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O N 3 'O 0 7 d n N O J A 0 A p A O O Uq u� f» 0 O co b C) s� y Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 404948 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: Banaszewski, Dave Troy Township 040 - 1252 -07 -000 CST BM Elev: Insp. BM Elev: BM Description: TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 1 Benc mark /6'/'/ /OD, d Dosing Al 5; B B & __11_ 9 1- Aeration Bldg. Sewer , - , , }� , �i1Ct 71 v� ; S. c7 g Holding SUHt Inle / 6• q -7, 2 TANK SETBACK INFORMATION St/Ht Outlet �t•7 q ­7• TANK TO P/L WE L BLDG. Vent to Air Intake ROAD Dt Inlet Septic SV d Dt Bottom i Dosing Header /Mani 2 'L, - &,T T Aeration Di Pipe 2 a r Holding Rot. Syst m 6 Final Grade PUMP /SIPHON INFORMATION vli -S Manufacturer Demand St Cover PM Model Number T Lift Fri oss System Head TDH Ft I Force Length �: ia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width Length No. Of Tre es PIT DIMEISIONS No. Of Pits nside Dia. Liquid Depth DIMENSfCNS ��U� 6�'' SETBACK SYSTEM TO P/L BLDG W L LAKE/STREAM EACHING Mamdactur r INFORMATION HAMBER Type Of System: Model Number: IBUTION SYSTEM q19116 eAA"&4rj � Bader/ anifold i Distribution r 2 / x Hole Size x Hole Spacing Vent it Intake Length Dia Length � �Dia II 'Sp e l c Q i n g 3 ✓ �I`Q/w 01 -� �''" SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only c72N� lh S Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 1 Yes No <= Yes No COMMENTS: (Include code discrepencies; persons present, etc.) Inspection #1: 1 / 1 6 -2-- Inspection #2:q/ ( 16, / 6 -L- Location: 289 St. Andrews Or Hudson, WI 54016 (Unknown 19 T28N R19W) Troy Village Lot 77 Parcel No: 19.28.19.1328 1.) Alt BM Description = S'T ( am LL P � t r6t, L "g- -ftjA� 0P4CV NA L AA#J 66-K n" yr o 2.) Bldg sewer length = 3C �1/YWC Yt lM54v - r S4f^ r ' a-,-01 ts"`4 ,,to', amount of cover = Gli?IQY� h �� ' �� >1 g br 4y SA-5 �t �Qfl • lvb 1 `✓15P JC01'da - 7 Plan revision Required? 2: Yes ii+� No -- - -- - 1 Use other side for additional information. — �b J �� Date -rwu s Si at re � _ Y .kf�t �yIS Cert . N C1 SBD -6710 (R.3/97) (x J / _�� GV i .z i9 lVisc onsin . Wn Ave.. P.O. Box 7162 T. ROIX son. 3707 - 7162 Site Address i; � n t of Commerce � `` s' � `` Y id ©i9(G 289 ST. ANDREWS DR. Sanitary Pe �on sanitary Permit Number -/ 0 4 in accord with Comm 83.21, Wis. Adm. Code, personal information yon � ide R E C E i • Revision my be used for secondary puposes MM Law, siS. i m I. Application Information - Please Print All iintortnation State Pisa .D. Number AUG 2 2 Property Owner's Name Pattxl N ST. CROIX C W I " DAVE BANASZENSKI b - 12 - 070 - 000 19.28.19.1328 Property Owner's Mailing Address n 474 HAYWARD AVE. NO. -- 'A -- 'A' s19 28 N k9 E City, State Zip Code Phone Number Lot Number Block Number 77 Subdivision Name CSM Number OAKDALE MN 55028 TROY VILLAGE U. Type of Building (check all that apply) Ocity O 1 or 2 Family Dwelling - Number of Bedrooms 4 PER SUBMITTED HOUSE PLANS OVillage 0 Pubiic/Commercial - Describe Use - glLwnd A TROY 0 State Owned 41f4v- Nearest Road Chambers -3 trenches -9 chambers ea. X 3 11" Bio dek*w III. Type of permit; (Check only one box on Hat A (numbering scheme for internal use). Complete line B V applicable) A. 1 ❑ New 2 ❑ Replacemms System 3 ❑ Replacement of 6 ❑T tree stem I Tank stem B. Chteck if Sanitary Permit Previously Issaod Permit Number ate Issued ` I z .. 