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HomeMy WebLinkAbout040-1255-10-000 CEIVED County t a� 4 Safety and Buildings DIRIOn"' v• R 2$ �� 201 W.Washington Ave.,P.O.BOX 7162 Sanitary Permit Number(to be filled in by Co.) a S Madison,WI 53707-7182 5� NIZY�DEVELOPMENT State Transaction Number Sanitary Permit Application N In accordance with SPS 38321(2),Wis,Adm.Code,submission of this form to the appropriate governmental trait u required prior to obtaining a sanitary permit. Note:Application fortes for state owned POWTS aze submitted w Project Address(if different thaw mailing address) the Depaztmeut of Safety and Professional Servies. Personal information you provide may be used for secondary j r� 6'r(Je) 4•�,D purposm in accordance with the Privacy Law,s.15.04(l m Stars. I ✓�5'1 L A tieation Information-Please Print All Intormatio Parcel# Property Owner's Name ) 3 a �.. Property Owner's Mailing s Property L ovation C , ' 3 9 b p2F.=Bly Iq Govt Lot Aipply) Code Phone Number /.�AJLt! 'l�. Section''ll .� trcie) V1 TN; R� orW ng(check all a L.ot# Subdivision Name elling-Number of all a V Block# ❑Pub lic/Commercial-Describe Use I X b S ❑Ci CSM Number ❑Village of ❑Stale Owned-Describe Use Town of III.Type of Permit: (Check only one box on line A. Complete line B if applicable) A. ew System Replacement System ❑Tmatment/Holding Tank Repla ent Only ❑Other Modification to Existing System(explain) 1z T) utoA s w ZZ-� CG.�.�N'woneher✓gel Permit Revision ❑Change of Plumber ❑Permit Transfer m New List Previous Permit and Date Issued Before xpiration owns rte Urn't onent/Device: Check all that a 1 I /J _Pressurized In-Ground ❑Pressurized In-Ground ❑At-(made ❑Mound>24 in.of suitable soil ❑Mound<24 m Itfte)�oil Ll ❑Holding Tank ❑Other Dispersal Compament(explain) ❑Pretreatment Device{explain) V LK- / ✓✓✓� V.Dis rs* Treatment Area Informatio Design Flow(gpd) Design Soil Appli Rate(grdsf) Dispersal Area Requu f) Dispersal Area Pro d(sf) V/, n VL Tank Info Capacity in Total #of Manufacturer o Gallons Gallons Units New Tanks Existing Tanks 's. C Septic or Holding Tank Dosing Chamber VII.Responsibility Statement- 1,the undersigned,ass ponsibility for installation of the POWTS shown on the attached plans. Plum 's Name(Print) Plumber' 1 aturc MP/MpRS Number Business Pboru N Pl �Address(Street City.State•Zi ) _ }• -7 VIII.County/Department Use Only A roved ❑ Petznit Fee[1 b D�atje ued Issuing Ag PP Reason for Dalial /I �I DL Cond pKgW0V*N$gM.easons for Disapproval Ul' I&Velope,,- pez✓�CLe Al,, ) 1.Septic tank,effluent filter and 3,� , dispersal cell must be serviced I maintained �yty� / /VIA.I rt �°n an n as per management plan provided by plumber. `l.b 1�-Q 2.All setback requirements must be maintained n I p (V a r- d6-r- s s pX-1 �e 1 1�1 co -apptE5ttach to complex plans for the system and submit to he County only on paper not less than 81a x 1 inches in six Q SBD-6348(R. 11/11) row County - ` - - y~ rrt fAArq; Safety and Buildings Division (5 Jib lD`cy, ,`f• 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to he filled in by Co.) 41- ~r7 Madison, Wi 53707--7162 a ' Sanita ~Y Permit Application State Trtmsac;tioa 1J 1n er In accordance with SPS 383.21(2), Wis. Adm. Code, submission of taxis finrn to the appropriate goy..((~ unental m is required prior to obtaining a sanitary permit. Note: Application Corms for state-owned 1'OW'f'S arL~rst - - - - the Department Of Safety and Professional Servies. Personal information you provide may be used for s rd to } Project ddress (tt dtl3creu~tt~o rnailirrg udd~e~~ OA~ _,purposes in accordance with the Privacy Law, S. 15.04(1 (m), Stats. .J. Application Information - Please ~'rint All Inc Property Owner's Name Parcel 1) I'roperry Owner's Mailing Address - - Dyes-~'l1~_~ Property Location Cei City, state Govt. Lot Zip Co/de~ / Phone Number / / I I. a of Ruildin - - - - - T _C~ ..Q_ N; R uvte on p g (check all that aPl►iy) - Lot a ApE W or 2 Family Dwelling- Number of Bedrocr Subtiivisio - - - ~ n Name Ok sad la.ti Blcrck 7/o c ` LI Public/Commercial - Describe Use _ City ot! State Owned-Describe Use CSM Number village of crwn of . ~Q Z tCJ I a 4- ZZ LZ C, L4 - ype of Permit: (Check only o e box on line A. Complete fine B if applicatble) A ew System - - ❑ Replacement System -E] 'freatment/Holdutg T' url Replacement Onll Other Modification to Existing System (explain) ❑ Permit Renewal ❑ Permit Revision Ll Change of Plumber ~J Permit '1'rarrsfer u Flew List Previous Permit Number and Date Issued IBefore Expiration Owner La:1a•_ I[V. Type ofpdWTStem/Component/Device: ----1.x1? y)------------------- 1 _ _ /t!