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HomeMy WebLinkAbout040-1034-95-005 County: St. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Sanitary Permit No: Safety and Building Division INSPECTION REPORT 552383 0 (ATTACH TO PERMIT) State Plan ID No: GENERAL INFORMATION Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Parcel Tax No: City village X Township Permit Holder's Name: Troy ,Town of 040-1034-95-005 Madigan, Jose h & Heather SectionTrown/Range/Map No: CST BM Elev: Insp. BM Elev.. BM Description: 0 760 13 tri 8.28.19.1121 1 TANK INFORMATION ELEVATION DATA MANUFACTURE CAPACITY STATION BS HI FS ELEV. TYPE Benchmark 3, (S /63. LS Septic s r 1'69'-5 Alt. BM Z 3 /,6 3 5 Dosing 3' ~S 3 ©JpA Bldg. Sewer 79-73 Aeration PO a t_ `~G ~v J ✓ bo St/Ht Inlet 5.9) 97.74 Holding St/Ht Outlet . 31 TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent _toAir ntake ROAD Dt Inlet Dt Bottom ~ Septic ~Is / ~r Header/Man. 7 13 174.52 Dosing 7 Aeration Dist. Pipe 9k - G5 , 7 O f~ Holding Bot. System 7.9 75 Final Grade , gC) 9~', 77 1 PUMP/SIPHON INFORMATION Demand St Cover A , 35 Manufacturer C~Sd- GPM ; Model umber TDH Lift riction Loss ead TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM enches DIMENSIONS No. Of PInside DiLiquid= th No. Of Tr BEDITRENCH Width ELen DIMENSIONS ~ L KE/STREAM LEACHING Manufacturer: SETBACK SYSTEM TO CHAMBER OR INFORMATION Type Of Syste^ UNIT Model Number: ~ cawe 16 d-/d 4- /6 = 0`6 DISTRIBUTION SYSTEM tion x Hole Size x Hole spacing vent to Air InJpS Distribu ~ dl Header/Man~o~ / 1 ~ 2~ Pipe(s) Length is Length Dia pacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Mulched Depth Over xx Depth of xx Seeded/ odded Depth Over Bed/Trench Edges Topsoil Yes Rfl No Yes No BedlTrench Center ~ nspection #2: COMMENTS: (Include code discrepencies, persons present, etc.) Inspection Parcel No: 08.28.19.1121 Location: 436 Coulee Trail fka Cty. gd. FF Hudso WI 5 016 (~IEE 1//4 NVt( 1/4 8 T28N R19W) NA Lot 1 ` ~"i 11a,. Ga J ~3 { I - ~-J 6L.: _s 4- L-ac.1L5 a j n 1.) Alt BM Description = I 2.) Bldg sewer length = 27 JiJLJL - amount of cover = Plan revision Required? Yes No L(P Use other side for additional information.- Cert. No. Date Insepctor' Signature SBD-6710 (R.3/97) PLOT PLAN N Project Name: Joseph & Heather Madigan Repacement Septic System Legal Description: NW 1/4 NE1/4, S8 T28N R19W P.I.D: M040-103344-955.-00055 Subdivision Name: NA Lot W Township: TROY Parcel Size: SCALE: 1" = 40' County: ST. CROISystem Elevation: 4 inch Sch 40 -ASTM D2665 Slope: 4 inch 3034 -ASTM D3034 A BM1 Elevation: 100.00' To of 2" PVC Di De T3=96.50' BM2 Elevation: 101.30' To of 2" PVC pipe ■ Backhoe Pits: NOTE: Existing septic tank and drywell to be abandoned as per code Q ~ ~ AdO~ r BtA.L W F LL A®fo Ski POOL tA~ A 10 t ,M i5~ iNFa ~ S rG ~~CtS i iNG r sy~" 1 5:"T. VJ/Pwr o i% s'~ s C©U L/ A-1 L i2! u% t ` 3 9 TO CvULf- 'TP-AIL P.IV County _ Safety and Buildings Division s / C ~O l R~GO 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI7ib/ 2 $ r ,~~N 25 2412 _ 55 Z 3 Y3 `S°~py"Emit Application State TransactionNumber In accordance with SPS 383'.Lyl'Iz), Wis. Adm. Code, submission of this form to the appropriate governmental unit 'AvI A is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Add ss (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. S"JL l 1. Application Information - Please Print All Information Property Owner's Name Parcel # JOSEP ~rJco c Tyge7' 44,0/ Iq Dy©-/D3~-~~'~®s 1 Property Owner's Mailing Address ~Q 1 Property Location 2 6 l ai~0 _L!C T1 141 L Govt. Lot City, state Zip Code Phone Number _K y,, 0 y<, Section 14 vlS© to V V 1 1,51-1016 T Z 8 N' R irc1E o12w ) 11. Type of Building (check all that apply) Lot # I v % I or 2 Family Dwelling - Number of Bedrooms Subdivision Name ~lrS?1 /J Block # El Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use C\S Nu q qo y ❑ Village of Town of C97 - Zoe ~ . III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑ New System Replacement System El Only Treatment/Holding Tank Replacement ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner Vn 16n f -K, S . j j IV. Type of POWTS System/Component/Device: Check all that apply) ISNon-Pressurized I,n-Gro ~d ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound0- > 24 in. f suitable it ❑ Mound < 24 in. of suitable soil ❑ Holding Tank L'7 Other Dispersal Component (explain) retreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdst) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System t vation 75-0 D. 5 l/aV-- / S'Q © 15-00 96, S© VI. Tank Info Capacity in y Total # of Manufacturer Gallons Gallons Units ` ?O L Y L® 1\ 5-2 5js e U y New Tanks Existing Tanks a a`j a`U 6~ W)i E,3 a Septic or Holding Tank r~ O D I ~C /A Dosing Chamber ! J VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum i re MP/MPRS Number Business Phone Number ,~j I JDOtj SC14MITT y 7Z3760 7i5 -7PO --©Y8 Plumber's Address (Street, City, State, Zip Code) VIII oun epartment Use Only Approved El Disapproved Permit Fee 0 Date Issued ssuing Agent gn e $ 7 S ' (126,l 2 ❑ Owner Given Reason for Denial IM iMVproval/Reasons for Disapproval / 1 Septic tank, effluent filter and . dispersal cell must all be serviced / maintained SPS 3 g 3. 3 3 as per management plan provided by plumber. „hV 40 6-,KX_ 61A- 2. All setback requirements must be maintained cp ' nces. O tom- C) 1 j9 - NjA) AJe- Attach to complete plans for the system and submit to the County only on paper no less than 8 1/2 x 1 t inches in size SBD-6398 (R. I1/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Madigan Replacement Septic System Owners Name: Joseph & Heather Madigan Owner's Address 436 Coulee Trail Hudson, WI 54016 Legal Description: NW1/4, NE1/4, S8, T28N, R19W Township Troy County: St. Croix Subdivision Name: 5.15 Acre Parcel CSM 07-2016040-88 Lot Number: 1 Block Number Parcel I.D. Number 040-1034-95-005 Plan Transaction No. Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross Section Page 4 Septic Tank Specifications Page 5 Effluent Filter Information Page 6 & 7 EZ Flow Information Page 8 & 9 Management and contingency plan Page 10 Septic Tank Maintenance Agreement Page 11 CSM Page 12 Warranty Deed Page 13-16 Soil Evaluation Report Designer: John Schmitt Licnese Number: MPRS 223760 Date: 6/25/2012 Phone Number: 715-760-0486 /!L Signature: 4~~A loor In-Ground Soil Absorption Component Manual Version 2.0 SBD-10705-P (N. 01/01) Page 1 of 16 PLOT PLAN N Project Name: Joseph S Heather Madigan Repacement Septic System Legal Description: NW 1/4 NE1/4 S8 T28N R19W P.I.D: 040-1034-95-005 Subdivision Name: NA Lot 1 Township: TROY Parcel Size: 5.15 Acres SCALE: 1" = 40' County: ST. CROIX System Elevation: T1=96.5093.70' 4 inch Sch 40 -ASTM D2665 Slope: 3% T2=96.50' 4 inch 3034 - ASTM D3034 A BM1 Elevation: 100.00' To of 2" PVC pipe T3=96.50' A BM2 Elevation: 101.30' To of 2" PVC pipe ■ Backhoe Pits: NOTE: Existing septic tank and drywell to be abandoned as per code Q ~ I $M'Z W FUL 0 30/0 B3 I Ski Poo6 10-11 yN t .C- ist-rNf ig.r 1~F ~YlsT~NG ~'~yw```® s g~0aoo i i t{a(A sr_ s r. /PdL`{~ol~ s ~ 3Y0 lit' ` COU T-R A.) L 4 0 I 2q TO CoULf TQA1L PIVJ SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Page Of Project Name: Joseph & Heather Madigan 3 No. of Cells 10 Per Cell 3 ft Cell Width 30 Total No of EZ1203H 100 ft Cell Length 500 sq ft EISA Per Cell 3 ft Cell Spacing 1500 sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: Infiltrator Gravelless Leaching Unit Model: EZ1203H Typical Cross Section Finished Grade 99.7 ft Observation Pipe with approved cap or vent i am am am 11■. ■ ■ ■ aI Soil Backfill 38 in Geotextile Fabric -NN 96.5 ft Infiltrative Surface 12 in 0 7 89.1 ft Limiting Factor 88 in Slotted and Anchored Vent/ Observation Pipe with Cap Plumber/Designer Signature: License 223760 Date: 6/25/2012 Installation Instructions for VAEZfl TM E Zflow Systems in Wisconsin FILTRATOR . Wisconsin Department of Commerce, Safety and Buildings 5. The Absorption area (SF) necessary for a given site shall Division, has reviewed the specifications and/or plans for this be sized based on maximum daily sewage flow (GPD) and product and determined it to be in compliance with chapters the Permeability for the site. If certain criteria is met, the Comm 82 through 84, Wisconsin Admin. Code, and Chapters EISA sizing can be used in Wisconsin, resulting in a 40% 145 and 160, Wisconsin Statutes. All sites must meet the Site smaller drainfield. & Soil Conditions & Locations & Isolation distances as noted in local regulations. 