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HomeMy WebLinkAbout040-1253-20-000 .discs^sr Dcarcrienl of commeme PRIVATE SEWAGE SYSTEM uouny St. Croix Satiety and Building Drnsgn INSPECTION REPORT ;a^AaR Perme No 606963 GENERAL INFORMATION IATTACH TC PERMIT`, Plan IC Nn Personal aor,v riv you orov,dc Ir'av tic a:ma tats sclc'ear, pu¢ny-s I °r,,r r I nw 5 1` G 1 jlrr'i Perms Ho fore\"rn: Cny "Alape -c,-hr -rcc Tar. I,: Robert 8, Judith Tellander TOWN OF TROY 040-1253-20-000 HM Elrv 1 Ins-. BM Else: 6N Je,:n,pb"n >cclic;vi,nmdY,anyar/dap No 00 -t-. e1 Wo ak i~ 19.28.19.1333 TANK INFORMATION ELEVATIO14 DATA I YPL NIANUFAC IURER. CAPACI Ty SIA-ION EtS HI FS FI F4 Septic l~ ~C UenObmark Fk Ua _ML L: 4.1o Ia f0o.eo Dosing AII.Lit! •s:l n ~rJ ~,~,q 11.4 8 S f 4 Wk 760 T III . it Rldc seine 11o~ IoK u.~ Y sly -,nldlnq SUHI Intel SY Y SUM Outlet TANK SETBACK INFORMATION 9 ( 4.0 TANK 'U P^L VOT S_DG 'o-Ilo.All intake WAD O: Intel Svphr. DI Rollum llf/ fb.lab Dosing I "DI I i 1 Owl / Header:!Aan .0~ q,5..3 Aeration DIM Pin( / yp.po7 45.2.3 Holding B:d SyT~~ O.I stoat Grade PUMP/SIPHON INFORMATION 5f 55 4~•~~ Mlan,Itacnnel remand St Cover Model Numner ,ft r, P - OLf 04J P. ins 7U 00.30 9 D TRH Idlnetii~ n Syslcr, head 11 Iti.gl ~d _o _ f9. _ _ Furccmaln ennth Jla ^ :Ir.l 1, 1e:c 1151 o;• M - SOIL ABSORPITIION SYSTEM I)IMFN Of PI, r: Ins, is .ilium ?c -In BEM'TRFNCII aN 1 coats P.a y Tmnrhi•e ^ PIT DI SIONS NO OIMFNSIGNS SETBACK SYSI_MI (O pt- D_DG t4,F11 LA USTRF-AM LEACHING MandacGrtcr CHAMBER OR ~ ~\u~ INFORMATION -YP•"-:">^.:'"n' , LJ UNIT Nod,- rJnrnue- l DISTRIBUTION SYSTEM 4- vat FeaCer.'lAanAoid Jlstlm,bOn -ule _r x HO< Sp"rang "nrl It, A - "take (7\ {inrti G/C~J .•nn'n -.i,a_ Ian~pn u,a Snw: SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only rn,l~rred 'rnm reptr :,,r s ,,d &,d. 1,r:.h..enler 1 bea:Tre^:h Ecpes Tn-.;oil Nc vs..: nNc COMMENTS: pnclude code dlscrepe Imes. persons present. etc: Inspection ti' Inspecton ui Location: ;144,y'I ANDRW.S DR lieu CovF'r C Grt x T. 1.: All RMt Gcsca,phon - 2: Erldg `.evmr Icoath - s - vn,ount of doves - -,;,ya ' ar n]v:5ion addo VE6 Nn other si!lc tot lul adl0onal mformalior, N:: f}N - J t r< Safety and Buildings Division ST CROIX 201 W- Washington Ave., P.O. Box 7162 Sanimry 1'rmri[ Nmnbcr fto he filled in b 2/ ^ I e Madison, WI 53707-7162 by Co,> Sanitary Permit Applle'atfeStec Transaction Number In accurdamc wnh 1PS3 ♦ 1!2, Ni,,, n . , (Mir, submwsion of dsis fmm to the apptopi ia(r govenn"Jal unn AVf4" required pose ua oM1[usm+ ,nna i+nut Nola Ap h,,,c., forms for .t:ue-ownai 1'Olvl'S arc submitted to I'r • at AJJrrss pfdi(&rrpl than rrwiling address) the Dcpanmrn of Gayety ,,d 1 f .i.m J ti ae c.. Pcncnal infinmapon you Provide may be aced for sccomkvey pwA lia wuh the Pn e1 I5 IIlml, SIaIS. I rf f ~ a~ys~~ -piranon information -Please prig, l nfor on - 11 +r /w~17(r/I CCti.LJ PmFrny 01 ncr Alit Marne ~ Yarecl a ROBERT AND JUDITH TELLANDER _ 040 1253-20-000 Pwpelty Own, > Aladmg ,\ddresx Pmiserty Location 1294 ST. ANDREWS PLACE (lty, State Govt. Lot _ 7rp('odc Yhanc Number HUDSON WI NE NW a, Section, ig _ _154016 (circle onc) II. Type of Building (cheek all that apply) a, sr.., T 28 N, R 'a _ E or a I of 2 Fmndy Dwrlltna NumMr of llcdronnsQ 82 Subdrv rsmn Name n TROY VILLAGE 2ND ADDITION her PubliuCmnmercml Ikscrihc Ise sir.... D City o1 SmtenOwncd - fkscnbc L'sc CSM N= C Village of +t 1•__O~ r' PI w r q ~L G/o )D loxn of TROY II I.'1 ype of Permit: (CChheck only o r box on lire A. Complete line B f applicable) A New System ❑ Rci,iwcmem System C Trealmrnt%F1olAmg I auk Rrplacarsent Only 13 Other Morlificalioo to Fxicting Svstrns (explain) R.. L. ❑ Prnnn Renewal ❑ Permit Rcvsion List Prcvrous Permit Numhn and Date Issued L Clmnge of Plumbe ❑ Pe mit Transfer to Nrw Before Fxpiranon I I I' Pci Owner W. Type of POWTS Sxs[em/Componc Dnvea• ~h ~Z F/ _ eck all That apply) S ENo.lPrcssmual ln.Giowvl~ f•icwuricd in Ground AF(iredc IJ Wand, 24 in. of sutable soil Mound <24 in of smtablc sod ❑ HoldinP Tank I- Other DnprnaTponcan (explain) _ ❑ Prcoratmeot Ih vier (explain) V. Dispersa_I?re ent Area lnformalioo: frUewp, Ilow (PJxi Design SoJ Apphcation Rate(grds0 Uispttsal Area RoquireJ isf~ 7 Dis sal A tcaRo 'cd + 600 .7 pc' { (sfl Svrtcm sop 857.14 900 19 . 