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HomeMy WebLinkAbout040-1273-30-000 (2) Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 605049 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: John & Taren Weyer TOWN OF TROY 040-1273-30-000 CST BM Elev: Insp. BM Elev: BM Description: 86 1 Section/Town/Range/Map No: / o9 6" . 17.28.19.1520 TANK INFORMATION ELEVATION DA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark 3~ 161. /66 Cw, 164.1, e---A Z56 Alt. BM tG.. J 3. ' °IS . Z Aeration Bldg. Sewer Holding St/Ht Inlet I TANK SETBACK INFORMATION 1A St/Ht Outlet TANK TO P/L WELL BLDG. / en SAir Intpke ROAD ) O ~L ~+3 C~ Sift V 0, Dt Bottom ___1. Se tic *756 ,775 Z7 Dosing Header/Man. 'b /b 9r D i 164- Aeration Dist. Pipe Holding Bot. System PUMP/SIPHON INFORMATION Final Grade 141 It 3 g Z. Manufacturer DeP^and St Cover Model Number qbg if 7Forcema~in Friction Loss S TDH Ft Length Dia. Dist.toWell - 17- N.) SOIL ABSORPTION SYSTEM BED/TRENCH Width Lengt~ y No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dot Liqult7411Qt` DIMENSIONS (MAN SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR L'+ Type4f System : UNIT Model Number DISTRIBUTION SYSTEM 4-to 4 Header/Manifold JF 11 Distribution Ix Hole Size x Hole Spacing Vent to Air In ke Pipe(s) 1 6C Length z7 Dia Length \ Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center 2 Bed/Trench Edges Topsoil G Yes E No es [~No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: Location: 322 DAY FARM RD JG;,,~ 5 1.) Alt BM Description V e.., 0 V'--. 2.) Bldg sewer length - amount of cover Plan revision Required? El Yes No I Use other side for additional informati n. 16? Date Insepctor Signatur Cert. No. SBD-6710 (R.3197) ° met ECOVED `s - - - _ _ 1 5 U Tnuuatr S CYtI Divisivr. County - ___.---------------_-1 JUN 15 2018 / l?Utz bGashm2ton Ave L.QO~x P-C?_ Aux 1 162 Samtary Permit \ St Croix County 5--o-, umber {m be filled in by Co-} . I ?vladts' ~t~•i - }7 _ Community Development _ Il~r✓J O'Z'~ Ir -tC Ordance ttiitll SPS 383 _1(21 Wis Adm Cock. Suomi j0 ssrutt of thisrm o die t(rtpro~,nt(c u~ n t qt t eu ;st o: to abta tun, tntcnt; I tru t nary pvmut NOfe: Appitrtuon torms for st te-ocvncd PO i`S aresubmitted to + n7 dtn xddressj--} ilcs= '3e ° r gat is rid Profctsonat Sc.rnieec Personal uttbrmation you provkic maa be rice{l for secondary Protect kddres ,'ti dr lcrartt dial, tx+t S in ac Ord ne with the Pnva I.I 7 i.5 t t 1(nt}, st its. Application Information Pic ast Print All Infors?t t£st - ~ 3~ oa ~~M rrpe:ty Ow ne ~ Parcel 43, t iAstEN CJEYE~ I - "ro,~<=tv O,anu - Mal lm- - f.?730 Ao 0 - Property t ocat,4.t _ _ _ AY Alt ~~jj Govt. Lot 1 Zip Code Plt(me Number Section 17 eiz? i. Type of Building (alter k ail tt ,at a I) PA i I X; R or 2 Fanri!,,• D%vel l r - :umtltr of F32 ] 1ri> r,; - - Suban ista~„ AarnW - Publit;%Cotutncrcial-DescribeClse F~-fStti .,t 5t;:te Owned - Describe Use j CSM Number r t. ;tgc of - fl Frixi" t?