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HomeMy WebLinkAbout040-1246-60-000 r Wiscdnsin Department of Commerce PRIVATE SEWA SYSTEM y- G Safety and Buildings Division Count INSPECTION REPORT St. Croix GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. 353322 Permit Holder's Name: ❑ City ❑ Village ❑ ToWn of: State Plan ID No.: Troy Develo me I Troy Township INA A , tb4l� CST BM Elev.:- Insp. BM Elev.: BM Description: Parcel Tax No.: ��y _ 7 /­ 040- 1246 -60 -000 TANK INFORMA ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic �;� ✓. /e&o Benchmar 1 z ( 3.'{3 p4e . Q� Dosing U � 06 Alt. BM Aera Bldg. Sewer H g St / Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P/ L WELL BLDG. Air I nz m Ven= e ) a Dt Inlet Septic > NA Dt Be,, s q . 3 ' Dosing > 5' / > NA Header/ Man. era I - A Dist. Pipe Holdir5g Bot. System PUMP/ SIPHON INFORMATION —SL. , ` Final Grade Manufacturer �, Demand St cover .p Model Number L _/ I L PM ) -� Q TDH Lift Lriction f Z SystemZ TDH ZFt Forcemain Length q6, r Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED /TRENCH width Len th ( No. Of Trenc es PIT No. O is Inside Dia. Liquid Depth DIMENSION Z r DIMENSION SETBACK SYSTEM TO P/ L BLDG WELL LAKE/STREAM LEACHIN Man cturer: INFORMATION Type Cif ' 4 - / M I Number: System: >Z - S S CHAMB OR U4T DISTRIBUTION SYSTEM Header / Manifold I I Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia._ Length 3 S Dia. ) (Z. Spacing N Z r/ ___ I SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed/ Trench Edges Topsoil ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present etc J Inspection 1: o:� a 9 /cm Insp ection : = / Ge Location: 345 Lindsay Road, fludsor}, WI 54016 (SE 174 SE 1/4 24 T28N R20W) - 24.28.20.1268 Troy Village - 6 1.) Alt BM Description = p g . I I c}. ��y 2.) Bldg sewer length 0 r - amount of cover = >S 3.) contour = g T • Z-j C S CL+ q . �. = 88 Plan revision required? ❑ Yes Pa No Use other side for additional infordation. x SBD -6710 (R.3/97) Dat Inspector's Sigvfature Cert. No. < t� ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: e } 6 � i ° E � f Y ° 6 2 } x k # # I { S j t � € I ! 3 e s m ! k `c 4 am. ff t ; F ; .a —...., ...,. .. .�......��.. ate..,...., ... . ......... .... . .. .. ...... ..... ...... .. _ ..}.....�... P .. ».:....� a. h $ B E ! 6 qS pp I 3 # 4 f _ € � �� } 2 — a f— �3 f s a I @ a x � € € { i € e 9 ( 1 } I s, S �........:...°.. _} .. A £ ,�...... ,_. ._. ...e .. _ ......... i g a S S �S '7 Safety and Buildings Division Vi scons i n SANITAERMIT APPLICATION 201 W. Washington Avenue P O Box 7302 Department of Commerce In accord with Comm 83.05, Wis. Adm. Code Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less Count ro i than 81/2 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 353 3 2Z Personal information you provide may be used for secondary purposes p check if revision to pfevious application [Privacy Law, s. 15.04 (1) (m)). State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION P erty Ow er Nam Property Location N, R E W �. 1/4 S� 1/4, S a T t v�0 rope Owner's Mailinj Address Lot Number Block Number N tate M A 1 Zip Cod 3 Phone um Subdivisi Name or CSM N ber l r�A. ry\N s t II. TYPE BUILDING: (check one) E] State Owned its Nearest Road Public 1 or 2 Family D welling - No. of bedrooms El V own o f I M L► CiSGL �� III BUILDING SE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑Apartment/ Condo O ev 0 -- f a. 5 (o 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recrea tonal Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/ Bar/ Dining 4 ❑ Church/School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel /Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. X New 2 E] Replacement 3_ [j Replacementof 4 E] Reconnection of 5_ E] Repair of an System ________ System____ _________TankOnly___________ - __ Existing System - --------- Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non - Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 Mmound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 In- Ground Pressure / 42 ❑ Pit Privy 13 ❑ Seepage Pit x 43 ❑ Vault Privy 14 ❑ System -In -Fill 3T3 , VI. ABSORPTION SYST M INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation SCE. S Yf 37-5 M4 9741sl Feet Feet VII. TANK Ca ac t in allorys Total # of r Prefab. Site Fiber- Exper. INFORMATION New Existi s n Gallons Tanks Manufacturer s Name Concrete stun- Steel glass Plastic App Tanks k Septic Tank 5 �S.E �S ❑ ❑ I ❑ ❑ ❑ ift Pump Tank i� 9 3 1 ❑ ❑ r ❑ ❑ ❑ Vfff STATEMENT I, the undersigned, assume responsibility for in lation of the onsite sewage system shown on the attached plans. PI mber's Name: (PrI I =ure. ) MP / MPRSW No.: Business Phone Number: t o a.0 S3 7 `7!S- b -.5 Plumber's Address (Street, City ,Zip ode): ^ , 1 �� Lo - 'a of 7 `f e IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved nitary Permit Fee (Includes Groundwater D ate Issued Issuing Agent Signature (No Stamps) ;( Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination 3 ,25 1 -3 - 7 ` X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: SBD -6398 (R. 4/99) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber INSTRUCTIONS 1. A sanitary permit is valid for two (2) years. 2. Your sanitary permit may be renewed before the expiration date, and at a 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. 4. Changers in ownership or plumber requires a Sanitary Permit Transfer / Renewal Form (SBD -6399) to be submitted to the county prior to installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licerised' qurripe "r whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildiags Division, -698- 266 - 3151: - - - To be complete and accurate this sanitary permit application must include: I. Property "owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Ty of p ermit. Check only one on line A. Co line B if p ermit is for tank replacement, reconnection or re pair. YP P Y P P P � P V. Type of system. Check appropriate box depending on system type. VI- Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. 