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040-1250-80-000
n (A o < C - � c k T ° } ® \ ¥ © ƒ � X � © 2 7( 7 7 0 m )\ ®/ 2 Q T, o > ) . e - , > Sr \ E \ ( $ / � « ' . 6 k E j o E s$ k § a a » % ] ° § § k j - % @ / m / : a \ \ . l CL f E E }\ g f � g / / I ¥ % 0 - c } C @ \ §U C. 0 . \ k ) § \ 0 CL / \ / I \ § E c / \ § z $ƒ m g 2 2 2m k % » « ] k \ / § J U ƒ \_ ° E ; {2 ® 7 ■ (A E § 4 § % o z } �. � ƒ � \ \ S § § o § \ 9 ,A\ E } /\ , % � . � } z 2 � F / \ ■ z [ - � ■ _ � / §% 0 \ $ § 2 CL ] \ $ z 3 z » . % \ � \ 4 t ) } § 6 G I � Co . 0 \ / � a � CL \ ƒ � \ � 5 . e \ � § � , / \ \ j W srpnstn 0eparo„ent of Industry. SOIL AND SITE EVALUATION REPORT Page / of 3 Labor ar*, i (Jvman Relauoru Oivisoon of Safety S Bwldinp in accord with ILHR 83.05, Wis. Adm. Cade COu�p� �� Attach complete site plan on paper not less than 812 include x 11 inches in size. Plan must but / '' not limited to vertical and horizontal reference pant (BM), direction and % of slope, =ale or PARCEL I.O. dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: /� PROPERTY LOCATION if/TlNEiVfsfL aWt_0P,0W"7 4,C/e,C ,4TloW GOVT. LOT $E 1/4 IVPJ 1/4,S/ T Z 8 N,R 9 Al W P OWNER':S MAILING ADORE LOT x BLOCK 8 SUBO AME OR CSM >< G STATE ZIP CODE PHONE NUMBER QCITY QVILLAGE OWN NEA EST R AO , i 4-i vE MAI 575 4- (lo /A 1s7 7SG 9 T,eo r :T A1W4f6 pQ New Construction Use p(J Residential / Number of bedrooms Addition to existing building L I Replacement (] Public or commercial describe Code derived daily flow dOO gp d Recommended design loading rate z9- bed, gpd/ft trench, gpd/ft Absorption area required Soo bed. ft Soo trench, h2 Maximum design loading rate 4• ¢ bed, gpd/ft 0, trench, gpd/ft Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design / site considerations 5'EE �(/o ?�5 O.t! 6 Parent material Flood plain elevation, if applicable IV R S = Suitable for System CONVENTIONAL MOUNO 1144110UND PRESSURE j AT•GRADE SYSTEM IN FILL HOLDING w K U =Unsuitable for system I❑ S WS ❑ U CIS O U ff S ❑ U ❑ S Iffu 1 ❑ S .® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence 8curd3y Roots GPO /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed (Tench /'W 5Ak !yI r G'tv v4 D. S/ w -0 5ik �N� w A ¢ a.S Ground BZ a¢ 6 v �r 5 ✓� S D, 1, elev. g?L2. ft. .93 � 4 _519 S AV, D, ¢ O. S Depth to g¢ 1 50 -71 10 S /' Sr,� S Sic / 3 ��t�,� �� C w /v k 0. ¢ o. 5 li r 6 — s O�J J — lie Remarks: Boring # >. 8/ j3 Z Z-Zf3 /DY/l ¢ 3 _' /,S CS6,eG Mt✓�r acv ��� . 7 ®. � Ground B 9Y• % it BlL / -so Sye 5 8 /s /CS6,C M V4 Depth to B Z 50 -70 Oy2 ¢ ¢ — /s Zc56� n" �r Iv,C Q: limiting ,ECEIV �J, _ N 1 997 1 — Remarks: 4 ST C ROIX Name:�lewPrint JAMES D. FILKINS _....__._ _ _ _.. .. 10 f 1 � (715) 4 4'031 _ _t3NtN0 OGDEN ENGINEERING CO., 113 WEST WALNUT ST., RIVER FALLS, WI 54 S'Igrfaaue Data: CSTM03988 PROPfiAr7CWNER �O�/T�NENt�L y SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D. # Depth Dominant Color Mottles Texture structure Come Boudey Roots GPD / tt Boring # Horizon in. Munsell QU. Sz Cont. Color Gr. Sz. Sh. Bed ffTrF s / ZP Y,e ¢.3 Z // -Z3 vYC 0-110 _ /s k ,w "Irr D. 7 0.8 Ground $/ 3 -3 /0Ye 91 s Z C 5.6k /Nrler ccS ✓� �•7 D. 8 Q Z 37 S/ Apyw ¢ 5 Ds rti / C w Depth to f 3 S� Gt3 /OYe .S /3 W/ SYe limitin factor Remarks: Boring # M soma Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 13 Ground Depth etev. iL to kmiting factor Remarks: SSD 4=( R.otilD2) 0 PAGE 3OF3 SITE PLAN I 8- Z8 Z I \ u r F7 ; Lev. = 89 9• � �- '1x 0 0 8 SsZ B- 5791 V) Z o 7" S N NOTES: PROVIDE MINIMUM OP 1' SAND BETWEEN BOTTOM OF BED AND EXISTING GROUND. MOUND TO BE A MINIMUM Off': 25' FROM DWELLING; 50' FROM WELL; 5' PROM LOT LINE. SCALE: 1 " = 40' OGDEN ENGINEERING CO. JAMES . FILKINS, CSTM03988 Civil Engineers i Land Surveyor 113 W. Walnut St. River Falls, WI 54022 !?' 715 425 -7631 DATE: ( � Wisconsir Deparmwnt of Indus", SOIL AND SITE EVALUATION REPORT Page I ofd labor and14uman Relations Division of Safety s, Buildings in accord with I 83.05, 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 % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance q *d. APPLICANT INFORMATION - PLEASE P FOR1ilA�(ON REVIEWED BY DATE PROPERTY OWNER: `. � LOCATION E ,Z 5 Z Z fo JOtaA) A ,6AKA � TI' Omfir5 MAA CU � wy 19 T ZS N,R 19 W PROPERTY OWNER':S MAILING ADDRESS I. T # BLOCK # SUBD. NAME OR CSM # CITY, STATE ZIP CODE PHONEtM CITY (]VILLAGE OWN NEAREST ROAD * kA C60N t L401 "' 1715) �' fi New Construction Use pCJ R Napit;e; [ ]Addition to existing building j ] Replacement [ ] Public or comet Code derived daily flow 600 gpd Recommended design loading rate 0.5 bed, gpd/ft ftnch, gpolft Absorption area required 5 bed, ft 600 trench, ft Maximum design loading rate Q ._- bed, gpd/ft 0• g trends, gpd/ft Recommended infiltration surface elevation(s) A M »'Qll 4 7 -,ft ( \ referred to site plan benchmark) Additional design / site considerations — v Parent material 5A m1D-1m ►a4;i' GLAC%A L - nu— Flood plain elevation, if applicable Al A - ft S = Suitable for system CONVENTIONAL ND IN GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem ❑ S U S❑ U ❑ S U ❑ S U C3 S 0 U CIS U DESCRIPTION REPORT Depth Dominant Color Mottles Structure GP Texture Consistence D /ft Boring # Horizon in. Munsell Ou. Sz. Cont Color Gr. Sz. Sh. � Roots Bed Tre & 4 ' Z 1 JT-2� 3 J 3 -- 1 rn ) rr, CS — .1 0. c Id Ground 3 3/ 4 t4 tv elev. g44_D ft. 4 - 3 j f. K C S NJ P A3 C p Depth to g 3 ' �" % 1 11 limiting factor Remarks: N064Z013 3 , 15 AvAOST SA- rvY -A a+bKIUtJ H Hilt, W1rAKLN C�RMlaAj ye *z - AAdDs Boring # o 1 0 - 2 0 10 v Z 2 Z� l0 Y 3� 3 1 rn S b1C M Ground 3 - b to 31 — 15 1 mSbK mfr — .� ,61 e li g - 9 7,SY 3/Z I MSb M41 5 -44 3 I�tiK"� b m; 110 Depth to O 2a Iimiti'ng K 31H K `� S � mSbK y — — P N Remarks: ut''C2W �j XS t IEAICL\J Nh5 \MeAKWC.eMSAT2s' 7MYR3 /2 �ST M arge: ease Print Phone: 'CIS 14 Add ress: 63 ST, \JEK r - 1 540Zz Sl Date: 9 Iff -0e. Z 7, / 7 CST Number: Mck � 1 1901 X770-7 Page Z of PROPERTYOWNER �Ul�/hPnEL-F, "TO} -1N SOIL DESCRIPTION REPORT _ PARCEL I.D. #t Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bour>d3y Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed iTreft 6 - 13 1'4 Z — - 1 rr 5bK 0. — z 13 2Z I D 5h _ 1 m !:w YYa S - 0. Ground 3 zi -26 10 1 4 — 1 5 yylsbr, y4r Q.5 - 0 elev. as43 ` h. 4 1 OYK 3 y I s I ryl z�bK m Y Depth to limiting factor Remarks: 5 ' , a .