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040-1254-10-000 (5)
Wisconsin Department of Commerce Safety and Building Division PRIVATE SEWAGE SYSTEM INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name- City Village Township TROY A & DARCY LADUE VARGAS TOWN OF TROY CST BM Elev- Insp. BM Elev- BM Description- 96-I(P I Go"k of L-0-ri TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic nr%cinri A S� TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic . IS� ��C 1 Dosing A in r�+: �'1 PUMP/SIPHON INFORMATION Manufacturer Demand GPM Model Number TDH Lift Friction Loss System Head tH Ft Forcemain Length Dia. Dist. to Well 1 1 x;.s SOIL ABSORPTION SYSTEM ELEVATION DATA County- St. Croix Sanitary Permit No- 645461 State Plan ID No - Parcel Tax No- 040-1254-10-000 Section/Town/Range/Map No: 19.28.19.1342 STATION BS HI FS ELEV. Benchmark Alt. BM Bldg. Sewer St/Ht Inlet St/Ht Outlet Dt Inlet /or, Dt Bottom 4 45311 Header/M.:.n Bot. System 1 Final Grade 05 10 2. oco St Cover BED/TRENCH DIMENSIONS Width Length �ti -TI 15 S No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION I SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer - �tiFstT� Type Of System: I�a ,4���-, � Tn3- ��W� , -1 I I(02� Model Number - E'L FL.AvJ DISTRIBUTION SYSTEM Header/Manifold Distributio ole Size x Hole Spacing Vent to Air Intake KPipe( Length �2 Dia ....... . ..................... Len th Dia pacing ❑, SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only I Pmvwr Depth Over Depth Over xx Depth of xx Seeded/Sodded x Mulched Bed/Trench Center Bed Tren s oil ❑ Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 284 ST ANDREWS DR 1.) Alt BM Description = 2.) Bldg sewer length = Exssrsoct - amount of cover = Plan revision Required? ❑ Yes No Q 23 Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Si nature Cert. No. 10 2. A MCD Department of Safety & Professional ServicesAideI County ST. CROIX f , 5�nitary Permit Number (to be filled in by Co.) iv on Industry Services: woo " " ob -- i I 5S ar� t Application 10. StitcTransaction Number I P Inaccordance with PKMM su mission of this form to the appropriate governmental unit NA is required prior to aining a sanitary permit. Note: Application forms for state-owned POWTS are Submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(l )(m), Stats. SAME I. Application Information — Please Print All Information Property Owner's Name Parcel # T 2 C) V. A Ar n A R C V 1. A F) I f E_ X7 AR GT,&(� 040 - 1254 - 10 - 000 Property Owner's Mailing Address Property Location 284 ST. ANDREWS DRIVE Govt. Lot NA City, State Zip Code Phone Number HUDSON, WI 54016 651 - 734 - 1160 N W i/,, NW 14, Section 19 T 8 N R 19 ly" & W IL Type of Building (check all that apply) Lot # CY I or 2 Family Dwelling — Number of Bedrooms 4 91 Subdivision Name TROY VILLAGE 2ND ADDN. Block 4 0 Public/Commercial — Describe Use 0 City of NA El State Owned — Describe Use C3 Village of CSM Number NA ClTown of - _TROY 111. Type of POWTS Permit: (Check either "New" or, "Replacement" and other applicable on line A. Check one box on line B. Complete line C if applicable.1 A. 0 New System '-TRepolaccment System 11 Other Modification to Existing System (explain) E Additional Pretreatment Unit (explain) R. E I lolding Tank "*In -Ground 0 At -Grade E Mound F Individual Site Design 0 Other Type (explain) C. ❑ Renewal Before D Revision ❑ Change Of P]Llmbcr Transfer to New Owner (List Previous Permit Number and Date Issued Expiration 4531 8 / 04-23-2004 ,J I**". Dispersairfreatment Area and Tank Information f?,Vg� —.,v A /0) M Design Flow (gpd) Design Soil Application Rate(gpd/sf) "Dispersal Area Required (s t) Dispersal Area Proqbred (sf) S} stern Elevation 600 0.7 857 875 97.40 FT. Capacity in Total 4 of Manufacturer Tank Information Gallons Gallons Units to U New Tanks Exislins _TaiTk's U a. (4 I V) U Septic or Holding Tank r�y 12- 5 0 1250 1 HUFFCUTT , — X Dosing g Chamber 750 7 "0 1 IIUFFCUTT X V. Responsibility Statement- 1, the undersigned, assume responsibAity for insta))Adon of the POWTS shown on the attached plans. PlUmber's Name (Print) PI s i nat e MIKE RODEWALD Z; MP/MPRS Number 931384 Business Phone Number 7 15-425-6200 . PILIMber's Address (Street, City, State, Zip Code)ool' 285 C.T.H. SS, RIVER FALLS,' WI 54022 VI. County/Department Use Only Approved ova r7l Q; r m ve� E'Re Permit Fee Date Issued Issuin Agent Signat e r Given on for Denial 2,2 a)/ Conditions qf'A6prov SYSTEM OWNER: Sepbe tank, effluent filter •and dispersal cell must be serviced / maintained as per V%et Alt anagement plan provided by plumber. setback requirements must be maintained as per appiicaoie coae mpaniwiemic oans r the s stem and submit to the County only on paper not less than 8 1/2 x I I inches in size 4yv,� o,4 '51 7/ L,5-/ /bOLJL� r-tv q e 4% SBD-6398 (R. 03/22) /QL2- Plat Plan RECEIVED Page 2..,-of ,.