HomeMy WebLinkAbout040-1232-50-000
Wisconsin Depanr,ent of Coy-coerce PRIVATE SEWAGE SYSTEM Cc.,ny St. Croix
Safely are Uui oirq. 1;osoc
INSPECTION REPORT SanlaryPer^-IVo
(A` rACH TO PEAT) 605129
GENERAL INFORMATION state Plan II; N9
PerSpra rf Jr'-..tier you p'ande -ay oe used for seooneary p.,rposes IPn'uacy Laa, s 15.M II:inI
Pclmr Pc oc'S Na°e Cey Wage To/lEhio Parcel Tax No
Christopher & Kathleen Haroldson TOWN OF TROY 040-1232-50-000
CSI B:! I lei nsp BY Elev BM Dev;•iil Secucr: TO,,v'RangeAIap N-
/6 l k CS-( 03.28.19.1151
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTJKER 5 CAPACITY STATION L BS lit FS ELEV
r 7 14,Z1 //Z.2 /oo
Septic Tw + Bencnroarx /tr0
L fZSO y 3L
l,~;esA.. LP
AI! Bfv
Io4L SZS r~1.... C.o it 3.45 /68.5
Aeration Bldg. Sewer ~•4q 767. 3Y
Hctdng StiHt Inlet
~ (1-95 /4s . z8'
TANK SETBACK INFORMATION St+ tit Or.!Iel 7. 3 10
TANK TO PiL WELL BLDG A' Intaie ROAD D: Inle:
Sectic DI Bottom All- C4 Dosing Heade0Aan
Aeration _ - Dist Pipe ` 4 Vr9
Holdrg got System
Dil 6lJ
Rnal Graph
PUMP/SIPHON INFORMATION J 3.10 /Ol-Z(p
tdanifac:urer Demand St Cover
5
hdodel Nxrbe' GPh1 11-7r
T
1 5.0 9R,2
TDH Llft yVen- Head TDH Ft
_T S. 3 9'l, o f
Force'ram Lei Ih D'a. Inst :0 "Nell g ~ L.sz Q7, vrel
SOIL ABSORPTION SYSTEM t ~f ,F `0 11 1r Z •,13 $
BEDfTRENCH I ergtn No. Of T -S~ l , PIT DIMENSIONS No O' P Is Inside Dia UvuLe : t n
DIMENSIONS 3, 1 Ga 13 1 tre4eW~ 1~
SETBACK SYSTEMro P+L BLDG WELL LAKEiSTREAM LEACHING rdanu'ac!u•er~~ Flnx✓
INFORMATION CHAMBER OR
T':F° O` Svtern UNIT Mcde N.mo
CO K✓~,..~a 38 (4 till, w~
DISTRIBUTION SYSTEM to V 4'-o
= /8
HeaCC V`ABn I. 'I r I D s;r OUi on a Hule Size a Fble SPacirn; ✓en: tO Ai' Intake
Le-31h Ca T lean Da Spa:ng_..
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Geptr O',e- Depth Over xn DecC of Sccecd~sodced xx f,I..Iched
111.1 110-h Center 47 _ Ile9f710"tn hC.'jES TJ(%SCd qty No ~~V'5 NO
COMMENTS: !Inclide code d scr~epennciespersons present. etc.) Inspection 41 QQ Inspec ion #2
Location: 531 TRILLIUM LN in•Wr 66VII f 6
1.'I Alt BM Descrip:.ton = 1 ~r
2 1 Bldg sever leigth = It nn c~ I OL d rt
- amount of Cover = 7 ~Z 6A r_✓fC/I~/ 1~ \ J(
Pan •evision Requ red? Yes x I ~ tilt
6 7P
Use osier side for additional infofmal J
Dale. HSep-'c' SB u:u cent. No
sHOET•n,;H ale?;~
l nrr1G 1
Safety in( Buildings D l n /
SP rl ,,.r 1Q 2~`a 201 W.
SMashingim'Ave.. P.O Bo 162 luvl:uy Ycnnn Numbcl Ihr rv fillet to by ('n~
Madsc: . VVI 53/07-7162
sel~.
anital V Permit Appltea tots S:alcTrens c .m Number
Sanitary-
r c' .okl . Ih STS - ;s;
i > t n l ~Iv. suhm r Ih III I
un cJ l I I leis'. I r l _ p I I ♦ I r f In' I t c d Pu U' I~:r: I nor - Lt Ruicrl nddnss Iil diffe,r:l than mailing addre, i
Ov Dumn I t I , q1.' ar I I I, ..u nal v I er I nl:m,.au u I pro: dv ma; h. ucd-I ;.:ua
r r ,m d:.n.t'.:1 II I In:yII I.n.f.I
Cpplir moil lnlilrm ikon Pleast Pl'u 11 lnformati r
~r per.: /)KI ~~IIt,,•:\:Illy.s ~Y A7td 1
~f p Plopcn)' 1oe:nton n 3'
a~. 9,)151.