9 V L Tank Into Ca -icy in Total g of - )1anufacturtt Gallon, (ialkms I l1nib \c» Tank. ? Fz.uing Tarts E-4 D rlnic rr uolmng t aril 1250 1250 ISER X I(lum.+cr 750 - 750 _ WIESER X VII. Respnnsibllilp Statement- 1, the undersigned, assume responsibilin for installation ofthe PON"fS shown on the attached pons. Plwnbrr's Narnr IYrinq Plumbs MP!MYRS Sambre I usmess Phone Number PAUL R KOEHLER L~ /lam 225410 7lszab Plumbn Address IStrect,('ity.Statc, 7ip(ode) 321 WISCONSIN DRIVE NEW RICHMOND WI 54017 VIII 'ounty DDeepartment Ilse only f _ appuoed ,]Pr irnnitQQFcc Datc sued Isswn grnt Si(matut rl into R_wsoi for Denial (~O I IX. (-ondt rayons fire Disapproval y _ -p1 J 1. Sept lark t n 1 3) 14.eQ tKe..~- r lae n,Meplnc tr y , L is p ayem plan I'll W plwnbe . 2' ftWk nruWIrIoe S mvul [.c r. a,rl, it c-! Y Pa I Mcc r"I 041 / lydiJar:af. Attach eo rnmplae plans br the gs[tm sad suhmir (o be Courty oWr on paper vot leis than 81+? s 11 Ioehn in sire SRD-6398 (R. 11 I I I /1 M \1 \ ~ ymj 1 \ l (L 1 \ I A i ~ n \ ' ~ 1 v v \v ~ m m m ~ Z~ _ r D \ Z ~p ft A H NI I O ~ ~ ~ I O N O ~ T N r C I I a T f m o p a O I \ I ~ V T = T \ I L. ~ m 2 \ I Z 00 \ \ I T ~ T 2 I > N Z D \ \ \ jc ~ ~ JC O I 2 p 2 \ GI Ll m\ m a A N m ~ D N ` D \ > \ I 3 C_ ~ ~ O C m 4,p \ Q o m rpi z v_ ~ = Z F,9 1 \\R I o m x ~ ~ A ~ ~ l f \ m N O d ~ y ~ \ N 7 A ~ 1~~ ~r {A I O T 9 ~ r O' m A~ ~ t W m N A y 'G !'1 ~ I m I ~I t- I~ I N 2 Z ~ ti ~ ~ ~ Im m ~ o x w Z ~ K I ~ 1 m 'o O_ C a j \ Oy ti 3 C { r I c m rr N ~ I I ~ y p I ~ I A ' m 1 CONVENTIONAL COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name, DERRICK i TELLANDER Owners Name ROBERT AND JUDITH TELLANDER Owner's Address: 294 ST ANDREWS PLAC'L' HUllSON WI 54016 Legal Description: NE 1;4 NW 1!4 SEC 19 T 28 NR 19W Township: TROY County: ST CROIX Subdivision Name: TROY VILLAGE 2ND ADDITION Lot Number: 82 Parcel ID Number 040-1253-20-000 Page 1 Index and title Page 2 Plot Plan Page 3 _ System Sizing & Cross-Section Page 4 _ Filter Specs Page 5 Maintenance Information Page 6 _ Management Plan Page 7 St. Croix Cty Septic Tank Maintenance Form Page 8 Warranty Deed Page 9 CSM or Plat Attachments: Soil Test & House Plans Designer/Plumber: PAUL R KOEHLER License Number: 225410 Date: 10,•'3012018 Phone Number (715) 246-2660 Signature Designed pursuant to the in-Ground Soil Absorption Component Manual for PowTS version 2.0 SBD-10705-P (N.01/01). Page 1 W W m F LL N Y OI Q O Z N W N ~ ~ Q O d O m 3 ~ o ~ 5 Zo 41 Z ~ d w z zz z } 3 Q Q > F C N Q N 'y N C T U W m ~ ¢ m m U ~ g rn ~ ~ z N O J c N O \ G > .F N \ 5 ° N W ~ ? N J 3 = ¢ w 00 O\\ b.~db ° z w LL i' ` w m ~O \ t~ Z O o 3 0 f `.z Q a 0° ri F rn x w l7 -1 Z ~ \ \ N J ` Q 09 ~ ~ O O w d 0 \ Z O ~ Z Y 3 3 x \ ~ N \ 3 z 3 \ W Z W ~ ~ O ^ d ` W w Of \ O m w ~ ` ` ti x Z N O ~ ~ O Q \ Q F J d .-1 N O \ m 0 LL LL ^ ti ~ O OW N p o ~ ~ d~ N W m O N O ~ \ m m ~ ~ .