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040-1326-19-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 582021 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 Township Parcel Tax No: DCCI Land Planners TOWN OF TROY 040-1326-19-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: yn cs"r 17.28.19.2211 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER 1 CAPACITY STATION BS HI FS ELEV. Septic ►>✓5e ~ 1•tjK, ~4D0 Benchmark 16Zq -Z) Dosing L (o dQ Alt. BMr `i.,, y Pp I d Sz Bldg. Sewer Holding St/Ht Inlet TANK SETBACK INFORMATION St/Ht Outlet 3. -15 31.63 TANK TO P/L WELL BLDG. V t to Air Intake ROAD Dt Inlet Septic 7 l /6 1 , r AFt^ Z Y Dt Bottom Dosing Header/Man. b 7--) ,7. Z 9f . ZI!p Aeration Dist. Pipe 7r2,f5' Z(, Holding :d- Bot. System S. Z '-Z. y Z(i 6 ~C PUMP/SIPHON INFORMATION Final Grade Manufacturer Demand St Cover ~I / / JD~~ y g GPM (-A/ Model Number TDH Lift Friction Loss System Hea T)H Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length/ s No. Of Trenches PIT DIMENSIONS No. Of Pits Inside D' . Liqui a th DIMENSIONS 3 9'S sA 3 ~ie- _ l~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: Z li t~ INFORMATION CHAMBER OR Type Of System: , / G UNIT Model Number: 1 dvf t/C •/Ir ~ Alk V-' I•~- DISTRIBUTION SYSTEM _ gx3=z 4-t ZS Header/Manifold_ g it Distribution ix Hole Size Ix Hole Spacing Ven o Air In ke Pipe(s) L- Dia Length Dia Spacing` SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only " Depth Over t Depth Over xx Depth of jxx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil No I --f5 es ~ No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 385 MEADOW VAL~Rl- / / ~ Ls✓Q~, C . a, ~f 5 L- a X12.5 -6 fry 1.) Alt BM Description = 2.) Bldg sewer length = 3f , - amount of cover A i~(A V D 1 CrdL k EZ. I~/ew 4L ~e~' ~d %ZC O• !o Plan revision Required? Yes *6'0 2 Z Use other side for additional information. ~ SBD-6710 (R.3/97) Date Insepcto Signal a Cert. No. e oft 1000 Aft N1 County Safety and Buildi ivis'on r c4o;x fl & S 01 W. Washington Ave,,, C X 7 62 Sanitary Permit Number (to be filled in by Co.) Madison, WI 3707- ST CROIX C UN"IY 7~ 5~ Z b Z AMR ROOF" anltaly ermit ppiication state Transactio Number In accordance with SPS 383.21(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 submitted to Project Address (i different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law, s. 15.04 1 m , Stars. jf L Application Information - Please Print All Information Ohe~9~~ UQ Property Owner's Name Parcel # c C: :r L la c 040-- )3>4- I9-006 Property Owner's Mailing Address Property Location 17. a Ot i a l 180S Awi, 1 S V - 4 S Govt. Lot Al_ City, State Zi Code Phone Number Zip N-W- _a61'/, Section Z t 541>1 circleSn _ ~OtW T 7.O N; R II. Type of Building (check all that apply) Lot # Al or 2 Family Dwelling -Number of Bedroo s Subdivision Name B El Public/Commercial -Describe Use 6k 6%hb ❑ City of ❑ State Owned - Describe Use Q~LQ' p~ c~J CSM Number ❑ Village of ' 6" Ouj Town of 7W 1, III. Type of Permit: (Check only one ox on line A. Complete line B if applicable) A.. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) 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) il~Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank O er ispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Trea ent Area Information: Design Flow (gp( ) Design Soil Application Rate sf) Dispersal Area Required (sf) Dispersal Area Proposed System Elevation 7sv 17 J a72 Zoo', 9 .3ja VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units y o v ^ New Tanks Existing Tanks o xWl! O /,0 a- U v y v U a Septic or Holding Tank 1000 D t~D ' S JAI Dosing Chamber VII. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber; ;,Signature MP/MPRS Number Business Phone Number ~v/ 12 l('oc~i/try Aw22 SI//a 5'e- -2 64 4V Plumber's Address (Street, City, State, Zip Code) 22-1 w cai► _ ♦i dG /Uc.~' ia►aati. ~j VIII. Coun /De artment Use Only Approved ❑ isa Permit Fee Date I sued Issuing nt Signature Owner Given Reason for Den 7 ✓ IX. Condi sans fo ?