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040-1257-10-000
County: St. Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556396 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: Permit Holder's Name: City Village X Township Tro , Town of 040-1257-10-000 Hessler, Robert & Bernice Section/Town/Range/Map No: CST BM Elev: Insp. BM F_1s+~ IBM Description: ^ GG 24.28.20.1364 TANK INFORMATION I CWi`/\ ///V( ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic y✓- ` (p Benchmark /b7. LJ 7'5 Alt. BM r-. C1 , .141. r Dosing A ® (M" y • Y O Bldg. Sewer C 2 J Aeration 7, 3'~ W. ✓ Holding St/Ht Inlet 09 / St/Ht Outlet TANK SETBACK INFORMATION ~-f TANK TO r P/L~ A~~IV L A BLDG. V to Air Intake ROAD Dt Inlet Septic ,t k! ! Dt Bottom Dosing ✓ J /Q (07 l S Header/Man. s~ A14. 7 Aeration I , Dist. Pipe Z •75 1611 .7 III Holding Bot. System -7 3• Final Grade PUMP/SIPHON INFORMATION ' Manufacturer II-- Demand St Cover F I Jam, oL~T• L- GPM w Model Number [lam - 4 17.4 # (03 /Q Z - PF'orcem L jnLee Friction Loss System H~~ea~,L,.J ,,L TD ; FA2 ~IQ ~ angt / Dia.2/Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of enche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 6- ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM CHAMBER LEACHING Manufacturer: INFORMATION Type f System: UNIT Model Number: 6 116 14 11 65 . DISTRIBUTION SYSTEM e I Ora Header/Manifold / Distribution x Hole Size x Hole Spacing Ve Air I ke Pipe(s) 7 2 3 f l/ 3 ,OS V Length Dia Length ~ . Z3 Dia Spacing 3. v SOIL COVER X Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over xx Depth of xx Seeded/S dded xx Mulched Depth Over ~ Bed/Trench Center W Bed/Trench Edges Topsoil ' ~ Yes L` No _ es_, No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / I 31< -Z- Inspection #2: 51 / Z e/ /3 Location: 270 St. Annes Park gay Hudson, WI 54016 (NW 1/4 SE 1/4 24 T28N R20W) Troy V'Ila 3rd Addition Lot 104 Parcel No: 24.28.20Q1364 Ile 1.) Alt BM Description = = = O J 2.) Bldg sewer length / oture~ - amount of cover f 7 4 e,n. Plan revision Required? ❑ Yes No Use other side for additional informati n. - Date Insepctor's SCert. No. SBD-6710 (R.3/97) Land Use ST. CR O I . ~~/i/T{ 1Y/ Planning & Land Information 0 Resource Management Community Development Department Wednesday, May 29, 2013 Robert J. & Bernice Hessler 270 St. Annes Parkway Hudson, WI 54016 Regarding septic inspection for Robert J. & Bernice Hessler. Location of Property in St. Croix County: Municipality: Troy, Town of Subdivision or Plat: Troy Village 3rd Addition Certified Survey Map: Lot: 104 Address: 270 St. Annes Parkway Dear Applicant: A septic inspection of the above reference property was conducted on May 28,2013. This property is located in the NW 1/4 SE 1/4 of Section 24, T28N R20W, Troy Village 3rd Addition (Lot 104 Troy, Town of, St. Croix County, Wisconsin. At the time of the inspection, this septic system was found to be code compliant for a 4 bedroom home. Additional Notes: 1200/800 Wieser to 6.67'x90' mound cell. Tank installed 12/31/2012. If you have any questions regarding this, please contact our office at 715.386.4680. Sincerely/ngton 'O/D Ryan Yar Zoning Specialist cc: file Phone 715.386.4680 Government Center, 1101 Carmichael Road, Hudson, W154016 Fax 715.386.4686 www.sccwi. us/cdd www.facebook. com/stcroixcountywi cdd@co.saint-Croix. wi. us J fi > QQ S f /rf 7C ~ \ ~ f f ~rr f o rJ \ ( a d ROBERT & BERNICE HESSLER WOODBURY, MN SCALE=1"-40' o O s a`"e••, 10/30/12 r o r Q ,r BENCHMARK. #1 CORNER POST -I ~b ( BENCHMARK #2 N/A f v d j ? cs c( ( ! - SYSTEM ELEVATION 102.85 4 i d 0 1/4 SE 1/4 SECTION 24 28NR20W 6 f = OWN OF TROY 1 o f/ 3 N. 040-1257-10-000 1200 GALLON SEPTIC TANK G WIESER TANK W/POLYLOK 525 FILTER o % s 40 4- a e Q G o ~ 1 # commerce.wi.go Safety and Buildings Division County ~ .r 201 W. Washington Ave., P.O. Box 7162 ST. CROIX :C O Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) t~lepartmernftt oomrnerc, State Transaction Number SaA ary eApplication ZI In accordance with s. Comm. 83.21(2) ,Wis: ode, submission of this form to the &p, to go m ntal unit is required prior to obtaining ,S aiy permit. Note: Application forms for state wne7 F.o Project Address (if different than mailing address) submitted to the Department oPI ) 'merce. Personal information you provide may be us or sel~ohd purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. "771 !9-. 