--NOV � 12022 ; PROPERTY OWNER: I av_� I �IAMCus _ 1" =�_Py Aq F1- se"tm uNrr cDD y(except where noted) Legal Description: j�%� �/ T/�i7 1�.t �„���y � backhoe pit A North owl �qq. bq� err. t W0 -70 Lo- Site location: Pg 1 of 4 Pg 2 of 4 Pg 3 of 4 Pg 4 of 4 Attachments: D05�D PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet Component Manua! Design References: Version 2.0, SBD-10705-P (N.01/01, R. 10112) Index & Cover Sheet Plot Plan Dispersal Area Cross -Section &Plan View Management Plan EnclosurE POWTS A lication for Review Soil_ Evaluation Report & Site Ma c 1s •, OTAL PAGES, Warranty Deed Project Name / Description Owner Name(s): Phone: - 154 - fi i*0 Owner Address: 284 ST. ANDREWS DRIVE, 144.t�50nS Wr Zip: 540I t-o Project Address: _ (SAME) Goat. Lot: NA NW 1/4 of NW 114, Section 19 , T 28 N-R 19 E or W ti Township: TROY county: ST. CROIX Project Parcel ID M 040 - 1254- 10 - 000 LU-1 et 4 T0V I LLAOC "d Atzm. TROY & DARCY VARGAS Designer Information Designer Name: MARY JO HUPPERT Phone: 715 _ 428 _ 1775 Designer Address: 28497 KING ARTHUR# CT., DANEURY Zip: 54840 hollisterdesign@outook.com ,�•��;i'.`.+ar E-mail. License Number. 1859 - 007 I • r :.j.. � �..� 9 �Sq�I •.s s 4 � r., ADD DIVERTER�''� ' let 2021 I �r • W{r - Signature: Date: atu" required ch submitted copy. Plot Plan RECEIVED Page Z. of I I NOV 012022 PROPERTY OWNER:I,,.,Oy 445 ��RCyAwC&q 5ret. eR,51X e UNTY CDD Legal Description: It-LAGE A FT. (except where noted) r] == backhoe pit POvtawL-5 Arts North V 1 00,0"., 2 .......... 100,Iq 0 44. Lo- r I)o vo of Site location: �>()_%D IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with EZ1 203HP Bundles 3-ft Trench (down -sizing credit) �ILa��wr aaw�a wr.rarr•ra.rr. swrrws.w Geotextile limitcovermin. bwm:h SOIL COVER •aa•a�as•a�a s*i'aaaaaaa• depth (ty•k qb System t• AT Septic Tank(s) Mam9actur . HUFFCUTT Septic Tank(s) Volume(s): 1250 9W gal gal gel Effluent Fftr Menu%c ww. ORENCO Effluent Fater Model #: B i o-TUB E TYPICAL TRENCH CROSS SECTION VIEW (No Scale) Provide minimum 3 ft separation between trenches. TYPICAL TRENCH (Show location of inlet / outlet pipe connection on plan view.) PLAN ViEV1l " 0 observation pipe ahal be i bbid (No Scale) �J at jundlon bdwaran Wo w*L Perforated Lateral observabon awe --, (typical) (typical) B = 70/55 ft (typical) INSTALL PER TRENCH: i O' 70; It '' ': 0 t' 7 10-ft bundles @a 50 ft EISAlunit = 850 ft, + 5-11 bundles @ 25 ff EISA/unit = 25 1111111110 ft2 OBSERVATION PIPE DETAIL (No Scale) Serww-TWw or •�, - - Firzirrwd Grade Sip cap {�� ''` (rnuifiad a sead•d� 4-0 PVC Poe ' .. s + ' •►« Topsoil Cover Top of pipe to bnr*wft , • •�, (min. 1 food at or above &*shed grade (4) 114'-- x W scats 9 ( sped ~• ••,f fnllytrNbn •.� ..� Ste• 10 ft (tyvkal) A = 3.0 ft (bpi) �— EZ1203H Bundle (typical) (mfd by 1r�° vator Systems, Inc.) Install pursuant to nmufacksu s kwtucoom. Proposed EISA per trench = S?5 fta, Required Infiltration Area = 857.15 ftZ - ' trenches = Proposed Total EISA = 875•00 ft2 Distribution Method: branched manifold PAGE 4 OF 4 In -ground Gravity Management Plan IMPORTANT -- The owner of this in -ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to requirements of SPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383-52 (2), Wisc. Admin. Code, this system shall be considered a human health hazard if not maintained in accordance with this approved management plan. Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in accordance with SPS 383.52 (3), Wisc. Admin. Code. Maximum Dispersal Area O eratin Limits: Design Flow = =I] gpd; BODs:5 220 mgL*'; TSS:5 150 mgC; FOG :5 30 mgL*l Inspection Checklist INSPECT EVERY 3 YEARS o type of use o age of system o nuisance factors (i.e. odors, user complaints, etc.) o mechanical malfunction (i.e., pumps, valves, switches, floats, etc.) o material fatigue (i.e., leaks, breaks, corrosion, etc.) o solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes) o neglect or improper use (i.e., exceeding design capacities, prohibited activities, etc.) o extent of ponding in distribution cell prior to dosing o dosing irregularities - if applicable (i.e., pump re -cycling, float switch settings, etc.) o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.) o distribution lateral or