HomeMy WebLinkAbout040-1326-13-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
597356
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]
Permit Holder's Name: City Village Township Parcel Tax No:
DCCI INVESTMENTS / MICHAEL ST6 TOWN OF TROY 040-1326-13-000
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
(1b • ( r~oen!,, 17.28.19.2205
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
1(JG Q. ~ 49 lad, 1604
~
Dosing b lS~~~ Alt. B ~Mr, ~~1~Q i~ ~t~•3
? a' taz Bldg. Sewer roc.
t r~
Holding, St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION ~Qd. 4q
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ~ ~s „ 7~ [ Dt B om
Dosing Header/Man. 77~
Aeration Dist. Pipe 7.60
Holding Bot. System
PUMP/SIPHON INFORMATION Final Grade
Manufacturer
Demand St Cori. r l~ Cup
L/i, GPM
7~(~ joY3 tZ
Model Number
TD Lift Friction Loss System Head TDH Ft r-`,sue
F rce ain ength Dia. st. to eu
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length-y No. Of Trenches PIT DIMENWNS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS 7ft~J• }
SETBACK SYSTEM TO P/L BLDG WELL LAK~/ AM LEACHING Manufacturer.
INFORMATION CHAMBER OR gmy.
Type Of System: r ( UNIT
Model Numbers
DISTRIBUTION SYSTEM v
Header/Manifold l/ Distribution x Hole Size x Hole Spacing Vent to Air Intake
a Pipe(s)
Length / Dia 7 Length " Dia Spacing I 1_~ i -
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/Sodded i xx Mulche
Bed/Trench Center Bed/Trench Edges Topsoil
3, D es ❑ No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 406 MEADOW VALLEY TRL
1.) Alt BM Description = r 0"J^~ / a~, Ls / ✓ /
2.) Bldg sewer length = f Dltaf t~;~
-amount of cover = w
Plan revision Required? ❑ Yes ❑ No I f S
Use other side for additional information.
SBD-6710 (R.3/97) Date Insepctor's Sig atur Cert. No.
5~ - I~ r 3
_ / County
afety~ a Buildings Dion ' St. Croix
t2
1;,~ P~ r1 201 W. Washington Ave., P.O. Box 7162 Sanitary Permit Number (to be tilled in by Co.)
P ( MAY ~I 1U 2017 Madison, WI 53707-7162
'L4 -7
bg ST. CROLK COUNTY
~r»*xss° w x r - x
State Transaction Number
Sanitary Permit Application
r t „
In accordance with SPS 38321(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 POW] S are submitted to Project Address (it different than mailing address)
the Department of Safet}' and Professional Servies. Personal information on provide may be used for secondary;
purposes in accordance with the Privacti Law, s. 15.04(1)(m)_ Stats. 406 Meadow Valley T r l
1. Application Information - Please Print All Information
Property Owners Name Parcel #
DCCI Investments / Michael R. Stevens' 040-1326-13-000
Property Owner's Mailing Address Property Location
PO Box 445 Govt. LotL-
Cit). State Zip Code Phone Number NW _ y, NW / Section _ 17
New Richmond 54017 715-246-2320 (circle one)
-1 28 N_ R19 XXrW
11. Type of Building (check all that apply) Lo( #
XXor2 Family Dvkelling - NumberofBedrooms 1 5 13 Subdivision Name trc
dt~~k# Meadow Valley q Troy
k' -a ?SF, Gb•
❑ Public/Commercial -Describe Use
❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
J ~_i t`3Y R* -,N -7,4 t 'fown of Troy
L+' '~~l Nib ti',,.f-o.
111. Type of Permit: (Check only ohe box online A. Complete line B if applicable) - '
A
QX1ew System ❑ Replacement System ❑ Treatment/Holding "Dank Replacement Onk ❑ Other Modification to Existing S\ stein (explain)
B. :09enmit Renewal ❑ Permit Recision ❑ Change of Plumber [I Permit Transfer to New List Precious Permit Number and Date Issued
Before Expiration Owner
IV. Type of PONN'TS System/Component/Device: (Check all that apply)
.
