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r _- Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and $uil ` 'ng 9ivision INSPECTION REPORT Sanitary Permit No: 420695 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Kozak, Timothy Troy Township 040 - 1247 -30 -000 CST BM Elev. Insp. BM Elev: BM Descri on: Section/Town/Range/Map No: (J 6 - c l� f'1'1 9 �1 24.28.20.1275 TANK INFORMATION EL VATION DAT TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic 11 Benchmark 1 /31'A "'�j Z . 2.3 3 o d b posing �0 � Alt. BMr v &4�� 3 .o� a Aeration C� 0-7.� r - Bldg. Sewer / Holding TANK SETBACK INFORMATION St/Ht Outlet TANK TO L #WB DG. Vent to Air Intake ROAD Dt Inlet Septic X � 3 r � D t Bottom f ` y 2 - (o p "1 0 Dosing r -60,( Header /Man. 3) v` Z.3 i Aeration DIoe S 03 Holding Bot. Syst m PUMP /SIPHON INFORMATION Final Gra e Manufacturer Demand St Cover GPM �r �h S GtbdV� Model Number p 3Z• ��. � 9 d. 33 TDH Lift ( Frictign Los System Head T7 Ft Forcemain Len ` Dia., /i Dist. to` we b 7 (!�- ,te I 2�OL J e SOIL ABSORPTION SYSTEM / VI .,' . aZ,4� BEDITRENCH Width Length I N o. Of 11, Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L l:: BLDG WELL LAKE /STREAM LEACHLW Manufacturer: INFORMATION C R OR umer: Type stem: -3 y n � � (� UN Model Nb DISTRIBUTION SYSTEM � 4 C Header /Manifold Distribution ole $izee x Hole Spacing Vent to it Intake ipe(s) 1/0 L �h Length ' Dia _ Spacing 3 , x H I d G Z,34 r! SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only p 4 AAd 6 Depth Over O Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center r Bed/Trench Edges Topsoil RIN Yes 0 No , Yes [] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 49 / d3 Inspection #2: / / / Location: 277 St Anne's Pkwy Hudson, WI 54016 (E 112 24 T28N R20W) Troy Village Lot 33 Parcel No: 24.28.20.1275 a � 1.) Alt BM Description = 97,-? 0 P _ 1 f 1I ( 7 -v�y s�/L( � S�/f7�I� ray �AG�d7/� 2.) Bldg sewer length - ?, 5 �� r /- - amount of cover = 3.) Contour = 1 L) ' 33 t (11'rJ P1 ' �lq-a 6'(1t nof— �2✓- (� 4: ✓� 5 Plan revision Required? �1 Yes No - S Use other side for additional information. o e SBD -6710 (R.3/97) Date Insepctor's Sign Cert. No. Safety and Buildings Division County 4 201 W. Washington Ave., P.O. Box 7162 iscvnsin Madison, WI 53707 - 7162 Site Address Department of Commerce 7. ,q-A)VCF s Sanitary Permit Application Sanitary Permit Number In accord with Comm 83.21, Wis. Adm. Code, personal information you provide Af2cy0 1 6— may be used for second purposes Privacy Law, sl5. 1)(m) ❑ Check if Revision I. Application Information - Please Print All Information State Plan I.D. Numbe g;yfyf; oTesw4 I $ Z 2 Property Owner's Name a Property Owner's Mailing Ad / dress Property Location 2 S 4<S T 09 N, R ZO City, State Zip Code Phone Number Lot Number • Block Number - / Subdi Name CSM Number lv till ( ��d l - 140 1 V b c� 11. Type of Building (check all that apply) aS I 5 nW` i ❑City A 1 or 2 Family Dwelling - Number of Bedrooms (3�►ws ❑Village ❑ Public /Comore ial - Describe Use IRTownship - jW d El State Owned ��"^� •� " If t tt Nearest Roams f ��� (L 9 K SO n� v = o•sa 6 A 1 P III. Type of Permit: (Check only one box on line A (numbering scheme for internal use). Complete line B if applicable) A. For County use 1 % New 2 El Replacement System 3 El Replacement of 6 El Addition to System Tank Onl y Existing System B. ❑ Check if Sanitary Permit Previously Issued Permit Number Date Issued IV. Type of Permit: Check all that a I)(numberin scheme is for internal use) YP ( PP Y g 44 ❑ Non - Pressurized In- Ground 21g Mound 47 ❑ Sand Filter 50 ❑ Constructed Welland 22 ❑ Pressurized In- Ground 41 ❑ Holding Tank 48 ❑ Single Pass 51 ❑ Drip Line 45 ❑ At -Grade 46 ❑ Aerobic Treatment Unit 4 Recirculating 30 ❑ Other V. Dispersal/Treat ent Area Information: 64 Design Flow (gpd) Dispersal Area Dispersal Area Soil Application Percolation Rate -System Elevation Final Grade Required Proposed Rate(Gals. ays /$q.Ft.) (Min. /Inch) 9 Elevation VI. Tank Info Capacity in Cr Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Tanks Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank /" l C �n Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plum s Name (Print) Plumber's Signature MP /N4PRB Number Business Phone Number Plumber's Address (Street, City, State, Zip Cod 6 5 -�—E� t u f VIII. County Depa rtment Use Onl Approved ❑ Disapproved Sanitary Permit Fee (includes Groundwater Date Issued Issuing Agent Signature (No Stamps) Surcharge Fee) El Owner Given Initial Adverse 2 Determination ✓ � J Es6�= 'k Ar IX C�ondit}Qns o Approval/Reasons or Disapp oval 04 � _ e� o � C o. nI / S,t�valC�.. d LaR. Ct � -cuo w,p C.c� __ ---- -- Attach complete plans (to the County only) for the systgm n r not less t an 81/2[x 11 inches in size SBD -6398 (R. 05101) CCJJ - PLOT PLAN - Pa ge 3 of 7 • t Scale 1 "_ 40 ' • I o �o �. 3a V BM o a3 L It O¢y N ec �t-IU� Wtk � ►3�'�tZ Q M t�) - �L. 7 00 O ' O►- TO I .:, J 'Bilk - -- R - � �? � =�0 - 3 ..�, _ 1 ti \tZC�►�.► ['l i� E_ CST "CoCz:�L�c._- -_ -- - - - - -- ^-� NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be �O /GS ogallon capacity manufactured by wt CS Cp L., Cy— K1 f 11 1$o0 Z P.S V-1-- F t L 4. Bench mark 5. Divert surface water around system to prevent ponding at the uphill side. �4 Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Visconsin www.commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov James Doyle, Governor Cory L. Nettles, Secretary February 04, 2003 CUST ID No.267341 ATTN: POWTS Inspector ARTHUR L WEGERER ZONING OFFICE WEGERER SOIL TESTING & DESIGN SERVICE ST CROIX COUNTY SPIA PO BOX 74 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/04/2005 Identification Numbers Transaction ID No. 834443 SITE: Site ID No. 654522 Tim Kozak Residence Please refer to both identification numbers, 281 St Annes Parkway above, in all correspondence with the agency. Town of Troy, 54022 St Croix County SE 1/4, NE 1/4, S24, T28N, R20W Subdivision: Troy Village FOR: Description: Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 886545 Revision The submittal described a conformance b o has s been reviewed for c nformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in Cond1 chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: APPF General Approval Requirements: DEPO MEM OF • This system is to be constructed and located in accordance with the enclosed approved plans and with the WE C�FiJFi) "Mound Component Manual for Septic Tank Effluent for Private Onsite Wastewater Systems" SBD- 10572 -P (R.6/99) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems" SBD- 10573 -P (R.6/99). • Per manual cited above, limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • Access to the filter for cleaning must be provided per Comm 84 product approval conditions. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required • The well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption area. chs. NR 811 & 812c • 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. Stat 1 . 4 ARTHUR L WEGERER Page 2 2/4/03 • Comm 7 83.22 A co of the approved plans, specifications and this letter shall be on -site during construction () PY p p P g P and open to inspection by authorized representatives of the Department, which may include local inspectors. w Responsibilities: Owner espons�b ties: • Comm 83.52 Responsibilities. 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. • Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /installation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure,' or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 60.00 Fee Received $ 00 0. Balance Due $ 0.00 Charles L Bratz POWTS Reviewer II , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz @commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715)726 -2544 TITLE SHEET Page of MOUND SYSTEM FOR A 3 BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD -1057 P and the Pressure Distribution P: SBD- 10573 -P lanual C�. 6/ gq� C 1a. 6 l 4 9 LOCATED IN THE Z 1 / L OF THE -- 1/4 OF SECTION Z Y , T Z8 N, R - Z (3 W, TOWN OF �-�U� -j ST• C-�L�C COUNTY, WISCONSIN. OF . TiZ1 V1 C'R 6 c INDEX PAGE 1 of 7 TITLE SHEET PAGE 2 Of 7 SYSTEM NA'iAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUi.iPING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR RECEIVED FEB - 3 2003 SAFETY & BLDGS 011J. )O W A y PREPARED BY ` OFCOAWE RCE E�E�ER SO 2 L TESTS r4C W� AND. DES = GrV ipDNC� P.O. Box 74 421 N.iain St. River Falls, WI 54022 Phone 715 - 425 -0165 Fax 715-425-6864 E' •..