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Home My WebLink About040-1326-07-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 584795 GENERAL INFORMATION State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)] N f\ Permit Holder's Name: City Village Township Parcel Tax No: DCCI Land Planners TOWN OF TROY 040-1326-07-000 CST BM Elev: Insp. BM Elev: BM Description: g~ ! - S Section/Town/Range/Map No: M l 17.28.19.2199 TANK INFORMATION a!) ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic nnoe Benchmark 6, b 04 W. 0 L/41L~/ 4~ (1000 d6t I Alt. BMDrP Aesatien Bldg. Sewer F: 4q) U 1 /L, E. 6 5 4.82 1o2.T3 HotdiPfg ~ aA S Ht Inlet ~ • ~ ~ O / ~ TANK SETBACK INFORMATION Ht Outlet TANK TO / WELL BLDG. Vent to Air Intake ROAD Dt Inlet n n Septic 1 I~ Dt Bottom Dosing Head an. I 91. Aera ' in Dist. Pipe 9 .3 j 4 3 3S' Holdi Bot. System 13.ba l3.e~ 13.V. i4~Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover u 7 qGP M Number ID/ ..,q TDH Lift Friction Loss SysN ad H Ft I emain LengtE:-' Dia. Dist. to Well SOIL ABSORPTION SYSTEM '7.5 f- -7,5 f--7 , `J BED/TRENCH Width 1 Length No. Of Trenches PIT DIMENSIONS No. Of P s Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:' ) INFORMATION T pe Of System: CHAMBER OR / UNIT Model Numb { ' X11 y21 tVff 9W*T~IBUTION SYSTEM Hea Manifold Distribution Ix Hole Size x Hole Spacing Ve to Air In ake 11 Pipes Length i Dia Length Dia Spacing SOIL COVE x Pressure Systems Only xx Mound Or At-Grade Systems Only rBeod/Trench pth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Ce nter d/Trench Edges ,1 Topsoil Yes No Yes t I COMMENTS: (Include c e repencies, persons present, etc.) Inspection #1: Inspection #2: del~~ Location: 400 MEADOW VALLEY BAY 1.) Alt BM Description = 1 I-kY, C4 2.) Bldg sewer length = 4 - amount of cover = ~J" ~ Coltf OR all P -Pi~UI o~ra~ Plan revision Required? Yes 9(-- No ' n Use other side for additional information. _ A J SBD-6710 (R.3/97) Date sepctor s Signature Cert. No. County f °g Safety and Buildings Division ST. CROIX ( 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Sp J AUG 20iIb Madison, w X70 71s b ST CROIX COUNT 3AZSADB5HSDOO State Transaction u her Sanitary Permit Application 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 roject Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used fo secondary 400 MEADOW VALLEY BAY purposes in accordance with the Privac y Law, s. 15.04(1 (m , Stars. L Application Information - Please Print All Information HUDSON, WI 54016 Property Owner's Name Parcel # DERV/A11-.PLUS N 040-1326-07-000 0.w Property Owner's Mailing Address Property Location 1-7. a , P.O. BOX 445 Govt. Lot 7 City, State Zip Code Phone Number NE NW Section 7 7 NEW RICHMOND, WI 54017 N/A (circle one) T 25 N; R 19 E orQ' It. Type of Building (check all that apply) Lot # 9 1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name El Public/Commercial - Describe Use 40A4 OBI k# MEADOW VALLEY J r N/.A ❑ city of CSM Number Li Village of ❑ St Owned -Describe Use 3 to 7,5*-75} 7 S a J N/A [JCTownof TROY III. Type of Permit: (Check only o e box on line A. Complete line B if applicable) A. New S stem y ❑ Replacement System El Treatment/Holding Tank Replacement Only El Other Modification to Existing System (explain) ous Permit Number and Date Issued List Previous Permit Renewal ermit Revision ❑ Change of Plumber❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS S stem/Com onent/Device: Check all that apply) IR Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ ther Dispersal Component (explain) ❑ retreatment Device (explain) C V. Dis ersal/Trea ent Area Information: Design Flow (gpd) Design Soi( Application Rate(gpds Dispersal Area Required (sf) Dispersal Area Proposed sf) System El anon ' 750 .7 1,071 11125 VL Tank Info Capacity