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HomeMy WebLinkAbout040-1312-13-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 569539 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: Delta Construction, Inc. I Troy, Town of 040-1312-13-000 CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No: , Z_ 1 04.28.19.2043 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER : .� CAPACITY STATION BS HI FS ELEV. Septic ri - /zrJ Benchmark 3. Z /63-7 7 Az + 7 Alt. BM 3 /Q d . 3 Aeration Bldg. Sewer Holding St/Ht Inlet 7•(4, �G •3 St/Ht Outlet • O TANK SETBACK INFORMATION 71 9(, TANK TO L P/l WELL BLDG. en o Air Intake ROAD Dt Inlet `� \ O� Septic s� j Z 7 �' ' Dt Bottom Dosing Header/Man. 17 .3 9S Aeration Dist. Pipe .3 75• `9 Holding Bot.System ?:y c7.q• V b� 3, PUMP/SIPHON INFORMATION Final Grade /06 �7 Manufacturer Demand St Cover 3 . 160 GPM F Model Numb TDH Lift Friction Loss System Hea TDH Ft Forcemain Length Dia. Dist.to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width I Length INo.OfTrenches ^ PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 7� z rell4w \ ___1,SETBACK SYSTEM TO ! P/L BLDG WELL LAKE/STREAM LEACHING Manufacture INFORMATION CHAMBER OR .}✓1��'It a+e-%-_ Type Of System: UNIT JI � j Mo I Nu er: ?to JI N Lv� DISTRIBUTION SYSTEM 15�6 o ZZ a-ZZ 4 -�g Header/Manifold / Distribution x Hole Size Ix Hole Spacing �Vent to it Inta e 9 � Pipe(s) ` g `\ ���` 'els Len th Dia Length Dia Spacing SOIL COVER / x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth f xx Seeded/Sodded xx Mulched Bed/Trench Center 61, Bedlrrench Edges Topsoil es g No Yes L No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: ! / Inspection#2: Location: 525 Olivia Court Hu son,WI 54016(NE 1/4 SW 1/4 4 T28N R19W) Cottage Meadows Lot 13 Parcel No: 4. 19 43 1.)Alt BM Description= ` ' �'�- ✓u— `dA.l� l^r a'- 2.)Bldg sewer length= Z 7 -amount of cover= / M Q v1► pL�� Plan revision Required? R Yes ❑' No Q�' 7 Use other side for additional information. _ Date Insepctors nature Cert.No. SBD-6710(R.3/97) P T PLAN PROJECT Delta Construction ADDRESS 206 2nd St. Hudson Wi 54016 NE 1/4 SW 1/4S 4 /T 28 /R 19 W,,TOWN Troy COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 5/28/14 BEDROOM 4 CONVENTIONAL XXX IN-G D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of iron pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL SYSTEM ELEVATION 97,0/96.7 4.8' below arade L Scale is 1" = 40' >6„ Quick4 Standard 276' Property Line unless otherwise of Cover eaching Chamber ith 20.0 ft2 of Area noted .6ft^2/pair of end caps 4' LonGrade at System Elevation 34 All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. 101' 100' 2-3' X 90' cells with>3' spacing B.M.* Pro 4 Bedroom House B-1 0 2% Slope 129' Property Line 40, 30' 27 ST 50' B 232' Property Line Vents B-2 74' 94' 153' Property Line County ` Safety and Buildings Division )L O 201 W.Washington Ave.,P.O.Box 7162 Sanitary Pami<N (to be sued in by Co.) Cj v p� Madison,W1 53707-7162 V' PA11D C/ Permit Appl ief--- State Transaction J - In with S is.Adm.Code,sobmissi�of this fog to the appropriate governmental unit `� is required prior to permit Note:Application forms for state-owned POWTS are submitted to Project Address 0f 116- 1 dM tallies address) the Dept t of Professional Servics. Personal