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. IX. County/ Department Use Only. X. County/ Department Use Only. .CoV'iplete plans ;,and '�iecifications not smaller than 8 1/2 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; pump or siphon tanks; 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 performance curve; pump model and pump manufacturer;.D) cross section of the soil absorption system it- required by the county; Q soil test data on a 115 form; and F) all sizing information. ---------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) fora number of regulated practices which can effect groundwater. The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. Safety and Buildings w 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 _ TDD #: (608) 264 -8777 6consin www. commerce. state wi us Department of Commerce Tommy G. Thompson, Governor Brenda J. Blanchard, Secretary February 23, 2000 CUST ID No.273085 ATTIC POWTS INSPECTOR CALVIN POWERS ZONING OFFICE POWERS EXCAVATING INC ST CROIX COUNTY SPIA 1969 185TH AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 RE: CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/23/2002 Identification Numbers Transaction ID No. 295879 Site ID No. 187037 SITE: Please refer to both identification numbers, Site ID: 187037 above, in all correspondence with the agency. St. Croix County, Town of Troy SE 1 /4, SE 1 /4, S24, T28N, R20 W Facility: Troy Village - lot 26 FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 648098 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. 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 constructionf installation/operation. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 02/10/2000 ` FEE REQUIRED $ 180.00 FEE RECEIVED $ 180.00 Gerard M. Swim BALANCE DUE $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 785 -9348, Mon. - Fri. 7:15 AM to 4:00 PM j swan @commerce. state.wi.us WiSMART code: 7633 I N7V .. APPLICATION FOR REVIEW., POWTs alcon sin - Complete all pages- Department of Commerce - Safety & Buildings Division This page maybe utilized for fax appointment requests Bureau of Integrated Services Complete and indicate date plans will be in our office NOTE: Personal information you provide may be used for seJondary Complete for co nfirmed appointmen . purposes (Privacy Law s. 15.04(1)(m)]. Not available for POVYTS at this time. 1. Private Sewage Submittal 2.;Type of Submit ction ID: System Type New ( ) Groundwater Monitoring ( Replacement s Related Trans. ID: ( ) ( ) (')C) (' )Petition (attach form S Site Evaluation tmertit Date ": POWTS System At ) � ed Grade Review er. ( ) Experimental Review ) Holding Tank ( ) Engineered System ) Nonpressureized In- ed Office: Ground- conventional must be received in the office of the appointment no later than Pressurized In- in days before the confirmed appointment. Ground 3. Project Site Information -Fill in all known information. ( `� Mound Site Number ( ) erobic System ( ) Sand Filter Number & Street: ` ( ) Constructed Wetland Legal Description• - Sli; S oZ W ( ) Other County S'I'C ro' Kity village ( ) Town of Gallons per Day: Q Std Facility Name: (individual and /or business name of project) Building Type (check one): ( X) Dwelling, 1 or ,2 family "'O p Cod Facility Address: (p ject address) e ( )Public Building S s'30 ( , )Sta N te- owned'Building ( O� � oQ ... 4. After plans are reviewed, please: (check all that apply) _ Mall ` lans to custome 11 2, 3, 4: "Call when completed: -- � P _Requesting parry will pick up Circle customer number from below. Other: 5. Complete the following designer /owner /requesting information. Utilize the check boxes when designer, owner or requesting party is the same to avoid repeating information. De""l"gn"br (Gg"s tRRegii" �' sti" n�Pd "�if`differ8`iit',tha"de`�i §., C�fiSfti '�f�3 L First Name me Customer Number First Name • Last Name Customer Number c� P S C pany Name Company Name IQ V-S Address G Address State Zi +4 (9 digits) n p ( digits) City State Zip +4 (9digits) t� ` t7 ,.1 Phone Num umber (ar ea code) Fax or Internet (area code) Fax or Internet hers if applicable. Check others if applicable a er n e r ( ) Pa er ( ) Requesting pa Owner ) P nforiatlon� "C,t t""Pme Last Name Customer Number,, First Name, Last Name Customer Number ;t j Company Name Company Name Address Address J' C;,;r State Zip +4 (9digits) City.',; fate ZIp+4 (9digits) FEB 1 ' 0 20 P ;ono Plumber (area code) Fax or Internet Phone Nu e Fax or Intemet i A �,r Check others if applicable ■ rs if applicable s Payer,. (,,.)Other "S.PAYABLE TO DEPT.OF COMMERCE TOTAL AMOUNT DUE $ `' ; 11 era Review Code T633 PAGE - &OF MOUND SYSTEM FOR AaBEDROOM RESIDENCE LOCATED IN THE F 1/40F THE Sl� 1/40F SECTION, QW, TOWN OF �ro _,s Cro COUNTY, WISCONSIN. -Tfo �;t`a Ol a tQ INDEX PAGE 1A OF 9 TITLE SHEET PAGE 1 OF 9 WORK SHEET PAGE 2 OF 9 WORK SHEET PAGE 3 OF 9 WORK SHEET PAGE 4 OF 9 WORK SHEET PAGE 5 OF 9 PLOT PLAN PAGE 6 OF 9 PLANVIEW CROSS SECTION PAGE 7 OF 9 DISTRIBUTION PIPE LAYOUT PAGE 8 OF 9 PUMP CHAMBER PAGE 9 OF 9 PUMP PERFORMANCE CURVE PREPARED FOR T roy aao C.-Ak - .Q, Q� aac7 ��► .�. m fo -s PREPARED BY POWERS EX14ikKATING INC. O�fi a _ s _moo t-i p a 0 3 3 1969 185th AVE NEW RICHMOND, WISC. 54017 P 0 T• 715 -246 -5135 COnditI D of OoM �%NGs . RIM O�aN E S E N NpE NGE . G O F SEE -rro ,1(ap Loz aco WORKSHEET - MOUND SYSTEM DESIGN PROBLEM: Design a mound system for a .3 - &� V'Co n - The site characteristics.are:' Depth to groundwater or bedrock .. 5 in. Landslope .� z P , �. Z a Percolation rate .!_. n.7 in. Distance from dose chamber to distribution system _ ft• Elevation difference between Dump and distribution system ..S ft. Step I. WASTEWATER LOAD = 3 B,,04r-oowl Step 2. SIZE THE ABSORPTION AREA A) Area required Asa 1 ' Z ' 3 sq. ft. �s B) Bed or trench length (B) _ $ j ;37r. "�,� ft. C) Bed or trench width (A) s� _,5,.,� ft. D) Trench spacing..,(0 k{t Wastewa der load .2 4 coal /ft /day B /'� ft• t re ir: e� H Step 3. MOUND HEIGHT A) Fill depth (D) Q ft. B) Fill depth (E) ■ D + slope (AYI - P) / ft. s / -t (0 vs /.z5 C) Bed or trench depth (F) X83 ft. D) Cap and topsoil depth (G)"- ft. l E) Cap and topsoil depth c �� 5 ft. OO Lot d Y Step 4. MOUND LENGTH 1/ A) End slope (K) _ (D + E F + H x 3 1 ft. \ 2 / � V-B a Q 6) Total mound 1 th (L ?_(!C) 9 ' e ft. 5. MOUND WIDTH Al) Upslope correction factor A2) Upslope width (J) n (D + F + 6)(3)(factor) = A 7 S ft. . - •.83 -t1 1 3X B1) Downslope correction factor = B2) Downslope width (I) _ (E + F + G) ( 3)(factor) ft. Cl) Total mound width (W) for bed a J + A + I a3• ft. j.s + /c.ci a3A - C2) Total mound width (W) for trenches a �•• J + + (no. trenches -1)(c) + A + I ft. Step 6. BASAL AREA A) Infiltrative capacity of natural soil y gal. /ft /day P B) Basal area required = wastewater flow natural soil infiltrative-capacity /lay / /ohs sq. ft.,; 4s C1) Basal area available for bed for sloping sites = B x (A + I) //924 ft. 75 XCs -I- /6-V /l 9a -S C2) Bas are avail le for trench for sloping sites = B W �J + A 1= X sq. ft. 7l C3) Basal area available for trench or bed for level sites = B x W = sq. ft. L_i_censo ' _ Date 2` Step 7. DISTRIBUTION SYSTEM 7A) SIZE DISTRIBUTION SYSTEM . L? 1) Hole size = in. 2) Hole spacing = _.._ in. 3) Distribution pipe length in. 4) Distribution pipe diameter = z _ in. 5) Spacing between distribution pipes = _ in. 6) Distance from sidewall to distribution pipe,D in. 7B) DISTRIBUTION PIPE DISCHARGE RATE ft. 1) Number of holes per pipe 2) Flow per pipe d t GPM 7C) SIZE MANIFOLD 1) Manifold is central/ end 2) Manifold length a 0 — ft. 3) Number of distribution lines s a 4) Manifold diameter 3 in. 7D) SIZE FORCE MAIN 1) Minimum dosing rate = 7 GPM 2) Force main diameter = in. 3) Friction loss ft. 7E) TOTAL, DYNAMIC HEAD 1) Vertical lift = ft. 2) Friction loss = < ft. 3) System head 2.5 ft..