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040-1326-23-000 (2)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division 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 Jeffery and Jenna Althoff TOWN OF TROY CST BM Elev: Insp. BM Elev: BM Description: Nor&: "�.,k d. �� �� 9 -hw. �I���+�� 1 � - � �n06 bjhm 4 et�S�1�5 ",+w 51-14 66 ow &wg7 4. " Q minl mal biwnc} }o 1..Jv 2�.4SJ 1 - fps i •{' �K JIISt 4 'k.. �-A" bWAmck. TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic t� &#L- 4-2- 11��e s�C 1 D oo g�l m TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic lq1 63 , DGSiftg Se?�L 2 Aga. PUMP/SIPHON INFORMATION Manufacturer - p Demand GPM Model Number DH L' Fri on Loss System Head TDH t orcemain Length - Dia. Dist. to Well SOIL ABSORPTION SYSTEM 9 ELEVATION DATA County: St. Croix Sanitary Permit No: 651318 State Plan ID No: Parcel Tax No: 040-1326-23-000 Section/Town/Range/Map No: 17.28.19.2215 STATION BS HI FS ELEV. Benchmark &}[1m DF -EKZS�<< cS�� . 99 b y (Oq 9y iirn^) D Alt. BM Bldg. Sewer 10 3 1 } St/Ht Inlet 2.q5 lol.�y St/Ht Outlet 3. 22 � I of 33 Inlet Si VZ SY _#2 - OAC+ I vo. 91 Header/Man. gb.yl Dist. Pipe Bot. System �� <QGloc .5 919 (x2) 9�- I's Final Grade cfl . 6\ St Cover 7.56o BED/TRENCH DIMENSIONS Width Length No. Of Trenches PIT DIMENSIONS Of Pits Inside Dia. Liquid Depth SETBACK INFORMATION SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING CHAMBER OR UNIT Manufacturer: Z-j�LT?,Prrm Type Of System: 4._ OnlJthti sb� �'� . � I � 5D Model Number: lbw DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length_ Diu Spacing SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only Depth Over Depth Over �Edg��� xx-Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center �� Bed/Tr Topsoil ❑ es ❑ No ❑ Yes ❑ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Location: 371 MEADOW VALLEY TRL 1.) Alt BM Description = 2.) Bldg sewer length = f, , $,: ys' �, �, ys. �vw, 7' Inspection #2: amount of cover = i I AW174-oti vj:VL-(. '?ve I' Fem- -I1NK I PDT Cw5roc1ty #r -T�AE Cf-_ Plan revision Required? ❑ Yes No 21,6 Use other side for additional information. �5 9 SBD-6710 (R.3/97) Date Insepctor's Sig ature Cert. No. wr► l T) 4 5AA1 -2o,23 St Croix 2023 Vrofessional Sei & -Nices, 'Indtis-try Sa n i i. Li ry I Ir- rm i I N umbe r (to tic I I Services Nvisioti StaieTransaction Number Sanitary Permit Applicatioll L 10.1 L] I I L%J I 'LO 1 L t I I I I I C Mil Nolo Application forms 1'or state-owned POWTS arc submwed io Proicc( Atldrcss (II'difTerent than mal �kdd I c q,� I JEFFERY AND JENNA ALTHOFF 0 qO "I. Typt of POWTS Pcimiil: (('h-ech- ciffier "New" or "Replacenieni":and Olher allplicable 4in linc A('heck one box oil line It. Coniplete line C1 ADDING THREE MORE BEDROOMS Holding Tank El In-Ool,11,11-1, LJ Ai.-Gridc El El Renewal Bel-Ure 0 Revision C11d11!_'C ol'I'lluniber rranstler to New Ownei List 11revious Perim Numberand Owc Issucd e? Lr!2-Z IN msper%aifrreatnient Area and Tank Information: LN-143 L20 3xb5;'19-n,-6vS :-� E2_ Na, XJ,;i-.- HE ;1,)wncr (C-Tiverni Reaso; i' Pi Dcni d p p'-L s % ke- exe (An �y ~."^^ to..~/^.~ *^.. 1.. ... ~ct,~ ~. ,...^. .". I . ^.. '.`` ~. ,`.—. ." 1k,— 1^~ ` 1 2 ` " 1116tc . = Nu Project Name-, Owner's Name Owner's Address: Legal Description" Township County - Subdivision Name, Lot Number: Parcel ID Numbev. CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE leffintid JcnnLa Althoff 371 iiicadlow valley trail hUdsoti kvi n w, 1/4 ri w 1 /4 sec 17 2 8 n 19w tr(--)v st cl-()Ix 23 4 13 —16 --23- Page I Index and title Page 2 Plot Plan Page 3 Ste rn Sizing & Cross -Section Page 4 F filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St, Croix Cty Scptic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachmcnt5. Soil Test & House Plans Des[gner/Pllurrber: PaUll F License Number- 21 _15410 Date. t t Phone Number (715) 2-46-2660 signature Uesig r, ed iD uvsvi r-. i: to t�.e ir r c. il Absorption Component Manual for I 10%N—S Vers ion 2 0 S L3L)- 1 07-D 5-F f N C 1 1r) 1 pagp dff H� cr,h l.J Lot 13 T R L,) 0 ,� k) CS-C 10 SIT �f ---_ t� LAJ r ` y j r � - I I --( r\ t 4.6 q-� , I�- ir- YO s � C) (p 4z-" 2.�0 LJ �1 rrNb. CIS 1q4- ibLo mA 11 sy�� st- aff T ea�aw Lit 23 T ZiN par��J 0 4v-13a� CS-C 10 I �ddTw fv Oo ' • SA, I�— Ir- YO C) pz --- _. --- f�e,�61hlt� CIS 1`+�- ibLo f7f f!f qrlflrfftdPldfldlflpfdf+RPl+flfdldif If Idf IfiJflflfdPlfldd@f! 1 fltgdtflffltGf{lffldllldlfltlffdiRilffdfldlfltfdlflPllflfltU � dtPldtlltfUfldfldfldfllPVflfflffltllfltClHlflfPflffdClNfo �llf +flfIdtddffC�ltfff fj;fltfdRtfdfl}flfltfdfr w • : . `. v , . a14 a f t k �y t ,y"�ie.�;} -•4 yGr� y. • �' �'r . � .. � �" ��`tu �' `'r. • IICR1 'y `G � f. ` A'- '.q A' • k �.. l�lk 4 �, `1� ir� .5 _ � �r. ' ` �• ��-c� a rig P "�]i'� }n�id ';�,� 9 it y ,N(.' tin f> S 8 Y f� i�i R k� � � � 6y Ij� .?, 1 ,-i•.,. SOI I. ABSORPTION SYSTEM DETAIL. I GRAVEL.L.ESS LEACHING UNIT Page of Project Name: 2 No. of Cells ft Cell Width tt Cell Length ft Cell Spacing tlo• Per Cell f Total No of sq ft EiSA Per Cell sq ft Total EiSA Manufacturer Model Lff Ing Length EISA Rahn Infiltrator EZ1203H-5ft 5.01 26.0 a1 Zn3 H-1 aft L 10.01 50.0 Gravelless Leaching Unit Manufacturer: Gravelless Leaching Unit Model: Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent in Soil Backfll . ::; :;: Geotextile Fabric .: ft Infiltrative Surface 12 in 0 _ _ _ _ ft Limiting Factor in Slotted and Anchored Ventf Observation Pipe with Cap Plumber/Designer Signature: License #: 1072 S �jp Date: if d2 -ft- wl Z C.'. Pli Ciduc rs ion at PON10k Inc. Pi.-525 Effluent Filter PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) ni,ikiliq il one 4 the largest filters in -its class. It has 525 Ili -tear feet of 1/16"" filtration slots. Like the Polylk-ik PL-122, the T'L)lOok- PL-525 has an automatic shut-(-.)ff ball installed with every filter. When the filter is removed for cleaning, the L)all �Nlill float up and temporarily shut off the systern so the effluent won't leave the tank. I& Features: a Rated for 10,000 GPD (gallons per day). 