6. Place EZflow bundle(s) in the EZflow configuration ap- proved by system design permit specified for the particu- The approved products are 1203H (3-12" bundles with pipe in lar site. The top or center-most bundles containing pipe center bundle in 5' or 10' lengths) and 1203HP (3-12" bundles are joined end to end with an internal pipe coupler. Any with pipe in each bundle in 5' or 10' lengths. additional aggregate only bundles that may be required, should be butted against the other aggregate-only bun- A single pipe bundle contains a four inch perforated pipe sur- dies and do not require any type of connection. rounded by EPS aggregate and is held together with poly- ' ehtylene netting. A single aggregate bundle contains aggregate 7. The top of each GEO cylinder contains a filter fabric pre- only and is held together with polyethylene netting. manufactured in between the netting and aggregate. The fabric is inserted to prevent soil intrusion. The installer Materials and Equipment Needed shall make sure the the GEO is positioned upward and is • EZflow Bundles in contact with the fabric contained in the adjacent cylin- • EZflow Geotextile Fabric : der before backfilling. • EZflow Internal Pipe Couplers • Pipe for Header and Inlet 8. The EZflow Drainfield Systems should be installed in a • Backhoe/Excavator level trench in all directions (both across and along the trench bottom) and should follow the contour of the ground Installation Instructions surface elevation (uniform depth), with all continuous The instructions for installation of EZflow products are given adjoining 10-foot cylindrical bundles placed end to end, below. This product must be installed in accordance with state with central bundle distribution pipe interconnected, rules defined in chapters Comm 82 through 84, Wisconsin Ad- without any dams, stepdowns or other water stops. ministrative Code, and Chapters 145 and 160, Wisconsin Stat- utes, as well as the local health department's current design 9. The trench top shall be graded such that water will not manual. : pond. Backfill should be seeded or sodded immediately after completion to reduce erosion. 1. After the local health department has determined sizing, configuration, and layout for the EZflow systems, stake 10. EZflow EPS bundles are flexible and can fit in curved or mark with paint the location of trenches and lines. Be trenches as may be necessary to avoid trees, boulders, or careful to set correct tank, invert pipe, header line or dis- other obstacles. tribution box and trench bottom elevations before instal- lation of pipe bundles. 11. EPS aggregate is lighter than water, therefore, it might be expected that natural buoyancy forces would tend to 2. Remove plastic EZflow shipping bags prior to placing cause EZflow assemblies to float out of ground when bundles in the trench(es). Remove any plastic bags in the ponding occurs. Field experience has shown, however, trench before system is covered. that this is not a problem when systems have a minimum of 6" of soil cover as recommended by manufacturer. 