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040-1296-60-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 569550 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)]. y� Permit Holder's Name: City Village X Township Parcel Tax No: Schumann, Glen &Cynthia I Troy, Town of 040-1296-60-000 CST BM Elev: Insp.BM Elev:I BM Description: Section/Town/Range/Map No: D ' 0 /" - C'-J) - C� 19.28.19.1708 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION 13 HI FS ELEV. �t S •S f Q Septic /t� �- / 2�� Benchmark �� �. /ate Dosing c��11 "' ,�4/j Alt. BM �,•a y l t` '7 , 07 Aeration v J Bldg.Sewer j >G47 3 76-5- Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WEB BLDG. Vent to Air Intake ROAD Dt Inlet f� Septic •'� / Dt Bottom. Dosing Head /Man: Aeration Dist. Pipe/. c� Holding PUMP/SIPHON INFORMATION Final Grade r -t Manufacturer I ") d St Cov GPMr I k►� n a�< <t 3 : 17 , -7 Model Number ` 7 66--�J r 71 41 . lTDH Lift Friction Loss Syste Head TDH �,Ft / Forcemaih Length Dia. , Dist.to Well L s�C SOIL ABSORPYION SYSTEM BEDITRENCH Width Length jNo es PIT DIMENSIONS No.Of Pits Inside Dia. Liquid Depth DIMENSIONS � <..( (q) 6, I . SETBACK SYSTEM TO P/L_N 1BLD IWELL LAKE/STREAM LEA ING Manufacturer: INFORMATION CHAMB OR 7 Type Sy tem: Model Number: �7,vr}c > � scam^ DISTR SYSTEM �t2n = - He er/Mani C/�, Distribution �. x Hole Size ole Spacing Vent to Air Intake °<{e f 'r Pipe(s) �� J // P / v - c / Length_Dia r ,s Length & Dia ( '� Spacing if b p SOIL COVER x Pressure Systems Only xx Mound gr At-Grade Systems Only - 1 x� Depth Over Depth Over xx Depth o reeled/Sodded xx Mulched �C1 Bedlrrench Center Bed/Trench Edges t� ,, r� G tr / Yes 0 No Yes L No COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: -7 / �'t' Inspect�6�,#2:-/ 2�/ t Gti�se.Q.� low �J�✓ �� Location: 381 Mitchell^R�d;Hudson,WI 54016(NE 1/4 SE 114 19 T28N R19W) Trebus Valley Estates Lot 1i Parcel No: 19.28.19.1708 1.)Alt BM Description= 1 a 10 2.)Bldg sewer length -amount of cover= -/ i,� ii / %t e1 ,7,< ,.. �C�� - i I4 G• u�.t,t].:�- � �v (.t;'f J J��C'-{'"a,{. yam, / G1'�.�t�°E�� T — — -- ----- --- - , i Plan revision Required? Fas] Yes No , , ) /� r Use other side for additional information. _�L A SBD-6710(R.3/97) Date Insepctor's Signatur Ce, i f Kb < 'E lie +. � et saf*and Btdidhtgs DM" 4 201 W.Wasltinp w-Ave..P.O.Box 7162 Sanitary Permit (tobefIlhdisbyco.) Nladson,WI 53707-7162 TO CPAID ermit Applic cm Stfe Tlamacfim Numba c G u Ads Code, of this Eon am ae appru�e � Z n earn sps:�,� i. ILZI q2— is a sauiwy penwK Nom Applies imm for sbja-owned POW M are sebm tW Prayax Addtwsa(sf ae tbau add: ) the Dcpwftuwt of Safdy and POhwomt S xvmm Perso®al yon provide mmy be used for pu inw8h*e PfiVICY> is. Ixml SIatL L lit4tio2 hdormim m— All Information Property Ownees Name U, ftope"0wwesMaihWAAM= Property Locatim 76 Y BYO - et 41, GovLl.at C city;Soft zip Cc& PhoncNmnba NE v, 55 sew,J WCO p V N► N 551 T—rt R1� IL Type of Building(check all that apply) " P(l or 2FinailyDwellbW—Number ofBedi)oms 4 Sbbdivisiontlaw 6k. ezb Block# ❑ DestaibeU- o r"Cl 10.r• ❑C, ❑Stao 0�wae•d—De CSmN� ❑❑viw of Town a£� ���I� J JG ;<- JIX M Type of permit: (Cheek only one bm on line A. Complete line B if applicable) A. ,$Ntw System ❑Rcpt Systcm ❑Tmam=WHdftg Talc Rgdwmmutt Only ❑0t wmwkMoa w Syst—(—PI-) B. ❑Permit Renewal ' Revision ❑ of Plmmber ❑1?a®it Treosfs m New Lid previous perms Numba and Date 1Su Before FxpaWim - Owner W.Type of PUWTS S asgtlDevice: Cheek all that a °✓ , ❑Non-Pr kWmated ❑Promwiad ia-Gcound ❑AACaade >2a m.of ode s1 ❑lid<2a i/.a£ e Iw5 ❑Holdit gTanlc 00dwrDup=uiC0ffVo0mdII ❑Pammuncmit Devito I7, eat Area Information: Ares p T191 pevffiion Design Flow( Dew,soil o a�VL Tank fo C7 in Total #of Calm Crdlians Units N-wTawm F�gTasts $ i v o< Tit Imp 2 > VII.Responsibility StatemeRt-I,the aadc�s+gacd,s us respeos�ity for ios�H=tion of the 1'OSYI S shown 2ttarl 11 17�� Plumbers Name(Print) Pluurber's S' Business phone N- 2 1 Z.z. Z Z, 715- 7 y(,l plumWs Address(Stye Cm,Stag Zip Cade) �?0, VI1lL!Q0natyfDe rtment use Only _ Pamit Fax_ Die Is�ti� slmnedm Rtalsat for Denial UL Co, ns for Disapproval C re. 1. 7ffieptie tank afftIbAt ke-r I ghd' . 3 GO,�c •,fi uyw U ti �7 PAM d d4&salCeirnuSf all be services f<Priairita l rJl �r"� +'`, LI as per rxianegement plan proviclid W. by pin z: as� a�io n 4 a `&4 &Der to osdpieft plums far the syneee aid to fire csamF only os p aotLss : to s:s 56 i SBD-6398 R 11/11) , -z' ( l'aa.. new �. JEFFERY V FOX Page 2 7/17/2014 Limit activities in the area 15'beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(1).Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia andorf Please Include a Copy With Your POWTS Plan Review tegrated Services Payment Submittal. (715)634-7810, Fax: (715)634-5150,M-F 8:00 a.m.-4:45 p.m. WSMART code:7633' pat.shandorf @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 "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. otipARTN�hj DIVISION OF INDUSTRY SERVICES stir O� Yl 9 10541 N RANCH ROAD HAYWARD WI 54843 3a Contact Through Relay www.dsps.wi.gov/sb/ 9 �G� www.wisconsin.gov A w �O sSION��S� Scott Walker,Governor Dave Ross,Secretary July 17,2014 CUST ID No. 223242 ATTN.