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HomeMy WebLinkAbout651284 020-1495-03-000 (2)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 Oevering Homes Investments TOWN OF HUDSON CST BM Elev: Insp. BM Elev:f Description: [� -aIBM GM-L TANK INFORMATION TYPE MANUFACTURER CAPACITY Septic c.� �sSCQ aeo 16so Dosing 7 Aeratio Hold TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Septic 55 r / Dosing `t �t u r Ae ra HOI PUMP/SIPHON INFORMATION Manufacturer Dema GPM g14-- 9-Ot Model Number TDH Lift Friction Loss System Head TDH Ft ct,� I n J,0 1 3,30 Forcemain Length Dia. it Dist. to Well 2 r SOIL ABSORPTION SYSTEM ELEVATION DATA County: SAN-2023-208 St. Croix Sanitary Permit No: 651284 State Plan ID No: Parcel Tax No: 020-1495-03-000 Section/Town/Range/Map No: 35.29.19.3190 STATION BS HI FS ELEV. Benchmark r Alt. BM Bldg. Sewer t7 ` r O.bo SUHt Inlet � • � 99-60 St/Ht Outlet Dt Inlet Dt Bottom 12 • $ 95. $D, Header/Man. / Dist. Pipe 3 3� D5,3v Bot. System Final Grade aA l2`-tr St Cover [ r (o�.feo q-� `f 30 01-30 7 BED/TRENCH Width Length I No. Of T►eas4e6, PIT DIMENSIONS No. Of Pits Inside Dia. Li DIMENSIONS U 1 } 1 , 6 CWEL`L` SETBACK SYSTEM TO P/L A- LDG LAKE/STREAM LEACHING anuf urer: INFORMATION Type Of System: ( q �, CHAMBER OR UNIT odel er: 5 3 �- DISTRIBUTION SYSTEM Header/Manifold Distribution Hole Size x Hole Spacing Vent to Air Intake Pipe(s) , / r It Bb 2 ix Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over Over xx Depth ofxxSeeded/Sodded xx Mulched Bed/Trench Center TBedprench Edges Topsoil ❑Yes ❑ No ❑Yes ❑ No COMMENTS-, (Incl de code discrepencies, persons present, etc.) Inspection #1: ttr'I3 /Lo23 Inspection #2: �) W �-�VM - Location: 735 MAGOO RD 1.) Alt BM Description = 1 2.) Bldg sewer length - amount of cover 3) S-,dj-- s, la -LIP vt �nspe ca.�-Pd1 to �Lrae Plan revision Required? ❑Yes X No �[ 3f 23 Use other side for additional information. � � Date Insepctors Signature �l Cert. No. f' MULLMLY OCi ViGUN LNV11t V11 •_•"•t . ;\ 4822 Madison Yards Way r �-- Sanitary Permit NuM T&N byCa.) P!� P 2023 Madison, W153705 11.0. Box 7162 �a Madison, WI 53707-7162 SAN-2023-208 2 Sanitary Permit Application SttatteejTransaction umber In accordance with SPS 383.21(2), W is. Achn. Code, submission of this form to [lie appropriate governmental unit LJ Project Address (if d ff rent than mailing address) is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Department Safety for the of and Professional Services, Personal information you provide may be used secondary purposes in accordance with the Privacy Law, s, 15.04{1)(m), Slats. �, . I. Application Information Please Print All Information. -- �C Property Owner's Name ( Parcel N r` .� f _ Properly Owner's Mailing A' ress - - Properly Local n IL J ! J Govt. Lot -�" Section } City, State Zip Code phone number 1 el LhJ _ _ ,�'/., mo a N R E W If ype of Building (check all that apply) .--a Lot k� Subdivision Name 1 or 2 Family Dwelliltg - Number afi3edrootns 'ublic/Coercial - Describe Use ❑mm . Block # ❑Clly Of -.� ...._. _ ❑Slate OxJtted -Describe Use Village of w CSM Number Town of III. Type fPOWTS Permit: (Check either "New" or "Replacement" and other applicable on line A. Check one box on line B. Complete line C it a li e. A' E 5 stem Etc lacement System )they Mudillt ltion to ExistingSystem (explain) Additionat Prl'trCaimlellt Ifni[ ex lain) ) 11 R'' ❑liolding'I'ank In -Ground t Grade :D ©tvlaund — Individual Site Design Other'l'ype (explain) (conventional) ❑Transfer to New Owner List Previous Permit Number and Date Issued C. ❑ Renewal Before []Revision hange of Plumber Expiration IV. Dispersal/Treatment Area and Tank Information: lz X 0 /H �pI1Q Design Flo4i (gpd) Design Soil Application Rate(gpd/sf) DispersalRequl d (sf) Dispersal) Proposed (sf) ystem evation - > ]Area I Area IL ® r ✓✓✓ Capacity in Total # of Manufacturer Tank Information Gallons Gallons Units u v Ncw Tanks Existing Tanks o 0 _ a a U < Vn tql nc or Holding Tank t 1',y4111g Omni V. Responsibility St. ent- 1, the undersigned, assu e r possibility for installation of the POWTS shown on the attached plans. Plumber's Namc (Print) Plun gnaturc MI'/MPRS Number Business Pho e N ber , �t Plumber's Address (Street, City, Stat , ..ip Code)"I 1 "7 t N . CountylDepartment Use Only Approved ved Pertit Fee Date Issued Is,u 1, Agent Signature �El OwnerGiv n i al r lv� Conditions ppr6yal V11Z,-. -tl 3),��1 SYSTEM OWNER: _ I. Septic tank, effluent filter and dispersal cell t nt 5 l�rtn t t 1r must be serviced / maintained as per 1 u management plan provided by plumber. 