_er y =a TN pct of Permit: (Chu z. mti uric hu" vil ttnc Complete #tnc i# ailpbcable) V( ti tc.u !t - - - - • , t.:t~ n 1r~te r ~1 Trc.attuct, ltotdittg 7tn:: N_cpiaccmcnt (`nlv ~ rt. SL r rct 1- ut} _ i L7 Ptrttt Pc tcx.d _I Permit it.e ,;:,n t ' ('tt- ----7- ~ a,-.ae of n ,t.rt.b.; ; P41nvt , ra stet to Nov Lisi Prat .taus Pcr'mtt ` UMbe and 5atc issued i Before I too ation Owner yL3 9/3 r rat ai P~31v'TS bystetnlcamponenUDevic e (Check all that D - T lv) 15, 'lion P s nz d hi-Gtotiod ❑ PresSurired fit-Ground4 ~ -C;1at.c- r' ~ - 1 oana _-t ? in, or su1 ahlc soil btautd : 24 t ."kbl- soil _ loldn ,'r r+ . uDispcrstttomtru2?.e. tuna c srtt, -o. ~Yfs el Sai I rest c,ttt i e8 {tfOr3Rfltiaf2: - - nohm + =pdJ Design Sod 1pplica(km Rate( _p - t - e - - _ j ; li CO i Drsoen. + ca Rcuairca rst Dispersal Arcn Prnttoscd T,rt nrcr's~ - - Ass 8s_a Cap;:city III 876 Total n- i ~aansttacturcr T--~1 T- ~r U (ions f,;ttions [ nttti E r i 12S6 A is _ - ( 3 cesnanstl>ilt>?' Statettteut- 1, the uadcrsibned assr=mc c espansrhdrh for installation of the V011 FS shown on the attached ph us. Yiut bet > :'rime ('riot) - I Plumber. ' „o I kiI,/ f' S \umber Business Phone Number PI] i,,lhef's S y trcdi, C_!R•, Sttt:C. L!p 1.x....3 - /1f G .7 p8 r. WY ZS- i a~a.~D LJ~ S,y734 tunt4 (Dept.-t rrenc Lsc 0itI - - - t -pit P-e 1 r 1 E c I) it {z sued Cc a w o~ 70 uen Strrm'att3rSa L3 Sapp, aL„i - It .#4 r. i ir to 6,4 er- +i cell rust all be "rIcas r nte!nt4,rgy -is per narAgernent plan ptu iioeri by plumber'. 2. All sef.bwk rec;0t-,men,,s must, tie inaink, WA as per VFlkn-lbls c:nr'r: I ~.rdi l1Ar?II3. _ e.till' tI. . t.~ +i~t . i' t i t 1/t ::%Y_._--_-- o I ~ ~ I t•c, T \ ~i ~ M ` cC1 41 16 ~ n c My ~ V 14, \ c CA - , 4 e afI 2 b t 1 ~j V ~ ry it ~ v v 1 IQ © Gp v V Q 'fj Q 1iC : ~Ci/YJ ~ . , f ~A!(F✓ _f41~Yc ?"-,re. %n14Aav✓P 'dtJ 5,1tEt-t4 ~rvf#T~ ner's Name,- tr - i. k/#Y ~Artrr ~O Tows fi e. p=ity of TRciY t - lumber yy !-i-)dIvlsl.on Nallle: 7"/toy wa a rt_c' i~.?.Number: D4a- 1.77330-Q6 6 - Index and Tine Page Plot Plan with Cross-Sec i fi)? ck ii fCti' lie 3 Scl)tic Tani: Specificati()jt ~e PCVTS Owner- < \ianILf ) u1 3i13f tllll'.ili ~ .f -.icci7 ti Signature: Date: G-/-.?a/8 Desicaned pursuant to the following PQWTS Component Manual and DSPS 38I-38--~. . _ t1?-~_7rJLit1. ...t,l o ~a ~ o 3 h J~ i \ M /1 m v V a lei 43 1t1J~~ i ys T o ~k 44 s 3.. Ma Q x ~ a rti \ 1 1 141 h ~ ` M v V ~ b C ~ ~ D 4 vt ~ c ~ 3 it h 0 @; ` V v 1-97 1 N hr co co ` NNCj o ti co co I LO i I r ~ v r ff ° N i fij LL ti 4 It ~ ~ o x r) LL LL h LL 1 i 4 j W C I L o l11 n WJ { ^ - ° - I-0 4 ti O U W Lo _ti LO U U U Y to LU zw~~ c m o J o ~ a LL Q, CN o / co C\j { o0 ( w" Cti m s i O m ~ C\j C Q W xu 0. no U M Z Z, LL U 5 x° W U R 0 O a i C) v z w o col ' q ° 111 + w' { . a o I I 31 k- B c-5 U ul W lu 'jwo GO t Q z ~ Q ~ e Sinn,;1OSI, str of gest, and iTlosi corio mica! oivei ~ r ,aive ever invented fcr septic tank 'each '_e!c'.. i of tough molded plastic that will not shatter, bend, rust or corrode. !t is lighter in weight. easier to handle arc: i.-s .pensive to si it ?e diverter v_'. i;ree-way valve stem, arnoved from the neti.`l '3; .onnect 4" plastic _ r v . . ~e ie , installing caps). The Diverter shield w, ich houses Me diverter stern may be cut to desired lengir 05 i Pkg. ter ?art No. Description Cot 101" Q Y. (ias.l 575P 4" PVC Diserter Value Wire 4 9.50 or' 575 AB - - S Div@.r[e r V4 L..aive B}3Cit 13U i CLOSED 2 V7 0 TANK TANK TANK d 5 6 i t '11tP'~10 Us1ad O-PEMcVE uv ~ T!% N he NDS gravity flo.Ad Backwater Valve is ;'greet senders. It is available .Iternative to cast iron valve he quick action flapper a!lc`.. : ,eai. Flapper can be easily removed and replaced if required. `treaded access cap is designed for hand tightening. Access cap neoprene gasket provides a positive seal. Valve hub ,utlets fit 2'. 