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HomeMy WebLinkAbout040-1241-70-000 r Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 463344 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)J. Permit Holder's Name: City Village X Township Parcel Tax No: Vivoda, Mike & Linda I Troy, Town of 040 - 1241 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: , i Section/Town /Range /Map No: / ()0-& 1 0 0 ,� 9 M 1 21.28.19.1228 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 7 7 - 7 - (a. 0(0• /a4 -0 Septic ` / �U BenchX / C , , 7(a Dosing Al f- -A jj 4 Lv qa rw / I Io3.3 3 Aeration �6 l - B ldg. S ewer <C /At /O' 57, f 2 Holding St/Ht Inlet ! , 2. • 1�6 'y St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet J Septic / I Dt Bottom r 3 fj �- Dosing V441k dy" I Heade a . Aeration Dist. Pipe Z d Holding Bot. system PUMP /SIPHON INFORMATION Final Grade �K Cc _ Manufacturer GP and St 8 1 C4`A K Model Number / `_ I gL / D / - 7 'Jq / 7 g O TDH Lift Fricti n Loss System Hea < 12.12,57. Forcemain Len ! Dia., h Dist. to Well 7 SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIM IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /0 �tL� SETBACK SYSTEM TO P!L BLDG WELL LAKE /STR M ACHIN Manufacturer. INFORMATION CHA E OR Type Of System: 25 i > r U Model Number: DISTRIBUTION SYSTEM Header / Magid Distribution 7 x Hole Size x Hole Spacing ent to Air , ;e n A L ipe( h (,7j R a Length Dia G Length Dia Spacing S �D Z I SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over t Depth Over xx Depth of 7S d Yes No Bed /Trench Center ' l/ ( Bed/Trench Edges Topsoil Yes COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / t / Inspection #2:�/ 22 /d Location: 583 W n ate Drive Hudson, WI 54016 (SE 1/4 NE 1/4 21 T28N R19W) Wyngate Lot 7 P�� Plo "" Parcel No: 21.28.19.1228k 1.) Alt BM Description 2.) Bldg sewer length _ L�_ , - amount of cover = l S�UK F�� Jv ` - L L '- r Plan revision Required? El Yes 1- No = 2D I_� , Use other side for additional information. � 1_ Date Insepctor's Signatur Ce SBD -6710 (R.3/97) Safety and Buildings Division County 2 W. Washington Ave., P.O. Box 7162 "'T �s J tson, WI 517 ? °'_ "" Mary Permit Number (to be filled in by Co.) cans�n ( Department of Commerce v ) 2 � ? Sanitary Permit Appli a Vkdress I.D. Number In accord with Comm 83.21, Wis. Adm. Code, personal inform tion you prb'vide i p ! O� = 5, l � # may be used for secondary purposes Privacy Law, s15. 1)(m) (if diff6rent than mailing address) I. Application Infor ation - Please Print All Information e ry r r rv�_ �-_X Sd3 �r •� ��r, Property Owner's Na me Parcel N t X Block 8 N 9�9 1 5q 64LIVII-2f -- ) - Property Owner's M ailing Address Property Location Oo Z 2 S4 t,6, YV t _ %,Section City, State Zip Code Phone Number .5 441 - Z 7 / ✓ � j -. (circle ) II. Type of Building (check all that apply) I �,pl T � � N; R �g E or� ® I or 2 Family Dwelling - Number of Bedrooms rI _ 5 Subdivision Name CSM Number ❑ Public /Commercial - Describe Use h 41 ❑ State Owned - Describe Use - ❑City_ ❑Village %Township of III. Type of Permit: (Check only one box on line A. Complete line B if applicable) �]'�� A ' New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner 1V. T of POVVTS System. (Check all that apply) ❑ Non - Pressurized In- Ground K Mound > 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 ❑Leach' g Chamber El Drip Line ❑ Gravel -less Pipe ❑ O er xplain) / V. Di s p ersal/Treatment Area Informa t'o too' M � D = o. 6 — 00 Design Flow (gpd) Design Soil Application Rate sf) Dispersal Area Req fired (sf) Dispersal Area Propos (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units W /' ^ - n �i _100 Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank �� t� / v�s�' 1 W �S ✓�. G ���" ✓n Aerobic Treatment Unit .