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HomeMy WebLinkAbout040-1303-00-044 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division Sanitary Permit No: INSPECTION REPORT 552321 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., c/o Jeff J. Husby- Troy, Town of 040-1303-00-044 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: iad 3,~ t G.' 22.28.19.1779 TANK INFORMATION ELEVATION DATA FS ELEV. I TYPE MANUFACTURER] CAPACITY STATION BS HI Septic Ben hma Nw 5. f,3 /ds.L /z~ lL~ :11-4 Dosing ✓ Alt. BM 1 y 1.6 l• 7 M. l I'' ~J 1- Bldg. Sewer 44",6 Zak- A- 70/,(03 Holding St/Ht Inlet 7. UZ. 61 ~ O TANK SETBACK INFORMATION St/Ht Outlet TANK TO ~P/L WELL BLDG. ent Air Intake ROAD Dt Inlet Septic 56 l X210 54 Dt Bottom 94/,~7 Dosing J / I Header/Man. Z /15 L .7 _7s0 ~z~ 35 Aeration Dist. Pipe Z 9~ ~(J Z,7 Holding Bot. System 3. / /d z O PUMP/SIPHON INFORMATION Final Grade 195 IJ3• Manufacturer De and St Cover Go ~L s GPM - 3 7 Model Number L 33,3 CO,.-a,~,r TDH Li. Friction Loss System Head TDH T ,Zc66-71 , Forcemain Length Dia. Dist. to well Z SOIL ABSORPTION SYSTEM BED/TRENCH Width Length Ns PIT DIMENSIONS No. Of Pits Inside Di~ Liquid DIMENSIONS /6 66 ~ SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of S stem: D O IF UNIT Model Number. DISTRIBUTION SYSTEM Header/Manifold Distribution i/ x f He Spacing Vent it Intak APipe(s) Q Q~ 11-ength-zia Length ~u ' Dia / Z6 Spacing 5 9 O z' Z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only a Depth Over Depth Over xx Depth of xx Seeded/S dded jxx Mul ed 7Z Bed/Trench Edges Topsoil I P4~ Yes 5jj No Yes ❑ No Bed(Trench Center / .72-' COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: g ZQ/ i nspection #2: / / Location: 218 Walnut Hill Way River Falls, WI 54022 (NE 1/4 SE 1/4 22 T28N R1 9W) `nut Hill Far aka a Tribute Parcel No: 22.28.19.1779 1.) Alt BM Description = ~z o J_e_'C~s c.J( 2.) Bldg sewer length - amount of cover = 42- Plan revision Required? [5] Yes -if /No Zc~ ~3 Use other side for additional information. Date Insepctor's Si nature Cert. No. SBD-6710 (R.3/97) w Plot Plan - - Page 6 of S Property Owner C T lwE R.s. 14Qft Legal Description LeT 41y wAwLL-r tt1L(-;r74r-An, (4ftmpt where noted, or THE SB i4 5zz} TzBN, R ~q rower! of ► ~oY, { L~ = Backhoepij 57 e"iY 10-01 VTy w LS&W 6I,J . Mya tso3- 00- 04g 1.07 uT>L.L-v) North I i i a~ ~6p 0 4~4~' ~ntt& taNE NIIT ply ~-wE> { lob too, ca ` Qy Elm r~ 4 75 e# , S ` A)SW r¢ 'frwK I J I~ 3 h S 1 u-i Air~ S Cn3ay -M I's C/ ate Location: 5~ a~r4+o t+r c~EC.ZZ j commerce.wi.gov Safety and Buildings Division County X rum Ave., P.O. Box 7162 ]L CZ O Q con 53707-7162 Sanitary Permit Number (to be filled in by Co.) ssin Department of Cowww" 3 Sanitary Permit Appl' tion State. -TrransactionMun er In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission o is the appropriate governmental ` 0 6 0 b address) unit is required prior to obtaining a sanitary permit. Note: Appli tion f owned POWTS are Project Address (if different than mailin submitted to the Department of Commerce. Personal informatio you prov or secondary J purposes in accordance with the Privacy Law, s. 15.04 I m Stats. Q { _ ~L( (,J~ Aide y 1. Application Information - Please Print All Informs ' n Property Owner's Name i z Parcel # 06 _ 1363 60 - O Property Owner's Mailing Address QU Property Location e 17 9 Govt. Lot City, rate Zip Code Ph/one N Section Z A C J 1,V 1 ( 6 Z/ [ ( y Z `-Z Z L _ ~7 21 Q (circle one ~ d T Z O N; R~Eot~ II. Type of Building (check all that apply) Lot 1 or 2 Fancily Dwelling.