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Home My WebLink About040-1326-04-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTION REPORT Sanitary Permit No: GENERAL INFORMATION (ATTACH TO PERMIT) 597415 Personal information you provide may be used for seconds State Plan ID No ry purposes [Privacy Law, s.15.04 (1)(m)] Permit Holder's Name: City Village Township Parcel Tax No WILLIAM D SAUL TOWN OF TROY 040-1326-04-000 CST BM Elev: Insp. BM Elev: BM Description: SectionfTown/Range/Map No 17.28.19.21961 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark T['S o®.0~ Alt. BM Aeration K ~i • b -re Lo - Bldg. Sewer I Ho ing SUHt Inlet 4~. t St/Ht Outlet TANK SETBACK INFORMATION q7 TANK TO EWELL BLDG. Vent to Air Intake ROAD t I et 1 . 71 Septic , 7 D t Dosing d~ Header/Man. Aeration G~ Dist. Pipe ;q Holding "1& 1772 _ Bot. System 'P~ ID.(~ b, (o PUMP/SIPHON INFORMATION Final rade rld 5.? too glvlanufacturer Demand St Cover GPM I. ~d l~ Friction oss System Head TDH Ft ength pia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENNS No. Of Pits Inside Dia. Liquid DDIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL INFORMATION W I,AKfF/STREAM LEACHING Manufacturer: Type Of System: CHAMBER OR d- UNIT Model Number: . J DISTRIBUTION SYSTEM / l Header/Manifold Distribution +-10 G~ x Hole Size x Hole S acin ! ~ e N Pipe(s) P 9 Vent to Air Intake Length LO Dia l Length Dia - Spacing_- _-I- C5 SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only C• Depth Over Depth Over :::]xx Depth Bed/Trench Ce nter xx Seeded/Sodded xx Mulched DedthrOve Edges Top. des No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1 Inspection #2: Location: 382 MEADOW VALLEY TRL -0 de OVA e p`&v- 1.) Alt BM Description = YY G~ 4- ~3 2.) Bldg sewer length = 1r cmb[~, , umjq ~..I C, q~tt ~tt P~a q~ ~ amount of cover = pYt ~~v~ c~I ~V.c ~raoc~ It ~ J• ~b . ItI~Hb Plan revision Required?! Yes ❑ No Use other side for additional information. I / rL I L.~/j') Q QI SBD-6710 (R.3/97) Date Insepctor's Sign, ur l L Cert. N No. No. ST. C. OIrX Ct7U^ITY ST CROIX COUNTY - ON-SITE VERIFICATION / FORM f a rty C vmer Property L ocation &A. Lot 1:4 1A S T N R ! .(c 1 'C1,.,,ner s t lal ling A°,:ldress Lot Block, x "--d-A. Naw cc CSfvW 7 -v d .Slat- Zip Phccc' Plumb-r t t ❑Cify ❑'r'illag- ❑Tcr~,n hlearastRcgd ❑ 14orlstruch n l,l.a:❑ R-s.identia1 Number of bedrwins _ C.od-cl__dvccJdeGignflov;rate GPD ❑ Rr~f o:nr.nt ❑ Pul:llc or~uommen:ial -Describe: P ifenl m Ild rnl Flocd Plain le-valion if applicable t. c a r71 mrn Ir<~ r J - - and Gymn'e%laliom: 1 /I F-1 13c4irrg 4 El Being rrr . a ❑ Pit Ground surfncc, Myv. _ fl Ci`epth to Iirnifilyd factor in. Soil Ap licatico Rate Horizon Co14h Lv:,minant Color Redcux De-&-riptien Texture Structure Ccm7 ist-nc- Boundary Rooks GPCk R faluns41 0u. Sz. Cont Color Gr. S,z. tih. Eifel 'Fffit2 ❑ Being 1,.Bcnnq 4 f n• El l r>t~i s Y Pit Cn_u bli ~cae It. c'c'pttr~o Inrntinyf<jr in. Sa A L,licaticiI Rate Horizon 5:-plh G-aninant Coker Recloi DesailAbn Texture Stru_ture Consist-nc- Boundany P.oots GPDA, in. rAinscil (u. Sz. Cont. _:ohr Gr. Ss7 517. "Eff#1 Eff 2 • ~ 4 '715-386-4680 ST. CROIX COUNTY GOVERNMENT CENTER 71 5-386-4686 FAX~I CDD@CO.-SAINT_CROIX.WI.US 1 101 CARMICHAEL ROAD, HUDSON, WI 54016 WWW.SCCWI.uS cClr CI s:Aedd\zonshare\sanitary & soils\soil reports & on-sites Comm 85\on-site forms & letters\county soil on-site form.doc f.