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040-1235-20-000 (3)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village Township Aaron S. Dolney I TOWN OF TROY CST BM Elev. Ilnsp. BM Elev IBM Description: h-f TANK INFORMATION C C ov-e-� ELEVATION DATA TYPE MANUFACTURER r CAPACITY Septic tti�VIT f'Gt-� �-W t. Fang Holding TANK SETBACK INFORMATION "®Mm® •, ®�AEWM MEMO= MIWTAMM�= PUMP/SIPHON INFORMATION Manufacturer emand G Model umber TDH Lift Friction s System Head TDH Ft Forcemain L gth Dia. Dist to well SOIL ABSORPTION SYSTEM STATION BS HI FS ELEV. Benchmark Alt. BM BxtShn Bldg. Sewer SUHt Inlet SUHt Outlet d f2fhilBf (,pvt/ Wn '1 -- y Dt Bottom Header/Man. Dist. Pipe AA5C Z,IIJ Bot. System T t 0 q r1t 00 Final Grade St Cover � 100- 0 b.00 0l(o.00 T 7. oo lamA BEDITRENCH DIMENSIONS Width s I Length �� I No. Of Trenches Li PIT DIMENSIONS No. Of Pits ide Dia. Dept SETBACK INFORMATION SYSTEM TO P/L (Ma IBLOG IWELL JLAKEJSTREAM I LEACHING CHAMBER OR UNIT Manufacturer: Type Of System: co T G r 1 r I" Model Number: Q y DISTRIBUTION SYSTEM 1 7_ i- VLt VI L1+1`i Header/Manifgltl II 1 L1 Distribution Pipe's) / / / x Hole Size x Hale Spacing Vent to Air Intake 1< Length Dia I Lan Dia Spacing glh SOIL COVER x Pressure Svstems Only xx Mound Or At -Grade Svstems Only i 11� Depth Over o Bed/Trench Center Depth Over Bed/Trench Edges xx Depth of Topsoil xx Seeded/Sodded xx Mulched x I Yes No ❑ Yes No COMMENTS: (Include code discrepencies, persons presenj etc.) Location: 545 GILBERT RD 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover Plan revision Required? as i(/ G Use other side for addition Inform i . I t I ` Date SBD-6710 (R.3197) eetiort #1: Inspection #200' �Qar irescnr pre4r �d In r Actors Signature Carl. No. i 6'r-I,A t, s)IAI-a oI R _(9a3 — - AUG 02 2019140t latlarb� S..ba Diio IM 11a/¢a Ave SriIrRa,( O-ps :NrI;lf1 St. Croix CDan li Co tC.8LLO1! ttr b eomadoewr M M21MWiL AOIL Cok ti�d far alas hajut Adir(ifam r ebgidpwo4Mbj%artrf emwE Naac Appbarmisfw aaieilafr &e DapowwoadbafgadPmhmmaa goicea PoeimbmAbn ym paab a a+ Ya baso.i,m,Y ltc lat c 15 1 . !rt , > E)sus G,1 L bWbmtae—„rr PON F up" s Douce O4o -1z 3s'�zo -oot) � a ". 'mmum 03. i9, 1 n8 - RDA ca.c t<a — L11E o+r.ara Zo �Wwmhff flu o5w, W-a b !o/z - 5- nhrdHaiYet(aiedaai6111Melattb) u Ll� lfr I m2 Paly Da. �cUw4 -Nb. dr B.� ilC WDOD I st.1 Dpnl Rbdat uA ❑ PwwMKxssaii - Daa.aba Ur r' ❑ E24, d ❑viand T►2oi CSM❑RblaOard-Daaair[L Naaaabar llall10- -- TMaf w m.Tye*fFwmIb (Chwkeebwe w`aA. GmpbbitiofmppMMW A. ❑ Now $7.r TMMM&AM tTd t.Wb.aramO* ❑Ob. WlltafrbBu.y t3W.(ayY.) IL ❑Psi Row"w 1lstRaai.m ❑, L*PmehadtNrt. R.b.B,�sam o..e 299/ 67 IL- 03 9 r air Naahmmd blia.d eler.md b$a.. ❑ AKeefe ❑hard> M b dmeibme ❑ WWAd <M a ufmid"d ❑ O.er DYgao•I C. Po (wN.e1 F l LTFA ❑ r rr.r D.. a. t aa+� v. Am s le4.abc Ddp (atdl Da.iP e.a Aepli.a0- DiAa.rsi As (!) D*Md Ama haeo.of tl+r irV VL Taah dais Cyeigb Tani td H.dmrr Raft r. h/ �. n 3 •trtc,.tf VD. 8lrsat!-4r a.�. E.bw.i.�d..fOMtEAw�rYalWat Pla..b.rl lEs PYrYer1 NaaaaM[ Baai.. abra Naaae. ,� 5 uva37 7C5- 579- 5� .Aids Mood. CW.eaMZ*Left) S r eAC)7T5z! 72 vm. um i er.iaka Dab mood I Q' Comm n: c• Ega me •i-a 4ieprr:.�.� CO nuet all be nAix>s _ " �ni.: eS. � as per marayemen! plan plDridel uv plumber. Z. Ar ee!bYIk IMC,IIH�'. tfll4�tSl Wa:aZ.1�GJi.E •: V sprtpFNaW�corislu�rtAres. Awr��/w r rgrwra.sert�a3•!'1I'•lTra�as. aaa_s �o. as s a.a• La2- SBD-63" (R.OU14) 7 J 3�-5 PLVT PL-Ati ,AAKDA3 LNU)g / NOTICE: Please provide the following: • A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic lank manhole cover. Show alternate benchmark, if applicable. PLAN VIEW h Z, 39e AaA€5 Y y/ Gr tlq'i1 jZ� &44�1 c. 3!