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HomeMy WebLinkAbout040-1327-33-000 vvl;cu""r Depagtrm rl of PRIVATE SEWAGE SYSTEM C""!v St. Croix Safer, In Rw diro P,,st;n INSPECTION REPORT Sanoawvei°'tNC GENERAL INFORMATION AI TACTI 10 PERMIT) stale Pla- ID .vc 605096 Pr-,aryl lrlnlmal on yc_ pro; de -.ay bP used fnr SPNW..ary p„rp;nos IPr:vacy Law. s.15..4 i t limiI Per--,t Homer`s Neme Clay ,,"I aya rvw-rsh n Farrel Tax Nn DCCI Investments LLC TOWN OF TROY 040-1327-33-000 ST Rkt F er I^so. BM Lev. 61,1 Oesa pticr Se, %rn Town: R.;n9e l.1aF: Nc. 9_7,)4 I Q - l G5 17.28.19.2231 TANK INFORMATION ELEVATION DATA TYPF MANUFACTURER ` S CAPACIIY SIAI ION BS HI FS ELEV Sepik Benchrl21h y 7. / c S ° / Z~lJ its 9q,31 Al! BP.1 ~'I e Sz S F'tl L'_ 66J /7 9s, 1, 7 Aeration Bldg Seww 17- 1? 5. z Z_ Holding SUHt Ime: b - $ / TANK SETBACK INFORMATION SVHt Outlet 7 9, 7k5 4S. 59 TANK TO qPL V,'CLL BLDG Fero "AC I1taF:e ROAD Dl Inlet rt 1 ~ rt^ ~ Seelic ~7 So / V Dt Bottom Dosing Header.-Man 16,/(p 4Q, l S Aerat en Dis; Pi❑e 16,3 ~.w .o Holding - - _ - B;:I Sy's:ere 197, 02 Phil Grade PUMP/SIPHON INFORMATION P J ~ CK • 3 F,lanufar.%iiw Demanc St Cover 5,17 t GPM V Xi tdodel Nvn ter _ TDH Liz Frict'.on Lcss system TDH F: Forcerta.n I ergtn Da I>:Sl to :^iell _ SOIL ABSORPTION SYSTEM DE WI RE NCH vdiwr' length Nn O'tr -h- PIT DIM€NSIONS Na D`rts 1 InSIee DIa lmwr. Depth DIMENSIONS -3, 1 gO t-7~ y (rem , 1 - , J~ _ 1 SFTBACK SYSTFPA TO PrL BLDG WELL LAKEtSTREAPA IFACHING Ma'm'ac:wm / ! v J INFORMATION CHAMBER OR r'/~ T. o ;.re- UNIT C. J Mccel Nu"•oa•' L "_~L I~ 33 ti t 0..m DISTRIBUTION SYSTEM N Ili -leacerrManilnd G r.r outer m Fn e Size x •IC.u Saaurl +Ferl :c Air Intak~ PiP-rs~ O{L~ rnm L D,-cth Ca Rp.1 Pro SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only e+.3 '0 mar!(., Depth 'er Jep~h r' 'er feptr rr SeededSetlcec xx Pd.ilchee F!e~]!Iren Ceme' 19 3z r-" I n,h I dq, lp'c Yes N6 es Vo COMMENTS: flndude code discrepences, cersons p•esert ex Inyeaion Ft Inspection #2 Location: 366 MFAD(.P,V VALL Y TRI. 7' 3z Gory... O G/L F~~d u..l S U k- 1 ) Al! BM Descnpt on = ( C'6 U t'_ 2.j Bldg sewer length = 1'5 . - amount of weer = y/ o(No ~ SQL Plan revision Required Yves ' ~I Use other side for add Ronal vionnal J ` J Owe V,jrp 7n'[ 1.171.1p v N' SBD-671G IR f arr~`, ,,I County 1 - I Safety and Buildings Division F,I 201W. Washington Ave., P.O., Box 7162 St rm-iy Ma sambry permit Number (ter be filled in by Co II (~g. 4y6,537p7162 Sanitary Permit Application state 'I ac N her In ace:ccwifl,S]1s t, r 211: , W rs Adm. Code, subrmssion of this form to the appropiate governmental unit NotrApplicatin (ou fur sLterowmd POWTS ate submitted to Pmject:lddrccc lif do emat tat nailing mhtreas' the L*ent o(Safely and Profl-ssnoal SevierPervmal m(ormation you pnovdc maybe used for secondary accordance with the Privacy l.aw,,. 14.04(Ikm) Stat, _ t..A r IiadOn Information - Please Print All lnformn-Wo 366 Meadow Valle Trail Property Owner's Name D Parcel a 0 iv- 13»-33 axx Propcrt-v Owner's Mailing Addrec, pmperiv fen noon ~ 17.99. q.aa3~ I 1505 Hwy 65, PO Box 445 New Richmond WI 54017 ,t,1,,, 33 (',n. State ~7ip ('ode phone Number SE NW !y.5ecnar 17 New Richmond WI 54017 715-246-2320 28 (cndcone) II. Type of BufldinQ (check all that apply) \ ,,,k' Lot a 1 R -1A L or w R1 tar 2 Fannly Uw'clhng Number of Bcdronnts `a ) W G3 33 Subdivuan Name f-"* «<TT"' ~\w~ Block a v r i J PubadCommercial Utscnhc lave _ G City of 1-\1A1e Owned - Descnbe Use - CSM Number O village of ` IxTown of Tiny-- _ IIt. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. Mew System ~ Rephacmrnt System I ❑ I Maim-01oldmg Tank Rcphicement Only O Other Mnd,ficaUOn in Fxistmg System (explain) B. L Permit Renewal ❑ Permit Revuion ❑ L'han c of plumber List I'me me Permit Number and Dale Issued R O Penn Tramfe m New Before Lxpualion Owner 1' c T' IN.1 ' e of POWTS SvstCWCOM onenUDevi": Check all that apply) ,gi Noml4rssun7ed In-(irnm,d O Pressurized In-Ctound O At-Grade ❑ Mound > ]A m. of suitable soil ouad < 20 w. of suitable sod Ll Holding I ank ❑ Other Digx+rsal Component mxplainl_. Prematownt Device (explain) V. Dispersai7Preatment Area Information: Iksn(,m Flow (R(x~1" 1 Design Sod Applicatmn Ratc(gpdsD Unslresal Area Required (sf) Utssppe+sal m PmposM (s() Sysem FI,,,t,oa 600 / I 7 I 858 900 V1. Tank lnf. C'apacio, to Tool J of Manufuctum Gallon, Galloro Units New zeds Existing 'tank, I ,tu r V a eo a i:J r. ..L a kpA a Hrieag Tad 1 IM 1250 I Weiser X sing ChsmM1Cr r VII. ResponsihillR Statement- 1, the undersigned, uswnr rapnmslDlhlp for 'in, allation of the PO W'I:S shown on the attached pleas. C Plumber's Name (Ptintl Plumber's Si atwNIP NIPItS N'umte Husuress Phone Number Countryside Plumbing & Heating v-~ 664713 775-246-2660 I Plum(srr's Address IStrccl,frt. -Mje 7;p Ccdc( - - - - -1 321 Wisconsin Drive New Richmond WI 54017 Vlll. COunIx artment Use Only - ❑ Apprmrod r U,sappurved - Permit Fee Dale Issued Issuing Ag I Srgmmum n Owner Given Reason for Uwiei S`f8 ~Cr.~ot8 I Conditions of Approvab'Reasmns for Disapproval rJJ YS ![M OWNER Septic tank, emaert filter and dispersal cell must be serviced i maintained as per management plan provided by plumber. AA 11 setback regu:rroments must be maintained as per applicahlf ec.:a iOrtMY7npty?u+r yt.aa r r+r r+M1e a,ucm mA auGndt ro tM Coaery tardy nn payer eon kn IM1.o X t¢ x 11 inekea to site SBD-6398 (R, 11 I I) i CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name DCCI Land Planners Lot 33 Owners Name DCCI Lan Palaners Owner's Address: 1505 llwy 65 PO Box 445 New Richmond WI 54017 Legal Description: SE 1/4, NW 14, S17, T28N, RI 9W Township. Town of Troy County St Croix Subdivision Name- Meadow Val let of Troy I st Add Lot Number: 33 Parcel ID Number: 040-1327-33-000 Page 1 Index and bile Page 2 Plot Plan Page 3 System Sizing & Cross-Seclioa_ Page 4 Fitter Specs Page 5 Maintenance Information Page 6 Management Plan Page 7 St. Croix Cry 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 Date: 07/25/2018 Phone Number (715) 246-2660 Signature Designed pursW nt to the In-Ground oil Absorption Component Manual for POWTS Version 2 0 SBD-10705SP (N.01/01). Page 1 Bm 2 Lot 33 parcel id 040-1327-33-000 o Two 90 ft trenches ez flows 0 Bench mark 1 100.00 top of electric trnaformer 3% slope Bench mark two 5.85 top of steel lot corner pipe Slope 3% scale 1 "+40 ft System elevtion 93.5 0 0 n ~ I \ \ 1 N i i Wieser 12 alt k i ` 525 p lock filter \ I \ I \ I \ I \ I ` 4 \ Q \ I 'oo \ I s~OO \ i v e~a~ I 6P \ Q~\v I 0 I % O bm1 I ~o I ~P 1 I I / I / i Proposed well O i SOIL ABSORPTION SYSTEM DETAIL / GRAVELLESS LEACHING UNIT p•ge_of Project Name: DCCI Land Planners Lot #33 _l- No. of Cells Per Cell .3 ACell Width Total Noof 2 90 n Cell Length Sv sq ft EISA Per Cell 3 ft Cell Spacing qoo sgft Total EISA Manufacturer Model l.e In Len th EISA Ratl L Inftltraw EZ12031-1-511 50 25.0 E212031+10ft 10.01 So.o Graveiless Leaching Unit Manufacturer: 17 Flow Gravelless Leaching Unit Model: 12 17 ba d _ I Typical Cross Section Finished Grade It Observation Pipe with approved cap or vent n 1rSoil8ac11 n in rGeotextile Fabric f v O 12 in ft Infiltrative Surface n ---y 8 n Limiting Factor to I~ Slotted and Anchored Vent/ W _ Observation Pipe with cap Plumber/Designer Signature: License M 664713 Date: 07/25/2018 PaLy~q]C Inc. °~ermaa, ."Pic".s„,..,~. Zabel' PIS 525 Effluent Filter dh'as1PWlar VrN:c6 ADamo~<"'tl.br M:. I'I: 525 Filter I he PL-525 Filler is rated for 10,0110 GPD (gallons per day) making it one of the largest filters in its class. It has 525lineai feet of 1 /16" filtration slots. Like the Polylok PI.