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HomeMy WebLinkAbout040-1316-13-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 552392 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)J. Permit Holder's Name: City Village X Township Parcel Tax No: Boyd, Christopher & Cara Troy, Town of 040-1316-13-000 CST BM Elev: Insp. BM Elev: BM Description: Sectionfrown/Range/Map No: 66M 1 G~T° 05.28.19.2069 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic _ Z. r Ili®v Benchmark Z /65.3 /OZ -7 r Dosing , Alt. BM ~Q tt # /O ! g' 9 (o,7 Aacatien Bldg. Sewer rt 11, 51-4 Holding St/Ht Inlet I S b g(y l TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. V,gnt to Air Intake ROAD Dt Inlet Septic i 33 1•5 Dt Bottom Dosing / S iS C Header/Man. 12.0 Z 7- ~ J 7J Aeration Dist. Pipe I Z Hold[ng Bot. System 13-(0 7 Final Grade PUMP/SIPHON INFORMATION i Manufacturer Ll( GPI nd St Cover Model Number ( d._.__= v.. ...x_:,. ~..n. TDH Lift Friction Loss System He~y~A TDH Ft //'IT w - Forcemain Length Dia. i 1 Dist. to Well Z SOIL ABSORPTION SYSTEM id Depth BED/TRENCH Width 1-Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dial Liqu DIMENSIONS qyr~ ~t~i~G, o, SETBACK SYSTEM TO VV P/L BLDG WELL LAKE/STREAM LEACHING Manufactureyt INFORMATION CHAMBER OR A ~G 3 Type Of System: 75 ~L A JA- UNIT Model Number: O a.Je ~ o n. G KAI_~ DISTRIBUTION SYSTEM $o J IS 3(a JL-e, 4-.J Header/Manifoly /J Distribution Ix Hole Size Ix Hole Spacing Veto Air Intake Pipe(s) 00 ~.~a~ Length 5 Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Mulched Depth Over Depth over xx Depth of xx Seeded/Sodded T Bed/Trench Center Bed/Trench Edges Topsoil es No Yes Q No ti COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 513 Autumn Blaze Trail Hudson, WI 54016 (SE 1/4 SW 1/4 5 T28N R1 9W) Cedar Woods Lot 13 Parcel 1: 05.28.19.2069 1.) Alt BM Description h~a~Z 2.) Bldg sewer length - amount of cover = db~et~/o.t-ue~ A -7 Plan revision Required? Fe-1 Yes No c,~ 2~ I Z 3 Use other side for additional informatin SBD-6710 (R.3/97) Date Insepctor's S' ature Cert. No. SITE PLAN Chris Boyd SE,SW,S8,T28N/R19W Lot 13 1.96A.C. Troy township St. Croix county System elev. 95.1' thru 91.93' LEGEND I BM: 102.?' top of PVC pipe r n00 A 2BM: 98.5' top ofPVC piped LN% r c~ ~~n ~t~aU1~ X - pit q ~.v O - grade elevations - - contour No Comm 83 set back problems Scale 1"- q0' except where indicated Ito Wet zoo ~ ~ - a1a ~2a ose ...goo o . - W pan c 9 or daY 4'x-1 ~ ~ • . 7i -...~~'~C7~D ` - project: BOYD page o1 RECEIVED County Safety and Buildings Division St. Croix 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) ~scons 1 0 ~ 7 Madison, WI 53707 7162 Department of Commerce 608 266-3151 56-2_3qs/ F;:F State PlanI.D. Number State Sa~Cf WIN-11ftit Application Z Project Address (if different than mailing address) In accord with Comm 83.21, Wis. Adm. Code, personal information you provid maybe used for secondary purposes Privacy Law, sI5.04 I)( m) 513 Autumn Blaze Trail I. Application Information - Please Print All Information Property Owner's Name cel # Lot # Block # Mr. Chris Boyd 040-1316-13-000 13 Property Owner's Mailing Address Pro C l 1580 84th Street 2067 City, State Zip Code Phone Number SE SW '/4, Section 