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040-1318-00-051
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 563872 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)]. Permit Holder's Name: City Village X Township Parcel Tax No: Smith, Brian & Sarah Troy, Town of 040-1318-00-051 CST BM Elev: Insp. BM Elev: IBM Description: n Gn Section/Town/Range/Map No: ,/QU ~cJG 5 11.28.19.2126 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE 7,,/, k CAPACITY STATION BS HI FS ELEV. Septic 2n 3 Benchmark A /zoo Dosing ADO Alt. BMr/, (tel. Lo w" A /67 C-~~D x T. Aer#io e5 Bldg. Sewer Z •7 1Qq Holding v SUHt Inlet /DI /Q l~ TANK SETBACK INFORMATION St/Ht Outlet TANK TO i~lL( WELL , BLDG. Ven to Air Intake ROAD Dt Inlet Septic 7 56 / 7Z, 1 Dt Bottom 3 <7'-7 • 9 Oft Dosing > SO / 7Z Header/Man. ld(" Aeration y / SD Dist. Pipe 5 • ~y . Bot. System ,f. 16S.1 Holding Final Grade PUMP/SIPHON INFORMATION A-7- -7 Q C Demand St Cover /0 t~ .L l X67 Manufacturer 7 GPM Model Number 34,31- j a L Vr 7~ ~jf~ TDH Lift Friction Loss System Head TDH' 7 ft Forcemain Length D/I Dist. to Well /J, /,7 SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. renchLI PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS -7 9-2 /J1 SETBACK SYSTEM TO P/ • BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type o tem: Z I / J UNIT Model Number: Jfb✓✓~ DISTRIBUTION SYSTEM "A- > Header/Manifpld 4 Distribution -rj/ x Hole Size x Hole Spacing Vent o Air Inta Pipe(s) 3, v Length Dia Z Length 5 Dia Spacing w SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over 1 Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Edges Topsoil No es rual No BedlTrench Center 7, I COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /b 3 Inspection #2: / / Location: 719 Crest Curve Hudson, WI 54016 (NW 1/4 NW 1/4 11 T28N R19W) Hills of Troy Lot 51 P1 G"J ` arcel No: 11.28.19.2126 1.) Alt BM Description = F'r P. I o w (9K. 2.) Bldg sewer length = 7Z ~C~ rv~IL 5 o y" - amount of cover 41nsepctors Plan revision Required? ~ Yes No f Use other side for additional information. ~J Date Cert. No. SBD-6710 (R.3197) 719 ~ta~t ~E Zursr /D, _ _ E- /3.2 ~ ~ j,~l~✓ _ ~ aD ~ yO Loy- SU L6 r S/ Lor S~ c SPS 383, y3 S~r~,~crs rrET ~c~~AEV~-t~A6a~ CuaD~dFioa~~ t ~.~/A.✓ Srir,✓ ~ ~itE',pfiu£~ayE ~ousf, t 7/9 Ly.~vE CA~srs1~ I °5~6 Lo r s; /~i~cs aF j'~1oY Q~DPE~e~ r Aw IVI .2.9 IV 19Af a pats t 30 ~..✓.d of ray Sr. ~itbrx Co, dAa9~~ ~Aoi°o sEO c1-~. t 414 3o,~Y l G ~a G✓/ESE~t /,?So/7scs i ~ , Loiy,6o jA.✓K o a "wG Sc.y. 5~d O.7G S I G Q 7 x S7 ~6aK ,p~STit~~urra.✓ cez, a~B.S X ' / fODUD OowTS S, E~, - SOS 9 ' o.✓ ~ iay y ~aro4,c /off. y f I /3.7 -i z i Esc ~ i'1SL a M 97.9 ~ia~~ s> 6.r /ado OoG 9 4 ~o"ysa✓ o/E.J TaO of //y "/~co,✓ ~/f~E I G ~ / ,SPACE ~ 0 i~ ~o ,yy~ty Industry Services Division County „Sj Xd.'X © r 1400 E Washington Ave Sanitary Permit I n by Co.) P J1'`I P.O. Box 7162 Madison, WI 53707-7162 ~P -Sanitary Permit Application State Transact CionNumber In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit ZZ / t is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if di eretttthan m i ing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary L purposes in accordance with the Privacy Law, s. 15.04(1 (m), Slats. %llil~ 7 1. Application information - Please Print All Information / 9 C~4tdE~itESr /~D. Property Owner's Name kl~ Parcel # .S /rte o ~/Q r~o..~ 0~{D - 1315 - 60. 6 S l Property Owner's Mailing Address Property Location / Z l z a7 Ca E.eG ,f//1/uE JO!/,re Govt. Lot City,, State tip Code Phone Number VIAI y., /VAJ y., Section " a/LY 89-GBao a Ircleone II. Type of Buildin T e~0 N; R ; o V g (check all that apply) Lot # 91 or 2 Family Dwelling- Number of Bedrooms Subdivision Name 6 ~ ~ slo - /LLS aF ~i(cY ❑ Public/Commercial-Describe Use . v ~0 J Sty ~ 4 `ti f ❑ State Owned - Describe Use CSM Number 8-Yillage of / Town of I' Ad V 7 A- 7 a✓n. CCJ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A' XNew System ❑ Replacement System Only El ❑ Treatment/Holding Tank Replacement Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS S stem/Corn onent/Device: Check all that a I G Li J /01-r. ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound 24 in. of suitable soil Xmound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat nt Area Information: G 1 Design Flow (gpd) Design Soil Application te(9 sf) Dispersal Area Required f) Dispersal Area Pro ed (s System Ele~ation Gaa X0 V. Goa 5 Go 9 11? /o 5.9 4,1 /ayy 60,+7er Vl. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units .r v V m New Tanks Existing Tanks u o D ro U 0. Septic or 73ckiiag.Twik /If r1c CONCRETE Dosing Chamber y~-0 75-0 . ' -1/ z/ t/ VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumbe ' i ature MPflvNW; Number Business Phone Number o EL E a?313YG 715' `7.7 -S.764 Plumber's Address (Street, City, State, Zip Code) G"ns fir. ~✓y a u.Q ~,o I.fJT .5'y Vill. County/Department Use Only pproved prove Permit Fee Date 1f sued Issuing A Signature teen Reason for enial $ YZ~ ba g/ 3/fJ IX . CniriffitTAYll easons for Disapproval 3 Ge n~ f.'at S ti S t i4 Ptb 1 Septic tank, effluentfrlter and dispersal cell must all be services / maintained are- as Pi c tom` t r 5 ` per management plan provided by plumber. 2. AN set*k requirements ML be maint8ialid as pal applica w code / ordinauigs;: Attach to complete plans. for the system and submit to the County only on paper not less than 8 in x I I inches in size SBD-6398 (R0313) otirART, tN DIVISION OF INDUSTRY SERVICES 10541N RANCH ROAD HAYWARD WI 54843 y I) J Contact Through Relay ~l S P S y www.dsps.wi.gov/sb/ www.wisconsin.gov ~O ss10IN ~ Scott Walker, Governor Dave Ross, Secretary August 08, 2013 CUST ID No. 231346 ATTIC- POWTS Inspector JOHN HERBERT PELKE ZONING OFFICE PELKE PLUMBING ST CROIX COUNTY SPIA N 6298 ST HWY 25 1101 CARMICHAEL RD DURAND WI 54736 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/08/2015 Identification Numbers COND Transaction ID No. 2290306 SITE: Site ID No. 793723 AP Brian Smith C/O Creative Home Construction Lot 51 Please refer to both identification numbers, DEPT OF 719 Curve Crest Rd above, in all correspondence with the a enc 42 OFESSI Town of Troy DIVISION OF I St Croix County NWIA, NWI/4, S11, T28N, R19W Lot: 51, Subdivision: Hills of Troy FOR: Description: Mound, 4 bedroom residence SEE CO Object Type: POWTS Component Manual Regulated Object ID No.: 1441446 Maintenance required; 600 GPD Flow rate; 18 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01/01, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01101, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes 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. • The pit areas that are located under the stone aggregate shall be inspected by the county for proper filling and compaction prior to plowing of the site. These areas maybe subject to settling after the construction of the (mound / at-grade) component. The area of the pit(s) shall not be considered as part of the effective absorption area. Reminder • 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. I JOHN HERBERT PELKE Page 2 8/8/2013 ! / J r • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • 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. • Maintain well and waterline set backs per SPS 383.43(8)(1). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. • Insulate building sewer per SPS 382.30(11)(c). 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 Industry Services 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 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer, Integrated Services WISMART code: 76,33 (715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Pelke Plumbing & Well Drilling Inc Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. i JOHN HERBERT PELKE Page 2 8/8/2013 • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • 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. • 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. • Insulate building sewer per SPS 382.30(11)(c). 