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HomeMy WebLinkAbout040-1272-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT sanitary Permit No: 567284 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: 040-1272-70-000 Chard, Christopher&Aimee I Troy, Town of CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: A)t,,,J 17.28.19.1514 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE CAPACITY STATION BS HI FS ELEV. Septic , Z Benchmark Q/ /001 3 �O 3 per_ Alt.BM Aeration Bldg.Sewer l5 941. Z Holding St/Ht Inlet y'q 93.3 TANK SETBACK INFORMATION St/Ht Outlet 7• ( 93. z TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ S�J Septic �5Z / ��� Dt Bottom � Dosing Header/Man. ,$,S W. $/ _ Dist. Pipe -VZ ell-7 �P Aeration - 91•ego Holding Bot. System 64 �V Z Final Grade 0 4'6 0 t PUMP/SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM /6 BEDITRENCH Width Length No.Of Trends PIT DIMENSIONS No,Of Pits side Dia. Liquid Depth DIMENSIONS 3 �a 3 /r SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufac eery INFORMATION CHAMBER OR Type Of System: / / /,Q� UNIT Model Nur�tier: CenJt.n.�%�o ZlX/ /3Z /4Z /V rl dv.`e�lt �T' d5 DISTRIBUTION SYSTEM ZZk3 = Header/Ma ifol N Distribution x Hole Size x Hole Spacing Vent o Air Intake e 4•Pfi Pipe(s) ` G.1 Length Dia Length ` Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center �� Bed/Trench Edges \ Topsoil \ es No Yes No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2: / / Location: 409 Lost Rock Lane Hudson,WI 54016(SW 1/4 SW 1/4 17 T28N R19W) Troy Wood Lot 38 / Parcel No: 17.28.19.1514 1.)Alt BM Description= i GcJ�. G�,a,�^. 3 �.Oc1a✓S D✓` 2.)Bldg sewer length= �/ -amount of cover .� T_ - - T --- - � Plan revision Required? Yes o ?? Use other side for additional information. __ J -- - Date Insepctors,Sig ture Cert.No. SBD-6710(R.3/87) dS Zjaa 0 �z �,- J i m V 1 Cl- _ I I � o �Y) AdO3 � 4 a rr) o � r)r) �3 C �/ Safety and Buildings Division ,. } Gl ` � 201 W.Washington Ave.,P.O.Box 7162 Shy Permit Number(to Ve OW in by Co.) :$ 53 707 7162 � Madison,WI L /2!/ / sT.cRC�: �rmit Appli& o state Transaction In Kris.Adm.Code,submission of this form to she In t is required prior to obssmrog a sanitary permit Note:Application forms for shame-owned POWIS are steed to Project:Address(if ddM=&than marling address) the Department of Safety and Professional Samos. Personal information you provide may be used for secondary purposes in accordance with the Privary Law s 15-04(1)(m Stam /► L Applicaden Information-Please Print All Information Go' Property OwaWs Name Parcel# Govt Lot City; Z p Cade Phone umber yS Yzj-) VS section a T A A N; R,�_�E:t Type of Bnildiag(tlteclt all that ap Lot# 2�1'or 2 Family Dwelling-Number of Subdivision Name f Itock 0 Pubh"c/Commurial-Describe Use 6 k C10 D f t c\ ❑City of 0,State Owned-Describe Use (M,A CSM Number 0 Village of own of "7;;d t/ LA zz r HL Type of Permit: (Check only one boa on line A. Complete tine B if applicable) A- 0 New system 0 Replacement System 0 Tteatm=41otding Tank Replant Only 0 Other Modification to Foisting System(explain) B. 0 Permit Renewal W<=Rmision 0 Change of Phmsba 0 Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration owner � ,`t�-( Out 4 IV.T of POWTS S stem/Com nentlDevice. Check all that apply) L81 Non-Press=wd In-Ground ❑Pressmized le-Ground ❑At-iradc ❑Masud>24 is of suitable soil ❑Mound<24 is Of snitable soil Qb 0 Holding Tank 0 Other Dispersal Component(explain) ❑Prat Device(explain) V.Pigersalfrreatment Area Information: Design Flow WXQ Design Soil Application R Dispersal Area Required 1s / Dispersal Area Proposed( Systemm Elevation VL Tank Info Capacity in Total #of Mannf muse Gallons Gallons Units $ -02 _ cg New Tanks Existing Tanks U in W w C) a. sepae air Holding Tank aOC� LYE '�$ Q.