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040-1294-30-000 (4)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)], Permit Holder's Name: City Village Township David & Laura Franta TOWN OF TROY CST BM Elev: Insp. BM Elev: BM Description: 9z. 0� I qnL C-Av.-c TANK INFORMATION TYPE MANUFACTURER CAPACITY I Septic vv Dosing Aeration Holding TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic • xis Dosing Aeration Holding PUMP/SIPHON INFORMATION Manufacturer Demand f\ GPM Model h aml ►er fN TDH L ft m Fric Syste t1i H Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: SAN-2023-294 State Plan ID No: Parcel Tax No: 040-1294-30-000 Section/Town/Range/Map No: 16.28.19.1688 STATION BS H I FS ELEV. AA -Bit c+4 l.et t Dt-rnfeI Dt Buiiom Ho.,.a..O nafl-: Bot. System (ncwW VX W (� t Final Grade St Cover R���,t+7�e ��h�k I oz. �3 lo.�-s �❑b� �9_6 BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 31V0 ❑ -. SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR _ Type Of System: S > � UNIT Model Number: �w��nfi dna DISTRIBUTION SYSTEM Header/Manifold Distribution x H Size x Hol acing Vent to Air Intake Pipe(s) Length �-5 Dia Length Dia Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Bed/Trench Center 2 Depth 0 -r Be rench Edges depth of Tops�iL, � xx Seeded/Sodd x Mul Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Location: 516 E COVE RD 1.) Alt BM Description = 2.) Bldg sewer length = E0,gj - amount of cover = Plan revision Required? ❑ Yes No Use other side for additional information. 1 Date SBD-6710 (R.3/97) Inspection #2: 15 11� Insepctor's Signat re Cert. No. Industry Services Division County Croix 5 St. Al A 1400 E Washington Ave Sanitary Permit Number (to be filled in by Co.) P P.O. Box 7162 Madison, WI 53707-7162 Sanitary Permit Application NOV (A_ ,, G,_ 0 State Transaction Number gwelinn ent unit In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate W is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to the Department of Safety and Professional Services. Personal information you provide may be used for secondary Project Address (if different than mailing address) inses accordancewith the Privacy Law, s. 15.04(1)(m), Stats. 516 East Cove Road I. Application Information - Please Print All Information Property Owner's Name Parcel # David & Laura Franta 040-1294-30-000 Property Owner's Mailing Address Property Location 516 EAST Cove Road Govt. Lot SW 1/4, NW 1/4, Section 16 City, State Zip Code Phone Number Hudson, WI 54016 (circle one) T 28 N R 19 E or C1_1 If. Type of Building (check all that apply) **I Lot Subdivision Name I or 2 Family Dwelling - Number of Bedrooni,, 13 Piney Woods # ❑ Public/Commercial - Describe Use Block R City of El State Owned - Describe Use CSM C 0 n -e, E] Village of N Town of Troy Number 111. Type of Permit: (Check only one box on line A. Complete line B if applicable) El New System Z Replacement System El Freatment/HoldingTank Replacement Only El Other Modification to Existing System (explain) B. El Permit Renewal ❑ 11crmit Revision ❑ Change of Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Number Owner 463389, 4/12/2005 IV. Type of POWTS System/Component/Device: (Check all that apply) E Non -Pressurized In -Ground El Pressurized In -Ground EJAt-Grade El Mound > 24 in. of suitable soil El Mound < 24 in. of suitable soil El Holding Tank El Other Dispersal Component (explain) 0 Pretreatment Device (explain) V. Dispersal/Treatment Area Information: #J4',nA_ Z xti 9 )o') E2. Vzlow Tren," from g�%6kAAQN boat Design Flow (gpd) Design Soil Applicai.1011 Dispersal Area Required (st) Dispersal Area Proposed (st) System Elevation 450 Rate(gpdst) 643 700 97.8', 973 0.7 VI. Tank Info Capacity in IQ Zabel N\ZQ Gallons Total 4 of rot Manufacturer Ln Ne\A,, Tanks Existing Tanks Gallons Units Septic or Holding "Dank 1000 1000 1 Wieser Concrete H El 171 El 1:1 Dosing Chamber 650 650 1 Wieser Concrete Sai El D 0 El Vill. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) I'l U r s SiAlature "Im MP/MPRS Number Business Phone Number John Schmitt , I I I Z 223760 715-760-0486 Plumber's Address (Street. City, State, Zip Code) 586 Valley View Trail, Somerset. W1 54025 VIII. County/ epartment Use Only Approved 1&:lVisap �,)ved Permit Fee Date Issued Issuing Agent Signature )2/ ,3 caner Given - son for Denial 1 1 IX. Conditions of Approval/Reasons for Disapproval 3) Kno4lir-Sr i im [wAh CceViCccikion fam SYSTEM OWNER: 1. Septic tank, effluent filter and dispersal cell must be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code I ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 1/2 X I I inches in size SBD-6398 (R03/14) Project Name: Owners Name: Owner's Address Legal Description: Township County: Subdivision Name: Lot Number: Parcel iD.Number Plan Transaction No. CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Franta 3 Bedroom Replacement Soil Absorption Area David & Laura Fnanta 5l6East Cove Road Hudson VV|54Ol6 Troy St. Croix Piney Woods 13 Block 040'1294-30'000 Page I Index and title Page 2 Plot Plan Page 3 Septic Tank Specifications Page 4 Existing Tank Certification Page 5 Effluent Filter Information Page 6 Dose Tank Cross Section Page 7 Pump Curve & Specifications Page O System Sizing & Cross Section Page 9 EZFlow Information Page zO Management and contingency plan Page ll Sanitary System Qwnership/AddressForm Page lZ Warranty Deed Page 13 CSMorPlat Attachment Soil Evaluation Report Designer: John Schmitt LicneseNumber: yWPRS 223760 Date: Phone Number: 715'760'0486 Signature: /In -Ground Soil Absorption Component Manual Version 2.1 May 