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030-2131-39-000
Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County: St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561005 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes (Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No Oeverin Homes LLC, aka Oeverin Pro ertie St. Joseph, Town of 030-2131-39-000 CST BM Elev: Insp. BM Elev: BM Description: Section/Town/Range/Map No. 23.30.20.1093 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER S CAPACITY STATION BS HI FS ELEV. Septic ~Y T,., /a60 Benchmark S Dosing G Alt. BM „-,f S OO ~o ,N.rba Awatien Bldg. Sewer r) i_- ~Gea l~N S ~O Holding St/Ht Inlet 9 St/Ht Outlet TANK SETBACK INFORMATION TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet Septic 7 X60 y /,06 7 _ Dt Bottom Dosing /QQ _ Header/Man. Aeration Dist. Pipe Holding Bot. System Final Grade PUMP/SIPHON INFORMATION Manufacturer ,I~~ Demand St Cover t' I C6~ ZS L, '4L . , GPM Model Number TDH Lift Friction Loss System Head TDH Ft Forcemain Length IDia. Dist. to Well SOIL ABSORPTION SYSTEM BED/TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS SETBACK SYSTEM TO P/L BLDG WELL LAKE/STREAM LEACHING Manufacturer: INFORMATION CHAMBER OR Type Of System: rj ni UNIT Model Number: DISTRIBUTION SYSTEM Header/Manifold Distribution x Hole Size x Hole Spacing Veryfko Air Intake Pipe(s) Y✓ 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 xx Seeded/Sodded xx Mulched Bed/Trench Center Bed/Trench Edges Topsoil ,Yes F_ No Yes No COMMENTS: (Include code discrepencies, persons present, etc.) Inspe. n #1:~7C/~►~) / 1-7/ ZO P Inspection #2: / / Location: 113 Heritage Trail Houlton, WI 54082 (NW 1/4 SW 1/4 23 T30N R/2_0W) SetttWleNrsRGlen L39 Parcel No: 23.30.20.1093 1.) Alt BM Description = r.' I L`" 4-J`~" a 1- 5 o,,,- 2.) Bldg sewer length = /6-, L - amount of cover = O G ~ea~ `ems ~v 5 ►MO(~ y r 30 /f ,El~ev` of 44~ o,- re-6 Plan revision Required? Ful Yes Fwl No Use other side for additional information. L_~~_ Date Insepctors Signature Cen No SBD-6710 (R.3/97) Co1171'tteme.W1.90V Safety and Build Disisi County . 201 W. Washing Z., P.O. ~ i aeo n s n Madison, Wl~ 53707-7162 Sanitary Permit Number (to be filled in by Co.) of Commerce 1 Sanitary Permit Application State TTrransaction Number vernmental Z F 11 5 77JI to go in accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this form to the lt.,4 unit is required prior to obtaining a sanitary permit. Note: Application forms r te- II OWTS are Project Address (if different than mailing address) submitted to the Department of Commerce. Personal information you provide be used"Fi ~bc ndary purposes in accordance with the Privacy Law, s. 15.04 1 m , Stats. r1 • rw 1. Application Information - Please Print All Informatio _ L- ! JJ u ` / Par Property Owner's Narne 2 cel # / ~r_ 411 '2 030-0 Property Owner's Mailing Address f Property Location A (r t-4 /',1, 0 1/1 ? 4 &-1 hwl~ s Govt. Lot • &11,41.5"'/ City, State Zip Code p Phone Number Section 2'-> L / S o! 7 -cam. C~r l~ on~Y `y !!~C tm T N; R > E bf / II. Type of Building (check all that apply Lot # L/ ~or 2 Family Dwelling - Number of Beedroo J _ Q 3 Subdivision Name ❑ Public/Commercial -Describe Use ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of / + ❑ Town of /2 ~r 90 4_+ 6C46:k~_ - III. Type of Permit: (Check only one box on line A. Complete line B if applicable) A. w System 11 Replacement System El Treatment/Holding Tank Replacement Only ❑ Other Modification to Existing System (exPlain ) B. ❑ Permit Renewal ermit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Da Issued Before Expiration Owner /C' 26 IV. Type of POWTS System/Component/Device: (Check all that apply) _ ❑ Non-Pressurized In-Ground ❑ Pressurized In-Ground t-Grade ❑ Mound > 24 in. of suitable soil ❑ Mound < 24 in. of suitable soil ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) V. Dis ersal/Treat nt Area Information: Design Flow (gpd) Design Soil Application R (gpdsf) Dispersal Area Required (s Dispersal Area Prod (so System Elevation VI. Tank Info Capacity in Total # of Manufacturer Gallons Gallons Units v U New Tanks Existing Tanks g , p & U rn rn w C7 i~ O ' Septic or Holding Tank Dosing Chamber )41 - v VII. Responsibility Statement- 1, the undersigned, assn ponsibiifty for installation of the POWTS shown on the attached plans. Plumber's Name (Print) , Plumber' nature MP/MPRCS Number Business Phone Number / ~ ~ ell Plumber's Address Street, City, State, Zip Code '7 Z ~CJ t -P'~-t / U dun < l VIII. on epartment Use Only Approved Disapprove Permit Fee Datc Issued Issuing e t Signature pproved $~5.~ 3~/3 er Given Reason enial IX. Condittptdasons for Disa royal ~1 Js~ ^ / /faO A `$eptic-tank, effluent filter and /1 ~(e" ~J 1~ - ! Aispersal cetl must all be ser*es / maintained M''t' as per management plan provided by plumber. 2. 1111Fs1leakrequVements must be maintained IA Attar to complete p aas r e system and submit to the County ory(y oa rt~nos ss th~ t!i x 111 ac ea io aiic rod A ~ l ~ p/~l r JLlifi ~JL SBD-6398 (R. 01/07) Valid thru Ol/09 / e w` t3 QCf~Yw✓t PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 SW 1/4S 23 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 100.0' BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK 1000 gallons DOSE TANK SIZE 630 MOUND SEPTIC TANK SIZE HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none - BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 1001 ❑ BOREHOLE O WELL *H.R.P. same as benchmark Heritage Trail 360' Property Line 3 Acre Parcel Scale _ 1 4° _ 10' B.M.* 99.5' 100, 100.5' Grading is to be done B-1 to divert run-off away from system 2% Slope Pro 3 Bedroom House B 3 Huffcutt Combo Tank Tank is to be properly p bedded and provided with lockdown covers B-2 with approved warning labels Area 15' below system is to remain undisturbed 36' Property Line o,TAR rrQ Safety and Buildings 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 3 ` Contact Through Relay 1 9 y www.dsps.wi.gov/sb/ 16 t_ - .~w www.wisconsin.gov srorrPVS Scott Walker, Governor Dave Ross, Secretary February 22, 2013 CUST ID No. 226900 ATTN: POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL PLAN APPROVAL EXPIRES; 02J22J2015 Identification Numbers Transaction ID No. 2211574 SITE: Site ID No. 786677 Oevering Homes Please refer to both identification numbers, 113 Heritage Trl above, in all correspondence with the Town of Saint Joseph easy St Croix County NWl/4, SW1/4, S23, T30N, R20W Lot: 39, Subdivision: Settler's Glen FOR: Description: At-Grade, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1405086 Revision; Maintenance required; 450 GPD Flow rate; 37 in Soil minimum depth to limiting factor from original grade; System(s): At grade Component Manual, Version 2. 