HomeMy WebLinkAbout040-1296-30-000 County:
AWisconsin Department of Commerce PRIVATE SEWAGE SYSTEM St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
506263 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:
Merhar, Robert I Troy, Town of 040 - 1296 -30 -000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No:
6a (V\ 1 C1 T 19.28.19.1705
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER f5 ' CAPACITY STATION BS FS ELEV.
�. 25 IOy. t5 ioa
Septic Li; e. �' `� ♦ /�� Benchmark
Dosing � C�Ja'' Alt. BM � -- J 7 �1 Z ° ��o• �3
Aeration \ Bldg. Sewer Z C 71 .3 3
� • 9
Holding St/Ht Inlet
, s
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Jy ♦ Dt Bottom g
Dosing 1 .tip / S A ♦ _ Header /Man. Z ♦ . /61 , S%
Aeration /VT Dist. Pipe 3 O$ 1A 17
Holding Bot. System 3 "16 164 • 5
Final Grade
PUMP /SIPHON INFORMATION Z'D$ taZ " ��
Manufacturer .3 L d1 GPM D emand St CD; r ���
5 �,
a 7. SZ
Model Number o C 2.S ` `
TDH I L)'ft Friction ' S � �Los� System H�d 5 TDI-(r„t
. 7 r-
Forcemain Length 0 Dia. Z 41 Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trench PIT DIMENSIONS No, Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System : z1 I -) A �j UNIT Model Number:
\OJ /vim"
DISTRIBUTION SYSTEM Nw,1c, Imo. L;
Header /Manifold / Distribution C Z ♦ / x Hole Si r x Hole Spacing Ve�� Air Intake /� J
f P O 41 !� L� -3 / 1
Lengt Dia f Length " I Dia ' y Spacing r"
SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only
Depth Over 1 Depth Over xx Depth of xx Seeded /Sodded ulched
Bed /Trench Center 7+ 1-' Bed /Trench Edges\ Topsoil t � es j No es No
� Y
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: V / 43 / 0 - Inspection #2:
Location: 395 Mitchell Road udson, WI 54016 (NE 1/4 SE 1/4 1 T28N 19W) Trebus Valley Estates Lot 13 P rcel No: 19.28.19.11705 -[
I 50' 1, S �
1.) Alt BM Description = , ��' �� ( L sNd�eX.
♦ J /fie +f- PI o �1 g.� `�--; r.�, o �' T.,..�t c �tr.`�
2.) Bldg sewer length =
- amount of cover =
d 2r G v i p Plan r evision Required? Yes No Use other side for additional information. Date ature Cert. No.
SBD -6710 (R.3/97)
,
Safety and Buildings Division County `
V � isconsin
201 W. Washington Ave., P.O. Box 7162 Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by
Department of Commerce ( 608) 266 51 Sd Z
Sanitary Permit Appl I.