5_ New Richmond, WI 54017 715/308-3215 T28N/R 19w II. Type of Building (check all that apply) X 1 or 2 Family Dwelling - Number of Bedrooms Four Subdivision Name CSM Number Cedar Woods ❑ Public/Commercial - Describe Use ❑ State Owned - Describe Use City Village X Township of Troy III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. X New System Replacement System Treatment/Holding Tank Replacement Only Other Modification to Existing System B Permit Renewal Permit Revision Change of Plumber Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration owner IV. T m: eck all that apply) 01 Non -Pressurized In-Ground Mound > 24 in. of suitable soil Mound < 24 in. of suitable soil At-Grade Single Pass Sand Filter Constructed Wetland Pressurized In-G J olding Tan7t~ Peat Filter _ Aerobic Treatment Unit -Recirculating Sand Filter Recirculating Synthetic Media Filter " Lea hing Chamber Dri Line Gravel-less Pipe Other (explain 3 A7/ I" Z V. Dispersal/Treatment Area Information: ti Design Flow (gpd) Design Soil Application Rate(gpdsf) ispersal Area Required (sf) Dispersal Area Proposed (sf) ystem Elevation 600 ✓ 0.7 Q~_ - VV%I 857.14.sq.ft. 900q.ft. r 95.1' thru 91.93' VI. Tank Info Capacity in Total umber Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks SO* or Holding Tank 1200 1200 1 Wieser Concrete X Aerobic Treatment Unit v!(/ ,~j t n (3 Oik Chamber 800 800 combo/ 1/X VII. Responsibility Statement- I, the undersigned, a ume respo sibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber' S' ature MP/MPRS Number Business Phone Number Kent Hoke NW224199 715/962-4155 Plumber's Address (Street, City, State, Zip de) 200 Bremer Ave., Suite D , Colfax, WI 54730 VII oun epartment Use Only 1LXC Approved El Disapproved Sanitary Permit Fee ncludes Groundwater Date sued ssuing Agent Si t ps) Surcharge Fee) -7 ~Jh ❑ Owner Given Reason for Denial 46 "0 1Q IX. Conditions roval/Reasons for Disapproval OW IT 0 1 Septic tank, effluent filter and dispersal cell must all be serviced /maintained as per management plan provided by plumber. & maintained ~ ) 2. All setback arequirements must ho pplicable code/ordinances. as per app) - Attach complete plans (to the County only or the sy em on paper not less than 81/2 a 11 inches in size D,t~ aV-t'41 ~ 74-~ W11141 .IIS?f ~ C4-,Ie. /rVn--_4 D-y - 1-' SITE PLAN Chris Boyd SE,SW,S8,T28N/R19W Lot 13 1.96A.C. Troy township St. Croix county System elev. 95.1' thru 91.93' ~3kan sLk X (ACC) - `''l 3• 0"`') LEGENDS IBM: 102.7' top of PVC pipe 2BM: 98.5' top of PVC pipe 47400 X - pit O - grade elevations - contour No Comm 83 set back 1 problems ~"?i Scale 1" - Y0' except ' where indicated L\0 ga r~ U 2m oSe~ IZo~$oo sue, C- ~i kfer- project: BOYD page 4 PRIVATE ON-SITE WASTEWATER TREATMENT SYSTEM (POWTS) New site Index and Title Sheet PROJECT NAME AND SYSTEM TYPE: BOYD / Conventional system by lift tank OWNER: Chris & Cara Boyd 1580 84 b St. New Richmond, WI LOCATION: Street Address 513 Autumn Blaze Trail, Hudson,_ WI Legal Description SE1/4 SW1/4,S5,T28N/R19W Township/County Troy township St. Croix county CONTENTS: page 1 title page page 2 owner's manual page 3 operations page 4 reports page 5 pump tank cross section page 6 effluent pump curve