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040-1308-00-168
� 7 Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division � INSPECTION REPORT Sanitary Permit No: 463258 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: / Troy Development Corporation Troy Townshi Ae CST BM Elev: Insp. BM Elev: BM Description: Lb� Section/Town /Range /Map No: r$$V, I 6m i c_ C.e rl^ } 24.28.20, TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS S ELEV. /• Septic e7 Benchmark Z , 3 QQWP C ." Alt. BM Awatien (f � Bldg. Sewer `Z r u Holding C,v SVHt Inlet TANK SETBACK INFORMATION St/Ht Outlet � TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Z _ A4 G . 1 4:5 j � Dt Bottom �,� 7Y. q7 Dosing Z IV+ A: �5 i 46 > Header /Man. $ 7 0 Aeration Dist. Pipe U $ p Holding Bot. System e� �/ 0 3� �✓ PUMP /SIPHON INFORMA Final Grade l �� Manufacturer „,Zb f— C � GP� and St Cover Model Number G i G � /� 1 /_f- TDH Lift Friction Loss System ead TDH Ft `TA /1434 �. 7`, ►3 Forcemain Length • / Dia. Z / Dist. to Well SOIL ABSORPTION SYSTEM BED /TRENCH Width p Length No. Of Trenches PIT DIMENSIONS No. Of its Inside Di_ Liquid Depth DIMENSIONS � zee Z _71e,” SETBACK SYSTEM TO P/L JBLDG IWELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR / Type Of System: UNIT / ` n �� A' Model Number . DISTRIBUTION SYSTEM JA' Header /Manifold Distribution x Hole Size x Hale Spacing Vent to Air Intake Pipe(s) L \ Length Dia Spacing \ SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over r Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center 56 Bed/Trench Edges \1 Topsoil - f No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / ! J \ Inspection #2: ! / Location: 324 Lindsay Road Hudson, WI 54016 (SE 1/4 SE 1/4 24 T28N R20W) TroVilla e 6th Addition Lot 168 Parcel No: 24.28.20. 1.) Alt BM Description = - a� Q�" a. h� + — C.0 c3U�- 2.) Bldg sewer length = 66 - amount of cover = 16 1 Plan revision Required? Yes o Use other side for additional information. J __�I ___� L Date Insepctor's Si nature Cent. No. SBD -6710 (R.3/97) r— Satery and Buildings Division County - 201 W. Washington Ave., P.O. Box 7162 , � r ��y� �! -- VE l r1� Madison, �1'I >37 - 7162 Sanitary Permit Number (to be filled in by w at ti (608) 1 l z b _ � Department of Commerce jUiiarY r erlYlit Ap ry licat ti State Plan I.D. Number hi accord with Comm S3.2 1, Wis. Adm. Code, persona] info ration �V may be used for secondary purposes Privacy Law, s �.0 t i li Project Address (if different than mailing address) iic ,fiou luformatiou - Please Print All Information - H U 00 .. _ C 3 2 4 �1_ � 1'rol,c � OwnaYs Name , / / f Parcel # Lot ## Block ST. CROIX COUNTY ZONING OFFICE / z; iipirty Owner's Mailliig Addicss Prop e Location i ie Seat �+ 5t /o Section e Zip Code Phone Number � on L f t C / % SCE circle oil 1 fyoc of Building (check all that apply) � T �� N; R�_ eT _ � _ on par y i tom+ 1 nt - it an7ily Dwelling - Number of Bedrootrt, L ubdivision Name CSM Number 1 U Puuiio,C onmrercial- Describe Use U State Owued - Describe Use ❑Ci ❑Villa e s ty S runt ht - P of Ill. Cype of Permit: (Check only one box on line A. Complete line B if applicable) —� OgN ew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration P Plumber Owner I lV. tv p:: of Ya'4y1TS System: jCheck all that appl PI''r"avri`Pressurizcd In- Ground ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Constiucted Wetland ❑ Pressurized In- Ground ❑ Hording Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter ❑ i;acircularing Synthetic Media Filter Leaching ,,// g Chamber ❑Drip Line Yy.Gravel -less Pipe ❑Other (explain) V. l➢is ersalJTreatment Area Information: 7(gpd, '� oW � ? llesign Flow (gpd} Design Soil Application Rapersal Area Required (sf) Dispersal Area Proposed (s ystem Elevation -� Vi. Tank Info Capacity in Tot Manufacturer Prefab Site tee] Fiber plastic Gallons Gallo Concrete Constructed Glass New Erastiug Tanks " Tan Septic or Holdutg Tank rx- Aerotric 't'reamreut Unit Dosing Chamber i V11- Responsibility Statement- I, the undersigned, assume espons' y br insta of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' gnatu S Number Business Phone Numb r e Plumber's Address (Vt eet, City, State, Zip Coda) — VIM Couu /De arnnentUs 1 — r _Approved ❑ Di rov Sanitary Pemrit Fee "'ncludes Groundwater Date Issued Issuing A nt Sign ture o Slacnps) Surcharge Fee) ❑ Owner Given Reason o al 2 — Y`s. Conditions pprov 1 -- SYSTEM 0 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 i Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) 8HhNLS INC. FAX NO. : 6517389327 Nov. 262004 07:52:" F'6 f1cra c V j u f i, 6V `raw v� �.+���, To..��, g,,,� -r -P i:�- soil- k' - - - ter= - -- _ _ _ ...� -.. 200.00' Y F .� i c : ? C) f,'ir' { �v z S � Q 168 . EL 7.4 LQ Lew f. • ` - �. 11. 888 r � TOTAL_ !�.-- I I i liAhN S I iv _ FAX NO. : G517389327 Nov. 26 2004 07: 52AM PG 1 � - - �-sic2•c� V '� u �__ - LOT 16 Mzz�u - ..f L �- �� cKzty. y 7 i LO S f � A 4 dqx n � t v i• n r �..;.; ELEV. S r � �` ELEV 887.4 y 20 L,�O' Ei-E`V . 