HomeMy WebLinkAbout040-1308-00-153 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
574314 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No:
Personal information you provide may be used for secondary purposes[Privacy Law,s.15.04(1)(m)].
Permit Holder's Name: City Village X Township Parcel Tax No:
Diebel, Christopher J. I Troy, Town of 040-1308-00-153
CST BM Elev: Insp.BM Elev: BM Description: Section/Town/Range/Map No:
.$' c� / c-5T- 24.28.20.1972
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER K,'AJ6 CAPACITY STATION BS 7 HI FS ELEV.
Septic i 1 '�, 0 Benchmark
W I`•e5w F1 .A. ,f•S /Z �• `/b�� $7S. 8
Alt.BM
� S F.It�., cow
Aeration Bldg. Sewer 7 dZ Q•9y
Holding St/Ht Inlet
7- 5151-q94,
TANK SETBACK INFORMAT ON St/Ht Outlet S• Sf'9 3 •B
TANK TO P/L WE BLDG. Vent Air Intake ROAD Dt Inlet
Septic 5•7 Dt Bottom
Dosing 4� Header/Man. 9 �� �92 •7
Aeration Dist. Pipe
Holding Bot. System a•zz.
Final Grade
PUMP/SIPHON INFORMATION L•
Manufacturer Demand St Cover/' c
GPM
Model Number
TDH Lift Friction Loss System Head TDH Ft
Forcemain Dist.to Well
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No.Of Trenches ' ,,/� Liq
PIT DIMENSIONS No.Of Pits Inside Dia. uid Depth
L5 1 DIMENSIONS fe `�°V '_--_
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufactulr ��
INFORMATION CHAMBER OR
Type Of System, s' S/ /O UNIT Model %)jm r:
DISTRIBUTION SYSTEM ZL.+-LL
Header/Manifcjld � Distribution\ � � x Hole Sizes x Hole acing Vent to Air Int ke
Pipe(s)
Length Dia Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx De of xx Seeded/ dded xx Mu ed
Bed/Trench Center Al./ Bed/Trench Edges**., Topsoil Yes No Yes No
COMMENTS: (Include code discrepencies,persons present,etc.) Inspection#1: / / Inspection#2:
Location: 314 Lindsay Rd-Hu on,WI 54016(SE 1/4 SE 1/4 24 T28N R20W) Troy Village 6th Addition Lot 153 Parcel No: 24.28.20.1972
• e t fit► a v�
1.)Alt BM Description= ��� Go`��� �,�:�►.S F'-
2.)Bldg sewer length= 3Z
-amount of cover= PT N n n
e.^— GEC.
--- --- ---t, 41risepctor's G Plan revis ion Required? �] Yes No � 7
Use other side for additional information. __Date Signat a Cert.No.
SBD-6710(R.3/97)
!
i
_-T
j
I
pp �
i
C
:
� O
N
,
, I
_ ..
py
N1
County
Indust ry_X V�FETAiC71rF� ....
i
Industry Services Division
15 2 O 14 1400 E Washington^A+aSe Sanitary Permit Number(to be filled in by Co.)
i �U P.O. Box 7162!, t
ST. CROIX COUNIf4adison,WI 5&707-7162
:;OMMU,1411 DEVELOPME
State Transaction
Number
Permit Application Sanitary Perm
In accordance with SPS 383.21(2),Wis.Adm.Code.submission ofthis#born'to the appropriate governmental unit A
is required prior to obtaining a sanitary permit. Note:Application forms for state-owned PO\VTS are submitted to Project Addres (if different than mailing address)
Department of Safety the De P .and Professional Ser+�ice& Personal information you provide may be used for secondary
> _
u oses in accordance with the Privacy I ar�v,S. 1 5.04(1)(m),Stats.
