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HomeMy WebLinkAbout430557 040-1282-00-000Wisconsin 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 (Pr'vacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Derrick Construction Inc. I Troy Township CST BM Elev: Insp. BM Elev: j BM Description: I ANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Dosing Aeration Holding TANK SETBACK INFORMATION =�=MWAIWK-w mmm MnIA PUMP/SIPHON INFORMATION Manufacturer , Demo PM Model Number TDH Lift Frictio L s System Hea TDH Forcemain Length Di Di o Well SOIL ABSORPTION S ELEVATION DATA County: St. Croix Sanitary Permit No: 430557 0 State Plan ID No: Parcel Tax No: 040-1282-00-000 Section/Town/Range/Map No 19.28.19.1591 ftmkwh-lk� Benchmar k 'AIMLWWJ� MWVFAI� IWAV4,WW'=� E0 IN P. APF r � INA BED/TRENCH DIMENSIONS Width Length No. Of;;W015S PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L XBLDG IWELL I LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer Type Of System: Model Number. UIS I KIt31U I ION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SUIL L;ll x Pressure Svstems nniv YY Mnunrr nr at_f--,Io Svet- nnly Depth Over Depth Over xx Depth of xx Seeded/Sodded Mulched Bed/Trench Center Bed/Trench Edges Topsoil jxx Yes No Yes Nc COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / Inspection #2: / / Location: 224 Muirfield Trail Hudson, WI 54016 (SW 1/4 SW 1/4 19 T28N R19W) Troy Village 4th Lot 128 Parcel No: 19.28.19.1591 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? Yes No Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Signature Cert. No ST CRX CO ZONING hint, 0001 U�� *bd i!1S.-nes—t I w Ave, VO, BM 7M w *4"hm W1 53707 - 7092 M"Pa Y, $swift m6a (to be fiikd M by ce�) De tenant of Corn )FFiCE lux) 26145" �� SSA S" Plan M.D. Sanitary Permit Ap--pWation 10 AMW "40 COMMa 9311. Wks, Aden. Cedc� gs;mmamd mavarwasaw you provich: J'raTW Address (if d4aM 11tra W.Uhng address) =t WAY be UNA be awendwy porpma nnwy Use. 05."IXros) 1. AppNeadon Inforwavioas - Mom rrto An Wernaefispas hmpaq OwNes NOON Mock 0 GwM'5 M M _ AA*4w rr%w"y tAuatw city. Soft zap Cade L TOD tk R 19 L, (lr&-) a& xt 'f7 AAA, P-4"- of S=-Man Nwbm9(2 a4&w-;= Wt =(2 L)4 AcLSM -tr ', stave owned - D"w*4 U-- -b* -I— —0�— 11L Tyr it rwaxit, (cb*a Orly 009- box as K*c A. Comokbr rnows Rd appfitalsk) A. �qt4maa Sy". 0 jwpamc. sy. D rervia r=www 0 rat" RINVISM 0 rassamassmasotw&.a Teak Replaoemtstt tit, 0 hrow Trawfe I* Now 13 Od. mwdk-- to EXMW4 svw- Law Pr -acars Forwasi ikovabe ad Da* issued Debit Expatstift FlwttDer ovviw IV. Type of PGWIS Syuqw: (Ckwk A that moDW) CL, ffm-Nnowbadim-CorowA j)l44Omt;j24M-VfUd&*Ae&=1 C)M*.ud<Z4Mafwjk"coil DA101W, OSink PossSamidFifta C3 CCeafaadad wilstihIM a Prawanad w-ommod c Hwan T=* n Fax rim, nA&e6kTftwmwt-%,t O1t#cvtuban4s-dF1%ar QLeKwaschmmisw ODag [sae Ocoavd• washr Dodser(awspbse) V. Dinerst"rests"At AM.Imformseties. Flim Ow", W4, A"Gcaidw RjMOWdgO Dwpwjol Am Gqa­-W (1A An-, Ai4wed Q)TS BnOt" -Qc_ �) I f--1 // /,- r -15-CL- YLTITO 140 cqpfxiq in TOW ?4"*a Masoftevra PM" site sadel FAM lat"M / Golkwo Cisibrus of,hart CO.'stu New I taboas Teak. Two "k M.M-4 T-& —7— -A— (10 VU. Rap6wsMarWj StWamema- 1. 0. smadwteat -4 tt. FOWiS am -fusM-laalP. Planiba's Now (7 OtTT"""I""' BaAweaa Fbont Nwnba I — 13! Maws AdAaaieCkrzarL City. SCOM Zip Code) Sr�'itin � Q -P V111- E22!M2M -rtaaawt Use 2!