The URL can be used to link to this page

Home My WebLink About040-1253-40-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No (ATTACH TO PERMIT) 592278 GENERAL INFORMATION 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: PATRICK & DEBORAH VOGLER TOWN OF TROY 040-1253-40-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: 100,0 rov 19.28.19.1335 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Alt. B 1 ('~t~r t' 8 q , p Aeration Bldg. Sewer Holding St/Ht Inlet St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet_,_--.. Septic Dt Bottom Dosing,_ Header/Man. ^ Dy _ . Q bo ~ o T+ I Aeration Dist. Pipe / Holding Bot. System / /p.0 t0.'~O 9 Final Grade PUMP/SIPHON INFORMATION 3.0 7?• cZp Manufacturer Demand St Cover M CI/2 ` Y~ Model Number--__ TDH Lift Friction-Coss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Len th No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia... Liquid Dep DIMENSIONS S 01 a SETBACK SYSTEM TO 11 P/L BLDG WELL LA E/STR M LEACHING Manufacturer, INFORMATION CHAMBER OR Type Of System: t t UNIT Model Numb Y) ` Ceti ae 3T t- DISTRIBUTION SYSTEM Header/Manifold Distribution / Ix Hole Size x Hole Spacing Vent to Air IntaPipe(s) ~ Length Dia Length Dia Spacing 1,s eA-V SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over I Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil Yes No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 290 ST ANDREWS DR 1.) Alt BM Description = ~O G.l.,,S ✓ 2.) Bldg sewer length = y - amount of cover = L/ Plan revision Required? ❑ Yes ❑ No 1 l ~1 g q Use other side for additional information. Date Insepctor's Signature Cert. No. SBD-6710 (R.3/97) - Y0 County Q _~1 r e`ECE Safety and Buildings Division K 201 W. Washington Ave.; P.O. Box 7962 Sanitary Permit Number (to be filled in by Co.) NOV c `1 r Madison, Wl 53707-7962 IX COUNTY Z .79 ;0MMU9 ermit Application State Transaction, 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 ess (if different than mailing ad ) the Department of Safety and Professional Servies. Personal information you pr ide may be used for secondary q < oses in accordance with the Pri Law, s. 15. 1) m), Stats. I 5 . e L Application Information - Please Pri information Property Owner's Name ' 1--) Parcel ) 3 _ yU_ Property Owner`s Mailing Address Property Location 2 l q.. i0+ 7 (1 f1, tjril ~J I Govt Lot City, State 11 , Zip Code Phone Number Section 1 Z-( ZX%'1 ~A T-Z Z N; R r ircle one If. Type of Building (check all that apply Lot # E orr w t ~lir 2 Family Dwelling - Number of Bedroo I (f~ Subdivision Name T L j /J ❑ Public/Commercial -Describe Use ❑ City o Q State Owned - Describe U CSM Nwnber ❑ Village of r- wmoff% <-'1 III. Type of Permit: (Check only one b x on line A. Complete line B if applicable) A. System Q Replacement System Q Treatment/Holding Tank Replacement Only Q Other Modification to Existing System (expiain) f B- Q Permit Renewal t Revision I Q Change of Plumber Q Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner ~,z,; / IV. ype ofPOWTS SYStem/Com onent/Device: Check all that apply) -A ig Non-Pressurized In-Ground Q Pressurized In-Ground Q At-Grade Q Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil Q Holding an Other ersal Component (explain) ❑ Pr eatmcnt Devi (cxpI "A r V. Dis rsal/Trea ent Area Information: . Design Flow (gpd) Design Soil Application R dst) Dispersal Area Required (sr Dispersal Area oposed (sf) System Ele VL Tank Info Capacity im Total of Manufacturer Gallons Gallons Units LOS - New Tanks Exisan8 Tanta J v ~ / T ~ c y ° a~ ai Septic or Holding Tank _ Dosing Chamber n VII. Responsibility Statement- 1, the undersigned,- u e responsibility for installation of the POWTS shown on the attached plans Plumber's Name (Print) Pi Signature MP/Iv1PRS Number Business Phone Number CrL ~'l~ Phnnber's Address (S treet, i[y: ,+Zip l ~ { 2- "0 VIII _Cafinty/Department Use Only Approved isapprove Permit Fee Date Iss ed Issuing, t Signature 76 zs~, even Reason for Denial IX. Conditt ' ons for D' pprovai La eA, t " . ttark, Ei1luGni 14 t~ &ffip tto cell rust all be snlIces ! r.