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HomeMy WebLinkAbout018-2015-00-005 Wisconsin Department of Commerce PRIVATE SEWAGE SYSTEM County; St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 561014. 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No Oeverin Homes LLC, aka Oeverin Pro ertie Hammond, Town of 018-2015-00-005 CST BM Elev: Insp. BM Elev: BM Description Section/Town/Range/Map No. J bZ z 35.29.17.1124 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER L! CAPACITY STATION BS HI FS ELEV. R. Septic , y l Benchmark Z• S M4 5 /4Z .15 Dosing Alt. BM a t "a v,~-d✓~v r Q✓L Z ' GO ✓w C/ per. Bldg. ewer 7 q C 2_Z Holding St/Ht Inlet 6 \ TANK SETBACK INFORMATION St/Ht Outlet TANK TO P/L WELL BLDG. Vent to Air Intake ROAD Dt Inlet 1 So ~A Septic / 36 i Dt Bottom Dosing Header/Man. 61 J 36 7 r r /63:SS Aeration Dist. Pipe 3 gC Holding Bot. System 1163, / d~ PUMP/SIPHON INFORMATION Final Grade QQd~~ a Z Ad Z Manufacturer ZO e Z / Dem St Co er g_~ GPM 1 v 1i 9 3 '77/ 1,77 95 Model Number TDH Lift Friction Loss System Head TDH Ft 17,31 (10 'U 3. 5 Z1,$~ ~a~+ r' t /4/•~5 Forcemain I Length JDDist. to well zbin, SOIL ABSORPTION SYSTEM BEDITRENCH Width / Length f No. Of/~jrench PIT DIMENSIONS No. Of Pits Inside Dia Liquid Depth DIMENSIONS $ 5 -7 /,C e - - SETBACK SYSTEM TO P/L IJBLDG WELL LAKE/STREAM LEACHING Manufacturer INFORMATION Type Of,Jystem: ~Ji CHAMBER OR //V)e / ,3 Z 1 Z zC UNIT Model Number: ~J DISTRIBUTION SYSTEM SoJ4t - Header/Manifold if Distribution / z J / x Hole Size J/ Ix Hole Spacing / Ve Air Intake y Z Pipe(s) !t~ 7- 3 /z Length Dia Length Dia Spacing W SOIL COVER x Pressure Systems Only xx Mound Or At-Grade Systems Only Depth Over Depth Over xDepth of xx Seeded/Sodded u xx Mulched Bed/Trench Center 1 7 Bed/Trench Edges Topsoil I G~ 71 No s No L. COMMENTS: (Include code discrepencies, persons present, etc.) Inspection #1: Z / //9/ ~.3 Inspection #2: 6 Z b/ 13 , v rC 0/o d Location: 857 191st Street Baldwin, WI 54002 (SW 1/4 NW 1/4 35 T29N R17W) Croix Hills Lot 5 Parcel No: 35,.A9 17.1124 1.) Alt BM Description = r', C.,_ V~ 2.) Bldg sewer length = 3 rZ - amount of cover 00 Plan revision Required? ❑ Yes No F6 TZ D Z Use other side for additional information. - - - - Date Insepctor's ignatur Ce t No. SBD-6710 (R.3/97) TOTAL DYMAW HEAD pp YEy' O N p. pp O N P O N ♦ O. m O N O s; _ r + tJ~ tJ~ rn J j i _ J J J METERS A U O U O N O N O U O N O U m ~ p O U 4 FEET O U O N O U O U O N O U O ~OV N 0~+~ 44 qN OY OUi N 01 0~. "0000, 14 00, 1000 O \ cl~ p 1UDU a N $ ~ 2 N ITI i5 22 0 8 8$ S iS i~ 8 S o N m D 000e _0 o a w♦ I; ii o r -100 m N r oo~ c S yyyQ~~~~ N N N < op, i3 x 1 1 1 1 1 1 1 1 I 1 1 1 1 G' Z 000 ~;o 0 ~ I I I I i 1 1 1 i I I l i N i8 k+ D D w v V ~ CO ~CII v U 1 I 1 1 I I 1 I I I 1 1 1 N g 1 1 1 I 1 1 I I I I I 1 I u (D Z ~i ~ r~ 1 1 1 I I 1 1 1 1 1 I 1 I + o ~ ~ ` "-4 m P I I f i I l l l i f i f l f+" : t ro q fA m M A a o T g C I I I I I I I I I I I I I c c Z I I I I I I I l l l 111131 s 10 V I I I I I I I I I I I I C n ~ pa~ 3m = 0 ~L°~1' C ~~IIIIiIiI»~s~~$8s ~V o~ o, o, 1 1 1 1 1 1 1 1 1 1 1$ i Ell~ C mm,11111111a~~~i~Illlillll~E~s~ „o~ ~ l i: 1 1 1 1 1 1 a o I I l I i l i 9 t a ~ sr w w l i i i 1 1 1 1 111 u v t a a a F g I I I I i 1 8t! sa$~~u$s~~,, = N m I I I I I i 1 1 1 f sa"t9~?~ j rfI1I11111~e. it n°v:j 9 ~Illislk~U~~11111~~~ ~II11:1111~a~s~~~~ 11 a~aa0v9uum9aa9 N Co C4 ra u r ` / ~ ~ y a l l l 1 st $Ypt3Bt5es~~ ~ I l l i 911 v ib~~ N O M C 0 x 1 1 1 ~k~sacses~a- "5i9~~ n rn - go r r 117 cn IM Z Z PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 NW 1/4S 35 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 103.1' 1.6' sand lift BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1 .0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. same as benchmark i Town Road 677' Property Line 'dell is to meet all DNR setbacks Property Line Scale = 1/4" 10' 3.5 acre lot E `~el~ev i''fo ~ Huffcutt Como B-2 tank Z0 ❑ Grading is to be done to Pro 3 divert run-off away Tank is to be properly Bedroom from system bedded and provided Houe with lockdown covers with approved warning labels • t eQL B-3 B-1 Area 15' below grade is to ❑ remain undisturbed 102' 5% Slope 1 01.5, 101' 100' M.