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040-1310-00-028
t Msconsin I DApartment of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506376 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: DCCI Land Planners LLC I Troy, Town of 040 - 1310 -00 -028 CST BM Elev Insp. BM Elev. BM Description: Section/Town /Range /Map No: 17.28.19.2015 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER • ''"7 CAPACITY STATION BS r I FS ELEV. . p f IZ. oZ ti p • ZI A bt `f vz • ill Septic Benchmark jj X361 Alt. B )r , 3 l 3 .1 Aeration - "" m ' Bldg. Sewer b7 /V Holding St/Ht Inlet ` 2 �� $ • 9 � TANK SETBACK INFORMATION St /Ht Outlet •155 95�8. TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet \ 6mJq1 J� Septic Z7 ' Dtot�� ; Dosing _____ Header /Man. 3.11 •8l Aeration Dist. Pipe 9.3 Holding Bot. System e Final Grade PUMP /SIPHON INFORMATION ' k- w ' • t � Manufacturer Demand St Cover GPM C.J ' f •3t 953 Model Number - TDH Lift Friction Loss System Head TDH Ft 7, 1 3 Ic� Forcemain Lenbtkt Dia. Dj' o Well - ., -- SOIL ABSORPTION SYSTEM BED /TRENCH Width Length 1 No. r` f Trenches PIT DIMENSIONS No. 1 0f Pits Inside Dia. Liquid Depth DIMENSIONS / (X+ j r12•.+.. C.. � _ p SETBACK SYSTEM TO � P/L BLDG WELL � LAKE /STREAM LEACHING Manufacturer: n ,� INFORMATION CHAMBER OR OcSI Type Of System: UNIT Model Numb G i ++11 t . t D �d Al A ... . ' er R C- 3 A �AN,Nk +ti row l H DISTRIBUTION SYSTEM f�a Zd y = T6 d-e� K, Header /Manifold t / Distribution x Hole Size x Hole Spacing Vent to Air ntake�, Pipe(s) i J Length Zy _ Dia Length _ Dia Spacing - SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed /Trench Center .� - Bed/Trench Edges Topsoil 2 • �-! �� Yes L No Yes No COMMENTS: (Include code persons present, etc.) Inspection #1: / ! Inspection #2: I / Location: 320 Meadow Ridge Court Hudson, WI 54016 (SW 1/4 SE 1/4 17 T28N R1 9W) Meadow Ridge of Troy Lot 28 Parcel No: 17.28.19.2015 1.) Alt BM Description = • :_ Lb 2.) Bldg sewer length = I (` amount of cover ,ti-� ��� a 3 C OV, 44 Plan revision Required? _ ;Yes No Use other side for additional information. Date Insep or Sig �ure Cert. No. SBD -6710 (R.3/97) vvv 1 � commerceml.gov Safety and Buildings Division County 201 W. Washington Ave., P.O. Box 7162 �T� �C� t X t i o - epartment Madison, WI 53707- 7162 Sanitary Permit Number (to be filled in by Co. ) s e o n s n of Commerce i5o (P 3 Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission, of this form to e ap ri A+ governmental unit is required prior to obtaining a sanitary permit. Note: Application forms fo tate -o d roject Address (if different than m ing address) POWTS are submitted to the Department of Commerce. Personal information you provide may b sed�� secondary p urposes in accordance with the Privacy Law, s. 15.04 1 (m ), Stats. C � j I. Application Information - Please P ' t formatio G l/ Property OwnerN+i/\ Parcel q k• T_ t o Q-O -1 S\ o -O n - O �-SS Property Owner's Mailing Address J•+ Property Location / Z-0 t"A 2 \o c>-E Lok C Zo��j Govt. Lot Cit , State Zip Code j Phone Number S W , , k, S�= 1 /4 Section %4_0 Svt-►, k-ADk 5'q -0 k(. (circle one) II. Type of Building (check all that apply) A pk Lot A T Z-g N; R Fso D ' R' 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name 1 1 -3 u6% .: Or e. cW Blockq P'1\�a \C.c.ats cot�20� ❑ Public /Commercial - Describe Use �. tn(GL ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of 1 �- 5-Town of III. Type of Permit: (Check only Ime box on line A. Complete line B if applicable) A' 51Jew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B • ❑ Permit Renewal ❑ Permit Revision ❑ Change of ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner (L� ,11 + , J„j� ` IV. Type of POWTS System /Component/Device: (Check all that appl V U `s 5 L O CAA L3 N on- Pressurized In- Ground ❑ Pressurized In- Ground ❑ At -Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treatment Area Information: Design Flow (gpd) j Design Soil Application Rate ( dsf) Dispersal Area Required (sf)� Dispersal Area Proposed (sf) System Elevation gi4•q c1 S5.q(Q13.q 1 931•C( VI. Tank Info Capacity in Total q of Manufacturer Gallo Gallons Units c New Tanks Existing .r g Tanks A/ 8es/ r;11', a U in n Septic or Holding