El Mound> 24 in. of suitable soil 11 Mound < 24
5d~on-Pressurized In-Ground El Pressurized In-Ground 11 At-Grade _ in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment
Device (explain)
V. Dispersal/Treat ent Area Information:
Design Flow (gpd) Design Soil Application Rate,(gpdsf) Dispersal Area Required (sf) Dispersal Area Proposed (sf) System Elevation
750 .7 - I c'~ 1.4z ! S ,5
VI. Tank Info Capacity in Total # of anufacturer
Gallons Gallons Units o
New Tanks Existing Tanks 2
Septic or "oldingrank 1000/600 1600 1 Wieser w of loc 52
Dosing Chamber
X'11. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumbers Signa ure MP/MPRS Number Business Phone Number
Tim DeYoung - 664713 715-246-2660
Plumbers Address (Street. City. State. Zip Code)
-3Zj
~r~~IAK~~~~ L✓/1v~ E't'p..~ /CL ~il~,yl~ t~~'~~ ~I
VIII. County/Department Use Only
Approved Disapproved Permit Fee Date ~sueq ISSUmp A , Ont Signature
❑ = ~
❑ O\Nrner Gi\ cn Reason for Denial
1\. Condit n b!PTIMMeasoilt
far Disapproval
1 Septic at*, 61`11:c n; itt M11 3 1 t7U + +ti~ ~%4 d t '
dispat" i a0 must all be spoOoms .1 ~;nt~'- ec J r S ' r f r
_per -narA"rent plan pfovide,f by plu nbe:.
as
2. AN'aa1cK'Irertenv~.prtast be r-la;nt, ire
n per 9pFA=ft codip / adnanru><. c
Attach to complete plans for the svstem and submit to the Court ond) ~on pape not less than 8 1/2 x 11 inches in size e- d
SBD-6398 (R. 11/I I)
LOT 13 MEADOW VALLEY OF TROY
NW1/4NW1/4S17T28R19WTOWN OF
N1 TROY
SCALE 1"=40 FT
SYSTEM ELEVTION 96.5
BM1=100
BM2= 98.66
BM2 \.'_$1=100.81
BM B2=101.16
B3=102.61
\ INSTAL SYTEM HIGH SIDE TOWARDS
B3.
THREE 75FT TRENCHS OF EZ FLOWS
100 YEAR HIGH WATER LINE
100 C0f4T-O U R_ - - \
i
1 102
I
I
Observation 1
1 ~
pipes
I B SLOPE 3%
i Q B3
_
I ~ 104
1 ~
I Three
i
j ez flow trench-
Wieser 1000/600 1 0 deck
Combo septic tank 1 0
1 Pro-
Poly lock 525 filter 1 posed
I garage
1 house
1
1
1
I
I
Proposed well Drive way
I
I
I
0-10
1 3
I ~
I
1
I
I
1
CONVENTIONAL COMPONENT DESIGN
Residential Application
INDEX AND TITLE PAGE
Project Name: DCCI Investment / Michael R. Stevens
Owner's Name: Same
Owner's Address: PO Box 445
New Richmond WI 54017
Legal Description: NW 1/4, NW!/4, Sec 17, T28N R 19 W
Township: Troy
County: St Croix
Subdivision Name: Meadow Valley of Troy
Lot Number: 13
Parcel ID Number: 040-1326-13-000
Page 1 Index and title
Page 2 Plot Plan
Page 3 System Sizing & Cross-Section
Page 4 Filter Specs
Page 5 Maintenance Information
Page 6 Management Plan
Page 7 St. Croix Cty Septic Tank Maintenance Form
Page 8 Warranty Deed
Page 9 CSM or Plat
Attachments: Soil Test & House Plans
Designer/Plumber: Countryside Plumbing License Number: 664713 / 225410
Date: 05/30/2017 Phone Number (715) 246-2660
Signature
I
Designed pursuant to the In-Ground Soil Absorption Component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01).
