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HomeMy WebLinkAbout040-1292-50-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 578984 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: Pahl, Mike & Kris Troy, Town of 040-1292-50-000 CST BM Elev: Insp. BM Elev: BM Description: t Sectionlrown/Range/Map No: IVOT 0L4.A)t> /()0. 00 1 rep .64,104 d1Jy% G~tlkL 24.28.20.1672 TANK INFORMATION ELEVATION DATA &JW S/DE of 'aklEtL TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic mar w/polyloy Be-me cF~»M&a + x.30 [off /d v. DO Dosing F, 4~ Alt. BM Aeration Bldg. Sewer OJ Holding St/Ht Inlet q. io St/Ht Outlet aQ TANK SETBACK INFORMATION 3d [ Z•®Q TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 1:15, N. d 1q, _ Dt Bottom Dosing Header/Man. ~O Qt- p- Aeration Dist. Pipe t Holding Bot. System i PUMP/SIPHON INFORMATION Final Grade to 00 F'Pq 30 Ma a er St Cover GPM Model Num (9ra.~ ~na~ ~ TDH Lift Fn System Head M t WWS ~nOyvI( Forcemai ngth Dia. Well ;Q41 T-F-A, if; i SOIL ABSORPTION SYSTEM I 'R 6;rj4q BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ~ z 3- r ,l 1 SETBACK SYSTEM TO /P /L BLDG) W01A LAKE/STREAM LEACHING Manufacturer: p INFORMATION CHAMBER OR /4I F~L 0a e Type Of System: + 2 , ~.om/15AJTf"#- 3z> 114 UNIT Model Numbed (A [ DISTRIBUTION SYSTEM Hea der/Manifold Distribution Ix Hole Size Ix Hole Spacing Vent to Air Intake ~ N Pipe s Length_Lj_ Dia_ ength Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 3'_ u Bed/Trench Edges Topsoil Yes E] No 1:1 Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1:- § Z7 Inspection #2: Location: 303 Lindsay Road Hudson, WI 54016 (SE 1/4 SE 1/4 24 T28N R20W) Troy Village 5th Addition Lot 144 Parcel No: 24.28.20.1672 vE~JFI~-j , 1.) Alt BM Description = Sf LotA4✓ ~~CT~ ~IQDM LS7" ~otsl.0 NaT 13E7 2.) Bldg sewer length = LWfI S DuG BY HE~1 ~nlb °F DELL , 3` ~o`^) SYST ~ - amount of cover = >-I jb (/atey SpICS~ N£l1 HEQ i~ C~uL f? 3El L'@ ST. I~H~ ~ itlo wEL~- fYf ~/rspEZT7i~, ~o~ G~~FS ]7c_To~JeD 3Y Ft, LA#4 ~ Plan revision Required? FIN] Yes No Z ~7 / Use other side for additional information. 7Jo_ SBD-6710 (R.3/97) Date 'Insepctor's Signature Cert. No. V tly Al ~rj SIC 0 p Y ~ ~ f ;Z -7 RECEIVED commerc~ye ~✓Lgov Safety and Buildin ivi ' ounty /T L ' 1 2 U ~ J 201 W. Washington Av J ' • e-lb I ^ n Madison, WI 53707-7162 -j Sanitary Permit Number (to be filled in by Co.) s&2W IOMMUNIV unitary Permit Application State TransactionNuAm1b In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental ' , unit is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purpo in accordance with the Privacy Law, s. 15.04 1 m , Stars. ✓ h:2 L I d S a~ I. Application Information-Please Print All Information a Property Owner's Name Parcel # Y t?<-e d` /~_je i 5- 0 11'.0 -i z qz -s o - d vv Property Owner's Mailing Address Property Location I / 2-020' ~~a) L ew l0 Govt. Lot City, State Zip Code Phone Number (circle one) II. Type of Building check all that apply) Lot # T N; R!" E or w Zy Z8. ,110 9 Z Zo- 9<1 or 2 Family Dwelling - Number of Bedrooms IV Y ✓ Subdivision Name 11 d 1. V lock Public/Commercial - Describe Use b ❑ City of ~DJ ❑ State Owned - Describe Use CSM Number ❑ Village of U [J Q / Q Town of . Type of Permit: (Check only one box on line A. Complete l' e B if pplicable) A. XNew System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) ~3- 3'x-1 Z' B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply)-- a JT 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 (expla') ' V. Dispersal/Treatment Area Information: 6Y cL "e 4/ ' Design Flow (gpd)/ Design Soil Application Rate sf) Dispersal Area Required sf) Dispersal Area Propo ed (sf) System Elevation be~OW rad_k ~S"o ✓ e 7 417-27 go e " e_ !