HomeMy WebLinkAbout040-1310-00-024
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
561079 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)(ni
Permit Holder's Name: City Village X Township Parcel Tax No'.
Sander, Co & Jessica Troy, Town of 040-1310-00-024
CST BM Elev: Insp. BM Elev: Description: -r' Section/Town/Range/Map No
00 BM ( G 5 1 17.28.19.2011
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION B 5 /0 I Z FS ELEV.
Septic e J T1. I /L s Q Benchmark , 75 !a1~ 16
F• l t
Dingong Alt. BM
Aeration Bldg. Sewer 1.61, b
Holding St/Ht Inlet L f Z 9 7• S
TANK SETBACK INFORMATION St/Ht Outlet J4• 9 7 /
TANK TO P/L WELL BLDG. AVent r Intake ROAD Dt Inlet
od-z
Septic 311 / i Dt Bottom
Dosing Header/Man.
Aeration Dist. Pipe
qi. 05
Holding Bot. System Qn
C7e ,c
PUMP/SIPHON INFORMATION Final Grade g~ `73 -
Manufacturer Demand St Cover c
GPM J A-3 77 • 9
Model Nu r
-7~ e 9/. Y
TDH Friction Loss System Head T Ft
Forcemain Length Tia. Dist. to Well
L_ 1 771 1 . /Z
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 3 S~ -
t rev_ c
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer
INFORMATION CHAMBER OR P,' If - Type System: 3/ 5 UNIT Model Number: ~1
C 3 /1f"f aw
gO~~n.JE.~.-d" ow Z ~ I-~ts1^-i-
DISTRIBUTION YSTEM ljd ~d.k„ 7 Sa li r !„Q, ZQ le 3 = (op
Header/Manifold / Distribution x Hole Size 0 Hole S acing Vent t Air ti ke
g ~7 Pipe(s) p
`f ~
Length Dra Length Dra *I--- Spacing
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 ~C s Bed/Trench Edges Topsoil - -l
3, ~ Yes No No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / /
Location: 312 Meadow Ridge (Court Hudson, WI 54016 (SW 1/4 SE 1/4 17 T28 R19W) Meadow Rid e of Troy Lot 24 Parcel No: 17.28.19.2011
1.) Alt BM Description = Gd✓G e td-- o cJIG O
2.) Bldg sewer length = y5 /
- amount of cover = 42- %yz 7
Plan revision Required? Yes o ! bature Use other side for additional information. SBD-6710 (R.3/97) Date Insepctor's Cert. No.
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county
and Buildings Division
Safety
a D 201 W. Washin n Ave_, P.O. Box 7162 S -!5,;-
9~ unitary Permit Number (to be filled in by Co.)
P Madison, Wl 53707-7162
~sz
Sanitary Permit Application State Transaction Number
In accordance with SPS 38321(21 Wis. Adm. Code, submission of this fond to the appropriate governmental unit _A IA-
is required prior to obtaining a sanitary permit Note_ Application forms for state-owned POWTS are submitted to Project Address (if different than matting address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary
y( CCld/d
in accordance with the Privacy Law, s. 15.04(1)(m), Stats. 2) 7
1. Application Information - Please Print All Informatio
Property Owner's Name f' q Parcel #
Property Owner's Mailing Address O Property Location
18110 Govt Lot Zt~ t
City, State
107F Or L. Y., rp Code I'Allit ben Sz- Y., Section 7
7~"1L 4 1 T o?8 N; R~Eoce<9
II. Type of Builifing (check afl that apply) Lot #
P(Ior2F=ilyDwetliog-NumberofBedrooms SubdivisionName
~
6k oL6 pla Block# / /~~gQoa l~/DIE
0
PubliclCommercial-DescribeUse 4525 - 45 ^ 19 eity 5f
❑ State Owned - Describe Use W- CP- CSM Number 8 ~+llaga of
/gym 1Q G~ ~ Town of Zu''
M. Type ofPermit: (Cher ly one boa on line A. Complete line B if applicable)
A. New System ❑ Replant System ❑ Tmat..VHodmg l ' Tank
Replacement Only ❑ Other Madification to Existing system (explain)
B. 0 Permit Renewal ❑ Permit Revision ❑ Change of Plumber 11 Permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Owner 44 C
IV. Type of POWTS System/Comptusent/Device: Check all that apply) J(Non-Pressuozed In-Ground ❑ Pressurized In-Ground ❑ At-Grade Q Mound > 24 in. of suitable soil ❑
Mound <24 in. of suitable soil
❑ Holding Tank Other Dispersal Component (explain) Pretreatment Device (explain)
V. Dispee rsaUT treat Area Information:
Design Flow (gpd) Design Soil Application Rate( pdsf) Dispersal Area Required (sf) Dispersal Area Prosf) System Elevation
Goo .S /~?ao 3.8 tZ~~ 9i.S~9o.S~ 89.5
AT Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units 2 o u o
New Tanks Existing Tanks ~ c a ~ $ g as I~ L P ~~✓1/aP~ &F- w 0 a
Septic or*k*IirWT=k
Dosing Chamber
VII. Responsibility Statement- 1, the ®odersgned, assume responsibility for installation of the POWTS shown on the attached plum
Plumber's Name (Print) Plumber's ' MPft4PM Number Business Plmce Number
EI_A~r ,73
Plumber's Address (Street, City, State, Zip Code)
Al ea 98 SF wy s' ,~,~o Zjj 5'Y,7
VIII. Conn ent Use On
Approved Permit Fee Date IF7_Z_113
d Issuing Si 00 Givce for Denial $ " / 75 s IX. Con ` - easons f isapproval
1 3 ~o nC~ a
Septic ank,'effk1lontfilter J
dispersal celtmus( all be:smerv)ces [ nairitair~ed
.
