Loading...
HomeMy WebLinkAbout040-1296-10-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division * INSPECTION REPORT Sanitary Permit No: 420539 0 GENERAL INFORMATION (ATTACH TO PERMIT) tate Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. " = T_14 -�", 110 • Permit Holder's Name: City Village X Township arceI Tax No: Marsollek, Mike I Troy Township 040 - 1296 -10 -000 CST BM Elev: r Insp. BM Elev: BM Description: (), ZZ 1 703 TANK INFORMATION i ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 2D Septic Benchmark >r 12 5Z N SD ( El ZD ao • o Dosing / � r [ C1 Alt. BM l� /,� p ) JO•c9 J � Aeration Bldg. Sewer Holding St/Ht Inlet (;t/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic }D ( f _ Dt Bottom l 11, 30 )4 (1-0) ( •3o Dosing c � \ � 2 � r Header /Man. Aeration - — Dist. Pipe 3 a q Holding Bot. System qO " -20 8' -43 PUMP /SIPHON INFORMATION Final Grade , .,;L( be 12 �f s';j tMW - od Manufacturer , r Demand St Cover GPM Model Number I A CIII I , 0 t Lift t Friction Loss System Head TDH �DH rcemain Length t Dia. Z Dist. to Well ' SOIL ABSORPTION SYSTEM S .3fl BED/TRENCH Width �t Length f No. Of Trenches PIT DIMENSIONS No. O its Inside Dia. Liquid Depth DIMENSIONS +! SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEAC NG rModdel urer: INFORMATION Type Of System: CHAMBE Nl n > u t ' (fi ( \ t1 mb er: 0 J DISTRIBUTION SYSTEM Header /Manifolfl Distribution x Hole Size x Hole Spacing Vent to Air Intake �( z it Pipe(s) i t r o r 3 it Length 1'� Dia Lengt Dia 2 Spacing �' (p 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 Bed/Trench Edges Topsoil lid Yes [n No j Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 11 1 2-1 / 0 2 . Inspection #2: Location: 398 Mitchell Road Hudson, WI 54016 (N 1/4 SE 1/4 19 T28N R19W) Trebu alle states Lo�1 Parcel No: 19.28 \ 1.) Alt BM Description = � o� /1 / _ l 1 L °i ✓e4!' ltio 9- .� ..• � I tO. 1 .t�tn du¢o� 2.) Bldg sewer length 0 / r 1 /p� 3 amot(nt of coved _ �l�r ( ( L S ° Zp V G,r,1 / ► ► u�- o� _ . G n revision Required? No 1 F69 Use other side for additio or ati SBD -6710 (R.3/97) J � — C C-" t �� In sep ct n or Signatur Cert. No. AL Safety and 201 Washingto Ave., P.O. Box 7162 County r NN Pisconsin Madison, WI 53707 - 7162 Sine Address De artment of Commerce / -r -o Z 3 Z 3`19 YA1 fR -ftu_ {Zi-'-, Sanitary Permit Application SaruutarY Permit Number In accord with Comm 83.21, wis. Adm. code, Pe y P rsoumat iaformadon you provide 531 ❑ Check if Revision may be used for Purposes Privacy Law, s15. 1 m I. Application Information - Please Print All Information Stai Plan I. Number Property Owner's Name Parcel Number Property Owner's Mailing Address Property Location , r 9us� u T N, City, State Zip Code L , P" Number Lot N Block Number ��' vi_ Subdivision Name CSM Number II. Type of Building (check Ot that apply) aS Per 5 (Ro-IGS11 ❑city r 2 Family Dwelling - Number of Bedrooms l,� c" wti �+� ❑Village ❑ Public/Commere jj sc 'be Use ! o— P 11 State owned t -' + G Nearest Road 2 11 tID i (n ! 1� III. Type of Permit: (Check only one box on line A (numbering scheme for ` internal use). Complete line B if applicable) A. ew 2 ❑ lacement stem 3 ❑ 7��unry use Rep Sy Replacement of 6 ❑Addition to stem Tank stem B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apps )(numbering scheme is for internal use . A - (tom 44 ❑ Non Pressurized In- Ground ound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized BWround 1 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. DispersaVrreatinent. Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.FL) (Min./Inch) Elevation X00 O .O �0 9 . VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existin Tsars 'tads Septic or Holding Tank _ Dosing Mamber VII. Responsibility Statement I, the and C? erdgn responsibility for installation of the POWTS shown on the attached plans. Pi Name (Print) Plumber's MP/MPRS Number Business Phone N r Plumber's Address (Street, City, State, Zip CW VIII. Coon me artment Use Onl Sanitary Permit Fee (includes Groundwater Dace Issued Is su ing Agent Signature (No Stamps) Approved ❑ Disapproved 8m Ps 11 Owner Given Initial Adverse Surcharge Fee) Q 3z S I V12 0 Determination ply J / \ IX. Conditi�f�pdVRelosons for ' pproval r Attach pkte plam no ooi7) for the sy*em on paper not Jess than SW z 11 mehes in sire SBD -6398 (R. 05101) PLOT PLAN IJECT Mike Marselak ADDRESS 7391 Bruder Trail Inver Grove Heiahts Mn 55076 N 1/4 SE 114S 19 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/6/02 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND )00( SEPTIC TANK SIZE 1255 LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none IL BENCHMARK V.R.P. Top of Nail in aspen ASSUME ELEVATION 100' Filter Zabel A -100 ❑ BOREHOLE (DWELL *H.R.P. NW corner of property SYSTEM, 96.7' ELEVATION Scale = 1/4 = 10' B.M. #1 Grading is to be done to divert run -off away from system Please note: On B - 1 10/6/02 1 went out 96' and field verified the % slope and found it 94' ❑ B-2 to be between 11 and 12 %, system was 92' designed with a 12% Slope 90' ❑ B.M. #2 c B -3 12% Slope o Area 15' Below System is to remain undisturbed r m Huffcutt Combo Pro 4 Bedroom y 577' House Property Line Tank is to be properly bedded and provided with s Well is to meet all lockdown covers with 5 setbacks found in Comm. approved warning labels 83 Trebus Valley Rd Safety and Buildings ' 10541 N RANCH ROAD HAYWARD WI 54843 TD #: (608) 264 -8777 1SC0hs n www www.commerc . w isc o ns ov Department of Commerce •wiscnsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary October 25, 2002 CUST ID No.226900 ATTIC• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING, INC ST CROIX COUNTY SPIA 1008 192 ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 5401.7 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/25/2004 Identification Numbers Transaction ID No. 797895 SITE: Mike Marselek Site ID No. 652214 Trebus Valley Rd Please refer to both identification numbers, Town of Troy above, in all correspondence with the agency. St Croix County NE1 /4, SETA, S19, T28N, R19W FOR: Description: Mound 600 Gpd. Object Type: POWT System Regulated Object ID No.: 876290 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" Version 2.0 SBD- 10691 -P ( N.01101) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD- 10706 -P (N.01101). • Comm 84.10, All materials used in this installation shall conform to the provisions of this chapter. A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. 