ication State Plan Number
In accord with Comm 83.2 1, Wis. Adm. Code, personal informatio u provi / i /3S,5 7
may be used for secondary purposes Privacy Law, s 15.04(1)(m Pr�t Address (if diffcrept than mailing Tess)
I. Application Information - Please Print A n r ation A � ft � '
Property O er's Name 2007 Parcel # Lot # , 3 Block #
J UL 16 Property Owner's Mailing Address Property Location
ST. CROIX COUNTY
A '/.5je�!_'/., Section O
City, State Zip C e Phone Number
T N; Rk or(W j 17 69
II. Type of Building (check all that apply) 6K �D 5 ��� •••+++ 5 )
I or 2 Family Dwelling - Number of Bedrooms �la�_ Subdivision Name ` CSM Number
❑ Public/Commercial - Describe Use C ✓ ��
11 State Owned - Describe Use $ ` J 7 0 ✓ r 1 l ] City ` ❑Village Township of op \/
III. Type of Permit: (Check only one box on line A. Complete line B if applicable) ` ��
A. New S stem
y ❑Replacement System ❑ Trcatmcnt/Holding Tank Replacement Only E) Other Modification to Existing System
B List Previous Permit Number and Date Issued
C1 Permit Renewal C1 Permit Revision ❑Change of C1 Permit Transfer to New
Before Expiration Plumber Owner /
IV. Type of POWTS System- Check all that apply) 60
❑ Non - Pressurized In- Ground kiviound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑
Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑
Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) `
V. Dispersal/Treatment Area Information: Ca 1W V
Design Flow (gpd) , Design Soil Application Ra (gpdso Dispersal Area Required (so Dispersal Area Proposed (s System Elevation J
VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic
Gallons Gallons of Units Concrete Constructed Glass
New Existing A/4
Tanks Tanks (4Q� t
Septic or Holding Tank //r/tA MOP
� > s
Aerobic Treatment Unit
Dosing Chamber / `^ lO
VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plum s Name (Print) P Signature MP/MPRS Number Business Phone Number
V 11 t , l� Z 7l 77 —32
Plumber's Address Street, City, State, Zip Code
VIII. County /De artment Use Onl
Approved ❑ tsappro Sanitary Permit Fcc (includes Groundwater Date I Issuing A t Signatur o mps)
Surcharge Fee) Ob ❑ er en Reason o ial
IX. Conditions of Approval/Reasons for Disapproval
SYS'1'Elllt OWNER' 3) lUd 6_1__r Ck f 5r — e ,A-.._.
1. Septic tank, effluent filter and
dispersal cell must all be maa� r4� �Gt�vu 2 p r C D 4 J
as per management plan provided by Plumber.
P
2. AN si11t1mk requirements must be maintained �� e
as per appl amble co&J'orditm*s.
Attach complete plans (to the County on or the system on paper not less than 81/2 x I I inches in size -
y
90111, �ek-i — rnasd- �
SBD -6398 (R. 01/03) Aq /} /� l
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4003 N KINNEY COULEE RD
commerce.wi.gov LA CROSSE WI 54601 -1831
isconsin TDD #: (608) 264 -8777
www.commerce.wi.gov /sb/
www.wisconsin.gov
Department of Commerce
Jim Doyle, Governor
Mary P. Burke, Secretary
July 11, 2007
CUST ID No. 222774 ATTN: POWTS Inspector
HENRY F GROTE ZONING OFFICE
CERTIFIED SOIL TESTING ST CROIX COUNTY SPIA
E4366 353RD AVE 1101 CARMICHAEL RD
MENOMONIE WI 54751 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 07/11/2009 Identification Numbers
Transaction ID No. 1413557
SITE: Site ED No. 727351
Robert Merhar Please refer to both identification numbers,
395 Mitchell Road above, in all correspondence witE the agenc
Town of Troy
St Croix County
NE 1/4, SE 1/4, S19, T28N, R1 9W
Lot: 13, Subdivision: Trebus Valley Estates
FOR:
Description: Three Bedroom Mound System / New construction
Object Type: POWTS Component Manual Regulated Object ID No.: 1139588
Maintenance required; 450 GPD Flow rate; 65 in Soil minimum depth to limiting factor from original grade; System(s):
Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version
2.0, SBD - 10706 -P (N.01 101)
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 enclosed approved plans and with the
component manual(s) referenced above.
• 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 down slope of the dispersal cell 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.
• 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.
P:o.W.T:S.
Conditionally
A P P 0 RD VE: D
I l OEPGRTWNT ni: C RARAGDrc
HENRY F GROTE Page 2 7/11/2007
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
6"P A���Fee Received $ 175.00
� ` Balance Due $ 0.00
erard M Swim
POWTS Plan Reviewer, Integrated Services
(608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART'code: 7633
jerry.swim@wisconsin.gov
cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 726-2544, Friday, 7:00 A.M. To 3:30 P.M.
