HomeMy WebLinkAbout040-1156-30-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
556369 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: !
Meyers Family LLC, c/o Joseph E. Jr. Troy, Town of 040-1156-30-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
(Xo ~j✓!/j / IG.6l 24.28.20.611 L
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic y ~ 1.5 Benchmark
F,,~.. a•s lZ5 0.o5 100.65 scab
D Alt. BM 7E•
F, t L.,... 1C, ~o ~G J~ZS Jjew S 63 W
Aeration Bldg. Sewer
17,26 'T7. 73
Holding St/Ht inlet 45 f y.5- -5
TANK SETBACK INFORMATION St/Ht Outlet
S
~S
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
-4/1 S s h
Septic 7 50 / 93 3 Z)
/ 7 /DO / Dt Bottom `
Dosing Header/Man.
O
Aeration Dist. Pipe 1D • Y 9 ° g
9Cr g8. 0 9
Holding Bot. System 55 BV . 1
2.95 V7• /
PUMP/SIPHON INFORMATION Final Grade 4 • y5 73 - to
Manufacturer Demand St Cover S. 93
GPM n a- Gv 11Y 93 /,06 9i
Model Number
TDH 1Ift Friction Loss Syste TQH Ft
Forcemain a IDia. Dist. to Well
SOIL ABSORPTION SYSTEM
BEDITRENCH Width Length No. Of Trenches I - PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ~
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: /
UNIT Model Number:
DISTRIBUTION SYSTEM ✓r.`, z >f- Z t St Z Ats
Header/Manifold Distribution x Hole Size x Hole Spacin Vent to Air Inta
/ Pipe(s) 1--, Eases ^ ~5
Length 7 Dia T Length Dia ~SUacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/So e~es xx Mulched
Bed/Trench Center ~a Bed/Trench Edges Topsoil
t E No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / /
3~~4c,
6-4-Parcel 253 Cove Road Hudson, WI 54016 (Gov't Lot 2 24 T28N R20W) St. Croix Cove Lot n- ~ "Parcel No: 24.28.20.61
1.) Alt BM Description = T" G6Je l_ C~~; 4- 4e_j~t 0 r ~ c G o rl,n Q~,~
2.) Bldg sewer length = 2 Z ~-e 1 o c%~ T C~u e a ab// s
- amount of cover
Li y
U
µL o~ 6aJ•e.~- a» bl c~~oa ~o A_J
-
Plan revision Required? Yes No 7
J) 3 5/
Use other side for additional information.
SBD-6710 (R.3/97) Date Insepctor ignatur Cert. No.
County
2 ED Safety and Buildings Division St. Croix
0 S ; r k ry 201 W. Washington Ave., P.O. BOX 7162 Sanitary Permit Number (to be filled in by Co.)
Madison, WI 5371
44 State Transaction Number
p~ ary Permit Application
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate govemmental:unit Na
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address)
the Department of Safety and Professional Services. Personal information you provide may be used for secondary
purposes in accordance with the Privacy Law, s. 15.04(1)(m , Slats.
IN
1. Application Information - Please Print All Information 111
C253
Property Owner's Name Parcel # (f Y~
Joe Meyers - 2 e Y-3 " m, I V R.4 L-L C 161 -1006-MONO O f(0 -1156 X30
Property Owner's Mailing dress Property Location I ! L \
256 Cove Road Govt. Lot 2 J
City, State Zip Code Phone Number Section 24
_
(circle o e)
Hudson, WI 54016 715) 386-8538 T 28 N; R 20>Ow
;_11 e f Building (check all that apply) Lot # yktt
or 2 Foamily Dwelling - Number of Bedrooms 4 Subdivision Name p r~
Block # Plat of St. Croix Cove - 54
❑ Public/Commercial - Describe Use Na
❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
Na PTown of Troy
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. ❑ New System alacement System El Treatment/Holding Tank Replacement Only El Other Modification to Existing System stem P Y g Y (explain)
B• ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date sued
Before Expiration Owner ry( Z I.
