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040-1247-00-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 453495 0 ` (ATTACH TO PERMIT) GENERAL INFORMATION tate Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. % - & = TQ�t►t)S , /_ Permit Holder's Name: City Village X Township Parcel Tax No: Holte, Michael I Troy Townshi 040- 1247 -00 -000 CST BM Elev: Q ` In BM BM escription: n jt ►'V'40�/ SectionfTown /Range /Map No: l l ��✓� `('^ (� / 24.2 .20.1272 TANK INFORMATION ELEVATION DATA = Ll 6 /L q, GL TYPE. MANUFACTURE �� \ CAPACITY STATION BS HI PS ELEV. Septic ` Be nchmark Dosing ( t t Alt. BM Aeration � Bldg. Sewe /S ( r (5 � ��. IS v5 Holding St/Ht Inlet !Z 22— St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / Dt Bottom ,� I Dosing t l t It Header /Man. 1 2-0 O(.�v Aeration Di st t. . Pipe Q 2.23 1 - 23 1o(.� Holding B vatPm � " l Z'<7U Z- YO p gyp PUMP /SIPHON INFORMATION F l W l 1.'e -* (2t X - � Manufacturer Demand St Cover , �- GPM .y C q �• c7 Z o el Number O , 3 k. TDH Lift ' Friction Loss System Head TDH f Ft 2. .23 2-1. 1 Z) see, R^ t it Z MIT Forcemain Len g 1 ia. �r Dist. to well >O 2 SOIL ABSORPTION U TEM n-s,� BED/TRENCH Width 1 Length No. Of T cn lies PIT DIMENSIONS No. Of Pits Inside ia. Liquid Depth DIMENSIONS 9 1 6 1 SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type f ystem: C CHAMBER OR J � / G -- UNIT- Mo umber: DISTRIB U ON SYSTEM J�( (� Heade Manifold a Distribution x Hole Size !� x Hole Spacing Vent to Air Intake Length / Dia r L ngth ��.5 Dia /. y Spacing 3 / r v J 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 c�1 Yes No : Yes � � �� No COMMENTS: (Include code discrepencies, persons � esen a nspection #1: l d / / Inspect' n # 7 i3 r 1 = � ��� t2�V Location: 352 Lindsa Road Hudson, WI 54016 SE 1 4 2 N R2 Tro l la a Cof 30 � Par el No: 24.28.20 ( ) Y 9 f 1.) Alt BM Descriptio( Z... � � Q � t �f-�, 2.) Bldg sewer length -3:T It � � - amount of cover = L, 7 P.1 - wfl - Z /0 �0 6 Plan revision Required? Yes C� Use other side for additional [nform�Go Cert. No. Date Insepctors Signature �// I SBD -6710 (R.3/97) S U Safety and Buildings v ' n County _-� 7 f� 0 201 W, Washington Ave. .0. B 162 t `� Visconsin on, WI 53 7 - 71 Sanitar Permit Number (to be filled in by Co.) Department of Commerce ( 26 -3151 C� ys3 Y P Plan I.D. Number �� Sanitary Permit Appli , — �� In accord with Comm 83.21, Wis. Adm. Code, personal informati 'de may be used for secondary purposes Privacy Law, s15.04(1) ti� G/� 41//) Proj t Address (if different than mailing address) tiC CU I. Application Information - Please Print All Information �i t ;� Property Owner's Na me Parcel N 1 � V7 Lot N 30 Block N YlIC� P o ® - JV Property Owner's M ailing Address // roperry Location - 4oZ -7 JI �_ '/4, JVC 4,Section _ City, State. Zip Code Plione Number 0 / Z�(circle one) ( T �N; R E or® II. Type of Building (clieck all that apply) / 2 Subdivision Name CSM Nu mber P.1 or 2 Family Dwelling - Number of Bedrooms J ❑ Public /Commercial - Describe Use t7 Y " �/� /L � ❑ State Owned - Descri e Use Mr nt.d q ❑City_ ❑Village ;Tbwllship of 4 hov-l III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System p y 8 1 y ❑ Re lacement S ❑ Treatment/Holding Tank Replacement Only Other Modification to Existing System B. ❑ Permit Renewal Permit Revision El Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that appl ❑ Non - Pressurized In- Ground X- Mound > 24 in. of suitable soil ❑ Mound G 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber ❑ Drip Line ❑ Gravel -less Pipe ❑ Odier (explain) V . Dispersal/Treatment Area Info rmat' n: 6 6eA vo, �? Design low (g ) Design Soil Applica on Rate pdsf) Dispersal Area quired (sf) Dispersal Area P oposed (sf) System Eie tion 471 1 r 5 0 VL Tank Info Capacity iii Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or bolding Tank CA Aerobic Treatment Unit i,/ /1 Dosing Chamber —� W t /(/U VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum er's Na me (Pr' n) Plumb is Si gna e MP /MFRS Number Business Phone Number u. Z b f�9 z Plumber's Addre ss (Street, City, State, Zip de) VII Count Department Use Onl Approved 11 Disapproved Sanitary Permit Fee (includes Groundwater Date ksued ssuing Age Si r ( tamps) Surcharge Pee) (p Owner Given Reason for Denial Q 11 LX. Conditions of Approval /Reasons for Disapproval � � d 5. 4 tacit plete plans (to �Cuwy n�),Iy)fo, e sys m o�Paw �11SF n 8 1/2 x 11 inches in size SBD -6398 (R. 01/03) I 1 S Ga / c GJc :sue.- /04rD /�So T «K ar � I I O "Arl L f '� !D/i v e U+asr 8 2 oz. a o a 131 Vl lot u � 4 a t3 2 03 f ZZ of " Zo �m1 goo r y 9 Safety and Buildings commerce .Wi.gov 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 ■ ■ TDD #: (608) 264 -8777 i sco n s i n www.commerce.wi.gov /sb/ Department of Commerce www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary October 01 2004 CUST ID No.226497 ATTN: POWTS Inspector ROGER D NELSON ZONING OFFICE NELSON PLUMBING ST CROIX COUNTY SPIA 122 E SUMMIT AVE 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 10/01/2006 Identification Numbers Transaction ID No. 1064626 SITE: Site ID No. 688373 Michael & Pat Holte Please refer to both identification numbers, Lindsay Road above, in all correspondence with the agency- Town of Troy St Croix County S1 /2, NW1 /4, S24, T28N, R20W Lot: 30, Subdivision: Troy Village FOR: Description: Proposed Three Bedroom Mound System — Revision; (mound location) Object Type: POWTS Component Manual Regulated Object ID No.: 976328 Maintenance required; 450 GPD Flow rate; 29 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The approved changes will become an addendum to the plans that were previously approved on August 23, 2004. All other portions of the plans shall remain the same. 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: • 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. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(7) - 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. Co11di o17all �v 4� ' Pr-Rnvrn ROGER D NELSON Page 2 1011/2004 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS, 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 stars 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Our records indicate that additional money is due for the service requested Section Comm 2 61(2) Wis. Adm Code lists that revisions to plans shall be $75 Our older application incorrectly lists the fee at $60 The new form that is available from our website lists the correct fee Please remit the additional amount due as soon as possible. 