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HomeMy WebLinkAbout040-1303-00-027 PRIVATE SEWAGE SYSTEM County: St. Croix Wisconsin Department of Commerce Safety and Building Division Sanitary Permit No: INSPECTION REPORT 561008 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: Westview Construction, Inc., c/o Aaron Clay Troy, Town of 040-1303-00-027 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No: ?T. /I 8 OT_ 22.28.19.1762 TANK INFORMATION ELEVATION DATA t~ TYPE MANUFACTURER CAPACITY STATION 7.5~ FS 917 1 ELEV. i Septic ) Benchmark qp, ~p f ! 77 OO Dosing Alt. BM +-7 :1 G.r Aeration„ Bldg. Sewer `7 %if 3 " I 4 Holding St/Ht Inlet -7 QV <r5 J St/Ht Outlet TANK SETBACK INFORMATION TANK TO WELL BLDG. vent to it intake ROAD Dt Igl~t Septic Dt Bottom Z9 7 25 S~`t~ - 02 r Dosing 41, Header/Man. a 10 17 Aeration r.r' ,1, r Dist. Pipe Holding Bot. System /ad .Z e. Final Grade PUMP/SIPHON INFORMATION Manufacturer ( Demand I'Ver Zoe( GPM f<'V-14 ryl J3.p Model Number TDH Lift Friction Loss System Head TDH Forcemain Length / Dia.Z p/ Dist. to Well SOIL ABSORPTION SYSTEM b A 59 17 BED/TRENCH Width Length / No. Of Trench PIT DIMENSIONS No. Of Pits Inside Dia. Liqui Depth DIMENSIONS ( /&j ~i " SETBACK SYSTEM TO ~/WC.J P BLDG WELL LAKE/STREAM L CH G Manufacturer: INFORMATION CHA R OR Type Of System: 13 ?6 / NI l Model Number: lnOJ y DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size f/ x Hole Spacing 5 -o/ Vent Air Intake 4 (o G^ Pipe(s) ~Q /1 IV . 77 6z' Length Dia Z Length ' Y • 7 Dia Spacing- 3-SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth of 1xx Seeded/Sodded x Mulched Bed/Trench Center V7 Bedfrrench Edges \ Topsoil ' Yes No es1 No COMMENTS: (Include code discrepencies, persons present, etc.) Ins on #1: ka Inspection #2: ~O/ ~y3 \ Location: 252 Walnut Hill Way River Falls, WI 54022 (SE 1/4 SE 1/4 22 T28N 19 ) alnuk a i he Parcel No: 22.28.19.17622 p 1.) Alt BM Description = 1 (j [[2.) Bldg sewer length = - t 6~^~# CI ~ ~p~S ate, ~p~Dw - amount of cover = Itiec.: 1 Plan revision Required? ❑ Yes No ` j - q75 Use other side for additional information. Date Insepctor's /ature Cert. No. SBD-6710 (R.3/97) From:TOTAL EXCAVATING 715 555 5555 12/05/2012 14:26 #138 P.002/003 R~U)SJ-T.. FL 0T PLAIq Pg L6T27 Y t,2? AC SCALE. t z 4D Tlo o a 14 Nl~, ma, • f I&a Ryrt 14o . _ [_2.56/ 750 Mew m T 4, RkOF71r 'rr :5T#er$ WERE N 4r "T ~ -W HE PJ: -t 0 11 45 t-OM)"-x7'FP - - qli ~o S3 ~ sLoP~ l 4 , J-- rIll 7 1 County Safety anI I~#ir~a~}iion ST ct O / X 201 W. Washind Ale 5 d." box 7162 Sanitary Permit Number (to be filled in by Co.) P Madison, WI 53707-7162 Sanitary Permit Applitoyf State~Tjrans~ctionNumlb~er In accordance with SPS 383.21(2), Wis. Adm. Code, submission of this form to the appropriate governmental unit o(I ' pa / Q is required prior to obtaining a sanitary permit. Note: Application forms for state-owned POWTS are submitted to Project Address (if different than mailing address) the Department of Safety and Professional Servies. Personal information you provide may be used for s dary I LJ~~~~ 957'1 u oses in accordance with the Privacy Law, s. 15.04 1 m , Stats. 4✓ 19-1 ilk, 1. Application Information - Please Print AI for io Property wner's Name Parcel # ,r W 0// to 3 ~r z'l Property Owner's Mailing Address Property Location T 7 Q ~tr~ka' ` Govt. Lot~~ City, State Zip Code Phone Number S E 1A /4, Section (circle on-)- T Type of Building (check all that apply) L T~ N; R E oW j° - I.1 or 2 Family Dwelling - Number of Bedrooms Subdivision Name N Lin,I ni, l El Public/Commercial - Describe Use 6k, ❑ City of ❑ Villa ❑ State Owned - Describe Use CSM Number Village of (Town of A- /Da ~YO>l o S 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 Existing System (explain) i B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner P T 1 IV. Type of OW S System/Component/Device: Check all that a I~, J 0ZJ 6,4_ , El Non-Pressurized In-Ground El Pressurized In-Ground El At-Grade El Mound > 24 in. of suitable soil AMound < 24 in. of suitable soil ❑ Holding Tank ❑ O her Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Tree ent Area I form ion: L.TV _746,i__ Design Flow (gpd) Design Sol ppli tion Rate(gpdsf) Dispersal Area Require X0 Dispersal Area ;Pro a System Elevation Oe dr 0 Q h©t3 co 1 © 8 VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units p o ,d, New Tanks Existing Tanks c n P. V v~ ti rn ii C7 a Septic or Holding Tank oG d d ZSdf ca,+~c L Dosing Chamber 7 ,go a tC VII. Responsibility Statement- I, the undersigned, assume responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) Plumber's Signature MP/MPRS Number Business Phone Number I P ens p o SS ~sl - 4 Plumber's Address (Street, City, StateJiip Code W 99o,S ~r7 Xist s =a ~s 1,c7~ S o VIII. County/Department Use Onl pproved ❑ prove Permit Fee Date sued Issuing t Signatur X5. 