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HomeMy WebLinkAbout018-2009-47-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 556397 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 Hammond, Town of 018-2009-47-000 CST BM Elev: Insp. BM Elev: BM Description: QQ Section/Town/Range/Map No: D 64,67 04.29.17.1031 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchm I GST 3.6 1615, /Gla. y~ Dosing_ r Alt. BM LA) 0 L21 I 'li'll o~qvss -1 Aeration BI Holding St/Ht Inlet U Z 9'7~ g TANK SETBACK INFORMATIONS t J 1; St/Ht Outlet TANK TO / L L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic \ Dt Bottom ti ` l V , M1 2 ,`f 4- Dosing `l~3 . 72 / / \ loo,~° Header/Man. 35 Aeration t r x- _C Dist. Pipe Holding Bot. System Z•~ i PUMP/ IPHON INFORMATION Final Grade d• cturer &ftk Demand St Cover it D ate/ ~.fGPM 26; /6Z. s Z! Model Number A46 Tv - v~ TDH Lift Frictio nLoss System H7ad9 TDH I L It '-7 717~ I~ Forcemain Length IDia. / / Dist. to Well mv 3 • /D .4 SOIL ABSORPTION SYSTEM BED/TRENCH Width ' Length No. Of rench s PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 19 S-7 rRie-d - BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR SETBACK SYSTEM TO ft^_ Type Of S stem: UNIT Model Number roca DISTRIBUTION SYSTEM Header/Mani old Distribution Ix Hole Size x Hole Spacing VenAir In ake Pipe(s) 7 Length Dia Length S4 Dia 2 Spacing T Z SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of xx Seeded/Sodded xx Mulched Bed/Trench Center -16, / 7 Bed/Trench Edges ` Topsoil ( Yes No ~~es No I rri 17 COMMENTS: (Include code discrepencies, persons present, etc.) nspection #1: / 77 t m Inspection #2 / - / 3 X :--S rx " ( 60 P/a Ok Location: 1787 117th Ave Hammond, WI 54015 (SE 1/4 NE 1/4 4 T29N R i si a eig s of 41 Parcel No: 04.29.17.1031 1.) Alt BM Description= 2.) Bldg sewer length = 50 3 0 /70 3?, , 0 of - amount of cover = ty r r 44 I 4 , 4r. 20 Plan revision Required? ❑ Yes No s 13 ~~s35 Use other side for additional information. Date Insepcto _pat Cert. No. SBD-6710 (R.3/97) PLOT PLAN PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 NE 1/4S 4 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 101.1 ' 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 4,56 # of chambers none 66 BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 1001 ❑ BOREHOLE O WELL *H.R.P. same as benchmark Y y1,.~ ~e acre lot Scale = 1/4' = l y' S~~ y ~ Pro , 3 , ' Bedroom a Town Road A Tank is to be bedded ith lockdown covers wit approved warning labels el I is to meet al I DNR setbacks Huffcutt Combo Ta Uri 1 00.5, \b.,._.._ B 1 08.1 ' adi ng is to be done 99.5' to ivert run-off awa from system 256' Property Line B- Area 15' below system is 6% Slope to remain undisturbed 394' Property Line B.M. /G convnerce''JOV Satatytupd Buildings Division Coun co n s i n 2(11 W. Washington Ave., P.O. Box 7162 Madison. UVl 53707-7I6.7 s.,oLu~r ~'vrm~ uinbns (lo w, -,-ain by c,o rn at Catmttrm~emarna 5 5 ~0 3 c'-1 Sanitary Permit Application State setiumber In accordance with s. Comm. 83.21(2). Wis. Adm. Code, submission of this forth to tie u ental unit is required prim to obtaining a sanitary permit. Note: Application forms fo POWTS are Project Address (if ditlerent Ih 11111 mailing address) submitted to the Department of Commerce. Personal information you provide mdy"be used for ndary u oses in accordance with the Privacy Law, s, 15.04(1 m} Stats. (-79r7 t / I. Application Information - Please Print Ali Informatio* Property Owner's