HomeMy WebLinkAbout040-1310-00-027
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
561043 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:
DCCI Land Planners LLC, do William H. & Ma Troy, Town of 040-1310-00-027
CST BM Elev: Insp. BM Elev: BM De criipti~n: Section/Town/Range/Map No
rJ2 D Z o _M 17.28.19.2014
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
eptic ) Benchmark
P 5
Dosing Alt M
Aeration Bldg. Sewer r
Holding St/Ht Inlet
93 70
TANK SETBACK INFORMATION Ht outlet VL S %V 6 y5 136.7
TANK TO /L WELL BLDG. Ven to Air Intake ROAD Dt Inlet La y
Septi Dt Bottom
Dosing n 2 ea /Man. 21t 411, VW t,
Aeration Dist. Pipe
r S yZ
Holding Bot. System
03 el 2-3,,
PUMP/SIPHON INFORMATIO ) '7 30, 5
Manufacturer Demand St Cpv r
GPM - S Y-S . D 1 l i I t0
Model Number
'K Crsrrii q 39, Z
TDH Lift Friction Loss em Head TDH Ft
Forcemain Length a. Dist. to Well
SOIL ABSORPTION SYSTEM. ,0o, 60 CO 01
BEDITRENCH Width r ength / ro. Of Trenches PIT DIM IONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS
SETBACK SYSTEM TO P L BLDG WEL LAKE/STREAM LEACHIN n fa r f
INFORMATION CHAMBE O"IA
T e Of System 7 J r
y , >,L3 ~ UNIT Model Number:
RIBUTION SYSTEM ✓ SCF( 0 -l cD d
Hea /Manifo)d /I Distribution r x Hole Size ix Hole Spacing ent Air Intake
-J Pipe(s) ' rf , !
Length Dia Length Dia Spacing 106
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over / Depth Over xx Depth of xx Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil ❑ Yes E] No Yes No
COMMENTS: ((include code discrepencies, persons present, etc.) Inspection #1: -fUpection #2:
Location: 318 Meadow Riddg.Je~Ct. Hudson, 1(VI 54916 (SW 1/4 SW 1/ 7 T28N 119W) Meadow Ridge of Troy Lot 27 Parcel No: 17.28.19.2014
1.) Alt BM Description = u 1 yh S` (,f1 tOCi f
2.) Bldg sewer length = CJC~' r.~/_ `U~~~, r
- amount of cover
> z d I
AJ A4
Plan revision Required? ❑ Yes N y
Use other side for additional information.
SBD-6710 (R.3/97) Date Insepctor's Signa ure Cert No
04/08/13
DCCI LAND PLANNERS, INC
P.O. BOX 445
jj NEW RICHMOND, WI 54017r (cyy~
C a
4 SYSTE -95.0
u +31
318 MEADOW RIDGE COURT
Il HUDSON, WI 54016
r SW 1/4 SW 1/4 SEC 17
T 28 N R 19 W LOT 27
TOWN OF TROY
Z (MEADOW RIDGE OF TROY
I BENC 10.0 T~/ ~
0 " SCALE: 1"= CO~~
WIESER 1250 LP
;W/POLYLOK 525 FILTER
i
y 5> E
cl
Jr~~JJ~~\/~ Gee ,
J4 3~
1 t
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iAN
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RECEIVED
commerce.wi.gov (}y~ Safety and Buildings Division County
APR i#261JW Washington Ave., P.O. Box 7162 ST. CROIX
's C o n s i n Madison, WI 53 Sanitary Permit Number (to be filled in by Co.)
Department of Commerce StAID
Sanitary Perffftt pp ation State Transacti[on~Number
In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental /v
unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Add re s f iflere than ~ttai address
submitted to the Department of Commerce. Personal information you provide may be used for secondary
3 fQa(,[ B(,(JtY
purposes in accordance with the Privacy Law, s. 15.04 1 (m , Stars.