Goa. Lu; - h,$latr .I. <'.1
4 Phune Nambor SL S~
R ti Fk ~4ro l-2 : Sr<lion 3
M ldY / 7 2 d / irdc onel
II 'I ypc nt Rulldiny! lchrcA :dl Ibul apph I / c".r' I rl T IJ N. K Fur 5v
7 F.n i I)s rlln,r V-mbcr of fic.ha+ms(\ / / Su:+dnds/lJan \uNZ!'
(j~L !*tik ( OunuGr GtlOlJr~_
~ :'uhhcC nm rziaf U I Lrc Us.
vu' ( rs d
NIalt•Oxnt D:r.c- Ibvls- C .MV N.unhcr L7 bdh~c of
r ~y 1~j'r vn of r
AIT1
ne
I11.'I)d1p-ep{vmiL• '(Check only one box on line A. Complete line (S if applicable)
w Sy.l.:-r ! R ,,la.:.:mem Syacrr I Trc:utncrtF I .ur, lxi], R pla..nncnt galy I L OIhe M1ludilicatinn to Lxtslmg System (explain)
IS r P n 3vrCW: Punur ft -e u J
o t IrI i'u.nl:c: I - List Pln iuua Permit NunthcrmJ title Issued
innit Trm.r.:r m Ncsv
Hcli vpll unn It ncr ~!V
I\',.ry of PUAFTSSsstem,CompontnCDevirt• IC,hu6 all that
V r ~~~7T7•~
lom Pm. I I'n linr l l I lcsv l i l lr c lol ,V-(o t/.D ~-1 Vk L nd t of of sib I loll L Mound.:. Ll in. o1 mobic sod
I 11.1'Ingl rl. .~>Uthn Dli rd I , I. L. x;a li-rr1 Teti--
_ ~ J Prtu uuurm I lc I -.I Icxplainl
\ Dispersal 'Ire 1_tnlent Area Information -
Il ,III~m ~i dj D. Ir,,I APp-I III I IAxp~pJdl Dls nn:d4m3 Rruumd W, pl-I.vrsel AYC3 Pm{wsrotlfsD ly~acm Elrsalion
r D(S ~~r5 7.1 ADD 99.2 99. a~ 97.7.
M1 I'a lik lllfo t Ipa tv n 'total
'(or M1fanuluawn
Gallon, Gallon, Lints
/ wly! II1 s
f~ N.•w'ranhi hrvGng T.:nk` W 0~- !Z~ ~~It
S, ~n I<.I Ih:IJn, Ind. ~ /zf r~ I S/j -r - - ~z ~ I` J ~ V G.
T If. RespollsdnlityStalenlt•nt- I. the under agned. aaum ttsponsihilils for i tallatian nl'lhe PO%% IS chovin on the attached plans.
1 L6, Nm t, II uu I P. u_Ih T Lame I \IPplf Kl Nuntfvr I~ 4usincss Phone N... idler
I unl r'. AJh IStrxl. (nv SIxe.7iP( Filer
M1III Counts Uv uhnc•nl I wOnly -
~Q-}'kpp: d 1 hrq•p ui ' I yPcmust fee Ual: lssueC u.ug Acc~-SICnBIIUC - J
~i tl 11% ll~ r It ..rr. for Uenal 7(/"'ZZ"Z CJ f` /
I\. Conditions of \ppruxal Reasons fur Disapprusal tom(..:
SYSTEM OVJNEI~
1. SI ftlc tank eHloenl filter and
d'spl rn~ II rus( Le see 'ICec ; ma ntaLn__
_ as per man r1C`rlt fl n `r.wi(1e ribe r. _
sullen to c.:mplclr plan, for thc+ 1J11110H3b1nm1(I(HOl1AIIgIITEPA011A V0D210'1L1PM'llnlnl('1_t>.Il incbo. in .ier -
9E j a~'i(; Ir ll'aIt le pCd Pi09!indrCe S_
vilot man Page 0&41
PROPERTYOWNER: Ct+I~I~pPn ` K~r~~Eti vcosan(
1 40 FT.
