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Home My WebLink About040-1129-30-200 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 499118 0 GENERAL INFORMATION (ATTACH TO PERMIT) a PI I No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m) 3 . = Tr-rrrv,7 • At Permit Holder's Name: City Village X Township Parcel Tax No: Brosi, Mark Troy, Town of 640 - 112- 1. 3o - Zoo CST BM Elev: Insp. BM Elev: BM De ription: 50ctio ow Range/Map No: ql~. to .(0 = Chi B>M Z CST k~ 34.28.19.54( TANK INFORMATION ELEVATION DA TYPE ~ 00, MANU,FAC~TURE~ ryn • CAPACITY STATION BS HI FS ELEV. r Septic S Ow- Be chmark ,,d •(00 9&.I0 Dosing L • tr Alt- BM Aeration Bldg. Sewer / s 80 9s zo Holding St/Ht Inlet ~•3 g3.6s St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic + ~ry / Dt Bottom 'l•~ CID -015 Dosing Header/Man. / .(o ?q. 10 r ( t0 Aeration Dist. Pipe .l o ~q.r O r 0-10 Holding Bot. System A / • / 6.60 / t0 b .60 F'nal Grade PUMP/SIPHON INFORMATION W rL1 kb..?- 12 ~t~si Q op MLjA-W6 J Manufacturer Demand St Cover -(TTL~ G 1~ GPM Q 1 C~ I q Model Number 10.11 C~~~r ~l.(~~/ f • 10~ ° ! ~o• / TDH Lift oPI Friction Loss System Head PH It 'k o .90 3•Z57 ~I~tS Forcemain Length Dia. 2 n Dist. to Well SOIL ABSORPTION SYSTEM .j~ BEDITRENCH Width r Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Li u' th DIMENSIONS O ~S.a 11 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHI kilatl5facturer: em: CHAMBER INFORMATION Type Of S stem: UNI T1 gem: odel Number: DISTRIBUTION SYSTEM y~ PIL Header/Ma Id Distribution t t t + x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 1 3 rt q si Length P - Dia Length 3 (?A-)Dia / / Spacing 13 ~I SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of eded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil xx Se Yes ~D No E] Yes E] No CO ENT (include code en ies, rsons esent, Ins ction #1: t > P % 1240 (P Inspection #2: U.) to'%strLs' Elul Location: 654 Swedish Mission Road River Falls, WI 54022 (NW 1/4 SE 1/4 34 T28N R 9W) Lot 1 Parcel No: 34.28.19. 1.) Alt BM Description = 2.) Bldg sewer length = -amount of cover = 2V `+t AK4 fNt 3) clet o4 •09+ Plan revision Re'uired? ❑ Yes No Use other side for additional informati n. / ` r 1D SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No. Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety arid Building Division Sanitary Permit No: INSPECTION REPORT 499118 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)i. r'.-{,N~' Permit Holder's Name: City Village X Township Parcel Tax No: Brosi, Mark Troy, Town of CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No E 8.19. TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer ~04f f o Holding St/Ht Inlet r SUHt Outlet TANK SETBACK INFORM ION i TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet V 3, Septic Dt Bottom r l J' i JOF Dosing Header/Man. Aeration Dist. Pipe t, Holding Bot. System Final Grad PUMP/SIPHON INFORMATION 'y*{ tl ° ,f Manufacturer Oknand St Co G Model Number TDH Lift Friction Loss System Head TDH i f r l Forcemain Length Dia. Dist to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIM IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS r, SETBACK SYSTEM TO 1- P/L BLDG ELL LAKE/STREA LEACHING Manufacturer: INFORMATION NAMBEIR OR Type Of System: r y UNIT Mode Nrmiber_.-_._ DISTRIBUTION SYSTEM , Header/Manifold Distribution x Hole Size x Ho pacing Vent to Air Intake Pipe(s) Length Dia Length -F Dia Spacing SOIL COVER x Pressure tems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of us Seeded/Sodded X, Mud :hed Bed/Trench Center Bed/Tren dges Topsoil Yes v Yes vo COMMENTS:, (Include code dipcrepe es, persons present,.etc) Inspection #1: Inspec #2: Location: 654rSwedish Mission Road nknown.