L Application Information—Please Print All Information
Parcel#
Property O er's Nan1e
Property Location /' Iq-72l
Property Owner's flailing Address lf, J
Govt.Lot
Zip Code Phone Number '+, F I Section
City,S e uit
T ? N R�
IL Type of Building(check all that apply) Lot
Subdivision Name
1 or 2 Family Dwelling—Number of Bedrooms
Block
❑PubliciCommereial—Describe Use�%U:�� n City of
�/9IA U2 t 'bV G 2 ❑ Village of
❑State Owned—Describe Use (:slvt Number
,�Tovsn of
III. Tv erml . heck only one box on tine A. Complete line B ifap ticable)
A. ® t Iew System ❑ Replacement S}stem ❑ Traatment/14olding Tank Replacement Only ❑Oder Modification to Existing System(explain)
B. ❑ Permit Renewal ❑Permit Revision ❑Change of ❑permit Transfer to New List Previous Permit Number and Date Issued
Before Expiration Plumber Owner
o POWTS S,� tern otn onent/Devjce: (Check all that a h')
Non-Pressurized In d ❑ Pressurized In-Ground [I At-Grade ❑ Mound>24 in.of suitable soil ❑ Mound<24 in,of suitable soli
Oilier Dispersal Component(explain) .. ❑Pretreatment Device(explain)
V.Dis ersaUTreatment Area Information:
Design.Fiow(gpd) Design Soil Application Dispersal Area Required(st) Dispersal Area Proposed(st) System Elet
Rate(gpdsf) ✓
X1.5
VL Tank Info
Capacity,in o v
Gallons Total =of a '- U
Manufacturer B as
Gallons Units 'o New Tanis Existing Tanks
Septic or Holding Tank ❑ ❑ ❑ ❑
Dosing Chamber ❑ ❑ ❑ ❑ ❑
VII,Respo ibility S tement— the undersigned,assume t esponsibiliiF f allation of the PQyVT5 shown on the attached plans.
MP:AiPRS Number Business Phone Number
Plumb tame(I'ri Plumber's Si _
Plumber's Ad ess(Street,City.Star ,Zip Coda)
VU1 ountv/De attment Use Only _
approved Disapproved Permit Fee !ti Date ssued suing gnat#
❑ Owner Given Reason for Denial S
1711
Cry �yaUReasansforDisapproval 3 j/UG'�/��tc - / � LtZWi !',f' ,p4WJ
1.Septic tank,effluent filter and SGi/�1 i1 a / fU /'" r
dispersal cell must be- rvi�ed/maintained G� 4 Gam( p /�
as per management plan provided by plumber. j,� + �f l / .(�.(�-�/ e
2.All setback requirements must be maintained
p s for the system and submit to the Co ty only ann ppaper not less than 8112 s 1 t inches in size
CONVENTIONAL COMPONENT DESIGN
Residential application
INDEX AND TITLE PAGE
:< . . € >_ :: : Project
::L ."•\ ;:i?{.\,.•'::::v�::\:K:};}:•:}:}'y\\•:
•:+ " �iT•�\-
•. Name:
:y\}v-.•Y':is u:1`\::.p•�• ''}i} .:.y.v':4 ��-' :'i�F{i
_ }>:}
Owner's
•\'ue4`: Win:
0 � MI �.>: r Nam
.... ...... Owners
Zi
Address:
- \:�-:•\�w ii y4i'^..\ +i}i::n i::\\�j:<::+::TG::i�.n�iy:}.}::?�ativiti Xx-X;
•�,,\ \ ti:ti.1. lS.P,.:: �;xif;.2fn4^-PY��: \ i!i 1
)4. .v' - ..:\v:�t:�O:x iti)f,+�?ti.• v''�\\�v:•4.<"'r Oi:•�.f yn!::.:r
'-•:a<E 'ti.}}.`.i\:=:;:::}'.•::-:;;v'?:.::5:,.:�?:}A•`.t:��-:;}.a++agt;?}3;;:z;?}4:r:..}yY.•:�,: -'4
Legal Description:
Subdivision: Lot
Town:
County:
Parcel ID#
Designer/Plumber: License
Signature: Date: `7
Comments
r\acianarl nrircoinnttn tha In_Grmtnrl cnil Ahcnrntinn r mmnnnant mnnimI fnr POWTS Version 7-n
r
I '
I
I
I
i
,
_
! '
I
,
,
j
,
I '
l
`I !
