Loading...
HomeMy WebLinkAbout040-1272-50-000 Wisconsin DVrtrnent of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Sakmty Uhd Building Division INSPECTION REPORT Sanitary Permit No: 399608 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: Village X Township Parcel Tax No: Johnson, Jason City Troy Township 040 - 1272 -50 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELE ATI N DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic , \ Benchmark o Alt. BM uJ --4a o {=c� /•i la s Aeration Bldg. Sewer ry �/_ % Holding S t Inlet S O tlet. TANK SETBACK INFORMATION D TANK TO P/L W BLDG. to Air Intake ROAD lel 1- � SASE A 41 • r Septic I vc bottom Dosing 3 / �J Header /Man. Tr Aeration / D Dis fe 10 2 1 - 7 Q �( Tqb 1, sl�n8 "Z 7 Bo . Syst Holding L �9 /� 91-6- Final Grade PUMP /SIPHON INFORMATION Manufacturer GP and St Cover � Model Numbe TDH Lift F ' n System Head TDH Ft Force Length Dia. o well SOIL ABSORPTION SYSTEM BED/ Width /� Length No. Of Trenches PIT DIMENS No. Of Pits Inside Dia. J Uquid - Depth DIMENSIONS 3 SETBACK SYSTEM TO P/L BLDG IWE LL LAKE/STREAM LEACHING ur i INFORMATION HAMBER O Ty" Of System: UNIT Model Number. DISTRIBUTION SYSTEM A Header /Manifold Distribution �/Yl b--V5 x Hole Size x Hole Spacin Vent to Air Intak� It Pipe(s) r 1 /�,� t/ Length Dia Length ( 0 0 4 t0 �' spacing1 / SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over IDepth Over xx Depth of r xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil [1:1] Yes o No ®Yes ❑ No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: /�/ o Y Inspection #2: Location: 419 Lost Rock Lane Unknown ( , W ' / 1/4 / SW 1/4 17 T28N R19W Troywood Lot 36 Parcel No: 17.28.19.1512 1.) Alt BM Description' r "Uo (as,y, ) '2 b o t- L 5 -v►� L �� ��� �` drCv�ec`'&I} 2.) Bldg sewer length = �(�,C,, s+ /0 t 1GV>n�T - amount of cover = ', S j4t' z( kACA - 1 (lt�i Plan revision Required? Yes ❑ No Use other side for additional information. ` Date Insepctor's 'gnature Cart. No. SBD -6710 (R.3197) / Nisconsin Department of Commerce SOIL EVALUATION REPORT Division of Sa£ity and Buildings Page of .' in accordance with Comm 85, Wis. Adm. Code County 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. Re 'ewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). (Z/3 /0, Prope Owner Property Location vt. Lot 1/4 1/4 S T N R Z(or) W Property Owner's Mailing Addr ss of # Bloc # Subd. Name or CSM# - T 4 City State Zip Code Ph a Nu, bat, 2 1 2� 2 L) Ci ❑ Village Town Nearest Road ( ) U IV / �I New Construction Use: Residential / Numl ier of bif)tbhLkii OFFISE C de derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if appli a e ft. General comments / J CFIVE� and recommendations: sti 6:1 9,e? S1 CiiOth Boring # E] Boring t ` zOfWIOGpFppE �' Ground surface elev. g ��� ft. Depth to limiting factor ® Pit ,• oil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boun G in. Munsell Qu. Sz. C nt. Color Gr. Sz. Sh. *Eff#1 *Eff#2 4. 40 23 77 Boring # ❑ Boring ® Pit Ground surface elev. ff, Depth to limiting factor t „(if in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. gont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 ` d c s T + Efflugnt #1 = BOD > 30 < 220 mg /L and TSS >30 _< 150 mg /L * Effluent #2 = SOD, < 30 mg /L and TSS < 30 mg /L CST Name (PI se P nt r Signature CST Number Address �r Date Conducted Telephone Number SBD -8330 (1107/00) G Property Owner Parcel ID # Page of Boring # ❑ Boring Z pit Ground surface elev. ft. Depth to limiting factor 4&,j in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu, Sz. Cont. Color Gr. Sz. Sh. •Eff #1 'EtfN2 s — _ 1 i Z ' Boring # ❑ 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-' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 {I� s Boring ❑ Boring g d oun surface elev. � ft. D epth to limiting factor pit Gr } , � P 9 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 � s Sep — Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. SBD•8330 (R_ 07/00) 1 / � ��Sa� �oh�lsa1 ��r,� �uUYl.