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HomeMy WebLinkAbout040-1295-70-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safett*nd Building Division INSPECTION REPORT Sanitary Permit No: 430695 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: Weick, Anthony & Monica Troy Township 040- 1295 -70 -000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town /Range /Map No: 00 O Tb d 19.28.19.1699 TANK INFORMATION U ELEVATION DATA TYPE MA UFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark fie - I 25& 5. n a s.z /001 Dosing � � Alt. BM Aeration Bldg. Sewer . S 0 07 Holding St/Ht Inlet .o0 8' . Z TANK SETBACK INF RMATION O ✓in k-O ryc- car - [,��i 2� St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 32 � 028 All Dt Bottom Dosing r Header /Man. Aeration Dist. Pipe 6.s g9, Holding Bot. System r Final Grade PUMP /SIPHON INFORMATION S S G f t r Manu ac ure Demand St Cover GPM Model Number S a TDH Lift Friction Lpss System Head TDH Ft 3. . rl ' a �L ►�3 Cr Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS / / l // 2 SETBACK SYSTEM TO P/L BLDG 7 WELL LAKE /STREAM LEACHING Manufacturer: INFORMATION Type Of System: CHAMBER OR M,10 36 q� / f UNIT Model Number. DISTRIBUTION SYSTEM Header /Manifold # Distribution f x Hole Size x Hole Spacing Vent to Air Intake / JJ // Pipe(s) / I! / 3 or L DiA Lengt Dia f h Spacing 3o S /f ` 3 S u SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only a 0lf5 Depth Over Depth Over xx Depth of xx Seeded /Sodded j xx Mulched Bed /Trench Center / Bed/Trench Edges / Topsoil ' / Yes No Yes x1Jo COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: .5- S / Ot �L_ I Location: 378 Mitchell Road Hudson, WI 54016 (NE 1/ , SE 1/4 19 T28N R19W) Trebus Valley Estates Lot 7 ,, ��P11a --rcel No: 19.28.19.1699 �v 1.) Alt BM Description = 10'e_ 6PY_ /`� E Gvrrt.� �'� y) 2 /Agvt. fad' o 2.) Bldg sewer length= �L - amount of cover = 7 /(,pu / O-s't Plan revision R f . es ! No Use other side for additio nformati l t! I SBD -6710 (R.3/97) Date Insepctor's Signature Cert. No. Safety and Buildings Division County e 201 W. Washington Ave., P,O, Box 7162 Madison, Wl 53707 - 7162 Sari Permit Number (to be filled y Co.) ed ifl b - N_Vm nsin (608) 266-3151 � 3d 9 ) Department of Commerce State Plan I.D.Num 090 Sanitary Permit Application ' In ecco with Comm 83.2 1, Wis. Adm Code, pen ana information you provi oay be used for secondary p urposes Privacy a I mia (lxm) Project Address (if different than mailing address) I, Appllcattoa banon - Please Print All information Parcel N Lot N Property "P vmer's Name property Location Property Owner's Mai ass � Alt /� S 1 ( rt y,, S4 ' /�, section Zip Code Phone Number City, rate 1 / /aircle u POP 5r711 Z T _9 R o� IL Type of Buildi g (check all that apply) Su 'vision} Name , CSM Number s 4 1 or ? Family Dwelling - Number of 00m; — sc _ - f#�, -1: r., -- O PubliclCommercittl - Describe Use / ❑City_ ❑Village ownship of O State Owned - Describe Use 10 , k 60 III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ❑Replacement System C1 T eatment/Holding Tank Replacement Only ❑ Other M to Foisting System New System- o B. O Permit Renewal (3 Permit Revision ❑ Change of ❑Permit Transfer to New list Previous Permit Number and Date issued Before Expiration Plumber Owner 1V, Type of POWTS S stem: k all that a l 0 Single Pass Sand Filter ❑ O Non - Pressurized In -Oroun Mound > 24 in. of suitable soil ❑Mound < 24 in. of suitable soil ❑ At -Grade Constructed Wetland ❑ Pressurized In- Onound C3 Holding Tank C3 Peat Filter ❑ Aerobic Tteatment U C) Recirculating Sand Filter C3 Recirculate i S thane Me" Filter C] Chamber ❑ Drip Line ❑ Gravel -less Pi ❑ Other (explain) V. Dis ersal/I'resttnent Area . 