*c WC) Boring # I D -10 O 7 4 2 — 15 Mshx M r CS — ' Il. • ra L - QY 3 _ 1 MV Ground - O -1 _ m3 )< rv, �Y' 6- 0. elev. T _ q 3 l v+n / _ Q m i Depth to limiting �- — limiting fac tor Remarks: N-0%Z z0►J 4 u ONO.1 -4 -- Boring # a WIN Ground elev. ft. Depth to limiting factor Remarks: Boring # F Ground elev. R Depth to limiting factor Remarks: CCf1 -a97n /La nKia91 - Page E w PLOT PLAN Property Owner 'RW.'CAMj;L1= Legend: I "-'I0'EarCg&r 'VOTEO Legal Description LOT 66 'T120y BM =ID T0 OF 60 PENNY MAIL V 1 LL,dGF . LDc A7ED � N T t +E � ��z '1 S Z T FLA�%� STSKea / ��vfl'ri oil q49. �y T'Zq�l� 12ZOr•1 4 0 5►4, TZSN R14W� ❑ = soil boring w /backho 7OWN o f TROY, sr.caux C.oUJJT'Y, I-J�. (M6LZ5 or LOT A""- ta'PPK ") SF 5tkej Nt AVS r-CA LOT u NF p.ccc�cv. EL 8gq.'f4 I LOT LOT y 69 P I ❑ f)-qs2 'n EL 799.4 8 - 4 53 S � 900.0 VI g-45 l �L 449. W ?A2KW4 Y /D,E UT /L / >Y 25' oR c FROM �K�wFiEw 1101ASelpf" � OK (ISENMR FKDA pTICT14 WELL- - ro 3E 50' 04 4~'TE1e FRS DKAVJFimz d �6 SsPrIC Z l; Signed C S T R I oG K-� 0 37 25 07 L#kMIOIS ,D -TO �r 5' OJCQ ABArer t Date AIOAI. L5 1946 Fa,'A PKOPE CtY UNS Rev lye. Z SepTIC -rAN1L 1'O ME Z' OK lmlC�f E� F�nti PRDPSn' uNE Wisconsin iepartV ent of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix S44�t nd 3u ;9ing Division Sanitary Permit No: INSPECTION REPORT 399658 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Parcel Tax No: Troy Development Cor oration I Troy Township 040- 1250 - 80-000 CST BM Elev: t Insp. BM Elev: BM Description: co TANK INFORMATION 1 1 01 ELE ATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 13 / Ooh, c� Dosing Alt. BM 3,L�) 31 ' lol ,fi Aeration Bldg. Sewer //! Holding St/Ht Inlet .Q3 Uo 4 � D r TANK SETBACK INFORMATION St/Ht Outlet l TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / r Dt Bottom Dosing Header /Man. Aeration Dast:-Pg7e Holding Bot. Syste � PUMP /SIPHON INFORMATION Final Grade L) �Iq• 3 Manufacturer Demand St Cover GPM Model Numb TDH Lift is ' Loss System Head TDH Ft Forcemain L ngth Dia. SOIL ABSORPTION SYSTEM AS0k RENClj> Width Length INo. Or en PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENS S 31 3 � 1 1 SETBACK SYSTEM TO /L L WELL LAKE /STREAM LEACHING Manuf turer: INFORMATION Type Of System: I CHAMBER OR O otepw , f D UNIT Model Number: If 1( 1 5 r i � DISTRIBUTION SYSTEM Header /Manifold I t Distribution x Hole Size Ix Hole Spacing Vent to Air Intake Pipe( Length Dia Length is SOIL COVER x Pressure Systems Only xx Mo Or At -G rade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes j No Yes ! No 1 COMM NTS: (Inc co screpencies, persons present, etc.) Inspection # 1v / . �oQ' L Inspection #2: -j��i& A c Location: 332 St. Annes Parkway Hudso WI 54016 (Unknown 19 T28N R19W) Troy Village Lot 68 Parcel No: 19.28.19.11310 1.) Alt BM Description = �P, �\SI � (do �W 2.) Bldg sewer length = 2 l VJ �G� 10 • S t� - amount of cover = (g 4- rlS•S� �-% • 3 0 1 i Ian revision Required? " Yes No -O Z Use other side for additional information. L. QJ J►•%— _ SBD - 6710 (R.3/97) Date Insepctor's Signature Cert. No. Ilk 4 v ` °' Safety and Buildings Division County a" 201 W. Washington Ave., P-0. Box 7162 Madison, WI 53707 -- 7162 i Address ,sconin Department of Commerce 3 Sanitary Permit Applica-lioii!R'!E(,L',4,F�'VC,'xj anitary Permit Number In accord with Comm 83.2 1, Wis. Adm. 0xic, personal infori tation you provide Check if Revision _mad _b used for secondary E��2ses Privacy Law, st .1014(t IN 2Gp 2!�� I. Application hifonnation - Please Print All Information L Late Plan I.D. Number Joe Property Owner's Nam s boo C--f- farce] Number ZONING _j 73 Property Owner's ?VA.Iing Address Property Location U %,S T R City, _SV1t__ Zip Code Phone Number Lot Number Block Number 6 f subdivision Name CSM Number S11-V 1W/ H. Type. of Building (Check all that apply.) 0 City 1pt_-1 or 2 Family Dwelling - Number of Bedrooms ❑ Village ❑ Public/Commercial - Describe Use 0 �/ 7X6;(JCV&---5_ TownstAj2 ❑ State Owned 1 /3 • _7S - 7 CA Nearest Road 7_07 &0� _ifl. Type of Permit: (Check only one box online A. Numbering is for internal use.) (Complete line B, if applicable.) A. #!VNcw F_ placement of 6 ❑ 0 Addition to For system 2 Q Replacerne I System 'El Re nly Existin SXs!gW County use _I 'rank 0 B. (71Cbeck if Sa Permit Previously Issued Permit Nom Date Issued uT Sy_q - (Check all that appl 'N,)n --Pressuriz^l Ir-Ground 21 El Mound 47 ❑ Sand Filter qn ... f Wetland 2 2 ,,st. .m 2 ressurlztd hi-Ground 41 ❑ l4o)ding Tank 48 El Single Pass 51 11 Drip Line — 7) 45 0 At-Grade 46 0 Aerobic Treatment Unit 49 ❑ Pecirculating 30 Li Other OKI Percolation Rate System Elevation Final Grade Design Flow (V pd) Disl)cr",al Area s -ial Area oil Appi ti R ed Propo o g -Ratc((;aIs.1Days1Sq,Fl.) I (Min.finch) Elevation 67� 1 7 P _0__ _VI. — Tank Into Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallom of Tanks Concrete Constructed Glass New _ tanks Septic Dosing Chamhe_r VIL Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached Plans. Plumber's Name (Print) Plumber's Signature MPIMPRS Number Business Phone Number 141 Address (Street, City. State, 2Y(f Code) VIT1. County/WDa ijent Use Only Date Issued 1. Sanitary Permit Fee (includes Groundwater , Wffig �Ag t Signs re tamps) W owner ciy4m Initial Adverse I Surcharge Fee.) AJOIVe W64)4)1 94 a _TX_.Condiflorts: of AypprovnL'Rex�ons foi- Disapproval AV-EP 64* CMD Re— co W, SyS-11�5 W�,M J r 0 Rix. qt 6W Abe gar Cevev-s co.�T Rgyw P 2 AfjCcLda V�+ ;-ee y-dtd i +S X: pA P 6- _ / & L.5p g ov, , e ? /A n h-f y BI Z 6 Ateneb complete plans (to the Coomty only) for the system no paper not less than 8112 x 11 Inches In sin - . r 1.. i. I , a ' , i ' I ; , 1 I ; _ —�—__ _ �. —•j _._.. — �_._ —�— __.t— __l._ _1_. _ . ;__ { ---� _ 1. _ . i- � T ( { I - -`1-- { l j i i • i � � I r ! { Clf CE M UEs cc VI o r — + 3 -1--+ ; { fl ♦ S - -- - lot VI � [ � 5 7 3 4e •v 7 lJ X8.93. PID # CU — (� '/4 � /4,S T � �TV,R l I LOT J2L BL._ SUB L ` !� /(',, j C❑ V❑ TO 1 MPRSW 242514 r - `�' • 2-4 N K K W A\ r7 30 (0 -3. 2 b ? is Wisconsin Department of Commerce SOIL EVALUATION REPORT Page ,,. of J Division or safety and Buildings _... in accordance with Comm 85, Ms. Adm. Code County gl-, c�o� Attach complete site plan on paper not less than 8 172 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. Q 0 - 12-50- go - ()oD Please print all Information. view by ' Date Personal Information you provide may be uasd for secondary purposes (Privacy law, s. 15.04 (1) (m)). Z Q Property Owner Property Location MIKE F, Get S'!0 J oMF 114 �W 114 S )� T N R 1 9 w Property Owner's Malling Address Lot # Block # Subd, Name or CSM# ,sg4 -01 2 VILu1G� city Slate Zip Code Phone Number 0 City ❑ Village XjTown Nearest Road CaM AGJr. & I /Vry►{j 1 550 i (, 1 ( 45 9- 1 c i72 T F C) St K% New Construction Use Residential r Number of bedrooms _ Li_ Code derived design flow rate - GPO 9 Replacement rl Public or commercial - Describe Parent material _ 016? W!\ SN Flood Plain elevation it epplicabis .�- -- General comments I Zl,�f �IYL�JeODU�' and recommendations: �lJ�>:I.yftOlal+t-- („yfJel„uJD "LiZB - Z�1TIA� 6 5 �N10t -iJO Rcei.- AcWe/A'T FKQm OwmID oi,- 03- �. ST coax COUNTY �] goring -Sj ZOMNGOPFICE a Boring # Pit Ground surface elev. qj g5 — rt. Depth to limiting factor 7 0— / S )cati Rate Horizon paptrl Dominant Color Redox Description Texture Structure Consistence Bounds is 1 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 'Eft#2 11 6 4 , P i r sj -M my r 0" O a Z b I vg Zjj ci r, c I Jf- 0, 1, 3 13 1 0 s dch — ab 013 o. )g- z3 3 a , o,Z o D o 3 mS s rnl 3 — o.-1 �.Z Boring Al a goring F l p; Ground surface elev. � p.� ft. Depth to limiting fact or ? �?S_ !n• Soil lirxition Rate Horizon Depth Dominant Color Redox Description Texture Structur© Consistence Boundary Roots D /tF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'E"'I 'Ef*2 t _S 1 S, Z� - m s rnaS o, 5 0 ,9 7 - 5 '22 NI '' ` S -Lsb 3 33 t� 1t; Z r tS -L 1h y -39 b 3 — St( Z� s a - Or5 0,8 Z 5 b Y , 0. S 0 •V W 7 y _ t � u rl ant #1 = BOD > 30 < 220 mg1L and TSS >30 � 15 nap ' Effluent #2 = SOD < 30 rng/L and TSS _ CST Number CST Name (Please Print) Signature / / - M A 0 H o l-L s T & 7r.