page 7 combination tank detail page 8 filter information page 9 cross section page 10 site plan PLUMBER: H & H Plumbing, LLC SIGNED: Kent Hoke CREDENTIAL MP 224199 DATE: July 3, 2012 page 1 of 10 POWTS OWNER'S MANUAL MANAGEMENT PLAN FOR NEW SEPTIC SYSTEM POWTS MAINTAINER: H & H Plumbing LLC ph. 715/962-4155 LOCAL REGULATORY AUTHORITY: St. Croix County Zoning ph. 715/386-4680 SEPTIC TANK PUMPER: H & H Plumbing LLC ph. 715/962-4155 DESIGN PARAMETERS influent/effluent quality (values typical for domestic (non-commercial wastewater and septic tank effluent) fats, oil and greases (FOG)<30mg/L, Biochemical Oxygen Demand (BOD)<220mn/L, total suspended solids (TSS)<250mg/L SYSTEM SPECIFICATIONS FOR REPLACEMENT SEPTIC Four bedroom (600-GPD) single family residence 1200/800gal combo Wieser Concrete tank Orenco 14BA effluent filter three distribution cells, 3ft. X 60ft. with BioDiffuser Arc 36 infiltrators soil applicatioon rate 0.7gpd/ft2, area required 857.14sq.ft. absorption area credit 25.0 per chamber, proposed area 900.Osq.ft. (components must comply with WI. Adm. Code Comm 84 and be installed per manufacturers specifications) DESIGN CRITERIA SBD-10705-P (N.01/01) "In Ground soil absorption component manual" Version 2.0 MAINTENANCE MONITORING SCHEDULE Inspect condition of tank(s) at least once every year (maximum 3yrs.) Pump out contents of tank(s) when combined sludge and scum equals 1/3 of tank volume Test alarm and float at least once every year Inspect dispersal cell(s) at least once every year Clean effluent filter at least once every year project: BOYD page 2 of 10 OPERATION The property owner is responsible for the operation and maintenance of the POWTS and submission of required reports. The quantity and quality of the wastewater stream will affect the performance and longevity of your POWTS. The installation of water-saving appliances and fixtures along with prompt pair of leaks reduces the wastewater volume. A!„ aar xs, devices aad f<iunda;6% ~ d be e wat+eir ' ~ t &',4a:; gio ever ' 'a'ble. Note: This does not include laundry waste, showers, dishwater, etc. This system is designed to handle domestic strength wastewater, however the disposal of food based greases and food solids such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodegradable items such as baby wipes, tampons, sanitary napkin, condoms, cigarette butts, should not enter the system. Chemicals such as petroleum products, paints, disinfectants, pesticides, etc. should not be flushed into the system as they can seriously damage your POWTS system. la l`~otttt"dte , Avoid traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. INSPECTIONS Inspection shall be made by an individual carrying one of the following licenses or certifications:- Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septic tank pumper. Alarms should be tested on a regular basis by the homeowner. If an alarm sounds, contact and individual licensed to service POWTS, There is normally 1 day reserve under regular operating conditions, however water should be conserved until the system is corrected to prevent back-up of sewage into the dwelling or surfacing Septic tank component inspection must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks of leaks, measure the volume of combined sludge and scrum and to check for any backup or ponding of effluent to the ground surface. Access openings used for service, or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings >S" in diameter shall be secured with an effective locking device. When the combination of sludge and scum in any tank exceeds 1/3 or more of the tank volume, the entire contents of the tank shall be removed by septic tank pumper. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacture's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Septic Filter inspect at least once a year. Remove filter basket from canister. Clean if needed. In-Ground Gravity Component Dispersal Cells inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulatory authority. Ponding at depths >75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. project: BOYD page 3 of 10 COMBINATION SEPTIC TANK / PUMP CHAMBER tt~b Scale} Approved Locking Manhole Cover AwProved Cap, With Warning Label Attached Weatherproof Approved Cl- Warning Label Junction Box Vent Ca ox P beK_ a,.~~ b 12a Minimum Final Grade- 4" Mi ni mum i quick '1B" Mine Disconnect s 1/4„ Weep Baffle i dole approved Joint i Extending 3~ ` Alan D" Onto Solid Soil On B Joint Approved b; w!~ OAO e c Extending 3 S ~Ss"• ` Onto Solid Soil Off tr D Conc. Block 14 3" of Bedding Under tank--/ ,goto: PeAaa and Alarm Are On Se rate it 9 7p L~?wF 120, O w a C_ use 1~1, UoY~ 3a, ' a ~ Qls Tank Manufacturer: ~~s,~ /SZ• 6 g ~ria~r~ mss Tank Size-Septic/Pump : t 2-W / V--0 Gallons Alarm Manufacturer: _ N m rl .~pacities: AZE3inches or 003ZGallons Snitch 7fTF-- rnecA~a-+1i~ U -*7 r + B inches or yy, y8 Gallons re r: t.►~Ete. ~aY. + Cinches or I Gallops Model Number: q H + DncheshlorZ2 all ons . Mi nimum Di sciarge ate: o Total .3& inches or oo. Gallons Vertical Difference Between Pump Off and Distribution Pipe: /5,(o Feet nol 22.2.q Minimum Required Supply Pressure:.:.'m"e4 ...0............ Feet 200 Feet of Force Main x Friction Factor/700 Feet: +q, 78 Feet Z Inch Diameter Force Main a Total Dynamic Head:...-25, 'Feet project: BOYD y page 5 of 10 REPORTS Reports for maintenance, inspections and monitoring shall be submitted in accordance with Comm83.55 Wisconsin Administrative Code. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. COMM 83.33, Wisconsin Administrative Code. I All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. 2.) The contents of all tanks and pits shall be removed and properly disposed of by a septage servicing operator. 3.) After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken to provide a code compliant replacement system: {x } 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 are will result in the need for a new soil and site evaluation to establish a suitable replacement area. { } suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank maybe installed as a last resort. { } 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 located a suitable replacement area. If no replacement area is available a holding tank maybe installed as a last resort. { } mound and at-grade soil absorption systems maybe reconstructed in place following removal of the biomat at