(NW 1/4 SE 1/4 34 T28N R1 9W) NA Lott Parcel No: 34.28.19. 1.) Alt BM Description = 2.) Bldg sewer length = amount of cover = 4,ts►L.. > a 1~ r r r x. YeS NO 4 y~ y i h t t r'.- b4 L 4At.lG} K' L Plan revision Requlrell . Use other side for additional information. ; 4- A 0_ +'1 i' - D2tej { Insepctors Signature i )rtjNo SBD-6710 (R.3l97) r . _ . - l.t I~ 10109/2006 8:03 17156581344 M GUSTUM PAGE 01 i 64 51 ji /45 k` i v.4 ad I I ~ i I . ! 49. I t' Oki P I ~ - I I I i ~ I I I I ~ I Is UA_A~ T (r i I .u oet and Buildings ' ' ' Vt. unty N 20 shin n Croix IscOns,n ison, WI W507 "1"b ite Address a d wedish Mission Rd. Department of Commerce qO Sanitary Permit licat n S itaryPermitNumber o~) Ixco'~;~~~. In accord with Comm 83.21, Wis. Adm. Co nal informal n yot opt heck if Revision maybe used for secondary purposes Privad Law, s15.0 1)(m) ,GNING UFFle 1. Application Information - Please Print All Information State Plan I.D. 'N/umber / 7 / Property Owner's Name Parcel Number Mark Brosi Pending Property Owner's Mailing Address Property Location 565 Cty. Rd. M NW%4; SE'/4; S34; T28N, R19W City, State Zip Code Phone Number Lot Number Block N`Vr'ber River Falls, WI 54022 (715)426-4924 / Ah+ Subdivision Name CSM Number G5►w 8z~o5Fr7 ✓vl2/ 5 33 II. Type of Building (check all that apply) Gk e7 46M.• 11 city_ X 1 or 2 Family Dwelling - Number of Bedrooms ~.a 01A_. P 11 Village ❑ Public/Commercial - Describe Use X Town Troy ❑ State Owned Nearest Road v1 a-tL Swedish Mission Rd. III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. 1 New 2 Replacement System 3 11 Replacement of FExisting Addition m For County use Syste`m~X Tank Only System B Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: (Check all that apply)(numbering scheme is for internal use) 44 ❑ Non -Pressurized In-Ground 21 ❑ Mound 47 ❑ Sand Filter 50 ❑ Constructed Wetland 22 ❑ Pressurized In-Ground 41 ❑Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line C~L~ At-Grade 46 ❑ Aerobic Treatment Unit 49 ❑ Recirculating 30 ❑ Other (~~J_jc / ! i 3 V. ent Area Information: Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation System Elevation Final Grade Required Proposed Rate(Gals./Days/Sq.Ft.) Rate Elevation ~b (Min./Inch) 9480' 96.09' 450 750 ft2 750ft2 .6 N/A VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing //b Tanks Tanks [N Septic 1000 1000 1 Skaw Precast X Pump VII. Responsibility Statement- I, the undersi , ssume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plu is Signa MP/MPRS Number Business Phone Number Thomas D. Gustum 227618 715 658-1344 Plumber's Address (Street, City, State, Zip Code) N13450 937th St New Auburn, WI 54757 VIII. County/ eartment Use Only proved Disapprove Sanitary Permit Fee (includes Groundwater Date Issued Issuin gent Signature o Stam X-Ap Surcharge Fee) C>0 Owner Giv nitial Adve D ❑ 5 15 /p (D ion / IX. CondiReasons for Disapproval 1. Septic tank, effluent filter and dispersal cell must all be servites / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code / ordinances. Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD-6398 (R. 05101) Q - U ~ m Q °s 3 i rn CU z 0 ~ W . C4 m N T\ = F)M V ~U,Etr.F z: a N L j U CD Q > 3 m p` C7 cA (h is CL m U N fh 0 O Q O n. ~ a V O v t 3 :3 to c .6 O Q p C7 _ I 0--o' U U U ov 2M 2 GC d ~ r ~ N ~ Q a a m o ' z o OEI Q r- 1' .70/0 EL - a = co mCi 0 t l ° <V on tp r d y b o W \ 26" o~ Do c Eu> <qo L~-1 ~ J co w w(n = u it " y co N it m m OD Q U co Q 4 p v m Q 41 rn (fl Z o ishM6s~on---------- OD r o Cc) N o (Q Lf) _ m aLL N ~ O Y~ m1n C\ ~ to (r a : N V 8 3 j U ~ C7 fn Q ' CL U l0 M 0 O Q O ~ Q a t ~ o o c c (f) o> 0 0.10 o ~ 3 0~ ih i : ~ ,awl a co 2 O F- a. to Ir m w LO v 0.01 h E' o F7 i ~ S►oRe 7% o cr- $ co mrn `L- O Oo "2 II 2 7 O u U o 1 w O p W w m Q a3i J mwLU U) x 2 n ~ ~ m °p . F- „mm p m a r Safety and Buildings wi. 1340 E GREEN BAY ST STE 300 commerce.gOV SHAWANO WI 54166 TDD (608) 264-8777 isconsin www.commerce.wi.gov/sb/ Department of Commerce www.wisco isconsinsin.go .gov Jim Doyle, Governor Mary P. Burke, Secretary June 13, 2005 CUST ID No.227618 ATTN: POWTS Inspector THOMAS GUSTUM ZONING OFFICE GUSTUM SEPTIC SERVICE ST CROIX COUNTY SPIA N13450 937TH ST 1101 CARMICHAEL RD NEW AUBURN WI 54757 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/13/2007 Identification Numbers Transaction ID No. 1144313 Site ID No. 699926 SITE: Mark Brosi Please refer to both identification numbers, Swedish Mission Rd above, in all correspondence with the agency, Town of Troy St Croix County FOR: Description: At-Grade System for Mark Brosi Object Type: POWTS Component Manual, Regulated Object ID No.: 1022884 Maintenance required; 450 GPD Flow rate; System(s): At-grade Component Manual, SBD-10570-P (R.6/99) 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: • This system is to be constructed and located in accordance with the approved plans, and with publication SBD-10570-P (R. 6/99) "At-grade Component Manual Using a Pressure Distribution System for Private Onsite Wastewater Systems". • The pressure network is to be constructed in accordance with publications SBD-10573- P (R. 6/99) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81)". 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. i THOMAS GUSTUM Page 2 6(1312005 In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 Keith A Wilkinson POWTS Plan Reviewer, Integrated Services WiSMART code: 7633 (715) 524-3630, Fax: (715) 524-3633 , M-f 7:45 am - 4:30 pm kwilkinson@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist (715) 726-2544 I , . EG o5 VJ 10 At Grade S6\v GS Did , pg 1 of 6 &s~.o Cover Page Project Name: Brosi 3 Bedroom At Grade Owner's Name Mark Brosi Owners Address 565 Cty. Rd. M River Falls, Wi. 54022 (715)426-4924 Legal Description NW %4 sE % 4 Sec 34 T 28 N, R 19 WW] Township Troy County Saint Croix i Subdivision Lot# C, ,u da : ioll(illy Parcel ID# pending r:TMl:NT 6FC6M,NP,ERC E YY CI IS4)N OF SAFETY AND BUILDINGS ~..'e0 J~ Table of Contents THOMAG D. p9 SSE CORRESPONDENCE GUSTl11vl ; 1 Cover page ` 1201 2 At-Grade Sizing Calculations 3 Pressure Distribution Layout and Dynamics j qY 31 4 Dose Tank Calculations/Pump Curve I 5 Management and Contingency Plan 6 Plot Map total # of pages: 6 Designer Name: Tom Gustum License D1201 Date: 6/7/2005 Ph. 715-658-1344 Signature: At-Grade Design Methods Used per "At-Grade Component Manual For Private Onsite Wastewater Treatment Systems" (Version 1.0) SBD-10570-P (R.6/99) per " Pressure Distribution Component manual for Private Onsite Wastewater Treatment Systems" (Version 2.0) SBD-10573-P(R.6/99) i At-Grade Page 2 of 6 Sizing Calculations Project Name: Brosi 3 Bedroom At Grade Site Conditions Design of Entire Component Private Dwelling or Commercial: p (P or C) Upslope Width added to A (E): 2.0 ft % Slope: 7% Total Width of Distribution Cell(C): 12.0 ft. # of Bedrooms 3 Perimeter Beyond Aggregate (D): 5.0 ft Depth to limiting factor: 40 in. Overall Width of Component(W): 22.0 ft. Absorbtion rate of in-situ soil: 0.6 gal/ft2/day Overall Length of Component(L): 85.0 ft. Effluent quality LE #1 • Elevation of Lateral in Cell: 94.80 in. Max BOD effluent value: 220 mg/I Height of Component