3", 4". or 6" DWV pipe and may be adapted to 2". 3". 4". or 6" sewer and drain pipe with NDS DWV to ;eviler & Drain Adapters. ht,veight, easy to install. Horizontal installation required; with arrows on top of the valve hub pointing in the direction the flow of water- Access riser with over offers a simple, economical if em t""U nber A =sec eigft riser :r. ! assess to the valve Ior inspection and i LisR 275 ^.10 5.03 0.53 16 I 4 ".-aintenarce. The riser may be cut to I! 275PR 2.1 E3 5.03 3.53 16 i 4 °sired length. 375F, 375 3.51 i 7.5G 6.10 ! 16 G i [ 3-SrR, 3758 3.51 7.56 6.10 i 16 6 j 475P,475 E 4.47 11.13 1S 16 8 ! e 51F-R. 475,9 4.47 11.13 13 f r R f r1' ~ I ~ ~y 675P. 677 How All Jimensir,,ns are norninni, All wo;gl is core for s! ippinO purpn,; 2 E: L a u u✓ Z v a v 'o 4-1 ~j iIII3 4 0 Q1 = f sn n r - T _ 1 ~ H C > ~ i Q ro a o v E uj c m aY ~2 r'N 17 P1 "6 v y V UA n ci J T 1 v .6.Ji v Q1 ~ d M e Y u : j s N J 4.L i v C kA ti T m r~ 4~ ~ J O y ~ J ~ v .d 1 t. ~ Z ~ J n~ Y AEC Q: • L C ~ 4 ' p v r CL tj vyeyQ ~ - u 2Z F C W N 4 A C r C, k f; U ~ ! rn R, ~ ' -C 7 vNi 7 4 C v Y iii *~i ai 1 c E Ln u c v E 4-4 a i.] a c n ~T Q R a j u R. 2 v tic. kj, : tJt .TOi✓~/ r< 3'R~tE~/ G1EYE~L Septa eptic Capacity 41-5 0 al C7NAl Limit = i r. j Septic Tank :r.anufacturer $Ki9e~ r~ 7' i NEW a, SCCNPARAMETERS _ i ES65 r ~ yA~ Effluent Fitter Manufacturer Number of Bedrooms (100 gp Number cfhcdroom) ~Efftuettt Filter Model l bf-/o NAi ~umberofCommercialUnit's _ l LPump Tank Capacity _ dal 9 tiAj Estimated cloy: (,average) 6 ralldav _ __.fo^v _ ( N Puma Tank 1,Ianutacturer 1 © ';\1 Al Dcsi= flow" (D1VF) estimated x 1.5 loth aal,`day i rump Manufacturer + © \AJ "oil Application gate _ 7 eaildayrf~- Pump Model i L71 1VAj - - l Pretreatment Unit (,g'~r1) !niluenUFf'fluent (duality t. , e Ai i`.Ionthl . era^e l SandiGravel Filter PeatFilter Fats. Oil L Grease (FOCI) `30 mi. Mechanical .=\eration 0 Wetland Biochemical Oxygen Demand (BOD-) %L - 0 t 0 Disinfection M Other: Total Suspended Solids (TSS) S lit) mar/l.----~ (,Manufactt,rcr: tilodei: n ttonthiy At erase 1 j Soil Absorption Component lIA) retreated Effluent Quality (u NA) I Biochemical Oxygen Demand (BOD;) ~ 30 mg,,L ~ X In-ground (gravity) fl In-ground(pressurized) Total Suspended Solids (TSS) <;Q mg l- glade Mound Fecal Coliform, (geometric mean) I r: C7 Drip-line _ G Other: _ t0 clit/ 100mL l - ~ l~'erticai Distance Tank I~ottam io ServiccPad: !`~,~Ct ,laximum Eftluent Particle Size I US, inch diameter LHorizontal Distance Tank(s) to Service Pad: t - Dispersal ;nit :NUg./'Model 'Number: _ EZ LOi.I l.ib3ri~ ~u.►~OL6S _U tiA a;culations. Soil Dispersal End Cap (Dispersal Unit EISA) L;'A'S; - Application Rate = Area Reouired - %3SA - cr (Trench Width) _ 4-Units or Total Length o 'Crench(st G a o _ . 7 o Fr:. Y_ Av w Les - - n N _ S k, - R i ff 7 "Dcsian of Pressure Distribution Networks for Septic Tani:-Soil Absorption Systems" Publication 9.6 (SSWMP \lanual) "CC Fiowtech Niound Component Manual" Version 1.2 I "I7- Fiotr hound Component Manual" Version Si?