-o 4.1 _zr VI. Tank Info Capacity in Total # of "Manufacturer Gallons Gallons Units d o b v New Tanks Existing Tanks ' PO 1 b 1 5 u q n Cl+ U rn y rn w p U A. Septic or Holding Tank & i, Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature RS Number Business Phone Number !T/, tC,`Gt tnn ScAwY~ -Ac , :2 9.?9gt7 71s~s8~' 3 t.7 / Plumber's Address (Street, City, State, Zip Code) VIII. Gun epartment Use Only / - Approved ❑ rPermit Fee Date Issued Issuing Agent Signature ❑Ors tven Reason o ial 75, D a lZbl J L IX. Conditions of ApprovaMeasons for Disapproval 3, hNs ,l l 1b ,e m3 ~n jUr a4- ~1S 7 -3811 SYSTEM OWNER: ✓ „ 1. Septic tank, effluent filter ar.d b (D W q ►'4CLe ` Mkt x~ M d,'t od-p-111 0 dispersal cell must be serviced / maintained A+ g3 ~Z as per management plan provided by plumber. All setback requirements must be maintained NDM- (Qj 6n PI b l-P)AA %S +l kf'Aa le J3i4 as p pV"J j~41f ffMaand submit to th County only # Paper not ies thaa 1/2 x 11 inches in I Q C See CST j 6, ',c Y ( n AJ A,/ CST hard to SeQ> D~ (►~~`I1 1'. UYIQ, SBD-6398 (R. 02/09) CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: Owner's Name:, Owner's Address: !/2o g G~`i< 9'e fly ~c~aoj h its 1~ .5 vim' 2 `7 Legal Description: Gc1 SW%cr~, Township: Z~ d ~z_ County: ~~o Q Subdivision Name: Lot Number L ~zl Parcel ID Number: t a Page 1 Index and title Page 2 Plot Plan Page 3 System Sizing & Cross-Section Page 4 Filter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber; r~ 7 y" License Number: 71~' (7 Date: / Phone Number rG 312J Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101). Page 1 1 Q ACA ti OJ-5 ~S t91, A ~ `L i Boll Absgmtlon System CMM Section ft 4° Schedule 40 Fines Greda PVC Vent Pipe Vfnth Vent Cap WS-1 Leaching --O, Chamber Cg ft System Elevation ft f~ Soil A0#omtion System Plan View 72 R ft 1 _h Leming Trench 1 Chambers 4" Dia. Trench 2 Header Vent Or Observation Pipe , I i Trench 3 Leaching Gib m 3 fft"at~ons Manufacturer ~i And Model Li? a C 4JS- p/,)5 EISA Rating 2 a sq ft per chamber Soll Application Rate '7 gpd/sq ft ?SO gpd Design Flow •2~ Soil Application Rate : EISA = Chambers 3 rows of -Z chambers each. Page of POWTS OWNER'$ MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner T Y'r`S 3 Septic Tank Capacity al ❑ NA Permit ~ - Septic Tank Manufacturer D NA DESIGN PARAMETERS Effluent Filter Manufacturer Act ~ .44v .,iV ❑ NA Number of Bedrooms S ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units )'NA Pump Tank Capacity al ❑ NA Estimated flow (average) b ere% al/da Pump Tank Manufacturer 1,d 'e s;' ee- ❑ NA Design flow (peak), (Estimated x 1.5) gal/day Pump Manufacturer ❑ NA Soil Application Rate gal/day/ft' Pump Model ❑ NA Standard Influent/Effluent Quality Monthly average" - Pretreatment Unit ❑ NA Fats, Oil & Grease (FOG) 530 mg/IL ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODE) 5220 mg/L ❑ NA 0 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dieperpal Cell(s) ❑ NA Biochemical Oxygen Demand (BOD,) 530 mg/L © In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L © NA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) <101 cfu/i00mi CI Drip-Line ❑ Other: Maximum