~Non-Pressurized In-Ground C] Pressurized In-Ground u At-Grade U Mound? 24 in. of'suitabio soil CJ Mound < - 24 in. of suitable soil "at)S _ Holding Tank f❑ Other Dispersal Component (explairl)~ _ ❑ Pretreatment Device (explain). _ Dis ersal/Treatarent Area Information: _ - - - L/-- - DBSIgn Flow (gpd} Design Soil Application Rate( t) Disperse! Area Required (sf - T~ispc r al Area Propo ed {st) Systeft - VI. Tank Info Capacity in Total # nt Manufacturer - - Gallons Gallons Un its i 2 Sepic or HoldingTank Dosing Chamberp esponsibility Statement- I the undersigned as't to res onsibili for installation ui' fhe 1 UCV'[5 shown or, the attaclred plans. - l lumber's Narne (Print) - [ Plumb igltatare ---LL - - My/MFRS Numbers Business Phone Number z Ern, Plumber's Address (Street, City, State, Zip Code) VII Dun /De rartrnc nt Use Approved Permit Fee Date: Is ed Issuing A e Signature - n Reason firr Demia 475. do (P I o ~3 IX. Cond'i/Iteasona f'or Disapproval 11. 15eptic tir►k, effk tt filter tn7i& ! r{ P~ ~rd G w~ disperstf! cell must all rte services n as per management plan provided by'pk_xn_ber. 2. All setbaclc i ernenfs mx* [~Rk tr►eintai * is W 4 code / ordfn_ ire. j Attueb to camptete pleas for tLe system and subunit to the County Duly ua paper nut fns an 8 r/z s 11 inches in sue SBD-6398 (R_ 11/11) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 NW 1/4s 30 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/3/13 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 881.1/880.7 4' below qrade of tank, piping shall be Schedule 40. Road B ..M. Well is to meet all 30' setbacks required by Vents WDNR B-1B 0' 4% Slope 0 5 -1C 2-3' X 90' Cells with >3' spacing B-1A B-1E 20' 0 15 1 ST 25' B-1D Pro 4 Bedroom House 885' 884' Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area Scale is 1 = 40' 12" 5.6ft^2/pair of end caps Property Line unless otherwise 4' Long Grade at System Elevation noted 34" Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 6/3/13 Owner:Oevering Homes Location: NW1A NW1A S30 T28 N,R19W Lot 1 Troy Glen Troy System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet Signature License number #22 00 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 NW 1/4S 30 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 6/3/13 BEDROOM 4 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL * H. R. P. Same as Benchmark All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 881.1/880.7 4' below qrade of tank, piping shall be Schedule 40. Road M Well is to meet all 01- N~ L setbacks required by Vents WDNR B-1B 0' 4% Slope 0 5 -1C 2-3' X 90' Cells with >3' spacing B-IA B-lE i 20' 01 I 15 SI 1 25' B-11) Pro 4 i Bedroom House 885' 884' 2L Quick4 Standard Leaching Chamber ith 20.0 ft2 of Area Scale is 1" = 40' .6ft^2/pair of end caps Property Line unless otherwise Grade at System Elevation noted 34" Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.6ft 2 pair of end plates Finish grade elevation Typical Installation 884.5' Vent ACI Grade kent 3' 4" 3' X30/34 Septic Tank 5' Long 1 5' S' Long 3699 G rade at System Elevation Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A-881.1' B 880.7' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page_ of FILE INFORMATION- SYSTEM SPECIFICATIONS Owner ~ - _,__-Qe,7P✓_ Septic 1'enkCapacity /oZsS'' ❑NA Permit # _ -----T - . _ dal Septic TEnk Manufacturer L ❑ NA DESIGN PARAMETERf_ Effluent Filter Manufacturer -{-ca- ❑ NA Number of Bedrooms 4/ ❑ NA Effluent Filter Model ❑ NA Number of Public Faciliry Units - NA Pump Tank Capacity - NA j Estimated flow (average) Pump Tank Manufacturer ~ NA Design flow (peak), (Es(imated x 1.5) 4;2 al/day Pump Manufacturer _ NA Soil Application Rate.