••• °• • ,, U X55 RL54YpgTw JOB NO.. i - Mound System Management Plan p age Z of Pursuant to Comm 83.54, Wis. Adm. Code Sebtic 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 even 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, Safety and Buildings Division. 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 for frost protection. Influent quality into the mound system may not exceed 220 mg /L BODS, 150 mg /L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and 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 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual (SBD- 10572 -P (R. 6199)] 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. ContinQencv Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning Office at 11S - ��(_ y6$0 ST. 0 -IZ 4 .) �X The system installer at The tank manufacturer at � [C) _ 3ZS — LyIE�g The effluent filter manufacturer at The pump manufacturer at - PLOT PLAN 4O Page 3 of 7 t � , Scale 1 "= " z lo i ll aq a erg DlS1 v�z.L3 � ,o� a 3 • � r < � � N ec - C7 zg�• 83 1 _ -0-100-0 '0"1 -FOB Or- 8- .�ZM40 - -_Sax ..__ \.1ztl-) P L P E U co - -- 'Co � i > SO ` FiZOM oU NOTES: 1. Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( -� required). 3. Septic tank to be �� �C�S Ogallon capacity manufactured by �&JICSzz" ck))j E w/ )Z) 1800 ZA�t FiL 4. Bench mark_ 5. Divert surface water around system to prevent ponding at the uphill side. Face y• t Approved' aSTH C33 Distrieu;icn Fipe Medium Sand I epscil I b LA I l z Slope Distribution Cell or Force Main Plowed 2" to 2- aggregate From Pump Lcyer 0 p.5 RE. E C) Ft. CROSS SECTION 0- a li�OUYD SYSTEM F U R. G O. S Ft. A 9 Ft. f \ 0 Ft. - Linear L - - - C - It ozc_r_c P.c =P1 GAD /!:,Y FT E S� F• Design Loading Ra t` =D.38 GPD /cQ FT r 1 5 Ft. J S F t. ,K `?, Ft. 4 Z 9 Ft . �} - observation Pipe _— - - - - -- --- -- _- - - == - - -� A a -�-- -- - - - - - -- --- - - - - -- ------ _ - - - - -- _-- - -- 0— � Y6 - e______ _ Force Main W `- - -- - ------ ----- - - - - - -! — �4istribution „ Pipe Cell of to 2 aggregate Observation. Pipe --- (�ehbr secare2y) - PLAN VIED OF g HOUND SYSTEM Distribution Pipe Layout Page S of Place the holes at the bottom t o.f the distribution . a ion pipes at equal spacing. cing. Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of long turn or 45 ° fitting to a oint within thin six a inches of the final grade. Terminate the ends of the laterals with a valve :threaded cap or . threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug, FVC ^ Lateral M n ld ifo :Lateral � C X x x x x!Z xQ x x x x Lateral Length — Lateral Length — Distribution Line — —o h fZ•1J 1 Ft� � S pvC Uzi: yt f i o -- P Ft. Hole Diameter 1� Inch S _3 Ft. Lateral 1 Inches) X Z 3 Inches Manifold Z Inches Force Main " Z Inches I of holes /pipe 13 Invert Elevation of. Laterals lbd,O Ft. (4 S.33x 6= 3 s J - Combination Sept4c;Tank and PUMP CHAMBER CROSS SECTION ANO SPECIFICATIONS' PAGE OF 7. NEUT CAP WEATHER PROOF JUUCTIOU DOX .. 'i - C. I. VEIJT PIPC APPROVED LOCKIJJC. 110 - FROM OOOJL. AANHOLE COVER ; -JL111 '-iWOOW OR FRESH wAtZrJISJG LN%EL.. sp�ila>J C' lPE A� IUTAKE coraputT ` wlr�ncLrsl� GrP � t , r� >`�;uts� 6'•�w. - -01`1 I YrAIU. IS�MIJJ. � ---- - - - - -- c \ IAJLET PROVIDE I - -_ — �]"" AIRTIGHT SEAL I I I I I Approved Z>�8�t �� °� I Approved point w/ _��Up I 111 Joint w/ PVC pipe - JI ALARA PVC pipe Is I I I I ou C 1 I �.Oc� I I LLEY. __� PUMP �� OFF D COUCKETE BLOCK 3" Appko"C-t ti . . RISER EXIT PERMI'TT'ED OIJLtJ IF TAWK MAI;UFACTURER HAS SUCH APPROVAL I SEDD:Nr. __jj„__�oo t,�4 SEPTIC f SPEC.IFICATIOUS DOSE TAWKS MAIJ UFACTU;LCR. C�)�,J AJUMBER OF DOSES: S ,O w PER DA., TAJJK 51ZE: 1D00 1 6 -SO CALLOUS - DOSE VOLUME z ALARM MAUUFACTURCR: S -�� �C�Z� S` ` . S T EM3 MICLUDIMG 6ACULOW: GALLONS MODEL WUMBER: l 0 1 4W CAPACITIES: A= _ 3 O�j CALLOUS IUCHES OR SWITCH TYPE: M�Z�'•UQ..