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HomeMy WebLinkAbout040-1252-60-000 sconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix safety and Building Division INSPECTION REPORT Sanitary Permit No: •, 430088 0 F GENERAL IN (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: Peek, Max I Troy Township 040 - 1252 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Y jW 5*tk - z , 6 Section/Town /Range /Map No: l o p (� / �'Lt v E L �� t. LJrrte /A� Sur��K� 19.28.19.1327 TANK INFORMATION EL VATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM _ rVAnd -` 4 I Aeration Bldg. Sewer Holding '� St/Ht Inlet 3� pry l v y (� TANK SETBACK INFORMATI .'NfN'�J � 6 t/Ht Outlet �� TANK TO P/L WELL BLDG. Vent to Air Intak ROAD Inlet / Septic, 1 / � 0 I ! � Dt Bottom / Dosing "1 eader an. Aeration Dist. Pipe 13 , 0 Holding Bot. System 7 C ,L PUMP /SIPHON INFORMATION Final Grade fiM� n I •� Manufacturer Demand St Cover GPM `4 yt - 7,s Model Number TDH Lift c oss System Head H Ft Forcemain, Length Dia. e T.- OIL ABSORPTION SYSTEM BEDf ltl!"CH Width 7 Length 7 No. Of Trenctt s Cf 5 PIT DIMENSIONS No. Of Pits Inside Dia. ILiauid De DIMENSIONS •"1 q 3.3 15 Q SETBACK SYSTEM TO 1 P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION . CHAMBER OR Type Of System: / �,� j n �" UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length `n • l Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center — Topsoil ✓ _ Ye ['] No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 /81 / D 5 P m Location: 287 St Andrews Dr Hudson, WI 54016 (NE 1/4 NW 1/4 1Q42 R19W) Troy Village 2nd Addition Lot 76 Parcel No: 19.28.19.1327 1.) Alt BM Description = I�� /ti�j6trt. sc�rcz 2.) Bldg sewer length = �R "v� v `fV f7 o� s amount of cover - i�,� Jul ✓W �-� W J Plan revision Required? rs de for additional I Yes No Use other information. � 01 -O� � SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division Comity �� 201 W. Washington Ave., P.O. Box 7162 Vvisconsrn Madison, Wt 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266 3151 Department of Commerce y3 PO N State Plan I.D Numt)er Sanitary Permit Application In accord with Comm 83.21, Wis. Adm. Code, personal information you provide may be used for secondary purposes Privacy law, sl5.04(lxm) Project Address (if iflerent than mailing address_) 1. Application Information - Please Print All Information 2 ��JrrT RECEI � EQ Aa -0'AAd Pr rt Owner's me arcel # 1AA # Block # 3 ri� �x e Pr rty Owner's Mailing , Ad dd dress y Lacation /S� -Vww Pi S ' ..)!k 00N � � rri y Ad /., Section City, State Zip Code riawwo! �L / /� &Circle ) �3� (� T N; R�E o� 11. Type of Building (check all that apply) ubtiivisiar►Naate CSM Number Y or 2 Family Dwelling - Number of Bedrooms ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use T ❑City_ ❑Villageownship of 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' N El System ❑ Replacement System Treatment/Holdmg Tank Replacement Only ❑ Other Modification to Existing System H. Permit Renewal El Permit Revision [I Change of ❑ Permit Transfer to New Flist Previous Permit Number and Dare Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that appl kNon - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter Chamber El Drip vel -less Pi ❑ Other (explain) V. Dis ersaVrreatment Area Information: , Design Flow (gpd) Des 7Gallons on e(gpds0 Dispersal Area Required (sf) Dispersal Area Ptnpos