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HomeMy WebLinkAbout040-1272-00-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division , INSPECTION REPORT Sanitary Permit No: 430418 0 GENERAL INFORMATION (ATTACH TO PERMIT) - 2 Z 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: Village X Township Parcel Tax No: City Trok, Richard Troy Township 040 - 1272 -00 -000 CST BM Elev: Insp. BM Elev: BM Description: ./ Section/Town/Range /Map No: Ap ac /. C4" T PI -r rely B.Ik, 20.28.19.1507 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION QS FS F�L�V� Wit fet (J� Septic Benchma[k_ 8. fo-7 /U Dosing Alt. BM 3.0 /0 S &7- Aeration Bldg. Sewer �--q :2L Iq Holding St/Ht Inlet I l5 / O1 TANK SETBACK INFORMATION St/Ht Outlet TANK TO _-R/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet `- Septic a �t ®/ DN1ott�o tm " 6 ��/ 7 b • (�Z d i � Dosing \� �f Header /Man. l°- Z Aeration / Dist. Pipe _56 Holding Bot. System -5 /� 2. /} PUMP /SIPHON INFORMATION ® Final Grade � + 4, Manufacturer Demand St Cover, / GPM Model Number ® 7 - r TDH Lift�� friction ss System Head / T � Ft /0'0 0 /� Forcemai Length Dia. A Dist. to\ Well CP S 12 . 3 / Z J SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length f No. Of Tr ch s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS _ .-- SETBACK SYSTEM TO P/Lg BLDG WELL t LAKE /STREAM LEACHING Manufact trer: INFORMATION CHAMBER OR Type Of System: UNIT M Model Ny b DISTRIBUTION SYSTEM Cel S''K 57' X t�hs. Ptp.a IA ems. ere,�l Header /Manifold Distributions x Hole Size If x Hole Spacing a6 Vent to Air Intake Dia it Pipe(s) q 3 V /� �lD� �3� Length Length 5,U Dia z Spacing ` SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over y Depth Over j xx Depth of xx Seeded /Sodded xx Mulched Bedlrrench Center f - S Bed/Trench Edges Topsoil Yes ' No Yes Na COMMENTS: (Include code discrepencies, persons pre t, etc.) Inspection #1: /d / / IIn p ion #2: /0 Location: 428 Windy Hill Road Hudson, WI 54016 (NE 1/4 NW 1/4 20 T28N RI 9W) Troywood of 31 rcel o: 2 8.19.15 1.) Al B Descriptio 4E co r N � `j ( v e l ' e L 3ex bo ad cc to r� �!� met cc a .'�� S , Z ♦ �f3 2.) Bldg sewer eni gth = j q+ amount of cover = Plan revision Required? Yes K o J !v = Use other side for additional informati �_ � _. � ! L SBD -6710 (R.3/97) Date 41nsepcior's Si nature Cert. No. N visconsin Safety and Buildings Division C culm 201 W . Washington Ave., P.O. Box 7082 Madison, WI 53707 Sanitary Permit Number (to tic filled in by Co.) De artment of Commerce (608) 261 -6546 20 /e Sanitary Permit Application State Pl an I .D. Number .� In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide C 1 2// - 7 6 - Froms. /b ' may be used for secondary purposes Privacy Law, sl5.04(I)(m) Project Address (if different than mailing address) L Application Information - Please Print All Informat - R, L � _,. ---1 4za � 1 � ( I) "` R6. 0 a Tt Property . er g 's ,Name, ID Parcel # Lot # Block # ���VtL�Y U- IZ _7 z -(� -GYM Property Owner's Mailing Address S03 Property Location � Z /•, kfJ /., Section City. State Zip Cod T !jPyr��ipiµllp¢Fr II. Type of Building (check all that apply) 4,S S tau T N; RE Subdivision Name _ CSM Number XI or 2 Family Dwelling - Number of Bedrooms - ❑ Public/Commercial - Describe Use q t ❑ State Owned - Describe Use 5Dy ❑ ' r ❑City_llage�ownship of T/� t VV III. Type of Permit: (Check only one box on line A CompleO line B if applicable) A. %New System ys ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System B. ❑ Permit Renewal ❑Permit Revision ❑Change of [I Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: Check all that apply) K 54 ❑ Non - Pressurized In -Ground XMound > 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 Cham ❑ Drip Line ❑ Gravel-lesi Pipe ❑ Other (explain) V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation 3 v16 • y , 13 �� VI. Tank Info Capacity in Total Number Manufacturers Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Clamber :J VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum 's Name (Print) J Plumbcr' f Signature MPIMPRS Number Business Phone Number a �5Z x/ JZ1 Plumber's Iddress. (Street, City, State, Zip Code) 21 � VIII. Countv v. !De artment Use Onl IK Approved El Disapproved Sanitary �f� ary Permit Fee (includes Groundwater Date Issued 1 g Agent SignaMes:tam:ps) Surcharge Fee) 2 ❑ Owner Given Reason for Denial 3 D '- Q 2-CiD3 IX. Conditions of Approval/Reasons for Disapproval SYSTEM OWNER, 1 Septic tank, effluent filter and ckpersalooll must all fie serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances. Attack complete piaas (to the County only) for the system on paper not lets than 81/2 x 11 Inches In size SBD -6398 (R. 08/02) Owv�•� � YJ 0 IDS S o-IV .:�. 1,atJ�'� •!. aV Io f PRIVATES WAGE SYSTF�� n (/ Con 9� APP DIVISION OF SAFE AND BUlj0V o, (_ SEE CORRES CNDENC a �` 3s^ � � GtS• z i 14 01 J S. 16, Stoyet ' rl 1 a. =_ QL l 4 No ws %. 1L..<l. r O PY \, 0.c- t PC e . i� J.XA, C... dl- O I ` Safety and Buildings 4003 N KINNEY COULEE RD LACROSSE WI 54601 -1831 TDD #: (608) 264 -8777 iscons►n www.commerce.statemi.us /sb www.wisconsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary September 25, 2003 CUST ID No.226524 ATTN: Rod Elsinger ROGER L TIMM ZONING OFFICE TIMM EXCAVATING ST CROIX COUNTY 3128 20TH AVE 1101 CARMICHAEL RD WILSON WI 54027 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/25/2005 Identification Numbers Transaction ID No. 921175 � SITE: Site ID No. 665590 f' b i i d Please refer to both identification numbers, ` Richard Trok 428 Windy Hill Road above, in all correspondence with the agency. Town of Troy St Croix County NE1 /4, NW1 /4, S20, T28N, R19W "} Lot: 31, Subdivision: Troy Wood FOR: „ Description: New 3BR Mound` Object Type: POWT System Regulated Object ID No.: 922303 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: A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. 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 Dennis R Sorenson Wastewater Specialist, Integrated Services WiSMART code: 7633', (608)785 -9336, dsorenson @commerce. state. wi.us r Richard Trok - Mound 11 . FO n action Tra s �4 Construction Materials and Techniques O All materials must comply with Comm 84 and be installed in accordance with manufacturer" N specifications. Construction methods must comply with the following Component Manuals: Mound, SBD - 10691 -P (01 /01) Pressure Distribution, SBD- 10706 -P (01/01) Location: Lot 31, Troy Wood NE 1/4, NW 1/4, Sec. 20, T 28 N, R 19 W Town: Troy County: St. Croix Date: September 25, 2003 Owner: Richard Trok Address: 428 Windy Hill Road Hudson, WI 54016 Plumber: Roger Timm Signature: b4�6 License 4 MPR 226524 tGE SYS T EM Attachments: 6748 -Plan Approval Application ,'a : SBD -8330 1, % ; page 1: cover 2: design criteria & calculations 3: plot plan SLE CORRESPONDENCE 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management page 1 of 8 f,+ v t Design Criteria `n Residential Wastewater Contaminant Load: 30 mg /L < BOD < 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 qs%' gallons /day hydraulic load Design Calculations In situ designed loading rate 0 .4 gallons /sq. ft. per day Depth to estimated high ground water 24 in. Depth to bedrock Z 4 in. Cross slope at system % Force main length