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HomeMy WebLinkAbout040-1118-90-100 Wisc, sin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and :*,wilding Division INSPECTION REPORT Sanitary Permit No: 483976 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Berres, Steve I Troy, Town of 040 - 1118 -90 -100 CST BM Elev: ,( 1 /0-§ nsp. BM Elev: BM Description: ! Section/Town /Range /Map No: 10 6 •0 • 6 ! 31.28.U.482H TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION H FS ELEV. BS /4 . y 00, 6 Septic / r 60 /1 B enchma rk (/ 7 o 9'107 a /0L6`. o Dosing ( Alt. BM Aeration rm I j � Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION SUHt yule o TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inle Septic Dt Bottom / 2 Dosi > �� / 2 ! r 2 Head a . 5 Aeration 5 (� D ist. P ipe S S - -- a 3 Holding Both / Final Grade --�-- o PUMP /SIPHON INFORMATION Manufacturer V De S� yer — ►� / D Model Number n , ' / 4 .Z y D m TDH Lift Friction Loss Sy em Head Ft 13. 2.S �.s .s v� 2' ` Forcemain L nglh� I Dia. --2/1/ Dist. t Wen SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS S SETBACK SYSTEM TO P/ BLDG WELL LAKE /STR LEAC G Manufacturer: INFORMATION CHA ER OR Type f System: / UNIT Model Number. DISTRI , N SYSTEM S Heade anifol Distribution x Hole Size x Hole Spacing Vent to Air Inta I `/ Pipe(s) 73' / Z 2 D ' /Z� 2 • S_ 3 S t{l�— Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx M r At -Grade Systems Only Depth Over Depth Over Depth of xx Seeded /Sod xx Mulched Bedlrrench Center Bed/Trench Edges Topsoil 0 Yes - 1 ® Yes ®No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:�� 7/ Inspection #2: d / (1 Ile a Location: 366 Page Lane (off Cty. F) River Falls, WI 54022 (SW 114 NE 1/4 31 T28N R1 9W) N Lbt.2 Parcel NjZ. 31.28.1 1.) Alt BM Description = v i ou // 2.) Bldg sewer length - amount of cover = Plan revision Required? Fa o Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's ignature Cert. No. J comrnerce"gov Safely and Bud "S County i r 2O l W. Washington Littr7l °"; in Madison, WT 537 7Ifi2 ;, ' Sanitary Permit Number (in he filled in by Co.) Department of Commerce Q' 7 Sanitary Permit Application Some Transaciioo Number ���58� In accordao Comm, e with s. 83.21(2), Wis. Adm. Code, submission of m this form to the appropriate governental unit is required prior to nbtaming a sanitary hermit. Note. Appticamon forms frn state- owned POW TS are Project Address (if differen hanrrlailingaddress) submined to the Department of Commerce. Personal information you provide may be used for secondary Lq ur ses in accordance with the Privacy Law, s. 13.04 1 (rat , Stats. &� 1. r� li - p cation Information - Please Print All I_n tation _ Property Owner's Name J / Parcel # )1 Property Owner's Mailing Address + YV - Property l_ot;ttion A IX COUNTY � Govt- [,at City... tale Zip Co <l- � ��� .31 / Section fret" o fit U� lI r�1u _ T . N: R _. E oUW 11. Type of Building (check all that apply) lot i m' 2 Family Dwelling Numberof Sedto ms Subdivision Name ,�� Block Public/Commercial Describe Use - -- Q State Owned -- Describe Clse C:SM Number V6 � ❑ Village of `}/ A Q Town of�Q !/ t l � � / J✓ �f' 1 111. Type of Permit: (Check only one box on tine A. Complete line A it appiicabie) A. — ❑ New System "placement System ❑ Treatment /Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. © Permit Renewal ❑ Permit Revision 1. I Change of Phtmber ❑ Permit Transfer to Nety List Previous Permit Number and Date isstxd Berore Expiration Owner i l V. Tie of POWT S ystemfCom p onenUDevice: (C ail tha all�rty�_ [] Non Precsurized ht Ground E3 Pressurized In Ground ❑ At Ciradc Q Mound > 24 in. ofsuitable soil ❑ Mound < 24 in. olsuitable soil x Holding "rank U Othei Dispersal Component (explain)_ _ ❑ Preucaiment Device (explain)_ 7 / .tM.Of Q V. Uis ersal/Treau rat Area Information: _ Z, [X Flow (gpd) 1?esign Soil Application Rate(gl ,1) Dispersai Area Required Is)) ispersal Area Proposed (50 Syst SO •� o yso yS 10 VI. Tank Info Capacity isi (oral # of Manufacturer cations Gallons Units o N cv Nnv Tanks Existing Tanks ( ( c r N c a v in H in Septic or Holding Tank l ow ee nosing Chamber 00 0'6 :::::d VII. Responsibility Statem 1 , the undersigned, assume responsib for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature , MP /MFRS Number Business Phone Number Plumber'�Acldress . C ity, Slate, Zip Code) v 0 - -- $ 1) t )Ol VIII. oant /De artmen Use Only raved � ivenReaso Pe t Date lsst 1 Issuing Signature �Z App, 9 �i �o 4 0 knia) /I IX. Contiiti pp►Wr. ! easans for Di approval 3> f q P rbd I 1. Septic tank effluttnt filter and dispersal cell must all be services / maintained LIA - i N e "' r•✓` �rt+•� as per management plan provided by plumber. 2 All setback requirements must be maintained n /� -Z� .leach ht comptele plans for doe srstenr and snhnut Wilie Comity onto nn fer not less than R 112 s I I inches ill size nn � aJJ � GOd�C.� S13D -6398 (R 01107) Valid thru OI/09 cam All .SEe ✓e�lv L3erre.s . P 36G Pagz �a-.,c 5ec. 3 /, 77.284. e /gcJ rn. o f 77,32,' e �n� /b 3t • Cro,u �. chi. ,2 /°'x K ayo- N /B - 90 -ice • Bs P.opased Wce�s �c�e�r,o� C�{ai►, fa. �;riSE %� cJeuCJSCmcr..�e r,ySymTc..0 Srx Ae/� /k�><�T /6�� 3d¢ /ko'a,, 6, to EYS /tadlll �/�ottsr'r( S! "s�„(,y�j�J.C.a� i S�ed � J •"' w 7 Leo o � 3 bedram'' v �� h " r R sS, dancC 2 y 83 , 3 J EX;f6' 1J;�2rsrt /� o �� •� o/oen lawh ch ° f o ° j1 1 0 e �oroosec� 1auv , datZ3.S1.K99.5�I' '� ^v,• l 5 c 1✓ � � d � .Sc / � /a � 5 she,., Glen &6< /o3SOaE i� �..SD'Con c`e ur o ff\ 0 I Safety and Buildings 10541 N RANCH ROAD commerce HAYWARD WI 54843 Contact Through Relay s c o n s i n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Aaron Olver, Secretary August 17, 2010 CUST ID No. 222904 ATTIC• POWTS Inspector JAMES W BOUMEESTER ZONING OFFICE BOUMEESTER & SONS EXCAVATING INC ST CROIX COUNTY SPIA 1070 HWY 35 N 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/17/2012 Identification Numbers Transaction ID No. 1841580 SITE: Site ID No. 759225 Steve & Lois Berres Please refer to both identification numbers, 366 Page Ln above, in all correspondence with the agency. Town of Troy, 54022 St Croix County SWl /4, NE1 /4, S31, T28N, RI 9W FOR: O Description: Mound, 3 bedroom residenceP C 111 t o Object Type: POWTS Component Manual Regulated Object ID No.: 1276963 , O T � Maintenance required; Replacement system; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor fr O original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribui Component Manual - Version 2.0, SBD- 10706 -P (N.01 101), SSWMP Pub. 9.6; Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructe OFF and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. SEA G 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: Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • The existing septic/ holding tank(s) must be inspected for structural soundness, size and baffles and must be brought into conformance with the requirements of COMM 83, Wis. Adm. Code. If it does not conform a state approved tank must be installed. • The bottom of the distribution cell shall be level per the Mound Component Manual. The "D" dimension shall be a minimum of 12 ". The maximum fmished slope of the mound surface shall not have a slope ratio steeper than 3:1 per the Mound Component Manual • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner JAMES W BOUMEESTER Page 2 8/17/2070 of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L Shando� / POWTS Plan Reviewer, Integrated Services WiSMART code: 7633 (715) 634 -7810, Fax: (715) 634-5150, M -fr 8:00 - 4:45 pat.shandorf @wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www. commerce. wi. gov /SB /SB- Buildin�zContractorPro- ram.html JAMES W BOUMEESTER Page 2 8/17/20`10 of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per COMM. 83.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of COMM 84. 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L Shand4f POWTS Plan Reviewer, Integrated Services WiSMART coder 7633 (715) 634 -7810, Fax: (715) 634-5150, M -fr 8:00 - 4:45 pat. shandorf @wisconsin. gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. "Construction business" means a trade that installs, alters or repairs any building element, component, material or device that is regulated under the commercial building code, chs. Comm 60 to 66, the uniform dwelling code, chs. Comm 20 to 25, the electrical code, ch. Comm 16, the plumbing code, chs. Comm 81 to 87, or the public swimming pools and water attractions code, ch. Comm 90. The term does not include the delivery of building supplies or materials, or the manufacture of a building product not on the building site. For further information, go to our website: www. commerce. wi. Qov/ SB/ SB- BuildingcontractorProtram.html t MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Berres 3 - bedroom residential mound Owner's Name: Steve & Lois Berres Owner's Address: 366 Page Lane River Falls, WI 54022 Site Address: Same Legal Description: SW1 /4NE1 /4, Sec.31, T.28N., R.1 W. Township: Troy County: St. Croix Subdivision Name: CSM Vol. 6, Pg. 1656 Sall Lot Number: 2 Block Number: Na Yd �tiPO� S Parcel I.D. Number: 040 - 1118- 90- 100 oo��� 0� I � P NO Plan Transaction No.: Unknown N GE QO Pagel Index and title +� Page 2 Data entry / Page 3 Mound drawings Page 4 Lateral and dose tank l Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Site Plan Page 9 Attached soil evaluation reports i Designer: Jim Boumeester License Number: 222904 Date: 07/30/10 Phone Number: (715) 386 -9020 Signature: (a Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01) Version 5.1 (R. 06/06) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R; Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.001 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for 1.501 Peaking Factor (e.g. 1.5 = 150 %) fecal coliform of — 36 inches. 