HomeMy WebLinkAbout040-1303-00-051
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix
Safety and Building Division Sanitary Permit No:
INSPECTION REPORT 556393 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 040-1303-00-051
CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No:
0-7 6.5-1 22.28.19.1786
TANK INFORMATION ELEVATION DATA
TYPE MANUFACTURER -6 CAPACITY STATION BS HI FS ELEV.
Septic 21 Benchmark /UrtC -7 5 9. 7
d
Dosing Alt. BM G 2,
Aeration - Bldg. Sewer
•7 95 - S I
f olding St/Ht Inlet
St/Ht Outlet
TANK SETBACK INFORMATION
TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet
Septic 0 Dt Bottom 33 73. 5 Pal Dosing NA / ;76 % Header/Man. b / . 7Z
Aeration - Dist. Pipe
1.0 7Z-
Holding - Bot. System
/,7 161,6Z_Final Grade
PUMP/SIPHON INFORMATION 6 . b 16 L 7~-
Manufacturer Demand St Cove y 33
GPM L~ ov /,62
~
Model Number C6 w 1-61 3, (Q ~d1 Z . 7 '77,
TDH Lift Friction Loss IS Y Head TDH Ft ~L
/ Z
17. 1, y 3. 9 13-#3 T a~ ,.iAo S.6 AI, V
Forcemain Length CC Dia. Dist. to Well 3,61 AA-
SOIL ABSORPTION SYSTEM
BED/TRENCH Width Length No. Of Trenches PIT DIM NSIONS No. Of Pits Inside Dia. Liquid Depth
DIMENSIONS ? 5 7 !ve 11~. I-,-
SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer:
INFORMATION CHAMBER OR
Typ'Moo, stem:
!5 Q*i A A_._ /v ^ 7 UNIT Model Number: DISTRIBUTION SYSTEM
Header/Manifoldj Distribution / L x Hole Siz x Hole Spacing f Ve Air Int ke
Pipe(s) Z
Length1 _Dia Z Length Dia z Spacing ✓ v
sc~
SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only
Depth Over Depth Over xx Depth of xx Seeded/ dded xx Mulched
BedfTrench Center 1. 7 Bed/Trench Edges Topsoil ,Yes [f No NN ,Yes [71 No
COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: /Z- Inspection #2: / /
Location: 277 Walnut Hill Way River Falls, WI 54022 (SE 1/4 SE 1/4 22 T28N R1 9W) Walnut Hill Farm aka The Tribute, Parcel No: 22.28.19.1786
66
1.) Alt BM Description
2.) Bldg sewer length 4- r
- amount of cover
del, OL-W
Plan revision Required? ❑ Yes 'No
- - Use other side for additional information. _ ~ _
Date Insepctor's ignature Cert. No.
SBD-6710 (R.3/97)
D
i
111,7012-0 2-
commerce.wl.gov ~Sulety and 13uildin s llivision Count -
[t4loperimmistsccll 201 W. Washington Ave P.O. Box 7162
rfawi Madison, Wl 53707-7162 son:wry Porn t Nmnb r(t b., by ..:o.)