- Number of Bedrooms 4k o4 Bloc W4t--/UUf (LC FA-&M ❑ Public/Commercial Describe Use I ❑ City of ❑ State Owned - Describe Use / CSM Number ❑ Village of r/ Town of k-lk e- III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. O New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) List Previous Permit Number and Date Issued l B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) A61, ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade rd Mound> 24 in. ofsuitable soil ❑ Mound <24 in of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) 45 / V. Dis ersal/Creat nt Area Information: Design Flow (gpd) Design Soil Application Rate(gpds Dispersal Area Requir O Dispersal Area Pro a(s>D System Elevation ,J I ~ &Co ` /,I VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units n v ° v New Tanks Existing Tanks 52'S k 6' rd j~ rn ~ 'w c7 a Septic or Holding Tank Dosing Chamber VII. Responsibility Statement- I, the undersigned, assume responsibility for Installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's 'gnaturo MP/Ki3 Number Business Phone Number O/L 66y01,1 Z Z bf~ is` Z Z3 Plumber' Address (Street, City, State. Zip Code) ~i 12-2- ,~u~2 UCH . G LL uJ LU ( J~ {~D VIII.-County/Department Use Only J 14 Approved rsapp Permit Fee Date s -7 Issuin gent Signature rven Reason o I $ ~24 Z IX. Condi asons for Disapproval i $eptic tank, etfltltartt filter and t A. dispersal cell must all be services / maintained s ~(1(~~, J d r,5 /fief `/U f as per management plan provided by plumber. 2. A11.sef1back requirements must be maintained '%=f T6 comp e e p ans or Me system and submit to the County only on paper not less than 8 to x 11 inches in size SBD-6398 (R. 01/07) Valid thru 01/09 ' 9EyARTkg~ Safety and Buildings 3824 N CREEKSIDE LA d 9 HOLMEN WI 54636 3 a S Contact Through Relay P S www.commerce.wi.gov/sb/ ?t w www.wisconsin.gov ~O 'sSIONAL'~ Scott Walker, Governor Dave Ross, Secretary March 26, 2012 CUST ID No. 224832 ATTN: POWTS Inspector MARY JO HUPPERT ZONING OFFICE HOLLISTERS SOIL TESTING & DESIGN ST CROIX COUNTY SPIA W9875 690TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 03/26/2014 SITE: Identification Numbers C&j Builders Inc Transaction ID No. 2068649 218 Walnut Hill Way Site ID No. 777773 Town of Troy Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. NE1/4, SE1/4, S22, T28N, R19W Lot: 44, Subdivision: Walnut Hill Farm FOR: Description: Four Bedroom Mound System / 5% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1364440 Maintenance required; 600 GPD Flow rate; 32 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative C e~ S`AT'E SEWAG and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be cons 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 N~ requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145 stats. pIi415iON Of 901T The following conditions shall be met during construction or installation and prior to occupancy or use: Reminders: • A sanitary permit must be obtained from the county where this project is located in accordance with the SEE CORRESP 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 SPS 384 product approval conditions. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. _ l MARY JO HUPPERT Page 2 3/26/2012 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. SPS 383.54(1). • A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(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 Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety& Buildings will be +M modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. 