in Total # of Manufacturer • Gallons Gallons New Units o v Tanks Existing Tanks v o y, v a co Septic or Holding Tank: 1,600 0 , 1,600 1 W ESER X 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' "gnature MP/MPRS Number Business Phone Number PAUL KOEHLER 225410 715-246-2660 __-4 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017 VIII. C-ount-Y/Department Use Only Approved DisapproN Permit Fee Dat Issue Issuing g t Signature caner G ven Reason for enial [X. Condi o A caSqp s fer. isapproval 3~ Qtl1 (1 ' J~ ~C~ ~yµQ,pw nS'ep R , e uFltt T1R8* al t7 dV.~r dispemai cell must all bseN, ;es frylg Al R4 as per management plan provided by plumber. (v, NI~A.J>~ t`a{a ~`n~(ZA^ et~~ ~Y1 2. A I-sefair* recaWmments must be lasinte itted as per aWaicabltl code / crdinanim. 4 0 rvu^ a Attach to complete plans for the system and submit to the County only n paper not less than 8 t/2 x 11 inches in sizes SBD-6398 (R.II/11 ) t (J ~ ~ 1 J~. CL.eJ lr~,Gr~ i i CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: DCCI Investment, LLC Owner's Name: Same Owner's Address: PO Box 445, New Richmond W1 54017 I Legal Description: NW 1/4, NW 1/4, S17, T2 8N, R19W Township: Troy County: St Croix Subdivision Name: Meadow of Troy Lot Number: 7 Parcel ID Number: 040-1326-07-000 Page 1 Index and title Page 2 Plot Plan i 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: Tim DeYoung License Number: 6647 ( 3 Date: 08/19/2016 Phone Number (715) 246-2660 i Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.Q,SBD-10705-P (N.Q1101). Page :1,, ~I i ~I I DERRICK AGRIMSON LOT 7 MEADOW VALLEY 400 MEADOW VALLEY BAY System elevation 95 .7 . - I! HOUSE 5 BED- DRIVE WAY U ROOM BORING b~~ O .I PROPOSED WELL, BORIN I ~ i BORING I 10 t9 G Jy~~ V ® 525 POLYLOCK FILTER b WISER SEPTC TANK 1000-600 COMB TANK 3 EZ FLOW TENCH NG ERNATE DRAIN FIELD DRAINAGE EASMENT 100 YR HIGH WATER MARK BM 1 100.0 BM 2 95 DERRICK AGRIMSON LOT 7 MEADOW VALLEY 400 MEADOW VALLEY BAY System elevation 95. ~i it ' I: HOUSE i. 5 BED- DRIVE WAY \ ROOM BORING p BORIN PROPOSED WELL... I BORING I I 0 0 525 POLYLOCK FILTER b WISER SEPTC TANK 1000-600 COMB TANK 3 EZ FLOW TENCH NG ERNATE DRAIN FIELD DRAINAGE EASMENT 100 YR HIGH WATER MARK BM 1100.0 BM 295 SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page _of_ Project Name: L-/ er'r IC -e FQn s J No. of Cells rJ Per Cell J ft Cell Width ~!Total No of ft Cell Length So sq ft EISA Per Cell It Cell Spacing sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EE Z1203H-5ft 5.0' 25.0 1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: t Gravelless Leaching Unit Model: ~Z 1.20 CwAr Typical Cross Section Finished Grade ft ~ Observation Pipe with approved cap or vent ~e e • Soil Backfill S4 in Geotextile Fabric ft Infiltrative Surface 12 in ft Limiting Factor CC : f in Slotted and Anchored Vent/ Observation Pipe with Cap Plumber/Designer Signature: License A1J~ ~2 f yJ~ Date: ~lj ~10/ 2 6~G SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page-of Project Name: -40 err /C /T r.,,., No. of Cells ~s Per Cell It Cell Width Total No of 7- It Cell Length ~~So sq ft EISA Per Cell ft Cell Spacing i7,~,~ _ sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EZ1203H-5ft 5.0' 25.0 EZ1203H-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer: --71- Gravelless Leaching Unit Model: AZ /,2d 3 J~ Typical Cross Section G Finished Grade ft 90)1 Observation Pipe with approved cap or vent Soil Backfill Y~ in ■ Geotextile Fabric ft Infiltrative Surface 12 in O I I X, , ft Limiting Factor in Slotted and Anchored Vent/ Observation Pipe with Cap ■■........■....<<.-::::.....■.........