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HomeMy WebLinkAbout040-1310-00-017 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 556367 0 GENERAL INFORMATION 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: DCCI Land Planners LLC, do William H. & Ma Troy, Town of 040-1310-00-017 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: cJZ 9 , 6-5r 17.28.19.2004 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic y~ Z Benchmark I,f .s / 76 931: 9Zg.7 Dosing Alt. BM Po J b Szs z 7~5. -405 '93T V Aeration Bldg. Sewer io,~ T~f9. a ~ Holding St/Ht Inlet 9 X34.8 TANK SETBACK INFORMATION St/Ht Outlet 2 • ~I X13 3 TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Lje J- S J4r-A` \ Septic i Dt Bottom Dosing Header/Man. q7,7. 12- Aeration Dist. Pipe 17.7 Holding Bot. System I/•& 9 7 S --7 PUMP/SIPHON INFORMATION Final Grade S• 5 53 2 Manufacturer Demand St Cover GPM y3 7-RI Mode er TDH Friction Loss System He TDH Ft Forcemain Length Dist. to Well SOIL ABSORPTION SYSTEM 1-415 BEDITRENCH Width Length No. Of Trenches ( PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 Q r (t G~~tip SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION Type Of System: 1 '1 /t ~,Q UNIT CHAMBER OR Model Number: lje,n✓e /o^ I )25 / ) J /V1~ DISTRIBUTION SYSTEM a X19 Header/Ma nifo I Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Sa 0 Length Dia 4 Length \ Dia Spacing SOIL COVER,--2,0' x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded Tx Mulched Bed/Trench Center 5. 5 3 Bedfrrench Edges\ Topsoi Yes No a Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: 1 / Location: 483 Meadow Ridge Lane Hudson, WI 54016 (NE 1/4 SE 1/4 17 T28N R1 9W) Meadow Ridge of Troy Lot 17 Parcel No: 17.28.19.2004 1.) Alt BM Description 2.) Bldg sewer length = CO - amount of cover = ~ n JI u n YnPlan revision Re uired? ❑ Yeo Use other side for additional informatI Z _ Date Insepctor ignature Cert. No. 3710 (R.3/97) ~ I DCCI LAND PLANNERS, INC P.O. BOX 445, NEW RICHMOND, WI 54017 NE 1/4 SE 1/4 SEC. 17, T 28 N R 19 W i ~ TOWN OF TROY LOT #17 SUBDIVISION: MEADOW RIDGE OF TROY 10/11/12 SCALE 1" = 60' BENCHMARK #1 929.62 BENCHMARK #2 N/A a~ rp SYSTEM ELEVATION s l"1 1000 GALLON SEPTIC TANK WEISER TANK W/ POLYLOK 525 FILTER ' S^ ~ 5 C._'3 .r•3 y 4-60' TRENCHES OF EZ-FLOWS " 1 1 1 ~ it 4 RED: EIVEr COPY WT 19 2012 PLANNING i ZONING OFFr;. County Safety and Buildings Division St. Croix D RECEIVED 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) S p $ l£ Madison, WI 53707-7162 OCT 15 2012 -7 pU11 W~~~lt Application State Transa„c/a Number In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appro gmental unit 1 W a is required prior to obtaining a sanitary permit. Note: Application forms for state-owned S e ub~itte to Project Address (if different than mailing addre s) the Department of Safety and Professional Servics. Personal information you provide in used for secon 483 Meadow Ridge 'Mt-1 purposes in accordance with the Privacy Law, s. 15.04(1)(m), Stats. WI 54016 Hudson, L Application Information -Please Print All Information Property Owner's Name Lf✓ Parcel # DCCI Land Planners,-_-[m= 040-1310-00-017 Property Owner's Mailing Address Property Location ZOO l I PO Box 445 Govt. Lot , City, State Zip Code Phone Number N- y,, _qE- y4, Section 17 New Ichmond, WI 54017 715-246-2320 (circle one) T28 N; R 19 E or W II. T e of Building (check all that apply) Lot # 2 Fami)y Dwelling - N rtber of Bedrogms 3 17 Subdivision Name Q(/ o,n ~lcb Bloek# Meadow Ridge of Troy ❑ Public/Commercial - DAcribe Use 1/y 5-*,(d - no ❑ City of ❑ State Owned - Describe Use CSM Numbee ❑ Village of kJ Town of