4004 IV. Type of permit: (Check all that apply)(numbering a is ) 44 §1 Non - Pressurized In -Ground 210 Mound Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In- Ground 41 ❑ Holding T 48 ❑ Single Pass 51 ❑ Drip Lame 45 ❑ At - Grade 46 ❑ AeTgbip tment unit 49 ❑ Recirailaft 30 0 Omer V. t Area Information: Xlffio defuser Zabel filter A -100 Design Flow (gpd) Dispersal Area Diskrsal Area Soil Application Percolation Rate System vation Final Grade Required Proposed Raoe(Gals./Days/Sq.R.) (Min./Inch) Elevation ___ 600 857 857 .7 94.5 97 VI. Tank Info Capacity in Total Number Manufacturer Prefab Steel Fiber Plastic Works Gallons of Tanks Concrete constructed Glass New Existiaa Tanta Talcs Septic or Holding Tank X - 1250 1 WEISER X Dosing Chamber VII. Responsib ffiq Statement- 1, the aaderdgoed, aamne r espoasibUity for w on of the POWTS shown on the attached plans. Piumbees Name (Print) MPIMPRS Number Business Phone Number TODD FEATHERSTONE l 242514 715- 381 -1704 Plumber's Address (Street. City, State, Zip CW P.O. BOX 467 HUDSON WI 54016 VIII. Coup /De ent Use Oral Approved ❑Disapproved Lri nuY Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Stine Fee ❑ Owner Given tial Adverse �� . � , 0 ` f l ?,00 Deoertninstioa IR. Conditions of Approval/Reaso for e(r 'Ines N�S ; nex� rr © • q 4Z e� "�` s Ts - r plats 00 the CoMy ody) for the etas oa paper awt ko than a 1 h ht size fr i C.r la.. IMILC '� C W (a:1 P- 1a ` SEFI"3 8 (R. 05101) sec J -i c K r alocation IVED Wisconsin 6e eM of C) merce AUG �I � o EVAL ATI ON REPORT Page 1 Of 4 Division of Safe and Buildings 0, i Comm 85 Wis. dm. Code minty St. Croix Attach complete site plan on paper not le &:AW iii liize. P n must include, but not limited to: vertical and ho (61), di on and Parma I.D. !' percent slope, scale or dimensions, north n and is nce nearest road. 0-7 d � Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location NE 19 28 W Bruce Lentzen Homes Govt. Lot 1/4 NW 1/4 S T N R 19 Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 502 2nd Suite 204 77 - Troy Village City State Zip Code Phone Number []City []Village Town Nearest Road Hudson WI 1 54016 ( )386 - 5050 1WY i St. Andrews Drive New Construction Useo Residential / Number of bedrooms 4 to 5 Code derived design flow rate 600 to 750 GPD Replacement Public or commercial - Describe: Parent material l necc over till Flood Plain elevation if applicable NA ft. General comments This report is an addendum to a report that was filed on 2/2/98 for Continental Development with a sanitary and recommendations: permit already having been issued to Bruce Lentzen Homes recommended system elevation 89.50 Re +era r.c e-D is 6M 34 y III�� Boring # 0 Boring � III Q Pit Ground surface elev. 96.10 ft. Depth to limiting factor >130 in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -7 10yr3 /2 - sil 2msbk mfr cw 2f .5 .8 2 7 - 18 1 1 4/6 sil 2msbk mfr cw if .5 .8 3 18 -130 7.5yr4/6 s Osg till - - .7 1.2 c l '� •� Boring # ❑ Boring 98.80 >146 L� El Pit Ground surface elev. ft. Depth to limiting factor in, Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0 -17 10yr3 /2 - sil 2msbk mfr cw 2f .5 .8 2 17-26 10 4/6 sil 2msbk mfr cw 1 f .5 .8 3 26 -146 7.5yr4/6 - s Osg ml - - .7 1.2 i ' Effluent #1 = BOD > 30 220 mg/L and TSS >30 < 150 mg/L uent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) CST Number Thomas Nelson �" 227387 Address Date Evaluation Conducted Telephone Number 1432 120th Street, New Richmond, Wl 6/18/02 715- 246 -2454 Prop" Owner Bruce Lent Hom es Parcel ID # � d O 1 1 51 0 7 - 00 0 Page of 2 4 Boring Boring >138 # Ground surface elev. 97.90 fl. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -10 10yr3 /2 - sil 2msbk mfr cw 2f .5 .8 2 10 -32 1 4/6 - sil 2msbk mfr cw if .5 .8 3 32 -49 7.5yr4/6 - s Osg ml cw - .7 1.2 4 49-66 10yr4/4 - sil 2msbk mfr cw - .5 .8 5 66 -138 7.5yr4/6 - s Osg ml - - .7 1.2 9Y- S o y Fl*-] Boring # Boring 96.60 >130 pit Ground surface eiev. ft. Depth to limiting facts in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef1#1 *Eff#2 1 0-16 10yr3/2 - sil 2msbk mfr cw 2f .5 .8 2 16 -27 sit 2msbk mfr I cw if .5 .8 3 27 -40 1 7.5yr4/6 - is Imsbk mvfr cw - .7 1.2 4 40 -130 7.5yr4/6 - s Ng ml - - .7 1.2 0 win 95.05 >135 El Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0 -10 10yr3/2 - sil 2msbk mfr cw 2f .5 .8 2 10 -25 7.5 4/6 - is Imsbk mvfr cw - .7 1.2 3 25 -30 1 10y6/1 _ sil 2msbk m f r cw - .5 g 4 30 -38 1 4/4 c2d5yr5 /8 cl Imsbk mfi cw - .2 .3 5 38 -60 7.5yr4/6 - Ifs 2msbk mvfr cw - .5 .9 6 60 -135 7.5yr4/4 - 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 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 -264 -8777. SBD- 8330Test (R.07 /00) Property Owner Lenzen Homes Parcel ID # 0 y o 2, K 0 7 - O d O Page 3 of 4 Boring # Boring 1 �1 pit Ground surface elev. 94.40 fl. Depth to limiting factor > I38 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fIe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#1 I 'Eff#2 1 0-8 10yr3 /3 - sil 2msbk mr cw 2f .5 .8 2 8 -24 7.5 4/6 - is Imsbk mvfr cw if .7 1.2 3 24 -36 10y173 /1 c2d5yr5 /8 sil Imsbk mfi cw - .2 .3 4 36 -58 10yr4 /4 - cl 2msbk mfr cw - .4 .6 5 66 -138 7.5yr4/4 _ s Osg ml - - .7 1.2 Boring # Boring Pit Ground surface elev. _ fL Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eft#1 *Eff#2 Digitally si Mow 2 by Thomas as Nelson DN: cn=inomas 17. Nelson, o =T Foundation, Date: Signatu 08:38:05 re Valid L Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 Effluent #1 = BOD > 30 5 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 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. SBD4330Tca (R.07/00) Z rLk C C- � rn � 'Z 0- Cv e S L - 7 7 Tr c, �, c� R aj, >a� Cl 6 1 a 5 0. e s c- -1 -f - , `- 3 O' um3 To? ui- SCOIC 1Qn� r" LO Q coo( 1 p U , 4 0 / 1, p ll 1 Qr, 4 �e� �qt I� cfoo (' S► I 1 0 a. eq R ti olynally Th omas n by • Nelson - cn = b g . (G � � � on =Thomas t� o=The v 10 g 5, o S ou,, ��S a � f Signet N e I so n� .� 19 1 y — 1 ure 09:25:42 Valid -06W : i : _ --�- I , ! t : I , j I _ _ t 1 , , w , ! I , , 1 t a Pi" F A il C F ! IiSWj2 +4 I r - ...._. 1 1 ` - -- Safety and Buildings Division - -- County z - _ � -- W 201. W, Washington Ave., P.O. flux 7162 N isconsin Madison, WI 53707 - 7162 Site Tess 28Q S _ D epartment of Co mmerce z: , 3 i9�oL a//�1�� - -- Sanitary Permit Number Sanitary Permit Application 9�8 In accord with Gomm 83.21, Wis. Adni. C)de, personal information you provide Check if Revision may be used for secn ndatr�aerses Privac - I. Application Information - Please Print A I Informati n state Plan I.D. her Property Owner's Name Parcel N r ►9 . to. /g MAR 14 20 U � N1���_�? ��ze% - - - -- - - - -- - _ � Property Owner's Mailing Address perry Location l ST. CROIX COUNTY ZONING OFFICE — 1; ` k; S/ T - R 4 E f_'ity, State Zip Code Phone Number Lot Number Block Number 77 Subdivision Narne CSM Number II. Type of Building (Check that apply.) a� � ❑City 171 1 or 2 Family lhvelling - Numba f .1 al ❑ Village_ ❑ Public /Commercial - Describe Us �- - �� �. - - -- _ - - - -- ❑ State Owned - -`�- --- -- ------ -"'" -'-'__ _r. —_ - - -- _ owtuhi ----- 13`x v. *r Cls Nearest Road III. Type of Permit: (Check only one b n litre A. Nu mberi is for internal rase) (Complete fine B, if applicable.) A. 111 New C7 li,eplaa nett 60 A:idition to� 2 13 Replacement System k For County use System � -- --- __ - - -� C )ny _ E.