0 1, 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 ;tenanceof the POWTS. T Sinc Fee Required $ 175.00 Fee Received $ 175.00 '^ Balance Due $ 0.00 Thomas E Devereaux Plumbing / POWTS Reviewer II, Integrated Services (715)634-3026, 7:45 am - 4:45 pm Mon. - Fri. WiSMART code: 7633` tdevereaux@commerce.state.wi.us cc: Leroy G Jansky, , Wastewater Specialist, (715) 726 -2544 w Cover Page Shaun Bird Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 10/6/02 Owner: Mike Marselek Location: Lot 11 Trebus Valley Estates System type: Mound System Manuals Used: Mound Component Manual version 2.0 (01/31) Pressure Distribution Manual version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section /Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7 -9. Maintance and Contige cy n 10 -12 Soil test t•!•�• e()l A x � pIDlGS Signature License numb r 90 10/6/ 0 2 oRFSPOIoEt�Ga o ��79� • PLOT PLAN PROJECT Mike Marselak ADDRESS 7391 Bruder Trail Inver Grove Heiahts Mn 55076 NE 1/4 SE 1 /4S 19 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 10/6/02 BEDROOM 4 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1255 LIFT TANK SIZE DOSE TANK SIZE 765 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 600 # of chambers none BENCHMARK V.R.P. Top of Nail in aspen ASSUME ELEVATION loo° Filter Zabel A -100 [:]BOREHOLE O WELL H. R. P. NW corner of property SYSTEM 96 .7' ELEVATION Scale = 1/4 = 10' Grading is to be done to B.M. #1 divert run -off away from system Please note: On B-1 10/6/02 1 went out 96' and field verified the % slope and found it 94' ❑ B-2 to be between 11 and 12 %, system was 92' designed with a 12% Slope 90' ❑ 4X B.M. #2 B -3 12% v Slope -° F CD Area 15' Below System is to remain undisturbed r CD Huffcutt Combo Pro 4 Bedroom 577' House Property Line Tank is to be properly bedded and provided with Well is to meet all lockdown covers with setbacks found in Comm. approved warning labels 83 Trebus Valley Rd a.c�,uer No y Date Non -Woven Filter Fabric 4" Observation Pipe Perforated Below Filter Fabric r Distribulion Pip ASZ'!i C -33 Sand i 'L Topsoil _ ` E ,.; , o •�, � 1 /,)- 7. slope Bed Off 2 2 force Main Plowed Drain Rock From Pump Layer Cress Section Of A Mound 'System Using E A Bed For The Absorption Area F G A Ft. h /•� 9 Ft. • 1 �l� Ft. '• 3 (U • 3 Ft. << „ L rkrn U'/°s w Ft. r — L J 470bservotion Pipe-,,,, e — m A --------- - i _ _____ Frce Main From Pump W � � - -------- - - - - -- ---- - --- C) Distribution Bed Of V -2 %Z Pipe Drain RocK 4 Observation Pipe Permanent Marker Pi pe or Rods Pion View Of Mound Using A Bed For The Absorption Area - P ^GE OF Perforated pipe Oetoii �0 i ad Vies Perloro +eo { y ' PVC P.Pt e notes t.ocoted On &Otto -. s� Are Equanr SPeeea Ir fa d } Q a PvC Force Main fttess ttotsr nts+cs re c«+n4c4;or PVC Monifold Pipe ��S'f/+ D�C. Oistriau+on . Pipe 14 ,r 2 4-1103- ' • - Distribution Pipe layout p Ft. R R. X O2 Inches Y Inches Signed: Hole Diameter nch Lateral Plinch(es) L Number Manifold " Or Inches Date: Force Main " 7:Z Inches - I of holes /pipe Invert ElevAtion of Laterals Ft. . Na4e pr SEPTIC TANK PUMP CliAMBER CROSS SECTION AND SPECIFICATIONS 4" Cl VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER W/ PADI=x s FINISHED t3RADE WARNING LABEL f►��K��►. 