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HomeMy WebLinkAbout040-1303-00-074 . Croix Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556323 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)]. Parcel Tax No: Permit Holder's Name: City Village X Township Town of 040-1303-00-074 Oeverin Homes LLC, aka Oeverin 2007;tior rtie Tro , 74 - .Sp CST BM Elev: Y Insp. BM Elev: 9z: ~ s~ l _Section/Town/RangelMap No: 22.28.19.1809 (7 2, TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI =ELEV. -3.5- ilk j F Septic nc ark b 7 2e~ Dosing . BM Bldg. Sewer Z-3 L2 -e Aeration 71 nlet ~s D Q,~ Holding St/Ht Outlet TANK SETBACK INFORMATION TANK TO / W BLDG. Vent to Air Intake ROAD Dt Inlet ?c ff Septic t~/ wll t' S k 2 Yyt~.N~ GIB Dt Bottom/ -,4- Z • / j' Iv Hea r/Man.' L S 3 Dosing Aeration Dist. Pipe 3 Holding Bot. System 0 V_ ~/1 y 2 93 ,?~j 1~ L inal Grade G' PUMP/SIPH INFORMATION i'x•Y- ►t Manufacturer. De and St Cover S Un Z SS~, GPM Model Numbers TDH Lift rictiq(t Loss Syste He TDH . Ft /t Forcem in Le th Dia /J Dist to ell SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenches PI DIMEN IONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS ..:rte SETBACK SYSTEM TO /L BLDG WE L LAKE/STREAM E Manufacturer: ER OR INFORMATION Typ O System: U Model Number: DISTRIB TION SYSTEM r 3 j a~ SC i~ a :evv x Hole Size x Hole Spacing Vent to Air Intake Header if1 A Distribution 4 { ' 11 J .17 Pipe(s) +3 2~ Cl _ (41 AIA Length f Dia Length Dia G Spacing SOIL OVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed(rrench Center Bed/Trench Edges Topsoil C I11f / Yes No 0 Yes 0 No d ~j / v Z COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: / / / IP(.! In pection #2: lam/ ~~'7 u w" .19.180 Location: 263 Walnut Hill ay River Falls, .WI 54022 (SE 1/4 SE 1/4 22 T28N R1 9W) Wall ut i I m;ka Tl'ie Trib to Parcel No. 22.28 I~( ,era 1.) Alt BM Description = d` 2.) Bldg sewer length = f 's 3,~,~Y/~ mlyt l -amount of cover= ~~~p 0~~--- - f Plan revision Required? Fv~ Yes WNo Use other side for additional information. 1 - Date Cert. No. Insepctol s Signa ure SBD-6710 (R.3/97) PLOT PLAN PROJECT Overina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 92.5' 3 BEDROOM CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of steel conduit pipe ASSUME ELEVATION 100' Filter BEST GF10-8 ❑BOREHOLE O WELL *H.R.P. Same as Benchmark Property Line B.M Scale = 1/4" = 10' 1 Acre Parcel Well is to meet all WDNR Setbacks Grading is to be done to divert run-off away from system 92.5' .0 91.5' Property Line 90.5' 89.5 ~ B-3 Huffcutt Com o lank 6% Slope $b Area 1 ' below grade is to remain u turbed Pr Be-rTroom Ae - - 7 Tank is to be properly bedded and provided with lockdown covers with approved warning labels Cq-9ie Propert Town Road 1V ° rs' afety and Buildings Division County / commerce.wi.gov j 1 tW. Washington Ave., P.O. Box 7162 _ ' Madison, WI 53707-7162 Sanitary Permit Number (to be filled in by Co.) iscons~n B `.iiZ Department of Comm®rce AuG t`~`' ' } ~ ' 1 tale Transation Number Y Sanitary Per cation 7 3 7 NW In accordance with s. Comm. 83.21(2), W s. 3~m. ode, submission of this firm to the appropriate government unit is required Prior to obtaining a Sanitary permit. Note: Application forms for state-owned POWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide may be used for secondary purposes in accordance with the Privacy Law. s. 15.04(1 (m , Stats. 