- °�'S ft. 4) Total dynamic head = ��� ft. tV l01 ()\0 i 7F) PUMP SELECTION 1) Pump selected will discharge GPM at 1.5 ft. total dynamic head. 2) Pump model and manufacturer SIN. P, 7G) DOSE VOLUME 1) 10 times void volume of distribution lines t. gal. /cycle 2) Daily wastewater volume 4 doses /24 hrs. x I/R Y gal. /cycle 3) Minimum dose volume #'' q 1 ' /,37�� gal . /cycle r �75 7H) DOSE CHAMBER 1) Minimum capacity required a Gpd gal. Licunse :'u: i coy _ �� -� a 111 C v I S IO I ' u I I 11_ A- 517 I I I N WY -- �rj�oa�n�t i I � I r I Q I M h o I _ I I I - - 1 ; - - - -- - -- �i :'. r ro Y Q o \e�►►�n 1 Pa g` ( a �1 FCL- e Y , y Straw, Marsh -Hay, Or Syntho Covering Distribution Pipe Medium Sand Top�I1� % Slope Bed Of�— 2 !2 Force Main , Plowed Afl9fega,le Loyer Cross Section Of A Mound g System..Usin E 1-)S Ft. A Bed Fot The Absorption;AYea F .�£�3 Ft. G t Ft. A ' Ft:. N i Ft. fined: g Ft. . cense Number: .,._., K i� Ft. Date: - S oo L 015.8, Ft. j �- Position I /0 r9 Ft.i e Mai _ W�� F . Force �n L Observation Pipe PA i o- - - - - - - - : Distribuliorr r8ed Of !�— 2 !� t 2: 2 Pipe Aggregate L Observation ,Pipe Permanent �Morkers,��' ��' ,.' � - • , I I I I sn View -Of Mound Using A Bed For The Absorption Area w IJ V W V ' IN pa9Q• Perforated Pipe Oefoll End Vhw End Cod Pfrforoh0 PVC Pipe, MO Locat • d O n m 90P1 • . o r Are .Equally Spaced d O A. ASS r'�bc•tar) � � , ,' • t•acJ Hoti Sho`ul'd De u - ._.. , •' ' Wxl 7o End Cap . •e; ; tE DiitribuliOn PIP Layout P Ft. R' Inches Y is i ��-�j ;—� Signed: 1101L OiaJnctCr �hch License Humber: Lateral Fianifold Dater � =S' '.:. p0 inc }res` Force Main :" Inch0� l of holes /ptpc Invert Elevation of Laterals Ft.. r 1 1 1 11 -., S EPTIC TANK 6• ' PUMP CHAMSE CROSS SZCTION AND 5Wk;Ult .0-;A_ lul'10 I ' �o v A lo'c a SP v V Y 1 0 Cl VENT PIPE 12 MIN. ABOVE GRADE E WEATHER PROOF' 25' FROM.DOOR, WINDOW-OR JUNCTION BOX APPROVED FRESH AIR . 1 - NTAKEe WITH CONDUIT MANHOLE COVER n W PADLOCK & FINISHE C • R GRADE �+ I ISER WARNING LABEL 6" MIN. ABOVE G ADS — }— ,.-- -- 4 " MIN la.'! IN. 6 MAX. ; icik I 'INLET ' ~ WATER TIGHT SEALS GAS — f TIGHT 411 BAFFLE A SEAL i APPROVED CI PIPE —J_ ALM JOINTS W/ CI 3' ONTO B i I PIPE 3' ONTO SOLID __v_ n ON SOLID SOIL SOIL PUMP OFF £LEV . FT. �- -- I Y pf ic't RISER EXIT D PERMITTED ONLY IF.TANK MANUFACTURER -HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE . TANK MANUFACTURER: 1u , ps.p NUMBER 'D•OSES PER DAY: TANK SIZES SEPTIC 100c GAL. DOSE VOLUME INCLUDING DOSE ©o GAL. FLOWBACK:. GAL.- 1 ALARM MANUFACTURER: CAPACITIES: A = /V INCHES = AL. MODEL NUMBER: !ol I�w SWITCH TYPE: B = 2 INCHES = j_ GAL. PUMP MANUFACTURER: .,�o�d� O C = �•. INCHES =� GAL. MODEL NUMBER: g5 will L D �,� INCHES = !o_ �.g GAL . SWITCH TYPE: oa i REQUIRED DISCHARGE RATE GPM PUMP 6 ALARM WIRING AS PER ILHR WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE PEET + MINIMUM NETWORK SUPPLY PRESS RE .. 2.5 FEET + _.. _ FEET FORCEMAIN X 0.45 FT/100 FT. ' FRICTION FACTOR ' , . 29 FEET T.OTAL DYNAMIC HEAD 72 _ FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGT'U' WIDTH ^; DIAMETER LIQUID DEPTH SIGNED: LICE SE R: DATE. S . N NUMBS o1 - {� (• In AAA �j LQ �.r •-'�Q V �Q \O y OT `l'r� P `mil OT ` , Goulds PC, Submersible Effluent Pump 3885 EIIAwX MA :i F. I b.Gr S ' APPLICATIONS • Overload protection mtast smooth operation. Silicon � can be operated continuously Specifically desig for the be provided in starter unit: bronze impeller available as without damage. g • Shaft: threaded, 400 series an option. *=' Bearings: Upper and following uses: stainless steel wer heavy duty ball bearing ' z • Homes ■ Casing: Cast iron volute lo Farms • Bearings: ball bearings type for maximum efficiency. construction. • Trailer courts upper and lower. 2" NPT'discharge adaptable ■ Power Cable: Severe duty • Motels •Power cord: 20 foot for slide rail systems. ?, `,; rated, oil and water resistant. lengths available). • Schools standard length (optional Single phase: im Mechanical Seal: SILICON Epoxy seal on motor end �. • Hospitals CARBIDE VS. SILICON provides secondary moisture '' /s and' /: HP –16/3 SJTO Industry CARBIDE sealing faces. barrier in case of outer jacket • • Effluent systems Stainless steel metal parts, damage and to prevent oil with 115 V or 230 V three prong plug. BUNA -N elastomers. wicking. SPECIFICATIONS * '/2 HP –14/3 STO with n Shaft: Corrosion - resistant ■ O -ring: Assures positive Pump bare leads. stainless steel. Threaded sealing against contaminants Three phase: design. Locknut on three and oil leakage. • Solids handling capabilities: p � ' /4" maximum. • '/2-1 Y2 HP –14/4 STO phase models to guard • Discharge size: 2" NPT. with bare leads. On CSA against component damage AGENCY LISTINGS • Capacities: u p to 128 GPM. listed models – 20 foot on accidental reverse rotation. SP length SJTW and STW ■ Motor: Full submerged in Canadian Standards Assoctauon • Total heads: up to 123 feet y TDH. are standard. high -grade turbine oil for • Mechanical seal: silicon lubrication and efficient heat UL Underwriters Laboratories carbide -rotary seat/silicon FEATURES transfer. carbide- stationary seat, 300 m impeller: Cast iron, semi- ■ Designed for Continuous series stainless steel metal open, non -clog with pump - Operation: Pump ratings are parts, BUNA -N elastomers. out vanes for mechanical seal within the motor manufacturer's • Temperature: protection. Balanced for recommended working limits, 104 (40 continuous , .140 °F (60 intermittent. METERS FEET' • Fasteners: 300 series 90 stainless steel _ — � S ERI E S: SIZE: ZE: h W SOLIDS • Capable of running dry.,. 25 80 WE1 RPM: VARIOUS without damage to - components 70 NREl H 5FT Motor ° 6o j Single phase: _ Eo — • ''A HP, 115 V, 200 V, 230 V, 15 50 60 Hz, 1750 RPM; '' 2 HP, z - 115 V, 60 Hz, 3500 RPM; c 40 VI E04H '/2 HP –1' /2 HP, 230 V, a – 60 Hz, 3500 RPM. F 10 30 Built -in overload with. 20 WEO automatic reset. 