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, &4GP� Fee Required $ 75.00 Fee Received $ 60.00 Gerard M. Swim Balance Due $ 15.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm Make Checks Payable To jswim @commerce.state.wi.us Commerce. WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: 3 bedroom Mound Owner's Name: Michael & Pat Holte Owner's Address: 1101 Maple Street Hudson, WI 54016 Job address: Lindsay Road Legal Description: S 1/2, NW 1/4, S 24, T 28 N R 20 W Township: Troy County: St. Croix Subdivision Name: Troy Village Lot Number: 30 Block Number: Parcel I.D. Number: 040 - 1247 -00 -00 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings RECEIVED Page 4 Lateral and dose tank SEP 2 0 2004 Page 5 System maintenance specifications tr ,: Page 6 Management and contingency plan rnrH; of c -?cE Page 7 Pump curve and specifications , �� oF SAFETY AND BUILD SAFETY & BLDGS 01r Page 8 Plot Plan k Page 9 Concave Mound Configuration pONDENCE �E_E COF�r� Designer: Roger Nelson License Number: MP 226497 Date: 09/16/04 Phone Number: 715 - 273 -4444 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 4.0 (R. 04/03) Page 1 of 9 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) r Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44 -3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 450.00 Design Flow (gpd) 7.00 Site Slope ( %) / 100.00 Contour Line Elevation (ft) ✓ 24.00 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd /ft Distribution Cell Information 50.001 Dispersal Cell Length Along Contour (ft) I 9.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (c or e) a Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g. 0.25) 4.00 Estimated Orifice Spacing (ft) = 11.54 ft /orifice 1.50 Forcemain Diameter (in) 90.00 Forcemain Length (ft) Does the forcemain drain back? Y 87.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 8.26 Forcemain Drainback (gal) 13.67 Vertical Lift (ft) 29.65 5x Void Volume (gal) 2.23 Friction Loss (ft) 37.91 Minimum Dose Volume (gal) 22.39 Total Dynamic Head (ft) 16.07 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 x x 1.00 x x 1.50 1.25 x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.001 S_ epttic Tank Capacity (gal) Total Working Liquid Depth (in) Weiser 800 - 325 -8456 IManufacturer gal /in (enter result in cell B49) Dose Tank Information Effluent Filter Information 650.001 Dose Tank Capacity (gal) I Zabel 1- 800 - 221 -5742 1 Filter Manufacturer 17.001 Dose Tank Volume (gal /in) IA100 Filter Model Number Weiser =Manufacturer Project: 3 bedroom Mound Page 2 of 9 Mound Plan View ...................... .............. ... ................................. 1 'O b servat ion . . . . . . . . J . . . . . . . . . . . . . Obse on pe .............. ...... -* /10 B . . . . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . .. FK ----- - K A 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . B 0 . . . . . . . . . . . . . . . . . . . . - - - — - - - - - - - - - - - -- :-� ' . ................... .................... .......................... ................................. ................................. ............................ .... ............... ................... ................................. ......................................... ..................................... ........... ...... L Mound Component Dimensions - SEE pAC.,g_ 9 -oF 9 -At-$0 AJ 9. 00 ft E 19 in H 1.00 ft K ft 50.00 ft F 900 in 1 10.94 ft 68.39 ID 12.00 in G 0 ft J 5.58 ft W 25.52 ft 450.00 (ft) Dispersal Cell Area 1 996.841 (ft) Basal Area Available 9.001(gpd/ft) Linear Loading Rate 1 5.00 (ft) 1110 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 102.75 (ft) ► H 2 G ........................ F Dispersal Cell 101.50 (ft) Lateral ....... ....... ....... ....... 101.00 ....... Invert .. .................... .. .. ..... ......... ........... Dispersal Cell . Elevation E ............ D ....... - : ............. ......... .......... ....................................... .............. ......... ............ ......................................... .......... * ... ......... ................ ..................................... ........... . ......... . .. ................ ..... .............. 4 4 4— 100.00 (ft) Contour Elevation 7.0 % Site Slope Geotextile Fabric Cover 0 Shading Key A -0 E 0. L T Dispersal Cell See lateral details on Topsoil Cap 1.5 ft Page 4 for number, size, .2 Subsoil Cap 0 5 C and spacing of laterals. ASTM C33 Sand d Laterals are equally F OE= Tilled Layer 0.5 ft spaced from the U) distribution cell's Aggregate 0 centerline in the A distribution cell (AxB). Project: 3 bedroom Mound Page 3 of 9 End Connection Lateral Layout Diagram Center the laterals over the A & B dimension •= Turn -up v6lball valve or cleanoutplug Fl.m. P dentica l IE X —� I Hales drilled on the bottom of the lateral equally spaced Laterals & force main of PVC Sch 40 (per COMM Table 84.30 -5) onnection via tee or cross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.00 in Orifice Spacing (X) 4.04 ft Lateral Length (P) 48.48 ft Orifices per Lateral 13 Lateral Spacing (S) 3.00 ft Orifice Density 11.54 ft /orifice Lateral Flow Rate 5.36 gpm Manifold Length 6.00 ft System Flow Rate 16.07 gpm Manifold Diameter 1.25 in Total Dynamic Head 22.39 ft Forcemain Velocity 2.92 fUsec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and -► Comm 16.28 WAC Disconnect in. min. Tank component is properly vented �- Alternate outlet location Forcemain diameter Weiser 800 - 325 -8456 Manufacturer 1.5 in. Capacityl 650.00 Gallons Volume 17.00 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 24.01 408.09 C B 2.00 34.00 P ump off elevation (ft) C 2.23 37.91 � 87.83 D 10.00 170.00 D Total 1 38.241 650.00 11 Dose tank elevation (ft) 3" Bedding un er tank. 87.00 Alarm Manuafacturer IS. J. Electro Systems Alarm Model Number 1101 HW Pump Manufacturer I Myers Pump Model Number I ME 40 Pump Must Deliver 1 16.07 gpm at F 22.39 ft TDH Project: 3 bedroom Mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Installed by Nelson Plumbin Phone 715 - 273 -4444 POWTS Regulator's Name St. Croix County Zoning Phone 715- 386 -4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 ft Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test month) Pressure System Laterals should be flushed and pressure tested every 1.5 years Mounidi Ins ect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished • ....... ........ Grade 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Swe ep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: 3 bedroom Mound Page 5 of 9 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg /L BOD 30 mg /L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: 3 bedroom Mound Page 6 of 9 ME40 Series myew 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE O 50 100 150 200 250 300 350 40 12 35 10 W 30 r e Z Z5 z2.3q r-,0 H T 20 s ° J ¢ 15 Q / O 4 F- I 10 2! • lu 2 0 0 0 10 20 30 40 50 60 70 60 90 100 CAPACITY GALLONS PER MINUTE GP01 1101 Myers Parkway. Ashland, Ohio 44805 -1923 ' B Telex 98-7443 419/289 -1144 FAX 419/289 -665 T K3326 7/91 Printed in U.S.A. 1 ,moo rya, A f Loy 3I { L o 7'.30 fs 3 �d 82ot � o , • £ v - o � !3 2 03 y i; LaYL Concave Mound Configuration (Deflection / Effective distribution cell length) x 100 (6' / 50') x 100 =12 % Deflection Actual distribution cell length = [(% Of deflection x 0.00265) + 11 x effective distribution cell length [(12 x 0.00265) + 11 x 50 = 51.59' Mound width must be increased 69.98' Mound cell must be increased o 51.59' Page 9 of 9 ' � � ECE'V r Wisconsin Department of L ALUATION REPORT Page l 3 Division of Safety and Buildings t� in accordance with Comm Wis. Adm. Code Attach complete site plan on paper less , X G ` I kiphes in e. Plan must County ST. CROIX include, tit not limited to: vertical a direction and Parcel I.D. 040 - 1247 - 00 - 00 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all informabon. 7 5 7� Date /� Personal informabon you provide may be used for secondary purposes (Privacy law. S. 15.04 (1) (m)). i & (/ Property owner Property Login ❑ CI MICHAEL & PAT HOLTE Gov S NW 114 S 24 T 28 N R 20 E (or) W Property Owner's Mailing Address ! of # Block* Subd. Name or 1101 Maple Street 30 — T roy Village City State Zip Code Phone Number Yllage [DTown Nearest Road Hudson, WI 1 54016 ( ) NR Lindsay Road New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD ® Replacement Public or cornmrerrcel - Describe: Parent material It General comments New report submitted to include Boring 4 information to move Mound System to 1 .00' contour with 1.00 & ar►d s � hed) (Property address: 352 Lindsay Road) a # Boring Q Pit Ground surface elev. 100.00 ft. Depth to limiting factor 39 in. Soil Ram Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Corti. Color Gr. Sz. Sh. *Eff#1 *E-W 1 0-4 10YR3/2 — sil 3f -mabk ds cb 3vf-co 0.6 1.0 2 4-16 10YR3/2 — sil 2f -mabk dsh a b 2vf-m 0.6 1.0 3 16-36 10YR3/4 — sil 3fabk mfr aw Ivf-m 0.6 1.0 4 36-39 10YR3 /6 — sl lmsbk m`fir — — 0.4 0.6 9_ — — Isbr — — — — — — (Horizon 3 has many si cu.) 2 Boring # Boring 98.1 36 El Pit Ground surface elev. ft. Depth to limiting factor in. S� Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. I *Eff#1 *8W 1 0-4 10YR3/2 — sit 3fabk ds cb 3vf-co 0.6 1.0 2 4-10 IOYR3/2 — sit 3fabk dsh as 2vf-co 0.6 1.0 3 10 -24 10yR3 /4 — sil 2fabk mfr aw 2vf-m 0.6 1.0 4 24--36 10yR3 /4 — is Osg m l cb lvf-m 0.7 1.6 5 36- — — till/Isbir * Effluent #1 = BOD > 30 220 mglL and TSS >30 150 mglL ' Effluent #2 = BOD —< 30 mgA. and TSS < 30 mglL CST Name (Please Price) Signahre CST Number M Jo Hollister 224832 Address Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 08 - 12 - 04 (Revised: 08 - 30 - ) (715) 426 - 1775 I Properly Owner HOLTE (Lot 30) Parcel ID # 040 - 1247 - 00 - 00 Page 2 of 3 a Boring # 0 Boring 95.90 ' Pit Ground surface elev. R Depth to knifing factor 36 in. Sad Application Rate Horizon Depth Dominant Color Redox Description Texdxe Structure Consistence Boundary Roots GPOW in. Munsefl Ou. Sz. ConL Color Gr. Sz. Sh. `Eft#1 'Eff#2 1 0-4 IOYR3/2 — sil 3f -mabk ds cb 3vf-co 0.6 1.0 2 4 IOYR3/2 — sil 3f -mabk dsh as 2v-co 0. 6 1.0 3 13 -36 10YR3 /4 _ A 2f -mabk mfr as 2,f-m 0.6 1.0 4 36-40 IOYR3 /4 flf IOYR4 /6 sil lfabk mfr aw 2vf-f 0.4 0.6 5 40-50 — I OYR3/6 f2d IOYR5 /6 s&sl Om mvfr — — 0.4 0.6 (Horizon 5 is banded & wc) Boring # t J Boring 100.70 a Pit Ground surface elev. fL Depth to limiting factor 24 in. Rate Horizon Depth Dominant Color Redox Description Textum Structure Consistence Boundary Roots GPDW in. Munsefl Qu. Sz. Cont. Color Gr. Sz. Sh. `Etf#1 'Eff#2 1 0-4 1OYR3/2 — sil 3fabk ds cb 3vf-co 0.6 1.0 2 0-12 sil Malik dsh as 2vf-co 0.6 1.0 3 j2- OYR3/4 — lmsbk mvfr aw 2vf -m 0.4 0.6 4/' 24 — — lsbr — -- — — ..- — 5 ng Boring Bori # 102.00 16 • Pit Ground surface ete ft. Depth to lirr>iting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Stnxturs Consistence Boundary Roots GPDW Munsel Ou. Sz. Cont. Color Gr. Sz. Sh. `0f#1 `Eff02 16 — lsbr Effluent #1 = BOD > 30 220 mg/L and TSS >30:s 150 mg& * Effluent #2 = BOD < 30 mg/L �nd TSS < 30 mg/L 1 i The Department of Commerce is an equal opportunity service provider and employer. If you need assistf nce to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 8 -264 -8777. SBD- 8330Tat (R.07Po0) I I PLOf PLAN p r fY Om OL M PAT L N7• /'� �! D Z Q. IIW j V 1why tam 7w D PXE jAi g4waXc UxAmni .c e� C i ~ NG W/ P �9 �b NO COMM 83 5Ma MMZM5 F F LOS s P P P to ,00 1 ZD 0 � Et- w 40 N. p - a , .1 �1,00� BI t t :vlwx. , o r ....0w.umInduwrr. SOIL AND SITE EVALUATION REPORT X1_0 1 kvwm Law p an of samw S in accoro vath ILHR 83.05. Wrs. Adm. Code COUNTY ST. CROIX AV * ownpi etm sne Oman paper not W" than a 112 x 1 t kchm in size. Plan reaar indud.. but PARMLO. s not Nmifed fm % and fmrimcmd n[Kenee Point (8M). >ioPe. s oma or dxnerrsiorred, nosh arrow. and locamon and drstanme W' S, E1N REVtE0 BY OA APPLICANT iNFdRMATiON— PLEASE PRINT ORMI I01W LpCATtmi E 1 /2S 242 28 NR 20 W TOM Rif 3I.E & JO1Di 1NtW 1/2S 19T 29 NR 19 -SNI W W4peMVOlM0rSWAJWAWMS i j 7W SLIBQ. wWE OR CSM s 260 COUNTY ROAD F 3 TROY VILLAGE tXiY SPATE CtJOE ROAD 54016 =(7 S7 L.