HomeMy WebLinkAbout040-1306-29-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division
INSPECTION REPORT Sanitary Permit No:
556312 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:
Oeverin Homes LLC, aka Oeverin Pro ertie Troy, Town of 040-1306-28-000
CST BM Elev: Insp. BM Elev: BM Description: Sectionrrown/Range/Map No:
V11 08.28.19.1856
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER , CAPACITY STATION BS HI FS ELEV.
Septic 3 Benchmark
+F ~ ~dt~O . t,p /OZ •(p /per
F'.'t Eck. ~✓~5i AI
/ - S
Aeration Bldg. Sewer 7~P
Holding St/Ht Inlet
c~
93 /
TANK SETBACK INFORMATION St/Ht Outlet T-7
TANK TO P/ WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic ' Dt Bottom
Dosing Header/Man. ~G
Aeration Dist. Pipe
5~~ G q
Holding Bot. System
PUMP/SIPHON INFORMATION Final Grade
~b
Manufacturer GPmNtand St Cover.
Model Numb
TDH ft Friction Loss System He TDH Ft
Forcemain ength Dia. Dist. to Well
SOIL ABSORPTION SYSTEM .
BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS Z -T
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR ~ ,r ( m
Type Of System: UNIT Model Number:
r
70 4 5;&
DISTRIBUTION SYSTEM
Header/Manifolds III Distribution ` x Hole Sx Hole Spacing Veruto Air nt e
Pipe(s) \
Length Dia 1q Length Dia Spacing
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth f xx Seeded/ dded xx Mulched
Bed/Trench Center i, / 1 BedlTrench Edges Topsoil
to ~Q No Yes No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / Inspection #2:
Location: 427 Jordyn Lane' Hudson, W~I /54016 (NE 1/4 SE 1/4 8 T28N R19W) Sunset View Lot 29 Parcel No: 08.28.19.1856
1.) Alt BM Description = 'l 1 61JA-1-
t
2.) Bldg sewer length = '20 C t~ « S Cam, Ut^.
- amount of cover = !
Plan revision Required? ❑ Yes 'No
Use other side for additional information. '
SBD-6710 (R.3/97) Date Insepctor's Si ature Cert. No.
OT PLAN
PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond WJ 54017
NE 1/4 SE 1/48 8 428~ / 9 W TOWN Troy COUNTY ST. CROIX
MFRS Shaun Bird 226900 DATE8/13/12 EIE&DROOM 3
CONVENTIONAL XXX IN-GROU PRESSUkE CONVENTIONAL LIT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons 1411-"1' TANK SIZE DOSE TANK SIZE
HOLDING TANK S'jZ LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
ar,,NCHMARK V.R.P. Top of survey Iron ASSUME ELEVATION 100° Filter BEAR Filter
❑ BOREHOLE ~ WELL *a,g,p, SameasSenchmark
SYSTEM ELEVATION 95.3' 95.5' 4.7' below prede
All piping shall be SDR 30/34, within 10' Well is to meet all
of tank, piping shall be Schedule 40. setbacks required by
WDNR
Jordyn Lane
II
A additional
boring will be Pro 3
done to lower Bedroom
-louse
i
system elevation
to a better
depth 309
tt
l~
80'
B-2
f
Z6
80'
2-3' X 66' Cells with >3' spacing
B-3
Vent 25' ants
o pe B-l
Q7uick4 Standard
of Cover Leaching Chamber .100,
with 20.0 ft2 of Area
10.2ft^2/pair of end caps 401
4' Long 12"
3 4>, Grade at System Elevation B.M.
