The URL can be used to link to this page

Home My WebLink About040-1291-30-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croi Safety and Building Division INSPECTION REPORT sanitary Permit No: 479309 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: Jonsson, Grant I Troy, Town of 040 - 1291 -30 -000 CST BM Elev: I Insp. BM Elev: t BM Description: q /� Section/Town /Range/Map No: $b s v�a A dt g Z t t, a 24.28.20.1660 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. 25 Septic Benchmark v } I W 656+ 1595 q V r .'0o - - w1 g t $ $(os- Dosing � Jla s•w�►.+.�' w+n�1e� �- .u.e� auS .� A BM p j•qs 0�09•�fS Aeration Bldg. S wer q. Holding SUHt Inlet 30 r St/Ht Outlet r t TANK SETBACK INFORMATION �-.SS Qfo3•� TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / 2$ r Dt Bottom o ----^ Dosing Header /Man. Aeration Dist. Pipe a �. z •9s Holding Bot. System q , fo r Final Grade I QlLI9 4 PUMP /SIPHON INFORMATION L"') ual g`-f I• '"S:(o 865,80 Manufacturer Demand St Coves w. r - , 7S" r .�yril 311 r: 3 (oS 6 r Model Nu ber I TDH Lift Friction s System Head TDH Ft Forcemain Leng :j!! jj= LD = ,sIo = WeII SOIL A SORPTION SYSTEM ENCH Width t Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIME 3 V64 3 SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Man ufactur INFORMATION CHAMBER OR r Type O System: ( w / \ UNIT Model Num r. r 'c DISTRIBUTION SYSTEM Head Manifold Distibution x Hole Size x Hole Spacing Vent to Air Intake w- Pipe(s) Len th Dia Length Dia Spacing J SOI COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of TSeeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Fm Yes ® No Q Yes Q No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: � � Inspection #2: – - t — " T � Location: 327 Lindsey Road River Falls, WI 54022 (SW 1/4 SE 1/4 24 T28N R20W) Troy Village 5th Addition Wt 132 Parcel No: 24.28.20.1660 1.) Alt BM Description =�oP • 01 A S.) Jam` ` S"' ' , 2.) Bldg sewer length= I$` � � g , Tv� {0 GK�-� 'F^2 uu.�&as S( - amount of cover = )$ + .I+ '' • 6tc�ls W ce s U U011 L. $� �at) 3) _ : ,ti.t cs. -. r� o-4 c**. vOk-u- •sue_ -- Plan revision on Required? Yes :K No T tn1 Use other side for additional information. - I �eA/.a SBD -6710 (R.3/97) Date Insepctor's Si nature , Sys. krt / dos t —`'^^ -�- �, T in 9 c -� I — CCO( .� w ow la 4b l F�� 1 f � ash' l V �� v � ��,� � , -�- ,,�, ,� � ' I� 5�� -��. Parcel #: 040 - 1291 -30 -000 07/12/2005 11:47 AM PAGE 1 OF 1 Alt. parcel M 24.28.20.1660 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): * = Current Owner * JONSSON, GRANT & NANCY GRANT & NANCY JONSSON 13 WOODLAND VISTA RICE LAKE WI 54868 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description SC 4893 SCH D OF RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.047 Plat: TROYV -TROY VILLAGE 5TH ADD'N 040/02 SEC 24 T28N R20W LOT 132 TROY VILLAGE Block/Condo Bldg: LOT 132 FIFTH ADDITION Tract(s): (Sec- Twn -Rng 40 1/4 160 1/4) 24- 28N -20W Notes: Parcel History: Date Doc # Vol /Page Type 11/26/2003 747693 2463/506 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/23/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.047 229,000 0 229,000 NO Totals for 2005: General Property 1.047 229,000 0 229,000 Woodland 0.000 0 0 Totals for 2004: General Property 1.047 229,000 0 229,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safely and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 