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HomeMy WebLinkAbout040-1247-60-000 Wiscon,in Del3artment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix SafetyAd Building Division INSPECTION REPORT Sanitary Permit No: 430685 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: Pomfret, Brenda Troy Township 040 - 1247 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 9�3 ►� of 24.28.20.1278 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic /4 1,P � �Z66 Benchmark _ k 4 t qrl Z 703 g Dosing Alt. BM 1 1 Co w G, 44 �Vd Z Aeration Bldg. Sewer `96g ' Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet i Septic ' t ! ZI j Dt Bottom Dosing I Z / 221 i -2 I ) Header /Man. J -9 J -167+ Aeration 1 Dist. Pipe to 1 -' 167. 6 Holding Bot. System / 7 C)k U �� Iv PUMP /SIPHON INFORMATION Final Grad; � i5 C 16G • 61S 5 Manufacturer Demand- St Cover GPM 4- K, �. l�I) , [SS Model Number iE) q C e ti�o.� � � 7 /0� • "JG TDH Lit , Friction Loss System Head rDH 1 Z Ft Forcemain Length— Dia. /I Dist. to Well it 12-9 j SQk L ABSORPTION SYSTEM BED ENCH Width � � j Length � No. Of Tr ng ches PIT DIgtIENSIONS No. Of P\ Inside ia. Liqu�Oep th DTME NSIONS 1 ( \\ SETBACK SYSTEM TO I P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer INFORMATION CHAMBER OR Type Of System: / �y ,Z,91 UNIT Model Numb l L , l 7 Q�y 1 DISTRIBUTION SYSTEM Header /Manifold l) Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) 5� I- (� _t Length Dia Length Dia Spacing ' lQ '3 x i# — G J a5 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 t r1 Bed /Trench Edges \ Topsoil ' \ / � YYes No xYes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: — 7 / K / """))) Inspection #2: - 7 / Location: 271 St. Annes arkway Hudson, WI 54016 NW 1/4 NE 1/4 24 T28N R20W) Troy Village Lot 3E Parcel No: 24.28.20.1278 1.) Alt BM Description = I I �� 2.) Bldg sewer length - amount of cover = Ch Plow' Plan revision Required? Yes No Use other side for additional information. __ - - ✓ (� SBD -6710 (R.3/97) Date Insepctor' Signatur Cert . No Q� \ 61 / Al A I'l v l / 11 SID � Safety and Buildings Division County ` 201 W. Washington Ave., P.O. Box 7162 14 Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) (608) 266 -3151 30 �R Depart ant of C o m arc N I 1 State Plan LD. Num 0/ Ss o }2 = vtcau �F ' t Application x In omm 83.21, Wis. Adm Code, personal information you provide act Address (if dill t than mailing address) maybe used for secondary purposes Privacy Lsw, s 15.04(1 xm) � � � I 1. Application Information - Please Print All information PA4 Property Owner's Name a Parrgl - ` * # W 000. ffJJ / K Property Location Property Owner's MajlAg Address }n� n W A, Nt ' 'h, Section o; City, rate Zip Code Phone Number / amle yp�e) / a Y J T� N; R � E o�dl� 1 , 11. Type of Bui ding (check all that apply) s — Subdivision N e CSM Number I or 2 Family Dwelling rrtm - Number of D ooms ❑ Pubbe/Coereiai - Describe U r, = 406. St) r r , ❑City_❑vdiag ownship of ❑State Owed - Describe Use 0 1C�b W` ill. Type of Permit: (Check only one box on tine A. Complete line B if applicable) A. New System ❑Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System