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040-1245-80-000
FEB ST.CROD(COUNTY ,OMMUNITY DEVELOPMENT FIELD INSPECTION & SERVICE REPORT INSTALLATION AUTHORIZED SERVICE PROVIDER Installation Addres : 31-/ •,4i7hCd /Q r �o0.y Nam 01_AeS 0,711 Sar) Owner Name: �/' Street: s 2 Mail Address: 3/7 ,5�. /���1B5 w Mail Address: 1. �k�d6m, W/. 5yc/ro / ! ciry State Zip city 5CQ0 (A State t4'/.Zip :5,5/0.20 Phone S73- Fax Phonf.(?/5);ZV8-7X7 Fax(-//5)2,/8-774W e-mail ZGOS e-maiI e/Yl-CPI el INSTALLATION INFORMATION Model N Blower Brand and Serial No. Date of Installation Date of last pump-out i Size W�--/0 0C,,,4 •,2 2-04 EQUIPMENT DETAILED COMMENTS OF SITE CONDITIONS- OPERATION YES NO MAINTENANCE PERFORMED OR REQUIRED Electrical Pan el(s Visual Alarm 0 eratin Audio Alarm Operating (if resent Blower (s): Air Inlet Filter Clean Blo,%er Hood Vents Clear ~ Excessive Noise Excessive Vibration Treatment Unit (s): Unusual Odor 71P m a(vi -t? Svstem Vent Pum out Required: Primary Settling Zone Aerobic Treatment Zone EFFLUENT: LIMIT RESULT I Estimated Daily Flow �wr H (Standard Units) 6-9 S.U. Color Clear I Temperature Dissolved Oxygen effluent 2 m L Odor Slightly Musty odor not septic) OWNER SIGNATURE TEC NICIAN SWNAJURE SERVICE DATE ZS . /9. iZlab� FIELD INSPECTION & SERVICE REPORT INSTALLATION AUTHORIZED SERVICE PROVIDER j installation Addres : 3 17 5f. -4417C�5 Acr 00,y Nam a►-nes- Owner Name: 6a4r Street: Zt�2 \Iail Address: 3�7 5,z r7e,5 w��. Mail Address: e. �' I � mil• s�"'lo Ci State Zip City 0,5ced (A State 0/.Zip $ O Phone Fax Phon�(1/S)AV8-7X7 Fax 77W e-mail 6;0.5- e-mailQC��;/ dY1�f2.^ INSTALLATION INFORMATION Model N Blower Brand and Serial No. Date of Installation Date of last pump-out i Size s/0 EQUIPMENT DETAILED COMMENTS OF SITE CONDITIONS— OPERATION YES NO MAINTENANCE PERFORMED OR REQUIRED Electrical Panel(s) Visual Alarm Operating t Audio Alarm Operating (if resent) j/ Blower(s): .fir Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment Units : Unusual Odor System Vent Pum out Required: Primary Settling Zone .aerobic Treatment Zone EFFLUENT: LIMIT RESULT Estimated Daily Flow 5U L&.- ,.yvt H (Standard Units) 6-9 S.U. ¢ I Color Clear -� Temperature ' Dissolved Oxygen effluent 2 m L Odor Slightly Musty odor not septic),.,-----\ OWNER SIGNATURE TECUMCIAN SIGN SE VICE DATE M7 i FIELD INSPECTION & SERVICE REPORT INSTALLATION AUTHORIZED SERVICE PROVIDER installation Addres : 3 4n17d,5 Nam c,. QryleS o.rl Sar-� Owner Name: �CZ W' Street: - S 2 Mail Address: 3/7 5$ -• -4,?neS t . Mail Address: G City' State Zip Ci Q5C-W (A State 01 Zip S O Phone (.Z&,2,) ' Fax Phone(1/.'�)2ZV8-7X7 Fax(9/SJ21/8-77W e mail ZG0.5- e-mail QCP._5o,/0 cNl�fei' e�. GL INSTALLATION INFORMATION i Model N Blower Brand and Serial No. Date of Installation Date of last pump-out Size w/(- /0 0ct1 .,2 S.24/3 � EQUIPMENT DETAILED COMMENTS OF SITE CONDITIONS- OPERATION YE NO MAINTENANCE PERFORMED OR REQUIRED Electrical Panel(s) Visual Alarm Operating ✓-- -%udio Alarm Operating (if resent) Blower(s): Air Inlet Filter Clean Blower Hood Vents Clear Excessive Noise Excessive Vibration Treatment Unit (s): Unusual Odor I Svstem Vent i Pum out Required: Primary Settling Zone Aerobic Treatment Zone I EFFLUENT: LIMIT RESULT - - i Estimated Dail I pli (Standard Units 6-9 S.U. c ice Color Clear Temperature Dissolved Oxy, en effluent) Odor Slightly �t - i Musty odor r I not se ti OWNER SIGNATURE TEC NICIAN SIGN2kTURE S RVICE DATE 5-- C� i� County Safety and Buildings Division St. Croix 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) .y P Madison, Wl 53707-7162 1 111161AIV~ I State Transaction Number Permit Application k in accordance with 83. Wis. Adm. Code, submission of this form to the appropriate vernmental unit is required pri or to ing a sanitary permit. Note: Application forms for state-owned POW submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be usecondary PUYM~s in accordance with the Privacy Law, s. 15.04(1 m , Stats. Same I. A lication Information - Please Print All Information Parcel # Property Owner's Name ST C ~~o~ Kevin Larson R°,~~ 040-1245-80-000 / Z 1 Property Owner's Mailing Address GNTI Property Location / ) Govt. Lot /l 317 St. Anne's Pkwy w y,, NW y, Section 19 City State =54016 Phone Number (circle one) Hudson, WI (262).573-2605 T 28 N; R 19--E or W II. Type of Building (check ail that apply) Lot # / I 1$ Subdivision Name L or 2 Family Dwelling - Number of Bedrooms 4 L S2 /IPlat of Troy Village Block # 0 Public/Commercial - Describe Use Na 0 City of CSMNumber ❑ Val of 0 State Owned - Describe Use own of TM Na III. Type of Permit: (Check only one box on line A. Complete line Rif applicable) A. 0 New System 0 Replacement System 0 Treatment/Holding Tank Replacement Only t ter (explain) ddition of septic tank~.Filter ~►~-I (vh.Q. List Previous Permit Number and Date Issued B. ❑ Permit Renewal 0 Permit Revision 0 Change of Plumber 0 Permit Transfer to New Before Expiration Owner #320246 issued 9/16/98 IV. Type of POWTS System/Component/Device: Check all that a 1 0 Non-Pressurized In-Ground 0 Pressurized In-Ground 0 At-Grade o > 24 in.. of suit/able soil 0 Mound < 24 in. of suitable soil 0 Holding Tank 0 Other Dispersal Component (explain Le-1155 eatment Device (explain) White Knight WK-40 ATU V. Dis rsaUTreatment Area Informatio S ech STF 100 a ent filter to tailed at ttm dischar e Elevation Design Flow (gpd) Design Soil Application s al Required (s Dispersal Area Proposed (sfl System 95.98' 600 Gpd 2.00 Gpd/Sq. Ft. 6 300 sq- ft. app '600 Sq. Ft. t' VI. Tank Info Capacity in Total 0011 Manufacturer Gallons Gallons Units s~ New Tanks Existing Tanks U h w 3 a 1,250 1,250 1 Wieser Concrete X Septic or Holding Tank Dosing Chan bbea 750 1 Wieser Concrete X VII. Res Onsibility Statement- I, the unde gned, assu responsibility for installs the POWTS shown on fire attached plans. Plumber's Name (Prim) Plumber's ignature MP/MPRS Number Business Phone Number James K. Thom son 5--- 1VIPlZS 30021 715 248-7767 Plumber's Address (Street, City, State, Zip C 340 Paulson Lake Lane, Osceola, Wl 54020 VIII. oun /De rtment Use Onl roved Permit Fee Date I ued I uing Agent S gn App ❑ Disapproved $ 150. 00 i! v / 0 Owner Given Reason for Denial 4 IR. Co diSTE of A~~pppprovaUlteasons for Disapproval 3 QUrneA, -7 SYSTEM OWNSFZ; 4 ` 1.1 1. Septic tank, effluent filter and dispersal cell must be_s0vi_Ced /maintained - l(i.cG{~ClL a~ as per management plan provided by plumber. ~w ig~ _ fS. / d 2. All setback requirements must be maintained x6alwy 4t as ve, system and submit to the OU7 oe pa n 81/2:11 iac6es to siae SBD-6398 (R. 11/11) S / k 1, Index & Tilte Sheet - Mound POWTS Rejuvination Project Name: Larson Mound rejuvination W/ White Knight WK-40 ATU Owners Name: Kevin Larson Owner's adress: 317 St. Annes Pkwy, Hudson, WI 54016 Site address: Same Project Location: Subdivision: Plat of Troy Village Legal Description: SWt/4 NW 1/4, Sec 19 T .28N., R. 19W., Town of Troy, St. Croix Co., WI. Parcel ID 040-1245-80-000 Page 1 Index and Title Sheet Page 2 Treatment Tank / ATU installation cross section Page 3 Mound Dispersal Cell Sizing Calcualtions Page 4 ATU Specifications Page 5 ATU POWTS Agreement Page 6 ATU POWTS Service Contract Page 7 ATU POWTS Maintenance & Contingency Plan Page 8 Filter Specifications Page 9 Existing Treatment Tank Certification Page 10 Septic Tank Maintenance Agreement Mater PI r Restric ed Service: James K Thompson, Dept. of Comm. Credential #30021 Signature: Date: ~s Page 1 Of 10 Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01101) - Crm pnzscar' in P "',~,~o br~.s~ ~ er C12 a, r line. P ✓.C. hrM-SQ .