Page 1
LOT 13 MEADOW VALLEY OF TROY
NW1/4NW1/4S17T28R19WTOWN OF
N1 TROY
SCALE 1"=40 FT
SYSTEM ELEVTION 96.5
BM1 = 100
BM2= 98.66
BM2 131=100.81
BM 62=101.16
B3=102.61
\ INSTAL SYTEM HIGH SIDE TOWARDS
B3.
1 THREE 75FT TRENCHS OF EZ FLOWS
100 YEAR HIGH WATER LINE
100 CONTOUR-
i ^
I 102
1
I
Observation I
I ~
pipes
I B SLOPE 3%
B3 -
I 104
1 ~
1 Three
i
j ez flow trench-
Wieser 1000/600 1 0 [deck
Combo septic tank 1 0
I Pro-
Poly lock 525 filter 1 posed
1 garage
I house
I
L.... _
1
I
1
Proposed well Drive way
II
1
I
1
I
I
1
1
1
1
SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page_of_
Project Name: DCCI Investments / Micheal R. Steven
3 No. of Cells 705 Per Cell
3 it Cell Width 21/3 Total No of EZ10
75 ft Cell Length 50 sq ft EISA Per Cell
3 ft Cell Spacing 22.5 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: Infiltrator
Gravelless Leaching Unit Model: 21 EZ1203HO-10' 3 EZ21203 H-5'
Typical Cross Section
Finished Grade 101 ft
Observation Pipe with
approved cap or vent
p•!
Soil Backfill
SLR in n 'J
Geotextile Fabric
r
n
Infiltrative Surface
12 in
ft Limiting Factor
T
71? in Slotted and Anchored Vent/
7~~~Observation Pipe with Cap
■...ne..■.n.e..n......:....■ern........■.....■.■.■n■■■■.....■...■.MIKE...
Plumber/Designer Signature: Countryside Plumbing and Heating
License 664713 / 225410 Date: 5/30/17
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of '2-
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner Septic Tank Capacity , =i gal ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
1"f Pte`
DESIGN PARAMETERS Effluent Filter Manufacturer 11 NA
Number of Bedrooms S' ❑ NA Effluent Filter Model Z5- ❑ NA
Number of Public Facility Units ,ANA Pump Tank Capacity gal NA
Estimated flow (average) }'v =i gal/day Pump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5)
gal/day Pump Manufacturer 1~7 NA
Soil Application Rate ? gal/day/ftz Pump Model NA
Standard Influent/Effluent Quality Monthly average* ¢ Pretreatment Unit 1~ NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) -<220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 51 50 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) Q] _NA
Biochemical Oxygen Demand (BODS) 530 mg/L I -Ground 1 ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) <30 mg/L ❑ NA ❑ At-Grade ❑ Mound
Fecal Coliform (geometric mean) <10' cfu/100ml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size %e in dia. ❑ NA Other: ❑ NA
Other: ❑ NA Other: ❑ NA
*Values typical for domestic wastewater and septic tank effluent. Other: ❑ NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ,s' ❑ month )(s) (Maximum 3 years) El NA
_5r year (s
Pump out contents of tank(s) When combined sludge and scum equals one-third (Y3) of tank volume ❑ NA
Inspect dispersal cell(s) At least once every: 3 ❑ month(s) (Maximum 3 years) ❑ NA
0 year(s)
Clean effluent filter At least once every: ❑ month(s) / El NA
❑ year(s)
s 4-
Inspect pump, pump controls & alarm At least once every: ❑ 11 month( yeaarr((ss) )
) A
Flush laterals and pressure test At least once every: ❑ month(s) Et NA
❑ year(s)
Other: ❑ month(s)
At least once every: El year(s) NA
Other: NA
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications:
Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator. Tank
inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks,
measure the volume of combined sludge and scum and to check for any back up or ponding of effluent an 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 the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113,
Wisconsin Administrative Code.