� -�vc.L , �os� �G'� �.�f✓,�,� Al I E cf LiN °® 1 2002 T - -� - / �•`,c7�� 3X /l'� Ty 7" .Ti a 33' �a1� Safety and Buildings Division County 201 W Washington Ave P.O. Box 7162 i W. sg., (` �O�c o Madison, WI 53707 - 7162 Site Addm" i Department of Commerce J c57 �-k �6 Sanitary Permit Application S '�" ry 3 19 (AC' W In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for secontiary purposes Privacy Law, sl5. ! m I. Application Information - Please Print All Information Sate P UkLRL N Property Owner's Name Parcel Number J " -11Y11A1 i 0" — Zfi2 - 5 - 000 Property Owner's Mailing Address Property Location S N,R 49 Zi City, State Zip Code Phone Number Lot Num r Block Number Su bdivisio n Name CSM Nunibc II. Type of Building (check all that apply) CEIVED , ,'t ❑City i 1 or 2 Family Dwelling - Number of Bedrooms � i ❑Village ❑ Public /Commercial - Describe Use r I}Towtuhip ❑ State Owned �_ 3 r X /077 a k ST C4iOtfc c's Nearest Road (25 JU '1 3 06. Z S�l OOI+r"1( III. Type of Permit: (Check only one box on line A (numbekieme for unterna}�ej Complete line B If applicable) A or County use 1 ® New 2 ❑ Replacement System 3 ❑ Replacement o! �'?. System I I Tank Ordy Eris B. ❑Check if Sanitary Permit Previously Issued Permit Number Date Issued TV. Type of Permit: (Check all that apply)(numbering scheme is for internal Ilse) .4 - 1QD 44 0 Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wedand i 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pus 51 ❑ Drip Litz 45 ❑ Al -Grade 46 ❑ Aerobic Treatment Urut 49 ❑ Recirculating 30 ❑ Other , V. D etsal/Treatment Area Information: - , s Design Flow (gpd) Disp crsal Area Dispersal Area Soil Applicauun Percolation Rate System Elevation Final Grade Required Proposed Ratc(Gals. /Days /Sq.Ft,) (Min./lneh) Elevation i VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber PlauiC Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank .0 Dosing Chamber VII. Res asibility Statement- I, the undersigned, a responsibalty for installation of the POWYS shown on the attached plans. Plum r' ame (Print) Plumber' Si to MP/IvfPRS Number Business Phone Number 1 Plumbers Address (Street, City, State, Zip Code p � VIII, County /De artment Use Onl X Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ' ❑ Owner Given Initial Adverse 1 , _Determination IX. Conditions of Approval /Reasons for )is )pro, I { S S KA"A �" & tnAG c C.44 C oJW�cn or N4hc a S. R R-1 � PA.' � Auach complete ptans (to the County oWy) (or the "em oa papa aoe kaa thanes SW x 11 Inches In atse SBD -6398 (R. 05/01) i / = •S � �'�r l � s s�`'.�r� �1 87 7 .5 �- 95 70 L �� ode �Jz s�6i C 33' i I � 1 J T u � / Q J Safety and buildings Division Cou i 201 W. Washington Ave., P.O. Box 7162 ® AW cons) iff Madison, WI 53707 - 7162 Site Address be artment of Commerce -# L G61- ' LA#jE Sanitary Permit Number Sanitary Permit Application 319 ( t� In accord with Comm 83.21, Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for secondary purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information Sate P D. Number Property Owner's Name Parcel Number Property Owner's Mailing Address Property Location L u:S N.R City, Stan Zip Cafe Phone Number Lot Nttm r Block Number t i Su bdivisio n Name CSM Numlxr r U. Type of Building (check all that apply) � CEIVED (3City 1 or 2 Family Dwelling - Number of Bedrooms ^ r _"" ❑Village ❑ Public /Conuttercial - Describe Use 4" gTowruhi ❑ Sate Owned � 2) 3 r K /0V C I b ) ST >CWXX Nearest Road III. Type of Permit: (Check only one box on line A (numbe 'theme for wternaiars�e,1 Complete line B If applicable) r � -- or County use A. 1 ®New 2 ❑ Replacement System 3 C3 