` O 38' 1— 4SoTMp Io53 0 r usz S3 (Vaty-rA"'n TRGN RSSJ-N`ED 4��coPy INDICATE NORTH ARROW La 1 4/ PAGE 1 OF 4 In -Ground Gravity Plan Index & Cover Sheet collIuor►snrnr r WDOM r Vanion 2.0. SOD-10706 P (NAtl01, R. 10n2) Pg i of 4 Index & Cover Sheet Pg Z of 4 Plot Plan Pg 3 of 4 Dispersal Area Cross -Section 6 Plan view Pg 4 of 4 Management Plan Owner Name(s): —A-Aswiq s. Do-NLY Phone: 161 z, gbS�1� Project Address: GovL Lot -- .vc 1/4 of 5W 19, Section � Township: 'Ti4DX County: Projact Pam 1D #: OyD - 143:i za-00 0 zip: A:Pvol (� GY 5T c IVUX Designer Naar: 8�AKV ,1-fkPr't,'Zr Pham 715 - c A -1-1. `- Design rAddrses: Yg49-1 1<pAfd&AgUmHmF!5 C+.� QAVRixj!��wr ap: 4"em Eirlsa %loll tsiet�es�n �' nui lnoK. d&*% This �e¢ E7 Signature. Da>e: HNtIPPmp •.1. * . D 18" . PUT PL-41V NOTICE: Phase provide the following: A plan view sketch showing everything within 100 feet of the system. Two horizontal reference points to center of septic tank manhole cover. Show alternate benchmark, if applicable. PLAN VIEW h a' y�LU[ J 3 DCDO-Pu ^ 1l0y", 12 INDICATE NORTH ARROW O": z --, Z. 3W -AeAFS 9 WZ - 8 -13bt - TOP Cr 1" -tttox �,vE- ipaoG I EaK v LL O m w na —rI101 yZl ,/,h x rt'. l2 ,Sszl = h x tsH Qtaln�sXz is'�n°'1 =)n7 ;JSh (""Saw AA 1A NVId HOMM L7wJIdAL x . VSi3 Wjl Pad - sapu■q £ i Almh -wvwyMPQ .r SLM-W -dVsowed- ,s'�—.�Mr�.i90�omw.n�d � + �w,�..Tr■.��..+ 'i �' - 3 A OL 0 woos ►R- t�..�e..wrw.� Oh d (l VZ i i z � on �xaal aad llvIsNI ww■o�ws f eif+ 33S T , _: ..._ "..-a�--------,f----_�.rs—_ s'.." r■�. Low w.4+..m.40 nsm, MA F uoynq ■ate �a ..,..-..o do..ar srvopoc Ll70 -.P.. UMWMW UaP••a.• 66.•.LFTU "WANH WUN �--T Uo "s UNIMs (epS ad AKMA NOLL?39 SSCOMO HON3b1 IVJIdAi —� sw■���-ss �l p--~— i— Pe.LO (am P) Uxulu17F£ V3MV'1VS2i3dSta A-UAVZ(O aNnOWJ-M ��02 ; � PAGE 4 OF 4 In -ground Gravity Management Plan Tfr orwnar of 1Ns in�oud gnevby syswn itr bs iaspoirbls far psrpsial apwafain and rnridsnrwa pusuwt 10 nquismmile Of WS 3024K YAM Adair. OWL Pwwwd to WS 303,52 (21 Wbc. Adffdn, Coda, this syMrn 4W be cansltwad ■ lasrnen hasgi l■ not maldsird In aamdwo wAh rob approved mmnprriw , Plan. Fwtm m% #A Yr1 13 end WANAN lmioe safviss dd be 'by s rsgYlwM POW M McYdaiam in scoordanoewit SPS 383M (31 Wlaa. Adman_ Code. Design flow r gpd; SIM S 220 wqO; TU 5150 mgO; FOGS 30 @ qL ' bunction mama YISPECT EVERY 3 YEARS 0 t w of use o ago of syelem o and mwe fadon (L` odors, uw r mmplaiib, ab) o madnmiry no"Wowi (Le.. P mP, vdvas, ar- , o mderli Ueeue (le., lsi`R trade. omsaiarti ab) o sands vaiarrs in arrwmlc ia�ama >•ni(a) and srry dstrbnaian appnslwrwsa(a) (la, daibndan / dnap bunaa) o nsdact or inpww use W. eaased.p design oipsdses, pwlnbI adlvsim, aim) o mdr , Of m N& in dlobbnion ors pdor to dos, n a chit hepAwlses - ■ appfabw (v pw4m4Wcfta d wfth aeuir n aftL) o eMciial mrporierdt - f sppsaatte (La, uiiinp, aaswdarw, asbdnea, oariauls, tinwr, atwna4 sue) o dkftftdlon iaterd or lelwal airs pi>f4 #fflMw leWW ddsl p eau-aanyme b - 19 apsa cow) o arface dednwpe Of elbwrt ar asu%e badrtp bb sbu hme rived WIMTAN EVERY 3 YEARS (or ohm neoeae" _ o�JignalooMduMbePwr4WbvaGoriWmdsWbWmwiciIrp of ' fowws 'under s. 2e1: tE Wla. ShAL srbm the vskow of soak Y b�h) e +gassads arlhbd (up *A y*Add vabsae of twdq* or no negnie - by imel arakmo& OYpaad d aornI ahse be psawt b tit I I& Wlea A6ric Coda o CONOILWAIM •W be impeded wary 3 yams and shse be dearrd wbwi aseeeawy to moon any aDowr N1alled bde accordtV b ffmatacfusra rPriaaiota A aarsiiq pafod r alrga be Oadm frn 12 luxle 31 nisiilsaaaoe npmb abet be sabwdlled is tba plaParblaal�eeetrtmmt area it aoemiraoa s SPS]03.iiWwtAirinCode. bepsrlm4raaapasatfOlaas►ess�als0�tec 4lrrr orissvibaloraoapsW. } :J7Pl: C'== .1'"'--/>:�y'! PMnc 'i/S-^o - '_----_ LMWOarmnn *Urdt: 5T ll(. COMM 17y OEJ6LOAAEAM Rmw -715-366-1460 _ Leal govwrromt utt addew P u DSOM w z1P: —4WOU, Any dd dhe part of Ilia sysarn shd be npaied, rag' or MOMW ptasuent b WS Mil (1� MAID Atw)a Codw Repduct fait mpiawlwt of wad it nleiatrrlioiip meponml dw1 aongly sin 3P3 303, Vftr Aaaln cods GO ptodlld for dl PS 3 or pfyalnl nMoC de. of the POINTS may bo wed urns approved bytlis dep�baai - ti aoctidenos air SPS 361, wises ,4dnii_ Cade. In the overt that any MW bsebnmt oonlpmnmt of #ft POURS araiot be wpisd ! shall be wplsced paamd b a Plan aaiabled In tar F - , apanc, far revisw and ggnvaL A idad ingtormd dipmaY °laapmait my be abandoned and naplsrad by a oodemnnprying dapwsal oaa4ansnt ti a pre•dslsnla d aiaa of au&dit satk. M use of 2" POINTS Is disc rd wed, ! dW be abarrda - in eooardmws roan SPS 3e3.33, Wlsa Admix. Code. ST. CROIX COUNTY ZONING DEPARTMENT AS BUILT SANITARY REPORT r N Owner BPtifi luQ } 1v _ Address a4ti tiN coo City/StatelJ � rt, Legal Description: Lot �_ Block _ SubdivisioniCSM R RmWED19, ,. :n otiont 7 ; ,-,I .9 / Tc.y V. NE /,SW Sec. TT?%N-R() W, Town of PIN tl SEPTIC TANK DOSE CHAMBER HOLDING TANK INFORMATION: Tank manufacturer Size ST/PC(Ow / Setback from: House (a Well4�te P/L�—Ve SG Pump manufacture Model — Alarm location ------- — (HOLDING TANKS ONLY) Setbacks: Service roVent to fresh air intake -. a Line Meter locati Alarm location SOIL ABSORPTION SYSTEM: Type of system: f "t - a Width 3 Length 5 V Number of Trenches Setback from: House Jo_ Well 77S' FT )S' Vent to fresh air intake 7 /(J(" ELEVATIONS: Description of benchmark T P of -T-r O A! ? i RR Elevation ( O o . 0- Description of alternate benclmark Elevation _ Building Sewer ST/HT Inlet ST Outlet / 7 �' Wet PC Bottom — Header/Manifold Top of ST/PC Planhole Cove 9 Y U Distribution Lines () 6% 7 . ? () 97 -7 () 4 7 • a 1 Bottom of System () 15-1 � (} 5 5, ,Q () 9 15. 9 a Final trade c} f J ) c) 9 1 a c) ar r 91) Date of installation i/ *ermlt number State plan number Plumber's signature License number DDa 9 0Date inspector AW c N CaMleoe pld pon at 0 25.00 A SECTION A -A PERMANENT FOAMED -IN POLYURETHANE GASKET THIS AREA MAY BE FILLED WITH CONCRETE FOR ADDITIONAL WEIGHT I A Material: Copolymer polypropylene 3.10 Color: Green 4.50 Drainage and Septic Products I PART NAME: 24" RISER LID Tut-TRe, Inc. TELEPHONE: U7.550.10/1 PART #: 1200 FI"a coup TOLL FREE: soo.382.700D 24 - RISL - GREEN u 12.00 i A W 24.I0 024.20 -'�1 025.70 — SECTION A -A A 13.00 Drainage and Septic Products Tul-rne, Im. TELEPHONE: $47.550.1011 -__ _ 1200 Flex Court TOLL FREE: 000.382.7009 r 9 Material: Copolymer Polypropylene Color: Green PART NAME: 24 X 12 RISER #. 24 X 12 - RIS - GREEN 2.01 4 6 0 4 a A 0 Ono-. JtU l ION A -A I 1 it INFILTRATOR The Quick4 Plus Standard Chamber offers maximum strength through its two center structural columns. This chamber can be installed in a 364nch-wide trench. Like the original line of Quick4 chambers, it offers advanced contouring capability with its Contour Swivel Connection- which permits turns up to 15-degrees, right or left. It Is also available in four -foot lengths to provide optimal installation flexibility. The Ouick4 Plus All -in -One 12 Endcap, and the Quick4 Periscope are available with this chamber, providing increased flexibility in system configurations. Am%,. Maximum Strength Quick4 Plus Standard Chamber i Specifications Sim 34"W x 53"L x 12"H i (864 mm x 1346 mm x 305 mm) Effective Length 48" (1219 mm) Lauver Height 8"(203 mm) Storage capacity 47 gal (178 Q Invert HdW — 0.6" (18 mm), 5.3" (136 mm). 