` • `+~t~-~c gas per Mwagement plan pi c, naeh by Illwnbe;. ~ t/e I 2. -A11~' 1M .VM musttA tram, ir:e,i Gr! 1 as p«' VOP&MMS 0066 I :MlnanM. v Attach to complete plans for the system and submit to ounty only 0 paper n/ot~s than 8 L7 X 11 inches in SBD-6398(R. 11/11) Soil Test and System PLOT PLAN PROJECT Patrick Voaler ADDRESS 6654 E. Riverdale St. Mesa AZ 85215 NE 1/4 NW 1/4S 19 IT 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 89.8/89.7 7' below grade 11/17/17 BEDROOM 4 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 50' 30' M.* 314' Property Line h.- 4d 20'-#3, 40' R-1 S' Vents 10' ST ' 35' 0% slope 20 ~B-2 B-3 2-3' x 88' cells with >3' spacing Pro 4 Bedroom House Scale = 1/4" = 10' All piping shall be ASTM SDR 30/34, within b 10' of tank, piping shall be ASTM F891 Vent >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps St. Andrews Drive 12" 4' Long 3 4 Grade at System Elevation " R k Wisconsin Department of Commerce SOIL EVALUATION REPORT _ Page of Division of Safety and Buildings s 00" d t as 85, Wis. Adm. Code Coun S-~'• 1r` f1FVE~-~~tt h am, ~ Attach complete site plan on papa ~gq~$bh`8 1/2 x 11 inches in size. Plan must include, but not limited to: verlF~Rl'1 horizontal reference point (BM), direction and parcel percent slope, scale or dimensions, north arrow, and location and distance to nearest road. / ✓ U t/ f✓ Please print all information. Ravi ed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Z V 7 Propelt"»roner Property Location Govt. Lot IAA 1 /4 v',71 /4 a~ T2-8 N R E (o W Property Owner's Mailing Address Y Lot # Block # Subd. Name CSM# I I t 1, L/ 1 City ( State Zip Code Phone Number ❑ City ❑ Village Town <N,^earest Road r~ L1 1 ( ) 1 r o c ew Construction Use: Residential/ Number of bedrooms Code derived design flow rate S s GPD ❑ Replacement ❑ Publi or co ercial - De be: Parent material u r Flood Plain elevation if applicable General comments and recommendations: System Type •G System Elevation 71 Bonn9 # E] Boring 5~ pit Ground surface elev. l t ft. Depth to limiting factor ` tin. 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 Jj r L -717 J5 r ~ r 11 ~441 Boring # ❑ Boring ® pit Ground surface elev. C ' L ft. Depth to limiting factor 3 i7in. 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 -L- ~r C" 'd" K Effluent #1 = BOD. > 30 < 220 mg/L and TSS > < ma ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) na CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 4017 11-12 7 715-246-4516 Property Owner _ Parcel ID # Page of Boring # El Boring L r pit Ground surface elev. ft. Depth to limiting factor J~hn. 