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HomeMy WebLinkAbout430557 040-1282-00-000 (2)Wisconsin Department of Commerce PRIVATE 'SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 430557 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may he used for secondary purposes ]Prvacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Derrick Construction Inc. Troy Township 040-1282-00-000 CST BM Elev Insp. BM Elev: BM Description: Seclio !TownlRange/Map No: 19.28.19.1591 TANK INFORMATION EI FVATInN nATA TYPE MANUFACTURER CAPACITY STATION HI ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. S er Holding SUHI ftl TANK SETBACK INFORMATION St/Ht t e TANK TO P/L WELL BLDG. Vent to Air e AD Dt Inlet Septic t Botte Dosing ender/Man. Aeration tis. t. Pipe Holding System PUMP/SIPHON INFO ATI INFinal Gra Manufacturer Dem d PM St er Model Number TDH Lift Frich. L s System Hea TDH Forcemain Length Di Oi o Weil o VIL NDaWnr I IVVd a I - BEDITRENCH DIMENSIONS Width Length No. Of Tr en s PIT DIMENSIONS No. Of Pils Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L ZBLDG IWELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer Type Of System: Model Nwnber r.ruv I rvry o I a I Qm SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over Im Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes _j No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:/ ! Inspection #2: / / Location: 224 Muirfield Trail Hudson, WI 54016 (SW 114 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 Ej No Use other side for additional information. 1 f SBD-6710 (R.3/97) Date Insepctor's Signature Cart. No. ("CUE1VEp Aln Tt�f- t3w�t Dief]ioo - �' wP f■ ,t°')Ct>U+v)rtc GC artment of Cam ING 201 W. ioW Ave, M, Bvx 7 D1 wt ssw7-ioez�q.ca'j FFICE t9M) x14546 5-57- s'"q• "'"``. �J litPermit App ation Y itm'd M C— lilt. Wk. Ad0 Cedl, p.w d Yfwnrftr T . p—k 7r�""LD / ' a - T—ff - m y be uxed rot weea AWY pwru FdwEV taw, at s.0e11 NnV Addnu (itddiTraA draw w ' f addrrt) I. Apptkatbw rdarfarnier - pltau rTrr AU Irrtw..aa;.w �--- ^ 22 s hoPetry Oeler'e tdeme - rands Lot s I � Dlefk M MANS Aa+>reer hefab itr,3400 s.2..=lC.x, s.crww J—J-- f IL tt .19 type W iattdlrg (Neeet t fir) 00 �7 NAh . -for(*) ii •s Naaw CXti NaFw�lrn Ntl efb DweaW� - Nrrnlea d _ ❑ Pet t f�car nfarobl-t>us ,be = I 1 U -t 1, _� tF 0 sw t)www - t)oetief ute G )Csf M C� �j, ` � 11:.'1}pe eflerwrftt (Clock ere treat M lire A. 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Res al stokmea(- t, M ewdwrNpnel, Art N t4c rOWT4 aiewr wf t►f ■rotelyd daw4 rimdmr'a Nemc Dwaiwcsr rb—NwmbaFrl~-- 1 ■ ANtaw __ m? Aft. C rfteewt fhe 1 F7.APPtar'rd ❑ OiwpProrod GI•.w Rmww ter t)rtYt Sanwt Pamir Fw(irw7wdrt Cho—ft* r srwat.sw t:�, $ 350 — t„r.1 DaftI—Nd 2W F Serwatin w ). ---_ ,0rwr iICC$YSTtMEUVV forMuppm sl 4QttivDfL�0 1 Septic tank, effluent filter and dispersal cell must all be serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable codelordinances. wwe0 tww,Pwrr Pins (M W (:wr1T r+t/ ssr W �W r rMse ww m w.sw sMe � r� ,w--..... SBD-6398 (K. 08/02) ��--(�� �,*trk �.