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040-1249-10-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 563883 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: Wright, Robin &Jerita I Troy, Town of 040-1249-10-000 CST BM Elev: Insp.BM Elev: BM Description: �_. SectionlTown/Range/Map No: Uv % 5 1 19.28.19.1293 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER S CAPACITY STATION .y `_ �I FS ELEV. J� �(dGipl Septic 511 Benchmark t,J•'e _ �;/t,, s /z So S. 3`j 106- ldd Alt. BM F �o I Sz5 /sd- /6f. �. Aeration Bldg. Sewer Holding St/Ht Inlet 74, $, TANK SETBACK INFORMATION St/Ht Outlet �• Z 9-7. TANK TO P/L WELL BLDG. QVgat46 Ai Intake ROAD Dt Inlet ` +I l 5 5,� Septic , �� j / Dt Bottom O 2-7 Dosing Header/Man. Aeration Dist. Pipe o,3 95 Holding Bot. System 1! 3 9� PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover� GPM r`, � OJ{� 2. •Z � aS . �o Model Number TD H Li Friction Loss System Head DH Ft Forcemain Length----__ ia:. Dist.to Well --- SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length No.Of Trenches PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 9a Z 1 jrjL SETBACK SYSTEM TO P/L / BLDG IWELL LAKE/STREAM LEACHING Manufacturer: INFORMATION HAMBE Type Of System: ��/ I '37-1 7!> /./ 14,14 Model Numb DISTRIBUTION SYSTEM 2 Z Z Header/Manifold., /1 Distr(bution x Hole Size x Hole Spacing V nJo AAirr Intake _ Pi p e s �— �� v T 11-ength /�J Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ---•�- � Yes L] = Ye No s C No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: J-z,, nspection#2: / / Location: 314 St.Annes Pkwy. Hudson,WI 54016(SE 1/4 NE 1/4 19 T28 R19W) Troy Village Lot 51 F'"— Parcel No: 19.28.19.1293 1.)Alt BM Description 2.)Bldg sewer length -amount of cover Plan revision Required? Yes No '�, /b Use other side for additional information. L_ �__� J (p X31 Date Ins ors Si lure Cert.No. SBD-6710(R.3/97) - 7716632saffilli , Safety and Buildings Division 2p1 W.Washington Ave., P.O. BOX rmit Numb er(adison 7 71 ; 1 State Transaction N un bar Sanitary hermit Application. in accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate govermnental unit ,required prior to obtaining a sanitary permit. Note:Application 1.'ornas for statpe-ow d,PC b Sad Project Address(if different than mailing addr\es the Department of Safety and Professional Servies. Personal information you roN4 "stay'.,e 2i noses in accordance with the Privacy Laws 1 S U4(l)(ai) Slats. I. A lication Information-anc )Please Print All Information Parcel# Pr arty Owner's Name f ``, boo CU�\ Property Location Proper y Owner's Mailing Address ` © Govt.Lot A City,State Zip Code Phone Number -y,, j v, Section— (circle on J` T8 N; Its Eo Wr Lot# 11._,/Type of Building(check all they apply) 1 Subdivision Name 1 Y--11 or 2 Family Dwelling-Number of Bedrooms ___ 1 l Block# n/ -P Cx.Td`� -- ❑Public/C.om mercial-Describe Use �f7 ❑City of CSM Number ❑ Village of---- i ❑State Owned-Describe Use_. JZ Town of . -- III.'Type o 3Permit: (Check only one box on lane A. Complete line B if applicable) A ❑ Other Modification to Existing System(explain) New System -I Replacement System ❑ Trealment/H.olding Tank Replacement Only List Previous Permit Number and Date Issued rB. ❑Pe rmit Renewal Permit Revision ❑Change of Plumber ❑Permit Transfer to New Before Expiration Owner Type of POWTS System_/Component/Device• (Check all that apply) - - ❑Non.-Pressurized In-Ground [I Pressurized In-Ground El At-Grade ❑Mound>24 in.of suitable soil El Mound<24 in.of suitable soil • - ❑ I-lolding Tank ❑ ❑Pretreatment Device(explain)_ _ Other Dispersal Component(explain)_ --- _ V.Dis ersal/Treatment Area Information: Design Flow(gpd) Design Soil Application Rate(gpdst) Dispersal Area ltequired(sf) Dispersal Area Proposed(sl) System Elevation Total #of Manufacturer VI.Tank Info _ Capacity in ; o Gallons Gallons iJnits New Tanks Existing Tanks U to w C7 a Septic or Holding Tank 6 - Dosing Chamber — VII.Responsibility Statement- I,the undersigned,assume responsibility for installation of the POWTS shown on the attached plans. s Signat e MP/MPRS Number Business Phone Number Plumber's Name Print) P1 14>0 0111 I Ste - Plumber's Address(Street,City,State,Zip Code) a WY- VIII. .ount eparkment Use 0111 j Permit Fee,,; Date 1 sue Issuing Agent,ignat}ue / pproved ❑ Disapproved ❑Owner Given Reason for Denial IX.Conditions of Approval/Reasons for DisapprovalG I Attach to complete plans for the system and submit to the County only on paper not less than 8 r/z x 11 finches in sire SBD-6398(R- 11/I1) Document No. II IIII�,iI�II1IlII�II�IIII)I) AFFIDAVIT OF CORRECTION 8 2 0 5 3 9 8 Plat of Troy Village Tx:4169684 991326 I,James D.Filkins,Registered Land Surveyor,License#S-2246,hereby certify BETH PABST No. REGISTER OF DEEDS that the Plat of Troy Village,Recorded in volume 6 Pa a 89 Document Y g , ,. g , 559959, St. Croix County Registry, located in the Town of Troy,St,Croix ST. CROIX CO., WI County,Wisconsin,shows Note#5 on sheet 2 which states"The following lots RECEIVED FOR RECORD must have mound systems: 1 through 10, 15, 16, 18, 19,21 through 45,47 01/10/2014 3.10 PM through 49,51 through 55,59 through 64,69 and 70". This note was changed EXEMPT #: on February 4, 1998 by an Affidavit of Correction,document 9572333 REC FEE: 30.00 recorded in Vol. 1293,Pg. 189,to read:"This note is herby changed to read as follows:The following lots must have mound systems: 1 through 5, 16, 18, 19, PAGES: 1 21 through 45,47 through 49,51 through 55,60 through 64,69 and 70." This Return to: note was again changed on January 25, 1999 by an Affidavit of Correction document#596458 recorded in Vol. 1398,Pg.476,to read:"The following lots James K. Thompson must have mound systems: 1 through 3,5, 18, 19,21,22,23,25 through 45, 340 Paulson Lake Lane 47,48,51,52,54,55,60 through 64,69 and 70." This note was again Osceola, WI 54020 changed on July 14, 1999 by an Affidavit of Correction document 9606849 recorded in Vol. 1442, Pg. 81,to read:"The following lots must have mound Parcel ID#: 040-1249-10-000 systems: 3, 18,21,23,25 through 45,47,48,51,52,54;55,60 through 64,69 and 70." This note was again changed on April 26,2000 by an Affidavit of Correction document#621942 recorded in Vol. 1505,Pg.605,to read:"The following lots must have mound systems: 3, 18, 25,26,29 through 45,47 , 48,51,52,54,55,69 and 70." This note is hereby changed to remove lot 51 from the list of lots requiring mound septic systems to read as: "The following lots must have mound systems:3, 18,25,26,29 through 45,47,48,52, 54,55,69 and 70." Dated this_-Day of 2014 i o 1 es .Filkins S-2246 (Date) State of Wisconsin ) ) ss. County of Pierce ) A 4fr'iOM0�'m t: am °es D. Filkins known to me to be the person executing the foregoing instrument. Subscribed and ;'"� ;tppyy or �„t ist day of-� uQ/5� ,244 �� i aam hotnpso I�OT UBLIC,State of Wisconsin 's•. . •a. 5.