Tank t ZS-� t ZSb t W n %M Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for ' tallation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature /MPRS Number Business Phone Number �� k &.A. \4 -<LL\j. 1-4 &T k�� ttt, Tvzxi Ck _+ Plumber's Address (Street, City, State, Zip Code) N - 1-60 C akt►ti-K 2 o rk�� L , L (�r �l V `Lt? ��1 Sit �3� VIII. County/Department Use Onl Approved Perm Fee J Date I sued Issuin gent Signatu e N-Owl err Given Rea for Denial $ ! ✓`� ���z� 07 IX. Condi*ffi'RffW 0V*%1WReasons for Disapproval on 1. Septic tank, effluent filter and 3, Tz CGS r 4- ••� . dispersal cell must all be services / maintained ) Q as per management plan provided by plumber. ✓ L•Qrt� (�Q, / GMtii 2. All setback requirements must be maintained ✓ ( U I' at per applicable code / ordinances. Attach to complete plans for the system and submit to th County o ly on pa er not less t an 12 x 11 inches in size n n SBD -6398 (R. 01/07) Valid thru 01/09 .516p ; a 00.1 . e�AW4r -. c4? o CJ'+ c� > rp bo N� 111 s �� �, � �� ✓ a f ' 1 � 1 f J � CAS l a CT c 0 9 v 11 � � 3 j J _ a cy 0 mil © O ev rte^ J N f (4 0 J o ° o ck Qj N�1 o 'J° CA r f_ C-4 s �-�/ � a N - _9 (p 1p k o 1 � er o- fY qr � � 3 00 k .�J s o l 13, It l 'q V.9 i i � a x r a f L/I LA d f v . s J d � - d o j d d d t d 7 o � 0 o J v S O `� 7 ORIGINAV #2631 SCOItSi11 OIL EVALUATION REPORT Department of Comme accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and B n Certified Soil Testing, LLC ' County Attach complete site plan on paper 2 x 11 inches in size. Plan must St. Croix ?r include, but not limited to: v n horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. 040-1310 Please print all information. Revie d By Date Personal information you provide ma be-ase acy Law, s. 15.04 (1) (m)). �� Q Property Owner Property Location Bescup, Terry & Kathy Govt. Lot / SW 1 /4, E1/4, S17, T28 N, R 1 9W Property Owner's Mailing Addres Lot # Block # Subd. Name or CSM# 320 Meadow Ridge Court 28 Meadow Ridge Of Troy City S to ZFpTC6&0 limber ❑ City ❑ Village ® Town Nearest Road Hudson Troy 1 320 Meadow Ridge Court ® New Construction Use: ® Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe Parent material loess over pitted till Flood plain elevation, if applicable NA ft. General comments 10'x 60' rock cell mound on 936.9 @ 0.4 gpd /sq ft basal loading or shallow in- ground trench system @ 0.3 and recommendations: gpd /sq ft loading w/ system elevations 2. ' below surface contours FT Boring # ❑ Boring ® Pit Ground surface elev. 939.3 ft. Depth to limiting factor > 90 in. ISoil Application Rate Horizon Depth Dominant Color, Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eft #1 •Etf#2 1 0 -4 7.5YR 3/2 - sil 2 m gr mvfr Cs if /m .6 .8 2 4 -21 10YR 3/6 - sl 1 m sbk mvfr gs 1m .4 .7 3 21 -40 10YR 3/6 - sl 1 m sbk mvfr gs im .4 .7 4 40 - 60 10YR 4/4 - sl 1 m sbk mvfr gs 1m .4 .7 5 60 -90 10YR 4/4 - s 0 sg ml - - .7 1.6 P 3 has Is inclusions; H4 has thin bands I & 44ras regular sl bands; mound is optimal system for this site; deep sand not consistent or - 2� F Boring # ❑ Boring ® Pit Ground surface elev. 936.9 ft. Depth to limiting factor > 78 in. ISoil 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 1 0 -10 7.5YR 3/2 - sil 2 f sbk mvfr Cs if /m .6 .8 2 10 -14 10YR 3/4 - sil 1 m sbk mvfr gs 1m .4 .6 3 14 - 10YR 3/6 - sil 1 m sbk mvfr cs 1m .4 .6 4 33 -43 10YR 3/6 - sl 1 m sbk mvfr cw 1m .4 .7 5 43 -53 10YR 4/4 s 0 sg ml Cw lm .7 1.6 6 53 -78 7.5YR 3/4 D - sl 0 m mfr - - .2 .6 All elevations relative to assumed 952.1 at Nelson B -3; oversize in- ground trench system to account for textural variations; B6 has some s inclusions ' Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg /L Fffluent #2 = B < 30 mg /L and TSS <30 mg /L CST Name (Please Print) S natu T CST Number Henry F. Grote I 222774 Address Certified Soil Testing, LLC Date Evaluation Conducted Telephone Number E. 4366 353rd Ave. Menomonie, WI 54751 10/16/2007 715- 233 -0398 y, SBD -8330 (K07 /00) r,` Property Owner Bescup, Terry & Kathy Parcel ID # 040- 1310- 00;b28 Page 2 of 3 3 [I Boring Boring # pit Ground surface elev. 934•$ ft. Depth to limitistiq factor > an:. Soil Application Rate factor Horizon Depth Dominant Color Redox Description Texture