* ply 674' Property Line _ 0017117erce"VA-90V Safety and Buildings Division Count W wFh 201 W. Washington Ave., P.O. Box 7162 y' f _^0/ Icon ` Madison, WI 537()7-7162 Sanhury P~r~n"at Number be tallt~f in by Co.) or Cotninerce J d SanitaitO° Perrr0jApplieation Stt}ate Transaction Number In accordance with s. Comm. 83.21(2), W is ;Ad~tn3„ submission of this form to the appro tai -1-1,91 ~ unit is required prior to obtaining a ,Farm[. Note: Application forms for state-owned ar ro'ectMess (if ftse eni than iling ad ress) submitted to the Department of C ce. Personal information you provide may be used econ purposes in accordance with the Privacy Law, s. I5.04(1 m , Stats. ! 1. Application Information - Please Print All Information ( / y Property Owner's Name Pat'W. # Property Owner's Mailing Address Properly Location Govt. Lot 4 City, State Zip. pde Phone Number <1 Y4 )6!1Z Section J ,l°v t/ C-~,~ _ I ~~J LA) 1 S LIED •P~ N R ircie II. Type of Building (check all that apply) Lot r 2 Family Dwelling- Number of edrooms::~:) Subdivision Name l/1V Block# A-5 ❑ Public/Commercial - Describe se ❑ City of ❑ State Owned - Describe Use CSM Number ❑ Village of _ wn of III. T I mit: (heck only one box on line A. Complete line B if applicable) k New S stem ❑ Replacement System El Treatment/Holding Tank Replacement Only El Other Modification to Existing ex lain Y System ( P ) B. ❑ Permit Renewal ❑ Permit Revision ❑ Change of Plumber ❑ Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Owner IV. Type of POWTS System/Component/Device: Check all that apply) ' ❑ Non-Pressurized In-Ground ❑ Pressurized lu-Ground ❑ At-Grade ❑ Mound ? 24 in. o suitable soil ound { 24 in. of suitable soil ~ ❑ Holding Tank ❑ Other Dispersal Component (explain) ❑ Pretreatment Device (explain) C~ ~c7 V. Dis rsal/Treatment Area Information: Design Flow (gpd) Design Soil Applic, on Rate(gpdsl) Dispersal Area Req ' ed (s0 Dispersal Area Pro Deed (sf) System Elevat}ar~ ~ J 7 215' -~Jr I rJl 'VL Tank Info Capacity in Total # of Manufactur r Gallons Gallons Units New Tanks Existing Tanks /~Y QI lJ (~l d~, v~ u, ~7 a. 7 Septic or Holding Tank Dosing Chamber ~v IVIL Responsibility Statement- 1, the undersigned, assn ponsibility for installation of the POWTS shown on the attached plans. ?lumber's Name (Print) Plumber's lure MP/MPRS Number Business Phone Number C a)~ "S Zz eym Number's Address (Street, City, State, Zip de} fi omit /De rtment Use Only Permit Fee Date ]as ed lsesuing Agent ignat e Approved ❑ Disapproved $6925, ~U 7 ❑ Owner Given Reason for Denial - 44~ LWt oval/Reasons for Disapproval 3 o ~ Gl 2- 1. Septic tank, effluent filter and dispersal cell must be serviced / maintained as per management plan provided by plumber. 2. All setback requirements must be maintained as per apples, icable codelordinances. Attach to complete plans for the system and submit to the ty 9#1y on limper not less than 1/2 P 11 ineh size rl / m om _ ~~Z~7/ii/YC ~ :I BD-6398 (R- 02/09) L~tJ~ .VAR Tb~N 5 rQ.n Safety and Buildings Jo$ 141 NW BARSTOW ST FL 4TH WAUKESHA WI 53188-3789 Contact Through Relay ' ow www.dsps.wi.gov/sb/ www.wisconsin.gov 9[ON Scott Walker, Governor Dave Ross, Secretary November 05, 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 PLAN APPROVAL EXPIRES: 11105/2014 Identification Numbers Transaction ID No. 2170054 SITE: Site ID No. 785820 Oevering Homes Please refer to both identification numbers, Croix Hills Lot 5 above, in all correspondence with the Town of Hammond a encv. St Croix County SWI/4, NWl/4, S35, T29N, R17W Lot: 5, Subdivision: Croix Hills FOR: Description: Mound, 3 bedroom Object Type: POWTS Component Manual Regulated Object ID No.: 1400539 Maintenance required; 450 GPD Flow rate; 17 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 an with the "Mound Component Manual for Private Onsite Wastewater Systems VERSION 2.0" SBD-10691-P (N.O1 1 th "Pressure Distribution Component Manual for Private Onsite Wastewater Treatment Systems O .0" i SBD-10706-P (N.01/01). o The building sewer and distribution network piping shall be of material listed in Table 384. 