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HomeMy WebLinkAbout040-1252-20-000 . .._.. _ _ o @ o ■ -0 0 � §&t'§%2 � � con � k & � 0 \ ( ( ƒ ° § a / $ �- ± ; e m- 2§/ ( k k ¥ # k w a m � ® I 2: 0 9 q ° a § a § Cr ® ! 2 .� j 2? k k 2 ; w r $ §/ E to ® C E CD ° ; o E ®c 0 E @ v > % o m � / i ] ; CD & « a § & o k: % 2 0 , ° S 0 o 0 o m » 2 0 2 8 8 o S 2 / / § § § § E c ;t C § a ƒ ■ . 2 2 k o -n ° w ® K § ■ ■ ■ ~ 2 Oro M c < ® m � R > , 2 2 CL k E % > 2 { 2 = 2 ; § & § > E o 9 % ° ° - b m o = 0 (D B ; ; ƒ ID_ [ / 2 FT O v � \j ° /I2zCO) � CL z o P 2 / 2 G (D m CL / z . § § 7 z ; % > /§ / CD CD ao� ©, n =2 , §7§% ƒ R \if 2 =E, 4#�@ k cy. 2 _ ƒ k] 2f $ $ o a- % § -&s / \/% / $ƒ« a � © [ 0 G 4 % Q 0 i a � o CL � � k Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix SafQty and B•aildirg Division INSPECTION REPORT Sanitary Permit No: 4 - ' / (ATTACH TO PERMIT) 395139 0 GENERAL INFORMATION 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: Troy Development Cor oration I Troy Township 040 - 1252 - 20-000 CST BM Ele '. Insp. BM Elev: BM Description: s t TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic ZS —d Benchmark sing Alt. BM a d - - _ - - Z � 1 Aeration Bldg. Sewer j' Holding St/ t Inlet o 9 � TANK SETBACK INFORMATION t Outlet l0 . TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 725' s Dt Bott m -- Dosing Header /Man. Aeration Dist. Pipe / ♦ 9 DO. 'l Ot /- - Holding Bot. System A L p, 3 '?f. 9Z L L Final Grade /0 tr Sd' PUMP /SIPHON INFORMATION 03.0 7 Manufacturer _ d St Cover 3 C2 GPM 16 Model Number TDH Lift Fric' oss em Head TDH Ft Forcemain ength Dia. Dist. to We SOIL ABSORPTION SYSTEM s BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 r SETBACK SYSTEM TO I P/L JBLDG IWELL LAKE/STREAM LE NG Manufacturer: INFORMATION Type Of System: i OR �' I Z r 7 p i �� Model N �ber c J 4 e DISTRIBUTION SYSTEM u/' �, ,k swe� Header /Manifold Distribution I x Hole Size x Hole Spacing Vent to Air Intake �y N Pipe(s) Length a , 5 — Dia `I Length 3, Dia Spacin l 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 Ll Yes (K N Yes [] No COMMENTS (Include code discrepencies, persons present, etc.) Inspection #1: Z Y 0 inspection #2: Location: 279 Saint Andrew Drive Hudson, WI 54016 (NE 1/4 NW 1/419 T28NR Trb Village / Parcel No: 19.28.19.1323 - �l +cars 7bJt QG�:7im. a�� (A cc/s = S" ll/LtS y �pI 'Y 1.) Alt BM Description � �ao �ooi �� �^1 � 1�r`n 2.) Bldg sewer length = +� Sor� ><<51 2-3 >�P so, , d"r zp s ex:sFrd Y - amount of cover = > (�' e1cV� °�" k/a.s A ✓oar, �� 2 - 3 A< /. -f s ar - d �' � w Y)6'4s /3*S-e /aSAiF / 41 � Doriu ar..d to,4 4 --spa area �cade C Ztivl/ Gl�rtyn„ 11�r dRG� � Plan revision Required IJ Yes � No r / Use other side for additional information. D 2� ,� - !� 4 Dat Insepctor's nature Cert. No. - SBD -6710 (R.3/97) a - 7 9 An���ws 3� L 07 -7 L-) a' Y x x �� o Sanitary Permit Application Safety & Buildings Division In accord with Comm 83.2 1, Wis. Adm. Code 201 W. Washington Ave. See reverse side for instructions for completing this application PO Box 7302 14sConsin Personal information you provide may be used for secondary purposes Madison, WI 53707 -7302 Department of Commerce (Privacy Law, s. 15.04(1)(m)] (Submit completed form to county if not , state owned.) Attach complete plans (to the county copy only) for the sy of less than 8 -1/2 x 11 inches in size. County J State Sanitary Permit Number ❑ Che jl tapkYlTis xlication State Plan I. D. Number I. Application Information - Please Print all Information r' Location: Property Owner Name - V L U operty Location ..