~)2007 l SBD - 10854-P (R. 1; 12) "AL-Grade Component Manual UsingPressurc Distribution" Version 2"0 X SB G'- 10705-P (N.01/01) "in Ground Soil Absorption Component Manual" Version 2.0 i SBD - 10691-P (~_01:Q1) "VVlouud Component Manual" Version 2.0 u SBD - 10657-P (8.6199) "Drip-tine Effluent Disposal Component Nlanuai" 7, SBD - 10706-P (N-Olio F) "Pressure Dist, ibution Component %Munual" Version 2.0 i Other: r~,'; L:.','CE VZC3 Vi'fi) T? ?G SC r DE' i - eAsz{`~'l.l ANNCF_ AND N,1A~i.~CiNTO NT r\'Il'C4 Event kryice Frequency uiriphnspect dispersal cell(s), clean filter At least once ever': " 13 months "3 years Other: _111`1`11H, po=lo ~ pump contaris, alarm. pretreatment unit ( At leas, once every: I _ months C3 3 years X\ _A ugh and pmssu:e test laterals At least onee °yery months 71 3 vears_ \.A l2'f ^Ai4B OPERATION: For new construction. prior to using the POWTS check treatment tank(s) for the presence of pa,nc „~iiaCtS (lr othel' cliellllcals that may impede the ircatilient proms andi0r damage the dispersal C il(s) Ii -01 r 1 5 cvt~ct c t u contents of the tank(s) removed by a septage ser icing operator prior to use. System start apSita! rile infiltrative surface. `c; property owner is responsible for the operation and maintenance of the POWTS and submiss,o 0 ,!ua ity of the wastewater stream Mill affect the nerfarmance, and tone ity of your PO'WTS. The instillation of stater saving appliances ,tul'es aiotia li ith prompt repair u? leaks reduces the ltasie,Lvatei" ?'olui3ne. Also the brine or w ste li water 6$t rt_tt 1 -~1 t l!lier clear avater treatment, devices and foundation drains should be discharged to the ground surface wheneve pl x iude laundry waste. showers, dishwater. etc. system is designed to handle de±mcstic strength wastewater; liowevtr_ the disposal of food based ercases. gas. c ct:inlc: 1r:i. seeds, bones; and food solids, such as those produced by a garbage disposal should be minimized. Toilet tissue is the only paper that should be discharged into the system. Other non-biodc..radable items; such as baby wipe:., tampons; sanitary napkins condorns, cigarette but dental floss. End coi_t(tn mlhs, Should not ent%r clip, S%!Stciil. CilenlicalS, Such its pets"oletim prodtlC1S, paint, disin€fectant5, pesticid .T; 0! 110 1 .1_ S,V Ur nkin~ watersupply. Maintain a re-gularsteady flow by spreading laundr , vvashin~> ace 7 7 all system components. Compaction ofsnuw overtltcdispersal unit may ca use it to tie ze upghout the week. Avoid vehicle uaftic over INSPECTIONS $ MAINTENANCE: Inspection shall be made by an individual carrying one of the following licenses or 1~ertifrcations. %-}aster Plumber. Master Plumber Restricted Sewer. POINITS Maintainer, or Scptage Servicing Operator (per the attached Maintenance Schedule). Tank inspections must include a visual inspection of* [tic tank to identify any missing or broken hardware, identily anv -racks or teaks. measure the volume ol'combined sludge and scum and check For any backup or ponding of effluent to the ,,round surface and test all electrical equipment such as pumps and alarms. Any defects shall be promptly corrected. Exposed openings greater than R inches in diameter shall be secured with effective locking devices to prevent accidental or unauthorized entry the tanks. When the combination ol'sludge and scum in any tank exceeds one-third (1/3) or more of the tank volume, the entire contents of the tank shall he removed by a Septagc