�I J =r=f — �, _ 2 l � 83Z Address Date Evaluation Conducted Telephone Number 54422 12 I ( -Ol-Olt5 y2b -1�7S ) r LET VS / Property Owner /y1� {z G 1} Gt+s`oM1H� 5 ) Parcel ION ON 1L50 -4 0��� Page Z of 3 a Boring # ❑ Boring _ Pit Ground surface elev.- ft. Depth to limiting factor In Soil ication Rats Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ff In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0 -� 0 WK 2-h S -rn -rn I,Z Z -21 tovr2z L 0• 3 .2 - 30 S 3J -- 15 m t sb J S JT-1 o. 7 1, Z D -33 S`I� 1s - m�WY 0. 5 33 3 L4 -- St m 01-W -� a,5 0. q - o w t s f sbK J >a 1� o•� 1,7- j F Boring # Boring cos r.� Pit Ground surface elev. 1 �•� s Oepih to limiting lector _ In. c nly - licadon Rate Horizon Depth Dominant Color Redox Descrip on Texture Structure Consistence Boundary Roots GPDM in. Munsep Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'EK#2 mS 0 d av) t.z S ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. R. Depth to limiting factor In. SoY icatlon Rats Ho izon Depth Dominant in. Munse Colo Redox Description Texture Structure Consistence Boundary Roots GPO/ff ll Qu. Sz. Cont. Color Gr. Sz. Sh. '£lf#1 'E1iK2 ' Effluent #1 = BOO, > 30 < 220 mg1L and TSS >30 < 150 mg/t. ' Elfluenl #2 = BOO < 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. 9aD•3)10 PRAM) pAC� 3� 3 PROMM Omek: CLk-S ONE tiQ,,C--5 % KE KN G �.DT - CO OF F F- uEcarRW- - 0 - 50Mr "NG W/ 6ACKNOE NO COMM 83 5ET13ACK PRONLEM5 ® z eta N OT coSY� 'gM ppsT I P` + ' � ti + 3 � t p`R i I P � � 1 v job 00 I a � 1� SRS it LQ�A ION 9 (� t 1 t i I 5"t? C 5 — J6/`� - 2z4�32 w PAT: 12-0-7-0 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix S�fety B ilding Division , INSPECTION REPORT Sanitary Permit No: 399658 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: Troy Development Cor oration Troy Township 040 - 1250 -80 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION 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 BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length 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 1 xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No ] Yes ]] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: Location: 332 St. Armes Parkway Hudson, WI 54016 (Unknown 19 T28N R19W) Troy Village Lot 68 Parcel No: 19.28.19.1310 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = 3.) Contour = — — Plan revision Required? i] Yes •�] No Use other side for additional information. Date Insepctor's Signature Cert. No. SBD -6710 (R.3/97) VWvensm 0"ratient of Industry. Sol SITE E U A T I O N REPORT Page /- of 3 ♦ Labor aro- Human Relations _ r0ivAjon of Safety & BuJdmgs accord with ILHR 83 .05 \ . Wis. Adm. Code � C0�' Attach complete site plan on paper not I n 81/2 x 11 i es in size. PI must include, but not limited to vertical and horizontal reference pot , direction and % of Pe, scab or PARCEL I.O. N dimensioned, north arrow, and location and distance to APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE P90PERTY OWNER: PROPERTY LOCATION IS/77W"rAL % tLoP/l/E.t/7 � L,iTlo^/ GOVT. LOT SE 1 14 Nw 1 /4,S/ 9 T N.R 9 W � P OPERTY OWNER':S MAILING AOORE�W ' / ,S LOT x BLOCK X SUED. N AME OR CSM S Z 3v / Gf60v ?WAL Ake. wC wr'e Z3o l0 o Y �L L G , STATE ZIP CODE PHONE NUMBER CITY OVILLAGE OWN NWEST ROAD ,4 /�vE �/✓ s"5'4 (A-C) 7 7-f' 7 8 ',G o Y J' 7 NA/ES �Q New Construction Use (XJ Residential / Number of bedrooms ¢ ( ] Addition to existing building L ] Replacement ( ] Public or commercial describe Code derived daily flow 6010 gp d Recommended design loading rate bed, gP -- trench, gPd/ft Absorption area required Soo bed, ft trench, fit Maximum design loading rate 4• _ bed. gpd/9 4. trench, gpd/tt Recommended infiltration surface elevation(s) It (as referred to site plan benchmark) Additional design / site considerations SEE Ale 2 !VAI C e Parent material �vE i /LL O�T��// Flood plain elevation, if applicable /I/ It S s Suitable for System CONVENTIONAL MOUND IN-GROUNO PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TT w K U - Unsuitable for stem I ❑ S cru 9S ❑ U ❑ S O U Cgs ❑ u C3 S 18N ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Roots GPD /ft Boring # Horizon in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed TII�r1d1 j /O yiL 3r /z Ground BZ ¢� S Ori2 ¢ G �s• C s d,eL v �r 5 / ✓� S O. !, elev. $9 3 ft. le eg' 3 — 5 /056j 44 -r Depth to P limiting factor o ay,� 6 — 5 D� l �✓ 0. 10 .8 Remarks: Boring # /'ry'e ,IMd1 w 11 Z-Z9 /OY/l ¢ 3 A tv le Ground sS ' Ik ✓ Tr G w 44 Q. 7 8 Q. 8 % ft BlL / -So /Oyu G Ca I . 5/0 Ar le5l7 ' MWe XS v4 BZ 30 -710 ©r/L ¢ — /s Zc g6k �r — , Depth to Imov ` NILI Remarks: I I.: ft 4 1997 F N a tio - Mme Print JAMES D. FILKINS ROW (715) 4 ,77631 STN OGDEN ENGINEERING CO., 113 WEST WALNUT ST., RIVER FALLS, WI 54022 ZON INU e: Date 3 97 CST Num4„ `. 88 i 3 P90PERTYCITNER e0Atr1NbVr,#L SOIL DESCRIPTION REPORT Page_ Z of PARCEL I.D. Depth Dominant Color Mottles Structure Roots GPD /ft Boring # p Texture Cor>sistienoe Bdtusay Bed n in. Munsell Qu. Sz Cont. Color Gr. Sz. Sh. g Ground 3 -3 /O 91 4- Iy� � elev. ft. 5 v Depth to �3 S� Gt3 /OY� s13 .5 Y,e s 5 %� L'� /►I �r Iv D. ¢ 0. s smitin Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Boring # 13 Ground elev. tc Depth to lirrdting facto Remarks: PAGE 3 OF 3 SITE PLAN B- z8 z I u r 0 Q y 0 a 8 ssZ Go T 6 9 h vs Z 0 7" .a NOTES: PROVIDE MINIMUM OF 1' SAND BETWEEN BOTTOM OF BED AND EXISTING GROUND. MOUND TO BE A MINIMUM Off': 25' FROM DWELLING; 50' FROM WELL; 5' FROM LOT LINE SCALE: 1 " = 40' OGDEN ENGINEERING CO. i JAM D. FILKINS, CSTM03988 Civil Engineers i Land Surveyors 113 W. Walnut St. River Falls, WI 54022 DATE �3�9 �7 (715) 425 -7631 Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 t N visconsin Madison, WI 53707 - 7162 Site Address Department of Commerce OoZd �3fo jZ s� P� Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide 3 1 ra may be used for secondary purposes Privacy Law, s15.04(1)(m) Check if Revision I. Application Information - Please Print All Information State Plan I.D. Number 7 fr3 s Property Owner's Name Parcel Number �f Ale .�,� 0 1:(O Property Owner s '_ Address !� Property Location /G I / d (/ 0' Af /'` �U► �'`� 'k; S ( / TL �N, R! 7 City, State Zip Code Phone Number Lot Number Block Number qr q 7����� ? Subdivision Name CSM Number H. Type of Building (Check all that apply.) / n /, / Q, 1 or 2 Family Dwelling - Number of Bedrooms (S�e a �� )GYa ui t' O city O Village • Public/Commercial - Describe Use ownshi • State Owned Nearest R oad 5� nZ M. Type of Permit: (Check only one box on line A. Numbering is for internal use.) (Complete line B, if applicable.) A. New 2 O Replacement System 3 O Replacement of 6 O Addition to For County use System Tank Only Existing System B ' 0 Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of POWT System: (Check all that apply. Numbering is for internal use.) 44 O Non - Pressurized In -Ground 21PUMound �6. 