� VJnS t`kc.T`vr� COShC. J W,% ��>✓Y� 1� ( �g tj I i�� w C) 8dn/� ``q q-5 Iv Cz+J K:cl�rYwrtd �tx>� Syo 17 IDooc.Sz s z�� (vie lbro Z' -fowl //I _ $ ! Z F"Lou e) to A�7 n r l, ka C El,ton' L a'4-. S� 4R\t B+r,-6Pie\e Pod c�i to AL l3\ r \ 9 0 t� Q fi %� Ivisconsin 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 ATTN: POWTS Inspector ZONING OFFICE ST CROIX COUNTY SPIA 1101 CARMICHAEL RD HUDSON WI 54016 SITE: Derrick Construction Co. Muirfield Trail Town of Troy St Croix County SW1/4, SW1/4, 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 Safely and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601-1831 TDD #: (608) 264-8777 www.cornnnerce.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.01101) 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 afler 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. Scats. P.O. W.'T.S. Conditionally CALM W POWERS 1R Page 2 1 1 /1 1 /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. Slats. • 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 ma, 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, Gerard M. Swim POWTS Plan Reviewer- Integrated Services (608)-789-7892, Mon. - Fri. 7:30 am to 4:15 pm jswini@eonimerce.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 URE SHEET PAGEI OF_ "S MOUND SYSTEM FOR A_,_ BEDROOM RESIDENCE This plan has been prepared in accordance with the Mound Component Manual SBD- 10572-P and the Pressure Distribution Manual SBD-I0573-P. CR. 6/99) (CR- 6/99) Ca LOCATED IN THE-Sw 1/4 OF THE; ) 1/4 OF SECTION I q ,T;) 81, R_RW, TOWN OF ST. CROIX COUNTY, WISCONSIN. INDEX 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 -P—R—E�P�ARER. —D FO/� 'h'r�riC�gir--tiov. \u r�G PO $ok (1 q-S 1V.,,w AZ, &w n, j -1- �yyo 17 PREPARED BY POWERS EXCAVATING INC. 1969 185T" AVE. NEW RICHMOND, WIS. 54017 PHONE: 715-246-5135 FAX: 715-246-5135 CELL: 715-381-9920 RECEIVED OCT 2 7 Z003 11 .*.► v k- ul SAFETY & BL.DGS DN. DEPARTMENT OF COMMERCE DIYSAF TYAN06UILDINGS SEE CORRES NDEN'E ' Fact r— s3 S. s t-t --r-,Av)u pry=? tom:, llJ ux—) Al c'Arf-,0U. Cv )— 1;7 �l � . � S T- ro r �C r [-Z F'Lows��zow ,A $nj '1 o p �� i o'4 4 mA 8 m `r pq fe\ e�4 Pad C ( ►c, ncam i " �- Sa" Page I Of Synthetic Cov ;ring A5-Tm- C33 Medium Sand Topsoil S It 96 Slope Bed Of E Z- Fjoc':)� istribution Pipe G F" Fofce Main Cross Section Of A Mound System Using A Bed For The Absorption Area A Ft, B Ft. K Ft. L Ft. Ft. Positionof force Main W Ft. -Plowed Loyei E 4, F G Observation Pipe K------ A k- --------------- 4 1 �,Distrlbution Pipe Observation Pipe GAChor _IKS-4m Plan View Of Mound Using A Eled For The Absorption Area Uistributioo_Pipe Layout pose q_ of Place the holes at the bottom of the distribution pipes at equal spacing. Remove all burrs from the pipe and holes. F_tteod the sad of each taterd up with the uie of Iemg ww or e5• Suing to a point within snt i xhw Of** &&I gads. Tom! dw a k oftie i gaaats whit a valv§Cdweadld CW or theaaeiad pAtg_ Praride aocesa > iTd gtada %r the calve, thteadad ar t3Qvatad plttg. FVACc�ss Ras,_ }VC vim► PvG jF CrVtl-1 [--MWON 1 i-L " "— -- P Ids U" h'NSl � POdo �jLC.