-1 S N Z Q1 C1 w \ \ \ l < T vVi co a m m m d N O `1 O\ O© V \ l \ m SOIL ABSORPTION SYSTEM DETAIL! GRAVELLESS LEACHING UNIT aage_or Project Name: ROBERT AND JUDITH TELLANDER 2 No. of Cells 9 Per Cell 3 ft Cell width 18 Total No of EZ1203f 90 a Cell Length 50 sq ft EISA Per Cell 3> it Cell Spacing 900 sq ft Total EISA Manufacturer Model Lai Length EISA Rat/ Inhftralor EZ12031-1-511 5.0' 25.0 EZ1203K10fl 10.0' 50.0 Gravel less Leaching Unit Manufacturer: EZFLOW Gravelless Leaching Unit Model: EZ1203H-10FT 7, 1 Typical Cross Section / r4-N1 4 Finished Grade ft Observation Pipe with / T o approved cap or vent in r~Soil Backfll • J . I a 1 / Geotextile Fabric ~fff Infiltrative Surface 413, / 12 ir I Q ~ _ ~~.1 i I Limiting Factor 60 3d in I - - lofted and Anchored Vent/ D Observation Pipe with Cap Plumber/DesignerSignature: License m 225410 Date: 10/30/2018 I r Z 2 - - J d r _ w i- -.:l w O S Z a a C'J Q W Q. Lu Oi_ dNQ c o a~acl: wa° J zo!6Z0~Z Ud of w Z f r - - = _O W J a: =3 co LIJ p O j - a "...t 4Lrg Lim r is W 1 J1 _ aJ w°a ~w U Z d 0 Q J < r O r J 00 w ~ T'.' V) r Q w aolr JUG y~ v \ O m LL 2 m 0 J LO m w N Q. CO E_ U Ln va N co U-.l w n ¢ J ~ Y VIVII{I(I11I ` ' LL >R-oWOUIR.:3T2 98 8-SZ~ -008 0bnod\ CSLb< 4N 'yapb N3CIYM Ol IJI,H $'1 9:LfM z -lsod 3cvn O. o0 oo -,76 N n lVf1NVW OI1d3S 8nod-3ad .o-.l=.. I :31tla5 dav. As wx o 313NOUDD 13131M 8h-09L/09ZVA \ p w w w w ~ J U H Q < z O coo u < W U V) W W VI a (n a° Q. yoyb~ m (n w a I m W Z O J vJ F Q J In Q w X0 a:0 < m _Q l7 > W o O Q d °m 0-M ZZ w O Kc Q z w O C F- 0 Z x r H O Q O N Ow <<° Q~ V) F ~Sj 3 LL o I n p N mN Www u< Z o. C) C) o~ ° Q o o G O O ~m QaON N z0 zN y a d LC) LL- ci L, 8 w x x p < co 0 ~ `vooo(na j 00 (oo ~NN~(nk' N,6 CO o - s < d L^LJ \h NtON• W41 p W<V Wzr N W U =z Y O LL N "WJ0 mzw- SP! o $$Q~ K U \a WN Zo 2ND pJ >Z(x7Z 00 5 ~aU1 OUN ON~ Q O m0. x0 W(=j JY N3 m°U~2J3:m 0 3 <YU ~ U Z <V)~ Z z F o 0 ~ W Q y K Y O W Q w O o z V) O z z Q O< ((JJJJ/ Q W N I Q I H < Wes-.. „tS ° ° z a wi ° o S i o\ \ L__ r I G z 1 ~ _ / III I w I I I N 5 I ---M1 N u I w l\~/ I 05 I I II o o v .et, I ..m I _ I I W v J I I 0 1 4 .9 s w / III I o ' - - W I ry t 4 z w 0038 < z' fs w ..98 sV „99 i Q POWTS OWNER'S MANUAL St MANAGEMENT PLAN Page I of Z FILE INFORMATION SYSTEM SPECIFICATIONS Owner ROBERT AND JUDITH TELLANDER Septic Tank Capacity 1250 al G NA 'ermit t Septic Tank Manufacture., WIESER G NA DESIGN PARAMETERS Effluent Filter Manufacturer POLY LOCK G NA Number of Bedrooms 4 G NA Effluent Fitter Model 525 G NA Number of Public Facility Units X NA Pump Tank Capacity 750 al C NA Estimated flow (average) 400 al/da Pump Tank Manufacturer WIESER O NA y Design flow (peakl. (Estimated x 1.5) 600 slide Pump Manufacturer GOULDS C NA Soil Application Rate al/da /ft' Pump Model EP04 G NA Standard Influent/Effluent Quality Monthly average' Pretreatment Unit C NA Fats, Oil & Grease (FOG) 530 mg/L G Sand!Gravel Filter C Peat Filter Biochemical Oxygen Demand (BODE) 5220 mg/L C NA C Mechanical Aeration C Wetland Total Suspended Solids (TSS) 5150 mg/L O Disinfection O Other: Protreated Effluent Quality Monthly average Dispersal Cal (s) C NA Biochemica: Oxygen Demand (BOD61 530 ni G In-Ground (gravity) 19 In-Ground (pressurized) Total Suspended Solids (TSS) S30 mg/L C NA n At-Grade C Mound Fecal Coliform Igoometric mean) S10' cfu/100m1 _ G Drip-Line G Other: Maximum Effluent Particle Size Ye in die. C NA Other D NA Other: Other: C NA C NA *Values typical for domestic wastewater and septic tank effluent. Other. C NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: 3 7 m Yeao (s) nthlsl (Maximum 3 years) C NA dI r Pump out contents of tank(s) When combined sludge and scum equals one-third (Ki of tank volume C NA Inspect dispersal cell(s) At least once every: 3 CL month(s) yearlsi (Maximum 3 years) G NA Clean effluent filter At least once every: f ~n on(s) - 0 NA Inspect pump, pump controls & alarm I At least once every: 3 D monthisi C NA ~year(s) Flush laterals and pressure test At least once every: D monthisi D yearls) Vl NA Otner D monthlsl At least