Structure Consistence Bourn` oots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. :.,,, "'"" • *Eff#1 'Eff#2 1 0 -7 7.5YR 3/1 - sil 1 f -m sbk mvfr cs if /m .4 .6 2 7 -22 10YR 3/6 - sl 1 m sbk mvfr gs lm .4 7 3 22 -40 7.5YR 3/4 - sl 1 m sbk mvfr gs lm .4 ,7 4 40 -80 7.5YR 3/4 - sl 0 m mfr - - 2 .6 of mound is optimal system for thi ite; versize in- ground trench system should work w/ good maintenance Lj F 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 I i If mound option is used, recommend 10' x 60' rock cell on 936.9 as upslope edge of rock w/ 0.5' sand fill @ 0.4 gpd /sq ft basal loading via individual site design w/ 2:1 slopes L] 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 I � I i If shallow trench system is used; recommend 5 - 3' x 80' leaching chamber trenches on contours with distribution box for equal loading; dry weather conditions for installation to minimize smearing of sides & bottoms 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 altemate format, please contact the department at 608 -266 -3151 or TTY 608 -264 -8777. SBD -8330 (R.07 /00) Certified Soil Testing, LLC - II v c4 3 � J ( f C J J 2 � f l l rl tA 1 _ \ �n a' Gn of CA o ^^ y � 1� i 00 i k a � 0 _j I i LOCATION SKETCH MEADOW RIDGE OF TROY TOWN OF TROY FINAL PLAT OF: S &N LAND SURVEYING INC. LOCATED IN PART OF THE SE1 14 OF THE SE1 /4, PART OF THE NEIA OF THE SE114 , PART OF THE NWt /4 DOUGLAS J. ZAHLER OF THE SE1 /4, PART OF THE SWIM OF THE SE1 14, PART OF THE SWt /4 OF THE NE7 14 AND PART OF THE 2920 ENLOE STREET SEI /4 OF THE NW7 /4 OF SECTION 17, T28N, R19W, TOWN OF TROY, ST. CROIX COUNTY, WISCONSIN. HUDSON, WI 54076 4 ih9 .,c444b 4du6 I mres PREPARED FORT nsr eo b� jecli4ns 1 p m wi pea 14 OCCI LAND PLANNERS INC. ROno Scc9. 236.15,236,16,236 20 and 236.21(1).,d (2). 1505 HW Y 65 Wiv St- as provided by 5. 236.12, Wii, SSm NEW RICHMOND, WI 64017 SECTION 17, T28N, R19W o6pan nrndl4 i.vaN1,� m .... � t + LOT 31 + + , X93 HN. ""'°.,,,,6...94 t 524 `n lwl 1..1"�>=16F..J t LOT 30 / 05 LOT 20 °••��• a ��2� / ♦ / 0�4 9 / ? m �� / /��,.•'� // N IDENITIFICATION I;U OF SLOPES 20% �� AND GREATER Is m 4 a {{ I / / 'r!• / i N � 5 W q� SCALE IN FEE'( 1• = 100' m r CURVE DATA TABLE (AU IEN91N5 AnE W FEET) r j , ) RBI .g 'o j r ® Curve Wedu. CwlVd Olor6 fAO4 N< T-1 B6aF9. O \ I u I 100 0 100 mew/ wl (.19u Aede e.wu9 (� u (.1vu Tmgw11 u 7mgn1 al wI am Wl 196).002955'.' MI}'Jx4 1 S6J 1027.52 N6pld3eY .511718 "F 3154.000978']9 53,40'424 920.x4 12114 561]5014 5113871 p g �1 1 \ 560 °42'50 "E 1mm .m.. C] O.L 10 30 7.00 05' .". III - V00.54 1960) 'I.." 1.7921'514 M733J'10"E aF,' ¢4< \\ I 297.86' 1mv 1 t C4 g1.1130]].0019'3W3r I W5rE .0.H 590.53 N72-WE NWIVWE \ 90.00 91'3X2e S)T W4 71.61 79.90 5 IeW SMl1'b'E .31 wo \I CS 3330D 0620'11' 5167.1.4E 40.11 69.65 5)11'364 51053 al i° \ w°( OUTLOT 5• WO+ CO 4)3 46).00 2 W E 2 VII 19`W .10.1] 211.94 9b52'094 5. m \ Asa \ CONSERVA4g1 MEA OWNED ' C) .00 2455'07 53422'50.54 293.61 501.67 51471 5511r04•E \ .3 HERS 00 0)91 52'50V 2 5109 55.12 15151411 145t•S 521 SSO - ']SIJ'E oD.L. 6 \ T •, a A550 LION IJJ.00 )253'21' sJ9VG215'E 145.15 1.655 SIIZ]'IJ'E 53/27044 1.695117',/) 4 15 •{ C6 ]17.00 7014'52' S 14' ']I•E .539 167.5] 53656 S IIW4 4 29 ]11.00 36'48'15• 31514.49.,E 15 146b 53156 SI15D'424 \ 16 • 4 \ 9005 :e m740 0W37' 516W,2&VE m.n 1'1.23 su3W42Y Sa92r9,E 36>.0o 48 1.19• sn29 us•E a.ee 4110 wnxWe 51158 CR OCUS. CPO_ • {• \ t °µA�y,EH co 99.90 459410• SWSS'u•w eLJZ 62.93 S.36 SW174f'W cl1 4,•19 • N75723' 54 113- 3n 0 S] rH'w NWW'33'W HILL RD. p ° H��L "'/ \ wO r ° w• '� ""'° 2.1 mo n - 2.Ols•E 9591 loxes slo•1rH's sull'sJY A, 2. - 955927 58611'36.5 109.11 120.01 1 1.50 23 60. 00 2419'46' Nb'13 13.91 34.20 NSW40UT N-V54% 655W2r H16'40'40.5'1V 109.11 120.07 14 6 5'544 N59'10 10 N]I1 "Z. N37W'265'W 61.32 6x93 N5WW35'W N14*W24'W C. 317.00 0611'19' U-51 1..51 H14 W2YW H"'Wo'W Q r § LOT 2 \�41 yl c14 36100 ]013'54 N135WJ1'w 200.07 II=kl WW N3nW5rW n.\ s 1 ]6x40 1e•4W' m N21 110.M I1621 H66nb5'w H]SM'W = g m `11 '\ '. 38 �':J'-"`rV O.L 5 0]SWb' .1650 %4 24.15 "'W"1•W N3aW57 N , 1 a2 OF W;S� '% CIS 211A0 a]OS']6' N0 11XSIT 26184 314.70 N=%I'57W 1..14'394 m4 OyLV� C16 J]J.00 I5}5'SW N]r4W4WE 18.9] )). HH16'WF 0'NY N e459.2]'E 2)648 \ 4 F, O.L S 3] IV 08141'3]' N -VI 35.13 4 NHZ6']9Y NX11'b'E SP - ]100 OT I'OS' .24•.