2. All setback requirements must be maintained as per applicable code / ordinances. Attach to complete plans for the system and submit to the County only on paper not less than 8 IR x t I inches in size ti11 D-6398 (It. 03/21) SAN-2023-208 System PLOT PLAN PROJECT Oevrina Capital ADDRESS 1433 Cernohaus Ave. New Richmond Wi 54017 N 1/2 NE 1/4s 35 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 105.2' DATE8/22/23 BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT BOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE 'TANK SIZE 650Gallon HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of ChambersNone BENCIiMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELI, *II.R.P. same as benchmark 1 05.2' M COPY C B - 3 455' Property Line Magoo Road Wieser Combo Septic B-2 103.5'104.5' 105.5106.5' Area 15' Below At - Grade is to remain undisturbed Grading is to be done to Pro 3 Bedroom House Well is to meet all WDNR Setbacks divert runoff away AL from system Scale 1 "= 40' 0' 40' 80' 0 PI- r� Wisconsin Department of Safety and Professional Services Division of Industry Services 4822 Madison Yards Way PO Box 7302 Madison, WI 53707 September 12, 2023 CUST ID NO.: 226900 SHAUN R BIRD 1432 120TH ST NEW RICHMOND, WI 54017 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 09/12/2025 MUNICIPALITY: TOWN OF HUDSON ST. CROIX COUNTY SITE: OEVERING CAPITAL 735 MAGOO ROAD HUDSON, WI 54016 N 1/2 NE 1/4 S35 T29 N,R 19W FOR: Design Wastewater Flow Value: 450 Bedrooms: 3 Limiting Factor(s): 38 Inches Maintenance Required: Effluent Filter SAN-2023-208 Phone:608-266-2112 Web: htto'Ndsps.wi.stov Email dsns6i)wisconsin.Kov Tony Evers, Governor Dan Hereth, Secretary Identification Numbers Plan Review No.: PWTS-092301995-C Application No.: DIS-082337712 Site ID No.: SIT-120533 Please refer to all identification numbers in each correspondence with the Department. At -Grade Component Manual - Version 3.0 (May 2022- 2027) Pressure Distribution Component Manual - Version 2.1 (May 2022-2027) SITE REQUIREMENTS • A full size 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. A Department electronic stamp and signature shall be on the plans which are used at the job site for construction. The following conditions shall be met during construction or installation and prior to occupancy or use: • A sanitary permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.19, Wis. Stats. • Prior to the construction of the dispersal area, check the moisture content of the soil to a depth of 8 inches. Proper soil moisture content can be determined by rolling a soil sample between the hands. if it rolls into a''/e-inch wire, the site is too wet to prepare. if it crumbles, site preparation can proceed. if the site is too wet to prepare, do not proceed until it dries. • 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. • All piping shall conform to SPS Table 384.30-3 and SPS Table 384.30-5 • Insulate building sewer beyond 30 feet per SPS 382.30 (11)(c) • Well setbacks to meet chs. NR 811 & 812 • Tank Installation to follow all manufacturer's recommendations. • Verify property line(s) prior to installation. • Pump Floats to be set and verified per the approved plan. SAN-2023-208 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 and Wis. Admin. Code § SPS 383.540). • 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 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 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. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/instal lation/operation. In granting this approval, the Division of Industry Services 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. The Division does not take responsibility for the design or construction of the reviewed items. Inquiries concerning this correspondence may be made to me at the contact information listed below, or at the address on this letterhead. Sincerely, r.r,�ie' f e'ri Katie Petzel Division of Industry Services Phone: 608-574-1189 Email: katie.petzel@wisconsin.gov Fee Required: $250.00 Fee Received: $250.00 Balance Due: $0.00 Refund Expected: $0.00 SAN-2023-208 Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 08/22/2023 Owner:Oevering Capital Location: N1/2 NE1/4 S35 T29 N,R19W 735 Magoo Road, Hudson Manuals Used: At -Grade Component Manual version 3.0 (May 2022-27) Pressure Distribution Manual version 2.1 (May 2022-27) Page# 1. Cover Page 2. At -Grade Plot Plan 3. At -Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7. Filter Specifications 8.4 Maintance and Contingency Plan Attachments: Soil Test Shaun Bird Signature F 4 -*-k License number 226900 Page 1 of 9 SAN-2023-208 System PLOT PLAN PROJECT Oevrina Capital ADDRESS 1433 Cernohaus Ave. New Richmond Wi 54017 N 1/2 NE 1/4s 35 /T 29 N/R 19 W TOWN Hudson COUNTY ST.CROIX SYSTEM ELEVATION 105.2' DATE8/22/23 BEDROOM 3 CONVENTIONAL AT -GRADE XXX CONVENTIONAL LIFT BOLDING TANK MOUND SEPTIC TANK SIZE 1000 Gallons LIFT TANK SIZE DOSE 'TANK SIZE 650Gallon HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of ChambersNone BENCIiMARK V.R.P. Top of Survey Iron ASSUME ELEVATION 100' Filter Lifetime ❑ BOREHOLE O WELI, *II.R.P. same as benchmark L,B,M.` 1 05.2' M C 7% Slope B - 3 455' Property Line Magoo Road Wieser Combo Septic B-4A1 0 6.5' 103.5'104.5' 105.5' Area 15' Below At - Grade is to remain undisturbed Grading is to be done to Pro 3 Bedroom House Well is to meet all WDNR Setbacks divert runoff away AL from system Scale 1 "= 40' 0' 40' 80' At -grade System Sloping Site Cross Section and Plan "+ ________--____________________ri___.,, r y r-r-• •fir; ': ti.w••. ;ti.S•', •'.•`. '••` �•• 1• I }}:"..; . r;.•; ��: •: •.•::::;:;r; ;; ;• . ti w.ti•w• • • .rti• I ;r:...'.: • �,:;f;: ;.: ::': ;: ;::•r•`':'•` •` •.•��•:.;�;"r.1 •J•r•r: l; S••r •r;�'ti 5j•'. �•'+'�ti',•..:•. tir w.. r .:ry��:a.ti:.�+,•ti.ti.w•w•'• ti ,• r:r r r rS?ti.�tirtirti;{ rtir k { ''•. ;.r r r r r w . r ..ti;ti�:::'r:'`f r,?•r,r f , • . . I L:�.;.w•w w "'ti ti ti tir+. r r :::: ;ti::' "'r rw rti{ r I r,r rw r•.rti wrwr•r r •r�rw f ti I `: tie�fti rwrw� r4 wry ,; • •ti •. •. ti•ti r ?; ^:r:r r r r.; t F rrrr•r } � (� C r r;? :? :,;.;{;tirtirwrwr rti w w ". wrtirwr; •. w� ':r r:rtir"�rwf rwr r. tir:r..•;r;:;rrrfr•rrrr• �wti•.ti ,•rtirti I E r w w r r r r }tirtir ti ti tire; wr r l } C r r rwrti;wrtif{r r�rtirti a r t rti w w" k r tip.::,�:• ,.. .?w� f;�ti; rti r r•. •rwr rti. r ti. r:i r r r rtirwf:r ..•.:, • ;;:,.w• :r:-,,:�r�r;r•: •: •f;?• 'r' ti;y.•.;:;.,:::.•. .w•tirl�,tirwr :�;+;.•^...•,. r,r,r,r,r.r.r;r..;r:r•r•},•?{ti:,:;.,?.,:•.?{;{;•..•.:{. } I }rr r.. r;:;::. .ti••.•w.w•4:'�:'ti�'���,_..�:�—"-"mow' •- - 1 r { y�• .._� — 1 /6 l3 �T 1 SAN-2023-208 View I 1 '1 Flowed �:'�; = Clean aggregate Q = 4 in. sch. 40 pvc I I basal area {ti '/, to 2 '/, in. dia. observation pipe L J Geotextile Fabric Lateral with 2" aggregate over pipe Topsoil Cap �"—' Slope Direction �� Observation Pipe With Cara --, Topsoil Cap GENERAL INSTALLATION, The at -grade }area sal aaea tI©xtW) is the desigli contour. staked out and plawedxwithna vegetation is mowed and raked off the site. the plow depth to moldboard or chisel plow. Plowing may not 1proceed dr b � ee the palms of the hands.wet enough atTl e A x � area is farm a l/a inch soil wire when a sample is rolled covered by clean aggregate deposited overhead by a backhoe, Special care must be used when placing the aggregate to minimize compaction of the plowed surface. After�yrn the topsoil i cap is protect placed, the entire at -grade is seeded and mulched to promote vegetative groCvth, from freezing. The observation pipes are perforated in the lower 6 inches and secured in place. 03/05 lgj Page of SAN-2023-208 Force Main Pressure Lateral Layout One Lateral — End Manifold �-- Threaded Cleanout Lateral Turn -up —► Plug X ---� L Long Sweep 90 Bend Pressure System Construction Distribution Network Specifications Lateral Diameter In. [Pth terals are constructed of Schedule 40 PVC Orifice Diameter In. e. Orifices are drilled perpendicular to X Orifice S acin In. pipe with a sharp drill bit and face down. L Lateral Len th Ft. teral turn -ups terminate with a threaded Force Main Diameter 2 , In. ariout plug and are enclosed in a 6-8 inch Ft. diarneter lawn sprinkler valve box accessible Force Main Len th from finished grade. 03/05 lgi • • • • • Grade • • • • • • 6-8 Inch Lawn Sprinkler Valve Box Page of I SAN-2023-208 Septic -Dose Tank. Cross Section And Pump Performance Specificatiol'l'S 1'a��k Manufacturer Gc,'Je° -p,-- _ _ Y Pump Manufacturer l tutk _t;l Number Pump lylode[ Number Mod Total't'ank Capacity Alarm Ntanufacturel' !