& KA,V..d 0 Dimpprowd Owvw Cpo�en Reason far Dean, Fame FFee(imiades 1111� SUMCKY surdwarp Fee) 4 35D — DY. 1?2CD IX for DuapprIswal S 1 Septic tank, effluent filter and dispersal cell must all beserviced/ maintained management plan provided by plumber. as per requirements must be maintained 2. All setback as per applicable code/ordinances Adboeft -"k* PftW ift WA ICW#M" 9-4, War at MY— - F-9- - - SBD-6398 (R. 08/02) b t- o ao ys ocy 32a,S X 4`7 t� 0(k w --rrov u,-i�)r-s y* Aid tot* a(T �ro r Como " x t-D 4 C) - f �$ � _uo _ C) 11 V r� i {3Zd. & X Z A/o91 J// - 'S C-Z Flows/Row 6m, Y"o L CA- Z�n�t io n Q R\t i Nvisconsin Department of Commerce November 11, 2003 CUST ID No.220537 CALVIN W POWERS JR POWERS EXCAVATING, INC 1969 185TH AVE NEW RICHMOND WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/11/2005 A7TN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1 101 CARMICHAEL RD HUDSON WI 54016 SITE: Derrick Construction Co. Muirfield Trail Town of Troy St Croix County SW1/4, SWIA, S19, T28N, R19W Subdivision: Troy Village - 4th Addition - lot 128 FOR: Description: Proposed Three Bedroom Mound System Object Type: POWT System Regulated Object ID No.: 929326 Safety and Buildings 4003 N KINNEY COULEE RD IA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.commerce.state.wi.us/sb www.wisconsin.gov Jim Doyle, Governor Cory L. Nettles, Secretary Identification Numbers Transaction ID No. 938904 Site ID No. 667920 Please refer to both identification numbers, above, in all correspondence with the agency._ The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/01) and the "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems VERSION 2.0" SBD-10706-P (N.01/01). • The EZFlow units must be installed in accordance with the manufacturer's printed instructions, the plan approval and Comm 83, Wis. Adm. Code system sizing criteria. If there is a conflict between the manufacturer's instructions and the plan approval, the plan approval and code requirements will take precedence. • One out of every five orifices in each distribution pipe shall be installed at the six o'clock position to allow for thorough drainage of the distribution laterals following each dose The remaining four orifices shall be installed in the 12 o'clock position. All pipes must drain after dosing. • The mound observation pipes shall be located at a junction point between two units so as not to create separation of the bundles with in a product. • Limited activities are allowed in the area 15 feet down slope of the component area. Soil compaction, excavation, vehicular traffic and other similar activities that impact the treatment and dispersal are prohibited. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. P.O.W.7.S. Conditionally CALVIN W POWERS JR Page 2 11/11/03 Conditions of Approval Continued: • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • Comm 83.22(7) - A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report per Comm 83.55, that is acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, &406-� Gerard M. Swim POWTS Plan Reviewer - Integrated Services (608)-789-7892, Mon. - Fri. 7:30 am to 4:15 pm jswim@commerce.state.wi.us cc: Leroy G Jansky, Wastewater Specialist, (715) 726-2544 Fee Required $ 175.00 Fee Received $ 175.00 Balance Due $ 0.00 WiSMART code: 7633 TITLE SHEET PAGE_j_OF DATE; MOUND SYSTEM FOR A BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual .`O ND��CE SBD- 10572-P and the Pressure Distribution Manual SBD-10573-P. GORR ��SQD CR. 6/99) (CR- 6/99)�GQ� LOCATED IN THESk-,� 1/4 OF TH1,5- V-) 1/4 OF SECTION f C1 RAW, TOWN OF , ST. CROIX COUNTY, WISCONSIN. ro � k` r /-r l `cam PAGE 1 OF 8 TITLE SHEET PAGE 2 OF 8 PLOT PLAN PAGE 3 OF 8 PLANVIEW CROSS SECTION PAGE 4 OF 8 DISTRIBUTION PIPE LAYOUT PAGE 5 OF 8 PUMP CHAMBER CROSS SECTION PAGE 6 OF 8 SYSTEM MANAGEMENT PLAN PAGE 7 OF 8 PUMP CURVE PAGE 8 OF 8 CROSS SECTION OF E Z FLOW [� PREPARED FOR (� Pox tE I V -,Q- . PREPARED BY POWERS EXCAVATING INC. 1969 185T" AVE. NEW RICHMOND, WIS. 