HomeMy WebLinkAbout040-1276-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
. Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
515253 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:
Sherman, Tami A. Troy, Town of 040 - 1276 -70 -000
CST BM Elev: Insp. BM Elew BM Description: Section/Town /Range /Map No:
j 11 M ` k % 17.28.19.1539
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION ` BS / HI FS
Septic / ' Benchmark 16J1/ /
Dosing ( Alt. J.
4, , a ,
` Bldg. Sewer
/.5, I
Holding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Aent to Air Int a ROD Dt Inlet Aq
Septic ' 6b 76 Dt Bottom
Dosing 5J / / _ Hder/Ma�
r
Aeration Dist. Pipe
Holding Bot. System
PUMP /SIPHON INFORMATION Final Grade /i 163
Manufacturer Demand t Cover
S
� � ` GPM r,J � .�G,LJ 1Pj�✓ l.,P
Model Number LL1! /oi 7
`7C
TDH Lift Friction Loss System Head TD p t G
Ud61 3.3 p.
Forcemain Length / Dia. I Dist.toWell
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenc h e PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 7:5 � �.� ��
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION A CHAMB T OR
T yp eO Model Number:
stem: `6'
� �L
DISTRIBUTION SYSTEM �.)1
Header /Manifol� / Distribution j , / , x Hole Size jr x Hole Spacing Ve to Air Intake 6 Pipes) ( ! Z
Length Dia Length 7Z Dia Spacing
SOIL COVER j x Pressure Systems Only xx Mound Or At -Grade Systems Only �,...
Depth Over Depth Over Depth of xx Seeded /Sodded xx Mulched
Bed(rrench Center Bed/Trench Edges Topsoil f 7 j
s ®No No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: �b /5 / Inspection #2:
Location: 397 Eagle Bluff Court Hudson, WI 54016 (NE 1/4 NE 1/4 17 T28N R1 9W) Eagle Bluff Lot 71 I , Parcel No: 17.28.19.1539
1.) Alt BM Description = 1
2.) Bldg sewer length =
- 61)
amount of cover
Plan revis
Use other i on
for information. No
Date Inse or's Sign re Cert. No.
SBD -6710 (R.3/97)
v
� �X
✓� y
1
S PAID
Safety and Buildings Division County
eomnteme.Wl -ow 201 W. Washington Ave., P.10. N*x 7162 v d"
sc on s i n Mattison, W1 53707-7162 Sanitary Permit Num er (to be filled in by Co.)
!6 /5 Z5
State Transaction Number
Sanitary Permit Application -�
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmenta project Address (if different than mailing address)
unit is required prior to obtaining a sanitary permit. Note: Application forms for state -owned
submitted to the Department of Commerce. Personal information you provi
secon ry
oses is accordance with the Ptivac Law, s 15. l m , Stgts. a
I. Application Information - Please Print All Informs /n Parcel #
Property Owner's Name ` Q 41 1 d v� pop
T dw i v k e r 1 "/ N Property Location
CrQ
s Mailing Address 1X IC
Property Owner' g � C
SjING g xpt %tAG pFF Govt. Lot
C Zip Co dev inner �' /., ' /., Section
City, State (circle on
C. T
Z N R E W
OTC Lot Sit
II. Type Building (check all Apply) Subdivision Name
r 2 Family Dwelling - Number of Bedrooms �Q / t-
Block #
OJ°sC.- w
C01 Public/Commerciai - Describe Use ❑City of
CSM Number ❑Village of
❑ State Owned - Describe Use / Town of r60 --
A
�f
III. Type of Permit: (Check only one box online A. Complete line B if applicable)
El Other Modification to Existing System {explain)
A
ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only
List Previous Permit Number and Date Issued
❑ Change of Plumber ❑ Permit Transfer to New
B. Permit Renewal ❑Permit Revision Owner
Before Expiration
IV. T e of POWTS S stem)Com onentlDevice: Check all that appl
❑ Non - Pressurized In- Ground ❑ Pressurized In- Ground 11 At -Grade ❑Mound >_ 24 in. of suitable soil Mound < 24 in. of suitable soil
❑ pretreatment Device (explain)
❑ Holding Tank ❑Other Dispersal Component (explain) _ �
V. Dig ersaUTreatment Area Information: S s
Design Flow (gpd) Design Soi! Application Ra O Dispersal Area Required Dispersal Are�roQo
1 • 6
Capacity in Total # of Manufacturer � �
VI. Tank Info Gallons Gallons Units U
V
New Tanks Existing Tanks
Septic or Holding Tank
Dosing Chamber J
VII. Responsibility Statement the undersigned, assu sponsibility for installation of the POW f shown on the S N mbe ached Plans. ess Phone N ber
Plum
Plumb i ature
be Name -'s (P rin t)