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 ❑ Boring # ❑ Boring ❑ pit Ground surface elev. ft. Depth to limiting factor in. Soil lication 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 --4 ❑ Boring F Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BODS < 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 TTY 608-264-8777. SOD-8330 (R.NUO) Property Owner _ Parcel ID # Page of ❑ Boring 9 Borin # ~ Pit Ground surface elev. L%w-, ft. Depth to limiting factor ~~n• Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDNf in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 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/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I ❑ Boring # Boring Ground surface elev. ft. Depth to limiting factor in. F-I ❑ pit Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 Effluent #1 = BOD5 > 30:< 220 mg/L and TSS >30 < 150 mgA- ' Effluent #2 = BODS < 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 TTY 608-264-8777. SBD-5330 (8.6100) Soil Test and System PLOT PLAN PROJECT Patrick Voaler ADDRESS 6654 E. Riverdale St. Mesa AZ 85215 NE 1/4 NW 1/4S 19 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 89.8/89.7 7' below grade 11/17/17 BEDROOM 4 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 50' 30' .M.* 314' Property Line 20' S 40' 0-1 B-1 35' Vents 10, ST 20' 35' 0% slope -2 B-3 2-3' x 88' cells with >3' spacing Pro 4 Bedroom House Scale = 1/4" = 10' All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Vent >6" Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps St. Andrews Drive 4' Long 12" Grade at System Elevation 34" 111111 •M 1. ~J . o~ ° County c 2<Jg? Safety and Buildings Division R 201 p j 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be filled in by Co.) Madison, WI 53707 7162 • r~ OIX COUNTY DEVELOPMENT 22 79 Sanitary Permit App transaction Number In accordance with SPS 38321(2), Wis. Adm. Code, submission of this tone 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 secondary purposes in accordance with the Privacy Law, s. 15. I) In), Stan. / f L Application Information - Please 'nt I Infor ation f L7 ff c t^ Property T's Name Parcel # > 1/0 3 ,r Property Owners Mailing Address Property Location rl L ► 1. a 0 . ~q, ; 3.7j 5 IZ; Da - Govt Lot City, State Zip Code Phone Number /11/tE T/,lW11 Section le ons')O~' 11. Type of Building (check all that apply) Lot r 2 Family Dwelling -Number of Bedroo Subdivision Name Block El Public/Commercial - Describe Use ❑ City ►`O~ 0..I`. ❑ State Owned - Describe Use CSM Number ❑ Village of / G1,4a `b'n of i 22422 IlT. 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 ❑ Pertnit Revision ❑ Change of Plumber ❑ Ferntit Transfer to New List Previous Permit Number and Date lssued Before Expiration Owner . / IV. T of POWTS System/Com onent/Device: Check all that a 1 ' { 7 Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in of suitable soil ❑ Mound < 24 in. of suitable soil rtl ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis rsaVrrea ent Area Information: gn Flow (gpd) Design Soil Application Rate dsf) Dispersal Area Required f) Dispersal Area Pr d (sf) 7- 2, VL Tank Info Capacity in Total it of Manufacturer Gallons Gallons Units o y! NM Tanks Existing Tanta 'y c d ° ~ a m ~ n. U cn P C75 C~ Septic or Holding Tank Dosing Chamber K I I VII. Responsibility Statement- I, the undersigned, assu onsibility for installation of the POWTS shown on the attached plans. Pl s Name (Print) Plumber,'S. e MP/MPRS Number Business Phone Number ZZ6' Plumber's Address (Street, City, State, Zip e) VLiI ounty/De artment Use Only Approved ❑ Permit Fee Date sued Issuing' t Signature en Reason for enial • ~9 J -7 IX CoaditS p ons for Di approval 1. Sept: X, Erflmnt Me? M3 P_y tt t~lslxr.:ai ceN rust all ggsni•:ic~s ! r"='nta;; a 3' IC.tQ. a- gs per glaralgement plan pro+iaed t,v plumbee. /y~ r 2. IM' iii 4 :O'm tP mt t* i Idint;,Ir.Ed ,5 e ~ NC so per appiftm 006 1 Cf&r W1. / Attach to complete plans for the system and submit to the County ~only on p not less than- 8 t2 x 11 inches in sin w SBD-5398 (R 11/11) 4~ g System PLOT PLAN PROJECT Patrick Vogler ADDRESS 6654 E. Riverdale St. Mesa AZ 85215 NE 1/4 NW 1/4S 19 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 93.5/93.2' 5.5' below grade 4/11/17 BEDROOM 4 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of NE corner post ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *H.R.P. same as benchmark 314' Property Line 45' 45' B.M.