8.0" (203 mm),12.70 (323 mm) APPWM in t� &MeAAf The Quick4` Plus Standard Chamber Quick4 Plus Standard Chamber Benefits: Two center structural columns offer increased stability and superior strengtn Advanced contouring connections Latching mechanism allows for quick installation Four -foot chamber lengths are easy to handle and install Supports wheel loads of 16,000 Ibs/axle with 12" of cover 4W Quick4 Plus All -in -One 12 Endcap Benefits: • May be used at the end of chamber row for an inletloutlet or can be installed arid -trench • Mid -trench connection feature allows construction of chamber rows with center feed, as an alternative to inletting at the ends of chamber rows • Center -feed connection allows for easy installation of serial distribution systems • Pipe connection options include sides, ends or top Quick4 Pius AII-in-One Periscope Benefits: • Allows for raised invert installations • 180° directional inletting • 12" raised invert is ideal for seria applications Certified by the International Association of Numbing and Mechanical r Officials (IAPMO) �' 1 Quick4 Quick4 Plus Standard Chamber a — — 6=d M r�p.wa i .r �nd.r�. rI e.r Ll '1 Quick4 Plus All -in -One 12 Endcap PPFS&AM PPE DRA PONi3 LOCATIONS R PLACK —m Quick4 Plus All -in -One Periscope QUKM Pws ML4N-MFGMMC0PE pm'SpdEl) I SIDE VIEW DRTMTW WATIM 720MOE00E6. 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Y!laralm, tsar, OirA1. and SddYlda r.r.O!d.'ad awwrlmdYNdm WIPTMtlwd.dM ebdbYamddaadaabaaYY FtMw .dab YMwr T•dadodr Y.!gd.•d b.d.Tty. wawns, eur.aA11Pma Fa /totl!Frd.rMlMd.wp Wwm T.P.wbpla CmdmP,ebd.aawq,APoKDp .TL1F VxWO dTL1QePPaW,.Lad PayEom Ya a.d.!rAd FOIAdL, be. TIIF�TffE M a mDeerw YadPtlaw d TOF-THE. reC. Uat►Mb %bi,,s Y • tadmttrk dmET ILe O3a164!W/.M MYLY Ttl.,WepI�,LLC Nrl.!,urr.wd Niwl..U9A RLIBR, Oe!E • . •• b-.. • - tea 220. r G ,ter `♦♦�♦� Ep``.td Ile rt'll! �'". ry •�tlior� 1 W Is win W. W In 111011'11U 11-11 0 3.1 N1hr57.1 ..... N 7.1 W1053'U•1 ---- ll 7.1 s110ss'419 11-I1 O 1'1 161041'11•1 ---- U 2.1 IIf011'1{9 ----- SI 1•1 315057'11•1 U-11 N ]9 816011'l19 19 Nlks'N9 U-11 U 19 1/10U'N11 ..... U 19 N501171'1 --- 11 1'I NfOU'U'l ..... {1 111 t11051'If•1 ..... 1{ 19 1370111I3•1 /FN U in N)0N'N'1 ..... Is S•1 1110l5'56'1 ..... 11 1.1 111-11.0.1 51-51 /1 1.1 111011'N•1 51-4 11 p um 11p41 main If7.N' 11071'/1• U)0/1'11'1 III."' ))RI'il• us011'11.5•1 217.11' IS011'111 julton1.1'I /17.11' smi'l)' 12lost•11.5'I 117.11' N0UY1• 196011-21.5.1 111.11• 11015.11• SIOSPH91 IU.$$. 405s'N' 12501/'11.1.1 sit.*' 1/011'11' NIMO•21•1 III.N' s10u'13• 1110S1'11.5•1 II1.N' 11011'U' Nf .m.1 411.0' 11011'N• u1lis-251 Iu.N' 31016'15' 11{0s{'ll.s'I /U.11' 110N'16' 1N0U'U7 333.11' 1701t'10' R OWN% 11).N' 6011•U• IIN51111.1 311.11' 110U'U• U1011'104 111.11• IN011'I11 u1011'1I7 Isom, 11011'lt' 11f0N'29•1 MATCH \ 4� LINO L99M )OIII01 ULUX 111.11' 174.17' 111011'NY LN111'15'1 111.71' IN.71' L1100/'16•1 11m),11.1 23.14. I7.15' 11/41'31•1 IN0lPU11 N1.11' 1u.11' 111016•11•1 N1011•17'1 W.U' 151.11• SIA6,11'1 U1031.1311 221.11' IH.611 11701t•1111 N1011'an 391.11' 3".11' 111011'414 N101115111 711.1/• N1.11' 11401645'1 NI011'I1'1 U7.11' 41.71' 141411-47.3 1 M01{'164 11.11' 20.10. 111011'/7.1 NfOU'75't ISS.11' 1S5.61' 115057'19•1 12701112511 u1.N• Ill.". 