Loading...
HomeMy WebLinkAbout040-1322-02-000 1 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. CfOIX I!i Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 563895 0 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Pilne , Mark & Laura Troy, Town of 040-1322-02-000 CST BM Elev: 1 160 Insp. BM Elev: BM Description: Section/Town/Range/Map No: G ~6 19.28.19.2166 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER, 3 N. 16 CAPACITY STATION T BS HI FS ELEV. Septic Benchmark ~c 16 9.S /fib Dosing J ' Alt. BM ZS /os ~i! 3. Bldg. Sewer 7-77 166 , V rr.` 6 Zataty-- A- ioa Holding St/Ht Inlet Xl i Z4i TANK SETBACK INFORMATION St/Ht Outlet TANK TO ~ L WELL BLDG. Vent to it Intake ROAD Dt Inlet Septic A- #6 Dt Bottom 1 Dosing 40 - Header/Man. 33 165, 0 Aeration $ Dist. Pipe 3.3 /d Y• 9 Holding Bot. System 14. Final Grade PUMP/SIPHON INFORMATION Z.3_3 • O /44 061 Manufacturer G c c) L C GPmNtand St Cover a 5 • Model Number P / Z5. 5 TDH Lift Friction Loss System Head TDH 211 c7 , 7 15•Z(t Forcemain Lengtq Dia. If Dist. to well L(p Z (/'c - SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of TyCf~ches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid peQ_th DIMENSIONS 16 46' 9L„J( SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type stem: , ) UNIT O Nl~j^~ Model Number: \ DISTRIBUTION SYSTEM Header/Manifold istribution / x Hole Size x Hole Spacing Ven Air Intake ipe(s) 0-6 Z Length .~~Dia IOZs Length Dia /J Spacing 3,331 v SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/S )dded xx Mulched Bed/Trench Center 17 7 Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: ~~7 / 3D/ /3 Inspection #2: Location: 374 Peaceable Hill Rd Hudson, WI 54016 (NW 1/4 SE 1/4 19 T28N R1 9W) Troy Overlook `0,7 Loth k" Parcel No: 19.28.19.2166 GnJ.,~ G / 1.) Alt BM Description F.JL4,. = G Ti C~ Jtb 2.) Bldg sewer length = Ito 01, fVsvis -amount of cover Plan revision Required? Nfl Yes No /A ) r ~l Use other side for additional information. V / 1 ~V SBD-6710 (R.3/97) Date Insepctor's nature 41 Cert. No. Plot Plan page 6 00 Propany Owner MM- ~ 1"= 40 Legal Description t-o7 z 212-0\1 0v'e2 LD0L {accept where noted) N VJ VE aF -r- t17 'A 1 = Backhoe Pit IT?101, 5-F e7,p x :Ads North cm t s~ SJ 4 lr Site Location: v County Safety and Buildings Division l 2e3 o =201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) a S K Madison, WI 53707-7162 /6 3 9'7!5 o State Transaction Number Sanitary Permit Application 2 Z S 2 in accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit erent than m~ i gaddress) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if Vc-c4cp-a the Department of Safety and Professional Servies. Personal information you provide may be used for secondary 3~ oses in accordance with the Priv Law s. 15.04 1 m , Stats. I. A lication Information -Please Print All Information Parcel # Property Owner's Name rp` 9 Property Location Z 1 / Property Owner's Mailing Addres S V r < 0 Govt. Lot C i © T R ~A K.5- 2S 71-A , t City, State Zip Code Phone Number' <C0 0 NIw Section N~ (circle one T N R II. Type of Building (check all that appl Lot # y) Subdivision Name qi4 or 2 Family Dwelling -Number of Bedrooms ~ e r I ~ L~ ~tA Block # V ❑ public/Commercial -Describe Use O Q ❑ City of CSM Number ❑ Village of 11 State Owned -Describe Use / Town of :E III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. P~New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued B. ❑ Permit Renewal, Q Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Owner Before Expiration ' IV. Type of POWTS System/Component/Device: Check all that apply) ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade )&Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersaUTreatm t Area Informatio : " Design Flow (gpd) Design Soil Applicatio te(gpdsf) Dispersal Area Rire (sf) Dispersal Area Propos (sf) System Elevation d g;3 1I Z1 101115 8 ank Info Capacity in Toof Manufacturer 2 c U Gallons Gallons Units New Tanks Existing Tanks 77 o w G4 ~ T~ ~a. U in H v7 w C7 a, Septic or Holding Tank v © ,C7 ~J`e0 wl C Dosing Chamber / J~ / < < S VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. PI ber's Name (Print) Plumber's Signature MP/1@R8 Number Business Phone Number 494 -Z(o lu er's Address (Street, City, State, Zip Code) L~5-6-- L yW 6-1~z 4 C10 ( ~ o l VIII. Coun epartment Use Only Permit Fee Date Issued Issuing ent Sign proved isapprov even Reason for Denial $ Od / 3 DL Condi easons for Disapp 'dval is Septic tank, effluent fitterind wl t5 p G(`wa,. ~-r dispersal cell must all be serVlCes / malnta1 w as per management plan prodded by'plurn*. 2. setlock requlrett►ents rlluct, be 1Ywh tii"o as ' coQe ror~nals. " Attach to complete plans for the system and submit to the County only on paper not less than 8 L2 x 11 inches in size SBD-6398 (R. 11/11) tirART~lE DIVISION OF INDUSTRY SERVICES ' yti~j NT p~ 3824 N CREEKSIDE LA o / 9 HOLMEN WI 54636 j ` f >V Contact Through Relay S www.dsps.wi.gov/sb/ 9y~ P S cw ~wSD www.wisconsin.gov Q c A~OFESS1or:a4'~ q Scott Walker, Governor ~,3 Dave Ross, Secretary June 27, 2013 ST ooy'r'() Q%AV CUST ID No. 224832 ATTN: POWTS Inspector MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 06/27/2015 SITE: Identification Numbers Mark & Laura J Pilney Transaction ID No. 2259621 374 Peaceable Hill Site ID No. 791974 Town of Troy Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. NW1/4, SETA, S19, T28N, R19W Subdivision: Troy Overlook; lot 2 FOR: Description: Three Bedroom Mound System / 5% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1433734 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), Pressure Distribution Component Manual - Ver. 2.0, SBD-10706-P (N.01/01, R. 10/12); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code curio requirements. APP No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, ~LL OF stats. PROFESSIO p~~ The following conditions shall be met during construction or installation and prior to occupancy or use. D~ ~w'01V OF IND Reminders oe el • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. SEE • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • A copy of the approved plans specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department which may include local inspectors. MARY JO HUPPERT Page 2 6/27/2013 ` r Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 This Amount Will Be Invoiced. (Vera!dZM Swim When You Receive That Invoice, POWTS Plan Reviewer, Integrated Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jerry.swim@wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly q,•, Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed ' b~yPS Chapters 360-366. MARY JO HUPPERT Page 2 6/27/2013 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Industry Services reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 250.00 0era Thi s Amount Will Be Invoiced. rd M Swim When You Receive That Invoice, POWTS Plan Reviewer, Integrated Services Please Include a Copy With Your (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal. jerry.swim@wisconsin.gov WiSMART code: 7633 cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Industry Services (formerly Safety & Buildings) will be modified. Code references with prefixes starting with "Comm" have been replaced with "SPS" to recognize the relocation of the Division of Industry Services from the former Department of Commerce to the Department of Safety & Professional Services. Additionally, all IS (formerly S&B) codes have been renumbered 0 k' and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed aA0A'% b PS Chapters 360-366. RECEIVED ` JUN 1 0 2013 INDUSTRY SERVICES MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: MARK & LAURA J. PILNEY Owner's Name: same Owner's Address: 372 Milwaukee Road Hudson, WI 54016 Legal Description: NW 1/4 of the SE 1/4, S 19, T28N, R19W Township: Troy County: St. Croix Subdivision Name: Troy Overlook Lot Number: 2 Block Number: NA Parcel I.D. Number: 040 -1322 - 02 - 000 T101VALLY Qauu-V V- D Plan Transaction No.: SAL SE AND Page 1 Index and title JAL RVICIES Page 2 Data entry USTRY SERYICes ~o,~o~tllltlt►r1111►A~„ii Page 3 Mound drawings Page 4 Lateral and dose tank * Page 5 System maintenance specifications Page 6 Management and contingency plan ©N'~ENC.,F • ; _ - Page 7 Pump curve and specifications r Page 8 Plot plan ILLS r /~~f~~"OV11T7fi►Dilitlli►i»~~U`~`` Designer: Mary Jo Huppert License Number: 1859 - 007 Date: 06/06/13 Phone Number: 715 - 426 - 1775 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both SSWMP Publication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01) Version 7.0 (R. 03/2012) Pagel of 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) I Residential or Commercial Design Note: Sand fill (D) calculations assume a I 300.00 Estimated Wastewater Flow (gpd) Table 383-44-3 in-situ soil treatment for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal coliform of 36 inches. 450.00 Design Flow (gpd) 5.001 Site Slope 103.10 Contour Line Elevation (ft) 24.00 Depth to Limiting Factor (in) 0.40 In-situ Soil Application Rate (gpd/ftz) Distribution Cell Information 45.06 Dispersal Cell Length Along Contour (ft) = 10.00 Cell Width (ft) 1.00 ~ Dispersal Cell Design Loading Rate (gpd/ft2) IL -A--11 Influent Wastewater Quality 1 or 2 Are the laterals the hi hest omt in the distribution_ Y Pressure Disribution Information network? Enter Y or N (C or E) " e Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation (ft) 3 Number of Laterals of the highest point. _ 0.156 Orifice Diameter (in) 2.75 Estimated Orifice Spacing (ft) = 9.38 ft2/orifice 2.00 Forcemain Diameter (in) _26.00 Forcemain Length (ft) Does the Forcemain drain back? I°~ Y *C0:0 Pump Tank Elevation (ft) Enter Y or N 4.55 System Head (ft) x 1.3 4.24 Forcemain Drainback (gal) 5.69 Vertical Lift (ft) 41.58 5x Void Volume (gal) 0.38 Friction Loss (ft) 45.82 Minimum Dose Volume (gal) 0.00 In-line Filter Loss (ft) 25.85 System Demand (gpm) 10.62 Total Dynamic Head (ft) Lateral Diameter Selection Manifold Diameter Selection in. dia. options choice in, dia. options choice 0.75 1.25 x x 1.00 1.50 x 1.25 x 1 x 2.00 1.50 2.00 x 3.00 x Gallons/Inch Calculator (optional) Treatment Tank Information ; Total Tank Capacity (gal) i__.._.