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HomeMy WebLinkAbout040-1280-20-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 479370 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Lau, Ryan I Troy, Town of 040 - 1280 -20 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 35 : S 1M -Z 17.28.19.1574 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic (� ` Benchmark 1/- S q4 q 3 !5 .5 Dosing Alt. BM 4 �. 9. L R3 7.4 % Bldg. Sewer 1J4 '7 2.75 Holding St/Ht Inlet ` ° I 3Z. St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WE l� BLDG. Vent to Air Intake ROAD Dt Inlet `� \ Septic 7 � � , � 1-3 / 1 � / Dt Bottom 1� � 1 � G • Q Dosing ) 71 / 3 1 Header /Man. 7 2Z T3 7. 1$ Aeration Dist. Pipe 44 q3 7 . d5 $ ,i Holding Bot. System I �� Final Grade PUMP /SIPHON INFORMATION &_ r Z_ �b 9y Manufacturer r s Demand St Cover a.+ GPM �� W+�.. 73 7 . Model Number M,` I 65 IT e 5 TDH Liz p Friction Loss � T �\ (• C Forcemain Length Dia Z_ Dist. to well '97 1 SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 4-!Z - Z, -e SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION CHAMBER CHAMBER OR Type Of System: / ( UNIT Model Number: G bAo Rio v,O � Z 3� 10z 0z ,�t0 iii J c1t� DISTRIBUTION SYSTEM Z34 Z7 — `{ Header/Manifold // Distribution x Hole Size x Hole Spacing Venr Air In e Pipe(s) Length - 7 Dia — I Lengt Dia \ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over / Depth Over xx Depth xx Seeded /So ed xx Mulch K Bed/Trench Center Bed/Trench Ed es To soil g p Yes ] No es No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: 1 / Inspection #2: Location: 471 Omaha Roa Hudso WI §46016 Nov 1 E 1/4 17 T28N R19W Eagle Bluff Lot 42 Parcel No: 17.28.19.1574 P a � F'a i ull< v�_ 1.) Alt BM Description = ��„ akk se jv, 2.) Bldg sewer length = 1 3 - amount of cover = / j Yes Plan Required? Use other revis for additional informat oi' n: o r ` s mi _ - - - -- — -- - - — Date A - Insepctors i ture Cart. No. SBD -6710 (R.3/97) Safety and Buildings Division County W 201 W. Washington Ave., P.O. Box 7162 4 C N visconsin Madison, WI 53707 - 7162 Sanitary Permit Number (to be filled in by Co.) Department of"Commerce (608) 266 -3151 S ry Permit Application State Plan I.D. Number In accord wii Wi . Adm. Code, personal information you provide may tie us .04(1)(m) Project Address (if different than mailing address) I. Application Information — PleE ie Id ormat on �7/ 0 Property Owner's Name A U Parcel # t # ! Block # oa Property Owner's Ma iling Address I I 1 A 1 0 1 4 11 Property Location ZONING OFFICE ( � 15 7C f 1 O -0 U y A VE AJ ' A, JVr— 'A,Section 7 J City, State Zip Code Phone Number OAk E Z v - Q (circle one) II. Type of Building (check all that apply) �, 13 ry �, S � N; R'>�t W 0 1 or 2 Family Dwelling - Number of Bedrooms 1312- �d A6B-t/ Subdivision Name CSM Number ❑Public /Commercial - Describe Use �� � LG, t°�A� Acct ,­-r ❑ State Owned - Describe Use ❑City_ ❑Village (Township of t20 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A ' & New�stem ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) I LNon - Pressurized I - d ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ At -Grade ❑ Single Pass Sand Filter ❑ Cons cted Wetland ❑ Pressurized In- Ground ❑ Holding Tank ❑ Peat Filter ❑ Aerobic Treatment Unit ❑ Recirculating Sand Filter El Recirculating Synthetic Media Filter Leaching Cham ❑Dip Line ❑Grave less P' Other (explain) SQ V. Dispersal/Treatment Area Information: Design Flow (gpd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal rea Pro s (sf) I System Elevation (,D 7i S' 3 0 - 0 r ruF9c , 39, d VI. Tank Info Capacity in Total Number Manufacturer Prefab Site Steel Fiber Plastic Gallons Gallons of Units Concrete Constructed Glass New Existing Tanks Tanks Septic or Holding Tank Aerobic Treatment Unit Dosing Chamber VII. Responsibility Statem I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's ame (Prin t) Plumber' Signature MP /Number Business Phone Number � o�. 