•1154 41.1) .' N]Wll'NT 20 ] 1.110'414 M SJN636yIf'�7Y i4 Lt9 X104 1698'32' 5832,794 75 ;!;o 202.1. sl]l9'10'E WE .1. 09 V W .4715 79106 116.27 .96 1WE 30233 O 1 \\ c16 20 56).00 173421' H625W -VW 171.10 171.75 1.88721,E S7411'IWE �?, t9 581.00 4021'05" N54IV 5•W ]91.12 399.32 57416 103SSI4Y - LOT 28 \ 1 � \L /J 0.L 556).00 ]ID3']4' H1BRJ'SYW ]Olb T. 5]355'.4 .112'.'E I I \ \' \\�NF'�)/ C20 67).00 335'53 51971 3561a 584.19 SO332 WIVE LOT 21• as33.. s33.. . m Upy1V 1V.1 ne.eo inwo sox $9s� P au ue r 217.00 2,)9'52' S21'W WY 101.4) 10658 5)550'JS'E 5070 1 , •J �� �5 C31 263.110 29'39'5' X2110`1.19 140.11 141.56 NOJId WW .555512', 19 I {�$ ( \ >, f1.,.. C23 59700 Sri)'S2' .''.'w 521.7] ]26.21 H33W rW NO33 WW 311. NS O i 1 O 6*�. ��1{ .wn66rY WJ.00 0'28716' 29rl e'W 7].2' 73.8] .3530'54, 1.2824'04', c:a QL 4 561.00 25']1'24' N15'3V22 : W 250.50 -Is N2e74'o4 No25'a RR3 ]'57' N24']4']6Ww 48609 -41 NO352'40'W NH}e'3rW \ 00 9]3. 1510'04• N102r42'W 187.06 161.5) 1.035'40', 24189x'.', 9 a N 83.00 913'53' 2W'.1'w -71 111.Po N992H'W .616'17, r LOT 27 1 „1 r \� m°o C21 547.0 "Bros• 050 )37.61 M147 H4o "ro64 x812'1•12.4 w , �j,'IP 11 ,7.00 3351']0' SCJ6'WE 200.93 20227 1.1011'064 N6 50).00 1616']8' 5'5 14 "E 161.50 181. 1.6192'.6 w 9 43).00 17'11'55' .1141 14.1 I1I.96 IN- 1.8119 He357'11E �psCHENi, _/ �� \\ 1 x`_21 OWE _ Z F�v ]0.00 014,49' 5 7]2]585 " 91)5 2 1.10 2 5) ]57114 SJS'J9'SaG I) , e6W'�� 11 2uu1 2505 54130544 6oeu4bsC 51722'51', .131 96.79 s39314•35•E 5125WJ1'w 06'36'11' S- 11'51.WW 55.]2 55.37 S7350'J1'W 51119'12', W3 513.00 41111" S6030'O 404.1 9'W 5 413.05 WIZ9'IYW S4 l*N'W LOT 26 / � ! /� 1 ^ 3)3.00 041329• 57lr27.5•w 43.91 4302 -'W'2'- 57)W4rW 10 573.00 18 Ser46 16565 196w1 41'5' -w -I.." LOT 22 / e 573.00 1615'5]' S49lr1 'w IR.69 16241 555165,, 540 . W. 67).00 ]n2•te' N11WZYw 424.1. 435.00 .516'14')2 56612'20', 133.00 011519• NS Vsx5'w 111) 1187 HMSIeW N53W3rW JY CII '' / b 9 61).00 2035'54 1.614'19', 229.96 1]115 X5W']XW N1126'23'W ��yy R 1 7 63).40 1255'49' .6034'19.5', 14155 14215 "416 X6712'14', L AS'�y9 / :Sfi / v •1 9 67).00 0 W.' 24,29'34, 41.03 4).03 N6711'leW Sa6Z'20'W 58 / T j.''dd e C3. 59100 I91W22' N 22 60.] 88'29'W 19 .1.15 5961 2WW N7]IWIWW 131X55' N W'414W 1]0.65 130.96 SW221WW ..6 445 LOT 25 NHY , \ . 5s lm 0594'2)' M531bLWW 50.x0 5.21 N)573'4WW N»IWIWW LB-2- ..0 : � /' 7 / '� 0 C35 367.00 5W41'2W NI35WJ7'W 100.1. SM.W H7319'17'W 24.'31 1 \ / W' e367- S67 564'N' 9'25 ]85 4W 1.." .07 .1119'1)', 1.10141.'19 m \ % O.L 3 367.00 01'.r])' N157W 55 11.19 11.19 1.1619'1.', N14'31'STW Cie 513- 25W'12' N-IVYW 2)9.6] 241.90 N1411'57'W N -I'W'W ryry/ LOT 24 U'ryl d1 ^'\ 1 6 C]) 26700 0,20'11' NM7r15'w ]691 3663 N- 3"ll'Is 24)211'5,, / 180 -9260 ` \ V CJe 30.00 4616)1 N1391'IWE 41.85 H.31 .-l'-'W MW � 167.00 131VW S.Sr" 61.88 81.82 SJIIWI'W 5.14'355 0. r coo 19100 B]91']W SOx9'S1'W DS.W tl0.42 SH16 S Wln BENCH HMN: lOP ( / �1 1 \ 1 1 JO 29100 46')5 521 W'O9'W 22).90 2..2' S -WIs'IN 502,.21 O.L 6 193A0 w = 5013'.4 Ir1.30 180.33 SO20021 SJW39'57E CII 167.00 3749'04 S7X44! 1•W 94.35 9555 S5T1919'W Nenl C42 3 04 2'1, N73'H01'E I—. SBn11TE 1.57,29 5 2)300 O,9-5r NarIW]rE 16.01 18.97 S tlS .5521 H -916.0 W a f V ; LOT 23* \ ()t��vl 29 2)3.00 2-12' Nll7t'OSY 111]4 114.19 Na57a N5T '2PE s6 / o-�,` 7 N0 r OUTLO 5 oMEO * OUTLOT S* \ \ \ A� ` � S R EawNEH mrylV CONSNVA- MEA OWNED f3�'.� �\ )" =1 % SSOCIA- a - OCIA WNERS y. CA w n ASSOCIAIN)N AB: f `- ..- ..- .._.._.. _ .. 1.894 118.39' - -� / YCCpi. BENCH YMN: lOP / 1007.6'_. J�11 OF AWYINUY � V 51/4 cOR. LNUYOlT, 1.6654'19 "C 1119.46' SEC. (7 f1EVA90N 916.5 588 °54'19 "W 1622.12' _SpI7H uNE OF IHE SEI /1 I I I UNPLA "C'LL�) 1.AN DS I I I Ws Hsmaw(NT oRATtm By wwAY MANE ace xo. noel -os oAre m/al /zws REWSm: o9 /4e/2oo3 SHEET 3 OF 3 SHEETS 1 P; F � , • ' POWTS OWNER'S MANUAL MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner u-v Septic Tank Capacity ItTb gal ❑ NA Permit # Septic Tank Manufacturer ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer et ❑ NA Number of Bedrooms 100 d/bedroom d, ❑ NA Effluent Filter Model F t ❑ 1,.; Number of Commercial Units NA Pump Tank Capkcity gal ® NA Estimated flow (average)* 4a-o al /day Pump Tank Manu