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HomeMy WebLinkAbout040-1303-00-056 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. C r oix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453305 0 GENERAL INFORMATION (ATTACH TCarPERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.1 .04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Bright Keys Developers I Troy Township 040 - 1303 -00 -056 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: Oc) 00 Q) iy\. G5 ( 22.28.19.1791 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM ' ✓ cvf✓C> �.y l l Co.D Aeration Bldg. Sewer ID 1 1� Holding St/Ht Inlet te TANK SETBACK INFORMATION St/Ht Outlet I y C( TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet _ -s,z.z 'V� V Septic , Dt Bottom �5U �c ";rte ► I 5.0 )7 ����• Dosing nut Header /Man. ' ?J 10q 7� Aeration Dist. Pipe 1 4 P, 103.� Holding Bot. System 5 qy 103 ag PUMP /SIPHON INFORMATION Final Grade Not cu Manufacturer Demand St Cover GPM Model Number ---, 1 .� - C e n� �. l f.(, 1 d l I(, TDH Lift Frictio Loss System Head T)H F Forcemain Length Dia. Dist. to eli G SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. i th DIMENSIONS d� r SETBACK SYSTEM TO P/L BLDG IWELL LAKE /STREAM LEACHIN facturer: INFORMATION CHAMB OR Type Of System: �) Muu n C3� 15Y Iv� r :.- (J /A D T Model Number. DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake f Pipe(s) 3 Length .2-i Dia 2 Length 1 4 Dia / .S 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 In Center + r Bed/Trench Edges + Topsoil , l . 1 � Yes [D No ,_ Yes COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 16 ' 7 / 6 Inspection #2: ✓rJ / l9 / �"� Location: 663 Tradition Tr Unknown (NE 1/4 SE 1/4 22 T28N R19W) Walnut Hill Farm Lot 56 C� V ovJ Parcel No: 22.28.19.1791 1.) Alt BM Description = 7 T. "Tip ,, lr �� { ct u` � , 2.) Bldg sewer length = I cy' Ci 0. t- "� '� zT 6 "��`' p1d+...! nt of cover = ' r r To c - ,92 t,ato r7 �c 1h sired? Yes No dditional informat n. L/d Date � - -- Insepctors Signature Cert. No \A 0 0 r� Q Z� J 14) $ o t3 �y ED ca Ciro r o 3 c C D _u =. � C t 1 W r« �.� 1 t C =< <� o. Co r' 1 m �=► CO- Q m 0 t 1 v yw 1 Ne o � s © ILA jo �o l3 v V45e S u a Lo E Safety and Buildings Division County 201 W. Washington Ave., P O. Box 7162 v scvnsin Madison, WI' 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of Commerce (608) 266-3151 3 30 5— Sanitary Permit Application ro State Plan I.D. �Q -` p In accord with Comm 83.21, Wis. A dm. C od , personal nal information p �umber e rs you may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address (if different than mailing address) 1. Application Information - Please Print All Information p Property Owner's Na me / r �� N C K Parcel N Lot N Block # 7.) C,¢ woo � t �:uu4 SG -- Property Owner's M ailing Address Property Location o N� 54, E' 14,Section City, State Zi Code Phone Number •� �/ 6 C� 5� ���r►"f� /'� N • 5 04 ? L 7� • 7 7 • J O Z. T Z. O N; R 1 ( E Ie W) _7 I C I .. Type of Building (check all that apply) a, der , •� �� Y]1 or 2 Family Dwelling - Number of Bedr �+ms .vwxt aA d"^s • Subdivision Name �C Number ❑ Public /Commercial - Describe NU i se � � �tJ 9�0 w 4 / 7— /+ /S 1GQ i r ❑ State Owned - Describe Use 1 ❑City_ ❑Village ATownship of T R 0 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A, kNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. El Permit Renewal El Permit Revision 11 Change of ❑Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) ❑ Non - Pressurized In- Ground Mound > 24 in. of suitable soil ❑ Mound < 24 is of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing ' Tanks Tanks W Septic or Holding Tank rl w-f► �2 a ) s Aerobic Treatment Unit l.0 Dosing Chamber if yt ! xTf/t VII. Responsibility Statement 1, the undersigned, assume responsibility