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HomeMy WebLinkAbout020-1481-02-000 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: (ATTACH TO PERMIT) 561007 0 GENERAL INFORMATION 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 Hudson, Town of 020-1481-02-000 CST BM Elev: Insp. BM Elev: BM Description. Section/Town/Range/Map No ! GS T_ 07.29.19.3051 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS I FS ELEV. Septic 1.•~- o Benchmark Ha~ Dosing Alt. BM G ~52a~. To a 2• Z ' J Aeration Bld .Sewer G.zS ADD • Holding St/Ht Inlet 7, 5 coq. Z. TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Veneto Air Intake ROAD Dt Inlet \ Septic 76 24 BOO i Dt Bottom Dosing I Header/Man. -7 e(L' Aeration Dist. Pipe 616 ac. Holding Bot. System V qs•y 6~ .7 PUMP/SIPHON INFORMATION Final Grade + 13 L{. d 0~ Manufacturer GPI nd St Comer, ' 1\~ 5 161 M e, Q&N Mod Number 1I!! TDH Li Friction Loss System Hea JTD~ Ft Forcemain Length Dia. Dist. to Well SOIL ABSORPTION SYSTEM BEDITRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS /6& /CZI 3 SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufltu~',/f INFORMATION Typte Q / 7S 7 CHAMBER UNIT OR ModelJ'.~N~nJ~er: DISTRIBUTION SYSTEM CIL- ZS ZS je(,5 /0"S Header/Manifojd ~ Distribution 1 x Hole Siz~ x Hole Sng Vent to Air n take Pipe(s \ Length Dia Length Dia Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of eeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ` xx S des No No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Z /3 k- Inspection #2: / Location: 1034 Autumn Oak Lane Hudson, WI 54016 (SE 1/4 SW 1/4 7 T29N R1 9W) Whispering Oaks Lot 2 ~~Parcel No: 07.29.19.3051 1.) Alt BM Description = 1 CG ~ C ~41~ ~ac+~ O►'~ 2.) Bldg sewer length = 2 nl f 31 I - amount of cover = o het fir- S~-.'~l Plan revision Required? ❑ Yes No L Use other side for additional information. 4;= SBD-6710 (R.3/97) Date Cert No. 4 "y~, ~ 4; PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SW 1/4S 7 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/12/12 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .3 ABSORPTION AREA 1530 # of chambers 7 BENCHMARK V.R.P. Top of steel pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping sball be 81Y TEM ELEVATION 96.0/65.9/95.8 4' below qrade f tank, piping shall be Schedule 40. Well i to meet all A- t,- setbac s required by WDN 0 2"1 L Scale is 1" = 40' - unless otherwise noted Pro 3 v~ bedroom Housq STO 20' 0' B-2 2 99.5 19 ' 30, J 1% Slope 50' 101B 3-3' X 102' cells with > ' spacing 50' Vent n >6" Quick4 Standard of Cover Leaching Chamber Vents B-1 with 20.0 ft2 of Area 10.MA2/pair of end caps 349' Property Line 4' Long 12" 3 4" Grade at System Elevation ti cornmerce.wi.gaw Safety and 3uildings Division Count c 201 W, Washington Ave., I' O. Box 7162 ~ 1 . Madasora, Wf 537[)7-71 Gx .S`unicury r~orn,:+Nu„~Ler w ntt s a.. by .::o.) troleS~C nsrr~ - ill of ts,o ni- Sanitary Permit Application ~ State Troosa viliion Number b! accordance with s. Carmn. 83.21(2), Wis Adm. Code, submission of this form to thr~ropPee go8ur unit is required prior to obtaining a sanitary permit. Note: Application tbrms for stat[rct tecl POW TS Project Add 'SS !f different th mat ng address) s ibmitted to the Department of Commerce. Personal information you provide may be used°'fersec indary D 3 v~►~L AJ purposes in accordance with the Privacy Lars, s. 15.