information you provide may be used for sawndazy Dumom in with ft Priivw Law,s.15.04(l)(ml States �'-- L Av011icadon Wormatiion—Please Print All Wormation Property Orvors rName ULC���w' Parcel# Property Owner's/Mailing Address n Property Location Z-0 to 2✓ 90!9Ld c city,State Zip Code Phone Number yyS�yti Sotxioo J T� N; R W Type of Building(check aU that apply) �# 1 a 2 Family DWdung—Number of Bedrooms 3 Subdivision Name Cle— fed W t:t� Block# Ce ❑PubiiclComnracial—Describe Use�Ae, —�`�'' — ❑City of / CSM Numrber D vmar of ❑State Owned—Describe Use 2- & - Gans W Z2.+- Z Z C� eau of �r III.Type of Permit: (Check only one box one line A. Complete line B if applicable) A system ❑Replacement System ❑TreatmenNfloldmg Teak Replacement Only ❑Ol6er Modification to Fsesting System(�P ) B. ❑Permit Renewal Permit Revision ❑Change ofPlumber ❑Permit Transfer to New Ust Previous Permit Number and Date Issued Before Expiration Oevna �� IV.Type of POWTS S Com nent/Devioe: Check all that l h Ground ❑Pressurized Ice-Ground ❑At-Grade ❑Mounds 24 ern of sudable-1 ❑Mound<24 is of suitable soil/JS ❑Holding Tank ❑odw Disperad Component(explain) ❑Pretreat Device(explain) V.Dixpwsa&reatm Area Information: Design Flow(gpd) Deign Soil Application Dispersal Area Required(sf) Dispersal Area Proposed(at) IS dG v VL Tank Wo Capacity in AM Unft G v Nees Tsnles Fzs'tiat Taoi� ' :M; in a Septic at Holding Talc D°sin8(>sebQ VII.Responsibility Statemen i,the and bitity for iasm4ation of the POWTS shown on the attached plans. Plumber's Name(Print) MP/MPRS Number Business Phone Number /J— Mumrbees Address(Street.City.State,zip O� -11I Co /De ant Use Only permit Fee Date Issuing me S*U Approved C�� r Ream for DeniT S DL Con rp, asons for Disapproval 3 J.1 tb t r%e a...J ptio'tank,17ltbntftiterand ,S ✓k�.:, a dispersal cell must all be servkes I maintained �Oer+Ge>,.•+ruti e 1as per management plan provided by plumber. u ents must be':maWaitfed 2tt lclt re trern wetaeb to nmpide Pins for tie s�atem and subuk to the Coaatr MIY M Papa not test Rae a in x I I indm in site VJ SBD-6398(L 11111) P T PLAN PROJECT Delta Construction ADDRESS 206 2nd St. Hudson Wi 54016 NE 1/4 SW 1/4S 4 /T 28 /R 19 W,/TOWN Troy COUNTY ST.CROIX 5/28/14 BEDROOM 4 MPRS Shaun Bird 226900 DATE CONVENTIONAL XXX IN-G D PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of iron pipe ASSUME ELEVATION 100° Filter BEAR Filter ❑ BOREHOLE O WELL SYSTEM ELEVATION 97.0/96.7 4.8' below arade J4' Long ent Scale is 1" = 40' Quick4 Standard 276' Property Line unless otherwise Leaching Chamber with 20.0 ft2 of Area noted �5.MA2/pair of end caps " Grade at Sy stem Elevation 34" All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. 101' 100' 2-3' X 90' cells with>3' spacing B.M.* Pro 4 Bedroom House B-1 0' 2% Slope 30' 129' Property Line 30' 40' ST 50' B-3 232' Property Line Vents B-2 74' 94' 153' Property Line �wx.pJw ��b:� . ^ sosa.+saswsnunaw°,xar SNOI1VI1313 �i9,CS1!1tli le[L1i`SIL'3JIii0 � '5ix1501y'S'ratliA-�nOtl$hCLLYA3l3 8T��61CJ :J.w LS YJKN'tl xNL91�P,9L��fY1� m 931T�1.1!1$ii6,MBt1M'n3QY3n1LJM3f. z C� .wrsLSO�:aa wsn nlrud �w l"JL°_nvnwaSlHLjL 9ND1W-df10 ANV NVIUSIM-'1SNOO`d1-13a heGUOJivl�lpalL{pn JpMMA MIMHIC SIHI YSSUII�MIdq OXY ns+twa�u:ns.rmvtlo L131N370NIU!7l19MON7Jd Q sill�ln-w swnoa3a,m�3lvnos+cJ n a i o g6� LL. 0 LL 3 "N\ ® QQ Iii \\ J I I W LII 2� 1 � I � \� K t i iIIII .I II II o0 o r El lu All I ,i _ ❑ '�,� - - : ❑ ;ODD ®®❑�Q W. 