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HomeMy WebLinkAbout020-1481-03-000 PRIVATE SEWAGE SYSTEM County: St. Croix Wisconsin Department of Commerce Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561006 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 Propertie Hudson, Town of 020-1481-03-000 on/Town/Range/Map No: CST BM Elev: Insp. BM Elev: BM Description: 8-/ T Secti 5i G5 1 07. 19.3052 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURE _ ` CAPACITY STATION BS HI FS ELEV. ~ w~ Septic T^ 3 Benchmark q, G - , r 1?ar~tng Alt. BM " o Aeration Bldg. Sewer -7.7 T72 ~LY Holding St/Ht inlet 7.15 St/Ht Outlet 7 7 TANK SETBACK INFORMATION 9' 9,:f ' TANK TO 'f P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Nc r+A' Septic Dt Bottom It T13 > /DO Dosing Header/Man. Aeration Dist. Pipe /dig? ' aCg,_ ?-Z / Holding Bot. System `>'1 4 7711 IDZ Final Grade PUMP/SIPHON INFORMATION Manufacturer Demand St Cover 3 GPM Mo Number TD Lift Friction Loss System H TDH Ft Forcemain Len' Dia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width / Length No. Of Trenche PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS Z t to SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufac r r. INFORMATION CHAMBER OR Tju Type Of System: ~Z9 NA- UNIT Mo I Nu er o 2-4 11319 ] avIs DISTRIBUTION SYSTEM AJ4tA,.- 23fZ3 = ~lo Header/Manifol Distribution =xoleVent to Air Intake Pipe(s) _ Length__ Dia LDia_ Spacing SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xx Depth Off xx Seeded/Sodded xx Mulched Bed/Trench Center BedlTrench Edges \ Topsoil ` Yes No Yes ] No COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Inspection #2: / / Location: 1038 Autumn Oak Lane Hudson, WI 54016 (SE 1/4 SW 1/4 7 T29N R1 9W) Whispering Oaks Lot 3 Parcel No: 07.24.19.3052 1.) Alt BM Description = r' 14'.- e"'0J4-"`" /1 ~ 2.) Bldg sewer length - amount of cover = OF Plan revision Required? Q Yes No Use other side for additional information. - Date Insepctor Signature Cert. No. SBD-6710 (R.3197) 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 12/3/12 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 .5 ABSORPTION AREA 900 # of chambers 44 BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 93.5/93.3 6.5' below qrade Amber Ridge Drive Vent All piping shall be SDR 30/34, within 10' >6" Quick4 Standard of tank, piping shall be Schedule 40. of Cover Leaching Chamber with 20.0 ft2 of Area Well is to meet all 4' Long 12" 10.2ft^2/pair of end caps setbacks required by 3 4 Grade at System Elevation WDNR 11 ~ Scale is 1" = 40' unless otherwise noted 100' 99' B-2 192' 20 ST 0 Pro 3 Bedroom 4% Slope 50, House 40 10' 2-3' X 90' C 1 B-3 with >3' sp ing 0' i B-1 316' Prop rty ine O) _ v~ ❑ Bonm9 Parcel ID # Page of Property Owner © Boring # Pit Ground surface elev. y ' h• Depth to limiting factor in Sal i D n Rate Roots GP/(P Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary •Eff#1 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 0. 1~ r31~- t S-~ 15 I V-1 If /,6 1 10, 7,1 7, Os 0 ❑ Boring S/ Boring # Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Pit Roots GPDW Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary •Eff#1 •Eff#2 . Sz. Cont. Color Gr. Sz. Sh. d in. Munsell Qu O !!;Jl '9") ~ ` s )g w~ ~ D 44411 L] Boring In. a Boring # Ground surface elev. ft. Depth to limiting factor Soft motion Rate ❑ Pit Horizon ')epth Dominant Ca or Redox Description. Texture Structure Consistence Boundary Roots GPDIff in. Gr. Sz. Sh. •Eff#1 •Eff#2 Munsell Qu. Sz. Cont. Color • = < 30 mglL • Effluent #1 = BODs > 30_< 220 ntglL and TSS >30 150 mglL Effluent #2 BOD6 30 nVI and TSS stance The Department inr an alt mate format, le contact pthe department at ployer. If you 608-266-3151eorr TTY 608-264-8777. services or need material SOD-8330(StAM) - ll'90V Sarblty slid Buildings Division - ~scoh w 201 W. washington A've., Ptl3o`r~162 County- ~~rnpr s ,n Madison. WI 537U'T-~7,j6.7 1A o)Conaneree ~ SunLuiy