�jK3 �1
Plumber's Address (Street, City, State, Zip Code
VIII. Coon IDe artment Use Only Permit Fee Date I ued Issuing t Signature
�ppproved ❑ sapprove $ tCJ�✓ Di'� 5 7 10
❑ n Reason for Denial /t
IX. Condit' gFasons for Disapproval 3) �^ /► / ! OJT+ �}st..
1; Septic tank effluent filter ant!
dispersal cell must all be services I maintained a.�12 /
as per management plan provided byplumber.
2. All setback requirements must be maintained
Attach to complete plans for t e system and submit to the County only on paper not less than 8 vz x 11 caches in Size
SBD -6398 (R. 01/07) Valid thru 01/09
PLOT PLAN
- PkOJECT Tami Sherman ADDRESS 544 Briana Lane Hudson Wi 54016
NE 1/4 NE 1/4S 17 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX
SYSTEM ELEVATION 101.2' 1/.5' sand lift
BEDROOM 4
CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 750 # of chambers none
BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEST GF10 -8
❑ BOREHOLE O WELL * H. R. P. Same as Benchmark
Eagle Bluff Court Scale = 1/4" = 10
3 Acre Parcel
Eagle Bluff Drive
Area 15' below system is
to remain undisturbed
100' 99.7'
9 B -1
4% Slope
6 -3 Mound sits on top of bluff
Grading is to be done to >25% Slope
divert run -off away from
system
B -2
W I is to meet all
WD R setbacks
Pro 4
Bedroom Huffcutt Combo Tank
House Tank is to be properly
bedded and provided with occ)
lockdown covers with
approved warning labels
PLOT PLAN
PROJECT Tami Sherman ADDRESS 544 Briana Lane Hudson Wi 54016
NE '1/4 NE 1/4S 17 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX
SYSTEM ELEVATION 101.2' 1 /.5' sand lift BEDROOM 4
CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE 765
HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 750 # of chambers none
IL BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEST GF10 -8
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Eagle Bluff Court Scale = 1/4' = 10'
3 Acre Parcel
Eagle Bluff Drive
Area 15' below system is
to remain undisturbed
100' 99.7'
9 9'. B-1
4% Slope
Mound sits on top of bluff
B -3
Grading is to be done to
>25% Slope
divert run -off away from
system
B -2
Well is to meet all
WDNR setbacks
Pro 4
Bedroom Huffcutt Combo Tank
House Tank is to be properly
bedded and provided with
lockdown covers with
approved warning labels
L
Safety and Buildings
141 NW BARSTOW ST FL 4TH
It commerce.wi.gov WAUKESHA WI 53188 -3789
lepa rtment ■ Contact Through Relay
sc o n s i n www.commerce.wi.gov /sb/
of Commerce
www.wisconsin.gov
Jim Doyle, Governor
Aaron Olver, Secretary
May 04, 2010
CUST ID No. 226900 ATTN.• POWTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING INC ST CROIX COUNTY SPIA
1008 192ND AVE 1101 CARMICHAEL RD
NEW RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 05/04/2012 Identification Numbers
Transeetion ID No. 1790770
SITE• Site ID No. 756238
Tami Sherman Please refer to both identification n rs,
Eagle Bluff Ct Lot 7 above, in all correspondence vt�t1>j
Towll of Troy
St Cry County
NE1 /4, NE1 /4, 517, T28N, R19W
Lot: 7, Subdivision: Eagle Bluff
FOR:
Description: Mound, 4 bedroom
Object Type: IOWTS Component Manual Regulated Object ID No.: 1264276
Maintenance required; 600 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade;
System(s): Mound Comonent 1Vlamt4 Version 2.0, SBD- 10691 -IRIN 01 /01), Pressure Distribution Component
Manual - Version 2.0, SBD - 10706 -P (N:01 /01); Effluent Filter
The submittal described above has been revieVved for conformance with applicable Wisconsin Administrative
Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This Wstem is to be
constructed and located in accordance with the enclosed approved plant and with any component Amnual(s)
referenced above. Tbo4*vner, as definf im chapter 4.01.01(10), Wisconsin Statutes, is responsible for compliance
with all code requiren*Ws.
