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HomeMy WebLinkAbout030-2131-45-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: Safety and Building Division St. Croix INSPECTIONtREPORT Sanitary Permit :No: GENERAL INFORMATION (ATTACH TO PERMIT) 538746 0 Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. State Plan ID No: Permit Holder's Name: City Village X Township Parcel Tax No: Oeverin Homes LLC, C/o Kenneth J. Oeverin St. Joseph, Town of 030 - 2131 -45 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: ' ~ 2 C45T 23.30.20.1099 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER �h S F CAPACITY STATION BS HI FS ELEV. enc Septic Bh ark �o Ur 05r Alt. BM Aera Bldg. Sewer r c� St /Ht Inlet 63 / 61, 9 Holding 163 6 '-5 � / 4L w.5 . 9 TANK SETBACK INFORMATION St /Ht Outlet TANK TO 5 P/L :WE LL BLDG. Ve to Air Intake ROAD Dt Inlet Septic / i / Dt Bottom Dosing / i 7 5d /66 9 3 Header /Man. Aeration Dist. Pipe / ,/ Holding 3' � 7 o, Bot. System y PUMP /SIPHON INFORMATION G St Cover Final Grade l Manufacturer / Demand �QZ L ' PM �ZS� . Model Number Z � , TDH Lift qI Frictions o� 7 Agh � System Head TDH� Forcemain Length 55 Dia. i/ Dist. to Wel / Z 7/ SO ABSORPTION SYSTEM BED /TRENCH Width Length NF4PIT DIME SIGNS No. Of Pits Inside Dia I Liquid Depth DIMENSIONS r `7 J SETBACK SYSTEM TO P/L BLDG INFORMATION AKE /STREAM LEACHING Manufacturer Type Of Sv J . �� Z3 / CHAMBER OR ,^,/ /� UNIT Model Number: DISTRIBUTION SYSTEM aJ Header /Manifold Distribution / // I x Hole Size l Pipe(s) '1 �/ Ve t to Air Intake Length T Dia_ Length 7 Dia Spacin 3 1(o p SOIL COVER x Pressure Systems Only xx Mound Or At - Grade Systems Only t Depth Over Depth Over xx Depth of xx Seeded /Sodded Bed/Trench Center r Bed /Trench Edges Topsoil I G� xx Mulched Yes Ej No Ves No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: 3 1 Inspection #2: 5 / /`r /_ // Location: 1446 Settler's Way HHoulton, WI 54082 (N / NW 23 T30N R20W) Settler's Glen Lot 45 Parcel No: 23.30.20.1099 Wa 1.) Alt BM Description = ' O ' �`/ Tt/� , C in. 4- 4.j 2.) Bldg sewer length = C15 / - amount of cover Plan revision Required? Yes :I No Use other side for additional information. 1 ( (0g3 7S SBD -6710 (R.3/97) Date Insepctor's gnatur Cert No Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Buildi(tg Division INSPECTION REPORT Sanitary Permit No: • 538746 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Clevering Homes LLC, c/o Kenneth J. Oeverin I St. Joseph, Town of 030 - 2131 -45 -000 CST BM Elev: Insp. BM Elev: BM Description: Section /Town /Range /Map No: 23.30.20.1099 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration Bldg. Sewer Holding St /Ht Inlet St /Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic Dt Bottom Dosing Header /Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP /SIPHON INFORMATION Manufacturer Demand St Cover GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS —7 SETBACK SYSTEM TO P/L BLDG WELL LAKE /STREAM LEACHING Manufacturer INFORMATION CHAMBER OR Type Of System: UNIT Model Number: DISTRIBUTION SYSTEM Header /Manifold Distribution x Hole Size x Hole Spacing Vent to Air Intake Pipe(s) Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Edges Topsoil 0 Yes C1 No I Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2: / / Location: 1446 Settler's Way Houlton, WI 54082 (NE 1/4 NW 1/4 23 T30N R20W) Settler's Glen Lot 45 Parcel No: 23.30.20.1099 1.) Alt BM Description = 2.) Bldg sewer length = - amount of cover = Plan revision Required? 0 Yes 0 No Use other side for additional information. SBD -6710 (R.3/97) Date Insepctor's Signature Cert No sPAID F f Safety and Buildin s Divi ion County c aamm� ce.wl.gaw 201 W. Washington Av , P.O. Box 7162 Madison, WI 53 7 -71 `BAR 0 2 2 iitry rrrut Number (tO� fiilled ' by Co.) 1 7 � l scons ln ]eparttmottt of Commerce 4 � -- -... 