-- = 'm de's. Sep ember 6,2015 0 ' '',' d St.("tbi" Approval Certification Approv ording by the St.C oix County Community Development Department B Title 41W-b L146 Ce -p-V1q170n/ S jlFc is r Signature � '' � �U�ifn� Date / /U 2li Instrument Drafted By: James K.Thompson,340 Paulson Lake Lane,Osceola, WI,54020 St, Croix County 991326 Page 1 of 1 I OOOP0'* o mar j'to v\ 'Ro vt m a isie r . 314 5f Atwe'-s kAvs 4;CeASe 01 CO 0 4 O� l I bILG V)Ullrt w� YS' a-T►�NC,6I �a 0 � �a a� Soil Absorption � ���� 10 U0 'qD Fn al ra�1r ft I PVC vpm pipe Witli Vent Cap Leaching- i► �'� Chamber ay5tem t;lev►akforw _ F_ i k 011 A S flo > gwrn Pja'k yjtw fi 1-6 c.,hinq Trench I ("11 berg Tre --1 I 4"Die. Header Bi- leatipps Man UfaCturer And Model Lk � "J 't 13A Raking,, 9q fi Per('harnber Soil AAi puc,aficari Rate , / gp�d � .Cg ._ .._L�---._`'h•'�-f�:i� 00. —�UU g�rd Design f=fnvAj- .' U _Soil Application Rate �(� FISH _ 13 __ !C`:harark,.rs rows of D;( ckrartabers eec11. Page $0 Absorotion avatenc Jogs §ection 4"Sc,.hedute 40 Final Gzra4*-- PVC Afem Pipe 1Afith Vent Cap Leaching 1-1141 1/ . . , Chamber r J . C ---- ---, 4 ft,W v— System Elevatlon jo—i—IA—bsorp ton a a ft Chambers IMM-111-VKHM, ff MUIR 4"NO. Header ff PIT MMIfavftfref And Model E SA Rafing:-Q-0—I;q ft per chamber Soil.AppUcafion RsteA.17,-,--..-gpd/sq ft gpd DE,,qjgjj F&OjAj orowg chambars eacil. Page_ map ve sit r . Z,OCodll* molt ? Co►k) owl of �---� B n si mto V 1uul G ,0 S,4"c s I YS Vn�Vtulll) CL I <l ,IIV 3a 9tiYART1{�vT y o1P STATE OF WISCONSIN INDUSTRY SERVICES DIVISION 9� Department of Safety and Professional Services Field Services P.O.Box 78 Schofield,Wisconsin 54476 (715)340-0407 Phone A�OS6ION i+�'S� Governor Scott Walker Secretary Dave Ross (608)283-7465 FAX -' D November 13, 2013 James K. Thompson A.C.E. Soil & Site Evaluations �'2°" �°"`�` 340 Paulson Lake Lane Osceola, WI 54020 Transaction No. 20751-901 PLAT REVIEW Perm. File No. 20751 SUBJECT: Lot#51, MOUND AREA RESTRICTION WAIVER- PRIVATE SEWAGE SYSTEM ONLY TROY VILLAGE SUBDIVISION PLAT SE%NE % S24 T28N R19W TOWN OF TROY, ST. CROIX COUNTY The Division of Industry Services has reviewed the request to waive the restriction requiring only a mound type POWTS on the above referenced property based on documentation of a recent soil evaluation by James K. Thompson dated September 06, 2013 which indicates the tested area on Lot 51 is suitable for an in-ground dispersal unit. Therefore, the Division hereby waives the above-mentioned restriction and has no objection to the use of an in-ground POWTS System, provided that the system is constructed in accordance with the applicable requirements of chapter SPS 383 Wisconsin Administrative Code. Note: All requirements of SPS 383 shall be met prior to Sanitary Permit issuance. All necessary Plan Approvals and Permits required by the City, Village, Township, County or other governmental agency shall be obtained prior to installation. This release does not guarantee the outlot above is buildable. City, Village, Township, County or other governmental agencies may have further rules restricting building and/or POWTS placement. We recommend that this release be incorporated into a Correction Instrument under s. 236.295, Wis. Stats. to eliminate future questions regarding the use of a POWTS on Lot# 51 . You may want to contact Plat Review concerning those procedures. Inquires should be directed to me at the number listed below. Please refer to the file number shown above. Si �y Eid rin A. Taylor Wastewater Specialist Division of Safety and Buildings (715) 634-3484 edwin.taylor @wisconsin.gov cc: St. Croix County Zoning Office 2345 wlsconsin Department of Commerce SOIL EVALUATION REPORT Pee I of-3 Division of Safety and Buildings in accordance with Gomm 85,Was.Adm.Code A. .Soil&31te Ev tions Abch oe oos site plan on paper not less"n Mix 111nches in afZ& Plan must St,Cr �amel�'Y _ Croix lm+j&,but not llnrW to:vertkal and hort¢ontal 110101'M)point(BM),direction antl pementaipe,stile orowamsions,north arrow,and location end distance to meat road. 0-1249-10-00 0 Please print all intonnatlon. Reviewed By Date gw*nsi inkmotim you Pmde may be used fcr set WXY purposes(RNMY law,05.04(1)(m))• Property Owner Properly Locat n Robin&Jerita WNW Govt.lot �SEI/94 NE 114 S 24 T 28 N W Property Chuner's Mattlng Address Lot# Block# .Name or CSM* 9935 Cloman Path 51 m na_ _ a Troy Vlllsge City �- State Zip Code Phone Number ^J City J village a Town Nearest Road Inver Grove Heights MN 1 55076 1 Troy 1 $14 St,Anne's Parkway 10 New Construction Use. jej Residential/Number of bedrooms --- 4- Code derived design flow rate 600 GPI7 1 Replacement J Public or commercial-Clesc ba; Parent material Glacial Outwash Flood plain elevation,if applicable n8 General comments and recommendations: Site suitable for conventional POWTS dispersal cell with 0.7 gpd/sq.ft./day loading rate.Recommended infiltrative surfaces elevation=94,00', Ong# ..,J Baring fQ Pit Ground Surface eiev, 100.97 ft, pepth to limiting factor >133" in. Sol Appilration Rate Hoftn Depth Dam(nart Color Redox Description Taxtaue Struadure Consi*m Boundary Roots In, Muaeett Qu,Sx.Cont.Color W.SL Sh. 1 1 0.27 1Dyr4/4 none gr sl fill na dh gi 24f 0.0 0.0 2 27-54 1Oyr4/4 none sills 2msbk/Osg dh/dl gw 1vU 0.6 1.0 3 54-72 10yr514 c2d 7.5yr5/8 sit lfsbk mvfr aw 1vf 0.4 0.6 4 72-78 7.5yr4/6 none loos 0sg ml cw - 0.7 1.6 5 78-133 1 Oyr514 _ none s Osg di - - 0.7 1$ Horizon cons a an unsortetl mixture s s. loading rake acts most resin con tron u n onion. 385.3003)(a)3 app;ied to discount rdox.features associated with tension WuraW sit over coarser sands_ ❑Borin # g -J Baclna Z �Pit Ground Surface elev. 101.67 ft. Depth to limiting factor -- ----- " in. Sall Applirsfton Rate Hatton Depth Domimm"t Cola Redox Degc OM Texture Stmclure Conememe Boundary Roots G PD in. Mansell Qu,Si.Cont,Color Gr,5i.Sh. *E 1 2 1 0-18 10yr3/2 none ail 2fgr mvfr Cs if= 0.6 1.0 2 18-27 1Oyr3 13 none fall Osg ml gw 1vf1m 0.5 1.0 3 27-34 1Oyr4/4 none - r ifs -. 