1W MARY JO HUPPERT Page 2 3/26/2012 I 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. SPS 383.54(1). • A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(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 Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be Nie modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. -W MOUND AND PRESSURE DISTRIBUTION COMPONENT DESIGN Residential Application INDEX AND TITLE PAGE Project Name: C & J BUILDERS INC. Owner's Name: (same) Owner's Address: 952 Ridgecrest Street River Falls, WI 54022 Legal Description: NE 1/4 of the SE 1/4, S 22, T28N, R19W Township: Troy County: St. Croix Subdivision Name: Walnut Hill Farm Lot Number. 44 Block Number. NA K. SYSTEM Parcel I.D. Number. 040 -1303 - 00 - 044 al~ Plan Transaction No.: Page 1 Index and tide )V, E`L``~~~gQtdi6~t Page 2 Data entry 'AND BIIII.M'GS ,d Paige 3 Mound drawings ' ' Page 4 Lateral and dose tank + MARY JO+~~ Page 5 System maintenance specifications ~D~~i~ (~d, n- ro'' Page 6 Management and contingency plan 00 D 4 Page 7 Pump curve and specifications Page 8 Plot Plan illit~~U Designer: Mary Jo Huppert License Number: 1859-007 Date, 03120112 Phone Number. (715) 426-1775 Signature: Designed Pursuant to the Mound Component Manual for POWTS Version 2.0 SDB-10691-P (N. 01/01), and both SSWMP Public soon 9.6 Design of Pressure Disbrlibttion Networks for ST-SAS (01/81)srrd Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01101) Version 5.1 (R. 06106) Page 1,0 8 Mound and Pressure Distribution Component Design Design Worksheet Site Information (R or C) R Residential or Commercial Design Note. Sand fill (o) cap Adations assume a 400.00', Estimated Wastewater Flow (gpd) Table 83443 in-sfu wN bsabnent for 1.50 Peaking Factor (e.g. 1.5 = 150%) fecal colifonn of 36 inches. 600.00 Design Flow (gld) 5.00 Site Slope 101.4Q Contour Line Elevation (ft) ,32 Depth to Limiting Factor (in) 0.60 In-situ Soil Application Rate (gpd/fe) Distribution Cell Information 60.00 Dispersal Cell Length Along Contour (ft) = 10A0 Cell Width (ft)' 1.00? Dispersal Cell Design Loading Rate (gpdMr) 1 influent Wastewater Quality (1 or 2) Are the laterals the highest in the distribution Y Pressure Disribution Information network? Enter Y or N (C or E) E Center or End Manifold 3.33 Lateral Spacing (ft) If N above, enter the elevation (ft) 3! Number of Laterals of the highest point. 0125; Orifice Diameter (in) 2.25. Estimated Orifice Spacing (ft) = 7.41 fig/orifice 2.00 Forcemain Diameter (in) w 20.00= Forcemain Length (ft) Does the forcemain drain toads? Y 93.00; Pump Tank Elevation (ft) Enter Y or N 6.50 System Head (ft) x 1.3 3.26 Forcemain Drainback (gal) 8.73 Vertical Lift (ft) 55.91 5x Void Volume (gal) 0.47 Friction Loss (ft) 59.17 Minimum Dose Volume (gal) 0.00: In4ine Filter Loss (ft) 33.37 System Demand (gpm) 15.71 Total Dynamic Head (ft) Lateral Diameter Selection Maniifiold Dlereter Selection n in. dia. option s~ in. dia. options choic 0.75 1.25 x x 1.00 1.50 x 1.25 x x.._ 2.00 x 1.50 3.00 2.00 x 3.00 x GalioniOnch Calculator (optional) T_ reabno t Tank Infoffhation Total Tank Capacity (gal) 1200.00 Septic Tank Capacity (gal) - Total Working Liquid Depth (in) Wieser Manufacturer [1 gaprn (enter result in cell B49) Dose Tank Information Effluent Filter Information 800.00 } Dose Tank Capacity (gal) PO" Filter Manufacturer 22.24' Dose Tank Volume (gain) _ 525 n...... Filter Model Number Wieser Manufacturer Project: C & J BUILDERS INC. Page 2 of 8 Mound Plan and Crass Secation Views T . o . o ff w is j- I I z r T L T A 10.W ftf E 12.00 in H 1.00 ft K 7.56 t i t)V.Ocl !t ~.LJ 1 ll.l~ I IL L. ! 6. 13 IL D 6.00 in G 0.50 ft J 4.62 ft W 22.fi3 ft 600.00 (ft2) Dispersal Cell Area 1080.881 (ft) Basal Area Available 10.00 (gpd/ft) Linear Leading Rate 6.00 (ft) 1/10 B Obs. Pipe Placement Mound Cross Section View Finished Grade 103.67 (ft) 1 1 / ` p~perSa~Ceq `iuz.