi Saf ety and Buildings Division County 201 W. Washington Ave., P.O. Box 7082 Madison, WI 53707 - 7082 Sani it Number (to be filled in by Co.) sconsin 608 261 -6546 Department of Commerce ( ) State Plan I.D. Number Sanitary Permit Application. In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy Law, s 15.04(l xm) Project Address (if different than trailing address) 1. Application Information - Please Print All Informatio R 4 t.43 g Ma_ Property Own�ame Parcel # Lot # Block # �jn� flr QrJ Properly Owner's MailiEs Add � Property L.oc T. CRO!X COUN,l Section City, State e a 7 r ircle grq LwC J SS t '� -4� c ;/ E IL Type of ding (check all that apply) Subdivision Name CSM ber 1 or 2 Family Dwelling - Number of Bedrooms � ❑ Public/Cornmer+cial - Describe Use / U ❑ State Owned - Describe Use ❑City ❑ lageowt►ship of III. Type of Permit: (Check only one box on line A. Complete line B If applicable) Q O — rZ� A • System Replacement System T Replacement Only C1 Other Modification td Existing System ❑ ❑ reatm entlHoldin 8 Task eP L ❑ Change List Previous Permit Number and Date Issued B. ❑ Permit Rene Revision ge of ❑ Permit Transfer to New �� / Before Expitsti Plumber Owner Q 3 TV. Type of POWTS stem: Check all that appl n - pressurized In- Ground ❑ Mound a 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressuriz :9L . Chamber C1 Holding Tank ❑ Peat Filter El Aerobic Treatment Unit [I Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) , V. DispersaVrreatment Area Ififormation: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area RequirE(sf) Dispersal Area Proposed (sf) S stem El 'on Zl / D - . Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fi0cr Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanits Tasks Septic or Holding Tanis Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement - 1, the unde >� assume responsibIlIty for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum ign e MP(MPRS Num r Business Phone Nu ber � r Plumber's Address (Street, City, State, Zrp 4,e� I. Coun 7 1, at List Use Onl 4pproved Disapproved Sanitary Permit Fee (includes Groundwater Date issued Iss in ent Signature (N Stamps) Surcharge Fee) _-n _ �` Ow Given Reason for Den ial (� IX. Conditions of ApprovaMeasons for Disapproval SYSTEM OWNER, � `tat �,, 5 ' � `a'' � "• S 1 Septic tank, e#flu ®nt filter and dispersal cell must all be serviced /be serviced / maintainer ..,.n� as per management plan provided by plumber. 2. All setback requirements must be maintained I ti . •) as per applicable code /ordinances. Attach complete plans (to the County only) for the system an paper mot less than 81/1 z 11 Inches is size SBD -6398 (R. 08/02) Soil Test and S PLOT PLAN PRO Ani Moraan ADDRESS 13539 Foxberry rd Savaaa Mn 55378 1/4 SW 1/4S 17 /T, N/R 19 W TOWN Troy COUNTY ST. CROIX ' MPRS Shaun Bird '226900 10/8/03 26900 / DATE BEDROOM 4 CONVENTIONAL )00( IN -GR ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE T __ SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambe 39 IL BENCHMARK V.R.P. Top of Steel Fence Post ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL .H.R.P. Same as Benchmark SYSTEM ELEVATION 96.5/96.0/95.5 2.5' below grade Property Line Vent >6 „ Standard Biodiffuser Leaching Chamber of Cover with 31.1 ft2 of Area 0 , 6' Long 11 „ 34" Grade at System Elevation B -1 70' Plans Designed Using Conventional Powts Manual Version 2.0 Pro 4 Bedroom 20' B -2 House n 6. M. T Test done for 20' 50' conventional by 0 , Tom Gustom rs- - 4, Vents 5' 30' B -3 10% Slope 70' B -3 Area of soils not suitable for conventional system 63' Cells with ents �< v. Spacing _ c0 10' B -2 o M 30' B.M. Property Line 0 1? C 11 Soil