r p NA Design flow (peak), estimated x 1.5 + to u-0 ' I/da Pump Manufacturer p NA Soil Application Rate 4 o,s 'al ft Pump Model 6 NA Pretreatment Unit p Influent/Effluent Quality (NA❑) Monthly Average - ❑ Sand/Gravel Filter X at Filter Fats. Oil & Grease (FOG) < 30 mg /L ✓ CD Mechanical Aeration etland Biochemical Oxygen Demand (BODs) t / [3 Disinfection ther: Total Suspended Solids (TSS) < 220 mg /L v Manufacturer: 5 250 m L Dispersal Cell(s) el: Pretreated Effluent lity + ++ Q O Monthly Y Y Avera e 8 Biochemical Oxygen a ODs) TS In- ground (gravity) [0 In- ground (pressurized) 5 30 mg /L E) At-grade ❑ Mound Total Suspended 'ds (TSS) < 30 mg /L D Drip-line Fecal Coliform ometri ean) D Other: 10'cfu/l00m1 D Leaching Chamber Manufacturer Maximum Effluent Particle Size 1/8 inch diameter Model �2� 1l_ Approval Stipulation *Wastewater Flow Verification on and calculations: Soil Application Rate o gpd/ft� Area Req. (Other than bedroom based) Absorption Area Credit per unit ft j Minimum Number of Chambers "Z 0 ❑ Aggregate Desi w/Loadin Rate= ft' " Values typical for domestic (non - commercial wastewater Materials: all materials must comply with WI Adm. Cod: and septic tank effluent. COMM84 and be installed per manufacturers specifications '•'Values typical for pretreated wastewater. and approval letters. DESIGN CRITERIA ❑ "Wisconsin At -grade Soil Absorption System, Siting, Design & Construction Manual" (Converse et.al.1990) ❑ "Wisconsin Mound Soil Absorption System: Siting, Design & Construction Manual" Converse, J.C. and E.J. Tyler. Publication 15.22 ❑ "Design of Pressure Distribution Networks for Septic Tank -Soil Absorption Systems" Publications 9.6 ❑ "Design of Conventional Soil Absorption Trenches and Beds ". R.J. Otis - ASAE Publications 5 -77 and "Design Manua I - Onsite Wastewater Treatment and Disposal Systems ". EPA 625/1 -80 -012 October 1980 ❑ SBD - 10570 -P (R.6/99) "At -Grade Component Manual Using Pressure Distribution" ❑ SBD - 10567 -P (R.6/99) "In Ground Absorption Component Manual" ®'SBD - 10705 -P (N.01 101) "In Ground Soil Absorption Component Manual" Version 2.0 ❑ SBD - 10628 -P (N.6/99) "Recirculating Sand Filter System Component Manual" O SBD - 10656 -P (N.6/99) "Split Bed Recirculating Sand Filter System Component Manual" ❑ SBD - 10572 -P (R.6/99) "Mound Component Manual" O SBD - 10691 -P (N.01 /O1) "Mound Component Manual" Version 2.0 ❑ SBD - 10595 -P (R.6/99) "Single Pass Sand Filter Component Manual" ❑ SBD - 10657 -P (R.6/99) "Drip-line Effluent Disposal Component Manual" P P P ❑ SBD - 10573 -P (R 6/99) "Pressure Distribution Component Manual" ❑ SBD - 10706 -P (N.01 101) "Pressure Distribution Component Manual" Version 2.0 ❑ Drip -line Effluent Dispersal Component Manual for Multi -flo Onsite Wastewater Treatment Units MAINTENANCE AND MANAGEMENT MAINTENANCE MONITORING SCHEDULE Service Event Service Frequenc Inspect condition of tanks At least once every ❑ months 9 ears Maximum 3 vrs i Pump out contents of tanks When combined sludge and scum equals one -third 1/3 of tank volume Inspect dispersal cells At least once eve ❑ months C ears Maximum 3 � ; Clean effluent filter At least once every ® months ❑ year (s Inspect pump, pump controls alarm At least once every ❑ months ❑ ears 0 NA Flush laterals and ressure test At least once every ❑ months ❑ ears LZ NA Valves At least once every ❑ months ❑ ears ® NA Other: At least once every ❑ months ❑ ear (s) p NA ,j START UP Page Z o( 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. t/ OPERATION The property owner is responsible.for the operation'atid'ifigihieriance of the'POWTS ind submission of required reports. The quantity and quality of the wastewater stream will affeathe perforrriance4nd lorigeirity of your POWTS. The installation of water-saving appliances and fixtures along with prompt repair of leaks reduces the wastewater volume. Also the brine or waste from water softeners, iron removal units, other clear water treatment devices and foundation drains should be discharged to the ground surface whenever possible. Note: this does not include laundry waste, - showers, dishwater, etc. ✓ This system is designed to handle domestic strength wastewater, however the disposal of food based greases