0 525 lirtear feet of 1/16JVP filtration. o Accepts 4" and 6" SCHD 40 pipe. ,s Built in inLyas deflector, * Automatic shut-off ball when filter is removed. e Alarm accessibility. * Accepts PVC extension handle. ILL-5 25 Installation: Ideal for residential and con-imercial waste flows up to 10,000 gal Ions per day (GPD). I - I-occite thy' nu det of the septic tank. 1/16 " Fi I tra tl* ( BUX1110 '). Remove the tank cover.,wid . pt,imp tank if necessari . 3 At'L_Vjlt'' 4" & 6' Ci I i i c t, hc fil I t t, r housi.ng t t.i t I i L., 4 ()r 6"' outlet pipe. If (A I V) 40 pi PC the filter is not centered Ll M101- I he access opening use a Poly] ok Extend k Lok or piece o I p i pe to c e n ter (i I ter. 4, Insert the 17L-525 filter into its housing. 5. Rcplace and secure the septic tank cover. PL-525 Nlaintenance: The PL-525'Effluent Filters X�7 III off icier tIv for several years Linder normal conditions before m.lUiring cleaning. It is recommended that the filter be L-leatied every time the tank is Pumped, or at least evc,ry three vears. If the in ta I lcd f i I ter contairis an optional alarm, the mvner will be notifiedbyan alarin when the filter needs servicing. Senlicing shoLild be done by a certified septic tank pumper or installer. septic I . Locate dic nutlet of Elie septic tmik_ I R"LMION-L' m irk cover and pump tank if necessary. 3. Do r 101 U L-,C J: j Ll 111 LjI J1 L' %v I ien filter i s rem(iv ed, 4, Pij H 11 -525 cartridge out of the housfiig. 5 H L I I t I f f f i I [ ( s I k 1 �7 er the septic tank. Make sure all �t 1h " 1 1111 I)Llk'k I ],I kO septic tank. j['j'Ltj.t to IC- J'1jtt2j_ �r-,Ji-tridge back intci the housing main �l ire Lhe filter is 1-11-01"IcrIN, ali6mcd and complek!ly insk-rtc& scctll-c t3l'lk OUMOOF SITI Alarm Polvlok, Zabel & Besi filters accept and ..M switch tional) ,Cpp I s I P V C . t U TV� I ( ) 11 f 1.)ndlu Rated for 100 ()()() G PD 525 Linear Ft. of 1/16" F1 I I -r,i ! rf m C110ts Ex end &-- Lokl'-'. Easily 111stalk into ev�;tinc; tak,,ri C) Polylok, inc. 3 F`alrfield Blvd. Wallingf-Ord, C-T 06492) Toll Free: 877.765.9565 Fax: 203.284.85) 14 w\�w,j)olylok.coni 4" CAST -A -SEAL ro w QD a �cr_ �� rr �� rr �r rN: 1 I� FILTER OR BAFFLE 4" CAST -A -SEAL ""- OUTLET V) L) an PUMP PAD TANKS ARE MANUFACTURED TO MEET OR EXCEED ASTM C--1227 REQUIREMENTS WLP1 000-MR TANK SPECIFICATIONS. DIMENSIONS: WALL: 2 1 f 2" BOTTOM: 3" COVER: 5" MANHOLE: 24" I.D. PRECAST CONCRETE RISER HEIGHT: 53 1/4 LENGTH: 8'-- 8" WIDTH: 7'--2" BELOW INLET: 42" LIQUID LEVEL: 36" WEIGHT: 6,790 LBS. INLET AND OUTLET: 4" CAST--A--SEAL BOOT OR EQUAL GASKET INLET AND OUTLET BAFFLE AND FILTER: WISCONSIN, SEE DETAIL #10 (OTHER STATES SEE CHART) LIQUID CAPACITY: 27.83 GAL/IN HOLDING TANK: OUTLET HOLE PLUGGED ACTUAL CAPACITY: 1,085 GALLONS LOADING DESIGN: 8'--0" UNSATURATED SOIL TANK CAN BE USED AS: SEPTIC l HOLDING f PUMP OR SIPHON COVER: MIX DESIGN #8 (NO FIBER) TANK: MIX DESIGN #10 (STRUCTURAL FIBER) CUSTOMIZED TANKS: FOR CUSTOM TANKS CONTACT WIESER CONCRETE REVIEWED BY REVIEW DATE w O O O O � O w- m O O O1- J � 3t w ul 1■� � Ln C� z co w I ©U) o I O W�o LaiD SHEET N0. 1 � OF 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN page I of FILE INFORMATION '-)wner an jn eff d jena a(thoff DESIGN PARAMETERS Number of Bedraoms 7 EJ NA Number of Public Facility Units 700 E N gal/day ll Estimated flow (average) Design flow �peak ), (Estimated 1.5) 1050 ,;Dii Appfic-.at i on Rate .7 a I / d ay Jf_ ::,iaril and Influent/Effluent auality Monthly ave-rage. Fats, Oil & Grease (FOG) �30 mg/L BioChemical Oxygen Demand (30 D r) rng/ L 7 NA 'fotal SLIspended Solids (TSS� l 50 mg/L treated ffluant Quafi*,-y Monthly average Blocnemical Oxygen Demand (BOD.) .530 mgIL atal Su,spemded Solids iTSS) _<30 mg!L 0 NA -ocal CDllform Igeometric mean) 1 0'r 0 u, I 00ml Maxlrriun� Elf uent Elar-ticle Size Y;a are d I r-1. E] N A,. E r� A Other, *Values typical for dorne.qvc wastewaler and septic tank affluent. MAINTENANCE SCHEDULE SYSTEM SPECIFICATIONS Septic Tank Capacity 1255/1000 gal ® NA Scotic Tank I'VIanufacturef hufcut/ wiener 0 NA Effluent Filter Manufacturer poly lock C1 NA Effluent Filter Model 525 0 NA Pump Tank Capacity gal IR NA '1 an k Manufacturer R NA, PrUMp MHnufacturer ER NA Pump Model Z NA Pretreatment Unit NA 11 and/ Filter 0 Peat Filter 11 Mechanical Aeration ® Wetland EJ Disinf ection 0 Other: Dispersal Ce11W C1 NA Z In -Ground (gravilty) In-Gfound (pressurized) 0 Avi5rade 11 MOUnd 0 Drip-Lir)e Ll Other: othf±i: 11 N A Other- :1 NA Other: LJ NA Service Event SurviCe Frequency Inspect condition of tank(s) At least once every: El month(s) (Maximum 3 years) 3 00 yearW C1 NA Pump Dvt coat eats of tank(s) Wh en combined sludge and scum equals one-third (Y.) of tank voliume Inspect dispersal cell(s) At least once every: At least once every: mo r] nth(s) 3 Z year(sl (Maximum 3 year.'� 0 month(s) � yearW ID NA Clean effluent filter Irispeci pump, pump controls & a�arrn At least once every: FJ monthis) EJ yaarl sl 91 NA Flush laterals and pressure test At least once every: EJ mon E-] yea7�sl!this) NA Other: At least once every: ❑ montWsw yeahs) NA Other- D NA MAINTENANCE iNSTRVCTIONS 1nspecttDn:s of tanks and dilspe,sal cells shall be made by an indlividual carrying one cif the following licenses or rertificatiors - Mastr',r PlLimber; Master Plumber Sewer; POWTS Inspector; POWTS Mairita-Iner, Sept age Servicing Operator. 7art K in8pe� tiuns must in-.1ude a visual inspection of the tan kls) to identity any missing ar"Droken hardware, identify any I;racksor leaks, measure the volur-m., of combi,,ed �-,Iudqe and scum and to check for any back up or ponds inn Of effluent an -thF. grouind surfVace. T h en d 'Ispersal ce.11z;)sha�' IL -)c- v ii,spected to check the effluent levels in the observation pipes and to cher-A fur any pcmdinq 1,, I sually I _rata a failing of effluent an the grounc, s-ti-face. The ponding of effluent on the ground surface may indi.,condition and rDqUires the immediate notification ol the local reguiator�: authority. When -the combined ac�7,umulabort. of sludge and scum in any tank equals any -third (Y.) or more of the tank volurne., the entire contents of the tank shalli be retroved by epiage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servi6na at intervals of -_:J 2 months, shal, he performed by a ner-fified POWTS Maintainer, 4. S=Vir.