I. Application Information - Please Print All Information ~S
Property Owner's Name Parcel #
DCCI LAND PLANNERS 040-1310-00-0027
Property Owner's Mailing Address Property Location
P.O. BOX 445
ot -
City, State Zip Code Phone Number SW %4, SW /4, Section 17
NEW RICHMOND, WI 54017 N/A (circle one)
II. Type of Building (check all that apply) Lot # T 28 N; R 19 E orOV
1 or 2 F/a'mily Dwelling -Number of Bedrooms 4 O L Subdivision Name
1 r.) - 2 ri
:3-&CS k"),s Block# MEADOW RIDGE OF TROY
❑ Public/Commercial - Describe Use
❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
6 Town of TROY
III. Type of Permit: (Check only one box on line A. Complete line B if applicable)
y ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
1B.1 New S stem
List Previous Permit Number and Date Issued
Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New
efore Expiration Owner
IV. T WTS System/Component/Device: Check all that apply)
Non-PresPressurized In-Ground At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
(l
Mel(t,~►~ ' - 3, / t i
sal Component (expl ain retrea ent Device (explain)
V. Dispersal/Treatment Area Information: ~ yy~
Design Flow (gpd) Design Soil Application Ra gpdsf) Dispersal Area wired (sf) Dispersal Area roposed (sf) r~l rnEl600 .7 3 857 900 VI. Tank Info Capacity
in Total # of Manufacturer
Gallons
Gallons Units
New Tanks Existing Tanks `wo° y
0
a U yr ~ ~ w (7 a.
Septic or Holding Tank 1250 LP N/A 1250 1 WIESER X
Dosing Chamber N/A N NI 0
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. _
Plumber's Name (Print) Plumber's Signat MP/MPRS Number Business Phone Number
PAUL KOEHLER 225410 715-246-2660
Plumber's Address (Street, City, State, Zip Code)
321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017
VII Count /De artment Use Only
Approved ❑ Disapproved Permit Fee Date ssu d suing Agent S gnature
❑ Owner Given Reason for Denial $ ~7~_' ~ 1,3
IX.SCog islgnOsV~rovaUReasons for Disapproval ^,f
/ vvZ S L
1.YSepttic M tank, effluent filter and / ` r( nv~N°-" 0 ~ ~
dispersal cell must besjYloed / maintained (v0 l0~,~4 W Iv
as per management plan provided by plumber. ~,s.,l&_ ti pZ9. 5lL~ 5~/S
__Z
2. All setback requirements must be maintained V"
4V 1,g /L+ J&,aj q 7/ 2 ,l
as per app ica e C If61I1aus for the system and submit to the County only on paper not less than 8 1/2 x 11 in hes in size
SBD-6398 (R. 02/09) Valid thru 02/11
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name:
CI,.~o'
Owner's Name: ,Q cc- Z' Lam, ri-
Owner's Address:
Legal Description: -22 S It,/
Township: ~p
County: C
Subdivision Name: /Yzrc~/ o,~ ,~o
Lot Number: a 7
Parcel ID Number: y~ `1,?1~ -06 -C~D2~
Page 1 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
Attachment : Soil Tes House Plan lrl~
Designer/Plumber: License Number:
Date: Phone Number ? 5',6--~
Signature
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
I
W._...._ 04/08/13
DCCI LAND PLANNERS, INC
P.O. BOX 445
NEW RICHMOND, WI 54017
SYSTE 95.0 P447?`
318 MEADOW RIDGE COURT X 1431
HUDSON, WI 54016 TU7rvv
f SW 1/4 SW 1/4 SEC 17
T 28 N R 19 W LOT 27
i
TOWN OF TROY
;MEADOW RIDGE OF TROY
' BENCHMAR 100
SCALE: 1"=
`,WIESER 1250 LP
'iW/POLYLOK 525 FILTER
v
f
oot "w
4 ~ t t'`1
~ ~ O 1
J N d ~o
} pp 6 Qo 1 i
a 2 K"
v py
1
, lb.
f
I
Soll Absorption System Cross Section
ft
4" Schedule 40 Final Grade -
PVC Vent Pipe
With Vent Cap '1 - ft
Leaching ♦ Gr 2
Chamber ft
System Elevation
V ft ft ~ ft ~.J
O ~
i
Soil Absorption System Plan View
ft
{
ft
I
ft Leaching Trench 1
Chambers
4° Dia.