888.1 i3 �/ /ice TOTG! r Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ of Division or safety and Buildings In accordance °° pdm. ode (� �' � (� County 5 t !�1 Attach complete site plan on paper not less than 8 112 11 ind R ei EU. kEQt include, but not limited to: vertical and horizontal refs ce point (BM), direction and Parcel I.D. / PEN D j N(o percent slope, scais or dimensions, north arrow, and to tion and distance to nearest road1 Please print all Inform tlon. V L 1 2 9 2003 Rdviewe Date Personal information you provide may be used for secondary urpos Property Owner ZONING y Local n -601..t t- se 1/4 SG 114 S Z4 T .Zti N R ?J) c ><W CO VtIA M NT Coma. Lot# Block # Subd. Name or CSM# Property Owner's Mailing Address t t -A C-E i no .R EKJ0Fr sT ;M� 5W BOO /b8 TiR� lo�tRu�►J. City titate Lip Code Phone Number ❑ City ❑ Village ® Town Nearest Road &1A11MF- 4 (7 b '5) 75 7- 7 6 I'KD ! LI1u05AIJ ROAi� New Construction use:X Residential / Number of bedrooms Code derived design flow rate GPO ❑ Replacement ❑ Public or commercial - Describe: Parent matenal _ D1rt - / _1a L - t_t✓U1A L Flood Plain efevatlon ii app lica General comments and recommendations: COtu�lG�.tT10JJtL Z�.1 -(�KaU,Na�f JC4it5 0,5 LDAMA , RATE: V J Z-� 0 , r7 (,L cl e4p. - a-. A {Boring # Boring I� n. (/ I Pit Ground surface elev. _ - ft. Depth to limiting factor _ Sod icaGon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 Eff#2 I -5 o ZIZ — L 3-F m d5 3 0.5 o z I zf- d sh Cb _ O.S A St 3 )L1- 1e /Z — Sol f d C W - b +-5 0- 4 -n 011 3 — st I z 1� s L o. 5V — Is It s K d5 �_ 0. k.2 b° X7 -3 (0 7 - Vit i d I D.Z 1. z s s d� I 4- vRs — — o.� t. z Boring (HoevAW 1 .1 kn5 MANY Sk WATS i HOKA Z40A _ HAS Boring # I f I p;l Ground aurtzce elev. g y . V tt. Depth to limltlng factor _ 7 n• sell • ilption Rate u Horizon Depth Dominant Color Redox Description Texture Structure I Consistence Boundary Roots GP01ff? in. Munse{I Qu. Sz. Cont. Color Gr. Sz- Sh. 'Eff#1 Eff#2 1 0 -4 o R �Z — L 3f-m d5 Ccb Z -10 z1 — L s s .� 3 -14 t 3 — 5+♦ dS CS -n^ .J •� `f 14 -1 y 0 �� = 5 s dl s - ( Z S ►9 -78 1OvR s I 0- 0, t,Z Effluent #1 = BOO > 30 < 220 mg1L and TSS >30 < 150 mg/L ' Effluent #2 = BOD _< 30 mg/L and TSS _< 30 mgt►. + CST Name (Please Print) Signature O C5T j 8 2 N }A J0 HOt_I_ STE 83Z Address Date Evatuation Conducted Telephone Number W9875 b90 {h AVe, R1vE FAu-S LJT 54022 Q-?�-o3 �'1t5 y2b -1�7S 01 I y 3 Property Owner s D � �.,_ � w� PmE"P Parcel ID # u �" _ Page of E] Boring cam' / Boring # `G(3 (pQ 7 n. F C7 oplt Ground surface elev Vii Depth to limiting factor __ Soft Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'E02 •la Q7Z -- 'ryl ds .5 �•� 2 _zl zIz — L Zf - mabA d (!,b 2vf- .S r 3 Zj - 4K_—Y2 — St Z- oo< d h a y 3/ , I z oj< d cs l vF-M o p. q �ab�C dF1 CS v -Nt o, 5 /y 5 7 7 - o�fcsJ ❑ Boring E-1 Boring # ❑ Pit Ground surface elev. �__ h. Depth to limiting factor in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 Eff #2 Boring ❑ Boring # Ground surface eiev. _____ ft. Depth to limiting factor _ in. Pit ❑ Sol Ncation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff' in. Munsell Qu. Sz. Cont. Color Gr. Sz_ Sh. 'Eff#1 - Eff#2 ' Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608 - 266 -3151 or TTY 608- 264 -8777. MID-9330M 6M) j i - lye , LOT 16v i 1WZA V LL-AC ;G TOWN o F "S MM , ST. CKoot Cowoll Wl OA:SIu , 1Y(f 1KON F► SOIL PM5 — t v- 2u0.00' vi u 1 LOS 168 W O N n N 4 o o� 4 , M •- N 19 O t O N Z I! O i 1 l I g 168C ELEV. 883.6 1 } i mo o• B 16 A ELEV 887.4 ® B 1688 200x00 El: 884 ELEV. 888.18 tow i Wisconsin Department of Industry, SOIL AND SITE EVALUATION REPORT Pag I of labor and Human Relations g Division of Safety & Buildings in accord with ILHR 83.05, Wis<A r bode ' f�, \ COUNTY ,, s7 •��1K Attach complete site plan on paper not less than 8112 x 11 inches in size. r�cxfust irKlp6 but - not limited to vertical and horizontal reference point (BM), direction and ° /�i� ik pe, scils or PARCEL I.D. # k4qp L,,j r dimensioned, north arrow, and location and distance to nearest road. ' F f `� F _ � APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE ' PROPERTY OWNER: PROPERTY LOCATION CO "37t tV �L M T CzTLA"z - 8 ' 1l4 SE. 1 /4,SZ4 T '2-$ ,N,R Z,0 E ( W PROPERTY OWNER':S MAILING ADDRESS • COT LOCK # SUBD, NAME OR CSM # CITY, STATE ZIP CODE PHONE NUMBER ❑ ILLAGE ' NEAREST ROAD B k-rvi V �z , t^1 N SS 4,�y (SCE New Construction Use [DQ Residential / Number of bedrooms [ j AddibQn to existing buildin c T Replacement [ ] Public or commercial describe Code derived daily flow b O gpd Recommended design loading rate ___ gpd/ft ` trench, gpd1ft Absorption area required SS 18 bed, ft 150 trench, ft Maximum design loading rate - ' bed, gpd /ft " trench, gpd/ft Recommended infiltration surface elevation(s) SSO • S - ft (as referred to site plan benchmark) Additional design / site considerations SITE' 1U IN %Tfr1 LtEf ON PEE q Parent material Lk- t '- o.yk�2 6t�t,frt, ou'rkJ tR S N Flood plain elevation, if applicable 1J ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable fors stem 0S ❑ U ®S ❑ U 0S ❑ U , Q S ❑ U C'S ❑ U a s _ ■ U SOIL DESCRIPTION REPORT W n # Horizon Depth Dominant Color Mottles Texture ( Structure (��nce Botxx1ary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed jTrench vv 'S tz — st 1 z►�sb� �h �s , s .