-e, report sit �fll b-_ orovided to the Iota! regrji6t.u.Fy aiLA'hority within 10 da�,s of o4i any service event. Page 7- of START UP AND OPERATION For new construction, Fir iia!o to Use of the POVV'S chrtck trea'Li-ng-,rit tan V.Jsj for the presence of painting products or other chemicals t.r-,a4, may impede the treatmcint proco�ns and/or, damacqE the disper sa[ celks'), 11 high conre,ntrations are defected have the contents of Vie tank(s) re -moved by a sa-mtage operator prior to use. S it ystem start up shall not occur v-.,heri sail pond ions are frozen at the infiltrative surface. DuNno powe., outages pump tanks ni@-�r fill', above normal' high eater levels. When power is restored the exce1c;s v;astcvvatcr will be discharged to the dispersal Ccll(s� in one large dusz&, over loading the cell(s) and may result in the backup or surface discharge of effivant- To avoid this, sit-jatlon have the contents of the purnp tank removed bye a Septage Servicing Oper aioA Phor to restofir)g power 'to the effluen! purnp or contact a Fri umber or PO' `TS Maintainer to assist in manu0y operating the pur-np controls to restore normal levels within the pump rank. Do riot drive or park vehicles over tanlr-s and dispersal cells. Do not drive Dr park, over or otherwise disturb OT compact, the area within 15 f Pat d ow n s I ape of any mou rid or at-g rade soil absorption are a. Reduction or elimination of the foI13r%ling from the wastewater stream may irnprove the performance and prolong the life of the POWTS- antibiotics; baby wipes; cigarette butts; condotns; rDtton swabs; degreasers,, dental floss; diapers„ disinfectants.- fat; foundation drair, {sump pump) water; frulit and vegetable peel'ings; gasoline; grease; herbicides; meat scraps; modications; oil; .painting prDdacts ; pesticides; sanitary napkins; iar.iporis; aind waft tef so brine. ABANDONMENT �.Vhcn the POVV'TS iails and/or is perm anejifly taken ou-L of service the following steps shall be taken to insure that the sysiom is in C0_ I 'n '3, Wis,.�;onsin Adrn nistrative Code. ,T)p]7an_e P FOperly and safel�y abandoned . with chapt--F �'_-OfTIr 83.1.) 0 All piping to tanks and pits shall be ditsc.Dflnecied and the abanjonc-d pipe openings sealed. The onn'tents, of all tanks and pits shall be reran -wed and properly disposed of by ia Sepzage S�rvircjng Opprator. After purv,ping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN if the POVVTfails and carrot be. repaired the ic)[Im&,-ing measures have been, Drmus'll be taka-n, to provide a code compliant replacement system: k.- I -I 0 A SU i*1-9 Dle replacoment area has been evaluated and may be utilized for the Jo at of a repla.ar_-ment soil absorption systen-i. The rplacement area should be protected from disturbance and compaction and should no be infiringed upon by requirea setbacks from existing and proposed struc.ture, lot fitnes and vvalls. Failure to protect the rep la',,.,ernent area vvill re-suft in the need for a now soil and site evaluation to establish a suitable rep laNcoment area. Rcplaccmeat systems mu-st comply with the rules in effect at that time. 0 A. sultable replacement area is not available due to setback and/or soil limitations. Barrino advances in POWTS tochnology a �jcildi-,iq tank mary be i.--istalled as a last resort to repL-)cc the failed P0\-k71,;, VA Tha 4as—net be��11'err :1 to f4e,111111''Itl a-vuft s b% t-- P a_—dm, ,*e of F9 c3 IL LO L T17-:�ding k L p L. L I L 11 1 F. � I V 3 7`1 M4y be �,���e �Ijall �ali t)4 1,6 rTe:n� Aj&_�%J a Ni S:7W (J C-71 0 01 Mound and at -grade suil absorption systems m3-y be rec•�nsiructed in place fcell Dwing removal of the biornat i4l infiltrative surface. Re�,-onstrurtlons of such _rysiems must compiy vvth the rules i ne a ec, at triar lime.. < .-- WARN ING> > SEPTIC, PLIMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND.!OR INSUFFICIrENT OXYGEN. Do NOT ENTER A SEPTIC, PLJMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF, A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLED, Name COUNTRYSIDE PLUMBING Phone 715 246 2660 P0VVTS MAINTAINER N ar ePAUL R KOEHLER 715 246 2660 SE-1 �_ r:: D LOCAL REGULATORY AUTHORITY TAGS SEERVICING OPERATOR 1PUMPER) TName Narne MARCO SEPIC t�:; T%Y f20�J (Aj 715-928-2649 1:F rt o, i:,,,i n- v.: I.- :- zji- 1:, t z,,.? cl, t r. c o m ri jLL� r) "I 11L V.!I': ti -,i rr-L c-- f n m m 8 2W.22 2 b) I d & f and 8 3 . 54111 2 1 & 3) Wisconsin Ad ml n istrative Code Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4111116 . k Z)CCF�� Owner .0 es Location: N 1 /4 NW1 A s 17 T28 N, R 19W 371 Meadow Valley Trail Troy Manuals Used: In -ground absorbtio n system (version 2.0) Page# 1. Cover Page 2. Plat Plan I Chamber Cr s Section 4-6. Maintana and Contingency Plan 7.Pilter Cross ion Signature License ni ber #2269oo �.r County . VAsconsin Depar�c�t Cc mrs r RI' ATE SEWAGE E SYSTEM `[ I}C 0 Safety s P4 f uildirDi n _sir INSPECTION REPORT 5snitary r�e��;� Nv: 584721 GENERAL INFORMATION (ATTACH TO PERMIT) Mate Plan 10 No: Personal irsformabon you provide rmy be € wd for seawdary purpose Nnvacy Law. s.15.0* (# ft$mait Huider's Names City Vi�age Town" Parcei fax No DCCI Investments TOWN OF TROD-� 3-3-D CST DIIA lriev. nrp. SM E ev. SI I e c �. 5ect*n/Townf an a�' AaF tea. 17.28-19.2215 iwYi ail i a wzai "%. i ! :: i map Y TANK INFORMATION t:Lt:VA I lUN WA # A TANK SETBACK INFORMATION PUMPISIPHON INFORMATION .......... STAT'I0N BS HI FS EL.EV Bench rna tk : f Bldg . Sewer r • � � SVHt Inlet it Swit. Outlet . ,� � 14Z, IN IrOet Dt Batton] Header/Man, -' Dist, P ' it a Sol, system i Finat Grade. ,,,,. =1 $I cove x SOIL ABSORPTION SYSTEM B DIMENCH Oridttt en t DIMENVON r hio of t'renchez PIT DIMENSIONS No. Of Pits €n&rie Dta Liguic Depth SETBACK SYSTEM TO PtL eLDG WELL LAKEiSTREAM LEACHING OR Manufacturer. -Z^0P INFORMA►TiON Type Of Sy slamA// 600w��Vw�xs 03(o ASS I CHAMBER , UNIT kl olej hlgrnber.. So-4- DISTRIBUTION SYSTEM Lath e7(44 HeadmWan"d Distrbuticn x 14010 Six* x H0,9 Spacing Vanl tQ Airtake Length D is Length Dis Sprir:ing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only D th Over Dept€ Over xx D"th of ).x Smde,�t.'S�ard x u1 heQ 9e ,'Tr":* Cam#* r Se XTreencji Edges Top" as w s No } No OMMEN°TS: l lvde die dcsarepone-ipc- nammng present, etc.I IrlspeCtion 11, inspealon *2: Location: 371 MEADOW V EY 'l R L t.) All BM Description 2:) Bldg sewer len}th �. , �► - amount of cover! Plan revision Requires'11� . _ _ Yes Nv A5 Use vt1w side for ad tional infofmaticn. Gate SBD-071C (kax.T;f Cron:., J-, JeJec, ova 153 371 1 ...... .. { ........... ............. tnsepcttx � t�CBture �'��. '�c PLOT PLAN PROJECT Creative domes ADDRESS 707 Commerce Drive Suite 410 Woodbury MN 55125 NW t ! 