Test and System PLOT PLAN PROJECT Jim Moraan ADDRESS 13539 Foxberry rd Savaaa Mn 55378 1/4 SW 1 /4S 17 /T N/R 19 W TOWN Troy COUNTY ST. CROIX 10/8/03 4 MPRS Shaun Bird 226900 DATE BEDROOM CONVENTIONAL )00( IN -GR ND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 39 BENCHMARK V.R.P. Top of Steel Fence Post TI oo' ASSUME ELEVA ON i Filter Zabel A -100 ❑ BOREHOLE O WELL sH Same as Benchmark SYSTEM ELEVATION 96.5/96.0/95.5 2.5' below Trade Property Line Vent >6„ Standard Biodiffuser of Cover Leaching Chamber 80' with 31.1 ft2 of Area 6' Long 1 1 " 4 „ Grade at System Elevation B -1 70' Plans Designed Using Conventional Powts Manual Version 2.0 pro 4 Bedroom 20' B -2 House T Test done for 20' 50' conventional by 0 , Tom Gustom B -1 Vents 35' 30' B -3 10% Slope 10' B 70' -3 Area of soils not a suitable for conventional system a 3 -3' X 63' Cells with Spacing 10 B-2 Vents g M 30' B.M. Property Line 11 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County � �- 0 r / 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 horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information R " by Date Personal information you provide may be used for secondary purposes (Privacy Law. s. 15.04 (1) (m)). 101r310 3 Property Owner Property Location r— J 4q r 01 -r r � Govt. Lot 1/4 LL) 14 S T N E or) Property Owner's Mailing Address Lot 11 1 Block # I Subd. Name or CSM# City State Zip Code hone N ber ❑ City El Village own Nearest Road New Construction Us Residential / Number of bedrooms Code derived design flow rate GPD ❑ Replacement �/❑ Public or 7mercial - Describe: Parent material �J'L.C��I�G¢� L�J Flood Plain elevation if ap livable General comments � ,2 v� p 3 REC E{V E Q► m and recomendations• / �� OCT 10 2003 Boring 1 ST CROIX COUN 1 Boring # (" Pit Ground surface elev. ft. Depth to limiting factor in. ZONING OFFICE Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 0 Z Z I o —Z or 4S. Boring # Boring 4 Pit Ground surface elev. 11-yft- Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ri S 6 - 5 ' fq I lo 3 / S , 3 A1114 ` • Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si r CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 r�3 715 - 246 -4516 I _ Page of Property Owner _ Parcel ID # Pa 9 Boring # ❑ Boring M pit Ground surface el,3 � ft. Depth to limiting factor �� in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDO in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 o �s 93.3J F-1 Boring # E] Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I Bating a Bating # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon Depth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2 I • Effluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mg/_ ' Ef fluent #2 = BOD < 30 mg& and TSS 130 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. SOD -8330 (8.6/00) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: - St. Croix Iftd Building Division INSPECTION REPORT Sanitary Permit No: • 430369 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: Morgan, James I Troy Township 040 - 1270 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /town /Range /Map No: 17.28.19.1489 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 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 BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM to Air Intake Header /Manifold Distribution x Hole Size x Hole Spacing Vent Pipe(s) Length Dia Length Dia Spacin SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil El Yes E] No 1-] Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 435 Corcus Hill Road Hudson, WI 54016 (SE 114 SW 1/4 17 T28N R19W) Troywood Lot 13 Parcel No: 17.28.19.1489 