-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 shirt off the system so the effluent wont leave the lank. Features: 1/16" Filtration Slots Alarm Switch • gated for 10,000 GPI) (gallons per dap). n 10 rt00 GPD (Optionali • 525 linear feet of 1/ 16" filtration. r V lJ 'C. Accepts P' %'C • Accepts 4" and 6" SCHD 40 pipe. Extension Handle • Built in gas deflector • Automatic shut-off ball when finer is removed, • Alarm accessibility Pw d for lo.tlno CPD • Accepts PVC extension handle I'L-5215 Installation: Ideal for residential and commercial waste flows up to 525 Linear Ft 10,000 gallons per day (GI'D'). nt Ij 16' Filtraoinn Slot, 1 Locate the outlet of the septic tank. " i 2 Remove the tank cover and pump lank if necessary. 3. Glue tire filter housing to the 4" or 6" outlet FIPe, If SeHD au pipe ~ On, filter is not centered under the access opening use a Polylok Extend & Lok or piece of pipe to center filter- 4. Insert the PI: 525 filter into its housing. i - - r S Replace and secure the septic tank covet' Certified to NSF/ANSI Standard 46 PL 525 Maintenance r--- The PL- 525 Effluent Filters will operate efficiently for i 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, i the owner will be notified by an alarm when the filter needs servicing tiwrvicmg should he done by a certified 1 )L c"" ~`~1101 septic tank pumper or installer. I Automatic Shut-Olf Ball 1. Locate the outlet of the septic tank. 2 Remove lank cover and pump tank if necessary. 3. Do not use plumbing when filter is removed, f-~ 9- Pull PI -525 cartridge out of the housing. 5. Hose off filter over the septic tank. Make sure all 111011, solids fall back into septic tank. I Ell` lr G Insert the filter cartridge back into the housing making sure the filter I% properlyaligned and completely inserted. uutd,L11SnWio-ill. I Alarm FaendkIukr^• I nhl-t, 7..1 I N Nast filters incept F.,,dN installs 7. Replace and secure septic tank cover. o,.I.....offiu,r•s,,itchanda;ain,. nfl"..,amgtank, Polylok, Inc 3 Fairfield Blvd. Wallingford, (7 06492 Toll Frec: 877.765.9565 Pax: 203.284.8514 ,seaw.polylolc.com 7 -Rig 31" 9Sb8-SZ~-008 :afY~d-150 31 r0 00 W 00 31 Y0 OSLf9 W 'xxla N301YR 01 dR,H Sn 91LfM Z O \ lVf1NVYV 3Ild3S w ow =anod-3ae ~3ir eav, ue NMVao 31380000 V3S31M N14-OSZIM v m w n w F J rc J m Z m W JW b O 00 z `0 Z N a W l/) d U W yN~ ~f I > O J a W H J F A r W L: L~l yC1 Z p N CO ad < j J T W O Q a m O ieQ Z W m a w x` g a rc v p z ~ d m ~ mn y D my r L o Q C CS v 2 Q a o m r w1~ o- z a 6 ~V pOp t m~ J 1+O U fn UT p \ O~ V 4 IL Z -fO6NaJ W` mWN tG 4~ O Q ?2o zw VI o O Na1.~ N\>OF ~N ~N< 1 NQ N W.,1< OD ~ LLI p O ~O Q ~N x 0 . NO• W11~~N <U H O< W O T! F N Q. N aJ^~~Z W~~f stn ~ YxU U \ OCZY If V) 0~-4 8z~ C5 ~0 Sa"zoZOO°~0 0 - qis m m p Oow ~~0 Z N#m U3m co ZI ~rU ~~Ov 0 Z8< Z V N NU Z Z O m Q Z 1~1~~1 Y = J a U>z V) ~ I a a f2 N Z U ~ w < D .OS _m O r iY 1 ~ ~ I n I I~ ~ m II a I. 3 < 0I I a - li _s t~~ I II ~ - I w 1 ¢ i r I 1 a zl- i - .fS a .98 03b1f103b SYrI „~09 ~d Y Z a F- POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page I of 12, FILE INFORMATION SYSTEM SPECIFICATIONS Owner DCCI Land Planners Lot #33 Permit 0 Septic Tank Capacity 150 at O NA Septic Tank Manufacturer Wieser 0 NA DESIGN PARAMETERS Effluent Fitter Manufacturer PolyLOck 525 C NA Number of Bedrooms 4 0 NA Effluent Filter Model 525 ❑ Nq Number of Public Facility Units RNA Pump Tank Capacity at X~+ Estimated flow (average) 450 al/da Pump Tank Manufacturer ~A Design flow (peak), (Estimated x 1.5) 600 al/da Pump Manufacturer IaNA Soil Application Rate •7 allda /h` Pump Model - J$NA Standard Influent/Effluent Quality Monthly average • Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L 0 Sand/Gravel Filter 0 Peat Filter Biochemical Oxygen Demand (BODr) 5220 mg/L NA 0 Mechanical Aeration 0 Wetland Total Suspended Solids (TSS) 5150 mg/L O Disinfection 0 Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) 0 NA Biochemical Oxygen Demand (BODE) 1530 mg/L ;Kln-Ground Igravity) 0 In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L RNA 0 At-Grade 0 Mound Fecal Coldorm Igeometric meant 510' ctul100m1 0 Drip-Line 