IV. T e of POWTS S stem/Com onent/Device: Check all that apply
y ' u
191on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ _ of suitable soil
❑ Holding Tank ❑ Other Dispersal Component ❑ Pretreatment ice(ex 1 [
V. Dispersal/Treatment Area Informati : 42 Infiltrator "Q4 Plus" Standard chambers 4 endca s, of Lok PL-525 effluent filter
Design Flow (gpd) Design Soil Application R e Dis er Are se
600 Gpd 0.70 Gpd/Sq. Ft. 857.15 sq. f4. 860.40 Sq. Ft. 87.00' & 88.00'
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o d v
New Tanks Existing Tanks w c y U "
a U ii, y rn w C7 Q.
Septic or Holding Tank WLP1,250-MR 1,250 1 Wieser Concrete X
Dosing Chamber
VII. Responsibility Statement- I, the dersigned, assum responsibility for ins f the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's ignature MP/MPRS Number Business Phone Number
James K. Thompson , MPRS 30021 (715) 248-7767
Plumber's Address (Street, City, State, Zip Co
340 Paulson Lake Lane, Osceola, WI 54020
VI . Coun /De artment Use Only
Approved ❑ Disapproved Permit Fee Date Issued /issuing Agent gna
~f ( c
❑ Owner Given Reason for Denial $ ~ / S / Z
IX. Conditions of Approval/Reasons for Disapproval 0 PzC`
BYE:. •ii~ r
e• ' 4D low SAS 3,
djo;wwil 441A1Mtd snarMin"
.Iwo r+W WwAded by L,,,, ~G tla-~ ~ . L v 4T&V7
46 e p ns for the system ands mil to the County onl paper n t less than 81/2 x'11 inches in size
SBD-6398 (R. I I/11)
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Conventional POWTS Index & Tilte Sheet
Project Name: Meyers 4 Bedroom Replacement Conventional POWTS
Owners Name: Joe Meyers
Owner's adress: 256 Cove Road, Hudson, WI 54016
Site address: 253 Cove Road, Hudson, WI 54016
Project Location:
Subdivision: Lot 27, Plat St.Croix Cove
Legal Description: Gov't lot 2, Sec. 24, T.28N., R. 20W., Tn of Troy, St. Croix Co., WI.
Parcel ID 040-1156-30-000
Page 1 Index and Title Sheet
Page 2 Site Plan
Page 3 Dispersal Cell Sizing Calcualtions
Page 4 System Cross Section
Page 5 System Management Plan
Page 6 Filter Specifications
Page 7 SepticTank Cross Section
Page 8 Parcel map
Page 9 Septic Tank Maintenance Agreement
Page 10 Waranty Deed
Attachments: Soil Evaluation Report
Mater P ber Restri ted Service: James K. Thom son, De 't. of SPS Credential #30021
Signature: - Date: & Zo~Z
Page 1 Of 10
Design pursuant to In-Ground Soil Absorption Component Manual for POWTS, version 2.0 SBD-10705-P (N.01/01)
~Oe,/' W230 S
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& crt- ,4 drive,aaya~- 'P°s'~¢/1Ce 2 Shydec~
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Meyers 4 Bedroom Dispersal Cell Sizing Calculations
1. (4 bedrooms)(100 gallons estimated flow)(1.5 design factor) = 600.00 Qpd design flow
2. Infiltrative capacity of native soil = 0.7 gpd/sq. ft.
3. Absorption area required: 857.15 sq. ft.
4. Absorption area as proposed: 870.60 sq. ft. (42 chambers + 6 end caps)
Infiltrator "Quick 4" = 20.00 sq.ft. EISA per chamber, Infiltrator "Quick 4" end caps = 5.10 sq.ft, EISA
857.15 sq. ft. - (4 endcaps)(5.10) = 836.75 sq. ft.