Properly
Line
~p N
\I~ir
commerce.wl.goV Safety and Buildings Division County L
01 W. Washington Pte. Box 7162 `7 1 0 1
~~t
seo n Madison, WF 62 Sanitary Permit Number (to be filled in by Co.)
geM of to~mnerce 55 h3
t,lepa 4 0 Q-
Sanita 'Permit Application State Transaction Number
in accordance with s. Comm. 83.21(2), W§.'A~t~. iswfilfFs ' of this form to the appropriate boyemmental
unit is required prior to obtaining &tW*~permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address)
submitted to the Department of Commerce. Personal information you provide may be used for secondary
u oses in accordance with the Privacy Law, s. 15.04(1 (m), Stats. Ua i - f 0
1. A lication Information - Please Print AllWo5p!;T!MN if a
J
Property Owner's Name Parcel #
Property Owner's Mail ddress - Property Location /Os(
l
lel/ Govt. Lot p~
city, state ! Zip Code Phone Number 1_~/., Section
/(A-C-1, ) N; R / le o W
II. Type of Building (check all that apply) Lot #
or 2 Family Dwelling - Number of Bedrooms 27 Subdivision Name
O/C Ga yp OR ~Block #
❑ Public/Commercial - Describe Use 1 ❑ City of
CSM Number [I Village of
El state owned -Describe Use
Z 'IU•3a- Ce.l S t0 71-4 J,- own of
III. Type of Permit: (Check onl one box online A. Complete line B if applicable) 9
A. 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 ❑ Permit Transfer to New
Before Expiration Owner i-+
IV, a of POWTS S stem/Com onent/Device: Check all that apply)
on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil
❑ Holding Tank ❑ er Dispersal Component (explain) ❑ Pretreatment Device (explai
-
V. Dis ersaUTrea ent Area Information: t t°
L!;g,n Flow (gpd) Design Soil Application Ra gpdsf) Dispersal Area Required (sf) Di sal Area Pro o ed (sf) Syse vation
L/~9' ' 3
VI. Tank Info Capacity in Total # of Manufacturer ' o o
Gallons Gallons Units U o -2
New Tanks Existing Tanics / [ a
w U is rn w C7 0
Septic or Holding Tank N~ Dosing Chamber
VII. Responsibility Statement- I, the undersigned, assum sporisibility for installation of the POWTS shown on the attached plans.
Plumber's Name (Print) Plumber's afore MP/MPRS Number Business Phone Number
Plumber's Address (Street, City, State, Zip Code)
1
VIII. oun /Department Use Only
Permit Fee D;V13 ssued Issuing ent Signatur
Approved isapproved $ .y~ co
Z
even
Reason for Denial IX. CondijS"TdMWVReasons for Disapproval
1. `$iptic tank, effluent filter and /n7
.dispersal cell must all be services / malnhined a cnta, ' t-o
as per management plan provided by plumber, w
2. A!149 b wk fegWernents must. be msint§M
as per appAc" cods I ordlrtertb*ss
Attach to complete plans for the system and submit to the County only on paper not less than 8 12 x 11 inches in size
SBD-6398 (R 02/09)
OT PLAN
PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
NE 114 SE I/4S 8 IT 28 9 W TOWN Tray COUNTY ST. CROIX
1VIPltS Shaun Bird 226900 nATE8/13/1 BEDROOM 3
CONVENTIONAL IN-GROU PRESSURE CONVENTIONAL LIFT HOLDING TANK
MOUND SEPTIC TANK SIZE 1000 gallons LIIe r TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of chambers 32
BENCHMARK V.R.P. Top of survey Iron ASSUME ELEVATION 104' Filter BEAR Filter
❑ BOREHOLE a WELL It, p, Same as Benchmark
SYSTEM ELEVATION 95,31955 4.7' below grade
All piping shall be SDR 30/34, within 10' Well is to meet all
of tank, piping shall be Schedule 40. setbacks required by
WDNR
Jordyn Lane
A additional
boring will be rPo 3
done to lower Bedroom
system elevation -louse
to a better
depth 30'
S
80'
B-2
80'
2-3' X 66' Cells with >3' spacing
B-3
Vent 2$ , ents
2% Slope I3~1
Quick4 Standard
of Cover Leaching Chamber 100
with 20.0 ft2 of Area
12„ 10.2ft,,2/pair of end caps 40'
4> Long Grade at System Elevation
Properly B.M.*
3 4" Line
'i
Cover Page
Shaun Bird
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 8/6/12
Owner: Oevering Homes LLC
Location: NE1/4 SE1/4 S8 T28 N,R19W 427 Jordyn Lane Troy