� w$ Z 1 S 3`8 1 31 f, S " 1 Z.vrn S btit Ground 6� O S9 w► �S _ ,� elev. e` a4 •o ft 4 1 % -Ilq toK rz - V/6 S U S9 M Depth to limiting factor -2 ll\{` Remarks: Bring # � o - 1.Z ►o�,tZ .3LZ � • st 1 2rlsbk �`Fh �`.`� - .s _ B Z �Z_L6 - 7 • S `-t 2 31 y - � su s►- o sg � cs -, .g G elev. �i ft Depth to S -�zo -s s st. a sg vn I •� •8 limiting factor Remarks: CST Name: - Please Print Phone: Arthur L. We erer 715 - 425 -0165 dress: - egerer Soil Testing & Design Service - P.O. Box 74 River.Falls,WI. 54022 Signature °! 4 - Z 9 7 - l37 Date: CST Numbe 2 202 54 �' PROPERTY OWNER Cj hk 11.)WTV— bk�J , SOIL DESCRIPTION REPORT Page 2 of PARCEL I.D. # IV G I Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ;:•: < >::, Bed Trench Z Zga{S 3Lto S Ground 3 L15-10b to `'t R elev. 9 ea.6 ft. Depth to i limiting t factor 7 i�G f Remarks: Bo In # , o 6k 11 S2 t o `t 2 3/ s i t Z►�c sb M m't�t- S — • d Ground 3 SZ,IL4 l0J - m V /6 S c� Sg N1 •`1 � - $ elev. i 8 ' Depth to -- limiting factor i > Ibb o i Remarks: B ring # s c 1 Z>w S 6 wt`F� Cw S } �:: Z 3a ='!� I��t lr — s 11 W1 3 bk w41 • zI .3 Ground I tal 5 I f t. Depth to limiting factor Remarks: 0-1$ t u `1. vz- 3 L Z S l � L`� � b IZ w►. �� � — , � , 1, F 2 -1 to KIL Zf Z _ 1n 3 -704'1 around " ;lev. i )epth to imiting actor �U h Remarks: _ PROPERTY -OWNER CLAM tJQitII'V.. U'C,y . SOIL DESCRIPTION REPORT Page 3 of� PARCEL LD. # is "ZO !y Borin # Horizon Depth Dominant Color Mottles Structure GPD /ft g Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Bed Trench x G C w — • 5 . b Z 16 1 O Li 2 3/L Z-* S }, Z vvt t- G S — S • 6 3 _ ` `7 Z 3 Ground ... L I 1 3b 30 '� S y g _ S d 6 v 9 elev. R ,o ft. i Depth to limiting factor } i Remarks: Boring # Ground elev. f t. Depth to limiting factor Remarks: Boring # Ground elev. ; it. Depth to limiting factor Remarks: 3oring # around �lev, R. )epth to imiting actor Remarks: _ •rl na•,nn •'.r . ,. PLOT PLAN Pag of g y � SCALE 1 "= SO Lt►�� s rM 2 0� _ LoT L S U K1 E acv XQI I�v6 sl sertt uN � W X- Z" w W1� S'lY1•Fx� LuT l3 �o LL" 99Z' S 6 l3'1 P� gLY,0L6 �5, 15 ltit`RPtt. c PveQ ice t'L.91S s e. ►]Z c / ,�s Low 'c'Rc1� . eL , e 8o S tiivL a ETL 878 / t'rL t _ �k 8Z 9 s B 131D � �~ 5 • fl, t G e.tJl S trLBB6 4 FMV of Pltc►wvtNJ `1�t �� Q `7 _ 89o.°Ry ' o )v f-Ipnv- tr`► tv - - L�►s Z - Z1ZFyei(�; �Yt 3 'xZS' 1�u6 wl_H1�� -:.: try p_� �' w t-wv s L w eP�'riu►a- � �� �g�L_ �'�n P � 5 - C�t� C�� 1 �'h - ( 715 ) 425 -o n5 A CST Signature Date Signed Telephone No. CST #— Wisc onsin Department of Industry, SOIL AND SITE EVALUATION REPORT Page I of Labor and Human Relations g Division of Safety &Buildings I in accord with ILHR 83.05, Wis. Adm. Code ' COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (8M), direction and % of slope, scale or PARCEL I.D. # 1, dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY _ DATE PROPERTY OWNER: PROPERTY LOCATION CO 1 ' 3 7L tJ T (_ZrLvz 604: -6G; 5Z 1/4 SE, 1 /4,S T Z$ ,N,R ZA E (o W PROPERTY OWNER':S MAILING ADDRESS. LOT BLOCK # SUBD. NAME OR CSM # \Z3 u1 ��l�ZM. )�Ui:E *1•- 2.3(� �j ` — T -Q \l-LftGE �e�-- CITY, STATE ZIP CODE PHONE NUMBER PCITY ❑VILLAGE [32rOWN ' NEAREST ROAD B �tti-t ry , ►^-I fv s s 41114 l- VKJN-s`P�t [XI New Construction Use [b4 Residential / Number of bedrooms V [ J AdditiQn to existing building (J Replacement (J Public or commercial describe Code derived daily flow b o o gpd Recommended design loading rate - bed, gpd/ft - (6 trench, gpd/ft Absorption area required 'BS 'B bed, ft - )50 trench, ft Maximum design loading rate bed, gpd /ft -' trench, gpd /ft Recommended infiltration surface elevation(s) 950-s - $ 5 ft (as referred to site plan benchmark) Additional design / site considerations SEA 1U IN Sffti-lspt ON ?'f�G F q L Parent material s ASS o - vN� Gt�L tint, pub A 3 N Flood plain elevation, if applicable NA+ It ru = Suitable for system CONVENTIONAL MOUND IN•GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK I = U nsuitable fors stem OS ❑U I ®S ❑U I. ®S ❑U I A QS ❑U I as ❑U CAS 0 SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure I I GPD /ft B rin # Horizon Texture Consistence Bardary Roots j in. Munsell Qu. Sz. Cont Color I `Gr. Sz. Sh. ` Bed Trerx� :w , :<n,.:.:;: r €_: r VL 3 c z s i t ZVA A v> •:`� " Z tS 3� L u �tCL 31b - — s � 1 Zvn S bk vn, - fir. �S Ground 3 3a-q". elev. eri� ft Lp--1 Vl( - S U s9 M) Depth to limiting factor I L \A" Remarks: Bring # f '•tip 1 o - LZ 10 3LZ - st1 Zrti "��h c-'^ -' - ,s 3 �•S 1- i f2- 31y _ S G►. O Ground elev. y t v `� lz Yl6 S ��ft V g9 M Depth to 5 � "� .S `1R 3Ly _ S Vt G� 0 s as limiting factor Remarks: CST Name: Please Print Phone: Arthur L. We erer 715 - 425 -0165 dress: eg erer Soil Testing & Design Service - P.O. Box 74 River.Falls,WI. 54022 Signature 9' 4 - Z47 - JZ Date: CST Numbe 22025[F PROPERTY OWNER CL)KM tbJ 'ZAQ. SOIL DESCRIPTION REPORT Page of PARCEL I.D. vz l )L�) /v G Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ITrench Ground -3 q5 -10L t0 4 R elev. Depth to limiting factory 6 1 Remarks: Bo irk # 0- z m s blz r-w t > >< Z t3 S2 1 0 `12 3 /•G - S)1 Ztin sbh mph Ground 3 sz -lo? l0 `trL '��6 S Sg t• — . `1 i .