( '1. � 6 1 /4 / ,�/ � 4eve—�� C/ /fit? ✓t T f� � , / — yl.%F 4/1/4, S/9 T� RlA (or Pfppgrty Owne s MailinnnAddress/1 / S1 CfJOIX _ Lot Number 1 /LCD f Blo ;k Number rti K 6� i `j�GC/i cis S'l4 N T` CMNTY /L� 1�cTf rCr�� / City, j State Zip Code P Subdivision or CSM Number II. Type of Building: (check one) S S ❑ City )E. 1 or 2 Family Dwelling -No. of Bedrooms : 0 Village ❑ Public /Commercial (describe use):_ Frown of ❑ State -Owned Nearest Road r � 2 3 x 93 Parcel Tax Number( tl S 060 III. Type of Permit: (Check only one box on line A. Check box on line B if applicable) I . AY, 1q, 1,3-;2 A) 1. EKNew 2. ❑ Replacement 3. ❑ Replacement of 4. 5. 6. ❑ Addition to System System Tank Only Existing System $) Permit Number Date Issued ❑ A Sanitary Permit was previously issued IV. Type of POWT System: (Check all that apply) Non- pressurized In- ground ❑ Mound ❑ Sand Filter ❑ Constructed Wetland ❑ Pressurized In- ground ❑ Holding Tank ❑ Single Pass ❑ Drip Line ❑ At -grade ❑ Aerobic Treatment Unit ❑ Recirculating ❑ Other: V. Dispersal/Treatment Area Information: , e. L FL — l� 1. Design Flow (gpd) 2. Dispersal Area 3. Dispers Area 4. Soil Applicatio 5. Percolation Rate 6. System Elevatiofi 7. Final Grade Required Proposed SI ��) Rate (Gals. /day /sq. ft.) (Min. /inch) ✓ Elevation 5�v i sOr j lo w /0 VII. Tank Capacity in Total # of Manufacturer Prefab Site Steel Fiber- Plastic Information Gallons Gallons Tanks Con- Con- glass New Existing crete strutted Tanks Tanks ❑ 01 ❑ ❑ ❑ VIII. Responsibility Statement I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Ph, s Name rent) Plumber's re (nos pg 9 MP/MPRS No. Business Phone Number Plumber's Address (Street, City, State, Zip Code) IX. County/Department Use Only ❑ Disapproved Sanitary Permit Fee (Includes Groundwater Date issued Iss 'ng Agent Signature (No stamps) 1,4[ Approved ❑ Owner Given Initial Adverse Surfiarge Fee) 1W_ - Determination �? Z.z �-- 30 2txr( X. Conditions of Approval /Reasons for Disa provaI Co Ls SBD -6398 (R. 07/00) Nti 1 I D r 3 �RiCI� a N Not 6 M 57 fps' AsP�a� ` ORt i I OI kj r h I 3 z AtioR� wS D " Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05, Wis. Adm. Code Environmental By Design Attach complete site plan on paper not less than 8'h x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal referen jx*A48M), direction and _ St. Croix _ percent slope, scale or dimensions, north arrow, o(c*r pnd,1istagce to nearest road. parcel LD.# APPLICANT INFORMATION . P/e s nt mat d Personal information you provide may be used for ry pu Law, s: 15. (1) (m)). K leWed 2t)b I ty Property Owner Pro erty Location Continental Develo Govt Lot NE 1 NW 1/4 S 19 T 28 N,R 19 W Property Owners Mailing Address Let Block # Subd. Name or CSM# 12301 Central Avenue NE, Cou M '72 Troy Village 2Nd Addition City State Z'io;CoQa & W�itOi6lE E City ❑ Village [ZTown Nearest Road Minna olis MN ; ; Troy St. Andrews Drive ❑ New Construction Use: ❑ ReSidentlat4-t4 Brooms 4 ❑Addition to existing building ❑ Replacement ❑ Public or commercial describe Code Derived daily flow 600 gpd Recommended design loading rate_ .7 bed, gpdfft? .8 trench, gpdffta Absorption area required 857 bed, ft? 750 trench, fF Maximum design loading rate .7 bed, gpdffts .8 tr ench, gpdA Recommended infiltration surface elevation(s) By Designer _ ft (as referred to site plan benchmar Additional design / site consideration Parent material loess Over Glacial Outwash Flood plain elevation, if applicable ft =Suitable for system Conventional Mound