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HomeMy WebLinkAbout040-1249-30-000 a o� VOL 1.•98 PAU 596455 KATHLEEN H. WALSH AFFIDAVIT OF CORRECTION REGISTER OF DEEDS TROY VILLAGE ST. CROIX CO., WI RECEIVED FOR RECORD 01 -25 -1999 3:30 PM I, James D. Filkins, Registered Land Surveyor, AFFIDAVIT S -2246, hereby certify that the Plat of Troy EXEMPT # Village, recorded in Volume 6 of Plats, Page CERT COPY FEE: 89, Document No. 559959, St. Croix County COPY FEE: 2.00 located in the Town of Troy, St. TRANSFER FEE: Reg Y . RECORDING FEE: 10.00 Croix County, Wisconsin, shows Note No. 5 on PAGES: i Sheet 2 which states "The following Lots must have mound systems: 1 through 10, 15, 16, 18, 19, 21 through 45, 47 through 49, 51 through 55, 59 through 64, 69 and 70." This note was changed on February 4, 1998, James D. Filkins by an Affidavit of Correction, Volume 1293, Ogden Engineering Co. Page 189, Document No. 572333, to read: 113 West Walnut St. "The following lots must have mound systems: River Falls, WI 54022 1 through 5, 16, 18, 19, 21 through 45, 47 I_ p ogo -i?y_ o - voo through 49, 51 through 55, 60 through 64, 69 �fi6 and 70." This note is hereby changed again read: `o vg ir 9'S - 90 ooh Lot "The following lots must have mound systems: Parcel I.D. Number 1 through 3, 5, 18, 19, 21, 22, 23, 25 through 45, 47, 48, 51, 52, 54, 55, 60 through 64, 69 and 70." Dated this �Z�� day of 1999. ```�����CJ`Ci lO f � /V//, ii i Ja D. Filkins S -2246 1k JAMES D. FILKINS -' S-2246 RIVER FALLS, State of Wisconsin ) wl OQ� ss • County of Pierce ) �� s lU Personally came before me this /2 day of JA - zVUAkU , 1999, to me known to be the person who executed the foregoing instrument--/and acknowledged the same. y Commission Exp r s 'ham LUP .y ST. CROIX COUNTY APPROVAL CERTIFICATE Approved for recording by the St. Croix County Zoning Office Date �a.v� • 'L S, l 9 9 y' 02,06/1998 11:17 608- 785 -9330 SAFETY AND BUILDINGS PAGE 01 SAFETY AND BUILDINGS DIVISION 2226 Rose Street LaCrosse, WI 5d w NN " i ' sconsin Department of Commerce Tommy G. Thorrp"n, eovenW tillimn J. Mccoshen, secretary February 6, 1998 Post -it' Fax Note 7671,E 6/9$ a 2� Tai G�oc GQ _ I�rom CoA)ept GR9 P IJ 6 Co ' Lam, D . O,C ENVIRONMRNTAL BY DESIGN P'onAe Phone 1432 120 ST. Fez # Fax NEW RICHMOND WI 54017 RE: PLAN 98200SO FEE RECEIVED: 405.00 TROY VILLAGE LOT 53 SW,NW,19,28,19W TOWN OF TROY COUNTY OF ST. CROIX MOUND SYSTEM PETITION FOR VARIANCE TO CODE SECTION(S): Comm 83.23(1)(e)l. The Department has reviewed the above - referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters TLHR 50 - 64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one of plans with the Departments stamp of approval at the construction site. The installer shall notify the appropriate Inspector when inspections can be made. All of the statements and supporting documentation included with the petition were considered. Since your request is similar to other petitions approved by the Department (e.g.S93 00901), the petition is approved. The variance requested was to the installation of a new mound on a slope Of 14 percent. This petition approval is granted conditionally with the understand' all of the petitioner's statements included on the variance appli iiT and any other documents submitted to the Department will be car lti Thi variance is specific to the subject petition and cannot be use f a ..� additional modifications. ri. All permits required by the city, village, township or county ~ 'll obtained prior to installation. p ~', 5T CR0 1A C,OU OFFICE -'L z awNG S80- 5524 -9 (R.07/96) - 02/0611998 11:17 606 -765 -9330 SAFETY AND BUILDINGS PAGE 02 SAFETY AND BUILDINGS DIVISION 2226 Rose Street LaCrosse, WI 64803 VlAsconsin Tommy G. Thompson Governor Department of Commerce William J. MaCoshen. Secretary ENVIRONMENTAL BY DESIGN Page 2 February 6, 1998 PLAN 9820050 Ynquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, Gerard H. Swim Plan Reviewer P.O.W.T.S. Plan Reviewer (608) 785 -9348 cc: ST. CROIX SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 '\*Isconsin Madison, Wisconsin 53707 Department of Commerce Tommy G. Thompson, Governor William J. McCoshen, Secretary ARTHUR L WEGERER WEGERER SOIL TESTING AND DI SERVICE' PO BOX 74 421 NORTH MAIN STREET RIVER FALLS WI 54022 n Dear Mr. Wegerer: Re: Lot 53, Troy Village, Town of Troy;-Saint Croikh. 6' linty The Division of Safety and Buildings has received a request to evaluate note on the plat concerning the above referenced property. This note limits the installation of soil absorption systems for liquid waste disposal on the lot to mound type soil absorption systems. This request is supported with information, which indicates that this lot is acceptable for development with subsurface soil absorption systems. Therefore, the Department hereby waives the above - mentioned restriction, provided that any soil absorption system be located away from soil boring number 4 and that individual waste disposal systems are constructed in accordance with the applicable requirements of chapter Comm 83, Wisconsin Administrative Code. Issued by the Department of Commerce Division of Safety and Buildings By: David Russell, P.E. Plat Review, Division of Safety and Buildings 608 - 267 -3605 cc: Saint Croix County SBD -5524 (807/96) • ' S I • 'ROIX COUN'T'Y ZONING DIFPAR'I'MI• AS BUILT SANI'T'ARY RE;1'01'E' Owner Address -�n City /Stale i. r ;Q '9 a r , Legal Description: Lot ,� Block /1_ Subdivision/CSM It Q %' Sec. Lq- T o ' , , T2EN -11 W own Y PIN `# - C- SEPTIC TANK — DOSE CHAMBER — MOLDING TANK INFORMATION: Tank manufacturer /,(�P p x Size ST/PCI 401 Setback from: House —� Z Z We > P /L Z Pump manufacturer Model ---- --•- -. Alarm location (BOLDING TANKS ONLY) Setbacks: Service road Vent to fresh air intake AM Meter location �} Water Line Alarm location SOIL ABSORPTION SYSTEM: Type of s y ste m: � Z ?E Setback from: H ouse Z Length Number of Trenches Well P2 - 7.S Vent to fresh air intake ELEVATIONS: Description of benchmark Description of alternate be nchmark p Elevation O — f15En'1 E.y Leo 3 6 Elevation 1_091, 3�4, Building Sewer L, - �t ST/HT Inlet Q 5, g ST Outlet IdJ�, 5 PC Inlet --" PC Bottom Header/Manifold Jv � o Top of SUPC Manhole Cover Distribution Lines ( ) 3 ( ) ( ) Bottom of System Final Grade L/ 2/ 9 1P ermit nu - er Date of installation 3 �5 - State plan number 11 Plumber's signature �� l'C License number I ffipj Datc / /X /gg Inspector 1\ omploc plat plan K Wisuvnsin Department of Commerce Safety and Buildings Division PRIVATE SEWAGE SYSTEM County: INSPECTION REPORT ST. CROIX GENERAL INFORMATION (ATTACH TO PERMIT) Sanitary Permit No.: Personal information you provice may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. 