• Vf Dosing Chamber VII.Responsibility Statement-I,the undersigned,assume responsibility for installation of the POWTS shows an the attached plies. Plumber's Name(Prime) MP/MPRS Number IBnsinuss Phone Number 6 -/ Plumber's Address(Sheet,QIN tip Code) Co eat Use only Appro� 0 Permit Fee Issued �8 Signature own " &Rcmm-Vx Denial s ✓ ° J� IIL Condi I'M - asons for Disapproval f- $ep6C'taruk filler anti , tfifspersaI cell must dkl be services l mafnlauteti 'Ast�.Mwp wont SI46 prov�dgd by O!u M par= tJ01N/OM �� r Ana&to esspide plans for the systm and sobesit to the County only on paper not less than 8 W x it inches in size SBD-6398(R.11111) ZJ n�.N 3Z �° o i�j 1 0 Zvi x � I v 4 fo ` M �� � V-) rn �� §oli Absoration system Cross sQctlon 95.00 ti 94.00 ft C Schedule 40 Final Grade PVC vent Pipe 91.80 VM Vent Cap ft Leaching --► 90.80 ft Chamber i System Elevation V 3.00 R 6.00 ft ft $0 Absoration§VW= Plan VWW ft I 3.00 ft 6.00 ft Leaching Trench 1 Chambers ITIT"I 1"I I I 11111111111111111111111111111 Ill I I I I I I I I I I IM 11 4 Dia. Trench 2 Header Vent Or Observation Pipe Trench 3 l eachirm Chamber 8periticatlons Manufacturer And Model %, L J`��, Q,.,, EISA Rating 20.00 sq ti per chamber Soil Application Rate 0.70 gpd/sq ft 900-OA gpd Design Flow+ 0.70 Soil Application Rate - 20.00 EISA= 65.00 Chambers 3 rows of 22.00 chambers each. Page of rRECE(VEiD a ORIGINAL 2 3 201 Q . Ev ►Mr�oaT OopRd 3 ����� : CROIX��I� —Co�e►86►1Ms`nlal.C'bde ��d :'OMMUNITY D VV'E LO M"EENT i p11+o Wa dsiiabFftWA camw i�cM+da,iutaotbiedlot�l�wdidoripoprpOiK�. mod- pAmd M - penOwt lglasori � adlaeaimaadbaesRi. O o— o-eod �rta4alSltH?f#. - _ �+opwq►ownrr _ � G z 3 � Propr�rar�ls �w '�SJEV 11K 8 T 1P N R / E ffij WO 81id files jW c 6 illelle lift a0com jDay tea• �lraentRord �iMel/tf�wRw�af6r�boers�r,tbJldrMd 13PAo omow& ❑ p� _ rlrri�nfosrala 9vo ppp AIM � ;�r c � # - aad C iyr vtH hpyr a�� Sa���.r c / r ys��+�. �/�v, — 90� El II PR 9�ds�iaoe s•s R Dq&biWe > 6 IL flamon Dupli posiowat RNbtOsp�foo FTL C ddom Rook- il�o! CtsR<CwLcd r 6k9z.9h. 'm F2 �. F it 4 to # ❑ a9 2 ' la-l% - ' OMNI r�ioeater_ �•s- i, iitaor y/c IL Nodoon Orr ploai�,tp sd I L aft CmLcft fbft aPO! l d ^ d / S rnsi3/C by _ F /.O EEI cxr N■os�lrrao Pii� - �rt�: iBQWGLad'm<u cwvA lldiers s Cowdrd TdrpUo�s mom mom ■�Hf �®mm� ■ t _ mm��w�������as t t i . r ►, '~. is • . 71 _ Ir 1 O I 4 � j Na k4 1 (� h CA I b 9 v s. s N rI V n f + Safety and Buildings Division County 5 t� � 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) :° ' � �7 'I Madison,WI 53707-7162 anitary Permit Application ',� State Transaction N /ber In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate gove ental unite ., �' / t is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTS azeOtt d to Pro dress(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for seco purposes in accordance with the Privacy Law,s. 15.0 1 m Stats. L Application Information-Please Print All Information Property Owner's Name C/ Parcel# 1 Property Owner's Mailing Address f Property Location (O `� 1� S Govt.Lot /`� City,State Zip Code Phone Number al "` y, 1A Section _ / , I rb circle one .T pe of Building(check all that apply) / Lot# T��N; R_!