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HomeMy WebLinkAbout040-1308-00-166 County Safety and Buildings Division iAA 201 W.Washington Ave.,P.O.Box 7162 Sanitary Permit Number(to be filled in by Co.) na Sp ` rat Madison,WI 53707-7162 C� X's State Transaction Number Anawryermit Application N� In accordance with S 383.21(2),Wis.Adm.Code,submission of this form to the Pate governmental unit is required prior to ob ining a sanitary permit Note:Application forms for state-owned' S are submitted to Project Address(if differa►t than mailing address) the Department of Sa ry and Professional Servies. Personal information you provide ma for secondary ses in accordant with the Privacy Law,s.15.04(1 tn),Slats. I. Application Inf mation-Please Print All Informati Property Owner's Nar ie Parcel# Property Owner's Mai ing Address Property Location FLOC A� Govt Lot ` City,State Zip Code Phone Number •r T,4- V.,�_%, Sectio (circle one T N; R�EoOW II.Type of Buildin (check all that apply) Lot# Subdivision Name 1 or 2 Family Dwel ing-Number of Bedrooms dk OA C v.'S Bloc ❑Publie/Commerciai Describe Use ❑City of CSM Number ❑Village of ❑State Owned-Des vibe Use Ly Town of 4 C/ Z & e l w Z Z CL,. III.Ty (Checi only one box on line A. Complete line B if applicable) o.,- A New Sys te ❑Replacement System ❑Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System(explain) List Previous it Num B. ❑Permit Re al ❑Permit Revision ❑Change of Plumber ❑Permit Transfer to New Permber sued and Date Is Before Expim n Owner I stem/Component/Device: Check all that a 1 Non-Pressurized I round ❑Pressurized In-Ground ❑At-Grade ❑Mound?24 in.of suitable soil ❑Mound<24 in.of suitable soil 5 ❑Holding Tank C Other Dispersal Component(explain) ❑Pretreatment Device(explain) V.Dis ersabTreat ntArea Information: Design FIow'gpdV Design Soil Application Rate(gpds Dispersal Area Required(sf) Dispersal Area Proposed(sf) System Elevation i VI.Tank Info Capacity in Total #of Manufacturer Gallons Gallons Units New Tanks Existing Tanks ` 7 W U U y t.✓ (� �i �C►5 . oe a C7 y Septic or Holding Tank Dosing Chamber VII.Resp nsibili Statement-I,the undersigned,assume respo sibility for installatioa of the POWTS shown on the attached plans. Plum er' ame ) Plumber' Si MP/MPRS Number Business Phone Number - �- Plumber's Address el,City,State,Zip Code) VIII.Coun /De tment Use On[ Permit Feee Djate ssued• Issuing t Signature Approved isapp $ 7 �✓' / I�o I iven Reason'for IX.ConditVNM 0010OWeasons for Disapproval 1 �5epti tank,effluont filtar and disp rsal cell must all be servlces,l maintained as p r management plan provided by pluMber. 2 A#si tack tequlrements-must beffiainlWnid up qrs pplk 6tl3 code/ordinahcss Attach to complete plans for the system and submit to the County only on paper not less than 8 12 x 11 inches in size CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Nam( Owner's Na e: �2,),r� ��df�� / ' /��•JGR Owner's Add ess: Legal Descri Lion: __ �� r� tEC �� TSB.