4 � ,
Robert Merhar - Mound
Construction Materials and Techniques
AlUaterials must comply with Comm 84 and be installed in accordance with manufacturer's
sa fications. Construction methods must comply with the following Component Manuals:
Pressure Distribution, SBD- 10706 -P (01 /01)
Mound, SBD - 10691 -P (01/01)
Location: Lot 13, Trebus Valley Estates
NE 1 /4, SE 1 /4, Sec. 19, T 28 N, R 19 W
Town: Troy
County: St. Croix
Date: July 12, 2007
Owner: Robert Merhar
Address: 395 Mitchell Road .`
5 C 0
Hudson WI 54016
' HENRY F.
G
Designer: H ?nry Grot 1699 •' *:'
—
ENOMONIE:
Wis.
Signature: �
License: WI D — 1 9 -007 l
Attachments: SBD -10577 - Plan Approval Application
SBD -8330
Page 1: cover
2: design criteria & calculations
3: plot plan
4: system cross section
5: plan view, lateral detail owIs Of
sir iY aNU �u�► ��NCs
6: pump tank exit detail
7: pump curve 6 S� E ECORRE ONDENCE
8: system management
page 1 of 8
K
Design Criteria
Residential Wastewater Contaminant Load: 30 mg/L < BOD5 < 220 mg/L
Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L
Fecal Coliform > 10,000 cfu/100 mL
Fats, oils, grease < 30 mg/L
3 Bedrooms x 100 gal/bedroom/day x 1.5 d �-O gallons /day hydraulic load
Design Calculations
In situ designed loading rate (D.: gallons /sq. ft. per day
Depth to estimated high ground water 6 d in.
Depth to bedrock Ln' O in.
Cross slope at system % w v
Force main length S �' ft. of in. a 3
Manifold/header length �' ft. of �'Iz in. 0, 174
Drain -back gallons
Lateral length @ S ft. of 2 in.
Lateral elevation ° ft. @ bottom of lateral
Lateral hole size �� to in. @ b in. ( 3 ft.) Spacing
g holes /lateral 3 $ holes total
Lateral volume 9 `� 3 h g allons
i -- g
Total lateral discharge rate gallons /minute @ 2 S ft. head
i
Network pressure compensation losses S ft.
Elevation difference —� 4 'S ft.
Friction loss ft. @ gallons /minute
Total dynamic head ` `g 5 ft.
Pump /s *on 4 gpm @ 2 0 ft. of head
Manufacturer ° "A k.. 3 Model #
Dose volume g3.8 gallons
Lift/si*on tank C-0 –1-10 6 0-0 gallons
Septic tank gallons
Effluent filter �- t
Measurement pump on and off ° in.
Height alarm from tank bottom in.
Reserve capacity 3 3S } gallons
specs.calcs.res
i{
Page of
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w v w w X01 '"`/ J v �e�(, OdL �.,�M �+ C•S w� � �.Oc..�+- G' 1
V&`vt �•XeC �`► �'�1w,7vit,�G.wt
�3 � � Q0 Ab (v w = �, S � � g h T' c "'1' .. I d�%1 cJ'� �'" �.. Z , S a,•�
^ MnH
WEATNERPROJP
LOCKIWG C0VER nJNCT
WAir'N iN ,c ABED ,
QUICK DI4C.OVVLCT ---,
a S� .nos ..� \ • 4.