of Commerce 5
~-Stmtn'1'raustwlionNamber
Permit Application
lot accordance with s. Comet. 83 1,1(2};-Wi Code, submission of'this furrn to the appropriate govurmmontul
unit is required prior to,~o~► 40 -permit. Note: Application tbrms for state-owned POWTS are Project Address (if different than mailing address) ^
submitted to the Dtypwi&1t`~ii of Commerce. Personal information you provide nay used for secondary
u 2ses in accordance with the Privacy L tn•r, s, 15.04(1)(m), Stats. AA - _~7 -7 W/o (Ylw~ ' t l W01
Pco Applicao ners Nsurnmaffort _ Please Print All Information
y Ow ~ - Parcel
o 0_/30 _0.05
r - - -
P -operty Oww~'s/Mailing Address C Properly Locution / 7 JV65,
Govt. Lot - - - -7
City, State Lip Code Phone Number - A'S f A Section [r
p ircle one
N; it
If. Type of Building (check all that apply) Lot
or2 Family /w,.e-l-lVullibek9fBed"U ~/Name
W y t t Block Yf
L Public/Commercial - Describe Use
El city of,.-
CSM Number Village of
C State Owned - Describe Use
HL Type of Permit: (Check only one box on line A. Complete line B if applicable)
ew system ❑ Replacemmit System ❑ Treatment/Hokling Tank Replacement Only ❑ Other Modification to Existing System (explain)
List Previous Permit Number mud Mite Issued
B. ❑ Permit Renewal ❑ Permit Revision E-1 Change of Plumber ❑ Permit Transfer to New
Before Expiration Owner _ - ,
I1' Type of POWTS System/Component/Device: (Check all that apply) 7,,
24 able soil
Pressurized in-Ground ❑ Pressutized ln-Ground ❑ At-Grade Ll Mound ? 2A in. orsuitablc snit Qe'
❑ Nan-
❑ holding Tank ❑ Other Dispersal Component (explain) Pretreatment Devi_-
- fz V. Dis ersaUPreatment Area Inforuintion: - D sigh Flow {gpd) Design Soil Apphca on Ra~e(gpdst) Disprsal Areu Required (sY) Dispersal Area
P posed W) Flavation
C
V 1. l'anl< infa Ca,)acity in Total d of Manufactu r
(latlons Gallons Units . v _ •2
Now Tsutks Existing Tatdcs
w~ C~ 'r~"n ~ cn w c~J w
septic or Holdiug Tattle - - /L -
posing Chamber- - .i v
V Il_ Reapo laity Statement- 1, the r~ttderaigned, assume respousibility for inst oil of the PORTS shown on the attached plans.
Plumber' a (Print) Plumber's Signature MP/MFRS Number Business Phone Number
tuber's Address (Street, City, State, Zip ( ode) t -
V ill. t %De rtm )nt Use Only-
Permit Fee Date slued - •uing Agent S' net ~
pproved ❑ Disapproved C(~r7~ Z
Q owner Given Reason for Denial G _ _.__L _
'M s t rovallReasons i'or Disapproval dva r'►^` ~~s, ~ - - - -L ~~=~~i.~ dit~
~!n ,
Law -5~ 8W?Rr:
1. Septic tank, effluent filter and
dispersal cell must be serviced / maintained lr Lt ItA& ke~ abo-h 4-4-4
as per management plan provided by plumber. 1
2. All setback requirements must be maintained
- ras for the system and submit up the count only ea paper not fuss than 81IL s 1 t etches ial)sice - _
,)3D-6398 (R. 02/09)
-PAR Td~~~4
Safety and Buildings
o 141 NW BARSTOW ST FL 4TH
WAUKESHA WI 53188-3789
y Contact Through Relay
`Gw www.dsps.wi.gov/sb/
o - S www.wisconsin.gov
~'ssroNP~ 'I
Scott Walker, Governor
Dave Ross, Secretary
November 05, 2012
CUST ID No. 226900 ATTN.• POWTS Inspector
SHAUN R BIRD ZONING OFFICE
BIRD PLUMBING INC ST CROIX COUNTY SPIA
1432 120TH ST 1101 CARMICHAEL RD
NE`vV RICHMOND WI 54017 HUDSON WI 54016
CONDITIONAL APPROVAL
PLAN APPROVAL EXPIRES: 11/05/2014 Identification Numbers
Transaction ID No. 2170055
SITE: Site ID No. 785821
Oevering Homes Please refer to trres
h identification numbers,
Hillary Farm Rd Lot 51 above, in all pon
dence with the
Town of Troy agency
St Croix County
SE1/4, SETA, S22, T28N, R19W
Lot: 51, Subdivision: Walnut Hill Farm
FOR:
Description: Mound, 3 bedroom
Object Type: POWTS Component Manual Regulated Object ID No.: 1400542
Maintenance required; 450 GPD Flow rate; 14 in Soil minimum depth to limiting factor from original grade;
System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01101), 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 for Private Onsite Wastewater Treatment Systems VERSION 2.0"
SBD-10706-P (N.01/01).
The building sewer and distribution network piping shall be of material listed in Table 41e,A
384.30-5, Wis. Adm. Code.
In the event this soil absorption system or any of its component parts malfunctions so as to F
the hazard, property owner must follow the contingency plan as described in the approved plans. In owner
must comply with the operation, maintenance and monitoring duties as described in section V 11 of the mound
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).
SHAUN R BIRD Page 2 11/5/2012
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.
Sincerely [Fee Required $ 250.00
his Amount Will Be Invoiced.
Julia Lewis-Osborne When You Receive That Invoice,
Please
POWTS Reviewer 2, Integrated Services Include Copy With Your
(262) 397-6005, Fax: (608) 283-7481 Payment Submittal.
julia.Iewis@wisconsin.gov W~SMART code: 7633
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.