✓ u/ Township: County: Subdivision I,ame: Lot Number: /�f Parcel ID Nu ber: Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing Page 4 System Cross-Section Page 5 Filter Specs Page 6 Maintenance&Management Plan Page 7 Se tic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat DesignerlPlu ber: License Number. � �� 7/,�_________ Date / Phone Number yrpj- Z Signature Designed pursuz nt to the In-Ground Soil Absorption Component Manual for POWTS version 2.0 SBD-10705-P(N.01101). Page 1 183s�s -W �9r,JRry a Ap oc§", ..Q _W aye ,47 r3 � 'L 66-7 y $oil am2woton System Gross Section C _sg2j,/ ft Final Grade 4'Schedule 40 PVC Vent P" lath Vent ew � ` -�—ft Leaching --0. Chamber �' ft Elevation 3 ft Soil Qbsomdon Srrsteta Plan View q� ft ff } - Leaching Trench 9 ft Vent Or Observafion Pipe Cumbers OA, Er✓OS !'M' {C• Trench 2 Header Leaching Chmber/SR1292-10-00 Manufacturer And Model �,; 4"J'A" EISA Rating r�sq ft Per chamber Soil Application Rate gpd/sA ft gPd Design Flow -2 Soil Application Rate= EISA= Chambers 2 roves of chambers each. Page —Of P K IM INSTALLATION INSTRUCTIONS PL-5251PL-625 FILTER AwAft INSTALLATION INSTRUCTIONS Center later q with openfng J.SN- ,.,r"" Wit.? ;%• r�j:���7a '� ����s. � 0. v> y 1*t.IF ry ilk. {FU� }.• { a a; ' �"yl v✓ 13. %f N `-1x r n"i.•'�j � i_ rt { Y��+ aY}�y�`•3$• � J'��', ���j�s va'y; � ,y 's: ..4 J i �'.F ` ri '" �~v� iS 4�fi yai..�'_.r. �°"• Step 1: _ Step 2: Step 3: (A)Locate the outlet of the septic tank. (A)Before installation,place the (A)Glue the filter housing on the (B)Remov a tank cover and pump tank filter housing on to the outlet pipe. outlet pipe. If necessa V. (B)Make sure that the housing (B)insert the fFiter cartridge In the is posiitioned so the filter can be housing,making sure the filler removed from the tank for cartridge is properly aligned and maintenance and service. completely inserted In the housing- MAINTEI IANCE INSTRUCTIONS ,` k fia7 lc,., r Y 7{'*°�ita"S'' .� � V •a>•. � ' � �.lf,G, .. _ �}"'.r S!,.Y• � �:+ i s ��y���� ate' yet ! _� a •i`'�`a^:' y "'- .. ' '' 4°y'' `-`t' s.'i F >. a F <� sue: !-- �'�,t,.�'• ��,�� � .�`•�..• � r v Fr yy4 !F � .r-a?+T nor`• M n� � 4 5�.4fiS�S 2x �... �4 �` ! M .t`'1`7.2. ±Y'+'f'GA: .t/ 4`v.ih Sly. o-x Z;• F"-txyqr`!'�!' Step 1: Step 2: Step 3: Locate the o et of the septic tank. (A) Remove tank cover and pump (A)Insert the tiller cartridge back if necessary. into the the housing mating sure DO NO FUSE PLUMBING (B)Pull the filter out of the housing. the filter is properly aHghed WHEN F ILTER IS REMOVED and completely Inserted. (C)Hose off the Nor overthe septctonic SE- �`E Make sure all solids fail back into the (B)Replace septic tank saver. septic to tIVEiEI±I. Jt I 1 1L7"ER ::.. :.<..:.< POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page/a-of FILE INFORM ATION SYSTEM SPECIFICATION Owner Septic Tank Capacity ]ga o NA Permit Septic Tank Manufacturer o NA Effluent Filter M anufacturer o NA DESIGN PA ETERS Effluent Filter Model ❑ NA Number of bedr oms o NA Pump Tank Capacity al -e NA Number of Com nercial Unit 6NA Pump a Tank Manufacturer NA Estimated flow( vera e) gal/day Pump Manufacturer NA Design flow( e ), (Estimated x 1.5) dd gal/da Pump Model aNA Soil Application Rate -7 gal/day/ft' pretreated Unit Influent/Effluent Quality Monthly Average* ❑Sand/Gravel Filter o Peat Filler Fats, )ils &Grease(FOG) <3U ntl,/L n