sf) System / V1. Tank Info Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons of Uni ts � ( / � Concrete Constructed Glass New I Existing Tanks Tanks septic vFiiehdiorii4n4 ODD ,FEW/ Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement - 1, the under ned, a ponsibiJ1ty for installation of the POWTS shown on the attached plans. Plumber�� lame (Print) PI ure MP •, RS Number Business phone Number �/4P� L tiZ Plumber's Address (Street, City, State, Zip e) 40 a r ✓��r�r�� JAAC f Lt?f'i VIl Count /De artment Use Onl Approved ❑ Disapproved Sanitary Permit F�cludes Groundwater Da lssu suing t Si s) Surcharge Fee) �I tT� �� O ❑ Owner Given Reason for Denial 1X. Conditions of Approval/Reasons for Disapproval ,,l � G%t:0►- dVO"t� sil on `- 10 , e 3 S': T - 7b L kK f' ` Ve h complete plans (to the County only) for the system on pape t lealman at x t t loches ig size BI, -6398 (R. 0 _- yoe4 < �pc_ 3 J - 35 J Y 3. 4 3 � ( 166 ie 883.0 - I lof t f; l \, r .t' ,� r X9 6 f �' t 6 i7r r - ti oI r B -279 t f 1 076 1 L L __ -- v � F r pc� i W. 875 . irOttor: 870 t f t 05.2 07.4 ' / g o o ° / / /' ��/ f r F `68 9 r BB 877 ` / i 90. 2 r / 906.4 t t ! ��, / ,�� l• L l 8 1 / r '• o0 if T.L. Sinz Plumbing Inc. E5609 708th Ave. /�� �� �1p T Q1,f Phone: (715) 235 -2644 Menomonie, WI 54751 !� l Fax: (715) 235 -2592 Z.0 / 74 7W y X vZAJE www.tlsinzplumbing.com �l l I = �0 Io 10 ��� �L�E✓ �n �5 U 'r�/ I° 93 �siAL�- Z - Z.7V 43 '5771.) iNF' its+ oEe s eE� sys�tw of 10&+ q << C4n4m,w 1 �iG�«Tl /000 �A -LCvi✓ � c3 g� 4 *4" f- IF ---- X, _.w � ST /f�1v2Fr.✓S p21 T.L. Sinz Plumbing Inc. E5609 708th Ave. Phone: (715) 235 -2644 Menomonie WI 54751 �' `� �' " e �x 7 Phone: (715) 235 -2592 1-0 74 7koy www.tlsinzplumbing.com l N 1 ,- bJN P SO-r4 E = I C'D SE C Ox 'oA 5 Des A� r-LCV rex I �ti � tss /N�i /f/LN'OEQ S lit,[. 5 � (3 g 4 ST *,, Ajpk a.3 Oet Wisconsin Department of commerce SOIL EVALUATION REPORT Page 1 of 4 DivIslon of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County St.Croix Attach complete site plan on paper not less then 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and Horizontal reference point (8M), direction and Parcel I.D. ,/'` percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 7U '�� �� — — wo Please print all Ink maiion. awed b Date Personal Wonnation you provide may be used for secondary purposes (Privacy taw, s. 15.04 (1) (m)). Property Owner Property Location NE 19 28 a Govt. Lot 1/4 1`1W 1/4 S T N R 19 E (or® Excel Homes, Inc. Minnesota Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 9119 Alger Court 76 - Troy Village 2nd Addition city Stale Zip Code Phone Number ity [3viNage [D Town Nearest Road Inver Grove MN 1 55077 1 ( 6 1 Troy SL Andrews Drive New Construction UseE] Residential / Number of bedrooms 5 Code derived design flow rate 750 GPD © Replacement ❑ Public or commercial - Describe. Parent material i nPCC Ov,-r Cy]pcial fh,t wash Flood Plain elevation if applicable NA ft, General comments This is an addendum to a report that was submitted on 2/2/98 under the name of Continental Development. The and recommendaWns: pose of this update is to increase the size of the area so as to accommodate a 5 bedroom residence. The application rates have been changed for borings i through 5 so as to reflect the new co a requu�ements. FTI Boring # [] Boring is Pit Ground surface elev. 106.51 ft. Depth to limiting factor > 120 �, Soli Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff? in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eft#1 *Etf#2 1 0 -18 10yr2 /1 sil 2msbk mfr cw 2f ,5 .8 2 1$- 1 4/6 - sii 2msbk mfr cw if .8 54 -120 7.5 5/6 - s Osg ml - - .7 1.2 RECEIVED APR W ST. CROIX COUNTY 2 ring Bo # Boring 102.72 >120 ZONING OFFICE E] Pit Ground surface elev. ft. Depth to limiting factor NJ. Soil Application Rabe Horizon Depth Dominant Color Redox Description Texture Stru Consistence Boundary Roots GPD/ffP In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *ElW 1 0 -10 10yr2/1 - sl 2msbk mfr cw if .5 .9 2 10 -23 7.5 /6 s Osg ml cw if .7 1.2 3 23-42 10yr2 /1 - sl 2msbk mfr cw - .5 .9 4 42-43 •5yr4/2 - sl 2msbk mfr cw - .5 .9 43 -120 7.5yr6/6 s Osg ml - - .7 1.2 Effluent #1 = BOD > 30 220 mg/L and TSS >30 150 mg/L • Effluent #2 ' BOD < 30 mg/L and TSS < 30 mgi - CST Name (Please Print) Signature L � CST Number Tbomas C. Nelson - 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond WI 4/16/02 715 -246 -2454 1 e :OWRN llnd elesuv . ;uewnaoQ )Ioos sswppVI Property Owner Excel Homes Parcel 10 # Page 2 of 3 Boring 3 Bones # Q pit Ground surface etev. 103.41 ft + to � factor >14U in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMf in. Morison Qu. Sz. Cont. color Gr. Sz. Sh. "Eff#1 'Eif#2 1 0 -54 10yr3/2 - sl 2msbk mfr cw if .5 .9 2 1 54-72 4/4 - sil 2csbk mfr cw if 5 .8 3 72 -90 10yr4 /4 - is 2msbk mfr cw - .7 1.2 4 90 -140 7.5yr4/4 - s Osg ml - - .7 12 v i - tItJLC�(. Boring # 9 Pit Ground surface elev. 106.17 ft. Depth to limiting factor > 14t1 in. �(�'„JJ Pit Son Application Rate Hoizor Depth Dominant Color Redox Description Texture Structure tore Consistence Boundary Roots GPD(W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I "Eff#2 1 0 -19 10yr3 /2 - sl 2msbk mfr cw if .5 .9 2 19 -52 sl 2csbk rnfr cw if .5 .9 3 52 -7 ifl 4/6 - .1 2msbk mfr cw - 8 4 2 -130 7.Syr6 /4 - s Osg ml - - .7 1.2 . T h t/ 1 Boring # Borin 103.17 >130 Pit Ground surface elev. ft. Depth to nrmiting factor in. Son Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots G PDff in.' Munsen Qu, Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 I "Eff#2 1 0 -5 10yr3 /2 - sl 2msbk mfr cw if .5 .9 2 1 5 -19 / sl Osg ml cw I if .5 .9 3 19 -59 10yr4/6 - sl 2msbk mfr cw - .5 .9 4 59-7 7.5 /4 - sil 2msbk mfr cw - .5 .8 5 72 -130 7.5yr6/4 - s Osg ml - - .7 1.2 " Effluent #1 = BOD > 30 220 mg/L and TSS >30:5 150 mg/L " Effluent #2 = BOD < 30 mg/l. and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or Seed material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608- 2648777. SM- 8330Test(8.07100) Property Owner Exc Homes, In c parcel ID # Page 3 of 4 ' Boring Boring # Pit Ground surfaceeiev. 100.78 ft. Depth to limiting factor >120 in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'EfF#2 1 0 -12 10yr2 /1 - sil 2msbk mfr cw if .5 .8 2 12 -21 1 7.5 5/6 - s Osg ml cw if .7 1.2 3 21 -52 l0yr _ 6 sil 2msbk mfr cw - •5 .8 52.120 7.5yr616 - 1 s Osg ml - - .7 12 illw h G� a Boring Boring # Pit Ground surface elev. 100.00 ft. Depth to limiting factor > 120 in Sofl lion Rate Horizon Depth Dominant Color Redox Description Texture Smicture Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-6 10yr3/2 - sil 2msbk I mfr cw If .5 .8 2 6-20 sl 0SR I ml cw if .7 12 3 20 -60 1 4/6 - sil 2msbk mfr cw - .5 .8 4 60 -73 7.5yr6/4 - sil 2msbk mfr cw - .5 .8 5 73 -120 7.5yr6/4 - s Ng ml - - .7 1.2 F - 1 Pit Boring # Boring Ground surface elev. ft. Depth to limiting factor in. SoN Application Rate Horizon Depth Dominant Color Redox Description Texture Sure Consistence Boundary Roots GPD/ff In. Munsell Qu. Sz. Cord. 