System type: In-ground absorbtion system(conventional)
Manuals Used: In-ground absorbtion system (version 2.0)
Page#
1. Cover Page
2. Plot Plan
3. Chamber Cross Section
4-6. Maintanance and Contingency Plan
7. Filter Specifications Sheet
Signature
License numb r 0226900
OT PLAN
PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
N 114 SE i/aS S /T 28 /l 19 w TOWN Troy COUNTY ST.CR01X
MFRS Shaun Bird 226900 DATE 8/13/12 11GDROOM 3
CONVENTIONAL XXX IN-GROU PRESSURE CONVENTIONAL. LIFT HOLDING TANK
MOUND SEPTIC TANK SIzE 1000 gallons LII-r TANK SIZE DOSE TANK SIZE
HOLDING TANK SIZE LOAD RATE .7 ABSORPTION AREA 651 # of clambers 32
]BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 100' Filter BEAR Filter
❑ BOREHOLE (DWELL *H,g,p, SameasBenchmark
SYSTEM ELEVATION 95.3' 955 4.7' below grade
All piping shall be SDR 30134, within 10' Well is to meet all
of tank, piping shall be Schedule 40. setbacks required by
WDNR
Jordyn Lane
A additional
boring will be Pro 3
done to lower Bedroom
system elevation House
to a better
depth 30'
s
s0'
B-2
80'
2-3' X 66' Cells with >3' spacing
B-3
Vent 25' eats
2% Slope B-1
~6„ Quick4 Standard -I TO,
of Cover Leaching Chamber
w i th 20.0 ft2 of Area
10.' ft^2/pair of end caps 401
8 12" M.
4 Lon Grade at System Elevation B.
Properly +
3 4"
Line
Cross Section of Infiltrator Quick 4 Leaching Chamber
Typical cross section for 2 of 2 cells
Quick 4 Standard Leaching Chamber
with 20.0 ft2 of Area per Chamber To be >1' above grade
10.2ft^2 pair of end plates
Finish grade elevation
Typical Installation /40
Vent Grade ren,
i
5.75 .411 30/34 Septic Tank 75
5' Long 1 5 5 Long Grade at System Elevation
3 6" Grade at System Elevation
Spacing 5'
2-3' X 66' Cells
Same on other end Observation tubeNent
At end of cell
A
B
16 chambers per cell
System elevations:
A_--9~ y S• 3
B 97.2'
POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner
r~2J / p ~ Septic Tank Capacity gal ❑ NA
Permit # Septic Tank Manufacturer ❑ NA
DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA
Number of Bedrooms ❑ NA Effluent Filter Model NA
Number of Public Facility Units NA Pump Tank Capacity al
NA
III
Estimated flow (average) al/day Pump Tank Manufacturer I)I NA
Design flow (peak), (Estimated x 1 5) v gal/day Pump Manufacturer 11 NA
Soil Application Rate , al/da /ftz Pump Model NA
Standard Influent/Effluent Quality Monthly average' Pretreatment Unit ❑ NA
Fats, Oil & Grease (FOG) S30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BOD5) 5220 mg/L NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(s) ❑ NA
Biochemical Oxygen Demand (BODS) 530 mg/L -Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) <30 mg/L XNA ❑ At-Grade ❑ Mound
Fecal Coliforrn (geometric: mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size X in dia. ❑ NA Other: NA
Other: NA Other: NA
'Values typical for domestic wastewater and septic tank effluent. Other: NA
MAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: ❑ month(s) _ ears (Maximum 3 years) ❑ NA
Pump out contents of tank(s) When combined sludge and scum equals one-third of tank volume ❑ NA
Inspect dispersal cell(s) At least once eve ❑ onth(s) Maximum 3 ❑ NA
ry~5 ear(s) ( years)
Clean effluent filter At least once every: month(s) ❑ NA
ear(s)
Inspect pump, pump controls & alarm At least once every: ❑ month(s) NA
❑ year(s)
Flush laterals and pressure test At least once every: ❑ month(s) NA
❑ year(s)
Other: At least once every: ❑ month(s) NA
❑ year(s)
Other:
N:
MAINTENANCE INSTRUCTIONS
Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: M ster
Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer, Septage Servicing Operator. Tank inspections 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
combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be
visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface.