(kt(1){mj, SWtS. - a 1. Application Information - Please Print All Information - : W )ol Property Owner's Name 4F Pal t! - Y,operty Owner's Maili Address Property Loontiol3657 I Govt. i of City, state Gip Code Phone Number (k-,)%., Section cle on N; It 1. Type of Building4 (check all that apply) Lot # _ Z Dwelling Number of Bedroo _ Subdivis[on Name ~7 or Z Family Klock It / - Describe Use FJ City Cit ~ Public/Commercial- ❑ y ot ~ CSM Number U Villugeof ❑ State Owned - Describe Use J - W oil;- (Check only one box on line A. Complete line B if applicable) Typ"dTar - ow Systa ❑ Replauerrtant System ❑ TreatmentlHolding Tank Replacement Only 0 other Modification to Existing System (explain) List Previous Penr+it Ntmrber and Date Issued B. ❑ Permit Renewal El Pcrmit Revision E-1 Change of Plumber ❑ Permit Transfer to New Before Expiration Owner - - - I17 . T e of POWTS 5 stent/Com l eat/Device: (Check all that apply) din-Ground ❑ Pressut ized ln-Ground ❑ At-Grade ❑ Mound ? 74 in. of suitable soil LJ Mound < 24 in. of suitable soil ❑ Holding `fartk ❑ Other Dispersal Component (explain) _ _ L pretreatment Devi, e (exp in)_--_-__-- - V. llis ersaUTreahnent Area Infornltttio-~~ ow (gpd) Ih-sign Soil Applicmion te(gpdsl) Dispersa Area Required (st) - Dispersal Area Propose (st) System l lev ' a^ Dl i'1 r.. 1. `tank Info - Capacity in Total # of Manufacturer c ( iallons Gallons Units 1 o 1, i~ BID Now Tauks - - Existing Tanks b u~ rn is. ~U a se W. or tioldia8 Tarot posing Chamber vil. Responsibility Statet t~ 11, Z---- onsibility for installation of the POWTS shown on the attached plans. -plum W's Nam (Print) re MP/MPRS Number Business Phone Number )er's ddress (Street, rtyState, ount /De rtment US O-- - in g nt afar Pamit Fee Oil Date is/snd g P Approved U Disapproved g L~ ❑ Owner Given Reason for Denial I Conditions of Approval/Reasons for 'Disapproval SYSTEM OWNER, v ~ J 1012q-7, 4I 2- 1. Septic tank, effluent filter and dispersal cell must be serviced / maintained as per management plan provided by plumber. (f 2. 1Qtt)_ rk rwa ~!'r=R'-°nrteh n, kj o r root irss than Ye s tt mebu i it as per applicable Cl RirUIFl~tS p sns or esys and subwitt the ~uuutY aly a SBD-6398 (R. 02(09) ,~X>f' PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SW 1/4S 7 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/12/12 BEDROOM 3 CONVENTIONAL XXXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .3 ABSORPTION AREA 1530 # of chambers 75 BENCHMARK V.R.P. Top of steel pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE SWELL *H.R.P. Same as Benchmark 1 TEM ELEVATION 96.0/65.9/95.8 4' below qrade tank, piping shall be Schedule 40. Well i to meet all R UTU 0/6 WDN s required by 2.7 L Scale is 1" = 40' unless otherwise noted P-1 Pro 3 u~ bedroom House STO 20' 100' B-2 19 99.5' : 30' J ,J 1% Slope 50' T 10B-3 - 3-3' X 102' cells with > ' spacing r 50' Vent >6„ Quick4 Standard of Cover Leaching Chamber B-1 with 20.0 ft2 of Area Vents 10.2ft^2/pair of end caps 4' Long 12" 349' Property Line 34" Grade at System Elevation im N$4°40'lb'-C a i v.. t _ .d to O 4 {913.35} LOT 3 CQ -t*, 44,604 SQ. FT. a + J o p 1.02 AC. LOT 7 t N N 2 m 55„S 348.9T o° w 68,964 SQ. FT. J cn N ` rn t $ 1.58 AC. N L.B.O. = 914.3 {916.861 z OT 20 + {915.97} 53i • 45, 691 SQ. FT. 25"W 283 ° .A ~ 1.05 AC. ; t t 583 46 ` t t ' ` ° ` N81°44t47"E 38271 f o J j ~ LOT 6 co too k 43,906 SQ. FT. J w 1,01 AC. LOT 1 t~ E 59,241 SQ. FT. tt E 7- 1.36 AC. ` c) S06°00'26"E 12.26 I o O • E E S89°5832"W 245.37 E c N o S89°56'01 'W 250.12 i.: 20.00` I b3 I i S89°58'32"W 147.01' I N °o_ I J t I I I 0 ! I Q i Q I, E I I i I c= F F I _ 0 I Z Z FFS`G711 ca o E I i C ! Q N a 2E I_ - o O_ O I f r:" I k t QW 1 p in kC I E ! h 00( m j _----ice,-- I ! Imo, I k 79 k rns I 4T Q) _ I fI f O E~ I I~ I~ a t ~ ~ I j f nag f I E W E p t~ 1 '~1 E~ k ~r I! I k 9P I E E I OUTLOT 2 33' 33' 66 ' I E 7,000 SQ. FT. ! <<~ E k 0.16 AC. ! N89o5841"W