2022 SYSTEM PLOT PLAN Franta 3 Bedroom Replacement Drain field Flow: 450 GPD Attath design flow calculations for Attach Project Address: 516 East Cove Road227 E Lower Pine Lake Lant commercial plans: BM1 Symbol: A BM Elevation: 92.08 Pipe Materials / ASTM Standard BM Description: Septic Tank Manhole Cover Tables 384.30-3 & 384.30-5 BM2 Symbol: A BM Elevation: 83.88' 4" SCH 40 PVC pipe ASTM- D2665 BM Description: Dose Tank Bottom 4" SCH 3034 PVC pipe ASTM-D3034 Slope Gradient of Tested Area: (8%) Well Symbol (if applicable) Notes: See CSM for Complete Lot Property Line Existing 1000/650 Septic/Dose Tank w/Zabel A-100 Effluent fitter \ _BM2 m J Driveway a Garage Existing 3 Bedroom House 7 O Existing V*H R/W East Cove Road Cul De Sac Distribution Box B2 COPY N Scale: 1 " = W 0 60 90 120 152 r � ■ B3 T2 -`102= _ 85'2"SCH40 T3 PVC force main T4 B1 100'\ 1 J Property Line T1- Existing 3'x68' Infiltrator Quids 4 Trench El.= 99.90' T2- Existing 3'x68' Infiltrator Quids 4 Trench El.= 99.79' T3 Proposed Xx70' EZ Flow trench El.=97.80' T4 Proposed 3'x70' EZ Flow trench Ei.=97.30' Page 2 SYSTEM PLOT PLAN l" rants 3 Bedroom Replacement Drain field Design Flow: 450 GPD N Attach design flow calculations for Project Address: 516 East Cove Road227 E Lower Pine Lake Lanc commercial plans: BM1 Symbol: & BM Elevation: 92.08 Pipe Materials / ASTM Standard Scale: 1 " _- 60' BM Description: Septic Tank Manhole Cover Tables 384.30-3 & 384.30-5 0 60 90 120 BM2 Symbol: ,Q, BM Elevation: 83.88' 4" SCH 40 PVC pipe ASTM- D2665 BM Description: Dose Tank Bottom 4" SCH 3034 PVC p4m ASTM-D3034 2 Slope Gradient of Tested Area: (8%) 15 Well Symbol (if applicable) Notes: See CSM for Complete Lot r � Property Line Existing 1000/650 Septic/Dose Tank Distribution w/Zabel A-100 Effluent fitter Box B2 04, -1 M2 ■ B3 m Bm 1 t� Q ... ... ... . . . . . . T2 �10�-- ' . . . . . . . . . . 85'2"SCH 40 1 T3 ~' QDriveway PVC force main �T4 a B1 ~--� Garage 100'\ Existing 3 Bedroom House \ O J Existing WOell T1- Existing 3'x68' Infiltrator Quids 4 Trench El.= 99.90' T2- Existing 3'x68' Infiltrator Quids 4 Trench El.= 99.79' T3 Proposed 3`x70' EZ Flow trench EI.=97.80' .c T4 Proposed 3'x70' EZ Flow trench Ei.=97.30' --r R/W East Cove Road Cul De Sac a 0 a Property Line Pase 2 12'-2" 4" CAST--A-SEAL 4" CAST--A--SEAL ! I II II U I I II IL .• Ifll owl .01 ' 1 O� � L -� � � I I FALTER OR j I BAFFLE I II I 4" VE N T �- J.- OUTLET kA PUMP PAD WLP1 000 TANK SPECIFICATION S DIMENSIONS:an- a WALL: 3" BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER o HEIGHT: 54 1 /2" LENGTH: 12'-2" ul WIDTH: 7'-0" BELOW INLET: 43» E LIQUID LEVEL: 38 o WEIGHT: 14,940 LBS. a o QO INLET AND OUTLET: t a a 0 4" CAST -A -SEAL BOOT OR EQUAL GASKET m o INLET AND OUTLET BAFFLE AND FILTER: ; < WISCONSIN, SEE DETAIL #10 in o (OTHER STATES SEE CHART) W n LIQUID CAPACITY: 26.32 GAL/IN (SEPTIC) Ii„1 17.00 GAL/IN (PUMP) LOADING DESIGN: 8'--0" UNSATURATED SOIL _ Y tD ••� z °0 TANK CAN BE USED AS: o I SEPTIC/SEPTIC, SEPTIC/PUMP, OR SEPTIC/SIPHON� C I �1 0 COVER: MIX DESIGN #8 (NO FIBER) 0 TANK: MIX DESIGN #10 (STRUCTURAL FIBER) En am 0 CUSTOMIZED TANKS: immi FOR CUSTOM TANKS CONTACT WIESER CONCRETE 3 REVIEWED BY REVIEW DATE DRAWINGS SUBMITTED FOR APPROVAL APPROVED BY: APPROVAL DATE: PRODUCTS NEEDED BY: SHEET NO. OF 1 TANKS ARE MANUFACTURED. TO MEET OR EXCEED ASTM C-1227 REQUIREMENTS PAGE 2 of 2 The interval for servicing septic tanks is set by state and local code. Throughout the United States, there is a wide difference of opinion on what this interval should be, but most regulatory agencies suggest two to five years. The Zabel filter, which does not increase the frequency of servicing for the tank, should be cleaned when the septic tank is normally inspected and pumped. However, our filter is virtually self-cleaning. The continued action of the anaerobic organisms on the Zabel filter causes lodged particles to disintegrate and fall to the bottom of the tank. If your filter contains a SmartFiltere alarm, you will be notified by an alarm when the filter needs servicing. Step 1: Locate the outlet of the septic tank and remove the tank cover. Step 4: While holding the cartridge over the access opening, rinse off the cartridge with fresh water, being careful to rinse all septage material back into the tank. AVW Step 2: Remove the tank cover and pump the tank if necessary to prevent any solids from escaping to the the drain field when the filter is removed. 4 Step 5: Insert the filter cartridge back in the case, making sure the filter cartridge is properly aligned and completely inserted in the case. Replace the septic tank cover. e Step 2: Firmly pull the filter handle and slide the cartridge out of the case. lryou have a filtered" vuisa- Case model filter, be sure and spray clean the outlet opening before replacing the filter. Residential Applications Certified to ASV SINSF Standard 46 Copyright 20 14, /tic, Ali iiql,: 0�681'vvd Prndj,jct(1;) covarerl by one or more IJ S. and/or Internafionsil piotontq Other r 'I and 1nh%rnqf1nn4f patoontc rMx. y ho Pioneflng 1-877-765-9565 / wwwpolylok-com Page 5 PAGE 5 OF 6 SEPTIC r PUMP TANK SPECIFICATIONS (No Scale) 4"0 Vent Pipe >10 ft from Building 12" Min. or 2.0 ft above Established Flood Elevation (typical) Appruv,��d Cap I R A rw% /� r-3 -r A K I T.Vent I Anchor tank(s) as necessary pursuant to SPS 383.43(8)(g) Finished Grade CAPACITIES @ 16.25 gal/in Depth (in) Volume (gal) A 19 308.75 B 2.0 32.5 [C1 7 113.75 D 12 195-00 4 A Eiectricai must conipiy witn SPS 316 and NEC 300 Extend manhole riser as necessary. —T...