1370U•15'1 /N011'1111 94.11' N.05' IIS011'11•1 114011'15'1 111.16' 117.17• 11101/•N•1 1110U'N•1 N.SS' sul' N1016'71.1 thou-1/•1 111./1' 1/1.11' 10041'1/'1 141011'04•1 115.11' 111.11• 111014'II.1 161011'11.1 179.sl' 111.51' 1111641,12.1 U1011'11.1 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 and/or dose tank presently serving the following residence: (Street address) 5'f5 644t5&ZT /Zb located at: ! '/4, -=4N 'h, Section c 3 ' Town :!f N, Range--jj—W, Town of �r , 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 requirements of SPS. 384.25, and it (they) appear(s) to be functioning properly. Most recent date of inspection or service Did flow back occur from absorption system? Yes_ No_ (if no, skip next line.) Approximate volume or length of time: gallons minutes Tank Capacity: JAL -Li - Construction: Prefab Concrete V_ Steel Other Manufacturer (if known): iA,1KS Age of Tank (if known): J q p y Permit number (if known) Z 9l S> W�-li►. �P'*1`�q� _k�7-ter �la�.�-� 5 (Licensed Plumber ignature) (Print Name) ptjAA5 n 274C37 (Title) (License Number) Ng/MPRS 07/29/2019 (Date) Form to be completed by licensed plumber (Dept of Safety and Professional Services Chapter 305 and s. 145.06, Wisconsin Statutes) or licensed disposer (NR 113 Wisconsin Administrative Code) Rev. 2/2012 w' 1 1 •1 le OwnerlBayW Atkg(A s DOWN&-Y _ Mailing Ad&= 5y5 Co/LWr F E) . III ham Ply & Zo>®g Depwmeat for now citylState :} lI RSG U , L�Z Pm Idmb atkon Number 6"O - 12-3S- 2D - 000 _ i'ropaty Location ,Nt % , SAA) -A, Sec. Q3 , T ?K N R-a W, Town of T12C Subdivision Plat Wow eog ArLq i 5r 4 DD_k) . Lot # AL. Cerd&Dd Sauey Map 4 Volume Page # Warrawty Deed # (before 2007)Volume _ Page # Spee boar Orap. lot Liam Wwftfidlo�.lymOno Iapapw m and nxwns� of yaw rpbc sI ' aadd molt in iw pswa0ae &ha •o boas twetea lapw mammm�ooay.raotrspgootlrewpretaatevwyiw•�••saraomr i[ae•ded bafr�dP�p•r. WYt7aepatima the aydaa tr• s8ie tie bacOm a[de septic t•t: w taaafttlstdgs a de rtarre dipeal prr.e< Owarw wsiaataaam tamoesibWb6s a tiwi&ds ISM 3933M) wd n fS*ter 12 -St daaComij Smi•wy Oaiaaecn The pspw4 a vgm to wdwl to St C m Coaq liwwea &Tama Dopmro r a ambfi a bm ierat, yrd by de over wd b7 a wts•rpia I jmaaa9 phwshm, nowicetdphodw or a Scawsd p=W w wwiyep tie (1) ds aw4ft vartriwestr dwpeal 4raw is a proper apwaaisa em"M wdlr(Z) ohm dpechm aed pmmpwg (tflwmawyX tie sephe ba is h: dm 1/3 fia widWIML Use; the mdemissd have mod do above tegmosww mdspen lu mooch de Rum snoW dtMent sYaw w & de dm6wh oat brk hwmk w so by da Dapwwmat of Sadg Aad Pmhm ed Swvmm adds Dspwhnmo of] I 'Rmo cm• Stye MEIW era CrtitirEftm ww:w iw 7a wpie a7arabr bee anted saw be esstplmed ed &tamed Io to SL CA= Comy 7laala; a la®L Depwwsed wide 30 &p atbe tiae7ear ogwabm dMe. I/we c=Ufy dst as =nfu: mMtf4 r the to dw bee of my bar Iwowte�s. Uwe am�we de atlas(:)dole pspwt7 dmat- , dove, by vame of a wsrdtaY deed aowtbd a Uraw of Deed& Ofei. Number of reda�l J _ 7 / 29/2019 DATE —AW o6ms6m dra w awWT&UA d war molt a de m h" permit be m revolted W ds Aamin6 & Zmist;D"mmot — Ladd& Mid die appiiutioa a Moon 1 wmay deed 0a de Resew of Ikadc OOrs wed a aapy of de caufod mvq aa4 if RArraoeD is made is da wwdtay deed (a". "n) i MAcorsin Depainm t of I nduay. SOIL AND SITE EVALUATION REPORT Labosand Murton Relauom Attach complete site plan on Paper not lass than 812 z 11 inches in size. Plan must include, but • 0: f rat limited to vertical and horizontal reference point (EINI), direction and % of dope. scale or f - dimensioned, north snow, and location and distance to nearest road. uAlft REVIEWED BY) ' l APPLICANT INFORMATION -PLEASE PRINT ALL INFORMATION PROPERTY OWNER: PROPERTYLOCATI .T Richard Stout .LOT _SW 1!1$ 3 28 SA 19 WW PROPERTY OWNER S MAILING ADDRESS Lars BLOCK $ 9U . NAMEQR,43SM a 1353 Awatukee 7 ❑OTY ❑ -LAGE ' CITY, STATE ZIP CODE PHONEN1Al Hudson, WI. 54016 015)549-6731 Troy l' Rd. jig New CdLatruCton Use pol Residential r Number of bedrooms 3 1 1 Addition to etdsbrg Wilding I 1 Replacement [ I Public or commercial describe — Code derived da ry flaw 450 gpd Recarmended design loedrg raN - 5 - bed, gpdfV - 6 trench, gpd* Absorption area required 900 bed, M2 750 trendh, ft2 Maratasnl design loading rare • 5 bed, gpdAt2 -6 Wil gpW Recommended infiltration surlaw wvabol 95.92 8 (as rell to sie plan benclenerh) Additr0naldea0l&BMooreidwMfgM alt site= 94.86' el._ _ Parent malarial outwash Flood plain eievalson, i applicable na It S . Suit" for system COFNBliIOIYI ®S ❑U MOIAdI ®S ❑U III ®S ❑U AT-0IWOE [RS ❑U SYST91 N FILL MS ❑U FiOLDWr: TAN( ❑S UU U-Urslilabbfa Boring Al 1 Ground aev. 97.36 R Depth ID limning fal SOIL DESCRIPTION REPORT ©� a �© • _ - t.. ����� ©� � apt . t.