3. This product must have geotextile fabric that meets re- quirements of s. Comm 84.30 (6) (g), Wis. Adm. Code, installed directly on top of the product and extending 1203H-GEO down along the sides of the product to a point at least six : inches from the bottom of product. : Geotextile Barrier Material 4. When installed in a trench, the trench should be dug to a width of 36 inches. This not only saves labor in excava- 12" tion, but also provides better load-bearing capacity after backfilling is complete. Oxlnc. INSTALLATION INSTRUCTIONS Innovationsin Precast, Drainage Zabel' PL-525/PL-625 FILTER & Wastewater Products A DMsIon of PaY& Inc. INSTALLATION INSTRUCTIONS Center filter with opening W N J M0 S k. ~ e Additional pipe or G?, Polylok Extend & Lok° Glue for centering. Step 1: Step 2: Step 3: (A) Locate the outlet of the septic tank. (A) Before installation, place the (A) Glue the filter housing on the (B) Remove tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. if necessary. (B) Make sure that the housing (B) Insert the filter cartridge in the is positioned so the filter can be housing, making sure the filter removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted in the housing. MAINTENANCE INSTRUCTIONS a~ .e Step 1: Step 2: Step 3: Locate the outlet of the septic tank. (A) Remove tank cover and pump (A) Insert the filter cartridge back if necessary. into the the housing making sure DO NOT USE PLUMBING (B) Pull the filter out of the housing. the filter is properly alighed WHEN FILTER IS REMOVED (C) Hose off the fitter over the septic tank. and completely inserted. USE RUBBER GLOVES Make sure all solids fall back into the (B) Replace septic tank cover WHEN CLEANING IFILTER septic tank. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_of FILE INFORMATION SYSTEM SPECIFICATIONS Owner: Joseph & Heather Madigan Tank Manufacturer: Wieser Concrete r NA Permit # -5-1 K Septic E Dose Holding Volume: 1500 gal DESIGN PARAMETERS Tank Manufacturer: Wieser Concrete F NA Number of Bedrooms: 5 r NA F Septic E: Dose Holding Volume: 900 al Number of Public Facility Units: NA Vertical Distance Tank Bottom (s) to Service Pad: ft Estimated (average) Flow: 500 al/day Horizontal Distance Tank(s) to Serivice Pad: ft Design (peak) Flow = estimated x 1.5: 750 gal/day Specific servicing mechanics must be provide if vertical is>15 feet or if In Situ Soil Application Rate: 0.5 gal/day/ft2 horizontal is > 150 feet. Specific instructions to be provided on back. Standard Domestic Influent/Effluent Monthly average Effluent Filter Manufacturer: Polylok F NA Fats, Oils & Grease (FOG) :530 mg/L Effluent Filter Model: 525 Biochemical Oxygen Demand (BOD5) :5220mg/L r NA Pump Manufacturer: IF NA Total Suspended Solids (TSS) s150mg/L Pump Model: High Strength Influent/Effluent Monthly average Petreatment Unit Fats, Oils & Grease (FOG) 530 mg/L Manufacturer: Biochemical Oxygen Demand (BOD5) 5220mg/L NA r Mechanical Aeration r Peat Filter 9 NA Total Suspended Solids (TSS) 5150mg/L r Disinfection r Wetland Petreated Effluent Monthly average r Sand/Gravel Filter r Other. Biochemical Oxygen Demand (BOD5) 530mg/L Soil Absorption System Total Suspended Solids (TSS) 530mg/L NA a In-Ground (gravity) r In-Ground (pressure) r" NA Fecal Coliform (geometric mean) 5104cfu/100m1 r At-Grade r Mound Maximum Effluent Particle Size: % in dia. F N r Drip-Line r Other. Other: r Other: F NA MAINTENANCE SCHEDULE Service Event Service Frequency When combined with sludge and scum equals one-third of tank volume Pump out contents of tank(s) When the high water alarm is activated month(s) Inspect condition of tank(s) At least once eve : 3 of year(s) (Maximum 3 ears) r NA r month(s) Inspect dispersal cell(s) At least once eve : 3 as year(s) Maximum 3 ears) r NA r month(s) Clean effluent filter At least once eve : 1.5 10 year(s) r NA month(s) Inspect pump, pump controls & alarm At least once eve : r year(s) I✓ NA r month(s) Flush laterals and pressure test At least once eve : r year(s) r NA month(s) Other: At least once eve : r year(s) r NA Other: MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Insepector; POWTS Maintainer; Septage Servicing Operator (pumper). Tank inspections must include a visual inspeciton of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and a check for any back up or ponding of effluent on ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicated a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumualtion of sludge and scum in any treatment tank equals one-third