r''erasAl Number (lu bo Oliva n by Sanitary Permit Application 60~ State ransac io Number In accordance with s. Comm. 83.21(2) Wis. Adm. Cade, submission of this forte to theunit is required prior to obtaining a s appropriate govern' ntal~ an, e submitted to the Department of Commerce. ~ permit, Personal Note; intbnmation you Application provi rgvis for state-owned POWTS Proj ect Address (if diflerellE than mailing address} de may be used for secondary u ses in aa:ordance with the Privac Law s• 15A4(1 in Scats, />6R ~ 1. Application Information - Please Print Ali Informations J Property Owner's Name - Property Owner's Mailing Addres ~ ^ ~ ~ a 0 3 pr Property Luoalion 3o5 z, City, state l Govt. Lot Zip Code Phone Number r t..c~'/ Section -7 II. Type of Betiding (check all that apply) Lot # 1' a_L N; R B W r 2 Fal ly Dwelling- Number of Bedrooms 3 Subdivision Name ak e-o Hlotsk / ❑ Publio/Commrmiai - Describe use P k FJ city uI• ❑ State Owned - Describe Use _ ~ CSM Number ❑ Village of - 2. U+ 01- Cal 6 tom' 2 Z J- Z2 s--- own of M. Type t r permit: (Check only a box on tine A. Complete line B if applicable) A. New System ❑ Replacement System ❑ Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (explain) B. © Permit Renewal El Permit Rovision El Change of Plumber 11 Permit Transfer to New List Province Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Comp onent/Device: Check all that a i on-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade ❑ Mound ? 24 in. of suitabks soil ❑ Mound < 24 in. ot'sviiable soil P~c1, ❑ 1-lolding Tank ❑ r Dispersal Cornpnnent {exp in) ❑ Pretreatment Device (expluir:) s V. Dis al/Trea ent Area Inforruil a: Design Plow (gpd) Design Soil lication R (gpdsf) Drs ersal Area Reguir (so Dispe al Area Prop em Elev 'on S- ill - 1 13 >7; VL Tank Info Capacity in Total # of Manufacturer Gallons Gallons Chits a New Tanks Existing Tanks U w ri~ rA H 4 Q) Septic or Bolding Tank CIA IJoaingChamhtn G IVII. Responsibility Statement- C, the undersigned, a e resporrsibiiity Cor installation of thePOWTS shown on the attached plans. Elumber's , Name (Print) Plut Signature MP/MPRS Number Business Phone Number CAC 'lumber's Address (Street, City, State, Zip c - ZV "Y DI Z ' ILK Caunt /De rtment Use Only pproved PermJit Fee Date Is used/ Issuing Signature iven Reason enial ! 7C~ " ' "6 lZ IA 1 K. Condi»i(ItttTet¢(Reasona for Disapproval ~rrl / /b ew 1. Septic tank, effluent filter and e4, dispersal cell must all be services / maintained &.41 ce, as per management plan provided by plumber. 2. AD seMack requirements must be maintaindd as per applicable node / ordinar im'. Attach to complete plans for the system and submit to the County only nn paper nut less torn 61/2%1 t iuehes in area c,IBD-6398 (R- OV09) 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 12/3/12 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 .5 ABSORPTION AREA 900 # of chambers 44 BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑ BOREHOLE O WELL - H. R. P. Same as Benchmark SYSTEM ELEVATION 93.5/93.3 6.5' below qrade Amber Ridge Drive Vent All piping shall be SDR 30/34, within 10' >6" Quick4 Standard of tank, piping shall be Schedule 40. of Cover Leaching Chamber with 20.0 ft2 of Area 10.2ft^2/pair of end caps 12" Well is to meet all 4' Long Grade at System Elevation setbacks required by 3419 WDNR Scale is 1" = 40' unless otherwise noted 100' 99' B-2 192' 20 ST 0 0 3 Bedroom 4% Slope 0' House 10' 40 2-3' X 90' Cells B-3 with >3' spacing 0' B-1 316' Property Line i Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 12/3/12 Owner: Oevering Homes Location: SE1/4 SW1/4 S7 T29 N,R19W Lot 3 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 nu er #226900 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 12/3/12 BEDROOM 3 CONVENTIONAL X00C IN-GROUND PRESSURE CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons LIFT TANK SIZE DOSE TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers 44 BENCHMARK V.R.P. Top of 1/2" pipe ASSUME ELEVATION 100' Filter BEAR Filter ❑BOREHOLE O WELL *H.R.P. Same as Benchmark SYSTEM ELEVATION 93.5/93.3 6.5' below qrade Amber Ridge Drive Vent All piping shall be SDR 30/34, within 10' >6" Quick4 Standard of tank, piping shall be Schedule 40. of Cover I-eaching Chamber with 20.0 ft2 of Area 10.2ft^2/pair of end caps Well is to meet all 4' Long 12" setbacks required by 3499 Grade at System Elevation WDNR Scale is 1" = 40' unless otherwise noted 100' 99' B-2 192' 20 ST 0 0 3 Bedroom 4% Slope 0' House 10' 40 2-3' X 90' Cells B-3 with >3' spacing 0' B-1 316' Property Line Cross Section of Infiltrator Quick 4 Leaching Chamber Typical cross section for 2 of 2 cells Quick 4 Standard Leaching Chamber with 20.0 ft2 of Area per Chamber To be >1' above grade 10.2ft^2 pair of end plates Finish grade elevation Typical Installation 99.9' Vent ~ Grade ~ Vent 3, 4„ 131 x/30134 Septic Tank 5' Long 1 37 5' S' Long 1 Grade at System Elevation 3691 Grade at System Elevation Spacing 5' 2-3' X 90' Cells Same on other end Observation tubeNent At end of cell A B 22 chambers per cell System elevations: A-93.5' B 93.3' POWTS OWNER'S MANUAL & MANAGEMENT' PLAN Page of FILE INFORMATION _ SYSTEM SPECIFICATIONS Owner ~~G~(`'~ ! Septic Tank Capacity p Nq Septic Tank Manufactui er ❑ NA DESIGN PARAMETERS Effluent Filter Manufacturer f- 1a- ❑ NA Number of Bedrooms ❑ NA Effluent Filter Model 0 NA Number of Public Facility Units A Pump Tank Capacity JNNAA gal/day Estimated flow (average) PumpTa nk Manufacturer Design flow (peak), (Estimated x 1.5) y al/da Pump Manufacturer Soil Application Rate allda /ft2 Pump Model _ Standard Influent/Effluent Quality Monthly average* Pretreatment Unit - Fats, Oil & Grease (FOG) S30 mg/L ❑ Sand/Gravel Filter ❑ Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L El NA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) x150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality i Monthly average Dispersal Cell(s) 0 NA Biochemical Oxygen Demand (BODs) 530 mg/L In-Ground (gravity) El In-Ground (pressurized) Total Suspended Solids (TSS) s30 mg/LVA ❑ At-Grade 11 Mound Fecal Coliform (geometric mean) 5104 cfu/100m1 I-] Drip-Line [I Other: Maximum Effluent Particle Size %k in dia. ❑ NA 11 Other; - - - - Other: NA NA Other: - - ❑ NA "Values typical for domestic wastewater and septic tank effluent. Other:- - - 0 NA MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tanks ❑ month(s At least once every: ) (Maximum 3 years) ❑ NA ears ~ Pump out contents of tank(s) When combined sludge and scorn equals one-third (X) of tank volume ❑ NA Inspect dispersal cell(s) _ At least once every: _ Q month s)- - )__tear(s (Maximum 3 years) DNA ZZ ❑ f._-- Clean effluent filter _ At least once every: nth s) ar (s ❑ NA Inspect pump, pump controls - & alarm At least once every: p monthis) s) 11 NA Flush laterals and pressure test At least once every: - D years} s) 11 NA pthec At least once every: _ p month(s) ❑ NA Other: ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an individual carrying one of t Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Sept age Servir1 g lOperator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent on the ground si rrface. The dispersal cell(s) shall be visually inspected to check the effluent levels in the observation pipes and to check for any ponding of effluent on the ground surface. The ponding of effluent on the ground surface may indicate a failing condition and requires the immediate notification of the local regulatory authority. When the combined accumulation of sludge and scum in any tank equals one-third (X) or more of tl ie tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordant,) 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 s12 months, shall be performed by a certified POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of an,, service event. START UP AND OPERATION Page of For new construction, prior