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Home My WebLink About040-1292-60-000 Wisconsit 5:partment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety am Building.Division INSPECTION REPORT sanitary Permit No: (ATTACH TO PERMIT) 499287 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: Troy Development Corporation I Troy, Town of 040- 1292 -60 -000 CST BM Elev: Insp. BM Elev: BM Description: nn Section /Town /Range /Map No: B9 Z. $ i G CIST 24.28.20.1673 TANK INFORMATION ,�; A ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic L �� 3r /z(t Benchmark -7' �� , ?C1z ,, 90"v. •7 i Alt-W, Aeration Bldg. Sewer .8 X73 . a5 Holding St/Ht Inlet $9z.o5 TANK SETBACK INFORMATION St/Ht Outlet 7. 17 I'D • 7 TANK TO PIL r WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ Septic l7 I , t/rr 3a i Dt Bottom Dosing Header /Man. /Z, o 8'S6. �3 Aeration Dist. Pipe /Z. a$ Holding Bot. System PUMP /SIPHON INFORMATION Final Grade 5.35 'ro93 • SZ Manufacturer Demand St Cover,,,, ` PM 2-73 '79 7 LnIG OJ Model Nu er -- TDH Li Friction Loss Sys ead TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width / Length No. Of Tre r PIT DIMENSIONS No. Of Pit Inside Dia. Liquid Depth DIMENSIONS 4 I /� �� SETBACK SYSTEM TO P/L JBLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR -L • I �7C�W Type Of System: � i 3D / � )� � _/� UNIT Model Number; rbv� A L�,tJ DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size I x Hole Spacing Vent to Air Intake I Pipe(s) \ \ -$ Lj .4ill Length Dia T Length ` Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Q 5 Bed /Trench Edges Topsoil \ Yes No es No COMMENTS: (Include code disc pencies persons present, etc.) Inspection #1: / / Inspection #2:__/ / Location: 301 Lindsay Road Hudson, 4016 (NE 1/4 SE 1/4 24 T28N R20W) Troy Village 5th Addition Lot 145 Parcel No: 24. 8.2Q�1 7 1.) Alt BM Description = i n 6z C ft Je `7 ,r5 3b3 I �� P' U Sa.�` t 2.) Bldg sewer length = r' J / Ar - amount of cover = � 4 L d � e l f - ,D.4 �a KP� Lao `'�• �`'`� y � Plan revision Required? , Yes No L 2 � �? r„ Use other side for additional information. J v Date Insepctors nature Cert. No. SBD -6710 (R.3/97) Coll nnnerce.Wi,gov Safety and Buildings Division Count y 201 W. Washington Ave., P.O. Box 7162 � � '� ) x sco s i„ Madison, WI 53707 -7162 Sanitary P6rmit Number (to be filled in by t t i nepwhinent of Commerce e 4 cl Z g Sanitary Permit Application la Transaction Num r In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the a W404TS j t1 unit is required prior to obtaining a sanitary permit. Note: Application forms for sit are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for seco u ses in accordance with the Privacy Law, s. 15.04(1)(m), Slats. yt(j� I. Application Information - Please Print All Information �1 Property Owner's Name J , s EIV D _ Property wne s Mailing Address FE B f� Property ocation - B V ZOO&vt. Lot City, State Zip Code Phone N tuber ,� y,, Section ST, CROIX CO (circle one)- / 73) Lot # 11. Type of Building (c eck all that apply) ok T N; R E o1, /(O Subdivision Name I or 2 Family Dwelling - Number of Bedrooms oA f r� Sdbw� i dock # --- ❑ Public /Commercial - Describe Use kbL P [ ..