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 Industry Services 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 Fee Received $ 250.00 Balance Due $ 0.00 Patricia L Shandorf POWTS Plan Reviewer, Integrated Services WiSMART code: 7633 (715) 634-7810, Fax: (715) 634-5150, M - F 8:00 a.m. - 4:45 p.m. pat.shandorf@wisconsin.gov cc: Pelke Plumbing & Well Drilling Inc Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. r Private Onsite Wastewater Treatment System Index and Title Page Project Name: ,~i2/A~✓ '5irlr.✓ / a,.y /dAd rS Own es Name: Aow-) .~.y r y c% G /1£AS'/UE ~o.rE ~.~.ss-.u•~r/d,r - OwnWs Address: 707 Zo,wyzAe£ A-WldE, .Salts' y/D - _ T Gs/ a89- ~8oa _ • rIONA"CC.'~." Legal Description: -,,VW. NGJ. a?8it/, /9 Gl ROVED Town, WhLre. of ;;-gay SAFETY ANU Ivlunicipalrtp: Sr--R311CES Couay: Sf ~,eorX DUSTRY SERVICES • S`abdivisionName: ~t F ~llo Y ~L_ Lot Number BlockNumbea: ;RESPONDS Parcel LD. Number: Page l ~ir/,OEX ~ P7irtE Page 2 Ito r ~t,v.~ Page 3 C/loss ~EG rio.r /'LEA ~/i~a! of a.✓o Page 4 G APE ly rE-~r,~~ l,~yd~r Page 5 .SE',orrc ~,~.✓.r ~~urv ~i~/ArxcrE.i ~itoss -SEc cio.~ S~s-cs. Page 6 ~uy/° ~E-/l~O~r,•JiO.,JGE ~i~/f0 Page 6ro~1 rs ow.,~E.~ s ryA.rluEL t ~,o~LErr~✓r ~t~~J Page 8 page9 rE/t /i✓fORi9'A!'/o~✓ Name o€Dedwer: f o E Li==NWnber: sue- Date: _ 7-19 - o?al3 Designed Pl~ to the Following POVM Componemt Manual and n 5P s 81-83: //~oa.~B ~a/Y/fP6.rrEroJ' .Jail cJE.csi6.~ ?o ,SED-/DG9/-/d ~A01 wlo/) _ /"~E✓~.Su~t E !(Ll.~T/L/~l~lJt►•~l ---~ON/6NE.rl-~-~i0/~✓u./L ~lEirsiav - ~dD-,/a7as-/~- lif/ 0~~6 /n I"T'AOyrIEN p'S : .So/L Ev,OLUAT/vn1 ~EDeaT~ 719 `u r~E <<t--sr 61D, yo , _ _ _ _ G3 - !'ifs, /3,7 x 330 ~ Go r Lor sv 16r S/ Lor S.2 ~L~ S17!r 383. Y3 S~ra,tcrs ,yEr Cu•~DL`v~t~~sn~ CU,~DEJFioo4o~ ( 71 / LyR vE ~!1 esr WD. l osEd Lor s; "51"vZ5 of rfoy Da~~E~~~ ~!laios6o r /Il~ N~ J/ .?8~ l9~ p tilEt~ 330~✓✓ of r o, Sr, <<t6,X Co, Y~~Pdc 3ody - - > %1 ~rf~tor✓ ttaoE~ l G% ~ ~ l L✓/E"seX /aSo/isa t ~d lGo -f'&o tL F~° o a aApe- ScN. 5~0 0.76 S r ( Q 7 Y87 llotr oOlSTaleurre.~) ctrl[ Powrs ZOA) /n1 E.2. - /aG S ' I l F-/3. rOO 6,C lila,✓ O/PEG ,SP~cE i l~ v I f d i+ O 04 W a •.4 so •i. A l 3c k '0 s. v 41 AiA :~z N3 x .~o A_ 1 t , it go- 1 •Q o f1 - - 3c ` I)c W ar wo - ~ H • ~ Z v OQ• V• t • as. as aWi ss si u -y ~ t ! . ! ts. ^ 'e] J++ \ two 0 04 1 ~..r p e = H a v Cr ' o d L w a ~ ~ F n V y 0 iz ry ^ y Q 44 _ H x a y i INZ - i h . v x v a • v VI rvi v Q r r W NHNN ~ W - H u u u u C O~~ww.l► ,WtHZ~~ x~~wwwv>>e~+ I . P age S of 9 SEPTIC TANK &'PUMP CHAMBER CROSS SECTION*AND SPECIFICATIONS ..i Sc.w f'o. 4" CI. VENT PIPE 12" MIN. ABOVE GRADE 9 WEATHERPROOF /O~ FROM DOOR, WINDOW OR JUNCTION BOX APPROVED FRESH AIR INTAKE WITH CONDUIT MANHOLE COVERS er~ow W/ PADLOCK & WARNING LABEL 4 " MIN. 1$" IN. INLET WATER TIGHT SEALS ,a~sr GAS• TIGHT ► VAPPROVED Gf -/o A SEAL I ficr'E,t JOINTS WITH APPROVED ; ALM APPROVED PIPE PIPE 3` ON 3' ONTO ONTO SOLID C SOLID SOIL SOIL' PUMP OFF ELEV. 9896 FT. -I-- OFF RISER EXIT D PERMITTED ONLY IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS- SEPTIC./ DOSE TANK MANUFACTURER: ,c G oA,[.~ErE NUMBER DOSES PER DAY: S. / (/9 ~ ~ - //6.7 f y, / TANK SIZES: SEPTIC laSo GAL. DOSE VOLUME INCLUDING DOSE 7So_ GAL.. FLOWBACK: /?0.8 GAL. ALARM MANUFACTURER: TE gyo~,•ecs CAPACITIES: A = jo,S INCHES = Y911 GAL. MODEL NUMBER: `7- ,~,C`ALERr / SWITCH TYPE: dAZ5. B = ~2_ INCHES 32.2 GAL. PUMP MANUFACTURER: ZOELLEC ~.~tN C = 7.5" INCHES = 476.9 GAL. MODEL NUMBER: !S/ SWITCH TYPE: Ec.yAwic,~a D = 8.0 INCHES = lWgf 8 GAL. REQUIRED DISCHARGE RATE 301-47 GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC VERTICAL'DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE 8•S FEET MINIMUM NETWORK SUPPLY PRESSURE . . . 