or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Admininistrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, petreatment units, and any servicing at intervals of <_12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 30 days of completion of any service event. (Rev.2/05) Page of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During extended power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose and may overload them resulting in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) discharge; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide the opportunity to obtain a sanitary permit for a code compliant replacement system: ❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ® The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. WARNING: TREATMENT TANKS AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES AND LACK SUFFICIENT OXYGEN TO SUPPORT LIFE. NEVER ENTER A TREATMENT TANK OR HOLDING TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK IS VERY DIFFICULT. ADDITIONAL INFORMATION: POWTS INSTALLER POWTS MAINTAINER Name: John Schmitt Name: John Schmitt Phone: 715-760-0486 Phone: 715-760-0486 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name: Owners Choice Name: St. Croix County Zoning Phone: Phone: 715-3864680 This document is intended to meet minimum requirements of Ch. Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. Use of this document does not guarantee the performance of the POWTS. (Rev. 2/05) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer JQ-51-:--Pjj A tUd J~CA-7-tl F10 y4 d 6 t) Al Mailing Address 1-136 Co u L 6 9 T,,,eL , Y" SG AJ 'S-'/016 Property Address .5,4me (Verification required from Planning & Zoning Department for new construction.) _ I City/State Parcel Identification Number 10-1/0 .103 41- > LEGAL DESCRIPTION Property Location N Y4 , N '/4 , sec. T 2_N R jW, Town of %,2® y Subdivision Plat: , Lot # / . Certified Survey Map # Volume _ Z , Page # ?-0/ 6. Warranty Deed # 8 5-6 7 (before 2007)Volume Z Page # 130 Spec house ❑ yes Kno Lot lines identifiable i~ yes ❑ no SYSTEM MAINTENANCE AND OWNER CERTIFICATION 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. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, 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 staring that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms a yze..--~X -(9 /60077111/ IQ SIG T OF CANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 09/07) Department of #lsso SOIL EVALUATION REPORT- S P s Safety and in accordance with Comm 85, Wis. Adm de Page 1 of Professional Services Schmitt Soil Testing, Inc. County Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must St. Croix 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. -1034-95-005 on, I Please print all inform p+ eA Reviewed Date / Personal information you provide may be used for secondar rptseb{turu)w, s. 15.04 (1) (m)). - ZS v' Property Owner ~ Property Location Madigan, Joe & Heather 1UN 2 6 2012 Govt. Lot NW1A NE1/4, S8, T28N, R18W Property Owner's Mailing Address Lot # i Block # I Subd. Name or CSM# 436 Coulee Trail PANNING & ZONING OFF 1 ~ I CSM 07-2016040-88 City State Zip Code Phone Number City Village Town Nearest Road Hudson WI 54016 651-226-4282 Troy Coulee Trail New Construction Use: Residential / Number of bedrooms 5i Code derived design flow rate 750 _GPD Replacement Public or commercial - Describe: _ Parent material Outwash Sand Flood plain elevation, if applicable NA ft. General comments Replacement area is suitable for a conventional system with a 0.5 gpd/sq ft rate. Possible system elevation for area is 96.50 ft, and recommendations: Slope of area is 3%. a Boring # Boring _ 'Pit Ground surface elev. _100.09_ ft. Depth to limiting factor _135+_ in. Soil Application Rate Horizon Depth Dominant Color i Redox Description Texture Structure Consistence, Boundary Roots GPD/ft2 in. Munsell ! Qu. Sz. Cont. Color Gr. Sz. Sh. ! L Eff#1 'Eff#2 1 0-11 10yr3/3 none I 2mgr mfr as i if,2vf 0.6 0.8 2 11-17 10yr4/4 none sit 2msbk mfr gw im,if 0.6 0.8 3 ! 