479309 0 GENERAL INFORMATION 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: Jonsson, Grant I Troy. Town of 040 - 1291 -30 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range/Map No: 24.28.20.1660 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic I LSL � Benchmark Dosing Alt. BM • q Aeration Bldg. S 1 r Holding St/Ht inlet • � TANK SETBACK INFORMATION St/Ht Outlet • TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic / 28 ,/ Dt Bottom Dosing Header /Man. Aeration Dist. Pipe SA Holding Bot. System Final Grade • gyp s .( P P /SIPHON INFORMATION Manufact rer Demand St Cov 2 PM Model Numbe TDH Lift Fric oss System Head H Ft Forcem Length Dia. Dist. to Well IL ABSORPTION SYSTEM RENC Width j Length No. f Tr nches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIM S ` .5 3 SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer. /L INFORMATION CHAMBER OR l� Type Of System: { / UNIT Model Numbe . >�� DISTRIBUTIONS STEM Header/ a ' 016 Distribution x Hole Size x Hole Spacing Vent to Air Intake P' e s q5 - Lengt Dia Lengt Dia Spacing SOI&ZOVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No 1 Ztrl di repenci , rs ns present, etc.) Inspection #1: Inspection #2: 7 Lindsey Road River Falls, WI 5402)(SW 1/4 SE 1/4 24 T28N R20W) Troy Village 5th Additi n of 132 Parcel No: 24.28.20.1660 1. Alt BM Description = _t _�c (,W� _ 2.) Bldg sewer length = 39 j� 5 -, � 1A - amount of cover = 4t2 + , / 41 1 f �� - Plan revision Required? ]Yes � . No Use uww Use other side for additional information. � —_ — SBD -6710 (R.3/97) Date Inse o Signature Cert. J _Wle • Safety and Buildings Division County Ce O (� 201 W. Washington Ave., P.O. Box 7162 Madison, WI 5 anitar Permit Number (to be filled in by Co.) N vhKonsin (608) 266 3151 '^ `° .ty( 79 3 6 Department of Commerce Mate P n I.D. Number Sanitary Permit App 0n �; ;; In accord with Comm 83.21, Wis. Adm. Code, personal i r }anon yd' provibe t } JPrb ect ddress (if different than mailing address) may be used for secondary purposes Privacy Law, sl;S:04(1)( S-I CR�1 /; t ,U . J r "FI E I. Application Information - Please Print All Information AV Parcel tf C Lot •!J/ /? -Z Block N Property Owner' Na le GI..J (_ 7 Property Owner's M ailing Address Property tocation 6 r t /a, ,Section City, State /� / / Zip Cod Phone Phone Number 1L1 f�� J v tv ( l V ` 6 T N: R c ircle or 1� e) • / . II. Type of Building (check all that apply) �.e,�,2 — ' l Subdivision Name CSM Number 1 or. 2Family Dwelling - Number of Bedrooms . � r1/ ❑ Public /Commercial - Describe Use ❑City ❑ State Owned -Describe Use / - _ ❑Vt lag I�Townshtp of �� 4 III. Type of Permit: (Check only one box online A. Com plete line B if applicable) — 12— Z — 3 — 0 A' 0 New System p y' ❑ Re lacement S stem ❑ Treatment /Holding Tatilc Replacement Only 11 Other Modification to Existing System B. El Permit Renewal El Permit Revision El change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. TXpe of POWTS System: (Check all that apply) -Non - Pressurized In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 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 ❑ Other (explain) V. Dispersal/Treatment Area Information: Design Flow�(gpd) Design Soil Application Rate(gpdsf) Dispersal / y 7 ��S� Arrea Required (sf) Dispersal A a ystem Elevation • / z QLt I C/G VI. Tank Info Capacity in Total Number Manufacturer Prefab _ e Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit (O! Dosing Chamber VII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Na me (Print) Plumber's Si gnature MP /I Number Business Phone Number �b4cqL N _6K� --- Plumber's Addre ss (Street, City, State, Zip Co VIII. unt Departmen Use Onl Approvzd isapproved Sani Surcharge Fee) tary Permit Fee (includes Groundwater Date Issue Issuing ent Signatur o Slat �� 00 �Z El eas for De ial IX. Conditions of Approval /Reasons for Disapproval 3 L9 SYSTEM OWNER: ) 1. ` Septic **, effluent filter and / `�v i f l , P_ � ! W t < < n a dispersal CON must all be services / maintained c � I ds per MM UMOMOr t plan provided by plumber. b Q C `�' J 2. AN *sWsok requirements must be maintained Q �, as par qW&WO a*& / adimicss. f e. i J Attach complete plans (to the County only) for the sys m on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) P LAN LL �—�- 61 00 te 6 S D c 0 r� � e6 M-- ti 56 AJ 7 - 12 - as Nt L L 6 g' � Wisconsin Department Industry, Labor and Human Relations SOIL AND SITE E V A L U.AT I O N REPORT Page I of 3 Division of Safety 8 Buildings in accord with ILHR &SAS, Wis. Adm. Code r COUNTY ' Attach complete site plan on paper not less than 8 112 x 11 inches �6 siXe. Plan must includr§, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. p l,u G dimensioned, north arrow, and location and distance to nearest road: ' PaEWED _ ATE APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION EVI 7 �S PROPERTY OWNER: PROP L00?ffION . -' y CO 1.i tJ " rn -t-- c,rt 89'FF -E8T Std 1l4 S E 1 /4,SZ W 4 T =, PROPERTY OWNER':S MAILING ADDRESS • LOT # Bl_Ck - #'' SUBD. NAME OR CSM # ` 'L3o �"L "____- TRo \J1,L\.ftGE t> . CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE GOWN jNEAREST ROAD B Lf►n fv wt N S' -S 43 ( ) Ta-oY l'Ltvo S4M 20h� [}J New Construction Use Residential / Number of bedrooms AdditiQn to existing building (] Replacement [ ] Public or commercial describe Code derived daily flow boo god Recommended design loading rate - bed, gpd/ft • b trench, gpd/ft Absorption area required 8 So"' bed, ft S o trench, ft Maximum design loading rate • "1 bed, V$ • $ trench, gpd/ft Recommended infiltration surface elevations) 3 S9 -t5' • Bt3TtF �ive1�S1 ft (as referred to site plan benchmark) Additional design /site considerations SEza� 1-V1rle TM 1 w S11ft'LU--nZ oti CT 3 Parent material L W - W .s ot✓Lrv 6LVUA OvTwf}S LEI ' Rood plain elevation, if applicable QA ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for s stem COS ❑ U S❑ U ® S El 2 S ❑ U I ® S El U ❑ S 11 ru SOIL DESCRIPTION REPORT Borip # Horizon Depth Dominant Color Mottles Structure GPD /ft �z Texture Consistence Bouxiaryr Roots in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. g� rer><tt cik4,.evh1. :i` 3 c Z \S 3$ Lo - t2 31L s � col � 'F� e_ g • �1 s Ground 3 3� - Llb - I S `J R- 31 S GIP 0 S as vh \ •1 .8 elev. 4- bS.n It Depth to limiting factor Remarks: Boring # o -kZ i0 `1R 3 LZ Z VZ 36 l w-m- 3h. e Ground elev. � •6S 6 It rA Depth to limiting tt \ factor Remarks: CST Name Print Phone: Arthur L. We erer 715- 425 -0165 egerer So'1 Testing & Design Service -P.O. Box 74 River.Falls,WI. 54022 Signature: °! 4 - Z 14'7 - l Z) Date: 1 1 ` CST Number: . 9 220254 PROPERTY OWNER (2UKM SOIL DESCRIPTION REPORT WQX) tt.. • Page ? bf 3 PARCEL I.D. # 1�� JL►Q) /v � Bippg # Horizon Depth Dominant Color Mottles in Texture Structure GPD /ft ..: . Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Consistence Boundary Roots Bed Trench z 1 Z -3b 't tz 3C s i 1 Z� gbk ►�� - es — • s Ground 3 3b —13 •S LIIZ 3l elev. EL 6\1 O S 1� 7 Depth to limiting factor >113 '` Remarks: ' _ > I o- u� ►Z [ Z — s i \ 2.►n s b 1� vn - '..• >..n:::..i:t 104 lz Ground ' efev. 86.0 tt. Depth to limiting l � factor Q r Remarks: Boring # €>< r< Z Z2-lb 3 l,6 -121 1 •S Y231 Ground S �-6�- � Sg elev. 8 16S- - ) it. rl Depth to limiting factor I Remarks: I 3oring # r around llev. f t. )epth to imiting actor Remarks: _ PROPERTY OWNER CQ — SOIL DESCRIPTION REPORT • Page ? of =, PARCEL IA lv B ripg # Horizon Depth Dominant Color Mottles Texture Structure GPD /ftk in. Munsell Qu. Sz. Cont. Color Consistence Boundary Roots Gr. Sz. Sh. Bed Tren s, S b -1Z ► O `11z 31Z, e,tN 5 Z 11 -3t, 1b 't ►z 3L6 Si l Zr►� S �,,�� es _ - S b Gro -3 3� -Q3 - ) -S 1-11z- Sly Depth to limiting i factor > l3 3 '' ; Remarks: g # :: I o 3 1 R. 31Z l b4 tZ Ground 3 6b - �ZS • S -1 tZ 3 el elev. 8bb.o It. Depth to tt } limiting l factor 11 Remarks: Boring # Zl o —Z 4:: 31L S 3 66 -L2'1 1 <S Y2 S Ground eL elev. 1 36sa ft. # rl Depth to limiting factor I > Remarks: 3oring # i ;round _ 3lev. ft. )eplh to imiting actor Remarks: _ P LOT P LAN Page 3 of 3 a SCALE 1 "= 50 ' / / �`1 � .�65 - 34 on) UPCIL i Ll�� -t21 tl�l SLD.e o F 1D``1�UPLR^Q /��- t`1.8�S_8�, e�r.l 1�aPstL sIDC of 1V" glee � J / 0 / Cti P � ►N 1 ��- ��► `LAS l ily- I. TtiTRJ�i t`2 _3- o 0 0 nLL y - — - - -- ��E� T % - rWjsE ZO_ -BE pri- ��ST zS'_ �4— _ R lJ, lG l+ CA- - ?A-Q W - S ffZ (715 ) 4L — n'I65 CST Signature Date Signed Telephone No. CST # - e- . --- -- _ .mot -- - Combination Sep-tic-Tank and PUMP CHAMBER CROSS SECTIOIJ AMD SPECIFICATIOMS ' �� f� - VEkIT CAP WE =ATHER PR001` /v � JU►UCTICU 80x / J - (c.i,vDiT PIPC , APPROVED LOCKIK�r, FROh1 DOOR, MAID TOLE COVER ',i,QDOW OR FRESH T A1k INTAKE ca�p�ir u i tJ I y I/JSr�cTlorJ PIS J PROVIDE I _ - -- r AiR T TILH SEAL APPROVED • JOINT. A I I I �,PPKGli C �[JIa;T. W /C.I. PIPE 0F, Tank construction I II I I /C.T�. "il'EoAc' shall comply with ALARM NSW 83.15 and 83.20 e I II eon I C) I,~ PUMP -- _ OF'" ED Q j�C� CUIJCRErE K151R EXIT PERMITTED 01JLy IF TAUK MAQUFACTJRC.R HAS SUCH APPROV L_ SEPTIC f SPCCIFICATIC)QS DOSE 7A rj K5 MAIJ FACT UKCR : 1JUMHER OF DOSES: 5 a o� . P L C.►,:: TA1,IK LIWE; GALLON!. D05� VOLUME _ ALARr1 h S S ��ZIT�� S`-12n� 3 IKICIrJDING 5ACKFLOW: G.41..L.C;,1;, MODEL 1 JUMBCR: S � 1 �w _ CAPALITILS: A = - = ryP eo SWITCH - C: ) � - j �U( Y - B =- � IuChESOR _�� „S,..LUf.:.S PUMP h1AMUFAC.TUREA: �O D MODEL k1UMBER: ,�nLLJL.'S } `O / � D � � -y 1 5W17CK TUPE � : �L�1ZC'U2 j IKICHE3 0R S ��LLDl15 )JOTE: PUMP AMD ALAKri nKL TO 15Z MIUIMLJ D15CKARGE RATE GPM INSTALLED OU 5EPt CIR�-U!TS VERTICAL DIFFEKEk1CC DETWILU PUMP OFF Au D. 5U D15TRIT'1OM PIPE_ � it rE.ET -f- MIIJIMUM ;JCTWORK SUPPLY PRESSURE , , , / 0 FEET M + FE ET OF FORCE AIA1 X >� /loo fj.FRICI'IOL1 FALTOR - - r EET TOTAL DyQAMIC. HEAD F Pump chamber DIAMETER IMTERAIAL. DIMLMSICJA OF TA1JK: LENGTH _•WIDTH �. f - ,;LIQUID DEPT'vl i BOTTOM AREA — 231 GAL /INCH APR -12 -2005 16:28 FERGUSON ENT HUDSON 715 386 6144 P.01 [g GOULDS PUMPS Submersible Effluent Pump b� o PE "ILYM PUMP b• SPECIFICATIONS MOTOR FEATURES Pump — General; General: ■ Corrosion resistant • Discharge: 1 NPT • Single phase construction. • Temperature: 