HomeMy WebLinkAbout040-1259-90-000 (2)
Ws nsin Depacmenl of Commerce PRIVATE SEWAGE SYSTEM Cou-.ty St. CrOIX
Safety and Bu Id ng Divison
INSPECTION REPORT Sanitary pzrmi: No
GENERAL INFORMATION (ATTACH TO PERMIT) Stare Plan ID Nc 605128
Perscna nfc-ma:icr you ptaoce may be .sec for secondary pu'poses:Pnvoci La'x. s ri C4 Il:imil
Pe'mi: Hcde'S Name City Village Tcv.rsho Pa'cel Tax No
Jeff & Therese Haney TOWN OF TROY 040-1259-90-000
.:SI ItPA i lev nsp. 91.1 Elev BY Cescriol on Se-low I CVrr•RangPleap No'.
/13.71 5 6, jz' 18.28.19.1388
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Benchmark
/z5v -ro zF 6 ~{.1y {/3-7
Dosirg I! Alt. BM C8_1tA_ ~r 6.43 /
Ae•at on _ Bldg. Sewer
Holding SUHt Idle:
TANK SETBACK INFORMATION SUHt Octlet
TANK TO P1 VdELI. BLDG Vent io Air Iri ROAD Of Inlet VAS (p. L7 aZ. Z
Secuc utBOacm/ L O (o• 3a 14Z ,t•']
o O'-! e V
Dosing Heacer:Man. 9-& c?"li W
Aerxion - Dist. Pipe C
9.r ~g9.37
g--- Hot System 6 .V7
Told,
r 9q. a
.
PUMPISIPHON INFORMATION F,na Grade
(.4 $ ~a! • q`I
lolanufaCILrer Demand St Cover * D //3
GPIo!
Model N,tmber
TDH Gf. Fralod Loss System rica9 TDII Ft
Fcrcemari Length Dis-. ro b•Jel , t LS /b$.47 2 •Q /A L .44
SOIL ABSORPTION SYSTEM
BEDrTRENCH :'v. 710 ;.cr Jlh No. Or'ersnes PIT DIMENSIONS No Or Pis 1 Inside Die Lldwc Depth
DIMENSIONS 9a '7 1
SETBACK SYSTEM TO V P:L LjBLDG /WFL.LL LAKErSTREAPA LEACHING ma-u`acur
INFORMATION CHAMBER OR Te% G ~~✓t-
Type Ot SiStznl, UNIT fgoce(~ ~l1-b~
v✓ 0e O 57 Z$~J ~V ~5 P/mss
DISTRIBUTION SYSTEM A Z5s jl di-ef, id- a
Ir•zadeNhtani': 1( Jisnou ir.n x I-C e Size x Hole Spao^.g Vent to Air l)/ntake
y =iprts' '50"'-(ti
L,,,qt / Did _cn)ln_ D5 ~
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
f?eotn Oyer DeF'h ("rer xx Dept-) o' eed:Sodded x~t 6au cnec
Bedr IrEntr "'.Ni q ` Sec Tremc I d"s Topscd ` xx Sde _ Yes Nc ves N^
402-1
COMMENTS: ;Include code dlscrepences. persons present, etc) Inspechod #1: InspCClio•1 #2.
Location: 389 DEER VALLEY DR C ~p„IJL 1 S~~~G 110/,•
1.) AL' BPA Descript or =
2.) Bldg sewer length = ~•K~.~T'~~ Coots.- ^ ~ F •
- a•roun: df cover =
Plan revision Requuedn J Yes > No og /D
Use othe'side for acditional information. D _ _ 1
Dale Insepctors S:g lure Cert. No.
SBD-0710:R. 1:97;
aoir -a yG
_ ~r I} Safety and Buildings Division Nt Croix
~ $ 1 'Q01 VV. Washington live., P.O. Box 7162 1 tm'.m Permit Numhei f n i , I,I I
rS pUfa 1 t 201 Madison, WI 53707-7162
Sanitary_ Permit Application vt 1r1lw.Iaion VIII(
In I I Tarn wit 1 SI 1 O ii NV I, i ("'j,
.nMmssl n t .'us Ilrml I'I n- appn pit In I wrrnmen[al unit
t
~ h ten no"; Dear a Ina n: ,not tv tuni: V 1pph~ I I n It,tit, f ,,r IJis ,titled I'(NV I1 are xuhmiti:d m
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rnlcci Addns<pfdlhcrcnl nrmmnlin;yniJ
l M Cal 1 tni n: I sI ntal Sini Tenon tl ali aoa You pmeide may be usca rise +ndan tianle w e~ V,~ ~n.