Effluent Particle Size Y. in dia, ❑ NA Other: ❑ NA Other - ❑ NA Qther;' _ ❑ NA *Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: month(s) (Maximum 3 years) ❑ NA year(s) Pump out contents of tank(s) When combined sludge and scum equals one-third (!3) of tank volume ❑ NA Inspect dispersal cell(s) At least once ever ❑ ~Mnonth(s) _s. l cell y: 3 Xyear(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: A / Mes {s) (s) ❑ NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ year(s) ❑ NA Flush laterals and pressure test At least once every: - ❑ month(s) ❑ NA - ❑ year(s) Other: ~ At least once every: ❑ month(s) ❑ NA E3 yearls) ❑ 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 hack 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 authority. 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. START UP AND OPERATION Page of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. 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 by required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need for a new soil and site evaluation to establish a suitable replacement area, Replacement systems must comply with the rules in effect at that time. IJ 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 NOT 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 INSTALLER OWTS MAINTAINER Name So( e. e.•-,s. ~Yg1, Name Phone 7l S~~r ~'l!_-~- Phone - SEPTAGE SERVICING OPERATOR j MMPER) L0QAL REGULATORY AUTHORITY Name Name tr P-Q,y IV-rl Phone Phone ~S - g (P ' / (!0 a A This document was drafted in compliance with chapter Comm 83.2212)Ib)(1)(d)&(f1 and 83.64(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MA Rn EItAN CE AGREEMENT AND 0VVTTRSH1P CERTIFICATION FORM OwnerBuyer /(ll ati~d s -Mailing Address l 120 IN ~ 4c.~ l~r Wry b~ a MN S 2-1 t opeM, Address 30 -I trY.~SL~~i ~~~1,y►~ l) rte1 U~J (Verification required " Planning Zoning Dcpaz anent for Be consr:uction ) City/State Parcel Identification Dumber. 19-1"0 - L L9 I - So 60 0 LEGAL DESCRIPTION property Location,-Grp 1/4 : 01A) K, Sec. /37, T 21 N R 61 W, Town of ,•zr ✓ Subdh ision Plat: J-;-7_ Lot # 1 y~y . Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volume , Page # Spec house L yesx no Lot lines identifiable 0 yes 0 no SYSTEM NI.AIN'LM TANCE AND OWNER CERTIFICATION Improper use and maintenance of 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. Owner maintenance responsibilities are specified in §SPS. 383.32(1) and in Chapter 12 - St Croix County Sanitary Ordinance. 1be property owner agrees to submit to St Croix County Planning & Zonng Department a certification form, signed by the owner and by a master plumber; journeyman plumber. restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping Cif necessary), the septic tank is less than 13 fall of sludge. Uwe, 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 Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Cezbicarion stating that your septic system has been maintained must be completed and returned to the St Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that. all statements on this form are true to the best of my/our knowledge. Uwe amlare the owner(s) of the property descnbed above, by virme of a warranty deed recorded in Register of Deeds Office. I! umber of b ' 5/ V Ceti( l~ SIGINATURE OF APPLIC_A S) DATE ***.Any information that is misrepresented may result in the sanitary permit being revoked by the planning & Zoning