0, SBD-10854 (N.03/07), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s. 145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and wit a f l%ound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N~ "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment S to SICI'f3 SBD-10706-P (N.01101). ' * "l { The building sewer and distribution network piping shall be of material listed in Table - V d. 384.30-5, Wis. Adm. Code. In the event this soil absorption system or any of its component parts malfunctions so as to create a filth hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must comply with the operation, maintenance and monitoring duties as described in section VIII of the mound component manual. A copy of this information must be given to the owner upon completion of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). SHAUN R BIRD Page 2 2/22/2013 Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/insWiation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sincerely, Fee Required $ 85.00 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2, Integrated Services Payment Submittal. (262) 397-6005, Fax: (608) 283-7481 WiSMART code: 7633 j ulia.lewis@wisconsin. gov cc: Charles L Bratz, POWTS Reviewer Il, (608) 789-7893, 7:45 am - 4:30 pm Monday - Friday 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 Cover Page FEB 19 2013 INDUSTRY SERVICES Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 1/10/13 Owner: Oevering Homes Location:NW1/4 SW1/4 S23 T30 N,R20W 113 Heritage Trail St. Joseph System type: At-Grade Manuals Used: At-Grade Component Manual version 2.0 SBD 10854 (N. 03/07) Pressure Distribution Manual version 2.0 SBD 10706-P(N. 01 /01) Page# 1. Cover Page 2. At-Grade Plot Plan 3. At-Grade Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-11. Soil test 12. Filter SpeciLns Shaun Bird Signat License number 226900 'r PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/'4 SW 1/4S 23 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 100.0' BEDROOM 3 CONVENTIONAL AT-GRADE XXX CONVENTIONAL LIFT HOLDING TANK MOUND SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE .5 ABSORPTION AREA 900 # of chambers none BENCHMARK V.R.P. Top of survey iron ASSUME ELEVATION 1001 ❑ BOREHOLE O WELL *H.R.P. same as benchmark Heritage Trail 360' Property Line 3Acre Parcel Scale _ 1/4" = 10' B.M.* 99.5' 100, 100.5' Grading is to be done B-1 to divert run-off away from system 2% Slope Pro 3 Bedroom House B-3 Huffeutt Combo Tank Tank is to be properly ❑ bedded and provided with lockdown covers B-2 with approved warning Area 15' below system labels is to remain undisturbed 36' Property Line At--grade System Sloping Site Cross Section and Plan View , l; Dimension Feet - ■ ■ ■r■r•r r r•r+r r j•J■r•r•r■r■J+r r r j.j•r•r•r r j•r•r r r• ' A 2- L•L L•S L S•S•'tirS•'L`''SL~"M14•S6~'M14, 4 ti ti ti "SL "Lw L"L ti"'S'"S''Ry'4~•S■11.1■•1■.'L•SyS•S 'V,•S•S•M1 S+L• _ I tr+r•r•r•r•r■r•r•r;'r•r •SrS•S■S■L■".•S•S■M1 L ■ " ■ , L■ S+S•L■'L•M1•'L•'L•9■■S■S•S•S M1•S• B I ':''~r'•Lrti ti'LfS.~+q.y'irry:'L+".~~'.~'•L~5~r1■+'1~~'L~1■~'LrS~Lr'L?SfSrSr'kx"rSr~■j■r•r•r+r•.f'.if.j•j.r•r r•r• :'1.•L:1.~Li'L~'L:'LiS~SrM1•L S~%Sr4~LJL%~LrL~'L:SfL+L~4:L■,L,L■S:'ry,•ti':L':S'r:'I'y:Sf1~'~'■LrM".~5.r•'LrtirrL'L~ I -----06 B--- L•L■L•S•L•S•L•'V.■YL+'~•'+•'~•';•h'•;'+S•ti'•L•S•L•L•S•S•S•S■S•S•L•S•S•S+S•L•S•S+S•L•S•L•S•S+~ y ,r,j.j.r.j•r•j.r.j•j+r.r r r j.j■j,~"l■•1..jM1•r•J 1■j.j.j+J.J ~•J•r•.r•J'J"r'r"'t"r"'"J` I r•J J S.r~ '"`'.r,1.+`L~S~SfL~L'`.•S..td1.•S•L■L•L•S''1"'"'''S'■'S'`'Si•S`S''~,S"S"~`••5'•S+5'rS`L■+~■ I w'4,:'L~,L•'1,'ti,•''L:•L:1.:'+.': I r+r,r•j•1•r•+r'•r•J•r•r•r+j•j•.'•j■r•r~r r•r r•r•r•j•j•j•J•j•r•J•r•J r Jtit! i .L. ,.L•'S. 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Z - - 1 = Plowed IN ~ Clean aggregate 0 - 4 in. sch. 40 pvc I I M1.M1, basal area r;:';■• '/z to 2'/z in. dia. observation pipe Lateral with 2" Topsoil Crap aggregate over pipe Observation Pipe With Cap Geotextile G Fabric .j. I~ r JLrLJ l'l. Lateral Invert M1.ti ~•~.M1+L Topsoil Cap r+J ,"r•r r•r•r+ ■r:r+r■r•r•r~rr•r• II S+'fi•'L•'L•S•1■S•SyS S•M1•S•S S S ~"~'"i", ■ ~.5,j~~1~~j~~1'~r■r~r r•L~~r'Lj''.rU;'RK-'1%r~r~:L r J r,r•J.r.r+j•r.,' it r■r r~r;r.r.r.r_•+rsr S L+'L•L•S•S•L•S•S .F S■ . r+~ .J..r;r.j.j.r■r■r + r r Ft t,OCCtOUr M1r L"L,M1.L■M1. , ~L•LyS•L ~po, S7 •r r.j•r•r•.r r•r r I J L S L•S•L L S L. S S l ~l ,•'.:.x :r:r r■r~r:r•r■."•r■r r•J J r r r r '{:t !4~S+S~S L■S■L■S•M1 S•'{"M.S•'yr'L' I I t D Plowed Surface Slope Direction __-4. GENERAL INSTALLATION: The at-grade area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The basal area (l., x W) is staked out and plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a. '/f inch soil wire when a sample is rolled between the palms of the bands. The A x B area is covered by clean aggregate deposited overhead by a backhoe.. Special care must be used when placing the aggregate to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire at-grade is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are perforated in the lower 6 inches secured and 03/05 lgj Page - of - Pressure Lateral Layout One Lateral - End Manifold J Threaded Cleanout. Lateral "Turn-up Plug Force Main - L Long - - - Sweep 90 Bend ------Pressure System C"anstructiou llistri'bution Network S ecifications trlYCted of Schedule 40 l -ln. Laterals are cons WC Lateral lliameter 5 In. pipe. Orifices are drilled perpendicular to orifice Diameter In the pipe with a sharp drill hit and -face down. - - - X (Orifice S acre ZS Lateral turn-ups terminate with a threaded Ft. L (Lateral Len thL_._. In. cleanortt plug and are enclosed in a 6-8 inch Force Main Diameter pt. diameter lawn sprirrizler valve box accessible Force Mir eL nth From finished grade. •0••• Grade 6-8 Inch. Lawn Sprinl -ler Valve Box forage 03105 lgj i Septic-Dose ank Crass Section An Pump P+erfonnance Specifications 1'ac,k Manufacturer Pump IvCarnufactarer A~ N...._...., Pump Model Number ~Tatik !viola! Number - Alarm Total Tank Capacity r- Alarm Model Number vlVYaX. Depth 3 Switch TYPO - 7"ot DEG bead (TDD)^- Feet Filter ~actarer i _ /d Filter W0&1 Netvvat'k Toss _ uired Force Main Loss Minimum p ~erFormance iteq CrpM Pt TDH Total S ` 3. - pudet Manhole dun. 400 Above Grade With Manhole Min. 4" Above Grade Looking D04100- Inlet Manhole Securely Momted With Locking Oev ice L Ci" I3eYoW Cirde Sear Watertight Weatherproof Junction Box saw FWqhed6m& uMU YYYW Went Min. IT' Disconnect Above Grade Means '11l►ith vent Cap ' Y Y Y Y Y{y iY{YiY{.,YYYiiiYaYLYV`apY~a~aiiYVYiyi`.YYiY1 Y i ' +„I, YV • L L i YiY y YY Yy YyYi yrolLyLiYiYiYa`iYa'i`ai , .~YYYi i~{, Yi ~~ii,~~.ryrL iw et H Irde Ya~~ +`YY ♦p ,~Y YaYY iY+' i'i.. YiY 1/411 y r+ sY i avacity Switch Wool) Y { i I1 ikVo 'V'olume Gal. yY~, D1 n: Yncl ,,t ~Ye3sYVC~ AY ! ' Owelevafion rr 3 Ft Epttom (dose) G 7, Elevation D Y . ' y (dead) D F1. V 3 V i YyL,.,YV YLiY.:Y IY.Y rY: i .~ww'^'.~r.w"'wW. +y+Y s /YiY YiiYi Yi YiiiY~Yi6~ YYa ,~yi - ,.~.-~y~-• R_,iY'r.i-•C'r''rb_i i Y i i i Y~ YJ°i YVr4yiy+YiifiiiYLiii Y~L,i,Y~iVii i r i i i i i 1 i 1 i i i i Y i i .~.~..~c-Y , L Y YiY Y Y<Y Y Y 1 i a 1 i a { I I a a Y iiiYiLiYYL~Y~Ya V V i i V 1 a i i< the •`I`i c'-i.~..y-~-~i-i'i~ V V• T -i'i J it Y YiYiIs j aroi <yi aY iLiYf`iiiro iri°aYVYVYayiY irVYlyaY YiYiY+Y iYiYiY~Y~ ~ 6 Y'~ 61L ~ i i { { { i i f - ~ W ~t1Yry ii tfLW Idoga tank is bedcWd and baoh. filled in accordance ~Yy, optic OW munutacture I may not CANERAt, INSTALUXI()r4± umum depth o 'fury as. $ cifiod. b lock) nn effective ioeking dev" ~ grand y rodwA spprOval slwif i"CI rns. Mast' Iv' manufacturer s p !Manhole covers expos to gr tank `W t►gh wilh be, exceeded ~witho~ut pxior app~• aver! rnatiorialy conne+~tod tothe „ Soh. 40 p1IC to bridge the tank ir►stalled, piping at the h4a, and outlet is of ail r or g• force main is 9lo~'sd with laid an stable soil IQ ant s U lte9 NEC, 300 and COMM 16.23. "oy1 and tl+e sleeve. ►.s sealed ~►atert~~~Y El~`sc~►l :son►ive comp . e7LCavarl Pn910 - Of 02105 U V LaserJet 3100; 1 11b bb"' tf02 ! rvldy-.I-uu c.vuriri) ' uy., 9 EH SERIES SU1AP/EF"F"LUENT PUMP .r,.._____.__..~__.___..,_..._.._.... 11.85 • •-_----.~-.w__~ C) Specifications w mm wow MQNM11/CFI1lIF~ ! Ow w. I Wil 19 a1wM1 Mm VA ta>tr1 1r 1AUS ft.w 1 1 V It tt W MI - 47 1;! iB.U w 24 9.11 z 11.41 Kd.91 503330 UTASA 41?0 115 314 11.(1 11100 JU 54 55 gC 0.11 w 11.64 X1.94 3k11 QM 6-5 1000 70 54 55 41 32 18.0 .11 11.04 w 8J4 0a1 pM11 M340 OUGSR N' a 280 8A V4 1 41 8A 11.8 20 27 t+7 3 8 r 1.34 ~ &0 1000 70 d4 55 .11 X11.649 91N-0A AFS 50&150 UUC6A 4; 0 115 r 11 /3. 0 b.6 1 711 qui- 5 fislredr~WrUslalries9iwmOS.` Go1~0ou5 0u11'Ra1ed -"liltk Wmtwasldwaierowmsararatedeoa5n0au5tWtYU bmO~t~l'~runwithlntl~ construction__ FLUW- LirEcrSMUOIR ]Vlot4r Hvusm - _ xy C;oated Cast irtro 0 U100 2000 poly Carhoflal[c ~L L~ _1 l_ Impeller Matenai- - - -y - ilxe eller'P ~ Clost'4! V'ane.