/! — —� Alarm Model Number G- �1\4ax. Bury Depth f Switch Type �- %l7PC402C 1Filter Manufeteturc�r "Filim Model Number Minimi.un_Fump performance Required _� iwt TI7H� Total Dynamic Head (TDH) _ Feet _ Distal Pressure Network Loss' Force Main Loss Outlet Manhole Min. 4" Abav$ Grade With Manhole Min. 4" Above Grade Locking Den ice, Inlet Manhole With Locking Device < 6" Below Grade Sealed Watertight Securely Mounted Weather-proof Junction Box �- -- Finished Grade .. .� .,.. ,,. .�. �.. Outlet Filter Inlet Baffle Switch SettJn>t gKescrve Capacity "1'ank Volume — GPI __ Dimension, Inches Volume Gal. (reserve) A; L ,may (alarm) B 2 _ (dose) C (dead) D [J Total Vent Min. 12" Disconnect Above Grade Means With Vent Cap 11 so 1A is _Effi-�o I Im Off Elevation C ,'�--'=� Bottom D Elevation . Z Ft GLi NER.AL INSTAkLLATION: The septicfdose tank is bedded and back tilled in accordance with the manufacturer's product approval specifications, Maximum depth of bury as specified by the manufacturer may not be exceeded without prior approval. Manhole covers exposed to grade have an effective locking device (padlock) installed. Piping at the inlet and -outlet is of approved material, connected to the tank with watertight fittings, and laid on st.abl soil to prevent settling or sagging. The forcd main is sleeved with A" Sch. aft i'VC to bridge the tank c. __ _ - _ ion a 2d the sleeve is sealed watertight. Electrical services complies with NEC 300 and Comm 16.28, 02105 U page —i— of f SAN-2023-208 280=SERIES 112 hp Submersible Effluent/Sump Pumps Performance Curve: 280-Series The Liberty 280-Series provides a cost effective" mid- range,, pump for on -site waste water systems, liquid waste transfer and commercial heavy-duty sump pump applications that require higher head or more flow. Designed around Liberty's unique "Uni-Body" casting, the 280-Series will provide years of reliable performance. All Models Feature. • Vortex style impeller perni ttirlg passage of solids Lip to%" 1 • 416 stainless steel rotor shaft • Permanently lubricated upper and tower ball bearing • Epoxy powder coat finish • All fasteners - corrosion -resistant stainless steel • 1'Jx" Discharge • Stainless steel bottom screen -easily removable ■ Maximum fluid temperature: 140' F. 280-Series Cord Lengths Model 10' 25' -2) 3510) 50'(-51 280 Standard Optional optional Optional 281 Standard Optional optional Optional 1283 Standard optional Optional N/A 287 Standard NIA N/A 10' cord length standard on all models. For optional lengths, add "-2, -3 or -5" suffix to model number. Example: for model 28o with 35' cord, order 280-3 Motor Specifications A hp 60 Hz 3450 RPM Oil filled, thermally protected (PSC) Permanent Split Capacitor 8.0 amps (115V) 4.0 amps (208/230V) Iii Q 10 15 20 25 30 35 40 45 5o tat) ov aU r U.S, Gallons Per Minute 38 78 114 156 192 228 270 Liters Per Minute Dimensional Data: Weight:29 lbs. Height: 13" Major Width: 10" (model 287) Minimum Sump Diameters: Model 281, 283.. lei" Model 287 VMF... 10" FactoEI Model 281, 283 Model 287 setting T311 urn /''urn The Model 283 features a fully adjustable wide-angle float. Differential adjustments can be made easily by tethering the floatto the dis- charge pipe orother mounting point. Vertical float model 287 is not adjustable. 287 Model260 — Model 281 Model 283 Mode{ VMF-Serles Manual, Wide angle4JII Wide angle switch Vertical mag- no switch float switchfloat series netic float for with quick -with smaller pits - -{ disconnect(piggy-back) will operate in plug a 10" diameter sump SSP�+x SP� t ,:, c us Certified / �AR Speolhoativn are•ublvc t to change with o u t n ohGo. Liberty pumps • 7000 Apple Tree Avenue • Bergen, New York 14416 • Phone 800-543-2550 Fax (585) 494-1839 Copyright 0 Liberty P-,II IJS] Inc. 2D1'i www.hbertypurnpS-colts All riglits reserved. urr 20co Rc5Jt7 ,o-,9 --o4E,A .. lul 9j SECTION A -A 71- 61 FIQWTS OWNER'S MANUAL & MANAGEMENT PLAN ......-r.