and oils, vegetable /fruit peels and seeds, bones, and food solids such as those roduced b a gar P y e dis osal should g g be minimized. Toilet � P o let tissu ' e is the only paper that should be discharged into the system, Other non - biodegradable items such as baby wipes, tampons, sanitary napkins condoms, cigarette butts, dental floss, and cotton swabs should not enter the system. Chemicals such as petroleum products, paint, disinfectants, pesticides, antibiotics, solvents, etc., should not be flushed into the system as they can seriously damage your POWTS and contaminate your drinking water supply. Maintain a regular steady flow by spreading laundry washing throughout the week. Avoid vehicle traffic over all system components. I Compaction of snow over the dispersal unit may cause it to freeze up. i O Valves Valves shall be operated in the following annex: I C3 Alarms Alarms should be tested on a regular basis the home owne . f an alarm sounds, contact an individual licensed to service POWTS, There is normally a . l day res en d er regular operatin nditions, however water should be conserved until any problems with the system are correc ed to prevenfback•up of sewage in the dwelling or surfacing. INSPECTIONS Inspection p on shall be made by an individual carrying ne of the followin g licenses or certifications: Maintainer or Se g fications: Master Plumber Restricted Sewer, POWTS Main to a Servicing Operator Plumber, Master P 8 $ p (per the attached Maintenance Schedule). Septic Tanks Component Tank inspections must include a visual inspection of the tank 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 backup or surfacing of effluent . Access openings used for service or assessment shall be sealed and/or locked upon completion of service. Any defects shall be promptly corrected. Exposed openings greater than 8 inches in diameter shall be secured with an effectiV e locking device to prevent accidental or unauthorized entry into the tank. When the combination of sludge and scum in any tank exceeds one -third (1/3) 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 NR1 13, Wisconsin Administrative Code. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to manufacturer's specifications. Provisions are to be made to retain solids in the tank. Filter cleaning may be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. 0 Pump Chamber/Treatment Tanks Co onent The inspection must include a test ° 11 electrical equipment such as pumps, alarms and floats. A visual check must be made for leaks, backups, su irig;'mis ' or lirokeri security devices and other hardware and the condition of the filter. Any service needs or repa s shall be prompt en care of. Page 3 of 3 Wn- Ground Gravity Component Dispersal Cells The inspection shall include recording the levels of ponding, if any in the observation tubes and a visual inspection for any evidence of surface seepage or discharge. Any discharge to the ground surface must be promptly reported to the regulator authority. Ponding at depths greater than 75% of the height of the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. D Mound, At- Grade, In- Ground Press The inspection shall include reco g the levels of pondin , any in the observation tubes and a visual inspection for any evidence of surface seepage or disch e. Any dischar to the ground surface must be promptly reported to the regulator authority. Ponding greater than 75% of t height the component may indicate overloading or impending hydraulic failure necessitating more frequent monitoring. The pressure distribution system is pro ' ed with a ening at the end of each lateral to be used for flushing. The laterals should be flushed at least once ever ee (3) years. Pr ure checks of systems with multiple laterals should be done to ensure that equal distribution of fluent is occurring to promote the longevity of the system. REPORTS Reports for maintenance, inspec ' n, and monitoring shall be submitted in accordance with COMM 83.55 Wisconsin Administrative Code. ABA NDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to ensure that the system is properly and safely abandoned in compliance with Ch. 