�T MfAAJ P � Ft. Hole Diameter �� Inch 5 -3 Ft. Lateran 0 Inch(es) x Inches Manifold ' Indies Force Hain " Inches oaf holes/pipe` % q Invert Elevation of Laterals //% 5 Ft. 4" Cl VENT PIPE 12" MIN, ABOVE GRADE S 25' FROM.DOOR, WINDOW OR FRESH AIR IfiTAKE tb,4' Cl-RISER 6" MIN. - r' ABOVE GRADE INLET WATER TIGHT SEALS Cl JONTO 3' SOLSOIPUMP OFF ELEV.l01.5 FT. — pm V j"_ N WEATHER PROOF JUNCTION BOX APPROVED WITH CONDUIT MANHOLE COVER W/ PADLOCK 6 WARNING LABEL 4" MIN. I� I ` GAS- i TIGHT A SEAL B f I V C Y D' 3" APPROVED BEDDING UNDER TANK SPECIFICATIONS APPROVED ALM JOINTS W/ Cl ON PIPE 3' ONTO SOLID SOIL, OfF AA RISER EXIT PERMITTED ONLi IF TANK MANUFACTURER — HAS APPROVAL ONCRETE PAD SEPTIC / DOSE 'LANK MANUFACTURER: ��QSC'rS ``po NUMBER DOSES PER DAY: TA14K SIZES: SEPTIC [o0c> GAL. DOSE VOLUME INCLUDING DOSE (off GAL. FLOWBACK: //,I, P GAL. ALARM MANUFACTURER. cs CAPACITIES: A = INCHES = AL. MODEL, NUMBER: pn SWITCH TYPE: B = 2 INCHES = 335 GAL. PUMP MANUFACTURER: tt C = 6,7 INCHES = //�2.3GAL- MODEL NUMBER: EQ t L SWITCH TYPE: _ -\ D = ja INCHES = GAL. REQUIRED DISCHARGE RATE PUMP PUMP S ALARM WIRING AS PER ILHR 16. 23 WA( VERTICAL DIFFERENCE BETWEEN PUMP// OFF AND DISTRIBUTION PIPE . / 0 FEET + MINIMUM NETWORK SUPPLY PRESSURE FEET * /_30 FEET FORCEMAIN X ��FT/200 FT. FRICTION FACTOR , c;21S FEET T.OTAI, DYNAMIC HEAD = (� FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTA ; WIDTH ; DIAMETER LIQUID DEPTH POWTS OWNER'S MANUAL lit MANAGEMENT PLAN Psga I'll SE ff�Fl�itlYlAT1vN Pettit 0 pE/rl PARANl ❑ NA Number of ❑ NA fitetttier of fIl lic Facility tk+ttG_---- ----_-_---- F.stkreated (average► 'Fkrw ��'p ��—._�ldt�` Design (peek) flow ([stimatad x 1 .5) —� �C>- _galld Soil AppNcation Rate r atJd Lila Standard Inflt STWEfftuent Quality Mo average' Fats, on &Grease 1F0(31 -.30 tng/i_ SiW:hOrel oxygen Oorlttd (BOf).) 5220 rng/I ❑ INA Total ", Pertded Solids 'SS) - pretreated Effluent Quality Monthly average Bioctremical Oxygera Demand IBODsJ 53O rngll- 0 NA Total sutrpended Solids (TSS) 530 rMI Fecal Colifvrm (georreetric mean) 570' citrll fXlrnl -_ - --- - Maximum Fffluent Particle Size - Y in dia. ❑ NA �-- --_-- ___.--- - --------- — -- a NA • V atues tyPcal Vier dorne'stic 'wastewator and septic ter* affluent YSTEM SPEECN`IC� / c.a QS Y S ( dm Gl NA Tank K4wwfact gal Cy septic ❑ Does ❑ Holding - vol Uc�tJ__ INA lf- LJi NSF rS (1r�tYt( _(l Teak Msn+rfac"l gel __! L7 Septic�CDo.. Cl Hoidhtg _ ---- ❑ NA EfflIOM Filter Manufacturer- Efslll Fkw Made( l -- � U NA Fume Manufacturer cj, t A,o Modes pump pretreatment Unit ❑ Sand/Graval IIIC} Feet Fitter ❑ Mechanical Aeration O Welland ❑ Other: C] Disinfection Manufacturer `___-....-_.__-_�-_--- D NA Dispersal Cellts) ❑ tn-Ground (prassuriaadl C7 in -Ground (gravity) ()(Mound C7 At -Grade t] Dap----- C] Other: _ --_---. --`.- _- -- - C7 NA -� ------ Ci NA NUNfENANCE SCI49:130 .E Swvbce FrequencY Sarv(ce 1?verrt ❑ month(a) (lHatttrrxlm 3 YeMa) L7 tdA tnspect condition of teal (s} ---- --- At least orerae every- Yeari) of tank volume - — -- -_ -- equals one third (Y,} end scum equ L1 rlP, --- __ ❑When corn!»ned sludge lirgh water alarm is sc ____---.