I
i
1
I I
n � �
I
I
,
j I
{
I I
I
I _
I
I
I
I
' , I
I
r
I �
,
,
'
: � I
I I
I
I
I
I
:
Soil Absomp ion Stistem Cross Swoon
PVC Vera Pipe
/ U1fM Vent cap
Leaching
Chamber —' System Elevation
Soil Abso #ion SVSte m
Plan View
mo
yo ft
ft
Learning Trench 1
Vent Or Observation Pipe Chambers
49 Dia.
Trench 2 Header
Leaching Chamber Sgeefficafi ne
Manufacturer And Model ��
EISA Rating sq ft per chamber Soil Application Rate 7 gpd/sA ft
gpd Design Flow _Soil Appliicaffon Rate s— :L EISA= Chambers
2 rows of chambers each.
Page of
0
INSTALLATION R
w
zabef g
A1d Fes.
BSiytas�N1
T
INSTALLATION INSTRUCTIONS
,
a opening
Flt -s ` - ..z . r„•y .r j- T .eI�t 'c3CcFta�-:;v `_
•' ' t s ..,.,,'F ��.: y�s �.� seta-`
r °
_'.�'i •.�-'-643,.: .� :�. � -'
Step 1: _ Step 2: Step 3:
(A)Locate the outlet of the septic tank (A)Before installation,place the (A)Glue the MW housing on the
(B)Remove tank cover and pump tank fitter housing on to the outlet pipe. outlet pipe.
if necessary. (B)Make sure that the housing (B)lnMt the i oa P 1n#*
is positioned so thefifter can be housing,nvong
removed from the tank Dior cath is propeitY aligned
maintenance and service. completely inseded in'#he houskS
!MAINTENANCE INSTRUCTIONS
Alff
WOW
•!Quit,., rt < �-st,�,---+�` ''xaK,� 8��i t' �}_ _ _
s u �..ay -y,,,...�"�` -'"'ryr .,cam S.' .�+ � �tit•- _
jam T
t
".•'kpck, '.�i r S•-y 4• � .z °' x}�� �d.Z'E��"h•r..• ..
Y Y C' '•
�t`3�•ry-4..: ''sm•%rt--ta r�.i' .�:;Lr.2° .> ,�.` .,�"
step 1: Step 2: stop 3:
Locate the outlet of the septic tank. (A) Remove tank cover and pump (A)Insert the tamer MUldge back
if nec essmy. thtn the the housing maft sure
lie s _. 's (B)Pull the tic'out of the housing. Via'Is propel eri+ad_
(C)Hose off Me Mier over ft septic fianic �-
E'#�LJ GirOS !Mace sure all solids gall tack into the ($)R���c�Dover
'11f H t�I lit i I f i TER' septic imw
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page "5 Of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity al ❑ NA
pz,rmit# 3 Septic Tank Manufacturer, ❑ NA
-711 Effluent Filter Manufacturer ❑ NA
DESIGN PARAMETERS
Number of Bedrooms
❑ NA Effluent Filter Model _ ❑ NA
Number of Public Facility Units
❑ NA Pump Tank Capacity gal $1 NA
Estimated flow (average) al/day
Pump Tank Manufacturer IN NA
Design flow (peak), {Estimated x 1.5} gal/da
Pump Manufacturer NA
2 Pump Model
Soil Application Rate al/day/ft
Standard Influent/Effluent Quality
Monthly average Pretreatment Unit ,�NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filtbr ❑ Peat Filter
Biochemical Oxygen Demand (BODS) :_220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality
Monthly average Dispersal Cell(s)
❑ NA
Biochemical Oxygen Demand (BODr,) :530 mg/L In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) <_30 mg/L ❑ NA ❑At-Grade ❑ Mound
Fecal Coliform (geometric mean) :5104 cfu/100mi ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size Ya in dia. ❑ NA
Other: ❑ NA
Other. - ❑ NA Other: ❑ NA
Other: ❑ NA
'Values typical for domestic wastewater and septic tank effluent.