Mechanical Aeration o Weiland Biochemical O ygen Demand(BODs) <220 mg/L ❑ Disinfection O Other: Total Su pended Solids(TSS) <150 m Manufacturer Monthly Ave rage** Dispersal Cell(s) Pretreated Effluent Quality ❑ NA OIn-ground(gravity) o In-ground(pressurized) Biochemical O cygen Demand(BODs) <30 mg/L ❑ At-grade o Mound Total Su pended Solids(TSS) <30 � m - ❑Drip-line ❑Other: Fecal Colif (geometric mean) <1U 4 cfu/100mI. Maximum Efflu t Particle Size '/s inch diameter j values typical for domestic(non-commercial) wastewater acrd-septictank-ef luent. ** Values typical for pretreated wastewater MAINTENANC SCHEDULE Service Event - Service Frequency Ins act condition f tank(s) At least once every ❑months id year(s) (Maximum 3 rs) out content., of tank(s) When combined sludge and scum equals one third('/)of tank volume Inspect dis ersal c ell(s) At least once every ❑months s) (Maximum 3 rs) Clean effluent flit r At least once every_ ❑months 0 ear(s) Inspect pump, pui ip controls &alarm At least once every o months' o earls 0 NA Flush laterals and ressure test At leastonce every o months ❑ ear(s) us NA Other: At least once every ❑ months ❑ ear(s) js NA Other: At least once every ❑months o ears a NA MAINTENANC E INSTRUCTIONS Inspections of tar,ks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; vlaster Plumber Restricted Sewer; POWTS Inspector;POWTS Maintainer;Septage Servicing Operator. Tank inspections ust include a visual inspection of the tank(s)to identify any missing or broken hardware,identify any cracks or leaks, rr 5asure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface, The dispersal cell(s)shall be visually inspected to check the effluent levels in the observation pipes and to check for any pon ling of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition nd requires the immediate notification of the local regulatory authority. When the combin d accumulation of sludge and scum in any tank equals one-third(%,)or more of the tank volume, the entire contents of the tar k shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of fluent filters, mechanical or pressurized POWTS components,pretreatment components,and any other maintenance or monitoring at intervals of 12 months or less shall be performed by a certified POWTS Maintainer. A service report sl all be provided to the local regulatory authority within 10 days of completion of any service event. START UP AND OPERATION For new construct on,prior to use of the POWTS check treatment tank(s)for the presence of painting products or other chemicals that my impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanks(s)removed by y-a septage servicing operator prior to use. Page �11 of START UP AND OPERATION For new construct n, prior to use of the POWTS check treatment tanks) for the presence of painting products or other chemicals that may impede t e treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) rem ved by a septage servicing operator prior to use. System start up sl all not occur when soil conditions are frozen at the infiltrative surface. During power outa gas pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the ispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoic this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effli ent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or p k vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet dov fn slope of any mound or at-grade soil absorption area. Reduction or elim nation of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibio cs; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safe) 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 cant nts of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pun ping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravi 1 or another inert solid material. CONTINGENCY PL IkN If the POWTS fai and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement syst . 1 A suitabl replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system. rhe replacement area should be protected from disturbance and compaction and should not be infringed upon b required etbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wi result in a need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply m ith the rules in effect at that time. ❑ A suitab a replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technolo y a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluatioi must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be ir stalled as a last resort to replace the failed POWTS. ❑ Mound aid at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrativ surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNING>> SEPTIC, PUMP A D OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A PERSON FROM T E INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COM IIENTS i POWTS INSTALLEI POWTS MAINTAINER Name Name Phone _ Phone SEPTAGE SERVICIIiIG OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Name Phone Phone This document was d afted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f)and 83.54(1), (2) &(3),Wisconsin Administrative Code. to I ul Of Of if ON / / t .•. \ l / � r cot l { uI 11"I ST CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buy r Z Mailing Ad ess ,1s_� Property Address (Verification required from Planning Department for new constructs ) City/State lr'` Parcel Identification Number LEGAL DESCRIPTION, Property Lc mtion 1/%, _ '1., Sec. ,::- Tom$N- _W, Town of Subdivision G�� l h,— , Lot # ��6 Certified S irvey Map # . Volume , Page # -- Warranty Deed # Volume , Page # Spec house 0 yes [/no Lot lines identifiable byes O no SYSTEM b TE AN E Imps ruse and maintenaneeof your septic system could result in its premature failure to handle wastes.Proper maintenance consists ofpw aping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system can affect the 'unction of the septic tank as a treatment stage in the waste disposal system. The 1 roperty owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a master pt ,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewater disposal system is in proper op natirig condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge. Vwe,the undo 3igned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth,here as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin. Certification stating