�wCSa� �eAG D� mm cowucsian $; [ 1 Atldi m W exi5" btWW9 i I ROOMOWK PutRcaeoeenett�aldele Code d9ri and daily f v -600 gpd Reoammuled desip brefCng Tale e- '¢' . bed. WW0 "WL 9PL n area revue SAS bed. n2 Ste' ho ri RZ dsdW kWft rare., —bed. 9Pem L i 9Pd* p rKrfeftded it at su t melenion(sl BY DESIGNER 4 (as reftffed losiN plan bendmat" pig deign / sile caWWa"8 fee N Me 0 0 W 4616 - 3 Flofft n T7l.L />oGo� i ?'G Rood plain elevaW. I appirWle $ sSlllidl>fe tOr Sysl9rn �N@1114rA1 ff tAOlete NtiAOlelOP AT-GRAM (( SYSTHA Of FtL 1 HOf.OU TAet U =w>s�:m f ps tau 1 Bt OU Os � OS INU 1 Cis 9U 1 OS IaU SOIL DESCRIPTION REPORT Depdf ] (3andriant caw NOW Suucvme GPD Horizon in, mtumW I QL SL Cam Cola ITexture Ge. Sz. Sh. Bed Irmnch eonng # :� A 0-18 lOYR 3/4 ---- sil Zmsbk mfr ca 0.5 :0.6 201 B1 18-29 IOYR 4/6 --- sil 2msbk mfr cw Lvf 0.5 0.6 B2 29 -39 10YR 4/6 f2d 7.5 YR 3/4 sl icsbk lafr c Lvf 0.4 0.5 &0und delf. R 32-4 10 — last -- 3R_4 tt Dmm to Remarks: Borkv # A 0-10 IOYR 4/2 --- Z —csbk w v" 0.6 Z0 B1 10 -37 LOYR 4/6 --- sil bk r s of 0.5 `0.6 I BZ 37 -65 LOYR 4/4 =, 7.5YR 4 csbk nf r s of 0.4 €0.5 Ground dew. R 65 -70 LOYR 8/3 Lmst 908 - 1 Bepth m l 3 - I Ms Pi (m) 425-7631 %A RLKM E oG08# a r�I� CO. 113 WEST W ALNt1T ST.. RMM RILLS. w! 54022 0aw CSTIMwbsr: 1 Safety and Buildings Division County i 1* W. Washington Ave., P.O. Box 7162 St. Croix COOSIO WI 53707 — 7162 Madison, Sanitary Permit Number (to be ed in by Co.) _ Department of Commerce (608) 266 -3151 3 Sanitary Permit Application yy State Plan ,D. Numhe ✓ In accord with Comm 83.2 1, Wis. Adm. Code, personal information you provide a�1L! G 7 may be used for secondary purposes Privacy Law, s15.04(1)(m) Project Address different than mailing address) I. Application Information — Please Print All Informatipn 352 dsay Road Property Owner's Name Parc t # Block # Michael & Pat Holte D^��D�o 30 Property Owner's Mailing Address r ro 1101 Maple Street 2 24 ' /4, '/4, Section City, State Zip Code hone luumber Hudson, WI 54016 28 2d circleone) IL Type of Building (check all that apply) T N; R r � Subdivision Name CSM Number a 1 or 2 Family Dwelling - Number of Bedrooms Public/Commercial - Describe ,lUse k (p R t y , Troy Village ❑ State Owned - Describe Use ft `nL l Z(- 1 E]City ❑Village Br ownship of Troy I11. Type of Permit: (Check only one box on line A. CITplete line B if app ' ble) A. 0 New System ❑ Replacement System . g ep y g ys ❑ Trea -it/Holding Tan lacement Only ❑ odification to Existin S �r B. 11 Permit Renewal 11 Permit Revision ❑ Change o ermit Transfer to New Lis ous Permit Number ued Before Expiration Plumber er IV. Type of POWTS System: Check all that ap 1 ❑ Non - Pressurized In- Ground 0 Mound > 24 in. of suitable soil /eat \Fi n. of suitable soil ade ❑ single Pass Sand Filter ❑ Constructed Wetland ❑ Pressurized In- Ground Holding Tank 11 Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ Recirculating Synthetic Media Filter ❑ Leaching Chamber (3 Drip el -less Pipe ❑ Other (explain) V. Dispersal/Treat ent Area Information: Design Flow (gpd) Design Soil plication Rate(gpdsf) Disp al Area uired Dispersal Ar roposed (sf) System Elevation 450 0.6 7 f 45 450 9 7• 98.58 VI. Tank Info Cilpacity in Total Numbeif Manufactur Prefab Site Steel Fiber Plastic Gallons Gallons of Uni Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank 1000 1000 1 Weiser x Aerobic Treatment Unit Dosing Chamber 650 650 11 Weiser W /J VIL Responsibility Statement- 1, the undersigne assume responsibility for installation of the POWTS own on the attached plans. Plumber's Name (Print) Plumb 's a MP/MPRS Number Business Phone Number Roger Nelson MP 226497 715 - 273 -4444 Plumber's Address (Street, City, State, Zip 122 East Summit Avenue Ell sw h, WI 54011 VIII. Coun /De artment Use Onl 0- 1 6proved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued I ing Agent ign ps) Surcharge Fee) -1 2 L 7 (/U 2 C 3 ❑ Owner Given Reason for Denial �t ``' IX Conditions of Approval/Reasons for Disapproval 3 G�2i'��✓J S- �t �rc� SY STEM OWNER: f n Co Septic tank, effluent filter and (�•Y,,.r -., 3• S� dispersal cell must all be serviced /maintained as per management plan provided by plumber. 2. All setback requirements must be maintained a per applic code /ordinances. e ur� p3 r 3 76f o, > S r 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. 01/03) �l f i i CJc: sc.- /DOD /�oSo T •� 1r i 1 a 1 VO ? r Loy` 3 I � L o x'30 i f ot IV 3 !�d i 1-3 `b ! h ►b'� , ��lo o �.. (O p l3 2v3 (� 8l q o Lo A9 /00 7 9 n G 9 Safety and Buildings 4003 N KINNEY COULEE RD commerce LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 isconsin www.commerce.state.wi.us /sb www.wisconsin.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary August 24, 2004 CUST ID No.226497 ATTN.• POWTS Inspector ROGER D NELSON ZONING OFFICE NELSON PLUMBING ST CROIX COUNTY SPIA 122 E SUMMIT AVE 1101 CARMICHAEL RD ELLSWORTH WI 54011 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/24/2006 Identification Numbers Transaction ID No. 1053783 SITE: Site ID No. 688373 Michael & Pat Holte Please refer to both identification numbers, Lindsay Road above, in all correspondence with the agency. Town of Troy St Croix County S1 /2, NW1 /4, S24, T28N, R20W Lot: 30, Subdivision: Troy Village FOR: Description: Proposed Three Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 976328 Maintenance required; 450 GPD Flow rate; 29 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.0 1 /01), Pressure Distribution Component Manual - Version 2.0, SBD- 10706 -P (N.01 /01); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the approved plans, and the "Mound Component Manual for Private Onsite Wastewater Systems Version 2.0" SBD - 10691- P(N.01 /01). • The pressure network.is to be constructed in accordance with publications SBD- 10706- P(NO1 /O1) "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems - Version 2.0" and/or the sizing methods of publication "SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81)". • 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. • The area within 15 feet horizontally below the system shall remain undisturbed. Vehicular traffic or soil compaction in this area is prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. C iti"on a f 7 P R cj� V ROGER D NELSON Page 2 8/24/04 • Comm 83.22(7) - 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. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. 