--- r al/da /ft2 Pump Model _ NA Standard Influent/Efflue.it,Quality Monthly average" Pretreatment Unit - - NA` Fats, Oil & Grease (FOG) <30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen I)emand (BOD5) _Q20 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland - Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfeeaion _ ❑ Other: Pretreated Effluent Quaiity A Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD5) 530 mg/L -Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) :530 mg/L *A ❑ At-Grace ❑ Mound Fecal Coliform (deome::tric mean) x104 cfu/100ml _ L1 Drip-Line fJ Other: Maximum Effluent Particle Size in dia. L1 NA Other: - - ------El NA Other: Other: A ❑ 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: - ❑-meont hCs) (Maximum 3 years) ❑ NA FSs Pump out contents of tank(s) When combined sludge and scum oquals one-third of tank volume ❑ NA Inspect dispersal cell(s) _ At least once every: L],monthfs) Maximum 3 ears NA - J earth; _ ( Y ) Clean effluent filter At least once every: - months s) -----A Inspect pump, pump controls & ailanrr At least once every: ❑ monthrs) ❑ year(s ❑ NA Flush laterals and pressure test At least once every: El month(s) 11 year(s) Other: NA At least once every: ❑ monthrs) Other - - _ ❑ year(s) NA INA MAINTENANCE INSTRUCTIONS Inspections of tanks and d spersal 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 Servii.ing Operator. Tank inspections must include a visual inspec:tio i of the tank(s) to identify any missing or broken hardware, Identify any cr.icks or leaks, measure the volume of combined sludge and stunt and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to cherk the effluent levels in the observation pipes and to check for any pondi of The ponding of effluent nr the ground surface may indicate a failing condition and requires thegimmedatetnoon the grounace. tification oftherlocal regulatory authority. When the combined ar,curni"tlatiorr of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents the tank shall be remove:( by a Septage Servicin O era of 9 p for and disposed of iri actor A canc.. with chapter Administrative Code pter NR 113, Wisconsin 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 S12 months, shall be performed by a certified POWTIS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of arn, service event. dl , 7-r y+ I 1 'a~'F'~i'~**4'j'-'f b4lh4F ~ > + 11, I t i F16 k. 1 I 1 1 .II I I II 1 r F~ I ` I I~ I + 11 1 ' t , 2502 AOP"~' 37 I ~.W+t}F W r I II ~L F 11 I k. ~ ! ~u14 r g M I: Page of START UP AND OPERATION For new construction, prior to use of the POWTS' check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a soptrage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surta-,e. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the disp , a sal cell(s) in one large dose overloading the cell(s) and may result in the koackup or surface discharge of effluent. To avoid this situation hive the contents of the pump tank removed by a Septacle: Servicing O»erator prior to restoring power to the effluent pump or contail 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 eliminatlon 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; f u t and vegetable peelings; gasoline; grease; herbicides; meat scrapE ; medications; oil; painting products; pesticides; sanitary napki 'Is; tarnpons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following step:; 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 rat by a Septage Servicing Operator. After pumping, a I 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 tc 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 meiy be installed as a last resort to replace the failed POWTS. O The site has nct 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 .I systems may be reconstructed in place following n:moval of the biomat at the infiltrative surface, Reconstructions r ..anstructrons of such systems must comply with the rules in effe(,t at that time, ~ <<WARNING>> SEPTIC, PUMP AND 07H:E-R TREATMENT TANKS MAY CONTAIN LETHAL GAS3ES AND/OF1 INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMS rANCES. 