2msbk �mvfr -ow_ lvf 0.4 0.6 4 34-44 10yr3A3 none sit 2fsbk mfr CW 1vf 0.6 0.8 5 44-57 1(W16 rn3p 7.5yr5/8 ail Om milt aw lvf 0.0 0.2 6 57-70 1Oyr4/6 none s Osg dl ow - 015 110 7 70-140 10yr514 ir,~E $ Osg dl - - 0.7 1.6 Effluent#1 m 6006?30<_220 mgA„a TSS>30 -150 mg/L "Effluent#2 m 805 1.30 mall.and TSS_30 mglt. CST Name(Please Print) Sign to: CST Number James K.Thompson - 3802 Address A.C.E.Soil&Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane.Osceola,WI W20 9/8/2013 716246-7767 TnnM "7VA9 HZIS V 1IOS R 0 V LOLL M SIL Xyd 00:2T CTOZ/60/60 I Property Owner Rabin$r]enrol Writ ,_, ,,.,- Parcel ID# 020.1249-10-400 Page 2 of 3 3] Boring# ^ lei Boling Gmurxt Surface elev- 10X.46 ft. depth to limiting factor 7136" in. Soli Applioatbn Rafe Pit Horizon Depth Dominant Calar Redox DescrlpHon TeMra Stnslure Conits8M Boundary Roots " D "61 2 In. Mansell Qv-St.Gant.color Gr.SL Sh. 1 0-13 10yr3/2 none sit 2fgr mvir ca ifmc D.6 7.0 2 13-18 1Oyr313 none fsl Osg--+. -4 mi gw 1vUrn 0.5 1.0 3 18-28 10yr414 none 2msbk rnvfr Cw 1vf 0.4 0.6 4 28-40^ 10yr3/6 none sil 2fsbk mfr T cw ivf 0.6 0.8 6 40-51 `10yr3/6 m2d 7.5yr5/8 sit Om mfr aw 1 v 0.0 0.2 W 6 ^� 51-72 10yr4/6 none s Osg y dl aw - 0.5 1A 7 72-136 10yr514 - none s Osg dl - =- O, 1.6 Boring# —I Boring ft, Depth to limiting factor In. Sop a rWIN R04e Ph Ground Surface elev. Horizon NO Dor*ant Color Radox Dworipilon Texhrre Stnxture Conststence Boundary Roots "Eff1!f "Eff#2 in. Munsett Qu,8Z Cont.color Gr.Sz.Sh. t3oring# J Boring J Pit Ground Surface eiev. ft. Depth to uniting lector tn. Sod Applicatlon Race Horizon Depth Dominant Odor Redox Dasrxlptbn Texture Sbrudure Consistence Elaurrdary Rooft 'Eff#1 'Eff#2 in. Munwil Qu,St.Cont.Color Gr.Sz.Stir• Effluent#1 $OD 6'30 i 220 mg/L and TSS>30 a 150 mgIL "Effluent#2 Y BODs s.30 mall,.and TSS<_30 mpA- Ile Department of Commerce is an equal opportunity service provider and cmptoyer. If you nerd assistance to access scrviCcs or need material in an alternate format,please contact the department at 609-266-3131 or TTY 608-264-8777. $Bb-8330(077) A.C•t.W& Ewrruetlons 700 fd1 "IYA3 3.LIS v u0s 3a Y 69LL 9PZ STL Xdd 00:9T £TOZ/60/130 sow rlOW13 jo 36�vas- �oJc Ile r'rt r1•�'S'd? 1- `•q,0/d 'T7-¢Y 7:ASA• -. QQbMy '� M'GY.4 K-.S-Y. U V Y VA7 d �0 g, 11 4 tl ti .-. - PJ.a nnnl "I�A� �,,IS '8 1109 V9LL qfz 2% xvd 00:ST CT09/60/60 ?os+°°p~~~ County Safety and Buildings Division St. Croix 4 201 W. Wdis in WI 53707-O. 62 x 7162 Sanitary Permit Number (to be filled in by Co.) 3 83 Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission f:this forth to the appropri emmental unit 22-10 L[ / Y is required prior to obtaining a sanitary permit. Note: Application forms for state-owned PO bmitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide ay be use wndary _purposes in accordance with the Privacy Law, s. 15.04 l m , Stats. f~ 314 St. Annes Parkway L Application Information - Please Print All Information Property Owner's Name ST Parcel # Robin & Jerita Wright ~R%~~ 040-1249-10-000 Property Owner's Mailing Address 11, jy Property Location 9935 Cloman Path Govt. Lot I City, State Zip Code Phone Number` y, N E Section Inver Grove Heights, MN one) 55076 XXX xxx-xXxx T 28 N; R -IM E or W 11. )Kype of Building (check all that apply) Lot # 1 or 2 Family Dwelling -Number of Bedrooms Subdivision Name hr~ 51 Ole - Block # Troy Village ❑ Public/Commereial - scribe Use Na ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Na Town of Troy III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit Revision El Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Como onent/Devicet Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ound 2:24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsallTreatment Area Information: Pol Lok PL-525 effluent filter Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required 40 Dispersal Area Proposed (sf) System Elevation 1.0 gpd/s .ft. -33sand /ZD U / 20 j 905.50' at 6" above 3 600.00 Gpd s .ftnative soi 600.00 sq. ft. 600.00 Sq. Ft. 905.00' co. ntour VL Tank Info Total # of Manufacturer , Gallons Gallons Units .g ~ New Tanks Existing Tanks a U ~ vi w C~J' a Septic or Holding Tank 1,250 0 1,250 1 Wieser Concrete X Posing Chamber 750 0 750 1 Wieser Concrete X VIL Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plum 's Signature F14V/MPRSNumber Business Phone Number Jim Boumeester P 222904 (715) 386-1920 Plumber's Address (Street City, State, Zip Cal 1070 H 35 N., Hudson, Wl 54016 YII~L Coun /De artment Use Only Approved ❑ Disapproved Permit Fee U D Issued Ise ng A t S' er Given eaanReason for Denial $ ( g Zro - fan uen"~ for Disapproval Z-5)1 dispersal cell must / d ktt; al3rYCeS1_/ maintaine"7U1~ 7 Q / Me k as per management plan provided by plumber. 2. All setback requirements must be maintained G7'tiI/~C'tit r Lim' a c comp Adam far the system a 90 submit to the Coon my on taper no Iesa infi 1 iaehes in efu Z SBD-6398 (R. 11/11) ~~-f3 -7r~ r 1 77C $~3oEnnaTAAf DIVISION OF INDUSTRY SERVICES 3824 N CREEKSIDE LA HOLMEN WI 54636 s g 1 DS Contact Through Relay S www.dsps.wi.gov/sb/ www.wisconsin.gov A~OSSIONp~ Scott Walker, Governor Dave Ross, Secretary August 14, 2013 CUST ID No. 222904 ATTIC- POWTS Inspector JAMES W BOUMEESTER ZONING OFFICE BOUMEESTER EXCAVATING ST CROIX COUNTY SPIA 1070 STATE ROAD 35 N 1101 CARMICHAEL RD HUDSON WI 54016 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/14/2015 SITE: Identification Numbers Robin & Jerita Wright Transaction ID No. 2290498 314 Saint Annes Parkway Site ID No. 793747 Town of Troy Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. SETA, NEIA, S24, T28N, R20W FOR: Description: Four Bedroom Mound System / 2% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1441571 Maintenance required; 600 GPD Flow rate; 39 in Soil minimum depth to limiting factor from original grade System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, 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. CQN The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. APP No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, OF stats. PROFESSIO amou of INC The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders: • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. .