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 um in all tanks and it shall p p g, pits s 1 be excavated and removed or their covers removed and the void space filled ith soil, g ravel or other inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: 1.'5�iA 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 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. O A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technolog a holding tank may be installed as a last resort to replace the failed POWTS. C3 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. O Mound and at -grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltran\ e 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 GASES 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 Name Phone \s - - Z-2z ,- "Ss\ Phone SEPTAGE SERVICING OPERAT Pum er LOCAL REGULATORY AUTHORITY Name Agency Phone Phone \S'— 3 52 b- 4-b S Z o t � wlsoonsin Department of Commerce IL EVALUATION REPORT P age 1 of 3 Division of Safely and Buildings in a with CoWn 85, We. Adm. Code -. countly Attach complete site plan on paper n 81 i St. Croix include, but not limited to: vertical and I pole Parcel I.D. Pending nt:!a— I - - v. v:::•.°rn �:�. .....H. w nA 1_ n� �:�....e M w wbw .n.A Please print a ir►trrm n. S r P 2 1 2005 n Ur u Personal information you provide may be used for secondary pu (Privacy Law, s. 15.04 (1) (m)). Property Owner ZONIN do DCCI Land Planners Inc 1/4 SE 1/4 S 7 T 28 N R 19 E (or) W Property Owners Mailing Address Lot # Block # Subd. Name or CSM# 1505 HWY 65 I 2R I I Meadow Rid of Tm_v City State Zip Code Phone Number []City []Village ■ own Nearest Road New Richmond I Wl 1 54017 1 ( ugy I East Cove Road El New Co whiction Used Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD n Repiacement rl Public or commercial - Describe: 17..'t matoxfal Loess over E lacial till Fkxxf Plain nkmahnn if annlirahle 1T A it 1 General comments and recommendations: 5 ►�, .5 I1 R f l w. _ t 1 Bing U [a Pit Ground surface elev. 941.68 n Depth to limiting factor in. Rate Horizon Depth Dominant Redox Description Texdxe Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 'Era2 1 0-10 10yr3/2 - sil 2msbk dsh as 2f .6 .8 1 2 1 10-29 I 1 r.-AIA I - I sil I l msbk I C I r.w I If 1 .4 I .6 I 3 29-62 7.5yr4/4 - is Osg dl cw _ .7 1.6 4 62 -140 7.5yr4/6 - s Osg dl - - .7 1.6 I I I 1 I I I 1 I 1 1 2 Boring > 140 # Boring 0 B 950.19 a `• Pit Ground surface elev. ft. Depth to limiting factor in. Soti Application Rate Horimn Depth Dominant ZcQ Redox Desc riobw Texture Structure Consistence I Boundary_ I Roots GPDW I I in I M IalaPll I (311 Si r'.nnt ' r A r I I r;r S7 Sh I I I 'FfRp1 I 'FfW — 1 1 0-30 10yr4/4 - sl Ifgr ds as 2f .4 .6 2 30-50 1 /6 - is Osg dl cw _ .7 1.6 3 50-90 5yr4/4 - sl Om dh cw _ .2 .6 on_l10 /Y 5 1.0 � 4 � , �� 1V Y � I 11 S I �'� I Q � I I I I � I Effluott #1 = BOD_ > 30 < 710 mall and TSS >30 < 150 moll ' Eflluent 02 = BOD_ < mg /L and TSS _< 30 mu& ('.4T NmTw Twaeo Prim — - S4innahlrP �_ r--,T m.■ @. Thomas C Nelson '�— 227387 Address Date Evaluation Conducted Telephone Number 1432120th Street, New Richmond, W1 9/18/05 715- 246 -2454 Property Owner DCCI Land Planners Inc parcel ID # P ending 2 3 Page ❑ � # P B trin9 Ground surface elev. 952.09 R Depth to limiting factor 100 i in. Sod Application Rate Horton I Depth I Donnxt Colod Redox Description Texture Structure Consistence i3ourxtary Roots GPDM ( ( in. ( Munsed ( Qu. Sz. Cont. Color ( ( Gr. Sz. Sh. ( ( ( - Eff#1 -002 1 0 -7 10yr3/2 - sil 2msbk dsh as 2f .6 .8 2 7 -50 5 4 - sl I fgr dsh cw if .2 .6 3 50-100 5yr7/4 _ £s Osg dl cw - .5 1.0 4 1(N) -140 5- Rui'a ( Boring* W, out n L Lj Pit iiround sunace elev. tt. uepm to Inning factor in. Appl ication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. - Efr#1 *01102 1 1 1 1 1 1 1 1 1 1 1 1 F-1 Boring # Boring pit Ground surface elev. ft. Depth to limiting factor in. Sod Application Rate Horizon Depth Dominant Redox Description Texture Stnx3um Consistence Boundary I Roots GPDW in. Munsell Qu. Sz. Cont Color Gr. Sz. Sh. - C-01 -Eff#2 ' F86 wnt s1 c Finn > in < ?m rywnA and TSR >In < 15n mnA ' Fflh cant ik7 a Rrlr1 < 3n mnA aryl TSR < 3n nrfA 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- 2648777. SBD4Mor-r Ia.mroo> DCCI LAND PLANNERS, INC. ® SOIL BORING Lot # 28 - MEADOW RIDGE OF TROY SW 1/4 OF THE SE 1/4 OF SECTION 17, A BENCHMARK T28N, RI 9W, TOWN OF TROY, ST. -TOP OF CONDUIT, CROD( COUNTY, WISCONSIN. ALT BENCHMARK • -TOP OF CONDUIT TOM NELSON CST - Lic. # .227387 H NOTE THE CONTOURS IDENTIFIED ARE PRIOR TO CONSTRUCTION. ENVIRONMENTAL BY DESIGN 1432 120TH ST. CONSTRUCTION GRADING WAS IN �•.H\� PROCESS DURING SOIL TESTING. • NEW RICHMOND, WI 540.7 7 CONTRACTOR MAY NEED TO = I CONFIRM FINAL CONTOURS ph. # T15 246 -2454 DURING INSTALLATION. • `° ~ �. gl SCALE IN FEET 1' -40' _ � y 100 0 100 ►may 3 "E 78. NB- 52. 