2 z 6 2 7 1J Z 77 i� Plu 's Address (Street , City, State, Zip e) VIII/County/Department Use Only Approved El Disapproved Sanitary Permit Fee (includes Groundw#ker D Iss ed uing Agent Si a e ( ps) Surcharge Fee) ❑ O wner Given Reason for Denial U � IX. Conditions of Approval /Reasons for Disapproval / # gas• �' !.a ns� 'YSTEM OWNER: 3 �" g� / �Y� `✓np��� Septic tank, effluent filter and --5 /�—�I� tT �G�° � Z � lot , dispersal cell must all be serviced / maintained S// 2�� �ST as per management plan provided by plumber. L� S� Gum Gf/n flirt o� 2. All setback requirements must be maintained as per applicable code /ordinances. haYt./ 4�C� �Gyz�lnt Attach complete plans (to the County only) for the system on paper not less than 81/2 x 11 inches in size SBD -6398 (R. 01/03) J eS W �e)� a I �� Z_ pN � y � MA o N Aw � 9 ��►'� t wo AfPdc PIPE 7 heove- 6. -ati a o �0+ � AJ a `'- h, � AVP Zz6V97 ,sloe 7 6e-&- 13 6 ? f� a /D V �I' C L 4 CONVENTIONAL SYSTEM CROSS SECTION I, NO SCALE i 11 11 'i �G: i V 11 12 E 1 COVER R COVER 2 CO 1 __. 12 CO E 'NI , • . 1 , •i xl' u .......z. , '1 I ...,...r.,: n , .. ,., .ti,.:. .. a.? a... , .. a,d;!,• 1 1 ......tJ.•I ..> :. 1... 1 ,. ::.r':';t`i; �;!',7: t : ..t 1. .. .... ,. t ..... .,.. ..l ,I � .., > l , ..f �. , k l .. ..... LL ......, v ... ....:. ..1,) .'.I.. r:i1:.t .. 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I I. � . ... .,. , ....1i.... ..... l .. .. 1 .. ::.:•.n:4� ' � i::' . >�!'.:3•:!dES:':' :.,., n .. .., 1 ..v ., � u.l..,• ) ...,.. .. t r ...:.h,.• ... .:..,: .:.,., o ,.,,.... :: , •::::;,: ?: 1. i lj;r'f' °' 7t i ..... ..... 11 . ......... .......,,.. ... ..l.l .. .. :.t..., .: ,. ,.. .... ,. {�„ 1 :: `ii ��i 341 1: I I I ELEVATION T IN SITU SOIL T2 QUICK a STANDARD FNFI.LTRATO.R DIMENSIONS: HEIGHT 12" LAYING LENGTH 40” WIDTH 34" I I i III Combination Sep.tac: Tank and - PL1MP CHAMBER CROSS SECTION AND SPECIFICATIONS - VDIJT CAP WEATHER PROOF ju)JCTIORI HOX . ti`C.I. VEA1T PIPE APPROVED LOCK1ti1G MA1JHQLE COYER PQLV IO' FROM Dom y yup.(2),)11JG Lf�BEL.. - 'i1 ,IDOW OR FRCSH Cox�I 1T �sP�t1o�J �' IpE q>K fiJTAY - I 6" w. loo T ` -- ----- - - - - -- �.: PROVIDE I '� IMLE T ^ -- AIRTIGHT SEAL I I I I gq�t� I APPROVED J0117TS APPROVED JOINT W /C.T. I'IPE�Kp'c W /c.z. PIFz61Z Tank construction I 11 ALARM shall comply with I II 1LH', 1,3.15 and 33.20 ° I I OBI c •I I I I E PUM OFF P -� -_J _OQ _CT a�DCx 3" APPRN - RISER F_XIT pF_Fj'tITIED ONLY IF TA MAUUFACTUREK HAS SUCH APPROVAL g pplNG SEPTIC f 5PECIFICATIDQS DOSE W l CC? ��•C��T� IJt1MbER OF OOSCS: PER t1A� TAIJK$ MA►JU FACT U9,ZR.: TAMK :,IZC:_ 1 Zf D — ��D CALLQQS D05E VOLUME ALARM MAWUFACTURI`R: S' - LE zQ StIS���1 I►�CLUOIKIG 6ACKflOW _L1 -� GALLONS MODEL QUMbrR' �QL �� CAPACITIES: A= �3 M CHES OR L V CALLOUS SWITCH TYPO: 8 = Z IWCHES'�OR J � [ _ 7 C+ LL0U5 BUMP hIAIJUFACTURCR: � Z - 1r � � / ©E-t L� C=— IUCHES OR T/` LLQUS MODEL IJUMDER: ______ ll D =iniLHES OR f ALLOAJS SWITCH TYPE: W � ���' _ _ WTE: PUP1P AUD ALARM ARE TO 01. MIIJIMUM DISCHARGE RATE _ - GPM IN5TALLEO OW SEPARATC CIRCUITS VERTICAL DIFFEKENCE DETWI`EiJ PUMP OFF AQ0..015TR1bUTIOQ PIPE.. o FEET i - MfiJIMUM NETWORK SUPPLY PRESSURE , ; .. 0 - FCET + FEET OF FORCE !'C X 3 / fLFKICTIOU FACTOR_. 