__- , 100_0.006 Septic Tank Capacity (gal) , Total Working Liquid Depth (in) Wieser_ L0 T._ Manufacturer _ _ gal/in (enter result in cell B49) Dose Tank Information Effluent Filter Information 600.00 Dose Tank Capacity (gal) IPolyLokw_~.,_____...._ ..I Filter Manufacturer 16.76, Dose Tank Volume (gal/in) 525 Filter Model Number Weiser___y Manufacturer Project: MARK & LAURA J. PILNEY Page 2 of 8 Mound Plan and Cross Section Views 1/10 B :::::::::::::::::J Observation Pipe I ' . . . . . . . . . . . . . . . I* K. s.}+.++$,r.::r.:.r.r.r.r.r•r.r.r..r.r,;°..:•::,,`.•`r.r:r.r,r,r,r.r.r.;.}.f;3 :f • 11eti.1.1.1 1°S-'.•1aye1 11. L.S.1:1:'u:• 1+L 1 1 1~ 1 1•° 1 11+ti 1• 1.1+1.1• r=r•r•. r•r'r•r-r•r-+•,r:r.t.:❑ r.r.r.r.r:f r.r..~.s.. °r.P.r:}.r :.r r•r.r^r A • '.,1.'~.M1. 1..°.S.S.S.1..e.1."..1..0. 5 :.1..•.1 '..S.i.1..~.1.°..1.1.S.L.S:4:•~-• .v+1,-+.5. ' r•1•r. r.r.r.r. r.r•.".r+r.r•r r.r. r.r.d'•r .r. r.r.r.r.r.r•r.r.r.. r. r.r• r=,A..°°•• Z•1 1.1• 1+1.1+•.'1•''•1•'.•S•1.1+ 1.1.1.1 i'1'•.•1.1•°.'1°1.1•'.•1.1°S•1+°.•1° 1"1=1*°.. r•r •r•r•l+r +r'r•r•r •r +r•d•r•r•.'•r.r.r.r.r.r.d•."•r.."+r ..+°.r.r.r•r.der.rnr.r.r .r^T r^.^.r,r.r • 4.5....1••,.1.4....5....".....1e".e..,i.'ti.S.'w.S.'L.L.S '4.1.,...+.^n.S..e,.,..-..+•Le...1.1..°+1.'L.'..°n..~.'S.S. W 1. B I . . . . . . . . . . . . . . .'.~i~l•.•.'.'.•.'.'.'.'.'.'.•.'.'.•.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.'.•.•.'.'.'.'.'.•.'.'.'.'.'. L Mound Component Dimensions Down slope toe extension made. ft A 10.00 ft E 18.00 in H Aft ft K Aft B 45.00 ft F 9.25 in ft L ft D 12.00 in G 0.50 ft J W 450.00 (ftz) Dispersal Cell Area 1125.00 (ft) Basal Area Available 10.00 (gpd/ft) Linear Loading Rate 4.50 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Aggregate Dispersal Area Finished Grade 105.87 (ft) 0 ..1.!!llr...... • H I = F Dispersal Cell 104.60 (ft) Lateral 104.10 (ft)-► - Invert Dispersal Cell Elevation D 4 4 ' 103.10 (ft) Contour Elevation 5.0 % Site Slope Geotextile Fabric Cover Shading Key 0 Dispersal Cell See lateral details on 1 Topsoil Cap ° 1.5 ft rjJ+r•r•r.r•r•r=r•r•r•r•r=r+r Page 4 for number, size, ® o 1 .1+1+1•'.•1'1=1°^+.1•+„',+1.1. ❑ ~ Subsoil Cap Z 0 j and spacing of laterals. . 4,1%1? 4.4 ' ::4::;. ASTM C33 Sand 1 r•r.r1 : r=r.r•r Laterals are equally lu tir/r,.r.ayr"r°r F Ilu• I _P '4:grr spaced from the Tilled Layer H 0.5 ft Tvpical Lateral r'r°r.r 'vi 1.1+1*Y1~w+".-'.+`++1r distribution cell's Aggre9 1: 1o1n"o+L 4•Sa .°.•".,1 ate d' o ~ •atir:~".~ti?:~~~,a~~~~~sn~+m~~~~'.r ••r• •r•.'