836.75 sq. ft./20.00 = 41.83 chambers required
Number of trenches: 2 & 21 chambers per trench (42chambers total)
Trench width: 2.83'
Trench length: 86.00'
Trench spacing: 9.00' on center
Total system area w/ 6' trench spacing: 12.00'x 86.00'
14L(/f~
Ci4yy~ e~
Pg. 3 of 10
1
Soil Absorption System Cross Section
92, a -
ft
k4" edule 40 Anal Grade 88,0 ent Pie j~
ent Cap 894)
ft
Leaching 87, 0
Chamber g8 d 'ft
System Elevation
33,0 If ft 1v.0 ft
Soil Absorption System Plan View
i
I
ft
3.v ft
(o,y ft Leaching Trench 1
Vent Or Observation Pipe Chambers
R\
4" Dia.
Trench 2 Header
Leaching Chamber Specifications
Manufacturer And Model=A„~- Q-yC ~.Sc~w~iQ~~cS
I EISA Rating a0.0 sq ft per chamber Soil Application Rate 0.70 gpd/sq ft
gpd Design Flow O. w Soil Application Rate ?D. C/ EISA = 342- Chambers
I
j 2 rows of Z/ chambers each.
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\ = WLP1250-MR MIERER CDIICRETE DRAWN BY: SME SCALE: 1/4"=l'-O' PRE-POUR:
m REV.
SEPTIC MANUAL DATE: JANUARY 2012 DATE:. POST-POUR:
Z W3716 US HWY 10 MAIDEN ROCK, W1 54750
REVISED JAN. 2012 800-325-8456 FILE: V01250-MR
P~, 7o /a
Conventional Septic System Management Plan
Pursuant to SPS 383.54, Wis. Adm. Code
General
The conventional septic system shall be operated in accordance with SPS 382-384 Wis. Adm. Code, and shall be maintained
in accordance with component manual SBD-10705-P (N.01101). All local and/or state rules pertaining to system
maintenance and maintenance reporting shall be complied with.
Septic Tank
Septic tank servicing mechanics comply with SPS 383.54(1)(e). Septic tank to be located within 150' of service pad, with
bottom of tank to be 15' below service pad elevation. The operating condition of the septic tank and outlet filter shall be
assessed at least once every two years by inspection. The septic tank contents shall be removed when the sludge and scum in
the tank exceed 1 /3 the liquid volume of the tank. The contents of the septic tank shall be disposed of in accordance with NR
113, Wis. Adm. Code, by an individual certified to service septic tanks under s. 281.48, Stats. If the contents of the tank are
not removed at the time of a biannual assessment, maintenance personnel shall advise the owner of when service will be
needed to maintain less than 1/3 scum and sludge accumulation in the tank. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank
that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be
serviced if the alarm is activated. Septic tank manholes risers, access risers, and covers should be inspected for water
tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of
service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater
than 8 inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into the tank.
No individual should ever enter the septic tank as dangerous gases may be present that could cause death. Septic tank
abandonment shall be in accordance with Comm83.33, Wis. Adm. Code when the tank is no longer used as a POWTS
component. The addition of biological or chemical additives to enhance septic tank performance is generally not required. If
such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings
Division.
Soil Absorption Cell
Trees or shrubs should not be planted directly on the soil absorption system. The area above and around the system should
be seeded and mulched as necessary to prevent erosion and provide some degree of frost protection. Traffic (other than for
vegetative maintenance) over the system is to be avoided. Soil compaction may hinder aeration of the infiltrative surface
within and above the system and will promote frost penetration during cold weather months. Cold weather installations
(October-March) dictate that the system be heavily mulched for frost protection.
Influent quality into the system may not exceed 220mg/L BOD5, 150 MG/L TSS, and 30 mg/L FOG. Influent flow may not
exceed maximum design flow specified in the permit for the installation.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the
owner. Levels above 4 inches indicate an impending hydraulic failure requiring additional, more frequent monitoring.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition. Excessive ponding within the dispersal cell will be eliminated by installing a new soil
absorption cell to bring the system into proper operating condition.
Questions on the operation or maintenance of the system should be directed to the installing plumber, Jim Thompson at (715)
248-7767 or the St Croix County Zoning Department at (715) 386-4680.