1 formation: R od (sf) Dis I Area Proposed (st) ystem Elevation Desi Flow (gpd) �. Oita So plieati4o te(gPdsn is e 9 QO Manufsc Prefab Site Steel Fiber Plastic Vi. ank Info Capscityin Total Number Concrete Constricted Glass Gallons Gallons of units New fi:Wng Tanks Tartly, Septic or Holding Tank Aerobic Trcutmeru Unit Du,, -K Chamber V11. Res bUl Statement - 4 the under ed, a e s nsibW for ins of the PoW rS shown on the Btu Phone Number Plu Name (Print) PI : Si Plumber's Address (Street, City, State, tip C y { r (57 lv 0 9 ! Ij�' P Idwt ►�-t V111. County/ artment Use Onl Sanitary Permit Fee (includes Groundwater Date Issued suing gent Signatur No Stamps Approved ❑ Disapproved Surcharge Fee) - ❑ owner Given Reason for Denial 7 �� IX. Conditions of Approval/Remons for Disapproval SYSTEM OWNER, Septic tank, effil.164W and dispersal cell must A a serviced / maintained as per management plan provided by piumbef, 2. All setback requirements must bq UNiftained as per applicable code /ordinances. Attacb eompleu plans (to the County cols) ra,.tbe ryrtem oa paper sot ku than a1R t 11 latbei in t • e SBD -6398 (R. 01/03) r , .a 1 1 y. t, t• �`y�..t :t � . fie`:. PAGEj-OF g . NAME : fit,` - LOT#_ - - LEGAL DESCRIPTION;f lb S I /4,SjLT�N,R, ' SCALE: 1"= �D - I �n ELEVATION: jDQ - N FIT BM I DESCRIPTION: T " ® * `� BM 2 ELEVATION: BM 2 DESCRIPTION: v SYSTEM ELEVATION: SYSTEM TYPE: r \o` x 6 e ck � a d o��� st DATE: SIGNATURE: i I i I II I I I �'^ , ��� Safety and Buildings 4003 N KINNEY COULEE RD LA CROSSE WI 54601 -1831 \*is T DD #: (608) 264 -8777 consin w w w.comm www.wisconsin.gov www.wiscon isconsin.gov n.gov Department of Commerce Jim Doyle, Governor Cory L. Nettles, Secretary January 29, 2004 CUST ID No. 139462 ATTN: POWTS Inspector I TODD L SINZ ZONING OFFICE T L SINZ PLUMBING INC ST CROIX COUNTY SPIA E5609 708TH AVE 1101 CARMICHAEL RD MENOMONIE WI 54751 -5520 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 01/29/2006 Identification Numbers Transaction ID No. 965090 SITE: Site ID No. 670351 Anthony & Monica Weick Please refer to both identification numbers, CTH F above, in all correspondence with the agency. Town of Troy St Croix County NEIA, SETA, S19, T28N, R19W Lot: 7, Subdivision: Trebus Valley Estates FOR: Description: Proposed Four Bedroom Mound System Object Type: POWTS Component Manual Regulated Object ID No.: 940530 Maintenance required; 600 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade Systems: Mound Component Manual for POWTS -Version 2.0, SBD- 10691 -P (N.01 /01), Pressure Distribution Component Manual for POWTS - Version 2.0, SBD- 10706 -P (N.01 /O1); Biofilter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: • This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for POWTS - Version 2.0 "; SBD- 10691- P(N.01 /01), and the "Pressure Distribution Component Manual for POWTS - Version 2.0 ", SBD- 10706- P(N.01 /01). • A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • Comm 83.22(7) - A copy of the approved plans specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. UFZ ditional i ±' 4 P` PR "D vp- P. UEPARrmAr._ • TODD L SINZ Page 2 1/29/04 Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • Comm 83.52(1)(a) - The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • Comm 83.52(2) - A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, &461� Fee Required $ 175.00 Fee Received $ 175.00 Gerard M. Swim Balance Due $ 0.00 POWTS Plan Reviewer - Integrated Services (608)- 789 -7892, Mon. - Fri. 7:30 am to 4:15 pm jswim @commerce.state.wi.us WiSMART code: 7633 cc: Leroy G Jansky, Wastewater Specialist, (715) 726 -2544 Henry Grote r Anthony and Monica Weick - Mound Construction Materials and Techniques � All materials must comply with Comm 84 and be installed in accordance with manufacture specifications. Construction methods must comply with the following Component Manuals: s Mound, SBD - 10691 -P (01 /01) Pressure Distribution, SBD - 10706 -P (01/01) Location: Lot 