Name t parcel # Property Owner's Mailing Addle Properly Location City, State Govt. Lot ~ Zip Code hone Number Ya, 1,15 Y, Section s - ircie ofleh A.o.r Type of Building (chock all that apply) Lot # 1' N, lt~ 2 Family Dwelling - Number of Bedrooms y Subdivision Name < W/~~~ El Public/Commercial -Describe Use t2 Block ~I'a _ y~ C_ City of ❑ State Owned - Describe Use CSM Number IJ Village of i S >C-57 Ali gown of _ III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Lxisting System (explain) B. D Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date issued Before Expiration Owner IV. Type of POWTS Systern/ComponeaVDevice: Check all that apply) p ❑ Non-Pressurized In-Ground ❑ Pressurized la-Ground ❑ At-Grade and ? 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) Pretreatment Device (explain:) / G IZ V. Dispersal/Treatment Area Information: ` Design Flow (gpd) Design Soil Application e(g d t) Dispersal Area Rtlqui st) Dispersal Area Propo (st system Ele ' A 17 VL Tank info Capacity in Total # of Manufacturer 8 a Gallons Gallons Units c New Tanks EKdrting Tanks E? u u L./ ,V ~ ~ cg H h ~ w C7 a Septic or Bolding Tank I Dosing Cbnmbw 9 C) WIL Responsibi ity Statement- I, the undersigned, assu possibility for installation of the POWTS shown on the attached plans. 'lumber's N (Print) Plurnber' store MP/MFRS Number Business Phone Number J_ lumber's Address (Street, City, State, Zip Code) 17 11 C An I nt /Department Use Only pProvad Permit Fee Date ued Issuing t Signature asontbrDeni 1pZ~'~ ~L X. Contli p S R11Reasons for Disapproval 3> 0 J~ / ect 1. Septic lank, effluent filter and D 4"" ~ dispersal cell must all be services / maintall►ed w .5 cd tl_ j as per management plan provided by plumber, 2 An setback requirements must be.maintairidd A~J.1 r 11 per llpphcebIs icdde / orditta lOft, -7) CD rGtiS Attach to complete plane for the system aad submit to the County only on paper nut leas than s to Y t t ucb to are, P ',I BD-6398 (R_ 02/09) g~o~e~nxn~ o~ Safety and Buildings T 141 NW BARSTOW ST FL 4TH o<' s WAUKESHA WI 53188-3789 Contact Through Relay . www.dsps.wi.gov/sb/ y o` www.wisconsin.gov OssroNa~~~ Scott Walker, Governor Dave Ross, Secretary November 26, 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 NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 11/26/2014 Transaction ID No. 2178055 SITE: Site ID No. 786265 Oevering Homes Please refer to both identification numbers, Hillside Heights Lot 47 above. in all correspondence with the Town of Hammond agency. St Croix County SE1/4, NE1/4, S4, T29N, R17W Lot: 47, Subdivision: Hillside Heights FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1402911 Maintenance required; 450 GPD Flow rate; 26 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative 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 pla a*tvnth the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-1069. 109 and the Pressure Distribution Component Manual for Private Onsite Wastewater Treatme stetfi N 2.0.. SBD-10706-P (N.01/01). ~ W, U IS k6d The building sewer and distribution network piping shall be of material lis, 384.30-3 and 384.30-5, Wis. Adm. Code. cO,QX* In the event this soil absorption system or any of its component parts malfunctions so as to create a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must comply with the operation, maintenance and monitoring duties as described in section VIII 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 1112612012 