Pg. 5 of 10
• • Filters
tPL-525 EFFLUENT FILTER ( MM CM L,)
Polylok, Inc is pleased to add its
new commercial filter to its existing
line of quality effluent filters.The
PL-525 is rated for over 10,000 GPD Alarm
(gallons per day) making it one of accessibility Accepts PVC
the largest commercial filters in its extension handle
class. It has 525 linear feet of 1/16"
filtration slots. Like the Polylok
PL-122, the new Polylok PL-525 has
an automatic shut off ball installed 525 linear feet
with every filter. When the filter is of 1/16"
removed for cleaning, the ball will filtration slots -w Rated for over
float up and temporarily shut off 10,000 GPD
the system so the effluent won't
leave the tank. No other filter on s
the market can make that claiml Accepts 4" & 6"
SCHD. 40 Pipe
PL-525 Maintenance:
The PL-525 Effluent Filter should
operate efficiently for several years
under normal conditions before
requiring cleaning. It is recom-
mended that the filter be cleaned'
every time the tank is pumped or
at least every three years. If the
installed filter contains an optional
alarm, the owner will be notified`
by an alarm when the filter needs
servicing. Servicing should be Gas deflector
done by a certified septic tank Automatic shut-off
pumper or installer. ban when filter
1. Locate the outlet of the U.S. Patent No# 6,015,488 is removed
septic tank. 5,871,640
2. Remove tank cover and pump
tank if necessary. PL-525 Installation: 1. Locate the outlet of the
3. Do not use plumbing when septic tank.
filter is removed. Ideal for residential and com- 2. Remove the tank cover and
4. Pull PL-525 out of the housing. mercial waste flows up to pump tank if necessary.
5. Hose off filter over the septic 10,000 Gallons Per Day (GPD). 3. Glue the filter housing to the
tank. Make sure all solids fall 4" or 6" outlet pipe. If the
filter is not centered under the
back into septic tank. access opening use a Polylok
6. Insert the filter cartridge back Extend & Lok or piece of pipe
into the housing making sure to center filter.
the filter is properly aligned and 4. Insert the PL-525 filter into
completely inserted. its housing.
7. Replace septic tank cover. 5. Replace the septic tank cover.
~5, ~~'~o
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner c a e Irk ael-,s
Mailing Address ZS~
Property Address 253✓-Q2cf JSG,-,~ Sid/6
(Verification required from Planning & Zoning Department for new construction.)
City/State Parcel Identification Number 0 -30 - 6W
LEGAL DESCRIPTION
VaU~_- - /6 e,-7-
Property Location - 'A , '/4 , Sec. , T 2- N R 20 W, Town of
Subdivision Plat: Aa- 4a,,t in , Lot # ~ .
Certified Survey Map # , Volume , Page # _
i
Warranty Deed # 9~ 341?0 (before 2007)Volume , Page #
Spec house ❑JYAo Lot lines identifiable es ❑ r
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.
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. Uwe am/are the owner(s) of the
property described above, by virtue of /a warranty deed recorded in Register of Deeds Office.
Number of bedrooms
l/mil/z
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. 09/07)
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State Bar o Wisconsin Form 1-2003 8 0 8 8 1 5 6
WARRANTY DEED Tx :4067445
963830
Document Number Document Name BETH PABST
REGISTER OF DEEDS
ST. CROIX CO., WI
THIS DEED, made between Shirley J. Watson, a single person, by her Power of 09/20/2012 11:24 AM Attorney, Jodi Sachsenmaier EXERECMPT MPT#:NA
NA
("Grantor," whether one or more), FEE: 30.00
and MFRC LLC TRANS FEE: 438.00
PAGES: 1
("Grantee," whether one or more).
Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area
estate, together with the rents, profits, fixtures and other appurtenant interests, in St.
Croix County, State of Wisconsin ("Property") (if more space is needed, please attach Name and Return Address
addendum): Part of Government Lot 2 of Sec. 24-28-20 described as follows: KRISTINA OGLAND
Commencing at the Southeast corner of Lot 27 of St. Croix Cove Subdivision; ESTREEN & OGLAND
thence S38130'E 66.13 feet to point of beginning; ence 501E on Southerly line 304 Locust
of Cove Road 40.0 feet; thence S221351E 404.9 feet; thence S86045'W 267.5 feet; Hudson WI 54016
thene N22135'W 241.2 feet; thence N34050'W 14.0 feet; thence N55010'E on '
Southerly line of Cove Road 222.9 feet to the point of beginning,
040-1156-30-000
Parcel Identification Number (PIN)
This is homestead property.