`( U 8 = IMCHES'OR �� C, ,LLOLIS PUMP MAJJUFACTURCK 1•L�-S C: _IUCHES OR CALLOUS MODEL UUMBER: _ �� 4O p= �Z � Z IAICHES OR ZO ' GALLOWS SWITCH TY Y'1LZC PE: Y DOTE: PUMP AJJD ALARM AR L TO 6_ 10 M{J,{1MUM DISCIiARGE RATE GpM INSTALLED OM SEPARATE CIRCUITS VERTI AL DIFFEREMCE DETWEEU PUMP OFF AUD- DISTRIBUTIOM PIPE.. \3 js ^2 � L � �� FEET + M IJIMUM METWORK SUPPLY PRESSURE FEET -�K L< 3) + S FEET OF FORCE MAIN X Z 19 F 00FZFRICTIOU FA FEET TOTAL 0tWAM{L HEAD 1 y FEET As per manufacturer l`� <O gal /in. Liquid depth 3S M E40 Series MYM 4/10 HP Effluent and Drain Water Pumps Performance Curve MODEL ME4O EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 I W 30 W W Z 25 8 X Z W 20 ~ _ 6 O a 15 F-- 31.98 4 H 10 F- 5 2 0 0 10 20 30 40 50 60 70 80 90 100 0 CAPACITY GALLONS PER MINUTE 1z 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91 Printed in U.S.A. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of _ Division of Safety and Buildings ; inaccorda wlth;�d+infi'5, CO El Count C40-0 �K Attach complete site plan on paper not less than 8 1 x 1 ,sIe,, Plani must Include, but not limited to: vertical and horizontal ref rent, ) dt On And Parcel I.D. percent slope, scale or dimensions, north arro w, a d• 014c)!1 447- 30 - 0 Please print all information. Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 18.04 (1) (m)). ASS-1 Property Owner Property Location T1M0TM4 CAK --A WZ.^K )(4 d2-)d S24 T 21 & N R 20 Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 2.L4 7SA8Y 99*111 .55 ?7ZDy VILItA&C City State zip Code Phone Number ❑ City ❑ Village 81 Town Nearest Road uors0-Q o 40 1 C7 I I ) 531 - z 90 TP01 AAAM5 MIJY • New Construction User Residential / Number of bedrooms _ - !s— Code derived design flow rate _ � _ GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material OLCWRsW/ - L-q,., Flood Plain elevation if applicable AkA- ft General comments O. S r F1w and recommendations: MMA. J D SN1 - O,y LOAD fay -RN E a Boring # Boring Pit Ground surface elev. _ QS_ ��_ ft. Depth to limiting factor 3f_ in. Soil A Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etfi#1 'Eff#2 4 oyt�Zl► — L Zf'5bk MAr a6 34-10, 0.5 0 -S' 211 - Ls I in &6K m vfir o, 1 .2- 3 - S �Q 4 -t LS w S O.Iv y - 3 - 7 10410/4 2 M K S 05 5� --y 3 �, 3 LS 1 nn ab MAY a � 0 t "7 1, G w�- .sYK3/ s p s �1 W — 0-1 2-] Boring # Boring Pill Ground surface elev..�_ ft. Depth to Umiting factor _ in. 'cation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary RootJ!-Efffil GPD /tf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#2 1 D ?lt L Zf ab K -m Z 14-1-S zh - b v- b -to -q PAP 3 2 - co 0.4 0 -1v 4 y 3 5 - 11 -co 10 ,28 - - 59 /o , (14g /y - si I s ors q- to - -4K 3 L Ljjnab(l r r u� -6D 0.4 0 .6 7 4S- 7,s uent #1 = BOD > 30 < 220 mg/Land TSS >30 15 ' K rttuent'{2 = BOD < 3-mg/L iTd TSS < g/L CST Name (Please Print) ignature CST Number MA J0 HALL F - ZZ q 93Z- Address Date Evaluation Conducted Telephone Number W`i815 6qC +K Aver 1k1VE jAl1S WI 59022 �� -24- 3 L7�5 yob -1�7S Property Owner _ _�_ ParcelID# 12y7 30 _000 Page of "► — Dil E] Boring Boring # th to limiting factor De Pit Ground surface elev. in. Sofl Ilcetion Rate g], Sp _ ft. P Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots oll' fY Efi#2 I in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ` 0 J4 I t v �-- rrrt abK Jfir rrF- o.S D 8 2 -10 `12�z t_ if abK my r 3 s t_ Zf abK 4 .3 luv �/ std S ,s o S -38 to tZ3 t - tna bK m r 6 B_5 SYe S1 (M –LWA 'f-�tr Z m 0 7 -53 f Boring ❑ Boring # Dpit Ground surface elev. ft. Depth to limiting factor — In. Soil lication Rate , Horizon Depth ominant Color Redox Description Texture Structure Consistence Boundary GPDfff Roots 'Eff#1 Bff #2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Boring Boring # D Bo o Ground surface elev. tt• Depth to limiting factor _ �^ in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture ture Consistence Boundary Roots •Eff#1 fEff#2 in. Munsell Qu. Sz. Cont. Color : :Gfr.Sz. Sh. i Effluent #1 = BOD > 30 1220 mgll and TSS >30 n 150 mg/L ' Effluent #2 = BOD < 30 mg/t_ and TSS < 30 mg/l i 1 •rhe Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or need material in an alternate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. seo x3sora.aoor Prof PLAN f'MM OMM OzAK ll Mo LA ENn: = YO LOT 3 E Pm- OF £LF A J AI E 2 sway - rZf U!j! L lM-D A10, 42 si -501L DOING W/ 6ACKNOE F NO COMM 83 5ETACK PROPLEM5 ST � V SCALE � EL Cl9.00 X43 � i l_oT 3 3 PM e x 56UP C5T 2zy83z PL.A1 N v Im PAS: 241 -a� k R vile'. it 1F.4 ° 1F, i —u uGJT Iii f 1; •, -• _ _ 1 _ :;I�EI i �d.,IrlEEP 7t1, _ � F>;-;E GF O f� � yI :- ' i %il • t ( I I (1 1 • i I 1 i 1 1 \ ,.