104•F (40 °C) • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 and 230 volts M Thermoplastic impeller and fully submerged. • Built-in thermal overload pro- cover, • Solids handling: 1 /2" tection with automatic reset. ■ Upper sleeve and lower maximum sphere, • Class B insulation. heavy duty ball bearing • Automatic models include a • Oil- filled design. construction. APPLICATIONS float switch. • High strength carbon steel ■ Motor is pemtanently sally designed for the S p e ' • Manual models available. shaft, lubricated for extended • Pumping range: see • following uses: P 9 g PE31 Motor service life. • Mound Systems performance chart or curve, • .33 HP, 3000 RPM ■ Powered for continuous • EffluenUDosing Systems PE31 Pump: • 115 volts operation. • low Pressure Pipe Systems • Maximum capacity: 53 GPM • Shaded pole design ■ All ratings are within the • Basement Draining • Maximum head: 25' TDH PE41 Motor working limits of the motor. `� .. • Heavy Ditty Sump/ PE41 Pump: • .40 HP, 3400 RPM ■ Quick disconnect power Dewatering • Maximum capacity: 61 GPM • 115 and 230 volts heavy leng • Maximum head: 29' TDH • PSC design i ea ea or vy duty uty volt 16� TW with grounding PE51 Pump: PE51 Motor. plug • Maximum capacity: 70 GPM • .50 HP, 3400 RPM ■ Complete unit is heavy duty, • Maximum head: 37' TDH • 115 and 230 volts portable and compact, METERS FEET • PSC design ■ Mechanical seal is carbon, 40 r ceramic, BUNA and stainless PE511 I I MODELS: K31, PE41, Pest steel. 35 _ I I I I I I i I I HP:.33..40, 50 ■ Stainless steel fasteners. t o 30 P i �^ I i Y -,► 2 GPM » I I i f I I • AGENCY LISTINGS ;.� I I I 1 Fr �, I' • T � � � C US Q 20 F -�-� ! I Tested to UL 778 and CSA 222108 Standards 0 15 By Cain Standards IlfSpoaOoo ► - •� i .( �. I.. I :1.. I . I h- � •-f i — i _I F'ik#1R3650.9 10 ^°-' l I I I I i i i i• i' Goulds PUMPS is ISO 9001 Registered. 5 : .I 0 ..I• I III lir I 0 0 10 20 30 40 50 60 70 GPM 8o 0 5 i0 15 m Goul P umps ® 2004 TIT Water Technolog PACITY Effective tune, 2W4 � �'' "� ITT Ind nu Strl 60w+ S� l{Nyo� a w � S�3 pp'Op.. N ♦ 1 LOT 131 0 ' LOT 132 0 ¢• o • H -25' N ' N • W b LOT 133 «� 1j) 1 41 40? ail ;a C40V 41 a \ ^ h A sk . X• _ O � " �� F s S6 G • p p o — — 8 r - -. p4 F Pr F r ROAD LLI Z I, Douglas J. Zahler, Registered Wisconsin Land O Surveyor, hereby certify that the above mapped property F was surveyed by me or under my direct supervision and Of W p }- that this map is a correct representation to scale of the c 0 p boundaries to the best of my knowledge and belief. yP DOUGLAS J. 2�� Q Q ZAHLER Z LW z Z 5-2145 J r D HUDS N, m I W LEGEND LLI J FOUND V OUTSIDE DIAMETER IRON PIPE ' 0 LLJ; ...... • • . SETBACK Cr } N M — — — UTILITY EASEMENT Q NWTM 1 :2 1 X WOOD LATH SET AT SETBACK LINE see rw 50 Oct 21 03 04:43p David E. Cramer 715 -236 -7644 p.3 • OCT-21-2003 U.-53 CCUTtNENTAL DULP CORP 763 757 2532 P.03/03 � r f f /, ,� ��; \` ti ♦\ \ ` \� r V) \ [ 1 .. .e.. • 1 � � � � k - 71_x. \r_ \ A r \ ` �� ` \ \♦ \\ \ N f911 +6Z Od/ \ \ rw Cn ol t pF ! oo . \ -�� —! � • �_ � � r ..� , , 1' !+ 1 I ! ' 1 f � 1 _ \ I 1 \ \`� \� ♦\ \ y �r��"r�� r i r . \ 1t' GPAVQCi PtAW `rl / 1 f f � . ic I t� y �tE h�b 1 Tl �hl r • TOTAL P.03 4, 1810 CRESTVIEW DRIVE HUDSON, WISCONSIN 54016 PHONE: 715.381.5334 FACSIMILE: 715.381.0236 e CONVENTIONAL SYSTEM CROSS SECTION • NO SCALE 12" COVER 1 2" COVER 12" COVER I'�• %s•si -• ` "� > "`,:1;:1'`-`•3. �'£":�; ?j'hi�; ,i�`E: .:ku�ii:: aJ:: t:kll '1CI;;.:,:.: "7.z3i.a"i;i. >•' ' : >�'F ,,_..