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 Name Phone -o?r - - Phone SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUy'HORITY Name Name c. W Phone Phone4 _ v This document was drafted in oornpliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. FILTER CARTRIDGE INSTRUCTIONS IlnlG alatirltn s•r ep x Dry It the Milani' case .antff the fend of t:hr outlitt pipe to ensuro it is Centered "today- the moccta,s, opening. If not, tilt)" either insert tnorrr Idpii into tit" tank through the outlet or soloatst wield (0lue) additional pipe uritu the outlet pipe. L ,rep a While Ums erase Is still try fitted uh ttfu outlet pipe, rr,easure, the longth of 40-Jncb pipe needed to bracla the filtrar to the tank snil wait if utilteing the uptional a:upplemantal swe support. If side support rnathud. Is nut utrfi,ctd, proceed to stall foul yr .p ~ For installations utill aq the pptianll supidemontal side support: soiuer t weld the % -ihelt pipe unto the filthe case. If ride suppurt Mathieu it toot utiliZAd, preesed UP step fW: ,J11 Solvent wbid the filter ease Otto the autFet tsi{re. Insert the filter cartridge into the Carle, pi'atisl"!p dawn until the filter !oohs Into the buttotri of this rare- 8 ilf a Vfi5 switch is u1Ih:ra:d_ insert into the filter and lock by turning Clockwise 90e, maintenance 1. 't'he effluent filter should be daisired every time the,%uptic tatrfc to serviced. 2. open the outlet access aparNlrg to inspect the tank Old 10tur, 6 5, raunlp the septic tank lcorrrpklW, y, nukiho stirs to rotridiln the sludyu 18yaa' oa the bettanr at this tair:k and not giant the scum and effiuunt, ,u 0_ once the eokrent level has bwon towered below the invert of tho nutlet pipe, ltratily putt up on the filter handle to dialodge this , cartridge from, the cos t,. 5, slide the rarirldele up antl at a: of the case ffrr Ciaatlbag, i;. rf a VIt5 switch curnnecteld to err mart" fs plittiarft, the swlti ll sfrould be rernoved by turninq tvuritbrclockwiso gill, gild deaurAd } with water only. t y. While holding the tyrrb'idpe on 6ts We (large flat surface f rrbru , ° ^t. • down) twat- the a cass opening, rirfse off this miltrklge witit watue A~. only, rriakirlg sure all sceptage: material is rinsed back Intu tare tank,. ' a. if VRS switch is utilized, rrepli4ce by Inserting intu filter- atiil P turnitrg dodcwise SO". t. ` li, arc'1. 9. Insert the itltitr cartridge back into the visa, presi:iag dnfiurrufttlf the filter Jocks into the bottom, of the case. ltl.lfapiace and secure the ucces:i ulrelllntl on the t6nk. r.,ir•+a.':.v:'','Ic ^ye;;4MI:VL':YKrti 't,4~. "r [it~t'41~:N:,2Ir~4.l WWW:beamn4tie.lcom i!t'J'"14 LMETIMS (653.458.3) 12 ~YYiU~i1i wM~rr~ rr~r +rwMwMM~ +M~rgN~ Y 4 S 89*44723" -ift l ' .60-001 ji"k " 2,502 ACRES 33 # 108#972 S-Fv i ~t ~•sR** k~ %A70p ~ xt+ zy +r M+ t ss ■ 89'052, 1$" 339.48' ST, CROIX C'OUN'TY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer___d!?JPac_ Mailing .Address 1 `-E 3 P r ,tit2 Ali - --2-~ c- r Property Address ~ rl, C9. - ~-CJ~ -----q--T. r i - ' Q (Verification require born Plannin Sc Zonmg.I)eparttnent for new constntction.) City/State Parcel. Identification Nttmbe-r LEGAL DESCRIPTION Property Location /ULJ % , AIv %4 , Sec. La T g N .R. ~ W, Town of' Subdivi.sian. .Lot # Certified Survey Map # - /'olu~rne l'<<ge Warranty Deed # volume l'a~e # Spec .house ye ito Lot lines identifiable ye: no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your, septic system could result in its premature failure to handle wi stes. Proper maintenance consists ot'putnping out the septic t,-uk every threw years or sooner, if needed, by a. licensed puanper. What you put into the system can affect the function of the septic talc as a treatment stage in the waste disposal system. Ownerr maintenance responsibilities are specified in. §Conrm. 83.52(1) and in Chapter 1). St. Croix County Sanitary Ordinance. The property owner agrees to submit to G31. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, ;journeyman, plumber, restricted phimber or a licensed pumper verifying that ( I.) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if nece,isitry), the septic tank is less than 18 full of sludge. I/we, the undersigned have read the above requirements and agree to inaintain the private sewage di.,aposa.l system with the standards set: forth, herein, as set: by the Department of Cormnerce and the Department of Natural Resources, Sate of Wisconsin. Certification stating that your septic system bas been maintained must be completed and returned to the St. (".roix t~ounty Planning & Zoning Department within 30 days of the three year expiration date. I/we certify that all statements on this for k are true to the best of my/om knowledge. I/we amlare tl..e owner(s) of the property described above, by virtue of a warranty iced recorded in Register. of Deeds Office. Number of bedrooms-' d z~FM(7_4 N' PLICAW NS) DATE - ***Any information that is misrepresented mayre;ult 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 cerfafied survey map if reference is made in the warranty deed. (REV. 08/05) qy ti N K~ {e In O ~f g~g'Wl G F 8 N FO IIIH m J ~W ~W 9i` Z S~ ~a mN oil SHE ~I i~~tT= Eff k J^C 1 i. o33 o O `~S `v oo ~~5 rn Q ¢ N Po ~'o u~i zg~g Q IR §x 1. 8 - I' --1---- C 1 . . r.,... 1 t-t I II. _ _ a i I I' i i:, i ~ I I M1 'f 1 I[ OI I f.. R I I I I I x I I I a I I 1 I 4 f i i ^I I•I- - ~ i~ t w J _ n.:., . . I 1 !B O I T- --T I .rtr .v I I 1 I T-T I 654 I :.I _ 'J a 1 I I A* 1 I• ® L J L J I I 1 I I lil I I I I aoie~emnu.uwwa~ ~ I yy I I I I ry ~85~ ~ _ I 1 I I I ~~3 ~ i I I b 1 1 I [a I 1 I- 8 e I rn,~nnr.., I I ~ 8 8 ~s .tom O ~ ~Y 3q£464~~ o O ; x Cggr~ a 5 } C cy ~ Q 'o z oig g 8 c 2 I Jill 131 w ~ 3 0 ~ N'J` WW Y ~ NZ m I I I I I I I I I . ~~3 I I 3E6 j I . 1 0 I ' z 4~ SI? u I ~ x a 7e ws " El ® ~9a i 8 a I -Q . RI I g' o o • ~g i X ~~j q33 ii 5; - " ~ § i 6Ix I i C~ ~ w,aaov,mn • V-4twonranoepa~ntollndusuy, SOIL AND SITE EVALUATION REPORT Page-/ of LaW, and Human Relauons Division of Safety & 8uddings in accord with ILHR 83.05. Wis. Adm. Code COUNTY Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to vertical and horizontal reference point (13M), direction and % of slope, scale or PARCEL I.D. # dimensioned, north arrow, and location and distance to nearest road. la1606 APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION R IEWEDBY DATE PR . PROPERTY LOCATION GOVT. LOT IV&l 1/4 / &AI4,S -TOT ZS .N.R If `Ej" W PR ! OWN S MAILING AODR LOT # BLOCK # SUED. NAME O 14 C1 ATE CO P NE NUrr~~ER []CITY ILLAGE OWN NEAREST ROAD K'Y P,o pQ New Construction Use Residential / Number of.bedroorrs I J Addition to existiq building j J Replacement (J Public or commercial describe Code derived daily flow gpd Recommended design loading rate bed, gpd/ft2 trench, gpolft2 Absorption area required ~S 7 bed. ft2 7✓r0 trench, ft2 Maximum design loading rate D. _7 bed. gpd/ft2 0- Strench, gpd/ft2 Recommended infiltration surface elevation(s) e,?Z. P /A//t , &4~5/.O lfl-Tft (as referred to site plan benchmark) Additional design I site considerations N! TiA z- c ,4z. T. = /Z ''A 7 S ' 8 /N17'6l96, To G esf- Parent material Gdj 4014Z- DUTGUl4.5~ Flood plain elevation, if applicable Al, - ft S . Suitable for System CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN FILL HOLDING TANK U -Unsuitable for stem 19 S o u I ®S C31-1 ES O U B[ S❑ U Os E u O S U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Texture Structure Consistence Bounidtvy Roots GPD/ft Boring # Horizon in Munsell Qu. Sz. Cont Color Gr. Sz. Sh. Bed Ttt3rK:h Ile B 9-L? /OY,e ¢ - G6si/ 3~~-b~ C w Zvi' D 5 •G Ground L~ Z? 3 ,PY - AGos Ora G~~ C'w Zl/-~ 0.7 .8 elev. 90 Depth to limiting factor Remarks- Boring. # /esdk Al w Zvi O,¢ D.S ,~qZ DY,e 51G 61V ZiOs64- ,15/f ~w Zvi 169, S O.G Ground WOW c ' Depth to limiting f - T 8, 1~ 2aVi NTy ti' Remarks: CST Name:--Please Print JAMES D. FILKINS Phone: (715) 42 7 ress: OGDEN ENGINEERING CO., 113 WEST WALNUT ST., RIVER FALLS, WI 540 Signadue: Date: 9• Z S f 8 CST Number: 222952 PROPIaRTYOWNER ~ie/G' .VZEi✓ SOIL DESCRIPTION REPORT Page Z of 'PARCEL I.D. Munsell Color Ou. Sz. Mottles Cont Color Structure Consrswrice Bo~>d3ry Roots GPOift in. h Dominant Boring # Dept FHornizon Texture I Gr. Sz. Sh. Bed ITrz ` o_g pylL Z /Z- / 0,04 d~ aw ,Slo•~ Oxsi4 dk C v14 ,S IO. $z-~¢ /oyx SG - /s csd,~ ~5~ ~w 3~F o•~ o. 8 Ground geWi•.