54017 PHONE: 715-246-5135 FAX: 715-246-5135 CELL: 715-381-9920 • . r r r v%# w ir.. " DEPARTMENT OF COMMERCE IDIVJSION OESA�TY AND BUILDINGS SEE CORRESMNDENCE RECEIVED OCT 2 '7 Z003 SAFETY & BLDGS DIV- P) b l Ply POL?4a- �- t s [ct -r-aX A-) / ; u 'ACIA, 4N eel) i6 �Z f-/o e4 i// - 'S EZ F[.ows�Row 6rt; to p �. d1 Snku. C Et [oo ca ";;7 t ioa 5 Synthetic Cow -ring AOri- C33 Medium Sand f Topsoil 3 % Slope Bed Of E- y- F-jut 3- Page Of istribution Pipe For_ — Force Main Cross Section Of A Mound System Using A Bed For The Absorption Area Position of Force Main A Ft. 8 Ft. K C1/-5 Ft. L Ft. jFt. I Ft. W IJ.5 Ft. Plowed Layer D /�2 CVA E I5, F;ti . G (0 �- H J" t Observation Pipe fir- ----------__ __ _-- �s k- __--_----------1----------- ®---------.� �Dislributiory ! C�� Of Pipe l Observation Pipe dincho r S. c+a mly Plan View Of Mound Using A Bed For The Absorption Area Diytribu,cion Pipe Layout Pate �-f of Sz- Place the holes at the botCOM of Cho distribution pipes at equal specina. Remove all burrs from tee pipe and holes. F.mwd are ood of enb AMM vp *6 dr un of bog a= at 45' $gig m a PWO I lom snc bdm ofdo o Sod Made. Tile de aa& of** i�b WA a vll�-tba+erWe* or thssrid Pius P�+veinie aoaosf �oim 1Pw� far dye .a i• �aosdd nap w plvr- *cc.F ss atcIL_ z-,+'csi L CROSS- s A4X-agbL� JF py` ,rvG •ta�rd -ti MMiM % LAN" PLw'N V�� P --Q P Ft. Hole Diameter VV Inch S Ft. Lateral - ' A Inchies) X Inds Manifold ' 0 Inches Force Nefe " a In6es # of holes/p i peJ 7 Invert Elevation of Laterals /// 5 Ft. .. .� . W 1 1414 1.. L „ It 1 U 1. 14" Cl VENT PIPE 121' MIN. ABOVE GRADE & ? 25' FROM.DOOR, WINDOW OR FRESH AIR .IfiTAKE 4" Cl RISER 6 " MIN. ---- _ ABOVE G ADE I8 "' Mlid I N L E T � L____ }\'WATER TIGHT SEALS T . t L; A O I P I P E --}- 3' ONTO B SOLID �r SOIL C PUMP OFF ELEV . IOI .S FT. — -- D WEATHER PROOF JUNCTION BOX APPROVED WITH CONDUIT � jNp�LOCKV 6., —WARNING LABEL 4 ", M IN . •pl GAS- TIGHTS SEAL 3" APPROVED BEDDING UNDER TANK SPECIFICATIONS APPROVED ALM JOINTS W/ Cl ON PIPE 3' ONTO SOLID SOIL OfF *A RISER EXIT PERMITTED Orin,', IF TANK MANUFACTURFR HAS APPROVAL CONCRETE PAD SEPTIC / DOSE TANK MANUFACTURER: NUMBER DOSES PER DAY: _ TANK SIZES: SEPTIC (000 GAL. DOSE VOLUME INCLUDING DOSE tooc GAL. FLOWBACK: //% GAL. ALARM MANUFACTURER: S � " ' c� CAPACITIES: A = G� INCHES = MODEL NUMBER: �( SWITCH TYPE: B = 2 INCHES = 335 GAL. i'U M P MANUFACTURER. 5 C = INCHES = GA I• MODEL NUMBER-, C.-Q 31) L SWITCH TYPE: D = INCHES = t;AL REQUIRED DISCHARGE RATE .3/, A` GP/// � / PUMP & ALARM WIRING AS PER ILHR 16. 23 WA, VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE /v FEET + MINIMUM NETWORK SUPPLY PRESSURE . ��,.5 FEET FEET FORCEMAIN X ,/�FT/100 FT.�FRICTION FACTOR . �?, FEET TOTAL DYNAMIC HEAD = FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER LI QU ID DEPTH of OWNER'MANUAL �� MANAGEMENT PLAN �° poW S sYs�ra+t ..... .,r� a ❑ " ak Tank Uj : ; e r5 C WFORar�ADON 00 teal rvrr*r : c p poseLp � (�C3 NA Tank N1Lgat Pp saps �a0 NA f E"kwti Fftw Frhn Number of Public Facility Urfts -----"`- y� Efiltwit FOW Model 0 NA � tom) ,, 3 v Ptrnp �� �;.Xo s oesign () flow - tEstirrtated x 1.51 FttartP Model D a NA S,o,R Application hate ` PMtrrts►A tl ,�.� ° F"eat Filter ._._.....�...