7' FEET TOTAL 0O JAMIC HEAD Z FEET As per manufacturer gal /in. RPR 16:28 ENT HUDSON 715 386 6144 P.01 L61 GOULDS PUIVIP5 Submersible Effluent Pump PE �1 r La • Rl yeff PUMP 0, - SPECIFICATIONS MOTOR FEATU Pump — General; General: ■Corrosion resistant •Discharge: I 'A" NPT • Single phase construction. • Temperature: 104 °F (40 °C) • 60 Hertz ■ Cast iron body. maximum, continuous when • 115 and 230 volts ■ Thermoplastic impeller and fully submerged. • Built -in thermal overload pro- cover, • Solids handling: 'k• tection with automatic reset ■ Upper sleeve and lower maximum sphere. • Class B insulation. heavy duty ball bearing • Automatic models include a • Oil -filled design. construction. APPLICATIONS float switch. • High strength carbon steel n Motor is permanently Specially designed for the • Manual models available. shaft. lubricated for extended following uses: • Pumping range: see PE31 Motor service life. • Mound Systems performance chart or curve, • .33 HP, 3000 RPM ■ Powered for continuous • Effluent/Dosing Systems PE31 Pump: • 115 volts operation. • Low Pressure Pipe Systems • Maximum capacity: 53 GPM • Shaded pole design ■ All ratings are within the • Basement Draining • Maximum head: 25' TDH PE41 Motor working limits of the motor. • Heavy Duty Sump/ PE41 Purnp: • .40 HP, 3400 RPM ■ Quick disconnect power Dewatering • Maximum capacity: 61 GPM • 115 and 230 volts head duuty 1� rd length, h • Maximum head: 29' TDH • PSC design heavy or duty volt grounding PE51 Pump: PE51 Motor: plug. ■ Complete unit is heavy • Maximum capadW. 70 GPM • .50 HP, 3400 RPM Com f • Maximum head: 37' TDH • 115 and 230 volts portable and t is ea METERS FEET • PSC design ■ Mechanical Seal is carbon, 40 — ceralmml BUNA and stainless PE511 r- ---,• I _ i .,. _..�. 4 j I MODELS: K31 real, PE51 steel. 3 HR .33, .40, .sa ■Stainless steel fasteners. 10, 5 i• I• I 30 •PE4 I ' - I -,► GPM I ., . ! I I I I AGENCY LISTINGS i 1 Fr LU II I U I i � I � I I i d 20 I Tested to UL 778 and ' I CSA 22.2 108 Standards I_ ' By Cam Sbndv& ASSOaa6,n File#Ut3rAg 10 I i i ' ' ' i Goulds Punlx is ISO Wm Registered, � I l II �i I I Il i, I 0 0 0 i I - I i I � I � • �. I ..I .� I' I C I I ' ' � I I ' 10 20 30 40 50 60 70 GPM 80 0 5 10 75 m Goulds Pumps CAPACITY ® 2004 i7T Water Technology, InC. ?� Effective Ju X0°4 BPE3 i/41 4 ITT Industries Wisconsin Department of Commerce SOIL EVALUATION REPORT Page _ of 2-_ Division of Safety and Buildings In accordance with Comm 85, Ws. Adm. Code County Attach complete site plan on paper not lose than 8 112 x 11 Inches In size. Plan must Include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 040 IZ 940-- 2 r 000 Please print all Information. viewed Date ^ v Pononel inlormellon you provide may be used for secondary purposav (Privacy Lew, o. 15.04 (1) (m)l. Property Owner Property Location P1mM L LJF+- 31ILC C *-S -T-NC, N W 114 NE 114 S 1 "7 T 2$ N R faQ Property Owner's Mailing Address Lot # Bbck # Subd. Name ar MW tLQ 5D ( Z-'h Sr. 4Z - �14C -�tE 5L U FF City State ZJp Code Phone Number ❑ City ❑ Village ELTown Nearest Road L. AM P-LM 4 i M)1 ((o5l) 4 3k6-3-5,501 - M0 Y 1 -D New Construction Use. X Residsntfal 1 Number of bedrooms Code derived design flow rate ❑ Replacement 0 Public or commercial • Describe: Parent material _ Ol- Tin/,/ :50 Flood Plain elevation if applicable N • R. and re ommments HOLIC - "CO 7✓Sif��1 -!sH NrcW fl�rc�t �iC SN-GP.QW3tJ oN ,3 1.�Rt O r IA ���? �J and recammendatlon . i "'(1 ACAttS 'BASED t7U ojua1NA 'TeST DA'�t>EDit -0� 1 X NT S SEC a chi Ro of -T FOK 1309AA) &, n�F cF r ❑ Boring # ❑ Boring O*WA,10"1 Pit Ground surface elev. 1�1 3,_Z? ft. Depth to limiting factor y 119 in. ScA A Rata Horizon Depth Dominant Color Radox Description Texture Structure Consistence Boundary Roots GPD/tf in. Munse Qu. Sz. Cont. Color Or. Sz. Sh. 