�cis - ice - S ystem B ❑Check if Sanitary Permit Previously issued it 11 e Date Issued V I . Type of POWT System: (Check all that apply. Bering is for internal use.) 44 2�Nom .- Pressurized [n- Ground 21 ❑ Mound 47 ❑ Sand Filter 5011 Constructed Wetland 22 ❑ Pressurized In- Ground 41 Hold Twit 4.8 L7 Single III 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑Aer to Treatment 49 ❑ R& circulating -- 30 V Dispersal /Trea tment Area Information 1 Desagn Flow (gpd} Disperval Area ins t Arfm x :i A catkon on Rate yswm Flevatinn Final Grade - -- - -- f Required n av Mc k !te(Gals. aysl _} ( Min. /Ina $lcw�_ _ VI. Tank Info Capacity i T ot -� Number Manufa; r efah Site Steel Fiber Plastic Gallo Galinzs of `1a I Alcrete Construct Glass New tsting Tanks auks Dining Chamber • VII. Responsibility S ement- I, the tin signed assume respotesibilit; fur ' st a the PO S shown the attac plans, Plumber's Name (Prin PI xr's Si tu' - -- -- - P! Nitroher Business Phone Number - - -^ <> Plumber's Addr (Street, City, State. C e }� VIII._Co t /Deepaa Use U y u Disapproved Saziitary Permit Fee (includes Gro d r Date Issued Issui g Agent Sigma re (No Stamps} ved Appro ❑Owner Given Initi Adverse - ` - Deiernination - Srucita rgt• Fce�) � _ -a �--- ._�...__- 225 r,, lq IX Conditions of Apprpval/Reas for isa prtawaM , � ��S S ��d �r/+�. � �YSyu... ht,s �►2 a•l,l Attach complete *ns (v< the t c,umty and y ei the ., rat taper not less than 1V2 t 11 imhm uu sine i Alp ' 4N, -*., ��Nimx R + =z_x_ N rn X - ' (P c�nTmmz '� = () �� " Z �omAA a N _ Z o_ zz r � � = -+ I I I I I L '0 I � E l5' TBAGK _ m •I or • I � r z fj' 0 I 8 I � u+ L N I� D � 0 - - - -- I m IBS Imo, I, I � � I � IM IU3 I 3 I I� I a S 02 00 00 W 32 U1 a NX 1 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'h 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 dimensions, north arrow, and location and distance to nearest road. Parcel I. D.# APPLICANT INFORMATION - POsse print alt information. Personal information you provide may be u 'for secondary purposes (Privacy Law, a. 15.04 (1) (m)). ieWed By Date 2t70 Property Owner P ', Property Location Continental Develop °' _ L ' l '; Govt. Lot - NE 1/4 NW 1/4 S 19 T 28 N,R 19 W Property Owner's Mailing Addressi Lot # Block # Subd. Name or CSM# 12301 Central Avenue NF, Suite'236' jqQ 77 - Troy Village 2Nd Addition City tate zip cc�� O Num r ❑ City ❑ Village ❑Town Nearest Road Minneapolis `'OUNTY Troy St. Andrews Drive ❑ New Construction Use: � "Residential / Numbet'o edrooms 4 ❑ (Addition to existing building 1. ❑ Replacement I blic orcomfrter I. describe Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/fP .8 trench, gpd/fF Absorption area required 857 bed, fts 750 trench, ft Maximum design loading rate .7 bed, gpd/ft .8 tr ench, gpd/fF 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 applicable ft S= Suitable for system Conventional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system NS o U ® S U ® S❑ U ® S❑ U [Is ®U ❑ S N U SOIL DESCRIPTION REPORT • r xkb - Depth Dominant Color Mottles Structure GPD/fF Boring# Horizon in Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 1 1 0 -19 10yr2 /1 - sil 2msbk mfr cw 2f .5 .6 2 19 -48 10yr4 /6 - sl 2msbk mfr cw if .5 .6 S Ground 3 48 -110 7.5yr5 /6 - s osg ml - - .7 .8 , } etev 104.32 ft Depth to limiting factor >110 Remarks: 2 1 0 -4 10yr2 /1 - sil 2msbk mfr cw 2f .5 i .6 S — 2 4 -54 10yr4 /6 - sil 2msbk mfr cw if .5 .6 Ground 3 54 -120 7.5yr5/6 - s osg ml - - 7 8 '}— elev 106.88 ft Depth to limiting , factor tot .v 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 20 PROPERTY OWNER: Continental Development SOIL DESCRIPTION REPORT ® Page 2 of 3 PARCEL I.D.