- Count} Safety and Buildings Division St Crpoix 1° ` 1) 201 W. Washington Ave., P.O. Box 7162 Sanitan Permit Number (to be filled in by Co.) P Madison, WI 53707-7162 y Permit Application State Tranxmn Number In accordance with SP is. Adm. Code, submission of this form to the appropriate governmental unit N is required prior to o sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of S and Professional Servies. Personal information )ou provide may be used for sccondary_ purposes in accor with the Privacy Law, s_ 15.04(1)(m), Stats_ $2 Meadow Valley trl 1. Application Information - Please Print All ' mation Propert) Owner's Name J- &J.., Parcel # William D Saul 040-1326-04-000 Property Owner's Mailing Address Property Location 7743 County Rd 11 Alexandra MN 56308 ~i Govt. Lot 4 Cit), State Zip Code Phone Number NW NW 17 Section Alexandra MN 65308 circle one) T 28 11. "hype of Building (check all that apply) N: R 1 ~ x~or W Lot # X yfg 4 4 Subdivision Name ~ LJ I or 2 Famil) Dwelling - Number of Bedrooms bK 4~ Block# Meadow Valley of Troy ❑ Public/Commercial - Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of Z v LJ 16+47~ V Y`fTOwnof Troy 111. Type of Permit: (Check only a box on line A. Complete line B if applicable) ❑ Replacement System ❑ Treahment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) Nev` System B. ❑ Permit Renewal ❑ Permit Recision ❑ Chanee of Plumber [I Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. 'k e of POWTS Svstem/Com onent/Device: (Check all that apply) ~ ANonL-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound > 24 in of suitable soil ❑ Mound <24 in. of suita le soil - ❑ Holding lank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat ent Area Information: Design Flow (gpd) Design Soil Application Rate pdst) Dispersal Area Required (s Dispersal Area Prop d (s) System Elevation -7 It) 0 0 N'I. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units v u New yanks Existing Tanks v s w o I~SZ Septic or Holding Tank Wieser 1250 1250 1 lese XX Dosing Chamber I'll. Responsibility Statement- 1, the undersigned, assume responsibility for installation of the PONN"I'S shown on the attached plans. Plumber's Name (Print) Plumber's Sienature MP/MPRS Number Business Phone Number Countryside Plumbing 664713 715-246-2660 Plumber's Address (Street, City. State- Zip ode) 321 Wisconsin Drive New Richmond WI 54017 'III ounty/Dc artment Ilse Only X pproved approve Permit Fee Date ssued Issuing tSignature n Reason for Denial $ 7 Q d5. 00 71 IX. ('.onditFAX#X easons for Disapproval t . , etllt~ni tfRta* vrhi t,fsper su cell must all k"i fcpS r, a itjU ec rs.p rp;Mregemen! plan p!a iiaeh Uy Nluinbe,, 2. 'A *06i!i re WPft. anvS muutou.rnant, Kit "I as pw sppkilbh owk / ad ums;, Attach to complete plans for the sNstem and submit to the Counh. only on paper not less than 8 I/2 X I I inches in size SBD-6398 (R. 11/11) N1 NW 1/4NW1/4S17T28R19W LOT 4 MEADOW VALLEY OF TROY BM 1 ELEV 100 Wieser con- BM 2 ELEV95.37 Polylock 525 filter crete 1250. nk BOREING 199.64 Proposed house l%/f 102, BOREING 2 99.64 B2 BOREING 3 97.04 98- SYSTEM ELEVTION 96- TRENCH 195.8 BM2 81 TRENCH 2 94.04 BM1 8% slope ~S wCect t.Ja'S GoJ~l2cJ 1 d~vrin Sv{o~~~J~ !on Gor►.Sr7Jo✓t G4 j n5~a~~ed~ J'A. or.s~ naQ. , s S;' r0. 11 66 OPOSECDRAI~N GE t e aJ~ ~ EASMENT rL' CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: William D. Saul Owner's Name: William Saul Owner's Address: 7743 County Rd 11, Alexandea MN 56358 Legal Description: NW 1/4. NW 1/4, Sec 17, T28N R 19 W Township: Tory County: St Criox Subdivision Name: Meadow Valley of Troy Lot Number: 4 Parcel ID Number: 040-1326-04-000 vPage 1 Index and title 'Kage 2 Plot Plan Page 3 System Sizing & Cross Section Page 4 Filter Specs -Page 5 Maintenance Information Page 6 Management Plan v 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 & Heat