• ♦ �/ z �1li�. ' '� �%= �i� / � t / 1 I 1 t , 9T2� ` 16 +96.0$ i , /r - ` ~ 1 , 1 • \ 8-174 941.3 �42-7 / di / ♦ J M 1 8� 167 1 , , i I J / Jr li 10 1 1 i e- 17a 9-109 L ' 5 \''' 944.0 w 1 t 8-108 'r \ � [[ \ Je- Dom' Q 9-150\ � ,' - 'b =196 , 937.x , 6-- 194 L b T 33. 9--199 IF S-T92 "50 • � � � . PC .. Z_ - � / X 200 � /` \ 4� 104 41 913.0 - --Z Safety and Buildings • 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 TDD #: (608) 264 -8777 Visconsin www .commerce.state.wi.us /sb Department of Commerce www.wisconsin.gov Scott McCallum, Governor Philip Edw. Albert, Secretary January 02, 2003 OUST ID No 267341 ATTN: POWT,S Spector ARTHUR L WEGERER ZONING ICE WEGERER SOIL TESTING & DESIGN SERVICE ST CR COUNTY SPIA PO BOX 74 1101 RMICHAEL RD RIVER FALLS WI 54022 H ON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/02/2005 Identification Numbers Transaction ID No. 824683 S E: Site ID No. 654522 . n1 Kozak Resid Please refer to both identification numbers, 2 t Annes Parkway Labove, in all correspondence with the agency. Town Troy, 54022 St Croix my SE 1/4, NEI 24, T28N, R20W Subdivision: T illage FOR: 3 Description: ee Be in Mound tern Object Type: POWT Sys Reg ted Object ID No.: 886545 The submittal described above has b reviewed for conformance wit plicable Wisconsi ist tive Codes and Wisconsin Statutes. The submi I been CONDITI AL A VED. T�e s deli in chapter 101.01(10), Wisconsin St tes, is ponsiblt for lia th all code re re nts. The following conditions shall met during c truction or inst lationonn an o pancy or use: General Approval Require ts: • This system is to be co ructed and locatevn accor e with the enclosed approve 1 with the "Mound Component nual for Septic Tank Effluent fo vate Onsite Wastewater s" SBD- 10572 -P (R.6/99) and the "Pr sure Distribution Component Manual=- rivate Onsite Wastewa Treatment Systems" SBD- 10573 -P (R. 9). • Per manual cite ove, limited activities are allowed in the area 15 feet s fthe component area. Soil compactio excavation, vehicular traffic and other similar activities th ct the treatment and dispersal are prohibited • Access to t filter for cleaning must be provided per Comm approval conditions. Maintenance jt informatio must be given to the owner of the tank explaining th eri is cleaning of the filter is required ROVED well must be a minimum of 25 feet from any POWTS tank, and a minimum of 50 feet from the absorption IMF " area. chs. NR 811 & 812c • A Sanitary Permit must be obtained from the county where this project is located in accordance with the _ .we quirements 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. Stat • 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. l 1 e 4 V � t� x ,t z •+ ic ARTHUR L WLGLRER Page 2 1/2/03 Owner Responsibilities: • Comm 83.52 Responsibilities. 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(l). • 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. • Comm 83.55 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction /instal Iation /operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ f75.00 Balance Due $A 0.00 Charles L Bratz J POWTS Reviewer 11 , Integrated Services WiSMART code: 7633 (608)789 -7893 , 7:45 am - 4:30 pm Monday - Friday cbratz@commerce.state.wi.us cc: Leroy G Jansky , Wastewater Specialist, (715) 726 -2544 V y ' TITLE SHEET Page of FOUND SYSTEM FOR A 3 BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD -1057 P and the Pressure Distribution SBD - 10573 -P Ctz. 6lgq C tz. LOCATED IN THE SC 1/4 OF THE NE 1/4 OF SECTION Zy , T Z N, R Z-0 W, TOWN OF Sr• '�LYw 1 X COUNTY, WISCONSIN. INDEX PAGE 1 of 7 TITLE SHEET PAGE. 2 Of 7 SYSTEM MANAGEMENT PLAN PAGE 3 of 7 PLOT PLAN PAGE 4 of 7 PLAN VIEW -CROSS SECTION PAGE 5 of 7 DISTRIBUTION PIPE LAYOUT PAGE 6 of 7 PUMPING CHAMBER CROSS SECTION PAGE 7 of 7 PUMP PERFORMANCE CURVE PREPARED FOR N � a2Z °�oZn� S ►,Z��r - ��1v L`z F w) SgD L-L PREPARED BY WEGEFZEF:;_" SOIL . ?'EST I NCG AND. 37ES 3 calm �EiZi1 3 CE P.O. Box 74 421 N.Main St. River Falls, WI 54022 Phone 715 - 425 -0165 "�, �� V, Fax 