� Dosing Chamber n C 9 5C / �' ✓ VII. Responsibility St atement - I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plu ber Si gnature MP /MPRS Number Business Phone Number car e"s;a S e SS 4 2/4 Plumber's Addre ss (Street, City, State, Zip Code) L,;y SS C�11 i t r - e.* , 5,f0 Z Y VIII. County/Department Use Onl Approved ❑ . a proved Sanitary Permit Fee ' cludes Groundwater Date Issued Iss ing A t Signature ( o Stamps) Surcharge Fee) ��✓_' �� ❑ Reason for Denial `j IX. Conditions Approv SYSTEM NER; I Septic tank, effluent filter and dispersal cell must all be serVig2d / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches In size . l SBD -6398 (R. 01/03) 'SLOT FLw 3 at7 L, r Scat e = �0 0 _...........^.... L o7 9 WeA �� so p w �r �6 ®eoll 50 �oMBa / U M P w I Z b e! b o 0 o e lk 00.00 0„ L A i�h P,Pa I? w I Lafi� C,O Safety and Buildings 4003 N KINNEY COULEE RD commerce.Wi.gov LA CROSSE WI 54601 -1831 • TDD #: (608) 264 -8777 isconsin www.w www.coe.wi.gov/s sin.go / iscosin.gov Department of Commerce Jim Doyle, Governor Mary P. Burke, Secretary February 24, 2005 CUST ID No.220554 ATTN.• POWTS Inspector CARL P HEISE ZONING OFFICE CARL HEISE EXCAVATING ST CROIX COUNTY SPIA 1042 S MAIN ST 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/24/2007 Identification Numbers Transaction ID No. 1111680 SITE: Site ID No. 694992 Mike & Linda Vivoda Please refer to both identification numbers, Wyngate Drive above, in all correspondence with the agency. Town of Troy St Croix County SE 1/4, NE 1/4, S21, T28N, R19W FOR: Description: Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 1005050 Maintenance required; 600 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade; System: Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: DEPARTMENT OF Approval Requirements: O FTEV i • This system is to be constructed and located in accordance with the enclosed approved plans and with the SEE CORRES) "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). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. Stat I - CARL P HEISE Page 2 2/24/2005 • Comm 83.22(7) A cog of f 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. • The changes made to this plan on 2/24/05 by this reviewer were acknowledged and approved by the system designer. Owner Responsibilities: • Comm 83.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. • Comm 83.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 .J Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789-7893, 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 i 200 P O 285 COUNTY EXCAVATING RIVER ' ROAD SS � 800 - 828 - 37235 "" 5 22 715- 425 -6200 715- 425 -8466 FAX ` wo ` r TITLE SHEET MOUND SYSTEM FOR BEDROOM RESIDENCE LOCATED IN THE Y. OF THE Y. OF SECTION, �21 T_�L N, R I W; TOWN OF _T 5T C ro � k COUNTY, WISCONSIN. INDEX PAGE 1 OF 7 TITLE SHEET PAGE 2 OF 7 SYSTEM MANAGEMENT PLAN PAGE 3 OF 7 PLOT PLAN PAGE 4 OF 7 PLAN VIEW -CROSS SECTION PAGE 5 OF 7 DISTRIBUTION PIPE LAYOUT PAGE 6 OF 7 PUMPING CHAMBER CROSS SECTION PAGE 7 OF 7 PUMP PERFORMANCE CURVE ` x` Y C OAIMERCE PREPARED FOR AN INGS hI j KE 4 LiN DA VrV0 ;01y N� N e e 59 7 �5 ROVER FAD WI 54622 PREPARED BY CARL P. HEISE CST/MPRS 220554 This plan has been prepared in accordance with the Mound Component Manual SBD- 10691 -P and the Pressure Distribution Manual SBD- 10706 -P. i AUG -07 -00 04143 PM LUND BUILDERS INC. 71542395TS P.O Mound System Management Plan page Z of 2 Pursuant to Comm 83.34, Wis. Adm. Code e�nk Shall be maintained by an individual Cartifisd to service septic tanks under $. 