-% -4- ❑ City o ❑ State Owned Zescnb , Use CSM Num r El Village of I " -6& px � SY :6TJ, 1M Town of L� III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System y p y ❑ Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. El Permit Renewal ❑Permit Revision El Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that appl Non- Pressurized In-Ground ❑ Pressurized In-Ground ❑ - r A e ❑ Mound > 24 in. of suitable soil [I Mound < 24 in. of suitable soil A At-Grade _ ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat ent Area Information: p Design Flow (gpd) Design Soil Applicatio ate(gpdsf) Dispersal Area Required (st)/ Dispersal Area Propo ed (sf) System Elevation VI. Tank Info Capacity in Total of Manufacturer Gallons Gallons Units New Tanks Existing Tanks o v 0 R w Ya �aJL SZ'5 Septic or Holding Tank 7 Dosing Chamber VII. Responsi i Ity Statement- 1, the undersigned, assume responsibi for installation of the POWTS shown on the attached plans. Plumber' e (Prin Plumber's ignature MP /MPRS Number Business Phone Number Plum 's A ress (Street, City, State, Zip Code) VIII. County e artment Use Onl Approved ❑ Di approved Permit Fee Dat Iss Issuing nt Signature $ T•� 77 b� 11 Ow Reason asons for Disapproval nial S IX. Condit ��I 3 ) 1. Septic tank, effluent Met e61W I+ n �l dispersal cell must ail be 22&A / rtmMtainad t `.�Q� fbt JcS f �2 PeAwoe. �' 8O U " as per management plan provided by plumber. is 2. AN setback regttiremm" roust be maintained �6 t) SR.. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD- 398 R. 01/07) Valid thru 01/09 ' IJt �. 1�: we.J3.- .+.e 5 J J 6Q�- t�l.b� Q'a C:.'CV �•"�oc /�O �� , 4 I gor, d" ;ihb +Ti�40 9bo' 91(1„. - j 4 qco5 lath ab a �a v i aJ ,r+ pY 71 1 J f Y o p o o 7 p. yew � Q y Y ®� j LAGE 'HE SE 1/4, THE NE 1/4 OF THE SE 1/4, AND THE SE 1/4 OF N, R20W, AND THE NW 1/4 OF THE SW 1/4 AND THE SW 1/4 C T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN, F OUTLOT 9 OF THE PLAT OF TROY VILLAGE. MONUMENT, I i WEIGHING I 1 1/4" x 24" OUTL O T 2 * /LINEAR FOOT SET pLITLOT CORNERS TRO Y VIL L A GE PE W E I G H I N G y S I ET. UND . o / EMENT . 11 00 ACRE 43,560 S.F. SEMENT . �„ pp '' ° . •. E, SEE NOTE #3. O 144�?�0 1.000 ACR INFORMATION. ^� O°^ �O- p,O 43,560 S.F. S )° \ T PATH. �" �ti \ �, 'o .00 O E SE 1 /4 ° O ° ^O Sj 1.0 0 ACRE A5 ° °, gip' p,� 43,560 S.F. , 142 o / 1.000 ACR�2S N� 43,56 S. F. -- o =� - -- O pp O , 141 °° °p0� 1.000 ACRE \p, 3,560 S.F 140 0' °o- �'� 1.002 ACRE 3,660 S.F. LLI D��#G7f93L mmm TROY VILLAGE FIFTH ADDITION ►4.11 LOCATED IN THE SW 1/4 OF THE SE 1/4, THE NE 1/4 OF THE SE 1/4, AND THE SE 1/4 OF THE SE 1/4 OF SECTION 24, T28N, R20N, AND THE 0 1/4 OF THE $W 1/4 AM THE SW 1/4 OF LOCATION MAP THE SW 1/4 OF SECTION 19, 728N, RIK TOM OF TROY, ST. CROIX COUNTY, WISCONSIN, �w�, ■OMX"�� BEING PART