Cover Page
RECEIVED
NOV -5 2012
Shaun Bird
5AI ETY & BUILDINGS
Bird Plumbing Inc.
1432 120th St.
New Richmond Wi 54017
715-246-4516
Date: 10/ 28/12
Owner:Oevering Homes
Location:SE1/4 SE1/4 S22 T28 N,R19 W Lot 51 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 Specifi 'ons and cross ection
Shaun Bird
Signature
License nu er 226900 .4
b,' (L~JrGs
~CF
PLOT PLAN
PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017
S .E 1/4 SE 1/4s 22 /T 28 N/R 28 W TOWN 19 COUNTY ST. CROIX
SYSTEM ELEVATION 100.9 1.9' sand lift
BEDROOM 3
CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK
MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630
HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none
BENCHMARK V.R.P. 1/2" steel conduit
ASSUME ELEVATION 100'
❑ BOREHOLE O WELL *H.R.P. sameasbenchmark
Property Line 21po, o S
10 Slope B-3 1.1 Acre Parcel
97' 98'
STIr~- , B. M. 99' Scale = 1/4" = 10'
Well ❑ B-2
100'
B-1 o 100.48'
Area 15' be I ow system is to
remain undisturbed
1ely(~__ Huffcutt Combo Tank
~J&) We is meet
all QNR Property Line
setbacks 212
Grading is to be done to divert
run-off away from system
Pro 3 Bedroom House
Tank is to be properly bedded and
provided with lockdown covers with
v approved warning labels
Hi I I arm Road
Mound System Cross Section and Plan View
T {77 E i tXlA i ce, 4rf ~ u f 1l t f. f7 Ri41 1 .-I,gR(t{1~I~ mr +R fir +n -`qer w. M" "f 1fer W w.. ,n• nnw .
U. 1111Dimension Feet
A
J
;t - -
f
'I
I'
I3
I,
D
1
A Er x I E
L
F
.ZG
H
I TI
f
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i
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K 91 3
W
s. ~ WC.r.v':.. rJ -.'.3+ ,w:~' WJ~.;„N. ~•~=•LF evYir.i+r..r :w 11+1'~~~,e i. ~r.... ~~.r I.r~ ire rr :j,-ir''. ~ :y'I
. 3r...
K 13- Z
L Slope 11"0%
k=' =Topsoil = ASTM C-33 =Clean aggregate = 4 in. sch. 40 pvc
Cap Material
sand fill i/z to 2 '/2 in. dia. 0 observation pipe
- - E
Geotextile rj H
Fabric
f
D
.E
. I'
Ft Contour Plowed Surface
h
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 may not proceed if the soil is wet enough at the plow depth to form a `/a inch soil wire
when a sample is rolled between 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 sand 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 to promote vegetative growth, limit erosion and protect from freezing. The
observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange.
10/07 lgj Page _ of
Pressure Lateral Layout
Two Laterals End Manifold
4 Threaded
l® i Cleanout
Lateral Turn-up No Plug
Manifold
M
X
L o Long;
?Force Main Sweep
90
Bend
Distribution Network s ecifreations Pressure System Construction
Lateral Diameter 2 In.
Manifold Diameter Z In. Laterals are constructed of Schedule 40 PVC
pipe. Orifices are drilled perpendicular to
Orifice Diameter 316 In. 10
X Orifice S acin _ In. the pipe with a sharp drill bit and face down.
L Lateral Length) j Ft. Lateral turn-ups terminate with a threaded
M Manifold Length) Ft. cleanout plug and are enclosed in a 6-8 inch
a
Force Main Diameter diameter lawn sprinkler valve box accessible
_ Ins
Force Main Len th d Ft. from finished grade.
Grade ;
•
6-8 Inch Lawn
Sprinkler Valve
Box
Page of _
03/05 lgj
i
Septet-Dose TCross Section And Pump perfomume Specifications
. Tank .
r
Ptun A~Iaaufacturesr
Tank Manufacturf p Model Number
Tank Model Number
Alum Manufa'm
Total Tank CaPacit+ AJUMMM
1+Jumbar
Max. Bury Deptlm I Switcsh Type `G r
i
' TOW Ay a Head ('I'DH) Feet -
Filter Manufacturer `
Filter Model Number Ele~ration Hoed. '
DlsW1~seuza
Network. Logy
orxnan~a Rdquired Force Main LOSS
Minimum Pump
Ft TDH Total
Outleit Manhole lint 4" Above Grade With Msahale Min. 410 Above Qrrade
Yn1et Manho With LockWS Device
Looking De~ico, Securely Mounted
< 61 Below G4 de Sealed "WatKdWA W po+oof _
` Junction Boot .
fte am
Figiehed Grade ,.....e, .
