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HomeMy WebLinkAbout040-1295-10-000 0 CO) 0 r 03 0 T n T 0 Q! Z a z CL Q 0 0, (D .0. M 0 U) rn N 0 CID Cl 0 L5 6 O l C.) Z > CL :3 I W 0 (D C CL 0 CD 0 Z 0 X n o r . (1) Cc 0 00 a JEU 3 CO) to Cr W :r rn D z > > o 0 CD CL "m e CD (D in z 0 Z 03 T m 00 (1) M Z U 0 to Z CID ? 0 Z 21. CD V) cz 0 00 CD fn 0 County: St. Croix Wisconsin Department of commerce P RIVATE SEWAGE SYSTEM Sanitary Permit No: Safety and Building Division INSPECTION REPORT 463436 0 [Privacy (ATTACH TO PERMIT) Law, s. 1 5.04 (1)(m)]. Parcel Tax Ncl� g State Plan ID No GENERAL INFORMATION I Personal information you provide may be used for secondary purposes Insp F Eie Elev: BM D esc r iption: d Permit Holder's Name: City Village X Township 040-1295-10-000 Stalock, Michael I Insp. BM Trov. Town of Section/Town/Range/Map No: .1693 CST BM Elev: 19.28.19 ELEVATION DATA TANK INFORMATION CAPACITY B n hmark STATION B HI FS ELEV. TYPE MANUFACTURER Septic Alt. BM I 3 TYPE i E - Jl 0 6,00 A_ Bldg. Sewe 160 101 Aeration 3 r ewe 411A St/Ht Inlet Holding St/Ht Outlet TANK SETBACK INFORMAT TANK TO W ELL BLDG vent to Air intake ROAD Dt Inlet Dt Bottom Septic 7 ZO an. c AMU- Dosing 1�_ I Dist. Pipe Aeration 4- * 1</ (Di l Ho ii Ung Sot. System /00. 3.3 97 (ol I Final Grade PUMPISIPHON INFORMATION Demand St Manufacturer GPM -e 54 Al Model N ber 2 1k 33 TDH Lift 2 z ictio n Loss System ead . . (0 It. t . . . . . . . . . . . . . . . . . . I Length ia It Dist. to Aell Ir I /J la) + - 1� I I :!:l I I I :1I 151!i I 0 SOIL ABSORPTI S YSTEM o. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Dept BED/TRENCH Width Length %___ DIMENSIONS 17— BLDG WELL Manufacturer: SETBACK SYSTEM TO M odel Number: INFORMATION Ty System: 1 �� UNIT DISTRIBUTION SYSTEM x Hole Size X Hole Spacing ve to Air Intake Distribution it Z_ Pipe(s) r 2 — S.acing 3zllll, Length- Length Dia SOIL COVER x Pressure Systems Only Xx Mound Or At-Grade Systems Only xx Mulched xx Depth of jxx Seeded/Sod d Depth Over / Depth Over N j s INo Bed /Trench Edges Topsoil Yes o COMMENTS: (include code discrepencies, persons present, etc.) Inspection #1:L/ Inspection #2:----!-/- Estate L �Fil " Cel No: 19.28.19.169 Location: 350 Mitchell Road Hudson, WI 54016 (NE 1/4 SE 1/4 19 T28N R19W) Trebus Vplley 1.) Alt BM Description =Tor 01411 2.) Bldg sewer length - amount of cover Plan revision Required? Yes > No (D Cert. No. Date Use other side for additional information. Insep r' igna r SBD-6710 (R.3/97) y a C � Safety and Buildings D visyy'gqn County 201 W. Washington Ave., NVIF.Wonsin Madison, W1 53707 Sanitary Permit Number (to be filled in by Co.) (608) 266 -3151 3 1/3 G Department of Commerce // to Sanitary Permit Application �� o Pl I.D. Number ' �`�' �'9 _ -r In accord with Comm 83.21, Wis. Adm. Code, personal information yo provid may be used for secondary purposes Privacy Law, s15.04(1)(m Pr 'ect Ad r yy(if diff erent than m I. Application Information - Please Print All Information IIIA Property Owner's Name ZONING O F el Lot # Block # z'n �_, /I r, — Property Owner's Mailing Address Property Location Section City S ode Phone Number I n ` l cir one II Type of Buildi (check all that apply) ud s or Subdivision Name CS umber 2 Family Dwelling- Number of Bedrooms ❑ Public /Commercial - Describe Use ❑ State Owned - Describe Use ❑City ❑Villaggwn �p of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) 040 - )2. 