Grade, elev. (,
--->
9 77777777 - , W7777M�,
IL
4 PVC sch '
40, 3' onto -
4" PVC
solid ground � \ �ch 40
MAHu4LE
24" -1.0. , �� vent
/04" T
�
oo
GA'R.L7vL0 A j zr�, c�`' NOLF / 4" PVC
(-QSY,ET 10rlT',-� sch 40,
A�
ALL P I ft 3' onto p solid
co►w E LT io►+S �— "^/ 4`a ON — ground
0
P LJXP
C o Nc�e f-T�
\ b�oCK
SEPTIC 5PCC.IFICATI0 IJS
OOSf �� •
TAWKS MAW UFACTURCR: 1JUMBER OF DosEs: _ per day
T A►JK SIZE ; ° -�D-,O GALLO►JS DOSC VOLUME
AL_ARI'1 PI/WUFACTURCR: S `< -� Y� WCLUOIMG 6ACKFL.Ow: gallons
/'MODEL WUN1bER: \ ° I \4 `" CAPACITICS; A = � WcHEs OR
1 gallons
SWITCH TYPE; " 1 Z 8 IwckEs OR 3 S• SZ gallons
1 =
pump hAQUFACTURCR: C_�r_0\1 i ° g g allons
mODEL ►JUMDCR', �SO,gc
0■ 9 INCHES OR gallons
SWITCH TyPf: �Q'`'i"`v "
DOTE' PUMP AWD ALARM ARE To OE
MI► iMLJ DISCNAKU RATC S ' GPM INSTALL Du SEPARAIyE circuits
i
VLRTICAL DIFFEKILWC( bETWEEIJ PUMP OFF A►JD 013T1tIbUTI0W PIPE., � 5 FEET
+ n �IhuM ►JETWORK SUPPL. PRCCSURE . , , , , . , . �,S' FEET
+ Sb FtET OF FORCC MAI►J X \ , I 0i f /IooftFKICTIOU FACTOR. '0'T? FEET �S
TOTAL. 01 JWAMIC, HEAD = lez Sl FF.[T
36
IIJTEFt►JAt, DIME1JSl01Jt O( TA1JK: l.E►.1C+7H :w,OTH � ,LIQUID p[PT> -
I C
ITT GOULDS PUMPS
Wastewater
PERFORMANCE RATINGS COMPONENTS
Total Head Gallons Per Item
(ft. of water) Minute No. Description
EPO4 EPOS 1 Impeller
5 53 – 2 Base _ �\ / 6
10 46 62 3 Pump Casing �� \
15 36 55 4 Mechanical Seal
20 21 46
5 1 Ball Bearings 6
25 0 33 6 0 -Rings y
30 — 11 7 Power Cord 5
8 Oil Filled Motor a +3
Motor Housing/ r
9 Stator Assembly
10 Motor Cover
METERS FEET ..... ...__...
10 lj1 1..........
9 30 ......... ......... ........ f-5 GPM _.
8 2.5 FT
25 ......... i.. ......... 1 ......... ..
p 7
_ ......... .................. . ....
6 20 .........
v �
z 5
0 15 ......... ..... . ._.. . ....... .....
J
Q 4 EPOS
0 i�
3 101 .. ....... ..
EPO4
2
1 ,
—�_ _
0 10 20 30 40 50 GPM
0 2 4 6 8 10 12 m'lh
CAPACITY
3 — 4 o
a
0 System Management
Management of this system is critical. As a condition of approval of these plans this system management section must be
reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If
problems develop with the adsorption system or any other system components, the installing plumber, Roger Timm, 715- 772 -3214, or
the St. Croix County Zoning Department, 715- 386 -4680, should be contacted for assistance.
General
Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which
flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of
contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to
settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as
water, a dose tank or compartment to allow a dose to be accumulated, a pump and controls or automatic siphon, and finally some type
of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health.
- m the se
1. If the septic tank is installed prior to sheet rock and /or painting, pump tic tank before normal use begins to ensure p
adherence to contaminant load design criteria.
2. Install water - saving appliances whenever and wherever possible.
3. Repair even small water leaks as soon as possible.
4. Never pour grease or oil down any drain or stool.
5. Garbage disposals are not recommended; if you must have one, use it sparingly
6. No paper products other than tissue should go into the system.
7. No chemicals should go into the system.
8. Avoid surge flows of water; try to spread laundry throughout the week.
9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans.
10. If septic or dose tanks are no longer used, they must be properly abandoned.
11. If construction timing and weather could create a frozen infiltration system, weather - proofing with plastic sheeting and
heavy mulching may be required to maintain a functional system at start-up.
12. The upslope toe of the mound system must be landscaped with additional fill to blend this area into the
upslope natural grade; this will minimize the possibility of the system trapping surface run -off; final settled slope should
be 2 -3% over the system or 2 -3% diverting surface run -off around the ends of the system.