Vent Min. IT Disconnect
Above Grade Means
VOIA Cup
;,'1► ,Y,►;,lt . tt ►+Y + {Y 4Y.Y+ ,Y{~ Y.r
i _
putted Filter i,
Wet Ham:
~i+ t%► A ►il 1 /411
1
wy{($Y~(sj~ Y,r Weep
f3PI Vlore
Tank'Vo B
V'alume Gal. :
+ Dtmfon :bra f ,
f,f, ~ / +y/` }Y (may" ftf
f'r' • 6 ll Y, C `•r
reserve 4%; Off 'a
2. v l Ft ,m
71 r~ Elevadon
r. + doge) D
Ft
D ILI
30
Total
~fira .f,,+ , + s + t +,,,,,,,iy,,,Y•,•i i ♦ +.+vr~ i ~Y,1,! .~Y,,+.,Y,I,Y,.+I,.,Y~ +s+►,YS~.Ya.1+t+lyY.4+1.~{1{~+Y{iil . 1
r:•:•;{rar; +r+r~Y~r4Y~►~I~YiYSti+t.t,Y.Y+Y ~C{Y I,l,Y Y,Y+ i 1 / t 1 t , + , + 7 + ,~._sI'~~,t ;i8 D aEU .bOR C in acQ01^d~LGd with &e
GENERAL IN~STaLATION: -Mm. sep t of boy -0. Iled: by th° utufaeturer may not
duat•appeoval , 1~lexitrmum d fictive fockbmg device (padlock' is' menu r'$ p°ro rovgl. Manholes coves upa►sed to ll . bave an
- . with wsttight fittings, ano
be exceeded without dPP Ved material, 0 the tank
etalled. Piping at ft jWd and atttlat is of app T-ro ;he .
(or. . foree~Main•i l usd ifh Q 40 iu and Comm 16.2tt'the teal:
at Wong laid on stable soil to ! l e ri~oo complies urtth NEC.
is waled watet"tight. ~ E1+eotcica . ,
excavation and the sue, of
02105 i
v LaserJet 3100; 1 11b bbl duf ; MNY-o-Vu &-jump, ~eM
9 E H SERIES SU MP/E:FFLU E NT PUMP
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a Won rwaar. 1~NIr MrrNwrwt
Searrstn IMBIN 6Ee W Btl OW fllxrrlq
rrlsl Mrs N' 11Bi ftkl SOS 9 It IT
,1 ag 178 80 34 B.H 111Ox694
OWN 80BrS4 low u1Q 115 7m go 1A00 76 64 56 32 S7 r ge &0 MOAN
yBW~I s0g1tD IRICB► Yin a IN 8.5 1000 70 M 55 17A 1006 70 61 db ~ 41 88 73.6 iA' 77 9.11 11144 ~ro1
vWj.m Nov. Ot O 4qo 115 3M a
aaAMuawovb~-"~ aualaump~ cnte~conoaimur~ri+~rlawrr'~hefr+roru~rrAq~M~°1'e~r~ramoer
Consimal
FLOW- LtrERS/H[iuR Cost Iran
Motor Housitl BAY.. CflatAS~i
u ~ooo aooo uono Poi Cuthonf3ua
-Ympellar M~etiltl
Sn
ao
1'1'W'-'4rl Shull Soul Ni"c with aarl:on and
cesminlema Steel ~ ~aiala~ac,9coel _
Ito
21
Hearings U' stem and Lower
Ball Beerinp
c
0
n ~ 0 . 6U e9
rrow- QkLON3MIaUTr X,itt1E itir ut rump Co.