MAINTENANCE SCHEDULE
Service Frequency
Service Event
❑ month(s) (Maximum 3 years) ❑ NA
At least once every:
Inspect condition of tank(s) year(s)
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y,) of tank volume ❑ NA
❑ month(s) (Maximum 3 years) ❑ NA
Inspect dispersal cell(s) At least once every: 19 year(s)
❑ month(s) ❑ NA
Clean effluent filter At least once every: 121year(s)
❑ month(s) NA
Inspect pump, pump controls & alarm At least once every: ❑ year(s)
❑ month(s) fig,NA
Flush laterals and pressure test At least once every: ❑ year(s)
Other: ❑ month(s) $NA
At least once every: ❑year(s)
Other: g NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface.
The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding
of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the
immediate notification of the local regulatory authors
When the combined accumulation of sludge and scum in any tank equals one-third (Y3) or more of the tank volume, the entire
contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
GMW(4/01)
Page-Z-of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tanks)for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
t
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33,Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon b�
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area wi.
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site
evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank
may be installed as a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO O
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT_ RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTAL E POWTS MAINTAINER
Name Name
Phone Phone
l
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHOR
Name Name
Phone Phone 0
This document was drafted in compliance with chapter Comm 83.22(2l(b)(1)(d)&(f)and 83.54(1), (2) &(3),Wisconsin Administrative Code.
ST CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
Mailing Address 7c/S / 31ST AJ. 0 -P- bA&L: MAL q �l Z�
Property Address 3 l J_jAJ = '�6 ,
(Verification required from Planning Department fir new construction)
City/State (v r VJ-E Parcel Identification Number Q Vd" / 36F- 00 3
LEGAL DESCRIPTION,
Property Location __ '/., ,5� `/., Sec. , T,g_N-R�y Town of —
Subdivision . / � , Lot # .
Certified Survey Map # , Volume , Page #
Warranty Deed # q0 Z O , Volume , Page #
Spec house ❑ yes 0,no Lot lines identiflableXyes, no
SYSTEM MAINTENANCE
Improper use and maintenanceof your septic system could result in its premature failure to handle wastes.Proper maintenance
consists of pumping out the septic tank every three years or sooner, if needed by a licensed pumper. What you put into the system
can affect the function of the septic tank as a treatment stage in the waste disposal system.
The property owner agrees to submit to St. Croix Zoning Department a certification form, signed by the owner and by a
masterplumber,journeyman plumber,restricted plumber or a licensed pumper verifying that(1)the on-site wastewaterdisposal system
is in proper,operating condition and/or(2)after inspection and pumping(if necessary),the septic tank is less than 1/3 full of sludge.
I/we,the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards
set forth,herein,as set by the Department of Commerce and the Department of Natural Resources,State of Wisconsin. Certification
stating that your septic system has been maintained must be completed and returned to the St. Croix County Zoning Office within 30
days of the three year expiration date.
SIGNATURE OF LICANT DATE
OWNER CERTIFICATION
I (we)certify that all statements on this form are true to the best of my (our) knowledge. I (we)am(are)the owner(s) of
the property described above,by virtue of a warranty deed recorded in Register of Deeds Office.
s '
ap
SIGNATURE OF APP ICANT DATE
Any information that is mis-represented may result in the sanitary permit being revoked by the Zoning Department.******
**.Include with this application: 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
Wisconsin Department of Commerce SOIL EVALUATION REPORT Page_ _of
r
Division of Safety and Buildings ;
in accordance with Comm 65,Me. Adm. Code ColXtty t
ST. C-Rol,
Attach complete site plan on paper not less than B 112 x 1 1 Inche
include,but not limftod to:vertical and horizontal reference point( M),dl -WIVE[ P LD
percent slope,scale or dimertalons,north arrow.end location and distance to nearest road. t
Please print all Information. Ra by
Date F
�, 2 r� �00 �l 166
Panonaf information you provide may be usod for secondary purposes(P acy a 5.0 ,t
Property Owner S Pt K V I
�'ONTINEIJT L DE El_OPMEM LocJ �f Y
W
0 7
COO,?. -
Property Owner's Mailing Address of# ' 8ltxlc# Subd. Name or CSM#
I Ii00 A 9EXZP-,Qj 6T. Ail S SutjE 100 1 TROD( U►t_v+C-C (,;,r* `AtMM.