(is) (is not)
Granter warrants that the title to the Property is good, indefeasible in fee simple and free
and clear of encumbrances except: easements, restrictions and reservations, if any, of record.
Dated I' U
(SEAL) 04ZAL, (SEAL)
" *S it ey J. Watson by her Power of Attorney Jodi Sachsenmaier
(SEAL) (SEAL)
* *
I AUTHENTICATION ACKNOWLEDGMENT
Signature(s) Shirley J. Watson by her Power of Attorney
Jodi Sachsenmaier STATE OF )
authenticated Z~ ) ss.
COUNTY )
*Kristina O land Personally came before me on ,
TITLE: MEMBER S ATE BAR OF WISCONSIN the above-named
(If not, to me known to be the person(s) who executed the foregoing
authorized by Wis. Stat. § 706.06) instrument and acknowledged the same.
THIS INSTRUMENT DRAFTED BY:
*
Kristina Oland, Estreen & Oeland Notary Public, State of
304 Locust Street, Hudson. WI 54016 My Commission (is permanent) (expires: )
(Signatures may be authenticated or acknowledged. Both are not necessary.)
NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.
WARRANTY DEED O 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003
* Type name below signatures. INFO-PRO- Legal Forms 800-655-2021 www.infoproforms.com
1 of 1
alrx
Parcel 040-1156-30-000 10/22/2012 04:29 PM
PAGE 1 OF 1
Alt. Parcel M 24.28.20.611 L 040 - TOWN OF TROY
Current ❑X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
O - WATSON, SHIRLEY J
SHIRLEY J WATSON
253 COVE RD
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): * = Primary
Type Dist # Description " 253 COVE RD
SC 2611 SCH DIST OF HUDSON
SP 1700 WITC
Legal Description: Acres: 2.000 Plat: N/A-NOT AVAILABLE
SEC 24 T28N R20W PT GL 2 COM SE COR LOT Block/Condo Bldg:
27 ST CROIX COVE SUBDIVISIONS 38 DEG E
66.13 FT TO POB: N 47 DEG E ON S LN COVE Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4)
RD 40 FT; S 22 DEG E 404.9 S 86 DEG W 24-28N-20W
267.5 FT; N 22DEG W 241.2'N 34 DEG W 14
FT; N 55 DEG E ON SLY LN COVE RD 222.9
more...
Notes: Parcel History:
Date Doc # Vol/Page Type
09/30/2011 942287 TI
06/20/1967 288693 433/490 WD
2012 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 11/09/2009
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 2.000 110,000 101,300 211,300 NO
Totals for 2012:
General Property 2.000 110,000 101,300 211,300
Woodland 0.000 0 0
Totals for 2011:
General Property 2.000 110,000 101,300 211,300
Woodland 0.000 0 0
Lottery Credit: Claim Count: 1 Certification Date: Batch M 205
Specials:
User Special Code Category Amount
I
I
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
I
2305
Wisconsin Department of Commerce 1 SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings( 7 ,L0 in accordance with Comm 85, Wis. Adm. Code A.C.E. Soil & Site Evaluations
County
Attach complete site plan on )caper Off Ttinches in size. Plan must St. Croix
include, but not limited tP~ nzontal reference point (BM), direction and 1 .
