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Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 572883 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: Belon ia, Thomas I Troy, Town of 040-1271-40-000 CST BM Elev: Insp.BM Elev: BM Description: Sectionlrown/Range/Map No: /6C> t/i S 20.28.19.1501 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION B 6 Z I` FS ELEV. z. Septic r L� �,n Benchmark -7,35 e5•w( •1 .o /ar,� 107, 668 Dosing Co,�,�a 2•L' O Alt.BM `a J `7.5 '75,• Aerafio—n Bldg.Sewer y„ Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. ent Air Intake ROAD Dt Inlet Septic 6Z 7 1 Dt Bottom /3.r, _d g r Dosing / / 21 / / ! Header/Man. / 75 ,g$. 8 s Aeration Dist. Pipe Holding B .System p).15 L .PUMP/SIPHON INFORMATION Final Grade � 7 Ts Manufacturer / Demand St Cover f 46 C GPM 7-5' 9S l Model Number i5p a Z6 5 �O✓1��� !Z . �clf.7 Q. TDH Lift Friction Lose System Head TDH4 '� t 5 Forcemain Length_ Dia Dist.to Well r� SOIL ABSORPTION SYSTEM �J BEDITRENCH Width Length No.Of nch PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS /_ •�1� �. SETBACK SYSTEM TO ,✓ P/L BLDG a/ WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Typm6u ^ ,4)stem: x /t J UNIT Model Number: AM DISTRIBUTION SYSTEM E Header/Manifl r i IDistribution 1 /1 x Hole Size Ll I l x Hole Spacing I ( Vent to AirIntake a� Pipe(s) y 3 ` Length 3 Dia �' Length r Dia /`� Spacing SOIL COVER / x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over "� TDe Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center / ' y4 5 rench Edges Topsoil / tt , Yes � No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: /7/ If I spection#2: Location: 445 Windy Hill Rd Hudson,i WI X40 6(NE 1/4 NW 1/4 20 T28N R19W) Troy Wood Lo 5 Parcel No: 20.28.19.1501 1.)Alt BM Description= / -� G�.I, V-- 2.)Bldg sewer length= •7 t V" -amount of cover= Plan revision Required? [51 Yes No —- 5 _ Use other side for additional informat n. SBD-6710(R.3/97) Date Insepctor's Signat a Cert.No. 11,? ' ti Safety and BOildings Division VT4 ((o , rill 'l; --- ^. '� '1." 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in lv�Co.1 1 S p, =' r-I r Madison,Wi 53707-7162 t ' s S i1 F Z w A __ ~ y State Transaction Number Sanitary Permit Application 23l a��Z In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit _ is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS are submitted to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary 4 445 , A t purposes in accordance with the Privacy Law.s. IS.04(I)(m),Slats. J I I, t L A. .lication Information-Please Prin Information Property Owner's Name D Parcel# AA �LL ( b7 E'eIcyn 14 __. Property Owner's Mailing Address di ) 1 ) Property Location D 4� Z7) 4r7 m,e a ���5' ��1t I l ( a Govt.Lot �y ��D 6 1 City, Zip Code Phone Number F y, 4, Section 9d tt �} lr � 0 Q irclt nt N 6 P -r"1 T t90 N: R /7 E oYi U.Type of Building(check all that apply) ` Lot f 1;11 or Family Dwelling--Number of Bedrooms 5' Subdivision Name BI. : Tm 1���>a/ Public/Commercial-Describe Use t t ( j k 13 City of 0 State Owned-Describe use as,-... CStv Number ©Village of _.._.._ . i GP )( 75 X-60A• , ... III.Type of Permit (Check only one box on line A. Complete line B if applicable) ZP-6 Q.. - .New System ❑Replacement System 0 Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(exphtmt B. 0 Permit Renewal 0 Permit Revision 0 Change of Plumber 0 Permit Transfer to New List Previous Permit Number and Date/1776z { Before Expiration Owner $�i 7 IV.Type of POWTS System/Component/Device: (Check all that apply) 0 W, r' r O Non-Pressurized In-Ground ❑Pressurized In-Ground 0 At-Grade El-Mound>24 in.of suitable soil 13 Mound<24 in.of suitable soil //ci.....a Holding Tank ❑Other Dispersal Component(explain) Pretreatment Device(explain) 5� i#._; .1 V.Dispersalfrrea ent Area Information: Design Flow(bpd) Design Soil Application Rate(g s Dispersal Area Required Dispersal Area Propose sf) System Elevation / y4C3 r3 3 11 (/s'Q i"7 . ESL ,i2, ?7 0 -- VI.Tank Info r C'agacity in Total #of Manufacturer s ' s Gallons Gallons Units u v'$ '?tg New Tanks Existing Tanks i'„ is le rZ Sz5 ,s a ii &I it a !/ ! U sR Si rn u:C7 F. Septic or Holding Tank J f0 3 o /A ) ( t er x Dosing Chamber 61 s `(t.)Q VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. Plu ber's Name(Print) Plu Signature h4PMt Nu Business Phone Number 1 /A. i 41t 4V - k ePe ''y6 9 2/Sd-v22'-9i '$ Plumber's Address Street,City,State,Zip Code) /bu 9D 0 72t /be y er F A t 009cl , ,.. VII ,linty/Department Use Only / /e- le Permit Fee Date I tied Issuing -/t Signatu , ilk , .: ,ved r s ,, • - q �j II s. •. wen Reason for Denial j S 1sIZ5' C6 3 // /✓ � r _ TX.Condi��easons for Disapproval \\ / t < /�' i� PP 3J Lar1.s:41 d� r & S . I'r6J • G f.'•Septic tank,effluent filter and (��(1 �� � I 1 , ' �' dispersal cell must at be services/maintained 1 e- -C.Ca" Lm.J j Tom' e '"'t': as per management plan provided by plumber. 2. Attufback requirements must be-Maintained as per applicable aPplicalatcodei ordinances. Minch to complete plans for the system and submit to the County only on paper not less than 8 l!z a I I inches in size SBD-5398(It. 1 1/11) CHARLES L WEBSTER Page 2 9/30/2013 is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(i).Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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 Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, 40111111 Fee Required$ 250.00 This Amount Will Be Invoiced. si When You Receive That Invoice, Patricia L Shandorf Please Include a Copy With Your POWTS Plan Revie - stegrated Services Payment Submittal. (715)634-7810, Fax (715)634-5150,M-F 8:00 a.m. -4:45 p.m. WiSMART'code:7633 pat.shandorf@wisconsin.gov cc..Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Note! Effective January 1,2012, all codes under the jurisdiction of the Division of Industry Services(formerly Safety&Buildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed t .4 - PS Chapters 360-366. • 1tF DIVISION OF INDUSTRY SERVICES (rATART. 10541N RANCH ROAD t � HAYWARD WI 54843 3 �.Skr Contact Through Relay 9 P www.dsps.wi.gov/sb/ 1a www.wisconsin.gov 4oSSIONA15, Scott Walker,Governor Dave Ross,Secretary leAs September 30,2013 ., CUST ID No. 220673 ATTIC•POWTS Inspector ��, G00N4C CHARLES L WEBSTER ZONING OFFICE WEBSTER SOIL TESTING&DESIGN SERVICES ST CROIX COUNTY SPIA 4K N5815 770TH ST 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/30/2015 Identification Numbers Transaction ID No.2310072 SITE: Site ID No. 795872 Tom Belongia Please refer to both identification numbers, 445 Windy Hill Rd above,in all correspondence with the agency. Town of Troy St Croix County NE1/4,NW1/4, S20,T28N,R19W Lot:25,Subdivision: Troy Wood Addn FOR: Description:Mound,3 bedroom residence r ©N Object Type:POWTS Component Manual Regulated Object ID No.: 1450758 CO rj[)1 111 PROV Maintenance required; 450 GPD Flow rate; 28 in Soil minimum depth to limiting factor from original grade; System Mound Component Manual-Ver.2.0,SBD-10691-P(N.01/01,R. 10/12),Pressure Distribution Component OF SAF Ver.2.0, SBD-10706-P(N.01/01,R. 10/12); Effluent Filter PROFESS 10NAL The submittal described above has been reviewed for conformance with applicable Wisconsin AdministrattrAStoN OF iN�US and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. SEE coRREs. 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: Key Item(s) • 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.In addition,the owner must insure that the operation,maintenance and monitoring duties as described in section VIII of the mound component manual are complied with.A copy of this information must be given to the owner upon completion of the project. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15'beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it CHARLES L WEBSTER Page 2 9/30/2013 to the standards or specifications of chs.SPS 382 and 383 and this chapter and ch. 145, is of a type conforming P Stats. • Maintain well and waterline set backs per SPS 383.43(8Xi).Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. 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 Industry Services 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 and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia L Shandorf Please Include a Copy With Your POWTS Plan Revie - stegrated Services Payment Submittal. (715)634-7810, Fax: (715)634-5150,M-F 8:00 a.m.