City State Up Coda Phone Number C3 City ❑Village X Town Nearest Road
I_RINE 55u44 c7�3 >75^7-75(0 0y uNas� teD�
(� New Construction User Residential I Number of bedrooms 4 Code derived design now rate 00 — --
GPD !
t •
❑Replacement Public or cornmerdai-Descilbe:
Parent material
cc a �,tt A l �V I A I_ Fiood Plain elevation if spplicaoie
_ QL f_f�_
-Z— `
General comments
and recommendations: CtNVS& n0,kjX oFtAldJ� TREaKtFF6 '�t`� 7 2,/� n L� (�
0.-7 U)A W(.� 7iR7E f J 1 7
L=��441
Boring El Boring
#
rj n R Pit Ground surface elev, gqq. rt.��`�` ' pih to limiting factor 7 _in Sp;i IicaUOn Rate '
5,q4 n Depth Dominant Color Radox Description exture Structure Consistence Boundary Roots ! GPOIfP
n. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'Effftt Ett#2
0-Zy y -
�.
z� — ;
0 y2a 4 5 vt� _ s Q5 —
0:1 L ,
CS - 0.7 (f Z- E i tv
5 ib3-70 4 S .7 Z
'7 )LA-IZ o S — 5 d 1 -- V.7 .Z-
r-re;i�o�tzous S, lr r•+A'4 [10 96
[] Boring L({ORIZON WAS VLAC•9O 0 w-rid OAJ 4 H�►S 30-35�
Boring# II
Pit Ground surf2Ce elay.�a /_ ' pth to limiting(actor 7 /(��— n• Soil ' {cotton Rate f
I�f t
F I-lonzon Depth Dominant Col Redox Descripli sere Structure Consistence Boundary Roots GPO/ff
1 Gr.Sz.Sh. 'EB#1 'Ett#2
in. MunseO Qu.Sz. Cont.Color
1 9 to zl — L -t. 1 0,5 0.S
Sil M-L C' - 0'S 0`s
-7 le 4
s d l a.5 0•-7 1•Z i
1 C5
7L- loyfcs 5 A.-r I� z
Effluent#1 =BOD >30 220 mg/L and TSS>30< t 50 mgA. Effluent f12 a BOD S 30 mg1L and TSS<_30 mg1L
CST Name (Please Print) Signature CST
ml M JO HOt.I_ S-M Zz 8
Address to valuation Conducted Telephone Number
W98?s la4o{KAVe, wvE FALLS Wi 54022 0 - ? -03 �"�tS yzb-1"175
JI
r
Page 2- of
Property Owner COAJ-fI�EA1'u4L l7&v�i cPM Parcel ID#
C] Boring CJDKP-
�� rang# Boring {
$ C1�pll Ground surface ele _ ft epth to limiting factor in. Soil Application Rate y
Text Structure Consistence Boundary Roots GPD/ff
Horizon Depth Dominant Color Redox Description 1 ,
in. Munseli Ou.Sz. Cont.Color Gr.Sz.Sh. 'Eff#1 Efi#2 y
0-9 10_'W�q Z_ 0."1 ,
Z q-13 — dS i -r+t ��� I.Z y
3 13-ZS 60 4I m-t_ J CLS �rF-rn orS o.�
32-43 0 V 3/4 d
1. Z
_� 43s y s 1 ci 0.7 1.z
r
_ ❑ring# Boring
^y;, pit Ground surf ace elev. _—ft. Depth to limiting factor 7 4 y —in• Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture I Structure Consistence Boundary Roots GPDIff
ti
in. Munsell Qu.Sz. Cont.Color Gr.Sz.S I 'Eff#1 Eff#2
y
�q-qg to N 5 0. — 0.7 1,Z y
S S fC &je. f4o S 10 rel GR.
r
❑ Boring
❑ Boring# Ground surface elev._—_--ft. Depth to limiting factor_ _ _in.
❑
pit Soil Apolication Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/ff
in. Munsell Qu.Sz. Cont.Color Gr.Sz.Sh. 'tff#1 'EB#2
II
1
Effluent#t =BODs>30<220 mglL and TSS>30<150 mg/L 'Effluent#2=BOD,<30 mglL and TSS<30 mg/L j
j F
rj
"Che 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.