5 • Class B insulation. ZZ Iarea pl "asa: _ - - -- • '/2 II? –1'/z HP ?_00/230/ o 0 4u0 V, 60 Hz, 3500 RPM 0 10 20 30 40 50 60 70 80 90 100 110 120 130GPM Class 3 insulation. p 10 20 30 m CAPACITY e 1035 Gc;;1,!' Pumps Effective May. 1995 B3885 Viii`:: onsin'D aoanm�n� 01 111dUS . SOIL AND SITE EVALUATION REPORT Page t of _1_ t. toor and Human Rnianons 0} vi sjon atsatery. 1 6 w ld ng s in accord with IL.HR 83.05. Wis. Adm. Cade CUUN rY � Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan m include. ST. CROIX ust iude, but PAACELI.O. q not linVted to vertical and horizontal reference point (8M). direction and % of slope. scale or dimensioned, north arrow. and location and distance to nearest road. APPLICANT INFORMATION- PLEASE PRINT ALL IN FORMATION REVIEWED BY DATE i P POP iky 0wN0: PROPERTY LOCATION E 1/2S 24T 28 NR 20 W TOM RUE ZIELE & JOHN AND BARB RUEMMELE GCNT. LOT 1/4W 1/2S 19T 29 NR 19 -6440 W PROPERTY OWNEA':S MAILING AODAESS LOT x I t e" SUBO. NAME 0A GSM 8 260 COUNTY ROAD F 26 TROY VILLAGE CITY, STATE ZIP CODE PHONE NUMBER Ci'fY t — E QrOWN NEAREST ROAD 1 HUDSON WjSgONSTN 54016 (71 5 ) 386 ITROY New C,<Mtr=cn Use (X J Restdenttai I Number of bedrooms 4 t Addition to existing building j t Replacement t } Public or commeraal desatbe Code derived daily flow 6_._ 00 go Recmmmended design loading rate 0 bed. gpoltt trerictt, gpd& Absorption area regclired 5 bed. ft SDO Irench. n2 Maximum design loading rate j a- - 5rbed. gpd19 a - 1 trench, 9NA . Recomrnerlded infiltration suaam elevations) BY DESIGNER 4 (as referred to site plan benchmark) Additional design I site considerate E£ ii/D 7E 3 Parent mataial �4� Rood plain elevation, if applicable N/A ft S - Suitable for system CCMemoNAL ?f" 1MGROUNO PRESSURE AT -GRADE SYSTBA IN FLL WOLOM TAW U= Unsuitable for system 1❑ S L$U I INS ❑ U I as EU I Q S OU I C1 S M 1❑ S ffU SOIL. DESCRIPTION REPORT Depth Dominant Color Moms Stricture GPO /ft Honzon in Munsefl Ou. Sz. Colt Color Texture Gr. Sz. Sh. ICons�sterlcel8ourtmry Roots ITmrldt Boring Al I0 110'M 4/3 I --- I sl 2msbk mfr as I lvf I0.5 1 0.6 =62' A2 I17- 34I10YR 3/2 I - -- sit 2m -csbk mfr gw lvf 0.5 ;0.6 I 1 134 - 50 10YR 4/2 I - -- sicl 2mabk mfr cw Ilvf 0.4 t o.5 Ground dw• B2 50- 58I10YR 4/2 lflf 5YR 5/8 sicl 2mabk m fr cw lvf - -- 8 C1 58- 63110YR 5/6 - -- s Osg ml as lvf I--- I - -- Aeom to rimrorlg C2 63 -72 lOYR 5/6 c1d 10YR 3/4 I s I Osg 1 1111 I - -- lvf --- I --- 50 19 Remao= Boring Hanzort+ Oeptn I nt: Dominant I Momes (Texture I Structure ICartssroE:nca�Elou>aaYlRoots GPO /ft4 in. Munsefl au. Sz. Ca Cow Gr. Sz. Sh. I Bed Trerlat Al 10 -23 110YR 3/3 1 - -- 11 2m -csbk lmfr trw . 1 . ry� 63 x63 A2 23 -48 10YR 2/2 - -- sil 2msbk mfr as lvf 1 0.5 1 0.6 Giourd B 148 -80 I10YR 4/6 I - -- sil 13mabk mfr I - -- lvf 0.5 10.6 elev. - 8 Omit! to kwN 80 F crnarv: i Print JAWS 0. FUNS R10f « (715) 425 -7831 CCOEN E3` dNEEAING CO.. 113 WEST WALNUT ST.. RIVER FALLS. M 54022 G oats �jo 97 3s88 aOPEgt^rowNER SOIL OESCRIPTION REPORT Page of 3_ )ARC&L I.O. t 77r! ptn O omtnant Color ' N11=es Texture LM Swcture , Rooa G ?C /tt� r r3r Sz. Sh. 9 Trernt Baring # II Al 0 -27 I 4/3 1 - -- Ilfs Ilcsbk Itnvfr I w 6vf- I0. 0.6 I I I I ' A2 27- 63110YR 3/3 - -- 16; - A3 63- 75I10YR 3/2 1 - -- sl ds 2 Ground elev. A4 75 -871 10YR 2/1 I - -- sil 2mabk � f i �- -- of 0.5 0.6 it. I I I I I . Deom to I I limmng > 87 1 i I i Remarks: Horizons Al, A2 and A3 appear to be recent outwash on top of A4 Boring •.� I I 1 1 I I :i :� I i ( I i I ound I I I It 090 to I 1 I limning Remarks: Boring • I I I I I � � I 1 I F Ground I I I I I I etev. 1 It. Oeom to fmtnng I I ! laCtor I I I I I I Remarks: Bonng # I I I I I Gmurxt e1ev. tL � O.m to PAGE 3OF3 SITE PLAN NOTES: PROVIDE MINIMUM OF 1' SAND BETWEEN BOTTOM OF BED AND EXISTING GROUND. MOUND TO BE A MINIMUM OF: 25' FROM DWELLING; 50' FROM WELL; 5' FROM LOT LINE. GoT zs v� P 4 .a s� DoT' z� B ENC Hi�� , ¢x, -56 3 . 3 87b 97 SCALE: 1" = 40' OGDEN ENGINEERING CO. ' TM 988 Civil Engineers & Land Surveyors - 1 ttlivS CS 03 1 54022 113 W. walnut St. River Falls, W i�10 7 (715) 425 -7631 WMc onsa+ 0epartment of Industry, SOIL AND SITE EVALUATION REPORT Page L of 3_ Labor and Human Aetaoons Oq%jon of Satety & BuiWings in accor with ILHR 83.05. Wis. Adm. Cade COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST. CROIX not limited to vertical and horizontal reference 0 ir and % of slope, scale or PARCEL 1.0. is dimensioned, north arrow, and location and e'to• newest rb ;•` APPLICANT INFORMATION —PLEA (NT LLNFOR N CEWED8 DATE � 7�0 Ealligg . -� PROPERTY OWNER: PROPERTY LOCATION E 1/2S 24T 28 NR 20 W TOM RUEMMELE & JOHN AND GOVT. LOT 1/4W 1/2S 19T 29 NR 19 - 640 W �� A_A_R_M97a 4 PROPERTY OWNERS MAILING ADORE " LOT x I t9e" SUBO. NAME OR CSM 4 260 COUNTY ROAD F bT�ROIX 26 TROY VILLAGE ( iprry CITY STATE DP C pg# CITY C3VILLAGE MrOWN NEAREST ROAD HUDSON W 540 1 — TROY SA as New Construction Use [K I Residential 1 e. o s 4 ( ] Addition to existing building L I Replacement ( I Public or commercial describe Code derived daily n 600 gpd Recommended design loading rate 0 '� bed, gpdtft trench, gpd* Absorption area required o0 bed. 9 50 trench, ft Maximum design loading rate �i.` bed. gpd/ft D•G trench. gpdht Recommended infiWation swtace elevations) BY DESIGNER R (as referred to site plan benchmark) Additional design I site consi 69 No ?f,S ,0,4/ ^ 3 Parent material oS T/L G U T�u,9 S Rood plain elevation, if applicable N/A ft $ s Suitable for system CONVENTIONAL MOU IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U - Unsuitable for system I ❑ S lZU I ®S ❑ U ❑ S KU I C3 ZU I ❑ S ®'tJ I ❑ S f'U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure 8t Homan in Munsell Gu. Sz. Cont Color Gr. Sz. Sh. Bed ITrt�rdt Boring # [B2 0 -17 110YR 4/3 I - -- sl 2msbk mfr as lvf 10.5 '0.6 62`+ 17 -34 10YR 3/2 - -- sil 2m —csbk mfr gw lvf 0.5 0.6 34 -50 10YR 4/2 I - -- sicl 2mabk mfr cw lvf .0.4 0.5 Gmu nd ew . 