4 NW t 14 S 17 i•r 28 N / R 19 W TOWN Troy COUNTY T. CROIX SYSTEM ELEVATION 94,2/94.1 5' below grade 4111116 4 DATE CONVENTIONAL X)O( 1 N-GROt. ND PRESSURE CONY E NTIONA1. 1JOLDING TANK MOUND SEPTIC TANK SIZE: 1255 gallons LIFT' TANK SIZE DOSE THINK SIZE HOLDING TANK SIZE LOAD RATE • 7 ABSORPTION AREA 8,91 # of chambers 44 BENCHMARK V.R.P. Top of 2" pipe ASSUME E1J. VATI.ON 100" BOREHOLE WELL * •R ��(yR P ► same as benchmark All pipino sbali he.ASTMSI R30 34,within 0` of tank, piping shall be ASTM F89 Filter Lifetime Filter Quick4 Standard Leaching Chamber with 20.0 fit of Ai -ea 5.6ft"2/pair of end caps i rack at SysternElevation Scale = 1/4" = 10' Property Li n e POWrS OWNER'S MANUAL & MANAGEMENT PLAN Rne � of 3ZO ire, 0'r �Alrwl =111- ........... F 4 Ak A Roje�1t;kt.5 � 0 *V&kA6 bv;ml fu dskrl I Pwqwlk-pi, wagbw*22w an -[I S-wft taf* eflux-fit ;..V I .b U—LL L p �kMp 0 Ut C fr tank(s) Inspect d1spensal cok(s) P dp JP .0 a 17- 1 ush 4teraks Ord pmwsure tnt - - KUM 2 50 W-1 ROT. [j So!p* Tangy C3 NA ...... gal NA. SepbrT , ank Wnufactufor E� FiRer Wiiufawturlur r A Eft Filer Mode4 wr 13 RA 'Plump Tank Capadty NA Pump Tank MwutacWter KA PnOreatmed UM 0 Saiwi/Grawl Ftar 0 Mechwh;W AwwtKxi C3 D ir�nkhcbon msvem,l t!(4n-Ground (grLav;ty) IJ At-GnmJe 0 D*Li Other D NA 0 Peat Fiftw L) Wot" 11 KA 17 In-Grour?d (pnasswized) L1 mound 11 NA 13 NA 13 NA Swvic* Fmquency marith(s) At knW anco evur. �:x-2 (Ul;Lx*ntffn 3 Vow) Ll NA Yea- �K Whan embined Wdge and vurn equals ono -third M of tank VOIXAM 0 NA A! 10�cul onco emy (NwL)*nUM 3 pam) C3 NA At leaaM woce eywy. manth(s) yearl s) 0 NA A: least once every: C) NA A kost onoe wary- 13 L1 RA A-*. law orre ev" [3 mcwrl"16) NA 11M W%lr tau-I"L Its ISF-Isj �n4oecforts of Wks arod d�s�nl,-W cods "11 be made by an end1w4i"I cmr-Ong Gne cf tv folkwng lzwsw cq- cetkabon,s. MaMtaf Plumber, Master Plumber Rwtd� Sevier, PCNVTS Inspodw - POWTS Mairtamer� Iseptage Sarvic�ng, OperalDr. Tan*- inspeqbms must 4v*jde ;@ vWjW j n s pocfim of the ta* s) to �d onfify arty rni s&'n-g or bra ker, h:ardwa re, . den,�N apy a-ad�5 or �e�. measure th e vc� U n-ie of ccmrdb�nW sJudgu and s=.m W-A tn check for arry back up or pmding of effluent on tw qr�;?und surface. The 6"rial cell(E) shaq t�e sae tmpeced ,,o check V* eftuent �evaft in bv ObserowWn pi%ms " to che<* kx wiy po ri ding d eftmM on ",,he grou nd au rface. 'The 7or4rg of efRuent on the grrAx*kd wrFaoa n-ray tndk2te a fiaMing car&bw and requires the irnmedWe rKtfc;aMcqi e u-x- local, roagidsiory authwity. tM wmbi;-ed aoc-,LMW&w of *jdg e and wum in a rTy tank equals onG-tnird (�-) or more of the tar* Ydunie, tt* whre coMerIts of i Te tau* sW be removed by a WusW Servmling Opermor and dmposM crf in accordark--a wAh �,-�Pter NR 113, WIU;Qr6*1 Admir�stabve C-jrlp. PJ1 ebw seMcm. iad,udiN but not lin� to ttm serwk�nq of eftem fftm, n*dwioW or pressurtM =rmpcf*ft, preteatment units. ind any seMcing at owmK of :0 2 M o uft, s ha V be perlo mield cy a cerdfied FVY0 b ma InI, a iiii e r- 'k sennce report sha R be pmvdad to the lo� regu I atory authe * widl-i n 10 d ays ofoxn p le tio n of an y se nAm event 1 Yti i RE i i`IM 1M' M III s . �•" * .; �. ■ � - * lapY i - t=_ i * a ` Il w - 1 � i LIF IF A °1w• 4� • s iplk ■ i • 11 r IR � * y � a r f+ t : �'ti s°• M i +-- -d 1 4 lip i I i AM VT- 11- b i i It IS RE Ip ma a AIF1' � � �, „ YF F y � a n � * ■ *� i ■ IN dh qp AINER I � F�� a 1R IN STALLER { w { Kam }. ... .r= a} Name Phone � r R Rti SAGECl N OPERATOR P U _. , w Pfiw ..m wn Cam. P ".1► � � Th din ��� la ` . .............. .. ........ 0'amm � |sow - -- | / ell /A4 � / � � ' � | / Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 5.6ft^2 pair of end elates Typical Installation Vent Grade 3' 4" , r-*' 30134 Septic Tank 3 6 Grade at System Elevation Spacing_. System elevations., 94.' B 94.1 3' To be >1 ` above grade 0/ Finish grade elevation 99.0 Vent r I - -� 4� Long. 'Trade at System Elevation 2-3' X 90' Cells Same on other end Observation tubelVent At end of cell A 22 chambers per cell B Doc-Linicrit NumhCT State Bar of Wisconsin Form 1-2003 WARRANTY DEED Documcni Name THIS DEED, mace between Joseph B. Saltin, a single person ("Grantor," whether one or niore),and ki-frey Althoff and Jcnn2.A lilinff, liusb,ind and if as survivorshlip marl tal property (ItGrantce," whether one oT mk)rc ' ). 0 ra n tor, for a valuable consideration, cnnvey� to Grantee the following dc.�ribed real estate, t0gCt,hQ-T %,V101 the prtiFits, fixtures and othar appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is needed., please attach addendum): 1168650 BETH PABST REGXSTER Of DEEDS ST, CROIX CO3 wi RECEIVED FOR RECORD 07/06/2023 12:07 PM EXEMPT#: FEE C FEE 30.00 TRAPAS FEE 20565.00 PAGES: 2 *—The elbove recording information verifies that this document has heen ofectronically recorded & return tO the SUbmitter Rccordw.,, A, L7 ii See Exhibit "A" for property descniptiou, amachcd hereto and made a Ipart livrk-t& Nankc an(] Rdum A(Wrc�.,; I 1100 Wayza(j 1, iuitc I iO L Minntionka, MN 55305 907,1,126-23000 Parcel I tlen 11 ri (iat 1 oti Number ( PIN ) This hunicocad properLy. (1, k nf it) Grantor warrant� that the title to the Property is good, indefeasible in fee simple and ftec and clear of encumbrances exccpt: d (s I --,A L) ,P .Seph 1. Sa L111 2% UTIT ENTICA _F ION ACKNOWLEDG.