Trench 2 Header
Vent Or Observation Pipe
Trench 3
Leaching Chamber Specifications
Manufacturer And Model . 6 f
EISA Rating ~d sq ft per chamber Soil Application Rate pd/sq ft
C~ aD gpd Design Flow / 7 Soil Application Rate , 0 ~ ? EISA = I Chambers
3 rows of chambers each.
Page of
Wisconsin Department of Commerce IL EVALUATION REPORT Page 1 3
Division of Safety and Buildings
in a 5, Wis. Adm. Code
Attach complete site pan on County St. Croix
paper than jr
1R~ Pa10ei I.Dinclude, but not limited to: vertical and ho~
l j!~ star':° to ^w. ws Please pnnY an P 2 12005 Personal information you provide may be used for seccy Law. s. 15.04 (1) (m)). 7a la s
Property Owner
DCCI Land Planners Inc ZONING Z ®i
- Phi
1/4 SE 1/4 S 1 T 28 N R 19 E (or) W
1 Property Owner's Mailing Address Lot # Block # Subd. Nacre or CSM#
1505 NVNY 65 1 7.7 1 1 Meadow R id_ue of Tmv 1
City State Zip Code Phone Number ity, []VIlage ■ own Nearest Road
L New Richmond WI 54017 1 1 East Cove Road
[ El New C utruction UseE] Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
n Replacement Public or commercial -Describe:
Parwlt mriariai Loess over elacial till Fkxxf Plain Rlovatinn if anolirAWP -A
ft 1
General comments t n
and recommendations: .
Sys -!V Le_
Alt- tao
f nOng
y ~ ,vrar~wxlys ,j.
IL~JI Pit Ground surface elev. 929.66 it Depth to limiting factor "t b in.
Soil Application Rate
Horizon Depth Dominant Cobr Redox Description Texhue Structure Consistence BoundaryRoots GPD/fl?
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'EfT#1 *Eff#2
1 0-35 10yr3/1 - sil 2msbk dsh as 2f .6 .8
2 1 35-45 1 i n.-e ie I - I sil 1 1 mchk I dsh I cw 1 i f 1 .4 1 .6 1
3 45-55 10yr4/4 - sicl Imsbk dsh cw _ .2 ,3
4 55-70 7.5yr4/4 - Is Os dl -
cw ,7 1.6
5 70-140 7.5yr4/6 - s Osg dl - - .7 1.6
_I ! I I I I I I 1 1 1 1
2 Boring # Boring ✓
F El 933.86 >142
Pit Ground surface elev. ft. Depth tD limiting factor in. SW IGation Rate
Horizon Depth Dominant Colod Redox Description Texture Structure Consistence Boundary Roots GPD/F
1 I in I MUM" I Oil Ri Cant r',&. I I rr q, Rh i I 1 "Firm I -Ftrln
1 0-8 10yr3/1 - sit 2msbk dsh as 2f .6 .8
2 8-16 1
sil lmsbk dsh cw if .4 .6
3 16-52 7.5yr4/4 - sicl Imsbk dsh cw _ .2 .3
4 52-PL, I - S va
1 1 7._yi4;6' 1 1 is I di I I--a L6
I
Efltuent #1 = BOD. > 30 < 220 ma_ & and TSS >30:5 150 mNL • Effluent #2 = BOD_ < 30 ma_ IL and TSS < 30 mdL
r _ST Namw jkft 4p Print1 Rinnah lra - 'I r_ST hh n*w
Thomas C Nelson 227387
Address Data Evaluation Conducted Telephone Number
1432120th Street, New Richmond, WI 9/18/05 715-246-2454
Property Owner DCCI Land Planners Inc Parcel ID # Pending / Page 2 of 3
Boring #Boring
Pit Ground surface elev. 928'51 ft. Depth to limiting factor 140 in.