•POWTS Inspector JEFFERY V FOX ZONING OFFICE JEFF FOX CONTRACTING&SEPTIC INC ST CROIX COUNTY SPIA PO BOX 565 1101 CARMICHAEL RD DRESSER WI 54009 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 07/17/2016 Identification Numbers Transaction ID No.2421921 SITE: Site ID No. 800779 Glen&Cindy Schumann Please refer to both identification numbers, Co Rd F above,in all correspondence with the agency. Town of Troy St Croix County NEl/4, SE1/4, S19,T28N,R19W FOR: Description:Mound,4 br res Object Type:POWTS Component Manual Regulated Object ID No.: 1477198 Revision;Maintenance required; 600 GPD Flow rate; 32 in Soil minimum depth to limiting factor from originalADITION System(s):Mound Component Manual-Ver.2.0, SBD-10691-P(N.01/01,R. 10/12),Pressure Distribution Com Manual-Ver.2.0, SBD-10706-P(N.01/01,R. 10/12), SSWMP Pub.9.6; Effluent Filter APPROV DEPT OF SAFE The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative C1g %FESSIONAL and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constrcOF and located in accordance with the enclosed approved plans and with any component manual(s)reference'. The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.14 stats. SEE CORRESP The following conditions shall be met during construction or installation and prior to occupancy or use: Key Item(s) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans.In addition,the owner must insure that the operation,maintenance and monitoring duties as described in section VIII of the mound component manual are complied with.A copy of this information must be given to the owner upon completion of the project. • This approval is for a revision to previously approved Transaction number 2385002. The approved changes are: the location of the septic tank/pump tank has changed and the location and configuration of the dispersal cell has changed(see plans). • The bottom of the distribution cell shall be level per the Mound Component Manual. The"D"dimension shall be a minimum of 6". The maximum finished slope of the mound surface shall not have a slope ratio steeper than 3:1 per the Mound Component Manual Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. JEFFERY V FOX Page 2 7/17/2014 • Limit activities in the area 15'beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(1). Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricia andorf Please Include a Copy With Your POWTS Plan Review tegrated Services` Payment Submittal. (715)634-7810, Fax: (715)634-5150,M-F 8:00 a.m. -4:45 p.m. WiSMART code: 7633 pat.shandorf @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 "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. e MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Glen S Cindy Schumann Owner's Name: Owner`s Address: 3340 Richmond Ave Woodbury MN 55129 Legal Description: NE1/4 SE1/4 S19 T28N/R19W Township: Troy County: St. Croix Subdivision Name: Trebus Valley Estates LLY Lot Number. 16 Block Number. "D TY AND Parcel I.D. Number 040-1296-60-000 SERVICES Plan Transaction No.: RY SERVICES Page 1 Index and title Page 2 Data entry Page 3 Mound drawings )NDEN Page 4 Lateral and dose tank Page 5 System maintenance specifications Page 6 Management and contingency plan l Page 7 Pump curve and specifications Page 8 plot plan Page 9 soil test Designer. Jeff Fox License Number: MPRS 223242 Date: 06/19/14 Phone.Number: 715 755 2461 Signature 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 Mound and Pressure Distribution Component Design Site Information R Residential or Commercial Design Note: sand fill(o)calculations assume a 400.00 Estimated Wastewater Flow(gpd) Table 383-44-3 in-situ soil treatment for fecal coliforrn of-36 inches. 1.50 Peaking Factor(e.g. 1.5= 150%) 600.00 Design Flow(gpd) 7.50 Site Slope(%) 96.44 Contour line Elevation (ft) 36A&Depth to Limiting Factor(in) 0.60 In-situ Soil Application Rate(gpd/ft2) Distribution Cell Information 67.00 Dispersal Cell Length Along Contour(ft) _ _ 896 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? e Center or End Manifold 2.99 Lateral Spacing(ft) If N above, enter the elevation (ft) M 3 Number of Laterals of the highest point. 0.156 Orifice Diameter(in) 2.75 Orifice Spacing(ft)= 8.34 2/orifice 2.99, Forcemain Diameter(in) 40. Forcemain Length (ft) Does the forcemain drain back? Y 91.00 Pump Tank Elevation(ft) 4.55 System Head(ft)x 1.3 6.52 Forcemain Drainback(gal) 5.53 Vertical Lift(ft) 90.22 5x Void Volume(gal) 1.2 n Loss(ft) 96.74 Minimum Dose Volume(gal) In-line Filter Loss(ft) 38.77 System Demand(gpm) 11.33 Total Dynamic Head(ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in. dia. options choice 0.75 1.25 1.00 1.50 x O 1.25 2.00 x 1.50 x 3.00 2.00 x 3.00 x Gallonsiinch Calculator Treatment Tank Information Total Tank Capacity(gal) 1250.00 Septic Tank Capacity(gal) Total Working Liquid Depth(in) Wieser Manufacturer ��gaVin(enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity(gal) Lifetime Filter Manufacturer 22.24 Dose Tank Volume(gatrn) 01/08/14 Filter Model Number Wieser Manufacturer Project Glen&Cindy Schumann Page 2 of 9 Mound Plan and Cross Section Views - 1/10 B © J Observation Pipe - S �—K — O Q A L Mound Component Dimensions 8.96 E 14.06 in H [E4.39 00 K 7.88 67.0 F 9.50 in z 54 L 82. D 6.0 in G 0.50 J W 22.8 600.32(ftz)Dispersal Cell Area 1 1239.28 (ft2) Basal Area Available 8.9 (gpd/ft) Linear Loading Rate 1 6.70 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 98.73(ft) H :p G = F Dispersal Cell 97.44(ft) Lateral 96.94(ft)--►� — Invert Dispersal Cell 0. Elevation E D ®. 0 96.44(ft)Contour Elevation 7.5%Site Slope Geotextile Fabric Cover Shading Key 4 in. + Dispersal Cell See lateral details on Q Topsoil Cap s a. 1.5 ft Page 4 for number,size, © 0 Subsoil Ca © � and spacing of laterals. p d 0 Q 1 Laterals are equally © ASTM C33 Sand obse �— / F spaced from the ® � Tilled Layer rvati 0.5 ft Typical Lateral p © distribution cell's © 0 Aggregate on centerline in the PrPe Imo_ distribution cell(AxB): A Project: Glen&Cindy Schumann Page 3 of 9 End Connection Lateral Layout Diagram Ceroer 0,i? the A is Edirr,ension 0=Turn-up -,r-I-manoutpluq P AH I i,,ef A a—t-J�wic a[ X Hot es drilled or,rf,e br,,rorr.ot t�c-I yr—j.1 3`7' S Later a[ for c ern-ain Sr h 40 Pl..