1 -CrM - A0 A " System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) ❑ Non Pressurized In- Ground ❑ Mound> 24 in. of suitable soil ❑ Mound <24 in. of suitable soil ,� t -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersa&Area Required (sf) Dispersal Area Proposed (sf) System Elevation i J VI. Tank nfo Capacity in Total Number / Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units W (OBQ —) (� Concrete Constructed Glass New Existing Tanks Tanks' Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statement- I, the undersigned, responsibility for installation of the POWTS shown on the attached plans. Plumb 's Name (Print) Plumber's Si MP//MPRS Number Business Phone Number 7) / Plumber's Address (Street, City, State, Zip Code 7 VIII. Coun /De artment Vse Onl Approved ❑ Sanitary Permit Fee includes Groundwater Date Issued Issuing nt Signa Stamps) A Surcharge Fee) ' n Reason r Denial IX. Conditions pprov 1 SYSTEM OWNER: 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) i ael Stal PLOT PLAN och A DDRESS 5729 25th Ave S. Mln nea DOIIS Mn 55417 E IMS 19 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX TEM ELEVATION 100.0 BEDROOM 3 VENTIONAL AT -GRADE )00( CONVENTIONAL LIFT HOLDING TANK ;MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of 3/8" Rebar ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE (D WELL * H. R. P. Same as Benchmark Property Line Grading is to be done to 180' divert run -off away from System B -2 ❑ B -1 10 B.M. Alt Top of rebar @ 100' 100.2' 0 99 = ITO B-3 6% B.M. Slope Area 15' below system well is to meet all to remain undisturbed setbacks found in Comm. 83 >5b Huffcutt o ank��`� Pro 3 Tank is to be Bedroom properly bed provided with lockdown covers with approve warning label o r Scale = 1/4" = 10 554 557' Property I I Property Line Line �S 2 J ul �- �9�) _ 4 / e 65 Q� • Safety and Buildings * 4003 N KINNEY COULEE RD commerce.wi.gov LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 t isconsin www.w www.coe.wi.gov/s / Department of Commerce isconsin.gov Jim Doyle, Governor Mary P. Burke, Secretary April 05, 2005 CUST ID No.226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/05/2007 Identification Numbers Transaction ID No. 1123954 SITE: Site ID No. 696560 Michael Staloch Please refer to both identification numbers, 350 Mitchell Rd above, in all correspondence with the agency. Town of Troy St Croix County NE1 /4, SE1 /4, S19, T28N, R19W Lot: 1, Subdivision: Trebus Valley FOR: Description: Proposed Three Bedroom At -grade System Object Type: POWTS Component Manual Regulated Object ID No.: 1011620 Maintenance required; 450 GPD Flow rate; 40 in Soil minimum depth to limiting factor from original grade System(s): At -grade Component Manual, SBD- 10570 -P (R.6/99), Pressure Distribution Component Manual, SBD- 10573 -P (R.6/99); Biofilter 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. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. 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 approved plans, and with publication SBD - 10570-P (R. 6/99) "At -grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems ". • The pressure network is to be constructed in accordance with publications SBD - 10573 -P(R. 6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) ". • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. 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 approval conditions. .o.w. rs. conditio11; lly SHAUN k BIRD Page 2 4/5/2005 • Comm 83.22(7) - 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. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. 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. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WSMART code: 7633 jswim@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 3/30/05 Owner:Michael Staloch Location:NE 1/4SE1/4 S19 T27 N,R19W Lot 1 Trebus Valley Troy 350 Michell Rd. System type: At -Grade Manuals Used: At -Grade Component Manual version 1.0 SBD 10570 -P (R.6/99) SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At-Grade Cr i n �'�� � C Cross Section w cE a � MMER pt PARTMENF DY D N D BUILDINGS 4. Pipe Cross Section /Pipe Layout DIVIS 5. Pump Chamber Cross Section ON DENCE 6. Pump Curve SEE CORRE 7 -8. Maintance and Contigency plan 9 -11. Soil test Shaun Bird RECEIVED Si nature APR - g Y 2005 5 License number 2 6 v SAFETY & BUILDINGO i PLOT PLAN PROJECT Michael Staloch ADDRESS 5729 25th Ave S. Minneapolis Mn 55417 NE 1/4 SE 1 /4S 19 /T 28 N/R 1 9 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 100.0 BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of 3/8" Rebar ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Property Line 180' Grading is to be done to divert run -off away from system B -2 B -1 ❑ 10 B.M. Alt Top of rebar @ N 100' 100.2' b : I� �— -- p 99 � B -3 Slope Well is to meet all Area 15' below system setbacks found in to remain undisturbed Comm. 83 Huffcutt Combo Tank Pro 3 Tank is to be Bedroom properly bedded and House provided with lockdown covers with approved warning labels Scale = 1 /4" = 10' 554' 557' Property Property Line Line Page Of Distribution Pipe Detail For Lateral #detwork A ce s TuRt -t -uP �CLtAi4ou't _ PVC Force Hain pVC Distribution Pipe P L ast Hole Should Be Next To TuR�i -�tP ss � U ft. Role Diameter Inch X r Inches Lateral Diameter Inch(es Y 1Y Inches Force fain Diameter Inches # of boles /Pipe J Invert Elevation Of Laterals Ft• Signed- License Humber: Date: i + S PE CIFICA TIONS SEPTIC TANK € - UMP CA MBER CROSS SECTION AND SP£ FICA I WEAmERPRWF v == G VENT PIPE IZ" MIN ABOVE GRADE JUNCTION BOX APPROVED F R OM DOOR, WT RpOW OR WITH CONDUIT MANHOLE COV �` W/ PADLOCK 6 ;INTAKE � _ Ig . , � ;. BEL Ftt£��� Pm & �IARKI�iG LABEL 9 GRADE 4" MIN . �a -, t8�+�. I8" a INLET Ea WATER TIGHT SEALS '�" TIGHT r �ED A SEAL ; `. `1t?I�I� PE FI LTER ! ALM AP B = ' ON �IID SOIL APPRWED PIPE 3' C r OFF OM SOLID — f — -_ SOIL PUMP OFF ELEV - l- J . T — D 3 u AYPROVED BEDDING UNDER TANY CONCRETE PAD SPECIFICATI002 r /S cd/�vrlo DOSES pER DAY: r SEPTIC I DOSE ;,RINSER DOSES "A '23iC MAN�IFAC vC ME T- NCLUDIHG .. - �� L- i GAL- DOSE ; F LOWBAC K : � b— - r5 SIZES: SEPTIC GAL TAN K - 3 .� ��.. DOSE NCHES = �. CAPACITIES = 3 6 GAL - AyKgM Mpi�iUFAC1T3RER ` � .2 INCH Mo D£L RDi38 = L ✓�`�. = ��rGF'L' APE : / cs .L— V C INCHES SWITCH TYP f _ I3 �FAC'I�3RF plimp M DEL NUMBE �,, 16. 23 AC I'1CH TYPE: . 7✓GQIf pDTiP £ AiyARm idlRli'�G AS PER ILHB RATE �— FEET ZZ SN l3ISCMARGF- IBUTIflN PIPE . FEE'£ REIWIR DISTR - - ----- FEET pU14P OFF AND VERTICAL DIFFERENCE 3 pu IRE - ' £ggC'TIOH FACTOR . - • fr EETZ•d 1 + MIN ` M NETWORK SUPPLY X J FT/ IQ 11 DYNAMIC tip { / rEET FORCEM�" T O �� ; 'Di . / , W �nTt4 _- _..._.� /6"D LENGTH � ENTERNAL DIMENSIONS OF gUMP TAr�K= I.IQI3ID ' DA E L I CE: 5IGNED: _ - TOTAL DYNAMIC HEAD /CAPACITY PER MINUTE HEAD CAPACITY CURVE EFFLUENT AND DEWrATERING V MODEL. 152/153 mODEL I 152 153 M 50 Feet i Meters GoL Liiers Gol. I Lifers 5 1.5 69 261 77 291 153 1 p I 3 - 1 51 231 70 i 265 12 40 152 15 4.6 I 53 201 61 231 a 20 6.1 ! 44 I ] 67 52 197 _ I 25 7.6 34 129 42 159 30 a 30 9.1 23 i 87 33 125 0 35 1p.? I -- - 22 i 85 Q 2p 40 12.2 i -- -- 11 42 1 Lock Voive: 38.0 F i. (11.6m) Ft. (I3.4m)I 4 D 14508 10 0 2 i p 40 60 80 100 GALLONS t— s 1/4 —� LITERS p 80 ] 00 240 320 - 3 27/32 5/3- -1 FLOW PER MINUTE ;\ 3 27/32 CONSULT FACTORY FOR SPECIAL APPLICATIONS _ 6 • Timed dosing panels available. ® i 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with I an alarm. l • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable �--- r --r level long and short cycle controls. • Sealed Qwik -Box available for outdoor installations. See FM1420. • Over 130 (54 °C.) special quotation required. I I i 12 /5 15T153 Series 1 I 15?J153 MODELS Control Selection Model l volts -ph Mo Am I simplex Du le: N152 115 1 Non 8.5 1 2 or 'z SN152 115 1 Auto 8.5 Included 2or3 sKZ°s' E152 230 1 Non 4.3 1 2 or 3 - -1 I BE152 230 1 Auto 4.3 Included 2 or 3 Ni 53 115 1 Non 10,5 1 2 or 3 SELECTION GUIDE SN153 115 1 Auto 10.5 Included 2 or 3 E1 33 230 1 Non 5.3 1 1. Single piggyback variable level float switch or double piggyback variable level float FE153 230 1 Auto 5. 