+ ° •r•r+ •r•r• .r=r centerline in the A distribution cell (AxB). Project: MARK & LAURA J. PILNEY Page 3 of 8  Plot Plan Page 6 ofd Property Owner 1"=4Dft. Legal Description (-oT z, -moy Qver-Loor,, (except where noted) `/y of TtaE 5~- 'f ~ N w , 5 ! -11 Tz8lg 17104 O-PM a~ 13 = Backhoe-pit North Fo,F0 3 3~TJZ.ooM CG F3/ P 1A)F-IC O Op'9 0 3~~o~ t0 i x,31 z _ !ZI fi~ + Site Location: 00 U s31b1's5 a _ ~ ~3'li'vn sne3al N `5sg rN o I b/I 3S 3H1 30 b/I MN 3H1 !O 3413 1SV3 r s ° e (,04.80£L X-8) ~ o wW~~ ~6 ,99'90£L M "£b,9Z.00 S Y`~ - ,bf'OfZ ,96'O6f ,OZ'9LL mw Gym 56 F °O \ W I .as / ~y pNw 9 u; a _ o z I iy Fop `A. b V i vi ° N 03.15'37'• W 303.92' I F a p Z~ 109.19 m I v E- W- of \ \ a~rv W 2~0 ~5 m ~,sL Ip y~o 1~-11 iGS I \ z W ~ •ry ~ ~ N 1fi'28 j9i n x c~ .a Z° v': I I',~, v vwi W H W J I -u u- j fV m I .a w W w N 01'45 24 W - 2 I N r o SN o -27754- < 00 w a O o I o I F °n a I m .sL W - z \ I N >;ke g x ;:o l I \ in / so \ s_3 05 -Z a z ml 1 l a I 'm ,L'9LZ Z . o ¢ L---- - 1 II^I CDC W N 02'29~56_W 238.a6_ II I I Da I ,`\a\ pm °F C < o I O ° \N I \ ® O;_ 5. 1 i~II ° O^ O U W ^ z N 04'3807_W 277.79 , ~ ~ ~e\ t• ~ ~ ~ ! - \ _ ^ I Na I / 3/~~\ F% r 50.1 m O co o C'I I / 2^/ O~"m' \ Sy\ 3' m.. cc cc n~~ I Foa F omo I Itr°i E,y - - _ - _ _ _ _ I m so'ol io•\`J\II\ XL L6 - J z p WI\. 1-.\ _ _m, `x rv_ JIZ p u w Z 4L09 3 „f V.6Z.LO N .L6'OLL z\ \ ^ \~11 zwo r s 1~ S6£ 3 „fb,6Z.10 N I 1~ \ N 00'50'46" W 203.67' \ \ z V'v ! k - Sl 'd 'b84 "70A M,.9~,/.i.00N' 'V'211 ,1099 4 d3d j„ AVMHDIHbHN/72I J(i•- !O 34/7 AVM-30=1HJIN A38315V3M.,. ..I)'. 'v DQ °Zl 'o.~l 1 S./ ,f99S9Z o i 1V ,L4.9££ 3 XII 6Z LO N - f " 9ZN (a a n 'v 3NIl 4/L H11105 H180N dir. - - - - - - - - - - - - m w ° Q~ 02I i TT ~~TT/-~ o _ s "3" avod !1 W 1V.11 0 ~ A1NnoD N/107 10 3 N77N3IN3,1 1N3J - - - a~arrn ~aai o jig os gz m3 a m\ m\o al° z ° s € 15 ~ _ fo o m~ w~ffi °2g- za`w> wa C6 vri s~ r °g Q° °ma„a ao O A Y. z~ z ~?o~ Svc _z ~owFa o ° ° ao zS_' Q dz ° ~ v~wi3o - oZZ aY-0 0 p Z~~ vwi3 aw=-CZ¢- O a a0 ~Wy~1vZxZi ~ry Q~~ 7 OwV'~ j- °30 m 3as&3o w az xoil+viS 'x-3F Ch z z S^» Wes Y xs p o Nm ~Oa> z w a ° r- °Oaaz ~N?xcwi o~~a° FZw m .,3 z wo'-^Fw- ~°-per°a a'noz'aQ osp U U ~zl z F Z<1 01 ~u mwo m~6"6'~ Q-. oz ao a zz ° a z °o~am0 W F am.°--'_a of w~~op oN^ Gax CP:. WQ1 2 I 1'~9=~z C1. o io i E ~oaoa~ F Ana Wpm avian ~vwi Wno~ -4 E 0 E5 o F'E wz F w ~°m a wx ° a ~~o-01. i W ~ac°>°zw wra°~- 2°o -1 ~Ua °z z vaz '0 w m a W z~Q z< o¢a W mv0i~ozw Noou°i c°i~a a q 0 Fom a zs ar oam .n O oo waJ n '°a O zw~ ' O°n _ - _ Fv'ni a " rc z z Nz F f po - aw u° W wo NA'R~ O a fL% zzvwi~a n'v n~ ooJ4 Cs. w d o Z J. OvOH A1tin0-- - rv a ° o ¢ ¢ 'x^ a J ° Q m,- w ¢ ° n w rn uxi0 U z2 m x ¢ W mom°QO~ wi%~Q W mmwo oz uxsa inazLl ax O J 3 w ¢ auwrz3 ¢ oowi E.6 mF, a ooh .a ti z - I mF-°N N > z wz - LK azs waa F wo ~'^~n t/] v~wiw °r~z P.q .a q'^ IQ i ¢ ¢ ocx.1 ~>a z °°-°o° a zw z mW ,Z " z o w. ~a° R'+zaz ox~ W w0 ro F > o'oz - vi wa'^XF'^UF~ L]1' oazwo C7 pz¢a' p _iMa i~ rr. avxi~ W f/L ° U] c1a 08/11/00 FRI 13:12 FAX 715 386 4686 ST GRX CO LUNOG WJ V U• ST CRaIX IC~~ AGREEMENT SEPTIC TANK AND OWNERSHIP CERTIFICATION FORM ownedBuyer -77 Mailing Address v s 1 l/ property Address (Vcrificatioa rrqu from Planning D artmeat for new construction) Crf Zia b. Z20 Parcel Identification Number City/State EGAL DESCR~TIO//''N'' ~ Town of Sec. L2, ~op~ L,,atioaAf See- L2, 2 Lot # vim- t Subdivision Volume _ .Page # Certified Survey Map Z Volume Page # Warranty Deed # Lot lines ideatifiable;& yes ❑ no Spec house O yes lFrno SYSTEM MA TENANCE rrmature failure to handle wastes. Proper mainteuan improper use and maintenance of your septic system court result m its P a lie eased pumper. What you Out into the system coal of pumping out the septic tank every three