� I;tanrtwid >�ffk,sftc °"aEity Friar Filter ❑Wetland �, qii & Grease (FOG) � ntt potion �� m� ❑ NAMridignirAd❑ ate B,o�:th ot� �'� '�°.) ° p'� Total Suspended Soikls CrST also tom. S1So W/ OL Manufactum— D NA pretreated Effltwtt Quality MordDispersal Cep(s) ❑ l,Cxround edl Siochemtce! Oxygen Deng ROD') � tnglL 13 Kt.Ground t 1 ° � ((Mound Total Solids (TSS) 00 ONI � fir) Fecal CO sttr' cwoor i p DrLkO U ottw. ❑ NA ❑ NA Maxwnurn Effluent POI Size Y. in dta. ❑ HA ❑ NA Other: and septic tar* oft• •VeMiers typical for dontastic wasbewatw MAIM SG" Serwice frequency fl rrtorfihte) (IMmxknwn3 yearshl ❑ NA event condition of tank(s) At least owe a+�tttY� �" p�-third (V of tank Volume dg actsn p NA slue tigh Wamawron I � ❑ NA pump out ca"ta>nts of tanktsl ° When #w rttorNh 3 tsl IMaximyears) �urn - At least Orton every: ° ° tsl ❑ NA inspect dispersal GOW --- - - ---. At least once &VI TOW mor thtsl © N A Clean effluent ft`itw �.____------- P= PUMP cordrois h ata� At least once ev'erl►: _..--- -_. C� NA --- --' trospect p yssrts) � At least orux ❑ mortthis) ❑ NA Rush taterds and Pt tbst 0 ) At IBast once every: ❑ NA •_ licenses orMAjNcertifications individual carrying one of the fnEiowin9 Operator Ipun^per! ><EIdA1�lGE lfrtSTFtUC s be , Septage Servtc cracks o Inspections of tanks arhri rfBsi � r0wTS hisG�� F'OW TSB ken hDrdware, identify any pttxrtiter: Master plumber tankis) tD kkwv fY any of effluent on the grourx Master t tttci+ade a v inspection of the back up por"*v fof an anyof at+orh pipes ertd to cFtndi Tank inspections cn slt� and scum and a cttadr 4ori )evels kt the absen► an leaks, measure the volume of mined to dwa the affluent surft�ce may ery indicate a fang condition surface. The dispersal cell(s) i be vis�lY� ected Porgy effluent an the Wound ponding of effluent we the ground surface• IY,i or more of the tank volume requires the irrtrrtediate notiflCation of the local r °ry au"torlI t tank egtMis ora"tfittd , tt When the combined acc> 1en Of shdgs and scant to Solingoperator and d of in accordance with chapter NR entire contents of ttte tank 1 , shalt be removed by a S�� a��� � pressurized components, Rretreatme Wisconsin Admm►strath►e Coele. of effluent filters, but not limited to the servicin4 a certified pOWTS Maintainw. All other services, irtcltr+fmg of St 2 mortihs, shall lte taerfOr►nsd by servicing at iniervats within 1 O days of completion of any seMce evrent. srnits, and any GMW (2ic� A service report shell be provided bo the local 1.1194 Mwy att�mY Goulds '`` �X ° uL1 A ai.,,rLible Effluent Pump it 1�J APPLICATIONS Specitcaily designed for the • Qvertoad protection must be provided in starter unit. �Y smooth operation. Sim bronze Impeller avaffabie can be operated continuously following uses: • Shaft: threaded, 400 series as an option. without damage. • Homes • Farms stainless steel. • Bearings: ball bearings i Casing; Cast iron volute a Bearings: Upper and lower heavy duty bag bearing • Trailer courts • Motels upper and tower. • Power type for maximum efficiency. 2 NPT discharge adaptable construction. • Schools cord: 20 foot standard length (optional for slide rail systems, ■ Power Cable: Severe duty rated, oil and water resistant • Hospitals lengths available). • Mechanical Seal: SWCON Epoxy seat on motor end • industry Single phase: CARBIDE VS. SWOON provides secondary moisture • Effluent systems ' % and % HP —16/3 SJTO t. "DE sealling fam barrier in case of outer jacket with 115 V or 230 V three Stainless steel MOW parts, damage and to prevent oil SPECIFICATIONS prong plug. BUNA-N efastomers. wicking. Pump ' Yet % HP —14/3 STO with bare leads. ■ Shad: Corrosion -resistant ■ 0-ring: Assures positive • Solids handling capabifi2ies ,': maximum. Three phase: stainless steed. Threaded design. Locknut on three sealing against contaminants and oil leakage. • Discharge size: 2' NPT. • :4-1 h HP — 14M 5TO with bare leads. On GSA phase models to guard against component damage • Capacities: up to 128 GPM. • Total heads: up to 123 feet listed models — 20 foot length SJTW and STW on accidental reverse rotation. Futty AGENCY LISTINGS @ Canadian szanaa� TDH. are