ft. of Z in. Manifold/header length 4 ft. of in. Drain -back zZ•zY gallons Lateral length Z @ ft. of � z in. Lateral elevation ft. @ bottom of lateral Lateral hole size 3 �1 b in. @ 3 b• o in. ( 3• o ft.) Spacing \ R, holes /lateral holes total Lateral volume q `� 3 b gallons Total lateral discharge rate 2 s'O gallons /minute @ 2 •�� ft. head Network pressure compensation losses ° •� S ft. Elevation difference ° t • z ft. Friction loss Z • % ft. @ Z gallons /minute Total dynamic head 2 ft Pump /si*n 1 0 gpm @ Z� ft. of head i Manufacturer C1_- Model # n S Dose volume g S g gallons Lift /si0on tank - - bso t9 , MD gallons Septic tank gallons Effluent filter Measurement pump on and off in. Height alarm from tank bottom b • in. Reserve capacity S3' + gallons specs.calcsxes Page Z of lye � lyw . to 0 IA PRIVATE WAGE SYS � o M., 1 va uo na %4 Gw..� A P P DIVISION OF SAFE S A SEE COFcr- E Lr (a 4� 3s" tuo.� (��,.L, � Gtr• z i 7 �AS L r3 rt xxx h ��o.a 10.2 <.p,.�ar•�. 'ul.L1 =_= s»»> el 4 CD i 4L � 4S YO�-►c 0.rM�q t�t, �D `jilowl Z'r 1 orb o •.�..,.� M b 11 1 s r 1.44' vml OA M ° Z d (w wwl dw j i i I � ----7 Qa' V I r a1 1 4 f..Q� M Q �1 � O \ �.. t pM ►\ 1' , 4.0 3.o' 3.0' t S'4 0' �r•� -2� "/ V��Vt �O tC or ay,F ` � 4 -�1 y � •� �•. -} C yr 4 vim. �-q \ PP�.� LO.CKIWG�GOVfiR ,TLNCT�cti LtJA/t'N !NG l I � avICK D�aco�v►GT ---1 Fla. ---- IL I , - 4 ° PIPE 3' t np ND►gSuaP�EO ��^ SOIL. \ 4 0 24 �I ins . r Zo,p" SKLT ZOWT 4 B AFFLE. L. P^ a I AL i t � ;�' ��• i I Q uN II I i d�OGK I SEPTIC t SPECJFI v ems,, TAW -S MAWUFACTURCR: IJUM9CR OF DOSC5: r P h TA►JK 51ZC; � �� GALL0QS DOSC VOLUME �b1•"d ALARM MAJJUFACTWKrGR; `,-�'d IWCLUOI/JC, OACKFLO�✓: hODCL UUN!lCR: ° I 14 CAPACITIES: A= � � WCHES Oh SWITCH TyPC: ' 3S•S2 . �✓° ou'� B Z �C�CSOa PUMP 11AWUFAC. TURCR: C a � 0 .,.iwLtn[S OR MODEL QUMbEK. 4 � 1 - S { Ow � IN,NES OR 5WI•TCH T!JPC: ~� " WOTE' PUMP AWD ALARM ARC TO tL MWIMUM DISCHA RATE 2r' � GPM INSTALLEO O�J SC PA RA VERTICAL DIFFEKE1JCf OETWEEW PUMP OFF AUO DIJTRIISUT {OW PtPE.. \� FEET + MiuiMUM uETWORK SUPPLY PR CCZ UFLC . . . . . . FCET + la o FEET OF FORCE MAIN X_ �� F /ioo►tFKICTIOU FACTOR. Z $ FEET S � '— ILA TOTAL 0 HEAD = ZS.L3 FEET IWTERQAL DIMLW6101JC OF TAWK: LEWC.TH ;WIDTH ;LIQUiO C)CPrH PUMPS M GOULDS Submersible Effluent Pump A, EPO4 3 871 EP05 lo w APPLICATIONS • Fully submerged in high ■ EP05 Impeller: Thermoplas- ■ Bearings: Upper and lower grade turbine oil for tic enclosed design for heavy duty ball bearing Specifically designed for the lubrication and efficient improved performance. construction. following uses: heat transfer. • Effluent systems ■Casing and Base: Rugged • Homes Available for automatic and thermoplastic design provides AGENCY LISTING operation. Auto- superior strength and corrosion • Farms manual o • Heavy duty sump matic models include resistance. �' Canadian standards Association • Water transfer Mechanical Float Switch ■ Motor Housing: Cast iron (CSA listed model numbers end • Dewatering. assembled and preset at the for efficient heat transfer, in "F" or "C ".) factory. strength, and durability. SPECIFICATIONS ■ Motor Cover: Thermoplastic Goulds Pumps is ISO 9001 Registered. FEATURES cover with integral handle and • Solids handling capability: float switch attachment points. 3 /4" maximum. ■ EPO4 Impeller: Thermoplas- 0 Power Cable: Severe duty • Capacities: up to 60 GPM, tic Semi -open design with rated oil and water resistant. • Total heads: up to 31 feet. pump out vanes for mechanical • Discharge size: 1'12" NPT. seal protection. • Mechanical seal: carbon- rotary/ceramic-stationary, BUNA -N elastomers. • Temperature: 104 °F (40cC) continuous 140OF(60°C)intermittent. METERS FEET • Fasteners: 300 series 10 + stainless steel y 30 . _;...