-x. nnr_r�Clf"•hTlf"1N.S' IFILE INFORMATION Owner Permit # !DESIGN PARAMETERS Number of Bedrooms ❑ NA Number of Public Facility Units NA Estimated flow (average) } al/da I Design flow (peak), (Estimated x 1,5) 7-SO cial/day 1 Soil Applicailon Date--------------- aVJda !R� Standard Influent/Effluent Quality Monthly average' Fats, 011 & Grease (FOG) 530 mgl_ B[ochemlcal Oxygen Demand (HODa) 5220 mg/L 2 NA Total Suspended Solids (TSS) 5150 mg/L Pretreated Effluent Quality Monthly average Biochemical Oxygen Demand (121006) 530 mg/L Total Suspended Solids (TSS) 530 mg/L '76,NA Fecal Coliform (geometric mean) 510' cfu/10Dmi Maxinjum Effluent Particle Size in die. ❑ NA 1r,tr pr NA `values typical for domestic wastewater and septic tank effluent. SAN-2023-208 Parse _- '.r [AINTENANCE SCHLDULE _ service Frequency Service Event I ❑ mont s) �, (Maximum 3 years} � NA [Inspect condition of tank(s) At least once every: ear s When combined sludge and scum equa;s one-third (%) of tank volume ❑ NA 1Pump out contents of tank(s) Month(,) (Maximum 3 years) El NA llnspect dispersal cell(s) At least once every: ear s - f months) ❑ NA I'_Iean effluent filter At least once every: r.t ear s C] month(s) p NA � Inspect pump, pump controls & alarm At least once every, ear s 0 month(s) NA _. 1=lush laterals and pressure test At least once every PU year(s) O month(s) NA —17ther. At least once every: C1 ear s —__ ❑ NA MAINTENANCE INSTRUCTIONSMaster I[Plumeber; Master Plumber Rtestrictted Sewer�POWTShcnspectorl POWTS Maintialll be mae by an individual carrynnernSeptage Seoe of the irvicinglOpe ato , TankfInstpections must [include a visual inspection of the tank(s) to Identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of icombined sludge and scum and to check for any back up or ponding of efflund ent check on the any surfding of The dispersal cell(s) shall surface. tUisually inspected ffluent check ontheground surface the hey bind vateo a Pip�NngaconditCon and requires nthleglmmedlaiot notification on the uo ground local The ponding of Iegulatory authority. When the combined accumulation of sludge and scum In any tank equals one-third (X) or more of the tank volume, the entire contents of !-.he tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin Administrative Code, pretreatment units, 101I other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, Isnd any servicing at intervals of 512 months, shall be performed by a certified POWTS Malnteiner. 1� service report shall be provided to the local regulatory authority withln 10 days of completion of any service event. � W- � SAN-2043-208 page --� for the presence of painting products or other chemicals tr'Elt START UP AND OPERATION process and/ damage the 6spersal cell(s). If high concentrations are detected have the contents o H For new cnnstruc1Von, prior to use of the Pt7WTS check treatment tanks) may impede the treatment p tank(s) removed by a septage servicing operator prior to use. System start up ower is restored the excess wastewater will by shall not occur when soil conditions are frozen at the infiltrative Su ace. power outages pump overloading the cells) and may result In the backup or surface discharge power o the During p urn tanks may IVii above normal highwater levels. When p stator prior to restoring p discharged to the dispersal cell(s) in one large dose, tank removed by a Septage Servicing atIn9 the lump controls to restore normal levels To avoid this situation have the contents of the pump effluent pump or contact a Plumber or pOWfS Maintainer to assist in manually op sot, the area within within the pump tank. Do not drive or park vehicles over tanks and dispel orc"lls area, not drive or park over, ar otherwise disturb o�COmB life of the POW71; 15 feet down slope of any mound or at -grade sot a improve the performance and protong foundation drain from the wastewater stream may p dlaperb; disinfectants; fat: eat scraps; medications; oil; pa;ntirlg prpdtlCl�S; Reduction or elimination of the following condoms, cotton swabs; degreasers; dental floss; antibiotics; baby wipes; cigarette butts; aelin s gasoline; grease; herbicides; m (sump pump) water; fruit and vegetable p g pesticides; sanitary napkins; tampons; and water softener brine. Y roe i ABANDONMENT�ollowjng steps When the POWT S fails ater Comm 83.