lateral orifice plugging (measure lateral distal pressure — compare to design specification} o surface discharge of effluent or sewage back-up into structure served Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary) o Septic and dose tank shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis. Stats. when the volume of solids In the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or as required by local ordinance. Disposal of contents shall be pursuant to NR 113, Wisc. Admin. Code. o Effluent filters shall be inspected every 3 years and shall be cleaned when necessary to remove any accumulated solids according to manufacturer's specifications. A servicing period will always be greater than 12 months. System maintenance reports shall be submitted to the proper local government unit In accordance with SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to: Name of individual or company: MIKE ROD EWALD/BETTE N DORF EXC. Phone: 715 - 425 - 6200 ST. CROIX COMMUNITY DEVELOPMENT Local government unit. Phone: 715 - 386 - 4680 H Local government unit address.. UDSON I W1 ZIP: 54016 Any defective part of this system shall be repaired, replaced, or removed pursuant to SPS 383.51 (1), Wisc. Admin. Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code. No product for chemical or physical restoration of the POWTS may be used unless approved by the department in accordance with SPS 384, Wisc. Admin. Code. Contingency Plan In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to a plan submittod to the appropriate agency for review and approval. A failed in -ground dispersal component may be abandoned and replaced by a code -complying dispersal component in a pre-deters-nined area of suitable soils. System Abandonment If use of this P0VV7S is discontinued, it shall be abandoned in accordance with SPS 383-33, Wisc. Admin. Code. • ftw min Dap~ of Comnmm SOIL AND SITE EVALUATION PaP 1 of 3 DivWan at shy snd Buklkvs in sc oord with Comm 83.08 Wis. Adm. Code .�. F.nv�n�many� Dd A � lbP� on P&W nit N= than 8% x 11 Imes in size. plan mustmwwww� bw*lde, but not ikT*Asd to: vertical and i'qdZopW referaxy paht (BM), Courtly �cdon and percent , � or dimemsiorrx, rah er►d bca*m wsd dlebnoe to nearest road. St. Croix � Parcel l.D.* APPLICANT INFOMA'TIQN - prjpt an Wom, wyon. ` Dale Porrx�ri woier�lian you prorrld� way b+ t'Priu�cX �.�w, a. 15.04 !7 T (rn)). R811iA'YMNd By .....__. pmpe* 0"~-Prope V Location Contimc W Dcvel menx r `'wF' -. Cam, Lot - NW 1/4 NW 1/4 S 19 T 28 N,R 19 W Properly Owners Maw Addreee _ , � .. _._�. .�..._... ._........�,._. •� tt�k Lot i Blotic Sued. Nana or C$M 123Q 1 Central Avenue N 23Q �'.. 9 _ - L T V�li 0 Swond AddiUan ,CN • 'Cam; •'.;•�: r7 C#y M YIaoe Town Nearest P4W - A�i us Troy SG Andrews Dare L79 Now Cm*ucdon ;. 1Adof bedrooms d jAddftn ID etasting butq-- [.� R L7 Pw* or CoowW0WcW describe Code Denved daffy ioaw . 600 9pd o jtecofxnended de*n loading rite '? bed, 9A�`7i'tMj h, 9pd1f area d '� W �� Tc f� i7 rerxh, le Mxdmum design W tn9 rate bed, W6r bench, g xiV Rewrignmandu ingbaft swfaco obvakm(s) 8 Dcsi ft (as re red ID site Oan boner AM" dew, ! she consideration Pww mawiai LM g1majFtood plWn e1jMW NA R S=Suitable for system Co weaftlal Mound #n-Ground Pmwm AT -Grade Syslsm in Fill NddN T is L)-4* gable br qon ®S ❑ U 13 S❑ u 0 S [,l u 0 Sou 03 ®U C] S 0 u SOIL DESCRIPTION REPORT . ,.� A Horizon Dt inant Odor Moon ,� smxk re B GPDf �� in. Munsd Qu. Sz. Coat. Color Gr. Sz. Sh. dar3► Roots i Bed Trench 1 1 0- 1 t QyrZl1 - ail w 2msbk mfr cw 1 f S. b 2 l 1-40 10yr4/4 2msbk --- .__ ..� .. ._.�....__.... ..w.- _._ __.__ .... mfr cw 1f .5 .6 4* Ground 3 40-56 7.5yr4/6 cs os ` eiev -- 8 m1 cw - .7 .8 . �. 101.73 ft 4 56-1 I 0 7. 5Y�t.5/4 s osg m1 ' 7 8 LDepth ID ririq F r I . factor _ 4 7 -90 �.. 01, 1 Owl 6 10yr2/ 1 - sd 2msbk snfr cw If 5 6 . 2 t 6-44 1 Oyr4/4 sit 2msbk j mfir cw If .5 Crwnd 3 44-52 ' T.5 416 ��.. _ S ml cw - 7 .8 , 101.99 R __— 4 52-1 I 0 7.5 YR5/4 S asg ml . ? - 8 Depth toban facw >110 i Rwrwks' FNarmCST (Plena Print) Signature: Tako one No. bQww C. lid= 715-246-2454 4dmm EnvironaamW k can - Qatu CST Number fiat a 1432 120th Street, New WI %ol7 1l30t98 M02605 6 P. PROM If OWNOW - SOIL DESCRIPTION REPORT Page 2 at 3 PARCEL. IDA By D-nism 3 Ground elev 4. Depth to Arming #aCtO�r 4 Gr�tmd elev 100.26 R Depth to l�rr>r�ng tacdar >1lv_. 