5T, I ctionDlumb / Sanitary Permit Application p(,gNNING & ZONIN ( / -f In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the a menta unit in required prior to obtaining a sanitary permit. Note: Application forms for state -owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary u i) ws in accordance with the Privacy Law, s. 15.04 1 m , Stats. I. A.p licatioa Information - Please Print All Information Parceil# , +' � Property Owner's Name 2 , 2 q 1 W �!( Property Location Prol Owner's Mailing Address / r /O95 �b1/ 3 �e Govt t G Zip Code Phone Number y. %., Section Z City State p circle one) T 2 � N; R E or II. ' ype or Building (check all t pp Y) LO Subdivision Name or 2 Family Dwelling - Number of Bedrooms 0 1� oJse.- B lrifi� ❑ 1'tiblic/Commercial — Describe Ilse / ✓� ❑ City of r CSM Number ❑ Village of ❑ tai ate Owned - Describe Use n of sj � Q — _ S X57 a III.. Type of ' Permit: (Check only one box on line A. Complete line B if applicable) rBeforc stem ❑ Replacement S ystem 11 Treatment/Holding Tank Replacement Only ❑Other Modification to Existing System (explain) Renewal El Permit Revision El Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued piration Owner r IV.. Type of POW TS System/Component/Device: Check all that a 1 - ❑ Mon Pressurized In Ground ❑Pressurized In Ground 11 At >_ 24 in. of suitable soil ❑ Mound < 24 in. of sui le it / f ❑ }folding Tank ❑Other Dispersal Component (explain)_ - ❑ Pretreatment Device (explain) V. Dis rsaUTreat nt Area Inform 10 Design Flow (gpd) Design otl Appl gpdsf) Dispersal Area Require f) Dispersal Area P po (sf) System Elevation o y�v 4 / �o�� VII. Tank Into n Total # o Manufacturer Gallons Units ' U a isting Tanks All, /` F •, " �y 'n ,✓ U in rn w New Tanks C7 P, Sepiic or Holding Tank �( Dusing Chamber , \ SIP I V11 t. Responsibility Statement- 1, the undersigned, ass sponsibility for installation of the POWTS shown on the attached plans. Phambes N me (Print) Plum ature MPIMPRS Number Business Phone Nu ber Plumber's Ad ress (Street, City, State, Zip Cod T- VIII oun /Department Use Only Permit Fee Date ssue Issuing nt Signatu Approved Disapp S L/ wne (�- I.X. Conditi3yS1W �"Wasons for Disapproval J Q 1 Grl `a raj r �"t A 41".1 " i AAP_ I. Septic tank,efflueritfiner and V A� t i �.talwte.Qt:n. . dispersal cell must all be services F maintained wt "� t� iJ as per management plan provided by plumber. Z All Aback regttiremerits, must.be maintained 4) � t i r 41 w Attach to complete plans for the system and submit a the County only on paper not less tT 8 W x 1 ehes In / size / e (,�l�.. r Ft� tY• ,03131-6398 (R. 01/07) Valid thru 01/09 PLOT PLAN PROJVCT Oeverina homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NE 1/4 NW 1 /4S 24 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 100.4' BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none Ilk BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100 Filter BEST GF10 -8 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Lot Lines not to scale 3 Acre parcel Scale = 1/4" = 10' Tank is to be properly bedded and provided with lockdown covers 525' Property Line with approved warning labels Settler's Way Grading is to be done to B.M.