HomeMy WebLinkAbout040-1303-00-055
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No
GENERAL INFORMATION (ATTACH TO PERMIT) 538815 0
State Plan ID No
Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)j.
Permit Holder's Name: City Village X Township Parcel Tax No.
C&J Builders Inc. Troy, Town of 040-1303-00-055
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No
10 (p, Z 'j 4~- l 22.28.19.1790
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER r CAPACITY STATION BS HI FS ELEV.
' S Z•72- X09.6 ob
Septic IZA Benchmark
I i /ZS~ J, p,4 I b-7. Z
Dosing Al g
`75b ~ w. 'x r z' I "'77,34 1/3 •'9 4s, 22-
I*) Bldg. Sewer
a Zb 14 7.35 V7, 97
Holding St/Ht Inlet
TANK SETBACK INFORMATION St/Ht Outlet
TANK TO ~P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic Dt Bottom
/8 - 1Z.1 ~s•2, Z._.,
Dosing Header/Man. _
/L- 142.E
Aeration Dist. Pipe
510 102 - ` (o
Holding Bot. System 7.62 161. '7PUMP/SIPHON INFORMATION Final Grade
S /Q 3 . ~o ot.
Manufacturer Demand St CoAr 37 g3 !;'S
GPM Model Number /
Cow ~-n~r x.74 /do. 5
TDH Lift Friction Loss System Head TDH t
17. 9.IZ 3•ZS ~7
Forcemain Len~~~ Dial Dist.toWell
/
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. ]Liquid Depth
DIMENSIONS [ ~ \
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type System: J~ \
Q J UNIT Model Number:
DISTRIBUTION SYSTEM / O
Header/Manifoy / Distribution / 17- Hole Size Z1, Ix Hole Spacing vent to ai, i,lak 7
Pipe(s) i
Length 3 Dia Length !tea Dia Spacing x 3114: 2 ,zi. s il
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only G
Depth Over Depth Over xx Depth of rI T x Seeded/Sodded xx Mulched
Bed/Trench Center Bed/Trench Edges Topsoil I P-.
w ey Yes I_] No 1'es N;
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2:
Location: 661 Tradition Trail U known SE 1 /4 SE 1/4 22 T28N R1
Z_ ( 9W) Walnut Hill Farm aka The Tribute Lot 55 Par el No 22.28.19.1790
1.) Alt BM Description = ~ l / _ _
2.) Bldg sewer length = ( G ~~d Q
- amount of cover
O Yom,
Plan revision Required? ❑ Yes No
Use other side for additional information.
Date Insepc 's Signat a Cert. No
SBD-6710 (R.3/97)
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No.
538815 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:
C&J Builders Inc. Troy, Town of 040-1303-00-055
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No
22.28.19.1790
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
-1
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
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Type Of System: T
Model Number:
DISTRIBUTION SYSTEM
Header/Manifold ID istribution x Hole Size ix 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
U Yes L] No ~ Yes Nr.
COMMENTS: (Include code discrepancies, persons present, etc.) Inspection #1: Inspection #2:
Location: 661 Tradition Trail Unknown (SE 1/4 SE 1/4 22 T28N R19W) Walnut Hill Farm aka The Tribute Lot 55 Parcel No: 22.28.19.1790
1.) Alt BM Description =
2.) Bldg sewer length =
- amount of cover =
Plan revision Required? ❑ Yes ❑ No
Use other side for additional information.
Date Insepctor's Signature Cert. No.
SBD-6710 (R.3/97)
tximmereeml.gov Safety and Buildings Division 2tt.-I.hon 201 W. Washington Ave., P.O. Box 7162 T 1
7DID sc o n s i n b S V 707-71 b2 (to be filled in by Co.)
epartment of Ccnutrerce t"'M,I; Sanit ary P rmit Application Number
In accordance with s. Comm. 83.21(2), Wis. Adm Code, s si ~~j to th appropriate governmental 11,7915J&
unit is required prior to obtaining a sari it. ~APP J h~tti~ forms for state-owned POWTS are Pro'ect Address (if different than mailing address
)
submitted to the Department of Commerce. P rsonal Sfo i0%lj fgvide in ~ be used for secondary
ses in accordance with the Privacy Law, s. 1 0 1 TT 1,T) ~ ~rq~ ! A
1. Application Information - Please Print
AN &h.mation
Property Owner's Name Parcel #
ifeii s6 G~-~ 8,~; t~ o#oj13,03-- 66- 055
Property Owner's Mailing Ad ss Property Location y
S/ a ► ' Govt. Lot. )F;~
City, state 1 Zip Code Phone Number SF- y, y, Section
AS W S` z -i 9/vim V C9.9 a 3~ (circle one
II. Type of Building (check all that apply) d L Lot T 09 N; R ~ E ors
211 or 2 Family Dwelling - Number of Bedrooms (55) Subdivision Name
t u~ Bloc W a) b j Fa r"
❑ Public/Commercial - Describe Use
❑ City of
❑ State Owned - Describe Use CSM Number ❑ Village of
/ MTown of r t?