years or sooner, if neededby can affect the Enaction of the septic tank as a treatment stage in the waste disposal syst- ed by the owner and by a form., theoa sisite gnwastewater disposal system The party owner agrees to submit to S, Croix Zoning j)gwt teent . a certification insrt0rplumbcr.Io='gtaAp1=bcr; m~nctcdplu:nbcr or a lreeasedp~Pa tic task is less than 113 ful of sludge. Of necessary). the s~P is in proper opt condition and/or (2) afttr inspection and pumping r with the etaadards Vwe, the undersigned have mad the above requirements and agree to ~ the private sewage disposal system mortification d mast n the D completed eat of Natural to soma s.State of Wisconsin and returned to the St_ Croix County Zoning Office within 30 set forth, heroin, as set by the D nt Of Commerce stating that your septic system 1{as days of the three y~r tion data. L / DATE SIG OF CANT OWNER CEIt ICATION our imowledge. I (we) am (arc) the owner(s) of I (we) certify that all statements on this fo ty are tare to the best of of Deeds Office. the property described above, by virtue of a warren deed recorded in Register PATE SIGNATURE OF APPLICANT at.«~fkf revoked by the Zoning Departure resented may result in the sanitary Pelt being Any infor=tion that is mis-tcp - eation: a stamped warranty dad from the Register of Deeds office warranty decd 00 Include with this appt'e a copy of the certified swaY =p if reftxeaoe is made in dz 8107365 State Bar of Wisconsin Form 1-2003 Tx:4084757 WARRANTY DEED 967826 BETH PABST Document Number Document Name REGISTER OF DEED ST. CROIX CO.,.w THIS DEED, made between Troy Overlook Development, LLC, a Wisconsin 11/19/2012 3:29 P limited liability company EXEMPT#: NA REC FEE: 30.00 ("Grantor," whether one or more), TRANS FEE: 225.0 and Mark A. Pilney and Laura J. Pilney, husband and wife, as survivorship marital PAGES: 1 property . ("Grantee," whether one or more). Grantor, for a valuable consideration, conveys to Grantee the following described real estate, together with the rents, profits, fixtures and other appurtenant interests, in St. Croix County, State of Wisconsin ("Property") (if more space is Recording Area needed, please attach addendum): Name and Return Address / Kami Telschow Lot 2, Troy Overlook, Town of Troy, St. Croix County, Wisconsin. J Alliance Title 7380 France Ave South 4250 Edina, MN 55435 File #09484 Reference Address: 374 Peaceable Hill Road, Hudson, WI 54016 040132202000 Parcel Identification Number (PIN) -This is homestead property. (is) (is not) Grantor warrants that the title to the Propertrtyy is good, indefeasible in fee simple and free and clear of encumbrances except: Roadways, Easements, Restrictions, Encutnbrances, and Rights of Way of record. Dated November 12, 2012 Tro O ook Devejppffi- t LLC a (SEAL) (SEA ) * Thomas Patnode, Governor/ ief Financial * Renee Patnode, Governor/Chief Manager and Secretary * (SEAL) (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) M►N W-SUTR Vadm, W1911 am TRUIN08 I-SATE OF WISCON&P4- t authenticated on ) ss. R&C State of Minnesota 1 i COUNTY M Commission E ues It311Z \Ij * Personally came before me on November 12`h, 2012 , TITLE: MEMBER STATE BAR OF WISCONSIN he.abo a-n ed~~ .D~ 1 Lw ChD (if not, t +;(1 • ~1 ~ OA~~ authorized by Wis. Stat. § 706.06) to me lkn a pers (s wh executed t 9e foregoing i stru we e he-s THIS INSTRUMENT DRAFTED BY: Redmon Law Chartered*(Richard Lau) 401 Second Street, Suite 200 Hudson, Wisconsin 54016 Notary Public, State o Wisconsin My Commission (is permanent) (expires: (Signatures may be authenticated or acknowledged. Both are not necessary.) NOTE: THIS IS A .STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. 