Legal Description: !S 01~!U?2 6LJOQ t (except where noted)
Teti
R kl. IWA) PF -yze y >7. t ~e1tx 31 l~ = backhoe pit
0 so-- igoo
53 1X I u t ,c• LAN e
4
1U
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In-Ground Gravity Plan PAGE 1 OF 4
Index & Cover Sheet
Component Manuaf Design References:
Version 2.0, SBD-10705-P (N.01/01, R. 10112)
Pg 1 of 4 Index & Cover Sheet
Pg 2 of 4 Plot Plan
Pg 3 of 4 Dispersal Area Cross-Section & Plan View
Pg 4 of 4 Management Plan
Attachments: Enclosures:
Fl i_Trt; 'Wre 5 POVVTS Application for Review
7,1,rofK ~1'Ee s Soil Evaluation Report & Site Ma
_t Z Faa~J ~:>Pcc.s ~Ky,4NT t X17 --it /Z)36V3/
TAlle H(:-~~~ti T
Project Name / Description
Owner Name(s): Crtl=isroPits~ /C a rn~1'EN r l~ih'Ct ~5u~ 1 Phone:
Owner Address: ,`z3s ~Ka-vcFS mc ilu~~oti` Zip: :5~70/6
Project Address: J3$ 7K1 tta u.0 LANE
Govt. Lot: - ~ 1 /4 of , E 1/4, Section o 3 T -f N-R /E Q or W o
Township: T/:CY County: 9-. oeclx
Project Parcel ID CqC~__ rz3z - 50- 06 D
Designer Information
Designer Name: !L ~Ar~,y _ 10 f luf'PeKT Phone: 715 _`14- _ ! 7
Designer Address: ZkL191 S~KI V&, I~KTHur<s C'i l~,nNR ~ , n Zip: -5919 C
E-mall: AOUslefclrS(rl 'D t~ (DOK PQrv~ .1.his5a\G
7 P i' 4067 stenil)
License Number. I fi t o ` J'
ber. - c 9
, f. AIARY
Remarks: /111r,
NU
PPC s
01859
e
RIVER FALL&.
rte:
1 1 _ ~1/11ry11Mri~41pN\\~~`A
Signature: Date: :y-- >ri,,,~
oiiipm . naturo f nwl on qftgh SubirOW copy.
i PlOt Flan any
PROPERTY OWNER: CH Klsr ph
----~_El~ ~ /CkTH[•EEN ~G~4SL~L,~ j" _ ~ FT.
Legal Description. 7 IS bwyT24 11i0C11 ~F~ (except where noted)
TOF4 R -T" WA) ST, badchoe pit
TRCY CRO~x ~U
0" 3~-50- OCO Z531 21 U6 Z. Z8 ACrZFS
North
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Site location_
° PAGE 3 OF 4
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In-ground Gravity Management Plan PAGE 4 OF 4
IMPORTANT:
The owner of this in-ground gravity system shall be responsible for its perpetual operation and maintenance pursuant to
requirements of SIPS 382-384, Wisc. Admin. Code. Pursuant to SPS 383.52 (2), Wisc. Admin. Code, this system shall
be considered a human health hazard if not maintained in accordance with this approved management plan.
Furthermore, all inspection and maintenance activities shall be performed by a registered POWTS Maintainer in
accordance with SPS 383.52 (3), Wisc. Admin. Code.
Maximum Dispersal Area AroMln.. r t..y.
Design Flow = &100 gpd; 80C6 5 220 mgL-+. TSS S 160 mgL"; FOG 5 30 mgL-'
Inspection C klkr INSPECT EVERY 3 YEARS
a type of use
o age of system
o nuisance factors (i. e. odors, user complaints, etc. )
mechanical malfunction (i. e„ pumps, valves, switches, floats, etc)
o material fatigue (i.e.. leaks, breaks. corrosion, etc.)
solids volume in anaerobic treatment tank(s) and any distribution appurtenance(s) (i.e., distribution / drop boxes)
extent or improper use (i.e., exceeding design capacities, prohibited activities, etc.)
ponding in distribution cell prior to dosing
o dosing irregularities - if applicable (i.e., pump recycling, float switch settings, etc.)
o electrical components - if applicable (i.e., wiring, connections, switches, controls, timers, alarms, etc.)
distribution lateral or lateral orifice plugging (measure lateral distal pressure - compare to design specification)
o surface discharge of effluent or sewage back-up into structure served
Maintenance Checklist MAINTAIN EVERY 3 YEARS (or when necessary)
n Seotlc and dose ank/sl shall be pumped by a certified septage servicing operator licensed under s. 281.48 Wis.
Slats. when the volume of solids in the tank(s) exceeds one-third (1/3) the liquid volume of the tank(s) or
as required by krcal ordinance. Disposal of contents shell be pursuant to NR 113, Wisc. Admin. Code.
0 Effluent Nlterlst shall be inspected every 3 years and shall be cleaned when necessary to remove any
accumulated solids according to manufacturers specifications- A servicing period will always be greater than 12
months.
System maintenance reports shall be submitted to the proper local government unit in accordance with
SPS 383.55 Wisc. Admin. Code. Report any component failure or malfunction to:
Name of individual or company: /11 J H6 )lC0F-1V,,RQ a 6& FIJ DOh'F EX Phone: 715- y25= &?L'L)
Local government unit. S~.(•PCIYettjL'ri trMAJjyi-t I cIlEttFP01": 7157-386-`/650
Local government unit address: ~ IM` CA/r b(~t ZIP: S` ,911,
Any defective pert of this system shall be repaired, replaced, or removed pursuant to SPS 363.51 (1), Wisc. Admin.
Code. Repair or replacement of failed or malfunctioning components shall comply with SPS 383, Wisc. Admin. Code.
No product for chemical or physical restoration of the POWTS may be used unless approved by the department in
accordance with SPS 384, Wisc. Admin. Code.