-,-_pe. S P'S Table 384 30-6 F Number of Laterals 3 Orifice Diameter 0.16 in Lateral Diameter 1.50 in Orifice Spacing(X) 2.85 ft Lateral Length(P) 65.59 It Orifices per Lateral 24 Lateral Spacing(S) 2.99 It Orifice Density 8. Lateral Flow Rate 12.92 gpm Manifold Length 5.97,ft System Flow Rate 38.77 gpm Manifold Diameter 1.50 in Total Dynamic Head 11.35ft Forcemain Velocity ----3-9-6-Wsec Dose Tank Information Locking cover with warning label and locking device and seated watertight Electrical as per NEC 300 and SPS 316.300 WAC 4 A Tank component is p AXate outleet location f Forcemain diameter Wieser Manufacturer 2 in. Capacity 800.00 Gallons Volume 22.24 gal/inch Weep hole or anti- Dimension Inches Gallons Siphon device A 18.72 416.36 B 2.00 44.48 Pump off elevation(ft) C 4.35 96.74 91.911 D 10,90 242.421 r—Total 35.97F-800.001 Dose tank elevation(ft) 3"Bedding under tank. 91.00 Alarm Manuafacturer Septronics Alarm Model Number MJJ1 Pump Manufacturer Zoeller Pump Model Number BN152 Pump Must Deliver 38.77 pm at F-71-1.-3- ft TDH Project Glen&Cindy Schumann Page 4 of 9 Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer X,"v ' = Pump Manuhcu= 7. r,t,l C Y Tank Model Number �c; Pump Model Number L 'v j:Y _Z- Total Tank Capacity Alarm Manufacturer Max.Bury Depth t t Alarm Model Number k)6('�d i� Switch Type Filter Manufacturer �._`- r Total Dynamic(lead(MR)-Feet � Filter Model Number ' Elevation Head Distal Pressure Network Loss Minimum Pump Performance Required Force Main Loss GPM (a? I Ft TDH Total Outlet Manhole Min.C Above Grade With Manhole Min_4"Above Grade Locking Device. Inlet Manhole With Locking Device <6"Below Grade Sealed Watertight Securely Mounted _� Weather-proof��, 1 Junction Box �. Finished Grade ... .. — ♦�j .-. T Depth of Cover Vent Min. 12" Disconnect Above Grade Means Ft With Vent Cap <'<'< '�'�'<'<'<'<'<'<'<'<'<'t V L1Uet s` Outlet Filter _-- Inlet ?:} -- Inlet Baffie ---- - ,,---- } A a ;t Switch Settings and Reserve Capacify ;; ti 'i /4>, '= Tank Volume= GPI �` Weep Hole Dimension Inches Volume Gal_ B } {reserve}A 1P. >` (alarm) B 2 off Elevation _ C as t < Ft ' < (dam) C . - `l� ;< Bottorn >�} {dead} D i� r , Y '� D r` Elevation T `� > i a - �' 7' 3 > ! > �t < Total � > }`3 , 3 3 3 a S s t!t>< 3<}<3 t t}t3< < < t'i < t i < < <a< <a<>t! !> > GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer maY not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device(padlock) installed. Piping at the inlet and outlet is of approved material,connected to the tank with watertight fittings,and laid on stable soil to prevent settling or sagging. Tle force main is sleeved with C Scb.40 PVC to bridge the tank excavation and the sleeve is sealed wafexbght Electrical service complies with NEC 300 and Comm 1628 WAC. 02/05 LJ Page of Mound System Maintenance and Operation Specifications Service Provider's Name Jeff Fox Phone 715 755 2461 POWTS Regulator's Name Pierce County Phone 715 273 6747 System Flow and Load Parameters Design Flow-Peak 600 gpd Maximum Influent Particle Size 118 in Estimated Flow-Average 400 gpd Maximum BOD5 220 g/L Septic Tank Capacity 1250 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600.32 Maximum FOG 30 mg/L Type of Wastewater,Domestic Maximum Fecal Coliform > 4 100 mL Service Frequency Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested eve 1.5 years Moundl 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 ZI Grade 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box . . . . Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: Glen&Cindy Schumann Page 5 of 9 Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General This 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. 10112))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 POWTS components. Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,Slats. The contents of the septic tank shall be disposed of in accordance with NR 113,Ws.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 fitter is equipped with an alarrn,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. Afl 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. Coll 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 BODS,150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS,30 mg/L TSS,10 mg/L FOG,and 10"cfu/100 mL for highly treated effluent. influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral,and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice dogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,and any levels above 6 inches considered as an impending hydraulic failure requiring additional,more frequent monitoring_ Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank,pump,pump controls,alarm or related wiring becomes defective the defective component(s)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. 06/16/02 } - --- WD/FLOW TUfPJL { t, r • ;mot•,. CURVE G 3' AND moms 151 52/ 53 151 152 153 20 69 20 77 2M 40 233 IP 70 265 .212 To 3-1 61 7AIk w 7A 3ml 53 tg7 52 197 20 159 Ift rmm 34- 125 25 23 87 33 ILI 22 as ap 35 42 40 IL fit 44 IL 10 IL r., c ^�i ` t t :�.