Puf~P pE~tFpRa+aNCl Cr1RVE _ Yci sn. 11e1U• Uhd&QWm LftO 18157
Pharr+rr +iUS 9w7.7813 •S4t~si i05 2>lf.i
~ BrxRNai aalNgarer'iN^~t1Nd~ot:~{om
Pam 44829b --v7ros
www.Littleofadtftmp.com
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Wisconsin Deparbnent of Commerce SOIL EVALUATION REPORT Page / of 3
Division of Safety and Buildings
in accordance with Comm 85. Wis. Adm. Code County
5T • G~ D/
H
~ A bu ,t
EROSION CONTROL PLAN must be Parcel I.D. 7-
percent /N
;troad. pL•v0~^~ rr- b
completed before sanitary permit issuance eviewed Date
Pemno knIbmution you provide may be used ror secondary purposes t--CY aw, s w.an (1) (mp. ~Q 1
PropertyOwner TODO Property Location
D!G p
'r'O 17Q ~3 E Tf~fl O Al'~G^' ~~e f Goy L Lot Al /rVq S ~G 114 S 7-L- T 16 N R I / E (or) W
Property Owner's Mailing Address Lot # Black # Sutxf. Name r CSM#
!4 015 CA Wi LL .,5/ IVALW O'r w I I >ci41e~'(
City --rM ER State Zip Code Phone Number O City ❑ Village W Town Nearest Road ~
6•00 HT5 MN 5S07(p &St) ayg• lof~ -rRoy so. 6-10068
r O D GPD
h
New Construction Use: (L~ Residential I Number of bedrooms Code derived design flow rate 10
❑ Replacement ❑ Public or commercial - Describe: %A
Parent material d OW-77? / f? ' Flood Plain elevation if applicable ft t
General corn marts w` e / [ - fh2 t0 J 'A ~
and recommendations: k-A
R
Si4~0
2, 2-
N
L ~tJ #0 st Pi Ground surface elev. • ft. Depth to limiting factor in. ~ Appkafion Rate
Horizmn Depth Dort Color Redox Description Texture Structure Consistence Boundary Roots GPDff
b
~
in. Mu nsefl tau. Sz. Cont. Color Gr. Sz. Sh. 'Etf#1 TO
o-4-1 icy z Z- zfs 6 w 3 7- . s
f -r-s Ce) /
3 -Z.6 yve *'60 SQL 2~shK s et - • 5
cr ti
4
# Borirv --7 2-
® Pit Ground surface elev. ft Depth to tirnitirrg facts' in. SON inn Rate
Horizon Depth Dominant Color Redgx Description Texture Structure Consistence Boundary Roots GPDlffr (~1
in. Munsell Qu. Sz. Cont color Gr. Sz. Sh. 'Eff#1 '01#2
L z`FShIC' GI~SG, 4-) 3 . -S • N
s N
Z- 2- -Fs PC Ald
/6 s/& zfshk ~ s
14
r G~' ,v
Ef luerd #1 = BCC > 30 < 220 ma L and TSS -30 < 150 mpt ' Effluent #2 = BOD 130 rrg& and TSS 130 mglL
CST '
Cst Name (Please Print) • "241-6 R i C1,T- Signature W2-
5
Address Uibricht & Assgciates S Data Eval ua~n Conducted 7t f • 77a, ONu y Z--
Privat d'~o
2812 10th Ave.
Spring Valley, WI 54767
PINS' . 4PPRO X . Z yo s
oyo.
• zD • o~
dyo • 10*6
oyo-/o8( ~D•~
• o~
o yo • /o *6 - 70
o yo - /o f'6 ee •
0 R I G N AIL
L : ,y
-ra.PV S lE e s revT- l
rty Parcel ID # Z 3
BOMV Pam
F3-1 t Ground surface efev / (O • / ~l#t- Depth to li "Wq factor kL
S oil Rate
llotfzon Depth n. D Mn se RedoxDesavion Texture shucttne Consistence Boundary Roots GPDAT
ltt. Munw Qu. Sz Cont. Color Gr. Sz. Sh. - 1 .E
Xsw
Z p VIIL' I,
L z s! Gc~ • s
210 Vk Sit- ifs 1,~ c~, S . S
k4 i(
1
F--j a
8orertg $oritxt
El pit Ground surface elev. R. E"th to limiting factor in.
Sod kohon Rate
Horizon Depth Dominant Redox Description Texture su re Consistence Boundary Roots GPD/ft2
in ik u sell Qu. Sz. Cont. Color ta't. sz Sty: `EtT# t -EffM
Boring Boring ,
lit Ground surface elev. f t. to l"ardting factor ks
Depth i)ort~rrant Sod Application Rate
RedoxLlescription- Texture Structure Cot>sisterrce Batrttiary Roots I
t in. Murseff Qu. Sz. Cont. Color Gd. Sz Sh. `Etf#1 `EN#2
I
I
t -
F-I I
Boring # Boring
Pit Grounds elev. ft. Depth to WOW factor ~ In.