* 0' Scale = 1/4" = 10' 30' ~ 40' Vents 90' B-5 B-1 2-3' X 90' cells with >3'spacing 70' B-3 Pro 4 4% Slope 105' Bedroom House ST 25'- B-4 B-2 All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Vent >6„ Quick4 Standard of Cover Leaching Chamber with 20.0 ft2 of Area 5.6ft^2/pair of end caps St. Andrews Drive 4' Long 12 10 Grade at System Elevation y~ 34" Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 4/11/17 Owner:Patrick Vogler Location: NE1/4 NW1/4 S19 T28 N,R19W 290 St. Andrew Dr. Troy Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and ntingency Plan 7.Filter Cross Sectiov Signature License numbed/226900 I System PLOT PLAN PROJECT Patrick Voaler ADDRESS 6654 E. Riverdale St. Mesa AZ 85215 NE 1/4 NW 1/4S 19 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 93.5/93.2' 5.5' below grade 4/11 /17 BEDROOM 4 DATE CONVENTIONAL XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1255 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 891 # of chambers 44 BENCHMARK V.R.P. Top of NE corner post ASSUME ELEVATION 100' Filter Lifetime Filter ❑ BOREHOLE O WELL *II.R.P. same as benchmark 314' Property Line 45' 45' B.M.* 0' Ns~ Scale = 1/4" = 10' 30' 40' Vents 90' B-5 B-1 2-3' X 90' cells with >3'spacing 70' B-3 Pro 4 4% Slope 105' Bedroom House ST 25' 0' B-4 B-2 All piping shall be ASTM SDR 30/34, within 10' of tank, piping shall be ASTM F891 Vent ALo Quick4 Standard Leaching Chamber with 20.0 ft2 of Area w ft^2/pair of end caps St. Andrews Drive 2" Grade at Sys tem Elevation 34" Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 5.6ftA 2 pair of end plates Finish grade elevation Typical Installation 99.0' Vent G rade Vent 3' 4" 3' X30/34 Septic Tank Long 1 5' S' Long 1 3 6" Grade at System Elevation Grade at System Elevation Spacing 5' 24 X 90' Cells Same on other end Observation tube/Vent At end of cell A B 22 chambers per cell System elevations: A-93.5' B-93.2' POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity al El NA Permit # Septic Tank Manufacturer ❑ NA 3ESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units NA Pump Tank Capacity NA al j Estimated flow (average) gal/day Pump Tank Manufacturer NA Design flow (peak), (Estimated x 1.5) K0 J avda Pump Manufacturer NA Soil Application Rate aUda Iftz Rump Model NA i Standard Influent/Effluent Quality Monthly average` Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) <220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) <_150 mg/L ❑ Disinfection ❑ Other. Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L 1'.4n-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L _R~VA ❑ At-Grade ❑ Mound Fecal Coliform (geometric mean) 5104 cfu/100ml ❑ Drip-Line ❑ Other: MMaximum Effluent Particle Size 15 in dia, CI NA Other. ❑ NA !Other: Other: NA ❑ NA `Values typical for domestic wastewater and septic tank effluent Other I7 NA IAINTENANCE SCHEDULE Service Event Service Frequency Ilnspect condition of tank(s) At least once eve month(s) ry" ears (Maximum 3 years) ❑ NA !Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA !Inspect dispersal cell(s) At least once every" ❑ month(s) /R year(s) (Maximum 3 years) ❑ NA Clean effluent filter At least once every: ear((s) r orr ❑ NA s) I nspect pump, pump controls & alarm At least once every: 0 years} s) NA 19ush laterals and pressure test At least once ever ❑ month(s) y' NA 13 year(s) ether. ❑ month(s) At least once every: ❑ year(s) A "her: ri - - ❑ A MAINTENANCE INSTRUCTIONS !Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Mister !Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank inspections must !include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of immbined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of {:he tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin Administrative Code. INI other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, find 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. Page of START UP AND OPERATION other chemicals th~jt For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting Products or may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of tht; 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 bp discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park Vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area withln t5 feet down slope of any mound or at-grade soil absorption area. Reduction or edmination of the following from the wastewater stream may improve the performance and prolong the life of the POVVT$_ antibiotics. baby w pn; cigarette butts; -condoms; cotton swabs; degreasers; dental floss; diapers; disinfedarsts, fat; foundation drain (sump pump) water; fruft and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • Ail piping to tanks and pits shall be disconnected and the abandoned pipe opening sealed. • The contents of all tanks and pits shall be removed and property disposed of by a Septage Servicing Operator. After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption systelnm. The replacement area should be protected from disturbance and compaction and should not be infringed upon by requitled 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 ruie;l in effect at that time. 0 A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technoiogy a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. if no replacement area is available a holding tank may be installed) as a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiitfive surface. Reconstructions of such systems must comply with the rules in effect at that time. <<WARNiNG>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TAN UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE O~ A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAINER d Name F:tp Cz <-i l2 _ , Phone J J J SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY Name Name Phone J s- Pone 7 Ell This dmirnent was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(t and 383..54(1), (2) & (3). Wisconsin Administrative Cade. - i \ i i1 ~;I~11~ NO- i l l P O d I i P U ~ C / , •r r ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer U D ~D Mailing Addr , ~j y (Verification required from Planning & Zoning Departmen new construction.) City/State Parcel Identification Ntnnber G -'U rrs ~a LEGAL DESCRIPTION Property Location V., 1 /a , SeC T 1_ 9 N / W, Town of M C2lam' / V_ Subdivision,, 2 Lot # Certified Survey Map # Volume , Page # Warranty Deed # Id `'l Ll , Volume Page # Spec house yes 0 Lot lines identifiable yes no SYSTEM MAIN'T'ENANCE 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, -d 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 form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed purger 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 bas been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. I/we eettifyy that all statements on *form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the property described above, py virtue of a deed recorded in Register of Deeds Office. t.