$ elev. 8 $3•o ft. Depth to limiting factor ? tub � Remarks: Boring # .3� z_m r E lu ti- Z. 2 : Ground elev. 0825 ft. Depth to limiting 1 factor, 2"1 O Remarks: 3 er # t c) -tvz 3 Cz si I k v�`fl•- �w :3 around — ,lev. 88-. L ft. )eplh to imiling actor )011 1 1 1 --- - - Remarks: PROPERTY•0'�NER CUKTTll.lkbultcL 'Z)q . SOIL DESCRIPTION REPORT Page 3 of PARML I.D. # lZ1E Np) /V G Boring # Horizon Depth Dominant Color Mottles Boundary GPD /ft Texture Consistence Bouary Roots ..< :`, ,.., in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. t p`1 \Z 2> Z. Bed Trer� Z 16-3(, I -�nS�k m`FI. C — •S •6 S Ground 3 26-00 - ).S `fIZ 3/y — S d6 C) Sg wt \ - • .Si elev. ge ft. Depth to l limiting factor EE ] Remarks: Boring # Ground ; elev. ft. ; Depth to limiting factor Lj Remarks: Boring # i3 ; Ground elev. j — ft. Depth to limiting factor { Remarks: 3oring # C3 around ;lev. it. Depth to imiting actor Remarks: _ Y PLOT PLAN Pa y of ' Ab SCALE 1 "= 50 LoT L�7 sv� `Dt � vG at - ofte U NE �-nT \15 .Zs 6N l''l,�z" wuuv fit: $V t L D set" t U'V tit X Z," wOU1� TTAize LoT 1.36 1=t.88Z s ._.� 8.137 l�. l37 A tNt�R �R �H�S 8, t31 F -V-Z53 6/ vP RZ 1 Cli�S . PvetL t c� !'t,97a 5 s. t3Z c ^5 ' Luw �R�C1f (!L, S eo 5 q s B. 131 b s' 3. t l G �t X06 9 WTU1 OF 1�1PC1+�ulNW �1�LV� Q!"? _ 8`10.°Ly Ohl 1 VQ NW SLgt Q v_� _av : � s L __:�? _ei'nu►�%,_ �_ _A99e t?uY 1 i� 59 -Z°t7 X 37 zz oZSy - -. CST Signature Date Signed Telephone No. CST # -i (n (n I0 N O I A 66' WIDE INGRESS ARD - EMM' FASNErNT C oo N Z O �/TGF� O N x �C_ NO ,347000 �4z I � Z rn � 1 � I � rn , I I / , 1 I N �_. � r w N 01 E 244.32'1 33 3 3 I Op I i 4 27' 200.05' v — �- OD r 4► — 1 I I ,00, Co f4 io 0 I�I� �g VAR /ABLE c vD I oo° I I - cv_rarH - WO MM 1 1 O nl Z N Tl � W - I co V m w I i I I I to ( I r C" LV 1 I 1 I� ° I �I N 1" „ 0 02 m v n ti I rn 20 E vl = I 244.35' 1-4 Z I = l Oly I I CD IOIC � , U 1 � 1 I� �• I� I. \ A 100 , I� {• �'o' I I. I , �h V 1 l O ISQ) I 1 • m I I IV I o I I tU) I 1 ,56'Li•Z 1 1 I M „00 ,00°90 N VAR /ABLE O1 i i --� mo - - - - - -- - c�Z 1 I - WIdTf>� _ z , 1 / I 1 1 / I�10 D� 1 FN I cal �I z I 100' I cs ' � 1 V I,N I 0 '/. - %P I I vl n 14 I I ,, . • s� � c.,., ��'p N O I �O / 2w \, /9 9 \\ (no to �� ' \` \ \ 2 „'� C” ` \ ` \ \ °o•, I w ' �m m l o J \ 6 6' I r• m I c� w 1 -l► , w v► D C)1 1 1 S 04 m 0 312.65' `°_ Cv / ^\ rn I I 1^ O vJl� '� III O z 1 OCA V , w Qp I / � • W ITV I I-n Cho Cll � in N > ( N 00 ° 31' 46" E N A � N w o 325.00 ao i of i , . �- I1, � • :' I I _ _. Private On -Site Wastewater Treatment System ( POWTS) Index & Title Sheet Owner: J YI z Project Name and System Type: Location: Street Address _ 4 Z ) c d z 1 C t 6 d r Legal Description ^ - cr c C. r Township /C�Aty Contents: Page 1: Sanitary Permit Application Page 2: Plot Plan Page 3: Soil Test Page 4: State Approved Plans Page 5: Septic Tank Maintenance Agreement Page 6: Warranty Deed Page 7: POWTS Owner's Manual Management Plan Page 8: POWTS Owner's Manual Management Plan Page 9: POWTS Owner's Manual Management Plan Page 10: Certified Survey Map Page 11: Copy of House Plans Attachments: i� Plumber /Designer: Mike Rogers Credential Number: 225094 Date: fiat'- CONTINENTAL Owner's Name 1 12/3/04 Review Date N Y or N Highly Pretreated Effluent 3 ft Suitable Soil Below System 12 in Chamber /Unit Height 8 ft Maximum Bury Depth 3 Ezflow EZ1203HP & EZ102H 600 Igpd Estimated Daily Peak Flow 0.50 gpd /ft In -situ Wastewater Infiltration Rate 1200.00 ft` Chamber /Unit Area 50.00 EISA ft / Unit _ 24 # of Chambers /Units 880.00 ft Proposed SAS Elevation 26.50 Bottom Area ft` / Unit Soil Surface Acceptable Finished Grade EL 4 (ft) Boring Grade Limitation SAS Elevation (ft) System Minimum maximum Number Elevation (ft) Depth (in) Lowest Highest Elevation? 882.00 889.00 1 887.40 120 880.40 886.40 No 2 884.00 86 879.83 883.00 Yes 3 883.60 80 879.93 882.60 j Yes 1. Depth of suitable soil required below the infiltrative surface for treatment. 2. Total height of chamber in inches. 3. Maximum bury depth as per manufacturer's recommendations. 4. Based on chosen system elevation, and chamber height. Top of chamber is finished grade may be required to meet minimum or maximum code standards. Version 4.0 (04/03) BARNES INC. FAX NO. 6517389327 Nov. 22 2004 07:14PM P13 a E oo L ..w- �. co CQ L Z co a co ,� � p U t o r• — N co c; �w, Q cq w 0 a m OZ V 9 uj tr QQQ i i L1 1 CL TnTA1 P. ti 1` BARNES IN C. FAX NO. : 6517339327 Nov. 22 2004 07:13PM P12 it A NDSW o Lr AVw r �,,�. v �_ ..,. .... .. ,... • � -,y, uv_: v...ry r GJ 1 .J r G.