the infiltrative surface. Reconstruction of such systems must comply with the rules in effect at that time. WARNING SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTIAN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSONFROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE. project: BOYD page 4 of 10 53" 96" 41" z r rn w r, n 3 ~ I I ` J/ 6- 44 D m 1r, r t • < II < / LL-7-7 D Z A u u In 39" > A rn g z 2 c ~ n 4 D N Z ;a X v > x r r Z Z v rn N Z z O O r r x D v Dz " D p v mi mi ~QOgf-mrow (nn z f o ZN o0 z z C) o*z > -P- rn SZ "5Q~v- ZmAO oto -O m m.. p p rUf p ~CNip np SGr°~S O:rx OrN n m n m= N D m00 mAp -I -10.. IV c -0~ rD O n ~Z~c=1~C mZio rrn~ ,°-p Ni 0S(nn r z ~Zm01 0oAFni~rnwN w rrIO P n O \Orn DO Ivw V, >,:r,, r io P O m m N r p C Z Oo in --1 U1 n N D m N w cn tm*I D I m co Or. C. D -!l CD rn C7 p O m 0 =p~c).. p m DD co mo n z z Z Q0 rn-mini ro o0 0 D, O >O r0 rn N Z C C D r-rA- nrD 1 CD1 , A Z Z > 3 OJ ° co N ;o (A N m N Zc C) M~ m~0 O -t ~ C Z 4 ~ O oFF*1 NO Om> m m 0 Z r C m c z O r- ;o To 0 FA z m z z r. N rn WLP1200 800-MR SCALE-.1/4" REV NO. DATE: \~o SEPTIC MANUAL EIMER collIETE DRAWN 8Y:SWT J \ G W3715 US HWnO. MAIDEN ROCK, WI 54750 DATE: JANUARY 2008 REV. JAN. 2008 800-325-8456 FILE: WLP1200 800-MR Effluent Purn f 9 4/10 HP Applications • Dewatering, water transfer, effluent and wastewater removal Capacity - Liters per Minute 0 100 200 300 • 4/10 HP shaded pole motor with • Upper sintered sleeve bearings; 35 10 overload protection lower ball bearings 30 9 • Designed for continuous duty • Multiple switch options for • High head model automatic operation m 25 8 • Epoxy coated cast iron housing • UL / GSA listed c 7 and cover 20 6 .9 • High impact ABS base 5 w • Carbon/ceramic shaft seal X 15 4 = r° 10 ,r. 3 c 5 ati. F- Series • 2 Capacity: 70 GPM 0 5' Electrical:115v, 60Hz 1 (265 LPM ®1.5 m) 23N 60Hz 0 0 Shut oft: 32' (9.8 m) Operation: Automatic or Manual 0 10 20 30 40 50, 60 70 80 Liquid Temperature:140OF (60eC) Solids Handling: 3/4" (19 mm) Olsdrarge:1-1/2" FNPT (38 mm) Capacity -Gallons per Minute Impeller: Closed vane polycarbonate Volute: ABS Model ,tern # Model Vats Cad Switch Type On Level Off Level M. 9'-14' 2"-6° 509350 9EH-CIA-FtFS 115 Piggyback Mecharikal Float 6m 23 cm-35.6 cm 5cm-15.2 cm 509360 9EH-CIA-RFS 230 20Piggyback Medmnical Float 9"- 14' 2'-6- 6 m 23 cm-35.6 cm 5cm-15.2 cm 20' 1 - 509331 9EH-CIA-VDS 115 6 m P"taCkV0" 0ia~igm 35.6 cm m - 40: 40.6 cm 10.2 4 cm '-1 -15.2 cm 509330 9EH-GM 115 6 Manual - - 509340 9" 230 6 ' Manual - - T--1, 1 m I Features Cast Iron U per sintered cover sleeve bearing Oil-filled \ motor housing Cat iron Motor designed epoxy coating to for maximum resist corrosbn performance lower 1-1/2' FNFr ball bearing (39 mm) Carbon & ceramic face seal Engineered, Glass-filled Am6 thermoplastic (19 rt mj s olids V.I../.mpeller _ r seal for maximum Stainless steeI For we iMaiitati'm 11.800.701.7 efficiency wear ring ~ O Xec ° i3o\1 D -p a.ge (a e s to e CROSS SECTION - not to scale Three cells 3ft. by 60ft. (identical) observation pipe Finish grade or 98.0' vent pipe (12" above grade' >12" of filled material ➢ 3ft of Natural soil drain back to tank r. System Elev. 95.1' thru 91.93' >3ft of suitable soil