.~a1L IN,-, 1119 Gtltl llr♦wll.. (I0. rnl claw'.e IcI S?1b. r111 Stan _ Jvr lIJ1 K
L_ 1Lphudion Information Please Print 111 Information l
}'~np;n•. u.atrr'> Name Piro l0 -
Jail V` 'I hcrcx ! lase- _ (1-10-1259-90-000 I'll p.t curt ncr e x alit ad J: ess - p -__nc [ I ~pv« Y Lr almn . ag. 9.1386
i
389 Dcel Valle Dr. (t sl I of
( t" N.e.. /I nods I'ho Nnmber NE. NE
i
Iiad:on. 14'I ~ 54016 (651) 270-3158 28 N. R_19 11. 1\ pe of Building (check all that apply) Lat - '
I..n Futmk 1;u61i1,, 'cunthcral Bcdmorn 09 Sobdtvim-n Now
~7 Block a
)c P J Cl(_S MR-C\~_ Plitt of Deer Vallrs
i'u h;!C{ :¢Itlllert'lAI I lt...<'!he t >e I Na
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I I City' Of
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v, r uv. ncd I>.xnbc U;r lV: Nuuthcr _ E V illagc of
J~~ i/ V l ,4 jl, r 41 (9 l nxn r,l _Troy
_
III.
I\ pc of Permit: (Ch('ck onl\ one hov od line A (.Ri letc lion. R if appllc nble1
Il\1 Nt,Icnt _r®kcplacentenl Svmcni I remittent' I loldln, , an: ReplaccineiiL Oldp I -I OUIm Mtahbeallnn l! Iv -,II : u
It. 1 Tamil Rutetval 1 Pet Inn Revi>ian Chancerl f'Iwnbcr 1_i1410oys~~il Numhc
III permn'IYansler to Nctt 55'//~+
,;.Irre I vl a tlw I Owns
h issued
Ijjjjb````lylu of Pp\\'iS is stem/ComponenLDvvim: 1(-heck all that apply) - 1 ~C ~ /rL jl~~~J-,
1 ,clic J In rimlm.l I I I russuw,J In 6roonet l M (bade Mound . l In. ofwmlAlc aol mound 21 In. of m:.UI (f I! q(1(~7-
h« I f I Wk 1 I lhv Ili p naI Compt nun Iuplun; _ L~ Pit trslir ur. Dcv v Icsplaini -
l
Dupe vl Tn «nunt Area Information: II IMihralor Quick I Sl nrI I J 1111.11 ih:unhars $ ° pair urJ Ira qq
I.'c I n I t t I_pd I Il wo Soil 1pl li.auon R ttL%Ndsfl Dispenai 1r t pnnvl sl; Ui tlvwd Area I r pnecd i f) s)xtern f ley' I il U
('00 .0 (ip(Il- 0r (ipit Sq. F/ 8s 1 sq fl 890,40 sqON,
JIA
\ 1. )elk Info T Capacm in i11.!I Manufacturer '(U[,
GalRln Gnllou. UniL tw
New ImIL.
. Uv op I,n>. lei
_ a Well,.,rt 1,250 1,_250 1 Wieser Concrete 11 Rc%ponsihrhty Stalement- 1, the u Irrsigr rd, assme responsibilin for jaeudlation of the 1.O\\ I S shown on
Ills attached plane "•S (;,t
I lamb Iw nw I I nt.4 ! Plumbcr'y Signanu MP:MI RS Nunlbci R tI . '•i.:mlrj TIJ
tamt k IhOnI Sun ~~->,JS---- A41IRti1(1021 l l5 )=1x 12C
plrnlh; saJlr+ v•cU.I :q. SCaceJip Codc} f~ 2CtOW~-
d0 P;mlaon I ;Ikc Lune. i )weola. W1 `4020 l
\'111.tlruuty:Uepnepnenl Ilse. Only - i
Pormn Fee Date ssucd I sumr
cn4Sivnalu
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I f i e J r ~
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t ti rldvlnlza,onfbl Denial
I\. r ;,editions of Approvdal+Reasons for DisapprSM TEM OWNER: r I - - -
1. Septic tank, effluent filter and
disperse) cell must be sernce0 i malnle,ned
as pcr maragerient plan prcvidec ty plumbur
2 Al setback rpr Iorements most tw melrtalnu'J
- klu,h In complrm plow for ",won amt 1'1 ..al ly the he C Iloilo, indite@8
anhnlil to ) nni) .,n paprr non Its. than a 1:2, It inch" in site
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389,rkcr,:~: .