percent slope, scale or dimemsions, north arrow, and location and distance to nearest road►?~ Parcel I.D. r `
040-1156-30-000
Please print all infonnation. Fie d B Date
Personal intonnation you provide may be used for secondary purposes (Privacy law, s.15.04 (1) (m)). 1
Property Owner Property Location (0(
Joe Meyers Govt. Lot 2 SW 1/4 NW 1/4 S 24 T 28 N R 20 W
Property Owner's Mailing Address o°~l# Block # Subd. Name or CSM#
256 Ofevw Road p( W-kh-,' [dfl- f'l^ St. Croix Cove
City VVZ' State Zip Code Phone Number rty J Village jej Town Nearest Road
Hudson WI 54016 715-386-8538 Troy 253 Cove Road & Cove Lane
J New Construction Use: yj Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD
V Replacement -J Public or commercial - Describe:
Parent material Glacial Outwash Flood plain elevation, if applicable na
General comments
and recommendations: Site suitable for conventional P lspe 0.7 gpd/sq.ft./day loading rate. Proposed
infiltrative surface elevations t (be 6.0' below grade.
F Boring # _ I Boring
Pit Ground Surface elev. 94.29 ft. Depth to limiting factor >1 1T' in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-9 1Oyr3/3 none sit 2fgr dsh cw 3fmc 0.6 0.8
2 9-17 1Oyr4/4 none sl 2fsbk dh cw 3fmc 0.6 1.0
3 17-29 7.5yr4/6 none sl 2msbk dh cw 2fm,lc 0.6 1.0
4 29-49 7.5yr4/6 none Is Osg dl cw 1f,m 0.7 1.6
5 49-117 1Oyr5/6 noone s Osg dl - - 0.7 1.6
Horizons #4 & 5 contain approx. 10% gravel & cobbles.
I
Boring # --j Boring
_vj Pit Ground Surface elev. 90.96 ft. Depth to limiting factor >112" in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fe
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-9 1Oyr3/3 none sil 2fgr dsh cw 2fmc 0.6 0.8
2 9-16 1Oyr4/4 none sit 2fsbk dh cw 2fm,1c 0.6 1.0
3 16-32 7.5yr4/6 none sl 2msbk dh cw 1fm 0.6 1.0
4 32-49 7.5yr4/6 none Icos Osg dl cw 1fm 0.7 1.6
5 49-112 1Oyr5/6 noone s Osg dl - - 0.7 1.6
Silt inclusion observed extending to 53" ow gra at south west side of pit. c2d 7.5yr4/6 redox. concetrations observed within inclusion at outer
edges due to tension saturation.
* Effluent #1 = BOD? 30 < 220 mg and TSS >30 < 1)0 mg/L E ent #2 = BOD5 <30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signatur . CST Number
James K. Thompson - 3602
Address A.C.E. Soil & Site Evaluations Date Evaluation Conducted Telephone Number
340 Paulson Lake Lane, Osceola, W1020 10/15/2012 715-248-7767
` Property Owner Joe Meyers Parcel ID # 040-1156-30-000 Page 2 of 3
3 ] Boring # -I Boring
0 Pit Ground Surface elev. 93.27 ft. Depth to limiting factor >118" in. Soil Application Rate
F
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
1 0-9 10yr3/3 none sil 2fgr dsh cw 2fmc 0.6 0.8
2 9-29 10yr4/4 none sil 2fsbk dh CW 2fm,1c 0.6 0.8
3 29-48 7.5yr4/6 none sl 2msbk dh cw 1 vf,f 0.6 1.0
4 48-56 7.5yr4/6 none Is Osg dl cw, 1 of 0.7 1.6
5 56-118 10yr5/6 noone s Osg dl - - 0.7 1.6
' 3
❑ Boring # Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/If
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
❑ Boring # J Boring
J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2
I
* Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BODS S.30 mg/L and TSS <30 mg/L
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.