�JG r .: M / L L i M ��'�rflrt O •�_ e o ,0e ,''�► ! t + t� now � 1 ! �► s p two I wo dop ago "00 doe �. .YOM; a; r Ale r �. amp ,err' r ... 4 r ft= Now 'R r /� ,k- V CA Wes✓ Z 7� nn trL200��tS3 'ON xb 4 WOE.: 6d kd�'� :9® VOW ..� N TDH Calculations TOTAL DYNAMIC HEAD CALCULATIONS Gravity or Pressure Dosed Systems CONTINENTAL Owner's Name 12/3/04 Review Date X ff Gravity Dosed, or gpd Design Wastewater Flow X Pressure Dosed ft Total Combined Lateral Length Y or N Fo rcemain Drainback in Lateral Diameter ffj 75 ft Forcemain Length E 2 in Forcemain Diameter 215::d gpm System Flow Rate M 1.04 ft Minimum Design Head ft Vertical Lift ft Forcemain Friction Loss , 14.04 ft Total Dynamic Head 2.55 ft/sec Forcemain Effluent Velocity Choose Pump That Discharges At Least: 25.00 gpm at 14.04 feet TDH Maximum close volume is >20% of design wastewater flow gal Maximum Dose 0.0 gal 5x Lateral Void Volume 12.24 gal Forcemain Drainback 12.24 gal Forcemain Drainback #VALUE! gal Maximum Dose Volume 12.2 gal Minimum Dose Volume Version 4.1 ( 07/03) LL PUMP PERFORMANCE CURVE MODEL 151/152/153 TOTAL DYNAMIC HEAD /FLOW So PER MINUTE 14- 153 EFFLUENT AND DEWATERING 12 40 MODEL 151 152 153 � 35 i 10 152 Feet Meters Gal. Liters Gal. Liters Gal. Liters v 30 5 1.5 50 189 69 261 77 291 a 10 30 45 170 61 231 70 265 0 8 25- 151 15 4.6 38 144 53 201 61 231 0 20 6.1 29 110 44 167 52 197 �- 6 20 25 7.6 16 61 34 129 42 159 30 9.1 23 87 33 125 15- 4 35 10.7 -- -- -- - 22 85 10 40 12.2 -- I -- -- -- 11 42 2- Head: 30 ft. (9.1m) 38 ff. (11.6m) 44 ft. (13.4m) 5 0145086 0 10 20 30 40 50 60 70 80 90 100 GALLONS LITERS 0 40 80 120 160 200 240 280 320 360 t„ y g � Ci l q`' yF�Ly $/d'A1 OW PER MINUTE 014508A Model 151 Models 152 / 153 r.. ✓c.1� vri i.� - � + i AI ,p V�➢7- ;1'`� ;�' �` 9'�` .7 �'i F�Og7JINl j-r -- 5 7/32 I V _ 6 1/4 3 7/8 �— - -�.r 4 5/8 s$"Y � � 3 27/3 5/8 • Timed dosing panels available. 3 7/8 1 3 2ij • Electrical alternators, for duplex systems, are available and supplied with an alarm. - —{ • Variable level control switches are available for controlling o ®` j 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 FM 1420. • Over 130 °F. (54 °C.) special quotation required. -- II 11 1 1/16 12 ' 1/6 161/152/153 Series 151!1521153 MODELS Control Selection 4 S/8 ! Model Volts -Ph Mode Amps Simplex Duplex N151 115 1 Non 6.0 1 2or3 J BN151 115 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 2or3 BE151 230 1 Auto 3.2 Included 2 or 3 151 SK2064 N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4.3 1 2 or 3 SE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2or3 _ E153 230 1 Non 5.3 1 2or3 SELECTION GUIDE BE153 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. A CAUTION 2. See FM0712 for correct model of Electrical Alternator E -Pak. All wstallaiiun of contruis, protection devices and wiring should be dune by a qualified 3. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) IicenseJ electrician. All electrical and safety codes should be followed including the mast recent National Electric Code (NEC) and the Occupational Sat`ety and Health Act (OSHA). Or (4) float system. RESERVE P0VVt'_:RE_j For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 ,7 ` ® Louisville, 49 Manufacturers of. . L LD SHIP T0: 3649 Cane ane Run Road Road ��?? ® Louisville, KY 40211 - 1961 QZMZ17YaOMPB �FNCE lff& http://www.zoatter.com PUMP �0 (502) 778 - 2731.1 (800) 928 -PUMP FAX (502) 774 -3624 © Copyright 2003 Zoeller Co. All rights reserved. FRU'i BARNES INC. FAX NO. 6517389327 Nov. 26 2004 07:51AM P4 Yr•.a t • r WiscominOepamnantolCommer'.a SOIL EVALUAT!ON REPORT Ppga_ j of Dioulon of Satety and 9ulidings in accoroanca with Corn 85, Wis. 60m. Code °"--- County Attuch complete cwe plan on pioper not Less than a 112 x 11 Inches o SIza. Plan must ---� irxluoe, but not tlmitoct to vertical ana hortxontel reference point (SM), direction and Parcel I'D. parCe ntslope, scale or dimen north arrow. ynd location on distance to nearest road. C PEA fl I �B " • please print all information. Reviewed by Date �= Pis rfonal 6rtroMAhon too pro►ida fnay beusaa far 4Qra rids ry 9Urpoxal rP.;vacy l•w, a_ 15.04 t t) (h+1). Ptoportyowner 7 Progarty Location CaD v �� n ti T Ct^ err 5� 114 Sr* 1 /4 S 24 T Zj N R 2-0 w rt'mpersy>Dwnar's MekllftS ACdtosx lot >x Blur it i SuDd. Name or CStytW '• �' � its -R C7 E i 0a T -T S 1 co " City State Zip Code PlIone Number ❑ City L jj Village Town Nearest Roap i Q1.�k1�1� f M ' 1 X5 t (7 6'5)'757 - � ' "MD 5A ROt�i� fi New Construction UsG j&.Rsstdentiat / NumCCr of Cndrooms _ Code dorived design flow rate .�Q D _ _ GPQ 1 Replacement [] Puglia or wmmeroai • Dascrl4u: —. a --- .