~ft. Depth to Grrntlng factor Remarks: Boring # 7,w-sAe Gilt Gw /z-Z9 oY~ ¢ ~s /~s~,~ ds c Zvi D ¢ A!5 C/ q.s ye S6 _ ~S G~~► ~l qw Z~~ p.~ ~0 g Ground elev. z ~s oy~ s s.~ l - yr o• o, g $$3 ft. Depth to limiting ff1 7 Remarks: Boring # f~ a~Z /D /f 3/z / Zr~.sbk old ~w - D.~`o.ro r~ z ~s ysA le w Zvi le 9. ¢ D . ` ~ 26 DY2 ¢ ¢ a / Ground elev /doc e•7` D•8 r~ Depth to / limiting r~ J factor r/ Remarks: Boring # Ground elev. ft Depth to lirmting factor Remarks: 580-6330tR.0.5/D2~ • PAGE 3OF3 -SITE PLAN ~F~/C'if/j9A2,C, ?'oP D~ / " /,QoN ,a/,off= $86 , /Z 8-/B 8 /C ~O ® ® -14 3 ° 13v GAT T2o y c~~EN ~C ~A SCALE 1 50' / NOTE: DRAINFIELD TO BE A MINIMUM OF: 25' FROM / DWELLING; 50' FROM WELL; 5' FROM LOT LINE. I OGDEN ENGINEERING CO. JAMto' D. FILKINS, 222952 Civil Engineers & Land Surveyors 9Zs. S 113 W. Walnut St. River Falls. WI 54022 DATE: (715) 425-7631 Wisconsin Department of Industry, SOIL AND SITE EVALUATION / 3 L°abor and Human Relations Page of Division of Safety and Buildings in accordance with s. ILHR 83.09, Wis. M~ ~r Attach complete site plan on paper not less than 8 1/2 x 11 Inches in size. Plan must County S T 'n A - - Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. # 006- 3- 0_0 APPLICANT INFORMATION - Please print all Information. Revs by Date Personal Information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ Property Owner Property Location 1_X 06/L'E 3 101 Y 6U 061c-_ Govt. Lot 4AU 1/4 AJ1/4,S 36 T2-9 N,R /y E (or WD Property Owner's Mailing Address Lot If Block# Subd. Name or CSM# 3 3ai P1,4t v VHF w o,e • 145111 City State Zip Code Phone Number Nearest Road vii a Ct' Town Ril/~v S40ICt pis) 3P~ • SS7lc ❑ City El Egg O 'New Construction Use: residential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial -Describe: = Code derived dally flow Co 0~ gpd t 1,0 Recommended design loading rate bed, gpdNt2~tre4 , g Absorption area required bed, ft2 trench: ft~ Maximum design loading ratty' x bed, gpd/ft2 S trench, gpd/ft2 Recommended Infiltration surface elevatlon(s) s-~ ft (as referred to site plan benchmark) Additional design/site con rations 5.--- Parent material ✓$GS y ey1eIC'4,*YPT` 6/* 7-- Flood plain elevation, If applicable e ft S = Suitable for system Conventional Mound In-Group Pressure AT-G3 de System In Fill Holding Tank U = Unsuitable for system ❑ U LA'Sun El U L~ S ❑ U I D-6 E] U ❑ S [~'U ❑ S SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed ,Trench o is ~dYe 2-z s~~ ~fsh.~ w 6ie 3- i . Z ; . 3 z s • L io 2,1(5✓ die s 5 /3, Yx 31) Ground q , ; . S .3 13 ' /0 1 - SL 4W 5,& -6X c5- elev. _ .8 0 0 s Os d1V Depth to limiting factor Remarks: Boring # 1 e- 49-17 /d y l ~7GS`✓~' E57 / /0 Yk 3 X51; . G Q' /O ► 2 C 'f - J L #Shvie e 1 , S Ground .S elev. . y'~•-eft. G ds - - s Depth to limiting factor > 2-in. Remarks: CST Name (Please Print) Signature Telephone No. P 0 l3 7 Zl/d/fiG41r- eS- 3 e& • 819 5 Address Date CST Number y- -74- eSPtf ~2,q Ulbricht & Associates Private Sewage Consultants 655 O'Neil Rd. Hudson, Wis. 54016 GtN pRl s i /3. 4v o Gam- SOIL DESCRIPTION REPORT PROPERTY OWNER Page ? Qf PARCEL I.D.# GO GS,~J Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GVD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench 3 o~~ 16 ye 3/3 L /7e f ,AM ~e c s z /G /D lvie L lv"'rp cC 5 . . 5 Ground 6 -3 AQ Y118 4 l 0 f G/C, ,S i • 7 , ' g elev. ~j (P 3aft. /0 51- S Depth to limiting factor fin. Remarks: Boring # 17 )6 ! /6 R 311- 516. y CS - • L'•3 Ground ',S J L /Tsi✓ 7 J elev. fg-tt. 5 /0 ~ s CP Q ~ • ~ Depth to limiting factor ll ~in. Remarks: Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GrD/ft2 ille in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench Boring # /O - J~/L / S i G f • Z: . 2-7 31_ 5/(/ / 7 M.