~.CtMA~+1 froPoszd oJk~z~~~- we'-1(d A.T. u. ~owti- proposed 5ym-6" 6rF-100 eCrhtsf7i Fi l bc-r L (~so ( 2 o-'lo MOUND DISPERSAL CELL SIZING CALCULATIONS 1. Design Wastewater Flow: (4 bedroomsx100 gpd estimated flowxl50% design factor,); 600 end Design Flow 2. Infiltrative capacity of ASTM C-33 sand fill: 2.0 gpd/sq, ft. off. quality #1 3. Absorption area required: _ 300.00 sq. ft. 600 gpd / 2.0 gpd/sq.ft. at eff. quality #1 4. Existing absorption area: 500.00 gg, ft. Number of trenches: 1 Trench width: 5' Trench length: 100' Pg. 3 of 10 Page 1 of 1 KNIGHT TREATMENT SYSTEMS Attention: MARK C NOGA, PRES. 281 COUNTY ROUTE 51A OSWEGO, NY 13126 Telephone: 800-560-2454 Fax: 315-343-2941 Product Name: WHITE KNIGHT MICROBIAL INOCULATOR/GENERATORS„0 Model Number(s): WK-150 AND WK-200 ENHANCED BIOLOGICAL INNOCULATOR GENERATOR; THIS APPROVAL AND ITS CONDITIONS ARE LIMITED TO USE & INSTALLATION IN NEW POWTS SYSTEM DESIGNS; SEE SPECIFIC CONDITIONS FOR RESIDENTIAL WASTEWATER AND HIGH STRENGTH WASTE/COMMERCIAL [WK-150: MAX. DWF 2000 GALS./DAY; RESIDENTIAL STRENGTH WASTEWATER; MIN. TANK CAPACITY = 3000 GAL. or 1.5-DAY RESIDENCE TIME WITH 2-DAY RESIDENCE TIME PREFERRED; NOTE: THE WK-150 IS ONE WK-40 AND ONE WK-78 INSTALLED IN A SERIES; SEE ATTACHMENT FOR INSTALLATION SKETCH] [WK-200: MAX. DWF 2400 GALS./DAY; RESIDENTIAL STRENGTH WASTEWATER; FOR HIGH STRENGTH WASTEWATER/COMMERCIAL USE; MIN. TANK CAPACITY = 4000 GALS. or 1.5-DAY RESIDENCE TIME WITH 2-DAY RESIDENCE TIME PREFERRED; NOTE: THE WK-200 IS TWO WK-78 INSTALLED IN A SERIES; SEE ATTACHMENT FOR INSTALLATION SKETCH] MAX. BOD5 1500 MG/L/DAY; FOR AVG. F.O.G. SEE STIPULATIONS REGARDING TREATMENT TRAIN. Product File No: 20110173 Attachments: 20110173A Download approval letter and attachments for 20110173 as a zip file archive Product Name: WHITE KNIGHT MICROBIAL INOCULATOR/GENERATORa„O Model Number(s): WK-40 AND WK-78 THIS APPROVAL AND ITS CONDITIONS ARE LIMITED TO USE & INSTALLATION IN NEW POWTS SYSTEM DESIGNS [WK-40: MAX. DWF 750 GALS./DAY; RESIDENTIAL STRENGTH WASTEWATER; MIN. TANK CAPACITY = 1000 GAL. or 1.5-DAY RESIDENCE TIME WITH 2-DAY RESIDENCE TIME PREFERRED] [WK-78: MAX. DWF 1200 GALS./DAY; RESIDENTIAL STRENGTH WASTEWATER; FOR HIGH STRENGTH WASTEWATER/COMMERCIAL UP TO 1500 MG/L BOD5; MIN. TANK CAPACITY = 2000 GALS. or 1.5-DAY RESIDENCE TIME WITH 2-DAY RESIDENCE TIME PREFERRED; FOR MAX. AVG. F.O.G. SEE STIPULATIONS REGARDING TREATMENT TRAIN] Product File No: 20100070 4000 http://dsps.wi.gov/php/sb-ppalopp/prodcode_result.php/STA-3/SEWAGE_TREATMENT_APPARATUS_... 4/1/2013 Document No. I I III it III I Illiilill II I l i l i i l i ATU POWTS AGREEMENT 8 1 8 7 8 6 7 Tx:4155741 987422 BETH PABST Owner name and address: REGISTER OF DEEDS ST. CROIX CO., WI Kevin Larson RECEIVED FOR RECORD 317 St. Anne's Parkway 10/10/2013 12:45 PM Hudson. WI 54016 EXEMPT This indenture, made by Owner and their successors in interest, own a REC FEE: 30.00 POWTS (Private Onsite Wastewater Treatment System) requiring regular PAGES: 1 monitoring and maintenance in accordance with the manufacturers recommended Return to: procedures. These procedures must be performed by a manufacturer authorized St. Croix County Zoning Dep't. service provider licensed by the State of Wisconsin to perform these services. Results of these procedures shall be reported to the appropriate Governmental 1101 Carmichael Road Unit as required by code. Suite 1200 Hudson, WI 54016 Location of POWTS: 317 St. Anne's Parkway_ Lot: 18 Block: Na • Subdivision/CSM: Plat of Troy Village being part of SWY4NW'/< Section 19, T 28 N R 19 W Tn Of Trov St Croix County. Wisconsin. Parcel Number: 040-1245-80-000 POWTS DESCRIPTION: One (1) White Knight WK40 containing one (1) aeration treatment unit with treated effluent discharged to existing mound dispersal component. OWNERSHIP RIGHTS AND RESPONSIBILTY FOR POWTS: Property Owner as described holds sole ownership rights and is responsible for insuring inspection, opera ' nand maintenance of POWTS. V_:~ Kevin n Q (Dffie) Acknowledgement: These named, Kevin Larson, known to me to be the p rson executing the foregoing instrument. Subscribed and sworn to before me this -f- day of ' '2013. TA1kY=PUBL;I9,`State of Wisconsin - - w4e,'My ~,6mmi' sio ~ z Tres: September 6.2015 ~SdO,YttttJ Instrument Drafted By: James K. Thompson Pg.5 of 10 1 of 1 ATU POWTS SERVICE CONTRACT The proper operation and maintenance of the components listed below will significantly influence the performance and life expectancy of the POWTS (Private Onsite Wastewater Treatment System). This agreement authorizes A.C.E. Soil & Site Evaluations, L.L.C. personnel (Service Provider) or their representative access to the POWTS components during regular business hours to perform regular inspections and routine maintenance of those components. It is herby agreed by and between Owner and Service Provider that in consideration of the payments provided for herein, Service Provider vgill provide a manufacturer trained and State licensed inspector to perform periodic inspections of the POWTS components as set forth below. Service Provider will prepare a written inspection report after each inspection containing any recommendations for the operation, maintenance, and or repair of the POWTS deemed appropriate by the Service Provider. A copy of the report will be provided to Owner and the appropriate Governmental Unit. Service Provider will supply additional services, parts, or labor only after authorization by purchaser. This agreement does not assume any responsibilities or obligations that are normally the responsibilities and obligations of the Owner and does not cover any costs associated with operation, maintenance and or repair of the POWTS. In no event shall Service Provider be responsible for any special or consequential damages, including but not limited to, loss of time, injury to person or property, or incidental economic loss due to equipment failure for any reason whatsoever. This agreement shall remain in effect for a period of two (2) years from the date of POWTS installation, and will be automatically renewed each year thereafter unless amended or cancelled by either party with 30 days written notice. This agreement may be cancelled by Owner only if replaced by a service contract with another service provider authorized to inspect and maintain the specific POWTS components in question. Purchaser agrees to pay Service Provider the sum Of 150.00 per inspection. Four (4) inspections will be provided over the fast two-year period at six-month intervals. Payment for the first four inspections will be included in the cost of the POWTS design. One (1) inspection per year will be conducted thereafter with inspection fees billed at the time of inspection. Additional fees associated with effluent testing, when required, will be billed at time and material cost. POWTS DESCRIPTION: One (1) White Knight WIX-40 containing one (1) aeration pre-treatment unit, pre-treated effluent discharged to existing Mound dispersal component constructed in accordance with State Code. POWTS Location: 317 St. Anne's Parkway, located in: SW %4 NW '/4 of Sec. 19, T. 28 N., R. 19 W., Tn. of Troy, St. Croix Co., WI, Parcel # 040-1245-80-000 Owner name and address: Kevin Larson St. Anne's Parkway Hudso WI 401 10- 1 113 (Deland Ri ter) (Date) Service Provider: A.C.E & Site Evaluations, L.L.C. 34 au,so Lake Road sceola, 54020 (J pefK. Thompson) (Date) Instrum t Drafted By: James K. D"ni son Pg. 6 of 10 ATU POWTS Mound Dispersal Cell Management & Contingency Plan Pursuant to Wisconsin Dep't. of Safety & Professional Services 383.54, Wis. Adm. Code General The POWTS shall be operated in accordance with Dep't. of Safety & Professional Services 382-384 Wis. Adm. Code, and shall be maintained in accordance with component manual SBD-10706-P (N.01/01). All local and/or state rules pertaining to system maintenance and reporting shall be complied with. Questions on the operation or maintenance of the system should be direct to the installing plumber, Jim Thompson at (715) 248-7767 or the County POWTS Inspector at (715) 3864680. Effluent Quality The sewage effluent concentration levels generated at this site will be residential strength effluent as defined by the Wisconsin Dep't. o Safety & Professional Services. Influent quality entering the dispersal component of the POWTS may not exceed 30mg/L BODS, 30 MG/L TSS, and 30 mg/L FOG. Continggncy Plan If the septic system or any of its components become defective, the component shall be repaired or replaced to keep the system in prop, operating condition. Aeration Treatment Units shall be immediately repaired or replaced with approved components of the same or eqi performance. Persistent ponding within the dispersal cell will be addressed by removal of contaminated materials and reconstruction o the mound. Septic Tank The operating condition of the septic tanks shall be assessed at least once annually by inspection. The septic tank contents shall be removed when the sludge and scum in the tank exceed 1 /3 the liquid volume of the tank. The contents of the septic tank shall be dispo: of in accordance with NR 113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the content, the tank are not removed at the time of the annual assessment, maintenance personnel shall advise the owner of when service will be needed to maintain less than 1/3 scum and sludge accumulation in the tank. Any treatment tank opening deemed unsound, defective, o subject to failure shall be replaced. Exposed access openings shall be secured by an effective locking device to prevent accidental or unauthorized entry into tanks or other components. No individual should ever enter a septic tank or pump tank as dangerous gases ma} be present that could cause death. Start-Up Procedure: 1. Inspect aerator operation weekly to verify air flow, turbulence, monitor water flow, etc. for 30 days. 2. Test effluent samples as needed to determine BOD, TSS, & Ph levels of effluent. Biannual Monitoring & Ins ec i n Procedures - Dispersal Cell: failure. Biannual Monitorine and InsReetion Procedures: L Visually inspect all system components. 