�,. , r, . .....: {• •i:a+, .,.. ;, ..�: ...: i:; :'.: ,,,...y:4 q•:r.:.., ...: ,� „•. ::3:k:a .,Ft ::'1.1 `: i;d:.,.,C:: :•r•r .. .n t.,..J .:� ... . -.i .. .,.:.. ..,:i 1`. •',.... .. ��:: 1: :::: •: - '�U�i: '•'kl�: •, :'.I•:•. ` P;E °:�4 "'•�Vp,: n �••,g, {:'1.,,:i �:i,; >:l' u........k..S lu,,...,. n.:r,u.l.1...:.:.1 .. ., .:. ,......n,, ..., •1• �"i: ;:i', rt., •'Y 1, - :;c... ? •4 4 ,.... , . k :.. ........ , .. +,L , ' r .. 4 •.::. .:...... .....:: . t:: ,:1.•,i iJ:., t .; £" .t, � : +n ,. ,.,:..: r s. ..�.....+ .z 1.1 .... , .. <,t Il.,..n .. .... ... .... • r I.. .. . r. , ....: .... ,. , <':>'r.:; n 4„ rr... v..., � r, .•..:..£k.,,,' ::'11,1, ..:....k.,. +• rl.. ,. ... \:.. '� ..' k,,: b., ,L LI rti' : � : \i:i; > cf r.l. dT; ; . n .,.. ,, •rt,. . ....., r: 1:r: ,:.. ,4;, .;1' °, ,: .n`'r 7; :: ,.Y. ,LI; a,l; ^; :,>♦.!1J'i t >., ,,J; �' : >�.I!E,. AI• ...,. ,:.,� , ...:. ..k II � ... ,. t .7.1 .. ..: .. .....:....:. t.. 2 � ..... .,,. 4. u,. .: .,... .:'. ,i,':i,;:::: EI II,, :.k ,1' ,�t. ,. .. ., .,. ..2f ..w.,..:, .., n a ...,... ...1 •:.�' ::.. ` i::l i !'I�.. ..a9': �` ... ... Y I �'i 1�tr.. tla i't•151,1i .... 1....1 ...... 1. ......... I ........... � l ........ � � : t��ii ' '.cz..S �'t ...�. .., k . : . ... t . t,l�.. k I � t , ., 1. ., . �. f.E!.: ..4.�'!i�i:ii :. li.il; . l,. .,.. . t 1• , 1 :4 �. {I�.. .. . <: .1:.. ..1 ..,�... .. ..e L.1. ..! ....Y 1.' ,: J. '� ,�� ;.�� y:l`�ii:,• .... � 1 �,...., .... .I ....,.... : ,.,. n.. ....::..r ,.� .......:...... .. � ......:.., i; .. ,.,..... .. l , , ..n... .11, ...: ..,... 1 . , ' �:! r,t•i %.b',:' r.a ,rn:�.1 „ ,phi:' <” ..+� 1 ,. as 1'• y �� ..i!: {w.. n, :... .....,. ,.. :1 ,... ..k.�r1 +: r J, ., ..: ...... J .1 It . .. .. ,. .. .. r 1 .,.,.,... v I . ,,.� .. r . ... . ... ..... . ✓'e., ,'. ' :, i. . ILy n1: •. •i ?!� ° . �!� E °ja ~ k F. :I : , ...�....:.,...,...z ,..,.... n: r. 1 ...:.........• . r, ...:... ... .... ......,. ..�..........,:. , I. ::: . {.'4it ".' .,t., z ,...:.,, - {.t�. ...... u,,. ,a.. .. +.. ..:.�'r ;t : 1.. 1..... ,;.,!? .,... :..:: r I.. l: I. 1'! ,'.1.:: ',, �:' 1 � .1.. ••:ah'.,V' . .<<.A:,. <.,..:.h I il. ... � ... .: 'k: •.v�.., •...... .':+�•)'.:. ". .,.� ..:'. •: :. k'',:'�'.': ;::t - II :1,.. .,t� .it:r ,. 1..,. �.... ...... 1 .....: .. t<. L. ,,... '• I I ...... . . ..... J .... r ....J, ,... f r,l � : ...) .. 1'!::.':f.; ;:L:Ih .4E {, '.l..r ' il. '�;5... .. 1 i :a4't a § ,_ 1 ..:: n t. .L.,.. ......s ,; .:•k �.y1::i ;''.; :. , :y;i;J� �!Ji,' 1. AH f.hYl, i'la'i l .`4`• ::' i . rlrr`;1 {� "' J � :41 ti::'.�'� ` .1. :......:.:,,�:.,.:..,, ...n.. i1 r °;:.:.:. r•.: •, . L 1 � :'ij;: 4N ........ ,';;�; a 1✓,1 �'i�;::'.! J;;;�:.:,:,: .� &.�l ... ....... .....1 .. ,...... .., 4;;::,.•,.: ,�. .z.'... ......>i,.� ti ..... ,...E .. r 11 ...........: .. �:, ,..... ...,. .. L•e,.:.' ..':1 ": ..SJ1 �,arK .. .. ..I ... , ......... 5 h� .... ..�I,..... ....r:m ,�:`: y "41l!'� „4.i��i .,3..�; L. r:��:., .;•�,::••;.;�,;;�. I' t ' •{ 111, . J �! .. l.tl ..1... .. kE : 11 •. ... n ..:. L .... E.III„ ..,r'!:I:'1......... . {:,;1::1" 1:11�� d` Src� `3 I.' ,l . •;1 � ..., .,. 1 . ... ..,r., ...i.., ,...: .:.M . ILI , .. ...:. .�,..,.. .. . sl .::.......... . : :.•e... (: �:�: I : I..�� :�:v. ,l,L �, .•F �rl::::: �' l . .2... ,2.1, � ,. ,, 1.. 