7 X fo J S 47 O Sand Filter 50 O Constructed Wetland 22 Pressurized In Ground 41 Holdigg Tank 48 0 Single Pass 51 Drip Line 45 O At -Grade 46 OAerobic Treatment Unit 49 O Recirculating 30 OOther V. Dispersal/Treatment Area Information: 0 '7 L X 4 P71 0 —, Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate Tystern Elevation Final Grade C'73 Required Proposed Rate(Gals. /Days /Sq.Ft.) (Min. /Inch) Elevation � ✓ CorCi ✓ ✓ �� ✓ . ;> �2 ,? 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 mac! t � 1C VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's S MP /MPRS Number Business Phone Number Plumber's Address (Street, City, State, Zip Code) VIII. Coln /De partment Use Onl O Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) 19 Approved Owner Given Initial Adverse Surcharge Fee) Determination 0 3 Z s I L VZ IX. Conditions of ApprovalMeasons for Disapproval 1. Effluent filter to be installed and maintained per manufacturer's recommendations. 2. System may not be installed within the 10 ft. utility easement along the property line. 3. The septic system is sized for a 4 bdrm residence. A violation of the state administrative codes would be created if any modifications are made to the structure that increase the # of bdrms /design wastewater flow (see affidavit 1807/64). Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in she I - 1�ofia�' PAKKWAY 1 X S II �o 4 90 0 X Ec FAKK W AY t I �Q a PROJECT CUSTOM ONE HOMES PAGE 8 OF 9 Safety and Buildings 401 PILOT CT STE C ' WAUKESHA WI 53188 -2439 TD #: (608) 264 -8777 erc �sconsin www www.comm .wis c ons .wisonsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Acting Secretary November 06, 2001 CUST ID No.242514 ATTN: POWTS Inspector TODD C FEATHERSTONE ZONING OFFICE FEATHERSTONE EXCAVATING INC ST CROIX COUNTY SPIA 368 TOWER RD 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/06/2003 Identification Numbers Transaction ID No. 685967 SITE: Site ID No. 6 38325 Custom One Homes Please refer to both identification numbers, 332 St Armes Parkway above, in all correspondence with the agency. Town of Troy, 54022 St Croix County W1/2, S24, T28N, R19W Lot: 68, Subdivision: Troy Village FOR: Description: Mound, 4 Bedroom Object Type: POWT System Regulated Object ID No.: 818733 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10691 -P (N.01 /01) and the 'Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10706 -P (N.01 /01). In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approvalevditions. A Sanitary Permit must be obtained from the county where this project is located in eF requirements of Sec. 145.135 and 145.19, Wis. Stats. o RTC Inspection of the private sewage system installation is required. Arrangement r inspe F made with the designated county official in accordance with the provisions of Sec. 145.20(2, ' . Stats. FT R' TODD C FEATHERSTONE Page 2 11/6/01 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 obtained 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. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Julia a Lewis- Osborne POWTS Reviewer 2 , Integrated Services WiSMART code: 7633, (262) 548 -8638, Fax: (262) 548 -8614 jlewis@commerce.state.wi.us MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: COSTOM ONE HOMES Owner's Name: CUSTOM ONE HOMES Owner's Address: 7584 80TH ST COTTAGE GROVE MN 55101 Legal Description: El /2,S24, T28, R20W & W1/2, S19, T28N, R1 9W Township: TROY County: ST. CROIX CO. Subdivision Name: TROY VILLAGE Lot Number: 68 Block Number: Parcel I.D. Number: Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 SITE PLAN Page 9 SOIL TEST Designer: TODD FEATHERSTON License Number: 242514 Date: 10/233//01 Phone Number: 715 381 1704 Signature: Designed Pursuant to the 17 /Z Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81 o 40;` R re Version 3.11 (05/01) PaW f 9 oy" o�oF�cF Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83 -44-3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 600.00 Design Flow (gpd) 1.00 Site Slope ( %) 899.60 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.70 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 90.00 Dispersal Cell Length Along Contour (ft) = 6.67 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) c Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation (ft) 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) (e.g. 0.25) 2.00 Estimated Orifice Spacing (ft) = 6.82 ft /orifice 2.00 Forcemain Diameter (in) 65.00 Forcemain Length (ft) Does the forcemain drain back? Y 894.00 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 10.60 Forcemain Drainback (gal) ' 5.77 Vertical Lift (ft) 81.28 5x Void Volume (gal) 4.22 Friction Loss (ft) 91.88 Minimum Dose Volume (gal) 13.24 Total O Head Dynamic ft 57.67 System Demand (gpm) Y Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.00 1.50 x 1.25 2.00 x x 1.50 x X 3.00 2.00 x 3.00 x Gallons /inch Calculator (optional) Tre Tank Information iZ 1565.00 Total Tank Capacity (gal) W1 565 -M I Septic Tank Capacity (gal) 36.001 Total Working Liquid Depth (in) WEISER Manufacturer 27.`63 4"71 gal /in (enter result in cell B49) Dose Tan Information Effluent Filter Information WLP1000- "Dose Tank Capacity (gal) JZabel I Filter Manufacturer FZ7. 7 Dose Tank Volume (gal /in) A100 Filter Model Number WEISER Manufacturer Project: COSTOM ONE HOMES Page 2 of 9 Mound Plan View T 1/10 B . . . . . J Observation Pipe 3 — A I �. L Mound Component Dimensions A 6.67 ft E 12.80 in H 1.00 ft K 8.48 ft B 90.00 ft F 9.50 in 1 7.29 ft L 106.95 ft D 12.00 in G 0.50 ft J 6.67 ft W 20.64 ft 600.00 (ft Dispersal Cell Area 1 1256.44 (ft Basal Area Available 6.67 (gpd /ft) Linear Loading Rate 1 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 902.39 (ft) --► r..ff.. • H F 901.10 Cell 901.10 (ft) Lateral 900.60 (ft) —► — Invert Dispersal Cell ; 3❑ ; t Elevation E D - • \• \•\ \ \�\ 4�\ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \ \\ \\ \ \ \ \ \ \ \ \ \\ 4 \ \ \\ 899.60 (ft) Contour Elevation 1.0 % Site Slope � � r ° reotextile Fabric Cover Shading Key c_. Dispersal Cell See lateral details on 1❑ Topsoil Cap c ° 1.5 ft Page 4 for number, size, Subsoil Cap ti ' and spacing of laterals. �' ; ;.. Laterals are equally ©❑ ASTM C33 Sand � F h \ ® Tilled Layer 6 y 0.5 ft Typical Lateral "\ :+ spaced from the 5 r���`�Y` Ag v .." } ` > 5 distribution cell's ❑ ❑ 0 _��A centerline in the distribution cell (AxB). Project: COSTOM ONE HOMES Page 3 of 9 Center Connection Lateral Layout Daigram Force main connection via tee or Wass to manifold at anli point. Laterals are identical ( p 121 =Lateral iagram Here S ,L • =Turn- upwrballvslvor IE- X � IFsf2 ( rrt2�l Laterals kforce main of PVC Sch40 of as n out plus pet COMM Table 94.30.5 Holes drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.06 ft Lateral Length (P) 44.29 ft Orifices per Lateral 22 Lateral Spacing (S) 3.33 ft Orifice Density 6.82 ft� /orifice Lateral Flow Rate 14.42 gpm Manifold Length 3.33 ft System Flow Rate 57.67 gpm Manifold Diameter 2.00 in Total Dynamic Head 13.24 ft Forcemain Velocity 5.89 ft/sec Dose Tank Information Locking cover with warning label and looking device and sealed watertight Electrical as per NEC 300 and Comm 18.28 WAC Disconnect 41n. min. Tank component is properly vented n L Farcemaln Alternate outlet ocation diamete r WEISER Manufacturer 2 in. Cap acity 1000.00 Gallons _ T Volume 27.83 gal /inch A Weep hole or antl- Dimension Inches Gallons B siphon device A 14.63 407.18 13 2.00 55.66 C Pu mp off e levation (ft) C 3.30 91.88 895.33 D 16.00 445.28 D Total 35.931 1000.00 1 Dose tank elevation ft 3" Bedding under tank. r— 894.00 Alarm Manuafacturer ILEVEL ALARM Alarm Model Number �L 1 Pump Manufacturer IZOELLER Pump Model Number 1137 Pump Must Deliver 57.87 gpm at 1 3 ft TD Project: COSTOM ONE HOMES Page 4 of 9 i Center Connection Lateral Layout Daigram Force main connection via tee or cross to manifold at any point. Laterals are identical p e Lateral Diagram Here i= Turn -up mlball valve or I#- x —+x12 I xi2 +l Laterals & force main of PVC Sch 40 of es n out pl u g per COMM Table 84.30 -5 Hales drilled on the bottom of the lateral. Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 2.06 ft Lateral Length (P) 44.29 ft Orifices per Lateral 22 Lateral Spacing (S) 3.33 ft Orifice Density 6.82 ft /orifice Lateral Flow Rate 14.42 gpm Manifold Length 3.33 ft System Flow Rate 57.67 gpm Manifold Diameter 2.00 in Total Dynamic Head 13.24 ft Forcemain Velocity 5.89 ft/sec Dose Tank Information Locking cover with warning label and locking device and ' sealed watertight Electrical as per NEC 300 and - -► Comm 16.28 WAC 4 in. min. Disconnect \ r Tan component is properly vented y F— Alternate outlet location Forcemain diameter WEISER Manufacturer El 2 in. Cap acity I W LP1 000- Gallons Volume 20.27 gal /inch A Weep hole or anti - Dimension Inchb§ MVU B siphon device A #VALU I B 2.0 C P ump off elevation (ft) C 4. 895.33 D 1 .00 D Total #V UP #VALUE! I F Dose tank elevation (ft) 3" edding unZIer tank. F 894.00 � Alar anuafacturer I LEVEL ALA AM A ; ,U / -Mp rm Model Number LVL 1 Manufacturer IZOELLER Pump Model Number 1137 Pump Must Deliver 57.67 gpm at 13.24 ft TDH Project: COSTOM ONE HOMES Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name TRI CO SANATATION Phone 715 - 386 -2130 POWTS Regulator's Name ST CROIX CO ZONING Phone 715 - 386 -4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1565 -M gal Maximum TSS 150 mg /L Soil Absorption Component Size 600 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Freguencv Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Ins ect for ponding and seepage once eve 3 years Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished • .............. ................ Grade \ 6 -8" Diameter Lawn • Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral \� :>::: >:: >: >:! <' Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: COSTOM ONE HOMES Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01 /01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the fitter when removed from its enclosure. If the fitter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD5, 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg /L BOD 30 mg /L TSS, 10 mg /L FOG, and 10" cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: COSTOM ONE HOMES Page 6 of 9 .t W HEAD CAPACITY CURVE MODELS 1371138 MODELS 137/139 Ft. Meters Gal Ltrs. _ a 5 1.52 93 352 25 10 3.05 79 299 I:: J i 15 4.57 64 242 i ;r ] `i .. 4 "s /'^ 6 2c 20 6.10 36 136',�r;. - —+ 25 7.62 8 1 30 15 Lock Vafve: 26 V 1/7 NP1 4- - 10- r- 2 I 0 S. GALLONS 10 20 30 4G 50 60 70 80 90 100 110 f9s 90 160 240 320 400 0 FLOW PER MINUTE X9921 _I. I, �! ---- - SN373 CONSULT FACTORY FOR SPECIAL APPLICATIONS • Three phase pumps are available in 200I208V, 230V or 460V, • Variable level control switches are available for controlling single and three • Electrical alternators, for duplex systems, are available and supplied with phase systems. an alarm. • Double piggyback variable level float switches are available for variable • Mechanical alternators, for duplex systems, are available with or without level long cycle controls. alarm switches. • Over 1307. (54 °C.) special quotation required. • Simplex Panels are available for 3 phase pumps. • Refer to FM0806 for 200° F. applications. • • Control alarm systems are available for 1 phase pumps. t37 Sante - 47 lbs. 139 Seri - 51 lbs. SELECTION GUIDE Sing" Seal_ __ Corsrol Selection L s 1. Integral float operated 2-pole mechanical switch, no external control required. Model volts-ph Node Amps Simplex Du Isx _ MA UL M137/139 115 t Auto 10.7 1 or 1 s 8 _. y Y 2• Single piggyback varable level float switch or double piggyback variable level N1371139 115 1 N on 10.7 2 or 2 6 7 3 or 5 & 6 Y Y float switch. Refer to FM0477. aN137 115 1 ---- Auto - -- 10.7 -- Y Y 3. Mechanical alternator M -Pak 10 -0072 or 10 -0075. Refer to FM0495 D1371139 2 1 A uto 5.6 1 or 1 --8 -- Y Y 4. Simplex three phase control panel. Refer to FM1228. &8 E137 i139 -------- 230 1 Non 5.8 2or2 &7 3or5 &6 y y H137i139 200208 1 Auto -- 6.2 1&8 — Y N 5. See FM0712 for correct model of Electrical Alternator E ._. - i • 11371139 200.208 1 Non 6.2 2 & - -- 7 3 or 5 & 6 Y N 6. Variable level control switch 10 -0225 used as a control activator, specify duplex - - - _J1 31l139 200.208 3 Non 4... F137/13D 230 3 2.6 4 364 ors &6 Y Y • Non 2.6 4 Y -- (3) or (4) float system. 3 &4 or 5 &6 Y 6137 I 460 _ 3 Non 14 _ 4 3 &4 or s &6 N t 7. Four (4) hole J-Pak, junction box, for watertight connection for hardwired GIN 460 9 Non 1.4 4 3 &4ar5 &6 N N_ simplex operation, 10 -0002. • No molded plug "single piggyback swatch included. 8. Two (2) hole J -Pak, for Watertight hardwired Poonnection or splice, 10.0003. Pumps must be operated in upright position. CAUTION Three phase units require a control switch to operate an external magnetic contactor. AG ins;Wa 11 of cor*pK pmWcdm devi e6 and yyidng should be 0011@ by For information on additional Zoeller products refer to catalog on Piggyback Variable Level F',oat a qualified licensed electrician. All electrical and safety codes should be Switches, FMO477; Electrical Alternator, FM0486; Mechanical Alternator. FM0495, Alarm Package, followed including the most recent National Elill Code (NEC) and the FMO732; and Sumy3ewage Basins, FMO487. Occupational Safely and Health Act (OSHA), RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. • MAR To: P.0 sox 16347 Louisville. KY 40256-0347 MerxAacfurersoJ SHIP TO: 3649 Cane Run Road ® Louisville, KY 40211 - 1961 !1 n ►►ttp : /iwwwso.lbr. corn (502) 778 -273f • 1(800) 92a -PUMP Q�eun PGx sae Swe /999 FAX r502 774-0624 - PROJECT CUSTOM ONE. HOMES PAGE 7 OF 9 ' � R 1 s �N N tFs PAKK W AY y Tr d t X f ee-el f 7v i �` �47� 41-0 s� n l o 'loo, o G 1 6 y w q. 40 2-43 KK WAY PROJECT CUSTOM ONE HOMES o . r PAGE 8 OF 9 OCT -10 -2001 13:42 CONTINENTAL DVE_P CORP ?63 ?5? 2532 P.02 %05 V yconSir• 0e0a,rtf — Of inouh —, .7 v t r- 041 -all �. • ^ - � ^ •� - - I a r s.