384.30-5, Wis. Adm. Code. In the event this soil absorption U' system or any of its component parts malfunctions so as to create a heath 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 11/5/2012 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. Sincerely, 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 Nate: Effective January 1, 2012, all codes under the jurisdiction of the Division of Safety & Buildings will be modified. Code references with prefixes starting with "Comm" will be replaced with "SPS" to recognize the relocation of the Division of Safety & Buildings from the former Dept. of Commerce to the Dept. of Safety & Professional Services. Additionally, all S&B codes will be renumbered and addressed in a "300" series. For future reference, the Wisconsin Commercial Building Code will be addressed by SPS Chapters 360-366. - Cover Page =Cfff IVIED Shaun Bird NOV -5 2012 Bird Plumbing Inc. SAFETY & BUILDINGS 1432 120th St. New Richmond Wi 54017 715-246-4516 Date: 10/ 28/12 Owner:Oevering Homes Location:SW1/4 NW1/4 S35 T29 N,R17 W Lot 5 Croix Hills Hammond System type: Mound System Manuals Used: Mound Component Manual Version 2.0 (01/31) Pressure Distribution Manual Version 2.0 (01/31) Page# 1. Cover Page 2. Mound Plot Plan 3. Mound Cross Section 4. Pipe Cross Section/Pipe Layout 5. Pump Chamber Cross Section 6. Pump Curve 7-8. Maintance and Contigency plan 9-12. Soil test 13. Filter Specifications cross section Shaun Bird Signature License number 22 0 ;w GY t 4 PLOT PLAN PROJECT Oeverina Homes ADDRESS 1433 Cernohous Ave Suite A New Richmond Wi 54017 SW 1/4 NW 1/4S 35 /T 29 N/R 17 W TOWN Hammond COUNTY ST. CROIX SYSTEM ELEVATION 103.1' 1.6' sand lift BEDROOM 3 CONVENTIONAL AT-GRADE CONVENTIONAL LIFT HOLDING TANK I MOUND XXX SEPTIC TANK SIZE 1000 gallons DOSE TANK SIZE 630 HOLDING TANK SIZE LOAD RATE 1.0 ABSORPTION AREA 456 # of chambers none BENCHMARK V.R.P. Top of 3/4" pipe ASSUME ELEVATION 100' ❑ BOREHOLE O WELL *H.R.P. sameasbenchmark Town Road 677' Property Line 'del I is to meet al I DNR setbacks Property Line Scale = 1/4" 10' 3.5 acre lot Huffcutt Combo B_2 tank ❑ Grading is to be done to divert run-off away Pro 3 from system is to be properly Bedroom bedded and provided Houe with lockdown covers with approved warning labels B-3 B-1 Area 15' below grade is to ❑ remain undisturbed 102' 5% Slope 101.5' 101' 100' B.M. 674' Property Line Mound System Cross Section and Plan View :f~rT ++r I~{, A~.i_RRR! r 1mwff~~~}~1'5 i t° " v~r! ~f +Re en,r +n~ ,wr, ,+•,r nr a+.,,. Dimension Feet A I J B D r~ E F - 8~- W~ t G a -Zr H v I q ::A 1. I i i J i K c „r r.i~ LLt-y.-v+.x w'.w r„y_j.rcy,,,,.'.~. .,.i . r w~ . . _ ,'iW r.. l• YY r . r r - L K B Z- Slope L 0 ~9 z =Topsoil = ASTM C-33 =Clean aggregate = 4 in. sch. 40 pvc w r Cap Material sand fill '/2 to 2 %2 in. dia. observation pipe Geotextile H Fabric F ;i D E Ni. Ft Contour Plowed Surface Slope Direction GENERAL INSTALLATION: The mound area is staked out along the design contour. Existing vegetation is mowed and raked off the site. The mound basal area (L x W) is plowed with a moldboard or chisel plow. Plowing may not proceed if the soil is wet enough at the plow depth to form a '/A inch soil wire when a sample is rolled between the palms of the hands. ASTM C-33 quality sand is placed immediately after plowing. Sand is placed with a tracked machine keeping 12 or more inches of sand under the tracks or is placed overhead by a backhoe. Special care must be used when placing sand of less than one foot thickness to minimize compaction of the plowed surface. After the topsoil cap is placed, the entire mound is seeded and mulched to promote vegetative growth, limit erosion and protect from freezing. The observation pipes are slotted in the lower 6 inches and secured in place with rebar or a closet flange. 10/07 lgj Page - of Pressure Lateral Layout Two Laterals End Manifold 4 Threaded ' Cleanout Lateral Turn-up Plug Manifold M * X I L Long Force Main Sweep /1 90 Bend Distribution Network S ecilrcations Pressure System Construction Lateral Diameter In. Manifold Diameter In, Laterals are constructed of Schedule 40 PVC In. pipe. orifices are drilled perpendicular to Orifice Diameter _q/ 16 X Orifice Spacing)... 