% ENT Signature(s)_ :iuthcnticatcd on F -1-ITLIE--. MEMBER STATE BAIR, OF WISCONSIN 0 f, na authorized by Wis. Stat, § 706.06) 111 IS TNSTR FNT D RA 1_,TFD R Y: Watcrmark -Vitle Aggicy I S1i,-A.,-.j,a Johnson I 1100 WaLa Bqu1c%,.-,-ii�1, Suitc 15011MitST,Akii4.-:i N4_N 55305 STATF OF MINNESOTA, COLTMW OF IIENNFPIN This in�trumcnt -vas acknow1cdgcd bcforc me 011 day of .2 0r by H. salun-1 a sing1c person. signatune Of n0taTlal OfFICCT Title and Rank SHA,5TA !MM VJdFiva,0JO1f .,�2N0:2-55 N Notary Nubile Style of mini'lesola YCOmr" s5 or) ► :xPir'es 113 1 ;1 T(: 4 111.0 A 1: r !! e rjtjC2tUL1 UT nc nol iw-ccssary,� NOTE: �N\ NI(M)l 1- ICA I IONS TOTI I IS F(W-Ni SI 1011 .1) BE tTFAH IN MIN IA FI VM WkIZRANTY DEED 'i° 211,111 1 %� TN'l I T; % R OF W1 S C0 N 1� IN, F(W'NI No, 1-21101 St Croiy,, CounNe 1168650 Page 1 of 2 Exhibit "A" Property Description r.ot 23, Meadow Valley of Troy, Town of Troy, St. Croix County, Wisconsin. St. Croix County 1168650 Page 2 of 2 w. tmxty Safety and Swaings Dmsion i ••R `� i� 201 'V_ Washington t Ave_,Poo, E4,, 4 7162 r: c Madtsw, VP 53707-7 9� SarMtary v .... T ...................... I S= T-, b =cW44= sft SPS *.583.`:(20 , W-is. Adm (-x; ,, stb�oc ofth's fmm to the 8pPmpna= gm is nqu� r to �;�� p:tui :'t�tc: �picata�c wry Mums atW rt _ for suu-* art cubit= two KcFjw. Addrms if �t dw ft a t of Wet; gut �fcssi�a: Servics �'�� infsxnub� va IO�c � mai��c,� Prtv�. L.aw_ s 1,j AppY Fr � � v��xt f��c scx� � .0[ Imo. r _ hcatign faformaijo MAU Print AS Information f15 ..f . C Sriv.. hp Lode loom NtOber � 4�- EL 'Ypt of BuDding (Ebmk all tb3t apply) ;. T ....... Publkjco�ciw - Lac use .�. C3 State OwTcd Describe L se _ .. CS.M. N tr .. ' ` a of Permit: C# rtk only v baz nil fine A. Completeliae $ i'applictble) ijk ,..... ........ [ _.....++.----..ww.-...-..v SYSMM = B. FwR►�i P. Revision .J bac o3 Yi�_ - ... Lm F-TmouParmh ba rd Dwtirruti���cd OwIrM #CRa�_....� .._ .... .7%� S��li?flCsiY:�#ttC all tbAC l►' Holding Tate n USff I>�al CO���, explairi)..., _ _ v. I13 a Trcat tut Ams lu format on • _ Des` Row (,Wd'sign Spil Applicj:j�0 Ratr 43G� smd A -ma Rcgr.� {;f� l :spe�sa Ar sfl i� ieti lei %? Tank Info C MWu.113cnxrrT Ams N:WaW, v c ir lu Sepac or a - 4, 'VVM. Rrs ossibllity Statement- the u�rrdors' sod, pbamber"s 'am (Prinf� r ppasi b W i }� for iidu lis tiom of tbt pMshown oa the attac bed ply, �.��ia�t� �-i i ��� � a Y� • YT f x') ...... _.._. s N'M. _ _. _. ��isatY�� 9��es# �. SG Q©3y. Apprwed Daft C'; I sUu3'V t �1Baum { was R.oa�i� t'�r Jro:at � � L"L Ca n di � sa s. LF U114MF cell M. V51 all k& r ? ri *A per nWago meneplan pro' dded by plum � i,+�,w '� Z fit. W I. iaunti irkd 40 *LMIkeb t4 CamQ3ow Plaw i ►r tit s ^r;t z soitntit.Es _......... COUgoD GlyosPOP" Got ksswe9II kw--b"1) Li ett +Wits� Aja4930) i P#% PLOT PLAN PROJECT creative Homes ADDRESS 707 Commek :e Drive Suite. /-10 oodbuty MN 55125) NW 1 �# s , ' '� c R w Y1-(-) �'N Troy COUNTYT. OR SYSTM-fit: ELrl'V.4'110N 94,2"'�94,1 :'5' below orarJe DATE 4f 11 BEDROOM 4 CONVEINTI NAL IN-GROUNDPRESSURE CON- 'ENTIOri4-L LIFT 1101.1)]NG TANK m(si. NTD SEPTIC TAN SIZE 2555 gallons LIFT TANK SIDE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE -7 ABSORPTTO?N' ARL'.4 $91 # of chambers. 44 kk BENCH M A RR V.R.P. Top of 2" pipa �ELEVATION 1 Opt' .�,. � ASSUME Filter Lifetime Filter DOREII0I.47 WELL � t1. t�. ��. same. as nenchmark nt All piping shall be AST.\4CDR 30..)4, within 10of tangy. piping shall be ASTM I~S111 L..eaehi r _, amber with 20.0ft2of Area 5.6ftt► pair of end cap; Grade at Srsstem Ele-vation 13 P 2 FI) C-1 Zs a% Scale = 1 /411 = 10, property I. -A n e s ' t # f�"mA city/stme M- - — - N R2 W, Town o �n �-+ Sub., h 9 �. Survey Map all 'Warranty Ned #_ Ell _._ .` Y Loot Yal no a 4-L ITO yw.. ,! M �'*�z. y■'6., M P' #■m `�.... fit-: }. * i 'ii'Y+4Pfi �' +''i ■ R ■ %#b# 1' " 1 It /'" :'# !':. io MfF i.�.. * y #.. ■ + '�tiwr ..• ', '.fi.. + �.;. F f } ■ �♦ 41 ■a# w t ti MM litl Ul # -y 1'r . IN F #i,r4P � �g # ► .• � w■ rt� �; ti< #i # # � 9r ' E r +# � r � � ! Y!#i�w i�';� � �!#it o �� �� F 4 . .. .. 1 �Yr �.�,., o-rw■ M.• * r�M! ■ * ■ ilip t r1' #�• wsf #�* r AM ,. M f s -411 Y . '! ..•hvvlp md Ifte#' _e s #. .dart= •. t, tkie Ccl'dfir r1 R 4t _ WYOW SqXr, I rTcm1tx* ISM' r bd rMs" be muiplebd and rnh=med o ffic RL Croix=i fir. Y M1 Z4>a� DcPm3ux=t wid= 3 0 days of tLe ffim y= Aun &Lr-. exrwsu th& 02 0A. or mrT tnr, tO the b4e9t of turv= kmo wledgv Llwe mrn4m the s) S-IGNATM 01F APPLICAN7(S) DATE ........... ypp"14 "_1 Ate', �'� 1" E �', *r "� }1 IMF' ■ F �: wf: i< R r "�M# r'#° Yr ": ST. C R OIX L J N -1 "'Y' SANITARY SYSTEM FileOffice U-se Ot?ly �� OWNERSHIP/ADDRESS FORM creatend 212o27 Community Development Department wili utilize this information to provide the property o�jvner with information regarding operation arid maintenance of your new or replacement sanitary systeml This information will be provided as part of our ongping efforts to protect public liealth, your wellIr r I groundwater surface water, property values, and county resources. Once approved, I* completed form and educational information will be sent to you by ern all. If you would like to ViCAAW., your ,ssued sanitary permit onlinc-:,, Y(ou can do so by using the Properly Files Scanned weblink. KINN M1 6911 yj :I A ILI 19[41 10A Orj KAN d Is] z I Owner/Buyer JEFF AND JENNA ALTHOFF Flailing Address 371 MEADOW VALLEY TRAIL City/State/zip HUDSON WI N Phone Number (,e.qu1Fe_U,.I) j /A Err all Address (required) N/A Parcel Identification Number 040-1326-23-000 (found on the property tax bill) M 4 :10TAIIIIIIII G **41119KII, at][6] Z I Properly Location NVV 1/4 e NW vi, Sec. 17 r T 28 N R 19 W, Town of TROY SubdMslon Plat: Certified Survey Map Warranty Deed # Nunibei of bedrooms 7 Nu,w Property Address kStiff Initials) Lot # 23 f Volunle A. Page # (before 2006)Volunie , Page # Spec" house 13 yes N no Lot lines identifiable E yes 0 no OFFICE USE ONLY (Ver-Ification of new address required from Comi-runny Developn)ont Department fc, nvvv construction-) This forni rrust be submitted with all Private Onsite Woter Tre-atn3ent ystem (POWTS) applicotions. New System: Include w1"0,j 0-7!!'s forai a recorded rrow), deed fror?i the Rester of Deeds Office and a copy of the certified S t j I- Vey, i x) ap it r efere n c e is i �? ode in the iva f-r o f i ry de e o. C.,.mmtjmty Developr-iwnt Depejrtr7�)ent -- Land Use Division 715-386-4 680 St. Cro'x Cou[ity Gov.,_:,riiiiient Center 715-245-4250 Fax cddCa)scc%Ni_onv 1 101 Carin i c 1, i a (,-, I Road, H ud son, W 1 54016 W11V W, S(T tivi. a 0 V An CoOLUMN \,. Iw REAR ELEVATION voo a 1�-O am% # .mik i i mom vow i owp% 1 A -s- i o-ok i E30X DOAN SETA IL_ 4w- trti craola" EA. MID esWO&OW W W"m . ...... ... . 