------- "-- _ -, i'rrmp out contents of 'truxkls} Li When tits morrtfi{sl (Ntaxlenure 3 `/ears) ❑ NA -- Inrspect dispersal ce►J(s► At least Once every: --_- -.---- 0 rmxtth(s) l I NA - ---''�"'------ Glean effluent fitter At lea-zt tsracki everY: ---.___.__-.-------'-'-'0 earls) month(R) --- 9.l tJn pect purt�, 1» controls & sla[tn ..-Y At feast orate every- __ _ yearia) _ _ -------" !7 NA _-_ rRushlaterals ared pressure test At least onlae every: ❑ monthls) U tJA eet: �— — At §east once av'arY�'"----..-^."_-_._._—.-----_._ [1 NA i....--..-- _. ,AMNTENANCE LNSTRUGT1ONSs in one of the following tircn aepspera(attli� tmeperi Inspections of tanks end dispersal Celts shall tee made by an inrJivirluapOw S Maintafrtor; Saptoga Seav tg any cracks o any missing or III hardware, identify Master Pltlmlrar; Master plumtrar Restricted Saver; pOWYS lnspec of effluent on the gto+•rat Tank inspections must include a visual inspection a f the �mk(usl�toa+check for any back up or Pond°ng III Pipes and to check for an teaks, measure the volume of combined sludge impacted to check the effluent levels in the obs," ndicete a failinit condition an surlsce. The dispersal. Cashel shall be visiratlY .Pal of effluent on the ground surface "I ponding of effluent on the ground surface. fire port ry requires the imtnediate natiticat(on al the brat regulat ory authority. tl. 5erviring Dperatar and disposed of in act.' with chapter NR 1 1' When the carrtbiteed accumulation of stodge and scorn an any tteatment tank e4uals one-third {Yet or n+ore of the tank vo umr.. entire contents of the tank shalt be rerrroved by a Saptag Wisconsin Administrative Cola. All irther services., trtchlding but not lin.itad to the servici+eg of elv�eneneetillbV'ao certifiodnpfjWTS Maintw nercnn+PCj1ents. t+retrnatm units, and any servicing at intervals of ii 2 mantles. shall be t of cornPletion of any service event. A service report shalt be provided to the local regulatory authority within 10 days I;Pn1N (?1: is APPLIC ATIONS 4eclAcaily designed for the following uses: • Homes • Farms • Trailer courts • Motels • Schools • Hospitals • Industry • Effluent systems SPECIFICATIONS Pump • Solids handling capabilities: Y.' maximum. • Discharge size: r NPT. GP • Capacities: op to 128 M. • Total heads: up to 123 feet TON. • Mechanical seal: silicon carbide -rotary seatlsif icon carbide stationary seat, 30O series stainless steel metal Parts. BUNA-N elastomers. • Temperature: 104'F (40•C) continuous 140"F (60°(;) intermittent - Fasteners: 300 series stainless steel. Capable of running dry without damage to . components. hlolor Single phase: • % HP, 115 V. 200 V, 230 V. 60 H2,1750 RPM. % HP, 115 V, 60 It, 3500 RPM. % HP —145 HP, 230 V, 60 Hz, 3500 RPM. • B"Ift-in Overload with automatic reset. • Class B insulallw Three phase: " "h HP — 1 % HP 200/230/ 460 V, 6o Hz. 3500 RPM, • Class B Insulallon. n'945 G—kfs Pumps • Overload protection must be provided in starter unit. • Shalt: threaded, 400 series stainless steel. • Bearings: ball bearings upper and lower, • Power card: 20 foot standard length (optional lengths available). Single phase: •'r4 and % HP —16M SJTO with 115 V or 230 V three Prong plug, • Y-154 HP —14r3 STO with bare leads. Three phase: •+4-1%HP-14/4 STO with bare leads. On GSA listed models — 20 loot length SJTW and STW are standard. FEATURES a impeller. Cast Iron, semi - open. non -clog with pump - Out vanes for mechanical seal Protection- Balanced for METERS 25 20 g: rs i t0 s 0 FEET Goulds SUL,«i,..