OF OUTLOT 9 OF THE PLAT OF TROY VILLAGE. b CURVE TABLE LEE a�A¢ M w 1181/ ma Xa QUO m IXw1 tm CAM SEVIN MM MW N. W SAM on we rpw 11 w � rw(TR 0m). ' I -- ...... CI 1 Gar Awi.w N' 1 ww m,m m.m NAwA.rl XN77w1 INwr1 r tlmnN 1111A.or N'Irw ISa pl.x 1Awn.r51Nww1 INww1 1p'1x'18N PIRRICINS i It XrNlNa ally worr IN.w X1.41 trwtl.ri 1Nwwi Irwrf , 1.0.yAIRM X001, SET, t I /4' 124' OUnD11 241 - 0 wNWAY wrrw A.w A.AS 1rup.rr In'wN•X IrAw1 Ipa'PIIC RI811NC I.1yAIRIA rmi SEl 1 I . , IA l�11:I i'wrr 111 0:n N0'11. N:a( AU'1r`r1111.31r! AT ALLoTIVLa Alomt101om, TROY WAGE CI _ ml w Nwm mw mm I AwN.r 1 I A'wr 1 1gww --- ^- V NN1t a - m.w I1 10.0 w.lr 1xYPr.Y1 l llwwl IriV3I'1 , 11/4' 124' 10 Plat X19111141 i- T � , Ni a4-0 1 a - W.N Nww Al.w 11L.w IN'w N.r! IwirwI INw II'1 I NfAII[g1 SCI. Cp - mm w4P lr w.m w.m SaYI'Stk[ tggNwl SWR N'I 1�yQ(, T CIt la m.w Nww Ix.w ta.w "' 'wN.Y 1 1 wxw 1 I11'wN' [ 1 ! I/1' lam PIR, 110/0. �� IM � C 1� al 111 II1.N Irv N.w 41.11 11140x.?( 111 /rl Ia'RJI'f /\ IJ - 111.m N'Nr w.R 111.w !11'w31.Y[ IWI11rl Iwrwl CN ql 311.w wwr r.n If.tl 131wN.r1 tWRAP 1WIX411( I Ii /1 "ITGI PIPE, fD50. e11 lit nAr " w.w w.x Irwaxl Iwlrx'1 1wmw! \,ia4aD5 a1.w m w a r w r w.fi IN.w 1rwa.rl Iwwww! I l 1llww Nww( ! - - IY WIN UTILITY EAW. `' SCNL•Y I np 4yrt tt 1a n. p'r .tl 111110 N'N'A.Y[ S Nw7I --- � WxIwJDI Ex N w.m '3 IN. IN.W 1rwR•YI Ill'ww1 IINww( \ \ v' \ ^F/ CIA - Iw:w Nww w.w 40.11' M AwN.Y ( 1 1 1 uww [ IQ 110E aAINIR EAttwNf CIA w Im.w rww I.w 11.4r MawN.r! Xllwwl 1rww1 tit Im.w M �.R Il.w N31wN.0 XAwwl IWwr' C0 - M Sprig Jq.w WE NNw x.1111Nw INN 1 rww1 -•- SUILDIIC WIM LIR, SEE NOTE p. nl mnwa in .w wor m. WIN Xrwu.Yr Irww1 lwxwi \IdOD m mMa W.m wifr w.w as Xirva.Y1 XwxIr1 1rxw1 rN-f FRJ'104Y ROCIUD INOIN111 1 .4ySw bs tllA0la m.w "" w.w w. I'N sowleN INwwr \ Crmw11 GAS wow 1111 Jn.w 111'xN.Yv NNVmI IN "1PJr1 6 \ S w - AMR a'wx• 311.1y Will 1rwm.Yl SWxr11 WSW I ` E11911C WAT CAAI PAM. ,%'/ (1 \ f\ Al" uc OF IIE 141\ 9 1/4 a R Y , \ IAm Aq[ • 45750 9J. . \ 142 \ on: 1. x " aX Nip�up STS wr41pwb8NfY wpXa ,l-0CD �� ) No I x KM IRS 6101 Is mMN Nr � • �� 1184 I Sra2YI52xT5,ll110r2kY°)rOL / - f. .._.._.._. NkNw I , 1.M NaLlrwl r�ll wwum NSeN, w31R iN'Annwm t 1 No V i IN All, wlwk mwl � � { hib5 , X M wnr mn Xe aI XilrNpl I¢N Nw III an¢. y S� 141,j J. i N ww X[p /g 111 f �, IDm / 1,11 l Fun X. 95 // 411 \ g�(?1N u 8 IT M em� 111 m Km A wwas p r K wltAmlrla W. �n1NNww dill al RAN uLOU. .RO;� ✓vl� 11_8 I \, DW Ss / ; ' `nnI ax - 5 I7�f 1 ' / (A(r2• ` �;ry \. ^ 2 80.111 a ISO 11 I�tlpA p�X4�WWK �C / 7 \ / w / amw nxw,Nwwlwanmw rwl�X won. 'liiaa (. 1111X1,11 I. Led mwslNwuwr4lrxna¢Xm UmtoA W.N. A ALL IIOI mN INl` 0 W) a WAS= 4 O"w rMml Ij I IA01 AOIFS aw NNAIw. 1 111X01 a q wwll, lNwWw w ADr OUTLOT 2 V 'D / IAOY VXLAGE_ \ r 1 M - 19 " i i Rh! . Imp x n nnw -01,10 118 1137 \ �E /P WTl0r 9 Y WMIW L", I i M....,..., 1 N a N0 a l 2 YN 2 n TROY VALACE i 125 r / ¢�EVAicN155Pm - - � �YR DUnOf s 1 - - 1 � � 1 V . 