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I ' K _ 1 ItV 1 V7: u 1 WI J 7` h .VA l( ; 1 _ _ _______________ ........... __________________ .'____ ��J`'' I fit.. �, / rs• a.r A.,1 E ri mil_' dg� za a`z - 411 Sr• Q i i I 0 ._____R.cv c_y .___., K•M1 .. .9 EL .9i ,p.25 6.d B6 6:90'b l OZ AM 31VC[F FUISN3tl N[F]_A7BYMMn S]iA5 MY 91mSN3gO LAHLOTNOf11' iI O/� VV4 p,L•.MI r¢4WrtKU MYf LefSfa`FN!:3l iio SAS_l�'GON VSdO FpflOro SNUlYA3'3 p0\/1�NIV/ro -]LVL IF WRN�1 2FN-f�ll>o YARN�OIIi S3an10'S32R wY3BGNY NSOYSNAi w3l. +tOZ GL�:uYO At11F1 nwN.l JlY'1]TI SI�YNW W sYNw2laNn:AeNmvao N/uaLFNhe'3��iq9�tp N KwFn;rIAlNB+LeM]1O.Ft!a.?Y/•Y a Q sAiNlnew-v Mmw 8aanm Ynq NVW3SIM' 1S NOJ Hl713a (13!WIY2St•O'J Ll»wLw] �s 7 5 . U. 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I f `'G�i P.O.Box 7162 2Q Madison,WI 53707-7162 y �p y>.a O�� State Transaction Number �� it Application In accordance with SPS 383�'1Q�j V m.Code,submission of this form to the appropriate governmental unit a' ddress) is required prior to obtainilg permit. Note:Application forms for state-owned POWTS are submitted to Project Add if the Department of Safejv rofessional Servies. Personal information you provide may be used for secondary G u ses in accordancerbdth the Privacy Law,s. 15.04(l m,Stats. I. Application information-Please Print All Information Parcel# Property Owner's Name Property Owner's Mailing Address Property Location Z6 4 3� 20 2. .�. Govr�.ot City,S te' Zip Code Phone Number /. t� '/4, Section ircle or W II. ype of Building(check all that app dk eA U Subdivision Name or 2 Family Dwelling-Number of Bedro ms 7 P'"�` BI ❑Public/Commercial-Describe Use 1 �'� ❑City of CSM Number t ❑Village of ❑State Owned-Describe Use own of Z �- �o�- III.Type of Permit'. (Check only o e box on line A. Complete line B if applicable) �. A' w System ❑ Replacement System ❑Treatment/Holding Tank Replace nt ❑Other Modification to Existing System(explain) B. ❑Permit Renewal ❑Permit Revision ❑Ch ge o Plumber ❑ nsfer to New List Previous Permit Number and Date Issued Before Expiration er — `[ (a,kl. LIL of POWTS S stem/Corn onent/Device: Check I th t o O1�� I .T e /)J Pressurized In-Ground El In-Ground. 11 At- nd>24 in.of suitable soil ❑Mound<24 in.of suitable soil / Holding Tank Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.DispersaVrreati Pent Area Information: o� Desi n Flow(gpd) Design Soil Application R (gpdsf) Dispersal Area Required(s Dispersal Area Pro ed(sf) System Elevati 9 57 V1.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units n w c tj New Tanks Existing Tanks w 11 ( r? o — Septic or Holding Tank, Dosing Chamber VII.Responsibility Statement- a undersigned,0 responsibility for installation of the POWTS shown on the attached plans. MP/MFRS Number Business Phone N mber , Plumber's Name(Print) PI ignature n `e1J Plumber's Address(Street,City,State; ip Code 1 VIII.Coun /De artment Use Only Permit Fee Dat Issu Issuing t Signature pproved ❑ Disa roved $ q )4 ❑O er Reason for nisi IX.Conditlg*9#Wj rtpAjM;asons for Disapproval 1 Septic tank,effluent fitter and ii � r�re✓�ct dispersal cell.must all be services/maintained as per management plan provided by plumber. /f (-wc, o n t 3.