---- -^ Parent tnotostai - t"t �`Zt;1 A t L r, i L - fooa Fjain ctlo -fation ii apptic3biy _ t• r Goneral comments } and recommen& ioAt, (! JVT& - WAL 'L) G D 'TP- p-picHlan� 4 . � 8cnng 80ring ff around surtaca elay. !t. Depth to,Imtting factor _ �ZL in. t� P S Soil A iir,6tion Rate Horitop Depth Domirlartt Cotnr ROdox Desctiptien i gY!Ure structure Consistence Boundary Rooks G fsD /tP in. I Munseil ou. Sz, Cont. Color Gr. Sa• Sh. •E � •e(t"Z nr )i7� Sk Z 4 ,. i.. 5 - 1 W7 Z ❑ LtioVjZC '+ C4 teas MfkAj tA art s ; ;.tote r► r Z-04 Hs r0-(0% Boring �k- �� porSng F e3 V ft. Depth 3 zSl Pit Ground urizceniev. �� 1 h to IirsLteng tac in or _ 7 o� . c�,tl ' tkatECr, Raw Horizon Ocpth Dominant Color Radax OeSgipUon Texture Structvre Consistence sou ntlary Roots G PDli>= in, Murisetl Qu. Sz. Cont. Color 3 h , •S �traz t �'RL — L 0 -4 4 - c� 5 13Jrc-C ` r '4" - ttM Y Z T I 3 3 — S7 A5 C9 -Ml 9 ' �t3 - l4 1 � yt2. r�. s I — 11Z A b �. r F- fAudclt # = Boa, 30 220 mSJL and 7S5 >30 _ 150 m91L ' Fifl;�ant #2 BQO _ 30 rtt9n. and TSS _< 30 rrt9rl. +3: t CST Numbw t ` : CST Name (Plessa Print) Sl rawre 2Z 8 s J Data Evaluation ConauCed Tempnorae Nurnnar T -r' t j9875 AVE:. A . PklVE9,FAU -S Wf 0 g -off L715 '�2b -1 75 L, 40 U .a PO`v'irTS OWN]EWS MANUAL MANAGEMENT PLAN : r SYSTEM SPECIFICATIONS w�a w t Septic Tank Capacity r ,� g ❑ N 3 Septic Tank Manufacturer r 7 El NA 1 8!Gki iP Ali JrETFRS Effluent Filter Manufacturer � , � / ❑ NA '�uiub of Bedrooms 1QOgpd/bedroom p NA Effluent Filter Model _ � Dn ❑ NA j NuiitUer of Commercial Units _ NA Pump Tank Capacity ;, gal ❑ NA dwared flow (average)' e, gal/day Pump Tank Manufacturer L� r E' ; ter ❑ NA Dc.si�n flora_ (peak), estimated x 1.5* g al/day Pump Manufacturer zs> C] NA c ^ G' g y P El NA Soi1 Application Rate � gal/day fe Pretreatm Unit [l NA ailaont/Eifluent Quality (NAP) Monthly Average ** i ❑ Sand/Gravel Filter Peat Filter - D � 'rats. Oil &Grease (FOG 5 30 mg/L El Mechanical Aeration D Wetland Dsuciexnical Oxygen Demand (BODs) Total Suspended Solids (TSS) < 220 mg/L D Disinfection [I Other: <_ 250 mg/L Manufacturer: Model: -,- - -. * ** Dispersal Cell(s) �etiLaied Effluent Quality ❑ Monthly Average ❑ In ground (gravity) ❑ In- ground (pressurized) Bio&lieinical Oxygen Demand (BODs) < 30 mg/L ❑ At -grade D Mound Total Suspended Solids (TSS) i l .cal Coliform (geometric mean) 5 30 mg1L [I Drip-line C3 Other: --- <10 cfu/100mi ❑ Leaching Chamber Manufacturer l,axicntuun Elltluent Particle Size 1/8 inch diameter Model ?- t 1 -_7 /t Approval Stipulation ' *l' astewater Flow Verification on and calculations: Soil Application Rate g pd/ft z Area Req, j;z, it (Oilier than bedroom based) Absorption Area Credit per unit fc' Minimum Number of Chambers ❑ Aggregate Design Flow/Loading Rate- Ailin " Values 'typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Code ;uud septic tank effluent. COMM84 and be installed per manufacturers specifications * *Values typical for pretreated wastewater. and approval letters. ]DESIGN CRITERIA ri "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.a1.1990) 0 "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 L - "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 0 "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis - ASAE Publications 5 -77 and "Design Manual - Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980 C3 SBD - 10570 -P (R.6199) "At-Grade Component Manual Using Pressure Distribution" 0 SBD - 10567 -P (R.6/99) "In Ground Absorption Component Manual" C] SBD - 10705 -P (N.01 101) "In Ground Soil Absorption Component Manual" Version 2.0 _I S13D - 10628 -P (N -6199) "Recirculating Sand Filter System Component Manual" d SBD - 10656 -P (N.6199) "Split Bed Recirculating Sand Filter System Component Manual" 0 SBD - 10572P (8.6/99) "Mound Component Manual" 0 SBD - 10691 -P (N.01 /01) "Mound Component Manual" Version 2.0 o SBD - 10595-P (&6199) "Single Pass Said Filter Component Manual" 0 SBD - 10657 (R.6/99) "Drip -line Effluent Disposal Component Manual' n SBD - 10573 P (R 6199) "Pressure Distribution Component Manual" o SBD - 10706 -P (N.01101) "Pressure Distribution Component Manual" Version 2.0 Cl Drip -line Effluent Dispersal Component Manual for Multi-flo Onsite Wastewater Treatment Units C� MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every 1 7 ❑ months dD year(s) (Maximum 3 yrs .) Pump out contents of tank(s) When combined sludge and scum equals one -third (1/3) of tank volume inspect dispersal cell(s) At least once every 57 ❑ months 0-year(s) (Maximum 3 yrs.) Clean effluent fill - er At least once every '� p months c2l,year(s) Inspect pump, pump controls & alarm At least once every D months �M year(s) (3 NA Rash laterals and pressure test At least once every ❑ months ayear(s) p NA 'V'alves At least once every ❑ months 0 year(s) rda NA Other: At least once every ❑ months years) Z NA Page of i- L edw coxasiraction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that 111ay lwpddf , the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the rcruoved by a septage servicing operator prior to use. Sys sL rt up