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 &46�� Fee Received $ 175.00 Balance Due $ 0.00 Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm WiSMART code: 7633 jswim@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 r Mound System Maintenance and Operation Specifications Service Provider's Name Installed by Nelson Plumbing Phone 715 - 273 -4444 POWTS Regulator's Name St. Croix County Zonin Phone 715 - 386-4680 System Flow and Load Parameters Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 300 gpd Maximum BOD5 220 mg /L Septic Tank Capacity 1000 gal Maximum TSS 150 mg /L Soil Absorption Component Size 450 ft' Maximum FOG 30 mg /L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu /100 mL Service Frequency Septic and Pump Tank Inspect and /or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthl Pressure System Laterals should be flushed and pressure tested every 1.5 years Mound Inspect for ponding and seepage once every 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30 -1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn -up Detail Finished ........ • • • • • .. Grade . 6 -8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Sends Same Diameter as Lateral Project: 3 bedroom Mound Page 5 of 8 Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD- 10691 -P (N.01/01) and SSWMP Publication 9.6 (01/81)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8- inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October- February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg /L BOD 150 mg /L TSS, and 30 mg /L FOG for septic tank effluent or 30 mg /L BOD 30 mg/L TSS, 10 mg /L FOG, and 10 cfu /100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Project: 3 bedroom Mound Page 6 of 8 i i S Ga / c c OD / �S4 T « �► k � 1 s Loy` 3l f L o x nn a . D Q Iz Iry let D ' i to A9 ST CROIX COUNTY SEPTIC TANK MAINTEN, ANCE AGREEMENT AND O ERSHIP CERTIFICATION FORM Ho (+e_ OwnerBuyer Mailing Address `� 1 IVIAR L 15 -4- #a .l3 fl "1 f-`J/ s�'D Property Address 3 Lt ��a�s�X +�c1, ' u �t�n am (Verification required from Planning Depadment for new construction)_ City /State Parcel Identification Number 15- Q ' D LEGAL DESCRIPTION Property Location 4— n ` �, ! y '/4, Sec. , T N -R Town of 0 Subdivision `s VILL A6 E , Lot # Certified Survey Map # , Volume // , Page # tY Z bZ Pag 1 Warran Deed # Z ,Volume a e # _ Spec house O yes no Lot lines identifiable V�es ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenan consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into, the syste 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 master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal syste is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludg Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standar set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificati• stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within: days o e three year expiratio date. SlGqA2W OF APPLI A T 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) the property described above/byvii of warranty deed recorded in Register of Deeds Office. SIGNATU ,OF APPLICA 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 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE AEG 1 Project Name: 3 bedroom Mound WrL 82004 Owner's Name: Michael & Pat Holte vLDG�+ Vu D/V Owner's Address: 1101 Maple Street Hudson, WI 54016 Job address: Lindsay Road Legal Description: S 1/2, NW 1/4, S 24, T 28 N R 20 W Township: Troy County: St. Croix Subdivision Name: Troy Village Lot Number: 30 Block Number: Parcel I.D. Number: 040 - 1247 -00 -00 Plan Transaction No.: Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 Plot Plan Designer: Roger Nelson License Number: MP 226497 Date: 08/16/04 Phone Number: 715 - 273 -4444 Signature: /', , /� f, I I Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB- 10691 -P (N. 01/01), and SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST -SAS (01/81) Version 4.0 (R. 04/03) Page 1 of 8 DIVIzouN UtSj#LJY AND BUILDING SEE CORRES UNDENCE 08/24/2004 09:37 TAX 121002 Mound and Pressure Distribution Component Design Design Worksheet Site Information (r or c) rl Residential or Commercial Design Note: Sand fill (D) calculations assume a 300.00 Estimated Wastewater Flow (gpd) Table 83 -44-3 in -situ soil treatment for fecal 1.50 Peaking Factor (e.g. 1.5 = 150 %) coliform of - 36 inches. 450.00 Design Flow (gpd) 7.00 Site Slope ( %) / 98.001 Contour Line Elevation (ft) " 29.001 Depth to Limiting Factor (in) 0.60 In -situ Soil Application Rate (gpd /ft ✓ Distribution Cell Information 60.001 Dispersal Cell Length Along Contour (ft) = 9.00 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd /ft 1 I Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y 0 r N (c or e) 91 Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation ft 3 Number of Laterals of the highest point. 0.125 Orifice Diameter (in) (e.g_ 025) 4.00 Estimated Orifice Spacing (ft) = 11.54 ft /orifice 1.50 Forcemain Diameter (in) 40.001 Forcemain Length (ft) Does the forcemain drain back? Y 87.00 Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 3.67 Forcemain Drainback (gal) 11.25 Vertical Lift (ft) 29.65 5x Void Volume (gal) Friction Loss (ft) 33.32 Minimum Dose Volume (gal) (18.74 Total Dynamic Head (ft) 16.07 System Demand (gpm) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. die. options choice 0.75 1 1,25 x x 1.00 x , x 1.50 1.25 x 2.00 1.50 x 3.00 2.00 x 3.00 x Gallons /Inch Calculator (optional) Treatment Tank Information Total Tank Capacity (gal) 1000.001 Septic Tank Capacity (gal) Total Working Liquid Depth (in) Weiser 800 - 325 -8456 1 Manufacturer gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 650.00 Dose Tank Capacity (gal) JZabel 1- 800 - 221 -5742 JFilter Manufacturer 17.00 Dose Tank Volume (gallin) JA100 Filter Model Number Weiser Manufacturer Project: 3 bedroom Mound Page 2 of 8 Mound Plan View _ T 1/10 B •'•'. . . .... . •. •. .:.... . . . . . : : J Observation Pipe 3 — K _� ......................... . L•L•: •:•L.. .L,L,L,.,,. �.•,. ,.,.. .�.. L,. ,L.L.. .•• ..•..,,. _ _ - �•r•r•,r• •.� :f :,• :r::. J.,r. j:; .::J. J :; .r :f.J.J�j. 1•L•• L•L•• ••.:•L• 5 �: L•L•L•:••..L••. L•L••. L•:• • • A r J•:• J•: •:•. •r.: •:• J•J•. •:•r•. •. •. •. •J•r•r r., , r•• •.• .. . •'•'''J'J'J: J•: •:•J•J •J•J•J•r•J•J•J•: •: •'••J•'•'r'r•r'r'r'r: J'J: J: •J•r• . • • • . W .7.:.. B. ' •' .... i . . . . . . . . . . . .:. ... I . . . .. .... . ....... .. .. .. .. .. . . ... .. ....... ............................... L Mound Component Dimensions 9.00 ft E 14.56 in H 1.00 ft K 7.95 ft S B 50.00 ft F 9.00 in z 9 ft�O L 65.89 ft �" D 7.00 in G 0.50 ft J 4.55 f W 22.90 ft 450.00 (ft) Dispersal Cell Area 1 917.72 (ft) Basal Area Available 9.00 (gpd /ft) Linear Loading Rate 1 5.