All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment
units, and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer.
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page Z of
START UP AND OPERATION
For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals
that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents
of the tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface,
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of
effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring
power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to
restore normal levels within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area
within 15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the
POINTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat;
foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil;
painting products; pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is
properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with
soil, gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or:must be taken, to provide a code compliant
replacement system:
❑ A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption
system. The replacement area should be protected from disturbance and compaction and should not be infringed upon by
required setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will
result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must
comply with the rules in effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS
technology a holding tank may be installed as a last resort to replace the failed POWTS.
f~ T
hJ aluati a o dmg ank
be e ai e 2V4(8 M: n16 CahJS`TKCI~L D~
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the
infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time.
< <WARNING> >
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER p /
Name ,i l,~r~ Name /t
Phone ?i f Z Yc~ G 6o Phone ~l~ : Z~S c~ G~~
SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY
Name / D
C~~✓yc~ S-~ .<< Sr~e~~.~.t Name ST. Ct~.U ( i7U~ 2011f1~
Phone
This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (31, Wisconsin Administrative Code.
N80°54'59"E \
225.63'
25'
25
i
--870_-
.a d
o y~
13
W I E N L8.0 871.60 i~ M cv
F
Im I I
i I- I c 13.5 o a -
ll.s - 40' NORTH
I f f l 7,0' ~3 N U LU
\ I - a ".a: _ ILO, ~ ~ / ~ : VVV LLLtttJJJ 40
t~ I \ 11 LEGEND
I~ I .F I J / X WIRE FLAG SET
I I .1 I~ ® WOOD HUB SET AT OR 10' OFFSET OR
i I ' I\ i\ I j ( ON BUILDING EXTENSION
I t \ \ Il DRAINAGE DIRECTION
FOUNDIRON MONUMENT
If I . . • . . . . • . SETBACK LINE
t DRAINAGE AND UTILITY
EASEMENT
a - - - - DRAINAGE EASEMENT
DRIVEWAY ENTRANCE
~DO LOCATION
F}' t
RAID
ELEVATIONS SHOWN ARE NAVD 1988 DATUM.
NOTE:
FRONT AND SIDE SETBACKS ARE
SHOWN PER THE APPROVED AND
RECORDED PLAT OF MEADOW
VALLEY.
Ml@ M4M M F(p
DERRICK CONSTRUCTION
LOT 13, MEADOW VALLEY (Meadow Valley 11) "m yam..^=r
TOWN OF TROY .vam e.. nno.o.rFn.m
M
STAKEOUT PLAN autl,eor~unaglassWes SO 199d Suneq
h., ~ . , ► z~ht l ~T-521° lffii n c i,
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.
Ftature~.: tl6" 11iltration Slots
Alarm Switch
• Rated for 10,000 GPD (gallons per day). (optional)
• 525 linear feet of 1/16" filtration. 10,000 GPD
Accepts 1" PVC
* Accepts 4" and 6" SCHD 40 pipe. Extension I candle
• Built in gas deflector.
* Automatic shut-off ball when filter is removed.
Alarm accessibility. Rated for
10,000 GPD
Accepts PVC extension handle.
ffff
PL-525 lnst all<ation~
Ideal for residential and commercial waste flows up to 525 Linear Ft.
~ ofl/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 SCItD 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.
Certified to
5. Replace and secure the septic tank cover. NSFIANSI standard 46
PI-S25 Maintenance.
The PL-525 Effluent Filters will operate efficiently for
several years under normal conditions before requiring
cleaning. It is recommended that the filter be cleaned
every time the tank is pumped, or at least every three
years. If the installed filter contains an optional alarm,
the owner will be notified by an alarm when the filter
Gas Deflector
needs servicing. Servicing should be done by a certified
septic tank pumper or installer. \nton,atic
Shut-Off Ball
1. Locate the outlet of the septic tank.
2. Remove tank cover and pump tank if necessary.
3. Do not use plumbing when filter is removed.
4. Pull PL-525 cartridge out of the housing. ,
5. Hose off filter over the septic tank. Make sure all
solids fall back into septic tank.