I 20.60'. HMTTLEY LANE Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 12/12/12 Owner: Oevering Homes LLC Location: SE1/4 SW1/4 S7 T29 N,R19W Lot 2 Whispering Oaks Hudson System type: In-ground absorbtion system(conventional) Manuals Used: In-ground absorbtion system (version 2.0) Page# 1. Cover Page 2. Plot Plan 3. Chamber Cross Section 4-6. Maintanance and Contingency Plan 7. Filter Specifications Sheet Signature License number 26900 I PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SE 1/4 SW I/4S 7 /T 29 N/R 19 W TOWN Hudson COUNTY ST. CROIX MPRS Shaun Bird 226900 DATE 12/12/12 BEDROOM 3 CONVENTIONAL XXX IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .3 ABSORPTION AREA 1530 # of chambers 75 BENCHMARK V.R.P. Top of steel pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark All piping shall be SDR 30/34, within 10' SYSTEM ELEVATION 96.0/65.9/95.8 4' below qrade of tank, piping shall be Schedule 40. Well is to meet all setbacks required by Amber Ridge Drive WDNR Scale is 1" = 40' unless otherwise noted Pro 3 bedroom House STO 20' 100' B-2 99.5': , 192' 30 1% Slope 50' i, 10, -3 3-3' X 102' cells with >3' spacing 50' Vent >6„ Quick4 Standard of Cover Leaching Chamber Vents B-1 with 20.0 ft2 of Area 10.2ft^2/pair of end caps 4' Long 12" 349' Property Line 3 4„ Grade at System Elevation Cross Section of Quick 4 Standard Leaching Chamber Typical cross section for 2 of 3 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber 10.1ft^2 pair of end plates To be >1' above grade / Finish grade elevation Typical Installation 100.0 ,jV ent Grade Vent 4" 4' X30/ 34 Septic Tank 5' 4' Long 1 Grade at System Elevation 34" Grade at System Elevation 3419 Spacing 5' 3-3' X 102' Cells Observation tubeNent Same on other end To be located on end of Cells %A B System elevations: C A__96.0 B95.9 25 chambers per cell C__95.8 .0jV Y.: FILTER CARTIRIDGE INSTRUCTIONS Installation STTFP I Dry fit the filter case anta the and of the outlet pipe to ensure it is centered under the access opining. If feat, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. STEP 2 While the case Is still dry fitted on the outlet pipe, measure the length of U-inch pipe needed to bract, the filter to the tank end wall if utilfzing the optional supplemental side support, If side support method. Is not utilized, proceed to step four. s•; FF, 3 For installations utifizing the optlarral supplemental side support: solvent weld the X14-inch pipe onto the filter case. If side support method is not utilized, proceed to step four. Solvent weld the filter case onto the outlet pipe. Insert the filter cartridge into the case, pressiml down until the filter locks into the bottom of the case. If a VRS switch is utllia*-d: insert into the filter and fuck by turning clockwise 400.',:; 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 correphately, making sure to remove the sludge layer on the bottom of the Wrlk and not just the scum and effluent, r ` 4. once the effluent level has been lowered below the invert of the t' outlet pipe, firmly pug up on the filter handle to dislodge the cartridge from the case. 5. Slide the cartridge up and at it of the case for cleaning. r4 6. If a vRs switch connected to an alarm Is present, the switch should be removed by turning counterclockwise 900 and cleaned with water only. 7. While holding the cartridge en its side (large flat surface facing y , down) over the access opening, rittse off the cartridge with water "i only, making sure all septag'> material Is rinsed back into the tank_ a. If vRs switch is utilized, replace by inserting into filter and turning clockwise 90°. i ax 9. Insert