— Weatherproof ,unc tion Box.Approved Locking Manhole _j with Waming Label Attached (typical) 4" Min. or 2.0 ft above Established Flood Elevation T (typical) Y? Ny -7, Quick Disconnect 7� 181, Min. . 4 (typical) A i rl Wpen Hole' A 1 Alarm B On [C] *Pump Tank Liquid Level 40 in S> -Off D 2 Concrete Force Main Diameter Block 30 7 Force Main Length = 85 ft Force Main Void Volume = 13.85 gal A 3" Approved Bedding Material Beneath Tank [ ] Total Dose Volume (TDV) 1113.75 gal/dose L(5X total lateral void volume < TDV S 0.2X design flow) + (force main drainback volume) MIN. PUMP DISCHARGE RATE = 20 gpm MI IRAD '7ANIV- Volume = 650 gal Wieser Concrete Manufacturer: Pump Manufacturer: Zoeiler Pump Model: 98 �See attached pump curve.) Controls/Alarm Manufacturer: Level Alarm Controls/Alarm Model: DVLM-- Float switches containincl mercu[y are prohibited. - Annrovpd .1nints with Approved Pipe 3 ft onto Soild Ground (typical) PUMP -OFF 84.33 ft ELEVATION INSIDE BOTTOM 83-33 ft ELEVATION = z. Vertical Head = 16.50 ft + Min. Supply Head = ft + FM Friction Loss = 1.18 ft + Fitting Loss* = ft (min. supply head x 0.3) TOTAL DYNAMIC HEAD = 17.68 ft SEPTIC TANK(S'. Total Volume = 1000 gal Manufacturer(s): Wieser Concrete Install approved effluent filter at the septic tank outlet i , p�Mp-J&rk ImMe W %I _tately 11pstremm of thp Filter Manufacturer: Zabel Filter Model: A-1 00 U) X ULJ 6 z 4 0 2 0 10 20 30 40 50 60 70 80 GALLONS F LITERS 80 160 240 FLOW PER MINUTE TOTAL DYNAMIC HEAD/FLOW PER MINUTE EFFLUENT AND DEWATERING MODEL 98 Feet Meters Gal. Liters 5 1,5 72 273 10 3.0 61 231 15 4.6 45 170 20 7.1 25 95 Shut-off Head- 23 009971 6 1 r4 4 F'l 3718 4 I-L2 X'11-1a NPI 12 V16 F-T 1 f �J�p, 4 2152 j. L' SK1102 • Electrical alternators, for duplex systems, are available and Variable level float switches are available for controlling single supplied with an alarm and three phase systems • Mechanical alternators, for duplex systems, are available Double piggyback variable level float switches are available for with or without alarm switches variable level long cycle controls Refer to FM 1922 and FM0806 for temperatures above 130'F 98 Series Control Selection Simplex Duplex Model Volts -Ph Mode j Amps M98 115 1 Auto 9.4 1 4 N98 115 1 Non 94 2 or 3 4 D98 230 1 Auto 4.7 1 4 E9E 230 1 Non 4.7 E 2 or 3 4 SELECTION GUIDE 1. Integral float operated mechanical switch, no external control required. 2. For automatic u-,p single piggyback variable level float switch or double piggyback variable level float switch. Refer to FIV10477, 3. See FM 1228 for correct model of simplex control panel. 4. See FM0712 for correct model of duplex control panel or FM1663 for a residential alternator system. For information on additional Zoeller products refer to catalog on Piggyback Variable Level Switches, FM0477: Electrical Alternator, FM04K Mechanical Alternator, FM0495: Sump/ Sewage Basins, FM0487: Single Phase Simplex Pump Control, FM1596: Alarm Systems. FM0732. J A CAUTIO=N All installation of controls, protection devices and wiring should be done by a qualified licensed electrician. All electrical and safety codes should be followed including the most recent National Electrical Code (NEC) and the Occupational Safety and Health Act (OSHA). 7 17�lhv V _-OWN" OPTIONAL PUMP STAND PIN 10-2421 2 Reduces potential clogging by debris. - Replaces rocks or bricks under the pump. - Made of durable, noncorrosive ABS. - Raises pump 214 off bottom of basin. - Provides the ability to raise intake by adding sections of 11/2" or 2" PVC piping, - Attaches securely to pump. - Accommodates sump, dewatering and effluent applications. NOTE: Make sure float is free from obstruction. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL Tv: PO 90,Y16347 Louisville KY 01,56-047 L. Manufacturers of 7 Z�A�\ SHIP TO: 3649 ( Ane Run Road AV Lua,',Vfile, KY 40211-1961 �7mv�ffg F1*4T 19YAF rg A. UMP wwwlzoelfer,com FMA'j'502) 774.36d4 C; u p y i i tits reserved. pht 2012 Zui,-i4ji Co. All riy Page 7 IN -GROUND DOSED -GRAVITY DISPERSAL AREA Stepped Elevation Trenches with EZ1203HP Bundles 3-ft Trench (down -sizing credit) Geolextile Cover SOIL COVER 7 12" min. 12" 7YPICAL TRENCH (typical'i CROSS SECTION VIEW (No Scale) Provide minimum aft separation between trenches. min. trench depth . 16 (typk;al) Lowest Trench (as applicable) OBSERVATION PIPE DETAIL Highest Trench (No Scale) Screw -Type or System Elevationr> = 97.80 ft97.50 ft; ft; ft Slip Cap (loose) 4"0 PVC Pipe Top of t�, to rriiinate at or abMelinf=',AN grade WPICAL TRENCH (Show location of inlet / outlet pipe connection on plan view."" (4) 1 A"- 1 /2" X 6 " Slots I -<- PLAN VIEW (No Scale) 4110 Observation pipe shall be installed at junction between two u n ts. Perforated Lateral Observation Pipe (typical) (typical) -7/— B= 70 ft 'typical) INSTALL PER TRENCH: 7 1 0-ft bundles @ 50 ff EISA/unit = 3!50-- ft2 + 0 5-ft bundles @ 25 ff EISA/unit = 0 0 111 Anchoring Device 10 ft (typical) A= 3.0 ft =_j (,ypical) EZ1203H Bundle (typical) (mfd by infiltrator Systems, Inc.', I Install pursuant to manufacturer's instructions. Proposed EISA �)er trench —350 ft2 Required Infiltration Area = 643 ft2 x 2 trenches = Proposed Total EISA = 799 ft — Finished Grade (mulched seeded) Topsoi' ' Cover (min. 1 foot) Infiltration Surface Distribution Method: distribution box LI Installation Instructions for E OWTU Z I EZ, Owstems inisconsin flbvy INFILTRATOR Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area (SF) necessary for a given site shall Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow (GPD) and product and determined it to be in compliance with chapters the