17-28 10yr4/4 none ! grsl 2msbk mfr cs 2m 0.6 1.0 2 0.7 1.6 4 8-49 10yr6/4 none cos ! Osg ml cs ! 5 -135 ! 10yr6/4 j none j s Osg ml 0.7 ! 1.6 7?~ OS 21 Boring # Boring Pit Ground surface elev. 100.14 ft. Depth to limiting factor 133+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description 1 Texture Structure Consistenc Boundary Roots ' GPD/ft' in. Munsell Qu. Sz. Cont. Color i Gr. Sz. Sh. 'Eff#1 'Eff#2 1 I 0-16 10yr3/2 none I 2mgr mfr as 2m,2vf 0.6 i 0.8 2 16-29 i 10yr4/4 none $il 2msbk mfr gw 2m,ivf 0.6 0.8 i 3 29-35 Oyi r4/6 none ( sl 2msbk mfr gw I ivf 0.6 1.0 7 1.0 4 35-54 10yr6/6 none cos Osg ml Cs 5 54-78 10yr6/4 none fs Osg ml cs 0. 10 6 78-133 10yr6/4 none I S ( Osg ml { j 0.7 1.6 " Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 s30 mg/L and TSS s.30 mg/L CST Name (Please Print) Sign~I CST Number Thomas J. Schmitt227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 6/13/2012 715-760-1978 SBD-8330 (11.07/00) -Property Owner Mad~t an~Joe & Heather Parcel ID # 040-1034-95-005 Page 2 of Boring 3 Boring # Pit Ground surface elev. 99.45 _ ft. Depth to limiting factor 137+ in. Soil Application Rate F Horizon i Depth I Dominant Color Redox Description ; Texture Structure ~Consistencel Boundary j Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color j ; Gr. Sz. Sh. `Etta *Eff#2 1 0-14 j 10yr3/3 j none I 2mgr i mfr I as ! 2vf 0.6 0.8 2 14-21 j 10yr3/4 none - , sil 2msbk mfr gw 1vf 0.6 1 0.8 3 21-29 10yr4/4 none sl I 2msbk mfr gw I im,1vf j 0.6 1.0 4 29-51 j 10yr6/6 none cos Osg_-_ ml j cs 0.7 I 1.6 5 48-1371 10yr6/4 none s Osg ml - 0.7 I 1.6 'Boring F-1 Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color ' Redox Description I Texture j Structure lConsistence,j Boundary Roots I GPD/ft2 j in, j Munsell Qu. Sz. Cont. Color 1 Gr. Sz. Sh. Eff#1 Etf#2 1 I I j I I ' - I i Boring Boring # Pit Ground surface elev. , ft. Depth to limiting factor in Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure jConsistence; Boundary Roots I GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. j 'Eft#l 'Eff#2 I Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L ' Effluent #2 = BOD5 < 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 TTY 608-264-8777. SBD-8330 (R.07/00)- Schmitt Soil Testing, Inc. Page 3 of 4 Conducted by: Conducted For: Schmitt Soil Testing, Inc. Name: Joseph & Heather Madigan Thomas J. Schmitt, CST 227429 Address: 436 Coulee Trail 1595 72nd St. City, State, Zip: Hudson, W154016 New Richmond, WI 54017 Phone: 715-760-1978f PI D: 040-1034-95-005 Signature, Lot No.: 1 Date 6 Legal Description: NWl/4 NEU4 S8 T28N R19W Backhoe Pit Township, County: Troy, St. Croix County Bench Mark 1 El. 100.00' Top of 2" pvc pipe. Bench Mark 2 El. 101.30' op of 2" pvc pipe Slope= 3% / V 40' S-3 B I .W1WF[. L 3 w I I 7ANI +f=L_~ w~ CLL- _ Ll Ne 1 1 1•~. t - .t . r' s _ r ti Rr o e: s T n- F - r. r~ Amw h .r M VOL 12 PG f. . Id`s T `sue 440505 CERTIFIED SURVEY MAP Located in part of the NE4 of the NW4 and part of the NWk of the NE4, all in Section 8, T28N, R19W, Town of Troy, St. Croix County, Wisconsin. 2 Ni Corner of d o eef+ r . r`C ~D Section 8 N 'U o a~ Awa a4 I5bb N ~ H N 01 . ° ° C ° O N C W O ~ N W C Unplatted land .t L 8 L ro N8805913911E ° s n 4J 0 320.001 i° 3.5' 235.00' 85.00' a L {I 7 ro L y W O N ~ C ro I rea ncluding R/W 224;l~1 Sq. Ft. ~ 5.15 Acres o N I SCALE IN FEET .°I I bl f4 Area Excluding R/W: 0 100 200 340 207,468 Sq. Ft. °71 v 4.76 Acres o 3 y ro ta s LOT I c C11 M ui~ M house E oo y 19 County Section Monument outbuildings v a o 1n x 2411 Iron Pipe Set, weighing 0 9- 1.68 lbs. per linear foot. 1 N L C. a s- A Existing Fence Line o (SEE DETAIL c W BELOW) ° N OWNER 0).' e a1, Glen Wiese l 00 Rt. 3 zl °D I dl River Falls, Mi. 54022 C c >I •i ~,y \ S33°32'IT~~ m j a I N 1 .1 rr 7.00' ~ dl m I •1 %P M j •;j ~'0 1. ALLEN G. o~j,~~,~ \ :Ys NYHAGEN O s n S-1407 HUO N, u o_ 00 2 ?c• 4.46' S} Corner of \ Section 8 DETAIL 1" = 10' this instrument was drafted by Fran Bleskacek job no. 87-02-188 AN 24 08 v T PAGE 2016 