4 4,e_5 1. Application Information -Please Print Information /CJ Property Owner's Name r Parcel # ROBERT & BERNICE HESSLER 040-1257-10-000 Property Owner's Mailing Address Property Location WOODBURY, MN Govt. Lot City, State Zip Code Phone Number I>TW y,, ~y4, Section 94 OODBURY, MN 55125 28 20 (circle one)-, II. Type of Building (check all that apply) Lot # T N; R E or 1 or 2 Family Dwelling - Number of Bedrooms 104 Subdivision Name ~J a~ Pit- ~o-~ Block# TROY VILLAGE 3ri ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of J ~I Town of TROY G , (a-7 k" 96 146 PJ kJ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. [I New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ 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 7 Ot/ IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade T] Mound > 24 in. of suitable soil ❑ Mound < 24 in, of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) / 9 V. Dis ersaVTreatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Requir sf) Dispersal Area oposed (sf) System E evati V/ . 6 1000 1 1'D 85 A13. VI. Tank Info Capacity in Total # of Ma factu er 30 Gallons Gallons Units _ a 2 t) 1-0 New Tanks Existing Tanks WIEnSER L c y a W t' ~11K. a U w C7 w Septic or Holding. Tank 1200 I SE X Dosing Chamber 800 VII. Responsibility Statement- I the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature _ MP/MPILS Number Business Phone Number PAUL KOEHLER f✓ 225410 715-246-2660 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017 ~~,,VIIM Coun /De artment Use Onl jq Approved C~~, Permit Fee Date sued Issuing nt Signatur9;,) ss nReas e nia( z~ 1Z 44~ I X. Condig g E#yReasons for Disapproval It 1. 'Septic tank, effluent lifter and 31 J j_ ~G dispersal cell. must all be servlce a l maint~l as per management plan provided by plumber, 2. AD setback requifernents must. be maintairtdd J 50 G in Attach to complete plans for the system and sub 't to the County only on/ p~apex not less 8 112 x ebesinsizt (,rJ {ux.. ~o.Jk, L tii^^11 ✓✓lnF°J,'J SBD-6398 (R. 02/09) Valid thru 02/11 ~ o > a ( r t 11m O / $g rcr )3 ~j ROBERT & BERNICE HESSLER J WOODBURY, MN \ ~ SCALE=1"-40' o o '2•• 10/30/12 ~ BENCHMARK #1 CORNER POST BENCHMARK #2 N/A l< SYSTEM ELEVATION 102.85 d T 7 c► ~t _ o ~ s~ 'y f d f a NW 1/4 SE 1/4 SECTION 24 40 6,s pX- T 28 N R 20 W f TOWN OF TROY 3 P.N. 040 -1257-10-000 1200 GALLON SEPTIC TANK o j WIESER TANK W/POLYLOK 525 FILTER s .n ci 3- e + O f~ g o sQ M v ART:~N Safety and Buildings 51' , Toy 10541 N RANCH ROAD HAYWARD WI 54843 3 ! D S Contact Through Relay P www.dsps.wi.gov/sb/ www.wisconsin.gov O sSION +ti'w Scott Walker, Governor Dave Ross, Secretary November 26, 2012 CUST ID No. 225410 ATTN POWTS Inspector PAUL R KOEHLER ZONING OFFICE COUNTRYSIDE PLUMBING & HEATING INC ST CROIX COUNTY SPIA 321 WISCONSIN DR 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 11/26/2014 Identification Numbers Transaction ID No. 2169864 SITE: Site ID No. 785791 Robert & Bernice Hessler Please refer to both identification numbers, Lindsay Rd above, in all correspondence with the agency, Town of Troy St Croix County NW1/4, SE1/4, S24, T28N, R20W 'T FOR: p•~ w~ Description: Mound, 4 brres condltiO Object Type: POWTS Component Manual Regulated Object IDNo.: 1400387 Maintenance required; 600 GPD Flow rate; 34 in Soil minimum depth to limiting factor from original grade Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manu f9i 2.0, SBD-10706-P (N.01101), SSWMP Pub. 9.6; Effluent Filter ~Y The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes SEE COYN and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • 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. In addition, the owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the mound component manual are complied with. A copy of this information must be given to the owner upon completion of the project. • It appears that the POWTS is proposed to be built in the 25' setback area. Check with proper authorities prior to construction of the mound to be certain all setback requirements are met. • This mound is designed to be installed on a level site ( less than 1% slope). If there is greater than 1% slope, the mound may not be constructed as designed and a revision will be required. • The proposed pump is near its limit with the proposed total dynamic head. If upon installation, the total dynamic head increases, the proposed pump must be reevaluated and may be inadequate. PAUL R KOEHLER Page 2 11/26/2012 Reminder • The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installation of float switches or relays that contain mercury. • The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle size. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to service the filter shall terminate at or above finished grade with a watertight cover. • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual 0 Materials shall conform to the requirements of SPS 384.10. No fixture, appliance, appurtenance, material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system, unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. 0 Maintain well and waterline set backs per SPS 383.43(8)(i). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. 