2 ! Z caner eason for D 'al $ IX. Condit1s~~Reasons for Disapproval (Z J~~ I JC~O V V ~1 nL''~~ w 1. $eptic tank, effluent filter and ) titi~~ l "dispersal cell must all be servIces / maintained W 1 b a: .~a.,ticfL /'/1 tro f gT;toti , as per management plan provided by plumber. 2 All setback requirements must be maintained as per appkeble code I ordinaricas. 4 4CA_J t Attach to complete plans for the system and submit to the Coun only on paper n7 less han 8 1/2 x 11 inc n size SBD-6398 (R. 11/11) I n, \ From:TOTAL EXCAVATING 715 555 5555 12/05/2012 14:26 #138 P.002/003 R~U)Sl'f- 1...*FLDT PLAN L6T2.7 !,2? 4C 5 CA f 2 L6 / t 4 U~ 0 t~ ~Ltr t ) Pd ~1Osp<<P 6A Szvh q - 14 a r4>5 s 4'PpC .5 - L2.56/rT50 Wr&6E-A Ca)JCPPAV ~4 Y<< .u44,PxoFeRrY st'R'C~s WARE or zrlcRa~; o1Z)V G sctGS 4-1+1.ou794 n 6R~ ti t ~y lC s3 SLOPY i- r Tea f? /Qq4 t ~g~p ~ ~erGe :rt oT ~rn.~o,'ty E.., I V ! rA f ~ 9 P.R Safety and Buildings 3824 N CREEKSIDE LA oZ 0S ? HOLMEN WI 54636 Contact Through Relay 3 ~ K P S www.dsps.wi.gov/sb/ 9 1 °w www.wisconsin.gov ~O sSIONA~ S~ Scott Walker, Governor Dave Ross, Secretary December 06, 2012 CUST ID No. 220554 ATTN.- POWTSInspector CARL P HEISE ZONING OFFICE CARL HEISE EXCAVATING ST CROIX COUNTY SPIA W9905 710TH AVE 1101 CARMICHAEL RD RIVER FALLS WI 54022 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES: 12/06/2014 SITE: Identification Numbers West View Construction Transaction ID No. 2179972 Walnut Hill Site ID No. 786539 Town of Troy Please refer to both identification numbers, St Croix County above, in all correspondence with the agency. SETA, SETA, S22, T28N, R19W Lot: 27, Subdivision: Walnut Hill Farm FOR: Description: Four Bedroom Mound System / 6% slope Object Type: POWTS Component Manual Regulated Object ID No.: 1404412 Maintenance required; 600 GPD Flow rate; 20 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/O1); 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 P. 0. requirements. Condit, 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. APPR( The following conditions shall be met during construction or installation and prior to occupancy or use: D11/ISION Of SAFETY, Reminders • A sanitary permit must be obtained from the county where this project is located in accordance with the 4SSC CORR Spl 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. • A state approved effluent filter is required. 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. • All POWTS component piping material shall be SPS 384, Wis. Adm. Code compliant. • The area within 15' downslope of the dispersal cell shall remain undisturbed. Vehicular traffic, excavation or soil compaction is prohibited in this area. • 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. CARL P HEISE Page 2 12/6/2012 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • In the event this soil absorption s stem 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. • 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. 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 Fee Received $ 250.00 Balance Due $ 0.00 card M Swim POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsin.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. is I CARL P HEISE Page 2 12/6/2012 Owner Responsibilities • The current owner, and each subsequent owner, shall receive a copy of this letter including instructions relating to proper use and maintenance of the system. Owners shall receive a copy of the appropriate operation and maintenance manual and/or owner's manual for the POWTS described in this approval. • 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). • 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. • 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. 