2. Monitor existing dispersal cell to determine condition of bio-mat and remediation of hydraulic 3. Evaluate sludge levels in septic tanks and pump contents as required by inspection. 4. Inspect treatment tank outlet filter & clean as needed. 5. Determine dissolved oxygen levels. Collect and submit BOD, TSS & Ph samples as needed. 6. ATU Inspections shall include the following: Blower Unit: Inspect blower unit and air intake, clean or replace filter as needed. Check for excessive heat, noise or vibration. Alarm &/or Control Panel: Test electrical connections, current draw, alarm, pressure switch and high water alarm. Adjust or repair as needed. Treatment Unit: Inspect manhole rings, covers, locks, vents, etc. determine operating condition of the unit by visual observation & measuring sludge volume in treatment tanks. Measure dissolved oxygen, temperature and pH of effluent. Collect effluent samples for B.O.D., Ph & T.S.S analysis as needed. Replace Bacterial Inoculators annually or as needed. Pg. 7 of 10 SIM/TECH lir FILTER Simrrech Filter The GAG Sim/Tech Filter is unique to the industry, engineered to provide maximum protection for your sanitary pressure system. tE?t ~ The Sim/Tech Filter has been designed as an effluent filtering device :o Eh` assure small holes in the distribution piping remain unclogged. Pressure distribution systems are very effective in treating effluent, but only when holes remain open. Many of these systems only partially fail, causing r contamination of ground water long before the system shows any visible signs of distress. r Placing a filter just before entering the forced main is a simple solution. f The filtering device installs by simply screwing onto the discharge port of any effluent pump, thereby filtering out contaminants before they enter the distribution system. Thus, maintaining even distribution of effluent. 3 The GAG Sim/Tech Filter protects any pressurized system including: S .na Filters - Spray Irrigation Systems - Pressurized Chambered Systems Recirculation Sand Filters - Mound Systems rT Scistl -9y1ev"' 11'X1ifttettriYtce - ~~'cortomical ~~xtett,& (i~e o' U2ai)i~ielc{ - JYrtp?oves S-'~ Itceyit rtcality 6y assu4ift5 evert Sfi1,,(e;tt Su6.mezsi6(e ~urrtys - (2art 6e c<sed in 6otA ?~esic{e)triad chic{ ~OlY)Y~1e7CLa~ ~~~~(Ccit(UYIs d Order Model Description List Price STF-100A2 STF-100 GAG Sim/Tech Filter (field assembly) egg c_. 972~" I ~ y The STF-110 has well over 112 mile of filtration media with over 319 cubic inches of open area to eliminate clogging. The 2,215 square inches of filtering surface allow a flow rate of over 1200 GPD, filtering to 1/16 inch diameter. This incredible amount of filtering surface is achieved through the unique shape of each triangular bristle, which more than doubles the filtering surface, with no uniform holes or slots to plug. W Order # Model Description Lift Price STF-110 STF-110 Disposable Septic Tank Filter (yellow bristle) _,.3s 6-5 0~' (b ST. CROIX COUNTY ZONING OFFICE CERTIFICATION STATEMENT FOR UTILIZATION OF EXISTING SEPTIC TANK(S) This is to certify that I have inspected the existing septic and/or dose tank presently serving the following residence: (Street address) 317 Page Lane, Hudson, wi 54017 located at: SW '/4, NWE '/4, Section 19 , Town 28 N, Range 19 W, Town of Troy , St. Croix County Wisconsin. Upon inspection, I certify that I have found the tank(s), to the best of my knowledge, will conform to the requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service October 2, 2013 Did flow back occur from absorption system? Yes X No (if no, skip next line.) Approximate volume or length of time: Unknown gallons 15 minutes minutes Tank Capacity: 1,250/750 gallon Construction: Prefab Concrete X Steel Other Manufacturer (if known): Weser concrete A (if known): 15years, installed 10/29/1998 ermit nu b=known) James K, Thompson icensed Plumber Signature) (Print Name) MPRS MPRS #30021 (Title) (License Number) MP/MPRS October 4, 2013 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 9 0 ~'la P~ . ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Kevin Larson Mailing Address 317 St. Anne's Parkway Property Address Same (Verification required from Planning & Zoning Department for new construction.) City/State &Bo Parcel Identification Number 040-1245-80-000 LEGAL DESCRIPTION Property Location SW pia NW '/4 Sec. 19 , 28 19 Troy T N R W, Town of Subdivision Plat: Troy Village Lot # 18 Certified Survey Map # Na Volume Na , Page # Na Warranty Deed (before 2007)Volume , Page # Spec house 17yesEko Lot lines identifiable Oyes[] no SYSTEM MAINTENANCE AND OWNER CERTMC'ATION 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 §SPS. 383.52(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. Uwe, 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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained 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. 1/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number 7_70ows 4 /0 / 7/ f3 GNA 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. 04/12) 984984 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI STATE BAR OF WISCONSIN FORM 2 - 2000 RECEIVED FOR RECORD .08/29/2013 08:58 AM Document Number WARRANTY DEED EXEMPT # NA 30. 0 . THIS DEED, made between Gary M. Gingrich and Jaimee D. TRANS REC FEEFEE: : 1290 Gingrich, husband and wife, Grantor, and Kevin James .00 Larson and Gall Renee Larson, husband and wife, as PAGES: 3 Survivorship Marital Property, Grantee. **The above recording information Grantor for a valuable consideration, conveys and warrants to verifies that this document has Grantee the following described real estate in St. Croix County, been electronically recorded Wisconsin: returned to the submitter :.i Lot 18, Plat of Troy Village In the Town of Troy, St. Croix County, Wisconsin. Recording Area Name and Return Address: Edina Realty Title, Inc. 520 Commons Drive Woodbury, MN 55125 1096934 Exceptions to warranties: 040-1245-80-000 Easements, restrictions and rights-of-way of record, if any. Parcel Identification Number (PIN) This is homestead property. Dated this day of August 2013 M, ingrich Jaim . Gingrich WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000 1 of 3 . s.... .t...'. AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF 1~~~1111'ICSo r~ COUNTY OF - authenticated this day of August, 2013 - ko'l Personally came before me this the above Gary M. Gingri ch and Jamie D. Gingrich, TITLE: MEMBER STATE BAR OF WISCONSIN husband and wife to me known to be the person or (if not, persons who executed the foregoing instrument and authorised by §706.06, Wis. Stats.) acknowledged the same. THIS INSTRUMENT WAS DRAFTED BY _ Martin D. Henschel 6800 France Avenue South, Suite 410 Edina, MN 55435 No ary Public, State of Minnesota " (Signatures may be authenticated or acknowledged. Both are not necessary,) My commission is permanent. (If not, state the `Names of persons signing in any capacity must be expiration date:) typed or printed below their signature. _ .1m is +r JESSICA LOU KLATT ' -.~Notary Public- Minnesota MY commission Expires Jan 31, 2015 • :1 •f WARRANTY DEED STATE BAR OF WISCONSIN FORM No. 2-2000 2of3 .1 u•r .M S+~'L''+.ryi c `1:.: .•..s.+.xv~~~.t.r:,. . v.''•3 'rte C5 I M ~ o 0 a a I o I ry M N ~ I d I 'C1 o z Z C c LL O Q I N z H rn z o 1 Z a m 04 rn U N 0 z O a v r p,°. ui 1 v v 'S o Lo U) 4)N o 2 2 1 ~w 0 E > > "+d o `o d o p CN 0 0 0 o S N N O O O I~j 1 'O w cE N N N I 0 O O 3 C U C O cc z z O Z O C) N a z C y~y > Q i f6 L m C/) O. nooIL a 1 ~w 2 O c N N :I o WSJ a a tv ; 0 •N Naaa a co o ai U) J U m rn 0) ~j N U (D N } 0 o 0 a O O N N 0 a) a n co C N Q } fn N ° o o o C) O 65 o N ° C N N N U a a oo a L. L6 3 U of c 0) 0) c rn r- rZ ~ H w w o l p ~ v v N d 'D '0 ~l O O H ° Cl O z N it w (n O ~ V CC ~j m d y it d ` d CL 4-, .2 4) ~i A 0(L2 Ov0 y SI•. CROIX COUNTY ZONING DEI'Al ' km AS BUILT SANITARY REPORT' __oo / Owner Address ISo D~'~ City/State ( 1 ~~c.