Replacement of system Tank Only Exis B. C3 Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use) /Q — /QU , 44 Non - Pressurized In- Ground 21 C3 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland j 22 ❑ Presurized in- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. D' ersal/Treatment Area Information: - i � I Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min./Inch) Elevation Iq AIZ 5�!;- i VI, Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Dosing Chamber •C VII. Respgasibility Statement- I, the undersigned, a§s=e responsibility for installation of the POWTS shown on the attached plans. Plum r' tune (Print) Plumbcr' Si to MP/MPRS Number Business Phone Number Plumbers Address (Street, City, Sate, Zip Code / c / < VIII, County /De artment Use )nl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fet) f ❑ Owner Given lriwl Adverse 2 107, /p� IX. Conditions of Approval /Reasons for Disapprov I A n e _ n - n C�Wc�t.o ^Ce S, r 1.(�. e�e�' ,�v.�►a� c�.n., /►, A4,l�w�Ol.t ` +s - cc 5 , T�►� -+r-- t� ��i «A --1 p hu--b compktc pram (to the County onl for the "em oa paper a kas than 8111 a 11 loeba In Mae SBD -6398 (R. 05/01) Safety and Buildings Division County 201 W, Washington Ave- P.O. Box 7162 I�consill Madison, Wl 53707 - 7162 Site Address Department of Commerce © d Itx ?4", LAQ, Sanitary Permit Application s '�" ry 3C1q l0OF In accord with Comm 83,21, Wis. Adm. Code, personal information you provide ❑ Check if Revision may be used for =ondary purposes Privacy Law, sl5. 1 m I. Application ]reformation - Please Print All Information State P ,D. Number Property Owner's Name Parcel Number — ", J .1 i 0+0 —1 LIZ - SO -two Property Owner's Mailing Address Property Location L _ ,SLcJ k5li 'b' S N. R City, Statc Zip Codc Phone Number Lot Numbf r Block Number t'^ Su bdivisio n Name CSM Number II. Type of Building (check all that apply) CE�VEO ❑City D9 1 or 2 Family Dwelling - Number of Bedrooms _ _ _ ❑VUTA e 8 ❑ Public /Commercial - Describe Use NOV foTowns n ❑ state owned 1 tk S1f �+Rpx "'} Nearest Road � 2) 3 x 1 r— '�'' C -4 - o -e, �� 3`k oh•z / I�Sh M. Type of Permit: (Check only one box on line A (numbe eme for tnterna� fis l Complete line B if applicable) A. 1 ® New 2 ❑ Replacement System 3 C1 Replacement of T ; 4 - � County use S sum Tank Onl x's B, ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply) (numbering scheme is for internal use) /Q. —tCD 44 0 Non - Pressurized In- Ground 210 Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Litz 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. DispersaVrreat ment Area Information: V 22 ' 4 Design now (gpd) Dispersal Arta Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed }Late(Gals. /Days /Sq F(.) (Min./Inch) Elevation '7<Q 33, Z-3 199,33 Vz i VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tucks i Septic or Holding Turk _ � /zC Dosing Chamber VII. Res asibWty Statement- I, the undersigned, a responsibility for installation of the POWTS shown on the attached places. Plum r' *lame (Prig) Plumber' Si to MP/MPRS Number Business Phone Number Pltrmber s Address (Street, City, State, Zip Code Z L VIII. Count /De artment Use Onl Approved ❑Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) ❑ Owner G i v e. Initial Adverse D __ __ cter u N. Conditions of Approval /Reasons for D oq tt Se��ar 5 W44 k rennet t e. p¢,� d.{xp.�i c•�' - �¢ C orot o e�4►xc e S. �(�,�. e.