Department_ Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. =V. t14aZ) 1013433 BETH PABST SF Restructing, LLC REGISTER OF DEEDS State Bar of Wisconsin Form 1-2003 ST. CROIX CO., WI WARRANTY DEED RECEIVED FOR RECORD 06/09/2015 2:19 PM Document Number DocumentName EXEMPT#• NA REC FEE: 30.00 THIS DEED, made between SF Restructuring, LLC, a Minnesota limited TRANS FEE: 285.00 liability company PAGES: 1 ("Grantor," whether one or more), and Kristine S. Pahl and Michael Pahl, wife and husband **The above recording information verifies that this document has been electronically recorded ("Grantee," whether one or more). & returned to the submitter Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area estate, together with the rents, profits, fixtures and other appurtenant interests, in St Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address needed, please attach addendum): Partners Title 1330 Hosford St Suite B Lot 144, Plat of Troy Village Fifth Addition in the Town of Hudson WI 54016 26417 Troy, St. Croix County, Wisconsin. 040-1292-50-000 Parcel Identification Number (PIN) This IS NOT homestead property. (is) (is not) Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except: Dated June 8, 2015 SF Restuu turin LLC AV~. (SEAL) (SEAL) * Jeff D oer, Secretary (SEAL) (SEAL) AUTHENTICATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) ss. authenticated on RAMSEY COUNTY ) * Personally came before me on June 8, 2015 TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Jeff DeBoer, Secrea-ry of S Restructuring, LLC (If not, to me known on(s) wh -e-'x t d the foregoing authorized by Wis. Stat. § 706.06) instryment a cknow edge THIS INSTRUMENT DRAFTED BY: * Lorrie . DeMars Bruce Clark Notary ub -c, State ' esota my omm ka~s permanent) (expires: 1/31/2020 ) (Signatures may be aut~( enticated acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY CATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED © 2003 STATE BAR OF WISCONSIN FORM NO. 1-2003 * Type name below signatures. 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III r ~ x r 1 2-2 -u III o - -0 III ,i 20" PLR"TRUSS 19.2" JlL r III < I i A v II ~ A rn (r J I n ti y se II ~ 3 1 L, D m z UJ IljjW I oAll !5 z II11A IA p °II O ~p E ~o~ Illlr ID 3 < ~i I o 3 v I ~a' II jr I! 0 22'_0^ O Oil II 1 12'-0- 1111= I• 8 111 1 II I ~ III I - - - - - - - - - - - - - - - - - 3'-0" ARCH I 20'-W - I 26'-0" I a v o D m I A I 1 N m ~l I ~ I O I I -V I 3 2xAlT TREED ° I 6.5. I6 I t5 1 0 1 I ~Z X IL-1 I b I I I I ~ I ~ 0 y I IN W I I I I I 1 L I I C I I --48- - - ----------J I 2-2x10 TRD- PLUSH -I I----------------------- III N NIII I I I III x 2x10 ~'lll I I I I I 111 O TREATED OIII I I I I I II I C.~Jill i I IIv vll LLi 1 I 1'-6" I -n s-o• rll I I ~I I Ill rill I I ~tl~ ~f1V~ 21- I ~g•-0^ 16,_0. I 29-0" A z x -4 I m0, 00` O U -0 ra 4 . n O a -4 I I SEC I I 3~~ ' 1 I I1DH3664 2 mIF IITOH3860 M 15 p TOP • 1'-11" k SET ON SILL PLT N "BUILT-INS c 48" BUILT-IN ' cw (1 i- r- L ° 1'-6" v. AA C x a 40 40 1 Z1 o -~1 r N O A ~ A N i9 v ITT A y =N -4 r A 3 r r 20" 19.FLR.TRUSS O s 2' - - - - - - - - ARCHED SOFFIT 0 c 1. < - - - - - - - - 1- - A Z GIRDER FLOOR TRUSS r 91-0" 1'-4" I1'-2~ w L VIII A ~ - Dill ~ m ~Ilv N p ~ =111 o 6'-3. O III N v M W 7~111~~t1 r 3-2x10 M Wr Dlilg r ITDH3664-2 O 20" FLR.TRUS_ S ~ _ =III 19.2" O.G. V! I 20" FLR.TRUSS O N 0 'J ffl-j O.G. A s ~7 T-3" 10'-0 (1 Illlyl o ~WIIImI v it z 20" FLR.TRUSS Op - - - - o FLUSH 8.5. - - l' IIIgI