~TO (it) i aterai F 101.90 (ft) + Invert Dispersal Cell Elevation D 11 1.40 IT Ccntcur 9eva*ior. 5.0 % Site Slope f`-en4cy4jlc Fahrt(; Cover Sh-a- Ing Key g T_ Dispersal Cell See lateral details on l .J 1 i opsoii 1;ap o i.5 it Faye 4 nor iyumbei size, Subsoil cap " i © OO T and spacing laterals. ASTM C33 Sand F Laterals are squaf,'y, g [ Idled Layer 0 ~5 ft Typical Lateral spaced from the r ~ dntnfit~t?cm rn!! S C5J J Aggregate o t'1' I centerline in the J~--- "t distribution' cell (AxB). i i'vizl,.t. v ik v u ll`v l'~J ifVV. Page of G i:-:df Cannectcr, Lateral., Lzycut Diagram :=.rnteztF.r~,rstiai~t~•~tF.r=4GC.•r.~t.F~~h !z Tur:s-up,MDai:'a:~ryh•.lvxa€b~n.JUtF~3ug Alit ; xer s;3 are .d4nr.~c N Gt' X I fi ss Gt a4 cw. rt.c a-srtcne...d i t.-.7 r:ter'ai - _ i Y•l.are. a. o C... 7rev-Girl CG PVC Set. 4-31 Fie C-)N V T.:2 . 4 cr_ `i3 1 { F-xce n ain a nrw4 -nc r..: a ter •x c ivs3 tc• rnar.:±.ml, w, a" e-~irtit. Number of Laterals 3 Orifice Diameter 0.125 in Lateral Diameter 1.25 in Orifice Spacing (X) 2.25 ft Lateral Length (P) 58.50 ft Orifices per Lateral 27 Mttnr~el Gno..:.. lp% 7'1 4 n''1fIC~ r~an~~F ~ f~ic ..ce _.t .....C~ %-i Lateral Flow Rate 11.12 gpm Manifold Length 6.67 ft ,.,ci,.u ~ r l rNt•..ow .n.,+. r-'~_ e,...-_•~..,....p..<.r.. .fie 7-. Qyaiaec 0, o r U is 111106 to V U vial siawi 6.25 111 Total Dynamic Head 15.71 ft Forcemain Vekxdy 3.41 ft/sea Dose Tank Information 1-cc4•ing ccver .%t ::gym=.ng lattel and loor*ina clev*cP and Electrical as per NEC 300 and -i Comm 16.28 WAC _4~_ 4 in. min. Tank component is properly vented 4-r~--Ll-- Aftemateoutlet I ~ ktr~2hon Forcemain diameter Wieser Manufacturer i ( 2 in. Volume .24 q Uinch A `FB`I I Weep We or anti- 1limension Inches Cations g ( t s6nr,oo dev;c~e A 23.31 518.43 -T - I I Lj C 2 59.17 oil I I 93.67 v vv; 1 r .5a 1) D _ Total 16.011 800.00 ,11 ♦ Uose tank elevation 3" Bedding uncier tank. 93.00 Alarm Manuafacturer ;Tank Alert Alarm Model Number "HW101 Pump Manufacturer Gould Pump Model Ntrmher PF 4141 Pump Must Dell carer F77 .W1 r~ 1 ~ i* TD i P- ;P CO & S BUILDEP.V INIC. 1-1 'Ar Cs s Mound System Maintenance and Operation Specifications Service Provider's Name Johnson Sanitation M Phone (715) 273-5811 POWTS Regulator's Name ~St. Croix County Zoning Phone (715 386-4680 System Flow and Load Parameters Design Flow - Peak 600 gpd Maximum Influent Particle Size 1/8 in Estimated Flow - Average 400 gpd Maximum BOD5 220 mg/L Septic Tank Capacity 1200 gal Maximum TSS 150 mg/L Soil Absorption Component Size 600 ft` Maximum FOG 30 mg/L Type of Wastewater Domestic Maximum Fecal Coliform >10E4 cfu/100 mL Service Frequency Septic and Pump Tank Inspect and/or service once eve 3 ears Effluent Filter Should inspect and clean at least once eve 3 ears Pump and Controls Test once eve 3 ears Alarm Should test monthly Pressure System Laterals should be flushed and pressure tested eve 1.5 years Mound Ins ect for ondin and seepage once eve 3 ears ottler Miscellaneous Construction and Materials Standards 1. Observation pipes are slotted and materials conform to Table Comm 84.30-1, have a watertight cap, and are secured in as shown in the mound component manual. 