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& and TSS <_ 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608- 2648777. san4330rat tnmiooi 3Mnitirvin3mx4eut49L153 Mhm - 1,ma 1432120"` throat wwww Richmond iwYZ '71S -24O -24!54 Page 4 of 4 BMl Top of NE lot corner 100' BM2 Top of SE lot corner 99.46' B1 106.51 B2 102.72 B3 103.41 B4 106.17 B5103.17 B6 100.78 O y" B7 100.00 � '8 2 � Q^ 4 6� � 31� Tom Nelson 227,387 3M3mwI1'1:3ozLmmieimta1 My ]COamil an 1A452 12O"` Otw4bat N4e-ww Ric3hm4pad IWVZ 71�r246 -St4S4 Page 4 0� 4 BM1 Top of NE lot corner 100' BM2 Top of SE lot comer 99.46' B1 106.51 B2 102.72 B3 103.41 B4106.17 So , B5103.17 B6 100.78 B7 100.00 ���SG ' rA / 31 �r ar a� L 31� -�►� Scud �n -�n,� Tom Nelson 227387 1 v VI Ol IM . NTX BY D E 51GN 1432 120 STREET, NEW RICHMOND, WISCONSIN 71S -246 -2454 PROJECT NAME TROY VILLAGE 2nd ADDITION DESCRIPTION: NE %, NW/4, SECTION 19 „T 28 N, R19W TOWNSHIP: TROY COUNTY: ST.CROIX LOT: 76 SUBDIVISION: TROY VILLAGE 2"d ADDITION (o0 ' � 6Jo Sol X( �00 7 0 f - - -- - -- ---- - - - - -- _ - - -- _ -_ - - - - - -- - ''`_ __ '� [3 5 � 1S S� f, eap't S " ” =40' BM 1 orner Bost ground surface elev. 100 Tom Nelson BM 2-SE corner opt r d surface elev 99.46' cshno2605 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmental By Design Attach complete site plan on paper not less than 8'/Y x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow, and locati and distance to nearest road. Parcel I.D.# _ APPLICANT INFORMATION - P ste�tit Personal information you provide may be u oridary Purposes Da (Privaoy'"W s. 15.04 (1) (m)). vlewe y 03 Property Owner f, °r1 Property Location Continental Develop Govt. Lot - NE 1/4 NW 1/4 S 19 T 28 N,R 19 W Property Owner's Mailing Address �,' Lot # Block # Subd. Name or CSM# 12301 Central Avenue NE, Mite 230 ;� s? _._I 76 - Troy Village 2Nd Addition City Slue Zip odd umber _:: ; ❑ City ❑ Village ETown Nearest Road Minneapolis CWING JF Troy St. Andrews Drive IN New Construction Use: esitatitial f Nt>ter' edrooms 4 jAddition to existing building Replacement Pu describe Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/fP .8 trench, gpd/ftz Absorption area required 857 bed, ftz 750 trench, fP Maximum design loading rate .7 bed, gpdhf .8 tr ench, gpolfF Recommended infiltration surface elevation(s) By Designer ft (as referred to site plan benchmar Additional design / site consideration Parent material loess Over Glacial Outwash Flood plain elevation, if app licable ft S= Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system ® S❑ U ® S❑ U ® S u N S❑ u ❑ S ®U ❑ S® u SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPM? Borin Horizon Texture Consistent Boundary Roots 9# in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ;Trench ................. 1 1 0 -18 10yr2 /1 - sil 2msbk mfr cw 2f .5 .6 2 18 -54 10yr4 /6 - sil 2mskb mfr cw if .5- .6 Ground 3 54 -120 7.Syr5 /6 - s osg ml - - 7 8 elev 106.51 ft Depth to limiting ,�a Z factor 3 >120" Remarks: 2 1 0 -10 l 0yr2/ 1 - sl 2msbk mfr cw If .5 .6 2 10 -23 7.5yr5/6 - s osg ml cw if .7 .8 Ground 3 23 -42 10yr2/1 - sl 2msbk mfr cw - 5 6 elev 102.72 ft 4 42 -43 7.5yr4/2 - sl 2msbk mfr cure - .5 j .6 Depth to 5 43 -120 7. - s osg ml - - .7 i .8 limiting factor >120 Remarks: CST Name (Please Print) Signature; Telephone No. Thomas C. Nelson ' �� "� 715 -246 -2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, WI 54017 2/2/98 MO2605 21 PROPERTY OWNER: Continental Development SOIL DESCRIPTION REPORT 2, Page 2 of 3 PARCEL I.D.