7, Trebus Valley Estates NE 1 /4, SE '/4, Sec. 19, T 28 N, R 19W Town: Troy County: St. Croix Date: January 28, 2004 Owner: Anthony & Monica Weick Address: 8481 Marsh Creek Ro Woodbury MN 551 Plumber: Todd S' z Signature: License : MP 139 Attachments: SBD -10577 - Plan Approval Application SBD -8330 — Soil Evaluation Report Page 1: cover 2: design criteria & calculations 3: plot plan 4: system cross section yr COMWFRCE 5: plan view, lateral detail u'visloN OF SAFE Y AND BUILDINGS 6: pump tank exit detail 7: pump curve 8: system management SEE GORRE ONDENCE page 1 of 8 I�; y � Design Criteria Residential Wastewater Contaminant Load: 30 m < BOD < 220 mg/L Anticipated septic tank effluent 30 mg/L < TSS < 150mg/L Fecal Coliform > 10,000 cfu/100 mL Fats, oils, grease < 30 mg/L Bedrooms x 100 gal/bedroom/day x 1.5 6 0-0 gallons /day hydraulic load Design Calculations In situ designed loading rate 0 44 gallons /sq. ft. per day Depth to estimated high ground water I in. Depth to bedrock " in. Cross slope at system % Force main length ft. of 2 in. Manifold/header length b ft. of in. Drain -back -+' a e ( gallons Lateral length S6 ft. of �`IZ in. Lateral elevation , ft. @ bottom of lateral Lateral hole size ' A 6 in. @ a in. ( 3 �� ft.) Spacing l -:+ holes /lateral 1 holes total Lateral volume gallons Total lateral discharge rate 3 6 b gallons /minute @ 2 ft. head i Network pressure compensation losses ft. Elevation difference 13 ft, Friction loss � ' 1 � ft. @ � S gallons /minute Total dynamic head Pump /si)�hon 4 4' gpm @ 2 ° ft. of head Manufacturer eA°, Model # s Z Dose volume gallons Lift/4hon tank (.o gallons Septic tank gallons Effluent filter a� (�'�`' �„ pY o F ` c�gZZ' `4-'Q Ya Measurement pump on and off o in. Height alarm from tank bottom (b , 0 in. Reserve capacity gallons specs.calcs.res Page Z of g PAGE_!� OF 8 NAME: Loa'C L LOT# - :7- LEGAL DESCRIPTION : /4S!JI /4,Sia_TlN,R, ILE(o�W f SCALE: 1 "= �D ELEVATION: 1DO BM I DESCRIPTION: Logo er� e�a� r�2 C BM 2 ELEVATION: BM 2 DESCRIPTION: SYSTEM ELEVATION: T $ 0 T' SYSTEM TYPE: YV1 91, r-A - \ O x 6 0 v o t V g� c 6to Vo �j SIGNATURE: DATE: 1 �I I 9 ` 3 �. 46�f_ b'' �a.1 c..., Z 0. w. \ � b i�bco:1 3 k{ N i I I V. I . v - fi -- o ' 2 Iz.tl 0 4' % Ab .... «� �• `. � t.�� b�r I L 1 ` 1 P VC SC� Oro 4L ", a IL Sb .o' ��!, b � �'1 �1 t� c r. 1 .� A.a. � 0.0..•. � Q.�. � c c .., 1. ; ., t.,,,� [�. (� Z � O A �-� l 3 S i �sl > o.bb �, = 33,lib w �,� •1 i�� c t . s WEATHERPROJF LOCKIWG GOVfiR JUNcT` °" QVICK D14C.OVV CT --1 c, --�- T G K .. >e 1 W 4° PIPE 3' rip NDIbTua8E0 °" SOIL, 24'' T. M. I I e" 40 hwadr wL..o � a.r7vc.0 A o� lrFN SlC>:T )Wr,, W F L E RLI. P^ 4 a .l AL 3 o—C Go KN E LT 10 P-44 ON — i I+Wta�:`Ja: JQ I C c 1 n Clete. 1+ \�Q/v :h Owt�a. S O �J o v 0'r 2aCo Cs r `• 6 � tZ. • 14 QA pwyP D t CoNt.RF 6 4L 0 c /=h SEPTIC f _ SPEC IFI }V� DOSE T A kj MAkJU FACT UiLCR: IJUMBER OF DOSES: � � _ PE K . _ TAIJK SIZ C : �'l� .-+3-0 GALLOWS DOSE VOLUME v g _ A�A0.r1 /'1IJJUFACTUiIGR; Sc'1 v,\a�y` IIJCLUOIWG 6ACKFI.OW: \b CAPACITIES; A= IJJCHCS OK JWITCH TyP[: IucHES OR Gur^,P MANUFACTURER: �oe. 1J 2 C • 511 IucHEJ OH ^ - MOOEL ►JUMDCR: D INCHES OR \Sj b3 SWITCH T!lPf: �MQ.��.i.v w _uQr_E: PUMP AWD ALARM ARC TO 6C MlwI IMUM DISCHAK" RATE '� GFM INSTALLED O SEPARATE CIKC VC0.7ICAL DIFFCR DETWEEU PUMP OFF AUO OIJTRIbUTIOW PIPE., 13 S FEET (� + M ►JCTWORK SUPPLY PRCSSUAC . . . , , . FCCT�'�� + 4� FEET OF FORCE MAIN X z � g F� \, 1\ IooltFRICTIOW FACTOR. FEET t — TOTAL Ot WAMIC. HEAD s gb FEE T IIJTERUAL 0 IMEfJ610tU>c OF TAWK: LEkl(&TH ;w DTH ;LIQ DEPTH • TOTAL DYNAMIC HEAb /CAPACITY HEAD CAPACITY CURVE PER MINUTE EFFLUENT AND DEWATERING U , MODEL 152/153 w W MODEL 152 153 UJ 50— Feet Meters Gal. Liters Gal. Liters 153 5 1.5 69 261 77 291 12 40 152 10 3.1 61 231 70 265 0 15 4.6 53 201 61 231 a N�� I _ 20 6.1 44 167 52 197 30 8 - � 25 7.6 34 129 42 159 o 30 9.1 23 I 8 7_ _ 33 1 a 20 35 10.7 -- -- 22 85 40 12.2 -- -- 11 42 4 10 Lock Valve: 38.0 Ft_ (11.6 ,. ) 44. F (I 3.4,)! 