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 and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia L Shandorf Please Include a Copy With Your POWTS Plan Reviewer, In grated Services Payment Submittal. (715) 634-7810, Fax: (7 ) 634-5150 , M - F 8:00 a.m. - 4:45 p.m. WiSMART code: 7633'.. pat.shandorf@wisconsin.gov cc: Charles L Bratz, POWTS Reviewer II, (608) 789-7893, 7:45 am - 4:30 pm Monday - Friday Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: DERRICK/ HESSLER Owner's Name: ROBERT AND BERNICE HESSLER Owner's Address: i i Legal Description: NW 1/4 SE 1/4 S 24 T 28 NR 20 W Township: TROY County: ST CROIX Subdivision Name: TROY VILLAGE ~n,lV r AID Lot Number: 104 Block Number: Parcel I.D. Number: 040-1257-10-000 Plan Transaction No.: ON Page 1 Index and title Page 2 Data entry Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan Page 7 Pump curve and specifications Designer: PAUL KOEHLER License Number: MP 225410 Date: 10/29/12 Phone Number: 7152462660 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 5.1 (R. 06/06) Page 1 of 7 Y ♦ ~ I Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note: Sand fill (D) calculations assume a 400.00 Estimated Wastewater Flow (gpd) Table 83-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of - 36 inches. 600.00 Design Flow (gpd) 0.00 Site Slope 102.85 Contour Line Elevation (ft) 34.00 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/ft) Distribution Cell Information 90.00 Dispersal Cell Length Along Contour (ft) = 6.67 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate (gpd/ft) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution C Y Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifold 3.34 Lateral Spacing (ft) If N above, enter the elevation ft 4 Number of Laterals of the highest point. 0.188 Orifice Diameter (in) 3.00 Estimated Orifice Spacing (ft) = 10.01 ft2/orifice 2.00 Forcemain Diameter (in) 30.00 Forcemain Length (ft) Does the forcemain drain back? Y 90.85 Pump Tank Elevation (ft) Enter Y or N 3.25 System Head (ft) x 1.3 4.89 Forcemain Drainback (gal) 12.00 Vertical Lift (ft) 81.16 5x Void Volume (gal) 0.96 Friction Loss (ft) 86.05 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 39.32 System Demand (gpm) 16.21 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.00 1.50 x 1.25 x 2.00 x x 1.50 x x 3.00 2.00 x 3.00 x Gallons/inch Calculator (optional) Treatment Tank Information 800.00 Total Tank Capacity (gal) 1200.00 Septic Tank Capacity (gal) 43.00 Total Working Liquid Depth (in) WIESER Manufacturer 18.60 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 1000.00 Dose Tank Capacity (gal) POLYLOCK IFilter Manufacturer 15.00 Dose Tank Volume (gal/in) 525 _ Filter Model Number WEISER Manufacturer Project: DERRICK/ HESSLER Page 2 of 7 Mound Plan and Cross Section Views 1 1/10 B ............v...... QObservation Pipe _ 1 FKA ,.p r.r.,r.,p• f t .r.f•r•r•r•#.r. r•#.r"•+}•r•f•#•#.# r t. - r,e°r4rx.x°r`:ryr~ri.-.^.,p.",F:~x"r:#~ryJ`.°."`+*+tx°t x`?:dx'r4#vi"`l,`t. r~raO r•`d.$?r:r^e :o°: r:r~ I B 11 . . . . . . . . . . . . . . . . . . . . . . . T 1 ..-1'............. L Mound Component Dimensions A 6.67 ft E 6.00 in H 1.00 ft K Al ft B 90.00 ft F 9.50 in 1 5.38 ft L ft D 6.00 in G 0.50 ft J 5.38 ft W ft 600.30 (ft2) Dispersal Cell Area 80 (ft2) Basal Area Available 6.67 (gpd/ft) Linear Loading Rate 9.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 105.14 (ft) F Dispersal Cell 103.85 (ft) Lateral 103.35 (ft) - Invert Dispersal Cell Elevation n Q. . 102.85 (ft) Contour Elevation 0.0 % Site Slope Geotextile Fabric Cover Shading Key o,- Dispersal Cell See lateral details on 1❑ Topsoil Cap ° 1.5 ft L`L•S•L•L.R•L•L+S•L•L•1.L•L.L Page 4 for number, size, O r r r.r"r.r"r.r r.r•r.r"f•#• 2 Subsoil Cap N O L.L.L•L.1.L.L.L• .L•L"L.L•L•L and spacing of laterals. r•r r•r"r r•r•r• r.r.i,~;•r ~.r. #.#"r. Laterals are equally ASTM C33 Sand L.S.L•L 4. L*L.L. L•L.L•L R lC r•r r.r.r.r.# i•r.r=#•r•;r r-r r- ~ L•"+•L".°'°:`'!5,^S .Lty.L .°b:"+:'+`4";.L x •r•r .°•#Lr. L.L• ;.L. F spaced from the Tilled Layer c m 0.5 ft ~;%;Z. Typical t_ateral N L # distribution cell's YL""".. L.L.L•L•S S*LxLr1:L. L•S"L:L 4.4•L•L•L•L. x..L+ti eL•S•4•i•L• L © r•r"r•s« Aggregate v c i.r•r•r.r•f.f,#.# r.r.#.r•r centerline in the L.L.L•°..L.L. +.L•L~L."«•L•°+•L•L•S"L A distribution cell (AxB). Project: DERRICK/ HESSLER Page 3 of 7 Center Connection Lateral Layout Diagram For*# rile oorat*dw vta t a cx*ss ffw#oW 4A mV point. L ti +ral~ we ldwtlo .l 11 Turn-up Wbsallvslvectr L tats&Force main of PVC Soh 4€1 clatnoutplug l W W Table $4.30-5 on the btottom of 0* la+ke -0, Number of Laterals 4 Orifice Diameter 0.188 in Lateral Diameter 1.50 in Orifice Spacing (X) 3.05 ft Lateral Length (P) 44.23 ft Orifices per Lateral 15 Lateral Spacing (S) 3.34 ft Orifice Density 10.01 ft2/orifice Lateral Flow Rate 9.83 gpm Manifold Length 3.34 ft System Flow Rate 39.32 gpm Manifold Diameter 2.00 in Total Dynamic Head 16.21 ft Forcemain Velocity 4.02 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Comm 16.28 WAC 4 in. min. Disconnect Tank component is properly vented Alternate outlet --t,pzfl-4 :c at;c: 4Forcemain diameter WEISER Manufacturer 2 in. Ca acit 1000.00 Gallons Volume 15.00 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 46.93 703.95 B 2.00 . 