315979 MU IT6M' ES /KERRY BECKER ❑City ❑village Town of: State Plan ID No.: TROY CST BM Elev.:- Insp. BM Elev.: BM Description: _ Parcel Tax No.: f f S l'--e A-5 �5l ` 5 t3m # ( 04 0 - 1249 -30 -000 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. e-c- Benchm ir , �q 1 8 b S Dosing Aeration Bldg. Sewer C /07,(/3 Holding _--- - - - - -- St /Ht Inlet 7.9- 1 ©S-P, TANK SETBACK INFORMATION St /Ht Outlet TANK TO P/ L WELL BLDG. Air Intake ROAD Dt Inlet eptic 0 f j �' 2 NA Dt Bottom Dosing NA Header / Man. Aeration Dist. Pipe Jv 4x6 e C>, Holding - -- Bot. System lei 9q. n PUMP/ SIPHON INFORMATION Final Grade Manufact r errand Model mber GPM TDH Li Friction Syste . T Ft H ead Forcemain Length' la. Dist. To well SOIL ABSORPTION SYSTEM BED / TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liq pth DIMENSION )� 75 DIMENSION SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM CHING anu efa_ INFORMATION Type O�n r r ��� �� ®, ,._ CHA MBER Model N er: S ste II DISTRIBUTION SYSTEM Header/Manifold Distribution Pipe(s) ; [ x Hole Size x Hole Spacing Vent To A r Intake Length _ Dia. Length Dia. �I Spacing • f ; 1 , �� c� SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded/ Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) a_5— - LOCATION: TROY 1 9.28.19,SW,NW 318 ST. ANNE'S PARKWAY 2- (3 S: Ire,.. -t k4e Ct Plan revision required? ❑ Y s No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Si ature Cert. No. Safety and Buildings Division SANITARY PERMIT APPLICATION 2201 W. Wa ington Avenue Box 1 4 . 4 co nsin In accord with ILHR 83.05, Wis. Adm. Code Department of Commerce Madison, WI 53707 -7302 • Attach complete plans (to the county copy only) for the system, on paper not less County�� 20 l than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State Sanitary Permit Number 31 5 1' -l9 4— Personal information you provide may be used for secondary purposes ❑ check it revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan I.D. Number I. APPLICATION INFORMATION - PLEASE PRINT ALL INF RMATION Prop rty Owner Name Property Location /V i �4 f Gytdt r;°�2. /4 N /a, S T Z , N, R 1 E (or Property Owner's Mailing Address / Lot Number Block Num A ��Y S City, S at Q r Zip Code Phone Number Subdivision Name r CSM Number f UIC. ) Z !20 (JfG &f II. T YPE F BUILDING: (check one) [] State Owned E !t� Nearest Road ❑ VII age O 1< wy Public 1 or 2 Family Dwelling - No. of bedrooms gr Town OF I11. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) �+ 1 ❑ Apartment/ Condo d /7 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 IV TYPE OF PERMIT (Check only one box on line A. Check box on line B, if applicable) A) 1, ust New 2. E] Replacement 3, ❑ Replacement of 4. E] Reconnection of 5. E] Repair of an S stem 5 stem - - __ - _ Tank (?nly___ ___ ______ __ Existing System -- -___ - Existi 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 gSeepage Bed 21 ❑ Mound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ In- Ground Pressure r 42 ❑ Pit Privy 13 E] Seepage Pit 2 X 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 Requ' ed ( ft.) Prop�esq. ft.) (Gals/day /sq. ft.) (Min. /inch) / Elevation Feet lo9 R Feet VII. TANK Prefab. Site .Fiber- Exper. INFORMATION in gallo Total # of Manufacturers Name Con- Steel lass Plastic App New Existing Tanks Concrete strutted g T nks Tanks e tic Tank �� S Lift Pump Tank /Siphon Cha �_ El El ❑ E 0 VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. Plum s Name: (Print) , Plumber's S nature: (No gS rMP/MFRWNo.: Business Phone Number: �_ �lX`�L -Soy✓ ,6 � Z - 7 Z —� Plumber's Address (Street, City, State, Zip Code): IX. COUNTY / DEPARTMENT USE ONLY ❑ Disapproved Sanitar Permit Fee ( includes Groundwater, ate slue Issui nt Signature (No Stamps) Surcharge Fee) J 'Approved E] Owner Given Initial �� t � S jl S�j Adverse Determination X. CONDITIONS OF APPROVAL/ REASONS FOR DISAPPROVAL: SBD- 6398 (R.11/97) DISTRIBUTION: Original to County. One copy To: Safety & Buildings Division, Owner, Plumber D� h v v v 4� �v • AJ (A 4 4 �s 4 -4 t2 vVL7 - - --------- - .......... ........ . . . 7 6) 7 . L L) E2 �f SAFETY & BUILDINGS DIVISION 201 E. Washington Avenue P.O. Box 7969 *isconsin Madison, Wisconsin 53707 Department of Commerce Tommy G. Thompson, Governor William J. McCoshen, Secretary ARTHUR L WEGERER WEGERER SOIL TESTING AND DESIGN SERVICE PO BOX 74 421 NORTH MAIN STREET RIVER FALLS WI 54022 Dear Mr. Wegerer: Re: Lot 53, Troy Village, Town of Troy, Saint Croix County The Division of Safety and Buildings has received a request to evaluate note on the plat concerning the above referenced property. This note limits the installation of soil absorption systems for liquid waste disposal on the lot to mound type soil absorption systems. This request is supported with information, which indicates that this lot is acceptable for development with subsurface soil absorption systems. Therefore, the Department hereby waives the above - mentioned restriction, provided that any soil absorption system be located away from soil boring number 4 and that individual waste disposal systems are constructed in accordance with the applicable requirements of chapter Comm 83, Wisconsin Administrative Code. Issued by the Department of Commerce. Division of Safety and Buildings By: David Russell, P.E. Division of Safety and Buildings Plat Review, .� ,�,••' -` - 608 - 267 -3605 �,' .4 0 _- -Faint Croix County —' J' ST c9arx COUNTY L,J ZONING OFFIC ` °..� X � SBD5524 (R.07M) t W GERER SOIL TESTING.and DESIGN SERVICE - SOIL TESTING - SEWER SYSTEM DESIGN - MORTGAGE SURVEYS June 15 ,1998 ' `�/ ATTN: David Russell '`� Safety and Buildings Division " - , ._.-+ 201 West Washington Avenue F- Box 7162 t 1Q�8 Madison, WI 53707 - 7162 i, ,� ix �� Dear Mr. Russell; Fi�E /� r As per our recent telephone conversation, r submit the following. On May 9,1997 the plat of Troy Village in the Town of Troy, St.Croix County, was certified by Jeanne Storm of the Department of Commerce. The plat was recorded at the County Register of Deeds Office on April 6,1998. A note on the plat requires a mound system to be installed on Lot 53 and others. Further testing has revealed soils suitable for conventional type systems. The owner of Lot 53, Kootenia Homes, is requesting a waiver for the mound system requirement for said Lot. Enclosed, you will find a soil test report by me dated June 15,1998,. a soil test report by Thomas C. Nelson dated April 30,1998 and an on -site verification letter by James K. Thompson, assistant County Zoning Administrator. The house is presently under construction and is nearing completion. Please contact me if anything else is needed. Thank you. Since ely- Arthur L. Wegerer cc: Kerry Becker Kootenia Homes 7975 Afton Road Woodbury, MN 55125 P.O.BOX 74 421 N.MAIN ST. RIVER FALLS,WI 54022 PHONE 715- 425 -0165 Wisconsin Department of Industry SOIL AND SITE EVALUATION REPORT P \ of 3 Labor and Human Relations — Division of Safety & Buildings in accord with I LHR 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 ST G lX not limited to