014 0 20 40 60 80 100 GALLONS LITERS 0 80 160 240 320 e '/' 3 27132 4 5/8 y FLOW PER MINUTE e ! j CONSULT FACTORY FOR SPECIAL APPLICATIONS 3 27/32 • Timed dosing panels available. OD e 3 2/32 • Electrical alternators, for duplex systems, are available and supplied with an alarm. 1 • Variable level control switches are available for controlling single phase systems. • Double piggyback variable level float switches are available for variable level long and short cycle controls. �— • Sealed Qwik -Box available for` outdoor installations. See FM1420. • Over 130 °F. (54 °CJ special quotation required. 1521153 Series 5 1521153 MODELS Control Selection - -� Model volts -Ph Mode Amps Simplex Duplex I 1 _Nt52 15 1 Non 8.5 1 2or3 T 5 BN 152 I 115 1 Auto 8.5 Included 2 or 3 E152 230 1 Non 4.3 1 2 or 3 1 —J— SK2064 BE 152 230 1 Auto 4.3 Included 2 or 3 N153 115 1 Non 10.5 1 2 or 3 BN153, 1 15 1 Auto 10.5 Included 2or3 SELECTION GUIDE BE1 1 230 1 Non 5.3 1 2 or 3 1. Single variable level float switch or double p iggyback variable level float BE 153' 230 1 Auto 5.3 Included 2 or 3 9 p iggyback p 99y switch. Refer to FMO477. o CAUTION 2. See FM0712 for correct model of Electrical Alternator E•Pak. All installation of controls, protection devices and wiring should be done by a Qualified 3. Variable level control switch 10 -0225 used as a control activator, specify duplex (3) licensed electrician. All electrical and safety codes should be followed Including the most recent National Electric Code (NEC) and the Occupational Safety and Health Act (OSHA). or (4) float System, o� a RESERVE POWERED DESIGN oS For unusual conditions a reserve safety factor is engineered into the design of every Zoeller pump. MAIL TO: P.O. BOX 16347 Z Louisville, KY 40256 -0347 Manufacturers of. . O SHIP TO: 3649 Cane Run Road /- ® Louisville, KY 40211 -1961 Qua /TY PUMPS SINCE /9,95' http://www.zoeller.com PUMP L O (502)178.2731.1(800) 928 -PUMP FAX (502)77 4- 362 4 C Copyright 2000 Zoeller Co. All rights reserved. System Management Management of this 'system is critical. As a condition of approval of these plans this system management section must be reviewed with the owner, and the owner must be provided with a complete set of plans including this management section. If problems develop with the adsorption system or any other system components, the installing plumber, T.L. Sinz Plumbing, 715-235 - 2644, or the St. Croix County Zoning Office, 715- 386 -4680, should be contacted for assistance. General Proper functioning of an on -site disposal system, "septic system," is significantly dependent on the volume of water which flows into the system and the level of contaminants in that volume. The lower the volume of water and the lower the level of contaminants, the better and longer the system will function. Typical system components include a septic tank or compartment to settle out solids and contain greases and oils, a filter on the outlet of the septic tank to retain small particles of the same density as water, a pump tank or compartment to allow a dose to be accumulated, a pump and controls, and finally some type of soil adsorption cell to recycle the water in a manner to protect ground water quality and public health. 1. If the septic tank is installed prior to sheet -rock and /or painting, pump the septic tank before normal use begins to ensure adherence to contaminant load design criteria. 2. Install water- saving appliances whenever and wherever possible. 3. Repair even small water leaks as soon as possible. 4. Never pour grease or oil down any drain or stool. 5. Garbage disposals are not recommended; if you must have one, use it sparingly 6. No paper products other than tissue should go into the system. 