_L E ot� IL�l 1 or 2 Family Dwelling-N her of Bedroom LI! ^d �� Subdivision Name S Q�2 Y10!e Block# 6 ❑Public/Commercial-Describe Use �I ❑ City of ❑State Owned-Describe Use '"` r roD V ,-, CSM Numb El Village of 6 0 VS n� Ld'`Town ofT III.Type of Permit: (Check only one boa on line k Complete line B if a c e) A' New System y El Replacement System ❑Treatment/Hdding lacement Only El Other Modification to Existing System(explain) `` B. El Permit Renewal El Permit Revision ❑ Ch ge of Pl jeNr El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV.Type of POWTS S stem/Com onent/Device: c 1 t 1 LJ Non-Pressurized In-Ground El Pressurized In-Ground -G e ❑M >24 in.of suitable it ❑7�Mo td<2t}in. suita to soil ❑ Holding Tank ❑Other Dispersal Component(explai � e ent Dez lam V.Dis ersaUTreatment Area Information: �- Design Flow(gpd) Design Soil Application Rate(g dsf) DispersAl Area Required(sf) Dispersal Area Proposed(sf) Syste Elevation ®c7 • l� i3U� 9` . 3 U VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units New Tanks Existing Tanks rn> i Y L(/G d a U y v3 w C7 Cs. eptic or olding Tank �J� r� ) ing Chamber VII.Responsibility Statement- I,the undersigned,assuipe resp9psibility fo installation of the POWTS shown on the attached plans. Plumber's Name(Print) Zpmb Si gna MP/MPRS Number Business Phone Number Plumber's Address(Street,City,State,z de) ^ VII oua /De artment Use Only 190Approved ❑Disapproved Permit Fee Date Issued Is ing AgeXSturej ❑Owner Given Reason for Denial $ -7 IX.Conditions of A roval/Reasons for Disapproval TEM OWNER: v -G ✓ C( 7"� I�2�1�071�'� �2/ �!1 O CCU y, a��da 1` ' 1. Septic tank,effluent filter and ��- dispersal cell must be serviced/maintained t as per management plan provided by plumber. (A com e s ystem and sub it to the Co ty only on paper not less than 1/2 x 11 inches in size as per applicable cd�ior6inarPces. syS � IM Sa1�1�11 - Y 2 "� ae _wnk-�D.� Q 36 r� .� � SBD-6398(R. 11/11) CJGLad O►'+ -> Sf p�*7 t-i Qom•(- 2G�R ll1C.Q.(/Q� r'r► !b �� CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Chard Sewer Owners Name: Christopher & Aimee Chard Owner's Address: 393 Valley Commons Hudson Wi. Legal Description: SW 1/4 SW 1/4 S 17 T 28N R 19W Township: Troy County: St. Croix Subdivision Name: Troy Wood Lot Number. 38 Parcel ID Number: 040-1272-70-000 Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing&Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test&House Plans Designer/Plumber. Keith Knudtson License Number: 648443 Date: 11/22/2013 Phone Number (651) 470-1737 r2 Signature L Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P(N.01/01). Page 1 s ( t C., x mA Z AW OZp S m -�tN 7 j -.5i2z G ' t w L� V _ OQ 33 0 fl co tp k , • (, ( sue N. 4 - , WI c.N is, , N __ . 6SO,_,, • v•1/4 0 S G ■ t :54 1 ro , 3 r - 3 3.-- o O o n -v --t S (Ai 1 Soil Absorption System Cross Section ft r f-- 1 95.80 ft 4'Schedule 40 Final Grade PVC Vent Pipe 94.30 With Vent Cap ft Chamber _÷ n rilr' 93.30 L �--- -� �-- System 3.00 ft 4.00 ft ft Ppco WI itAitvh- -b Soil Absorption System Plan View a vr�samda o•ei)pd/c4V4p. rte' . ft 3.00 ft 11110 111111111111111111111111111111111111111111111111111 4.00 ft Leaching Trench 1 Chambers '+1 IIIaIIIII111JIIIIl111J11 II11(11I(.