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
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201 W. ioW Ave, M, Bvx 7 D1
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s'"q• "'"``. �J
litPermit App ation
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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)
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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