List Previous Permit Number and Date issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New Before Expiration Pluaber Own IV. T e of POWTS S stem: Check all that app ❑ > 24 in of suitable soil ❑ Mound < 24 in. of suitable soil C1 At -Grade [D Single Pass Sand Filter ❑ Non - Pressurized ln- Ground t Mound _ ❑ Constructed Wetland ❑ Pressurized In -Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter Recirculatirt Synthetic Media Filter ❑ L c&c hi ng (umber ❑ Dri p Line ❑ Gravel -less Pi ❑Other Isin) V. Dis ersaUT'reatment Area information: stem Elevatio t 6 u� Design Flow (gpd) Design Soil Applicatio te(gp Dispersal Ar lteuitedl Dispersal Area posad js� �SY q0� 0 e > C a l J .� /� t� J o 7 1 in Total er Manufacturer Prefab Site Steel i r Plastic V1. Tank Lnfo CnPac h Concrete Constructed Glass Gallons Gallons its New Exiatinl{ Tarns Tanks Septic or �..i�''- " - "�•�` �� jj,> v f/V / Aerobic Tmarmcru Unir Du,inK Chamber � `�"� V11. Responsibility Statement - 1, the under ned, res nsibW for installation of the POWTS shown on the attached lane. MP RS Number Busineu Phone Number PIu ame (Print) PI L St t / ?!tom ZJX_`" Plumber's Address (Street, City, State p ) Vill. Count /De artment Use Onl Sanitary Pennit Fee (includes Groundwater Date Issued ssu' Agent Signature ( o Stamps) Approved ❑ Disapproved Surcharge Fee) ? � � i 3 11 ❑ Owner Given Reason for Denial J IX Conditions of Approval/Reasons for Disapproval -3 � �,�.,�� C A it SYSTEM OWNE p "'�S"'�r � 1 Septic tank, effluent filter and dispersal cell must all be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code /ordinances Attach complete plans (to the County only) for,. the system on paper not Icia than 51/2 x 11 lacbes In size SBD -6398 (R. 01/03) SITE PLAN �.or 35 SCALE: 1 " = 40' r j- 1�vc- S�Q CA O x 6 o' ce,k i - Ja kp Sko ve- 01-E% = 9,03. 79 e- S- kk o wt R O I�S NOTirS: 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. 122f - 6o py AME FIL KINS. CSTM03988 OGDEN ENGINEERING CO. Civil Engineers i Land Survqryon 4'11- 1-9 7 113 W. W31Mur St. River F3us. wi 5402° 17151 425.7631 Safety and Buildings 4003 N KINNEY COULEE RD 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 January 29, 2004 CUST 1D No. 139462 ATTN: POWTS Inspector TODD L SINZ ZONING OFFICE T L SINZ PLUMBING INC ST CROIX COUNTY SPIA E5609 708TH AVE 1101 CARMICHAEL RD MENOMONIE WI 54751 -5520 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/29/2006 Identification Numbers Transaction ID No. 965072 SITE: Site ID No. 670345 Dan Brown Builders Please refer to both identification numbers, St Anns Parkway above, in all correspondence with the agency. Town of Troy St Croix County NW1 /4, NE1 /4, S24, T28N, R20W Lot: 36, Subdivision: Troy Village FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 940519 Maintenance required; 600 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original grade Systems: Mound Component Manual for POWTS - Version 2.0, SBD- 10691 -P (N.01 /O1), Pressure Distribution Component Manual for POWTS - 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 enclosed approved plans, the "Mound Component Manual for POWTS", SBD - 10691 -P (N.01 /01) and the "Pressure Distribution Component Manual for POWTS", SBD- 10706 -P (N.01 /O1). • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A 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. Note: The downslope, southeast corner of the mound shall be located no closer than five feet from the lot line. conditie TODD L SINZ Page 2 1/29/04 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 hem necessary for code compliance. As per state stats 101.12(2), nothin in this review g rY P P g shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 175.00 Fee Received $ 175.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Henry F Grote , Certified Soil Testing Dan Brown Builders - Mound 4�k� 2pG Construction Materials and Techniques Vs All materials must comply with Comm 84 and be installed in accordance with manufacturer's specifications. Construction methods must comply with the following Component Manuals: Mound, SBD - 10691 -P (01/01) Pressure Distribution, SBD - 10706 -P (01 /01) Location: Lot 36, Troy Village NW '/4, NE 'A, Sec. 24, T 28 N, R 20 W Town: Troy County: St. Croix Date: January 28, 2004 Owner: Dan Brown Builders Address: c/o Bonte Excavating 1420 Davis St. Hammond WI 5 Plumber: Todd Si Signature: License : MP 139 6 Attachments: SBD -10577 - Plan Approval Application SBD -8330 — Soil Evaluation Report Page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section 5: plan view, lateral detail 6: pump tank exit detail 7: pump curve 8: system management DEPARTMENT of corr�nF►��E DIVISION OF SAFETY AND BUILDINGS , - --page 1 of 8 SE�EC RK SP�OE NC r L Design Criteria Residential Wastewater Contaminant Load: 30 mg/L < BOD < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg /L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L Bedrooms x 100 gal/bedroom/day x 1.5 gallons /day hydraulic load Design Calculations In situ designed loading rate ° �s� gallons /sq. ft. per day Depth to estimated high ground water in. Depth to bedrock > 1 in. Cross slope at system S Force main length 2 ° ft. of 2 in. Manifold/header length 6 ft. of z in. Drain -back 4 , Z gallons Lateral length 3 @ S 6'° ft. of 1 z in. Lateral elevation `� o�.s ft. @ bottom of lateral Lateral hole size )i b in. in. ( 3 • S� ft.) Spacing holes /lateral S holes total Lateral volume ��,45 gallons i Total lateral discharge rate 33,bb gallons /minute @ ft. head Network pressure compensation losses ft. Elevation difference g • ft, r Friction loss Z ft. @ 5 gallons /minute Y Total dynamic head ft. Pump /sipirn S 3 gpm @ ft. of head Manufacturer ��' �" Model # Z Dose volume �S',3 gallons Lift/siplYon tank "`G� � C.o v � ' gallons Septic tank gallons Effluent filter a� �� ur C��¢�•�o F i o�8Z2 -� 4-Rn Measurement pump on and off S` in. Height alarm from tank bottom ° in. Reserve capacity gallons specs.calcs.res Page Z of C SITE PLAN 1 L" T 35 SCALE: 1 " = 40' f (/lX1I 1_L1 1f Z o z" t� v 5-k e way n Go: �7 CA zt1�� O hL o 2aL S o \� ok O4,J c4JQ--4 NOTES: PROVIDE MINIMUM OF l SAND BETWEEN BOTTOM OF BED AND EXISTING GROUND. MOUND TO BE A MINIMUM OF: 25' FROM DWELLING; 50' FROM WELL; 5' FRCM LOT LINE. DAME V FILKiNS, CSTM03988 OGDEN ENGINEERING CO. Civil Engineers i Land Survoyas 113 A'. Walnut St. River Faus, W1 5402? f 7151 425.7631 TnTAl P qd l 3.. a p� rt �t e�•o � 1 �.