-Lib le Effluent Pump aI 3885 smooth operation. Silicon bronze impeller available as an option_ z ■ Casing: Gast Iron volute type for maximum efficiency. 2' NPT discharge adaptable for slide rail systems, ■ Mechanical Seal: SILICON CARBIDE VS. SILICON CARBIDE searwo faces. Stainless steel metal parts. BUNA-N elastomars. ■ ShaIC Corrosion -resistant stainless steel Threaded design, locknuf on three phase models to guard against component damago on accidental reverse rotation. ■ Motor. Fully submerged in high-grade turbine ail for lubrication and efficient heat transfer. ■ Designed for Continuous Operalloir. Pump ratings are wtihin the motor manufacturer's recommended working timiis, can be operated continuously without damage. a Bearings: Upper and lower heavy duty ball bearing construction. ■ Power Cable: Severe duty rated, oil and water resistant. Epoxy seat on motor end provides secondary moisture barrier in case of outer jacket damage and to prevent oil wicking. ■ 0-ring. Assures positive sealing against contaminants and oil leakage. AGENCY LISTINGS t CCanadian Standards Atsmiarlon UL Undermft" laboralrales 3PM CAPACTTV 30 my Elloelhro ma , 1995 ,'c`-r ('I T Y /fAtYnt I fJAtf;tm —36" j Void F'a1 me - - -' - ,..•u-ti.. kkyp-) Void Cor.(rrclmr in A�fxc�am i, rcn al SZ45q. U.U. ul' 4- Fipe r A-625 i_, _e V u1d velum[ M* 1inOi' fi. = 5. 1,r •I Z-3125i. I t2inlfl } -R n U.I t' 0' G. U.. n l renter cylinder = 125 inches Yofd volun.c m ag8rcgaw of -- crlindcr l�2nr1F�-1.14• I•.52<`a22 f(' i 17nr 1 �1 J' ). U- nr outside cybnders = 12 nnAes raid vnlnmc in outside avlirelcr5 = 2 • }.I� I •.S7a = vU 1 fN 12o1n, old .ufume al M1[om between c.-irndrrs 24jn r"" 1, � 6n '�� �12w/fl 12"n, ir, s {r 1J =U-_`Is (♦" r *`121nefi� and .mums a1 outside bauom cvraos f l2 u f.o1d .nknne bar_ cylinders! 0 213 : 2 - U. I08 r[' vat void vnlumt = 0- 117 ,- 0-422 : "I - U.715 - U. 103 - f. 76J cubic fi : R dons pec ft = L763 X 7.48 - 1 I..` [a0aes ner linear ft If err — A"c -11— fi (2 Sidewnfis) BotiOm Total Sail In[crfatc .lrea Prnjected Tr—b Ar ca I 5ldewall (ftiy;bl = 12 rn. ': = 2.00 Sy.ft. Bnrtom � 36 In = 3.00 Sq.Ft. j Projected TrentM1 Area =­ 5.00 5q.Ft. It f'nl I _1 EPS vggregai' Trench System EZ1203H FZflow Ring -Industrial Group 65 Industrial Park Rd. Ooklond. TM 38c)60 91f.1n 1 cf 1 11_27-1), 1 wkq-oopw*TWK* ol cu..w SOIL EWE UATION REPORT D#wsimofsAsYmnd&fiWV, �--m - -3 -IC Comm B& Vft. A&. Code AMoch oo"Wi0o "o pion on piper not b" 6m a U2 x I I kct in W., ccosIty Pkm awo -ki tww—pawp4d-wcft am PaioW LU MobaromhommOOMUMolka"dl -1, — I a Do PION" populy Tj�Fl R Codlk dm*md d..Adn S. rft GM Q P46kor If oil Q3 t USC OL rffi Dmmdh in bow- 6.060, kLQt Pd.Dm—.pn 9L CMIL