for installation o e POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature 4oWtMPRS Number Business Phone Number 2Z6 S its 7?a '3yI/Z Plumber's Addre ss (Street, City, State, Zip Code) I ' � z / z /o & A . S,o2��� U� // �1/- y Ce 7 VIII. County/Department Use Onl Approved ❑ Di o Sanitary Permit Fee (includes Groundwater Date Issued Iss ing ge\ Signature No Stamps) Surcharge Fee) ❑ wner Given Reaso tal v IX. Conditions 4df Approval /Reasons for Disapproval SYSTEM OWNER: 3 / � I 7 z D °Io 7�� 1 Septic tank, effluent filter and dispersal cell must all be serviced maintained as per management plan provided by Plumber. t 2. All setback requirements must be maintained aaS1 as per applicable code /ordinances. Attach complete plans (to the County only) for the system on paper not less than 8112 x 11 inches in size SBD -6398 (R. 01/03) t Safety and Buildings ov PO BOX 7162 commerceml. g MADISON WI 53707 -7162 TDD #: (608) 264 -8777 i sco n s i n www.commercestate.wi.us /sb www.wisconsin.gov , tc of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary June 02, 2004 CUST ID No.226375 ATTN: POWTS Inspector ROBERT W ULBRICHT ZONING OFFICE ULBRICHT & ASSOCIATES CO ST CROIX COUNTY SPIA 2812 10TH AVE 1101 CARMICHAEL RD SPRING VALLEY WI 54767 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/02/2006 Identification Numbers Transaction ID No. 1004651 SITE: Site ID No. 684254 William & Sue Lodge - Dwelling Please refer to both identification numbers, Tribute Pkwy Rd above, in all correspondence with the agency. Town of Troy, St Croix County NE1 /4, SE1 /4, S22, T28N, R19W Lot: 56, Subdivision: Walnut Hills Farm FOR: Description: New Mound System / 600 gpd Object Type: POWTS Component Manual Regulated Object ID No.: 960892 Maintenance required; 600 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 101); 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: C"J ♦ This system is to be constructed and located in accordance with the approved plans and with the component manuals listed above. E A copy of the approved plans, specifications and this letter shall be on -site during construction and open to DI V/S P 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. SEE COfh 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. i ROBERT W ULBRICHT Page 2 6/2/04 /rPagel Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Private Sewage Plan iewer , Integrated Services WiSMART code: 7633 (608)266-2889, M - F, 0630 - 1500 Hrs pepagel@conunerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 I l ` ' ULBRICHT & ASSOCIATES CO. 2812 10th Ave. - Spring Valley, WI 54767 Reg. Designers of Engineering Systems 715- 772 -3442 Private Sewage Consultmft PROJECT INDEX Plan I.D. # pate 2. q - X0 Owner 16- . s� • Phone 16 7 15• - 7 ' 7..l • 3 q q r Lo Address /POf Aw. 6 e . 57 4 1 11W f 7& S 50 - Z — Legal Description Cpl s'(p UT i L S A-60tit S(9 J3 PIA) 0 �{D • i3o3 00. 00 Z �v 6 Se See. 2-Z, T e.. R 1'7 w Town of T 0 V County ST C 12 t` XI C.S.T. R - LeR ;cc - 2-2 4 3 ^ 1 S Installer R. 2410(ci, f Local Authority/ Supervision ST. c (2 o c' x C T Y. zo AJ i A3 cr PROJECT DESCRIPTION ,�/ cv Go•� s 7�v T�oA-� —,x'02 ,�- y /.301 RA . 2�e S i 6 DA I L-q wA S TE W , '�,1"e2 •cr�� Ulbricht & Associates � F� �,,, ,� 2 � 2Q0 private Sewage Consultants A 2812 10th Ave. �� BA GS, DW. Spring Valley, Wl 54767 0 �( & SAF 2 s Pg.l PLOT LAN VIEWS Pg.2 SYSTEM CROSS SECTIONS ,& SYSTEM PLAN VIEWS (REVERSE SIDE DETAILS INSPECTION PIPES & FABRIC /TOP FILL DETAILS) Pg.3 PIPE LATERAL LAYOUT (REVERSE SIDE SHOWS DETAILS OF LATERAL CLEAN OUTS) Pg.4 DOSING CHAMBER CROSS SECTION & SPECS. Pg.5 PUMP PERFORMANCE SPECS (REVERSE SIDE SHOWS PUMP DETAILS) Pg.6.OPERATION, MAINTENANCE REQUIREMENTS (REVERSE SIDE SHOWS SITE & SPECIFIC PROJECT DETAILED INFORMATION,UNIQUE TO LOCALE AND GOVERNMENTAL UNIT AREA) G The attached plans and specifications are based on the following approved manuals: "Mound Component Manual For Private Onsite Wastewater Treatment Systems 11 (Version 2.0 SBD- 10691- P(N.01 /01) and "Pressure Distribution Component Manual For Private Onsite - wastewater Treatment Systems" (version2.0) SBD- 10706- P(NO1 /01). r c z «` ^o W �. 