-Anse ok Oqu*ements mustbe.maintalned Attach to complete plans for the system and submit to the County only on paper not less than g 112 x l i inches In size SBD-6398(R0313) Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/10/14 Owner:Delta Construction Location: NE 1/4 SW 1/4 S4 T28 N,R19W Lot 13 Cottage Meadows Troy System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet 8-10. Soil Test Signature License numbe 6900 PLOT PLAN PROJECT Delta Construction ADDRESS 206 2nd St. Hudson Wi 54016 NE 1/4 SW 1/4S 4 /T 28 N/R 19 W TOWN Troy COUNTY ST.CROIX MPRS Shaun Bird 226900 DATE 4/9/14 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 650 # of chambers 32 IL BENCHMARK V.R.P. Top of iron pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL SYSTEM ELEVATION 97,0/96.7 4.8' below arade Vent >6„ Quick4 Standard Scale is F = 40' Leachin Chamber 276' Property Line of Cover with 20.0 ft2 of Area unless otherwise 4' Long 12" 5.6ft^2/pair of end caps noted 34' Grade at System Elevation All piping shall be SDR 30/34,within 10' of tank,piping shall be Schedule 40. 101' 100' 2-3' X 68' cells with>3' spacing B.M.* Pro 3 Bedroom B-1 House 0' 2% Slope 30' 129' Property Line 30' 40' ST 50' B-3 232' Property Line Vents B-2 74' IL 94' 153' Property Line Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end plates To be >1' above grade Finish grade elevation Typical Installation 100.81 t / Grade Vent 400 �, ��30/34 Septic Tank ,Sven 5' S' Long 1 3 6" Grade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 68 ' Cells Same on other end Observation tubeNent At end of cell A 16 chambers per cell B System elevations: A_96.0' B 95.9' ST.CROI K COUNTY SEPTIC TANK MAINTENANCE AGREEM9NT AND OWNERSHIP CERTIFICATION FORM "D Owner/Buyer pJ o v Mailing Address 2 O w �. Property AddreSS 52 5 0 CIS— r., (Verification required from Plamimg&Zoning Department for new ) City/State Parcel Identification Number L&G_CRUMON Property Location V.,Sec. ,T_Z Y N R.=�N,Town of�c� Subdivision Cerdfied Survey Map# ,Volume ,Page# Warranty Deed# ,Volume C� Page# Spec house (`yes Jno Lot lines identifiable( yam J no SYSTEM MAD=NANCE ANDS-OWNER CLRTMCATION I inper use and maintenance of your septic system could result in its premature failure to bandle wastes. Proper waintlenaace consists of pumpimg out the septic tank every three years or sooner,if needed,by a licensed pumper. What you part into the system can affect the famction of the septic tank as a treatment stage in the waste disposal system. Owner maintenance mobilities are specified in¢Comm.83.52(1)and in Chapter 12-St Croix County Sanitary Ordinance. The property owner agrees to submit to St.Croix County Planning&Zoning Department a catficstion form,signed by the owner and by a master plumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on4te 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. Vwe,the undersigned have read the above requirements and agree to maintain,the private sewage disposal system with the standards set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin. Certification stating that your septic system has been maimairued must be completed and retuned to the St Croix County Planning& Zoning Department within 30 days of the dm year