~~•~r"..~ f- Legal Description: Lot _ Block Subdivision/CSM # I l' yr Sec. 12, T28 N-RAW, Town of wd PIN tt o~ 7 0$-10 SEPTIC 'WANK - DOSE CHAMBER HOLDING TANK INFORMATION: 120 Tank manufacturer Size ST/PCI2 5a/ 730 Setback from: House _Q,2_ Well P/L y'SJ Pump manufacturer es~t,l~s Mode! t,~ ~a Alarm location (HOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake Water Line Meter location Alarm location SOIL ABSORPTION SYSTEM: Type of system: Width S o Setback from: House ` Length Number of Trenches • Well p/L' Vent to fresh air intake 7S ELEVATIONS: Description of benchmark 4yd) Description of alternate benchmark Elevation Elevation Building Sewer l , ST/HT Inlet g 9, ST Outlet ! 9 PC Inlet PC Bottom S, 05 Header/Manifold Z Top of ST/PC Manhole Cover Distribution Lines 9l , 2 (y) `l d 7 z ( ) Bottom of System( ) 160 o 4~- ~~j d-~. ( ) Final Grade ( ) / 3 ( ) Date of installation/ /9-1 s~ermit number State plan number A4o?7ZL Plumber's signature License number 3 Date/0 /f / $ Inspector Complec plot plan + Wismnsin Department of Commerce /V 30 Tro ~1 11 ~ Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary320246 Personal information you provice may be used for secondary purposes [Privacy L S.15.04 (1)(m)]. Permit Holder's Name: it Village lit, Town of: State Plan ID No.: DERRICK CONSTRUCTION/TROY DEV' L''RO)p CST BM Elev.: Insp. BM Elev.: nBMDescripti n: Parcel T l~ ~4W=1245-80-000 TANK INFORMATION ELEVATION DATA A9800433 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. eptic OV C ~6 Bench c.F osin Aeration Bldg. Sewer /Vo Holding i St/ Ht Inlet D0. 1 fG ~~~j TANK SETBACK INFORMATION St/ Ht Outlet ~D• 9q, v Vent TANK TO P/ L WELL BLDG. Airl to ntake ROAD Dt Inlet Septi N NA Dt Bottom In NA Header/ Man. /04.gf Clto Aeration NA Dist. Pipe /601 la g&O loll Holding Bot. System i0 A•g q S-q6 PUMP/ SIPHON INFORMATION Final Grade e/S q9 Manufacturer, Demand Model Number ~I 7o GPM TDH Lift 11.E Lriction Systerrx~4 TDFjr(~;~ t Forcemain Length&d Dia. 3" Dist. To Well S L ABSORPTION SYSTEM Q~Wl DIMENRENN H Width t Length I No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING. facturer: SETBACK INFORMATION Type O i CHAMBE Model ter: System: YN r ti C UNIT DISTRIBUTION SYSTEM 11 8 4.- wc, f L.4 Header /Manifold Distribution Pipe(1) ' x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Z Spacing & SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over FDLepth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Trench Edges LZ Topsoil c ["Yes ❑ No 1~4es E] No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 19.28.19,SW,NW 317 ST. ANNES PKWY - TROY VILLAGE LOT 18 4- r, Wsl1 w~~ Cowf~c-,o~ C N~~1~'~r'~ X11 'I 5"~7'.„~ ygoU,,c~`,e• (Dow em - °P g4wf I1 ;Y t tb -~11q~ j~I~ ~0\)1-7~q6 ~~a X13 i ~ ~ 1 Qla~ Io Plan revision required? ❑ Yes No Use other side for additional information. ( ( '7 SBD-6710 (R.3/97) Date Inspector's Si ature rt. No. i r r ngAve. ion ERMIT APPLICATION 20Safety and SANITARY P 1 E. Washi shingt ngton Ave. 201 E. W Visconsin Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code Madison, 7969 Madison, W1 WI 53707-7969 • Attach complete plans (to the county copy only) for the system, on paper not less Count than 8112 x 11 inches in size. C • See reverse side for instructions for completing this application state Sanitary Permit Num([ber The information you provide may be used by other government agency programs ❑ Check if re^vi7~sion to pre application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number 1. APPLICATION INFORMATION - PLEASE PRINT AL INF R N _1_77W Property Owner Name y erty Location t• ~r~~C. w /4 N U_51/4, S t1 T N, R ESr) W Property Owner's Mailing Addre Lot Number Block Number 1505 O a A .r. City, Stat_e Zip Code Phone Number Subdivision N e or CSM Numbe~ N 4,g C e~ I ( (S) 11. TYPE BUILDING: (check one) ❑ State Owned ❑ ity Nearest Road Public 1 or 2 Family Dwelling - No. of bedrooms E] Village A Town OF III. BUILDING USE: (If building type is public, check all that apply) Parcel Tax Number(s) 1 ❑ Apartment/ Condo I 0_q l oL S - 2 ❑ Assembly Hall 6 ❑ Medical Facility/ Nursing Home 10 ❑ Outdoor Recreational Facility 3 ❑ Campground 7 ❑ Merchandise: Sales/ Repairs 11 ❑ Restaurant/Bar/Dining 4 ❑ Church/ School. 8 ❑ Mobile Home Park 12 ❑ Service Station/ Car Wash 5 ❑ Hotel / Motel 9 ❑ Office/Factory 13 ❑ Other: specify 1V. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. ___Y_ ew 2_ ❑ Replacement 3_ Re lacement of stem ❑ p 4. ❑ Reconnection of 5. E] Repair of an Tank Only- Existing System Existing System B) ❑ A Sanitary Permit was previously issued. Permit Number Date Issued V. TYPE OF SYSTEM: (Check only one) Non-Pressurized Distribution Pressurized Distribution Experimental Other 11 ❑ Seepage Bed' 21 00ound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 Icl In-Ground Pressure 42 ❑ Pit Privy 13 ❑ Seepage Pit 43 ❑ Vault Privy 14 ❑ System-In-Fill VI. ABSORPTION SYSTEM INFORMATION: 1. Gallons Per Day 2. Absorp. Area 3. Absorp. Area 4. Loading Rate 5. Perc. Rate 6. System Elev. 7. Final Grade (J000 1 Required (sq. ft.) Proposed (sq. ft.) (Gals/day/sq. ft.) (Min./inch) Ele at'on ~'6-0~ /-)-0 V f Feet 4Zkeet VII. TANK Capacity INFORMATION in gallons Total # of Manufacturer's Name Prefab. Site Fiber- Ex er. New Existin Gallons Tanks Concrete con- Steel glass Plastic App Tanks Tanks strutted eptic Ta / I,ISO ❑ ❑ ❑ ❑ ❑ L Pump Tank he++{iTaRfber u C ( ❑ ❑ ❑ ❑ ❑ VIII. "IMPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plumber's Name: (Print) Plu er's Sign tur o6tamps) M FFMPRSW No.: Business Phone Number: ~ae.~~: X15- -1 S .31 Plumber's Address (Street, City, State, Code). IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate slue Issuing Agent Signature (No Stamps) KA Approved ❑ Owner Given Initial Surcharge Fee) Adverse Determination z;v ~°/ao 9 /~o~g8 X. CONDITIONS OF APPROVAL-/ REASONS FOR DISAPPROVAL: Gr~ SBD-63M (R.11/BB) DISTRIBUTION: Original to County, One copy To: Safety & Buildings Division, Owner, Plumber . ~ S 7 e s Safety and Buildings 2226 ROSE ST lA CROSSE WI 54603-1905 Nvisconsin Tommy G. Thompson, Governor Department of Commerce William J. McCoshen, Secretary September 04, 1998 CUST ID No.220537 A7TN.• Rod Elsinger CALVIN W POWERS JR 1969 185TH AVE NEW RICHMOND WI 54017 RE: CONDITIONAL APPROVAL APPROVAL EXPIRES: 09/04/2000 Identification Numbers Transaction ID No. 142776 Site ID No. 158625 SITE: Please refer to both identification numbers, Site ID: 158625 above, in all correspondence with the St Croix County, Town of Troy agency. SWIM, NW1/4, S19, T28N, R19W Lot: 18, Troy Village Subdivision: Derrick Construction FOR: Description: Mound Object Type: POWT System Regulated Object ID No.: 419985 The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The following conditions shall be met during construction or installation and prior to occupancy or use: • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Adm. Code. • Before the sanitary permit can be issued however, a revised soil and site evaluation report must be submitted to the county. Specific areas needing correction are: (1) The site is reported only suitable for a mound (rating) but the recommended infiltrative surface is indicated as below grade, which is not acceptable. (2) The design loading rate is not consistent with the proper load rate assignment found in Table O for the soil morphological conditions reported. (3) Boring #2 is reported as containing re-dox features in horizon #3 but there is no clear description supporting that contention, and that is not acceptable. • Please feel free to contact me if you wish to discuss this requirement of soil condition reporting. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(d), Wis. Stats. - copy of the approved plans, specifications and this letter shall be on-site during construction and n t3 ! inspection by authorized representatives of the Department, which may include local inspectors ?