` Nugibek of bedro 6 c 1-5- SIGNATURE 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. 08/05) 62758 S.F. ► W~ f S` N 86°51.48'• W 44648 S.F. 1.441 ACRES 1.025 ACRES ► 335.23 3314.19' ► tQ c 1 7$ 36 ► ► 63097 S.F. 13 S.F. _$_'4. _ _ o ► 1.448 ACRES 3 ACRES, 46761 S.F. c14 .1.073 ACRES ► • ..............20 W 6~ C10 84° 19, 00P E 338.28 h 13 C6 S 83 IN 80 H ,OS' OURT C9 N 84°19' ~E 318.90' 260, w / E C S 07°06' 32 1s ► BIRY ALE _21- c:? 0 I 58.07' 4- 77 r 79. l S.F. ► 45947 -S.F. ► g0, 3 R=80' N g '45.101 000, 00,.E 224.47' v 1.055 ACRES ACRES N \ N 8$°W• 00- W d0,E C7~ ~8 /r 90 Lv 318.00' 9g~3, . ` ' o 0 46291 F. 1.063 CRES, 76 ' ° M o $ $ o N N •f 44520 S.F. 00 00 43630 S.F. N $ 9 N (n N r. I 1.022 ACRES 1.002 ACRES ° 44778 R F z ► r-~ S-~ 3NNM J.OML ' XX 101 'NO SM3NONY 1NI d, of c X W015(YJ e 4 } } FA. KK lk~7a I I I @R Lh~J II ~ I I I to I I I II y I , I I I it ,HG p ,o, 1x1 p ! I °9 vlw. ow rr t AG Y { ~ f 1 d I I i Q " z ~ ➢ R ~ ~➢E ' 11 ~ 'r O n' y G p 1 g O t 1 i - x< LL -L i Rb a ~ ------y-~ I J x 114 g ai o-.r R;" Fns ; tlj Y s -1 F ~ wn ? 8° ' ~ ~ ~Y: e -1g v ~ Y I L LG rl R t , s Oi ~ 1111 4 iii b ^^^4tttiR Z➢l I I I .hll L Q o 1 "II ~ I g g11 ~ 's #J` #t X11 ~3 ~ !RIP Y s I gas I .rn a,i• ~G wl .rn gl6 ai s b i~ a°S € a 3N?M;.OT:U'XX10-l • •g=~~ a~ -guts 'NO SM3INGNV 1NIVS ObS u wao X :E ? F f I I I I I F I I ~ I I I I I I ; I I I I I I I 1 I I I 1 1 4 I I ~ ~YR~ ~ I i K d ~B9] I I ~ ~ ~ I mm ~ ~ O ~ ~ 1 I I I I \ 1 I I I 1 I I I I I I I I I I I 1 I I I I I I I 1 I I I ,~'&3~,c-g I I 1 1 I 1 I 1 I I I 1 I I I 1 1 'I An .or,fl I 1 I 1 ~ I I I I I I I I I I I I I I r I I I I 1 1 I I I I I I 1 1 11 I I 1 I r _ ~ 1 I I I I Y i I p I p! 7 1 ~t iii ~y n J L______-_- R m~i[uow~.• ~~t`'~ ~ I I ~ I aloe I 1 1 j ~ h ~ " 1 MvIVLO~OFwY ~1 iG s I V'-+N'~iA oK ~Ftl I I ~ tlk , p ~ 1 LLLLLLLIJJI iii i i ~1 tl.33 I i m3~ = i 0- ~.a-. .rc 1 i li ~ i : i Z 1 N\. ona ' I 1 0 h ~1 - O , 4 gi Y a lL 3 • I f I -----J " mill iii i Y `Y,`l w Twv a~u - ^II /n as (il\ .O~G 1-1 1~ " R ~ Iwclc II F ~ 41 3~ K ~ ggAg~ ~ I a9 s_ I K ~~5 ® t 1 9 I y I 444~~5 m R T h II A-.a a R I r--r 1-_-_ 1 1----- I f'-----'r we oo. A,c ~ _1"'I r--- oc - # 1 77 -------1 I F I- I I I I ~ I I ii t l F I 1 K ~ - - - - - - - - - - - - - - - l i ~ 1 I l p p I I ~ I I h I I I I va0 I I I ~I I I 1~ ~I F- p p l g g f. GI I N I I I I ,D I I b E:~ II 1 1 I I I I 1 L________________J r Zli L----- -----~I § g I " I I 1 i 9 rrT -14 a 1 VIII III I III111111 I 11111111 ' ~J I LL1' AI-1 AI-1 O.. .L .•I .F1 .fl I 3NS(G AOSI 'XX 10-1 X 'b0 SMgNCNV 1NIV5 01,Z: eg ~ i=`{4?t~, fCi§}€4i~ OL m~ir O w ® w ~ P I'® ® g III ,;I W IE I I ° W III III ~'®a LU !I III m'' I I I , I' I I ~1II III z DD ® W ° Op IL a HN m m 7 Wisconsin Department of Commerce SOIL AND SITE EVALUATION Page 1 of 3 Division of Safety and Buildings in accord with Comm 83.05. Wis. Adm. Code Environmental By Design Attach complete site plan on paper not less than 8'/s x 11 inches in size. Plan must County include, but not limited to: vertical and horizontal reference point (BM), direction and M. Croix percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel LD.# Q / APPLICANT INFORMATION - Please print all Information. 