No person m* engage in or w6tk at plumbing in the state unless licensed to do so by the Department per s. 145.06,
stats.
The following conditions sWItit trip daring construction or installation and prior to Canby dr use:
This system is to be gptructed eruct located in accordance with the enclosed approved Olans and with the "Mound
Component Manual fbi P**e Onsite Wastewater Syste>ft VER SION 2.0" SBD4Q691 -P (N.01 /01) and the
" Pressure Distribution Component Manual for Private Onsite «tewAter Treatment Systor-,VERSION 2.0"
SBD- 10706 -P (Nfl1 Oh 1 `f
In the eves Otis soil absorption stem or Of its component arts functio hazard th
tP system an3' P P � tl0y�,, �
the property owner must follow the contingency plan as described in the a oved pft, , the owner
must comply with Ike ope4atien, taintenance and monitoring duties as descn in se cU 1' the mound
component manual. A copy of this information must be given to the owner upo6 etion a project.
�o
All holding/treatment tanks are to comply with Comm. 84.25(7)(x). �RF
Maintenance f0oWation must be given to the owner of the tank explaMing that periodic cleaning of the filter is
required. Access to'th'e filter for cIpAing must be provided per Comm 84 product approval conditions.
t. .
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SHAUN R BIRD Page 2 5/4/2010
A Sanitary Permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.135 and 145.19, Wis. Stats.
Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
Owner Responsibilities:
• Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation
and maintenance of the POWTS occurs in accor&nce with this chapter and the approved management plan
under s. Comm 83.54(1).
• Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as
required under s. Comm 83.54(4) shall be considered a human health hazard.
• Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the
county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the
component(s) utilized in the POWTS.
A copy of the approved plans, specifications and this letter shall be on -site during construction and open to
inspection by authorized representatives of the Department, which may include local inspectors. All permits
required by the state or the local municipality shall be pbiained prior to commencement of
construction/installation /operation.
In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions
should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this
review shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the
address on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
S el_y, Fee Required $ 250.00
Fee Received $ 250.00
Balance Due $ 0.00
Julia Lewis- Osborne
POWTS Reviewer 2, Integrated Services WiSN1ART cdeF 7i
(262) 397 -6005, Fax: (608) 283 -749
julia. lewis@wisconsin. gov
Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in
Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings
Division of the Wisconsin Department of Commerce.
"Construction business" means a trade that installs, alters or repairs any building element, component,
material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the
uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs.
Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does
not include the delivery of building supplies or materials, or the manufacture of a building product not on
the building site.
For further information, go to our website: www. commerce. wi. gov/ SB/ SB- BuildingContractorPEgg_ram.htnil
Note: Effective March 29, 2010, we are consolidating our Shawano full- service office with our Green Bay office.
Please address all plans, correspondence, mail, etc. related to previous Shawano services, for delivery after that
date, to: Division of Safety & Buildings, 2331 San Luis Place, Green Bay, WI 54304. If calling moved Shawano
staff after that date, call (920)492 -5601.
' f
Cover Page
Shaun Bird RECEIVED
Bird Plumbing Inc. APR 2 3 2010
1008 192nd Ave
New Richmond Wi 54017 SAFETY & BUILDINGS
715- 246 -4516
Date: 04/ 20/10
Owneffami Sherman
Location:NE 1/4 NE1 /4 S 17T28 N,R19 W Lot 7 Eagle Bluff Troy
System type: Mound System
Manuals Used: Mound Component Manual Version 2.0 (01/31)
Pressure Distribution Manual Version 2.0 (01/31)
Page#
1. Cover Page
2. Mound Plot Plan
3. Mound Cross Section
4. Pipe Cross Section /Pipe Layout
5. Pump Chamber Cross Section
6. Pump Curve
7 -8. Maintance and Conti ncy plan
9 -12. Soil test
Shaun Bird
Signature
License ber 226900 L
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Page__:, °
03/05 Igj
Septic -Dose' dross ion And Pimp Perfo�e Specificaxios
Tin* MW
Tank Model N
Tdtal Tank' A#�u Maues'' e:C s
4
•`k �� k. I � .4 �T y r , ,,f._. •[ .elf .d` i�e' 'w' J -t Z. AA /jl'
Total Dye Head (TDH) -Feet
Number
01 . � Head
Filter Model 3 S
Dim Pry
4
Minim PUMP Required Force Meta Loss
Ft 3Dl I Total
panel Maaho�o i 'm. 4" Abo a C�tade With , 4": Abam t Eel
8Dia0k� -at. ': �, Loalcm8l7avioe
G" Below Grade Seaied WdufLat Weati.a-ploof
aim
aft
Dhmonged
Abon+e fnlade : Mesms
• With Vat Cap
switch
r
"' rte - ���.�, , -• .. "- "-
Inl+et •' �ttl+�t Baffle ,.• ••
'. r. Tat3k $ 1401C
' Volume Gal.
k .} Dime�om. . ;•; ..