III. Type of Permit: (Check only one bog on line A. Complete line B if applicable)
A. Cr New System ❑ Replacement System
❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number and Date Issued
B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber Follwpzl nit Transfer to New
Before Expiration IV. Type of POWTS S stem/Com onent/Device: Check all that apply) O!\. 0 04 UL.,;/ --J
❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade A Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ~
❑ Holding Tank ❑ Other Dispersal component (explain) ❑ Pretreatment Device (explain) 5
V. Dispersal/Treatment Area Information:
Design Flow (gpd) Design Soil A lication Rate(gp f) Dispersal Area Requir sf) Dispersal Area Prop d f) System Elevation
6 DO 1 d, 4 ADD 104)0 17a j pl, D 13 f
VL Tank Info Capacity in Total # of Manufacturer
Gallons Gallons Units w o,
New Tanks Ddsting Tanks 1 q
7-5 96 rn~ in wc5 a
Septic or Holding Tank 960 1 asv 1 ~ ~ C Kra ~
Dosing Chamber rA .s t7
VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Prri7nt)L( Plumber's Signa M+PIMPRS Number TBusiness Pharr Nuumbeery
ear) 1". / Jeo do70SJ ~,5~'~ orl-Q77T
Plumber's Address (Stmt, City, State, Zip Code)
0.5 16 ~o+ 1 drf Y S4v Z
VIII. Coun /De artment Use Only
Approved Disappm Permit Feet Date Issued Issui gent Signature
iven Reason for al $ loZ J '
IX. ConditMmvAvWteasons for Disapproval t t
1 Septic tank, effluent finer and 3~ 1~~~ ~ o.n 5 r A- rod
dispersal cell must all be services / maintained
as per, management plan provided by plUmbilir, w 1
2-At setback-fequirementsmust.be.m" n 1
ass psr spocAW code ! ord.
Attach to complete plans for the system and submit to the County only on paper not less than 8 in a 11 inches in size
MW now
SBD-6398 (R 02/09)
' ~titi AR~'~ Ff NT Safety and Buildings
10541 N RANCH ROAD
HAYWARD WI 54843
Contact Through Relay
P , www.commerce.wi.gov/sb/
www.wisconsin.gov
X. 10-NS' Scott Walker, Governor
Paul F. Jadin, Secretary
August 08, 2011
CUST ID No. 220554 ATTN.• POWTS Inspector
CARL P HEISE ZONING OFFICE
TOTAL EXCAVATING ST CROIX COUNTY SPIA
W9905 710TH AVE 1101 CARMICHAEL RD
RIVER FALLS WI 54022 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 08/08/2013 Identification Numbers
Transaction ID No. 1972516
SITE: Site ID No. 769681
Jeff Husby Please refer to both identification numbers,
S Glover above, in all correspondence with the agency.
Town of Troy
St Croix County
SE1/4, SE1/4, S22, T28N, R19W
Lot:'lSubdivision: Walnot Hill Farm
FOR:
Description: Mound, 4 br res
Object Type: POWTS Component Manual Regulated Object ID No.: 1326103 ROM
Maintenance required; 600 GPD Flow rate; 30 in Soil minimum depth to limiting factor from original grade; Systell'~~A3'2dih'
Ezflow Mound Component Manual, (R. 8/07), Pressure Distribution Component Manual - Version 2.0, SBD-1070674
(N.01101); Effluent Filter
Pi-PAp,1MEtlT (
The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative CodesDl'.',:S+C,N E1
and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructe -
and located in accordance with the enclosed approved plans and with any component manual(s) referenced above ~l.-■
The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code CORRE'
requirements.
No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06,
stats.
The following conditions shall be met during construction or installation and prior to occupancy or use:
Key Item(s)
• 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. In addition, the
owner must insure that the operation, maintenance and monitoring duties as described in section VIII of the
mound component manual are complied with. A copy of this information must be given to the owner upon
completion of the project.
• The float switch shall be a type that does not contain mercury. 2009 Wisconsin Act 44 prohibits the installation
of float switches or relays that contain mercury.
• The proposed pump is near its limit with the proposed total dynamic head. If upon installation, the total
dynamic head increases, the proposed pump must be reevaluated and may be inadequate.
• The proposed pump is near its limit with the proposed total dynamic head. If upon installation, the total
dynamic head increases, the proposed pump must be reevaluated and may be inadequate.
CARL P HEISE Page 2 8/8/2011
• The gravelless system components must be installed in accordance with the manufacturer's printed instructions,
the plan approval, and COMM 83 system sizing criteria. If there is a conflict between the manufacturer's
instructions and the plan approval, the plan approval and code requirements will take precedence.
• The designer proposes to install a state approved effluent filter to achieve the requirement of wastewater particle
size.. Pursuant to outlet filter product approval stipulations, maintenance information must be given to the owner
of the POWTS explaining that periodic cleaning of the effluent filter is required. The access opening used to
service the filter shall terminate at or above finished grade with a watertight cover.
