HomeMy WebLinkAbout040-1256-80-000
s yr County L V
Safety and Building ision
ti 201 W. Washington Ave. B 7162 Sanitary Permit Number (to be filled in by Co.)
P OC;T Madison, WI 53707- C
$
6 ST. CROIX COUNTY
E _P4
Sanitary er nit Application State Transaction Number
In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit x E7
is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to trTject Address (if different than/rrailin address)
the Department of Safety and Professional Servies. Personal information you provide may be used for secondary Z~ , A~W T- j )P&W/I
puwWrposesmacc ordance with the Privacy Law, s. 15.04(1)(m), Stats.
1. Application Information - Please Print All Informati
Property Owner's Name Parcel #
15T6 I ~l n iVsol~ ow o00
Property
(~Owner's Mailing Address Property Location aA • .
j) D t t q Govt. Lot ~/bk
City, State Zip Code S Phone Number /yy~ - y, y., Section .2i
~J~~ 0 ?j ((crrcle one
1 LLB / /
AW
H. Type of Building (ch ck all that apply) Lot # T 28 N; R Z7) E or W
A or 2 Family Dwelling - Number of Bedrooms Subdivision yN~ame /u
Block # I-ROY 11I L -6 ~ 4 r" t
❑ Public/Commercial -Describe Use
❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
6 `r G ✓ 1 Town of
X 64 19
M. Type of Permit: (Check only one box on line A. Complete line B if applicable)
A. gNew 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) A p v
❑ Non-Pressurized hr-Ground ❑ Pressurized In-Ground ❑ At-Grade Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil H
❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain)
V. Dis rsaVfreat eut Area Information:
Design Flow (gpd) Design Soil Application (gpdsf) Dispersal Area Required (s Dispersal Area Propose sf) System Elevation
o• ysD `~Z ~d i 125 /0l7 <-3~
VI. Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units o d v
New Tanks Existing Tanks ° 2 A
ro 0 SZ a v vo Vn i C7 w
Septic or Holding Tank
Dosing Chamber p fi
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber' Signature MP/UAVANumber Business Phone Number
zle 7 715,2-7 -1 y -T-7 7
Plumber's Address (Street, City, State, Zip Code)
W( o
VI oun /De artment Use Only A
Permit Fee Date ssd Issuin ent Signature.I I Approved ❑ $ ~
E_92ep@ien Reason for ial ~Zs Zue/~
IX. Cond' Y1easons for Disapproval r
1' = t4* tank, elfhtent MW and 3 Co o A'% .dispersal cep mtaet all be siervisas 1, maintained
ti
as permenegornent plan provided by plumber. `f t C W l
~ , .~►b :ss~rck requl~lltfi ~tst ke m~n~~ir~d
as par appNcebieCode / ordlunm,
Attach to complete plans for the system and submit to the County only on paper not less than 8 llz x 11 inches in size
SBD-6398 (R. 11/11)
Hot PIM e 90 -
Owner. s~
I ~ = 40.t
1-sr Legal Dewr4ndon t®z, y v~~&-r- 3r2,1 (except rgD 1,4 iwE yw' y OF - .S e 5 sW- z,V2EA4) R m A e
Pit
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Y- y
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Y~R1.1 rE, DIVISION OF INDUSTRY SERVICES
3824 CREEKSIDE LN
HOLMEN WI 54636-9466
o'j ® 1P~
Contact Through Relay
Cj http://dsps.wi.gov/programs/industry-services
19 P www.wisconsin.gov
2~~ tiv
4 Scott Walker, Governor
~OssroN~~ S~
Dave Ross; Secretary
October 05, 2015
CUST ID No. 224832 ATTN: POWTS Inspector
MARY JO HUPPERT ZONING OFFICE
HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA
W9875 690TH AVE 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
CONDITIONAL APPROVAL -
PLAN APPROVAL EXPIRES: 10/05/2017
SITE: entification Numbers
Steven and Diane Johnson TID No. 2610315
264 St Arme s Pkwy 17463
Town of Troy se refer to both identification numbers,
St Croix County , in all cones ondence with the a ency.
NW1/4, SETA, S24, T28N, R20W
FOR:
Description: Three Bedroom Mound System / 1% slope
Object Type: POWTS Component Manual Regulated Object ID No.: 1557003
Maintenance required; 450 GPD Flow rate; 36 in Soil minimum depth to limiting factor from original grade
System(s): Mound Component Manual - Ver. 2.0, SBD -10691-P (N.01101, R. 10/12), Pressure Distribution
Component Manual - Ver. 2.0, SBD-10706-P (N.01101, R. 10/12); Effluent Filter
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed
and located in accordance with the enclosed approved plans and with any component manual(s) referenced above.
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code
requirements. CO NDIT
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, APP
stats. DEPT OF S The following conditions shall be met during construction or installation and prior to occupancy or use: P C S S I C M
[)[VISION OF INS
Reminders
• A sanitary permit must be obtained from the county where this project is located in accordance with the
requirements of Sec. 145.19, Wis. Stats.