* Pro 3 divert run -off away from Bedroom system House B-3 huffcutt n combo tank 99.5' � I� 99.4' B -1 B.M. #2 99 B -2 3% Slope Area 15' below system is to remain undisturbed 200' Property Line 406' Property Line Survey Iron for adjoining lots Safety and Buildings 3824 N CREEKSIDE LA commerce.wi.gov HOLMEN WI 54636 Contact Through Relay i sconsin www.commerisco sin.go/ Department of Commerce www.wisconsin.gov Scott Walker, Governor Paul F. Jadin, Secretary February 28, 2011 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1008 192ND AVE 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 02/28/2013 SITE: Oevering Homes Lot 45 Identification Numbers 1446 Settlers Way Transaction ID No. 1910134 Town of Saint Joseph Site ID No. 764508 St Croix County Please refer to both identification numbers, NEIA, SWIA, S23, T30N, R20W above, in all correspondence with the agency. Subdivision: Settlers Glen; lot 45 FOR: Description: Three Bedroom Mound System / 3% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1301403 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD- 10691 -P (N.0 1 /0 1), Pressure Distribution Component Manual - Version 2.0, SBD - 10706 -P (N.O1 /O1); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code R (CWT requirements. Con dttiolZ No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06A R� stats. The following conditions shall be met during construction or installation and prior to occupancy or use: DEPARTMENT OF COA DIVISION OF SAFETY AND Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the EE CORRESPON requirements of Sec. 145.135 and 145.19, Wis. Stats. • Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. • A state approved effluent filter is required. Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per Comm 84 product approval conditions. • The area within 15' downslo p e of the dispersal cell shall remain undisturbed. Vehicular traffic excavation or p soil compaction is prohibited in this area. • The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installation of float switch r relays h contain mercury. Pleases specify an alternative prior to product es o e ays t at co to p fy p p applying for a sanitary permit. SHAUN R BIRD Page 2 2/28/2011 • A copy of the approved plans, specifications and this letter shall be on -site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. Owner Responsibilities: • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. Comm 83.54(1). • A POWTS that is not maintained in accordance with the approved management plan or as required under s. Comm 83.54(4) shall be considered a human health hazard. In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. • The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, ` Fee Required $ 250.00 Fee Received $ 250.00 Balance Due $ 0.00 Gerard M Swim POWTS Plan Reviewer, Integrated Services (608)789 -7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART'code: 7633 jerry.swim@wisconsin.gov cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M. Notice: Starting July 1, 2009, no person or entity may engage or offer to engage in construction business in Wisconsin unless they hold a Building Contractor Registration, or equivalent, issued by the Safety and Buildings Division of the Wisconsin Department of Commerce. Cover Page 13ECE ED FEf3 1 7 ZG 11 Shaun Bird SAFETY a 8L1,LD S Bird Plumbing Inc. 1008 192nd Ave New Richmond Wi 54017 715- 246 -4516 Date: 2/15/11 Owner:Oevering Homes Location:NE1 /4 SW1 /4 S 23 T30 N,R20 W 1446 Settler's Way St. Joseph System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page, 2. Mound Plot Plan IVY 3. Mound Cross Section -fED MERCE 4. Pipe Cross Section /Pipe Layout B ERCE G3 5. Pump Chamber Cross Section 6. Pump Curve FENCE 7 -8. Maintance and Contigency plan 9 -13. Soil test Shaun Bird Signature License nu a 22 900 PROJECT Oeverina homes PLOT PLAN ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NE 1/4 NW 1/4S 24 /T 30 N/R 18 W TOWN Richmond COUNTY ST. CROIX SYSTEM ELEVATION 100.4' BEDROOM 3 CONVENTIONAL AT -GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of 1" pipe ASSUME ELEVATION 100' Filter BEST GF10 -8 ❑ BOREHOLE O WELL H.R.P. Same as Benchmark Lot Lines not to scale 3 Acre parcel Scale = 1/4" = 10' Tank is to be properly bedded and provided with lockdown covers 525' Property Line with approved warning labels Settler's Way Grading is to be done to B.M.