715 - 425 -6864 C ©n AP P, sg EiLa', -J'(7H f DL"J' 2 G 2002 1 Z_ —OZ JOB NO 0 72 -- 27 -Mound System Management Plan page Z - of Pursuant to Comm 83.54, Wis. Adm. Code �, Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 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, Safety and Buildings Division. Pum 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 S tem 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 for frost protection. Influent quality into the mound system may not exceed 220 mg /L BODS, 150 mg/L TSS, and 30 mg /L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and 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 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82 -84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD- 10572 -P (R.-6/99)] arid 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. Continaency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions about the operation or maintenance of this system should be directed to: The County Zoning-office at 11S_ ,LJ The system .installer at S — 3- t..[ ( 4 qU t� l�NJ The tank manufacturer at %oo 11\J L (FS lz__ Z The effluent filter manufacturer at �0O- � S��{Z• Zlfia� The pump manufacturer at - -- PLOT PLAN Scale 1 " =q�)' Pale 3 of LID to X35 U%z_ na t s Ur1 � PST 1v �Zt3 q3 Z-8_03- 3�f Y ZS 7 - -- NOTES: 1, Elevations shown are existing ground elevations unless otherwise noted. 2. Install 4" observation pipes with approved caps. ( Z required). 3. Septic tank to be l oo0 )6S Ogallon capacity manufactured by W L 7S f) - 7 v etiu W / P�4800 ZP�B�L Pi L 4. Bench mark . I _ —1... °13 O S f O.K j . Divert surface water, around system to prevent ponding at the uphill side. Pace Of 7 PDDray.e^ Synthetic Covering AST -H C33 Distribution Pipe Medium Sand tG Topsail F — Elev. 3 E Slope Distribution Cell of Force Main Flowed z" to 2 " Aggregate From Pump Layer D 0 •S Ft-. E O Ft. CROSS SECTION OF A MOUND SYSTEM F p Ft. G O. S Ft. A 9 Ft. l;' l -0 Ft. Linear Loading Rate= q . GPD /LN FT 8 S 4 Ft. Design Loading Rate= , 0- \}GPD /SQ FT 1 I � Ft. J S Ft. K 8 Ft. W Z8 - Ft. �} -observation Pipe A a 7 � K -� --- -� 8 - -- --- - - - - -- ------=- - - - - -- =--- -- 6 Force Main �--- ! -- - - -- - - - - - -! - t"cce Cell of to 2k" ," Pipe 2 aggregate Observation. Pipe Glae4cr stcsrely) 1 - PLAN VIEW OF A MOUND SYSTEM 4 Distribution Pipe Layout page S of Place the holes at the bottom of the distribution at equal spacing. Remove all burrs from the Pipeandpholes. Extend the end of each lateral up with the use of long turn or 45* fitting to a point within six inches of the final grade. Terminate the ends of the laterals with a valve,:threaded cap or . threaded plug. Provide access from final grade for the valve, threaded cap or threaded plug. - T `t P. N ct� L. Czas s PvC FuC PVC Lateral Manifold Lateral X x x x x!Z x!2 x x x x 'Lateral Length — ........ Lteral Length — P Distribution Line P LPrt�l �J SEW _— P — cc..�s s�X —o r>��Fc7w S P VC''OQ� � 11vJ i o —_ _�7a Ft. Hole Diameter Inch S 3 Ft. Lateral U ) Inch(es) X Z3 lnches Manifold " Z Inches Force Main " Inches of holes /pipe Invert Elevation of . Laterals ° 1. 3 8 � O Ft. = S.33x 6 = 3! •�� GPM Combination,-Sept4c; and PUMP CHAMBER CROS5 SECTION AND SPECIFIC ' PAGE OF - VENT CAP WEATHER PROOF JUIJCTION BOX 41 C.I. VENT PIPE APPROVED LOCKING 1 ` FROM DOOR, MANHOLE COVER ;A %%WDOW OR FRESH +� - 'p+RIJ1t1G LNZIEL, u ` Pnit:n A ►J � IPQ LP IJJTAKE J coiapVlT • wlm�lls� z�rp � t Ft N LsrHD Ct 3 6 -- i ,,__ �. IB IMLET PROVIDE AtRT1GHT SEAL I III V Approved ZfSmZL- A I IC I Approved joint tr/ is _tboo I i ( joint w/ PVC pipe a I II ALARM PVC pipe I 1 C i ou 9 Z -7• 0I•� 1 CLEY. " t 7 PurtP � OFF D , COUCKETE BLOCK RISER EXIT PERM17fED 01.JLy IF TAWK MAIJUFACTURER HAS SUCH APPROVAL 3 «ApPQotigp • �BFDOtN4 SEPTIC E SPECIFICATIOUS DOSE _ TA1JK MAUU FACT UFL EK: w �J - Col.)L � 1JUMl3EA OF DOSES: L�•q PER DAB TA1.1K `,IZE: 1 �yU ! �S� GALLOkJS D05C VOLUME 2 ALARM MAUU FACT UFLER: S.S� T�� O C I 3 INCLUDING 6ACKFLOW: GALLOt15 MODEL WUMBER: l D ` N W CAPACITIES: A_ � � I u CHES OR 30� SWITCH TAPE: "MCUR -7 GALLO&j5 PUMP PkAWFACTURER: �"1 Z S 8 - Z I1ICHES'OR 3 G� LLOM5 C s - 11JLHES OR I GALLOUS MODEL NUMBER: ti �. '� D D = ZQ� SWITCH TYPE: ��R cxL jg2f ` CHES R �j GALLOMS MOTE: PUMP AMD ALARM ARE TO bE MI>VIMUM DISCKARGE - RATE OPM INSTALLED CUAI 5EPARATE CIRCUITS VERTICAL DIFFERENCE DETWEEU PUMP OFF AIJO..1)I5TRIBUTIOQ PIPE.. , 1- 0 0 FEET f M11 AIETWORK SUPPLY PRESSURE . ; • . 