-G es* Z' 3 Ground /Q G L /T f~ /H^ 1"X e S 9S elev. - d • S - 3tt. /p S- Depth to limiting , factor In. Remarks: Boring # Ground elev. ft. Depth to limiting factor ..In. Remarks: SBDW-8330 (R. 08/95) L r 10 w o` ' O vJ 0 o ~ C c c i R 0 W w Q_ P 0,; goo c Q O's N ~ i y ci W / `I I ' Parcel 040-1113-90-000 07/25/2007 02:35 PM PAGE 1 OF 1 Alt. Parcel 30.28.19.469A 040 - TOWN OF TROY Current X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner O - MCGEE, LYLE LYLE MCGEE 321 PLAINVIEW DR RIVER FALLS WI 54022 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 313 PLAINVIEW DR SC 4893 RIVER FALLS SP 0100 CHIP VALLEY VOTECH Legal Description: Acres: 2.678 Plat: N/A-NOT AVAILABLE SEC 30 T28N R1 9W PT NW NW BEING LOT 1 Block/Condo Bldg: CSM 12/3264 2.678 AC Tract(s): (Sec-Twn-Rng 40 1 /4 160 1/4) 30-28N-19W Notes: Parcel History: Date Doc # Vol/Page Type 03/30/1998 575966 1309/559 WD 07/23/1997 787/496 07/23/1997 783/498 2007 SUMMARY Bill Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/21/2004 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 2.678 56,000 0 56,000 NO Totals for 2007: General Property 2.678 56,000 0 56,000 Woodland 0.000 0 0 Totals for 2006: General Property 2.678 56,000 0 56,000 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 00'0 00'0 00'0 lelol soBae4O;uenbullap se6je40 leloadS sluawssessy leloedS ;unowy AjoBaleO apoO leloedS jasn :slelaadS S~Z 43les :94ea uol;eol;l:paO :;unoO wlel0 :>llpaao Aiello-j 0 0 000'0 puelpooM 006'06£ 009'£6Z 00£'L6 669'6 A:pedoJd IWWOE) :9002 aol slelol 0 0 000'0 PUelpooM 006'06£ 009'£6Z 00£'L6 669'6 Aljadoad IeMOD :LOOZ ao; sle;ol ON 006'06£ 009'£6Z 00£'L6 669'6 L0 IVUN301S3~1 uoseab a;els Ie;ol anoadwl pue-l sway sse10 uol;dl.iosad b00Z/ LZ/LO :paBue4O ;set : suollen len 0 :4;Inn passessy :enleA;a)ljeW i1e3 Me ANdwwnS LOOZ 0M 699/60£ 1 9969L9 8661/0£/£0 odAl oBed/10A # ooa a;ea :i(ao;s!H lowed :sa;oN t,jr L/1 v7 M61-N9Z-0£ / (b/1 091 b/L Ob 6u~1-uMl-39S) :(s);oe.il p O`d 669'6 ti9Z£/ZL INSO :Bp18 opuoOp10019 £ 10-l ON139 MN MN id W L2J N9Z10£ 03S bL 61 3 9 ll`dnt! lON-b'/N :jeld 669'6 :seioy :uol;dl.iosea leBe-1 t~~ ~ cco17 a¢, Z41 H0310A k3-1-IVA dlHO 0010 dS SITdd 213/U2:] £69t OS 2j0 M31ANIV-ld LZ£ uol;dljosad #;sla adA.L iJewiad :(se)ssa.ippV A:pedoJd leloadS = dS IooUoS = OS :s;ola;sla ZZOV9 IM STIdd 2JgAl2l 210 M31ANIVId LZ£ 3300H 3-1)x-1 31.1 '33JOIN - O jaumo-oo Luaaano = o 'jaumo juaaino = p :(s)jaumo :ssa.ippy xel 0 00 adAl;lwJad #;!waad # uol;eollddy eajy sales # deW a;ea leolao;slH a;ea uol;eaa0 NISNOOSIM 'AiNnoo XI02j0 '1S X ;uenn0 .10211 :~O NMOl - Ob0 069b'6 L'8Z'0£ IaoJed III L =1O L 3E)Vd wd £s: L L LOOZ19Z/LO 00Z-06-UW0tl0 laaaed I n FILED FTi R0dE MA1' 2 8 1997 T>f H. W~ &4 ► ro; JUN --5 1997 sf~ ~ aeD►sterof fDeeds ST. CR 0IX COUNTY 560007 ti V SURVEYOR'S RECORD CERTIFIED SURVEY MAP BROOKE AND MARY WOLF Part of the Northwest 1/4 of the Northwest 1/4 of Section 3:0, Township 28 North, Range 19 West, Town of Troy, St. Croix County, Wisconsin. NW CO R. sec. 30,T28N,R/9W, NL/NE NWI/4 N114 COR. SEC.30, T28N,R19W, /COUN7Y BERN TS EN NA IL) UNPLA TIED LANDS /COUNTYSURV£YOR'SMON.) f~fl7~ R/E'A"S T) S89-45'07"E 2,506.62' PLC VI hj b 693. 1194.21' 66 131Z.37' /7,9/ g ~-693.84' 2/6.38' 2 7 N 89.32'50"W 11-94.14' 0 O ~ /00' M „ MO 15, ROAD SETBACK LINE H LOT LOT 2 0 .y O LOT 4 2.678 ACRES Z. 686 ACRES Z/. 000 ACRES //6,675' 0•//6;986 SO.F Q I 9/4, 77/ SO. FT. \ Q ti ti S0. FT.~ b Z. 502 ACRE 20.4 55 ACRES EXC. ROAD R.O. ` M q Z,100; AC. N h EXC. ROAD O.W. O O O b 89/ h h EXC. OAO .N ~ O/3 S0. FT. R ~ /08,999.' FT. O O ~ ~I R. O. W. p h O W Qwner's Add ess: /08,9/5 SO. FT. 2 a 321 Plainview Dr. / 1 v ° River Falls, WI S 022 2/5.84' •I ' ` 91" iron pipe 7 N89.407"W 432.21' JI 3 b ° i 3 found. m N 2 W= h h i h 0111 x 24" iron m b N N pipe weighing 3 ¢ DRIVEWAY / ~ M OI ° 1.13 lbs./llri. b N£OSV W \ ft. set. ti Z~Fence. OWELL a 3 h m R (10.00') v 0 e 3 Indicates i DPOOL ° - - - - a i previously Q P recorded data. O s£Pr/c O ~ 3 O CA = k b o W~ LOT 3 b m 9.699 ACRES \ Q ? WATER COURSE 422, 485. SO. FT. 3 Q Q 9.643 ACRES EX C. ROAOR.O.W. \ W O V 3 f4 M POND ELEV. 420,034 S0. FT. ` ~ U Z ~ - 3 W > i ~V\S£T8ACK LINE ? 