• Inspection of the private sewage system installation is required. Arrangements for inspection shall be made wi `EE rtizS
the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats.
• A state approved effluent filter is required. Maintenance information must be given to the owner of the tank
explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided
per SPS 384 product approval conditions.
• The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or
soil compaction is prohibited in this area.
• A copy of the approved plans specifications and this letter shall be on-site during construction and open to
inspection by authorized representatives of the Department which may include local inspectors.
I
MARY JO HUPPERT Page 2 10/5/2015 c
Owner Responsibilities
• The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating
to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and
maintenance manual and/or owner's manual for the POWTS described in this approval.
• The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS
occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans.
• The owner is'responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized
in the POWTS.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 250.00
This Amount Will Be Invoiced.
erard M Swim When You Receive That Invoice,
POWTS Plan Reviewer, Division of Industry Services Please Include a Copy With Your
(608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal.
jerry.swim@wisconsin.gov WiSMART code: 7633
cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm
MARY JO HUPPERT Page 2 10/5/2015
Owner Responsibilities
• The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating
to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and
maintenance manual and/or owner's manual for the POWTS described in this approval.
• The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS
occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1).
• In the event this soil absorption system or any of its component parts malfunctions so as to create a health
hazard, the property owner must follow the contingency plan as described in the approved plans.
• The owner is responsible for submitting a maintenance verification report acceptable to the county for
maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized
in the POWTS.
In granting this approval the Division of Industry Services reserves the right to require changes or additions should
conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review
shall relieve the designer of the responsibility for designing a safe building, structure, or component.
Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address
on this letterhead.
The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any
others who are responsible for the installation, operation or maintenance of the POWTS.
Sincerely, Fee Required $ 250.00
This Amount Will Be Invoiced.
CoerardMwim When You Receive That Invoice,
POWTS Plan Reviewer, Division of Industry Services Please Include a Copy With Your
(608)789-7892, Mon - Fri, 7:15 am - 4:00 pm Payment Submittal.
jerry.swim@wisconsin.gov WiSMART code: 7633
cc: Edwin A Taylor, Wastewater Specialist, (715) 634-3484, Monday - Friday 8:00 am To 4:30 pm
I
MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN
Residential Application
SEA INDEX AND TITLE PAGE
ern
Project Name: STEVEN & DIANE JOHNSON
Owner's Name: (same)
OwrmWs Address: 687 Broadway St. S _
Stillwater, MN 55082
LEI Description: NW 114 of the SE 1/4 Sec. 24, 728N R20W
Township: Trod
County- SL Croix
Subdivision Name: Troy Village 3rd Addn. ONNALLY
Lot Number 102 - Block Number NA J :F OVED
ETY AND
%L SERVICES
Parcel I.D. Number: 040 -1256 - 80 - 000
STRY SE VICES
Plan Transaction No.:
Page 1 Index and title
Pam 2 Data entry
E NC; E
Page 3 Mound drawings
Page 4 Lateral and dose tank
NMJO Page 5 System maintenance specifications
Page 6 Management and contingency plan
I) 1M Page 7 Pump curve and specifications
LAVER Page 8 Plot plan
W1
*46 tltltlt
Designer. Marry Jo Huppert Umense Number 1859 - 007
Dom: 09/p5 j15 Phone Number: 715 -426 -1775
Signature:
Designed Pursuant to the
Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01101), and both
SSWMP Pubiication 9.6 Design of Pressure Distribution Networks for ST-SAS (01/81) and
Pressure Diabibution Component Manual Ver. 2.0 SBD-10706-P (N. 01101)
Version 7.0 (R. 03/2012) Page 1 of 8
Faae main *Onmc6 Aa tot or emss to awacid at and Fem. Lawats a* Wrok al ,
+E~_ P
* - 'FUM. tp v9 bsM v* w or j+'X --+W2 Lat"S ifOfiCll s* h 40 PVC
oWenoutpiup per SPS T 384,3066
HoMx,~iMd on tRar bouoa► of tMt iiofral.
Mound and Pressure Diefbibution Component Design
Design Worksheet
Site information
(R or C)_ MR Residential or Commercial Design Noce: sand to (fl) calct~ asp a
1 300.00 Estimated Wastewater Flow (90) T ' sod Vedlivwd , s for
110 Peaking Factor (e.g. 1.5 =150%)
450.00 Design Flow (gpd)
1.00 site slope
99.80 Contour Line Elevation (ft)
38.00 Depth to Limiting Factor (in)
" OAO In-situ Soll Application Rate (gpd1e)
Distribution Ceti Information
45.001 Dispersal Cell Length Along Contour (ft) = 10.00 Cell Width (ft)
I 1. Dispersal Cell Design Loading Rate (gpdW)
M 1 influent Wastewater Quality (1 or 2) Are the laterals the highest point_ rg_.....
in the distribution_ y p
Presure Dkwomton InfornwMon network? Enter Y _
(C or E) l Center or End Manifold
3.33 -Lateral Spacing (ft) If N above, enter the
w 3 Number of Laterals of the highest point .