Permeability for the site. If certain criteria is met, the Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40% 145 and 160, Wisconsin Statutes. All sites must meet the Site smaller drainfield. & Soil Conditions & Locations & Isolation distances as noted in local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap- • proved by system design permit specified for the particu- The approved products are 1203H (3-12" bundles with pipe in lar site. The top or center -most bundles containing pipe center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles are joined end to end with an internal pipe coupler. Any with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required, • should be butted against the other aggregate -only bun - A single pipe bundle contains a four inch perforated pipe sur- dles and do not require any type of connection. rounded by EPS aggregate and is held together with poly- chtylene netting. A single aggregate bundle contains aggregate 7. The top of each GEO cylinder contains a filter fabric pre - only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The • fabric is inserted to prevent soil intrusion. The installer Materials and Equipment Needed shall make sure the the CEO is positJoned upward and is • EZflow Bundles in contact with the fabric contained in the adjacent cylin- • EZflow Geotextile Fabric der before backfilling. • EZflow Internal Pipe Couplers • • Pipe for Header and Inlet 8, The EZflow Drainfield Systems should be installed in a • Backhoe,'Excavator, level trench in all directions (both across and along the • trench bottorn) and should follow the contour- of the ground Installation Instructions surface elevation (uniform depth), with all continuous The instructions for installation of EZflow products are given adjoining 10-foot cylindrical bundles placed end to end, below. This product must be installed in accordance with state with central bundle distribution pipe interconnected, rules defined in chapters COMM 82 through 84, Wisconsin Ad- without any dams, stepdowns or other water stops. r-ninistrative Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design 9. The trench top shall be graded such that water will not manual. pond. Backfill should be seeded or sodded immediately after completion to reduce erosion. 1. After the local health department has determined sizing, curved configuration, and layout for the EZflow systems, stake 10. EZfiow EPS bundles are flexible and can fit in or mark with paint the location of trenches' and lines. Be trenches as may be necessary to avoid trees, boulders, or careful to set correct tank, invert pipe, header line of dis- other obstacles. tribution box and trench bottom elevations before instal- lation of pipe bundles. 1 1.EPS aggregate is lighter than water, therefore, it might • be expected that natural buoyancy forces would tend to 2. Remove plastic EZflow shipping bags prior to placing cause EZflow assemblies to float out of ground when bundles in the trench(es). Remove any plastic bags in the pondinq occurs. Field experience has shown, however, trench before system is covered. that this is not a problem when systems have a minimum • of 6" of soil cover as recommended by manufacturer. 3. This product must have geotextile fabric that meets re- quircments of s. Comm 84.30 (6) (9), Wis. Adm. Code, installed directly on top of the product and extending • 1203H-GEO down along the sides of the product to 3 point at least sly • inches from the bottom of product. Gco t cxt i I c Bar-,u Material v , lqw 4. When installed in a trench, the trench should be dug to V V V��_ a width of 36 inches. This not only saves labor in excava- • tion, but also provides better load --bearing capacity after • V� VV V V%1VVk1VV%,VvVVVVV� V V 4v 4 backfilling is complete. • 9 * 0 0 * 0 0 9 0 * 0 0 9 # 0 Page 9 PAGE 4 OF 4 In -ground Dosed -Gravity Management Plan lWaT.0-A-Cl 1, 11111 a The owner of this in -ground dosed -gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SIPS 383.52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area Operating Limits: Design Flow = gpd; BOD5 :5 220 mgL-'; TSS:5 150 mgL"; FOG:5 30 rngUl Inspection Checklist INSPECT EVERY 3 YEARS • type of use • age of system • nuisance factors (i.e. odors, user complaints, etc.) • mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) • material fatigue (i.e., leaks, breaks, corrosion, etc.) • solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution J drop boxes) • neglect or improper use /.e., exceeding design capacities, prohibited activities, etc.) • extent of ponding in distribution cell prior to dosing • dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) • electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) • distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification) • surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) Septic and dose tanks) shall be pumped by a certified septage servicing operator licensed under s. 281-48 Wis. Stats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filter(s) shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit in accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: Local government unit: John Schmitt Phone: 715-760-0486 St. Croix County Community Development Phone. 