`* HUMaA Reladans N, D slan a t S:re+Y a e ,xtangs in accord with ILHA 83.05, Wis. Adm. CoCe c;OU � 1 Attach complere site plan on paper net teas than it 54 112 x 11 inches in size. Plan must include, but PARCEL LD. a not limited to vertical and horizontal reference point (8M), direction and %of slops• gals or dimensioned, north arrow. and location and distance to nearest road, REVIEWEDBY OATEi APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTY LOCATION Jotaa AR6AaA► ' •T�• A rS RL �"I'�1 z.L� >:,4vx•.;4= W wYzyts 19 T ZS , N R 19 w PROPERTY OWNERS MAIUNG AOORE53 LOT a fll OCtt z SUED. NAME OR GSM + ? C T. t4. K 66 — - rez Y V UJ�6c CITY, STATE 71P GOOF PHONE NUMBER OCITY 011ILLw,;- TOWN NEARE5T ROAD 4- %A CSoN wo t � hrS). � z90Z Y �' µ New Construclion Use Dy Residential I Number of bedrooms 4 -- ( I Addition to existing building l Replacement ( I Public or commetad describe Code derived daiy flow 6 r71 t ]_ gPd Recommended design loaning rate 0.5 bed. gpat 9pdM Absorption area required 500 bed. n2 600 Venc t. ft Maidmum design loading rate _,bed. 9pd/ft g Mtch. gpdtft Remmmended infiltration surface elevation(s) nggMM t Ah war Y . t ( a s sr lea to site plant benchmark) Additional design! site considerations Parent material . Sk++LQ�tO�>~ j GLA4- AL -nA 3- — Flood plain elevation, it apRtitabte M Pr h S a Suitable for syst CCNVEtdr10NAL 0 IN•GAOUNoFIRS5sURE AT•GRAD SYSiEv w F'fi L HOLDING TANK U. Unsuitable for swtem 1 a s U al S 13 u ❑ S U ! ' a s M 1 ❑ S ga U [3S O U DESCRIPTION FIEPORT Depth Dominant Color Moales Texture Structure RootsG QOrtt Bonn # Honzon z,ContCoior Gr. Sz. Sh. I 1 T� 9 Munsail du. S 1 in. 4 rt �... z L!6 Z rr,:; 1< Ground 3 I I 3 1 u I <' ,d y u I 1 r-A st i �r C 3 1 P! N Vo I sw lf. y �: u 3 1 r ` I ► mob C. l I 1 Depth to $. G , v t , f ~ "j Li VJr �,r" 1 I cr lo J I 7pa I l l I I ! 4 i Remarks: HIM ` ti a ras' - �.,rt> zt►a t4 u Acs Boring s► `` 1 5 Cr f ( •.0.� ( O- to v 2 /z. MIT f, 451: 2- Z� !d v mShK M•�f I I -� •'} ' Q•7 Ground I 0 . g e1ev. q 7. Y 3I Z I Mab M4 ; G p s -yy I 3 ILV �t"It�� t o W 1 I ti, rn to ll� q _ >< "� /y v •� u S m Sk1 K factor Remarks: -g , , c nit Ida to h 5 W ef%K W AIDS, . ,N7¢ + 3h Phon F S e: ST, lJ�!� 1r -z,t: S + �Z02?� Oan/�. 2 z, / 7 CST Nsnser 1/ all f(7 GV n101� 14Q1 Z"7 n'7 HOMES 9AOF9 •, ' OCT -10 -2001 13:42 CONTINENTAL DULP CORP 763 757 2532 P.03/05 PyOPEATYOWNER '/�iY1MrLF T9µ SOIL DESCRIPTION REPORT PUP L?,Of � PARCEL I.O.8 O I Dominant Cola► MOMS Texture I Structure 1 18wWrY I Rants GPO/ft< Banng # Horizani in. MunseU Ou. Sz. Cont. Cola I Gr. Sz. Sh. I Bea -Try Mlbf MILL/ IS z L3 .22 I� !43 f 1 m`.biC - 0• Ground -2fe l0 K `-r A `5 ` C S 0 1 CIL. . tL 4 2-60 t o 3 �, � s 0 -9 a .5 O epM to iimiting I lactor Remarks:_ Boring # }} 4 _ f �-10 ov 1 4 7 1 ! l5 I � I r CS . 0, Z. .� lov �lu 6.7 6- Gratin I m� II 4 .-? 1 9 Gratin 4 - �4 c�� 31 � .. 1 .. 4 m i Q J 1 { 1 Depth to remarks: -1±Q ►.1 W R O OSL" ��AAYTE -- Baring 9 I I I Ground Nev. Depth to I I l I I ( Remarks: Boring # 4 Ground I elev. � I Depth to I I lacct7r E l I I ( ( F9 I ( PROJECT CUSTOM ONE HOMES 0 0CT -10 -2001 13043 CONTINENTAL DULP COPP 763 757 2532 P. 0•:% PLOT P�,A`I Legend: : !� yon Fred YJHEKS property owner _4Z�1EN�M�LC .Ua Legal Description L4TbB TfZD*"f gM 0 Top Or 60 PENp Okl-- VILLA c C r►' IN It+5 V- 112- - 4 C- LZYfM0A1 Z49.7y T 4AJI R7 W % / 2., 51q, TZ$N R1gW� ❑ soil baring w /backh, 7QVJ.J of T(oq ST.Gswlx CoUATY w1-r (ft1JC�L�S ar LDT A-ce p q5:- I u,4. El M I4F�S w11 U' u F 14C�wCACy . EL Q° 1 LOT $ cor csc ❑ -y5 V1 EL 799. w l L� a - y53 40 O K goo_ 8-4-Ti F.L Y99.0 ~- L f __.. EL Q49. bD A2;<04 Y }{buSF -TO 2,5 09 ' IF ,E,�S r 5' ac GW W -ro 50' Ott Cac�'►� S ig:iec CST 25' 0c. br. =:''� � F+�^� S�atK TiW t; 0:!V70? Date ?' 4b �M+•1P�EL4 - 10 $L 5' o,ccrtEt ,Qc�/ /�A�• Z y, /99? PKhPi5CN UAIG scgna - TAlV L - ZF5 Z' 0 e 00 UAJE PROJECT CUSTOM ONE HOMES PAGE 9C OF 9 'rswr,,,i:' Deportment of Industry, SOIL AND SITE E V A L U A T 1 O N REPORT Page I of -37 14bor s and Human Relations Division of Safety & BUldings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 ' n size. Plan must include, but C not limited to vertical and horizontal reference point i ibr a 1%, slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and dista o rdad., IE7 DATE APPLICANT INFORMATION - PLEASE P o�l1LL I j ATIO ..,� PROPERTY OWNER: -1 � r � �? ,PR ERTY LOCATION E Z� .S Z 2 ZO .10144 AK6AAA ' Tl�firs 1Z MM�tt 1 wY s 19 T ZS N.R t9 W PROPERTY OWNER':S MAILING ADDRESS _ v Cp lyg> ; iLO # BLOCK # SUBD. NAME OR CSM # ZOO C.T. t4. F / k 6 — Tiez V V I t.L1 CITY, STATE ZIP CODE 4 E N ITY QVILLAGE OWN NEAREST ROAD New Construction Use pC] Residential / Number • , ' ( ] Addition to existing building L I Replacement [ ] Public or commercial describe Code derived daily flow 0 gpd Recommended design loading rate 1 3.5 bed, gpdtgaa trench, gpd/ft Absorption area required 500 bed, ft 600 trench, ft Maximum design loading rate 1.? bed, gpd/ft 0. $ trench, gpd/ft Recommended infiltration surface elevation(s) is tQe IR M w'=T 4 7 , ft (( aarefferr re ed to site plan benchmark) Additional design / site considerations — v Parent material 5A- wD39O mQ' GLAD AL - 'nL.,- Flood plain elevation, if applicable Al A• ft S = Suitable for system CONVENTIONAL ND IN GROUND PRESSURE AT GRADE SYSTEM IN FIL HOLDING TANK U= Unsuitable for stem ❑ S U S❑ U [3 S U ❑ S O U ❑ E U ❑ S W U DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Co � Roots GPD /ft i<(W in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench I 15 rnZ6Y, rh 1; — ,$ 7- _ 3 J3 -- 1 rn S I r�n�r cs - (). Ground 3 3/ Gld y 1 C elev. I g94�ft. 4 _ y 3 t mSbK le C. p Depth to _ 3 t?" L W 1 limiting factor Z � „ Remarks: kAOKAZOA "S 15 ALMMT SATVKA "TED', 4tf 1 4 N>Ae \AMAKLY 0EMTsA Mn Z Ye mod% Boring # 0- to v — 15 1 s rn\j Lr — d. 0.9 451 < z SbK rr+ Ground 3 - 10 3 14 15 1 m.S nn ;r — 1 e l ev. Oft _ 9 7.5y 3 /z. C 1 1 N\Sb M� 1w} 0. . 0.9 5' -44 3 Iuv �Wto t o �l � 5 � 1 b M; P Depth to 0 -2 d limiting b _ ' 3 /y K y S� mSbK Y' 2 rt Remarks: PMC 2W y s5 WVAxu/ 1FMEgrFmi 4ortzf3AJ 6 Nh5 WeAK01CAffiTroftQ - 2aVlf -V2 VA40 CST M air e, : ase Print Phone: 11S - 1? Address: b� •.�. ST ik r- L5 54oZZ Sign Date: Rk • I"-oW-z CST Number: N01 , 19Q I 7, 707 PROPERTY0WNER 'a MMES -F, "SONnI SOIL DESCRIPTION REPORT Page _, of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounckvy Roots GPD /ft ..cw in. Munself Qu. Sz. Cont Color Gr. Sz. Sh. Bed Mmnch 1 6-13 Iti Z — - 1 rr5b 0.S - . . 7 -a I 13 17- lbvk V3 — 1 1 m 4w yy\;Y - 1 -i Ground 3 z, - iwy K 1 4c4 1 S YT4 S - 017 Al I elev. Sq4�` ft. 4 mob- IOYK 3 U i S1 I rv+.�bK ,nn r Depth to limiting factor Remarks: 5A-� MM we yQ Boring # 1 0 -10 10y K z4 -" 15 r CS — 0.110 L 0 3 3 1 vrLhK MVAY _ ' O- g , Ground o -1 — Is I m3 K ri. f Y aw — 0.7 0 g elev. Q t70. o ft. Depth to • '34- 10 \1 K-6 It o S1 1 rn Z. X r OJ4 0-T limiting factor Remma`r7cs: H tA�I 4 W6a+ciy �tdM►�, p Boring # :> Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: _ _ PLOT PLAN Pag of Property Owner 'RkA.E.MAAGLL= Legend: III- 4i00EX NIOTED Legal Description LOT 68 'Troy BM =(%) TOP OF 60 PENNY MO IL R-A &A&M VILLAebF. (�Cf4TEO I A) TN-� E�VZ Ste_ Er J 119. - 7 r�tl q9'9. �y ' TVA K � N%1 514, TZ %N R14hJ� ❑ = soil boring w /backho Tow,q OF - SOY ST,CRO►x COUJUTY� Wx (P(W.I1C-5 or Lo - " - AIM �PPRo�C•� Su�VEy M APS PCAL u n- cc.wtacy. GL g9q.7y l' l I LOT % y 69 p I ❑ 8 - 45 2 'n EL 4'99.4 cw - ❑ g -453 I 50 19 900. v I A0 I � s -4s'r EL Y49.0 E� 449. b0 rFA2K04 Y }{OUSE 1'O 3E : f0 W /O,E UT /L / >Y 25' OR G�TIrK F�COM u�Fl�►FIEW ,Er9S�/ylEi!