'Ett#1 'Eff#2 ( 0 - 8 104K. -- L Z r C 0,.5 .8 Z 4 -1 2 /1 — 51 _ K -3 ( .5 0.9 ,(c -a 10M-3L s cc abK M,4fr C S D.q orb -! o 104 K 3 /4 -- s ZTQb rAq dL!s 0.5 0. S 36 -4q to o r, 3 k( A5 5 7-4-to 03 (rZ 7 b3 - t i q I.OV fit/ cS f • M s O d 1 — � - O, 1. Z L LQV 1iA5 <'35 O o� 7 2 Boring # pt Boring Idf Pit Ground surface elev. q 2 g Z� ft. Depth to smiting factor �1�1_ In. cop A Rate Horizon Depth Dominant Color Radox Description Texture Structure Consistence Boundary Roots GPDIfP In. Munsell Qu. Sz. Cont, Color Gr, Sz. Sh. •Eff#1 'Eff#2 ( 0 -$ to ab -co 0.5 0.9 z- g -r Z z t, 0- 0. r(, - i o Yr -*4 — t- I MaJO 5 -ca O.Y O.b 7, �- 10 YK 3 CS 0 1. 10 y 14 f M S CS - 0 1-4 (Z Oy H AkS M O I.Z Effluent #1 = BOD > 30:S 220 mg1L and TSS ;-30 1 190 mg/L &Zuent 92 = BOD -< 30 mg/L and TSS -< 30 nWL CST Name (Please Print) Signature CST Number iYIA o ! LL STE ZZ 3 Address Date Evaluation Conducted Telephone Number 1.09875 ego K Ade, VE FAU WI 54022 43r -0Z. - 715 y16 -1'7715 t r PLOT PLAN PAaAff z I'ROf"rtzlY OW1R; VEAu3 FLM&d 0 LE &iLF - M- - TO P OF fVC P M 7' W 46 R - 2— kANA m W -SON, GORING / C3ACOa I NO COMM 83 P120MM5 o� j L0'C yZ Z 2 dD 0 � gZR.D$ t ers �FRor!u�ST- r" 5�84�� p , r 3 s�s + IN 0 Q ' l)IT N1 ALP 61. 9'+ Rv. � 51CUP C51 SAC, 224 8 3 Z DA9: o - Zl' -02 FROM.:LIFESTYLE_HOMES FAX NO. :6514365113 Mar. 11 2002 01:15PM P3 MAR -M -2= 13! 58 COMT 1 AwNTOL DULP COPP WS 757 2537 P. QQ/ iO •, •• •~ • •• �• N 8INIhnMV* cow MAR Aft Ow ^- Adsch in mm teen m rAn wr 1m1 im mm R to * { t mmm 11 wn P nKm Mtick but Rd Nmtrd 19 wow IN me m"I mwm Pont 191M1. Okw" ent Psrant el*11, eo>tte or • nOM afICw. so kv.-" Ud dkbum W eOmr L Masse print &0 kift nudoe, t�.rtNe.nton yaa taw nw++� �a�wmwesa tt�r u+►,s,u� n� 110. 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Deg • 6 ict w0 " 0 � maw 421 V. ]taro Nail River falls, NI 408Z �r� 711- 429 -0165 Wisconsin Department of Commerce SOIL EVA REPORT Page of 3 Division of Safety and Buildings ?' . in accordance with 4arn Rdm 1EbdQ unty Attach complete site plan on paper not less than S 1/2 x 11 in ze• L I I.D. include, but not limited to: vertical and horizontal reference dire oli `' P Q61�0.. ;Par percent slope, scale or dimensions, north arrow, and location to nearest road. Please print all informatio r ti� fy 7 �u'IjG d'vi wed Date y 4 \l w � c/�l Personal intomiation you provide maybe used for secondary purpose (Privacy Law. — Property Owner C}t S . CO 0 FZ fIW§0j*Pg , ) 1 - 00 kJnMQ),3_ ML DQk3EL0PMEkj C°01ZPo�2t�' o r /I /4 1< S I7 T Zb N R lq E (or W Property Owner's Mailing Address 1 bt C. { Subd. Name or b# 1 l6 00 1° �0 q&j S i�RJEE 7 ME: , S U 1)7�F 113 o i=' G LE S L UFf City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road L3 ►" NJ I S54V9 1 ( 761) ZS7 --1566 TC c) OMiA-'WR R ® New Construction Use: [�] Residential / Number of bedrooms �_ Code derived design flow rate 0 O GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material `-b k�-: % 3 Flood Plain elevation if applicable General comments and recommendations: x W_"`j 'MUM F Boring # ❑ Boring pit Ground surface elev. z- +� ft Depth to limiting factor ? Z 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#1 'Eff#2 )- Z IZ 3 2 I 1 i�3 — s i ► 3 `�Sb►� c� s � e&J - . S . lb`tr CSbyc \n Uq -:I l6 s lis 1 es b�c MU�'lr CS — . Lt' _lo L F71 Boring # ❑ Boring ® pit Ground surface elev. Q ft 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#1 - •Eff#2 - lb - 3B lo�>z 31� s�1 I ?�isbk � �1 — , S •B 3 3-63 l0`mvA 6'Z• s o S wt I • Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) C Signa re . CST Number Arthur L Wagerer 0�'3 220254 Address W e g e r e r Soil Testing & .Design Service Date Telephone Number 421 N. Main St. River -Falls, WI 54022 � j_S_d 715 -425 -0165 i i Property Owner Parcel ID # pEh b )U (:� Page Z of 3 Boring # ❑ Boring ❑ pit Ground surface elev. q 33.0 ft. Depth to limiting factor 8 O 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#1 •Eff#2 I o - L K) 1 Z -- sal Z �s bh v� `Pt- es3 �� . 