1. Application Information - Please Print All Information Parcel # Property Owner's Name C - G O ( ` " Property Location Property Owner's Mailing Address g Q ) .1_71 ✓t D Govt. Lot Zip Code Phone Number/,, 't/4, Section L~- City, State circle 90-1 T~ N: EorW II. Type of Building (check all that apply) Lot # Subdivision Name or 2 Family Dwelling - Number of Bedt ooms r __`zf+~t✓"tT.e.~.t~r' ~..,.~:~~t < ~~t.i Block# - ❑ Public/Commercial - Describe Use ❑ City of CSM Number El V' lage of ❑ State owned -Describe Use Town of / 0 PN ype of Permit: (Check only one box on line A. Complete line B if applicable) ❑ Other Modification to Existing System (explain) w System ❑ Replacem~3nt System ❑ Treatment/Holding 'lank Replacement Only List Previous Permit Number and Date Issued ❑ Permit Renewal ❑ Permit Re ,Iision ❑ Change of Plumber ❑ Permit Transfer to New Owner Before Expiration e of POWTS S stemlCom ogent/Device: Check all that,a d 24 in. of suitable soil ❑ Mound < 24 in. of suitable n-Pressurized I n~Grotin ❑ Pressurized In-Ground ❑ At-Grp olding Tani: ❑ Other Dispersal Component (explain) Device (explain) ! L . % 5~~ t f dL , , r. V. Dis rsal/Treatment Area Information: f) Sysm Elevation Desi Flow (gpd) Design Soil Applicttton Rate(gQdsf) Dispersal Area Required (sf) Dispersal Area PropoJ 1d ' (sf) 5 Capacity in Total'' # of Manufacturer VI. Tank Info U iallons Gallons Units f 2 E~ New Tanks Existing Tanks ev'r a. U cn w C7 R Septic or Holding Tank 7 l Dosing Chamber Y_ 3 v J` VII. Responsibility Statement- 1, the undersigned, assume res ility for installation of the POWTS shown o the attached plans.usiness Phone Number RS Number Plumber' (Print) Plumber's Si v v Plumber's Address Str eet, City, State, Zip i-ode) d VIII. oun /De artment Use Onl IWu-in Age tSi~ature Permit Fee Date Issued g f f Proved ❑ Disapproved A ❑ Owner Given Reason for Denial ovaUReasons for Disapproval Ix. C 1 Septic tank, effluent filter and ti a. f t dispersal cell must all be serviced I maintained as per management plan provided by plumber. 2. All setback requirements must be maintained for the system and submit to the County only on paper oot less than 8 trz x 11 inches in size SBD-6398 (R. 02/09) p~gARxa g~ ion Safety and Buildings ~o141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 Contact Through Relay www.dsps.wi.gov/sb/ www.wisconsin.gov a'~ss[oNt+L~ Scott Walker, Governor Dave Ross, Secretary August 20, 2012 CUST ID No. 226900 A77N.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 08/20/2014 Identification Numbers Transaction ID No. 2137347 SITE: Site ID No. 783028 Oevenng Homes Please refer to both identification numbers, Walnut Hill Farm Lot 74 above, in all correspondence with the Town of Troy agency. St Croix County SE1/4, SE1/4, S22, T28N, R19W Lot: 74, Subdivision: Walnut Hill Farm FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1387680 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01101); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/01) and the 'Pressure Distribution Component Manual fbi Private Onsite Wastewater Treatment Syst~ins VERSeNl' 0(O SBD-10706-P (N.01/01). The building sewer and distribution network piping shall be of material listed in TJ'e4 and 384.30-5, Wis. Adm. Code. In the eve nt this soil absorption system or any of its component parts malfunctions so as h hazard, the property owner must follow the contingency plan as described in the approved plansowner must comply with the operation, maintenance and monitoring duties as described in secmound component manual. A copy of this information must be given to the owner upon completion of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). ` M SHAUN R BIRD Page 2 8/20/2012 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. A Sanitary Permit must be obtained from the county where this project is located in accordance with the 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. Owner Responsibilities: • SPS 383.52 Responsibilities. 