expiration date. Uwe certify that all statements on this form are true to the beat of my/our knowledge. Lwe am/are the owner(s)of the property deemled above,by virtue of a deed recorded.in Register of Deeds Offica. Number of bedrooms Al. AT[7RI:OF APPLICANT � (S) DE ***Amy information that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department*** 1w1ude wif this applua Um a recorded warranty deed from the Register of Deeds Ofke and a copy of the certified survey map if whrence is made in the warranty deed. (REV.08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page _ of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity Ell l7 NA Permit# Septic Tan k Manufacturer 0 NA DESIGN PARAMETERS Effluent Filter Manufacturer - �L ❑.NA Number of Bedrooms ❑ NA Effluent Filter Model f' ra, NA' Number of Public Facility Units Pump Tank Capacity NA Estimated flow(average) aVda Pump Tank Manufacturer NA Design flow(peak),(Estimated x 1.5) �`� gal/clay Pump Manufacturer �+ Soil Application Raise / aUda /fti Pump Model NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit '' NA Fats,Oil&Grease (FOG) _<30 mg/L ❑Sand/G-avet Filter C1 Peat Fifter Biochemical Oxygen Demand (BODs) 5220 mg/L ❑NA 0 Mecharical Aeration ❑Wetland Total Suspended Solids (TSS) 5156 mg/L ❑Disinfection - ❑Other: Pretreated Effluent Quality Monthly average_,4 Dispersal 1;ell(s) 13 NA Biochemical Oxygen Demand (BODs) s30mq(L " . -Ground(gravity).] ❑In-Ground(pressurized) Total Suspended Solids (rSS) :530 µ ❑At-Grace O Mound Fecal Coliform(geometric mean) 5104 bfu/1066il," ❑Drip-Line ❑Other: Maximum Effluent Particle Size 3k in dia, . ❑ Na Other: -- — NA Other: -- ---0rNA Other. >�:._ • . NA *Values typical for domestic wastewater and septic tank effluent. Other: a �.' r-il NA MAINTENANCE SCHEDULE Service Event Service Frequency , ❑monthfs) Inspect condition of tank(s) At least once every: I— ear s� (Maximum 3 years)' ❑ NA , Pump out contents of tank(s) When combined sludge and scum equals one-third(Ya)of tank volume 0 NA Inspect dispersal cell 11 months s)s) At least once every: marts___ (Maximum 3 years) © NA — – — ❑months s) � NA Clean effluent filter At least once every: I 'D orth;_ Inspect um um controls&alarm At least once every: NA P pump, pump — 0 years, – Flush laterals and pressure test At least once every: 0 monthi s) NA _ _ O year(s� Other: At least once every: Q year hl s) NA Other: —i — – 6 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 Sery(Ing 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 or the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to chect;for any ponding of effluent on the ground surface. The ponding of eilluent 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 or more of ti ie 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 filters, mecharical 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 an!,service event. Page of START UP AND OPERATION For new construction, prior to use of the POW7 S'check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or darrage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s)removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill ab3ve 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 th(i 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 