0 Other: Maximum Effluent Particle Size Ya in dia. QKNA Omer Q(JA Other EYNA Other: P(NA ' Values typical for domestic wastewater and septic tank effluant. Other ❑ NA MAINTENANCE SCHEDULE Edispersaf ervice Event Service Frequency ondition of tankls) At least once every: .7 months! (Maximum 3 years) 0 NA ~Q year(s contents of tank(s) When combined sludge and scum equals one-third %J of tank volume 0 NA spersal cell(s)At least once every: =oar lsl (Maximum 3 years) 0 NA i ent fitter At least once even: lsl DNA ) mp, pumF conttols & alarm At least once every: lsl ) ANA als and pressure ter. At least once every: (s) ) ANA At least once every: lsl RNA O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and disper sal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector, POW'fS Maintainer; Septage Servicing Operator. Tank inspections must include a visual inspection of the tank(sl 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 (Y) 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, snall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 1C days of completion of any service event. START UP AND OPERATION Page 2 of Z For new construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals (list may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tanklsl 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 Collis) 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 calls. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or ai-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 she 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. The-s4s has no! bee evaluated to ide itify 1' 111 1 !!1! 1: team _UPQR ta"we a# 0, PQ1'CrS_a,.~ slue ' be' a ai 9ZD14115nE1~ fbR_AJ ys/ - mg tank `-0IJSTR (iCTl 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 Name Countryside Plumbing & Heating Name Paul Koehler Phone 715-246-2660 Phone 715-246-2660 EI SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name Darrel5 Septic Name tl 20rv AJ Phone 715-425-1025 Phone L-7/fT- Tn!s document was dratted i, compliance with chapter Comm 83.22(2)Ib);1)(d)W11, and 63.5601, (21 & (3), Wisconsin Administrative Code. ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer DCCI INVESTMENTS Mailing Address PO BOX 445, New Richmond, WI 54017 Property Address 366 Meadow Valley Trail (Verlficarion required 5om Planning it Zoning Departrnem for slew twnstruction.) City/State Hudson Parcel Identification Number 040-1327-33-000___ LEGAL DESCRIPTION Property location _ Sea 17 . T _28_N R_jk_W, Town of Troy Subdivision Plat: _ Meadow Valley of Troy First Addition _ Lot k 33 Certified Survey Map 8 Volume , Page k Warranty Deed 8 (before 2007)Volume _ , Page $1-- Spec house E3yesQmo Lot lines identifiable pyesC;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 ficemed pumper. what you put into the system can effect the function of the septic tank as a treatment sdge in the waste disposal system. Owner maintenance responsibilities an specified in §SPS. 393-52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zo'ning Departmem a certification form, signed by the owner and by a master plumber, journeyman plumber. restricted plumber or a licensed pump" verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) aft" inspection and pumping (if necessary), the septic talk is less than 113 full of sludge. Uwe, the undersigned have read the above requmem"KS and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety And Professional Services and the Department of Natural Resources, State of Wisconsin. Certification sating that your septic system has beea maintained must be completed and retuned to the St. Croix County Plarming & Zoning Department within 30 days of the three year expiration daft Uwe certify that all statements on this form sire true to the best of my/our knowledge. Uwe anvare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms 4 /aT 