6.Sp FLET �S,O�L• 3� + �_ FEET OF FORCE MAIN X �_�9 F .0FCFRICTIOU FACTOR— L y FEET TOTAL DyNAPUC. HEAD = 11 — FEET As per manufacturer gal /in. Liquid depth 3 �` r � ' r ME40 Series 4/10 HP Effluent MVW9 and Drain Water Pumps Performance Curve MODEL ME40 EFFLUENT PUMP CAPACITY LITERS PER MINUTE 0 50 100 150 200 250 300 350 40 12 35 10 N W 30 W W F— „� H 25 8 E Q 2 2 0 / 8 6 t ti J 2 < 15 J O Q 4 10 rr- 2_ i 5 0 a 0_ 0 10 20 30 40 50 60 70 80 90 100 CAPACITY GALLONS PER MINUTE 1101 Myers Parkway, Ashland, Ohio 44805 -1923 419/289 -1144 FAX 419/289 -6658 Telex 98 -7443 K3326 7/91`_ Printed in U.S.A. wsconsin oepartfn�nt of Industry. $OIL AND SITE EVALUATION REPORT Page _L_ of tabu arrD Hunan Roiauons / T OiviaWn bt Sat eW S 8w►dngs 2 ,J'7 .14r ivCS PXW in accord with ILHR 83.05, Wis. Adm. Code ! COUNTY V 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 pant (9M) 99n7a of slope, sale or PARCEL I.O. x dimensioned, north arrow, and location and distance .road. / S �T 33 6 V! L APPLICANT INFORMATION – PLEASE PRI INF M4LTION= I 08Y OATS V Z 0 PROPERTY OWNER: POP IACATION 2S 24T 28 NR 20 W TOM RUEMMELE & JOHN AND BARB f' G;2 P 1 14W 1/2S 19T 29 NR 19 -640 W PROPERTY OWNER':S MAILING ADDRESS t S r C � 9 L r SU80. NAME OR CSM tr 260 COUNTY ROAD.F Cot X0 0( TROY VILLAGE CITY, STATE TIP CODE p ILLAGE MrOWN NEAREST ROAD HUDSON W 54016 ( - E .Ja45 r�' 29%JA4 p(1 New Construction Use [X ] Residential /Number � °� �*Ilono existing L 1 Replacement ( 1 Public or contrmertzal desaibe Cade derived daily flow 600 gpd Recommended design loading race D, ¢ bed, gpdM — trWXh. gpd* Absorption area required Oo bed. ft ov trench. ft Maximum design loading rate _ a ,. bed, gpd1ft2 , gpd1ft Recommended infiltraatiot surface elevations) BY DESIGNER ft (as referred to site plan benchmark) Additional design/ site considerations 5� iVP reo DN et%e 3 Parent material plain elevation, if applicable N/A It $ Suitable f or system CONVENTIONAL MOUNO I N-GROUNO PRESSURE ATGRAOE SYSTeA IN FILL HOLDING TANK U: w rn tutable for system I❑ S 0 U ®S ❑ U ❑ S CUU ❑ S s U I ❑ S fa U I ❑ S Z U SOIL DESCRIPTION REPORT Boring Horizon Oeptn Oominant Color Mottes Texture Structure GP itt I � I Roots in. Munsell Qu. Sz Cont. Color I Gr. Sz. Sh. sea trwaf 555. A 0 -10 10YR 4/3 - -- sil 2msbk mfr aw 12vf -t 0. 0.6 B1 10 -30 10YR 4/6 ` - -- ` sil 3mabk mfr cw 2vf rO .5 .6 Gtound B2 3 47 .5YR 4/6 f1f 5YR 5/8 1 sc I lcabk mvfi I cs 1vf - - -' - -- elev 9 R 47- 50I10YR 8/6 - -- lmst Depth to ,/Q — A.� 9 30 Q h1 � I ( I I Remarks: Boring # A 0 - 13 I lOYR 4/2 I - -- I sil ' 2msbk I mfr I gw 2vf4 0.5:0.6 y556" °a B1 I13 -31 IOYR 4/4 - -- I si 2msbk mfr I w 2vf 0.5 0.6 B2 31 -40 lOYR 4/6 - -- sici 12mabk mfr Icw lvf 0.4 !0.5 Ground efev. C1 40- 55I7.5YR 4/6 I - -- is lcsbk mvfr cw lvf 0.7 0.8 9 0 to C2 55 -73 .5YR 5/6 I - -- i s Os ml Icw lvf 0.7 0.8 epth liming R 73-76 10YR 8/6 I - -- lens t - -- - -- - -- factor - -- - -- 73" Remarks: CST Name: --Reme Print JAMES 0. FUNS (715) 425 -7831 Addmw OGDEN ENGINEERING CO., 113 WEST WALNUT ST., RIVER FAUN, WI 54022 Stgnaturr Dui gllot 7 CSTM03988 PAOPFMOWNER SOIL. OESCRIPTION REPORT Page 2 of 3_ PXiiC�'L�I.O "r ' Oepttt Oom�nant Calor Monies tru Scture G ?Oirt� • Horizon � (Texture ( ( I oots R .n Munsell Qu. Sz. Conn. Color Gr. Sz. Sh. -3ea rrercri Boring # A 0 -15 10YR 4/3 ` sil 2msbk Imfr 5EW of —f 0.5 0.6 194: B1 15 - lOYR 5/6 - -- sil cw of 0.5 0.6 35 -42 10YR 4/6 - -- sl lmsbk mfr LW of 10.4 0.5 Ground elev . 