�. t t - Rod pa wean tW ; • n two an slow ale 32 aq t � �7 in I 43 1 218 0 no ma b S3 - , !: c ,r f' l! - bad vl :J `tom i 17 `�'`' 'ter ',;� 2 S` �`•. v� � ,� '; / /f t 1 _ 1 <� Jj t , i I C r SOIL EVALU f4W WP.Q @ #1215 ' ar Department of Safety and Professional Services Page 1 of 3 Division of Safety and Buildings � i '} Keith E.Stoner in accordance with Comm 85,W' . Attach complete site plan on paper not less than 8%x 11 inches in size. County include,but not limited to:vertical and horizontal reference point(81 (, p CCU St.Croix percent slope,scale or dimensions,north arrow,and location and disY�ritlC TfdateL . Please print all Information. Personal information you provide may be used for secondary purposes(Privacy Low,s.15.04(1)(m)). Rev 040-1 Date Y::;� 1 2 Zl / Property Owner Property Location Glen&Cindy Schumann Govt.Lot E114, EI/4,S19,T28N,R19W Property Owner's Mailing Address Lot# Block# I Subd.Na4 or CSNW 3340 Richmond Ave 16 1 Trebus Valley Estates City State Zip Code Phone Number City ❑Village ® Town Nearest Road Woodbury 1 1 551291 Troy 1 381 Mitchell Rd ®New Construction Use: ® Residential/Number of bedrooms 4 Code derived design flow rate 600 GPD F]Replacement El Public or commercial-Describe: Parent material Silty Alluvium Flood plain elevation,if applicable NA ft. General comments Propose a 9 x 6T mound cell located along the 96.44'contour with a system elevation=97.W. U pslope mound contour staked and recommendations: onsite. F-11 Boring# ❑Boring , ®Pit Ground surface elev. 95.02 ft. Depth to limiting factor 36 in. ISoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. •Eff#1 *Eff#2 1 0-4 10YR3/3 - sit 2mgr mvfr Cs 3f-co 0.6 0.8 2 4-14 10YR3/4 - Sit 2msbk mvfr gs 3f-co 0.6 0.8 3 14-26 10YR4/4 - st 2msbk mvfr gs 2f-CO 0.6 1.0 4 26-36 10YR3/2+3/4 - Sit lmsbk mvfr gs 2f-CO 0.4 0.6 5 36-42 10YR3/2 fif5YR5/8 sit impl mvfr gs 2f-m 0.4 0.6 6 42-65 10YR4/4 - sil 1-2msbk mvfr - if 0.4 0.6 F--� Soil field capacity at 42" 2 1 goring# ❑Boring ®Pit Ground surface elev. 97.39 ft. Depth to limiting factor 32 in. ISoil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. -Eff#1 I *- 1 0-7 10YR3/3 - sl 21 gr mvfr Cs 3f-W 0.6 1.0 2 7-23 10YR4/4 - Is Osg ml gs 3f-co 0.7 1.6 3 23-32 10YR3/4 - sl 2msbk mvfr gs 2f-W 0.6 1.0 4 32-52 10YR3/3+3/4 fif5YR5/8 sit impl mvfr - if-W 0.4 0.6 'Effluent#1=BODS>30<220 mg/L and TSS>30<150 mg/- *Effluent#2=BODS<_30 mg/-and TSS<_30 mg/- CST Name(Please Print) Signature: CST Number Keith E.Stoner 22459 Address Keith E.Stoner Date Evaluation Conducted Telephone Number 23220 Wood Creek rd.Siren,Wl 54872 6/42014 715-653-2324 SBD4330 fR 11/11) f Property Owner Glen&Cindy Schumann Parcel ID# 040-1296-60-000 Page-__2_of 3 a Boring# ❑Boring ®Pit Ground surface elev. 95.74 ft. Depth to limiting factor 44 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fts in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. `Eff#1 "Eff#2 1 0-9 10YR3/2 - sil 2msbk mvfr cs 3f-co 0.6 0.8 2 9-19 10YR3/4 - sil 2f-msbk mvfr gs 3f-co 0.6 0.8 3 19-34 10YR3/2+3/4 - sil imsbk mvfr gs 2f-M 0.4 0.6 4 34-44 10YR4/4 - sil 2msbk mvfr gs 2f-oo 0.6 0.8 5 4456 10YR4/4 f2d5YR5/8 sid 2msbk mvfr - 2f-m 0.4 0.6 Soil field capacity at 42" ❑Boring Boring# Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. •En#1 -EfW2 ❑Boring Boring# Pit Ground surface elev. It. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft= in. Munsell Qu.Sz.Cont.Color Gr.Sz.Sh. 'Eff#I •Eff#2 "Effluent#1=BOD?30<220 mg/L and TSS>30<150 mg/L 'Effluent#2=BOD5<30 mg/L and TSS<_30 mg/L The Department of Safety and Professional Servicese is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,contact the department at 608-266-3151 or TTY through Relay. � . H bd bd bd M ' II W pd ''a w N . C o0 bC 0 II II II u, cb o C - ;o B b f � fb z � vo 0 a ,(b 0 b A O° A b r a �• o '( in a O / R) y N � oN. mZ• o o CN t/1 y o �l rr 'i S' A� A � C c A u O Safety and Buildings Division connty�r I C(�t�6 201 W.Washington Ave., P.O. Box 7162 Sanitary Permit Number(to be filled in by Co.) cvn Madison,WI 53707-7162 ^( y Sanitary Permit Application State Transaction Number In accordance with SPS 383.21(2),Wis.Adm.Code,submission of this form to the appropriate governmental unit 5 d�� is required prior to obtaining a sanitary permit. Note:Application forms for state-owned POWTSd to Project Address(if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide m �dory r r Gpurposes in accord�ance with the Priv acy i Law,s.V 15^•.0/4 V 1 (i m),Stat�s. I. Application Information-Please Print All Information ./1 *ro` NJ��✓�j g" ��V\ t W•�""}"j���_ e. / Property Owner's e c D /Z.?toO-b O 0 7 QV � Property Owner's Mailing Address ,� OF 0� Property Location y�p �� PIA-1 Govt.Lot 6 City,State Zip Code Ph6de umber /v 1/4, Section JI_ /\A I �5'� fl (circle one) Z� N; R� E o _ Type of Building(check all that apply) Lot# T 1 or 2 Family Dwelling-Number-of Bedrooms Subdivision Name /� ❑Public/Commercial-Describe Use 6k �D Bloc ( rJVJ V L ❑ City of ❑State Owned-Describe Use CSM Number ❑ Village of I -' ,,/� 19 Town of�l� 9, Zy � 5 / )Io -Z (� III.Type of Permit: (Check only one box on line A. Complete line B if applicable) 17 X A ew System ❑Replacement System Treatment/Holding Tank Re la m ly ❑Other Modification to Existing System(explain) List Previous Permit Number and Date Issued B. ❑Permit Renewal ❑Permit Revision ❑Change of P b it Transfer to New / Before Expiration W.Type of POWTS System/Component/Device: Check all that a d ❑Non-Pressurized In-Ground ❑Pressurized In-Ground ❑At-Grade wNfound>24 in.of suitable soil ❑Mound<24 in.of suitable soil ❑Holding Tank ❑Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersal(Trea ent Area Information: a, Design Flow(gpd) Design Soil Applicatio)Xate(gpdsfl Dispersal Area Require if) Dispersal Area Propo 1,d(s System Elevation j VL Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units a 2 o u New Tanks Existing Tanks Septic or Holding Tank ;` C� G✓ "J Dosing Chamberj`� VII.Responsibility Statement- I,the undersigned,assume responsibility fo installation of the POWTS shown on the attached plans. Plumber's Name(Print) I P ' ' e RS ber Business Phone Number �F� ,fix 2 23z• Z 71-5-755. Z Y b Plumber's Address(Street,City,State,Zip Code) VIII.County/De artment Use Only pproved rsappro Permit Fee rven Reason for Dem (�25 °a Da su�ed �`� Issuin ature $ V41 IX Condrti�$ Weasons for Disapproval 3 t!D •��S !A. w�a t ',V*l0'tank,effluafit AW V4 a• t.` dispersal cell mutlt all be secvtces/mainta cted t�� W t-t.�► Q.r �'`': as perlrtamagement plant peQ*0ei1 by plurnlor. ..;{1htl l l i3trlertt�,tt net be t aiMa�in �) /Uo e.A-• oG 5 S te•+.