3 included 2 or 3 switch. Reter to FM0477. o caunoN 2. See FMO712 for correct model of Electrical Alternator E -Pak. Ali installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 - 0225 used as a control activator, specify duplex (3) licensed electrlcian. Ali electrical and safety codes should be followed including the most or (4) float system. recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL 7 P_O- BOX 16347 Louisville, KY 40256 -0317 Manufectlmof. . SNIP TO, 3649 Cane Run Road Louisville KY 40211 -1961 Qvau TY�•LGllvS lhlf /939 eI /p (502) 778.2731.1(800) 928 -PumP /mp://www.zoader com / �, "` M. FAX 1502) 774 -3624 © Copyright 2000 Zoeller Co. All rights reserved. MF NT PLAN Page E of poWTS Owt4ER'S �pNUAL 8� MANAG SYSTEM "t)gal INFORMATION i Septic ?ank CaPa ' FILE i Cc 2�t P -1 ou Septic Tank manufacturer owner P en»it �. Effluent Etter Man��� EJ Effluent 'Ito MQdei ESIGN P� Tank t:apadtar Ntow of 90moms Nq Pump NA N,MW Of C'WWe� Units 3 � aYd Pump Tank M curer flow (average)Pump Mantic hAw ❑NA DesVn flow (PWV ). ( mated x �-� aVd Pump Model ent Unit Sod ApPOn Rabe Monthly average- Pr etxealm � S p Peat Filter trrfluent'/Eflluent Quality ;3o ;3o mg1L 3 Mechanical Aeration ❑Other_ Wetland Fats Oil &Grease ( 1 5220 mg/L C3 Disinfeot+on mkW Oxygen Demand (BODE 5150 m fL Manufaclatrer Bi • clad Boras ) al CeII(s) ressurized) p Total SusPe' Monthly average"' t)isp� t1 In -ground (p fd Effluent Quardy 0 n-9round (gravItY) p Mound SODS) �0 mg e -grad p ether_ Biod+emi Oxygen Demand ( 530 mg/L p Dn ine S011 (T ) non- oann1er11k83iO"r'SOC Total Suspen metric mean) : 51 0 1% cful4 pOmt Fecal Cordorm (g valuestYPic fOr doh Y inch diameter sep� � elHuent ter - Maximum Effluent panicle Size «. Values hptcaE for OK� wastewa Service FreQuency TE MAINNANCE SCHEDULE 6year(s) (Maximum 3 yes.) Service Event ❑months At least once every oats Inspectcondi io en combined sludge p m one - third (y,) of tank volume n of tank(s) Wh and scum ear(s) (Maximum 3 YrS•) 3 Pump out contents of tanks) At least once every ar(s) I sat cell(s) D months ' ct d i At least once every r(s) p NA p months clean effluent fitter At least once every r(s) p NA ntrols A am ta► J ,? p months InsP9d PP mp. Pump co At least once every p months ❑ year(s) 0 NA Flush laterals and Pressure test s) p NA At least once eve? ❑ months II yew( X10 At feast once every 00or Septage licenses or INSTR UCTIONS an individual canting one of the following GE S inspector. POW'rs Ma'cntainer, MAspeci 1NSTR ns dispersal Ceris s hat! be made b?' WT- any missi or broken ng Ins of tanks and drspe Plumber Restricted Sewer: to en* Master plumber: Master pn of the tank( } m and to check for any back up tions: ns must include a volum ins om ed sludge a d oche the effluent levels Seth n I perator. Tank inspecoo O ore the volume of combin nd scu chid t effluent on the cracks or leaks, meas .The dispersal oelt(5) shall be visually inspecte hardware, iden�Y any round surface - round surface The P° authority and to check or �mg of effluent on the g for any pondrng of effluent on the g mediate no tion of the local reguWa in the Obseiva�n Pipes and requires the im surface rr►aY indicate a failing C,o tank eQ nd °ttro oats one -third (Y� of in accOrd or more of the rank volume, thNR groom a and scum in any Sid ance '�' mutation o sludge a Septage Servicing Operator. and dispo When