-4:45 p.m. WiSMART code.7633, pat.shandorf@wisconsin.gov c,Edwin A Taylor,Wastewater Specialist,(715)634-3484,Monday-Friday 8:00 am To 4:30 pm Notel Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services(formerly Safety 8o-1iuildings)will be modified. Code references with prefixes starting with"Comm"have been replaced with << "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed -> S Chapters 360-366. . ,e;c Webster Soil Testing & Sewer System Design Charlie Webster, Owner N5815 770th Street Ellsworth, WI 54011 WI Licenses: MP220673, ST220673, PE18803 Telephone(715) 273-3430 POWTS Index Sheet Page 1 of 8 Mound System for a y 3 Bedroom Residence Property Owner/Project: Tom Belongia NE1/4 NW1/4 S20, T28N, R19W 445 Windy Hill Rd Town of Troy, St Croix County Parcel I. D. 04127140000 Page 1 Of 8 Index Sheet \_LY Page 2 of 8 Plot Plan Page 3 of 8 System Cross Section (Y AND Page 4 of 8 Distribution Pipe Layout SERVIC VICES Page 5 of 8 Pump Chamber Layout RY SER Page 6 of 8 Pump Performance Curve Page 7 & 8 of 8 Management Plan ,oN© too t S CO* --� :VP /A � E E 41, fib 7.7",11 )(3 Component Manual Used: Name: Mound Component Manual for POWTS Version: 2.0 SBD-10691-P Dated: January 30, 2001 Name: Pressure Distribution Manual for POWTS Version: 2.0 SBD-10706-P Dated: January 20, 2001 • CO Z m 41 -;7-----..*-------- Z ,o Vs" ,it 6 t-t i / . 4) / / 0 tea.: d j 1 z....... , ,, t () . fp .ts ti.., L � L. G 4. y - a • '4– — rt s t " ,, 0 �..- go V, [N Lt I, . M -i. -c -4 Lt.: - fi u S S '� b z s .z Q h O v ` O J c tom—. o `', 9 p -� yo b "N i e�` J ac. � �g> 0 A J t \-1) o 4_ b `� ft' 0 .,e0, c„,....1- -t. rt 1_ ----- -4— \ I.I e 0a ` 0 1. '-i 9 w'I d—j U Q i 0 N ` Je i r f era IL To,47 cI ' . a c sic pi, C,,,, rJ' e c t��o r7 Pagt Of Cam/ Approved Synthetic Covering • �s�-r� 33 Distribution Pipe Medium Sand / G Topsoil ' •„ �� El < '7 7- p >- ev .,,,,.� 0 • . ice` y _..�` `� h1r-� • rr r rlrn r . 67 % Slope Bed Of J- 2 Force Main Plowed Aggregate From Pump Layer cv«{ao..dm 76..,4- 0 6 1b. 67C Cross Section Of A Mound System Using E X02' g %/l. 0.07 ct~ l k (0 A Bed For The Absorption Area F 7 .I . 9 t. � G 0.$-Ft. A 6 Ft. H /JO Ft. Linear Loading Rate= 6.QGPD FT B 7,5'� Ft. g /LN T Design Loading Rate=OGPD/SQ FT j /3 Ft. r i r X j 7 Ft. ( . 7 Thk.t dtd/rf 1 • K 8.. Ft. c 11fCr.t J I L 31 Ft. r)lt c!i idrer.//tn d W 2-C Ft. I. -)J Observation Pipe �L k- ------- w B K A _I.,- -,4-,,..=-) 6-,--cies to ,9, .-4), ic.-------M At fold pg.p e y 4 �, .- I Distribution Bed Of 2.— 2 • i Pipe Aggregate 4 Q 1 -..i. t Observation Pipe,` • 11 °- (Anchbr securely) OLsc�t-d t/0.... P•,es to /11'e d. N7/n•Mcr/►. i.•t1MciLrk O !' 9 /hcheJ it ?rav, 944 4/ITn (4..-0) ().. %`/ 4 f c ei f', A)fr e 74‘e bo i'tafrn �• / / Ci. O i�+e�CS 3"�s t#eiq� ffi ,6 a r c c cc� a � dy c�oi e. Plan View Of Mound Using A Bed For The Absorption Area . /1/1 O u n o� P/C?h ,ro 73,77 Be///10� et, . P 40ig 8 . Perforated Pipe Detail 0 1 7 E nd_ Yiew )Perfoceled / PvG Pipe `00� Le / as%CP 1 1 Holes Locared On Bottom, 0 SC t alc •d% Me EQUQUy Spoced :../ i fK OM 4 Klis ---� ii/t t '�- S d1 t < .<:V7- 4if I , pistroution 1 Pipe Seems _ dc�'d.l . P 7cFt. Distribution Pipe Layout S -? Ft. 441f, it. fro wAy c/. `v k. t, Ce. - C� f/ J ? !_ . H /I/4h. -5-1/- s rev"-, 144_ X 3 C Inches -- S o C - f , c2... _ .0,17 ,, , z . Inches / . Hole Diameter 9 Inch Lateral " / 4 Inches Manifold 2 Inches Force Main " Inches if of holes/pipe i Jn.ceesS b.X 7 �7�.-- +-Loci Ad P L- Invert Elevation of Laterals / t �1�te.r 1 I TY/ic1 / L 1tcr.1‘e.,,,I _ _..,� P,./o. e,., d de/-J,/ Place 1st hole/8,'u, from s.tAcioirdkAfttirof4beirti with succeeding holes at., C,'#tintervals_ �Ci,4 , d f7 Be,rdr l o,., /O / Q, Page �Of 6 . Co r,5iA)f.'.,, .re pi lc.1- 4//@'4 4,r1¢ a 1 k16ef- (No Scale) p . Approved Locking Manhole Covers e,�,,, With Warning Labe15 Attached "`''i w.ndou.or P "L. _ , Weatherproof Approved QJc ,r',7xe ____Juncton Box Vent Cap -,� ��.t�.i/���� � 12" Minimum -V \ , cFI4)/G,,+o% '�' 44.11:eof»;Math _ ; I.t _' 4" Minimum } - ` . .-i` (1 I hr Quick 18" Minimum Disconnect _ 1 /4" Weep 8..�,, fi/pee 4.60/kA6,4 COVOL e*zis Baffle I Hole Poly /ekS =( S ____ , eop , \ . br- (pp�.ved Alarm 6N+ B , e j.,,-'vt/ek t On eri tt8f.nst.ppe . C , k,.'t<,.„ig,...4 *APPROVED ! Off 6' j < E1” 9.).. ),,C-- by coy or to JOINTS WITH Ail I /°r°"'O!°.+«'J APPROVED PIPE to P'`"`"P 3' ONTO D SOLID SOIL I Conc. 3'°cK 3" of Bedding Under Tank-1 ' pa,* pw p Orcllldr,.? on sep cib•ott, eat*ccs.i'7$ Number of Doses: 6./Per Day Gallons Per Day/Dose_�: 74•oZGal 1or.s ,f Volume of Backflow:�.'-f1j+ 'A Gal lens Tank Manufacturer: u,"csc ��csGfe f'roducls-Zrhc Total Dose Volume - _ 64- Gai icns Tank Size-Septic/Pump: /D00 AcG 0 //Gal 1 ons Alarm Manufacturer: s . ,e_ i34,,,, i,u $ Model Number: 5. E ,Pu.., J`'f4-s*e∎- Ca acities: A ...3 inches or?&3 Gallons Switch Type: /iiccd4r7 /cu, + B inches or Gallons Pump Manufacturer: Gv.,./ + C_ inches or--P'---Gallons Model Number: 36-'7/ 6-i°© 4 /I + D'inches or /© / Gallons 1 Minimum Discharge Rate: 2_6-3-- GPM .'Total = inches or 6-p 4. Gallons vertical Difference Betw.een Pump Off and Distribu ion Pipe :5:43-"Peet Minimum Required Supply Pressure - -s'' ° ( i 3°S%s,) + 6.4—Feet (0 Feet of Force Main x d-77Friction Factor/100 Feet: +o.s Feet , . Inch Diameter Force Mai n Total Dynamic Head: = . e .pFeet Internal Tank Dimensions: Length/ t,yWidthp 4t, Liquid Depth .'6; ,. E ti !Gl f a) ,/J_ 4...s... c4a., `..r cc, ft: ///_ 7(5,a /, c4 • • p"! 0.., 0/ Pict', A, Tod,' Beh 0 ,' i Q. I); c Pa, vo Pc)--130vIn q,,, -e Effnt Pum_tfor &-- 3871 EPO5 APPLICATION •Fasteners:300 series •Fully submerged in high •Motor Housing:Cast iron stainless steel grade turbine oil for for efficient heat transfer, Specifically designed for the •Capable of running lubrication and efficient strength,and durability. following uses: dry without damage to heat transfer. •Motor Cover:Thermoplas- •Homes automatic •Effluent systems components. tic cover with integral handle Availidge for aad Motor •Farms ...I...iiii. monodic and float switch attachment •Heavy duty sump .EP°4 Single Phase:SA HP' models'W inshode‘."1"---Medisekal. °Ms' 115 r 230 V,60Hz 1550 . •Water transfer Root Med amombled and le Pewee Cale:Severe duty RPM,o buift in overload with rated oil and water resistant •Dewatering automatic reset. Preset et as fambrY" 11 Barbet Upper and lower • EPO5 Sing phase:a5 HP, SPECIFICATIONS 115 V,60 Hz,1550 RPM, FEATIMES heavy duty ball bearing Pomp:EPU4 built in overload with BIN Impai construction. :Thermo- • Solids handling capability: automatic reset. plastic Semi-open design AGENCY LAE= 1/4"maximum.. • Power cord:10 foot ■vitti pump out vanes for • Capacities:up to 55 GPM. standard length,1.6/3 SJTO mechanical sea protection. a Coombs Mimimk knoxiMfon •Total heads:up to 24 feet with three prong grounding `P m EPI15 Impeller Thermo- --'. • Discharge size:11/2.NPT. plug.Optional 20 foot (CSA listed model numbers • Mechanical seal:carbon- length,16/3 SAW with plastic soolosod design for end in"P'or"AC".) roved rotary/ceramiostationary, three Prong grounding Phig imp performance. BUNA-N elastomers. (standard on EPO5). II Casig ad Am:Rugged •Temperature: thermoplastic design provides 104°F(40°C)continuous superior strength and 140°F(60°C)intermittent corrosion resistance. • Fasteners:300 series METERS FEET r 1 1 stainless steel. 10- • Capable of running dry without damage to 9- 30 - - components. Pump:EPO5 8- • Solids handling capability: a 3A"mwdmum. - i 7- an'a 11 • Capacities:up to 60 GPM. .4141 g 6- 20 •Total heads:up to 31 feet. a • Discharge size:118 NPT. 1 5- I E. • Mechanical seal:carbon- al," lap' .4_ , rotary/ceramic-stationary, -1 4.. < BUNA-N elastomers. F■ , 0 . •Temperature: 1- 3- 10 104°F(40°C)continuous 140°F(60°C)intermittent 2- - - 5 . 1 - 1 0- 0 "4.4..., 0 10 20 30 40 50 GPM / , a ,g--,, I I 2 4 0 8 10 12 nom CAPRCITY s 0 1995 Goulds Pumps,Inc. Effective May,1995 • • POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of • ' FILE INFORMATION t� SYSTEM SPECIFICATIONS Owner 7o yi L e/c>� ? , �S, Septic Tank Capacity fQ p O gal ❑ NA Permit* Septic Tank Manufacturer C(//es e ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer p4 /0 k ❑ NA Number of Bedrooms 3 ❑ NA Effluent Filter Model 5 ZS— ❑ NA Number of Commercial Units . *NA Pump Tank Capacity .d' 0 Q gal ❑ NA Estimated flow(average) �j 0 U gaf/day_ Pump Tank Manufacturer (J,'t,s v.