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 Fee Received $ 250.00 Balance Due $ 0.00 raid M gimP POWTS Plan Reviewer, Integrated Services (608)789-7892, Mon - Fri, 7:15 am - 4:00 pm WiSMART code: 7633 jerry.swim@wisconsirl.gov Note: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. RECEIVED DEC 0 3 2012 Total ExcavatinR, LLC-"1&8UILD1NGS N8618109& River Falls, W154022 Tel (715)426-1777 Fax (715)425-7314 TITLE SHEET MOUND SYSTEM FOR 4 BEDROOM RESIDENCE LOCATED IN THE _1/4 OF THE1/4 OF SECTION i,, T N, R 1 9 W TOWN OF Y jar ST r r o i COUNTY, WISCONSIN. J INDEX PAGE 1 OF 7 TITLE SHEET PAGE 2 OF 7 SYSTEM MANAGEMENT PLAN PAGE 3 OF 7 PLOT PLAN PAGE 4 OF 7 PLAN VIEW - CROSS SECTION PAGE 5 OF 7 DISTRIBUTION PIPE LAYOUT PAGE 6 OF 7 PUMPING CHAMBER CROSS SECTION 7.S. PAGE 7 OF 7 PUMP PERFORMANCE CURVE firs. a/IX PREPARED FOR VED Wr5fvl W CONSTR40'10N 41VDewca,NGS _R 11) 67P F a,5 W t _ J40 DIV D PREPARED BY C~ Carl Heise CST/MPRS 220554 W9905 710' Ave. River Falls, Wl 54022 Cell 651-492-8594 Fax 715-425-7314 This plan has been prepared in accordance with the SBS Manual i From:TOTAL EXCAVATING 715 555 5555 12105/2012 14:26 #138 P.003/003 Total Excavat_imow 91, 1 N8618109& River Falls, WI 54022 Tel (715)426-1777 Fax (715)425-7314 TITLE SHEET MOUND SYSTEM FOR 4 BEDROOM RESIDENCE LOCATED IN THE _ 1/4 OF THE j ll1/4 OF SECTION ?,2. Ty R N, R~ W TOWN OF • Q S~ ProiA, -COUNTY, WISCONSIN. INDEX PAGE 1 OF 7 TITLE SHEET PAGE 2 OF 7 SYSTEM MANAGEMENT PLAN PAGE 3 OF 7 PLOT PLAN PAGE 4 OF 7 PLAN VIEW - CROSS SECTION PAGE 5 OF 7 DISTRIBUTION PIPE LAYOUT PAGE 6 OF 7 PUMPING CHAMBER CROSS SECTION PAGE 7 OF 7 PUMP PERFORMANCE CURVE PREPARED FOR Wj551"ui w comslrRUCT ION PREPARED BY Carl Heise CST/M PR5 220554 W9905 710th Ave. River Falls, WI 54022 Cell 651-492-8594 Fax 715-425-7314 This plan has been,prepared in accordance with the SBS Manual / M o t/ A l U p9 ~Jv n r y 1M u n ~~'i 2 From:TOTAL EXCAVATING 715 555 5555 12105/2012 14:26 #138 P.002/003 REU),S1=P......'PLDT PLAN L 6T 2 7 Y 1, 2r A~ C 5 CA Le . / i 40 T-°wn a~ 1 ~~CLts r P✓~6SCCB t 4 E3~ Rat 14 4, "All V C (2.501750 WIE5E A-ZaNG PRO w r<< i A 'T,u4G,,PxoFeRrr V#eVS WERE Nor ~3ht'T i .WtiS X011 - TE 57- w45.t' 0M)",S;rO,p Z 6l ~ D. W sT~~-L P©a rs .~c~ ~ ~1/ s d TVT r ti S3 ~ s1,op~ l N r3 1-4 f Approved Barrier Cover - Fill Material - Distribution Cell G u.., --G Cap- 4-~ _ : - N r ~4 Y E D ,--Tilled Area Slope Figure 3. Detailed cross-section of a mound ' E t,~4 Cress Sect an Of A 14ovnd S7sterrt using F A Sad For The Abscrgtion Arta G 0..~ A Ft. Iz 6 00 Ft. • ~ 1 ~ Ft.• Ft. K I b. 5 Ft. Alternate Pasiticri L 1 21,06F t. . FcrcerMain W 2.6 Ft. L - 1 ~dObstrvation Pipe-~ X - A ~ _ _ i ~Foree w From. 3 ' p Distribution Bed Of %Z~- 2 Pipe Drain ROCK I ~N .Observation Pipe Percnansnt. Marker Plpe or Rods Plan View'Ot.mound _ Usfr+a A Bed For Tf,• Absorntlan Arse =r 1 ~'"~~t.` +I!'~i.,rlsWSre..`1'1....''.k...~'..~...j..a_,..w .:f?:r.',1~".'Y.:.ia....d.`n~~~~•~I►N~C.s:,, ' B.Cr;tr a,Ly``~' Oa A/' ~vrvy bQi LLt I<b 11.0- 71542 r v. v Distribution Pipe Layout P.0 e ..r2. of -7 Place the holes at the bottom of the distribution pipes at equal spacing, Remove all burrs from the pipe and holes. Extend the end of each lateral up with the use of long turn or 4511 fitting to a yoiat within six inches of the fhal grade. Terminate the cads of the laterals with a valve,-threaded cap or threaded plug. Provide accts from fraal grade for the valve; threaded cap or threaded plu,. " '1=~~CEsg BOX . ~cq L Z,CL'JS S A MLL WNW Y r X12 r/2 ti;... x Y 1 n1 h - Wtnl ltnQth - P 231.7 en 'n* Pl.laiv V\ew o-. e7 LJ~ u \ 1'J 1.Z L% t,AST' M (F t ce 4 FRO" t:01D (du. Weje4o) P ± "1 Ft, Hole Diameter 3 10 inch S~_Ft . Lateral " Z inch(es) X-2,9 LInches Manifold " inches Force Main inches #of holes/pipe Invert. Elevation of Laterals ►06, Ft. c Q~ C-~. x (oI~" ~ ~ ~3tn -2j= Ss 4 G.P.M. Page_,~ Of SEPTIC TANK &-PUMP CHAMBER CROSS SECTION AND SPECIFICATIONS 411 VENT PIPE 12" MIN. ABOVE GRADE & WEATHERPROOF 25' FROM DOOR, WINDOW OR JUNCTION'BOX APPROVED FRESH AIR INTAKE TWITH CONDUIT MANHOLE COVER W/ PADLOCK & FINISHED GRADE WARNING LABEL y +~-4" MIN. 18" IN. 6" MAX. b LL~ ti . INLET ~WATER TIGHT SEALS GAS- ' - TIGHT i►` /APPROVED A SEAL , JOINTS WITH APPROVED -B ; ALM APPROVED PIPE PIPE - ' ON S31 ONTO OLID SOIL RISER EXIT PUMP OFF ELEV. ~FT. OFF D PERMITTED ONL IF TANK MANUFACTURER HAS APPROVAL 3" APPROVED BEDDING UNDER TANK CONCRETE PAD SPECIFICATIONS SEPTIC / DOSE n TANK MANUFACTURER: W i~s~r ~ow c 4'i.