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and~82.3op~o),2. ~
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Conventional POWTS Index & Titlc Shcct
elect Name. I lane, 4 bedroom Repl ConvenlionaI Dispersal CclI
ttuncrs Name: Jell & Therese I lane,
Ur+ncr's address. -;89 Dccr Valle, Dr., Hudson. 141 5,1016
Site addresz: Sallie
P ojc:l location:
~ubdiv ision: lot 09, Plat ol'Deer ValleN
Leal Description: NF1ri NL!a, Sec. 18, 1.28N_. R. I9W., Tn. of I im SL Cruix Co., AVI.
Parcel ID 040-1259-90-000
Page I Index and I itle Shect
Page 2 Site Plan
Page I Dispersal Cell Sizing Caleulalions
Page 4 Dispersal Cell Class Section
Page 5 Infiltrator "04•" Chamber Specifications
Page 0 PolyLok P1,525 Lillucnl Filter Cross Section
Page 7 System Management Plan
Page 8 Septic. Tank Maintenance Agreement
Page 9 Certification for Utilisation or Lxisling Septic lank
pace 10 Parcel Map
Page I I \A, arr<anty Decd
Attached: Soil Evaluation Report
%Ijwl P unbcr Reslritaed Service James K: -Thompson, DSPS Credential r X0021
Si;,na[ure: dry . f 7 / 5 Date: Le CL j 261
Page I i I I' I
I lciicn pursuant w In-❑namd Sod Ah.orpGun Componnl Manual liv POW 1l , 9 SllD-l0705-P (11 W !
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Proposed d;rcrs;a„
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az
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Hanev 4 Kedroom Dispersal Cell Sizim-, Calculations
1. (4bedrooms)(100 gallons estimated Ilow )(1.5 de,iim tactor) - 60090 ( ipd design flow
2. Intiltrativr capacity ofnative sail - 0.7
fit.
Absorption area required: 857.15 sg._Ii.
1. Absorption area as proposed: 890:10 sq..ft. (44 chamber, - 2 pair end captii
Infiltrator, Quick 30.00sq.ft.HSAper chamber,Inlilnw,.t }sir 4"'endcaps 520sq.N,HSA~pair
85',.15 sq. IL (2 pairendcaps)(5.20i 846.? q. It
816.75 sq. 11.x20.00 -42.14 chambers required
\umbcr oftreachcs: - o---'2 chambers ter trench chambers total)
french width: _R" 4'1
I Tench Icn,'Ih: 91.00'
french spacing: _ 9,00' on center
Total system area w6* trench spacing: I2.00's 91.00'
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Quick4 Plus All-In-One Periscope INFILTRATOR WATER TECHNOLOGIES. LLC I-INFILTRATOR "I
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Pl►XL~~gAC Inc
mrortrco,;"a,.,:, zatxr. PL-525 Lfflucr.t I
d /i u:rn'.rtc Vmou:f•. 4 ]m- =al~I<k Iv_
PL-525 Filter
The PI I titer is rated for 10,1000 GI'i) (gaIA,ns in,r ;1,1%' ) nmk: nt; i; one .1; th% larl;est filters in it, fa ss _ I:
5251ine5r foot of I% It-" filtration slots. I_iko Ihr Polvlok 1'1; 122• the Pol•rlok 1'1_-525 has an automatic shut-olf boll
installed with even• filter. When the filter is renurved tor cleaning. III,, hall will heat up and temporarily shill c-H
the svstcm so the ettluent won't leave the tank.
Ieatun•s: lrlb" Filtration Slots
:T.m n:>v: is
• Rated Inr 1 U.ODU GI'D (gallons per day} Inpl;nnall
,25 linear feet of 1 /1G" hItTatinn. 110,000 GPll
• Accepts I" and b" SCllD 40 I,ipe. I enr:,nu•o
• Built in gas detlcclor_ l
• Automatic chul off hall when filter is removed.
• Alarm acce•csibiliIv w
HIMOO • Accepts PVC ettension handle
Pl -525 Installation:
Ideal Inr rt-sidenllal and commercial waste Ilows up to gallons per day IGPD). _ Ltr,LLien'-Li.
I Locate the outlet of the septic lank
2. Remove the tank cote and Pump tank if nr ressatv E:
3. Clue the filter housing to lhr 4` er 6` outlet pier If ;CI lu a p:p. .
the filter is not centered under Ihr atceSS oFcrun;; use a
Polvlok Extend Sr I ok or piece lit pipe to renter filter.