ST. CROD(COUNIY CMPFAHBMWPAMPLANNIN~ AND ZomG commffmE CURVE DATA TABLE RADIUS CENTRAL CHORD CHORD No. LENGTH ANGLE BEARING LENGTH TANGENT BEARINGS ARC LENGTH 1-2 11459.16' 1008'12" N55°33'37"W 227.33.' N56°07'43"W N54059 31"W 227.33' 3-4 11421.16' 1°16'03" N55°29'41.5"W 252.65' N56°07'43"W N54051 40"W 252.66' 5-6 11409.16' 0001'44" N54°5010311W 5.75' N54°50'55"W N5404991111W 5.75' SURVEYOR'S CERTIFICATE I, Allen C. Nyhagen, registered Wisconsin Land Surveyor, do hereby certify that by the direction of Glen Wiese, I have surveyed, described and mapped the land parcel which is represented by this Certified Survey Map; that the exterior boundary of the land parcel surveyed and mapped is described as follows: A parcel of land located in part of the NA of the NEa and part of the NE4 of the NW4, all in Section 8, T28N, R19W, Town of Troy, St. Croix County, Wisconsin; further described as follows: Commencing at the Nk corner of said Section 8; thence S01000'21"E along the north and south one-quarter line, 220.85 feet to the point of beginning of this description; thence N88059'39"E 85.00 feet; thence S01000'21"E along the west line of Certified Survey Map volume 5, page 1385, 798.51 feet; thence N56007'43"W along the centerline of C.T.H. "FF", 183.23 feet to the point of curvature of a 11459.16 foot radius curve concave northeasterly whose central angle measures 1008'12" and whose chord bears N55033137"W and measures 227.33 feet; thence northwesterly along the arc of said curve and centerline 227.33 feet; thence N00034'30"E 562.12 feet; thence N88059'39"E 235.00 feet to the point of beginning. Subject to right-of-way for C.T.H."FF" as shown on this map and all other easements of record. I also certify that this Certified Survey Map is a correct representation to scale of the exterior boundary surveyed and described; that I have fully complied with the current provisions of Chapter 236.34 of the Wisconsin Statutes and the Land Subdivision Ordinance of the County of St. Croix in surveying and mapping same. 9 Allen C. Nyhagen VOLUME 7 PAGE 2016 1111111 IIIlI IIIiI 11111 IIIII 1111! 1111 111111 1111 1111 * 8 5 6 7 5 6 1 State Bar of Wisconsin Form 1-2003 856756 WARRANTY DEED KATHLEEN H. WALSH REGISTER OF DEEDS Document Number Document Name ST. CROIX CO., WI RECEIVED FOR RECORD 08/02/2007 08:30AM THIS DEED, made between Anthony C. Nasvik and Nancy A. Nasvik, husband WARRANTY DEED and wife EXEMPT e ("Grantor," whether one or more), REC FEE: 11.00 and Joseph Madigan and Heather A. Madigan, husband and wife TRANS FEE: 1179.00 PAGES: 1 ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address "buvr 41L &e 7! needed, please attach addendum): -7 55V 5 River ley Abstract & Title, Inc. z Part of the NE 114 of the NW'/. and Part of the NW 1/4 of the NE 114 of Section 8, 1200 ford street, suite 201 Township 28 North, Range 19 West, St. Croix County, Wisconsin, described as Hudson, wt 54016 jj tc4_ 0-) jj V-35 follows: Lot 1 of Certified Survey Map filed August 24, 1988 in Volume 7, Page File # 2694865 2016, Document No. 440805, Town of Troy, St. Croix County, Wisconsin. 040-1034-95-005 Parcel Identification Number (PiN) This homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Easements, restrictions and rights-of-way of record, if any. Dated July k, 2007 (SEAL) (SEAL) * * Anthony C. Naffik ZA/ (SEAL) W~ (SEAL) * * Nancy A. NasvAL AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) authenticated on )Ss. S4 . a COUNTY ) * ~t `s P 0 1(; r . Personally came before me on July 2007 , TITLE: MEMBER STATE BAR O ?ysfl c~ the above-named Anthony C. Nasvik and Nancy A. Nasvik (If not, to me known to be the person(s) who executed the foregoing authorized by Wis. Stat § 706.06) insln ent and ackno 1 e the same. i THIS INSTRUMENT DRAFTED BY: Attorney Doug Berg 1200 Hosford Street, Suite 201 Hudson, WI 54016 Notary Pub ' , State of Wisconsin ter- C - My Commission (is permanent) (expires: (ft-tures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. 