30.00 C P♦ ump off elevation (ft) C 5.74 86.05 -t - 91.85 D 12.00 180.00 D Total 66.67 1000.00 1 r- Dose tank elevation (ft) 3" Bedding un er tank. 90.85 Alarm Manuafacturer ALDERON POWER POST Alarm Model Number Pump Manufacturer HYDROMATIC Pump Model Number SHEF 40 Pump Must Deliver 39.32 gpm at 16.21 ft TDH Project: DERRICK/ HESSLER Page 4 of 7 Mound System Maintenance and Operation Specifications Service Provider's Name COUNTRYSIDE PLG Phone 715246-2660 POWTS Regulator's Name ; COUNTRYSIDE PLG Phone 715-246-2660 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600.3 ft2 Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ondin and seepage once eve 3 ears Other Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure pipina materials conform to the reauirements in Comm 84. Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. i Lateral Turn-up Detail Finished • • Grade v1 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: DERRICK/ HESSLER Page 5 of 7 ` Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Slats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched as protection from freezing. Influent quality into the mound system may not exceed 220 mg/L BODE, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component(s) shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. Project: Page 6 of 7 k M J ss ~ F /1 41. t' , yFf ~ 4 6 4. t. i t\ f /fa c r r ff ) e- 7 4 6 Ole / p s f .4.e ROBERT & BERNICE HESSLER '8 ¢ 4e WOODBURY, MN OZ ~ SCALE=1"-40' o f,~ 10/30/12 v 6 o BENCHMARK #1 CORNER POST O a~ i f BENCHMARK #2 N/A d~j y r{ fr`f SYSTEM ELEVATION 102.85 o v ~ i ; `~P c1 o NW 1/4 SE 1/4 SECTION 24 6 E' Q T28NR20W e TOWN OF TROY I, 0 3 P.N. 040-1257-10-000 ( f G ' 1200 GALLON SEPTIC TANK o / WIESER TANK W/POLYLOK 525 FILTER c i \p U 4 C] ~ ~ ~ Os Cy _ J u ~ oho ~ i -47 00 0 of ~ \ 8J .01 LU In ~ Z ~-oQ \ \ `s' '12 l ti . a1HWODZWW '3113 99-b9-5Zc-008 OLOZ 'Ndf a3SLA38 0 \ 09L49 m INOON N3aIVW of AMH sn 9LLCM Z :an0d-1sOd • :31va otoa AavnNVr :3iva -ivnNVY4 OLLd3S F- 0 n38 313Y~110~ 13131M W =anod-38d «o-.t=.f L -31v3s 3WS a NMVaa ari-008/OOZLcrm N \ W J Z F W Z W 6 W~ a O o w Cy J d' Q U Q W N ~ O N Z UOO d U^ F~ w O (n C) Wo W: k o Z- a F u_ ^ w Q ^W z V)) m 000 ~o~ c o 2m Q H Iw- O Q ~vi m oqhQ zz !g z ~ m z L- w m w m W ¢ o 0 W Om O J QJU JJ Q O> U iJ O O z w .w J Q J F 0 Q QQ W U m in m z>¢ p O W Z I- F Q O F- W C9 O o_ O o O > Q co m (9 Z to O., w oc o O _n W Z L~ 33 W Z O N O U 0 a JQ ~Ctn !9p* a > F (/)0 i Y rn Q C-4 z 00 V- a ~O~`tMow f /)WFI mWN MN O Z10 QUd cn in F= Fn ~0 CJ* avOh_JL~~~W<Q Wma MN m O= NWU 6z YZ~ O aLLJ O 0 a io "w)(02 (OZ>m(Oj ~4U F2yC F- ~ >`l J. 3~F W05 FN M Din ~zw V Q d pW N fNJ..OfYO~zF 3 0m OQYOOW Q w mF(n xo WU Z2zin-i U Za,QZNO U 0- a U Y~Z ZWO_ x Nw J z Z3m U2=~J WH ' ~~c9 Arno NO LLJ Z U W&W 2 - !L Q J J O Q Y >Z O Or z 'p a Z z U~ U N Q W U Z j «6£ a w O a `r 2 a O Sv0 «6 re 0 «8£ do w w N U N (O aU a Ji , «9£ Q Q W c ►W- m V) w Sd0 «04 do I- 1 W n~ICQII d' U 4 Q M lL J Q Z W 0038 Q «96 SV «£5 Y z Q f- r INSTALLATION INSTRUCTIONS Zabel, DMvb,6£o0Wk1M. PL-525/PL-625 FILTER A 3 Wis!ewaSyPmGr~s PL-525/PL-625 FEATURES & BENEFITS Features & Benefits: e Rated for 10,000 GPD • PL-525 = 525 Linear Feet of 1/18" Filtration PL-625 = 625 Linear Feet of 1/32° Filtration PL-525 PL-625 *Accepts 4" and 6" SCHD. 40 pipe The PL-525/625 Effluent Filter should operate efficiently • Built in Gas Deflector for several years under normal conditions before :Automatic Shut-Off Ball when Filter is Removed requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped or at least every . Alarm Accessibility three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the *Accepts PVC Extension Handle filter needs servicing. Servicing should be done by a certified septic tank pumper or installer. RECOMMENDED PRODUCTS V Polylok PVC Filter Extension Handle Risers & Riser Covers, Extend & Lok- Riser Safety Screens Filter Alarm Panel and Polylok risers bring: your Polylok.Extend & LokT4 Polylok safety screens SmartFilterTm Control septic tank cover to grade. is a simple, easy to use prevent tragic accidents Switch This allows locating and solution that can extend from happening: by children Potylok filter alarm panels servicing your filter easier the inlet or outlet pipe and and pets failing. into open and switchs provid a visual and time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of