vertical and horizontal reference point (BM), direction and % of sloe, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to n o - \ 30 APPLICANT INFORMATION- PLEASE PRI 4 PORMATI REVIEWED BY DATE PROPERTY OWNER: G t -? PERTY LOCATION CEIV Ei.1 S►3 1/4 N W 1/4,S \ 4L Z ,N,R 1 E ( W PROPERTY OWNER':S MAILING ADDRESS - I LOT BLOCK # SUBD. NAME OR CSM # I On's 1' 1v vtj) � dL , JUN 1 6 99Q � - _r_V Q4 V1,t_\_ 6 e- CITY, STATE ZIP COD HONE NL b U j)( SCI [:]VILLAGE ®TOWN NEAREST ROADrtzooN CT'. w�1�$V�`t �t ►IV SSIZS -IZ) �YS TI�U ST. RMVI;S P1z>A.Y. New Construction Use [xJ Residential tpedrooms /AX [ J AdditiQn to existing building j J Replacement [ J Public or cwmme da§ctloe Code derived daily flow bOU gpd Recommended design loading rate - bed, gpd/ft - trench, gpd/ft Absorption area required 8 S 6 bed, ft2 - 1 5 O trench, ft Maximum design loading rate -) bed, gpd/ft • � trench, gpd/ft Recommended infiltration surface elevation(s) O 7� • O ft (as referred to site plan benchmark) Additional design / site considerations S T�_ ► 4SW 'TO ifv S_M CK) � f 3 OF- 3 Parent material L o `•TS S oUeR G\_f -Jr_ OvTkj RSN Flood plain elevation, if applicable M ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable fors stem ®S ❑ U ❑ S ®U RS ❑ U ❑ S ®U ❑ S O U EIS ® U SOIL DESCRIPTION REPORT W �voT stJV �� D �)I:) Sl7E Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed rerx }xY 4: r o -ZZ ,_s�s2 X13 — s e sbk m y . Lj . S n - Yo - I . S 4 Iz 3 1Y - '5 11 - Z s ) wn .....•4. rFnx Ground 3 yb -49 1u`1R 31 L � S1`� Sit awl �,�'r- cS _ tJ� •Z elev. 1Z - ft. y 4 8 - to3 �0`1R y !y _ S p s9 Depth to 3 +�s V)V Z CO *A r1 3.0R 4 St S Mft jjr E lnJ limiting factor S 1-1o1'r 7cvuF . >I Remarks: Boring # � > , 3� - i • S H R. 313 - S 0 S9 w ,1 $ Ground elev. 10 -5 ft Depth to limiting factor Remarks: CST Name: - Please Print Arthur L. W e e r e r Phone. 715 e rer Soil Testing & Design Service - P..O. Box 74 River Falls,WI 54022 Signature: Date: CST Number: ' .. ° 18 - 139 1 S - - -9b M00576 t a PLOT P LAN Page 3 of 3 sc�L� 1'' = 30 ' p? I � �.S 1 g�4 / �TT'PSC�� CZ- ET.PoVZT 8Y � ONJ SI \Jmt FI Wnollj LIZ. �r�Ps�►.�, gsS�sTM�r t�WB o Z1:�FJQ fP� W ISTZ MR, i t g.3 hS �-- __ Bh1 tk-4 03•o _ 'N k`R P-1, S`tSTtM ZS' suLTKgI- g.'t, 7Z Lit to8 s ect , 0-�H - 8' Y -) S' U„ JG L. �Z ul* OF `nkv- lAi GN Qpo?fiCI sL wj&bETC ap LqfsG`4 C w*h a ee s @ \-I mF: .ALnhl - QR r S L[ S s C.l4 . N s3VZ� Va 1►v Tb, "TPA -A „ A ►m Y'rk I 1q um C)F=- y,Z Coves OuM `rite iii Paz. DbQz ova ¢� LL�`�1 CCt�'v�.(321ZS wtY'�t tai. w1u1"t -� Wisoonsin Department of Industry SOIL AND SITE EVALUATION REPORT Page of 3 -tabor and Human Reladons Derision of Safety a Buik6ngs in accord with ILHR 83.05, Wis. Adm. Code _. COUNTY Attach complete site an on pl plan paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. 0 10 - \ Aq - 33 APPLICANT INFORMATION PLEASE PRINT ALL INFORMATION REVIEWED BY DATE PROPERTY OWNER: C /t PROPERTY LOCATION \k 80W.E(YF- S►NJ 1/4 NW1 /4,S % ZZ ,N,R 1 E( W PROPERTY OWNER' - .S MAILING ADDRESS LOT # I BLOCK# SUBD. NAME OR CSM If l °lams k - A �1`1 xzk t� 5 3 - T'�o`{ vt.LuA- 6 e- CITY, STATE ZIP CODE PHONE NUMBER ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD - z.00r.J Cr. W 0 Y1S$\X I-f r MN SS1't S (b lZ ) - )a I - 221 Y.•$ ST. 'hWA%JI;S Pk.wY. pq New Construction Use [ >q Residential I Number of bedrooms L{ [ J AdditiQn to e xisting Wilding j J Replacement [ ] Public or commercial describe Code derived daily flow bW gpd Recommended design loading rate bed, gpd/ft , trench, gpd/ft Absorption area required 85 FD bed, ft -1 S O trench ft r Maximum design loading rate , bed, gpdfit • trench, gpd/ft Recommended infiltration surface elevation(s) O 3 O ft (as referred to site plan benchmark) Additional design/ site considerations S Q)�E tiw`Ct �o W STA oil ?'ft - 3 of 3 Parent material Lo i''3 Z oU�-rR G` e tftt CJ\J T l kSH Flood plain elevation, if applicable m • A • ft S = Suitable for system CONVENTIONAL MOUND IN- GROUND PRESSURE AT -GRADE SYSTEM IN FILL HOLDING TANK U = Unsuitable for system EIS ❑ U I ❑ S ®U I US ❑ U [is ®U [is ®U [IS ® U * YvoT svL Stl� Dv� �o SOIL DESCRIPTION REPORT p\-g)%AZgeo St7E, Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourxlary Roots GPD /ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed 4tnch `.4 nwwZ - x ZZ Z_ t2 o- s 13 — s � � e sbk wl v� c-k, � . Ll , s i 1 „ 1 2 21 - , 40 -S Ground 3 yo 4& ►n `i R- 3) L � S CS _ N� • Z elev. \o - 1 3 ft. I/ 98 -1c3 lo`1fL Wy - S O S Depth to 3S p Z eor1 3 .04 4 (�� p S`t g w'1ft�4E ln� t @ limiting factor `Ttt'1 S I�oTTI 7_cvvF . > lD3` Remarks: Boring # -.. p 3� -i. S b IL 313 - S d S9 hA �-vv .1 Z - �9 Ground elev. 10 -5 ft. Depth to limiting lacttorr Remarks: TName- Please Print Phone: Arthur L. We erer 715 - 425 - 0165 e Soil Testing & Design Service-P-0. Box 74 River Falls,WI 54022 ' Sgnahxe. 0 q s 13 9 Date: 6 - � 9b CST Numb 0 0 5 7 6 PLOT P LAN Page 3 of 3 e.Z 8.1 ©Vl tk Z �Po ART 8 L �t M R s C, 1UEL4ON R t' y NSI - M V 1021FI C n01,..1 1'ti P s� , prss � s'M�1' ZC�J IN 6 P�1"11►J 1S71ZJ)'f012 6.Z L'1,1.08 s suVT"tX- Pi"vjal FOR - 3'x '1 S' UAJG l aTvj Z \tAtSN 0 i I\c l`ry S�D�.tti�1z L�AcL� C FHt ►�(3S @`-( �rv VF $ 1S w� � wc r� 1 w1V� c�1= U.Z �U ouLM `ntC LsPcElti C��- tR2"Rs v��. C3� r- �U�2.� 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 Attach complete site plan on paper not less than 8%z x 11 inches in size. Plan must FReviewed Environmental By Design include, but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. APPLICANT INFORMATION - Please print all information. Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Date Property Owner Property Location Kootienia Homes, N Govt. Lot SW 1/4 NW 1/4 S 19 T 28 N,R 19 W Property Owner's Mailing Address Lot # Block # I Subd. Name or CSM# 7975 Afton Rd 53 Troy Village City State Zip Code PhoneNumber u City ��illa. e Town Nearest Road Saint Paul MN 612 - 731 - 2345 Troy Troon Court j� New Construction Use: IN Residential / Number of bedrooms 4 ❑Addition to existing building Replacement F Public or commercial describe Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpd/fts .8 trench, gpd/fF Absorption area required 857 bed, ftz 750 trench, fP Maximum design loading rate .7 bed, gpd/fts .A tr ench, gpd/fF Recommended infiltration surface elevation(s) 97.50 & 99.00 ft (as referred to site plan benchmar Additional design / site consideration Parent material Loess over glacial outwash Flood plain elevation, if applicable ark ft S= Suitable for system Conventional Mound In -Ground Pressure AT -Grade System in Fill Holding Tank U= Unsuitable for system M S❑ U ❑ S® U ❑ S® U ❑ S M U I EIS ®U ❑ S® U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Structure GPD/W Borin Texture Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 1 1 0 -15 10yr3/2 - sil 2msbk mfr gw 2f .5 .6 2 15 -28 10yr5 /6 - sit lcsbk mfi gw if .2 i .3 Ground 3 28 - 110 7.5yr - s osg ml - - 7 8 elev 99.32 ft Depth to limiting factor >110 Remarks: 2 1 0 -12 1Oyr3 /2 - sil 2msbk mfr gw 2f .5 .6 2 12 -25 10yr5 /6 - sil lcsbk mfi gw - .2 i .3 Ground 3 25 -110 7.5yr - s Osg mi - - 7 8 elev 100.57 ft Depth to 1 limiting �— factor >110 I I I I I I Remarks: CST Name (Please Print) Signature: Telep o, o.