Over Lateral: 15.5 in. Max TSS effluent value: 150 mg/I Height Over Rest of Cell: 13.5 in. Final Grade of Component: 96.09 ft Design of the Distribution Cell System Design Flow: 450.0 gal/day Distribution cell credit width (A): 10.00 ft Distribution cell length (B): 75.0 ft Observation Pipes Area of Distribution Cell: 750.0 ftz Location from end of cell: 12.5 ft Contour Elevation: 94.30 ft At-Grade Plan View D~ ~116 Observation ~1/6~ D Pipes B Irv :v c L i B I~ D r L At-Grade Cross Section Final Grade Lateral Invert Synthetic Fabric Cover Material - ~--Distribution Cell System Contour-- rR d 416 Observation Pipe q d a 4 , 45 Tilled Area 10.66 Jd~ 0 C A Slope Notes: Distribution cell aggregate to comply with Comm 84.30(6)(1) Synthetic Fabric covering on cell per Comm 84.30(6)(g) Distribution Cell to have minimum 6" aggregate below lateral and 2" above. At-Grade Page 3 of 6 Pressure Distribution Calculations Project Name: Brosi 3 Bedroom At Grade Lateral Layout Lateral/Manifold Design Lateral elevation: 94.8 ft Lateral diameter: 1'~z In. Rows of Laterals: 1 Lateral to upper cell edge: 2 ft Manifold type: center Lateral discharge rate: 15.15 gpm Orifice diameter: o.188 ] In. System discharge rate: 30.31 gpm # of Laterals: 2 Distal Pressure: 2.5 ft Lateral Length: 37 ft Orifice Spacing/Distribution Forcemain Friction Loss Orifice spacing (X): 19.73 Inches Forcemain length: 56 ft Orifices per lateral: 23 Forcemain diameter: ~ 2 v In. Avg. ft2/Orifice: 2 Friction loss in forcemain: 1.107 ft Avg. Lin ft/Orifice: Lateral Side View forcc -~4•l~if°nft7ltf Lateral Lateral 'r x 'r x x x x x 7r 7r x x 7r ;f x x x 2 2 Lateral Length Lateral Length Lateral Plan View Lateral Length ti Turn-up w/ball valve or cleanout plug 0 0 Orifices on bottom of lateral equally spaced PVC laterals and forcemain to comply with specifications per Comm 84.30(2)(e) Clean Out Detail Observation Pipes Clean-out plug Final Grade or ball valve Water tight cap or plug Lawn Sprinkler Box Slot Note: Closet Collar 6" Minimum may be used in Long Sweep 90 f plane of 3/8" bar or two 45's 'L 3/E3" Bar Lateral At Grade Management Plan pursuant to comm 83.54 W. A. C. page5 of 6 Owner's Responsibility- The component owner is responsible for the operation and maintenance of the component. The county, department or POWTS service contractor may make periodic inspections of the components, checking for surface discharge, treated effluent levels, etc. The owner or owner's agent is required to submit necessary maintenance reports to the appropriate jurisdiction and/or the department. Septic Tank: Septic tank(s) are to be inspected routinely and maintained by department approved individuals when necessary in accordance with their approvals. The use of chemical/biological "treatments" is not required or recommended. If such additives are used, make sure they are approved by Department of Commerce, Safety and Buildings Div.. Effluent filters are to be removed & cleaned as necessary, with provisions to keep solids from passing the septic during removal. No more than 1/3 of the usable tank volume may be occupied by sludge/scum. 3 year inspection: If tank has greater than 1/3 volume sludge, tank contents must be emptied and disposed of in accordance with NR 113 Wisconsin Administrative Code by an approved individual. If the inspector does not recommend pumping of the septic tank, then the owner must be notified of when pumping should be done as to not exceed 1/3 sludge volume. Septic tank should be routinely inspected to be watertight and of good repair. Pump/Dose Tank If an effluent filter has been installed in the pump/dose tank, it