License Number: 664713 Date: 07/17/2017 Phone Number (715) 246-2660 Signature Designed pursuant to the In-Ground Soil Ab ptionn component Manual for POWTS Version 2.0 SBD-10705-P (N.01/01). Page 1 NI NW 1/4NW1/4S17T28R19W LOT 4 MEADOW VALLEY OF TROY BM 1 ELEV 100 Wieser con- BM 2 ELEV95.37 Polylock 525 filter crete 1250t nk BOREING 199.64 wry Proposed house 102. BOREING 2 99.64'`^ 62 BOREING 3 97.04 98-. SYSTEM ELEVTION tnl 96- TRENCH 195.8 BM2 B1 TRENCH 2 94.04 BM1 8% slope PROPOSED DRAINAGE EASMENT SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT Page_of_ Project Name: Derrick / Saul No. of Cells Per Cell 3 It Cell Width d Total No of fc' 1) It Cell Length z7 e.7 sq it EISA Per Cell ft Cell Spacing S-4, sq it 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: EZ1203H-10 Typical Cross Section Finished Grade ft Observation Pipe with approved cap or vent ■ i Soil Backfill • i Geotextile Fabric j ft Infiltrative Surface 12 in ~ q ft Limiting Factor L G in ~ Slotted and Anchored Vent/ Observation Pipe with Cap ■..■ie■.■■n■....■.■■..........■....v■■..■■...■.■....■■■.■■ e■........ s■■.s Plumber/Designer Signature: Countryside Plumbing & Heating License 664713 Date: 7/14/17 r , r rr,:.; ' zab r P1,525 EffftlCllt Filter e. ,1~ 'rr?ii^F.5 (JSinnolP .~k:r:s. 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. leafures: /Its" H11r do n. Slots • Rated for 10,000 GPD (gallons per day). Alar a itch 10 000 GPD (Opt i» onal) • 525 linear feet of 1/16" filtration. ,Accepts 4" and 6" SCHD 40 pipe. G~ Accepts V PVC Extension Handle • Built in gas deflector. • Automatic shut-off ball when filter is removed. * Alarm accessibility. Rated for 10,000 GPD • Accepts PVC extension handle. f PL-523 I nsta(lation; Ideal for residential and commercial waste flows up to 525 Linear Ft. 10,000 gallons per day (GPD). of 1/1h" 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 SCHD 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 NSFIANS1 Standard 46 ILL 2:~ Nlainteaaancex The PL-525 Effluent Filters will operate efficiently for several years under normal conditions before requiring cleaning. It is recommended that the filter be cleaned every time the tank is pumped, or at least every three years. If the installed filter contains an optional alarm, the owner will be notified by an alarm when the filter needs servicing. Servicing should be done by a certified Gas Deflector septic tank pumper or installer. automatic 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 ,i m t xs<„ tf sure the filter is properly aligned and completely inserted. Polylok Zabel & Best 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: 203.284.8514 www.polylok.com 8N-09ZW •31Id 95 9-5z~-009 0 \ anod- 09Lb9 IM 'NOOd N301VW OL I.MH sn 91LTM z isod Siva 00/00/00 Siva IVIINVA OI1d3S w LLJ 7jf10d-3?Jd :3~VOS d3M 75 NMvaO 3130 01l00 M3531M 8w_09Z1M N W w ~J N HQ w _ Of Q C Z 07 w O J Z 0 co Q O Of ~ z~ ~ w a Ind } O O 0 0 m w d m r2 O W J i W In Q o O ^ < ¢ J m F ¢ ¢ X00 0:4k< z o a U H p ° o Z O OQ QJU -1 D w~ H 3 o a - LL v) w Q in CLo O m(n Jww d 0- z w O Q a° m U i~ O vi 1 w w ell D \ O v a < ° ~ y ¢ a J E5 O Q N Z ~Z-"N LL U? ~ O Lo 't m W I ¢ ¢ W (n _ s D \ O O N N mLLu N dQ O 000 Z -00 U N F W O OF-JL~.