-,„t..�MIN 1 PROPemowNER Richard Stout SOIL DESCRIPTION REPORT Pape 2 of 3 PARCELIA.a pending Lot#41 Boring N 3 Ground elev. 98.9 ft. Depth b FmiCng few95 BOfIr10 • Ground eler. 99.0 tt. Depth ID limiting factor +841. Baring N 5 Ground eiev. 98�35 L Depth b Ymltp factor +80 Ground elev. n. Depth to Jim" factor Horizon Depth in. Dominant Color Munsell Motley Ou.Sz.Cae.Color Texture Structure Gr. Sz. Sh. Cor613merm BwnJ y Roots GPD/ Bed gch 1 0-9 1 r2 2 none 1 2 1 mfr cry 1f 2 2 9-16 10 r4 4 none aicl lfahk mfr 9X if 3 16-27 7.5 r4/4 none sl 2csbk mfr Qw 4 . 4 27- 5 r i .G 0 I v Remarks: ©. r : =Mm�! M M ©m 'l- mM •M. MCMM- m- �== EM INFRIP"film -- Remarks: © MCI : r -- ' ��10M -ME ---�1UI_EMIM Remarks: rnemarxa: Sa0�330IR.05N2) _— r S l EEVS SOIL SERVICE Gory L. Steel 1554 200th Ave. CSTM2298 Richard stout New RidMn , WI 54017 MPRSW 325a Nam+ S3-T28N-R19H (715) 246-6200 tom of Troy Tlot *41-Ootmtry Wood N 1'=40' Hn.= top of 11'steel pipe a el. 100' Wbl •"V JS •i�C�XX"�� Gary L. Steel 4-23-96 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM Safety and Building Division INSPECTION REPORT GENERAL INFORMATION (ATTACH TO PERMIT) Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)I. Permit Holder's Name: City Village X Township Oeverino Homes LLC, aka Oevednq Prooertie I Trov, Town of TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER ;e% CAPACITY Septic G � ;Ia�25 Dosing � ��L Cg e-oe- Aeration Holding TANK SETBACK INFORMATION TANK TO PIL, 644— WELL BLDG. Vent t Air' make ROAD Septic Z 7 T �f �� I —_ Dosing Aeration r D Holding PUMPISIPHON INFORMATION GPM Dist. to SOIL ABSORPTION SYSTEM BEDITRENCH Width Length / No. Of Trenches DIMENSIONS / ZZ -2- N SETBACK SYSTEM TO P/L BLDG INFORMATION T ��ff S tern 1 / ,r, YpeLO/v✓e � o ( o DISTRIBUTION SYSTEM Ft STATION BS HI FS ELEV. Benchmark Z / `L / 07 JA r r K.J An. BM V7,11 Bldg. Sewer �.a /az./ SUHt Inlet /66 S SVHt Outlet Dt Inlet Dt Bottom HeaderlMan. / A 99.1 ,O nnai oraoe ,^ V 7 401162, Q162I / STREAM LEACHING CHAMBER OR di UNIT Length_�Dia� ILengtth ` Dia Spacing I I I `a'r SOIL COV . ora ..m Rvcfamc nniv rx Mound Or At -Grade Svstems Only Depth O Depth Over xx Depth of toe Seeded/Sodded roc Mulched Be enter N t Bed/Trench Edges Topsoil -I Yes L� No [—'Yes /,,( Y T (I lude code discrepancies, persons present, etc.) Inspection #1:_/_!_ Inspection #2:_I_/_ 11 on: 654 Tradition Tr it R� er Falls, WI 022 (SE 1/4 SE 114 6 T28N R19 Walnut Hill Farm aka The Tribute Lot Parcel No: 22 8.19.1741 1.) Alt BM Description = 1 O s..11Gi i n O /t���/�, (1� Gd yv. 2.) Bldg sewer length = I /L; NO fo. 49 L� - amount of cover HZ on Plan revision Required. ❑Yes }NK/No Use other side for additional information.I SBD-6710 (R.3197) __ � J I pcxow dnwuq- Cen No. Date Inse Em Em rr �y r�' ,odoslr)' savices MvwM „t6l uo E weihm Ave Cawly ST /, a)( PI162 �i,`.� 1`. 