Sal ication Rate
Horizon Depth Dominant Co~ Redox Description Texture Structure Consistence Boundary Roots GPD/fP
I I in. I Munsell I Qu. Sz. Cont. Color I I Gr. Sz. Sh. l I I I `Eff#1 -Eff#2 I
1 0-37 10yr3/1 - A 2msbk dsh as 2f .6 .8
2 37-44 I 4 - sil Imsbk dsh cw if .4 .6
3 44-70 7.5yr4/4 - Is Osg dl cvr _ .7 1.6
' w 17f 1-140 L 7 c.. ~F - I 1 n-.g 7
T 1 0
1
5 _
L--1 U Pit t rouno surface elev. IL Lrepm TO rrmrong racxor in.
Soil Appli Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •EfF#2
~ ~ I I I l 1 1 1 1
I I i 1 I I i I I I I i
Boring # o
ring Ground surface elev. IL
FIB
Pit Depth to limiting factor in.
Sal ication Rabe
Horizon Depth Dominant Colod Redox Description Texture Struck" Consistence Boundary Roots GPDff
I in. I Munsell I Qu. Sz. Cone Color I I Gr. Sz. Sh. I I 1 I 'Eft'#1 I •Eff#2 I
FtRi wrM i!1 = RArI > < 72n mnA and TRS >v < 15n mnA * FfM wnl W = Rnn < An mnA aril TRR < Rn mM
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 608-2648777.
seo-ss 4* pc.07A10)
DCCI LAND PLANNERS, INC. ® SOIL BORING
Lot # 27 -MEADOW RIDGE OF TROY BENCHMARK
SW 1/4 OF THE SE 1/4 OF SECTION 17, •
T2SN, R1 9W, TOWN OF TROY, ST. -TOP OF CONDUIT
CRODC COUNTY, WISCONSIN. ALT BENCHMARK
-TOP OF CONDUIT
TOM NELSON CST - Lic. # 227387 N NOTE: THE CONTOURS IDENTIFIED , ~ •
ENVIRONMENTAL BY DESIGN ARE PRIOR TO CONSTRUCTION. CONSTRUCTION GRADING WAS IN wrr• • LM2 \
1432 120TH ST. PROCESS DURING SOIL TESTING. • "u~,
NEW RICHMOND, WI 54017 CONTRACTOR MAY NEED TO =I
a ~
CONFIRM FINAL CONTOURS •
ph. # 715-246-2454 DURING INSTALLATION. \ 11 • 'O7" r
•
SCALE IN FEET 1' - 40' •
1100 0 100 1OT°
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w p~ ~ 1 1 • 10
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INSTALLATION INSTRUCTIONS
:~v~noMmr, t ArrW9 AZi ortofPWokI- PL-525/PL-625 FILTER
s w:gcw:.a~~-~
PL-525/PL-625 FEATURES & BENEFITS
Features & Benefits:
o Rated for 10,000 GPD
• PL-525 = 525 Linear Feet of 1/18" Filtration
PL-625 = 625 Linear Feet of 1/32" Filtration
z
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 *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.
RECOMMENDED PRODUCTS
lia Polylok PVC Filter
Extension Handle
i~'
..f
"x a
Risers & Riser Covers Extend & LokTm Riser Safety Screens Fitter Alarm Panel and
SmartFilterTm Control
Polytok risers bring your Polylok Extend & LokTm Polylok safety screens Switch.
septic tank cover to grade. is a simple, easy to use prevent tragic accidents
This allows locating and solution that can extend from happening by children Potylok filter alarm panels
servicing your filter easier the inlet or outlet pipe and and pets failing, into open and switchs provid a visual
and time saving by elimi- make filter and/or baffle septic tank entrances. and audible no 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
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O
` POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner DCCI LAND PLANNERS
Septic Tank Capacity 1250 gal ❑ NA
Permit # (a Septic Tank Manufacturer WIESER O NA
DESIGN PARAMETERS Effluent Filter Manufacturer POLYLOCK 0 N A
Number of Bedrooms 4 0 NA Effluent Filter Model 525 ❑ NA
Number of Public Facility Units M NA Pump Tank Capacity gal A3 N a.