5 58 10YR 4/2 flf 5YR 5/8 sicl 2mabk mfr cw lvf - -- 8 58- 63I10YR 5/6 - -- s Osg m1 as lvf - -- I - -- Oeoth to limiting C2 63 -72 10YR 5/6 cld 10YR 3/4 s Osg ml ( - -- lvf I - -- - -- fac»>5O" ( ( I 77 Remartcx • - Bonng # Honzon+ Own IDomtnantColor I Mottles (Texture I Structure I Conststence &UvalylRoots GPO /ft in. Munsell Qu. Sz. Cant. Coto Gr. Sz. Sh. I Bed Trer m Al 0 -23 10YR 3/3 - -- 1 2m —csbk I mfr w lvf 10.5 I 63 ; 10=i 2 —48 10YR 2 2 - -- 2 A2 3 sil msbk mfr a / s lvf 0.5 0.6 Ground B 48 -80 10YR 4/6 - -- sil 3mabk mfr I - -- lvf 0.5 10.6 8 70.9 ft. Oepth to favor I i > 8011 Remarks: Fftne:-_Filease Pnnt ,JAMES D. FUNS Phmr (715) 425 -7831 OGDEN ENGINEERING CO., 113 WEST WALNUT ST., RIVER FALLS, WI 54022 � Dat. / CSTM03988 PRaPERTY')WNER SOIL DESCRIPTION REPORT Page 2 of 3_ PARCtZ 1:0. � Oepth Oomtnant Cotor fubrstes Structure Roots ��GPO/tt,4 Horizon Texture z. Sh. B= =V 'TrertCt Boring # Al 0 -27 1 lOYR 4/3 - -- Ilfs lcsbk (mvfr I w Lf-flQ.j 0.6 315 A2 27 -63 10YR 3/3 - -- - A3 63- 75I10YR 3/2 I ___ sil w/ sl ban s 2msbk mfr Lw �vf- O-S n-6 Ground elev. A4 75 -87 10YR 2/1 - -- sil 2mabk Imfi �- -- of 0.5 0.6 B74.4 It. Depth to limiting i fa ( I Remarks: Horizons Al, A2 and A3 appear to be recent outwash on ton of A4 Boring # Ground elev. ft. Oepfh to limiting factor Remarks: Boring Ground elev. It I i Oepth to lirntting I I factor Remarks: Boring # } Ground elev. tL 080 10 lithttirtg factor I I Remarks: StdO- es30f A.OaltiZ) •° PAGE 3OF3 w SITE P LAN NOTES: PROVIDE MINIMUM OF P SAND BETWEEN BOTTOM OF BED AND EXISTING GROUND. MOUND TO BE A MINIMUM OF: 25' FROM DWELLING; 50' FROM WELL; 5' FROM LOT LINE. GOT ZS �v P ' O V p cl 3 �s e s� o� GoT ToP 4 / 101* �,Q � /PE 56 3 870 97 SCALE: 1 " = 40' OGDEN ENGINEERING CO. JAMES ILKINS, CSTM03988 Civil Engineers &Land Surveyors 113 W. Walnut St. River Falls, WI 54022 DATE: 7` l�/97 (715) 425 -7631 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer r 0 , l x vf loorwem 0 0v io d a byt '!S7 &L Y S. Mailing Address j 301 1i%V(U X 7,0[7 , �IQ�nG �� •�5� T 2 / Property Address o� 4 (Verification required from Iflanning Department for new construction) City /State Parcel Identification Number O LEGAL DESCRIPTION Property Location C ' /4, _.5� '/4, Sec. &, T -&N -R RO Town of Inv Subdivision 1 t l ,Lot # Certified Survey Map # , Volume , Page # Warranty Deed # 4 55 Volume , Page # Spec house X yes ❑ no Lot lines identifiable Ayes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance ' consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The 'property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewaterdisposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification . stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days f e t ee year expiration date. S. CO- // . Z4 o SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the p o erty described above, by virtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. * * * * ** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed :J.>ty,.3 MMMAKiY I�s ro • - /' OOOMAIR NC oL V TI W.V. 54 1�11Nrlrw W wrial . . 0MAY. 2 7 19lt a'a{ 7w Deyatflar..rt • Ilsrabratd.a�s �� tDwttts� Wkccausib, Thu tbs sold Grttatrx, Isar a ntth>tbM ot:icNipatiocc .tts nto aatta�ut �aattpa oonvtsya to Gcatttea do following dtaaibsd real tat= is tro;: Cettttev Cowq. Svcs of Wbcaaa: I•re,i idtaaikatktil!Iaat1� Lots 10woulih IS, Lois 67 SWovo 63 &W Lft 6& &no 70 ofdM PM of Troy Yllags. $ Ctoi� Cotioi�: ariaeoctain and that potion of CMk» t of We Plat of Troy YI� daaiitd ca F lIM A aWCW b a and - Ouclots 1 tnd l to dw Plat of Troy Viitge, h Coobc co.tcly.lAlbcoasln A ootnoe of tt+o•e INabd pqr - y„y�i / wPlgef b d+laea� Jo�a b >t a- and W M•a A taamom (U4raa0 Tepri..i 0 to a0 W howdoaati aN i�rtaaaaaq 6twt�a bcba Aad man .treait nr +►. rw . wd. �, is fig •aqi• t d M sonar ataacwtr r•tart gaup . suawfits, oovenaiws, tuWIMIwta and biOwey++ffft 0( %y Offocor'd ow WE %went Md ache/ ON M A& MAL) •'• ftl.; C. .a awu Gam _, �*•.-- --a„'� �tAW AU'TMBMICATION ACiNOWLEMMEW Sian•t•r•1,) STATE Or WNC04" , to w, : up— auibeadicatad this of 14�,_ ��, .. �• Pststically ca>as bal6cs ala this _ . dq of y do above nonal Till & ME ATE HAR OF WISCOWM t�•t. atihwt d by s7KO& Mite %W to M I-11 - to be the paM erbo astalsd 61 &rgpwg lostrawnt +ad admowladp to taw. TUN /r'l7flt*AW WM OIIA/!LD !Y mum UL - *1 Sda i f� Notary INMIC Pow*v. WI, X4-wm nV M alYeaMef W R Mb w wr h/y Cos wguim is apl7aeent• (if rA aw wtpkam dm M. oA N n wyAt�a .e INI � hl* •Ilwr..n Wiscgnsin Qepartment of Commerce PRIVATE SEWAGE SYSTEM Safety anrrBuildings Division CountyST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Sanitarit41v9.: Personal information you provice may be used for secondary purposes [Privacy L , s.15.04 (1)(m)]. C HAR WS CU�� CO . � Y❑ Village E] Town of: State Plan ID No.: CST BMElev.: Insp. BM Elev.: BM Description: ParceINb'a,:1246- 60-000 TANK INFORMATION ELEVATION DATA A9700263 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht outlet TANKTO P/L WELL BLDG. Air to I ntake ROAD Dt Inlet ir Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP/ SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft H ead Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM I BED /TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMEN I N I I DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header / Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 24.28.20,NE,SE 345 LINDSAY ROAD LOT 26 Plan revision required? ❑ Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. ADDITIONAL COMMENTS AND SKETCH SANITARY PERMIT NUMBER: I I i i I I Ai sconsin SANITARY PERMIT APPLICATION 2 e 01E.WashingtonAve P.O. Bo x 7969 Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County �• Ore I than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number agq #yq The information you provide may be used by other government agency programs ❑ Check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Propert Owner Name Property Location ��_` Q Budd C 114 4� 114, S y T , N, R.2b E ( Property Owner's Mailing Address Lot Number Block Number D1 02 6 City, State Zip Code Phone Number Subdivision Name or C:SM Number W 1A ( ) f I ' II. TYPE 'OF BUILDING: (check one) ❑ State Owned if Nearest Road Public 50 or 2 Family Dwelling - No of bedrooms 4/ own OF CD uw III BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo 1 D #0 _ l A Al (p 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 E] Restaurant/ Bar/ Dining 4 ❑ Church/ School 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel/ Motel 9 ❑ Office/Factory 13 ❑ Other: specify IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. p§ New 2. ❑ Replacement 3_ ❑ Replacement of 4. ❑ Reconnection of 5_ ❑ Repair of an System System Tank Only Existing System ________ Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non- Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed 21 XMound 30 ❑ Specify Type 41 [:]Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System -In -Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade 6 / Required (sq. ft.) Proposed (sq. ft.) (Gals/day /sq. ft.) (Min. /inch) Elevation 00 QQ 0 8 7'Y © Feet TG ,3 Feet VII. TANK Capacit gall Total # of Prefab. Site