6. Insert the filter cartridge back into the housing making
sure the filter is properly aligned and completely inserted. i ` ' ' t I Ea =t all
Polyto k Label & Best filters accept Easily ly installs
7. Replace and secure septic tank cover. the SniartFilter® switch and alarm. into existing tanks.
Polylok, Inc. 3 Fairfield Blvd. Wallingford, CT 06492 Toll Free: 877.765.9565 Fax: 203 284.8514 www.polylok.com
an-009/000A :3113 9 5 8- 5 Z~- 0 0 8 o\
aflOd-1SOd 31V0 00 00 00 31V0 09LV9 IM 'AM3 N3OIVIN Ol .IMH Sn 91L~W w~
n3a 313H000O M3531M ~bf1NdW OIld3S = w \
:af10d-3ad „0-,l= 4
„ l :31VOS dOM :1.8 NMVaO
wi-009/00ow V)
0
LL)
J
w w H Q
Q z m O
w D o
C) C~
~ ° _ J
w V) a
w O
af -1 Z j U a N m LLJ w CL m
ff^) O a O w F g o E w l/1 Q °
V I ° w J w rL J Z m ~ ~w
z F- 00 C-L O~ vv < H Z 0 o o
z
I..L O Q m 0 4kQ Z Z d w H Q F- C) 3 O > Z ¢
H
m > v
a o
w p 0Q QQU J Q N U Li0 Z Q a z o
Q moo 0 mvwi wHw Q0 Z a O~ ¢ a o
O U Jww o D w z p a
m J I 0 Ul N (n O z~ N ¢
O LL 00 n - Q Q w CO (n Y LLJ (n (D o'n U-) o N~ m w w ai ~ o Q ci a a
C) o °o I < F V) p Fin
O w ,J>N ~LLJ < U JZ~ z uwi U C~C0~ Z~
LO tii 0) Z: LLJ F- Fn V) \ a W N Q °
O NN~~OH JH OQw 0°W Q N w U w 0W F- fn
W m N 0 ~7
jM: ~0= 0 U2 a-
Y °QOOQwLLI Ld Q~~ a~° U O a(n 0
0
z F o 0
Z N3mU:2 SJ3mJ z U
Q J J = Q Y Y N
p z z U< U
J
Q
w
N
Q
I
H
U w ~
J
z D "vg a F-
~ o a z
w
m
a ui
~ \ -
/
O\
D
I
5: V)
o ► o w
Q Of w U
J
Lnn Q „S l9 w
m/~ I I I O
0
F-
_ ~
w
Z U
L~ L,
003a z
,,26 sv 69 Li
Q
N
Y
z
Q I
H i
ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer
G~
Mailing Address GX-A C"s 4C~' r-7
Property Address
(Verification required from Planning & Zoning Department for new co ~ tructiou.)
City/State O 2!~>u ~61 1 Parcel Identification Number
LEGAL DESCRIPTION
Property Location ILP '/4 , 4 W % , Sec. A2 , T '21;N R I'' W, Town of
Subdivision AA;~b~f Lot #
Certified Survey Map # Volume , Page #
Warranty Deed # -1415 05 , Volume , Page .4
Spec house yes no Lot lines identifiable yeses no
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 pat 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 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 &
Zoning Department within 30 days of the three year expiration date.
Uwe certify that all statements on this form are true to the best of my/our knowledge. Uwe am/are the owner(s) of the
property described above, by virtue of a warranty deed recorded in Register of Deeds Office.