once every: C year(s) NA Othen PQ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following liconses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Saptage Servicing Operator. Tank !nspections must include a visual inspection of the tank(s) to identify any missing or broken hardware. identify any cracks or leaks, moasure 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 loca! regulatory auurority. When the combined accumulation of sludge and scum in any tank equals one-third :Yl or more of the tank volurne, 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 fitters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 512 months, snall be performed by a certified PONS Maintainer. A service report shall be provided to the IDCa; regulatory authority within 10 days of completion of any service event. Page Z of 2 START UP AND OPERATION For new construction, prior tc use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal ce(lls). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above norma' highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cellls; in one large dose, overloading the call(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss: diapers; disinfectants; tat; foundation drain (sump pumpl water: fruit and vegetable peelings; gasoline; grease; herbicides; meet scraps; medications; oil; painting products; pesticides; san'rary 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. Baring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. p71 T , . /~IJt alua i . o rng tank b e al ?(1N4 5 rTSa i<p a5"577ZU~-Tt pnJ ❑ 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 effort 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.COM Name PAUL R KOEHLER Pnone 715-246-2660 Phone 715-246-2660 SEPTAGE SERVICING OPERATOR (PUMPER) LOCAL REGULATORY AUTHORITY Name _DARRE 4 PTIC Name ST. lf_t~z o AI 20N11 Phone Phone "I&PID This documam was dratted in compliance wrtn chapWi Comm 63.22(2)lb);11idAifl and 93.54111, (2) & (3), Wisconsin Administrative Code. Septic-Dose Tank Cross Section And Pump Performance Specifications Tank Manufacturer WEISER Pump Manufacturer GOULDS Tank Model Number 1250-750 Pum Model Number F.P04 Total Tank Capacity 2,000.00 Alarm Manufacturer SJ RHOMBUS Max' Bury Depth 8.00 Alarm Model Number PS PATROL 7 Type APPROVED TYPE Filter Manufacturer POLY LOCK TotaqDDynnammnii Head (TDA-Fee, Filter Model Numbe525 J Elevation H10 00 Distal Pressu0.00 Network Los.00 mp Pefoance ReqForce Main . 0 ^ Total Outlet Manhole Min. 4" Above Grade With Locking Device. Inlet Manhole Manhole Min. 4" Above Grade < 6" Below Grade Sealed Watertight Securely Mounted With Locking Device weather-proof Finished Grade Junction Box Depth of (Q Cover Vent Min. 12" Ft Above Grade Disconnect Means With Vent Cap l 6,53 . < . < < X / Outlet Filter Outlet Inlet Inlet Baffle 60 llb' Switch Settings and Reserve Capacity A y"I X Tank Volume = GP! I 3.3 Weep Dimension Inches Volume Gal. B Hole (reserve) A 25 420.00 (alarm) B 2 C 33.00 Off Elevation (dose) C g 145.08 _ Ft♦ (dead) D 12 193.44 Bottom Total 48 791.52 D Elevation GENERA., INSTALLAITON; The septic/dose tank is bedded and back filled in accordance with the manufacturer's product approval specifications. Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and outlet is of approved material, connected to the tank with watertight fittings, and laid on stable soil to prevent settling or sagging. The force main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.28 WAC. 02/05 LJ Page of • 4' I • . • Wastewater METERS FEET 10 - 9 30 I =4-5GPM 8 2.5 FT 25 O 2 1 - 5 15 Q 4 EPOS - 3 10 - - EP04 5 1 -L 0 00 - - 10 20 30 40 50 GPM 0 2 4 6 8 10 12 ms/h CAPACITY MODEL INFORMATION r Order -(Minimum T Float Minimum Ma rx mum'Shippingl LHP Volts Amps Circuit Phase Switch Cord Discharge Minimum Minimum Number Breaker Length Connection On Level Off Level Basin Solids Weight Style Diameter Size Ibs.kg r'')4' 1 l i c fJ vL_h _r jai iud Vrgl L I'U41'A f c.qt~ , hde AnylN 1t1' 1 ~ 1 6" 21 / 9.5 11.5 12 Al Fluff ~F F0411f ( ry45o Itch 2G Manual Manual 20/9.1 4 F:h:ItAC P199Yharki :;tide-Ang!e~ 120 El 6' 21/9.5-~ f -pelt f l"r. i NO S'wIcn IU' 14" Manual Marv.,al 20!9.1 230 G 0 FPO412F vlu gi No Swatch Manual P4anuar yr; CP~511F 2C' hlonual Maruei .lh 1 P U9 5 3 2U No S yybv:ack «h : r ?1%10 Epo me Pu,, 12' b'u'ide Angle 23.•' 10.4 -.e(OS 7F 230 1 65 lU Plug 2..,b'-nual P4anual - 27 - f~~ _f ~ No S ntcFF ST. CROIX COUNTY SUFIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CRR'1"IFICATION FOIUVI MricuBuyer-Robert W Tellander, Judith A Tellander Mailing Address 294 St. Andrews Place, Hudson, WI Property Address 294 St. Andrews Place (Verification required from plann:ng & Zoning Fie an en for new construction.) City;State Hudson, WI Parcel Identification Numbet040-1253-20-000 LFCAL DESCRIPTION Property Location _ 'A . is , Sec. 19 T28 N R 1 9 W, Town of Troy Subdivision Plal:Troy Village 2nd Addition 'Lot 82 Certified Survey Map ft Volume Page ii Warranty Deed # (before 2007)Volume . Page Spec house❑y"Elno Lot lines identifiable Dyes❑no SN'STF.M MAINTENANCF AND OWNER CERTIFICATION Improper use and maintenance of your septic system could reamlt in its premature failure to handle wastes. proper maintenance consists of pumping out the septic lank every three yours or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic lank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in SPS. 353.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. -I'he property owner agrees to submit to St. Croix County Planting & Zoning Department a certiftcatior, form, signet) by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site w%nstcwater disposal system is in proper operating condition and:br (2) offer inspection and pumping (if necessary), the septic tank is less than 113 full of sludge. Uwe. the undersigned have read the above regairemencs and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Safety Ard Professional Services and the Department of Natural Resources, Stale of Wisconsin. Certification stating that your septic system has been maintained must he completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statemeon this form are true to the best of my/our knowledge, Uwe anvare the owner(s) of the property described above, by v:rtuc a warranty deed recorded in Register of Deeds Office. Nurtmber of bedrooms 4 2 e- .~~.C - Z 1004,18 SIGNA'l URE OF APPLICAN'T'(S) DATE "'Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. • include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in lite warranty deed. (REV. UL12) C 7 now t r 411 t + a t CO &0 8+ z w P z Ux j a 'n - ~ v y V J =c - - TROY V LLa.GL SECOND AD UIT!ON f ]S' ~Lw ' 4 tC:+- n u: r I' c Lr u 4 . r Y? li cr mf Nn v M SE IN 1l4 ib; \ 'n[ liw I:< 1 SN Y V TC H u f ..CCI OY t9• 73Ek R 11 1 1: 'In I.CGY9Y • Y , _ '~1 CUILOi p ;IF Ik P LAIOV °.Ot vtlA:. IUwN :Y ITIY, SI CY•fl[ OUI11, t 1. (off 4 42 1 fl 1 I 1 5•~ 5 w l 14 I i~: :oil ~JI 93 191 ~ asbil _ _ ' ~1_ K^a-~J 118 ~i viFFl >a i lvo L t J ?gam""" I-L 1 1 I II' ~1. - A X71- I I Il 4fa~-• . ~ ~ m~ S .L I 1yy' ~ r ~1 I N•~ •..n: w. iwY l~tt .n w.-. arpv.YK~t t4 - I 19 Iv~~1~ p y s N LN,s t~ I ~ •.+f'1 ~1 I I tt. {.~cr.,n 1. '>I I'A.~.,r1}' Y~~:% r .tu ¢✓s'IV, rv.tn.nw 1 - 7~•~'•1 It Jr 1 A _ i 1.:.I1 •.~w. r ¢.r ♦ m a> I 1 1'" a ~~i+ ll Y ~lo Ini I VA -R0" VILLACL SLCCND; rDITICN CxAIEJ M ~U. Ne vA C1 It . 1, 11. 11. .r IP: : TIE .'x Ill. T.c SL I1.I \'x 1.. I'll IK ''e .i- C! 1.e I It< CI >:CTOV 19. 