7. No chemicals should go into the system. 8. Avoid surge flows of water; try to spread laundry throughout the week. 9. Septic tank effluent must be less than or equal to the design criteria specified in page 2 of these plans. 10. If septic or pump tanks are no longer used, they must be properly abandoned. 11. If construction timing and weather could create a frozen infiltration system, weather - proofing with plastic sheeting and heavy mulching may be required to maintain a functional system at start-up. Maintenance 1. The septic tank must be inspected every three years by a properly licensed person. 2. If necessary, the septic tank must be pumped to remove solids and scum; pumping is required if the combined scum and solids volume equals one third of the tank volume. 3. When the septic tank is pumped, any solids in the bottom of the pump tank must be pumped, and the filter must be back - washed into the septic tank to remove accumulated material. System use may require more frequent filter cleaning. 4. Periodic observation pipe inspections should be made by the homeowner to examine the state of the in -situ soil adsorption cell. Quarterly inspections are recommended; a licensed plumber should be notified if effluent is consistently ponded in the adsorption cell. 5. If this system contains specific treatment components other than those mentioned here, maintenance requirements will accompany their specifications. 6. The pumping components for this system include an alarm which must be installed and remain on a separate circuit from the pump. If the alarm is activated, minimize water use and notify a licensed plumber for service as soon as possible. The system allows reserve capacity to accumulate some necessary flow until normal service can be restored; this volume is minimal, and no more than one or two days should pass before any necessary repairs can be made. 7. Avoid compaction such as vehicle traffic within 15' down -slope of the adsorption system. 8. Avoid disturbing the system itself such that might encourage erosion or disturb the required seeding of the system. 9. Particularly avoid winter traffic such as sliding or snowmobiling which might compact snow and lead to increased frost depth. 10. Surface drainage must be diverted around the system; avoid landscape changes which might send surface run -off into the system area. 11. Warning: Do not enter septic, pump or other treatment tanks; death may result because they may contain lethal gases or insufficient oxygen. Contingency Plan Wastewater monitoring of volume and quality is not a normal requirement for low effluent strength systems; such monitoring may become necessary if problems develop. Any necessary monitoring shall be done in accord with the requirements of Comm 83.54 (2). Pumping and hauling of wastewater may be necessary while analysis and repairs are implemented. Additional testing, designing, and /or installation of additional treatment components or conversion to a holding tank may be necessary. Page 8 of 8 Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County S-� , Oro; x Attach 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. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. - O 6 Please print all information. awed by Dat Personal information you provide may be used for secondary purposes (Privacy Low. s. 15.04 (1) 2 j2fl Property Owner Property Location �- M © n A�- Govt. Lot IV C 1/4 ILr 114 S J4 T 2g N R 19 E (ore Property Owneed Mailing Address Lot # Block # Subd. Name or CSfM , T 4 / 8 ' 1 M-,-,gk r 7 7 City State Zip Code Phone Number O City ❑ Village IS Town Nearest Road ( ) I N F �( New Construction Use: I@ Residential / Number of bed s Code derived de ign flow rate 4 f 5-6 GPD ❑ Replacement ❑ Public or commercial - Descri : 11 �c. Parent material / ctrl r 4lo8d