* Pro 3 divert run -off away from Bedroom system House B-3 huffcutt combo tank 99.5' ❑ n 99.4' B-1 B.M. #2 99 B -2 3% Slope Area 15' below system is to remain undisturbed 200' Property Line 406' Property Line Survey Iron for adjoining lots Mound System Cross Section and Plan View Dimension Feet A A } B 5 7 l r D i T E I r 3 A i � F - $ W G I z H i 1 i 0 I i J, 1 K D f: L 7 r r r r r r rr' yr. .r .r r.. r .r r r r r r r �' i,r r r r r r r rr r. iD 'V r I /✓ __. K 1 8 1 z E SI Ee L r - — ,.l = Topsoil = ASTM C -33 = Clean aggregate = 4 in. sch. 40 pvc 0 Ca Material sand fill '/2 to 2 '/z in. dia. observation pipe L A r Geotextile H Fabric . F Ft D E Plowed Surface Ft Contour Slope Direction _ may GENERAL INSTALLATION: The mound area is staked out along the design contour. Ex'sting vet dation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a' /4 inch soul wire when a sample is rolled between the palms of the hands. ASTM C -33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than o lne foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing, The ob:;; -,rvation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10!07 lgj Page of Pressure Lateral Layout Two Laterals — End Manifold 4 Threaded Cleancrtot Lateral Turn -up --► Pluu Manifold i M X —� L Lon;;`> Force Main �J� Sweep 90 Bead Distribution Network Specifications Pressure System Construction Lateral Diameter cA- In. Manifold Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter 5116 In. pipe. Orifices are drilled perpendicular to X Orifice Spacing) In. the pipe with a sharp drill bit and face down. L Lateral Length) Ft. Lateral turn-ups terminate with a threaded M Manifold Length Ft. cleanout plug and are enclosed in a 6 -8 inch Force Main Diameter ��'- - In. diameter lawn sprinkler valve box accessible Force Main Length Ft. from finished grade. Nv. of oR � � ices t-Ar z� $ • • • • • • ••••• Grade •••••• • 6 -8 Inch Lawn Sprinkler Valve Box Page of 03 /051gj 'Septic T ank Cross Section And Pump Performance Specifications Pump Manufactu — Tank Manufacturer U_ p Model Number 'i ank Mociel Number Alarm Manufacturer Q C -�v r Total Tank Capacity b 3 a Alarm Model Number 01-- v Iax. Bury Depth witch Type SEE CORRESPONDEN An Total Dynamic Head (TDH) - Feei Filter Manufacturer � .S"T �" Filter Model Number i e F/ Elevation Head Distal Pressure .0 Network Loss Minimum Pump Performance Required Force Main Loss GPM1 @ ' ; Ft TDH Total - .. - - -•- Outlet Manhole Min. 4" Above tirade With Manhole Min. 4 Above ('Aade Locking Device. Inlet Manhole Securely Mounted With Locking Device: < 6" Below Grade Sealed Watertight Weather -proof -► Junction Box - -- Finished Grade won U.Uw — Vent Min. 12" Discorn sect Above Grade Melons With Vent Cap . / Y,Y 1 Y r Y,r,Y,Y r r r,',r,,a .��;:`:`, :`i :: ;a;ls,a,a,{;a;{;a{;a; { ,r, > :`: r �.; outlet Filter Inlet Baffle ' Inlet A Switch Settings and Reserve Capacity V1r -'eP Tank. Volume = j GPI il:,le IX Dimension Inches Volume Gal. . > (reserve A' ..>' .Y. Off Elevation C al B ,. ` ' �' ' • ` 'Bottom (dose) C • -� 7 - (dead) D S ation D ' ' ','lev 3 Total a . { a e �,T'r��4T��i� , �' iTY—e'T'Y'Ti'T "tT'i"i"f-s'i'TiT a i a { . r,.,.;a,r,ri r .r :. °a` : : :� �rY�.'. a i i 1 i <, ,' Y 1 s ,,1,.� ,1i ,., r,1 . a . a l a >` / S, 1,{ 1, 1,f, {,a, a,{, a > ,,, Y ,,a, {,a, {, `, ,.,• :Y s ,1 a { { a i . 1 1 < { 1 { a 1 �ii the GENERAL INSTALLATION: The septic /dose tank is bedded and back filled in acco den m� GENE :4.�� not manufacturer's product approval specifications. Maximum depth of bury as specified by the menu a , I,1 ock ) be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (p fitt , i and installed. Piping at the inlet and outlet is of approved for r main is sleeved with 4" Sch. 40 PVC obridge th t nk laid on stable soil to prevent settling or sagging. T excavation and the sleeve is sealed watertight. Electrical service complies with NEC 300 and Comm 16.211. 