/T 5' OK G � FKD,01 SepneTAWK, T o Be 56' o .4~ - r a FRDM wF1 25' oc d rM71M& FOM ss+Pr+c TA�+JK Signed CST fA O 3707 ICAAM1PI LD - M 3& 5 00c-CEArttit Date MOM. ZS 14% Few P+ PECri UAS ,ee� 1H,e- Z -7 , /997 Sugn a - TAN X - M ISE 2! OK F'IGAM. pa uNE- 4 Y � ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwncrAhyer Mailing Address 7S �° ►/� Property Address 3?�)2. A11 m s Y a o i� U ry l& (Verification required from Planning Department for new eonxkuc ion) City/State G S D v, I /1 iS Parcel Ideatification Number jAgAL DESCRIPTION .F- %- Property Location h %,, Scc. - Z 5+ T � ° lei R Town of TR© ,A" '� ZS� t2(q w rta fir, of TYLOLI Subdivision ` - r& L 1 V �. n��. - _ Lot # CutMed SmTey Msp # Volume Page # Wterraaty Deed # ZS Vownw — h , page # Spec h(mm g yes ❑ no Lot linos identifiable ❑ yes Q no Pa Ndmainteummofymnptksydemco kids tin its, Wit- tohsn Wastes.Ptnperaushecasooe eocsiett of punipigg oat the Woe tank Bray dm ]►ear: or sooe,ey if aeodod by a kensod pumper. What your put into do system an affect tie fimcdw of tiro septic tank as a hntm w stage is die waste dos wd system. no prnperty owner agmes to submit to St. Cro"bt Zed Dep:ttmtnt s wgtafiationfatm, signed by the ownet and by a . �' p�33► �PiratsietodpTvmber�: lioeasodpnwpecvadyiag> �( Ijdreon- dtesesstaivatcrdispvsalsJst�em is is ProPa QPc=tin8 condition and/or (2) after icispoc6m nod p (i f y). the sepfr tm*.is leas than W Iutl of sludge. Vwc, the andecdsood bavt read fire above regnuemenu and agrm to mahenin the pcivata sewage disposal system with the somdaids set foadh, betein. as set by the Deparownt: of Commerce and die Depark a at of Natural Rmacm State of Wiseoarin.. Caftation 4 atigg that yepr sgPde cyst :m has bear mast be convicted and retomed to die SL Cwk County Z.oedrrg Offioe widdn 30 days of die fimp DATE �CERTrFICA O I (we) certify that an stn OR this fora are We to ttie best of my (our) i®owlodga. I (we) am (are) the ownet(s) of of a anaranty decd reCOr+dod is der of Deeds Office. (ANA )U OF A DATE infO� that is m h4 pc wvkdmay result m die utdtary lmnk being IM49ced by the Zoning Dopactzi=L ii Iadade Kith this applieation: a stamped warranty deed from die Ragi W of Ooods offree a Copy of the certified survey cup if r state is made in die warranty deed CO JIrdENTRL DEV CORP TEL NO.757 -2532 - Sep 01. >0 2 39 P.02 i 1 1 1 ST CRyIX COUi•Nff S131''17C TANK MAINTENANCE AORBEtABNT . AND OWNRRSI-11P CgRTIFIC AnON FORM Owner /13uycr" _ ( om e c G — Mailing Address _..._....---- •— _�_.. - - -- — f -- Property Address _ _T :.._7 WS � � — (Verification required from Planning D�partrnmc for naw oonstruatlosi) City/State — _. _ -•— Parcel Identification Number _ LEG ULSQUY"11 �y � Z-4). fi z�►� t�zow ��? Y Z , Property Location ' _ w ' ' - W, Town of Subdivision . Lot Certified Survey Map-#-,_ � Volume . .Pago # Warranty Deed # Volume Z .�, Page # y Spoc house �d yes ❑ tto Lot lines identifiable j2f'yes ❑ no S YSTLh1 MA1 N_f_NNANC:I:1 Improper use and maintenance of your• septic system could result in its premature failure to handle wastes. Proper maintenance oonsists of ptunping out tlte septic tank every tlu•ce ycros or sooner, if nocded by a lieodsed 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 agt= to submit to St. Croix 1,,o Dopartmoat a cettISeation ioipa, toped by the owner and by a master plumber, joumeyma n plumber, restricted plumber or a Ucensod pumper verifying diet (1)1bo on -alto wastewaterdisposal 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 eludge. I/wc, the undersigned have read the above requirements and kgree to maintain the private sewage disposal system with the standards srt forth, herein, as Ice by the Department of Commome and the Department of Natural Rosotrroos, State of Wisconsin. Ceriiftcatiou stating that your septic system has been maintained must be completed and returned to the St. Croix county Zoning 0Moe within 30 days of die tierce year expiration date. SIGNAII)XV Olt AI'1'LWAM' DATE O) NSR CERTIFIC 1 (we) certify 013.1 all Statements on this than ate true to the best of +my (our) imowledge. I (we) am (arc) the owner(s) of (he property described above, by vinuc of a warranty deed iecorded in Ptegitter of Deeds Offloe. /C Ifolo SIGNATURI'. OF AITLIC:,AITF - ._.....r DA17i 0004 Any information tUt is uiis- represented may result in the sanitary permit being revoked by the Zoning DepaMent. 0000 °• Include will, this application: a starryxd warranty dood tt+om the Register of Doors offioo a copy of the cettified sptvey trap if rt (coo a is made in tbo warranty deed r �nl 1807PAG 64 667146 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI Document Number Document Title RECEIVED FOR RECORD St. Croix County 01 -03 -2002 2:30 PM ZONING AFFIDAVIT Occupancy Affidavit CERT FEE: COPY FEE: 2.00 -r�� �},� l TRANSFER FEE: "'F V� PM t `� T- �' © F — � RECORDING FEE: 11.00 PAGES: I Name — (Owner) Typed or printed being duly sworn , states, under oath, that: 1. He /she is the owner /part owner of the following parcel of land located in St. Croix County, Wisconsin, recorded in Volume Page . S Document Number Croix County Register of Deeds Office: Recordin Area 1 Name and Retu n Address A parcel of land located in the 1 /4 of the _ '/4 of Section s� �/c �� pS/nA- T ?.� N — R 2d W, Town of -]� , St. Croix -7S 6-t, 01 � County, Wisconsin, being duly described as follows (include lot no. and Cam/' 5 VM MN subdivision/CSM or detailed legal description): �'� � 8 -T� V . v lz S �; T2 ICI , R 2D w t,J /Z C , T z8N n Yd - /,,? S a - � D -- d'c�0 l� 3 - 1 - 0 w N OF - rnO� S1 GP-©t X CPU N - f, Parcel Identification Number (PIN) As owner of the above described property, I acknowledge that the septic system serving this residence is sized for a bedroom home, or a design flow of &CO gpd. The design flow is calculated by assuming 150 gpd for 2 individuals per bedroom. There are currently _ occupants living in this residence; _ occupants are permitted based on the design flow. Therefore the septic system serving this residence is code compliant. However, I understand that if there are intentions to exceed the number of permitted occupants, the system will need to be modified to accomodate any increased wastewater flows and /or contaminant loads. I also acknowledge that I will make this information available to any future parties interested in purchasing this property. Dated this day of �� 2 o C � . RICK A. JOHNSON NOTARY PUBLIC -MIMOM G�fffl � ' S. GOOD W COMMISSION EXPIRES AUTHENTIC ICAN r.CKNOMUPLEDGMFNT Signature(s) STATE OF WWWAMM ) AA 4 n y% Q S o V a Ano Ko )ss. authenitcated this day of Strom* County. ) t� Personally came before me this day of ' k 9 <- 3 QC 1 the above named * C 1n��1 -es 5• (IDOIC. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Stats.) instrument and acknowledge the same. THIS I STRUME T WAS DRAFTED BY AA Notary Public, State of Wisaeasin ►M�hv.� 5vi-w (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. If not, state expiration date: necessary.) Date: / - 3 / - O�- "THIS PAGE IS PART OF THIS LEGAL DOCUMENT - DO NOT REMOVE" This information must be completed by submitter. document title. name & return address. and PIN (if required). Other information such as the granting clauses, leagal description, etc. may be placed on this first page of the document or may be placed on additional pages of the document. Note: Use of this cover page adds one page to your document and $2.00 to the recording fee. Wisconsin Statutes, 59.517. RIVER VALLEY ABSTRACT Fax :715- 386 -7664 Jun 6 2002 0842 P.02 r ' vol. 9 845PA E 484 ��, y HALM STATE BAR OP WISCONSIN FORM - Ippa 1I TA "I 'ITfi$ OF DEBDg WARRANTY DEED 97. CROIII Co. MI DOMEW4 worm. J?