42 -50 17.5 YR 4/ 4 - -- 1 bk mf i s Lvf NP NP Depth to R 0— 4 lOYR 8/3 - -- lmst - -- - -- limiting factor 42" FT Remarks: Boring # is ;>s Ground I I I elev. ft Depth to I I limitng ta= Remarks: Boring # I I I I I l I I I L Ground elev. Depth to limitng I i fa=r 1 I Remarks: Bonng # Grourd eiev. fL Depth to lianting later Remarks: seoa�olA.oa�arzt •" PAGE 3 OF 3 r SITE PLAN SCALE: 1 " = 40' �/Js 4-- H1�T v/ DoT 3--3 VA ti 32- 60 � 3 (od ` Td, o� A0 I", rj3 /.45 L 31 3 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. I - OGDEN ENGINEERING CO. JAMS D. FILKINS, CSTM03988 Civil Engineers & Land Surveyors / 113 W. Walnut St. River Falls, Wl 54022 DATE: �L °�Y (715) 425 -7631 r ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer 1 /A A Mailing Address Z 2 Ck Q Y �D f� D tom' �,� d �( ° ( 6 Property Address 2, (Verification required from Planning Department for new construction) �� � '� Identificati Number - Z - o r5 Parcel Identt ' /State ,�'L� D / � o - 0 3 city LEGAL DESCRIPTION Properly Location e v, — Y, Sec. T 2 s N -R a W, Town of l Subdivision T co t)l C - L yi-& 6 . Lot # 3 Certified Survey Map # Volume �— . Page # -- Warranty Deed # :%2 7 2 , Volume Z/ 3 0 . Page # Spec house ❑ yes Pg� no Lot lines identif able M yes ❑ no SYST -M. MAIlVTENANCE 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 re! tic 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 li cense d p verifying that (1) the on -site wastewater disposal system. is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. 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 cnt of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating ttw your tic system been intained must be completed and returned to the St. Croix County Zoning Office within 30 days a year xpira ' n dat 0 � ' SidfqxwrtF, OFAPPL I 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 property 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 7 rr + l J 2 13 0 P 15 `t KATHLEEN H. MALSH REGISTER OF DEEDS STATE BAR OF WISCONSIN FORM 2 - 1998 ST. CROIX Co., MI WARRANTY DEED RECEIVED FOR RECORD Doer Number 02/04/2003 08:30AK This Deed, made between EXEMPT 8 AEC FEE: 11.00 f T roy Development Corporation, a Minnesota Corporation TRANS FEE:- Grantor, COPY FEE- T imoth y A . an C oza CERT COPY FEE: alluee. +� PAGES: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate to St. Croix County, State of Wisconsin: t ;P Lin of the Plat of Trov yi llao � R``-.p dM Alai- - =-_• -- the Town of Troy, St. Croix County, Name and RewmAddress 1 Wisconsin. Timothy and Carla Kozak Subject to Declarations of Covenants, Conditions and 2243 Ruby Road ! Restrictions for Troy Village, recorded in Vol. 1241, Hudson, MN 54016 Page 256, as Doc. No. 559964, and the Declaration of Golf Course Covenants, Conditions and Easements, - - -- =-� 11 recorded in Vol. 1241, Page 301, as Doc. No. 559969, I all as appearing in the office of the Register of Deeds 0 40 - 1247 -30 -000 i! for St. Croix County, Wisconsin, and such other pare Idatiftatlon Number P" !! easements, restrictions and reservations of record, Thi is not homestead property I or in use, and the "Buyer" obligations contained in (is) (is not) the Purchase Agreement for this lot. .I ,I u I I i This deed is being recorded to correct the legal description in Vol. 2111, Page 621, Doc. No. 705998. i( II ! II II Exceptions to warranties: ;I Dated this 24th day of January 2003 j (SEAL) (SEAL) i • Charles S. Cook, President I' Troy Development Corporation II (SEAL) (SEAL) 1 AUTHENTICATION ACKNOWLEDGMENT I Signature(s) Minnesota !I State of W+scoera+rr, Anoka County, authenticated this day of Personally came before me this 24th day of January 2003, the above named Charles S. Cook, President Troy Develoanent Corporation II TITLE: MEMBER STATE BAR OF WISCONSIN to Ur r" me known to be the person - who executed the foregoing authorized by 5706.06, Wis. Sats.) Instrument and acknowI d a the same. II ! � THIS INSTRUMENT WAS DRAFTED BY !I TROY DEVELOPMENT CORPORATION R ick A. Johnson li Notary Public, StatreFWNeonew County, Minn. I� Charles S. Cook, President M it y commission is permanent. (If not, stair expiration date: (Slgratunts may be authenticated or acknowledged. Both are not January 31 2006 ,) necessary) i • Nantes of . 1 in . e. n m w be I Ian. person signing ray pet Y typed or printed below Itrk , ,can. ■ fl � I� STATE BAR OF WISCONSIN d ., Ire. WARRANTY 0480 FORM Nn. 2 - I Oda RIC A � . Wis. COMMSION OWM `! ,W<ll1AflY 31,2006 � V: AY DISTRICT) 7 so On 0 1. 568 ACRES ko� ':~ All " � o (6 04 8600p. S o �\` �k0 O (0 7 F O O O O or z 49343 S.F. 1 47 1.133 ACRES / C77 71513 S.F. 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