~z -SEE • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A cony 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 JAMES W BOUMEESTER Page 2 8/14/2013 e Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of 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. Slncer ly, Fee Required $ 250.00 • Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jeny.swim@wisconsin.gov cc: 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 9 "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to 10 T"13 the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered _ d addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed 4m"~s'~ SS Chapters 360-366. Al 40 AM it ~ ~ RECEIVED JUL 2 4 2013 MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIG Residential Application _--U,~ 4 r,r SERVICES INDEX AND TITLE PAGE Project Name: Wright 4 Bedroom-PdWkta-,ment Residential Mound Owner's Name: Robin & Jerita Wright Owner's Address: 9935 Cloman Path, Inver Grove Heights, MN 55076 Site Address: 314 St. Annes Parkway, Hudson, WI 54016 Legal Description: SE1/4NE1/4, Sec. 24, T.28N., R.20W. Township: Troy County: St. Croix Subdivision Name: Na Lot Number: Na Block Number: Na Parcel I.D. Number: 040-1249-10-000 rl~Atwtty Plan Transaction No.: ROVED AND "AFEry Page 1 Index and title JAL SERVICES Page 2 Data entry USrRY Page 3 Mound drawings `SERVICES Page 4 Lateral and dose tank Page 5 System maintenance specificatio1iVZ0:,,CE1YCr,=E Page Management and contingency Page 7 Pump curve and specifi at o splaPage 8 Site Plan Page 9 Attached Soil Evaluation Report Designer: Jim Boumeester License Number: 222904 Date: 07/17/13 Phone Number: (715) 386-9020 Signature: &3A~ Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P (N. 01/01, R. 11/12), 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, R. 10/12) Version 7.0 (R. 11/12) Page 1 of 9 t 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 383-44-3 in-situ soil treatment for 1.50; Peaking Factor (e.g. 1.5 = 150%) fecal coliform of 36 inches. 600.00 Design Flow (gpd) 2.001 Site Slope 905.00! Contour Line Elevation (ft) 39.00Depth to Limiting Factor (in) 0.50 in-situ Soil Application Rate (gpd/ft2) Distribution Cell Information 100.00; Dispersal Cell Length Along Contour (ft) = 6.00 Cell Width (ft) 1.00' Dispersal Cell Design Loading Rate (gpd/ft2) 1 Influent Wastewater Quality (1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) C Center or End Manifold 3.00 Lateral Spacing (ft) If N above, enter the elevation (ft) 4' Number of Laterals of the highest point. 0.125; Orifice Diameter (in) 2.00. Estimated Orifice Spacing (ft) = 6.00 ft2/orifice 2.00 Forcemain Diameter (in) 80.00 Forcemain Length (ft) Does the Forcemain drain back? Y 897.00` Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 13.05 Forcemain Drainback (gal) 8.08 Vertical Lift (ft) 62.76 5x Void Volume (gal) 2.79 Friction Loss (ft) 75.80 Minimum Dose Volume (gal) 0.00: In-line Filter Loss (ft) 41.19 System Demand (gpm) 17.37 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options J choice in. dia. options choice 0.75 1.25 x x 1.00 1.50 x 1.25 x x 2.00 x 1.50 x 3.00 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information 750.361 Total Tank Capacity (gal) 1250.00 Septic Tank Capacity (gal) 37.001 Total Working Liquid Depth (in) Wieser Concrete Manufacturer 2018 gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 750.36 Dose Tank Capacity (gal) PolyLok Filter Manufacturer 20.28 Dose Tank Volume (gal/in) PL-525 Filter Model Number Weiser Concrete Manufacturer Project: Wright 4 Bedroom Replacement Residential Mound Page 2 of 9 Mound Plan and Cross Section Views T 1/10 B J Observation Pipe j A 5 W B :Q I : 41 L Mound Component Dimensions ft K 6.99 ft A 6.00 ft E E 7.44 in H EAft B 100.00 ft F 9.25 in I ft L 113.99 ft D 6.00 in G 0.50 ft J ft W 17.05 600.00 (ft2) Dispersal Cell Area 1203.46 (ft2)Basal Area Available 6.00 (gpd/ft) Linear Loading Rate 10.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 907.27 (ft) - ♦ H G 1 F Dispersal Cell 906.00 (ft) Lateral 905.50 (ft) Invert Dispersal Cell Elevation Q 905.00 (ft) Contour Elevation 2.0 % Site Slope Geotextile Fabric Cover Shading Key $ T Dispersal Cell See lateral details on 10 Topsoil Cap L 1.5 ft Page 4 for number, size, Subsoil Cap and spacing of laterals. Laterals are equally ASTM C33 Sand Z F spaced from the Tilled layer 0.5 ft Typical Lateral distribution cell's © Aggregate o centerline in the A distribution cell (AxB). Project: Wright 4 Bedroom Replacement Residential Mound Page 3 of 9 Center Connection Lateral Layout Diagram Force main connection vi a ree or cross to manifold at any point. Later als are identic al 'fr S i P S •o Turn-up vriballvalvaor (r}(-ylrx~; l x1241 LaOerals Morcerrt.50 Sch 410 PVC - cleancvtplu9 per SPS Table 384.30-6 Holes drille4 on tl,e tottom of lire later al. Number of Laterals 4 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.01 ft Lateral Length (P) 49.25 ft Orifices per Lateral 25 Lateral Spacing (S) 3.00 ft Orifice Density 6.00 ft2/orifice Lateral Flow Rate 10.30 gpm Manifold Length 3.00 ft System Flow Rate 41.19 gpm Manifold Diameter 1.25 in Total Dynamic Head 17.37 ft Forcemain Velocity 4.21 ft/sec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and ► SPS 316.300 WAC 4 in. min. Disconnect Tank component is properly vented E Alternate outlet location Forcemain diameter Weiser Concrete Manufacturer_ 2 in. Ca acit 750.36 Gallons Volume 20.28 gal/inch A Weep hole or anti- Dimension Inches Gallons B siphon device A 20.26 410.92 B 2.00 40.56 C Pump off elevation (ft) C 3.74 75.80 897.92 D 11.00 223.08 D Total 37.00 750.36 Ooh se tank elevation (ft) Bedding un er tank. 897.00 Alarm Manuafacturer SJE Rhombus Note: Switches Alarm Model Number SJE 1011421 containing mercury may not be used in Pump Manufacturer Zoeller this system. Pump Model Number BN 152 Pump Must Deliver 41.19 gpm at 17.37 ftTDH Project: Wright 4 Bedroom Replacement Residential Mound Page 4 of 9 Mound System Maintenance and Operation Specifications Service Provider's Name Jim Boumeester Phone (715) 386-9020 POWTS Regulator's Name St. Croix County Zoning Dep't. Phone (715) 386-4680 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 1250 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ftz 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 Purnp and Controls Test once eve 3 ears Alarm Should test month) Pressure System Laterals should be flushed and pressure tested eve 1.5 ears Mound Inspect for ponding and seepage once every 3 years Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in SPS 384, 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. Lateral Turn-up Detail Finished ~T.• •~~~~~r~~o~~r~~ Grade 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: Wright 4 Bedroom Replacement Residential Mound Page 5 of 9 Mound System Management Plan Pursuant to SPS 383.54, Wis. Adm. Code General l his system shall be operated in accordance with SPS 382-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01, R. 11/12), SSWMP Publication 9.6 (01/81), and Pressure Distribution Component Manual Ver. 2.0 SBD- 10706-P (N. 01/01, R. 10/12)] 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 SPS 383.33, Wis. Adm. Code when the tanks are no longer used as PO'VVTS 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 suoject 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, Stats. 