__._.....__ _. , __.. -► swnn • Capable of running dry without damage to 8- zs Fr components. 25 7 Motor: • EPO4 Single phase: 0.4 HP, u 6 20 . ...... ...... 115 or 230 V, 60 Hz, 1550 5 .. RPM, built in overload with o 15 _ . automatic reset. 4 • EP05 Single phase: 0.5 HP, c epos 115 V, 60 Hz, 1550 RPM, 3 10, _......_ _.:...._..._........ _., ._ -. -. .. ............ _ . ............. _...... _...... , . built in overload with EPO4 automatic reset. 2 • Power cord: 10 foot 5 standard length, 16/3 1 SJTOW with three prong _ grounding plug. Optional 20 ° 0 0 10 20 21 4 30 40 50 GPM foot length, 16/3 S1TW with three prong grounding plug ' (standard on EP05). 0 2 4 6 8 10 12 m3 CAPACITY Goulds Pumps © 2000 Goulds Pumps a� g ITT Industries Effective February, 2000 B3871 V r 4 ' 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, Timm Excavating, 715- 772 -3214, or the St. Croix County Zoning Office, 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 aseptic 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 pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. I . If the septic tank is installed prior to sheet -rock and/or painting, pump the septic tank before normal use begins to ensure 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 pump 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. 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 pump tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. 4. Periodic observation pipe inspections should be made by the homeowner 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, pump 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, designing, and /or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 ORMENAL A 1847 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page t of 2 Division of Safety and Buildings in accordance with Comm 85 Fd EOE� Certified Soil Testing i County Attach complete site plan on paper not less than 8%x 11 inches in size. Plan m St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction percent slope, scale or dim emsions, north arrow, and location and distance to n. E P Q Q4 I. D. 04 1272 - - 000 Please print all information. - - - - - CRO4X �gyrfWed B Date `' f Personal information you provide may be used for secondary purposes (Privacy Law, s. 1 ON1NG FFI CE ® c�' a (.lX� Property Owner Property Location Trok, Richard Govt. Lot NE 1/4 NW 1/4 S 20 T 28 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 428 Windy Hill Road 31 1 Troy Wood City State Zip Code Phone Number City _j Village f} Town Nearest Road Hudson WI 1 54016 1 Troy I Windy Hill Road , K1 New Construction Use: 16 Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement Public or commercial - Describe Parent material loess over till Flood plain elevation, if applicable NA General comments and recommendations: install 10'x 45' rock cell mound on 101.2 contour as upslope edge of rock w/ 1.0' sand fill Boring # -i Boring Pit Ground Surface elev. 99.4 ft. Depth to limiting factor 24, in. Soil Application Rate Horizon I Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Eff#1 I - Eff#2 1 0 -3 10YR 3/2 - sit 2 m gr ds gs 1f /m .5 .8 2 3 -8 10YR 3/2 - sil 2 f sbk ds cs 1m .5 .8 3 8 -18 7.5YR 4/4 - sil 2 m sbk mfr cs if .5 .8 4 18 -24 7.5YR 3/4 - scl 0 m mfr cw if 0 0 5 24+ LSBR I occasional gy si coats on peds in horizon 3; 2 pits to west along & below 99.4 contour showed limiting factors @ 31" & 32" w/ redoximorphic featur s in scl Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L ' Effluent #2 = BOD < 30 mg /L and TSS < 30 mgr CST Name (Please Print) Sig at re: CST Number Henry F. Grote ` 222774 Address Certified Soil Testing Date Evaluation Conducted Telephone Number E. 4366 353rd Ave., Menomonie, WI 54751 9/4/2003 715- 233 -0398 c 0 o Hti` lu w.LO�Zg -Yti� 4.N . ott 1' 1 TV �►: �.a IJ ..