In - Ground Pressure AT - Grade System in Fill Holding Tank U= Unsuitable for system ` NS ❑ u ® S ❑ u ® S ❑ U I ® S ❑ U EIS ®U ❑ S ® U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/fe Boring# Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. C�nsistenc Boundary Roots Bed Trench 1 1 0 -25 10yr3 /2 - sl 2msbk mfr cw 2f .5 .6 s 2 25 -35 10yr4/4 - sil 2msbk mfr cw if .5 .6 �— Ground 3 348 7.5yr4/4 - s osg ml cw if .7 .8 , elev 109.9 ft 4 48 -140 7.5yr6/4 - s osg ml - - 7 8 , Depth to —�— limiting factor >140 Remarks: 2 1 0-45 10yr3/1 - sl 2msbk mfr cw 2f .5 .6 � 2 45 -57 10yr3/3 - sl 2msbk mfr cw if .5 .6 Ground 3 57 -135 7.5yr5/4 - s osg ml - - 7 8 , elev 104.64 ft Depth to limiting factor >135 Remarks: CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson - 715- 246 -2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, Wl 54017 2/3/98 MO2605 25 I PROPERTY OWNER: Continental Development SOIL DESCRIPTION REPORT ® Page 2 of 3 PARCEL I.D.# Environmental By Desi Horizon Depth Dominant Color Mottles Texture Structure onsistence Boundary Roots GPD/fts in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ! Trench 3 1 0 -6 10yr3 /1 - sl 2msbk mfr cw 2f .5 .6 •Sr 2 6 -30 7.5yr5/4 - s osg ml cw if .7 i .8 , T Ground elev 3 30 -64 10yr3 /1 - sl 2msbk mfr cw - 5 6 • Y 108.24 ft 4 64 -145 7.5yr5J4 I s I osg ml - - .7 .8 . } Depth to limiting factor >145 Remarks: 41 1 0 -16 10yr3 /1 - sl 2msbk mfr cw 2f .5 .6 Sr 2 16 -30 7.5yr5/4 - s osg ml cw if .7 .8 Ground elev 3 30 -50 10yr3 /1 - sl 2msbk mfr cw - .5 .6 . s 110.24ft 4 0 -140 7.5yr5 /4 - s osg ml - - .7 ! .8 Depth to limiting factor >14 Remarks: 5 1 0 -72 10yr4 /4 - sl 2msbk mfr cw 2f .5 .6 2 72 -89 10yr3 /1 - A 2msbk mfr cw if .5 .6 Ground elev 3 89 -116 10yr4 /4 - sil 2msbk mfr cw - 5 6 -� 107.12 ft 4 116 -150 7.5yr5/4 I s osg ml I - - I .7 .8 Depth to limiting factor >150 Remarks: Ground elev Depth to limiting factor I Remarks: N BY DE A GN 1432 120`h STREET, NEW RICHMOND, WISCONSIN 715 -246 -2454 PROJECT NAME TROY VILLAGE 2nd ADDITION DESCRIPTION: NE %, NW/4, SECTION 19 „T 28 N, R19W TOWNSHIP: TROY COUNTY: ST.CROIX LOT: 72 SUBDIVISION: TROY VILLAGE 2 nd ADDITION I a re 5 ► 2 65 � SCALE I" =40' Tom Nelson BM i NE corner post ground surface elev. 100' cstmo2605 BM 2 i : : : tv i C7 -4--H -1 - r 1- : j I : I i r ff I i 1. ST CROUC COUNTY SEPTIC TANK. MAINTENANCE AGREEMENT AND " OWNERSHIP CERTIFICATION FORM Owner/Buyer Je d r5 p Mailing Address - 7 OG ! sT SST SL/0) Property Address -t 7 7 n A . v L wt (Verification required from Planning Department for new construction) D 4� City /Stat , Parcel Identification Number. LEGAL DESCRIPTION _ Property Location %4, Acv' /4, Sec., T -R_Z� W, Town of Subdivision. �r D� Lot # - 7 2 . Certified Survey Map # . Volume . Page # Warranty Deed # 574S 7 . . Volume . Page # f Spec house ❑ yes no Lot lines identifiable yes ❑ no SYSTEM MAIMNANCE Improper use and maintenance of your septic system could result in its.premature fail=ta handle wastes. Proper maizitenance consists of pumping out the septic tank every daze 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 in. the waste disposal system. The property owner agrees to submit to• SL Croix Zoning Departzent a certification form, signed. by `the owner and by a masterplumber, journeymanplumber, restrictedplumberora licensedpumperverifying that(1) the on -site wastewaterdisposal 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: Uwe,. 