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 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osbome Please Include a Copy With Your POWTS Reviewer 2, Integrated Services Payment Submittal. (262) 397-6005, Fax: (608) 283-7481 WiSMART code: 7633 julia. lewis@wisconsin. gov Nate: 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 Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 11 / 22/12 Owner:Oevering Homes Location:SE1/4 NE1/4 S4 T29 N,R17 W Lot 47Hillside Heights Hammond 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 Specifications an c oss section l~ Shaun Bird Signature License nu 226900 O~1 v'%r Y~~ , es c;F PLOT PLAN PROJECT Oeverina Homes LLC ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 NE 1/4S 4 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 101.1' 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. Top of 3/4" pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL * H. R. P. same as benchmark L acre lot Scale = 1/4" = 10' Pro 3 Bedroom House Town Road Tank is to be bedded with lockdown covers with approved warning labels Well is to meet all QNR setbacks Huffcutt Combo Tank 100.5' B-2 100.1' Grading is to be done 99.5' to divert run-off away from system 255' Property Line B-3 Area 15' below system is B-1 6% Slope to remain undisturbed 394' Property Line B.M. Mound System Cross Section and Plan View w" NII 'TT r^r n}n !n~ Rn rf !1~ l+M ~t7117 TII~ tplR~ if7rn +nel ~ w, rtT .tin a~ ~ ~e r+n ~ wp w+ ,+lw 1e+ M. Dimension Feet J A ~a B _ t D i I - A I E, F 04 at VY" r $ ~ I G t 'ZI H d i7 :1. I I 'r 4 a J I G EEK r; 7 4-, o-:...~..------------ - W L Slope 61.0 °7 = Topsoil = ASTM C-33 = Clean aggregate = 4 in. sch. 40 pvc Cap Material L-A sand fill '/2 to 2 '/2 in. dia. 0 observation pipe Geotextile ` Fabric H F f E /od Ft Contour flowed Surface Y• Y Slope Direction 1 GENERAL INSTALLA'T'ION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mciund 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'/4 inch soil wire when a sample is rolled between the palms of the harms. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine ke)6i 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, 10/07lgj Page of Pressure Lateral Layout Two Laterals End Manifold 4 Threaded Cleanout Lateral Turn-up Plug Manifold M X t' L Long Force Main Sweep 90 Bend Distribution Network S eeifications Pressure System Construction Lateral Diameter In. Manifold Diameter In, Laterals are constructed of Schedule 40 PVC Orifice Diameter In. pipe. Orifices are drilled perpendicular to X orifice S 1g) ~2 In. the pipe with a sharp drill bit and face down. L (Lateral Length) Ft. Lateral turn-ups terminate with a threaded M Manifold Length) Ft. cleanout plug and are enclosed in a 6-8 inch Force Main Diameter ~ In. diameter lawn sprinkler valve box accessible Force Main Len Ft. from finished grade. TIC Grade 6-8 Inch Lawn Sprinkler Valve Box Page _ of 03/05 lgj Septic-Dose rank. Cross Section And Pump Performance Specifications 4- Tank ibla_nufactu Pump Manufacturer Tank Model Number Q 6 Pump Model Number _ Total Tank Ca cit 3 Alarm Manufacturer UC Max. Bury _..`T. .~--Z; Almm Model Number G_ Switch Type Filter Manufacturer ~ A2-- -w Total Dynamic Read (TDR) Feet-- Filter Model 'N'umber_ - - Elevation Dead Wtal Pressure --31r U - Network Lass 0 - Minimum Pump rtormarwe Required F arcs Main Mass . _ GfPM r~TDH " vital OutW 1.1+fanholo "rr. 4" Above Grade With Looking E*~ is v. law manhole Manhole Min, .Above Grade < 6" Below (h*de Sealed Watertiuht Scourely Mounted With Looking Device Weather--proof i ieherl Grade Function Boy. Fii wr frr fffr fwr fff. WO T Vent Min. 12" Above Grade Disconnect With 'd'ent Cap Iuleat~s •5 if• ' ••~••+"a"i"t"./.!."i".!.". off} . . ! . 