- ❑ NA Design flow(peak), (Estimated x 1.5) 40 Q gal/day .Pump Manufacturer Co,„,/ci ❑ NA Soil Application Rate 0_3 3gaUday/ft2 Pump Model 38 T/ E Pd 4 ❑ NA Influent/Effluent Quality Monthly average' Pent Unit XNA Fats, Oil&Grease (FOG) 530 mg/L ❑ Sand/Qravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) 5220 mg/I. ❑ Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other _ Manufacturer Pretreated Effluent Quality XNA Monthly average" Dispersal Cells) Biochemical Oxygen Demand (BOD5) 530 mg/L ❑ In-ground(gravity) ❑ In-ground(pressurized) Total Suspended Solids (TSS) 530 mg/L ❑At-grade ❑ Mound Fecal Coliform (geometric mean) 510'cfu/1 00m1 ❑ Drip-line ❑ Other: Maximum Effluent Particle Size K inch diameter • values typical for domestic(non-commercial)wastewater and septic tank effluent •+ Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every ❑ months ❑year(s) (Maximum 3 yrs.) Pump out contents of tank(s) When combined sludge and scum equals one-third(3 )of tank volume Inspect dispersal cell(s) At least once every ❑ months ❑year(s) (Maximum 3 yrs.) Clean effluent filter At least once every 3 ❑ months Xyear(s) Inspect pump, pump controls&alarm At least once every ❑ months ❑year(s) 0 NA Flush laterals and pressure test At least once every ❑ months ❑year(s) ❑ NA Other At least once every 0 months ❑year(s) ❑ NA Other At least once every ❑.months ❑year(s) ❑ NA * J4,E 1-ceomme' cif c<eponff fl/!',r pit et PVery •7ye)is.4-7ekecomm.o d tai 41- MAINTENANCE INSTRUCTIONS y.04.. c/tds, .P//*b. every ,P,■/1 to .01,•/ &iffy p-•41•0+41 dwr•1V ,Fhe •..1n>f'eM'- Inspections of tanks and dispersal cells shall be made by an individual carrying one of tt(e following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer; POWTS Inspector; POWTS Makttainer, Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s)shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third(3)or more of the tank volume,the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113,Wisconsin Administrative Code. • The servicing of effluent filters, mechanical or pressurized POWTS components, pretreatment components, and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s)for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s)removed by a septage servicing operator prior to use. H 4.1.� d T lac h C07- 8e./163,7 Page of 9 System stall up shall not occur when soil conditions are frozen at the infiltrative seam. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal mks)in one large dose,overloading the cell(s)and may result in the backup or surface discharge of effluent To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction orelimination of the following from the wastewater stream may Improve the performance and prolong the life of the POWTS: and; baby wipes;cigarette butts;condoms;cotton swabs;degreasers;dental floss;diapers; disinfectants;fat foundation drain(sump pump)water,fruit and vegetable peelings;gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides;sanitary napkins; tampons;and water softener brine. ABANDON1d Egr When the POWTS fails and/or is permanently taken out of service the following stePs shall be taken to insure that the system is properly and safely abandoned In compliance with ch. Comm 83:33,VVisconsin'Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall'be removed and property disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been,or must be taken, to provide a code compliant replacement system: • ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. - ID A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. X'Mound and at-grade soil absorption systems may be reconstructed In place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. «WARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER j Name 770 . G6/ / �1 k c q Y ecti Name A.,cc. Phone - Phone .1— S! /0 4 9 q a SEPTAGE SERVICING OPERATOR(PUMPER) LOCAL REGULATORY AUTHORITY Name X t—cr /-y e ��s ,�c p 7`7 c Agency 5-- t Cva qty �o�i Phone 7/5" - — /O Phone 7/S — i e' ' - 4 6 6' This document was drafted by the staffs of the Green Lake,Marquette and Waushara County Zoning and Samson agencies. This document meets the minimum requirements of ch.Comm 8322(2)(b)(1Xd)&(f)and 83.54(1).(2)&(3),Wisconsin ikkukaistrative Code. Use of this document does not guarantee the performance of the POWrS. GMW(2/01) ST.CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM f Owner/Buyer .. _7/J14 P P 10 n 1Q Mailing Address yYS' /jJe n h1l1 PC9 4+ ( ,,A ,) 11e'1 eCC Pity A �- j � J/ (Verification required from Planning& �' ; Department for new construction.) / City/State / Gr(iO)7 //l// . Parcel Identification Number 44/27/ 0e1 6 LEGAL DESCRON Property Location FV4 , 1/4,Sec.__ ,T N R dyj Town of 71-2)91_ • Subdivision - , Lot Certified Survey Map# ,Volume ,Page# • Warranty Deed# 9964 ,Volume , Page# Spec house yes no lot lines identifiable el no _z__.1 - _.0_1 • tki_' t. l t Ateed 3fO ie Q 1 teed CJ f i e S Improper use and maintenance of your septic system couldresult 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§Conn.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 foam,signed by the owner and by a master plumber,journeyman phunber,restricted plumber or a licensed pumper verifying that(1)the on-she wastewater disposal system is in proper operating condition and/or(2)after inspection and putting(if necessary),the septic tank is less than 1/3 full of sludge. 1/we.the undersigned have read the above requirements and agree to mama the private sewage disposal system with the standards tot fords,herein,as set by the Depute ofCoa np+ce and the Department of Naturantetiotiratil.State of Wiscomin. Certification stating that your septic system has been meidamed must be completed and returned to the St.Croix County Planning& Zoning Department within 30 days of the three year expiration date. 1/we certify that all statements on this form are a -to the best of my/our knowledge. I/we ariare the owner(s)of the property described above,by virtue of a warranty deed - .,, -. in Register of Deeds Office. . of .4v,1 • 1-104.je_ 4_3/.1A:20 SIGNATURE©F APPLIC (5) J DATE 45-- ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Dot.*** 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. (�tIv. 08J83} • 0 ..004.T' ., 1 . ) i i il co 5 g § a g; CI•x°°900 04° / % �l f J I N N f ry id's°le Z� f / I e' N I ' b : fib //' O9 ` � J( / / of / ,t0-Leg M.1119.98.41011 1 ? .-1 ' Q amt.* W JIM , I/ qm © �QD Y t `IbLwr r o`, ;I M �,, / N N 1 1 © g_ � 1 ,� 0 t \ z 1 � W 0 t ..., -----, i R 1 1 y 1 \ 10 1r1 , W • \\%9L1 I 1 \\ \♦ I 1� . I . F CO CC \ \ • � • \ fil •0 // 11; \ /1 N $ . \ r _ 4�A L...._ ♦.mow ammo ....J 'ILL .PP .110'<<1, .1113,0 I. IVZ'Z«1 3 09 1 00000 N ° f+ ^cJ 979663 BETH PABST State Bar of Wisconsin Form 1-2003 REGISTER OF DEEDS WARRANTY DEED ST. CROIX CO., WI RECEIVED FOR RECORD 06/03/2013 08:00 AM Document Number Document Name EXEMPT # NA REC FEE: 30.00 THIS DEED,made between William J.Peterson and Karen A Peterson,husband TRANS FEE: 310.50 and wife PAGES: 1 ("Grantor,"wi}ether one or more), / and Thomas Belon:ia and Barbara Belon:ia ! . • ni ay t l i_ ' J **The above recording information verifies that this document has been electronically recorded ("Grantee,"whether one or more). &returned to the submitter Grantor,for a valuable consideration,conveys to Grantee the following described real Recording Area estate,together with the rents,profits,fixtures and other appurtenant interests, in y County, p St. Croix Count Count ,State of Wisconsin (•if more s ace is Name and Return Address Thomas and Barbara Belongia needed,please attach addendum): LOU Troy Wood,in the Town of Troy,St Croix County,Wisconsin. -1- f- `- 'L, r - i 040127140000 Parcel Identification Number(PIN) This is not homestead property. (is)(is not) Grantor warrants that the title to the Property is good,indefeasible in fee simple and free and clear of encumbrances except: NONE Dated Ma 2013 (SEAL) . 