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). • SPS 383.52(2) 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. • SPS 383.55 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. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. ly, Fee Required S 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2, Integrated Services Pavment Submittal. (262) 397-6005, Fax: (608) 283-7481 WiSMART code` 7633 julia.lewis@wisconsin. gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be 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. i RECEIVED Cover Page AUG 13 2012 SAFETY & BUILDINGS Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 8/ 8/12 Owner:Oevering Homes LLC Location:SE1/4 SE1/4 S22 T28 N,R19 W Lot 74 Walnut Hill Farm Troy System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-12. Soil test 13. Filter SpecificationAandcr s tion Shaun Bird Signature License number 2 601 a, G, ,sue PLOT PLAN PROJECT Overina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SE 1/4S 22 /T 28 N/R 19 W TOWN Troy COUNTY ST. CROIX SYSTEM ELEVATION 92.5' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of steel conduit pipe ASSUME ELEVATION 100° Filter BEST GF10-8 ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark Pro ert Line B.M.* Scale = 1/4" = 10' 1 Acre Parcel Well is to meet all WDNR Setbacks Grading is to be done to divert run-off away from system 92.5' B-2 B-1 u r, 91.5' Property Line 90.5' 89.5 ~ B-3 Huffcutt Combo Tank 6% Slope Area 15' below grade is to remain undisturbed Pro 3 Bedroom House Tank is to be properly bedded and provided with lockdown covers with approved warning labels Property Line Town Road :Mound System Cross Section and Plan View - - - Dimension Feet J -A- d - i B _ l 1 D v ' •3• F . Y-• r T'..r rTr .rT3 rT•.r.3} ,r, }Y:•}~.'}•:•. - ~ gr} .ti }tir r { 'r}} fv}'} . {,,r }3~`.{{3{~{•'•.;r'w{:':':~.;.;..• - A ( i.{;f}{~} i iyi{.i3 } r .f}{. Tr•r {}f I'r3Yrr 3rf 3•rv .3.}.r.3.r.r ; I ~r i r r r } ~ f rT3~} 'fit}ti• } a.} ~ ~.y.{. ti wL. .ti. -x~~ ,y{ :~r~ 3~r• 4•Fr• .3 r 3•r.r.r}} rTri}r r r r. r y r• •r• T .r}r•3fr•r }}3 rTr.rT3 r.r r r .r} .r} . I f r r r.3 {.r 3.r.r f [1 t3 W 40 I r - :7: I G I S I r. H c~ 1 - I I I I J U I, r K 3 - W K- i B _T Z L 1 = Topsoil = ASTM C-33 3. = Clean aggregate = 4 in. sch. 40 pvc Cap Material sand fill 'frt'~r ' 0 /z to 2 /z in. dia. observation pipe J LA Geotextile _ G H Fabric } ' r{r.{r {"fir}wf fryr}r .r.} r} rr r}r D E Plowed Surface Ft Contour Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing mad,- not proceed if the soil is wet enough at the plow depth to form a'/4 inch soil wire when a sample is rolled I&tween the palms of the hands. ASTM C-33 quality !sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing ,and of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched .o promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebal• or a closet flange. 