■ Plumber/Designer Signature: License /l1"'o 22 J'IJr Date: 2 6/&/ Wisconsin Department of Commerce R~CLUATION REPORT Page 1 of 3 Division of Safety and Buildings R J ith Comm 85, Wis. Adm. Code County St. C roix Attach complete site plan on paper LAT. 1' inches in size. Plan LILAd Include but not limited to: vertical t~l > r~iYce point (BM), direc Parcel I.D. ~4~-13 -0-000 Percent slope, scale or dimensiowarth #tt vt.„agd Bidreferenced to 3 Y6~ Y ate GGKK VI V UNIY JJ~t eview ~15WIAP"BKeEv tT W DND E $ u j Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (i k.. ,GDSS Z Property Owner Property Location DCCI Land Planners Govt. Lot NE va NW r4 S T 5 N R 19 w Property Owner's Mailing Address Lot # Subd. Name or CSM# P.O. Box 445 7 Block # Meadow Valley of Troy City State Zip Code Phone ❑ City ❑ Village 0 Town Nearest Road New Richmond WI 54017 Troy Meadow Valley Bay 0 New Construction Use: 0 Residential / Number of Bedrooms 5 Code derived design flow rate 750 GPD ❑ Replacement ❑ Public or Commercial - Describe: Parent Material Loess over Till Flood Plain elevation if applicable N/A ft. General comments and recommendations: 1 Boring # Boring 0 Pit Ground Surface Elevation 97.8 ft. Depth to Limiting factor >135" in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftin. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-8 10YR3/1 - SIL 2-m- r mfr g gs 3f 0.6 0.8 2 8-19 10YR3/1 SL 2-f-bk mfr gs 2f 0.6 1.0 3 19-33 10YR3/1 - SL 2-m-bk mfr gs 1f 0.6 1.0 4 33-56 10YR3/2 - SL 1-co-bk mfr gw 1f 0.4 0.7 5 56-69 10YR3/4 - LS 1-co-bk mfr cw - 0.7 1.6 j 6 69-135+ 10YR4/4 S 0-sg ml - - 0.7 1.6 ❑ Boring Boring # Opit Ground Surface E to 93.5 ft. e th\ Limiting factor >125" in. _ j 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 F 1 0-15 10YR3/2 - SL 2-m-bk mfr gs 3f 0.6 1.0 2 15-44 10YR3/1 - LS 2-co-bk mfr cs 1 f 0.7 1.6 3 44-67 10YR3/4 - GRS 0-sg ml cs 2f 0.7 1.6 C 4 67-125+ 10YR4/4 - S 0-sg ml - - 0.7 1.6 r i r ' "rt L ~ 1O * Effluent 41 = BOD,> 30!5 220 mg/L and TSS > 30 < 150 mg/L ue #2 = BODS 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Si ature .1-2 CST Number Mark Iverson 46672 Address Date Evaluation Conducted Telephone Number P.O. Box 155 Hammond, WI 54015 August 1, 2016 715-796-5664 Property Owner DCCI Land Planners Parcel ID# 040-1326-07-000 page 2 of 3 ❑ Boring 3 Boring # opit Ground Surface Elevation 95.3 ft. Depth to Limiting factor >125" 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 0-9 10YR3/2 - SL 2-f-gr mfr gs 2f 0.6 1.0 2 9-25 10YR3/1 - SL 1-m-bk mfr gs 1f 0.4 03 r 3 25-39 10YR3/1 - SL 2-co-bk mfr cs 1 f 0.6 1.0 4 39-52 10YR4/4 - GRS 0-sg ml cs 1f 0.7 1.6 5 52-64 10YR3/4 - GRS 0-sg ml cs 1f 0.7 1.6 6 64-84 7.5YR4/4 - VGRS 0-sg ml cs - 0.7 1.6 7 84-125 10YR4/4 S 0-sg ml - 0.7 1.6 ❑ Boring ~ V Boring # Elpit Ground Surface Elevation ft. Depth to Limiting factor in. Soil App Iication 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 ❑ Boring 5 Boring # ON Ground Surface Elevation 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 I i * Effluent # 1 = BOD;> 30 < 220 mg/L and TSS >30<- 150 mg/L * Effluent #2 = BOD, < 30 mg/L, and TSS < 30 mg/1- 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. Z c 100 yr flood line Page 3 of 3 B-2 p 93.5 a_ BM#2 - Top of 1" Iron Pipe 95' 94 BM#1 - Top of 1" PV_C Pi B-1 B-3 100.0' 97.8 95.3 96 100 98 House 0 ft. 24 ft. 40 ft. 80 ft. BM# & Description Bench Mark *00 E levation = Boring Location & Elevation Owner: DCCI Land Planners Site Information: Completed By: Mark Iverson, PSS #197 P.O. Box 445 NE1/4, NW1/4, S7, T25N, R19W P.O. Box 155 New Richmond, WI 54017 Town of Troy Hammond, WI 54015 St. Croix County 715-684-9125 Phone:N/A CST# 46672 ~IEEIVED County Safety and Buildin n ST. CROIX f 201 W. Washington A )4e-, P.O. Bo Sanitary Permit Number (to be filled in by Co.) PS $1.0 p L P E Madison, WI 5 2 % f ~MUNI"fY S g,4 ~c"'1 ~N1 Transaction mher Sanitary Permit Application State 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 (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for seconda 400 MEADOW VALLEY BAY purposes in accordance with the Privacy Law, s. 15.04(l)(m , Stars. 