# Environmental By Design Horizon Depth Dominant Color Mottles Texture Structure � Onsistence Boundary Roots GPDfff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0 -54 10yr3/2 - s1 2msbk mfr cw if .5 .6 2 54 -72 10yr4/4 - sil 2csbk mfr cw if .5 .6 Ground 10 elev 3 72 -90 10yr4 /4 - is 2msbk mfr cw - ' T-, �.6 103.41 ft 4 90 -140 7.5yr4/4 - s osg ml - - .7 .8 Depth to limiting factor >140" Remarks: 4 1 0 -19 10yr3/2 - s1 2msbk mfr cw if .5 .6 2 19 -52 10yr4 /3 - s1 2csbk mfr cw if .5 .6 Ground elev 3 52 -72 10yr4/6 - sil 2msbk mfr cw - .5 .6 106.17 ft 4 72 -140 7.5yr6/4 - s osg ml - - .7 .8 Depth to limiting factor >140" Remarks: 5 1 0 -5 10yr3/2 - sl 2msbk mfr cw if .5 .6 2 5 -19 7.5yr6/4 - s1 osg ml cw if .7 .8 Ground elev 3 19 -59 10yr4/6 - s1 2msbk mfr cw - 5 6 103.17 ft 4 59 -72 7.5yr6/4 - sil 2msbk mfr cw - .5 .6 Depth to 5 72 -130 7.5yr6/4 - s osg ml - - .7 .8 limiting factor >130 Remarks: Ground elev Depth to limiting factor Remarks: ENVI;ONMENTOL BY D E51GN 1432 120 STREET, NEW RICHMOND, WISCONSIN 715-246-2454 PROJECT NAME: TROY VILLAGE 2nd ADDITION DESCRIPTION: NE%, NW/4, SECTION 19,,T 28 N, R19W TOWNSHIP: TROY COUNTY: ST.CROIX LOT:, 76 SUBDIVISION: TROY VILLAGE 2"d ADDITION 1 qc - 7 135 v, 1-4 2 1 SC Al =40 Tom Nelson BM I I � orner post ground surface elev. 100' cstmo2605 BM 2 SE comer post ground surface eley 99.46' f 08 %28!01 WE 15:11 FAX 715 388 4686 ST CRX CO ZONING � doc Z 001 1 ?C3ltlri•5 OWNIER' MANUAL GE MANA#jrdfgrr#i rL^n -- FILE INFORMATION SySTEM SPECIFICATIONS Owner Septic Tank Capacity f Wj9 i ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN pARAMETiI~RS Effluent Filter Manufacturer L ❑ NA 3 CI NA, Effluent Filter Model k G NA Number of Bedrooms Number of Commercial linos A Pump Tank Capacity gal Estimated flow (average) ga .ADD lJday Pump Tank Manufacturer A Design now (peak), (Estimated X 1,5) S-0 Sal /day Pump Manufacturer ,FM`IA Soil Application Rate e - ;aaVday /h Pump Model e lnf(uenV£fRuent Quality Monthly average* Pretreatment Unit A ❑ Sand/Gravel Filter ❑Peat 'Filter Fats, Oil Sz Grease (FOG) s30 mg/L p Mechanical Aeration O Wetiand Biochemical Oxygen Demand (BODs) :5220 mg /L ❑ Disinfection C] Other: Total Suspended oild ( T55) 5150 T V - Manufacturer Pretreated Effluent Quail tZXA Monthly average" Dispersal Cells) Biochemical Oxygen Demand (BODs) :530 mg/L gIn- ground (gravity) 4 fn- ground (pressurized) Total Suspended Solids (TSS) s30 mg/L ❑ At -grade ❑ Mound Fecal Collfonn ( mean ) s10 cftt /10omi ❑ D5 -line ❑ Other: Maximum Effluent Particle Size h Inch diameter * Values typlCdl for domestic (non.tommercla!) wanewater and septic tank effluent. * • Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Frequency Service Event Inspect condition of tank(s) At feast once every ❑ months eyear(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one -third (h) of tank volume Inspect di sp ersal cell(s) At least once every ❑ months year(s) (Mmdrdum 3 yrs•) At least once every ❑ months Wyear(s) Clean effluent filter 6iQ its /� ❑months d year(s) DNA Inspect pump, pump controls et:alarm At least once every Flush laterals and pressure test At