must be removed & cleaned as necessary, with provisions to keep solids from passing to the mound component during removal. The pump, float switches, and alarms must be inspected at least every three years for proper operation. Pump/dose tank should be routinely inspected to be watertight and of good repair. At-grade and Lateral System The at-grade system component must remain free of ponded surface water prior to pump operation. If 4 inches or more water level is detected in the observation pipes, the owner must be notified of possible problems/failure. The designed daily flow capabilities of the component should never be exceeded. Trees and any other deep rooted vegetation should never be planted, or allowed to grow anywhere on the component. Activities OTHER than mowing/maintenance (i.e. excessive walking, pets, vehicles, etc...) could compress the component and reduce it's absorbtion capabilities and/or possibly cause it to freeze in winter conditions. Lateral distribution pipes should be flushed out/tested every 18 months using the cleanout points at the end of the distribution laterals to remove scum that may clog orifices. Performance Monitoring: Performance monitoring must be done at least once every three years following the installation or at the time of a problem, complaint, or failure. Contingency Plan: If the septic tank, pump tank or any of their components therein (including floats, alarms, pumps, etc) become defective, the defective tank or component must be replaced immediately to ensure that the system can operate as designed. If the at-grade component cannot accept wastewater or ponds wastewater to the surface, the component must be repaired or replaced in it's current location by either: extending basal toe to provide added absorbtion area; or by removing the clogged bacterial mat,aggregate cell, and distribution piping within the cell and replacing said components in order to return system to proper working order as required. i I f ~ 2017 WiisconsinDepartment ofCorn EVALUATION REPORT pap 1 of 3 Division of and Buildings Safety with Gustum Septic Service County Attach complete site plan on paper not less than 8' 1 inches in size. Plan must St. Croix include, but not limited to: vertical and horizontal refer pant it6~C and percent slope, scale or dimensions, north arrow, and tion and m nc2tde d- parcel I. D. pending Please print all inferm on.ST. l'R plh r 0 Revie By Date /5 0 Personal infamatim you provide may be used for secondary (s))}~I ~C (n)). U Property Owner Pr tion Brosi, Mark Govt. Lot n/a NW 1/4 SE 1 S 34 T 28 N R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 565 Cty Road M n/a n/a N/A City State Zip Code Phone Number _j City __1 Village ✓J Town Nearest Road River Falls WI 54022 715-426-4924 Troy Swedish Mission Road ✓i New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD Replacement _J Public or commercial - Describe: Parent material outwash Flood plain elevation, if applicable n/a General comments and recommendations: Part of new proposed 3 acre parcel. Recommend at-grade system along 94.3' contour. a Boring # _J Boring 1/J Pit Ground Surface elev. 94.7 ft. Depth to limiting factor 44 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz 'Eff#1 'Eff#2 1 0-8 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.6 0.8 2 8-14 10yr4/4 none sil 2msbk mvfr cw 1 m 0.6 0.8 3 14-25 7.5yr4/6 none gr. sl 2msbk mvfr cw - 0.6 1.0 4 25-44 7.5yr4/6 none gr. Is 1 msbk mvfr cw - 0.7 1.6 ION-0 2 -r5 8 sil 2msbk mfi - - 0.6 0.8 5 44-60 10yr4/6 c2-3p 7.5-%-r 5 8 Boring ~ Boring # __j bell Pit Ground Surface elev. 94.7 ft. Depth to limiting factor 