=81 YED P09 9=MD This Deed, made ber an '2Sa? 11 a 39 AM t rat on, a M nrtaeota Oo rat on E """ • end Hike Rvtth 1aA 7n -- Cant 7 W PBIE: 11.60 T P 1 Me 239.70 pF F1Se Cr es eetal0 M ter. k wh r a ra Cranae. dexrl0ed r e s t elo eonrtdmtbn Wfl%Vs and warrents to Grantee the Ionowing �. Crp�x Cotrnix State of WOsoomm. { Lot 68 of the Plat of Troy Village let f Aaditioe► in the Town of T _ • - -.::-> r �-�:,� ,' Nisconain. r Q 1 '• �. Cmix Oounty, "r^'"m�+asame N Mike Rygh Homee, Inc. SuWOct to Declaration@ of Covenants, Cla on nditie and r'eet South Pe Page for Troy Villat2a, recorded in Vol. 1241, Cottage Grove, ?4m 55016 G Paget 236, ae Doc. No. 359964, and the Declaration of Golf Coura� cove rants, Conditions and Easemmte, C�., -` � , recorded in Vol. 1241, Page 301, as Doc. No. 599469, C.. all as appearing in the office of th 9 for 9t. CtnLx Count Register o! Dsede 0 1250 - - 000 d Y Count Niaconsin, and Such other rote eaeetetettt8, restrictions and reservations of record, flue 1a not to 1n use, and the "Auger" obligations contained in '--- }hOmu,eedP the Purchase /agreement for this lot. Ua UsnoJ I \ i 11 ti BwApdom to warrenove Dated this 27th wyol PebruarY 2002' 'I REAL) � • Charles S. Cook, Prseidant Troy Dewlopnent Oorporation PEAL? (SEAL► AUTHENTICATION ACKNOWLEDGMENT 9tenetu,:W Minnesota State of Wtscee.f,,, y. Anoka tuthenUryud this ey, of tltY 00 �Ool r.-- YC Pit day of Ctwrlaa S d.,t t obey. maned t • Trov Dwya-123m— t Ooroorktian L TALE. M$MBER STATU BAR OF WISCONSIN suewwd me known to be the person _•_ who ottet:uted the fore ro by 4' OO, W0. $1&12J kt ledge the sera@ euumant and adutow � t Of nor . a Wit OWTED BY TROY DEVIMOPME" CORPMTION • hick A. Johnson Ij Charles s. Cook, PresidentNotary h,bbc. Stete.ei{1 *m"mAn0ka count , IW rimy b0 awheretneed or aekrowW` Bosh ere not 61y CO�ntw b1Y 3l taanent Qf rot, auto Minn. 1t'plgdm da w 1� tae, r, ah. ae. w. wwwrra4 ,wwa.�+w- pM,era.a.tnw,w.twa. j ZRIArm DE40 "TAT" l ie /M. a - ypj k epat P=- w ommw .NNIU1IRY?I. JOOB /l _ _ r S fA IT ItAR OF '1'ISCONSIN FORM I - 1982 199i j WARRANTY DEED Document No. VOL 1 ?41 pm ?54 This Deed, made between ^_� ST. C. ..1 —` John 1 Ruem and Barbara .4 R uemm.•t, his wife and Thon____i __as 1. #Wd Q m — Ruc m and Nell L. Ruemele h' w' e - - -- - - - 'MAY. 2 7 .09 - - -- — --_- - _.__ ,Grantor. and _ _ -- — J o � O' A i' Development Corporation _ ` — ` —� r �U. — -R 5 PM Iflrytsotr a oa.ur — - -- Grantee, Witnesseth, That the said Grantor, for a valuable consideration -._ This space reserved for Rewrdmg Dm NAME AND RETURN ADDRF is conveys to Grantee the following described real estate in _ St. Croix County �� A County, State of Wisconsin: (Parcel Identification Number) Lots 1 through 45, Lots 47 through 6" and Lots 68 through 70 o he Plat of Troy Village, St. Croix County, Wisconsin and that portion of Outlot 8 of the Plat of Troy Vi h+tfir A attached hereto, and Ow lots I and t P 3 o the Plat of Troy Village, St. Croix County. Wisconsin ---- I l: A portion of the above described property is homestead property of the Grantors, John J. Ruemmele and Barbara A. Ruemmele. (is) (is not) Together with all and singular the hereditaments and appurtenances thereunto belonging; And grantors _ warrants that the title is good, indefeasible in fee simple and frtr and clear of encumbrances except I casements, covenants, restrictions and hig h way t gl way rights of way of record and wdl warrant and delrnd the same. Dated this — — 4 J i day of 19 - C � � ✓Y+�� (SEAL.) % • } hn J. R mel ' (SEAL) Thoma . R emmele :t-E f, � t4 �_� � • fc i l� � (SEAL) /, --�-Z.^-- ..+�- � {.SEALI Barbara A. Ruemmele ' Nell L. Ruemmele AUTHENTICATION ACKNOWLEDGMENT Signature(s) John J. Ruemmcicand Barbara A Ruemmele his wife and STATE OF WISCONSIN ) _ Thomas J. Ruemmele and Nell L Ruemmele his wife ) ss. authenticated this -& JJk of Ma , 19 County- ) - -- Personally came before me this day of — .19 the above named •_ Samue R. ari _ TITLE: MENtsu's f TE BAR OF WISCONSIN (If not, authorized by 5706.06, Wis. Slats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Heywood & Cari S C Samuel R Cari • 204 Locust St. , P.O. Box 125 Hudson WI 54016 _ Notary Public County, Wis. (Signature: may be authenticated or acknowledged. Both are not My commission is penman. (If not, state expiration date: necessary.) •N. of persoro signing in my capacity should be typed or primed below their signatures FOicAd No 1 -1982 a I I Armemwd I I PAV51' EXHIBIT A A parcel of land located in the SE -1/4 of the SW -1/4, the NE -1/4 of the SW -1/4 and the NIX- 13 of the SW -1/4 of Section 19, T28N, R19W, Town of Troy, St. Croix County, Wisconsin, described as follows: Commencing at the South 1/4 corner of said Section 19; thence ri00o19'39 "E (assumed bearings referenced to the North -South 1/4 Section line of said Section 19 which bears N 0019'39 "E ) 1305.22' along said North -South 1/4 Section line; thence N89o31'29 "W 660.36' to the point of beginning; thence N89 "W 637.26' along the North line of Lot 4, Certified Survey Map, Volume 4, Page 993, Document No. 366634; thence S00o04'41 "E 298.00' along the West line of said Lot 4; thence N89o33'26 "W 24.04'; thence Northerly 211.84' along a 1533.00' radius curve concave Westerly whose chord bears N04a26'28 "E 241.58'; thence Northwesterly 176.98' along a 433.00' radius curve concave Southwesterly whose chord bears N11o47' 14 "W 175.75'; thence S89 ". 1 9"E 678.56'. thence S00o14'07 "W 114.75' to the point of beginning. This parcel contains 1.808 acres, more or less, being 78,756 square feet, more or less. Subject to easements of record. The parcel shown on this document is being added to the parcel shown on the document recorded in Vol. 4, Page 993, Doc. No. 366634, de-rribed as Lot 4, Certified Survey Map, to create one parcel, and this transaction is thereby exempt from Chapter l8 of the St. Croix County Land Use Regulations pursuant to Section 18.05(A)(3). A N011'J�S */l HinOS —HINON ,8l'ILZ9 3 ..6£ ,61o00 N d w 'k ° N N tp S . b 'd �.r 0 e p Ki O� Z N N O Q Z N N r ,6 _ _ _ _ _ 1,00 10 00 0 W �. �v ►. vj 0 / N < I� �� C� INI� .N I �� !s Q'.` r r, 'll � �`� E `"• I M ..00 ,000£0 N I J , W I I S 07 °00 00 u: I - !! : k ' , 309.18 cn �+ 'O w IN ^ N Q 3 CJ ` $ 1 L4 W �°Sg Q �e ^ o _ coo N $ ! $ 0 00 - (11 ,p 1 e c0 1 O M W1 N Ip J N ,ZS'96£ M 0190 ,Z1►o£0 N 1 1 v 1 Q ,6£'LSl £l'4lZ N , L6'L4Z , W vi 5 3 00 , 000£0 N �y 6 N z W 1 I I p v f� W ei 1 �.1 I N O N w 00 CD (O ._ N 1 VII I ) I N Q CO ^� ^ � �'�` � $ O 00 3� I � 0 00 L4 O 1 l0— --�= g •f 7 r1 LO 00 Z'86 3 Il0 D I `� G�'9 I ` 1 U') O M - g :9� -�__ z N v t $6 3 „ 00 ,00.9 S M , 00, SI (0 `,rs Q' �FJ ' o t°D e W 08'£8 8�"S��`' : G� S , 3 t 00 �` U „00 1000£ S 1 : j O "a g. Li (0 p w a $ $ I Q, •.t via �n c g N 3 ,.00 ,OOo 0 I r ` r I Q e to.) N Yr M� eW � ! 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