HomeMy WebLinkAbout040-1310-00-030
Wisconsin Department of Commerde PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
552368 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:
T'Kach, Steve Troy, Town of 040-1310-00-030
CST BM Elev: Insp. BM Elev: BM Description Section/Town/Range/Map No:
, 17.-18.19.2017
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic 1660 Benchmark 2,75 7436V 01,
Alt. Bn G6%
Aeration Bldg. Sewer
~C ,(ol qy 7, zyc
Holding St/Ht Inlet '2- -k 71(1,4101
TANK SETBACK INFORMATION St/Ht Outlet 17
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic i Dt Bottom _
Dosing Header/Man. T~
93 F
Aeration Dist. Pipe
Holding Bot. System
s. t-z ct 37 9 ~
PUMP/SIPHON INFORMATION Final Grade a
Manufacturer Demand St C er ~G~d 7
.ql ~i &5 / T `7.
Model GPM ( 401 70
TD Lift Friction Loss Sys ea TDH Ft
Forcemal Length Dia. Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. P uid Depth
DIMENSIONS 3
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: (547- r~
INFORMATION
Type Of System: CHAMBER OR F"
Z-0
UNIT Model Number: r !
r1 V d 2 ( u 1~ a"r
DISTRIBUTION SYSTEM 5 LOX Z 94-a~
Header/Manifold j 11 ID istribution x Hole Si e x Hole Spacing Vent to Air Intake
Len9 th~ Dia 4 Pipe(s) N, Dia \ ` Spacing So.
Length
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only 'E°
Depth Over Depth Over xx Depth 1xx Seeded/Sodded 1xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil
Yes M No Yes ~ No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 332 Meadow Ridge Court Hudson, WI 54016 (SW 1/4 SE 1/4 17 T28N R19W) Meadow Ridge of Troy Lot 30 Parcel No: 17.18.19.2017
1.) Alt BM Description
2.) Bldg sewer length = 5Z
- amount of cover = ~7 n
42- O
Plan revision Required? ❑ Yes No
Use other side for additional information. tf/-
SBD-6710 (R.3/97) Date Insepctor's Si ature Cert. No.
County
Safety and Buildi ~~Dtvin ST CROIX
Q $ 201 W. Washington Ave.;T. ~ 7162 Sanitary Permit Number (to be filled in by Co.)
PS Madison, WI 5370 7
4 552, 3(,
Sanitary Permit Ap/hho n State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission oap 'ate governmental unit
is required prior co obtaining a sanitary permit. Note: Application w TS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Servics. Personal infonide n y d for seconda
purposes in accordance with the Privacy Law, s. 15.04(t)(m), Stats. 332 MEADOW RIDGE
I. Application Information - Please Print All Inf
Property Owner's Name
roN Parcel #
T
STEVE T'KACH & VICTORIA GAUZE ~~%ry~~Q`✓`'`:`' 040-1310-00-030
Property Owner's Mailing Address J Property Location
v,..~L C
PO BOX 7296, Govt. Lot 30 Zo 17
City, State Zip Code Phone ~r SW SE Section 17
SUPRISE AZ 85314 CF (circle one
T 18 N; R 19 E oW
II. Type of Building (check all that apply) Lot #
of or 2 Family Dwelling - Number of Bedrooms 3 ~y l Subdivision Name
Ok Block # `/~•J MEADOW RIDGE OF TROY
4,4 011- ❑ City of
❑ Public/Commercial - Describe Use 11
❑ State Owned - Describe Use CSM Number ❑ Village of
n'~ e L 1. r 151_154- jsr, ~ 1s ~.~w10 'Gt ^6 ® Town of TROY
,
III. Type of Permit: (Check only o he box on line A. Complete line B if applicable)
A. New System
❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner
Al ~f. +0Z,
IV. Type of POWTS System/Component/Device: (Check all that a Iv) + no
11 Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soihcL'a..4@f
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis ersal/Treat ent Area Information:
Design Flow (gpd) Design Soil Application Rat gpdsf) Dispersal Area Required Dispersal Area Prop ed ( Syst in Elev tion
450 y //Z- ZZ S-.