Maintenance
1. The septic tank must be inspected every three years by a properly licensed person.
2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids
volume equals one third of the tank volume.
3. When the septic tank is pumped, any solids in the bottom of the dose tank must be pumped, and the filter must be back - washed
into the septic tank to remove accumulated material. System use may require more frequent filter cleaning; initial inspections of the
filter should be made every 6 months until a minimum time sequence is determined.
4. Periodic observation pipe inspections should be made by the owner to examine the state of the in -situ soil adsorption cell.
Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption
cell.
5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany
their specifications.
6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the
pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows
reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than
one or two days should pass before any necessary repairs can be made.
7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system.
8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system.
9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth.
10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system
area.
11. Warning: Do not enter septic, dose or other treatment tanks; death may result because they may contain lethal gases or
insufficient oxygen.
Contingency Plan
Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring
may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54
(2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, desiQnini,
and /or installation of additional treatment components or conversion to a holding tank may be necessary.
Page 8 of 8
Vscvnsin ORIGIN S O EVALUATION RE #2585
Department of Commerce in accordance with Comm 85, Wis. A T Page 1 of — 3
Division of Safety and Buildings Certified Soil Testing, LLC
Attach complete site plan on paper not less than 8'/: x 11 inches in size. Plan must ounty St. Croix
include, but not limited to: vertical and horizontal reference point (BM , direction and
percent slope, scale or dimensions, no r C is an to nearest road. Parcel I.D
040 -1 6 -30 -000
� _
Please print Review t Date
Personal information you provide may be uscondary purpose cy Law s. 15.04 (1) (m)). / Z '7 il IN 7 Q
Property Owner Pr perty Location �
Merhar, Robert B. Go t. Lot NE1 /4, S 1/4, S19, T28 N. R 1 9W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
395 Mitchell Road 13 Trebus Valley Estates
City State Zip Code Phone Number 7 City illa e
y Nearest Road
i_� 9 X Town
Hudson WI 1 54016 1 Troy 395 Mitchell Road
X New Construction Use: ® Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement L Public or commercial - Describe
Parent material loess over pitted till Flood plain elevation, if applicable NA ft.
General comments install 8' x 57' rock cell mound on 100.0 contour as upslope edge of rock w/ 0.5' sand fill @ 0.4 gpd /sq ft
and recommendations: basal loading
Boring #
j Boring
X Pit Ground surface elev. 102.4 ft. Depth to limiting factor > 84 in. ISoil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft=
in. Munsell Qu. Sz. Cont. Color Or. Sz. Sh. *Eff#1 *Eff#2
1 0 -8 7.5YR 3/2 - sil 2 m gr mvfr cs 1m /c .6 .8
2 8 -18 10YR 3/6 - sil 1 m sbk mvfr gs lm .4 .6
3 18 -84 7.5YR 4/4 - sl 0 m mvfr - im .2 .6
H3 has some irregular, discontinuous 7.5YR 3/4 sl bands; SS (rags below 72; some Is & s inclusions below 18"
Boring
❑ Boring #
�; Pit Ground surface elev. 92.6 ft. Depth to limiting factor > 65 in. ISoil Application Rate
Horizon I Depth I Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0 -5 7.5YR 3/2 - sil 2 m gr mvfr gs 1m /c .6 .8
2 5 -26 7.5YR 3/3 - sil 1 m sbk mvfr gw 1m .4 .6
3 26 -65 10YR 3/4,3/6 - sl 0 m mvfr - 1M .2 .6