0*00"" *kV" Cem~,rwm we We -to frig umda" vw"o ON omw 0" -m- '"aw ams"mm"mft mfti�4" "mowv lu 20 t W"T*^vw 21-d" 5T-er 10 ry - ---- -- --------------------------- ....... ...... ..... . ..................... A, -A- .... .... .... .... .... ... - . ... .... no, KkA. ........... q.......................................or-go ....... INO -444W mmvr4s TO IW "M UND -wolm4no-4 UW?PK#ZTM M A=Xftr f*W- #W.L C* WWI "I FAMILIr f* A-4 W. raw ftmuw" FUIIJRE- ...... . ...... .. . ........ - - - - - - - - -- zt�L - - - - - - - • 6rW .-- - 14 . WWI Mftt m -*Oct "am ft"Am% ... ... .... .... .. ..... ..... ..... ..... 7A wo roka *oft W M WWARM rw. ON Wwo Pm HECA 000 - - - - - - - - - - - - - - Ram 'r UNE )(CAVATED 10A 40 NK POOW W"AM ........... 43� 1 --- 1 - -- - al4 Wl CAMWAMW rt.L . . .......... . .... .. ------------- - - ------------- . ........... ........ ....... ............. .. ... ....... . ....... ................. .................... 7 L -4 ...... .. 7 . . .. ... .... 2 -ir - AWA4& .......................... . . .. .. .. .. ........ ------- .. . .... ...... . .............................. . ... . . .... .. . . ....... BA!5EMEN7 FOUNDATION PLAN ev? mi FxAV-wf4w C PtArNIPIA, c4ft Room Awb*mew *Wk OMW MW 4F MWPMM, �M AKOM V mAmt,wwa <~"MOW p Mo 4-- ftw ot#odo piers" Awe fit 4#4"Mpa" op lid €I` ' ..•'may ................. -i� � .t' ................... . ........... _ .__ ......,� t �1 3T271► � V� i ' ' .. FIX "tMI AW E f � s 4 € � � �fWrVs �RT�3+�6 i � At...�,�YnC '}\"!«•nwr�sY i { # Wffs to go &*-e 0►pP. +rr�rrMlr arhr�r�rr�+��r� L 3 *r*A # �N �f+�AwMZ 1 wR.`+IE�Ik4�i�r " T. �,r,►wiR�ArrauliE i rrle�r#f1E •�: i` i.rsrrwr yawrr►�m ftmow �{ � € � � • ] L^4Mrw�*tir'Ms1l �•�' �1Mr11µ -.a4...... ..•.J.ap sm-mo !1p"ANFm •:!1'w 11Ro*" sum -err► L hmm ass *r ohm s E F ..�. - T f 1 �J� l . F c t'l ! It, KD r SAS j LM IMP in K� ...`AUX r. PAP r P.AW ' , „ i �.► mow.'. 5 CAP, &� k r� : f _ - ._.......,�• � tea LY' T ■ 1Eer1. ^�^-�" a � s � �� -•�-- � �C-0' � ��1" Gt� !ram .DER � � ►.^ . � 1 y1� www�r r�r �w.r r� ; � `• 4 � � M /n..i...w � .. � �R. � i � � f � i t*........... '� } F r11 �PC i �,.. �.�lr yr•r• ,r N w . .�.,......,..��� t K w rrNra �► 1! wrM11FN *,. y,�f,r��pF� �A. � 0 _ w._ },; ..................... �114 ...................... + r • 71% 7 "��f...... ... ............................................. »-....�. ....-,...»......,................... �. -- ... �... ., .. ....................... �...,._. v......................_._. .._..............._................._.. .............................................. ..... .. .. .. . .. ...... . .. ....... ...................... W41, ............................... ........ . . ................................................................ . ............................................. . . ... .. .... ... 00 ................ . . . . .. .. ............................................ ... ....................... . ......... ...... - ................... NOTE: — ---------------- A*a ............................ 6 .......... . ...................................... Jq* --- -C"XV 904LVt%* TO ft 12* ME OW L to 4VAOM TO A0.2-2kiffs U". APPM ". CiMMO& 2 Vd� OAW- 5 144' 012M *CxL oewofm TO w V'W ......................... zoo m, SA----H CAA ........... . ..... ILI . ...... te TVID- 24 -- ---------------- *as ............. ........ T; . . ........ - - - - - - ------- VOL fq4. ... .... ........................... . . .... . .. . . ........ . . .. .......... . .. . ...... ..... .. . . ......... LAUN. .............. ............ A.- v V&v lot tjLOFT ..... .................... ... . ...... .... . ......................... ........ --------- --------- ........ ..... ZL 4 2,4 5ECRR 4 Y CPT W- 2 4. . . .. ..... TH HIec r. w CAh IV &A AS ft%,, i Ir fol& V&A BATf4 I sa PY. 2-4 Lvr ............. - - - ---------- - v 5 ITTIN& :2 62 W. qFr_ a —dr --vp ........ ...... I .... .... ....... ................... .......... . ... ....................... IL.... ........ . ..... A .... ........ ....... oil- ......... . ................... . ....... ...... . .......... J . . . ........................................... . ...... . ............ ............................. . .. ... . 4-V . . . . .. .................................................... .. ................. ............. . . ....... ................................ . . .... ... . . .................. . . . ................... ............. ........................... ... ....... . . .. .......................... ... . .......................... ..................... UPPER LEVEL. FL. OOR PLAN I,w a 1%4r 1 It 6 oftwowv m -,4 M Ia woomuw. W$ lot" P". fts-a&*4m PX, a t-w I 4= Meow" ow ft"*poor" oft Pam =***Me at ow &%rw &.01 OMV04 ro %w"Ve"Nowo 10 ftswo"Awwww*w" MRIO�oavj~ ft" am* w4wwk"ow"ff% 1 *a *%owAft ow"kaoxwo 0 I wo wwom IM60"'V K*A* v owww -AWL-4 Lc p f �N # E 17 1 (10 ACRF- S 'a v D J" I VRNLWAYLGZAll,', F_ AT winw-i S L 0 P F_ �Al* C> --,2o ci V SURFA r-F M P INA(ti' 'DRAINAU 16 \rRES f 4C 3M S%VIDE. 7,; I lb 20- IN. tic) I I Oki I I SWALE W ACR F 4tV 4 ra I 21 AC*H F S IRAINAGF A.A. 1 8 LASLUENT N. kh N kk- 23 Ppoposm—_ J U� AD WU li w .4 1, 4 C; X L I KI I IS X t vp� co p 0 9bk k, CL IMP lk� 00, 4-ea 5V.7DF_ z 4 X A? B0 I LAIA SWAIA, All. z or r.j v w4v OR AIN' V-111 U!li E -1 -A 1% 41� -9k, A -3 *_j _2 L� L; AIM % A(.R FS LIJ I I,' 'All CUkB & GUTTER DT Nm U 1:7 As X Mol A C RFS, — 0 _j v-0 rT 0 1 i W, -V-ntTr.1- CL y I INF kC ellll w 4�$ IN X Ile. 0 Ilk LL. Ul L, UN L) I I N N NCI z 4 L f7XIS TPN® FIT r jr-J F 0 A krjR N F-- MOA 'DEC] rl y I lclRJ2-0pj I ft, 'j, N w V,l F,j 5-%. 