3.3 FEET + .~S FEET FORCEMAIN `X ?.S- FT/100 FT. FRICTION FACTOR', 7 FEET TATAL DYNAMIC HEAD = / .S FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH SS ; WIDTH ~00 DIAMETER LIQUID DEPTH y8" G"C4 w TOTAL DYNAMIC HEAD/FLOW w PUMP PERFORMANCE CURVE PER MINUTE MODEL 151/1521153 EFFLUENT AND DEWATERING 50 14 45 153 MODEL 151 152 153 12- 40 Feet Meters Gal. Liters Gal. Liters Gal. Liters i 10 152 5 1.5 50 189 69 261 77 291 10 3.0 45 170 61 231 70 265 15 4.6 38 144 53 201 61 231 0 8 25151 20 6.1 29 110 P38 167 52 197 25 7.6 16 61 129 42 159 0 6 20 30 9.1 - - 87 33 125 35 10.7 - - - 22 a5 15 40 12.2 - - - 11 42 4 1o Shut-off Head: 30 ft. (9.1 m) 1.6m) 44 ft. (13.4m) 0145088 2 s Model 151 Models 1521153 10 20 30 40 50 60 70 80 90 100 - LITERS - 6 7132-~ 67/32 LITERS 0 40 60 120 160 266 240 280 320 360 3 716 4 518 3 718 498 FLOW PER MINUTE CONSULT FACTORY FOR 3718 -3}6 014508A Vill a t SPECIAL APPLICATIONS 37~ 378 • Timed dosing panels available. • Electrical alternators, for duplex systems, are available and supplied with an alarm. • Variable level control switches are available for controlling single phase systems. I • Double piggyback variable level float switches are available I for variable level long and short cycle controls. - - • Sealed Qwik-Box available for outdoor installations. See 1111116 I +2+e I FM1420. - T • Over 130°F (54°C) special quotation required. 415/16 53/8 151/1521153 Series - st<2444 slczosa 151/152/153 MODELS Control Selection Model -Volts-Ph Mode Amps Simplex Duplex N151 115 1 Non 6.0 1 2 or 3 BN151 115 1 Auto 6.0 Included 2 or 3 E151 230 1 Non 3.2 1 2 or 3 BE151 230 1 Auto 3.2 Included 2 or 3 not "Easy assembly" N152 115 1 Non 8.5 1 2 or3 BN152 115 1 Auto 8.5 Included 2 or 3 (pump not discharge pipe included.) E152 230 1 Nat 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2or3 N153_ 115 1 Non 10.5 1 2 or 3 BN153 115 1 Auto 10.5 Included 2 or 3 E153 230 1 Non 5.3 1 2 or 3 BE153 230 1 Auto 5.3 Included 2 or 3 SELECTION GUIDE 1. Single piggyback variable level float switch or double piggyback variable level OPTIONAL PUMP STAND P/N 10-2213 float switch. Refer to FM0477. Reduces potential clogging by debris. 2. See FM0712 for correct model of Electrical Alternator E-Pak. ' Replaces rocks or bricks under the pump. • Made of durable, noncorrosive ABS. 3. Variable level control switch 10-0743 used as a control activator, specify duplex Raises pump 2" off bottom of basin. (3) or (4) float system. Provides the ability to raise intake by adding sections of 11/2" or 2" PVC piping. A CAUTION Attaches securely to pump. All installation of controls, protection devices and wiring should be done by a qualified • Accommodates sump, dewatering and effluent applications. licensed electrician. All electrical and safety codes should be followed including the NOTE: Make sure float is free from obstruction. most recent National Electrical Code (NEC) and the Occupational Safety and Health Act (OSHA). RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. © Copyright 2008 Zoeller Co. All rights reserved. POWTS OWNER'S MANUAL AND MANAGEMENT PLAN FILE INFORMATION SYSTEM SPECIFICATIONS Owner ,Ci ,J eyZT y a /a o„rE Septic Tan;an SD al ❑ NA Permit # Septic Tanurer DES .c Lock, ❑ NA DESIGN PARAMETERS Effluent FiManufacturer Number S7' ❑ NA of Bedrooms (100 d/bedroom) Effluent FiGf-/o ❑ NA Number of Commercial Units Pump Tank al ❑ NA Estimated flow (average) a0 aUda Pum Tank rer / ❑ NA Design flow (DWF), estimd x 1.5 CoD aUda Pum ManZp re a A-.0 ❑ NA Soil Application Rate /.d al/day Pum ModS/ ❑ NA Influent/Effluent uali Pretreatment Unit X NA Q ty (NA❑) Monthly Average ❑ Sand/Gravel Filter ❑ Peat Filter Fats. Oil & Grease (FOG) < 30 m /L Biochemical Oxygen Demand (HODS) g ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) ~ 220 mg/L r7 Disinfection [I Other: 5 150 mg/L Manufacturer: Model: Pretreated Effluent Qua] i Soil Absorption Component ty ❑ Monthly Average ❑ In-round avi Biochemical Oxygen Demand (HODS) < 30 mg/L g ty) [3 In-ground (pressurized) Total Suspended Solids (TSS) ❑ At-grade J'Mound Fecal Coliform (geometric mean) 30 mg/L ❑ Dri -line ❑ Other: <10 cfu/100m1 ❑ Dispersal Units - Manufacturer Maximum Effluent Particle Size 1/8 inch diameter C] Aggregate Cell(s) Model Calculations: Soil Dispersal (EISA) or DWF _ Application rate Area Required = (Aggregate Trench Width) _ # Units or Total Len hgtt of Aggregate Trench(s) 06 - o = 600 - 7 = 87 DESIGN CRITERIA ❑ "Design of Pressure Distribution Networks for Septic Tank-Soil Absorption Systems" Publication 9.6 (SSWMP Manual) ❑ "ICC Flowtech Mound Component Manual" Version 1.2 ❑ "EzFlow Mound Component Manual" Version 8/20/2007 ❑ SBD - 10854-P (R.1/12) "At-Grade Component Manual Using Pressure Distribution" Version 2.0 ❑ SBD - 10705-P (N.01/01) "In Ground Soil Absorption Component Manual" Version 2.0 P<SBD - 10691-P (N.01/01) "Mound Component Manual" Version 2.0 ❑ SBD - 10657-P (R.6/99) "Drip-line Effluent Disposal Component Manual" 9 SBD - 10706-P (N.01/01) "Pressure Distribution Component Manual" Version 2.0 ❑ Other - MAINTENANCE MONITORING SCHEDULE - MAINTENANCE AND MANAGEMENT Service Event 3 "rfr Service Frequency Pump/inspect tank(s), ins ect dispersal cell(s), clean filte At least once every: ® 13 months Cg 3 ears ❑ Other - Inspect um & um controls, alarm, pretreatment unit At least once every: ❑ months ®3 ears ❑ NA Flush and pressure test laterals At least once eve : ❑ months ®3 ears ❑ NA 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 chemicals that may impede the treatment process and/or damage the 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. 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 repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. 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 oils, vegetable/fruit peels and seeds, bones, 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 napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, Page 7 of 9 disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or . certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or y p ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds one-third (1/3) 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 NRI 13, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Solids washed from the filter shall be retained in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a I day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the-dwelling or surfacing. 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. SPS 383.33, 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 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 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: ❑ 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 render it unusable. Replacement systems must comply with the rules in effect at the time of replacement. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. 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 erect 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 PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name J'ok.J Name Ai t- (f 0'2 Laov,6/•,~ Phone 713 G 7,?- S.764 Phone / G7,?- S G6 SEPTAGE SERVICING OPERATOR (Pumper) -L/„l,C,✓ov,J LOCAL REGULATORY AUTHORITY Name Agency ~2c✓ o o mw-e 4fcll4e Phone Phone 71_S 38 d Page i~ of 9 disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. Compaction of snow over the dispersal unit may cause it to freeze up. INSPECTIONS & MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Maintainer or Septage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of the tank to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and check for any backup or ponding of effluent to the ground surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination of sludge and scum in any tank exceeds one-third (113) 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 NRI 13, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Solids washed from the fitter shall be retained in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Alarms should be tested on a regular basis by the home owner. If an alarm sounds, contact an individual licensed to service POWTS, There is normally a 1 day reserve under regular operating conditions, however water should be conserved until any problems with the system are corrected to prevent back-up of sewage into the. dwelling or surfacing. 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. SPS 383.33, 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 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 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: ❑ 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 render it unusable. Replacement systems must comply with the rules in effect at the time of replacement. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. j 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>> 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 PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name T011✓ S1-< /!P•a?3/dYG Name j-6" s'izr 644E Lues1. i, Phone 7/3 47,?- S.7.94 Phone /S G7,2- S 6L SEPTAGE SERVICING OPERATOR (Pumper) -~.✓.<n/atJ,J LOCAL REGULATORY AUTHORITY Name Agency Sr. 94.,x o ZoAm-m Off/GE Phone Phone 7/.1'- 80 Page 9 of 9 its m -o c ,~YY ° ` 3 a Y ti IJ6 I CL.Z. i t vpp a rCa 130 ' O Z ' l~•' le ~Jz' -r V Q u r -~4-1 f' Q Li ~ o a m v s~ > • Z aY~$Y 0 'a 52M V-4 0 0 %n -0 N 4~ W N mE 'a ~ r- mc o h C [ (u ui 4m ~N m 4- =N C O c>ornm F dr .2 4-J 1~ 3= au Lb N W If m a CL Ai -0 -d ;M v v a 0 a. ~ Q L 0 i7 m V R o H o O S Fri Y ~ ~ Q c a, X dvtm~ Q c(cu E o- c~c r~~•.•.~I 3 EE Z Yc~v r mva; Vol ►~i c d ea B E c O !V ~3v c c a 4 d T V M L~ m y L O - v~ m a ~c ~I Q~ VvAt - - d d E ov ~TaYc: lau o Nat Q.~'.II d .0 C C. L N O O` 3 I A O.~r O m v w Dili N`9prnw~s ca~~nu oco _ 3mo~ r - -0 0 O-C is cr CL 14 m ° V 3« s 0 I/) i N L N O O O -.ft ` o a w V o ~ °~p•'vE aA I - m c a m io n m C N N j U~ m Y L - O Y y O W N LZ 41 -C m _ c m ~ a ~ E a aar ~ vii 5 m it ~ 9 ri n~sE y 3£ j •O o aaN~ey in m L C C CO W CL Cm W E-. N ~i aai m a°i w m E c 0 41 ~ _ H a= Y Y~ c v H£ CIO U *4 El V.4 E c a o ~.v .j y sm. w 7 Q C ° F 1 i. . m •id - m T3 d) i~ a a o - r m m m m m r m m ` fir" 0 t N + _ ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND ' OWNERSHIP CERTIFICATION FORM Owner/Buyer „ C reo -4 , V e- K"4 S --L Mailing Address a Property Address r t G~ r ti-~ (Verification required from Planning & Zoning Department for new construction.) I City/State co ~2 Parcel Identification Number 040- 1318- DO- 05 l LEGAL DESCRIPTION Property Location 11/4 , 1/ , Sec. 1 , TN R I I W, Town of T Subdivision Plat: - i 1 s o -4 np!/ , Lot # Sl Certified Survey Map # (083 75- , Volume , Page # 4-'-*>SZ- Warranty Deed # (before 2007)Volume Page # Spec houses 0 no Lot lines identifiable/yes 0 no r 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 §SPS. 383.52(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 Safety And Professional Services 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 fo are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, by virtue of a warran deed recorded in Register of Deeds Office. Number dooms c. Zi29 /1 IGNATURE 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. 