Fiber- Exper. INFORMATION Gallons Tanks Manufacturers Name Concrete Con Steel glass Plastic App New Existing structed Tanks Tanks Septic Tank or an ,2 - 0 — .Zo U) e- G ❑ ❑ ❑ ❑ ❑ Lift Pump Tank Htarmber /86 f) / ®e t ) ❑ 1 ❑ 1 ❑ 1 ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. P ber's Name: (Print) mad Sign to e: (No Stamps) MP /MRR'MNo.: Business Phone Number: C S e r 6 d 7/ Plumber's Ac dress (Street, City, St te, Zi ode : IX. COUNTY/ DEPARTMENT USE ONLY Disapproved Sanitary Permit Fee (Includes Groundwater E I ssue Issuing Agent Signature (No Stamps) Approved E] Owner Given Initial Surcharge Fee) I 11 Adverse Determination X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: 3 (R 11/96) DISTRIBUTION: Original to County. One copy To: Safety 6 Buildings Division, Owner, Plumber __� INSTRUCTIONS ' 1. A sanitare�rrtsialid foro (2) years. ♦ 1 • 1 l_ 2. Your sanitary perm ma a renewed before the expiration date, and at a time of renewal any new criteria in the Wisconsin Admi . #v� 4"ill be applicable_ 3. All revisions to this permit must be approved by the permit issuing authority. 4. Changes in ownership or plumber requires a Sanitary Permit Transfer/ Renewal Form (SBD -6399) to be submitted to the county priorto installation 5. Onsite sewage systems must be properly maintained. The septic tank(s) must be pumped by a licensed pumper whenever necessary, usually every 2 to 3 years. 6. If you have questions concerning your onsite sewage system, contact your local code administrator or the State of Wisconsin, Safety and Buildings Division, 608 - 266 - 3151. To be complete and accurate this sanitary permit application must include: I. Property owner's name and mailing address. Provide the legal description and parcel tax number(s) of where the system is to be installed. II. Type of building being served. Check only one and complete # of bedrooms if 1 or 2 Family Dwelling. III. Building use. If building type is public, check all appropriate boxes that apply. IV. Type of permit. Check only one on line A. Complete line B if permit is for tank replacement, reconnection, or repair. V. Type of system. Check appropriate box depending on system type. VI. Absorption system information. Provide all information requested for numbers 1 through 7. VII. Tank information. Fill in the capacity of every new /or existing tank, list the total gallons, number of tanks and manufacturer's name, indicate prefab or site constructed and tank material. Complete for all septic, pump /siphon and holding tanks for this system. Check experimental approval only if tanks received experimental product approval from DILHR. VIII. 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. IX. County/ Department Use Only. X. County / Department Use Only. Complete plans and specifications not smaller than 8 1/2 x 11 inches must be submitted to the county. The plans must 'l 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; vvater mains/water service; streams and lakes; pump or siphon tanks; 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 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; and F) all sizing information. ----------------------------------------------------------------------------------------------------- GROUNDWATER SURCHARGE 1983 Wisconsin Act 410 included the creation of surcharges (fees) for a number of regulated practices which can effect groundwater. t The monies collected through these surcharges are used for monitoring groundwater contamination investigations and establishment of standards. SAFETY & BUILDINGS DIVISION I State of Wisconsin Department of Commerce July 16, 1997 2226 Rose Street osse WI 54603 WEGERER SOIL TESTING 421 N MAIN STREET PO BOX 74 RIVER FALLS WI 54022 c;4 O� RE: PLAN S97 -40869 VED: 180.00 CHARLES CUDD CORP f � NE,SE,24,28,20W TOWN OF TROY COUNTY OF ST CROIX MOUND SYSTEM The Department has reviewed the above - referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50 -64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All permits required by the city, village, township or county shall be obtained prior to installation. Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, c and M. Swim Plan Reviewer Section of Private Sewage (608) 785 -9348 SSO -7997 (R.11196) i ,,. _ �,; _ ,:.: _ _ r; , ; �. . _ _ ... :,; ;. ;. � Page of 6 S97-40869 � MOUND SYSTEM JUL 1 1997 FOR A 4 BEDROOM RESIDENCE SAFETY a SL . GI V. LOCATED IN THE N E 1/4 OF THE S e 1/4 OF SECTION z q , T Z8 - N, R Zz W, t TOWN OF _r\zV , S1 - • G\Z.AUC COUNTY, WISCONSIN. Thy V 1u-A6 e INDEX PAGE 1 'of 6 TITLE SHEET PAGE 2 of 6 PLOT PLAN PAGE 3 of 6 PLAN VIEW -CROSS SECTION PAGE 4 of 6 DISTRIBUTION PIPE LAYOUT PAGE 5 of 6 PUMPING CHAMBER PAGE 6 of 6 PUMP PERFORMANCE CURVE PREPARED FOR 1 �OZ w oODDI��� � Q.1 U E WC�fl1�. 8Vi2,�' , F-'IN SS1Z5 PREPARED BY WEGEF;tER SO I L TEST I NCG AND. ES = D ®r ^i+ P.O. BOX 7; 421 N. MAIN ST. �.*�� •'''•.`�� W. �na y RIVET F;us. NI 54022 ART Po 0 llp ll 7I5- 42`.r-0165 We EREl1 Condit E{ BWORTK VET �.Wl RO ,� W ' SIG N E4 ONOENCE - 7 —t SEE G JOB NO. j � y � + i { z -- PLOT- PLAN Page 7 - of Scale 1 '= 40' s. 562 Z-Z-O• S � _ @t , 8'�O.g7� Ott `IDI� of 1'' tRph� P�P� SS 1 1 1 6.315 1' 1 � pv c ` b� 1NC3� CAIN PA cT J I' OR D t 31UR p o k- 3 z s ✓� o G g.5 3 - a r9J 0 F S j N ID 4 � J I 1 6 OAZ ` � 1 h V 1� i ' f 1 / t NOTES -1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install permanent markers at end of each lateral. ( y required) 3. Install.4" observation pipes with approved caps. ( 2 required) 4. tank to be \'Ls o gallon capacity manufactured by 5. Bench Mark S fOVE 6. Divert surface water around system to prevent at the uphill side. - I Page 3 Of 6 Approved Synthetic Covering �sTr� C- 33 Distribution Pipe Medium Sand Topsoil = —_- -_�- F Elev. 8 - 7 Y,0 � i o 3 E b S % Slope Bed Of 2 2 %2 Force Main Plowed Aggregate From Pump Layer D �,o Ft. Cross Section Of A Mound System Using E N• q Ft. A Bed For The Absorption Area I F 0 Ft. G 1,o Ft. A 8 Ft. H % Ft. Linear Loading Rate =g•j GPD /LN FT B 63 Ft. Design Loading Rate= O.y.GPD /SQ FT j R io Ft. J S Ft. K 1 Ft. A+te�� Position L SS Ft. of Force Main W 3 - L Ft. L Observation Pipe r 0 K Distribution Bed Of 2 2 1 2 Pipe Aggregate Observation Pipe Permanent Markers (Anchor securely) Plan View Of Mound Using A Bed For The Absorption Area Page Of 6 Perforated Pipe Detall 0 End View ) Perforated End Cap_ PVC Pipe Ja ��p ,a � L C I a ,S Install permanent at end of each lateral Holes Located On Bottom, Are Equally Spaced Q S P PVC Manifold Pipe + � Oistn ution PVC Force Main Piee Lost Hole Should Be I Next To End Cap End Cop P 30 Ft. Distribution Pipe Layout S � Ft. X_ Inches Y 4` Inches Hole Diameter "Y Inch Lateral Inches) Manifold Inches Force Main " Z Inches # of holes /pipe 8 Invert Elevation of Laterals 8)4•S Ft. Il ' Place 1st hole 4 f w' succeeding holes e from center of manifold with g at q8 intervals. Last hole to be next to the end cap. PUMP CHAMBER CR055 SECTIOIJ AND SPECIFICATIONS' PAGE S OF VEWT CAP 4* C.L VENT PIPE WEATHER PROOF APPROVED LOCKING MANHOLE JUIJCTIOU BOX COVER WITH WARNING LABEL ? 