— as pu ippNoW4t at�tt��• / Attach to complete plans for the system and submit to the County only on paper not less an 8 12 z 11 inches in size/ J I SBD-6398(R. 11/11) v JEFFERY V FOX Page 2 4/1/2014 Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15'beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it is of a type conforming to the standards or specifications of chs. SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(1).Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. A copy of the approved plans,specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patric and rf Please Include a Copy With Your POWTS Plan R ie er,Integrated Services Payment Submittal. (715)634-7810, F : (715)634-5150,M-F 8:00 a.m.-4:45 p.m. WiSMART code:7633 pat.shandorf@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 "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. a /'ANT DIVISION OF INDUSTRY SERVICES yy� � ok 10541 N RANCH ROAD HAYWARD WI 54843 0 � .; Contact Through Relay 3 p •e www.dsps.wi.gov/sb/ www.wisconsin.gov O ss10's � Scott Walker,Governor Dave Ross,Secretary April 01,2014 CUST ID No. 223242 ATTN.•POWTS Inspector JEFFERY V FOX ZONING OFFICE JEFF FOX CONTRACTING&SEPTIC INC ST CROIX COUNTY SPIA PO BOX 565 1101 CARMICHAEL RD DRESSER WI 54009 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 04/01/2016 Identification No.238 Numbers Transaction ID No.2385002 SITE: Site ID No. 800779 Glen&Cindy Schumann Please refer to both identification numbers, Gl Gl Rd F above,in all correspondence with the agency. Town of Troy St Croix County CpND�T� NE1/4,SETA, S19,T28N,R19W AppR FOR: OF S Description:Mound,4 bedroom residence CV-pT O Object Type:POWTS Component Manual Regulated Object ID No.: 1477198 ESS, Maintenance required; 600 GPD Flow rate; 33 in Soil minimum depth to limiting factor from original grade; Sys gs-4 OF iN Mound Component Manual-Ver.2.0,SBD-10691-P(N.01/O1,R. 10/12),Pressure Distribution Componen W Ver.2.0, SBD-10706-P(N.01 101,R. 10/12), SSWMP Pub. 9.6; 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 SEE CO and located in accordance with the enclosed approved plans and with any component manual(s)referenced above. _ The owner,as defined in chapter 101.01(10),Wisconsin Statutes,is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: Key Items) • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard,the property owner must follow the contingency plan as described in the approved plans.In addition,the owner must insure that the operation,maintenance and monitoring duties as described in section VIII of the mound component manual are complied with.A copy of this information must be given to the owner upon completion of the project. • Care must be taken to preserve the bench mark during construction or establish a new bench mark with the elevation set to relate to the original bench mark. • The mound must conform to the shape of the contour. • The bottom of the distribution cell shall be level per the Mound Component Manual. The"D"dimension shall be a minimum of 6". The maximum finished slope of the mound surface shall not have a slope ratio steeper than 3:1 per the Mound Component Manual JEFFERY V FOX Page 2 4/1/2014 Reminder • The orientation of the mound system must be such that the longest dimension is oriented along the surface contour per SPS 383.44(6)(a)2. • Limit activities in the area 15'beyond the down slope edge of the mound per Mound Component Manual. • Surface water drainage shall be diverted away from the system area per Mound Component Manual. • Materials shall conform to the requirements of SPS 384.10.No fixture,appliance,appurtenance,material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,unless it is of a type conforming to the standards or specifications of chs.SPS 382 and 383 and this chapter and ch. 145, Stats. • Maintain well and waterline set backs per SPS 383.43(8)(1).Consult the Department of Natural Resources for well setbacks and other regulations and exceptions. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department,which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance.As per state stats 101.12(2),nothing in this review shall relieve the designer of the responsibility for designing a safe building,structure,or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below,or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation,operation or maintenance of the POWTS. Sincerely, Fee Required$ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Patricm4-- and rf Please Include a Copy With Your POWTS Plan R e er,Integrated Services Payment Submittal. (715)634-7810, F :(715)634-5150,M-F 8:00 a.m.-4:45 p.m. WiSMART code. 7633; pat.shandorf @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 "SPS"to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety&Professional Services.Additionally,all IS(formerly S&B)codes have been renumbered and addressed in a"300"series. For future reference,the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. �OtK) INA ANI_,Q I C) E AN wom)a1�-i tit tO .r f-:12"i m0fil seliq Sig -rzLq i W / -Tt, Wtj 2:Z.3Z�_Z --tR�X�aC A A ZL m5o , e. c PIV A, AlL-T J.;l f7_j9 - ICL MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN INDEX AND TITLE PAGE Project Name: Glen&Cindy Schumann Owner's Name: 3340 Richmond Bay Owner's Address: Woodbury MN 55129 Legal Description: NE1/4 SE1 14 S19 T28 N/R19 W Township: Troy County: ST. Croix Subdivision Name: Trebus Valley ID Lot Number. 16 Block Number: Parcel I.D. Number. 