5 Ground elev 100.24 It Depth ID ng fact+ >im Ground dev fa l~4a#zonDeA in. 6- Dofnant Cola muml Motes Qu. SL Copt Texture � r. SL Sh, Boundary ROM GPDff 8e� : Trench 1 0-16 10yr2/1 SU 2msbk mfr cw if .5 .6 2 16-29 1 Oyr4/4 - sit 2msbk mfr cw 1 f .5 .6 3 29-46 7.5yr4/6 - s C" ml cw - .7 .8 4 46-105 7.5YR5/4 - s Ogg 1 tw - - .7 .8 1 0-12 10yr211 - sil 2msbk mfr mff cw l f .5 .6 2 12-26 ' 10yr4/4 - A 2msbk cw if .5 6 3 26-40 1 7.5yr4/6 a asg ml cw - .7 .8 4 40-110 7.5YR5/4 s osg rrd - - , .7 .8 201. Remarks: 1 0-12 10yr2l1 - A 2msbk m$ cw 1 f ._ ..+.ram i rrf ` cw I f . S .6 .5 .6 2 12-25 w..r 1 Oyr4/4 ._w.. ...w - .-..._ A -..-.. 2msbk 3 25-45 7.Syr4/6 - s asg cnl cw 7 .B 4 45-105 7.5YR5/4 - s 09g m1 - - .7 .8 t Remarks: Reffwka: I 4 ►fo dip E____Nv190NM NTfit BY DESIGN 1432 1201" STREET, NEW R[CElMOND, WISCONS[N 715-246-2454 PROJECT N TROY V�LAaE 2nd ADDITION DESCRIPTION: AN�, NWnA, SECTION 19„T 28 N, R29W TOWNSHIP: TROY COUNTY: ST.CR4IX LOT: 91 SUBDIVISION:. TROY Vll iAGE 2"' ADDITION �( � � �.. r. .ten r...a r.• .rraf� ..... r w � w.. +... f �..r��-a wm aM�a-,..r SCALE V=40' a Tom Nelson �. are i _N Line Post Ground surface elev, t 00' csmuo zbu sM 2 NE Loot Corner Ground Surface elev. 95-16 T- re�J� ; �. LIOJ T. LA 7ro 'At File #: S'r. CKo�- , N -F Y, SANITARY SYSTEM Office Use Only OWNERSHIP/ADDRESS FORM Created 212021 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information will be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the ProiDertv Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer TROY & DARCY VARGAS Mailing Address 284 ST. ANDREWS DRIVE City/State/Zip RIVER FALLS, WI 54022 Phone Number (required) 651 -734 - 1160 Email Address (required) Parcel Identification Number 040 - 1254 - 10 - 000 (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION Property Location NW X4 1 NW X4 Sec. 19 IT 28 NR19 W,Town of Subdivision Plat. TROY VILLAGE 2ND ADDITION Certified Survey Map # NA Warranty Deed # 742067 Number of bedrooms 4 TROY , Volurne NA Page (before 2006)Volume 2425 Page ., Lot # 91 NA 159 Spec house 0 yes N no Lot lines identifiable N yes 0 no OFFICE USE ONLY New Property Address (Verification of new address required from Community Development Department for new construction,) (Staff Initials) (Date) This form must be submitted with oil Private Onsi'te Woter Treatment System (POW TS) applications. New System: Include with this form a recorded warranty deed fron? the Register of Deeds Office and a copy of the certified survey mop if reference is mode in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd2s.ccwi.a®v 1101 Carmichael Road, Hudson, WI 54016 www.sccwi . C710V Z z moo 16, ., 131 KD Apt .mop R-80 0 97,87 � N ' 9C,� 0'f17 45.22443732 S.F. � � 1.004 ACRES CPO gocp ` 64c�5� � / 0 � 46291 .�. N r'- `� �' \ cu � � o "? 1.063 CRES 0".o VVAvg* M Q M O 1tJ fO �p ip fj vj O � 00 43630 S.F. �� 8 s o j ui N (n i°+ w sfe 1.002 ACRES vo co 44278 S.F. Z i,,, 00,0 1.0 16 ACRES q0'• k' 210•g7b p 0 � � ; o� 0o�� ��� � � o o 9, N . N Z � Ir 91 o � �s � 4615 F. � sue,, � 57 � 58 � � � ���s�= 1.060 ACRES. o0 a.0 40 l , U r - � TROY IVILLAGE , � W � � 927 V_ ' � � j ♦ a o Li� 44040 S. 59 o m o 1.011 ACES s 07 t77 � 45947 -S.F � 1.055 ACF N 880001 00•• I318.00 76 i 44520 S.F 1.022 ACF N 88000' pp" y � 378.00, I 75 � 44441 S.F. � 1.020 ACRE N 90.00'00" W � 318.19' 74 1 45251 S.F. � 1.039 ACRE i N 88100p• Op^ yy 339.19' dft �-� - � 73 z a4 , � '~ 0 '� 46539 S.F. R=80"0 �.= z61 CIV •` 1.068 ACRES � ..... _.... ..._ ...— z�• I � 'sa5$1/P -.. - - 93 1111111111!1111 60 44397 S.F. � cn , ... . - 1.0 19 ACRES 0 LA VP,°�Rs Plo7' I�l✓Fn� ' U 28� sr A�GreLOs nJ L,J Nw i9 aP I.y Ti�,� oc ir�y- Tr�� I�.vrne .Trod lleq� a"`� Lo T- at I { � l Orr mf `moo t ko r Co�� Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT r GENERAL INFORMATION ( )EACH' TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.1 5.04 (1)(m)]. Permit Holder's Name: City Village X Township Vargas, Troy & Darcy Troy Townshi CST BM Elev.- Insp. BM Elev: BM Description: 161-0) TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic Z 56 Dosing [Aeration a Holding TANK SETBACK INFORMATION TANK T(1 PA 1A/FI I AI r1 (_ Vent to Gir Intake TANK TO PfL WELL BLDG. Vent to Air Intake c ��C Septic ,r Dosing Aeration Holding \ PUMP/SIPHON INFORMATION �j Manufacturer Deman Model Number TDH lift 1, FrictiN Loss System Head TDJ Ft Forcernain Length I I- Dia. Dist. to Well I L" -- - - - - __ /j SOIL ABSORPTION SYSTEM ELEVATION DATA County: St. Croix Sanitary Permit No: 453118 O State Plan ID No: Parcel Tax No: 040-12 54-10-0 00 Section/Town/Range/Map No: 19.28.19.1342 STATION BS HI FS ELEV. Benchmark 0S /M,0.tF� AC) Alt. BM 21,6 1�4 ,57 11 5 Z Al 1/. 