5 .13 Z 6 ZS I 316 SLI Zh,, s 6k j 3 z S -gz I -VA — s�4Is L�sbk m04r L – •SC �1� qz-ao �.s�l Z — S osoj 61 1 C3 z C TLD S1b�AS tr 1 Q Boring # ❑ Boring F ❑ pit Ground surface elev. ��q- ft. Depth to limiting factor 3 S In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 1 0- o l o- R- z Li -- s i 1 z s b m `e►-- C ) , b Z n -3 S w-1 lZ 2z6 _ s> i 1 Zhl sbk �'�V- _ 3 3S-b'7 toYiz3l6 e�� �S�tt2 F-1 Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor In. Horizon Depth-- - --- Redox Description Texture Consistence Boundary Roots GPD fion Rate Depth-- In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Ut1 W 0 ( L! TIi W/ t�1 [Z S g L CtU�, v Z tS • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD, < 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. SBD -1330 (X6/00) • PLOT PLAN Page 3 of 3 Scale 1'= W0' 0 7 K ti �\ o a � az. fl�s7vvz.43 �' 's � � ,s • � 1B 4 � / IN` i g � ��. „-,o 3' I �,o — ,l 0''' Fo��j YO 3L UN Su lT(tB�L Avg 1b ltis��— F•lC�i rN Prl. L l p�cC ft fl kip L NN . S CA -PL3- . 31uu bin _p�-6 p� wl-LP�}_ $M -- f ou - `N ot~ pcR. Wo't...J P(. 3 r f i L0T V.Z Lo q'l -00 715 - 425 -0165 220254 00 -31S -4Z CST Signature Date Telephone Igo. CST No. Job NO. Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County S �-, L° t?- IV, complete site plan on paper not less than 8 1!2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 7 esjr,.�W G percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner C,} S , C-0 C Property Location C eQ1'ft(- bQ _TLoPM Ekj-j (°oZPor'Z-j-�-'Ti o>v 6&A K3 LQ 1/4� 1/4 S �1 T 18 N R Lq E (or Property Owner's Mailing Address Lot # Block # Subd. Name or9ftW I 1 v STZZ ET' N E , S UI) - lE )v _ PsGLE. 8 L,UF-r City State Zip Code Phone Number ❑ City ❑ Village ® Town Nearest Road �L��� I mtv 1 S5 Y 9 1 ( - ) 63) Z s - 7 - - I566 - rml• Qmp Rom © New Construction Use: Residential / Number of bedrooms 3 Code derived design flow rate 4 S 0 GPD ❑ Replacement ❑ Public or commercial - Describe: Parent material Flood Plain elevation if applicable K3 fL General comments and recommendations: )` OU K- b W� R 'Y- S v' D ts U 11 a k1 C-ELL 8 , a Boring # ❑ Boring rn Pit Ground surface elev. 94k.0 ft. Depth to limiting factor 3 1 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz in. Munsell Qu. Sz. ' Cont Color Gr. Sz. Sh. •Eff#1 I •Eff#2 ' Z' g 3 ►0`12.31b � . S! i 3 TJ� 1 L S y't Ct.V - - �� Lo V rz- 3/ �l'F 1 S - t rzslQ3 st 1 p u _ 3 1�s C) ,o �t � •O s F1 Boring# ❑ Boring _. ® Pit . Ground surface elev. C1 q-) Z fL Depth to limiting factor Z L Z 3 in. Soil APP lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ftz Munsell Qu. Sz. Cont Color Gr. Sz. Sh. •Eff#( - - Eff#2 o �o� -rrz 3l i _ St Z`�Sb►� m,`f� cam, l ,5 .$ Z -gyp LO - 1MW(, 3 yo_S �S�►Z31 — �g �eS bL t Y't v`�'4- y S3 -lZ LO`1rZVjb _ s C L: :S9 wt I _ _ 'L. 2 • Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 _< 150 mg/L Effluent #2 = BOD, mg& and TSS < 30 mg/L CST Name (Please Print) Si tune a a CST Number Arthur L. �Wegerer a L 00-3 - YI - 220254 Address W eg e r e r Soil Testing & .Design Service Date Telephone Number 421 N..liain St. River Falls, WI 54022 11_S-.;w 715 -425 -0165 Property Owner co v— P. Parcel ID # p01JtN A J G p Z o f 3' F3-1 Boring # Boring pit Ground surface elev. 5 �• S ft. Depth to limiting factor L A 2) In. ❑ ° l 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 #1 •Eff#2 o_ Ip R z!Z s L 1 Z`f'Sbk w� 1�' • s a 3 i9 -14S 10 R. S `6 l e 5 b►2 muff -- C - .6q lo`titi_Sl� �l�F rLf 2 s/e 1`Fs a w v _ , o 0 Q ^ I hJ S W c t? F-1 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 /ftz In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 • Eff#2 F-1 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 /ft= In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 • Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L • Effluent #2 = BOD 130 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. SBDQ8330 (86100) i PLOT PLAN Pa;e 3 of 3 . Scale 1'= gyp' L-0r L , i n p Q o T urq p P aorr m n eF azLL Lr- - IF S o uTLzT Ck or iytfl o �j p 3 .