least once every a months 17 year(s) 173 NA toes: At least once every ❑ months ❑ year(s) CI NA Other: At least once every Cl months ❑ year(s) ❑ NA MAINTENANCE INSTRUCTIONS inspections of tanks and dispersal cells shal PCrn by an PO M intainer; S the following licenses or ptage Servicing operator, c Tank Inspeceo Plumber; Master Plumber Restricted Sewer Inspector must include a visual Inspection of the tank(s) to identify arty missing or broken hardware, identify arty c su rface. s or leaks, measure t volume of combined sludge and scum and to check for any back up or ponding of of uuent on t h e for y ponding of effluent on cell(s) shall be visually Inspected to check the effluent levels In the observation pipes and to the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. tank When the combined accumulation of sludge and scum in any tank equ is o ne disposed o In accordance with accordance NR 1 �3, Wlscons contents of the tank shall be removed by a Septage Servicing Operator p Administrative Code. ressurized pOWTS components, pretreatement components, and any other The servicing of effluent fliters, mechanical or p maintenance or monitoring at intervals of 12 months or less shall be performed by a certtfled POWTS Maintalner. A service report shall be provided to the local regulatory authority within 10 days of completion of ariy service event. START UP AND OPfEItATiON For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or or other chentl that may impede the treatment process and/or damage the dispersal cell(s). If hi concentrations are detected have the conten nr rhn rankfsl r*movad by a senwe servicing operator prior to use. 08%28/01 TUE 15:11 F.41 715 386 4686 ST CRI CO ZONING 1002 Pies °f.. System start up shall not occur when $oil CondlUons are from at Inflitrative st+rfacv. During power outages pump tanks may fill above normal highwater kveis. When power Is rutoried the excess wastewater wit) be d'ucharged to the dispersal cell($) In one large dose, overloading the cells) and may result In the backup or surface dlschargr u? effluent. To ivold this situation have the Contents of eels pump tank removed vy • Sspup Servicing Operawr.prW to rtstodot power to the effluent pump or contact a Plumber or POWTS Malntalrtar to assist to manuaity operating the pump controls to restore ncrmai levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise dlswrb or compact, the area wlchin 15 feet down sivpe of any mound or at-grade soli absorptikn area. Reduction or rtlminadon of the following from the wastewater W#sm r"y Improve the performarKe and protons the Gfe of t`►e POWTS. antibiotics; baay wipe:; cigarette butts, Condon% CbuOt$ swabs; degreasers; dental doss; diapers; dWnfettanu; lot: foundation dratn (sump pump) water, fruit and vMubfe peetlniiM 9"M; grease; herbicides; meat scraps; medications; v)f; t?aintlnK grodtict3. pesticides: sanitary naokins, tampons: and wetter softener brine. ARAN DON EM ENT When the POWTS fails and/or is ptmwanomly usken out of service the following steps shall ba taken to insure that the system is properly and safelY abandoned In compliance with ch. Comm 83.33, Wisconsin Adrrtlnbtrative Codes • All piping to tanks and pits shall bt Qlsconnected and the abandor+sd pip+ openings maled. The contems of all tanks and plu shall be removed and property dbpond of by a Septage servicing Operator. • Aftpr pumping, ;li tanks and plu shall