7 �.' �r�, 135. �' 4 SCALE M1 FEET �I U[ � +; n , I .111111 1 , jRZ.f111719_ As 1 J 2 o N In t 1 127 yl d, • \ u•I .III ?b[s1 1 134, \, j ti f °auAVV , 140 xD � J �IUDI v. 118 * � �•• .1 w' •� OWFII FiglIm11N0 f0IN8 i I �I \ I \\ Alto FALLS, NIMMIN Som QVROT 9 Aw aim IHn 110 a a No, m, Ma. _ a TROY KALE iI 129 RVIE THIS ISM DAY OF wpb M, q 9 4 OUTLOT 16 Pow OF I '� 1.012 AIRS I 101.127 Sf. I S M CONGA \ \ 11 LK a Tw •. >< 4 , SEW 24 Tt. st 114 a SEC 24 - - MU _ TRAM a 1281 Alm 71.41 (2 1/2' fm PR) C41 { - •- . -. -. -. � C R II'N 1 -�• R �:' - - -- / FF ' - '- •- •-*-- - " -• -• •- -•. N CI do AL(S SIJ11 SP, ii`Qr N a X O NN7r IS', 16wAY �• i 4 T "�¢ -� - r CSµ - -f .. -_ _- _- - -T - -- -- 1 _ - GSLI YcY.7 101 i LDj -- -- r- - --= �r -- t it -= - - -� ',�-- - - -- --1 --- V y 7 VOI. 181 PACE 158 �I I x I, . I ry„wA 1 (Djl 40j1 J. P A VL�.4 C V a. +'u'31" _� I I LL 2 PAGE 19611 - - - - - 1 Yq b a PA(ll( ,pqN Hi) rROr_ GLEN Z �J_ >� PA7-1777 PAj£ 1777 I - A - TIO I¢TN D o IS Film A mini � I1 _ D[(Ar�R ael'1: i I I T!ROV gEw p0'VVE � 4�J�4o sE[f 1 a 2 i L' W=gnsin Department ofIndustry, SOIL AND SITE EVALUATIQX- REPORT Page I of I-) Labor and Human Relations Division of safety & Buildings in accord with ILHR 83.0�,'�ifils`. Adm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in si a Plan must include, but not limited to vertical and horizontal reference point (BM), direction an4 % of slope, scale or PA7.D. # 1\� EKj LN r, . dimensioned, north arrow, and location and distance to nearest road.' APPLICANT INFORMATION- PLEASE PRINT ALL INFORMATION R r B V__ DAT 9 b PROPERTY OWNER: PROMTYc_}OCATION N W -Ski /01- S Y° Iv t � L w il CO s,Z - S1, N �3c�1'1 U� ►yt T ��-(Z . N t /4 "fie 1 4 1 S14 Z-$ ,N,R Z O E ( W PROPERTY OWNERS MAILING ADDRESS• TYl :' P a��t� �S' NAME OR CSIM # 1Z.0 l,l.f�G E �l.'�'�fiD D . CITY, STATE ZIP CODE PHONE NUMBER ITY []VILLAGE [RrOWN ' NEAREST ROAD B Lrn fu , wl ry s S 4�y ( ) Ta-o�t L ttiAJ�S [X] New Construction Use [4 Residential / Number of bedrooms L4 [) AdditiQn to existing building j ] Replacement [ ] Public or commercial describe Code derived daily flow 6 o u gpd Recommended design loading rate — bed 2 9 9 , gpd/ft b trench, gpd1ft 2 Absorption area required $S % bed, ft y trench, ft Maximum design loading rate • _-) bed, gpd /ft • $ trench, gpd/ft Recommended infiltration surface elevations) S '6d • 0( PA MU*vLft31 (as referred to site plan benchmark) Additional design/ site considerations SIE7� Nom 'p Parent material I_zZSg aV L M K-ISH Flood plain elevation, if applicable 891 It S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FlLL HOLDING TANK U= Unsuitable fors stem �S ❑U ®S ❑U ®S ❑U I ®S ❑U ®S [:]U ❑S ®'U SOIL DESCRIPTION REPORT Bori # Horizon Depth Dominant Color Mottles Structure I Trerxi� GPD /ft 9 Texture Consistence Bouxiary Roots Bed tea in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. :,R :< I o -tl lo�ttz �tZ Si % eS 'a Z 1 1 -3? 1 S `i \Z 31� - s�S 1 �sbk mv'(�r Clv Ground YL(, - S o s M CQ S - -� •$ elev. 8 0 12. o n 4' -\� 1� �t R Y 16 - S o Depth to 3 �ucL D>� A 1V_j CW910�1 of 10`12S13101n -0 w/ C1 �• `1 limiting f t .