HomeMy WebLinkAbout040-1308-00-165 Wisconsin Department of Commerce t PRIVATE SEWAGE SYSTEM County St. Cro ix
Safety and Building Division -
INSPECTION REPORT Sanitary Permit No
463305 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
Dan Lang Homes I Troy, Town of D D-1 — A
CST BM Elev: Insp. BM Elev: IBM Description: Section/Town /Range /Map No:
g17• Z" Ar �-- A - 19.28.1
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic , Z Benchmark
Alt. BM �; �� �� • � � � "7
Aeration Bldg. Sewer � /
--_ /
Holding St/Ht Inlet • 1 G
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Cajiji
Septic r I 0 i Dt Bottom
Dosing /V Header /Man.
Aeration Dist. Pipe (0-9 %39 4 • 04
Holding Bot. System \
PUMP /SIPHON INFORMATION Final Grade -7 - z-- q
Manufacturer Demand St Cover
GPM 3 Z '897
Mod mber ✓ - -` 3 `
TDH Li Friction Loss System Ijead TDH Ft 77 , , Q� Z ,
L. 0 J Z I�IC
Forcemain Length Dia. Dist. to Well
1J� t
SOIL ABSORPTION SYSTEM
BED /TRENCH Width Length, No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufa m:
INFORMATION CHAMBER OR 8 �
Type Of System. 1 / UNIT Model Numbe n
DISTRIBUTION SYSTEM
Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Ai Intake t
Length 1 7 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 1 • Bed/Trench Edges Topsoil s No Yes No
COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / / Inspection #2: ! /
Location: 220 Muirfield Trail Hudson, WI 54016 (SW 1/4 SW 1/4 19 T28N R19W) Troy Village 6th Addition Lot 165 Parcel No: 19.28.19.
jW $
1.) Alt BM Description = ��• ` �2� "^S I—s
2.) Bldg sewer length = Zq
- amount of cover = 41
GeJ�-
3�
Plan revision Required? Yes ><'No ��ZL75
Use other side for additional information. n C 5.' ' / ��' ✓ ✓✓
Date Insepctor's ignatu Cert. No
SBD -6710 (R.3/97)
I __
County
Safety and Buildings Divisions li /t`J 1
201 W. Washington Ave., P.O. Box 7162
ar Madison, WI 53707 - 7162 Sanitary pertrdt Nambec (to be filled in by Co.)
Mr n ( 608) 266 -3151 3 3
De R of Commerce
Sanitary Per APPlication Z
thsl inforn "on Yo" P�� Project Addr= (if offers& than tanlias address)
In saxrd with Comm 83.21. Wm Ada. Code, � ��''• s15.04(1Xm) �
may be used for aeoond P47060 P4P47060 sry o
t All Intorn2atioa v Z v�
L ApPliOII �fotrpation — Please Prin Yatcei #
PAV gt ow
CZ i✓ sT cFolx cuuN , PropeccyLocad �
� ZONING OFFICE_
zip Code Phone Nhraber
' S ��o T -" N 7 r-W7
`w
ad S vw+ gy�vistonNaW CSMN
TL of BttUdiztB {d►e* all that aPPb) / 17 y A-z
1 or 2 ramay P"'oulng — or seosooms
of
PublidCotntncr61d - Desaft Use Y' OtYafklQ
Stare Owned - DLscribc U B iY appliable)
..; BL Tree of Permit: (Mock aWy am bm on lieu A. Complete line 1'sok R� Ody Other ModiScsdon a EdstmS SY�"
A ew System Replacement Sysmm
TtwW M/Nold°8
change of Permft Tra"sfer to New
List Previoas Permit Number and DOW Tssaed
B. Pent Renewal Permit Revision Plumber Owner
Before B>ZPdo"
IY. of PORTS Cbedc all that • 1) At -Grade suoe Pass Sand Filter
Mound � 2n. of sortable soil Mound < Z4 fa of suimbl4 soil Sand Filter
.,�udwd Lt-0mund 4 i Peat Filmy Aecoble Treatment Unit Rodr9h
we d prrasudzed in Howinwg Tulle Omer ( , e.