Aai-Z n A �ation i applicable General comments and recommendations: SYS7ti"'� 2 t ev ! g. © v ST. CROIX COUNTY C GS 1 _ . , G1 ZONING OFFICE I Boring # ❑ Boring ® pit Ground surface elev. 7• U ft. Depth to limiting factor 6 7 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 - Eff#2 D - ll 1 D r 312 5L 2 rn rn xr C I V; is V r `1(1 SL 2 ,r s bk rryi�t' c vv — F J • q 3 --5D Ib vr W-5 SL 3ms ry i S �-► - /p �3 F/ F - 7.5 y / .3c 1 O►r, -'; — FTI � # Boring ` ® pit Ground surface elev. -7 • d ft. Depth to limiting factor 3 2 in. r*Eff Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. #1 'E ff#2 '0-9 10 r3/ -- 9 1 2 b rr4 CS l .5 , S 2 9 1 y r L1 13 _ s I 1 2 rr , t - fi r ' - C l 5 3 I t.p 32 (O y r --- S L 2 m ­C� C w 4 32 a to y r 4 /& ClF'7, 5 yr /4 - . i.2 Efrluent #1 = BOD > 30 < 220 mg& and TSS >30 < 150 mg& ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) - _ Signature CST Number Address Date Evaluation Conducted Telephone Number I Property Owner tC Parcel ID # Page of 3 Bori ❑ Boring 1- 3 1 pit Ground surface elev. q�. ft. Depth to limiting factor 55 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 t o•-io I Y r.312- 2 r c I 5 9 Z to-1 1p I-I --- SL 2 ro f4* -pr c I v-P 5 9 3 15 -211 10 S/ SL 2m-sb1< ry Cw Ivy , 5 �1 to — t_J�> C w - 5 c 1 5 '6 & — S G i - - .7 1.Z Boring # ❑ Boring a [] pit Ground surface eiev. ft. De to limiti P� n9 factor in. Soil — Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Being # ❑ 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/fti In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 I Effluent #1 = BOD < and TSS >30 < 150 < , y , �/� < mg 1L Effluent #2 BOD 30 and TSS 30 /� 8 > 30 220 _ 5_ "^.Y� _ "'STS 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. seo.asw t LW) PAGES OFa NAME: Lo-&!CL, LOT#�_LEGAL DESCRIPT'ON;Sf l /4SW1 /4,Sj- TZ,LN,R,ff E( SCALE: 1"= ELEVATION: 0 n / BM 1 DESCRIPTION: ,l- BM 2 ELEVATION: BM 2 DESCRIPTION: x SYSTEM ELEVATION: TV, 0 SYSTEM TYPE: � 0 06 elck q / SIGNATURE: DATE: / Z y O Y 1500 F SOIL EVALUATION REPORT AA4 zd s � Wisconsin Department of Commerce page 1 of 4 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code A.C.E. Sal & Site Evaluations Attach complete site plan on paper not less than 8' %x 11 in inrsit . must County St. Croix include, but not limited to: vertical and horizontal refer igt;m "dm p aQd Parcel I.D. percent slope, scale or dimemsions, north arrow, ce:toti�efi road. 040 - 1078- 20 -000, ID #19.28.300 Please dt tall inf on. F ' P � Reviewed By Date Personal information you provide may be used for puipalLv, Property Owner / ion J.T.B. Properties, L.L.P. C/O John W. ie n C NE 1/4 SE 1/4 S 19 T 28 N R 19 W Property Owner's Mailing Address ST G+'h- Lot # ,r ' Block # Subd. Name or CSM# 1564 West University Avenue Trebus Valley Estates City State Zip Code ,! rtY ) Village lei Town Nearest Road Saint Paul MN 55104 1' ' ' Troy County Highway T" 0 New Construction LIM ]0 Residential 1 Number of bedrooms 3 Code derived design flow rate 450 GPD �;,; j Replacerner t _ j Public or commercial - Describe: Parent material G lacial drift _ _ Flood plain elevation, if applicable n a General comments and recommendations: Recommend installing mound system at elev. = 100.39' at 14" above 99.22' contour. Boring # J Boring Id Pit Ground Surface elev. 100.89 ft. Depth to limiting factor 63° in. Sod Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft *Eff#1 *Eff#2 1 0 -11 1Oyr3/3 none sl 2fsbk mvfr as 2f,lmc 0.5 0.9 2 11 -21 7.5yr4/6 none sl 2msbk mvfr cs 2f,1 m 0.5 0.9 3 21 -34 1Oyr4/6 none Is 1msbk mvfr ai 1f 0.7 1.2 4 34 -39 5yr4/4 none scl 2fsbk mfr aw 1f 0.4 0.6 5 39-63 1Oyr4/4 none sl 2msbk mfr aw 1vf,f 0.5 0.9 6 63 -76 1Oyr6 /4 f2d 7.5yr5/8 s Osg dl ci 1vf 0.7 1.2 7 76-86 1Oyr6 /4 - L.S.B.R. - - - - 0.0 0.0 M sm Baring # Boring Pit Ground Surface elev. 99.16 ft. Depth