$ ' g- �TT 1 etuJ /Ulu v Flly► ►vo Ent fZ , _72Z t e2Ir X1r kfib A'T1 Lr vt= H tt "22 - Remarks: 1?°in # L Z $ =z..[. - � �s� r Z3Lc� - is �e-sbk vnU'fI� ct� •1.�a 3 z► -5%3 -- 1 -S -i It- YLy esbh U -4 , s Ground elev. y S o - lo $ t p `-t �l6 - Sg r► 1 - -Z i -'b It t Depth to limiting factor - 7 113 ' Remarks: CST Name:— Please Print Phone: Arthur L. We erer 715- 425 -0165 egerer Soil Testing & Design Service -P.O. Box 74 River.Falls,WI. 54022 Signature: "1 13 - Z q 7 _ 13 u Date: I' y g CST Number: . I 220254 PROPERTY OWNER CUhf QkE)k)TtA- '1IZQ- SOIL DESCRIPTION REPORT Page ` of _ PARCEL I.D. # �Z is /Lrp) A/ ra t Bori g # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft \3 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trerxh t: >t C ;; � O —ll �D`l \Z �L2 S 1 �. b1SbIZ 3 �S � Z • 3 Z it - fib 1�H2 Z- s1) Zcsbk yy, es - . S -` Ground 3 y6=16 Lb It R- 31 elev. 889_ ft. `4 6 -L Luktz4( /G — S U S g Y►'1 — �'1 bu Depth to limiting 3 factor Remarks: Bring # , � ti � • s 1 d c \ ov►� �n � i c S Ground : elev. . 4 0 1S -01 VGA Sz- V1b Depth to c 9 A r" tht Cri= �b v- h. NS t 'F w / 0` lR 2 / / 0 y- limiting ! factor a ! Remarks: L Boring # -31Z S t Z4 'bk WI 1. 0- VA S Ground s Z3 3 2 1 L P- 2-L 2 C� 2,r►1 a-�k �� C S `{ , S elev. q 17 - 1 6g I() `t R V /` _ S t- 0 39 vvt — • -� . $ 8 9Sn ft. Depth to . limiting factor > L68 Remarks: 3%ng # o �o b 3 L Z :} F...... I a - 31L — s i 1 2 - Sb�c ► vt S 1CSbNt mv�F�- around n Nev. 11- Y/L B %.9 ft. )epth to S u -t�6 �u� t t� -416 — S U s� w1( — - .g actor S fM IvOTz t� 3 i�Z B a xJ G actor Remarks: _ •rl n'ra!1rf� , .r .. n Il PROPERTY OWNER Cj . SOIL DESCRIPTION REPORT Page ' of PARCEL JUp) /v G Bo # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont. Color Consistence Boundary Roots Gr. Sz. Sh. Bed Trerxh } I 0-11 V° -1 \4- '-'ht_z si 1 l �tsbk g sl) Z(2- sbk m'Fi CS - . S •` Ground 3 yb 1b W 316 l�sbk elev. n1 fF- eS • �l -S o ft. 4 16-Mi L L) J i— �G _ S U S g >�l 1 - •, u Depth to limiting factor > L l0" ; Remarks: , jring # <,�,;t_ >. >< >3 '511 1 w► Sbk Grou F�; `�tQs e\ oW d elev. (4 °lS -131 1 WA Q- lb ` Depth to c 9 A "tv- C)4= lb /6 Lv / 0` lR �� / p 1^ sic-, limiting factor 36" Remarks: ' 3oring # 3 12 st cS s I• to s i 3 3 2 lULi W 2.L 2 — c l Z►,a g,�k r� Y1 e S �l I . S around !lev. y z -t 6$ 1 t) �t R V /L s G t- o s9 1 — • -� , g ft. )epth to . miting actor >L68 Remarks: oling # F Lo`t's 3/[ round 1�SUltt r U �'►- �S •'1 .$ ev. 38 - lu I u `1 R Y�(o — S c� g9 r+'l) �InJ 1 - .