0 0 c 0 N- 0 0 ( I n c mfr �t i y o,a 5 7` 16 7 cs� � p a —. H O -i I O Cjf C=r d - -• co O COD d 1� 3 co -° `=tnn� -U c t t ! ..:: c t W Cl) cm co t �- O t yN s z t �► -P �A ! D 37 5 � J 373� Tz- - P5 2 of C ROSS SeCTIOAJ of M OUAU D -� w . T tj f3 ED t3en OF l " ro DiSTRi(SuTionj 1 1� AyyQc G rk«kaFSS P -• 'IF T°P sorb u'f 7E,Pr�ri�i�L� sYsrE:M D"' F p M T•o E E �, / R/tT,O MEIN. ; � � • . �D i f ' SAID /// Plowro Topsoi L- //� t °7o SLOPE Uw`FoRI"1 M No PE • REP MA 9C F r ELEV/4T'rorJ 5 —• �� E / 7 Z Fr. IMVF-Rr 'OF 2 IA't£'Rh�S F b � FT, - � G S F T. To o f Rack l 3. 70 H �•O T • Top O P II /b F I A TE R A I S 3• & 0 -- D FoRcE MAW A / FT. Fr (• - - - -- - - -- T- l Z__ F r K - >) T Z O w Y __ -- F T N W 3Z ° r f T Btt? OF PVC- cAPPEd To i z" q9 j REIrA . d(35E R VhTI o,� Pipes /t7(-,4 7'1 PERMAjP MARKERS (raps 4f Gle,4,0 ovj Sw��r��� R E u; J BAS AL /tR �/� `D wh 5 t'E' F•l ow & 0 - 0 SOIL /,V'f i I rv2AT,v E c AQA.c ry sat. Fr. S d BAS M atRe,N _ ( + 1 - / 6 v / (o . .5 .? iP�S SGTr�r� � lit` �.- Observation pipe Distribution cell 6•• 6 .. Cover material Fill material-- _ MTtd C33, fine aggregate) Tilled area <--Slope Force main Figure 6. Cross - `section of a Mound System Water tight cap Tap of . 4` min. dia. leaching Re air couplings chambe Slot 6. 6" min. min. in.. Infikratrroe surface Water Closet Go { {ar Barprl{" m dIa.) Figure 8 — Observation Pipes O Af y N� Iri rYAV fie Q IfFyoees ?f7 L/tTzf 9 L 4-57 C 3 67o 16 5�a i • I.sT�i oF5 P� CEOTR AL-, HAAn i F©c_ D Fr P Z R c 5 F r (-EOTRAL. PnncE MA(k) X 3.� 1,)c 35 Fr o n Pvc Y �S �•- PRR"AtUE TOTAL V(9tD Ubi u m E GAI5, 'Pi STA,jc ft L N oI ti v r a NIETE .31 7oT�� (/0/0.18 R w� p �s n PA t- NcµES CEAJT MAutFvLa Z 7 S Fop M " Z ��cNES - ,�-,oF NoIES/P;P j7 I.uVERT E LEVA71( of LATI; S SIDE- .F OP, l0 3. y6 ARM t N L Cho b f-� T V (_ �--i• — hT� A' fir �� PERT RATED PIPE DIQ %F %�'�'" (� • Re'MovF- All -bp I \ BURRS . y •Nobs 1 ©� A 1� N-a f-e� � . TEb o,v (3oTT'oM EavAIIY S,pAcF-D , T7 { S TR; C3urto� ��SchAR (rE RATS' Po - R � Rch LArP-Rq t_ GAL TOTAL ! 7( STR M OTIoO 'Di5ctHAR RATE r O / � r &A•�- /MI*JU. 6 a•5' MI'MI MUM 14 '> PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS P,4 I of 6 CAP j p i PE �D fo �v�.vpocJ, �7ooie i¢, /.0 >>t,c -E VEHT PIPE WEATHER PROOF APPROVED LOCKING JUMCTION BOX MANHOLE COVER 1 o , 12 "MIU. w/ (,,41,0 I A13EI I F ppr , �I GRADE I Z-- � y" MrIJ. 7 7 r '14 1 J, L -- IB" M1tJ. C O U1 ND T 1/ ,0 �� - - - -- IAILET PROVIDE I - -_ -- 1 AIRTIGHT SEAL I i p I i t APPROVED JOItOT A INS `' f� I I (� APPROVED JOINTS w/ PI PE A N EXTENDIIJG 3' (�O I W/ PIPE �0 Q I I) ALARM EXTEIJ 3' OUTO SOLID SOIL 8 1 ( II ONTO SOLID SOIL 6C;4 , g0 Poc gv Pt, ON p Q - t v ELEV. f FT. PUMP -� OFF 'LISE 3 5 OP K 'gtDVIA) 6- D (• y /y o,PE s� lj VA f ioAJ BLOCK Sit vl� RISER EXIT PER/ GULy IF TANK MANUFACTURER HAS SUCH APPROVAL SEPrIc E S PE G I F I'CATI0M DOSE LU /'�"$�'f2 42W CLI /- & TANKS MANUFACTURER' IJUMBER OF DOSES: PER DAH TAIJK SIZE: fiALL01.15 DOSE (p �'. ALARM MANUFACTURER: G"4t al p INCLUDING BACKFLOW: //O GALLONS MODEL IJUMBER: L CAPACITIES: A= �`+ INCHES OR Vj GALLONS SWITCH TYPE: !O _ _. $ !J - � � T . g - 2 INCHES OR GALLOWS PUMP MANUFACTURER: _ZoE /� L - / C V C= /1 INCHES OR � � GALLOWS MODEL NUMBEK: 1 3 - 7 lZ lT /' 1 �Q - D= f �`� INCHES OR Y_Z v GALLONS SWITCH T9PE: -P1 66 5V16'W NOTE: PUMP AND ALARM ARE TO BE MINIMUM DISCHARGE RATE Y5 GPM � INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE $ETWEEN PUMP OFF AND DISTRIBUTION PIPE.. 7.2�o FEET -f- MINIMUM NETWORK SUPPLY UR P ESSE . . . . . . 