715-386-4680 Local government unit address: 1101 Carmichael Road, Hudson, WI ZIP: 54025 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submitted to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre -determined area of suitable soils. System Abandonment If use of this POWTS is discontinued, it shall be abandoned in accordance with SPS 383.33, Wisc. Admin. Code. page 10 ST. CRO lU N T Y SANITARY SYSTEM File #: Office Use Only wwww- OWNERSHIP/ADDRESS FORM Created 212021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer David &Laura Franta Mailing Address 516 East Cove Road City/State/Zip Hudson, WI %4016 Phone Number (required) 612-221-1773 Email Address (required) davefranta@gmail.com Parcel Identification Number 04©-1294-30-goo (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location SW 1/4 1 NW /4 Sec. 16 IT28 N R 1 9 W,Town of . Troy Subdivision Plat: Piney Woods Certified Survey Map# Plat Warranty Deed # 784517 Number of bedrooms 3 New Property Address (Staff Initials) Volume , Page # Jot # (before 2006)Volume 2728 ,Page # 275 Spec house [3 yes N no Lot lines identifiable N yes [3 no OFFICE USE ONLY (Verification of new address required from Community Development Department for new construction.) 1 2Z ) I I Z.... 3- (Date) This form must be submitted with all Private Onsite Water Treatment System (POWTS) applications. New System: Include with this form 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. Community Development Department - Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd@sccwl.gov 1101 Carmichael Road, Hudson, W1 54016 www.sccwi.gov Page 11 U. 2728E 27 STATE BAR OF WISCONSIN FORM 1) - 1982 LAND CONTRACT Individual and Corporate (To BE USbD FOR ALL TKANSAC�FIONS WHERE OVER Document Number $25,000 IS FINANCED AND IN OTHER NON -CONSUMER ACT TRANSAC7171ONS) CONTRACT, by and between Donald 0. Rodahl and Joyce .. Rodahl, us and 110d wifea_ v. or hi marital property, ("Vendor", whether one or more) and David G. Franta and -aura A. ]Frantz, husband and wife as survivorshi marit 19m;MM-_ al laroverty ("Purchaser"', whether one or p more)- Vendor sells and agrees to convey to Purchaser, upon the prompt and full performance of this contract by Purchaser, the following property, together with the rents, profits, fixtures and other appurtenant interest (all called the ",Property"), in h9lbMIRS1 and_Uife al vivo hi marital 1prouIrlyu County, State of Wisconsin: Piney Woods.Subdivision . Town of Troy Croix Countyr WI Recording Area -7 tta Z#- n5 IL -7 KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX CO. r V1 RECEIVED FOR RECORD 01/10/2"5 LAND CONTRACT EXERT # REC FEE: 13. TRANS FEE: 420-90 COPY FEE9 CC FEE: PAGES-0 2 Name and Rcturn Address Lea A. Deskar, Attorney RODLI, BESKAR, BOLES & KRUEGER, S.C. 219 North Main Street, PO Box 138 River Falls, W1 54022 040-1294-30-000 Parcel Identification Number (PIN) This is not homestead property. (is) (is not) Purchaser agrees to purchase Iffic PTOPC'rtY and to pay to Vendor at such 21all m rjasonably diritcjLd_, the sum of S1,42.0%L_00 in thefollowing manner: (a) Sa�,00 at the execution of this Contract; and (b) the balance of $1 OE.00-00, together with Interest from date hereof on the balance outstanding from time to time at the rate of 64/6 ... percent per annurn until paid in full, as follows Monthly payments of principal and interest of $886.05, commencing February S, 2005 and monthly there -after provided the balance Is paid In full on, or before January 5, 2020. Fuj"tuwIng any default in payment, Interest shall accrue at the rate of 1Z°io per arinurl, on the el-11ire alnuunt la default (which shall include, without limitation, delinquent interest and, upon acceleration or maturity, the entire principal balance). Payments shall be applied first to interest on the unpaid balance at the rate specified and then to principal. Any amount may be prepaid without premium or fee upon principal at any finne after date of 09sing. \*YjblEx In the event of any prepayment, this contract shall not be treated as in default with respect to payment so long as the unpaid balance of principal, and interest (and in such case accruing interest from month to month shall be treated as unpaid principal) is less than the amount that said indebtedness would have been had the monthly payments been made as first specified above; provided that monthly payments shall be continued in the event of credit of any proceeds of insurance or condemnation, the condemned premises being thereafter excluded herefrorn. Purchaser states that Purchaser is satisfied with the title as shown by the title evidence submitted to Purchaser for examination except: Easements, covenants and restrictions of record. Purchaser agrees to pay the cost Gffuture title evidence. If title evidence is in the form of an abstract, it shall be retained by Vendor until the full purchase price is paid. Purchaser shall be entitled to take possession of the Property on date of.020139- Cross out one. s,rATF, BAR OF WISCOMSIN LAND CONTRACT - Individual and Corporate FUR." No. 11 - 1982 Page. 12 07 V? #7 8 P 2 6 L L Purchaser promises to pay when due all taxes and assessments levied On the Property or upon Vendoi's -interest in it and tD deliver to Vendor U a P_ n t n demand receipts showing SUC p J_ loss car dan-jage, o�;casioncd by fire, extended coverage perils and such Purchaser shall keep the improvements on the Property insured against R it aluo through insurers approved by Vendor, in the sum of Mull and ins rub V ther hazards as Vendor may require, without co-insurance, than the balance owed under this Contract. Purchaser shall pay the but Vendor shall not require coverage in an amount more in the standard clause in favor of the Vcndoes interest and, unless noddoftherwisyns�uT�nce risurance premiums when due.The policies shall conta romtivece loss to epo�jted with he Prop vr,ting, the original of all