4? In. the pipe with a sharp drill hit and face down. L Lateral Length) _ `7! Ft. Lateral turn-ups terminate with a threaded M Manifold Len th Ft. cleanout plug and are enclosed in a 6-8 inch Force Main. Diameter _ In. diameter lawn sprinkler valve box accessible Force Main Len th r Ft. from finished grade. Grade ;Cj • • • • • '.ice"" ' 6-8 Inch Lawn Sprinkler Valve Box Page of 03/05183 Septic-Dose Tank Cross Section And Pump Performance Specifications Maiaiuer.a Tank ManuCturor Puny, Tanis Model Number Pump Model Number "die Total Tank Capacity 0 Alarm Mangy ~ -sa Max. Bury Depth { Alarm Model Number Swit& Type I E Iter tar Mncturer (TDk - Feet Model Number Elevation HOO MOW Pressutft Network Loss Minimum Pump T irtaace !n__DH Force Main Loss Gp Total t' Sy outlet bbinhole 14~n. 411 Above OnWe With Manhole Min. 40 Above G mde Locking Deuce. Inlet Manhole Securely Mauerted With Looking Device < 6,, Below are Sealed Waterrtiaht Weatha~pmof Junction Box k- + Fit isbed Grade OW ..Y • r ~ rr wr Went Min. 12" Disoonneot Above Grade Mean ' With Vent Cap Outlet Mer b2let Baffle s , iai A Swttah S a'd #.em01ve Capac ,>a► . 'A" Weep Tank Va Dote Dirn"on Inches Volume Gal. 3 (reserve) A; . 5- anon alarm B ; 2. o C „ Bottom i i (as e) d Ft ( ) D ; S ; D Elevation Total C7 - Ft ia`. 'P„„e,aa,►,,,faa, •.►a aY tyl.rr►tfa+ y'Iy,YaY a,aaa,as, „aa„+,.,,.,,,,,►.►,~,~eaa„ a„~,i, ,a, . ....+„a+."a....' >~Ya.aY /~+Y+Y•' '•Y+'1►~►.'.► '.>a~.~ ./a/.►.as►.►.►!>,'+1+.,>~s+Y,Y,YaY,1aY Y,Y,t.►1►aY/Y.YiYf>1► Ya► ►.►.`i .`'i a' >.►t►,►t a►,L' /,r,> r.►.:'f►a~4 {Ya~ GENERAL INSTAA`LLAnOM The "PdO/dose talc is bedded. and bao s filled in accordance with the manufacturer's product.approval specifloadons. Mujur rm depth of bury -as, specifled, by the inanufacturer may not be exceeded without p iox 4pproual. Manhole covers exposai to O M& have an cffaative looking device (padlock) installed. Piping at the inlet and oath is Wf approved rnaWal, connected to the teAk with. watertight fittings, and laid on stable soil to pt+gt►artt M ing or sagging. The .join.is sleeved V6 *I s*. 40 PVC to bridge the tank excavation and tili .slemve,is filed*Owttght. Elei Icat vice complies WlilrNEC 300 and Comm 16.28. Page of 02105 LJ 4 1 rib bbl ad;e! = may.a•vv G...v, 'aR Lasel•Jet 8100; a19~'f 9E: M SERI E:8 SiUMP/EFFLUENT.PUMP 19,65 0 p>11~ eels as a► +a allxaan a If aa Oaks* Ip91Np IIh,IAa WON Y pip 415 ae 150D 75 54 55 47 11 189 84 B.11111,eAK&8A 991 oal wim 1 ga 9.11 t 11.66 x a9A 9W 85 1500 291.0 am 1 4++9 75 84 % A 81 18.5 ~ ~ 49 88 18.a 79' arJ 8.!11!1.91,0.66 0.0i'm now 5Ual0 A~0 195 8fA 1a.0 VM 70 eA 4 ..OR J a8r rlleo~on5m11wdaWri MA06a9h,Y+YAetytatlalbuat~w~aatatM661wmvur 13MA&M ppAlnuouaO~y1MN6._"ii6t1Oi1IdlM~glx~111plIIAAi FLAW" LITERS/M17162 7Il~O'O(~ Motar litous' ,~7ty Coned Gast Iran a two eooo aa°u Impeller Material Pa Cltrbonato Im l*' 10 ao volute AB3 Power TI1V'At 7 g w mer116t+aim1 Bhallt, Beat Nitrite with carbon attd 80 + Jxf8mw faces Stairllell6 4tse ~ T1tat¢+rtter6 sB a.3 Shat1 _ - Upper Sleeve and L Over Ball Booing% ° r o - cta s nNS.rlrNU a° Li a GlatIt Ftlgmn 69Co. MW F WORMAMGt: CUIRVE P41 Bn, 19~f1°• t1Ndb-0 G1bb 48!67 113V (~1i7 rbo : x-'7.7531 ■ F"t 409.3A&18W 8i m1{tf1 aWt,blot m* IgInku"m 0 PbRr14Q6~56 --Q710e ~yw~l~~tFlStmp.COrlot P~ ` RESEIVED #1808 Visconsin SOIL E LUATI N REPORT Department of Commerce i ccordan with " l r~ s Ts.AdA Cod Page 1 of 3 Division of Safety and Buildings- Steel's Soil Service, Inc. St. Croix Attach complete site plan on paper not less that W 11 inches in siz%-IPyaR(W OUNT Co ty include, but not limited to: vertical and horizontal referen0kpoint BM), airec`fion an percent slope, scale or dimensions, north arrow, and location an Par I I.D. Ll~ F distance to a-amst roxi Please print all information. Reviewed Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). Property Owner Property Location French Homes, Inc. Govt. Lot na SW1/4, N4/4,S35, T29N, R17W Property Owner's Mailing