System installed using ARC 36 infiltrators 12 chambers per cell = 300 sq.ft. X 3 cells = 900.0 sq.ft. proposed 857.14sq.ft. required TOP VIEW - not to scale front of cell 45, fitting at end of rbmirt pipe toward top of chamber 12' drain back to tank 2,~, "manifold vent at end of cell _ ARC 36 infiltrators end of cell 4' by 2' fernco /or PVC observation All three cells (identical) 3ft. by 54ft. ea. project: BOYD page 9 of 10 EFFLUENT RLTER Sizing Biotubel Effluent Filters Fiuw 4. Srm(; Blames E"weNr Purees These charts show the relationship between Biotube filter size (d iame", design fbw, and mean time between leanings. The larger the filter and the smaller the flow, the longer you can go between cleanings. For example, a typical three-year cleaning frequency would require an 8-in. filter for up to 2,500 gpd, a 12-in. filter for up to 5,000 gpd, and a 15-in. fitter for up to 8,500 gpd. Assumes a properly sized watertight tank and residential strength waste. See Orenco document NDA-FT--FT-1 for more information. 1250 Residential Applications 9000 Commercial Applications 8000 v IOW ~r = 7000 3 750 3 o _ O iL 625 •0 . LL i, ~ 500 ~a ay 4000 `4 N 3000 375 _ m ~ FFa •i~i sa tF 1.,,_ 250 ~•js p1F 2000 a i;;r;:r.~is ~••~'j~ 1500 ~'Y'tpllllii 1 Ynl)i'7iF2FF tIiti Ito, ; - Fltlt.7F(:lil 125 ' :,F1ti,tO7FFal(tif 1000 500 0 0 3 4 5 6 7 8 9 10 11 12 3 4 5 6 7 8 9 10 11 12 Mean Time Between Cleanings Mean Time Between Cleanings (Years) (Years) EFFLUENT RLTERS Residential Biotube-, Effluent Filters (FT) FT Series Base Inlet Model NOMENCLATURE FT❑®22-14B❑ Toptions: A = float bracket FSO = overflow late Base inlet model Cartridge height: 14' standard FT S Om N'It2t Housing height: 22' standard Fff rttRW Filter diameter (inches) 08=8' Blank = 1/8°filtration P = 1/16' filtration Biotube effluent filter semis o~b SITE PLAN Chris Boyd SE,SW,S8,T28N/R19W Lot 13 1.96A.C. Troy township St. Croix county System elev. 95.1' thru 91.93' LEGEND ::E3 taDo 3 X (QO LA7 3 1c~CovJ I BM:.] 02.7' top of PVC pipe 213M: 98.5" top of/" PVC pipe h~ 11 ~ c.,j,-M A-,3n X- pit pit q ~,C7 O - grade elevations - - - contour No Comm 83 set back problems Scale 1" - q0' except do, where indicated ~c Ff a~° 6~ . 2p~ 40 i I^ ose I Zoo 00 a \ w 5l 2~d,o o d~tw h d-o ink Q~ project: BOYD page 10 of 10 "v Wisconsin Department of Commerce SOIL EVALUATION T Page I of 3 Division of Safety and Buildings In accordance with Comm 85, Wis. County 12, Attach complete site plan on paper not less than 8'/z x 11 inches in size. Plan must St- CIO1X - Include but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. O4O- ]•£1W- Percent slope, scale or dimensions, north arrow, and BM referenced to nearest road. Please print all information Reviewed Date Personal information you provide m be ses vacy Law, s. 15.04 (1) (m)) z~ 0 Property Owner Property Location G&L Land Development, c. Govt. Lot SE SW s 5 T 8 N R 19W E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# C7 W12491 890t' Ave. 13 Cedar Woods City State Zip Code 7-Ph-~ie- ❑ City ❑ Village 0 Town Nearest Road River Falls WI 54022 715:386-2928 Troy Coulee Trail / FF 0 New Construction Use: 0 Residential / Number of Bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or