. LAW Go vel- Pi
C
S Meda 1?Uter �y
V .
s went Areit Infosmatloo� p g quired O
(� .tea ( ��
soU Appo She `��
p
� dgt� -2 Suet Piber lsstiic
() l,�armfac�sr muu l� Co and r Concrete
YI. Tank Info ry bh T 0SUDns o N umber �cO
Gallons
P40W r�a�
Tomb T
Sep6rat ttcldisE Tact a� � '
TWOWAOt
t?adot � n of the PO R'1R sb°dn Oa the stittathed
silty for ratio Busirhms Phcare N
yIy Stateaatmt L t P MPMiP
RS Number � J ' � 7 . 1 J
Plumber's (»)
�
plumber's Address cSttek City, Stuow 21p
/v Date sorted Si (NO Sn°
YID. t Use Onl s permit Fee odes GrormdwaW
- nal".a — R� Shrrctratge Foe) Di �r 13enial v V
EL Candltions
SYSTEM OWNER:
1 Septic tank, effluent filter and
dispersal cell must all be serviced /maintained
as per management plan provided by plumber.
2. All setback requirements must be maintained
as per applicable code /ordinances.
(� Cously poly) for the r� p" PaP� �° 814 z it lathes t" doe
Attack t P�
r
PL PLAN
PROJECT Dan Lana Homes DRESS P.O.Box 60 Stillwater Mn 55082
SW -1 SW 1/ 19 /T 28 19 W TOWN Troy COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 2/3/05 BEDROOM 4
CONVENTIONAL XXX IN- GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # of chambers 28
IL BENCHMARK V.R.P. Top of 11/4" iron Pipes? ASSUME ELEVATION 100' Filter 7-abeIA -100
❑BOREHOLE O WELL *H.R.P. Sameasl3enchmark
Please note: I have no idea where the
benchmarks are at on this soil test,I assume SYSTEM ELEVATION8 94.8/894.93.8' below qrade Q oriqinal B -A
they are the survey irons but don't know
which one, also no alternate benchmark has Well is to meet all Plans Designed Using
been provided as per county code, Pam Help! setbacks required by Conventional Powts
g 149' Property Line WDNR Ma Xersion 2.0
Vent
.7 0
9 ,2A > 6» Standard Biodiffuser
of Cover Leaching Chamber
C with 31.1 ft2 of Area
� - - - -__ � „
6' Long 11
0, 3 4" Grade at System Elevation
Ven
B -B
2 -3' X 88' Cells with >3'Spacing
0'
B -C
55'
Additional testing may
need to be done to lower
system elevation 325' Property Line
0'
25'
Property B -A
Line
10'
15'
Pro 4 Bedroom House
Murifield Trail
PLO PLAN
PROJECT Dan Lana Homes DRESS P.O.Box 60 Stillwater Mn 55082
SW •114 SW 1 /4S 19 /T 28 19 W TOWN Troy COUNTY ST. CROIX
MPRS Shaun Bird 226900 DATE 2/3/05 BEDROOM 4
CONVENTIONAL XXX IN- GROUND ESSURE CONVENTIONAL LIFT HOLDING TANK
,
MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 872 # f chambers 28
IL o cha be
BENCHMARK V.R.P. Top of 11/4" iron Pipes? ASSUME ELEVATION 100' Filter ZabelA -100
❑ BOREHOLE O WELL *H.R.P. Same as Benchmark
Please note: I have no idea where the
benchmarks are at on this soil test,I assume SYSTEM ELEVATION8 /894.93.8 below qrade @ original B -
they are the survey irons but don't know
which one, also no alternate benchmark has Well is to meet all Plans Designed Using
been provided as per county code, Pam Help! setbacks required by Conventional Powts
149' Property Line WDNR M ersion 2.0
j'ng nt J
1I �� ,Z` Standard Biodiffuser
,q Leaching Chamber
with 31.1 ft2 of Area
0' 3 4„ Grade at Syste m Elevation
Vent
B -B
2 -3' X 88' Cells with >3'Spacing
0'
B -C
55'
Additional testing may
need to be done to lower
system elevation
325' Property Line
0 '
325'
Property B -A
Line
10'
15'
Pro 4 Bedroom House
I
I
Murifield Trail
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page I of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County
'►�f/ED ST• CROP
Attach complete site plan on paper not less than 8 112 x 11 Inc as in s
include, but not limited to: vertical and horizontal reference poI (BM), d Pa I.O.
percent slope, scale or dimensions, north arrow, and location a id distance to nearest road. �1°ENOIN C.