450.00 Design Flow (gpd) 10.00; Site Slope ( %) 102.50 Contour Line Elevation (ft) 24.00', Depth to Limiting Factor (in) 0.40'. In -situ Soil Application Rate (gpd /ft Distribution Cell Information 75.00 Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter" YorN (C or E) a Center or End Manifold 2.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 3; Number of Laterals of the highest point. 0.125 Orifice Diameter (in) 2.50 Estimated Orifice Spacing (ft) = 5.00 ft /orifice 2.00: Forcemain Diameter (in) ........_.. . 80.00, Forcemain Length (ft) Does the forcemain drain back? Y 93.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 13.05 Forcemain Drainback (gal) 3y 10.00 Vertical Lift (ft) 70.12 5x Void Volume (gal) Friction Loss (ft) 83.17 Minimum Dose Volume (gal) i 0.5 ' -line Filter Loss (ft) 37.07 System Demand (gpm) . 9 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 — 1.25 x 1.00 1.50 x 1.25 x x 2.00 x x 1.50 x 3.00 2.00 x _ 3.00 x Gallons /inch Calculator (optional) Treatment Tank Information 805.12' Total Tank Capacity (gal) Weeks Concrete TanManufacture al 21136 37.001 Total Working Liquid Depth (in) Septic Capacity (gal) gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 805.12; Dose Tank Capacity (gal) SymTech ;Filter Manufacturer 21.76' Dose Tank Volume (gal /in) STF 100 -A Filter Model Number Weeks Concrete Manufacturer Project: Berres 3 - bedroom residential mound Page 2 of 9 Mound Plan and Cross Section Views ................... ............................... 1 1/10 B �y Observation Pipe : L�.►::: 1 — T 5 A W B: ........................................................ ............................... L Mound Component Dimensions A Al2.00 ft E 19 .20 in H 1.00 ft K Eaft ft B ft F 9.25 in z 12.30 ft L ft D in G 0.50 i ft J 5.24 ft W 450.00 (ft Dispersal Cell Area 1372.77 (ft Basal Area Available 6.00 (gpd /ft) Linear Loading Rate 7.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 105.27 (ft) ---► G H I F 104.00 (ft) L ♦ Dispersal Cel( Lateral 103.50 (ft) —► — Invert Dispersal Cell Elevation D :: 4 ... 102.50 (ft) Contour Elevation 10.0 %Site Slope Geotextile Fabric Cover Shading Key 2- Dispersal Cell See lateral details on 1❑ Topsoil Cap o ° 1.5 ft Page 4 for number, size, Subsoil Cap y `o and sp acing [�"'.•::•::� �: •:;::•:,�:..;.�;•::•;•:::::;•: of laterals. ASTM C33 Sand f0 ° Laterals are equally Tilled Layer 0.5 ft Typical Lateral. spaced from the Y _ distribution cell's © Aggregate o centerline in the A - distribution cell (AxB). Project: Berres 3 - bedroom residential mound Page 3 of 9 End Connection Lateral Layout Diagram Crn[Pr it`P later o+ 1 11.0 Ji b B dITIPn TIPn • = Turn -up v i W ll ,21-o — of ownout plug P All litrt ris ..ate i4.r,[ic el iE- 7t —�I Hol drill" on tlw bot[om of [ho 149-1 PylJi� iriiCld S 1-4i.rals L foot• marl of P'vC 5th 40 (pP COPAM TW* 84 90 -5) Folcr rt..r connecllwl vio I<r trl crosn e.-., manlf old ..[ ir.y porn[ Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.53 ft Lateral Length (P) 73.37 ft Orifices per Lateral 30 Lateral Spacing (S) 2.00 ft Orifice Density 5.00 ft /orifice Lateral Flow Rate 12.36 gpm Manifold Length 4.00 ft System Flow Rate 37.07 gpm Manifold Diameter 2.00 in Total Dynamic Head 19.29 ft Forcemain Velocity 3.79 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Comm 16.28 WAC . 4 in min. Disconnect Tank component is properly vented E- Alternate outlet location Forcemain diameter Weeks Concrete Manufacturer 2 in. Capacityl 805.12 Gallons T Volume 21.76 gal /inch A Weep hole or anti - Dimension Inches Gallons B „ siphon device A 19.18 417.31 B 2.00 43.52 C l 1 Pump off elevation (ft) C 3.82 83.17 T 94.00 D 12.00 261.12 D Tc 37.001 805.12 iF Do se tank elevation (ft) 3" Bedding uncTer tank. F7753.00 Alarm Manuafacturer Zoeller Alarm Model Number A -Pack 10 -1494 Pump Manufacturer Zoeller Pump Model Number BN 152 Pump Must Deliver 37.07 gpm at 1 - 9 - , - 2 - 9 - 1 ft TDH Project: Berries 3 - bedroom residential mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Jim Boumeester Phone (715) 386 -9020 POWTS Regulator's Name St. Croix County Zoning Dep't. Phone (715) 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished ••............ ............... .... .......... Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution ... / ...... I ... .. .. Long Sweep 90 o rTwo 45 Degree Bends Sarre Diameter as Lateral Project: Berres 3 - bedroom residential mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals (SBD- 10691 -P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706 -P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. 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 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verity proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shruos should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg /L SOD 30 mg /L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. 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 if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency 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(s) 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 absorption and dispersal media and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. I Project Page 6 of 9 N • PUMP PERFORMANCE CURVE MODEL 151/152/153 TOTAL DYNAMIC HEAD /FLOW PER MINUTE 74 45 153 EFFLUENT AND DEWATERING 2- MODEL 151 152 153 = to 35 t52 Feet Meter Gal, Uters Gal. Ulm Gal. Liters v 5 1.5 50 189 89 261 77 291 10 3.0 45 170 81 231 70 285 o a 25 tst �- 15 4.6 38 144 53 201 81 231 / • 20 6.1 29 110 44 167 52 197 20 25 7.8 16 61 34 129 42 159 ?'D r 30 9.1 - 23 87 33 125 75 35 10.7 22 85 1 to 40 12.2 Shut-off Head: 2 30 ft. (9.1m) 38 ft. (11 Bm) 44 L (13.4m) i 5 0145088 G 10 20 30 40 50 60 7o BO 90 1 cpurx/s � .S 1 /Gp d LrrERS 0 a0 BO 1 0 160 200 240 2811 3 0 360 FLOW PER MiWTE 014508.4 Model 151 Models 1521153 C'ONSULT FACTORY FOR SPECIAL APPLICATIONS �1 67!72 61M -- 1718 t SIB ] 27/72 459 •Timed dosing panels available. 3 718 Electrical alternators, for duplex systems, are available and j ] 2l S2 supplied with an alarm. 4 Variable level control switches are available for controlling ® 1 3713 a27M single phase systems. �- Double piggyback variable level float switches are available for variable level long and short cycle controls. Sealed Qvvik$ox available for outdoor installations. See FM 1420. Over 130'F. (54 °C.) special quotation required. I I I I 151)1572153 Series s 12'13 1 MODELS Control Selection Model Volts Ph I Mods Amps Simplex Duplex t 43,8 5 ve N15 115 1 Non 6.0 1 2 or 3 BN1511 1 Auto 6.0 Included 2 or 3 -- -- — — — E751 2 - 3_01 Non 3.2 1 1 2 or 3 BF151 Z30 Auto 3.2 Inclu 2 or 3 su24u 5x2064 - -- N1 52 11 5 1 Nan � _ 8. 5 1 -4 8 }_ 2 3 BN152 115 1 .I:- Auto 8.5 Incuded l 2 or 3 E15 - 2 230 t? Non 4.3 1 2 8 3 BE152 2 — 1 Auto 4.3 Included 2 or 3 N153 5 1 i Non 10.5 1 2 or 3 BN531 115 1 1 Auto 10.5 Included 2 or 3 E153 230 a _ 1 Non 5.3 1 2 3 _ SELECTION GUIDE BE 153 30 Aulo 5.3 Included 2 of 3 1. Single piggyback variable level float switch or double piggyback variable level float 0 CAUTION switch. Refer to FM0477. istauaadn of controts, protection devices and wiling snouid be done by a qualified 2. See FM0712 for correct model of Electrical Alternator E -Pak. :cnseo electnran An elactncat and safety codes should be followed Including the most Nato a 51e. ,'ode (NEC) and the oocupahonal Satery ano heaun Act (OSHA) 3 Variable level control switch 10 -0225 used as a control activator, specify duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO P.O. BOX 16347 - -- - - - - - -_ - . __ Louisville, KY 40256 -0347 Manufacturws of SHIP TO: 3649 Cane Run Road /ten o Louisville, KY 00 9 1981 ( 5�) (8) 9 28-PUMP QW/ry SNCf /9,99 httpYAvww.zoeller.com PUMP L i!. FAX (502) T74-36 © Copyright 2004 Zoeller Co. All rights reserved. �� 7�© • • Ek/'� grade er c�! SEe✓e451as 8erras Pte° 3(& A &L-c �� ✓c/S cJI• SS�d 2.2 .La�.L, C.s.•i � /iGs6, (� {� Sec. 3 / T, .2B�1., � / cJ. T... c f � ((�1 /b St . C a 7x Co. c..c)�. ,2 77 32 bo'l 2. V 36 acres I ' � ,g Pio pasedWe�s �cre�x,o�,. EX.SE ;.