� +S.9 ft. eplh to S u -lbb lu`I tZ y/6 — S O S citing S PC " NOTE Vt 3 �Z 8 a Ju G ctor Remarks: I PROPERTY OWNER CO-MIJQXJ'Ttc � SOIL DESCRIPTION REPORT Page 3 o PARCEL LD. f fit; AUp) Iv C� Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft 3. in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. : :...:. Bed Tw G ' 0 - 12 �o`'t - si1 z�sU1Z m Z M-1 Z log- tvz - S S9 1"l� �S - • .9 Ground 3 3Z_lUt3 - �4 , 9 - , 51$ - y� 3 elev. V ft. 4 lo$ -ISM VZ34�Z 0 9 Depth to limiting Cam w S I� KJY- 0 lZMV- ZLZ )p S 13 1 c ` f OF •S �t f± 3 s Remarks: Boring # Ground i elev. ft. Depth to — limiting factor Remarks: ' Boring # r i Ground elev. ft. Depth to limiting f factor j Remarks: 3oring # 13 around I :lev. R. Depth to imiling actor Remarks: PLOT PLAN Pa of SCALE 1 "= So' Tyo , -- L M -- -wT ZS" T -u�`1 1 lzL ctt� .8.13 V C B►1 �L890. 8.134A M V"IPN- \ 6•ljtlF S� • D _. -wL NCIG_ c " R 4C C'Y`� �i p�ivv6 L x.[_ -MUK . of 3 -� OF- - Q_U LuT � } a4- zg� -i3� zz ozsy -. - (715 ) 4 .S -O 6S CST Signature Date Signed Telephone No. CST # PLOT PLAN Page of SCALE 1 "= So' Tvo s � 1'ru�;s � � .. 8E �T LET 2S" T- -�Z -u�`1 ►l��c1#� 4,'Qt Q- 8gol I \ 'am — EL 890. I&A3 A \-WfN WL , PIPN• 'g. Vitt r h� s• 0 --- Ati- s'Tt�L__L-I OF jj q wT \13 zzozsy _ 715 ) 42.5 -016 5 _ CST Signature Date Signed Telephone No. CST # POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of FILE INFORMATION SYSTEM SPECIFICATIONS Owner ) _ Septic Tank Capacity ga l ❑ NA Permit # Septic Tank Manufacturer - s ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units NA Pump Tank Capacity al I9-NA Estimated flow (average) gal/day Pump Tank Manufacturer Z-NA Design flow (peak), (Estimated x 1.5) w'i gal /day Pump Manufacturer -0 NA Soil Application Rate `� gal /day /ft2 Pump Model NA Standard Influent /Effluent Quality Monthly average* Pretreatment Unit 0,NA Fats, Oil & Grease (FOG) <30 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 <30 mg /L 0 In- Ground (gravity) ❑ In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L gNA ❑ 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 Event Service Frequency inspect condition of tank(s) At least once eve ❑ month(s) (Maximum 3 ears) ❑ NA n'' year(s) y 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 eve ❑ month(s) (Maximum 3 ears) ❑ NA ry' 0 year(s) y Clean effluent filter At least once every: ❑ month(s) ❑ NA S year(s) inspect pump, pump controls & alarm At least once ever ❑ month(s) NA y' ❑ year(s) ='::s` laterals and pressure test At least once every: ❑ month(s) ANA ❑ year(s) v y At least once every: ❑ month(s) n NA ❑ year(s) 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. Wnen combined accumulation of sludge and scum in any tank equals one -third (Y or more of the tank volume, the entire come c` the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Viscc -.s�- ministrative Code. i =r. ices. including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment a se =icing at intervals of _<12 months, shall be performed by a certified POWTS Maintainer. s:73;'! be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page e�2 Of 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 Name Phone - — �– Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY 'Jame Name -acne Phone s : _ -e ^t was d awe: - =_ : "ance with chapter Comm 83.22(2)(b)( ":4d) &(f) and 83.540►, (2) & (3), Wisconsin Administrative Code. START UP