Commercial - Describe: Parent Material Flood Plain elevation if applicable ft. General comments and recommendations: B-1 was completed during the preliminary soil assessment on July 22, 2005. S5 ❑ M Boring # Boring 0 Pit Ground Surface Elevation 96.1 ft. Depth to Limiting factor 32&>110 in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-10 10YR3/2 None SIL 2-f-gr dh aw If 0.6 0.8 2 10-21 10YR3/3 None SIL 2-m-sbk dsh gw if 0.6 0.8 3 21-32 10YR4/4 Nnne L 2-m-sbk mfr gw if 0.6 0.8 4 32-44 /4 f-1-f 10yr5/3 & 7.5yr4/6 L 1-co-sbk mfr gw if 0.4 0.6 5 44-55 10YR4/4 None FS 0-sg ml aw None 0.5 1.0 6 55-11 10yr5/4 None GRS 0-sg ml - Non 01 ' 1.6 2- 164 / -,2 Boring # Boring ❑ a OPIt Ground Surface Elevation 97.6 ft. Depth to Limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 `Eff#2 1 0-12 10YR3/2 None L 2-m-sbk mfr CS if 0.6 0.8 2 12-20 10YR4/3 None SICL 1-m-sbk mfr gs 1f 0.2 0.3 3 20-29 7.5YR4/4 None SL 1-m-sbk mfr gs 1f 0.4 0.7 4 29-110+ 10YR4/4 None S 0-sg ml - Non 0.7 1.6 3 03 * Effluent #1 = BOD5> 30 220 mg/L and TSS > 30!5150 150 mg/L * Effluent #2 = BOD, 30 mg/L and TSS 5 30 mg/L CST Name (Please Print) Signature CST Number Mark Iverson a 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 December 20, 2005 715-796-5664 Property Owner G&L Land Development, Inc. Parcel ID# 040-1022-70-000 page ---Z --of 3 3] Boring # 0 Boring Wit Ground Surface Elevation 98.1 ft. Depth to Limiting factor >110 in. Soil ApgAication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDMe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-10 10YR3/3 None SL 1-m-sbk mfi as 2f-m 0.4 0.7 2 10-21 7.5YR4/4 None S 0-sg mi Cs 2f-m 0.7 1.6 3 21-50 10YR4/4 None GRCOS 0-sg ml Cs 1f 0.7 1.6 4 50-110+ 10YR5/4 None S 0-sg ml - None 0.7 1.6 I a Boring # ❑ Boring 0pit Ground Surface Elevation ft. Depth to Limiting factor in. Soil A lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 Boring # 0 Boring 0pit Ground Surface Elevation ft. Depth to Limiting factor 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 *Eff#2 # Effluent # 1 = BOD5> 30 < 220 mg/L and TSS > 30:5150 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 T-FY 608-264-8777. Site Diagram 0 ft. 24 ft. 40 ft. 80 ft. Page 3 of 3 N f r f LOT -13 r~ 40 < o - ACA. X r 3 r r "L r~ 98. -1 95' f 96.1 s,J- r rrs ei &2 9 98' 99' A A =Lot Lines 13M# & Description . Bench Mark Boring Location & Elevation House and well location to be determined Elevation 100' Owner: G & L Land Development Inc. Site Information: Completed By: Mark Iverson, PSS #197 W12491 890th Street SE 1/4, SW 1/4, S5, T28N, R19W 680 Larcom Street River Falls, WI 54022 Town of Troy Hammond, WI 54015 St. Croix County 715-796-5664 Phone: 715-386-2928 CST# 46672 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owne uyer CH2~S7a Z 2/~~ Mailing Address Property Address 7 'Z5 Ti ' (Verification required from Planning & Zoning Department for new construction.) City/State i~ Lf SQ Parcel Identification Number 0~~ _ 3~1o r ' LEGAL DESCRIPTION ' S V" '/a Sec. T 2 a N R 9 W, Town of Property Locations V Subdivision Plat: Lot # / J Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume Page # Spec house ❑ yes C 1'6 Lot lines identifiable /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 stating 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 virtuwarranty deed recorded in Register of Deeds Office. Number oms / G A O PLICANT(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) i 8 0 6 2 2 6 4 State Bar of Wisconsin Fonn 1-2003 Tx:4044938 _ WARRANTY DEED_.. 