CoMMnencv Plan
In the event that any failed treatment component of this POWTS cannot be repaired, it shall be replaced pursuant to
a plan submitted to the appropriate agency for review and approval A failed in-ground dispersal component may be
abandoned and replaced by a codecomptying dispersal component in a pre-determined area of suitable soils.
System Abandonment
If use of this POWTS is discontinued, it shall be abandoned in accordance with SIPS 383.33, Wisc. Admin. Code.
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m fD, RAW BY. WCP SCALE: 1/4
WIESE1 CIICIETE
SEPTIC MANUAL REV.
Z W3716 US HWY 10 kWDEN ROCK. 1N 54750 TE : 00/00/00 DATE. -T-POUR:
800-325-8456 E, MIM-0
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- ~"ice •-'an•.. M4F~
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s are quick to install,
',lodular construction all%vs
ngineered for op;in:ai sturage anti ainsolptlon efficiencie,:
uility to tumour alorly ;.loped ,lies and aruu.d trews
ghtweioht system is perfect for repairs and tioht
isily hand carried into position reducing time ar
of ?U' lengths with simple snap, intemal coupl
ester cieanup at the job site with the elimination
~inuf>^hwil on recycled ni;iteri;rs rather than
wide variety of diameter; and configurations to ri-
{:q foved in many jurisdictions vntl an increased
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?H GFO 12021 GFO 1)26H-GE':
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.....:..I 800.689.775:1
www.ezflowlp.r
www.infiltratorsystc
For technical assistance, installation instructions or customer service, call Infiltrator Systems at 800.61r
EZ1203H
v.v.. 12u
24°
4.625 -
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Bottum
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12-1/2" DIA. (typ.)
Void vodmr Suit )ntrrface Area In. to- SlL
Yoid COeffclent in Aggregate given at 14% Sidraall (2 SId,allq 18 "din
1- ` 3.14
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SAFETY AND BUILDINGS DIVISION
Plumbing Product Review
P.O. Box 2658
aP I tt Madison, Wiswnsin 53701,2658
!.°rt TTY: Contact Through Relay
•P`-- Scott Walker,
" Governor
Dave Ross, secretary
October 11, 2013 - - - -
INFILTRATOR SYSTEMS INC.
GOVERNMENT AFFAIRS DEPARTMENT
4 BUSINESS PARK RD
PO BOX 768
OLD SAYBROOK CT 06475
RV: Description: LEACHING SYSTEM, POLYSTYRENE AGGREGATE
Manufacturer: INFILTRATOR SYSTEMS INC.
Product Name: EZFLOW DRAINAGE SYSTEMS
Model Number(s): EZ1203H (3-12" bundles with pipe in center bundle in 5 ft. or 10 ft. length).
EZI203HP (3-12" bundles with pipe in each bundle in 5 ft. or 10 ft. length).
EZ1201 P (1-12" bundle with pipe in 5 ft. or 10 ft. lengths), EZ1201 A (1-12" bundle
containing aggregate only).
EZ0701A (1-7" bundle containing polystyrene aggregate only in 5 ft. or 10 ft. lengths).
EZ1203H GEO (1-12" bundle with non-woven geotextile fabric installed at 180 degrees on
the upper side of the bundle, pipe in 5 ft. or 10 ft. lengths).
i EISA of EZ1203 H, EZ1203H-GEO or EZ1203HP in 5 ft. lengths - 25.0 sq. fl./product,
EISA of EZI203 H; EZ1203H-GEO; EZ1203HP in 10 ft. lengths = 50.0 sq. ftJproduct,
Width = 36 inches, Height = 12 inches, Max. depth of bury = 8 It.).
Product File No: 20130145
The specifications and/or plans for this plumbing product have been reviewed and determined to be in compliance
with chapters SPS 382 through 384, Wisconsin Administrative Code, and Chapters 145 and 160, Wisconsin
Statutes.
The Department hereby issues an alternate approval to s. SPS 383.44(4)(a)l.a.; 384.30(6)(k) based on the
Wisconsin Statutes and the Wisconsin Administrative Code. This alternate approval is valld until the end of
October 2018.
This alternate approval supersedes the approval issued on 4/10/2012 under product file number 20120139.
This alternate approval letter shall be incorporated with your previously approved plans and/or specifications
approved under product file number 20120139.
This alternate approval is contingent upon compliance with the following stipulation(s):
• This product must be installed in accordance with the manufacturer's printed instructions, product approval, and
plan approval. If there is a conflict between the manufacturer's instructions and the product approval and/or plan
approval, the product approval and/or plan approval will take precedence.
When this product is installed in a dispersal cell that is sized based on the EISA rating stated in the regarding
block of the product approval letter, this product must receive wastewater having a BOD5 value less than or
equal to 220 mg/L, a TSS value less than or equal to 150 mg./L and a FOG value less than or equal to 30 mg/L
on a monthly average.