AND OPERATION Page of 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 Name Phone _ _ S__ Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name `acne I Phone ? as =tea_ - __— =nce with chapter Comm 83.22(2)(b -' �' &(fl and 83.54(1), (2) & (3), Wisconsin Administrative Code. y WQL 1416 FACE 444 STATE BAR OF WISCONSIN FORM 1 — 1982 600744 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS DOCUMENT NO. ST CROIX CO., WI RECEIVED FOR RECORD This Deed made between 04-06 -ft199 10:45 AN John J. itbxmrrwle and Barbara A. Rttgrme e, his wife, and YARRANTT DEED tmlas J. Ru a Ne T,. P e, is wife, EXERT 1 17 Grantor, CERT COPY FEE: COPY FEE: and . TRA115FER- FEE: - Troy Development Corporation RECORDING FEE: 12.00 PAGES: 2 Grantee, Witnesseth That the said Grantor, for a valuable cotssiderad conveys to Grantee the following described real estate in St. Croix THIS SPACE RESERVED FOR RECORDING DATA County State of Wisconsin: NAME AND RETURN ADDRESS & Carl, S.C. 125 f 54016 See Attached Exhibit ^Air d 97.5 9/ PARCEL IDENTIFICATION NUMBER This Deed is given in partial satisfaction of a certain land Contract dated May 20, 1997, and recorded on May 27, 1997, in Volume 1241, Page 331 -332, as Document Number 559970, as amended by Amendment dated January 12, This is ".0t homestead property 1999, and recorded January 14, 1999, in Volume 1395, Page 458, 6tm (is not) as Document Number 595728. Together with all and singular the hereditaments and appurtenances thereunto belonging; And Grantor warrants that the title is good, indefeasible in fee simple and free and clear of encumbrances except easements, covenants, restrictions of record and any liens or Iltetmbrances created by act or default of Grantee, its successors and assigns. and will warrant and defend the same. Dated this 12 day of j2292 y ,19 99 �. (SEAL) (SEAL) John Ruierivnele ■ J. Ruartttele (SEAL) Q'� �f"c ' Rn (SEAL) ■ Barbara A. Ru earrele Nell L. Rtti mlele AUTHENTICATION ACKNOWLEDGMENT Signatum(s) John J. Rttatroele and Barbara A. State of Wisconsin, Ruatmele, his wife, and Thomas J. Rtterrrele ss. County. authenticate i ay of Jattutary 19 99 Personally came before me this day of 19 , the above named Samuel R ri TITLE: BER 5 BAR OF WISCONSIN I (If not, authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY I tleyw)od & Cari, S.C. , Box 125 tb.tdson, wi 54016 Count Wis. Notary Public, Y• (Signatures may be authenticated or acknowledged. Both are not My commission is permanent. (If not, state expiration date: ii necessary.) • Names of persons signing to any capacny should by typed or printed below their signatures. STATE BAR OF WISCONSIN Wtseonsin Lega! Blank Co.. Inc. WARRANTY DEED Form No. 1 - 1982 MXwaukee, Wis. VOL 14 _1.