3 .2.5 FEET, 6AC(A- O P - � / � + �,L FEET OF FORCE MAIM . X �I F 00,T.FRICTIOM FACTOR.. FEET 'qvr -- TOTAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF TAUK: LENGTH O y / / ;WIDTH - � - ;LIQUID DEPTH O THIS POWT SYSTEM SHALL INCORPORATE PER COMM. 83.44(2)c A PROPER ZABEL FILTER MODEL # A - 1 6-D t!. -- SEPTIC TANK, per Comm.83.44 (2) (c) shall be equipped with an outlet attached approved filter device (Zabel fiiter). Tank shall have an approved above ground locking manhole cover for regular (every 12 months or less).inspection & servicing by a licensdd service pumper. HEAD/ 0 2 W 115 CAPACITY 3 110 3 tj 2 105 CURVE �,'95 - 26 90 26 85 EFFLUENT °° — , - MODEL I and Q 75 MODEL 189 DEWATERING = 70 165 V 20 �. a ,6 p 55 F 16 MODEL 0 14 163 MODEL 45 168 12 140_ � 1 35 10 MODEL 30 t37, 138 MODEL 8 25 185 SEWAGE and 25 DEWATERING 6 20 MODEL 15 MODEL 161 4 7 10 1tL W 2 MODEL W to 5 53,S5, >s 57.59 I 0 24 80 GALLONS 10 20 30 40 50 70 80 8o 100 110 75 LITERS 0 80 160 40 320 400 70 FLOW PER MIN TE r 29 �. p to so- MODEL Q 295 W T 55 = 16 U 50 14 MODEL Y 294 p. 12 'w- Q 35 MODEL F - 10 293 O 38 MODEL 284 - g i MODEL B 20 262 15 4 F F 10 f L Z ffZ Oi 2 88 S o - 3280 Old MJftm Lane GALLONS 10 20 30 40 50 60 70 6o e9 100 1 120 130 140 150 160 170 180 190 P.O. Box 16347 LouAwNe Kentucky 40216 LITERS 0 80 160 240 320 400 480 Soo 640 720 (502) 776 -2731 - FLOW PER MINUTE 6 "137" Cast Iron Series CAPACITY " 139" Bronze Series HEAD UNITS/MIN Feet Meters Gal. 5 1.52 104 394 Ltrs. • Automatic or Nor: - Automatic. 10 3.04 79 300 • 1 12 H.P., 1 Ph., 115V, 200 -208V or 230V. 15 4.57 64 242 • '/2 H.P., 3 Ph., 200 -208V or 230V. 20 6.10 36 136 •Non- clogging vortex impeller design. 25 7.62 a 30 26' • Passes % inch solids (sphere). Lock Valve: • 1 NPT discharge. cenaaianStandards • Float operated, submersible (NEMA 6) 2 pole �� listed SP Assoc. Approval available mechanical switch. • Automatic reset thermal overload protection. 137 series SC 2225 • Stainless steel screws, bolts, guard, handle and 139 Series SO-111S arm and seal assembly. ■•gyp■ - Yg. b Of b ' Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code ' Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48. Slats. The contents of the septic tank shall be disposed of in 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 113 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. , Puma Tank The pump (dosing) tank shall be inspected at least.once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is Installed within the tank it shalt be inspected and serviced as necessary. Mound 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 penett 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 BODS, 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 distribution system Is provided with a flushing point at the end of each lateral. and it Is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test Is performed It should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and N 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 [SBD- 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 dez!h. 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. Continoencv 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 the defective component shall be Immediately repaired or replaced with a component of the same or equal performance. 