4" MIN. a i8" IN N C•=• 4a6Eta x. a. INLET � 1` WATER TIGHT SEALS G°i5 ' • TIGHT a t ED S WITH FILTER --�— �- SEAL ` ALM PIPE APPROVED g ; PIPE 3' —T ON 3 ONTO ONTO SOLID C SOLID SOIL t SOIL PUMP OFF ELEV . T. -- OFF D 3" APPROVED BEDDING UNDER TANK CON TE PAD SPECIFICATIONS V SEPTIC / DOSE ,5 TANK MANUFACTURER: A NUMBER 0 AY : TANK SIZES SEPTIC `�`S GALS DOSE V LO gACK•. / ✓ GAL DOSE ALARM MAMJrACZURER: G' 5 CAP T A = INCHES = GAL. MODEL NUMBER: B = .2 INCHES = GAL. SWITCH TYPE: C = 9 INCHES r I/LGAL. PUMP mANUFACIURER: oo, MODEL NUMBER: - D INCHES = Z2 cAL• SWITCH TYPE: A l E/ REQUIRED DISCHARGE RATE PUMP E ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE ' ,/ FEET MINIMUM NETWORK SUPPLY PRESSURE . . . . . . • • • • • . �, FEET +x FEET FORCEMAIN X 3 3 — _ FT /100 FT. FRICTION FACTOR ey TOTAL DYNAMIC HEAD = . �WXDTHH 0 ; DIAMETER INTERNAL DIMENSIONS OF PUMP TANK: LEN D SIGNED: LICENSE NUMBER: DATE: 1/88 d1 � < 1 HEA Single Seal Design .r Weight 53 tbs. r ■����■ ©moo® MODELS "1,0"41W EFFLUENT AND DEWATERING Sk r Double Seal Design K! tm Weight 73 lbs. EFFLUENT i. M \\\ \I®mWM�����m ®mm11WmOMMINNmOMMOC ®mm® ®mom® ►\ ■ \ \ \I,�m ®mm ©gym ® ■ \ \ \ \I®�° ®memo ®m ®m ®o ® � Oo NINNIN \O \ \ MEN KINSMEN less an 30 je TDH. \ ►'\ .�®�. �i�ii iii � � ��iiimm�� ® ®m�m�m ®m�aa .. Mod column-explosion proof Pump see FMO219- INNONNEMON \�►.\ 11� \`!SON O\N����� . =a \III\ \ \����► \���� 4 sow �� Y' , f ✓ r J Maintenance and Contingency Plan for a Mound System Maintenance Plan 1. Septic Tank is to be pumped once every 3 years. 2. Dose Chamber is to be pumped at the same time as the septic tank. 3. Effluent filter is to be cleaned once a year. Please note: a larger filter is being installed in order to extend the maintenance interval of the filter. 4. Once every 3 years the mound is to be inspected via the inspections pipes in the at- grade. The laterals are to be inspected via the cleanouts. 5. Owner agrees to limit greases, garbage, and water conditioner discharge into the system. 6. Pump and electrical components are to be checked at the time of the pumping. 7. Owner agrees to leave the area 15' below mound undisturbed. 8. The owner agrees to save this plan. 9. Trees, shrubs, and other similiar vegitation are not be planted on system. The system is not be driven over. 10. Effluent Quality is not to excede the requirements found in Comm. 83 Contingency Plan 1. Pump alarm goes off, call pumper and pump out dose chamber and septic tank if needed, then bypass pump float and try pump without float. If this works, float is bad, replace float. If pump still does not work, check power at the pump with a electrical device such as a hair dryer. If no power, check breaker inside house and call a electrician. If there is power, then pump is bad and needs to be replaced by a plumber. 2. If mound fails, determine cause of failure, test another area or remove pipe and sewer rock, retill soil, install new mound system. 3. Replace any other failing components as needed. Important Phone Numbers Plumber: Shaun Bird 715- 246 -4516 Pumper: Tom Mondor 715 -246 -5148 St. Croix County Zoning 715 - 386 -4680 Shaun Bird #226900 10/6/02 r POWTS OWNER'S MANUAL- & MANAGEMENT PLAN Pa" Ir SYSTEM SPECIFICATIONS Owner INFOt2MATlON Septic Tank Cry •�� ai C3 NA Owner �'� Septic Tank Manufacturer 0 NA Pane. Effluent Filer Maturer 13 NA DESIGN PARAtVIETERS � NA Fil6er Mods — Q 0 NA Number ' of Bedrooms purrs Tank (pact' ,� [7 NA Units NA of C� - Number pump Tank manufaduuer' 0 NA Estimated flow (aver) 0 NA" Design f low ( 1008 1 0. (wed x t.v� �� O NA Pump Sail Apo Model Unfl ✓ Rate tlAond* b FjW ' a Peat Filter I�1° r s o M 13 Wetland Fa W Oil A Grease (FOG) 3o mgtl t3iocl> Demand (t300 s1 a D orn Total Suspended Solids (�) :91 0 m9A- Manutac —bm O Other Pretreated EflNtent Quailhf 60D e.