WY
� : c= -, �.. •• {� may,
a
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GENERAL INS'�A ► , ► riat
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avoid MisalhotSon bava ttm mnbents c ftie p ternow d bya
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1Al m Ste PtrilYi'S tied his p outofsmice CA icamft steps std f fa10 ft tree
b is � YAM dL Cotes 83.33. Morlsolosmob 00dw
AB F%ft m ad pile stems be db=mmcbed aid the aba &Weed pipe Opeeir'�S so0led.
• it�e af.�::n ana pSs aha be sierno+a and prod* arbya
s Atmt Vj=*g3M a$ f ft and pet she$ be e MW removed ar• f= aemova dared the VON
• S�ed�lh�9ra�etorirtertc�etfat. • .
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lftlre � �` � �:".° +, :oest3�etffi pa�Oda ar+paeie` "
A,iukobis demer r s beers evahaftid and may be uSzed for th= ioc900 Ofs me
abompftn sysbm Tim r ecent area shodSd be ptcbecWd fraen 6�srbarrce old cotttp¢mt w aad sw :mt
be k1fiff 10 P upon by ff*m exisk:g =4 proposed $Mscbuo, tot 8 and vAlft Fallum bD -
prvgecx the ngpiaoeerxot etas v&V rat as the need fore am
,. };� rrsctst aorrtpty �nRttt the rtrtes to effect at Seat Sssta.
II Asc fe srena' ftnctawm5mbWd . mtD setbzr and1xsad ad f is a
to logy a is � t W&!n ►be as a test resort to reprsoe thO fS:
POVI
~ sate tas cart it ematmewd to ktertW a' suftsbW r+eptaosreent area, Upon tan" of an PC3YWTS a s6it•and
sbe eb"ahlaffm meet be perfosrDe� do locate ff « amble nwinoccnent sr+ea. tf no rep rieataree fm awaftbb a,
tr3ak nW be lnne as s last resort to rapt&= the tam Pcnrt `S
aud.at gradg =W a6soepdon s mW be rsoosstr=ftd in pftoe fiolom ft xwnomd o€the blame at
no one sz Deg. �3aoetSd s of ssxtt systwm sasses ' the sales la ett ezt� fiattScsce:
SSglr„ PtiM Ate? OTfM 3' TAMM VAY CWrAW LETHAL. GASSES AMPM l�TCOC�E.
Do mmT ENTMA 8tt0C, V=WcKOT§mt TREATM 'lI TAW UMDiM AidY CLICEOMAMM MATH TRAY
ltt'SIii.T. MU=M•tFA FMW THE Wn3WR OF ATAW WAY BE DMICULT OR ARP.OStiI F:
•ADDITIC FAL 0D t
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of
Division of Safety and Buildings ���� �I -
ih accordance with Comm 85, Wis. e
`� County
Attach complete site plan on paper not less than 8 1 x 11 i pmust
include, but not limited to: vertical and horizontal ref �I Irection and Parcel I.D.
percent slope, scale or dimensions, north arrow, an ocatio}I'dnd distance to nearest ro / y U
Please print all infor ation. Q r1�10 Review y Date
Personal information you provide may be used for secondary rposes �VIAw, s. 160, 7
A6
Property Owner S� G� U Ion
Lio r r� J pNN�N� & Govt. Lot 1 /4 1 /4S N R Llj
E (o rw
Property is Mailing Address Lot # Block # Subd. Nam e or CS
1 N C. r.32 ~ 7
City State Zip Code Phone Number ❑ City ❑Village Town Nearest Road
ew Construction Use: Residential / Number of bedrooms Code derived design flow rate — 60 a GPD
❑ Replacement ❑ Public or commercial - Describe:
Parent material .(�9 C'i�D try _ �., i 29i 1f� S2-' Flood Plain elevation if applicable
General oorrxnents
and recorrunendatkms:
System Type wa /' S 5a �2 !1 67 System Elevation
FF1 Ong # p� Boring
qct Pit Ground surface elev. M ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtlf
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Effi#2
rrn
1
3 / ,.. e /
`
Boring # m ❑ Boring Q Q
�+ pit Ground surface elev. V ' �! 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
Z 6 /0 1 / 1 19� C s
• Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 mgA Effluent #2 = BOO 1 30 mg/L and TSS < 30 mg/L
CST Flame (Please Print) Si CST Number
Bird Plumbing, Inc. Shaun Bird 226900
Address D to Evaluation Conducted Telephone Number
1008 192nd Ave, New Richmond, WI 54017 _ 715 - 246 -4516
i
Property Owner _ Parcel ID # Page of
❑Boring
1- 3 - 1 Boring # spit Ground surface elev. I Ln. � 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
0�1 c,— d
Z �� o s, c'
❑ 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/ff
in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 I 'Eff#2
❑ Boring
F
Boring # Ground surface elev. ft. Depth to limiting factor in.