'S-1 �Apr- Al (SEAL) * illiam J.Pe er .n *Karen A.Peterson (SEAL) (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF Minnesota ) )ss. authenticated on • Washington COUNTY ) * Personally came before me on the above-named William J.Peterson and Karen A.Peterson, '' TITLE:MEMBER STATE BAR OF WISCONSIN husband and wife. (If not to me kn wn to be the person(s)who executed the foregoing authorized by Wis. Stat.§706.06) ins - d owled ed the same. THIS INSTRUMENT DRAFTED BY: *Cu' Wenner Es c m Chad E.Novak WI Bar#1055802 Notary Public, State of Minnesota 1 My Commission(is permanent)(expires:01/31/2015 ) (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. L_ WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NO.1-2003 $Type name below signatures. 1 of 1 r Property Owner Humbird Land Corporation_ _ Parcel ID*.Pending Page 2 of 3 2 Boring# J Boring 16 Pit Ground Surface elev. _-- 965 ' ft. ,Depth to limiting factor 40 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots -.. GPM? _.. *Eff#1 *Eff#2 1 0-9 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 9-13 7.5yr4/4 none sl 2msbk mvfr cw 1f 0.5 0.9 3 13-24 7.5yr4/6 none sl 2msbk mfr cw - 0.5 0.9 4 24-32 7.5yr4/6 none Is 1 msbk mvfr cw - 0.7 1.2 5 32-40 10yr5/6 none sl 2msbk mfr cw - 0.5 0.9 c2-3d 10yr7/2' 6 40-48 5yr4/3 sl 2msbk mfr - - 0.5 0.9 7.5yr5/8-- 1 3 Boring# J Ong ei Pit Ground Surface elev. 89.0 .___ft. Depth to limiting factor —28 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP_Dir *Eff#1 *Eff#2 1 0-8 10yr2/2 none sil 2msbk mvfr as 2f,1 m 0.5 0.8 2 8-14 10yr3/3 none sil 2msbk mvfr cw 1f 0.5 0.8 3 14-23 10yr4/4 none sil 2msbk mvfr cw - 0.5 0.8 4 23-28 10yr4/6 none sil 2msbk mfr 1 cw - 0.5 0.8 c2-3d 10yr7/2 5 28-40 7.5yr4/6 7 5yr5/8 gr.sil 2msbk mfr - - 0.5 0.8 Boring# :_1 Ong , 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 GPDlft2 *Eff#1 *Eff#2 I *Effluent#1=BOO?30<220 mg/L and TSS>30<150 mg/L •Effluent#2=BODS<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. 1343 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85,Wis.Adm.Code Gustum Septic Service County Attach complete site plan on paper not less than 8'A x 11 inches in size. Plan must St.Croix lYsws:<rlr as'/,/ include,but not limited to:vertical and horizontal reference point(BM),direction and Parcel I.D. � // percent slope,scale or dimemsions,north arrow,and location and distance to nearest road. Pe,dirtg°271 — 7v '060 Please print all infn,matign. _ _, • Date Personal information you provide may be d-hi*ye.* tto iiPritacy Law,s.15.04(1)(m)). If G i,� ./2.--0/a 4-3--- Property Owner �` Property Location Humbird Land Corporation 4/ ; ;rt-c-at' , _Govt.Lot NE 1/4 NW 1/4 S 20 T 28 N R 19 W Property Owner's Mailing Address;...,.;' t''�' \ Lot# Block# Subd.Name or CSM# 332 Minnesota Street, East;1711? ,,,v ry , ' 25 n/a Troy Wood Subdivision City \Statg Zi1t de Ighohhe �r , i` p City �j Village p Town Nearest Road Saint Paul 1\M 1`) 55101.Tn 222-554,45. / Troy E Cove Rd/Windy Hill Road ).. zoisii r:nFFlCE 1,1. New Construction Use: 1><Rii idential/Numberpktiedims 3 Code derived design flow rate 450 GPD A Replacement ' tilkibr rill cube: Parent material loess Flood plain elevation,if applicable n/a General comments and recommendations: Part of 2.44 acres. BM#1= 100.0'. BM#2=93.76' Recommend mound system along 97.5'contour. P55 from preliminary boring work done 5-5-00. P55 Boring# :_1 Boring i/ Pit Ground Surface elev. 98.5 ft. Depth to limiting factor 24 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfft2 *Eff#1 *Eff#2 1 0-10 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 10-16 10yr4/4 none sil 2msbk mvfr cw if 0.5 0.8 3 1 -24 10yr4/6 pnone sil 2msbk mvfr cw - 0.5 0.8 4 24-40 10yr4/6 031.5 5/g 2 gr.sil 2msbk mfr - - 0.5 0.8 'I Boring# J Boring j Pit Ground Surface elev. 96.5 ft. Depth to limiting factor 36 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= *Eff#1 *Eff#2 1 0-13 10yr2/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 13-22 10yr3/4 none sil 2msbk mvfr cw 1f 0.5 0.8 3 22-28 10yr4/4 none sil 2msbk mvfr cw - 0.5 0.8 4 „.„.2.W 10yr4/6 none sil 3msbk mfr cw - 0.5 0.8 5 36-41 10yr4/6 0275y 5/8 sil 2msbk mfr - - 0.5 0.8 *Effluent#1=BOD 5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L — CST Name(Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St.,New Aubum,WI 54757 11/18/00 715-658-1344 Apr-03-02 03;43P Alexander home builders 651 4366916 P.03 • • . • f )' ..,'.. / 1343 Wisconsin Department of Commerce SOIL EVALUATION REPORT page 1 et 3 Division of Safety and Buildings comm sturn Spec SerAce in accordance with omm 86,Wis.Adm.Code ' County Attach complete site plan on paper not less than illi x 11 inches in silt Plan must St.Crobc....,.._ _ include,but not limited to:vertical mid hectoliter reference point(BM),direction and percent slope,scare or dimmable,Wit woe,and button and distance to nearest road -P—ard-e1.143.---- --- - pending Please print all infonnadon. - •- -- - Reviewed Sy Date Parma(intormatioa you panda may Oa used for secondary mow(Privacy Law,a.15.04(1)(m)). 1 Property Cosner Property Li:cation Humbird Land Corporation .._._ Govt.Lot NE 1/4 NW114 S 20_. T 28_ N R 19 W Property Owner's Marling Address --- -..------- LiiisiXii C IS .Nein*Of cii4 332 Minnesota Street, East 1404 25 I n/a 1 Troy Wood Subdivision Cy ' Stale Zip Code Phone Number . J City j Village e TNT Nearest Road Saint Paul 1 MN 1 55101 i 851-222-5555 _ Troy E Cove Rd I Windy Hier Road ad New Construction Use e Residential r Number of bedrooms .3 Code derived design flow rate 450 GPO J Repiacernent J Public or commercial-Describe: Parent material _loess .., , Flood plain elevetion,if applicable Na General=merits and recommendations: Part of 2.44 acres. BM#1= 100.0'. BNI#2=93,78' Recommend mound system along 97.5'contour. P55 from preliminary boring work done 5-5-00. P55 axing* -.1 Bering Pit Ground Surface elev. 98.5 t Depth to limiting factor 24 in. Soil Application Rate Horizon I Depth Dominant Color Rados°sectarian Texture 1 Structure .. Consider=I Boundary - -Roots 1 _. 0-10 10yr3/2 none sin 2msbk mvfr as 1 2f,lm m 0.5 0.8 2 , 1 0-16. 10yr4/4 none sin 2msbk mvfr cw if 0.5 0.8 . ....- - --------------- 3 16-24 10yr416 none sir 2msbk mvfr cw 0.5 0.8 . _ . .. .. 4 , 24-40 10yr4/8 ... .51, gr.Sil 2msbk mfr. - - 0.5 0.8 7 , ---- . • . .. , . . . ._. , . . , . ......._. 1 Boring# -.-1 80tIng 4 Pit Ground Surface elev. 96.5 ft Depth to limiting factor 36 in. Sol Application Rate Horizon Depth I Dominant Color Redoa Description Texture Structure I Consistence i Boundary j Roots OPDM •Eff#1 *Elf#2 1 0-13 10yr2J2 none ell 2msbk mvfr as 2f,1m 0.5 0.8 ... . ... . _ . ........ 2 13-22 10yr3/4 none sil 2rnsbk . mvfr cw 1 f 0.5 4.. 0.8 3 22-28 10yr4/4 none sil 2msbk mvfr cw - 0.5 I 0.8 4 28-36 10yr4/6 none sil 3msbk • mfr cw - 5 36-41 10yr4/6 c. -3c1 10yr//2 7.5yrS/ ail 2msbk mfr - - 0.5 0.8 •Effluent#1=EIOD?30<220 mg&and TSS>30<160 mg/l. •Effluent 42 a SOD c 30 rngiL.and TSS<,,,,30 mg& s- -CST Name(Please Print) CST Number Torn Gustum Signaillfl 227618 Address Gustum Septic iren 4ce Date Evaluation Conducted Telephone Number N1341 937h St,NO Auburn,WI 54757 11/18/00 715-658-1344 Apr-03-02 03 :44P Alexander home builders 651 4366916 P.04 property Owner Humbird Land Corporation Parcel rD# pending _ Page 2 of 3 IT Boring# -1 9 e Pit Ground Surface elev. 96.5 ft. Depth to trending factor 40 in. Soil Application Rate . Horizon Depth j Dominant Color Redox Description Texture 1 Structure Cansisterre I Boundary Roots GPDM' _ "E1101 'Eff02 1 0-9 10yr3/2 none sil 2msbk mvfr as 2f,1 m 0.5 ' 0.8 2 ' 9-13 i 7,5yr414 none sl 2msbk mvfr ow if 0.5 0.9 3 13-24 7.5yr416 none si 2msbk mfr ow - 0.5 0.9 4 24-32 7.5yr416 none Is 1 msbk mvfr cw - 0.7 1.2 5 i 32-40 10yr5/6 none Si 2msbk mfr ow - 0.5 0.9 6 40-48 5yr413 c2-3d 7 Syr g7/2 si 2msbk mfr - - 0.5 ( 0.9 I 3 goring# J Being e Pit Ground Surface elev. 89.0 ft. Depth to limiting factor 28 in. Soil Application Rate Horizon Depth ' Dominant Cola ` Redox Description Texture Structure Consistence I Boundary - Roots Eff#1 Di Effill2 1 0-8 10yr2/2 none sit 2msbk mvfr i as 2f,1m 0.5 l 0,8 2 8-14 10yr3f3 none sil 2msbk mvfr ow ` 1f i 0.5 I 0.8 3 14-23 1Oyr4/4 none sil 2msbk mvfr ow j - 0.5 0.8 4 23-28 i 10yr4/6 1 _none ail I 2msbk mfr r ow - , 0.5 0.8 — -- I c2-3d 10yr7/2 w_..S - 28-40 ; 7.5yr416 7.5yr5/8 gr.sll 2msbk mfr _ I 0.5 0.8 I 1 s Boring# J Bring ;Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate ' Horizon Depot 1 Dominant Color 1 Redox Description Texture Structure Consistence I Boundary Roots "E GPM I 4 'Effluent Sim BOO e 30.4_220 mg4L and TSS>30<130 mgll •Effluent 112 i BON J0 mgll.and TSS<10 mg/L The Department of Commerce u as equal opportunity service provider and employer. lfyou 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. 