281.48, Stats. The contorts of the septle tank shaft be disposed of, n accordant-11 with NR 1 13, Ms. Adm. Cade. The operating cordition of the septic tank and outtat `liter Shall De assessed at ;asst Once every 3 years by inspection. The outlet filter sha:i be ci!ar.c. 93 necessarf to ensure proper operation. The 3tter carflCge sncod not tie removed uniess prav;sicrs are made tc retain solids in 1w tark teat may steugh oft the filter wh*r, rer;vcd from its arc: *sure. If the filter is equipped with an alarm, tte biter shalt be seMced'f the alarin `s acSvated crntinuously Intermitiert fitter afarrrs may indicate surge flows or an'mpend!r.g continuous a!aan. Tito septic tank shall have ils Jantents removed when the volume .•f sludge and scum In the lam exceeds 113 tte liquid volume of the Lark. If the contents of the !an); are riot removed at the time of a irionnial assessment, mainlerarice personnel snail advise the owner of when the next saoice needs b 5s ;erforrned to maintain less than maximum scum ar,; sludge accU- nuiaticn In the tank. The addition of biological or cherrica: add3: 9uildings Oi ves to ennance septic tank performance is gene-3lty nct required. However, ivlston. suet prcdt.cts are used they •hail be approved for septic tank use by the Department of Commerce. Safey and f The *sing) tank shell be inspected at least once every 3 years. All switches. al arms. and pumps shall be tasted to VW111y proper operation. If an effuent Aitar is ins :titled within the tank it $11311 be inspected and servlcad at necessary ', *g WW and Preesun D fst t rr . • . No trees at shrubs should be planted on the mound. Planttrgs may be made arcunc the ntc.nd'3 perimeter, and Ine mend snail be seeded and mulched is •tacessa to prevent erosion and to ;mviCe some protec for from !roar yenetraticn. Traafc (other than far vogst$.;ve mainterance) on the 'hound is not recommended since soil corr.pactkn • ay hinder aera:i_r. of the lefittrative surface within the mound and snow compactlon in the winter will pro r. ate frost ple ,etraacn. Cold weather Mstalfatons (October- February; dictate that me me,:nd be heavily muthed for frost protection. Influent quality irtc the mound system may not eAceco 220 rrg!L 8005. 1!0 mg/L TSS. ane 30 mgr ,'. FOG. Influent ;low may riot exceed maximum design 1cw speciflcd in :ke permit toe this instatlat;on. The pressure dlstrit;ution system :s provided vith a Flushing point at the end of each lateral, and Ca recommenced mat each lateral be flushed of accumulated solids at,'east once evory 1 18 mcrths, W hen a pressure test .s perizrmed it sh.cutd be eorlpared :o the initial test wean the system was :nstallea to determine if orifice clo;girg has occured and if orifice Jean'rt5 is required to maintain equal dist: °Cudcn within the dispersal cell. Cbservadon pipes whin tl.e dispersai cell shall be : socket `cr effluent pording. Pcndtrg levels Oatl !~e reported to the owner, end any teve!s above a inches xnst doted as an Imoend:ng hydraulic `auure requirlrg 3=Lonal, ?tore frequent menttorIng. ra1 Ths system shalt be operated n accordance witty Corrm 92.84 Y:'s. Aar, Code, and st•,atl maintaired :n atca'danca with its' eomponent marual ($8i; 10372•P (R. 6199)) and fowl or state rules pertairing, to system rnainterarce and maintenance reporting. Ne arse should ever enter a septic or pump turn since dangerous gases may to present 7,at could :ause death. Septic and pump tank abandonment shell be in accordarce with Comm 83.33, Wls. Acre._ Code when the tanks are no longer used as POWTS etmpanents. $eptic