~N H I Q Q J0_ ~ JO ¢ W \(n2 s NOs J>N JQU JZ~ O¢ (n 2 Z N~ _N ~Wn 000zW^ ~H F-FW F- 2U 0 J un0 YrD N~ 0F-2 JF- 0Qw 00W ¢ zF- J (n W U WN ¢O ZJ0 w 2 2 0 002 00(nI D U z 0_ ~ F¢-.J~ p m pW 0D 0J1- 1ZOZpJjO Zs ¢ ZU) ¢ F-F- Z W XU Y ¢0 o¢wW_w0o U OSU X N z Z3m U~SJ3mJ?i o zo¢ z U N ~g W F- F- o o o Q J J c o ¢ Z ~Y 0L- F- 0 z z J 2 0 < V) Z O¢ 0 F- U w I ¢ fn I F- ~ z w ¢ ~ LLI :2 U LLJ O "Og w W O r N Q II N Q I. Li II o II ' s > w II N II o I „cti I o I a N o J I w I w \ g /i / I I + o I ~ w N U ~ W w D J z Z_ ¢ W „99 a32iinn0 i Sv Y z F- POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of 71- FILE INFORMATION SYSTEM SPECIFICATIONS Owner Septic Tank Capacity /25v gal ❑ NA Permit # Septic Tank Manufacturer I't,l < ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model J-_<' D NA Number of Public Facility Units ❑ NA Pump Tank Capacity gal q NA Estimated flow (average) ~y gal/day Pump Tank Manufacturer I1 NA Design flow (peak), (Estimated x 1.5) ! tr/ L~ ! -1)C2 gal/day Pump Manufacturer NA Soil Application Rate gal/day/ft2 Pump Model `-1 NA Standard Influent/Effluent Quality Monthly average* Pretreatment Unit ANA Fats, Oil & Grease (FOG) <30 mg/L and/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) <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) ❑ NA Biochemical Oxygen Demand (BODS) <30 mg/L ~In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 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: ANA Other: ❑ NA Other: NA *Values typical for domestic wastewater and septic tank effluent. Other:A MAINTENANCE SCHEDULE Service Event I Service Frequency Inspect condition of tank(s) At least once every" ❑ month(s) 3 Z year(s) (Maximum 3 years) El NA Pump out contents of tank(s) When combined sludge and scum equals one-third 0) of tank volume ❑ NA Inspect dispersal cell(s) At least once every: ❑ month(s) (Maximum 3 years) ❑ NA 81 year(s) Clean effluent filter At least once every: ❑ month(s) ❑ NA • K year(s) Inspect pump, pump controls & alarm I At least once every: ❑ month(s) NA ❑ year(s) Flush laterals and pressure test I At least once every: ❑ month(s) NA ❑ year(s) Other: ❑ month(s) At least once every: 11 year(s) JNA 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 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 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 <12 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 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 POWTS: 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 POINTS technology a holding tank may be installed as a last resort to replace the failed POWTS. f T aluati a o drng~ank 'n be i e Tai e D+41 13 TfB~ ~2 n! l Ca~rs77zc1 ❑ 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 Name Phone 7/y -2~~ ' Phone 7/S~'?1~6° ?~>b C) SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name <.~'ir/ Sv c fnc~c,~ Name ~T. ~'~U( C~uNJ 20AVl Phone r This document was drafted in compliance with chapter Comm 83.22(2)(b)(1)(d)&(f) and 83.54(1), (2) & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer i i1o\ ~1 Mailing Address t.t J~.2~'~~~j zj Property Address`~~~ i (Verification required from Planning & Zoning D partmem for new construction.) City/State 1 Parcel Identification Number 2-k LEGAL DESCRIPTION Property Location t4Y-#" yq , ~ ~A Vi, Sec. T N R W, Town of c,' t7.lc__~ Lot # Certified Survey Map # , Volume , Page # Warranty Deed # Volume Page # Spec house ves no Lot lines identifiable( y1,10 es SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St. Croix County Sanitaty 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 andlor (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of 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 " 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 wa anty deed recorded in Register of Deeds Office. Number of be r ours ATURE 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. 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SITE ADDRESS: ti~ p 20. ° G 382 MEADOW VALLEY TRAIL 7yp Opts - ~~.