policies covering t , erty shall be I c applied to restoration or repair of the L dor otherwise $pairwritininsurance proceeds shall b:ornpanics and Vendor. Unless Purchaserand VenIToperty damaged, provided the Vendms restoration oo be economically feasible. waste to be conu-nitted on the Property, to keep the Property in good tenantable condition Purchases covenants not to commit waste not allow was act, and to cornpiy wlih ail laws, ordinam;cs arid regalations affec-ting ind repair, to keep the Property free fromliens superior to the lien of this Contr he Property. e fully paid and all conditions shall bnff llyperfedVendor agrees that in case the purchase price with interest and other moneys shall b'It on denriand, execute and deliver to thDede simple, of the ,he times and ill the ;vtoLarker above lipai;irwd' vend'of w, e 0 any liens or encumbrances created by the act or default of Purchaser, and except. n Property, free and clear of all liens and encumbrances, except exceptions. agrees that time is of the essence and (a) in the event of a default in the payment of any principal or interest which continues i for a purchaser event of a default in performance of any other obilgation ot'Purchaser which continues period of 20 days following the specified due date or (b) in the personally or mailed by certified mail), thPurchaserthc the sdfor a period of 2Q days following written notice thcreof by Vendor (delivered perso which ebywaives), balance under this contract shall become immediately due and payable in full, atVptidwaw)unprovided by law or in wing rights and remedies (subject to any limitations provided by addition to those and Vendor shall also have the following title and interest jr, the Property and recover the PrOPCrIY back ton, tCrMLn&te this contract and Purchaser rights, with equity-. (i) Vendor may, at his opt Purchasers full payment or the entire outstanding balance, through strict foreclosure with any equity of redemption to be conditioned upon hereunder (in which event all amounts previously paid interest thereon from the date of default ®t the rate in effect on such date and other amounts duc - or fulfill this Contract afurlaententrouchastr Wis to redeem)byPurchaser shall be forfeited as liquidated damages for failure to fU ding balance, with interest (ij) Vendor may sue fDT Sr. pttanpymof the entire outstan i e and sr perfotmance of this Contract cOm creunder, in which event the Property shall be auctioned at judicial sal thereon at the rate in effect on the date of default and other amounts due h rc�hase price or any portion thereof, or (iv) Vendor Purchaser shall be liable for any deficiency; or (iii) Vendor may sue at law foot entirquietpquitable interest of Purchaser is d and remove this Contract as a cloutitle in a -title action if the c n may declare this Contract at an en possession of the Property and have a re�Gseappoly riinsignificant; and (v) Vendor may havePurchaser ejected from posse 6011suf Vendor, anelectioll (i), (ii) oriv) anusulatements or Ac profits during the pendency of any action underY Upon Vendor if and when ped in litigation and all costs and expenses including reasonable of any of the foregoing remedies shall only be binding under (whether abated or not) to the extent not prohibited by law and expenses of title attorneys fees of Vendor incurred to enforcc any remedy here and shall be included in any judgment incurred, . evidence shall be added to principal and paid by Purchaser, as of foreclosure of this Contract, Purchaser consents to the appointent of a Upon the commencement or during the pendency of any action . s es, and receiver of the property, including homestead interest, to collect the rents, is u . and pofitproperty during the pendencyof such action,such rents, issues and profits when so collected shall be held and applied as thecourshall direct, Purchaser shall not transfero sell or convey any 1C%S1 or equitable interest in �consenp(yassument oi any of purcilaser's rights undel' this Contract or by optiop, long-term lease or in any other way) without the priorwritten of Vendor less tither the outstanding balance payable under this Contract is first paid in full or the interest conveyed is a pledge or assignment of Purchaser's interest under this Contract solely as securitY for an -indebtedness of Purchaser. In the event of any such transfer, sale or co�uj�yance without Vendor's written consent, the entire outstanding balance p;AyaLj>je uIlder this Cunt-ract shall become irra-LicdIatcly due and payable in , at Vendor's option withOut n"Ce Vendor shall make all payments when due under any mortgage outstanding against the Property on the date of this Contract (except for any mortgage granted by Purchaser) or under any note secured thereby, provided Purchaser makes timely RlYmavmentsamounts tn under this jiso made by PUTchaser shall be Cor.tract. PurchascrrMY make any such pa)-muents directly to theMortgagee if Vendor fa ; to do -;o and 6 considered payments made on this Contract. Vendor may waive any default without waiving any other subsequent or prior default of Purchaser. Ali tcrnls of this Contract shall be binding upon and inure to the benefits of the heirs, legal representatives, successors and assigns of Vendor and Purchaser. (If not an owner of the Property the spouse of Vendor for a valuable consideration joins herein to release homestead rights in the subject Property and agrees to join in the execution of the deed to be made in fulfillment hereof ) Dated this .5th day of January. 