When this product is installed in a dispersal cell that is sized based on the EISA rating stated in the regarding
block of the product approval letter, this product must be installed in individual excavations that create a
dispersal cell that is horizontally separated from other dispersal cells in other excavations by at least 3 feet. The
3-foot measurement is measured between the closest outside edges of the product listed in the regarding block
of the product approval letter.
SBD 10564-E M.I OM7) File Rel: 13014502.DOC
INFILTRATOR SYSTEMS INC
Page 2
October 11, 2013
Product File No: 20130145
• When this product is installed in a dispersal cell that is sized based on the EISA rating stated in the regarding
block of the product approval letter, this product must be installed in a dispersal system, which has the top of the
dispersal cell at or below original grade of insitu soil.
• This product must have geotextile fabric that meets requirements of s. SIPS 384.30 (6) (g), Wis. Adm. Code,
installed directly on top of the product and extending down along the sides of the product to a point at least
6 inches from the bottom of the product.
• This product may he installed in dispersal cells in place of stone aggregate specified in approved POWTS
Component Manuals or Department approved systems. When the distribution cell is not sized based on the
EISA rating, the dispersal cell area must be equal to or greater than the area required for stone aggregate.
• This product may be installed at a depth that exceeds the maximum depth stated in the regarding block of this
approval, when the manufacturer provides in writing that the proposed installation depth is acceptable for the
individual installation.
• The following stipulations apply only to the EZ1203H-GEO, 1-12 in. and 3-12 in. bundles with non-woven
geotextile fabric installed at 180 degrees on the upper side of the bundle, pipe in 5 ft. or 10 ft. lengths:
1. When installing EZ1203H-GEO in 5 ft. or 10 ft. lengths, the product must be installed with the geotextile fabric
facing upward.
2. When installing the 3-12 in. bundles, trenches must be excavated no wider than 42 in., with a 36 to 40 in.
trench width preferred. (Although EZ1203H-GEO is not, to date, recognized in the EZFLOW Mound Component
Manual.)
3. Geotextile fabric meeting the requirements of s. SPS 384.30 (6) (g), installed directly on top of the product
and extending down along the sides of the product to a point at least 6 inches from the bottom of the product.
When installing model EZ1203H-GEO, the fabric width shall be at least 5 ft. wide.
4. When installing the 3.12 in. bundles, bands used in transport must remain intact during installation.
5. Pipe connectors are necessary for the transition between differing pipe materials (e.g., polyethylene
corrugated piping and PVC pipe), meeting s. SPS 384.40, and must be used to assure piping does not separate
during construction and backfilling. (Example: Include pipe connector such as AC-VCOUPLER-4 for both
Schedule 40 and 3034 PVC 4 in. pipe.)
• For gravity distribution of wastewater, the distribution cell piping shall meet the following conditions:
1. The cell units (bundles) shall be 12 inches in diameter +i- 1 inch.
2. The cell units (bundles) shall be manufactured in 5 and 10-foot length sections, 2 inches.
3. The 4-inch pipe within the bundle shall be certified as complying with ASTM F 405, Standard Specifications
for Corrugated Polyethylene (PE) Tubing and fittings.
4. The 4-inch pipe shall be offset from the center towards the top of the bundle whereby 5 to 6 inches of
aggregate is located between the bottom of the pipe and the bottom of the bundle, and 2 inches of aggregate is
located between the top of the pipe and the top of the bundle.
5. The 4-inch pipe shall be connected by an internal coupling device to allow continuous connection from one
bundle section to the next.
6. The end-to-end gap distance between pipe containing bundle sections, as measured from the straps fixing
the netting to the pipe or from the face edges of aggregate on adjoining bundles, shall be no greater than
3 inches.
7. The header or manifold pipe connected to the 4-inch pipe within the bundle shall be at least 6 inches above
the infiltrative surface of the distribution cell, or the 4-inch pipe within the bundle shall be connected to the
header or manifold pipe using an adapter that raises the invert to at least 6 inches above the infiltrative surface.
• The EISA rating reduction may be used in dispersal cells less than 36 inches in width.
1. The maximum excavation width of the dispersal cell is 42 inches for a 33 to 36 inch bundle.
INFILTRATOR SYSTEMS INC
Page 3
October 11, 2013
Product File No: 20130145
• Otherwise as permitted in this Alternate Approval, the stipulations of the In-Ground Soil Absorption Component
Manual for Private Onsile Wastewater Treatment Systems (Version 2.0) October 2012, (SDD-10705-P (N. 01/01;
R. 10112)) apply.
A copy of the manufacturers' installation instructions shall be onsite and available at the time of installation.
A copy of this alternate approval shall be onsite and available at the time of installation.
• Additional information is included as attachment(s) to this letter; see attachment A.
In granting this alternate approval the Division of Industry Services reserves the right to require changes or additions
should conditions arise making necessary for code compliance. Nothing in this review shall relieve the manufacturer
of the responsibility for designing a safe component into the built environment.
The department is in no way endorsing this product or any advertising, and is not responsible for any situation which
may result from its use.