$1 its required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. r sr c ar~8 c s, z0/V/ NG a ~ c~ s CALVIN W POWERS JR Page 2 9/4/98 Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. Sincerely, DATE RECEIVED 09/04/1998 ~ FEE REQUIRED $ 180.00 DENNIS R SORENSON, WASTEWATER SPECIALIST FEE RECEIVED $ 180.00 Field Operations BALANCE DUE $ 0.00 (608)785-9336, MONDAYS 7:OOAM-3:45PM DSORENSON@COMMERCE. STATE. WI.US cc: Leroy G. Jansky, WWS (715) 726-2544 Rod Elsinger, St. Croix Co. Tom Nelson, CST ` W.;cy1ri>;in Dopadnront of Coololo " SOIL AND SITE EVALUATION t)ivisron of 8aloty and Duilrtorys Page of rlnreau of Integrated Servicwl in accordance with s. ILHR 83.09. Wis. Aden. Code ~a / Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County `J include, but not limited to vertical and horizontal reference point (BM), direction and porcont slopo, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. N APPLICANT INFORMATION - Please print all information. Reviewed by Date Personal intormauon you provide may he used for secondary purposes (Privacy Law, s 15.1]4 (1) (m)). Property Owner Property Location ~-o f C --Pt L/& t~ Govt. Lot 1/4 1/4,S T ,N,R E (or) W Y1 Al Property Owner's Mailing Address Lot Q# Block# Subd. Name or CSM# City State Zip Code Phone Number ❑ City ❑ village [Town Nearest Road 54 New Construction Use: residential / Number of bedrooms Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow _ gpd Recommended design loading rate bed, gpd/ft2 trench, gpd/ft2 Absorption area required bed, ft2 trench, ft2 Maximum design loading rate bed, gpd/ft2 trench, gpd/ft2 Recommended infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations Parent material Flood plain elevation, if applicable ft S = Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill Holding Tank U = Unsuitable for system ❑ S 29-u KS ❑ U ❑ S &u 19s KU ❑ S KU ❑ S -E1 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft2 Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Ground - elev. ft. . S 5/15 Co12 o s Depth to limiting factor in. Remarks: l va, l i e vi c avk PA44uP k4-L, "tq mw4 S 5`_~f So I f 4-V lkclt v 5 lm war AAA-., Gl LGlrl 06,( JL//7 MA : f F ..r r s i p 3 Safety and Buildings Divcision Bureau of Integrated Services Hayward Office LaCrosse Office Madison Office Shawano O'?r~e Waukesha Office 209 W. 1st St. 2226 Rose Street 201 E. Washington Ave. 1340 E. Grcc;ii gay St. 401 Pilot Court, Ste. C Rt 8, Box 8072 La Crosse, WI 54603 P.O. Box 7969 Suite 300 Waukesha, WI 53188 Hayward, WI 54843 Phone (608) 785-9334 Madison, W- `'3707 Shawano, WI 54166 Phone (414) 548-8606 Phone(715)634-4804 f=ax (608) 785-9330 Phone (60?:)?6-3151 Phone(715)524-3626 Fax (414) 548-8614 Fax (715) 634-5150 Fax-(608) 237-9566 Fax (715) 524-3633 INSTRUCTIONS: To save time, schedule your review with one of the offices listed above prior to submittal. Fill in all applicable data and submit this form together with fees and plans/information. Your submittal must be received at least two working days prior to the appointment at the office where your review was scheduled. Please call any of the listed offices if you need help filling out the form or have questions on what information to submit. PLEASE PRINT VERY CLEARLY. A sample of a completed form is on the reverse side for your reference. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1)(m)). 1. APPOINTMENT INFORMATION - If you have scheduled an appointment, fill in the information requested below to save time: Appointment Date Reviewer Name Plan Identification Number ir a 7 -7 2. PRO CT INFORMATION If this review is a revis' n or extension to your existing plan identification number, provide that number here: ProjeA Name County ❑ City ❑ Village Town of. Project Location GOVT. LOT W 1/4 P W14,S ( T N,R t ~r) W 3. APPLICATION FOR 4. FEE COMPUTATIONS FEE SUBMITTED System Type (check one): System Type' (include new and existing tanks) A ❑ At-Grade Up To 1,500 gallon septic tank ....................................$110.00...................... /0 H ❑ Holding Tank 1,501 - 2,500 gallon septic tank .....................................$120.00...................... M fR Mound 2,501 - 5,000 gallon septic tank ...RE.00 Q N ❑Non-Pressurized In-Ground (Conventional) 5,001 - 9,000 gallon septic tank 0.00...................... P ❑ Pressurized In-Ground 9,001 - 15,000 gallon septic tank $ 0 ❑ Other. AU'~7~ J01 N998 Over 15,000 gallon septic tank .....................................$500.00...................... Up To 1,000 gallon dose chamber $AFET.Y.s&7519uS:..PIV '70 Building Type (check one): 1,001 - 2,000 gallon dose chamber 80.00...................... D JE3 Dwelling, 1 or 2 Family 2,001 - 4,000 gallon dose chamber ...............................$100.00...................... P ❑ Public Building 4,001 - 8,000 gallon dose chamber ...............................$120.00...................... S ❑ State-Owned Building 8,001 12,000 gallon dose chamber $140.00 Over 12,000 gallon dose chamber ...............................$160.00...................... Up To 5,000 gallon holding tank 60.00...................... Code Derived Daily Flow (OU gpd 5,001 -10,000 gallon holding tank ...................................$100.00...................... Over 10,000 gallon holding tank ..................................$150.00...................... ❑ Check if Replacing Existing System Experimental System (additional one time fee) ................$300.00...................... Revisions to Approved Plan 2 60.00...................... Petitions for Variance: Setback ...................................$100.00...................... ❑ Petition for Variance Site Evaluation .........................$225.00...................... Plumbing $225.00...................... Revision $ 75.00...................... ❑ Groundwater Monitoring Groundwater Monitoring Per Site $ 60.00 (other than a proposed subdivision) ❑ Site Evaluation in Lieu of Groundwater Monitoring Site Evaluation in Lieu of Groundwater Monitoring 60.00 Subtotal: 1 Priority Review: Enter same amount as Subtotal: MAKE ALL CHECKS PAYABLE TO: SAFETY AND BUILDINGS DIVISION Total Fee: 5. SUBMITTING PARTY INFORMATION Telephone No. (include area code & extension) LL"qpany Name Co tact Person No. & Street Add ss or P.O. Box ~ City, Town or Villa State Zip Code s Aerobic or prepackaged treatment system fees are calculated based on equivalent size septic tanks and dose chambers. t Revision fees are not applicable to temporary holding tanks or extensions to existing approvals. NOTE: Fees are pursuant to Wis. Adm. Code, Chapter ILHR 2, and are subject to change annually. OVER - SBD-6748 (R. 07/96) j fiN u ; C?jz, lob WORKSHEET - MOUND SYSTEM DESIGN Pot o- PROBLEM: i Design a mound system for a C o-- The site characteristics are: Depth to groundwater or bedrock in. Landslope.i! - 02 Percolation rate Distance from dose chamber to distribution system ft. Elevation difference between Dump and distribution systern $ ft. / Step 1 WASTEWATER L CAD .c)r`''O„`^ ~aw`a cal.' Step 2. SIZE 'THE ABSORPTION AREA A) Aa•ea required ,500 sq. ft. B) Bead or tr-nch length (B) _ /Da ft. C) Bed or trench width (A) >1 s S ft. D) Trench spacing (C) r wastewa er load .24 (3al/ft2/day B.~._, ft. TI-t-r t5 es " Step 3. MOUND HEIGHT A) Fill depth (D) ft. B) Fill depth (E) - D + slope (Aj') ft. C) Bed or trench depth (F) '$3't• D) Cap and topsoil depth (G) = ft. E) Ca d top oil depth (H) = ft. J. n Old- 1J S~r:CK \.OY~S~AuC, ~.v~ S~ !~f tjtA s19 7agrk RI kJ • i So N.., y 10-% Fa Bin l~ rt~Y u 1~c~0" ll~:>T le Step 4. MOUND LENGTH a A) ..End slooe (K) _ D + E1+ F + H x 3 J61 aft. B) Total mound lengt (L) = B + ?_.(K) ft. ta~Jo.~ /~+y Step 5. MOUND WIDTH 14 Al) Upslope correction factor = (9 A2) Upslope width (,l) rt D + F + G)(3)(factor) _ ft. / *f X-5 x 77 B1) Downslope correction factor = 4 6to B2) Downslope width (I) E + F + _ /t0 (favc tor) •___~~f C1) Total mc+und width (W) for bed = J + A + I -0 ft`. 54o y i C2) Total mound width (W) for trenches = j + ~ + (no. trenches -1)(c) + A + I ft. Step 6. BASAL AREA A) Infiltrative capacity of natural soil gal./ft2/day B) Basal area required = wastewater flow ~o?~ natural soil infiltrative capacity sq. ft. C ~ V, C Cl) Basal area available for bed for sloping sites = B x (A + I) _ sq. ft. C2) Bas are avail le for trench for sloping sites = B W J+ A sq. ft. IP-5 e) Q Basal area available for trench or bed for level ites B x W = sq. ft. Li.,; ri c, E u : o . f y- Y'( A) Ai Pig 0 n l pj5PS N l.s 6S Lod O 1 ro Y l~ yam, Step 7. DISTRIBUTION SYSTEM Per 7A) SIZE DISTRIBUTION SYSTEM f 1) Hole size in. 2) Hole spacing = 6 in. 3) Distribution pipe length ti-k 4) Distribution pipe diameter 1kx in. 5) Spacing between distribution pipes = _Q~ in. 6) Distance from sidewall to distribution pipe = D in. 1B) DISTRIBUTION PIPE DISCHARGE RATE ft. 1) Number of holes T'r pipe = 1-7 7 2) Flow per pipe GPM 7C) SIZE MANIFOLD 1) Manifold is central/ end 2) Manifold length a 0_ ft. 3) Number of distribution lines_ 4) Manifold diameter in. 7D) SIZE FORCE MAIN 1) Minimum dosing rate = GPM 2) Force main diameter = in. 3) Friction loss 70~ ' /6-v ft. 7E) TOTAL DYNAMIC HEAD 1) Vertical lift = $•0 ft. 2) Friction loss e 6 ft. 3) System head 2.5 ft. a~ ft. 4 Total dynamic head = 4 ft. C' G ~N'y J sos N Y (oS ' j~© fay ~ ,q. j2 ~.k...