Troy III. Tye (Check only one box on line A. Complete line B if applicable) A. New System El Replacement System El Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Pennit Revision ❑ Change of Plumber El Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: (Check all that a 1 ) n [jtNon-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade' I ❑ Mq, nd 24 in. of suita oil Mo d /<`2/4yiin. of suitable ;Soil ❑ Holding Tank ❑ Other Dispersal Component (explain) e Zw ~'y/ UI T~ ' / 6 e t ev~ (elamq " " - `yv/ Z V. Dis ersal/Treatment Area Information: RT ?3 2. Design Flow (gpd) Design Soil Application Rate dsf) Dispersal Area Required (s~ Dispersal Area Proposed System Elevation 450 .4 1,125 1200>~:~+ Z w. l VI. Tank Info Capacity in Total # of Manufacturer U Gallons Gallons Units o New Tanks Existing Tanks o 2 c`°c 1000 U in _ a Septic or Holding Tank 1000 1000 _ Weiser w/ pQlyl ck 525 Dosing Chamber r C/ VII. Responsibility Statement- 1, 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 DeYoun 664713 715-246-2660 Plumber's Address (Street, City, State, Zip Code) CoU~ ~b E: &1CT 521 Vl/►scv,Js' / nlm /J v✓ IZcu-~M ont ~n/~ l 7 VIII. ountv[Department Use Only pproved El Disapproved Permit Fee Date Issued suing Agent Si at [CA a 10 ❑ Owner Given Reason for Denial ' 22 G~ 1X. Conditions of ApprovaUReasons for Disapproval I(~ Gv- ~10717~ } 6tf q Z (o. t z ~ ~uuew ay L o ccdu~ -M~' -for the system and submit to the County only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 11/11) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Meadow Ridge of Troy model #3 Owner's Name: DCCI Land Planners, M INC Owner's Address: PO Box 445, New Richmond WI 54017 Legal Description: NK NE 1/4 SE 1/4 Sec 17, T 28 NR 19W Township: Troy County: St. Croix Subdivision Name: Meadow Ridge of Troy Lot Number: 17 Parcel ID Number: 040-1310-00-017 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: xx 664713 Date: 10/9/12 Phone Number 715-246-2660 I Signature Designed pursuant to the In-Ground Soil sorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101). Page 1 I DCCI LAND PLANNERS, INC P.O. BOX 445, NEW RICHMOND, WI 54017 NE 1/4 SE 1/4 SEC. 17, T 28 N R 19 W TOWN OF TROY LOT #17 SUBDIVISION: MEADOW RIDGE OF TROY 10/11/12 `c. aQ3Z''1 , SCALE 1" = 60' a ~ BENCHMARK #1 929.62 BENCHMARK #2 N/A w" SYSTEM ELEVATION + 9 oj.~ ,rte ' ~,y r9 I 1000 GALLON SEPTIC TANK °w ~,ss I WEISER TANK W/ POLYLOK 525 FILTER 4-60' TRENCHES OF EZ-FLOWS R \ kC9`f. 1-Af1.v pa ~ ~I; ai 1 1- $ Sets ECEIVEr. OLD' 19 2012 PLAWNG & ZONING Of;Fr . Soil Absorption System Cross Section 4" Schedule 40 17 31 ft. PVC Vent Pipe with Vent Cap Final Grade Barrier Material 12, I 36' Q -2 L 1:5k Kft System Elevation all - Z2 2 Soil Absorption System Plan View ft (00 ft 60 ft Trench 1 Trend 2 Vent or Observation Pipe EZFIow 1 Chambers Leaching Chamber Specifications Manufacturer and Model 'F Z x l w 5 r ~c. It- EISA Rating sq. ft. per chamber Soil Application Rate / gpd/sq. ft. -1 60 gpd Design Flow = I L/ Soil Application Rate - s O EISA = Z 2S Chambers ►rows of chambers each EZ1203H vvvovvv ° r`} a=~" ....eve V*vvv ..v r....»!. »;..v:s:::•r~: ..eel.. 11 ~=.r.~:..;~;~~ ..v• 12 24 q,,:.~ vse 4.62511 a v.. 1 " 1/2 Ciro. 18.84,• e. a .vv ...}.9~ r. ....~.vi we- .v.ler ..ev.vv ~•>r~.... 8 Boll 2 4, Vold Volume 1~-1/Gtt Di In.~2 Void CaefFuieltt is wggr,egau give[, at 57.4%. krI 2.1 O.D. *f4" pipe = 4.625 inches SidewaA (2 Sidewags) 1210 ( I ~ = 3.14 Void volume per Know IL = 3.14 !R • •tR -0.117 fe BUtkm C t2ia lit 2A0 O.D. of cetttercytisder- t2.S in*q Totd Soil interface Area 5.1+1 SQ. . Void volumeioaggtzg ofcuntercyli rw(3_ts'(t2at 8)•`3.14•( 4-.422W l` `112e~/R J O.D. ofvutside .Yfi Kim.