p z 19.2" O.G. O (1 ~ 4 ni M c MICRO r -l r HID, 16'-10" ID, M q z DRAWER o"""o I DW 1 III it Z 01111 1 11 1T-11' v 1111 22-2 I ? --i I1I *~4 36" GOOKTOP 3'-0" ARCH W/ HOOD < O O 6'x8' P.D. O O O 3-2x10 26'-0" 20'; FLR.TRUSS 6'-3" 9.2" O.C. N (S ° N v -4 G m -O z A N O ~ O 20" FLR.TRUSS x a T 3 N b p 19.2" O.G. O A M m i> z <;a (1 E ll ~n p. 0 r A Cl I \ 16'-0. BENCH/CUSBIES - J \ WALL GIRDER (VERIFY) - - - - - 2-11 1/8" L - - - - - - - - - - - - - - - - - - - - GIRDER ITDW or ITDH 48 Q u TOP • 111" TOP -'-11" N 111 b DN 2-2x10 2-2x1 TZ '0 GRADE 2'-11" T-11" 34" 2'-10" V-6" o, ~v 2"-0 5'-10 5'-10" 6'-4' x I n 20'-0" • N zx ~1 y0~ 6'0" ~ A D f z y m D N 1V o'rn ~i rgO Ex M lr1 ~i A O _n o ~ A 12'-0" 't TRUSSES o 20> 2-2x10 m E E ITDI4366O-2 D 2-2x10 D TOP • "f'-6" m ITDH38M m F TOP ® 9' OFF LND B. - - - - - - A 6 - - - - - - - - - - - 0 -4 E N 4'-0" 4-0" I \ \ / I I I E E I I 14 w OOO n - I I I I w OO D = I I ~-p(AI I~_ o ~ I I mm~ I I ~i I I TRUSSES c I I z I I \ 24" I I O O ITi I I 1 N ;P Lo N o I I I I i I I Au I I ~ I I r D I~ I I o d I I w 2.-6. -0 r z ~ ~------------J\ I 1' 3 N I \ I 2-2x10 Ol p r~ IC----------------y ICA 7 FiXI A TEMP TOP -T'$ 32" SLI IN - d III 3'-b" AR r - , :14 I ~ III ~ I I TRUSSES III -----I - 4'--8" - I 1'-2" 96" I I o ° E D" 5,6' I I 4'-0" 24 i I nl P 1 ra TA -0 N cS E I i r,, T = A III o =I D Dm 7C j. a ~1 Cl I 1accES~ VIII ~ I.I O Y. III 0 (P 8" v n 7- (5 ~ III 01 3 \ (1 ' III bo^ p tt~ III W \ P III i o J1 o a III „ .III LOW B.I. a _ pro W s m 16'-4" I (P 15'-4" D N 4 2" 24" 42" n jp N z i O.G p I mmmE~ I a ^ $O 0 V O W I ITDH ET. T2- 2x1 I I I I I I I I I I I I I I I I PLOT PLAN Page 3 of 3 SCALE I"= SO ' n, ~N - 842.81' o^i Iy~tx4~1 1'11 4. _ aS ZAW o tti tTLi`c~ TMa cfts ~o WT Ift" -~'t 897.$7` prv 1 t OJAI tit Die 5 ' ILP wT ~z ~ 00 9R_Z9`2, t33 Z 1 CST Signature 5 4 2 5 -D 1 Date Signed Telephone No. 5 CST # t~ 1+Vtsoonsin Department of Commeme SOIL EVALUATION REPORT Page -1_ of -3 DWI= of Safety and Buildings In accordance with Comm 85, Wis. Adm. Code COQ' 5T, Cpp t X Attach complete site plan on paper not less than 8 1/2 x 11 inches In size. Plan must Include, but not limited to: vertical and horizontal reference point (BM), direcOon and parcel I.D. percent slope, scale or dimensions, north arrow, and location and dlstence to nearest road. OqO- 12-'??- - so - 000 Please print all Information. ewe • Dater Personal Informalion you provide may be used for eeoondary purposes (PrNecy Law, s. 15.01 (1) (m)). - v 0 Property Owner Property Location rJ1;` 14 OF r2 .zy ) fz.so } D UDJTIAI&>UTAL--"pEVEt_OP1 C-AT CoKP, xsw~ NW 1/4.5\41/4 w Property Owner's Mailing Address Lot q Block 0 Subd. Name or CSW $Op Ab'---121.?~--E -`W. N E. Sup ~E 100 14q - RD V11~-AGT--- ~FifTkt flbDN city State Zip Code Phone Number City C]Mllags ZTown Nearest Road 13l_AtNti ►J 55449 (-7( -5 -757 - 7 51,$ a 1.aN SA O ~ New Constructlore Use, Residential / Number of Code derived des flow rate COQ GPD ❑ Replacement ❑ Publk: or corrlmarcial - Dee,, Parent mal8021 _Q1Ujklh, 5H ~lA f9611 teT6va n it ` ilcable A 1 A General comments COUN~~ andrecornmendstlons: COn)v>rN IIo/JAt- tfZFJ~ICtrES S-V. C~-FA ~iX Boring 0 ❑ Boring 6,5 ~Z PI( Ground surface elev. 19 Z g ft. Depth to limiting factor In. Soil Application Rate Horizon Depth Dominent Color Redox Description Texture Structure Consistence Boundary Roots 52-PD/ff In. Munseli Ou. Sz. Cont. Color Gr. Sz. Sh. 