� s ( fl d mw 0 1n- ground (pressurized) 530 mg/L B�al wed sows (TSS) 530 mglt- a �' a "- Feed COMM mean) e.1 o duf100mI ](ir>cttdratrletier • Values typical kw dmwsft (�Q vuaswmW and Maximum Eftkte<tt PaOda Size .. v� bvw forpwo. MAINTENANCE SCHEDULE Service Frequency Service Event At fast once every j G months s) (Maxime'r 3 yrs.) 1p condition tanks) and scum equals one-third (Y,) of tank volume pump out contents of tank(s) When combined sludge S ) 0 months (Maximum 3 yrs.) I S) At least once every At least Once every s a mOnfl's ) Clean effluent filter At least once every 3 a months s) a NA Inspect PUMP. PUMP controls & alarm a s) 0 NA Flush and ted At feast once every o months 13 year(s) ❑ NA At least awe every oher: At least once every o months 0 yem(s) 13 NA Eli t MAINTENANCE DISTRDCTIONS l c stall be made by an individual carrying one of the following ilcanses or Inspections of tanks and � Plumber Resbicted Sewer. POWCS ins tor' POW1S Maintainer: Sel"ta" certilic s. Mast must Include a vista of the tw*(s) to identNy any m�9 or broken Secvk*l9 Operator the volume of coml*wd sludge and scum and to check for any back up haldwwe a y credits or leaks. measure the vbu* ktspe� to check the effluent levels idetdgy cell(s) stall or ponding of etfl on the ground surface. The d'ispof eff t n the ground wrlece• The potndkng 1 't a' the and to check for any � On of the local mWW101Y authork- lo the o f te a f �ition and requires the ktwr e ground wXftW may and scum In any Of sludge tank equals one4h (K) rf 10te Of the tank volume. the When the co mblned accumulation a S ervicing and disposed of in accordance vrsth ch NR entire ax* uo the tarn sh M be removed by . 113. VVbconsin Adtntnistrative Code. - components, and any The seivkrtg etiluent � or pressurized POWI"S components. co mponents;, other nw6tenac� or monitwng at intervals of t2 months or less shah be pertained by a o fled event A s report snail be. provided to the local regulatory autho&y within 10 days of completion O an y somm START UP AND OPERATION s far the presence of Pig Produce or otheT f=or new ocestru�. P� to use of the POWTS check treatment twdc() s if concer►trations are his that may impede the treabnent process dr a s d Cag s °� to use deter have the contents Of the tanks) ) removed by a epag Page of System start up shag not occur when: sowcordibons are frozen at the Infiltrative surface- q ges pt fad tNtWW above normal higtnwater levels. When powW is reshxW the exc ss wawtewa� vA be di9dtarged b the cell(q) in one large dose, ovmbatg the ceg(s) and may n3SU� its the t a suuface of ' To avoid tfas Sid on have the cortlertts of the pttfttp tank remo by a backup r suds e, isc a P 10 fes*X*V power b the et>aM pump Or contact a Plumber or POWTS Mahtainer to assist it rnWUW opt It" PMP O eD resirxe rnarraal levels wilMn lire pnxnp tardc. arer tanks rate! dispersal cells. Do not drive or park aver. or otherwise disturb or compact. th e a ea wi not drive or park vehicles nwund or st1pade Boll absorpdon any. thrtinit 15 feet down slope