The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local .
regulatory authority.
When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of
the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with chapter NR 113, Wisconsin
Administrative Code.
All other services, including but no( limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units,
and any servicing at intervals of 512 months, shall be performed by a certified POWTS Maintainer,
A service report shall be provided to the local regulatory authority within 10 days of completion of any service event.
Page of
START UP AND OPERATION
For new *construction, prior to use of the POWTS check treatment tank(s) for the presence of painting products or other chemicals that
may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the
tank(s) removed by a septage servicing operator prior to use.
System start up shall not occur when soil conditions are frozen at the infiltrative surface.
During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be
discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent.
To avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the
effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the pump controls to restore normal levels
within the pump tank.
Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within
15 feet down slope of any mound or at-grade soil absorption area.
Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS:
antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain
(sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting products;
pesticides; sanitary napkins; tampons; and water softener brine.
ABANDONMENT
When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly
and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:
• All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed.
• The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator.
• After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil,
gravel or another inert solid material.
CONTINGENCY PLAN
If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant
replacement system:
'~~A suitable replacement area has been evaluated and may be utilized for the location of a replacement soil absorption system.
/ The replacement area should be protected from disturbance and compaction and should not be infringed upon by required
setbacks from existing and proposed structure, lot lines and wells. Failure to protect the replacement area will result in the need
for a new soil and site evaluation to establish a suitable replacement area. Replacemeni systems must comply with the rules in
effect at that time.
❑ A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a
holding tank may be installed as a last resort to replace the failed POWTS.
The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation
must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as
a last resort to replace the failed POWTS.
❑ Mound and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative
surface. Reconstructions of such systems must comply with the rules in effect at that time.
<<WARNING>>
SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT
ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE.
ADDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name
E Name
Phone Phone , -
SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY
r _
Name L Name Ae=p
Phone a Phone . 3~
This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code.
FILTER CARTRIDGE INSTRUCTIONS
Installation
Ill', ,~n
STEP I Dry fit the fitter case onto the end of the outlet pipe to ensure it is
centered under the access opening. If not, then either insert more pipe into the
tank through the outlet or solvent weld (glu
e
pipe. ) additional pipe onto the outlet
P 2 While the case is still dry fitted on the outlet pipe, measure the length
of 3h-inch pipe needed to brace the filter to the tank and wall if utilizing the
optional supplemental side support. If side support method is not utilized,
proceed to step four,
r r' ~ For installations utilizing the optional supplemental side support:
solvent weld the %-inch pipe onto the filter case. If side support method is not
utilized, proceed to step four.
Solvent weld the filter case onto the outlet pipe. Insert the filter ,
cartridge into the case, pressing down until the filter locks into the bottom of
the case.
If a VRS switch is utilized: insert into the filter and lock by turning
clockwise 900., _
Maintenance
2. The effluent filter should be cleaned every time the septic tank Is
serviced, +
2. Open the outlet access opening to inspect the tank and filter, +
3. Pump the septic tank completely, making sure to remove the sludge
layer on the bottom of the tank and not just the scum and effluent,
4. Once the effluent level has been lowered below the invert of the `
outlet pipe, firmly pull up on the filter handle to dislodge the $
cartridge from the case.
