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.
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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.
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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)
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~ 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