02/05 Page of U - 1 715 bw WAY -v -ww ..._— lay; L"GrJOt 3100; LA L IJA c �H 5iER1 SiU M1� /E�'"FLL��N It mom ILU 4 p wr► w UiON Y+9 ts6 39 70 5b is v Lss tHAlyifr AWN s il'U 1DJ! A s "*a wow t11RM ytg i� � � Iwo� tw�tarAM 1 r !'iil�oA . rt ow �aYr Motor �" Caw Iton 3w as W Am - 7a t� Bad ' cwt and as �• ut a.� �e� � SwMfM cwu . - -- dc� Puw � /oRn 9l�id: •-' AjLa pag .. of AGEME14T PLAN QOWTS OwNtill MAN UAL & �S SPECORCA �i�1s gepetbTax Old u D �4L 1�� :lYfAt �t�i P P r c� e� DNA g T!if* � - EEM�ij w �'� ICI NA mat [ ' 0 NA g W. oo- p,� :.3 �" C1 NA �� HK3D a n NA Tg * - lurnbv +CFA OVA PUMP. Numb or of Gbnnme Untts �� Tunic gnu LC Q NA ES tour Pump m►� t pn P flaw U pump M dod _ DNA � ANWIkwo c F101111 F101111 l+Aocrthh► *Venl6i• Pretre+tt�r� Lt - 13 Post Filler _. ..--- • i3 Swiffleti�t atttnd �rdltnen� uluerat t�ustuy S3t7 milt- C3 MedM*01 fl W Fes, 01 & CdnMM (FOG) s220 �ti p pisfife�n E3 Other H�Oa, ,�8S1 50 4 .. TOW pmb"Wol E uent Qum* J" D� M m p i ed (yt Y) er flwj 0 S30 mill e D Other" - .• TOW S sd t ao& M Si0` ci�aJ40QmI Q �rpee,i�aMrMr+d _ l=ewd K lnandlametsr vSd(+-�° S1ba 'y'P°o Max inttt�•rc Efllusnt at(t>de 1 t EN IU4CE S+H�L.E servtcs Fmquency - � Event ` b months Ks) (M um 3 yYS.} At feast once avert' n of scum aigc�Es on t[tkd (� ottaslc voiwne dHio and ���n 'stud a . :. fns ed 9e when comt�Fn a r( (W eAmurn 3 fires.) PUMP w." Cwtents of tsnkts) At least ante emery �- f3 month - �t nsp dts mnw MKS) £7 nuxdha s) Al least Once every D m0now O NA rfaen n! 1lfuerstl� ter' - .. At least once every s) 0 NA At least Once e nsp� FVeuP. t�P �� � afstnn p moeYtlts -. mom very teat D s) Q NA t]wdt blow+ and preawr�s leg8t =on�QOOVW D nwindw YAK II S) D NA least r ` ` t . rxUsr M >iowum or a�Urue�ttEldAtVtc� ce lls elf be rnalde by an indivkkUld c�t� one of d" Wo**16 � 8eptslif= jnspaoBrc+e of plutnbsr t1AasW plumber Restricted sir; PO TS irtsp� Idol �l WW Or imp "" �E•farts: Meow tnusat ktcktde S Yiauai k SPOCU n of tfte ) s� a:,d dtsctK bru lc up Serviot'ji f OP�Of Tank � me the volume of combined sludge M t�edC 00 etpt�ant levels t�ardrnsi% k Y SM Or tea ks. The dispersal mss) WOU bib vta�' � dl on Ives rye �rdi V of On 1 P of aftfttettt 011 tRte Sri � o ��, ktoal n9t�isMri► e� phW end gmund W110 0 "M k9k*1e a nand req I the * � �� W Or � o W* Oh NR e �d scum h Se ltrnk a4 of M =Old*" When nye colnhirtsd af:d9 $ SePt,� Senddlt� disposed l+ no inth WOM c, nteults a� the t8nk t;tta� alit' i f3, Wien a u� POVIM COMPO tW'S' P &Ia;OMMOr t3 serwtCmg of 12 moMhS or less shd be pw � � e�ni radar nib or monk 1i ta6o 8U"* whin 10 dOS r f comma Mpo>`tstWft pvAded to the focal raga rY START Ulf AND OPERATION . PERATION of P � UCf S r a dler For new 4=n$M x dw. Pry to use of dte PDV►�s oh ndfor d t do- for t 0 Pr � the � pro cess sndlor damigs the daspereat K )- chemiea:ls #jet teat' impede brx dw 10 "se, CISW' I too the tAnbe o of the tonl4s) rarnovad by a septsge go - servi ci ng a�er8 p l do start up Sha11 not occur When When �`l•conditions are irozei:n at,the infiltrate u restored the e>mess Ste' es p mp two= MW Tlii above nort he l water Ise. o ve O�+s po �°� � oett(s} t in one longs se. at'laading the oeB(s) and m2ty result in the !loo then d� id this situation have the conten of the pump tank removed by a �tp o sr>trfac+a g ... t the etPftuent p+umP or contact s plumber. or POWT ` Mafiiainer a o ressocing Yt Y fns p=p O°n� to restore normal levels within the pump tank - assist timlre or v t; W and dish t�S. Do not drive car pack Over or oflltsntrise dssbuc� orcomPa .w dw aces wMin 15 feet down slope of any mound or alt -grade surf at>scirptOn i a- from the wastewater sbwm may improve the ped6rinmoe and g the I f' RelucdOn or eraMnaWn of the � rte butts; condoms; cotton swabs; degr ; dental fon. e>f the pOWTS= �; babyvrripw.