� UNTy Thomas C. Nelson 715.2§ sl NG O FFICE Address Environmental By Design Date CST Num 1432 120th Street, New Richmond, W1 54017 4/30/98 MO2605 / c� PROPERTY OWNER: Kootienia Homes Kenn SOIL DESCRIPTION REPORT - PARCEL I.D.# Page 2 of 3 Environmental Bv Desi Depth Dominant Color Mottles Structure Horizon Texture onsistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed 'Trench 3 1 0 -11 10yr3 /2 - sil 2msbk mfr gw 2f .5 .6 2 11 -19 10yr5 /6 - sil lcsbk mfi gw - 2 3 Ground elev 3 19 -110 7.5yr6/4 s osg m1 7 g 100.53 ft Depth to limiting factor >110" L—L Remarks: 4 1 0 -6 10yr3 /1 - sl 2msbk mfr gw 2f 5 6 2 6 -20 10yr4 /4 sil 2msbk mfr gw if .5 .6 Ground elev 3 20 -33 1Oyr4/4 U7.5yr4/4 A lcsbk mfi gw - 2 3 103.73 ft 4 33 -120 7.5yr5/4 s Os ml 7 t; & Depth to limiting factor 2_ Remarks: 5 1 0 -16 10yr3 /6 - sil 2msbk mfr cw 2f .5 .6 2 16 -60 10yr7.5yr5 /4 - s* Osg ml cw - 7 S Ground elev 3 60 -125 7.5yr - s* osg ml 7 g 101.41 ft Depth to limiting factor >125" Remarks: * horizon banded with s lOvr4 /4 Ground elev Depth to limiting factor Remarks: CC Irl e- 0 leh� C o(zP Ste' /y wYy Sec eL (�►Ci U 11 I � r oe/ �p S ice, � � 7 erv X ��• _ I • _ loft sy I 2-0 CIIJ 5 a3 � � a n �� s t .r • o L I i i 1 A mi n e s T w� Y C O ( L r 0lS 5�. -, L,7 el� �� r�or, IOO/ I �► 30 raote ST. CROIX COUNTY WISCONSIN ZONING OFFICE N N fig N 11 fi w ` ST. CROIX COUNTY GOVERNMENT CENTER N�NNG 1101 Carmichael Road Hudson, WI 54016 -7710 (715) 386 -4680 May 4, 1998 Wisconsin Department of Commerce Plat Review ATTN: Leroy Jansky Box 8911 Madison, WI 53708 -8911 RE: Onsite soil verification, lot 53 of Troy Village Subdivision, Sec. 19, Tn. of Troy, St. Croix County, Wisconsin Dear Leroy: I have reviewed the soil report for the above mentioned lot in Troy Village subdivision, filed by Tom Nelson, CSTM #02605 and have conducted an onsite soil verification of the lot. My findings have verified that soil conditions as reported by Mr. Nelson are accurate. The soils located at this site are suitable for subsurface sewage disposal with soil loading rates of 0.7/0.8 GPD /sq.ft. If you have any questions with regard to the above findings, please do not hesitate in contacting our office. Sincerely, James K. Thompson Assistant Zoning Administrator cc: Tom Nelson file ' lA bjr and DeparOne Relations ti ons Industry, SOIL AND SITE EVALUATION REPORT p LabSr and Human lti age __ Of Division of Safety &Buildings 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 (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION— PLEASE PRINT ALL INFORMATION REVIEWEDBY DATE PROPE TYQWNER: EG Y LOCATION R T 1/4 1 /4,S T ,N,R E ( W PROPERTY OWNER':S MAILING ADDRESS BLOCK # SUBD. NAME �}� CSM # . CITY, STATE ZIP CODE EH NUMBER ❑VILLAGE WN NEAREST ROAD r'a Ittlew Construction Use ["esidential / Number of bedrooms [ I Replacement [ I Public or commercial describe [ 1 Addition to e�6ssting building Code derived daily flow gpd Recommended design loading rate bed 2 2 9P� trench, gpd/ft Absorption area required bed, ft trench, ft lu Amum design loading rate bed, gpdfit 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 CONV IONAL MOUND IN GROUND PRESSURE AT SYSTEM IN RLL HOLDING TANK U = Unsuitable fors stem L ❑ U [IS ❑ U ❑ S ❑ U ❑ S ❑ U [Is ❑ U [Is ❑ U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft in. Munsell Qu, Sz, Cont. Color Texture Consistence Boundary Roots �� Gr. Sz. Sh. Bed rer>cfi Ground elev. ft. Depth to limiting factor V ✓ -t� 6e "o -�.ey Initial: • ✓ Date 0��9(� Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety-and Buildings Division Count Y ST . CROIX INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) SanitarMV9.: Personal information you provice may be used for secondary purposes [Privacy L Z s.15.04 (1)(m)j. KOOTENIA N HOMES INC. �,RCI7 Village Town o : State Plan ID No.: CST BM Elev.: Insp. BM Elev.: BM Description: Parcel 130:_:1249- 30-000 TANK INFORMATION ELEVATION DATA A9800084 TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Aeration Bldg. Sewer Holding St /Ht Inlet TANK SETBACK INFORMATION St/ Ht Outlet TANK TO P / L WELL BLDG. Air I ntake ROAD Dt Inlet ir Septic NA Dt Bottom Dosing NA Header / Man. Aeration NA Dist. Pipe Holding Bot. System PUMP / SIPHON INFORMATION Final Grade Manufacturer Demand Model Number GPM TDH Lift Friction System TDH Ft Forcemain Length Dia. Dist. To Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT No. Of Pits Inside Dia. Liquid Depth DIMENSIONS DIMENSION SETBACK SYSTEM TO P / L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type of CHAMBER Model Number: System: OR UNIT DISTRIBUTION SYSTEM Header /Manifold Distribution Pipe(s) x Hole Size x Hole Spacing Vent To Air Intake Length Dia. Length Dia. Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth Of xx Seeded /Sodded xx Mulched Bed /Trench Center Bed /Trench Edges Topsoil ❑ Yes ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepancies, persons present, etc.) LOCATION: TROY 19.28.19,SW,NW 318 ST. ANNE'S PARKWAY Plan revision required? E] Yes ❑ No Use other side for additional information. SBD -6710 (R.3/97) Date Inspector's Signature Cert. No. r A l i cons i n SANITARY PERMIT APPLICATION 201 E. W shi ion 201 E. Washington Ave. Department of Commerce In accord with ILHR 83.05, Wis. Adm. Code P.O. Box 7969 Madison, WI 53707 -7969 • Attach complete plans (to the county copy only) for the system, on paper not less County than 8 112 x 11 inches in size. • See reverse side for instructions for completing this application State sanitary Permi it t 7 Number The information you provide may be used by other government agency programs © 1 �� Check if revision to previous application [Privacy Law, s. 15.04 (1) (m)]. State Plan Wy tuber I. APPLI ATI N INFORMATI N - PLEASE PRINT AL INF RMATION ZOQ SZ-') Property Owner Name Yy Property Location 100 Q 0 n .W 1/4 N W 1 / 4, S 1 T a$ , N, R 19 E (or) W Property Owner's Mailing Address � O Lot Number �� Block Numb City, State Zip Coe Phone Number Subdivision Na or CSM Nu , b� TVA W 40p by� N) U s ► � ( ) 20 11. T P B IL ING: (check one) El State Owned ❑ It ge Nearest Road Public 1 or 2 Family Dwelling ❑ Vil a - No. of bedrooms Town of TIL fLC>Ot.1 k R III. BUILDING USE (If building type is public, check all that apply) Parcel Tax Number(s) 1❑ Apartment/ Condo 0 1 0A� 9_ 3 V 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 IV. TYPE OF PERMIT: (Check only one box on line A. Check box on line B, if applicable) A) 1. Rf New 2. ❑ Replacement 3_ ❑ Replacement of 4_ ❑ Reconnection of 5 ❑ Repair of an � System -- - - - - -- System ------- - - - - -- 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 RMound 30 ❑ Specify Type 41 ❑ Holding Tank 12 ❑ Seepage Trench 22 ❑ 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 O Req i 500 500 eed (sq. ft.) Pro o eed (q. ft.) (Gals/day /sq. ft.) (Mi� (Minch) �/ Elevation 3 t• V Feet Feet VII. TANK Capacity INFORMATION in gallons Total # of Prefab. Site Fiber- Ex per- Gallons Tanks Manufacturer's Name Con glass Plastic A p p New Existin Concrete d Steel Tanks Tanks strutte Septic Tank lanK I ja oo We-c ❑ ❑ ❑ ❑ ❑ Lift Pump Tank- 4iphon- EtTiMer — J u V O I I I L ip e K ❑ ❑ ❑ ❑ ❑ VIII. RESPONSIBILITY STATEMENT I, the undersigned, assume responsibility for installation of the onsite sewage system shown on the attached plans. __ Plumber's Name: (Print) Plumber's Si nature: (No Stamps) MP /MPRSW No.: Business Phone Number: � �i p Plumber's A M dress (St City, Sta e, Zip Cod ` e � : l t , I V I ( SW S kA1A - 0 oL W1J 0 �o IX. COUNTY/ DEPARTMENT USE ONLY ❑ Disapproved Sanitary Permit Fee (Includes Groundwater ate Issue I ' AGt ssuin Agent Signature (No Stamps) A Approved ❑ Owner Given Initial CC/r\ Surcharge Fee) Q Q � Adverse Determination U� //DC> Z �f� l< X. CONDITIONS OF APPROVAL / REASONS FOR DISAPPROVAL: S066398 (8.11196) DISTRIBUTION: Original to county, one copy To: sal i eq Bui&ngs Division, Owner, pNrwlber SAFETY AND BUILDINGS DIVISION 2226 Rose Street LaCrosse, WI 54603 �sconsin Department of Commerce Tommy G. Thompson, Governor William J. McCoshen, Secretary February 6, 1998 ENVIRONMENTAL BY DESIGN 1432 120 ST. NEW RICHMOND WI 54017 RE: PLAN 9820050 FEE RECEIVED: 405.00 TROY VILLAGE LOT 53 SW,NW,19,28,19W TOWN OF TROY COUNTY OF ST. CROIX MOUND SYSTEM PETITION FOR VARIANCE TO CODE SECTION(S): Comm 83.23(1)(e)l. The Department has reviewed the above - referenced submittal. Conditional approval is hereby granted for the system plan submittal. All noted items must be corrected. The review and approval of the system is based on chapter 145, Wisconsin Statutes, and chapters Comm 83 and 84, Wisconsin Administrative Code, and is contingent upon compliance with any stipulations shown on the plans. This system has not been reviewed for the code requirements set forth in chapter Comm 82 or in chapters ILHR 50 -64, Wisconsin Administrative Code. This plan submittal approval will expire two years from the approval date, or if a sanitary permit is obtained, plan approval will expire on the day the initial sanitary permit expires. The licensed plumber responsible for this installation shall keep one set of plans with the Department's stamp of approval at the construction site. The installer shall notify the appropriate inspector when inspections can be made. All of the statements and supporting documentation included with the petition were considered. Since your request is similar to other petitions approved by the Department (e.g.S93- 00901), the petition is approved. The variance requested was to allow the installation of a new mound on a slope Of 14 percent. This petition approval is granted conditionally with the understanding that all of the petitioner's statements included on the variance application form and any other documents submitted to the Department will be carried out. This variance is specific to the subject petition and cannot be used for any additional modifications. All permits required by the city, village, township or county shall be obtained prior to installation. SBD- 5524 -E (R.07/96) File Ref: 1 SAFETY AND BUILDINGS DIVISION 2226 Rose Street LaCrosse, WI 54603 isconsin Department of Commerce Tommy G. Thompson, Governor William J. McCoshen, Secretary ENVIRONMENTAL BY DESIGN Page 2 February 6, 1998 PLAN 9820050 Inquiries should be directed to me at the number listed below. Please refer to the plan number shown above. Sincerely, §�� Gerard M. Swim Plan Reviewer P.O.W.T.S. Plan Reviewer (608) 785 -9348 cc: ST. CROIX RESIDENTIAL MOUND DESIGN INDEX AND TITLE SHEET Project Lot 53 Troy Village r� Owner Continental Development Address 12301 Central Av. NE Suite 230 Blaine MN., 55434 Legal Description SW, NW, Section 19, T 29N R19W Township Troy County St. Croix Subdivision Name Troy Village Lot No. #### -`_i'3 Parcel ID Number Plan ID Number 9820050 P.O W T's' Conditionally INDEX SHEET PAGE ONE VED MOUND CALCULATIONS PAGE TWO APpR MOUND DRAWINGS PAGE THREE F COMMERCE PRES. DIST. CALCS. & LATERALS PAGE FOUR DEPpRjM pFETY pNt) 1LDING s PUMP TANK DRAWINGS PAGE FIVE ptiVIS"' Pum Curve PAGE SIX Site Plan PAGE SEVEN SEE CO 'P NDENCE Soil Test Page 1 PAGE EIGHT Soil Test Page 2 PAGE NINE Soil Test Page 3 Site Plan PAGE TEN Designer Jim Boumeester License Number MPRS03404 Signature Phone No. 715 - 386 -9020 & 2 46 -24 Date 1 -14 -98 Notice: Tampering with this file by unauthorized persons is prohibited. RECEIVED Deliberate modification will result in disciplinary action under s. 145.10, Wis Stats. JAN 2 8 1998 SBD- 10462 -E (R.04/97) Page 1 of I C SAFETY & BLDGS. DIV. RESIDENTIAL MOUND DESIGN Eight Bedroom Maximum Complete information in red framed boxes as necessary. (y or n) n Is the system over creviced bedrock? Slope 14 % Number of bedrooms 4 Wastewater flow rate 600 gpd 2271 Lpd Depth to limiting factor 36 in 91.4 cm In situ soil infiltration rate (code) 1 0.5 gpd /ft 20.4 Um Contour line below the upslope edge of absorption cell 84 ft 28.65 m Use standard fill depths? C ^J OR Designer spec'd in cm Place X In box to use standard depths (1$ 24, A+4 Inclusive) OR specify design flit depth. Center or end manifold c (o or e) Estimated hole space 3.5 ft Not a Hnal calculation. Lateral spacing F : 4ft Minimum dose >= 10 times void volume Use a 0lateral spacing for trenches. Pump tank elevation 84 ft outside bottom of tank Number of laterals p3q0ft Force main diameter 2 in Force main length Force main actual dia. 2.067 in SYSTEM SOLUTIONS Inch - pounds Metric Cell media "x" one only. Estimated daily flow F 600 gpd 22 71 Lpd x Aggregate and pipe Absorption cell Design load rate & area 1.2 gpd /ft2 500.0 ft 46.45 mz Chamber and pipe Linear load rate 9.5 gpd/ft 117.8 Lpd /m Design width (A) 8 ft 2.44 m Cell length (B) 63.0 ft 19.20 m Depth of cell (F) 10.4 in 26.4 cm Sand filter Upslope fill depth (D) 12.0 in 30.5 cm Downslope fill depth (E) 25.4 in 64.5 cm Basal area required (gpd /infiltration rate) 1200 ft 111.48 m Supporting components Topsoil depth 6.0 in 15.2 cm Subsoil depth at center 12.0 in 30.4 cm Subsoil depth at cell watt 6.0 in 15.2 cm End slope toe length (K) 11.8 ft 3.60 m Upslope toe length (J) 6.1 ft 1.86 m Downslope toe length (I) 20.6 ft 6.28 m Total mound length (L) 86.6 ft 26.40 m Total mound width (W) 34.7 ft 10.58 m Project: Lot 53 Troy Village Plan 1. D. 1 E +07 Page 2 of 10 MOUND PLAN VIEW observation pipes (typical) .I W= 34.7 ft — o A� A= 8.0 ft 2.44m 10.58m B= 63ft 19.2m B - -- K J= 6.1 ft 1.86 m I E = 20.6 ft 6.28 m K= 11.8ft 3.60m I L = 1 