❑ Pit Soil Application Rate
Horizon 7epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/fF
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, 130 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.
SM9330 (8.6/00)
Property Owner Parcel ID # Page of
F-31 Boring # F] Boring r�
spit Ground surface elev. W D 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
z a r----
a 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/ff
in. Munsell Cu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
❑ Boring # ❑ Boring
C1 Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Applicab on Rate
Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence . Boundary Roots GPD/ff
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.
SOD -8330 (R.(0O)
Pla
Soil Test Plot
;al
Name Tami Sherman S Bird
Address 544 Briana Lane
Hudson Wi 54016 s1 #226900
Lot 7 Subdivision Eagle Bluff Date 4/20/10
NE 1/4 NE 1/4S 17 T 28 N /R W Township Troy
Boring Q Well PL Property Line County ST. CROIX
IL BM or VRP Assume Elevation 100 ft. Top of 1/2" pipe
System Elevation 101.2' *HRPSame as Benchmark
Eagle Bluff Court It Scale = 1/4" = 10
3 Acre Parcel
Eagle Bluff Drive
100' 99.7'
99' B-1
❑
4% Slope
B -3 Mound sits on top of bluff
>25% Slope
B -2
El
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address r-54 (' �(`�p` -Ao
Property Address � j e � 1 v �' ov-� So ✓1 (AJ .
(Verification required from Planning Department for new construction.)
City /State 4�Ac,-)(J1 J �_ Parcel Identification Number U - I a - 7 Q bC�o
LEGAL DESCRIPTION
Property Location %4 , V4, Sec. T 2-3 N RW, Town of t rc�
Subdivision l{ 1 v Lot #
Certified Survey Map # , Volume '— , Pagc # `—
Warranty Deed # a t , Volume " , Page #
Spec house yes no Lot lines identifiable yes no
SYSTEM MAINTENANCE
Improper use and maintenance of your septic system could result in its premature failure to handle waste . 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. Owner ma' itenance
responsibilities are specified in § Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Zoning Department a certification form, sign by the owner and
by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site astewater disposal
system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is 1 ss than 1/3 full of
sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage dispos d system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, Stat of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix ounty Zoning
Department within 30 days of the three year expiration date.
SIGNATURE OF APPLICANT DATE
OWNER CERTIFICATION
Uwe certify that all statements on this form are true to the best of my /our knowledge. Uwe am/are the ov Mer(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office
�f � I/ LP /a
SIGNATURE OF APPLICANT DATE
* * * * ** Any information that is misrepresented may result in the sanitary permit being revoked by the Zoning epartment. * * * * **
Include with this application a stamped warranty deed from the Register of Deeds Office and a copy of the certif d survey map if
reference is made in the warranty deed.
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State Bar of Wisconsin Form 1 - 2003 9 1
WARRANTY DEED BETH PABST
REGISTER OF DEEDS
Document Number Document Name ST. CROIX CO., WI
RECEIVED FOR RECORD
02/25/2010 08:30AM
THIS DEED, made between Troy Development Corporation, a Minnesota WARRANTY DEED
Corporation EXEMPT I
( "Grantor," whether one or more), REC FEE: 11.00
and Tami A. Sherman TRANS FEE: 375.00
PAGES: 1
("Grantee," whether one or more).
Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area
estate, together with the rents, profits, fixtures and other appurtenant interests, in 1 �-
St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address
needed, please attach addendum):
River Valley Abstract &Title, Inc.
1200 Hosford Street, Suite 201
Lot 7, Plat of Eagle Bluff in the Town of Troy, St. Croix County, Wisconsin Hudson WI 54016
File # 2804534
040- 1276 -70 -000
Parcel Identification Number (PIN)
This is not homestead property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except:
Easements, restrictions and rights -of -way of record, if any.