1 I CO• C.DH 1 . CO Q I au' 1 Jd .;I CO LI li N / I I , % , i = U , N Q r 0 u) r OL 1 / co rn I , I I ' , C lf-1 lf-) I co I -3 0_ I � u t° N i I ;g I I Z ad0/S o I �m o CO co z I 1 ; Lc) 1 N co I CO 6) / , , I I I I I , , l I I 1 I I LCD 7 I I , 0 0 C 0 = O O 0) O C _ U O d L) U 00 tf) _ a' N O Cr, cn CO Cr) o Y CO 6 iEi c 1 W r-NU C ~ O r'� �? N C CO 5 O N v U O N 4.-_'t Z' H. 1.Z § .V.g o) 2U (l.ladod d _�y Z o al __J)— L2_1 -g c w° x s C _, , a gm ES QS m v W w cn E a N:=7.:S 0 H I I I W Si i.7.5-JZF(5H o • 4, N 2 m co CC- 1 16. U CO i Q__ C o I'' ai ° I',"', Q Errk a to a4 o \ l 1 45 1 co v o c z c To O = [ N4 la h Q � d' • z h o 0 C i z N N C VIO op N I- Z a m F- ' o U� o z v n �\ w z z o a N c E 0 ,- a CO 0 0 N N i N t440 >, i3 o a _0 a O O O t1 N • oaaa a 7 O N • N t N J V w p Z 2 O y c O m to Q ':;3; • C"r 7 w 1 O O N• N C • y O CC O O D I. O O O N a) F c .7 ` c C V' N 0.1 N >. X N .- O O = E • I' V _ O 0 to Lq O L O N I— I Q O CL Z O CC i RI 4* w w E m Ial L1) 7 Jt Q d • a y .5 `y II' r�1 E -c c °w' ca "I.1 A OOo Ouoi Wisconsin Depz:rtment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safetland Building Division Sanitary Permit INSPECTION REPORT 217 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)]. 7 g Permit Holder's Name: City Village X Township Parcel Tax No: Alexander Homes I Troy Township 040 - 1271 - 40-000 CST BM Elev: Insp. BM Elev: I BM Description: )e TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS I FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head I T DH Ft Forcemain Length Dia. Dist. to Well r T SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. uid Depth Liq DIMENSIONS —7 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil 1 Yes No [1 Yes _ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 445 Windy Hill Rd Hudson, WI 54016 (NE 1/4 NW 1/4 20 T28N R19W) Troywood Lot 25 Parcel No: 20.28.19.1501 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = 3.) Contour = Plan revision Required? Yes * No - -� -- - Use other side for additional information. - - SBD -6710 (R.3/97) Date Insepctor's Signature Cart. No. i Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 s' CR 0 j )( VIseonsln Madison, WI 53707 - 7162 < Site Address e/ Department of Commerce Z _Iss �31r Y S w/tiv r /!.L e . Sanitary Permit Ap lication Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide �8a 11 Check if Revision ME be used for secondary purposes Privacy Law, s15. 1 m / I. Application Information - Please Print All Information R�CE�v State Plan I.D. Number Property Owner's Name 1 2002 Parcel Number - -00 Property Owner's Mailing Address ST CR NG G O O F CE Property Location N 't / Y ONI Sk 4, S J qA T OV N. R City, State Zip Code ne Number Lot Number Block Number _/5'V Subdivision Name CSM Number H. Type of Braiding (check all that apply) A e ❑City ® 1 or 2 Family Dwelling - Number of Bedrooms - []Village - ❑ Public /Commercial - Describe Use T O ❑ State Owned 1 y jam( g 7 - S [.�Q Qi►/ Pl�c�2 rest Road III. Type of Pe : (Check only one box online A (numb ring scheme for internal e). Complete line B if app . le) A. 1 09 New 2 ❑ Replacement System 3 ❑ Replacement of 6 ❑ Addition to For County use - System Tank Only Existing S ste B. ❑ Check if Sanitary Permit Previously Issued Permit Number V at Iss IV. Type of Permit: (Check all that apply)(numbering scheme is for internal e) 44 ❑ Non - Pressurized In- Ground 21$0 Mound 47 ❑ Sand Filter U 50 o j 22 ❑ Pressurized In -Ground 41 ❑ Holding Tank 48 ❑ Single Pass ,\ 11 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other V. Dis ersaW TIMM tment Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate System Elevation Final Grade Required Proposed Rate(Gals. /Days /Sq.Ft.) ./Inch) r � Elevation � SOU.s /0) �0- t /ao. VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks /„ /L, y& -gs Af 6" Y6 �7 Concrete Constructed Glass New Existing qq p Tanks Tanks Sevu or Holding Tank O - Dosing Chamber tfov o v VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number Plumbe A dress (Street, City, State, Zip Code 7 S u Yo VIII. oun /De artment Use Onl Approved ❑DisapprovedIarY Permit Fee (includes Groundwater Date Issued gent Signature (No Stamps) Surchargf Fee) _7 13 Owner Given Initial Adverse . qL G � Determination � 1K. Conditions of Approval/Reasons for Disapproval 1) e/eov) D V WJnr� W/71/ �t10AV -4 Pca K ew - �►us� r�av� TAW Z) PJ0V J?LQ? 6yS TI� 4 rm LAJi" t'tt VT_ �69J1 t2.i�QN Star FRv,» 1Vo41 5 6_)K14, 4,, /�.2aP�R7y Attach complete plafts 0o the County only) for the system on paper not less than 81/2 a 11 inches In size SBD -6398 (R. 05101) _ t Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TD #: (608) 264 -8777 erc N visconsin www.vAsconsin.gov .vAs c ons vw.wisonsin.gov Department of Commerce Scott McCallum, Governor Philip Edw. Albert, Secretary May 08, 2002 CUST ID No.692428 ATTN: POWTS Inspector ZONING OFFICE MARK STA14NKE ST CROIX COUNTY SPIA 715 6TH ST N 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 05/08/2004 Identification Numbers Transaction ID No. 729921 SITE: Site ID No. 643852 Alexander Homes Inc. - Windy Hill Rd Please refer to both identification numbers, St. Croix County, Town of Troy above, in all correspondence with the agency. NEI /4, NW1 /4, S20, T28N, R19W FOR: Description: Proposed F Bedroom Mound System Object Type: POWT S stem Regulated Object ID No.: 819047 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: General Approval Conditions: • 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" SBD- 10572 -P (R 6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R 6/99). • 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. • 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. Note: Changes made to this plan on 5/8/02 by this reviewer were acknowledged and approved by the system designer. Owner Responsibilities: 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(l). �n 0. w jtt' •T,S• MARK STAHNKE Page 2 5/8/02 Owner Responsibilities Continued: • 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. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is 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. g P h' g g g P 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 WiSMART code: 7633 jswim@commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 r �Il scons,ln APPLICATION FOR REVIEW Deportmern of Commerce - Complete all pages- POWTS Safety & Buildings Division ( ) Check if Confirmation is Desired: ( ) faxed, () mailed Bureau of Integrated Services NOTE: Personal information you provide may be used for secondary Confirmation of assignment to a reviewer. purposes [Privacy Law s. 15.04(1)(m), Stats.) Transaction ID: 1. Private Sewage Submittal 2. Type of Submittal: System Type (Vj New Previous Related Trans. ID: ( ) Soil Saturation Determination Report ( ) Revision Estimated Completion Date: t� ( ) Interpretive ( ) Replacement Assigned Reviewer: _ 54 Determination ( ) Petition (attach form SBD -9890) /� ( POWTS System ( ) Experiment, approval# Assigned Office: Z-4 0, .eC_4..LE ( ) At Grade ( ) Holding Tank (l� Component Manual (Include each Circle your choice of offices below: ( ) Nonpressurized In- component manual name, # and Ground date on title page of plan) Next available appointment in any office, 2. Green Bay, 3. Hayward, ( ) Pressurized In- ( ) Individual Site Design LaCross , 5. Madison, 6. Shawano, 7. Waukesha Ground { V) Mound 3. Project Informat' - Fill in all known information. ( ) Aerobic Treatment Unit Project/Site Nam ( ) Sand Filter _single pass Location, Number Street of project (if unknown, indicated nearest road) /„l &oy /a recirculating Legal Description: /Yr- A A!,. CAQ T_� /vA 19 k%l � ( ) Constructed Wetland County City Village Town of ZLg ( ) Drip Line ( ) Other: 4. After plans are reviewed, please: (check all that apply) Building Type (check one): ( �/) Dwelling, 1 or 2 family — Call customer 1, 2, 3, 4 (circle number)* *Refers to customer number from below ( ) Public/Commercial -_ Requesting party will pick up Building _✓Mail plans to custome1 3, 4 (circle number)* ( ) State -owned Building F 4 Gallons per Day 5. Complete the following designedownerlrequesting information. Utilize the check boxes when desi wne r requW party is the same to avoid repeating information. 