1 ! . s t / 1 . . ! 1 r ! } / } f Y . 4 1! Y! i!" f! f l I f ,~f, 1,1 a r{ V a, r r V a/ a r. l. r. r r,. f,l • • i 1.1 1"1 I.1 Outlet, Filter inlet .ra._ Inlet Beffte ,•.al a~~.• it 1. --t- Switch%ft ~ sand Reserve Capacity A . , Tank Volume = GPI r,.;. _ f ! Weep ,.alr Dimension; Inches Volume Gal. " rps-per{/e r3 Hots Ai 466 r'ra al B 2 ~J If IV/ Y '"1 y O E vatian (dose) C C fya~r y t..J tr ~ let ra (dead) D 7 !a. 5'-" Bottom f f Total D Elevation , }1} a r a } a~',". r a•.•a"IY.~a'r••"r1t"t!~'tyVr.•t"t"."."i t"+'• :~.fl.ts! f~f}a}ref . al}irl frrY~+"i f{sS~. ~.•.t.'r'r' a.•.'1r1•lar•r•.a!'.al'.r,••all ,I,.,,, r,',rr'.,.'~ `-0 l' L 1+Ia1.re;r.,r.r.,,+,r.,.,fa lFa/t t41f/f1fV It tl•faI }r li lt, GENERAL INSTAI•I.•ATYON: The septicldow tank is bedded and back filled in , manufuturer's product approval NPOO f'iadiot28. Muimum depth of ' Of4ctaetwrer with the be exceeded without pi'iot dtoprovat. Manhole covers er~c boy as speeiifed by the msnu may not installed. P049 st dw inlet and amt is of approved material, connectedvto tthhe~with looking watertightcBt cgs, a kd laid on stable soil to Prevent swiing or sagging, The form main is sleeved with 4" Sch. 40 PVC to bridge the tank excavation and " sleeve is sealed watertight. Eleotrioal service complies with NEC 300 and Comm 16.28. 02/05 U Page _ of y V LaserJet 3100; 1 71b obw uoG/ ; Art14y»a-~a a.vk~rio, MeM 9 EH BERMS SUMP/EFFLUENT PUMP 11,8$ 8.85 ! • Q c a • SiesaRion~ NNtll 411 Una r am 114>f fAL 111N1 4L ft tI18i. NWO ArNAlIA14 4 1I W V W " 9tl ow (NA1110 09M 6048 RW 0110 115 314 In 100e 70 G4 15 At 82 13.9 W 24 #.11 013400 9WI4W BM340 ULCM 01.0 240 814 O.A 1002 70 W 55 41 82 13.9 V 21 8.11 x 11.BA x OM 214060 SUM OI= 4090 1155 814 tae 1009 70 94 66 41 V 13.8 80' 97 901 x11,64 1L14 0a4buai Duly R1Nd-"LION GHrt1W ~xsla.toapumpc aarorabdcorAinwusdut~eanbn0xu11heYann.►w1Nb~r46np0fa0NlseDwnw' FLQW- LITCR$ZMt1Uk cmet-~at1©n o 000 8006 ion Motor ,Housin B 01~k+ Co41t4sd C`.aast Irna Impclier Matarixl Poly Curbotlate 30 I0 lta ll~r' Closed Vane Volute ABS 7.s P r Cord _ SJTW-A MQch=imll shaft Saul Nitrite with carbon and ' a ceramic faces ~ Faai~rtex~c~ Stainkas Steel s.g Shaft Bminp Upper Sleeve and I.awer 0 0 PAMI HCAH4s C LID 0 60 e0 FLOW- GALLONS/MINUTE PUNP EFCJRMANCE CIJRVC e18v s404Z uttu Giant ftnmp C06 PC) 00, 13916 0 Uldd omn 01% OX 13157 PNoann {08dr17~7a11.1'1u1i 44!.338.1830 www.LfttleolantPht6mp..com P.m iN: c..wwar,ux~ urp.oeJgatw Fam 946036 - owm .J POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of FILE INFORMATION SYSTEM SPECIFICATIONS Owner t Septic Tank Capacity 11 NA Permit # al Septic Tank Manufacturer a NA 0ESK3N PARAMETERS Effluent Filter Manufacturer DNA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA Number of Public Facility Units ANA 'Pump Tank Capacity o NA 6 " o al Estimated flow (average) i/da Pump Tank Manufacturer NA Design flow (peak), (Esflmatad x 1.5) j -'lam gal/day Pump Manufacturer r NA Soil Application Rate --=1=- al/da /ft2 Pump Mode! El NA Standard influent/Effluent Quality Monthly average" Pretreatment Unit Fats, Oil $ Grease (FOG) 530 mg/L fD Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (60Ds) 5220 mglL D NA D Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection O Other: Pretreated Effluent Quality Monthly average Dispersal Gell(a) Biochemical Oxygen Demand (BODs) sap rng/L, ❑ NA -Ground (gravity) ❑ In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L "(NA ❑ At-Grade Vound Fecal Coliform (geometric mean) :5104 cfu/100m1 ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size 36 in dia. El NA Other. Other: NA 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: moat ts) tear sl (Maximu73, year s) ❑ NA Pump out contents of tank(s) When combined sludge and scum equals one-third (X) of tank vol❑ NA Inspect dispersal cell(s) At least once every: inth+'s) e (Maximum 9 years) O NA ar s' Clean effluent filter At least once every: Barters) El NA Inspect pump, pump controls & alarm monthfs At least once every: 'b ear s`) DNA Flush laterals and pressure test At least once every: ❑ ear h(s) ❑ NA Other; jit At least once every: O monthls) otne~: ❑ year(s) O NA MAINTENANCE INSTRUCTIONS O NA Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or certifications: Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage Servic:ln Master 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 an back er g Operator, Tank inspections must visually inspected to check the effluent levels In the observation pips and to check for any dslirface. ing of The dispersal cell(s) shall be The ponding of effluent on the ground surface may indicate a failing condition and y effluent on the ground surface. regulatory authority. requires s the of the immediate notification of the local When the combined accumulation of sludge and scum in any tank equals one-third or more of the tank volume, the entire contents of ehe 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 512 months, shall be Performed by a certified POWT.S Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of anw service event. I START UP AND OPERATION Page__-_-_ of 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 shalt 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 Ooerator prior to restorin the effluent pump or contact a Plumber or POWTS Maintainer to assist In manually operating the pump controls to restore npormal tf-gels 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 scrape; medications; oil; painting products; pesticides; sanitary napkins; tampons; and water softener brine. ABANDONMENT When the POWTS falls and/or is permanently and safely a a d ned in compliance with chapters Comm 8333, service Wisconsin Adminiisetrrative shall Codetakpn to insure that the system is properly • 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 Septagrr Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with troll, 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 sysWrn- 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 tines 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. 13 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. z site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil': and site evaluation t 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 blomat 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/Olk INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DH;ATH 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 7 L a r±~' 2' Name Phone 02-r_2 514- V j Phone -a J•- SEPTAGE SERVICING OPERATOR PUMPER) LOCAL REC3ULATORY 'r' AU Name HORIT Name _ cc` Phone Phone - _ 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. b installation 'Ta'px try (lt the alter rase onto rh ~gY1■1 1 se+kered