'tr, t. .... r. ,,. ,.... ... r.;. ;•,..::. .., �H1 �' :L. Ii: •.'> r•il'., J,�.:':'� +r ` 3: I I I r> ' .n .i. .... ....> ...r. .,. i.11l ......:....:.i ��...... ..: •..:. 1�, .. ,:1: 51 :Ilil iili: ;�� >.. .r. (('' p, . ... t .,. ... ,.1. I .r. .. .. .1... ...... 1 ... x.: ...... .. 'r;i' •. t�'�C'1 : !, }eE .. ,.. i,. .. .,.,. i. ....w .. ..+..: k.,. .� .... t.....:: � ..: ....,. .,. ..,. 1..;. ti9: ;::. 1 I'1 Eir„ ,'•' "S�ji 'R:a::.y ... ,. /I ..,.. :r4r .... : .,.1. ... ,.. ... , lr\ ..:.... . � ... ,... ,:•:: •�...:.\ , - :. `E i I.. ,. J•�:;: i' . 111 1 ..... • . ...:. .114 11 .....:. ,.. 1 r... ..E 1 .. 4 ... , i •: ...1+1. I .k. .1 : \C 1.,�.'+. .: �," : .u,,....., ti ..,..., , . ... +... ... .5 ..S.:.E.....,.: ,.. � ....,,,,., .. ... : 1'i:: .u: :�' �'r'4 ^�� •`'f ° ,i3'< � .Y >' ..... .. .,, .....1 .. r .1.. ... .:• ..., .. a.. ... t.:. t ..... .:1H�: Fiji �', ll. •b �,. :re:. xr.' ? > :';•::.,. .F::3: I i ,...1.1 .... .t.:,M :. -I :... t.:l .. I .. .. .l C ...Y ..,.I •,.. � r' ?• ''��`:. ,. '!�' ..,., n .. ._ ... 1 ..: .,tt. .. 11.1..,• , ill. .,.. r : ... ... .. .:... .. :::.. ... �. � l <S.`� ,r :.{ I 1 I ELEVATION TI �7 IN SITU SOIL T2 T3 i QUICK 4 STANDARD 1NFILTRATO.R DIMENSIONS: HEIGHT 12" LAYING LENGTH 40" WIDTH 34" I i ' I I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM W` a ld ( 707 y��q/L Owner/B -- Mailing Address Z 61 n raq(�n ( U v - I Property Address (Verification required from Planning Department for new construction) City /State 7'k0 / 'uuO s ` 1 1 `ZI: Parcel Identification Number LEGAL DESCRIPTION J�6 r /ZW 36 _ 06 Property Location ' ' /a, Sec. T7�T -R W . Town of 4iaK - - Subdivision a) , Lot # / Z Certified Survey Map # , Volume , Page # Warranty Deed # `t 76 / ,Volume 2, Page # Spec house ❑ yes QLtfo Lot lines identifiable es ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenanc consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the syster 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 syster 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 standarc set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certificatio stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 3 days of the three ear expiration date. -d SIGNAtURE OF APPLICANT DATE OWNER CERTIFICATION I (w certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) c the property escribed above, rtue of a warranty deed recorded in Register of Deeds Office. SIGNATURE OF APP T 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 man if reference is made in the warranty deed POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa / of "L FILE INFORMATION SYSTEM SPECIFICATIONS Owner -- nj 5 4J Septic Tank Capacity ,5 al ❑ NA Permit # v Septic Tank Manufacturer (�i��_X ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer AV d;L ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units --- ❑ NA Pump Tank Capacity al ❑ NA Estimated flow (average) d'b gal/day Pump Tank Manufacturer ee2 ❑ NA Design flow (peak), (Estimated x 1.5) gai/day Pump Manufacturer uL 0 ❑ NA Soil Application Rate 0 7 gal/da /fts Pump Model 7 10 ❑ NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD 530 mg /L Mn- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L ❑ NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510° cfu /100ml ❑ Drip - Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Even Service Frequency Inspect condition