¢G~ _ _ HUDSON, WI 54016 UsF Fp \ o p p /5O. ryo oR~y~ ,ZS. 70, m' 25' So N / SFp~iC T.O.H. XXX.XX a LOT 4 44,330 SQ. FT 1.018 AC. LEGEND 25' x WIRE FLAG SET • • ® WOOD HUB SET AT OR 15' OFFSET OR ON BUILDING EXTENSION N88' 15_33"E-- DRAINAGE DIRECTION FOUND IRON MONUMENT DRAINAGE . . ' • • SETBACK LINE DRAINAGE AND UTILITY EASEMENT - EASEMENT PIPE EL-XXX XX _P_IPEEL•XXXrX) - - - - - - - DRAINAGE EASEMENT NORTH ` - N88 35 33 E-- SCALE: 60. DRIVEWAY ENTRANCE LOCATION 15 30 NOTE: bUTL6T 1 FRONT AND SIDE SETBACKS ARE _ SHOWN PER THE APPROVED AND i OPEN-SPACE RECORDED PLAT OF MEADOW ELEVATIONS SHOWN ARE NAVD 1988 DATUM. VALLEY. DERRICK CONSTRUCTION M LOT 4, MEADOW VALLEY (SAUL RESIDENCE) ® e o n,n TOOT OF TROY,,. STAKEOUT PLAN AuthGonsu@indassociates S&N Land Surveying Q,~_o„ ""KK TMo ~n+n~ DepartmenRE C E I O EVALUATLON REPORT #1743 it S P Safety and in accordance with Comm 85, Wis. Adm. Code Page 1 of 3 s Professional Servi - Schmitt Soil Testing, In-- `~~.l~ 1 12014 Attach complete site plan on a County P p per, riches in size. Plan must St. Croix include, but not limited to: vertical trfd 6?Y~fit,:-V4 )2 point (BM), direction and percent slope, scale or dimeAri~jrrsal 1~~~P~t9d distance to nearest road. Parcel I.D. Please print all information. - v 64 R iewe - Date 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 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 4 I 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 i i Public or commercial - Describe: Parent material Outwash Sand Flood plain elevation, if applicable NA 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) 95,6' & and recommendations: 94.8'. Slope is 8%. Boring ❑ Boring # i ! 1 Pit Ground surface elev. 99.64 ft. Depth to limiting factor 110_+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD_/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Efr#1 'Eff#2 1 0-17 10yr3/2 none sl 2mgr mvfr as 2vf 0.6 1.0 2 17-22 10yr4/6 _ none sicl 2fsbk mfr gw 2vf 0.4 0.6 3 22-35 10yr4/4 none scl 2msbk mfr gw 1vf 0.4 0.6 4 35-40 7.5yr5/6 none Is icsbk mvfr gw ivf 0.7 1.6 5 40-110 10yr6/4 none s Osg ml 0.7 1.6 Boring # ]Boring 10` Pit Ground surface elev. 99.64 ft. Depth to limiting factor 115+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consisten Boundary Roots GPD/ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eff#2 1 0-15 - 10yr3/2 none sl 2mgr mvfr as lvf 0.6 1.0 2 15-24 10yr4/3 none sl 2fsbk mvfr gw 1vf 0.6 1.0 3 24-38 10yr4/6 none Is icsbk mvfr gw 1vf 0.7 1.6 4 38-51 - 7.5yr5/6 none cos Osg ml cw 0.7 1.6 5 51-115 10yr6/4 none s Osg ml 0.7 1.6 Effluent #1 = BOD5> 30 < 220 mg/L and TSS > <.150 !L ` Effluent #2 = BOD5 < 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-9330 (2 07/00) Property Owner DCCI Land Planners Parcel ID # Page 2 of 3 l Boring Boring # Pit Ground surface elev. 97.04 ft. Depth to limiting factor 108+ _ In. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell I Qu. Sz. Cont. Color Gr. Sz. Sh. + [ `Eff#1 *Eff#2 1 0-14 10yr3/3 _ none sl 2mgr mvfr gw 2m,2f 0.6 1.0 2 14-19 10yr3/1 none I 2fsbk mfr gw 2m,2f 0.6 0.8 3 19-27 10yr3/4 none sil 2msbk mfr gw 2f,1vf 0.6 0.8 4 27-36 10yr4/4 none SCI 2msbk mfr gw 0.4 0.6 5 36-108 10yr6/4 none s Osg ml 0.7 1.6 4] Boring # Boring Pit Ground surface elev. 97.74 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 0-36 10yr3/2 none sl 2fsbk mvfr Cs lvf 0.6 1.0 2 36-53 7.5yr4/4 none Sid 2fsbk mfr gw lvf 0.4 0.6 3 53-58 7.5yr5/6 none Is Osg ml gw 0.7 1.6 4 58-112 10yr6/4 none s Osg m1 0.7 1.6 ~ Boring Boring # _ Pit Ground surface elev. _ ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#t *Eff#2 * 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 