any Reduction or elir*tadion of the jo&MkV from the v r islawader stream may improve the � and Prig the tie Of the POWTS: � baby t> cadoms: oo�tton swabs: deg�eM denW GOW dislinfacb1*15; fat A4 dtnirt (rtutnp P.m and vegelabie Pte% meat s mew � p Pry Pte' Y taloen t of service out the fONowitg 4a taken W :mane Neat the a N�tite P try s e t* in � with ch Comm 83.33.1Mitso0nWn Admktl buM Code: system is PgmIY attd safely • AN * tg to tanks and pits shell be dtsoor>neded amd the abandoned Pipe • The = t u ft of all tanks and pas shall be removed and properly dlsposed of by a Septage Safvift OPerater: • Alter MOP". all tanks kW P � removed or their owers removed oW the void space Mad with soil. gravel or another kwt wild nuWbL CONTINGENCY PLAN the treasures have been. must be taken. W provide a code If the POWTS fads and cannot be repaired comptlartt replemrient • ai has been evaluated d may be uNzed for the location of a replaem cent sod ❑ A She ro� area ant area should be protected from d*Wrbance and =nPe�n and should not be ~ from and proposed shuck". lot Nrtes and wells. Failure to Proms the replacement area will resat it tine need for a new sod and site'evaduatian tp establish a sukabie replacement area- R� system mus corms with the rules in effect at that time. area is riot available due to setback ardor sod Imitations• Barring advances in POWTS (3 A chnolog n hok rttent be insWed as a last resort to replace the faded POWTS- t Y a lto t9 tatdcrnay t Upon fadtNe of the POVVTS a sod and site has not been evaluated to identify a suitable replacement area. � if no replacement area is avallable a sde evaluation must be p� to locale a std" repiaoerrtout hoWV tank M b installed as a last resort to replace the faded POW rS atgrade so removal of the biomat at sand il s may be reoon in following thy, surface- Reconstructions of such systems must comp w ith the rules in effect at that time SEPTI PUMP T'MENT TANKS MAY CONTAIN LETHAL- GASSES ANDFOR INSUFFICIENT OXYGEN. SEPTIC, P A S OTHER U OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RE NOT ENTER A S F A P P UMP FROM THE INTERIOR OF A TANK MAY BE DFFICULT OR *APOSSMX— RESULT.. RESCUE OF A PERSON ADDITIONAL- COMMENTS POWTS MAINTAINER POWTS INSTALLER Name r✓ J Name ni Phone _ r �/ Phone Z WW Vj=Mh LOCAL REGULATORY AUTHOR" ITY SEPTAGE F . TF7 7#EA=qU9ft AWmxy i Name Phone d Phone Uwe" s aralb�a ge oro en . ara Cauf► ZWft WW SanRation - aoa This n+• � or cif. Comm ss zzf�NXtX*I ace e3 wi). czy &M. s" rose Use of tNAs dof�rfrfsf►n aces ,wf fl guarantee aye pedommm or the Powrs. 1504 - D xa 5f ��/ Wisconsin Department of Commerce SOIL EVALUATION REPORT ALIA -A Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code NC-E. Sal & Site Evaluations Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference an and D. percent slope, scale or dimemsions, north arrow, and Ioetn� dist�nge crest road. parcel I. 040 - 1078- 20 -000, I D #19.28.300 Please print all in _ B p ewed Personal information u y y Ir, 1 you provide may be used forn�ary W ses s I1 Z'O Z Property Owner ! Proper! Li cation J.T.B. Properties, L.L.P. C/O John W. le en ovt. Wit :' ! NE 1/4 S 1/4 S 19 T 28 N R 19 W Property Owner's Mailing Address , i Lot # Block # Sutxi. Name or CSM# 1564 West University Avenue ` ` ST c 1;'k_ Trebus Valley Estates City State Zip C �� one Z City J Village e Town Nearest Road G1=iZ ; Saint Paul MN 1 55104 �'�5 -646 -1967 , j� Troy County Highway "F" 01 New Construction Use: 01 Residential / N 3 Code derived design flow rate 450 GPD I Replacement Public or commercW - Describe: Parent material Glacial drift — Flood plain elevation, if applicable na General comments and recommendations: Recommend installing mound system at elev. = 96.20' at 6" above 95.70' contour. Boring # Boring Pit Ground Surface elev. 96.20 ft. Depth to limiting factor 59�- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtftZ *Eff#1 *Eff#2 1 0 - 1Oyr3/3 none sit 2f mvfr cs 2fm,1c 0.5 0.8 2 9 -20 1Oyr4/3 none sil 2fsbk mvfr cs 2fm,1c 0.5 0.8 3 20 -29 1Oyr4/3 none sil 2msbk mfr gs 2f,1m 0.5 0.8 4 29 -59 1Oyr4/4 none sil 2msbk dsh cw 1fm 0.5 0.8 5 5- 2 1 Oyr4 /6 f 7.5yr5/8 s Osg dl aw - 0.7 1.2 6 72 -93 10yr4 /6 none Ifs /sl/sic 0o_ H#6 is an unsorted mixture of 1 msbk Ifs, 1 csbk sl, & Om sic with 20% of horizon comprised of 11Z'- 2" limestone fragernents. a Boring # �j Borin Pk Ground Surface elm 94.92 ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfF *Eff#1 *Eff#2 1 0-6 1Oyr3/3 none sil 2f mvfr cs 2 0.5 0.8 2 6 -16 1 Oyr4 /3 none sil 2fsb mvfr cs 2fm,1 c 0.5 0.8 3 16 -32 1Oyr4 /4 none sl 2msbk mfr cwr 2f,1m 0.5 0.9 4 32 -39 7.5yr4/4 none sl 2msbk mfi aw 1 f 0.5 0.9 5 0 10yr5 /4 f 7.5yr4/6 SMS Om ds iw - 0.4 0.6 6 60 -71 1Oyr5/4 none L.S.B.R. - - - - 0.0 0.0 H#5 consists of Z'- 4" stratified layers of 10yr516 s, 1 msbk 0yr5/4 lfs, & Om 10yr4/4 Ifs. Horizon #6 is comprised of >50% 1 /2" - 4" limestone fragments. * Effluent #1 = BOD 5 > 30 < 220 mg1L and TSS > < 50 mglL t #2 = BOD <_30 mg1L and TSS < mg1L CST Name (Please Print) Sign re: CST Number James K. Thompson � s.._ — 3602 Address A.C.E. Sal & Site Evaluations VDate Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 20 12/5/01 715- 248 -7767 property owner J.T.B. Properties, L.L.P. C/O John parcel ID # 040 - 1078 -20 -000, ID #19.28.300 Page 2 of 3 31 Boring # � Boring Pit Ground Surface elev. 90.63 ft. Depth to limiting factor 34:-- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW *Eff#1 *Efl#2 1 0 -12 1Oyr3/3 none sil 2fs mvfr cs 2fm,1c 0.5 0.8 2 12 -23 1 Oyr4 /3 no ne sil 2fsbk mvfr cs 2fm,1 c 0.5 0.8 3 23 -34 1 Oyr4 /3 none sil 2msbk mfr cw 2f,1 m 0.5 0.8 4 34- 9 1 Oyr4 /6 f2_ f 7.5yr4/6 scl 2msbk dh aw 1 fm 0.4 0.6 5 39 -50 7.5yr4/6 f2f 7.5yr5/8 Ifs 1 msbk ds cw - 0.4 0.6 6 50-60 1Oyr5/4 none L.S.B.R. - - - - 0.0 0.0 H#5 consists of 2" - 4" stratified layers of I Oyr516 Osg s, 1 msbk 1 Oyr514 Ifs, & Om I Oyr414 Ifs. Horizon #6 is comprised of >50% 1/2" - 4" limestone fragements. F-1 Boring # �j Boring f _J Pit Ground Surface elev. ft. Depth to limiting actor in. Soil Application Rate Hoizot Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 i F-1 Boring # I Bori _ ft. Depth to limiti factor in. f Pit Ground Surface slap. � Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 2 *Eff#1 *Eff#2 * Effluent #1= BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal op service provider and employer. If you need assistance to access services or P 4 PPo rtY need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608 -264 -8777. r - - • _': /ua n n �rvlr�rK; /)a; / i n /Js f" yt .o' B � /de e y75. �3 S 77 A � own � oad OOP( I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGRBEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer o ,1 Mailing Address / Pro Address • PAY (Verification required from Planning Department for new constzuction) City /State Parcel Identification Number o 4 129 - I o LEGAL DESCRIPTION / r Property Location %s, Y., Sec,��, T O`l� ran N R W, Town of/ r Subdivision � � �%�� / .