Dated February , 2010
Troy Devel n C o tion
(SEAL) (SEAL)
* * Courtnie Kirvela , Vice Pre dent
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT a
Signature(s)
STATE OF MINNESOTA )
authenticated on } ss.
�lvaGc� COUNTY } c ;
* Personally came before me on February 22 2010 Z
the above -named Courtnie Kirvela , Vice President of Tro m
TITLE: MEMBER STATE BAR OF WISCONSIN Development Co oration z
• C
(If not, to me known to be the pe n(s) who executed the foregoi
authorized by W is. Stat. § 706.06)
in,t` ment edged the same. m
THIS INSTRUMENT DRAFTED BY: 0 qRM A ROV ,.
A ttorney , D oug Berg
1200 H My
osford Street. Suite 201 Hudson, W1 54016 Commission (is permanent) (expires:
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED 00 2003 STATE BAR OF WISCONSIN FORM NO. 1 -2003
1* name below signatures.
s
Wisconsin ospirvnent of Commerce SOIL EVALUATION SORT Page 1 of 4
Division of safety and Buildings j
in accordance •Kith Comm 85. vVis
,_�) . CROIX
Attach complete site plan on paper not less than 8 1/2 x 11 inches in :rdiand st
include. but not limited to: vertical and horizontal reference point (8M { L11 i I.O: ` 1 — 7 / 5 3�
P peg ercertt slo scale or dimensions, north arrow, anocaon art d ltid d' est 70'C Please print all information. (� +l 7 �' ' ` oats
Personal Infoenadon you provide may be used far sec
SH CR X
Property Own HARL . COOK o ZpNINGOFFlCE
CONTINEN VELOPMENT CO ORATIO -- v4r=�r }I4 S 6 T28 N R19 1)T(6rlW
Pro carters Mading Address Lot BIW or CSM#
11800 ABERDEEN ST. NE, STE 100 7 GLE BLUFF
[ City state Zip code Phone Number I] City ❑ village (3 Town Nearest Road 39 7
BLAINE MN 55449 ( 763)757 -7568 TROY EAGLE BLUFF CT.
® New Construction Use: Residential / Number of bedroome 4 Code derived design flow rate 600 GPO
❑ Replacement �] Public or commeraal - Desrnbm
Parent material Loe s Flood Plain elevation if applicable N . A . ft
General comments u at '7 and recommendations: ' G
Pi # Q
® Pit Groundsurfaceelev. 1029.0 ft. Depth to limiting factor 35 n.
Sod Application Rate
Horizon Depth 0off Redox Desorption Texture I Structtue Cortsatenoe Boundary Roots PO /fF
in. Murd" Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ew E
A 0 -4 10YR 4/2 -- sil 2f r ml aw 3vf -m 0.5 0.8
B1 4 -20 110YR 4/4 1 sil 2msbk ds gw 3f -co 0.5 0.8
B2 20 -35 lOYR 5 - Sl 2mabk dsh cw lvf -f
C 35 -39 IOYR 6/8 f2d 5 y sc1 lmabk mfi 1cw lvf 0.2 0.3
R 39 -46 10YR 8/6 -- lmst -- -- -- lvf -- --
P B0" # a sawn 1030 D to li factor 20 in.
® Pit sf Depth Sod Application Rate
HM M Depth I Dominsnt Redox Desatpoon Texture Structure Consrstenoe Boundary Roots GPD/R
in. Musa Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eftltl I 'Ef'f#2
A 0 -6 10YR 3/2 -- sil 2f r mfr aw 2vf -m 0.5 0
B 6 -20 10YR 4/6 -- sil 2mabk mfr cw 2f -co 0.5 0.8
R 20 -30 10YR 8/6 -- has - -- -- if -- --
Effluent #1 = SOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = 60D _: E 30 mg/L and TSS < 30 L
CST Name (Please Print) Signature CST Number
JAMES D. FILKINS �' 222952
Address OGDEN ENGINEERING COMPANY Date Evaluation Conducted Telephone Number
11 -22 -99
113 WEST WALNUT ST., RIVER FALLS, WI 54022 3 -7 -00 3 -8 -00 715 -425 -7631
i J
r
Property CHARLES S. CO OK Parcel 10 # pa 2 of 4
Sonr9 # Q Bonn;
Q Pit Card surtece s 1030.8 ft oepm to li m&q fam 2 0 in.