# Environmental By Design Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPD/fts in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ! Trench 3 1 0 -19 10yr2 /1 - sil 2msbk mfr cw 2f 5 6 S 2 19 -44 10yr4 /6 - sil 2msbk mfr cw if .5 .6 S^ Ground elev 3 44 -65 7.5yr5/6 - s osg ml cw - 7 ! .8 ^� 108.22 ft 4 65 -84 7.5yr4/4 - cs osg ml cw - .7 ! .8 - �- Depth to 5 84 -120 7.5yr5 /4 - s osg ml - - 7 i .8 limiting factor j j q, ` q I >120" Remarks: 4 1 0 -18 10yr2 /1 - sil 2msbk mfr cw 2f .5 .6 -IS" 2 18 -51 10yr4 /6 - A 2msbk mfr cw if .5 i .6 S Ground elev 3 51 -120 7.5yr5/6 - s osg ml - - 7 .8 •� 106.51 ft Depth to limiting factor >120 Remarks: 5 1 , 0 -32 10yr2 /1 - sl 2msbk mfr cw 2f .5 .6 � 2 32 -54 10yr4/4 - sil 2msbk mfr cw if .5 .6 s' Ground elev 3 54 -120 7.5yr4/4 - s osg ml - - .7 .8 109.34 ft Depth to gfs. 08 - Z q 0 $ limiting factor >120" Remarks: Ground elev Depth to limiting factor Remarks: 0 BY NMENTHL D � 1432 120 STREET, NEW RICHMOND, WISCONSIN 715- 246 -2454 PROJECT NAME TROY VILLAGE 2nd ADDITION DESCRIPTION: NEB/, NW/, SECTION 19 „T 28 N, R19W TOWNSHIP: TROY COUNTY: ST.CROIX LOT: 77 SUBDIVISION: TROY VIUAGE 2"d ADDITION e: ��ft V A --A 6y � 2 ------ Jo 1 1 � a SCALE 1 " =40' Tom Nelson BM i SE corner post ground surface elev. 100' cstmo2605 BM 2 - T t ' { I � I 1 I 1 I� ' — _._.a._— _f.__. — I — I 1 ; I 1 , i 1 1 1 I I f - } i I ' ! 1 , in U) 'n L0 I[ LO Ln 4) LO Il) u) u7 If) U) In u: L:) If) C.) ) N ti N ) L V In U r• �� N �. t .� N N ra r` N tll rJ ►. r t.O CIO C4 CA r `:) M C-) M (C N N O cq N tJ N C") M N O N M U7 C': C) O W ,') Co CO M r If O to M) CJ (N CCU ` O CS Cl) O � co r` trl 4 Q ` 0 31 i In u') U') In Ln If) V 177 .n :n In V7 If) +w L o n in In U7 In to � L In O O Ln N I.7 ., r- r+ r- N (V fi O) N N N r` N 4) N N N G) rJ O d N N N !: M co a) (D cc) � ~' c� �- CO cp C ` M � CO O O N h � _ w E U cn�-r NC) E U 1-0 00 u 1 E U uc NNO <) U con .1 M 10 r T r> .,J ,� In - h �7 t J m m . 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C) M m 'S) C) r L ;.J rD C; no 0 .� �. r,' CD (0 O Cv ,� L G r) In � Q CJ G N O L 7 c' tD CfJ r� C -4 9 C7 t'�l M co cr 1 Cl) C IN C7 if iT cr t.- C) CD Y a O..! tt C. co So Ln �� N a' C I' ) c- C:) lA r N C) :V M M d O a:r to CJ 11) II) LO (O U] N y I CO :L) Q) CJ ` i a) LA CD co 'C3 •p Z3 ( A U u) v n O a) Ir) 4 u N 0) O] r` - Lo r) ._) V cV C.7 C1 r- in �) J V C)) C) t` 'J) r) V to C,': O O O O C j C - r O Ci ri 6 C , 0 C) 0 'L C, r O? O O G tly 0 D M d � E O a U). tt M N ►� [ox 6.n [t M N ro � Cl) N O ul v M N 0 O o 0 0 4 O . O t� ® c o o J c 6 C7 4 � O o CQ v) to N "� 4 • Private Onsite Wastewater Treatment System Management Plan .Septic Tank And Gravity in- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Gomm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567 -P (R.6/99). Table 1: System Des i n Specifications Sanita Permit Number Number of Bedrooms Design now - Peak ( pd) �a Estimated Flow - Average (gpd) Septic Tank Capacity (gal) Soli Abso tion Component Slze (ftz) Type of Wastew Domestic Table Z: Soil AbsoripAtio n Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Com ent Design Flow - Peak Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg/L 220 Maximum TSS m L) 150 _ Table 3: Maintenance Schedule Septic Tan Inspect and/or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 y ears Soil Absorption Component insp once every 3 years Se is Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. Ti3e contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code (Servic;ir g Septic or Holding Tanks, Pumping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition ofthe s and outlet filter shall be assessed at least once every 3 years by iinspection. The Zuutlet felt shall be cleaned as necessary to ensure proper operatio The filter cartridge should not be removed unless provisions are ma e o retain solids in the tank that may slough off th filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter 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 scum and sludge 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 an 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. 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 the tank. No one should enter a septic or other treatment or holding tank for any reason without being In full compliance with OSHA standards for entering a confined space. she atmosphere within the sspdc or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be dltfllcult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. mo il Abs Lion Com nt car�p pone The soil absorption component serving this structure Is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least three The inspection shall include recording the levels of ondin once eve h ee ears. p 9 N Y pe g , if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be. avoided particularly during winter months. The compaction or removal of snow cover over the component may lead to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. 2 Monopment Plan for a Septo Tanh and Soil Absorption Component Plantings o deep-rooted _rooted trees and shrubs directly over or within ten feet of the p component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 CONTINGENCY PLAN I the he POWTS falls and cannot be repaired the following measures have been, or m ust be tak ers , to p rovide a code compllant replacement system: don of a rc lacement soil absorption IA sultable repiacernert area has been evaluated and may be utilized t0� the location p n S fiat bt Inlsi The re pla c ement :rea sl► should be rotec't+ed horn disturbance and compaction and hot>Id nC e4 vpon by system o p i t ac fr om xlstln and p rop o sed strvctum, lot firm and wells. Failure to protect the replacement area will requ r:d se b W o e E P po result In the Head for a netiv soil and set e evaluation to establish a sultaNe replacement era. Replacement syst ems must comply with the rules in effect at that rime. 0 A 3ultable replacement area Is not available due to setback and /or soil Ktriltatiol+.s. Barring advams In POWTS technulm a holding tank may be installed as a last resort to replace the failed POWTS- 0 The site has not been evaluated to identify a sultabb repiacamsit area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a sultabla replacement uca. If no replacement area Is available a holding tank may be Installed as a last resort w replace the failed POW7$,, a Mound and at-grade soil absorptlon sys -Ams may be reconstructed In place following removal of the biomat at the mu c om p ly with the rules In effect at that time. lnflivacive surface. Re <onstrvctions of such systems u play < < WARNING > > SEr'flt:, M'UMtr AND OTHER TREATwIEN7 TANKS MAY CONTAIN LETHAL GASSES AND /Olt INSUFFICIENT OXYGEN. DO NOT