2. Dispersal cell aggregate conforms to Comm 84.30 (6)(i), Wis. Adm. Code. 3. All gravity and pressure piping materials conform to the requirements in Comm 84, Wis. Adm. Code. 4. Tillage of the basal area is accomplished with a mold board or chisel plow. 5. The mound structure and other disturbed areas will be seeded and mulched to prevent soil erosion and help reduce frost penetration. Lateral Turn-up Detail Finished • + • • • Grade vt 6-8" Diameter Lawn Threaded Cleanout Sprinkler Valve Box Plug or Ball Valve Distribution Long Sweep 90 or Two 45 Degree Bends Same Diameter as Lateral Project: C & J BUILDERS INC. Page 5 of 8 i Mound System Management Plan Pursuant to Comm 83.54, Wis. Adm. Code General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manuals [SBD-10691-P (N.01/01), SSWMP Publication 9.6 (0181), and Pressure Distribution Component Manual Ver. 2.0 SBD-10706-P (N. 01/01)] 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. 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 fitter 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 perfommed 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. 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 Distrtbu*m 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 as protection from freezing. i Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG for septic tank effluent or 30 mg/L BOD5, 30 mg/L TSS, 10 mg/L FOG, and 104 cfu/100 mL for highly treated effluent. 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 6 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. Corrtinaency 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(s) 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 absorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. See Page 5 of this plan for the name and telephone number of your local POWTS regulator and service provider. Pretreatment Units The information and schedule of mananagement and maintenance for pretreatment devices such as aerobic treatment units or disinfection units are attached as separate documents and are considered part of the overall management plan for this system. ITT GOULDS PUMPS Residential Water Systems APPUCATIONS MOTOR Specially desklned for the following uses: General: • Mound Systems • Single phase • EffluenVDosing Systems • 60 Hertz • Low Pressure Pipe Systems • 115 and 230 volts • Basement Draining • Built-in thermal overload protection with automatic reset. ' Heavy Duty Strrrrp/ ~ Dewate9 Class B d • High strength carbon steel shaft SPECIRCATICH6 PE31 Motor. Pump-Generak • 33 HP, 3000 RPM • Discharge. 11h" NPT • 115 volts • Temperature:104OF (40°Q maximum, continuous when • Shaded pole design fully submerged. PE41 Motor. • solids handling: 'A" maximum sphere. • .40 HP 3400 RPM • Automatk models include a float switch. • 115 and 230 volts • Manual models available. • PSC design • Pumping range: see performance chart or curve. PE51 Motor. PE31 Pump: • .50 HP 3400 RPM • Maximum capacity: 53 GPM • 115 and 230 volts • Maximum head: 25' TDH • PSC design PE41 Pump: • Maximum capacity: 61 GPM AGENCY LISTINGS • Maximum head: 2-T TDH PE51 Pump: • Maximum capacity: 70 GPM • Maximum head: IT TDH c ks Tested to UL 778 and t3A 222108 Standards By Carmlian Standarck Awadaf on METERS FEET File #LR38549 40 - - - raoHx L ten, 1 ~ t- -t r-+ 35 10 a_ r _ i . I _ GOt" Punlp3 b ISO 9001 kgMered. t 2 GPM 30 -r 1 FT t- Er 1 I . 2C 7-1 j 7/ - x 10 - i - ~ 5 _ 1 I f- 00 10 20 30 40 s0 60 70 GPM 60 O S M 10 1s "13/h I CAPACITY i Plot Plan - - Page 8 ofs C~ T T3u.rwER.s , Pro Owner , . 1~=40fl. Legal Dewcription LeT Uy WAW6tT tt,LL~W-1 (rcept where noted, NG /a or- mE s~ szz TzT4, R is w 7omW oP n- + L`I = $ackhoepli ,5r, Amy e -,AJTY V31.%d GIAJ. boa-)Z03-00-0 ; /.07 AOKE (zts vJAVO UT r-tu..L- WAY) North 00 ~.ycoQ~~Q- ~ i 4~'- ~~ENL& Li!