� 1 "'I � y Z - - �.,9 yH1G�f.3[<I�DIA:-PIiC�.A1PE`u 715- 425 -0165 220254 00 -31 S— y CST Signature Date Telephone No. CST Into. Job NO. l P. ISO • SAFETY AND BUILDINGS DIVISION 4003 N. Kinney Coulee Road Cot'T Merce.wl.gov LaCrosse, Wisconsin 54601 -1831 TDD #: (608) 264 -8777 isconsin Jim Doyle, Governor Department of Commerce Mary P. Burke, Secretary April 26, 2005 Mary Jo Hollister W 9875 690 Avenue River Falls, WI 54022 -4011 Dear Mary: RE: Soil reports and supplemental data by others I have reviewed your questions about submittal of soil and site evaluations using profile data and elevation contours collected by others to supplement your reports. I also discussed such submittals with Leroy Jansky, one of our code experts. Your submittals as they stand are incomplete. Hopefully the following guides will help clarify what more is needed and will help in the future. We agree that a CST may refer to and use data of another CST when compiling a report for a site. It is public record once it is submitted and filed with the county offices. But to do it, the entire document that the other CST had done, with his /her legible signature, needs to be submitted in order to meet the code standard of Comm 85.40(2)(b). Note that the signature would no longer have to be an original since the document is already filed and is now available for general use. (I doubt one would be able to get a signature from the original submitter) Elevation and location data must correlate. Leroy indicated that it is messy using a MSL datum and assuming elevations. You'd have to locate the BM that the engineers used or convert the contours to elevations that you are referencing to the BM you establish. So it is possible to do so if it seems to make sense. I n i without I ion I would of support using just one sheet out of several submitted inclusion f the o pp 91 signature sheet, and unless you also were to be very specific about who did it and which specific bore hole you included in your defined suitable area, etc. It would likely take a pretty concise and maybe somewhat lengthy title page to adequately cover the material if you didn't submit the entire document. Obviously the reports will get quite big with all the extra pages. Certainly it makes sense to use the previously submitted profile details, bore hole locations and elevation data in locating the individual system areas on lots after platting. But you have to be careful to make sure your submittal is a stand -alone document and that all the included data is clearly identified and referenced to your benchmark horizontally and vertically. Having dissimilar location or elevation data won't work. Personally, I think it may be harder to try to include other data in your own report than simply using it for reference and collecting your Y 9 our own. In some cases all you might need is a hand boring or two where the other data is sufficiently detailed. Expression of elevations on the contours by engineering would likely at least require establishing one of them off your own benchmark, and then incorporating the others according to the contours they had collected. SBD- 5524 -E (R. 1/05) File Ref: C:\DOCUME-I\PAMQ\LOCALS-IkTEMP\SOILREPORTSMARYJ026APRIL05—.DOC 1 Mary Jp Hollister Soil reports ' April 26, 2005 Page 2 Again, I hope this answers the questions you had (although maybe not exactly as you hoped) as well as covers the topic adequately. If there are further questions, or comments from any of you, feel free to ask. Sincerely, Dennis Sorenson Wastewater Specialist, La Crosse office CC: Leroy Jansky Jim