ENTER A SIEPTIC, pUMla OR OTFICR TRILATMBNT TANK UNDER ANY CIRCUMST DEATH MAY RESULT, RISCU9 OF A PER11ON FROM TNIK INTiRIQR OF A TANK MAY $9 DIFFICULT OR ttrcvllct�Rt i. ADDITIONAL COMMENTS POWT3 INSTALLER POWTS MAINTAINER Name o s,[,n �, Name Phone -_ 3.P /- ?o Y F-Phone StrTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name Agency �� ro eQ ear _ _._ - T cROIX Cb M SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM t Cyer (� ddress " , Property Address �-�' '`✓ (Verification roquimd from Planning Department for new construction) �- Cigdstate Parcel Identification Numbe ,- [Z ; Z r � I,WAL DESCRIPTION Property Location %., / <, Sec. T R jjW, Town of - f- Subdivisio Lot #. Certified Survey Map # volume Pap # Way nod # l rY volume CJ i p age Spec hat>sc 0 yes no Lot Lines idencifiablees C1 no SYSTEM MAMMA= Improper use and rnaiatenaaa of your septic sy* meauld z= ft kits V mru ata i.-Waae to handle wastes. Proper msintcaanee consists of pumPigg out rim septic tame every throe years or sooner, if nneaded by a iiceesad puanper. Yhat you put into the Mtem can affect.ft #unction of the septic tack as a twatnzat stage in the wsft drsposal:syst= Tltia property owner 49= to atrbmit to St. Croix Zcnting Depattmrat s ced5cafioafma. signed by the ow=. mad* a zn2Sftrp h=bcrjo=eYm&npb=baY FIR po ora bmsodp=pervecifyiagthat(1)tbeon sitewastcwatcrdisposslsysnem is in proper operating condition and/or (2) alter inspection and p=ping #f aeoessary), the septic tank is less than 1/3 full of sludge. L/uRra, the under4gnod ban read the sbova requi em enu and to pia the private Mwage disposal system with the standards W forth, hexcic,'as Set by du Department of Commerce and the Department of Piatural Resources, State of Wiswasht.. Cettifcattion taaligg that Your septic cyst= has be= maintained must be completed and retained to the St. Croix County Zonirg ()ffice within 34 days o throe expiration data. S1GXA7LMr0F APPU DATE Q',ERTIFc'ICA'1'rON I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owne*) of Wa above, by virtue of a wananty deed mcordod in Re &ter of Deeds Office. I TURK F APP1.:I DATE s « « * «t My information that is mis4cp==tedmay result in the sanitary permit being revoked by the Zoniag Department. «" •« «• Include critic this application: a stamped warranty dead fi= the Register of Deeds office a copy of the certified survey sup if rcferenoe is made in the wastanty deed 4.; r K - t W ; in � 46 -dk ♦ 16 '1 ♦ 1 ' doomp ao lop .r ` r •. . � ---rte' 1 Qp� o~ 1 ' of i � 0, f68 O+ 77/d r C; in Ire op i GEN f ' ! ft on yu, � rn An �d WdEE : ET 200E ST dad T89LLLESTL : ON Xdd 2131N80 SB7dS 30U A 61: WOid 4 iG :1464 PAGE 340 12345 KATHLEEN H. WALSH ~TAPE 8An OF WISCONSIN FORM 2 - 1996 REGISTER OF DEEDS D NO. — WAPIFIANTY D EED ST CROIX CO ., WI - - - -- --- _____�...___--- - -_ - -� RECEIVED FOR RECORD Tro De a M 10-20 -1999 9:00 AM Corporat Grantor -- - - _1 - - - - -- - - - -- — WARRANTY DEED -- -- -- - - -- - -- - - - - -- -- EXEMPT # conveys and warrants to - CERT COPY FEE: COPY FEE: David P. Banaszewski and Sherry K. Banaszewski, TRANSFER FEE: 299.70 husband and wife RECORDING FEE: 10.00 PAGES: 1 the following described real estate in St C r o iX -- _County, State of Wisconsin: - - - - -- RETURN TO I,Ot 77 of the Plat of T roy Village in the Town of David and Sherry Banaszewski Troy, St. Croix County, Wisconsin. 