as.per management plan provided by phlmbe.
;L. Ap.aogeck requWarnerft must be rn aaltaiq $
63 peg ap~ioode,l prc8rreriees.
Attach to comphte plans for the system and submit to the Comay only on paper not less am 8,n z It inches is size
SBD-6398 (K 11/11)
l a F G
Private On.site Wastewater Treatment System
Index and Title Page
P,cojectName: COltY'` JESSicA ~.J~E~ - 5~frt ~trou~o Oo~rs
Owner's Name: Co.¢y T~ssic.9 S,g,~o~.t'
Owner's Address: /8/,~ 4✓. 3!` 0 Sr
~L1.9. /f~ Soa Y y
Legal Description: /7 e~BiV 19 X/
MtmicipaW. T_ own. V e, , C2y of 711o Y
County. j /y' C~10/X
Subdivision Name: /%~q/✓osJ GL/lJd~' of r,&,;l
Lot Number: i~ Block Number.
Parcel I.D. Number. D oo - oay
Page 1 /~~,✓oE x f. G/ re z- . 5~u-e r
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Page 3 ~EI~l7G i► q•✓~ . ~PEG~F~G ATio.✓ S
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Page 5
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Page 7
Page 8 A4G-rycN~E.~rs - Soi~ z-aw t u.f rio r ~El~oR r-
Page 9
Name of Designer. To, ,v A -A t- License Number:
Signature: Date: y- 9 - 0?0/3
Designed Pursuant to the Following POWTs Component Manual and Comm 81-85:
In-Ground soil Absorption Component Manual for POWTS (Ver. 2-0) SBD-10705 P (N. 01/01)
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POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page ! of to
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner
6~Y J E SS/cA AOE~C Septic Tank Capacity 1W60 gal ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
L✓/ESEs ~.rC,cerE
DESIGN PARAMETERS Effluent Filter Manufacturer ~6S r ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model l,L 1D ❑ NA
Number of Public Facility Units J$' NA Pump Tank Capacity gal ~O NA
Estimated flow (average) ~(160 gat/day Pump Tank Manufacturer ❑ NA
Design flow (peak), (Estimated x 1.5) `pp gal/day Pump Manufacturer ❑ NA
Soil Application Rate gal/da /ft2 Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit dNA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) 5220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODr,) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L ❑ NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Ys 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: ❑ month(s) (Maximum 3 ears) ❑ NA
3 ear(s) y
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: ❑ month(s) 3 C' year(s) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: W month(s) ❑ NA
❑ year(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) XNA
❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) ONA
❑ 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 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.
START UP AND OPERATION Page-4-,of lv
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
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
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 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 z6,e; Name oH~ ~~1 E`1eE
Phone 7lS" C7.1 A?LC / Phone - C W - Sd641
SEPTAGE SERVICING OPERATOR (PUMPER) - LOCAL REGULATORY AUTHORITY
Name Name 4! lMlx Z4,11i r4 DfE~C~
Phone Phone 71.5' J9 3 46 80
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
Page of
STARTUP 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
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
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 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 O PSI` Name yTovnJ ~~~1,r El,KE Lu~l.~/~~ .