the combined a� shall be m rnoved �y vents: and any entire contents of the tan t,ve Code retteat#fient compo ri y Cont nsin Admin ister co mponents, P fled t � 0 Maintainer mechanical or pressurized POWTS comp ifo�� by a Cerb Tile Se Mng of effluent firs. 12 months or Tess shall be A? feNon of any service event t re authority within 10 days of corn o P ther maintenance or morittoring at interva . - ' A servige n� shall 'be provided to the Iota roduds or other �e pence of painting p sTART UP AND OPERATION treatment tank(S) for If high conWtratjonS are For new pon5tl�n• PR or to use of � PD�S ��. er C sal Cell(s). chemicals that may impede the treat et moved by process and/o damage the disc r 1 pr to use - el a septage servicing Pe p detected have the Contents of the tank( Page of t -1 conditions are frozen at the infiltrative surface. When P� is mstpred t!1@ S in start u p shall not oxur %"en above normal tlghwater levels. the ce ll and may result in the s) tanks V one large dose, overioadn9 tank removed by a o utages p>�P impel ceii(s) in 1S of the pump D ��� r wai be � Of effluent To �id this th eeffluent pump or contact a Plumber a POWYS Malcttatner to :rIeStong bacicu p � g Opel p s to estore normal feveis within the pump b . Septag ng tW PUMP rk over, o otherwise disturb or compact assist in manually and Crisper" oaf . Do not drive a r Do not drive or patio vedel over tam mound or at - grade soil absorption area . he area w ithin 16 feet down s-111136 of arN rove the performance and Prolong the life t fre,rn the wastewater stream fay imp (jeQrtaasers: dental flass; Reduction or- erunination of the f+altowing rte butts; condoms: cotton swabs: antibw ios: baby vlriPas: dgan✓ v�ater fruit and vegetable peelings; gasoline; grease; herbiddes, meat of the POD: f,�cida on JiWn {sumP P F) brine - dfsktfectanls: fat; •011; ( des; sanitary napkins; tampons; and water soften scraps; ng Prod , Pia AgANDONMME'IT taken out of senrioe Comm 83.33, the follov fra steps strati b5 taken t insure that the When t h e ppyyfg {airs andfar is pew m�omn� with ch_ Wisconsin Administrative Code sys� pmperfy artd safely abandon Openings sealed• its st►a11 �be disconnected and the abandoned Pipe 0Pe � e $eryicing operator All Piping to tanks and p" ro disposed of by a Septa9 The contents of an tanks and pits stiall be removed and p roperty IY and [fie void space f After p � mP ing, all hanks and pl shall be excavated and re . moved or their covers removed filled ,.? soil, g�yei or another inert solid material. CODiTMGENCY PLAN the following measures have been, or must be taken, to Provide a code if the pOWTS falls and cannot be repaired compliant replacement system: been been evaluated and may be utilized for the location of a replacement soli ❑ A suitable re placement area area should be protected from disturbance lines and wells. Failure and compaction and should not absorption system. The replacem from existing and proposed structure, ilure to be infringed upon by requir+edwi result in the need for a new soil and sitWeval �rn establish a suitable prole the replacement area ms must comply with the roles in effete replacement area- Replacement Sys ere laeement area is not available due to s� o an d/or eptaoe t he ed POWYS- advances in PO ❑ A suitabl . P be �tled as a last �lokrgy a holding tank tray a suitable replacement area Upon failure of the POWTS a soil.and _ evaluation must be identify nt area is available a site has not been e valuated to locate a suitable replacement area. If no repiaceme rte perms hg tank may tie installed as a last resort to replace the failed PO _ a� fo[lowing removal of the blomat of may be reconstructed P the nfiitrat3ve Surface. RecOnsttu' ns of such systems must Comply With the rules in effect at that time. ind <<WARNING" TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN - SEPTIC, PUMP AND OTHER TREATMENT CIRCUMSTANCES. DEATH MAY DO NOT ENTER A SEPTIC, PUMP OR OTHER TP EATMENT TANK UNDER AAIY RESULT.. RESCUE OF A PERSON FROM THE INTERIOR Of A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL. COMMENTS • pOWTS MAIIVTAi ER POYIfTS INSTALLER Name ,1 Name w Phone ? i s-7 j Phone LOCAL REGULATORY AUTHORf[Y SEPTAGE SERVICING OPERATOR PUMPER agency l� f l E N am e d 77 - _2 7 ` Phone ..