to use of the POWTS' check treatment tank(s) for the presence of painting product or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentration; are detected ave the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the contents of the pump tank removed by a Septage Servicing Ouerator prior t 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 proton the life of the POVVTS: 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 fails and/or is permanently taken out of service the following steps shall be taken to insure that the system is properly and safely abandoned in compliance with chapter Comm 83.33, Wisconsin Administrative Code: * All piping to tanks and pits shall be disconnected and the abandoned pipe openings sealed. 0 The contents of all tanks and pits shall be removed and properly disposed of by a Septagn 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: 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 ar a will result in the need for a new soil and site evaluation to establish a suitable replacement area. Replacement systems must comply with the rules in effect at that time. A suitable replacement area is not available due to setback and/or soil limitations. Barr,ng advances i POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. ❑ The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a oil and site evaluation must be performed to locate a suitable replacement area. If no replacement area is availi:Ve 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 iomat 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 ANDIOf INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DI ;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 e LPhone Phone c~ SEPTAGE SERVICING OPERATOR PU PER LOCAL REGULATORY AU711ORITY Name Name / Phone - - n 1_. o? t~-- l 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. C}' 01 ~ i RTER INSTRUCTIONS y' , Installation ST p T pry fit the filter case onto the and of the outlet pipe to ensure it is centered under the access opening. If not, then either insert more pipe into the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. =P 2 While the case is still dry fitted on the outlet pipe, measure the length of Sib-inch pipe needed to brace the filter to the tank end wail if utilizing the optional supplemental side support. If side support method is not utilized, proceed to step four. I TFP 3 For installations utilizing the optional supplemental side support: solvent weld the V4-inch pipe onto the filter case. If side support method is not utilized, proceed to step four, Solvent weld the fitter case onto the outlet pipe. Insert the filter ; cartridge into the case, pressing down until the filter locks into the bottom of the case. t (y- ..cam,. If a VRS switch is utilized: insert into the filter and lock b turnip clockwise 90°. 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 fitter. 3. Pump the septic tank completely, making sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent. i' 4. Once the effluent level has been lowered below the invert of the outlet pipe, firmly pull up on the filter handle to dislodge the cartridge from the case. S. Slide the cartridge up and out of the case for cleaning. b. If a VRS switch connected to an alarm is present, the switch r.t., should be removed by turning counterclockwise 90° and cleaned s with water only. 7. While holding the cartridge on its side (large fiat surface facing down over the access opening, rinse off the cartridge with water only, making sure all septage material is rinsed back into the tank. a. If VRS switch is utilized, replace by inserting into filter and turning clockwise 90°. 4K a. 9. Insert the filter cartridge back into the case, pressing down until the fitter locks into the bottom of the case. , • , 10. Replace and secure the access opening on the tank. it il'e.. ,-qa{:'f: -r. .ire'i , z;:.,.;~s:,., www.bearonsite.com 877-ML€ILTERS (653-4583) 1 1 i bi( MS 3Hl 30 ,6L'6£8! 