Phone 7/S G7.~- ,1L6 Phone ..SS C o7 - ~'dLG
SEPTAGE SERVICING OPERATOR (PUMPER) - ~,✓,L'/11G~J~./ LOCAL REGULATORY AUTHORITY
Name Name Z/&/x- ze.-dl e DfLiG~
Phone Phone 71-5- JBG - fVd 80
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code.
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer O-
Mailing Address
Property Address Zcn 4 e ~o
(Verification required from Planning & Zoning Department new construction.)
City/Star ow" ei+- r Parcel Identification Number
LEGAL DESCRIPTION -E &"(Ik-f
Property LocatiorjQ/'V, 5.'1a , Sec. ! 7 T _a~ R,( W, Town of A,-
Subdivision Plat: L6 /mss cso C > Lot
Certified Survey Map # , Volume , Page #
Warranty Deed # q-7 F q q3 (before 2007)Volume , Page #
Spec house OyesFerio Lot lines identifiable Oyes[]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 §SPS. 383.52(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.
llwe, 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 Safety And Professional Services 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.
1/we certify that all statements on this form are tlue 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 ecorded 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. 04/12)
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Tx:4127469
978943
THIS DEED made between DCCI Land Planners Inc., a , BETH PABST
Wisconsin Corporation REGISTER OF DEEDS
("Grantor") and Cory Sander and Jessica ST. CROIX CO., WI
Sander, wife and husband, as survivorship marital property,
("Grantee"), 05/20/2013 3:53 PM
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: 212.70
County, State of Wisconsin: PAGES: 1
Recording Area
Name and Return Address
Lot Twenty-four (24), Plat of Meadow Ridge of Troy, in the Township
of Troy, St. Croix County, Wisconsin A,;R,-V bV Or ~ A?.d- -5/C,--4-
Q0V vitke~ W1 5u5/I3
Prk id- we :5
040-1310-00-024
(Parcel Identification Number)
This is not homestead property.
Dated this 17th day of May, 2013.
DCCI Land Planners Inc
Corpor to N me
=h.R. ck
ensS ret
STATE OF WISCONSIN
ST. CROIX COUNTY
Personally came before me this 17th day of May, 2013, Ronald L. Derrick, President, and Michael R. Stevens,
Secretary of the above named Corporation, to me known to be the persons who executed the fore oin nt
and to me known to be such President and Secretary of said Corporation, and acknowledged that the~sv
foregoing instrument as such officers as the deed of said Corporation, by its authority. 0 B
i
JEFFREY >ryy
THIS INSTRUMENT WAS DRAFTED BY J r Wi ams ' s
Michael R. Stevens Jy
OCCI Land Planners, Inc. Notary Public St. Croix County, Wiscor> ;F~F +O~~'r
PO Box 445 My Commission Expires: March 27, 2016.111% WISC
New Richmond, WI 54017
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W)sconsin Department of CorrWM41 e t SOIL EVALUATION REPORT Page 1 of 3
Division of Safety and Buildings '
In once Comm 85. Wis. Adm. Code
County
Attach complete site plan on paper than 11 incp 1 St. Croix
include, but not limited to: vertical and point" ire~cbon a Parcel I.D.
new a.~ ...dw . .r. _ . r.Mr ..4 1 Wn_b w n rod --A
mease pnnr an imonn on.-S E FP 2 1 2005
Personal information you provide may be used for secondary p rposes (Privacy Law, s. 15.04 (1) (m)). W31-64r
Property Owner ZONING n a
DCCI Land Planners Inc Govt Lot 1l4 SE 1/4 S 1 T 28 N R 19 E (or) W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
1505 I4WY 65 24 Mendow Ridoe Of Tmv
City State Zip Code Phone Number ity village ■ own Nearest Road
New Richmond WI 54017 ( ) East Cove Road
New Construction Usee Residential / Number of bedrooms 3 to 4 Code derived design flow rate 450 to 600 GPD
Replacement n Pudic or commercial - Describe:
I Prant mat nal Loess over elacial till Fhxxi PWn alavatinn if anniirAhla -A . it
General I
comments 5' s s- . 5 lca.~t;d•~ ca.~-e._ - and recommendations:
a`
~i n swing
E] pit Ground surface elev. 941.92 ft. Depth to limiting factor >90 in.