0.188 Orifice Diameter ('m)
Yf1 3.SOi Estimated Orifice Spacing (ft) = 11.54 ftz/orifice
, .
_2.00 Forcemain Diameter (in)
M 178.00 Forcemsin Length (ft) Does the forcemain drain bads? Y
82.00 Pump Tank Elevation (ft) Enter Y or N
System Head (ft) x 1.3 29.03 Forcemain Drainbadc (gal)
E~125
7.89 Vertical Lift (ft) 59.95 5x Void Volume (gal)
_2.57 Friction Loss (ft) 88.99 Minimum Dose Volume (gal)
0.00 In-line Filler Loss (ft) 25.56 System Demand (gpm)
23.711 Total Dynamic Head (ft)
Lateral Dkinwiter SefecWn Manifold Diameter Sele doa
in. dia. o bons choice in. Edia. choice
0.75 11.00 1x x1.25 x 21.50 x x 3_ x
2.0~/0~ x ~ i
3.00 .y ..,.....,.T...,.fl . f
I\ . Galkw nch CakubAw (optional)
Treatment Tank Infomration 1 Total Tank Capacity (gal)
1000-00 Septic Tank Capacity (gal) Y Total Working Liquid Depth (in)
Wieser R m W i Manufacturer gal/in (enter result In call 849)
Dose Tank Information Efuent_FOW IMonnatlon
650.00 Dose Tank Capacity (gal) oiyl ok Filter Manufacturer
Filter Model Number
`17.00 1 Dose Tank Volume (gaUin) 525 ,
Weiser m _Manufacfiurer
Project STEVEN & DIANE JOHNSON Page 2 of 8
t
PVC
plus
~ioal -
PVC
e
n
WYA
p1u
S
eai
!`C
Mound Plan and Cross Section V'Ww*
1/10 B
K : r.rY.r•r.r•r- y r a.r.d-r- r•r.rr.. r.r ~•r t•r. rr rti <p'.l.t.i.,•r•,a r.. r rY '
S•'L•YS+1.'NLK•YY4•SK.YYS<Y '.•'L•YL.S.YYS•S.YS~MS•YS .KKWL LKH
JM<f.J• r.t•J•J•,f•.P•J•J.J•J.J .••J•Ja••J•J•JY.J•J.J•f•l+hJ.•~J•J•
'~.<S•Y1.4•SKxY1.•S+Y#K•S• 5 VS•YS•1•YS•S.VSKK•1•SKKK.Y K•YS•1 A
r•hr• r-r.r-JY•r.r.r• •r•r•r.r•r-r•r.rYY.r.r•r•rY•r-r-{Y r.r•r•r•r '
'°hr.S1..<'yP•r::.~~1Y~rYAJ.+r•J.."=r~J+Jir.."•'SMJir:'r~"T+JSd°L.d l l4w•r~fid.lr•r.Yrw •Y.•Sw7'~r -
S.LK•1•SKKKK.SK+V L•LK•S•S.Y`~KK+SK•L•S•YS.YL•'NSK+YS.S.Y#•'.•S•LH•L.S.YS
w 1. B
i
L
Mound CoMponent DifneMkMa
Down slo toe extension made.
A 10.00 ft E 7.20 in H 1.00 ft K A30.16 ft
B 45.00 ft F .25 in I 15.00 ft L ft
D 6.00 in G 0.50 ft J 5.16 ft W ft
450.00 (fe) Dispersal Cell Area 1125.00 (fe) Basal Area Available
10.00 (gpd/ft) Ling Loading Rate 4.50 (ft) 1/10 B Obs. Pipe Placemervt
Mound Cross Section View
Aggregate Dispersal Area
Finished Grade 102.07 (ft)
/
G H
.JIJf!!!/~/J..I:JIJf.
F Call 100.80 (ft) Lateral
ENSPOMW
100.30 (ft)--~ Invert
Dispersal Cell
Elevation D
4
4
x 80 (ft) Contour Elevation
1.0 % Site Slope
Geotextile Fabric Cover
Shading Key T Dispersal CeN See lateral deter on
Topsoil Cap _ 1.5 ft r•r.T•rrY.r.J r•r,r.r t.r Page 4 for number Size
Cap r•r•.^.fr~'•1.r.r.r:r.~•r•J.r
Subsoil ~ and spacing of .