10' FROM DOOR, I2 'MtU. WIIJDOW OR FRESH I AIR INTAKE I GRADE I y" MIN. ` � .�. Ie• MIU. CONDUIT �"— — ________ --- - - - - -- \ K \ • PROVIDE -- IMLCT AIRTIGHT SEAL � II v APPROVED JOINT/ A Tank construction shall comply I I'I APPROVED JOINTS with ILHR 83.15 and ILHR 83.20 I II I I I I ALARM I I I oN C CLEV. F7. PUMP- , -' -� � OFF D C) CO LICKETE CLOCK 3" APPRoYED RISER EXIT PERMITTED OWLy IF TANK MAMUFACTURLR HAS SUCH APPROVAL gCpplµ4 5PEC.IFICAT10KJ5 DOSE S TA.0 MANUFACTURER. NUMBER OF DOSES: 3 ' PER Why TANK SIZE: 000 GALLONS DOSE VOLUME r 1`1 Z • 3 ALARM MAUUFACTUII'.LR: S•Z .;�� )v\�}� -c INCLUDING BACKFL.OW: GALLONS MODEL NUMBER: CAPACITIES: A INCI{ESOK GA LLOQ5 SWITCH TUPE: E" auyz_y 8 = Z INCHES OR S -2 ' 14 GALLOWS PUMP MANUFACTURER: 1'1` i �ZS G = 6 INCHES OR )_ GALLOWS MODEL NUMBER: S� M 0- t L , I INCH O R .) _� GALLOWS SWITCH TYPE: C - .JR Y MOTE: PUMP AWD ALARM ARE TO DE � 9 � �• MINIMUM DISCHARGE RATE 3 �' �� GPM INSTALLED ON SEPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEW PUMP OFF AIJD- DISTRIBUTION PIPE.. 7'19 FEET t MIAIIKUM NETWORK SUPPLY PRESSURE . . .. .. 2.50 FLET -} ZS FEET OF FORCE MAIN X 2.�y F � 0.6`'! I oo fr FRlCTtou FACTOR. FEET .� TOTAL DyWAMIG HEAD = ` FEET DIAMETER — II INTERAIAI. DIMLIJSIOAI� OF TAWK: LEAl6TH ;WIDTH .- -�; LIQUID DEPTH BOTTOM AREA — 231= GAL /INCH AS PER MANUFACTURER = Z j GAL /INCH __ V6/ L 91-V£5I — — TOTAL HEAD IN FEET o Ui o U1 o Lnn o o O All I 0 0 N � O � O A - 0 D w �--� - O m —{ w D H 0 O G > ° r F -+ cn 0 N U1 f�1 0 +' Z O C H J m z o C N -� o OD m 0 W N O O W O O O (n Ol TOTAL HEAD IN METERS w O.taar vn( of fmovsw. SOIL AND S I T i~ 1 A L U a T ION R E °GAT P :qe — ot - t_,00• sna.Numnn A..i,.00 of S41.cy 4 $jy to a ccord Nltrl iL.HR 8.' Wis. Awn. cace C:)Uty re 5T. CROII Attach carrTopte =t• plan on paaar not less than 8 72 X 11 inGhez in size. Plan MU:d include. but PARCEL R z not lintttod t0 va•ttcal at'td h0tiz0M3j retererlc pant (W). p (W). direca0n and :. of a 3C2e or diMMj;,OnQd rmuln aacw, Ind IocalOn 3110 Ct3t3nCD tO nearest fOaC. - T ALL INFORNA,1a N AE` /tElMEOeY OATS APPLICANT INFOR �_ PAOPEr71Y CWNE : iz��� �'� CL;�'�. PROPG; l LCC:A7iCN E 1 / 2S 24T 28 N X 20 W R17EItttELE GOVT. LOT u.W 1 / 2S 19T 29 NR 19 -Marl W1 TOM Pf*OPEMY OWNE.4'S AMIUNG A00RES S LOT s SU80. NAME OR C:-lu s 260 COUNTY ROAR is :6 1 TROY 1 7ZLLAGE i CITY. STATE ZIP CODE PHONE NIlAA8Er7 , TY IU,AGE t OWN (NEAAEST ROAO HUDSON W 54016 ( 7i) 2n -�9 TROY Ll,r SAY 12a. New COnSIT=W Use IK ) AO%dennal t Nuatoer of baarooms 4 ( 1 Acntion to existing btnlding j � Replacement ( I Puck or commefcat demnee Code aenved a* now 600 . gX 0 Re=mnetltlea aestgn loaning ram 0 '¢ bed. 410orft2 1- trena gpalt At= 00n area required c� bed. ttZ S melon. ,t2 V3X MJM design bamrtg rasa bed. gpdm G trt;�ff„"'1, gpoltz Reratrnnenaea inftlttatzotl stlrtar t';watlon(s► BY DESIGNER ft (as rewrea to seta plan benchmark) Addbonal aemp r site a=aeramtxts gg n/o -7^/ .ai iE 3 Parent mmanal 55 i /G 4 v Tu�i�ts Roca plant elevation. it appticacte N [ A _ tt L u a Swmable iof System i CCNVeMCNAL �+OUNO IN- GACL'NO PRE$$t)RE AT G;;AOE a'YST IN � FO -ANK - u rtsul=te for system I C S O U 1 9 S C U G S Q3.t U C C S Gru 0 S Rr U SOIL DESCRIPTION REPORT I Oepm Dominant Cow nnalus Stru=re I GPOItte Nonzon) l C !Texture S Gr. Sz. Sty. �C�sez�,f�rm„,RoO.�I Sea :Tn1tn1 in Munsell Cu. Sz Corn .,olor 8onn9 AL ,0 -17 I LOYR 413 -- , sl 1 _msbk Mf : as , 1vf , 0.5 0.6 - -- ga 1 t 0.5 0.6 :.7562 AZ 17 -34 10YR 3/2 I I sil 12a -csbk mfr ` BL 134 -50 I10YR µ/2 I - -- sicl ( Zmabk { mfr ( Cw I1vf i0.4 :0.5 Gicum I f J �"• B 150 -58 1 10YR 4/? [If 5 5i8 I sicl Zmabk mfr l c.1 11`�f 1 - -- I - -- 8 C1 �58 03110YR 5/6 - -- ,s Osg ,ml as lvf - -- 1 - -- Qew is Grraonq CZ Ib3 -:Z 110YR 5/6 1 cld 10YR 3/4 j s I Osg I tnl I - -- 11vf 1 ~- �--- 50" Ru mart= ' Moses Texture Boring z Horizon 0acm Oorninant Color Mos � 1 ( Texture c. i Coe tlCS t&Xtt V AootS ,n, nnun c�u. S ,a rtt. Cesar G•...' Sh. ! Sea irBnC: Al 10 -23 110YR 3/3 ?:Z -._sbk I mfr I ow I v" 10 . 5 i .f03 I - I - I I sii I'_rtsbk I mfr as Ilvf �0.5 I 0.6 Grouna B 148 -80 1 1 0 YR 4/6 I -- 1 sil 1 3mabk I mfr I--- 11vf 10.5 10.6 87 it. Dem la I I I 1 I 1 1 > 80 Iaernartcs: JAMES 0. FtLKNS P7° (715) 425 -7831 CGCE:V �4C114&'—ESiNG CC.. 11 'NEST WALNUT S'- RIVER FALLS, `M 3404^. Sgrt>mrc Data: t„iT Nutnoi •fj�ia /97' CSTUO3988 Wisconsin Dapar"nt of IndustrY• SOIL AND SITE EVALUATIO REPORT Page -L of 3 Labor and Human Rwtauorrs Division of Sal" 8 6wldngs in accord with IL.HR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST. CROIX not limited to vertical and horizontal reference point (8M), direchon and % of slope, scale or PARCEL I.O. p dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION — PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION E 1/2S 24T 28 NR 20 W TOM RUEMMELE & JOHN AND BARB RUEMMELE GOVT. LOT 114W 1/2S 19T 29 NR 19 -64" W PROPERTY OWNER':S MAILING ADDRESS LOT x Bte tf0 SUED. NAME OR CSM ft 260 COUNTY ROAD F 26 TROY VILLAGE CITY, STATE ZIP CODE PHONE NUMBER CITY aILIJVGE MrOWN NEAREST ROAD HUDSON WTSCONSTN 54016 (715)386—Z902 ITROY 14 rJ QSA aA V New Constn cdW Use (X I Residential,' Number of bedrooms 4 ( J Addition to existing building I I Replacement ( I Public of commercial describe Code derived daily flow 600 gPd Recommended design loading rate 0 bed. gpd1tt trends. gpdM Absorption area required 00 bed. ft SpO trench, 9 Maxanum design loading rate go _ 5 bed. gpdtIt , gpdqt2 Recommended infiltration surface elevation(s) BY DESIGNER it (as referred to site plan benchmark) Additional design / site considerati 4-9 IVO 7 0A1 E 3 Parent material y5 Rood plain elevation, if a pplicable N/A it �U�-.2tnjls=wtable for system CONVENTIONAL. MOU NO INGROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TAW for system I S l�U I [9 s u s KU C] S ZU I [2 s �'[1 I s ffu SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure C GPD /ft in Munsell u. Sz. Corn Color Gr. Sz. Sh. Bed ITrwM Boring # Al 0 -17 I10YR 4/3 I --- sl 2msbk mfr as lvf 10.5 0.6 62> A2 17 -34 10YR 3/2 - -- sil 2m —csbk mfr gw lvf 