8972 Hunters Way Subject to Declarations of Covenants, Conditions Apple Valley, MN 55124 and restrictions for Troy Village, recorded in Vol. 1241, Page 256, as Doc. No. 55996 4, and "J `-J the Declaration of Col f Course Covenants, Parcel Identification Number (PIN): Conditions and Easements, recorded in Vol. 12/11, Page 301, as Doc. No. 559969, all as appearing in the office of the Register of Deeds for St. Croix County, Wisconsin, and such other easements, reservations, restrictions and reservations of .record, or in use, and obligations contained in the Purchase Agreement for this lot. This is — --- .__.______ homestead properly. (is) (is not) Exception to Warranlies: Dated this 13th dn of O ,19 99 - - -- — - -- - -- -- (SEAL.) (SEAL) Charles S.- _Cook, - President Troy Development Corporation - -- -- -- - - - - -- (SEAL) — - - -- (SEAL) * AUTHENTICATION SS((��ACKNOWLEDGMENT Signature(s) S IATE OF IRR2 TA ss. -- -- Anok _ _ County. authenticated this day of Personally came before me this 13th day of October fg 99 the above named -. har- e-S— SA o o - r - es; d P n +. _ Try -Deve Qp-m c or nrati um Ivnowulg nescrwe0 real estate in `-' V_ �- 1 - U 1 X .�__.__.. ^_. �:011rlly State of Wisconsin: -- _ -- - - -- -- • RETURN TO 1,0 t' 77 of the Plat. of Troy Village in the Town of David and Sherry Banaszewski Troy, St.'Croix,County, Wisconsin. 8972 Hunters Way St.thject to Declarations of Covenants, Cond- Itions Apple Valley, MN 55124 and Restrictions for Troy Village, r-ecordnd in - -- Vol . 1241, Page 256, as Doc. No. 55996A, and /D q the Declaration of Golf Cotir-se Covenants, Parcel Identification Number PIN : Conditions and Easemenia, recorded in Vol. 1241, Page 301, as Doc. No. 559969, all as appearing in the office of the Register of Deeds for SL Croix County, Wisconsin, and such other easements, reservations, restrictions and reservations of record, or in use, and obligations contained in the Purchase Agreement for this lot.. This— is no ` - - -- homesleadproperty. (is) (is 1101) Exception to Warranties: Dated this 13th — — - -- - ------- - - - - -- ------ - - - - -- day of � - -- Oct 99 -- - - -- - - -- - - -J_— �>7"!� - -- -- -- (SEAL) - -- —. (SEAL) Charles S. Cook President Troy Development. Corporation -- - -- ------------------ - - - - -- (SEAL) _- - - - - -- (SEAL) AUTIIE14TICATION ACKNOWLEDGMENT Signatures) ------- -- - - - - -- - - - - -- — STATE OF�UMQT4 ss. - - - - -- -- - - -- -- - -- - -- - - -- _ Ano ka _ _ county. authenticated this day of - -__ -, _ 1g — Personaliv came before me this 13th day of October ,19 99 the above named ea ic]Pnf Tr°�`- pevelSZpment<C9 ion TITLE: kAEMRFri f�l - naE RAR OF to me known to be tha person _ — who executed the TrIIS INSTRUMENT WAS L1M authorized by C 70F A rrri) Ely foregoing instrument and /ack orprI d e1he same. kr — b E [i1 TROY DEVELOPMENT CORPORATION '/ U O` l � — -- - - - - -- -- -- ---- - - - - -- N Nancy L. Clif ti Notary Public -, -_ An ka County s-MINN (Signatures may he authenticated or acknowtodged F301h are not necessary.) My Commission is permanent. (If not, stale ax iration date: Jan 31 ,} ) �rJ­'s of prrernra signing in any c-'p;lcily ' 110131 -1 L? lyp01 or printed hull r; Ihrir Jgi •ilm oc. WAnnANTY DEED S132 NTF 0021A S rATE BAR OF wisconsiN Nelco Forml, P.O. Box 10208, Green Bay, WI 54307.0200 rnrm 1J1) 7 -- 199R '1 NANCY L. CLIFT .11 NOTARY PUBLIG-MW30TA MY COMMISSION EXPIRES JANUARY 3112U IVNIIDIHO Z D 0 UJ z -j ui LU ul < cc 0 CL ui Lu LU 0 Lu x H z L) LU z M 0 cc z LLJ LU O O Z R CL < w < m a: W ui C3 D Cl) 0 x U) LU LL C) 0 w z Z P- Z a. z 0 z z Lu u j X 0 a. I ui w 5 U) Z, I . z 0 < ui T 0 L) w < 1 . 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