SBO•II UO rR.6M ry}
r ,
r "
FI gr PLAN p�� y
OW
�-50L riG1 NCA W1 P
FINAL GRADC- SLG(JHTION S °l Z
i
LOT
153
y
B 153A
ELEV�89(�.
ti
Sr.
�j RaT
81_ 536
61548 ELEV. $4-6.(v
ELEV. $qSg
F�0" PLAN
pPGC���
pROf' RT OWNER; 0 - . P- 'Try�- L�G�NU /�= 5'0
t�Eu �oP�lEU1' CoKP 3M- O r I 's- ip�s I
a_ DEx�Ip�ION; �oz t53 T�� v,u�r.�
CO TaURS i
K) OF' Y_iST. KD x_ �L-�/. ..�,90�_.._ RnPosw caw rpuRS►
1 -501L. OPNG W/ 3X-qa
NO COMM 83 5,--'l3PCK PPOMM5
The site\N as after soil c\aIILK&ons were
Oj compicted (see page v�ith final grade cicvations).
SNstem cicvations should not he affected, but
depth below grade will need to be determined
based on the amount of cut or fill. BM
cic\ations should have remained constant.
ELEV. 896".7
a
_ 898------- �
15
ELEV 899.4 SOT
\ "
81536
B 154\ ELEV. 898.4 > �, EI!_E '. 89 .72
4A \. ELEV. 89 .
97.7
rD
moo.
92 71.44 ELEV. 894.26'- LEV. 896.52
237.84' 1 1 134.
84°53' 49 E 9
B 158C ELEV. 894.1
81578 88 _
ELEV. qS1A- —- —-
-896
t %Aw C5T Aldu c -
ZZLAV3Z
GAIE: Q1-LH-9L'5 _
jbko`�Nk;�
<1 152 \.
^. �p \ 1.059 ACRES
137 / / �0 ��p ^` 46,132 S.F.
/ / S/
136 \a'/' po �y 1.223 ACRES `\
\ — — �•'�,; � �� �. / \ srR° 53,271 S.F. \ v
ir
154
135 1.004 ACRES
ir
�90 0p, 0 43,741 S.F.
S892 14"E
�
- „ E 237.84' 71.44'
N 84 053 49 131.71' 71.44 ¢2.61'
106.13' _ 134_05
Ilk
155
X906bp 1.063 ACRES/ t g
Z A
<46.304 S.F. / I I , ( 1
ts \ �° . / 1 I I W I I W ik
POINT OF �� ,� 156 06 i �o I 1� €
BEGINNING "B” �\ \�r0� �y\, ry /1.024 ACRES 1 o N 15 7 I o N I 15 8 I o.• •c
44,581 S.F. 0 1.026 ACRES 1.000 ACRE
6 3 2 I M 1 44,705 S.F. I oo►� 143,566 S.F. I o� �"
1 Ji
L--i z;I I L 166 �� �� - 1
1.419 ACRES \ \
I _ 61,829 S.F. POINT OF :v
BEGINNING "A"
�•_`� 34.37' 150.00' 134.05'
C5 eK _ 3 6
OUTL O TRGY�/J�A GE F/FTH A
_ T 15 _ _ _ _ DDITIOIV w4�13,
—��I - -- - - _- - __ - - - -
-��I -- -- -_ -_---- _ �I PLA /NV/EW DR/ VE
N 8857' 16" W 2656.68= — — I -
616-
LOT 1, C.S M_, VOL. 2
L 0 T 2, _C.S.M_, VOL. 6 33' 33' PAGE 416_— -- 0- - x,34178_
PAGE 1777, DOC. 421950 1 — — — — —
T DEL ANDER DR/ VE
PROPERTY OWNER CUkM1..1kbu' IVt bZV . SOIL DESCRIPTION REPORT Z,
Page_of
PARCEL I.D.#_ /v to
Bo i # Horizon Depth Dominant Color Mottles Structure
��� in. Munsell Qu.Sz.Cont.Color Texture Consistence Boundary Roots GPD/ft
Gr. Sz. Sh.
3! Bed Trench
C. 3
Ground
elev.
89Y.
Depth to
limiting
factor
Remarks:
d 6h o S g ►�J _ _
Ground !
elev.
i
ag s.l it.