under the zaeoess a end of if.. outlet q9 tank thro Weening. It not pshe to ensur plPe• e it is ugh the outlet or solvent weld + then either insert more pipe i~ the (yiue) addltianal pips onto the outlet f % While the cane is st8l d S sii.inch pros needed b dry fitted or, they outlet pipe, measure the length optional sUPplamentei side race the fliltat to the tarok end waEl if utNizing the proceed to step four, , if side support uutthod. is not utilized, fir' S For installations utilizing the optional supplemental side suort: utilized step solvent proceed to step f~ onto the After rq If side wpport erra~hod is mat Solvent Weld the filter case onto the Outlet i e. Insert cartridge into the case the case. Pressing dawn until the litter locks the bottom 1f d V's switch is clockwise 90°, utilized: insert into the filter :~x4 and lock by turning Maintenance 1. 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, ( 9. Pump the septic tank completely, making sure to remove the sludge ^ f layer on the bottarn of the tank and not just the scum and effluent. 4. Once the effluent level has bean lowered below the invert of the ipe, outlet Pull ertridge frortrrthe case.p on the filter handles to dislodge the 5. Slide the cartridge up and out of the case for cleaning, r 'e 6, If a VI25 s stdtch connected to an alarm is present, the switch should be removed by turning counterclockwise 809 and deanad with water only. a 7. While holding the cartridge on its side (large flat surface facing down) over the access opening, rinse Off the cartridge with water rye. only, making sure ail seAtage +a t material 1s rinsed back into the tank. d ' nr ` 8. If VRS switch is utilized, replace by inserting into filter and turning clockwise 90°. 9. Insert the filter cartridge back into the ca the filter locks into the ba• pressing down until tta it m of the case. ~+^t . 10. Replace and secure the access npsnrng Gh the tank. k. "•y: ..:L-'..:ityr;•,•,:.iS ,.hYl :,4M1 !C]1'H.r! -1,'¢:. •'l f,:( • Www.bear"Site.ca10 877-MLPILTERS (653-4583) I I ~~II ~ I II DOCUMENT No. STATE BAR OF WISCONSIN FORM 1-2003 WARRANTY DEED 8 1 1 1 3 7 2 Tx:4088416 968786 THIS DEED, made between Exemplar Inc., a Minnsota corporation BETH PABST ("Grantor" whether one or more) conveys and warrants to Oevering Homes, LLC, REGISTER OF DEEDS a limited liability company ("Grantee", whether one or more), e o owmg-"' ST. CROIX CO., WI described real estate in ST CROIX County, State of Wisconsin: 12/04/2012 4:10 PM Lot 47, Plat of Hillside Heights in the Town of Hammond, St. Croix County, EXEMPT*: N/A Wisconsin. REC FEE: 30.00 TRANS FEE: 51.00 PAGES: 1 RETURN TO St Croix County Abstract & Title Co. Inc. 219 S. Knowles Avenue New Richmond, WI 54017 Tax Pa=cl No: 01 B-2009-47-000 This is not homestead property - Exception to warranties: Municipal, and zoning ordinances and agreements entered under them, recorded easements for the distribution of utility and municipal services, recorded building and use restrictions and covenants, and further except 2012 real estate taxes. Dated this 2 9 th day of November, 2012. Exemplar Inc., a Minnsota corporation By: Theodore W. Holsten, member y: Linda L. Holsten, member AUTHENTICATION ACKNOWLEDGMENT }y, ej Signatures authenticated this 1 cl day of (Vv ✓ e - 6 z/ , STATE OF 20 ss. COUNTY OF 2 n ~e 1!h TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me this th day ol'November, 2012, the (If not, above named Exemplar Inc., a Minnsota corporation by authorized