or pump tank manhole risers, ac :ass risers and covers should be inspected for water tlgnL•tess and soundness. Access openings used for 33retce and assessment si^al be saaied wa :erig,1 upon the completun of service. Any opening deemed unsc•und defective. or subject to fa +:ure must tie replaced. `:xposed accaas eoanings greater than 8- :ncne3 in d.ameter shat be secured by an ef'ecsve !ociirr; device to pre 3ccidenta; ::r unauthc:ized entry Into a tacit or component. COn1moency Flan 0 the sep':c tank or an) of its compcnerts become defective the tack or ,ornpenert shall to repaired or replaced to keen tie system in proper cperatirg conditions. It She Losing tank, pump, pump controls, alarm or related wirirg becomes defectivo the detective component shall tie hnmediately repaired or replaced with a comporen: of the same or *Coal performance. If the mound component !ails to accept wastewater or begins to discharge wastewater to the ground surface. it will be repaired or replaced in IW present location ty inrr easing basal area if toe leakage occurs or by'ramcving Ciolegically dogged adsorption and dispersal media, and related piping, and replacing said corponenta 3s deemed necessary to brirg the system into proper operating condition. Questions on the operation or maintenance of j1i yste:;t should be directed to the Count .r Zoning office at �;s•.3i10b10 or to the licensed plumber who installed the system. b ©T r7 5o/ L oT Q o , C) 1 vr` r L' I I )250/15a COMea u 7�NK, SEpt�C/Futip w Zabel ��� � ;firer l o o � � 1 elk EZ I oo - Do 0. G " A i; In 144 OiA,'M P,Pa ,�� Lett Designe 'r_ KO Date Non -Woven Filter Fabric 4" Observation Pipe Perforated O .Distribuf ion Pipe Below Filter Fabric ASTH C - 33 Topsoil E �- i ` % Slope Bed Of ���- 2 %2 Forct Moen �Fto «ee Drain Rock From Rump foyer D Cress S ection Of A Mound 5 stem Usin EOjtv A Bed For The Absorpt Areo G 5 A Io Ft. h =-�- g Ft. Ft.. (o Ft. Alternate Position L 114 - Ft. of W 1_ Ft. Force Main L - 140bservotion Pipe -� K PA Force Main W �' — - - - - - -- - - -- Frorn. Pump � : S Oistribution ed Of % 2 % Pipe Drain Rock 4 Observation Pipe Permanent Morker Pipe or Rods 1 Pion View Of Mound Using A Bed For The Absorption Area �� ._a: -4.' err r�L BIILLEF� irrC 715-42 �. Distribution Pipe Layout p0je 5 of Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the Pipe and holes. Extend the end of each lateral up with the use of long tutu or 45 fitting to a poiat within Six 'aches of the liml grade. Tc=inate the ends of the laterals with a valvd threaded cap o • threaded plug. Provide accUs from final grade for the valye; threaded cap or thr=ded plug. ACEsg BOX . Were! Minikl� Uterw V t x za 1XQ x x x � . • , ; f d h - l.Naal ltnath - P e-i en •n* • PL4rN V \E - P Ft Hole Diameter 3 /gyp inch S 7J Ft. Lateral " 1 inch(es) X _Inches Manifold 2 _inches Force Main " _inches #of holes /pipe _ Invert. Elevation of Laterals L) Ft. �SX O, G.P.M. j SEPTIC TANK 'PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS G od • WEATHER PROOF JUNCTION BOX APPROVED WITH CONDUIT MANHOLE• ; C0 1 FINISHED GRADE .W/.? Ock WARNING'' MIN:' 18" IN. 6" MAX. "n INLET WATER TIGHT SEALS GAS- TIGHT 41 LT SEAL 1 APP ROVED� CI PIPE i • ', ALM JOINT$-. 3 ONTO SOLID pN PIPE',3SOIL PUMP OF F ELEV . 9 ER'- FT. OFF '� RISER; PER.