0.5 0.6 B1 34 —�10YR 2 ' - -- sicl 2mabk mfr cw 1vf 0.4 0.5 Gmutnd elev. B2 50 -58 10YR 4/2 f1f 5YR 5/8 sicl 2mabk mfr cw lvf - -- - -- 8 C1 58- 63I10YR 5/6 - -- s Os g ml as lvf - -- - -- Oeotlt to limi6rtg C2 63 -72 10YR 5/6 cld 10YR 3/4 s Osg ml I - -- lvf - -- - -- faaz 5 011 ( 1 I Rwna;rks: Boning # Horizon Oeptn Dominant Color I Monies ( I Structure j I GPO /ft Texture I Consistence 8otsldaly Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I Bea Tremn Al 0 -23 10YR 3/3 ( - -- 1 2m —csbk mfr w 10.5 10.6 6 3 A2 1 23-48 10YR 2/2 -- sil 1 2msbk mfr as lvf 0.5 0.6 Ground B 48 -80 10YR 4/6 - -- sil I3mabk mfr - -- lvf 0.5 10.6 slay j ' 8 70.9 it. I Depth t factor I ` > 80" Remarks: Names —flew Pr*tt ,AMFS '0, F"14S Phone. (715) 425 -7831 OGDEN ENGINEERING CO., 113 WEST WALNUT ST., RIVER FALLS, WI 54022 S'"am Data: X019 7 CST Number CSTM03988 PROPERTY OWNER SOIL. OESCRIPTION REPORT Page 2 of _ 3 PARCEL I.D. i Oeptn Dominant Color Wines Texture Structure Roots Roots G ?Oitt� Horizon Z . Sh. s 'Trerrn Borin . g # Al 0 -27 lOYR 4/3 - -- ifs lcsbk Imvfr l of -f10.5 0.6 A2 27 -63 10YR 3/3 1 - -- - A3 63- 75I10YR 3/2 I ___ sil w/ i sl ban 2 bk Ground Lfr vf elev. A4 75 -87 10YR 2/1 - -- sil 2mabk I fi -- of 0.5 0.6 374.4 ft. Deptn to limrong factor 87" Remarks: Horizons Al, A2 and A3 appear to be recent outwash on ton of A4 Boring Ground elev. f t. 0 80 to litmting factor Remarks: Boring z Ground elev. It Oeptn to I limiting I I factor I Remarks: Boring # Ground elev. ft 000 to li miting factor I I Remarks. sBC.atsota.atLCr� w PAGE 3OF3 -SITE PLAN NOTES: PROVIDE MINIMUM OF 1' SAND BETWEEN BOTTOM OF BED AND EXISTING GROUND. MOUND TO BE A MINIMUM OF: 25' FROM DWELLING; 50' FROM WELL; 5' FROM LOT LINE. Z_ z s �0 O .e -sGz V � 3�s � s e V a� DoT z� 040V.. = 870.97 SCALE: 1 " = 40' OGDEN ENGINEERING CO. JAM D. FILKINS, CSTM03988 Civil Engineers & Land Surveyors 113 W. Walnut St. River Falls, WI 54022 DATE: �l °O�� 7 (715) 425 -7631 S T C - loo 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 CH�es. C.uOD (,o Location of property ME: 1/4 -SE 1/4, Section —_ ,T z.ib N - LCD W Township - ("T : qp Mailing address i y�Z W �a0�►[.e i�� vE w�vp�3u�2Y l�N Ss /z.5' Address of site 34S L►ico , ,A`f 14uosoo -1 W I Subdivision name 'fr_o-f U, Lot no. 7 Other homes on property? Yes X No Previous owner of property rme-f bex L�VPEt­two�JT Co CLP Total size of property 1, toq 4- Acvcs Total size of parcel A MCA. Date parcel was created ml-mzit 1997 Are all corners and lot lines identifiable? _ Yes No Is this property being developed for (spec house) ?' x Yes No Volume IZ4l and Page Number 15ye 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 references to a Certified Survey Map, the Certified Survey Map shall also be required. PROPERTY OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge that I (we) am (are) the owner(s) of the property described in this information form, by virtue of a warranty deed recorded in the office of the County Register of Deeds as Document No. — _. 55 91111 , and that I (we) presently own the proposed site or the sewage disposal system or I (we) obtained an easement, to run the above described property, for the construction of said system, and the same has been duly recorded in the office of the County Register of Deeds as Document No. 5S`1�7� 0 Signature of Applicant Co- Applicant - 7- 3 -9 Date of Signature Date of Signature l S "1 10> SEPTIC TANK MAINTENANCE AGREEMENT St. Croix County OWNERIBUYER L LOW Lr? MAILING ADDRESS Ilbo2 woofow'Lz D2 IJ000 uvt�`f Raul SsI PROPERTY ADDRESS 3 Li mos. P (location of septic system) Please obtain from the Planning Dept. CITY /STATE t-�uo sear / W I PROPERTY LOCATION WE 1/4, SE 1/4, Section Z4 C Z - E_ N - IZ ZO �V TOWN OF T�rLOy ST. CROL COUNTY, \YI SUBDIVISION t ,A4nE LO'f NUMBER Z-(o CERTIFIED SURVEY MAP , VOLUNIT 17-41 PAGE 35 , LOT NUMBER 2[0 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 licensed septic tank pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. St. Croix County residents may be eligible to receive a grant for a maximum of GO% of tite 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 system properly maintained. llte property owner agrees to submit to St. Croix Zoning a certification form, signed by the owner and by a mater plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge and scum UWe, the undersigned have read the above requirements and agree to maintain the private scv"agc disposal system in accordance with the standards set forth, herein, as sct by the Wisconsin DNR. Certification stating that your septic has been maintained must be completed and returned to the St. Croix County Zoning Officer within 30 days of the three year expiration date SIGNED: — - __- Dn.rc: - 3 - 7 St. Croix County Zoning Office Government Center 1101 Carnticltael Road Hudson, \VI S4016 RN ER W LLEY ABSTRACT F ax: 715 - - 7664 Ju.1 3 '97 10:52 P. 02 559977 vt 1 7 41. WARRANTY DEED DOCUMENT NO. ST. C ROIX Co., W1 This Deed made between TROY DEVELOPMENT fKCaturPaoac CORPORATION, a Minnesota corporation, Grantor and CHARLES C. CUDD CORP., A Wisconsin corporation, MAY' 2 7 199 7 Grantee, r 3:15 PM `Y *t,t,_.._ - R 01-i-k Witnesseth, That the said Grantor conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: to Lots 24. 26 and 44 of the Plat of Troy Village in the Town of Troy, St. Croix County, Wisconsin. Subject to Declarations of Covenants. Conditions and Restrictions for Trot/ Village, recorded in V 2 4 1 Page 256 as Da. No. 559964 Tax Parcel. No. and the Declaration of Golf Course Covenants, Conditions RETURN TO: / and Easements, recorded in Vol. 1241, p 301, as Doc_ No. 559969 Robert W. Mudge, P.O. 469 , all as appearing in the office of the Register of Deeds for St. Hudson, WI 0 16 Croix County, Wisconsin, aad such other easements, re'cervations, restrictions and reservations of record, or in wse. T ArG §F Ell This is not homestead property. 70 G _ Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances, and will warrant and defend same. Dated this �Q day of May, 1997. TROY DEVELOPMENT CORPORATION Charles S. Cook, President STATE OF WISCONSIN )SS ST. CROIX COUNTY Personally came before me thif of May, 1997, the above named Troy Development Corporation, a Minnesota corporation, by Charles S. Cook, its President, to me known to be the person who executed the foregoing instrument and acknowledged the name, being authorized so to do. THIS INSTRUMENT DRAFTED BY : !r,_ Robert W. Mudge, Attorney 110 2nd St., P.O. Box 469 9 (expP * ires)) ,Qft2u , State of Wisconsin Hudson WI 54016 My Co . si 7izAM I (I