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 docd from. the Register of Deeds Office and a copy of the certified survey map if referen" is made in the warranty deed. (REV. 01/12) r; a't 1 P a l l KAMMU IL VALSR sr. I Ix oo°EYi RECEIVED FOR RECORD LDWTED WARRANTy DEW W14/2W et:gWN Document No. Y DI !DEED RU FEE$ 17.9@ 71la Dead made between VALLEY LAND / COTRANS AT F r Aft. Se DCCI~ ~tGtwtm sad Y ~ r 4 WhOmeth, That the said Grantor conveys to emottie oatain real eaxate in st Croix Comfy, swc "'iisin, legally dc8m%ed on Exbrbit A hereto Obe "PmpatS' l Together with all and singular beeditamenta aP howet t t to belonging ~ TO ~ retanoing, bowiever, wnintur ~ an easement as set forth in Exhibit B haem; except Grantor covenants ands Frye Tea LD.: / _ ^psa Grantor has not made, done, rcWtsents the executed or 2-1~i8'9~n suflEned any act or thing wbeaoby the above* described Property or any Part tbernOt now or - at any time hatter, sbsB or may be imPailod, charged or encumbered in any - - ma>mer, and Cmmtar will warrant title to the abovedouribed Pagoaa the bowevag that thgame e from or ftiMugh Grantor as a result of any 6 ~ ~ all conveyance: hereby made and the warranty of Grantor is rung pray A d, sobjart to those Matta act forth on Exhibit C hereto. fin ma limited by and Dated thid day o0 nuary, 2005. VALLEY Lkm ooNTANY, A Minnesota an Q oa Roger D. Bevers AMNOWLS»cEME,T Notary Public STATE OF State of WisCOnsin COUNTY Ozx ) SS P~ PCrSOzi0Y dent ofc'~ Wire me ~s ~ day of January, 2005, the above named Land may, a hf=eaota Gall B. Valley AS m me ]mown to be the person who eamwted the Alegomg n~ having full hy to do so and auth Saint-, ' >IIatrlrment annd d ac aelmOWledgOd the blip, $1121c or_ tijj~9y+ - S88°35'33"W 1 " = 30'-0" 48.33' • APPROXIMATE SFPT /C LOCATIO,-%' 20' . 1~ s \o I ~ Z w I pS cp i \ O N ~I 157, r. W N 2s I o~tio le~ L ohyh i oP QP N89°59'11"E 50.97' JQo~~~ 0) s~ T MEADOW VALLEY MODEL #3 ~T MFADO U' 1 ALLL'Y OF TRO P I.7RST ADDITION, L07'33 1 V 4BEDROOM HOME }i~ ¢ #j ~T Q e F FIT e3 s Q r e ~ A P, r° `141 F lyf3 fr i. E~Qi T eo 0 ~i' e i s 3s f t Sr ~s!lh r 'rlYr f ~s~~l~ss ~t: 3Y Qi~r ~ 11 fili!e~~ s .~l3 5 ty ~ tiC(C rr f f 5 EFi c, ~QFj 39! a e Fsi j ° r f [y s; !1 ~o~!i t tt pp i ~ i9 I!Y^'t 7533! 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' fns t, ~ 9plb i i p ( C y a- R _ N e a s e_a_r- `1 +3- ' - IE¢E i (I^ 3 i' fFt f~As if rj;~ ETj F~,~ G; i~A TRk`k i!17.r 3txx a ` f !•iAI •e~,T rice e,a'.rlvtl GAhAiil4Y All; J{ ci ' t T - 4}9 IS l 't'~is~a~e y5e. s~i, ~s; 18 f r r 5 t ft s 4e,L let i lr 3 e I e ~ Ah i trY" 1 4"IF 1 i ei hl II yFf~ e. -r-l~e~1 f to ~Y E iy! ~a i i A A i E ilf A y t j~ l Q x ~3 3 I y, ~ e y A e y i R! t t S F .il l i f _t R i 4 a s f 1 - I -4 1 t ii S 1 S II 7 f I i ~f I 7 l :t n7l DERRICK HOMES 715-zac 2320 Lf1T o:,4Id'.4D0 R' {'Al LE'Y' ui { f ' IYIi yp ;t~~ .A....m, it 1- ~ ~ -a.' :;,dll• of A~~6 t ;i' E/ e 6 t f G "f J 9 pr _ 1 V IEI E f fc' d' ON i41 df , j s~f ¢f VC ti Et~ °`t}Sd a ~ tl~f ` ~ 1 'fd tCf II9ii I ~ , • i3a t~o itj ~fE f~i I-JJ i; ~ f~S Z e ,i};' it } ~a e 7 f i t• ~ i , : 3 2• I ff F5f 7. € Sri { STf ; CL Y~' I n'e ~ ~ iQs 1~tf T,. E E ~ Yh ~ I 1 J li'» t f Y. tti -41 :1-- +,mx .coy. ~ „I''' 3#1t Je41 . -vv~ t.d C !I• ^l9i I f I EI 41~ •I i r ` I } Ili r : ,'iI 11 ,E DERRICK" HOMES 715-246 2320 ~'F i. III , E; Cli Oil, L0T :SS ,V6.IDOA' V.1/./,EY "It~i~i I ~t~ r lit 11th _ tiaaR II ` I I a:'FFI i9 ~ ' FI T ;e~tl f II td it t ii I~ h if pill M- T I I 1~ t` 1~ ,aalct ~i T ll ay~ ~ ~~i ~ t 41" 1 ~YyV~ 'I ai~ Hi~I I iz ti I I L 1 fl t II ~i ~ 1 ICI; ~ r I w: th q,~,ittl , DERRICK HOMES ors 24e-23ZO i! ,q ( = LOT 33 ME.fOOW a'ALI.6Y I pll I~ C 3 LL ~ r h! Z \C I ~ < l! Y t DERRI('k" H0,1fli S 715-246-2320 !'{71uq7.7 t•s•,1'pnl~~ I III f'! 