�SITTED IF : • TANK MANUFACTUR HAS APPROV 3" APPROVED BEDDING UNDER TANK CONCRETE PAD =ri SPECIFICATIONS SE ?TIC / DGSE TANX MANUFACTURER: NUMBER DOSES PER DAY: S TANK SIZ=•S : SE ?TIC / 2 GAL. DOSE VOLUME INCLUDING DOSE 7�_ GAL. FLOWBACK: M o GAL. A L ,RX MANUFACTURER: $ �'j� r, S >s . CAPACITIES: A = I F 731NCHES = �y� • > L C- MODEL NUMBER: _1 SWITCH TYPE: B = Z INCHES = Y Y,:7A. TUR. 7.R c ✓ C = INCHES _ MDDEL NUMBER: 1 L /- S�3 SWITCH TYPE: ry = �, D = I,iC�:ES ) =c = U =RED DISCHARGE RATE GPM PUMP E ALARM WIRING LlR 16.23 `IERT CAL DIFFERENCE SET_WEE, �2•� *I PUMP OFF AND DISTRIBUTION PI MI • FELT } N -IMUM N1TWORK SUPPLY PRESSURE + FEET FORCEMAIN _X FT /100.FT.• FRICTION FACTOR . �,�c - FEET T �� ++ -7. y 2- T -OTAL DYNAMIC BEAD NTERNAL DIMENSIONS OF' PUMP TANK: LENGTH . ; WIDTH ; DIAMETER _...� f� = LIQUID DEPTH �� �0, ;7q, a � �s c , Y77 LICENSE E NUMBER. DATE. 1 /88 r HEA CAPA u F. L L ER C. o . 1 CUR VE 20 100 2 so i EFFLUENT :° '° MOO" 7i MODEL 1 °° and 22 1 DEWATERING = '° i o � ' �• Moo [L ' E 163 MODEL H 1• 12 •0. 3i 10 U009L YOD[L 30 137, 13S SEWAGE and ° u _ _ DEWATERI �° '"°°" • ,i 7 �-- 10 — MOO[L O 9 r i GALLONS 10 20 30 f0 50 f0 70 w i n 10o 1110 21 f° — — -• -- UTERI 0 fA 160 400 75 FLOW PER MINUTE 20 —.. —. I i _ x < 14 MODEL I_ — 4 I 2" T �� MoDEL ol � 3f -- J ".1 F 10 r— 293 — I — _ _T I MODEL ^ i �... a. O 1 }—r 264 — j MODEL 262 I 1 II ` is I -- - i` -- -- 10 I - OfLLE/Q O. _ - MODEL � I I 2 f I 207, US -- _ .• -- _ 0 3280 ON Mfrs Lww GALLONS t0 20 3o 40 f0 io 70 so 90 100 110 120 130 1l0 iso ,SO *6 100 1f0 P.O. Box low � Loukv KmA cky 4016 ._._. LITERS 0 so 100 240 .._ 320 440 160 i140 120 FLOW PER MINUTE i ' Wkponsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page of v Labor and Human Relations INNision of safety a BWUngs in accord with II-HR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. dmensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION DBY DATE f , ?mom PROPERTY OWNER: PROPERTY LOCATION TAON b L: GGW 9T SIr 1/4 K)E� 1 /4,S2-1 T Z�B ,N,R [.q E(0 W� PROPERTY OWNER' :S MAILING ADDRESS LOT BLOCK # SUBD. NAME OR CSM # S CITY, STATE _ ZIP CODE PHONE NUMBER []CITY []VILLAGE MOWN NEAREST ROAD Rti U'�lZ' ,1N1 sgoz tO�, 3487 -`w 1 [� New Construction Use NJ Residential I Number of bedrooms [) AddiltQn to existing building I I Replacement [ ] Public or commercial describe Code derived daily flow 6� gpd Recommended design loading rate y bed, gpd/ft 1 trench, gpoltt Absorption area required S(N3 bed, ft S �o trench, ft WAmtun design k> oV rate -S bed, gpolft , trench, gpoltt Recomrended infiltration surface elevation(s) 1 O - . O ' ft (as referred to site plan benchmark) Additional design! site considerations y'1.ovh./j w / S" y- 6 - 3 r-• r ki . 1 OF Sffi.jb R L ,. Parent material St t_}-c-1 OVNZ!u Flood Pain elevation, if applicable N . k It S = Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = unsuitable for stem ❑ S ®U ®S ❑ U [I S ®U T EI S IO U D S ®U [IS 13 U SOIL DESCRIPTION REPORTS 20D'f Depth Dominant Color Mottles Structure gBed Boring # Horizon in. Munsell Qu. Sz Cont Color Texture Gr. Sz. Sh. Consistence Roots L � Gr our d S 1. S `l R 3Jy h4 U T t - eS elev f l 1.3 `t (z S/`d g S -S) - ).S`fR3J s/ s1 0�, m >• -r�F� _ _ -- Deplh to Gmittng factor ' Remarks: Boring # - S i O`t tz 313 S1 Z w1S bk y"► `Fl- `t- 3 b �P 0 1-Z S lu ' 31b s1 Z�'sbk ►n l^ C-S S fie: t: is , Ground I elev. Sb-S7 - ) - Sy I23 4 s`ttz si S cwn " — � >0 ft � s Gmibg tacmr Remarks: Name:— Please Print Phone: Arthur 715 -4 2 5 -016 5 - . We erer egerer Soil .Testing. &- .Design Service -P.O. Box 74 River:Falls,WI 54022 Suture: - - Date_- CST Number:- _ MOO 576 - PROPERTYOWNER ���h� SOIL DESCRIPTION REPORT Page Z PARCEL I.D. tl it Depth Dominant Color Mottles Texture Structure Consistence Bourxy Roots : GPD /ft. , Boring # Horizon In Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 0 --8 �� �Z 313 s Zw, s� w►� cu 'w - 3i ..! �0 3 1.f _ s �) 2`F s�k vn 14 �\4 S11�4sig o Ground 3 -S� 1 S-1tz31y loY%Z st3 Si vK` V elev. Depth to limiting factor t Remarks: Boring # t 1 Ground elev. Depth to limiting . factor Remarks: Boring # r Ground and elev. it. Depth to limiting . fact or Remarks: Boring # Ground elev. Depth to limiting ` factor i Remarks: SBO- A330(R.05/92) i +. PLOT PLAN Page 3 of 3 SCALE 1 "= SQ ' rs s ' 0 1� 1� I:J 1CP o � 0 � N � 0 Q CZL�It ° - ` 2 3 I % T cart a ►t cT D %Z O 1 S l vyz.Q ! °f I CD 1 �9 6 ol>t!