� � 1�L 4-0 (;� asp` rL Z i �M Vl.t� q K �Iz. ax- �C..2 Sac a� No ws U 4 Y 1349 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'/2 x 11 inches in size. Plan must County St. Crob( include, but not limited to: vertical and horizontal referenee point (BM), direction and percent slope, scale or dimensions, north arrow, aqd location and distqince to nearest road. Parcel I. D. pending g Please print �i1.w6n ►at6n ` R 'awed By Date Personal Information you provide maybe fdygecondarjp�c�os fPmcy Law, s,1�04 (1) (m )). 0(Q 3 Property Owner �, Property Location Humbird Land Corporation - f t< ., r iGovtl Lot NE 114 NW 1/4 S 20 T 28 N R 19 W Property Owner's Mailing Address tit -bat Block # Sub�Narnneoir CSW 332 Minnesota Street, East 1404 r`,. ST aoix 1 n/a Troy Wood Subdivision City State A� City J Village ✓ Town Nearest Road Saint Paul I MN I 5 !!Ll:' •:..., 651- 222 -5555 -"' ' Troy I E Cove Rd ! Windy Hill Road r 1� New Construction Use: a Residential tliur bAr of bed"nooms 3 Code derived design flow rate 450 GPD Replacement j Public or commercial - Describe: Parent material loess over shale bedrock Flood plain elevation, if applicable n/a General comments and recommendations: Part of 1.90 acres. BM #1= 100.0'. BM #2= 95.0'. Recommend mound system along 100.5' contour. P63 from preliminary boring work done 5 -5 -00. [ F613 Boring # J Boring N Pit Ground Surface elev. 100.9 ft. Depth to limiting factor 46 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 1ft *Eff#1 *Eff#2 1 0 -9 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 9 -12 10yr4/4 none sil 2msbk mvfr cw 1f 0.5 0.8 3 12 -18 7.5yr4/6 none gr. sil 2msbk mfr cw - 0.5 0.8 4 18 -32 5yr4/4 none sil 2msbk mfr cw - 0.5 0.8 5 32-46 5yr4/4 none sil 2msbk mfi cw - 0.5 0.8 6 46 -52 10yr6/6 c3d5yr5/82 UWB - m - - 0.0 0.0 Boring # J Boring Pit Ground Surface elev. 100.9 ft. Depth to limiting factor 26 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlft *Eff#1 *Eff#2 1 0-8 10yr3 /2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 8 -13 10yr4/4 none sil 2msbk mvfr cw 1 f 0.5 0.8 3 13 -19 7.5yr4/4 none sil 2msbk mvfr cw - 0.5 0.8 4 19 -26 7.5yr4/6 none gr. sl 2msbk mfr cw - 0.5 0.9 5 26 - 5yr4/4 02 7 5/2 sl 2msbk mfi - - 0.5 0.9 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 50 mg/L * Effluent #2 = BOD <30 mg/L and TSS <30 mg/L CST Name (Please Print) Signature: CST Number Tom Gustum ,y 'A 227618 Adder Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St., New Auburn, WI 54757 11120100 715 -658 -1344 I property Owner Humbird Land Corpo �— Parcel ID # _pending__.__ — — Page 2 of - 3 , 2] Ong # Boring r/ Pit Ground Surface elev. __- 99.4 _ ft. Depth to limiting factor — - in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots __- GPD& -_ *Eff#1 *Eff#2 1 0-8 10yr3 /2 none sil 2msbk mvfr as 2f, 1m 0.5 0.8 2 8 -11 10yr5/2 none sil 2msbk mvfr cw 1 f 0.5 0.8 3 11 -15 7.5yr4/4 none sil 2msbk mfr cw - 0.5 0.8 4 15 -2 1 7.5yr4/ none gr. sil 2msbk mfr cw - 0.5 0.8 5 21 -27 7.5yr4/6 none gr. sl 2msbk mfr cw - 0.5 0.9 6 27 -35 5yr4 /4 c2 -3d 10yr7 /2 sl 2msbk mfr - - 0.5 0.9 - — 7.5 - - -- ❑ Boring # J Boring ` f Pit Ground Surface elev. ft. Depth to limiting factor in. AppFcation Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Raots GPD/ftt *Eff#1 *Eff#2 F Boring # _1 Boring J Pit Ground Surface elev. _ _ _- ft. Depth to limiting factor - - -- . in. Soil Application Rate Horizon Depth Dominant Cola Redox Description Texture Structure Consistence Boundary Roots GPDIft *Eff#1 *Eff#2 � I ' 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. I� U m � r v 4 CV � cm Z - g i l l o _ %AJ u u .