1S3M 3H.1 30 3Nn 1St13 s - - ^ ,tQ'Qtrl trZ'SZt fiZ'Strt m b9'69l of im 99'Ltrt „ w Si --"-'7 Oa co W -4 W 'Y Y \~lp ,1~r Y z y ! on W x" CZ r, -N co Z8'ZE jU, cn~O v, Nrn0 rn DSO rn ~A-0Ar W 3.0 W0.009 N ° y w co bob -A. 0 c> w H N O A j l W CID O i~ r o v r.a Q ,OL•sat N ~,TiLOL 'ZJ 3.a0tLSoZON - - - _ &9OJ5;.ZOS AM1.80L5oZQS a s V fi~£ 88'96 ~ 60 W.OQS- CI O1 to co (0 0 4b, 03 U) N oCA) (n w -4 es 'a .n Q h1 ; r CO N O . l o i L" o~ rn O C9 s A 101, 1 U CD > c-n 0) 11 0 ITI n G~ fJ cNA j q ~r tp;~ ! ~~c3 N 7p1 QO Ell ~ i W ,99 r } ee y cjD ~ D CC tr r N.. 196' to L - - - ~ - - ,tr t'tr6Z .99 LO'ZEZ t M.Str•E I t t M.Otr,£to00S St! a3( ----i- 4 _ n_ s E3'8E93tM.5tr,M.OOS t ` oo0Oz0 CL -0 co cn cn a n w o - ca w V rn cn ~ ~ ID CD y CD (7 C A 6 v 3 9 w ~cno mo 3 ~=1 Q~c 'CD O O O N O fl cD S Q C!J "j - Ul N W (N,~ N A (~~a A e. w (M CD ca tD C/1 Q co m to O- p N © _ \IM~" v'i Oy W W V W W W W W V p p. co t11 A z p = on {lt t~ CD 0 0 0 0 0 0 0 0 0 0 O:~ C A N Oo 0 a p C'1 - p W S ^'n N w 0 0 0 0 0 0 0 0 0 0 0: p' to N rn CCa f!i ..a j O ~7 (Cp 41 f0 ~ O 61 W -t O m w I71 iv -w m x 5 ~ - w tT Ci Z, (D CD ; U, M t Ql 1 • 0 0 0 f A A i O i j' Cl f.\ C CL CD n C 0 - 2 ST. CROIX COUNTY SEPTIC TANK MAMTENA.NCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/BuYer t LC Mailing Address? Property Address (Verification required from Planning & Zoning Department for new construction.) City/State Parcel Identification Number LEGAL DESCRIPTION Property Locatiox .S~ _ Y. Sec. ~ T ~N It W, Town of , Subdivision Lot # Certified Survey Map # Volume Page # Warranty Deed # Volume Page - Spec house t9) no 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 iu §Corlim. £3352(1) and in Chapter :l2 - 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 tr a licensed pumper veritying that (1) the on-site ,vastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1 /3 fult of sludge. i 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 & 'toning Department within 30 days of the three year expiration date. I/we certify that all statements on this tbrrn are true to the best of my/our knowledge. I/we arn/are the owner(s) of the property described above, by virtue of a T an ty deed recorded. in Register ofDeeds Office. lumber of bedrooms- ~ICNAT )F APPLICANT(S) DATE *"*.Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. Irtclude 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) i 8 1 1 3 5 1 2 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 NW? Holdings, LLC; a Wisconsin Limited 12/11/2012 2:54 PM Liability Company, Grantor, and Oevering omes, 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 ar3, 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. 020-1481-02-000 & 020-1481-03-000 Parcel Identification 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 :'~O+ day of November, 2012. JhNW gaaot LC Member AUTHENTICATION, NAT Y p~ ACKNOWLEDGMENT Signature(s) Ic OF WISCONSIN ) (P ROIX COUNTY. authenticated this 23rd day of November, 2012 '9 O ) ss. Personally came before me this day of November, OF w~ 12 the above named John Parotti , the Member of NWP * Holdings, LLC tome known to be the person(s) who executed TITLE: MEMBER STATE BAR OF WISCONSIN the fore oi4int owledged the same. (If not, 4authorized by § 706.06, Wis. Stats.) Me ee 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 arc not necessary.) *Names of persons signing in any capacity must be typed or printed below their signature 1 of 1 WARRANTY DEED STATE BAR OF WISCONSIN roftn-I No. t-zaul , v.-~ a ~ _ ~ - -•,~t~t, .r-.~ -t- ~ ~ ■p O~ _ • N • ^ ~ G a a~ N 0 S~ tl 6!ti d A S~ ~ ~ ~ ~ N 1S 'I 4 ~ a~ a _ ~ ~ ~ ~ ~ ~ ~ M i r ~ 1 _.,..,.__~_..___.....~..~.~_.~.~._....y.._ a i a~ . _ a-AV R AS ~ r w d r _ f f N wl Lit w r.