4bN N'9N'. BFicl. XTIOI 4 a TIE i'LAT X NOY 'ILL-CF. M'%- U "OY, :T. 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RON PVE• ELEV. - 8 20R~o ,1 N B8600' 335.57' i 15 1 0 11.013 ACRES ~9" 1so- w 82 `N Broo' 00" E s~~ 4 S.F. 1.003 ACRES I I z 260.00' ,p eo do z ~ - 1 0 o I 692.SS-• - N 88000'000 E o I 79 F 00 326.21' Oo I $ $ 46775 S.F. m 85 00 83 1 t o 1$ 1.074 ACRES o 0 62758 S.F. 1.441 ACRES 4 44648 S.F. 1 i, m I £ N 86°51.48" W o q 1.025 ACRES I 335.23' 8 N U I + 1 N I Jo, p0. o N 83.00' 00" E co I N ~ I ~ m Bp 00 314.19' 1 .o fO .o i a B, pi I 78 N N 86 1`~` I NI 1 I~ 1 63097 S.F. °-+o 993 S.F. s 84 gi i 1 1.448 ACRES ° N I 156 ACRES, r 46761 S.F. 20.19' 4 c7J 1.073 ACRES 226.73 1 0 ps' C6 S 831*W I C10 E 338.28' ~o B4- 00' IP 260. 16 ' W COURT ~J C9 318.90' rnu SIR VD E N 84.19' 00" E • I~f~ - X01 I I S 07°06'32" E - 77 58.07' m 37 1 1 N n one -~iio37' 1 b 45947 S.F. I r ' .III IIi NOLLlaaV aNZ `d.VN119 AOU./. .17Naals39 9,r41L I I Iti ,I I It ~aN07 as s I Liu OZL'Z967. $lL '011 P 1 ICfI:~ li- r{ - w o I 1 I I A 1 41 I 1 Wv r.. - ' I aA I=' e p F > f A G . ~ I AA .1.~ Ill.;.. 1 S n !A ! 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'A.AFt/,7D AON1 '28 107 j 't l NAUNV7791 I, ID RRR'ON . i • L-- a. 1'- _de t tll p 2 wo b e J zl k 5 `11 h0 p HIV ♦ I!i ' ♦ t'~. C .L t ~F 2 S ii t/ 1 x3 ~ €1 sr a 3 } e•r [F F r r=i , rG „t t~2• y ~f 8 t e ! 4Fs s~ r f p{. C 6ixd ~fF IF .tip t i n~ ,t a 'eF eF7i ~ ~ ~ ~J ~ e F~°3a' Sig •S~ J4 a fn' t ~ i Y c.~ a P t ~ ~e 6 ~ •3,~~r ~1ff Frf pp; >'rt ~ y~h ELI { o e Y i tac iJIC i ti'F k j 1 j Oz ~ Yya Izt O In I ~r / I rL e e Q g 4 aj 3z e t? s b r 4 a a U I N soons i Department of Commerce SOIL AND SITE EVALUATION Page I of _ D vsun of Safety and Bui'dings in accord with Comm 83.05 Wis Adm Code t: mmvnuaanel lay Design Attach complete site plan on paper not less than 8Y. x I 1 inches in size. Plan must County include. but not limited to: vertical and horizontal reference point (BM), direction and St. Croix percent slope, scale or dimemsions. north arrow, and location and distance to neaiest road. PalcelID.# Q Iasi t...'-rJ APPLICANT INFORMATION - Please print all information. personal info maton yc. ude may be useq'for secondary Nrpases (7rtildey tv F. ifl ao it, ;m)1. Revl d B ' It Date d . ~ _ Fmpedy Caner ?mprrty Lutivn~~ t - _ Gcvt Lo! - NF hit VW 1.,*4 S 19 T 29 N,R 19 W Plcpedy C•nners Mailing.Add,= 'Lo' 8 Block If Subd, Name cr CSII - - 12301 Central Avcnue NE. Suite 230 8 '1 rov Village Second Addition City Stq", Zip Code PhorelI r=iDi ' Village Tnwn Nraresi Road \4ittnea olis \1\ 'frog St Andreyys Dri%c New Construction Use, Residential r' Number of bedrooms 4 Addition to existmg budding . Replacement Public or commercial describe Code Derived daily flow 600 gpd Recommended design loading rate .7 bed, gpdflP .8 trench, gpolff Absorption area reouired 857 bed. (t' 75.0 trench, ft lytaximum design loading rate .7 hed gpdrfF .8 trench. gpdV Recommended infiltration surface elevation(s) tic tkarstncr _ ft (as referred to sit a an b nc Additona! design 'site cons!derabon,_C,radma rcguintt to mwt caic iequirements fix maximum deoth topinc tIZ, Parent material Lccss oy_cr Glacial Out"ash Flood lain elevation, if applicable NA I S=Suitable for system ::onven:ioral MoLnd r-Gro"rd'res•re A- i;rade System It FiG Hokl.ng Tank U=Unsuitable for system j LI It u S S U S U SOIL DESCRIPTION REPORT Depth Dominant Color IAottles Structure GPDJft, Boring# ! for zo° in. I•Aunsell Qu. Sz, Cont. Color ' exiore Gr. Sz Sh Consistence Boundary Root's Bad t rrnch 1 0-32 10v1; 2 Is Inlgr mvfr OW It - 1 2 32-52 - SN O 4 Is I mgr ntvfr cIs if S 6 Ground S 52-68 I0yi*5'8 sit 2mgr mfr cw 5 e.Ie.V 1Oj,45 It 4 68-78 IOyr 518 c2d 25vr41R sit Imgr n11i ON - NA NA f- I - Depth to 5 78-145 7 5vr4: i; IS osg Jill 7 8 limiting Final grades to meet the requirements of the code ...:.Cut to 102.40 factor 68' - - - - Remarks 1 0-18 10vr3:12 - Is Imur imrl cyn If S G 2 18-27 7Syr4i-1 - Is Impr ~w $ fi Ground 3 27-50 Inyr5i8 - sit 221111 mfr cW 5 6 elev , - 10. 