00.00 w ZI 3 4 -ONO 0ELEf` BENCHMARK TOP P/Pf ASSUMED J 3 /D' 693. B2' ~ 495. 00' 91 N 89'45'57W IIdy2' S L INC NW I14 NW 114 h UNPLA TIED LANDS ,`~~t~~e~eeetr~yi W 114 COR. COR. SEC. 30, T28N, \ wO~~',I R /9 W, I COON TY SURVEYOR'S MON.) . This instrument drafted by Laurence W. Murphy LAU1131 SCALE / 200' W HY o .9 50' /00' 150,200, 300' 4 00' 300' 600' S 7 a ? :RIVER FALLS.,;' J~ . WISC. • Dated: March 20, 1997 ~p •LANQ•SJQ♦ "Revised this 21st day of May, 199 Laurence W. Murphy Registered Land Surveyor SHEET 1 OF 2 Vol. 12 Page 3264 ~'Wsconaln Department of Industry, 3 Labor and Human Relations SOIL AND SITE EVALUATION Page of Division of Safety and Buildings in accordance with s. 11-1-11 `183.09, Wis. S T G ^ Attach complete site plan on paper not less than 8 1/2 x t 1 Inches In size. Plan must County Include, but not limited to: vertical and horizontal reference point (BM), direction and percent slope, scale or dimenslons, north arrow, and location and distance to nearest road. Parcel I.D. If APPLICANT INFORMATION`- Please print alt Information. Revi by Tea D1te D Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ! v K~fs Ta Property Owner AA Y 6u aG~ Property Location , /,3iP06/CE , Govt. Lot IVV 1/4 /(/4/1/4,S 3d T Zg N,R /g E (or W Property Owner's Mailing Address Lot If Blocklf Subd. Name or. CSMlf 3a i P 1,4iv vIE w o~ CSM AEAjP/.JG~ Cl f State Zip Code Phone Number Ne ❑ ~a a Town 4 s t/0 16, r5 ) 3~jp ss7(o E3 City [f] New Construction Use: BResidential / Number of bedrooms 3 Addition to existing building ❑ Replacement ❑ Public or commercial - Describe: yS'e - Code derived daily flow Cv O gpd Recommended design loading rate bed, gpd/fl2 7 trench, gpd/it2 Absorption area required bed, ft2 trench, ft 2 Maximum design loading rate bed, gpd/(t2_-F-trench, gpde Recommended Infiltration dace elevallon(s) s-A-L Pr, 3 ft (as referred to site plan benchmark) Additional design/site conslder qns leek ~2~ ~~C you C-- V-0Z S ' Parent material SC 5 g[ ' 1304 !l0 T Flood plain elevation, If applicable N it S = Suitable for system ,Conventional Moou In-Grow d Pressure AT-"a System ,Inn,Fill Holding Tank U = Unsuitable for system U S❑ U 9S ❑ U lrJ s❑ U P S 11 U El S LU ❑ S awT SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure Consistence Boundary Roots GPD/ft2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed , Trench l / &-/0 /oye Z i - 5/G / -She i►r-r`V CS 1 ,?4- , Z : , 3 v o /G /0 GS /,w S c 'I 1 . -2: - bdo S r 7 •O Ground 3 (p ZS 75 yX G li~ /,yyr f, elev. Cj att. - i 5'/CL /~S ~ • CCs - ~ 2-' < 3 S /o S/CQ O G~ - . 7 Depth to limiting factor in. Remarks: Boring # OT /d 2 3/ 5L hICS r /wt-70~e Q S / • y ' z- g i~- /o le GS 140 S GS • 7-9 3 i--36 o ..S . 6 Ground X0 ill S s - ? , elev. Depth to limiting factor yIn. Remarks: ' CST Name (Please Print) Signature a ephone No. - P013tFVT- l/ 1fl/ -47- s 3e6,- 019 75 Address Date CST Number Ulbricht & Associates 1' r Private Sewage Consultant ` • ~ ~ 655 O'Neil Rd. Hudson, Wis. 54016p ORIGINAL r PROPERTY OWNER 13. SOIL DESCRIPTION REPORT Page `a■' PARCEL I.D.# GO 7- Y CS1 Boring Al Fiorizon Depth Dominant Color Mottles Structure 2 Texture Consistence Boundary Roots GVpjft In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 / o -`l Y/le z S/L /~~s lJr~ 4i fie /-/,c , z : • 3 2, /ay ev. 3 /o S/G Lfs /h-r f c s v~ . s . el "d C~ 3 o1~ft. I D ~13XU T s U S ,e ate' _ 7 4 0 tiiiXc SiL s ~r~ ' . z ' • 3 ~eplh to 11miNng factor In. d Remarks: Boring it / 0-7 io yif 2-/2 - 5iL i7Cs~e 4" c s / . z 3 z 7-16-1.0 9 3 40 io vle 3 - SZ- /ash 4vr-F as Y •S Ground S V • '7 'Z! elev. Depth to limiting factor 7 f6.- in. Remarks: tiorizon Depth Dominant Color Mottles Structure D/( In. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench Boring g ioY/e 2-l2- S!G 150cshk /Jr'Fie G' S - z : •3 ~--IPIOYX 5/3 Ground 5 2 : .3 .0 4& .elleev. It. 1/0 Depth to limiting factor f0 -i"' Remarks; Boring # Ground elev. tl. Depth to limiting factor .In. Remarks: SBDW-8330 (R. 08/95) r w jg i r y ~ 03 -Az- 515 ~ m c \ G w O.S ? 9p C am`s o ` ~ Q 1t o o~ w ~ `ri p ~ 1~ c °d 0 ~y Oo ~l N a ~ N \o ` y