H2 is slightly gritty w/ s; H3 has some Is & s inclusions; conventional, pressure distributed (or drip dispersal) system possible w/ highly treated
* Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 * Effluent_ #2 = < 30 mg /L and TSS < 30 mg /L
CST Name (Please Print) Sig at re: CST Number
Henry F. Grote 222774
Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number
E. 4366 353rd Ave. Menomonie, WI 54751 6/21/2007 715 233 - 0398
SBD -8330 (R 07 /0o)
Property Owner Merhar, Robert B. Parcel ID # 040 - 1296 -30 -p, .. Page 2 of 3
F 3 'Boring ,.a .4 �_ •
Boring # .u... ; . w
Pit Ground surface elev. 95.0 ft. Depth to limiting factor > 110 in. Soil Application Rat
Horizon Depth Dominant Color Redox ion Texture Structure Iconsistence Boundary Roots I GPD /ftz
in. Munsell Qu. Sz. Cont. Cola Gr. Sz. Sh. `Eff#1 - Eff#2
1 0 -8 7.5YR 3/2 - sil 2 f sbk mvfr cs 1m /c .6 .8
2 8 -23 10YR 3/6 - sl 1 m sbk mvfr gs 1m .4 .7
3 23 -38 10YR 4/6 - Is 0 sg ml gw lm .7 1.6
4 38 -65 10YR 3/6 - sl 0 m mvfr cs - 2 .6
5 65 -110 10YR 4/6 - Is 0 sg ml - - 7 1 .6
I
some 7.5YR 3/4 sl inclusions in H3 and H5 w/ some Is inclusions in H2
F B oring# Boring
� Pit Ground surface elev. 100.0 ft. Depth to limiting factor > 60 in.
Soil Application Rat
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff #2
1 0-3 7.5YR 2.5/2 - sil 1 m gr mvfr cs 1m .4 .6
2 3 31 10YR 3/3 - sil 1 f sbk ds gs 1m /c .4 .6
3 31 -38 10YR 4/4 - sl 1 m sbk dsh gs lm .4 .7
4 38 -47 7.5YR 4/4 - sl 0 m dsh gs I lm .2 .6
5 47 -60 7.5YR 4/4 - Is 0 sg ml - - 1 .7 1.6
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common gy si coats on peds in 1-13; stratified SS gr /fragments @ 34 -41 "; some sl inclusions in H5; untreated, "conventional' trench system is
possible not recommended due to massive sl @ depth requiring large area
` 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.
M -8330 (R.07100) Certified Soil Testing, LLC
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address
Property Address tY.h,e, la
(Verification required from Planning & Zoning Department for new construction.)
City /State 17 / Parcel Identification Number D Y8 - I Z16-- i.m — 41 _ 0 �
LEGAL DESCRIPTION
Property Location 1VZ ' /4 , 5E '/4 , Sec. , T ZS N R_ff_W, Town of
Subdivision V , Lot # 1 .
Certified Survey Map # , Volume , Page #
Warranty Deed # ° 86380_7 , Volume 6 2 Page # b �S
Spec house yes (ncy Lot lines identifiable 0 no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in 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. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site
wastewater disposal 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 returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
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
prope escribed above, by virtue of a warranty deed recorded in Register of Deeds Office.
i u e f bedrooms
GNATURE OF APPLICANTS)
DA E
** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * **
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
8 1 46216
2946 21s
. KATHLEEN H. )dALSH
AFFIDAVIT OF S CROIX W I
Document Number CORRECTION RECEIYEn FOR RECORD
12/20/2005 09:50AN
(TYPE OR PRINT CLEARLY IN BLACK OR RED INK)
CORRECTIVE AFFIDAVIT
AFMNT, TRACY L. TURNER h ere b y EXEMPT q
swears or affirms that a certain document recorded on the 18th day of REC FEE: 13.00
AUGUST 2005 (yam) in volume ZSS y r TRANS FEE:
page fins . as document number 803807 which was recorded COPY FEE:
CC FEE:
in ST. CROIX County, State of Wisconsin, contained the following PAGES: 2
error (if more space is needed, please attach addendum):
RANTEE NAME SPELLED INNCORRECT
Recording Area
AFFIANT makes this Affidavit for the purpose of correcting the above document Name said Return Add=
as follows (if more space is needed, please attach addendum):
RVAT 2682861
ROBERT B. MERHAR 040 - 1296 -30 -000
/ Pastel Idendfication Number (PM
AFFIAN'T is the (check one)-
• Drafter of the document being corrected.