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? E] Yes ❑ No f Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. — NIL � Sbfety acrd Buildings Division Cotrory ` � 60 ' X 201 W. %shington Ave., P.0- Box 71( 2 , ��� �� Madison, WI 53707 - 7162 Sanitary Prnnit Number (to be filter in I: ;, Co (608)266 -3151 6 De artment of Commerce J t) Number Sanitary Permit Application' F lit accord with Comm 33.2 1. VVis. Adm. Code. personal information you provide V -- om Privacy L.aw, sly. 1 m Project Address (if different t ailint.adtims) cos be used for secondary ptup aK X ) L Application Info a n - lease Print All lufort s a t Property Owner's Nerve parcel k t e j; loch X _J f © � S . GROIX Property Owner's Mailing Address C 5 V </ See don Stion r / _ City, Stec Zip Code / Phone c r 1 0 ; A � 'F- U. Type of Willing (ch that apply) S t�6s Subdivision tfame, I or 2 Fancily Dwell* ns - N of iiedroom!t O Ptrblic/Commercial - Describe U — r0 " ❑ State Owned - Dtk- Abe Use • Z� !1c' �vil ownahip of T/D M. Type of Permit: (Check only one n line A. Complete 7Tan Q » I a'1 -• 20 - coo A' System ❑ Replacement S ❑ 1 atment/tau C my ❑ Othcr Modification to L•z i sting S ystee i List Previous Permit Number and Date I. shed ❑ Permit Rene:wul ❑ Pmnit Rt!vision Yaage of fer to New Before Expiration P IV. TY13o of POWTS System- Check all that appl on - Pressurized in- Grotatd CI Mood ? 24 in. of suitable eoi land a 24 in. of suitable : oil ❑ At -Grade ❑ Single Pass Sand Filtcr C1 Constructed Wctland ❑ Pressuri= zed ❑ Holding T ❑ ikrr ❑ Aerobic l'reatncecct Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter g b p in* vet - 1 ez lain) V. Dis IfPreatment Arta ormadon: —1 Dcsipt Flow (gpd) Design Soil A 1) cation RideNp& ispersal Area Requi Disp seat AlefProposed (sf) ysttxn Elevation Vi. Tank Info Capacity in T drnber Manufit. rer Prefab Site i :' c Gallons Gallons of Units Concrete Constructed Glaa ar Na Existing Tanks Txncrc Septic or tioWuts Teak Aerobic TteumenuUtt¢ - Dosing Chnniber VR. Responsibility Statement 1, itijad a tasuRadon of the POWTS shown on ttte hed plans. PI 's Name (Print) lure s ature AdLOtms Numb, r B ulfts Done Nutty LL/t,J �iL/ • � .S/ Plumber's Address (Sire Ci% Stpff 406C ) i VIII. Cous /D coartment We 001 X )pr _ proms Sanitary P Cro ludwata Date IS 1 Sui Agent Sign Stamps) N Surcharge Fee ❑ Ow ivcn Reason for at iX. Conditions at Ap aURcaians for ' ap CAJ SYSTEM � 1 Septi nk, effluent titter a n e 11 disp al cell must all in ' t& at�. - as management plan pro by p er. 2. All setback requirements must b lned as per applicable codelordinances. Attseb cempleat pion (ta the Ctwwty racy) for the syettxa on paper act It. a z It imb sir SBD -6348 (R. 01103) r As Ar ip a v P OT PLAN PROJECT Jim Moraan ADDRESS 13539 Foxberry rd Savaaa Mn 55378 1/4 SW 1/4S 17 /'r 28 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 9/12 BEDROOM 4 CONVENTIONAL XXX IN -GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1260 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 1212 # of chambers 39 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE Q WELL sH.R.P. Same as Benchmark SYSTEM ELEVATION 96.5/96.0/95.5 2.5' below grade Property Line Vent Plans Designed Using g Conventional Powts >6 „ Standard Biodiffu Manual Version 2.0 of Cover Leaching Chamber with 31.1 ft2 of Area 6' Long 11 " Grade at System Elevation B -1 70' 34" Vents -2 T 401 -3' X ' C 1s with >3 Spa Pro 4 Bedroom B-2 House r � ~ 30' B -3 Please e: Tested away is in a lowlE d, and further testin ir will be done! o c� ° o M i i Property Line A 'iY'4 I", 1331 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 o f 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Gustum