Reminder
• The orientation of the mound system must be such that the longest dimension is oriented along the surface
contour per COMM 83.44(6)(a)2.
• Limit activities in the area 15' beyond the down slope edge of the mound per Mound Component Manual.
• Surface water drainage shall be diverted away from the system area per Mound Component Manual.
• Materials shall conform to the requirements of COMM 84. Comm 84.10. No fixture, appliance, appurtenance,
material, device or product may be sold for use in a plumbing system or may be installed in a plumbing system,
unless it is of a type conforming to the standards or specifications of chs. Comm 82 and 83 and this chapter and
ch. 145, Stats.
• Maintain well and waterline set backs per COMM 83.43(8)(i). Consult the Department of Natural Resources for
well setbacks and other regulations and exceptions.
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. All permits
required by the state or the local municipality shall be obtained prior to commencement of
construction/installation/operation.
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
Patricia L-Sandorf '
POWTS Plan Reviewvx- tegrated Services WiSMART code: 7633
(715) 634-7810, Fax: (715) 634-5150 , M-fr 8:00 - 4:45
pat. shandorf@wisconsin. gov
cc: Leroy G Jansky, POWTS Wastewater Specialist, (715) 828-5902, Monday, 7:00 A.M. To 3:30 P.M.
S 1 t
JUL )i
Total Excavating,.
N8618 1090th River Falls, WI 54022 Tel (715)426-1777 Fax (715)425-7314
TITLE SHEET
MOUND SYSTEM
FOR
BEDROOM RESIDENCE
LOCATED IN THE __~Z1/4 OF THE 1/4 OF SECTION v1,:,7 , T_aB N, R )'7 W
TOWN OF Y Rfj X57-Loj 4. COUNTY, WISCONSIN.
INDEX
PAGE 1 OF 7 TITLE SHEET
PAGE 2 OF 7 SYSTEM MANAGEMENT PLAN
PAGE 3 OF 7 PLOT PLAN ona
PAGE 4 OF 7 PLAN VIEW - CROSS SECTION ~12U1~y
PAGE 5 OF 7 DISTRIBUTION PIPE LAYOUT )VED
PAGE 6 OF 7 PUMPING CHAMBER CROSS SECTION T COMMER
PAGE 7 OF 7 PUMP PERFORMANCE CURVE YAND BUI INGS
#3ENCE
PREPA ED FOR
ITT u s by
-3fq 57eet1,ea pf /C/3j!5)
C
J?Lv-{Y Falls wr s4ozz
PREPARED B
Carl Heise W 1~<
CST/MPRS 220554
W9905 710th Ave.
River Falls, WI 54022
Cell 651-492-8594
Fax 715-425-7314
This plan has been prepared in accordance with the SBS Manual EZF16W mot,),
Co ~,O py B~
~r~sSuvC 7tjTr~q 6^ ~ orr-P mno't ►~~ru a~ ~ffr5~d/h Z
n-Y r7
Mound System Management Plan
Pursuant to Comm 83.54, Wis. Adm. Code
Septic Tank
The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the
septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and
outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to
ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that
may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if
the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The
septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of
the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise
the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in
the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required.
However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and
Buildings Division.
Pump Tank
The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to
verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary.
Mound and Pressure Distribution System
No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound
shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic
(other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the
infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather
installations (October-February) dictate that the mound be heavily mulched for frost protection.
Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG. Influent flow may
not exceed maximum design flow specified in the permit for this installation.
The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each
lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be
compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is
required to maintain equal distribution within the dispersal cell.
Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner,
and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring.
General
This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its'
component manual [SBD-10572-P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance
reporting.
No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and
pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as
POWTS components.
Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access
openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed
unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall
be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component.
Contingency Plan
If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the
system in proper operating condition.
If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be
immediately repaired or replaced with a component of the same or equal performance.
If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired
or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption
and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper
operating condition.
Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector.
:--PLOT PLAN .
KCAL F_ J_',30
_ T -55 1.22 Ac.
o ~ra 54
C- L1,
ProPacaa ~
'W5f4"f>rg40
O
a -►25c~.S=VCES-En _ Rol
O
~o
~ M
fip-0
gf
LoT
6 Ar LOT TL
G GG. i o~.2
-PLOT PLAN
. v~At -1 3p f
30 , -A ,
- LOT 55 1.22 AC.
o R aSeo
Prop S2
j 4 QY hl Hoyh-e-
S'4 "SCq 40
O
a -►Z:SO /-'75a -V,Ct E S ER--Cali- = f'ILTEA
-~-CQAWIMR W- POLY LOe525 0
F ~
u O
u'l
M
-•i' '
~i
! 0p 214 'Rb~►^ Gar oP 7/4
a
ZV7
WN, 1,
: PV
; Vnlt Z}1StII on Cell %IN
Cover Mat rW
N. FM Nfat=W
'Finish Grade (ASTM C33, fing aggregate)
i 3~ `D O! - - - - - -
TMed Aria
Slope Fora Main
Cross-section of a ,mound svstem
_ _ Using EZ Flow product # 1203H .