~ Icr low J 7F) PUMP SELECTION 1) Pump selected will discharge GPM a 1-~ ft. total dynamic head. 2) Pump model and manufacturer W o .311 L Z2 /f P 7G) DOSE VOLUME 1) 10 times void volume of distribution lines 7 cA gal./cycle 2) Daily wastewater volume : 4 doses/24 hrs. gal./cycle 3) Minimum dose volume gal./cycle 3t 8 K 1H) DOSE CHAMBER 1) Minimum capacity required = ~Q gal, Ucvnz;+, f-5 I - ! ---I- ! _ _ _ - - t _ --I - - - 11 Y S-D Jot 1 - - - Cip?, Y ?El A - - - p IV two - - - - In _L 11-4 162 R S 71 Page L Of bS -Po ' 1J e Lhhw.~~-~ W s S w1-11( N L- y~ s ici Ta tv A iq uJ Straw, Marsh Hay, Or I ~ y V LW p ~~T Ig Synthetic Covering 53 _ Distribution Pipe edium Sand _ Top~oll r 1 ° % Slope Bed Of 2~- 2 1,- Force Main Plowed Aggregate Layer D Ft. E Ft. Cross Section Of A Mound System Using F 83 Ft. A Bed For The Absorption ATea G / Ft. A S Ft. H Ft. ed : B Ft. AGE SYgTEN► nse Number: QAnS 7 K 1 Ft. 1(E SSW Wally ~~V A H -IY ~S L '~Ft. 'P i Ft. condto Alternate Position Ft. T .1~ Ip11~ gW of P%Q. ~tlp P S~ l- 4ET1 Force Main W Ft. L k~-SPONpENCtc . gEE C RRir Observation Pipe i i Force Main Distribution. \,,-Bed Of iM-2 2M Pipe Aggregate I Observation Pipe Permanent Markers Plan View Of Mound Using A Bed For The Absorption Area Pago ~ 49 Perforolod Pipe Detail End View Par(oroled End Cop( PVC Pipe Hoke Located On Bottom, . W ot`o ~`e e Are Equally Spaced L) C 'P? -S - ally do coo S o, rr',tb, tat) Sp►F V15~ON E Lo►1 Hole Should Be EiG ONE Nast To Eno Cop ggR~SP Oittrib.ulion Pipe Layout S / Ft. R S X 3(_ Inches Y _,3a Inches Signed: Ilolc Diameter Inch Lateral " /tea Inci) License t{umber: L Manifold 'Inches Date: Force Main 3 Incise; N of holes/pipe Invert Elevation of Laterals '95,5 Ft. ~-•r SEPTIC TANK PUMP dAMBER CROSS SECTION AND SPECIFICATIONS r° I ~11~3~ 1~~~ i 4" CI VENT PIPE 12" MIN. ABOVE GRADE E WEATHER PROOF' 25' FROM.DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH'AIR-INTAKE WITH CONDUIT MANHOLE.COVER W/ PADLOCK 6 FINISHED GRADE 4" Cl RISER WARNING LABEL 7 6" MIN. AB OV E G AD E 4 " MIN 18" VIN. 6" MAX. INLET GAS- WATER TIGHT SEALS TIGHTi 4" . ~ 11A BAFFLE SEAL : APPROVED , ' ALM JOINTS W/ CI C PIPE 3I ONTO ON PIPE 3' ONTO SOLID , SOLID SOIL SOIL PUMP OFF ELEV . FT. OF RISER EXIT PERMITTED ONLY IF.TANK MANUFACTURER &War HAS APPROVAL 3" APPROVED BED R T i CONCRETE PAD S P I a 8~1~'~ SEPTIC / DOSE t/ TANK MANUFACTURER: Id.50 2.~~ o~y~s NUMB a FREDAY : - RRASP . TANK SIZES: SEPTIC /d.50 GAL. LUME INCLUDING DOSE GAL. FLOWBACK: f ~d GAL. ALARM MANUFACTURER: 5T c. 5y~t-CAPACITIES: A = 30.7 INCHES = S15;4 GAL. MODEL NUMBER: /ol A o SWITCH TYPE: (ca` B 2 INCHES = Ogg, GAL. PUMP MANUFACTURER: w4SlS C = L INCHES = / GAL. MODEL NUMBER: D SWITCH TYPE: D = INCHES = EY,Z GAL. REQUIRED DISCHARGE RATE GPM PUMP 6 ALARM WIRING AS PER ILHR.16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE S FEET + MINIMUM NETWORK SUPPLY PRESSURE 2.5 FEET + -70 FEET FORCEMAIN X FT1100 FT. FRICTION FACTOR • . FEET .TDV-L -DYIL&KIC I MAD INTERNAL DIMENSIONS OF PUMP TANK: LENGTH 'v ; WIDTH DIAMETER LIQUID DEPTH SIGNED: _ LICENSE WKBER: o S 37 DATE: _ $ - g 1/88 P r« SEWAGE' AND EFFLUENT r6MP-3 a1 a.~ tom: r : , LIST DISC. Y j i rti;?;•. ,:1.. O=ER0311 142 MOM ~1/3 fi1 115 V Effltxrt Px 1/21• eolids 256.80 172.10 .n. ,Yx nijf 't '[PD011 Submersible l QY'`"`' MODEL EP0311 Effluent:Pump. METERS FEET SIZE 3/8 c SOLIDS 25 0 00 4 E 12 10 20 24 20 32 34 40 t , GPM 0 21S 5.0 7.5 mVh. CAPACITY ' r_ films Performance Curve 388-rup MCrKAA MT ...MODEL 3fifi5 ` a - SIZE '/4" Solids 00 wcatt_ i. 20 J. t ; 16 so - 1I 10. wcen r~.:~ OC D 1•.•. , 'y • o 1 0 20 b 40 ' 'e0 to ' f0 OD 1 t00 110120 oPN . f: e`. _ . - J to 20 " m CAPACITY LIST DISC. 00!JN603111. 142 14E0311L 1/] lip 115 V Lar N 3/4' solids `191 .SS 329.35 , t• r• t~.11'•<.,. r OJUP %TE0311M 142 ' HE0311M 1/3 VP 115 V Mod ft 3~4" solids 491.5S 329.35 0aiPt+ al Ill 142 WE051'11i 1/2 UP l15 V 1116 K 374" r6lidn 704•.25 '4~1;OS y COUNE071211 142 h'E0712H 3/4 HP 230. V Hlph M 1/4" solids !443.65 565.25 'jt ..1:a':'''' tVL 04ir, P1GE Fxn pfiggiPtAf= Nm 58DCIFICATICCls. 1' ~ DLTT 30 PAGE DIu 'IYCIE 10/BO •1^'14•••....• 'i:ar.. . Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division ofSafety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmental By Design Attarh 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 (13M), direction and County St. Croix percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel LD.# APPLICANT INFORMATION - Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Reviewed By Date Property Owner Property Location,--:-4 Continental Development Govt. t SW 1/4 NW 1/4 S 19 T 28 N,R 19 W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 12301 Central Avenue NE Suite 230` 1 TROY VILLAGE City State Zip Code PhoneNumber ❑ City ❑ Village ®Town Nearest Road Minneapolis MN Troy ` TROON COUR New Construction Use: ® Residential I Number of bedrooms 4 ❑Addition to existing building Replacement ❑ Public or commercial describe s Code Derived daily flow 600 gpd Recommended design loading r ~.7 bed, gpd/f1? french;gpdR /`bso"J^ rea required s 750 _n ft- , bed, ft -Uancl , f► gum design loadin n a .7 bed, gpdffl .8 tr, aod/ft2 Recommended infiltration surface elevation(s) 90 o sl plan benchmar Additional design / site consideration Parent material LOESS OVER GLACIAL TILL Flood lain elevation, if applicable NA ft S=Suitable for system Conventional Mound A-Ground Pressure AT-Grade System in Fill Holding Tank U=Unsuitable for system ❑ S ® U ®S ❑ S ® U ❑ S ® U ❑ S ® U ❑ S ® U L If REPORT Depth Dominant Color Mottles Structure GPD/fF Boring# Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistent Boundary Roots Bed nch 1 1 0-13 10yr3/2 - sil 2mabk mfr cs 2f .5 6 2 13-40 10yr4/6 - sil 2mabk mfr cs if .5 .6 Ground 3 40-50 1Oyr4/6 - Is mvfr ml cs - 5 .6 elev 94.33 ft 4 50-96 10yr5/8 - s Osg m1 - - 7 8 Depth to limiting factor Remarks: 2 1 0-7 1Oyr4/3 - sil 2mabk mfr cs 2f .5 .6 2 7-23 1Oyr5/8 - sit 2mabk mfr cs if 5 6 Ground 3 23-90 10yr3/6 - S. Os ml - - .7 .8 elev 4 g 93.58 ft Depth to limiting factor >90 Remark _*Inclusions of sil mottled at 28". inclusions are dominant enough so as to restrict the hole for a mound only CST Name (Please Print) Signature; Telephone No. Thomas C. Nelson 715-246-2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, WI 54017 7/14/98 227387 68 k PROPERTY OWNER: Continental Development SOilr ®FSC IPTIL)k r SPORT ® Page 2 of 3 PARCEL I.D.# ' Environmental Design Depth Dominant Color lvtucs Structure GPD/fi? Horizon in. Munsell Qu. Sz Cont. Color Texture Gr. Sz. Sh. nsistence Boundary Roots Bed Trench 1 0-19 10yr3/2 - sil 2mabk mfr Cs 2f .5 .6 '3 2 19-26 10yr5/8 - sil 2mabk mfr Cs if .5 6 Ground elev 3 26-32 10yr4/6 - is lmvfr nil Cs - 5 6 94.66 It 4 32-96 5/8 - s Osg ml - - 7 8 Depth to limiting factor off J >'96 d Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: EMI ON~vil&1VILOt BY DE51GN Y - T 1432120" STREET, NEW RICHMOND, WISCONSIN 715-246-2434 PROJECT NAME: TROY MLAGE DESCRIPTION: SW%, NW/4, SECTION 28„T 28N, R19W TOWNSHIP: TROY COUNTY: ST.CROIX S~. Q,,,, e s P~ y LOT:-:1$ SUBDIVISION: TROY VILLAGE N Safi ~ ~q a a o ML o i~3 SCALE 30' Tom Nelson BM i NW L01' Power box top Elevation sl►s 2 Nw zoc 100, Telephone pedistal Elevation 101.53 60,E cso2 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 'Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmental By Design Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsions, north arrow, and location and distance to nearest road. Parcel I.D.