___...... . 7,5 iVlt chuuical shaft Sea[ "itriie with carbon and W ceramic fi►ccs ti za - 'Z: - erg - nlelss Steel W Steel.,.----------- Slzafi to- - _ E!_5 13earcittgs Upper Sleeve wid Lower Hall Bearings 1r u r a ~n ao Ea so y j F LtIV - GALLCINS/NINUTC. ■ Lithe, '~it~ir>ut M MP MP co- NEE I'URV E d'() Box I3flta, Okfabows City. ()K 93157 _ 115V 6UHT P4ons:4U5.'14r/.25t1 1t19.228.15511 + f L lEmrih cuxrowarsewlr~uKt~rotxoro t/ • 4 F4xm 495235 -.07103 vt WW 1LittjcGlaatPumpr-CO4" 1 POWTS OWNER'S MANUAL & MANAGEMENT PLAN Pa9e__ SYSTEM SPECIFICATIONS ILE INF!ORMATtON Septic Tank Capacity a( 11 NA owner LP~ # Septic Tank Manufacturer e p NA DESIGN PARAMETERS Effluent Filter Manufacturer 13 NA Number of Bedrooms p NA Effluent Filter Model ❑ N,4 NA Pump Tank Capacity ee; 3" gal 11 NA 43 Number of Commercial Units- Estimated flaw (average) da Pump Tank Manufacturer 11 NA L.~. Design slow (peak), (Estimated' 1.5) aVda Pump manufacturer _ ❑ NA ❑ NA Soil Application Rate galldayW Pump Modal Montht average" S~d/pretreatment Filter [I NA Grevel Unit Influent/Effluent Quality Monthly Peat Filter Fats, Oil & Grease (FOG) 530 mg/L p Mechanical Aeration ❑ Wetland Biochemical Oxygen Demand (BOOS) 5220 mg/L ❑ Disinfection El Other. Total Suspended Solids (TSS) 5150 mg1L Manufacturer Pretreated Effluent Quality - --"NA Monthly average" -5ispersal Cell(s) 530 m/1- 11 In-ground (gravity) ❑ In-ground (pressurized) Biochemical Oxygen Demand (BODs) g oun Total Suspended Solids (TSS.) 530 mg1L -grade 0 0 Mound _ Fecal Coliform (geometric mean) 510` cfu/100ml ❑ Drip-line --Other: Maximum Effluent Particle Size _ Y. inch diameter A Values typical for dornerstic (non-co nmercla~ wastewater and septic tank effluent. Values typical for pretreated wastewater. MAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every Y- ` ❑ months -91,year(s) J(Maximum 3 yrs.) T Pump out contents of tank(s) - - When combined sludge and scum equals one-third (Y3) of tank volume - inspect dispersal cell(s) At least once d months 76year(s) (Maximum 3 yrs.) every Clean effluent filter At leas Inspect pump, pump controls & alarm t once every ®manths~jj-~'~ year(s), At least once every - ❑ months'/Ryear(s) 11 NA_ - At least once every 0 month,-Year(s) ❑ NA - - Flush laterals and pressure test pn1B1 At least once every 0 months ❑ year(s) 1 aver- L t least once every G months 11 year(s) ❑ NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal cells shall be made by an Individual carrying one of the following licenses or POWYS inspector, POWTS Maintainer. Septage certifications: Master Plumber; Master Plumber Restricted Sewer; Servicing Operator. Tank inspections must include a visual inspection of the tank(s) to identify any missing or broken hardware, Identify any cracks or leaks, measure the volume of combined sludge and scum and to check for any back up or ponding of effluent 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. The ponding of effluent on the al ut ority- ground surface may indicate a failing condition and requires the immediate notification of the local regulatory When the combined accumulation of sludge and scum in any tank equals one-third (Y,) or more entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of in accordance with ch. NR 113, Wisconsin Administrative Code. The servicing of effluent filters, mechanical or pressurized POWYS components, pretreattment components, and any other maintenance or monitoring at irftervals of 12 months or less shall be performed by a certified POWYS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event- START UP AND OPERATION For new construction, prior to use of the POINTS check treatment tank(s) for the presence of painting products or Other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. ----ST.4.RT UP AND OPERATION Page Of,-.-- For- new construction, prior to use of the POI IMI-S check treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process andlor Zmage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. Systern start up shall not occur when soil conditions are frozen at the infiltrative surface. Durinq 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. I o avoid this situation have the contents of the pump tank removed by a Septage Servicing Operator prior to restoring power to the effluent purnp or, contact a Plumber or POWTS Maintainer to assist in manually operating the pirmp controls to restore normal levels within the pump tank. Do riot drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or othenvlse 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; nil; 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 take, i 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 • 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. (aken, to provide a code compliant replacement system: El 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. CI A suitable replacement area is not available due to setback and/or soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation 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. und and at-grade soil absorption systems may be reconstructed in place following removal of the biomat at the infiltrative scrrface. Reconstructions of such systems must comply with the rules in effect at that time. <WARNING>> SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DIHATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE, ADDITIONAL. COMMENTS POWTS INSTALLER POWTS MAINTAINER Name r.~ - Name 1 Eel r - - - - Phone Phone SEPTAGE SERVICING OPERATOR UMPER LOCAL REGULATORY AUTHORITY JName Name Phone J - - Phone 7L i his document was drafted In compliance with chapter SPS 383.22(2)(b)(1)(d)&(f) and 383.54(1), (2) & (3), Wisconsin Administrative Code. V&Cbnsin Department of Commerce SOIL EVALUATION REPORT Page of_ Division of Safety and Buildings in accordance with Conlin 85, Wis. Adm. Code County Attach ctxnplete site plan on paper not less than 8 i/"l x 11 inches in size. Plan must include. but not limited to: vertical and horizontal reference point (BM), direction and Parcel l - - 0 percent slope, scale or dimensions, north arWw, and location and distance to nearest road. r 07 Reviewed b Please print al! iniormai"ir~rr. ~v- Y n erg Personal inforrnaiion you provide may be used for secondary purposes (Privacy Law, s. i 5-04 (1) fir)). Property Owner Property Location rr } 1 c Govt. Lot 1 /d,_-l4) 114 S -el T N F2 C, (j_ E Property Owner's Mailing AddqgWs Lot W riloclc # Sutxl. Name CS '1# city state lap Code Phone Number _ _ t city (7 Village Town Nearest Road t Construction Use' Residential / Number of bedrooms Code derived design flow rate UPI-) 0 (Replacement Public or curnmertjal - Describe: Parent material - f=lood Plain elevation if applicable ft. General ccrrnments and recurrmwndations: 5 stern 'C e . - - - ~a .~ysiern Elevation -AM _ Boiling At 11 Boring ~ . ~ pit Ground surface eleV4!Depth to limiting factor in. Soil ~Ppjlckqlon Rate Horizon Depth Dominant Color Redox Description •rexture Structure Gonsistence Boundary Roots _ _GPD/W in. Munsell Qu. Sz. Cont. Cdor Cyr, Sz. Sh. •Eff#l 'Eff r2 9-12 '40,- 31 z- _Z7 /oo/4- J4 - - e Boring# RIP30itririg If J II Ground surface elev.lew, Zft. Depth to limiting factor in. Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary _ Roots GPr_W in. Munsell Qu. Sz, Cont. Color Gr. Sz. Sh. 