the filter cartridge back into the case, grassing down until , the filter locks into the battvun of the case. IQ.Repiace and secure the access opening on the tank. " ::7 i:',:f~:. t"-'".'l=`4~; ;0.Y1 :'{?:T1trt! ~ 1t,4;-'1 r:.::irEt':.1~'.H:a¢!f•1.S.Y"'. vt►ww beamnsite.com. 877-MLFILTERS (653-4583) 12 F Wisconsin Department of Commerce SOIL EVALUATION REP PAID Page of J Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County Attach complete site plan on paper not less than 8 1 /2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. Le ~j percent slope, scale or dimensions, north arrow, and location and distance to nearest road. O ~T 6 l Please print all infortnatio R 'ew b Date TT Personal Information you provide may be used (or (rivacy w, s. 15.04 (1) (m)). G il- f 0 A /V Property Owner Property Location 1116010 Govt. Lots 11455( fi/4 S~ T 2Y N R E IA'o Property Owner's Mailing Address 36 .-I- 13C A Lot # Block # Sum. me or CSM# - cokj N ICE - r (n 2 City fate Zip Cod P ❑ Vill City ag T Barest oad • NNIN r _ 1 New Construction Use.~Mesidentiai / Number of bedrooms Code derived design flow rate J~ GPD ❑ Replacement ❑ PUbG r commercial - Desccrrjhe, Parent material =~~5 ALP A u GVirl~; L.r~ Flood Plain elevation if applicable - l - - ft. General carlrrlents rc 0,4>-& jJ Aq ~ and reoorrKrtertdatlons: 1,'!S j~5 SLte~ ~pT.a] C r-U ~O->1 -Sri System Type System Elevation ?3 L1 ILL r SDc.~ Boring # , El Boring pr Pit Ground surface elev.1 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD1fF In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 -Eff#2 o -t> 03l r, - ' _3 Z o-1$ e a s~ . G1--/ Boring # Boring FE] j~ 12 Pit Ground surface elev. LOD_l/ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDM In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 p Q,31L ,8 30 S- y, to ~1 ~t/+,- O 1✓) t • Effluent #1 = BOO > 30 < 220 rrKA and TSS >30:5 150 • Effluent #2 = BOD 130 mg/L and TSS < 30 mgA- CST Name (Please PrInQ - - ture CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 5401 715-246-4516 2_ property Owner _ Parcel ID # Page of C Boring © Boring # pit Ground surface elev. r Depth to limiting factor in. Sal Application Rate Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDfff Horizon Deptlt •Eff#1 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 1 .77 L 2 Boring ❑ Boring # F-1 ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots •E GPO/t~E in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. ❑ Boring Boring # Ground surface elev. ft. Depth to limiting factor in. ❑ Pit Soil Application Rate Horizon 'lepth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots ,E GPD/fF Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. Effluent #1 = BODY > 30:< 220 mgfL and TSS >30 1150 mg1L • Effluent #2 = BOD, < 30 mglL and TSS 30 rng1L 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. SBD-9370 (RAW) R Soil Test Plot Plan Pr Ject Name NWP Holdings Shaun Bir Address 573 Cty Rd A Hudson Wi 54016 CSTM 6900 Lot 2 Subdivision Whispering Oaks Date 1011 10 SE 1/4 S W 1/4S 7 T24 N/1119 W Township Hudson Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Steel Pipe S ste * H 11 pSame as Benchmark Afftbege ri Scale is 1" = 40' unless otherwise noted v 100' 99.5' B-2 19 1% Slope 0' .M. 1%-3 40' 3 J 50' g T13-1 0 349 Property Line c THE EAST LINE OF THE SW 1 /4 OF N 0 q ¢ SECTION 7 SEARS SW'13'45'W AS Zz z vi w O a REFERENCED TO THE ST. CROIX p O O Z w L O N vi F 2 } w COUNTY COORDINATE SYSTEM 3 m 76 9w'w' Hw¢w U Nw~~i - ¢ 3°d2p ¢Lry /AQN W f<..3 ~J<gw w m m c m~L U=tT10C Z~J2a0 vl uia<2~z0 w Np~= 8 a $ ~¢OZwO' xCyO OFwxwOV3 f7j fhwz w 0 2 _ ¢F < G ~D°ou~ o<¢pa ~ L m w v~ w w a p UFUO~~w ~Fwp0 i< z 8 to $ o~m€ ~~a¢z°¢~ ~5rii~dn wgSx w W € G ~ppiu3m ffi o c°~ ' Np1N~ p u'3Z ¢ zz ¢ nm ao 00IOU i0~pm w m¢ F¢za ~Www O ` m ° V ¢~a W99 w sp w Op3 1 S 3 jp~~a~o ¢~a¢oF ° E c z¢ w c7 ¢ rL W¢ Z j W o?