1. Application Information - Please Print All Information HUDSON, WI 54016 Property Owner's Name Parcel # D N cQn~L( 040-1326-07-000 Property Owner's Mailing Address Property Location Y 7, Sf . u~ ~cl P.O. BOX 445 Govt. Lot 7 City, State Zip Code Phone Number NE NW Section ~7 NEW RICHMOND, WI 54017 N/A (circle one) T 25 N; R 19 E orb II. Type of Building (check all that apply) Lot # Subdivision Name I or 2 Family Dwelling - Number of Bedrooms A&, 7 J + # MEADOW VALLEY r o ❑ Public/Commercial - Describe Use &16 ❑ City of El State Owned -Describe Use CSM Nube El Village of I 7,1,1-7.6 4-75 r4~;Townof TROY box on line A. Complete line B if applicable) Q III. Type of Permit: (Check only o f V114 lacement S stem ❑ TreatmendHoldin Tank Re I m nl ❑ Other Modification to Existing System (explain) 4' CR New System El Replacement y g p Y _ B. ❑ Permit Renewal ❑ Permit Revision List Previous Permit Number and Date Issued ❑ Ch e Plumb P it Transfer to New Before Expiration wner lG~ IV. Type of POWTS S stem/Com onent/Device: Check al t Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Gra ❑ Mound > 24 in. of suitable soil ❑ Mound 124 in. of suitable soil ❑ Holding Tank IT-0-ter Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dispersal/Treat ent Area Information: n Design Flow (gpd) Design Soil Application Rate(gpd Dispersal Area Required (sf) Dispersal Area Proksf)Syste- atio 750 .7 1,071 1,125 •6 % VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units New TanksExisting Tanks i./ 0 'dLV) iiU a Septic or Holding Tank 1,600 0 1,600 1 W ESER 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's S/gnature _ MP/MPRS Number Business Phone Number PAUL KOEHLER 225410 715-246-2660 Plumber's Address (Street, City, State, Zip Code) 321 WISCONSIN DRIVE, NEW RICHMOND, WI 54017 VIII Coun /De artment Use Only pproved ❑ Permit Fee Date sued Issuing I Signature iv en Reason for Denial IX. Condi p easo for Disapproval •t 6,11. eptl. r. , et lit<nt Y¢r 3 JI 11 disper<:.ui cell mutt ill i e ! rnt in r`ri (sM a rtdY~ CA, has per man~agge~meent pl~F1 p1 Fred by plwrber. w 1 ~ O` 2. = 4,i'~gWN I'Ae11~i A1.wart. !@ 170tcir,64 os pw rAppaloeble aodb / odinaAm, 1 ) bc~ c,,S- 4-3s 6, a: 1C. Attach to complete plans for the svstem and submit to the County only on per not less tlhan- 8 112 x I I inches in size e SBD-6398 (R. 1l/11) 6ALI 5) DERRICK AGRIMSON LOT 7 MEADOW VALLEY 400 MEADOW VALLEY BAY System elevation l ~I n n t HOUSE 5 BED- DRIVE WAY ROOM O ;j PROPOSED WELL. G 525 POLYL CK FILTER i BENCH MARK 10O:bTOPSTEE-L'......._._ ISER SEP C TANK 1000-600 COMBO TANK PIPE ALT BENCH MARK 100.01 TOP 3 FLOW TENCH 75 FT LONG STEEL PIPE LTERNATE DRAIN FIELD AINAGE EASMENT 0 YR HIGH WATER MARK i CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: DERRICK/AGRIMS011 /DCCI LAND PLANNERS Owner's Name: DERRICK/AGRIMSON Owner's Address: P.O. BOX 445 NEW RICHMOND WI 54017 Legal Description: NE 1/4 NW 1/4 SEC 7 T 25 N R 19 W Township: TROY County: ST. CROIX Subdivision Name: MEADOW VALLEY Lot Number: 7 Parcel ID Number: 040-1 126-07-000 Pagel 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 C Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: License Number: Date: Phone Number Signature Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 DERRICK AGRIMSON LOT 7 MEADOW VALLEY 400 MEADOW VALLEY BAY System elevation S : (P, ~ r ~I . 1 r HOUSE 5 BED- DRIVE WAY 1 ROOM ~I ♦ PROPOSED WELL. 