3 Bldg. Selver P4,5 12 q-7 St/Ht Inlet 114.7 Z_ 7 St/Ht Outlet tInet Dt Bottom Header/Man. -7. �5 Dist. Pipe -7 Bot. System T • ,,5 c/7' Final Grade Y.? /bit 1 St Cover C� BED/TRENCH Width Length r No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth DIMENSIONS (00 :5 cc � N%,-- SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR Manufacturer Nt UNIT se Type Of System: y m: 1 co� 61IJ A-- /J74— Model Number I I 21 DISTRIBUTION SYSTEM Header/Manifold r Distribution x Hole Size x Hole Spacing Vent Aar ntalie�, �,o SOIL COVER x Pressure Svstems Oniv xx Mound Or At -Grade Svstems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No 51M COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / 2_2f Inspection Location: 284 St Andrews r Unknow ( W 1/4 NW 1/4 19 T28N R19W) Troy Village 2nd Addition Lot 91 Parcel No: 19.28.19.1342 P 1.) Alt BM Description r 2. Bldgsewer length = - amount of saver = L � . �J r Plan revision Required? Yes No 1 Use other side for additional information. 7� SBD-6710 (R 3/97) Date Insep � 's Sian re C d r,15 yod �' 51M COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / 2_2f Inspection Location: 284 St Andrews r Unknow ( W 1/4 NW 1/4 19 T28N R19W) Troy Village 2nd Addition Lot 91 Parcel No: 19.28.19.1342 P 1.) Alt BM Description r 2. Bldgsewer length = - amount of saver = L � . �J r Plan revision Required? Yes No 1 Use other side for additional information. 7� SBD-6710 (R 3/97) Date Insep � 's Sian re C d r,15 yod �' Safety and Buildings Division County 201 W. Washington Ave. P,©. Box 7162 <5 r ;Alllc-dLn by Co.)madivn' W? 5 R&M ='j Number (to be ruled in by Co ISC n (608) 26 3151- CEIV EV )4 5 ?) of ornmerce De Seats Plax LD. Numba -- - ----- --_ Sanitary Permit ApplicationPPR 12 2304 n y e Ln accord with Comm 93,21, Wis. A&M Code, PU=W inf0=2110 U Proy' "W At dmu (if c=rt tbAuJ3 mailing address) purpom Pd vacy Law, s 1 5.04(l X . ........ may be used far S=03d"Y ST. CROIX T CO ZUNING OFFI 2- - Please Print All In(ormation C 13 4 1, Application luformation C->C)o ( Block 9 Property Owner's Name 9 --__. 4- Property -wropertyowua's aitingAddress Ung M ij V) IZ4, SM-6 on 19 3t) t 4 Zip Code phone Nuziber Cary State (circle one) s-yl 0 L) r ubdivis on Ntme GSM Number 11. Type of Buil 'U9 (cbeck sill that fiPPIY) ubj&yi rL or 2 Family Dwelling - Nuzw of Sedrooras rL) ourrie aAAf2 Pubuc/CommcrciaJ - Describe Use ou '�. Ocity ovilage growDsj3jp of1 ❑ - ULI SLate Owned - Describe Use 3 k 1. Type of Permit: (Check only one box on line A. Complete line 8 it applicable} — , 0 T�a=cnt/Holding Tank RePIALOCUlent Only C) other ModifwAtlon to Existing System A 7New System 0 Replacen=t SYstcm 4 - — and Dal Issued List Previous Permit Number C1 Cbange of ❑ Permit Transfer to New C] pern-Lij Renewal C3 Permit Rievisim ❑ pIUU4)Cr Owncx Before Expiration 1Y T e of Powrs System: Check sill that AP.21 okt-Grade 0 Single pass Sand Filter C1 on - essurited in -Ground❑ Mound >- 24 in. of suitable soil 0 Mound < 24 in. of suitable so t.tuitaRecirculating Sand Filter❑ Constructed Wetland 0 Pressurized In-Ckound 0 Holding T&nk 0 Peat Filter C). Aerobic T�Uft=t fit�jg S)Tthetic Mtn FUtr-r eachin Curnber Gnvcl--!!!S �p ❑ i}C�S lam► RecimW atmeat Area Information: fem El V. Dispersain"re Dispersal Area Required (so Disposal Area Proposed (so S PCSIF Soil Applicatioc AALC�Spds Design Flow (gpd) �O , 77 7 (z 00 Prefab --,SAtej Fiber Plastic Total Nun miulufactur_fop ed- Glass V1. Tank info capacity in T�UJ Concrete COnstilLid WOUS Callous of Units Ncw SxWng Tanki Tanks splic or rev 7 77 -- ----- Acru6ic Trciotnicry unit airing ChAmbcr -7 S� 0 ity Statement- 4 the under an iDs4bWty for tnstzlUdon Of the POVvTS ShOWI) On the A"JkCbed plans. VIL ResponsIbU M.P/Kpks Number 7 , Buii=u Pbonc Nurnber S p 1,, ,bw Name {Print) under // p C plunibcT's Address (Street, City. Su-f-"7 COte, Zip W I sui Agent Signs (No Scamps) VIII, Count epartment Use 0D1Y Date issued - Sari tuy Pemit Fee (includes Groundwater Kproved 0 Disapproved Surchu&e Fee) -2 SU 0 0 en Rxas<m for Denial I t IX Conditions Approve Proia to fu. SYSTEM OWNER: YL - Septic tank, effluent filter and 6-4.. C- jZ7 dispersal cell must all be serviced /. maintaigad- as per management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code/ordinances Aftath compitte platy (to the County 0aly) for -the system on paper oot less thax 5] fz L I I Incogn to a s: SBD-6398 (R. 01/03) I vd-1 � '7 134 1 J v 91 ?V7 .� -----� I ) h--� I I (1T-/ c7nI U _e4d Q 1 .y J -41) r` 1. W ` i r� ED EVDepartment of Safety County - - ST. CROI X & Professional Services, 5Pinitary Permit Number (to be filled in by Co.) .