-•- � • ets Phone �p Is d ocrr mnt me e C 1 `� a nd Sann�atiort a9ef>des- Th Wo w salts of are Gram L ske. MaMuede end Waushara County Zoning Tats avarmentwas dr'stted by t artd 83 -KI), (2) & (3), Wisconsin ArlrttituTs fig Code. Use of tttls d�rttent does not the nlwmum requasments of nti Comm 83_ZZM(b)( l(d)�M WIN 1 t1 guaaaw the performance of the POWTS. 13sN3131'l : 3b nL to r4 tS a�tg 2u-Edo a uo sa -My U01adlosgV allu ?S e t{� t� stun apea9 -,K u•csu0251fi 3o uoi3aag SBOAD puv A uVZd 1 9Z : ,Z� b ,g< li a .canoe �sos . jo.caia uoangp4sl f Z 31tt�3�� ► "212 0 . 1 137 t 89/t l ft{' 1494 Wisconsin Department of Commerce SOIL EVALUATION REPORT S p ao 84; p age 1 of 3 Division of Safety and Buildings in accordance w m 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations County Attach complete site plan on paper not less than 8 1 i Ws' .FQ m t _ St. Cr include, but not limited to: vertical and horizon f ant (BM), di in Parcel I.D. percent slope, scale or dimemsions, north arr lion ar)listance to 040- 1 078- 4 0 -000, ID #1 9.28.302 Please print all atio� CEN10 \. - -- - B - Date -- Personal information you provide may be used Y ndary purposes (Privacy Law, s. 15.04 (Tj(jnl y ZZ Property Owner r ropwty ion J.T.B. Properties, L.L.P. C/O Jo hn W. lel n 7 Govt.'tot SW 1/4 SE 1 S 19 T 28 N R 19 W - - Property Owner's Mailing Address h - Lot #'," Block # Subc1 Name or CSM# ZCINIING 15 West University A venue 'r Trebus V alley Estates City State Zip Code orl` City ViIlage] Town Nearest Road Saint Paul MN 1 55104 6 r Troy I County Highway "F" New Construction Use: g Residential ! Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement J Public or commercial - Describe: Parent material Glacial drif Flood plain elevation, if applicable na General comments and recommendations: Site suitable for At -grade system. Recommend installing mound system at elev. = 101.30' at 6" above 100.80 ' contour to increase dispersal of effluent through system area. Bonng # J Ong -- 1 Pit Ground Surface elev. 100.75 - ft. Depth to limiting factor -_ 40 `_'_in. Soil Application Rate Horizon Depth Dominant Cola R Redox Description Texture Structure Consistence Boundary sots GPD /ftz *Eff#1 *Eff#2 1 0 - 11 10yr3/3 none sl 2f mvfr cs 2fm 0.5 0.9 ( 2 11-19 10yr /4 none sl 2msbk mvfr cw 2f,1m 0.5 0.9 `P 3 19-40 10yr4/6 none sl 2msbk mfr cw 1 f 0.5 0.9 ( 4 -58 1Oyr4/4 f2d 7.5yr4/6 sil 1msbk mfr gw 1f &vf 0.5 0.8 5 58 -84 1 Oyr5 /4 m2d 7.5yr 5/8 s/Is/sicl 1 csbk dsh - - 0.2 0.3 Boring # J Boring Pit Ground Surface elev. 100.83 ft. Depth to limiting factor __ 48 " in. Soil Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD /ft= *Eff#1 *Eff#2 1 0 -10 1 Oyr3 / 3 none sl 2fsbk m vfr c s 2fm 0.5 0.9 , (� 2 10 -22 1Oyr4/4 none sl 2msbk mvfr cw 2f,1m 0. 5 0.9 3 22-48 1Oyr4/6 none sl 2msbk mfr cw 1 f 0.5 0.9 �P 4 48 -72 1Oyr6/4 f2f 1Oyr4/6 s Osg ml - - 0.2 0.3 ------------ - - -- - H#4 contains colkMal sl and limestone fragements. - Loading rate adjusted to reflect reduced permiaibilty associated with abrupt textural changes. * Effluent #1 = BOD ? 