� and/or Is permanently taken out of service Wisconsin Administrative shall taken to Insure that the system Codeis p p and safely abandoned in compliance with chapI e o enings sealed. • All piping to tanks and pits shall be disconnected and the abandoned p A p a Septage Servicing Operator. • The contents of all tanks and pits shall be removeaproperly d I ma disposed their covers removed and the void space filled with S1101, After pumping, all tanks and pits shall be excavated gravel or another inert solid material. or must be taken, provide rovide a code compliilint CONTINGENCY PLAN it the POVVTS falls and cannot be repaired the following measures have been, telm- replacement system.re utied and compaction and ShoEald not be infringedel upon in the neied replacement area has been evaluated and m8utiilxed for the location of a oil absorption sys ❑ A suitable A protected from disturbance 'The replacement area should be pcomplywith the rut 0El in setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacem far a new soil and site evaluation to establish a suitable replacement area. Replacement systems muslin Pt]WT5 technalogK a affect at that time, CD A suitable replacement are dlas a lastriesolrtto replace the failede due to setback rPOINTS.n'tations. Barring advances a soil and site evaluaiion holding tank may be installs The site has not been evaluated to Identify a suitable replacement area. Upon failure aft e must be perfor med to locate a suitable replacement area, If no replacement area is available a holding tank may be installed) as a Iasi resort to replace the failed POWTS• be reconstructed to piece following removal of the bicmat at the infiltrative Mound and at -grade soil absorption systems may ! tiwith the rules in effect at that timo. surface, Reconstructions of such systems must comp y <<WARNING77 OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDIOR iNSUFFIC}ENT OXYGEN, t70 NOT SEPTIC, PUMP AND ENTER A SEPT IC, PUMP OR OTHER TREATMENT TANK UANY DR MPOS51t3LEANCES. DEATH MAY RESULT. RESCUE O' A. PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT A[ ITIONAL COMMENTS POWTS MAINTAINER pOWTS INSTALLER Name r-------��" Name Phone 5— �. C► ' �� �` — 'hone --- �.00AL REGULATORY AUTHORITY S> PTAGF SERVICING OPERATOR PUMPER NameR ,�Name /` [ Phonephone — L. V 1w.onsin Administrative Cade. This document was drafted !ncomAtVance.with chapter SPS 3,3.22(2)(byj)(d)&(t) and 383,54 lwq CAN e)QQ ST. CtSANITARY SYSTEM File #: r""" Office Use Only OWNERSHIP/ADDRESS FORM Created21202'1 Community Development Department will utilize this information to provide the property owner with information regarding operation and maintenance of your new or replacement sanitary system! This information will be provided as part of our ongoing efforts to protect public health, your well, groundwater, surface water, property values, and county resources. Once approved, this completed form and educational information witl be sent to you by email. If you would like to view your issued sanitary permit online, you can do so by using the Property Files Scanned weblink. OWNER/BUYER INFORMATION Owner/Buyer Mailing Address `1 �+ City/State/Zip Phone Number (required) Email Address (required) , Parcel Identification Number (found on the property tax bill) NEW SYSTEM: LEGAL DESCRIPTION ; Property Location J eta , 5ec3 Town of Subdivision Plat: T-1—L4, 7 Lot # Z�' Certified Survey Map # Volume --~ Page # Warranty Dees! #],� (before 2006)Volume Page # Number of bedrooms __ 5 Spec hous5KYes 11 no Lot lines identifiald/104yes © no OFFICE lJs£ CrNLY New property Address � C ��. 0 GAS (Verific Lion of ew address quired from Community Development Depbrtment For new construction.) 9 z� z3 (Staff Initials) (Dat ) This form must be submitted with all Privote Onsite Water Treatment System (POWTS) applications. New System: Include with this form a recorded warranty deed from the Register of Deeds Office and a copy of the certifier) survey map if reference is made in the warranty deed. Community Development Department — Land Use Division 715-386-4680 St. Croix County Government Center 715-245-4250 Fax cdd[_sccwi.gov 1101 Carmichael Road, Hudson, WI 54016 www.sccwi,gpv State Bar of Wisconsin Form 1-2003 WARRANTY DEED Document Number it Document Name BY THIS DEED, Oevering Homes, LLC, a Wisconsin limited liability company, ( hereinafter "Grantor," whether one or more), conveys and warrants to Oevering Homes Investments, LLC, a Wisconsin limited liability company. ( hereinafter "Grantee," whether one or more), the following described real estate in St. Croix County, State of Wisconsin: SEE ATTACHED EXHIBIT A Exception to warranties: easements, restrictions and covenants of record; highway and street rights of way; and Municipal and zoning ordinances and agreements entered under them; and further except real estate taxes accruing in the year of this conveyance. Dated J �/ Oevering Homes, LLC, a Wisconsin limited liability company By: Oranzo J. Oevering, member AUTHENTICATION Signature(s) authenticated on TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by Wis. Stat. § 706.06) 1140575 208 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI RECEIVED FOR RECORD 10/05/2021 03:36 PM EXEMPT#: REC FEE 30.00 TRANS FEE 3,675.00 PAGES: 2 **The above recording information verifies that this document has been electronically recorded & returned to the submitter Recording Area Name and Return Address St. Croix County Abstract & Title Co., Inc. 575 N. Knowles Ave., Suite #B New Richmond, WI 54017 Parcel Identification Number ( PIN) See attached exhibit A This IS NOT homestead property. CARPENTER ANDREA S Public (SEAL) Notary F 4� State of Minnesota Expires My Corn mfssio n 31, 2022 .' .1anuaty THIS INSTRUMENT DRAFTED B,K* St. Croix County Abstract & Title Co., Inc., by Andrea S. Carpenter at the direction of the Grantor. 21-S29382 ACKNOWLEDGMENT STATE OF W4se&isiN ss. COUNTY Personally came before me on 0 3 `D 2o2 1 the above -named Oranzo J. Oevering, member of Oeverin Homes, LLC, a Wisconsin limited liability company, to me known to be the person(s) who executed the foregoing in ment an 4nowledged the same. Notary Public, State of-Wiss 4iri �> ! ?t / 1 Z- My Commission (is permanent) (expires:_ (Signatures may be aulhenlicaled or acknowledged. Both are not necessary.) NOTE: THIS IS A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED. WARRANTY DEED D 2003 STATE BAR OF WISCONSIN FORM NO. I-2003 * Type name below signatures. St. Croix County 1140579 Page 1 of 2 SAN-2023-208 Legal Description Lots 167. 169, 170, 171 and 172, Plat of Evergreen Valley III in the City of New Richmond, St. Croix County, Wisconsin. Lots 15, 16, 17, 18, 20, 21, 22, 23, 24, 28, and 29 County Plat of Summer Prairie Second Addition in the Town of Hudson, St. Croix County, Wisconsin. 261-1300-00-167 261-1300-00-169 261-1300-00-170 261-1300-00-171 261-1300-00-172 020-1106-90-200 (part of) St. Croix County 1140579 Page 2 of 2 SAN'2023'208 FOUNDATION PLAN FOUNDATION 00 0 N Cl) N O N C, S tSAs b23-20i� Wisconsin Dep�;-b� of Commeme SOIL ALUATiON REPORT Page of Division of safety and Buildings c:� 4 "ems!vim Wis. Adm. Code , Attach complete site plan on paper not less than B 112 x 11 inOws. in site. Plan must tY mndude, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. q F� percent slope, scale or dimensions, north arrow, and location and distance to nearest road. C) " 19 f rJ - 0 j ' 0 d c) Please print all information. Reyierved by Date Pr(Spyi irAormrtian you provide mil' de used for lacanRa7 i jpOvscy Law, i- 15.04 (1 ) (m)}. LLA,y,•� ✓ 'd- y`f 114 Prey Owner Property Location tt r- Govt Lot Ili L(jL114 114 5 3 ,j T Z:2 N R 1 q E for Property Owners Mailing Address Lot # Bbck # r _L Name or CSM# 35 I C�y State Tp Code Phone Number ❑ City Viliage own Nearest Road Constructor► Use. ntial 1 Num6er of bedrooms Code derived design flow rate �IL! GPD ❑ Replacement p PWI Ammeroaf._ tee: _ Parent matanal 0 z i ##t "' Fkod Plain elevation if applicable - ft, General Comments and rraarrnshdskvw: System Type 2LJ System Elevation 1 # . Pit Ground surface elev. fl Depth to WftV factor ✓( `in- �J PAM =® v p Bonn Pit Ground sur%ce eiev.Lo r R Depth to km&V factor in. t a e.r,s„ mow, o FAMMi�� _ - cnruera wl - estxa_ s Ju c "u "YL and 755 a313a 15OMW Ef xvt 02 = BOO, < 30 mg& and TSS c 30 m lL CST Name (Please Print) Si re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1432 120th St, New Richmond, WI 54017 ii� r -f - - `D 715-246-4516 SAN-2023-208 Owner — Parcel 1D # Page of j�j�Prowty Pit Ground =lace etev. R Depth factor in S0: � Ficmizon Depth Dominate Redox Texirre 5tnttirre Cons n Bouaxfary liaols GPL1r1F in. MLInsea 0u. SL ConL Color tar, Sz Sh. 