that yo septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30 days of the y expiration da e. SIGNATURE APPLIC DATE l(wc certify that all statements on this form arc true to the best of my (our) knowledge. I (wc)am(are)the owncr(s)of the prope 6 ribed above y virtue of a warranty deed recorded in Register of Deeds Office. G SIGNA F APPCL � � C�� /J a DATE i Any i iformation that is mis-represented may result in the sanitary permit being revoked by the Zoning Department.****** ** Include wi It this supplication: a stamped warranty deed from the Register of Deeds office a copy of the certified survey map if reference is made in the warranty deed 1= TP��. t3�.4rLQPAnENT ca iP CO�rn � N LOT 66)-TgoY \)t1..l.,P��,�'oulad t1eSJ , 5T. C.ROki � T"i ,V3 TOP OF w� es�tro� 166 61, s ape \ 38.44' _ f F k 1 6 Z 0 ,4 131666 6166A ELEV. 892.0 ELF 94.0 qs ' s s -,a96, �g4r' 6166C ® B16 7C ELEV. 897.2 �0i 201.42' ELE I. 895.1 �U.8 tY�-o8-c3 155 1. ACM ago AM rw sop �r�. a. s .arMr .ter "We 1 i • t 1111111111 IIIII IIIII II111 N IIII 8221664 State Bar of Wisconsin Form 1-2003 Tx:4181651 WARRANTY DEED 994367 BETH PABST Docume tNumber Document Name REGISTER OF DEEDS ST. CROIX CO., WI 04/03/2014 11:26 AM THIS DEED made between Tribella Properties,LLC EXEMPT*: N/A REC FEE: 30.00 ("Grantor,"whether one or re), TRANS FEE: 157.50 and Davi I J.Elzin a and Catherine E.Elzin a,husband and wife as PAGES: 1 survivorship marital property ("Grantee,"whether one or more). Grantor,for a valuable consideration,conveys to Grantee the following described real LHudson ng Area estate,toget r with the rents,profits, fixtures and other appurtenant interests, in St Croix County,State of Wisconsin("Property")(if more space is d Return Address needed,pleas attac a endum): alley Abstract&Title osford St. Suite 201 Lot 166, Pl t of Troy Village Sixth Addition in the Town of Troy, St. WI 54016 Croix Cou ty,Wisconsin. 00358 040-1308-00-166 Parcel Identification Number(PtN) This IS NOT homestead property. (is)(is not) Grantor wary is that the title to the Property is good,indefeasible in fee simple and free and clear of encumbrances except: Easements strictions and rights-of-way of record if any. Dated Ap ril l 2014 LORRIE L. DEMARS Tribella erties,LLC NOTARY PUBLIC STATE OF WISCONSIN (SEAL) *Jose It 1 wicki,M anagin Member (SEAL) (SEAL) * AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF WISCONSIN ) ss. authenticate on ST CROIX COUNTY ) * Personally came before me on April 2,2014 , TITLE:AMBER STATE BAR OF WISCONSIN the above-named Joseph Klewicki,Managing Member of Tribella Properties,LLC (If no to me known to be the person(s)who ec tt t• oregoing authoi'zed by Wis.Stat.§706.06) instrument and knowledged the THIS INSTI 1,UMENT DRAFTED BY: /=6rrie .DeMars Fran Iverso /Notary Oblic,State of consin 1200 Hosfojil St. Suite 201 Hudson WI 54016 My C fission(`' anent)(expires:March 20,2016 nowledged. Both are n ) (Signatures may be authentic ed ckot necessary.) NOTE:THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED ©2003 STATE BAR OF WISCONSIN FORM NO.1-2003 Sfybarabh i$943&Page 1 of 1 1 1 , Cal A 04 Lu ---.