Coley T~o shx*m QL a& WL sortfamstalkn two xf rA v+ r Iry DWAW" raxft I um Gpow low I Q&&Lcwt Cabr W-SLsk *EW Harz IL AA t L2-20 d It.3:5 Jumvn- -- T4lWaftMKnbw '7 if, 3 �rrrrecy, 00 A 6M 45,4,L1i�- t�. (�- -jam � - _ _ �--- swgY sw14 sty i a& N ) I 9 w v ; tom / '�- ST CROIX COUNTY SEPTIC TANK M kfNTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Carr SVni7 Property Address —Z-Zy R,4 / 2F ts t Ps T'Z4_ L ,� (Verification required from Planning Department for new construction)_ City/State Parcel Identification Number _� 4 !z-Ojc_'i C ,0.� LEGAL DESCRIPTION sy�/ Property Location S` 0y, y, Sec. '� N-R W, Town of Subdivision f/l "� 4c � l+ Lot # Certified Survey Map # ,Volume Page # Warranty Deed # �" ` L , Volume t , Page # /S__ Spec house yes ❑ no 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, journeymanpltimber, restricted plumber or a licensed pumper verifying that(l) 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 statingAt your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 Wye ee ar�a ' da - IGNATURE- OF APPLICANT / / U DATE OWNER CERTIFICATION AGNAOF cc that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of rib d abi , b r f a warranty deed recorded in Register of Deeds Office. APPLICANT DATE ****** Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. ****** r,G ** 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 i 1 912P sis STATE PAR OF WISC'ONSIN FORM 2 - I99S WARRANTY DEED Document NuM1Y9r 'his Ned, made between rtyy rent Corporat on a M nnesota Corporation and Derr ck Constru tion Co an In �ramor, KAATHHLEEN }I.WAALS.4 REGISTE1 OF DEED ST. CRo X Co., WI RECRIVED FOR RECORD "-19-2Q*2 9:30 AN NARRp y DEED EXE7IDT # RETRAS&P NRE;C11B2e90 FEZ APT C0?Y F$E: PAGES: 1 Grantor, for a valuable ��-^--• Grantee, If mnslderatWn, conveys and warrants to Grantee the following described rags eaten in St. CroiX 127 County, State of Wiscortsln: Ibt12 of the Plat of Tr RecwmU An i on in the Town of Troy,Stl1Croix Ct` Name AN Return Wisconsin. Derrick Construction_Cbmpany, In I Subject to Declarations of Covenants, Conditions and New Box 4nd Restrictions for Troy villa a re New Richmond, WI 5407 Page 256, as Doc, 4 r corded in Vol. 12of Il N°' S59961� and the Declaration of Golf COurse,Covenants, Conditions and Easements, recorded in Vol. 1241, Pa all as appearing in the Officelofat a Re.9ister5of6Deed 12 00-000 0 p 1i2$2- o- for re Croix Count , WiOconuin, and such other Q-1282- 0 easements restrictions and rese Parcel IoentifiCadon Nunby (PIM i restrict o rvationa, of record, Thu is not It or in use, and the "Buyer" obligations contained in homestead property the Purchase Agreement for this lot, bt) Oa not) 'i r I� a i Excepttom to warranties: I: �t Dated this nth d,y of Py 2W2 z� ,� _ (SEAL) • Charles s. Cook President Troy lkvmlopment Corporat on (SEAL) AUTHENTICATION Signature(s) Authenticated thb _. day of � TITLE: mFmBER STATE IlAR OF WISCONSIN (If not, Authorized by 5706,06. Wis. Scats.) THIS INSTRUMENt WAS DRAFTED RY TROY D)VEL,OPMENT CORPORATION Charles S. Cook, President (SlBrnturrs rruy be authenticated or acknowledged. Both are not necesaary) (SEAL) ACKNOWLEDGMENT Minnesota State of W,t, s. An3',ta Cnn`� Personally came before me thlt7s1 day of —!