~ NUMBER DOSES PER DAY': ,_c~, TANK SIZES: SEPTIC JpSo GAL. DOSE VOLUME INCLUDING ~q'l~Bt~zv DOSE 750 GAL. FLOWBACK: ~ GAL. ALARM MANUFACTURER: FLECrro CAPACITIES: A = 2kIIINCHES = J6Q GAL. MODEL NUMBER: 1 V SWITCH TYPE: B = 2 INCHES = jL,?GAL. PUMP MANUFACTURER: 2 pe1~g(~ C = INCHES = ► 34. ~gGAL. MODEL NUMBER : 1 loI SWITCH TYPE: D = 1.53 INCHES = 1 0.5. OL GAL. REQUIRED DISCHARGE RATE GPM PUMP 6 ALARM WIRING AS PER ILHR' 16.23 WAC VERTICAL DIFFERENCE BETWEEN PUMP OFF AND DISTRIBUTION PIPE . . 14, l B FEET + MINIMUM NETWORK SUPPLY PRESSURE . . . . . . . . . . . . . . 3, 2~9;_ FEET + 1Zr> FEET FORCEMAIN X (a~FT/100 FT. FRICTION FACTOR ~~FEET TATAL DYNAMIC HEAD FEET INTERNAL DIMENSIONS OF PUMP TANK: LENGTH ; WIDTH ; DIAMETER LIQUID DEPTH k j op s _ K_,j,~ lb)=pPR 5'it1CH_X5'"PER-'C~C1tF~ g - --.-r . :T . ;`e:nt~hFi"~ ' 754LiF6R/7:'Vr t! ' , ' r v ♦ • - - r. Ntl K W PUMP PERFORMANCE CURVE EFFLUENT MODELS 3/8",1/2" & 3/4" SOLID PASSING CAPACITY ,40 42- 135 40 181 130 A CAUTION Model 185/4185 38 125 should not be subjected to less than 120 30 feet TDH. ~ 166 115 4186 34 1,0 32 105 too 30 95 28 ~i 90 26 85 80 0 24 165 = 4165 VT 0 75 22 0 70 163 0 4163 20 65 18 ,61 169 55 61 4189 16 140 50 4140 188 14 5 4188 4 12 152 35 153 to- 30- 151 8 N85 25 137 139 20 98 6 15 _ 4 ~ 10 2 • 5 53.55 0 10 2,0 30 10 60 BO ..-..70 80 90 t00 110 120 130 140 150 GALIONS Pe..y~°'s^ i- ie L . LITERS 0 s.` fiid 80'x'14 160 s" 240 xv ' Man" a ~ © coPYri9h>~ 2004"1 e1~er Co All rights reserved"" u Y a AK H, From:TOTAL EXCAVATING 715 555 5555 12/06/2012 08:39 #139 P.002/002 Def. 5. 2012 4:21 PM No, 0934 P. 1 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 ceil(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 hlghwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cep(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 ch. Comm 83.33, Wisconsin Administrative Code: • All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. The contents of all tanks and pits shall be removed and properly disposed of by a Septage Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void space filled with soil, gravel or another inert solid material. CONTINGENCY PLAN., If the POWTS fails and cannot be repaired the following measures have been, or must be taken, to provide a code compliant replacement system: 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. 0 The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is available a holding tank may be installed as a last resort to replace the failed POWTS. 0 Mound and at grade soil absorption systems may be reconstructed In place following removal of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules In effect at that time. ctWARNING»SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DEATH MAY RESULT, RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAYBE DIFFICULT OR IMPOSSIBLE.. ADDITIONAL COMMENTS: POWTS INSTALLER POWTS MAINTAINER Name C4av / Name Phone S/ 'f ? 55-r Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY Name /S S )/i c Agency S/ Phone 7 / s / S Phone 215- -3,91 8 1 1 4 6 6 1 Tx:4091418 STATE BAR O WISCONSIN FORM 3 - 2000 969458 QUIT CLAIM DEED BETH PABST Document Number REGISTER OF DEEDS THIS DEED, made between Citizens State Bank, Grantor, and ST. CROIX CO., WI Westview Construction, Inc 12/13/2012 3:37 PM Grantee. EXEMPT#: NA Grantor quit claims to Grantee the following described real estate REC FEE: 30.00 in St_ Croix County, State of Wisconsin (the "Property"): TRANS FEE: 108.00 PAGES: 1 Lot 27 of Walnut Hill Farm, Town of Troy, St. Croix County, Wisconsin. Lot is sold "as is, with all faults" o? 3 G:A1?!! rG, ZONING 01' i r Recording Area Name and Return Address: Tide One //18952 Together with all appurtenant rights, title and interests. 