Cress Section Of A viound S stem Usin F ' .0
A Bed For The Absorption Area G
A Ft. h 1.
6 00 Ft.
IFt.
J Ft.
Y. 8 Ft.
Alternate Position L Ft.
of
u ~5 Ft.
Force Main
L
140bserv°tion Pipe
B r K
Force Mc
W z 1' - - -------4 From Pu
7,~
3 ~
~
p Oistribution Bed 01 %2~- 2 %2
Pipe Oroirt ROCK
I ~N
Obzervction Pipe Permanent. Marker
PI pe or, Rods
I _ Plon View ID ound tlsin A'8ed For TAe Absorption Ar o
AO 04 .47 PM LUND BUILDERS lNr. 71542 9 w, 0,,
Distribution Pipe Layout pe S of
Place the holes at the bottom of the distribution pipes
at equal spacing. Remove all burrs from the pipe and holes,
Extend the end of each lateral up with the use of long turn or 45° fitting to a point within 4-c
inches of the f2hd grade. Terminate the ends of the laterals with a valv¢,'tl readed cap or
. threaded plug. Provide access from Enal grade for the valve; threaded cap or threaded plug.
"f `y P pct? L CC~as s s
ML'p tYt Ma ifcld taUtC
trsl
Y x x x V2 x12 x x
31tnf tndh - t tttni ltn~th - P
O+st:i6utlan 'nt
f P
07-
htv~F~~
__~bRil l~ q N0~ A7.12.60 ANp I VOCE AT.6:04 O.C10CI< 4;RfPEA7 pA7rL-kN
Hole diameter inch
y
5----Ft Lateral " inch(es)
X-2Y I/
Inches Manifold
Z inches
Force Main " Z inches
#of holes/pipe-
Invert Elevation of Laterals i0/," Ft.
~1 61, = 13 $!a n4 = 5.5. 44 G.P.M.
Of `7
Page_/
SEPTIC TANK &'PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS
4" VENT PIPE 12" MIN. ABOVE GRADE 6 WEATHERPROOF
25' FROM DOOR, WINDOW OR JUNCTION BOX APPROVED
FRESH AIR INTAKE WITH CONDUIT MANHOLE COVER
W/ PADLOCK 6
FINISHED GRADE WARNING LABEL
~~-4" MIN IN.
18 " I N . 6" MAX.
i
INLET "
'
WATER TIGHT SEALS GAS- ~
- -Ft~TE TIGHT, \)APPROVED
A SEAL JOINTS WITH
APPROVED -B ALM APPROVED PIPE
PIPE ON 3' ONTO
SOLID SOIL
C i
PUMP OFF ELEV . FT. OFF RISER EXIT
D PERMITTED ONL
IF TANK
MANUFACTURER
HAS APPROVAL
3" APPROVED BEDDING UNDER TANK
CONCRETE PAD
SPECIFICATIONS
SEPTIC / DOSE
TANK MANUFACTURER: Wl e5~~ Gtih NUMBER DOSES PER DAY:
tzar
TANK SIZES: SEPTIC )250 GAL. DOSE VOLUME INCLUDING
DOSE 5 GAL. FLOWBACK:A4.6 GAL.
ALARM MANUFACTURER: Z -c,7 _0 CAPACITIES: A = Lq INCHES = 1400 GAL.
MODEL NUMBER: 16 tA)
SWITCH TYPE: YA CYewry B = 2 INCHES = ~;2,,?4"GAL .
PUMP MANUFACTURER: 0F C = 9,97INCHES = AtrGAL.
MODEL NUMBER : I
SWITCH TYPE: ,Grp D = I.7Z INCHES = AE; Z-GAL.
w v, -
REQUIRED DISCHARGE RATE 5$ GPM PUMP & ALARM WIRING AS PER ILHR 16.23 WAC
VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE FEET
+ MINIMUM NETWORK SUPPLY PRESSURE FEET
+ 150 FEET FORCEMAIN X FT/100 FT. FRICTION FACTOR 9,1 Z- FEET
TOTAL DYNAMIC HEAD - FEET
INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER
LIQUID b TI
x ,lt st a yr.c w4 ' f / -rsT`-Trt-7~FR TN T3 Ilft lY1~IJ1~ -
v~..#`s'µ''r~4$ :2• ~ F,}•~v a ti*+ .T:.,y~ r ~ ro_ ~M~I - ~
Kda IN e p c_ ;kr.:. . .
On-Sie .
h
tz w PUMP PERFORMANCE CURVE
EFFLUENT MODELS
3/8",1/2" 8 3/4" SOLID PASSING CAPACITY
140
42
135
40 191
130
36 125 D CAUTION Mydel 185/4185
should not be subjected to less than
120
36 186 30 feet TDH.