Sincerely,
Glen A. Jones, M.S.
POWTS Product Reviewer
phone: (608) 267.5265
fax: (608) 767-9723
ernail: glen.jonesCa)wi.gov
COUNTRY wooD
f, HE "WV%> Or 7HF St114. Mir !r Nc. W,; fr :L rq r'R 7..,E
f;t b'7
Th S r ri 1 . r!r l "/4 P:D 04 PAW ilt f'E(14 0
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it
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12
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f 6 15
1•
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I 1. \
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. SHEET 2 OF 4 SHEETS
S 1'. C ROIX COUNTY
SEPTIC LANK MAINTFN.AN('I. AGREEMENT
AND
ONN NF.RSHIP CERTIFIC'A IION FORM
Owner'Buyer e AAS'~0 e'c
Mailing Address 71) 66~r;,;Gil ZA i<<J , r f /~S
/ ~ pp
Property Address 531 / ~{,,,,ts~~i✓
(Verification required From Planning K. /onurv Uspartnwnt lo. new con%tntcuor.)
City State Parcel Identification Number 12-31-ece -
LEGAL DESCRIPTION
Property Location , SQec. T LZrN R ! Cr NN'. I own of Qa~
Subdivision Plat: - co"~'yy (VICC~ ~_`/r(t "C~( Lot-`
Certified Survey Map # / Volume . Page ti
Warranty Deed (before 200'7)Volume Page
S ec'nonse❑vc 410 Lot lines identifiablc,2tye<❑11o
SYSTEM MAINTENANCE AND ON1'NER CERTIFICATION
lmproper use and m.nnlcnar,"ul yuur.eplic "'rem soul:'. result in its premmure Caiiorc to handle wastes. Proper
matnlomnne crnuists of pumping out the septic lank cverp three.cars or sooner, if needed. by a licensed pumper. Mmi you for into
the system can :dtect the lunclimt of the septic tank as a i:c:ument stage in the waste disposal system. Owner maintenance
responsibilities arc specified in ;SPS 383 , i2(I i and in (.'halter 12 - St. ( roil (bunt. Sanitary Ordinance.
I he property owner agree: to submit to SI. Crui\ County Planning S Zoning Deparm,cut a certification Iona, signed by the
owner and by a master plumber. ioameyman plumber, restricted plumber or a licensed pumper wrifytng that (I I the on-site
wastewater disposal system is in proper operaling condition and or 1 alter inspection and pumping (if necessary), the septic lank is
less than 1 3 full ol'sludge.
I: we. the undersigned have read the aboae requircmenls and agree to maintain the pri<;ac sewage disposal system with the
standards set forth, herein, asset by the Departmenl ol'Sali ty And Prol'essional Services and the Department ofNaurral Resources.
S[atc ofAVhconPal. (erlCication Mating that your septic symen) has bec,l mainl.lined mast be completed and returned to the St. Cross
County Plamnn. K /omng Department within 30 days of the three year csptraoon date.
I: we certify that all statements on this tome are nne to the best of n)\ our knowledge. I!we am are the owner(s) of the
props tY described above. by t trlue of a warr:uuy deed recorded in Register of Deeds Office,
Nun erbedroums'
SIGNATY'RE OF APPLICAN I (S) ATE
'»".4m intminal w tam :s misrep.cxntcd may result ht the sanitary permit being revoked by the Planning K Zoning Department.
Include with this application a recorded s%.mamy deed from the Register of Dceds off ice and a copy of the certified survey map if
n•ference is made in the warranty decd.
(REV. 04:12)
w--)nsinDedanmentotIndustrv. SOIL AND SITE EVALUATION REPORT g, e 1 of 3
nano Human Relations
Oi,r...on of satory 8 8uddinds -n accord with ILHR 83.05. Wis. Adm. Code J~
Attach complete site plan on paper not less tnan 8 v2 x 11 inches in size. Plan must include. but t '
not limited to vertical and horizontal reference point {BM), direction and °ro of slope, scale or CEP L ~~n J N
dimensioned. north arrow. and location and distance to nearest road
APPLICANT INFORMATION-PLEASE PRINT ALL INFORMATION G 31 °Z _RE -?W-- cit ,7j D 7
DROPER-Y OWNER. PROPER'YLOCAT.CV
Richard Stout GOVT. LCT SE tr.t SE 1T.. SIdr,W
PROPER-1' OWNER S YA I NG ADDRESS i r LOT if BOCK v SURD NAME 0
1353 Awatukee Trl. < na Country iioo //5i
CI .STATE Z'P CODE o40NE NUMB- (]CITY ❑VILLAGE ❑CTCWN NEAREST ROAD
Fudson, lei.54016 1711 549-6731 -Troy I Tower Rd.