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 system should be directed to your county zoning or health inspector. i SEF REVERSE SIDE Pg.6 FOR MAINTENANCE REQUIREMENTS SPECIFIC To 'rots SITE, DESIGN, AND COMPONENTS I I MAINTAINCE OF SEPTIC SYSTEM POWTS ( landowner) is reponsible Maintenance of this system. bl proper operation and ular servicing is necessar g Periodic inspections and syst`ent. The owner s y for the safe healthy operation of.this e reports o uired by tCOde to submit all necessary mainte nance /inspecti the controlling ,authorities. SPECIFIC CONTACTAGENTS sT 6*i2o1 x e rY * Governmental authority/ inspectors: 396 * Licensed installer, responsible for providin g an operation/ maintenance "Users" manual:.. - * Licensed service / in spection agent other than installer: 3 �1p • 3 0 * Electrician, for pump, electric controls, wir units: * 1 , 4 0 IMPORTANT OWNER MAINTENANCE RE UIREMENTS 1• Winter traffic (sledding area shall not , shoveking, etc. the cell, freezin permitted, or frost can /willoss the winter, g u p the system. Disconti Penetrate.,.into (a vacaction trip, resulting . ios use In the lead to freeze up n no wa nuos ) can also 2. Water conservation hydrolically o needs to be rcised! Or s stem can be verloaded and destroyed. designed for a maximum wastewater Y This sys flow of hem was , 3. POWTS a __ ._) gals• daily. re not designed to accomodate wastes from a disposal unit - dis oral unit or other unnatural sources garbage. p destro such waste materials will overload.and Y this system. 4 • If a power o:itage occurs, or a In a p tem orary ov p fails, it erload of may + result effluent bein which may adversely impact the celg Pumped into the cel wh is recommended that a licensed pumper em re commended t (leakage). It , allowing the pump to return to dosing Y the dosing tank, Your installer immediate) o the correct amounts. Y for advice. 5. Neglect of the ve getative cover (the ce erosion traffic P can lead to failure* insulation REGULARLyly�AT�Rn,I,HEsVrO ilure. Compaction or heavy Y t he system. It IE NECESSARY TO the ystetn beneath IS EG T stiff OVER gr NOT sufficientAalone t !1 Effluent in ov er• alone e t0 ma intain a 6 • Periodic In spections by the owner necessary. Inspection or his Into the system: and agents, I. ystem: on the mound port have been incorporated Inspect ion Pipes), cleanoot basal area (effluent l aterals, at each ti terminals on level out. The filter P - fo r flushi the pressurized n ground c oyer system in the tanks (via and cleaning the laterals person /manhole). Only a IIcensed1a a locked above & severehOUld be performing this work properly safety . Eviden which Y quali6ied s Ystem s trey y risksce of effluent involves health tment cell shall also be regularly in the ���� gularly inspected_. r Wisconsin Department of Commerce SOIL EVALUATION REPORT Page l of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code comp lete site County S. �. C� 0 /` Attach com pl plan on paper not less than 8 1/2 x 11 inches in size. Plan must include. but not fimited to: vertical and horizontal reference pant (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. J7 3 Please print all information. I Rev 'wed by Date �/ Personal information you provide may be used for secondary purposes (privacy Law. s. 15.04 (1) (m)). I / 2 GL Property Owner C1 Property Location Q / OR &A r I <AVs C J7DPN A- 0A 1(900 Gov L L /" 6 114 5 � , 114 S Z' T 2 -S N R �/ IS (or) W Property Owner's Mailing Address Lot # Block # Subd. Name aettOW /So N. W. ,4U1z • S& T #1115 5iy State Zip Code Phone Number ❑ City [I Village KI Town Nearest Road v A/ SSo�z ( ) j o 5D • /OG 1Zd % New Construction Use: ®.Residential V Number of bedrooms Code derived design flow rate CO O GPD ❑ Replacement ❑ Public or co - Describe: Parent material /01: ✓ S O U Flood Plain elevation if applicable �� _ ft. General comments _ andrecommendations: " ��� T�,S/ /$ Jaie AOVW © Boring # ❑ Boring /D3 ? 