Address Lot # 5 Block # Subd. Name or CSM# P.O. Box 350 na Croix Hills T-1 City State Zip Code Phone Number City ❑ Village ❑ Town Nearest Road S S ' SRoberts WI 54023 715-718-2929 Hammond _790TtrSt ❑ New Construction Use: Residential / Number of bedrooms 4 Code derived design flow rate 600 GPD ❑ Replacement ❑ Public or commercial - Describe: na Parent material Silty sediment and underlying reddish sandy loam till Flood plain elevation, if applicable na tt. General comments Mound Design, system elevation 103. based on contour line elevation 101.65ft. No deviation from site and recommendations: area with out first contacting soil tester due to poor soil conditions i _ le- 5 h (0 66 iLs n K F 1-1 Z Boring # ❑ Boring Pit Ground surface elev. 102.15 fl. Depth to limiting factor 22 in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 *Eff#2 1 0-6 10yr3/2 none A 2msbk mfr cs 1vf .6 .8 2 6-11 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 11-22 10yr4/4 none scl/sl 2msbk mfr gw na .4 .6 4 22-48 5yr4/4 c2d 7.5yr5/6 sl om mfr gw na .2 .6 5 48-60 7.5yr4/4 c2d 7.5yr5/6 sil/sl om mfr na na .0 .2 2 ]Boring # Boring pit Ground surface elev. 102.15 ft. Depth to limiting factor 17 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 1 0-6 10yr3/2 none A 2msbk mfr a 1vf .8 2 6-17 10yr4/4 none sicl 2msbk mfr gw na .4 .6 3 17-36 10yr4/4 c1d 7.5yr5/6 scl 2msbk mfr gw na .4 .6 4 36-48 7.5yr4/4 c2d 7.5yr5/6 scl om mfr na na .0 .0 * Effluent #1 = BODS> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD5 s30 mg/L and TSS <_30 mg/L CST Name (Please Print) Signatur% CST Number David J. Steel J❑ 248956 Address Steel's Soil Service, Inc. Date Evaluation Conducted Telephone Number 994 200th St. Baldwin, WI 54002 11/22/2005 715-760-0347 SBD-8330 (R.07/00) 1 Property Owner French Homes, Inc. Parcel ID # Pending Page 2 of 3 r3 Boring # ❑ Boring M Pit Ground surface elev. 100.05 ft. Depth to limiting factor 18 in. Soil Application Rate ❑ Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ft' in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 "Eff#2 1 0-8 10yr3/2 none sil 2msbk mfr cs 1Vf .6 .8 2 8-18 10yr4/4 none Sd 2msbk mfr gw na .4 .6 3 18-50 10yr4/4 c2d 7.5yr5/6 scl om mfr na na .0 .0 ❑ 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/ft' 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 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 ` Effluent #1 = BOD5> 30 < 220 mg/L and TSS >30 <150 mg/L ' Effluent #2 = BODS < 30 mg/L and TSS <30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608-266-3151 or TTY 608-264-8777. SBD-8330 (R-07/00) Sted's Soil Service, Inc. STEEL'S SOIL SERVICE INC. 3 of 3 David J. Steel French Homes Inc. 994 200th St. CST-POWTSM SWl/4,NWl/4,S32,T29r1,R17W Baldwin, WI 54002 Lic. #248956 Town of Hammond, St Croix Co. Direct 715-760-0347 Croix Hills Lot, 13 Fax 715-684-3449 This soil evaluation was conducted to satisfy a zoning requirement, it may or may not be suitable for your use. The location of this test may or may not be as shown, as permanent lot lines were not established at the time the soil test was conducted. Legend N 1" = 40' I ♦ = Benchmark Ele. 100.00 ft Top of 3/4" pvc pipe • = Alt Benchmark Ele. 100.10 ft ❑ Top of 3/4" pvc pipe = Borings Boring Elevations B1 = 102.15 ft B2 = 102.15 ft B3 = 100.05 ft B4 = 0.00 ft 6 5 r C.,` a / ~ f 71r 7~` a5 ; 6'5:0- „Lt,Z X .O N s~, \ M\\ Y \ ~c'~ \ 4 \ _J6 oc,~ 1 y 1 I ,1 1 \ y 'agof o y y i 1 1 4 1 1 \ I 11 1 \ N 1 ( I 1 \ 'i I 1 1 1 I cA \ 'Z91~ MIM JZO~ ,Q l.0 N 1 1 I ' I z /z l / I 1 1 I i` co 00 ! / / I I I bzD 7& tr) ij, /t Q co '4 14 -Pk. e OD U; 00 00 (s (n /0 up Z 4~ u) / 'fi S 0 A1, 7- I OD / w / / rn 420 I, x TCO / W • / / ~AA J ! 