-+ ,— - SSrrdmu T13QN `---a ,../ •-----+ ~; T- 1 1 fZAI097 S-400M!m MON39 1 ' n �Nnvm t r i ! Sod a� I;f i zJNnl37 aMd01s 'O o Z'ra m Swaii N00,1=1.o _ MWV2M QNVH cn 1 , { ; tit L _ _ _ _ _ _ -j � I ----------a , i 1 f ----------- a 1 1�1 •--^ ---a i -- ------------- ---------' {. 1 1 i l � U 1 IR' 3 m ° ; 1 , , i 1 W t t t ! 1 1 1 1 1 1 1 1 1 C +{ t n 4p t 1 ) 1 LU 1 1 r _ 1 1 � �u • n ' 1 t 1 1 1 i t 1 1 , 1 1 ! N 11(18 O Nl-111t1s3 t 1 1 t t 1 e t �- ------- ------- ---------------- ------------------ ------- -a E Wisconsin De partment of Commerce SOIL EVALUATION REPORT Page_ l of 3 Division of S Sty and Buildings In accordance with Comm 85,YVis. Adm. Code County ST,CgDt Attach tole site plan on paper not less than 8 112 x 11 inches sizo. `,C I include,bu not limited to:vertical and horizontal reference point(B ),dir I V E anal D. _��f✓L percent slo e•scale or dimensions,north arrow,and location and stance to nearest road. Revle ed by Data 1)Please print aN information. (J( � 9 2� 3 Personal to rmaaon you provide may be used for secondary purposes(Pr ecy Low.1.15.04 )(mil• - Property Own 1? y�p-1 y T E ifa_SE 1f4 S .2-1{ T X1V N R20 w Property Own is Mailing Address Lot a Block# Subd.Nance or CSMft I JU100 A5F-kJDFgA ST N c sua-� g oo loo(, — TRH I v k Lt-A G E Lo',K ARIL* . City State ZJp Code Phone Number, ❑City ❑Village ®Town Nearest Road d1.At)- 4 49 i 10)757-7 "tYZD i L AJD5A ROAD New Cons ruction Use:&Residential!Number of bedrooms Code derived design now rate_ SP�.Q _GPD ❑Replecome it ❑ Public or(xxnmercial•Describe: Parent mater LJZIA;5&/ A LL—r,--U lA L Flood Fish elevation if applicaoie General com gnts and recomma datlons: C0)JL1 SJ M`l0A1AL �JJ-!oKOUIN p -MrOlP1C ';ZS 0,-7 LOAD%rJG, F-4TE Bon g ❑ Boring y� pit Ground surface elev.���—ft. Depth to Ilmhing factor 7 COL in. (cation Rate Horizon D opth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDRf n. Munsed Ou.Sz. Cont.Color Gr.Sz.Sh, 'Etfitl Eftff2 L ��-M d5 d.5 0, Z L -(a djoix d--4, O-W -M •S .3 3 lurt2 P mAb d5 M D,S o.9'f 1 &5 o 3 — I W - 0, I.Z Z � dl — 0.7 I, Z t � I BorinC g ❑ Boring 1W Pit Ground surfn-ce Slay. •z ft. Depth to limiting factor q� in. Soil ' Imlion Rate t Horizon D ipth Dominant Color Radox Description Texture Structure Consistence Boundary Roots GPDOIF t n. Munseli Du.Sz. Cont.Color Gr.Sz.Sh. 10#1 Eff#2 I :� Z 5_q 0,4 2lz — L -m abK A rnJ r1n 0-5 —0-8 I ; 3/� — L K d Z - -: 0•� f-( 1435, ' '1 3JL 5 1 v - 0--7 I,Z S y 4/ i 5 101L( 0.1 1 4 � ► IlEffluent p1 -BOO >30<220 mg/L and TSS>30< 150 mg/L 'Effluent#2-BOO _30 mg/L and TSS<30 mg(L e J 1 CST Name i lease Print) Signature CST Number it nl 0 HO t-L ST E ZZ 4 9 32— t Address Date Evaluation Conducted Telephone Number j t W9g�5 69C�'ApE, RIUE P,,FADS WI 54 02- Q-��a3 C."?►5 142.6 1-1 7S ' P"dOPERTY OYVNEii e L -SOIL DESCRIPTION REPORT Page?