¢ 2 0 4 ¢ <y o m m lwaz(ywwmwU O¢c~ ~Oi wxz¢o 1 1 ~ Y awu Hj3<wojZ 3 zm< tsN mUpw~ 8 wow ° ¢ ¢ n wc7z 60 r Fd F`°3mE~5~£ t¢~i>=~~>v= =Swpo p a¢¢~~z t 00 oc2~ °c~ 39FZ p3-¢< W~ Np.3 pw 0 `n 0'¢~ { {4 N t~ m ¢W w l= Z U0 0¢w O U N y~ w p Q f wx (L W ' m.• of¢aa. awt F w ¢¢p ¢Z Ww¢¢ S mm a: 8aa i~wE3E Q wpm'' rcpo =O~~`~`OVS ¢Z~¢U I¢ pmmm mcS Zz t°ii=0 3~rua mmUN=<I:O ' t LSm OU N « sm ~ _o aL3savodus I®1 E t ~ I ~ I I I I I I P 15 avow ► I I I I Z LOT 9 C.S.M. fid I I LOT 42 ce i VOL. I PG. 978 U -SO0°13'45'W 684.01'- - m / 1 427 I~ / i ' / .1 112' ` 9.D~' 182' - - I- - -t _ )to w ~ze i/i , N \ y 1 \o :3 w i \ \ ¢ \ /r 508° 100"1N 16 3 I w w \ l - oss x e 37 • - - - S31•IDb' 9L'0 l 10.71!7.0 y w O - - - - - - 1 N00°01100°E 405.11' _ I .126.~i _ IN LOT 11 C.S.Q. ~n 1 i M~a 'c' co ~I I r/ mm \ 1 b ~m " S00°00'10'E ` 1 ¢ -W 282 UU V II 11 \ \ \ ✓ 3 LOT 7 - - - - - - v \ \ VOL. 23 'PG. 5588 \ l 160' 145' 121 ~ \ SMALL \ \ EAST \ F THE ST 1839.79 OFTHE SWYa 140' TRACTS / J e - i 7 ~ ~ SMALL TRACT ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer - 0'!~o P l _ Mailing.Address 3 M wt Property Address c- (Verification required from Planning Zoning Department for new construction.) Parcel ldenti Ccation Number. Ooh v Y LEGAL DESCRIPTION q Pro ert Location59 '/a , Se(,.-? T Z r N R W Town of Subdivision.. Certified Survey Map # Volume Page # - Warranty Deed # ~ ~ - - Volume ~ Page Spec: hous yes, no Lot lines identifiabl 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 t: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 :l2 St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Deparhnent a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (I) the on-site wastewater disposal system is in proper operating condition and/or (2) after- inspection and pumping (if necessary), the septic tank: is less than 1 /3 full of sludge, I/we, the undersigned have read the above requirements and agree; to maintain the private sewage disposal system with the standards set: forth, herein, as set: by the Deparb went 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. 1/we certify that: all statements on this form are true to the best. of my/our knowledge. Uwc 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 - ~IC;NATL i 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 fiom. the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page of PILE INFORMATION SYSTEM SPECIFICATIONS Owner 0e ,:'2 r ` Septic Tank Capacity gal ❑ NA Permit #j_ r ,rc~ o r'1 Septic Tank Manufacturer 100 1 I 1 ?ESIGN PARAMETERS Effluent Filter Manufacturer ❑ NAA Number of Bedrooms ❑ NA Effluent Filter Model ❑ NA i Number of Public Facility Units ANA Pump Tank Capacity gal NA Estimated flow (average) 3LIO al/da Pump Tank Manufacturer NA NA Design flow (peak), (Estimated x 1.5) ~'~j al/da Pump Manufacturer It! - III NA Soil Application Rate J al/da Ift2 Pump Model Standard Influent/Effluent Quality Monthly average* Pretreatment Unit NA Fats, Oil & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BOD5) 5220 mg/L 0 NA 0 Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg1L ❑ 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) <_30 mg/L XNA 0 At-Grade ❑ Mound Fecal Coliform (geometric mean) 510q rfu/100m1 ❑ Drip-Line ❑ Other: iMaximurm Effluent Particle Size k in dia. ❑ NA Other: EJ NA (Other: ❑ NA Other: ❑ NA I Other: "Values typical for domestic wastewater and septic tank effluent. ❑ NA NIIAINTENANCE