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 Co mmerc e 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 three year expiration date. - 7 / /o /L ( 7IA OF 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 the pro at3' cried above, by of a warranty deed recorded in Register of Deeds Office. Tt1RE 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. Private Onsite Wastewater Treatment System Management Plan Septic Tank And Gravity In- Ground Soil Absorption Component Pursuant to Comm 83.54 Wis. Adm. Code each Private Onsite Wastewater Treatment System (POWTS) shall include information and procedures for maintaining the system within the parameters of Comm 83 and 84, and the conditions of approval by the department, agent, or governmental unit. The approved plans and permits for system are on file at the county zoning or health department. This management plan complies with Comm 83.54, Wis. Adm. Code, and the In- Ground Soil Absorption Component Manual for Private Onsite Wastewater Treatment Systems SBD- 10567-P (R.6/99). Table 1: System Design Specifications Sanitary Permit Number S 1 S7 Number of Bedrooms Design Flow - Peak (gpd) Estimated Flow - Average (gpd) Septic Tank Capacity (gal) 1Z 5"a Soil Absorption Component Size (W) --m -1- Type of Wastewater Domestic Tab 2: Soil Absorptio Component - Limits of Reliable Operation Septic Tank Component Soil Absorption Component Design Flow - Peak (gpd) L I '- Maximum Influent Particle Size (in) 1/8 Maximum BOD (mg /L) 220 Maximum TSS (mg /L) 150 Table 3: Maintenance Schedule Septic Tank Inspect and /or service once every 3 years Outlet Filter Inspect once a year and clean at least once every 3 years Soil Absorption Component Inspect once every 3 years 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 (Servicing Septic or Holding Tanks, Purnping Chambers, Grease Interceptors, Seepage Beds, Seepage Pits, Seepage Trenches, Privies, or Portable Restrooms). The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. Th et i Shall be cleaned as necessary to ensure proper op r_i tion. The filter cartridge sh a removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the Management Plan for a Septic Tank and Soil Absorption Component filter is equipped with an alarm, 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 scum and sludge 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 an 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. 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 the tank. No one should enter a septic or other treatment or holding tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within the septic or other treatment of holding tank may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. Tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tank is no longer used as a POWTS component. Soil Absorption Component The soil absorption component serving this structure is designed to accept domestic wastewater from a residential facility. The limits of operation of this component are shown in Table 2. The longevity of a soil absorption component depends greatly on proper and timely maintenance, and system use within or below the limits of reliable operation. Good water conservation practices by all occupants and the installation of water conserving plumbing fixtures are key factors in extending the useful life of this component. The soil absorption component's operation must be assessed by inspection at least once every three years. The inspection shall include recording the levels of ponding, if any, in the observation pipes, and a visual inspection for any evidence of surface