- water, fruit and vegetable peeCmgs: ga�oe', g��• he[bi miss; me,I;: dam: fat foust"6" eittakl {swrlp P. P) saaps� mefficoons; aft: g p��� ` sanitary napkins: tampotls:'and water softener brine. ABANWNIMENT taken out. of Service the f0lloweng steps shad 49 taken to (nsure that the WrW the powre rdW and/or is pew Y system is pmp�y �d ��, abandoned in t�ortspfisltc� vvifh ch_ Comm 83.33, {Artstxms7n gdfTllrtisdative Code-. • AN piping to tanks and pets 8W .be disconnected and the abandoned pipe ppent�Se fiervidn9 Operator P P� sed of a P�9e • . 'tT.e e�tants of all tattks and pigs shall be riemoved and properly d�spo by • After Pumping, tanks and pits shaft be excavated and rem rs oved or their cove removed•and the void space all MW with ,sa. gravel or another In8d solid material. CUNTINCENCY PLAN the ficiilowing measures have been, or must be taken, to preveda a code if the P()Wi'S tails atld cannot be 19paae¢ compliant repla Wrieent system been [I A suitable r,eplaoerrlerttanea hms been evaluated and may be utilized for the location of a replacement soil t area should be protected from disturbance and compaction and should ntl absorption system_ The replasmen be infringed upon by re qukeed setbacks from existing and proposed structure, lot lines and wells_ [ =allure to profit the rep area win e�su(t in the need for a new soil and site le ort valuari to establish a sudable nt area Reptacernent systernS must Comply wi replaceme th the rules in effect at that time. CJ A replace je nt are re p la cement area i not available due to setback and/or soil limitations - Barring advances in Powr:, technology a holding tank (tray be i as a last resort to replace the failed POWTS- The site has not been evaluated to identify a suitable replacement area Upon lariats of the POWTS a sdd.and evaluation must be � to locate a suitable replacement area if no replacement area is available a hokfirtg tank may be enstalted as a last resort to replace the failed POWrS_ Mound and at gtadq 3 og absorpttou systems may be reconstructed in place following mmnovml of the blomat at surface, ins of such systems must comply with the rules in effect at that time �cYYARP((NL�� SEPTIC, PUMP AND OTHER T ATMENT TANKS M l� AY CO TIUN LETHAL 'XIS" AND1OR INSUFF'CLEN OXl a 3E1+1. DO NOT ENTER A SEPTIC ixLIMP Ott Q7HER TREATMENT TANK UIYD� A4Mlt CIRCUMSTANCES- DEATH MAY FZESULT- • RESCUE -OF A PERSOW FROM THE INTERIOR OF TANK MAY RE Dll~FICt1L7 OR IM POSSIBLE uI O m ONAL COMMENTS l'OWIS (NS7 R POWTS MAINTAINER Name cz u r2. game ph ,p? Phone SEPTAGE SERVICING OPERATOR 14IP LOCAL REGULATORY AU MORI Y c Name / l/� rJ Agency 62 Z_ Phone Phone / ✓ j Trt& daarmext was dadked by, Va sh As of the QWW a I sills. Marquede and Wa ushard Covoty &nlny and Sari 12 im 40RM*9- This d0c"Bfll malts VW tnimmuW nw r&smeats at CIh. Carua a3 22(2)&)( -id 83 . 54 ( 4 ). (2) S (j), Wiscrnsia Adrrdn&VztiM Cade use of tfrls document dws Wt guaranta the pec' wnanoe of the POvlrr5. ' � tillil Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 3 Division of Safety and Buildings i t in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and loca and distance to nearest road. D 3 D Ol / - 3 '" s fi R sewed y Date Please print all info ati60�. ti� ._ ` _.y Personal information you provide may be used for second ry purposes (Privacy Law, s. 15.04 ( ) (m)). �` 31 3/63 Property Owner f , ? Rippe Location corn 77 77 77 J G CC ovt. L /; 1/4 7 1/4 S �3 T 3O N R a E (or) tl� Property Owner's Mailing Addres Lot # Blodc # Subd. Name or CSM# / r � LP7 C r State Zip Code