5. Slide the cartridge up and out of the case for cleaning.
6. If a VRS; switch connected to an alarm is present, the switch
should be removed by turning counterclockwise 909 and cleaned
with water only.
7. While holding the cartridge on its side (large flat surface facing
down) over the access opening, rinse off the cartridge with water
only, making sure all septage material is rinsed back into the tank.
8. If VRS switch is utilized, replace by inserting into filter and
turning clockwise 40°.
9, Insert the filter cartridge back into the case 'j•"il±:•;r
the filter locks into the bottom of the case. pressing down until
10. Replace and secure the access opening on the tank. w1. ,J
is .sr.:-• , aHr, r..:d',i
WWW.beamnsite.com 877-MLFILTERS (653-4583)
12
~WisconsinDepa SOIL EVALUATION REPORT Page of
La Vti
Division of Safe2 ZQQ
in accor nce with Comm 85, Wis. Adm. Code
Attach com leCounty 1 . C
P (off than 8 1/2 x 11 inc, yes in size. Plan must include, but noa erence point (BM), direction and Parcel I.D.
percent slope, , north arrow, and location and distance to nearest road. l N~~V ~J/~/~ ~~mm
Please print all information. Re wed by ''Date
Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)).
'M°A u ?SUS-;
Property Owner Property Location r
t\J~1/4-x,1/4 S F-~,• T Z8 N R E(o)W
Property Owner's Mailing Address Lot # Block # Subd. Name or CSM#
P o. Box 3 3 Z9 - SUYQ s",7- viQj 7-' ,
City State Zip Code Phone Number ❑ City ❑ Village Town Nearest Road
t.3 f~~SRt✓t t,R~ Lv ~ 5 X10 I ~$S ,33 S E T 1Z-O`1' ~
21 New Construction Use: ® Residential / Number of bedrooms 3 - 4 Code derived design flow rate Ll S C) - `j U()'
- GPO
❑ Replacement ❑ Public or commercial - Describe:
Parent material G l-~f~C! 1~ L U liti~y~~ Flood Plain elevation if applicable N t.`1
ft.
General comments
and recommendations: ZL SUM r" 1~Qt lilt- j
L) 'T
F 1-1 Boring # ❑ Boring WLAAs ad F-60 Zft q,
® pit Ground surface elev. ) ~0 ft. Depth to limiting factor 7 in.
Soil Application Rate
Horizon Depth Dominant Co] edox Description Texture I Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2
~ ~ - l2 ~ o~t 2 Z t Z
Z ~Z-~ 6 to`t r2 1 ~ - S i ? ? v>7 s b%t t~t`i-- c~ _ , ~ _
~ -°t.3 10`112 / - S 0 S9 h1
I
[7~] i
Boring # ❑ Boring
® Pit Ground surface elev. ` Z ft. Depth to limiting factor Q 7 in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 'Eff#2
o- VI 10-1 IZzLZ
Z 1Z S 0 t u\-t Q- 316 Sit Z~ S b h'l`~y C S - . S . ~
3 Sb -9(4 1 uy~ _ S v S5 - \,z
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD5 < 30 mg/L and TSS < 30 mg/L
CST Name (Please Print) Signature CST Number
Arthur L. 'Wegerer 03 Z1S - Z~ 220254
Address W e g e r e r Soil Testing & Degn~ sign Service Date Evaluation Conducted Telephone Number
421 N. Hain St. River Falls, UI 54022 ~-Z715-425-0165
i
or
Property Owner ~ Et Parcel ID # Z ~ j
Page ' of
FS] Boring # ❑ Boring
® pit Ground surface elev. ft. Depth to limiting factor
Soil Application Rate
Horizon Depth Dominant Color Redox Description MG Consistence Boundary Roots GPD/ft=
In. Munseli Qu. Sz. Cont. Color 'Eff#1 'Eff#2
► O - \ Z 1p-1 IZ ZLZ - ~jj Z-9 letijz~//6 N J
EE
F-1 Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
a„
a Boring # ❑ Boring
❑ pit Ground surface elev. (t. Depth to limiting factor In.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2
In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BODE < 30 mg/L and TSS < 30 mg/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 file department at 608-266-3151 or TTY 608-264-8777.