10/07 lgj Page of Pressure Lateral Layout Two Laterals - End Manifold Threaded f Cleanout Lateral Turn-up Plug Manifold M X l - - 1.., 1~- - - Long Force Main r / Sweep 90 Bend Distribution Network S ecifications Pressure System Construction Lateral Diameter In. Manifold Diameter _ In. Laterals are constructer! of Schedule 40 PVC Orifice Diameter _ 3 6 In. pipe. Orifices are dri lied perpendicular to X Orifice Spacing) _ 027 In. the pipe with a sharp drill bit and face down. L Lateral Length) _ Ft. Lateral turn-ups terminate with a threaded M Manifold Len th Ft, cleanout plug and are inclosed in a 6-8 inch Foorcerce Manz -M-- Diameter ~ - diameter lawn sprinkler valve box accessible _ ~n• Force Main Length from finished grade. , • • • • • Grade 6-8 Inch Lawn Sprinkler Valve Box hage - - of 03/05 lgj 1 1 Septic-Dose I'ank Cross Section And Pump Performance Specificationr, Tank Marsufacturer y Pump Manufacturer l i ~f +e~ ~ ~ Tank Model Number G d Pam Model Number . Total Tank Capacity Alarm Manor G z„r eL l Max. Bury Depth f 9 Alarm Model Number t- f Switch Type z, Dynamic Filter Manufacturer Total Head (TDH) - Feet Filter Model Number Elevation Head / C Distal Pressure c O Network Loss Minimum Pumg rerfctrrnance Ro9aired Force Main Loss _ U GP S Ft TDH Total 1-5 JI/ Outlet Manhole lVi}in. 4'' Above C'rr8de With Manhole Min. 4" Above Grade Locking DO' 10e. fulat Manhole Mounted With Locking Device < b" Below Crt ►de Seared Waterda-ht Securely M Weather-proof 1 Junction box - r. -M w W.. rr r.n Fw- miekl CM& ~ ar Vent Mm. 12" Disconnect Above Grade Means tArIth Vent Cap : . • . .,~,."`1 ,Val+i'+'+'+'+~ `a'a~a'ai '<Y+L+` 'Y aY+/ Y+Y putlet Filter Inlet Baffle Inlet +r-- •L L.Y. .L,. A 1/4YS Switch 5`_a~t and Reserve Capacity Weep GpT Vole Tank VOIUMO volume Gal. moo- Dimension; inches :<Y (reserve) A: cl?.. 5 off Elevation C (alarm B ; 2 Bottom (dose) C': -s Elevation ` (dead) D . , ga. Z Ft ~ •<r<r+i'1i','<~i r~ .~-"r'--ter'-'. Total i L• + <,+~a~<,< 1~,,+' , Y< , <'i i i tai +r+`i ,Li i i i <',ra~+Yi ,rf { :'aYYY,r,Y,r,'f ,`i i'~~,'<' '+'+`,`a + i a`i sir ~ tYr':LSL.L<tia~~ +Y<>+YsY ir.YVYi rra. r.r~'.'Y,YS <r+,+. r.~.,Y a t . , • . filled in accordance with the INSTAL ~'i 01~; The dos W* is bedded and ba by the manufacturer may not GFNFRAL ! fications. Maximum -depth of bury as. Spell device (padlock) manufacturers product.a~►ptoval si Nava an effeattive locking without car dpproval., Manhole Covers eyposed to grade to the tank with watertight Httings, and be exceeded l installed. Piping at the ialet and outlet * of approved material, cAnnected 4„ Sch. 40 PVC to bridge the tank sett ing or sagging. T force main is sleeved with 300 and Comm 16.2x. laid on stable soil tc ~t Sleclri mice complies with NW excavation and the slol Is sealed wstertt8m• Page . Of 02/05 U W LaserJet 3100; 7 71~ ~b~ aael may-~-uo c.uur w,y y., a, 9EH SERIES SUMP/EFFLUENT PUMP 8.95 Q 0 ~ifMea~lvns AIM Cal H► ~ 71111AIQI 9111 14MI~EI "Wj! 3111m mot ~I ~M1 at alMli.itl AMWMIt 9 10 IV it ftj ktt 1Nat IM>flt111 gF>inM 508380 UUISA 4AD 115 361 13A 1000 70 54 55 It 32 19.0 21' 24 9.111Miltt" OW-C" 909340 mm AI.O 230 974 SA 1000 70 64 55 41 V 19:8 211' ?A 8.11 X11juts" 99"WWS 508150 Wim 400 115 34 13.0 1000 m 84 55 44 32 13.8 2. 27 8.11 111b AM JWAM am 4-0 go 34 FiS imp 70 fd, 56 41 32 1310 _ 4 V 0.111111jude CaiAlnra~tlrlyRMtd -"LUIkOfantllhseewawa~l3ledconunrout~4sloxgasYryaretaewMantiMMYEAMNdt~ekrMnt+prmpe•' FLtlw- LIrER$/H(XR OOV4l■1l true`t a loop 2000 3000 Motor Housing Epoxy Coated Cast Iron impeller Material 30 19 i~eller'rype Closed Vane . Volute _.AB5 W Power Cord _ SffWA 7.s 4 z0 Medumioai Shaft Seal Nitrite with carbon and ' S CCIatIWC faces -4 a FastCtl$rS Stainless Steel " 10 $llatt Stainless Steet Hearings Upper Sleeve and l aver I Hall Bm ings 0- Trff fill 11611"1111111U 0 20 40 50 90 FLOV- GALLONS/41NUfE t PUMP PERFORMANCE CURVE: utue aftnt Pwmp CO. 115v 6mz PC) am 11VIO- /lWwbme C W OK TUS7 Pkew. 4".W e.2611- FY: 4pe tie kle14 4,~ Ilf.04hWWW~ am