1 P4,r Q N, I "A� I WP'JF'YFNC' CON 1 RAC I �* I 1 4, L x -Ilk 0 AC C A AC Y PRk-)q TO A,',y rk L, llt,lP%. Ul MiL_ k� x 33 C5.2 paul@Dcou nitrysideph.com From: operatlons@ diggershotl i ne-com Sent-- Wednesday, October 4, 2023 11:29 AM To: PAUL@COUNTRYSIDEPI-I-COM Subject.- Diggers Hotline "I'llcket 20234013782 Diggers Hotline., Inc. (Wisconsin) Locate Request Confirmation Important Information The Start Date field is the day and time you specified your work would begin. You are NOT clear to dig until the Start Date and time. Utility locators will mark your dig location by the Start Date and time you specified. Diggers Hotline DIES NOT locate. Diggers Hotline simply processes digging information and trarsmits the inforniation tO Ll t i I ity rineniber companies. The utility companies are responsible for the locating of the undergrOLInd facilities. If you have questions about the locate markings, phone numbers are prDVided for YOUr convenience. In the. Members N otilf led section of t his t icket conf irmation, you wi I I f i nd phone n um be, rs next to the ut i I ity na nie. There are some areas in W1 that do not have underground fines, therefore this section might be empty. Private Lines are the responsibility of the property owner and will NOT be marked by utility locators. Examples of Private Lines include-, propane lines, water & sewer laterals, sprinkler systems, ornamental lighting, gas lines to pools, and electric lines to a garage or barn. You can hire contract locators to mark your Private Lines. Diggers Hot hfie-com has a list of locators available for hire. The niarkings are color coded based on the type of underground line, The color code cari be fOUnd at https: www.diggershotl'ine.com/colorcode. Ticket Information Ticket 20234013782 Seq ¢ 'I Prev j0LJs Ticket: Ticket icket Type: Standard Start Date, 10/10/2023 11-30-100 AM Call Date-. 10/04/2023 11:28.26 AM Ca Ile r: Con"Ipally, Address: Lwail. Field Rep, Contact Information .......... PALL KOEHLER COUNTRYSIDE PLUMBING & HEATING 321 WISCONSIN DR NEW RICHMOND W1 54017 PAU LCED COUP TRY IDEPH,COM PAUL KOEHLER Phone: or information County: S I CROIX placp: TROY TOWN Address- 3 /1 Phone, Cell Working For. (715) 246-2660 (715) 246-2660 JFFFRFY ALTHOFF (715) ?46-2660 Ext I Street: MEADOW VAL. ... .LE...... ..Y TRL .... ... .. ................... .................Intersecti.. .. ... ....on. ... . 1: MEA......... ...DOW VALLEY LN .......... ... ... I .On the N.............. ...............E side of the road approximately 110OFT N of MEADOW VALLEY LN Type of Work: SOIL BEST/REPLACING A SEWER SYSTEM .......... ............................ ... ..... Explosives: N Overhead: N Boring Equipment: N Pre -Marked: N Marking Instructions MARK THE ENTIRE REAR OF THE PROPERTY Remarks Members Notified BTC01 BALDWIN TELECOM INC BTC01 (651) 895-5892 SBC01 AT&T DISTRIBUTION SBC01 (262) 446-9821 SEC01 ST CROIX .. ..............EL. ....ECTRIC COOPERATIVE SECo1 �715) 556-2109 STC01 ST CROIX VALLEY NATURAL GAS CO STC01 (715) 555-2109 Work Site Polygon (NE/SW) Latitude: .......... ................. ... .4.. ..4.916628 Lon...... ... . .......gitude: -92.716643 Secondary Latitude: 44.917559 Secondary Longitude: -92.71596 2 Parcel #: 040-1326-23-000 - Valid as of 10/03/2023 08:28 AM Alt. Parcel #: 17.28.19.2215 Owner and Mailing Address: JEFFREY ALTHOFF JENNA ALTHOFF 371 MEADOW VALLEY TRL HUDSON WI 54016 Districts: Dist# Descri ! an 2611 SCH DIST OF HUDSON 1700 NORTHWOOD TECH Abbreviated Description: Acres: 1.048 SEC 17 T28N R19W MEADOW VALLEY OF TROY LOT 23 TOWN OF TROY ST. CROIX COUNTY, WISCONSIN Co-Owner(s): ALTHOFF, JENNA Physical Property Address(es): * 371 MEADOW VALLEY TRL Parcel History: Date Doc # Vol1Pa e Type 07/06/2023 1168650 1 WD 03/24/2023 1165085 1 QCD 01/13/2023 1163099 _ QC 12/17/2018 1075607 1 TOD more... Plat Tract S-T R 40% 160% GL BlocklCondo Bldg * 11-053-MEADOW VALLEY OF TROY 040-2015 LOTS 1/23 .17-28N-19W NW NW I LOT 23 2023 Valuations: Values Last Changed on 10/11/2022 Class and Descri tion Acres Land Improvement Total G1-RESIDENTIAL 1.048 101,200.00 702,000.00 803,200.00 Totals for 2023 General Property 1.048 101,200.00 702,000.00 803,200.00 Woodland 0.000- 0.00 0.00 0.00 Totals for 2022 General Pro e Woodland 2023 Taxes Taxes have not yet been calculated. 1.0481 101, 200.00 0.0001 0.00 702,000.00 803,200.00 0.00 0.00 Key Yy� ' -Primary 20 z3 -moo- �3 �g2 PROPERTY Al)[. ;;�;ESS: 492 MEADOW RIDGE TRH IL a HUDSON WI 54016 F N88°56'21"E 375.69` r 15 - N- UJ- G 4 W m o ! 48.0 ! Me I o AS. PiRCH a. c. Q MGARAGE ii T !11 HOUSE 5.0 LOT '#i+ *i Ln A Co n 0 6 DRAINAGE ,"A4 EASEMENT o - ! 1.149ACRES SOIL TEST AREA 50, 039 SF �� 9.0 G4D-1329-44-000 I 6 � ` En _r. it 85.0' o r i L. B. D, =1fl46.S 230.t1' m� I , I rn a So, -�. 1- C �a r I TEMPORARY HOUSE puma is � � gg� _U m CtJL-DE-SAC I i a EASEMENT I � _ Y31 rrirn 15, �- < 588'54' 19"t1W1 367.41' Cry /y z I L z O _ __j �-� J LL LEGEND I Z �mD = W OOO HUB SET AT 10' � C) 0 LLJ OFFSET, IS' OFFSET, OR ON p BUILDING EXTENSION < << < 1 ALL EXTERIOR BUILDING CORNERS C f MARKED WITH PIN FLAGS, C r: PRELIMINARY' FOUND IRC3N PIPE PER PLAT OR As NOTED 3 "' W r u d a] � z FOR REVIEW T.O.H.- TOP OF HUB ELEVATION (D =� f1� � 0 NO INDEPENDENT PROPERTY04 T'.O.P.- TOP OF IRON RIPE ELEVATION c� RESEARCH HAS BEEN — — — — UTILITY FASFNIENT u ac a u u NORTH CONDUCTED BY THE SURVEYOR. X 100.0 EXISTING SPOT ELEVATION OWNER/BUILDER IS w - SALE: RESPONSIELF FOR CONSULTING SETBACKS -TYPICAL UNLESS ME TITLE DOLUMENTS TO VERIFY ANY LATHER EASEMENTS, NOTE: OTHERWISE SHOWN: 0 30 60 COVENANTS, AND RE5TIC.TIQNS THE C "'„ "s SNt),'.'"d til ?,'F_ ARE DERIVED FROMTHE GRAD1fV€3 PLAN_ FRONT THAT MAY AFFECT THE i CT EXISTING GROUND ELEVATIONS 75' L I=VATIi I S SHOWN AFC PROPERTY. t IJ uuRING i P10USE STfAKING PROCESS. 