Soil Apploolien Raft
i tmaort Dofforwitcolor, Redox DaKrpoon Tenons SKMIMM Cara■erce I Boundary Roots GPMV
in. Munsed atr. SL Cant caw Gr. SL Sh. 'EMM 'Elm
A 0 -5 10YR 3/2 -- Sil 2fgr mfr cw 2vf -f 0.5 0.8
13 4 Sil 2msbk mfr cw 0.5 0.8
B2 11 -20 1OYR 4_5_ -- s' 2mabk mfr Cw 3f -cc 0.5 0.8
MUNW. R 20 -30 1OYR 8/6 -- lmst - -- -- if —
P # Q Bering
Q Pit Ground surface elev. 1027. h. oepm to limn" factor 36 gin.
Sod A2WUon Rate
Depth I Donnnant Redox Ossovoon Texture Structure Camatence Boundary Roots GPO/M
gin. Munses Qu. Sz. Cont. Color Gr. Sz Sh. EfMf1 'EffAt2
A 0 -5 10YR 3/2 -- sil 2f mvfr aw 0.5 0.8
BI 5 -15 10YR 4/4 -- 2csbk mfr 5zw 3vf-m 0.5 0.8
B2 15 -36 10YR 4/6 -- S1 2msbk mfr Cw 2f-m 1 0.5 0.9
R 36 -66 10YR 8/6 -- lmst -- -- -- if -- --
Boring # Q p Ground surface elev. 1029.2 h. 060M to Umi" factor 12 in.
l� t
Soil _ Ao0 icawn Rate
Depth Oonnnant Color Room Desavoon Texture Structure Roots GPIDir
in. Munso Qu. Oz ;ont Color Gr. Sz. Sh. I •"- m 1 'Efffe2
A 0 -5 10YR 3/2 -- Sil 2fjzr mvfr cw 1 3vf-m 0.5 0.8
B 5 -12 10YR 4/4 - Sil 3 0.5 0.8
R 12 -30 10YR 8/6 -- lm t -- --
' [1111 nett[ #1 = 800, > 301 220 rruyL and TSs >30 < 150 mg/L ' Effluent #2 = 800 30 mg& and TSS < 30 rrqL
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 = 608 - 264 - 8777.
SHDill01R.071001
r -
Parcel #: 040 - 1276 -70 -000 04/09/2008 11:16 AM
PAGE 1 OF 1
Alt. Parcel #: 17.28.19.1539 040 - TOWN OF TROY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner
O - TROY DEVELOPMENT CORP
TROY DEVELOPMENT CORP
11806 ABERDEEN ST NE STE 290
BLAINE MN 55449
Districts: SC = School SP = Special Property Address(es): ' = Primary
Type Dist # Description ' 397 EAGLE BLUFF CT
SC 2611 HUDSON
SP 1700 WITC
Legal Description: Acres: 2.515 Plat: 08- 037 -EAGLE BLUFF LOTS 1/43 040 -01
SEC 17 T28N R19W NE NE LOT 7 EAGLE BLUFF Block/Condo Bldg: LOT 07
Tract(s): (Sec- Twn -Rng 40 114 160 1 /4)
17- 28N -19W NE NE
Notes: Parcel History:
Date Doc # Vol /Page Type
2008 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/23/2006
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.515 219,900 0 219,900 NO
Totals for 2008:
General Property 2.515 219,900 0 219,900
Woodland 0.000 0 0
Totals for 2007:
General Property 2.515 219,900 0 219,900
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch #:
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
4
pmawtyowner CIJARLES S. _ COOK PerCal10 # 3
l
FP 9 Baring # Q Barn+9
® Pit Grourndsurfsceelev 1028.3 Oapth to lirly" factor 19 in.