� cJeeksC'�crr�e w'synTeL 3r�iuo Ae/� /k�•,f �: /E�• j /,orb 9W. - *,4W7 , - Ssn,C in,36a /ka/a•��oamp dite�ar�f.. ���"�� 2b be S lea &td oc/v L C/ "Sc�(. e,0AJ.C. a,E J � 3 s red 3 tlssw Ircodo- 1 i ■ 7 z':s�•vo��e. � a Open lawh ok 4^ l °Peso \ \ `•� `\�� � c I �e 1 Ga P�� �� , `� ` 41 A - o poxd rhoccndd •£13.S1�X93.s/.3' �v�cc l �.. k•�'� � � � u�( jr 75 d ;SP�rSe /C U/ 7ltrte. /a f�ia/s X 73.37 a /f8 "on r; ct6 V I ed 2 4 �aBS�i PAI ' '--SOIL EVALUATION REPORT 2218 Wisconsin Department of Commerce Page 1 of 3 Division of Safety and Buildings A.C.E. Soil & Site Evaluations � in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County St. Croix include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location nce to nearest road. Parcel I.D. Plea pr/ 040 Revie By Date Personal information you provi may be used for secondary purposes (Priv Law, s. 15.04 (1) (m)). Property Owner SEP p 1 Property Location Steve & Lois Berres t ` Govt. Lot SW 1 f4 NE 1 S 31 T 28 N R 19 W Property Owner's Mailing Addre ST. CROIX COUNTY Lot # Block # Subd. Name or CSM# 366 Page Lane PLANNING & ZONING OFFICE 2 CSM Vol. 6, Pg. 1656 City State Zip Code Phone Number J City J Village A Town Nearest Road River Falls WI 1 54022 1 715 - 425 -7466 Troy I Page Lane I New Construction Use: VI Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD M+ Replacement -J Public or commercial - Describe: Parent material Glacial till Flood plain elevation, if applicable Na General comments and recommendations: Site suitable for replacement mound system with 12" sand lift placed on 102.50' contour. Boring# -I Boring Pit Ground Surface elev. 97.05 ft. Depth to limiting factor Sol A pp 30" lication Rate Horizon 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 -9 1Oyr3/2 none sil 2fgr mvfr as 2fmc 0.6 0.8 2 9 -18 7.5yr4/4 none sl 2fsbk mfr cw 2fm,1c 0.6 0.8 3 18 -26 7.5yr4/6 none gr Is Osg ml gw 2f,1mc 0.7 1.6 4 26 -30 1Oyr3/6 none s & gr Osg ml aw 2f,1mc 0.7 1.6 5 30 -89 1Oyr3/6 m2d 1 2 s /sl /sil Osg /Om ml /mfr - 2f,1mc 0.2 0.6 Horizon #5 consists of an undifferentiated mixture of 10yr3/6 Osg gr s, 7.5yr4/4 Om gr sl & 10yr5/4 Om sil. Redoximorphic concentrations and depletions observed in sil material. Boring # J Boring 1�+ Pit Ground Surface elev. 103.25 ft. Depth to limiting factor 24 " in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/W in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 1Oyr3/2 none sil 2fgr mvfr cs 2vf,f 0.6 0.8 2 4 -15 7.5yr4/4 none sl 2fsbk mfr cw 1 vf,f 0.6 1.0 3 15 -24 7.5yr4/6 none gr is Osg ml cw 1vf 0.7 1.6 4 24 -35 1 Oyr4 /6 f2d 7.5yr5/8 sicl 1 msbk mfr aw 1 of 0.2 0.3 5 35-44 10yr4/6 f2f 7.5yr5/8 gr Is Osg ml ci 1vf 0.7 1.6 6 44 -82 1Oyr3 /6 m2dd .lXr55//8 /2 s /sl /sil Osg /Om ml /mfr - - 0.2 0.6 Horizon #6 consists of an undifferentiated mixturre of 10yr3/6 Osg gr s, 7.5yr4/4 Om gr sl & 10yr5/4 Om sit. Redoximorphic concentrations and depletions observed in sil material. * Effluent #1 = BOD? 30 < 220 mg /L nd TSS >30 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS < 30 mg /L CST Name (Please Print) Sign ure: CST Number James K. Thompson 3602 Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 6/28/2010 715 - 248 -7767 • Property Owner Steve & Lois Berres Parcel ID # 040 - 1118 -90 -100 Page 2 of 3 3] Boring # Boring r!{ Pit Ground Surface elev. 100.00 ft. Depth to limiting factor 43" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -4 1 Oyr2 /1 none sil 2fgr mvfr cs 2fm,1 c 0.6 0.8 2 4-15 1 Oyr3 /3 none gr sl 2fsbk mfr cw 2fm,1 c 0.6 1.0 3 15 -27 10yr4/4 none scl 2fsbk mfr cw 1fmc 0.4 0.6 4 27 -33 7.5yr4/6 none gr Is Osg ml cw 1fm 0.7 1.6 5 33 -43 10yr4/6 none gr s Osg ml gw 11fm 0.7 1.6 6 43 -65 10yr4/6 m2d 7.5yr5/8 gr s Osg ml - 1fm 0.2 0.5 Horizon #6 contains 1/2" - 1" bands of Om IOyr 414 fsl. Redoximorphic concentrations observed in sandy material immediatley above banding. F4 ]Boring # J Boring Pit Ground Surface elev. 96.0 ft. Depth to limiting factor 47" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 -23 10yr2/1 none I 2fgr mvfr cs 2f,1mc 0.6 0.8 2 23 -29 10yr3/2 none sl 2fsbk mfr cw 1 V 0.6 1.0 3 29-35 1Oyr4/3 none sl 2fsbk mfr cw - 0.6 1.0 4 35-47 10yr4 /6 none gr s Osg ml cw - 0.7 1.6 5 47 -97 1Oyr416 m2d 7.5yr5/8 s /sl /sil Osg /Om mUmfi - - 0.2 0.6 Horizon #6 contains 1/2" -1" bands of Om 1 Oyr 4/4 fsl. Redoximorphic concentrations observed in sandy material immediatley above banding. F 5-1 Boring # Boring L�f Pit Ground Surface elev. 100 ft. Depth to limiting factor Na in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0 - 1Oyr4/3 none Is fill Osg ml as 21' na na 2 8-48 10yr5/4 none s fill Osg ml cs 1fm na na 3 48 -60 1Oryr4/2 none Is fill Osg ml aw 1fmc na na 4 60 -88 1Oyr2/1 none l 2fsbk ds - 2fmc na na High concentrations of organics and coloration of H#4 may be masking redoximorphic features. Lanscape position and higly organic condition of H#4 precludes this area from installion of dispersal cell. * Effluent #1 = BOD 30 < 220 mg /L and TSS >30 < 150 mg /L * Effluent #2 = BOD < 30 mg /L and TSS -S.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. SBD -8330 (R.07 /00) A.C.E. Soil & Ste EvaluaGore ♦ e xI36 grade. elv- Cale SEe✓e &,-, 3(.G Pa c .LIZ �sirt , Sw�c/AE/ n Sec . 3 /, T.2,94, �P //#u). r.,. o f *e e-n e 7— /'0 ) / , Jt . C /Uix &. LAY' ,2 77,,32-' 111.'1,Y .z. J36 acres Piopased c,Jee�s Cor�crc�t a,., bar EX�sE %n u1CGC�sCmarc c W SymTc13rx ACl14ea,� yc;16 � I /n.s6x /,4�a��oamp discl�r�. �irozma.� I, yd'O �7o6-.,C7j, to bCS/t =mod CI✓a "S�.d.4d�J.C.a� i bme ou&t-4• ( 3 s hed 1 — � vew 3 bedropm CIO 0-1`5. Assam �titU 83 _ 4trcewtar., � �� 6" Open taw TX °Ch < •s6 k �,\ '�•°/ ` ' O � °,, �i `0� P•oPosc d nlakHd4 93.5/3' ° pc t Lg 75 d;sp�r54 /Gti /. 77(�tc /ar�rQ /s `�� �3� •\ E /yr/'X73.3�� /y& "a»Fct$ �occtdac o . ZS3: S e1W 6D bc /p.fStia� • �• v" � ¢bode /41 •� Can Ce ur 0 P� 3 o, 73 -do �w P I I V 1 L,.. L/ 1♦ V 1..► t . v i r , Oy Al Located in the SW 1/4 of the NE 1 /4 of Section 3 1. N 1/4 C: tir< l'f Ei� _c rl - rc_. St !'....�;v (��,lnty_ '.=4 l G251V , A 17 v'i ia�w.+ v. -..7 -._ . _ _ _.. - 0 bt�+ ' T ' CC `1. ( MY _fil.�ft �17T 00 T iou 31 Wisconsin, being etj � +-�: - 9:0 0 T.28N,R19W Map recorded in Volume 4. page 1C83. =v> JuT � C y CC for: Alirr ri jC'. 1l iiiitit . G'rV: Cr APPROVED ago • I t. 2, Oa Knoii N Hudson, Wi . 54016 W� p ti �► MAY 9 : I _ - ifiirLL�� 'cv riva NOR LI NE OF SW 1/4 OF HE !/4";A ` 2 J' +,.a �AwiuCRm W W_ Zi. WA S89 °31'08 "E S 89'31' 9 "E 5B5.49' 275.00' 277.32'' — ' 90 POINT OF BEGINNING - 310.493 �' 9)z =o LOT I _ LOT N C O� W I W W IA d V m W 96,647 SO. FT. N F1 106, 156 SO. FT. h M J (2.219 ACRES) c a INCLUDING RIGHT - Q n o OF- WAY(2.438 ACRES) z III m z 95,409 SO. FT. A o 0 ( EXCLUDING RIGHT- t OF -WAY (2.(80 ACRES) l� as.00' W sn I S 89'33'09 "E I i N g0� 56' 07 r. 308.'33'_ . l! 3 283.88 . LOT 3 p ) a E t72,984 SO. FT. INCLUDING C.S.M. VOL. I., PA43E IA y N , RIGHT- OF -WAY ( 3.970 ACRES) / V 910, SO. FT EXCLUDING 1 H ( IUj tV RIGHT - OF -WAY (3.71 6 ACRES) I C w N pl S 89'31'09"E o c> z 474.28' I W LOT 4 JAM J z �i 173,61? SO FT. INCLUOING ��/ RIGHT -OF -WAY (3.986 ACRESI ^ y a g f= U N 1 57,81 . 2 SO. FT. EXCLUDING fi l of RIGHT - OF - WAY (3•.622 ACRES) ^m Pow � y I 90 N I U! �fas�YfaG N I `; ,�f - - - -- PRIVATE ROADWAY EASEMENT 268.09' SCALE 111 FEET 1". 150 1 N 87'32'03 'W 304.30 / ) L O i00 200 35O 36.21' PAGE 165 t2V.vat tvfcrir`rx ` - }� STATE BAfl QF Y{/.j^C FORM. 1 1989 � - �j'%"' 9 � -°-A£ AFSfiRVED FClR RECORDING DATA WARRANTY DEEM 1>`. -- I� '`�'•�= I ST. CROIX CO.* V" ,.. nnQQ RC fJSPAGE� I y Reed for Rem (� If ty : t' — h- -n a, T eon1ta UrCC. ., - n �E1tS D8@Cl,madebetween� � "e G SC - - ^Ztot ilQ � i El lltt�Ts�nc7' r- 'vi i Pe a c joi n tena At 4:20 P x r M _ 11 II and S7teye27 C'.: _ lev,•e ill � A : Berrec . - fT E .L 1i ten=t--r with ri.faht a ^ I - i Ws'6 That the said Grantor, fora valuable consbjeratlOn_ • Q(tjJ } rr t s. and Ot conveys to Grantee the following described real estate in County, State of Wisconsin; Box 4 '86 River Pa it Lot 2 of Gertifiec� Sur. vey 3:a_� !fled ly ;r 2! , l� s Y� i 5402' in Vol. 6, prige 1656 "-s Document j.412528 located in the SNVI of PIE' of 5e, :ti I =. °, ' 2 "t P' -I cw' Tor o- Troy,- v.. L - -- ',° F tr 5;::C'. L' Tax Parce! No: �' - -'�R r (i •i bj�;Ctc;^ ±,, 4„d Stt}Tiect to an y et ilex re sCivB.0 re2trbwtions o record if ally, lu -'" l o ; l - a l l not- T)e deemed to extencl any such abler recorder the tern: �f t II �f n This_ iS n0t homestead property. (is) (is not) 111 Together with all and singular the hereditaments and appurtenances thereunto belonging; And A li >>7nT - r7t li warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except zZ ;ove and will warrant and defend the same. paten this, day of 13 ecerV.er 19 f c _(SEAL) �JP yu -i -T (SEAL) _(SEAL) i �� "1...(Z -ieY' 1 I� ` �(/1') tOl (SEAL) I� �i II T,t r, ^, 4- 71. �:rhrni r?i _ T.n 1 A _ RP_ rrq c I AUTHENTICATION ACKNOWLEDGMENT �I Signature(s) STATE OF WISCONSIN 1 1 County. ))) authenticated this day of 19 Personally came before me this day of the above named TITLE: MEMBER STATE RAR OF WISCONSIN !