SCHEDULE Service Event Service Frequency j ❑ Inspect condition of tank(s) At least once every: month(ear s)s) (Maximum 3 years) ❑ NA wlPump 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: 11 month(s) (Maximum 3 years) ❑ NA _ earls} _ ❑ onth(s) Clean effluent filter At least once every: ~ ear(s) NA Inspect pump, pump controls & alarm At least once every: ❑ month(s) ❑ NA _ ❑ ear(s) f=lush laterals and pressure test At least once every: ❑ month(s) ❑ NA ❑ year(s) ether: At least once every: 13 y oanth(s) ❑ NA ~7ther: NA MAINTENANCE INSTRUCTIONS (inspections of tanks and dispersal cells shall be made by an individual carrying one of the following licenses or certifications: Master IPlumber; Master Plumber Restricted Sewer; POWTS Inspector, POWTS Maintainer; Septage Servicing Operator, Tank inspections must linclude a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground surface. The dispersal cell(s) shall be 'visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. 'T'he ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local Regulatory authority. INhen the combined accumulation of sludge and scum in any tank equals one-third ('X) or more of the tank volume, the entire contents of l:he tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin Administrative Code. INI other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, land any servicing at Intervals of 512 months, shall be performed by a certified POWTS Maintainer. Ik service report shall be provided to the local regulatory authority within 10 days of completion of any service event. Page START UP AND OPERATION high are detected have othercontent hems s is tthja For new construction, prior to use of the POWTS check treatment ta(s) for may impede the treatment process and/or damage the dispersal cell(s). 9h concentrations 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 big in one discharge surfa the backup the overloading dose, effluenit discharged the dispersal c )conte tsaofthe pump tank remo ed by a aSeptagend may ing Operator prior toCerestor ng power to thle e avoid this is situation have 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 disinfectants-, fat; foundation of the oOn d al n antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; rndu l (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat scraps; medications; oil; painting p pesticides; sanitary napkins; tampons; and water softener brine. A13ANDONMENT When the POWTS fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is propel y and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code:. • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. • The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliilrnt replacement system: j d suitable replacement area has been is disturbance and ® compaction and should not be infringed upon by qui result area The replacement area should be protected from d replacement suitable and wells. t Repa theent systems must comply w th theh rue in in t setbacks from existing and prtia lot lines for a new soil and site evaluation to establish effect at that time. art to replace stbthe acfaan POWTSmitations. Barring advances in POWTS technology a ❑ A suitable replacement area is not la available due to holding tank may be installed a fail soil the and ❑ The site has not been evaluated suitable to identify a If nno rreeplacementarea isuavail ble a0ho ding t nk m ay be i staff edI'as must be performed to locate a suitable replacement area. a last resort to replace the failed POWTS. ❑ Mound and at-grade soil absorption amts must comply with the rules in effect foat that llows hgnremoval of the biomat at the