04/12) 972540 BETH PABST REGISTER OF DEEDS State Bar of Wisconsin Form 6-2003 ST. CROIX CO., WI SPECIAL WARRANTY DEED RECEIVED FOR RECORD J 02/04/2013 10:19 AM Document Number Document Name EXEMPT # NA J REC FEE: 30.00 TRANS FEE: 54.00 THIS DEED, made between BMO Harris Bank National Association, successor by PAGES: 2 merger with M&I Marshall & Ilsley Bank ("Grantor," whether one or more), and **The above recording information Brian R Smith and Sarah E Smith, husband and wife as marital property verifies that this document has been electronically recorded with survivorship rights ("Grantee," whether one or more). & returned to the submitter Grantor for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Recording Area needed, please attach addendum): Name and Return Address Lot 51, Plat of Hills of Troy, in the Town of Troy, St. Croix County, Brian and Sarah Smith Wisconsin. 9014 Jensen Avenue South Cottage Grove MN 55016 Property Address: 719 Crest Curve, Hudson, WI 54016 040-1318-00-051 Parcel Identification Number (PIN) This is not 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 arising by, through, or under Grantor, except municipal and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, general taxes levied in the year 2013, and Permitted Encumbrances described on the attached Exhibit A. Dated January 2013 BMO HARRIS BANK NATIONAL ASSOCIATION r- succes i M&I Marshall & Ilsley Bank (SEAL) (SEAL) * * B S. utz r, -ce President (SEAL) (SEAL) * ras~~ t * By: a~ t9- 4 - AUTHENTIC_ *Iw OT,'+'k '°ty: ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ss. authenticated on / r" A` crc~ l MILWAUKEE COUNTY ) {p` came before me on January p 2013 i the aboveYnamed Gary S. Kautzer, Vice President of BMO TITLE: MEMBER STATE BAR N~65IN Harris Bank N.A. (If not, to me known to be the p on(s) who cute the foregoing authorized by Wis. Stat. § 706.06) ent ckno a ed THIS INSTRUMENT DRAFTED BY: * Carol Lee Ho ins Marvin C. Bynum 1 1, & Kahn, S.C. Notary Public, State of Wisconsin My Commission (meat) (expires: April 6, 2014 ) 8969269_1 (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. SPECIAL WARRANTY DEED 2003 STATE BAR OF WISCONSIN FORM NO. 6-2003 * TWi ame below signatures. 4Elib ~G iF Aummwmu, 4 i!1 wwww"W dr WWRwbffpo b uREST Clue"RVE N '90"00'00" y~p~p~p ympt EhrYl! ~b 9Y~Ib 91101Y d~710E! 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JNJ wL v .P,.~IIII~,. sP rc I wl>av ow.4.. •~-•s W ~ i J I I ~I I I 1 ~ I sa I I I I , I I Q I ~ ' E A A -------J > 4 r____________J Oil YY ~~~III I ?Z~ ~ ~ I I , I I I F , L__ L_ I ~Y L___________________~ I I ~ , 7 I I ~ z I - s I ; I J I .b,n .0,9 n , .ohi I •~T I § a ' p F ~~i 1 I I ' I l ~ ~ I N~~ 'I z i§ § ~~s~ 9r.. 7€ IL I I Q I 9 BSI hl FI ~ _ _ I ; ~ ~ . p I ' affimms I § O § Y d ' 11 j F I 1- ` L____ 4 ~ I I I ` III I TM I I ~I pp II II I I O I I 6 ~e ~ r----~ I rar b II gyp' ' ro~ ~ I I 11 ~63 I 1 I' -orr II n I K AhC .OI•L CVy .O•.9 .411 .Y.9 .4.i .0+9 .O•.9 .b-.CL .P,II .Oh.P ,OhOL w$x AOZ!U d0 STIIH'IS 101 oGU' °~^iG~ «xrooL IM 'dIHSNM01 ,kO'aU ++nG ml roG iwn L ~aoveno mowL R y~y 0 3A?J(1:)1S3TJ7 bIL '"GwcGSll"".mo. rarnv. :slrolsvaa ~ g iN BM 00; NOYWpWax~Y~~ ~ 41-.N Z~ 1 1 AhN p, .h1 .hGl .r.. f0I it I W I I " A 0~P li iA a n it U, LI YVp l4 I y ` o F p Y~ pgg I F R .t,t ,I .h .hGl p P ' ~ ~~II q i ~ SS rn ~ O a3~ O )a > :RI Q T l Z ~s 11~y@ I ° p i i }I I ,z~ LLj i Fr-- (C~, I inXi[ IX 09 I inl lJ~yyjG a •f-n .ht z,v 9, 0 Y Q I " ~S m~ i y ~ v 4 H urnn a i~ i ~ Ma~wr't -r-- "s T"" I i I .ht .na .o-.l al .P.t .h. .D•.G .hi . , A.LG ~y$s J.02LL d0 S-17IH'IS 107 ~O°"' •OC~" IM "dIHGNM01 ,102LL RSA g'_' //111~,~I 3/\2U``YJ1I15aNv~ "b~iL. rK.mimM ro. aornvv gg20 Ux*EC~ ~JIV~QI~~Q ~"11.~WS ova aoi ,3 .w, cvnro d~~~~ U1 I I I I I I I ya I `A'L Q AM1'~ 1 I 1 I I I I .ha %a+ ~A I I 1 I I I 1 IL I I I~ 4 I I - I --l .~+i I fiPL ~ I I k.l P I I I I ~ L ~ I I f Ifl ~ I I~ I LI I I ~ I a p o s I Y iv Y Z O Seim V 4 rrrn B lu ' o O I ~ • 0 • I a" M I sum I'M b L N O C SB ,1.0211 40 ST IN A 107 y°f "'M0° e N S yw $~7 M 'dIHSNM01 ,102LL u w.«i va a~ aow~ g6 O 3n21rn 153217 bIL L~ rra.m~ aornuo ~ ~ ~ ? ~ ° lu - - W ~ W u I j ~ O n i J I o ° ii ~ ~ I qq~~ In ~u Ik Ox i Ills h ~ ~ ~ ~9 a M m H 4i9~~Ri®!-.