Number a edro
IGN TUBE OF APP ICANT(S) DATE
***Any information that is misrepresented may result in the sanitary permit being revoked by the Plannurg & 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)
Depa~~ E W D #1752
o SOIL li EPORT
3 P $ Safetyand 11 in accord Pirni8e with Comm 85, Wis. Adm. Code Page 1 of 3
Profession~lAUCTAej 201 Schmitt Soil Testing, Inc.
p(~q ~
Attach complete site p~~ 9h&" ir8Y. x 11 inches in size. Plan must County St. Croix
include, but not Iimiteti tay:~ I Q tili!CI,an ocagnce point (BM), direction and
percent slope, scale or dimensions, north arrow, and distance to nearest road. Parcel I.D. U , ~Z J
Please print all information. viewe Dale
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). ~ Z /
Property Owner Property Location
DCCI Land Planners 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 13 Meadow Valley Of Troy
City State Zip Code Phone Number City Village Town Nearest Road
New Richmond WI 54017 Troy East Cove Rd
New Construction Use Residential / Number of bedrooms 4 _ Code derived design flow rate 600 GPD
Replacement Public or commercial - Describe:
Parent material Outwash Sand NA ft.
_ Flood plain elevation, if applicable
General comments Area is suitable for a conventional system with a 0.7 gpd/sgft rate. Possible system elevation for Area 1 is 98.10'. Slope is 3%.
and recommendations: -p r IW4& 511jeC 7t37LM
S/VE 1i 4A/~G- Sh'~lLr/~ 4 //a~ ' cam! ~MJr74 r-
Boring 7 s?X'L L A-77 0
❑ Boring #
Pit Ground surface elev. 100.81 ft. Depth to limiting factor 115+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. `Eff#1 'Eff#2
1 0-9 10yr3/3 none sl 2fsbk mvfr gw lvf 0.6 1.0
2 9-22 10yr3/1 none sl 2msbk mvfr gw 1Vf 0.6 1.0
3 22-38 7.5yr4/3 none sl 2msbk mfr gw 1Vf 0.6 1.0
4 38-41 7.5yr5/6 none grs Osg ml cs 0.7 1.6
5 41-115 10yr6/4 none s Osg rr 0.7 1.6
Boring
❑ Boring #
Pit Ground surface elev. 101.16 ft. Depth to limiting factor 115+ in. Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots _ GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2
1 0-9 10yr3/3 none sl 2mgr mvfr cs 1Vf 0.6 1.0
2 9-13 10yr3/1 none sl 2fsbk mvfr cs 1Vf 0.6 1.0
3 13-25 7.5yr5/6 none Is Osg ml gw 1Vf 0.7 1.6
4 25-37 10yr5/6 none grcos Osg ml as 0.7 1.6
5 37-115 10yr6/4 none grs Osg ml 0.7 1.6
Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent # = BO 5 < 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 5/6/2014 715-760-1978
SBD-8330 (R.07/00)
Property Owner DCCI Land Planners Parcel ID # Page 2 of 3
Boring
F-1113oring # Pit Ground surface elev. _102.61 ft. Depth to limiting factor 116+ in.
- - Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -*Eff#2
1 0-8 10yr3/2 none sl 2fsbk mvfr as 1vf 0.6 1.0
2 8-16 10yr4/4 none sil 2msbk mfr gw 1vf 0.6 0.8
3 16-25 10yr4/4 none sl 2msbk mfr gw ivf 0.6 1.0
4 25-39 7.5yr5/6 none vgrcos Osg ml Cs 0.7 1.6
5 39-82 10yr5/6 none vgrs Osg ml as 0.7 1.6
6 82-116 10yr6/4 none s Osg ml 0.7 1.6
# Boring j , r 6
_i
Boring
F-1 1 Pit Ground surface elev. ft. Depth tJ limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#t `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/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2
Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 <150 mg/L ' 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-8330 (8.07100) Schmitt Soil Testing, Inc.