'I O r l i 525 POLYL CK FILTER BENCH MARK'100:0T0PSTEE.L' ISER S...................... E..P C TANK 1000-600 COMBO TANK PIPE ALT BENCH MARK 100.01 TOP 3 FLOW TENCH 75 FT LONG STEEL PIPE LTERNATE DRAIN FIELD AINAGE EASMENT 0 YR HIGH WATER MARK SOIL ABSORPTION SYSTEM DETAIL/ G?RAVELLESS LEACHING UNIT Page-of Project Name: ~r, No. of Cells Per Cell ft Cell Width f Total No of ft Cell Length sq ft EISA Per Cell _ ft Cell Spacing sq ft Total EISA Manufacturer Model Laying Length EISA Rating Infiltrator EE 1203H-5ft 5.0 25.0 203N-10ft 10.0' 50.0 Gravelless Leaching Unit Manufacturer:/1 fr<rt D Gravelless Leaching Unit Model- Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent Soil Backfill in ■ Geotextile Fabric ft Infiltrative Surface 12 in Yft Limiting Factor in Slotted and Anchored Vent/ Observation Pipe with Cap .............s::<<::.................................................. I Plumber/Designer Signature: License Date: &Z--2 Z ~~~G Tll• Inc. Innovations, Precast, Atainage Zabel' PL-'25 Effluent Flitei & Wastewater Products 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: 1/16" Filtration Slots Alarm Switch • Rated for 10,000 GPD (gallons per day). F i (optional) • 525 linear feet of 1/16" filtration. ~y • Accepts 4 and 6 SCHD 40 Accepts 1" PVC pipe. Extension Handle • Built in gas deflector. • Automatic shut-off ball when filter is removed. Rated for • Alarm accessibility. 10,000 GPD • Accepts PVC extension handle. PL-525 Installation: Ideal for residential and commercial waste flows up to ? 525 Linear Ft. of l/16" 10,000 gallons per day (GPD). Filtration Slots 1. Locate the outlet of the septic tank. _ 2. Remove the tank cover and pump tank if necessary. \ Accepts 4" & 6' 3. Glue the filter housing to the 4" or 6 outlet pipe. If scrip 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 i cleaning. It is recommended that the filter be cleaned 51, 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 Gas Deflector needs servicing. Servicing should be done by a certified septic tank pumper or installer. Automatic 1. Locate the outlet of the septic tank. Shut-Off halt 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 a.ll solids fall back into septic tank. 6. Insert the filter cartridge back into the housing making sure the filter is properly aligned and completely inserted. Outdoor sn,artFilterc- Alarm [Ytend Polylok, Zabel & Rest filters accept Easily installs 7. Replace and secure septic tank cover. , the SmartFilter(& switch and alarm. into existing tanks. Polylok. Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 20 3.284.8514 www.polylok.com M-MIOOolx a-IiJ 99t8-5Z~-008 ° \ - :anod-iSOd :31V0 00/00/00 31V0 OSL4S NA 'NOO2l N30lVw OL J.MH sn 9LL£M wf1NdW OIld3S w o :anod-3ad „0-,L=„4 L :33VOS dOM -AG NMV80 31380!!00 V3131M W dW-009/00OLM N w ~ J N ~ HQ < z 00 O W ° LLJ V) CL V) w w d af V) L~ N z Z:) O W O J Uw a F- a co Q m H ui n z N ~0 WOE ~v m < U H O °w o 2: 0 U F- M Z 2 Q \ m LLI V H 3 LL ` W 0 o< QQU JQ N U L~~ Q a c Q a D O W Q CC 0 a d~C! O O Vi mfn JWW OU Z d O~ U a n: O _U ° _ m J I L+ O V) N N O z V) Y ¢ n. 0 LL\^~m~0 ~N mWN Qi = O Q U 000 Q oo (n (f) 00 F- (A qh F-LLJ O W (D ih_j>CA H 1 F?v~i z N w C) F- 052 Zo L;j F- V) O NcVO~w.. ~3Q ANY OZQW Q w m F vwi 0 0 Y 0JFjZOZ OJ~O Zx,¢ ZN0 Q Z W it ~x Na' 5 QOOQWW W~ <to Q~0 U U ¢ (n O ~ Z Z 3 m (-):2 x J m J O Z U W 0 O Q J J 0 Q Z > Z W p Z Z J < 00~ U J wW N I Q I H U) Q F- C) W p J Q F- F- Z D a > ° a w w a ~ D N _ N I P 4M _j ` I I I w is I w ¢ \ Of w I U x N a Q / ws «f l9 £ W ~m / o 1 ~ I I I I W 0 W J U Z uL5 U- D Z 0b3d Sd f69 ww rn Y Z Q F Page of STARTUP AND OPERATION For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products, solvents or other chemicals or sediment that may impede the treatment process and/or damage the soil absorption system. If high concentrations are detected have the contents of the tank(s) removed by a Septage Servicing Operator (pumper) prior to use. Pump tanks may fill above normal highwater levels prior to startup or due to pump failures. Start up or restoration of power under these conditions is not recommended, as the excess wastewater will be discharged to the soil absorption system in one large dose causing an overload that may result in the backup or surface discharge of effluent and damage to the system. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator (pumper) prior to restoring power to the pump or contact a Flumber or POWTS Maintainer to assist in manually operating the pump controls until normal effluent levels are restored within the pump tank. System start up shall not occur when soil conditions are frozen at the infiltrative surface. Do not drive or park vehicles over tanks or the soil absorption system. 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 treatment tanks and soil absorption system: acids, antibiotics, baby wipes, cigarette butts, condoms, cotton swabs, degreasers, dental floss, diapers, disinfectants, fats, foundation drain (sump pump) discharge, fruit and vegetable peelings, gasoline, greases, herbicides, meat scraps, medications, oils, painting products, pesticides, sanitary napkins, solvents, tampons, and water softener brine discharge. 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 s. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks, pits and other soil absorption systems 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 (pumper). I • 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 the time of their permit issuance. ❑ A suitable replacement area is not available due to setback and/or soil limitations. If the soil absorption system cannot be rehabilitated and barring advances in POWTS technology, a holding tank may be installed as a last resort. ❑ 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 TREATMENT TANKS, PUMP TANKS, AND HOLDING TANKS MAY CONTAIN POISONOUS GASSES OR LACK SUFFICIENT OXYGEN TO SUSTAIN LIFE. NEVER ENTER ANY TANK UNDER ANY CIRCUMSTANCE. DEATH MAY RESULT. ESCAPE OR RESCUE FROM THE INTERIOR OF A TANK MAY NOT BE POSSIBLE. ADDITIONAL INSTRUCTIONS: POWTS INSTALLER POWTS MAINTAINER Name COUNTRYSIDE PLUMBING & HEATIN I Name PAUL KOEHLER Phone 715-246-2660 Phone 715-246-2660 SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name DARRELS SEPTIC SERVICE Name ST. CROIX COUNTY Phone 715-425-1025 Phone 3~.. 690 This document was drafted by the staffs of the Green Lake, Marquette and Waushara County POWTS regulatory agencies in compliance with sections r.evnm R3 99191(h)l1 WiMn and 83.54(11. (2) & (3). Wisconsin Administrative Code. POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page or FILE INFORMATION SYSTEM SPECIFICATIONS Owner DERRI-CK COMPANIES Tank Manufacturer: WIESER I:1 NA Permit # g] Septic ❑ Dose ❑ Holding Volume: 1600 (gal) DESIGN PARAMETERS Tank Manufacturer: IS) NA Number of Bedrooms: 5 ❑ NA ❑ Septic ❑ Dose ❑ Holding Volume: (gal) Number of Public Facility Units: KINA Vertical Distance Tank Bottom(s) to Service Pad: N/A (ft) Estimated (average) Flow: 500 (gal/day) Horizontal Distance Tank(s) to Service Pad: N/A (ft) Desi n Flow = estimated x 1.5): Specific servicing mechanics must be provided if vertical is >15 feet or g (peak) ( 750 A~ y) if horizontal is >150feet. Specific-instructions to be provided on-back. In Situ Soil Application Rate: .7 (gal/day/ft) Effluent Filter Manufacturer: POLYLOK ❑ NA Standard (Domestic) Influent/Effluent Monthly average Effluent Filter Model: 525 Fats, Oil & Grease (FOG) _<30 mg/L Pump Manufacturer: NA Biochemical Oxygen Demand (BODS) 5220 mg/L ] NA Total Suspended Solids (TSS) 5150 mg/L Pump Model: High Strength Influent/Effluent Monthly average Pretreatment Unit (FOG) >30 mg/L Manufacturer: (BODO >220 mg/L NA [ NA (TSS) >150 mg/L ❑ Mechanical Aeration ❑ Peat Filter ❑ Disinfection ❑ Wetland Pretreated