5 fl. 4 50-1401 7 5yr116 _ s os ml 8 Depth to limiting i factor >140" Remarks CST Name {P',easo Prnl! S;ynatere: - Teleahore No. -7 l---- -fhetrlas C. Nelsen 71:.?.1(:.2 •I:.I Address Bm'ironmcntul By Design Date CST Number Rat# - - I.132 Loth Street, Neo Itwlunund. WI S4(117 ?iiig8 J101 IS PROPERTY OWNER: SOIL DESCRIPTION REPORT 15 Page_ of 3 PARCEL I.D.# I!n-U,11 o.nm: % k:.pn Depth Dominant Color Mottles Structure GPDC- Horizon in fdunsell Qu. Sz. Cont Color Texture Gr. Sz. Sh. Consistence Boundary Roots Bed Trench 3 I 0-L1 I 10\0 2 Is Imgr nwfr _ Cw 2f .5 6 2 14-34 7.5vr4,,4 Is Imgr nn4r_.~ cw Ii I---.S 6 Ground elev 3 34-45 10viSi8 sit i 2mgr mfr ~H 5 ! 6 1-03 88 h 4 _ ;vr4r8 sd I, Imgr 11115 av - NA NA Depth to 4s-S4 . ffla~ g . l7 5VUvr.50?ti 6 C.d ' s osg nil - - 7 .8 54-110 limiting to be graded so as to be below restrictive horizon. ( 12 inch rule) factor 5 0,+ Lek'o "Loa Remarks: site to be r}aded so that s stem is beloNk the motded horizon K mectdepth requirenunls 4 1 1 0-12 101yr3i2 Is Imgr mvfr Cw 2f 5 6 - 2 12-34 10yr5iS - sil 2mgr ntfr Cw If 5 _6 elevund 3 34-140 7 Syr4r6 - s - osg ml -III - .7~ 3 105.57 f1 Depth to - limiting - - factor •140„ Remarks: 1 0-13 Ioyr3'2 - Is Imgr j nrvfr C", 21- 5 6 2 111-30 1 ovr5~8 it 2mgr mfr Cw I f 5 6 Ground - elev 3 30-140 75yr416 s osg ml .7 .R Depth to limiting - { - + factor >40" Remarks: Ground elev _ Depth to Iim4ing factor Remarks: ENVI~ONMENTRL BY DESIGN 1432 120" S1RITT, NEW RICI INIOND, WISCONSIN i L,-2 10 2-1) 4 PROJECT NAME: TROY VILLAGE 2nd ADDITION DESCRIPTION: NE'/.,, NW'/ SECTION 19„T 28 N, It19NV 'T'OWNSHIP: TROY COUNTY: ST.CROIN LOT: 82 SUBDIVISION: TROY 'VILLAGE 2nd ADDITION C 0 2 t2 65 SCALE 1"=40' Tom Nekon RM i NE corner post ground surface elev. 100' cslmo2605 BM 2 Nail in blazed tree elev. 105,45 - - - IL-17) CST-a0li'-d$,0 Wis. Dept- of Safety and Professional Service. " SOIL EVALUATION ORT Page - of Division of Safely and Bp4dings _ in accordance with SPS 385. Wis. Adm- Cod County ST CROIX Attach complete site plan on paper not less than 8 V2 x~I 11 inches in size. Plan must include, but not limited to: vertical and horizontal referenpe point (BM), direction and Parcel I.D. 040-1253-20-000 percent slope, scale or dimenslons, north arrow,anrf Ioeation and distance to nearest road. Please print all information. Reviewed Dale Porsonal mformaoon you pro': au may br: 'o, soconaary purposes (Privacy Law, s 15.04 (1) (ell. Property Owner Property Location ROBERT AND JUDITH TELLANDER Govt Lot NE 114 NWtr4 S 1 `8N R I9E (or) WO Property Owner's Mailing Address Lot q Block # Subd. Name or CSM# 294 ST ANDREWS PLACE 8 2 TROY VILLAGE 2ND ADDITION City Stale Zip Code Phone Number ity Village • own Nearest Road HUDSON Al 54016 ( I TROY New Construction Use Residential l Number of bedrooms 4 _ Code derived design flow rate . GPD Replacement Public or commercial - Describe: Parent material . LOSSES OVER TILL Flood Plain elevation 4 applicable ft. General comments RL-N TWO 90 FT TRENC'l1ES TOP OF KNOLL THREW TI IF TREES. TREES SHALL STAY INTACK and recommendations: SANDS WILL. STAY CONSISTANT. THE CON 'OCR DOES NOT SYTEM ELEVTION 9' X 93, f Zd~--a- Buring # 11 Boring El Pit Ground surface elev. 97.19 N. Depth to limiting factor 86- in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPDfft ' in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. tf#1 fl#2 A 0-9 IOYR3i2 SL IMSBK MVFR CW ^_M .4 B 9-19 7.SYR4+3 - - SL IMSBK MVFR C%V IF .4 BI 19-39 7,5YR44 SlE 2MGR MFR CW IVF .6 C 39-51 7.5YR4/4 S C'OSG ML AW - .7 Cl 51-86- IOYR6.4 S MSG ML .AW .7 9 2 Boring # ❑ Boring 92.8 1D f 86 t Q Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPDM ' in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 A 0.12 IOYR3+2 SL IMSBK M%'FR C'\4' 2M .4 B 12-24 10YR44 SIL 2MSBK MFR CS 2VF .