•Ch 4ar es S. Cook, preside abbe nam.rl _ Trov Development Corporation t0 me known to be the Parson who executed the foregoing Instrument and acknowledge the same.�►�� •J1tck A. Johnson Notary Publlc. Si*il a .L1tto.o"r♦w]jfoka County, Minn. My commission is permanent. (If not, scan expiration dote Janup 31 2:006:) ' Namn or "O'lankd In any wp.ally mum tx typ.a at Prltnaa b-.1— th.p uthlure, ' WARRANTY DEBD 9TATg BAR 0> WISCDNSIN FORM N,., 2 - 1 ass MCK A ��" t•° MauNN. V7�Pe. NOTARYKOX-ftNMBOTA W COfr9t LWON DPIRES IANUARY 31, 2000 wrsconsin Department of Commerce SOIL EVALUATION REPORT DiV-ionof Safety and Buildings ` in accordance with Comm 8 ,a/Vis.1Abh.' Code Z 2 Attach complete site plan on paper not less than 8 1/2 x 11 inche*/, , ,' 1- mu County Include, but not limited to: vertical and horizontal reference point �M){direcU 1a' rE,. Parcell.D. percent slope, sale or dimensions, north arrow, and location a d:distance to r s ��i1. 0 _ Please print all information. y �„ by Personal Information you provide ma be d ( '!- ` I �J "boo Page of Date y use or secondary purposes (linvdcy Law, s. 11 041) Property Owner rrl rlJ _ vr� Y✓h d� C �i fC2lkTS S . °WOI2 `; PrOptirtylL9cation ( n culv�rJt DC17�WPn 'ar�tN ,� ;r.y�' � /� c01ZP ` hJ'`'114 W 1/4 S lC) -r1111111" (car W Property Owner's Mailing Address Cbt,# BI "ck # ubd. Name or CSM# 1l'6 op FfBIZIZ) N� sul. ,.un l �`- t"tzoy Ut�LRG �l ri+ moo. city State Zip Code Phone Number ❑ City ❑Village ®Town Nearest Road $lv�tvEI MN 5S(4gg -7u)1-( 1)"1V112F.LLSl ® New Construction use:® Residential / Number of bedrooms _ Code derived design flow rate 0 D GPD ❑ Replacement ❑ Public or commerclal - Describe: Parent material LOTss Oar L - -M LC Flood Plain elevation if applicable General comments - ft. and recommendations: I wLwtu� 6 `CIF- s>1w RLL-, 2cf" Sates D�-Y!}�/l Boring # LI ocumg A ® pit Ground surface elev. U-7. 9 ft, Depth to limitina factor Horizon Depth in. Dominant Color Munsell Redox Description Qu. Sz: Cant. Color Texture Structure Gr. Sz. Sh. Consistence �— Boundary Roots Soil Application Rate GPD/ftz •Eff#1 •Eff#2 I.. p-9 fa72 3lz - sl 1 Z Fsb� m �i c� 1 v F S Z 3 - 1-7 ID 38 4-�S l 0 Lf ZL -S`123/(f 7,S�1(231 �� 1•S LtR sJB �� bin C tfi�i� Cg -o .O Boring # u S ® pit Ground surface elev. C)8. iFj ft. Deoth to Itmitina fartar (3O� Horizon Depth In. Dominant Color Munseli Redox Description Ou. Sz. Cont. Color Texture Structure Gr. Sz. Sh. Consistence -I Boundary Roots Soil Application Rate GPD/ft' •Eff#1 'Eft#2 D-9 lr`1R 2,tz — a. 11-Zo I D'-1 M 316 3 Zo 3o ti<SK231y o 30-�[2 1011i 6l(, elf ?.3 Lf Sfe S �, t t 0 . p . •Fm„e...,,, _oar, _,,, _...,.,--- •--- -- -- -ouu. c dV m91L and I SS < 30 mg/L CST Name (Please Print) Signature CST Number Arthur L.''We�erer rV,Iwo ; 'Z2 1Z8_ 220254 Address W e g e r e r Soil Testing &. Design Service Date Evaluation Conducted Telephone Number 421 if. t4ain St. River Falls, WI 54022 10715-425-0165 YLV 1 YLRiq Scale 1'=50' ra8e J Vl .