Servicin- Operator and disposed of in accordance with Ch. NR 113 . Wisconsin Admin. Code. Specific servicing mechanics must be provided if vertical is > 15 feet or if horizontal is I50 feet and instructions to be provided beloi%. The outlet filter(s) shall be inspected and cleaned to remove any accumulated solids according to mautufacturer'sspecifications. Solids ashed lrom the fitter shall he retained in the tank. Filter cleaning inav be necessary at more frequent intervals than stated in the maintenance schedule to keep the system operating. Alanns should be tested on a regular basis by the home owner. Ilan alarm sound, f)rtt,=.c, 2M, Ihere is normally a i day reserve tinder regular operating conditions. however ,,ystem are corrected to prevent back-up of-sewage into the dwelling or surfacir:. ARANDONrMENT. When the POWTS tails and/or is permanently taken out c, i the system is properly and safely abandoned in compliance with Ch_ SPS 3813-1, All piping to tanks and pits shall be disconnected and the abandoned pipe openings scaled. The contents of all tanks and pits shall he removed and properly disposed of by a Scptage Servicing Operator. :after pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space tilled vrith ,oi!_ gravel, or other inert solid material. O NTINGENCY PLAN- If the POWTS tails and cannot be repaired the IC>Ilowin~ measures have t> crt_ or rrusz be -akct_ hraeiuc n code compliant replacement system: A suitable replacement area has been evaluated and may be utilized for the location ofa replacement soil absorption system. Hic replacement area should be protected from disturbance and compaction and should not be infringed upon by required setbacks horn existing and proposed structure, lot fines and wells. Failure to protect the replacement area renders it unusable. Replacemcn_ wstems must comply with the rules in effect at the time of replacement. 'I : suitable replacement area is not available due to setback and or soil limitations. Barring advances in POW'I'S tcchnologv holding tank may be installed as a last resort to replace the failed POWTS. 3 lie site has not been evaluated to identify a suitable replacement area. Upon failure of the l'OWTS a soil and site evaluation mt ,;i 1,e performed to locate a suitable replacement area. It' no replacement area is available a holding tank may be installed as a In,: ,'csort to replace the failed POWTS. i i-found and at-grade soil absorption systems may be reconstructed in place 1cillowing removal of the biomat at the infiftr.aivc aurtace. Reconstructions of'such systems must compiv with the rules in eflectat that time. r MNGIIII SEPTIC, PCbIP AND OTHER TREATMENT "TANKS MAY CO'A'T LAN LE77TAI, GASSES .A\D,'01t Il:S(E f1C't<:A l OXYGEN. DO NOT ENTER A SEPTIC, PUMP, OR OTHER TREATMENT TANK UNDER ANY CIRCUIISTANC LS. DEATH NI AY RESUL; f. REST U E OF' A PERSON ~FROM TIIE INTERIOR OTA TANK _XI:AY' BE DI F°FICULT OR IMPOSSIBLE. 110NA1.COMMENT'S: fCE~RG_ENIE~rT YSrE71! C"o 6~ 1„)J wl_ed PIOWTS INSTALLER POWTS MAINTAINER Name: l'hone: 7/j G7y1-S.TtC Phone. SEPTAGE SERVICING OPERATOR (Pumper) LOCAL REGULATORY AUTHORI"h1 Name: ` / frame - T. e ~I/X LON~.