5 3 1 5• S•s Pit Ground surface elev. ft. Depth to lirnitutg factor in. Sod ADrilication Rate Horizon Depth Dominant Color Redox Desaiption Texture Structure istence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Tff#1 - Eff#2 / 0_/T /o Y R 3 1 c f - ---- -- L.s O i S /kW-F2 iw 3f -7 �• Z •3/ i0 Y2 Y 1 D nµuf2 c LO — /Cv D o b Boring # ❑ Borin &q . Y 5 y Sad • S* 7- s o , is Pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisteitoee Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Efr#1 'Eff#2 l 6- 13 /D V2 34 S L 'Zf 5h n t Wye w 3-F- 2 13-� iV /0 Y/z 5M /L Z 5 lc� Ha t �o . 3 •Yz /0 Yk 5/ /W z P tito / z4" h -oc c-s fT Effluent #1= BOD ( 2 >�300 p ! 220�mWL and TSS >30 150 mglL ' Effluent #2 = BOO < 30 ag& and TSS < 30 mg& CST Nam "am RO Pnnt) IL �GY6� r Signature � (.,� " — CST 5 Address Date Evaluation Conduded Telephone Nurnber M 2Z. -zoo 7!5• ? ?a •34 Ulbricht & Associates Private Sewage Consultants 2812 16th Ave. Spring Valley, WI 54767 ORIGINAL i r y Gv�4 f�U7` m�ls �'�i tij QRI(sk+ )�j Y(,o Property Owner Parcel ID # Page of a # ❑mss ��. s. S 5 , Pit Ground surface dev. ft Depth to in UmV todor 2- (fp im soy Application Ram Horizon Depth Donimarrt Color Redox Description Texture Structure ConsWanoe Boundary Roots GPDM in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. `E1 'Eff#2 D l lay 3/ s L of 5� /C AM V 3'� �o /.. 0 /b 2 z Co / &M 5A IVA P A 516 Z iw► F S ❑ ❑ PR Grouts surface elev. R Depth to knbV factor fa Soil Al 9 A rin Rate Horizon Depth Dorrisfant Color Redo( Description Texb" Sfruch" Consistence Boundary Roots GMW im. Morse! Qu. Sz. cant color Gr. Sz. Sh. — CW ❑ BonV# ❑ B C3 Pit Grouts surface elev. R Deptfn tD . tailor in Soil Application Ram Haizon Depth Dominant Color Redox Description. Texture Consistence Boundary Roofs "� GPDAF In. Mansell Qu. Sz- Cont Color . Sz Sh . EWn 'Etf#1 I T D # ❑ Grotard surface elev. ft. Depth to inrl" factor in. _ ❑ Pit sat Application Rate Horizon Dep6 DoMinart Color Redax Osscription. Texture Sirudrre Consistence Boundary Roots GPDdfI: in. Munsetl Qu Cart Color Gr. Sz. Sh. 'EM 'Ei#l2 ' EffKwt #1 = BOD 30 < 220 mWL and TSS >30 150 mglt ' Effluent #2 = BOO, 130 mg& and TSS w 34 rnglt The Department of Co is run equal opportunity service provider and employer. If you need assistance to access services of need maten in an alternate format, please contact the department at 608 -266 -3151 or TTY 608- 264 -8M. seaas3opr.6roor ( I N I-.- V 7 llz% y 3 4 uc O OD J •a - N � �. 1 y- ; �� _► fD _-1 CD 11►— � � . Qrs _ E C'N o N � �► --�` at 0 2 O 37 � , z Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. code CoWty �– Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must C include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope. scale or dimensions, north arrow. and location and distance to nearest road. Please print all Infornlation. Reviewed by Date ?p Pe"001 kd—b- you Provide +nay be used for secondary Purposft (lacy LOW. s. 15.04 (1) (m)). y Property o D �JERS T�fl �!� ToD . O - ) J Property Location �F 2.B Q 01 T f 11j1rA 4#A � Lot All � 11 /4 S T N R / E (or) W Property Owner's Mailing Address Lot # Block lij Subd. Name or CSM# (0 o 1 5 CA M LL Avr? . 5 (P I WALNO Ki JF�AjeAf � city - UDR State Zip Code Phan Number O ( city ❑ Village (a Town Nlearest Road -ROVE HT� MN 5so7(P ( C SI Zy8• tof -rRoy SO. CrtovER _ o New Construction Use: 0 Residential / Number of bedrooms 3 Code derived design flow rate Da GPD ❑ Replacement ❑ Public or commercial - Describe: _ tA Parent material /6Z55 GUIti Q Ayj k •/r6 /$* Flood Plan elevation if applicable � tt- General ' /Wgn!- T Svc T��3 /z X0 �4 /ly vxpa %A 5•S.S �' Bonng # ® 0 Boring Pit Ground surface elev. " �• n Depth to taniting factor in. Rate Sol Appfimhon Horizon Depth Dominant Cdor Redox Description Texhxe Struc4xe Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *M1 'Eff#2 b l 6.1Y /oVR31 L /fs A(� d S 4 j W 3 • Y • < N Z 1 •3 /o M z -FS k W ti CS i • s �A 3 •70 lo V 9 sc C2-A Mors Y16 IfShk k,vfi . Z • 3 � 0 U Boring # 0 Boring ! 