1296-60-000 "C Plan Transaction No.: Page 1 index and title �SpCNpE Page 2 Data entry ZFt Page 3 Mound drawings Page 4 Lateral and dose tank Page 5 System maintenance specifications '�� Page 6 Management and contingency plan Page 7 Pump curve and specifications Page 8 plot plan Page 9 soil test Designer. Jeff Fox License Number MPRS 223242 Date: 03/19/14 Phone Number: 715 755 2461 9 Si na e: v- C Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SBD-10691-P(N.01101, 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.01101, R. 10/12) Version 7.0(R. 11/12) Page 1 of 9 Mound and Pressure Distribution Component Design Site Information 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 fecai coliform of<=36 inches. 1.50 Peaking Factor(e.g. 1.5= 150%) 600.00 Design Flow(gpd) 11.00 Site Slope(%) 95.50 Contour Line Elevation (ft) 53.00 Depth to Limiting Factor(in) 0.60 In-situ Soil Application Rate(gpdff) Distribution Cell Information 65.00 Dispersal Cell Length Along Contour(ft) = 9.24 Cell Width (ft) 1.00 Dispersal Cell Design Loading Rate(gpd/ftz) 1 Influent Wastewater Quality(1 or 2) Are the laterals the highest point in the distribution Y Pressure Disribution information network? e Center or End Manifold 3.08 Lateral Spacing (ft) If N above, enter the elevation(ft) 3 Number of Laterals of the highest point 0.156 Orifice Diameter(in) 2.76 Orifice Spacing(ft)= 8.34 z/orifice 2.00 Forcemain Diameter(in) 125.00 Forcemain Length (ft) Does the forcemain drain back? Y 82.00 Pump Tank Elevation(ft) 4.55 System Head(ft)x 1.3 20.3 Forcemain Drainback(gal) 13.59 Vertical Lift(ft) 87.3 5x Void Volume(gal) 3.89 Friction Loss(ft) 107.76 Minimum Dose Volume(gal) 0.00 In4ine Filter Loss(ft) 38.77 System Demand(gpm) 22.04 Total Dynamic Head(ft) Lateral Diameter Selection Manifold Diameter Selection in.dia. options I choice in. dia. o lions choice 0.75 1.25 1.00 1.50 x x 1.25 2.00 x 1.50 x x 3.00 2.00 x 3.00 x Gallonslinch Calculator' Treatment Tank Information Total Tank Capacity(gal) 1250.00 Septic Tank Capacity(gal) Total Working Liquid Depth (in) Wieser Manufacturer �_]gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 Dose Tank Capacity(gal) Bear On site Filter Manufacturer 22.24 Dose Tank Volume(gal/in) Bear Onsite Filter Model Number Wieser Manufacturer Project: Glen &Cindy Schumann Page 2 of 9 Mound Plan and Cross Section Views 1FKI- 1/0 B . © . J Observation Pipe . O Q —A W ! _ : [3 . . . . . 1 L Mound Component Dimensions 9.24 E 18.20 in H 1.0 K ff285.4805 ft B 65.0 F 9.5 in z 12.57 L 6.0 in G 0.50 J 4.04 W ft 600.6 (ft2) Dispersal Cell Area 1417.87 (ft2) Basal Area Available 9.2 (gpd/ft)Linear Loading Rate 6.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 97.79(ft) --> i I F Dispersal cell 96.50(ft) Lateral 96.00(ft)—► — Invert Dispersal Cell ❑3 - Elevation E D 1 l 0 95.50(ft)Contour Elevation 11.0%Site Slope Geotextile Fabric Cover Shading Key 4 in. Dispersal Cell See lateral details on Topsoil Cap dia. 1.5 ft Page 4 for number,size, slotte © and spacing of laterals. © ,: Subsoil Cap d 1— 0 Laterals are equally © AS C Sand obse F spaced from the ® � Tilled Layer ryad Typical 0.5 ft m Lateral distribution celPs ® [� Aggregate on ❑6 ,r centerline in the pipe distribution cell(AxB). Project: Glen&Cindy Schumann Page 3 of 9 Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer W(ESE(L Pump Manufacturer It Tank Model Number W& 12S SOp Pump Model Number 5 Total Tank Capacity p Alarm Manufacturer ((a Max,Bury Depth Alarm Model Number (�(� Switch Type tvo-T fyxg R C. Filter Manuf REAR, Total Dynamic Head(TDH)-Feet Filter Model Number 136N I(? O Wi Tc Elevation Head Distal Pressure ,$ Network Loss Minimum Pump Performance Required Force Main Loss 3.8 GPM j—@ Ft TDH Total Outlet Manhole Min.4"Above Grade With Locking Device. Inlet Manhole Manhole Min.4"Above Grade <6"Below Grade Sealed Watertight Securely Mounted With Locking Device Weather-proof Junction Box -- " —' Finished Grade Depth of Cover Vent Min. 12" Disconnect Ft Above Grade Means With Vent Cap < < t < < t < < < < t < < < S S < < S S S t S C S < < < S < >< Outlet st Outlet Filter �� �� ------ Inlet >�> ��— Inlet Baffle >� ----- - - ------ 't' t < < <, ,t A > {} Switch Settings and Reserve Capacity t;s }` '�<" >`f Tank Volume= GPI st ;` Weep Hole a;> Dimension Inches Volume Gal. B > t >t? (reserve)A 3 40S. 3 5 < '< > a < 3%C* (alarm) B 2 t ; Off Elevation . C >; qty (dose) C 4t85 101. 76 `?� Ft ;{ Bottom >s> (dead) D �D.`9O 2 2. 2 t;� D ;� Elevation Total 6p0 a > a a > Ft >t yc> >s a t a s ac>s a s s t s t st>c s c> s t s s t>e s y 1,'.s>c>s t s>c>s e s t>t>t>t>s a c a 11:4s-C>>t c GENERAL INSTALLATION: The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device(padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4"Sch.40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 1628 WAC. 02/05 LJ Page of . . . End Connection Lateral Layout Diagram Later al-f &fn-rcernain Sc h 40 P'-'f--Per SPS Table --..'E:4 -;A-6 Number of Laterals Orifice Diameter 0.16 in Lateral Diameter 1.50 in Orifice Spacing(X) 2.76 ft Lateral Length (P) 63.48 It Orifices per Lateral 24 Lateral Spacing(S) 3.08 It Orifice Density 8.34 ft2/orifice Lateral Flow Rate 12.92 pm Manifold Length 6.161ft System Flow Rate 38.77 gpm Manifold Diameter 1.501in Total Dynamic Head 22.04 ft Forcemain Velocity 3,96Wsec Dose Tank Information Locking cover with warning label and locking device and sealed watertight Electrical as per NEC 300 and Tank component is property—Wffe-u— Let -U m te outlet location Forcernain diameter Wieser Manufacturer 2 in. CapacM 800.00 Gallons Volume 22.24 gal/inch Weep hole or anti- Dimension Inches Gallons siphon device A 1 23 405.F5 B 2.00 44-48 Pump off elevation(ft) D 10.90 242.42. r-TOT,71 35.971 800.00 Dose tank elevation(ft) 3"Bedding under tank. 82.001 Alarm Model Number MJJ1 Pump Manufacturer Zoeller Pump Model Number BN153 Pump Must Deliver F---3-8-7-71gpm at F---22-0-41ft TDH Project- Glen&Cindy Schumann Page 4 of 9 ` Mound System Maintenance and Operation Saecifications Service Provider's Name Jeff Fox Phone 715 755 2461 POWTS Regulator's Name St Croix Cty Phone 71586 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 600.6 ft2 Maximum FOG 30 mg/L Type of Wastewate Domestic Maximum Fecal Coliforml >10E4 100 mL Service Frequent[ Septic and Pump Tank Inspect and/or service once every 3 years Effluent Filter Should inspect and clean at least once every 3 years Pump and Controls Test once every 3 years Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested every 1.5 years Moundl 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 a�ifa�����O's ■�������aa��as�i Grade . . . . . . . . . 