__~fi/£CO~fyEw+> t~~awias _ _ Phone: AT ON STATEMENT N CS T SEPT!C TA ? ( ;presently serving the following residence: ."Stre':t address) J-U 4IY o(eD, _ located at: _ 1/4., .s,) _ ',1a, Section ~ 7~, Town~a8 N, Range W, own r , St. Croix County Wisconsin. Jpon inspection, I certify that I have found the tank(s), to the best of my b nowledge, will conform to the requirements of SPS. 3842 25, and it (they) properly. H, _tlon or service abso7 ptzon system? yes No 5( if no, skip next line.) pproximate volume or length of time: zailoi1s mIrMles sank Capacity: onstruction: Prefab Concrete ✓ Steel _ Other '`1lanufacturer (if known): _ skcr~ f ca 1` age of'Fan k (if l noivn): =,,mber (if known) 4::,31 3 ensed Plumber Signature) (Print Name) 2313 fla ?.._icense Number F VRS tea; i~Vl•l.1 LV i, ^..r FS1ple-w l b 'I"ce£ sea, p`Li loll."..' L epi `t11Ct -"'_anid 3. ro,"essional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed dispos r NR 113 Wisconsin. Administrative Code Rev. 2/201 M'. 51' CROIX COUNTY SEPTIC TANK l1~I.4INTENAt~fCE AGREEMENT AND OW-NERSNIP CERTIFICATION FORM Owner/Buyer _ ,G 2e Mailing Address Property Address i, " ice. S C ~ ~(Verifcation ley red from Planning & Zaninr, Depart a tt for new constru tion.) ~ r , r Cit}/State off Parcel Identification Ninnbet LEGAL DESCRIPTION Property Location* t f 5 '!Q Sec. i! T~ q N R 1 Town of Subdivision Plat: Certified Surrey Vlap # Volume Page Warranty Deed it ' (before 2007)Voltune Page Spec house Oyes[jdo Lot tines identifiable yes[]no SYSTEM MAINTENAiYC'E AND OWNER CERTIFICATION improper use and maintenance of vour septic s. stem 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 call affect the function of the septic tank as a treatment stage in the waste disposal system- Owner maintenance responsibilities are specified in SSPS. 383.52(1) and in Chapter 1" - St. Croix County Sanitary Ordinance- The property owner agrees to submit to St. Croix Counq- Planfling & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber; restricted plumber or a licensed pumper verifying that (t) 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 Iii full of sludge- Uwe, the nudersianed 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 Safer- And Professional Services and the Department of ifatural Resources. State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix Coutity Planning & Zoning Department within 30 days ofthe three year expiration date- I`we ceriil}, that all statements on t is form are true to the best of t11}flour knowledge. Ywe amlare the owner(s) of'the pi operty described above, by virtue of a w rants deed recorded in Register of Deeds Office- Number of bedrooms ' STG~vATURF , F AP LICANT(S) BATE Any -information that is :misrepresented may result in the sanitary permit being revoked by the Planning ~ . & Zoning Department. Include with this application a recorded wart-ant.y deed "m the Register of Deeds Office anti a copy of tlsc certified sort ry map if' reference is made in the warranty deed. (REV. Uaft2) E~~ c ,5T- d6 l 8, a Y s ttl~ient of SOI EVALUATION REP T #1929 5 P Safety a~ 1 4 218 in acc rdrnce wit m Wi Ad de % Page 1 of 4 Prof sional ices Schmitt Soil Testing, Inc. ~ r ix County unty , Attach complete site pla on pa Y n @Tuo%tt ' ches in size. P St. Croix include, but not limited t9: vtzrQi erence point (BM), erection and - - - - percent slope, scale or dYmensions, north arrow, and location and distance to nearest road. Parcel I.D. _ 