`t 3ly'DI�. PvC PIPE w / L�1 _ 96-09 � ( 71 ) 11 00576 CST Signature Date Signed Telephone No. CST # ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer ,___/V1 , Ke -L 41'j1d a. V vo d A_ Mailing Address Iy 'z 9 96 5 +-h _;�,'ye r Fti l is , Vur :5 V0 Property Address - _'f e_ r. (Verification require from Planning Department for new construction) 1 City /State Parcel Identification Number O / YI 70 - 040 LEGAL DESCRIPTION (T22?) Property Location SE y,, NE y,, Sec. Z / , T Z 8 N -R ! 9 W, Town of _ I ro Subdivision 1 `y I'1 Q �� ,Lot # 7 Certified Survey Map # , Volume ,Page # Warranty Deed # / Volume Z V _ , Page # 4 (y - ( Spec house ❑ yes 0( no Lot lines identifiable j$( yes O 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 plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I /we, 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 three year expiration date. Z / SIGNATURE O): 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 property described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** InORide 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 i U700P y e�� it STATE BAR OF WISCONSIN FORM 2 - 1999 Document Number WARRANTY DEED REGISTER H. DEEDS ST. CROIX Co., WI This Deed, made between Michael J. Reisdorf and Maril n J. RECEIVED, FOR RECORD Reisdorf husband and wife and Grantor, 11/22/2004 01:00PK Michael D. Vivoda and Linda M. Vivoda -5adee husband and wife WARRANTY DEED Grantor, for a valuable consideration, conveys and warrants t Grantee EXFJMPT the following described real estate in St. Croix County, State of Wisconsin REC FEE: 11.00 (if space is needed, please attach addendum): TRANS FEE: 264.30 R LVOt 7 P lat of Wyngate in the Town of Troy, St. Croix County, COPFEETE onsin. PAGES: 1 Recording Area Name and Return Address Michael D. Vivoda N8259 965th St. River Falls, WI 54022 040- 1241 -70 -000 Parcel Identification Number (PIN) This is not homestead property Exceptions to warranties; Ea (i (is not) sementsrestrictions and ri g , ghs -of -way of record, if any. Dated this 19th day of Novel fiber , 2004 * * Michael J. Reisdorf * Marilyn J. R sdorf J Signature(s) AUTHENTICATION ACKNOWLEDGMENT STATE OF Wi . ona n ) ) ss. authenticated this day of St. Croix County ) Personally came before me this 19th day of November , 2004 the above named Michael J. Reisdorf and Marilyn J. Reisdorf, husband and TITLE: MEMBER STATE BAR OF WISCONSIN wife (If not, to me known to be the person(s) who executed the foregoing authorized by § 706.06, Wis. Slats.) instrument and acknowledged the same. THIS INSTRUMENT WAS D Attorney Kristina Ogland * _ Virgi a R. Gartman Hudson, WI 54016 j Notary Public, State of Wisconsin VIRGINIA R. y My Commission is permanent. (If not, state expiration date: (Signatures may be authenticated or acknow ed B c g pyR a ary January 20, 2008 .) *Names of persons signing in any capacity must ri JAir signature. Information Professionals Co., Fond du Lac, WI WARRANTY DEED 11 1, OF �S AR OF WISCONSIN 800- 655 -2021 1111101 a ORM No. 2 -1999 " 2.06 ACRES 1 �� t 1 0 i g , w '�,►t. 3 / lk 2.59 ACRE "t S0. F 2.40 ACRES t (87, 142 S0. 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