4. Insert the PI -525 filler into its housing.
5. Replace and secure the septic tank cover. ® Certified to
. ~ NSF(ANSI Standard 46
P1.-525 liainlenance:
The. Pt.-525 F.lflueni Filters will operate ellirienlly for
several vears under normal conditions hr fore requiring ,,.:,t");•1, .
leaning. It is recommended that the filter be cleaned
every time III(, will, is pumped, or at least !,very three
years If the installed filter contains an optional alarm, r
the owner will lie nof it led by an alarm when the filter
Ga
ncr•ds s[_nrii in1;- rcicing shutrld be dont, b_y a c,-rf ifira
Septic tank pumper or installer. Xwom.rn
Shot-Oil L Ill
1 Locate the outlet of the septic lank
2. Remove tank cover and pump lards if necessary-
3. Do not list- plumbing when filter is removed. .
4. Pull PI: S2rr cartridge out of the housing. _
S I lose off filter over the septir lank Make sure all
solids tall hack into septic tank_
it. Insert the filter carindge back into the housinr• making
it 11 :rc6 III \InI I It f♦heir: :El
sure the filter is pmlxrly aligned and completelc inserl,'rl ,,d, i d.-I r. I ,t i;ln•r, accope lady ;ncw,ij t.
Replace and scatreseptie tank cover. ❑r,'Lm.,rll5le•::~"+,v h:h.u.J alarm. innu•ci,Lnp, tar..+
Pohlok, Inc ?Fairfield Blvd. Wallinlaord, CI (1014: -ILd1 Pr.c Fos: 03. 'R- 1= pol_ I~ ,.nn
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Conventional Septic System Management Plan
Pursuanl ui "PS I. 11'i>. ;1J111. lour
General
the comcllnou:d septic syacni shall be operated in accordance isith SP`, 18-'-+84 Wis. Adm. Code, and shall he I.rai:LUnl, It
hl accordance with conlponen manual SBD-10705-11 I N.01 011. All local and or state rules pertainmc to rystem
risiritenance and Maintenance reporting shall be complied vy ith. Ouestionc on the operation or maintenance of the s% -icn,
should he directed to the installing plumber, Jinn I hompson at 1715) 248 770' or the St. Croix County 7ouinr Ucp.,r i r
1 ? I I '86-4680.
Septic Tank
~gttic tank servicintt mechanics complc with SPS 181.5-1(1 )tel. Septic hulk to be located is Olin 150' of service pad.
',.:ram oflank to be - 15' below service pad elevation. I tie operatine condition of lire septic lank and outlcl litter shat: br
:cssed at lead once every I%vo years by inSpectinn. I he septic I;Mk euntenls shall be removed when the stud,c and scum in
:hc tank exceed 1!; the liquid volume of the lank. The contents of the septic tank shall he disposed of in accordanec i. ill \R
I i.t. Wis. Adm. Code, by an individual certified to service srptie tanks under i 28 1.18, Stals. If the contents of the t,Lnk ac
not removed at the time ofa biannual assessment, maintenance personnel hall ady ise die owner of whet service will he
needed to maintain Icss than I S scum and slucirc acct nndation in the tank. -I he outlet fitter shall be cleaned as necessary to
c:nurc proper operation. I he filter cartridge should not be removed unless provisions are made to retain solids in the lank
that may slou,h off ilic fitter when rentoved from ils enclosure. If the fitter is equipped with all alarm, the fitter shall be
,oI y iced if the alarm is activated. Septic tank manholes risen. access ri>ers, and covers should be inspected for water
1111:less and soundness. Access openings used for service and assessment shall he scaled waleltitght upon the completion of
Service Amy opening deemed unsound, detective. or subject to failure must he replaced. Exposed access openings ,_ron7 cr
Ihan 9 inches in diameter shall be secured bean effective lockbtg device to pickenl -itdd<ninl m mmi niorved :miry mu, I
4i individual should ever enter the septic tank as damoums Yascs mac he present than could cause death. Septic lan6
abandonment Shall be in accordance with Conun8 .11 Wis. Adm. Critic when the lank is no Inn:r_er used as a POWTS
component. I he addition ofbiotogical or chemical additives to enhance septic tank performance is twilerath not rc,;ui~ed. If
.rich ploducts arc used Ihey shall be approved for septic lank list, by the Department of Commerce, Safety arid Buildiri-,
Division.
Soil Absorption Cell
frees or Shrubs should not be planted directly on the soil absorption system. I he area above and around the system ~h: t.lr
be seeded and mulched as necessary to prevent erosion and provide sonic de: tee of frost protection. Traffic (other i tat i,,r
ve'etatiye maintenance) over the system is to tic avoided. Soil companion may hinder aeration of the infiltrative %k:i flrt
within and above the system and uvilt promote frost penetration luring cold wcalhcr months. Cold weather installation;
(October-March) dictate that the system he heavily mmdchcd li,r not protection.
Influent quality into the system may not eccccd ?20niv L BOD5. 1501 MG `I I'SS, and 330 in,, 1. FOG. Influent flow m:~k lot
exceed maxinnun desi_n Ilosv specified in the pewit for the installation.