www.umeofantftmlp.com 03 FOM 496235-07103 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page 7 of FILL= INFORMATION _ SYSTEM SPECIFICATIONS Owner ~ Septic Tank Capacity i El NA Permit # - - Ar ? Septic Tank Manufacturer- AZIEl NA DESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms - - ❑ NA Effluent Filter Model _ ❑ NA Number of Public Facility Units - NA Pump Tank Capacity_ -3 gal ❑ NA Estimated flow (average) gal/day Pump Tank Manufacturer- ❑ NA Design flow (peak), (Estimated x 1 5) 1l )-V al/da Pump Manufacturer _ • ❑ NA Soil Application Rate aVda /ft2 Pump Model J 7 ❑ NA Standard InfluenVEffluent Quality Monthly average" Pretreatment Unit NA Fats, Oil & Greaso (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODS) s220 mg/L ❑ NA ❑ Mechanical Aeration ❑ Wetland -fatal Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Cell(s) - ❑ NA Biochemical Oxygen Demand (BODs) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L ?<NA ❑ At-Grade >K11ound Fecal-Coliform (geometric mean) 5104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size ih in dia. ❑ NA other; TN Other: - NA Other: *Val ues typical for domestic wastewater and septic tank effluent. Other: MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every' El month(s) T ear s! (Maximum 3 years) 11 NA Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank volume ❑ NA Inspect dispersal cell(s) - At least once every: ❑ month. Is) - - (Maximum 3 years) ❑ NA Clean effluent filter At least once every: l D monthr s) - EI NA Xyear(s,', Inspect pump, pump controls & alarm At least once every: - I7 month(s) - - - .4B year(s; - El NA Flush laterals and pressure test At least once every: ❑ month{s) ❑ NA At least once every: ❑ 11 month) s) El NA Other" year(s) O NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master Plumber, Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servicing Operator, Tank inspections must include a visual inspection of the trYnk(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and It, check for any back up or ponding of effluent on the ground sr.rrface. 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 tiie 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 not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at intervals of 51:. months, shall be performed by a certified POWTS Maintainer. A service report shall be provided ti the local regulatory authority within 10 days of completion of an., service event. STARTUP AND OPERATION Page of For new construction, prior to ust: of the POWTS' check treatment tank(s) for the presence of painting products or other chemicals that may' impede the treatment proce,3s and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage sei dicing operator prior to use. System start up shall not occur wrien soil conditions are frozen at the infiltrative surface. During power outages pump tar KS may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cells; 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 .,,ontents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent pump or contact a Plumoer 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 ove,' 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 egetable peelings; gasoline; grease; herbicides; meat scrapf ; medications; oil; painting products; pesticides; sanitary napkins; tami,ons; and water softener brine. ABANDONMENT When the POWTS fails and/or is ; iermanently 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. 0 The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. 