nating digging to find tank installation a snap. impending. filter and tank entrance. Fits 3" and 4" pipe. servicing. For a full list of Polylok products please visit our web site at: www.potylok.com 3 a~ k„ SHEF40 Submersible High Head ; Effluent Pump Applications i • Septic Tank Effluent • High Head Sump • Dewatering a CH y 4 a -s t Pentair , ~tlTater Submersible Effluent Pump FEATURES The Hydromatic SHEF40 submersible pump is specifically designed to meet the demands of residential high head septic tank effluent or sump applications. The 1-1/2 inch NPT discharge pump features an energy efficient 4/10 horsepower motor, 115 or 230 volts, and is available in both automatic and manual configurations. The SHEF40 can handle capacities up to 70 gallons per minute and heads to 36 feet. The SHEF40 features a heavy-duty cast iron construction that provides durability for a long service life, as well as dissipates heat from the motor for cooler operation. All fasteners are stainless steel for corrosion resistance. The pump's semi-open, non-clog design impeller passes 3/4" (spherical) solids and is made from a super tough engineered plastic that provides the highest level of corrosion resistance and the toughness to withstand the impact of solid materials. The impeller, molded to a bronze insert, also features pump-out vanes to preclude material from building up around the shaft and seal. The pump's unique (patent pending) non-clog design baseplate has an electrostatically applied polyester coating for corrosion resistance and provides a strainer-free inlet capable of passing two (2), 3/4 (spherical) solids simultaneously. The inlet area is raised off the bottom of the septic tank or sump basin by the pump's 2" high legs constructed of engineered thermoplastic material for maximum corrosion resistance. The SHEF40's oil filled motor provides superior cooling characteristics, allowing the motor to run cool and quiet. The oil- filled design also provides permanent lubrication of the shaft bearings, minimizing maintenance and extending the service life of the pump. The oil- filled motor design allows for even heat dissipation. The windings feature a built-in thermal overload that resets automatically. Automatic models feature an easily adjustable wide-angle float switch, incorporating a unique piggyback plug arrangement. This plug allows for simple conversion to manual operation by removing the switch plug and inserting the pump's motor HYQRQMATIC Pentair Water Page 2 SHEF40 - Submersible Effluent Pump BENEFITS plug into the electrical outlet. This feature A. Oil-filled motor provides superior cooling and provides an easy way to periodically cycle the permanent lubrication of bearings, minimizing pump to ensure it is operating properly. maintenance and extending service life. The SHEF40 is a completely submersible B. Water resistant power cord with molded plug is pump for use in residential septic tank effluent available in 20' & 30' lengths and is easily field pumping applications and is available in automatic serviceable. Unique four point cable entry and manual configurations. Automatic models provides superior protection against leakage. feature a wide-angle float switch with piggyback C. Lower ball and upper bronze-sleeve bearings plug-in arrangement. Switch is adjustable, easy support motor shaft, minimizing the effects of to service and allows for simple conversion to impeller loads. This design results in minimum manual operation. friction and perfect alignment of rotor, for longer service. D. Heavy-duty, cast iron construction provides long life and assists in heat dissipation for cooler motor operation. t' E. Energy-efficient 4/10 HP motor runs cool and quiet for long life. Motor windings contain automatic reset, thermal overload protection. F. Mechanical shaft seal is carbon- and ceramic-faced f for long leakproof life. G. 1-1/2" Discharge NPT H. Corrosion resistant non-clog base with strainer-free • inlet capable of passing two (2), 3/4" diameter { spherical solids simultaneously. I. High corrosion resistant, semi-open non-clog impeller passes two (2), 3/4" spherical solids. "I J. 2" High corrosion resistant legs raise pump's inlet from bottom of septic tank pump chamber. . y. X61141 VOLCK switch r Pr I o HYDROMATICe Pentair Water Page 3 I SHEF40 Submersible Effluent . DETAILS Pump Characteristics Performance Data Pump/Motor Unit Submersible 40 Manual Models SHEF40MI SHEF40M2 Automatic Models SHEF40AI SHEF40A2 30 Horsepower 4/10 Full Load Amps 12 6.5 SHEF40 Motor Type Shaded Pole (4 Pole) FT 20 R.P.M. 1550 Phase 10 10 Voltage US 230 _ Hertz 60 Temperature 120°F Max. Fluid Temp. 0 10 20 30 40 50 60 10 NEMA Design A GPM Insulation aass B Discharge Size 1 1/2" NPT Dimensional Data Solids Handling 3/4 weight 28 