1. Ks 3 2- S•S. S . �� ® Pit Ground surface elev. ft. Depth to limiting factor in. soy Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDJff: (� in. Mtmsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Etf#1 I -Ef1#2 IN / 0- 0 y 3 — L A S�/C d 5W 2 0 51Z- zfsh 1 1,1 G / • S N z• 5 S• cz M r L ©.w( ,�+ vf� � • 3 . s /OVA • Elfluent #1 = BOD > 30 < 220 nVL and TSS >M : S 150 mg& ' Effluent #2 = BOD < 30 mg& and TSS 130 mglL CST Name (Please Print) . • ,u L43 i C k� signature 2 2 f Address Ulbricht & Assgciates Dare E T 71 f . 77 3 yy 2„- Privat 2812 10th Ave. Spring Valley, WI 54767 P/X5 f'o&e 4PV X . 2 - 1" 10 4 &C • oya • /ohs • So • ago oYo - � �� • io • � dyo • log( - zo • o� 7 • /A /�� /� /. To.PP 13 JE P 5 7"E - Gb Properivowner Parcel ra # Z of F 3 - 1 3 Borarg S a 3o S. SS . P't Ground surface elev. fl_ Depth to WnMV factor itt. Soil state tDepth Dominant Redt�c Descc�tion Texture Structure Consistence Boundary Roots GPDM Munsell flu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 *E#� 16 l G /7cs ds4 IL jh czA rc L D F Bourg # Bor,rrg Q Pit Ground surface elev. ft. Depth to limiting factor - Sofl plication Rate i ffoirzon Depth Dorrtinad Redox Desaip iOn Texture She Consistence Boundary Roots GPF1/t:x fn Munson Qu. Sz Corrt Color Gr. Sz. Sh. * # , pit Ground surface elev- ft. Depth to or Sol Application Rate Horizon Depth Dorrttnant Redox Destx - Texture Structure Consistence Boundary Roots G in. Munsen Qu. Sz Cont. Color (s {. *EM `Ett#2 t 4 s F - 1 �� # P "s# Ground surFace elev. / ft. Deptft to 9 factor &r. Soil Appkedon Rate Mortwn Depth Dominant Redox Descripffort. Texture Structure Conststenoe Boundary Roots GPM irs. Munsefl t' U Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = > 30 < 220 wQk and TSS >30 < 150 mglL ° Effluent #2 = BOD, < 30 mg& and TSS < 30 not The Department of Commerce is an equal opportunity service provider and employer. If you treed assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608-264-9777. sea ez�o (tzt+uo) r E PLOT PLAN WALNUT HILLS FARM. LOT # �` Pg. 3 of 3 Q = Contour elevation lines. = Backhoe Soil pits. Q = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. �r#�Z D SCALE: 1" = a FI O 1 1� • � �Q l• 7 ✓� 3 yZ , i �o Ld ° s d � 9ysa 13 o MOVNv BM 411 / 0s Mou.�v S� STE.� $ � lZ ►� S�}Nv log - ys 50 �vN� WO Y°k'5 GAAP .4r 5.0 • wr ��N� r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AM 65 1. 43 ©' i OWNERSHIP CERTIFICATION FORM OvvnerJBuyer BR M i eA - 1A Z, . 'TbNNk 41woW , 0 w.v - Mailing Address Aga 9 N W. 5Sf i N& /-A lq v - 550 ,?-2— —tft"6S j -- - 19 Property Address �0 3 (Verification required from Planning Department for new construction) KAr City /State Parcel Identification Number o y0 3o 3 - oo • & Z liql � * pe z d -- ZZZq I ?rX LEGAL DESCRIPTION T' le 0 z $ p Properly Location 'h, %., Sec. . T Z N R ' + W, Town of Subdivision XW Al y 7 l l Lot # Certified Survey Map # , Volume _ I , Page # C Warranty Deed # -7 Volume Z q Page # J �' Spec house ❑ yes X no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof 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, journeymanplumber, restricted plumber or a licensed pumper verifying that (1) the On wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department pf Natural Resources, State of Wis ^nnsin. 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 a three year C I WI date. SIGNATURE OF PLI 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 owna(s) of the proiXerty describes above, b virtue of a warranty deed recorded in Register of Deeds Office. //d le SIGNATURE OF APPLIC DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * « « « *« ** !