SBD-8330 (R.07/00) A.C.E. Soil & Site Evaluations
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Sr*C~~ LAND USE PERMIT Force Use Only
APPLICATION Revised 02-17-09
PLANNING & ZONING
APPLICANT INFORMATION
BSc-.Hes ~~a r*+P•50''' ~.~3.~
Property Owner: ,-Toe t' l yt's Contractor/Agent: A e . E F_Jva-lu"thOnj
Mailing Address: 25~ Colle eoa0/ Mailing Address: 3VO 4ix/sa-n / ~ 4,7-
, SS4J/b 0 ~c.2o (a
wu.dSoh Lot
Daytime Phone: (-%/S ) 386 -B•5 38 Daytime Phone: /5" 2S/8- 77~0~
Cell: (612-).260- k9A Celt:
E-mail: E-mail:
SITE INFORMATION
Site Address: 253 Cods arec_g f~ Ste,, W/ s-oaza
~Qd-t:• /ot 2
Property Location: 1/4, 1/4, Sec. ?-sl , T. 29 N., R. 2:0 W., Town of To
Computer 0 510 - //So - 30 - COO Parcel 20 • 46//Z
LAND USE INFORMATION
Zoning District (Check one): O AG. O AG. II (v~`AG. RES. ( ) RESIDENTIAL O COMMERCIAL O INDUSTRIAL
Overlay District (Check all that apply). O SHORELAND (vIVERWAY O FLOODPLAIN O ADULT ENTERTAINMENT
Type of Land Use Permit Request (Check one):
O Animal Waste Storage Facility $550 O W' less Communication Tower (Co-location) $550
O Nonmetallic Mining Operation $550 (ver St. Croix Riverway District $350
Signage $350 Shoreland $350
Floodplain $350 Temporary Occupancy $350
Grading & Filling, 12-24.9% Slopes $350 O Livestock Facility $1,000
( } Other:
O Permit processed in conjunction with a Land Division, Special Exception or Variance $50
State the nature of your request; )00 U)T`5
Zoning Ordinance Reference 3
SIGNATURE
I attest that the information contained in this application is true and correct to the best of my knowledge.
Property Owner Signatu . Date. '
Contractor/Agent Signature. _ Date
ONLY
c
Complete Application Accepted: & fZ/ J? By. GGt~~,
Fee Received: 12_117_112:-$3262 Receipt
715-386-4680 St Croix County Government Confer 715-386-4686 (Fax)
PZ000.SAWT-CR01X.WI.US 1101 Carmichael Road, Hudson, IM 54016 WWW.CO.SA/NT-CRQJX.M.US
GENERAL APPLICATION REQUIREMENTS Ilk
'
APPLICATION:
Applications will not be accepted until the applicant has:
• Met with the Zoning Administrator to review the application;
• Original plus 2 conies of the completed application submitted to the Zoning Administrator,
• Resolved any land use violations and paid any outstanding fees owed to the Planning and Zoning Department;
• Signed the application form (the signatures of the property owners and agents acting on their behalf are required); and
• Submitted the appropriate application fee (nonrefundable) payable to St. Croix County.
REVIEW:
The Zoning Administrator will review the application for completeness and assign a file number to the application. The Zoning
Administrator may require additional information and will notify the applicant of this within 10 days. Upon receiving a complete
application and supporting documents, the Zoning Administrator will:
• send copies of the applications to the appropriate reviewing agencies for comment. Applicants are encouraged to contact
their town to discuss their application and inquire about necessary building permits and approvals at the town level;
• schedule a site visit to the applicant's property, at which time the applicant shall flag all applicable property/project comers
and label the flags accordingly; and
• review the file and prepare findings for approval or denial of the permit within 60 days. Upon approval, the permit will be
mailed to the applicant or to the applicant's agent.
If approved, the land use permit will be valid for one year from the date of the permit issuance. The applicant may also be required to
apply through the Town for a local building permit. All site plans, pictures, and other materials submitted with the application become
the property of the Planning and Zoning Department and will remain in the file.
CHECKLIST FOR COMPLETE APPLICATION
❑ Completed and signed application form with fee.
❑ Original plus 2 copies needed.
❑ A general written statement that specifically explains the request.
❑ A statement indicating whether or not a private water or sanitary system is to be installed.
❑ Recorded Warranty Deed (may be obtained at the Register of Deed's office).