Soil Application Rate
Horizon Depth Dominant Coloij Redox Description Texture Stricture Consistence Boundary Roots GPDN
in. Mums ou. Sz. Coat color Gr. Sz. Sh. 'EW1 'Etf#2
1 0-13 10yr3/2 sl IfW dsh as 2f .4 .6
12 113-38 I l ju-AId I - I Is I oco I dl I cw I if I .7 I 1.6 i
3 38-90 7.5yr4/6 - Ifs 0sg dl .5 1.0
I I I I I I 1 1 1 1 I I
F2]Boring # Borng 930.87 >140 ✓
El Pit Ground surface elev. ft. Depth to limiting factor in. [Sod Application Rate
Horizon Depth Dominant Redox Description Texture r Structure Consistence Boundary Roots GPDW --y
I in I u. . ,.n I au R, r• m "r inr I I n r S, qh ~ I I I 'FfNI I `FIM I
1 0-8 10yr3/2 - sil 2msbk dsh as 2f .6 .8
2 8-15 I 4/4 - sil Imsbk dsh cW if .4 .6
3 15-24 10yr4/4 - Is 099 dl cw _ .7 1.6
21_lnn 7 1 6
4 r..~yi4,v - s vag ~ - -
' EfrWnt #1 = BOD. > 30 < 220 mWL and TSS >30 < 150 ffn& ' Effluent #2 = BOD_ < 30 ffxi& and TSS < 30 rwlL
r _ST Narrra IPLVAMP Printl - - _Sinnah ira r =RT Nh Wr*W r
Thomas C Nelson ~T FkI44 - ~kC n/6% / 1,J 44ow 227387
Address Date Evaluation Conducted Telephone Number
1432 120th Street, New Richmond, WI 9/18/05 715-246-2454
d
Property DCCI Land Planners Inc Parcel iD # Pending Page 2 3
Boring # pig Ground surface elev. 934.92 ft. Depth to limiting factor >138
in. Soil AWlication Rate
Horizon Depth Dominant Colorf Redox Description Texture Structure Consistence Boundary Roots GPDff
I I in. I Munsell I Qu. Sr- Cont. Color I I Gr. Sz. Sh. I 1 I I -Eff#1 I -Efr#2 I
1 0-8 10yr3/2 - sil 2msbk dsh as 2f .6 .8
2 8-16 1 4 - sil lmsbk dsh ew if .4 .6
3 16-25 Ipyr44/4 _ is Osg dl cW - .7 1.6
25-141 -r c....A rF nom.. 17 1 c
-t - - - - $ ..erg ua - -
i i Boring # ouiif~y \ 1~►)
U U Pit vrwrw sunacz arev. rtVl_ \4~1 w mrrmng rauvr 'n Soil Horizon Depth Dominant Color Redox Description Texture Structure Consistence
Boundary Roots !GP!DW;
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -EfI I ~ I I I ! I I ! I
I i i i i 1 I I 1 I i I
F Boring # Boring spit Ground surface elev. ft. Depth to limiting factor in.
Rate
Soli Application
Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPD/W
I in. I Munsell I Qu. Sz. Cont. Color I I Gr. Sz. Sh. I I 1 -Eff#1 I -Etf#2
- FM wM 91 = ROn > 3n < rm rwtA and Tc:Lq > An < 1.rn rmA - Ffld twat 22 = Rnn < an rmA and Ti4R < -V) mnA
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.
sen-ssaora,pe.arroo)
DCCI LAND PLANNERS, INC. SOIL BORING \ ' •
Lot # 24 -MEADOW RIDGE OF TROY =1
♦ BENCHMARK i
SW 1_/4 OF THE SE 1 /4 OF SECTION 17 o LOT"
•
-TOP OF CONDUIT • LOT tl
<
T28N, RI 9W, TOWN OF TROY, ST. •
CRODC COUNTY, WISCONSIN. ALT BENCHMARK \ / * R
-TOP OF CONDUIT
TOM NELSON CST - Lic. # 227387 N NOTE: THE CONTOURS IDENTIFIED
ENVIRONMENTAL BY DESIGN ARE PRIOR TO CONSTRUCTION.M
CONSTRUCTION GRADING WAS IN
1432 120TH ST. PROCESS DURING SOIL TESTING. , •
NEW RICHMOND, WI 54017 CONTRACTOR MAY NEED TO
ph. # 715-246-2454 CONFIRM FINAL CONTOURS LIT m'
DURING INSTALLATION. •
SCALE IN FEET 1 • JIV •
OI
1100 0 100
941.63
co ~
B1
® .92
39.8
09 .75 ~i
82 •I•
N. 4 .0
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3 ~
93 .5
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ks,