lbs. 3-7i8"-~«-6-518" (168.27) Power Cord 18/3, S1TW, 20' std (99.42) 5"(27) (30' optional) 3-718" (98.42) Materials of Construction 3-7/8" DISCHARGE (98.42) 1-1/2' NPT (38.1) Handle Stainless Steel Lubricating OB WWWric OB FLOAT SWITCH Motor Housing Cast Iron P Casing Cast bran Shaft steel mechanical Sea Faces: Carbon/Ceramic Shaft Seal Seal Body: Anodized Steel Spring: Stainless Steal n-3/a° 1( 116" Bellows: Bunn-N (28 92) (258.76) Impeller Engineered Thermoostic Upper Bearing Bronze Sleeve Bening t (92.07) 81 2-150. Lower Bearing S' a Row Bid Bearing 1 Bottom Plate. Polyester Coated Steel Fasteners Stainless Steel All dimensions in inches. Component dimensions may vary ± 1/8 inch. Dimensional data not for construction purpose unless certified. Dimensions and weights are approximate. On/Off level Legs Engineered Thermoplastic adjustable. We reserve the right to make revisions to our product and their specifications without notice. - Your Authorized Locol Dki ib ftr - F YDROMAT1C' Pentair Water / USA CANADA 740 East 9th Street Ashland, Ohio 44805 269 Trillium Drive Kitchener, Ontario, Canada N2G 4W5 Tel: 419-289-3042 Fax: 419-281-4087 www.hydromafic.com Tel: 519-896-2163. Fax: 519-896-6337 Cc3 2005 Hydromotics Ashland, Ohio. All Rights Reserved. item W-02-6680 1.5M 3/05 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND , OWNERSHIP CERTIFICATION FORM Owner/Buyer ROBERT AND BERNICE HESSLER Mailing Address wnnnxt gy, MN Property Address (Verification required from Planning & Zoning Department for new construction.) City/State HUDSON, WI Parcel Identification Number 040-1257-10-000 LEGAL DESCRIPTION Property Location Nw , SE % , Sec. 24 , T 28 NR 20 W, Town of TROY Subdivision TROY VILLAGE , Lot # 104 Certified Survey Map # , Volume , Page # Warranty Deed # , Volume , Page # Spec house O yes QXno Lot lines identifiable 01 yes 0 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. Uwe, 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. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe 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 4 SIGNATURE OF APPLICANT(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. 08/05) POWTS OWNERS MANUAL & MANAGEMENT PLAN Page 1 of Z, FILE INFORMATION SYSTEM SPECIFICATIONS Owner ROBERT & BERNICE HESSLER Septic Tank Capacity 1200 gat ❑ N1 Permit # - Septic Tank Manufacturer WIESER a NF DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOK ❑ NA Number of Bedrooms 4 ❑ NA Effluent Filter Model 525 ❑ NA Number of Public Facility Units N/A ❑ NA Pump Tank Capacity 800 gal ❑ NA Estimated flow (average) 400 gal/day Pump Tank Manufacturer WIESER ❑ NA Design flow (peak), (Estimated x 1,51 600 gal/da Pump Manufacturer HYDROMATIC ❑ NA Soil Application Rate • 6 al/day/fe Pump Model SHEF40 ❑ NA Standard Influent/Effluent Quality Monthly average" Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) X30 mg/L ❑ Sand/Gravel Filter ❑ Peat Liter Biochemical Oxygen Demand (BOD.) 5220 mg/L li NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSSI 5150 mg/L ❑ Disinfection ❑ Other. _ Pretreated Effluent Quality Monthly average Dispersal Cell(s) d NA Biochemical Oxygen Demand (80D5) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSSI <30 mg/L ❑ NA ❑ At-Grade bl Mound Fecal Coliform (geometric mean? 510' ofu/100m1 Cl Drip-Line ❑ Other: _ Maximum Effluent Particle Site Y in dia. ❑ NA Other: ❑ Nit Other: ❑ NA Other: ❑ Nit *Values typical for domestic wastewater and septic tank effluent, Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency _ Inspect condition of tank(s) 1 1% At least once every: 3 ❑ month(s) (Maximum 3 years) Nit year s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Yt,) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) El NA 3 nyear(s) Clean effluent filter At least once every: 101 a month(s) ❑ NA ear(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ W, ❑ ear(s) " 0 month(s) IN W. Flush laterals and pressure test At least once every: ❑ year(s) Other: At least once every: ❑ month(s) 11 N f O year(s) other: 1C1 Nf, 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, PO.WTS Inspector, POWTS Maintainer: Septage Servicing Operator. Tank inspections must include a visual inspection 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 to check for any back up or ponding of effluent on the 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 indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third W3) 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 11:1, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. t9i u Page Z of Z START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemio that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the canter 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 