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 BOD,5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 rng/L BOD;. 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 ovhen 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. Continaency 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 clogged absorption and dispersal n nedia, 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 9 PUMP PERFORMANCE CURVE MODEL 15111521153 TOTAL DYNAMIC HEAD/FLOW PER MINUTE 14 45 , EFFLUENT AND DEWATERING 12 MODEL 151 152 153 s 35 152 Feet Maters Gal. Uters Gal. uters Gal. Ulm = D- 30 5 1.5 50 189 69 261 77 291 10 , 3.0 45 170 61 231 70 265 o 8 25 151 15 4.6 38 144 53 201 61 231 20 6.1 29 110 44 167 52 197 ° 6 20 25 7.6 16 61 34 129 42 159 173r " 30 9.1 - L!J~E 33 125 I► 15 35 10.7 22 85 t0 40 121 - - 11 42 ShuWff Head: 30 fL (9.1m) 381E (11.Bm) 4411. (13.4m) 2 5 0145088 0 10 20 30 44 50 6l1 70 80 90 too GALLONS LrrERS 0 40 80 140 2bO 240 2110 3 3 R PER MINUTE 614566 Model 151 Models 1521153 P.AI. n7;~..nu~►~ cl,:tc-4-ye rlyl~ CONSULT ?ACTORY FOR G SPECIAL APPLICATIONS 67/32 619 3716 4w 32742 45A • Tuned dosing panels available. Electrical afternatom, for duplex systems, are available and 3 vr42 supplied with an alarm. S 7ro • Variable level control switches are available for controlling s Ira single phase systems. • Double piggyback variable level float switches are available l for variable level long and short cycle controls. • Sealed Qwik-Box available for outdoor installations. See FM1420. • Over 130'F. (54°C.) special quotation required. 11 11/18 121/6 1511152/153 Series 15111521153 MODELS _ control selection t-T Model Volts-ph Mode Amps Sim ex Duplex l 434 sva BN1 115 1 Nan 6.0 1 2 or 3 BN151 115 1 Auto 8.0 Included 2 or 3 E151 230 1 Non 3.2 1 2 or 3- BE 151 230 1 Auto 3.2 Included 2 or 3 SK2444 SK2064 N152 115 1 Non 8.5 1 2 or 3 BN152 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4.3 1 2 or 3 BE152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153 115 1 Au to 10.5 Included 2.3 E153 230 1 Non 5.3 1 2 or 3 SELECTION GUIDE SE153 30 1 Auto 5.3 Included 2 or 3 1. Single piggyback variable level float switch or double piggyback variable level float o CAUTION switch. Refer to FM04T7. Ail installation of controls, protection devices and wiring should be cone by a qualified 2. See FM0712 for correct model of ElectricalAHernator E-Pak. itcensea electrician. All electrical and safety codes should be followed including the most recent Nalion3! Electric Code (NEC) and the Occupational Safety and Health Act (OSHA), 3. Variable level control switch 10-0225 used as a control activator, specify duplex (3) or (4) float system. RESERVE POWERED DESIGN For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. Mac T0: PO. BOX 16347 P TO: 3 402M-0347 Manufacturers of.. SHIP TO: 3849 49 Cane Run un Road O ® Loulsvilla• KY 40211.1961 QIGiL/TY /-A/MPB SaCf /rJc%7 , hrip:AAlvww.zoelle(com ~(502) 778-2731 - 1 FAX (502) 774-3624~PUMP (5 ® Copyright 2004 Zoeller Co. Ail rights reserved. ~d x°49 w . I ® So;/ eJalc~a~~n/o~E • b y r /X%r~.s '1/10/97 i scc l - o' 99.~sC/or»a~ ~a~. =~~r6~odef/ei~~ s MA. sSO7~ Sr"%yr/EL~; See„z ~T,,zB~f. eve/. ~ D~'r•~ 294 C,-e S Pro pastel 1044 bbel P~oPascd ~ ~ SL 6¢drt~om ,Pcsi ~e~ c r- oaf U ,o~-53S t~/u do E.. se d ¢ . , % 'tut 4 Y 2 "Al rm 17 S'?,. 30 /'c7'C~Main ;1x1 i oe .oo o- Y iY a ~c ewttour - oho , . An nts Pa~,~w~~ PL-525 ,~Suent Fi tex Effl- ueut HW!s Polylok; JAc, Dag I of t W; I ill rf j ri I Yrel `I 1:S i i i j Pplylrak Inc. ~ Fair ftmlct 139VUr ilYlalllrrqfat'drT (i(i29x Osll roll r mm^ -705-99019 1=>iAta1t; pcaly'laak c'u►r~ i You a.rar !1e " t~r~t5)tat.t Details ' n Ii ( t * r wLU~~ T FILTER, i i Raising t bar in fl'i r toahr a I II,II F'nlylol<, inc is p( tASed i;a trd<i lt's new carnmerr..lal filter to it,, c.,xistiny lirtta of qt,sallty afflyent Mx%nd A i.R1klrm filtom. The PL-525 is ratecl for over 9 0,0011 GPO (Gallons PAr Ray) M.1141no it n, no of the largest ecmm6rCial filters in its !1: has EW line,v faet of 1/901" filtrFatinn slats. Like ft Moore s'i Riser C"vQ11ai'S Polylok PL-1 29, the new I:'of\)fNc PL-628 hats art autar•rtrztic ,hut oft hall inet.alled Nuith every ' flter, lAft- P the inter is rernovo.,i I for cleaning, the. hell will fl6at up mnd temporarily ah iA off i,1t.19'kPibution Boxes om the sy4tsrn so the off14tent wAr1'i lpave, the tank. Nn otller lifter on the mirlcet oan make tlta't A,COWSWes 7, ! plar'I s, easinsir PrWRtxp ' J r 1111 ano a"Xep s rdoms ~ n in InforTrtati r. C3 I {~q~.reste Quote, ~ ~ Irtbr Gs ~ 1 C9 r rar"fiO I ~ .m............,_..ti ..~_.r_.___..._..-. __-+-rr.+•xme+,+'^NA.O,e^,mnm,TnRlo,nM'.mn ! des, Sarni ry Tet Rated for 10,000 GPO ((;Allans Per Day) ~t A iEI$YI"'a 625linear;eetof 1/1611 filtration Reber racers Enlarge for utaos, o Aarept5 4" and Fr" SC HD, 40 pipe in 04 61efls1ptctr 1r1r~8 ernd Rameriwr~ A AutOmaticslunr rf hall whAn f itcar is rarriavacl 4 /alarm acm. ssiblllty ns m Aewapts PVC 8XIAnsion handle E~alrimsmpa I raiao Tho, Pl_~,54 UTIvent F1'lfer shOLdd operate afft0ently fnr ssvorcal yours tatltter nCri1'flal concRons liefrars requiring damning, it is rA(Immillsnded that thin fllt9t' he clasnacl every Fanyis,& Clamp time the tank is pcrmpad or rat least every threa years, If tha ineTalled ffiter cont~jns 111 (3pflnnal aim*rm the av✓nar will he no,, Ml erg by r n alantl when the frltar• tgeqds BeNi,wing, { ~~1~7fi1 m,1'E~1I~s Servicing should be clone by a oertiflerl septic. tank pumper or 1nSifiIle r. i ~E~I i r~~l ~i7S P~la~GltL7p~ Ri! WPrF~ M,ft- , 1. LOOAte the Outlet Of the septt , tank. Oder Crantlivil Prot ut t 2, 'Ramotr8 tank rover ana pump tank it necas,"rY. 3 DO nOt, 00 plumbiriq whorl filev is rs,,Mc))jefj, ~ R~k~tpR~~ and G~IC9 4.1 gull PL-52.9 Out Ot tile, hausinq. 