'Eff#1 `Eff#2 -7 r I F-Muent #1 = SODS > 30 < 220 mg/L and TSS >30 < t5o ~Effluent #2 = BOD < 30 mg/: and TSS < 30 rng/L CST Name (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Ci 'hate k valuation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 , 715•-246-4516 TER LARTRIDGE INSTRUCTIONS r' Instalation STEP 3 pry fit the fitter case into the erect 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 wend (glue) additional pipe onto the outlet pipe. , Fp 2 While the case is still dry fated on the outlet pipe, measure the length of 44-lath pipe "ceded to bracts the filter to the tank and wall if utilizing the optional supplemental side support, If side support method, Is not utgzed, proceed to stop four. s•r i.c* :t For instadattons utilizing the uptlond) supplemental side support, solvent weld the M-inch pipe; o4o the filter case. If side support Method is not utilized, proceed to step four. +.4. •~W N.VyR~ 1 solvent weld the fitter ease onto the nutlet pipe. Insert the filter cartridge into the rase, prossin I rdoWn until the filter locks into the bottom of -1, this case ;by' If a Vit5 switch is utiii;,xyd: insert into the litter and lock by turning r'`• clockwise 90°., .r;t,;z+; ,3•,' Maintenance 1. 'fhe effluent filter should be cleaned every time the septic tank Is serviced. z. open the outlet access operhig to inspect the tank and filter, 9. Pump the septic tank completely, making sure to rwreave the siudge layer on the bottom of the brnk and not Just the scum and effluent. 4, once tore effluent level has been towered below the invert of the uutiet pipe, firmly pull up on the niter handle to dislodge the r., cartridge from the case. 5. Slide the cartridge up and oltt of the case for deaning. 6, it a VAS switch connected to an alarm is present, tile 5Wjtr:h should be removed by turning countenclockwise 901 kind cleaned i. r'. with water only. :,t +A 7. While holding the cartridge an its side (large flat surface facing n} down) over the access opening, rinse off the cartridge With wale e only, making sure an septaqu material Is rinsed bad[ into the tarok. r • 8. if VRS switch is utilized, rwowce by inserting into liner aril - - ' turning clockwise 901. $ irli 9. Insert the filter cartridge back Into the case, pressing down until the filter locks into the bottom of the Case. IO.Repiace and secure the acce&s utreMng on the tank. e i:'ifr :,:°;"'+li" ~0.rt "dC ;rMr{! rV~r;i ..'V n,'tfr9tiM '•N~i:f•L1.Y"' AdL wwwbeamnsft.ienm 877-MLPILTIEkS [653-454* I y~ '~'r t, ~`ti gFt _t 1;~: ~N. ^v^': 4 -y^ Wisconsin Department of Commerce,1[ SOIL EVALUATION REAOPT, Page l of Division of Safety and Building 4 in acpordancewith Comm 85, Wis. Adm. Code ` County 1 y- t Attach complete site plan on pa r koltle than 8 1/2 x 11 inches in size. Plan must include, but not limited to: vel' Wand horizontal rrence point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north d location and distance to nearest road. O-ZTD Pie-.! nt all information. Re 7we Date v~ Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). / / (l Property Owner r"~J4= Property Location Q Govt. Lot 1/4_f4)1/4 S2 T N R Z_p E ~;Z &:!n ~ 4 "-f A.J Property Owner's Mailing Addqd~tfs Lot # Block # Subd. Name CSM# City State Zip Code Phone Number [:1 City C3 Village Town Nearest Road Construction Use- Residential / Number of bedrooms Code derived design flow rate a 2 GPD ❑ Replacement Public or commercial - Describe: Parent material ~:2 Flood Plain elevation if applicable J General comments and recommendations: System Type System Elevation a. 0 ❑ Boring F-/1 Boring # [ ~G pit Ground surface elev 7' ft. Depth to limiting factor ✓ in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 -1 /0,,,3/z- 2- _ ©ng # RBoring AV- Pit Ground surface elev. _Zt. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 Effluent #1 = BOD > 30 < 220 mg/L and TSS >30 1150 ' Effluent #2 = BOD < 30 mg/L and TSS < 30 mg/L CST Nam (Please Print) Si CST Number Bird Plumbing, Inc. Shaun Bird 226900 Address Date Evaluation Conducted Telephone Number 1008 192nd Ave, New Richmond, WI 54017 _ 715-246-4516 Property Owner _ Parcel ID # Page of a Boring # ❑ Boring S/ Pit Ground surface elev.- ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fF in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 •Eff#2 12 31, ,S - n^ Gam) 1 i✓ , ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 ❑ Boring # ❑ Boring ❑ Pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon ')epth Dominant Color Redox Description. Texture Structure Consistence Boundary Roots GPD/ff in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 •Eff#2 Effluent #1 = BOD, > 30 < 220 mg/L and TSS >30 < 150 mgA- • Effluent #2 = BOD, < 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an altemate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (8.6(00) . I ' Page °f - lb#__.. Parcel property owner - Boring ft Oozing # Ground surface elev. . Depth to limiting factor in. l 131 !mil Pit _ ` - _ _ _ t2oots d GPDfti` n De e Boundary°Cff#1 `t tt#2 C)orninant Color itedox Description Texture Structure Consistenc Horizo Gr. 5r. Sh, - Ciu. sz. Cont. Color 11Aunsell - In. C! S' ~7 j rte} , j Boring # Baling Depth to laruting factor in, Soil A )licalion Rate Ground surface elev. ft. V-- - _ - GP L J Pit LIlft - - - - Roots Consistence boundary Depth bonrirrrwrt Color Rj x Desuiptior~ Texture `Etf#1 `Ettw Horizon - 5z Cont. Color Gr. . Sh. in. Munsell Rate goring in. rcatlon ry Boling # t I Ground surface elev. Depth to limiting tadwr , _ Soil GPON----- - L_ _ t_s Pit a Roots Redax Descxiptian. 'Texture Structure Consistence Bound rY •Ett#1 'l:tf#Z Horizon 9epth DorMnant Color Gr. sz, 5h. in. MunseH C1u. Sz. Cont. Color EHluurrt #'L =13C7U5 !S 30 nom- and TSS_<., 90 mgfL "Effluent #1 = BODr y 30 220 nrglL and TSS 5'30:S 150 "'0& The Department of C o. 'rl y L603-264 87 n services (11" omntercc is an equal opportunity service prto department at 608,266 3151e department need material in an alternate format, Please contact tt s"W"330 (ROW) r Soil Test Plot Pla Project Name Oevering Homes LLC S Bird Address 1433 Cernohous Ave Suite A New Richmond Wi 54017 /~~SiM #226900 Lot 39 Subdivision Settler's Glen Da Ye 1/10/13 N W 1/4 S W 1/4S 23 T 30 N/R20 W Township St. Joseph R Boring Q Well PL Property Line County ST. CROIX BM or VRP Assume Elevation 100 ft. Top of Survey Iron System Elevation 100.0' *HRpSameasBenchmark Scale is 1" = 40' unless otherwise noted Heritage Trail 360' Property Line 3 Acre Parcel B.M.* 99.5' 100' 100.5' B-1 2% Slope B 3 B-2 336' Property Line - com+xtsrce.wi.$utr Sai'ety and Buildings Division County. - T s r~ 201 W, Washington Ave., I'.0, llcex 7162 Madison, Wl 53707-716? r s„nxu~ „ 1eparttmeatotCommerce Y un:a[ N//u~~r//,L~~cCC~~w Iw nnu,t in by .:_o.) Sanitaryy Permit ApplicationState lransrwttunNu+nber - , accordance with s- Conan. 83.2 1(2), Wis Adm. Code, submission of this form to the p Opria3tagaverncrl' n h L V "'f 7~ unit is required prior to obtaining a sanitary Permit. Note: Application forms for state- Project Address {if different than mailing addrt ss)"- s tbmitted to the Department of Commerce. Personal information you provide may be used Ibr wooliqii r _purposes in accordance with the Privacy !,Ls. 15.01(1)(m), Stats. 1. Application Information - Please Print All Information Property Owner's Nume - - Parcel d , 030 -.39 P'operty Ownet•`sMal'ItrrgAddress MV0 - , _ Property l.ouuliurt ~Jy ~I. < D 5 -z> 11-0 Govt. l 93 401 City, State Gip Coe Phone Num A A Y., section D `ircAL one) to l 7a -130 '7i I1. Type of Building (check all that apply) Lot N, Ii is o` W - 2 Family Dwelling- Number of Bedmo Subdivision N 441e. lol. -24, Z("- L Public/Commercial - Describe Use _ ❑ City of.--__-- ❑ State Owned - Describe Us / CSM Number ❑ Village of X 5 III. Type of Permit: (Check only one box on tine A. Complete line B if applicable) - ew System ❑ Replacemiad System El Treatment/Holding Tank iteplaeement Only U Other Modification to Existing System (explain) B. ❑ Permit Renewal ❑ Permit lteVision ❑ Change of Plumber ❑ Permit Transfer to New list Previous Yenidt Number and Dale lssued Before Expiration Owner I\'. Type of POWTS System/Compoornt/Device: Check all that a l ❑ 'Non-Pressurized In-Ground ❑ Pressurized In-Ground ❑ At-Grade and > 24 in. ul'suitable soil U Mound r 24 in. of suitablL soil ❑ Holding Tank ❑ Other Dispersal Component (explain)-___-_----.