power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restori! power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls 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 ari within 75 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 tt POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; f,1 foundation drain (sump pump) water; fruit. and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; ai 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 ( properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits 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 SeMage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled witt 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 a code eomplianl replacement system: C A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorpton 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 limes and wells- Failure to protect the replacement area v[ ill 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 that time. Q A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWYS technology a holding tank may be installed as a last resort to replace the failed POWTS. alua ' o m9 tk 1`~ .)k e' a fZOf(110 rrec~, f012 &ItMd' fi t 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> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NCT iE=1NTIER ASEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS f POWYS INSTALLER POWTS MAINTAINER Name CUITHIBYSIDE PLUMBING & HEATING INC. Name PAUL KOEHLER Phone 715-246-2660 Phone 715-245-2660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORM Name POWERS Name Cleb ( Phone 246-5738 Phone '7/~-- lv (7 This document was drafted in compliance with chapter Comm 83.22(211b)(t)(d)&(f) and 83.54(11. (21 & (3), Wisconsin Administrative Code. , ERViRONAERTAL~ 16K 19321201" STREET, NEW PIGAOND, NOW LA51 SAVED 6Y110ANA5 NELSON 715-2961959 TOM MR50ty 50il TOM 227387--2E MEM 91Mi OMiq 52 AI Troy Village - Lot m NW%4 SE V4, SECTION 24 T 28 N, R 20 W Troy Township, St. Croix County, Wisconsin Page 3 kf ~y 2._ ID~ 7-7`X~l f t i 7..5`~ ~ Set 4"k !F/ 1 t rod V SCALE 1" =40 Tom n BM I W lot corner Top of iron pipe ELEV 100' BM 2 Grovnd:surface next to fence post ELEV 99.48 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmental By Design Attach complete site plan on paper not less than 8% x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal refeente-po1rA.4BM), direction and St. Croix percent slope, scale or dimemsions, north arrow ~ locatlan~ard llistance to nearest road. Parcel I.D.# APPLICANT INFORMATION - P/~~e~prinf all inIformaf7c~n. 0 yo- Personal information you provide may be used ft ke' o dart' (P vacY laws.15.04 (1) (m)). VIeW By Dateg 14 r1 % :rr Property Owner roperty Location Continental Development Govt. Lot NW 1/4 SE 1/4 S 24 T 28 N,R 20 W Property Owners Mailing Address Lbt # Block # Subd. Name or CSM# 12301 Central Avenue NE Smite 2,30 104 Tro Willa a 7j City State ',dip dodeZft*Wtfiftt d City ❑ Village ®Town Nearest Road Minneapolis MN 5$4~ . , Troy Lindsay Road New stin ® Construction ®Res'idantial,~kuib,er-of'6edrooms 4 Addition to g building Replacement Use. F] Public or commercial describe ❑ Code Derived daily flow 600 gpd Recommended design loading rate 1.2 bed, gpd/fI21.2 trench, gpd/fF Absorption area required 500 bed, tF 500 trench, ft= Maximum design loading rate 1.2 bed, gpd/ftz 1.2 trench, gpdKF Recommended infiltration surface elevation(s) 4 4 104 ft (as referred to site plan be hm f Additional design / site considerations Parent material Loess Over Glacial OutWash Flood lain elevation, if applicable ft S=Suitable for system Conventional Mound In-Ground Pressure AT-Grade System in Fill F Holding Tank U=Unsuitable for System ❑ S ®u ®S El U El S ®U C] S ®u ❑ S ®u ❑ S ® U SOIL DESCRIPTION REPORT Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPDfiF Boring# in. Munseli Qu. Sz. Cont Color Gr. Sz. Sh. iced? Trrnch t A41 1 k 1 0-5 10yr3/2 - sit 2msbk mfr cW 2f .5 jly _6 2 5-25 10yr4/4 - sa 2msbk mfr CW IF .5j: 6 Ground 3 25-29 10YR8/3 - bedrx - - - - - - elev 100.37 It Depth to limiting factor 25 Remarks: rstt~ 2 1 0-13 10yr3/2 - 0 2msbk mfr cw 2f .5 i .6 n 2 13-34 10yr4/4 - sa 2msbk mfr cW IF .5,1:: .6 Ground 3 34-40 10YR8/3 j - bedrx - - - - - - elev - 102.86 ft Depth to limiting factor 34 Remarks: CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson - 715-246-2454 Address BnvirOmental BY Design Date CST Number Ref # 1432 120th Street; New Richmond, WI 54017 12/29/98 227387 82 ;'f az PROPERTY OWNER: Continental Development SOIL DESCRIPTION REPORT 16 0 Page 2 of PARCEL I.D. Environmental By Design Depth Dominant Color Mottles Structure GPM? Horizon in. Munseil Qu. Sz. Cont Color Texture Gr. Sz. Sh. nsistenc Boundary Roots Bed 'Trench 3 1 0-23 10yr3/2 - sit 2msbk mfr cw 2f .5 .6 2 23-36 10yr4/4 - sil 2msbk mfr cw IF .5 .6 Ground - - 4 5 elev 3 36-48 