5. Hose off sitar over the septic, tank. IUtsktl surra 6 all Anlids fill 4U11 IntO 80P*, Wrik, t ' tyy , Pnsort the flt~r cat'tlic9t~~t hac k intp the housing making sLlre the filtor iS pr lperly r~iirprad ~ir1r Iramplstiy rnsef~Pd. 7. RePltaae saPb6 tank cover. PL-525 Instailahon; Ic1at;( fOr rsrsfr1an&51 ~InCI OOfrinlpfY 391 PO wa4te fiOinrs UP to 10,000 (a;aflons Pei- aay (GpD), F 1. I ter ~1trr the n4itlst of that a 1 t R•wIr~';til'irQgW(+ e t s tans<. ; PUMP, Filter ana Rill +Rftmave tank cmior arij 1XIII)p taf)k if 11k~(:t'S&r7i+j', 3. Glue the filter hnt.rsillg to thra OP 8" 041110( pjpe, if the filtar is r1Ot cAncBpeQ and mr t Fi'$ Ain R Pa 4h* Accmss openin~g9, Iasm A Pot Iak fix Filter Alarm Pall! ran': 4- In-ort the FL,525 ilROF fn.,kO I •I.ns Y hou b t nr~ r-al< or piiaC p of pipe tO ltstr Con#rC111. <knrrter sin flhfe cl. r, l11'rlt'/~i,t%ih,'tti ~I ~nlt r>7l/G ~ ~Ittrwc~ rirni':t9iC .»r~'7Y~~•nrl„rr Tl`r~~ W~iG G :0 6167 tai 'i In f/ r ~r p ~ yy cxk r' L CL cl uj Mea.. CIL w~,r,.,......u; W b Z L 6 0 L 0 I, 1~ ( n Uc 1~ ~U1G AM No, 3066 P. 2 n GTr ~.xo r G"1 ~'r1 I~"d ~ I xr 0`7 g.' a rra ~ . `9a iv cis io* Vp ~ P y 'q-'> D k 4L. ell) Rp i Nov-11-2010 *45 AM St. Croix County Plan/toning 715-326-46£36 1/2 POWYS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATIGIN SYS,TENI SPR0JFI0ATl Owner 1 4lw p eKi )4 Septic Tank Capacity ) ;t-6 0 al Cl NA Permit # Jf 0 Septic Tank Manufacturer 41 K 0 NA AESI+~PI PARAiIABTIRRS Effluent Filter Manufacturer 0 NA Number of Bedrooms 0 NA Effluent Filter Medal A NA Number of Public FeciPrty Units -M NA Pump Tank Capacity '7 al , NA Estimated flaw (average) 3 u o a) d Pump Tank Menwfaoturer e) LJ NA Design flaw (peak), (Estimated x 1.5) ~00 a al de Pump Manufacturer z ~I< A NA Soil Application (Rata allda. J x Pump Mode! ED NA Standard Influent/Effluent Quality Monthly aversga* Pretreatment Unit ANA Fiats, Gil & eraase (FOG) X30 MOIL ID Sand/Gravel Filter d Peat Filter Biochemical Oxygen Demand (BQDs) X220 mg/l. a NA C3 Mechanical Aeration C3 Wetland Total Suspended solids ITSS) :0 50 mg/L A Disinfection 0 Others Pretreated Effluent Quality Monthly average Dispersal Cell(s) Cl NA 6100herr+loal oxygen Demand (1300al 430 mg/i. © In-Ground (gravity) l] In.around (pressurized) un Total Suspended Solids (TSS) 4SO mg'/L M NA C3 At~Grade 1q Mo13'Mawnd Fecal Coliform (geometric mean) glo, Ofu/100mI 0 Drip-Line Other: ANA Other; Maximum Effluent Particle $120 Ye in die, ANA Other; M NA Other: 0 NA other: Q NA "Values typioal for domsetia wastownter and saptlo tank affluar;R, 11l1A1N"~HNA I SIGH DU X service F164utanav Service Event rnonth(si (MAXIMUM S years) 0 NA Inspect condition of tank(s) At least once every: © ear s) Pump out contents of tank(s) When combined sludge and scum equals onewthird I%) of 'tank volume 0 NA morithti) (M;axit»um s years) © NA Inspect dispersal call(s) At least Once every: 13 earl Q M011 GIs) L7 NA clean effluent filter At least once ovary: Q r cl month(s) M NA Inspect Pump, pump contrdla & alarm At least onto every: 13 ear(n) Cfl~tnk - t1~) G( h!A Flush laterals and pressure teat At least once every; earls! mOnthls) M NA Other; At least once ovary: p ears 0 NA other, MAINTENANCE IN;3TRU E' ONS the Inspections of tanks and dispersal st shell be made by an TS Inspeotorrl POWTS Maone Swpg rtr)aing Operator, Tank Master PlWmfaer; Master Plumber Restri riOted Blew r, POW creaks cr teaks. broken Identify ware, any measure the must volume nel of ombia+e)dnsludg and acorn and tea checkff raany beakEup or pondingd of effluent on the ground 8wrfa0d, The dispersal the vol rn onding in the condition and requires the observation The dispersal cell(s) shall be visually surface. The Inspected the ground! surface may Indicate pipes and to check for of effluent on the ground url s Ponding of affluent on immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or More of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 718, Wisconsin Adminlatrativa Code. All other services, including but not 11MIted tt months, servicing hof performed effluent filters a , me anical or le~ iurized components, pretreatment unite, and any servicing at intervals of 912 A service report shall be provided to the local regulatory authority within 10 days of completion Of am 99I event. omw (e101) Nov-11-2010 10:45 AM St. Croix County Plan/Zoning 715-386-4686 2/2 START UP AND OPERATION Pegs of~ For new construction, prior to use of the PQWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal oel!(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System stare up shall not occur when soil conditions are frozen at the Infiltrative surface. During power outages pump tanks may fill above normal highwatmr lmvels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result In the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or PQWTS Maintainer to assist in manually operating the pump oontrole to restore normal levels within the pump tank. Do not drive or park vehicles over ',tanks and dispersal calla. Do not drive or park over, or otherwise disturb or compact, the area within 15 fast down slope of any mound or at-grade soft absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the fife of the PQWTS; antibiotics; baby wipes; cigarette butts; condoms; ootton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water, fruit and vegetable paalines; gae011118; grease; herbicides; meat scraps; medications; 011; painting products; pesticides; sanitary napkins; tampons; and water softener brine, ABANDONMENT When the PQWTS falls andfor is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code- * All piping to tanks 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, 1e After pumping, all tanks and pits shell be excavated and removed or their covers removed and the void spaoe filled with soil, gravel or another Inert solid material. CONTIN09NCY PLAN If the PQWTS fella 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 soli 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 welts. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replaosment systems must comply with the rules In affect at that time. Cl A suitable replacement area is not available due to setbaok and/or soil limitations. Barring advances in PQWTS technology a holding tank may be installed as a last resort to replace the failed PQWTS. C] The site has net bean evaluated to Identify a suitable replacement area. Upon failure of the PQWTS 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 FOWTS. 13 Mound and at-grade soil absorption systems may be reconstructed in place following ramovel of the blomat at the Infiltrative surface, Reconstructions of such systems must comply with than rules to effect at that time. < < WARNING > > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANORS. DEATH MAY RESULT. RNSOUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE, ADDITIONAL C4MIl INTS PRINTS INSTALLER PQWTS MAINTAIM Name ► m 64 +n Name Phone '7 (S 3 ` 4 f5~ S RV&N-N- i QPERATOR 4P PER) LOCAL t~tliUh&TC>~R1~ lkt3THORIT~i' Name bn Ile ~ Nema J ( C)e j)0 26IN 1 I, Phone Phone y c e b This document was drafted In compliance with chapter Comm 63,2{2)(b)la)(d1&(f1 and 83.54(7), (R) & (3), Wisconsin Administo-L rative Code, ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM r Owner/Buyer b W 1~ ~j ` I Mailing Address ` J C I J PCB. L jd e r 6 v c Al Property Address 3N t v 7 (Verification required from Planning Department ew construction) p City/State HOLM ~ Parcel Identification Number LEGAL DESCRIPTION aa Property Location Y4 %4, Sec. , T Z y N-R~W, Town of ~V Subdivision fi 9U016- V ` Lot # firov, Certified Survey Map # , Volume Page # Warranty Deed # 1 V 6 Volume Page # Spec house ❑ yes Id no Lot lines identifiable yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a masterplumber, j ourneyman plumber, restricted.plumberor a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic syst as been maintained must be completed and returned to the St. Croix County Zoning Office within 30 dart of th three year exp' atio date. S MATURE OF PI, DATE OWNER CERTIFICATION I (we) certify that statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of the describe ab e, virtue of a rranty deed recorded in Register of Deeds Office. t S ATURE OF APPLIC T DATE Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department. Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed II I~I~IIIIII IIIIIII~I ~IIIIII) 8101574 Tx:4079555 STATE BAR OF WISCONSIN FORM I - 2000 966458 BETH PABST Document Number WARRANTY DEED REGISTER OF DEEDS THIS DEED, made between James W. Caspers, a n=ied tttsn as his ST. CROIX CO., WI ;ricliv;r,ial i rbz Grantor, 10/31/2012 1:48 PM 00 and Robin E. Wright and Jerita K. Wright, , husband and wife as EXEMPT .00 survivorship marital property, Grantee. - REC FEE: : 30. Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 401.70 described real estate in St. Croix County, State of Wisconsin (the PAGES: 1 "Property"): Lot 51 of the plat of Troy Village in the Town of Troy, St. Croix County, Wisconsin. Recording Area Name and Return Address: Land Title, Inc. LTl # 334049 2200 West County Road C, Suite 2205 Roseville, MN 551 13 Together with all appurtenant rights, title and interests. 040-1249-10-000 Parcel Identification Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and fi-ee and clear of encumbrances except Easements, Restrictions, Reservations, Roadways, and Rights of Way, if any, of record. Dated this 17th day of AugtlSt, 2012. mes W. Cas erS * * AUTHENTICATION ACKNOWLEDGMENT Signature(s) ~~~SOI~I••. STATE OF WISCONSIN ) R ST. CROIX COUNTY COUNTY. ) ss. authenticated this 17th day of-August, 201 W; Personally came before tile this 17th day of August, 2012 ji 2 : Z the above named James W. Caspers 0_ft i~ Man q$ ° his 1 rid1-4,16LW Pf W-1-1y to me known to e tie person(s) who executed the TITLE: IvIENIBER STATE BAR OF WISC SI . foregoing instrtun d the same. (If not, TATS O authorized by § 706.067 Wis. Stats.) 9= THIS INSTRUMENT WAS DRAFTED BY *Kell J. Nelson Notary Public, State of W'scoust Larry S. Mountain - Attorney At Law Nly commission is pennat nt. not, state expiration date: ) 4/13/2014 (Signatures may be authenticated or acknowledge(l. Both arc not necessary.) *Names of persons signing in any capacity must be hyped or printed belcm their sienanue 1 of 1 WARRANTY DEED STMT. BAR OF\VISCON'SIN 1`0101 No. I-2000 Parcel 040-1249-10-000 08/23/2013 AM PAGE E 1 1 OF 1 Alt. Parcel 19.28.19.1293 040 - TOWN OF TROY Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - WRIGHT, ROBIN E & JERITA K ROBIN E & JERITA K WRIGHT 9935 CLOMAN PATH INVER GROVE HEIGHTS MN 55076 Districts: SC = School SP = Special Property Address(es): = Primary Type Dist # Description ' 314 ST ANNES PKWY SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 1.290 Plat: 06-089-TROY VILLAGE 1997 SEC 19 T28N R19W SW NW LOT 51 TROY Block/Condo Bldg: LOT 51 VILLAGE Tract(s): (Sec-Twn-Rng 401/4 1601/4) 19-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 10/31/2012 966458 WD 06/02/2004 764475 2586/506 WD 02/12/1998 571140 1287/434 WD 07/23/1997 1192/608 WD more... 2013 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.290 135,000 0 135,000 NO Totals for 2013: General Property 1.290 135,000 0 135,000 Woodland 0.000 0 0 Totals for 2012: General Property 1.290 135,000 0 135,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 F' w State of WISCONSIN Memorandum/Correspondence DATE: January 7, 1998 TO: Tom Nelson, CST MO N, ~ FROM: Leroy G. Jansky cr~a Wastewater Specialist, Senior cou"" ° ~ONtNGOFFICE E-mail Ijansky@commerce.state.wi.us Fax (715) 726-2549 Voice (715) 726-2544 e SUBJECT: Troy Village - Mound Waivers I just received the county onsite for Lot 49 in Troy Village. However, the review cannot proceed since no fees have been received by the Plat Review Section in Madison. There still seems to be some confusion regarding what's required to obtain a waiver to a mound restriction so I will try to outline our requirements. The fees are $80.00 per lot. Fees must accompany the submittal to DOA Plat Review. All information and fees are sent to: Department of Administration Plat Review PO Box 8911 Madison, WI 53708-8911 Unless a, waiver is obtained, lots restricted to mound systems on a recorded plat ~.M ~t~-yer~®gy-fiar~s+~as~e~iepose#rs~e°` .,Co n 85:04(5), Wis. Adm. Code, i However,.the restriction can be waived if it can be, shown that the lot meets the requirements of Comm 85,03 and Cormn- 85.4, Wis. Adm. Code. Each submission must be complete (i.e. soil's information, drawings, site plan, calculations, and supporting information for the lot in question). Do not reference documentation or materials included in other submissions. Basically, to obtain a mound waiver you need to show that the lot meets requirements for a below grade system in one of three ways. The first and most general way is to show that there is at least 10,000 ft2 of continuous suitable soil area for a below grade system and its replacement. Soil boring quantity and Tom Nelson January 6, 1998 Page 2 location must be adequate to support the below grade system conclusion. Information collected on adjoining lots maybe used to help prove enough area exists on the lot in question. A second way to go is to preplan the lot under Comm 85.04(7) using Table 85.04. This means doing enough soil and site work to show that there is at least 2,000 ft2 for the initial SAS and 2,000 ft2 for the replacement SAS. So there must be at least 4,000 ft2 of continuous suitable soil area. The areas must be large enough to support four bedroom trench designs, and setbacks must be considered. A third way, under Comm 85.04(7)(c), allows further reductions in continuous suitable soil areas. The code states that if a system can be installed in complete compliance with Comm 83 the department can approve greater reductions in depth and area of the minimum continuous suitable soil area. However, two contiguous four bedroom trench type SAS areas must still be identified. The detail required for this submittal is similar to that required for sanitary permit submission. We need to know exactly where the SAS will