Observation pipes within the dispersal cell shall be checked for eltluenl pondin.. Ponding levels shall be reported to the
owner. Levels above-1 inches indicate an impending hydraulic failure requiring additional, more Itequent monilorins.
Effluent Ilow shall be alternated between dispersal cells on a two-year schedule by use of diversion vahc. I fllur:u to
be divcried from new cell to old drainfield it .1 year annivcrsan of new system installation. Old drainfiehl b be anti/ d f it a
scar period- F-liloent dispersal to be alternated bel%wvn sy.telus on It Mo year rotating basis thereafter.
Contingency Plan
It the septic tank or any of its components become def cliye the tank or component shall he repaired or replaced to k p Iv
Systcm in proper operating condition. Excessive ponding within (tie dispersal cell will be eliminated by installing a ucw ,it
absorption cell to bring the system into proper operatin, condition.
S'f. CROIS COLT" FY
SEPTW-1 ANK MAIN'I f.NAN( F AGRI:1 ),11iN I
r\ND
O WNERSI TIP CER'FIFICATiON FORM
t ltvncr'Rnver Jeff & Therese Haney
\'Iailin-Address 389 Deer Valley Dr., Hudson, WI 54016
Ploperty Address Same
Wcrificatnon r yuired from Planning & oning Department f,t new construction-)
City State Parcel Identification Number 040-1259-90-000
LEGAL DESCRIPTION
Property Location NW NE Sec. 18 ,1"29 N R 19 W, T,,\,'n of Troy- -
,Subdivision Plat: Deer Valley ~j
- - Lot
Certified Survey Map # - - Volume Page
Warranri, Deed At 767182
- (before 2007)Volumc 2604 Page 4 562
Spec house Oyes Cato Lot liresddentifiable DycsOno
SYN'fEM MAINTENANCE AND OWNER CERTIFICATION
Improper ase and maintenance of your septic system ci rind result in :ts prernature failure to handle wastes. Prooor
maintenance consists of pumping out the septic tank every three years or sooner, if ncrdnl, by a licensed pumper What) ri 1 ir)•r.
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities arc specified in §SPS. 383.5211) and in Chapter 12 - St. Croix Comity Sanitary Ordinance.
The property owner agrees to submit to St. Croix County Planning & /emir., Department a eertifcatiou form, sieo_, !1w
owner and by a master plurrnher,joumeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-cite
wastewater disposal system is in proper operating condition and,'ar (2) alter inspection and pumping (if necessary), roe srlni: rk is
less than Ni till of sludg-c.
Uwe, the undersigned havr read the above rerluirumcnls and agree to maintain the private sewage disposal system wfcr tt:<;
stdndard.s set forth, herein, as set by the Department of Safety And Professional Services ar:d Cane Department of Natural R"wrecs.
State of Wisconsin. Certification stating that your septic system has peer maintained must be completed and retumed to the 4. Croix
County planning & Zoning Department within 30 (lays of the three year expiration date.
Uwc certify that all statements on this form are t4tu the best of myrnur knowledge. Uwc amiarc the owner(s) of err
properly described above, by valor.of a,warranty tl" r"rdcd set Regisirr of r)ccds Uf7ice-
r 1
Number of bcdroomc 4 f i
--'T-
7 20 18
iN,AT :RE O PPLICANT(C) - DA 1 L
"'Any information that is misrepresented may result in the unitary permit beme revoked by the Plarn mig & Zoning Dcr,ani,
Include with this applieation a rr::ordcd warranty decd from :he Regastrr of I)ceds Office and a copy of the certified sun, m
reference is made in the warranty decd.
(REV. 04/12)
Ps, 8a{ir
ST. CROIX COUNTY ZONING OFFICE
CERTIFICATION STATEMENT
FOR UTILIZATION OF EXISTING SEPTIC" TANK(S)
This is to certify that I have inspected the existing septic an&or dose tank
presently serving, the following residence:
(.Street address) 389 Deer Valley Or, Hudson WI 54016 located
at: NW Nl d, Section 88 To w1128 N, Range 19 W..
Town of Troy St. Croix County Wisconsin.
Upon inspection, I certify that I have found the tank(s), to the best of my
knowledge, will conform to the requirenlents 01'SPS. 384?5, and it (they)
appear(s) to be functioning properly.
Most recent date of inspection or service July 3 2018
Did flow back occur front absorption system? Yes No X
(if'no, skip next line.)