733707-7162 P®t Rjobw (ID be GOW by Ca) 11�Sanitary Madisaa v✓, Permit Application ShiaT'�rJa�Cb.a'N"� b as dw= wdh SPS 3931](21 Wm Adm Code, oba®m OfdWS form ID tltt eppagriele ®va®al coimd "' a roWucd Pm to obaeaog a nwwy perm[ Note: Apoiatim fain fa swb4v sd POWTS arc wbaioed b P.ojst Addmo (.fdff� d. nadmg addrea) aviors the Depadaeot ofSafidy end o Nufft W SPemmfi l vda m Yr p onde snag be used for Y l PXPOSM naomdnoewdtht ►.w & IS lXmj San L Apolleadw Iorexwdm - Plr his AB Isdsrmad" Piopety O"Meslb= Pma4 f wpm S. DOLN 040 — )z 3S—zo —000 Pmpaty Owmes blefig Ad* Aovaty,oeom 5 (ter RbOUD - C.ML LA VE %4 Y.. Secmn uty, slue Zip Code 14 m Nirbv Af Osw I,� a 3Ho/b %�z - 8�� 391b T Z8 It �` ' IL Type of BmsY (efeek an dot apply) lot / S.idi.maa Norse I a Family DwcUmg-Nuabe ofBadr ' D I St,4 f BIDCt Co W oo �p n1 ❑ Pd*c Cmmeeal - Deaibe Use ❑ city of ❑ soft OM d-Dwabe the Css4 ❑ Viumv Of Nadiw Tarof Troy ID. TPpe of haoaiC (Crab only owe box as Um A. Carprh Use B if applieirle) A" ❑New,SYMOm Rspho®ae Symea ❑Trem -Okid" Tat Rep6...i Ody ❑ Ods: Mobfimb= a faomwg System Ospin) IL ❑Pent Rmrwd ❑PwsA Resisim ❑ChwwofPbrba ❑Pe®s 1}�edvb New litPreviaofi4aWWnm*mmd Dsblamd Befaa F i i o.me Z99/ 87 ►Z — 03- 9 fVy. spow of ro T3 Creek OR that[WN-A-wr-dbr•Caoaod � ❑hmma®dFaCa ❑AWO& ❑Iford>24euf sort ❑biad< admm&*sal //❑ lw&* rack Obw Dopeal Cegma W (apan)r-/ LTE(, (elm) V. DbpwmVrr=d=W An o Iaiaeliew Design Ow (upd) Daip gal App,itim RaQgwhf)DrOgOrAM Retviwi fsn Arr Yropoecd (st) F]eadiaa y VL Took Imb Capeory to Gellms ask Gdk. 01 U vvgg 3t 3� New Tab T9Ya Tab p 5 s.Pfi:-4 s0(1,0001 WEEKs iW06F Vd Ragonswully Seeaeswest- 1, dw wwaeedgad, aas 4r s.aariaslaw due tVwtSswo r tore HteHN Iser Phrbws Name (Plmi Pheabe's Sganee FIFPIAWRS Numba Bomrsm Phme Nanha :Ak(65 1 2Z40:37 7i5- 5 79-2s5� 's Add,ve (SWO. city, saw ZIP Cade) CS e rH(VVE*1,4-S% 0 tIAZ 7T WT 5-472 VUL Use ❑ Approved ❑ Dmppmred Poe D.m Iswed Freon Agat Sipalme s ❑ aeoQ Givr R� for Do" IX. Caad:tiar of AppwsoVBeaaaae pore Dbapp meal Aamb a aaPYm ter srr ore sdarar aeaab dwCaaay ab —pT. awV ar a M.11 bete is A. SBD43N (R. 09114) •=Turn-upvdballvaheor IEX-)IEz,2 W241 Laterals & forCernam SCh 40 PVC oleanoutplug t per SPS Table 384 30b Holes drilled on the bottom of the letetal. PAGE 1 OF 4 Pg 1 of 4 Pg2of4 Pg3of4 Pg4of4 Flta�R sv In -Ground Gravity Plan Index & Cover Sheet component MW.W nesiyn Reiterermw version 2.0, SM-10705-12 (N.01101, R. 10/12) Index & Cover Sheet Plot Plan Dispersal Area Cross -Section & Plan View Management Plan POWTS Appiic Soil Evaluation c Tfl J K Project Name 1 Description for Review xt & Site M OwnerName(s): AAK0,J S, L)oUJ&Y Phone: (ilz- -3*1 Owner Address: 5 y 5 coy �e3 azT R p . } �u Ds o n) zip: Project Address: Gout. Lot: NL--- 1 /4 of 5i 1 /4, Section C�5 , T Z y Township: 1 rZOy County: 5r C sic Project Parcel lD# 041[-- lz312O-000 Designer Information or W Designer Name: ,NlAi7,,V -1-flLte CKT Phone: 7)5 - 1-775- Designer Address: 28LIq'1 KW& ArTfiutzs L+-. tlmgvK�+, t u zip: 598-s0 E-mail: h0ltt4,erJestqn r wHtoK- Lion This =my. r� Ae License Number. 109 - DD 7 ,•••••••••• Remarks: ( AfARY D last ���glii111L1� Signature: d Date: 7. 2z.T? 9r /1 /p Ply PLAN NOTICE: Please provide the following: A plan view sketch showing everything within 100 feet of the system. • Two horizontal reference points to center of septic tank manhole cover. Show alternate benchmark, if applicable.] .Ilk, IN -GROUND GRAVITY DISPERSAL AREA Uniform Elevation Trenches with Qcadc4 Standard-W Chambers 3-tt Trench (down -sizing credit) SOIL COVER arwb AAKOti howey . sapleTwa(a>WbaarhR ot0 a _9d _a —s+ tae .e F1r Mwd LIFE_ rjW rje,aac7wtbblk I-T;' TYPICAL TRENCH :s CROSS SECTION VIEW 4 _ < ,Y (No Scale) systern8@W'MM= ffi4 (trF60* Qt# 9andfirtl-W r cly Cap (Slow location of ir" / o" Pie c ooscdon e, pien view.) ----------�'--------0---- �_ ft INSTALL PER TRENCH: Qidca Sfo-W @ 20 ft' ESkkh lb, = Leo f 1) @ 4� + 3 PehsofendCW06f6SNpW- —J1 r Provide ff** n 3 ft separalion belrYeen bend `�° TYPICAL TRENCH l+nwnavil s PLAN VIEW t►"' (No scwe) TT TA03.01 —� m Slsldar6W chamber CA) x.iwbe. .