• Owner of the property described in the document being corrected.
El Other (explain: TITLE COMPANY ) -
The original document (in part or whole) is is not attach to this Affidavit (if original document is not attached, please attach legal
description and names of grantors and g tees).
Signed:
TRACY/ U ER
State of Wisconsin )
) ss.
County of ST. CROIX )
Subscribed and sworn to (or affirmed) before me this
19th day o DEC. 2005 _ 0 ����F�t�lg tttlf f
Virg is R. Gartman i
Nota ry Public State of Wisconsin ?�* VIRGINIA R.
My Commission (expires) Erg: January 20, 2008
_w
wj r
s
i IN�RUMENT WAS DRAFTED BY:
IVER VALLEY ABSTRACT .
This instrument l) is p is not (check one) a conveyance of real property as per s. 77.21(1) Wisconsin Statutes.
(A Wisconsin Real Estate Transfer Return is required for instruments that do convey real pro
oN a tnes of persons signing in any cap icy must be typed or printed below dteir signature.
17 i1 2869P 605
y KATHLEEN H. WALSH
State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS
WARRANTY DEED ST. CROIX CO.. WI
RECEIVED FOR RECORD
Document Number Document Name
sails /zOtas 10: WAN
WARRANTY DEED
EXEMPT #
THIS DEED, made between J.T.B. Properties, LLP REC FEE: 11.00
TRANS FEE: 345.00
( "Grantor," whether one or more), COPY FEE:
an CC FEE:
R PAGES: 1
( "Grantee," whether one or more).
Recording Area
Grantor, for a valuable consideration, conveys and warrants to Grantee the following
described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address
interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space is
needed, please attach addendum):
Lot 13, Plat of Trebus Valley Estates in the Town of Troy, St. Croix County,
Wisconsin. RiIE 20a
040 -1296- 30-000
Parcel Identification Number (PIM
This is not homestead property.
(is) (is not)
Exceptions to warranties: Easements, restrictions and rights -of -way of record, if any.
Dated
S -OX
(SEAL) -- - -- - - -- -- u (SEAL)
* *J.T.B. ProperV LP ,
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
authenticated on STATE OF )
) ss.
C 9P ��� )
*
TITLE: MEMBER STATE BAR OF CPSI Personally came before me on
(If not, the above -named J.T.B. Pro Pies.
authori zed by Wis. S 70" % to +`� ine known to be the erson(s) who executed the foregoing
THIS INSTRUMENT DRAFTl3QB�p\ in nt and ac ledged the same.
Attorney Kristina Oeland CJ�
Hudson, WI 54016
Nota P 961ic, Atate of
My Co mission (is permanent) (expires:
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED @ 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003
' Type name below signatures. INFO -PROTM Legal Forms 800 -655 -2021 www.infoproforms.com
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Loe &A#1\10A tj (U tk `b 8 S / �i 1 �S5 u� 0wisconsinDepartme EVALUATION REPORT' hLC,� Page 1 of 3
Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations
Attach complete site plan on paper not less than 8'% x 11 inch ' e. Plan must St. Crobc
include, but not limited to: vertical and horizontal refer on j$Fp), t r ' and
County
percent slope, scale or dimensions, north arrow, ti >d ls np est road. Parcel I.D.
040 - 1078- 20 -000, 113#19.28.300
Please dnt all in on. f
P �• Reviewed By Date
Personal information you provide may be used fo �i nary pu (Fl<Fpt��, s. 15.�1,(1r( V 6
Property Owner Propdrt� ion
J.T.B. Properties, L.L.P. C/O John W. en V 6 vt.14r ' NE 114 SE 1/4 S 19 T 28 N R 19 W
Property Owner's Mailing Address - ST ;pay, Lot # r Block # T bd. Name or CS
M#
1564 West University Avenue C011N'1Y 1� ,� Trebus Valley Estates
City State Zip C „` ity I Village &- Town Nearest Road
Saint Paul MN 55104 61 -1 Troy County Highway "F"
01 New Construction Use: g Residential 1 Number rooms 3 _ Code derived design flow rate 450 GPD
Replacement `j Public or commercial - Describe:
Parent material Glacial drift Flood plain elevation, if applicable na
General comments
and recommendations: Recommend installing mound system at elev. = 103.33' at 6" above 102.58' contour.