41 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' 'Eff#1 'Eff#2 1 0-9 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.6 0.8 2 9-15 7.5yr3/4 none sil 2msbk mvfr cw 1 m 0.6 0.8 3 15-24 7.5yr4/4 none gr. sl 2msbk mvfr cw - 0.6 1.0 4 2441 7.5yr4/6 none gr. sl 2msbk mvfr cw - 0.6 1.0 5 41-70 10yr5/6 c27-m Q`g 2 gr. sl 2msbk mfi - - 0.6 1.0 Effluent #1 _ BOD y> 30 < 220 mgJL and TSS >30 < 150 mg/L Effluent #2 = BOD5._30 mg/L and TSS <X30 mg/L CST Name (Please Print) Signatur CST Number Tom Gustum 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St., New Auburn, W1 54757 4/112005 715-658-1344 M ~ property owner Bros!, Mark Parcel ID # pending 5 Page 2 of ,3 Boring # Boring / N Pit Ground Surface elev. 92.4 ✓ ft. Depth to limiting factor 40 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff *Eff#1 *Eff#2 1 0-8 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.6 0.8 2 8-14 10yr4/4 none sill 2msbk mvfr cw 1m 0.6 0.8 3 14-27 7.5yr4/6 none gr. sl 2msbk mvfr cw - 0.6 1.0 4 2740 7.5yr4/6 none gr. Is 1 msbk mvfr cw - 0.7 1.6 ~2-3p 10} 2 sil 2msbk mfi - - 0.6 0.8 5 40-60 10Yr4/6 7 .Svr~8 8 ❑ Boring Boring ;Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Cotes Redox Description Texture Structure Consistence Boundary Roots GPD1ft2 *Eff#1 *Eff#2 Bing Boring F-1 Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 * Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD0_30 mg/L and TSS <-_~0 mg/L The Department of Commerce is an equal opportunity service provider and employer. ff you need assistance to access services or n~rr motor;ol on oltnmotP f rmot nlPOCn n f-f the dP ..t*„f .t 6r19-7ff-11 Gt - TTV rnR_7(,A_R777 I property Owner Brosi, Mark Parcel ID # pending Page 2 of 3 Boring F3 Boring# ill Pit Ground Surface elev. 92.4 ft- Depth to limiting factor ° 40 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots 'Eff#1 'Eff#2 1 0-8 1Oyr3/2 none sil 2msbk mvfr as 2f,1m 0.6 0.8 2 8-14 1 Oyr4/4 none sil 2msbk mvfr cw 1 m 0.6 0.8 3 14-27 7.5yr4/6 none gr. sl 2msbk mvfr cw - 0.6 1.0 4 2740 7.5yr4/6 none gr. Is 1 msbk mvfr cw - 0.7 1.6 c2-3p IONT7.-2 5 40-60 1 Oyr4/6 7 5vr~, sil 2msbk mfi - - 0.6 0.8 ❑ Boring # Boring Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDAF .Eff#1 'Eff#2 ❑ Boring # Boring _ Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots QPD/fF 'Eff#1 'Eff#2 Effluent #1 = BOO ? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS <._30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunitx sen-ice provider and employer. If vou need assistance to access sen•ices or f -f . 1--... +-f ~t AnQ_71~4_21 G 1 TTV AAR_')"_Q777 • D oo c~ v W c 000 ~pW W CD 11 V N O II II r ~ M m o m nmm:3. <<~ m mog o _cas o Co ~II ~ n. N N W o~ = o c a olS to iS g 0 a sy CA g a~ _ c tD N V A~ m C12 C OL 3 .A a S c v 0 a CA) w -o m w W ~ N G i p ~ i N s ,S.nAi n_9 : ~~p, tll CL jma Nan ' ci, B, A 3 ~ a N ~ N w N A B3'~~' 1 9E3 KATHLEEN H. WALSH Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX GO.. MI RECEIVED FOR RECORD This Deed, made between Lynn W. Brosi and June Brosi, 08114~2e06 04:25Pt1 husband and wife, Grantors, and Mark A. Brosi, a single person, Grantee. WARRANTY DEED Grantors, for a valuable consideration, convey to Grantee, E ``-v" -a the following described real estate in St. Croix County, State of REC FEE: 11.00 Wisconsin (the "Property"): TRANS FEE: COPY FEE: CC FEE: Lot One (1) of Certified Survey Map, recorded on 07-06-2006, in PAGES: 3 Volume 21, Page 5233, as Document No. 829040, Register of Deeds' office, St. Croix County, Wisconsin. Located in part of the Recording Area NW% of the SE%4 and in part of the SW% of the SE'/. of Section