----- 777ly-el-re-agn-MMevice (explain)- V. Dispersal/`freatment Area Information: D, si Flow (gpd) Design Soil Applicmior te(g dsf) Dispersa Area ltequir (Sf Dispersal Area Pro ed (st) S stem Elevation V 1. 'Panic Info Ca,mcity in Total # of Manufacturer Gallons Gallons Units o `d U New Tanks - - Existing TaAb DD 2 a -,u ? a Septic or Holding Tmdc - - - - - - Dosing Chamber y`- 3 0 - - V 11- Responsibiiity Statement I, the lrndersigned, assn risibility Yor installation of the POWTS shown on the attached plans. Plumsbw's ume (Print) Plumber' lure Mp/MPRS Number 13usrness Yhorn(~N~umber / Plumber's Address (Street, City, State, Zip( ode) VIII. uo nt 1De artment Use t Approved ~ Permit Fee Date lsjtued Issuing t Signature ❑ Di sap hven lorDenial $X25 .06 117;~/~Z - N. Coud~j6Wq@eRewonfi 1*0 Disapproval 3 Q J. (b ~ e ~~dw 1. Septic tank, effluent filter and ~D i nn dispersal cell must all be services I maintatng r' l r a; t.t. c ~D r.rt~l . as.per management plan provided byplutnbeR 2. AU se(back requirements must be rnaintttAcl / t p t n / as per appflceblecode / ordinartcet:. r t Attach to compiele plans for the system and submit to the County only ou era less t n s trc a t c r SBD-6398 (R. 02/09) PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 SW 1/4S 23 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 95.5' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of nail in tree ASSUME ELEVATION 100' ❑ BOREHOLE O WELL * H. R. P. same as benchmark Heritage Trail 3 Acre Lot Scale = 1/4" = 10' 450' Property Line Pro 3 Bedroom Tank is to be properly House bedded and provided with lockdown covers with approved warning labels dell is to meet al I DNP setbacks Area 15' below system is to remain undisturbed Grading is to be done to divert run-off away B-2 from system 95 B-1 2% Slope B-3 System is to be installed 94.5 along the contour 94.5' 94.4 B. M.,* 1 Property Line 220' exRT A Safety and Buildings 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 Contact Through Relay www.dsps.W.gov/sb/ www.wisconsin.gov ~3i011P~ Scott Walker, Governor Dave Ross, Secretary December 10, 2012 CUST ID No. 226900 ATTN.• POWTS Inspector SHAUN R BIRD ZONING OFFICE BIRD PLUMBING INC ST CROIX COUNTY SPIA 1432 120TH ST 1101 CARMICHAEL RD NEW RICHMOND WI 54017 HUDSON WI 54016 CONDITIONAL APPROVAL Identification Numbers PLAN APPROVAL EXPIRES: 12/10/2014 Transaction ID No. 2184716 SITE: Site ID No. 786677 Oevering Homes Please refer to both identification numbers, 113 Herirage Trl above, in all correspondence with the Town of Saint Joseph agency. St Croix County NWl/4, SW1/4, S23, T30N, R20W Lot: 39, Subdivision: Settler's Glen FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1405086 Maintenance required; 450 GPD Flow rate; 24 in Soil minimum depth to limiting factor from original grade; System(s): Mound Component Manual - Version 2.0, SBD-10691-P (N.01/01), Pressure Distribution Component Manual - Version 2.0, SBD-10706-P (N.01/01); Effluent Filter The submittal described above has been reviewed for conformance with applicable Wisconsin Administrative Codes and Wisconsin Statutes. The submittal has been CONDITIONALLY APPROVED. This system is to be constructed and located in accordance with the enclosed approved plans and with any component manual(s) referenced above. The owner, as defined in chapter 101.01(10), Wisconsin Statutes, is responsible for compliance with all code requirements. No person may engage in or work at plumbing in the state unless licensed to do so by the Department per s.145.06, stats. The following conditions shall be met during construction or installation and prior to occupancy or use: This system is to be constructed and located in accordance with the enclosed approved plans and with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.01/01)^d the Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systemsll7&2.0" SBD-10706-P (N.01/01). r The building sewer and distribution network piping shall be of material listed ia 30-3 and 384.30-5, Wis. Adm. Code. O In the event this soil absorption system or any of its component parts malfunctions so as to G~eate a health hazard, the property owner must follow the contingency plan as described in the approved plans. In addition, the owner must comply with the operation, maintenance and monitoring duties as described in section VIII of the mound component manual. A copy of this information must be given to the owner upon completion of the project. All holding/treatment tanks are to comply with SPS 384.25(7)(a). SHAUN R BIRD Page 2 12/10/2012 Maintenance information must be given to the owner of the tank explaining that periodic cleaning of the filter is required. Access to the filter for cleaning must be provided per SPS 384 product approval conditions. A Sanitary Permit must be obtained from the county where this project is located in accordance with the requirements of Sec. 145.135 and 145.19, Wis. Stats. Inspection of the private sewage system installation is required. Arrangements for inspection shall be made with the designated county official in accordance with the provisions of Sec. 145.20(2)(d), Wis. Stats. Owner Responsibilities: • SPS 383.52 Responsibilities. The owner of a POWTS shall be responsible for ensuring that the operation and maintenance of the POWTS occurs in accordance with this chapter and the approved management plan under s. SPS 383.54(1). • SPS 383.52(2) A POWTS that is not maintained in accordance with the approved management plan or as required under s. SPS 383.54(4) shall be considered a human health hazard. • SPS 383.55 The owner is responsible for submitting a maintenance verification report acceptable to the county for maintenance tracking purposes. Reports shall be submitted at intervals appropriate for the component(s) utilized in the POWTS. A copy of the approved plans, specifications and this letter shall be on-site during construction and open to inspection by authorized representatives of the Department, which may include local inspectors. All permits required by the state or the local municipality shall be obtained prior to commencement of construction/installation/operation. In granting this approval the Division of Safety & Buildings reserves the right to require changes or additions should conditions arise making them necessary for code compliance. As per state stats 101.12(2), nothing in this review shall relieve the designer of the responsibility for designing a safe building, structure, or component. Inquiries concerning this correspondence may be made to me at the telephone number listed below, or at the address on this letterhead. The above left addressee shall provide a copy of this letter and the POWTS management plan to the owner and any others who are responsible for the installation, operation or maintenance of the POWTS. Sin v, Fee Required $ 250.00 This Amount Will Be Invoiced. When You Receive That Invoice, Julia Lewis-Osborne Please Include a Copy With Your POWTS Reviewer 2, Integrated Services Payment Submittal. (262) 397-6005, Fax: (608) 283-7481 WiSMART code: 7633 julia.lewis@wisconsin. gov 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. , 4 . Cover Page Shaun Bird Bird Plumbing Inc. 