VI. Tank Info Capacity in Total # of Manufacture
U
Gallons Gallons Units o u_
New Tanks Existing Tanks ) v r
U C_
Seph or Holding Tank 1000 1000 1 E SER/ OLYLOCK 525
Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number
TIM DE YOUNG 664713 715-246-2660
Plumber's Address (Street, City, State, Zip Code)
321 WISCONSIN DR, NEW RICHMOND WI 54017
Vill4tountv/Department Use Only
Approved Permit Fee Date Is ted , IssuingA Signahtre
(a 4
n Reason for Denia
❑ w147-5.
IX. Condi ' easons for Disapproval t
1 Septic tank, eiflut filter ~ifitl 3 d { l ~t,r16 L
a dispersAl cell must all an services !maintained 49 /I~tbe rL • '
as per management plan provided by plumber,.. t'>e• m,esl IG j
2 AUsat 4 requ* 9* Cod~ must to ndd 6 p cl-o
Attach to complete plans for the system and submi o the County only on paper o less than 8 1/2 x I1 inches in size
r
SBD-6398 (R. I I!1l) Pf-It
Q In e, eW,,Y, ~ r
ele
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: Steve T' Kach and Victoria Gauze
Owner's Name: Steve T' Kach and Victoria Gauze
Owner's Address: PO Box 7296 Suprise AZ 85314
Legal Description: SW 1/4 SE1/4 Sec 17 T 18 N R 19W
Township: _ Troy
County: St. Croix
Subdivision Name: Meadow Ridge of Troy
Lot Number: 30
Parcel ID Number: 040-1310-00-030
Pagel Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber: Tim deYoung License Number: 664713
Date: 6/5/6 Phone Number 715-246-2660
Signature
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
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Da~~~Rt~ o Er~q / ~
take
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Sfeve T'Kach & Victoria Gauze
PO Box 7296 Suprise AZ 85314
1 / Date 6/5/12
Scale 1" = 50'
/ Bench Mark #1 top Of aaaly stake
I Bench Mark #2 Top of-Gal s€ake
/ System Elvevation 0.
{ SW 1/4 SE 1/4 Sec 17
I T 18 N R 19 W
Town of Troy
I P.N. 040-1310-00-030
332 Meadow Ridge Trail
Hudson WI 54016
l
1000 gallon septic tank
Weiser tank w/ PL525 filter
4-60' trenches
ALA
i
THE QUICK4 PLUS STANDARD LP CHAMBER
Quick4 Plus Standard LP Chamber Side and End Views
48"
(EFFECTIVE LENGTH)
8"
34"-~-L
Quick4 Plus All-in-One Endcap Front, Side and End Views
8 INVERT 9"
" 8" 10.4"
INVERT 3.3"
Quick4 Plus Endcap Front, Side and End Views Quick4 Pius All-in-One Periscope
4.5"
81
INVERT 3.3" 4.5"
Quick4 Plus Standard Chamber Specifications
Size x L x H) . . 34" x 53" x 8" 86 cm x 135 cm x 20 cm)
(W ( Invert Height 3.3", 9"
Effective Length 48"(122 cm) (8.4 cm, 22.8 cm)
i
INFILTRATOR SYSTEMS. INC. STANDARD LIMITED WARRANTY
i
I
I
INFILTRATOR
systems inc.
6 Business Park Road • P.O. Box 768
Old Saybrook, CT 06475
860.577.7000 • FAX 860.577.7001
800.221.4436
.z www.infiltratorsystems.com
For technical assistance, installation instructions or customer service, call Infiltrator Systems at :800.221.4436
U.S. Patents: 4,759,661; 5,017,041; 5.156,488; 5,336,017; 5,401,116; 5,401,459; 5,511,903; 5.716,163; 5,588.778; 5,839,844
Canadian Patents: 1,329,959; 2,004,564 Other patents pending.