~E ~ NIIT PIS- L~AIB> Im. ca ' gg7n' fl 19- i to - la/.y0 ' o AMW Wt tia TrwK ins% IOL.rO' ' i c a~ ,eRoYosT'-D w $~ROOn~1 'ljv~ ~ t1--arlG (A)&r -W -5eALE) lte Location: j! ;11~►a j . tk c,., E,C • L Z i a Ii > !E Division ot Departure f SOIL EVALUATION REPORT Page i of 3 Divisionn of Safety ar - in accordance with Comm 85, Wis. Adm. Code County ST. CROIX Attach complete alto plan on paper not less than 81/2 x 11 inches In size. Plan must include, but not limited to: vertical and horizortall nce point (BM), direction and Parcel I.D. 040 -1303 - 00 - 044 percent slope, scale or dimensions, north arrow nd and distance to nearest road. Please print aN Re by Date Personal information you provide maybe used for ndary purposes s. (1) (m)). Properly Owner A Pro rty location C & J BUILDS INC 3 G Lot NE 1/4 SE 1/4 2 T 28 N R 19 E (or) W Property Owners Mailing Address / Q "r L # Block # Subd. Name CSM# 952 Ridgecrest shoe NC' d 2OkZ"Olj y 44 Walnut Hill Farm AiA city State Zip Code ffi-m N p/ct (Ocity vdlage own Nearest Road River Falls, WI 54022 ( ) Troy Walnut Hill Way NewConstruction UseE] Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ® Replacement ® Public or commercial - Describe: Parent material loess over till Flood Plain elevation if applicable AA ft. General comments Mound System 0.50 sand fill 0.6 loading rate and recoinn ndations: System area moved due to location of proposed dwelling. Fil Boring # 0 Boring Q Pit Ground surface elev. 100.00 ft. Depth to limiting factor 32 in. Sol Applic"on Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/llr in. Muasell Qu. Sz. Cont Color Gr. Sz. Sh. *EW1 *Efl#2 1 0-3 10YR2/2 - sit 3f mvfr cb 3vf-m 0.6 0.8 2 3-7 10YAR2/2 - sit 3fgr mvfr ai 2vf-m 0.6 0.8 3 7-20 10YR4/4 - sit 2fabk mfr cw l vf-m 0.6 0.8 4 20-32 7.5YR4/6 - sl if--msbk mvfr aw lvf-f 0.4 0.7 5 3242 7.5YR4/6 c2d 7.5YR5/6 sl Om mfr 0.2 0.6 Horizon 4 has some Sr, 5% 2 ] ® Boring F Boring # El Pit Ground surface elev. 99.70 ft. Depth to limiting factor 36 in. Sal Apocation Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Ef#i1 *0182 1 0-3 10YR3/2 - sit 2fgr mvfr cb 3vf-m 0.6 0.8 2 3-8 10YR3/2 sit 2f tbk mvfr cw 2vf-co 0.6 0.8 3 8-19 10YR3/4 - sit 2fabk mfr cw Ivf-co 0.6 0.8 4 19-26 10YR4/4 - sit 2fabk Mft cw 1 vf-f 0.6 0.8 5 26-36 7.5YR4/6 - st If--mabk mvfr cs lvf-f 0.4 0.7 6 36-44 7.5YR4/6 c2d 7.5YR5/6 sl Om mfr 0.2 0.6 Horizon 5 has some gr & few cobs. * Effluent #1 = BOD > 30 IS 220 mg& and TSS >30:S 150 mg/L ' Effluent #2 = BOD 130 mg/L and TSS 130 rtg& CST Name (Please Print) S' CST Number Mary Jo Huppcrt ollister's Soil Testing & siRn) 224832 Address Date Eva Conducted Telephone Number W9875 690th Avenue, River Falls, WI 54022 03 - 20 - 12 (715) 426 - 1775 C & J Builders Inc. (Lot 44 040. 1303 - 00 - 044 2 3 Property Owner Parcel ID # Page of F3 ~_Boring Boris # 0 pit Ground surface elev. 102.10 ft. Depth to limiting factor 36 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDW in. Munsell Qu. Sz. Conk Color Gr. Sz. Sh. "Eft#1 -Eff#2 1 04 10YR2/2 sil 3fgr mvfr cw 3vf-m 0.6 0.8 2 4-7 10YR2/2 sil 3fabk mvfr cw 2vf-m 0.6 0.8 3 7-15 10YR414 sil 2fabk mfr cw lvf-m 0.6 0.8 4 15-24 7.5YR3/4 sl lfabk mvfr cs lvf-f 0.4 0.7 5 24-36 7.5YR4/6 sl 1fsbk mvfr as lvf-f 0.4 0.7 6 36-43 7.5YR4/6 c2d 7.5YR5/6 91 Om mfr 0.2 0.6 Horizons 4&5 have sand cis; horizon 5 has some gr; Bori O Boring# Png pg Ground surface elev. R. Depth to limiting factor in. Sol Rate Horizon Depth Dominant Color Redox Description Texture Sure Consistence Boundary Roots GPDW in. Muneell Qu. Sz. Cont. Color Gr. Sz. Sh. *001 -Etf#2 DBoring # Boring 9 P8 Ground surface elev. -ft. Depth to limlirg factor in. Sol Rate Hoyt Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPQ/lF In. Munsel Qu. Sz. Cont. Color Gr. Sz. Sh. *El`1#1 -Eff#2 ' Effluent #1 = BOD6 > 30:5 220 mg/L and TSS >30 1150 mg/L • Effluent #2 = BOD6 130 rrg/L and TSS < 30 rrg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD433Qre4 (R07i00) i Plot Plant for Site and Soil Evaluation Page 3 of 3 !f Property Owner C'~ w ~R s Svc. Legal Description L6 T Uys PJA L-AJ L[T J « (wept where noted) AIC- /K Dr 7n e S E er4~ s zz, 7z-M, R iq tvJ row J OF T FAY, ' I LJ = Backhoe pat ST G2UI}C ('01tr1TY WV- /,07 AC9EIS OA)SIAJ. Il0-1t,01-'aa_p4y ~.zcs v,ALA,uT t+«L-Wv) North i 11 ~9 f' WC.E LINE ~fJ~ ~ ~L L t ue ID Iot.