be excavated a removed or their covers removed and the void space filled with soil, gravel or another inert solid mArrial. CONTINGENCY PLAN If the POWTS fails ants Gannet be repaired the fallowing rtttasurts have O"n, or must be taken, W provide a code complimt reptaff S ystem; A sultablt replacement area has been evaluated and may be utNhud for the location of a replacement sail absorption system. The replacement area should be protected from disturbance and companion and shmW not be Infringed upon by required setbacks from existing and proposed WWWro, lot Rem. and wells, falluro to protect the replacement aria w result In the need fora new soli and rite evaluation to establish a suitable replacement area. Raplacement systMrns must comply with the rotes in effect at that Ume. A sutra a rep{ cenxnt area is not avallabte due W st#mCk• and/or soil tfmkstloas. her" advainm In POMRS cechnoivlp a tan y be InstiNed es a islet reptam die titled POWTS. ]CAe sit ha not eft coat f4 �ail*4 t a $W grit U situne f so "and'silta Ie"'vLtLL uat must b p+erfo ed lZuluW ac a. If no replaceme ear b ivallable a mad be In s d as a la rQ rt to re POWYS, 0 Mound and at•gra a soil absorption systems may be reconstrvued in place following removil of the biomat at the InnlVative surfaca. Racomtr uctlons of such systems rnu$t.cvtnply with On naks In effect at that dme. < c WAIItNINO > > SES•rIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANA /OR INSUFFICIENT OXYGEN. 00 NOT ENTER A SEPTIC, PUmF OR OTNtR TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT, RESGUi OF A PERSON! FROM TK% INTIERIOR OF A TANK MAY BE DIFFICULT OR {I.iPAt�lril i. . ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name NL "` !NLz Na me L S /af/Z 6' //V Phone yG 'Phone ZL 401� $EPTAGE SERVICING OPERATOR P MPIR LOCA R C01.1 TORY AUTH Nama I Agetxy 1C /N Phant 3 — 8fo ST CROIX COUNTY SEPTIC TANK MARTMIANCE AGREEMENT •AND OWNERSHIP CERTIFICATION FORM wm/B er _ x MJPe_.k Q Co 1 � I�r� � � -�� r � �oor� � � a^ � L � I n4c failing ddress D 9 mporty ddt�ess co a0 , 7 ST CA� (Verification required from Planning Department for new coastMctiogl— /Stet � � y� UJ T— Parcel Identification Number ® ®— a �J a —�°' O .EG ESCREPTIO 'roP Y 'o. V, Id ` /a, Sec. \, T _11_ 1 L N - W, Town of 7 r c y I ' t i I« t !#%j P'A`S` {for, Lot# 3ubtii n .r_ �—� - C Survey Map # , Volume .Page # Warranty Deed # &$q . Volume Page # Sp ❑ yes (' no Lot lines identifiable �& yes ❑ no use and mawtenanceof your septic system could result is its premature fellm to handle wastes. Proper maintenance cowdsts f mping out the septic tank every three years or sooner, if needed by a tiansod wbr�t you put into the system can function of the septic tank as a treatment stage in the waste disposal system, roputy owner agrees to submit to St. Croix Zoning Department a certification form. signed by d° owner and by a joum;ymanplumtxr, restrretedplumber or a licxnsedpumper verifying fiat (1) the osrcito wastewaterdisposi<i system is is prop cr operating condition and/or (Z) after inspection and pumping (if aeoessatY), the septi tank is loan than 1/3 full of sludge. maintain the private sewage disposal system with the standards l have read tiro above rcquitrmcats and Agra of Natural Resources, State of Wisconsin. Certification set forth. as set by Dgmtment of Commerce and the Dew to the St. Croix County Zoning Office within 30 wing your septic bas been