959055 BETH PABST Document Number Document Name REGISTER OF DEEDS ST. CROIX CO, WI 06/28/2012 1:48 PM THIS DEED, made between G & L Land Development, Inc., a Wisconsin EXEMPT#: N/A corporation REC FEE: 30.00 ("Grantor," whether one or more), TRANS FEE: 241.20 and Christopher Boyd and Cara Boyd, joint tenants as survivorship marital PAGES: 1 property ("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 needed, please attach addendum): FSA Title Services, LLC Lot 13, Cedar Woods Subdivision, St. Croix-County, Wisconsin. 5645 Memorial Avenue Stillwater, MN 55082 File No. 120443 St."Croix-County; Wisconsin 11 1 y c BCtify that this instrument is a 04 CotrBCt CM of ~ &CMUM 040-1316-13-000 on 04,64 Of few'd in my.ofllce and has Parcel Identification Number (PIN) This is not homestead property. (is) (is not) rty is good, indefeasible in fee simple and free and clear of encumbrances except: his pr t rs~rb t ove'nnnts and Homeowners Association By-Laws. Dated June 27, 2012 G &Q~L Land Development, Inc. (SEAL) Na- 41 10, ~ _ (SEAL) * * Glen M. Wiese, President 1 (SEAL) e-'Oetot" ~ (SEAL) * * Lola M. Wiese, Secretary AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF CO` LQ' ) authenticated on ) ss. S~ CCOUNTY ) * Personally came before me on June 27, 2012 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Glen M. Wiese as Presid M. Wiese as Secretary of G & L Land Developrife c. (If not, authorized by Wis. Stat. § 706.06) to me known to be the person(s) who execut t t$epAIF$Y inst to tan ack ledged the same. ~ PUBLIC IV, THIS INSTRUMENT DRAFTED BY: Baiers C. Heeren, FSA Title Services, LLC 5645 Memorial Avenue Stillwater, MN 55082 Nona Public, State of My inmission (is permanent) (expires: (Signatures 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 *jT001name below signatures. me"30b 9"1 tc kq ?a'.1i109 bms ev,u aed brit e7f0 dm rim to bi no ,s::: vd bed nW 0~ g1945~` MOM. COUNTY PLAT OF CEDAR WOODS 1 THE SOOTMAST V• OF TK SOO NWSI VG Arm PARE OF TK SOOTNWEST Va OF TM NHIs"9 I xanT[1nz[rVtui1[l~fAiNWESir1 uoiRTaRTI1E[wRFI[mfrtMSiTV1%Fr6rrlO0xrrKCAZr N6ISAq a iaid;5-201 V1 Of StUft F, MWNSW 21 NORTH. RANGE M WEST. 5,26' ~jr sar..T Ar0 j of N•.: f 5' ` yr' I TOWN OF TROY, ST. CROIX COIp[TY,WISCO1S11. Ix t 8 ~ N69'Ol'10"E ~,rewxmb 1321.12' Is.nlN-.I .woN.a.cnV (u,wt s OUTLOT t ft'tO%'`~/ 570,010 6f. / STORMWA IER `Tr walr O.+ol:m 620.5 SE/S11 15.38 acres RETENTION AREA ! 1 5' R 1 a N : Nom: 6661 , apl.[a1. a .Ia•m+a1m .x•.•+~1mI ~ 85E 9 arro nl.m.Nl. . s,plm.mw rm.a focwlNw a[.~IIa..W v. f:iiu-• (l u"' / Naru'a~t .area' Ip .~W[~rrw~i q:lwl •yxY( aJl gF.a_Sit asJY v z6-19 1 i LOT 10 I I LOT 11 5- w P, •a/ \ LOT 9 1 1 "f,a 1 I I Tea 5 C ~A$1 ¢ 7 1,.,2.•. E . a9 LOT 12 / xea I; 1 Al I1 C 9x.... r. / Ig ovxulYPRmAUpEOa, € \ 19-1 I if ( x.,:ae., / / rYf V.11INaE LOT e I~"1 I I If I I,r Ie A,. 11 ouRnF rrOeRmtnrr[. 22. 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