Effluent Monthly average ❑ Sand/Gravel Filter ❑ Other: (BODS) G30 mg/L Soil Absorption System (TSS) 5_30 mg/L ®NA Fecal Coliform (geometric mean) 5510` ® In-Ground (gravity) ❑ In-Ground (pressure) NA ❑ At-Grade ❑ Mound Maximum Effluent Particle Size Ye in dia. ® NA ❑ Drip-Line ❑ Other: Other: ❑ NA Other: ❑ NA MAINTENANCE SCHEDULE Service Event Service Frequency Pump out contents of tank(s) 12 When combined sludge and scum equals one-third of tank volume ❑ When the high water alarm is activated Inspect condition of tank(s) At least once every: ❑ month(s) (Maximum 3 years) C] NA 3 year(s) 3 Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) [I NA IT year(s) Clean effluent filter At least once every: ❑ month(s) NA 1 [jyear(s) Inspect pump, pump controls & alarm At least once every: [I month(s) C] NA ❑ year(s) Flush laterals and pressure test At least once every: ❑ month(s) C1 NA ❑ year(s) Other: At least once every: ❑ month(s) ❑ NA ❑ year(s) Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and soil absorption systems shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer, POWTS Inspector, POWTS Maintainer or Septage Servicing Operator (pumper). 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 a check for any back up or ponding of effluent on the ground surface. The soil absorption system 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 treatment tank equals one-third (33) or more of the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator (pumper) and disposed of in accordance with chapter NIR 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 30 days of completion of any service event. GMW-005 (02/05) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer l~< ~i-~V"•~Tj M: ~1.,~ U Mailing Address L-At /Vi c.:, W i Property Addresl~~ (Verification required from Planning & Zoning Department for ne constrtrcti n.) City/State Parcel Identification Number 13 Z (v LEGAL DESCRIPTION Property Location 4 , &Y4, Sec. , TN RVJ, Town of Subdivision Lot # Certified Survey Map # 7 , Volume , Page # Warranty Deed # - -7~~ Volume Z7 -,7 Page # "1 42 L, Spec house yes no Lot lines identifiabl 0yes no SYS'T'EM 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 §Comm. 83.52(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 foam, 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. 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 Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning S" Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on ythis orm are true to the best of my/our knowledge. Uwe amiare the owner(s) of the property described bove, by virtue of a wy deedrecorded in Register of Deeds Office. Number 00 43 URE OF APPL C (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. 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Wis. Adm. Code Page 1 of Professional Services Schmitt Soil Testing, Inc AUG 112014 County Attach complete site plan on paper not less than 8'% x 11 inches in size. Plan must St. Croix include, but not limited to: vertil. a00 NOZ nce point (BM), direction and percent slope, scale or dgiT gQNp tf Er L~ tNT and distance to nearest road. Parcei I. rJ Please print all information. Re ewed y ` - D t / Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location D_CCI 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 7 Meadow Valley Of Troy City State Zip Code Phone Number l City Village [ ;Town Nearest Road _.J New Richmond WI 54017 Troy East Cove Rd New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD -1 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/sgft rate. Possible system elevation for Area 1 is (Step Trenches) 975 & and recommendations: 967. Slope is 8%. Boring F-11 Boring # ~ Pit Ground surface elev. 100.20 ft. Depth to limiting factor 