(i C 24-29 7.SYR4~4 - S COSG ML CS .6 C'1 29-86+ IOYR5r'4 S MSG MI. CS F ' Effluent #1 = BOD , > 30 < 220 rrVL and TSS >30 < 150 mgR ' Elfluenl #2 = BOD , < 30 mcyL and TSS < 30 mglL CST Name (Please Print) Signature CST Number PAUL R KOEHLER ' 225410 Address Date Evaluation Conducted Telephone Number 321 WISCONSIN DRIVE NEW RICHMOND WI OUT 29 2018 715-246-2660 SBD-h311)I RI 1 r'11) ROBERT AND JUDITH 040-1253-20-000 2 3 Property Owner 1 , ernr: u Parcel ID # Page of 1-9 Boring # 13 Boring 94.48 86+ Pit Ground surface elev. ft. Depth to limiting factor in. Soil licauon Rate Horizon Depth Dominant Color Redox Description Texture Structure nsistence oundary Roots GPDlft ' in. Munsell Qu. Sz. Cont. Color Gr. Sz Sh. tf#1 ff#2 A 0-10 IOYR312 SL INISBK M\'FR ("K 2VF .4 C 10-30 75YR44 S OCBSG ML CS .7 C 30-86+ 10YR5+4 S OMS(i L CS .7 I 1 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor in. Soil Applicabon Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPDlft ' in. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 Boring Boring # Ground surface elev. IL Depth to limiting factor in. Pit F -1 Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure onsistence Boundary Roots GPD/ t ' in, Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. ff#1 ff#2 ' Effluent #1 = BOD > 30 < 220 mg1L and TSS >30 < 150 mgrL ' Effluent #2 = BOD : < 30 ngrL and TSS < 30 myL The Dept. of Safety and Professional Services is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format. contact the department at 60&266-3151 nr TTY through Relay. S3Dr:31: T,1c11 i1', ROBERT ANT) )UL)ITH 040-1253-20-000 - ~ Property Owner ['"-l -NAILk- Parcel ID # Page of ❑ Boring # oring -94.48 86+ Pit Ground surface elev_ R Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Re.dox Description Texture Structure onsistence oundary Roots GPD1ft in. Munsell OL. Sz. Cant Color Gr. Sz, Sh, ff#1 V42 A 0-10 10YR3*2 SL 1MSBK N4NTR CW 2VF .4 ( 10-30 1.5YR4'4 S OC13SG 19L C'S C 30-86- 1 OlR5 4 S ()MSG L CS ❑ Boring # ❑ Bonng ❑ Pit Ground surface elev. fl. Depth to limiting factor in Shc Application Rate u~ Depth nom..:... C!CC goA_y necM~tinn T.M.,. &tmrrlurP .onsistence mindary Roots GPD.H: in. y Munsell Qu Sz. Cont. Color Gr. Sz. Sn. tT#l ff#2 I Bonin # [Z)Boring D g Ground surface elev. R Depth to limiting factor in. Pit Soil A dication Rate Horizon Depth Dominant Color Redox Description Texture Structure .onsistence oundary Roots GPD.rft in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sn. ' 4f#1 ff#2 Effluent #1 = BOD > 30 < 220 mg& and TSS >37 < 15. mgfL ' EfB,ient #2 = BOD , < 30 mq!L and TSS < 30 mg.4 The Dept. of Safety and Professional Services is an equal opportunity service provider and employer- If you need assistance to access services or need material in ar alternate formal. contact the department at 608-266-3151 or TTY through Relay. t^' W \ \ `v W \ ♦ ~mi+ 1 \ 11 I ©```O\\© ~ w m W A 3 m 3 461 m D n 1 m w v z N S m N ~ / ~ O \ \ z ~ ^ W y ~ ~ N \ \ O uo°i ~ ~o m N ~ O 1 \ y V T T T ~ \ N f+ m r y D \ 1 \ ~ b Z Gl \ ~ ~ O ~n m ~ m Oy m m O \ m 0 m D o o \ T m z m\\\ 2 y p Z Gl F+ p O W \ m m O 1 a \ r ~ \ ~ m \ S t0 y V A co g`\ 3 C O F ~ O O m c O(y w m ii D z 3 N z > \\O O m O N N P = F9 \ n < p v R\ m N 7. y y N N A p m \ _ T m r to O S n Z m N I~1 y F.. 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