� (lf not. to me known to be the person S — who excuted the authorized by § 706.06, WIS. titats.) l^r nrI4%n instrument and acknowledge the same. it THIS INSTquMENT Vv AS i]RAFTED BY {I S �'. ' -- �1 ' ►' � If t ota: • Public v %,Ir ti (Signatures may be authenticated or acknowledged. Both My Cornmisal 7 iS peFh14tft I. (Itrnot, state expiration are not necessary. ) �i date. __'l� - t • L = 19 i 'NamPS or P?rsons sign­q,n anY'aPa­IV znoulr; Or D b.'i tn Ai .ns e '• ... f,. WARRANTY DEED STATE BAR OF WISCONSIN FORM No t .tA82 1<'T�� �-�.A •< °'t2 ^A r or Ra )! na :n 7. 7Qv • D 1 ?sc 1 N'r If 1 nr A parcel of land located in the SW 1 /4 of the NE 1 /4 of Section 31, T7.8N, R19W. Town of Troy, St. Croix County, Wisconsin, being also Lot 1 of that Certi- ed survey Map recorded in Voiurrvt 4, page 1083, more 'ul;y described as follows: ^^�^^ ° ^ ^• ^F, z.. ....� .;z CvTTici Gi Tutu Section mot, thence aU G7'Ly'`W (bearings. referenced to ±he North -South Quarter section line, assumed S0 1 27 1 29 "W) along the North- Soutt! 1/4 Section line 1310. 19'; thence S89 "E 141 .65' to the point of beg:nnmg; thence continuing 589 "E 585.49'; thence S5 "E 294.64': thence southwestarly 187, 10' along; the arc of a 334.64' radius curve concave to the northwest, whose chord bears S10o46'29.5 " TW 184.68 thence 326 658. 10 thence N37 "W 304. 30 thence N 1 1 "E 1054. 34' along the easterly right- of -%vay lint- ni C :nunty 'Trunk i-ISr.}- : : :•�. "I "` ; - ii:< r. r b eginn i n g , " J i.%l% 3>L �..� tJLhiiitiliiC, containing 549399 square feet (12.612 acres), more or less and being subject to all easements, restrictions and covenants �,-£ record. 1, ,James E. Rusch, registered Wisconsin Land Surveyor, do hereby certify that 1 have surveyed and mapped the above described property; that such plat is a trait and -7or 'c-ct renresen_tati_nti of the exterior b oundarie-a of the land six,rvPV4 -.d- and that T have frilly cnrnnlierl with the nrnviainna of Gee -ti^n 71A 3d of the'Wisconsin Statutes, the St. Croix County Subdivision Ordinance, and the Town of Troy Subdivision Ordinance to the best of my professional knowledge, un erstanding a elief, s,,�� {iliflllttftN SCION mes E. Rusch f .1AMES E. ° Professional Surveyor =; Rusch Survt.ying, Inc. w y R snM T w 407 Second Street M„dsm r �r Hudson, WI 54016 a ,{Q�• M This map is hereby approved by the Town Board of the Town of Troy. Da e 4 – 'I own—i Cierk CURVE DATA TABLE Cur c of a >c No. No. Angle Length Length Bearing 1 301.64' 32 168.65' 166.47' S18 "W 2 301.64' 5 28.58' 28.58' S2 31 "E 3 301.64' 26 140.07 138.81' S13 "W 2 334.64 32 187.10' 184.68 S10 "W 2 334.64 5 31.88' 31.87' S2 "E 3 334.64 26 155.22 153.83' S13 "W NOTE : The roadway easernent shown ilwreon is a private roadway, constructed over the abandoned County Trunk Highway "F" roadbed. Ally maintenance costs on. this roadway shall be shared pro -rata after its approval by the County Zoning Administrator. Should the roadway be takerx over by al nixanicipality as a public road, maintenance costs thereafter would be a public expense. volu:ae i'.> ;e 1G5o C dh Now S� IRNOW v ST. CROIX COUNTY ZONING-OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF AN EXISTING SEPTIC TANK This is to certify that I have inspected the septic tank presently serving the 5 4- L 0 1_s �2fz�QQ �' residence located at : S � �, N��, 31 Sec. _ , T a S N, R 8 W, Town of St . Croix County, Wisconsin. Upon inspection, I certify t at I have found the tank and baffles to be in good condition, and it appears to be functioning properly. Last time serviced 5 (j ) U Did flow back occur from absorption system? Yes No (if no, skip next line. Approximate volume or length of time: gallons minutes Capacity: Construction: Prefab Concrete Steel Other Manufacturer (if known): -- Age of Tank (if known): Y1�} PP (Signa re) (Name) Please Print rn 0.s (Title) / (License Number) (Date) Form to be completed by licensed plumber (s . 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - Plumber (applying for sanitary permit) Certification: In accepting the above statement regarding existing septic tank condition, I certify that the tank to the best of my knowledge, will conform to the requirements of I Q LHR 83, Wis. Adm. Code (except for inspection opening over outlet baffle). Name S r �_ ) 3b1� Y� -���5 t�cn Signature MP MP i ,/ RS 90 I i FILE INFORMATION POWTS OWNER'S MANUAL & MANAGEMENT PLAN Owner j SYSTEM SPECIFICATIONS Perfnit A S ev _Q " _�ol Ele e.li j of Bedroom FFffIj',er,j' c. Tan Capacity k ._ - 1 bUU O NA c ank Manufactuter Q NA DESIGN PARAMETERS ruler Manufarlurpr S rrt+g1t 0 NA er s � ---------- -_____ ---- _- - -._.. _ 13 NA Effluent Filter Model Number of public Facility �(Tli Q NA Qt U y nits - fl NA __ _. ('un,p Tank r apnc.it.y - — — Eatlmated flow faverage) - S �_ ❑ NA - -- yal/da Pump Tank Mantrlaeltirer - Design flow (peak), fEstimated x i.rl y _. �( -, - - O NA porn ► flallciay i M Soil Application Rate _ b Zoe 1 fit O NA Standord Influent /Effluent Qua - ` - -- - �_yal /day /Ft' PurP01111) Model lit V Monthly avers e «.- �1)__�_. IONA g pretfaatment (tr►ir Fats, O ;1 & Grease (f'O(;) <3C) rrrq /I_ i:1 fi:►nfi /ti�avr+l t'inrr Nochemiral Oxypnn harnanrl 1 . 1 Pear Filter r.l '271) n,p /I 11 N/1 i i Mnrh�rtir.nl /Lr+rntir,n I t WMlar►d Tota S uspended Solids (T "SS) 451 So n►y /l Pretreated Flnuent Chrality 1_l t)islnfQrrlar► MnmId Binchernlcal OxyyAn Demand r V aVt!ragn Pilpeinal CAII(q) _..._.. if oo 4530 n►p /L 11 in rfntowl U NA Total Suspended Solids iTSS) 530 u►p /t I] NA lgravily) 0 In (+round (pressurized) Fecal Collforr►► C'1 At !;cede Pkmo (geom etric, crease) S 1 U" clu/ t 00nt1 urld -- -- cl ur ip -iinp Maximum Effluent Particle Sisp Cl Other: otl►er: - -- . I" in din, I I N A rtfhnc - - ❑ NA I NA lht.n,. - - -- — — « t/nhteo typical inr dmmr.ctlr wgstawttt.!r nnri enpllc loop t!rthtnnt- - CT NA MAINTENANCE SCHEDULE NA Service Event Inspect condition of tankM Service Frequency ---- -- �, Rt (east once every: ® monthlel exirnum 3 years) IJ NA P ump out contents of tanks) ay ear{sl (M -- _. -_ _ Wile" combined sludge and %anon equals One iYI of tank volume Inspect disposal cell(al �_..__--- - - - - - -_ - -- _._ iJ NA At iaA4t OnCa "Very: monthi9) Clean effluent filter . y (Maxbnum 3 yeerel O NA At least ones avety '1 Cl�if1Qtahls► Inspect pum - - - - - -- - � �. .... of __ -❑' yeet(sl -- Q NA p ptrn ►D ('011(tols & alarni I I At least once every: U n►onthls) _ - ffi -- - - -- �yeo Flush laterals and pressure test 11 NA At 1081 once every: Q tntxttlt(s► - • .. _..(� year {sl O — NA __— othe►: ------ __.-- ___ -�- t least once every: O y eerf 'Is) O NA MAINTENANCE INSTRUCTIONS ❑ NA Inspections of tanks And dispersal cells shall be ids by at! individual carrying one of the follow; Master Plumber, Master plumber Restricted Sewer' insRectk)r1s mast include a visual inspection of the tank�(s► tosde sift' any missing or broken hardwar � �� or certifications- i POWYS Maintainer, Septage Servicing Operator, Took Th the volume of combined sludge and ectfrrt and to check for any back up or pond ;ng of effluent on the g The !!!sparse! celllsl shall be visually inspected to identify !illy cracks or leaks, Of effluent on the around surface. The pecte g of �t vn f a lo sur fil e may indicate a lei' f tmd surface. immediate notification of the local regulatory authority. pipes and to check Itrr any pondinp jelling cort�tlon and requires the When the combined 8 cCumUlation ("I sludge and scum in any tank eatrala nit -I rv, - - contents of the tank ei,en t,.. ART UP AND OPERATION pe" of or new construction, prior to use of the POWTS check treatment tank(@l for the presence of painting products or other chemicals tat may impede the treatment process and /or damage the dispersal cellisl. If high concentrations are detected have the contents ( the tw*f s) removed by a septage servicing operator prior to use. ystem start up shall not occur when soil conditions are frozen at the Infiltrative surface. uring power outages pump tanks may fill above normal hlghwater levels. When power is restored the excess wastewater wN be ' ischarged to the dispersal cogiai in one large dose, ovwloadjng the collie) and may result In the backup or surface discharge of ` ffluent. `To avoid this situation have the' contents of the pump tank removed by a Septage Servicing Operator prior to restoring ower to the effluent pump or contact a Plumber or POWTS Maintalner to assist in manually operating the pump controls to store normal levels within the pump tank. o not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact. the ores rithin 16 feet down slope of any mound or at -grade soil absorption area. Induction or elbnination of the following from the wastewater stream may Improve the performance and prolong the He of the OWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; aw dstion drain (sump pump? water; fruit and vegetable peelings; gasoline; grease; herbicides; meet scraps; medications; oil; sinting products; pesticides: sanitary napkins; tampons; and water softener brine. ANDONMENT Then the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system Is roperly and safely abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code- 0 AN piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. ft 041 0111tl100iitai Rill Ronal rlwo o tw woom f1A iAk1 *&6 wrN 1.whiuld 10160111ha 04 it+ a 000ii0id 1 i6414 a+P OWWWN • After pumping, all tanks and pits shall be excavated end removed or their covers removed and the void space filled with soll, gravel or another Inert solid material. *TINOENCY PLAN the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant splacement system: O A suitable replacement area has been evaluated and .may be utilized for the location of a replacement soil absorption` system. The replacement sea should be protected from disturbance and compaction and should not be.intrhtged upon by required setbacks from existing and proposed structure, lot Noes and wells. Failure to protect the fq*mmn area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules In effect at that time. D A suitable replacement area is not available due to setback and /or soil limitations. Barring advances In POWTS technology a holding tank may be installed as a lest resort to replace the failed POWTS. 