Phone ❑City C] Village �T own Nearest Road tY Z ( ) 4S9 - Z / 4 _ - Se New Construction Use: [� Residential / Number of bedrooms _ Code derived design flow rate A, 11 U GPD ❑ Replacement E] Public or commercial - Describe: Flood Plain elevation if applicable Parent material r 1' General comments �5� y � e f , �(�'� Sv , and recommendations: rr or��vu �I�✓ 9�SU sy S, C f Q(;;_� f ❑ (❑ Boring # Boring , O C) ft, Depth to limiting factor in. �- Pit Ground surface elev. P g Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz u in. M n se II Qu. Sz. Cont Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I -�© l 0 3/Z s i/ 2 rY) Fr S '� b 2 (0 -2 q lb l3 24-9 /O OW 7.5 < I SC_' Boring # ❑ Boring ® pit Ground surface elev. ; 19. Yb ft. Depth to limiting factor 30 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD /ft= in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 I 'Eff#2 2 Li- 30 M, — rr�sbk r c S 5 C ZP 7_f A� '5'_ k ' Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature CST Number c�Urv,,�cr 253 30 Address - h ' 1 �/< Date Evaluation Conducted Telephone Number 2x13 / 15? Z (7/5� Z-`! 7 ,-q U a Property Owner C_ Arr i Qqe ��or>�� Parcel ID # Page � of .� Boring # • ❑rn Boring Pit Ground surface elev. �9 5 � it. Depth to limiting factor 3 In. Soil Application Ra Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPO/fl In. Munsell l]u. Sz Cont Color Ge. Sz Sh. .. 'Elf #1 •Eff #2 3 3l - fib 16 ,jr b CZP 7- -(1 5L1 3 rnSbk- F-1 Boring tt ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor In. Horizon Depth Dominant Color Redox Description Sail Application Rai ,.._ ., Texture _Structure Consistence Boundary Roots GPD /ft' in. Munsell Ou. Sz. Cont. Color Gr. Sz. Sh. 'Eff #1 'Eff#2 a Boring # ❑ Boring ❑ Pit ' Ground surface elev. ft. Depth to limiting factor in. Soil Application Ralt_ Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD /ft= in. Munsell Ou. Sz. Con t. Color Gr. Sz. Sh. •Eff #1 •Eff #2 Effluent #1 = BODS > 30 < 220 mg/L and TS >30 < 150 mg/L • Effluent #2 = BOD < 30 mg/l. and TSS < 30 mg /I. The Department of Commerce is an equal opportunity service provider and employer. 1f you need need material in an alternate format, Y y 1 assistance to access services or rim please se contact the department at 608 -266- . ._.. .. � 3151 or TTY 608-264-8777. 4 8777. SBD -1770 (R07=) PAGE_;�_OF 3 NAME rig awe- LOT# qr LEGA DESCRIPTION v� ��w`� T 30 N R. 00 E(o6V SCALE: I"= BM I ELEVATION /Up U BM 1 DESCRIPTION -6g) d4 ( BM 2 ELEVA'T'ION q41 y BM 2 DESCRIPTION SYSTEM ELEVATION ___ S U SYSTEM TYPE m CONTOUR ELEVATION a SIGNATURE DATE y� Z PAGE 9 OF 3 NAME Ur /��� LOT #�1rLEGALDESK- uTmrION vF �.��1/ S7 T 3o N ZG SCALE: 1 "= �D BM I ELEVATIO /00- O BM I DESCRIPTION 4v o I OUc_ O t D e BM 2 ELEVATION 14.1 y BM 2 DESCRIPTION ( Oo� O b,.e _— ____ -- _ C• L 3 SYSTEM ELEVATION /DU SYSTEM TYPE YK CON'T'OUR ELEVATION " o U o n -- j p Ly �� d U • � rl'� Z 4 DATE SIGNATURE G�-� LOCATED IN PART OF NW 1, THE SW.1/4 .SEl/ SE 1 /4 OF SECTION 23, ALL IN T3 i �1,6; Lo CA-n a� BCcS� -d � d t sue'► -� C.� � . 890.2 LZAL3 GCr 893.4 x 1... ............... ......... .. .eoi.01 x X 887.9 OT 45 I SACRE8 � • ® (5.00) -; dos x .. • w ' • 888.2 y •,�.. y 4k x # 44 $. RES / ®® x A x ® 878.5 , T 43 00 ACR 881.5 . pi (5• ' t I� 881 81. AAMR 862.9 Aft 14 - t i j liiiil►li►ill►lII 8019658 STATE BAR OF WISCONSIN FORM 6 - 2000 Tx ; 4014899 SPECIAL WARRANTY DEED 931876 THIS DEED, made between Bremer Bank,. National Association, BETH PABST Grantor, andOeveriae Hour, LLC, a, Wisconsin limited liability REGISTER OF DEEDS company.Cuantee. ST. CROIX CO., WI Gruoor. for a valuable consideration, conveys to Grantee the following 02/07/2011 4:27 PM described teal estate in St. Croix County, State of Wisconsin (the .. Ptopgrty"): EXEMPT *: N/A Lot 45, Plat of Settler's Glen in the Town of St. Joseph, SL Croix REC FEE: 30.00 County, Wisconsin. TRANS FEE: 69.00 PAGES: 1 necardit g Ara Nam and Retum Address: St. Croix County Absuaa ter T'nk Co., Inc. 219 S. Knowles Ave New Richmond, W1 54017 SS 775M Together with all appurtenant rights, title and interests. 