1 of 1 -~xe+~TyR~r Department of ~jV%QIL EVALUATION REPO #1690 S P Safety and Vk in accordance with Comm 85, Wis. Adm. Code Page 1 of r tf Professional Services 12 Schmitt Soil Testing, Inc. O 5 2 County , Attach Acomplete site plan on n~~s"fhan 8/: x 11 inches in size. Plan must p paper St. Croix include, but not limited to: vertical and ho ' Lref~ q*int (BM), direction and percent slope, scale or dimensions, n hN~r pElt~!lio cation and distance to nearest road. Parcel I.D. W 040-1034-95-005 Please ~ lint all information. Reviewed By Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Madigan, Joe & Heather Govt. Lot NW1/4, NE1/4, S8, T281N, R18W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 436 Coulee Trail 1 CSM 07-2016040-88 City State Zip Code Phone Number City []Village ❑ Town Nearest Road Hudson WI 54016 651-226-4282 Troy Coulee Trail ❑ New Construction Use: ❑ Residential / Number of bedrooms 5 Code derived design flow rate 750 GPD Replacement ❑ Public or commercial - Describe: Parent material Outwash Sand Flood plain elevation, if applicable NA ft. General comments Replacement area is suitable for a conventional system with a 0.5 gpd/sq ft rate. Possible system elevation for area is 96.50 ft. and recommendations: Slope of area is 3%. a Boring # ❑ Boring Pit Ground surface elev. 100.09 ft. Depth to limiting factor 135+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EfW 1 0-11 10yr3/3 none I 2mgr mfr as lf,2vf 0.6 0.8 2 11-17 10yr4/4 none sil 2msbk mfr gw 1m,lf 0.6 0.8 3 17-28 10yr4/4 none grsl 2msbk mfr Cs 2m 0.6 1.0 4 28-49 10yr6/4 none cos Osg ml Cs 0.7 1.6 5 49-135 10yr6/4 none s Osg ml 0.7 1.6 ❑ Boring 2 Boring # 0 Pit Ground surface elev. 100.14 ft. Depth to limiting factor 133+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *EN#1 *Eff#2 1 0-16 10yr3/2 none I 2mgr mfr as 2m,2vf 0.6 0.8 2 16-29 10yr4/4 none sil 2msbk mfr gw 2m,lvf 0.6 0.8 3 29-35 10yr4/6 none sl 2msbk mfr gw 1Vf 0.6 1.0 I 4 35-54 10yr6/6 none cos Osg ml Cs 0.5 1.0 5 54-78 10yr6/4 none fS Osg ml Cs 0.5 1.0 6 78-133 10yr6/4 none s Osg ml 0.7 1.6 * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 s30 mg/L and TSS S.30 mg/L CST Name (Please Print) Sign t CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 6/13/2012 715-760-1978 SBD-8330 (R.07/00) Property Owner Madigan, Joe & Heather Parcel ID # 040-1034-95-005 Page 2 of 5 ,s,, Boring # E] Boring 3 N Pit Ground surface elev. 99.45 ft. Depth to limiting factor 137+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 1 0-14 10yr3/3 none I 2mgr mfr as 2vf 0.6 0.8 2 14-21 10yr3/4 none A 2msbk mfr gw ivf 0.6 0.8 3 21-29 10yr4/4 none sl 2msbk mfr gw im,ivf 0.6 1.0 4 29-51 10yr6/6 none cos Osg MI Cs 0.7 1.6 5 48-137 10yr6/4 none s Osg ml 0.7 1.6 [ ] Boring F-1 Boring # Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fts "Eff#1 "Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Boring F Boring # ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDlfP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 •Eff#2 ' Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <_150 mg/L " Effluent #2 = BODS < 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 TTY 608-264-8777. SBD-8330 (R.07/00) Schmitt SON Testing, Inc. Page 3 of 4 Conducted by: Conducted For: ' Schmitt Soil Testing, Inc. Name: Joseph & Heather Madigan Thomas J. Schmitt, CST 227429 Address: 436 Coulee Trail 1595 72nd St. City, State, Zip: Hudson, WI 54016 New Richmond, WI 54017 Phone: 715-760-1978 PID: 040-1034-95-005 Signature, .e . Lot No.: 1 Dat. /.l Legal Description: NW1/4 NE1/4 S8 T28N R19W Backhoe Pit Township, County: Troy, St. Croix County Bench Mark 1 El. 100.00' Top of 2" pvc pipe. Bench Mark 2 El. 101.30' op of 2" pvc pipe Slope= 3% / 1.. = 40' J 1 S~IP'2 j,3,lrnrhiN ~ p2ywrLL /c ~GuS ~ GtJfN~~w 3 1 10~ i I I ;'1. \ ~ ` i / i r_._ i~ r •r ~ ~ ~ ~ _ ~ ~ ~ I . ' ® ~ ,t. ~ ~ = i u,. ~ l 1 _ 1. ~ ~K ~'1 `_1 ~ ~ , _.t j ~ - i_,~,, ~ ~ i i i I ,f. ~ E,t f - i i { , ~i , j~ } _ i II - i / .v k .r ' q ^ E b Qti" n a`. `M1 w • f st:• " ► ti ' a :P i s • 4''... u -TV k"m „y W .4: if„t. s- CGS' .j•::': xr k~