Kleinhans Emily Lund SBD- 5524 -E (R. 4198) File Ref: C:\DOCUME-1\PAMQ\LOCALS-I\TEMMSOILREPORTSMARYJ026APRIL05—.DOC POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page L of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner m Septic Tank Capacity zev al ❑ NA Permit # �� Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer Z L ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ❑ NA Pump Tank Capacity 1'0-0 a l ❑ NA Estimated flow (average) g al/day Pump Tank Manufacturer tojIT-�r6e-Z ❑ NA Design flow (peak), (Estimated x 1.5) g al/day Pump Manufacturer � ❑ NA Soil Application Rate g al/day/ft 2 Pump Model C /Z s/ ❑ A Standard Influent /Effluent Quality Monthly average* Pretreatment Unit A Fats, Oil & Grease (FOG) 530 mg /L ❑ Sand /Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD 5220 mg /L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg /L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD,) 530 mg /L In- Ground (gravity) In- Ground (pressurized) Total Suspended Solids (TSS) 530 mg /L NA ❑ At -Grade ❑ Mound Fecal Coliform (geometric mean) 510 cfu /100m1 ❑ Drip -Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA Other: ❑ NA Other: ❑ NA * Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once ever ❑ onth(s) (Maximum 3 ears) ❑ NA p Y �i ear(s) y Pump out contents of tank(s) When combined sludge and scum equals one -third (Y of tank volume ❑ NA Inspect dispersal cell(s) At least once every: 2� ❑ nth(s) (Maximum 3 years) ❑ NA e r(s) Clean effluent filter l A J t east once eve onth(s) ❑ NA S �' �j' ❑ year(s) Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one -third IY or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event. GMW (4/01) Page Z of START UP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and /or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at -grade 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 scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and /or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWT ails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replaceme system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area 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. Barring advances in POWTS tech ology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ he it ha not been evalu d to identif a uitabla repl ment area lure a PO soil and site ion be pe or d t locate suitab repla ent o replacement area is available a ho ing tank ma e i al ed as a I st sort re ce the fails WTS. 13 Mound and at -grade it absorption systems may be reconstructed in place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. < <WARNING> > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND /OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER Name A) L Name Phone r Z7 �(� Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name C 20 / �L Z o Phone Phone - 7 1-5 - 3 9' 6 �6 8 0 This document was drafted in compliance with chapter Comm 83.22(2)(b)0)(d) &(f) and 83.540 ), (2) & (3), Wisconsin Administrative Code. I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer o��R Mailing Address Property Address �/ 1 d 1V,4 94 (Verification required from Planning Department for new construction) City /State Parcel Identification Number NO /1.00 ao o" LEGAL DESCRIPTION _ Properly Location %a, ' /., Sec. 1 - 7 , T - ZI N-R 4�1 — w, Town of 4ko Subdivision A u l e , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # � � 7 1� 7 , Volume Z U Page # z Spec house ❑ yes 5 no Lot lines identifiable 9 yes ❑ no SYSTEM MAINTENANCE Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restrictedplumber or a licensedpumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the t4ree year expiration date. SIG A O APPLICANT DATE OWNER CERTIFICATION I (we) certify