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 100.33 (ft) - -� rr�ff.. H G .:rrrrrrrrrrrrrr rr {rrrfrrrrrr�f_,_ F Dispersal Cell 99.08 (ft) Lateral 98.58 (ft) — Invert ::.:. E Dispersal Cell Elevation 3 :::::::::::. .. . .. . . ... .... . . . . ... ... a 4 w 98.00 (ft) Contour Elevation 7.0 % Site Slope Geotextile Fabric Cover Shading Key 'o _Q T Dispersal Cell See lateral details on Q _ Topsoil Cap 0 a. 1.5 ft •L• :• • .• Page 4 for number, size, © { "" Subsoil Cap , 5 , •'.ti( P�'r�' ., L and spacing of laterals. ©❑ ASTM C33 Sand `-° rtiLa _ ... �;:,a �r' F Laterals are equally T ical Lateral 'ti�'•�' s ® ®Tilled Layer 0.5 ft aced from the r:r rp r.:.: p I L:b �'•' distribution cell's L•L•L H r•r•, 5 :•J•r•� A ggregate ate o � : �r.: •: •:.:.: 'r•: J.r, centerline in the IF A distribution cell (AxB). Project: 3 bedroom Mound Page 3 of 8 08/24/2004 09:37 FAX 0003 End Connection Lateral Layout Diagram Center the laterals over the A & B dimension Turn -up wfCall vs Iwo or oloa n outplu g E P ' All IatoraL are idontioal IF. X �a.l Holes drilled on the bottom or the lateral gq.+alFj spaced Laterals h Force main of PVC son a0 S (per COMM Table 84.39 -5 Force main connection wa tee or cross to manifold at any point. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.00 in Orifice Spacing (X) 4.04 ft Lateral Length (P) 48.48 ft Orifices per Lateral 13 Lateral Spacing (S) 3.00 ft Orifice Density 11.54 ff/orifice Lateral Flow Rate 5.36 gpm Manifold Length 6.00 ft System Flow Rate 16.07 gpm Manifold Diameter 1.25 in Total Dynamic Head 18.74 ft Forcemain Velocity 2.92 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Comm Disconnect Electrical as per NEC 300 and -► 16.28 WAC 4 in. min_ Tank component is properly vented tE Alternate outlet location Foreemain diameter Weiser 800 -325 -8456 Manufacturer �_ 1.5 in. Ca aci 650.00 Gallons Volume 1 17.00 gal /inch A Weep hole or anti - Dimension Inches Gallons B siphon device A 24.28 412.68 C B 2.00 34.00 Pump off elevation (ft) C 1.96 33.32 87.83 D 10.00 170.00 D Total 38.24 650.00 Dose tank elevation (ft) 3" Bedding un er tank. 87.00 Alarm Manuafacturer IS. J. Electro Systems Alarm Model Number 1 101 HW Pump Manufacturer Myers Pump Model Number ME 40 Pump Must Deliver 16.07 gpm at 18.74 ft TDH Project: 3 bedroom Mound Page 4 of 8 i M E40 Series 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE O 50 100 ISO 200 250 300 350 40 IZ 35 10 � W 30 W W ~ Z 25 8 Z J 8;7 V W 20 6 0 Tw N a 15 a 0 h- 4 p 10 ~ 2 5 O 0 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE G Pr» 11o1 Myers Parkway, Ashland, Ohio 44805 -1923 419/288-1144 FAX 419/289-WN Telex W7443 K3326 7/91 Printed in U.S.A. 7 d CT / 1 "lUT <<1TALJ 'TY7 VylJ 1- 1_117Q e�OL _ / /l L/'1 C7 .lPl.l VVisconsin Department of Commerce SOIL EVALUATION REPORT page I of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code cou ST. CROIX Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I . 040 - 1247 - 00 - 00 percent slope, scale or dimensions, north arrow, and location and distance to Please owirrt all ir►fo1011 ff ° - r 7 �04 Date Personal iNonnation you provide may be used for secodary Pu �Iqr LA�v (1) G{,!/V►�+ / 2 6 r Property Owner MICHAEL & PAT HOLTE c +— Sly /4 �11 S 24 T 28 N R 20 Property Owner's Mailing Address Lot # iF Subd Name or CSM 1101 Maple Street 30 ! — Troy Village city State Zip vrRage ' own Nearest Road Hudson, WI L 54016 ( ) NK Lindsay Road New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 45 0 GPD Replacement ❑ PtrbGc - Describe: Parent material till/euWMsh— Flood Plain eWwation if applicable N-A ft. 4 s ,� �/� Mound System — 0.59 ft sand fill — 0.6 loading rate n D a � �� ll (See Borings from test dated 7 -report attached) ✓ +(J (Property address: 352 Lindsay R0ad)4 a Boring � � Boring ❑ 39 Pit Ground surface elev. 100.00 ft. Depth to limiting factor ru Soo 8po2ft Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence BourWary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfWl 'Etf#2 A 1 0-4 10YR3/2 — sil 3f -mabk ds cb 3vf-W 0.6 1.0 2 4-16 10YR3/2 — sil 2f-mabk dsh ab 2vf-m 0.6 1.0 3 16-36 — sr 3 mfr aw lvf-m 0.6 1.0 4 36-39 10YR3 /6 — sl lmsbk mvfr — — 0.4 0.6 5 39- _ — lsbr (Horizon 3 has many si as.) � ❑ 2 [] 98.1 Boring 36 0 Pit Ground surface elev. ft Depth to limiting factor in. Sod Rate Horizon Depth Dominant Redox D Texture %U*ue Cormistence Boundary Roots GPD/fF in. Murnsel Qu. Sz Cont. color Gr. Sz. Sh. 'Effftl 'EIfi2 1 0-4 10YR3/2 = sil 3fabk ds cb 3vf-co 0.6 1.0 2 4 -10 10YR3/2 sil 3fabk dsh as 2vf- 0.6 1.0 3 10-24 1QYR3 /4 — sil 2fabk mfr aw 2 m 0.6 1.0 4 24-36 10YR3 /4 — is Osg ml cb lvf-m 0.7 1.6 5 36- — — till/lsbr * Efamd IM = BOD > 30 5220 mg& and M >30 < 150 mg& ' fit #2 = BO < W mg& and TSS < 30 mg1L CST Name (Please Print) CST Number Mary Jo Hollister 224832 Address Date Evaluation Conducted Ted Nub W9875 690th Avenue, River Falls, WI 54022 08-12-04 (715) 426 - 1775 Property Owner HOLTE (Lot 30) Parcel ID # 040- 1247 - 00 - 00 Pam 2 Of 3 Boring # Boring E] Pit Ground surface elev. 95.90 ft Depth to 9 factor 36 in Soi Rate Horizon Depth Dominant Color Redox Description Tenure Struckve Consistence Boundary Rods GPD/lf in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Efr#1 - 082 1 0-4 10YR3/2 Y sil 3f -mabk ds cb 3vf-co 0.6 1.0 2 4-13 IOYR3/2 A 3f -mabk dsh as 2v-co 0.6 1.0 3 13 -36 lOYR3 /4 — sil 2f-mabk mfr -m 4 1 f1f 10YR4 /6 sil lfabk mfr aw 2vf-f 0.4 0.6 5 40-50 f OYR3 /6 f2d I OYRS /6 s &sI Om mvfr — — 0.4 0.6 (Horizon 5 is banded & F4]Bod # Boring (� • 100.70 Pit Ground surface elev. ft. Depth to g factor 24 In. . R Sad Application Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Rods GPDlf1' in. Munsell Qu. Sz. Cont Color Gn Sz. Sh. *Eft#1 *Eff#2 24 — — lsbr 5 ga B Onn9 102.00 16 • Pit Ground surface elev. ft. Depth to larriiing factor in. Sol Rate Horizon Depth Dominant Color Redox Description Texture &nxture Consistence Boundary Rods in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 *Efl#2 16 — lsbr * Effluent #1 = BOD, > 30 220 mg1L and TSS >30 _< 150 mg/l. * Efts #2 = BOD, _< 30 mg/L and TSS _< 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608- 266 -3151 or TTY 608- 264 -8777. ssD4339rag (R07/00) PLOf PLAN PRMNOMM. HOLM, M PAT =& M50IMl LOT ZO- - Tftl V I • - TOP OF IICF IAJ G Mfd i>— s zV gv /00. .c - 7VP O P lRbAl PIM- 6 ❑ -50L M46 W/ BALKI a NO COMM & " a FROUAA5 E E I E I � , i� Aq .00� EL MO � w o' N. t r " t ivy - a tom, 0»mMrndumY. SOIL AND SITE EVALUATION REPORT Page Ld tabW R.II o at s amw a awwww s in accord vAdv !1 4R 83.05. WIL Adm. Coda AStao sits phn on pow not km than 612 x 1 1 it i in ails. MW � • � ST. CROZE M C O. rat &nmd to vniai s and Irorm"ald rdwen m Pma OR*' dnrrebionad. rash allow. a m , I - I and 6trtrnCra Id OATE APPLICANT 11WORMATION- PLEASE PINNT p RW 10N AidWWky=A7m B 1 /2S 24T 28 NR 20 ' W O ftut u�w 1 12S 19T 29 19S 19 -6MAw AND SAM TOM MEW= & Stf81l. a11" OR c9U PROPEIiiY OWE ' ST TROY jjj j AGS 260 COD>9TY GOAD F � ZPCODE 4„rOSi4� 'i2eAD 5 pt j "a cma nc ian un (1; I Aeait mm, Nweber ( 1 M b "* l 1 [ [ Pt61ic ar ca etcial detaribt Coat driuea d* mw - 0 Wd Reooaraietded P laa� tar _49-4" bed. Aotorplieon area ratRticea gibed. , tmrtdt 1 Nlmomnm design btdit9 raft g f bet gpW E- L t GRft 9P" n smfecs,eltraliott(sl BY DESIGNIM — it (as rabtrad built plea betdraeMd . . Raodplairtale+ration. ita ppicr* N SA — R 1'araottt>aleeid fei r�1•- ••. -� $ s Stitablt TOf syttert ant tloNw. troth Q s l�u AmRAOB r Otn+D sir Im 1N F1L FtntolNri TAMt U= Urtsttimbit for sv$m Q S CSU ( 1Q S Q U ❑ s $u Q S Nu C3 12U SOIL DESCRIPTION REPORT Oapttt 11omiltsm Color Molaee Textnte Sftacttr[e C.ormist = RflCIS Bed O tetdt lHortimni m, 11 11 I QL SL Cent Color Gr. Sz Sh _ Bong # A 0-18 10YR 3/4 sil 2msbk mfr Cw 0.5 0.6 C 203 B1 18-29 10YR 4/6 --- sll_ 2msbk mfr cv tvf 0.5 b .6 B2 29 - 39 LOYR 4/6 f2d 7.5 YR 3/4 sl lcsbk r s 0.4 0.5 Gmund dw. R 3 1QU 813 last 31 - C L !L 6r9 29" Remarks: ,A 0 10YR 4/2 1 W - a.s 0.6 20 B1 10-37 LOYR 4/6 --- it bk r s of 0.5 = 0.6 of B2 37 -65 iOYR 4/4 m 7. c k 0.4 €0. Gmtxd tdev R 65-70 10YR 8/3 Lus 908.88 T l 1� [ 1 P JAM M RUOM NMI (715) 425-7631 OGDM ENG1 CQ. 113 WEST WALNUT ST- RIVER RALLY. Wf 54M x//0 c � gyp(" � SOIL OESGH{I' I IUM titr{+un 1 tiCE :..O. t t>*o n S � Fioa�s GPO prang iI Horizon O� r ! p SL CDM CDW T Gr. SL S A 0-34 10YR 4/3 it bk r 2vf d.5 B1 34-53 10YR 4/6 --- it bk r lvf 0.5 ilOtM{d B21 53 -60 10YR 5/6 s csbk r lvf --- t R B22 60-68 10YR 5/6 cld 10YR 3/4 fs fr s lvf .Sz:Z 0 C 68-80 10YR 614 Mit imNn9 am Remarks: ;rang Gmum one in ekv R i iarrn9 I • I xuM ew_ tL I Dom to Remarks: owing e i Gtound eier. t R in ta�mr Remad�s: 77028 ff U Z 6 Z S P S O `i KATHLEEN H. MALSH STATE BAR OF WISCONSIN FORM 2 - 1998 RE ICROIXOF DEEDS WARRANTY DEED OocunwM Number RECEIVED FOR RECORD -_- -- - ` - 07/28/2004 10:06AH This Deed, made between WARRANTY DEED I� Troy Developent Corporation, a Minnesota Corporation EXElPTi Grantor. REC FEE: 11.00 I� and Michael D. & Patricia B. Holte TRANS FEEL 329.70 COPY FEE: CC FEE: If PASES : 1 Grantee. it Grantor. for a valuable consideration, convoys and warrants to Grantee the following i described real estate in St Croix County, State of Wisconsin: :j Lot 30 of the Plat of Troy Village 1st Recunalr g woe Addition in the Town of Troy, St. Croix County, Name end Ratum Address i� Wisconsin. Michael D. & Patricia B. Holte II •1101 Maple Avenue Subject to Declarations of Covenants, Conditions and Hudson, WI 54016 Restrictions for Troy Village, recorded in Vol. 1241, 1 Page 256, as Doc. No. 559954, and the Declaration of t� Golf Course Covenants, Conditions and Easements. recorded in Vol. 1241, Page 301, as Doc. No. 559969, p40 1247 - 000 all as appearing in the office of the Register of Deeds ii for St . Cr oix C ounty, Wisconsin, and such other Parcel Iden9flCatlon Number (PIN) ( easements, restrictions and reservations of record, This is not homestead property. E or in use, and the "Buyer" obligations contained in (is) (Is not) � the Purchase Agreement for this lot. y i' i+ it ii )i }a Exceptions to warranties: !; Dated this 23rd day of Jul 2004' I' r �I (SEAL) (SEAL) I . Ric and Haiuptzok, Vice - Presid ttai Troy Development Corporation fl (SEAL) (SEAL) I� 'I AUTHENTIGATION ACKNOWLEDGMENT () Sigrtature(s} Minnesota State of %V+vvvTra+rr. �! ss. Anoka authenticated this day of Personall came before me this Lard day of I JU I 2004 . the above named R ichara Ha uptzok. Vice - President Try Development CorRoration ` - I TITLE: MEMBER STATE BAR OF WISCONSIN to I (If not, me known to be the person who executed the foregoing !I authorized by §706.06, Wis. Stats.) inatrument and ackrwwledge the same. ' THIS INSTRUMENT WAS DRAFTED BY IE if TROY DEVFMOPMEW CORPORATION Carrie A. Albrecht I Notary Public, S4afe.e&At1saofuAoAn0ka County, Minn. '• Charles S. CooK, President My comm sion is permanent. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both are not �/ �i necessary) ll �: • Noma of perso signing in any cepeary muA be typed « Primed below their ,ignumm !I STATE BAR OF WISCONSIN vlsoantr� lop* ek.* Oo.. Im. �I WARRANTY DEED FORM Nu. 2 -1998 MIIWaMee. Wrt. , AML CARRIE A. ALBRECHT NOTARY PUBLIC - MINNESOTA qW MY COMMISSION EXPIRES JANUARY 31, 2005 , ;lfiscpnsa: OeparUT*nt of Industry, SOIL AND SITE EVALUATION REPORT Page I of I_ Labor and Human Relations oivisan of Safety s Buildings in accord with ILHR 83.05, WiS. Adm. Cade COUNTY Attach complete site plan an paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST. CROIX PAACELI.O. a not limited to vertical and horizontal reference point (9M), dir f slope, scale or dimensioned, rorth arrow, and location and distance to n r4 l"" l I `3 REVIEWED BY DATE APPLICANT INFORMATION- PLEASE PRINT ORMI,�ION Ix PROPERTY OWNER: I 1LL tjVtL P LOCATION E 1/2S 24T 28 NR 20 W TOM RUEMMELE & JOHN AND BARB R L GOVT, GCVt,= 114W 1 /2S 19T 29 NR 19 - 6440W PROPERTY OWNER :S MAILING ADDRESS . �O �tOT - SU80. NAME OR CSM s 260 COUNTY ROAD F ST CROI - 3 t " I TROY VILLAGE CITY, STATE ZIP CODE P u ILIAGE OWN NEAREST ROAD HUDSON W 54016 (71 FFfC LIwaSA '20,4 0 ns New Catrt=W Use (X ] Residential / Number o i _ ( ( Addition to existing building E I Replaoement ( ( Public or commercial describe Code derived daily flow 600 gpd Recommended design loading rate D. g' bed, gptt — trlanch. gpd/ft Absorption area required 5 bed. tt SOO trench, ft Mahomum design loading rate D• S bed, 9MO 46 trench, gpd11t Recommended infillration surface elevatio(s) BY DESIGNER 4 (as referred to site plan benchmark) Additional design I site