�7FGLf44 EXHIBIT A A parcel of land located in the SE 1/4 of Section 24, T28N, R20W, Town of Troy, St. Croix County, Wisconsin, being part of Outlot 9 of the Plat of Troy Village, described as follows: Commencing at the S 1/4 corner of said Section 24; thence N00 °05'12 "W (Assumed bearings referenced to the North -South 1/4 Section tine of said Section 24 which bears N00 °05'12 "W) 980.10' along said North -South 1/4 Section line to the point of beginning; thence N00 °05'12 "W 1546.19' along said North -South 1/4 Section line; thence S89 °00'29 "E 807.58'; thence S47 °00'00 "E 197.66'; thence S28 °00'00 "E 66.00'; thence N62 °00'00 "E 106.61'; thence S49 °00'00 "B 211.15'; thence S41 °00'00 "W 107.74'; thence S49 °00'00 "E 240.00'; thence N41 °00'00 "E 39.70'; thence S49 °00'00 "E 66.00'; thence S41 °00'00 "W 36.65'; thence S02 0 23'31 "W 610.84; thence S13 °04'23 "W 345.16'; thence S43 °43'25 "W 157.50'; thence N74 0 00'00 "W 362.92'; thence Southwesterly 40.09' along a 367.00' radius curve concave Southeasterly whose chord bears S15 °31'34 "W 40.07; thence N77 °36'12 "W 66.00' thence N88 0 57'16 "W 760.06' to the point of beginning. This parcel contains 45.726 acres, more or less, being 1,991,830 square feet, more or less. Subject to easements of record. Grantors hereby Release and - Relinquish all in the roadway Easement described as follows: A roadway easement 66' in width, located in the SW 1/4 of the SE 1/4 of Section 24, T28N, R20W, Town of Troy, St. Croix County, Wisconsin, being part of the roadway easement shown on the Certified Survey Map, Volume 2, Page 561, Document No. 347000, described as follows: Commencing at the South 1/4 corner of said Section 24; thence N00 °05'12 "W (assumed bearings referenced to the North -South 1/4 section line of said Section 24 which bears N00 °05'12 "W) 980.10' along said North -South 1/4 section line; thence S88 °57'16 "E 811.04' to the point of beginning; thence NO3 °51'06 "W 16.88'; thence N04 °56'00 "E 110.02'; thence N85 °52'59 "E 66.40'; thence SO4 °54'59 "W 115.42'; thence S03 °56'37 "E 240.44'; thence S86 °08'58 "W 66.00; thence NO3 ° 51'06 "W 228.59' to the point of beginning. r � ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM OwnerBuyer Troy Development Corporation Mailing Address 11806 Aberdeen Street N.E. , Suite 290, Blaine, MN 55449 Property Address 301 Lindsay Road, Hudson, WI 54016 (Verification required from Planning & Zoning Department for new constructs -) City /State Hudson, WI Parcel Identification Number 040 - 1292 -60 -000 LEGAL DESCRIPTION Property Location 1 /4 , 1 / a , Sec. 24 , T- 20 W, Town of Troy Subdivision Troy Village �� nD�'/,s Lot ## 145 Certified Survey Map # , Volume , Page # Warranty Deed # 7yl , Volume _��_� Page # Spec house e � no Lot lines identifiable no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site 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 Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintain must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 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. Number of bedrooms z l � l 0 7 SIGNATURE OF APPLICANT(S) DATE ** *Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * ** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05)