�st►>Mer „e,asq�t ells f , � „cu� •ru �e„ tone Attach complete ptaw (to the County oatr) ror the "em on papa oot ku thaw Un x 11 IwAa la atze SBD -6398 (R. 05101) i � W �a ellk f iPv�rS.Qo l 'Pe asea f 71 �� Wisconsin Department of Commerce SOIL EVALUATION REPORT Page J__ of J Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County 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. Re - ewe by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). (? X) f Propert Owner Property Location Govt. Lot 1/4 y 1/4 S T N R(or) W Property Owner's Mailing Addr ss Lot # Bloc # Subd. Name or CSM# _3 City State Zip Code Phone Number ❑ City [] Village Town Nearest Road ( ) 'f New Construction Use: Residential / Number of bedrooms - 5 - Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if appli a e General comments CEIVEU and recommendations: ST CPOiX Mau F/I Boring # ❑Boring % .1tNG OFFICE ® pit Ground surface elev. ft. Depth to limiting factor c d 1n: - v oil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boun s GPD /ftz in. Munsell Qu. Sz. C nt. Color Gr. Sz. Sh. *Eff#1 *Eff#2 r 7 Cj Boring # ❑ Boring ® Pit Ground surface elev. ft. Depth to limiting factor ,(/ i' in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 I *Eff#2 -7 d f s S S S - - 6 * Efflugnt #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (PI se P nt) Signature CST Number Address Date valuation Conducted . Telephone Number SBD -8330 (R07 /00) l Property Owner Parcel ID # Page of Fil Boring # ❑ Boring ® Pit Ground surface elev. of Aej ft. Depth to limiting factor in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 r s _ F-1 Boring # ❑ 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 F] Boring # ❑Boring El 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 /ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD > 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 - 264 -8777. SBD -8330 (R.07 /00) C 94 J-7 a _� -Sv �.gm�P;�r9s 1 _T 3G C R \ I � roc 70 , ars I 1354 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 of 3 Division of Safety and Buildings in accordance with Comm a5, Wis. Adm. Code Gustum Septic Service Attach complete site plan on paper not less tha0Y4A1inc Courrty hes in size. Plan must St. Croix include, but not limited to: vertical and horiyenf,4. 1 refee��encepoin (M), direction and parcel I.D. percent slope, scale or dimemsions, nyrtK arrpwsind- locatiob andI I nce to nearest road. pending . Please p�n3ayl'nformagon. ;:� Reviewed By Date Personal informatio n you provide rrya�be used for se'4d (Privacy, law, 15.04 (1) (mJJ. 2-6 3l Property Owner j ::' ;property Location t n r ` ovt. Lot 1 /4 S W 1 /4 S 17 T 28 N R 19 W Humbird Land Corporation �__ r..�Q Property Owner's Mailing Address`, Sr C ROi X _' ` of # Block # Subd. Name or CSM# 332 Minnesota Street, East 1404 c:�,.rvrlr 36 n/a Troy Wood Subdivision City Statp., 'Z,id C / _ j City _j village e Town Nearest Road ,. ". Saint Paul I MN `Y0.1 654 -'- Troy E Cove Rd / Lost Rock Lane New Construction Use: y Residential ! Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe: Parent material outwash plains Flood plain elevation, if applicable n/a General comments and recommendations: Part of 1.62 acres. BM #1= 100.0'. BM #2= 93.85'. Recommend 89.7' system elevation. P26 from preliminary boring work done 5 -5 -00. [ F2�6 Boring # Boring 1/ Pit Ground Surface elev. 97.5 ft. Depth to limiting factor >75 in• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= *Eff#1 *Eff#2 1 04 10yr3/3 none sit 2mcr mvfr as 30m 0.5 0.8 2 4 -13 10yr3/4 none sl 2msbk mvfr cw 2m,1co 0.5 0.9 3 13 - 10yr4/6 none sl 2msbk mfr cw 1 m 0.5 0.9 4 30 -52 10yr4/6 none gr. sl 2msbk mfr cw - 0.5 0.9 5 52 -75 10yr4/6 none gr.Is 1msbk mvfr - - 0.7 1.2 a Boring # -1 Boring ✓J Pit Ground Surface elev. 91.8 ft. Depth to limiting factor >70 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= *Eff#1 *Eff#2 1 0 - 10 10yr 3/2 none sit 2msbk mvfr as 1f,1m 0.5 0.8 2 10 -15 7.5yr4/2 none sil 2msbk mvfr cw 1 f 0.5 0.8 3 15 -22 7.5yr4/4 none sil 2msbk mfr cw 1 f 0.5 0.8 4 22 -31 10yr5/6 none sl 2msbk mvfr cw - 0.5 0.9 5 31-41 7.5yr4/4 none gr. sl 2msbk mvfr cw - 0.5 0.9 6 41 -50 10yr5 /6 none gr.s 0 sg ml cw - 0.7 1.2 7 50 -70 10yr514 none s 0 sg ml - - 