0 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 sc iid 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 s,rea has been evaluated and may be utilized for the location of a replacement soil absorption system. The replacement area ssiould be protected from disturbance and compaction and should not be infringed upon by required setbacks from existing aW 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. Replacement systems must comply with the rules in effect at that time. ❑ A suitable replacement Brea is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be instEdled 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 Ioc Re a suitable replacement area. If no replacement area is available a holding tank may be installed as a fast resort to replace thr: 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 TRI-ATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER ASEPTIC, 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 S~ccc~ Name F Phone Phone J r 1 S15PTAGE SERVICING OPERATOF (PUMPER) LOCAL REGULATORY AU-"HORITY Name Name Phone r~ ~ `•~~~1 g Phone 3l7 (7 r This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wiscoi isin Administrative Code. 'ATER CARTRIDGE INSTRUCTIONS installation S-rEP 1 Dry fit the filter case anto the and of the outlet pipe to ensure it is centered under the access openhtg. If not, then either Insert snore pipe into the tank through the oudet or solvent weld (glue) additional pipe onto the outlet pipe. c:v(-.p a While the case is still 3r / fitted on the outlet pipe, measure the length of #4-inch pipe needed to bracu tire filter to the tank end wall if utilizing the optional supplemental side suppr,rt, If side support method. is not utilized, proceed to step four. vj.i, a For installations utilzhq the optional supplemental side support_ solvent weld the 4k-inch pipe onesr the filter case. If side support method is not utilized, proceed to step four. N.A., Solvent weld the filter ..,,se onto the outlet pipe, lhsert the filter cartridge into the case, pressing) down until the filter locks into the bottom of the caso. If a VRS switch is (rr5ett into the fi{ter and lack by turning 4! ..;3,. , clockwise 9D".;.. f Maintenance 1. 'The effluent filter should be t Itianed every time the septic tank is .terviced. L. open the outlet access opeolLiq to Inspect the tank and filter, s. rump the septic tank cornpb::trAy, snaking sure to remove the sludge - layer on the bottom of the taint, and not just the scum and effluent, 4. once the effluent level has tlra?n lowered below, the invert of the outlet pipe, firmly pull up on i t.e filter handle to dislodge the cartridge from the case. 5. slide the cartridge up and otit of the case for Cleaning, l' tf a efts switch connected tc .,m alorfn Is present, the swittlti should he removed by turnfr 5 ;otinterclockwise go" and deaned wikh water only. y t. While holding the cartridge en its side (large flat surface facing down) over the 41PGRSS openif►i), rinse off the cartridge With wntee dj• , only, making sure an septage: i"aterial is rinsed back into the tank. i t a. If VRS switch is utilized, repl;r,-,i by inserting into filter and - o turning clockwise 9o". 9, insert the filter cartridge back into the tare, pressing down until the filter locks into the bottom of 1:1. 