shall not occur when soil conditions are frozen at the infiltrative surface. a' >w Y io cri owner is res onsible for the operation and maintenance of the POWTS and submission of u required reports. The uanti p'P'� P P q� P 4 tY "d quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water - saving appliances aad fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water aor enees, iron removal - units, other clear water treatment devices and foundation drains should be discharged to the ground surface vvii,. uever possible. Note: this does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruir vt l5 and seeds, bones, and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non - biodegradable items such as baby wipes, tampons, sanitary napkins cuudoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, t.lisinfectwits, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS iiii . coatairiinate- your drinking water supply. a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Cc;inpactioa of snow over the dispersal unit may cause it to freeze up. L1 'Vuives 'Valves shall be operated in the following manner: Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any p oblems with the system are corrected to prevent back -up of sewage into the dwelling or surfacing. !N1 CTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Gptic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or ponding of effluent to the ground surface. Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effective locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NR113, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Pump Chamber/Treatment Tanks Component ' \ The inspection must include a test of all electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, surfacing, missing or broken security devices and other hardware and the condition of the filter. Any service needs or repairs shall be promptly taken care of. •Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surfacemustbe _promptly reported to the regulatory authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. Page of sv C. utW Ai- Grade, m- Ground Pressure The inspection shall inclade recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory uathorky. Pondiag greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure disiributioa system is provided with an opening at the end of each lateral to be used for flushing. The laterals should be flushed at least once every three (3) years. Pressure checks of systems with multiple laterals should be done to ensure that equal distribution of effluent is occurring to promote the longevity of the system. sports for maintenance, inspection, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative r'Jit i the P W 1'S fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is pi000riy and safely abandoned in compliance with Ch. 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 wiik, soil, gravel or other inert solid material. tit PY: IIN+GEN CY PLAN If Ylio 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 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. L3 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. L^7 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. p 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. <<)WA11N1NG>> S!.+ kTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEA'iIFI MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDY 0ONAL COMWIENTS PO'tri'TS S ALL POWTS MAINTAINER Name f ` % �i ' Name Phone d " Phone SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORITY blame I I Agency j . 0K Ce waT'r -B" ia! +Phone I Phone 41 1A;M>T ATA,1EXeGWTS OWNER'S MANUAL.doe Page of FROM BARNES FAX NO. : 6517389327 Nov. 26 2004 07:50AM P3 INC. uv., i �-Umr S CROI COIWrY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERT IFICATION FORM Owner /Buyer _ Troy Development Corporation Mailing Address 11806 Aberdeen Street N.E., Suite 290, Blaine, MN 55449 .. Property Address 3.�. � "t,-� o�.0 6 Gt�� � 6W7 . !'�/Z' ,5 LO / (Verification required fro Fanning Department tor new nstruetion.) City /State T r oy , W i s c o n s i n Parcel Numbe 0 0-jes 9 ©' zoo LEGAL DESCRfPTION Property I,ocatian S r ia , %;''Sec. . �T 4 `� N RO W, Tow 11 of - Subdivision V Lot # Certified Survey Map # � ; , Volume Page #I Warranty Deed # 6, 0 .Volume Y16 Page # —Z Spec house N yes 0 110 Lot lines identifiable)l yes O iio t SYS'ITF'm MAINTENANCE Improper use acid maintenance of youi'septic system could result in its.premature failure to handle waste;;. Proper maiateiiance consists of pumping out the septic tank every threeyears or sooner, if needed by a iiconsed'purnper, . Wlr�x- you.put i1)tc the system Can affect the f=mion of the septic tank as a tre2rment-,stage i%j the waste disposal system. ` The property owner agrees to submit to St. Croix County Zoning Department a cert.ifteation form, signed by the owner and by a taster plumber, journeyman plumber, restrioted