~~9Ee~~ogr~s6°wmoe~d~®~(}(0 - • ca ui :w.iw, , movw~ AO0 :U d0 5-111H 'IS 101 IM'dCHSNM01 ,10211 o; as an*sm lsaN,) wL uwaa~uraa,.,oa aornrn saanw am-mv ry ~ I i ~ I i ~ r s ~ J y u' w ~JLl W o A /I ,I a \ 9 f a E . i r - Wisconsin Department of Commerce ~48l~LFF-PORT Page 1 of 3 Division of Safety and Buildings F Comm 85, Wis Adm. Code County ST. CROIX Attach complete site plan on paper not less tha $,1LZx4.1-iAche3 in size. Plan must include, but not limited to: vertical onzontal referenFe point (BM), direction and ~ Parcel I.D. (P V percent slope, scale or dimensions, north arrow, and to tion To distance to nearest road.,, 43 1 ulss Review Date Please print all inform " n..?, XP, Personal Information you provide may be used for secondary purposes (Privacy Low, a: Y3 triY {4) (asN.: G~L~ t/y`- Q Property Owner Property Location M. LEONARD & MARGARET DELAURIERS Govt. Lot NW 1/4 NW 1/4 S I I T 28 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 706 Coulee Trail N51 Hills of Troy City State Zip Code Phone Number Elcity village ■ Town Nearest Road Hudson, WI 54016 ( ) Coulee Trail New Construction UseG] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement E] Public or commercial - Describe: ft• Parent material loess over till Flood Plain elevation if applicable NA General comments Mound System 0.75 ft. sand fill 0.6 loading rate and recommendations: (If pre-treatment system - below-ground drip irrigation 0.8 loading rate) A Boring # 0 Boring t`~ ~ Q pit Ground surface elev. 1071.40 ft, Depth to limiting factor 30 in Soll Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-4 10YR3/2 sil 3fgr mvfr cb 3vf-m 0.6 0.8 2 4-11 IOYR3/2 sil 3fgr&abk mvfr ai 2vf-m 0.6 0.8 sil 3f-mabk mfr aw 2vf-f 0.6 0.8 3 11-30 10YR3/4 4 30-32 10YR3/4 f7f 10YR4/6&10YR6/1 sit 2f-mabk mfr aw lvf-f 0.6 0.8 5 32-35 7.5YR4/4 f2f 7.5YR3/4 A Om mfr 0.2 0.6 Horizons 4& 5 have some gr; few cobbles. B Boring # F ]Boring 1074.50 27 v& fl pit Ground surface elev. ft. Depth to limiting factor in. Soillication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 0=4 10YR3i2 _ 611 3fgr fnvff ob h oo 0:0 01 2 4-12 sil 3fgr&abk mfr as 2vf-m 0.6 0.8 3 12-27 10YR3/4 sil 3fabk mfr as 2vf-m 0.6 0.8 4 27-30 10YR3/4 flf 10YR4/6&10YR6/1 sit 2mabk mfr as lvf-m 0.6 0.8 5 30-35 10YR3/4 f2f7.5YR3/4 sl Om mfr lvf-f 0.2 0.6 Horizons 4 & 5 have some gr. * Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatu CST Number Ma Jo Hollister L?IU 1 224832 Address .-J - Date Evaluation Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 09 - 06 & 17 - 05 (715) 426 - 1775 r DeLauriers (Lot N51) Parcel ID # (Pending) Page 2 of 3 Property Owner Boring C: Doring # 1074.00 18 ~ qb `L I [D pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate /ff Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD 'Eff#1 "Eff#2 Qu. Sz. Cont. Color Gr. Sz. Sh. in. Munsell 1 0-6 10YR3/2 sil 3fgr mvfr cb 3vf-m 0.6 0.8 mfr as 2vf-m 0.6 0.8 6-12 sil 3fabk 2 3 12-18 10YR3/3 sil 3fabk mfr ai 2vf-m 0.6 0.8 4 18-24 lOYR3/4 c2d I OYR4/6& I OYR6/1 sil 2fabk dsh lvf-f 0.6 0.8 cobbles. Some gr; few F-1 0 Boring # 0 Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 "Eff#2 Boring F-1 Boring # Ground surface elev. ft. Depth to limiting factor in. Pit Soil lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 F-1 A 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. M-8330Test(8.07100) IL r' Plot Plan for Hills of Troy Page 3 of 3 Town of Troy, St. Croix County, Wisconsin Lot s l I"= 40 ft Legal Description 2 ft. contours Backhoe pit i ~ I I 100 1o~y 5147L~t; ~i R-100A -99/f0 C ~ ray ~ BENCH AM RK- CH MARK: TOP OF 1 1/4" TO OF 1 1/4" IRON IPE IRON PIPE ELEVATION = tt ? ELEV ION = I%q,g1 6' WID Plot Plan for Hills of Troy Page 3 of 3 Town of Trroy, & Croix County, Wisconsin , Lot s1 I"=40ft Legal Description NwYA o~ r. ►iIZU 2 ft contours IZIGw, -ta~~ = Backhoe pit I ' ~ I I , I I t I i I 100 51®6tiay .sa' I - ~ I F1.1o ,off ~ ' I I R-10OA I -99/10 I 1~1. A NC 1 emac. 1 T 1 1/4" a tUb7 p_EV x.5'1 ' WID