ASTM C33 Sand 1 eterals are equally
'Q1 .i}1': " LgS•S. Spaced ~ the
0. Il •'r.'.rS.L K.1•S.S y YY'J ~ S
Tilted Layer f °i T . L IAY R74UlJ[I isbib{~ubon Ye,11p
Aggregate Q •rJ.r•r.rYY.r.r•r.rY.rr
VYS•YS•1•Y1•VYSK•V
1YYY•JY.J•J'.. J•J~J.hh l in the
S•S•LS-S-i•S.L+V V ..LK•
~e----r-W- A distribution can (AxB>-
Project STEVEN & DIANE JOHNSON Page 3 of 8
End Connection Lateral Layout Diagram
.aolose* *CW*1*.*Aasaa~,..skM+ r:muff.a+~resw~~wtr. o.ml.r.euiotr.o
b , I ai the s~al
HDOWS 000d aafte
'Lv*er4sft &*woe.*In Solt 4Q PHC per SPS T*bW 364 3" g wes aaman~fold at ar+' pout
P PF0m*mai*.oc%vwed**w1sft*cr4
Number of Laterals 3 Orifice Diameter 0.188 in
Lateral Diameter 1.50 in Orifice Spacing (X) 3.63 ft
Lateral Length (P) 43.56 ft Orifices per Lateral 13
Lateral Spacing (S) 3.33 ft Orifice Density 11.54 /orifice
Lateral Flow Rate 8.52 gpm Manifold Length 6.67 ft
System Flaw Rabe 25.56 gpm Manifold Diameter 1.50 in
Total Dynamic Head 23.71 ft Foncemain Velocity 2.61 ftlsec
Dose Tank information Loddng cover wit, wamhV
lam and admV device and Sealed WaWOOM
Electrical as Per NEC 300 and -"0
SPS 316.300 WAC Disconnect 4 in. man.
Tank conponent it Properly vended E- Alternate outlet
location
Eacemain diameter
Weiser Manufacturer 2 In.
Ca 650.00 Gallons !fi`
Volume 17.00 gairmch A
_ twie or anti-Weep Dimension inches Gallons g siphon device
A 20.10 341.74
B 2.00 34.09 C elevation
C 5.23 88.99 ~ PLffnp off 8261
.91
D 10.90 185.30 D
Total 38.24 650.00
~t~ elevation M
3" Bedding under tank. 82.00
Alarm Manuafacturer SJE Rhombus Note: Switches
Alarm Model Number }Tank Alert AB containing mercury
may not be used in
Pump Manufacturer Gould this system.
Pump Model Number PE51 -
Pump Must Deliver 25.56 gpm at a3.71 ft TDH
Pmject: STEVEN & DIANE JOHNSON Page 4 of 8
Mound % tam Wintenance and Operation Specifications
Service Providers Name Darrelf's Septic Service Phone 715-425-1025
POWTS Regulators Name St. Croix County Zoning - Phone 7t5-386-4680
Sy n FkAy and Load PA,raM
Design Flow - Peak 450 gpd Maximum Influent Particle Size 1/8 in
Estimated Flow - Average 300 gpd Maximum BOD5 220 mg/L
Septic Tank Capacity 1000 gal -Maximum TSS 150 mg/L
Sal Absorption Component Size 450 fe Maximum FOG 30 mg/L
Type of Wastewater Domestic Maximum Fecal Coftrrn >10E4 cfW100 mL
Sege Freauonev
Septic and Pump Tank Ins and/or service once every 3 years
Effluent Fitter Should inspect and dean at least once every 3 years
Pump and Controls Test one every 3 XtRm
Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested every 1.5 yeem
Mound I for ponding and seepage once 3 years
Other
MCA. g9+I and Mkt mis gll~d~rtds
1. Observation pipes are slotted and materials conform to Table SPS 384.30-1, have a watertight cap,
and are secured in as shown in the mound component manual,
2. Dispersal cell aggregate conforms to SPS 384.30 (6)(i), Wis. Adm. Code.
3. All gravity and pressure piping materials conform to the requirements in SPS 384, Wis. Adm. Code.
4. Tillage of the basal area is accomplished with a mold award or chisel plow.
6. The mound stricture and other disturbed areas will be seeded and mulched to prevent sod erosion
and help reduce frost penetration.
Lateral Tum-up Detai!
Finished
Grade
6-8" Diameter Lawn Threaded Cleanout
Sprinkler Valve Box Plug or Ban Valve
Distribution
Long Sweep 90 or Two
45 Degree Bends Same
Diameter as Lateral
Project: STEVEN & DIANE JOHNSON Page 5 of 8
Mound System Management Plan
Phnsawd to SPS 383-% Wit Adm. Code
General
Ito system stall be operated in aoaadence with SPS 362.84 W . Code, and shell maintained in accordance wwit h its' component
manuals MOO-10691-P (N.01101), SSWMP Pnubtiaation 9.6 ro1/81>, and Pressre u Distribution Component hisn uel Ver. 2.0 sOha-10706-P (N.
01101M and local or state ndes pertaining to system maintenance and
maintenance reporting-
Nooneshouldeveranto a septic or pump tank since deragerous gases may be present fiat could cause death.