4186
115
34
110
A
32
105
30 100
95
28
90
26 95
80
° 24 165
= 4165 ~Sj
0 15
22
r
° 70
F 163
0 4163
20 65
18 60
161 189
4161 4189
16 140
50 4140
188
14 5 4188
4
12 40
35152
153
10 ~
30 151
185
8 4185
25 137
139 ,
20 98
6
15
-
4
10- A
. 2
• 5
53,55
57,59
10 20 30 40 50 60 70 80 90 100 110 120 130 140 150 ~✓J\)
GALLONS
LITERS 0 80 160 240 320 400 480 560
FLOW PER MINUTE o+ -
Copyright 2004 Zoeller C6,,111 rights reserved
Oct-19-2010 01:59 PM St. Crcix County Plan/Zon ng 715-386-4686 1;1
ST. CROIK COUNTY
SEPTIC TANK MAINTENANCE- AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
owner/Buyer J e Les d-'
d ~ GTS ~✓tG...
l
Mailing Address
Property Address Lo ~ra + ~%o ~"1 Toy , .
(Verification required from Planning & Zoning Department for new constriction,)
City/State U50" W,7-
._T Parcel Identification Number 040 -130j!-06 L L DE PTION
Property Location , '/R . _ Sec. , T N R-2 j Town of
Subdivision Plat. WO-) h
ctr iy? ,Lot#ILE.
Certified Survey Map # , Volume, Page #
Warranty Deed # !jam (before 2007)Volume Page #
Spec house yes Ito Lot lines idenifflablo- yes: no
SYSTEM MAINTENANCE AND OWNER CERT FICATI N
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the fttnction of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. $3.53(1) and in Chapter 12 - St. Croix County Sanitary Ordinance.
'The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site
wastewater disposal system is in proper operating condition rind/or (2) after inspection and pumping (if necessary). the septic lank i%
less than 1!3 tiill of sludge.
1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards sot forth, herein, us set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin,
Certifioation stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning &
Zoning Department within 30 days of the three year expiration date.
Ilwe certify that all statements on this form are true to the best of my/our knowledge. I/we am/are the owner(s) of the
property described above, by virtue ora warranty deed recorded in Register of Deeds Office.
Number of bedrooms
_W) , L 7-
SIGNATURE OF APPLICANT(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 the warranty deed.
(REV. 08/45)
i
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a030884
Tx:4021836
STATE BAR OF WISCONSIN FORM 3 - 2000 938028
Document Number QUII CLAIM DEED BETH PA13ST
REGISTER OF DEEDS
THIS DEED, made between Citizens State Bank, Grantor, and C & J ST. CROIX CO., WI
Builders Incorporated, Grantee 06/24/2011 08:S6 AM
Grantor quit claims to Grantee the following described real estate in St EXEMPT#: NA
Croix County, State of Wisconsin (the "Property'!: REC FEE: 30.00
Lots 33, 43, 44, 49,58, and 72 of Walnut Hill Farm, All in the Town of TRANS FEE: 623.40
Troy, St Croix County, Wisconsin.. PAGES: 1
i
Recording Area
Name and Return Address:
Title One # 16514
i
Together with all appurtenant tights, title and interests. 0404303-00-072, 040-1300-00-049, 040-1303.-
00-058, 040-1303-00-043, 040-1303-00-044,
Property sold 'as is'. 040-1303-00-055, 040-1303-00-033
Parcel Identification Number (PIN)
This is not homestead property. i
lank
* Thomas W. Van Pelt, President & CEO -
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN ) i
Signature(s) ST. CROIX COUNTY. ) ss
authenticated this Personally came before me this 17th day of .June, 2011
the above named Thomas W. Van Pelt, President & CEO of
* Citizens State Bank, to me known to be the person(s) who i
TITLE: MEMBER STATE BAR OF WISCONSIN executed the foregoing instrument and acknowledged the I
same
1
(if not,
_
~7,/ ? <
authorized by § 706..06, Wis Stats ) Ogpi
/I A
PHIS INSTRUMENT WAS DWIED BY a Q gar * el M ae e-
ot Notary Public, State of Wisconsin i
H. Forecki, Attorney My commission is permanent. (If not, state expiration date:
Michael H
8/26/2012 3 ;
(Signatures may be authenticated or acknowledged. Roth are not necessary) '
*Names ofpersons signing in any capacity must be typed or printed below their signature