fonnat, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Schmitt Soil Testing, Inc. Conducted by: Conducted For: Page 3 of Schmitt Soil Testing, Inc. Name: DCCI Land Planners Thomas J. Schmitt, CST 227429 Address: 1505 Hwv 65 1595 72nd St. City, State, Zip: New Richmond, WI 54017 New Richmond, WI 54017 Phone: 715-7 0-1978 Subdivision: Meadow Valley Troy Signature Lot No. 4 Date Legal Description: NW1/4 NWI/4 S17 T28N R19W ® Backhoe Pit Township, County: Troy Township, St. Croix County PPo Poste A Bench Mark 1 El. 100.00' Top of 2' PVC pipe. Bench Mark 2 El. 95.37' Top of 2' PVC pipe. Slope= 80X D5~0 Scale 1"= 40' LO+ fi2e"~- 8~ 3YVJ 93 \ Q r,,L I P~vPoS~/~ Q2s~.zivi46 C As Cm &-;'V T - ~u -rL0 -r l ~0/VTR0t P7 -2 Wis. Dept. of Safety and Professional Services SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with SPS 385, Wis. Adm. Code County ST CROIX Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I. D. 040-1326-04-000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. Reviewed y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). l~~ ( 13 Zt7 Property Owner Property Location WILLIAM AND GWEN SAUL Govt. Lot NW 1/4 NW1/4 S 17T 8N R E (or) Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# 382 MEADOW VALLEY TRAIL 4 MEADOW VALLEY OF TROY City State Zip Code Phone Number City Village own Nearest Road HUDSON WI 54016 ( ) EAST COVE RD New Construction Useo Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD El Replacement Public or commercial - Describe: Parent material OUTWASH SAND Flood Plain elevation if applicable ft. General comments VARIFED SOIL. DO TO LARGE AMOUNT OF FILL ABOVE ORIGINAL SOIL TEST. and recommendations: FTIBoring # 0 Boring Pit Ground surface elev. 97.55 ft. Depth to limiting factor 128+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 1 0-48 FILL FILL FILL FILL 2 48-65 10 Y/R 3/2 NONE SL 2mg7 mvfr as 2vf .6 1.0 3 65-70 10 y/r 4/6 none sic] 2fsbk mfr gw 2vf .4 .6 4 70-77 l Oyr4/4 none sel 2msbk mfr gw 1 of 4 .6 5 77-82- 7/5yr 5/6 none is 1 csbk mvfr gw 1 of .7 1.6 6 82-128+ 10 yr 6/4 none s Osg ml .7 1.6 F1 2 Boring # F] Boring 128+ Ei Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 1 0-47 fill fl]] 2 47-59 10 /r3/1 none 1 2mgr mvfr as lvf .6 .8 3 59-72 10yr4/6 none scl 2fsbk mfr gw Ivf .4 .6 4 72-77 10yr4/6 none Is I csbk mvfr gw l of .6 1.0 5 77-84 7.5yr5/6 none grs Osg MI gw .7 1.6 6 84-128 10yr6/4 none grs osg ml .7 1.6 Effluent #1 = BOD 5 > 30:S 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number PAUL R KOEHLER 225410 Address Date Evaluation Conducted Telephone Number 321 WISCONSIN DRIVE NOV 27TH 2017 715-246-2660 SBD-8330 (R] 1/11) Property Owner WILLIAM AND GWEN SAUL Parcel ID # 040-1326-04-000 Page 2 of 3 F Boring # ® Boring Pit Ground surface elev. 99.6 ft. Depth to limiting factor 128+ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 1 0-48 FILL FILL FILL FILL 2 48-64 I OYR3/1 NONE SIL 2MGR MVFR AS l VF .4 .8 3 64-75 10YR4/6 NONE SCL 2MSBK MFR GW 1 VF .4 .6 4 75-90 7.5YR5/4 NONE SL 2MSBK MVFR GW .6 1.0 5 90-96 10YR5/4 NONE VGRCO OSG ML CS .7 1.6 6 96-128 1OYR6/4 NONE S OSG ML .7 1.6 ❑ Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 Boring# Boring Pit Ground surface elev. ft. Depth to limiting factor in. F-1 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ft 2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. * ff#1 * ff#2 * Effluent #1 = BOD s > 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD 5 < 30 mg/L and TSS < 30 mg/L The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, contact the department at 608-266-3151 or TTY through Relay. SBD-8330Test (R 11/11)