10YR8/3 - ls* 2msbk mfi 102.59 ft Depth to limiting factor >48 Remarks. * w/ bands of c1 10yr6/8 4 1 0-5 10yr3/2 - I 1 2msbk mfr cw 2f .5 .6 2 5-20 10yr4/3 - I sil 2msbk mfr cw if .5, L .6 Ground elev 3 2040 10yr4/4 - sit 2msbk mfr cw - .5 .6 103.02 ft 4 40-42 10yr8/3 - BDRX - - - - - - Depth to limiting fagot 40 Remarks: F Ground elev Depth to limiting factor Remarks: Ground elev Depth to limiting factor Remarks: Tro~,✓ ueveibpmen-f arMro*oi-, 12JUl Central Avenue NE Bloine, MN 55434 (612) 757-7568 OUTLOT 3 46 COMMON AREA - PARK Ac 4 9.406 ACRES 9 6.0 ' t 44 c 45 J i 'S6a AC LEGEND 14 AC 1.642?C UTILITY EASEMENT, 10' WIDE '0171 X .9 c ~ - - UNLESS OTHERWISE SHOWN. DRAINAGE EASEMENT, 10' WIDE 41 w 42~ z 47 ti►j UNLESS OTHERWISE SHOWN. h 1.617 ACq 1.106 C 48 49 BUILDING SETBACK LINE. 75' 40 064 A 1577 +e - - - UNLESS OTHERWISE SHOWN. _ 1.642 AC b. .L9L4Z~6 , J ~SO2, x ~ -3I058^• 1.291 AC •r" 1.013 ABC Q t~~ ' < . 240. 1 nor Ac I 3.310 AC 28 . 31 34 $ ^1.000 A. +~•4f~ , 7J3e Ac 240 1to ;4 AC- I GOLF COUR _ I s a •..••g. o J .S?. I •a1Z 4Zy1 o$~ 30 129 1 0AC 23 r 523.3~j• 2 ~~yy1~ 48 AG 25068AC''•./ N 1.075 AC -'1 I g•Y/ ? ?s. )C ,16.22• I 45• 259.05' 1 '9~ ~Y !9o k• I/'y fir, 10 i' J" 24 I OUTLOT 12 N do 103 wy 1. AC . 7AC..~ 0128 !°r / 1,bo5 ~~A COMMON AREA- , 60 Ac • ,238 A ~ri I M1 PAR .044 K aB°3s a 1~o 5AC, 7 Ac 6 , I . 27 5 g 15 102 I ~=0. ~1.22o AC/ I. I 1 1 360.81 ,.340 AC , • / ~ 4C • >as ~,y 26 I ti , 107 .y'o: ,10010 C . 1A94 A , 50 r 21003 AC / Q , 300 AC °j ~•J E°?8. moo"' 3V 1,-Ao 1.026 aim 317.71' 1~•. ^ 9 r 1108 r . ti ,.10 42AC 11 g5g a 20 4 y ! 109 ~,►es ? ?s/. z~ 1.048 A< Sa1 AC. .009 1 6 q 99 .a . F 7 ~ . ,.~el Ac a GOLF COURSE ^ .0, "111 c pia: v ' 117 11AC-, 2760 AC 98 ,006 AC +pJ 1.425 AC A 94 ' 199 1A32 AC j•..` J 6 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSfi1P CERTIFICATION FORM Owner/Buyer 1Z ~,1 l r - S S Mailing Address A4t4 57 Property Address I C3 t7i-'~ (Verification required from Planning & Zoning Department for new construction.) City/State flS~ 1 Parcel Identification Number C1 r 1 ZS l o `I 9:Zi LEGAL DESCRIPTION Property Location Z4 , T -Z$ NR -~-W,-Town of =1"1-d Subdivision Lot # fir. Certified Survey Map Volume , Page # Warranty Deed # Volume , Page # Spec house yes //ho J Lot lines identifiabl 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 5t Croix County Planning & Zonrug Departrneaf 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 andlor (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe, 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 §eptic system bas been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above; by virtue of a wa ty deed recorded in Register of Deeds Office. Number of b rooms- ~e 4- - Az~ SIGNATURE OF APPLICANT(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. 08105) f IuIuII 5 0 9 3 1 4 TX64071871 SPECIAL WARRANTY DEED 964759 13127H PABST REGIS run. OF DEEDS ST. CROIX CO., WI 10/04/20].2 3:00 PM This Deed, made between Dearborn Street Holdings, -LLC, an EXEMPTO: NA Illinois limited liability company, Grantor, and Bernice E. RE He"ssler C FEE:3t).OO And Robert J. Hessler; Grantees, T' BANS FEE: 108.00 PACxES: 1 Witnesseth, That the said. Grantor, for a valuable consideration, conveys to Grantees the following described real estate; together with the rents, profits, fixtures and other appurtenant interests in St: CroiX County. State of Wisconsin: RETURNTO: Tax .Key No-. 040-3257-101 0100 Lot 104, Plat of Troy. Village Third Addition in Elie Town of Troy, St: Croix County; Wisconsin. This is not homestead oronertv_. Grantor warrants that the title to the property is good, indefeasible, in fee simple, and free. and clear of encumbrances arising by, through, or under grantor except: municipal and zoning ordinances, recorded easements ror public utilities serving the properly, recorded building and use restrictions and covenants, and general taxes. Dated:. (fin .d' i wd, 201-Z. 0"rborn' Street Holdings, LLC, an Illinois limited liabuity cothpany (SEaL). gy:- (SEAL) ►~.~rri1~t~1 y ~~n (SEAL) ATTEST[.. 0-A1" (SEAL) ftym x, AUTHENTICATIf ON AC: KNn W LEDGE MENT Signature(s) STATE OF w;Lbvi~ill' ) ss. 1_l~G.vtIGC tv~ County j authentickted this _ duty of 200 fei'sbiielly bade bef rc me ou bCkybR:1` 1 , the above=nfirnad: TITLE: MEMBER. STATE BAR OF WISCONSIN (~n~ Hs2 r (ZSQX1 (If not, - authorized by §706.06, Wis. Stats.)- to me known to be the persons who executed the If - going instrumen nil acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY 1. JP~9~ Shawn R. Hillmann Cop BASS & Moglocl-s1 1 S L fIV[artu1t11::S1UO't4 }C~rtlugnpL ar c>.gires- V=' ~ •''3-}? e4ttt€tfrr~ 4,~w~`tGE,t.YN °`fr 1 U&I `'ji~ ~✓•}S G Oft i~` i~ 'rtf 61tpt4tt`'~ j of 'E i 259-05" -1 n 4~. 1 UJP% 4 1.055 ACRES 45,975 S r 10 00 103 OOF 649 ACRES , ooolwo, 1,828 -704