'Efft11 'Effp2 D-t~ t o L zT- L o.bl s W 15 al 7 -ZD 10\4P i 4 i0 b Sid -L 4-w-\ 0•Z_ y -4 0 A 0v P- 21 0, S rn~ t,2 5 G#Z, V4 A Hb1e kW 5T 7 ES Boring ft ~ Boring Pit Ground surface elev. $R ft. Depth to limiting factor In. Soil App;lcatiori Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Clu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 0-3 10~ 0 L maby, d 5 tab Zv --F 0,5 D, t 5-1 10Y►2Z11 ~ I ~ '74- M S 1h t3, O,5 0,8 2 3 -15 7,5YK3~ IS I OJmv' ,s 0.-1 Z_ 5 A-qo 5 0 I, 2. 12, 41,J 1►J Al t1 D+R.1 ZO S' C- -57 0A --4 • Effluent #1 * BOD > 301220 mg1L end TSS >30 = 150 nvk ' Effluent 92 a BOO 30 mg& and TSS < 30 mg/L CST Name (Please Print) gnature CST Number .10 H l.t_ srF-cJ J ZZ493- Address Date Evaluation Conducted Telephone Number W9~75 b40++•AvE~ RIDE FAuS WI 59022 09-03-02. "715 N2.6-1"17.5 yy) "S It~1~1"C sit- 17EV E~ ~y0- 12 9Z- 5~ - 00~ Pape PopertyOwner Paroe11D # ~f n Boring # Soring c' ng s I I pit Ground surface elev. _a94P R. Depth 1011mIU factor _ 7 g In. ~tl icsvon Rate Horizon Depth Dominant Color Redox Description Texture Structute Consistence Boundary Roots GPD/ff in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'ER#f 'EtT#2 (3-c~ zz S11 _ 1 ds 3~f S Q 3 27 3g I V iz~~ 12 , -t sb \.rf 0, z 0~ 3 31- IS - 0 m o Z- -Ivy Boring # ❑ Boring ❑ Pit Ground surface elev. ~ R. Depth to limiting Fedor ~ In. Soil App-lication Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPOM In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Efi#1 'EH#2 ❑ Boring # ❑ Boring Pit Ground surface elev. R. Depth to limiting factor in. Solt ApplIcation, Rata ❑ Horizon Depth Dominant Color Redox Description Texture Stnrcture Consistence Boundary Roots GP /ff In. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Etf#2 • Effluent #1 = BOO, > 30:< 220 mg/L and TSS >30 150 mgt. ' Effluent #2 a SOD, 130 mgll and TSS 30 rngrL 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. SOD-030 (R.6000) l~ ~ i ~ 111 ~1 PAG~~ -3 RI YV►T'` : CONS fieA AL VELOP- Ms~A► C0 r r ioES AD E 7KE 5~ N EC -501L OORW Ii/ VMVV✓ St. Owl)[ CODU*Y, w1X0NS1~- mo COMM 83 5efOKK PR03LEM5 2`f Zg, fib . i ~7 2 g~ gq Aj I A - 892. S 1a X145 A / 692. 1446 S.2 6 g gq~.2 i Q~~ ► ~1,►6144` 144 •J~ 143/1 / c- i 1436 +l r 6-16-07 , 42/113 ~v 143 avv. ~j SW, ,q 5lCd~En C5f ~JD s • 2`~ ~2zy832 PLAWV%>+vj 1,Q. y bale; 09- 03- 0 2 Parcel 040-1292-50-000 03/07/2014 07:50 AM PAGE 1 OF 1 Alt. Parcel M 24.28.20.1672 040 - TOWN OF TROY Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner 0 - AMERICAN CLASSIC HOMES LLC AMERICAN CLASSIC HOMES LLC 145 NEW ENGLAND PL #200 STILLWATER MN 55082 Property Address(es): * = Primary * 303 LINDSAY RD Districts: SC = School SP = Special Type Dist # Description SC 4893 SCH DIST RIVER FALLS SP 0100 CHIP VALLEY VOTECH Notes: Legal Description: Acres: 1.000 SEC 24 T28N R20W LOT 144 TROY VILLAGE FIFTH ADDITION Parcel History: Date Doc # Vol/Page Type 08/02/2005 802093 2856/065 WD Plat: * = Primary Tract: (S-T-R 40%a 160%) Block/Condo Bldg: * 09-009-TROY VILLAGE 5TH ADDN 130/145 24-28N-20W LOT 144 2013 SUMMARY Bill Fair Market Value: Assessed with: 236617 118,500 Valuations: Last Changed: 11/09/2009 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.000 135,000 0 135,000 NO Totals for 2013: General Property 1.000 135,000 0 135,000 Woodland 0.000 0 0 Totals for 2012: General Property 1.000 135,000 0 135,000 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: 12104/1998 Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 Wisconsin Department of Industry, SOIL AND SITE EVALUATION RO R T Page 1 of 3 Labor and Human Relations Division of Safety & Buildings in accord with ILHR 83.05, Wis.,A~dm. Code COUNTY Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but i ST ' G~-U L~ not limited to vertical and horizontal reference point (BM), direction and %of slope, scale or PARCELI.D'.