F
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r QUITCLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000
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WALNUT HILL FARM Li
ALL BEARINGS ARE REFERENCED TO THE EAST LOCATED IN PART OF THE SOUTHEAST 1/4 OF THE SOUTHWEST
LINE OF THE SOUTHEAST 1/4 OF SECTION 28, 1/4 AND IN THE SOUTHEAST 1/4 OF THE SOUTHEAST 1/4 AND IN P'a ''RNEWaY 1 FM 1' IRON vv[
T29N, R19W, ASSUMED AS S 00'11'24' E. PART OF THE SOUTHWEST I/4 OF ME SOUTHEAST 1/4 AND IN LOCATKAIS FDJ2A COUNTY
~OC 747018 _ ORMWIY TASEWENi J' ALUMINUM 4CNUWE",
All BUlDINGS TO BE CONSTRUCTED W THE NORTHWEST I/4 OF THE SOUTHEAST 1/4 AND IN PART OF
PROXIMITY WITH DRAINAGE EASEMENTS SHALL X410 THE SOUTHWEST 1/4 OF THE NORTHEAST 1/4 AND IN PART OF BUlNo SETSACNS 1 SET 1 1/4' BY 16' IRON FIN
HAVE A FINISHED FLOOR OR WINDOW WELL THE NORTHEAST 1/4 OF THE SOUTHWEST 1/4 AND IN PART OF - I7 UAUre EASEMENT w1 /177 Ues./n
ELEVATION NOT LESS THAN TWO FEET ABOVE (MISS OTKM91SE NOTED)
E OUCH WATER ELEVATION w.ln THE NORTHEAST 1/4 OF THE SOUTHEAST 1/4 OF SECTION 22, 1. sE1 J/4' a718' IRON RIN
TOWNSHIP 28 NORTH, RANGE 19 WEST, TOWN OF TROY, ST. CROI - o f "TS WT 15018s!r,
ALL LOTS HAVE ANET-BINIDABIE AREA COUNTY, WISCONSIN. N96 • 0 WATER EUDATION Al C OTN(R L01 CORNIRS
GREATER THAN 1 ACRE. 66 • UOW($t 601 O99G OPENING - • - - 70 rRAn us[u(N,
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WEST 1 CORNER 1 N8918'II E 5317,77 82513' SEC 22 n
SEC, 22 Ilk
69.60
1OK68` 752.e3 76,1.56' CONSERVATION EABEYENT U
THIS WT IS NOT PART
ourlor 1 OF THE Ho1~orNERS
ASSOCIATION, BUFFER
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~vr ,116 Ac. 3,1 III Ar. 110' 1IFI "1 1.12 Ar. Ix I 1 ° 6N„ a ROAD-
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PUT LOCATION ` U 0.77 k. 12, 1 cl 1 '1 N 6ixsr i °w:7J1 11' 1 c ,`0 6 ' 7~I I 1 I _ 1 1 It,
BUFFER i~ 1 \ ~1 11` 5t b,J " l u`n' u°w L1;Twr
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DRAFTED BY: KE`AN SAMUEL R(uy0: 11/06/01
NUNPHREY ENGNEERWG SHEET 1 OF 5
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page / of 3
Division of Safety and Buildings
in accordance with Comm 85. Wis. Adm. Code, 5T.' G~ 4/ I •V
include, but not a Parcxl I.D.
A"ch EROSION CONTROL PLAN must be
percent slope, sc completed before sanitary permit issuance Re by Date.
Pam" hfonm ftn you provide my be used for secondary Purposes (Privacy Law. s. 17.VY,
1
Property Owner TORO Property Location ffi&AAZ)
TA ~D Z3 ERS T'~t~ T_...r c/a A110Govt Lot A11 0 va ZL T N R & (or) w
Property owner's MaIlM Address Lot # Block # Subd. Name or CSM#
~otS CAt4~~Lv~e • 55 wAL N0r Ali fA~'~`-t
CRY --rA! WR State Zip Code Phone Number ❑ city ❑ village f.-ZTown Nearest Road
C,-.Ag0f H7-5 MN 5So7(P &5t) 198• 109~ ?-,toy so. &iotyek
0
New Construction Use: Residential / Number of bedrooms Code derived design flow rate r OZ~ GPD
❑ Replacement ❑ Public or commercial - Describe: - tA
Parent material DES S o yyi- -f%/l S Flood plain elevation if applicable
General commends
and newrmamnendations:~ jt ~~S ~U/•T~ %-2 /L10 U~VQ S
N
soft # Boring q. p (P S.S. S r
a in.
® Pit Ground surface elev. ft Depth to limiting factor 2
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff:
In. Mu nsell Qu. Sz cont. color Gr. Sz Sh. *owl 'Eff#2
o • ly ~b y LshKS
-5 %A
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Sofl rrcatioru Rate
Horizon Depth Domi kin( Color Redox Description Texture structure consistence Boundary Roots GPD/lf:
In. Mu nsell QU. Sz Cont. Color Gr. Sz. Sh. 'Eff#1
0 •i3 10y2 31-4,) F • Y N
13 . / io Yt S~ f s h lt- cs (f s
3 If -311 D 5~[- rFs lc AK -Fl' cw - • 2-- • 3
c2-A h 0-5 /(,:L /~'sh of
~a Y ~z
?"Y y/Z -7/
Effluent #1 = BOD > W :S 220 mglL and TSS >30 < 150 mg1L ' Effluent #2 = BOD < mglL and TSS < 30 MWL
Signature CST
CST Name (p, Print) A L6 R i c i T-
ZZ 5
Address Ulbricht & Assgciates s~ ~ valuation Conducted s. Telephow Number
Private
2812 1 Oth Ave.