Estimated flow (average) 40 gal/day Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) 600 gal/day Pump Manufacturer j3 NA
Soil Application Rate al/day/ftz Pump Model Y3 N,q
Standard Influent/Effluent Quality Monthly average* Pretreatment Unit3 N,a
Fats, Oil & Grease (FOG) 530 mg/L a Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection O Other:
Pretreated Effluent Quality Monthly average s III !'Z N,4
Biochemical Oxygen Demand 180DO 530 mg/L In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L )KNA Di ❑ Mound
Fecal Coliform (geometric mean) S10" u/100m1 O Drip-Line 0 Other:
Maximum Effluent Particle Size Y in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ Nib
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: 3. , ❑ manth(s) (Maximum 3 years) ❑ NA
EN year(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: 3 ❑ month(s) (Maximum 3 years) ❑ NA
J] yearls)
Clean effluent filter At least once every: 0 month(s) Q NA
YJ year(s)
Inspect pump, pump controls & alarm At least once every. 0 month(s) IN NJ!,
❑ yearls)
Flush laterals and pressure test At least once every: '0 month(s) M NA,
❑ year(s)
Other: At least once every: 0 month(s) 13 NFL
O year(s)
Other:
❑ N.9.
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 surfacs.
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 tl le
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 11:3,
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 512 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.
VJL L1/UO IU 1G:40 rAA 110 000 4000 a'1 (:KA UU GU1V11% LLD U U 5
Page of 2
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 ehemicsls
-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 oell(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; coil;
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
replacem ,,1%t1system-
0 A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptk,n
system. 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 K ill
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 POWYS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
W~ dlUa inn r++n.er ~,z.r 1 i pltiraa~a~nF~t~~rsf~rtl~ra~Fwane~-r~r~r-4f k
LPV G IGF/IOL.GIIIGIIL tlIGO 11 IIV IGF,ItlleG11,GIIL tl~16,tl IJ tlVtl11OY10 O ■IV IYjno tat1k
be ' e ai e • ?tZa(.r'18 rTr~ (Die- Nt~w/ CaNSMUCTL D
❑ 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 NCT
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 COUNTRYSIDE PLUMBING & HEATING, INC Name PAUL KOEHLER 225410
Phone 715-246-2660 Phone
715-246-2660
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORrTY
Name POWERS LIQUID WASTE MANAGEMENT Name S'r. d9 11
Phone 715-246 Phone 3W~._ q(0 ':r0
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(11. (21 & (3), Wisconsin Administrative Code.
1
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer C- w-N11) t fa c
Mailing Address P o box 44-S - k t c. 4e o %.1 b . W( Property Address 3 MIC T1,0Z W V, O L9, c 60-0 r'L. 0, D
_
(Verification required from Planning & Zoning Department for new construction.)'