of tank(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA ear(s) Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA I. / ❑ year(s) Clean effluent filter At least once every: p mon th(s) e [3 NA Inspect pump, pump controls & alarm At least once every: / ❑ month(s) ❑ NA z ❑ year(s) ❑ month(s) ❑ NA Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: ❑ y nth(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) « ' w Page Z of START 4JP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that May impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and /or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name /t��C y9/" Name Phone Z 7 64 Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name CAD /jL Zo �✓�^1� Phone Phone fd This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d) &M and 83.540►, (2) & (3), Wisconsin Administrative Code. 2463P 506 7476IS9 (� KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO., WI STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED RECEIVED FOR RECORD Document Number 11/26/2003 11 : 45AN I WARRANTY DEED This Deed, made between EXEMPT # i roy Develolxnent Corporation, a Minnesota Corporation REC FEE: 11.00 TRANS FEE: 689.70 Grantor, COPY FEE: an d Grant & Nancy Jonsson CC FEE: 1 Grantee. Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate in St. Croix County. State or Wisconsin: �+ ReCCrorp Area Lot 132 of the Plat of Troy Village 5th NemeaneRelurnAOdrsss r3-(lZ Addition in the Town of Troy, St. Croix County, •` � Wisconsin. Gr nt & Nanc n Subject to Declarations of Covenants, Conditions and 13 and Vista Restrictions for Troy Village, recorded in Vol. 1241, Rice Lake, WI 54868 '1 Page 256, as Doc. No. 559964, and the Declaration of !' Golf Course_ Covenants, Conditions and Easements, I recorded in Vol. 1241, Page 301, as Doc. No. 559969, Originally Part Of - I i all as appearing in the office of the Register of Deeds 040 - 1251 - 90-100 for St. Croix County, Wisconsin, and such other Parcel bdem acatlon Nurturer (PIN) I , easements, restrictions and reservations of record, This is not homestead property. +� or in use, and the "Buyer" obligations contained in (Is) (Is not) l the Purchase Agreement for this lot. I, I , ii i� c. 'I li II Exceptions to warranties: Dated this 24th day of November 2003 I; I; (SEAL) (SEAL) Charles S. Cook, President Troy Development Corporation �+ (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Ii Signature (s) Minnesota State of W+svoTts+n, ±i ii Anoka County authenticated this day of Personal)y came before me this day of Novem , the above named Charles S. Cook, President I� Troy Development Corporation I TITLE: MEMBER STATE BAR OF WISCONSIN to !� (if not, me known to be the person who executed the foregoing authorized by §706.06. Wis. Stam) Instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY - L✓Arl !; TROY DEVELOPMENT CORPORATION R ick A. Johnson � i' Notary Public. State.tt4'AliseensImAnoka County, Minn. Charles S. Cook, President My commission Is permanent. (If not. state expiration date: (Signatures may be authenticated or acknowledged. Both are not January 31 2006 .) necessary.) +• :i j, • Names orpeno.0 signing In any rapacuy nn," be typed or printed below their e�gnao,— '+ WARRANTY DEED STAT FORM OF t 1 008 SIN � �S�4EVVNfV1/V� M+vs . wo. RICK A. JOHNSON NOTARY PUBLIC- IMNNESOTA MY COMMISSION EXPIRES JANUARY 31,2W6 1B