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 12/ 5/12 Owner: Oevering Homes Location:NW1/4 SW1/4 S23 T30 N,R20 W 113 Heritage Trail St. Joseph System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-12. Soil test 13. Filter Specifications and r s section Shaun Bird F Signature . e/J License numbe 6900 C;VO !v/~c1P FLC'. PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 NW 1/4 SW 1/4S 23 /T 30 N/R 20 W TOWN St. Joseph COUNTY ST. CROIX SYSTEM ELEVATION 95.5' BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of nail in tree ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. same as benchmark Heritage Trail 3 Acre Lot Seale = 1/4" = 10' 450' Property/ Line Pro 3 Bedroom Tank is to be properly Ho use bedded and provided with lockdown covers with approved warning labels Well is to meet al I WDNR setbacks Area 15' below system is to remain undisturbed Grading is to be done to divert run-off away B-2 from system B-1 95 2% Slope B-3 System is to be instal led 94.5 along the contour 94.5' 94.4 B.M.#1 ~~B.M.*2 Property Line 220' Mond System Cross Section and Plan. View i _ Dimension Feet J r ` - - - c A : } B r D L i~•.i}r •vr 'r•• •v.vvvn v'v.,•,. . •ti I L A r ?v?f firif } r r F F~ r r r • 9~•r`i i r •~"L7~{• ill i;{`~iF'~~,~.~3~yA~.Vi~ti~~ }i r ~ ~ v. r l1 }};f, vw~ i'tf }i•• } }rl'{ ir~'i.r.• rr}Fv.v 4.vd'.'•v } I - - r { l;. r > r r G . L r M 7 C_ H r - - } 1 r r K 4zic K -y - - 7 L - blo ~e o r' '1 = Topsoil ASTM C-33 = Clean a gregate g 4 in, sch. 40 vc Cap Material sand fill 0 p /z to 2 /z in. dia. observation pipe Geotextile ' G 1-} Fabric ---yam` D r Contour Plowed Surface' Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour, 13xistin r vegetation is mowed and raked off the site. 'The mound basal area (L x W) is plowed with a moldboard o►~ chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a %a inch soil wire when a sample is rolled between the palms of the hands, ASTM C-33 duality sand is placed imm edrate after plowing. Sand is plac:f°d with a tracked machine keeping 12 or more inches of sand under the or is placed overhead by a backhoe. Special care must be used when placing sand of less thi , tracks or one root thickness to minimize comfroaction of the plowed surface. After the topsoil cap is placed, the than entire one mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet The 10/07 l flange. Page Pressure Lateral Layout Two Laterals Viand Manifold 4_----- -Breaded r CIMWOUt tzteral "Turn-rip Plug Manifold C.._. M X Long; Force Main Sweep 90 Bend y~ _Distribution .Networiic.~eeitications 1 Pressure System Construction Lateral Diameter [n. Manifold Diameter In. Laterals are constructed of Schedule 40 PVC Orifice Diameter pipe. Orifices are drilled perpendicular to X Orifice Spacing) in. the pipe with it sharp drill bit and lace down. L(Lateral Len th Ft. I.,atcral tug n-ups terrninate with << threaded M (Man%fold Leith} _ - -1-t- cleanocrt plug and are enclosed in a 6-8 ineYi Force Main Diameter _ In. dialneter ht wtt Sprinkler valve box accessible Force Main. Length- from iinishe d grade. we, oee Grade ~•~•~r•• 6-8 Inch Lawn Sprinkler Valve Box 03/05 lgj Page of Septic;-'Dose 'tank Cross Section And Pump Performance Specifications ar1FG Ml9[LUlaGttYrE3r _ I._ F'urnp Mane#ettu~eci l ank Modell umber v_ _ Pump Model Number Total `l`ark Capacity AFgrrr~ lll~nt~fae~tueer Cd r ~ _ • e t, ✓ Nlax. $llr~ 1]e Alarm Model Number switu Type filter Manufiu;turer Total Dynamic Read (1'011) Prot . _ filter Model Number _ Elevation lead Distal pressum Network, Toss - - Minimum Pump .edJormat uce Required - Force Main Loss ~ - - total Outlet Manhole Min. 4°" Above Gra& With Lo*ing Juice. Inlet Manhole Manhole Min. 4"' Above Grade < 6" Below fk'O& Seated Watertiaht C securely Mounted With Locking l:yevice Wetttker-p~r~sof l q Junction Box ..,1 l' Wished Grade Iy+11 MW Iftw i.. T Vent Min. 12" Disconnect Above tirade Means With Vent Cap VIA r•,f ,r ~~l traY I Y Y Y I i! Y 1 1 L i ) Y Y .'YIlII L i rye Y~'~~~Y 1 Y •LL`+ L M fa LVY ~.~Y•YVr~b~1~.~Y~Y•Y Y+Y~I,rI ;,iLV`YYi / VYa ; IV•Y V;YYVYIYI YYV; IY.YY I;♦ LY. . • Y'I Oudet Filter Inlet l11~4iGBaffle ILL, .II,r l f`. Y{y -.__~y_~{•~W1~y.¢..-..-y~yy-_/.y~-._~y.Yy._,_YY.~»p_..~.._._..-__._y_y~_~...,.,_._.~ I+.;. Switch i441,•~L'"J and Reserve /.~a~-)Al it f,+I .C i. YVI' Tank. Voluurle (xPC ,11i >~I Weep D imension, lunches Vert - wrt~►e ow, (reserve) A. Hole _ (alarm) - _ _ ,,YII ()f A' 2 _f L _ - - elevation - (dose)) C , S F ( >I: a (dead) r1 ~ , f y - LY+Y 1 Y otiknn elevation ,ICY Y.-.Y.-I...f•Y[_i...1'_CT~,'I..i~. ~~~!_T~T• _ 1Y~' 'w'i IY YY LIIV) Y 1 i i y~ y~^ yr yY~ V Y V ♦ 1 ~ S~ Y'T~ "Ty-i•-FTY~i"'f"~'TSTT~ _ _ 1 a / 1 ♦ Y / , I;I, ~ ~ ■I'~i 1•I'V•L < V` 1 'i` ')V~1`V 1~'1)II iaL b Y'r ilb YrIIY/}V>V)•I VY~Y+L• • V } V•/)i VI V;i15 Y < 1 '1`I V V 1-rFr-s-iTY- iLk1>'YY YLIrY Y1~ I V i!} YVL) Y i Y V t V V f/ V i V Y `.S.I y_.,_~.._•~y~.._._,~!}~.<rl. ..1 i Y /i 'y.Yfl YYli; {'aY 1 l ! 1`i ) Y Y Y 6V1 YVYVY YIYVLIY+ IY VIYI f11L V.lI II Ii'. VIYI11'Ya1 fY lYY 1 1'{ -5-~••:yi„1. 1 •V.:1,1+`r V. Va i.fyV 6 Y C( t{ t'/ f iYi (i t Y 1 1 V i 1 V V } V V/ f VLLI`L GENM.,kL Ilr STAECi1l'. A T')CUN': The septic/dose tank is manafacturcr lmdcied and back tilled in ac 's product aplrro~rel ttnetsifiai►tions. t~Iaximttm tie c,ordunce with t-110 be exceeded without P"r'"wovaF. Manhole covers poi of bury s sp i ll by the manuiat~trurer iYiay not installed. Piping at the inlal and outlet is Of ode have art efFeutive looking device (patltc►ck) laid on ytsbYe soil to prevent s~sttlirtg or sagg g p Tld f naterl i is "t8sleeved d to with the 411 tank wit 40 p ~ ugh t fittings, acrid exc:avaticlx, and the mlevve is sealed watertight. E180trical service complies with NEC 3 00 and Conlin 16.2s, the tank ridge OZ/o5 t.,.l p 4P LaserJet 3100; 7 r15 bbe bbd/ fty-u-vu e..,ur-sti, Abu 9 EH SERIES Sump/EFFLUENT PUMP .r" 7 I d arrll8 M Wiff 11 "mW MOINi1NNCElOMIOUNp low PKM 18 m WARM 48r arR NiNli or W$ 10'w.ki asyr816 0 if w iit.1 IN "a I4,tu1q 08! 1111 SW W U" 4118 li5 IN 14.0 SUM 18 64 55 41 88 18.1 W 24 6.11 i llA x I M MOW 508340 OMA 1410 a M s.5 1tls0 70 W 55 41 8r 18.1 W 24 911 ~ 1101 @.80 0@1-1468 588!60 WM 400 1115 am 48.0 low 7s 04 55 A KI ?3.8 29 V 8.11 t 11.64 x 0.84 27 B.ii x 11.51 N p.ea JOAM Nm me WO 64, 55 4`1 82 12.8 W, Da~nuousUobyRNed-"LiMMISmtNhstawwlerl~un+n>yanirdadr,~M"rn:wodnNyrbnpiu~lMyarannwVipferuY~i~rhWn4inacMrdllseWUr~" ru7w- L1TERSiHOW Const l! .!`Men a loon 2000 4100p Motor Housing Epoxy Coated Cast Imn Y... . 1171 eller material Poi Carbotlato ao-- _ 10 (rgpellet ._.Closed Vine . Volute A135^ is Power Cord SJTW-A Mechmiw Shaft Seal Nitrite with carbon and ceramic facub = 5 ~ 1%esterltsrs Stxinieisic S1ea1 1n Shaft Stainless SCeel ~e lriclgs ( Upper 51ftvc and (Lower bearings o ~n 4 rc, en rLOW- GAULONSNYNUTIL F ltP PLRF UROANCE C.tdRVE q5v 60"i Uttle Gdent Pump Co. PC) Box 12010 r ClIOidm" Citl; OK 73157 Vbmv 4Y5.447.751] Fw~: 493 73B.1951Y " E-rsrle: I:artamerrnwl~cr~ituhglrot pwo WWWr s 1l'S(H$M1tr"iHlPrv 11111[ FOrm 996236 -..OIAM POW'TS OWNER'S MANUAL & MANAGEMEN7 PLAN P FILE INFORMATION Owner - SYSTEM SPECIFICATIONS INS t° Per it # - r Tank Capacity Tank Manufacturer D1=SIGN PARAMETERS NA Filter Manufacturer' - Number of Bedrooms L7 O NA NA FilterModef NA mer of Public Facility Units u - A ank Capacity Estimated flow (average) ❑ NA dal ank Manufacturer ~f NA Design flow (peak)(Estimated 1.5) -LS%- ~jZj /da Pump Manufacturer NA Soil Application Rate / a!, . ` -r v--- al/da 1ft1 Pump Model Standard Influent/Effluent C~uaUtlr Monthly averae" Pretreatment Unit 1~ NA Fats, Oil & Grea;;e (T=UG) S30 mgJt. _----Biochemical Oxygen Demand g:( n Sand/Gravel Filter Ll Peat f=ilter ( s) s220 mg/L O NA 1-:1 Mechanical Aeration ❑ Wetland Total Suspended Solids ('TSS) 6150 mg/L Pretreated Effluent Quality _ I-] Disinfection 1:1 Other: Monthly average Dispersal Cell(s) E3iochemical Oxygen Demand (BADS) <30 mglL 11 NA Total Suspended Solids (TS5) 530 mg/L • NA Lf In-Ground (gravity) IJ In-Ground (pressurized) Fecal Cotiform • - 4 t~ At-Grade QUnd geon~srru mean) U cfu/100m1 i't~l Maximum Effluent Particle Size 0 Drip-Line 0 Other: in dia. 0 NA Other. Other: - - C.