# C5,.rpIAi G. dimensioned, north arrow, and location and distance to nearest road. APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION W -REVIEWED BY _ DATE PROPERTY OWNER: PROPERTY L ATJODi;- . ' -SW sM tq ,T-'Zb NLfz-l4k1 11)0A Ctj 1Q-TL N ~Zws-> n T' C ore-p , -6~ N~ 1/4 S L 1/4,S T ZZ3 N,R ZO E ( w PROPERTY OWNER':S MAILING ADDRESS. It ' BLOCK;# SUED.. N' E OR CSM # U LLLkG E 4 T W ~rD D --\C~P . CITY, STATE ZIP CODE PHONE NUMBER CITY ❑VILLAGE (RTOWN ' NEAREST ROAD BLR'wIj ~p"1N SS4,~y ( ) 11 L.LKj~)Sf j} j New Construction Use [4 Residential / Number of bedrooms _ [ ] AdditiQn to existing building j j Replacement [ ] Public or commercial describe Code derived daily flow 6010 gpd Recommended design loading rate bed, gpd/ft2 • 8 trench, gpd1ft2 Absorption area required 8 S B bed, ft2 -I S0 trench, ft2 Ma)dmum design loading rate • 7 bed, gpd/ft2 • trench, gpd/ft2 Recommended infiltration surface elevation(s)50 • d (-SM- W MkkjCEt"') ft (as referred to site plan benchmark) Additional design / site considerations SLY~ )-)OTIE l0 t rv STMefL 0)`1 1"ke it- 3 Parent material T--0N-Z5g o u)"2 C-" L rvL Qc,Z-r,,., rt-S LEI Flood plain elevation, if applicable 1j 114, It S = Suitable for system CONVENTIONAL I MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN RLL HOLDING TANK U = Unsuitable fors stem ®S ❑ U ELS ❑ U RS ❑ U I as ❑ U ®S ❑ U ~ ❑ S ® U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Structure GPD/ft 9 Texture Consistence Barxf3ry I Roots I in. Munsell Qu. Sz. Cont Color I I Gr. Sz. Sh. I Bed Tmnch yn >w Z g_~ l~` 1tZ 3L~ - S1l Z-m Sbk - ~,'Fh cS . S • e Ground 3 za 3'z -S `1 ~L V 16 _ - 1~s o g9 ti e s • s . I~~ Depth to S 1-136 ~•S~(23L - S 0 S9~ b limiting - factor CY) Y~'4V • S11 1~ P" -la' To Sbhz~,; L k Remarks: B~o~n3q # I' ► ~ 2 3 tz s i 1 1 wl s bk rn.~l- a~ S • Z - 3 tii^ z»; - z b Z S S -1 Vz YJ6 - 1 s Zcs bk U'Fk eS 1 -`v 3 ZS 313 t z l I s L 1 \ e Sbvc d-S •z- . 3 Ground siL S13 t si elev. ft 30 ~3 Win - \e~bk `ntv S - , Z` .3 5 3-85 li~s~ iS136 -S-1 %z s Depth to Jg s`t I ~Sbk N` C S - - z 3 limiting G -\SO lv`'L R4/ factor yr Remarks: CST Name: Please Print Phone: Arthur L. We erer 715-425-0165 ergerer Soil Testing & Design Service-P.O. Box 74 River_Falls,WI 54022 Signature. °j 4 - Z q 7 - \33 Date: CST Number:. L'Z_11' 99 22025Li. Wisconsin anRelations Industry, Labor and Human S01L AND SITE EVALUATION REPORT Page I of 3 Division of Safdty & Buildings r' in accord with ILHR 83.05, Wis.,, dl~ bode F COU Attach complete site plan on paper not less than 81/2 x 11 inches in size. PlaO must includb., but- ' ST ' ~Z-U l~ not limited to vertical and horizontal reference point (BM), direction and % of dope, scale or PARCEL IAi 6 dimensioned, north arrow, and location and distance to nearest road. , n i APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION fWVIEWED Y _ DATE PROPERTY OWNER: PF pPERTY LQaMN tl N- -SW tq , T-'Z)tJL fZt9w ~j Cl)►.~~1 tJ ~cZ1~1,U\~r'1 -t- C01t eT fJ~ 1/4 S,L1%4,S T 2-$ N,R Z.0 E( W PROPERTY OWNER':S MAILING ADDRESS- OT # I LOCK # SUBD N OR CSM # CA L t~U~ N.