040-1303-00-027 Parcel Identification Number (PIN) This is not. homestead property. Dated this 12th day of December, 2012. Citizens late Bank * G tc Ilaberman, /iee Chairman * * AUTHENTICATION ACKNOWLEDGMENT STATE OF WISCONSIN ) Signature(s) ST.CROIX COUNTY. ) ss. i authenticated this 12th (lay of December, 2012 Personally came before me this 12th day of Deccdnber, 2012 the above named Citizens State Bank by Gene i * Haberman, 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. Slats.) THIS INSTRUMENT WAS DRAFTED BY *Jay P •nfjel(1 C Notary Pubh , isconsin My commission is permanent. (If not, state expiration date: ) 8i7/2016 (Signatures may be authenticated or acknowledged. Both are not necessary.) *Names of persons signing in any capacity must be typed or primed below thei signar PEIVFIELD Notary Public State of Wisconsin of 1 QUIT CLAIM DEED STATE BAR OF WISCONSIN FORM No. 3.2000 I U) v cell 1,. WA~ V c C dW* 1• VIM ' • • i a I • • ' low i r Oct-19-2010 01:59 PM St. Crcix County Ptan/ton ng 715-386-4686 ti 1 ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGR1:2MENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer S~r i f s Mailing Address _ _C;~ D ,z`f eT Property Address o~_SQ ~ (Verification required from Planning & Zoning Department for now c struetion.) City/State Parcel Identification Number 040-13o,9-00- LEGAL a DE PTION Property Loclltlt?17 S '/a . '/,.See. , T cPA N Rt9 W, Town of Ted v Subdivision Plat: I h wrt ,Lot # 7. Certified Survey Map # , Volume , Page # Warranty Deed # (before 2007)Volunie Page # Spec house -yes no Lot lines identirlablo - es 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 §Cotntii. 83.52(() and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certifleation form, signed by the owner and by a piaster plumber, journeyman plumber, restricted plumber ora license pumper verifying that ( t) the on-site wastewater dispo.ttt1 system is in proper operating condition find/or (2) after inspection and pumping (if neccsstuy), the septic tank i% less than P3 till[ of sludge. 1/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards sat forth, herein, us 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. 1/we certify that all statements /wrranty orm are true to the best of my/our knowledge. I/we arrt/are the owner(s) of the property described above, by virtue ordeed recorded in Register of Deeds Office. Number ` edrooms 4 ATU OF APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department, Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if reference is made in the warranty deed. (REV. 08/05) F, Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of Division of Safety and Buildings in accordance with Comm 85. Wis. Adm. Code qty 57 Gle V I x-- 'v Buda but n il" EROSION CONTROL PLAN must be Parcel I.D. Z-07- D M percent slope, sa P~•VD~•~ G"• b completed before sanitary permit issuance Re by Date PersoMi k0bm atm you provide may be used for secondary purposes (Privacy Law. s.15.04 (1) (m)). Prop" Owner TORO Property Location TOr7D ZSERS-re V T- #11 Govt. Lot f111 0~ 51/4 ZL TZB N R E(or)W ~ Property Owner's MakV Address Lot # Block # Subd. Name or CSM# (P o t S CA K LL AUK- 2-'7 u/AGNv'C" Kill FA-64 City SN. WR state zip Code Phone Number O City ❑ Village IA Town Nearest Road 6'POVE HT5 MN 5S07(P (C SI)1'Y to~~ -r*oy so. 610vER New Construction Use: (9 Residential J Number of bedrooms _ Code derived design flow rate 0 r D'i7 GPD ❑ Replacement ❑ Public or commercial - Describe: - tA Parentmatetiai 1 D&S t U.Gt_, d/Oi4 ~'~J2 Flood Plain elevation if applicable fv~ ft• General comments and recommendations: uvj, M Boring # 0 Boring IS Pit Ground surface elev. ft. Depth to rmtitiftg factor 27 in. Sol Applicatim Rate Horizon Depth Dominant Color Red= Description Texture Structure Consistence Boundary Roots GPOJ(l: b in. Mu nsell QU. Sz. Cont. Color Gr. Sz Sh. 