infiltrative surface. Reconstructions of such systems <<WARNING>> k INSUFFICIENT RESCUE OI A NOT SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES TREATMENT TANK UNDER ANY C RCUMSTANCES.f DEATH MAY RESULTOXYGEN. ENTER A SEPTIC, PUMP OR OTHER OTHER t PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS MAINTA{NER - - POWTS INSTALLER F]gPhoneE0/,_))-_, me Name / 2C7 l` phone LOCAL REGULATORY AUTHORI Y SEPTAGE SERVICING OPERATOR P MPER Name Name - ~ ~ Phone J % ~ Phone J and 383.54(1), (2} & (3}, Wisconsin Administrative Code, This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) 1 Illl i II 8113512 Tx:4090393 STATE BAR OF WISCONSIN FORM 1 - 2000 969260 BETH PABST Document Number WARRANTY DEED REGISTER OF DEEDS ST. CROIX CO., WI THIS DEED, made between NWP Holdings, LLC, a Wisconsin Limited 12/11/2012 2:54 PM Liability Company, Grantor, and Oevering Homes, LLC, a Wisconsin EXEMPT#: NA limited liability company, Grantee. REC FEE: 30.00 Grantor, for a valuable consideration, conveys to Grantee the following TRANS FEE: 264.00 described real estate in St. Croix County, State of Wisconsin (the PAGES: 1 "Property"): Lots 2 and 3, Whispering Oaks, St. Croix County, Wisconsin. Recording Area Name and Return Address: Land Title Inc. File No. 391590 2200 W. County Road C, Ste 2205 Roseville, MN 55113 Together with all appurtenant rights, title and interests. 0-020-1481-02-000 20-1481-03-000 _ Palk t-kh3nt- ation Number (PIN) This is not homestead property. Grantor warrants that the title to the Property is good, indefeasible in fee simple and free and clear of encumbrances except Easements, Restrictions, Reservations, Roadways and Rights of Way, if any, of record. Dated this day of November, 2012. N H LC * hn a otti, Member * z Y AUTHENTICATIO N., ®,Q a. ACKNOWLEDGMENT Signature(s) IC OF WISCONSIN ) N ROIX COUNTY. ss. authenticated this 23rd day of November, 2011 9 3&& ) J~ ~G Personally came before me this day of November, ~F W~ 12 the above named John Parotti , the Member of NWP * Holdings, LLC to me known to be the person(s) who executed TITLE: MEMBER STATE BAR OF WISCONSIN the fore oing in t owledged the same. (If not, authorized by § 706.06, Wis. Stats.) Me ee J. Bune THIS INSTRUMENT WAS DRAFTED BY Notary Public, State Wisconsin My commission is permanent. (If not, state expiration date: Larry S. Mountain, Attorney at Law 10/27/2013 (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 1 of 1 WARRANTY DEED S'T'ATE BAR OF WISCONSIN FORM No. I-2001) I Parcel 020-1481-02-000 08/24/2012 09:38 AM PAGE 1 OF 1 Alt. Parcel M 07.29.19.3051 020 - TOWN OF HUDSON Current ❑X ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 11/08/2011 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - NWP HOLDINGS LLC NWP HOLDINGS LLC I 573 CTY RD A STE 100 HUDSON WI 54016 Districts: SC = School SP = Special P erty Addres s s( y Primary Type Dist # Description ' 1034 AUTUMN OAK LN SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 1.050 Plat: 11-039-WHISPERING OAKS 020-011 SEC 07 T29N R19W PT SE SW WHISPERING Block/Condo Bldg: LOT 02 OAKS LOT 2 (1.05 AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 07-29N-19W SE SW Notes: Parcel History: NEW FOR 2012. RETIRED 020-1002-50-055 TO Date Doc # Vol/Page Type CREATE 8 LOTS & 2 OUTLOTS. 03/22/2012 952988 COVNTS 11/08/2011 945347 AGREE 11/08/2011 945346 11/039 PLAT 06/24/2010 918098 EZ more... 2012 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Last Changed: 07/18/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.050 30,800 0 30,800 NO 05 Totals for 2012: General Property 1.050 30,800 0 30,800 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