by § 706.06; Wis. Stats.) Theodore W. Holsten'and Linda L. Holsten, members to me known to be the. person(s) who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY Robert L. Loberg / Loberg Law Office ' Notary Public pp~r County,wis- n~tv 1212748 / asc ( jA My Commission is permanent. (Signatures may be authenticated or acknowledged. Both are If not, state expiration date: not necessary) 1 1 3 ~ I J. r, 1 S p Names of persons signing in any capacity should be typed or printed below d~ signatures. gRADLG ti J. LINDER TNOTARY FUBIJC "MINNESOTA OfIANTY DEED try Commission Expires Jan. 31, 20116 No. 1.2003 ~u:~ LOCATED IN PART OF THE NORTHEAST 1/4 OF AND THE SOUTHEAST THE 1/4 OF SOU IHTHEtAJ SO THE NORTHEAST 1 /4 OF THE SOUTHEAST 1/4, TOWNSHIP 29 NORTH, RANGE 17 WEST, TOWN OF HAMMOND, ST. CROIX COUNTY, WIS( SEE SHEET 3 :a i ` 65409 S.f - ` \ \S)~ 43 \ 42 1.50 Ac. 44 \ 67792 S.F. N` 11 ►~1 001 00 I 79894 S.F. \ 1.56 Ac. 41 }1 0(30 Lo u 1.83 Ac. 11 n C34 v ``-N 7g27'54" ~ r C37 _C38 71.74'11 , l I - - W 432.28' ~Nry 40,35 -C367 M ' 1 } 74.1847" W - 45 iv Loo 69494 S.F. / 75.741 ~v rn ~I 1.60 Ac. .1 ! r N poi / / ! N'N ro 4il 79000 S.F. 1.81 Ac. II 1 46 82'5026" W -394-49' 101306 S.F. 2.33 Ac. Lli HWE = 1092.0' . tK ~`1/ 48 ( ' I cO LBO = 1094.0' tK tij /r \ 101489 S.F. 1 'IU 00 2.33 Ac. I 1 }I I 00 X10 LBO = 1094.0' , 1 { 1 1 HWE CC1 ~ 9.0 4 34 251 Wig. 3 I I } S LL- ' I I } -0 0 D 1 Hwe = 1092.0' V 4 I C~} CV N 'I b~ 367 11 _ ` + Leo = 1as4.a' i to 4 r~ I 0 Lij W HWE = 1092.0' oeP~ , ' {,1 1 } , O W LBO = 1094.0 4 \ } 50 i~ 49 ` 1 al N \ 137226 S.F. 91007 S.F. 0 0 I \ SOS 3.15 Ac. , 2.09 Ac. 510, IS I HWE = 1092.0'\ ~O, tS LBO = 1094.0' \>>2 l'1 c3~ 0`\ ST. CROIX CO UN rY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer c Mailing Address 141 Property Address ~ ~ U - ('Verification required fro] rt Planning & Zoning Department tar new construction.) City/State Parcel. Identification N'u ber 6 L??J~ - ' - CrtrQ LEGAL DESCRIPTION _ t. Property Location %1, Sec. , C' j N It OW,Town0f C~ f Subdivision Lot # Certified Survey Map # _ _ - Volume page # Warranty Deed # Volume - - :Purge # _ Spec hous yes ko 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 function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comrn. 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 veritying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) alter inspection and pumping (if necessary), the septic tank is less than 1/3 bull 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 be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. 11we certify that all statements o this form are true to the best of n y/our knowledge. 1/we am/are the owner(s) of the property described above, by virtue of 'a arranty deed recorded in Register of Deeds Office. Number of bedrooms -2..- APPLICANT(S) D.ATE IGNATC OF ***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 tite certified survey map if reference is made in the warranty deed. (.REV. 08/05) 1 ! r 39 ■ i~ fir ~ f © IN a C M I I -r Ulu a • Z 7--/7Q spa s+ca u r ~-r NI 1507 • Wisconsin Departm t of Commerce ' SOIL EVALUATION REPORT Page 1 of 3 Division of Safety a Buil(fi s in accordAnce with Comm 85, Wis. Adm. Code Steel's Soil Service, Inc. Attach com late s County p if8`ptan caqWerVwfte9s than 8'/: x 1 inches in size. Plan must St. Croix indude, but not limited to: vertical an fe nce point (BM), direction and percent slope, scale or dimemsions, north arrow, and-location and distance to