standard. ■Molar submerged in h As=lauon • Mechanical seal: silicon carbide -rotary seat/silicon carbide -stationary seat, 300 series stainless steel metal Parts, BUNA-N etastomers. • Temperature: i 04OF (40°C) continuous • Fasteners:00F (W�ISeerrnittent ries stainless steel. • Capable of running dry without damage to components. FEATURES ■ Impelfer: Cast iron, semi - open, non -clog with pump - out vanes for meclnaanical seal Protection. Balanced for METERS FEET Motor z+ Single phase: g ' % HIP. 115 V. 200 V, 230 V. 60 liz,1 750 RPM; 4 Hp, 1s 115 V, 60 Hz, 35M RPM: n � HP —1 34 HP. 230 V, < 60 Hz, 35M RPM. to • Built-in overload with ardorniafic reset. • Class B Insulation, 5 Three phase: • `h HP — 1'% HP 200/230/ 460 V, 60 Hz. 35M RPM. 01 • Class B Insulation. 0 f "5 Goulds Pumps ighV WX turbine on for lubrication and efficient heat transfer. ■ Designed for Continuous Operadorn: Pump ratings are Within the motor marnuiatturees recommended working limits, SLWerwrilers Laburalories fo 80 90 100 110 120 130GPM 0 �0 20 30 mim CAPACITY Effective May. 1995 � (lif "IT " EZ1203H EZ1203H a r t .. ....- ,.. .... j OtT � .....f. -t.L5et .. ... .►. .. ... ... ..., ►. i'j r� ....- t ... VVVVVW ww --?4n ?4„ 1, Rowtn Bottom i V 2id V.lurne Void Coef intent in Aggtegatc tzivcn at 57.4%4 Q.D of 4" pipe = 4.625 inches 1 Vold Yolumc per i irlear h a 3 t.? • � 2-1 r2�rtt { 't€t =U-it'ft' O-D. of coiner cylinder - r.5 mcttcs j Vord volume in aggregate of tearer cvltradu =` - 6. S®1 S.la •! 2-3 125. 1- ll �12wrryf i, t'smtk J �- 574= 422 W O.D. of ouwde cylinders }? ins Res Vold volume in outside cylinders 3 !-0 1' •.574 s Y0I ft' i, 12 is t fill r Vold voluMrat bonom betwren cslrndcrs - 1� 24w lea be. ) i t.12®tfi-?2ini ft \ arc voiume at outside bottom cvc um (t,'? of void valumr kxlwren cyilildersl 0.21 S : 2 iota! .oid volume - 0.1 1' + 0.42: r 0.40I � 0.215 - 0- i Olt = ?b3 cubic fl : ft Lallans per ft - 1.763 X 7.48 - 1j.2 ealiont ner fraear ft WK LEW era In- 3.4S S Sldewall (2 Sidewails) 18.84in - 14 12M IR 1 Bottom _ ,fit, Total Soil laterface Area 5.14 SQ.FTI Projected Trcac6 Arca Sidewytl Height = 12 m _ 2 00 Sq.Ft i Bottom = 36 in = 3.00 Sq.Ft. Protected Trench Area 506 Sq.Ft. P EPS Aggregate ff TTrench System I EZ1203H —�I � Zflo W � Ring .industrial Group i f 65 Industrial Paris Rd. ' Oakland. Tit .18060 SG1ig F1tE ttAQ� ¢t2n3r+-st SHM: t at t j r -27-tt' Whox i" Dopwamv of Care SOIL EVALUATION REPORT DIWab aSAW/w e&&*w in a000m*anoe wab Comm as, ww4. Aden. Go* S Aftch ow4ftu aft piw on pow not im to x 11 in viaw P %n awe rrduea bd aat&Nftd %K vwiadand bofo.� oowief%4, dMaPOon ow PWvW L®- �aaftoraw o"Ima aa.t„wmws,.r�eiorow,na dditn Dn w o , - _ 1 pbs" pr" RN kwbnnmftm by_ +...:.taw*for* , . P.(m_l_d3 A'o;X _c)() r� o.ra we o.< �, (�� opt to S w WS u.; W4 s j T N R I E ca mm* • mAxi N.wa or csw t7ly own We rest tto�d e- t =F!t�ec�R rribrial / Nmnbs dbedon k code dwI I dwripn saw raft t ❑ araarwarafd-Dwa _ p2 W" mmorw _ L oLF-;" s rt , \ l Roca Pblbk 4 000ftR x appftldit a_ o.e.w arm 9 �0QYw U56 Fil , , 0 � a"& k Doi owd Cuba wr.aor Redorr owot"e tNu. &L COML Cdw ToRkm or. St. ML (;o"m Mwws 8atrndwr iinols •••,• "aRi 'E#IR d7 9 a ` • ! J r' I /gyp e_ avp Allon �. -- S 56�L �,•� 4 G s 3/ o .. S S1rA o+r op" OlFlhfthg&Wftftr—�� 1--- oapb o on oma%m" Tomwe Be - I m smAdwy wools oPow © -N � 3 G / L;19 . S— ck " 0 Sh m J�S,rC C s �h P el L i�w1Y�i i >• wli ^ { % "�'� �� tab 3--3D ! W V w4g& EMMW ii Q iiW ;� iM XV& NO BS = W iigOL Na� Dow G 4{ n*mcfad • err � thrcaar r ; �' YLii r..C� ��� C� = DA G ti Q ��.�5 �.- °" ..�e�� P C'- — Nartrp # QQ ptt caYo�a�a aaatg3ro® a�+r. ��� r �j a, OR"Ah is ,�.. - " Snr itala t71 �+.P■ �wiaia�aai .., Eftmmw 11 c 800, > 30 5 280 wq& and TSS >90 c 150 n9t. ' EfbLm t 02 - HOOD:! 