[1II111 11111 Jf1111IIIIIIIIIIII111M1 JIli1II1IlLC `` 4'Dia. Trench 2 Header r Vent Or Observation Pipe 1111111liliiiliilllilliilililii1ii11iliiiiiililliiilliiliillililliliiiliiiiilil iiilil E— Trench 3 Leachina Chamber Specifications Manufacturer And Model EISA Rating 20.00 sq ft per chamber Soil Application Rate 0.70 gpsq ft 900.( j gpd Design Flow÷ 0.70 Soil Application Rate + 20.00 EISA= 65.00 Ch: j, $rows of ot L chambers each. 4'(I,3 (0,5 / r°`'"'af- ,- ? 2( 7 Page 3 of "l 1356 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings in accordance with Comm 85,Wis.Adm.Code Gustum Septic Service County Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must St.Croix include,but not limited to:vertical and horizontal reference point(BM),direction and �(,— / ii )-- percent slope,scale or dimemsions,north arrow,arMiocationaad distance to nearest road. Parcel I.D. 0( Please printalhpformation. R_ �� Date 19/6r YPersonal information you provide may used for secondary QutQoses(Pnvacy Law,a.15.04(1)(m)).Property Owner ,A ! - *,' property Location Humbird Land Corporation t, - vt.Lot 1/4 SW 1/4 S 17 T 28 N R 19 W L # Block# Subd.Name or CSM# Property Owner's Mailing Address ) �.��.�? ? ".�r ��il� _ 332 Minnesota Street, East 1404., T J, 1 38 n/a Troy Wood Subdivision City Stale-Zip Code P ellitI TDhiber �; J City J Village ✓ Town Nearest Road t� Troy E Cove Rd/Lost Rock Lane Saint Paul I MN'p;56�Q�� b(�-1��`-5��, Y I e New Construction Use a Resit erltial kNUrrb\r'oif rooms 3 Code derived design flow rate 450 GPD J Replacement J Public or corn-in-el-air Describe: r Parent material outwash plains Flood plain elevation,if applicable n/a General comments and recommendations: Part of 10 acres. BM#1= 100.0'. BM#2=98.9'. Recommend 93.8'system elevation along 96.8'contour. All borings from preliminary soil work done 5-5-00. , / -r P9 Boring# J Boring 0 'c / - - Pit Ground Surface elev. 82.8 ft. Depth to limiting factor >75 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 *Eff#1 *Eff#2 1 0-12 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 12-21 10yr3/4 none sil 2msbk mvfr cw 1f 0.5 0.8 3 21-30 10yr4/4 none sil 2msbk mvfr cw if 0.5 0.8 4 30-36 10yr4/6 none gr. Is lmsbk mvfr cw - 0.7 1.2 5 36-50 Oyr5/6 none gr.s 0 sg ml cw - 0.7 1.2 6 50-75 10yr6/6 none s 0 sg ml - - 0.7 1.2 P10 Boring# Boring Pit Ground Surface elev. 91.8 ft. >75 in. Soil Application Rate ✓.� Depth to limiting factor App' Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ft' *Eff#1 *Eff#2 1 0-10 10yr3/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 10-16 10yr3/4 none sil 2msbk mvfr cw 1f,1m 0.5 0.8 3 16-28 7.5yr4/6 none gr. Is 1 msbk mvfr cw - 0.7 1.2 4 28-39 10yr5/6 none gr.s Osg ml cw - 0.7 1.2 II 5 39-75 10yr6/6 none s 0 sg ml - - 0.7 1.2 *Effluent#1=BOD 5>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) SignaturE 4------- CST Number Tom Gustum Y�"y+'1 227618 Address Gustum Septic Service Date Evaluation Conducted Telephone Number N13450 937th St.,New Auburn,WI 54757 11/21/0 0 715-658-1344 r pre Wolin�_-_ y Owner Humbird Land Corporation Parcel ID# � ___- _ Page 2 of c3 _ P11 Boring# Boring Pit Ground Surface elev. 96.8 ft. Depth to limiting factor >78 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ GPD/ft' *Eff#1 *Eff#2 1 0-9 10yr2/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 9-16 10yr3/4 none sil 2msbk mvfr cw if 0.5 0.8 3 16-28 7.5yr4/4 none sil 2msbk mvfr cw - 0.5 0.8 4 28-37 7.5yr4/6 none sl 2msbk mvfr cw - 0.5 0.9 5 37-49 10yr5/6 none s 0 sg ml cw - 0.7 1.2 I 6 49-78 10yr6/6 none s 0 sg ml - - 0.7 1.2 `Pie icy _ 9'3 3 = 6 '' l x:dv✓ eila -,- °tAJL- f r P12 Banns# Boring /n CI 2 r( Pit Ground Surface elev. 100.1 ft. Depth to limiting factor >75 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GP.D/ft!