1W"NTY DEED . O 2003 STATE BAR OF WISCONSIN FORM NO.1-2003 * Type name below signatures. Dq 8 t-I p_eTj¢. N 70'. 4U.. «NC.C TI TL Wisconsin Department of Commen SOIL EVALUATION REPORT Page I of 3 Division of Safety and Buildi in a ante with Comm 85, Wis. Adm. Gi unty. ST. CROIX Attach complete site pn not less than 81/2 x 11 inches in size. Plan m st include, but not limited to: vertical and horizontal reference point (BM), direction ParXQ. 040 - 1322 - 02 - 000 percent slope, scale or dimensions, north arrow, and location and distance to neare~trrcio Please print all information. S1. 77iewe < Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1~P*go -1 3 Property Owner Property Location . MARK & LAURA J. PILNEY Govt. Lot NW 1/4 SE 1/4 S 19 T 28 N R 19 E❑(or)❑W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 372 Milwaukee Road 2 Troy Overlook City State Zip Code Phone Number []City Village ■ Town Nearest Road Hudson WI 54016 ( 651) 214 - 5765 Peaceable Hill New Construction LlseE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD 0 Replacement Public or commercial - Describe: Parent material glacial till Flood Plain elevation if applicable -ft. General comments Mound System 1.0 ft. sand fill 0.4 loading rate and recommendations: --~/Etf j -A- 'h ~ J yt a- Pgperty ddress: 374 PeaceabJ ill d ❑ Boring # ❑ Boring Q pit Ground surface elev. 103.86 ft. Depth to limiting factor 24 in. Sal Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDN in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-8 7.5YR2.5/2 sit 3fgr&abk mvfr cs 3vf-co 0.6 0.8 2 8-24 7.5YR4/4 cl 2fabk mfr cw 2vf-co 0.4 0.6 24-Isbr Horizon 2 has 40-45% rock fragments 2 Boring # Boring 100.16 41 E] Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-7 7.5YR2.5/2 sit 2fgr&abk mvfr cs 3vf-co 0.6 0.8 2 7-18 7.5YR3/3 sit 2fa&sbk mfr ci 2vf-co 0.6 0.8 3 18-41 7.5YR3/4 cl 2fabk mfi ci 2vf-m 0.4 0.6 41-lsbr Horizon 3 has 30-35% rock fragments. * Effluent #1 = BOD > 30:< 220 mg/L and TSS >30:< 150 mg/L * Effluent #2 = BOD < 30 mg/L and TSS 5 30 mg/L CST Name (Please Print) Sig CST Number Mary Jo Hu ert Hollister's Soil Testing & Design) n n VGA ?qwpe- 224832 Address ate Evaluation Co cted Telephone Number W9875 690th Avenue, River Falls, WI 54022 06 - 05 - 13 (715) 426 - 1775 Plot Plan for Site and Soil Evaluation Page 3 of 3 Property owner MARS. ~ LAuW -P' LN &-Y I"=40ft. Legal Description LOT z -MOY €wt10,L00K, (except where noted)- N VA of 1" SE-~/ ~51'?. T.ZSAJ -I;,' 117W -TbvM Or = Backhoe pit `rRoy, :5 CK,ok/X e-Ow"ry, wL---IC.DN--SIN North PR4Pps~ ~ 3 3~~~~M H~F~u NG STAKED BY D~J~I~R SR 4, 5~ 1"Fi \op, h~ y /P70 vmirz;-, I b. Kl ~P~ Site Location: N. v VVA _.l Visconsin SOIL EVALUATION REPORT #1973 Department of Commerce in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 Division of Safety and Buildings Steel's Soil Service Attach complete site plan on paper not less than 8%x 11 inches in size. Plan must County St. Croix 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. d y 13 Z Z GZ 6 / 6 Please print all information. Re ed By Dat u U Personal information you provide may be used w, . 