30 mWL and TSS 130 nV& The Dopattuc t of Coesnmerce is an equal opportunity scrviecc provider and employer. if you need assistance to wem m vioea or mood mat anal in an alummot kmmat, please conowt ttie depwtment at 608-266,-3 t S I or TTY 608-264-8'M. 1 1 46 41 �VS- So -. l pa? ,4--� /Y`o�y �Si rots -oc -cam ST CROIX COUNTY SEPTIC TANK NUUNTENANCE AGREEMENT AND Owner/Buyer ©��L-I U2— Mailing Address Property Address OWNERSHIP CERTIFICATION FORM G" Cam, /QQ, 2 2—_7 //I/L1 % 2 U97 (Verification required from Planning Department for new construction) City/State OS�t�f A),L � Parcel Identification Number LEGAL DESCRIPTION sy!) Property Location ��V4, S`J Y4, Sec. / , N-R / W, Town of �T• Subdivision,Lot # Z� Certified Survey Map # Volume . Page # Warranty Deed # �0 R Z/ 3 -L. Spec house yes ❑ no Volume _ `q 1 )-- Page # Lot lines identifiable es ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman pWrnber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating t your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 ;1GWXAATnURRP ar ex ' at' da OF APPLICANT DATE OWNS CERTIFICATION (we) cell" e that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owners) of the p e crib dabF f a warranty deed recorded in Register of Deeds Office. EIGNATURYOF 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 1\1 vLl\ VfILLLI flLJll\fll.l I Q/�11J VVV I VVN r JQI I JV LVVJ 1L •VJ r . VV Decr+rtsrtt NuMber This Dbed, made between J 1912P s15 STATE BAR OF WISCONSIN FORM 2 - 1908 WARRANTY DEED rG1' t Co at on a M nnesota Co rani and Derr ck Construct on Co c'�°10f �lpy I n c <---- - Gran Crarnot, for a valuable consideration, convoys and warrants to G following g described real estate in St. Croix y ne of the fbUowing � 127 County. State o! WJseonsln: Intl of the Plat of Troy Village 4th on in the Taws of Troy, St. Croix County, Wisconsin. C-Ei-a'1 0ie KATHLEEN H. WALSi1 RE131STFI OF DEEDS ST. CRO % Co., MI RECRIYED FOR RECORD 06-19-2002 9:30 AN NADM EXW 4 TRANS PER. eS2.90 CERT COPY FgEr PAGES, i i Reco"anp Ares Nara and Return Adofeee Derrick Construction:Company, In '!I Subject to Declarations of Covenants, Conditions and New Richmond, WI 54017 Restrictions for Troy village, recorded in Vol. 1241, li Page 256, as Doc. No. 559964, and the Declaration of Golf Course•Cotrenants, Conditions and Easements, recorded in Vol. 1241, Page 301, as Doe. No. 559969, "12 - 0 040•-1281�90-O all as appearing in the office of the Rtagieter of need 0-1282-00-OW 04d-1M-10-= for St. Croix County, Wisconsin, and such other Farce kiernd Gran Ntanba (pM easements, restrictions and reservations of record, Thu its not ii or in use, and the "Buyer" obligations contained in homestead property, ' the Purchase Agreement for this lot. (is) (la not) iI C i 'I f i i I' Exceptions to warranties: i• Dated this day of Nlay 2002 ,. .� (SEAL) (SEAL) i • Charles S. Cook. President Troy Dawlopttent Corporation +' ;SEAL) (SEAIJ f AUTHENTICATION ACKNOWLEDGMENT Signattue(s) Minnesota State of WtsV0"a+n, _ Arlc�',t5 Cou } �I authenticated this day of Personalty came before me this 11 day of II the dbr>>w< nam.A Charles S. Cook, President Troy Develapttent Corporation �! TITLE; MEMBER STATE BAR OF WISCONStN (lf not, Authorized by 5706.06, Wis. Stan.) TMlti INSTRUMENt WAS DRAFTED BY TROY Dr-T=PMENT CORPORATION me known to ba the person who executed the foregoing instrument and ackno�wwlledge the same. • .B.ick A. Johnson Notary PubUc. Stat�eFWwwnelaAnoka COtmtyr Minn.'