}ok New Construction Use It 1 Residentiai; Number of bedrooms 3 1 [ Addition to existing building
j j Replacement [ j Public or commeroal describe
Code derived daily flow 450 gpd Recommended design loading rate r bed, gpd12 .8 trench, gpdt2
Absorption area required 643 Ded tr2 563 trench. ft2 Maximum design loading rate ' I bed, gpdAt2 .8 trench, gp(Lht2
Recommended Infitntion surface elevabonis) 103.17 ft (as referred to site Dian benchmark)
Addit ona design i site considerations na
Parent material sLream terrace Flood plain elevation. it acplicabie na rt
S = Suaao;e for system CONVENTICV, V UND IN GPdUND PPESSU;E AT GRADE SVS-EN N F._. MOLD NG TANK
U=tlrsurable[orsvstem EIS uU [FS ❑U ?rS ❑U 1]S ❑U OS Ell U ❑S U
SOIL DESCRIPTION REPORT
Boring # Horizon Depth '.Dominant Color Mottles Texture Structure Consistence Roots GPDift
g ;n. I Munsell Gu. Sz. Cont Color Gr. Sz. Sh. Bed Trench
1 I D-10 Ii0 r3 3 none "1 2mcr mfr "w 2f 5 6
2 10-19 7.Syr4/4 nono is os mvfr if .7 .8
Ground 3 .9-80 110 r4 4 none cos os: ml na na .7 8
6 v7
10? fit. I
Depth to
limiting
factor
+801,
i
Remarks: ' LC(~ ~C G'Y~t. 2-2 a. ~F (c_~e<<c°rcc/ ~e1CtLz- _Slas~i'
Boring #
i
1 b-9 10 r3 3 none 1 2msbk mfr 2f .5' .6
2. L --15 X7.5 r4/4 none scl lfsbk mfr rw if .21 .3
Ground 3 5-86 7.5 r4 6 non
I I I
10;I1 it.
Depth to
limiting
factor
+86
Remarks: -
CST Name-Please Prml Phone'
Gar T.. Steel f~ 715-246-6200
Address 1554 200th. Ave. New R' chrond 11 5401 10-26-95
Sgnature Date: CSTNurri (•10"2298
PROPERTY OWNER eichard Stout SOIL DESCRIPTION REPORT r'age_2 of 3
PARCEL I.D. # -PC[- it-i `
Boringtt Horizon) Depth Dominant Color Mottles (Texture Structure Consistence 6wavylRoots GPD:It
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Bed iTrmrn
1 0-9 oyr4/3 none Sl 2mgr mfr I gw 2£ .5 .6
2 9-18 7.5.r4/4 none 1s osq mfr gw if .7 .8
Ground 3 18-84II0r4 4 none cos os ml na na .7 .8
elev
'.06.92 It.
Depth to
hmierw
'actor
+84 -
Remarks:
Boring tt
, 0-8 10 r3/3 none sl_ 2mcr mfr gw 2f S 6
4 ` 2 8-17 7.5yr4/4 none lS osg mv`r qw if 7 8
Ground 3 17-80 7.5 r4/6 none cos QS'- MI na na 7 .8
10e6 II
i
Depth to
limiting
fa+
Remarks: _
Boring k
1 0-7 Oyr?/3 none si 2m r mfr g w 2f .`i .6
2 7-15 7.5yr4/4 none Sl 2mgr mfr gw If .5 .6
Ground 3 15-80 7.5 r4/6 none cos osq m! na na .7 .8
_Mn -
Depth to
actor
- - L
factor
=80"
Remarks:
Boring #
Groura -
elev
Depth to
-
limmno
lactor
Remarks:
S9D-e330tR.05:921
STEEL'S SOIL SERVICE
Gary L. Steel Richard Stout 1554 200th Ave.
CSTM2298 SE4SE4 S3-T28K-R! 9T•7 New Richmond, WI 54017
MPRSW-3254 town of Troy (715) 246-6200
lot #58-Country Wood
N
1,,=40'
9M.- top of steel pipe el. 100'
Alt. RM.= top of steel fence post ? el. 103.75'
~ i Ccr~e<,r o
j ec<i tc c 7
b Z
a;cu11411u.11 rI
t~
ti 10`
L A~
/U
35~ `
0
Gary L. Steel
10-26-95
1Mscc6n Dopartme!jLoVS4fetyr~ ti F? T~feseidnal nines CC 5T-,20 19
O
Division of Industry-services - -7
2p\~ SOIL EVALUATI On ! I Page I of 4
, O in afcordan with SPS 383. Ws. Adm. Code
County
Attach complete site plan on paper rip(lesa ~ ~ 1112 x 11 inches in size. Plan must ST. CROIX
include, but not limited to: vorfieai altdht nzonlal reference point (BM), direction and Parcel I.D. - -
percent slope. scale or dirrT r nsions, north arrow, and locator) arid distance to nearest road, 0't(1 - 1232 ` JO - 000
Please print all information. Reviewed'by l Date
Personal information you p(onde may be used for sewrxiary p,rposes w,.,,cy Law, s. 15 o4 it) (T))
-
Property Owner Property Location 4
CHRISTOPHER & KATHLLEN HAROLDSON GOO Lot SL 114 SE 1/4 S 3 T 28 N R 19 E❑(or) I Property Owners Mailing Address Lot# Block # Subd.