10 % <Q '. Designertnformation''(Castdm'er l) , _,.' Regtiestin 1?arty ifs7ifferent than t (Cub 'toineG 3 First Name Last Name Customer Number First Name Las Customer Number n Company Name Company Name Address ++ Address f7 �~ City State Zip +4 (9digits) City State Zip +4 (9digits) Ph one Number (area code) Fax or Internet cell phone Phone Number (area code) Fax or Internet Check others if applicable Check others if applicable Owner Payer ) Requesting art ) Owner ( ) Payer flwntar <tnformation, Gustomer`,2 „ „ ;) , 'Other Please ec Customer 4 First Name Last Name Customer Number First Name Last Name Customer Number Company Name Company Name w v Address Address l% i /l/ City State Zip +4 (9digits) City State Zip +4 (9digits) Phone Number (area code) Fax or Internet Phone Number (area code) Fax or Internet Check others if applicable " Check others if applicable ( ) Payer ( ) Payer ( ) Other MAKE CHECKS PAYABLE TO DEPT OF COMMERCE TOTAL AMOUNT DUE $ Attach check here Review code 7633 SBD -10577 (R 7/00) THIS FORM IS VALID ONLY FROM 09/01/2000 TO 08/31/2001 l 6. Plan Review Fees for Private Onsite Wastewater Treatment Systems Type of Project ( CIRCLE THE APPROPRIATE FEE BELOW) FEE 1. All treatment components are previously approved under s. Comm 84.10 (2) or (3): Design wastewater flow of the proposed system: 1,000 gpd or less ....................................................................................... ............................... 1,001 —2,000 gpd ..................................................................... ............................... .......................$22.5.00 2,001 — 5,000 gpd .................................................................... ............................... ........................$275.00 greaterthan 5,000 gpd ..................................................................................... ............................... $300.00 plus $0.05 1g /d 2. One or more treatment components are not previously approved under s. Comm 84.10 (2) or (3): (Individual site design /deviation from component manuals and use of components without product approval): Design wastewater flow of the proposed system: 1,000 gpd or less ...................................................................... ............................... ........................$300.00 1,001 — 2,000 gpd .................................................................... ............................... ........................$400.00 2.001 — 5,000 gpd ..................................................................... ............................... ........................$500.00 greaterthan 5,000 gpd .............................................................. ............................... ........................$600.00 plus $0.05 /g /d HOLDING TANKS ONLY 3. Holding tanks previously approved under s. Comm 84.10 (2) (3 Design wastewater flow of the proposed system: 5,000 gpd or less ..................................................................... ............................... .........................$60.00 5,001 — 10,000 gpd .................................................................. ............................... ........................$100.00 greaterthan 10,000 gpd ........................................................... ............................... ........................$150.00 4. Holding tanks NOT previously approved under s. Comm 84.10 (2) or (3) and site constructed tanks Design wastewater flow of the proposed system: 5.000 gpd or less ..................................................................... ............................... ........................$120.00 5,001 — 10,000 gpd ................................................................... ............................... ........................$200.00 greaterthan 10,000 gpd ............................................................. ............................... ........................$300.00 Experimental System (additional one time fee) ................................................. ............................... ........................$300.00 Revisionsto Approved Plan ........................................................................... ............................... .........................$60.00 Petition for Variance (Include form SBD- 9890) .............................................. ............................... ........................$225.00 Revision to a previously approved Petition for Variance ......... ............... $75.00 Soil Saturation Determination Report — Per Site (other than a proposed subdivision).. $100_00 InterpretiveDetermination Report ....................................................................................... ............................... ....$100.00 Subtotal ..... ............................... Priority Review: Enter same amount as subtotal ..... ............................... Prior approval from a section chief is required for a priority review. If approval is granted, the priority will be reviewed within 5 days of receipt. Enter TOTAL (rounded to the nearest dollar) here $ i o0 and on bottom of FRONT PAGE Note: Fees are pursuant to Ch. Comm 2 and are subject to change annually; please contact any of the offices listed below for the most recent copy of this form. Comm 2 provides for a partial fee refund if a plan action has not been taken within the 15 days of receipt of all required information. 7. Appointment, Scheduling Information, and Plan Submittal Checklists. POWTS scheduling is not available. Plans will be assigned to a reviewer after receipt of plans. If you wish to receive confirmation of the assigned reviewer and estimated completion date please check the box in the upper right corner of the front page. Also note in the same location that you can designate a specific office for review. If you select a specific office your estimated completion date may be considerably greater than what would be possible in another office. Submittals received without a specific office indicated on the form may be assigned to offices other than the receiving office depending on reviewer availability. To obtain a submittal checklist call the material order unit at 608 - 266 -1818 or one of the full service offices listed below. Madison S &BD Hayward S &BD LaCrosse S &BD. Shawano S &BD Green Bay S &BD Waukesha S &BD 201 W Washington Ave 10541N Ranch Rd 4003 N Kinney 1340 E Green Bay 2331 San Luis Place 401 Pilot Court 53703 Hayward WI 54843 Coulee Rd Shawano WI 54166 Green Bay, WI 54304 Waukesha WI 53188 PO Box 7162 LaCrosse WI 54601 - Madison WI 53707 -7162 715- 634 -4870 1831 715 - 524 -3626 920 -492 -5601 262 - 548 -8600 608 - 266 -3151 Fax: 715-634-5150 Fax: 715-524-3633 FAX: 920 -492 -5604 Fax: 262-548-8614 Fax: 608 - 267 -9566 Email: haywardsch@ 608- 785 -9334 Email: shawanosch@ Email: greenbaysch@ Email: waukeshasch@ TDD 608 - 264 -8777 commerce.state.wi.us Fax: 608 - 785 -9330 commerce.state.wi.us commerce.state.wi.us commerce.state.wi.us Email: madisonsch@ Email: lacrossesch@ commerce.state.wi.us L commerce.state.wi.us I \j V\ V <zz CV1 \jj "j 3A )IS Nc x 4 7 z_ • ZI-I V4ftf C btFARTME NTOF OMSION COMMERCE SE A p EE COR Up 'WOE ACE � �xd 1r � fy � i� r<''y'��Z � � , a -�+ ii ��;�„;� =fi Mound System Management Plan Pursuant.to Comm 83.54, Wis. Adm. Code Page Z of The septic tank shall be maintained by an individual certified to service septic tanks under s. 281. tat disposed of in 48 , S s. The contents of the septic tank shall be dis P accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. typT� l JJ S P E�1� t71tJ - t-�?C Q u.t=►ve�f -..: Fu BLS L 2 -. C4z;70MQ12- . -- — Pum_ p Tank - - -AlS(Y/ 1?06 -Get- C�C�VIL�CO - UT -3 1RS — The pump (dosing) tank shall be inspected at least once every 3 years. All s s, alarms, and pumps shall be tested to .verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.' Moun I and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg /L BOD5,150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distributions stem is r Y provided with a fl lateral be flushed of accumulated solids at least on eeve 18�months. When a pressure test s r performed it should beeach compared to the initial test when the system .was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell,shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [S80- 10572 -P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and Pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. If g naencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective th defective component immediately repaired or replaced with a component of the same or equal performance. shall be If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired . or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and,dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of this s stems ' � y___ ..