. Charles S. Cook, President My commission is permanent. (If not. state expiration dale: (SignsaWrits may be authenticated or acknowledged. Both are not _ January 31 2:p06 nacessar�t) NW^ of pn.ve.lan[na M.,ry c.Wry min ee typ60 et prin ni "tow tivlr,+an.ilm — WARRAN7YD86D 9TAFORMN .2 $098�IN P"A.�"'t� scO"'a6' NDTHIVVU&C-ANISOWA 4 Wy comm" apm 7. JM ILIA N 31, 200E Wisconsin Department of Commerce Di\�on of Safety and Buildings SOIL EVALUATION REPORT Page I in accordance with Comm 85, Wis. Adm. Code Z Z ��� D � Of 3 Attach complete site plan on paper not less than 8 1/2 x 11 inches in See. Plan must County S-r . (2-M 1 X 1 include, but not limited to: vertical and horizontal reference point (BM); direction and Parcel I.D. P�1.1 O1lU percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 0 _ 12 81- - �- Please print all information. by '' // ^-- Date Personal information you provide may be used far secondary purposes (Privacy Law. s. 15.04 (1) (m)). Q/yYt Giwvh Property Owner FrTrT ,3 (° t�- L'eS S , �jp� Property Location CU►`]`CZ� J�F'rl �V�lOP�lf`?./I �`O1ZP_ Slj 114'SW 1/4 S iq T Z8 N R i°1 E(or W Property Owner's Mailing Address Lot # Bloc # Subd. Name or CSM# NE SL1L LuD 1Z8 I — -T`ZZ..O`j ULLLPv1C, L Ll-1{. RDD. City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road �L""S'NE r-"fv ='L�9 1 (263)-)52--)S6g Tvu3`4 IM\,)I New Construction Use: ® Residential / Number of bedrooms L— Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material LO t--,%s ov � -\--I LL Flood Plain elevation if applicable General comments / and recommendations: )` oviv,� w / 4 'x 6 aLZLL ✓ l�1uw1 b" of Sl°+,n RLL- (�24" $a1L t��-P7ir� l Z$ Boring # ❑ Boring A Ground surface elev. c1 �� ft. Depth to limiting factor 3 in. ® pit Soil Applicaton Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ftz 'Eff41 -Eff#2 0-9 !iJ`1p- 3/ 2 - S1 1 Z`�S�►c ') `- e� i v S 8 Z -Z� loKlz 3/ice — si I Z�Sb>t � eS - S ,8 3 Z� 38 319, — 6r `S �esbk M U F1- CS - ►- Z o"n c>t,evh%-� cs - o ) Z $ Boring # ❑ Boring _ @ ® pit Ground surface elev. Og i2� ft. Depth to limiting factor 0 in. Soil Application Rate Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft2 •Eff#1 •Eff#2 o- "�1z SiI Zsbli M"P>- g-z0 lC)'jii31b — st I ZSbk cS - S 3 2�)-30 -1, S `l 231y 30-L1z 6A elf �.sy� see .. S . o cc�� _ •o - Effluent #1 = B005 > 30 < 22D mglL and ► SS >3U _< I bU mgrL emuern ec - ovus � w u 1W L- dnu r 00 w uiy CST Name (Please Print) Signature CST Number Arthur L. •Wegerer 00�31�=1Z�_ 220254 Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number 421 N. Plain St. River Falls, WI 54022 1p- Z3_490 715-425-0165 S Property Owner Q1U,nJU��L L ) �OR.p Parcel ID # k'LOVD1W G � 1Zg Boring # Boring Page of 3 C t❑ l�Sl Pit Ground surface elev. Ot U b, S ft. Depth to limiting factor in. Horizoninant In.unsell Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Ra GPD/ft2 Qu. Sz. Cont. Color Gr. Sz. Sh. �2�2-L-, �z m 'Eff#1 "Eff#2 71Z 3/ `1Zy�`tR o 0 ❑ Boring # ❑ Boring ❑ Pit Ground surface eiev. ft. Depth to limiting factor in. Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots Soil Application Ra In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'E(f#1 I 'Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Soil Application Rate Horizon I Depth Dominant Color Redo, Description Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Eff#1 I 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD6 < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or M 608-264-8777. I SBD-8330 (R.6/00) to w PLOT PLAN Scale 1' = SO Page 3 of 3 Lo r- x�z9 WW1.04 CST Signature Date 6 qo j clot qol 11 t g tZgC i �O t.1u7�'t�e� e \ Olt- D lS TwZ 13 \ 71i-tS PrtZL�A J 1 ti �l09 Owl EL `i08 , s J 715-425-0165 220254 00-318- IZg Telephone No. CST No. ' Job NO. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code S " Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must County C M 1 X include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed by Date Personal information you provide may be used for seccndary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Ff7TIQ v� S (2x�)D� Property Location C lJ►�1 10 ( t �t"� -OPT-1 C� 1 e-U 1Z P_ 1 � S �-J 1/4 S W 1/4 S g T Z 8 N R pf E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1.$00 AJE SUt.°S IuD 1-Z-g — -Mz-o`f V l A L["jAdo City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road �L tiE r�N SS�l�i9 (763)�5? �56g i7ZaL4 I 1"1v112F1-TR [c New Construction Use: ® Residential / Number of bedrooms _� Code derived design flow rate o 0 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material LOFss 0y t'rc_ 'TILL Flood Plain elevation if applicable N,) A ft. General comments and recommendations: 1"1oV1�,� 1,j g '�, 6 D l�T�rZI>3UY�0,\1 c1�L U K,1 C:F S yid F=I L L- e t ZY' Boring # ❑ Boring A ® pit Ground surface elev. U—). 9 ft Depth to limiting factor 3 in. Horizon Depth in. - Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots J , / 4, FJ-UU" RdtC GPD/ftz •Eff#1 •Eff#2 0-9 13�2 SLl23ly — 6r iS �es�k tin -�ls -�,s� rz3� �l � s L R s is s l ow, CFw eve cs ) Z$ Boring Bonng # e .. ...... p g 13 ® pit Ground surface elev. �� 08.8 fL Depth to limiting factor �� in. Horizon Depth in. Dominant Color Munsell - Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' •Eff#1 -Eff#2 I rz 1 Z — . -1 1 Z'Fs 6lz Z 9-Zo 1p�f131b — s) I Z�sbk cS - 5 •S 3 �3o tiS`1231y - 1s os� 3�-�t� ►o� �z 6/6 elf syI? s1e S . o c0llexfl ,o . : o uuucu► w r = aws ou � [[u Mg/L ana t 55 >3U _< 15U mg/L Emuent #Z = 130D5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Nu_ mber Arthur L "Wegerer 00�3 R.".)Zg 220254 Address W e g e r e r Soil Testing & .:Design Service Date Evaluation Conducted Telephone Number 421 N. Bain St. River Falls, WI 54022 1p_ �,.715-425-0165 Property Owner (1�JT Q"'NAL Lam) . COR-jam, Parcel ID # Boring # ❑ Boring C ® pit Ground surface elev. a U 6. S ft. Depth to limiting factor 38 in. Page . of Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots soil Application Rate GPD/ft2 'Eff#1 •Eff#2 1Q,-jV 2 12 _ > i l ZSbk mom- Cam) 1 v F S 3 26 38 ) o'71z. 3/6 — s i t 1 esbk ti Y1 Ft- e g 3 � 38 - S8 1 O ylz 3/6 `�- )'F `� . S �12 S/ � S i 1 01-,-�, m '�L, _ , � • v Boring # U Boring L-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots soil Application Rate GPD/ft2 'Eff#1 •Eff#2 I" Boring # lJ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in, Horizon Depth In. Dominant Color Munsell Redox Description Qu. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Roots sou Application Rate GPD/ft' •Eff#1 •Eff#2 Effluent #1 = BODY > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODE < 30 mg/Land TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or = 608-264-8777. I SBD-8330(R.6/00) PLOT PLAN Scale 1' = SO Page 3 of 3 - \,Owo, Lo r- \Zq q 19 . qcB 907 j e.xa0, 11 1 1 c 1 OR— D�S`ivv2 �3 � 7t�lS A'iZl`A 1 J 11 r $' J.zg A e{ o b 9oq qo7 I-,---04,.rmv2 CF el . 908.0 B�llu►y �t� N \ J 715-425-0165 220254 (-�0-: 118' izg CST Signature Date Telephone No. CST No. Job NO. .i...........,B-407....................• � mm�r- _ LOT 4 • / o , , ',' C.S.M. ^^ VOL. 4 121'1 h { / I I /' / / / PAGE 9 V / / / / I o� B-406 / \ \ B-350 • / f \ r o r r / to 3-405 '1 r \ - ------------------- r r / PT 168+4?04 r ' I LOT 3 894.6 /ll , ^_ - / I `C >\\ `91 } CS.M • . r , 6-349 i / ' !� \ \ \ PAGE 993 2. �T/ 2589LL- \ w ,' / ( .I I r' I /�r II��\ I III I ,I• � I T y\` G2\911 8 i (� 63 \ +64.09 ��90-9.3 / / \ i LOT 1 ` �� -� C.S.M. I /J►'' r -44t / - VOL. 6 1 PAGE 1627 1 '/ 8 go 90.9 891.4 I f I I