86.6 ft �I 26.4 m typ. obs. pipe A X B refers to absorption cell width and length (anchored securely) J = upslope width I = downslope width K = end slope dimension LU 6^ (150 mm) MOUND CROSS SECTION lateral topsoil N subsoil cap D = 12.0 in 30.5 cm G E = 25.4 in 64.5 cm invert 95.5 ft F = 10.4 in 26.4 cm elev. 129.11 m see note F G = 12.0 in 30.4 cm D E ASTM C33 H = 18.0 in 45.6 cm Sys. 95.0 ft Sand Fill elev. 28.96 m 94.0 ft contour 14% 28.65 m slope Note: Absorption cell media will D = upslope fill depth plowed layer consist of aggregate and pipe E = downslope fill depth or leaching chambers and pipe F = absorption cell depth as specified �x Aggregate G = subsoil + topsoil depth at cell wall at right Chamber H = subsoil + topsoil depth at cell center Designer notes: If aggregate is used, it is covered with code compliant material Project: Lot 53 Troy Village Plan I.D. ### Page 3 of iC PRESSURE DISTRIBUTION CALCULATION Absorption cell Inch-pounds Metric Width (A) 1 8 ift 2.44 1 m Length (8) 63.0 Jft L 19.2 Im Lateral specifications Number laterals 4 Holes /lateral 9 holes Lateral length 29.8 ft 9.1 m Perforation dia. 0.25 in 6.4 mm Lat. dis. rate 10.49 gpm 0.7 Us Sys. dis. rate 41.96 gpm 2.6 Us Hole spacing 42 in 106.7 cm Lateral diameter Pipe diameter Design options Design choice Designer must 1in/25 mm X P /ac X' one choice 1 1/4in/32 mm X box from the options 1 1/2irr/40 mm X diar, provided. 2in/50 mm X x 3in/75 mm I X Manifold diameter Pipe diameter Design options Design choice Designer must 1in/25 mm X' one choice 1 1/4in/32 mm X P /ac from the options 1 1/2in/40 mm X box provided. 2in/50 mm X x diar' 3in/75 mm I X 4in/100 mm X Distribution system contains 4 latera /(s) LATERAL DIAGRAM - CENTER CONNECTIi Place correct lateral diagram by clicking in one of the drawings at right and dragging the diagram i Force main connection via tee or cross to manifold at any point. • Laterals are identical typical P end cap S IF X—+ If x12 I 02+1 Laterals & force main of PVC Sch 40 Last hole drilled next to end cap (per COMM Table 84.30.5) Hales drilled on the bottom of the lateral, • = permanent end marker equally spaced Inch-pounds Metric Lateral length (P) 30.0 ft 9.14 m Lateral spacing (S) 4 ft 1.22 m Manifold length 4 ft 1.22 m Hole diameter 0.25 in 6.35 mm Lateral diameter 2 in t 50 mm Number of holes per pipe 9 Invert elevation of laterals 95.5 ft 2 9 — 01 7- 1 m Project: Lot 53 Troy Village Plan I. D. 9820050 Page 4 of 10 Total dynamic head System head = 3.25 ft 0.99 m Vertical lift = 10.40 ft 3.17 m Are laterals the highest point in the Friction loss = 0.87 ft 0.27 m system? Yes "X" here. C � Total dynamic head = 14.52 4.43 m If no, what is the highest elevation Dose Volume downstream of pump? Lateral void volume = 20.9 gal 79.1 L Force main drain Minimum dose = 209.0 gal 791.1 L back to tank? ("k" one) Drain back = 5.2 gal 19.7 L x Yes Dose volume = 214. al 810.8 L No Typical Pump Chamber Layout In combination with state approved treatment tank. Tank construction as per Comm 83.20(3) WAC. approved manhole cover I weather proof l and w /warning label and padlock grade levels junction box � grade levels quick disconect aftemate 4" vent pipe electric as per NEC 30 outlet Comm 16.28 WAC location 18" (46 cm) min. wall of pump a PP roved chamber or outlet combination joint tank A 1/4" weep (trade levels alarm on hole as pump tank manhole a 4" min. above finished grade pump on B necessary pump tank man. =100 mm min above finished grade C vent =12" min. above finished grade pump 85.1 ft vent - 300 mm min. above finished grade off elev. 25.9 m D 3 " (75 mm ) of bedding under tank and anchor tank as necessary 84.0 ft Pump tank elevation 25.6 m bottom of tank Tank specifications: Weeks Pump tank = 12 gal /in Pump tank volume = 1000 gal Capacities Inches Gallons _ A= 53.5 641.8 Pump manufacturer: lGould -- B = 2 24.0 Pump model number: 3871.— G V c >5 C = 17.9 214.2 D = 10 120.0 Project: Lot 53 Troy Village Plan I.D. 9820050 Page 5 of 10 f vl y v` a a s 6r, PIMK` ,� ' j�i I i 1i � Swifitatin:.nS r - '1 Rd'l3T' ¢ METf FiS fEE7 Up to 40 GPPA � Discharge size 1 NPT - MODEL 3871 9 30 ~�!L� So lids : maximum, . lids: V MORW 25" Single phase: 115V l . a , . t 1 Materials Of Construction ;, 6 Brass/thermoplastic Features and Benefits I EPaS *Top suction eliminates a 3 impeller clogging;, *Corrosion resistant _ e f +Float actuated switch, 20 30 _40 so 0 2 A 6 8 10 12 mi +M CAPACITY MEiEHB F£fT _..... Pump Specifications Features and Benefits _. ' MODEL DVP03 R 20 -- "�"`"� -- '/ and '/= HP • EPO4 impeller- semi -open design 6 Up to 60 GPM with pump out vanes to protect a 4� ,- Maximum head to 32' mechanical seal_ Discharge size 1 V,' NPT • EP05 impeller - enclosed design Solids: /�" maximum for improved performance. 2 5 Motor • Hugged glass -filled thermoplastic o p; casing and base design provides All motors feature ball -° 15 20 25 30 35 0 o U.S.Gf'M bearing construction superior strength and corrosion Single phase: 115V resistance. p CAPACITY 6 s aom�hr Materials of Construction • Cast iron motor housing for Cast iron efficient heat transfer, strength, Thermoplastic and durability. Stainless steel • Corrosion resistant threaded stainless steel shaft. • Available for automatic and manual operation. • CSA listed models available. All Models are designed for continuous operation and feature stainless steel hardware. 0#. C tc �t C' ('; 10 Cd n n e 4 I V Q,v AL I o p M t��T' Swa nLi 19 TZaN rZ19 t - i Co 1 roy Uiil. S3 11�tCre Parcel E3 r� � t ti yo 1000 q�.l P" p Qe� 0 B 3 1200 99.1 • Sept Ic. ti r y 6 e(9 roo t53 t • We � i 17 —�--- FA 1n rl r —c, tZ k ( u A L Es E „7 C L+ li ►, cs Y, o� To sc 11 4 1 O r 4. �'l d 1 CI c 4 � � .10 �r1 Tub OF Te�e� n e �o 5r 2Lo $' 1 00 � L- and SOIL AND SITE EV Department of Industry Labor and ALUATION ' Labor Human Relations Page –I of Divisloh of Safety and Buildings in acco rdance with s. ILHR 83.09, Wis. Adm. Code Attach complete siO plan on paper not less than 8 1/2 x 11 Incites in size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and 5 1 C r o 1 )r fit slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. ft APPLICANT INFORMATION - Please print all information. Reviewed by Date Pemonel irdon -tion You Provide a U plc r1 mey bs used for scon edary rposes Pu (Privacy Law, s. 15.04 (1) (m)). f t Q. O �p P rope rty LoLocation Govt. Lot n e h T S W 1/4 n tj /4,S I T 25,N,R I� E (60 W Property Owner's Mr C ing Address ft BlodcN Sd�Name or ISMS t 1 01 e4rv-1 Au i�l�, S �.