SDD•8330 (R.6100)
L
`v J
Property Owner \i~ ~ ~ ~.O( Parcel ID # 1~~'~i~l )V G Page ~ ;of
j
a Boring # ❑ Boring
® pit Ground surface elev. fl. Depth to limiting factor > q~L in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP
In, Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. r •Eff#1 •Eff#2
O -\Z 1~H2 Z( Z. - St 1 Z`FSbl2
Z ►z Z Ip 31b
3 -9 !eti~2~~~ S o ~1~ - Z
F-1 Boring # ❑ Boring
❑ pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft'
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2
❑ Boring # ❑ Boring
❑ Pit Ground surface elev. ft. Depth to limiting factor in.
Soil Application Rate
Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ftz
in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2
Effluent #1 = GODS > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/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.
S[1P8330 (R.6100) '
Wisconsin Department of Commerce SOIL EVALUATION REPORT
Division of Safety and Buildings `
of
in accordance with Comm 85, Wis. Adm. Code
Attach complete site plan on paper not less than a 1/2 x 11 inches in size. County Page
include, but not limited to: vertical and horizontal reference point (BM), direction andt S C~
percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Parcel LD.
tV~'cvG
Please print all information. Reviewed by
Personal information you provide may be used fcr secondar Date
y purposes (Privacy Law, s: 15.04 (1) (m)).
PropEOwner Property Location 1/4~ 1/4 S T ? C3 N R ~ i--
Property Owners Mailing Address 9 E (cr) V.,
Lot # Block # Subd. Name or CSM#
P o. fox 3 3
El Z~ ISU NS j V
City State Zip Code Phcne Number
t3 LRk I I S C! O City ❑ Village T own
Nearest Road
!
New Construction Use: 3 Residential / Number of bedrooms
❑ Replacement Code derived design flow rate Lj S - OO__ CPD
❑ Public or commercial -Describe:
Parent material G Lie) 1 L- T) ~
General comments Flood Plain elevation if applicable F1
ft.
and recommendations: lC~ eUY~ 3 ~--A
0 CU---L--S , `3L S 1 " ~ ~-Lro
Boring # ❑ Boring
® Pit Ground surface elev. 1 U~ , y ft
Depth to limiting factor in.
Horizon Depth Dominant Color Redex Description Scil Applicaton Ra:-
I Texture I Structure Consistence Ecun1: Rocts GPD/ft2
in. Munsell Qu. Sz. Ccnt. Color
_12 1 Gr. Sz. Sh.
•EF-.#2
~~_Q3 IO~tZ / _ CS
S ~ 0 S~ ~ M ~ ~ I v•1 i, Z
Boring # ❑ Boring
El
®pit Ground surface elev. L ~ l ~ Z ft. Depth to limiting factor 2
in.
Horizon Depth Dominant Color Redex Descrip Soil Application Rate !
lion Texture Structure Consistence Boundary Rcots GPD/ft2
in. Munsell Cu. Sz. Cont. Color
Gr. Sz. Sh.
•Eff#1 'Eff#2
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Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 1150 mg/L • Effluent #2 = BOD < 30 m
CST Name (Please Print) - s _ 9/t and TSS < 30 emg/L
r
~ Signature b
CST
Arthur L.1 Wegerer 1S -
03 Z Zq 2220202 5 54
Address W e g e r e r Soil Testing & Design Service Date Evaluation Conducted Telephone Number
421 1. Hain St. River Falls, UI 54022
1219-f~3 715-425-0165
PLOT PLAN Page 3 of 3
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C'~"'"'"^'~- ~Z_lq 3715-425-0165 220254
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CST Signature Date Telephone No. CST No. Job NO.