~. Z3v 33 - Ull~.f GE t4T* ADD . CITY, STATE ZIP CODE PHONE NUMBER CITY ❑VILLAGE [MOWN ' NEAREST ROAD L K6fU wt fv S's 4,1y ( ) TR-oY L 1 S R~ CLpJt~p [XJ New Construction Use [~Q Residential / Number of bedrooms y AdditiQn to existing building [ ] Replacement [ j Public or commercial describe Code derived daily flow buo gpd Recommended design loading rate bed, gpd/ft2 $ trench, gpd/ft2 Absorption area required 8 S b bed, ft2 1S0 trench, ft2 Maximum design loading rate - -7 bed, gpd/0• b trench, gpd/ft2 Recommended infiltration surface elevation(s)O- - 0 X80`114 '}JC1f1;S~ ft (as referred to site plan benchmark) Additional design/ site considerations SqE- NOTE- to 1k) slirt--4e2 Of`1 Parent material OkJk- r-\-_ ft-L O(,Tw"Ii Flood plain elevation, if applicable IJ I~ ft S = Suitable for system cONVENTIONAL MOUND IN-GROUND PRESSURE AT-GRADE SYSTEM IN I'LL HOLDING TANK U = Unsuitable fors stem ®S ❑ U I 91S ❑ U E LS ❑ U I ®S ❑ U IRS ❑ U I ❑ S O U SOIL DESCRIPTION REPORT Boring # Horizon Depth Dominant Color Mottles Texture Structure GPD/ft in. Munsell I Qu. Sz. Cont Color I Texture Sz. Sh. Consistence B°undaq' I Roots Bed Trerxfi 10`112- I L-t Z g_zn 1D~llz 3L~ S1j Zm Sbk ril'~h CS , 5 • b Ground 3 za 3 Z , -S `1 %L V k _ ~S p g9 r" 1 e S - • S .1, elev. 89S•8ft 2=12 10`11Zyl~ _3 Depth to S 1-L-13 6 1 •S 1-2 3d - s p S9 Ml limiting 1 - factor b~, evr\, Ng ~S S vv~ X-> U CV L o~= 1 esb1~ f'~ s11 ~~Flf 2 spa yyt U ~^'1 p- s~ S L ll 1 R0 IN I t-f $ N S'b N~ - ` k Remarks: Bon # o_ t D -t- R 3 L-Z s j 1 wt Sbk Yn Fl- a. S - Z CZ. b 2.S Z. S `Z ~l~6 - 1 s Zcs bk ►~U'Q1., cS _ •-1 .Q, 3 ?S 3n ll~-It RZII Sl` ~CSbI-t r~'f-t' ~-S •Z .3 Ground vP_ S 13 ir s i \ elev. 3 0 ~3 Sat3.1 It. , ' 1o~{1i 513 l vnv S 3-85 s i 1 *1 t1 Depth to Z S ~i tZ 6 -1-s ►z s lg s t \ ~S bk S - - Z- • 3 limiting G -150 l~j`'L I-L G C-) factor - S S 1+9 [ - , 7 15~y ' Remarks: CST Name--Please Print Phone: Arthur L. We erer 715-425-0165 egerer So'1 Testing & Design Service-P.O. Box 74 River.Falls,WI. 54022 Signature: °1 ~1- 247 - 133 Date: CST Number:. 1,Z_l~_ 99 220254 I PROPERTY OWNER (2k)KM QkbA-tct_ t~kV , SOIL DESCRIPTION REPORT Page? of ~ PARCEL I.D. xjz)) tv a ~ing # Horizon Depth Dominant Color Mottles Structure Texture Consistence Bourxiary Roots GPD/ft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Tmndi _~~ii C o-9 (O~l R 312 s1, wtfh - s 6 Z 9- -3S luK~ y16 sil ~ls eS ~ esl~k n~vf c w • z. .3 G round 3 3S-~8 7•S-ty- Sly - Sd 6h C S`3 elev. i°ls.Sft. '4 Qa-SS ~~'"~tz-~/!6 F1 5 0_ LS t 1•Sti~t Slg o CS - {vhi -Z. Depth to S sS-tS3 t~j R V limiting S S S • Z . $ factor y ? ~S 3 Remarks: 6,on # r:>~ s t l z s bk M ~r- O-S Z 9-Za 1u1-1 Vz S1L slI ZMsbk rn~ti cg - •S IUIa u~y sl J 3 718 -513 Ground , s ~t ~Z 3 ! s 1 c S U~ : ` m ~'F~- ~>N - ' Z •3 elev. S&-b'1 1 S `-l1Z y!y 89~_Gft. r1l v'Ft- Depth to s b~-l S f3 1 b f S o S limiting factor Remarks: B4r # o -tZ L~ 2 lz - s t Z,►xa-bl►r wt'F i S - . S 1-S -1 h Ground 3 3$ 3l y S C3 sg 1 _ elev. , gq3 it. I Depth to limiting i factor Remarks: 3oring # >f around elev. ft. )epth to imiling actor Remarks: •rl o•r •rnrf+.'.r n . PLOT PLAN Page of 3 SCALE 1"= 5o ' n, ti. S ~ l rv t TL tom, Z1'tx'~/ ~S 4b `b ^S, a bolo _ - ~p -c v ~"'1 -Lt 89~.S~' ov 1t~ l RLU ~~t p~ `V 5 ~~+~E~O 8E H'~2~~T_.ZS `_F►?<aF1,I1~St(t~,~ . wt ~X1►~ u M - fl' cov ~2 c~v L Z eVwkft ~ff",, s, 9 9 -Zq-1- l3 3 •,5 '1 _ Z_ l' 4' 9' (715 ) 4 2 5 - 'I S CST Signature Date Signed Telephone No. CST #