# APPLICANT INFORMATION - Please print all information. Reviewed By flats Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Continental Development Govt, Lot SW 1/4 NW 1/4 S 19 T 28 N,R 19 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 12301 Central Avenue NE, Suite 230 18 TROY VILLAGE City State Zip Code PhoneNumber ❑ City ❑ Village ❑Town Nearest Road Minneapolis MN Troy TROON COURT ❑ New Construction Use: Z Residential ! Number of bedrooms 4 ❑Add Lion to existing building ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 600 gpd Recommended design loading rate 1.2 bed, gpd)fts 1.2 trench, gpolf * Absorption area required 500 bed, ft2 500 trench, f? Maximum design loading rate 1.2 (•s)bed, gpd/ft2 1.2 C(, nch, gpolft? Recommended infiltration surface elevation(s) 95.8 ft (as referred to site plan benchmar Additional design / site consideration tParent aterial LOESS OVER GLACIAL TILL Flood lain elevation, if applicable NA ft e for system Conve nial Mound lnGruund Pressure AT,Grade System in fill Holding Tank able for system 1 ❑ S® LlO S❑ U ❑ S ®u ❑ S® U ❑ S NU ❑ S® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure GPDtft? Horizon in. Munsefl Qu. Sz. Cont Color Gr. Sz. Sh. Consistence Boundary Rood Bed Trench 1 1 0-13 10yr3/2 - Sill 2mabk mfr cs 2f .5 .6 2 1340 10yr4/6 - A 2mabk mfr cs if .5 .6 Ground 3 40-50 10yr4/6 - is mvfr m1 cs - 5 6 elev 94.33 ft 4 50-96 10yr5/8 - s Osg ml - - .7 ! .8 Depth t0 limiting factor Remarks: 2 1 0-7 10yr4/3 - Sil 2mabk mfr cs 2f .5 .6 2 7-23 10yr5/8 - sil 2mabk mfr cs if .5 .6 Ground 3 23-90 10yr3/6 - s* Osg ml - - .7 ! .8 elev 93.58 ft ~b Depth to R limiting P 1 factor >90 - x 4 ur) Remarks: * Inclusions of sit mottled at 28". These inclusions are dominant enough so as to restrict the hole for a m CST Name (Please Print) Signature; @bp a No. Thomas C. Nelson - 7 Address Environmental By Design Date CST Nu of # 1432 120th Street, New Richmond, WI 54017 7/14/98 227387 68 r r PROPERTY OWNER: Continental Development SOIL DESCRIPTION REPORT sa Page 2 of 3 PARCEL I.D # Environmental B Desi Depth Dominant Color Mottles Structure GPD/ftz Horizon in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. onsistence Boundary Roots Bed ~ Trench 3 1 0-19 10yr3/2 - sil 2mabk mfr Cs 2f .5 i .6 2 19-26 10yr5/8 - A 2mabk mfr Cs if .5 .6 Ground elev 3 26-32 10yr4/6 - is lmvfr ml Cs - 5 6 '94361t 4 32-96 5/8 - s Osg n-d - - 7 i 8 Depth to limiting factor >96 Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: ti 4ROM : TOMOandOSTACEYONELSON PHONE NO. : 310 829 2975 JUL. 16 1998 02:10PM P4 DE51GN EBY 1432 120`h STREET, NEW RICHMOND, WISCONSIN 715-246-2454 PROJECT NAME: TROY VUJ AGE DESCRIPTION: SW36, NWV/, SECTION 28„T 28N, R19W TOWNSHIP: TROY COUNTY: ST.CROIX SUBDIVISION: TROY VILLAGE N L s 0 } C1 Lot . Z' 19 cl L ~ b3 g~ ~ gl SCALE 1."=30' Tom Nelson BM 1 NW LOS" Power box top Elevation 100' cstmo2605 BM 2 NW Lot Telephone Pedistal Elevation 101-53 1 FROM TOM0and0STACEYONELSON PHONE NO. 310 829 2975 JUL. 16 1998 02:09PM P2 Page_ 1-01 Wisconsin Department of Commerce SOIL AND SITE EVALUATION nape t)esyp~ Division of.. Safety and Buildings in accord with Comm 83.45, Wis. Adrn, Code } mct(' mplete site plan on paper not less then 8% x 11 hches in size. must and County $t. CrrJiX include, but not limited to: vertical and horizontal reference point ~ Parcel I.D.f! percent slope, scale or dimemaions, noft arrow, srtd location and distance to nearest road_ APPLICANT INFORMATION - Please print all information. Reviewed By Date p. whIs may be used for t6condary purpaees (FMw y Law, s. 18.04 (1) (m)). po,sw+al Inform~ you properly Owner t SW 1/4 NW 1/4 s 19 T 28 N,R 19 W - TO Location Contiaeaxtal Develo e~.t w - Block # Subd, Name or CSM# Property Owner's Oumers Mailing Address TYtOY'JILLAGE $ i30 _ _-ftip-i 12301 Central Avenue NE uitu v ®Town Great RoNtCrin~ea olis State Zip Code PhoneNumber L.1 , TgOON COURT UN Troy New Construction Residential / Number of bedrooms 4 ]Addition to existing building Replacement Use: Public or comnlerzial describe 600 gpd Recommended design loading rate ;7 bed, gpdW- ---finch, gpdMe Code Derived daily flow 7 ~ bed, gp~x ,g trench, gpolfP Absorption area required 857 bed, ft: 750 trench, fly Maximum design loading rate referred to site plan benchmar Recommended infiltration surface elevation(s) an ft Additional design I site considerations NA It Parent material LOESS OV1?.R GLACIAL TILL Flood lain elevation, if applicable S=Su'itabie for system Conventional Mound In-Ground Pressure AT4rade System in RU Holding Ta lk U -Unsuitable for system ® S El U 0 S ❑ u ® S ❑ U ❑ s ®U El S ® El u SOIL DESCRIPTION REPORT Texture Gr. Sz. Sh. iConsistenc Bound y Roofs ; Trench f3oring# R34 pth Dominant Color Mottles Structure GPDhr Munseil pu. Sz Cont Color 13 10yr3/2sil2rnabk n* Gs 2f 6 1f -40 10yr4/6 cs Ground 50 10yr4/6 ;6elev 94.33ft -96 10yr5/3 Osg ml _ 7 8 - • Y r- - Depth to limiting factor - - - Remarks: a I Oyr4/3 ~tl' - sil 2mabk infr cs 2f .5 .6 z3u;aCv* 2 7-23 10yr5/8 sit - -2mabk mfr es f 5 6 Ground 3 23-90 10yr3/6 - - s OSt3.__-- 7 i3 eley _ 93.58 It Dept to 16 factor _ - - 31 li: ;t;t 790 Remarks: rr l r od,t E~Addrv=EnVbVnrn=iAj e Print) Signatures: 71 -._w..... Ref rf lson J' - CST Number By Dcsrbm 7/14/98 MOZ603 120th Strout, New Richmond, WI 54017 ROM : TOMOandOSTACEYONELSON PHONE NO. 310 829 2975 JUL. 16 1996 02:10PM P3 r- 4" page 2 of 3 PRoPERTY OWNER! 4ov, ~ D["°►~ SOIL DESCRIPTION REPORT Desi PARCELI.DJ... GPDM2 Texture onsistenc Boundary Roots Depth Dominant Color Mottles structure !Trench I Munsell Gu. Sz. Cont. Color Gr. Sz. Sh. Horizon in in. 2f 5 6 . 2mabk cs mt 1 0-19 10yr3/2 ;Sr''Tr 2 19-26 10yf5/8 2mabk 6 Ground _ 1s lmvfr ml cs 5 .6 - elev 3 26-32 l0yr4/6 s 05R ml - .7 .8 94.66 ft 4 32-96 5/8 - - Depth to - limiting - - fact Remarks: •M1'~' -r- ~_xw.-n ..ri r. •._T Iii Ground - - elev _ Depth to limiting - I factor , Remarks: Ground elev Depth to limiting - , factor Remarks: _ - - Ground elev nw.__... Depth to limiting factor Remarks: >o-jsIn Meoartnwnt of industry. SOIL AND SITE E V A L J A T I O N REPORT Page 1 at 3 tabor and Human Relations Division of Safety s 8uiiddngs in accord with ILHR 83.05, Wis. Adm. Cade COUN iY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST. CROIX PARCEL 1.0. # not limited to vertical and horizontal reference point (8M n and °/a of slope, scale or dimensioned, north arrow, and location and dista o C44afte rp REVIEWED BY DATE APPLICANT INFORMATION-PLEASE P ~ACL INORMA7 - -dirk. PROPERTY OWNER: 4ry( PEATY LOCATION E 1/2S 24T 28 NR 20 W TOM RUEMMELE & JOHN AND B RU B=E - • LOT 114W 1/2S 19T 29 NR 19 -640 W PROPERTY OWNER':S MAILING ADDRESS Arp I 1997 -i. T# 9t6("tE-x SUED. NAME OR CSM 8 260 COUNTY ROAD F 18 TROY VILLAGE CITY, STATE ZIP COD PHONE 040M CITY CZVILLAGE OWN NEAREST ROAD HUDSON WISCONSTN 5401 6\ 12 ROY ST A,wi f- IZAWAV P4 New Catsf =0111 Use (R) Residential / A [ J Addition to existing building j ] Replacement [ J Public or commeraffbedeftr- Code derived daily now 600 gpd Recommended design loading rata bed. gpdM2 ~ trench. gpdM2 Absorption area required 04 bed. ft2 SOd trench. ft2 Maximum design loading rate bed. gNM22 D• S trench, gpd!(t2 Recommended infilbabon surface elevation(s) BY DESIGNER ft (as referred to site plan benchmark) Additional design / site cortsiderati IVo eS ON 10,0 e 3 Parent material ASS 7lLL m~T~•45~f Rood plain elevation, if applicable N/A ft tm2wn table for system CONVEKnONAL MOUND &GROUND PRESSURE AT-GRAD SYSTEM IN FILL HOLDING TANK suitabl e for system I❑ S Z I rs 1:2 U C: S ICU I❑ S t~U I ❑ S M I❑ S 25U SOIL DESCRIPTION REPORT Depth Dominant Color Mfg Texture Structure Consistertf~ Roots ~GPO/ttz Horizon in Mun II Qu.Sz.Contcolor Sz. h• Boring rt A 0-17 IlOYR 3/2 1 12f-msbk I mfr I i of-f I0.5 0.6 368`f B1 I17-27I10YR 4/4 1 2msbk mfr w of-f 0.5 0.6 B2 27-41 110YR 4/6 sl 2m-csbk I mfr I cw Ilvf 10.5 0.6 Gr~ovund 9d j .8 ft B3 I41-49 1 OYR 5/6 I f 2d 5YR 5/8 s it 2cabk mcw lvf Oepth to C 49-74 10YR 5/6 flf 10YR 3/4 f I--- I I limiting factor 4111 Remarks: Boring # I i A I0-10 110YR 3/2 I 11 12msbk I mfr l as 2vf-fy 0.5 .0.6 :69 B 10-26 hOYR 4/6 (cl 2m-cabk I mfi I cw (2vf I0.4 0.5 C1 26-37 J10YR 6/6 I s Osg Iml Las lvf 0.7 0.8 G Mev. round C2 7-72 I10YR 6/6 flf lOYR 3/4 losg. I I 11 Vf L 0~ It. I I I I 9 Depth to limiting I~~ I I Roma Horizons C1 and C2 have pockets 10YR Eftone-PleniiePrint ,TAMES 0. F(Wg "m' (715) 425-7831 OGDEN ENGINEERING CO., 113 WEST WALNUT ST., RIVER FALLS. m 54022 e: Date ~ ~7 C$TM03988 PROP RT; 0w)NIER Sell. OESCRIPTION REPORT Page wit _3 PARCF11.0. r Oeptn Dominant Color ' Moores (Texture Structure Cor>ststence 13aun ary Roots GPOM4 Horizon Munsell Qu. Sz. Cons Color Gr. Sz. Sh. Bed Bonng Al A ~1-9 OYR 3/2 I 2- 12vf-fl 0-5 3 I L6 Lvp A/& - cl 2msbk mfr gw 2vf-f 0.4 0.5 B2 6-28 OYR 4/6 sicl 2m-cabk mfi L v Ground elev. B3 8- 04.2 It 37 QYR 416 C 7-75 10YR 6/6 IS ~Sg 1 of .7 IJ.8 Oeptn to litrnting fa= Remarks: Boring # : Ground elev. 0epttt to limrong factor Remarks: Boring I I I Ground elev. f t. Oepth to lirmong factor Remarks: Boring # Ground elev. R Oapdt to limiting fa= I Remarks' S1a13-111 l0-G& I ♦ !.4 01 PAGE 3OF3 SITE PLAN NOTES: PROVIDE MINIMUM OF 1' SAND BETWEEN BOTTOM OF BED AND EXISTING GROUND. MOUND TO BE A MINIMUM OF: 25' FROM DWELLING; 50' FROM WELL; 5' FROM LOT LINE. ST 10 tVA/-S f -7,0 VIA 8-370 N 1 0 1 8.3 6 9 I Z-c 7' 17 rjTr~ rrr DoT l~ J~ C° 9°3- ~s OC ~D SCALE: 1 40' OGDEN ENGINEERING CO. JAMES F LLKI S, CSTM03988 / Civil Engineers & Land Surveyors 113 W. Walnut St. River Falls. WI 54022 (715) 425-7631 DATE: L 7 ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM nk ` Owner/Buyer 1 Mel,, = 6-t &jIL-11 i'r, e-.' 