25' SIDE a cz) C� ".VD W '2.8 DATUM, 25" REAR 1 OF 1 PAID Depa Safimy aod *r=C SOIL EVALUATtOWREPORT Jn accordance vw#h Comm 85., Wis. Adm. Code P49e .. ... I of 3 Profess' Schmid Soil Testing. Inc Attach "compete sde pian on County Ax'�jg% n size. Pin mum ,06rt�ti. I , st� oix include, but not ftded to- vent )FA (sm, cliredlon ar4 Parma I. permnt sloe, scale of 0 arc�w, and kwuVion and distame to nearest road P180SO fint all 1100MMOOR. . . . ..... P Rev By Date ftm"l h1k"n8t*n Ym PrOvIdO MY t* used kw secoMaq pu"ft (Povacy La*. s 15 04 (1) (m)) S11 Property Owner Property Location 4 [DCCI Land Planners Govt, Lot W11/4. N 1/4* T28N, R19W . . . ...... . . . . . . . ................................... - --- -- ---------- Prop es Mailing Address Lot # Block It Subd- Name CSM# 1 1505 Hwy 65 P.0, Box 445 23 Meadow V y Of Troy . . . . .. . ... . ......... . .............................. .. . . ... .. . /I ... ..... .... Cif ..... ... Nearest Road State Zip Code Phone Number CIV Town New Richniond Rd 11 540171 Troy East C I W ove ........... .. . Use* Now Construcoon Residential Y Number of brooms 4 Code derived design ftm rate 600 GPD Public or commercial - Describe: Replacemnt Parent ma*rml Outwo Sand __ NA Fly plain elevation, if aMficabie General comments Ama is suitable for a cmwftnal system with a 0.7` gAW rate_ PossW system elev*on for Area I is 95 U. slope i, S2% and recommendabom: Left*, Boring Boring . ..... ...... PA Ground surface eley. 99-20 ft, Depth to biting factor 115+ In. FSoi AppffKMhon Rate Monzon Depth Dominant Color Redox C*so*ion Texture; Structure I. Consislence.: Boundary Roots GPDM in. Munse(l Qu. S1. cord. color Cr. St Sh. D-10 10yr3/2 none ---------- - - - 2,mgr mvfr CS 1Vf 0.6 1.0 2 10-18 .. . . . ...... 10yr3/1 none $11 2fsbk a* 9W 1Vf 046 0.8 3 ............... ................. 18-26 1 ..............................•------ IDyr4/4 none sicl 2msbk . . . .. . ....... mfr 9W 0 A 0,6 1 0.6 1 1.0 4 none sl 2msbk mvfr gw . . .... . . .............. . . . . ........ .. . ..................... gw 1.6 5 31-35 10yr5/6 none Is Icsbk mvfr 0.7 . ... ........................... ...................... ... ..... . .. ................. . ........ gr1r ------ CS 0.7 1.6 6 35-43 7.5yrS/6 none ml OS9 ...... ........... ................ . ..... ..................................................... ...... ........................................... ................................... ................... . ... ........ ........................ . ................................... t 7 43-115; 10yr6/4 nom) S I OS9 ml 0.7 1 1.6 it Boring Boring P4 Grounds vace elev. A7 ft Deoh to. ding fa 115+ in. )Soil Appl"tkm Rate ------------------ Horizon Depth Dominant Color Redox Description Texture Structure Consistence BoundeFy Roots GPOW in. Munsell Qu. Sz. Cont. Color Gr. Sz, Sh. OF"I *Eff#2 0-6 1DVr3/2 none 51 2mgr mvfr CS 1Vf o�6 1.0 .......... ................................... ...... . ... . ............... . ..... ..... ---- - - ------------- ----- - --- --- 2 6-17 1 110IM311 "Orle Sil 2fsbk mfr 9W Ivr 0.6 0.8 ......... . ........ . ................ .. . ..... 3 yS1 17-28 10r3/4 none I . 2msbk mfr gw 1Vf 0.6 0.8 . . .... ............. .. ........ .. ...... ........ -- - ------ ----------- . . ........... ..... - - -- ----------------------- ------ --- -- -- -- ... ...... ... .................... . ..... ... ..... ............. ... ....... 4 28-36 1 7.5yr4/4 none $1 2msbk mvfr gw 0.61. ...... ... ... . -- - ------ ...... . ... ...... .. . ...... .. - - --------- - - 5 36-40 7.5yr4/6 none Is Icsbk mvfr gw 0.7 1.6 6 40-46 10yr5/4 none 91 OS9 9rcos ! M1 W 0.7 1.6 L. . . ........ . . ... . ............ . ...... ...................... ........ . ... . ............ . 7 46-115 10yr6/4 nom M1 ------ 1 0.7 1.6 Effluent #1 it BOO >, 30 < 220 rrgA- and TSS >30 < 150 mgit 110A f n uent #2 BO�30 m s < g i41L and TSS < 30 mg& 4 ,0%, CST Name (Please Print) Signature. j., CST Numb Thomas J. Schmitt 227429 . . . . ... . .. . ..... . .. ..................... ...................... . ..... ......................... .... .. ..... .. ........ ................................... ........................................................... .......... Address SChmitt Soil TeOng, Inc. Dole Evalualion Conducted Telephone Number 1595 72nd Street Now Richmond, VVI 54017 516/2014 715-760-1978 san6s.l.-w (ft row) 'ago 2 of Boring [] Boring Ea Pit rourd surface elev.— ..j. Depth to limiting f�ictor__ir), f elev,�ft.. G Sail ppli-cation late Hof izori Dr�plh In. 1 0-1 Dominant Color Munsell 1 r/ ERedox Description o- - Cont. Cotor NONE Texture Structure Gr. Sz. Sh.. I r� r Consistence m fr Booildary eats GPDIFt2 . EfFf# 1 * ff#2 of _ 1.0 0-7 1 Oyr/4 NONE r 0 Gg S O-SCI _ m1 1of .7 1,6 _ 4 1_. 1-1 1W 1r/4 NONE s_—_ 1 - v Boring 7 JO Boring E1 Pit -ar-ICE �1fG 11, C,t f� t I �r7itir�c ftr,. " ire. al ft, had boring done on oct 1 th by Paul Koehler 225410 Soil Applicatiori Fate Horizon Depth In. Dominant Color Mansell I edox Description Chu. Az. Cont. Color Texture Structure Gr- z_ Sh. cansisterice Boundary Foots P"[ /Ft-? . . Ef'1l } offs -1 r 3.1.3 NONE Is OMSG M1 ca 3vf 1.6 1 4-4 1 r I --___ ___ 1. i Boring # V 01-Ing 6,05 4 7 ❑ Flit Ground surface elev.Depth tG livilifing factor in- I elev. ft- i Soil ADIDI[Cation Rate Horizon Depth In. Dominant Color Munsell Redox Description Qu, Az, Cont. Color Texture Structure Gr. Sz. Sh. Consistence Boundary Foots FAD/Ft' *Eff#1 *Eff#2 a 0-1 10 yr 3/2 NONE. LS 1 Mr� r 1 1. 16-22 10 Yr 4/4 NONE � grcGs rya h , mvfr 0 M, Sg MI Ca_ . 1 22-42 10 yr /4 NONE NONE qw----- .7 1. 4- 4 10 yr/ i Sq 0 MSg M 1 � --__- .7 1. Effluent, 41 � BCD > 30 !� 220 nag/L and TSS > 30 ;Y 1 rn riig/t L tfIij irit #� = BC)I ) iy 30 rrigr t a id J 1,; S' ! 3 0 Mg/L bottom of'urre nf system 9.6 fop of septic beach mark 0 = 100 current system elevation 90.4 top of surface borings93-96 i PRopaa� \\ ROq� Pi ca 715 SQ. Fr. n AC — — ' 24.95' 4S7.84' "E 658,12' OF THE E NWI/4 15.00" ^� 48.33'\ 83663 MAI qj"' NOo r' R 11 mr- d `V" uk'q) ... ................ . VW00100 OWNERi7cL,-��y !-� rlenc,�, LI'm.# � zcS rils 1h W N ("J"' F ........... . ... .. ......... ... . ................... ......... N 11 E-1 W IL I AND/1-Oxx Ei 0 SBD-06499 (RI 1/20) 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: 1f you wish to renew the permit, or transfer ownership of # ca authority. t e erm�t lease contact he uu h permit, P ty AUTHkJRIZ'--JEI"j ISSUING ul"FFICEIR — DATE U N L -T"-Jld S S R E N 11 E, J W E "" B"VE j - f " U` R E T lux Al' ID A TrE, J ..... .....