'Etf#1 'Eff#2 1 0-o ioR ~iLZ ~ w •~7 L s . s ~A 2.5 Ca 1&r5 51 Z- 0. uk a ~ 7•Sn/R YCC~ oS~ f L # 0 Boring a ® Pit Ground surface elev. ft Depth to limiting factor Z G inn. Sol Application Rate t.. Horizon Depth Dominant Color Redgx Description Texture Structure Consistence BoundaryRoots GPDff in. Munsefl Qu. Sz Cont. Color Gr. Sz Sh. -Eff#1 -Eff#2 / o• o Y12 31 SQL 2 sh d5 4) w 3 . .S N z 11 /0 V/7 4y/ S~ L cw / I s N 3 V6, 2L / D SiL Z CS - S • Z ~toTS S~ [ 0, A,%s d u k o ~•s Yi2 y ~.ti seEZ-) oho .e Mont #1 = 800 5:- 30 1220 mglL and TSS >30:S 150 mglL • Effluent #2 = BOD < 30 mg& and TSS < W mg& CST Name (Please Print) ~ , -u~ R E Gl~- s9nahre0 6 ~ ZZ- ~ 5 Address Uibricht & Assgciates ~T 71 S• ?3 Conducted Telephone Nuffdw Privat 2812 10th Ave. Spring Valley, WI 54767 1 N A L 0y0 . io'F6 • so •oyo 0 - zd • o~ r y0 • /~g( oyo-/0Z oyo • is *6 70 • o~ oyo - io8~ ~o • aa~ ~JaGN v 7` Tovp T316 e 57'E©T- Propertyo%r,er Parcel ID# .Z~ Q Z 3 a~ of J Zv p t Ground surface etev ft. Depth to ~ factor in. Snit Efate t~arizorr Depth Doirinaif Cdw Redox DeSc[Won TftUe Sbuctt" Consistence Boundary Roots CIPM #t Munseti Qu. sz. Cont. Color Gr. Sz. Sh. `eA#1 L) . /6M 3 SQL 2~'s Z is 'V ~lt It w 3 iz- .S ` • ~ 2,A4, s J 7C i i ~---1 pit, GroOnd surface elev. ft Depth to Umi6ing factor in. Sol its Rate tlorizcxs Depth t)omiiaret Co~gor Redox Description Texture Structure Consistence Boundary Roasts GPDff in Munsen Qu. Sz. Court Color Gr. Sz Sh. 'Eif# I ~ Bonne # Q " pit Ground surface elev. ft. Depth to Vnitinng factor kr Std Rate Cokw Horizon Depth L7anfnant Redox Description_ Texture structure Cons Boundary Roots GPQ)W In. Munson Qu. Sz Court Coto Cam. Sz Sh. `Eff#1 `Eff#2 -a. F Bodng a # Boring Ground surface elev. ft. /Dep(hIoWfvWVftcW in. pit Soil Rate Horizon Depth DominantCojor Redox Description- T Sfiu-tie t;onsistenee ft ndary noots c POP in. Munseti Qu. SL Cant. Colo Gr. Sz. Sh. `Eff#1 *EfI#2 • Effluent #1 = BODs > 30 < 220 mg& and TSS > < 150 mgA- ` Effluent #2 = BQD, < 30 mgA. aid TSS < 30 mg(L The Department of Commerce is an equal opportunity service provider and employer. if you need assistance to access services or deed material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8977. s®o aa3o > r /-~GN v h1111 14~ iPry TDVV T3E R 5 Properwo%ener D Parcel ID r=age -Of 3 t -J I Ground surface efev tt. Depth to rim" factor Zv in. i Horizon Depth Dominant Gotor Rate Redox Description Texture Structure Consistence Boundary Roots GpDlF In. Mansell Qu. Sz. Cont. Wor Or- Sz. Sh. "Eff#1 'Eff#2 p . /o y2 3 .S/t zM„ j h w 3 .51 . sg- 244,,5G / 7c S 7~5 51L v ccS - . L 24. F-1 y N Boring # Boring 0 pit, Ground surface elev ft. Depth to Omiting factor;_ in. Sot! anion Rate Horizon Depth Dominant Redox Description Texture Structure Consistence Boundary Roots GPDf frr. Munson Qu. Sz. Catt. Color Gr. Sz. Sts. 'Eff#l '092 j Boring # Boring 1- --J pit Ground surface elev. ft. Deptts to limiting factor in. Soil AwRoation hate Hwlmn Depth Dominant Color Redox Description. Texture Structure Consfs Boundary Roots Gfflff in. Munseil Qu. Sz. Cont. Color GF. Sz. Sh. 'Eft#l 'Ett#2 Fl' Boring Boring # # pit Ground surface elev. fl. Depth to timiting factor in. $0 Applkation Rate Horizon Depth Dominant Col Redox Description. T Structure Consistence Boundary Roots 43PDRe In. Munsell Qu. Sz. Cunt. Color Gr. Sz. Sh. 'Elf#1 'Eff#2 * Eff writ #1 = Bt7D' > 30: 220 mgfl. acrd 7SS > < 160 aVL ° Effluent #2 = BCD' < 30 mg& and TSS < 30 "VL The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or, treed material in an alternate format, please contact the department at 608-266-315 f or TTY 608-264-8777. sea,t3m tsz~no) .r . PLOT PLAN WALNUT HILLS FARM. LOT # 2-7 Pg. 3 of 3 ,d = Contour elevation lines. ♦ = Backhoe Soil pits. Q = Benchmarks set, maRKED WITH FLAGGED lathes. 1/2" steel conduit pipes. SCALE: 1" = 2-0 l ~ ~ST~' vvv s,,~ „ fell ~ y: ~o a ~ o • f3 i w z,6 T- 2*7 ~0 1 3 Ld ~ r a 9 ~5 A tv 25 w YO feu ~ SO , L-07' /,/;e Q NVASCOnsin APPLICATION FOR REVIEW Department of Commerce -Complete all pages- POWTS Safety & Buildings Division NOTE: Personal information you provide may be used for Bureau of Integrated Services secondary purposes (Privacy Law s. 15.04(1)(m), Slats.] For plan status, check our website at h_ptt ://www.convnerce.state.wi.us/SB/SB-DivReviewStatusSearch.htmi Several counties have been delegated certain authority to review plans in lieu of Commerce. For a current list of those counties and their delegation check our website at hfp://www.commerce.state.wi.us/SB/SB-PowtsProgram.html. 1. Project Information - Fill in all known information. ' 7'- Confirmation of assignment to a reviewer. Project/Site Name \A/ CST U) -:w on 5 Trac- y Z>A'/ Transaction ID: Location,Number & Street of project (if unknown, ind'c ated nearest road) Previous Related Trans. ID: L.