� Lot # Certified Survey Map # . Volume . .Page # Warranty Deed # �' , Volume ?P ?T . Page # 00 `{ Spec house ❑ yes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could result m its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a mastaplumber, journeymanplumber, restrictedplumber or a licensedpumper verifying that (1) the on-site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and retuned to the St. Croix County Zoning Office within 30 days p three a iration date. l -"M GNATUkB OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p described e, by virtue of a warranty deed recorded in Register of Deeds Office. TURF OfF APPLICANT DATE * * **** A information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed U 2028P 00`f STATE BAR OF WISCONSIN FORM 2- 1999 6 9 6 2 5 9 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., MI This Deed, made between J.T.B. Properties, LLP, a Minnesota RECEIVED FOR RECORD Limit Liability Partnership _ 10 -30 -2002 10:30 AN - - -- — WARRANTY DEED Grantor, and Michael R. Marsollek and Jennifer L. Marsollek, EIDPT # husband and wife REC FEE: 11.00 — TRANS FEE[ 292.50 - - -- ..— -- - - - - -- - -- COPY FEE: _ --- - — -- - - - CERT COPY FEE: Grantee. PAGES: 1 Grantor, for a valuable consideration, conveys to Grantee the following described real estate in St. Croi V _ __ County, State of Wisconsin (if more space is needed, please attach addendum): Recording Area Lo Plat of Trebus Valley Estates in the Town of Troy. St. Croix Name and Return Address County, Wisconsin. 040 - 1296 - 10-000 Parcel Identification Number (PIN) 'this is not homestead property. (1€) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any. Dated this ay of October 2002 -- - -- -- ' * r AUTHENTICATION ACKNOWLEDGMENT Signature(s) _— STATE 'c OF�WISCONSIN ) — - -- -- authenticated this_ _ County ) __day of _ Personally came before me this QA of October 1 2002 the above named J.T.B. Properties, LL P, a Minnesota Limited Liabili -- Partnership TITLE: MEMBER STATE BAR OF WISCONSIN (IFnot, to nown to *�person( s) who executed the fore going i , tr d authorized by § 706.06, Wis. Scats.) ms THIS INSTRUMENT WAS DRAFTED BY Attorney Krishn O Notary Publi onsin Hu dson, WI 54016 _ My Commiss on is permanent. (If not, state expiration date: Signatures may be authenticated or acknowledged. Bath are not necessary.) _X ) • Names of persons signing in any capacity must be typed or printed below their signature. Tracy L l~.rprr9 pmra:rmnais company, F du 800-655-2021 WARRANTY DEED STATE BAR OF WISCONSIN Notary Pu FORM No. 2 -1999 State of wiscona' N .001 LAJ I E AA 3 .!O b� co .001 C-� O ►� "' / C 00 k. I ' ` 0 � I � N L �_ O I S13 .15 E >- �-- J� W 576.88' a W o 0 pl Z aj _ Q N D o Q J M W LL ' - aWW �! \ \ \ Q �W W I 00 N ^ o to m r� n m i JI I-- 3 Z \ \ O f ' `-W Z r °' 9 W Qp �Z�� / V) U I� ( 00 .s O to co 5 � E W 8�s VO co W .s� V" •�t F� W LL. ti � O z U 9�' 0 `9t C-� 00 , y N O i 1 Cl\ I (t o .-Z7� C( uc.