9 \ 4 � � t � 95 .09 � 8 1 a2 - \\ 111/12/2007 04.21 17153861002 DIVINE CUSTOM H301ES PAGE 02 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address P•O 2�0 O K) XMJ a o t S O A 14Z) Property Address 3 c&-O t1q eC") o Vo' 1 4v�5on ► S a (Verification required from Planning Department for new construction) City/State 4 so rl l �,� t Parcel Identification Number Oy 0 — 13 O DO — LEGAL DE SC ON Property Location SW A, S ( 7 a/, , Scc. 1 T At6_N Ra -W, Town of I C Subdivision ~ irmi Lot # a Certified Survey Map # , Volume , Pagc # Warranty Deed # '? g5 0 S -- o volume D'73 1 . Page �5S i Spec house yes �`� Lot lines identifiable �. ,SYSTEM BUOTENAANCE Improper use and maintenance of your septic system could result in Its premature failure to handle 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 afi'cct the function of the septic tank as a treatment stage in the waste disposal system. Owner mai itenance tespoassibilities are specified in § Cotton 83.S2(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix Canny Zoning Department a certification form, signei by the owner and by a master plumber, journayu mt plumber, restricted plumber or a licensed pumper verifying that (1) the on -site tt water disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is b = than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage a system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, Sta of Wisconsin. Certification stating that your septa stem has been maintained nwst be completed and returned to the St. Croix County Zoning Depaj#nt within 30 the a year expiration date. I 121 2 607 SIGNATURE 01rAPPLJCANT DATE OWNERCERT IJAV cenify that all Ownients on form are true to the best of any /our knowledge. Uwe amlars the ov Pner(s) of the pmp desc bo , bf"v' of a deed recorded is Register of Deeds Office /, /22/ Zt91� SIC} ATURE OF APPLICANT DATE sus••. Any information that Is misrepresented may result in the sanitary permit being revoked by the Zoning 10 epartment. ,r•... Include with this application a stamped warranty deed from the Register of Reeds Office and a copy of the certify sd survey ntap if reference is made in the warranty deed. b UM/ l0 zvvo Vo; oo rAJ 110 440 '6W40 Ut'+nxi%,& t vxrAmm1 wi uUS • 785�DS3 U Z 7 31 it. >rALS ✓ sr. Cam ° Co. IWI MMIYM FOR RECORD ' LVWM=WAIi1RANi'YDX%D ft /1412M 6 1140 M VaRRARTY OCED Docwacat No �.. HC 15• t N AM rg: iR95�. tIR Tbb Decd nz:da betar= v � u G0�'Y Fes: COWANY, I Minnesota IN� C ants PA � 3 DCCt LLD PLAPiPM" Whoeisttb. Ttmt ft sa Gra ntor caa"tc C mum certain rent amw in don F.�Inb► m of Wisconsin. loop' bxltO (the "Property"), Togotber with all and singulau' hm!editamoota and appurftmOe9 themuoto belan&g. Tbia oyance is without warretrty, C=Pt ara voor covirn ots end repractft the Tai LD,: Grantor tm not made, done, executed or • seed aaY act ors R " described property any 1Rrt at eny t= hm4er, shall or may be irnperikd, charged 'or =0uwb0rvd in' 'my mj=cr, and Crraator wiD warrant title m the abovo-d0m*t d PtUPCM a$iust.au PKSM claiming the same from or t3mmugh oQr�s howevor, that the con veywoce hereby made and the a result of any much act or t]tiAg. Pr set fortb tioa p,��ha'bit 8 beteto. waira o of O =tor is fvutltec' )imitcd by Kd subject to timsc DeAd this — day of Js:uua'y, Zoos. VALL%y LAND COMPANY, A 11 corpora ' - ACKNO�YLBDC�I STATE 0 )SS COUNTY OF - -----� . 205, the above flamed CsnTY 13- vall as perroually baforc canc:C rue ties day of ranuary, a Minnesota ccxporatiun, having full authority to do s4 and p of Valley Land ho executed the, foreOmg ins<<cu::eot and aanowlodgad the to me known to be the parao _ sarn fiq Stare' of f