030 -2131 -45400 Pacd Ideaiaeatim Number (PM This is not homestead property. Gtntor warrants that the title to the Property is good, indefeasible in Fee simple and frea and clear ofeneumbraoces,.arising by, ft6ugh or under Grantor, except Subject to existing highways and subject to easements and restrictions of record. Grantor's warranty Is limited to any events occurring subsequent to the time that Grantor took tide to the above- described real estate. Dated this I "day of February, 2011. Br er Ban i Ptati ai oentioa / ✓.' � By- Bradley Kro mar Vi t t / B lSident t � _ AUTtIENTiCATION ACKNOWLEDGMENT Signature(s) STATE OF MINNESOTA ) COUNTY WASHINGTON )Ss. authenticated this Personally came before me this I" day of February, 2011 the above named Bradley R. Kteemaa, Vice President of Bremer Bank, National Association to me known to be the TITLE: MEMBER STATE BAR OF WISCONSIN persons) who executed the foregoing instr u taR and (If nee, acknowledged the same. authorized by § 706.06. Wis. Stats THIS WMUMIt was DRAFIEo By C.i umesata Robert L. Lo My commission is ttent (1f noi, state expiration date:: (Sipsum s maybe authaniueed �Iuww can, ke a GL� - �/ .�/7/ ) eo rqT eery.) 'tame atpenom upping in my opw4ty must be typed or primed befmr tkir signmmue. TAMMY ANNE LUND SPECIAL WARRAM DEED STATE DAR OF WISCON - NOTARY PUBLIC - MINNESOTA ' c+ My C0MM1SSj0MVA 2013 1 of 1 NJDOPQ�@44flD_6�OOL [�47 CCO(�GdO C ' $TAT161B11�S.HC4 $ $ $ c Na0'41'�8"W /0Y3.62' wn axae _.__ __.__._� .__._- . __ _ ♦' $ i.� !i �41'Z6"W X4.01' 03 oi«nearFlciiRiiGGii� �• — — — — — 7 — — — N00'1Y''E a . I a /, r .............................. ♦ f$ a ACM 45 i $ Jam # / 9001ACFWS _ � ♦ 130.741 8Q. FT. �~ $ / VOOCC4rR n L i C cl oe C LO'T 44 p �1t �ar44 3.OMACREB ��i /ti ♦/ � a . 3.001 ACM 130,710 SQ. FT. ; / 4 p cl ♦ 120.734 8Q. p LOT 4Z' 3.000 ACF Ea / ) R +awa,..�X.00�Xm,eator 1P.M 80. Fr. 19.0._4.0 f OoMllwda t 88 p •- -100' 1 • ramDroummoo mormPrE p • XlT t•Wp10E0YUltl1 Xtf11MC •/ •••'` ORANAW ` ~\ I Q 1RIIE •tll tB11�6Nt p � '�'dai ...............� ° �F... \ may :ar owelwxr,ow p I 1totUr[ tusu►�uKM k. W.l. -882.0 I � 1 roar , _� N MrlrYtel�rer�i ��� \� � -- � ( �. --. -- 1• MwrwwrnMrewrs .s .. Y f -- •rwu•oex ew�wa ! ..... ....... ...., rl M�1�1stlMMt•M Ffa ,., ST. CROM COUNTY SEPTIC TANK MARUERANCE AND OWNESOW CBLainCATION FORM OwnerIB 4 - momimm puming P J 0n � arcel City /S4do T ,3D N fit L W -'f owe # ca J Lotion �=.� - gy p# Volume Cerdi" Survey 1Ksp # '�- , page # Volume .- - j — warranty Deed # ---- -- Lot Una id CJ no Spec UO f to WAG W80m PIIOPw Ito a e,,, oaodd rw* is ftB Win . by a voono" P'aaopw. amd tlro� Go a g e d to , 83.n(t)� in ter 1 Z ' St (koix Coaoty Sea Y a „ aR pod by ft r � sure to St Croix Ca Y P]amooasS $ zoning y owt (1)11ye awd W* is sabnOt 'Ttrs pcvPeri7► o p]aa . test a car s liceaned P (U6006mY). sep of W & o� mdby a a P �,�g �mdfaa� a�lor (2} vasboweW eased sBxeO't�o N � of wis onsin. re.ddyo:'b°v° ad to �� � S �Comny Planing 1,�,arfa, aas,etbY �� :ee 1� y� ayaoambes bees �, . 30 dq- Of�1 on *i form tm ru m Ihve anao/�e ohs) of Baas rsue 1� to the bed of oof, knowledge y abova. b9 v19° e of bedrooms 2 Numb UATE ATt3RE O AppLi�( rer►oioed b3► PLmmanB & Z b* �' ** . :cAay an�rnaa� tbm is s°npbe may a:� is the pert�dt'bo�n$ a y deed Offiuoa � s C0�' of �e oe ��' =W ' W,6 *Is SYPUCWM firaaon th Reg�sber of Deeds - 0mv. 0%" I - -- ------------- - - - - -- r 1 62 r M { ~ 4� r" � r C � p i n lo N V RCS A \S �ti 1 M k7 ,