Name or CSM#
538 Prances Avenue 15 Country Wood
Clry State Zip Code one Number ity ❑ Village • Town Nearest Road
lludsan \VI 5401ti
( ) Trillium Larte
New Construction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 _ _ GPD
Replacement Public of commercial - Describe:
Parent material sandy outwash Flood Plain elevation if applicable t ~ 8.
General comments
and recommendations: ComenUOnal In-ground Trenches 0.7 loading rate
L PROPF.RT}' ADDRESS: 531 TRILLIUM LANE:
Boring # ❑ Boring
0 pit Ground surface elev. 106.80 ft. Depth to limiting factor 108 in.
Soil Application Rate
Honzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munsell Do Sz. Cont. Color Gr. Sz. Sh. 'Eff#l 'Eff#2
1 04 7.5YR2.5 3 sil 21'sbk mfr cs 201in 0.6 O.R
2 4-11 7.5YR4•1 cl 2fabk mfi cs h•f-m 0.4 Q6
3 II-27 7.5YR34 Is Osg nil as IvGm 0.7 t.6
4 27-35 7.5YR44 - h' nd
f's Osa as Icf-f f1A 0.(
5 35-108 7.5YR4'3 cos Osg dl 0.7 1.6
sonic gm ICw r.,hs
:2] Boring # ❑ Boring
I (M.70 96
0 Pit Ground surface elev-_ ft. Depth to hinting factor in.
Soil A 6ption Rate
Honzon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF
in. Munson Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef(#1 'Eff#2
1 0-9 1.5YR2.53 sil 2fsbk mfr aw 2cf-co 0.6 o.g
2 9 36 ' 5YR4t4 cl Hank mti cs
Ivf-m 0.4 0.6
3 36-96 7,5YR3i3 - s&gr Osg ml _ 0.7 1.6
Icw cobs
' Effluent #1 = SOD, > 30 1220 n ffyL and TSS >30 < 150 mgfL ' Effluent #2 = BOO- 130 mTg(L and TSS < 30 rrttyL
CST Name (Please Print) Sig We CST Number
MARY JO ITUPPERT (Hollister's Soil Testin &Design 77/4 t[ ' 224832
Address Date Evalua' onducted Telephone Number
28497 King Arthur's Court. Danbury. \4'1 54830 1)7 - 19, 2018 715-426-1775
Property Owner- IIAROT DSON, Chriz & Kathleen U10 - I2i2 _ S0 . 000 2 4
_ Parcel ID # Page of
D Boning # Boning
Ground surface elev. 100.80
Pit _ ft Depth to Writing factor 108 m- Soil Application Rate
Horizon Depth Dominant Color Rodox Description Texture Structure Consistence Boundary Roots GPD/ft
in. Munsell Qu. Sz. Cont. Color Gr. Sz" Sh. 'EtW1 •Eff#2
1 0.9 10YR2/2 A 2f-msbk mvfr as 34-co 0.6 1.0
9-17 7.5YR3/3 s1 If-msbk infir Cs 24-co 0.4 0.7
3 17-27 7.5YR.14 s Os 41111cs E If-m
0.7 L6
4 27-108 7.SYR4r4 s Osg Ivf=f 0.7 1.6
some poets of cos _
I lorizon I has 15-20Yo gr; horizon 2 has pr.
r
Boring At Boring
Pit Ground surface elev. ft. Depth to limiting factor _ in,
Soil Applicator, Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDffP'
in. Munsell Qu. Sz Cont. Color Gr- Sz. Sh. •Efpkt •EH*2
Boring
F1 Boning # Pit Ground surface elev. _ ft. Depth to firming factor m.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft
in. tdunsell Qu. Sz. Cont. Color Gr. Sz. SK 'Eff#1 •EH#2
Effluent #1 = BCD, > 30 220 wql and TSS X30 < 150 md.1 ' Effluent #2 - BCD, < 30 rrx,'L and TSS < 30 rrgrL
'i T:r1NiVi i
Plot Plan Page 3ofz/
PROPERTY OWNER: _L'Hr~rs~pprr )~APf EE,y AAt-ZCL.bs(Itif 10 40 FT.
lexcept where noted)
Legal Description:._ "-r 15/G1AArMy WOG &Y4 OF THE 5t~ ~ 3
backhoe pit
7 9wH1 'TVk/,V If T,<Cy 57 CR01k CCIa QTY Ic
lW0 12 32-50- OCL) 561. Z. L8 AegES
"~i~+uN1 LA/V6
North
s i
~ t
1 a
l
5
'i , ;'.'1J11 ',~E9Ni3 L •,F IA1 v{41 '.'i uNr
t7~ p
7 1ti.1
1
i.,
i
,`..L TG lam:
_ i
Site location:
t1ARCrr~_~~
r
o~ a
Y
ItALI
.r.V
k
41k
• lb
d
2