7,>. '{I171~7Ij I~I 711 I{fie t ~I 11 LOT 33 .NF"ADO N' VALLEY I v- - r a ~I f i fF 2 111 16 y i { c 7-1 F. } li1~ ( 6 i fe of ' ~ ~ { m S H i0 ~ e y jl` E a i -jA V v'f r l l c v.Y e,'• ;f i' DERRICK HOME, 775 gas-zszo ~ f 'fll. S`~ i Y LOT 33 MEADOW VALLL'Y f~"~1 ~'1;`ll,,~jl7) IIrf~N,i Cs7-avo- ~a► D 'f nt k-U-bOIL EVALUATION REPORT 'Sj f 0 191895 _ in accordance with Comm a5, wit, Adm. Code 0V' "Pape 1 3 r SVBJpESECE9 RE Sot+milt Sii red sting. Inc. Attach complete sae plan on paper not leas u..,. Bp tree in size Plen moat Courtly JU St. iwJWe, but nd Fmied to: vertical and horizontal reference point (BM), direstion arM,lpvr"„o1J,E~ percent slope, Scale Of dimensions, north arrow, and location and distance to nearest road. Parcel J.D. R 1xv Please PAnialllnlormatlon. Peraonel inlo'meaon You provide may be used br seoorae Revbwed ale - 7 punxxes (PrrvacY law, s. 1s 01 (1) Im)). Property Owner Property Locelbn DCCI Lend Planners Govl. Lot SE114, NW1/4, S17. T28N, R19W Property (Turrets Meiling AdOrece - Lol • Blodt 19 Subd. Name or CSMM 1505 Hwy 65 P.O. Box 445 _ 33_ _ -Meadow Valley Of Troy 1St Addn CRy Slats Zip Code Phone Number I City - - -I n Village .Town Nearest Road New Richmond WI 54017 i Troy Meadow Vale Trail Frommmenuions' lon LISe: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD Public or commercial - Describe: utwash In Pilot Series - _ - - - Flood plain elevation, 0 applicable NA A, Area is suaebie for a conventional system with a 0.7 ons: 3%, 9Pd tale. Passible system elevation for Area 1 is 92.65' . Slope of area is F-11 L7 Boring 19 i - Boring Pa Ground surface elev. 97.14 _ fl. Depth to Funning factor 98+ In. Horizon Depth Dominant Color Redox - Soil Application Rate Deswfplbn , Texturo Seucture Consists Boundary Roofs GPDMt' in. Munull Du. Sz, Cont. Colo Gr. Sz. Sh. - *owl 'EMe2 1 0-10 10yr3/2 none L sit 2m9r_ { mvfr as 2vf 0.6 0.8 2 10-23. 10yr4/4 none 1 grsl 2msbk I m6 I { { - i 1 lvf 0.6 1.0 3 123.32 I IOyrS/6 - none I 15 l-tsbk-{I mfv 0. r ~ 0.7 1.6 1,15 q2-72 IOyr6/4 none ~s~---. p~ m~ as 07 5 72-98 I SOyr6/4 none os~ 059 ml --0.7 16 0 .2 Boring a Boring , pill Ground surface elev. 95.94 fl. _ Depth to limiting factor _ 9g+ In, Soil oil gpplicatbn Rau 11 Hinant Color I Redox DeewipTeture Stu Consbten Mansell Ou. Sz. ComlColorBoundary RGPD/M' Gr. SzSh. ,EM1 .EM 10yr3/2 nonesil 2m9r mvfr as 2vf 0.6 08 . 30yM/4 none grsl 2msbk mfr f ( W lvf L 1.0 ~ 10yr4/6 none sl Imsbk mfr gw 2vf 0.4 0.7 ~ 10yr6/4 torte Osg l as 0 .6 -t- 0yr5/4 none groos pyg ml - - as 0.7 1.6 0Yr6/4 .none s - -_1 _ml - - 0.7 j 1.6 ' EMuent et • BOD,> 30 < 220 mg1L and TSS 30< 150 mg& ' Effluent 192 = BODs < 30 mg/L and TSS < 30 CST Name (Please t Print) - - Signature: ~ //f= CST Nummg& ber Thomas J. Schmitt _ _ 227428 Address Schmitt Soil Tasting, Inc Date Evalumion Condu_cted T - - 1595 72nd SL New Richmond, WI 54017 6/22/2017 715-760- umber 1978 Sena). M07M) Property Owner DCCI Land Planners - Parcel ID a Page 2 of _ 3 Borirq a E, PBoring - Ground surface elev. _ 95.49 it Depth to banking factor _ 98+ in. dl Application Rate Horizon Depth Dominant Color Redox Description Texture Sinch. a Consistence Boundary Root GPD/M in. Mansell Qu. Sz. CoM. Color I Gr. Sz. Sh. •Emt •EIIal I 0 5 I0yr3/2 none i sit 2mgr mfr as 2vf 0.6~ 0.8 ? _r12 1Dyr4/4 none ITl 2mst* mfr gw~lvf 0.6 1.0 3 4 12-19 IOyr4/~ none 9- t 1~ M F ~ 7 f 0.7 6 1. 419-% 30yr6/4 , tgne 5-_x ~9 ml - 0.7 1.6 n Boring Boring a Ph Ground surface elev.. R Depth to IlmtOng factor in. Horizon h oil Application Role Dept Dominant Color Redox Desert Ion Texture Struaure Consistence, Boundary Roots GPDMM in. Muroell Ou. Sz. Cont. Color Gr. Sz. Sh. •Ella1 •Eas2 ❑ Boring N Boring Pit Ground surface elev. -.