4 C/) ML En Ix. / X00 SlZ / ••i- 00'6 eX 11ex~ Iv 5268 T L M jZO, L rM O A -VI L M N - -b/ L AS 3 H)-//~0//3 * 1 . TV TIWrG 19 -3 S83H10 AB 03NMO POWTS OWNER'S MANUAL & MANAGEMENT PLAN Page -Z of !"ILE INFORMATION SYSTEM SPECIFICATIONS -Owner a Septic Tank Capacity gal ❑ NA Permit # Septic Tank Manufactwer ❑ NA jOESIGN PARAMETERS Effluent Filter Manufacturer ❑ NA Number of Bedrooms O NA Effluent Filter Model ❑ NA 13 Number of Public Facility Units >19 NA 'Pump Tank Capacity 3 C7 al ❑ NA Estimated flow (average) allda Pump Tank Manufacturer ❑ NA 42Z2 g Design flow (peak), (Estimated x 1.5) 9<5Z2 aUda Pump Manufacturer ❑ NA ❑ NA Soil Application Rate al/da /ftz Pump Model 91 07- Standard Influent/Effluent Quality Monthly average` Pretreatment Unit NA Fats, OH & Grease (FOG) 530 mg/L ❑ Sand/Gravel Filter Ci Peat Filter Biochemical Oxygen Demand (BODs) 5220 mg/L OA ❑ Mechanical Aeration ❑ Wetland Total Suspended Solids (TSS) 5150 mg/L ❑ Disinfection ❑ Other: Pretreated Effluent Quality Monthly average Dispersal Celt(s) 0 NA ftc heroical Oxygen Demand (BODE) 530 mg/L / © In-Ground (gravity) © In-Ground (pressurized) Total Suspended Solids (TSS) 530 mg/L }I~NA 13 At-Grade Mound Fecal Coliform (geometric mean) 510" cfu/100mi ❑ Drip-Line ❑ Other: Maximum Effluent Particle Size 16 in dia, ❑ NA Other. ❑ NA Other: J NA Other: ❑ NA Values typical for domestic wastewater and septic tank effluent. ether' O NA I AAINTENANCE SCHEDULE Service Event Service Frequency Inspect condition of tank(s) At least once every: moat fs) (Maximum 3 years) ❑ NA ear sl Pump out contents of tank(s) When combined sludge and scum equals one-third (t) of tank volume ❑ NA ❑ Inspect dispersal cell(s) At least once every: month(s) , year(6, (Maximum 3 years) O NA Clean effluent filter At least once every: .1511 month,( s) ❑ NA ears Inspect pump, pump controls & alarm At least once every; mon`his) ❑ NA CE ear s Flush laterals and pressure test At (east once every: month(s) ~ ear{s} ❑ NA Other: O monthis} At least once every: q ear(s) ❑ NA Other: 0 NA MAINTENANCE INSTRUCTIONS Inspections of tanks and dispersal calls shall be made by an individual carrying one of the following licenses or certifications: Master Plumber; Master Plumber Restricted Sewer; POWTS Inspector; POWTS Maintainer; Septage 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 wirface. 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 the tank volume, the entire contents of the tank shall be removed by a Septage Servicing Operator and disposed of In accordance with chapter NR 113, Wisconsin Administrative Code, All other services, including but not limited to the servicing of effluent filters, mechanical or pressurized components, pretreatment units, and any servicing at Intervals of 512 months, shall be performed by a certlfled POWTS Maintainer. A service report shall be provided to the local regulatory authority within 10 days of completion of any service event, Page --y- of ;ITART UP AND OPERATION For new construction, prior to use of the POWTS' check treatment tank(s) for the presence of painting products or other chemicals that may Impede the treatment process andlor 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 hackup or surface discharge of effluent. To avoid this situation have the contents 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 rump controls to restore normal levels within the pump tank. Do not drive or park vehicles over tanks and dispersal cells. Do not drive or park over, or otherwise disturb or compact, the area within 15 feet down slope of any mound or at-grade soil absorption area. Reduction or elimination of the following from the wastewater stream may improve the performance and prolong the life of the POWTS: antibiotics; baby wipes; cigarette butts; condoms; cotton swabs; degreasers; dental floss; diapers; disinfectants; fat; foundation drain (sump pump) water; fruit and vegetable peelings; gasoline; grease; herbicides; meat 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 seale 1. e The contents of all tanks and pits shall be removed and properly disposed of by a Septagn Servicing Operator. a 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. :ONITINGENCY 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 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 andlor soil limitations. Barring advances in POWTS technology a holding tank may be installed as a last resort to replace the failed POWTS '-+e site has not been evaluated to identify a suitable replacement area, Upon failure of the POWTS a soil and