0.7 1.2 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mgtL * 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 N13450937th St., New Auburn, WI 54757 11/21/00 715 -658 -1344 Property Owner Humbird Land Corporatio - - - -__ Parcel ID #n F ] Boring # din�— _ -- - - — - -_ _ __- _- Page _ 2 of 3 Boring Pit Ground Surface elev. - ___ ___. ft. Depth to limiting factor >72 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Mift= j 'Eff#1 'Eff#2 1 0 - 11 10yr3 /2 none sil 2mcr mvfr as 2f,lm 0.5 0.8 2 11 -21 10yr3/4 none sil 2msbk mvfr cw 1f 0.5 0.8 3 21 -27 10yr4 /4 none sil 2msbk mfr cw - 0.5 0.8 4 2744 7.5yr4/6 none sil 2msbk mfr cw - 0.5 0.8 5 44 -72 10yr5/6 none sl 2msbk mvfr - - 0.5 0.9 Boring # Boring Pit Ground Surface elev. _— 911 __,- ft. Depth to limiting factor >78 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _- -GP= 'Eff#1 'Eff#2 1 0 -8 10yr3/2 none sit 2msbk mvfr as 1f 0.5 0.8 2 8 -13 10yr3/4 none sit 2msbk mvfr cw 1f 0.5 0.8 3 13 -26 10yr5 /6 none sl 2msbk mfr cw - 0.5 0.9 4 2 -42 7.5yr4/6 none sl 2msbk mfr cw - 0.5 0.9 5 42 -78 10yr5 /6 none sl 2msbk mvfr - - 0.5 0.9 Boring i F-1 # Borin Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots ___ __M /fts- 'Eff#1 'Eff#2 I I • 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. i o � J w 9 c y N a- -4- t� 9Z i t I o z � 17 C .1 m t: I oM � O W � N W W U It If r N m m m ap � o m POWTS OWNER'S MANUAL at MANAGEMENT PLAN Page _L of ` FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity gal El NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA NA. Effluent Filter Model [I NA Number of Bedrooms Number of Commercial knits �-NA Pump Tank Capacity gal CZ NA gal /day Pump Tank Manufacturer lff NA Estimated flow (average) Design flow (peak), (Estimated x 1.5) gal /day Pump Manufacturer .21 NA Soil Application Rate gal/day/ft' Pump Model Z NA Monthly average* Pretreatment Unit aNA InfluentJEffluent Quality ❑ Sand /Gravel Filter ❑ Peat Filter Fats, Oil a Grease (FOG) !00 mg/L ❑ Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BODs) :_220 mg/L ❑ Disinfection ❑ Other: Total Suspended Solids ( TSS) : 5150 mg/L Manufacturer Pretreated Effluent Quality ' ❑ NA Monthly average ** Dispersal Cell(s) Biochemical Oxygen Demand (BODs) _ :30 mg/L l5 In- ground (gravity) ❑ In- ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ At -grade ❑ Mound Fecal Coliform (geometric mean) :510 cfu /100m1 ❑ Drip -line ❑ Other: Maximum Effluent Particle Size A inch diameter * Values typical for domestic (non - commercial) wastewater and septic tank effluent. * * vaiues typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event inspect condition of tank(s) At least once every ❑months 9 year(s) (Maximum 3 yrs. ) Pump out contents of tank(s) When combined sludge and scum equals one -third (h) of tank volume ❑months 121 year(s) (Maximum 3 yrs.) Inspect dispersal cell(s) At least once every Clean effluent fliter At least once every 3 ❑months 9 year(s) Inspect pump, pump controls ez.alarm At least once every [I months ❑ year(s) ®NA Flush laterals and pressure test At least once every ❑ months ❑ year(s) ®-NA Other: At least once every ❑ months ❑ year(s) 0 NA Other At least once every ❑ months ❑ year(s) 19 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third ('�) 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 ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurize less shall O be performed by a certified POWTS Maintainer. a ny other maintenance or monitoring at Intervals of 12 months or A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START Up AND OPERATION of the POWTS check treatment For new construction, prior to use atment tanks) for the presence of painting produce or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). if high concentrations are detected have the contents nv the