Septic Service Attach complete P paper lete site Ian on a er not less than Or x.11 i chesin Ian must County e*6D St. Croix include, but not limited to: vertical and horizo r Cs t� ( BM , dir nand percent slope, scale or dimemsions, north ow, VTlocation and distance to nrarest road. Parcel I.D. pending Please p►int;all•i'afonn By plate Personal information you provide may be psed fQr secondary purpose's n"va'cy Law, s. 15:1]•1 ) (m)). Z 12b Property Owner 6}tt - 7 2GQO Pf Location Humbird Land Corporation F , 137 f 1/4 SW 1/4 S 17 T 28 N R 19 W Property Owner's Mailing Address nUr�Tv Block # Subd. Name or CSM# 332 Minnesota Street, East 1404 �ory rv� os Flcl ' n/a Troy Wood Subdivision City State Zip bode Rhone NUM ber�'\ I City __]Village e Town Nearest Road Saint Paul MN 1 55101 <6'S Troy E Cove Rd / Crocus Hill Road New Construction Use: y► Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement J Public or commercial - Describe: Parent material loess Flood plain elevation, if applicable n/a General comments and recommendations: Part of 2.0 acres. BM #1= 100.0'. BM #2= 95.4'. Recommend system elevation 94.8' between 97.8' and 96.3' contours. Boring # I Boring f/ Pit Ground Surface elev. 96.3 ft. Depth to limiting factor X in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= *Eff#1 *Eff#2 1 0 -9 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 9 -24 10yr2/2 none sil 2msbk mvfr cw 1f 0.5 0.8 3 24 -32 10yr3/2 none sil 2msbk mvfr cw 1 f 0.5 0.8 4 32-43 10yr4/4 none sil 2msbk mfr cw - 0.5 0.8 5 43 -58 10yr4/6 none sl 2msbk mfr cw - 0.5 0.9 6 58 -72 10yr5/6 none sl 2msbk mvfr - - 0.5 0.9 2 Boring # a Boring 3 6G 1/ Pit Ground Surface elev. 99.0 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 -11 10yr3/2 none sil 2msbk mvfr as 1f,1m 0.5 0.8 2 11 -18 10yr3/4 none sil 2msbk mvfr cw 1f 0.5 0.8 3 18 -26 10yr4/4 none sil 2msbk mfr cw - 0.5 0.8 4 26-48 10yr4/6 none Is 1 msbk mvfr cw - 0.7 1.2 5 48 -72 10yr5/6, 4/6 none Is 1 msbk mvfr - - 0.7 1.2 * 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 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 11116100 715 -658 -1344 Property owner Humbird Land Corporation Parcel ID # Page 3 F3 ] Boring # I Boring 16 Pit Ground Surface elev. ft- Depth to limiting factor >75_ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fP *Efl#1 •Eff#2 1 0-5 1 Oyr2/2 none sil 2msbk mvfr as 2flm 0.5 0.8 2 5-16 1 Oyr2/2 none SO 2msbk mvfr cw 1 f 0.5 0.8 3 16-24 1 Oyr3/4 none sil 2msbk mvfr cw 0.5 0.8 4 24-32 1 Oyr4/4 none sil 2msbk mfr cw 0.5 0.8 5 32-46 10yr4/6 none si I 2msbk mfr cw 0.5 0.8 6 46-55 7.5yr4/6 none SO 2msbk mfr cw 0.5 0.8 7 55-75 1 Oyr4/6 none sl 2msbk mfr 0.5 0.9 Boring # I Boring F I Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure.. Consistence Boundary Roots - _-GPD/ft' — -- * Eff#1 * Eff#2 F-1 Bonng # I Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots — GPD/ft •Eff#1 *Efl#2 Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = OOD - S_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 formal, please contact the department at 608-266-3151 or TTY 608-264-8777. La f �3 S B M ! EL -z /66,0` o a F P,, c. TP �� �, P 1 ./' Soc Imo r1 17 7 s A/ ac k, 8? Jcct /G `o® 8 T Crocus 41 ll ba C o�t�b u r Pa[4 o Acres 3M �Z �a9 3 o 3 Maintenance and Contingency Plan for a Septic System Maintenance Plan pumped once every 3 years. 1. Septic Tank is to be pump 2. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 3. Once every 3 years, cells are to be inspected v ' a the inspections Pipes at the ends of the cells. o limit reases, garbage, and water conditioner discharge into the system. 