- 12 inches . Projected Trench Area Vohs vohatte is outside eyHnd=- 1.3.1 ( bw `12is / @)' • s;s - 901 fe Sidewali Haight = 12 in.'2 - 2.00 Sq.FL Vohs votnple at bottom between cyltadera Bottom 36 in. - 3.00 Sq.FL - • _ fan . l t2m 1 is t2a~ t R~ (3'1 12ist k~,~ ' 0215 R' Projted TL epch Asva a SAR Sgjr L Void volume at outside bouorn corners (1/2 of void volume betwap cylind=) 0.28312 + 0.108 It~ Tout void volume - 0.117 + 0.422 + 0.901 + 0215 + 0.108 -1.7,63 cubic ft/ ft Galhuls per ft = 1.763 X 7.48 - 133 cal bwx per Haar R. EPS. Aggregate Trench System EZi 203H ~I-0w %6-bdustrioi Group 65 lnduAdcd Pork Rd. Ouldond. TR 38060 StA¢F FtIE HAUD E1F103i -ml . SHMI. I of 1 11-27-01 mO=~-0 -0 C;?CODD7 iC-IXcy, z C cn K < r o _n C) X20 r- ~z G7_0 Nm < O n m cn N z m D m I AO r- U)ij 0D 2 O 2 -mj n n CD C/) P. m rn a? z x Cl) -i Q 0> Z= v m O o o ~ z cn N CD ~ A ~ n C.J7 3 `O N O ~ O 0 Cn 3 J~ r IV cortw p wo oo C7 j 0 N O C7 W C') O 3 r 3 3 ca < wow m ca N 3 Cl) A 3 3 n O mcn >0 >O -u -u p o p aim Oo 4 z O z z ODD D = r n cn 5200 rn N-U ND2 `9 3 o m 30 z o ~rn ~o No m ~ C-) --I --1 0 K-v -v O 00>>O -n -n o 0 ~mooN :O C W r-' ;10 z v T -n ;u r n ~U'm m ^ - cyl co -w frn D Z ~ a' o m O y o .0 ~ T D m ma O 7 c32 C') -n .Z a m m c-:, Or z~ v v, T 1 m Win o rj) mn r Cf) m o D o m 3 r Y~ rn x F* CrI 00 7 co cn DO r C7 r m -V m c to y x~ (D m o m v 0 m ~ N n T (T c.n O 0 A IWflWE® 1 A 0 _ fJ ~ 1®PIOMi0YA91 u 3 WLn 0 r 3 pAp ~ ~ IV <J O _ n A ~ 0 3 N O O N 3 °D N O N r ~ n ~ ~ O 8~0~0 DI ~0 0~ u MORN 111 IN 0 O Mililill O O O p OO MIN 61 42" z 86" r m N -i WF 3" cn 0 45j" I 0 I I < < m -v C m mXX :I 0 rn ~ ~ r D 0 rn r- 3 9" > Ov ° rnZ D z Ox X r- <O< U7 m m 0 D ~ m A > D 0 Z C (A C ~ D 0 Zm D r 2 1= Z Z ;lu m (A Z D O D r r rn D C7 n D O D Z Z~ m l m i r Dp r up :e U) z 0 zx m Z Zr-x O oco 0 0 z DzZ --'~r-vz my0 OHO C N prN p 0 m0 N0 o C) 2p°=~ Xmm 017 2 ~ C CD -0 W r - \ c < z O=ff cnu'~ i rnmCzrn mvr'1?=N~ -p m p Or M DO OD Dm N >N-4 ND-4 m -4 >m 0F~0?0 ~ _ M Z D mm O 0-0 ~ v v)mD Dm r ~N~000. Zn_ m G7 to -i G = C D W 00 G7 (A (A U) c -Ti 0 m O Z c 0 ° mom Na N O ~~-0 u! n v O C to 00 r ODD D°0 0 m D N Z A CO D N \ mrZ 17.4 ~ =0 D -I X D ? r*i Z Z v p 0 Ln 0 O -Oi X N D D v°'1 DO :v O Z O r r -II 0 0 w z I m r -i C rN in S O m N Z ;0 D 0 0 v mm 0 --q O N m r m r z ;u -r rF- ao rri p Z O ;o m 0 m m -1 . z r z m m m N 1 WLP1000-MR M HERCINCIETE SCALE:1 4" - 1' REV NO. DATE- 0 CA 0 DRAWN BY. SWT SEP nC MANUAL z W3716 US HWY10. MAIDEN ROCK. WI 54750 DATE: JANUARY 2008 0 REV. JAN. 2008 800-325-8456 FILE: WLP1000-MR ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer )CAL-.1 LAN © Mailing Address r rJc" '~v ~C CtVi~~1 p I~-o r 44DO -t7 Property Address 1 v'1 Esoc V O ~4c (Verification required from Planning & Zoning Department for Lnew !cons ction.) City/State , O z04-i I Parcel Identification Number 64' 3 113 ~31cs 01`7 LEGAL DESCRIPTION Property Location '/a Sec. 1 , T .?t N-R^ tot W, Town of Subdivision PA C~l F1~ Lot # Certified Survey Map # , Volume , Page # Warranty Deed # C->C~ , Volume -713 , Page # Spec house es no Lot lines identifiab yes 3 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 §Cornm. 