Infiltrator, Equalizer, Quick4 and Quick4 Plus are registered trademarks of Infiltrator Systems Inc. Infiltrator is a registered trademark in France. Infiltrator Systems Inc.
is a registered trademark in Mexico. Contour Swivel Connection is a trademark of Infiltrator Systems Inc. m 2010 Infiltrator Systems Inc. Printed in U.S.A. PLUS010310AG-1
I
THEQUICK40 PLUS STARI"
nQuick4 Plus Standard LP Chamber
Quick4 Plus All-in-One Periscope Quick4 Plus Endcap Qui< <4 r-u AI,-;r Ore Endcap
The Quick4 Plus Standard Low Profile (LP) Chamber offers maximum strength through its four center structural columns. This chamber
can be installed in a 36-inch-wide trench. It is shorter in height than Infiltrator's other Standard model chambers, allowing for shallower
installation. Like the original line of Quick4 chambers, it offers advanced contouring capability with its Contour Swivel Connection'''`, which
permits 10-degree turns, right and left. It is also available in four-foot lengths to provide optimal installation flexibility. The Quick4 Plus
All-in-One and Quick4 Plus Endcaps are available with this chamber and provide increased flexibility in system design and configurations.
Quick4 Plus Standard LP Chamber
• Low profile design makes this chamber ideal for shallow applications
• Reduces imported fill needed for cap and fill systems
• Center structural columns offer superior strength
• Advanced contouring connections
• Latching mechanism allows for quick installation
• Four-foot chamber lengths are easy to handle and install
Quick4 Plus All-in-One Endcap
• May be used at either end of a chamber row for an inlet/outlet or can
be installed mid-trench
• Mid-trench connection feature allows center feed inletting of chamber rows
• Center feed connection allows for easy installation of serial distribution
systems
• Variable pipe connection options allow for side, end or top inletting
• Piping drill points are set for gravity or pressure pipe
Quick4 Plus Endcap
t
• Simple, flat design
• Allows installation of a pipe from the end only
• Piping drill points are set for gravity or pressure pipe
AV R US
Voic*4 T
to-
-
{
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i
} INSTALLATION INSTRUCTIONS
~N
Dainave AMm PL-525/PL-625 FILTER
PL-525/PL-625 FEATURES & BENEFITS
Features & Benefits:
e Rated for 10,000 GPD
• PL-525 = 525 Linear Feet of 1/18° Filtration
Yr.: PL-625 = 625 Linear Feet of 1/32" Filtration
Ery.
PL-525 PL-625 .Accepts 4" and 6" SCHD. 40 pipe
The PL-525/625 Effluent Filter should operate efficiently : Built in Gas Deflector
for several years under normal conditions before .Automatic Shut-Off Ball when Filter is Removed
requiring cleaning. It is recommended that the filter be
cleaned every time the tank is pumped or at least every e Alarm Accessibility
three years. If the installed filter contains an optional
alarm, the owner will be notified by an alarm when the *Accepts PVC Extension Handle
filter needs servicing. Servicing should be done by a
certified septic tank pumper or installer.
i
RECOMMENDED PRODUCTS
Polylok PVC Filter
Extension Handle
I
{r _
:r''~rr k''iFS
tAA
Risers & Riser Covers Extend & LokTM Riser Safety Screens Filter Alarm Panel and
Polylok risers bring your Polylok Extend & LokTm Polylok safety screens SmartFllterTm Control
septic tank cover to grade. is a simple, easy to use prevent tragic accidents Switch
This allows locating and solution that can extend from happening by children Polylok filter alarm panels
servicing your filter easier the inlet or outlet pipe and and pets falling into open and switchs provid a visual
and time saving by elimi- make filter and/or baffle septic tank entrances. and audible notification of
nating digging to find tank installation a snap. impending filter and tank
entrance. Fits 3" and 4" pipe. servicing.