considerations '596 NaTES v N AMLMO 3 Parent material M-4 /2P4 OA4 i 7e - Rood plain elevation, if applicable N/A It S = S wtable for system CONVENTIONAL MOUND I "ROUNO PRESSU AT- GRADE SYSTEM IN FILL HOLDING TANK U= Unsw=le for system 1 S Zu I Z S p U ❑ S ($U I Q S au I 0 S 2V 1 ❑ S RU SOIL DESCRIPTION REPORT Horizon' Depth Dominant Color I Mottles I Texture I ` Structure I Roots GP0 /ft f in. Munsell Qu. Sz. Corn Color Gr. Sz. Sh I I Bed Mirth Boring # A 0 -18 IOYR 3/4 - -- s 2msbk mfr cw 2vf 0.5 0.6 201 >> B1 18 -29 lOYR 4/6 - -- sil 2msbk mfr cw of 0.5 '0.6 B2 29-391 IOYR 4/6 f2d 7.5 YR 3/4 sl lcsbk jmfr lcs of 0.4 0.5 Ground elev. R 39 -42 IOYR 8/3 - -- lmst - -- - -- - -- -- - -- - -- 90 Q It. Depth to limiting I factor 29" Remarks: Boring # A 0 - 10YR 4/2 - -- 1 2m - csbk mfr cw of - f 0.5 0.6 < 20 2 B1 10 - 37 IOYR 4/6 - -- sil 2msbk mfr cs of 0.5 0.6 long B2 37 -65 IOYR 4/4 ml 7.5YR 3/4 csbk mfr CS Lvf 0.4 `0.5 Ground elev. R 65 -70 IOYR 8/3 - -- lmst -- --- --- 9 -- -- -- Depth to lifttibng factor 37" I I Remarks: Name: — Please Print yApAES D. FlLKWS P h 0 n O : (715) 425 -7831 OGDEN ENGINEERING CO., 113 WEST WALNUT ST.. RIVER FALLS, W1 54022 Side; Dam ¢ �° 7 rte? CSTM03988 PRa OWNER SOIL OESCRIPTION REPORT Page ? of 3 PARCEL I.t). 0 G P D/tt Depth I Oommant Color I Mottles Texture I Structure ROOD g� Boring # Horizon in ` Munselt Ou. SL Cont. Color Gr. Sz. Sh. A 0 -34 110YR 4/3 - -- Isil 12msb k f w 2vf 0.5 10.6 203 B1 34 -53 lOYR 4/6 - -- sil msbk fr w lvf 0.5 I0.6 B21 53 -60 10YR 5/6 - -- fs lcsbk vfr s lvf 0.5 IO 6 Ground I elev vfr I S lvf - -- ' - -- 9 B22 60 -68 10YR 5/6 cld 10YR 3/4 Ls �csbk Depth to C 68 -80 10YR 6/4 - -- s R 1 - -- - -- - -- Gnti6ng factor 60 Remarks: Boring # I } +R Ground elev. ft. Doom to limning factor Remarks: 8onng ;s ' 1 Ground ele . ft. I I Depot to firmang 1 ` factor Remarks: Boring # I ` Ground elev. ft: Oapth to lirmting factor 7 1 RemarW. S8d8.130(fi.Ot31?� PAGE 3OF3 SITE PLAN SCALE: 1" = 40' I /D 1 l 1 ':%e ,�rrSF��•✓T I I 8 - Zo z I 4 o � v B -Zo3 GAT z9 � 'NOTES: PROVIDE MINIMUM OF 1' SAND BETWEEN BOTTOM OF BED AND EXISTINS�G MOUND TO BE A MINIMUM OF: 25 FROM DWELLING; 50 FROM WELL; I LOT LINE. OGDEN ENGINEERING CO. JAME . FILKINS, CSTM03988 Civil Engineers & Land Surveyors � � 113 V; . Walnut St. ) 425 - 76315 WI 54022 DATE: 7 _ l �Q `wisconsin oapartrrr+nc of ^d�s�^/ SOIL AND SITE EVALUATION REPORT Page L of 3_ Labor and Human AManons Oivoswn of SatstY & Bwkkngs in accord with ILHR 83.05. Wis. Adm. Cade COUNTY ROIX ST. C Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must include, but PARCEL I.Q. not limited to vertical and horizontal reference point (BM), of siope, scale or dimersoned, north arrow, and location and distance t 4 road f APPLICANT INFO RMAT10N- PLEASE PLAIN ��1NF4Fj,�ATTON�F' RE1IIElNE08Y DATE PROPERTY OWNER: ry P LOCATION E 1/2S 24T 28 NR 20 W TOM RUEMMELE & JOHN AND BARB 1;L LFL- 114W 1 /2S 19T 29 NR 19 -6( PROPERTY OWNER':S MAILING ADDRESS _ LO Itee x SUBO. NAME OR CSM a 260 COUNTY ROAD F ST CROIX Q I I T ROY V ILLAGE CITY, STATE ZIP CODE NU ki.AGE OWN NEAREST ROAD HUDSON W 54016 ( - 4 9FF ICE LmOS �OAD New COMU1 coon Use ( j Residential / Nu s [ j Addition to existing building L j Replacement [ j Public or commercial descnbe Code derived daily flow 600 gpd Recommended design loading rate D- ¢ bed, gpd/ft trench, gpdM Absorption area required 0' bed. 9 Soo trench, ft Maximum design loading rate „Q• ✓ bed. gpd/tt� A w stench, gpdA Recommended infiltration surface elevations) BY DESIGNER R (as referred to site plan benchmark) Additional design/ site considerations SEE NoZJ!5�5 aw P -4L�E 3 Parent material - oifSS 771-1- Rood plain elevation, if applicable N/A h t S - =U�nsVuitable system I CONVENTIONAL I MOUND INwGROUNO PRESSURE ( A S AOE ( Q 241 ( Q ��UK U = f system CS Ta ` 0S ❑ U ❑ S au SOIL DESCRIPTION REPORT Horizon Depth Dominant Color ( Mottles Texture Structure (Consistence 8otuhdaly Roots GPD /ft in. Munsell au. Sz. Cont. Color Gr. Sz. Sh. 8ed ITmttndt Boring # A 0 - 10YR 3/4 - -- sil 2msbk mfr cw 2vf 0.50.6 20 I. B1 18 -29 10YR 4/6 - -- sil 2msbk mfr cw of 0.5 '0.6 B2 29-391 10YR 4/6 f2d 7.5 YR 3/4 sl lcsbk mfr IC Ivf 0.4 0.5 Ground elev. R 1 39 -42 10YR 8/3 - -- lmst - -- - -- - -- -- - -- - -- g 08 ..2 It. Depth to limiting factor 2 9 " Remarks: Boring # A 0 -10 10YR 4/2 - -- 1 2m -csbk f cw of -f 0.5 0.6 202 B1 10 -37 IOYR 4/6 - -- sil 2msbk mfr cs Ivf 0.5 0.6 B2 37 -65 10YR 4/4 m.1 7.5YR 3/4 csbk mfr cs Lvf 0.4 7 0.5 Ground elev. R 65-70 10YR 8/3 - -- lms t -- -° °- 9 -- -- -- I Depth to limiting �; i i Remarks: FSOMM. s —Plem Print JAS "� .0, FLKINS P (715) 425 -7831 OGDEN ENGINEERING CO., 113 WEST' WALNUT ST., RIVER FALLS, WI 54022 CST Nwobw- oats: 'f /- /- f / ?7 CSTM03988 PRCPERrYGWNEA SOIL DESCRIPTION REPORT Page 2 of _ 3 PARCEL I.D. r Depth Dominant Color Morales Texture Structure I jB�� Roots B ed ?,Tm Boring Horizon in. Munsell Clu. Sz. cont. Color I Gr. Sz. Sh. Bed TrenCt A 0 - 34 10YR 4/3 - -- sil 12ms bk fr gw 2vf 0.5 10.6 203' ` B1 34 - 53 10YR 4/6 - -- sil msbk fr w lvf 0.5 10.6 B21 53 -60 10YR 5/6 - -- fs lcsbk vfr s lvf 0.5 IO.b Ground i 90�n. B22 T60 10YR 5/6 cld 10YR 3/4 fs csbk vfr s lvf -- Depth to C 68 -80 10YR 6/4 - -- s 1 -- - -- - -- - -- Gnmting f actor 60" - I Remarks: Boring # .1.i/ilf[.10 Ground elev. ft. Depth to ( ` fimrong factor Remarks: Boring # I 1 I I I I ( Ground efev. It. I I Oepth to 1 limning I f factor -- T Remarks: Boring # I Ground elev. ft Depth to limiting factor Remartcs: 38Ca�01fi.0ar'OZ1 PAGE 3 OF 3 SITE PLAN Gor 9/ SCALE: 1 " = 40'' /o G o 7 � B Zo z I �O 8 -zo I I � B - Zo3 l LET z9 ,NOTES: PROVIDE MINIMUM OF 1' SAND BETWEEN BOTTOM OF BED AND EXISTING �G O ) MOUND TO BE A MINIMUM OF: 25' FROM DWELLING; 50 FROM WELL; 5 I LOT LINE. i t OGDEN ENGINEERING CO. JAMES . FILKINS, CSTM03988 Civil Engineers & Land Surveyors 113 W. Walnut St. River Falls. WI 54022 DATE: _L! /27 (715) 425 -7631 i p42.7 67 i 941.5` y. N ' 9 1 Of CL ► / / gL165� — , Ao F a -,� i e ,. I ,• ,, , ..� 'A �. /. a .�= w000 x145 981 1 I / + / 209 / 1 t ► Q \ 1� - r V 1 , t B— of V 8 - 19'A / i I / ►' ' 21Cr ' f95 Ot �..., / ' o. /' '00 —199 -- 192 \ w — — —8-104 t �.J /' 4 d o ol / / / t olo / / 0 N. ..� /� , / 904.8 ' - / 41 lop o oo � � / 8-14 g / / \ \ / ♦ \ =— = , 309,0% T 57 +22.8 901.1 4 -247 w / I do oo .4 / O � 900.8 / �, + • •+� / / / / �,