30 < 220 mg/L and TSS > < 150 mg/L * t #2 = BOD < 30 mg/L and TSS < mg/L CST Name (Please Print) Sig ature: CST Number James K . Tho 3602 Address A.C.E. Sal &Site Evaluations - -- - 'Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 20 12/5/01 715 - 248 -7767 Property Owner J .T.B. Pr opertie s, L .L. P . C/O John Parcel ID #_ 0 40 - 1078 -4 -000, I D #19.28.302 Page 2_of 3 3 ] Boring # J Boring 16 Pit Ground Surface eiev. __ _ ft. Depth to limiting factor 42" in. Soil Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots _ GPD /ftz __ *Eff#1 *Eff#2 y - - - - -� . . 1p 1 � 0-28 i 1 r'3/2 � -- n one sl 2fsbk mvfr cs 2fm 0 0.9 -_- _._ - -- _ - - - -- 2 28 -37 1Oyr4/4 none sl 2msbk i mvfr cw 2f,lm 0.5 0.9 3 1 37-42 10yr5 /4 none sil 1 csbk mfr �cw 1 f 0.2 0.3 4 42-67 10yr5/4 f2f 10 yr4 /6 sil Om mfr - if 0.0 0.2 -- --- -- - - -- - - -- -- - -- -- - -- - - - - � `n- H#4 contains colluvial sl and limestone fragements. Loading rate adjusted to reflect reduced permiaibilty associated with abrupt textural changes. 4] Boring # J Boring W Pit Ground Surface elev. - 51-M - ft. Depth to limiting factor 34" in. Soil Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPD/ff *Eff#1 *Eff#2 1 0 - 11 10yr3 n one fsl 1fs mvfr cs 2fm 0.4 0.6 2 11 -20 10yr4/4 none Ifs 1msbk 1 mvfr cW 2f,1m 0.4 0.6 3 20 -28 1 Oyr4 /6 none tsl 1 msbk mfr cw 1 f 0.4 0.6 4 28 -34 10yr4 /4 none sl 2msbk mfr gw 1f &vf 0.5 0.9 , 1 r /4 sil 1 msbk mvfr cw - 0.2 0.3 5 � 3 52 � Oy 5 m2d 7.5y 5/8 --' 6 5 2-80 1 Oyr5/4 m2d 7.5yr 5/8 s /Is - /sl 1 csbk dsh - - 0.4 0.6 - - - - - - - - -- - -- - - - -- H#6 contains 1/4" - 2" 7.5yr4/4 Om sl bands at 1" - 3" intervals. Loading rate reflects the most restrictive condition encountered. F-1 �# J Boring - - - Pit Ground Surface elev. _ ft. Depth to limiting factor in. FSRl Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Sz /ft - *Eff#1 *Eff#2 i I * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD -S 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. v S 89'35'25" E 1324.42' (N89'37'04'E) 'mil • ,20..6 40TH f.48 4546 S� s x'25' 366.64' K c. 4 292.06 / 'S SHEET 2 a. O PEN' Sp pCE-- _ .._ 7 LOT 4 a ' ` rr+ LOT 3 v 2.16/Ac. 4 d j 1 1 Akf .E. •900• t L ibbW" 1 y ' iQ1994 S.F.\ 3EMENT 1 s , OT 21 ` 2.34 Ac. M.F.E. - 900' 'MkA$W 4 . i HK �. 1139W S.F. It, . "K . .� � a�. 1 2 A 1Nf� OT 1 r �,t ELY 11 52 S.F. I I 3.49 Ac.) /� 6 M ► ' EM MM MME • F.E. 890' . / �, I �7 2• g ONAMAOE - EAIDMT LOT 22 \ M 170984 S.F. 3.93 Ac. 413 _ _ ` LOT 23 183329 S.F. / \ 4.22. Ac. M.F.E. • 89S i 1 LOT 24 � .= 1 171990 S.F. o ` 3.95 Ac. i• ' 1 1 M.F,E. - 893' Not 98917-98£ (5 LL) Xe-� • 08917-98£ (9 LL) O LLL - 9 L017S IM `uospnH peoa louplueo LOLL 831N301N3WN83AOJ AiNnoo XIOaO '1S •een _ ■rrnann� 213I33O OAIINOZ - n y NISNO3SIM T ,j A1Nnoo XIOao as Mar 19 05 11:02a Arlene Weikle 612- 729 -2071 p.2 ,-� ST CROIX COUNTY SEPTIC TANK IviAINTENANCE AGREEMENT AND OWNERSEU CERTIFICATION FORM owner/Buyer Michael Staloch and Chelsea Crouch Mailing Address 5729 25th Avenue South, Minneapolis, MN 55417 Property Address 350 Mitchell Road, Troy, WS H " _"� ►1 (Verification required from Planning Department for new construction) City/State Troy WS Parcel Identification Number 0`-0 - 1Zq S - to - OCID �• /6 `� 3) LEG_sr. DESCRIPTION Property Location NE %4, SE y,, Sec. 19 . T N -R 19 W, Town of Troy Subdivision TREBUS VALLEY ESTATES Lot ## 1 _- . Certified Survey Map # _ Volume Page # Warranty Deed # Volume T� } --, Page # - 1 Spec house ❑ yes 0 no Lot lines identifiable ® yes ❑ no SYSTEM MA2M LNAj4GE could result in its premature failure to handle wastes. Proper maintenance Improper use and maintenance of your septic system. Y a licensed pum What you put into the system consists of pumping out the septic tank every throe years of sooner, if needed b CIA affoet the function of the septic tank as a t eamsent stage in the waste disposal System The