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Lateral Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project= Glen&Cindy Schumann Page 5 of 9 Mound System Management Plan Pursuant to SPS 383.54,Wis.Adm.Code General This system shah be operated in accordance with SPS 382-84 Wis.Adm.Code,and shall maintained in accordance with its' component manuals[SBD-10691-P(N.01101,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 POWfS components. Septic or pump tank manhole risers,access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective,or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s.281.48,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 fitter 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 fitter is equipped with an alarm,the filter shall be serviced if the alarm is activated continuously. Intermittent finer 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 113 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 lank 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 around 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 BODS,150 mg/L TSS,and 30 mg/L FOG for septic tank effluent or 30 mg/L BODS,30 mg/L TSS,10 mg/L FOG,and 104 du/100 mL for highly treated effluent. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral,and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice dogging 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. CamUM2ncv 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 components)shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface,it will be repaired or replaced in its'present location by increasing basal area if toe leakage occurs or by removing biologically dogged absorption and dispersal media,and related piping,and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. ni :'.i _ . 09/16/02 J - t,. t i , It LoUTE AND j It mMEL-S 1.5111521153 152 !f3� uwm L red mom a& ut" 77 291 40 � { r t �� 0 Zil t 24 ng 25 20 23 87 1►� 40 12.2 I IL { i F-1 7Aft TOR vy s4 s a 3 7A CoNsULTFAC a to ago rt Zo � 42 i of_ Ow _r-ornmMUNNE rat ISO 3. Mx -..t . RESMVEPOVWMMDMN - -•fe<: :Gh=ter= "� s r s 1 _ 1f `�C `-f � �fL1 S I 2 tJlt', 1R ink T(\.wltij r 'T-1_�y Li l c � t�C --iRaMC_ A14--A fl� -ALT WW1. - 4` / A 177 T 1 a. J( (t 3' tF�t F /� i, 1, f �{ 1r I _ 1509 Wisconsin Department of Commerce SOIL EVALUATION REPORT '` -0 2 d B / Page 1 of 4 Division of Safety and Buildings in accordance with Comm 85,Wis.Adm.Code A.C.E.Sal&Site Evaluations Attach complete site an on a not less than 8%x 11 inches in size. Plan must County p PI paper St.Croix include,but not limited to:vertical and horizontal reference point B�dkecfion and p arcel I.D. percent slope,scale or dimemsions,north arrow,and loarest road. 040- ID#19 28 303 Please print all info►ynadon R By Date Personal information you provide may be used for�2cpndarq purposepvacy Laws 1b 04 p)�m)). e Property Owner r; Pr ovation J.T.B. Properties, L.L.P.C/O John W. ^L- n Govt Lot, NE 114 SE 1/4 S 19 T 28 N R 19 W Property Owner's Mailing Address 9 '� of#t Subd.Name or CSM# 1564 West University Avenue ' T y�Otk ti6 Trebus Valley Estates City State Zip hone Nurl col, (;ty ;_j Village �j Town Nearest Road Saint Paul MN 5510 - 'f 6-1967 ",~s' Troy County Highway"F" a _ tits New Construction Use: W1 Residential/ 3 Code derived design flow rate 450 GPD A Replacernerd �; Public or commercial-Describe: Parent material Glacial drift _ Flood plain elevation,if applicable na General comments and recommendations: Recommend installing mound system at elev. =96.00'at 6"above 95.50'contour. Available system area limits dispersal cell to a maximum length of 75'. � � 1=E8. Z,W � • �� F-1 Boring# Lj Boring jI, Pit Ground Surface elev. 95.62 ft. Depth to limiting factor 45" in. Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 -Eff#1 *Eff#2 1 0-9 1Oyr3/3 none sl 2fsbk mvfr as 2fm,1c 0.5 0.9 ,(o 2 9-18 1 Oyr4/4 none sl 2msbk mvfr cs 2f,1 me 0.5 0.9 ,(, 3 18-28 1Oyr3/4 none sl 2msbk dh cw 1fm 0.5 0.9 4 28-45 7.5yr4/6 none Ifs Om dsh cw 1f&vf 0.4 0.6 •s 5 45-83 7.5yr4/6 f2f 7.5yr 5/8 fsysysil Om dh - - 0.0 0.2 1-1#5 contains colluvial Om fsl,Om sl,&Om sit and limestone fragements. F-1 goring# jj Boring t Pit Ground Surface elev. 95.34 ft. Depth to limiting factor 35"�in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDKF "Eff#1 -Eff#2 1 0-5 1Oyr3/3 none sl 2%bk mvfr as 2fm,lc 0.5 0.9 .