Approximate volume or length of time: Na oallonS Na minutes
Tank Capacity: 1,250 gallon
C'onsuuction: Prefab Concrete x Steel Other
MatlllfaclUrer(lf known): Wieser Concrete
,Ai,e-of Tailk (1 f' k nown 14 years installed 10119!2004
Permit 1 umber (if kno f-453428 -
James K. Thompson
iccnscd Plumber Signature) (Print Name)
MI'F25 MPnS 830021
('title) (License Number) MP/M. PRS
July 18, 2018
(Date)
Form to he completed by licensed plumber (Dept of Safety and Professional
Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer
(Nlt 113 Wisconsin Administrative Code)
Rev. 3;'2012
I
DT 14 i LOT 13 LOT 12
I
1 \
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1
18,02"W 1324.32 i NoRI urlr of TI+E NEl/a
cress' 386.37
q~ 11 _
12 ba.
;1\ 2.71: A~:RES
?4 ACRES Al 118,098 SC. FT.
X38 Srd. 11. All i
~b
1 63~
1 828 36 W
1 / G
1 /
i ,
y i ~o
c1 al 10
2.799 ACRES
121,9?9 SQ. -T
s.~
1 ;
I
N89'14'49"'N b83.41'
f 6~' I 2 ~,ha ACRES r
IP8,939 SO
/ A -
I n H o hl ~ '
O; Oi Y J 1 _
I
i W ~ s I -
o y N89'26'42"W 622.89' F
o l
i L Li o p 1J
I2 Z 140'
.I J.4 71 ACRES r.
I j . . 1b1,16S SU. r T. Ci _I
I Q I EXCLUDING ROAD EASEMENT
?.989 ACRES
63_,,.~ 138,185, SR.. ? :.................1193 C32
X0.4._.-r:
C29 Z6,5 66' ROAD EASEMENT T❑ TOWN
:'vr- _MT71'
wsannsin 0e.panrrem of camnetim PRIVATE SEWAGE SYSTEM (,rurrr St. Croix
Safety and Bo lying Drv,s on ,
INSPECTION REPORT San,byPermit No 453428 0
GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No
Pefwnol intom-aton yuu Fravde nay De _sed fa se "ary purposes IPnvacy Law. ,.1504 ;I Ywn l
Penult Hovers Name. CCy Village X Tcwnship Pw- T0. No.
Haney, Jeffrey S. Troy Township 040-1259-90-000
CST 8M Elev. mso SM Elev. SM Desropton Ses.'mnia WRange li No.
/ C1c~. 5 T !~M f4- 18.28.19.1388
TANK INFORMATION ELEVATION DATA
TYPE IVANOFACTURER CAPACITY STATION BS HI FS ELEV.
Septic Herchmark
! yam-.. )Z\U ly !L 11&4 17 11
Dosing Alt. BM
i- S 1 C ✓ a
Aeration Blog. Sewer rr~~
Holding - SUHt Inlet
c-~ -7 131 loe-5-7
TANK SETBACK INFORMATION ISM It Outlet 7 ; /aG .So
TANK TO PIL WELL BLDG. Vent to Air Intake ROAD IN Inlet
Septic DI Bottom
Dosing - Header/Man f 15 11 w Fj
1 ( oo-
Aeration Disl. Pipe
Holding Bot System w I L4 - -4 2. 9 `1. 7 O
' W.4 9j II
Final Grade \
PUMP/S HON INFORMATION
Manufacturer Demand St Cover
GPM rt l ~1 s : <T_< U 37i G.3. 113.79
Model Number
TDH rriclion Loss System Head TDH FI
Force air Length jDia. 1st tcwer j
SOIL ABSORPTION SYSTEM
DEDITRENCII AI'2. , lnngtt Va Qf Trenr:he5 PITDIMENSIONS No ef=ils 1115,00 Uia. L.x ed Depth
DIMENS104S 'J 1 • /1
SETBACK SYSTEM t0 P;L BLDG/ (WELL LAKEtSTREAM LEACHING Ma ni.... r
INFORMATION CHAMBER OR
Tvx OI Syseui UNIT Model Number
C_'vn v2n~,rJ1`1 v0.] ~YGri N ~ G Z (-luw
DISTRIBUTION SYSTEM
1Heudur:L' QA D seibuticr +.ICk~ S>n Tn 11,10 SpacinG `,'ont IC An Intake
Pipe(51
Lergfr__ Uie rt ~ Length Oia Spacing_
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over G s 4. uepln Guar a Deplrt of aw S"Jed:Sodded ax 1i Beo,7w,c1; Ccn[er Bres'Tronch Edges Topsoil
Yes _J No Yes No
COMMENTS: pnGUde code disrrepences. persons present, etc.) Inspection ii ib t Ki Inspection 02:- _
kw 1
Location: 389 Dee, Valley, Drive f'.uddii.m, WI 54016 (NE 1:4 NF 114 18 T28N R19VJ) Deer Valley lot 9 Parcel INo: 18.28.'3.1388
1.) Alt 841 Description= ST Ct✓:./ r''/~ir t✓f3~ 64 r.„~S
2.) Bldg sewor length = y /o r e' `~1 s \'s'~`~ •Y U
- amount of rover = ) I t v~
Plan revision Required? ! Yes No
Ilse olhe, side for additional infornlah n
Dale Ir-cclVz- sni-0 Cen No
SBObR }V7(
NOT -"la
~ane~/ NE-~~y ASE `ly s~3 Tagu R~9w
(v teat 0 tv~a-,./ Ua~SrY Lo7 19
Ps' S0.e UL S3-5-79 --rroy s Cf o~C
A oyo-la59 -90-000
~ er^
aaos.S 7
a\ Top ~A CPic ~;Ps G, F` loo
4J' r X
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C;.oo
oft dDopme"Mor~ """m SOIL EVALUATION REPORT
~dc~Y11~~~~4~r wr ww~ a tax 11 biMwMM, raw"m o.w" 57 C,o y
~~rRIWl~..l~wew~r+awo~+nlai.rr~r Ap
~W+L.~.L.nw..arrwar G O ~9. - a
rwl "i kiftom ok,i rr o.r
Pftmq;L~ & was (love
S r41r F:-: VI M i T M w r
r a l..