City/State 4l0 50*J 4 ( Parcel Identification Number C3 4-CJ ' l3 1 Cl -0 C~ ' Z-7
LEGAL DESCRIPTION
Property Location5W '/a , '/a , Sec. T -Z6- N R 19 VII, Town of I y
Subdivision" Lot # 27
Certified Survey Map Volume , Page #
Warranty Deed # , Volume _7125) Page #
Spec house yes no 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 andlor (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. IJwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number f be tns
S NATURE OF A/PLICANT(S) DATE
***Any information that is misrepresented ma 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. 08105)
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\ m WLP1250-MR MISER COOCRETE DRAWN BY: SME SREV. 1 4°=1'-0" PRE-POUR:
-4 1
Om SEPTIC MANUAL W3716 US HWY 10 MAIDEN ROCK, WI 54750 DATE: JANUARY 2010 DATE:. POST-POUR:
\ ° REVISED JAN. 2010 800-325-8456 FILE: V012"
A
3 11
Parcel 040-1310-00-027 04/08/201P AGE E 1 44 OF 1
1
P
Alt. Parcel M 17.28.19.2014 040 - TOWN OF TROY
Current 0 ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
10/20/2005 00 0
Tax Address: Owner(s)' 0 = Current Owner, C = Current Co-Owner
0 - DCCI LAND PLANNERS LLC
DCCI LAND PLANNERS LLC
PO BOX 445
NEW RICHMOND WI 54017
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description 318 MEADOW RIDGE CT
SC 4893 SCH DIST RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 0.000 Plat: 10-085-MEADOW RIDGE OF TROY LOTS 1/31 040-0
SEC 17 T28N R19W PT SW SE MEADOW RIDGE Block/Condo Bldg: LOT 027
OF TROY ('05) LOT 27
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
17-28N-19W SW SE
Notes: Parcel History:
Date Doc # Vol/Page Type
10/20/2005 809848 10/085 PLAT
01/18/2005 785170 2732/370 EZ CON
01/14/2005 785053 2731/551 WD
02/13/2004 754206 2509/328 WD
more...
2013 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 11/09/2009
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 0.000 68,200 0 68,200 NO
Totals for 2013:
General Property 0.000 68,200 0 68,200
Woodland 0.000 0 0
Totals for 2012:
General Property 0.000 68,200 0 68,200
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
ae~ riuo eua..e. u - e-►u-rrru r. C1C
- 'Tg.St~53
U 2731 P 551 _
KATHLM H.. WALSH
DEEDS
5TREl3iST ER Co. OF, WI
. CROIX
` RECEIVED FOR RECORD
7 n A DEED @I/1412M 6LsOGPK
KARRARTY DEED
Document No, Elm i
REC FEE: 13. N
This Deed made between VALLEY LAND 7RJ~1S FEE: 19".98
r
COMPANY, a.Mirmesota corporation, Grantor and COPY. FEfi
CC FEE
DCCI LAND PLANNERS, INC., Grantee GE ° 3
.
Witnesseth, That the said Grantor conveys to
Grantee certain real estate .m St, Croix County, State
of Wisconsin, legally described on ExiubitA hereto
(the "Property"),
Together with all and singular hereditameats r q T
and appurtenance's thereunto belonging_ //449
This conveyance is without warranty,
except Grantor covenants and represents the
Grantor has not made, done,: executed -or T= LD.
suffered any act or thing whereby _the above-
described property or any part. thereof, now or
Z
at` any time hereafter, shall or may be d - D - ~4!70
periled, charged or encumbered ia: any
manner, and Grantor will warrant title to tic
above-described property against RE persons
' claiming the same from or though Grantor as
a result of any such act or thing, provided, however, that the conveyance hereby made and the
warranty of Granter is further limited by and subject to those matter set forth on Fxhibit,B_heaeto. .
Dated this day of January, 2005..
VALLEY LAND COMPANY,
A Min c~rpo .
Y.
ACKNOWLEDGEMENT
STATE O _
) SS
COUNTY OF
personal] came before me this
Y 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-me known to be the person who executed the foregoing instrument and aclmowiedged the
hc, State of
d. ion (expires):
_•---u CROCUS-
HILL -R-DV
.
o :r R r**LOT 29
LOT.28' ! 1
a-
_ 1 1
LOT 27
r
cl.
0.1
_((t
H LOT 26 J
O
Z.H
LOT 25 j•
• A
/ ~•LOT 24 vo,
LLoomWILO
MCH MAW. TOP
OF I- IRON FM
ELEVAUCN
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