17 The site hss" not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site„ evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a lost resort to replace the.failed POWTS. 0 Mound and at -grade soil absorpt * terhl�fJ(ybe reconstructed in place following removd oV-" biomet at the Infiltrative surface. Asconstructio I tsn+o must comply with the rules In effect at than sl►Rtt ► + > <WAPJ M G> UrM, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT•, IBITER A SEPTIC, PUMP OR OTHER TREATMF.IrYT TANK.UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. REBCUE OF A PERSON FROM THE ifV1ER1OR OF A TANK MAY B11 D*1p1LT OR IMPOSSIBLE. -,- DOMNAL COMMENTS triliT8 MiSTALLER y ++4 � ` M .• POWTS MAINTAINER •+ � ,;r ++: , Name t 8U Q Name Phone (S 3 A li 0�,b Phone .,, f v°„ to) , tai EPTAGE SERVICING OPERATOR (PUMPER) 31 ;•:v Y LOCAL REGULATORY AUTHORITY + �: �'►t Coro C�1% ' �.. Name b fi S ,. twri.s +tst -i .`+; Nam@ p f Va Phone `� l S"y b r�ea ° ` .;;. , _ Phone b y GI . I �+ u. d,.,...�.�..• ..... .a..a..r t.. - ....�ttr......k «r.. f.. 09 �M /9°rhu1I)AMA /1 . ...r O-1 MAr+° 021 t 491 UIf16 ,.,....M a =° —� ►� n ART UP AND OPERATION Page _ of or new construction, prior to use of the POWTS check treatment tankle) for the presence of painting products or other chemicals tat may impede the treatment process and /or damage the dispersal cell(al. If high concentrations are detected have the contents I tfie tankle) removed by a se ptage servicing operator prior to use. ystem start up shall not occur when soil conditions are frozen at the infiltrative surface. wing power outages pump tanks may fill above normal hiphwater levels. When power to restated the excess wastewater will be ischarged to the dispersal coplel in one large dome, overioadjIng the collie) and may result in the backup or surface discharge of (fluent. `ro avoid this situation have the' contents of the pump tank removed by a Septage Servicing Operator prior to restoring ower to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to Wore normal levels within the pump tank. o not drive or park vehicles over tanks and dispersal coils. Do not drive or park over, or otherwise disturb or compact, the was . +thin 16 feet down slope of any mound or at -grade soil absorption area. leduction or efMtination of the following from the wastewater stream may Improve the performance and prolong the 1111* of the OWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degressers; dental floss; diapers; disinfectants; fat; mutation drain (sump pump) water; fruit and vegetable peelings: gasoline; grease; herbicides; meat scraps; medications; oil; cutting products: pesticides; sanitary napkins; tampons; and water softener brine. ANDONMENT /lien the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is roperiy and safely abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code: • AN piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. It 4"fl IuNltliiifiii -tr1 ill IONI11 Iwo Nl wwwii 0 �4m"d* WN wf•i AA010 0116111111011104 46 M a Irt0414iha 004444wh • After pumping, all tanks and pits shall be excavated *rid removed or their covers removed and the void apace filled with jolt, gravel or another Inert solid material. gI INOENCY PLAN ' the POWTS falls and cannot be repaired the following measures have been, or must be taken, to provide a code compliant q taoem*nt system: [] A suitable replacement area has been evaluated and .+nay be utilized for the location of a teplacetnant soil dworptlon system. The replacement area should be protected from disturbance and compaction and should not be.ini**W upon by required setbacks from existing and proposed structure, lot Ones and wells. Failure to protect the replacement area wNl result in the need for a new soil and alto evaluation to establish a suitable replacement area. Replacement systems must compiy with the rules in effect at that time. O A suitable replacement area is not available due to setback and /or soil limitations. Barring advances M POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. C] The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site ; evaluation must be performed to locate a suitable replacement eras. If no replacement area is available a holding l tank may be installed as a lest resort to replace the.failed POWTS. Q Mound and at-grade soil absor i g P stir ; be reconstructed to piece following removal« ^O! biomat at the Infiltrative surface. Reconstruct bn "'' ' > Mn� must comply with the rules In effect at the 410/00 + , s . • ,., r NEPTIC. PUMP AND OTHER TREATMENT Y#'1NKS CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. 00 NOT W ER A SEPTIC. PUMP OR OTHER TREA'TMW TANK.UNDiER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE 1NTERiOR OF A TANK MAY. B6 D1LT OR IMPOSSIBLE. W DDIMNAL COMMENTS OWTS INSTALLER µy4N lux .x.• POWTS MAINTAINER ;w; " Yt ,� x+s,• Name I i,-, bU Name �;, J. Phone —7 J ^ � ! ', Te}: = ,} Phone 0i VTAG SERVICING OPERATOR (PUMPER) ' , LOCAL REGULATORY AUTHORITY :; � . N �j �1 A1R ' 7 /]� <�. i�� +�e� ;fal' All Name 1. 2 \ 0 () ( a yi N Phone 1 1 �-' 1 V// Phone 'h1..iw.....w..........i..f.�.. I.........�Il...w� ...GI...1....��. r.- 41 itAkL 861 ­A " &Aft 1 I'll L Ml Wt.,...w.t.. • w.riwirwN ►.. H ,r{. ST. CROIX COUNTY SEPTICTANK MAINTENANCE AGREEMENT AND OWNERSHIP CERT TICATKYN FORM . . ........ Mailing Address _ '`r�AQ L,4 � rA Z S , T Propeftly Address 366- PAGE LAAJC� RZVE�k (verification required from PlanniW Deparftment for view constnuction., EA Parcel W Ratification Nlunflt)er 04.0 - I! -loo LEGAL DESCRIPTION Property Location -ALE 1 , 4 4 , Sec. T N R _Zk Town Subdivision Lot Cerfirled Survey I.Map A Votunle Page Warranty Deed Volume. 7 page # spec house yes r,0 Lot lines identifiable yes no &Y—STEM ib!MNTENANCE AND OWNER CERTIFICATION ln—,rnper use and - of your septic system could result in its premature failure to handle. wastes. Proper 4sm- I cif Pumping out the septic tank every three years or sooner, if needed. by a licensed pumper. What you put into cons the system car. affi=Ct the function of the septic tank as a treatment stage in the waste disposal system. Owner - wintevance Res are specified in §Cotnm, 83.52(1) and in Chapter 12 - St. Croix County -Sanitary Ordinance, T —he F-Vlievty owner agrees to submit to St. Croix County.Planning & Zoning Department a certification foryn, nedbv*.hc `iro ner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the or-ske wa ­2 .Mewaterdisp,— ! system is All proper operating condition and/or (2) afler inspection and pumping ffneces-mM„ the septic tai. kw less IMn I t 13 fall of sludge. fAre, the undersigned h rea ave d I ats and agree to maintain the private sewage dla sys with the standards set forth, herein, as set by the = = nirrierce and the Department of Resowrmstate *fW h Sj congis 92-20 9 stating, that yow septic system has bw _A*@wftined must be completed and returned to the St. Cr Z within 30 days of the three Ysll�ion date, oix CotlrV_j pl=ing & .?are cerfif that all statements on this fbm� Am true to the best of tray /our knowledge- 1 1we arrilare the ovmer(s." of tL property descried above.. by virftle of a war. an_ty ieCorde d in Regi ster of Deeds Of fice. Num.ber of bed -1-nornis pp r , 27110 GN `t iATUM OF A LICAW(S) *** Any information that is inisre presen!ed MFif;1�44inthe sanitary permit being revoked by the PlanningA z4oft ng Department *** Include with this application a Was �d froin the Register o4' Deeds Office and a copy of the certified survey map if reference is nude in the --warity decd. (REV. 081051 T / XVd T0:1 I OTOZ/LZ/80 I , / f (ƒ J % n 7 k ' T • A% f ƒ 2 z / w e C2 / $ E§ a o F f Q _- > E a z / m @ © - § k k ( o n k. $ §\ 7 i § 2;' J 0 � a 2\ $ 3 E E m 8 E . § 0) ■ 2 m « ƒ E c m e $ § D 3 i o o � � o - \K � 4 CO CO 0; 0 r■ $ E $ & m o c a T T i. z 0 0 0 $ f � �j { z 0 § § ■ ■ E > 0 CD . D M C D ( a 3 » & . k 2 E 0 .. \ > 0 ' \ } f ƒ . ( � cn f I \ I k z § (6 (A / I + # § 9 0 " 03 M 2 § E§ �z o F z 2 / z $ w > . / c z % r ( . � $ . � @ , � U . � � � ƒ I � \ e o w / k 2 Parcel #: 040- 1118 -90 -100 06/20/2006 04:32 PM PAGE 1 OF 1 Alt. Parcel #: 31.28.19.482H 040 - TOWN OF TROY Current X 1 ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - BERRIES, STEVEN C & LOIS A STEVEN C & LOIS A BERRIES 366 PAGE LA RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.438 Plat: N/A -NOT AVAILABLE SEC 31 T28N R1 9W SW NE 2.438 ACRES LOT 2 Block/Condo Bldg: OF CSM 6/1656 FO FORMERLY KNOWN AS PART OF LOT 1 CSM 4/1083 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 31- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 07/23/1997 798/521 07/23/1997 760/179 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.438 54,500 135,100 189,600 NO Totals for 2006: General Property 2.438 54,500 135,100 189,600 Woodland 0.000 0 0 Totals for 2005: General Property 2.438 54,500 135,100 189,600 Woodland 0.000 0 0 Lottery Credit: Claim Count: 1 Certification Date: Batch #: 103 Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 i A g 'mss Of Co $bbda of �`li CERTIFIED SURVEY MAP 'T Located in the SW 1/4 of the NE 1 /4 of Section 31, a N 1/4 CORNER T28N, R 19W, Town of Troy, St, Croix County, I­- a SECTION 31 Wisconsin, being also Lot 1 of that Certified Survey 00 T,2 N,R19W OO s; ' Map recorded in Volume 4, page 1083. _ 3 Surveyed for: Alfred Schmidt, owner APPR �w 0 Rt. . 2 , Oak Knoll zz N cs Hudson, Wi. 54016 Y 2 ,� 1 (� {� (� Wo M O3 UNPLATTED LANDS ST. C'SC�I)( CQLN y F- m - - - - - - - - - - - - CO:..tP :EHEhISIVE PARKS %A,.eM,3 C � N NORTH LINE OF SW 1/4 OF' NE >I /4 zo.q�"G CGA&MAFFFE W OZ 14.65 S89 1 31 09 E r 5.40' 33 .17' w N S 89'31' 9 "E 585.49' w }- I 275.00' 277.32' W _ POINT OF BEGINNING - 310.49' 90' L3 6 33' i0 O 2 el 0 0 I LOT I � LOT 2 N I 0:0 I 10 O m WSW W N a 6,647 SO. FT. N Ej 106, 156 SQ. FT. t- M M I r z N (2.219 ACRES) p N INCLUDING RIGHT N - 1 J O m OF- WAY(2.438 ACRES) Q I z 9 5,409 SO. F T. 0 0 0 EXCLUDING RIGHT- OF- WAY (2.190 ACRES) N fj N 33.00' u 1 W I " S 89'31'09 0E N W N 80'S6g67 308.53'_. d� z 283-8 07 g ' "� LOT 3 3j � IQI l li I = 172,984 SO. FT. INCLUDING 1 C.S.M. VOL. 1, PAGE 181 v 6.) o RIGHT- OF.- WAY ( 3.970 ACRES) / W } '00) 161.9:19 SO. FT. EXCLUDING j V a W Cj RIGHT - OF - WAY (3.7:16 ACRES) 4 tt 3 I t N N ID x al S 89' 31 ' 09 "E O O z ' - 474.28' 36.81' � v - - 511.09 U- d. o i z LOT 4 z .._ JAM J GCI 173,612 SQ. FT. INCLUDING W RIGHT -OF -WAY (3,986 ACRESI .� 6 F- z e W cu 157 ,81 - 2 , SO. FT. EXCLUDING � �� SOn� i I v ^ �' c0/ 3 m RI GH T- 0 F- WAY (3 -.'622 ACRES) ^�, a �L i 9 go Vol CO CO A su. ti N 0 O I t> PRIVATE ROADWAY EASEMENT i 268.09' / SCALE IN FELT , v N 87 '32'03 "W 304.30 I "•ISO' 36,21' o 'oo zoo 350 C. S. M. VOL. i , PAGE - - - - - -- - - - Volume 6 Page 1656 y 5:3 n L 11 V371897 Rat t CERTIF'IE'D SURVYY Pj[A.P �tY, v DOUGLAS PAGE �� OOgtb '4 �.. Part of the SW 1 /4 of the NE 1 of Section 31, Township 28 North, _ ^ Range 19 West, Town of Troy, St. Croix County, l•;isconsin. N 1/4 COR. SEC. 31, 16 Indicates 1 Iron pipe found. T 28 N, R 19 W, 0 Indic =;tes 1 "x 24" iron pipe stake weighing .1.13 lbs /ft set. (COUNTY SURVEYOR' M0N.) SO° 27'27 "W 1302.32' 16 5 '- S 89° 21' 45 "E 11 78.79' — 14 1 :.'24 554.02 ' 558.45' LJ 9 0° 587. 1 8' 33.16' I 33. C6' , , 3 591.61 2 4 �M INfN!n oJ° N O 90' ;� O o m I co M O M I M N , N /) l LOT 2 w ( N I 6.854 ACRES 3 N Jam` 298,539 S0, FT. - W `Q 1 9 1 M z LOT I 12. 779 ACRES A/ B 1C1 ' v3 - 548,669 SO. FT. ' 1 1' N 88° 14'55 W 615.22' z N ° PROPERTY LINE�Z 1 ° 00'00 "E 626.06) moo W° 0 ~� I L g M ROADWAY I LL: O EASEMENT I W C7 - z f 90' C.S.M. VOL. I P� �� N J N �5 °Z �. • ° • JAMES L. KALE I"= 200' 9 0 4 0' � ' MURPHY N 87 32 20"W 304.44' _ _ IN 89017125"W) _ ;�. S - 1 0 4 2 ' RIVER FALLS, ' d 30 i i LAND C.S.M. VOL, I , PAGE 165 I 1 James L. Murphy _. t f_ Reg' stered Land S veyor BLOW /UP \ NOTE: LOT I PRESENTLY BEING USED FOR I AGRICULTURAL PURPOSES. / 1 CURVE DATA / h / CURVE CHORD BEAR, D15T. RADIUS a A N I0°51'53 "E 165.55 301.64' B " 18 3. 19' 33 4.64' M / p` 6 6' C " 201.77' 367.64 / 36.42 7 8 36.42' 22.07' 22.07'/ / 44.14' / Vol. 4 Page. 1083 APPROVED St. Croix County Records St. Croix County, Wisconsin JUN 19 1981 / (Descri on. reverse) \ ST. CRO(X COUNTY Volume 4 Page 1083 CO MPREHENSW PARKS PLAN NING AND ZONING COMMITTEE I Parcel #: 040 - 1118 -80 -000 06/20/2006 04:31 PM PAGE 1 OF 1 Alt. Parcel #: 31.28.19.482F 040 - TOWN OF TROY Current � X I ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Cc-Owner SHEILA J & GREGORY M WARREN O - WARREN, SHEILA J & GREGORY M 75 CTY RD F RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): ' = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 0.000 Plat: N/A -NOT AVAILABLE SEC 31 T28N R1 9W SW NE 2.219 ACRES LOT 1 Block/Condo Bldg: CSM 6/1656 FORMERLY KNOWN AS PART OF LOT 1 CSM 4/1083 Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 31- 28N -19W Notes: Parcel History: Date Doc # Vol /Page Type 10/20/1999 612414 1464/527 WD 11/03/1998 590655 1373/062 WD 07/2311997 966/611 07123/1997 7751297 more 2006 SUMMARY Bill #: Fair Market Value: Assessed with: 0 Valuations Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.219 53,000 251,000 304,000 NO Totals for 2006: General Property 2.219 53,000 251,000 304,000 Woodland 0.000 0 0 Totals for 2005: General Property 2.219 53,000 251,000 304,000 Woodland 0.000 0 0 Lottery Credit Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 f� .5 1 .. z 1 l �, , - t s G�af►IM, �' 4 s 1YtMgi *r a T7 I_ Jkw joint 11ETtJ11N TO � r' I-MawMtg dm►IOad mw4fftata n St . Ci ro ix ied sarvey Iftp filed May 27, 1 R 103w- , x 6 page 1656 3sT Document j- "412528 located R e 1t8 J of Section 31, T2 N, R19W , Tax Partial �!F yo St. Croix C i ,c on sin wither with and subject to any of " eare;aentss, covenmt N.: atsionw or restriiWi.ans of record, if any, but this med to extend any such other recorcice e,ci mbrl-riceer be;r011 ;° the ter!`: estall1irhed by law therefor. Nff [� fl �y� r ?< - �� n�"� he11vWrd propwt r. Z ' P M la} not) , ,+ /MM1r �rIM dl aad >MnYtMar th. MradMatnanfa and opuranwon tImmodo balonpNp; WAI � r � ��� mod, tndaNrNlta MI faa aMipla and fnaand atM► Of at10fA11brallt�aa astoapt y , � "C � 8� � M1 � F ` r `auidaNadtlN �s' w day of De aemdher OF ytr`^�LCL� s AilTiltl:ITICATgM ACKNOMf1ld�'N� � � � ^r - - -. STATE OF WISOOM>1111 Parao"Iy am" bNontaa of + �- Olt in t to me known to be Ma pan9n tt+ ± tM Ot, Wia. s ) f InatrwnaM and aoktgwl wtnsirt`attr7 ss . `' b ttilwfftt�id, eoM My ;H s )' dada. ) x ,,may, Liz `A4i Form - STC - 104 AS BUILT SANITARY SYSTEM REPORT OWNER t5 �� 0�?/I��S TOWNSHIP /Z SEC. T, N -R W ADDRESS 2 ST. CROIX COUNTY, WISCONSIN SUBDIVISION sol ;* , �2 - LOT LOT SIZE PLAN VIEW Distances and dimensions to meet requirements of I•LHR 83 SHOW EVERYTHING WITHIN 100 FEET OF SYSTEM c `. L Ky6� ` ! �� . I � S,ni . ' INDICATE NORTH ARROW A -- , N BENCHMARK: Describe the vertical reference point used L 6A Elevation of vertical reference point: Proposed slope at site: SEPTIC TANK: Manufacturer: Z )CZ�zS Liquid Capacity: le do GA Number of rings used: A)d Tank manhole cover elevation: Tank Inlet Elevation: Tank Outlet Elevation: Number of feet from nearest Road: Front 1 0 Side .0 Rear, d feet From nearest property line Front, 0 Side ,(R�Rear,0 feet Number of feet from: well - , building: (Include this information of the above plot plan)( 2 reference dimensions to septic tank) SEE REVERSE SIDE____ P ER 1 Ma facturer: Liquid Capacity: Pump Model: Pump /Siphon Manufacturer: Pump Size Elevation of inlet: Bottom of tank elevation: Pump off switch elevation: Gallons per cycle: Alarm Manufacturer: Alarm Switch Type: Number of feet from nearest property line: Front, O Side, O Rear, Q Ft. Number of feet from well: Number of feet from building: (Include distances on plot plan). SOIL ABSORPTION SYSTEM Bed: Trench: Width: � Length: D Number of Lines: 0/ Area Built Fill depth to top of pipe: 5;Z2 i Number of feet from nearest property line: Front, Side, O Rear, Ft /Z Y Number of feet from well: e C/ ' Number of feet from building: f (Include distances on plot plan). SEEP E e: Number of pits: Diameter: Liquid depth: Bottom of seepage pit elevation: Area Built: Has either a drop box O or distribution box O been used on any of the above soil absorbtion sytems? (Check one). HOL TANK Manufacturer: Capacity: Number of rings used: Elevation of bottom of tank: Elevation of inlet: Number of feet from nearest property line: Front, O Side, O Rear, O Ft. Number of feet from well: Number of feet from building: Number of feet from nearest road: Alarm Manufacturer: Inspector: Dated: Plumber on job: License Number: 3/84:mj DEPARTMENT OF INDUSTRY INSPECTION REPORT FOR SAFETY & BUILDINGS LABWR & HUMAN RELATIONS PRIVATE SEWAGE SYSTEMS DIVISION P.O. BOX 7969 BUREAU OF PLUMBING MADISON, WI 53707 State I.D. Number: SW4,NE4 Plan l. ,S31,T28N -R19W 9CONVENTIONAL ❑ALTERNATIVE State Plan Town of Troy El Holding Tank El in-Ground Pressure ❑ Mound NAME OF PERMIT HOLDER. ADDRESS OF PERMIT HOLDER: INSPEC 10 Steve Berres Route 1, River Falls, WI 54022 � -- A4 - css ••?0 BENCH MARK (Permanent reference point) DESCRIBE IF DIFFERENT FROM PLAN: REF. PT. ELEV.: 1 1;5T REF. PT. ELEV.. Name of Plumber MP /MPRSW No.: County: Sanitary Permit Number: Lyle J. Myers I 6219 St. Croix 106136 SEPTIC TANK /HOLDING TANK: MANUFACTURER: LIQUID CAPACITY: TANK INLET ELEV.. TANK OUTLET ELEV: WARNING LAB L YILDI LOCKING COVER PROVIDED. PROVIDED ES ❑N DYES ONO BEDDING. VENT DIA. VENT MATL.. HIGH WATER NUMBER OF ROAD: I ROPERTY WELL NG. (VENT TO FRESH ALARM FEET F INE AIR INLET ❑YES ONO DYES ❑NO NEARE ROM S T DOSING CHAMBER: MANUFACTURER BEDDING. LIQUID CAPACITY PUMP MODEL PUMP /SIPHON MANUFACTURER I WARNIN NG COVER G LABEL LOCKI PROVIDED: PROVIDED. DYES ❑NO ❑YES ❑NO I DYES ❑NO GALLONS PER CYCLE: PUMP AND CONTROLS OPERAT IONAL. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH (DIFFERENCE BETWEEN FEET FROM LI AIR INLET PUMP ON AND OFF) DYES 0 N NEAREST SOIL ABSORPTION SYSTEM. Check the soil moisture at the depth of plowing LENGTH I DIAME TEH MATERIAL AND MARKING Or excavation. (If soil can be rolled into a wire, construction shall cease until FORCE the soil is dry enough to continue.) MAIN CONVENTIONAL SYSTEM: WIDTH'. LENGTH NO. OF DISTR. PIPE SPACING COVER INSIDE DIA = PITS LIDOID BED /TRENCH TRENCHES MATERIAL: PIT DEPTH DIMENSIONS GRAVEL DEPTH FILL DEPTH IDISTR PIPE DISTR. PIPE DISTR. PIPE MATERIAL. NO. DISTR. NUMBER OF PROPERTY WELL BUILDING VENT TO FRESH BELOW PIPES ABOVE COVER. ELEV INLET ELEV. END. PIPES FEET FROM LINE AIR INLET NEAREST MOUND SYSTEM: Mound site plowed perpendicular to slope Check the texture of the fill material for PROVIDE A DIAGRAM OF SYSTEM and furrows thrown upslope: mound systems to make certain that it ON REVERSE SIDE. SHOW ELEVA- meets the criteria for medium sand. TIONS MEASURED. DYES 1:1 NO SOIL COVER TEXTURE PERMANENT MARKERS OBSERVATION WE LLS 1 1:1 YE S ❑NO DYES ❑NO DEPTH OVER TRENCH /BED DEPTH OVER TRENCH /BED [=PSOIL SODDED J SEEDFD MULCHED CENTER EDGES El YES ONO DYES F71 NO 1:1 YES ONO PRESSURIZED DISTRIBUTION SYSTEM: WIDTH. LENGTH. NO, OF LATERAL SPACING (TRAVEL DEPTH BELOW PIPF FILL DEPTH ABOVE COVER BED /TRENCH TRENCHES: DIMENSIONS MANIFOLD PUMP MANIFOLD DISTR. PIPE I MANIFOLDMATERIAL NO DISTR DISTR. PIPE OISTHIBUTION PIPE MATERIAL & MARKING ELEV.. ELEV.. DIA. ELEV, PIPES ELEVATION AND DISTRIBUTION INFORMATION HOLE SIZE HOLE SPACING DRILLED CORRECTLY COVER MATERIAL VERTICAL LIFT CORRESPONDS TO APPROVED PLAMS DYES ❑NO DY ES ❑NO COMMENTS: PERMANENT MARKERS: OBSERVATION WELLS'. NUMBER F PROPERTY WELL: BUILDING FEET FRM LINE DYES El NO DYES El NO I NEARESP � S ketch System on Retain in county file for audit. Reverse Side. SIG TITLE DILHR SBD 6710 (R. 01/82) Zoning Adminis -�-�-^ SANITARY PERMIT APPLICATION COUNTY ( ZY DILHR In accord with ILHR 83.05, Wis. Adm. Code STA ,E SANITARY PERMIT # —Attach complete plans (to the county copy only) for the system, on paper not less than STATE PLAN I.D. NU BER 8% x 11 inches in size. —See reverse side for instructions for completing this application. PETITION 1. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION. FOR VARIANCE ❑ YES � NO PROPERTD OWNER PROPFERTY LOCATION '/4 L /4,S T2r,N,R E(Or PROPERTY OWNER'S MAILING ADDRESS LOT NU ER BLOCK MBER SUB IVISION NAME CITY, STATE ZIP CODE PHONE NUMBER 77 CITY NEAREST ROAD, LAKE OR LANDMARK S 2 Z ❑ VILLAGE: Sff TOWN OF: 11. TYPE OF BOIL ING OR USE SERVED: Number of Bedrooms if 1 or 2 Family it.� -t.,�s OR ❑ Public (Specify): III. PURPOSE OF APPLICATION: (Check only one in #1. Check # 2,3 or 4, if applicable) 1. a. X New b. ❑ Replacement c. ❑ Replacement of d. ❑ Reconnection of e. ❑ Repair of an System System Septic Tank Only an Existing System Existing System 2. ❑ A Sanitary Permit was previously issued. Permit ## Date Issued 3. ❑ An Existing System has been inspected and soil conditions meet minimum requirements. 4. ❑ The System is shared by more than one owner /building. Attach Common Ownership Agreement to County Copy. IV. TYPE OF SYSTEM: (Check only one in ##1 and only one in #2) 1. a. %Conventional b. ❑ Alternative C. ❑ Experimental 2. a. ❑ System- b. ❑ Holding c. ❑ Pit Privy d. ❑ Vault Privy e. ❑ Mound f. ❑ IGP In -Fill Tank V. ABSORPTION SYSTEM INFORMATION: (Check one) 1. a. ❑ Seepage Bed b. A Seepage Trench c. ❑ seepage Pit 2. PERCOLATION RATE 3. ABSORPTION AREA ' 4. ABSORPTION AREA 5. SYSTEM ELEVATION 6. WATER SUPPLY: (Minutes per inch): REQUIRED (Square Feet): PROPOSED (Square Feet): � -- S �� Feet Private ❑Joint El Public VI. TANK CAPACITY U Site in allons Total # of Prefab. Fiber- Exper. INFORMATION New xisting Gallons Tanks Manufacturer's Name Concrete Con- Steel glass Plastic App Tanks Tanks structed Septic Tank or Holding Tank ❑ ❑ Lift Pump Tank/Siphon Chamber VII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the private sewage system shown on the attached plans. Plumber's Name (Print): Plumber's ' natur (No Stamps) P PRSW No.: Business Phone Number: j / S' Z5 Plumb 's Address (Street, City, Sta , Zip Code r �c�7 Name of Desig r: _ Vlll. SOIL TEST INFORMATION Certifie Soil Tester (CST) Name CST # r CST's ADDRESS (Street, City, State, Zip Code) Phone Number: A* (ZI 1 IX. COUNTY/DEPARTMENT USE ONLY ❑ Disapproved S nitary Permit Fee Groundwater ate Issuing Agent Signature (No Stamps) - Approved i ❑ Owner Given Initial �j) S arge Fee / Adverse Determination 12. � �"� `^'' jv CZD X. COMMENTS /REASONS FOR DISAPPROVAL: a6p(buw ma 3,je L1,,:n SBD -6398 (formerly Plb -67) (R. 03/86) DISTRIBUTION: Original to County, One Copy To: Bureau of Plumbing, Owner, Plumber INFORMATION & INSTRUCTIONS FOR COMPLETING A SANITARY PERMIT _V APPLICATION TO THE APPLICANT: 1. This sanitary permit is valid for two (2) years; 2. Your sanitary permit may be renewed before the expiration date, and at the time of renewal any new criteria in the Wisconsin Administrative Code will be applicable; 3. All revisions to this permit must be approved by the permit issuing authority. A new permit may be needed if there is a change in your building plans, system location, estimated wastewater flow (number of bed- rooms, etc.), depth of system, or type of system; 4. Changes in ownership or plumber requires a Sanitary Permit Transfer /Renewal Form (SBD 6399) to be submitted to the county prior to installation; 5. Private sewage systems must be properly maintained. The septic tank(s) should be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years; 6. If you have questions concerning your private sewage system, contact your local code administrator or the State of Wisconsin, Bureau of Plumbing, 608 -266 -3815. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description where the system is to be installed; II. Type of building or use served: If public is checked, indicate type of use (i.e. 10 unit apartment, 30 seat restaurant, etc.). Fill in number of bedrooms if building is a one or two family dwelling; III. Purpose of application: Check only one in ##1. Complete ##2 if permit is for tank replacement, reconnection or repair; IV. Type of system: check all appropriate boxes depending on system type. Check experimental only if project is in conjunction with University of Wisconsin; V. Absorption system information: Provide all information requested in ##1 -6; VI. Tank information: Fill in the capacity of every new and /or existing tank, list the total gallons to be installed, number of tanks and manufacturer's name. Indicate prefab or site constructed and tank material. Complete for all septic, lift /siphon chamber and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR; VII. Responsibility statement: Installing plumber is to fill in name, license number with appropriate prefix (e.g. MP, etc.), address and phone number. Plumber must sign application form. Fill in designer name if applicable; VIII. Soil test information: Certified soil tester's name, certification number, address, and phone number. IX. County /Department Use Only; X. Comment area for use by county or resaon given when application is disapproved. Complete plans and specifications not smaller than 8'% x 11 inches must be submitted to the county. The plans must include the following: A) plot plan, drawn to scale or with complete dimensions, location of holding tank(s), septic tank(s) or other treatment tanks; building sewers; wells; water mains /water service; streams and lakes; dosing or pumping chambers; distribution boxes; soil absorption systems; replacement system areas; and the location of the building served; B) horizontal and vertical elevation reference points; C) complete specifications for pumps and controls; dose volume; elevation differences; friction loss; pump P performance curve; pump model and `pump manufacturer; D) cross section of the soil absorption system if required by the county; E) soil test data on a 115 form. --------------------------------------------------------------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE On May 4, 1984, 1983, Wisconsin Act 410 was signed into law. This legislation is more commonly known as the groundwater