A A~-M Cl ~SL
t ^ cmr131410
~
ta" ~Q
IY~r4r~1 Mi//NrW~H1i~ ONNi~ d~ CO Or'O
~mewxftr- gw~IwM~w~wLilw L
Gomm
o-v-, b 3- 9 9 - F
w o.wr..ro.+. 103, a avr.e+.r w
a.W.L momma m"m Trr. arr.. w~u.
nn.a ac a.e 'w Mist
OLftwL
~ ~a'`~ s o5 rn 7 ,8
a.~i arra
ElU A aa.r...e.w. L
o.~wwar~arr
ISMS
R Wr Otii OWL6y~ .u.ML
'
~tM. .@<s WOOLS" Tai+n<aa SOIL @. <A wrTai<L
COW
cwmmaw
=!"M:Ze Lv__=_
c S f cv y- 7-ao oy 7is X96 q
0 P* a it
a~-• ° ~ _
t fammm Q~ Got oft Or. Y. fig
F] - - -
° tiaw...n..... IL Depaoandb9 aram.
Irw OM oara•1 IYr.a..M. Yuan sr.m owwm~ a ms" tf"s
6L r..r QL at OWL Cow Q. Sa. s 711f '!t.
it OMrr~~err__ I.
1Yr. OM ONOM*Cdw toast". Toom Odra tiro
" ffyr Qi 0tc CM&06tr Q.!!k
•l3Vr~It.6CA~>305f~wiyl "0786 *f0_1BD aipl '~wtR.BOD>=]Oiryl ad 7~8~lD myl
71a Dawa mW dOwraos Y w 9"r1 °ON~ 7 nt.ioa ~tediar ad 1r. If rea grad asaiaoroe M aaM/[MFtNM Of
MM NNW" in r @ban% fr6rr On" coma at 60&a -3151 w M 606&4H4fl7.
~a~wfr
~1 e'W rte,! S. a~.uy i~ NV YY WF'fq Sig TaFS-~.t ipQ~ ~4 u~
W l~ f al G~vs Fv'.ow J 4 , ocx -,Q Lot' tF 1
c:, ~.,e. ~c SctC~~ 1x.1 53s7$' r~ S C ro ;)C
P fB P / "~GL ~dd.3 Vice@} ~ o'40-1a.ST-96
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Wisconsin Department of Industry. SOIL AND SITE EVALUATION REPORT Page 1 of _3
LAhor and Human Relations
Division of Safety a Buildings in accord with ILHR 83.05, Wis. Adm. Code
CCJNTY
Attach complete site plan on paper not less than 8 112 x 11 inches in size. Plan must include, but St. Croix _
not limited to vertical and horizontal reference point ( id lBLlwri ark}S; of slope, scale or oARCEL 1 C. M
dimensioned, north arrow, and location and distan iglvei%rasfroad . 040-1070-10
APPLICANT INFORMATION-PLEASE P NULL I O10IIATION R°VIEWEOBY DATE
PROPERTY OWNER: PROPERTY LOCATION
Derrick ConStructio~n Inc.( z_ GOVT. LOT NE 14 NE1 G,S 18? 28 N,R 19 5a0r)W
PROPERTYOWNER'SMAiLNGACORESS t,.~ 9 LCTjt BLOCKI SUBDNAME ORCSMx
i505_Hxy_. #65 _ ^ k 9 i na er Valle
CITv, STATE 21P CCDE \,,t-'~ N8 t ITY nVI.IAGE f2t0VIN NEAREST ROAD
New Richmond, N'I• 54017 1,'1.246-2310 Troy E. Cove Rd.