11_2+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Ionsisten Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 *Eff#2 1 0-34 10yr3/1 none sl 2msbk mvfr gw 2vf 0.6 1.0 2 34-47 10yr4/4 none Is icsbk mvfr gw 2vf 0.7 1.6 3 47-67 10yr5/6 none grcos Osg ml as 0.7 1.6 4 67-112 10yr6/4 none grs Osg ml 0.7 1.6 Boring # Boring > ? Pit Ground surface elev. 100.45 ft. Depth to limiting factor 110+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistenc Boundary Roots GPD/ft2 in. Munseli Qu. Sz. Cont. Color Gr. Sz. Sh. "Eff#1 *Eff#2 1 0-15 10yr3/2 none sl 2mgr mvfr cs 2vf 0.6 1.0 2 15-24 7.5yr5/6 none vgrs Osg ml gw 1vf 0.7 1.6 3 24-72 10yr6/4 none vgrs Osg ml as 0.7 1.6 4 72-110 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 < 30 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 Boring Boring # pit Ground surface elev. _102.0 ft. Depth to limiting factor 112+ 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 0-23 10yr3/3 none sl 2fsbk mvfr gw 2vf 0.6 1.0 2 23-42 10yr3/1 none sl 2fsbk mvfr gw 1Vf 0.6 1.0 3 42-62 10yr4/4 none Is lcsbk mvfr gw ivf 0.7 1.6 4 62-82 10yr5/4 none vgrcos Osg ml cs 0.7 1.6 5 82-112 10yr5/6 none cos Osg ml 0.7 1.6 F-1 ] Boring Boring # I pit Ground surface elev. Depth to limiting factor i 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 i Boring Boring # Depth to limiting actor in. ft. f 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 T7 Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 <150 mg/L ' Effluent #2 = BOD5 < 30 mg/L 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 need material in an alternate format, please contact the department at 608-266-3151 or 1-1 Y 608-264-8777. SBD-8330 (R.07/00) Schmitt Soil Testing, Inc. Page 3 of 3 Conducted by: - Conducted For: Schmitt Soil Testing, Inc. _ Name: DCCI Land Planners Thomas J. Schmitt, CST 227429 Address: 1505 Hwy 65 1595 72nd St. - City, State, Zip: New Richmond, W154017 - New Richmond, WI 54017 Phone: 71 60-1978 Subdivision: Meadow Valley Of Troy Signatu' Lot No.: 7 Date .S -r /Y Legal Description: NWI/4 NWI/4 S17 T28N R19W - - ■ Backhoe Pit Township, County: Troy Township, St. Croix County Bench Mark 1 El. 100.00' Top of 1" Steel Pipe. NW Lot corner pipe.=(SS0.(.f') 0 Bench Mark 2 El. 100.01' Top of 1" Steel Pipe. SW Lot corner pipe. - - Slope= 8% Scale 1"= 40' Lo T8 /OD C9 T 83 (7~ ~2t~ w `5's' B►0 7 7 PRtlP~ ZL /oo yf~~~• ~lWL - - T 6 St. Croix DCCI INVESTMENTS LLC Municipality: TOWN OF TROY 1505 HWY 65 PO BOX 445 Permit Number: 584795 NEW RICHMOND WI 54017 Parcel Number: 040132607000 Alt Parcel Number: 17.28.19.2199 Site Address: 400 MEADOW VALLEY BAY Components Component Manufacturer Description Last Next Status Schedule Service Service Conventional EZ Flow 1203H Current 36 Drainfield Effluent Filter Polylok 525 Current 36 Septic Tank Wieser 1600 gal Current 36 No data found for Maintenance History, Notices, Violations, Notes Ip ~l 'r ~ Jam. uti \ ~y va _ oRA/ngcEEAS~r~fNr I bo Wrr p v , \ n C • ~y I `t N rt S r ~7 °a o w 1 v v Co 1 1 rr 0 Q 11 11` 1` n7 ti45 s 8~g • , I a C .s` 1 rtt O I \ > N• R / i pp"pstc C1 1 ' Il Xi cv~ 0' In -n 0 mX rn ~Am O m Oz~ Y/ 0 C A jD ~ o D DoT m T ^ i ✓ - cn r~Tl~ co rm- O~ DZ) m 55 m o c a -I D 9 D rC C (A m 0 D (n D --4 O 2 m C) Co O r, < `t fn p F < D m 2 rr 2 j z G) Cn on ~D~ {zC D D rD c7 m m c T ?1 m(~v~2w0 O~ m m~ -4 ~7 m0 mo z~ m zT o ~D r z m a ,n > X G) z m m D z C O Z~ a n ~•a 0-00mnom2 cn -4 cDn p m n z rn~ G c~a ~rCcn ccnm = m z 0zo r-Dmm0 mtn O m -i r. - O~mp'i paDm z 0 z r-o > vnm D> rn vm ~ m0m~> m z -4 n O CCU ' I O W N W N -n D U CT Ul (T ; W rn Q O rr ! rf r, C) r: Cp CL) ~1 co 2 r ti 0 r'' 2 Y. C c V G CT O roan, ~ n nr0 e DERRICK CONSTRUCTION LOT 7, MEADOW VALLEY (Agrimson) TOM OF lRoy ie n+. n.ia ruw . o.¢ rnsns STAKEOUT PLAN ".a Gens>.Itineissodites SMLand Survering