property owner agrees to submit to St. Croix. ZOaing Dcpartmaxt a certification form. signed by the owner and by a masterplumber jouraeymanplumber. ttxttieteflplumberor a Hoentod puwper verifying that (1) the on -site wastewaterdisposal system is is proper operating condition and/or (2) after inspection and pwgft (if °ocegsa5'), the septic tank is less than 113 full of sludge. Uwe, the nndc� have read the above requirements and agree to maintain the private sewage disposal system w ith the standards set forth, herein, as set by the t of Commerce and the Department of Natural R+esoutncs. State of Wisconsin. Certification c system bas been maintained nutst be completed and returned to the St Croix County Zoning Office within 30 Ming that your sgpis sys days of the tbru car expiratio DATE S ON ATURE " APPL j TN V WNER CER'rjg)1CA'I'I 1 (we) certify that all statements on this form are true to the be wnerls) of st of my (our) knowledge. I (we) am (arc) the o the property described abov , virtue of a warranty decd recorded is Register of Deeds Office. r /'_. � � •� oP,i ! 1St / c;5 x DATE Sl �l�I A OP I L I-ar IC11 u %/�ri • y t wit being covokcd by the Zoning Department. " +• • Any information that is this- represented may result in the sanitary permit •• include with this application: a stamped warranty deed from the Register of Deods office a copy of the certified survey map if mfetcaoo is trade in the warranty deed V 2 7 8 7 P 6 14 DOCUMENT NUMBER WARRANTY DEED REGI OF DE � J.T.B. Properties LLP, a Minnesota Limited Lia ST. CROIX Co.. MI bility Partnership RECEIVED FOR RECORD conveys and warrants to Michael . Staloch and Chelsea K. Cr u h single 04/21/2005 09:30AN Persons, as Joint tenants . th right of survivorship WARRANTY DEED the following described real estate in St, Croix County; State of Wisconsin: EXEMPT # REC FEE: 11.80 LO PLAT OF TREBUS VAt.1,F.y ESTATES IN THE TOWN OF TROY TRAMS FEE: 339.00 CROIX COUNTY, WISCONSIN. COPY FEE: CC FEE: PAGES: 1 J 1I ■ At f� LA I ♦ j ■ s6 1 Q ,L ?'oal sy X G✓'�aS s''M •t o ;131/01 % O/ �In L -0�3 9 C/� h6hi ��� 06117/2005 09:47 17157237111 1 PAGE 01 4154 123T Sweet Chippewa Falls, WI 54729 800.924.1516 �I .. . ,..... r}• 1•:::::: ',.;y.�•li`y,...,x °n..,�•,}:.., r .rr. ,r �,��.''".x;..: d"m ,f a� , .I`. � 1'r !jlj 1 ItY• 4 j .III IYI �It �: RI: +� 1 ,,, � ,.... i.:� ?i�• .. , f'li)ri Y.::j1�A'•'y,•+ �.�.: �,.,,:,;::.��.�;-; i t �ry„�. "• � j qw- ( .. June 17, 2005 RE :. Shawn Bird/Michael Stalock, Lot 1 Tlrevis Valley, Troy Townshig Shawn Bird will be installing a septic tank for the Stalock job. This tank will exceed the state approved tank depth of 8'. A septic tank has been manufactured with additi,o -nal rei,ttforcing and will be supplied to exceed the state approved depth on S else Olson President .. � .•gym•• :�:•:,,•a:n!I. : G�':li,•p',�I 1..;;, }, i.:nn.1.,,.y,:i.F r :1 „! � � 1' ..,x,.,. {� 1. � ' I .. y�'i�'i• :`•i. „�1'i�;i�,,i ";��j:;.'ifi�' �.• C'yiYi ";:fata: }" • • .I;. ' � �,, : •.h• , J'1 ?�., ,'.H, x:y. • �.,,� 1 ,�.j� :};�G: �: y?:, " "';{Cf:q,'t. ° �i4G.y � 4 •n. 1 "{ A :il i6Wiu� '. . . . • . . . . . . • . . . . . • �i'j���7�1 ; 1411; H�,F;1 ': � � N�} � L }1. ,.. ,,,. ,, ..r•... a i .r�ci � p ��f'i„I' � � . �. . �iiiti'J,SS•. 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T 1� C.S V OL. 6c L 4 , P 993_ 3 , P AGE 870 F N ' 0 0'00' 13" E 13 07.00 NORTH —SOUTH 1/4 LICE r (NOO*47'18 "W) N 01 °05'40" W 831.73' 66 00' - ��— 97.59' N Z I _ O c_ C] t O O O Z 00 c cn N > V1 m ip D tzj O I i70�i, 4 Os I > -,j N o n -� �� - y y D rn i I O L -4 Q _ Q D Z 0 4 w ' cf) C i M O � N ' w z 2 y r � N 02'36'31 E fia cn �V rn L4 r w a D Z ,I ` J o c� N J 00 \ 1 c C) w ZO to.� b ° p rrt 1 � � r `�� N 0 1­ 3 I , z Ul _ 1 LW r ° �o \ '•