Frump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal ceps. Do not drive or park over, or otherwise disturb or compact,the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of 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 scrape.; 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 property 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 replacement system: -Q/A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. he replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure,lot lines and wells. Failure to protect the replacement area 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 limitations. Bamng advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to idetntify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following Rx moval of the biomat at the infiltrative surface. Reconstructions of such sys#oms 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 POWTS MAINTAI ER Name y`/ Name Phone �' Phone J `j 6� SEPTAGE SERVICING OPERATOR P MPER LOCAL REGULATORY AUTHORITY Name Name P �- Phone ' �� ... Phone 7�J 6, This document was drafted in compliance with chapter l3PS 383.22(2)(b)(1)(d)&(f)and 383.54(1),(2)&(3).Wisconsin AdministraWee Code. ;,,•�•_ '.'�► HLTER CARTRIDGE + y-r�w� uty�are ari>�r ,trlta t►r.ttnrl of tlw wltwtt pqe td etufura it i� tegtccted ttrcder ti,.aioce.nr grwnihq. ti'rat%tiara,witttwr blu'titt raorri plea itdte,stew track titttrttab*'W euNst tx eolnetct sand%%a)+edditluha4 Wpli unto Ow outlet Pipe. -Frp R While Um r+o"15"dry M11d Oil an wlll�et pJl►�,tnugdury tfw(wvytfi of ifi-bu3t pipe anrded to brace the Mhar to the bNt apd wall If utmulnll the epNotwl*Wpiehteatsi We t um ort•.if saint support Arrthad.ii but trtliind, proared to do fa s'vv.1*.a For M"Emottpaw iltowng d w aptkml wupphttt"WtaI"Supperr: seiuerct tw"W toe%'4hoh plea ou"a the WOO ca Nk- if slide support m6ma d iz hat Udk vd,pra"d U$NO tout. Ss V§M W6W the triter care tihta the nutlet pine. yhwvt tl"e Killer cad t idga into the Cessi IM1104ig doers►Wd the MINV boke Into the butilmt t,r ' We t.. y' if a VAS t WWI co-:UNiket,d: itreart brie the#Whcr Old lock by ttirm ig dod wir't qtr. 1 �t•.y,: Iwdlii11iC1! 1. Thtr effluent VIVM AWN be ciemhed ovary tiou the"ptlC t&Mt fu srrvirefti. 2- Obeh the outlet ROOMS ap,rr,Nru to inspect the tank atld Mtar " S. pump the raptic tetck Ocaft mbely,r ukhg antra to recreate the siudpa laver tm the home"or the tank and not jtu*the*man Mail*MUSIA. ,u 8. Orit:e tits uAttwrct hrvet has bison lowered bub w tht:invert of tho t trutlet pipe,fitpdy pull up eh the"nor huruiie to dfdasige tier cbrt*hm frmgr the craw. w• 5. Slide tine rarWdga rip aid at it of tier C"m fta•t lnbng, S. t/a VAS swfth tanheeted to an Warm Is pr+asd,the sw#,ah sliuuW be rmnwrod by stunting raoht"Vdvdtwtsa W'tllid rlr mood with w*er only. + %. Whitt:holding the cartrWe ore Ns ridtt(large ftt utter:,*W facb,e down)owltlt•the avam op"I&Wkse Clothe W"Us with wbtrfr mAy,mining wire alt amptagt,hvWMlet is dn"d bards Into tha tank. +t�rt.•.'x ` a. if VAS,Switch Is uttd M,replace by IwaeMft iota tthm.and _._._�. �.