� �2� , Industry Services iv on 0c, CA .� � Application 10 State Transaction Number In accordance with P02M t , su mission of this form to the appropriate governmental unit NA is required prior to aining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Services. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04(I )(m), Stats. SAME I. Application Information - Please Print All Information Property Owner's Name Parcel # V A,Sr. Tl A R C� V I n TIV CST 12 .40% 040 - 1254 - ] 0 - 000 Property Owner's Mailing Address Property Location 284 ST. ANDREWS DRIVE Govt. Lot NA City, State Zip Code Phone Number H U DSON, W l 54016 651 - 734 - 1 160 NW` 'A, N W '/4, Section 19 T 28 N R 19 LX r W II. Type of Building (check all that apply) Lot # 91 or 2 Family Dwelling - Number of Bedrooms 4 91 Subdivision Name TROY VILLAGE 2ND ADDN. Block # 0 Public/Commercial - Describe Use ® City of NA ❑ State Owned - Describe Use ® Village of CSM Number -4 X EXTown of- _THY_ III. Type of POWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C if applicable. A. ❑ New S stem y(TReplacementy System Other Modification to Existing SystemQ g Y (explain) Additional Pretreatment Unit (explain) B. Q Holding Tank In-Gr6und ❑ At -Grade ❑ Mound ❑ Individual Site Design El Other Type (explain) C. ❑ Renewal Before Q Revision ❑ Change of Plumber Q Transfer to New Owner List Previous Permit Number and Date Issued -L Expiration 4531 8 104-23-2004 I I -W - - IV. Dispersairrreatment Area and Tank Information2MgA&x,J �v A Al (4 5W5_ b Design Flow (gpd) Design Soil Application Rate(gpd/sf) Dispersal Area Required (s ispersal Area ProVbed (so System Elevation SOP 600 0.7 857 875 97.40 FT. Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units �jj U U �' ,U New Tanks Exisling Tanks(, t c o.-. C" cia i �, 4, U L Septic or Holding Tank 1250 1250 1 HUFFCUTT X Dosing Chamber 750 750 1 1 iUFFCUTT X V. Responsibility Statement- 1, the undersigned, assume responsila" ky for inst"tion of the POWTS shown on the attached plans. Plumber's Name (Print) MIKE RODEWALD Pl s nat MP/MPRS Number 931384 Business Phone Number 715-425-6200 Plumber's Address (Street, City, State, Zip Code) 285 O.T.H. SS, RIVER FALLS'. WI 54022 VI. County/Department Use Only Approved ove Permit Fee Date Issued Y./1r L26 Issuin Agent Signat e Given Re on for Denial 2, Conditions Approv I ! ) SYSTEM OWNER: � tic tank effluent filter end dispersal p cell r must be serviced l maintained as per v �<C 1�'t ,• --- anagement plan provided by plumber. setback requirements must be maintained - • as per app Ica a Code Aolichnsfwmte glans r the system and submit to the County only on paper not less than 8 1/2 x t t inches in size I - I/ .e T)X�*4" 4f"uL. ckA 4�� 5 SBD-6398 (R. 03l22)kk L,5-/- t;bow /*--e 4 Aso% A? tven CL6 ?0 ss°6 le. � (o �n2{,�t.0��,�►��•t�la Wisconsin Depa rA of Safety and Professional Service )L rAq qi Division of Industry rvic" OIL EVALUATION REPORT Page I of st, Croix w' SPS 3-83, VVis Adm. Cade 0ity De 05P County ST. CROIX Attach complete sit PIA Ss an 8 V*2 x 11 inches in size. Plan must incJude, but not lirriAe�d'to: vertical and horizontal reference point (BM), direction and Parcel I D. 040 - 1254 - 10 - OM percent slope, scale or dimensions, north arrow, and location and distance to nearest road Please print all information. Re iewed by Date Personal irytorrn-Aiori you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location El 0 TROY & DARCY VARGAS Govt. Lot ---- N am' 1/4 N am' 1/4 S 19 T 28 N R E (or) W Property Owner's Mailing Address Lot # Block 4 Subd Name or CSW 294 ST. ANDREWS DRIVE 91 TROY VILLAGE 2ND ADDN. City State Zip Code Phone Number Village [E]Town Neatest Road RIVER FALLS WI 54022 I ST. ANDREMS DRIVE J- I 1 ( --3'4R 01" 11 New Construction Use[E Residential / Number of bedroorns 4 Code derived design flow rate 600 GPD EjReplacement El Public or commercial - Describe: Parent material LOFSS OVER GLACIAL OUTWAS1 I Flood Main elevation if applicable NA General comments CONVENTIONAL IN -GROUND TRI:--'NCI-11-,S -- 0.7 LOADING RATE; ADD DIVERTER and recommendations., ADDITIONAL BORINGS RE-Q1-J'IREDTo EXTEND INITIAL TF-.STI.'-.D AREA. I FT. VARIANCE REQUIUD FOR EXISTING NK. Cc!--& Boring Boring >96 pit Ground surface elev, 101-59 —ft. Depth to limiting factor in. I Horizon 1 Depth in. 0-30 Dominant Color Munsell Redox Description Ou. Sz. Cont. Color Texture fill Structure Gr. Sz. Sh. Consistence Boundary Roots GPD/ft' *Eff#1 *Eff#2 2 30-43 I OY R4/6 __ Sil 0 M Infi 0.0 0. 