~Q I i 1~ 33 raz.ro ` v J i Q i I ite Location: 3 cr eS !w i; I. , i I I S 00'11'24" E 2647.98' EAST LINE OF THE SE 1, 850.67' 135.67' 147.00' 128.53' 151.14' 137.62' N I` I I I I37~ -Ln i W I Q Qw I I~ I I ~I ~I (Qco CO Ico I N I~ Q Irn Q r i O N d.~ r- c~ O IW I (n QI~ ~ ~ ~ Iw co N (D ~ N I I co d N co \ ~Ln Is, I o I ~n CO "N I O ~W I Lz o "t~lo I r f win I I co Ioo o I IZ I_- Jz \ goo ~0. X90 I , 9 9~ W O 68_55' 139_59' 00 a "qz 00 9' M I \ \9~ r I z 9Z ` Sal _ - S 00'09'39., bill. U-) Al Q \ s~ osp / S 00'09' 39' ~c0 68.71' 134.55' - - Ln Cf) LL- Q) I l co Q0 ~ I cv ~ w LLJ 00 (n o~~~l zwl ~ ol moNl ~I~,,) 1 i o 6600 a~ ~n V) I ► U-~ p I rri I M vnl ~Z 3 "19-V,00.00 N zlJ I F I co I LZ'L z CY) pl~l l~ 9SZ 3 „OZ,ZS.00 N I N C\4 I ~ I Lo -l w I I Q QI.-6I v1- I U I o o I C\2 r0 J 134.55' LL- 00 I U) Q 16 co co S 00' Z w ,9 C) 00 00 I I z` z I _ 57. 2 ~ I 33 ~ 33' N 08'14' 01 LL- (n U co xz~ I ~n1~• Ln, "'fin i 03/28/2012 08:36 FAX 10001/001 03/27/2012 14'33 FAX 715 273 0444 NELSO4-PLUM9ING Ij001/001 ST, CROIX COUNTY SEPTIC TANK MAINTENANC$ AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer Mailing Address W-6~ f ---t4 (,L'S Cv~ 6 Property Address l.C t'(nJ- (Verification requited from Planning & zoning Depar =rnt for new construction) City/State Parcel Identification Number 0410- 30.3 - 0 b - 0 8 LEGAL DESCRIPTION Q Property Location , Sec.-7 T Z u N R W, Town of Subdivision wL- lV U4Y(LL,..~~ZM , Lot # Certified Survey Map # , Volume , Page # Warranty Deed # Volume 'Page # Spec house yes no Lot lines identifiable es no SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septio system could result in its premature rMlure to handle wastes. Proper xnainteuenec consists ofpumpinja our the septic, tank every throe yogis or sooner, if nooded, by a licensed pumper, What, you put into the system can affect the fvuctio,fl of the septic tank as s treatment stage in the wasu dioposml system. Owner maintenanco rosponsibilitiea are spocifed in ¢Comm. 83.52(1) and in Chapter 12 - tit. Croix County Sanitary Ordinanec. no property owner agroea tv eubmit to St. Croix CountyPlanning & Zoiti.ng Departmont a certification form, signed by rho owner and by a master, plumbor, joumoyman plumbor, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septiv tank is less than 1/3 full of sludge, I/we, the undersigned have lead the above requirements and agree to maintain the private sewage disposal system with the standards sot forth, herein, as set by the Dcpar=cnt of Commerce and the Dcpartmonr of Natural Resources, Stato of Wisconsin. Certifcatim stating that your septio system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Deparnnenr within 30 days of the three year expiration date. -T/we certify that all statements on this farm Ve true to the best of my/our knowledge. Vwvc am/are the owner(s) of the property dosoribrd abayo, by virtue of a warranty decd recorded in Register of Deeds Omce, Number o bedrooms SICr AI'LTRE O APPLICANT(S) DATE E ***Any information that is misrepresented may result in the asnitary permit being revoked by the Planning & Zoning Department Include with this application a recorded warranty dead frortt the Register of Det;ds Ofi*ice and a copy of the certified survey neap if reference is made in the warranty deed, (REV. 08/05) I I I` I I I I ll ~I 1~ 111 11 .Ill I 80 .3, 08 .84 Tx:4021836 STATE BAR OF WISCONSIN FORM 3 - 2000 938028 Document Number QUIT CLAIM DEED SETH PABST REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, Grantor, and C & J ST. CROIX CO., WI Builders Incorporated, Grantee. 