Boring # �j Boring
Pit Ground Surface elev. 102.63 ft. Depth to limiting factor 32" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /fl=
*Eff#1 *Eff#2
1 0 -5 1Oyr3/2 none sl 2fcr mvfr cs 2fmc 0.5 0.9
2 5 -13 1Oyr3 /3 none sl 2fsbk mvfr cs 2fmc 0.5 0.9
3 13 -32 7.5yr4/6 none Is 1csbk mvfr cw 1fmc 0.7 1.2
4 32 -58 7.5yr4/4 f2f 7.5yr 5/8 s/ls /sl Om mfi gw 1 fm 0.3 0.5
5 58 -72 5yr4 /4 f2f 7.5yr 4/6 sl Om dh - - 0.3 0.5
H#4 contains an unsorted mbc of 1 Oyr4/6 Osg s, 7.5yr4/61 csbk Is & 7.5yr4/4 Om sl. Redox cor►centrations appear at intertface of teadural changes
throughout horizon,
Boring # �j Boring
N" Pit Ground Surface elev. 102.55 ft. Depth to limiting factor 27 in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD111
*Eff#1 *EfM2
1 0-8 1Oyr3/2 none sl 2fcr mvfr cs 2fm,1c 0.5 0.9
2 8 -15 1Oyr3/3 none s l 2fsbk mvfr cs 2fmc 0.5 0.9
3 15 -27 7.5yr4/6 none Is 1 csbk mvfr cw 2f,1 m 0.7 1.2
4 27 -35 7.5yr4/4 f2f 7.5yr 5/8 sAs/sl Om mfi gw 1 fm 0.3 0.5
5 35-64 5yr4 /4 f2f 7.5yr 4/6 sl 1 csbk dh - - 0.4 0.6
H#4 contains an unsorted mix of 10yr4/6 Osg s, 7.5 & 7.Syr4/4 Om sl. Redox. crxx�erltrations appear at intertface of textural changes
t oughout horizon.
* Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >A< 150 mg/L * #2 = BOD < mg/L and TSS <30 mg/L
CST Name (Please Print) Signal :' CST Number
James K. Thompson � 3602
Address A.C.E. Sal & Site Evaluations D' ate Evaluation Conducted Telephone Number
340 Paulson take Lane, Osceda, WI 20 1215101 715 - 248 -7767
property Owner J.T.B. Properties, L.L.P. C/O John parcel lD# 040- 1078 -20 -000, ID #19.28.300 Page 2 of 3
F31 Boring # J Boring
JO Pit Ground Surface elev. 98.33 ft. Depth to limiting factor 33" in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
`Eff#1 *Eff#2
1 0 - 13 1Oyr3/3 none sl 2fsbk mvfr cs 2fm,1c 0.5 0.9
2 13 -20 1 Oyr3 /4 none sl 2fsbk mvfr gs 2fm,1 c 0.5 0.9
3 20 -25 1Oyr4 /3 none Is 1msbk mvfr cw 20M 0.7 1.2
4 25 -33 7.5yr4/4 none sl 2msbk mfi cw 1f 0.5 0.9
5 33-87 5yr4/4 f2f7.5yr4/6 sl Om mfi - 1vf 0.3 0.5
Ht#5 contains an unsorted mix of 7.5yr4/6 Om Ifs & 5yr4/4 Om sl.
F —I Ong # A Boring , j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM
"Eff#1 *Eff#2
I
F-I Boring # Borin
�,j Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots
*Eff#1 *Eff#2
* Effluent #1 = BOD 5 > 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.
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