to limiting factor 22 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe *Eff#1 *Eff#2 1 0 -10 1Oyr3/3 none sl 2fsbk mvfr as 2f,1mc 0.5 0.9 2 10 -14 1 Oyr4 /3 none Is 1 msbk mvfr aw 2f,1 m 0.7 1.2 3 14 -17 1Oyr3/3 none sl 2fsbk mvfr aw 2f 0.5 0.9 4 17 -22 1Oyr5/4 none Is 1msbk mvfr aw 1f 0.7 1.2 5 22 -27 1 Oyr4 /3 f2f 10yr5/6 sit 1 msbk mfr aw 1 vf,f 0.2 0.3 6 27-40 1 Oyr3 /2 none sl 1 msbk mfr cs 1 f 0.4 0.6 7 40 -56 1Oyr3/3 none sl 2msbk mfr cw if 0.5 0.9 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >3(- mg& t #2 = BOD <_30 mg/L and TSS < ,0 mg/L CST Name (Please Print) Sign ure: CST Number James K. Thompson o.,� 3602 Address A.C.E. Sal & Site Evaluations Date Evaluation Conducted Telephone Number 340 Paulson Lake Lane, Osceola, WI 54020 12/5/01 715- 248 -7767 property Owner J.T.B. Properties, L.L.P. C/0 John Parcel ID # 040- 1078 -20 -000, ID #19.28.300 Page 2 of 4 F2ajBoring # J Boring f6 Pit Ground Surface elev. 99.16 ft. Depth to limiting factor 22" in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 8 56-63 7.5yr4/4 f2f 7.5yr5/8 sl 2msbk mfr cs - 0.5 0.9 9 63 -96 7.5yr5/8 m3p 5yr4 /6 Ifs Om mvfr - - 0.4 0.6 F # Boring .J - Pit Ground Surface elev. __ 98.56 ft. Depth to limiting factor 25" in. Sal Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots *Eff#1 *Eff#2 1 0 -9 1Oyr3/3 none sl 2fsbk mvfr as 2f,1mc 0.5 0.9 2 9 -17 1Oyr4/4 none sil 2fsbk mvfr cw 2f,1m 0.5 0.8 3 17 -25 1Oyr4 /4 none Ifs 1msbk mvfr aw 1f 0.4 0.6 4 25 -29 1Oyr4 /4 c1d 7.5yr5/8 sil 1thinpl mvfr cw 1f 0.2 0.3 5 29 -36 1Oyr3/2 none sl 2msbk mfr cw vf,f 0.5 0.9 6 36 -52 1 Oyr4 /3 f2f 7.5yr5/8 sl 2msbk mfi cw 1 of 0.5 0.9 7 52 -70 7.5yr4/6 f2f 7.5yr5/8 scl 1 csbk mfi ai - 0.2 0.3 F3a]Boris # Boring Pit Ground Surface elev. 98.56 ft. Depth to limiting factor 25" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDIW *Eff#1 *Eff#2 8 70 -78 7..5yr4/6 m2d 7.5yr5/8 Is Osg dl - - 0.7 1.2 ' Effluent #1 = BOD ? 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS < 30 mglL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 264 -8777. SOIL AND SITE EVALUATION 1500 Page 3 of a PROPERTY OWNER. J.T.B. Properties L.L.P. CIO J ohn W. Nielsen PARCEL LU 040 - 1078 -20 -000_ ID# 19.28.300 A.C.E. Soil & Site Evaluations REPORT MEMO Soil evaluation completed for plat review purposes and prior to clearing or lot monumentation. Results indicate that the soils at this location are suitable for a mound septic system. Additional soil evaluation and clarification of system location /design may be required prior to POWTS design and sanitary permit acquisition. ♦ E /e ✓a for, d d a v �g9.zz' &tic,A r etc 63 A Lt. d. rn �e � &levy = 97.zy' ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Oi c. Mailing Address property Address (Verification required from Planning Department for new construction) City/State �(� � Parcel Identification Number LEGAL DESCRIPTION Property Location : L '/4, '/4, Sec. T ZZN- Rj-�_W, Town of f Lot # Subdivision Certified Survey Map # Volume Page # Warranty Deed # - 7 1 " 7� l q 7 • Volume _ P • Page # Spec house ❑yes � no Lot lines identifiable X y es ❑ no �,y4TEM MA ANCE remature failure to handle wastes. Proper maintenance Improper use and maintenanceof your septic system could result in its if nAeded y a licensed pumper- What you put into the system consists of pumping out the septic tank every throo years or sooner, can affect the function of the septic tank as a treatment stage in the waste disposal gym' ed by e owner and by a ent a certification fom1. sign th The property owner agrees to submit to St t. Croix Zoning D g that(') the on -site wastewaterdisposal system pl � y nraaPlumber, r (2) aft er ins dplum cti or a on and pum dpumpa ping (if neces sary), s eptic tank is less than 1/3 full of sludge. is in operating condition and/or (2) aRpxtid pum Proper op the vote sewage disposal