JA New Construction Use bc1 Residential; NunbePOlbPd[OQ11is AddJon to existing building
I I Repracement I I Public or oomme'cial describe_
Code dewed dairy flow 600 gpd Recommended design loading rate _ 7__ned, gpdn'2_y8_lrench, gpd'jt2
Absorption area required 858 bed. 112 750 _ trench, Y2 Maximum design loading rate meted, gpdit2_J_~_jrench, gpd+ft2
Recommended infiltration surface elevation(s) area A= 99.7-t3 _9Q, ?Q_111 (as referred to site plan benchmark)
Additional design ! site considerations nor
Parent material _ outwash - Flood plain elevation, if applicab a na _ fl
S = Suitable for system CoN•dt3,TIONA: NOL1C 'V GROJVO FaCS$Un[ AI-:TRACE SYSIEM 14 F!LL HOLDING TANX
U. Unsuitable for s stem ®S ❑ U (X1 S❑ U WS U U us U U WS ❑ U ❑ S IR V
SOIL DESCRIPTION REPORT
BoringaY Horizon. Depth Dominant Color Mottles Texture Structure ConSStesce Boundary Roots, GPDift
tn. Munsell Qu. Sz. Cont. Colcr Gr. Sz. Sh, ! Bed ..Trends
lA __1 - l0yr_9L3none sl 2msbK mfr_ cs 2f I .5 6
~oS OSg -
2 7_41 7.5yr 4/6 none 9w
Ground
3 41-84 7.5yr 4/6 i none ms osgmvf
elev.
103.x.
Depth to
limiting
factor Q4.7 _
+84" - ~~r - -
4S. ~/B!. ~ I
Remarks: -
I
Boring If
1 0-13 10 r 9 3 none- sl 2csbk _ mfr gw 2f__ .5-..6
2 2 13-84 7 _5yr 4/4 none cos j osml nor nor 7 i .8
Ground -
elev.
I
103.7-u. - - Depthto limiting
factor -
+84"
Remarks:
CST Namc:--Please Print Gary L. Steel Plume: 715-246-6200
Address: [554 200th New 'c ond, WI 54017
Signature Date' 6-3-99 CST Number: rn02298
1
PROPERTVOWNER Derrick Construction SOIL DESCRIPTION REPORT Page 2 of _3_
PARCELI.D.0 040-1070-10
Depth Dominant Color Mottles Texture Structure C GP
Boring # Horizon D!ft
onsistence ean~ Roots.--
in. Mcnseli Ou. Sz. Cont. Color Gr. Sz. Sh. -Bed TrertCr
3 1~0 8 _10 r 4Z3 none 1 2msbk mfr cs 2f 5
i I I
2 8-18-,..10yr 4/9 -
- --_nQne sl csbk_ _.mfL-: w IF -4 -E;
Ground 3 18-84 7.5yr 4/6 _ none cos os ml na na .7 .8
elev -
102.2h, -
Depth to 9 z o
[actor
84„
I
Remarks
Boring # I
1-- 0-9 _10yr 3/3 j none 1 2msbk _ rnfr cs 2f .5 .6-_
4 2 9-19 10yr 4/4 none sl lcs_b_k _ mfr gw _lf _.4 .5
3 19-84 7.5yr 4/6- none ms os ml na na .7
Ground ' - - 8
elev
Depth to -
limiting ~o Cl ?
factor - - - -
+841.
Remarks:.__ - -
Boring # - -
1 0-10 lOyr 3/3 none _ 1 2msbk mfr cs 2f .5 .6
5 -
JD-21 10yr 4/4 none- siJi. .2msbk- r- 4w ~5_--
Ground 2J-84 one JUS Qggna na_ _.7 .8 -7.5yr 4/6 elev.
100.6
ft. - - - -
Depth to
limiting
lector
+841,
Remarks-
Boring #
Ground
elev.
it.
Depth to
-
limiting
facto --~-T-- - - -
Remarks:
SBO-e330(R.05,'921
STEEL'S SOIL SERVICE
Gary L. Steel Derrick Construction, Inc. 1554 200th Ave.
CSTM2298 NF'INE', S18-T28N-R19w New Richmond, WI 54017
MPRSW-3254 town of Troy (715) 246-6200
lot #9-Deer Valley
This soil evaluation was conducted to satisfy a zoning requirement, it may or may
not be suitable for your use. The location of the test may or may not be as shown
as permanent lot lines were not established at the time the test was conducted.
"=40'
= top of 1" pvc pipe ~P el. 100.001
it. RM= top of 1" pvc pipe 'Zz el. 100.30'
1
5-5
i
6 • i-
5, e,
Gary L. Steel
6-3-99
i