•, tuts ing dackw ce tom. 9. lbs5ett Ntrs War cartridge bark iniw the acre,pears*domm.uwll a y. ,.. tfte Hlter leeks Into the boNorn of Nrr cress. "w W.Rwplate WW seem the intros ttp"10 stn the IMpit. . W ir••ai..v.;•'.o f:`YK;4N G'RLi14td •1,4.ut A."t IMGt'iJ:W;440f1:•r,. WWW.boarommit exam 9"-WMLT9*S(6534S03) /2 � . Apr 0914 07:14a p'2 Ll I II N'd ,�,• a T-W .Y.IIT a A' 3333 » b r 'QY Yd rd M1c lrY 11• °ilela+o�vrn .. wins i i � 4 � mot• 4 i I A T_W Y a r 1 '6•d • C I I a3 r'ee A° 4 � I r b=1P 1 �zr �I 4 � r 4� R 6r x• t-0•' :id sl'r 4 i0a; ............. 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"' N 1 z �� 1.00 Ac. �" \ 00 (jo 9 1 i n 39.43' 23.15' 114.31-— N 88'20 09 W to _ _ 153.74' n \ " `° N 88.20'09" w "�' �OT \ LOT 9 50'\ 1 \\ 2,98' C r� \ 43560 S.F. \ 1 1 \ \\ —153.64—— \ h I 917 I �� C�� \\� \ 1.00 Ac. \ _ 1 4o'! : U. 2868 P 044 4B Pz3598 �l KATHLEEN H. WALSH REGISTER OF DEEDS WARRANTY DEED ST. CROIX Co., WI DOCUMENT NO. RECEIVED FOR RECORD 08/16/2005 02:00PH WARRANTY DEED This Deed made between CORNERSTONE EXEWT # PARTNERS,a Minnesota limited liability company, REC FEE: 11.00 Grantor,and DELTA CONSTRUCTION,INC., a TRANS FEE: 3120.00 COPY FEE: Wisconsin corporation, CC FEE: PAGES: 1 Witnesseth,That the said Grantor conveys to Grantee the following described real estate in St. Croix County, State of Wisconsin: RETURN TO: TVA' ; (Ua3 t&(a Lots 1 1 )inclusive,Plat of Cottageeadows in the Town of Troy, t. Croix County,Wisconsin. This is not homestead property. Tax ID# 040-1014-20-000; Together with all and singular the hereditaments and 040-1014-50-000 and g 040-1015-80-000. appurtenances thereunto belonging; and Cornerstone Partners,LLC warrants that the title is good,indefeasible in fee simple and free and clear of encumbrances except easements,restrictions and reservations, if any,of record. Dat th day of August ,2005. CO TONE P HERS,LLC (SEAL) Its: AUTHENTICATION ACKNOWLEDGMENT Signature of as STATE OF WISCONSIN ) of Co Lartners, )SS LLC authenticated this day of August Wh �r4i, COUNTY OF ST.CROIX ) TITLE: MEMBER STATE BAR OF WHO'�I fIV }. .O*% above onamede before me this 15 t�ay of August,2005,the (Signatures may be authenticated or ackftdged. BdJQare not _ of Cornerstone Partners,LLC,to me necessary) CJ = known to the person who executed the foregoing instrument and acknow d the same. THIS INSTRUMENT DRAFTEi$NA"' . . 'G03 D.Peter Seguin ��i,,F OF W�`' MUDGE,PORTER,LUNDEEN&SE t� 110 Second Street,Post Office Box 469 Notary Public,State of wilco M-11-2005' My Commission(expires): Hudson,Wisconsin 54016 �77".-I Wisconsin Department of Comrneroe REWVfiQLUATION REPORT Page / of 3 Division of Safety and Buildings in a cordance with Ac m. Code _f'�`Jl ` s) v Ro Attach complete site plan on paper not less 81TLX11 iKd�es t 5T. G 1 X 0 Sim Include.but not limited to:vertical and Pa I�D _ Percent slope.scale or dimensions.north ar $rid de t ZONING OFFICE— Reviewed y Date Please print a e[rvr. X Personal Wonnation you Provide imay be used for secondary wpm WdvaW Law.a.15.04(1)(m)). �U Property Owner Property Location -To D t� 8(J e e 6Tei>T Govt.Lot Nib 114 51A11/4 s T 2 N R ICI E olj® Property Owner's Mailing Address lot Block# Subd Name rcaM 3R2 MA N4 CT co77 - M s1,bo City State Zip Code Phone Number O City ❑village ®Town Nearest Road J-f vD50n/ wi 1 5y-ON6 t 7ROY 50118VAO &P ® New Construction Use:® Residential/Number of bedrooms S-5 Code derived design flow rate "I 5 O- -7 50 GPD 0 Replaoarr eM ❑ Public or cornmerdal-Describe: _ Parent material LD£✓5 62 