nearest road. Parcel I.D. C~ - -7 Please print all information. Reviewed By _ Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). /C b Property Owner Property Location Cutting Edge Four, LLC Govt. Lot N/A SE 1/4 NE 1/4 S 4 T 29 N R 17 W Property Owner's Mailing Address Lot # Block # Subd. Name or CSM# E976 170 TH Street 47 N/A Hillside Heights City State Zip Code Phone Number J City J Village e Town Nearest Road Hammond WI 54015 715-796-2793 Hammond Cty Rd T New Construction Use: 16 Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD J Replacement _ I Public or commercial - Describe:N/A Parent material Ground and end moraines, pitted glaical drift Flood plain elevation, if applicable N/A General comments and recommendations: Mound design, system elevation 101.04ft based on contour line elevation 100.20ft. Boring # J Boring 01 Pit Ground Surface elev. 100.40 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 1 0-12 10yr 3/1 none sit 2msbk mfr cs 1f .6 .8 2 12- 10yr 4/4 none sic[ 2msbk mfr cs n/a .4 .6 3 26-50 7.5 yr 4/4 c2d 7.5yr5/6 slAs om mfr na n/a .2 .6 Boring # I Boring tI Pit Ground Surface elev. 100.40 ft. Depth to limiting factor 3k in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-16 10yr 3/1 none sit 2msbk mfr cs 1f .6 .8 2 16-36 10yr_4/4 none sicl 2msbk mfr cs n/a .4 .6 36-50 7.5 yr 4/4 c2d 7.5yr5/6 sl/sicl om mfr n/a n/a .0 .0 * Effluent #1 = BOD? 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) ~ f ignatur : CST Number David J. Steel 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St., Baldwin, WI 54002 9/7/2004 715-684-5680 Property Owner Cutting Edge Four, LLC Parcel ID # Pending Page 2 of 3 F3 ]Boring # Boring V1 Pit Ground Surface elev. 99.20 ft. Depth to limiting factor _ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots PD in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-15 10yr 3/1 none sil 2msbk mfr CS 1f .6 .8 2 15-36 10yr 4/4 none sicl 2msbk mfr CS n/a .4 .6 3 36-60 7.5 yr 4/4 c2d 7.5yr5/6 sid/Is om mfr n/a n/a .0 .0 F-1 Boring # -I Boring _j Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots P in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 a Boring # J Boring J Pit Ground Surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 * Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 <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. 1 Page 3 of 3 STEEL'S SOIL SERVICE INC. David J. Steel 994 200'x` St. CST-POWTSM Cutting Edge Four, LLC Baldwin, WI 54002 Lie. #248956 SE1/4,NE1/4,S4,T29N,R17W Bus.(715) 684-5680 Town of Hammond, St. Croix Co. Fax.(715) 684-3449 Hillside Heights, Lot 47 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. Legend 1"=40' ♦ =Benchmark Ele. 100.OOFt Top of 3/4" pvc pipe • = Alt Benchmark Ele. 100.2017t Top of 3/4" pvc pipe ❑ = Borings Boring Elevations B 1 = 100.40Ft B2 = 100.40Ft B3 = 99.20Ft B4 = OO.OOFt l~ 9( AW14 5-/ 69-494 S.F. 63. / ,p3 _ 1.60 R'c:-----'' N.B. 6T494- S.F.- -Il:H. 1.60 Ac. / 44/1 h oe - J 'Stx / \ J 982 S, 1.81 Ac. 78951 S.F. N.B. 1.81 Ac. W---.___ \ 1013 S.F. '39 • X2.33 Acoo 61~ , / dd, of dl - H \ N.B. b2343 S.F.,-, _ . M N.B. 2.12 Ac. 101f89 S. F. - - X2!33 Ac. N.B. 61975 S.F. / N.B. 1:42 Ac. LBO = 1094.0' ZZ/ H a It rl~ = 1094:0' i I r 49 , 91007 9.F. 2.09 4c. , 1 / W - N.B.- 81603\S.F. \ / W N.B. 1.87 Ali. W_ I \ ' I ~ '1 X7226 SWE.- 0235 F, / 3.15 Ac. \ •~Z % N.B. 076* N.B. 43 7 S.F. 1- ro16 1~ Cry 2.07 - A.B. 1.58 Ac. _ -N,B. 1. ` T LBO 1094 ~ VG C ER -fNT ~ , 72 :A>S-T~_E~ T ,.1 KTE x x t 55