��c a. 3 0 3 � ro. U i Jac, t, City State Zip Code Phone Number 13 City ❑Village Town Nearest Road 1 Ai n e Mn 5543 c ) S . r Now Constriction Use: Residential / Number of bedrooms �_ Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: Code derived daily flow VU gpd Recommended design loading rate -- 4--bed, gpolft r S trench, gpd/(t Absorption area required S v 0 bed, ft O O trench, it Maximum design loading rate ,_bad. gpd)fl • S trench, gpd/ft Recommended Infiltration surface elevation(s) ft (as referred to site plan benchmark) Additional design/site considerations t Parent material C C n L� d v. 4 c ,") , Flood plain elevation, if applicable it S = Suitable for system Conventional Mound Pressure AT -Grade System in ldi Fill Hong Tank U Unsuitable for system ❑ S US ❑ U ❑ S W U ❑ S Wu ❑ s Kl U ❑ s 0 U SOIL DESCRIPTION REPORT Boring # Horizon Depth Domi Color Mottles Texture Structure GP /n in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. � Boundary Roots r --rnu Be d , Trernch 1 -11 " R-. � S i k 2 i -23 -- L S i thS b K rn vCr q 6 1 Ground 'y ! b Q y L S 1 rh Sb K M v. r r, , 7 Ground 9 q1 1 b Q- 4 3 f•► I d S t y :� 5 c i. Z i' 1Ce K Depth to limiting factor 4 LIn. Remarks: Boring # r 0 - 1 3 to vr SW r1d Fr b z F 8 1 ve- 141-1 S ! 1 ► rti S6 m v C r u b 1 F . 7:. rr'•1 . 7 • . �i Ground Depth to limiting fa ctor 73-3 Remarks: CST Name (Please Print) Signature Telephone No. 1 A�Gcs Y1e lso -` p i s- �yrr - ).4 Sq Address t- o S'1 h t o R i cA Md r, Data � I � ' ^ � CST Number be (P O ?A &t, r e , 0 i E`i PROPERTY OWNER SOIL DESCRIPTION REPORT page 2 of PARCEL l.D.tf Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed . Trench 3 M 1 - -1 to Y9 LS A in 56K j b Z ,? • v 43► 19 , 40. — t ( Zr`1 C56 t' r Ground d Depth to limiting factor 17 n. Remarks: Boring # Ground elev. ft Depth to limiting , factor in. Remarks: Horizon Depth Dorrdnant Color Mottles Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench Boring # Ground elev. ft. Depth to limiting factor in. Remarks: Boring # Ground elev. ft. . Depth to limiting factor in' Remarks: $BDW -=0 (R. 08195) r AtC- 9 CF (C i' Go r o V{ 5` t 4 s ° 0 s 3 Ell 17 5 FA fbt ,.F t 1 Y 1 LC OF l 1 C t C ti �<, c ri ves cg y 4. , Wisconsin Department of Industry, $ TE EVALUATION Labor arid Human Relations Page of 3 Division of Safety and Buildings in 83.09, Wis. Adm. Code Attach complete site plan on paper not less than 8 1 inch Coun include, but not limited to: vertical and horizontal r ce point (BM), directio e ion n a m ' ` ty C ro t v percent slope, scale or dimensions, north arrow, a atio di a res raa f;. _..._' Parcel I. D. # ST CROlk APPLICANT INFORMATION - Please r I ir1 l ' P �' " Reviewed by Date Personal information you provide may be used for secondary (privacy W�S� Propeqy Owner t ti r erty Location � Govt. Lot S LJ 1/4 h r J 1/4,S 1 T 'Z$ ,N,R 19 Y (or) W Property Owner's Mailing Ad ess Lot # Block# Subd. Name or CSM# 1 )230 ( ern rc.� l��' nE. 53 ��" U 1 C' City State Zip Code Phone Number 11 City ❑ Road Village � Town Neares t ���,� nQ h ��y � ((gl2) ry goon Co" 12 New Construction Use: Residential / Number of bedrooms Addition to existing building ❑ Replacement 9 Public or commercial - Describe: Code derived daily flow Q 0 gpd -7 Recommended design loading rate bed, gpd/ft S trench, gpd/ft Absorption area required -- u'"v bed , ft r rench, ft Maximum design loading rate ? p (� -1 9 9 bed, gpd/�! _trench, gpd/ft Recommended infiltration surface elevation(s) - 1 1 , 5 It (as referred to site plan benchmark) Additional design /site considerations Parent material Flood plain elevation, if applicable n Q, ft S = Suitable for system Conventional Mound In- Ground Pressure I AT -Grad System in Fill Holding Tank U = Unsuitable for system S U ® E ❑ U 91 S❑ U U ❑ S ®U EIS R U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD /ft2 in. Munseil Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed , Trench 1 01 5 ►0 >� 2 ry2.ms6K m r W R �5 S I csW maC Ground ,i , , 3 elev. � g�0 -� 5 Q (efy J V S MI Q f __ , 7 • 1J Depth to limiting factor - 7 q k in. Remarks: Boring # 0-1 10 r 3/;L � �� a,rnSb� ��� � 2F ►5 ,� 2 �: 1Ze� ►b ���� st l 1 C 7 , 5 R (P S 0 - 59 r-i 1 - , 7 , 8 Ground ,,,, l obS l ft• Depth to limiting factor - Remarks: CST Name (Please Print) Signature Telephone No. h o n a s r) d 3 0 t - 7 1 5 - I - 145 q Address Date CST Number ty'3�. (a h S � - nQ CAr,o 1 1 - a 05 wYy S« ►g i L bN ) Foci LJ ro. 70"in S k, S+ ero% Co. I Hof sy l G °�S104�- N ICY o v Y I a 0- C I N i d w( b y c o2ne2 0.- s ter-, ( � ' 2'tv�tion X00 � �� _ 30 VOscoosinVepartment of Indusay. SOIL AND SITE EVALUATION REPORT Pa e II of 3 Labor r-id Human Relations g -_J__ Division of Satety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code _ COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but ST• I not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distan n a e APPLICANT INFO RMATION PLEASE ( b!�AA,� N REVIEWED BY DATE PROPERTY OWNER: PROPERTY LOCATION E (�� - 2, S 2 OftN 8AK AiC T1�0 �� Sal IJC W w %2r+,S 1 T L$ ,N,R 19 JbW W PROPERTY OWNER':S MAILING ADDRESS LOT # BLOCK # SUBD. NAME OR CSM # .000 C T , 4, IF 13 199? �.... 3 _ 1l -P r=s CITY, STATE ZIP COPE ' ❑CITY ❑VILLAGE ®TOWN NEAREST ROAD t.l.D Is t7 , TIGD GT, >` �Q New Construction Use R es identi Nti rrttrer�c#, Addition to existing building j l Replacement [ 1 Public or comm Code derived daily flow InQD gpd Recommended design loading rate 0-6 bed, gpd/ft 4.7 trench, gpd/tt Absorption area required & �5 7 bed, tt 750 trench, ft Maximum design loading rate 0.7 bed, gpd/it trench, gpd/ft Recommended infiltration surface elevation(s) .3E Mtn f3 ft (a s referred to site plan benchmark) Additional design / site considerations "N Erg Parent material t..t_ Flood plain elevation, if applicable Al-A It S = Suitable for System CONVENTIONAL I MOUND IN- GROUNO PRESSURE AT•GRADE SYSTEM IN FILL HOLDING TANK U= Unsuitable for S Stem ❑ S U ❑ S ®U ❑ S U 0 S El U ❑ S OU I ❑ S jau SOIL DESCRIPTION REPORT CpUn�Y aN_��r It -Z-T-9 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boixr:1 y Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed ITmnch 1 0 10 2 4z — I rn Z 0.1 01 2 1 31 t 15 1 m b — . `r! Ground t oy 3 N — -FS — — - 0. elev. Depth to limiting face, Remarks: J40Ktzo I z pftrk'r ?O OL ; 4NC!Z4+,tI 2 l+*S STS OF rOY,F?�z Boring # I - 12 z/Z — S 1 rr ab 0.7 i 0 Z I z- 2'7 I© 1 1 rh s /4 r 0. Ground 3 27- ba 1 5 03 elev. m — N Q �� h• Me Depth to limiting factor Remarks: CST Name.