that all statements on this form are true to the best of my (our) knowledge. I (we) am (are) the owner(s) of theyop described above, by virtue of a warranty deed recorded in Register of Deeds Office. SI OF APPLICANT DATE * * * * ** Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include with this application: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed I�l U. 2830 P 024 79859-7 KATHLEEN H. WALSH State Bar of Wisconsin Form 2 -2003 REGISTER OF DEEDS ST. CROIX CO.. WI WARRANTY DEED RECEIVED FOR RECORD Document Number Document Name 06/24/2005 01:50PK WARRANTY DEED EXEMPT t THIS DEED, made between E.A.E.A. Development, LLC, a Minnesota Limited REC FEE: 11.00 Liability Company TRANS FEE: 390.08 ("Grantor," whether one or more), COPY FEE: and Ryan Lau, CC FEE: PAGES: 1 ( "Grantee," whether one or more). Recording Area Grantor, for a valuable consideration, conveys and warrants to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant Name and Return Address interests, in St. Croix County, State of Wisconsin ( "Property ") (if more space is needed, please attach addendum): Lot 42, Plat of Eagle Bluff in the Town of Troy, St. Croix County, Wisconsin. Title Recording Services, Inc. 466144 79 Western Ave N 0506027 040 - 1280 -20 -000 SL Paul, MN 55102 WEST WALK Parcel Identification Number (PIN) ST. CROIX A 111111111001111111 WD This is not homestead property. (is) (is not) Exceptions to warranties: Easements, restrictions and rights -of -way of record, ifany. Dated �4 -r dS (SEAL) (SEAL) , * E.A.E. opment LC (SEAL) (SEAL) s AUTHENTICATION ACKNOWLEDGMENT Signature(s) l authenticated on STATE OF ) ss. ti+— COUNTY ) * TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me on (If not, the above -named E.A.E.A. Development. LLC, a Minnesota authorized by Wis. Stat. § 706.06) Limited Liability Company to me known to be the person(s) who executed the foregoing THIS INSTRUMENT DRAFTED BY: i strume d acknowl ge a same. Attorney Kristina Oglland S Hudson, WI 54016 * NOTARYPUSLIC- MINNESOTA Notary Public, Sta of My Commission Exxpires Jan. 31, 2010 My Commission (is permanent) (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED O 2003 STATE BAR OF WISCONSIN FORM NO. 2-2003 * Type name below signatures. INFO-PRO" Legal Forms 800 - 855 -2021 www.infoprofbrms.com I i Parcel #: 040 - 1280 -20 -000 08/08/2005 12:09 PM PAGE 1 OF 1 Alt. Parcel #: 17.28.19.1574 040 - TOWN OF TROY Current 'X: ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner O - TODD ALLEN HOMES TODD ALLEN HOMES 11291 SUNDANCE WAY WOODBURY MN 55125 Districts: SC = School SP = Special Property Address(es): * = Primary Type Dist # Description * 471 OMAHA RD SC 2611 SCH D OF HUDSON SP 1700 WITC Legal Description: Acres: 1.615 Plat: 1924 -EAGLE BLUFF 040/01 SEC 17 T28N R19W NW NE LOT 42 EAGLE Block/Condo Bldg: LOT 42 BLUFF Tract(s): (Sec- Twn -Rng 401/4 1601/4) 17- 28N -19W NE NW Notes: Parcel History: Date Doc # Vol /Page Type 02/02/2005 786489 2742/080 WD 02/02/2005 786488 2742/079 WD 04/11/2002 676064 1871/206 TD 03/27/2002 674693 1861 /599 WD 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/23/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.615 110,000 0 110,000 NO Totals for 2005: General Property 1.615 110,000 0 110,000 Woodland 0.000 0 0 Totals for 2004: General Property 1.615 110,000 0 110,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch #: Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 "Jul. 6, 2005 11 :39AM` ' CAPITAL` 1 "` "� No 3453 P. 2/2 "" JUL -06 -2006 02:23AM1 FROMI -TITLE 1WRDINO SERVICES 6612251461 T -TTO P.002/00Z P -161 R 2830P 024 -or 9ass7 em am qm Bs d T-mm 2^2003 ST C W ATMAIMITem pawimm IN NOW swap C414" SPUM 9 1 1:91!1( WA >rm l8i3 sr:rr�. 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