'E' ~~0~ Mailing Address ~ 301 Property Address (Verification required from Planning Department for new construction) City/State Ul~'fYn L(J Parcel Identification Number 0-140- LEGAL $O DESCRIPTION Sec. T_~29 N-RJQ W, Town of Property Location, Subdivision ae- Lot # . Certified Survey Map # , Volume , Page # WarrantyDeed # 66q 1 (P- , Volume 1,24 . Page # Spec house yes ❑ no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE 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. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a 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 maintained must be completed and returned to the St. Croix County Zoning Office within 30 days o the three year ex ' do date. Z~ SIGNATURE OF APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the rty described prov,c above, y virtue of a warranty deed recorded in Register of Deeds Office. R/& SIGNATURE OF APPLICANT DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed yy~~WAAARAKrV DEF~Ip TNa Deed, made, be"M sr (,F►'" OL: L • ' kha I. Rteaeame,le, ae,d a. rbeee A Itaatealelt boa Be aad 1'i,erll~ r Ipesa there *MAX 2 T 1"t - his and Grantor, 3:15 Nut Ut" Tray Davalaaomrutt ottsoratton mow. * _ IYMMerwaee. Gnantae. W Itnesseth, That the said Grantor, for a valuable consideration *N..rru,..ras.a.we,4t>t. wuatAwaaetnltt ~eosoe conveys to Grantee the following described rent eeara in L Croix.COM County, State of Wisconsin: man" leratitkwon N=ba) Lots I through 43, Lots 47 through 65 and Lass 64 through 70 of the Plat of Troy Village. 4; Croix County, Wisconsin and that portion of (MhN S of tlne Plat of Troy Village described on Exhibit A attached hero. and Outlae I and 3 to the Plat of Troy Village, St. Croix County:, Wisconsin ~R A p01e0a of!!a above Isetnbad popa~ _bommd@ d pa/r0' of alt Oraraa. )Oba RLRIIHYttt YO nabarl A 10=1111010 (e,) (t act) Toplne wita as and titplr the har4 amt m ad appmaranedes Aryls Mosaft Aw r7eaaset wCrseLL saw tbs I;d. is prd iedstnuibh a fee erA/k std aea M dot a[eneolnM.~on erergt . easements, covenants, restriction and highway Aom ofway of record red *fit %moa sad JAW due tans Uate1'ttin _ ZJ day of !SEAL) W AL, • s 9, X A - G' ,~c e~ nt<eLl~s~ ctt6iU) ~7'~ -~t7atAt.) ; . AUTHENTICATION ACINOWLZDGMENT SipasMa) STATE OF WISCONS24 Nsa L Ruaerwts_ En vib a , authenticated this _2L 40 oJ` County ; Personslly tonne before me this _ , day of Oppwp- up- der abovs named 7117.E' MP R6R1'FATE BAR OF WISCONSIN ttr.st, adbonaed by S706.O L Wis. Ss") to me known to be the person who eaecated the foregoing instrument and acknowtedp the scum THIS INMUM11110 WAS DRAT ZD BY • 204 Lg= SL. P.O. Box 12S Iled•%•e VVl x4016 Notary Public County. Wle. :Stamm may k awlenheelae a erae,owdedpd Bob ne mw My commission is pettmment. (1f oast, mw eotpiration dew 4tlrl4ep- drte, w we are* Ow w Vr.r ar ww mwwaw qNf ~y -1.003 ACRES 67080 &F. • z 1.540 ACRE a^o. $ • 1.0 rR C90 o N C+ 0 (o 7.90 $ _ 25 1.6,9, ' 0.58• - - - - - - - - - - co •401 ~ S 790 ~ 0107 C108 C1 Tc -t - S 630 6'! 5 74.64' 0,. C 25169-1- 00" C106 - - - - -9 7.0 5, 79000, 6 - 4 $ 00 E 19 0 9 46202 S.F. 18, I % M o0 .1.00 1 ACRES - 54061 F. V • y/ z ~ _ _ LC) oo` N 1.241 CRE/ S , 10 0 51141 SF. o w 45670 S.F. N x / ti0 1.04E ACRES oo Jam/ v~ 1.174 ACRES o co 76 / ^7 O / b' N y y o,, E s2o - / •S v ° ,~o mss, 2 )UTLOT 2 ' .0 oo' S8' use 0,)Cv !o ~ 10,g6 * b`, £ C-7 O~ •o ~ 86.19' 93.1 om. 179.38' ai s tea, 518 5 S.F. 142 e ham/ 51567/ S.F. 41 N 87000'00" 1.190 ACRES 1,184 ACRES 00.. o W ~I 83.00' - S s8•oo, 1.184 ACRES mwo Dorn , p83• 1' 17" E OUTLO w o a 43721 .F. 135191 U 120 \ `o 1.004 ACRES( v ~ 157.0 S 3.104 A( I S Z i N W o it 111 • R=80 105 , ?e,~¢'.;•s, W w w 1 O Det ~2 sp ¢`S k~ s 12 F o: N m 0, l~ N 2 h C49 G S6• 50345 S.F. ' Z o s SD CS• 1.156 ACRES \ ~ ~ cn 0,)g~ 9 . wr 48996%.F. 13 F ~6~8Zm ; G" 1.125 ACRES 'v - 44512 S.- (A N 1.022 ACRES mm 14 b, o cn o: co c~ /44704 SF. io = 52 162 W °z 04 ~ 1.026 ACRES m X03 W 6Z 0 2 s~g?4, / 69.00 0 \LE: 1 150' S s' ,4 4 e~•''F S90000' 00°W ` 150.09' 159.65' ,CALE IN FEET S 9 '00" W 20' WIDE l1T:LITY EASED' N" 150' 300 450' q-:2 J D. F I LK I NS S-2246 01V~ RE I STERED LAND SURVEYOR OGDEN ENGINEERING COMPANY a~ 113 WEST WALNUT STREET JAMES R' K NS" RIVER FALLS, WISCONSIN 5402 5-224a DATED THIS 26TH DAY OF MARC . 9 RIPER FALLS < WI % supt wlsarnsin ospartrront of Industn/• SOIL AND SITE E V A L J A T I O N REPORT Page 1 of 3 LaW( and Human oiauo s oivrston of Safety s &vidngs in accord with ILHR 83.05. WIS. Adm. Code COUNiY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST. CROIX PARCEL l.D. 4 not limited to vertical and horizontal reference poi and % of slope, scale or dimensioned. north arrow, and location and di r~ arettt.rc*#. REVIEWED BY DATE APPLICANT INFORMATION-PLEAS T A IORIIY r,I PROPERTY OWNER: PROPERTY LOCATION E 1/2S 24T 28 NR 20 W TOM RU BE & JOHN AND LMHE Pow. LOT 114W 1/2S 19T 29 NR 19 -640W PROPERTY OWNER':S MAIUNG ADDRESS r1#8 ~!9('lESU80. NAME OR CSM 260 COUNTY ROAD F ~7A C:f"' t-- f TROY VILLAGE CITY, STATE ZIP C ~~~4 CITY ILLAGE (R,]fOWN NEAREST ROAD ISCONSIN 5401 1 l - TROY S•r A.J.im R12A\JAY HUDSON W New Construction Use (X J Residential / e 41WWI~W 4 ( J Addition to existing building j j Replacement [ ) Public or commerdai desw Code derived daily flow 600 gpd Recommended design loading rate ¢ bed, gpdrf12 trench, gpdfft2 Absorption area required 2V bed. ft2 ~'d trench, 9 Mammtun design loading rate bed. gpdM2 4• S trench. gpolft2 Recommended infiltration surtace elevation(s) BY DESIGNER ft (as referred to site plan benchmark) Additional design / site considerate /Vo e S ©w E 3 Parent material ESS 7/rGL m~TwSN Flood plain elevation, if applicable N/A ft S a Suitable for system CONvemoNAL MOUNO IN-GROUNO PRESSURE AT-GRAD SYSTBA IN FILL HOLDING TANK U - Unsuitable for system I ❑ S ($U I QS ❑ U ❑ S KrU I C3 s kU I C3 S Zb (:3 S all SOIL DESCRIPTION REPORT Hari Depth Dominant Color Mottles Texture Structure Consistence eRoots GPO/ft zon in Muns II u S Boring # A 10-17 IlOYR 3/2 L 1 12f-msbk I mfr I i of-f IO.s 0.6 X368B1 I17-27 lOYR 4/4 1 2msbk mfr w of-f 0.5 0.6 B2 27-41 I10YR 4/6 I sl 12m-csbk I mfr 1 cw lvf 0.5 0.6 I f 2d 5YR 5/8 s it 12cabk mfi cw lvf I--- Ground 903 8 f B3 I41-49 I lOYR 5/6 t. C 149-74~10YR 5/6 flf 10YR 3 4 f Osq lvf Oepth to limiting tactor I I i Remarks: Boring # I i A I0-10 110YR 3/2 1 11 I2msbk Imfr las 2vf-4 0.5 0.6 X69 i` B 110-26 lOYR 4/6 Icl 2m-cabk mfi (cw I2vf 10.4 0.5 C1 26-37 hOYR 6/6 I s Osg M1 Las lvf 10.7 0.8 Ground I 11 elev. C2 7-72 LOYR 6/6 f10YR 3/4 I___ 90Z,b-ft. I I I I I I Depth to limning f ~ I I Remarks: Horizons C1 and C2 have pockets 10YR Nanw-~P me Pratt JAMES .0. FUINS Phone: (715) 425-7631 OGDEN ENGINEERING CO.. 113 WEST WALNUT ST.. RIVER FALLS, WI 54022 Signature: _ Oauc //a 7 ter CS M03988 PROPER--,'OWNER SOIL. DESCRIPTION REPORT Page I it 3_ PARCEL 1.0. a eS F orizon in. tn Dominant Color MotSles (Texture Structure Roots GP0/ft~ Oep Munsell Qu. SZ Cone Color Gr. S2. Sh. sac TM= I Boring # A -9 OYR 3/2 - - 0.5 :0 6 3 - cl 2msbk mfr gw of-f 0.4 0.5 1~ B2 6-28 OYR 4/6 sicl 2m-cabk mfi cw v Ground 04e ft. B3 ~8-37 kYR 4/6 C 7-75 0YR 6/6 s sg 1 of .7 .8 Depth to lirmdng fa= Remarks: Boring # Grotutd elev. tt. I Depth to limiting factor Remarks: Boring I I I I L Ground elev. It. 0eotn to limiting I I I factor Remarks: Boring # Ground elev. ft Depth to liftng facts I I Remarks: S00-6=111.OtfAZf PAGE 3 OF 3 SITE PLAN NOTES: PROVIDE MINIMUM OF 1' SAND BETWEEN BOTTOM OF BED AND EXISTING GROUND. MOUND TO BE A MINIMUM OF: 25' FROM DWELLING; 50' FROM WELL; 5' FROM LOT LINE. -70 4-- l7-Y p 1A - 370 ~ 8-36 g' - 0 D I 8- 3 6 9 GAT /9 oT l~ C° 9°3~ ~s 4C D © T ~7 SCALE: 1" = 40' OGDEN ENGINEERING CO. JAMEj% D. FILKINS, CSTM03988 / Civil Engineers & Land Surveyors 113 W. Walnut St. River Falls. WI 54022 DATE: ¢llO~9 (715) 425-7631