system with the standards I/we, the undecsignod have read the above requirements and agree to mamtam private State of Wisconsin. Certification ent of commerce and the Department of Natural Resources. Office within 30 set forth, herein, as set by the Department completed and returned to the St. Croix County Zoning stating that your septic system has been maintained must be comp days of the throe year expiration date. DATE �OF S I OWNER CER C ION knowledge. I (we) am (are) the owners) of I (we) certify that all statements on this form are true to the best of my o D our Office. the property described above, by virtue of a warranty deed recorded in Regist SI('NA F APP L ANT « ««« «« Any information that is mis- represented may result in the sanitary permit being revoked by the Zoning Department. warranty deed from the Register of Deeds office 00 include with this application: a s f the certifiod survey map if reference is made in the warranty deed co RIVER VALLEY ABSTRACT Fax:715- 386 -7664 Dec 29 2003 11:50 P.02 z 9 8 Z P 1 4 i 3 ? -e -7 4: le+ -' STAN aAR OF WISCONSIN FORM 1 - 994 Number ER WARRAMY DEED REGMER OF u. wALsH DEEDS 17acumcnt REGIS'T' DEEDS ST. CROIX Ca., va This Deed, made between J.T.B. Properties. LL P. a Mi. esoa RECEIVED FOR RECORD Limited Liability Partnershin Grantor, and Ant]I6I1v A- 11/25/2003 09; 45AN W,�e'ck and Monica,A. Weick lawband and wife Grantee. Grantoi,Tor a uabTe consideration, conveys and warrants to Granter WARRANTY DEED the following described real estate in St. Croix County, State of Wisconsin EXEWT # "Propextyn) (if more space its needed, please attach addendum):! REC FEE: 11.00 Lot , Plat of Tre�Valley Estates in the Town of Troy, St.l Croix TRANS FEE: 332.70 ounty, Wisconsin. COPY FEE: CC FEE i PAMS; 1 I i ! RemtdWg Area i Name and ddress i I Together with all appurtenant rights, title and interests. 04%-12W7 Parcel Idendficati Number (PIN) This is not homestead property i (is rA Grantor warrants that the title to the Property is good, indefeasible in fee simple and fret and clear of encumbrances except easements, restr and reservations if any of record. Dated day of J005-0 e 2003 I_T_B. Properties, LLP, a Minnesota Limited Liability Partnership , By. I AUTHENTICATION ACSN 1ENT Signatures) STATE OF WISCONSIN ) )SS. �. �uC ST. CROIX Co ) autheadcated this day (�, N�taN O ��ln Petsoiiaily came befo a me tmbitiat� day of 2003 the above named Spa J. .B. operttes,LLrabfinnesotiLLimUedLiabifty * partners by' TTMR: M1 MBER STATE BAR OF WISCONSIN (If not; to nne mown to be the perso (s) who executed the foregoing authorized by 1 706.06, Wis. Stats.) 's t and acjwow same. THIS INSTRU,& i WAS DRAFTED BY --• Sristina (Vaud, Fstreen mod Ogland 304 Locust Street, Hudson, W154016 Public, Vtate of W" nsin M y Commissice is permauei t. (If not, state expiration date: (Signatures may be authenticated or acknowledged. Both am not nw%sary.) ) * Names of persom sigaing in any capacity must be typed or pdnW below their sigmtt!uee. 10ftmulon Rofusionals Co., Food da Lac. WI VNAItttA3� ftt DEED STATE BAX OF WI §CONSJN $00655 2DZl FORM No. 1 1999 01/08/2004 03:27 7157491719 NORTHLAND SURVEYING PAGE 01 AW nz /on h,`/C, y i X loge r X tie.+ 1 / G— r X t0e.e x 194.9 X 1o0.e f0e.4f/ LOT 7 % 105 3.39 ACRES x ttr.+ 147,889 SO. F7, j K 103.9 i ip3zX x 10+,3 115.0 FlAO LAG X FLA x fa.0 10oA 100.4 % X 103.0 — Ij t0gr 103.1 IO I! 1 X t14.a x fms for ox,u pps x tW.e µWS ,tnz FLAG X 0(y ' • e •. RAG X FLAG: /-✓DMs P�/�� '�, t ` x iot•s y � j 1 r / PAGE ill RCVD AT 191200410 :02 :31 AM (Central Standard Time)" S1111:801 "DNIS ;8643" C$10:7157491719' DURATION (mm�ss):0042 vt ,, t p --- 000 � -1 1 MAI - r l' 1 .u. N ISO IS LDT `8 125M7 S) t 07.88 . V /Lo a loons S.� N. 1j f L O T 1476W &F.1 X X 3.39 AC. X J I 6 , 142061 S -V / 346 Ac. X TX 4546 .._....._ . . ... ' � J .. ....... z