❑ A complete site plan showing:
• project location in the town;
• lot/parcel dimensions with total lot area, property lines, and all applicable setbacks;
• location of existing access roads, right-of-way, road setbacks, and recorded easements;
• location of all existing and proposed structures with their square footage and distance from setbacks;
• location of existing and proposed POWTS, wells, driveways, parking areas, access, signs, and other features;
• location of slopes 12% and greater (minimum contours to be determined by the Zoning Administrator);
• all blufflines and slope preservation zones (Riverway) and setbacks from blufflines;
• location of the OHWM of any abutting navigable waterways and all setbacks from the OHWM;
• location and landward limit of all wetlands, specifications and dimensions for areas of proposed wetland alteration;
• existing and proposed topographic and drainage features and vegetative cover;
• location of floodplain and floodway limits on the property; and
• any other unique limiting conditions of the property or information deemed necessary by the Zoning Administrator.
For projects that involve land disturbance requests, the following additional information may be required:
❑ Detailed drawings (scale should not be greater than I inch to 200 feet).
❑ Grading plan showing grading limits and pre and post contours.
❑ Project schedule and contractor list.
❑ Erosion control plan (Best Management Practices).
❑ Storm water management plan stamped by an engineer and including all runoff calculations.
❑ Vegetation plan including schedule, seeding rates, and species size, type and location.
Other documents:
NOTE: All maps, plans, and engineering data shall be no larger than 11 x 17". No covers,
binders, or envelopes. Staple or paperclip your application in the upper left-hand corner.
Page 2 of 2, Rev 02117109
A.C.E. Soil & Site
Evaluations
Applicant: Joe Meyers
256 Cove Road
Hudson, WI
54016
A ent: James K. Thompson
340 Paulson Lake Lane
Osceola, WI
54020
Permit Request: Land Use Permit - Filing & Grading, <10,000 sq. ft. outside
Slope Preservation Zone within the Lower St. Croix Riverway District as required
by §17.36 F.2a.2
Proiect Description:
The site is located 253 Cove Road, Gov't. lot 2, Sec. 24, T.28N., R.20W., Town of Troy, St. Croix County,
WI., identified by the St. Croix County Real Properly Listers Office as parcel #040-1156-30-000. The
parcel is separated from the St. Croix River and associated critical slopes by Cove Road on its Northwest
side and by Cove Lane on its southwest. The site is not visible form the St. Croix River.
The proposed project includes the replacement and abandoned of an existing hydraulically failed POWTS
septic tank and drywell. Abandonment will be accomplished by removing all liquid waste and filling with
compacted sand fill. A connection will be made to the existing building sewer at 5%s' below grade and will
be extended from the southwest side of the house within a trench at 4' wide and 5l/2' - 3 `/2' deep. Total
trench length will be approximately 30'. A 1,250 gallon concrete septic tank will be installed requiring an
excavation of approximately 10' wide, 14' long and 7' deep. The trench will then be extended
approximately 20' to the beginning of the in ground dispersal cell. The dispersal cell will be 12' wide x 83'
long and installed at 5Y2'-6V2' below existing grade. The total area of disturbance for the project will be
approximately 1,500 square feet, complying with the requirements of the St. Croix County Lower St. Croix
Riverway Zoning Ordinance, Chapter 17.36 F.2a.2.
The proposed POWTS location is greater than 300' landward of the slope preservation area and located on
the opposite side of Cove Road. The floodway and floodplain are greater than 600' form the project area.
There are no wetlands on the site. All slopes within the proposed project area extend away from the River
with no continuous slopes leading to Slope Preservation Zones. Slopes across the area of disturbance fall
to the southwest and away from the River at approximately 6 - 10 There are no drainage ravines
present.
The proposed area of disturbance will be stripped of topsoil immediately prior to construction of the
POWTS. Topsoil will be stockpiled adjacent to the system area. A 100' undisturbed vegetated area will
exist around the area of disturbance. Excavations for material installation will be completed immediately
prior to, and will be closed immediately after installation of materials. Topsoil will be replaced within 4
hours of completion of installation. Re-vegetation will consist of spreading grass seed and/or straw mulch
across all areas of disturbance upon completion of project. Three Maple trees of approximately 6" - 10"
diameter and one Basswood at 16" diameter will be removed to accommodate the installation. Eight trees
of similar size or larger will be left within 20' of the area of disturbance.