3 43-8() 7.5YR4/6 Cos osg InI 0.7 1.6 4 80-96 7.5YR4/4 S osg d 1 0.7 1,6 some gr Boring # LJ Boring 102.14 >95 Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Honzon Depth irl Dominant Color Munsell Redox Description Qu. Sz. �rlt- Color Texture Structure Gr. Sz- Sh. Consistences Boundary R00tS GPDiff *Lff#1 *Eff#2 0- -1) 1 fill -- -- 31-40 1 OYR4/6 sil 0M T11fi - __ ().00.0 3 40-70 7.5YR4/6 Cos Osg ITI 1 0.7 Lo 4 70-95 T5 Y R4/4 S Osg 0.7 1.6 * Fffltjpnt Al = SOD > 30 < 220 mofl- and TSS >30 < 150 mall- * Effluent #2 = BOD < 30 mQ/L and TSS < 30 m/L CST Narno (P{aase Print) Sip 7 CST Nun4>it-1,r MARY JO HUPPERT(Hollistcr's Soil Tessin & Design) 2214832 zi4 - --- Address ate Evalu Condor-d Tplephonp Number 28497 King Arthur's Court, Danbury, Wl 54830 03-2542021 715-426-1775 S B D-93 30 (KO'I,,' 1 -,) 0 Page z- of 2 PROPERTY OWNER.- I'AD Uiv ;4A. ),-t --0- q I I Legal Description:I _ -T 4- 1) W X4 wvj 1, 1 )It Z j 1, �AL4- 2 ,� A b —L j . 1� I)J! L ZVI Dr(\ Site location: C CAP LA I rV - re 1 01f = = 60 FT. (except where noted) backhoe pit North l f i + "too, S riplotCOUNTY�Ro r- OWNER�QO TE SANITA Y PERMIT 04AUWL) so be 0 P VIOUSAOO Oil` Or !1 S r f PLUMBER]ftle**t, FAW&Lt LIC.# q3/ TOWN OF p SECI ? 19T.22 N, Rit. up AND/OR LOT*W.Aftmm&j BLOCK �- fr6ie \[,LLA6* —2 SUBDIVISION CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c.168;1979 c. 34,221;1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. AI O ZED ISSUING OFFICER -DATET IS PERMIT EXPIRES= UNLESS RENEWED BEFORE THAT DATE POST IN PLAIN VIEW VISIBLE FROM THE ROAD FRONTING THE LOT DURING CONSTRUCTION SBD-06499 (R11/20) Kevin Grabau From: Mary ]oHuppert«hoUisterdesign@out|ook.cnm> Sent: Tuesday, November 1'2O223:22 PM To: KevnGnabau;bettendorh@dishup.us Subject: RE: Vargas permit Replacement Attachments: Vargas plot plan addition.pdf Follow UpFlag: Follow up Flag Status: Flagged Hi Kevin' This one should be readable. Note there are to soil tests with 2 plot plans. ThanksU( Sent from Mail for Windows From: Kevin Grabau Sent: Tuesday, November l,202ZZ:0OPK4 /o: Subject: Vargas permit - Replacement Hello Mary Jo & Mike, Ben was reviewing this permit. Hehad some comments. Hewas not able toissue this permit until there isa legible site plan and the soil test site plans are clarified. Kevin Grabau I Community Development - Land Use Planner ST. From: Kevin Grabau <Kevin.Grabau@sccwi.gov> Sent: Tuesday, November l'2O222:2OPM To: Kevin Gnsbau<Kevin.Gnsbeu@sccwigov> Subject:[OO|al This E-mail was sent from "[DDLAl"(|PN[45OO). Scan Date: lI.OI.2U22I4:2O:O7(-O5OO Queries to: Kevin Grabau I Community Development - Land Use Planner 1 1101 Carmichael Rd Hudson WI 54016 T: 715-381-4382 1 C: 715-716-0698 Kevin.Grabau@sccwi.gov T. RO - ,PNTY Kevin Grabau From: bettendorf@dishupus RECEIVED Sent Wednesday, November 2'2O22EL3OAM To: 'Mary Jo Huppert'; KevinGnabau NOV 0 29027 Subject: RE: Vargas permit Replacement Attachments: Additiona|information.pdf $To CROC(COUNTY CDD Kevin, Attached is my original "AS -Found", its scaled & superimposed onto the aerial photo with the locations of Nelson's borings. This was then used for the design. Septic tank/pump tank is on the south side of the home. Trenches run east to west and were found to be installed past the limits of the original nelson soil test. Page 2 is one of the site plans from your file. It appears Ryan has drawn in the force main and trenches on to it. I'm not sure if Ryan drew in the septic tank in the wrong location also or ?, but it is located where the force main indicates on the drawing onthe south side ofthe home. Mary Jo&/met onsite todothe borings last year. l. | staked the locations ofthe original trenches 2. | staked the radius setback ofthe well 3. | staked the replacement trenches 4. VVedid the borings toconfirm soils for the existing trenches outside the original area and the replacement trenches. I'm pretty confident on the design/placement but we can meet if you would feel more comfortable. MikeRodevva|d 8ettendorfTransfer &Excavating 2O5[R-SS River Falls WI, S4O2Z 715-425-6200 From: Mary JoHuppert<hoUisterdesign@out|ook.com> Sent: Tuesday, November l,2O228:3OPM To: Kevin Grabau<Kevin.Grabau@sccwigov:;BettendorfExcavating Mike Rodevva|d<bet1endorf @dlshup.us» Subject: Re: Vargas permit - Replacement That drawing was not an as built...it was the drawing for the permit. It was not installed that way. Get Outlook for Android From: Kevin Gnabau Sent: Tuesday, November 1, 2022 4:45:46 PM To: Bettendorf Excavating K4ikeRodewe|d Mary Jo Huppert Subject: FW: Vargas permit - Replacement Sorry, | should have included Mike onmy reply. Perhaps osite visit is in order to verify placement of trenches, tank and well? Kevin Grabau I Community Development - Land Use Planner ST. 