Depth to ---
limiting
factor
M
Remarks:
Boring #
a r _
Ground
elev. ,
fAY•lft. i
_
Depth to
limiting
factor
Remarks:
3oring#
around
;lev.
ft. `
)eplh to
imiting
actor
Remarks:_
Wisconsin Departrnent of Industry, SOIL AND SITE E V A L U.AT UGN -REPORT Page I of 3
Labof and Human Relations 9
Division of Safety&Buildings in accord with ILHR 83 b5,W s.Adm.{;`ode
` C04NTY
Attach complete site plan on paper not less than 8 1/2 x 11 inches in sl e.Plan must include,but ST• C'�'�-U lx
not limited to vertical and horizontal refer PAR.EL I.D.#
reference point(BM),direction antl,9'o of sloe;scab or
ed o -
dimensioned,north arrow,and location and distance to nearest road. `i r
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMAT�N' REVIEWED BY _ DATE
PROPERTY OWNER: P.�,fiQ,P1=RTY LOCATION
114s� 1/4,SZ� T Z-b ,N,R Z.0 E(o W
PROPERTY OWNER':S MAILING ADDRESS• i1_T9# BLOCK# SUBD.NAME OR CSM#
— TttO�•I UL�LRGEc� ( 1
CITY,STATE ZIP CODE PHONE NUMBER DCITY UVILLAGE [MOWN NEAREST ROAD
s�_r'vlm ,w-L ti FS 4121y ( TQ-o�t t ►,,mss t°r�t cupwro
[X]•New Construction Use Residential/Number of bedrooms L/ //^^[ j Rn to xisting building
j I Replacement [ ] Public or commercial describe V 1.�� 0T7_144`3
Cade derived daily flow boo gpd Recommended design loading rate bed,gpd/ft2 •$ tre ch,gpd/ft2
Absorption area required %SE1 bed,ft2 -1 S ILI trench,ft2 Maximum design loading rate bed,gpd/ft2 •S trench,gpd/ft2
Recommended infiltration surface elevation(s) $"to•o' ft (as referred to site plan benchmark)
Additional design/site considerations S >U(ITE 10 k ki sTkx_Lt:rZ 30'j ` 3
Parent material �-L)fS3 ova GLf1CUr L Ov'rtAji}S N ' Flood plain elevation,if applicable N At - ft
S=Suitable for system CONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN RILL HOLDING TANK
U=Unsuitable fors stem ILS ❑U ®S ❑U ®S ❑U I Q S ❑U ®S ❑U ❑S IR U
SOIL DESCRIPTION REPORT
Bo # Horizon Depth Dominant Color Mottles Structure GPD/ft Texture Consistence Bouidary Roots
�y in. Munsell Qu.Sz.Cont Color I Gr. Sz.Sh. I ( I Bed Trench
S cw _ .z •3
2 of Zb lo`KR 3L3 —
st�i zmauk v►1iF - es •%! .5
Ground 3 ��y �.S`tR 3l y S 6t- 0 S% wt J - •1 .$
elev.
$94.-L ft
Depth to
limiting
factooprL,
Remarks:
fcr nzg#
1 10-CIZ eC6►- 0 g9 wt ) _ — .1 .$
Ground
elev.
Q- q'y ft
Depth to
limiting
factor
Remarks:
CST Name:—Please Print Phone:
Arthur L. We erer 715-425-0165
e
rgerer Soi Testing & Design Service-P.O. Box 74 River .Falls,WI. 54022
Signature °/ 7 - /y Z Date: �Z_`� Ct 9 CST Numbe 220254
PLOT PLAN Page 3 of 3
SCALE 1 "= Sp '
117 5�
G
S� �S i�NPcR.C,Y
/�J.. —!s-e-kE- :L=LEvfiT-tuvs
LuT
� v
Su\TK6t_C
Yu 2 l NA-71 R t_
Rr-n ftA-Ttt= 1M 9L / `�tea,,•
S Lt S`i�s
�v s E 1'0:D t �'T L.C�'h�T Z S-'PtiZO►� S!�ST��t J. /
W CELL k ♦ k
�5 J� _Q
1��1'KCC_
XV
�tlt S`t SLR-=Z = - _ - iE7 -�►t�"`p u�v
zzoz s y
( 715 ? 4 A-n•i 65
CST Signature Date Signed Telephone No. CST#
I
wswwiwwww � wwwwwiw
bfMA
Il _ 3 on$99500 p
In
r � � �`•`�.�.wiw •www •
N
t, st , �.