,.P. -,Pump,-,-
79.77
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
c
Owner/Buyer, n~~„-----
Mailing Address 1__ ~C1.~P~_
Property Address ya 7
(Verification required from P) ug & Zoning Department for new construction.)
City/State Parcel. Identification Number (1' / I l -1~c%
LEGAL DESCRIPTION
Property Location A/ '/a , Sec. T NR W, Town a r ~4
-7 Q
Subdivision Lot #
Certified Survey Map # , Volume - _ , Page #
Warranty Deed Volume Page #
Spec house yes rto Lot lines identifiable (3 no
SYSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
maintenance consists of pumpins out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
the system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance
responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 St. Croix County Sanitary Ordinance-
The property owner agrees to submit to St. Croix County Planning & Zoning Department certification form, signed by the
owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper veritying that (1) the on-site
wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is
less than 1 /3 full of sludge.
I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
standards set forth, herein, as set by the Department of Commerce and the Department of Natural Rt.-sources, State of Wisconsin.
Certification 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.
I/we 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 of a warranty deed recorded in Register of Deeds Office.
Number of bedrooms----:>
~IGNAT 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. 08/05)
8 0 x?4053281 3
960860
State Bar of Wisconsin Form 1-2003 BETH PABST
WARRANTY DEED REGISTER OF DEEDS
ST. CROIX CO., WI
Document Number Document Name 07/31/2012 4:05 PM
EXEMPT#: NA
THIS DEED, made between B & L Land Development, Inc., a Wisconsin REC FEE: 30.00
Cnrporation TRANS FEE: 140.40
("Grantor," whether one or more), PAGES: 1
and Oevering Homes, LLC
("Grantee," whether one or more).
Grantor, for a valuable consideration, conveys to Grantee the following described real Recording Area
estate, together with the rents, profits, fixtures and other appurtenant interests, in
St. Croix County, State of Wisconsin ("Property") (if more space is Name and Return Address
needed, please attach addendum): River Valley Abstract & Title
1200 Hosrford St. Suite 201
Hudson WI 54016
Lot 29, Plat of Sunset View Development in the Town of Troy, File: 2809469
St. Croix County, Wisconsin.
040-1306-29-000
Parcel Identification Number (PIN)
Dated July 30, 2012 This is not homestead property.
(is) (is not)
Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except:
Easements, restrictions and rights-of-way of record, if any.
i
E
B & L Land Development, Inc., a Wisconsin
Corporation
3
(SEAL) (SEAL)
* e T. eather olt President/Treasur r
(SEAL) (SEAL)
AUTHENTICATION ACKNOWLEDGMENT
Signature(s)
STATE OF KENTUCKY )
authenticated on ) ss.
JEFFERSON COUNTY )
* Personally came before me on July 30, 2012
TITLE: MEMBER STATE BAR OF WISCONSIN the above-named Lyle T. Weatherholt,
(If not, President/Treasurer
authorized by Wis. Star. § 706.06) to me known to be the person(s) who executed the foregoing
instill nt and ac a C.
THIS INSTRUMENT DRAFTED BY:
* Tamm J Cla +
Doug Berg
Notary Public, State of .y
1200 Hosford St. Suite 201 Hudson WI 54016 My Commission (is permanent) (expires: August 26, 201V' 1.
(Signatures may be authenticated or acknowledged. Both are not necessary.) Ca '
NOTE: THIS 1S A STANDARD FORM. ANY MODIFICATIONS TO THIS FORM SHOULD BE CLEARLY IDENTIFIED.;
WARRANTY DEED ® 2003 STATE BAR OF WISCONSIN FORM-NO; x-200 41 G
* Type name below signatures.
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