Septic aid pump tank abandonment ate be In accordance with SPS 383 33, Wis. Adm. Code when Una Wft are no longer used as
POWTScomponenis.
Septic or pump tank manhole risers, seem risers and covers should be inspected for voster tightness and soundness. Access openings
used for service and swaseement shell be sealek! vwbwdght upon the coenetion of service. Any opening deamed kmewxL defective, or
subject to Uure must be replaced. Exposed access openings greater than 8-inches in dernatar shall be secured by an effective locking
device to prevent accidental or unauthorized entry into a tank or compoernt.
NII&
The septic tank stall be mair4ained by an individual certified to service septic tarns under s. 28148, Stets, Thecordew of the septic
tank shrallbe deposed o f In aooordance with NR 113, Wit. Adm. Code. The operating condition of the septic tank and outlet filler shelf be
assessed at least once every 3 years by nepection.
The outlet tufts shall be cleaned as necessary to ensure proper operation. The War cartridge should not be removed urdess provisions
are made to retain solids in the tank that may slough off the Star when removed from its encoswe. H the OW is equipped with of alarm, the
filter shall be serviced N the ala nn is activated cordintrorely. it tent filter slams may indicaete sage flows or an Imhpendirng cordm xxm
alarm.
The septic tank shall have its contents removed when the vokune of sludge and scan in the tank exceeds 113 the tigrid volume of the
tank. if the contents of the tank are not removed at the time of a tri nnW assesamaK mairdenence personnel shall advise the owner of
when the next service mends to be performed to maintain less than ma n urn scum and sludge aca mutation in the tank.
The addition of biological or cemmral additives to shherwe septic tank perldrmanCe w generally not required. However, if such products
are used they shall be approved for septic tank use by the Department of Commerce.
. rs
The pump (do*V) tank shall the inspeded at least once every 3 years.
acrd switches, serviced aslaffne, s and pumps shall be tested to verily proper
operation. If an effluent filW is installed waif the tank it shall be Inspected AN
as necessary.
N2WA anti Pnsscre D"Oft" Svatwha
No trees or shrubs should be plerded on the acrd. Phartthgs may be made around the mound's perimeter, aid the mhourd shall be
seeded and mulched as necessary to prevent erosion and to provide some protection from front penetration. traffic (otter than for
vegetative maintenance) on the mould is not recommended since soil compsc ti m may tinder aeration of their ve surface within the
mound and snow compaction in the winter will promote toot penetration. Cold weather (October'-February) dictate that the
mound be heavily mulched as protection from keenv.
M*N rd kpuatity into the mound system may mot erased 220 mglL 0005,150 m9k TSS, and 30 mgrL FOG for septic tank effluent or 30
MOIL. 8005, 30 mOIL TSS,10 mVt FOG, and 10' clu/100 ml. for hi ft treated eMuent. Bdhuant flow may not exceed matarnm deep flow
specified in the permit for this eeWintion.
The presswe distribution system is provided with a fang point at the end of each lateral, and it a recommended that each lateral be
turd of accumulated solids at least ante every 18 months. When a pressure bast is perfirrmad it should be compered to the Initial test
when the system YAW installed to determine d orifice dMM has occurred and d orifice dealing a retained to rn intain equal distribubom
within the dispersal *A.
Observation pipes within the dispersal cell shall be dheedced for effluent phonding- Pending levels shell be reported to the owlet; and any
levels above F inches considered as of mnperctimg hydraulic failure requiring addle om i, more treyuent Wig.
M the septic taNc or any of its Coutlt am Plan
components become defective the tank or component shall be repaired or replaced to keep the system in
proper operating Condition.
ff the dosing tank, pump, pump controls, slam or related wiring becomes defective the defective component(s) shalt be i mnediately
repaired or replaced with a component of the some or ecuai performance.
If the mOund t nand fark t orth ~ hs to discharge ~r to the ground awface, it with be repaired or
P►eeec rr by inCreaskV basal area
leakage occurs by
media,and natured piping, and r+ep{s - said components as dawned necessary to bring the system tMo prow and dispersal
See Page 5 of this plan for the name and
telephone rrrrhber of your focal t'OIfVTS regulator and service proafder.
Pk sent jIft
7the inieamalion and schedule of manaraOement and melee for pretreatment devices such as aerobic treatment units or dnsinfeiction
units are attached as separate documents and are considered part of the overall management pion for thhie system.
Page 6 of 8
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND Oct
OWNERSHIP CERTIFICATION FORM I
Sr
,
Owner/Buyer y t n Vy M~~~® 00~a1f
pM~NT
Mailing Addres ~y ~,,y
Property Addr SGt f ~ c-F n
i" VWV - -rv-UU Tqp, W1 b I,P
IN (Verification required from Planning & ning Depa ent for ew construction.)
City/State 1PI Parcel Identification Number d 12-~5(P " go + 00
LEGAL DESCRIPTION
Property Location 1/4 , 1/4 , Sec. , T N R ;0 W, Town of lyd
Subdivision Plat: TOIA II IIA01ti TVIIrGt A41ti , , Lot # 102.