r;,nieW removed by a sentage servicing operator prior to use. System sur' up shah not occur when soil condltivns art frown at the Infiltntivt surface, During power outages pump tanks may Illl above normal higbwater levels. When power Is restored the excess wastewater will by discharged to the dispersal cell(s) In one large dose, overloading the cell(s) and may result In the backup or surface discharge u! effluent. To avold this situation have the contents of the pump unk removed by a Sepup Servking Operator.prlor to restonn,, power to the effluent pump or contact a Plumber or POWTS Malnulner to assist In manually operating the pump control, to restore ncrmal levels within the pump wnk, Do not drive or park vehicles over sinks and dispersal cells, Do not drive or park over, or otherwise diswrb or compact, the are. within 15 feet down slope of any mound or at-grade soil absorpwn area. Reductlon or ellmination of the following from the wastewater strearn may Improve the performance and prolong the life of tn� POWTS: antibiotics; baby wipes; clgarettx butts; condoms; cotton swabs; degreasers; dental floss; diapers; dWnfecunu; tat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; Crease; herbicides; meat scraps; medications; oil Pa inting croducts; pesticides; saniwrti naokins: tampons; and water softener brine, ASANDONEMENT When the POWTS Fails and /or Is pemianently taken out of service the following sups shall be taken to Insure that Of system is proprrly and safely abandoned In complince with ch, Comm 83.33, Wlsconsin Adminisuative Code: • All piping to links and plu shall be disconnected and the abandoned pipe openings sealed, • The contents of all tanks and plu shall be removed and property disposed of by a Septage Servicing Operator, Aher pumping, all tanks and plu shall be excavated and removed or thtlr covers removed and the void space fllled witr soil, gravel of another Inert solid material. CONTINGENCY PLAN If the POWTS falls and ca nnot be repaired the following measures have Been, or must be taken, to provide a code compliant replacement system; J& A sulubie replacement area has been evaluated and may be uUllzed for the location of a replacement soil absorption system. The replacement area should be protkcud from disturbance and compaction and should not be Infringed upon required setbacks from exliUng and proposed strucwre, lot lines and wells. Failure to protect the replacement area wili result In the need for a new soil and slit evaluagon to establish a suluble replacement aria. Replacement systems must comply with the rules In effect at that Ume. 0 A sulUble replacement area Is not available due W setback and /or soil llmltaikiru. Barring advances In POWTS technolod, a holding tank may be Installed as a last resort to replan the failed POWTS, 0 The slit has not bcen evaluated to Identify a sultabie 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 13 available a holding sink m. be Insulled as a last resort to replace the failed POWTS. Q Mound and at-grade soil absorption systems may be rtconstructed In place following removal of the biomat at the InflluaQve surface, krconstrvctlom of such systems must comply with the rules In effect at that dme. < < WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN, DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT, RESCUE OF A PERSON FROM TKE INTERIOR Of A TANK MAY It DIFFICULT OR IMNISSIRI F. ADDITIONAL COMMENTS POWTS I STALLO POWTS MAINTAINER Name _ N Phone Phone SEPTAGE 5ERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Apncy Phnne ST CROIX COUNTY SEPTIC 'TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM 'Owner/Buyer Lz�� 1 z_42',' ,-- ", - z,.., Mailing Address Property Address —� (Verification required from Planning Department for new construction) City /State Parcel Identification