(5 ? r1frob~ t /I + Estimated Completion Date: Legal Description: S YA 1C7 ry) `Q cf Assigned Reviewer: Countyj rO ! -X O City O Village (,I Town of Assigned Office: Mail to your office of choice below: Green Bay, Hayward, LaCrosse, Madison, Shawano, Waukesha 2. After plans are reviewed, please: (check all that apply) NOTE: We reserve the right to re-distribute plans to _ Call customer 1, 2 (circle number)* another office if needed to reasonably balance _ Requesting party will pick up turnaround times. Check http://commerce.wi.gov/SB/SB- J Mail plans to customer 2 (circle number)* DivDailyDoc. htm [#Next for office availability and next *Refers to customer number from below review date 3. Complete the following designer/owner/requesting information. Utilize the check boxes when designer, owner or requesting party is the same to avoid repeating information. Designer Information (Customer 1) Commerce Other Please Specify Below (Customer 2) Commerce First blame r Last Name Customer Number First Name Last Name Customer Number °&V' ) ? 1)os!'q Company Name Company Name " fo` -c' f~:k (L.1 'J 0 G -tie) Address Address City State Zip+4 (9digits) City State Zip+4 (9digits) Q,►.fev &115 \A? T_ =,,407- Z- Phone Number (area code) Fax or Internet cell phone Phone Number (area code) Fax or Internet cell phone - 40,92M !I6 - 4a5-- 9 314 Check if applicable n Check if applicable or specify relationship ( ) Owner C~ 15 Qi t w'tfi J. e4 ( ) Owner ( ) Other - specify relationship 4. Information and Plan Submittal Checklists. POWTS scheduling is not available. Plans will be assigned to a reviewer after receipt of plans. If you select a specific office your estimated completion date maybe considerably greater than what would be possible in another office. Submittals received without a specific office indicated on the form may be assigned to offices other than the receiving office depending on reviewer availability. Submittal checklists can be found in each applicable component manual. You may email technical code questions to ComSBPowtsTech wisconson. ov. Madison S&BD Hayward S&BD Lae Area S&BD Shawano S&BD Green Bay S&BD Waukesha S&BD 201 W Washington Ave 10541 N Ranch Rd eekside 1,340 E Green Bay 2331 San Luis Place 141 NW Barstow St PO Box 7162 Hayward WI 54843 I 54636 Shawano WI 54166 Green Bay, WI 54304 0' Floor Madison WI 53707-7162 715-634-4870 HANGE) 715-524-3626 920-492-5601 Waukesha WI 53188- 608-266-3151 Fax:715-634-5150 Fax:608-283-7444 FAX: 920-492-5604 3789 Fax: 608-267-9566 Email: 334 Email: Email: PlanSchedule@ 262-548-8600 TTY: Contact Through PlanSchedule@ 785-9330 PlanSchedule@ commerce.state.wi.us Fax: 262-548-8614 Relay commerce.state.wi.us commerce.state.wi.us Email: PlanSchedule@ Email: PlanSchedule@ commerce.state.wi.us mmmerce.state.wi.us RAKE CHECKS PAYABLE TO DEPT OF COMMERCE TOTAL AMOUNT DUE $ d Mtach check here Review Code 7633 SBD-10577 (R.12/01/2008) THIS FORM IS VALID ONLY FROM 12/0112008 FOR THE MOST CURRENT APPLICATION, CHECK OUR WEBSITE AT www.rommerce.state.wi.us/SB/SB-DivForms/POWTS a<0= 00 O g o vo eD 3.~.. 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NCrO UAiOf~D N ON VOA p N AWN O b969 FA CT Of0 000 O44 ChON ONCn ODOD < O O G C O G C O n cl O O O O O p v 00 O N 0 0 0 0 0 0 0 $ 0 0 0 0 0 0 0 0 3 N tb O o o ~ p m m m CIA, 7 Mound System Management Plan J ' Pursuant to Comm 83.54, Wis. Adm. Code I Septic Tank The septic tank shall be maintained by an individual certified to service septic tanks under s. 281.48, Stats. The contents of the septic tank shall be disposed of in accordance with NR 113, Wis. Adm. Code. The operating condition of the septic tank and outlet filter shall be assessed at least once every 3 years by inspection. The outlet filter shall be cleaned as necessary to ensure proper operation. The filter cartridge should not be removed unless provisions are made to retain solids in the tank that may slough off the filter when removed from its enclosure. If the filter is equipped with an alarm, the filter shall be serviced if the alarm is activated continuously. Intermittent filter alarms may indicate surge flows or an impending continuous alarm. The septic tank shall have its