O✓rW/yS H Flood Plat,elevation If applicable fL General comiments and Area Spo t Tested suitable for � — S L P. a conventional inground system(P.O.W.T.S.) F] # ° 110 3 © Pit mound surface elev. •d rl. Depth to Writing fador> 4� ti►. Sod Application Rate Horizon Depth Dominant Color Redox Oesaiption Texture Struchxe Consistence Boundary Roots GPDW In. Mtmsed Qu.Sz. Cora.Color Gr.Sz Sh. MWI -EW2 1 0-12 I0YR `'ll - :e 2-f,5 r mfr C-5 3 .!p 2 12-2(o IDVP.4/q. - 5C l 2rn5bK m I cL 5 2v4 `t .4v 3 26-37 Ivlriit-5 14 0 Scj M t a i 1,/f .—t 1 . (v �t 3-1-U IVYRS/-t , 5 0 SCI ot t — •"7 t to 5 - F UND 1 F GKCr L -2 F 2 # ° >97 in. ❑ Pit Ground surface elev.�L ft. Depth to limiting factor Sod Rate Hortmn Depth Dominant Redox Desaiption Texture Structure Consistence Boundary Roots GPDW In. Munsed Q L Sz Cont.Color Gr.Sz.Sh. -Eff#1 TIM 1 0-12- I vyR 2l2 2 2-f sbK mfr C5 3v-E . 40 . g 2 /2 -47 10 yx 5ldt -' 50-1 2 w!5bK ffifr 0-i Z v1{ -4 !o 3 7-97 22e sia — I S 055 1 - - -7 1•(p �D Etliusint#1=SOD >30<220 ntglL and tW>30<150 mg& •Effluera 02=BOEk 130 mg&and TSS<30 mglL CST Fyne(Please Print] Sigrtatrre CST Number En) Y (A 1--F3R Ili H 'T p'59934 Address Date Evaluation conducted TelePttorte Number 20/2- !0-o A vv- 5PR/Nt' V4 t-tEY MAy_io-zvof (7/_5J-,-7Z-3-5V+2_ For issuance of permits and designing Contact:Ulbricht&Associates Registered private wastewater consuftatttodphr d= Ulbricht &Associates 2812 10th Ave. Private Sewage Consultants Spring Valley,WI 54767 2812 10th Ave. 715-772-3442 Spring Valley, Wl 54767 .�x XI; �J�i25T�L DT �D�'�'RCa� phhg: 3 vF 3 A4FAoo WS Lod' /3 = ewnQC to AO%A Y..(PAM) A = Coa Tbvtz Utbritht ewageCaensultants ter;vats Sewage 2812 1 Oth Ave. 54767 String ValtrlV, For issuance o ermits and designing Contact:U 'icht&Associates Regis ed private wastewater consult Bed PkFfiM 10th Ave. Spring Valley,Wl 54767 160'r} BM f/2,u 5 iE T t P 715-772.3442 �� II Ali 1 Dj• �� q q•`73 g M I= too.oo loo' F33- 1 q•7 40� / F3a /0O•?9 lo' � ry �JA -- /Der N � 4 � 15 � � r A r E:\300-399\310-002\F!,o1 plot\310-002_FMAI_PIAT,dwq,6/14/2005 4:23:04 PM,1:200 i ilia, z F Z pt 167 9 A § C wn aT.x.aeg O IN � A d o ro � a z v,z a u I Pam I p¢p¢ g@g@ E tv x LANDS I S 02'41'23"W 737.68 UPLATI-0 LANDS $ 206.8 3Q F ag _ 6_ eZ fl1 Ag R q d H I —\ Z{-——322,098'—— 208.74' —— iox" 181 c �N\ A/ W/eti4 \ rN/ i' w' �"ISA€Al°ac �a I= ?J.\ �. .� / I €€ 88848 y y .; gS�b a "> r 18 1 r Id FA � D 41 8�• 1 1 ?�� ` ® >%8 $*Oy ic EDI/E Ig eels�T� —0 O \F! I \\� p0 �S�.L� S 02'41'23.0"W 416.99 a �I S318VA L \\'-- �\V \1 ,f£,LC•L4 N 265.41' 751.58' 1� OULOT 34m�e���� M 96 NAOC l _j II IIo g 9�6 40130 S.F.0O1°A110100g `� I y0�y g9N EASEMENT :1 4' ,9L'f91 M 0.92 Ae. wv4..nun yr sg.NW M60• L9.S_---•B9'Oel-- N z w vl,.o m ,G£'4L£M,AO,S£,90 -——— _-------437.05'_-------- 8 ,96'OfZ-_-_ O N 01'28'44"E 480,03 p L9'66ZM "49,42.40 D °w-u+J Ito q �" -- ---'— ----_s z SOLBERG -- S 01'29'24"W 579.16 0 --N—_—_---m N _w I I�17 t –129.92'-- S 09'3- (n F E 09 a 1 306.83'----- 6800 77.41�� 29 W20 N 1 --_ 4• 8 S 00'07'20" W 367.38' I zm O = _ N09'37'?B' ' --------283.87'-----_-93.71, I�?v>i I 9 3 2 pap _ �3 ,Yo 02.9' � � w l I a m --3 i �YI?� � I 8OT1�__ \•.�. PIyz zlrn�\ I Izrn Ns /+ TCn i N rot N I T' t. Z (, D' 1 � 6 E � m V J f• 0. / ? 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