2005. (SEAL) -Donald O. Rodahl (SEAL) f4ce PRodsC' AUTHENTICATION Signature(s) authenticated this day of VVW('TrY P, & f, Of % TITLE- MEMBER STATE BAR OF WISCONSIN (If not. authorized by 6706.06. Wis. Stats.) THIS INSTRUMENT WAS DRAFTED BY Attorney Leo A. Beskar A- RUDLi2 8ESK.A_Rb0LES & KRUEGERs-S.C. (Signatures may be authenticated or acknowWpd, Both are not necessary.) (SEAL) �w Z David G. Franta__ LN (SEAL) Laura A. Franta ACKNOWLEDGMENT STATE OF WISCONSIN_.) ) Ss. PIERCE Countv Personally came before me this 5th day o - f January 2005 the above'jjamed Donald O. -Ro hahL.--lovee I 90441"l-Da"As vl C. V er Laura A. Franta 41 to me known to be the verson(s) who'ethc q instrument and acknowledged the saMtju CJ _4S aft V —11777AI s-L-� 'ta Iota Public. �state 0 kthconsoll &Xlf not, state expiratjj4 P, 1P Nsme6 of porsons signing in any capacity should bs IYP@d or prin LAND CONTRACT - Individuel and COMOf AW below their signature, S-rATM BAR OF WISCO14SIN FORM No. it - 1913 ftqmvp Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Dffision of Safety and Buildings 1p In accordance with Comm 85, 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 not limited to: verfical and horizontal reference point (W), direction and Parcel I.D. \�er--Jz] I � cc percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all infonnation. eV' wed, by Date Personal informabon you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property CKYner Property Location 1 CAUL I A! CE R. 0 t�� f If 14 L � k) 114 1/4 S T � N R 19 E Property Owner's Mailing Address Lot # Block# Subd.NameorCSM# r7 city State Zip Code Phone Number city Village Town �rje o R 65- F� j kj�- S14 o 1"L 14 IS- 'u-N Z New Construction Use: 9 Residential / Number of bedrooms Code derived design flow rate t-"%-ib 0 Q GPO Replacement ED Public or commercial - Describe: I % 1 JAM a L 2�,Pl- - Parent material 0 UMAJ F� SSA Flood Plain elevation if applicable ST CPOx General comments CXXNTY I and recommendations: I 1Y, 6 Z 3L u �j Q W 0 �,,W LM 0F= TY 10. ZA Boring # Boring I )] 'pit Ground surface elev. ft. Depth to limiting facto � in Soil Application Rate Horizon Horizon Depth In Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Tosexture Structure 1, Gr. Sz. Sh. Consistence Boundary Roots *Effr"rl *Eff#2 Ll L q 0 C)'j � V11 '"W) • Z Boring # Boring . *7 in pit Ground surface elev. ft. Depth to limiting factor Soil Application R ate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence SoundQary, Roots ..—GPD/fIL2 *Eff#1 *Eff#2 Z 31 L-- s Z ` �O - �` s - I L) S4-1 f47--- 1 rs 30 -018 10 Lf Q--Y1 C) -- .-�, 1. ==Mai Effluent #1 x BODE > 30 < 220 mg/L dnd TSS >30 < 150 mg/L Effluent #2 = SOD < 30 ma and TSS < 30 mom. CST Name (Please Print) Ig WM Numbe r ;L '& *a= AAm&- Arthur L. Wegere - r NMI" 220254 T�elephme Number Address Weg" erer Soil Testing & Design S7ervice""Ol"-uonc'or'du(;&ted 421 ii. Nain 5t,. River Fall-s, WI 54022 7 15,w425-w0165 lk Property Owner - - Parcel ID Boring # ❑ Boring pit Ground surface elev. ft. L)epu i to limiting factor `7 In. Page of I Soll Annllmfion Rate I Horizon Depth In. Dominant Color Munsell Redox Description Qu. -Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff42 t-Vl Z Pnd Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth In. Dominant Color MunseU Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/112 *Ef1#1 *Eff#2 Boring # ❑ Boring D pit Ground surface elev. ft. Depth to lirrdUng factor In. �kp Rate I Soil 0' plication Horizon] Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Stiucture Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 • Effluent #1 = BOD > 30 < 220 rng1L and TSS >30 < 150 mg/L Effluent #2 r BODE < 30 rng/L and TSS < 30 mgtL The Department of Commerce is an equal opportunity service provider and employer. if you need -assistance to access services or need material in an alternate format, please contact the departinent at 608-266-3151 or M 608-264-8777. i SOD-8330 (R.6/00) PLOT PLAN Scale 1'=S�' Page 3 of 3 j . z lie 13.4 /3�� 6 qlll� so t fu l'n Arc.. s�2 �'0040 lz�_r doue molt ill 0 t 0 ' 1,.t� -r t3 Mugu,0 _ _ L Q 'NY- 1 � �L� 3 tc�" �'VC_ 1?t� VV l LV� •• _ .._�_� 715-425-0165 220254 �o 0 CST Signature Date Telephone No. CST No. Job NO Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for ,;w.rnia ry purposes [Privacy Law, Is 15.04 (1 V, I Vrn)l Permit Holder's Name- City Village X Township Franta, Dave & Laura Troy,_ Town of CST BM Elew 41 insp. BM Eiev: BM Description, )0 .,e-- TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY se�fic Dosing bpet Aeration Holding TANK SETBACK INFORMATION TA . NK TO F/L WELL BLDG. Vent to Air Intake ROAD Septic Dosing Aeration Holding PUMPISIPHON INFORMATION Manufacturer Demand GPM C > fqodel Number 10 P. le H LiJ6 Friction Loss System Head TD Ft IV Forcemain Length I Dia. if Dist. to Well SOIL ABSORPTION SYSTEM L A"LotAr L ENCH Width j Length Ne# Trendhes DIME 5 3 SETBACK SYSTEM TO BLDG WELL INFORMATION ITFr Of System: + DISTRIBUT STEM "Pig lu Distribution 0 VD P1r�4E� r County- St. Croix Sanitary Permit No- 463389 0 State Plan ID No: Parcel Tax No- 040-1294-30-000 Sectioni'l owWRanyei'MaP 1 .28-19.1688 _ L STATION BS H! FS ELEV. Benchmark I soll-, I Alt. BM E31dg. Sewer (A) 1 — St/Ht!nlet - And St/Ht Outlet Dt Inlet Dt Bottom Header/Man. Dist. Pipe (At lot. ► BOT Svstem •(OF ,Final Grade N St Cover 4L �Q see X 42 FPIT DIMENSIONS No. Of Pits --linside Dia. _--liquid Depth LAKE/61'REAM LEACHiNG Mare ldf)W CHAMBER OR WN—I'llo-I 1 UNIT IModel x Hole Size Ix Hole Spacing er be r Vent to Air Intake r� IIIIIIIIIIIIIIIWO Length Dia Length C Spacing SOIL COVER X Pressure Systems Only xx Mound Or At -Grade Systems Only ! rl% "f � xy Sceded/Sodded XX mujchj�(! Depth ovef Over XX Dc�h-.,o Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No co N - I lud c e discrepencies, persons present, etc.) inspection ?AIDSpo' Inspection #2-.