Number LE GAL DESCRIPTION Property Location ' /,, S,J '/ Sec. 17, T _ N -R-2 W, Town of Subdivision ®u�,9� s , Lot #. Certified Survey Map # , Volume , Page # Warranty Deed # �gD 'Volume Page # S9T Spec house (� yes O no Lot lines identifiable jJ yes O no SYSTEM MAINTENANCE Improper use and maintenanceof 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 andlor (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 lof in, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification ur septic syst has been maintained inust be completed and returned to the St. Croix County Zoning Office within 30 ree year exp at n date. SI =.,R APP I NT DATE O TIFICATION (we) certify tha all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p erty describn�E irtue o f a warranty deed recorded in Register of Deeds Office. R / ��/ D ( IG A R A E OF P CANT DATE ` ** "' Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. 00'*00 •• 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 17�i5 597 SPATE BAR OF WISCONSIN FORM 2 - 1998 662480 WARRANTY DEED KATHLEEN H. WALSH kEGISTER OF DEEDS Document Number 5T. CROIX CO., WI This Deed, made between Humbird Land C orporation, a _ RECEIVED FOR RECORD Minnesota Corporatio :1:00 RM WARRANTY DEED Grantor, and Scott R. Johnson and Jason M. Johnson EXEMPT it --- CERT COPY FEE: COPY FEE: TRANSFER FEE: 269.70 — RECORDING FEE: 11.00 Grantee. PAGES: I Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix _ County, State of Wisconsin: Recording Area Name and Retum A Lot 36 Troy Wood, Town of Troy, St. Croix County, Wisconsin /= v✓3' ,�cc___. • 040.1272 -50 -0 Parcel Identification Ntnnher (PI \) This is not homestead property. (is) (is not) Exceptions to warranties: Subject to notes, ease ments,restrictions,covenants and rights of way of record, if any, including but not limited to those for drainage,water tetention,ponding,and or utilities as may be shown on the plat of Troy Wood recorded in Vol. 8 of Plats, page 28,St. Croix County, Wisconsin. The warranties of this deed, either expressed or implied are limited by the grantor to the grantee, or anyone in the chain of title, to the consideration expressed herein, that being the sum of $89,900.00. Dated this _ 12th day of Novem 2001 Humbird Land Corporation *—Aus J. Bailton _ AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) ss. _ Ram County. ) Personally came before me this 12th day of authenticated this _ day of , 20 0_1 the above trained Austin J. B ailton TITLE. MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing (If not, instrument and acknowledge the same. authorized by § 706.06, Wis. Slats.) ■ • ' 41At! L-0N THIS INSTRUMENT WAS DRAFTED BY NOTARY PUBLIC•MINNESOTA Paul A. Bailton, Atto at Law ' Paul A. Bailton . MY CoMIass Ga ExPRES1J " _ Notary Public, State of Wis - (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. (11' not, state expiration date: necessary.) January 3 2005 'Names of persons signing in any capacity should be typed or printed below lheir.rignatures WARRANTY DEED STATE BAR OF W ISCONSIN FORM No. 2 - 1995 INFORMATION PROFESSIONAt.SCO,SAYANY FOND DU LAO, Wt Wxi.054011 O ON lo lu M C9 cm 0 ativ a Cl) i .000 lop i �i Q ^ �` ��ZO V /LMN= / 3 M p a � u . m�a � w I _ 0ZpZZ m i - z \ I s W _Sm =�z 11� V \ �iQ O�V1��1iijjff ao f -' a89.9 co co o 2. go6°a7'ai ° � z 0 0 3 0 _ � - _ a � 1 \\ cl m o ! W Z \ -- - - - - -- r J . / 99 L .36 994 A06 — J a -- - - - - -- • h O 64, M � � a LLI M 'C° 0 I W99 .93'0 & 3 .66'963 3.E940.00N i - -- - - -•-- z C C m O ° 3 ° q a — ISO q r q Q M 3 $ q E C 0 o. a Aei — c 4 r- E c m V ci a� w � (n CL a =1 c� 3 m a o Id m m L+ m Iq a � c L' m a,€ O z LL — W ix >= 0 F- Z W W rpo > w Z O J W C r w .� W (D U z z J c Z Q � Z O W M Cl) Z OC Q Q W U J w V CO) 3: LU 0 � O 4 w � U. U— O r}- W. 9 w w m F —I �Z °— w mO\ z U) O a� _ >A