Sari APPM=w Rats
Hartmn 060tttt owwwnt Color Redox OanNO Taxwm Strncuo Canawtas Boundary Rotes GPOW
in. MunsW au. SL cant. Color Gr. SL Sk lew Is=
A 0-5 10YR 3/2 -- sil 2fgr mvfr as 3vf -m 0.5 0.8
B 5 -19 10YR 4/4 -- sil 3mabk mfr cw 2f -m 0.5 0.8
R 1 -24 10YR 8/6 -- lmst -- -- lvf -- --
P 18 Baring At Q ecrr>rng
Q pit Groundsudscsaiw. 1030.5 ft 0a0w to Iimdfng factor 15 in. Sor A Rste
Horn I 06M Dcxrwwnt COW Redman M P Ta=e stucue coo w i sel'Bounday Roos GPCW
in. Mu nsw Qu. Sr- cant. color Gr. Sr. Sit 'tit *EW
A 0 -6 10YR 4/2 -- sil 2fgr mvfr Cw 3vf-m 0.5 0.8
B 6 -15 10YR 4/6 -- sil 3mabk mfr cw 3vf -m 0.5 0.8
R 15 -30 10YR 8/6 -- lmst -- -- 2f -m -- --
F Barxng # Q Boring 0 Pit Gnxundsurtaceelw. 1028.7 Oeprftto linMtlng faction 26 in• Sal A Rate
Honntut Dam 00minaritcow Redox On no"" n TeodtYS Sktx2LM Coneresncs Bounoary Roots GPCM
in. Mu nsall QU. SL cont. Cow Gr. Sr- Sh. 'aWt I IElfIM2
A 0 -6 110YR 3/3 -- sil 2fgr mfr cw 3vf -f 0.5 0.8
B1 6 -21 10YR 4/4 -- sil 12msbk mfr cw 3vf -cd 0.5 0.8
sic 2mabk mfi cw 2f -m 0.2 0.3
R 26 -28 10YR 8/6 -- lmst -- -- -- if -m -- --
EOluant #1 = 800, > 30 < ZM mglL am TSS >30 < 150 mgfL ' EMuant #2 = 800,:-< 30 rn94. and TSS < 30 mgfL
The Department of Commerce is an equal opportunity service provider and empiover. If you need assistance to access services or
need matenai in an alternate format. piease contact the department at 608 -266 -3151 or TTY 608 - 264 -8777.
sea- 93304a.071M
PAGE 4 OF 4
SITE PLAN
P2
r \ �
O J /
J f
v B P I f'
/ w B —P4 I
l � i
9
B —P 18 t Y
B —P5 6 —P9 ' I
�P6 \
NOTE: Bench marks are ground elevation at base of
4' wooden lath near each boring location.
rr
SCALES 1 4 ► ! 1
OGDEN ENGINEERING CO.
Akilro D. FILKINS, 222952 Civil Engineers & Land Surveyors
113 W. Walnut St. River Falls. WI 54022
D E: (715) 425.7631
r -
w n��
i • � � � .�_ - 9" .. •� rte. .. ��
v
9 E H SERIES SUMP/EFFLUENT PUMP
11.65
8.95 0 ,
0
Specifications
MODEL CAL SOLIDS SIZE RUNNING PERFORMANCE (GPM @ READ)
LISTING; NP 10LTS SHUTOFF Pwg Cpp WEIGHT DIMENSIONS M0. N0. (Dia M.) AMPSIITATTS 5' PSI IM I5' 21' (FL) (f.)
(us.) (g x t x EF(
9EH -t7M 509330 III= 4110 115 3/4 13.0 1000 70 64 55 41 32 118 20' 24 9.11 x 11.64 x 8.94
9EH-am 509340 UUCSA 410 230 314 6.5 1000 70 64 55 41 32 13.8 20' 24 9.11 x 11.64 x 6.94
9W- CIA-RFS 509350 UUCSA 4110 115 3/4 13.0 1000 70 64 55 41 32 13.8 20' 27 9.11 x 11.64 x 8.94
9EH- CIA -RFS 509360 UUCSA 4/10 230 3/4 6.5 1000 70 64 55 41 32 13.8 20' 27 9.11 x 11.64 x 8.94
Continuous Duty Rated — •Little Giant Wastewater pumps are rated continuous duty as long as they are run within the published ratings forthese pumps."
FLOW— LITERS /HOUR Construction
0 1000 2000 3000 Motor Housing Epoxy Coated Cast Iron
Impeller Material Poly Carbonate
30 io Impeller Type Closed Vane
Volute ABS
W 7.5 W Power Cord SJTW A
20 W Mechanical Shaft Seal Nitrile with carbon and
E
5 ceramic faces
Lj
Fasteners
W Stainless Steel
10 Shaft Stainless Steel
2.5
Bearings Upper Sleeve and Lower
0 Ball Bearings
0
0 20 40 60 80
FLOW- GALLONS /MINUTE
PUMP PERFORMANCE CURVE
115V 6 0HZ ll,Jll Little Chant Pump Co.
PO Box 12010.Oklahoma City, OK 73157
s F Phone: 405.947.2511 " Fax: 405.228.1550
• E -mail: customerservice @littlegiant.com
WWW. LittleGiantPump .COm �� Form 995235 — 07/03