— 1 5 ft Parcgl.No: 28.19.16 8 LoZoftion: 516 ast Cove Road Hudson, WI 54016 (SW 1/4 NW 1/4 17 T28N FiVN Piney Woods I % &"AL. 1.) Alt BM Description A5 To vvowv� tb�, INV t Lj_ 2.) Bldg sewer length -%o amount Of cover (0,. V j I# j 0 �. f �r *4 Plan revision Required? YOC %0e Nin tom-- .� � . Use other side for additional inform on. insepIctor's Signature Cert. No Date SBD-6710 (R,3/97) i Nvisconsin Safety and Buildings - gs Divis- Madison, W1 201 W. Washington Ave:. P 162 So County 57.7 6/?0 / X. Sanitary Permit Number (to be filled in by Co.) ( Pepartment of Commerce X"111- - __V Sanitary Permit tan li� It �0 � 011 SP" I.D. Number A.,iZ In W=d with Comm 83.21. Wis. A X��4 may be used for smorKiary 1 IX 0 0;0000 PrqjW Addrew (if different dm RUAM2 SkIress) I. Appilution. Infornutim - Please Print All Information o YO fl/ PivVeM Owner's iris me rxlu jP,4VE- parcel Lot I Block I 13) property owner's M ailkS Addren .5 r Property L OCatIOA 1-7 City, state /104V yo 4 OA f //; Vi Zip Code ptione Number 17-7 5. 200 R E 1 11. Type of BulldWg (che& all CW apply) T N; Subdivision Name CSM or 2 Family Dwelling - Number of Bedrooms �, _ ,� ❑public/Commercial - Describe Use .. vti Ocity avilL-W EfTowmhip of 7*)e SmW Owned - Describe Use A: L) In. Type of Permit: (Check only one box on line A. Complete tine B If applicable) J A. New System 0 RcpLwxiwa( Systen-I El Traawww1lolding Tank Replacement Only ❑ Oftr Modification to ExisftSylimm C1 Permit Renewal D Permit Revision El Change of El permit Tramfer to New List Pfevkms Permit Number and Dow issued Before Expiration Plumber Owner IV. f Powrs §YACM.. (Check all that apply) L 3 tAv�drL� &UA -%r-f Non 4kessurized In -Ground El Mound > 24 in. of suitabic soil 0 motim < 24 'rL Of saleable sod At-Gnde Sit It Pis SaM MW C Wrumd Wcd&W [I pnmwued In -Ground U Holdmg Tanis U Pea Filter U Aerobic Treatrixllt Unit E 1 R=ffQAaWV Sand Filter 0 Recirculating Synthetic Media Filter ❑ LeadWn Chamber 0 Drip Lim ❑ Gravei-less Pipe EEI (eXplain) A A 3 d& 2. - 6,4W)S _V. ]!Nq!eng,aVTreabnent Am Information: L)aign Flow (Vd) Ocsign Soli APIAWAtion Rato(A)da) Diispemal Area RequirLd (sr) Dis,r�.Z Area'?rLposed (sAIJ Stem Elty tin . G/ LIC 0 6P L VI. Tank Info Capacity in Gaftris Total. G1110M Number Of UTIM el- MRM44&turj� 0-VEAK0 6*OT Prefab Concrete Site Constmewd SW -Fiber Ghm Plastic New I / _ .}�� L`.T �`-yf � Septic or Holding Tank Tanks Tanks Aerobic Treamient Unit Dosing Chamber VII. Responsibility Statement- 1, undersigned, &Ssum responsibility r" hatanation of ffie POWTS shown on the allwbed pbm. Plumber's Na me (Print) If e, Si F!!"-t MP/MPRS Number 2,!, :�p I- Business Phone Numba 71S 73Li4 I Phwiber's AAft 83 (Street, City, State. Zip Code) /2, / 0 -?� /I- ZIV VIU. CARMtymepartment Use Only Sanitary Permit Fee (k%I'K"e3 Groundwater AMrowo n r)i.,, Date issued sued ^rnt Sjpatt"(No Starnes) ❑ Owner Given Reason far Denial Surdwgc Fee) I -- I I z IX. ConMons of ApprovaVReasons for Disapproval SYSTEM DiVNER. I Septic tank, qffjUent filter and dispersal CGII MUSI all rV aintahO plan provided by plUnlber as per management 2. Ali setback reqUirernents r"Ust he maintained as per appliCaW c0delOdn;anc" Anach aormoeoe pims (to the County only) r4w the "sim an paper not less don $112 x 11 inches in size SBD-6398 (R. 01/03) 0) W ,EAGLE. • .8.F ... 7 0U. T.L D 4 N0p TN 1 r ME OF THE SW 1 /4 OF THE NW 1.041 SE C T I ON 16 4, 4 c Nos* 3r+ be" E N�/ CQR. LOT l D l 880 5 7' 4 3" E 1 3 02. 440 TO7 .9 E o! 04..... .... ... .... ....,,, 3BB 22i/LL/JJ6. ..... �t ... • .. , • �� ....... .... . 81926' VALE EASEAENT :�� r�*.av ,� Hy 9 r r• oo 917.00 30' CQA I NAGE j. �T I J � ..• LFE919. '919.00 ` S 14038PP•W o ' � '�. ^' ' � �-• � • 14 38 E io , f :' r; 2 32 ACRES � 2s• E-: . ?^.,, - 4 - -. , ; -�,� r 00, 8 76 SO. F T. 4 fit .0r. 62'i ... �• 3T S39' S6' 32' 56.730 . .0 ' 335' S6' 32" E 46. 34' 1 :....................... ....... •..................... .: i S89' 36' 160E, 3 70. ! 7' G) ' i • r4 ................r......•...................... L OT 14 �a Vt............ ; � *0 L OT 14 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) 516 East cove Road located at: SW 1/4, NW 1/4, Section 16 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 Did flow back occur from absorption system? Yes No (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: 1000/650 Construction: Prefab Concrete --' X Steel Other Manufacturer (if known): Wieser Concrete Age of Tank (if known): 6/20/2005 Permit number (if known) 463389 (Licensed Plumber Signature) MPRS (Title) (Date) John Schmitt (Print Name) 223760 (License Number) MP/MPRS 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 Page 4 .5 ..... ... . �::.- ...... ... .... ........ :;.,... -..::: .::�!��-..!.: ..... . . . .. . . . . .. . ..... . ..... ... ............ ... . ...... .. ..... .. . .. ....... vnk- . ... ... . . . . . . . . . . . . . . . . . . . . . . . . . . . . ........... . . .................. . . . . ... . . . ErVIr-% A XTC1-3-1-5-j1jF1h 1"Y71kTIFAI-XILLA I..... ------------- 11 X1 1�.1 1 ][, CP 0 PLUMBER T C (J SLiMV� .... .... . ..... MAI NOo r `V" I q0 J` U , k1q) ` R mr- d to M 1 -7 # ? ?t , 3 0 C7 sr-ju KN9 IL I I& AND/ AM . .. . ... IOU a'"," I W- .......... ... .5m . .. ... SBD-06499 (RI 1/20) CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Nnta• Hvnit vv!Qh to rane,w the, ne,rmit nr trnnefe,r nwnprchin of