plumNr .or a h - ased pumper vet ifying that (1) the pn�sire wastewater disposa.i 5 system, is in proper operating condition andlor (2) after inspection and pumping (if necessary), the septic tank is less thsn 113 fuii of sludge. I /we, the undersigned have read the above requirements and agree to maintain the private $ewa disposal system with the �1 °standsrds set forth„ herein, as set by the Department of Cominerce .and the Department of Natural Resources, Mate of Wisconsin. ;Certification stating that your septic system ha' .been maintained- crust be completed and returned to the St. Croix C,ounty.Zonuig =1.I�epartment within 30 days of the three year expiiation date. 1 / ZV7 O SIGNATURE OF APPLICANT DATE OWNER GLP-TIFICATION Iiwe certify that all statements on this form are iron to the best of my /our knowledge. I /we am/are the owners) of the €' property described above, by virtue of a warranty deed recorded in Register of De Office. SIGNATURE OF APPLICANT DATE ;:`' "`••" Any information that is misrepresented may result in the sanitary pennit being revoked by the Zoning Department, Include with this application, a stamped warranty deed from the Register of Uc�eds Office and a copy of the certified s�uvey maw if reference is made in the warranty deed. z iti �'. VQL 1 f FA'E 1 °7 1 z 44 4 STATE BAR OF WISCONSIN FORM 1 — 1982 EsOCy744 WARRANTY DEED KATHLEEN H. WALSN REGISTER OF DEEDS DOCUMENT No. ST. CROIX CO., WI _.. RECEIVED FOR RECORD This Deed, made between j 04-06 -1999 10:45 AM John J. Ruerrrnle and Barbara A. Ru e, his wife, grid Th omas J. RUP111111 and Nell L. Ru ettttte e, his wife, MARRAFIT f DEED EXEMPT 1 17 Grantor, CUT COPY FEE: and. COPY FEE: TRRIISM- FI.Et- Troy DevelopTient Corporation RECORDING FEE. 12.00 i I PAGES: 2 Grantee, Witnesseth, That the said Grantor, for a valuable considerati i conveys to Grantee the following described real estate in St. Cr'x THIS SPACE RESERVED FOR RECORDING DATA County, State of Wisconsin: NAME AND RETURN ADDRESS & Cari, S.C. BcV 125 III21son, 1 54016 See Attached FJdlibit "Air PARCEL IDENTIFICATION NUMBER 1 f i 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 not homestead property. 1999, and recorded January 14, 1999, in Volume 1395, Page 458,: 4bd (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 easettents, covenants, restrictions of record and any liens or Encumbrances created by act or default of Grantee, its successors and assigns. and will warrant and defend the same. Dated this 12 day of January ,19 99 • (SEAL) (SEAL) Sohn Ruin mele J. , Ruamlele (SEAL) ; .��Q !` 2�"t y"c� (SEAL) Barbara A. RuemTmle Nell L. Ruettmele AUTHENTICATION ACKNOWLEDGMENT Signature(s) John J. Rtlemmele and Barbara A. State of Wisconsin, :i Rue mele, his wife, and Thomas J. Rulemlele ss. County authenticate i ay of January .19 99 Personally came before me this day of 19 , the above named San�el R Cari TITLE: BER 5 BAR OF WISCONSIN (If not, authorized by §706.06, Wis. Stats.) to me known to be the person who executed the foregoing I� instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Heywood & Cari, S.C., Box 125 i Hudson, [TI 54016 Notary Public, County, Wis. (Signatures may be authenticated or acknowledged. Both are not My commission is permanent- (If not, state expiration date: necessary) i9 J Names of prrwns signing in any capacity should by typed or printed below their signatures. STATE BAR OF WISCONSIN Wisconsin Legal elank Co_ Inc WARRANTY DEED Form No. 1 — 1982 Milwaukee. Wis. nL 141GPAU44 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 line 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 °05'1 2 "W 1546.19' along said North -South 1/4 Section line; thence S89 °00'29 "E 807.58'; thence S47 0 00'00 "E 197.66; thence S28 °00'00 "E 66.00'; thence N62 °00'00 "E 106.61'; thence S49 0 00'00 "E 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 "W 36.65'; thence S02 ° 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 °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 all - interest in the roadway Easement described 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 °05'1 2 "W) 980.10' along said North -South 1/4 section line; thence S88'57'1 6"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. 10' WIDE UTILITY EASEMENT. ........ ....... 10' WIDE fjA AGE EASEMENT. BUILDING SET6�ACK LINE, SEE NOTE #3. . G 393 �y J, OW ,win £AST L /AE CF THE SW 114 GIB' Thr SE 1/4 °" I 135 134 / 132 to L /ND Y R _ s 59 0. _ — — %p S 88 E 349.38' — d I 200.00' � POINT OF T 149.38 �'! m OUTL O T 16, ROY VILLA G F /FTH ADDI T /ON �� B \ '= 6\ Z w° 168 1 N_ 167 N 1 W 166 I \ I ♦ e _ , 1.122 ACRES - N L446WS-7 1 CES v $ 1.419 ACRES c 48.857 S.F. c co 61.829 S.F. • �Q ^ I Z f 4ER . S33051,08"t5 _ 8 8 N N 88.57' 16" SON PIPE) r� w 4 ts.t 5' ._._ i • �� N 88 16" W 26: /AV AF THE SE / _GIB'. SECT /Q!V 24 ZZ f _484 PAGS4� =fir a t(T1 CS.M VOL. _6 I LOT 2 C.S.M� — — DOC.A421950 I PAGE 1777 DC a HIS , NT ;,, DR ..Y ., Y