(sapproval 3 n J't ~V Ai J fsal Cefl must ill he servlbes /maim ff ff AA t/ 'as per msnegemerrt plan provided by plumber. 2 AN s0limfck req" must 0& rpaintairt'ed as Per applitatbfe code / ordinances. j, Attach to complete plans for the system and submit Yo the Co my only on paper not less than 8 1/2 x 11 inches in size SBD-6398 (R. 11/11) i i ~ r ~;s ~ cue a •'y / l J l C t' y~ -r P7 ~r. ( E c f rl -zl vv~ m \ I 'mot T CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: _0 G a,~ nL rl Owner's Name: Owner's Address: fl Legal Description: w S GGti R~ '"2 $ Rig W Township: T{ a t^ County: ST C~ 2i Subdivision Name: DU - Lot Number: L.DT Parcel ID Number: 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: ~j-'e ~C- License Number: AIC-7 ,.?2Syfy Date: 46 20 2rlr" Phone Number 7!S- -2 `1- .glee Signature Designed pursuant to the in-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01101). Page 1 i ~4S lrrp A'I . J 1 3-~~. ac M ~ N d ~L4' ~ LL9fi C^ J Irk F r . r\e~ K(7 M / d 3 0 ( 'a.a M ~ 4ti, "`dµ t SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page_of Project Name: No. of Cells_ Per Cell ft Cell Width 1 Total No of _ ft Cell Length 0 0 sq ft EISA Per Cell ft Cell Spacing sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-1011 10.0' 50.0 Gravelless Leaching Unit Manufacturer: 2' p w Gravelless Leaching Unit Model: Z , Z p ~~71G Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent L D Soil Backfill in s Geotextile Fabric O it Infiltrative Surface 12 in ~ I i -Y ft Limiting Factor n Slotted and Anchored Vent/ Observation Pipe with Cap Plumber/Designer Signature: License lf: 22 sy~~ Date: ta. 4i Inc Innovations it) Precast.➢rainaga _ a~ a= Zabel' PL-525 Effluent Filter & Wastewater Products v1 A Division of Polylok Inc,. PL-525 Filter The PL-525 Filter is rated for 10,000 GPD (gallons per day) making it one of the largest filters in its class. It has 525 linear feet of 1/16" filtration slots. Like the Polylok PL-122, the Polylok PL-525 has an automatic shut-off ball installed with every filter. When the filter is removed for cleaning, the ball will float up and temporarily shut off the system so the effluent won't leave the tank. Features: 1/1.6" Filtration Slats • Rated for 10,000 GPD (gallons per day). Alarm switch 1 00d ~ PD (Optional) • 525 linear feet of 1/16" filtration. ~ , Accepts 4" and 6" SCHD 40 pipe. Accepts 1" PVC Extension Handle • Built in gas deflector. • Automatic shut-off ball when filter is removed. • Alarm accessibility. Rated for • Accepts PVC extension handle. 10,000 GPD PL-525 Installation: Ideal for residential and commercial waste flows up to 525 Linear Ft. 10,000 gallons per day (GPD). of 1/16" Filtration Slots 1. Locate the outlet of the septic tank. 2. Remove the tank cover and pump tank if necessary. 3. Glue the filter housing to the 4" or 6" outlet If Accepts 4" & 6 pipe. SCFfD 40 pipe the filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter. 4. Insert the PL-525 filter into its housing. 5. Replace and secure the septic tank cover. - Certified to NSF/ANSI Standard 46 PL-525 Maintenance: The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified - Gas Deflector septic tank pumper or installer. _ Automatic 1. Locate the outlet of the septic tank. Shut-Off Ball 2. Remove tank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed. 4. Pull PL-525 cartridge out of the housing. = 5. Hose off filter over the septic tank. Make sure all solids fall back into septic tank. 3 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. Outdoor sn'artFxlter<.- Alarm Extend & LcskT" Polylok, Zabel & Best filters accept Easily installs 7. Replace and secure septic tank cover. , the SmartFilter'J switch and alarm. into existing tanks. Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203.284.8514 www.polylok.com ~SW~N9S p0S1YP'! %~A"V NVId 1503NV1S ..6 AM JO KUM wwco A3IIVA MOOV3W 6l lOl Nouon 11SN00 N31H830 O r a n J c+1 II O N 3 S O N O co 2W 2 C, W co U 0 J Y N m N M 11 2 W WW 0 o~i QYWU W? CD Z U N W m W I-- W O Lu W U W U J = Z co p p 0 W J Z W W Z W0: 2 c W C9J R J ~'LL O Co a Z0mz mw Q N Z F- O N o Q O Q} J U co Ym-~7~ V1 W Q Z m vm vU m LL N m m a N fN9 m U ONJ / CBE E9Z 3SZ$ • ~ l,0lN co J N 9f~Op Q W~ O / p q O o- z 01 • 'sue rr ` ` MEADOW ~ ~ W 2 U 7 W Z QW 2 ? Q W W Q m Zw Q Q Q2 ~Z CD ow a o0 LLI V W I ~ START UP AND OPERATION Page 2 of For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are die ected have the orate 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 discharged to the dispersal oell(sl in one large dose, overloading the cell(s) and may result in the backup or surface discharge effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restod power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating eratin the restore normal levels within the pump tank. y p 9 pump controls Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the ar 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 t POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; f.; foundation drain (sump pump) water, fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; a painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the followin st properly and safely abandoned in compliance with cha g eps shall be taken to insure that the system pter 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 wid 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 compliart replacement system: C A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorptkir system. The replacement area should' be protected from disturbance and compaction and should not be infeinged upon b) required setbacks from existing and proposed structure, lot lines and wells- Failure to protect the replacement area vL it 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 POWT"S technology a holding tank may be installed as a last resort to replace the failed POWTS. alua IN - mg ~a, m e a >40K18TT i~Or2- C~NSTR~I or l 7k 11 Mound and at-grade sore absorption systems may be reconstructed in place following removal of the blomat at tire. infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that time. < < WARNIll > SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUF'F'ICIENT OXYGEN. DO NC T "TER 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 cOMlu1ENTS r POWTS Ii1lSTALLER - - Name POWTS MAINTAINER or. 7~ jl 00, l Name Phol Phone 7 S'- Z Y~- 2~h SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name 2011~1~/. . Phone Name jf,~- - C~ It le) U rr Phan -3 r'P !v a This document was drafted in compliance with chapter Comm 83.22(2)(b)(11(di l<(f) and 83.54(11. (21 & (3), Wisconsin Administrative Code. POWTS OWNER'S MANUAL & MANAGEMEO 1 NT PLAN Page of -2 FILE INFORMATION MPermit## cc SYSTEM SPECIFICATIONS ~J Septic Tank Capacity 1-9 ~ qa( 0 N, Septic Tank Manufacturer (a~ C.•StY Q No DESIGN PARAMETERS Effluent Filter Manufacturer P Number of Bedrooms ❑ N ~ q NA Effluent Filter Model S ON I Number of Public Facility Units 0 NA Pump Tank Capacity Estimated flow (average) i gal _ N r A ~ gal/day Pump Tank Manufacturer Design flow (peak), (Estimated x 1.5) qal/da Pump Manufacturer p Soil Application Rate al/day/ftz Pump Model N.a Standard Infiuent/Effluent Quality Monthly average* Pretreatment Unit ` Fats, Oil & Grease (FOG) 530 mg/L Biochemical Oxygen Demand (HODS) s220 mg/L 0 NA ~ Sand/Gravel Filter ❑ Peat Filter Total Suspended Solids (T5S) 5150 mg/L ~ Mechanical Aeration D Wetland ❑ Disinfection (7 Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) Biochemical Oxygen Demand (BOD51 mg/L d NA JS In-Ground (gravity} ❑ In-Ground (pressurized) Total Suspended Solids (TSSI 530 mg/L Q NA ❑ At-Grade Fecal Coliform (geometric mean) S70' ofu/100ml ❑ Mound 4 Diip-Line ❑ Other: Maximum Effluent Particle Size Y in dia. ❑ NA Other: - Other: ❑ NA ❑ NA Other_ ❑ NA *Values typical for domestic wastewater and septic tank effiruent, Other: ❑ Nil MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: ❑ month(s) +3 0 Year(s) (Maximum 3 years) 11 Nit Pump out contents of tank(s) When combined sludge and scum equals one-third ()'s) of tank volume- ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) OL year(s) (Maximum 3 years) D NEB Clean effluent filter At least once every: l ❑ month(s) • F_ year(s) ❑ NA Inspect pump, pump controls & alarm At least once every. 