For a full list of Polylok products please visit our web site at: www.polylok.com
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner 5'~'@I Septic Tank Capacity /qap gal ❑ NA
Permit # Septic Tank Manufacturer LJ ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer o ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model `J Z ❑ NA
Number of Public Facility Units ~A Pump Tank Capacity gal >R:RfA
Estimated flow (average) d gal/day Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) 5 0 gal/day Pump Manufacturer >4-'KA
Soil Application Rate o . gal/day/ftz Pump Model ^<A .4
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit A
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) <220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5_150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Disp rsal Cell(s) Q~ (•d _L~ 13 NA
Biochemical Oxygen Demand (BODS) 530 mg/L n-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) <30 mg/L ~VA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Y8 in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: 3 l alOnth(s) (Maximum 3 years) ❑ NA PK ear(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every' ❑ onth(s) (Maximum 3 years) ❑ NA
r(s)
Clean effluent filter At least once every: ❑ yea~(sl(s) ❑ NA
Inspect pump, pump controls & alarm At least once every: ❑ month(s) A
❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) NA ❑ year(s)
Other: At least once every: ❑ month(s) ❑ NA
❑ year(s) Other:
❑ NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum
and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage 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 servicing at intervals of 5_12 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW (4/01)
Page of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage
the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade
soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts;
condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, 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 POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replTsystem. ant system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP 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 INSTALLER POWTS MAINTAINER
Name 66, Name
Phone 7/6- Z4 ~,r L b Phone
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name Name
Phone Phone -7/l 3S'(~ - .jl(o '&6 F7
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.5411), (2) & (3), Wisconsin Administrative Code.
I
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer pc.-,N 4N1 -b V i m o-' Zt
Mailing Address P.20 X g s 314
Property Address Czyy F p ~ Co ra
(Verification required from Planning & Zoning Department fo new construction.) y- I
City/State ~O S t--' r W t Parcel Identification Number 175 1 d 00
LEGAL DESCRIPTION
Property Location`s i/4 i/4 , Sec. 1-7 , T V6* N R 19 W, Town of
Subdivision- Lot # -30
Certified Survey Map # , Volume , Page #
Warranty Deed # S 7 9c , Volume , Page #
Spec house yes n~ Lot lines identifiable yes no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1/3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin.
Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue of a waryanty deed recorded in Register of Deeds Office.
Number of bedrooms
SIGNATURE OF APPLICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department.
Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if
reference is made in the warranty deed.
(REV. 08/05)
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Tx:4043309
ocument Number WARRANTY FED 957399
THIS DEED made between DCCI Land Planners Inc., a BETH PABST
Wisconsin Corporation ("Grantor') and Victoria A. Gouze and REGISTER OF DEEDS
Stephen J. T'Kach, wife and husband, as survivorship marital ST. CROIX CO., WI
property, ("Grantee"), 05/31,2012 1:04 Phi
EXEMPT#: NA
WITNESSETH, that the said Grantor, for valuable consideration REC FEE: 30.00
conveys to Grantee the following described real estate in St. Croix TRANS FEE; 178.50
County, State of Wisconsin: PAGES: 1
Recording Area
Name and Return Address
Lot Thirty (30), Plat of Meadow Ridge of Troy, in the Township of
Troy, St. Croix County, Wisconsin DCCI Land Planners, Inc.
PO Box 445
New Richmond, WI 54017
040-1310-00-030
(Parcel Identification Number)
This is not homestead property.
Dated this 30th day of May, 2012.
DCCI Lan anners Inc
rporate Name
* Ro rick sident
ichael R. vens Secretary
ucsaooSTtAJO alelS
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Wisconsin Department of Commerce S EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings
in a Com 5, Wis. Adm. Code
County St. Croix
Attach complete site plan on paper not 1 1/2 x
include, but not limited to: vertical and h rrtaI ref poi Parcel I.D.