—of 3 P11RG8.I.D.X M�jJ� CoK� FROM. OIR1coWPt�— BOrz1IJGS LCT IL-46 CpMPt�TFD B4 t zws FIW<EA s,Oezp_,) ENCJ1JEEk1N6 Oepttt I Oom�nant Color � MotUes (Texture I• SWcwre I=±18019cw GPO/ft' Boring Par Horizon in. Munsell C L SL Cant Color Gr. Sz. Sh. Root Bea iTi rC" 75 . A 0-11 _ 2fsbk mf gw 3vf 0.5 10.6 B1 11-17 LOYR 4 --- sil ( 2msbk mfr Ics 2vf 0.5 10.6 ('iOUM B2 17-28 7.5YR 4/6 I --- gcbsl I2m-csb mvfr cw 2vf 0.5 10.6 gyp. C1 28-52 10YR 6/6 --- s IOs ml cw lvf 0.7 0.8 869.8tt pow to C2 52-83110YR 6/6 -- gs JAJ/9 g ml --- lvf 0.7 0.8 �4 tsaot .2- 831' Rem Bonng# 2vf 10.5 0.6 1 10YR 3/2 --- sl I1 msbk mfr Igw 27 0 lOYR 3/2 -- sl 2m—cs mfr cw 2vf 0.5 0.6 4 lOYR 4/2 --- sil 2msbk fr cw lvf— 0.5 :0.6 Graxd ay 6 10YR 5/6 --- sil 3mabk mf i cs lvf 0.5 0.6 (87 4.5 ft 166-72 1OYR 5/ --- gsl lcsbk mfr w Ilvf 0.4 0.5 to �rtMUng 5 .5 ' 4/6 --- s Os ml --- lvf 0.7 0.8 N�Ctt3t > 85" Ib�ES Rena Horizons Al and A2 appear to be fill Pa�tj T V q Z' Bing I A -9 �OYR 3/3 I --- 1 (2msbk (mfr law 2vf-fl 0.5 0.6 3 31st B -16 OYR 4/4 --- Cl 2msbk mfr cw 2vf .4 0.5 Cl 6-43 �OYR 5/6 --- s Osg ml Is lvf .7 0.8 60pth C2 3-80 OYR 5/6 --- s Os ml --- lvf o l Gnuting tam 80" Rem Boring# A 0-9 10YR 3/3 --- 1 2msbk mfr aw 2vf4 0.5: 0.6 332: B 9-12 10YR 4/4 --- sl 12msbk mfr cw 2 0 Ground C 12-84 --- - Slev. i1 893.Stt Iigro >ta' i `P Rom LONTI iv NS�L MBA-:W PNIENT LID / cou '1 ,vJ�SCOnI51 ,/ (. ', M = 7AP OF TKO\A 5T. CRD�X \ t'Rpti f�fs w� P�t�xrto� g A) Wa �r �o 38.44' 166 Z N • J8 i B16 6A B16 B 0 94.0 EL X892 C-2 /a96i ® B16 C 5 8166 2- 201.42' . 88 •4.5 7) `.per`' 1 Lo l� -a8-cam CQ►JTI �TL ��vPnti Cod. / y0 LOT 161, TKCM V I L Lj. C;e, TWA) Sk-.CIAO o X cQ i\M, v.� ,_ - SMAt Pi r'FS Qt-��. 166 61, 38.44' %' S A r' VY-P 167 T: Z o W � O J .v O N N a N O ° Z Fx 81678 B166B ELEV��0 ELEV. 890.2 4� ,8 B 16�8A .gg� 8_ 1�6C ELEV 887.4 ® B 167C ELEV. 897.2® ® 218.15' ELEV. 895.1 V�- o9-oT-c5 L PROPERTY OWNER CU1MQt1U't'tC- 'Z�kl, . SOIL DESCRIPTION REPORT Page Z of 3 PARCEL I.D.# Tie Np)/V G Borin # Horizon Depth Dominant Color Mottles Texture Consistence Boundary Roots Structure GPD/ft in. Munsell Qu.Sz.Cont.Color Gr. Sz. Sh. Bed Trench Z ll-Zy l�`7R 3It. _ si I 2-►M Sdk CA eS — •S • 6 Ground 0 %% - .`1 •S3 elev. Depth to limiting factor `' ! fo�I' t Remarks: B� ng # - s � sic/ — S :?i Gt, OSS o�1 •1 . Ground I elev. �q�•l ft. Depth to -- limiting factor ob" i 1 g Remarks: o�r g # 3 _ ,. ::::., o_lo t��t�Z �Z G� s, 1 Z`�sb1Z �S�1 cs — . s • b r Z Io�ZZ 0-1 31 1 S!) Zvn SUh. 3 Z�-1p9 �.S Y2 3 t ,. S r# G►- U S � o�1 — .1 •� Ground elev. 8965 ft. r Depth to limiting factor i. >1 Oct Remarks: 3oring# around ;lev. ft. )epth to imiting actor T—I Remarks:_ Wisconsin Depart nt of Industry, SOIL AND SITE E V A L U AT f I R E P 0 R T Labct and Hum Relations Page of 3 Division of Safety&Buildings in accord with ILHR 83 05yWi9, Adm:Code COUNTY f ST• caZ u�k Attach complet site plan on paper not less than 8 1/2 x 11 inches in sizg'PI'sti must in"etude,txtt; not limited to ve tical and horizontal reference point(BM),direction and�o-of slope,scale or PARCEL I.D.# p�-►�p LN r dimensioned,n rth arrow,and location and distance to nearest road. 3 APPLICANT I FORMATION-PLEASE PRINT ALL INFORMATION REVIEWED BY _ DATE PROPERTY OW1 EER':SMAILING PROPER . Lt�CATtop fnR 1AT Cb>J-~,1 N �c��1.LjpwA T or sE va sE,J/4,sZ4 T Z-8 ,N,R 2.o Ef w PROPERTY OW ADDRESS. OT# BLOCK#' SW.NAME OR CSM# .m. 1�U�N.�. *t- i3� ........ .....:.. �'R�`� U l l.