Sod ftplication Rate
Hortzotl Depth Loot Rwt Color Redox Descripiim- Texture Strudute Consistence Boundary Roars GPM
In.- Munsell Ou- Sz Cont. Color Gr. Sz. Sh. `01#1 `Eff#2
° Effluent #1 = wo, > 3o < 22o wQ& mw TSS >30,c 150 w 4#L " Effluent #2 = BOD5 < 30 nlgll, and TSS < 30 mgtL
The Department of Commerce is an equal opportunity service provider and employer. Ifyou treed assistance to access services or
need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-9777.
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PLOT PLAN WALNUT HILLS FARM. LOT # / Pg. 3 of 3
Q = Contour elevation lines.
0 = Backhoe Soil pits.
O = Benchmarks set, maRKED WITH FLAGGED
lathes. 1/2" steel conduit pipes.
1001? SCALE : 1 -3 o F1
0 OT L-eT Low
q~.
b
VV
U~ 31
Z
o r
/DX70 50
q9
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fV yes 7 &22 ZKVI Fee.A-1
- s~yy~ r~ ~ovvv s ysT-
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i
1, 07 Ac: 10 i O PEN ACRES .115182 S.F.
- ~ K OUTLOT 5 2.s4 Ac.
\ N 88'08'09 E 449.20' -
' o s2 !yam s0 \
~O o5 189.15'
N 82'18'33" W ~S SSO~.~ \3,60 11 Zso_. 5 - - -
95.35' 20 e 37. \
\ 37 -N, o 1 2.5 50
HOUSE \ ` 47088 S.F.
z ~
36~
51
r---~-Q~~ 51437 S.F. 1.08 Ac.
, -BARN 1.18 Ac.
SHED SILO 1-
rA-, - h 12 21.69'
N
SH ED 35` I 13 - -14 _ 0142.53
QED' 17 I
r ~
524401 S. F.
12.04 Ac, ' I r 102.9
~ 142
41
3411 o l J ~
to I~
/ 33/
ES TACK LINE 57
CIO
50' DR GE EASEMENT & - . - . .
E 401.94' 59
AIN 12
'\..-..-N N 85'00'22" <v I 57312 S, F.
/ - - o; .(v~' / 1.32 Ac, .
1
1
18
9 S. F,
4581
32 i~~ L
o _ 1.05 Ac. O/ . N .60.53.
N 87'01'43" IN
`Sn. /1 o N 87'3,5 o6 W 71
a~' i .
POWTS OWNER'S MANUAL & MANAGEMENTPLAN Page of
FILE INFORMATION SYSTEM SPECIFICATIONS
Owner f Septic Tank Capacity gal 0 NA
_ 4
Permit # Septic Tank Manufacturer ❑ NA
1.1ESIGN PARAMETERS Effluent Filter Manufacturer El NA
Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA
Number of Public Facility Units -,4d NA Pump Tank Capacity j v al ❑ NA
Estimated flow (average) gal/day rump Tank Manufacturer NA
Design flow (peak), (Estimated x 1.5) J gal/day Pump Manufacturer NA
Soil Application Rate _ al/da /f12 Pump Model ❑ NA
Standard Influent/Effluent Quality Monthly average" Pretreatment Unit NA
Fats, Oil & Grease (FOG) 530 mg/L ❑ Bond/Gravel Filter ❑ Peat Filter
Biochemical Oxygen Demand (BODs) 5220 mg/L ~NA ❑ Mechanical Aeration ❑ Wetland
Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other:
Pretreated Effluent Quality Monthly average Dispersal Cell(a) ❑ NA
Biochemical Oxygen Demand (BODE) 530 mg/L ❑ In-Ground (gravity) ❑ In-Ground (pressurized)
Total Suspended Solids (TSS) 530 mg/L NA ❑ At-Grade >9~ound
Fecal Coliform (geometric mean) 5104 /1ooml ❑ Drip-Line ❑ Other:
Maximum Effluent Particle Size in dia. C3 NA Other. ❑ NA
Other: y ❑ NA Other: ❑ NA
'Values typical for domestic wastewater and septic tank effluent. Other. 0 NA
I
l AAINTENANCE SCHEDULE
Service Event Service Frequency
Inspect condition of tank(s) At least once every: mont ear is) s ( Maximum 3 years 13 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 every: ❑ e nthis) (Maximum 3 years) ❑ NA
Clean effluent filter At least once every: wear srs) ❑ NA
Inspect pump, pump controls & alarm At least once every: gmonthis) p NA
'gear(s)
❑ firionth(s)
❑ NA
Flush laterals and pressure test At least once every: or(s)
Other: ❑ monthis) ❑ NA
At least once every: 0 year(s)
Other: ❑ NA
FIAINTENANCE 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 Serviuing 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 an the ground si.irface. 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 accordencra 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 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 an!, service event.