be located, where the house and well will be, and that there are no other setback encumbrances that would adversely affect SAS placement. This memo may not have covered every aspect of mound waiver submittals, but should be helpful in your submissions for Troy Village. If you have any questions regarding this matter, please contact me. Wisconsin oeaarm,*nt of Industry. SOIL AND SITE EVALUATION REPORT Page I of _ 3 Labpr and Human Reta"Ons Division of Safety S I3taidin9s - 183.05. Wis. Adm. Code - CCQ1N TY it size. Plan must include, tut ST . CROIX Attach O°mt PARCEL I.D. 0 not limited t1 id % of slope, scale or y9- a- dimenaionea i ;qI DATE APPLICAN TION r. PROPERTY t PRO LOCATION E 1 W VM1Vl0'j TOM RUE] ~wE GOVT. Ir4W 1 / 2S 19T 29 NR 1 -640 W Q PROPERTY C ~j w"' 3 475 K SUED. -Rxm" C310110 260 COUI~ (w~~' -r" I TROY VILLAGE CITY, STATE ` Ci ILLAGE OWN NEAREST ROAD HUDSON l S ITY RO ~Q New Cons Wes`` rr2 O 1 Addi ' to existing building , 12 j~ Reptacame I m Code derived d i design loading ra bed. gpolft2 trench, gpol<t2 Absorption area -ts "rtiRn design loading rate bed. glA t2 trernch, g Recommended _-,aull" elevatwn(s) BY DESIGNER ft (as referred to site plan Aenchmark) Additional design I site considerations A1,9 9-5 O rG 3 Parent material LSS T/LG vvTwi~Sh~ Flood plain elevation, if applicable !NtA~j ft S - Suitable for system CONVENTIONAL MOl1N0 IN-GROUND RESSURE AT-GRADE SYSTEM IN HOLDING TANK U Unstutable for system I❑ S ICU I IBS ❑ U ❑ S U I Q S Zu I Q S i-uFA L l I S Bu SOIL DESCRIPTION REPORT Horizon) Depth Dominant Color Mottles Structure GPO/ft in. Munsell Du. Sz Corn Color Texture Gr. Sz. Sh. Consistence I I Bad Boring p Al 0-20 110YR 4/2 lfs 12m-csbk I mvfr I gw of-f 0.5 0.6 427 ' A2 ~0-39 10YR 4/4 lfs )csbk mvfr I w of -f 0.5 0.6 5YR 5/8 B1 I39-50I10YR 4/6 Ic3d 10YR 7/2 sl 12m-csbk mfr L w of-fl--- Ground elev. B2 I50-59 I10YR 5/6 I sil I2mabk mfi I 9w 2vf-fI 90.5...6- ft. YR 5/8 B3 59-72 10YR 6/4 Im3p 10YR 7 sil 12m-csbk mfi I--- - --Depth to I I limiting facto 39" I I I I I LI(f Groundwater observed' t: " Remarks: Boring # lei Zvf-f 0.51: 0.6 Al 0-14 lOYR 3/2 sl 2f-msbk mfr y < 4280 A2 14-28 10YR 4/3 S1 2msbk mfr w of-f 0.5 0.6 B 28-45 10YR 6/6 sicl 2mabk Lf-fj 0.4!0.5 mfi Ground elev. C1 45-70 10YR 5/6 s os ml as lvf 0-710 A 905.1 ft C2 70-72 10YR 5/6 flf 10YR 3/4 s osg ml lvf Depth to lirtnting to=70 o t I ( I Remarks: Name-Flew Print jA~ 0. Phone. (715) 425-7831 OGDEN ENGINEERING CO., 113 WEST WALNUT ST., RIVER FALLS. WI 54022 Signature _ Daw f l° '17 CST CSTM03988 PRupEM'6WNER SOIL OESCRIPTION REPORT Page of _3 PARca:1.0. 9 Depth Dominant Color Mottles Structure Roots GPO/ft'- Boring # Horizon I (Texture I Gr. Sz. Sh. lCarissuffIcsiBounMyI I Bed Tramn in. I MunseU Ou. Sz. Cont. Color Al 0-12 10YR 3 2 sl 2m-csbk mfr cw ViF -f 0.510. 6 429 A2 12-22 lOYR 4/3 sl 2m-csbk mfr w of-f 0.510.6 Ground B1 22-34 7.5YR 4/6 Ifs lc _ I0.6 i elev. B2 134-41 7.5YR 4/6 I sl 2msbk mfr rw 9Q 5- tt. - mf i taii-A Depth to B3 41-53 10YR 6/6 if 1f 5YR 5/8 sil 3mabk limiting factor 0 53-72 10YR 5/6 Imld 10YR 314 s os ml lvf 41" - Remarks: Boring # a I I Ground elev. it OepM to limning factor Remarks: Boring I I Ground elev. Depth to limiting I factor Remarks: Bonng fi Ground elev. ft Oeplh to lifn dq ta= I Remarks: 5004=04p.ottil<w PAGE 3OF3 SITE PLAN NOTES: PROVIDE MINIMUM OF 1' SAND BETWEEN BOTTOM OF \ BED AND EXISTING GROUND. \ MOUND TO BE A MINIMUM OF: 25' FROM DWELLING; 50' FROM WELL; 5' FROM LOT LINE. //A/ ox ~ _ SCALE: 1 40 L oT S~ Go7 sz e- *Z 7 G o T S2:~ ❑ opt 5v ►~o S T ~~v/vEs P~•eew~Y - /o 'wiOE e177417y i95E.I~E/'~r OGDEN ENGINEERING CO. JAME . FILKINS, CSTM03988 Civil Engineers & Land Surveyors 113, W. Walnut St. River Falls, WI 54022 DATE: (715) 425-7631 VOL V-93 PAGE 189 O°~-- AFFIDAVIT OF CORRECTION TROY VILLAGE REGISTER'S OFFICE I, James D. Filkins, Registered Land Surveyor, ST. CROIX CO., WI S-2246, hereby certify that the Plat of Troy ~iea'd for Pocard Village, recorded in Volume 6 of Plats, Page FEB 041998 89, Document No. 559959, St. Croix County 9:30 A M Registry, located in the Town of Troy, St. `O~ Croix County, Wisconsin, shows Note No. 5 on Register of Deeds Sheet 2 which states "The following Lots must have mound systems: 1 through 10, 15, 16, 18, 19, 21 through 45, 47 through 49, 51 through 55, 59 through 64, 69 and 70." This note is hereby changed to read as Francis H. Ogden follows: Ogden Engineering Co. 113 West Walnut St. "Thp_-fflllowfng lots must,- have mound systems: ~ River Falls, WI 54022 a thigh 7 18, 1 1"through .45, 47 r t trou 66th'tough 55:, through 64, 49,1 10 41 d` Dated this day of ~$244,00Y , 1998 Parcel I.D. Number Go /.,//V,, i Ja D. Fi.lkins S-2246 JAMES D. State of Wisconsin ) FILKINS s s . - M46 9-1 < RIVER Fes' County of /2 ) P1 F- rf U Personally came before me this `d day of 1998, to me known to be the person who executed the foregoing instrume and acknowledged the same. My mmi ' on Expires 97 $ -2 00 NQTAR ST. CR IX COUNTY 4~-A PUBLIC ~ APPROVAL CERTIFICATE 100 Approved for recording by the St. Croix County Zo' ffice Date 2 • y' 96 This instrument was drafted by James D. Filkins, Ogden Engineering Co. 113 West Walnut Street, River Falls, Wisconsin 54022 ST. CROIX COUNTY WISCONSIN ZONING OFFICE r r r r r r r r• ST. CROIX COUNTY GOVERNMENT CENTER 1101 Carmichael Road Hudson, WI 54016-7710 (715) 386-4680 January 6, 1999 Charles S. Cook Continental Development Corporation 12301 Central Avenue NE Suite 230 Blaine, MN 55434 RE: Waiver releases for Troy Village Dear Mr. Cook: I'm writing to request that a correction affidavit be recorded removing lots: 16, 24, 49, & 53 in Troy Village, from the deed restriction regarding mound systems. I will contact you again when additional lots in Troy Village received waivers from the State. I don't believe it's necessary to record an affidavit with each waiver. Note: Correction instruments must be approved by the town board and must be notarized prior to recording in the register of deeds office (I believe you have an agreement with the to record waiver town of Troy regarding this matter). It is recommend, but not required, releases on the deed. Please provide the Zoning Office with a copy of the recorded correction affidavit. We will make copies and place one in each property file. Since this is an integral part of the approval process its the developer's responsibility to follow through with the recording of the correction instruments. I will assist in any way to help this approval process go as smooth as possible. Please contact me if you have any questions regarding this matter. Sin e y Rod Eslinger Assistant Zoning Administrator