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. Uwe, 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 warranty deed recorded in Register of Deeds Office. Number o dro SIG ATURE OF AP ICANT(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) a POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of _ FILE INFORMATION SYSTEM SPECIFICATIONS Owner DCCI LAND PLANNERS, INC Septic Tank Capacity 1000 al ❑ No Permit 3 Septic Tank Manufacturer WEISER O N~ DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOK O N I Number of Bedrooms 3 17 NA Effluent Filter Model 525 ❑ Ne Number of Public Facility Units I~CNA Pump Tank Capacity gal KI No Estimated flow (average) 300 gal/day Pump Tank Manufacturer KI N.Q Design flow (peak), (Estimated x 1.51 450 qal/da Pump Manufacturer 12 N.4 Soil Application Rate 0 4,--" al/day/ft2 Pump Model IR N.4 Standard Influent/Effluent Quality Monthly average" Pretreatment Unit CI N.a Fats, Oil & Grease (FOG) 530 mg/L I7 Sand/Gravel Filter O Peat Filter Biochemical Oxygen Demand (BOOS) s220 mg/(. ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSSI 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cep --_~a O N,a Biochemical Oxygen Demand (BODS) S:iO mg/L In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ Mound Fecal Coliform (geometric mean) S10" efu/100ml 13 Drip-Line O Other: Maximum Effluent Particle Size Y in dia. ❑ Other ❑ NA Other: ❑ A 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 O month(s) (Maximum 3 years) ❑ Nit year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (Ys) of tank volume ❑ Nit Inspect dispersal cell(s) At least once every: 0 month(s) (Maximum 3 years) ❑ Nit 3 m year(s) Clean effluent fifter At least once every: Q month(s) 0 NA ear(s) Inspect pump, pump controls & alarm At least once every. © month(s) ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s)( Not, year(s) Other. At least once every: ❑ month{s) ❑ Not, O year(s) Other: O N6, 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 surfscs. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check far 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 (Y) or more of the tank volume, the entiv e contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 11:1, Wisconsin Administrative Code. All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatmerit units, and any servioing at intervals of s12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the focal regulatory authority within 10 days of completion of any service event. START UP AND OPERATION Page Z of 'G For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemic that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contei 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 surf ace. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restori power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls 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 of 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 tl POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fa foundation drain (sump pump) water, fruit, and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; to painting products; pesticides; sanitary napkins; tampons; and water softener brine. ARAND ONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system i properly and safely abandoned In compliance with chapter Comm 83.33, Wisconsin Administrative Code: s 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 wid 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 oomplian replacer t system: A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptkir system- The replacement area should be protected from disturbance and compaction and should not be infringed upon b) required setbacks from existing and proposed structure, lot lines and wells- Failure to protect the replacement area vt it result in the need for a new soil and site evaldation 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 soll limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ~ o atik alua " in9 ik e ~RUK($TT~ foie- N ~NS`TRd~-?t~ ❑ Mound and at-grade son absorption systems may be reconstructed in place following removal of the blomat 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 NC T 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 f Pt3WTs INSTAUJIM POWTS MAINTAINER Name i' V1'l beY6 t/ ✓1 4-r l V Name Phone -7 J Phone SEPTAGE SERVICING OPERATOR (MIMP€Ri LOCAL REGULATORY AUTHORITY Name S E✓ C% ~t-C, p,~ Pgf~Cs Name -j-. C D ( 20 1 ~C1 Phone Phone TNa document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&M and 83.54(11. 