- tV ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer �� ��� i Mailing Address Property Address /� a g 1� 0 1� d (Verification required from Einning Department for new construction) City /State 14LIla L 41 1 T-- Parcel Identification Number O yy – 1 � ?2" w o w LEGAL DESCRIPTION Property Location ,O 1 ' /., I " '/4, Sec. T 2$ N -R Town of _rr Subdivision W�� Lot # 1 Certified Survey Map # . Volume �—. Page # Warranty Deed # is Z Volume PI I Page # 1' Z Spec house ❑ yes '�wj--no Lot lines identifiable P,yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master lumber, journeyman lumber, restricted lumber or a licensed pumper that the on -site wastewater disposal s P � J Ym P � P P P ring 1 () sP stem Y 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 Zoning Office within 30 days of thre year piratio te. SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the prope d c ' ed a ve, b A a of a warranty deed recorded in Register of Deeds Office. 27 o SIGNAIURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed ti U 1911P 952 STATE BAR OF WISCONSIN FORM 2 • 1998 / WARRANTY DEED Document Number This Deed, made between Day Farm Investors, LLC, a Minnesota Limited Liability Company 6 8 1 9 2 7 REGISTER OF DEEDS Grantor, and Richard J. Trok and Mary Lee E. Trok, husband and wife ST. CROIX CO. , W, RECEIVED FOR RECORD 06 -17 -2002 10:15 All Grantee. "WKrY DEED Grantor, for a valuable consideration, conveys and warrants to EXEIPT t Grantee the following described real estate in St. Croix REC FEE: 11.00 County, State of Wisconsin: TRANS FEE: 344.70 Recordin 0-Y FEE Name A FEE: • 1 Lot 31 Toy Wood, Town of Troy, St. Croix County, Wisconsin r-- � Z 040-1272- 00-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Exceptions to warranties: Subject to notes, easements ,restrictions,covenants and rights of way of record, if any, including but rat 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 $114,900.00. Dated this 6th day of June 2002 Day Farm Investors, LLC ■ �— '� Y President Austin J. Baillon AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) ) ss. Signatures) R amsey County. ) Personally came before me this 6th day of authenticated this _ day of June 1 2002 the above named Austin J. Baillon F TITLE! MEMBER STATE BAR OF WISCONSIN to me known to be the person(s) who executed the foregoing Cf not, instmme t and ac led2c the same. authorized by § 706.06, Wis. Slats.) 41 w N l THIS INSTRUMENT WAS DRAFTED BY ° r' �'. PAULA. BAILLON z Paul A. Baillon, Attorney at Law ' Paul A. Baillon #' 'tCV r- PUBU rI r. NFS07A_ ...Fn 1t56'Jf t.Jt -200; SS44jj Notary Public, State of Wisctiii'sm ' "/L (Signatures may be authenticated or acknowledged. Both are not My Commission is permaiieitY (7Yt `Stara expiratinx date -: necessary.) January 31 2005 ) *Names of persom signing in any capacity should be typed or primed below their signatures STATE EAR OP WISCONSIN WARRANTY DEED FORM Ne. 2.1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC, WI 800 - 655.2021 STREET No W co x 54016 33 FOR: \ . Z �, 4� �► �I \ ND CORP, 10 V A 3TA STREET \ �y MN. 55101 •� ��� \ i 34 yz i A � b \ 2 8e i \ Q4 I A'O e ll w 1.90 ACRES 30 m 82,744 SO. FT. <� 2.17 ACRES — — — 94 SO. FT. •� 1 32 - ` 1- / 1.91 ACR I v 83,061 SO 29 ry 0 o I 1.84 ACRE3' C ' N 1 80,077 SO. FT. w I c i I w r--- ---11 o �I y LL I , 0 1 / / Sol V 03 w I a o N va T s