site evaluation J must be performed to locate a suitable replacement area, If no replacement area is avaitFible a holding tank may be installed as /84. last resort to replace the failed POWTS. ound and at-grade soil absorption systems may be reconstructed in place following namovel of the biornst at the infiltrative urface. Reconstructions of such systems must comply with the rules in effect at that time. ccWARNING» SEPTIC, PUMP AND OTHER TREATMENT TANKS MAY CONTAIN LETHAL GASSES ANDlOK INSUFFICIENT OXYGEN. DO NOT ENTER A SEPTIC, PUMP OR OTHER TREATMENT TANK UNDER ANY CIRCUMSTANCES. DNcATH MAY RESULT. RESCUE OF A PERSON FROM THE INTERIOR OF A TANK MAY BE DIFFICULT OR IMPOSSIBLE. ADDITIONAL COMMENTS POWTS INSTALLER POWTS MAINTAI ER 4 a Name Name Phone )J - G~~~ Phone SEPTAGE SERVICING OPERATOR PUMPER LOCAL REGULATORY AUTHORITY , Name Name +~GG rn_ Phone J Phone / This document was drafted in compliance with chapter SPS 383.22(2)(b)(1)(d)&M and 383.54(1), (2) & (3), Wiscorisln Administrative Code. 0N8 FILTER CARTRIDGE INSTRUCTIONS s-rep x Dry at the filter case onto the and of the outlet pipe to ensure it is centered under the mom* openlfog. If not, them either insert more pipe iota the tank through the outlet or solvent weld (glue) additional pipe onto the outlet pipe. TFP 2 While the case is stir "fitted an the outlet pipe, measure the langth of YA-inch pipe needed to braces the fika to the tank and wall if utilizing the optional supplemental side support. If side support rnathod. Is not utilized, prattaed to stop four, 'o'-'i P '3 For inatalfations utifW rrg the optional supplemental side support: solvent weld the '14-inch pipe onto the filter case. It side support method is not utilized, proceed to Map four. sakent weld the filter case ahto the outlet pipe. Thsurt Me filter • ran":"'..{rr cartridge inW the rase, pressing down until the filter irn:ks into the bottnm of +;;`+r,%•~Er the case. ' If a VKS switch Is utll"d: insert into the fitter and luck by turning ciackwice 800. Mairlltemnce 1. The effluent lfiter should be cleaned every time the sceptic tank Is serviced. , 2. open the outlet access Opening to inspect the tank and filter: 9. Pump the septic tank cornpkateiy, mnk4ng sure to remove the sludge layer on the bottom of the tank and not just the scum and effluent, ° nn 4. Once than effluent level has wean lowered below the invert of the outlet pipe, firmly pub up an the titter handle to dislodge the cartridge from the cast. ' , S. Slh[e the cartridge up and out of the case for claaning. 6, it a VAS switch wrineeted to an aierm is present, tine switch should be removed by turning counterdockwise 94° and cleaned with water only. '1. While haiding the cartridge e:n its side {large fleet surface facing " down) over the access opening, rinse off the cartridge with water only, making sure as saptaglr material Is doused back into the tank. 8. If VRS switch is utillmd, repiilce by inserting into filter and turning clockwise 90°. Insert the filter cartridge back into the case, pressing down until the filter locks into the bottom of the case. i0.fttplace and secure the rutce::s ripening an the tank- It "1=: ; M1Pt:'ft.a'a(rti? r lti ~i; 'I 1'' i rr4t :i,l:!'.N.nSiM,t Y wwW'.beaanS1te.c0B' 877-'NLVILTIERS (653-4583) ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/.Buyer Mailing Address Property Address J i J f / (Verification required from Planning & Zoning Department for new construction.) City/Stat,;~ ((i , ~ V`J Parcel Identification Number C5~/ D/J'~' - f LEGAL DESCRIPTION S_- ' 14 I i . Property Location , 5ec.3 T2l N.1 Z~- __W, 'Town ot=~ ~~3s? Subdivision Lot # Certified Survey Map # voletrrle Page # Warranty Deed # ~~j 9~~ _ / a a 1 y , volume Page # _ Spec house no Lot lines identifiable s " ~o SYSTEM MAINTENANCE AND OWNER CERTIFICATION Improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into the system can affect the function of the septic tank as a treatment stage in the waste disposal system. owner maintenance responsibilities are specified in §Connn. 83.52(1) and in Chapter 12 - St. Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumber, journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on-site wastewater disposal system is in proper operating condition and/or (2) after inspection and purnping (if necessary), the septic tank. is :less than l l3 full of sludge. "I/we, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with file .standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St:- Croix County Planning & Zoning Department within 30 days of the three year expiration date. T/we certify that all statements on this form are true to the best of niy/our knowledge. I/we am/are the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms-- ICNAT OF .APPLICANT(S) DATE ***Any information that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department- 1 nclude 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. 09/05) ~I IIIIIIIIIIII~IIIIIIIIIIIII I I 8 1 1 6 8 8 9 Tx:4093391 SPECIAL WARRANTY DEED 969930 BETH PABST REGISTER OF DEEDS ST. CROIX CO., WI 12/20/2012 2:56 PM This Deed, made between Central Bank a Minnesota banking. EXEMPTV: NA corporation succe§sor-in-Interest to The RlverBank REC FEE: 30.00 Grantor, and, Oeverina Homes LLC a Wisconsin limited liability TRANS FEE- 126.00 company. Grantee, WITNESSETH, That the said Grantor, fora PAGES: 1 valuable consideration conveys to Grantees the following described real estate in St. Croix County, State of Wisconsin: RETURN TO: ` c -SCAT-- 221:70&W-4" 47'P.10 !F PID 018-2015-00-005; ~S~G''~51 j 018-2017-10-000; 3cj~ 79S 018-2017-14-000; 018-2017-15-000 Lot 5, Plat of Croix Hills in the Town of Hammond, St. Croix County, Wisconsin. Lots 10, 14 and 15, Plat of Croix Hills 1st Addition in the Town ofHamrnond, St. Croix County, Wisconsin. Seiler to convey the title by special 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, whether expressed, implied, implied by law, or otherwise, concerning the condlt'ion of the title of the property. This is not homestead property. Dated this 30th day of November, 2012 Central Bank AUTHENTICATION (SEAL) Signature(s) By: Zach McBroom its assistant vice president i authenticated this day of (SEAL) TITLE: MEMBER STATE BAR OF WISCONSIN By (if not, ACKNOWLEDGMENT authorized by s706.06, Wis. Stats.) STATE OF MN } ss:. THIS INSTRUMENT WAS DRAFTED BY COUNTY OF Washington } Personally came before me this 301h day of LOBERG LAW OFFICE November, 2012 the above named Central Bank Robert L. Lobera/1212485 ao. by Zach MCBrOOm. Its assistant vice president (Signatures may be authenticated or to me known to be the persons who executed the acknowledged. Both are not necessary) ap/ fore g instrument and acknowledge the same. *Jjet~hy L Hund e NWY ytJNDLEY Rtrary Public shington_ County, MN. My Commission is permanent. (If not, state expiration date: 1/3112017 ) I i 1 of 1 I Parcel 018-2015-00-005 12/18/2012 AM PAGE E 1 1 OF 1 Alt. Parcel 35.29.17.1124 018 - TOWN OF HAMMOND ST. CROIX COUNTY, WISCONSIN Current [X] Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type # of Units 08/15/2006 00 0 Tax Address: Owner(s): 0 = Current Owner, C = Current Co-Owner 0 - RIVERBANK RIVERBANK 304 CASCADE ST OSCEOLA WI 54020 Districts: SC = School SP = Special Property Address(es): Primary Type Dist # Description ' 657 191 ST ST SC 0231 SCH D BALDWIN-WDVILLE SP 1700 WITC Legal Description: Acres: 3.510 Plat: 11-010-CROIX HILLS 018-06 LOTS 1/8 SEC 35 T29N R17W PT SW NW; BEING CROIX Block/Condo Bldg: LOT 05 HILLS ('06) LOT 5 (3.510AC) Tract(s): (Sec-Twn-Rng 401/4 1601/4) 35-29N-17W SW NW Notes: Parcel History: Date Doc # Vol/Page Type 02/25/2010 912352 DEED 08/15/2006 832265 11/010 PLAT 01/17/2006 816514 WD 10/25/2004 777851 2681/415 WD more... 2012 SUMMARY Bill Fair Market Value: Assessed with: 190571 Use Value Assessment Valuations: Last Changed: 06/07/2012 Description Class Acres Land Improve Total State Reason AGRICULTURAL G4 3.510 800 0 800 NO 10 Totals for 2012: General Property 3.510 800 0 800 Woodland 0.000 0 0 Totals for 2011: General Property 3.510 51,100 0 51,100 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 atti~J ~V►C~ NO NO W CWP 9ZC . 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