I
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, WI 54017
New Richmond, WI 54017
Phone: 715-7 0-1978 Subdivision: Meadow Valley Of Troy
Signature •r Lot No.: 13
Date S- y Legal Description: NW1/4 NWI/4 S17 T28N R19W
Backhoe Pit Township, County: Troy Township, St. Croix County -
A Bench Mark 1 El. 100.00' Top of 1" Steel Pipe. NE Lot corner pipe. _ (867.68') ~ • `
Bench Mark 2 El. 98.66' Top of 1" Steel Pipe. NW Lot corner pipe. _ (866.31') d~ 1
Slope= 3%
Scale V= 40' - . -
taw
I
2t+ -
Z
O,%r
T ~ ~ 61 ~ f 133 ~ ~
~I
Q
Cie•
P2oP~
~ o.~o
i L/ L£/ 10 JdZ S.LN3WW00 MNOM It AiNnoo MW+9ZM_M-9009'3-lid `JMa uioo•Burjjnsuooq;ne
LL29-[06-9[L I°L OEiY-ZSZ-9TL 1°L
'dIHSNM01 83d 03SLA36 £l/9L/£0 :Rva gTorq LA noryog 1241,g LA -°T¢omoa°N
*l/9L/40 3dZ NO110f12l1SN00 80.4 03SV3132! rot aims r aims
JdZ :A8 a3)133Ha 12°4S °oIQY 095Z 1°°fi °►TQ d°TovgUi 90t
a N1/3dZ :l,e HMVaa 93I~10 EDHM 91!!0 LL1'SOM03
w~// /
IY ( I ) Q z
U Y 2 Z /
1 N 1 13 1 aZ a w I w W wz Oz 0 o~ a
N N m° O h x 13 m~ w w co 0 0 ❑ / ❑O ❑O ❑a
~O 0 U-)O o h o - w x I0 C7 r ❑ I❑ ❑a wz (7 / / / J
r 0 I wLU ❑ O w w w W C9 rWnO
O z O Z z Z z I Z - ~w w W w z N I J i J > > 0- wa: ?O
Z i o v o I x wa ? I w c7 > I > _ ? Z~ Owr
W 1 U U w (Y ~3 I> Q O Z Q Q ❑ ?W u W Oa LLw ~Q
1 o I w ax Q x w ❑ o Q ~r ❑ 0 3 ❑v m>
rn o LL LL a - w < w ❑ cD o T x U) w ~ a Q
v I N N \ C:) p' I U) W I Q 0 (n w w H- w /
❑ 3 1 a Z= O
W Q ❑ ❑ ❑ ❑ XLL LL U)~
W I cD I w c~ 1 x 3 LL l o m w I w w I❑ W Un o u, x 07) w
J z ? N z f 0 x U x 0 z U o ❑ m (n w d ❑ a U) 3
V) a u~ x _ a I N a I O 1 0 LL a a a
W a w w 1 a ' a te I w w a 0 a l a a T a O
> w pLL I N R 1 /
x f1 I I I I \I I I I II I~ I 11\\ J / /ate/i//
\ ! I l l I 1~ 1 Ix I
\ x l J I I l I II I h l l i l 11 1. CtfU--
x / / m I I 1 / I a \ I ~Nll KiHEldObd,/
vi LLJ
X t II II h lV U) vo Sig
'U
M' O~
NiLoo
00
/ m x X / / / / / I 1 I I = Oj 1 M a/ Wow /-cn°v,--
l ❑O-i- wr
\ /lN0cn/TO0 /
C rM n /
1 l T / / / / / ( I lI \ / v^ 0~e' / o --j
x
X
wOZ
e J
3QW Nol
\ \ \ ! /'J wow/ e~ w wW
\\\7 ! ( / / / / / ry wx /_ONm~ 8/ w ~U7 7 e J /
w 00 V.