protection law. This change in statutes was the result of over 2 years of steady negotiation and public debate. The groundwater bill Ground -s— included the creation of surcharges (fees) for a number of regulated practices which Wisco jYV, ° can effect groundwater. The surcharge took effect on July 1, 1984. All of the water that buried i0as lfB is used in your building is returned to the groundwater through your soil absorption o system or the disposal site used by your holding tank pumper. The monies collected through these surcharges are credited to the groundwater fund adminis- tered by the Department of Natural Resources. These funds are used for monitoring ground- t water, groundwater contamination investigations and establishment of standards. Groundwater, it's worth protecting. SBD -6398 (R.03/86) APPLICATION FOR SANITARY PERMIT STC - 100 This application form is to be completed in full and signed by the owner(s) of the property being developed. Any inadequacies will only result in delays of the permit issuance. Should this development be intended for resale by owner /contractor, ( "spec house "), then a second form should be retained and completed when the property is sold and submitted to this office with the appropriate deed recording. Owner of Property Location of Property S W�_ - , Section , T Zg N -R �� W Township T Y'Q V !failing Address Address of Site Subdivision Name .Lot Number Previous Amer of Property / prm c. so- f th trjk- Total Size of Parcel 2 , 4 3 p Iq C r Date Parcel was Created j 2_1 Iq Are all corners and lot lines identifiable? 4 Yes No Is this property being developed for resale (spec house) ? Yes No Volume � and Page Numbe as recorded with the Register of Deeds. INCLUDE WITH THIS APPLICATION THE FOLLOWING: A Warranty Deed which includes a Document number volume and page number and the Seal of the Register of Deeds In addition, a certified survey, if available, would be helpful so as to avoid delays of the reviewing process. If the deed description refer- ences to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATIO i (Wel cehti.6y that aCC atatement6 on tW ¢oAm ane tAue to the but 06 my (Ouk) hncwtedget that 1 (we) am (cute the ownelr.(a 1 06 the pnopWy duchi.bed in thiA in6o4mation 6ottm, by viAtue o6 a waAAan.ty dee in the 066.ice o6 the Countyy Registeh o6 Deeds" Document No. Y / 2; and that 1 (We) pnedewt£y cRvn 1- pn.opoaed bite bon the sewage di�spoa ae eya em (on I (we) have obtained an eas ement, to nun with the above d6 ch i,bed phopen ty, bon the conatnuc ti.on o6 aai.d eyaten+, and the dame ha.e been duty n.ecohded .in the 066.ice o6 the County RegiAteA o6 aeeda , ab Docment No. y12 52 $ ) 0 SIGNATURE Olt OWNER SIGNATURE OF CO -OWNER (IF APPLICABLE) DATE SIGNED DATE SIGNED • EA - H a STC 105 r a SEPTIC TANK MAINTENANCE AGREEMENT o St. Croix County z t7 , a OWNER /BUYER e ► ? of res ROUTE /BOX NUMBER Fire Number CITY /STATE ZIP PROPERTY LOCATION: YV Z, _ Section J' T 2 5 N, R _W, Town of ' /'(� �( _ , St. Croix County, Subdivision Lot number Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance con - sists of pumping out the septic tank every three years or sooner, if needed, by a licensed septic tank pumper What you put into the system can affect the function of the septic tank as a treat- ment stage in the waste disposal system. St. Croix.County residents m_ y be eligible to receive a grant for a maximum of 60% of the cost of replacement of a failing system, which was in operation prior to July 1, 1978. St. Croix County accepted this program in August of 1980, with the requirement that owners of all new systems agree to keep their systems properly maintained. The property owner agrees to submit to St. Croix County Zoning a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veri- fying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if nec essary), the septic 'tank is less than 1/3 full of sludge and scum. Certification form will be sent approximately 30 days prior to three year expiration. H o I /WE, the undersigned, have read the above requirements and agree to maintain the private sewage disposal system in accordance with H the standards set forth, herein, as set by the Wisconsin Depart- ro ment of Natural Resources. Certification form must be completed and returned to the St. Croix County Zoning Office within 30 days of the three year expiration date. SIGN DATE —�� St. Croix County Zoning Office P.O. Box 98. Hammond, WI 54015 715 - 796 -2239 or 715 - 425 -8363 Sign, date and return to above address. r � ' DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUSTRY, DIVISION -LABOR AND PERCOLATION TESTS (115T MADISON WI 53707 HUNAN RELATIONS (ILHR 83.09(1) &Chapter 145) LOCATION: SECTION: TOWNSHI / LOT NO.:BLK. NO. SUBDIVISION NAME: �/ ,E ) /TRgN /RJc7E (a W ' A 1Ul : .� . LINTY: OWN 'S /BUYER'S NA E: M LING RESS: USE e 2 D TES OBSERVATIONS MADE NO. BEDRMS.: 1 COMMERCIAL DESCRIPTION: / PROFIL ES IPTIONS: PER OL ION o ESTS: UQResidence L�New ❑Replace I S (f� 3 All? RATING: S= Site suitable for system U= Site unsuitable for system rf CONV IONAL: M IN- GROUND -PR E: SYSTEM- IN -FIL OLDING TA : : RECOMMENDED SYSTE optional) CAS OU ❑U CJ'S DU EIS ❑S ❑S� If Percolation Tests are NOT re uired DESIGN RATE: q I If any portion of the tested area is in the under s. ILHR 83.09(5)(b), indicate: Fl oodplain, i n d icate Floodplain elevation: /t//9 PROFILE DESCRIPTIONS I BORING TOTAL D PTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN. ELEVATION OBSERVED EST. HIGHEST TO BEDROCK IF OBSERVED (SEE ABBRV. ON CK.) 7 ?�o /!s (J�Y�3n s , 3 617 S � a l�n n'Ie� s. B ? `1l0 (c )3 10 kf3n s , / v s g sm S , iok 6 n-5!, /4 61'2sc /S en'01 d S B3 ?6 . 7.5 ? G� s B� ?Co S. �� JS�k�nsi 33, / Cs s tF in B 7� amy > 7 f� "u$ns o�W6nsJ, � �n� Is rz Q. s B-; ?6 �1Ov. 5 > PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIO PERIO P R PER INCH P- / P- _3 oe P P P- P- PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION E � E 3 7 T F E E .. N -a a_ eK las- I P- a. 3 a�..� f E F E t p I, the undersigned, hereby certify that the t *ts r *3orted on this form were made by me in accord with the procedures and method pecifi in the Wisconsin Administrative Code, and that the data record a�i t� location of the tests are correct to the best of my knowledge and belief. NAME (print): �. +� [J TESTS WERE MPLET D N: a— r I Q— C ADDRESS: � CERTIFICATION�UMBER: PHONE NUM (optional ) : CST SI VRE: DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. 6 R-SBD-6395 (R. 10/83) — OVER — �1 w - I NSTRUCTIONS FOR COMPLETING FORM 116 - SET - 6396 To be :a com plete an accurate soil tt st, you reporL must inclufle: 1 . Complete legal description; 2. The use section= must clearly indicate whether 0jis is a residence or commercial project; 3. MAXIMUM number of bedrooms or cornmercial use planned; 4. Is this a new or replacement system; . Complete the s�aitl�s iliiy rating br�x� s. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER,SYSTENIS ARE RULED OUT BASED ON SOIL CONDITIONS; Pi. PLEASE use tine abbe eviations shown Mere for writing profile descriptions and completing the plot plan; 7, MAKE A LEGIBLE diagrarn accurately locatijrg your test locations. Drawing to scale is preferred. A sr pavate sheet may be used if desi!pd; 3, Make sure yokjr be rich marl/ and Vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate:: boxes as to dates, naives, addresses, flood plain data, percolation test exerrtp- tion, if appropriate; 10. If the information {such as flood plain, e levatioar} does not apply, place N.A. in the appropriate box; 11. Sign the form and Pit-C 3 your current address ano your co i,sca ion nuanccr; 12. Make legible copies and distribute as required. ALL SOIL "BESTS MUST RE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DA'B'S OF r :OMPLETION. i ABBREVIATIONS FOR {,ER7IFiF 3 SOIL TESTERS Sail Separates and Textures` Other Symbols st Slone {over 10" BR - Bedrock cob Cobble {3. 10' SS Sandstone gr Gravel (under 3 ") I..S Limestone *s Sand HGV1 High Groundwater cs C;ox'sc Sand Perc -... € ercolatior Rate med s Medium Sand VV '- Well fs Fine Sand Bldg .. -. Building is L. €:aarr'y Sand Greater Than *sl Sand Loam <. - Less That `I - Lraarn Bn _... Brw.,vr3 L tt B lac k s';:i .. Sys€ ciy Clay Loam R .._ Ri c sicl Si=ty Clay= Loam root Mot"'Ies sic Silty Clay ffl` few, fine, faint c .._ Clay C(" ..... cry €ninon, Coarse (fit _" Pea t min .-_ Manly, irie d,urni r. -, - ' ^•rlcr €, €9 -' d:.stinct - p ._._ pr ominent ' T <, X ` sr (xsai B N "I R rids Nll;r: k, •r1 RP -' vf"gica! F - ie?>.' i e F',rir €t I i TO THE OWNER: This soil test report is the first step in securing a sanitary permit. The county or the Department may request verification of this soil test in the field prior to permit issuance. A complete set of plans for the private sewage system and a permit application must be su'ornitted to the appropriate locai authority in order to obtain a permit. The sanitary permit must be obtained and posted prior to the start of any construction. u \r f- � t rr �U O u V1 `1 �o