Certified Survey Map # , Volume , Page #
Warranty Deed # 06 W (before 2007)Volume Page #
Spec house ❑yesOno Lot lines identifiable ❑yesOno
SYSTEM MAINTENANCE 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. 383.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal 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 Safety And Professional Services 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 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. I/we am/are the owner(s) of the
property described above, by virtue of a arranty deed recorded in Register of Deeds Office.
Num r o dro s 12
SIGN OF APPLICANT(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.
(REV. 04/12)
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Wisconsin Department of Safety and Professional Services
Division of Induslvfv"
ST. CROIX COUNTY SOIL EVALUATION REPORT Page 1 of 2
:,OMMUNITY DEVELOPMEW accordance with SPS 383, Wis. Adm. Code County
Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must ST. CROIX
include, but not limited to: vertical and horizontal reference point (BM), direction and parcel I. 040 - 1256 - 80 - 000
percent slope, scale or dimensions, north arrow, and location and distance to nearest road.
Please print all information. Rev by Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
Property Owner Property Location •
STEVEN & DIANE JOHNSON Govt. Lot NW 1/4 SE 1/4 S T 28 N R 20 ®r) W
Property Owner's Mailing Address Lot # Block # Subd. Name or 0610
687 Broadway St. S 102 Troy Village 3rd Addn.
City State Zip Code Phone Number []City []Village Town Nearest Road
Stillwater, MN 55082 ( ) St. Armes Parkway
E] New Construction UseE] Residential / Number of bedrooms 3 Code derived design flow rate 450 GPD
Replacement Public or commercial - Describe:
Parent material sandy outwash/till Flood Plain elevation if applicable NA
General comments Mound System 0.50 ft. sand fill 0.40 loading rate
and recommendations:
2 additional borings required to move system area and check limiting factors. Original test dated 12-29-1998.
Approved by Ryan Yarrington, St. Croix County Zoning Specialist.
Boring # 11 Boring
Q Pit Ground surface elev. 99.55 ft. Depth to limiting factor 36 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 " Eff#2
1 0-6 10YR3/2 - sil 3fa&sbk mvfr aw 3vf-m 0.6 0.8
2 6-12 10YR4/4 - sil 2fabk mfr cw 2vf-m 0.6 0.8
3 12-32 7.5YR4/4 sl 2fsbk mvfr aw lvf-m 0.6 1.0
4 32-36 7.5YR4/4 - is Os ml
aw lvf-f 0,7 1.6
36-till
gr.
Horizon 3 has 25-301/o
a Boring # Boring 99.90 41
pit Ground surface elev. ft. Depth to limiting factor in. al Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. "Effff1 'Eff#2
1 0-7 10YR3/2 sil 3fabk mvfr ai 3vf-m 0.6 0.8
2 7-12 10YR4/4 sil 2fabk mfr aw
2vf-m 0.6 0.8
3 12-16 10YR4/3 - sil lmpl mfr cw lvf-m 0.4c 0.6
4 16-22 10YR4/3 sic] lmabk mfr cs lvf-f 0.2 0.3
5 22-30 7.5YR4/6 A Ifsbk mvfr cs Ivf--f 0.4 0.7
6 30-41 7.5YR4/6 - cos Osg ml cw 1 vf-f 0.7 1.6
41-till
• Effluent #1 = BOD > 30:5 220 mg/L and TSS >30 < 150 mg/L Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) _ Sig CST Number
Ma Jo Hu ert Hollister's Soil Testing & Design) AWL&qF4~" 224832
Address Date Evalu Conducted Telephone Number
W9875 690th Avenue, River Falls, WI 54022 07 - 22 - 2015 715 - 426 - 1775
SBD-8330 (R07/13)
Plot Plan Page :?of~,
Property Owner srmJ ~a tasaN
1"=40ft
Legal Descriptcon zsr 10Z, I-M y y1 LLA&C- 3',4 (except where noted)
TES 1Ar T►+E V q OF -W SEA. .sue ;?Al •rzg~~~~ n = $ackhoe pit
ae-A
IDWAI ®F 7WV . a1: ~r~o~x Cewu7y ivw ws,~. J. IC1 ,gC
North
xXID
(,&A ,mop) ARGA A-CCE-"Is)
6D 1CNaRT" it-
cm.9o ffi
L•]1~Z Top OF C-
• ~o~ ~c SdX
A-1SkM /60.Od 1
S0FRoAk ~s B4 !