Page or
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:
o 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 Septagia 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:
0 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. Replacement systems must comply with the rules in
effect at that time.
0 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
' ust 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 mmoval of the biomat at the infiltrative
s rface. 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. DMATH MAY RESULT. RESCUE OF A
PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE-
%DDITIONAL COMMENTS
POWTS INSTALLER POWTS MAINTAINER
Name
Name
Phone ;I/ j
r Phone ? - r J r
t;EPTAGE SERVICING OPERATOR PUMP R LOCAL REGULATORY AU'T'HORITY
Name Name
-57Z &I 1~1 :Z
Phone 71J Phone x5 o
"his document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2)& (3), Wisconsin Administrative Code.
• • 1"'ILTER CARTRIDGE INSTRUCTIONS
InstaNation
wrr'a" x pry at the filter case onto the and of the outlet pipe to ensure it is
centered under the taccears trpmning. If not, titan either Insert more pipe into the
tank through the outlet or solvent weld (glue) additional pips onto the outlet
pipe.
5'rw d Whlk the calm is still try fitted an the outlet pipe, measure the length
of +tfi-inch pipe needed to bracts the fitter to the tank tend wag if utillzing the
options( supplemental side support. If side support ntathod, is riot utuizeii.
proceed to stop fout:.
!)•rir..i" 1 For installoWns utoit og the optional supplemental side support=
solvent weld the "A-inch pipe onto the fitter case. If side support method is not
utilised, proceed to step four. +a':.
.Solvent Wald the filter cants onto the outlet pipe. hisert the filter "u1;£•' {t
cartridge into the rase, pressing down until the filter locks Into the bottom of
the case.
If a As switch is uIALed- Insert into the filter and lack by turning ery,i~+~ `r •a
clockwise 9Qo, w r: w. n.
Maintenance
1. The effluent filter should be cleaned every time the septic tank is
serviced.
ii
2. open the outlet access opsrdng to inspect the tank and (soar,
9. pump the septic tank cornplotely, making sure to remove the sludge
layer on the bottom of the tasnk and not just the scum and effluent.
4. Once the effluent level has boart lowered below the invert of the
outlet pipe, firmly PUB up or" the filtar handles to dislodge the
cart'ridoo from the case. d
s. soda the cartridge up and'atit of the case for doming.
6, it a VA.S switch t "Aactod to art alarm is present, the switch i +
should be removed by turning countardockwiss 900 and tdesned
with water only.
7. While holding the cartridge ari its ride (large liat surface facing #1
down) over the aGMS uperllrlll, rinse off the cartridge with water
only, making sure ail septaga, material is rinsed back Into the tank.
a. If V .S switch is trtiored, replace by inserting into filter and
turning clockwise 90°. h!• ,
9. Insert the filter cartridge back into the care, pressing down until +i' ,
the filter locks into the hottrrstr of the case.
10.Replace and secure the accepts opening on the tank.
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w WW.beeMnsite sow 877MMLIPMTTERS (653-4583)
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ST. CROIX COUNTY
SEPTIC TANK MAINTENANCE AGREEMENT
AND
OWNERSHIP CERTIFICATION FORM
Owner/Buyer L) l-)
,~J-
Mailing Address// 33 eel-n a / _ PT AA-t2
~l-~
Property Address _~UG~ l%1 Gt s'I V V ►-C
(Verification required front Planning & Zoning Department for new corktruction.)
City/State le Ir ~ `_}f V V . Parcel Identi ication Number. ~ (,-130 3 - Olt ~ 405
LEGAL DESCRIPTION
Property Location s ~a 1/4 S~ '/a , Sec. 4-0 N R__~~ W, Town of _
Subdivision 14~& zd~4 Z~ / c`t r` n Lot # .J/_.