06/24/2011 08:56 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, 4419, 55, 58, and 72 of Walnut Hill Farm, All in the Town of TRANS FEE: 623.40 Troy, St. Croix County, Wisconsin. PAGES: 1 Recording Area Name and Return Address: Title One # 16514 Together with all appurtenant rights, title and interests. 040-1303-00-072, 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. ank -*'-Thomas W. Van Pelt, President & CEO * * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) 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 TITLE: MEMBER STATE BAR OF WISCONSIN executed the foregoing instrument and acknowledged the (If not, same. authorized by § 706.06, Wis. Stats.) GAP THIS INSTRUMENT WAS DRAFFED BY N M'Pub Gstn * el M ae er w~ae otI`tlt~on Notary Public, State of Wisconsin Michael H. Forecki, Attorney My commission is permanent. (If not, state expiration date: 8/26/2012 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) 'Names of persons signing in any capacity must be typed or printed below their signature QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000 1 of 1 Wisconsin SOIL EVALUATION REPORT Page / of 3 Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County ST Gre 4/' x-- ~ mdlude bbuutp EROSION CONTROL PLAN must be road Parcel I.D. 4 P ,up,~, !r- b percentsloP completed before sanitary permit issuance =Vie~by Date pefMW irdomwwn you provide may be used ter secondary WOWS- (Privacy LOW. s-15.04 (1) (m))- Property owner / TORO Property o.~ A Loca TD f~D T~fl -r t/!, Govt. Lot Al iAt $ 1/4S ~L T 2-6 N R I / E (or) W Property owners Mailing Address Lot # Block # Subd. Name or CSM# (no►5 -CA M1,1- Ave . WALNur Rill fA RAI ❑ village U Town Nearest Road state zip Code Phone Number ❑ City city SNWR SD. 1o~ER 6~ooc 'H TT MN SSPWe ( &51 ) Zy8• -rRoy o r D~ New Construction Use: 0§ Residential 1 Number of bedrooms Code derived design flow rate GPD tA ❑ Replacement ❑ Public or commercial Describe: Parent material ESS d U DJEWISI ' 17115 Flood Plain elevation if applicable General and recort mendations: • ,9 -r-* Th;5•7 " s ys r ecft 2ts~:~ G-- A/ .S,•vv Boring # Boring Z S S, S . ! 9 f a ® Pit Ground surface elev. ft. Depth to lmutin9 factor in. Sad iksfion Rate Horizon Depth Dw*wtt Color Redox Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Chi. Sz. Cont. Color Gr. Sz Sh. 'Eff#1 'Eff#2 C Sim z-fs,b,~ Z . S . / G•13 /d W 313, 2- (f 4L) 113 - /61 /0 YR \A S 9 C 16-2-7. /0 SSG Ziwt G~ c 5' "S 2.3 GZ o 5 L .3 -7 "s Y2 s/8 2 Boring Boritv 9~• y 25 S.S.S. . # ❑ a ®pit Ground surface elev. ft. Depth to limttirtg factor in. Sod ~catiorr Rate Horizon Depth Dominant Color Redgx Description Texture Structure Consistence Boundary Roots GPDff in. Munsell Ciu. sz. Cont. color Gr. SL Sh. 'Eff#1 'EM I o• /oyle 313 S/L a ShK 4 cur 2-f : S N 51z- Z A "I I L 9•/ /p Y)e 3 / • z5 /o S l~, ter,, c / 3 . S 41 5. y 2 Mo 5L O, d .3 •S ' Eftkmtt #1 = BM 5:o 30 1220 mglL and TSS >30 1150 mglL ' Effluent #2 = BOD < 30 mglL and TSS 30 mg1L Signature CST Number CST Name (Please Print) R , -A 1-13 R i c i-r- 6 37 5 Telephone Number Address Date Evaluation Cortduded Ulbricht & Assgciates /S D3 715. 77a • 3 yy 2- Private Sewage 2812 1 Oth Ave. Spring Valley, WI 54767 T'iNs f ~PORo y . 2 yo ~4 QCs . ~yfJ ' /o~S • So ~ 01/0 dyo - /t~~f~ • zo oyo-/0Z- &D•MV oyo. /0g(p - 70 - 6~70 ■