Of too
In
NJ
4 r
,/ •�
'`'� •
CMM Holdings, Inc.
275 Market Street
STE 544
Minneapolis, MN 55405
July 15, 2014
RE—Lot 153 Troy Burne Subdivision
Chris Diebel
CMM Holdings, Inc.hereby grants permission to release the sanitary permit for the residence on lot 153
Troy Burne Subdivision Town of Troy WI
Signed this 15 d 4
Jason Johnson
CEO/Managing Director
:i
982138 a
BETH PABST
REGISTER OF DEEDS
STATE BAR OF WISCONSIN FORM 2 - 2000 ST. CROIX CO., WI Y
RECEIVED FOR RECORD
Document Number WARRANTY DEED 07/12/2013 08:00 AM
THIS DEED, made between TriBella Properties, LLC, Grantor, EXEMPT # NA
and Christopher J. Diebel, A Single Person REC FEE: 30.00
TRANS FEE: 170.70 i
Grantee. PAGES: 3
Grantor for a valuable consideration, conveys and warrants to J
Grantee the following described real estate in St. Croix County, **The above recording information
verifies that this document has
Wisconsin: been electronically recorded
&returned to the submitter
Lot 153, Plat of Troy Village Sixth Addition in the Town of Troy,
St. Croix County, Wisconsin.
"Written permission to obtain a Wisconsin State ',
Sanitary Permit is required from CMM Holdings, Inc. 1j
DBA Dreamstructure DesignBuild, a Minnesota !`{
Corporation, prior to issuance of Permit" Recording Area _
Name and Return Address:
Edina Realty Title, Inc. i
400 South Second Street, Suite 115
Hudson, WI 54016
1072059 f:
x.
C`9
Exceptions to warranties: 040-1308-00-153
Easements, restrictions and rights-of-way of record, if any. Parcel Identification Number(PIN)
This is not homestead property.
Dated this 28th day of Ju i
TriBella roperties,
BY
.,
ason J s n Attorney in Fact for
Joseph Klewicki, Managing Member of
TriBella Properties, LLC
r
i
WARRANTY DEED STATE BAR OF WISCONSIN FORM No.2-2000
1 of 3
;Y
I:f
l
AUTHENTICATION ACKNOWLEDGMENT
Signature(s) STATE OF
/� ] �-
COUNTY OF
authenticated this 28th day of June, 2013 y2 2(�r
Personal) came before me this
* the above, Jason Johnson, Attorney in Fact for
TITLE: MEMBER STATE BAR OF WISCONSIN Joseph Klewicki, Managing Member of Tribella ;
(If not, Properties, LLC to me known to be the person or
authorized by§706.06, Wis. Stats.) persons who executed the foregoing instrument and
acknowledged the same.
THIS INSTRUMENT WAS DRAFTED BY I'I
Martin D. Henschel L-144-71) 17
6800 France Avenue South, Suite 410
Edina, MN 55435 Inge Andre
(Signatures may be authenticated or acknowledged. Notary Public, tate of Wisconsin
Both are not necessary.) My commission is permanent. (If not, state the
*Names of persons signing in any capacity must be expiration date: )
typed or printed below their signature.
INGE ANDRE
Notary Public
State of Wisconsin 7
f-D r !
i
WARRANTY DEED
STATE BAR OF WISCONSIN FORM No.2-2000
2of3
G,
, \
� (
; Exhibit& /
Legal De cr ,lon \
L0! 153, Plat of Troy Village Sixth Addition inthe Town of Troy, St \
Croix County Wisconsin. \
\
j
§
\
\
j
j
\
/
\
{
\
\
\(
i
\ �
� § �
d
� \
WARRANTY DEED STATE BAR OFWISCONSIN FORM No.z2000 \
3 of a
� d