'E!f#i 'Efi#2 r4, r __­ L l `�R # � D:r M QnLN I sa edam MN- GmLwsd S4.tlt" eiev- ff r1arAh r, 6%-:r:ne. I —a... ETfl wt #1 = EK)D, } 30 5 220 rnwL and TSS >30 5 ISO "V& ' Effluent #2 = 80Ds, 130 nV?L and TSS 130 mgk The Department of Commerce is an equal opportunity service provider and employer. If you nerd assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-2644777. saasswce &W5 SAN-2023-208 Soil Test Plot Pla " Project Name Urchins LLC Sli� B'd Address 1353 Awatukee Trail Hudson Wi 54010 TM #226900 Lot 17 SubdivisionSummer Prairie 2nd Add pate 10/15/20 N 1/2 NE 1/4S 35 T 29 N/R19 W Township Hudson Boring 0 Well PI, Property Line County ST. CROIX ` survey 1 or �'Rl' Assume Elevation 1flfl ft. Top of Y iron System Elevation TBa *HRPSame as Benchmark SAN-2023-208 OCT 2 2020 kj, Wmansin Dqwtrrant of SOIL ALUATION REPORT 4MNl*&M* Wis. Adm. Code co-ML.- � M"�zo— - DMalon of SB*y and SukkVs St, Croix �-'Jonty ft C Attach catspiste sie plan on paw not lose than 8112 x 11 Inches in &tze. Plan must trtdttds but not kneed to: vwtk-Al and horizontal reference point 0M. diredon and peroargislops. scale or dirnenslons, north arrow, and kxation end distance to nearest road. Pams�'-D- . please print am Infonnadon. D&W Pe kAwnwiloft you ployMs mWY be used for secwxWy mirim." JPrk*q Law. a. 16.04 (1) (m)). ZZ -);L� % 122W Gout Lot �j Y Zl 14 ZI �l 9 S 3 rT Z2 N R E Lml 0 1 Bk-lode SLbd Nam or C" A W% IN"M &k06wVWWVUCW Code delved design now rate �! s oh cir) GPD [3 ReMicerrient PL"W oornm Flood Main elevation U applicable fL Gerwalocinvients and flownrlwKilloor .. system rna Sr Soft# 0 soft Ground surface aloe. .3, J,L Do* 110 W'WQ tads r Rate Hl'lWn 1 00,11 1 Dwrttrtart Cdlo' Radox Dem"on Todure ftftn Conolsten"I ftwdWYI Roots I GPM h Muni I Chu. Sz. Cont color I I Gr, SL SK I I .- , , . --- MMOMFItwo �FT�VJDM®rll=�- "M IIIIMI fFMM W71ll FWe MMWAFMMWA7.� Mfl!>•/ 1111TWA W" I . 71 &AV 0 Borkv Pit Ground surlaos elev. Depth knftV factor ipl. -�Zft so to_ I ZZ P=l VAWR f Mi WA M M -M M � MOM WA M M WN * Effluent 91 a 90D. 3, 305 2M flak and M 3-305 150 ffoW / * Effkmt 02 a BOO. S 30 mD& and T35 S 30 MWL CST Name (Please Print) S re CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address - Date Evaluation ConductedTelephone NunV-vr 1432 120th St, New Richmond, WI 54017 7 A4, 2— 17 715-246-4516 SAN-2023-208 IE �Yo wnor Parcel ID rY � Rptt Ground artaoe ow. l p� i R Depth to f n*v tabor r1�h Papa of wit.MI n©Boring -1 - son R�`=C Horizon Dapfh Redox Dasaip m Taxturo Ststxsura Coraidarwa Bamdary Roofs GPM Ckr. Sz Cont Color Gr. Sz. Sh 'EtFi{1 I '06! ' Ettkrars X1 ■ BCOi > 30 S 22D rnpiL and TSS D-30 S 160 nvOL • Ettiuent 02 a WDf: 3D nV& and TSS S 3D nIWL The Department of Com=c= Is an equal opportunity service provider and employer. If you oeod assistance to access services or need material in an alternate format, Please contact the departrrmt at 6M266-3151 or T'TY 609-264-8777. =D410"QL4" SAN-2023-208 Sail Test. Plot PI Protect Name Urchins LLC 5 Address 1353 Awatukee Trail Hudson Wi 54016 ;'FM #226900 Lot 17 SubdivIslonSummer Prairie 2nd Add pate 10/15/20 N 1/2 NE 1/4S 35 T 29 N/R19 W 'Township Hudson Boring (:D Well 1'1, Property Line County ST• CROIX Assume Elevation 100 ft. Tow of surv� ey iran ?IE I S T ADDI TION UNPLA T TED LANDS s02048'32"w � o — S01 38 24'W IP 152.fi8' 81.74' S00029'51' W 351.15' N02012133"E 620.511 -MAOOO ROAD r/ L-47\ CO DEDICATED TO THE PUBLIC ' 6� 502°12'33"W 457.67' fv.`% 252.98' ~~ T �L13 W o M 80Z-EZOZ-NVS. d` f 3SAN-2023-208 C961X 1'0S-lz9q 735- Mh6m r-'"PANSFj:P V"Arl PREVIOUS NO. OWNER PAEs �-►JTC%'_iM.CWM , L�lL. PLUMBER �7 ' • i TOWN OF i .t AND/OR , BLOCK 0. WL66- W* at G —2WADOMIN SUBDIVISION K CHAPTER 145.135 (2) WISCONSIN STATUTES (a) The purpose of the sanitary permit is to allow installation of the private sewage system described in the permit. (b) The approval of the sanitary permit is based on regulations in force on the date of approval. (c) The sanitary permit is valid and may be renewed for a specified period. (d) Changed regulations will not impair the validity of a sanitary permit. (e) Renewal of the sanitary permit will be based on regulations in force at the time renewal is sought, and that changed regulations may impede renewal. (f) The sanitary permit is transferable. History: 1977 c. 168; 1979 c. 34,221; 1981 c. 314 Note: If you wish to renew the permit, or transfer ownership of the permit, please contact the county authority. cz� AUTHORIZED ISSUING OFFICER DATE Y?_&)2b2.3 THIS PERMIT EXPIRES yj 112,02 3 UNLESS RENEWED BEFORE THAT DATE SBD-06499 (R11/20)