Spring Valley, WI 54767
W41-NV T- h111 4rtiPM
-rOPP 13 -7E e 5 TEDT! Z0 7--
PMper(y owner Parcel ID # 5,5 rage Z Of 3
a,,g ly E) eor;rrsg S. J .
1= ---s t Groundswlacaetev. €i, Depth to !'ilting factcx " O S.
in
Sai icatiort Rate
t torizon Depth [7mlnant Color Redox Des4xi on Texture Structure Consistence Mjwu ry Roots. GPW
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Soil icafion Rate
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t4turisetl Q!, Sz. C41 t. Color G'. SZ. Sh. `I`ts
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SON Rate
t Wzon Depth D"nant Color Rednx Description- Te Structure Consistence Boundary Roots P[}
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pit Grounds me
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IM Munson Qu. Sz. Cont. Caton Gr. Sz Sh. *E01 'Eff#2
PLOT PLAN WALNUT HILLS FARM. LOT # Pg. 3 of 3
= Contour elevation lines.
= Backhoe Soil pits.
Q = Benchmarks set, maRKED WITH FLAGGED \
lathes. 1/2" steel conduit pipes.
55
d SCALE : 1 if - 30 Fy
Co.,v fo v )e G .v.~
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STO CROIX COUNTY
G ZONING
MEMO
DATE: 7/5/11
TO: FILE
Code Administratiolr FROM: RYAN YARRINGTON ST. CROIX COUNTY
715-386-4680
RE: LOT 55 WALNUT HILL FARM
Land Information &
Planning
715-386-4674
On July 5, 2011 an onsite was conducted for Lot 55 of Walnut Hill Farm. The site
RealPropcay has become very overgrown since the soil tests were done in 2003 and Carl Heise
715-3So-407 (Plumber) requested confirmation of the soil test location.
Rec, cling BM 1 and Boring #1 were located as per soil test however it was determined that
71.;-386-4675 during the house construction of lot 56 the northeast corner of lot 55 soil test was
disturbed. Plumber proposed new contour to the southwest and uphill. Boring # 1
of lot 54 will be used to properly define the modified area. The slope changes
slightly to the NE compared to NW as shown on original CST plot plan. BM 1 will
be destroyed during construction however plumber has transferred the BM
elevation relative to both South lot stakes as new benchmarks.
ST. CROIX COUNTY GOVERNMENT CENTER 715.386-4686 /-Ax
PZ@CO.SAINT-CROIX.WI.US 1101 CARMICHAEL ROAD, HUDSON, WI 54016 WWW.CO.SAINT-CROIX_WI,US
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Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3
Division of Safety and Buildings
in accordance with Comm 85, Wis. Adm. Code County 57"- *M
Attach complete sit v N H
Include, but not iimi EROSION CONTROL PLAN must be Parcel I.D. T
percerrtslope, scaU completed before sanitary permit issuance OWN s--
Revi ed by Date
Personal Information you provide may be used for secondary purposes (Privacy Law. S. ia.U% iv pnA.
Property Owner C TODP J Property Location v Q~ Q Gj
"j-DaD X73ERS T-CV T- d f3~~L^' 17 1. Govt. Lot Al i va $ 1/4S T N R ` & (or) W
Property Owner's.MailingAddress Lot # Block# Subd. Name or IM
(p O t S' CA H LL. AV'0- • IVAL/V D T" wi f PA RA( ~
CRY, --CA) WR State Zip Code Phone Number ❑ Ctty ❑ Village (.0 Town Nearest Road
611906 H7-5 MN 5S-07(e ( &S() Zyk• to9~ ?-Rohr SD. Gtovek ~C
v- Ll
New Construction Use. lA Residential / Number of bedrooms Code derived design flow rate ~ ~ GPD
❑ Replacement ❑ Public or me ai - Describe: 11A
Parent material /DESS U 1!1( / /S Flood Plain elevation Happlicable
General comments
and recommendations: ~ 7~~5 •r~ $l~,' 7'f~/L~ 1 ~R /'t
r
Boring# o Bow /00 1/ o z~ s. s. s . r
❑ pit Ground surface elev. ft. Depth to limiting factor In. Sal Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft: b
In. Munsell Qu. Sz. Cont. Color Gr. S7- Sh. 'Etf#1 'EBf/2 \
o., 100313 L z-fsJK
2- Y. 29 /0 Yle VA dA
3 o -7•SYR y C2 ~D 5L • y
> 5 ~o 0
8ori[1g # ® 4Boring 01-
pit Ground surface elev. . Depth to limiting factor in. S • Solt licatlorl Rate
Horizon Depth Dominant Col Redox Description Texture Structure consistence Boundary Roots GPD/fF
in. Munselt Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
o. /o y~ 3 L 2fs w 3. s
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Effluent #1 = BOD > 30:S 220 mg/L and TSS >30 < 150 rrg& ` Effluent #2 = BOD < 30 and TSS 130 mg/L
CST Name (Please PcM) Signature Z2 3
• -La le i ci.-r---
Address Ulbricht & Associates Date Evaluation Cm'd`x eci Telephone Number
Private Sewage Consultants s _ ~~3 7t s• 77A • 3 y`12--
2812 1 Oth Ave.