0 Dh'tED IL-2°h 48
o ~
b
l~T ~ U Z ~
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Site Location:
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.We &Psiri Department of Commerce SOIL AND SITE EVALUATION Page 1 of 4
1 Division of Safety and Buildings in accord with Comm 839I P, _ e En~'aonou~retsl Besi3n
Attach complete site plan on paper not less than 8% x 11 inches in size. File ~ ounty
include, but not limited to: vertical and horizontal reference point (BM), dire A did e. St. Croix
percent slope, scale or dirnemsions, north arrow, and location and distan i rr6arebt ~¢[I /E a I I.D.# m 0 r/ f,Yt .~7)
APPLICANT INFORMATION - Please print aff inform lei . V J d~ u-' C/
Personal information you provide may be used for secondary purposes (Privacy f l15.04,ki ft ))-r 11 1,~ 9 Date S
Property Owner roperty L
. L E 1/4 S 24 T 28 N,R 20 W
I,r i) i
Property C7,Wne~s Malfi ng Address e . Block # ame or CSMW
Tro Village( ~
12301 Central Avenue NE Suite 230
city State Zip Code PhoneNumber ❑ City a ❑Town Nearest Road
Minneapolis MN 55434 Troy Lindsay Road
New Construction Use: Z Residential ! Number of bedrooms X'Adibon to xisting building
❑ Replacement ❑ Public or commercial describe
Code Derived daily flow 600 gpd Recommended desi n loading rate _1 •2 bed, gpdff 1.2 trench, gpdff
Absorption area required 500 bed, W 500 trench, W Maximum design loading rate 1.2 bed, gpolfF 1.2 trench, gpd/ftz /
Recommended infiltration surface elevation ft referred to ' plan benc
Additional design / site considerate 5 System to be fl series of benched mounds down the slue
Parent material loess over Bed Rock Flood lain elevation, if a licable Na ft
S=Suitable for system Conventional Mound !n Ground Pressure AT Grade I System in Fill Holding Tank
U=Unsuitable for system I ❑ S ®u I ® S0 U I ❑ S N U I ❑ S® U I ❑ S® U I ❑ S® U
SOIL DESCRIPTION REPORT
Depth Dominant Color Mottles I Structure onsestenc Boundary i Roots , GPD/fts
Boring# Horizon i i Texture
in. Munseie Qu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
Y l i 0-14 toyr3/2 i - i sit 2msbk l mfr i cw 2f I .5 6
2 14-34 10yr5/6 - sill 2msbk mfr cw if 5 6
Ground 3 34-38 ~ 10yr8/3 - BEDRX I - I - I - I - I - -
elev i
102.67 ft
Depth to
limiting
factor I I
34"
Remarks:
Z 1 0-14 10yr3/2 - sit 2msbk mfr cw 2f .5 .6
2 14-31 10yr5/6 - sit 2msbk mfr cw if .5 .6
Ground 3 ~
elev 31-34 10yr8/3 - IBEDI?X~ - i - i - I - i "
~
99.32 ft
Depth to
limiting
i
factor
31" i i
Remarks:
CST Name (Please Print) Signature: Telephone No.
Thomas C. Nclson 715-246-2454
Address Environmental By Design Date CST Number Ref #
1432 120th Street, New Richmond, W1 54017 12/29/98 227387 82
P,RO°fjtTY OWNER: Continental Develornnent SOIL DESCRIPTION REPORT ® Page 2 of 4
e PARCEL I.D.# Environmental By Design
Depth Dominant Color Mottles I Structure onsistence Boundary Roots GPD/fF
Horizon in. Munsell Qu. Sz. Cont Color Texture Gr. Sz. Sh.
I I Bed Trench
1 0-14 10yr3/2 - A 2msbk mfr r_.w 2f .5 .6
2 14-29 10yr5/6 I - sil I 2msbk mfr I cw if .5 i .6
Ground
elev 3 29-32 10yr8/3 - BEDRX
100.94 ft I I I i I I I 1
Depth to I I i I I I I I
limiting
factor
29" I I I I I I I
Remarks:
i I I I i I I I I
4 1 0-14 10yr3/2 - sill 2msbk mfr cw 2f .5 .6
2 14-46 i 10yr5/6 - 1 sii. 2msbk I I& 1 cw I if I .5 v'
Ground
elev 3 i 46-62 I 7.5yr5i6 I - I )s 1 2msbk I mvfr 1 cw 1 - 1 7 i g
104.18 ft 4 62-65 1 10yr8/3 1 BED-XI
Depth to
limiting
factor
62
I i I I I I
Remarks:
Ground 1 1 1 i i
elev
I I I i I I I i
Depth to
limiting I I I I I I
factor
I I I I I I I
Remarks:
I I I I I I i I I
I I I I I I
Ground
elev i I i I I I
Depth to
limiting
factor I i I I I i
I I ~ I I I I
Remarks:
i~
INVIPONAERTAL Y P[5'6N
1432120x' 7PHT, KEW RiWAOMD, wq(04
SiN
L151,; WED 6Y Tt~On~AS Nt1 SP1v
7i5-~46-?~54
TROY VILLAGE -Lot #10
NW-, SE 1.4, s -vriON 24 I 2,8 N, R 20 w
I'rov 'Township, St. Croix Countt,., M isconsirt
Pape 3
JJ ff J f
f
NN'
r
SCALE I" =40
BM 1. NW Lot Corner Top Of pipe ELEV 100 Tom Nelson
-'/BM 2. Top Of Iron Pipe ElI V 96.24 227387
M
PROPERTY OWNER: Continental Development SOIL AND SITE EVALUATION Page ~ Of 4
PARCEL LU (J /p Enmwnmental By Design
REPORT MEMO
This site is very limited for a building site and mound area at the back of the lot. It is recommended that the system
be a series of "benched" mounds going down the slope with each mound being parallel to the slope.