4. owner agrees t 9 5. The owner agrees to save this plan. 6. Do not plant trees nor park nor drive over system. 7. Watershed is to be diverted away from system. S. Discharge into system is not exceed those required as per Comm. 83 Contingency Plan f s stem fails, determine cause of failure, use alternate area and install new system or 1. I y install system at a lower elevation. 2. Replace any other failing components as needed. Plumber: Shaun Bird 715 - 246 -4516 St. Croix County Zoning 715- 386 -4680 Pumper Tom Mondor 715 - 246 - 5 148 Shaun Bird #226900 ST `CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address � F e, Rn r yr SS 3 Property Address (Verification required from Planning Department for new construction) City/State Parcel Identification Number LEGAL DESCRIPTION Property Location t /<yL,2 %., Sec. / U N-a W, Town of Subdivision Lot # Certified Survey Map # . Volume . Page # f Warranty Deed _ 3Z— , Volume , Page # Spec house ❑ ye Lot lines identifiab ?4' ❑ 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, restrictedplumber 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. Uwe, 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 three year 77' on date. ?-- // / 40 Si O APPLICANT D TE OWNE CERTIFI e) certify, Ot all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the pr a descri ove, by virtue of a warranty deed recorded in Register of Deeds Office. S APPLICANT D TE * * * * ** 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 7361 32 r �� W. 2377PAa 526 KATHLEEN H. WAL REGISTER OF DEEDS ST. CROIX Co., WI STATE BAR OF WISCONSIN FORM 2- 2000 RECEIVED FOR RECORD Document Number WARRANTY DEED 08/18/2003 12:10PH WARRANTY DEED THIS DEED, made between Chonyeng Hurshuajer and Bao EXEMPT # Hurshuajer, husband and wife, Grantor, and James J. Morgan and Kelly M. REC FEE: 11.00 Morgan, husband and wife, as Survivorship Marital Property, Grantee. TRANS FEE: 299.70 Grantor, for a valuable consideration, conveys and warrants to Grantee COPY FEE: 2.00 th ollowing described real estate in St. Croix County, State of Wisconsin: CC FEE: PAGES: 1 ( L:ot C , 3 Troy Wood, Town of Troy, St. Croix County, Wisconsin. Recording Area Name and Return Address: Edina Realty Title, Inc. 400 S. 2" St. –Suite 115 Exceptions to warranties: Hudson, WI 54016 Easements, restrictions and rights -of -way of record, if any. 405907 040 - 1270 -20 -000 Parcel Identification Number (PIN) This is not homestead property. Dated this 15th day of August, 2003. * Chon g shuajer * Bao Hurshuajer * * AUTHENTICATIOhj(\ ACKNOWLEDGMENT Signature(s) 'n a \ \G STATE OF WISCONSIN ) Ste— ST. CROIX COUNTY. ) ss. authenticated this 15th day of au ust� \ S td, a Personally came before me this August 15, 2003 the above named Chonyeng Hurshuajer and Bao Hurshuajer, husband * and wife to me known to be the person(s) who executed the TITLE: MEMBER STATE BAR OF WISCONSIN foregoing instrument and acknowledged the same. (If not, authorized by § 706.06, Wis. Stats.) � 6 uv--, THIS INSTRUMENT WAS DRAFTED BY * Ch e r i l3 fun Notary Public, State of Wisconsin Edina Realty Title –Doug Berg My commission is permanent. (If not, state expiration date: 400 South Second Street # 115, Hudson, WI 54016 j _ 6 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2 -2000 80,871 Sid. r I . y \ \ / S89°51'27E 1.87 ACRES \ \ O / �� I a 81,450 SO. FT. y ( • 1 �,11 N Z 2.00 ACRES 1 y'a� 87,083 SO. FT. �� 1 �� d \ \ c c r X 29 DRAINAGE 1.95 ACRES I EASEMENT \ $ I \\ \ \ 85,133 SO. FT. $ I 13 �) 2.00 ACRES II S \ \� \ I 87,027 SO. FT. it i ' b74 . I ! ti — - 50.00 V� �°2e'54•w / 14 a, 'CROCUS � �► G1g SM -2&"- 50.00. 15 16 SEE SHEET 3 \ \ D BY : WILLIAM KANE JOB NO. 00 -46 DATE: 10/16/00 REVISED: 12/15/00 SKI