� \ o t�� w. a�l \ b i�bco:1 �e t �� 10,0 ISO �S� jj .j , 34 .e 1$r� ? V ` c� a.c7► 0� 1 +4e` � � a t �.. a P V �- S C..`1 � �n �► r.: � `lL ` � � fL. ..` LJ f_ T U. . IL-4 % b ow \4 4L 5� r I I I I I Is / 2 QU r �� b �. o\ o 1.� �. �...� �,- o-A WEA'fNERPROX)F LOCKIWG GOVER � NCT10h c'. Lc W Y.,V 1,U6 A /l BE/ . &pc Gl►iCK D��C.o�.1�GT --� -� IL 4 PYc GIP6 3' r>p ND it, TUabED SoI� 24" %.D. II c � 4o /ow" r rc �. w Lk. P I .r HC� (vR 51(ET 32j�J7 WFLE p11. PSIS. a 0 i AL i 1 6� Go w+ E LT 1 0 r+.S � �"`/ � K b .eQ Y'+ - � U'O � ON �' � ;; ►.: � ti :: 0'r 094 r R i PwlP CoMCRF1rc E`er I b�oCK SEPTic t ly _SPEGIFI•CATIQJ$ GCSE . TAU,_S "AWU FACT URCR; `� � v IJLiMBER OF DOSCS: _PEk TAWK SIZE; IZ' GALLOWS .DOSE VOLUME S c1 � i�� IWCLUOIN( OACKFLOW: A�ARr1 /'�IJJUFACTUiICR; MODEL WUIhpCR; \ e 1 \4 �zq,p 4,c 5 CAPACITIES: A= WCHES OK _ SWITCH TyPC: B= _ 0 . WCHES OR Gur^,v r1AQUFACTURC lk �`De °�" S _ C a iuCHCS OR ' MODEL QuMbEK, O� � IF�lLHES OR SWITCH TbP[; ��'"� " IJ TE: PUMP AWD ALARM ARC TO DC MlklW MUM DISCHARGE RATE -s-s G ►M INSTALLED OW SEPARATE CIK._ VERTICAL DIFFERCIJCf p[TWCCU PUMP OFF AUO OISTRIpUTIOW PIPC.. FEET + ""QIMUM NETWORK SUPPLY PKESSUPLE z FCCT4, + FEET OF i O R C[ MA l IJ X Z '� g F� O S Z oo ftFRICTIOW FACTOK. FEET — TOTAL OyUAMIC. HEAD F EET I►JTERWA<_ DIMEW5101JC OF TAWK: L EWCvTH ---- -• _;wiDTH -;LIQUID DEPTH --1 P- a ' TOTAL DYNAMIC HEA15/CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING Cr MODEL 152/153 w W MODEL 152 153 U- 50 Feet Meters 001. 1 Liters Go I I Liters 153 5 1.5 69 261 77 291 12 40 152 10 3.1 61 231 1 70 265 0 15 4.6 53 201 61 231 a _ 20 6.1 44 167 52 197 30 a 8 25 7.6 34 129 42 159 o 30 9. 1 23 8 7 33 1 I 20 22 85 35 0.7 -- -- i 40 1 2.2 -- - - 11 —i 42 4 10 Lock Voive: _38.0 Ft. 1 11,6rr);44.0 Ft" ('34mi', 014509 0 20 40 60 80 100 GALLONS LITERS I 1 6 1/4 0 80 160 240 320 3 27/32 -t'— 4 5/8--- FLOW PER MINUTE CONSULT FACTORY FOR SPECIAL APPLICATIONS a • Timed dosing panels available, 3 27/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. Sealed Qwik -Box available for outdoor installations. See FM1420. - • Over 130 °F. (54 °C.) special quotation required. 1521153 Series 12 /e 1521153 MODELS Control Selection r Model_Volts-Ph Mods Amp Simplex Duple N1 115 1 Non 8.5 1 2 or 3 BN 15 2_~ 115 1 Auto 8.5 Included 2 or 3 Et52 !230 1 Non 4.3 1 2or3 SK2064 ' K 152 1 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN t t Auto 10.5 Included 2or3 SELECTION GUIDE E 153 230 1 Non 5.3 1 2 or 3 BEt53' 230 1 Auto 5.3 included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float switch. Refer to FM0477. O CAUTION 2. See FM0712 for correct model of Electrical Alternator E -Pak. All installation of controls, protection devices and wiring should be done by a qualified 3. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float system. A RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Z Louisville, KY 40256.0347 Manulecturers SHIP TO: 3649 Cane Run Road ® Louisville, KY 40211 -1961 QUa[ /TY PUMPS S NCf �,9,�� PUMP !O. (502) 778.2731.1(800) 928 -PUMP http: / /www.zoeller.com FAX (502) 774.3624 © Copyright 2000 Zoeller Co. All rights reserved. System Management Management of this system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, T.L. Sinz Plumbing, 715 -235- 2644, or the St. Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. I . If the septic tank is installed prior to sheet -rock and /or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water - saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather - proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. 11. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and /or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 wmconsia oeparm -nt of industry. SOIL AND SITE EVALUATION REPORT Page J__ of ,-=r and Human Raiatlons Divisan _Human & a I -"ngs in accord with ILHR 83.05. Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST. CROIX not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.O. dimensioned, north arrow, and location and distance aFgs R IEWED BY OATS APPLICANT INFORMATION- PLEASE P T ALL INFORMA � (� PROPERTY OWNER: ROPERTY LOCATION E 1 / S 24T 28 NR 20 W TOM RUEMMELE &JOHN AND B \ YtU L CLCI J%- \ • LOT t/4W 1 /2S 19T 29 NR 19 -64") W PROPERTY OWNER':S MAILING ADDRESS -- L K '$t6e" SUED. NAME OR CSM to 260 COUNTY ROAD F '�Q 6 TROY VILLAGE CITY, STATE ZIP CO : - s� PHON CITY ILLAGE OWN NEAREST ROAD HUDSON WISCONSIN �a �7�1 OY dtJ &S 2 15260J AI pq New Construction Use (X J Residential let,bedrtaotC 4 Addition to existing building I 1 R eplacement (] Public or commer Code derived daily flow 600 gpd Recommended design Wading rate 4• ¢ bed. gpd/tt — trench. gpdM Absorption area required 5r ° bed. 9 ,0 trench, ft Mammum design Wading rate j- - 9: -- bed- gpd/ft D• G trench, gpdm Recommended infiltration surface elevations) BY DESIGNER ft (as referred to site plan benchmark) Additional design / site considerati SEE IV-0 TES eW PAhE 3 Parent material 40'e55 T L L A v wfr.S Flood plain elevation, if applicable N/A ft S Suitable for system MOUNO IN.GROUNO PRF�SIIRE AT -GRADE SYSTeA IN FALL HOLDING TANK U= Unsuitable for system I❑ S Z U 1 29S O U I 0S KU I O S Iffu 1 ❑ S C] S 1�'U SOIL DESCRIPTION REPORT jp �a rr, (I ?tsM De Hannon p S th Dominant Color Moines `tructure GPO /ft _ I Texture I Cor>sisterlce 8ourlday Roots in. Munsell Ou. Sz. Cont Color Gr. h. Bed IT Boring # A 0 -27 lOYR 3/2 - -- sil I3f -msbk 3vf 0.5 0. 245= B1 27 - 10YR 5/4 - -- lfs lcsbk as lvf 0.5 0.6 B2 38 -47 7.5YR 4/6 - -- sl 12msbk lmfr w lvf I.5 0.6 Ground elev. B3 47 -71 10YR 5/3 ml -2p 5YR 5/8 sicl 2m -csbk mfi 1 CW lvf 90 ft. Depth to C 71 -80 10YR 5/8 - -- s 0 s I - -- Lvf (- -- limiting fact 11 Remarks: Boring # I� A 0 -21 IlOYR 3/3 - -- sil Izf -msbk (mfr i i I v 246:;:; B1 21 -43 10YR 5/6 - -- sil L sbk lvf 10.5 0.6 y B21 43 -53 7.5YR 5/6 - -- sl lcsbk fr lvf 1 0.4 0.5 Ground elev. B22 53- 0 7.5YR 5/6 if 10YR 4/4 sl lcsbk mfr L W --- - -- 9 L _ 9 tt. - — C 60 -75 7.5YR 4/6 - -- gs +cos s 1 Ivf - -- Depth to