Please print all Information OCT 2 9 2003 R d by ` Date crI
Personal information you provide may be used for secondary purposes Pr Law, s. 15.04 (1) (m))•
Property Owner ia$�ibfi
ZONING FFIC
CONTIn)EA1 - TALL DE SL0fMEM CO&V. r jvJ 114 S IQ T .ZS{ N R III '"
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
I 1 `00 AB EKmEM ST N S SUITE 100 1105 — TROy U t LLAGE 1k
City State Zip Code Phone Number ❑ City ❑ village ® Town Nearest Road
1.Ai NC 554 14-9 (7(,3) - 1-75408 TKO`I I Ak% ktKFtF-=Lo TRAits-
4 New Construction User Residential /Number of bedrooms Code derived design flow rate 6o DO _ GPO
❑ Replacement ❑ Public or commercial - Describe:
Parent material _ n1.cjWA —'-tk A u_t_r -V i A L Flood Plain elevation if applicaoie
General comments
andrecommendatlons: C01J%Je 1T101)AtL- U - GK01,L4V TrCf��Ct 5
0.7 LoA0 jZY"RU
FA � Boring
Boring #
Pit Ground surface elev. _ 1t. Depth to limiting fact or > g4 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 'EH#2
1 0- '1 0vt2 — L f�b1< �Sh ah 54 - .S 0- T
2 7-1 - 5 0\(124i — L - M 0.10K A a'o - 0.5 0•
3 l -Z 0 oL* — S%k GI c J Z\tF- M 0 -5 - 0. (t
zv- 41 — s d.l q L #j 24- .Z 1. Z - t
5
3& -j4 to e, 5/4 d I
Boring # 0 Boring
Pill Ground surface elev. • � h. Depth to limiting factor _•._ 'n• � +{ Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO /If
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
0 -'i R — L- _
z 5 / 5�I z.F, a dh s _ .5 �-
3 I o 5 C1 -vJ -2 1. Z
r
' Effluent #1 = BOO > 3 0 : _< 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 ° BOD < 30 mg/L and TSS E 30 mgtL
CST Name (Please Print) Signature CST Number
ib)A ` .10 H6LLXS1 i 2Z 1 j 937—
Address Lj ate Evalua n Conducted Telephone Number
W9975 64C�'AVE, RIVE 1Z, "FALLS WI 54022 OS-ZX Lit y26- -1'17,5
w ,
I
(LoT Ics)
Property Owner (�' ►J Ttw1E/STA1_ Parcel ID IF � +�+ INS Page _ �_ of 3
D Boring # ❑ Boring CORD
-- �a Pit Ground surface atev. -M ft. Depth to limiting factor ? I Z in. Spit Applicstlon 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 'Etfff2
mWA d 56 a b ,S 04
s Lan
3 2--33 10 L d a5 6, - 7 - T ''
3 It ypk -'' 5 d I 2
❑
Boring
Boring N ❑ � ,
�_J ❑ Pit Ground surface elev. ft. Depth to limiting 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. 'Ef #1 'ER #2
i
Boring p
Boring t' '.•
❑ pit Ground surface elev. ft. , Depth to limiting factor in.
Shc A Icatlon Rata
Horizon Depth Dominant Color Redox Desertptlon' Texture SbWure Consistence Boundary Roots GPDlfP
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, 'Effol 'Eff#2
I'
;u
Effluent p1 = BOD > 30= 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BOO, < 30 mg/L and TSS 130 MWIL tl.
I.
The department of Commerce is an equal opportunity service provider and employer. 1 f 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•
sep.lJ l011< sue) 1r�
,
H
r
FLOE PLAN
rra znr~Z- Co INS - ENV 1' yo
c •
- 50L 130" wi rsAaJlcX
Fi►vi.. GRAot EVEV s
fig• � �
B 164A
ELEV. IR7.0. `.
ELEV. M-0
' 8165C
ELEV. $Q(v.'7
rn
ao
I
B 1648
ELEV. VIA W �
® _ 8165A m
ELEV. 447.3
67
165
L vA��• 0 i - -a4
F�Of PLAN
F' M OWNER; AIMZ&ZA. C I.EGENn: � •• y�
P
n>✓ CoKP
3M- • TOP of s P1PES
_ A nESCi;INON LnT 1 �, -rrZOy
gda /.D
CCUAI b C' Ou
-5011. �OMNG W/ 3PCYJ10E
V
UO COMM 83 5E TACK MOM
MS �
i ELEV. 897.24 E V. 899.70
149.02' 1 7777
B1658
ELEV. 899 ,
1
I ' "fIle itc radlc�a \t th tinal Lrradc cleat 011
I
I 1 completed ( cc �` = cndd not be affected_ but
B 165C , S�stcm e le�atton , b j
ELEV. 8.4 CP depth below =rack ill need to be dctcrmmed
" I based on the amount Crt cut or fill. BA
I,
t
i
cic�auon, should ha.c mmamcd constant
B 1'65A ~
I
$ EI tV. 898.6
:— LO M
ui N71 M N o I
a N
899
I
s02
9 00
I
165 8 6 j �� t
8g2 ,
X94 z L4 S 3 Z
149.02'