Q/ /d \ )1 G TQ00 X~• / > I o CIO J/ rU
/cb / / / / /Oal m0 J w~ O I ¢ N¢/ / t
co U) no 0 U)
Lij
/ / / / / / ~•y / 1 / /r I 1 a>
•%r/// /J / I . 11 a01 (nm \ y~ ro r~, 1\\ ~ / / / / / / / /
i 00 Al
0 U)
ujF-
LU 0)
/ o et8 I 1 i ti~ I\ a r¢ 13QLU \ / o r/ \ \ coo / X a i mnnn\ m X^ o] / / PW \ \
874 / m,`S~m / /ll ~~j \ \ \ \
-V ~ ! '001 0 gym'` / \ \ `W\~
X% i I a_ / I / 1 \ \ \ \
uj r- q Mc)
:l I p0 apWO
w \r¢\ \ \ /
Z M, W W \
- I W I i I I AM
® 1 3 ~j \ nx Lw~ j~ I/ \ \ \ `omen \ \`O
X I 1\ I O \\Oxw \ 1g 91, \
b ` \ \ OQH Taco ❑of''~X l Qp
\ \X t_ \ Ox- _n0 'OcnN I E X088 \
-0- U) CN
LLI P': M 0.
=OUP\\ X^w,`- _ i
LLJ
.'4 4j
d 2'ZO _ X~,. u~ + c saa§';i as SlEn aaah
B 2 F-N oW z a x <N c z. r g7 .3="^=4i x38 3: 691i~: P
m .r3
LL.
s~ ` ~ pp
K~N= rco 5 - Di 0 ri Q Nq~ p A 4RR'X"N^R.^.Sq Fs 3
O3OZ t,~d~W~ y^~ < 3~ °,9 5~H^Aa:Ya 1REFSd3s:39d3s
W ZF' v0~2 6a°i 99 d N 7ssaR;AF ^aFXRF^R 336,Na X,. ~^gg FBNRII
W V :3
O o'O o da~.RF~XXX51FFiRII iR .7 S~F~S~F~~
~ F LLx C-~ ~a7t?aF~ t~;.;,°33ullaa ^ r '"C..F?.C. >i
py 'y
Q O ~ v ` z €p B.~ 8s ;Ya3 ~a9~aa d'p^sRp
v ~u ale "
y'Xkr$D ibx""b~hpa~gr3x?;:isp ~
3 a~ =g=~_-~ ~ aaaX Pp xp s pFaa6gAF Xs
Z Z 3 55 gg 3`e i~ ~ -cam =5"e§ W3niix6'3~3a~7§ ~h~6'a~.hkbia:hdi?~~i~xb
W = Q 5'. 9 IIN a ~SS`€ ;m$oo 8Fl $8888888$868688 886 $gg$$$ $$$69 8$8§ 3
Q
; `$w5 0 35?ASAA3 X95¢ 33d3dSdaa"ad"ad??99
§ i 36 R !--Ug
z LL
0 O $ ' $ i ~`=WSz~ a 5355 55 55 5555§ p
G\ Z 3 g as8! S i 5 E. :aaa` b'°; €
Q O 5 (s 9 ~W°e38 g~ aoanac oa°° caa a a aaa"a@o
W f W W ~3Z `5 C 3S c8 WGg= gi€zug s
Raw
f f W~a$s °
0 • . o . i I it ~ ~ ~ 3a~t=^~~ aaa ~a~4 Wn~s~
~x3'at. ~~y3y33st~tea Saa Biq aa.
$ a a
1411 ~ ~ y
I PB /
Ln
'Dtiar~~J41. a
21 r44, W E ~N o
11 0_ ` / 8 _F •aztn \ $ ~ m W 3 s n ~ a K
~~Ay J , 1 d~ i ~ <,~t.,o ---_i 0`~ A""<ae 1.:• ~i ~ ~ a
y, r ,f~+~p R \I " / a -'•an.m, b Y 4c"' d` / ®i =
st\
w a. e ~ b ~ l C\ gG a'
•`~_'~A;~~ / r ~ r q r r~ . ~n ~ ~ ~ „ono 0
75
~Y yF. .ter gy~l ~iI" 1 6iy lam. ova°_?3
4 a q y m q
E -Q's
ux mmM ° ~
Z21. I
- 1
/ I \ ie~vo~~ m~a®avia I R I I a°a u va e~®a~u
/ I \ I I I l i i