'Y'NT.Y., From: Kevin Grabau Sent: Tuesday, November l,2O224:44PK4 To: Mary JoHuppert Subject: RE: Vargas permit - Replacement Ok, got your new drawing. But, the inspection in2OO4shows the trenches running no and onyour site plan they are shown Also itthe tank meeting setback from the well? The tank isshown north ofthe house onthe 2OO4inspection, but shown on the south side of the house on your site plan. (?) Are all of the soil pits/borings set to the same benchmark, so that the system elevation can be correctly calculated and installed? It get very difficult or impossible to set a system elevation if they are all not set to the same benchmark reference. Just trying to make sense of this one, but seems to have conflicting information. Thanks. From: Mary JoHupperL Sent: Tuesday, November 1,2O22 3:22PM To: Kevin Gnybau :; bettendorf@dishu us Subject: RE: Vargas permit - Replacement Hi Kevin' This one should be readable. Note there are to soil tests with 2 plot plans. Thanks!!! Sent from Mail for Windows From: Kevin Grabau Sent: Tuesday,, November 1, 2022 2:00 PM To: 'Mary Jo HupperV; Bettenclorf Excavating - Mike Rodewald Subject: Vargas permit - Replacement Hello Mary Jo & Mike, Ben was reviewing this permit. He had some comments. He was not able to issue this permit until there is a legible site plan and the soil test site plans are clarified. Thanks. Kevin Grabau I Community Development -Land Use Planner T. R O U NTY From: Kevin Grabau <Kevin.Grabau@sccwi.gov> Sent: Tuesday, November 1, 2022 2:20 PM To: Kevin Grabau <Kevin.Grabau@sccwi.gov Subject: CIDDIal This E-mail was sent from "CDDLAl" (IM C4500). Scan Date: 11.01.2022 14:20:07 (-0500) Queries to: helpdesk@sccwi.gov Kevin Grabau I Community Development - Land Use Planner 1101 Carmichael Rd Hudson WI 54016 T: 715-381-4382 1 C: 715-716-0698 Kevin.Grabau@sccwi.gov T. CR c �JNTY 2 9 2 STATE BAR OF WISCONSIN FORM 2 - 1998 WARRANTY DEED Document Number This Deed, made between Troy DeveloMent Corporation, a_Minnesota CoKpoKation Grantor. and Troy- A. & Darcy EaDue Vargas Grantee, Granter, for a valuable consideration. conveys an(] warrants to Grantee the following described real estate In St. Croix County. State of Wisconsin� KATHLEEN H. WALSH REGISTER OF DEEDS ST. CROIX Co. , WI RECEIVED FOR RECORD 10/01/2003 10:30AK WARRANTY DEED EXEMPT # REC FEE: 11.00 TRANS FEE: 299.70 COPY FEE: CC FEE: PAGES: 91 2nd c c () I ( 1. nu /V (."-I - - - � - Lotof the Plat of Troy Village 7 7 77," Name) and Return Adclresa Addition in the Town of Troy, St. Croix County, Wisconsin. Troy A. & Darcy La Due Vargas 'J'y _y Subject to Declarations of Covenants.. Conditions and 3�3_ Ea_g1Aa--Bca ley Dirlive Restrictions for Troy Village, recorded in Vol. 1241, W M V Page 256, as Doc. No. 559964, and the Declaration of db ry., J— Golf Course, Covenants, Conditions and Easements, 77 recorded in Vol. 1241, Page 301, as Doc. No. 559969, all as appearing in the office of the Register of Deeds 040-1254-10-000 for St. Croix County, Wisconsin, and such other Parcel ddar)lificaGon Nurnbef (PIN) w it ii easements, restrictions and reservations of record, This is not homestead property or in use, and the "Buyer" obligations contained in (is) (is not) the Purchase Agreement for this lot. Exceptions to warranties: Dated this 16th day of September (SEAL) 1 � = CZ I"rw-% L- - r3 r- cb c-_ 4 tqe% r% Troy Development Corporation AUTHENTICATION Signature(s) authenticated this day of TITLE: MEMBER STATE BAR OF WISCONSIN (if not. authorized by 5706.06. Wis. Scats.) 2003 (SEAL) (SEAL) ACKNOWLEDCNIENT Minnesota State of WiquirrrsTn, ;I Anoka County. Personally came before me this 16th September 2003 ___ day of the above named Charles S. Cook, President ---Troy Development Corporation to me known to be the person - who executed the foregoing instru t and acknowl e same. THIS INSTRUMENT WAS DRAFTED BY TROY DEVTM�OPMENT CORPORATION Flick A. Johnson lI Notary Public. SAP-s4-VV4w,4>ms4F+Anoka County, Minn Charles S. Cook, President My commission Is Permanent. (Jr not, state expiration d'ate'. (Signatures may be authenticated or acknowledged, Both are not january__?I_ necessary) _0 Narn*s of pvrson& siltnivS in any cap,4clty the type-d our printed t-mlow t1wif sigmattirr wwww W W W V W V IAOVVV^ U STATE PAk OF WISCONSIN W I k %KW��L Gogat 13 Co lr%c WARRANTY DEED FOkhl Nor. 2 - 199111 RICK KA d W's NOTARY PUKJC - WNNE90TA My COMMISSION EXPIRES fie) JANUARY 31, 2006 (SEAL)