_. _- *Eff#1 *Eff#2 1 0-11 10yr2/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 11-16 7.5yr4/4 none sil 2msbk mvfr cw if 0.5 0.8 3 16-23 7.5yr4/6 none sil 2msbk mvfr cw - 0.5 0.8 4 23-29 10yr4/6 none Is 1 msbk mvfr cw - 0.7 1.2 5 29-48 10yr5/6,4/4 none s 0 sg ml cw - 0.7 1.2 6 48-75 10yr6/6,4/4 none s 0 sg ml - - 0.7 1.2 P13 Boring# Boring Pit Ground Surface elev. 90.2_- ft. Depth to limiting factor >75_ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary I Roots GPD/ft2 *Eff#1 *Eff#2 1 0-10 10yr2/2 none sil 2msbk mvfr as 2f,1m 0.5 0.8 2 10-18 10yr3/4 none sil 2msbk mvfr cw I 1 f,1 m 0.5 0.8 3 18-26 7.5 r4/4 none • sil 2msbk mvfr cw - 0.5 0.8 4 26-42 10yr4/6 none gr.s O sg ml cw - 0.7 1.2 5 42-55 10yr5/6 none s,gr.s 0 sg ml cw - 0.7 1.2 6 55-75 10yr6/6 none S 0 sg ml - I - 0.7 1.2 *Effluent#1=BOD 5>30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BODS<30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. 0 sue' . -4. m C 6, T J do N ) ,...rN � o rY �. p ti 0 C1 X C VO (1 ) CSS+ CO 1 ziii a o o -11 I s D z N 53" AS _ 96" > REQD m 41" m r z zWmi C s > II I D n •u.1.- • �� ���_�. mUP 40" mss ' o 4" CAS N m m m D O XI 3" 44" 6" c� M m D x N — r o m O m i N 36" m ? 0 W 0 m U P 38" rri D rn 0 4" CAS I �— N r� z �� i , N iisl •-�" • K II 1 13 IO > 39" 1E1 o 0 -10 y z z r r 2 2 v --♦ C C DO z z 0 0 p r r N z x r D C m m m D 0 Om m N D D $*Z D O0 0 v D 4.D CWT frrl=KC) WAN Z �N rri x>7 3 � z Ot-N nC � D QNZ sz pr° zo-ZO OD% C .� m0 Cam r_ D r �x N 0 XIZc >0 -ar_ -a I— �W m r <C co _ m s KX Z2 = m 2 � DQ Z • ?m DmO<O�* m *°'(-1/.3 mm rn 0 D - z vv D<< Z ym oo -DIN-I I71f*11r7/04's D13 C70 v > a > (ot ZD rim c2 -0 O • NmD m (m04'• Qv- -cn �l0 7. O � 4C J NO'�*7i > co 0) � ' D < O m O c O Co u„ \ C mm r- v� Q CG' n -- m m 00 -1 CO 00 rQ -0 Q -1 ; m D my�^ CO Oa) D. m v m z o z C p D r C)rD O rp m N —1 7) y° w vm 3 m t-W r r'i O <++ \ x z -1 m 0 s —1 -< v m 7o H D ?1 m 13 z A 00 c z ° 0 N I- N 0 Z 71 0 �-- N D vOTI Co I '->,...' Z O g v Co Z C r M M 0 O ° m 0 O °cn D n N cn D z rA -1 Co o r m 0 7, rM o Q Q r H Z 7o m n — O � � N y1 Z m xi m po v •• M Z r m \ N WLP2000-MR 2 DRAWN BY: SME SCALE: 1/4"=1'-0" PRE-POUR: m 0 -I SEPTIC MANUAL DATE: JANUARY 2010 DATE:. POST-POUR: \ z W3716 US HWY 10 MAIDEN ROCK, W 54750 ° REVISED JAN. 2010 800-325-8456 FILE: WLP2000-MR �• 0 - Filters' r - -525 EFFLUENT FILTER PL-525:Filter is rated for `0,000 GPD (gallons per day) 1/16" Filtration Slots fig it" one of the largest filters —°ao class. It has 525 linear feet E 10,4 GPD filtration slots. Like the- __. ,V . iok PL-122,the Polylok Eamon Handle -5:25 has an automatic shut ball installed with every filter. - zen the filter is removed for ri1ng,'the ball will float up and _'-'"f---ternporarily shut off the system so F ihe effluent won't leave the tank. 525 Linear Rot 1n6• liki other filter on the market can _ Fikralion sl \V = _ ''� that claim. `® ' ONE �`' 10.000 GPD _ 1,1_::;,i' 1 k. PL-525 Maintenance: &ceps 4'D r ....._-■1., _ SCHD.40 Floe Abe PL-525 Effluent Filter should operate efficiently for several years GI) -'"A:' ,,-1.