__- hould be directed to the County Zoning office at -11S_ 386 - 4/46 0 or to the j licensed plumber who installed the system. ROM '-J iJ �: ✓ � i i F 11 l / i ,4 os f l Aso zoo P g 0 t/ R"c4" m L �f, o gen Wes= / S : r s Wit.'. \ , t7 G /t"' :V X3 0'., 6s' t' 1 67' F J AT i y, r � r 0` 3 I _ E } w s I V v 1 z I � w ° I I � 1 z � O m —� Q N1 � J Z � � C � W Q D � 1 z '.14 to � t w I w r a F v `l ill 4, Zl` At Z n J bd wuoe :80 Z00Z 80 'FpW £Z£0- 98£ -SZL ON Xdd Dui saay�.oag edd?Z World J N -J Lb V . © o k ILA 0 ]L A \ a 2 Y I ti � - J h Al 7 S N Z �y Q Y Y 3 � Z 3 Il k � vQ � • •, - �R6E 7 or 7 E40 Series IO HP Effluent and Drain Water Pumps Per ormance Curve MODEL ME40 EFFIL.FENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 30 10 tH W Ld H 25 8 x a z W `20 ~ = 6 15 F- 4 0 10 f- r J : 0 4 1.1 0 10 20 30 40 50 60 70 80 90 100 0 CAPACITY GALLONS PER MINUTE - 1101 Myers Parkway, Ashland, Ohio44805 -1923 419/289 -1144 FAX 419/289 -W8 ': Telex 98 -7443 K3326 7/91 nt � .. ed to U.S. Printed a o � cr z Lc) a m M_ 0 � � d NO tL K W O ° I U 0 Z �w ., o W �' W �� l a� io 1 F� .o �� o �M a Y F- W= ,`1 0Z U �G I �Va O 1- i` => C> _1 vv < 6 rr"0 O_W p Q p0 L�0E- h Z 3 0 N a N N V 0 z i �J Q o� 3v L,..< Q —U J N J Q Ir f' O p a I LWW 0 0 > > O n O LLJ z V o, I m p t J U) Q L. �� s ��' O Q W /� _ Np0g1'!Q W(n Mp O W �' O ��JJ - ` ' �� O G u 1- M N z < V) O V J N I In O I- J C W Q wJ_ (y = U W Zt M0 - r W U 1 ""fP) M C) Q J W N Y O� o� o�� oz� c3 �, N m Q w -i 0 00 -,t-J !Z z O - z °ma z a 0 Y_j z <c<� �QOOQWI..1 t+.10W Q* ate° 0 U Q r 3m U2 =J7mJ Z U7 W w ~ W Y J J 0 0 Z N r N U r Z O N z a <cWVi H 1 I 1 I I 1 I 1 1 I I I 1 c �+ T t�Om J I I N • 1 I . 1 I I 1 I 1 , I I I 1 z I 1 LO , 1 � . 1 1 1 I I I 1 1 r W F 0 lb r�5 1343 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Gustum Septic Service Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must County St. Croix "/yS(.ui' s7l �d include, but not limited to: vertical and horizontal reference point (BM), direction and ll,,!! //// percent slope, scale or dimensions, arcel I.D. sions north arrow, and location and distance to nearest road. pendi — g° - — 7V -0 Please print all infAmati9p. Date Personal information you provide may Law, s. 15.04 (1) (m)). �Q Property Owner Property Location Humbird Land Corporation �/ ` " �:, - ., - ,, Govt. Lot NE 1/4 NW 1/4 S 20 T 28 N R 19 W Property Owners Mailing Addr Lot # Block # Subd. Name or CSM# 332 Minnesota Street, Eastj'f4n44 mnn 25 n/a Troy Wood Subdivision City Stater zi Idhirlber City J Village r Town Nearest Road cT Paul - Troy E Cove Rd /Windy Hill Road Saint au �l[�I ` 55101'" _ 222 5 i y Y I ✓e New Construction Use: Re, idential / Number r _ 3 Code derived design flaw rate 450 GPD j Replacement Fwlbl�c�6r`,crr) lata ribe: Parent material loess Flood plain elevation, if applicable n/a General comments and recommendations: Part of 2.44 acres. BM #1= 100.0'. BM #2= 93.76' Recommend mound system along 97.5' contour. P55 from preliminary boring work done 5 -5 -00. I F5�5Boring # J Boring s/ 1/ Pit Ground Surface elev. 98.5 ft. Depth to limiting factor 24 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1ft *Eff#1 *Eff#2 1 0 - 10 10yi3/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 10 - 10yr4/4 none sil 2msbk mvfr cw 1f 0.5 0.8 3 1 -24 10yr4/6 none sil 2msbk mvfr cw - 0.5 0.8 4 24-40 10yr4/6 c 7.5yr5/8/2 gr. sil 2msbk mfr - - 0.5 0.8 Fq Boring # j Boring 1/ Pit Ground Surface elev. 96.5 ft. Depth to limiting factor 36 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' *Eff#1 *Eff#2 1 0 -13 10yr2 /2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 13 - 10yr3/4 none sil 2msbk mvfr cw 1 f 0.5 0.8 3 22 -28 10yr4/4 none sil 2msbk mvfr cw - 0.5 0.8 4 2 0 6 10yr4 /6 none sil 3msbk mfr cw - 0.5 0.8 5 36-41 10yr4/6 c2 � 5yrS /8 sil 2msbk mfr - - 0.5 0.8 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD -S mg/L and TSS < mg/L CST Name (Please Print) Signature: CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St., New Auburn, WI 54757 11/18/00 715 -658 -1344 i Property Owner Humbird Land Corporation Parcel ID # P ending - - Page _ 2_ - of _ x 3 _ F 21 Boring # Boring l/ Pit Ground Surface elev. - ____ -- -- . -- _ ft. Depth to limiting factor 40_ _ _ _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIfl' *Eff#1 *Eff#2 1 0 -9 10yr3/2 none sil 2msbk mvfr as 2f,1 m 0.5 0.8 2 9 -13 7.5yr4/4 no sl 2msbk mvfr cw if 0.5 0.9 3 13 -24 7.5yr4/6 n one sl 2msbk mfr cw - 0.5 0.9 4 24 -32 7.5yr4/6 none Is 1 msbk mvfr cw - 0.7 1.2 5 32 10yr5/6 none sl 2msbk mfr cw - 0.5 0.9 6 4 5yr4/3 c2 -3d 10yr7/2 ' sl 2msbk mfr - - 0.5 0.9 7.5yr5/8 — 3 ] Boring # Boring Pit Ground Surface elev. __ 89 .0 __ ff. Depth to liming factor 28 m. �J __- � Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots WWI' *Eff#1 *Eff#2 1 0-8 10yr2/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 8 714 10yr3/3 none sil 2msbk mvfr cw 11 0.5 0.8 3 14 -23 10yr4 /4 none sil 2msbk mvfr cw - 0.5 0.8 4 23 -28 10yr4/6 none sil 2msbk mfr cw - 0.5 0.8 c2-3d 10yr7 /2 5 28-40 7.5yr4/6 7,55/8 gr. sil 2msbk mfr - - 0.5 0.8 I F-1 Boring # _ Boring Pit � Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure I Consistence Boundary Roots __. SP_QLti = _ *Eff#1 *Eff#2 I i • Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD -S mg/L and TSS < _.�0 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. O aUt� 10jadoJd CN m a r � ' r r ' / C / ■ �U) IQ r rl) , r r ' ' r r r , � Ln co 3 N r ' r , r / r7 � a � r , m oO � , � r cc co I , m rn ' � I ' I 1 , I 7 1 , I ' I O O O C U O c U O Ln U OJ u _ m o I D cc 0 � z w Jda o OI Q� Y C d U ti O c m a m a cc 00 N o D �1O .o y > o U2M� r\ . •� J z Q" 0 auij (ljadOJd c F- U) z °' o c� > w c 5 o co y w W Q& s J w S C' c� Ev (L m� T m n w J n 7 r M t S W N 0 � it I I � cv [O m OC) � U CYO Q f FROM : 'Zappa Brotl -rs Inc. FAX NO. : 715- 386 -0323 Apr. 05 2002 09:09AM P1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE' AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address f O Ova,,. -G / vt wa� -eta PJAI SSaB. Property Address 4 (Veificstion required from Planning Department for new construction) City /State PN k ov Parcel Identification Number LEGAL DESCRIPTION Property Location SE 'A, Y�Z 'A, Sec_ N- R1._W, Town of � �• Subdivision Tl-o� Lot # 02 - C __. _ Volume Page # Warren Deed # 7 S , Volume � ,page # Warranty y ,/ - Spec house Ayes ❑ no Lot lines identifiable ❑ yes ❑ no SYSTEM MAINTENANCE Improper use and maintenancoof your septic system could result in its premature faiktre to handle wastes_ Proper main consists of pumping out t$e 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 masterplumber, joumcynianplumber, restrictedplumber or a licensed pumperverifying that (I) the on -site wastewaterdisposal system is in proper operating cgndition 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 Zoning Office within 30 days of the three year expiration date_ . yam SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION 1 (we) certify that all statements on this form are true to the best of ray (our) knowledge. I (we) am (are) the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF VYI DATF, 44 # * Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. www��w *' Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is madc in the warranty deed AR � � {� 7 c � p 7 STATE AR OFIVBC(YIVSdN p�ORM2 -7992 6 7 5 4 5 1 WARRANTY DEED KATHLEEN H. NALSH REGISTER OF DEEDS Document Number ST. CROIX Co., MI This Deed, made between Day Farm Investors, LLC, a Minnesota RECEIVED FOR RECORD Limited Liability Company 04 -05 -2002 9:45 AN WARRANTY DEED Grantor, and Alexander Homes Inc EXEMPT # REC FEE: 11.00 TRANS FEE: 314.70 COPY FEE: Grantee. CERT COPY FEE: PAGES: 1 Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin: Recording Area Name and Return Add L W Lot 26 Troy Wood, Town of Troy, St. Croix County, Wisconsin //�/.