-nclude 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 748766 STATE BAR OFWISCO SIN &R§ 2 KATHLEEN H. WALSH '2 D Z REGISTER OF DEEDS ST. CR01X GO., ICI Document Number RECEIVED FOR RECORD This Deed, made between Glover Land Company, a Wisconsin Limited Liability Company Grantor, and BrightKEYS Development Corporation, 12/10/2003 12: 30PH Grantee. WARRANTY ; DEED EXEMPT f Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County, State of Wisconsin (if more REC FEE: 11.00 space is needed, please attach addendum): COPYSFEE: 2241.90 CC FEE: Lots 1 through 16; lots 52 throng 56 d Outlots 2, 3 and 5, Plat of Walnut Hill PAGES: 1 Farm in the Town of Troy, St. Cr & ounty, Wisconsin. Exceptions to warranties: Easements, restrictions and right -of -way of Recording Area record, if any. Name and Return Address B 'g YS 1 Northwestern Ave. 8 1 ater, MN 55082 Part of 040 - 1086 -60 -000; part of 040 - 1085 -50 -000: Part of 040 - 1086 -10 -000; and part of 040- 1086 -80 -000 Parcel Identification Number (PIN) This is not homestead property. Dated this 9th day of December, 2003. Glover Company, L - * * * i I ACKNOWLEDGMENT AUTHENTICATION STATE OF WISCONSIN ) ) ss. Signature(s) authenticated this day ST_ c.421 1l County ) of , Personally came before me this �f r� day of 7 2003 the above named Glover Land Company, LLC, a Wisconsin Limited Liability Company to me known to be TITLE: MEMBER STATE BAR OF WISCONSIN the person who executed the foregoing ins ru entOap6Mrledged (If not, authorized by § the same. ALL Mttc 706.06, Wis. Stats.) Notary Pubfc State of Wisconsin THIS INSTRUMENT WAS DRAFTED BY ► / �� J �> > {_�_ BrihtKEYS Development Corporation, Donna M. Cawood, Notary Public, State of Wisconsin 1809 Northwestern Avenue Stillwater MN 55082 My Commission is permanent. (If not, state expiration date: ( Signatures may be authenticated or acknowledged. Both are not *Names of persons signing in any capacity must be typed or printed below their signature. WARRANTY DEED STATE BAR OF WISCONSIN FORA No. 2 — 2000 I KILL FARM • LEGEND /4 OF THE SOUTHEAST 1/4 AND IN OF THE SOUTHEAST 1/4 AND IN PROPOSED DRIVEWAY • FOUND 1' IRON PIPE SOUTHEAST 1/4 AND IN PART OF LOCATIONS FOUND COUNTY VORTHEAST 1/4 AND IN PART OF - -_------------ DRIVEWAY EASEMENT 3' ALUMINUM MONUMENT SOUTHWEST 1/4 AND IN PART OF — — — — BUILDING SETBACKS ■ S ET 1 1/4' BY 19' IRON PIN SOUTHEAST 1/4 OF SECTION 22, - - - - - - - - 12' UTILITY EASEMENT WT. 4.172 LBS. /FT. 9 WEST, TOWN OF TROY, ST. CROIX (UNLESS OTHERWISE NOTED) --- DRAINAGE SET 1.50 BY 18' IRON PIN DRAINAGE EASEMENTS WT. 1.50 LBS. /FT. HWE - HIGH WATER ELEVATION AT ALL OTHER LOT CORNERS Lm - LOWEST BUILDING OPENING - - - - 20' TRAIL EASEMENT ® SLOPES > 20% UNPLATTED LANDS _ OWNED �Y PLATTER EAST 1/4 rQ N 89'19'58" E 1321.44' CORNER�N SECTION FOUND 3 m COUNTY CONSERVATION �� � . BERNTSEN °D ALUMINUM ' EASEMENT MONUMENT I 69.96' �. THIS LOT IS NOT PART w N 81320.93' E OF THE HOMEOWNERS =T N ASSOCIATION, BUFFER 17e9u SPACE, OR OPEN ACRES ' .TS 41 09 80 _ N 78 E 11 I ; 1 150587 S.F. 0'00'49 �151.24� N 1 LBO Ac 10 1 ILA 8g3'�' D -� a \ \ z 4 a 1 38.83 tt�ug ' 1° \ _ \ a 9 1 8146237 S.k ' 1 I 4 18 8 97 n\ N tBp 11.06 A0 I I z 8 1 \ �'1. 8 A NIA � o 7 \ £ \46002 S.F\ A � a y 48438 S.F. x\1.06 Ac. + d m 4 \ `'\ 8 \ ` \ 1.11 A \ ` 30 s NI. — 118.E N 37 S.F. /m 5 'b 46900 S.F. - m n 1 O8 Aa \ \\ y+ 964 — t33_2g 12 Ac. ' ' \ X190 964 t- — - - - 140.25 \\ m 4 6 \ w / \ ` 140_25 10 E 881.89' —TD ROAD O 10 B�S,F\ c\� O �0 • q \ e, - _ •3410" E _ �4' I i 67 .05 � I Imlc < R�A� 6 / 9 180• 1— — -'1 EASMtLY 6�'a N i I s r ' / w \� &I 54 1 0 75 55 w 'o j g 53 I \ 53248 SA o ®Q� r y X 106 Ac I os A 1 1 1.22 Ae 1 £ \ 1.73 �b 1 l \ N I fl wl 1 \ 49159 S.F. I ' y / �1 12� F. \ a I I 1 \ \ rte +\ 1.13 Ac. / 1 1 1 \ 14 L 431' 14299' 46794 S.F. \ W 03' \ _1.07 Ac. .38, o �\ �� 4 .2 \ w N 218 8 '33' b �7!> 0 — 189 -15_ 8 , \ - - - - -�� W \ \ 315F zr\ 12.5 \ \ 48 50 49 \ s DRAFTED BY: KEVIN SAMUEL HUMPHREY ENGINEERING SHEET 1 OF 4