15.04 (1) (m)). ~d 1716 Property Owner Pr erty Location Tom And Renee Patnode Go . Lot na NV/4, SE114, S19, T28N, R19W Property Owner's Mailing Address Lot Block # Subd. Name or CSM# 225 Cty Rd F 2 na Troy Overlook City State Zip ode STP (dlK J City F] Village Town Nearest Road Hudson WI 54 Troy Cty Rd F N New Construction Use: N Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial - Describe: na Parent material Limestone uplands covered by glacial till Flood plain elevation, if applicable na ft. General comments Mound design, system elevation 101.50ft based on contour line elevation 100.00ft. Minimuum 18 inches and recommendations: of ASTM33 mound sand. -F-1-1 Boring # Boring Pit Ground surface elev. 100.00 ft. Depth to limiting factor 18 /in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 1 0-10 10yr3/1 none sil 2msbk mfr cs ivf .6 .8 2 10-18 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 18- 10yr7/4 none =racturec Limestone na na na .0 .0 Boring # ❑ Boring Z Pit Ground surface elev. 100.00 ft. Depth to limiting factor 36 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftZ in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-26 10yr3/1 none sil 2msbk mfr cs lc .6 .8 2 26-36 10yr4/4 none sicl 2msbk mfr cs na .4 .6 3 36- 10yr7/4 none =racturec Limestone na na na .0 .0 * Effluent #1 = BOD 5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <.30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signatur . CST Number David J. Steel , 248956 Address Steel's Soil Service Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 10/3/2006 715-760-0347 SBD-8330 (R.07/00) Property Owner Tom And Renee Patnode Parcel ID # pending Page 2 of 3 T Boring # ❑ Boring ❑ Pit Ground surface elev. 98.90 ft. Depth to limiting factor 21 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10yr3/1 none sil 2msbk mfr cs 2c .6 .8 2 6-21 10yr4/4 none sicl 2msbk mfr cs is .4 .6 3 21- 10yr7/4 none =racture( Limestone na na na .0 .0 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2 II III * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Steel's Soil Service r STEEL'S SOIL SERVICE 3 of 3 David J. Steel Tom & Renee Patnode 994 200th St. CST-POWTSM NW1/4,SE1/4,S19,T28N,R19W Baldwin, WI 54002 Lic. #248956 Town of Troy, St Croix Co. Direct 715-760-0347 Troy Overlook, Lot 2 Fax 715-684-3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend N 1" = 40' = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe ❑ = Borings Boring Elevations BI = 100.00 ft B2 = 100.00 ft B3 = 98.90 ft B4 = 0.00 ft k- aCr 7~ ~ 6Z) ZONED. aGRI ULTCIRAL _ - NORTH LINE OF THE NW ~4 OF THE SE 1/4> I , S 89'72'18" ,1 85.54 - 1 + w N 00 47 3$ ` E 2.41'` $14; - I I T \ I 264.18' ° • 20 V S\ \ v \ { N I LOT 13 _ - , , :tom ~,2 owl- 222 - _ X3.36'\ \ I,OT 1 twr o b _ 1. \ y \ LOT too t co co - I I _ a, I LOT 10 \\N \ \ ~~s \ / f' CP1 CV MI LOT 11- - co { gyp= 75' 44 .3 00 ' 188.80-0 4 / 79.04' P EAST 267.84' - - - EABLE- HILL /LM 3 I - g3' EAST 267.84' 6~• Q5 ~ 85 71 ~ 162.95 19.17 o - QD s~ pg I OD 'z z ..126 • % cA_ ~ - s LOT Ito 0 i ;~~1 I CP NSERVA71ON r COD) 5 L I L6T