-,-it . Depth to limding factor Sod Application R81e Horizon DepM Dominant Color Redox Descrp8on 7exluro Strtkturo Consistence' Boundary Rods GPD/M in- Mansell Qu. Sz Cont Color Gr. Sz. Sh. E01 •Eaa2 'Effluent a1 = BODS> 30< 220419A. and TSS >30 < 150 mgrl 'Effluent 02 = BOGS 5 30 mglL and TSS <_30 mgtL The Department Of Commerce is an equal nppommity service provider and employer. If you need assistance to alxcss services or need material in an alternate format, please contact the department at 608-266-3151 Or TTY 608.264-8777. saPAUO ploi ~lal Srrr.la Sol TWO. sec, Coodvcted b - ; - - I Page 3 of 3 . t - r - Y _ Condocfed-IF6 - r - 1 -i- - i - Schmitt& Sons Excavating, nc.. { Thomas -NOme ^ DCC'LLaad RLiaa s 586 Va -Tra cty; Slate' ZIP: -N~ Richmond. M 540)i7 I I S reel, 025._ - i - I Phone 1715 76 1978 L_ Subdols or: Meadoiv Vj11"jof Troy pst ~dda~ - - I i I 33 f L-Y~- I t- - =o 1. - - 1-Legal Deseriptbn . 4Mw144st-7 j-MN*f9W-- - --F- I i ■ Backho Pit L - _ Townsbip County , T Tb"him' St ~rolk_ Cdunty I I Slo OO.DD' TQ p ttit insr~ % _l Be ~ #~a o2 El.ti. ~I s -teep„al w forpipe - --I- - Scale 1"- fi I j LI ~-_l- J 1-4 - r-; ; -j i T-- J ~ I 1 ,l 1 1 I _ --i t ~ ~ B - I I I~ I I 1>1 - } ' --r - 1 1 - l 7- f_ l ` I 1 • t , I ! i 7 - i I -j 0 1 ',~0p _T- -i i ! - - DepaMrfenlof:', ~O ;t SOIL EVALUATION REPORT #1895 SPS in accordancx with Comm 85, Wis Adm Code ~V Page I of 3 i5vajoesece9g Schmitt Soil Testing, Inc Attach complete site plan on paper not less wa„ ties in size. Plan must County 01st N~ ENT Include. but not limited to vertical and horizontal reference point (BM), direction and O` percent slope, scale or dimensions. north arrow, and location and distance to nearest road. Parcel ID Please print all information. Reviewed Date Perscnal in'cr^..annn you pray ide nidy be use? iw secondary pulocses i Pm/ucy Le, s. 15 M i Ili imb Property Owner Property Location DCCI Land Planners Govt Lot SE114, NW1/4, SIT T28N, R19W Property Owners Mailing Address t of # !i Block # I Subd. Name or CSM# 1505 Hwy 65 P.O. Box 445 33 Meadow Valley Of Troy 1 St Addn City State Zip Code Phone Number City Village Town Nearest Road New Richmond WI 54017 ! Troy Meadow Valle Trail New Construction Use Residential l Number of bedrooms 4 Code derived design flow rate 600 GPD Replacement Public or commercial - Describe. Parent material O_u_twaSh plaid (Pillot Senes) Flood plain elevation, if applicable NA ft. General comments area is _trlabl? far a ccnaenl,onal system w4h a 0 7 gpdisgft rate Possible sysleai e evation for Area 1 is 92.65. Slope of area is and recommendations. 3a, 1 Boring # 1- 1 Boring Pit (;found surface elev 97.14 II. Depth to timihng factor 98+ in Sod Application Kale Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in Munsell Du. Sr Cont. Color Gr. Sz. Sh. T"i ! -E11#2 1 0-10 10yr3/2 none sit 2mgr mvfr as 2vt 0.6 0.8 -I 2 10 23 10yr4/4 none grsl 2msbk mfr gw 1Vf 0.6 lA 3 23-32 10yr5/6 none Is Icsbk mfvr qw 2vf 0.7 1.6 4 32-12 10yr6/4 none s Osg ml as 0.7 1.6 5 72-98 10yr6/4 none cos Osg ml ! 0.7 1.6 21 Boring # Boring Pd Ground surface elev. 95.94 It Depth to limning factor 99+ in Sod Application Rate Horizon Depth Dominant Color Rodox Description Texture Structure Consistent Boundary Roots GPDitl' in Munsen On Sz. Cont. Color Gr. Sz. Sh. -rtt#i •1111#2 1 0-6 10yr3/2 none sil 2mgr mvfr as 2vf 0.6 0.8 2 6-16 10yr4/4 none grsl 2msbk mfr gw ivf 0.6 1.0 3 16-26 10yr4/6 none sl Imsbk mfr gw 2vf 0.4 0.7 i 4 26-41 1Oyr6/4 none s Osg ml as 0.7 1.6 5 41-64 10yr5/4 none 9rcos 0sg ml I as 0.7 1.6 6 64-99 10yr6/4 none s 0sq ml 0.7 1.6 i Effluent #1 = 80D.,> 30 220 mg+L and TSS 130 150 mg:L 'Effluent #2 = BODS <.30 m91L and rSS <.30 mgrL CST Name (Please Print) Signature+ /,4_,,4-1- CST Number Thomas J. Schmitt 227429 Address Schmitt Soil Testing Inc. Date Evaluation Conducted Telephone Number 159572nd St. New Richmond Wl54017 6/22/2017 715.7601978 Page 3 of 3 Conducted by: Conducted For: Schmitt & Sons Excavating. Inc.. Name. DC('1 Land Planners Thomas J. Schmitt, CST 227429 Address: 1;05 Ilw, 65 586 Valley View Trail City. Stale, Zip: New Richmond, wI 54017 Somerset. W 154025 Phone 715-76 -1978 Subdivision: Meadow Valley of Troy 1st Addn Sgnat~e_ - _ Lot No. 33 GMe '1 --i- Legal Description. SE114 NWI14 S17'h28N