j
L QI
Maintenance and Contingency Plan for a Septic System
Maintenance Plan
1. Septic Tank is to be pumped once every 3 years.
2. Eff luent filter is to be cleaned once a year. Please note: a larger filter is being installed in
order to extend the maintenance interval of the filter.
3. Once every 3 years, cells are to be inspected via the inspections pipes at the ends of
the cells.
4. Owner agrees to limit greases, garbage, and water conditioner discharge into the system.
5. The owner agrees to save this plan.
6. Do not plant trees nor park nor drive over system.
7. Watershed is to be diverted away from system.
8. Discharge into system is not exceed those required as per Comm. 83
fflIngeni;y Plan
ption #1,,, rf system fails, determine cause of failure, use alternate area and install new
system in tested replacement area.
Option #2. Install system at a lower elevation, by removing chambers, removing biomat,
and install new system.
Option#3. No adequate area is suitable for replacement area, and system elevation
cannont be lowered. Install holding tank as last resort.
3. Replace any other failing components as needed.
Plumber: Shaun Bird 715 - 246 -4516
St. Croix County Zoning 715 - 386 -4680
Pumper Tom Mondor 715 - 246 -5148
Shaun Bird #226900
ST CROP COUN'T'Y
PENANCE A,�EMBNT
SEPTIC't�
HIP CERTIFICATION FOR
OyVNgR M
owner/Buyer D o " `
G o
-
,W�g Address . o �j
D amnent for new construction)
Property Address (Verification required from Plam=g ep V0 Z, 0'U
Parcel Ydeatification Number
City /S.tate
I,EC et DESC I? N -R 9 w' Town of
0
I.ocatior�— sue T ^_— �-- Lot #
pro perty
Subdivision 4 - � -- Page #
Volume
Certified Survey MaP # _ Volume Page # J
� ��— �-�• —�
# Deed � `Y
Warranty Lot lines identifi able Yes [3 no
S houseYeS no
S failure to handle wastes. Proper maintenance
MANM o f your 6e ptic systeut could res ult 'n eded by wed Wha You Put into the system
S tie and �1 m1mce ti tee yew , sooner, disposal system.
rn91
° p . tic tank every tment stage in the waste disp the owner and by a
consists of pua°Fv°g out she septic
can affect
the °n.of the septic task as a t a ce�cation fozm, sit;n� terdisposal system
verifYinB that (1) the ou -site wee 1 of sludge. agree to submit to St. C Zoning ccp
The pr ow plumber, restrictedplumber a sa c F s necessary) the septic tarslc is loss than standards ump (if nude
rp l =ber, j n and/or (2) afta � he
Pe sewage a disposal system with t tion
coaditro pr ivate se g CertifMa
is la proper operating agre to mainm the F
above rea Department of Natural g�ources, State of Zo>�� 30
Uwe, the undasii�d have read the of Cos:smeree and feted and returned to the St. Croix County
herein, as set by the Depart �n�ed must be comp
set forth. tic system has been 3 ^d
stating that Your set tioa date. /
Of. the three Year cxp� DATE
P
SIQNt' 1:[JR+E OF AP owpe ds) of
OWNER ICATI N on this form are true to the best of my {ours
imowledge. I (we) am (arc) the
�gT14F
O
-- -- ' e �y that a sta f a wash, deed recorded is Register of Deeds Office.
� pro p, d above, by 2 /O DA•1"h
pg PLI ermit being revoked by the Zoning DepUrMut.
Any information that is nus . fep
APCANT
resented result in the sanitary' P
!!!!!s
a copy do ftom the Register of Deeds office deed
St=V6d warranty d if reference is shade in the warranty
!! Include with this application: a of the certifi survey map
I
U. 2 7 3 5 P 4 5 8 785604
STATE BAR OF WISCONSIN FORM 2 - 1998 REGIST R H. OF DEEDS
REGIST
WARRANTY DEED ST. CROIX CO., VI
Docu ff d Number RECEIVED FOR RECORD
01/21/2005 12 :30PM
tt This Deed, made between WARRANTY DEED
li Troy Development Corporation, a Minnesota Corporation EXEMPT # 3
li Grantor,
t; FEE: 11.00
and Dan Lang_Hnmpc, ltd TRANS TRA FEE:
COPY FEE:
CC FEE:
Grantee.