+.. r. r+r MEN 1 I I , ` PAID Nisconsin Department of Commerce SOIL EVALUATION REPORT e of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code qty c. Attach complete site plan on paper not less than 8112 x 11 inches in size. Plan must ' include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. ZO "~lf~li0 3, percent slope, scale or dimensions, north arrow, and location and distance to nearest road. Please print all information. view Date Personal inforrrration you provide may be used for secondary purpos w, s. 1 (1) (m)). p rty Location Property Owner Pro Govl. i s 1 /45&jl/4 S? T 219N R E (o Property (barter's Mailing Address Lot # Block # Subd. or CSM# J 4 - 5• ~fn Q city fate zip Code P Nu%&~ONtNG Villag ;9TcJWn Barest cad 00, &Jil ( New Construction Use jtesidentiat /Number of bedrooms Code derived design flow rate 4 Q GPD 77 ❑ Replacement ❑ Pubfi or commercial -Des e: Parent material Flood Plaa7yeelevatir 1 licable ~ ft. General cornments / fo ,rte S/~' ~Qf~ 6 S / l and reoorrrrnendedoons: `~vm ,z q4a&d -740 V~ System Type U System Elevation # ❑ Boring a c~S=SoilApplicafion Jpit Ground surface elev. ft. pepth to lirr,iting factor a D in. Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fP `Eff#2 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. N*Eff .r ?3 e 312, 3 S t 2 _ / Z10 iw -/,122 S J ~l PEI Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor 49, g in. Sal 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 i / Sb1~G 16-zed I 0 • Effluent #1 = SOD > 30:5 220 mg& and >30 < 150 ' E8)uent #2 = BOD 130 mgA_ and TSS 130 mglL CST Name (Please Print) CST Number Bird Plumbing, Inc. Shaun Bird 226900 4~e~ Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 715-246-4516 property Owner Parcel 0 # pie of - + ❑ Boring L h J © goring # ~i Depth to limiting factor i" Sal Application Rate r~ Pit Ground surface elev. y f • Roots GPD11P Horizon Depth Dominant Color Redox Description Texture structure h Consistence Boundary 'Eff#1 'Eff#2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. 1o r31v c -5 i n ❑ ❑ Boring # Boring _ Depth to limiting factor in Soil Application Rate ❑ pit Ground surface elev. ft• in. Horizon Depth Dominant Col Redox Description Texture Structure Consistence Boundary Roots •E ff#1 GPDW Eff#2 in. Munseh Qu. Sz. Cont. Color Gr. Sz. Sh. ❑ Boring In. Boring # Ground surface elev. ft. Depth to limiting factor Soil ication Rate ❑ Pit Roots GPDIfE Horizon 'lepth Dominant Cola Redox Description. Texture Structure Consistence Boundary •Eif#1 'Eff#2 in. Munseti Qu. Sz. Cont. Color Gr. Sz. Sh. ' = < ' Effluent #1 =BODE > 30:<_ 220 rrrglL and TSS >30 150 mglL Effluent #2 BOD5 30 mglL and TSS 30 rngiL - 608-266-3151 ed TTY assistance t access . services or The Department of Commerce is an equal opportunity serviceprovider the ide andemployer. need material in an alternate format, please con department SOD-8330 (R.6=1 Soil Test Plot Plan _Proj@ct Name NWP Holdings Shaun Bir Address 573 Cty Rd A Hudson Wi 54016 CST 26900 Lot 3 Subdivision Whispering Oaks Date 10/ /10 SE 1/4 S W 1/4S 7 T24 N/R19 W Township Hudson Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of 1/2" pvc Pipe System Elevation TBD *HRpSameasBenchmark Amber Ridge Drive Scale is 1" = 40' unless otherwise noted 99' 100' B-2 192' 4% Slope 0' .M.* lOB-3 40' 50' B-1 316' Property Line 2 09:39 + Parcel 020-1481-03-000 08/24/201P AGE 1 E 1 OF A 1 P 1 Alt. Parcel M 07.29.19.3052 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): O = Current Owner, C = Current Co-Owner 0 - NWP HOLDINGS LLC NWP HOLDINGS LLC 573 CTY RD A STE 100 HUDSON WI 54016 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ` 1038 AUTUMN OAK LN SC 2611 SCH DIST OF HUDSON SP 1700 WITC Legal Description: Acres: 1.020 Plat: 11-039-WHISPERING OAKS 020-011 SEC 07 T29N R19W PT SE SW WHISPERING Block/Condo Bldg: LOT 03 OAKS LOT 3 (1.02 AC) Tract(s): (Sec-Twn-Rng 40 1/4 160 1/4) 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: 07118/2012 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.020 30,300 0 30,300 NO 05 Totals for 2012: General Property 1.020 30,300 0 30,300 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