seepage or discharge from the component. On steeply sloping sites, areas of erosion should be identified and reported to the owner for repair. The surface discharge of domestic wastewater or sewage from the system is prohibited and considered a human health hazard. Traffic around or over the soil absorption component should be avoided particularly during winter months. The compaction or removal of snow cover over the component may lead P p Y to hydraulic failure by freezing. This type of failure is usually temporary, but is difficult or impossible to repair until weather conditions improve. In general, soil compaction over this component will reduce diffusion of oxygen into the soil and dispersal cell, which may lead to more intense, and earlier, organic clogging of the soil. I 2 Management Plan for a Septic Tank and Soil Absorption Component Plantings of deep- rooted trees and shrubs directly over or within ten feet of the component should be avoided since root intrusion into the component may obstruct wastewater flow. 3 •07/17/01 TUE 08:50 FAX 715 386 4687 REGISTER OF DEEDS Z0 02 �. =' STATE BAR Of WISCONSIN FORM 2 — 1982 ' = W s TY 0FEQ f DOCUMENT NO. UOL PACE John J. Rupmm4Te anti Barbara A. Ruemtrtelc, his wif', end t REGISr R S rIrFlt Thomas J. and t1uelBmele..11e11_L. Bue�ul4elc,. � APR d 1998: 7 crnweis and Twa a rrant eve to ment"Coc o" 8x30 Abp f- -- - -. - -- - - -- —.... e TI,I3 SaA,.Z nFSEAWFn FOR Rct:OROiNG Oars F _ _ NAME ANU aETUnN AXRESS Sure of wiin deicribed real,came In St. Croix .. _._..........__ County. �. S yw od & Cari, S.C. " 5. PACY Box 125 Si son, WI 54016 C Outlot 6 to the Plat of Troy Village, St. Croix County, AV ' p , Wisconsin. 7 /CJ Fi_1Fr'F IIrnmf- FCATION NUMBER p K Vfa- This deed is given in partial satisfaction of that certain Land Contract dated May 20, le 1997, Recorded May 27, 1997 in Vol. 1241, Page 331 -332, Document Number 559970. #EXEMP� .' Ny • This is not — homrurad propeny. k Qrslt Gs not) 1 ` ,a Ex(kpr;vn(nuarrancics Easements, covenants, r astrictions of record and liens or ; Encumbrances created by act or default of grantee, its successors and assigns. e ; ` Dated this — i ,.., day of April — — .— A.D., 19 98 —• �''•. (SEAL) ..._..c.. (SEAL) 'T « / John ( Stuernmele . Thom s � ele d Barb A. Ruem"l,e — Nall L. Rue AUTHENTICATION AC§NOWLEDGMENC Z � John J. Rui;t ela a-n Barbara A. S of W iSCOTIOU, Ruemmele, his wife, and Thomas J. Ruemmele _•`� y "te Personal! carne before me this day of rye authenticaud ...,,, da of Affil _, 198_ y _ --�— 19_ iht abmv twlmtd y T[TLE:R S R OF WISCONSIN —_.. _._.... (if not. 1 authorized by §706 06, Wis. Sias) w me known 1') I•. .e petsor( • excGUled the f xe�tm +� : a' p 1! instrument and acknox ridge the sartu. I' THIS INSTRumENT WAS DRAFTED BY Ile 204�Loc O C Locust P.O. Box 12: Hudson 0 ff' — a t r WI 54 CrRtntg lA (Stgnawres Tray be authenticated or ackn Botli are not My (rmmissirm is permanent, (if not, stau exptrAutm date. w ) ( � tLmun of perwm5 slgniag in )n)• Mould b} typed or primed below Ihcu >t malw'4 ` I STATE BAR O( WISCO NIN N"arm Lam hum "a'K wa:.trwNrr aEea Form No. 2 — 1482 Mil-ft iO We r 2 r - )2.4 gg . !00 pp W '0 S. 1 AQ ES a � 10 7 � nr. `L V 46539 S O s- w w �- 1.068 ACRES r 1 N 76 • 4 24„ l l 214. pp S.F , kCRES j ! 0 '"A t -w+ (A • � 72 V . 10-96 , l 6 48117 S.F. , ' o 8.400? 1.105 ACRES ° 0.201 0 0 OD = rn 0 a ' 0 1 a N 4° 56' QQ " S 7 • o - a_ N _ $ Igo c ra 233'$ ZA m oo 1 71 �� 44304 S .F. LT � � Qo x.47 : ; 1.017 , ACRES. 0 t M ) f 0000 w � N oa 0 . 0 0 � • 69