> fir- \z4i � xp Lo r iz9 CST Signature 1Q- 7a Date 6 qo9 qo8 90l e.X7?,a>3 1 8«(2 D�S`(vyty3 e Olt - VIZ 7T}-1S H'l2l''fa 1 J �U\ B- LIYi /i 1 qoy go) �oT1pM CF a LL ry N J 715-425-0165 220254 Up-3�� 12S Telephone IJo. CST No. Job NO. Division of Safety and Buildings - - _-_. • ' '"' ' "' " in accordance with Comm 85, Wis. Adm. Code Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and local on and distance to nearest road. Parcel I.D. Please print all information. Reviewed by Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Cfwner R'ri"1.1 `v �FPCSLI5 Property Location Cl�1�fJ Page I of - 57- C� l) P��01ry 6 Date �- — I T-r � �Zlel-oP>M X co lz-6P_ "-_d` --- S l J 1/4 S W 1/4 S )C) T z8 IN )� E (or W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# k� Sr . NE SULTF t0D lzg — City State Zip Code Phone Number-0y l L` �' �� ADO ❑ City Lj Village ® Town Nearest Road �L.rc�.n�E MN �Ll�l9 (�63)'t57-7568 �1Z-U�f 1"1VlCZFt�,1.,� -�-� ® New Construction Use:® Residential / Number of bedroem: _ g Cade derived desi n flow rate ❑ Replacement ❑ Public or commercial - Describe: Parent material t_0�3 ov k:'1t 1 LL Flood Plain elevation if applicable ti A General comments — and recommendations: 1 �OVy�� W / Cl 1X r� t, tMuw b C= F1 LL_, t -d Boring # ❑ Boring A ® Pit Ground surface elev. Q u�- 9 ft. moth fn r, mr r .. 3 Horizon Depth in. - Dominant Color Munsell Redox Description Clu. Sz.' Cant Color - Texture Structure Gr. Sz. Sh. Consistence Boundary Soil Application Rate Roots GPD/ft2 'Eff#1 •Eff#2 Z 3, 0-9 -z� Z-) 38 la1?p- 3!2 1o��3lL 7.s7231y _ si 1 G� is Z�sbk ZOS)pk h m v`Fti es C3 _ t_ 2 Ltr? 3/8 sl on c w1o)teo cg _ D - 3 o , S S �-C 2 -l0y 2 S!°� - b`FS � �� m'�i-• - r�� n oanng # u - ® Pit Ground surface elev. 4 OH • F6 ft. Denth M limifinn r M— 3 Cl Horizon Depth in. Dominant Color Munsell Redox Description Clu. Sz. Cont Color Texture Swcture Gr. Sz. Sh. Consistence Boundary Sail Application Rate Roots GPD/ft, •Eff#1 •Eff#2 Z. 0-9 g-ZO tZL)a I i Z l0`tlz-31b _ - si1 S! � ZPsbk Z'�5b1•C CS - •S .g 3 20 30 ti-S'i23)y Is- o s9 M l 30-LL2 1011z 6lG e1��=5�R SIQ • - S .. p Ce>f i Q-. _: p -- - •••� . R� - ovus cu mgn, ana 155 < 3o mg/L CST Name (Please Print) Signature CST Number Arthur L.`':Wegerer00=31g`-1Z8` 220254 Adds Wegerer Soil Testing & .Design Service Date Evaluation Conducted Telephone Number 421 N. Main St. River Falls, WI 54022 10, �3_ 715-425-0165 rLV1 rLarl Scale 1'=50' page .� of D - I Lcrr \z� one SP Lo r kZq CST Signature Date R6 qp9 .906 Aol 1 P-IZsc � �"� :�-✓ -t)o ti)uT �-CIn�� ter' Olt- DISTW2.13 i 71t1S %i-tZl`A 1 - l J 11 ♦5' g' L'% A I yob gay 907 9nmjH1 pF OLrtL h" EL 40$ , s . J � N 715--425-0165 220254 Telephone No. CST No 00-3►�_ 1zg Job NO. ___............. _ r- . ... 13 LOT 4 I / - C.S.M. - - 12� �h +,, I ,'l, / PAGE 5 I O ' i B-408 ' / B-350 Or r 2 B-405 I i PT i68+�7'04 1 J / / j• �'�� , / .PAGE 993 �l � �6 92. i LLJ I 1,2 ��,5.a ----- I /I - - - - - -- 13-348 ,04 ��909.3 ' J / PT�63+0!5.q0 LOT 1 C.S.M. iZ O \ I I / I , VOL. 6 l I I I I 1 � 1 � PAGE 1627 890.9 • -- 1 h� C, 891.4 \ ♦ L \, - 7- _ - _ - ---- -- - _" ' II