1& case. ~ lo.Reptaca and secure the access: apersing on the tank. 1: :N:. ~"c ^K'yC ;4M7: is a'1!,*r; '1•'i,.f tlr4Y6f:: l~i,S~l!f•I,^,.q". . i. ~ . _ ...roe. . • wlww liearo,Wtexom 877-'MLPILTIERSi (653'-4583) 9~ea% 4v ST. CIZOIX COC7N'FY 2 $ 2Q~2 SEPTIC TANK -MAINTENANCE AGREEMENT AND sj }70N~NO oFFkc~ OWNERSHIP CERTIFICATION FORT NN~N~ Owneryguyer & Q f Mailing Address lv ~ f Property Address '3 (YD6 'Verification required from Planning & Zoning Department for new construction.) ~ City/State ,VV Parcel. Identification Number 0 - D 3 CMG-~7 LEGAL DESCRIPTION Property Locatioa~~r % N , Sec,. , T' N R W, Town of Subdivision L------------ Lot # Certified Survey Map # - Volume Page 4. WarranDeed # 962 3 P ~ Volume age Spec hcaus yes rio Lot lines identifiable yes 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 pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the fiinction 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 Depm1mut a certification form, signed by the. owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1.) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 113 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 Resources, State of Wisconsin. Certification stating that your septic system has been maintained must he completed and returned to the St. Croix County Planning & Zoning Department within 30 days (,f 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 AIGNA ~OF APPLICANT(S) DATE ***Any information that is misrepmsented 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 dcod. (REV, S/0S) ~isc>onsin Department of Commeme SOIL EVALUATION REPORT page / of 3 Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code CountY ST - GEC' O/ JL Attach complete site pl, 7- -b4WS- pperceennntslloope s~ or EROSION CONTROL PLAN must be Panel I.D. ~,P ~ AOM3 C>~-'~ 130~- V%. completed before sanitary permit issuance Reviewed by Date Porto" kftwwMon you PFVV1W m.y oo usw KW WUUWWWy PUgM s rr fV4W r W. N. w.ua tr) tm11• I :Y~~ Property owner ToDO Property t ocatlion ~ 0 Q p '-'o,~D 133 ERS T'~f~ /rte 410 #141 Govt. Lot A'1 4#9 J~ 1/4S ~L T Zv N RI? (or) W 10„ Property owner's Marimg Address W# Block # Subd. Name or CSM# !a D 15 CA It i L.L. Au t? - WAI v v T" Kill >FA RAf city --r"WR State Zip Code Phone Number city ❑ Village ( Town Nearest Road 61AWE E/ T5 M,v 5So74# ( &5t) 198• i0i ?-~eoy So. 6.100ek _ o g New C mtrudion Use: 19 Residential 1 Number of bedrooms _ code derived design flow rate ~ OZa GPD ❑ Replacement ❑ Public or commercial - Describe: _ tA Parent material /V S d V t, Flood Plain elevation if applicable ft. General comments and recommendations: • -4-le,q. 7"&`.S 7-8Z~) SO 77, ~-e- 29' /e + /ti o v v0 V1 S Y S' 7~tit 215 •ti S~`f 7~i l Y~ ssS N ~J1 0 Borkv # Boring ® Pit Ground surface elev. ft. Depth to limiting factor 2-6 in. Sol Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDff b in Mansell Qu. Sz. Cord. Color Gr. Sz. Sh. 'Etf#1 'E1#2 0 •/a 10y2 313 s/ L- 2;fJAt dS w • s • P w I - 3 -1-24o /o 514 / s 65 - • Z • 3 t /o t o C~ a! ~jsss' Boiling Boring t_! ® Pit Ground surface elev. Yll ft. Depth to limiting factor in. Sot Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD11f= 11,E In. Mansell Qu. Sz. Cont. Color Gr. Sz. Sh. -Eff#1 -Eff#2 z - t/ 0 Me A//4 51G hAf 3 17 - 2# N o ~iL uG, c - . s -9 AMA, /o Y/Z GZA HO1`5 S/cL s 1)rr01- • Z ~b We ~lZ Effluent #1 = BM 5:- 30:S 220 mg& and TSS >30:5 150 mg& ' Effluent #2 = BOD 130 mg& and TSS < 30 mgL CST Name (Please Print) •R -u LB R i GkT~ Signature 225 CSTNumber Address Ulbricht & Assgciates S Data j~ ConducW 7~s_ Telephone 2812 10th Ave. Spring Valley, WI 54767 I N A PAID `r P/X,5 Foie ,q-APROX - z yo its oyCj • /08 s • so • a~ o,Yo. /o'F(o dy0.10,?6 . Zo • oaa 0 yw /08(, - ~D • ~o o yo • io ~G~ - 70 • oar GIJ,~Giv v 7'' tf i// ~r`1~PM ToDV T3 JE e s TE©?- Z 3 toperlyowner lD# 7 f or r-_---i Parcel 1-31 p Kq Ground surfaceelev. ! 