31dj Personal information you pro ' may be used fors ndary purposes (Privacy Law, s. 15.134 (1) (m)). Re ewe Date Property Owner ProNeliy Location Govt; Lot - NE 1/4 NW 114 S 19 T 28 N,R 19 W Property Owner's Mailing Address C Lot i Block # Subd. Name or CSM# 12301 Central Avenue NE, Suite`230 84 - Troy Village Second Addition City State Zip Code OhpneNi imber ° ` City Uil!aqe Town Nearest Road Minneapolis MN Troy I St. Andrews Drive F-71 1 -1 LXSj New Construction Use: ~x, Residential ! Number of bedrooms 4 jAddition to existing building Replacement E Public or commercial describe Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpdV .8 trench, gpd/ft2 Absorption area required 857 bed, ftZ 750 trench., ft2 Maximum design loading rate .7 bed, gpd/ft2 .8 trench, gpdV - J Recommended infiltration surface elevation(s) B Desi er ft as refer to site plan b chmar Additional design / site consideration S 1 C~ ~G~ Parent material Loess Over Glacial Outwash Flood lain elevation, if applicable NA ft S=Suitable for system Conventional Mound In Ground Pressure AT Grade System in Fill Holding Tank U=Unsuitable for system E S❑ U El S C,' U L7 SD U S❑ U ❑ S Ell U ❑ S 11 U SOIL DESCRIPTION REPORT Depth Dominant Color Mottles Structure GPD/ft2 Boring# Horizon i in. Munsell Qu. Sz. Cont. Color Texture Gr. Sz. Sh. IConsstenc~ Boundary: Roots -Bed Trench 1 0-30 10yr2/1 is lmgr mvfr cw if .5 .6 2 30-42 7.5yr5/4 - s osg ml cw - .7 T .8 Ground 3 42-58 7.5yr4/6 - sit 2msbk mfr cw - 5 6 elev 98.1 ft 4 58-69 7.5yr4/6 c2d2 5 r4/ it Imsbk mfi cw - na na Depth to 5 69-140 7.5yr4/4 - s osg 1 - .7 .8 limiting Site to be graded so as to be able to install a code compliant system below the mottled horizon factor - - 58- ' Remarks: 2 1 0-3 5 I Oyr2/ 1 - Is l mgr mvfr cw if .5 .6 2 36-53 7.5yr5/4 - j s osg ml cw - .7 .8 Ground 3 53-64 1Oyr4/6 - sil 2msbk mfr cw - 5 6 elev - - - - 96.735 4 64-7 10yr4/6 c2d2.5yr4/8 sil lmsbk mfi cw - na na L Depth t0 73-150 7.5yr4/4 - I[- s osg 1 ml - 7 - 8 limiting site to be graded so as to be able to in-stall a code compliant system below the mottled horizon ~ - factor ---64 - Remarks: CST Name (Please Print) Signature: Telephone No. Thomas C. Nelson 715246-2454 Address Environmental By Design Date CST Number Ref # 1432 120th Street, New Richmond, WI 54017 2/3/98 M02605 13 i PROPERTY OWNER: Continental Development SOIL DESCRIPTION REPORT 13 Page 2 of 3 PARCEL Environmental By Design Horizon Depth Dominant Color Mottles I Texture Structure onsistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed Trench 3 1 0-9 10yr3/2 is lmgr mvfr cw 2f _5 .6 2 _ 9-17 _ 7_5yr4/4 - is 1 mgr mvfr cw 1 f .5 .6 Ground eleV 3 17-33 10yr4/4 - sil 2mgr mfr cw - .5 6 98.71 ft 4 33-150 7.5yr4/4 - s osg ml - - 3 .8 Depth to limiting . factor ` >150" Remarks: 4 1 0-24 10yr2/1 - sl 2msbk _ mfr cw 2f .5 .6 2 24-40 10yr4/4 - sl 2msbk mfr cw 1 f 5 6 Ground elev 3 40-80 7.5yr4/4 - gs osg ml cw - .7 .8 97.95 ft 4 80-140 7.5yr5/4 s osg,Y,1~ - 7 8 Depth to ' limiting factor >140 ~A4 Remarks: - - - 5 1 0-26 10yr2/1 sl 2msbk mfr cw 2f .5 6 2 26-46 10yr4/4 - sl 2msbk mfr cw 1 f 5 .6 Ground elev 3 46-55 7.5yr4/4 I - sl 2msbk mfr cw - .5 .6 99.25 ft 4 55-69 7.5yr5/4 - gs osg ml cw - .7 .8 Depth to 5 69-145 7 5 r5 _ - - - - I / S o mi 8 I--------~-- limiting 7 Y I sg I Initial system being a conventional. Alternate being a mound Grading in the initial area required so as to meet the optimum fa design rates and code requirements. >145" >14 ~ i Remarks: I Ground elev I Depth to I limiting factor - - ~ I I Remarks: A 1 NV 1 0NM NT fit BY DE51GN 1432 1201h STREET, NEW RICHMOND, WISCONSIN 715-246-2454 PROJECT NAME: TROY VILLAGE 2nd ADDITION DESCRIPTION: NEi/, NWX4, SECTION 19„T 28 N, R19W TOWNSHIP: TROY COUNTY: ST.CROIX LOT: 84 SUBDIVISION: TROY VILLAGE 2°d ADDITION i fl ~ 3 1 ~J i ~t f Q~ l~ t r C t G~~ C D (.fc...~ 2 SCALE Tom Nelson BM i NE corner post ground surface elev. 100' cstmo2605 BM 2 SE corner post at ground level elev.93.10