~ NA Otl►er: - - - CJ NA Values typical for domestic wastewater' and septic tank effluent. - - - 13 NA ether: MAINTENANCE SCHEDULE Cl NA Service Event --tion of At least once every.- - El Montt] !'S) rInspect ondition of tank(s) Service Frequency (Maximum 3 years) O NA _ ear s! t contents of tank(s) - _ When combined sludge and scum equals one-third ( ispersal cell(s) ) of tank volume At least once every: l=t NA uent filter (i1llaxirnurrr S years) 17 NA At least once every: mr~nthr sj mp, primp controls & alurrn - y, earls' _ i=l NA At least once ever--- 11 th(s) - lush laterals and pressure test ar s At At least once every: - 0 NA other: L7 manthls) vear(s} O NA - At least once every: 13 monthi5_. Other: - _ years IA NA 1161AINTENANCE INSTRUCTIONS NA Inspections of tanks and dispersal cells shall be made b y an individual carrying one Plumber; Master Plumber Restrictk rl Sewer; POWTS of the following licenses or certifcatiorrs: Master Inspector, POWTS Maintainer; Septa a Servicing Operator, a visual inspection of the t;.rnk(s) to identt~ any missing or broken hardware, identify any cr<iks or sludge and scum and tr. check for any back up or ponding of effluent on the ground sr r Teaks, measur e tet visually inspected to check the effluent levels in the observation pipes and l cheek for any o volume of The ponding of effluent an the errand surface may dace- The dispersal cell(s) shall be regulatory authority. g y indicate a falling condition and reqires h-ii immed atetnotffcation rof therlocal When the combined accumulation,~~rf sludge and scum in an oval the tank shall n be removed by a Sedge and SCUin any tank equals one-third Administrative Gode (A) ar more of fire teak volume, the entire contents of g Operator and disposed of f it) accordance with chapter NR 113, Wisconsin All other, services, including but not limited to the servicin and any servicing at intervals of . 1 months, shall be g of effluent filters, mechanical in pressor+xed components, pretreatment units. A service re performed by a certifred P(?W ~'S Maintainer. port shall be provided tr., the local regulatory authority within 10 days of completion of arn. • service event. START UP AND OPERATION Page of For new construction, prior to use of the POWTS' cc heck treatment tank(s) for the presence of painting products or other chemicals that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected have the contents of the tank(s) removed by a septage servicing operator prior to use. System start up shall not occur when soil conditions are frozen at the infiltrative surface. During power outages pump tanks may fill above normal highwater levels. When power is restored the excess wastewater will be discharged to the dispersal cell(s) in one large dose, overloading the cell(s) and may result in the backup or surface discharge of effluent. To avoid this situation have the rontents of the pump tank removed by a Septage Servicing Ooerator prior to restoring power to the effluent pump or contact a Plumber or POWTS Maintainer to assist in manually operating the Dump 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 eliminator) of the fallowing from the wastewater stream may irnprovc the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapcars; 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 property 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 Septagcr Servicing Operator. • After pumping, all tanks and pits shall be excavated and removed or their covers removed and the void spare 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: I:I 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 aria 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. ❑ A suitable replacement area is not available due to setback and/or soil limitations. Sarong advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS. The site has not been evaluated to identify a suitable replacement area. Upon failure of the POWTS a soil and site evaluation must be performed to locale a suitable replacement area. If no replacement area is availrchle a holding tank may be installed as a last resort to replace thci failed POWTS. Mound and at-grade soil absorption systems may be reconstructed in place following n:moval of the biomat at the infiltrative surface. Reconstructions of such systems must comply with the rules in effect at that time. .'<WARNING>> SEPTIC, PUMP AND OTHER TRI::ATMENT TANKS MAY CONTAIN LETHAL GASSES AND/OR 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 t; j A TANK MAY BE DIFFICULT OR IMPOSSIBLE. /,,DDITIONAL COMMENTS OWTS INSTALLER POWTS MAINTAINER Name Phone - ? Jn Phone ' 5E;PTAGE SERVICING OPERATOR UMPER =~t_ LOCAL REULATORY AU~'HORfTY Name 77 _ 19LC one Thus document was drafted in compliance with chapter SPS 383.22(2)(b)(t)(d)&(f) and 383.64(l), (2) a (3), Vllisaoa asin Administrative Cude. f Instaltlatiort eehter8d u-Y flt the IYltr, rase onto th nder the atcestG u e errd Ot the outlet tank through the ou pening• Ifrrot, then efth P+pe to ensure it ir. Pipe- tlet or solvent weld (glue) additional er lnsert' mare pipe into additional pip. Ohto the outl the et 01 %-inch pipe need shill dry fitted an thO Outiet uPtional st+PPleme to hrAce the filter to the tank 1aiPe, measure the length proceed to step youhtalr, side st,pPort. If side strPpntt e Methndod wall is if utilizihq the not Utilize t h }r a For instAHattarts utif,zinp the optional w u solvent weld tile 1/4-inch PIP( Onto the filter ease pIf side sal side srohoeed I r F roceed to step PPort: four, pf Method is ,at r .SO(vent ` cartrid Weld the filter case cartridge intn the rase, onto the fete case. p,e-lniq down u htif ,tfel: pipe I'sell: the filter thofe fitter lacks into the betto Ira VRS switch is utillzrd: insert into ockwise 'l0°• the 6lker and fork h tur Maintenance?`'; ' 'I Ile eftluent filter should be serviced. cleaned every time ':Ile septic tank Is open tine outlet access opening to Irtspect tlxt tank acrd filter. PUMP the septic tank rorn Betel , layer on the bottom of tilep'ank and ki g sure to rerrrove the sludyls a. not t• once the effluent level h just the scum and effluent. outlet as bee rr lowered below the invert (if thn pipe, firmly pule rartrid up or, the filter handle to ye from the rase. dislodge the S- slide tire c ' artrtdge up and out of the ~ 6. If a VRS case for r_learlin, switch cph,tiected to an alarm is prkse mOVed by trrrain nt, t the switch With 'should wbe rett c'ounterclnafewlsr; ater only. and cleaned 7• while holding the cartridge or' its side (large flak surfare fa ckrr, onF acr:ess opening, r4hse off the cartrid Y, making sure 311 septage ttrater►al is Ile with water + Iw.'. 13- If VR5 switch is rlttsed back, into the tank. „tilized, rePlal:e h tip turning clockwise 9p°- by inserting into filter and:' i 9. Insert the filter cartridge back into the the filter locks into the hott:arn use' Pressing down until j.,•,•~.i' . of the case. l!':•l 1 U. Re place and secure the access Opening on the tank. ' w.bearunsue COO 877-MLFILTERS (653-4583 ST, CROIX COUNYY SEP'T'IC TANK. MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM ~ i Owner/Buyer ._.I Q 0 e f-, n Mailing.Address~3__'1?tZ4_ Property .Address _ _ ---1~ 3 ate`- --r----- _ (Verification, required from Planning & Zoning Department for new construction) City/State - - Parcel Tdexttification Number" LEGAL DESCRIPTION Property Location '/a , Scc,~~ T _j NR 2 ow, Town of Subdivision. ---c<~1- Lot # Certified Survey Map # Volume Page # Warranty Deed # / V l d Volume M, Page - Spec house es no Lot lines identifiable ~ 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'purnping out the septic tank every three years or sooner, if needed, by a. licensed pumper. What you put into the system can affect the fitnctiorr of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(l) and in Chapter 12 - St. Croix County Sanitary Ordinance. 