-7101," under normal conditions before - .,_ __„A�, requiring cleaning. It is recom- `. mended that the filter be cleaned every time the tank is pumped or .a ar:,';e; _ at least every three years. If the . installed filter contains an optional f -,, 9,> alarm,the owner will be notified -� , -'--rp: "�" by an alarm when the filter needs ,, '�° rvicing. Servicing should be ?� - _ = n done by a certified septic tank := --s D -.- pumper or installer. U.S.Patent NO 6,015,488 R --.Bail WIWI Flier - 1. Locate the outlet of the 5,671,640 septic tank. 2. Remove tank cover and pump tank if necessary. PL-525 Installation: 3. Glue the filter housing to 3. Do not use plumbing when the 4" or 6" outlet pipe. If filter is removed. Ideal for residential and corn- the filter is not centered mercial waste flows up to under the access opening 4. Pull PL-525 out of the housing. 10,000 Gallons Per Day (GPD). use a Polylok Extend & 5. Hose off filter over the septic Lok or piece of pipe to tank. Make sure all solids fall 1. Locate the outlet of the . center filter. See page back into septic tank. septic tank. 19-21 for Extend & Lok 6. Insert the filter cartridge back 2. Remove the tank cover and information. into the housing making sure pump tank if necessary. 4. Insert the PL-525 filter the filter is properly aligned into its housing. and completely inserted. 5. Replace and secure the septic tank cover. 7. Replace septic tank cover. /l * it ...., mums POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page FILE INFORM ATION SYSTEM SPECIFICATIONS Ov ner Septic Tank Capacity z gal ❑ NA Permit# ( ,5 , 7 Z i Septic Tank Manufacturer LA j%C'5er ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer 4.14 I 0 V___ ❑ NA Number of Bedrooms El NA Effluent Etter Model 52 l, ❑ NA Number of Public Facility Units )I0A Pump Tank Capacity gel 01A Estimated flow (average) �p� gal/day Pump Tank Manufacturer Design flow (peak), (Estimated x 1.5) �f�o gaUday Pump Manufacturer 1A Soil Application Rate i � gat/day/ft2 Pump Model >4. 1/4 Standard Influent/Effluent Quality Monthly average' Pretreatment Unit tck. j/ Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter P Biochemical Oxygen Demand (BODE) 420 mg-/I_ ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Di Cell(s) VA. (e1-lr,�-�t. 01);(1r--4 ❑ NA Biochemical Oxygen Demand (13005) 530 mg/L In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L KNA ❑At-Grade ❑Mound Fecal Conform (geometric mean) <104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size sin ili . ❑ NA Other ❑ NA • Other. ❑ NA Other ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every; 3 ❑ montt(s) (Maximum 3 years) ❑ NA ear(s) Pump out contents of tanks) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 3 ❑YearnAlsl (Maximum 3 years) ❑ NA Clean effluent filter At least once every: , p�ar(s) ❑ NA Inspect pump, pump controls & alarm At least once every: 0 Y year()ts) ❑ month(s) A Flush laterals and pressure test At least once every: ❑ year(s) n'" Other: At least once every: ❑ year(s) ❑ NA ❑ ear Oilier. 4 ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s)to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third 09 or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent fitters,mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page of START JP 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 calls). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use_ System start up shall not occur when soil conditions are frozen at the infiltrative surface. • During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cells) 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 POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soi absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation- drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides: sanitary napkins;tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33,Wisconsin Administrative Code: - • All piping to tanks 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 another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or.must be taken, to provide a code compliant reps t system: 67 Amsuitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement not area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement area is not available due to setback and/or soil imitations. Barring advances in POWTS technology a holding tank may be-installed as a last resort to replace the failed POWTS. olio..... r,. .•r c "^'�ingn be e - ?gt -1 t 8 rI r 9 b -1.1 CDNST (JC.Tt pr.► k - ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO 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 R POWTS MAINTAINER Name 1 f( n Name Phone I 105)— 76— i 7 3 -7 Phone _ SE'TAGE SERVICDIG OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name I Po 1..3.Q ••S 4 ost-ick.,;,t' f,., Name s-r. C—k0 (19UarY 2 AIW4- Phone f 7/15-- A 5.16— 3"7 acT Phone –7( — 38'Co— Overt) This document was dratted in co to with Chapter Comm 832212MbH1)ld)&(fl and 83.54(1),(2) &(3),Wiseta is Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Christopher & Aimee Chard Mailing Address 393 Valley Commons -Hudson Wi. Property Address /01 10ROCK LA- J7 (Verification required from Planning&Zoning Department for new construction.) Hudson Wi. 040-1272-70-000 City/State Parcel Identification Number LEGAL DESCRIPTION Property Location SW ' SW 1/4 , Sec. 17 T 28 N R 19 W, Town of Troy Subdivision Plat:Troy Wood Lot # 38 Certified Survey Map#__ , Volume , Page# y, — Warranty Deed # �s J / before 247 Volume Page Spec house DyesClno Lot lines identifiable OyesOno -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. 1/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 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. t/we certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s)of the property described above,by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 6 mac., C A — — /3 « 1_ ( SIGNATURE OF APPLICANT(S) DATE **.Any information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department. m 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) • STATE BAR OF WISCONSIN FORM 2- 1998 I II IUII1 II II II I I I I I WARRANTY DEED 8 1 9 898 3 Document Number 985163 This Deed,made between Day Farm Investors,LLC, a Minnesota BETH PABST Limited Liability Company REGISTER OF DEEDS ST. CROIX CO., WI 08/30/2013 4:09 PM Grantor,and Christopher R.Chard and Aimee Chard,husband and wife EXEMPT*: NA REC FEE: 30.00 TRANS FEE: 599.70 PAGES: 1 Grantee. Grantor,for a valuable consideration, conveys and warrants to Grantee the following described real estate in St.Croix County, State