Name and Return Address 34, Township 28 North, Range 19 West, Town of Troy. t\Ao,r tV ,Q r cs S I S`-'S COU"1--j R66.A M Rt.fer F.tlSr tAi S~O~s V Part of 040-1129-30-000 and 040-1129-40-000 (Parcel Identification Numbers) This is not homestead property. Together with all appurtenant rights, title and interests. Grantors warrant that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: easements, restrictions, and rights-of-way of record, and will warrant and defend the same. Dated this 14" day of -4z,,,,s1E- 2006. (SEAL) -Ld.. rw. Q n--C.+ (SEAL) 'Lynn' W. Brosi (SEAL) p~-5FA- ` (SEAL) ne Brosi AUTHENTICATION ACKNOWLEDGMENT Signature of authenticated STATE OF WISCONSIN this day of 2006, ST. CROIX COUNTY Personally came before me this day of 2006, the above named Lynn W. Brosi an--' e TITLE: MEMBER STATE BAR OF WISCONSIN known to be the persons who pxeaW4WP e (If not, inst ment and acknowledge the t~ Q Q` authorized by §706.06, Wis. Slats.) M . Nota PuI!I r. S cons ry f My commission expires 04 ZDo THIS INSTRUMENT WAS DRAFTED BY C. L. Gaylord Attomey at Law P. O. Box 46 River Falls, WI 54022 (Signatures may be authenticated or acknowledged. Both are not 'Names of persons signing In any capacity should be typed or necessary.) printed below their signatures. I of l WFORMATION PROFESSIONALS COMPANY FOND OU LAC. W18OONSIN 60"SS-2021 ~S y 8 c- 9 4Z1 4 125 VOL 21 PAGE 5233 XATALTEA H. ALSH- REGISTER OF DEEDS ST. CROIX CO. MI RECEIVED FOR f4ECORD 07/06/2006 04:15PH CERTIFIED SURVEY MAP COPY FEE: CERTIFIED SURVEY MAY 2 LOCATED IN PART OF THE NORTHWEST 1/4 OF THE SOUTHEAST 1/4 AND IN PART OF THE SOUTWEST 1/4 OF THE SOUTHEAST 1/4 OF SECTION 34, TOWNSHIP 28 NORTH, RANGE 19 WEST, TOWN OF TROY, ST. CROIX COUNTY, NOTE: WISCONSIN. BEARINGS ARE REFERENCED TO THE WEST LINE OF THE SOUTHEAST 1/4 ASSUMED TO BEAR N00'14'35"E / / N 1/4 CORNER SECTION 34 OWNER: FOUND ALUMINUM SURVEY CONDUCTED AT COUNTY MONUMENT UNPLATTED LANDS C-i THE REQUEST OF THE TIF" OWNED BY PLATTER OWNERS: ol~l 8 E2S~LQaYE AG• LYNN & JUNE BROSI z w S 89'45'25' E 417.60' W 648 CTH "MM" 3, p RIVER FALLS. WI 54022 7• m o ~I 62 i~ H - - - - - - - - - - - SETBACK NOTE: alI~l~ - - - - - - V) FRONT SETBACK=150' 1 4 ZI~I SIDE SETBACK=50' I 1 IR REAR SETBACK=50' I I I 83 of o I r I I $ b~ i LOT 1 1lol OOD 50' 1 207100 S.F. IB w `v rrni I 4.75 Ac. 181 50' =~0I t,a w v°, 1 (INCLUDING ROW) I M M 191904 S.F. I I r ` 4.41 Ac. 1 (EXCLUDING ROW) 1 O O \ N O O \ O Z Z ~ z I ~ \ I 3 I ~ ~ r ~9 J H M ' ~ rR \ ¢ Ste. \ 4 4g 6>~R~~ \ \ ty 4so R9 p 1 LEGEND: 41 w SET 3/4" BY 18" IRON \ o PIN WT. 1.50 LBS./FT. $ UNPLATTED LANDS o n Z OWNED BY OTHIf M • FOUND 3/4 IRON PIN ELUSIVE QN ` S 1 /4 CORNER COUNTY SECTION MONUMENT SECTION 34 \ (FOUND AS NOTED) FOUND 1" I.P. ROOERLVNM \ ' 9 SOIL BORING WOODVALE BUILDING SETBACK LINE WIS O PROPOSED DRIVEWAY LOCATION THIS INSTRUMENT DRAFTED BY BRIAN PERSON RiJ SHEET 1 OF 2 ~1Zg o Vol. 21 Page 5233 1 of 2 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT 1 I y AND n~ OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Property Address 54 Lo 42 (Verification require from Planning & Zoning Department for new construction.) City/State, h Parcel Identification Number f Ar-I LEGAL DESCRIPTION Property Location 441 '/4 , Sec. , T Z8 N R__ j_W, Town of yz) Subdivision , Lot # Certified Survey Map # e6 -Lt 40 , Volume Z.k , Page # S Z 33 Warranty Deed # 13 Z. 17? , Volume , Page # Spec house yes no Lot lines identifiable yes no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtues of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 3 SIGNATURE OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05)