I
Parcel 040-1256-80-000 07/25/2007 11:19 AM
PAGE 1 OF 1
Alt. Parcel 24.28.20.1362 040 - TOWN OF TROY
Current X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type
00 0
Tax Address: Owner(s): O = Current Owner, C = Current Co-Owner
STEVEN C & SUSAN L FITERMAN O -FITERMAN, STEVEN C & SUSAN L
6867 VERDE WAY
NAPLES FL 34108
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description " 264 ST ANNES PKWY
SC 4893 RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 1.340 Plat: 2559-TROY VILLAGE 3RD ADDN 040/99
SEC 24 T28N R20W NW SE LOT 102 TROY Block/Condo Bldg: LOT 102
VILLAGE THIRD ADDITION
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
24-28N-20W
Notes: Parcel History:
Date Doc # Vol/Page Type
06/25/1999 605649 1437/64 WD
2007 SUMMARY Bill M Fair Market Value: Assessed with:
0
Valuations: Last Changed: 07/22/2004
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.340 350,000 0 350,000 NO
Totals for 2007:
General Property 1.340 350,000 0 350,000
Woodland 0.000 0 0
Totals for 2006:
General Property 1.340 350,000 0 350,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: 12/04/1998 Batch M PRGRM
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00
,De~;vle,1 ~',r:•
Tro~l, &*veibpmvnf Cbgmra&o- j,,
173011 Cenlyd A venue ME
Blaine, MN 55434
(612) 757-7568
OUTLOT 3
COMMON AREA - PARK 46
9.406 ACRES 4.7169 AC w
n
V' 37&07'
m
40
LEGEND 1.4 Ac F- 1.542 AC
UTILITY EASEMENT, 10' WIDE 10.71. 39
UNLESS OTHERWISE SHOWN. ?po{6, ry^o' ,:1
DRAINAGE EASEMENT, 10' WIDE 41 m 42 2 47'
UNLESS OTHERWISE SHOWN. 1.617 AC = 1.105 AC N
- - BUILDING SETBACK LINE, 75' ^ 40 N JJ os84 A t.5~37<c
UNLESS OTHERWISE SHOWN. _ 1.642 AC s°' 1Gt4 ,r
J
Cs h
129 7 AC 1.013 /k
3.310 AC I< . / 2 i:31AC I
zs
y N
•tpONV11 34 g 1.000 1 AI
i 038 Ac ° GOLF COUR
y
bo• I. I ~~(yyn 1723• ~ 2 •00 400~ALo I
w ,°O ,1~iS~, 13j.026 AC $ 1.23290 ` I
9, t.
N
h 62.36' 23 N
M 38I? N a 240.E V 246 ACS
2.506 Ac 1.0 AC ro 29 1 v
'6 1.313 C^ 2^
91 ~O ~ N I ro
6, 10 J 24 r I
N o ~AC AC6 . 1,b05 ACS I
OUTLOT 12
COMMO RK RE - N ry,s+03AC ? ryry ti1138 8
9.044 AC 1 ?Y 120"f5C , ry^ 27 1.1575 ` i
tieQ 10=o ",620 AC/
1.103 3eo.6}. i a,~ 106
.243
107 , o 11 1.594 AC I N 1.29
6 ^ ~ 1.000 c ,
10 i1 3 Ac / ,yO1 ,.300 Ac ^0`1"' 'O,r ^ se oy~ I I 50
vv 1 021-3 30'
377.7}•
108
H 1Z
W AC „h h X39 u • ^Cl
N 112
1 -`5$ ` s
1. Ac
181010 00 y l '4 n59A~ ?
M 6 `7 es,, ry 20 g
~3pp.81 15.8, 19 O 111 Id 1.04- AC
X30509 sc N GOLF OOt ,9 R
1.401 AC \ ry~ d4~ o
^09 1 ~ C^~ 2760 AC ro
98 N 1.006 AC y 2a
1.425 AC 9
g 1.004 A ^
1 1.632 AC 'j•., ry ,
v4 ~*?6
PROPERTY OWNER: Continental Development SOIL AND SITE EVALUATION 184 pie of q
PARCEL i.13.#
Environmental By Design
REPORT MEMO
This site is very limited for a building site and mound area at the back of the lot. It is recommended that the system
be a series of "benched" mounds going down the slope with each mound being parallel to the slope.