'The property owner agrees to submit to St:. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (l) 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 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 Slays of the three year expiration date. I/we certify that all statements on its form are true to the best: of ray/our knowledge. I/w+; armlare the owner(s) of the property described above, by virtue of a xviarranty deed recorded in Register of Deeds Office. Number of bedrooms zi v AIGNAI'i ():F APPLICANT(S) DATE ***Arty 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. 68105) NOQ"13' 101.64' ~ ~ . w-o- Popp W0ol W4" I as as , Nf ~ • W 3 all 1I i9 $ a 30 Q \ at~ot►+ 8111897. DOCUMENT No. . LLUITED WARRANTY DEED Tx :4088897 968918 BETH PABST REGISTER OF DEEDS THIS DEED, made between OP 2 Realport LLC ("Grantor" whether one or ST. CROIX CO. WI more) conveys and warrants to Oevering Homes. LLC ("Grantee", whether one or 12/06/2012 11.30 AM more), the following described real estate in ST CROIX County, State of Wisconsin: EXEMPT#: NA REC FEE: 30.00 Lo 39 d 40, Settler's Glen, according to the recorded plat thereof, St. Croix County, TRANS FEE: 105.00 Wisc PAGES: 1 RETURN TO St. Croix County Abstract & Title Co. Inc. 219 S. Knowles Avenue New Richmond, WI 54017 Tax Parcel No: 030-2131-40-000@030-2131-39-000 This is / is not homestead property Seller to convey the title by limited warranty deed without covenants of the title or the equivalent for the state the property is located. Seller makes no representations or warranties, of any kind or nature whatsoever, other than those set out above, whether expressed, implied, implied by law, or otherwise, concerning the condition of the title of the property prior to the date the seller acquired title. Grantor warrants that the title to the Property described above is good, indefeasible, and free and clear of encumbrances arising by through or under Grantor, except: NONE. Dated this 4' ay of November, 2012. O Realpo LLC B . Timo rown AUTHENTICATION ACKNOWLEDGMENT Signatures authenticated this day of STATE OF MINNESOTA 20 - COUNTY OF ~ ss' TITLE: MEMBER STATE BAR OF WISCONSIN Personally came before me this (Z day of November, 2012, the (If not, above named OP 2 Realport LLC, by Timothy J. Brown to me authorized by § 706.06, Wis. Stats.) known to be the person(s) who executed the foregoing instrument and acknowledge the same. THIS INSTRUMENT WAS DRAFTED BY -~Ja ~A.lti Robert L. Loberg / Loberg Law Office * (~tlo0►'a M L . P..~'01 Af~e ~Yl U Notary Public S~ f f County, 1212532 / ahn } 9~1. . My Commission is permanent. (If not, state expiration date: .1131 f ZOIS (Signatures may be authenticated or acknowledged. Both are w^A ).NANAAAAAAAA&%A^%NAA#V~ a,tuc sr not necessary.) w=. DEBORAH I_. RIDGEWAY E /~^r`~ No,ary Public-Minnesota LIMITED WARRANTY DEED ~'~/bA/ Commission Expires Jen 31, 2015 Form No. 1-2003 1 of 1 r w 19 f a N ' h W ~f! e / + awn AVM -r- + - - - - - - - - - - l~ OHO - ~ + Aft Q Sim a I a at r n oil . , a, + N ff+ ~N I Wisconsin Department of Commerce SOIL EVALUATION REPORT Page of 3 Division of Safety and Buildings in accordance with Comm 85, Wis. Adm. Code County r ix- Attach complete site plan on paper not less than 81/2 x 11 inches in size. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. percent slope, scale or dimensions, north arrow, and location and distance to nearest road. 36 ~a 3 '3 Please print all h Rev ~Wed' b Date 's Personal information you provide may be used for ndary)pb (Pri4ady., s. 1504 (1) (m)). 3 Property Owner Pr rty Location Q ~ s G~ 2 8 200? Go 1. Lot 1/4 _<,C~J1/4 S Z 3 T 30 N R Zcf E (or)4 Property Owner's Mailing Addressi-J Lot Block # Subd. Name or CSM# (-o- 72-o !~-Y6 I iLoa 'W-' s a1~e city State Zip Code on City ❑ Village EgTown Nearest Road S Z ( 1)`f-Zl -w 3s ® New Construction Use: Residential / Number of bedrooms Code derived design flow rate L/S7J ~~U U GPD ❑ Replacement I ❑ Public or commercial - Describe: Parent material I Flood Plain elevation if applicable General comments s-o and recommendations: S Y s ~em e1, V 9 s e'Ieu r `l q-5d Boring # ❑ Boring pit Ground surface elev. 9h • ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 I(~ 312 )L ~mSbk rrr c I v 5 q 2 i i L k I D 516 C Z P -T ~irqJW5-LL 2. k ❑I~ r- # Boring Boring { . (o g ~ 1 pit Ground surface elev. 0 ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft2 in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. •Eff#1 'Eff#2 I O -t2 t o. 2- sL 2r --)I c h j-- 5 .9 Z IZ-Z~ 10' 3L_ Zm) k tq 3 c ~l CZP7. co ~~L Zn-f--bk • Effluent #1 = BODS > 30 < 220 mg/L and TSS >30 150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS < 30 mg/L Number CST Name (Please Print) Signature ~ 2~3 3 0 9 Scnl u ^ I,er Address Date Evaluation Conducted Telephone Number /3 ~DTti S6 men C~1~ 5~ - S C 71 5) Z `f7- `lac k Property Owner 0(-w ICQ V 5 Parcel ID # Page of F-31 Boring # ❑ Boring Z Pit Ground surface. elev. 4y, ft. Depth to fimiting factor ~t In. Soil Application Ila Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/il' In. Mansell Qu. Sz Cone Cofor Gr. Sz Sh. 'Eff#1 'Effl12 1 { 2 l 2 ~ S . L 2rrg~l~ m S I V Q S 2 ►2-L 1 3 L m r e - 5 3 2 - ICS 1 P -1 5 14 k - '-4 F-1 Boring # ❑ Boring _ pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rai Horizon Depth Dominant Color Redox Description..- ,Texture -Structure Consistence Boundary Roots GPD/W In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 F Boring # ❑ Boring ❑ Pif • Ground surface elev. It. Depth to limiting factor in. Soil Application Ralt Horizon Depth Dominant Color Redox Description Texture . Structure Consistence Boundary Roots GPD1ft1 In. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 ' Effluent #1 = BODs > 30 < 220 mg/L and TSS >30 < 150 mg/L ' Effluent #2 = BOD, < 30 mg/lt and TSS < 30 mg/l. The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. seamo (r<orroo) ' i Dec-04-2012 11 52 AM St. ;_roix County Plan/Zoning 715-386.4686 2/3 e Property Owner t" 6 Parcel ID N Page C.. of 3 r~' ~oe9np Writing Q A!! Ground surface,elev. ~7'• it. Depth b 11rnttlng factor In, soil pcatloq Ra "on Depth Domtnent Cofer Radox Clnsariptiort YaxhneUuchua Canstctenaa Bw+ndBry (~ovfS GPDHL' tn. 11Junselt Ou. t3a. CairECclar ' , ' G. ft Eh. 't:Ff1E1 .Ella! ZZ 4 r ~ n ftArkg ❑ Borah ❑ Pit Opoetnd aurfaop: elev. ft. Depth to im1ltng factor in. a~~ pp Iceflon Rill Hadzon Depth . Dorrpinant t;nlcr Redox t esrrrpttan... .Texture , -$t s oture Canslslenoe Boundary Rawls GPD1fR In. Mansell 00. Sx. Cont. Color tat. Sx Sh. 10a1 'Ef10 Boring ❑ Boring pn Ground surface alev, ft, Depth to IImltlnp War in. 801 Application Rat. Horizon Depth Dominent Color Redox Desedpoon Texture . St ucdrue Consialanca !boundary Roots GPD/V In. munsell the. St. Coot Color or, sz. Sh. 'BtfN1 '!~1fNx Effluent #1 x BOD; 30 W 220 MgtL and TSS }30,c 130 mWL " EMLJeni N2 n 13ODS ~ 30 M01 and T83 t 30 mpll. The Department of Commerce 9s an equal opportunity service provider and employer. If you need assislance to access services or nerd material in an elt6mate fla mat, please contact the department at 08.266-3151 or TTY 608-264-8777. ~ewnotko7lool r 3 PAGE -OF- NAME 00,r / L'u ~ TOT#3 q LEGAL DESCRIPTION X S(QZ,S z T 3~J N R?:~ 0 E(or(5/ SCALE: 1"= L~~' BM I ELEVATION /DU. U _ e BM 1 DESCRIPTION BM 2 ELEVATION fDv. U BM 2 DESCRIPTION 11a I~~ e (fit ii SYSTEM ELEVATION `I S• S a t SYSTEM TYPE xc» &cK CON OUR ELEVATION '!G/• 5-0 0 L\O SIGNATURE ss - DATE Z3 -~Z