\.R'G E L�'► CITY,STATE ZIP CODE PHONE NUMBER I ❑VILLAGE [MOWN NEAREST ROAD B�-.rvw - f-t fv S,S 4l�14 f ) Q-oY �ttiOStM f'cp [}I New Constr iction Use Residential I Number of bedrooms [ I Additi n to existing building L j J Replacemen [ I Public or commercial describe TTU��6T Code derived da ly flow 60o gpd Recommended design loading rate - bed,gpd/ft2 $ trench,gp ft2 Absorption area squired S 58 bed,ft2 1 SO trench,ft2 Maximum design loading rate -, bed,gpd/ft2 - trench,gpd/ft2 Recommended i ifiltration surface elevation(s)690-S GtV32 4 -nt1 /'-kh?3) ft (as referred to site plan benchmark) Additional desig /site considerations S EE rQ0'T' 'TO I ti 5'Ttrta;.f`2 f�N �}- G� 3 Parent material Lo QSS ovC1L GLA-c i},-c.. 0 JV-/"N Flood plain elevation,if applicable N A ft ru=Suitable for stem 7EMINS'VENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK =Unsuitable f s stem D U ®S D U 91 S D U f�S D U Pas D U D S IOU U SOIL DESCRIPTION REPORT ��r n # Horiz n Depth Dominant Color Mottles Structure GPD/ft 9 Texture Consistence Bm-idar)r I Roots in. Munsell Qu.Sz.Cont Color Gr.Sz.Sh. r . .: rench Bed t�4%L "' Z 11-3 2 l0`i lZ 3lb s�► ZVnsblz ash Ground 3 3Z-10$ -)-5112 31y - S��� 0 95 elev. 8°f 6.9 tt Depth to limiting factor > Rema . # s t[ Zwc s b1f: ohs 1, �S -S . 6 3 )b-toy S�itZ 3ry - S Gu o S9 0� I - •� •S� Ground elev. 8°tl•8 It Depth to limiting factor > Remar : CST Name:-Please f rint Phone: Arthur L. We erer 715-425-0165 egerer S i Testing & Design Service- P.O. Box 74 River .Falls,WI. 54022 . Signature °1cl_Z47 - \39 Date: CST Number:. PLOT PLAN Page 3 of .3 s/I s o . Ov l.uT l3� i� < t3Utt_i�) Iw G \ StT R emtbI , U tv e--% \ t3.13gC- 8�0.- S fr+i SOO tr.Laa 6 s a,tla t? I �"'►- .L aq-)AL a ►s9A au Z" :t�? t39.6 4 et,99b? 0 3r'1 - �. 6e�,S4� olv I j I Nl�) 2 4 1 lZL>`7 a l Dt p�ZfUL - _ -St��E .t'>•T___�-�'Y�1T_..ZS___e1?u�1_�2.��ve.�s� 44-Z97-139 w 715 ) 4 .5-(1"I n�j-_ t CST Signature Date Signed Telephone No. CST# Parcel : 040-1308-00-166 03/07/2014 08:28 AM PAGE 1 OF 1 Alt. Parc #: 24.28.20.1985 040-TOWN OF TROY Current EX] ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map# Sales Area Application# Permit# Permit Type #of Units 02/10/2)04 00 0 Tax Addr ss: Owner(s): 0=Current Owner, C=Current Co-Owner TROY DE 1ELOPMENT CORP O-TROY DEVELOPMENT CORP 11806 AB RDEEN ST NE STE 290 BLAINE 55449 Property Address(es): '=Primary 201 MUIRFIELD TRL Districts: SC=School SP=Special 320 LINDSAY RD OR Type Dh t# Description SC 4893 SCH DIST RIVER FALLS SP 01@0 CHIP VALLEY VOTECH Notes: Legal De ription: Acres: 1.419 SEC 20 T N R20W PT SE SE; BEING TROY VILLAGE TH ('04)LOT 166(1.419AC) Parcel History: Date Doc# Vol/Page Type 02/10/2004 753934 09/100 PLAT Plat: *=Primary Tract: (S-T-R 4oi 16oi) Block/Condo Bldg: "09-100-T ROY VILLAGE 6TH ADDN 146/168 24-28N-20W SE SE LOT 166 2013 S MMARY Bill#: Fair Market Value: Assessed with: 236823 65,800 Valuati ns: Last Changed: 11/09/2009 Descriptio i Class Acres Land Improve Total State Reason RESIDEN1 IAL G1 1.419 75,000 0 75,000 NO Totals f 2013: General Property 1.419 75,000 0 75,000 Woodland 0.000 0 0 Totals fo 2012: General Property 1.419 75,000 0 75,000 Woodland 0.000 0 0 Lottery redit: Claim Count: 0 Certification Date: Batch#: Special : User Spec I Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00