limiting f actor Remarks: Nsnw. —Refw Ptiftt jA�S D Pho" (715) 425 -7831 "= OGDEN ENGINEERING CO., 113 WEST WALNUT ST., RIVER FALLS, WI 54022 S'gnaa,rw Oaa `! q7 CST CSTM03988 PROPEFMOWNER SOIL OESCRIPTION REPORT Page at _3 PAACEL I.D. 3 Oepttt IOomrnant Color Mottles Structure I I I GPDirt� Horizon in. MunseU Ou. Sz Cont. Color Texture Gr. Sz. Sh. I I� I Roots e� Trer�at Boring # - A 0 -28 10YR 3/2 - -- l 2f -msbk fr w 3vf 0.5 •5 _ 247 B1 1 28-37 10YR 5/4 - -- Ifs lcsbk as lvf 0.5 10.6 'S B2 37 -49 7.5YR 4/6 f3d 5YR 5/8 sl 2msbk mfr gw lvf - -- Ground _ - -- elm. B3 49 -73 10YR 5/3 m3p 5YR 5/8 sicl 2m -csbk Mfi cw lvf - -- - -- 9 04.1 It C 73 -81 10YR 5/8 - -- s 0 se n1 -- lvf - -- - -- Depth to limitin I tam I Remarks: Boring # Ground elev. it 000 to Riming factor Remarks: Boring # i I � Ground elev. tt. I Depth to lirmling I factor Remarks: Boring # Ground elev. ft Depth to li rm6ng ,at= I I Remarks: 580.8�0(Fi.oS1aZ1 PAGE 3OF3 SITE PLAN SCALE: 1 40 i W �l Z ¢5 0 �n O Z¢ o7' ��Ncls�•K, 71 ,�GEv. = 90 3• �9 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. OGDEN ENGINEERING CO. JAME FILKINS, CSTM03988 Civil Engineers & Land Surveyors / 113 W. Walnut St. River Falls. WI 54022 DATE: ¢! °�¢ (715) 425 -7631 Feb 11 04 03:21p Bonte Excavating (715)796 -2519 p.l (715)7 -2529 ' P.1 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREBMBNT AND OWNERSHIP CERTIFICATION FORM Owner /Buyer Mailing Address S 4 t In Property Address d — 1 1 S �n �. J (Venfieation required from Punning Dcparuncut for new construction) ,ap City /Stale 14 Lxg - s y-, , (""-) :T- Parcel Identification Number 1L.EGAI. DESCRIPTIO Property Location /Vo1 V- /JAC r,, Sec. 1 �8 N_R6D Tower o V' o - j Subdivi Lo # 3 C Certified Survey Map # — Volume - Page # Warranty Deed # L9 Volume Page # O Spec house J yes no Lot Iines identifiable yes O no SYSTEM INfATNTENA.NCE Improper use sad maintenance of Your septic ayatem could rtsulc in its premature failure to handle wastes. Propec twain tenancc caau= o. pumping out the septic tank every three years or soon if needed by a licensed puutper. what you put into the system ;.n /fleet the function of d3-- septic tank as a treatment e in the waste disposal system The prcperty owner agrees to submit to St. Croix Zoning Department a certification focn, signed by the owner and by e oastcrplumber, joumcyma.nplumber, restcietedplumberor a licensedpumperverifying that (1) the on -cite wastewater s in proper operating condition and/or disposal system C�) *Bu inspection and Pumping (if necessary), the "tic tank is less than 1J3 full of sludge. 'wc, the undersiguod have Head the above requirements and agree to maintain the private uwagc disposal system with the sc&cdardc :t forth, herein, as set by the Department of Commerce and the Department of Nataaal Resources, State of 'Wisconsin_ Certification �t�g that Y "tic system has been maintaiucd must be completed and returned to the St_ Croix County Zoning Ogles within 3o ays cf tL•c three year iaati date. GNATURE pF PLI DA 7E 'NVriER CERT'fIrICATION t (ac) certify that all statements on this £ortn arc true to the but of my (our) knowlcdgc. ! (we) am (arc" the owncr(�) e: c proxrty tics �bovc, y vi e of a warranty decd cccordcd in Register of Deeds Off ec. r t DA TE G?ti'AT(TRE O APPLIC DAZE * "' Any information that is ¢Lis- represented may result in the sari terry permit being revoked by the Zoning acpartment. • • • • •. Include wltb this application: a stamped warrant), deed f rom the Register of Deeds office a copy of the ccrtifiod survey map if rcfereacc is made in the wax:unty deed Feb 11 04 03:21p Bante Excavating (715)796 -2519 p.2 a J 2Q`�SP 25� r'9az6 /t KATHLEEN N. MALSH REGISTER OF DEEDS ST. CROI1[ CO. , MI STATE DAR OF WISCONSIN FORM 2 - I"S WARRANTY DEED RECEIVED FOR RECORD Daon »M hnber 11/14/2002 08 :30AM EXEWT i This deed, made between REC FEE; 11.00 Troy Development Corporation, a Minnesota Corpora TRANS FEE: 269,70 COPY FEE: 1� _ Cren,or. CERT COPY FEE: and D W. and Brenda 0. Pomfret PAGES: 1 �i Cmntor, for a valuable corts:dera conveys and warrants w Granter the laflowing described real estate In St. CLOi tlon, x County. Stale of Wisconsin: )� I Rru :,�nyl Lot 36 of the Plat of Troy Village Addition in the Town Of Troy, St. Croix County, Namead Roitnn A:orasa Wisconsin. First National Bank cf New Ricrmond 'i PC Subject to Declarations of Covenants, Conditions and e 13ox 89 N Restrictions for Troy village, recorded in vol. 1241, New Richmond, W1 5 i7 Page 256, as Doc. No, 559964, and the Declaration of Golf Course Covenants, Conditions and Easements, %) recorded in Vol. 1241, Page 301, as DOC. No. 559969, all as appearing in the office of the Register of Deeds G40- 1247 -60 -000 for St. Croix County, Wisconsin, and such other pa'eouaaMa ealbn NUmon( Nl - easeR,ents, restrictions and reservations of record, Th1. is not homcztead property. or in use, and the "Buyer" obligations contained in the Purchase Agreement for this lot. i ` Exceptloru to warranties: Dared thts 25th da of October 2002 i t; /j / Ij (SEAL) _ -_ (SEAL) Ch arles S. Cook, President II • Troy Development Corporation � rP° (SEAL) (SEAL) f AUTHENTICATION ACHNOWLEDCMENT ) Stgnawre(s) Minnesota State of wiveo rs!", r p p t!� r } y Anoka Count a . uUtendoted this day of UCerrre r carne before me this 25yth day of 1 —7 . the abive named I1 Charles S. Cook, President I Troy Develoanent Corporation �i I TR'LEr MEMBER STATE BAR OF WISCONSIN to } Of not. me known to be the person _ who executed the foregoing i! authorized by $706.06, Wis. S:ats) Ins acknow a ne me. THIS INSTRUMENT WAS DRAFTED ey I ++ I f TROY DEVELOPHDn CORPORATION R ick A. Jo nson 1! I : Notary Pul,lfe. County, Minn. i Charles S. Cook, President My cemmission IS Fermanent. (if not, state expl atlon date: I (Signatures may be authenticated or acknowledged. Both are nor Janu 31 2006 ) II necessary) ' { - N.mn or p.no,r uaninp M .nr uyx q, m�,:u br ryp.a a pnned beta. ,;.r .�y,,,n, ' +) STATEEAR OF WISCONSL .10 �t It— C.. Inc WARRANTY DEED FORM Ne.. Z - 1998 PoCI(A .RJt'sDiJ i ,.es, NDD-IN99M MY COMMISSION EVIRFS JANUARY 31, 2008 ■ >vx vn. WI R,■JC ■ tot kown I _ - r s � E •,`;� z `,3,� ° z� I a t F � t lots ZZ OF I tz 9'� v � IIN• . AMER lit, Flo s Y v;N i g r vE