�1 & "' � 040 - 127140 -000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Subject to notes, easements, re strictions,covenants and rights of way of record, if any, including but not limited to those for drainage,water retention,ponding,and or utilities as may be shown on the plat of Troy Wood recorded in Vol. 8 of Plats, page 28,St.'Croix County, Wisconsin. The warranties of this deed, either expressed or implied are limited by the grantor to the grantee, or anyone in the chain of title, to the consideration expressed herein, that being the sum of $ 104,900.00. Dated this 29th day of March 2002 Day Farm Investors, LLC * * by President * * Austin J. Baillon AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ) SS. Ramsey County. ) Personally came before me this 2 day of authenticated this day of March ) 2002 the above named Austin J. Baillon * TITLE: MEMBER STATE BAR OF WISCONSIN -- - (If not, to me known to be the person(s) who executed the foregoing inst t and acknowledge the same. ru authorized by § 706.06, Wis. Slats.) ZQ acknowledge ■ THIS INSTRUMENT WAS DRAFTED BY � W ��c:. PAUL A. BA ec c NOTARY FUBLIC•M.IMNESOTA Paul A. Baillon, Attorney at Law * Paul A. Baillon ';Y 'AY COM41iSSION EXPIRES 1.31.2005 Notary Public, State of Wisc (Signatures may be authenticated or acknowledged. Both are not My Commission is permanent. (If not, state expiration date: necessary.) January 31 2005 ) *Names of persons signing in any capacity should be typed or printed below their signatures STATE BAR OF WISCONSIN WARRANTY DEED FORM No. 2 - 1998 INFORMATION PROFESSIONALS COMPANY FOND DV LAC, R'I xnn -ess -3021 i ' ''28 I 1.35 ACRES g 1 58 SO. Fr. — -� o , sil 416 01 tn�1 i I 1.82 ACRES N a, � • \ ^a 79 SO FT. O i N � IV- 1 m 1416- o STORM WATER r� RETENTION . .A N POND N I � � ,. ,.f H.W.L. =1039 \ r r' LOW ENTRY ELEVATION m ' 26 r . I 2.51 ACRES / C I 109,368 Std. FT. C / `� ryoti I / I , , 5 �, / / / 2.44 ACRES / 106,093 SQ. FT / 21d / .35 ACI Ile / 58,642 St Al of w /s 0 P a r y DOUGLAS j. Tit ' L------ - - - - -, / ZAHLER `- - - - - -- =` S -2145 270.31' 223.56' UDSON. IS A , * , imb � - O 1p '0 r ' N88°000"E 471.35' O \• ` 7 - 0� mo ( (` E- .------------- - - - --� Q� om i ` i' 1 18 1 \ .,o $ O N! ! t I 1.83 ACRES I A J 79,660 SO. FT. I a _ 0 0 0 I ------- - - - - -- 1 1. 1 *3 nleo°oaoo•E a7e.1 a — — _ — — ` —. — Q ' O A DRAINAGE I �� EASEMENT I r a ___ 2.06J CRES — z v �� ./4,\ 89,750 SO. FT. r — ° b _ - r \ 'Z \� \ \ • // — r — 120.83' - -y, '/ \ 368.46 0.01' — g 12'3W 489.29 L, N8 0 STORM WATER RETENTION POND i \\� �� • -� \ \ \ H W.L. - 1041 W.0a 1.80 ACRES s0. FT. _ SO5 V 1 ' 2 1`E392 . v ? T 22 �, I DES ° 23 I ° I 1.64 ACRES � 1\ 1 ��_ --•� 1. o 1 .1.20 ACRE a 1 71,312 S0. FT. �. I 1 2 � 52,281 80. '! j t~ -100 I I 2.45 ACRES ' 1 106,724 SO. FT. S I ! 1 I I I $I• !A -J - '-- - - - --� L - - ---� SI �°' F------ - - - --1 205.22' 21 I.M'l m as 329.82' S 89 0 45'02" W 1306.49' ' o- o- a o Q UTLQT ' THE NW1/4 FUTURE ROAD RIGHT -OFD ` r ,Q�lj [5pp (Sp(t�pp `a 0.628 ACRES :27 . Apr -03 -02 03:43P Alexander hotne builders 651 4366916 P.03 1343 Wisconsin Department of Commerce SOIL EVALUATION REPORT pap 1 of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code Ousttan Sepw Service Anaeh canplels site plan on paper not Wu then 8% z 11 k4ss in size. Plan must Canty utclude. Wt not limited to: vertical and harizmtal reference point (SM), direction end _•_ St. Croix _ percent slope, scale or Owslons, n*M arrow, and butlon and dlatanee to nearest road Parcel I.D. - pending Pf"a s print aH 1Morrraadan. Ray weed by t� _ PeRG W Mgmetioe YOU pr0040e M4 be Uwd br semrdarr prrMW (Prbaay Lin S. 15.04 (1) (m)). r Property offer Property Location Humbird L Corporation Govt. Lot NE 19 NW 1/4 S 20 T 28 N R 19 W Property O.alers ✓ ftling Address (Al # Block / Su b& Name or CSfrea 332 Minnesota Street, East 1404_ _ _ _ 25 1 _via _ Tro rY Wood Subdivisio City State Zip Code Phone i umtw . — J City J Wlage 14 Town Nearest Road Saint Paul I MN 1 55101 j 651 222.5555 Troy E Cove Rd / Windy Fiih Road 16 mom Construction Use: 16 Residential t Number of bad, w. .3 Code derived design flow rate 450 GPD J tieptanement ) Ptd7iic or commercial - Describe: Parent material • loess Flood plan aleralion, ff applicable n/a General cownern and recarawx1atiau: Part of 2.44 acres. SM 01= 100.0'. BM #2= 93.76' Recommend mound system along 97.5' contour. P55 from preliminary boring work done 5 - - 00. P55 Boring a Boring 16 PR Grand Surface 9W. 98.5 1t. Depth to ii r&q factor 24 in. Soil AD*Afiw lute Horizon Depth Dominant Color I Redox DesccOw I Texture Shutters Consiswa swndsry Roob ;E. ff F ` 1 0 -10 IOyr312 none sll 2msbk mvfr I as 12f,1m 0.5 0.8 2 10.16 10yr414 I none I sil 2msbk mvfr cw 1f 0 5 0.8 3 i 16 -24 I 1Oyr416 I none sil 2msbk mytr ew - 0.5 0.8 C3 07r2 4 240 j 10yr416 gr. sil i 2msbk mfr - 0.5 0.8 j al3orirtg J Borin Id Pit Ground Surface elev. 96.5 it Depth to limiting factor 36 in. Soil Appyatbn Reis Horizon Dog I OaninantCaior Red%OurAptim Uwe ' StwM* Consistw4 j 8wx*y 1 Roots GPOfK •Ef1111 'Eff#2 1 0 -13 10y none sil 2ms6k mvfr as 2f,1m 0.5 0.8 2 13 -22 10 r3/4 none I Y l su i 2 msbk ! mvfr ! con � If 0.5 018 3 22 -28 10yr4 /4 none sa 2msbk mvfr j cw I - 0.5 0.8 4 28 -36 1Oyr4 /6 none , sit - 3msbk mfr con I - 0.5 0.8 5 36.41 10yr4 /6 c2- S IOvr712 sil 2mabk mfr ! - 0.5 0.8 yr Effluent #1 a 800 30 < 220 mg1L avid TSS >30 100 mgrL • Effluent tf2 a BOD c 30 mglL and TSS <_W mglt. CST Name (Phrase Print) Signa ure: CST Number Tom Gustu m.., 227618 -- Address Gustum Septic Service Dade Ewlustiot Conducted Telephone Number N13450 937th St, NavAubum W1 54757 11/18/00 715858 -1344 Apr -03 -02 03:44P Alexander home builders 651 4366916 P.04 Pro p Humbird Land Corporation Parcel 10# pending _ PNO 2 at 1 2 1 BaIng# J �9 �---� ✓J Pit Ground Surface elev, 9 6.5 ft. Depth t0 limiting factor 40 in. Soil Application Rate Haizon Depth Dominant Cola Redw Damptlan Texture I stnuture Canswwm Boundary Rods "EtfN1 GEQ 1 09 i 10Yr3/2 none 311 2msbk mvfr as 2f,1 m 0.5 I 0.8 I 2 9 -13 i 7,5yr4A none sl 2msbk mvfr cw If 0.5 0.9 3 13 -24 , 7.5yr4A none W 2rnebk mfr cw - 0.5 ` 0.9 42 7.5yr418 ` non e Is Imsbk mvfr Cw - 0.7 1.2 5 i 324 10yr5/9 none sl 2mabk mfr ow - 0.5 ( 0.9 -- 6 40 5yr4/3 c2 10yr7/2 al 2rnsbk mfr - - 0.5 0.9 7.SYr5/8 3 Boring a 1E Jn9 id Pit Ground Surface slev. 89.0 iL Depth to Ymiting factor 28 in Sol Application Rate Horizoa Depth j Dominant Color Redox Dasdption Texture Structure Cauislowe Boundary Roofs GPM& 'EfW - Efflf2 1 0.8 10yr+2/2 none sil 2msbk mvfr I as 2f,1m 0.5 0.8 - 2 8 -14 10yr3/3 f none ail 2msbk mvfr i cw 1f 0.5 i 0.8 3 14 -23 10yr4 non ail j 2msbk mvfr aw j - 0.5 0.8 4 23.28 ' 10yr4/6 none ail l 2mvbk mfr cw - 0.5 0.8 -- c2-3d 10yr7/2 2840 7.5yr416 7.5 /8 gr. sll 2msbk I mfr - 0.5 0.8 i Boring a J Boring 1 PR Ground Surface Ow. ft NO to firr* g factor in. Sal Application Rate Horizon Cepth I Dommmi Cola I Redox Deediom 1 Texture sWcWrs CmaBdence + Boundary Root Eff#1 Etfit2 i I I i ' Effluent 01 DOD 30 t= myL and TSS >30 < 130 nV& •Effluent 02 ■ BO0 mglL and TSS <x mdL, The Department of Commerce is as equal opportunity scrv= providcr and cnq)b er. Ifyou need &nWanm to acorn xrvms or need matedsl in an alternate format. Plum contect the department at 08 -266 -3131 or 7TY 608 - 264.8777. Apr -03 -02 03:45P Alexander home builders 651 4366916 P.05 c c N - t n r P N CO 3 , Q ' Q�i. haperty line � a tt iii tttt o � o SL I L j o a i � y ; P !. c � t Ic o e o � 1 ` 0 * N t m m I 0 10 l 10 P a i cy, �1 to v r 1 � I =L 16 co t R � - i t � ~ prpas�ly line I i 4 1i I i 9 tit