Spring Valley, WI 54767
c FI _ - „
PLOT PLAN WALNUT HILLS FARM. LOT Pg. 3 of 3
0 = Contour elevation lines.
• = Backhoe Soil pits. i 1~
Q = Benchmarks set, maRKED WITH FLAGGED
.lathes. 1/2" steel conduit pipes. NNIJ
SCALE : 1 2-0 FI
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b 0'"r CROIX COUNTY
le &#-A
l ON
EROSION & SEDIMENT CONTROL PLAN
Site location: 661 Tradition Trail, lot SS, Town of Troy
Owner(s): C&JBuilders Inc.
Parcel ID #22.28.19.1790
Code Administrrrrion '
715-386-4680 Under St. Croix County Zoning Code 17.70(3)(b) 5: "The (Zoning) Administrator may
attach reasonable erosion prevention conditions to a permit approved for issuance." In
Landlnformatiolt addition, Wisconsin Uniform Dwelling Code Comm. 21.125 requires the building permit
Planning applicant and/or landowner to follow erosion control procedures and maintain them until
715-386-4674 the site has been stabilized (Uniform Dwelling Code Comm 21 is available on-line at:
www.commerce.state.wi.us/SB/SB-DivCodesListing.html)
Real Property
715-386-4677 The Owner of the above parcel is responsible for notification of all contractors performing
construction activities on this site that an Erosion & Sediment Control Plan is in effect and the
Recycling following activities will be required in order to maintain compliance with the plan:
715-386-467.5
1. Maintain existing vegetation wherever possible to minimize erosion and sediment
movement. The primary source for construction site runoff will be the house
foundation and driveway excavation, well drilling, and soil stockpiled until final grading
and stabilization is complete. Septic system installation adds to temporary disturbance.
but establishing cover on exposed soils will prevent erosion. Apply seed and mulch as
recommended in #5 below.
2. Install construction entrance before any excavation begins!! Construction
equipment and vehicles must utilize a stabilized driveway access off public road for
heavy equipment; this includes cement trucks, well drillers, and other contractor's
vehicles that require access to the property during construction. Avoid muddy. rutted
conditions that may allow contaminated runoff to reach waterways and/or draina~
ditches. Property owner must repair damage to ditches resulting from multiple access
points and sediment tracked on public roadways must be removed at the end of each
workday.
3. Do not allow contaminated runoff to be directed onto neighboring property or into
surface water conveyances. Create temporary diversions graded ALONG CONTOUR
between excavated areas and any potential receiving waters (this includes driveway &
road ditches) by routing contaminated runoff into vegetated buffer areas on owner's
property. (A specification sheet for temporary diversions is available from county).
4. It is likely that contaminated runoff will not be contained with temporary
diversions, so installation of approved sediment control products (straw wattles, silt
fence, etc.) as shown on engineer's site plan will be required. The POWTS inspector
and/or building inspector will evaluate ESC plan effectiveness and recommend
additional action required to comply with applicable regulations. Control measures
should be installed prior to mound plowing.
ST. CROIX COUNTY GOVERNMENT CENTER
110 1 CARMICHAEL ROAD, HUDSON, W1 54016 71 53f~i5 /~,.r' !
PZPCO.SAINT-CROIX.WI.US WWW_C.O.SAIN1 CPUIX W U~
Page Two - ESC Plan Acknowledgement Form
t
5. Stabilize exposed soils (septic system included) with seed and mulch immediately after installation - DO
NOT wait for final stabilization and/or landscaping of entire site to establish permanent cover on the site.
when late-season weather conditions will not permit seed germination, a heavy straw mulch cover will
preti ent erosion until vegetation can be established. Erosion control matting can be applied any time of year
and,if installed properly, will provide protection even if seed germination is delayed.
r
The owner of record during site construction will be responsible for compliance with state and county code
requirements as specified in this Erosion & Sediment Control Plan. Please feel free to contact me With questions
regarding erosioli & sediment control product installation.
PLAN PREPARED BY: RYAN YARRINGTON, SOIL EROSION INSPECTOR #683475
Owner acknowledgement of ESC Plan requirements: /2011
(Please sigii and return original ESC form to Plannin oning Dept. A copy is attached to the owner's permit and
maintenance agreement, which is given to the plumber at time of permit issuance.)
Provide copies for excavation contractor, plumber, and town building inspector as needed
ST CROIX COUNTY GOVERNMENT CENTER
1 101 CARMICHAEL ROAD, HUDSON, WI 54016
PZC0C0. SA/NTCROIX. W/. US W W W. C Q' A I NI" C k U i X. W t1 J S
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