— Please Print Phone: C � Z 1 r ss: Sgn Oats: d &W, L7, 7CST Number: 0 A,1ov. ZT f"` nn 03770 PROPEM OWNER &U IF/AM P- =, _ t+A_ SOIL DESCRIPTION REPORT Page L of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bourx�ry Roots GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. B Trench '.. ' 0-10 10 YK 3 / z — 1 S m ,� C — 0. Z 10- 313 1 i r Cb — 0.7 0. f1 Ground 3 32-4 0 3/ Z rn r W 5 elev. YN,Qft 4 47 _Sb 101K 3 v. 4 h, io vr- Sc Depth to 5 Sa-g5 — S limiting — factor 4 2 Remarks: l-Ib10ZDA1 2 N,ts S WOM S OF iOYR /2. Boring # — I 0- I - 4Z — I — rnv r s 7 Z I - 0 Ye 3/ I S 1 m s6 rrv.Fr ' m Q Ground 3 7, 5 `/ 4 to 41 f m rn-�r; CwI — P AhO elev. "S 0 ytq 3 to y MK Si I mSb M aw Depth to S 10 Y 3 / 5� ! mSbK M aW Nip A) va limiting W 59-7U 7 Remarks: �AnyiznM S rr<ArvV► wl TF! ShME A Boring # .. ntinh53tik v Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor Remarks: Pace 3 of 3 PLOT PLAN Property Owner UGAAMELE Legend: 4/0 Legal Description LOT 53i TKDY NUTED BM = 01 SPIKE ►N sW 510e V LLa(7 IA1 - YHS i Yz Sze{, OF 130X ELDER TKEE -w+&I-E T29 N RzO� � In1 /Z S 19 T'Z g N R r #k Z tow pF bo pENNy NAIL � �J, �.LS - pN _0-1 3 "3 - F1A6�oF s TGw►� OFOY� ST, GC01Jc eOUNTY W =, soil boring w /backho C,SE� SU.2vF1 IAAp3 Fo L.oT UAJE p►NGtC ACCU ACA. } LOT L.OT 64e3 SL 8 8'b. Z (� EL 890, EL M. 0 M I N 9 0. Ilk o , L 9 03 .5 / kiioE 4-7 / ST. l�N�lES I y Signed CST MO ?0 i Date N0-1�2$ 1q% ,�E v, W; *e. z /997 Urbo r'id oasin D me n Re l a ti ons Industry. SOIL AND SITE EVALUATION REPORT P Ls Numalti g Of 3 Division of Safety 8 Buildings in accord with ILHR 83.05, Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but S7 I not limited to vertical and horizontal reference point (BM), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to ne a . f APPLICANT INFORMATION - PLEASE PRINT �`? OOAMATtQ?�I' REVIEWED BY DATE A PROPERTY OWNER: LOCATION E 2 S :24 / , OftAt 64K(3A�� � T"OMy4S AAeL � WW %2r4,s 19 T Zg ,N,R 19 JbW w PROPERTY OWNER':S MAILING ADDRESS €'1,? #<� LO BLOCK # SUBD. NAME OR CS # 000 C T, 4, F ,( 1 3 1 CITY, STATE ZIP CODE H NUMB ix ❑ ❑VILLAGE MOWN I EARREST ROAD ta.D 5401(0 KO CT, is PQ New Construction Use (�Q Residential / Num of Addition to existing building j ] Replacement [ ] Public or commercial dela; r k� Code derived daily flow ti00 gpd Recommended design loading rate 0- bed, gpd/ft 4 trench, gpd/ft Absorption area required bed, ft 7.50 trench, ft Maximum design loading rate 0 •? bed, gpd/ft trench, gpd/ft Recommended infiltration surface elevation(s) RIE i)C'refAl ktQ ft (a s referred to site plan benchmark) � Additional design / site considerations — f "'U zw' Parent material SANflS'1pNE /Gy4CjAL - LL. Flood plain elevation, if applicable AIA ft S = Suitable for system CONVENTIONAL I MOUND IN- GROUND PRESSURE AT•GRADE SYSTEM IN RLL HOLDING TANK U= Unsuitable fors stem D S U C3 S ®U Cl S O U U 0 S J8t U 1 ❑ S U SOIL DESCRIPTION REPORT Caun1T� * 11 -Z7 -4 Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Bounfty Roots GPD /ft in. Munsell Gu. Sz. Cont Color Gr. Sz. Sh. Be Tre & > •y l� > - I 10 zlz — I rn � - 0, 01 a� f 2 1 I 3 1 15 1 msbe f✓ — -1 0.7 Ground 3 p 45 — — S 0. elev. Depth to limiting factor Remarks: J40K t1 I E z Pke- ?O 0 ; 4W-!Z4 , kt ? 1+,45 STS OF f OYj??Vz Boring # 0 - 12. r-\s ab Z IZ -z'7 10 1 5 1 rns ✓ a Ground 3 Z7- bD Ib — 5 — 03 CLb elev. 4 _ b3 IOY o y/ tto I I m — N P gg2q It Depth to limiting factor Remarks: T Name : —Pease Print cT Phone: , 7 L r ss: 5r. t � K I T Sign r Date:.! AVAe. Z 7, JCST Number: 1110\). ZS. fR9L M 03770 -PROPERTY OWNER &LkGIAnnr=1 P= -Mt+nl SOIL DESCRIPTION REPORT Page Z of PARCEL I.D. # Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD /ft in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. � Roots t 0- I O 10 YK 3 / z — Bed Trench I, I S m vr� c — 0. 2 - l vie 3 /5 — I Cb — 0.7 0. Gro u nd 3 32-4 0 3/ — IX- 5� �. m r rn cwi p3,D � 4 47 10 K 3 114 4 /t , toyC�/ SC1 n. i C%d — N� p Depth to 5 Sp�S y _ 5 limiting m — — factor 4 2 „ Remarks: H(3KL 2 Nks S VOM'S OF %C) /2 Boring # 6(0 Z ► - 0 ye 3 / — I s Ground 3 / 1 4 7� `/ r4Y1 l0 4/ I 1 m bj< elev. y r+n2 p 2M.1 ft. 3 10 YR 3 to V r,41( 'I K ,61 % Si t m M 4 Depth to S 10 V 3/ 5 I MS)o m QI A) tj 10 l A 1 im factor to .7 Remarks: �t ov ► nil S r ►rrzn u,TIA SAME -4 AAJ r Boring # Y \ �1 Ground elev. ft. Depth to limiting factor Remarks: Boring # Ground elev. ft. Depth to limiting factor 77 j R emarks: Page 3 or= 3 ' PLOT PLAN Property Owner (Zul:MML -iJE Legend: ffI y0 Ex C rZoT WttBM Legal Description LOT 53, TKDY MUTED BM = 1#I SPIKE %m SW S1Oe 111LU4(09 LOCA"fED I N 7H'1= 102, sz OF (SO)r ELDE TrLEG- FL464E T29 Aj RzO� W �z� 5 l 9� TzgN� �1qW� 4►.v�` o T33 F A 6 sZ k TIWA) OF1T2 ST. CK0%A CouNTy� W=, = soil boring w /backo (,SE9 SURVEY MAPS FJr{ Lo'r LAM ANrotC Aeeul<Aey. } LoT S¢ L.OT SL fl 84e3 (� EL 3 yras � EL 99y,0 M EL$9Z4 / I N X9 0 n� fit. go3.S5 /o � 4/7/L iry V EgSE�YJ�Nr l S T. -- ? y Signed CST JJ,4( 4 MO 70 Date N0\1. 1 ,�E4- .f;*e, Z-7 /997 i{. w N 110 044, cco 264.94' N 1 p �� L. N 00 °31' 10" W E 71 6.7p� / M Z� ,6Z0 N z Ln m I cn 2p. � to ri m rn I o°' I N 60 0 00' 00" W N co I N w rn o z� 73.17' W$ N. ' I n o w rn - I N n :� $ o c I S 06 0 00' 00" E o N M I S 150.54' rn I I 2p 0 ° — ,� 190 °�,Z S 1 O ' . 3 2. 2 6, 36 9.5,3 , N 1 •B �Y �'v �� ON 4'�a 1 � I \ Ul ��aa w O Cn 0 , I cn cn C Ln �l O � � N N O 0 -� m 00 SRO° (� ' CA 29. w w Lin (Yl rn S3s° N 2 , Ul s o, O N �p ° N Ul O w cp ---i D -4 o'O pp o00 I ON O � �o ON m I Z ' N 1. v > 4' C. CD � N 186.04' 9�� ° rn o OD I N ° ,,. N ° SOO ° 00 00 „ E p°! I — - $ ST. AN EWS v ' oo ° 'im =' $ > 1 , 60 DRIVE m m N 85 E z Q' 66.00' o Ln i N S 05 0 00' 00" E v A O I °° w 98.21' o W I ' O c t , a? I - OD 0 NO3 0 42' 06 "W `r R 181.39' ASS rn SOD- N 1 vN v N C D O, co ti O F I I ° •% co �+ 1 OO° o I v N S 02 ° 00' 00" W 536.03' S I S 9�O' w 02 °00' 0 "E v� N0 S �4° 9 O -, '�'i. > ' F 356.31' rn � •� 0 , F v � , 9 S 02 0 00' 00" E 4/ -' cn ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer koo4ni 1 %- Harn Mailing Address 7 S AfA N ' RdC Property Address 3/8 $I Anne f (Verification required from Planning Department or new construction) City/State W bea ri silj Parcel Identification Number LEGAL DESCRIPTION Property Location 5 W_ %.,1 j L %,, Sec. T L N -R JJ-- W. Town of I"O Subdivision ir Lot # S3 Certified Survey Map # Volume Page # Warranty Deed # S(o 8 3 8 S Volume Page # 2 8 - s — Spec house H yes ❑ no Lot lines identifiable R yes ❑ no SYSTEM MAINTENANCE Improper use and maintenanceof your septic system could remit in itSprematumikilure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or can affect the function of the septic tank as a treatment if wooded a licensed pumper. What you put into the system stage in the waste disposal system, 2 by the owner master lumber. journeyman agrees to submit to 'St- restrictedplumberora St. Qroix Zoning rm, signed r. and by a P •] licensed pumper a certification fo rs is Proper operating condition and/or after ' P� vecrfymg that (1) the on -site wastewaterdisposal system () 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 Commerce and the stating that your septic Department of Natural Resources, days of the three date. State of Wisconsin. Certification system has bees maintained must be completed and returned to the St. Croix County Zoning Office within 30 C/ y gyp' n // 4 ( J�OOFvr�)A �a?'�CS Z'NC. SI O APPLICANT 3 / 3P / 98 DATE OWNER CERTIFICATION '(we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (arc) the owners) of the P rty described a , by virtue of a warranty deed recorded in Register of Deeds Office. SIG TUBE OF APPLICANT 3 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