CetrfifYed Survey Map # Volume Page #
Warranty Deed # I ~r q~ZO / 2 , Volume , ,Page it
Spec house no ye o lot lines identifiab yes no
~S7rSTEM MAINTENANCE AND OWNER CERTIFICATION
Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper
i naintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into
1 he 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 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 1/3 full of sludge.
Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the
tandards 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 be completed and returned to the St. Croix County Planning &
ironing Department within 30 clays 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.
Kumber of bedrooms-
ICNAT 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
7eterence is made in the warranty deed.
(REV. 08/05)
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$ Tx:4084950 7
STATE BAR OF WISCONSIN FORM 3 - 2000 967848
QUIT CLAIM DEED BETH PABST
Document Number REGISTER OF DEED
THIS DEED, made between Citizens State Bank, Grantor, ST. CROIX CO., WI
and Oc% ring 1-tomes LLC, Grantee. 11/ 19/ 2012 4:21 P
Grantor quit claims to Grantee the follo%ving described real estate EXEMPT#: N/A
in St. Croix County, State of Wisconsin (the "Property"): REC FEE: 30.00
TRANS FEE: 62.70
Lot 51 of Walnut Hill Farm, All in the Town of Troy, St. Croix County, PAGES: 1
Wisconsin.
Recording Area
Lot is sold "as is" with all faults. Name and Return Address:
7 e. N-,g-
Together with all appurtenant rights, tide and interests. (40-130-3-00-051
Parcel Identification Number (PIN)
This is not homestead property.
Dated this 91h day of November, 201.2.
Citizens 'tale Bank
* We 1-laberman, Vice Chairman
*
AUTHENTICATION ACKNOWLEDGMENT
STATE OF WISCONSIN )
Signature(s) Sf.CROIR COUNTY. ) ss.
authenticated this 91h day of November, 2012 Personally came before me this 9th day of November,
2012 the above named Citizens State Bank by Gene
Habcrnum, Vice Chairman to me known to be the person(s)
* who executed the foregoing instrument and acknowledged
TITLE: MEMBER STATE BAR OF WISCONSIN the same.
(If not,
authorized by § 706.06, Wis. Stats.)
THIS INSTRUMENT WAS DRAFTED BY *Ja P entie
I Notary Pub ' to of Wisconsin
~Qe opt r My commission is permanent. (If not, state expiration date:
4~ C(a fr t?_ t~ i- 8/7/2016 )
(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
EJAY P. PENFIELD
otary Public
e of W isconsin
1 of 1 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3-2000
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Parcel 040-1303-00-051 P
PAGE E 1 7 OF 1
Alt. Parcel M 22.28.19.1786 040 - TOWN OF TROY
Current ❑X ST. CROIX COUNTY, WISCONSIN
Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units
00 0
Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner
0 - CITIZENS STATE BANK
CITIZENS STATE BANK
375 STAGELINE RD PO BOX 247
HUDSON WI 54016
Districts: SC = School SP = Special Property Address(es): Primary
Type Dist # Description ' 277 WALNUT HILL WAY
SC 4893 SCH DIST RIVER FALLS
SP 0100 CHIP VALLEY VOTECH
Legal Description: Acres: 1.180 Plat: 09-092-WALNUT HILL FARM 1/75 040-03
SEC 22 T28N R19W PT NW SE WALNUT HILL Block/Condo Bldg: LOT 051
FARM LOT 51 (1.180AC)
Tract(s): (Sec-Twn-Rng 401/4 1601/4)
22-28N-19W NW SE
Notes: Parcel History:
Date D Vol/Page Type
03/05/2010 91 SD
21266 WD
12/10/2003 748768 2471/594 WD
11/19/2003 747018 9/92 PLAT
2012 SUMMARY Bill Fair Market Value: Assessed with:
0
Valuations: Last Changed: 08/20/2012
Description Class Acres Land Improve Total State Reason
RESIDENTIAL G1 1.180 40,000 0 40,000 NO 10
Totals for 2012:
General Property 1.180 40,000 0 40,000
Woodland 0.000 0 0
Totals for 2011:
General Property 1.180 52,000 0 52,000
Woodland 0.000 0 0
Lottery Credit: Claim Count: 0 Certification Date: Batch M
Specials:
User Special Code Category Amount
Special Assessments Special Charges Delinquent Charges
Total 0.00 0.00 0.00