of Wisconsin: Recording Area Name and Return Address Lot 38 Troy Wood,Town of Troy,St.Croix County,Wisconsin 040-1272-70-0000 Parcel Identification Number(PIN) This is not homestead property. (is)(is not) Exceptions to warranties: Subject to notes,easements,restrictions,covenants and rights of way of record,if any, including but not limited to those for drainage,water retention,ponding,and or utilities as may be shown on the plat of Troy Wood recorded in Vol. 8 of Plats,page 28,St.Croix County,Wisconsin.The warranties of this deed,either express or implied,are limited by the grantor to the grantee,or anyone in the chain of title,to an amount not to exceed the consideration expressed herein,that being the sum of$199,900.00. Dated this 26th day of August , 2013 Day Farm Investors,LLC * * by P*-49.4.. A Vice President * • Paul A.Baillon AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN )ss. Signature(s) Ramsey County. ) Personally came before me this 26th day of authenticated this day of August ,2013 the above named Paul A.Baillon * TITLE: MEMBER STATE BAR OF WISCONSIN to me known to be the person(s)who executed the foregoing (If not, instrument and_acknowledge the same. authorized by§706.06,Wis.Stats.) / G. ►. THIS INSTRUMENT WAS DRAFTED BY - �-r- Paul A.Baillon,Attorney at Law * Caroline B.Bowersox r!:„.-;?*' y., ` Notary Public,State of Wiscon - (Signatures may be authenticated or acknowledged.Both arc not My Commission is permanent.(If not,state expiration date: necessary.) January 31 2018 ,) *Names of persons signing in any capacity should be typed or printed below their signatures STATE BAR OF WISCONSIN WARRANTY DEED FORM No.2-1998 INFORMATION PROFESSIONALS COMPANY FOND DU LAC,WI 800-655-2021 1 of 1 At UWvCD E3V 04MCG3t m Rto a v x N 00°20'07" W 2603.731—i- WEST LINE OF THE SWI/4 V . . — _ . _._ . - 556.87' 1 i I I a, I t 1 a '' I c I r I 3 1 z 4�z' ' 1 a I 32 oo 0 I a • r t2m ID m � � m ii t a y 1 N 1 1 W• /\ ' NOO'Ot'8 'E 3 258.$8' _._1 210.28' 88.71' / \ 04 0 i ', CI r-03— N7 . 3.,, 4a' '1J O . . N �0 I :W tD , \• / , j i. D r=A YZ ""�w I m 0 • I0 y,i ci, 6> r o 0 800'07'06"W 488.02, 188' / ‘; . o S r-?1-a W y I '+ a , / 1 i. it o W �L 1 A 1 3-•*, _ 1 i _ . Parcel #: 040-1272-70-000 04/09/2008 10:33 AM PAGE 1 OF 1 Alt. Parcel#: 17.28.19.1514 040-TOWN OF TROY Current X ST. CROIX COUNTY,WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type 00 0 Tax Address: Owner(s): 0=Current Owner, C=Current Co-Owner O- DAY FARM INVESTORS LLC DAY FARM INVESTORS LLC 332 MINNESOTA ST E 1404 ST PAUL MN 55101 Districts: SC=School SP=Special Property Address(es): *=Primary Type Dist# Description *409 LOST ROCK LN SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 10.030 Plat: 08-028-TROY WOOD 040-01 SEC 17 T28N R19W SW SW LOT 38 TROY WOOD Block/Condo Bldg: LOT 38 Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 17-28N-19W Notes: Parcel History: Date Doc# Vol/Page Type 12/26/2001 666346 1799/595 QC 2008 SUMMARY Bill#: Fair Market Value: Assessed with: 0 Valuations: Last Changed: 09/09/2003 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 10.030 170,000 0 170,000 NO Totals for 2008: General Property 10.030 170,000 0 170,000 Woodland 0.000 0 0 Totals for 2007: General Property 10.030 170,000 0 170,000 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 I IIIII = I. 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