�1 'n W Yw-w9 bn�i-lKa�a A Proposed OSA pw bald - — ie Req,Jrod dYba/on Naa- j ��W DisbUdw Medw& —; trenUtes - Pfoposed Told EISA - _ fe AAAN d FO<.p 750 ;p,74Z;;otl,�t f�2guoullzdo Ijb7l.4 3 ; 20 sis t % wvr - r 5b, wdlTa or, 35/ 511 uNrm x�►fo (li 3 Hd' 48 r. y � Og 07_C� PAGE 4 OF 4 In -ground Gravity Management Plan NrQKrAKTu The owns of flra in -ground gravity system stt.i be responsible fm its perpolual operation and maidenance pursurt to reytiarnto to of SPS W-31 4, Wtec Adm n. Code_ Pusuent to WS 383.52 (2� Wiec. Admit_ Cadethis syslern stall be considered a human hesNit hazard it not mai faired in accordance wtih this approved management PWL FuAhemwre, alli apeclion end msi+tei na acliviies shellbe performed ty a rsgirierad POWS INtfainer in accordance wtYt SPS 383.52 (TL Wisc. Admin. Code_ MaXbM m Waoet> W Area OoaratiN Lifts: Design Fla„ w 7, -t gpd; WN S nD tevO; TSS 515o trgO; FOGS 3o mgl_'r INSPECT EVERY 3 YEARS o type of use o age of sydwn o nuisance factors (L& odors, user complairft at¢) o madveri al mallundon (Ls. pumPe, valves, mvkdvm floats, elc.) o mallen fatigue (lie., teaks, bfa9l�. corrosion, atc.) o acids veiene in anaerobic traernerr tangs) and any distribution appurienance(s) (Le., rjeibufan / drop boxes) o neglect or "Wqw use (Le., exceeding design cape dies. peldded activitiesk arc.) o exter dpondim in distribution call prior to 1, 1 g o dosing irregularities - If applicable (La.. pang re -cycling, float swNch settings. etc.) o ekx*icel components - if applicable (Le., will¢, rxmecflons, swfiYres, cordtrols Beam alarms elm) o distribution lateral or lateral orifice singeing (manatee lateral distal Vessua — dxxnp®e to dealgt spectfiCOM) o surface dfadwW of of kart or sewage back-W lido shuclure served 1111MAnUnance Chedust MAWTAW EVERY 3 YEARS (or when necessary) 0 3e00c and doss taNdai ahsM be PuFnpad by a certified septage servicing operator icarnse 'under s. 281.48 Wits. Slats. when On valuan of ao&b it flu trtqu) ascends one4t*d (Vb) fire Ygdd •straws of tba t er*(s) or as required by local ordinance. Disposal of Contents shell be pursuant to N2113. Wisc. AdminL Code_ o Clem fMtarfst shell be inspected arry 3 years and dad be dented when necessary to re niove any accumulated solids according to nnrwfactuer s apea'fiCaYor¢ A sevici V period will always be ¢eater than 12 months. Syatra msisbnm reports of W be aftellted to the prepay local t toil in aecordsrrn afitlt SPS 383 56 Wist Adwi► Coda. nd Nsport aoowportrrt laic cr o womo lux t Name of individual or company: 4bVA,4JCEZ =SS '/ C f er 0 Pt.. 7/5- Localgovennrentunit SV.C,12VO. CbMMwvlTy DEQELpeAAEArT- Phont '715-396-146W Local govemment u it address: H u D&W W.� z*3- _6Y& L_ Any defective Pert of fills sysl sn shall be repaired, replaced, or removed putarant b SPS 383.51(1� Witt- Adam Cade- Repair or rePltbenent d faired orrnefutdionft Coi,pmmm shall Comply with SPS 383, Wife. Admit. Code. No pfod c1 for dreetcai or physical rsaloralon of fie POWTS maybe used u less approved byte', deperinertt in accordance with SPS 384, Wiac. AdrriL Coda. C mdkMency Plan In the evert tiret any failed ineei nut component of Ctrs POWTS rarrtot be reposed. it shall be replaced PaWAN to a pen subntHed to the apprapniete agency for review, and approval. A bled in -ground dispersal oonVonert may be abandoned and rapaCa I by a code-eomptyfng dispersal component in a pre-dakani<red area of stalabfe Soil& If use of this POWTS is discortfrtued, it drei be abandoned in a000rdennoe with SPS 383.33, Wise, Adnin. Code.