13 month(s) ❑ (ear(s) 49 wk Flush laterals and pressure test At least once every: O month(s) Other: ❑ year(s) NL, At least once every: ©month(s) other: O year(s) s13~N~, N~. 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, inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, ides identify any cracks or leaks, measure the volume of combined sludge and scum and to check for an back u or The dispersal cell(s) shall be visually inspected to check the effluent levels In the observatiiong pipes f effluent t o check for any on the ground ponds s, of effluent on the ground surface. The ponding of effluent on the ground surface may indioat afail failing condition and eq i est he immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (Y) 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 11:3, 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. f!~'1!1 W V O Z 3}sag PP " as}-.. a- F x ¢s§r~p 2F Z" r p ~~V 3 ~imW ems m a d c }A } }Y ww Y } }Y z 2! 7S u' a 1~3 cu.o °x°•5.7 W"r N~ .a'~ E3 -9 R. B E o0 0 g o 2 . O ;z~ His ~s3W= o~- a q, ~ ~ n e st q~x•ce as R- qq g;R g 3 3 ° 2 u ° c s O° c .1 9Eat axe 9as~Q's°~3a98 W W V r f S N g &a:iR r~ >Xxiaax RR g x Rxg S y~ 8 '1 ~ Bx~~AIIaxxs d'xR Ai Add: ~~C~i~~~~~s8;~~ 00s 8 a } Ypa "x"3a"A 535a a~Y a ~ 3 h HIM 44ak§0k ba b k" k'saMa&kgkip u~. FO ~ • ~ ~ ~ ~ ~s:~~a~ I-~a~~ ~ ?a@sa. s e~asggeea qqagqagq5agga rae 0 2 LL Sc'< sx YiW ~g< ofRD4a~YC88E9-i~d95Y7d3d32dddSB"aS"ai § Aaaaa W H W .fl 86ne111 ill! "g€ ~nonnoo ea°o$ BOB a 2 282298 66 M is IM In CDYMlYCOOIIOWUF[M`~IB[r ~ A ' / J ~ / 0 -.K[D Y w~ Yl A ao'[[[_ R aYU W W ~ - g& / ~.(8 _ / % "sty / / / / I ~ 110 all zV qg[g[ ~`•,r,i j a3y..i-'"i ) i N>ty ~I sp~~M - Ye ` r ! ~Illt pg~= 13 O$ ~7 ~~Jh r nd~~! 1~ 1 g~ S \ ~A33~a`9 o m c -S -S f f f O v o - 'u a n I 1[ru[ I n.a[mx i Z~ I I I wF' 4 '4 W ~ o namoin V W V. V W ` I I I ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address Per' b G y~ 44TC, f ~ ['21 cj 3 ~ 11, 1.~ t M<, 4.~€ . t Property Address I (Verification required from Planning & Zoning Department for 2 new construction.) City/State Parcel Identification Number t3 2- C, LE..,. L DESCRIPTION P-le `ht~! Property LoG*Dn '6 kw '/q J j Sec. , T Z$ N R W 19 Town of I~ y Subdivision r'- %cJEF 1 9 Lot # Certified Survey Map # Volume Page # Warranty Deed # E,PL a rag 1 Volume 2l 1 , Page # S f Spec house yes no Lot lines identifiabl dyes 7;'lo SYSTEM MAIN TENANCE AND 0 'UV1[ER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper the maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into system can affect the function of the septic tank as a treatment stage in the waste disposal stem. responsibilities are specified in §Comm, 83,52(]) and in Chapter 12 - St. Croix county Sanitary Ordinance Owner maintenance The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed b the owner and by a master plumber, journeyman. plumber, restricted plumber or a licensed pumper verifying that (1) the on-site y wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage di osal standards set forth, herein, as set by the Department of Commerce and the D ye sP system with the Certification stating that your septic system has been maintained must be completed and returned ed to the SteCroix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on is form are true to the best of my/our knowledge. Uwe amlare the owner(s) of the property describe bove, by virtue of a w anty deed recorded in Register of Deeds Office. Number a s S G 1c, //3/ OF/APPLICANT(S) DATE ***Axay 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. (REV. 09105) fhb" rdui All) De artrrlWi s p = Safety and c ~L ~ALUADQ_NREPORT #1758 - Professional S"Cls Q j 2n accordance with Comm 85, Wis. Adm. Code Page 1 of 3 wry Schmitt Soil Testing, Inc. Attach complete site plan &ILlkilDOWNfiligpoint RX 11 inches in size. Plan must County include, but not limited t6. (BM), direction and St. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel I.D. Please print all information. 7 Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ / 2-119( Property Owner Property Location DCCI Land Planners Govt. Lot NW1/4, NW1/4, S17, T28N, R19W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 1505 Hwy 65 P.O. Box 445 19 Meadow Valley Of Troy City State Zip Code Phone Number ❑ City [l Village ❑ Town Nearest Road New Richmond WI 54017 Troy East Cove Rd ❑ New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement ❑ Public or commercial - Describe: Parent material Outwash Sand Flood plain elevation, if applicable NA ft. General comments Area is suitable for a conventional system with a 0.7 gpd/sqft rate. Possible system elevation for Area 1 is (Step Trenches) 957 & and recommendations: 95.0'. Slope is 8%. Boring # ❑ Boring Pit Ground surface elev. 97.65 ft. Depth to limiting factor 115+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 *E1142 1 0-15 10yr3/1 none sl 2mgr mvfr as 1vf 0.6 1.0 2 15-27 10yr3/4 none sil 2fsbk mvfr gw lvf 0.6 0.8 3 27-35 10yr4/4 none sil 2msbk mvfr gw lvf 0.6 0.8 4 35-47 7.5yr4/6 none girls lcsbk mvfr gw lvf 0.7 1.6 5 47-80 10yr5/6 none grs Osg ml cs 0.7 1.6 6 80-115 10yr6/4 none s Osg ml 0.7 1.6 Boring # Boring Pit Ground surface elev. 98.45 ft. Depth to limiting factor 112+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Efffl •E,02 1 0-8 10yr3/1 none I 2mgr mvfr as 1vf 0.6 0.8 2 8-17 10yr4/3 none sil 2fsbk mfr gw lvf 0.6 0.8 3 17-23 10yr5/4 none vgrls Osg ml gw 2vf 0.7 1.6 4 23-64 10yr5/6 none grcos Osg ml as 0.7 1.6 5 64-112 10yr6/4 none s Osg ml 0.7 1.6 * Effluent #1 = BOD? 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODS S30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signature: CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd Street New Richmond, WI 54017 5/5/2014 715-760-1978 SBD-8330 (R.07/00) Property Owner DCCI Land Planners Parcel ID # Page 2 of 3 3~ F Boring # E] Boring Pit Ground surface elev. 100.40 ft. Depth to limiting factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 -Eff#2 1 0-11 10yr3/3 none sl 2mgr mvfr Cs lvf 0.6 1.0 2 11-19 10yr3/1 none I 2msbk mfr cs ivf 0.6 0.8 3 19-30 10yr4/3 none sl 2fsbk mfr gw ivf 0.6 1.0 4 30-39 10yr4/4 none sid 2msbk mfr gw 1vf 0.4 0.6 5 39-60 7.5yr5/6 none Is Icsbk mvfr gw ivf 0.7 1.6 6 60-76 10yr5/6 none Is Osg MI Cs 0.7 1.6 7 L76- 10 10yr6/4 none 1 s Osg ml 1.6 g- . 7 F4Boring # Boring Z Pit 2 • y5 Grounds ace elev. 97. ft. Depth to limiting factQw 94+ Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consiste Boundary Roots GPD/ft- in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#l •Etf#2 1 0-16 10yr3/1 none SIL 2fsbk mvfr as 2vf 0.6 0.8 2 16-33 10yr4/4 none SIL 2fsbk mfr gw ivf 0.6 0.8 3 33-38 10yr4/6 none GRSL 2msbk mfr gw ivf 0.6 1.0 4 38-63 10yrS/6 none VGRCOS Osg MI Cs 0.7 1.6 5 63-94 10yr6/4 none COS Osg MI 0.7 1.6 F-I Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 - * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 <150 mg/L * Effluent #2 = BOD5 < 30 mg/- and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or SBD-8330 (R.07/00) need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. Schmitt Soil Testing, Inc. - - Cdueted by Page 3 of 3 Schmitt Soil Testing, Inc. Name; _ DCCI Land Plan&rs Thomas J. Schmitt, CST 227429 Address: 1505 Iiwy 65 _ f 595St - L;~tY; State; Z►1~:. - c mon ~'iS40i'T- - - - - _ New Richmond `WI.540i7 Phone 715=760-1978 - Subdivision: Meadow Valley; Of Troy: ---$igna ture ` - -~t~ua.~VUIl4S1-~- ■ Backhoe Pit ~9 - - - 88cfi IfAalfic~l ~pII;' flop oft" PvC-P~pe Township, County: Troy Townfihip, St. Croix County - -A_8ench-Mlad 2l"12.97'-Iop Slope=l g% - - - - - - Jam- - . - - - _ _ LJD - - -