RlgR' ■ Backhoe Pit Township. County troy Township, Sl. ('roix ('.ounty A Bench Mark 1 El. 100.00' Top of electrical transformer Bench Mark 2 EI.5.85' top of 1" steel lot corner pipe Slope= 3% Scale 1"= 60' M 2 S-6 ~Y" ` z ~ ~ Y3 h~Ca 93 qu /2 tot 33 1j 100 A0 ~up,c w wis I)ept. of Safety and Professional Services SOIL EVALUATION REPORT page I of 2 . Division of Safety and Buildings in accordance with SPS 385. Ws. Adm. Code County SI' C'KOIX Attach complete site plan on paper not less than 8 112 x 11 inches in sine. Pop narsl include, but not limited to: vertical and horizontal reference point (Bn~,, pir@cl:on and Parcel D 040-1327-3.31-000 percent slope, scale or dimensions, north arrow, and location and distance to nearest road. C!i Please print all information. Reviewed L Date Personal information you provide may ou r."rl Inr secondary pri'pcsos (Privacy Law S. IS U: ;1 l^16171116 Property Owner Property Location a DCC'ILAND PLANNERS Gov.Lot SL Ira NWttaS T 2bN R 19 S E(or)W Property Owner's Mailing Address Lot # Block # Sulad Name or CSM# 1505 11\Y'Y 65 110 BOX 445 MEADOW VAI.I.F) OF TROY I ST City State Zip Code Phone Number ity ❑Villaoe a own Nearest Road NEW RIC] IMOND Wl 5401, ( ) TROY MEADOW \,ALLEY ❑ New Construction Use❑ Residential f Number of bedrooms Code derived design flow rate GPD ❑ Replacement ❑ Public or commercial - Describe Parent material Flood Plain elevation it applicable _ ft. General comments DUG A HOLE BP.TWFFN 2 AND 3 120INCHES TO VERIFEY SOIL . BI AC'K DIRT TO RE REMOVED . and recommendations FILL TO BE TYNKLN FROM TOP Oh SY'STLM AND BLACK DIRT' RE INS I ALED AF'FLR SYTEM IS INSTALLED. BASMFNT N AS DLG SOILS APPAIK TO SPAT CONSI'I'EN'I 7I IRLW 011''I BE LOT, 4 ❑ Boring N ❑ Boring O Pit Ground surface elev. 95.9 _ ft. Depth to limiting factor 120- in. Soil A lira ion Rate Horizon Depth Dominant Color Redox Descnption Texture Structure onsislence Boundary Roots GPDrft in Munsell Cu Sz. Cont. Color Gr. Sz. Sh. ll:tt#l ' ff#2 A 06 10 YR 3r2 SIL 2M(iR MVFR AS 2VF .6 .8 B 6-16 10 YR 44 GRSL 2MSBK MFR CW I VF .6 .1 BI 16-26 IO YR 4r( SL I MSBK MFR (W 2VF 4 C IOY'K64 - ?6-4D S OSG MI. AS 1,6 C'I 40-120 10YR64 COS OSG ML AS 1.6 lr~ a Boring # FiBoring ❑ ❑ Pit Ground surface elev _ ft Depth to limitin factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsislence Boundary Roots GPDtft ' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh, ff#l ff#2 Effluent #1 = BOU > 30 < 220 m91 and TSS >30 < 150 mg!L 'Effluent #2 = BOD < 30 ru91 and TSS < 30 nig.L CST Name iPlease pwt) Signature CST Number /v.IU . O .22,,Q/,r Address Date Evaluation Conducted Telephone Number SBD-x?3011t1Ir'I I) i nom.... r, r..~..:. r^~:::---... o__,. ,-.,>..,_:-„e.,,..,, ~....-.•~•~'-~-,'relC:,. .,.w,,..,.... i 3 tl( 3J ~ 1 ,r- - II -rza-t ~Sc~mitt3 nc1 ~y-+ I Tr J. k~ 1! 227429 ; AddreM: t 1 65 -;ses y yew re- - ah. c. I wo= ~4o17 ,L P hdne: I oq"W ,71 19 8 ~~,y,• ~~ly~ VFYofst LO( _ ■ Ba P' i I Tdwnsh .I Tr~y 1 SL CaSu Be ch 1. 199. 'f ~icf el~etrlalrargloreNr - . B.e.d~oh ~la 2 $1:6.~~ioP ~7sIM~4c* 1„Pb i - - 996 I- 60' 1 -y k,71' ' I PtNI A-- U I _ I ~ ~_I I _ I j ! j I - - 4 - - - - - L I t- I yl Y; j L I 1 4-- 1 SOIL ABSORPTION SYSTEM DETAIL/ GRAVELLESS LEACHING UNIT Page-J-od Project Name: DCCI LAND PLANNERS LOT 33 2 No. of Cells 9 Per Cell 3 t Cell width 18 Total No of EZ1203 90 n Cell Length 50 sq n EISA Per Cell 3 o Cell Spacing 900 sq n Total EISA Manufacturer Model La ing Len Ut EISA Rahn Infiltrator EZ12C3H Sf 5.0' 25.0 EZ1203H-101t 10.0' 50.0 Gravelless Leaching Unit Manufacturer: Gravelless Leaching Unit Model: EZ1203H-10 Typical Cross Section Finished Grade 92-9 ft - Observation Pipe with approved cap or vent Soil Backfill 36 in ~Geotextile Fabric fl Infiltrative Surface 12 In 0 W X F fl Limiting Factor 36 in Slotted and Anchored Vent/ Observation Pipe with Cap f................ Plumber/Designer Signature: License#: 225410 Date: OCT 2ND 2018