percent slope, scale or dimensions, north arro d I lion and distance to nearest road. Q 3 d
Please print all inform 'on. S - 2005 Revi by Date
P 21 Personal information you provide may be used for secondary p oses (Privacy Law, s. 15.04 (1) (m)). ` D
Property Owner ST. CROI GRTgWV~-ocati n
DCCI Land Planners Inc ZONING S 1/4 SE 1/4 17 T 28 N R 19 E (or®
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1505 HWY 65 30 Meadow Ridge Of Troy
City State Zip Code Phone Number ity []Village • Town Nearest Road
New Richmond WI 54017 ( ) T-4- 0-Y I East Cove Road
El New Construction UseE] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
E] Replacement ® Public or commercial - Describe:
Parent material Loess over glacial till Fbod Plain elevation if applicable ~h R
General comments *with several continuous layers, 1", sl,
and recommendations: Om, 7.Syr4/4 7
F] Boring # 0 Boring
Pit Ground surface elev. 943.51 ft. Depth to limiting factor >120 in.
Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Stnicture Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "Eff#2
1 0-5 10yr3/2 - sl Ifgr dsh as 2f .6 .8
2 5-24 1 4/4 - is Osg dl cw if .7 1.6
3 24-54 10yr313 - lvfs Osg dh cw - .4 .6
4 54-120 7.5yr5/6 s Os dsh ,7 1.6
F 2 Boring # Boring 940.30 >120 ✓
El Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#'2
1 0-10 10yr3/2 sil 2msbk dsh as 2f .6 .8
2 10-25 1 4/4 - sil lmsbk dsh cw if .4 .6
3 25-40 1Oyr4/4 - is Osg dsh cw _ .7 1.6
4 40-80 7.5yr5/6 - lfs* Osg* dsh cw - ,S .4 .6
5 80-120 7.5yr5/6 - s Osg dl - - .7 1.6
T
!Dq < 30 mglL and TSS < 30 mg/L
' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = B
CST Name (Please Print) _ - Signature CST Number
Thomas C Nelson 227387
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, Wl 9/18/05 715-246-2454
Property Owner DCCI Land Planners Inc Parcel ID # Pending Page 2 of 3
F3 Boring # Boring 946.07 >110 f
' Pit Ground surface elev. ft. Depth to limiting factor M. 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. "01#1 -Etf#2
1 0-7 10yr3/3 - sil 2msbk dsh as 2f .6 .8
2 7-34 7.5w4/4 - Ifs Os dsh cvr if .5 1.0
3 34-50 5yr4/4 - Ifs Osg dl cw _ .5 1.0
4 50-110 7.5yr5/6 - s Osg dl - - .7 1.6
F-] Boring # BO""g
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Colo Redox Description Texture Stricture Consistence Boundary Roots GPD/W
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 "EfW
❑ Boring # Boring
Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate.
Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Foots GPD/lF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Efr#1 `Eff#2
" Effluent #1 = BODS > 30 < 220 mgIL and TSS >30:5 150 mg/L ' Effluent #2 = BODE < 30 mg/L and TSS 30 mg/L
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SM-8330Ted (R07/00)
r -
DCCI LAND PLANNERS, INC. ® SOIL BORING i ••~•*r
Lot # 30 -MEADOW RIDGE OF TROY Cpl
NW 1/4 OF THE SE 1/4 OF SECTION 17, BENCHMARK • • •
T28N, R1 9W, TOWN OF TROY, ST. -TOP OF CONDUIT - • uo.i •
CRODC COUNTY, WISCONSIN. ALT BENCHMARK e.. • '
-TOP OF CONDUIT • .eta. \
TOM NELSON CST - Lic. # 227387 N NOTE.- THE CONTOURS IDENTIFIEDI • i •
ENVIRONMENTAL BY DESIGN ARE PRIOR TO CONSTRUCTION. ~I • i CONSTRUCTION GRADING WAS IN
1432 120TH ST. PROCESS DURING SOIL TESTING. ul ~10p~ i
{
NEW RICHMOND, WI 54017 CONTRACTOR MAY NEED TO > WT W
ph. # 715-246-2454 CONFIRM FINAL CONTOURS
DURING INSTALLATION.
. 1
SCALE IN FEET f -
iia 40' '
100 0 100 °1 1
933.1
.66
9 .59
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9 4 3
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0
3rd-9404 4
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3 r'
1 iV
® 46.07/ -
7
~y 17.
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31', 942.92
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®943.51