121 & (3). wsconsin Administrative Code. • v-a. • Cali rWJ yl a74.•-y 1 V G`f1..I~fJ'Ty/ r . roc 2 7 31 P S 5 25 Ca ts --:t KATHLEEN B. NALSH REGISTER of DEED5 ST. CROIX Co., wI RECEIVED FOR RECORD LIl1ZTJi'ED WARItA.NrY DEED BUL412M3 8L:88Ptt WARRANTY DEED Document No, Exam # .90 This Deed made between VALLEY LAND SREC ANS FEE:FEE 10958 COMPANY, a Minnesota corporation, Grantor and : 1 8958. N DCGT LAND PLANNERS, INC,, Grantee PA FEE: 9 Witoesseth, Tbat the said Grantor conveys to Grantee certain real estate in St. Croix County, State of W%nsiu, legally desenbed on Extubit A hereto Ite P 3'" ( Together with all and singular hereditaments TURN T9, and appurtenances thereunto belonging- a This conveyance is without warrmty,. except Grantor covenants and represents the Grantor has not made, done,. executed or Tax LD-/~v -~-U~ suffered any act or thing whereby the above- described property or any pact thereof, now ar 7 at any time hereafter, shall or may be Dyd /D7 imperiled, charged or encumbered in any manner, and Grantor will warrant title to the above-described property against all persons claiming the same from or through Cmanbar as a result of any such act or thing, provided, however, drat the- conveyance hereby made and the warranty of Grantor is further limited by and subject to those matter set forth on Exlubit,B hereto: . Dated this day of January, 2005.. VALLEY LAND CONTANY, _ A Min corpora ' Y• Its: ACKNOWLEDGEMENT STATE O l COUNTY OF ) SS pcrsonally came before me this day of January, 2005, the above named Gary B. Valley, as president of Valley Land Company, a Minnesota corporation, having full authority to do so and to-sne known to be the person who executed the foregoing instrument and aclmowledged the II sum _ blic- I of cornrnission (ezpires): ' Wisconsin Department of Commerce IL EVALUATION REPORT Page I of 3 Division of Safety and Buildings in Will 85, Vft. Adm. Code County St. Croix Attach complete site plan on Paper 81 include, but not limited to: vertical and porn~1~~~1'} i Parcel J.D. percent slops, scale ordimensions, ion noA road. oya -Y j Please print It informs on. ~j Rev] by D73/Z6 Personal information you provide may be used for secondary (PrfitaCp L.2, 1 Ytm>). / Property Owner Property Locati DCCI Land Planners Inc ST. CR0 COUNTY S ZONIN OPYllW L /4 S 17 T 28 N R 19 E (or) W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1505 HWY 65 1 17 Meadow Ridge Of Troy City State Zip Code Phone Number ity Q VIRage E own Nearest Road New Richmond WI 54017 ( } East Cove Road El New Construction UseE) Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD Replacement 0 Public or commercial - Describe: Parent material Loess fiver glacial till flood Plain elevation if apple MA- ft. General comments conventional below grade system and recommendations: Fq Boring # 0 Boring El Pit Ground surface elev. 929.78 ft. Depth to limiting factor >98 in. Suit Application Ram Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-28 10yr3/2 - sit Imsbk dsh as 2f .6 .8 2 28-34 l 4/4 - sil l l dsh ew If 4 .6 3 34-98 10yr4/4 - sil Imsbk dsh - - .4 '6 2 F Boring # D Boring 932.94 >110 E) Pit Ground surface elev. ft. Depth to limiting factor in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texkm Siruetm Consistence Boundary Roots GPDff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-23 10yr3/2 sil 2msbk dsh as 2f .6 .8 2 23-34 1"A sil impl dsh Cw If .4 .6 3 34 10yr4/4 - sit 2msbk dsh cw _ .6 .8 4 46-110 7.5yr4/4 - s osg di - - 7 1.6 i I Effluent #1 = BOD > 30:S 220 mg& and TSS >30 < 150 mg& " Effluent #2 = BOD < mg& and TSS < 30 mgil_ CST Name (Please Print) Signature ,i•.._ CST Number Thomas C Nelson 227387 Address Date Evafuatiorr Conducted Tuna Nufnber 1432 120th Street, New Richmond, WI 9/18/05 715-246-2454 Property Owner , DCCI Land Planners Inc Parcel lD # Pending Page 2 of 3 F-3 Boring # Boring 931.69 >110 [D Pit Ground surfaceelev. ft. Depth to limiting factor in. Sal 'option Rate Horizon Depth Dominant Color Redox Ern Texture Structure Consistence Boundary Roots GPON in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *892 1 0-26 10yr3/} 2msbk dsh as 2f .6 .8 2 26-35 } /4 - sil lm l dsh cw if A .6 3 10yr4/4 2msbk dsh cw _ 6 8 4 45-110 10yr4/4 - sil Imsbk dsh - - .4 .6 Boring # P Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Colo Redox Description Texture Structure Consistence Boundary Roots GPDiff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Efr#l *EW I I Boring # Boring Ground surface elev. ft. Depth to thing favor in. 12 Pit Sort Appl~ Mite Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/* in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *EfM2 • Effluent #1 = BODS > 30:5 220 ftV& and TSS >30,c 150 mg& * Effluent #2 = BODS a 30 mg& and TSS z 30 mgn- The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. M4330Teat (8.07/00) DCCI LAND PLANNERS, INC. 0 SOIL BORING Lot # 17 -MEADOW RIDGE OF TROY" • $ y \ ~ NE 1/4 OF THE SE 1/4 OF SECTION 17, A BENCHMARK 4r T28N, R7 9W, TOWN OF TROY, ST. -TOP OF CONDUIT CROIX COUNTY, WISCONSIN. Q ALT BENCHMARK • t • -TOP OF CONDUIT • • • • • • • • TOM NELSON CST - Lie. # 227387 N NOTE: THE CONTOURS IDENTIFIED • ENVIRONMENTAL BY DESIGN ARE PRIOR TO CONSTRUCTION.,.. CONSTRUCTION GRADING WAS IN 1OTtp 1432 120TH ST. PROCESS DURING SOIL TESTING. w.+r NEW RICHMOND, WI 54017 CONTRACTOR MAY NEED TO ph. # 715-246-2454 CONFIRM FINAL CONTOURS • DURING INSTALLATION. a*+" SCALE IN FEET 1. a 40' • ounnr r iiiiiii 100 0 100 i / Y 1 931.69 B ey 9 78 3 .78 OJ 1 1 ` 01 \ ` OJ N N 01 It J II I I CI LAND PLANNERS, INC. ® SOIL BORING LOT to t # 17 -MEADOW RIDGE OF TROY • NE 1/4 OF THE SE 1/4 OF SECTION 17, BENCHMARK .•,o y T28N, Ri9W, TOWN OF TROY, ST. -TOP OF CONWT '~jO1'~ t M COUNTY, WISCONSIN. n ALT BENCHMARK • ' -TOP OF CONDUIT • . • • • • • TOM NELSON CST - LIC. # 327387 N NOTE: THE CONTOURS IDENTIFIED • ARE PRIOR TO CONSTRUCTION. LOT,a ENVIRQNMENTAL BY DESIGN CONSTRUCTION GRADING WAS IN 1432 120TH ST. PROCESS DURING SOIL TESTING ►orIV ►a+sr NEW RICHMOND, 11111 54017 CWTRACTOR MAY NEED ph. # 715-346-2454 CONFIRM FINAL CONTOURS • tww DURING INSTALLATION. • t SCALE IN FEET Y 40' • _ammr__ 100 b 100 i No \ 3 N 931.69 B1 \ 929.78 ' \ 3 .78 M 1 1 1 \ 14, t 32.94 r 14, 1 / \ o 1 O .__~.1.--~''`.~--~"°""°~'~'-- " \ ~-~-.-.-....may "''...,~...u-- J CONSERVATION AREA OWNED P BY HOMEOWNERS ; ` ASSOCIATION 1 Alp. : ~ , lop ! LOT i L4 LOT 12 ! N tBo ' •S21 g ~ 9 t • . LOT 10 ` 1.,...._ LOT 8 • - • LOT 9 r" 1 t,BO~a1so I ~ LBOs1so 1 g- 1, ~ _ _ , • dos 4>lazsf ow Rio Ole CZ C, i J~ i 1 ` zv' • t'v a ~ti ,.Aa 1 t LOT 16* y / fawn LOT 18* / \LOT 17* 1 LOT 19 m• i 1 1 \ .401, ` i OUTLOT 4 1 \ CONSERVATION AREA BY HOMEOWNER ASSOCIATION ~ i . ~Y I ~ ~ I X11'7 oI 0 -0-