contents removed when the volume of sludge and scum in the tank exceeds 1/3 the liquid volume of the tank. If the contents of the tank are not removed at the time of a triennial assessment, maintenance personnel shall advise the owner of when the next service needs to be performed to maintain less than maximum scum and sludge accumulation in the tank. The addition of biological or chemical additives to enhance septic tank performance is generally not required. However, if such products are used they shall be approved for septic tank use by the Department of Commerce, Safety and Buildings Division. Pump Tank The pump (dosing) tank shall be inspected at least once every 3 years. All switches, alarms, and pumps shall be tested to verify proper operation. If an effluent filter is installed within the tank it shall be inspected and serviced as necessary. Mound and Pressure Distribution System No trees or shrubs should be planted on the mound. Plantings may be made around the mound's perimeter, and the mound shall be seeded and mulched as necessary to prevent erosion and to provide some protection from frost penetration. Traffic (other than for vegetative maintenance) on the mound is not recommended since soil compaction may hinder aeration of the infiltrative surface within the mound and snow compaction in the winter will promote frost penetration. Cold weather installations (October-February) dictate that the mound be heavily mulched for frost protection. Influent quality into the mound system may not exceed 220 mg/L BOD5, 150 mg/L TSS, and 30 mg/L FOG. Influent flow may not exceed maximum design flow specified in the permit for this installation. The pressure distribution system is provided with a flushing point at the end of each lateral, and it is recommended that each lateral be flushed of accumulated solids at least once every 18 months. When a pressure test is performed it should be compared to the initial test when the system was installed to determine if orifice clogging has occurred and if orifice cleaning is required to maintain equal distribution within the dispersal cell. Observation pipes within the dispersal cell shall be checked for effluent ponding. Ponding levels shall be reported to the owner, and any levels above 4 inches considered as an impending hydraulic failure requiring additional, more frequent monitoring. General This system shall be operated in accordance with Comm 82-84 Wis. Adm. Code, and shall maintained in accordance with its' component manual [SBD-10572-P (R. 6/99)] and local or state rules pertaining to system maintenance and maintenance reporting. No one should ever enter a septic or pump tank since dangerous gases may be present that could cause death. Septic and pump tank abandonment shall be in accordance with Comm 83.33, Wis. Adm. Code when the tanks are no longer used as POWTS components. Septic or pump tank manhole risers, access risers and covers should be inspected for water tightness and soundness. Access openings used for service and assessment shall be sealed watertight upon the completion of service. Any opening deemed unsound, defective, or subject to failure must be replaced. Exposed access openings greater than 8-inches in diameter shall be secured by an effective locking device to prevent accidental or unauthorized entry into a tank or component. Contingency Plan If the septic tank or any of its components become defective the tank or component shall be repaired or replaced to keep the system in proper operating condition. If the dosing tank, pump, pump controls, alarm or related wiring becomes defective the defective component shall be immediately repaired or replaced with a component of the same or equal performance. If the mound component fails to accept wastewater or begins to discharge wastewater to the ground surface, it will be repaired or replaced in its' present location by increasing basal area if toe leakage occurs or by removing biologically clogged adsorption and dispersal media, and related piping, and replacing said components as deemed necessary to bring the system into proper operating condition. Questions on the operation or maintenance of this system should be directed to your county zoning or health inspector.