3 Depth to lanF6ng factor 2-6 int. J SW Application Rate Horizon Depth Do rt Cdor Redox Descripilon Texture StFUCb a Crxnsistence Sotmdary+ Roots GPDM In. Munsefl Qu. Sz. Cont. Caton Gr. Sz. Sh. `Efi#1 'EM . s . ~ o /-0 YKJ13 .-)-Fshi- ds w 3 / ~S L c S F-] • /p GZd2 n o T S ~ L K • Z - 3 lZ i i j Boring # Bod"g Q Pit Gmund surface elev. ft. Depth to &rrniting factor In. Soft ication Race Horizon Depth Dominant Color RedoxDescription Texture Siruckre Consistence Boundary Roots GPDM lrr. Murnseii tlu. Sz. Cond. Color Gr. Sz. Sh. 'EM ''ES Smi t Boring # Pit Ground surface elev. St. De/pth to 9 factor iCr. Soft NOCSOM Rate Horizon Depth Dorntrnant Redox Description- T Structure consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color G7, Sz. Sh. `EW1 `Eft#2 .a+ s E Boring # Boring pit G#°'a'd surface ft. Depth to trm"faun' In. Sol Rate Horizon Depth Damirianiq;okw R Descdp#m. Texture Sbvckwe Gor>sister~e 0ourdary Roots CiPOW IM Munseft Qu~Sz Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 i Effluent #1 = 0003 > du < 224 rrng& artd TSS >30 < 150 mgll ` Effluent #2 = BOD, 130 mglt, aid TSS < 30 mglL 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 depattrnent at 608-266-3151 or TTY 608-264-8777. seossza rrzs~no) r PJ,O'r PLAN WALNUT HILLS FARM. LOT # Pg. 3 of 3 = Contour elevation lines. • = Backhoe Soil pits. 0 = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. SCALE: 1" = 1 D,PNj-t- 1A N~ © /Dd' o Z.a jr LPb 0 13, L.h T k y~ }}I 1 1 tit C .34 ~ASr f D-` r S • svs~'~s~-~ ~ouv~ Sysr~..~-~ 111111111111111111111111 i 111111 8081786 Tx:4061884 STATE BAR OF WISCONSIN FORM 3 - 2000 962359 BETH PABST Document Number QUIT CLAIM DEED REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, Grantor, ST. CROIX CO., WI 0g~27/2012 1.36 PM and Oevering Homes LLC, Grantee. Grantor quit claims to Grantee the following described real estate in St. EXERECMPT MPT#: NA NA 30.00 Croix County, State of Wisconsin (the "Property"): ' TRANS FEE: 91.50 PAGES: 1 Lot 74, Walnut Hill Farm, Town of Troy, St.Croix County Wisconsin. Lot is sold "as is" witha_11 faults. Recording Area Name and Return Address: 5 Ca--F Together with all appurtenant rights, title and interests. 040-1303-00-074 Parcel Identification Number (PIN) This is not homestead property. Dated this 2nd day of August, 2012. Citizens State Bank * ene Haberman, Vice Chairman * * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST.CROIX COUNTY. ) ss. authenticated this 2nd day of August, 2012 Personally came before me this 2nd day of August, 2012 the above named Citizens State Bank by Gene Haberman, Vice Chairman to me known to be the person(s) who executed * the foregoing instrument and acknowledged the same. TITLE: MEMBER STATE BAR OF WISCONSIN (If not, authorized by § 706.06, Wis. Stats.) *Ja P Penfi d THIS INSTRUMENT WAS DRAFTED BY Notary Public, ate o Wisconsin My commission is perfnanent. (If not, state expiration date: J ' L I~C.I ~Q ti J ►'%4`\ r 8/26/2012 ) (Signatures may be authenticated or acknowledged. Both are not necessary.) PENFIrcI-D AY P• ubUc *Names of persons signing in any capacity must be typed or printed below their signature a14t00e 01 P hgtft 1 of 1 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000 I - . ~ a r.Vl''43., w ~ OVMOT -~-1 $ VI 036 w 79. 5 85-53'09-2 * ,4,8- E 422-72 J 143-7 143.M* 15 I , IY ~ a~ 1 7 5 f` ' r 63197 S.F./;"w I j 73 1, 45 Ac. i 1" 46136 S. F. /;o 45608 S.F. 1.06 Ac. /1.05 Ac. fin _ r I 57 17-2,920 1 t 146.00. 64 31 At 76 92-"- W 73 76 74. 3 24 40 4 Ac. 56619 s q. ft 1.30 Acres , l~ _ 25