(P 2 5-12 1Oyr4/6 none sil 2msbk mfr g 2f,1mc 0.5 0.8 3 12-22 1Oyr4/4 none sl 2msbk mfi cw 1 f 0.5 0.9 4 22-33 7.5yr4/6 none Is 1 msbk mvfr cw 1 f&vf 0.7 1.2 '�- 5 35-48 7.5yr4/6 f2f 7.5yr 5/8 Ifs 2msbk mfr cw - 0.5 0.9 6 48-70 7.5yr4/4 f2f 7.5yr5/8 sl Om mfi - - 0.3 0.5 1-1#5 contains fsl,Om sI,&Om sil and limestone fragements. *Effluent#1=BOD?30<220 mg/L and TSS> <150 mg/L #2=BODS<30 mg/L and TSS<_30 mg/L CST Nam(Please Print) Sign ure: CST Number James K.Thompson 3602 Address A.C.E.Sal&Site Evaluations - -Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane,Osceola,WI 0 12/5/01 715-248-7767 , L.L.P.C/0 John 040-1078-50-000,ID#19.28.303 Page 2 of 4 . � Property O� J.T.B. Properties, Parcel ID# 3 Boring# Boring h to limiting factor 41" in. 93.02 ft. Dept n9 R Sal Application ate a �' Pit Ground Surface elev. App Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM *Eff#1 'Eff#2 1 0-6 10yr3/3 none sl 2fsbk mvfr as 2fm,1c 0.5 0.9 ,(� 2 6-17 1Oyr4/6 none sl 2msbk mfr cs 2f,1mc 0.5 0.9 , (p 3 17-24 1 Oyr4/4 none sl 2msbk mfi cw 1 fm 0.5 0.9 , (P 4 24-41 7.5yr4/6 none Is 1 msbk mvfr cw 1 f 0.7 1.2 , 5 41-52 7.5yr4/6 f2f 7.5yr 5/8 Ifs 2msbk mfr aw 1f 0.5 0.9 6 52-84 7.5yr4/4 f2f7.5yr5/8 scl 1csbk mfi - - 0.2 0.3 H#5 contains colluvial Om fsl,Om sl,&Om sil and limestone fragements. F—I Boring# Boring ft. Depth to limiting factor in. Pit Ground Surface elev. — Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 Boring F-I # � �Bori Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 *Effluent#1=BOD?30<220 mg/L and TSS>30<150 mg/L *Effluent#2=BOD5<_30 mg/L and TSS<30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format,please contact the department at 608-266-3151 or TTY 608-264-8777. SOIL AND SITE EVALUATION 1509 Page of 4 PROPERTY OWNER: J.T.B.Properties,L.L.P.CIO John W.Nielsen PARCEL I.D.# 040-1078-50-000.ID#19.28.303 AC.E.Soil&Site Evaluations REPORT MEMO Soil evaluation completed for plat review purposes and prior to clearing or lot monumentation. Results indicate that the soils at this location are suitable for a mound septic system. This site is physically limited and restricts septic system size to accomodate a 3 bedroom septic system with a 6'x 75'dispersal cell. Additional soil evaluation and a clarification of system location/design may be required prior to POWTS design and sanitary pe rmit acquisition if arger system area is required. ♦ Elerl��ioh open C,,r 16, b. . : rl,; I I I'l 5 mal1 12ed.Cedar&ee.EIeuL= Q.36" 9X.SO Cone Loco d ed 9s� Asa' ■y a �v free, ASSu.,zeo' Elev: _ (d o.00" 9s 98' . `�' �f h // �.►?�1�� ��t3//rig 5.t: �.'"i: ,ll b• • 2,02 Ac M.VE."Ia 9 V '" � • '�'Hr•. :+ LOTS r ,4 k�A r ,� 102274 S.F. 3 \` fN` ."'?� # 2.35 Ac. W M.F.- X915 CASCMT LOT .. > p S.F. � - �� Ac. ,� 913' t FIB[ • LOT 1.7 o. 140148 S.F. 3.22 Ac. eASUMW ? MY:E.`910. is N ` ri 150' ICL4400 S.F. � +�• 2.40'Ac, J ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND �± �+ OWNERSHIP CERTIFICATION FORM Owner/Buyer l 141 4 C ii d y 5A#kf4tjM _..--.._._ Mailing Address 33YO ?it-hA4#kkd 64V W edbla" 8/Y 6Q2-11 Property Address ��/� /"l rcG f 11/ ud 5dtn W (Verification required from Planning&Zoning Department fort construction.) !% e -atce enft Ication-Tiim LEGAL DESCRIPTION L Property Location %a {, J F r/a, Sea_I T N RW,Tawn of TVO�r Subdivision Plat:Ll/Ib(t5 ��If y ,Lot#�. Certified Survey Map# _ ,Volume ,Page# ( Warranty Deed# I�2- 3 5Z (before 2007)Volume ,Page# Spec house Oyes0rio Lot lines identifiable Dyesono 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 pamper 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 tite above requirements and agree to maintain the private sewage disposal system with the standards set forth,herein,as set by the Department o€Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained musi be cormpleted and returned to the St.Cru x County Planning&Zoning Department within 30 days of the three year expiration.date. Uwe certify that all statements on thi form are true to the best of my/our knowledge. Uwe am/are the owner(s)of the property described above,by virtue of a wa auty deed recorded in Register of Deeds Office. Number of bedrooms ` '1 IdA URE OF A.PP.L.ICA.NT(S) DATE J ***Any in rmatio that is misrepresented may result in the sanitary permit being revoked by the Planning&Zoning Department.*** Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of tite certified survey map if reference is made in the warranty deed. (REV.04/12) DOCUMENT NO. II tIIiI(IIIIIIIIiIII(IItlI�1I�) STATE BAR OF WISCONSIN FORM 1-2003 $ 2 � � 2 8 2 WARRANTY DEED TX:4173423 992352 THIS DEED,made between J.T.B.Properties, LLP,a Minnesota limited BETH PABST liability partnership("Grantor"whether one or more)conveys and warrants to REGISTER OF DEEDS Glen E.Schuma n and C nthia .Schumann husband and wife as ST. CROIX CO., WI survey rs tlp marital proper Grantee her one or more),the following 02/06/2014 1:49 PM described real estate in ST CROIX County,State of Wisconsin: EXEMPT*: N/A Lots 16 a & 17,Plat of Trebus Valley Estates in the Town of Troy,St. REC FEE: 30.00 unty,Wisconsin. TRANS FEE: 495.00 PAGES: 1 TOGETHER WITH AND SUBJECT TO a 66 foot joint driveway easement between Lot 16 and Lot 15 as shown on said plat. RETURN TO St.Croix County Abstract&Title Co. Inc. 219 S.Knowles Avenue New Richmond,WI 54017 Tax Parcel No: 040-1296-60-000:040-1296-70-000 This is not homestead property Exception to warranties: Municipal and zoning ordinances and agreements entered under them,recorded easements for the distribution of utility and municipal services,recorded building and use restrictions and covenants,and further except 2013 real estate taxes. Dated this 31st day of January,2014. J.T.B.Properties,LLP,a Minnesota limited liability er hip y adley S.Diller,par r By:John W. Isen, partner AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF WISCONSIN 20_ 1 f COUNTY OF ST.CROIX ss. TITLE:MEMBER STATE BAR OF WISCONSIN Personally came before me this 31 st day of January,2014,the above (If not, named J.T.B.Properties,LLP,a Minnesota limited liability authorized by§ 706.06,Wis. Stats.) partnership,by Bradley S.Diller,a partner,and John W. Nielsen, a partner,to me known to be the person(s)who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY M , Robert L. Loberg/Loberg Law Office * L • (as 0 tel ° • -? Notary Public St.Croix County,Wis. = \%v 1317089/alm ? +. WARRANTY DEED �`!�j, �' Y`Fid NO.1-2003 St.Croix County 992352 Page 1 of 1 T � rA? cv loft, LL. an LA: Ewm4 'n R� • #�� - f � .Pr •, MIL `y I • map Alifty A2 Q lain's Drawing Room,LLC 2014 ,�3xSR S3 °rG 'H. 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