maintained must be completed and returned maintained zin date. Ob DATE O R R � we am are the owners) of I (we) fy t all statements on this form am true to the best of my (our) Imowledge. I (we) ( ) a ve, by virtue of a warranty deed recorded in Register' of Deeds Office. aly — DATE P ICANT sass« p rey • on that is sus- representcdmay result in the sanitary permit being revoked by the Zoning Department. « « « « «« « Ind de vii this application: a stumped warranty decd from the Register of Deeds office a copy of the certified survey map if reference is mado in the warranty deed U 1969P 5y2 �\ STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED KA6T6 9 HG V ALSH -7 REGISTER OF DEEDS Docs+rs«x Nu rrlbw ST. CROIX Co., MI r This Deed, made between RECEIVED FOR RECORD 09 - 06 -2002 �I. Troy Delopment Corporat on, ta a Minneso Corporation 8:30 AN ve Grantor, WARRANTY DEED and Max c ee EXEMPT # REC FEE: 11.00 TRANS FEE: 389.70 Grantee. COPY FEE: Grantor, for a valuable consideration, conveys and warrants to Grantee the following CERT COPY FEE: ' St. C r oix Count State of Wisconsin: PAGES: 1 described real estate I n Y• I Rcuen,nq Aron _ Lot 76 of the Plat of Troy Village 2nd ......- Name and Return Address Addition in the Town of Troy, St. Croix County, ' Wisconsin. Max E. McPeek 8619 Blooming Grove Road Subject to Declarations of Covenants, Conditions and Bloomington, IL 61704 Restrictions for Troy Village, recorded in Vol. 1241, Page 256, as Doc. No. 559964, and the Declaration of Golf Course Covenants, Conditions and Easements, recorded in Vol. 1241, Page 301, as Doc. No. 559969, I 040-1252 - 0 00 all as appearing in the office of the Register of Deeds p a r coi id for St. Croix County, Wisconsin, and such other antltiution N is no x homestead ho ( h ome stead ro it easements, restrictions and reservations of record, This property P Y or in use, and the "Buyer" obligations contained in (is) (is not) the Purchase Agreement for this lot. I i i I; Exceptions to warranties: I 26t August 2002 Dated this day of it �i� (SEAL) (SEAL) • Charles S. Cook, President Troy Development Corporation (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT �I Minnesota Signature(3) — Slate of W#scorntn, !i } ss Anoka County J Personally came before me this day of suthenUcated this day of the above named Charles S. Cook, Prea dent it Troy Develo nt Co ration I; TITLE: MEMBER STATE BAR OF WISCONSIN to (I( not, me known to be the person _ who executed the foregoing authorized b y § 706.06. Wis. Stats . Instrument and acknowledge the same. it THIS INSTRUMENT WAS DRAFTED BY J 7 T� ll TROY DEVELOPMENT CORPORATION R ick A Johnson Notary PuUllc. State Wueons+wAnoka County, Minn. t Charles S. Cook, President My commission Is permanent. (if not, state expiration date: ., January (Signature may be authenticated or acknowledged. Both are not 31 2006 .) ' necessary) • N•mn °f person •lanlna In •ny e•p•exy nnn De typed « prinl.d Debut iMlr STA TE 111urc. ■ TE IiAR OF W13CONSIN ' ° , n � ut ,', • .��� STA WARRANTY DEED FORM Nn. t - 1078 RICK A..IOFtJ�SON- a °x°°' ° IgDJ1'f PIRLIC -BATA MY COIsM iSSION EXPIRES JANUARY 31, 2006 a • 3 b o L-O c ^3 Z V o� LO ^ ; 3 V� 0 lu) Gj CL 3111: Q o W Ck U Z I � w o w J � �k ymHm kiN _ o I 1 o o .o 0 � O I N p � \ CD 0 10 GID o . 0 I �q Co Y . ^ Y Y Y Lai mc An +� Y �►� � gg =� Y .c�-1Y� Y Y Y Y � Y N?Y - . 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