040-A740-000 Please print all information. Reviewe y Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location Weyer, John & Taren Govt. Lot 41 /4 , W1/4, S17, T28N, R19W Property Owner's Mailing Address Lot # Block # Subd. Nam or CSM# 322 Day Farm Rd 44 Troywood city State Zip Code Phone Number City Village Town Nearest Road j River Falls i WI 54022 612-747-4362 Troy Day Farm 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 and Gravel (Burkhardt series) Flood plain elevation, if applicable _ NA ft. General comments Area is suitable for a conventional system with a 0.7 gpd/sgft rate. Possible system elevation for replacement area is (High trench) and recommendations: 89,80', (Middle trench) 88.70', (Low trench) 87.20'. Slope of area is 18%. F-11 Boring # - Boring - Pit Ground surface elev. 89.75 -ft. Depth to limiting factor 96+_ 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 0-14 10yr3/2 none sl 2mgr mvfr as 3vf 0.6 1.0 2 14-24 10ye4/3 none sl 2msbk mvfr gw 2vf 0.6 1.0 3 24-32 10yr5/6 none Is Osg ml gvv 1vf 0.7 1.6 4 32-96 10yr6/4 none s Osg ml 0.7 1.6 2 Boring Boring # Pit Ground surface elev. _ 89.75 ft. Depth to limiting factor 96+ 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 Tff#2 T- 1 0-13 10yr3/3 none sl 2mgr mvfr as lm,3vf 0.6 1.0 2 13-27 10ye4/3 none sl 2msbk mfr gw 2vf 0.6 1.0 3 27-96 10yr6/4 none s Osg ml 0.7 1.6 -~I t * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L " Effluent #2 = BODS < 30 mg/L and TSS S.30 mg/L CST Name (Please Print) Signature: p CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing, Inc. Date Evaluation Conducted Telephone Number 1595 72nd St. New Richmond, WI 54017 5/21/2018 715-760-1978 SBD-8330 (R 07/00) Property Owner Weyer, John & Taren _ Parcel ID # 040-11127330-000 - Page 2-of 4 37 ;Boring Boring # ; . pit Ground surface elev. - 93.65 ft. Depth to limiting factor 96+ 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 0-14 10yr3/2 none sl 2mgr mvfr as im,2vf 0.6 1.0 2 14-23 10ye4/4 none grsl 2msbk mvfr gw 2vf 0.6 1.0 3 23-32 10yr5/6 none Is Osg ml Cs 0.7 1.6 4 32-96 10yr6/4 none s Osg ml 0.7 1.6 17 Boring ❑ Boring # pit Ground surface elev. - ft. D pth to limiting factor _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 - - F-1 Boring # Pit Boring 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#1 *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 format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R.07/00) Schmitt Soil Testing, Inc. Page 3 of 4 Conducted by: - Conducted For: Schmitt & Sons Excavating, Inc.. Name: John & Taren Weyer Thomas J. Schmitt, CST 227429 Address: 322 Day Farm Rd. 586 Valley View Trail City, State, Zip: River Falls, Wl 54022 Somerset, W 154025 Phone: 715-76D-1978 ? PID: 040-1273-30-000 Signature Lot No. : 44 Troywood Date Legal Description: SWIM SW1/4 S17 T28N R19W ate g 0 Backhoe Pit Township, County: Troy, St. Croix County ® Bench Mark 1 El. 100.00' Top of house foundation Bench Mark 2 El. 98.19' Top of septic tank manhole cover 1 - - Slope= 18% Scale 1"= 50' - ; a' 6hl aGrs - NOTE: For full view of Lot see Aerial Photo (Page 4 of 4) 3 AI s ` Gf~C~ 0. j'vIJ / 7~LrN 4 Y _ -7kCh1c,y t'J F r I , 4 Y - - - fi - a i i t , a t ` - i - z ; i i dCl) ORMC All 10 ~~rr c g 4,4 N Ilk o a~ e {g . 4 1 ooj TTTTT~- a 3F Oki z. .0 90 x 0 s a* xN D t5` ~ r s 4. A