PAGES: 1
it Grantor, for a valuable consideration, conveys and wan to Grantee the Following
described real astate in $t • Croix County, State of Wisconsin:
Lot 1 of the Plat of Tro Village 6th r�earQa-ea
65
Addi in the Town of Troy, t. roix c=ounty, Name mid Retum address
Wisconsin, Dan Lang � Ames, Ltd.
221 East Street
Subject to Declarations of Covenants, Conditions and Stillwxter, MN 55082
.. Restrictions for Troy Village, recorded in Vol. 1241, , /
Page 256, as Doc. No. 559964, and the Declaration of 4Q �' C -01 ` 2 ?, " 1! 5 - ,)
Golf Course Covenants, Conditions and Easements. -= =a
recorded in Vol. 1241, Page 301, as Doc. No. 559969, part of 40 - 12 i
all as appearing in t 0 51 - 90 - 200
he office of the Register of Deeds Parcel Idarmttce Number "
for St. Croix County, Wisconsin, and such other is not homestead
easements, restrictions and reservations of record, This property.
or in use, and the "buyer" obligations contained in (IS) (is not)
the Purchase Agrearent for this lot. y
ii
c
This Warranty Deed corrects the name of grantee as shown in Warranty Deed j
In Vol. 2723, Page 289, Doc. No. 783744.
r•
ii
di
Exceptions to warranties:
Dated this 29th day of December 2004
t:
(SEAL) `s
* ichard Halupt o , Vice Presid fj
Troy Development Corporation
(SEAL) _ (SEAL) it
'i
AUTHENTICATION ACKNOWLEDGMENT
1�
Signatures) Minnesota i
State of V4seca atrr,
ca
authenticated this day of Parso y n came before me this 2 r1 t h JJJ day
December 2004 • the above named
R ichard Ha uptzok Vice President
Troy Development Corporation I,
TITLE: MEMBER STATE BAR OF WISCONSIN to IIIII;)
Of no t, me known to be the person who executed the foregoing .
authorized by §706.06, Wis. State.) instrument and acknowledge the same.
THIS INSTRUMENT WAS DRAFtED BY
' TROY DEVEWPNENT CORPORATION David F. Lamers
Notary Public, State - ef.WleaePA*Anolca County, Minn. t
Charles S. Cools, President My mmmtssion is permanent. (If not. state expiration date:
h
troy be authenticated or acknowledged, Both are not January 21 2009 ) it
t: • Namaa of paraon.:ranuia In any wpaeay mua tm qp,d or printed v), w ttw rtr awmnu.,
STATE BAR OF WISCONSIN wlaacrain Leal Bw,k Co., Imo. f
WARRANTY D860 FORM No. 2 - 11186 hilWoU,ea. WV• !
DOW O LWIM
WrARYPt0J0- &01ME80TA
MY ccttMtl lon Ey ns.Nn. 31.2009
. � 1
0 50 100 200 300
pl
e
GDo e
ti �
J S D. FIL INS S -2246 I �
R ISTERED LAND SURVEYOR I ��
JIAES D. DEN ENGINEERING COMPANY
K"NS _ 1234 S. WASSON LANE ~ I
S _ RIVER FALLS, WISCONSIN 54022 - j -
p' DATED THIS 15TH DAY OF OCTOBER, 2003. LZI
REVISED THIS 27TH DAY OF OCTOBER, 2003.
V REVISED THIS 22ND DAY OF DECEMBER, 2003.
I \�
S 89 E 1021.88'
I
— L
1 .32' 134.0 1 \ — — — — �� —
I I I I I \
$ Ig� 163 �- ( 164 (- 165 �° \
n \
162 -� /2.7
�'� ►%� N 1.045 ACRES M 1.1 2 —ACRES
• 1.000 ACRE N 1.000 ACRE o N . a — —
. "� 43,566 S.F. '`' 45,500 S.F. 48,432 S.F.
43,386 S.F. g
I I ( ( I I I
1 34.05' - 140.0 14
Z -j- - 0
- --
114 or s£cr/av i9
I C£Nr£RL l
A /NV /E
LOT 1 i LOT
C. S./ :j VOL. 1 �
GLEN 7 GE 3264
'ROY GLEN DR l VE I DO_C. X560007
h ; .